Remission, Carbs and Diabetes, what’s the deal
Type 2 Diabetes (T2D) is a chronic disease that effects people from all walks of life all over the globe. It is well documented that some communities such as the South Asian and Afro Caribbean community are at a higher risk of developing T2D. Other risk factors include obesity, inactive lifestyle, age, family history and polycystic ovary syndrome.
Factors such as diet and lifestyle are key in reducing the risk of developing T2D as well as managing blood glucose levels for those diagnosed with diabetes. Diet and lifestyle changes can also lead to remission of T2D. This document focuses on the low carbohydrate (carb) diet approach which can improve diabetes control and assist in achieving remission.
What is remission of Diabetes
Complete remission is 1 year or more of normal HBA1C and fasting glucose levels without the use of diabetes medications
Often referred to as ‘reversal’ of diabetes, this is when a person has been diagnosed with T2D but has managed to eliminate the signs and symptoms of the disease through diet and lifestyle changes alone and the blood glucose levels have returned to a healthy level, HBA1c levels below 48mmols(6.5%,for one year or more . These diet and lifestyle changes may also have resulted in weight loss which in itself can induce remission of diabetes.
The term reversal is misleading as diabetes cannot be reversed but can be in remission, should a person who has achieved remission revert to a poor diet and unhealthy lifestyle the diabetes signs and symptoms will return. Therefore it is misleading to state that the condition can be reversed.
If remission is achieved it is important to continue to have regular healthcare check-ups to ensure that your blood glucose levels remain in the healthy range, HBA1c below 48mmols and any early signs of diabetes related complications can be detected early.
How can remission be achieved
Weight loss has been shown to be effective in achieving remission in T2D this weight loss can be achieved by a calorie reduction and increase in physical activity. There are many ways to achieve a calorie intake reduction, through meal replacements, reducing portion sizes or reducing the intake of high calorie foods.
What about carbohydrates
Carbs fall into two basic categories: refined and complex.
Carbs are our bodies preferred source of energy and all carbs break down to provide glucose to the body. Our brains in particular rely on glucose for energy, having sufficient carbs in the diet prevents muscle degradation and also assists in fat metabolism. Carb foods also provide fibre which is important for long term health; other nutrients found in complex carbs include B vitamins, calcium, and iron. The type, quality and quantity of carbs is important and it is these factors that impact blood glucose levels and body weight.
Refined carbs can lead to spikes in blood glucose levels as they are easily digested and release glucose into the blood stream rapidly. Examples of refined carbs are white bread, biscuits, pastries, cornflakes, cakes and sugary drinks. Complex carbs take longer to digest and cause a slower rise in blood glucose levels, some examples of complex carbs are granary bread, rolled oats, sweet potatoes, potatoes, rice, wholegrain chapattis and pasta. Foods that cause a rapid rise in blood glucose levels are termed as having a high glycaemic index (GI) whilst those that are digested slower and cause a slower rise in blood glucose levels are termed as having a low GI. Foods that have a lower GI are recommended as a healthier option of carbs.
Current evidence suggests that low-carb diets can be safe and effective for people with T2D. They can help with weight loss and blood glucose management, and reduce the risk of cardiovascular disease. A low-carb diet may help people with T2D lose weight and achieve remission. However there is no consistent evidence that a low-carb diet is any more effective than other approaches in the long term, so it shouldn't be seen as the diet for everyone.
How can you lower the carbs in your diet
An initial step to lowering your carb intake is to identify how much of your current dietary intake is from carbs, a detailed diet history record will assist in identifying diet patterns and any hidden carbs you may be having, these can be in the form of hidden sugars in foods or drinks. An initial reduction of 40 -50% of current carb intake for most people can often yield positive benefits for blood glucose control and weight loss. This may not be relevant to everyone and advice should be sought from a dietitian who can accurately assess calorie requirements and provide an accurate value for total carb intake for a low carb plan. The low-carb diet must be adjusted according to your individual needs, this will be dependent on your physical activity levels, your age, gender and any other medical conditions you may be managing. Remember, we don't all need to eat the same amount of calories. Currently, there is no agreement on the definition of a low-carb diet - but, anything providing less than 130g/day of a 2000kcal diet (26 per cent of energy) is considered 'low-carb'. Anything less than 30g/day of 2000kcal diet (6 per cent energy) is considered very low-carb ketogenic and is not recommended as research suggests this is not sustainable even in the medium term.
If you decide to follow a low-carb diet, it's important that the carbs you do choose support a healthy, balanced diet. You should include fruits and vegetables, beans and pulses, dairy and low GI carbs. Cutting down on refined carbs, added sugar, cakes, biscuits and sugary drinks etc. is a good way to reduce your carbohydrate intake. Some diets suggest replacing carbs with fats (particularly saturated fat), however this may increase your risk of heart disease and may make it more difficult to lose weight as fat is high in calories. If weight loss is not desired than fat intake can be increased however it is advisable to opt for mono unsaturated and polyunsaturated fats in place of saturated fats.
Monounsaturated fats are found in:
• olive oil, rapeseed oil and their spreads
• avocados
• some nuts, such as almonds, brazils and peanuts
There are two main types of polyunsaturated fats: omega-3 and omega-6.
