Low-Carb: Not For Everyone

This is half of a point/counterpoint debate. Read the other half, “Why I Low-Carb” by David Mendosa[1].


Deciding what to eat is a daily challenge for those of us with diabetes. Clearly, a lot of any fluctuation in blood sugar comes from eating carbohydrates, so it is not surprising that there are many advocates of low-carb diets, such as the Atkins Diet, which recommends eating large amounts of protein and very little carbohydrate. But despite its alleged benefits, I’m not in favor of a low-carb diet.

What am I in favor of? A smart diet. A diet that works for you personally, based on your health, your level of activity, your cultural or religious background, and your likes and dislikes. A smart diet is usually a combination of protein, healthy fat[2], and unrefined carbohydrate that includes lots of fruits and vegetables.

One of the main benefits of unrefined sources of carbohydrate is fiber[3]. Fiber is essential to the health of the digestive system, and while it is possible to supplement a low-carb diet with adequate fiber, this can be difficult to do without unpleasant side effects[4]. Legumes[5], such as beans and peas, are an excellent source of fiber and are packed with other important nutrients, but they are not allowed in many low-carb diets.

A low-carb diet is almost always a high-protein diet. While using protein for energy does limit changes in blood sugar, we should not forget that many people with diabetes will someday develop kidney problems[6]. People who already have such problems should not be on a high-protein diet. And since kidney function can deteriorate gradually, with no symptoms[7] for a long time, it is questionable whether people with diabetes should risk the strain that a high-protein diet puts on compromised kidneys.

Other people who probably shouldn’t be on a low-carb diet include athletes, who need carbohydrates to replenish their stores of glycogen[8], and children, who require a wide variety of nutrients to grow properly.

Being aware of all aspects of your health is important before making any dietary change. A recent study[9] published in the New England Journal of Medicine, for example, found that a low-carb diet was better than a low-fat or Mediterranean diet[10] for weight loss, but that a Mediterranean diet was best for lowering fasting blood glucose levels. The low-carb group also had the highest dropout rate, which is definitely something to consider when looking at the results. But diet studies can be deceptive, because there is often a large amount of individual variation[11] among participants. Whether the goal is weight loss, blood sugar control, or improving cholesterol[12] levels, there is usually no single solution that works best for everyone.

People with diabetes have a lot of tools at our disposal for blood sugar control. The glycemic index[13] and new medicines[14] like Symlin can help prevent the postmeal blood sugar spikes[15] that give so many of us grief. Even taking insulin[16] five or ten minutes before a meal can help.

My personal experiences with dietary changes have dealt more with weight loss than with blood sugar management. I have tried cutting out significant amounts of carbohydrate at various times in my life, but I find that it’s not a very realistic diet for me to be on for long. Being a young adult, I am trying to live my life as close to normal as possible. I test my blood sugar several times a day and take my insulin accordingly, and I focus on eating balanced meals so that I can enjoy special occasions with friends and family without feeling left out. I have found that exercise has a greater impact on lowering my insulin requirements than straight low-carb diets. I also enjoy carbs, so finding a way to balance everything — by correctly counting carbs[17], exercising, and occasionally taking Symlin — has helped lower my blood sugar levels while increasing my enjoyment of life.

When it comes to food, the discussion should not just focus on low-carb versus standard or low-fat diets; it should also focus on being smart about carbs. Avoiding the typical pitfalls of the American diet, like soda or potato chips, will do a lot for your health without the need to avoid all carbohydrates. While some people may find that a low-carb diet works for them, it should not be recommended across the board.

Ms. Blass is author of the blog Lemonade Life[18], which chronicles the effort to balance work, friends, and diabetes as a twentysomething in the New York City area. She has had Type 1 diabetes for 14 years.

Read the counterpoint to this piece, “Why I Low-Carb” by David Mendosa[1].


Return to Diabetes Flashpoints main page[19]

  1. “Why I Low-Carb” by David Mendosa: http://www.diabetesselfmanagement.com/blog/Flashpoints/Why_I_Low_Carb
  2. healthy fat: http://www.diabetesselfmanagement.com/blog/Amy_Campbell/Oil_Changes_Part_1
  3. fiber: http://www.diabetesselfmanagement.com/articles/Diabetes_Definitions/Dietary_Fiber
  4. unpleasant side effects: http://www.eatright.org/cps/rde/xchg/ada/hs.xsl/home_4151_ENU_HTML.htm
  5. Legumes: http://www.diabetesselfmanagement.com/blog/Amy_Campbell/The_Beauty_of_Beans_Part_1
  6. kidney problems: http://www.diabetesselfmanagement.com/articles/Diabetes_Definitions/Nephropathy
  7. symptoms: http://www.diabetesselfmanagement.com/blog/Tara_Dairman/Kidney_Disease_Learn_the_Symptoms
  8. glycogen: http://www.diabetesselfmanagement.com/articles/Diabetes_Definitions/Glycogen
  9. recent study: http://content.nejm.org/cgi/content/abstract/359/3/229
  10. Mediterranean diet: http://www.diabetesselfmanagement.com/blog/Amy_Campbell/Mediterranean_Madness_FAQs_About_a_Centuries_Old_Diet
  11. individual variation: http://www.health.harvard.edu/fhg/updates/update0904c.shtml
  12. cholesterol: http://www.diabetesselfmanagement.com/articles/Diabetes_Definitions/Cholesterol
  13. glycemic index: http://www.diabetesselfmanagement.com/blog/Amy_Campbell/Glycemic_Index_and_Glycemic_Load
  14. new medicines: http://www.diabetesselfmanagement.com/articles/Insulin/Exenatide_and_Pramlintide
  15. prevent the postmeal blood sugar spikes: http://www.diabetesselfmanagement.com/articles/High_Blood_Glucose/Strike_the_Spike
  16. insulin: http://www.diabetesselfmanagement.com/articles/Diabetes_Definitions/Insulin
  17. counting carbs: http://www.diabetesselfmanagement.com/articles/Diabetes_Definitions/Carbohydrate_Counting
  18. Lemonade Life: http://lemonlemonade.wordpress.com/
  19. Return to Diabetes Flashpoints main page: http://www.diabetesselfmanagement.com/blog/Flashpoints

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