Low-Carb: Not For Everyone

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This is half of a point/counterpoint debate. Read the other half, “Why I Low-Carb” by David Mendosa.

Deciding what to eat is a daily challenge for those of us with diabetes. Clearly, a lot of any fluctuation in blood sugar comes from eating carbohydrates, so it is not surprising that there are many advocates of low-carb diets, such as the Atkins Diet, which recommends eating large amounts of protein and very little carbohydrate. But despite its alleged benefits, I’m not in favor of a low-carb diet.

What am I in favor of? A smart diet. A diet that works for you personally, based on your health, your level of activity, your cultural or religious background, and your likes and dislikes. A smart diet is usually a combination of protein, healthy fat, and unrefined carbohydrate that includes lots of fruits and vegetables.

One of the main benefits of unrefined sources of carbohydrate is fiber. Fiber is essential to the health of the digestive system, and while it is possible to supplement a low-carb diet with adequate fiber, this can be difficult to do without unpleasant side effects. Legumes, such as beans and peas, are an excellent source of fiber and are packed with other important nutrients, but they are not allowed in many low-carb diets.

A low-carb diet is almost always a high-protein diet. While using protein for energy does limit changes in blood sugar, we should not forget that many people with diabetes will someday develop kidney problems. People who already have such problems should not be on a high-protein diet. And since kidney function can deteriorate gradually, with no symptoms for a long time, it is questionable whether people with diabetes should risk the strain that a high-protein diet puts on compromised kidneys.

Other people who probably shouldn’t be on a low-carb diet include athletes, who need carbohydrates to replenish their stores of glycogen, and children, who require a wide variety of nutrients to grow properly.

Being aware of all aspects of your health is important before making any dietary change. A recent study published in the New England Journal of Medicine, for example, found that a low-carb diet was better than a low-fat or Mediterranean diet for weight loss, but that a Mediterranean diet was best for lowering fasting blood glucose levels. The low-carb group also had the highest dropout rate, which is definitely something to consider when looking at the results. But diet studies can be deceptive, because there is often a large amount of individual variation among participants. Whether the goal is weight loss, blood sugar control, or improving cholesterol levels, there is usually no single solution that works best for everyone.

People with diabetes have a lot of tools at our disposal for blood sugar control. The glycemic index and new medicines like Symlin can help prevent the postmeal blood sugar spikes that give so many of us grief. Even taking insulin five or ten minutes before a meal can help.

My personal experiences with dietary changes have dealt more with weight loss than with blood sugar management. I have tried cutting out significant amounts of carbohydrate at various times in my life, but I find that it’s not a very realistic diet for me to be on for long. Being a young adult, I am trying to live my life as close to normal as possible. I test my blood sugar several times a day and take my insulin accordingly, and I focus on eating balanced meals so that I can enjoy special occasions with friends and family without feeling left out. I have found that exercise has a greater impact on lowering my insulin requirements than straight low-carb diets. I also enjoy carbs, so finding a way to balance everything — by correctly counting carbs, exercising, and occasionally taking Symlin — has helped lower my blood sugar levels while increasing my enjoyment of life.

When it comes to food, the discussion should not just focus on low-carb versus standard or low-fat diets; it should also focus on being smart about carbs. Avoiding the typical pitfalls of the American diet, like soda or potato chips, will do a lot for your health without the need to avoid all carbohydrates. While some people may find that a low-carb diet works for them, it should not be recommended across the board.

Ms. Blass is author of the blog Lemonade Life, which chronicles the effort to balance work, friends, and diabetes as a twentysomething in the New York City area. She has had Type 1 diabetes for 14 years.

Read the counterpoint to this piece, “Why I Low-Carb” by David Mendosa.


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