The debate over low-carb diets for diabetes is one that refuses to die. Carbohydrates (carbs, for short) seem to become more and more maligned every day. And not just for people who have diabetes. Feeling tired and draggy? Feeling blue? Have a stomachache? Gaining weight? Blame carbs.
Websites such as lowcarbyum.com and lowcarbmaven.com and books like Wheat Belly and Grain Brain are dedicated to slashing carbs and make it pretty easy to get started. You even have your pick of low-carb diets to try: Atkins, South Beach, Paleo, and keto, to name a few. Truth be told, these diets — or eating plans, if you prefer — can be beneficial in helping people drop pounds and blood sugars at the same time. Researchers have been taking a closer look at these eating plans, as well, and more and more studies are coming out of the low-carb movement. But misconceptions about lower-carb eating plans still abound. Let’s take a look at some common low-carb claims and whether they are facts or falsehoods.
Evaluating low-carb claims
Claim: All carbs are “bad.” Period.
False. Thinking that every carb food is “bad” is a very misinformed and dangerous assumption. Plus, falling into the “good food/bad food” mentality can make it hard to eat healthfully. The fact is, almost all foods have their high and low points. Even something as seemingly unhealthy as, say, McDonald’s Double Bacon Smokehouse Burger with 1130 calories, 64 grams of carb, and 1920 milligrams of sodium, has some merits (protein, vitamin B12, iron).
Are some carb foods not so healthy? Sure. Cookies, candy, cake, and soda are a few examples. On the flip side, there are plenty of carb foods that are highly nutritious, such as sweet potatoes, quinoa, black beans, and raspberries. Refined carbs (e.g., cookies, cake, soda, white bread, white pasta) are the types of carbs to limit, whereas unrefined carb foods, such as vegetables, fruit, whole grains, and legumes, are good bets.
Claim: You can lose weight on a low-carb diet.
Fact. Indeed, you can. If you’re carrying extra weight, one of your health goals may be to shed a few (or a lot of) pounds. For people who are overweight, plenty of research shows that losing between 5 percent and 10 percent of body weight can lead to a number of benefits, including a lower A1C, decreased insulin resistance, lower blood pressure, lower blood lipids, and improved sleep apnea, not to mention improved quality of life.
One of the misconceptions about lower-carb eating plans is that they are better for weight loss than a higher-carb plan. In the short term, maybe. Yet, research shows that over time, it may not be true. The POUNDS LOST study, for example, tested four diets that varied in carb, protein, and fat. There were 811 participants in this study who were assigned one of four diets to follow. After six months and two years, respectively, weight loss was similar. Furthermore, all four diets showed an improvement in cardiovascular risk factors, such as cholesterol, triglycerides, and blood pressure. A more recent study, the DIETFITS trial, randomized 609 adults to follow a low-carb or a low-fat diet. After one year, there was no significant difference in the amount of weight loss between the two groups.
According to Melinda Maryniuk, a dietitian and certified diabetes educator, “The usual limiting factor for achieving success with a low-carb diet is that people tire of the limited food choices. If you feel like you can stay with a low-carb eating plan over time (and you have the support of your family), give it a try and see how it works.”
Claim: Carb foods are off limits on a low-carb diet.
False. Not necessarily. A low-carb diet doesn’t mean a no-carb diet. Nor would it be all that easy to cut out all carbs from your eating plan, although it’s definitely possible. There are quite a few versions of low-carb diets out there — here’s a run-down of some of the more popular:
• Zero-Carb Diet: No fruits, veggies, or starches — just meat, poultry, eggs, and cheese. And water.
• Ketogenic (Keto) Diet: Less than 50 grams of carb per day; heavy on fats and protein foods, with limited amounts of fruit.
• Atkins Diet: Starts out with a very-low-carb plan, and then gradually adds back carbs.
• South Beach Diet: Like other plans, this is also higher in lean protein and fat, with different phases whereby healthy carbs are added back.
Unfortunately, there is no universally accepted definition of a low-carb diet, which can cause confusion: What may be low-carb to you can seem like way too much carb for someone else. The same holds true for your doctor — he or she may tell you to go on a low-carb diet to help with your diabetes or weight loss goals without specifying what the diet should involve. You need to ask questions (and ideally, work with a dietitian) to find out just how much carb you CAN eat. Feinman and colleagues, in the journal Nutrition, attempted to set some parameters around the meaning of low carb by proposing the following definitions:
• Very-low-carb/ketogenic: 20–50 grams of carb per day (less than 10 percent of total calories)
• Low-carb: Less than 130 grams of carb per day (less than 26 percent of total calories)
• Moderate-carb: More than 130 grams of carb per day (26 percent to 45 percent of total calories)
• High-carb: More than 225 grams of carb per day (more than 45 percent of total calories)
Claim: The American Diabetes Association (ADA) supports lower-carb eating plans for people with diabetes.
Fact. Yes, this is true! The ADA actually is supportive of many different types of eating patterns, including Mediterranean, DASH, lower fat, vegetarian, and yes, lower carb. In fact, ADA’s Standards of Medical Care in Diabetes, which are released every year in January, acknowledge (and have so for several years now) that low-carb eating plans (less than 50 grams/day) are linked with improved outcomes for 3 to 4 months. And more recent research indicates that these outcomes may extend for at least a year.
Is a lower-carb eating plan for you?
It’s easy to get caught up in the low-carb hype that is rampant across the internet. There certainly is some merit to cutting carbs, especially because going lower-carb can help lower blood sugars and make it easier to keep them within your target range. On the other hand, eating patterns that are more moderate-carb, such as Mediterranean-style and a lower-glycemic approach (think whole grains, a lot of vegetables, lean protein) can also help people with diabetes achieve their glycemic goals. Feeling confused about going low carb? Maryniuk recommends you ask yourself the following:
1. What foods might you have to give up (or, at least, drastically cut back on)? Are you willing to do this?
2. Is this a plan that you will stick with for the long term? If you want to try a low-carb approach to give you a jump start, make sure you have a plan to move to a healthy eating plan longer-term.
3. Are there any risks for you of following a lower-carb plan? (Risks can include having kidney disease or osteoporosis.) Have you talked with your health-care provider before going low carb? If you go lower-carb, do you know how to adjust your insulin or other diabetes medicine, if necessary?
On the fence?
Going low carb isn’t for everyone. However, controlling your carb intake is important when you have diabetes. Because carbohydrate requirements can vary from person to person, it’s always a good idea to talk with a dietitian or diabetes educator to find out your own carb goals. Until then, the following can be helpful to get you started:
• Aim for 45 to 60 grams of carb per meal.
• If you snack, aim for 15 to 30 grams of carb per snack.
• If you want to lose weight, subtract 15 grams of carb from each meal.
• If you are very active or need to gain weight, add 15 grams of carb to each meal.
Is it working?
You can be the judge! Have you lost weight? Are you seeing lower or better managed blood sugars? How are your cholesterol and blood pressure doing? What’s your energy level like? While you’re at it, assess your overall quality of life: How easy is it for you to plan and prepare meals? Is your partner or family on board? Are you able to go out to eat or socialize with friends and find foods that you can eat? Do you see a lower-carb plan as a quick way to drop some weight or as a lifestyle that you can embrace long-term? Your answers to these questions will help guide your decisions.
Want to learn more about low-carb diets and diabetes? Read “Carbohydrate Restriction: An Option for Diabetes Management” and “Low-Carb Diabetes: What You Need to Know,” then try one of our top seven low-carb recipes.