A leading cause of death worldwide, since 1980, the number of people suffering diabetes globally has quadrupled (1). In the past decade, the number of prescriptions dispensed in Australia for diabetes medication has grown ten times faster than the population (2). Every five minutes, an Australian develops diabetes. Despite this, it is estimated that only 70% of people are diagnosed (3), concerning because over time persistent high blood glucose levels damage the body's organs and cause serious and potentially life-threatening complications (4).
In simple terms, diabetes is carbohydrate intolerance.
When we eat, glucose enters the bloodstream. High blood glucose levels are extremely harmful to the body so our bodies respond by shuttling this glucose into our cells with the hormone insulin (which feels something like that ‘afternoon slump’ or ‘sugar crash’). The more glucose in our blood, the more insulin is required to move the glucose into the cells. Over time, our cells become resistant to the effects of insulin, and so the body must produce more and more insulin to keep blood glucose levels (also called blood sugar levels) stable. Eventually, the body cannot produce enough insulin to overcome the cell’s insulin resistance and blood sugar levels rise. The body’s pancreatic ‘beta’ cells – which produce our insulin – become exhausted. So at the same time as not responding to insulin, our body’s ability to produce insulin diminishes. Therefore blood sugar levels are unable to be controlled, and result in the high blood sugar levels indcating type 2 diabetes.
Dietary carbohydrates perpetuate the cycle
Carbohydrates are the main dietary source of glucose, and increase blood glucose levels more than protein or fat. High carbohydrate diets therefore perpetuate this cycle of high blood glucose, high blood insulin levels, and insulin resistance. In this way, diabetes can be seen as a condition of carbohydrate intolerance, with carbohydrate consumption likened to ‘glucose toxicity’ and perpetuating insulin resistance (5).
Traditional diabetes care models include a low-fat, high-carbohydrate diet, exercise, and medication. Dosages of medication tend to increase over time, because the high-carbohydrate diet continues to put excessive glucose into the bloodstream, promoting further insulin resistance or, if the pancreas becomes exhausted, an inability for the body to produce insulin at all. This model of care is shifting however. In 2018 CSIRO released its recommendation for a low carb diet as an evidence based approach for combating metabolic syndrome and reversing type 2 diabetes (6).
How low carbohydrate works
A diet low in carbohydrates on the other hand means lower blood glucose to start with, requiring less insulin response and over time, insulin resistance gives way to insulin sensitivity. That is, the very process of diabetes can be reversed. Low carbohydrate diets have been shown to reduce HbA1c levels – which is a marker of your average blood glucose level over the previous three months. It’s worth reducing your HbA1c - a HbA1c concentration of more than 7% increases your risk of heart attack by more than 7-fold – independent of weight, cigarette smoking, and blood pressure (7).
With a low carbohydrate diet, it is possible for your type 2 diabetes to be prevented, treated and reversed.
And, by simply eating fewer carbohydrates, you may notice that you need less diabetes medications (including insulin). If medications are weaned at an appropriate rate, there will be fewer episodes of hypo (very low) and hyper (very high) blood sugar levels, and it will be a lot easier to lose weight. Eating less carbohydrate makes for an all round improved quality of life. Where complicating factors such as existing medications are involved, it is critical that these changes are medically monitored. The Low Carb Clinic can guide you on this journey, assisting you with medication management and monitoring your progress.
WARNING: If you take medicines for diabetes (insulin or tablets), you should seek medical advice before embarking on a low carb diet. Failure to do so may be lead to overmedication and hypos which can be life-threatening).
World Health Organisation. (2016, August). 10 facts on diabetes. Retrieved from World Health Organisation : http://www.who.int/features/factfiles/diabetes/en/
Australian Government Department of Health. (2017, December 20). PBS expenditure on prescriptions report 2016-17. Retrieved from The Pharmaceutical Benefits Scheme: PBS Expenditure and Prescriptions Report 2016-17
Sainsbury, E., Shi, T., Flack, J., & Colagiuri, S. (2018, July). Burden of diabetes in Australia: it's time for more action . Retrieved from http://www.novonordisk.com.au/content/dam/australia/affiliate/www-novonordisk-au/Home/Documents/180712_Burden%20of%20Diabetes_Its%20Time%20for%20More%20Action%20Report_Digital_%20FINAL....pdf
Health Direct. (2018, July). Complications of diabetes. Retrieved from Health Direct: https://www.healthdirect.gov.au/complications-of-diabetes
Hamdy, O. (2014). Nutrition revolution - the end of the high carbohydrates era for diabetes prevention and management (editorial). US Endocrinology, 10(2), 103-104. doi:DOI: http://doi.org/10.17925/USE.2014.10.02.103
Brinkworth, G., & Taylor, P. (2018). CSIRO Low-carb every day. Linfield, New South Wales: Macmillan Australia . Retrieved from https://www.csiro.au/en/Research/Health/CSIRO-diets/CSIRO-Low-Carb-Diet-Book
Feinman, R., Pogozelski, W., Astrup, A., Bernstein, R., Fine, E., Westman, E., . . . Worm, N. (2015). Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base. Nutrition, 31, 1-13.