Low Carb & other Popular Diets
Could they fix our problems with type 1 diabetes?
Michelle MacPhee, D-Mom
Low carb? Low GI? Keto? Paleo? Plant-based? If some of these terms create confusion, you’re not alone! This article clears up the confusion and cuts through the hype, providing a short description of each diet, a clear outline of the included/excluded foods, plus the pros and cons of each dietary program, so you have the power to make an informed choice that fits for your family – for a meal, for a day, or for a lifetime.
Share this Article
Eating low carb is a popular choice – and a source of controversy! - within the type 1 diabetes (T1D) community. Some people feel that it is the best and easiest way to tame the diabetes dragon; others feel that “kids should be kids” and that healthy eating includes more than a splash of carbohydrates.
To further complicate the issue, a low carb diet is often associated with blood sugar management for those with type 2 diabetes who do not take insulin, and are, therefore, more reliant on dietary interventions to keep high blood sugar at bay. I remember when our son was diagnosed with T1D at just over a year old, I turned to the internet for information about diabetes and received a deluge of information on how low fat, low carb diets were the way to go. I was confused, and not yet informed enough to separate the information that was relevant for type 2 diabetes from that relevant to type 1. Low fat for my toddler? Cut out whole milk?! Reduce his carb intake? No more bread or crackers?! Of course, that wasn’t the case, my baby needed whole fat milk and healthy grain products for his growing body and brain.
Whether you decide to change your family's eating patterns or not, information about low carbohydrate options is still valuable for T1D families. If we are informed, then we can make choices that fit best for our unique family – for a meal, for a day, or as a lifestyle. There are times when a low carb meal is the best solution to wrap up a day on the blood sugar rollercoaster. There are days when things start to snowball and I’ve had enough of battling the dragon; I just need to restore some balance and simplify things by reducing the carb intake for all the meals that day (or even a few days in a row). And for some families, the goal is to reduce the swings as much and as often as possible, and so a consistent low carb lifestyle fits best.
Information on low carb alternatives can also be helpful as we make different choices across the lifespan: you may find this information useful for your own dietary goals, separate from your child’s diabetes care. You may want to increase your energy, for example, improve your heart health, lose weight (anyone else have that extra covid 19?) or reduce symptoms associated with food sensitivities. If so, some of the dietary programs here may help you achieve your own health goals. After all, the best thing we can do for our kids is to take good care of their parents!
Does Our Family Eat Low Carb or High Carb? Somewhere In Between?
If you ask a hundred people what a low carb diet is, you may just get a hundred different answers. Even the experts don’t always agree on what qualifies as “low carb”. However, there are some general guidelines1 that we can use as a point of understanding for this article:
A High Carb diet includes more than 225g of net carbs per day.
Examples include: Vegetarian, Vegan, Flexitarian, Asian
A Moderate Carb diet includes 130 - 225g of net carbs per day.
Examples include: Mediterranean, DASH
A Low Carb diet includes less than 130g of net carbs per day.
Examples include: Paleo, The Zone
A Very Low Carb diet includes less than 70g of net carbs per day.
Examples include: Atkins / Eco-Atkins, South Beach, Bernstein
A Ketogenic (“keto”) diet includes less than 50g of net carbs per day.
“Net carbs”refers to the amount of carbohydrates available to your body for energy; it’s calculated by subtracting fibre from the total carbs.
Note that these guidelines are for adults. If you are reading this article with your T1D child or teen in mind, then adjust the ranges downward according to how much they eat compared to an average adult. For example, my 13-year old son now eats more than I do, so I wouldn’t change the figures at all, leading me to recognize that he currently eats a Moderate Carb diet. When he was 7 or 8 years old, he ate about half of what I did, so I would have cut these figures in half, estimating that Moderate carb intake for him would have been ~70-110g/day.
Using the guidelines above, we could say that an adult on a low carb diet consumes fewer than 130g of carbs per day. But within that guideline, different low carb diets vary in the amount of daily net carbs recommended, the foods that are featured and those that are restricted/eliminated, as well as the strictness or flexibility of the guidelines. There are both pros and cons to consistently eating a low amount of carbs:
- The Law of Small Numbers: Dr. Richard Bernstein developed his low carb diet based on his friend’s mantra for diabetes management “Big inputs make big mistakes; small inputs make small mistakes.” (Kanji Ishikawa, oldest surviving type 1 diabetic in Japan)1. The idea is that if you eat a large amount of carbs, you need to give a large amount of insulin, which give rise to large errors in insulin dosing; overdosing leads to hypoglycemia, while underdosing leads to hyperglycemia. But if you eat a small amount of carbohydrates, then there’s less room for error, which results in less variability (fewer and less extreme lows and highs), and, therefore, more Time in Range. 1
- More Time in Range means a reduced risk of diabetes-related complications.
