Diabetes Canada has traditionally advised a carbohydrate intake of 45-60% of total daily energy intake. This has been met with years of frustration on the part of both patients and health care providers, as many patients with diabetes find that a lower carbohydrate intake is better for both their blood sugar control and management of weight.
Diabetes Canada has now released a Position Statement on Low Carbohydrate Diets for Adults with Diabetes, which relaxes carbohydrate intake recommendations based on emerging evidence, a shift in international consensus regarding lower carb diets, and to provide important clarification for people with diabetes as well as their health care providers.
In the article, the authors review the updated evidence regarding lower or low carbohydrate diets in people with type 2 diabetes, with potential benefits being weight loss, improvement in blood sugars, and less need for diabetes medication at least in the short term (there is little evidence beyond 1 year). Also, it is not clear whether benefits of eating less carbs is related to eating less carbs in particular, or simply due to eating less calories. For people with type 1 diabetes, there is very little data to guide us, but some small studies have reported improvement in blood sugars, lower insulin needs, less blood sugar variability, and weight loss on a carbohydrate restricted diet.
KEY safety concerns:
- Insulin, sulfonylureas (eg glicliazide/Diamicron), and meglitinide (eg repaglinide/Gluconorm) medications that lower blood sugars may need to be reduced in advance of reducing carb intake, to avoid low blood sugars.
- People using SGLT2 inhibitors are at a higher risk of diabetic ketoacidosis (DKA) if they follow a very low carb diet and it has therefore been recommended NOT to eat a low carb diet.
- People with type 1 diabetes are at a higher risk of diabetic ketoacidosis if they follow a very low carb diet and it has therefore been recommended NOT to eat a low carb diet.
- People with diabetes eating very low carb diets may not be able to feel low blood sugars as well (due to changes in fuel utilization by the brain).
- The response to glucagon (nasal or injectable) as an emergency treatment for severe hypoglycemia may be reduced in people on a very low carb diet (due to less glycogen stores in the liver).
The article recommends that healthy low or very low carb diets can be considered as one healthy eating pattern for people with type 1 or type 2 diabetes for weight loss, improved blood sugar control and/or to reduce need for diabetes medication, but that it is important to consult with your health care providers to define goals and reduce the likelihood of adverse effects.
BOTTOM LINE: People with diabetes, as well as their dietitians and other health care providers, can breathe a sigh of relief in no longer feeling that they ‘have to’ eat at least 45% of their calories as carbohydrate each day. It is important to talk to your health care providers BEFORE making a change in diet in order to ensure that any change is done safely. As always, individual preferences for food types as well as treatment goals should be taken into consideration in construcing the optimal dietary plan.
The full patient summary from Diabetes Canada is available here.
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