Can low-carbohydrate diets be more effective than medications?

• Beta cells are pancreatic cells responsible for producing and releasing insulin, a hormone that helps control blood sugar levels.
• A recent study indicates that adults with mild type 2 diabetes can improve beta cell function by following a low-carb diet.
• Experts are concerned about the sustainability of the low-carb diet, but offer tips for success and alternative, evidence-based ways to improve beta cell function.

Beta cells are specialized pancreatic cells that produce and release the hormone insulinwhich helps regulate blood sugar levels.

People from type 2 diabetes you have a reduced response of beta cells to blood sugar levels. This may be partly due to excessive carbohydrate consumption.

Combination of beta cell failure and insulin resistance drives the development and progression of type 2 diabetes.

About one in 10 Americans has diabeteswith 90-95% of these cases being type 2, making it one of the most common and largely preventable chronic diseases in the United States.

A new study suggests that following a low-carb diet may improve beta cell function in adults with mild type 2 diabetes.

This approach may help them manage their disease more effectively and possibly eliminate the need for medications.

This randomized, controlled trial included 57 black and white adult men and women, ages 35 to 65, with “mild” type 2 diabetes.

Study participants had received a diagnosis of type 2 diabetes within the past 10 years and were treated with diet or medication, but not insulin.

Researchers asked participants to stop taking their medications one or two weeks before the baseline examination. Participants were then assigned to one of two diets for 12 weeks:

• a low-carbohydrate diet, containing approximately 9% carbohydrates and 65% fat
• a higher carbohydrate diet, containing approximately 55% carbohydrates and 20% fat.

They wanted to see if a lower-carbohydrate diet would improve participants’ beta cell response to sugar (glucose) compared to a higher-carbohydrate diet.

Both diets were designed by a registered dietitian to be “eucaloric,” meaning they provided each participant with the number of calories they needed to maintain their body weight.

The study provided participants with daily meals, detailed meal plan instructions, and weekly meetings with a registered dietitian.

During the dietary intervention, two participants in the higher-carbohydrate group and one in the lower-carbohydrate group resumed the diet metformin drugs and their data were included in the results.

After 12 weeks, researchers observed significant improvements in beta cell function and insulin release among participants on the low-carb diet compared to participants on the high-carb diet.

Specifically, they found that people following a low-carb diet saw improvement ANDinitial (fast) and maximum beta cell response, which was twice and 22% greater, respectively, compared to the response on a high-carbohydrate diet.

Results from an oral glucose tolerance test showed that after 12 weeks, the low-carb diet improved the effect of insulin on blood glucose levels by 32%.

Across all groups, black adults on a low-carbohydrate diet showed a 110% greater improvement in rapid beta-cell response compared to those on a high-carbohydrate diet. This effect was not observed in Caucasian adults.

Conversely, white adults had a 48% greater improvement in maximal beta cell response compared to those on a high-carbohydrate diet, which was not seen in black adults.

The study authors suggest that the differences in responses to dietary intervention observed across races may be due, in part, to biological differences in beta cell function.

Black adults may have a higher immediate insulin response to glucose compared to white adults, even if their levels of insulin sensitivity are comparable.

They concluded that “while (carbohydrate restriction) may be difficult for some patients, such a diet may allow patients with mild disease (type 2 diabetes) to go off medications and enjoy eating meals and snacks that meet their energy needs, while while improving beta cell function, something that cannot be achieved with drugs.”

The study showed this insulin sensitivityor the effectiveness of the body’s use of insulin, did not change significantly as a result of dietary interventions. Therefore, changes in insulin sensitivity are unlikely to account for the improved beta cell response characteristic of a low-carbohydrate diet.

In other words, the improvement in beta cell response was likely due to something other than changes in insulin sensitivity.

More research is needed, but Medical news today talked to Thomas M. Holland, MD, MSphysician-scientist and adjunct professor at the RUSH Institute for Healthy Aging, RUSH University, College of Health Sciences, who was not involved in the study to better understand how a low-carb diet can improve beta cell function.

“A carbohydrate-restricted diet may improve pancreatic islet beta cell function in people with mild type 2 diabetes by reducing the burden on beta cells to produce insulin. “This improvement is likely due to less glucose (from carbohydrates) entering the bloodstream, which reduces the need for beta cells to secrete insulin, potentially reversing some of the beta cell dysfunction caused by glucose toxicity.”

“While this benefit is more pronounced in people with mild diabetes, it may still help people with prediabetes (with an HbA1c of around 5.7-6.4%) or even people with more advanced diabetes, although the degree of improvement may vary depending on per person – added the Dutchman.

Holland emphasized that “a restricted-carbohydrate diet may be beneficial in the treatment of type 2 diabetes, but adherence, especially among older people, can be challenging.”

To make a low-carb diet more sustainable, he recommended:

• incorporating flexibility in carbohydrate intake while prioritizing whole, unprocessed or minimally processed foods high in fiber and nutrients
• diversifying and making the diet enjoyable
• monitor your blood sugar levels regularly, especially when adjusting or reducing your medication dosage under your doctor’s guidance
• consultation with a doctor is aimed at adapting the diet to individual health needs.

“While the ketogenic (very low-carbohydrate) diet can be effective when followed correctly, under the guidance of a dietitian or physician, a serious concern is the potential for a rebound effect when carbohydrates are reintroduced,” Holland warned.

He explained that these rebound effects can cause “significant weight gain and stress on beta islet cells to ensure adequate insulin production,” which could lead to negative health effects.

MNT he also talkedSheri Gaw, RDN, CDCESa registered dietitian, certified specialist in diabetes care and education, and owner of The Plant Strong Dietitian, who was also not involved in the study.