While the American Diabetes Association notes that many individuals with the disease or its precursor, prediabetes, employ carb counting to control their blood sugar on a regular basis, others have turned to ultra-low-carb diets as a way to manage their symptoms. These diets are highly restrictive and often limit followers to consuming no more than 20 grams (g) of carbs per day, usually with no added sugar, and, depending on the diet, increased protein and fat. Experts say they rarely have patients who ask about following a ketogenic diet or a modified paleo diet long term, but they can be useful for short-term weight loss if done properly. RELATED: 10 Popular Low-Carb Diets, and Their Pros and Cons When Stephanie Lofton was diagnosed with type 2 diabetes in 2015, she knew she needed to make some big changes to her diet. But after cutting her carbohydrates down to just 60 g per meal didn’t help her lose weight or manage her blood sugar, she turned to a more intense diet. Lofton, a medical biller in Marysville, Washington, says she decided to try keto in spring 2017 after seeing how some of her Facebook friends had lost weight on the diet. She was desperate to try something different because she couldn’t get her blood sugar under control even with insulin and after trying several types of diets, she says. “It came to another frustration point that medication really isn’t helping,” Lofton says. “I had tried many other things, like a weight loss program. I tried looking into bariatric surgery, and was very frustrated that all these things — like watching my food intake and my servings, 60 grams (of carbs) per meal — all of that wasn’t really making a difference.” RELATED: Does the Ketogenic Diet Work for Type 2 Diabetes? Trying keto may seem like an extreme solution for some people — the diet requires participants to get 60 to 80 percent of their calories from fat, Keto Connect notes — but Lofton says the high-fat eating style keeps her full and curbs carb cravings. “I’m feeling fuller for longer periods of time,” she says, “and I don’t feel like I’m deprived at all. I don’t miss rice, I don’t miss potatoes — I don’t miss those things.” And most important, she notes: Her blood sugar is at an all-time low. About a year ago, she went to the ER because her blood sugar levels rose to between 600 and 800 mg/dL — indicating she was at risk of a diabetic coma. But now, her postprandial glucose is between 150 and 200 mg/dL. “My sugars have been on a steady decline since March,” she says. Her A1C — a two- to three-month average of blood sugar levels — also went from 10.4 to 8.7, an improvement, though still in the range for type 2 diabetes, according to according to the ADA. While keto has worked for her, Lofton says, it’s not right for everyone. RELATED: 5 Ways to Help Lower Your A1C Diets that severely squeeze out carbs can be effective for weight-loss, but they’re typically not recommended for people with diabetes, says Katherine Zeratsky, RD, with the Mayo Clinic in Rochester, Minnesota. “I think the caution with a low-carbohydrate diet is the idea that it’s very restrictive,” Zeratsky says. “When you start getting into the very low carbohydrates, when you’re talking about 20 grams, which for some people would be a cup of [starchy] vegetables. … If there is someone who is interested in it, it’s very important they understand what a low carbohydrate diet means in a practical sense.” One study, published in the journal Nutrition & Metabolism, found a group of 28 people with type 2 diabetes overall lost about 6 percent of their body weight and lowered their blood glucose levels when they followed a keto diet for 16 weeks. The authors recommended individuals on this diet who have diabetes be under close medical supervision, and noted more research is needed on the diet’s long-term effects because the study was small and short term. RELATED: Risks and Benefits of the Keto Diet Everyone Should Know A review published in December 2015 in the journal Diabetes Therapy suggested ultra-low-carb diets were effective at managing blood sugar, decreasing weight, and managing cardiovascular risk in individuals with type 2 diabetes in the short term, but the benefits were not sustainable over the long term. When compared with higher-carb diets over a period of longer than about 12 weeks, the health results were similar. Learn More About How Lofton Used Keto to Get Her Weight Under Control
Low-Carb Paleo Diet for Diabetes: Pros and Cons
The paleo, or paleolithic, diet has become popular as a way to eat nonprocessed food in a way that’s similar to how early humans might have eaten in a hunter-gatherer society. Paleo diets in general cut out dairy, refined sugar, and grains. Eating low-carb paleo means removing items like rice, pasta, and legumes from your diet completely, but the carbs you eat will be from vegetables like fruit, beets, sweet potatoes, and leafy greens, such as spinach and kale. The diet also cuts out processed food plus foods allowed on other low-carb diets, including milk and cheese, and some people have an easier time sticking with the diet when more carbs are included. A small, randomized crossover study published in the Journal of Diabetes Sciences and Technology found that after three months, people who followed a modified, low-carb paleo diet saw greater reductions in their A1C, their triglycerides, their diastolic blood pressure, and their weight than those who followed a traditional diabetes diet. (The approach also increased their levels of LDL, or “good” cholesterol.) The diabetes diet in the study involved consuming no more than 6 g of salt per day, reducing saturated fat and total fat intake, and upping intake of veggies, fiber, whole grains, fruits, and veggies. Compared with the diabetes diet, the paleo diet involved eating less dairy, beans, potatoes, and cereals, and more veggies, fruit, meat, and eggs. Yet the study authors cautioned that the small sample size of 13 people per group, a lack of a blind trial, and the short study period means more study is needed on the subject. RELATED: Can the Paleo Diet Help People With Type 2 Diabetes?