- Less insulin means lower risk of severe lows.
- Less insulin helps with weight management (which may not be a relevant factor for many of our kids with type 1 diabetes, but may be important for adults with T1D).
- Diabetes Canada released a Position Statement on Low Carb Diets for Adults with Diabetes in which they note that “Research on lower-(carb) diets have shown improvements in people with type 1 diabetes, including lower A1C levels, reduced insulin requirements, less glucose variability, and weight loss.” The document goes on to say that “Healthy* low or very-low-CHO diets can be considered as one healthy eating pattern for individuals living with type 1 and type 2 diabetes for weight loss, improved glycemic control, and/or to reduce the need for antihyperglycemic therapies.” (emphasis added)
- When you switch to low carb eating, there is an increased risk of low BG if you do not adjust your insulin doses, because your insulin sensitivity changes. 1
- If you consistently eat less than 55g of carbs/day, you may need more Rescue Glucagon to treat a severe low (your body’s response to Glucagon may decrease on a low carb diet). 1
- You may be missing out on some otherwise healthy food choices (whole grains, some fruits, dairy) that are especially important for growing kids. You may be missing some vitamins and minerals found in whole grains and cereals (and so may need supplementation). 1
- If you replace the carbs with fat, unhealthy long-term eating patterns result, which can lead to insulin resistance, weight gain, and future cardiovascular disease.
- Diabetes demands that we focus on food: counting, measuring, and thinking can turn to obsessing, especially if we are counting carbs in order to limit intake. Kids with T1D are already at increased risk of eating disorders because of this hyper-focus on food; a low carb diet may further increase that risk. 1
- When kids (with or without diabetes) feel restricted or controlled, many of them react by rebelling, which may lead to power struggles and unhealthy food choices.
- The more restrictive a diet, the harder it is to adhere to it long term, especially for kids and teens who see their peers eating the “fun” stuff.
Examples of Low Carb Diets
Here is a brief description of some common Low Carb diets. You’ll find some overlap between the different approaches, but each has its “niche.”
The Paleo diet (“paleo” meaning “old, ancient”) focuses on hunter-gatherer-type food that was available before prehistoric humans started growing grain crops. The modern Paleo diet is less “Caveman” and more about picking up proteins and produce, while putting down the low-quality carbs (and dairy, in some variations) that proponents of the diet believe lead to “diseases of civilization” (systemic inflammation, digestive problems, obesity, heart disease, type 2 diabetes). Paleo is a Low Carb, High Protein diet that does not distinguish between lean versus high fat meat, instead taking a “snout to tail”2 approach to avoid waste and add variety by using as much of the animal as possible. For example, if you roast a turkey, you would eat the light and the dark meat, the organs, and the skin; you would also boil the carcass for bone broth. Some of my favourite chicken recipes (using skin-on chicken thighs) fit in the Paleo category.
Benefits of Paleo:
Challenges of Paleo:
Share this Article
2. The Wahls Protocol
The Wahls Protocol is a Paleo-adaptation developed by Terry Wahls, MD, that helped her reverse her own Multiple Sclerosis (MS) symptoms, get out of a wheelchair and into a long-distance bike race. The Wahls diet features moderate protein from high quality meat and fish (grass-fed), including organ meat; berries and an abundance of vegetables, including lots of leafy greens, broccoli and fermented veggies.
Benefits of Wahls:
Challenges of Wahls:
3. The Whole 30
Whole 30 is a short-term elimination diet (30 days) designed to help your body heal from the effects of inflammatory foods. Supporters say that it eliminates cravings, heals digestive issues, rebalances hormones, boosts immune functioning and increases mental health (reduces depression).
