In the ever-evolving field of nutritional science, the question of what constitutes a healthy diet remains a topic of significant debate. This is especially relevant for individuals with type 2 diabetes, where dietary choices play a crucial role in disease management. Recent studies have illuminated the potential benefits of a low-carbohydrate, high-protein diet, known as the carbohydrate-reduced high protein (CRHP) diet, in managing cholesterol levels and improving beta-cell function in individuals with type 2 diabetes.
The CRHP diet, which consists of 30% of calories from carbohydrates, 30% from protein, and 40% from fats, presents a stark contrast to the conventional diabetes diet that recommends 50% of calories from carbohydrates, 17% from protein, and 33% from fats. This dietary shift aims to reduce the intake of carbohydrates while increasing protein and fat consumption, potentially offering a new avenue for managing type 2 diabetes effectively.
Recent research underscores the potential advantages of this dietary approach. The Iso Study revealed that participants on the CRHP diet reduced triacylglycerol-rich lipoproteins (TRLs), apolipoprotein B, and LDL cholesterol, while simultaneously increasing high-density lipoprotein (HDL) cholesterol, also known as "good" cholesterol. These findings suggest that replacing some dietary carbohydrates with protein and fat may significantly enhance cholesterol levels in individuals with type 2 diabetes.
Traditionally, a high-carbohydrate and low-fat diet was considered the optimal choice for managing type 2 diabetes. However, emerging evidence suggests that a low-carbohydrate diet may improve beta-cell function, making the disease more manageable. The first Isoenergetic (Iso) study included 30 participants with type 2 diabetes, while a subsequent Hypoenergetic (Hypo) Study involved 72 participants. The Hypo Study found that following the CRHP diet was associated with decreased intrahepatic triacylglycerol (IHTG) compared to those following the conventional diabetes diet.
Further supporting these findings, a study published in January 2023 reported that 51% of participants achieved type 2 diabetes remission following a low-carb diet. This remarkable statistic highlights the potential of dietary interventions in managing and possibly reversing the course of the disease.
Despite these promising results, experts caution against completely eliminating carbohydrates from the diet. Monique Richard, MS, RDN, LDN, emphasizes the importance of carbohydrate quality and quantity:
“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 further elaborates on the nuanced approach required when educating individuals about carbohydrate intake:
“Often the first-line of addressing glucose control when working with those who have prediabetes or diabetes is adjusting carbohydrate intake as well as educating about why it matters (hint, carbohydrates break down to glucose which in turn affects blood glucose regulation), the quality, the variation among carbohydrate food groups (the carbohydrate profile of a donut is much different than the amount of carbohydrate in broccoli, or even a potato), and all the nuances in between.” — Monique Richard, MS, RDN, LDN
Yu-Ming Ni, MD, acknowledges the atypical nature of these findings but calls for further research:
“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
For those managing type 2 diabetes, finding suitable carbohydrate alternatives can be beneficial. Foods like potatoes with skin and sweet potatoes offer good sources of fiber and can be enjoyed with alternative toppings. Additionally, incorporating spaghetti squash, cauliflower, or shirataki noodles instead of pasta can significantly decrease carbohydrate intake while adding vital nutrients.
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