Considerations In Lower Carb and Diabetes








I ran into a very good paper the other day with contributions by some pretty famous names in the field, which sums up the benefits of a lower carb diet for diabetes beautifully.  The article is called “Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base,” published in the journal Nutrition in 2015.

This article is a fairly easy read as far as scientific journal articles go and for those who want to go through it themselves I’d recommend that, as it’s a very good article on this subject.

The article first discusses the fact that with science we need to be looking at all the evidence that we have for something, and not just large scale trials, and what happens is that those who are opposed to certain ideas often will use this as a means to discredit the information we have, but that’s not how science works, as we’re dealing with probabilities here and it doesn’t take a large scale trial to achieve a high degree of certainty or a very good understanding.

So we don’t tend to see large controlled trials with lower carb diets yet, but we have plenty of evidence in favor of it nonetheless, and data that is quite informative as well.   What’s truly ironic about this debate though is that the positions of those who oppose carb restriction aren’t really supported by any sort of science, but instead rely on a number of assumptions, and the data we have when we actually look at the effect of things like low carb diets end up painting a different picture.

So this really is all about evidence based medicine, but we actually have to look at the evidence to do that, and when we do, the low fat approach in favor of higher carb intakes ends up falling on its face.

The article makes 12 main points which point to carb restriction as being important to managing diabetes.  Point 1 is that carb restriction has the greatest effect on lowering blood sugar, which is obviously a goal of diabetic treatment, in fact this is what we understand the problem with diabetes to be, and even though it is not the central problem by any means, this is what they focus on, lowering blood sugar, so that should be seen as pretty important you would think.

While consuming more carbs than we can handle isn’t by any means the real problem here, we could say though that the inability to eat as many carbs as non diabetics certainly is, and is certainly a proximate cause of high blood sugar in diabetics.

So given this, it would only make sense to look to reduce the problem of high blood sugar by pursuing a diet that caused less problems with hyperglycemia, and this should at the very least be the primary treatment goal in designing diabetic diets.

There is plenty of evidence to show that carbohydrate restriction does provide better glycemic control, in addition to this making perfect sense because carb intolerance is a major defect with the disease of diabetes.  So we need to actually look to eat in a way that is going to benefit our disease if we are really interested in treating it.

Point 2 mentions the fact that the epidemics we now see with both diabetes and obesity are associated with a significant rise in carbohydrate consumption.  So in other words we eat more carbs these days and we also have more metabolic disorder, and there is every reason to believe that the two are linked, particularly since the consumption of carbs that we see today is historically high and may be exceeding our capacity.

It certainly exceeds the capacity of diabetics though, and well exceeds it, and while it may be important for the public at large to show more restraint in carb consumption, this is critical to us, since we have a disease that makes us far more carb intolerant than the average person.

Point 3 is that the benefits from a low carbohydrate diet does not require weight loss, and in fact we often see dramatic improvements in people’s blood sugar on a low carb diet without experiencing any weight loss at all, or very little.

However, low carb diets are also superior to low calorie or low fat diets for weight loss, even though there are no caloric restrictions on the low carb ones and people can eat all they want provided they stay within the carb limits prescribed, which is actually Point 4 of the paper.  So they look at some data showing this is indeed the case, and we know from our previous discussions that this is due to lowering insulin levels, and insulin is the primary hormone that regulates fat storage and fat loss, in other words, one’s weight.

Point 6 asserts that replacing carbs with protein is generally beneficial, and protein is certainly preferable to carbs in many ways, and managing blood sugar levels is just one of them.  Several studies have confirmed that several metabolic markers become improved when one replaces carbs with protein.

Point 7 addresses fat intake, which is at the crux of the debate, with a lot of people still believing that dietary fat intake is associated with greater risk of cardiovascular disease, but when we look at the studies, it is clear that this is not the case.  This false belief continues to persist though and even to the point where they will recommend that we raise our blood sugar a lot by preferring carbs over fat because fat is supposed to be so dangerous.

On the other hand we know that high blood sugar will do you in many different ways, including higher risk of heart disease, and both the high blood sugar and the high insulin levels that are required to metabolize high amounts of carbs are implicated.

So a high carb low fat diet ironically produces higher saturated fatty acid levels in the blood, which is point 8, due to the liver converting carbs to saturated fat.  So if you eat their diet to hope to reduce fat in the blood you are actually instead making this worse.

Point 9 is that the best way to prevent both types of diabetic complications, including the macrovascular ones they are particularly worried about, is through glycemic control.  Some diabetic medications, especially those that work by increasing insulin levels, have been shown to worsen macrovascular complications though, in addition to whatever other side effects they may produce.

The goal here needs to be to achieve good glycemic control on as little medication as possible, and a lower carb diet has been shown to be very successful in allowing for this while reducing or even eliminating the need for prescription medications.

Point 10 is that a low carb diet has been shown to be the most effective way to lower serum triglycerides and raise HDL.  High carb diets do a lot to promote heart disease and metabolic disorders and hyperlipidemia is just one of them in fact.

Point 11 covers again the fact that a low carb diet reduces or eliminates the need for medications, and I’ll add that this includes not only diabetic medications but medications to manage lipid levels as well, which are known to be particularly nasty, as well as reducing the need for other meds such as high blood pressure medication.

Finally, Point 12 points out that carb reduction does not come with significant side effects like medications do.  I have discussed elsewhere the fact that there are some but these are fairly minor and can be easily rectified with the proper adjustments, as opposed to the ones from medications which can kill you.

This is a very nice paper which takes a pretty comprehensive look at the benefits of carb restriction in diabetes, and there are plenty.

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