How Low to Go?

I’ve done somewhere around 50 grams of carbohydrates a day (30 grams when subtracting out fiber) for the past year. And my blood sugar control has been great. I’ve wondered how low someone has to go (or stay) in order to control Type 2 Diabetes. Certainly, the weight loss I’ve had (120 lbs) is a part of the solution. Being at a low body fat percentage now (7.5% per BodPod) has to help as well. My weight has been stable for 6 months now as well which means I’ve not lost or gained any weight – I was at 164.7 lbs when I took the BodPod test and today I weighed 163.7 lbs (close enough). My coffee consumption (which helps in weight loss for sure) is higher than ever before but I’m trying to keep the caffeine down by mixing in mostly decaf coffee. 

So all of this begs the question of how many grams of carbs I could tolerate. Now, I am not going to be testing this anytime soon. I find the advantages of being low carb just way too easy (see above for the results). I did find a study that might provide at least a partial answer to the question of how many grams of carbs can keep someone in remission from Diabetes.

The answer is in this 2009 study (Haimoto H, Sasakabe T, Wakai K, Umegaki H. Effects of a low-carbohydrate diet on glycemic control in outpatients with severe type 2 diabetes. Nutr Metab (Lond). 2009 May 6;6:21).

Now, I wouldn’t even call this diet at 30% of calories from carbohydrates a “Low Carbohydrate” by any definition that I would recognize but it has interesting results. One of the things that was interesting is that the study was done on severe diabetics (HbA1c levels of 9.0% or above). This is not a group of new diabetics nor were the participants young. They were a pretty good representative of Type 2 Diabetics with poor blood sugar control. The participants:

were instructed to follow a low-carbohydrate diet (1852 kcal; %CHO:fat:protein = 30:44:20) for 6 months in an outpatient clinic and were followed to assess their HbA1c levels, body mass index and doses of antidiabetic drugs.

The results were really good. Many of the participants got off their medications and:

HbA1c levels decreased sharply from a baseline of 10.9 ± 1.6% to 7.8 ± 1.5% at 3 months and to 7.4 ± 1.4% at 6 months.

These are similar to the results I got with the Low Carbohydrate diet when I got to an HbA1c level of 6.4. They are not as good as the results I got over the last couple of years with even lower levels of carbohydrates plus intermittent fasting.

In spite of being on a fairly low calorie diet (1852 kcal) they didn’t lose much weight. This group also didn’t seem to be all that obese since their BMI was around 24 (top end of “normal” weight).

Body mass index decreased slightly from baseline (23.8 ± 3.3) to 6months (23.5 ± 3.4).

So, if you are “normal” weight and diagnosed as diabetic then dropping from the Standard American Diet (SAD) 50% of calories from carbohydrates to 30% might give as good of control as exogenous Insulin without the long term increase in insulin resistance that comes along with Insulin therapy.

There was one telling outlier in the data.

One female patient had an increased physical activity level during the study period in spite of our instructions. However, her increase in physical activity was no more than one hour of walking per day, four days a week. She had implemented an 11%-carbohydrate diet without any anti-diabetic drug, and her HbA1c level decreased from 14.4% at baseline to 6.1% after 3 months and had been maintained at 5.5% after 6 months.