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Best Diet for People with Diabetes Low in Carbs

A randomized controlled trial shows that veterans following a meal plan that is low in carbs were better able to lose weight and control blood sugar.
Best Diet for People with Diabetes Low in Carbs
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A diet low in carbs, especially rapidly digested refined grains, can help people with type 2 diabetes lose weight and control their blood sugar. This is a welcome finding, as dietary recommendations for people with diabetes have been controversial and confusing. Some experts emphasize reducing the amount of fat in diets designed for weight loss. Since many people with type 2 diabetes are also overweight, nutritionists have suggested they avoid fat to lose weight. However, if you eat less fat, you usually end up eating more carbohydrate. Is that a problem for people with diabetes?

Fighting Diabetes with a Diet Low in Carbs:

A new study in JAMA Internal Medicine compared group medical visits for type 2 diabetes (JAMA Internal Medicine, Nov. 4, 2019). In the trial, which ran nearly a year, half the patients got standard care through group medical visits at the VA.  At the same time, dietitians counseled the other half on a low-carbohydrate approach to weight loss. These patients also attended group medical visits for their standard medical care.

What Did the Study Show?

Both groups improved their HbA1c, a measure of blood sugar control. In addition, those following diets low in carbs lost more weight, used fewer diabetes medications and had fewer episodes of hypoglycemia. Hypoglycemia, in which blood sugar drops too low, can be a serious medical problem.

The authors conclude:

“The results from this study indicate that intensive WM [weight management] using a low-carbohydrate diet can be as effective for glycemic improvement as medication intensification in GMVs [group medical visits].”

Previous Support for a Diabetes Meal Plan That Is Low in Carbs:

This is not the first time we have written about research supporting a low-carb approach for people with diabetes. Although all the participants in this research had type 2 diabetes, even people with type 1 diabetes have reported better blood sugar control when they eat fewer carbs. Dr. Richard Bernstein, who had type 1 diabetes himself, was an advocate for this approach based on self-experimentation.

Moreover, an earlier study compared in-person, on-site group visits to web-based nutritional counseling to achieve ketosis (JMIR Diabetes, March 7, 2017). The individuals who adopted a diet low in carbs were able to lose weight, lower their HbA1c and discontinue some of their diabetes medicines. 

A Conflicting Report:

On the other hand, a recent study from Scotland found that lower carbohydrate, higher fat diets were associated with elevated HbA1c values (European Journal of Nutrition, online Nov. 4, 2019). This was a survey rather than a clinical trial, so we don’t know what people were eating. It is entirely possible that the quality of the diet with respect to micronutrients matters as much as whether it is low in fat or low in carbs.

Researchers may not have established a best diet for diabetes beyond question. However, people who want to control their blood sugar might consider trying a low-carb approach.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
  • Yancy WS et al, "Comparison of Group Medical Visits Combined With Intensive Weight management vs group medical visits alone for glycemia in patients with type 2 diabetes: A noninferiority randomized clinical trial." JAMA Internal Medicine, Nov. 4, 2019. doi:https://doi.org/10.1001/jamainternmed.2019.4802
  • McKenzie AL et al, "A novel intervention including individualized nutritional recommendations reduces hemoglobin A1c level, medication use, and weight in type 2 diabetes." JMIR Diabetes, March 7, 2017. DOI: 10.2196/diabetes.6981
  • Churuangsuk C et al, "Lower carbohydrate and higher fat intakes are associated with higher hemoglobin A1c: findings from the UK National Diet and Nutrition Survey 2008-2016." European Journal of Nutrition, online Nov. 4, 2019. DOI: 10.1007/s00394-019-02122-1
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