Some types of omega-3 and omega-6 fats can't be made by the body and are therefore essential in small amounts in the diet.
Omega-6 fats are found in vegetable oils, such as:
• rapeseed
• corn
• sunflower
• some nuts
Omega-3 fats are found in oily fish, such as:
• mackerel
• kippers
• herring
• trout
• sardines
• salmon
Protein foods can also be increased to replace carbs, opt for lean meats, eggs and fish. For those following a vegetarian diet, nuts, yoghurts, soya based foods and Quorn are all useful alternative protein food choices, be careful with some vegetarian alternative food as they can have carb based fillers in, check the carb content of these foods if you are including these in your diet. Lentils and pulses are all good sources of protein and also contain some carbs so again remember to count the carbs in these foods if you are having them.
If weight loss is a goal then aim to have 50% of your meals based on Salads and vegetables, be careful with dressings and additions to salads etc. as sauces and dressings can often be high in sugars.
If you snack between meals ensure these are a low carb variety such as nuts, berries, low sugar or natural yoghurts or high grain cracker with lean meat/ cheese - aim to keep snacks under 10g of carbs
Medications and the low carb diet
Reducing the amount of carbohydrate in your diet may cause a rapid drop in your blood glucose levels and cause hypoglycaemia. This will require a medication review to be carried out by your GP, practice nurse or Diabetes team. Often medications will need to be reduced or stopped, this should only be done under supervision and supported by blood tests and monitoring of blood glucose levels to ensure they are well controlled. If you want to try the low carb diet then discuss this with your health care professional to ensure you receive the appropriate level of support.
People with Type 1 diabetes who have a healthy body weight and good blood glucose control should not follow a low carb plan. The most effective way to improve blood glucose levels in type 1 diabetes is to match insulin with amounts of carbohydrate being eaten; this is known as carbohydrate counting. Evidence for low-carb diets in children reports adverse effects such as poor growth, a greater risk of cardiovascular disease, and psychological problems. Low-carb diets are therefore not recommended for children with diabetes. Women with gestational diabetes should seek the advice of a dietitian to assess if dietary modification is appropriate during pregnancy.
Further links
low carb meal plan; www.Diabetes.org.uk
Diabetes UK interim position statement on remission in adults with Type 2 diabetes www.diabetes.org.uk
Diabetes Remission Clinical Trial 2017; www.Directclinicaltrial.org.uk
Dietary fat consumption in the management of type 2 diabetes www.bda.uk.com
Type 2 Diabetes in adults: management 2017 www.nice.org.uk
Risk factors for heart disease ; www.bhf.org.uk
Carbs and Cals world foods ;www.carbsandcals.com
Factors such as diet and lifestyle are key in reducing the risk of developing T2D as well as managing blood glucose levels for those diagnosed with diabetes. Diet and lifestyle changes can also lead to remission of T2D. This document focuses on the low carbohydrate (carb) diet approach which can improve diabetes control and assist in achieving remission.
What is remission of Diabetes
Complete remission is 1 year or more of normal HBA1C and fasting glucose levels without the use of diabetes medications
Often referred to as ‘reversal’ of diabetes, this is when a person has been diagnosed with T2D but has managed to eliminate the signs and symptoms of the disease through diet and lifestyle changes alone and the blood glucose levels have returned to a healthy level, HBA1c levels below 48mmols(6.5%,for one year or more . These diet and lifestyle changes may also have resulted in weight loss which in itself can induce remission of diabetes.
The term reversal is misleading as diabetes cannot be reversed but can be in remission, should a person who has achieved remission revert to a poor diet and unhealthy lifestyle the diabetes signs and symptoms will return. Therefore it is misleading to state that the condition can be reversed.
If remission is achieved it is important to continue to have regular healthcare check-ups to ensure that your blood glucose levels remain in the healthy range, HBA1c below 48mmols and any early signs of diabetes related complications can be detected early.
How can remission be achieved
Weight loss has been shown to be effective in achieving remission in T2D this weight loss can be achieved by a calorie reduction and increase in physical activity. There are many ways to achieve a calorie intake reduction, through meal replacements, reducing portion sizes or reducing the intake of high calorie foods.
What about carbohydrates
Carbs fall into two basic categories: refined and complex.
Carbs are our bodies preferred source of energy and all carbs break down to provide glucose to the body. Our brains in particular rely on glucose for energy, having sufficient carbs in the diet prevents muscle degradation and also assists in fat metabolism. Carb foods also provide fibre which is important for long term health; other nutrients found in complex carbs include B vitamins, calcium, and iron. The type, quality and quantity of carbs is important and it is these factors that impact blood glucose levels and body weight.
Refined carbs can lead to spikes in blood glucose levels as they are easily digested and release glucose into the blood stream rapidly. Examples of refined carbs are white bread, biscuits, pastries, cornflakes, cakes and sugary drinks. Complex carbs take longer to digest and cause a slower rise in blood glucose levels, some examples of complex carbs are granary bread, rolled oats, sweet potatoes, potatoes, rice, wholegrain chapattis and pasta. Foods that cause a rapid rise in blood glucose levels are termed as having a high glycaemic index (GI) whilst those that are digested slower and cause a slower rise in blood glucose levels are termed as having a low GI. Foods that have a lower GI are recommended as a healthier option of carbs.