Benefits of Whole 30:
Challenges of Whole 30 :
4. The Zone Diet®
The Zone Diet® is a commercial diet program, developed by Dr. Barry Sears, that focuses on reducing diet-induced inflammation; you’re “in the Zone” if specific clinical markers, including HbA1C and the level of insulin resistance in the liver, stay within an ideal range. To guide food choices, the company recommends following the Zone® Food Pyramid in which grains and starches are chosen least often, healthy oils and low-fat proteins are chosen more often, and fruits and vegetables are chosen most often. The Zone® is a Low Carb, Low Fat, Moderate Protein diet (that also highlights Low Glycemic Index carbs).
Benefits of The Zone:
Challenges of the Zone:
5. The South Beach Diet
The South Beach diet is not a strict “low carb” diet, though it is lower-carb than a typical meal plan. South Beach draws a line between what it considers “good” carbs/fats and “unhealthy” carbs/fats. It does not eliminate the whole category of carbohydrates but focuses on the quality of the carbs: low glycemic index (GI) carbs are allowed; high glycemic index carbs are avoided.
Benefits of South Beach:
Challenges of South Beach:
6. Atkins / Eco Atkins
Those who follow the Atkins / Eco Atkins diet limit the total amount of carbs consumed across the day, as well as the amount eaten at any snack or meal. Atkins Diet was the original version; it was criticized for being rule-bound and skewing a person’s overall diet away from healthy, balanced eating. Eco Atkins is the re-modeled, healthier version, which provides general guidelines within which you can choose the food habits that fit your needs. One key change is that unhealthy fats that can create cardiovascular problems (fatty meats, butter) were replaced with healthier, plant-based fats (nut butters, seeds, avocado, healthy oils). Atkins is a Very Low Carb, High Fat, High Protein diet; Eco-Atkins is a Very Low Carb, High Plant Fat, Moderate Protein diet.
Atkins:Protein & Fat (Chicken, Meat, Eggs) Leafy greens Low carb vegetables As low as 10% of calories from carbohydrates (when beginning the diet, only 20g/day of net carbs are allowed – that’s REALLY low!)
Eco-Atkins:Vegetables Fruit Whole Grain Bread and Cereals Oats 31% of daily calories from plant proteins (veggie burgers, tofu turkey, lentils, soybeans, tofu, tempeh, seitan) 43% from plant fats (nut butters, seeds, avocado, canola oil, flax seed oil, walnut oil) 26% from carbs (from the sources above)
Atkins / Eco-Atkins:Grains and starches (but don’t eliminate them) Avoid: Sugar Simple Starches (white bread, white rice, white potatoes, baked goods/pastries)
Eco-Atkins:Avoid unhealthy fats (fatty meats, butter)
Benefits of Eco-Atkins:
Challenges of Eco-Atkins :
7. Bernstein Diet
The Bernstein Diet (developed by Dr. Richard* K. Bernstein and outlined in his book “Dr. Bernstein’s Diabetes Solution) is a Very Low Carb, High Protein (LCHP) diet developed with a goal of achieving “normal blood sugars for diabetics,” both type 1 and type 2. [*Not to be confused with the other Dr. (Stanley) Bernstein, the founder of Dr. Bernstein Diet and Health Clinics.] The Bernstein Low Carbohydrate Solution is similar to the original Atkins diet, and has similar pros and cons, in addition to those listed above that apply to low-carb diets in general.
Share this Article
8. Keto Diet
The goal of a Ketogenic (Keto) diet is to bring the body into “ketosis” (state in which the body burns dietary fat AND stored fat for energy, rather than its preferred fuel source, carbohydrates/sugar). To do this based on food intake, carbs are extremely restricted (20- 50g net carbs/day) and fat intake is greatly increased (to 70% of your daily diet). The ketogenic diet was originally developed to treat epilepsy, and is still used for that purpose, as well as for rapid weight loss. A Keto diet is Low Carb, High Fat (LCHF).
MODERATE CARB DIETS
9. Mediterranean Diet
The Mediterranean Diet is so-named because it is rich in foods common in countries that border the Mediterranean Sea, such as Greece, Italy, and Spain. It is a diet low in red meat, sugar and saturated fat, while featuring fish, produce, whole grains, nuts, legumes, olives, traditional dairy products, and herbs and spices. Because of its balanced approach and variety of flavours, it’s consistently rated #1 Diet for Healthy Eating, #1 Easiest Diet to Follow, #1 Diet for Diabetes, and #1 Diet Overall in the U.S. News & World Report annual rankings of popular diets.
