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Doc, Are low carb diets a viable option for Reversal of Type 2 Diabetes?

Posted by Daniel Patrick on

“Carbohydrate restriction is a viable patient choice for type 2 diabetes,” Sarah Hallberg, DO, MS, ACSM-CEP, FNLA, FOMA.

Evidence presented by Dr. Hallberg suggests, "Adherence to a ketogenic eating plan, with proper medical support, could yield diabetes remission and sustained cardiometabolic improvements in a person with type 2 diabetes.

Dr. Hallberg addressed the World Congress of Insulin Resistance, Diabetes and Cardiovascular Disease.

“Nutritional ketosis supports diabetes reversal by reducing insulin resistance while providing alternative fuel to glucose with favoring signaling properties.”

Dr. Hallberg expressed her frustrations with peoples' low-carb diet perceptions saying, “One of my biggest frustrations is when we hear about low-carbohydrate and people are talking about something that is less than 40% [carbohydrates],” she said. “If [the diet is] somewhere around 40%, it is really a high-fat, high-carbohydrate diet. A low-carb diet is much lower than that.”

A well-formulated ketogenic diet is defined as a high, whole food fat plan (70% to 80%) that is low in carbohydrates (5% to 10%) with moderate or adequate protein intake (15% to 20%).

No GPS Foods

“One of the things we often hear is that this is a no-carb diet, and that is not true,” she said. “[Those who follow a ketogenic plan] eat a lot of leafy greens and a lot of nonstarchy vegetables each day. We insist on five servings of them. When we’re talking about under 50 g total carbohydrate intake a day, you can get a lot of vegetables in for that less than 50 g. What are you not eating? I tell my patients no GPS: No grains, no potatoes and no sugar.

Challenges and Perspectives in Nutritional Counselling and Nursing

  • Nutritional Counseling is a first line approach in the management of numerous chronic diseases
  • Requires training and education to facilitate patient centered approach to effective counselling
  • Advances in digital technology holds great potential to improve access to nutritional counselling especially for primary care patients
  • Caution is required to protect interpersonal relationships because these relationships are the cornerstone of effective nutritional counselling & primary care

EATING PATTERNS RECOMMENDED BY American Diabetes Association

Consensus recommendations

  • A variety of eating patterns (combinations of different foods or food groups) are acceptable for the management of diabetes.
  • Until the evidence surrounding comparative benefits of different eating patterns in specific individuals strengthens, health care providers should focus on the key factors that are common among the patterns:
    • Emphasize nonstarchy vegetables.
    • Minimize added sugars and refined grains.
    • Choose whole foods over highly processed foods to the extent possible.
  • Reducing overall carbohydrate intake for individuals with diabetes has demonstrated the most evidence for improving glycemia and may be applied in a variety of eating patterns that meet individual needs and preferences.
  • For select adults with type 2 diabetes not meeting glycemic targets or where reducing antiglycemic medications is a priority, reducing overall carbohydrate intake with low- or very low-carbohydrate eating plans is a viable approach.

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References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6780101/

https://iuhealth.org/find-providers/provider/sarah-j-hallberg-do-6498

https://care.diabetesjournals.org/content/42/5/731

https://www.medscape.com/viewarticle/923766

https://www.healio.com/endocrinology/diabetes/news/online/%7B477234dc-5458-46a6-b3e7-46bf5496ce61%7D/ketogenic-diet-viable-patient-choice-for-type-2-diabetes

https://health.gov/dietaryguidelines/2015/

https://www.healthline.com/nutrition/ketogenic-diet-foods#section2

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