Low Carb Diabetes Diet

The low carb diabetes diet using whole-foods is the most powerful of the lifestyle changes to naturally prevent or treat diabetes and achieve excellent blood sugar control. The combination of near-normal blood sugars, normalized insulin sensitivity and lower insulin levels can prevent or reverse many diabetic complications and minimize hypoglycemia (low blood sugars). In addition to the low carb diabetes diet, additional lifestyle changes can help improve your diabetes and prevent or treat many associated metabolic conditions. You can explore them in the Navigation Bar above.

Conditions Benefited By A Low Carb Diet

All of the medical conditions listed below have one thing in common: DIETARY CARBOHYDRATE INTOLERANCE. These conditions are also characterized by insulin and often leptin resistance with varying degrees of hyperinsulinemia (elevated blood levels of insulin).

Here is a list of conditions that can be prevented and treated by following a well-formulated, whole-food, low carb diabetes diet. Some persons with these conditions may need the additional benefits of a very low carbohydrate, ketogenic, diet. See here.

  1. Insulin Resistance
  2. Glucose Intolerance or Prediabetes
  3. Type 2 Diabetes
  4. Type 3 Diabetes (Alzheimer's Disease)
  5. Metabolic Syndrome
  6. Abnormal Cholesterol or Triglycerides
  7. High Blood Pressure or Hypertension
  8. Non-Alcoholic Fatty Liver Disease
  9. Obesity, Overweight, Abdominal Obesity (Visceral Obesity)

Why Does A High Carb/Sugar Diet Cause Diabetes?

The food industry started making processed foods after WWII because the factories that were used to make ready-to-eat meals for soldiers needed a new market. That would be us! Yes, the food industry decided that we all would be good customers for convenient, ready-to-eat food. The ingredients were and still are very cheap because the U.S. government subsidizes wheat, corn, rice, sugar cane, sugar beets, and soybeans that are used to produce the ingredients of processed foods including snack or junk foods. In fact, "snacking" was a marketing tool invented to increase the sale of these processed junk foods. Prior to the 1960s, snacking was not something people did. Americans typically had bacon and eggs for breakfast, and meat, vegetable, and a starch (e.g. rice or potato) or fruit for lunch and dinner. Breakfast cereals, toast, and orange juice for breakfast are all recent inventions that contain highly refined carbohydrates and sugars which are rapidly converted to glucose and fructose after digestion. As explained above, your poor beta-cells have to pump out lots of insulin to deal with this emergency. These surges of insulin over the years leads to insulin resistance and often to obesity. The engorged fat cells secrete leptin to tell the brain that you are full don't need to eat. However, leptin resistance can develop causing your brain to send inappropriate hunger signals despite the excess body fat. You can also develop an addiction to sugar from the frequent stimulation of dopamine in the reward center of the brain. You are probably not aware of this addiction, but if you think about what your favorite foods are you will likely list several foods that contain refined carbohydrates and sugar. Also, think about the foods that you have difficulty controlling the quantity that you eat. Can you eat just one Lay's Potato Chip? This quality of processed foods is not by accident. The food industry employs food chemists who use this knowledge of human physiology to design snack foods to be addictive by adjusting the sugar, salt, and fat content to reach the "bliss point" to maximize your consumption of their products. No wonder we have an obesity epidemic in Westernized countries! In most persons, this added body fat is characterized by an increased waist circumference or a "beer belly" even if beer is not the culprit. This is due to the accumulation of visceral fat which is inside and around your abdominal organs, especially the liver. When fat is deposited in the liver from eating refined carbohydrates and sugar, it is called non-alcoholic fatty liver disease (NAFLD). This abdominal and organ fat is different than the subcutaneous fat located under the skin. This visceral fat secretes hormones, called adipokines, which leads to both insulin resistance and inflammation. The insulin resistance leads to increased secretion of insulin by the beta-cells in the pancreas, called hyperinsulinemia (high insulin in the blood). It is this combination of insulin resistance, hyperinsulinemia, and inflammation that leads to numerous chronic diseases including diabetes, kidney, heart and vascular disease and most of the medical conditions discussed on this website.

