Doctors detail the benefits of carbohydrate restriction in diabetics

Something interesting came in the post today, though I’m not sure who it has come from because the person who sent it marked it with their email address only. The item is a photocopy from what I think is a book, that seems to be called ‘Diabetes for Beginners’. The page (page 36) has a diagram of a wheel split into segments of various sizes, each of which is ‘filled’ with pictures of certain foods. A full one-third of the circle is devoted to starchy carbs including bread, potatoes, rice, pasta, breakfast cereals and even some instant mashed potato too.

The person who has sent it to me has added the following words: Note that the recommended daily diet includes 1/3 carbohydrate.� It is not clear at this stage whether this individual is:

1. Making the point that because I don’t recommend much in the way of starchy carbs for diabetics, then I am out-of-step with conventional ‘wisdom’ and need to smarten up my act.

2. Saying ‘look at the ridiculous dietary advice diabetics are getting. Shouldn’t something be done?!’

Pondering which of these points is being made is pointless, I reckon, because the only one that has any merit is number 2.

Variously on this site, I have cited a considerable body of evidence which shows that controlling carbohydrate has the potential for significant health benefits, especially for diabetics. Not only is the science strong in this area, it is certainly supported by common sense: diabetics chiefly have a problem controlling blood sugar levels, so it makes sense to limit foods that tend to disrupt blood sugar levels including many starchy carbs such as bread, potatoes, rice, pasta and breakfast cereals.

The landing of this ‘food wheel’ on my doormat this morning is very timely, because just this week a group of scientists and doctors published on-line a review of the evidence for carbohydrate restriction in diabetics. You can see it here (click on ‘provisional pdf’ in the box).

The authors of this review make five basic assertions, which they then go on to validate by citing published evidence in the area.

These assertions are:

1. Carbohydrate restriction improves glycaemic control, the primary target of nutritional therapy and reduces insulin fluctuations.

2. Carbohydrate restricted diets are at least as effective for weight loss as low-fat diets.

3. Substitution of fat for carbohydrate is generally beneficial for markers for and incidence of CVD (cardiovascular disease).

4. Carbohydrate restriction improves the features of metabolic syndrome.

5. Beneficial effects of carbohydrate restriction do not require weight loss.

One point that the authors makes in this review is that while carbohydrate restriction is not for everyone, medical care is sometimes about choices. And one choice that physicians and their clients should be aware of the role of carbohydrate restriction in the management of diabetes, and the evidence for it.

If you have an interest in the management of diabetes, either from a sufferer’s perspective or as a health professional, I urge you read this article. Some lives may be saved and a lot of suffering prevented as a result.


Accurso A, et al. Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: time for a critical appraisal.Nutr Metab (Lond). 2008 Apr 8;5(1):9 [Epub ahead of print]

8 Responses to Doctors detail the benefits of carbohydrate restriction in diabetics

  1. Audrey 15 April 2008 at 4:40 pm #

    I have just been in Christie’s Hospital in Manchester for overnight chemotherapy. There was a lady in the opposite bed who was diabetic and having chemo, which was making her very sick.
    The evening meal was a choice of meat pie or vegetable lasagne. I heard her telling the nurse she hadn’t had much and could she have toast for supper. She had two slices.

    At 6.00am next day she asked for toast and coffee to settle the nausea. Then at 8.00am she had toast again. I mentioned it in my nosey way and she said the nutritionist had told her to have slow release carbohydrate and not to have any fat.

    Christie’s is a centre of excellence, but I noticed on a previous occassion that an diabetic “inmate” had a baked potato for evening meal and then felt hungry and got a sandwich. It was also Easter Sunday and all her visitors had brought her chocolate and biscuits.

    The nurses spent ages worrying about her insulin dosage.


  2. Cindy Moore 17 April 2008 at 11:56 pm #

    My sister has been type 2 for over 20 yrs. She is on max dose of 1 diabetic med and close to max on a second one. She’s also on 2 BP meds. Her A1c is elevated, over 7.0, but her doc says it’s good for someone with the disease for so long. Her BP is also elevated, rarely dropping below 140/80, and usually with a systolic in the 160s. Her weight is stable, a bit (20-25 pounds or so) over weight, but no different than the past 30 yrs or so. She’s 66, no CAD, but a year ago she did have stents placed in her neck due to radiation scarring….she’s survived cancer 3 times. She was scanned and had angiograms and found to have NO plaque in her heart or neck. (My parents and their families have no signs of CAD, even with rampant diabetes, but my sister is a half sibling and we know nothing about her dad’s family)

    So….the last time she saw her doc he told her to go back to the dietitian to make sure she was eating right. At that time she was told to eat around 30 grams (“2 carbs” by ADA standards, each “carb” actually being 15g) per meal with at least 2 snacks a day of 15g (“1 carb”). So the dietitian’s advice? Cut her fat and add fish oil and to add “a carb or two” (15 – 30 grams) to her dinner and try and add another snack (10 grams)! So, 110 grams isn’t enough, she’s gotta add another 25-40 grams!

  3. Terry 18 April 2008 at 6:07 pm #

    I’m a Type 1 diabetic these past thirty five years – on a high carb, high insulin, roller-coaster ride every day and night until I recently discovered Dr Richard Bernstein’s Diabetes Solution book. What a revelation!

