Should I be following a low carb diet with type 2 diabetes
Should I follow a low carb diet? This has been a topic that has come to me quite frequently recently. It makes sense. Carbohydrates are the foods which spike glucose levels. Therefore, following a low carb diet should prevent spikes in your glucose levels.
The question really is though, do you need to go on a low carb diet to achieve good glycaemic control or even remission?
Remember, many people eat carbohydrates and do not develop diabetes. In fact, they are a source of good nutrition.
From experience, the problem is more to do with eating too many carbohydrates and the wrong type of carbohydrates. If your type 2 diabetes has come about due to lifestyle factors such as weight gain, the solution is weight loss, not necessarily a low carb diet. You may find a low carb diet is the means you use to achieve this but your glucose levels will likely settle down just as well regardless of how you lose weight.
I’ve done a quick video on this above with some further thoughts below.
The right type of carbs
Some low carb diets such as keto diets can have people avoiding healthy foods like fruit and vegetables. This are nutritious foods that don’t need to be avoided. Fruit may need to be portion controlled but ultimately they can be enjoyed.
Keto diets avoid carbs which makes the body break down its fat stores. Fat needs to be broken down in the body so it can be used for energy. However, when fat is broken down it forms various different molecules one of which is ketones. Ketones can be used as an alternative fuel source to glucose in the body. Normally glucose fuels the muscles but is also the primary fuel source for the brain and central nervous system (CNS). Hence why people can feel irritable when they are low in glucose.
Ketones can also be used by the brain and CNS for fuel but they are a second choice fuel. In other words, the brain and CNS prefer glucose.
This type of diet usually means high intakes of fat and protein because these compensate for the lack of carbohydrate. This means high intakes of meat, fish, dairy, some vegetables and little to no fruit or starchy carbohydrates.
Therefore, various nutrients lack in this diet. One major nutrient being fibre because fibre is only available with vegetable, fruit and starchy carbohydrates. This can reduce gut health, increase the risk of conditions such as bowel cancer in the future and lead to consultation.
A more practical approach
Personally, I think it’s more about eating the right type of carbohydrates rather than aiming to go low carb or even induce ketosis.
The right type of carbohydrates are the nutritious slow realising carbohydrates. I’ve blogged on these before which you can find here.
As a quick summary the right type of carbohydrates are vegetables, fruit, beans, pulses, lentils, oats and wholegrain starchy carbohydrates. This is where the nutrients are and these are slow releasing or contain little carbohydrates.
The unhealthier versions of carbohydrates like white varieties of bread, pasta, rice, processed sugar, cakes, biscuits, sweets etc. These lack nutrients and are not great for glucose levels.
Easy food swaps
To adopt a diet high in good carbohydrates is quite simple. It doesn’t need a full diet overhaul but rather some simple substitutions.
Changing from white rice to alternatives like brown rice, basmati rice, quinoa and/or pearl barely etc can make a big difference.
Switching baked potatoes for sweet potatoes or new potatoes can help improve glucose levels as they are a more slowly releasing source of carbohydrate. New potatoes can be particularly useful because it helps reduce the total amount of carbohydrate at your meal.
Other patients have had success with replacing the above foods with vegetable options. For example, instead of using 100% pasta with spaghetti bolognese, change this for courgetti or strips of vegetables. This can be a complete swap or a split of pasta to vegetable. Another example is using cauliflower rice alongside or instead of actual rice.
Often the taste is not noticed if you flavour your food or have it with foods like bolognese.
You can also reduce your intake of starchy carbohydrates and replace these with vegetables. So the portions and proportions of your meals changes rather than the actual meals themselves. A good example is reducing the number of roast potatoes on a Sunday roast and replacing with vegetable options.
Usually we recommend at least 50% of a meal is made up of vegetables.
Correct carbs & portions are key
Therefore, carbohydrates aren’t evil. It’s more about choosing the correct types of carbohydrates and watching the portions of them. In practice we recommend starchy carbohydrates should be no more than a quarter of your meal. As mentioned, vegetables should be the predominant factor on your plate ideally. Try to bulk your meals out with beans, pulses, lentils and vegetables.
This helps keep the calorie content low, reduces the carb content of the meal and helps you along to achieve the 30g of fibre per day which is the current recommendation.
People who may benefit from low carb
There are some patients who are inactive or their diabetes has progressed quite far who may benefit from a lower carbohydrate intake. This is because they either don’t use up enough energy to convert enough glucose to fuel or their bodies cannot use glucose due to severe insulin resistance.
Have you noticed
When we discuss low carb diets we are coming from a starting point of eating too many carbs. When you look at the actual recommendations a low carb diet is actually just a normal carb diet in most cases.
However, when talking about very low carb diets and ketogenic diets, this is what I say is unnecessary.
Remember, some people will need more carbs than others. If you are active, your carb requirement will be higher than others. I explain this concept in the video above.