Taking the guess work out of low carb eating

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By Dale Cooke

Accredited Practising Dietitian


Is low carbohydrate eating an option for your patients? 


Low carb eating has been featured in the media for quite some time.


Diabetes Queensland health practitioners regularly receive queries about whether this method of eating is healthy and safe, so Diabetes Australia gathered a group to write a position statement on low carbohydrate eating for people with diabetes to provide a guide on current evidence.


Written by an expert panel of Credentialled Diabetes Educators, Accredited Practising Dietitians and an Endocrinologist, research was gathered, the reliable evidence was reviewed and the statement written.  As further reliable research becomes available, the statement will be updated. 


What can you tell your patients?

1. For people with type 2 diabetes, there is evidence that low carb eating can be useful in lowering blood glucose levels (BGLs), as measured by HbA1c, for six months and for faster weight loss for the first 12 months, than other interventions. It also results in improved risk factors for heart disease for two years. The best results seem to be for lower carb diets - less than 26 percent total energy from carbs.  Why only the first six or 12 months or two years?  There are a few reasons: the studies only went that long so we don't know what happens in the long-term. In addition, compared to normal dietary advice to lose weight and manage BGLs, people can attain the same results but it takes a bit longer. Lastly, after a while people stopped the low carb diet.  The lower the carb content the harder some people found it was to follow long-term.


2. For people with type 1 diabetes, there isn't enough good quality research to prove a benefit at present. There is anecdotal evidence and even more recent observational evidence but DA can't base its recommendations on anecdotal or observational evidence alone. 


3. It's important if your clients decide to follow a low carb diet, whatever type of diabetes they have, that you refer them to an Accredited Practising Dietitian to make sure they get all their nutrition. The lower the carb diet followed, the harder it is to meet nutrition requirements.


4. It's also important your patients talk to their GP or Endocrinologist for advice on whether to change their medication dosage and type. When they decrease their carb intake they will likely need to reduce medications that cause hypoglycaemia, in particular, insulins and sulfonylureas. The family of oral medications called SGLT2 inhibitors increases the chance of developing diabetic ketoacidosis (DKA) with low carb eating so this may require swapping to a different family of medications.


5. Make sure your patients monitor their BGLs. Besides wanting to see if the diet is improving BGLs it will also allow them to prevent unexpected hypos.


6. If your patients do follow a low carb eating plan they might have some side effects initially, such as tiredness and headaches. They also won't store as much glycogen in their liver, so the glucagon injection for hypo treatment won't work as well.


7. Research and international guidelines don't support the use of low carb diets in pregnancy or for babies and children as there are concerns about the fetus or child receiving adequate nourishment for normal growth and development.


8. If your patients have any health issues such as malnutrition, eating disorders, kidney or liver failure, or any rare metabolic disorders, get them to talk to their GP or specialist before considering following a low carb diet.


Keep in mind that everyone's diabetes is different so everyone's management will be a little bit different to your patient's friend, relative or neighbour who may also be living with diabetes. What works for one may not necessarily work for your patient.


One of the inconsistencies with carbohydrate modified diets is there is not an absolute definition of what low carb actually means.


Page 7 of the position statement gives a summary of what some researchers are using to define low carb eating, so if someone talks low carb to you, check what level of low carb they are talking about using this table.


The position statement reminds us what carbohydrates are made of and how the body uses them for energy. 


It also reminds us that following healthy eating guidelines and limiting carbs which contain very little nutrition (such as cakes, biscuits, slices, juice, soft drink, chocolate and sweet treats) is recommended as the usual way of eating for everyone, whether you live with diabetes or not.


Check out Diabetes Australia's Low carbohydrate eating for people with diabetes position statement.


If you have any queries about the National Diabetes Services Scheme or this article please call us on 1300 136 588.

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