The People's Perspective on Medicine

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.
Grilled chicken breast with green and red pepper, cherry tomatoes, lettuce, black olives, cucumber, pink pepper and fresh rosemary. Home made food. Concept for a tasty and healthy meal. Close up.

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. .
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Managing Diabetes
  • 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:
  • 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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I’m so happy for you, we all should eat this way! Congratulations,

I was diagnosed as pre-diabetic last year around this time. I knew I needed to lose weight. Despite not being obese, I was overweight. So, after some research and careful look at what and how I ate, I realized that my doctor’s advice to “eat a low fat diet and count calories” wouldn’t work, as I’d tried this in the past [I’m 76 and have yo-yo dieted most of my adult life] and always fell off. It leads to gnawing hunger. Only a fool would expect that doing the same old thing that failed would somehow magically lead to a better outcome now.

I went very low carb, a modified Ketogenic way of eating. I stopped eating anything with added sugar. I stopped eating “white carbs,” and I eliminated even whole grains and starchy vegs like potatoes. I ate healthy fats and proteins and plenty of low carb veggies. I began to lose weight and didn’t feel hungry all the time. Fats are satiating. I feel very, very good, with plenty of energy since my body uses fat and protein, including my own body fat, for energy and bodily functions. I get plenty of fiber from the veggies.

A year later, without religiously counting calories, I’ve lost 35 pounds, and all my blood markers are in the satisfactory range. I’m no longer pre-diabetic. I have no trouble at all sticking to this way of eating.

Intermittent fasting is very probably a “best diet,” is it not? Furthermore, I have become very curious about the so-called ‘potato hack” diet, as part of an intermittent fasting regimen. Can’t get much more carbohydrate than potatoes, yet there are many anecdotal reports of the health benefits, as well as some books and other materials. It’s an intriguing concept.

You can learn more about intermittent fasting for diabetes in our Show 1143: Can You Control Your Blood Sugar by Fasting?

As for the potato diet, my guess is that if you eat just potatoes, no salt, no butter, no nothing for several days, you will get bored enough to eat less. But we haven’t seen any research on it.

How did the researchers define “low carb?” I’m wondering what the daily limit was.

They have known for many years that a low carb diet is better for diabetics.

In the interest of being balanced, what about inviting Neal Barnard to Peoples Pharmacy?

He was on, many years ago.

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