Atkins Diet for Diabetes: Pros and Cons
The Atkins diet works in several stages, and the first stage is very low carb, with followers eating only 20 g of carbs per day for two weeks. The cardiologist Robert Atkins, MD, created the diet in 1972, when he published his first book, Dr. Atkins’ Diet Revolution, according to the Atkins website. This low-carb diet in general focuses on reducing carbohydrates by eating certain vegetables, proteins, and fruits. Eating fat sources like avocado and coconut oil, as well as full-fat yogurt, butter, and cheese is encouraged. Tina Marcus decided to try the Atkins diet when her doctor became increasingly worried about her blood sugar levels. After following the Atkins diet for two years, she lost 120 pounds (lbs), decreased her A1C from 11, which indicates diabetes, to 5.7 — the lowest threshold for prediabetes — and got her fasting blood sugar levels into the 70s. “I was very dedicated. Really for a year and a half, I did not deviate. I really stuck to the plan,” Marcus says. “You have to have a lot of willpower.” RELATED: How to Count Carbs for Better Blood Sugar Control Marcus notes avoiding sweets and foods like pasta, rice, and processed food wasn’t easy. She had to make a lot of lifestyle changes, as well, like exercising often and avoiding tempting situations. A study published in the journal Nutrition & Metabolism discouraged the Atkins diet for anyone with diabetes because the plan doesn’t limit fat, but noted the approach may be a safe way for people without the disease to lose weight effectively. According to a study published in the Journal of the American Medical Association, Dr. Atkins helped women lose weight better than other low-carb diets, such as the Zone diet, the Ornish diet, and the LEARN diet after 12 months. Learn More About How Tina Marcus Lost Weight on the Atkins Diet
Why Low-Carb Diets Can Be a Good ‘Stepping Stone’ for People With Diabetes
Anna Taylor, RD, CDE, a licensed dietitian at the Cleveland Clinic in Ohio, says very-low-carb diets can hurt people with type 2 diabetes if done incorrectly. She and Keratsky say it’s important that anyone with diabetes who wants to try a low-carb or ultra-low-carb diet meet with a dietitian or physician to create a plan and make sure their eating style won’t react negatively with their current medicines. “There are many, many interpretations of low-carb, ketogenic diets; many times patients simply do an internet search of the word ‘keto’ and find lists of foods to follow,” she says in an email. “This can lead to some pretty poor diet attempts.” Some of the concerns are around micronutrients — supplementation of electrolytes, vitamins, and fiber is often required on low-carb diets, Zeratsky says. And sometimes, these diets can actually lower the blood sugar of a person with diabetes to the point where it’s too low, which is also dangerous. (Low-carb diets are not recommended for those people with type 1 diabetes or anyone on insulin due to that risk, experts note.) RELATED: How Do You Tell the Difference Between Good and Bad Carbs? “A healthy diet should be a sustainable eating plan that provides adequate nutrition to support optimal health,” Taylor says. “For many people with diabetes, a low-carb diet is a temporary tool that can be used to support short-term weight loss and improved blood sugar control. However, I typically don’t recommend sticking with a low-carb diet permanently, as many micronutrient deficiencies can result from an unbalanced eating plan. I like to think of low-carb diets as a possible ‘stepping stone,’ not a ‘forever diet.’” The main concern, they say, is sustainability: Getting all the nutrients your body needs to manage blood sugar and overall health, and then sticking with it for decades can be hard on such a restrictive diet. Lofton says her goal is to use keto to get her fasting blood sugar levels under 100, and then her focus will shift to weight loss, which she feels keto is going to help her accomplish. Now, the high fat content curbs her cravings and helps her stay on track. RELATED: The Ultimate Guide to Following a Low-Carb Diet One of the biggest changes she’s seen, she says, is her attitude. When she used to have a setback — a high blood sugar reading or a 5-lb weight gain — she used to feel defeated. Now, she can put yesterday’s setbacks in the rear view mirror. “I have found a change in my attitude from, ‘Oh gosh, that’s it. I’m done,’” she says, “to ‘Okay, today was not a good day, but I really like my keto food, and I’m encouraged and I’m able.” For more low-carb eating inspiration, check out Diabetes Daily’s article “Go-To Snacks With 15 Carbs or Less”!
