Diabetes is a chronic condition that impacts millions of individuals globally, with current estimates suggesting that over 500 million people are affected worldwide. This complex disease requires diligent management, as maintaining optimal blood sugar levels can greatly minimize the likelihood of serious complications. One effective strategy for achieving better blood sugar control is adhering to a very low carbohydrate diet, where less than 10% of total caloric intake is derived from carbohydrates.

In this article, we will explore the intricacies of very low carb diets and their significant role in managing diabetes effectively.

Understanding Diabetes and the Impact of Food

Diabetes is a condition in which the body struggles to effectively process carbohydrates. When you consume carbohydrates, they are typically broken down into smaller units of glucose, which then enter the bloodstream. As blood sugar levels rise, the pancreas reacts by releasing the hormone insulin. This crucial hormone facilitates the entry of blood sugar into the cells for energy.

In individuals without diabetes, blood sugar levels are maintained within a tight range throughout the day. However, those living with diabetes experience a disruption in this system, which can lead to significant health issues. It is critical to manage both high and low blood sugar levels, as extremes can have serious consequences. Diabetes manifests in several forms, with type 1 and type 2 being the most prevalent. These conditions can arise at any stage of life. In type 1 diabetes, an autoimmune reaction destroys the insulin-producing beta cells in the pancreas, necessitating insulin administration multiple times daily to ensure glucose reaches the cells and maintains a healthy level in the bloodstream.

On the other hand, type 2 diabetes begins with the beta cells producing sufficient insulin; however, the body’s cells become resistant to its effects, leading to elevated blood sugar levels. To counteract this, the pancreas attempts to produce more insulin to lower blood sugar, but over time, the beta cells may fail to keep up with the demand. Among the three macronutrients—protein, carbohydrates, and fats—carbohydrates exert the most significant influence on blood sugar regulation. This is primarily due to their conversion into glucose by the body. Consequently, individuals with diabetes often require higher doses of insulin, medications, or a combination of both when consuming substantial amounts of carbohydrates.

Can Very Low Carb Diets Aid in Diabetes Management?

A multitude of studies supports the effectiveness of very low carb diets in managing diabetes. In fact, prior to the advent of insulin in 1921, such diets were regarded as the standard method for treating individuals with diabetes. Moreover, it appears that low carb diets can yield positive results over the long term, provided that individuals adhere to them consistently. However, many people encounter difficulties in maintaining a low carb diet over extended periods, as it often proves to be an unsustainable eating pattern. Recent research highlights this issue and emphasizes the necessity for further studies to fully understand the long-term ramifications of low carb diets.

In one particular study, participants diagnosed with type 2 diabetes followed a low carb diet for a duration of 6 months. Remarkably, their diabetes remained well-controlled more than 3 years later, contingent upon their continued adherence to the diet. Similarly, among individuals with type 1 diabetes who embraced a carb-restricted diet, a notable 48% experienced significant improvements in their blood sugar levels over a span of 4 years. This underscores the potential benefits of low carb diets for both types of diabetes, although the challenge of long-term adherence remains a critical consideration.

What is the Ideal Carbohydrate Intake for Individuals with Diabetes?

The optimal carbohydrate intake for individuals managing diabetes remains a debated subject, even within the community that advocates for carbohydrate restriction. Several earlier studies demonstrated notable enhancements in blood sugar levels, body weight, and various health metrics when carbohydrate intake was limited to around 20 grams daily.

Dr. Richard K. Bernstein, who lives with type 1 diabetes, has successfully maintained a daily intake of 30 grams of carbohydrates, sharing impressive blood sugar management outcomes with patients who adhere to similar guidelines. Conversely, other studies suggest that if a very low carbohydrate diet becomes overly restrictive, a moderate low carbohydrate intake—ranging from 70 to 90 grams or constituting approximately 20% of total caloric intake—can also yield positive results.

The ideal carbohydrate amount is likely to differ from person to person due to individual responses to carbohydrates, which are influenced by factors such as age, weight, height, gender, and physical activity levels.

The American Diabetes Association (ADA) emphasizes that there is no universal dietary approach that suits everyone with diabetes. Customized meal plans, tailored to individual dietary preferences and metabolic objectives, are recommended. The ADA also encourages individuals to collaborate with their healthcare providers to ascertain their optimal carbohydrate intake. To determine your ideal carbohydrate consumption, consider measuring your blood glucose levels using a meter before meals and again 1 to 2 hours afterward.

According to the ADA’s standards of care, the target blood sugar level two hours post-meal should remain below 180 mg/dL. Persistently elevated blood sugar levels (exceeding 180 mg/dL) over prolonged periods can result in complications such as nerve or kidney damage. Your individual tolerance and the macronutrient composition of your meals play a crucial role in this process. Remember that combining carbohydrates with protein and fats can decelerate glucose absorption, thus moderating the rise in blood sugar levels. Instead of completely removing all carbohydrates, a well-rounded low-carbohydrate diet should incorporate nutrient-rich, high-fiber carbohydrate sources, such as vegetables, berries, nuts, and seeds.

