Diabetes is a chronic disease that affects many people around the world.
Currently, more than 400 million people have diabetes globally.
Although diabetes is a complicated disease, maintaining the right blood sugar levels can greatly reduce the risk of complications.
One of the ways to achieve better blood sugar levels is to follow a low-carbohydrate diet.
In this article we provide a detailed description of low-carbohydrate diets to control diabetes.
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What is diabetes and what role does food play?
The body of a person with diabetes cannot effectively process carbohydrates.
Normally, when you eat carbohydrates, they are broken down into small units of glucose, which end up as blood sugar.
When blood sugar levels rise, the pancreas responds by producing the hormone insulin. This hormone allows the sugar in the blood to enter the cells.
In people without diabetes, blood sugar levels remain within a narrow range throughout the day. However, for those with diabetes this system does not work in the same way.
This is a big problem, because having blood sugar levels that are too high and too low can cause serious damage.
There are several types of diabetes, but the two most common are type 1 and type 2 diabetes. Both conditions can occur at any age.
In the case of type 1 diabetes, an autoimmune process destroys the insulin-producing beta cells in the pancreas. People with diabetes use insulin several times a day to make sure that glucose enters the cells and stays at a healthy level in the bloodstream.
In the case of type 2 diabetes, the beta cells produce enough insulin at first, but the body’s cells are resistant to its action, so blood sugar remains high. To compensate, the pancreas produces more insulin, trying to lower blood sugar.
Over time, the beta cells lose their ability to produce enough insulin.
Of the three macronutrients (protein, carbohydrates and fats), carbohydrates have the greatest impact on blood sugar control. This is because the body breaks them down into glucose.
Therefore, people with diabetes may need to use large doses of insulin, medications, or both when they eat a lot of carbohydrates.
Can low-carbohydrate diets help control diabetes?
Many studies support low-carbohydrate diets for the treatment of diabetes.
In fact, before the discovery of insulin in 1921, low-carbohydrate diets were considered a standard treatment for people with diabetes.
What’s more, low-carbohydrate diets seem to work well over the long term, if people stick to them.
In one study, people with type 2 diabetes followed a low-carbohydrate diet for 6 months. Their diabetes remained well controlled more than 3 years later if they stuck to the diet.
Similarly, when people with type 1 diabetes followed a carbohydrate-restricted diet, those who followed the diet saw a significant improvement in blood sugar levels over a 4-year period.
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What is the optimal carbohydrate intake for people with diabetes?
The ideal carbohydrate intake for people with diabetes is a somewhat controversial topic, even among those who support carbohydrate restriction.
Many studies found considerable improvements in blood sugar levels, body weight, and other markers when carbohydrates were restricted to 20 grams per day.
Dr. Richard K. Bernstein, who has type 1 diabetes, has consumed 30 grams of carbohydrates per day and has documented excellent blood sugar management in his patients following the same regimen.
However, other research shows that more moderate carbohydrate restriction, of about 70 to 90 grams of total carbohydrate, or 20 percent of calories from carbohydrates, is also effective.
The optimal amount of carbohydrate may also vary from person to person, as everyone has a unique response to carbohydrates.
According to the American Diabetes Society (ADA), there is no single diet that works for all diabetics. Personalized meal plans, which take into account your dietary preferences and metabolic goals, are best.
The ADA also recommends that people work with their health care team to determine the carbohydrate intake that is right for them.
To calculate the ideal amount of carbohydrate, you may want to measure your blood glucose with a meter before a meal and again 1 to 2 hours after eating.
Once your blood sugar levels remain below 140 mg/dL (8 mmol/L), the point at which nerve damage can occur, you can consume 6, 10 or 25 grams of carbohydrate per meal on a low-carbohydrate diet.
It all depends on your personal tolerance. Remember that the general rule of thumb is that the fewer carbohydrates you eat, the less the sugar spike.
And, rather than eliminating all carbohydrates, a healthy low-carb diet should include nutrient-rich, high-fiber carbohydrate sources, such as vegetables, berries, nuts and seeds.
Which carbohydrates raise blood sugar levels?
In plant foods, carbohydrates comprise a combination of starch, sugar and fiber. Only the starch and sugar components raise blood sugar.
Fiber found naturally in foods, whether soluble or insoluble, does not break down into glucose in the body, and does not raise blood sugar levels.
In fact, you can subtract the fiber and sugar alcohols from the total carbohydrate content, leaving the digestible or “net” carbohydrate content. For example, 1 cup of cauliflower contains 5 grams of carbohydrates, 3 of which are fiber. Therefore, its net carbohydrate content is 2 grams.
Prebiotic fiber, such as inulin, has even been shown to improve fasting blood sugar and other health markers in people with type 2 diabetes.
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Sugar alcohols, such as maltitol, xylitol, erythritol and sorbitol, are often used to sweeten sugar-free candies and other “diet” products.
Some of them, especially maltitol, can raise blood sugar levels in people with diabetes.
For this reason, use the net carbohydrate tool with caution, as the count on a product’s label may not be accurate if all the carbohydrates contributed by maltitol have been subtracted.
Also, the U.S. Food and Drug Administration (FDA) or the ADA does not use the net carbohydrate tool.
Which foods you can eat and which you should avoid
It is best to focus on eating low-carb, whole foods with plenty of nutrients.