Benefits of a Mediterranean Diet:
Challenges of a Mediterranean Diet:
Share this Article
10. The DASH diet
The DASH diet focuses on low-fat, high-fibre foods, while also limiting salt intake. The priority is in the name - Dietary Approaches to Stop Hypertension - which is a great match for you if you want to lower your blood pressure and improve your heart health. This isn’t the case for many T1D kids, so it might not be your go-to dietary regime; but in any case, it’s considered a healthy overall diet for most people, so it’s still worth a look. And if you’re curious about credibility, the DASH diet was created by the US National Heart, Lung, and Blood Institute (NHLBI). DASH is not a Low Carb diet, but it is Low Fat.
Benefits of DASH:
Challenges of DASH:
HIGHER CARB DIETS
11. & 12. Vegetarian & Vegan
A Vegetarian diet cuts out meat, poultry and fish, while a Vegan diet takes that one step further, eliminating all animal products, including eggs, dairy, lard, and honey. Both fall under the category of Plant-Based Since many plant-based protein sources also contain carbohydrates (think of chick peas, black beans, lentils), to get enough protein your carb intake increases, which is why plant-based diets tend to be higher in carbs than a typical diet.
Benefits of Vegetarian & Vegan:
Challenges of Vegetarian & Vegan:
Flexitarian is short for a Flexible Vegetarian Diet (developed by Registered Dietician Dawn Jackson Blatner), which means you eat vegetarian foods most of the time, with an occasional burger or steak when you really want it. Basically, becoming a flexitarian means choosing to eat more plants, and less meat.
Benefits of Flexitarian:
Challenges of Flexitarian:
Share this Article
What About the Quality of the Carbs???
Most approaches to diabetes management and meal planning focus on the amount (not the type) of carbs. When we carb-count, we ask: How many carbs are in that bread? And a cup of jasmine rice is treated the same as a cup of brown basmati rice – we bolus for 45g of carbohydrate and call it a day.
But what about the quality of the carbs?
14. Glycemic Index (GI) Diet
A dietary program based on the Glycemic Index scale accounts for this difference between jasmine rice (which is high on the glycemic index) and brown basmati rice (which is low GI), by ranking foods as Low, Moderate or High GI according to how quickly they digest (and therefore, how quickly they affect blood sugar). Foods that are high on the glycemic index raise blood glucose a fair bit, and do so quickly; low GI foods lead to smaller, smoother post-meal BG “spikes”.
The Bottom Line
You can see many themes across the different dietary approaches above… a tendency to reduce grain intake (which may be a reaction to the current over-consumption of bread products and low-quality grains in our North American culture), to reduce sugar (again, I think we tend to overdo it more often than not), and in the heathiest dietary approaches, to eat nutrient-rich foods, lots of fruits and vegetables, with a focus on natural, whole foods (in our family, we call these “foods the way God made ‘em!”) from a variety of food groups. We also do well overall to keep saturated fat and salt in check, consume healthy fats and oils, reduce our consumption of processed foods, hydrate well, eat mindfully, and treat non-naturally-occurring sugar as an occasional treat.
This last point is a sticky one for us T1D families, as fast-acting sugar is medicine for the treatment of lows! But perhaps that’s all the more reason to watch our overall sugar intake and save it for when it’s really needed.
Perhaps we all do best if we follow these more general healthy guidelines, using the more extreme diets only for a short time period and for a specific goal. If we do so, we really can’t go wrong in building health for ourselves and our families.
Wishing you all health, happiness and in-range blood sugars!
Share this Article
- Lorraine Anderson, RD, CDE presentation at No Limits for T1D (online), Sept 12, 2020 MANY THANKS TO LORRAINE FOR CONTINUING TO INFORM AND INSPIRE OUR FAMILY!!!
- Prevention® Big Book of Diets. 2020, Hearst Magazines, Inc.
- The Law of Small Numbers from Dr. Richard Bernstein’s “Diabetes Solution” http://www.diabetes-book.com/laws-small-numbers/
This material has been developed from sources that we believe are accurate, however, as the field of medicine (in particular as it applies to diabetes) is rapidly evolving, the information should not be relied upon, as it is designed for informational purposes only. It should not be used in place of medical advice, instruction and/or treatment. If you have specific questions, please consult your doctor or appropriate health care professional.