Which Carbohydrates Elevate Blood Sugar Levels?

In plant-based foods, carbohydrates consist of a blend of starch, sugars, and fiber. It is important to note that only the starch and sugar elements contribute to elevated blood sugar levels. The fiber that is naturally present in foods, whether it is soluble or insoluble, does not convert into glucose within the body, thus having no effect on blood sugar.

By deducting the fiber and sugar alcohols from the overall carbohydrate content, you arrive at the digestible or 'net' carbohydrate figures. For instance, in 100 grams of cauliflower, there are 5 grams of carbohydrates, with 3 grams attributed to fiber. This results in a net carbohydrate total of 2 grams. Furthermore, prebiotic fibers like inulin have demonstrated potential benefits in enhancing fasting blood sugar levels and other health indicators among individuals with type 2 diabetes. Sugar alcohols, such as maltitol, xylitol, erythritol, and sorbitol, are commonly utilized as sweeteners in sugar-free candies and various 'diet' products. However, some of these, particularly maltitol, may cause an increase in blood sugar levels for those living with diabetes.

Due to this variability, it is essential to approach the net carbohydrate measurement with caution, as the net carb count provided on a product label might not reflect the true contribution of all carbohydrates, especially when maltitol is factored in. Moreover, neither the Food and Drug Administration (FDA) nor the American Diabetes Association (ADA) endorse the use of the net carb tool. In fact, the ADA explicitly advises against using net carbs for calculating carbohydrate intake aimed at managing blood sugar effectively. This carbohydrate counter could be an excellent tool, offering comprehensive data on total carbohydrates, net carbs, fiber, protein, and fat for a wide range of foods.

Foods to Embrace and Foods to Limit

It’s advisable to concentrate on consuming low-carb, nutrient-dense whole foods, ensuring they are rich in essential vitamins and minerals. Moreover, being attuned to your body's hunger and satiety signals is crucial, regardless of the food choices you make.

Foods to Embrace

You can indulge in the following low-carb options until you feel satisfied. Remember to incorporate sufficient protein into every meal:

• Meat, poultry, and seafood
• Eggs
• Cheese
• Non-starchy vegetables (most vegetables, excluding those mentioned below)
• Avocados (butterfruit)
• Olives
• Oils like olive oil, coconut oil, along with butter, cream, sour cream, and cream cheese

Foods to Consume in Moderation

The following foods can be enjoyed in smaller portions, tailored to your individual carbohydrate tolerance:

• Berries: 100 grams or less
• Plain Greek yogurt: 100 grams or less
• Cottage cheese: 50 grams or less
• Nuts and peanuts: 30–60 grams
• Milk: 100 grams or less
• Other fruits besides berries: 50 grams or less
• Flaxseeds or chia seeds: 30 grams
• Dark chocolate (minimum 85% cocoa): 30 grams or less
• Winter squash varieties (butternut, acorn, pumpkin, spaghetti, and hubbard): 100 grams or less
• Liquor: 45 mL
• Dry red or white wine: 120 mL

Leguminous foods such as peas, lentils, and beans serve as healthy protein sources but do contain carbohydrates. It’s important to factor them into your daily carbohydrate intake. Drastically cutting down on carbohydrates typically results in lower insulin levels, prompting the kidneys to excrete sodium and water.

To replenish lost sodium, consider consuming a cup of broth, a handful of olives, or other salty, low-carb snacks. In such instances, adding a pinch of salt to your meals is acceptable. However, it’s essential to limit your overall sodium intake to no more than 2,300 milligrams (mg) for optimal health. If you are managing conditions such as congestive heart failure, kidney disease, or hypertension, consult your healthcare provider before increasing sodium levels in your diet.

Foods to Limit

The following items are high in carbohydrates and can lead to substantial spikes in blood sugar levels for individuals with diabetes:

• White bread, pasta, refined cereals, corn, and various other refined grains
• Starchy vegetables like potatoes, sweet potatoes, yams, and taro
• Juices, soft drinks, sweetened teas, etc.
• Beer
• Desserts, pastries, candy, ice cream, and similar items

A Sample Day of Very Low-Carbohydrate Meals for Individuals with Diabetes

Below is a carefully curated sample menu that contains 15 grams or fewer of digestible carbohydrates for each meal. Depending on your unique carbohydrate tolerance, feel free to adjust the portion sizes accordingly.