Insulin Resistance

In those with insulin resistance, the body resists the action of insulin to dispose of glucose properly. Although all of the mechanisms and sequence of events leading to insulin resistance are not exactly known, many are known in both animal and human studies. The combination of a diet high in refined carbohydrates and sugar from processed foods usually combined with excessive total energy intake in susceptible persons leads to insulin resistance. There is good evidence in animals and humans that isocaloric diets high in sugar also cause insulin resistance. This means excess total energy intake is not a necessary requirement to develop insulin resistance. Susceptible individuals means that there is a genetic component that allows insulin resistance to be expressed when exposed to significant quantities of refined dietary carbohydrates and sugars. It is apparent that the majority of persons have this genetic susceptibility. These persons will often have relatives with a history of type 2 diabetes, heart disease, or other metabolic diseases. But this does explain why you do see some persons who consume a Western Diet who do not develop these metabolic abnormalities. There is also a subset of individuals who are not overweight, but are insulin resistant eventually do develop type 2 diabetes. This is called thin on the outside, fat on the inside (TOFI). Yet another subset of individuals can are obese, but are not insulin resistant. This is called metabolically healthy obese (MHO). The problem with this term is it lacks a uniform definition. That is, there is no agreement on the metabolic criteria required to use the term: MHO. However in the majority of persons with obesity, insulin resistance is part of the mechanism that lead to obesity and because obesity itself contributes to insulin resistance, this vicious cycle needs to be corrected by addressing the insulin resistance directly. This is why a low carb diabetes diet is effective for weight loss. More on this here.

How A Western Diet Causes Insulin Resistance and Obesity

When dietary starch is consumed, upon digestion it is converted to glucose. Examples of refined starches include bread, pasta, corn products (e.g. Doritos, tacos), and potato products (e.g. potato chips, french fries). Examples of unprocessed starches include whole potato, rice, beans, and legumes. When sugar is consumed, upon digestion it is converted to glucose and fructose in equal amounts. Examples of refined sugars include cane or beet sugar and high-fructose corn syrup (HFCS). HFCS is a mixture of fructose and glucose in any proportion desired. Soda is usually a 60/40% mixture of fructose/glucose. Fructose tastes sweeter than glucose. Fruit and honey also contain sugar and are often refined as well: jelly, jam, dried fruit.

Once absorbed from the intestine, the glucose enters the blood and stimulates insulin secretion by the beta-cells of the pancreas which is necessary to shuttle the glucose to many (but not all) organs and tissues. The organs that take up most of the glucose are the liver, muscles, and fat. Once in these organs, glucose can be used immediately for energy or safely stored as glycogen for use between meals.

This process becomes abnormal when excessive amounts of refined starches and sugars are consumed usually, but not always, in the setting of excess total energy consumption via numerous mechanisms which I will highlight. The rapidly absorbed glucose after a meal stimulates insulin secretion excessively. Over many years of excess insulin secretion, insulin resistance develops which leads to further increased insulin secretion by the beta-cells. A viscous cycle forms where insulin resistance worsens hyperinsulinemia and visa versa. After many years of this viscous cycle, the pancreatic beta-cells lose their ability to compensate for the insulin resistance, and a relative insulin deficiency results. Now the glucose in the blood has no where to go because the muscles, liver, and fat cells are insulin resistant and the beta-cells can't produce enough insulin, so the blood glucose levels increase. This is call prediabetes or type 2 diabetes depending on the severity of the blood glucose elevation. Fructose also leads to insulin resistance in muscle, liver, and fat, but it does so without directly stimulating insulin secretion by the pancreatic beta-cells.

Glucose, Fructose, and Alcohol Metabolism

Once I explain how glucose and fructose (and alcohol) are metabolized usually in the setting of excess consumption, it will be clear how limiting these three carbohydrates in your diet will be beneficial. 

