high carbohydrate diets for people with diabetes
Does a high carbohydrate diet work for people with diabetes?
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Does a high carbohydrate diet work for people with diabetes? 〰️
Upon diagnosis of diabetes or prediabetes a common recommendation is to cut down on your carbohydrate intake. This has been the most popular opinion for many years, but is it the only way to improve diabetic health outcomes?
It is assumed that because diabetes appears to be a condition of poor blood glucose control, that if we decrease the amount of carbohydrate (glucose or sugar) in the diet then we will have less of a problem. However, I encourage that we look at diabetes as a condition of insulin resistance, which leads to blood glucose excursions out of the optimal zone.
What causes insulin resistance?
Insulin resistance can become more predominant for a number of different reasons, and just the like we can improve insulin sensitivity using different methods.
Insulin resistance is exacerbated by a number of different factors including obesity or increased fat mass, physical inactivity and a high intake of fat rich foods and highly processed sugary foods. This high fat / high saturated fat diet study actually showed no changes in accumulated fat mass in the participants but still led to impairments in insulin sensitivity.
The particularly confusing part about how high fat diets impact insulin sensitivity is how the insulin sensitivity is measured. For example, if the diet is low enough in carbohydrate, then very little insulin should be required to bring glucose into the cells of the body; when testing someone's blood this should theoretically show normal insulin levels and normal glucose levels which would lead us to believe that the insulin sensitivity is normal. However, if we use laboratory testing that is more precise for elucidating insulin sensitivity such as the HOMA-IR or oral glucose tolerance test (OGTT) which is the gold-standard test for insulin resistance , we see that those consuming high fat diets have a worse ability to clear glucose from the bloodstream because of impaired insulin sensitivity.
What does this mean?
If we change our dietary patterns to increase carbohydrate intake and decrease fat intake, then we can see a major improvement in insulin sensitivity. However, simply increasing your carbohydrate intake will not improve your blood glucose if you continue to eat a high fat content as well. People who eat a high fat/low carbohydrate diet can keep stable glucose levels so long as they remain on this dietary pattern long term, but if they flip between high fat and high or even moderate carbohydrate intake, their blood sugar stability and insulin levels will likely become erratic.
Why might a high carbohydrate diet be preferential to someone living with diabetes?
For people living with exogenous insulin dependent diabetes (type 1 diabetes) as you decrease fat intake and increase carbohydrate intake in the diet, we see that the carbohydrate to insulin ratio will vastly improve. For those living with non-insulin dependent diabetes melitus (NIDDM/ type 2 diabetes) we see that there can be major reductions if not complete cessation of anti-diabetic pharmaceutical agents such as metformin or semaglutide.
Furthermore, a high fibre/carbohydrate and low fat diet appears to decrease the risk of ever developing diabetes for those people at risk. This study gives a clear example of what dietary patterns are more likely to cause insulin resistance and which ones will maintain or maximize insulin resistance.
A recent study showed that both a high carbohydrate and a low carbohydrate diet when compared had similar outcomes in terms of HbA1C, fat mass reduction and fasting glucose measures. This study also found improved lipid parameters on the high fat diet, which illustrates the importance of speaking with a healthcare practitioner with knowledge of implementing a high carbohydrate diet for diabetic health (booking link below). By adopting a diet that has high fibre content, and possibly lower glycemic index/load, one should be able to achieve an improved lipid profile.
Adopting a high carbohydrate diet can also mean that we get to eat a much larger volume of food, this is due to the caloric density of foods. I find this to be a particularly good selling point for people living with diabetes who have been constantly having to under-eat to manage their blood sugar.
What types of carbohydrates to focus on:
Not all foods are created equally, and because of this there is some nuance in achieving a healthy diet that will optimize your insulin sensitivity and blood glucose. As previously mentioned, diets high in processed sugary foods such as cakes, candy and soda pop can be detrimental to diabetic health. On the other hand a diet rich in carbohydrate foods such as fruits, starchy and non-starchy vegetables, whole grains, beans and legumes are exceptional for diabetic health as well as general health due to their high fibre, antioxidant and nutrient rich content.
It all comes down to personal preference of dietary patterns for short term improvement of diabetic parameters; for long term diabetic health however I would suggest that a high carbohydrate, high fibre diet that is lower in fat would lead to better health outcomes overall for someone living with diabetes, as it does for their non-diabetic counterparts.
When trying any new diet it is highly recommended to follow the directions of a licensed health care practitioner. If you are interested in working with me please follow the link below to book an initial consultation or a free 15-minute consult to see how I can help you manage your diabetes and general health.
In Health,
Dr. Matas Nakrosius, ND
References:
https://my.clevelandclinic.org/health/diseases/22206-insulin-resistance
von Frankenberg AD, Marina A, Song X, Callahan HS, Kratz M, Utzschneider KM. A high-fat, high-saturated fat diet decreases insulin sensitivity without changing intra-abdominal fat in weight-stable overweight and obese adults. European journal of nutrition. 2017 Feb;56(1):431-43.
Freeman AM, Pennings N. Insulin resistance. InStatPearls [Internet] 2021 Jul 10. StatPearls Publishing.
Numao S, Kawano H, Endo N, Yamada Y, Konishi M, Takahashi M, Sakamoto S. Short-term low carbohydrate/high-fat diet intake increases postprandial plasma glucose and glucagon-like peptide-1 levels during an oral glucose tolerance test in healthy men. European journal of clinical nutrition. 2012 Aug;66(8):926-31.
Lindström J, Peltonen M, Eriksson JG, Louheranta A, Fogelholm M, Uusitupa M, Tuomilehto J. High-fibre, low-fat diet predicts long-term weight loss and decreased type 2 diabetes risk: the Finnish Diabetes Prevention Study. Diabetologia. 2006 May;49(5):912-20.
Tay J, Luscombe-Marsh ND, Thompson CH, Noakes M, Buckley JD, Wittert GA, Yancy Jr WS, Brinkworth GD. Comparison of low-and high-carbohydrate diets for type 2 diabetes management: a randomized trial. The American journal of clinical nutrition. 2015 Oct 1;102(4):780-90.
Jung CH, Choi KM. Impact of high-carbohydrate diet on metabolic parameters in patients with type 2 diabetes. Nutrients. 2017 Mar 24;9(4):322.
Ledikwe JH, Blanck HM, Kettel Khan L, Serdula MK, Seymour JD, Tohill BC, Rolls BJ. Dietary energy density is associated with energy intake and weight status in US adults. The American journal of clinical nutrition. 2006 Jun 1;83(6):1362-8.
Schwingshackl L, Morze J, Hoffmann G. Mediterranean diet and health status: Active ingredients and pharmacological mechanisms. British journal of pharmacology. 2020 Mar;177(6):1241-57.