Carbohydrate Restriction: An Effective Treatment for Type 2 Diabetes

Timothy N. Logemann, MD, FACC, ABOM

Type 2 diabetes is an epidemic of massive proportions, and if new data is any indication, we’re only seeing the tip of the iceberg.

Today is American Diabetes Association Alert Day, a time to reflect on shocking new updates that have been released by the Centers for Disease Control and Prevention (CDC): Eighty six million American adults- about one third of the population- has prediabetes, the precursor to full scale type 2 diabetes.  What’s more, ninety percent of people don’t even know they have it. Risk factors for prediabetes include age (especially being over 45), family history and excess weight.  In fact, the more excess weight one carries around the abdomen, the more resistant the cells become to insulin.

Prediabetes indicates that blood sugar level is higher than normal but has not yet progressed to full blown type 2 diabetes. Without lifestyle change, which often includes weight loss, people are highly likely to progress to type 2 diabetes.   For those who have prediabetes, the long-term damage to the heart and vascular system could already be starting.

Additionally, the cost to the American health care system as a result of diabetes is staggering:  According to the American Diabetes Association, the total estimated cost of diagnosed diabetes in 2012 is $245 billion, including $176 billion in direct medical costs and $69 billion in reduced productivity.

Thus far, we have been unable to abate the exponential rise of diabetes. The often handed, standard advice “eat less and exercise more” has not typically produced sustainable results in weight loss, and low-fat diets have certainly done little to arrest the diabetes epidemic.  Low-carbohydrate diets have been shown to be effective in the treatment of diabetes and metabolic syndromes without significant side effects- the benefits of carbohydrate restriction in treating type 2 diabetes are well documented.  Carbohydrate control can reduce elevated blood glucose levels, and in some cases, can even lead to reductions in medications.

A rigorous study led by Richard D Feinman of the Department of Cell Biology, State University of New York Downstate Medical Center, “Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base” points to a wealth of evidence that supports the use of low-carbohydrate diets as an effective treatment of type 2 diabetes.

Key indicators in the research make the case for a low carbohydrate regimen as an effective tool for diabetes control and prevention:

  • Dietary carbohydrate restriction has the greatest effect on decreasing blood glucose levels. Research shows that carbohydrate is the main dietary determinant of blood glucose and that restricting carbohydrates shows the greatest reduction in blood glucose levels.
  • During the epidemics of obesity and type 2 diabetes, caloric increases have been due almost entirely to increased carbohydrates. Also, particularly during the “low-fat” craze of the 1980’s, food manufacturers liberally dumped tons sugar in low fat snacks to compensate for flavor lost with the removal of fat.  Excess calories consumed in sugar- laden sodas and juices have also significantly increased over the past few decades.
  • Adherence to low-carbohydrate diets in people with type 2 diabetes is at least as good as adherence to any other dietary interventions and is frequently significantly bette This is at least partially because ketosis is an excellent appetite suppressant, and people typically experience greater satiety and far less hunger on low carbohydrate diets versus low fat diets.
  • The best predictor of microvascular and, to a lesser extent, macrovascular complications in patients with type 2 diabetes, is glycemic control. Patients with both type 1 and type 2 diabetes are at increased risk for cardiovascular disease. Low carbohydrate regimens have been shown to reduce risk for heart disease in these populations.
  • Patients with type 2 diabetes on carbohydrate-restricted diets reduce and frequently eliminate medication. By adhering to a low carbohydrate, ketogenic diet, people with diabetes can lose weight and as a result of the weight loss, often stop or scale back medications, including insulin. According to the study, “Dietary carbohydrate restriction, because of its increased effectiveness in glycemic control, frequently leads to reduction and often complete elimination of medication in type 2 diabetes.”

So how do we stem the tide of type 2 diabetes?  For starters, carbohydrate restriction is the most effective intervention for reducing all of the features of metabolic syndrome, including excess belly fat. Physicians need resources such as organized, structured weight management protocols that incorporate coaching, education and one-on-one support for their patients who are at high risk for type 2 diabetes.

By addressing obesity with a low carbohydrate, ketogenic eating plan along with ongoing oversight, physicians can go beyond treating symptoms and help patients achieve metabolic transformation and reach a healthy weight – enabling them to potentially avoid diabetes and live longer, healthier lives.

To join the ranks of healthcare providers fighting obesity, tweet @DrsFightObesity or use #DoctorsFightingObesity to keep the conversation going.

Timothy N. Logemann, MD, FACC, ABOM is a board-certified internist and cardiologist at Wausau, Wisconsin-based Aspirus Heart and Vascular, which offers a structured weight management protocol, the Ideal Protein Protocol. He is certified by the American Board of Obesity Medicine and is a member of the Ideal Protein Cardiology Advisory Board.