A Low-Carbohydrate, Whole-Foods Approach to Managing Diabetes and Prediabetes

Abstract

Diabetes is a systemic disease that has reached epidemic proportions worldwide during the past 30 years,1 and this trend shows no sign of slowing down. In the United States alone, it is estimated that almost 26 million people have diabetes, including 7 million not yet diagnosed.2 The statistics are even worse for prediabetes (impaired fasting glucose or impaired glucose tolerance), which is believed to affect 79 million Americans > 20 years of age.2 Risk factors for type 2 diabetes include, but are not limited to, family history, ethnicity, and obesity, whereas people with certain autoimmune conditions, pancreatic disease, and genetic predisposition are at increased risk for type 1 diabetes.3 Regardless of the type, individuals with diabetes experience abnormal carbohydrate metabolism because of a variety of factors, including impaired insulin secretion and insulin resistance. After carbohydrates were recognized as the macronutrient primarily responsible for increasing blood glucose, severe restriction was used to manage hyperglycemia before the discovery of insulin in 1922.4 Until the early 1970s, a lower-carbohydrate, higher-fat diet was considered appropriate for nutritional management of diabetes.5 In 1980, the first set of Dietary Guidelines for Americans included recommendations to adopt an eating pattern lower in fat to prevent chronic health conditions such as diabetes, cardiovascular disease (CVD), and hypertension.6 Although these guidelines state that they “do not apply to people who need special diets because of diseases or conditions,” many clinicians began recommending lower-fat eating patterns, and people with diabetes began adopting them. Although the American Diabetes Association (ADA) has recommended for more than 15 years that macronutrient composition and meal plans be based on individual preferences and needs, many clinicians continue to prescribe a low-fat meal plan for diabetes management. In terms of teaching carbohydrate consistency, a popular nutrition intervention used in …