The Low carb Diet
In the early 1980s, people with type 2 diabetes were advised to adopt a diet that included, eating small frequent meals, eating carbohydrate with each meal. carbohydrates should form at least 50 percent of all energy (calories) consumed, complex carbohydrates (starches should be eaten rather than simple carbohydrates such as sugars), the diet should be high in fiber and low in fat. Calorie intake should be restricted to enable people to lose weight.
Very little information was available regarding what this diet actually meant in practice. In addition, more patients have been encouraged to increase physical activity levels and again, very little information was provided about what would this translate to in real practice.
It’s not surprising then that ‘diet and exercise’ were often ineffective in controlling blood glucose levels and this has led to the use of medications as the main mode of management and control type 2 diabetes.
We have for a long time understood type 2 diabetes as a progressive disease requiring oral hypoglycemic medications and eventually insulin. However, in recent times, it has become certain that the process can be halted and reversed with the restoration of normal carbohydrate and fat metabolism.
The first evidence that diabetes can be reversed came from bariatric surgery (10)(11). Blood sugar levels of patients who had bariatric surgery for treatment of obesity normalized. After 10 years, 90% of these patients remained free from diabetes. The fact that patients who had bariatric surgery experienced normalized blood sugar levels in 7 days post-surgery, even before losing weight signify the importance of decreased calorie intake. Thus, it was, in fact, the decreased calorie intake associated with bariatric surgery that leads to normalization of blood glucose levels(3).
Over the last couple of years, studies have now focused on the low carbohydrate diet/hypocaloric diet on management and control of diabetes. The DIRECT study, a primary care-based study done in Scotland and Tyneside revealed that at 12 months, half of the participants achieved remission to a non-diabetic state and off antidiabetic drugs.
In 2009, the American Diabetes Association defined reversal (or remission) of diabetes as follows(12):
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