Current evidence suggests that low-carb diets can be safe and effective for people with T2D. They can help with weight loss and blood glucose management, and reduce the risk of cardiovascular disease. A low-carb diet may help people with T2D lose weight and achieve remission. However there is no consistent evidence that a low-carb diet is any more effective than other approaches in the long term, so it shouldn't be seen as the diet for everyone.
How can you lower the carbs in your diet
An initial step to lowering your carb intake is to identify how much of your current dietary intake is from carbs, a detailed diet history record will assist in identifying diet patterns and any hidden carbs you may be having, these can be in the form of hidden sugars in foods or drinks. An initial reduction of 40 -50% of current carb intake for most people can often yield positive benefits for blood glucose control and weight loss. This may not be relevant to everyone and advice should be sought from a dietitian who can accurately assess calorie requirements and provide an accurate value for total carb intake for a low carb plan. The low-carb diet must be adjusted according to your individual needs, this will be dependent on your physical activity levels, your age, gender and any other medical conditions you may be managing. Remember, we don't all need to eat the same amount of calories. Currently, there is no agreement on the definition of a low-carb diet - but, anything providing less than 130g/day of a 2000kcal diet (26 per cent of energy) is considered 'low-carb'. Anything less than 30g/day of 2000kcal diet (6 per cent energy) is considered very low-carb ketogenic and is not recommended as research suggests this is not sustainable even in the medium term.
If you decide to follow a low-carb diet, it's important that the carbs you do choose support a healthy, balanced diet. You should include fruits and vegetables, beans and pulses, dairy and low GI carbs. Cutting down on refined carbs, added sugar, cakes, biscuits and sugary drinks etc. is a good way to reduce your carbohydrate intake. Some diets suggest replacing carbs with fats (particularly saturated fat), however this may increase your risk of heart disease and may make it more difficult to lose weight as fat is high in calories. If weight loss is not desired than fat intake can be increased however it is advisable to opt for mono unsaturated and polyunsaturated fats in place of saturated fats.
Monounsaturated fats are found in:
• olive oil, rapeseed oil and their spreads
• avocados
• some nuts, such as almonds, brazils and peanuts
There are two main types of polyunsaturated fats: omega-3 and omega-6.
Some types of omega-3 and omega-6 fats can't be made by the body and are therefore essential in small amounts in the diet.
Omega-6 fats are found in vegetable oils, such as:
• rapeseed
• corn
• sunflower
• some nuts
Omega-3 fats are found in oily fish, such as:
• mackerel
• kippers
• herring
• trout
• sardines
• salmon
Protein foods can also be increased to replace carbs, opt for lean meats, eggs and fish. For those following a vegetarian diet, nuts, yoghurts, soya based foods and Quorn are all useful alternative protein food choices, be careful with some vegetarian alternative food as they can have carb based fillers in, check the carb content of these foods if you are including these in your diet. Lentils and pulses are all good sources of protein and also contain some carbs so again remember to count the carbs in these foods if you are having them.
If weight loss is a goal then aim to have 50% of your meals based on Salads and vegetables, be careful with dressings and additions to salads etc. as sauces and dressings can often be high in sugars.
If you snack between meals ensure these are a low carb variety such as nuts, berries, low sugar or natural yoghurts or high grain cracker with lean meat/ cheese - aim to keep snacks under 10g of carbs
Medications and the low carb diet
Reducing the amount of carbohydrate in your diet may cause a rapid drop in your blood glucose levels and cause hypoglycaemia. This will require a medication review to be carried out by your GP, practice nurse or Diabetes team. Often medications will need to be reduced or stopped, this should only be done under supervision and supported by blood tests and monitoring of blood glucose levels to ensure they are well controlled. If you want to try the low carb diet then discuss this with your health care professional to ensure you receive the appropriate level of support.
People with Type 1 diabetes who have a healthy body weight and good blood glucose control should not follow a low carb plan. The most effective way to improve blood glucose levels in type 1 diabetes is to match insulin with amounts of carbohydrate being eaten; this is known as carbohydrate counting. Evidence for low-carb diets in children reports adverse effects such as poor growth, a greater risk of cardiovascular disease, and psychological problems. Low-carb diets are therefore not recommended for children with diabetes. Women with gestational diabetes should seek the advice of a dietitian to assess if dietary modification is appropriate during pregnancy.
Further links
low carb meal plan; www.Diabetes.org.uk
Diabetes UK interim position statement on remission in adults with Type 2 diabetes www.diabetes.org.uk
Diabetes Remission Clinical Trial 2017; www.Directclinicaltrial.org.uk
Dietary fat consumption in the management of type 2 diabetes www.bda.uk.com
Type 2 Diabetes in adults: management 2017 www.nice.org.uk
Risk factors for heart disease ; www.bhf.org.uk
Carbs and Cals world foods ;www.carbsandcals.com