First, essentially every cell in the body can use glucose and when not consumed excessively, glucose is not toxic. This cannot be said about fructose and alcohol. When reading this you may also substitute the word "alcohol" for "fructose" and visa versa because they are both metabolized by the liver with a similar set of enzymes and result in the same damage when consumed in excess. Also, only the liver can metabolize fructose and alcohol in contrast to glucose. Here excess means beyond the liver's ability to safety detoxify the compound.

Without delving into the biochemical details too much, when excess amounts of fructose is consumed, the liver converts it to glucose, glycogen, and fatty acids (the later is called de novo lipogenesis) at the expense of ATP (adenosine triphosphate: the universal energy currency of cells) where as, alcohol is converted to aldehyde and fatty acids. The adenosine after being stripped of its phosphate motieties is converted to uric acid. The uric acid produced is felt to be part of the mechanism contributing to hypertension (high blood pressure) by blocking the synthesis of nitric oxide, a vasodilator (a substance that dilates an artery or vein resulting in lower pressure in the vessel) as well as leading to gouty arthritis.

The fatty acids  produced from fructose and alcohol are converted to triglycerides and packaged into VLDL particles (very low density lipoprotein) for export into the blood. This VLDL can eventually result in dyslipidemia (formation of abnormal cholesterol particles including oxidized LDL, glycated LDL, small dense LDL) which combined with inflammation leads to heart disease. The increase in triglycerides also leads to fatty infiltration and insulin resistance of the muscles, liver, and fat cells. Some of the triglycerides produced by de novo lipogenesis remain in the liver cells resulting in fatty liver disease. When due to fructose, it is called non-alcoholic fatty liver disease (NAFLD). When due to alcohol, it is called alcoholic fatty liver disease. This fatty liver disease, inflammation and reactive oxygen species (ROS) produced by either fructose or alcohol leads to steatohepatitis, and eventually cirrhosis and liver failure. Currently, the number of cases of NAFLD that leads to liver failure and liver transplantation exceeds the number of cases of alcoholic fatty liver disease. You can see that both fructose and alcohol have numerous serious consequences when consumed in any significant quantity. Neither fructose nor alcohol occur to any significant degree in an edible plant or animal. Thus, we have created our own source of numerous serious diseases which threaten to bankrupt our healthcare system! We do have a choice. We can change what we eat.

Essential and Non-Essential Macronutrients

The food we eat is broken down by digestion into three macronutrients: protein, carbohydrate, and fat. Of these three, carbohydrate (glucose) stimulates insulin secretion the most. The amino acids formed by protein digestion also stimulate insulin secretion, but does so by less than half that of carbohydrate (glucose). On  the other hand, dietary fat has little insulin stimulating capability. And recall, although fructose does not stimulate insulin secretion directly, the insulin resistance it causes leads to hyperinsulinemia indirectly. It is also true that excess dietary fat can lead to obesity and insulin resistance without directly stimulating insulin.

Dietary protein is necessary for life because amino acids are needed to make all of our bodies tissues. The same can be said for dietary fat. These macronutrients, protein and fat, are called essential nutrients. However, dietary carbohydrates are non-essential. This means you do not need to eat any carbohydrates to live a full and healthy life. Why? Because your liver and kidneys can make glucose from many other sources including protein and fat. Thus, eating dietary carbohydrate is totally optional. So if you are carbohydrate intolerant, it does not make any sense to eat them, now does it? Composing a diet from whole-foods that are low in dietary carbohydrate and have adequate amounts of protein, fat, vitamins and minerals is easy to do. The whole-food low carb diabetes diet, especially when cooked at home, is also lower in cost than processed or restaurant food, is very nutritious and satisfying, and will prevent and treat diabetes and other metabolic conditions more effectively than any medication. To me, that is a win-win situation!

Whole-Food, Low Carb Diabetes Diet

A nutrient-dense low carb dinner

A well-formulated, whole-food, low carb diabetes diet as the name implies should be composed of whole-foods that you cook at home rather than processed foods. The advantage to cooking your own food is that you have control over the ingredients which is important. It also costs half as much money to cook at home compared to eating processed or restaurant foods. What do you eliminate by not using processed foods? Well, you are able to eliminate many foods that contain refined carbohydrates, sugar, and vegetable oils. These three components of the modern Western diet contribute the most harm to health. These would include products made from grains (wheat, corn, rice), sugar cane, sugar beets, and potatoes primarily.

