Low Carb diets have been a popular diet over the last few years, neatly surpassing Paleo as the "in thing" for weight loss.
Low carb diets have not been recommended by main stream dietitians for a few reasons. Dietitians are required by law to only promote evidence based practice. This is both a blessing and a curse. It's good because it protects people from diet advice that could harm them, but a bad thing because it means that it takes our field a while to pick up on and be able to recommend new diet protocols for health and disease management.
This is great news for people with Diabetes, already following a LCHF lifestyle and needing support from their medical team. This is also great news for dietitians and people newly diagnosed with Diabetes because it gives us an excellent tool to help manage and treat diabetes.
So what is a low carb diet?
Low carb diets are poorly defined and are different from ketogenic diets.
Generally speaking, the average Kiwi diet contains between 200 - 300 grams of carbohydrates a day. This equates to between 45 to 50% of total energy each day.
A moderately low carb diet contains around 150 grams of carbohydrate a day.
A low carb diet contains around 80 to 100 grams of carbohydrate a day.
A ketogenic diet is a different kettle of fish, it contains between 20 - 50 grams of carbohydrates a day.
Ketogenic diets.
Ketogenic diets require the person to go into nutritional ketosis. Nutrition ketosis is a normal metabolic phase that happens during periods of fasting or starvation. It occurs when there is fasting (say over night, while you are sleeping or babies who haven't fed on milk within 2 hours will naturally go into this phase) . It's a metabolic phase that is designed to support our bodies when no food is coming in. It allows our body to break down fat and protein into ketones, which can be used by the body and brain for energy. A healthy body will readily swap from using carbohydrate as energy to breaking down fat and protein in various ways for energy when carbohydrates aren't able to be used. In nutritional ketosis, ketones can be measured in the blood around 0.5 to 5 mmol/L.
Diabetic keto-acidosis is a severe and life threatening diabetes complication - it is VERY different to nutritional ketosis. It can happen in people with Type 1 Diabetes, and can (rarely) happen in those with Type 2. In keto-acidosis ketones can measure over 10mmol/L and upwards of 20mmol/L. It can occur when the body has very high glucose in the blood, not enough or no insulin and high ketones.
What are carbohydrates?
Carbs are a macro-nutrient that provide energy to the body. There are three different macro-nutrients: carbs, fat and protein. Carbs are found in:
potatoes and kumara
rice
grains such as oats, wheat, corn, cereals and bread
quinoa, millet, amaranth, and other gf flours
fruit
vegetables
sugar and many sugar substitutes (honey, maple syrup, coconut sugar etc)
flour
foods containing sugar and flour ( baked goods, pies, doughnuts, biscuits, chips, lollies, chocolate etc)
dried fruits such as raisins, dates and figs
What is the evidence for a LCHF diet for someone with Diabetes?
The American Diabetes Association has written consensus recommendations for dietary recommendations for people with Type 2 Diabetes. These recommendations are:
1. Regardless of which diet type you enjoy doing, whether it be Paleo, Mediterranean or Vegan, what matters is that this 'diet' has lowered or reduced carbs. Or in other words: the main goal is to reduce carbohydrates for the best management of diabetes and glycaemic control, regardless of eating patterns.
2. That for people with diabetes individualised diet plans, that a person can stick to, is the way to go. That actual macronutrient ratio's (ie the proportion of carbs, protein and fat one eats) doesn't actually matter.
3. Recommendations for sodium (salt) is the same for the general population <2300mg/day
4. It is beneficial to focus on healthy fats (mono and polyunsaturated fats). Replacing carbs for healthy fats improves CVD risk in people with Type 2 diabetes. Foods higher in mono and poly unsaturated fats are: olives and olive oil, nuts, seeds, fish, avocado. Fish is recommended (also for general healthy eating) one serve of fish, two times a week.
5. Alcohol is recommended as no more than one standard drink each day for women and 2 drinks or less for men.
What does a LCHF diet look like and should I do one?
As with any diet choice, it needs to be:
1. enjoyable!
2. affordable
3. flexible
4. practical for you to do
So whether you choose to eat low carb and how low carb you go (moderate, low carb or keto) depends on all of the above, your current eating patterns and your health related goals. LCHF definitely has a range that you can use to your advantage and choose a level that suits you. And as with any eating plan, aiming for half your food intake to be plants is ideal. If you want to go super low carb, then choosing low carb veges over starchy ones and being mindful of the types and amounts of fruit you are eating can also be helpful.
If you have diabetes and are on medication, make sure you get medical advice from your GP or diabetes specialist to ensure your carbohydrate intake matches your meds. You may need to reduce your medications to suit a lower carb way of eating. High dose of diabetes meds, with not enough carbs, can lead to hypoglycemia (low blood sugars) which can be dangerous.
So are carbs BAD for me?
No! Most people can eat carbohydrates happily with no issues. Whole-food based carbs are loaded with fibre, vitamins and minerals and are an excellent energy source.
For the general population on each plate aim for:
Kids: 1/3 each of carbs, protein and plants (vegetables and fruit) and 1 to 2 tsps of healthy fats
Grown ups:1/4 carbs, 1/4 protein and 1/2 plants (vegetables and fruit) and 1 to 2 tsps of healthy fats
For people with diabetes, you still want at least half of what you eat to be plants, generally protein is the same to the general population, but you will need to increase your fat sources and amounts to make sure you are getting enough energy to replace the energy from carbs.
If you want to go low carb for health or for diabetes reasons, it is a viable eating pattern that can be really beneficial. But like any way of eating it can be done in a healthy way or an unhealthy way. Think: fried eggs with lots of fried bacon versus scrambled eggs served with fresh leafy greens and lightly pan fried mushrooms and garlic. Both low carb, but ones got a more powerful nutrition kick!
However you choose to eat, aim for mostly whole un-processed foods and you'll have mostly nailed it. If your eating plan or diet is stressing you out, if you feel guilty when you eat 'bad' foods or you have any history of eating disorders or disordered eating then re-read the above. The way you eat needs to be sustainable, enjoyable, flexible and practical for you to do! After all, your emotional and mental health is JUST as important as your physical health.
If you want help with how you are eating, would like to follow a LCHF diet, then get in touch. I have one on one face to face and Skype sessions available and can tailor advice to suit your needs.
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