Carbohydrate restriction in Type 2 Diabetes Mellitus
Carbohydrate restriction and ketogenic diets in patients suffering from Type 2 Diabetes Mellitus (T2DM) by Elzette Struwig RD(SA)
According to the United States center for Disease Control and Prevention, 85% of the diabetic patients are overweight and 55% are obese [1]. Due to the number of overweight/obese individuals increasing, the World Health Organization estimates that approximately 366 million people will have diabetes by the year 2030 [1]. This is of great concern, and can also be an indication that current practices, including dietary practices to prevent Type 2 Diabetes Mellitus (T2DM) are not effective enough to lower these figures. It is my opinion that current practices are focused on the management of T2DM and not as much the prevention thereof. Practices to prevent lifestyle diseases such as T2DM may include healthy eating, exercise, proper stress management, etc.
As mentioned previously overweight/obesity is associated with T2DM, thus the management of weight can help to prevent T2DM. Weight loss these days could be done quite easily due to the abundance of weight loss clinics and programs available. The challenges are to maintain a healthy weight, and when losing and maintaining weight, to do so in a healthy manner. Currently, a lot of individuals are following some sort of low-carbohydrate diet to shed some kilograms.
Being a dietitian myself who focusses on low-carbohydrate and ketogenic diets and follow such a lifestyle myself. I have seen that, if done correctly, this type of lifestyle may provide health benefits and is quite sustainable for most of our patients. There is also a vast majority of social media groups (not always following the correct medical guidelines) in which individuals find this type of lifestyle sustainable. I believe that sustainability is one of the most important aspects when choosing a specific dietary lifestyle, as, without it, it is just another quick fix.
But why can a low-carbohydrate or ketogenic diet be considered for the prevention of T2DM? Several studies have shown the benefits of ketogenic diets for patients with type two diabetes may include, weight loss, reducing HbA1c, reversing nephrology, cardiac benefits, improvement of lipid profile and even have a potential effect on reversing diabetic neuropathy and retinopathy [1]. Saslow et al. conducted a 12-month study in 2017 in which adults with elevated HbA1c and body weight assigned to a very low-carbohydrate ketogenic diet had greater reductions in HbA1c, lost more weight, and reduced more medications than those instructed to follow a moderate-carbohydrate, calorie-restricted, low-fat diet (2). The study also found that the ratio of triglycerides to HDL, which predicts coronary disease, decreased in the low-carbohydrate group compared to the moderate-carbohydrate group, suggesting that the very low-carbohydrate ketogenic diets may have certain benefits on lipid profiles (2).
As I have experienced the increased energy levels, better sleep, reduction in visceral fat, stabilizing blood pressure levels, so have many of our patients also experienced the benefits of a low-carbohydrate lifestyle. It is important to consider all aspects when choosing a dietary lifestyle, as weight is not the only indication of health. Make sure that the calories you consume count to contribute to your health, possibly prevent diseases such as T2DM and not contribute to them.
References
- Azar ST, Beydoun HM, Albadri MR. Benefits of Ketogenic Diet for Management of Type Two Diabetes: A Review. Obesity & Eating Disorders. 2016: 2; 22.
- Saslow LR, Daubenmier JJ, Moskowitz JT, Kim S, Murphy EJ, Phinney SD, Ploutz-Snyder R, et al. Twelve-month outcomes of a randomized trial of a moderate-carbohydrate versus very low-carbohydrate diet in overweight adults with type 2 diabetes mellitus or prediabetes. Nutrition and Diabetes. 2017: 7; 304.