Can Pre-diabetic and Diabetic Patients Benefit by Eating a Low Carb Diet?

Diabetes is rapidly growing as a health problem in our society. Currently, 18 Million people in the United States have diabetes. At a cost of $174 billion in 2007, people with diabetes have approximately 2.4 times the medical expenditures that would be incurred by the same group of people without diabetes. In the last 10 years, the number of people with diabetes has increased by 50%. You do the math!

At a time when debate is volatile within our government about healthcare reform, it is increasingly clear that more proactive care is called for at the level of the healthcare professional including the doctor, nurses and dietitians to help people with diabetes care for their illness and keep them out of the hospital with avoidable complications. And this is why I was pleased when my doctor recommended that I attend a diabetic class. As a patient, I accept responsibility for my health and care.

I am not diabetic. At least not yet. That's the good news. But when my blood glucose level jumped above 100, suddenly I was targeted and categorized to the "pre-diabetic" group. That's when I was contacted and asked to go to the diabetic class. The risk for pre-diabetes increases with age and as luck would have it, I am getting older every day!  Further, family history contributes toward the risk and it is linked to obesity, both of which I must claim.   It is finally time for me to face facts and become proactive in avoiding diabetes for as long as possible.

Pre-diabetes exists when a person's blood glucose level is above the normal level but below the point at which diabetes is diagnosed. Normal blood glucose when fasting is between 70 and 99 mg/dl. Pre-diabetes exists in the range of 100 - 125 mg/dl. When fasting blood glucose is 126 mg/dl or more, then usually a diagnosis of diabetes is confirmed. There are several tests that can be done and if you have concerns, it is best to take them up with your doctor.

Some common symptoms you might experience are increased thirst, frequent urination, increased hunger, unusual weight loss, or extreme fatigue. Or you may notice more frequent infections and wounds that are slow to heal. If you have not been diagnosed with diabetes, you should see your doctor if you have burning pain, numbness, or swelling in your feet or hands. Likewise if you are obese and don't exercise much, or have been told that your blood sugar is above normal. Seeing the doctor may be the first step in getting the help you need to reduce your risk for developing type 2 diabetes.

First, recognize that there IS something you can do about it and resolve to make the necessary changes in your lifestyle to avoid getting diabetes. This means educating yourself by reading, going to classes, and asking questions of your healthcare provider.

Second, get moving! If you are sedentary, start getting more exercise. It is recommended that we get 30 minutes of exercise per day. I will be the first to admit, this is a tough step. But it is also important to get started. I started with a 10 minute walk and worked up to 30 minutes per day. The more you move, the better. Swim, bike, walk the mall. Find something you like to do and get started.

Third, try to lose some weight. Even a few pounds will make a difference. And finally, change your eating habits so that you are limiting fats and eating more fiber. Starting out, I targeted my nutritional goals as 30% calories from fat, 50% from carbohydrate and 20% from protein sources. Because I also have heart disease, I targeted my sodium intake to be 1500 mg to 2000 mg per day. Try to eat the same amount of carbohydrate every day. This helps to keep your blood glucose more stable. Also, find ways to add fiber to your diet. Fiber slows the absorption of glucose and helps to keep your sugar level more level. My fiber goal each day is 30 grams. It seems like a lot, but you can find foods that fit in nicely to your eating habits. 

One that I have found is Chia seeds. It packs about 9 grams of fiber in 2 tablespoons. It mixes well with yogurt and makes an easy way for me to reach nearly one third of my daily fiber goal. There are high fiber breakfast bars (9 grams) and some high fiber breads (6 gm/slice) to make it easier. Add some natural fruit fiber and you are there.

As a daily guide, I read labels and apply the "plate" theory to my meals.  in short, the plate planner is simply dividing your plate into quarters.  One quarter is for lean protein (3 ounces), one for starch (1/3 Cup rice)  and the remaining half for vegetables (carrots, broccoli, salad).

That was my starting point. I am struggling with the exercise, but committed to making it happen. I just recently had my fasting blood drawn again and while my glucose is down to 102, it is still in the prediabetic range. Further, my glycohemoglobin (HbA1c) increased slightly. The HbA1c give us information about how well we have controlled our glucose in the preceeding 2-3 months. That being said, I reviewed my targets and goals and did some more reading. I came across some research done at the University of Minnesota that confirmed in my mind one of the conflicts I have with the nutritional targets I had chosen.

On 1500 - 1800 calories (yes, I keep a daily food log) I was not losing weight. Exercise helped, but for the most part, I just maintained my weight. In the past, it seemed the only diet that worked for me to lose weight was a low carb diet (Atkins). Unfortunately, my cardiologist did not agree and I found that it was not a long term solution for me. But, fewer carbs and more protein did seem to work for me. The authors of the University of Minnesota study coined the term LoBAG diet meaning low-biologically-available-glucose. In other words, a non-ketogenic low carb diet.

In their study, authors Mary Gannon and Frank Nuttall found that subjects who consumed a diet with a carbohydrate to protein to fat ratio of 20:30:50 (test diet) compared to a control diet of 55:15:30 had lower glucose levels and lower HbA1c levels after 5 weeks. They did not notice any change in cholesterol which would be a concern when increasing the percentage of fat from 30% to 50%. The authors surmise that "Potentially, this could be a patient-empowering way to ameliorate hyperglycemia without pharmacological intervention." They further noted that more work needs to be done to evaluate the long term effects of such a diet.

In managing my care with my healthcare provider, I have recalculated my nutritional targets to 40% fat, 30% carbohydrate and 30% Protein. That is a 20% reduction in carbohydrate calories. I will maintain my initial target for cholesterol at less than 200 mg per day noting variances on a daily basis, fiber at 30 grams per day, and sodium at 1500 mg per day. Using my food journal, I can easily monitor my consumption and make my meal plans accordingly.  Lastly, I am committed to bring stability to my exercise goal with 30 minutes of walking per day at 3.5 mph or more.

Gannon and Nuttall conclude that "a LoBAG diet can dramatically reduce the 24-hour glucose concentration and consequently the percentage of glycohemoglobin in people with Type 2 diabetes. These positive results occur without a significant change in serum lipids, except for a significant decrease in triacylglycerol concentration."

Their work is referenced as "Effect of a High-Protein, Low Carbohydrate Diet on Blood Glucose Control in People with Type 2 Diabetes". It seems promising as a methodology to lower HbA1c and is encouraging to me as a prediabetic type 2.

TO BE CONTINUED...

This concludes Part 1. I will end this series in Part 2 with a report on my personal experiences over the next few weeks including lab results and discussion points from my healthcare provider. I look forward to your comments and questions.