Breakfast: Eggs and Spinach

• Three eggs cooked in butter (1.5 grams of carbs)
• 1 cup sautéed spinach (3 grams of carbs)

This delightful breakfast can be complemented with:

• 1 cup blackberries (6 grams of carbs)
• 1 cup coffee with cream, optionally sweetened with a sugar-free sweetener

Total digestible carbohydrates: 10.5 grams

Lunch: Cobb Salad

• 90 grams (approximately 3 ounces) cooked chicken
• 30 grams (about 1 ounce) Roquefort cheese (0.5 grams of carbs)
• 1 slice of crispy bacon
• 1/2 medium avocado (2 grams of carbs)
• 1 cup chopped tomatoes (5 grams of carbs)
• 1 cup shredded lettuce (1 gram of carbs)
• Olive oil and vinegar dressing

For an enjoyable addition to your salad, consider:

• 20 grams (around 2 small squares) of 85% dark chocolate (4 grams of carbs)
• A glass of iced tea, optionally sweetened with a sugar-free sweetener

Total digestible carbohydrates: 12.5 grams.

Dinner: Salmon with Vegetables

• 4 ounces of grilled salmon
• 1/2 cup sautéed zucchini (3 grams of carbs)
• 1 cup sautéed mushrooms (2 grams of carbs)

To enhance your dinner experience and enjoy a dessert:

• 4 ounces (approximately 120 grams) of red wine (3 grams of carbs)
• 1/2 cup sliced strawberries topped with 1 tablespoon of unsweetened whipped cream (5 grams of carbs)
• 1 ounce of chopped walnuts (6 grams of carbs)

Total digestible carbohydrates: 19 grams

For further inspiration, check out our collection of seven quick low-carb meals and an extensive list of 101 healthy low-carb recipes.

Consult Your Physician Prior to Dietary Modifications

When carbohydrate intake is limited, there is frequently a notable decrease in blood sugar levels. This significant change often leads healthcare providers to lower the dosages of insulin and other medications. In certain situations, they might even discontinue the medication entirely.

For instance, a study revealed that out of 21 participants diagnosed with type 2 diabetes, 17 were able to either stop or reduce their diabetes medication when their carbohydrate consumption was restricted to just 20 grams per day. Similarly, in another research endeavor, individuals with type 1 diabetes consumed between 25 to 75 grams of carbohydrates daily for a duration of 12 weeks, resulting in enhanced blood sugar control and a reduction in insulin dependency. Notably, there were no reports of low blood sugar incidents or other negative effects.

If insulin and other diabetes medications are not adjusted in accordance with a low carbohydrate diet, there exists a considerable risk of experiencing dangerously low blood glucose levels, commonly referred to as hypoglycemia. Thus, it is crucial for individuals who are prescribed insulin or any diabetes medications to consult with their healthcare provider before embarking on a low carbohydrate dietary regimen.

Alternative Strategies to Lower Blood Sugar Levels

Beyond adhering to a low carbohydrate diet, engaging in regular physical activity plays a vital role in managing diabetes by enhancing insulin sensitivity. A well-rounded approach that combines both resistance training and aerobic exercises proves to be particularly effective. This holistic method not only aids in weight management but also contributes to overall health.

Additionally, prioritizing quality sleep is essential for maintaining stable blood sugar levels. Numerous studies have demonstrated a clear link between insufficient sleep and an elevated risk of developing diabetes. For instance, a recent observational study indicated that individuals with diabetes who slept less than 6 hours or more than 8 hours nightly experienced poorer blood glucose control compared to those who enjoyed a sleep duration of 6 to 8 hours.

Moreover, effectively managing stress is crucial for optimal blood sugar regulation. Practices such as yoga, qigong, and meditation have been recognized for their ability to significantly lower both blood sugar and insulin levels, providing a natural and holistic approach to diabetes management.

5 Foods to Limit or Avoid on a Low-Carb Diet

For those embracing a low-carb lifestyle, it's essential to be mindful of certain foods that can hinder your progress. Here are five categories of foods that you may want to limit or completely avoid:

1. Sugary Foods: Items like candies, pastries, and sodas are packed with sugar and can spike your blood glucose levels. Instead, consider opting for natural sweeteners like stevia or monk fruit.

2. Grains: Foods such as bread, pasta, and rice contain high amounts of carbohydrates. In Indian cuisine, this includes rice and chapati.

3. Starchy Vegetables: Potatoes and corn are examples of starchy vegetables that can elevate your carb intake. Instead, try non-starchy options like leafy greens or bell peppers to keep your meals low in carbs.

4. High-Carb Fruits: While fruits are often considered healthy, certain types like bananas and grapes are high in sugars. Consider incorporating berries, which are lower in carbohydrates and rich in antioxidants.

5. Processed Foods: Many packaged foods contain hidden sugars and unhealthy fats. Always read labels carefully and choose whole, unprocessed foods to maintain a healthy low-carb diet.

The Conclusion

Research indicates that low carbohydrate diets can be highly effective in managing both type 1 and type 2 diabetes. These diets have been shown to enhance blood sugar control, lessen the need for medications, and lower the risk of complications associated with diabetes. It's essential to consult with your healthcare provider before implementing any dietary modifications, as your medication dosages might require adjustments accordingly.