High or Low Carb Diets for Diabetics?

Here’s a valuable older study (JAMA. 1994. Effects of Varying Carbohydrate Content of Diet in Patients With Non—Insulin-Dependent Diabetes Mellitus. Abhimanyu Garg, MBBS, MD; John P. Bantle, MD; Robert R. Henry, MD; et al Ann M. Coulston, RD; Kay A. Griver, RD; Susan K. Raatz, MS, RD; Linda Brinkley, RD; Y-D. Ida Chen, PhD; Scott M. Grundy, MD, PhD; Beverley A. Huet, MS; Gerald M. Reaven, MD) which looked at carbohydrates vs Metabolic Syndrome markers. From the study:

Objective.  —To study effects of variation in carbohydrate content of diet on glycemia and plasma lipoproteins in patients with non—insulin-dependent diabetes mellitus (NIDDM).

Design.  —A four-center randomized crossover trial.

Setting.  —Outpatient and inpatient evaluation in metabolic units.

Patients.  —Forty-two NIDDM patients receiving glipizide therapy.

Interventions.  —A high-carbohydrate diet containing 55% of the total energy as carbohydrates and 30% as fats was compared with a high—monounsaturated-fat diet containing 40% carbohydrates and 45% fats. The amounts of saturated fats, polyunsaturated fats, cholesterol, sucrose, and protein were similar. The study diets, prepared in metabolic kitchens, were provided as the sole nutrients to subjects for 6 weeks each. To assess longer-term effects, a subgroup of 21 patients continued the diet they received second for an additional 8 weeks.

Main Outcome Measures.  —Fasting plasma glucose, insulin, lipoproteins, and glycosylated hemoglobin concentrations. Twenty-four-hour profiles of glucose, insulin, and triglyceride levels.

Results.  —The site of study as well as the diet order did not affect the results. Compared with the high—monounsaturated-fat diet, the high-carbohydrate diet increased fasting plasma triglyceride levels and very low-density lipoprotein cholesterol levels by 24% (P<.0001) and 23% (P=.0001), respectively, and increased daylong plasma triglyceride, glucose, and insulin values by 10% (P=.03), 12% (P<.0001), and 9% (P=.02), respectively. Plasma total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol levels remained unchanged. The effects of both diets on plasma glucose, insulin, and triglyceride levels persisted for 14 weeks.

Conclusions.  —In NIDDM patients, high-carbohydrate diets compared with high—monounsaturated-fat diets caused persistent deterioration of glycemic control and accentuation of hyperinsulinemia, as well as increased plasma triglyceride and very-low-density lipoprotein cholesterol levels, which may not be desirable.(JAMA. 1994;271:1421-1428)

This diet wasn’t particularly low carb since the difference between the high-carb (55% of calories from carbs) and so-called low-carb (40% of calories from carbs) wasn’t all that much (15% differences). But the results were impressive nevertheless. And it was important since the high-carb diet is close to the Standard American Dietary recommendations.

An earlier study had similar results (N Engl J Med 1988; 319:829-834. Comparison of a High-Carbohydrate Diet with a High-Monounsaturated-Fat Diet in Patients with Non-Insulin-Dependent Diabetes Mellitus. Abhimanyu Garg, M.B., B.S., M.D., Andrea Bonanome, M.D., Scott M. Grundy, M.D., Ph.D., Zu-Jun Zhang, M.D., and Roger H. Unger, M.D.). The results were:

As compared with the high-carbohydrate diet, the highmonounsaturated-fat diet resulted in lower mean plasma glucose levels and reduced insulin requirements, lower levels of plasma triglycerides and very-low-density lipoprotein cholesterol (lower by 25 and 35 percent, respectively; P<0.01), and higher levels of high-density lipoprotein (HDL) cholesterol (higher by 13 percent; P<0.005). Levels of total cholesterol and low-density lipoprotein (LDL) cholesterol did not differ significantly in patients on the two diets.

These preliminary results suggest that partial replacement of complex carbohydrates with monounsaturated fatty acids in the diets of patients with NIDDM does not increase the level of LDL cholesterol and may improve glycemic control and the levels of plasma triglycerides and HDL cholesterol.

Again, neither of these diets reached ketogenic levels. They did achived significant improvements in glycemic control but not enough to reverse diabetes.


Author: Doug

I'm an Engineer who is also a science geek. I was pre-diabetic in 1996 and became a diabetic in 2003. I decided to figure out how to hack my diabetes and in 2016 found the ketogetic diet which reversed my diabetes.

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