A low carb diet even without bodyweight reduction may help manage diabetes

Summary: Diabetes is the most prevalent metabolic disorder. For more than a century, guidelines have focused on its management through the intensification of therapy. However, intensive drug therapy does not necessarily lead to the enhancement of quality of life. More importantly, no drug therapy leads to disease remission. However, recent findings show that a low-carb diet along with bodyweight reduction may help considerably. Thus, new studies suggest that even modest weight loss of 5% or more may help prevent diabetes. However, the latest research indicates that a low-carb diet may help without any significant weight loss.

 Diabetes is an epidemic in every nation. In the US, 10.5% of the population is living with diabetes. However, in recent years, the focus has shifted to the early diagnosis of glucose intolerance. It appears that 34.5% of the US population is living with borderline diabetes, a condition called prediabetes1,2.

There have been other changes in recent years. For decades, researchers did not believe that reversal of diabetes or its prolonged remission was possible. However, new studies show that diabetes prevention and reversal or prolonged remission is possible through lifestyle interventions.

Thus, in recent years the American Diabetes Association (ADA) has released nutritional guidelines. These guidelines are based on multiple studies showing a considerable decline in glucose intolerance by reducing body weight. Therefore, ADA guidelines state that the focus should be reducing body weight by 5% or more. Further, a significant benefit is seen by lowering and maintaining body weight by more than 15%3.

New reports show that low carb diet may help even without considerable bodyweight reduction

The only way to reduce body weight is indeed through a considerable reduction in total calorie intake. Thus, it naturally means reducing the total intake of carbs. However, many individuals may not want a significant reduction in their body weight for various reasons. It appears that a low-carb diet may help in such cases.

Low carb diets like the keto diet have been among the most popular diet forms in the US for the last few years. It involves significantly cutting down the intake of carbs. Thus, a keto diet contains less than 10% (or even less than 5%) carbs of total calorie intake.

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The Keto diet focuses on increasing the consumption of fats. Fats do cause significant hyperglycemia. But more importantly, high fat and low carb diet force the body to use alternate energy pathways. It starts using ketone bodies for energy needs. It also results in increased mobilization of fats in the body.

In the new, small pilot study, researchers decided to combine the keto diet with intermittent fasting. The target of the study was significantly reducing carbs intake, with not much focus on bodyweight reduction.

In this small study, they enrolled three patients living with severe diabetes taking insulin and metformin. They belonged to three different weight categories, with one having close to normal BMI, the other obese, and the third participant with severe obesity3.

The study found that 4 months of keto diet combined with intermittent fasting resulted in 5.2 points decline in A1C without insulin, metformin, or other medications. There were also favorable changes in the lipid profile. They also, on average, lost about 8.7 pounds. 

Thus, this study demonstrated that cutting down on carbs intake may help even without significant weight loss. These findings are contrary to some of the recommendations stating that weight loss is the key to diabetes remission.

However, one should interpret the results of this study cautiously. All three patients were on a severely restrictive diet that eliminated almost all of the carbs. However, there was still a small but significant weight loss in these patients. Moreover, the study was comparatively in a small sample size and shorter period. 

Nevertheless, this study does highlight the importance of restricting carbs intake in managing diabetes. It shows that eliminating carbs from the diet without focusing much on total body weight loss may also be considerably helpful.

References

1. National Diabetes Statistics Report, 2020 | CDC. Published September 28, 2020. Accessed November 14, 2021. https://www.cdc.gov/diabetes/data/statistics-report/index.html
2. Prevalence of Prediabetes Among Adults | Diabetes | CDC. Published August 7, 2020. Accessed November 14, 2021. https://www.cdc.gov/diabetes/data/statistics-report/prevalence-of-prediabetes.html
3. Gavidia K, Kalayjian T. Treating Diabetes Utilizing a Low Carbohydrate Ketogenic Diet and Intermittent Fasting Without Significant Weight Loss: A Case Report. Frontiers in Nutrition. 2021;8:380. doi:10.3389/fnut.2021.687081