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Lower Carbohydrate-Heart Connection Confuses Some

Joy Pape, RN, BSN, CDE, WOCN

Jul 1, 2004

Caution: Consult your diabetes care team before starting a lower carbohydrate meal plan. Diabetes medications such as insulin or oral drugs that stimulate insulin production (sulfonylureas or meglitinides) will need adjustment to prevent hypoglycemia (low blood glucose) when carbohydrate intake is decreased.

Not only are many people who want to lose weight jumping on the low-carb caravan, so are some people who have diabetes. Some wonder why, since the message seems to fly in the face of conventional wisdom. Diabetes and heart disease are so closely related. Can a lower-carb meal plan help improve the odds? We’re learning.

It is no surprise that controlling carbohydrate consumption improves blood glucose, but that’s not the entire story. This change in diet usually includes an increase in protein and fat intake, the very foods most people with diabetes are taught to decrease. You would think this way of eating would worsen cholesterol levels, but if done correctly, it has proved to have a positive effect.

How do we know this? Over the last five years, a combination of personal results and research have shown some surprisingly consistent results, so that at least in the short term, we see

Greater weight loss
Decrease in triglyceride levels
Increase in HDL levels

Longer-term studies are being conducted to further assess the risks and benefits of the lower-carbohydrate approach to diabetes management.

Elevated triglyceride and decreased HDL levels are hallmarks of type 2 diabetes, obesity and heart disease.

Triglycerides are a form of fat that comes from food and is also made and stored in your body. Many times an elevated triglyceride level precludes diabetes, and it can also be a consequence of untreated diabetes. Elevated triglyceride levels have also been linked to heart disease, but the relationship is not as clear as that linking elevated LDL (“bad”) cholesterol levels to heart disease risk. The fasting triglyceride goal for nonpregnant adults with diabetes is less than 150 mg/dl, according to the American Diabetes Association’s Clinical Practice Recommendations.

HDL, or high-density lipoprotein, the “good” cholesterol, is a cholesterol carrier considered to be protective or healthy. HDL carries cholesterol away from the arteries and back to the liver, where it is passed from the body. A high HDL level seems to protect against cardiovascular disease. Some call it the “Draino” factor, protecting you against having a heart attack.

What should you do if you have type 2 diabetes and are obese as well? Should you follow the conventional medical nutrition therapy recommended by the American Diabetes Association based on the FDA’s Food Guide Pyramid, or should you choose a lower-carbohydrate meal plan? The best advice is to meet with your healthcare provider and discuss your options. Together, you can decide which plan is best for you. Once you decide, meet with a registered dietitian who is a certified diabetes educator to develop an individualized meal plan you can live with and enjoy and one that will also improve your health.

Categories: Blood Glucose, Diabetes, Diabetes, Food, Losing weight, Low Carb, Nutrition Advice, Type 2 Issues

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Jul 1, 2004

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