It is also important to pay attention to your body’s hunger and fullness cues, regardless of what you are eating.
Foods you can eat
You can eat the following low-carb foods until you are full. Also be sure to get enough protein at each meal:
meat, poultry and seafood.
- eggs
- cheese
- non-starchy vegetables (most vegetables, except those listed below)
- avocados
- olives
- olive oil, coconut oil, butter, cream, sour cream and cream cheese
- Foods you can eat in moderation
Foods you can eat in moderation
You can eat the following foods in smaller amounts at meals, depending on your carbohydrate tolerance:
- Berries: 1 cup or less
- Unsweetened Greek yogurt: 1 cup or less
- Cottage cheese: 1/2 cup or less
- Nuts and peanuts: 1 to 2 ounces, or 30 to 60 grams
- Flaxseed or chia seeds: 2 tablespoons
- Dark chocolate (at least 85% cocoa): 30 grams or less
- Winter squash (white walnut, acorn, butternut, pumpkin, spaghetti and Hubbard squash): 1 cup or less
- Liquor: 1.5 ounces, or 50 grams
- Red or dry white wine: 4 ounces, or 120 grams
Legumes, such as peas, lentils and beans, are healthy sources of protein, although they also have carbohydrates. Be sure to include them in your daily carb count.
Drastically reducing carbohydrates generally lowers insulin levels, which causes the kidneys to release sodium and water.
Try eating a cup of broth, a few olives or some other salty low-carb foods to make up for the loss of sodium. Don’t be afraid to add a little extra salt to your meals.
However, if you have congestive heart failure, kidney disease or high blood pressure, talk to your doctor before increasing the amount of sodium in your diet.
Foods to avoid
These foods are high in carbohydrates, and can significantly increase blood sugar levels in people with diabetes:
- bread, pasta, cereals, corn and other grains
- starchy vegetables, such as potatoes, sweet potatoes, yams, and taro
- milk
- fruits other than berries
- juice, soda, punch, sweetened tea, etc.
- beer
- desserts, baked goods, candy, ice cream, etc.
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Sample one-day low-carbohydrate diet for people with diabetes
The following is an example of a menu with 15 grams or less of digestible carbohydrate per meal. If your personal carbohydrate tolerance is higher or lower, you can adjust the portion sizes.
Breakfast: Eggs and Spinach
- 3 eggs cooked in butter (1.5 grams of carbohydrate)
- 1 cup of sautéed spinach (3 grams of carbs)
You can accompany your eggs and spinach with:
- 1 cup blackberries (6 grams carbs).
- 1 cup of coffee with cream and optional sugar-free sweetener
Total digestible carbohydrates: 10.5 grams
Lunch: Cobb Salad
- 3 ounces (90 grams) cooked chicken
- 1 ounce (30 grams) Roquefort cheese (1/2 gram carbohydrate)
- 1 slice of bacon
- 1/2 medium avocado (2 grams carbohydrate)
- 1 cup chopped tomatoes (5 grams carbohydrates)
- 1 cup shredded lettuce (1 gram of carbohydrates)
- olive oil and vinegar
You can equip your salad with:
- 20 grams (2 small squares) 85% dark chocolate (4 grams carbs).
- 1 glass of iced tea with optional unsweetened sweetener
Total digestible carbohydrates: 12.5 grams
Dinner: Salmon with vegetables
- 4 ounces grilled salmon
- 1/2 cup sautéed zucchini (3 grams carbs)
- 1 cup sautéed mushrooms (2 grams carbohydrates)
To complement your meal and dessert:
- 4 ounces (120 g) red wine (3 grams carbohydrate).
- 1/2 cup sliced strawberries with whipped cream
- 1 ounce chopped walnuts (6 grams carbs)
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Total digestible carbohydrate: 14 grams
Total digestible carbohydrate for the day: 37 grams
For more ideas, the following is a list of seven quick low-carb meals, and a list of 101 healthy low-carb recipes.
Talk to your doctor before changing your diet
When carbohydrates are restricted, there is often a dramatic drop in blood sugar.
For this reason, your doctor will often reduce your dose of insulin and other medications. In some cases, they may eliminate your medications altogether.
One study reported that 17 of 21 study participants with type 2 diabetes were able to stop or reduce their diabetes medications when they limited carbohydrates to 20 grams per day.
In another study, participants with type 1 diabetes consumed less than 90 grams of carbohydrate per day. Their blood glucose improved, and their likelihood of having low blood sugar decreased because insulin doses were significantly reduced.
If insulin and other medications are not adjusted to a low-carbohydrate diet, there is a high risk of dangerously low blood glucose levels, also known as hypoglycemia.
Therefore, it is important for people taking insulin or other diabetes medications to talk to their doctor before starting a low-carbohydrate diet.
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Other ways to lower blood sugar levels
In addition to following a low-carbohydrate diet, physical activity can also help control diabetes by improving insulin sensitivity.
A combination of resistance training and aerobic exercise is especially beneficial.
Quality sleep is also crucial. Research has consistently shown that people who sleep poorly have an increased risk of developing diabetes.
A recent observational study found that people with diabetes who slept 6.5 to 7.5 hours per night had better blood glucose management compared to those who slept less or more.
Another key to controlling blood sugar? Manage your stress, too. Yoga, qigong and meditation have been shown to lower blood sugar and insulin levels.