The low carb diabetes diet debate

When it comes to diabetes, few topics get as much heated debate as that of whether we diabetics should lower our carb intake intake or not. There are many books available these days that advocate significantly reduced daily carbohydrate levels and it’s always a hot discussion amongst people with diabetes.

Top down healthcare advice from the public sector relies on research to back up it’s recommendations and steers clear of making any hasty moves.

Department of Health carbohydrate guidelines

The Department of Health recommends that people take in about 50% of their daily calories as carbohydrate. This amounts to about 225-300g of carbohydrate per day. This is advice for the general public -people with diabetes included.

(Curiously, the panel that put these guidelines together are known as the Committee on Medical Aspects of Food who go by the rather unfortunate acronym, COMA.)

Diabetes.co.uk has recognised that a significant percentage of people with diabetes find the recommended amounts of starchy carbohydrate too high to be able to maintain acceptable blood glucose levels.

There has long been a call from the diabetic population to urge the Department of Health to define new guidelines with lower carbohydrate amounts for people with diabetes, particularly type 2 diabetes.

As someone with diabetes, I personally support the idea of people with type 2 diabetes being recommended to reduce their carbohydrate intake below that of the recommendations for the public at large. My reasons are as follows:

What arguments exist for reducing carbs?

  • Reduces post meal high blood glucose levels (spiking)
  • Can see improvements in long term control by way of reduced HbA1c numbers
  • The diet can help to kick start and maintain weight loss
  • Reducing after meal sugar levels can lead to more alertness (less brain fog) and less fatigue after meals
  • Reducing carbohydrate intake can lead to a lower dependence on medication for blood glucose control.
  • There is evidence to suggest that low-carb diets can help to restore insulin sensitivity and slow down damage to the pancreas’ insulin producing beta cells.

And the arguments against reducing carbs?

I feel that the extent of the disadvantages really depends on how little carbohydrates the diet contains and can also be a result of reduction of calories in the diet.

Generally speaking, the lower the level of carbohydrates, the more chance that the following may apply:

  • Hypoglycemic events may occur more often on a lower-carb diet
  • If the level of daily carbohydrates is under 50-70 grams per day, ketones can be produced which should be monitored to prevent ketone levels becoming too high
  • The possibility of headaches and constipation, this can be corrected by readjusting the amount of fibre and fluids in the diet –a dietitian can help with this.
  • Fatigue, if the calorie content is low
  • There is perceived to be a lack of long term research studies that confirm patient safety

One long time argument against a low-carb diet is that it promotes higher cholesterol levels. As with most other diets, whether this happens is dependent on what the diet contains and how strictly the carbohydrate is reduced.

On the last point about long term research studies, it could also be argued that there is also a lack of long term studies, specifically relating to people with diabetes, which confirm patient safety of the Department of Health’s recommended diet.

Is a reduced carbohydrate diet for everyone with diabetes?

Along with many others on our diabetes forum, I believe that the recommended amount of carbohydrates should be based on a more individual basis. For some conditions, such as cystic fibrosis, a reduced carbohydrate diet could be quite dangerous for example.

However, there is a strong feeling that, in general, the carbohydrate intake of the Department of Health recommendations are too high for the majority of people with type 2 diabetes and that levels of carbohydrate intake should be matched to people’s individual needs and preferences.

Whilst generally thought of as less of a necessity for type 1 diabetes, a result of the availability of fast acting insulins, there are plenty of people with type 1 who also find lower carbohydrate diets help provide more stability of blood glucose levels.

Women going through pregnancy with diabetes are one group who are often advised by doctors to go onto a tightly carb restricted diet as tight blood glucose control is so important for the health of the child.

How much carbohydrate are people with diabetes eating?

carbohydrate poll on the diabetes forum is currently showing that over 75% of respondents are on a diet which the charity Diabetes UK defines as a low-carbohydrate diet. [Figures taken from 78 responses at time of writing]

What do you think?

  • Are you somebody who has type 2 diabetes and can keep your sugar levels under control on a 200+ grams of carbs?
  • Is tailoring carbohydrate levels to individuals realistic?
  • Would you personally have worries over carbohydrate recommendations being lower?
  • Do you have type 1 and find that reducing daily carb intake helps?

Comment below and have your say on the issue.

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About the author

Benedict Jephcote

I have been researching and writing about diabetes for the best part of a decade. I have a passion for helping people with diabetes and championing their rights. Outside of diabetes, I have a love of music and seventeenth and eighteenth century history.

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