Research & Education

Low Carb in the Limelight

“It is clear that we made a major mistake in recommending the increase of carbohydrates load to >40 % of the total caloric intake. This era should come to an end if we seriously want to reduce the obesity and diabetes epidemics. Such a move may also improve diabetes control and reduce the risk of cardiovascular disease. Unfortunately many physicians and dietitians across the nation are still recommending high carbohydrates intake for patients with diabetes a recommendation that may harm their patients more than benefit them.”

--Hamdy O. US Endocrinology 2014;10(2)103–4  

This was written two years ago by Osama Hamdy MD medical director of the obesity and inpatient diabetes programs at the Joslin Diabetes Center at Harvard Medical School. It’s hard to believe more doctors and mainstream nutrition and dietetics organizations have not embraced the therapeutic potential of low-carbohydrate diets particularly when one takes into consideration the cost and side-effects of medication commonly prescribed to help manage many of the conditions low-carbohydrate diets have been shown to be effective for. (The short list of these includes type 2 diabetes type 1 diabetes metabolic syndrome dyslipidemia indicators of cardiovascular disease GERD PCOS and bipolar disorder.) 

The good news is word is trickling out to the public via very some very prominent coverage recently in The New York Times. Dr. Hamdy collaborated with Sarah Hallberg DO on an op-ed piece published on September 11 2016 titled “Before You Spend $26000 on Weight-Loss Surgery Do This.” The “this” refers to a low-carbohydrate diet. Patients should be informed that while it might seem like they’ve “tried everything” if they’ve never tried going a few months without all those supposedly “healthy whole grains” fat-free starchy foods and fruit smoothies it would be worth giving that a go before subjecting themselves to having their internal organs sliced & diced and setting themselves up for a lifetime of potential side-effects such as nutrient deficiencies and life-threatening infections. As Drs. Hallberg and Hamdy wrote “We owe our patients with diabetes more than a lifetime of insulin injections and risky surgical procedures.”

There may be patients of course for whom dietary and lifestyle changes are just too much of an emotional obstacle to implement on their own and surgery might be a good first step that helps them get started. But like Dr. Hamdy said it’s high time to put an end to encouraging high carbohydrate intakes across the board without taking into consideration someone’s metabolic suitability for such an approach. When someone’s blood glucose and insulin go sky-high upon consumption of large amounts of easily digestible carbohydrate the advice should not be to consume as much of it as they please and “take more insulin.” (After all no one would advise someone with a peanut allergy to eat all the peanut butter they want and just be sure to have an epi-pen handy.) Moreover many type 2 diabetics are already hyperinsulinemic. The last thing they need is more insulin. What they might benefit from far more is removing the dietary element that is causing blood sugar and insulin to rise so high in the first place. (Dietary carbohydrate is only one of many factors that influence insulin levels but it is the one most germane to the topic at hand.)

One thing is certain: something other than insulin is needed—and needed drastically and immediately—for the treatment of type 2 diabetes because insulin is not helping. While insulin will lower blood glucose acutely over the long-term as many diabetics can attest it only leads to more complications and co-morbidities. In fact a systematic literature review including all randomized clinical trials that compared the use of insulin hypoglycemic drugs placebos or dietary interventions for type 2 diabetes published between 1950 and 2013 came to the shocking—or really not shocking—conclusion “There is no significant evidence of long term efficacy of insulin on any clinical outcome in T2D. However there is a trend to clinically harmful adverse effects such as hypoglycaemia and weight gain. The only benefit could be limited to reducing short term hyperglycemia.” With friends like that who needs enemies?

More and more information is coming out about how misguided the standard dietary advice of the late 20th and early 21st Centuries has been. The sugar industry may have even had a direct role in demonizing fat and leading healthcare and nutrition professionals on an unfounded scientific witch hunt against saturated fat which has taken over six decades to undo. Unfortunately however despite subtle changes and slow movement toward recognizing bio-individuality and the potential dangers of blanket dietary recommendations the majority of laypeople seem to find out about the efficacy of the low-carbohydrate approach not from their physicians or dietitians but rather from friends family or coworkers or from forums and blogs on the Internet.

Generalized dietary recommendations are part of what got us into this mess in the first place so it would be wrong to claim that low-carb is right for everyone. It isn’t. But at the very least it should be offered and encouraged as a safe effective and low-cost intervention that requires nothing more than a change in mindset about what constitutes a “healthy diet.” (And maybe a supermarket tutorial about what low-carb food shopping looks like.) Most of all this encouragement should come from educated and trusted medical professionals more so than strangers online. It’s time for low-carb to move from the fringe to center stage.