Avoid carbs as a diabetic?

Eileen McNally

Hi friends! I have a client I am working with who's doc said she should be extremely low carb and increase fats in her diet. I believe it's not about restricting carbohydrates all together, it's about learning to stabilize our blood sugar throughout the day right @Bella Diaz ? I wanted to ask the community to help this client feel less alone and connect with other diabetics to gain more insight on how you deal with this. :)

Sawyer Paull-Baird

Hey Eileen-

I will just say a couple of things then leave it to Bella to answer from here since at the end of the day, this falls squarely in her scope of practice and outside of our own.

Most of the people I have worked with in the past with diabetes, especially those who are quite active, have done best on a diet that is lower in carbs, but not extremely low. Something along the lines of like 30-40% of calories, and co-ingested with other food sources to delay the rate of absorption/digestion. So, eating carbs as part of a mixed meal or snack, preferably something with some protein and fiber. Physiologically, there is some evidence to support these super low carb diets, however the problem, like anything, is adherence. For most people, sticking to what is essentially a ketogenic diet is not a sustainable lifestyle... and it doesn't matter how effective something can be, if it won't be followed long-term.

30min mark of this podcast here begins talking about nutrition and diabetes a bit. The whole resource is solid.

Another good point to make here is that one of the best things someone who is struggling to control their blood sugar can do is to build more muscle. Skeletal muscle is the largest reservoir for blood sugar in the body storing upwards of 500g. The more muscle one has, the better they tend to be able to regular their blood sugar, especially if they are exercising as during exercise, blood glucose is transported into the muscle cells independent of insulin.

Interested to hear what Bella and others have to say here.

Great use of the forum too!!

Bella Diaz

Hi @Eileen McNally- thanks so much for sharing this! I get the topic constantly as SO many pre-diabetic or diabetic individuals are told from their primary care physicians to just "eat as little carbs as possible" or to "avoid carbs", which can be extremely dangerous and counter-productive to the patient.

@Sawyer Paull-Baird shared a lot of great points about co-ingesting carbohydrates (CHO) with other food sources such as fiber and protein. This helps to slow the absorption of the glucose in the body and helps to improve overall glycemic control. The consistency of carbohydrates throughout the day will make it easier on the body to normalize blood sugar levels, and monitoring your carbohydrate intake through methods such as CHO counting, using the American Diabetes Association (ADA) exchange system, or using experience-based estimation, will help with this.

There has been lots of opposing views on those with diabetes following a low carbohydrate diet and this has been studied extensively in the last couple of years. As nutrition professionals, we continue to take people's lifestyle, preferences, daily nutrition needs, and insulin therapy/ medications into account before prescribing a specific CHO amount. An important change however was the ADA in 2019 made a change in their position statement to read, “research indicates that low carbohydrate eating plans may result in improved glycemia and have the potential to reduce antihyperglycemic medications for individuals with type 2 diabetes”.

Situations where low CHO diets would not be recommended would be in individuals who are pregnant, lactating woman, those who may be at risk for or have an eating disorder, or those with renal disease. Also clients who may be using sodium–glucose cotransporter 2 (SGLT2) inhibitors per the ADA. (American Diabetes Association. Diabetes Care. 2019 Jan;42 Supplement 1:S46–S60. https://doi.org.)

Carbohydrate recommendations for type 1 & 2 diabetes today are as follows:

• Carbohydrate intake should emphasize nutrient-dense carbohydrate sources that are high in fiber, including vegetables, fruits, legumes, whole grains, as well as dairy products.
• For people with type 1 diabetes and those with type 2 diabetes who are prescribed a flexible insulin therapy program, education on how to use carbohydrate counting, and in some cases how to consider fat and protein content to determine mealtime insulin dosing is recommended to improve glycemic control.
• For individuals whose daily insulin dosing is fixed, a consistent pattern of carbohydrate intake with respect to time and amount may be recommended to improve glycemic control and reduce the risk of hypoglycemia.
• People with diabetes and those at risk are advised to avoid sugar-sweetened beverages (including fruit juices) in order to control glycemia and weight and reduce their risk for cardiovascular disease and fatty liver and should minimize the consumption of foods with added sugar that have the capacity to displace healthier, more nutrient-dense food choices.

So whether you are consuming moderate CHO (~45% of your kcals) or low CHO diet, CONSISTENCY IS KEY. This means for example having 2-3 servings of CHO for women & 4-5 servings CHO for men per meal to assist in glycemic control. One exchange of CHOs is 15 g- so speaking with your practitioner or a registered dietitian (I would love to help!) would help you to determine a plan that is best for you!

I hope this helps!! :)

Eileen McNally

@Bella Diaz SO helpful! Thank you for your incredible insight :)

Patti Thibodeau

Very informative Bella! I especially like the listing of current carb recommendations!

I know that those with diabetes or prediabetes need to be more stringent, I think that when people in general say they want to follow a low carb diet, what they often mean is a no/low CRAP diet...CRAP is acronym for Carbs that are Refined And Processed. Very simplified, easy to remember and implement! I also think that when many health care providers advise their patients to eat ‘low carb diets’, this is what they mean but don’t have the time to fully explain and patients leave their appointments confused and not fully educated...they all need a Bella in their office to refer their patients to!

Mike Stack

@Bella Diaz and @Sawyer Paull-Baird, great information that you provided here (Sawyer, great call on increasing muscle mass). One thing I'll add in, because I think it gets lost in the discussion of diabetes management sometimes is the role of exercise and physical activity. Keep in mind movement is literally the way to circumvent the body's insulin dysfunction when it comes to diabetes. Since movement and exercise transport carbohydrate into the cell without the aid of insulin, movement and exercise is without a doubt the simplest first-line treatment for managing blood sugar. This just doesn't have to be formal exercise either. Meeting standard physical activity requirements (of 150 min/week or 10,000 steps per day) is a great way to manage blood sugar.

I say all of this because I feel like movement and exercise get lost in a more complicated (from a behavioral perspective) conversation around carbohydrate intake. Don't get me wrong I think managing carb intake effectively is very important, but it's also a behavioral challenge because of the ever-present impact of having to modify our diet. With that said, @Eileen McNally please make sure you pass along the information that Bella and Sawyer pointed out above, but also make sure your client knows how impactful exercise and physical activity can be to managing their diabetes (and as an added bonus, all of the other health benefits that exercise confers).