The chronic metabolic disease known as type 2 diabetes mellitus (T2DM) is marked by elevated levels of blood glucose (persistent hyperglycemia), insulin resistance, and insufficient insulin action and production.

Data from the Ghana Health Service (GHS) from 2017 to 2019 show that diabetes mellitus (DM) is a prevalent condition and a major cause of death in Ghana. In 2016, the Ghana Diabetes Association (GDA) reported that almost 4 million persons have diabetes in the country.

According to non-population-based studies, the prevalence of diabetes ranges from 6% - 9% in the adult population. Diabetes is a major contributor to cardiovascular illnesses, including chronic kidney, strokes, heart attacks, peripheral vascular disorders, and amputations.

Diabetes management requires suitable lifestyle changes to maintain glucose control while preventing complications. The low carbohydrate diet (LCD) is one dietary approach that is gaining popularity in the treatment of diabetes, particularly Type 2. It has recently emerged as a promising dietary option to improve glycemic control and overall wellness in diabetics.

LCDs are a broad category in which carbohydrate consumption is controlled and restricted, with varying percentages of remaining calories from other macronutrients (fats and proteins). There is no agreement on the parameters of these diets, and several phrases are used to refer to them, such as 'low carb, high protein' or 'low carb, high fat', depending on the macronutrient modification and focus.

When it comes to the diet's carbohydrate component, LCD definitions vary from low carbohydrate  to very low carbohydrate or ketogenic diets. The justification for using low-carbohydrate diets to manage diabetes stems from the awareness that carbohydrates are the principal macronutrient that influence the levels of glucose in the blood. Reducing carbohydrate intake can restrict the quantity of glucose that enters the bloodstream, potentially improving glycemic control.

How Low-Carbohydrate diets impact blood sugar

Low-carbohydrate diets help with diabetes control by lowering blood sugar levels and reducing insulin surges. Carbohydrates, particularly refined and high-glycemic types, are quickly converted into glucose, raising blood sugar levels. For people with diabetes, where insulin activity is reduced, this increase in blood glucose can be difficult to regulate and may result in chronic hyperglycemia.

By limiting carbohydrates, the diet successfully minimizes the requirement for high amounts of insulin to metabolize glucose, lowering insulin resistance. According to research, reducing carbohydrate intake can improve hemoglobin A1c levels, a long-term indication of blood sugar control, providing a sustainable strategy for those with Type 2 diabetes.

The Role of Ketosis in Energy Utilization and Metabolism

When the intake of carbohydrates is reduced, the body depends more on stored fat for energy, resulting in a metabolic state known as ketosis, in which it uses ketone bodies instead of glucose as fuel.

This change can encourage increased fat oxidation and weight loss, which are helpful for many diabetics. According to research, entering ketosis may help lower appetite and caloric intake, promoting weight loss and enhanced metabolic function. However, it is critical to closely monitor ketosis because an imbalance can develop to diabetic ketoacidosis (DKA) in people with Type 1 diabetes, which is a fatal condition that requires swift medical attention.

Weight Management and heart health benefits

In addition to improving glycemic control, low-carbohydrate diets have also been associated with weight loss in people with diabetes. Excess weight is a significant risk factor for the development and progression of type 2 diabetes, and weight loss can have a positive impact on insulin sensitivity, glucose tolerance and overall metabolic health.

Low-carbohydrate diets may help promote weight loss by lowering calorie intake and reducing insulin-stimulated fat storage. Some studies have shown a positive correlation between taking low carbohydrate diet and weight management, albeit individual responses varied. Furthermore, low-carbohydrate diets are seen to improve cardiovascular health markers such as lowering triglyceride levels and increasing HDL cholesterol levels, both of which are frequently compromised in diabetes and linked to an elevated risk of cardiovascular disease.

Nutritional balance and potential challenges

Although low-carb diets have benefits, they also have drawbacks, especially when it comes to guaranteeing adequate nutrition. Individuals who reduce their carbohydrate intake may unintentionally lose out on vital nutritional sources of fiber, vitamins, and minerals, such as fruits and vegetables and whole grains. Consuming enough fiber, for example, is essential for blood sugar regulation and gut health.

To address this, a low-carbohydrate diet should include fiber-rich, non-starchy vegetables, nuts, seeds, and low-glycemic fruits. Furthermore, carbohydrate restriction should be combined with a healthy fat and protein intake to provide adequate energy and maintain overall health. Lean proteins and heart-healthy fats like olive oil, avocado, and fatty fish are recommended to improve satiety and cardiovascular health without jeopardizing blood sugar control.

Considerations for individualized care

A low-carbohydrate diet can be challenging for some individuals in terms of its long-term sustainability. It is essential to find an eating pattern that aligns with an individual's values, preferences, needs, and treatment goals.

A dietitian can suggest ways to modify carbohydrate intake as people transition to or from a low carbohydrate eating pattern. Individualization is crucial for effective diabetes control with a low-carbohydrate diet, as factors like age, medication use, exercise level, and personal health goals should be considered.

It is important to note that, the implementation of a low-carbohydrate diet may require adjustments to diabetes medications, especially for those on insulin or other glucose-lowering drugs (sulfonylureas). These individuals must work closely with their healthcare providers to regularly monitor and make modifications necessary to prevent hypoglycemia.

A personalized approach, taking into account an individual's unique needs and preferences, is recommended for long-term success of a low carbohydrate dietary intervention. Patients should receive appropriate and ongoing education and support to support adherence and informed choices.

In summary

Low-carbohydrate diets have shown promise in managing diabetes, particularly Type 2 diabetes, by improving glycemic control, insulin sensitivity, HbA1C and promoting weight loss. However, their implementation requires collaboration with healthcare providers, careful medication adjustments, and a personalized approach.

When tailored to individual needs and combined with regular medical supervision, this dietary approach can help individuals better control their condition and reduce the risk of complications. Long-term adherence, nutrient balance, and potential challenges must be addressed to ensure safety and effectiveness. Further research and clinical support will refine and personalize dietary strategies, advancing diabetes management to meet the diverse needs of those affected by this condition.

Written by Dr. Laurene Boateng (PhD, RD) and Pearl Kudexa (MSc, RD)

Laurene Boateng (PhD, RD) is a Registered Dietitian and Senior Lecturer in the Department of Dietetics, University of Ghana. She is the founder and editor-in-chief of www.fullproofnutrition.com , a website committed to providing reliable, evidence-based, and practical healthy eating advice.

Pearl Kudexa (MSc, RD) is a Registered Dietitian and contributing writer for www.fullproofnutrition.com

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References

Chao, Y. S., & Butcher, R. (2019). Low Carbohydrate Diets for Diabetes: A Review of the Clinical Effectiveness and Guidelines. Canadian Agency for Drugs and Technologies in Health.

Galali, Y., Zebari, S. M. S., Aj Jabbar, A., Hashm Balaky, H., Sadee, B. A., & Hassanzadeh, H. (2024). The impact of ketogenic diet on some metabolic and non-metabolic diseases: Evidence from human and animal model experiments. Food science & nutrition, 12(3), 1444–1464.

Ghana Steps Report. (2023) https://www.afro.who.int/sites/default/files/2024-11/GHANA%20STEPS%20REPORT%202023.pdf