Which Foods Compose A Low Carb Diabetes Diet? 

A nutrient-dense low carb dinner

A whole-food low carb diet is generally defined as one that

  • is devoid of processed foods.
  • contains less than 100 grams/day of total dietary carbohydrate.
  • contains 1.2 - 2.2 grams protein/kg/day.
  • contains the balance of calories in healthy fats to achieve a lean body composition.
  • healthy fats generally come with animal protein foods e.g. eggs, beef, pork, dark-meat chicken, organ meat (offal).
  • added healthy fats include butter, cream, coconut, palm, and olive oils, but are not appropriate for those with excess body fat (excess body fat contributes to insulin resistance).

These foods are nutrient-dense and naturally low in carbohydrates:

  1. Beef, Lamb, Chicken, Fish, Eggs, and other animal products including organs (liver, heart, kidney, offal).
  2. Non-starchy vegetables - leafy greens like Brussels sprouts, kale, collard greens, cabbage, spinach, yellow squash, zucchini, eggplant, tomatoes (all cooked, raw, or fermented), raw carrots, and many others.
  3. Nuts & Seeds - Pepitas, macadamia, pecan, Brazil, walnuts, cashews, pistachios, almonds, others.
  4. Low Carb Fruits (frequency and quantity limited depending on one's metabolic response) - Avocados, olives, blackberries, raspberries, blueberries, others.

These drinks are naturally free of sugar which is important:

  1. Plain water, filtered water, reverse osmosis water.
  2. Unsweetened Tea or Coffee
  3. Does not include drinks with artificial sweeteners. Here's why.

Which Foods Should You Avoid On A Low Carb Diabetes Diet?

  1. Processed Foods - foods produced in a factory from more than one ingredient. (there are a few exceptions).
  2. Foods in the middle isles of the grocery store (there are a few exceptions). Shop in the produce, meat, dairy sections primarily.
  3. Anything that is naturally high in sugar or starch or has either added to it. About 74% of processed foods have added sugar! See sugarscience.org 
  4. Anything that contains vegetable oils: soybean oil, canola oil, corn oil, cottonseed oil, etc., added to or cooked in.

Drinks to avoid on a low carb diabetes diet.

  1. Any drink that contains calories of any kind: sugar or fat or protein.
  2. Any drink that contains artificial sweeteners. Here's why.

Why Is Low Carb An Advantage?

Now that I have explained the physiologic effects of the Western Diet, you can now appreciate why the low carb diabetes diet is truly effective in addressing insulin resistance, diabetes, and obesity. By eliminating refined carbohydrates and sugars, insulin resistance improves, appetite is suppressed, and one is better able to create a caloric deficit, if needed, to resolve obesity/overweight without needing to count calories. A low carb diet dramatically reduces the usual sharp increase in blood sugar after a meal. This results in a much reduced need for insulin secretion by the beta-cells. Over time, this improves insulin resistance. The reduction in insulin levels also sends a signal to fat cells to release fat as a source of energy rather than continuing to store it. Because the body fat is being used for energy, the reduction in dietary caloric intake does not feel like calorie restriction. In other words, the caloric restriction does not result in hunger in most persons. For some, the quantity of food eaten is often determined by habit as much as by hunger. So small reductions in the quantity of low carb food eaten over time will help resolve overweight/obesity. The reduction in excess body fat improves insulin resistance. Using this approach, prediabetes, type 2 diabetes, metabolic syndrome, and there associated chronic diseases can be dramatically improved or put into remission. I think using the term, remission, is more accurate than calling the low carb diabetes diet, a cure, for diabetes. This is because if you put your diabetes into remission with a low carb diet and then decide to go back to your old Western Diet, I would expect your diabetes to return. Note: Starting a low carb diet for diabetes and its associated metabolic diseases should be done with the supervision of your physician especially if you take any medications. Medications used to treat diabetes, high blood pressure, and some other conditions may need to be adjusted to prevent adverse reactions.

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