Low-carb for diabetes: Exploring the latest evidence

Are low-carb diets beneficial for diabetes – and can they help reverse type 2 diabetes? Nutritionist Kathleen Alleaume explores the latest evidence.

Type 2 diabetes, the most common form of diabetes, is one of the fastest growing preventable health conditions in Australia and New Zealand. It happens when there is a problem with the way the body regulates and uses sugar as a fuel. This is called insulin resistance. The condition usually develops in adults over the age of 45 but it is increasingly being diagnosed in younger people – including children, teenagers and young adults.

What is pre-diabetes?

Glucose intolerance, where people experience higher than normal blood sugar levels, starts before type 2 diabetes develops. In this phase, commonly termed pre-diabetes, people are often unaware of being pre-diabetic, but without intervention, one in three of these people will progress to type 2 diabetes within a span of five to 10 years.

The good news is that the risk can be reduced. By making some lifestyle changes including eating a balanced diet, doing regular physical activity and reaching and sustaining a healthy weight, people can help stop diabetes from progressing.

Diabetes remission

Recent research shows, in some cases, the development of diabetes can be stopped or even reversed. This achievement is commonly referred to as remission. Similar to preventing pre-diabetes developing into type 2, achieving remission involves making significant changes to your lifestyle, including improving diet, exercising regularly, and reaching a healthy weight, often around 10-15 per cent lower than your starting point.

Achieving remission means returning blood sugar levels to a normal range of HbA1c – or less than 6.5 per cent – without on-going medication.

It’s important to keep in mind that remission doesn’t guarantee that type 2 diabetes won’t come back if you regain weight or as you age.

Going back to old habits could result in blood sugar levels creeping back up, making medication necessary.

“Achieving remission requires dedication, a well-structured plan, and professional guidance and support, but its potential to transform lives makes the journey worthwhile,” says Dr Alan Barclay, PhD, Accredited Practicing Dietitian.

“Attaining this goal represents a major milestone in diabetes management and brings renewed hope to those dealing with the condition,” Dr Barclay explains.

“It reinforces the notion that type 2 diabetes is not an irreversible fate, but rather a condition that can be managed and even reversed with the right tools, support, and determination,” he says.

New thinking on low-carb diets

Traditionally, diabetes management has centred on medication, insulin injections, physical activity and dietary restrictions. But as knowledge about nutrition and metabolism evolves, experts are exploring the use of low-carb diets.

The body’s preferred energy source is carbohydrates. Limiting carbs and focussing on eating more proteins and healthy fats, in theory, can make the body switch from using glucose for energy to using stored body fat. This switch might help improve how sensitive the body is to insulin and decrease the ups and downs in blood sugar levels.

The real problem is, there’s no universally agreed definition of what a low-carb diet is. It’s often defined as having anywhere from 50g–130g carbs a day – that’s roughly less than 26 per cent of energy from a 8400kJ diet.

Several studies have delved into the impact of low-carb diets on diabetes remission, with promising results. In the DiRECT trial conducted in the UK, participants who followed a low-calorie, low-carb diet achieved significant weight loss and a high rate of diabetes remission. Similarly, research published in the journal Diabetes Care suggested that low-carb diets could help control blood sugar levels and reduce the need for diabetes medications.

A statement from Diabetes Australia recognises that low-carb eating can be an effective way of reducing blood sugar levels and losing weight among people with type 2 diabetes over a period of six months. However, since there is never a one-size-fits-all approach, this pattern of eating may not suit everyone, especially in the long term.

What are the effects of avoiding carbohydrates?

While we tend to think of carbs as foods – like white bread, pastries and cakes – which provide minimal nutritional benefits, there are many other carbohydrate options that provide an important array of essential nutrients and dietary fibre.

Whole grains, vegetables, fruit and legumes are all rich sources of various types of dietary fibre that promote intestinal health and support beneficial gut bacteria. Additionally, these foods supply a broad spectrum of nutrients vital to our overall well-being. When you remove these carbohydrate-rich foods from your daily diet, it can become more challenging to get the fibre and nutrients your body needs.

Most people enjoy foods that contain carbohydrates – they taste good! And enjoyment and satisfaction are also important parts of our eating experiences.

While our individual needs for carbohydrates will vary, claims that carbohydrates are unnecessary miss the bigger picture. It’s choosing the right types of carbs that matters, and this can substantially impact blood sugar levels, weight management, mood and energy levels.

As always, before making any radical changes, check with your GP or an accredited practising dietitian for the best eating pattern to suit your lifestyle and health needs.

Alternative sweeteners

When managing diabetes, people often look for alternatives to sugar to keep enjoying sweet flavours without causing quick rises in blood sugar. This has made sugar substitutes like aspartame, sucralose, and stevia very popular. While sugar substitutes are considered safe, it’s important to choose wisely.

Just because a recipe uses a sweetener instead of sugar, or a product says sugar free, that doesn’t automatically mean it’s healthy or won’t affect your blood sugar. Always check the nutrition details to make sure something is right for you or talk to a dietitian about it. Better still, retraining your tastebuds to prefer less sweetness by keeping sweet foods (sugar or alternatively sweetened) as an occasional treat will help you foster lifelong healthy habits.

Wonder drug?

Ozempic (semaglutide) is a new medication making a big impact on diabetes care and becoming known for helping with weight loss. People are talking about it on social media and there are rumours about celebrities using it for weight loss. It works by copying a hormone called GLP-1, which helps make insulin and can also reduce appetite. Requiring a monthly injection, it is generally prescribed to adults with type 2 diabetes when diet and exercise alone do not provide adequate blood-sugar control. It’s important to note that Ozempic is not suitable for everyone. Your GP will assess your medical history, current health status, and any other medications you might be taking before determining whether Ozempic is appropriate for you.

Long game

Managing diabetes through diet is not only about short-term blood-sugar control, but also reducing the risk of diabetes-related complications over time.