Answers from Dr. Greene

QUESTION:

It seems like so many people are on these low-carb diets these days. Are these safe for someone with diabetes?

-- Linda.

DR. ALAN GREENE:

Linda, that is an excellent question and one I am sure many people with diabetes are asking. The popularity of very low carbohydrate, high-protein diets has increased in recent years. The media (and probably some of your friends) make claims about how much weight you can lose if you follow such a plan. Since weight loss is a main goal for treating type 2 diabetes, the idea of eating few carbohydrates and making up calories with high-protein foods (which are often also high in fat) may have some theoretical appeal.

However, you should know that low-carbohydrate diets (restricting total carbohydrate) to less than 130 grams a day) are not recommended in the management of diabetes, according to the 2012 Clinical Practice Guidelines, which are the official standards of medical care in diabetes, though there is some controversy about this in the medical community.

Examples of low carbohydrate diets include Dr. Atkins' New Diet Revolution, The Zone, The South Beach Diet, Protein Power, The Carbohydrate Addict's Diet and Sugar Busters. The levels of fat and carbohydrate vary with each diet, but in general, all of these diets limit carbohydrate intake and are low in total calories.

Here are some areas of concern with low-carbohydrate diets:

• They can provide low levels of vitamins, minerals, and other important phytonutrients from food.
• They may (although they don't have to) provide high levels of unhealthy saturated fats.
• Your cholesterol levels may increase if you don't reduce calories.
• They are often very low in fiber.
• High protein diets may increase your risk of diabetic kidney disease.

On the other hand, there are some possible benefits of low-carbohydrate diets:

• They may promote short-term weight loss.
• They may reduce total calorie intake -- at least short term. This reduction may improve blood sugar control.
• Healthy fat choices can replace refined carbohydrates.
• Triglyceride levels may go down while the diet is followed.

While no single diet is advocated specifically for type 2 diabetes, the current American Diabetic Association (ADA) guidelines emphasize working with a registered dietician familiar with diabetes medical nutrition therapy (MNT). With this help you can learn the best types and amounts of carbohydrates for you. You will want to limit saturated fat to less than 7% of total calories, to minimize or eliminate trans fats, and to avoid too much protein (especially if you already have any chronic kidney problems). If you choose to use alcohol, this should be limited to a moderate amount (less than one drink per day for adult women and less than two drinks per day for adult men).

Perhaps what you include is even more important than what you limit. You will want to be sure to include plenty of vegetables, fruits, legumes, fiber-rich cereals, and whole grain foods in your diet.

In general, the ADA suggests that half of your plate should be vegetables and salad greens, ¼ of your plate should be lean protein, and ¼ of your plate should be whole grains, fruits, or other healthy carbohydrates

Alan Greene, M.D. earned a Bachelor's degree from Princeton University and graduated from medical school at University of California at San Francisco. Upon completion of his pediatric residency program at Children's Hospital Medical Center of Northern California in 1993, he served as Chief Resident. During his Chief year, Dr. Greene passed the pediatric boards in the top 5 percent of the nation.

Dr. Greene entered primary care pediatrics in January 1993. He is on the Clinical Faculty at Stanford University School of Medicine where he sees patients and teaches Residents. He serves as the Chief Medical Officer of A.D.A.M., Inc., a leading provider of consumer health information, and helps direct A.D.AM.'s editorial process. As A.D.A.M.'s CMO, he served as a founding member of Hi-Ethics (Health Internet Ethics) and helped URAC develop its standards for eHealth accreditation. He is also the Founder & CEO of DrGreene.com. Dr. Greene was also named Intel's Internet Health Hero for children's health. He is an author, medical expert, and a media personality.

He is the author of The Parent's Complete Guide to Ear Infections (People's Medical Society, 1997). Dr. Greene has appeared in numerous publications including the Wall Street Journal, Parenting, Parent, Child, American Baby, Baby Talk, Working Mother, Better Home's & Gardens, and Reader's Digest. He also appears frequently on television and radio shows as a medical expert.

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