If you live with diabetes, you’ve seen some version of the following questions:
“What is the best number of carbs to eat per day for great blood sugars?”
“Is low-carb the only way to manage blood sugars and get a good A1C?”
“I want to drop my A1C. Should I just stop eating carbs?”
If it’s not the most commonly asked diabetes-related question I hear, it’s certainly in the top three, and for good reason: Many, many people who switch to a low-carb way of eating find that their blood sugar control improves.
As carbs are amongst the quickest drivers of blood sugar spikes, reducing the source of the spikes should theoretically reduce the blood sugar elevations, right?
For example, if you normally eat 65 grams of carbs at lunch, and now you only eat 22g, the lowered carb intake should result in a lowered glucose peak post-meal.
However, as a registered dietitian and certified diabetes educator, I have worked with thousands of individuals living with both type 1 and type 2 diabetes, and I have observed what seems to work best to maintain great blood sugar control. I have type 1 diabetes myself, and I figure if I see it every single day in my clients, I should apply it to my own life.
And the answer is … *drumroll please* ….
I choose to NOT eat a low-carb diet
Patient after patient that comes through our practice is churning out A1Cs in the mid to high 5s or low 6s while not eating a low-carb diet.
You might think “How is this even possible, Ben?!”
Here are a few of the biggest takeaways I’ve seen when it comes to ways of eating while living with diabetes.
#1 — Food is just fuel … and it’s about optimal blood sugars for YOU.
Every person’s body is going to behave a little bit differently with how it chooses to process carbs versus how it processes fat, and at the end of the day, the two are just energy sources. Your body is basically a hybrid car, just instead of gasoline or electricity, you’ve got fat or carbs.
I tell people there are two ends of the spectrum: high fat/low carb and low fat/high carb.
Everyone is somewhere on the spectrum, and ultimately has to find where their body feels the best AND where their blood sugar control is the best.
I’ve personally tried both ends of the spectrum, as a self-proclaimed nutrition nerd who wanted to see the differences. I’ve eaten under 40g of carbs per day, and I’ve also eaten over 450g of carbs per day, as well as many places in between. I also maintained each lifestyle for over 6 months.
And what was the result?
I felt best AND optimized my blood sugars around 150-180g of carbs per day. Some days, I’ll have a bit more, and some days, I’ll have a bit less.
That is what works for me, but may not work for you — your body may feel better on fewer grams of carbs or on considerably more grams of carbs — and that is OKAY.
You can and will thrive from a diabetes standpoint once you find that perfect threshold for what your needs are.
#2 — If the insulin dosing is on point, either one can work (and if it’s not, you can still have hyperglycemia with either one)
Many people will gravitate to a lower carb diet because of what they hear about low carb making it easier to manage blood sugars, but what they’re not considering is the role of carbs in protein and fat metabolism.
Without going TOO far into the weeds, carbs effectively ‘spare’ protein breakdown, meaning that in the presence of carbs, protein is not broken down. But in the absence of carbs, protein can and will be broken down into glucose through a process called gluconeogenesis, which can raise blood sugars.
Additionally, lower-carb diets typically contain greater amounts of dietary fat, as there must be a substantial energy source from somewhere, and this fat can induce insulin resistance.
I’ve seen countless examples where individuals gravitate towards a lower-carb diet without any idea that the protein may break down into glucose and that the fat can cause insulin resistance, and they see their blood sugars rising to the 170-200 mg/dL mark and getting ‘stuck’ there for hours on end, which can have a detrimental impact on time in range, average blood sugar, and ultimately, A1C.
On the flip side, I’ve seen individuals consuming 300+ grams of carbs per day who have their dosing down to a science and have their blood sugars in range greater than 90 percent of the time on a consistent basis.
While this may appear counterintuitive, if dosing is done appropriately in either way of eating (i.e. factoring in carbs, proteins, and fats), blood sugars can be absolutely phenomenal.
#3 — You’ve got to be able to stick to whatever you choose
This is the most critical point: You must be able to enjoy how you choose to eat on a daily basis, while getting the nutrition that your body needs at the same time.
Many people find it exceptionally difficult to adhere to a lower-carb way of eating for long stretches of time, which can lead to a very dysfunctional relationship with food.
Here’s a really common sequence, especially for people who attempt to jump to very low-carb after eating a moderate to high amount of carbs for a really long time (as they ‘train’ their body’s machinery to adapt for a low-carb lifestyle):
Day 1-6: Lots of willpower, doing okay, maybe a tad bit weaker since muscle glycogen isn’t full
Day 7-9: Feeling a little gnarly and pushing through
Day 10-11: Feeling like they’re coming back to life, but feeling deprived of carbs
Day 12: Goes to dinner at a great restaurant for Italian food — can’t resist, and eats a ton of carbs in one sitting, since they’re now ‘forbidden’ due to how their brain now classifies food. This can spiral out of control.
Using an ‘all or nothing’ lens can be really damaging to the relationship we have with food, especially as people with diabetes, because we already have to consider food and its impact on our health to a greater degree.
This isn’t to say low-carb eating can’t be done successfully, as millions of people choose a low-carb way of eating and have sustained it for months and years. But, many people start to romanticize carbs and see them as forbidden, when they could simply consume them as a part of an ‘all foods fit’ type of approach and include them in their lives in a smart, effective way that permits blood sugars to remain in range as much as of the time as possible.
By finding a way of eating that is enjoyable, I’m not advocating for the consumption of multiple plates of pasta, breadsticks, and crazy desserts in a single sitting all the time, but from an adherence standpoint, the ability to include a variety of foods and not feel as though anything is ‘off limits’ (aka the periodic indulgence) can make a world of a difference to someone’s viewpoint surrounding food … and lead them to success in the short and long term.
For me personally, I’ve found at the 150-180g of carb threshold is one that I can sustain, still include the foods that I enjoy, and keep my blood sugars in range as much as possible.
Having done multiple ways of eating myself, there is certainly some merit to a lower-carb way of eating: lower peaks in blood sugar and, for some, better time in range. But the difficulty to adhere to and enjoy the way of eating can make it a major challenge to sustain for the long term for many.
I urge you to chat with your care team (i.e. registered dietitian and diabetes educator) and discuss what way of eating is the best for you and your blood sugars, so you can do the things you love while enjoying life to the fullest without any restriction from diabetes!