For years, a high carbohydrate and low-fat diet reigned supreme as the recommended dietary approach for individuals managing type 2 diabetes. However, recent studies suggest that a shift towards a low-carbohydrate, high-fat diet might offer significant benefits. Researchers and nutrition experts are now exploring how these dietary changes could lead to improvements in cholesterol levels and potentially assist in the remission of type 2 diabetes.
A study published in January 2023 revealed that 51% of participants with type 2 diabetes achieved remission after adhering to a low-carb diet. This finding is particularly significant as people with type 2 diabetes face higher risks of developing high cholesterol, a known contributor to heart disease. In October 2024, further research highlighted that a low-carbohydrate diet might enhance beta-cell function, thereby simplifying disease management for those affected.
The carbohydrate-reduced high protein (CRHP) diet, which consists of 30% calories from carbohydrates, 30% from protein, and 40% from fats, has been instrumental in these findings. This dietary approach contrasts with the conventional diabetes diet, which typically includes 50% carbohydrates, 17% protein, and 33% fats. Studies have shown that the CRHP diet can effectively reduce triacylglycerol-rich lipoproteins (TRLs), apolipoprotein B, and low-density lipoprotein (LDL) cholesterol while increasing high-density lipoprotein (HDL) cholesterol.
The Isoenergetic (Iso) study, involving 30 participants with type 2 diabetes, confirmed the effectiveness of the CRHP diet in managing cholesterol levels. Similarly, the Hypoenergetic (Hypo) Study, which included 72 participants, noted that weight loss resulting from the CRHP diet contributed to reductions in TRL and LDL levels while boosting HDL cholesterol.
Monique Richard, MS, RDN, LDN, emphasizes the importance of whole, unprocessed foods for those with type 2 diabetes or prediabetes. She advocates for incorporating a variety of carbohydrate sources such as whole grains, fruits, and vegetables into their diets.
“We know that patients with type 2 diabetes have higher risk for cardiovascular disease, regardless of the cholesterol levels, because the glucose in the blood can damage the lining of the blood vessels — we call it vascular injury,” — Monique Richard, MS, RDN, LDN
Nonetheless, Richard advises against completely eliminating carbohydrates from one's diet.
“Cutting out carbs completely typically is not beneficial in the long-term either. We need carbohydrates for fuel, for brain health, for fiber, for numerous reasons. However, it is about the type, the amount, and the quality of carbohydrates needed alongside protein and fat per individual that can make a significant difference.” — Monique Richard, MS, RDN, LDN
Richard underscores the importance of personalizing dietary choices based on individual responses to different foods.
“When educating my clients and patients on carbohydrates I let them know that ‘nothing is off the table’ (pun intended). It is all about understanding portion sizes as well as how that food acts in your body. One individual with diabetes may have a very different blood glucose reaction from pizza compared to another individual with diabetes,” — Monique Richard, MS, RDN, LDN
Yu-Ming Ni, MD, provides a cautious perspective on these findings.
“Usually low carbohydrate diets come with higher fat intake (and) that higher fat and cholesterol intake tends to lead to higher levels of cholesterol, so this finding would be a little bit unusual. I’d like to see it replicated in larger studies, but whether that actually leads to a reduction in cardiovascular disease is debatable, because we do know that generally higher carbohydrate, lower fat diets such as the Mediterranean diet tend to be a little bit more healthy and have lower rates of cardiovascular disease. My first reaction is definitely interesting and probably needs follow-up.” — Yu-Ming Ni, MD
As researchers continue to investigate dietary approaches for managing type 2 diabetes, it is clear that more studies are necessary to fully understand their effects. The complexity of individual responses to diets and the challenges inherent in dietary research mean that definitive answers remain elusive.
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