    I’ve ‘cracked’ the low carb diet. My breakfast consists of three slices of grilled ham plus a fried or scrambled egg. No bread. Just a hot cup of tea. I feel full and ready to go. No insulin needed except some basal insulin. Prior to my new low carb diet, my high carb breakfast would require me to take 5 – 7 units of fast acting insulin to ‘cover the carbs’.

    My lunch is tinned tuna with chopped lettuce, a small portion of tomato and bit of onion or carrot. Sweet peppers add ‘crunch’. I’m full. Sometimes I repeat this a few hours later if I’m tempted to eat more. My hunger disappears because I’m full again.

    My evening meal is breast of chicken, seasoned and then fried on a hot pan with minimal oil. Divide the chicken up to ensure it is fully and quickly cooked. I accompany this with salad (as above) or low carb vegetables such as broccoli or cauliflower. Again, delicious and filling.

    I barely use quick acting insulin any more! Just the odd one or one and a half units here or there (if I’ve allowed ‘carb creep’) And my use of long acting basal insulin has been reduced by 75 percent at a stroke. My blood sugar readings now range from 4 to 5.5. They used to go up and down like a lift in a skyscraper when I was on a high carb diet!

    I’ve always gone out power walking or jogging on a regular basis. My new low carb has resulted in an INSTANT hundred and fifty percent increase in the speed at which I am able to power walk or jog, as well as a similar increase in the distance I am able to cover in any one session. Crucially, I no longer get any symptoms like a slightly ‘tight’ chest when I exercise. My breathing is now easy and relaxed all the time I’m exercising. In fact, I can’t get out of breath no matter what I do – it’s only my leg muscles that get sore and stop me.

    The low carb diet works. The key is to stick to the regime I’ve outlined above. It takes hardly any preparation or time. And you don’t have to worry about your diabetes any more because if you’re not taking hardly any insulin you’re not going to have hardly any hypos, are you? Dr Bernstein calls this the ‘law of small numbers’ in his book. Small amounts of insulin have small effects. The low carb diet requires very small amounts of insulin indeed because protein and fat cause only very small rises in blood sugar levels. Compare that to what a high carb diet requires in terms of insulin. It’s a no brainer.

  4. audrey wickham 20 April 2008 at 8:57 am #

    This thought occurs to me: we hear a lot about obesity and diabetes but couldn’t it be that too much carb, which we now know is not the wisest food for a diabetic to eat also makes people fat. That obese people get diabetes not because they are obese but because the food they are eating gives them diabetes.

  5. danica 20 April 2008 at 9:28 am #

    Hello I think I wrote a message here once on the same topic but would like to say it again. My 10 year old was diagnosed with Diabetes 1 on 15 August 2007 and I decided to take on the Eat Right for your Blood Group Approach by Dr J D’Adamo. Being O Blood Group we don’t tolerate carbs. He has selected carbs i.e sweet potatoe instead of potatoe or home made spelt bread instead of any bread (small doses), On the 24 of September 2007, just about a year after he was off 10 units of fast ascting insulin per meal and off 15 units of basal insulin. He now has only 6 units of basal insulin at night. As an addition to this he has a small dose of active vitamin D as there is a belief that the lack of it is one of the many possible causes of diabetes 1. To add to this he rarely has dairy produce (in a book about diabetes by Dr Hamas there was a study undertaken by a university that states out of the number of rats that have been taking whey protein 95% became diabetic while on the samoan islands where children , after being weaned off breast milk don’t consume any other dairy there is no diabetes. All this makes me wonder how we came to eat what we eat

  6. danica 20 April 2008 at 9:31 am #

    Sorry , the timing is off on my previos message. It was a month not a year. So he was diagnosed 15 august 2007 and he was off fast acting insulin and only on 6 units of basal insulin 24 sept 2007. He is still on this dose.

  7. helen 20 April 2008 at 11:45 pm #

    Kind of a no brainer to me cut carbs & cut insulin.

    Somehow I don’t think the drug companies that manufacture insulin will be too happy about this do you?

    Why do you think the whole eat more carbs & starchy stuff is promoted so heavily by the medical people?
    Trace the money people always follow the money trail because there you will find the motive & the reason for all our faulty medical / nutritional advice. The “business with disease” does not want you to eat a healthy low carb diet as we were meant to it wants you sick no matter how much they go on about only looking after the health of the people. Sick people equals big dollars for dodgy drug “cures”. Healthy people equals no big profits for big Pharma.

  8. Brian Redwood 31 May 2009 at 10:07 am #

    I was type 2 diabetic injecting insulin twice a day (90units) for 14 years until I tried a different approach which involved reducing starch carbohydrates ( potatoes and bread ) in my case my weight went down and my insulin intake reduced and in less than six months I no longer needed insulin and have remained that way for 35 months with my HbA1C ranging from 6.1 to 5.4. My overall weight has reduced by 18.9% , my BMI from 29.8 to 24.8 but I still have 16lbs to lose to get with my intended design limits. My advice is be guided by your meter, eliminate food that elevates your blood sugar higher and for longer. Hopefully the number of xdiabetic type 2 will dramatically increase.

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