Can low-carb diets be more effective than drugs?

• Beta cells are cells in the pancreas responsible for producing and releasing insulin, a hormone that helps control blood sugar levels.
• A recent study suggests 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 low-carb diets, but offer tips for success and alternative, evidence-based ways to improve beta-cell function.

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

People of type 2 diabetes have a weakened response of beta cells to blood sugar. In part, this may be caused by excessive carbohydrate consumption.

A combination of beta-cell deficiency and insulin resistance stimulates 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 preventable chronic diseases in the United States.

Now, a new study shows that following a low-carb diet can improve beta-cell function in adults with mild type 2 diabetes.

This approach can help them manage their condition more effectively and possibly eliminate the need for medication.

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

Participants had been diagnosed with type 2 diabetes within the past 10 years and were on diet or medication but not using insulin.

The researchers asked the participants to stop taking the medication one to two weeks before the baseline testing. They then assigned participants to one of two diets for 12 weeks:

• a low-carb diet with about 9% carbs and 65% fat
• a high-carbohydrate diet with about 55% carbohydrates and 20% fat.

They wanted to see if a low-carb diet would improve the response of the participants’ beta cells to sugar (glucose) compared to a higher-carb diet.

Both diets were designed by a registered dietitian to be “eucaloric,” meaning the diets provided the number of calories each participant 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 from the high-carbohydrate group and one from the low-carbohydrate group regained their 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 those on the high-carb diet.

Specifically, they found that people who followed a low-carb diet experienced improvements iinitial (fast) and peak beta-cell responses that were twice and 22% greater, respectively, compared to those on the high-carbohydrate diet.

Oral glucose tolerance test results showed that after 12 weeks, a low-carb diet improved the effect of insulin on blood glucose by 32%.

Among all groups, black adults who ate a low-carb diet showed a 110% greater improvement in the rapid beta-cell response than those who ate a high-carb diet. This effect was not observed in white adults.

In contrast, white adults experienced a 48% greater improvement in peak beta-cell response than those on the high-carbohydrate diet, with no difference seen in black adults.

The study authors suggest that the different responses to dietary interventions observed between races may be due in part to biological differences in beta cell function.

Black adults may exhibit a higher immediate insulin response to glucose compared with white adults, even when their levels of insulin sensitivity are equivalent.

They concluded that “with the caveat that (carbohydrate restriction) may be difficult for some patients, such a diet may allow patients with mild (type 2 diabetes) to stop taking medications and enjoy meals and snacks that meet their energy needs while improving beta cell functions, a result that cannot be achieved with drugs.”

The study found that sensitivity to insulinor how effectively the body uses insulin, did not change much after the dietary intervention. Thus, it is unlikely that changes in insulin sensitivity were responsible for the improved beta-cell response characteristic of the low-carbohydrate diet.

In other words, the improved beta-cell responses likely resulted from something other than changes in insulin sensitivity.

More research is needed, though Medical news today talked to Thomas M. Holland, MD, MSphysician scientist and associate 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 low-carbohydrate diet may improve beta-islet (pancreatic) 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.”

“Although this benefit is more pronounced in patients with mild diabetes, it may still help those with pre-diabetes (with HbA1c around 5.7%-6.4%) or even those with later stages of diabetes, although the degree of improvement may vary from person to person. Holland added.

Holland emphasized that “carbohydrate-restricted diets may be beneficial in the management of type 2 diabetes, but adherence, particularly in older adults, can be challenging.”

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

• considering the flexibility of carbohydrate intake, favoring whole, unprocessed or minimally processed foods rich in fiber and nutrients
• adding variety and making the diet enjoyable
• regular monitoring of blood sugar levels, especially when adjusting or reducing medications under the guidance of a healthcare professional
• consultation with a health care professional is to ensure that the diet meets individual health needs.

“While a ketogenic (very low carb) diet can be effective if followed properly, under the guidance of a nutritionist or physician, a significant 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 islet beta cells to ensure adequate insulin production,” which can lead to negative health consequences.

MNT also communicated withSheri Gau, RDN, CDCESis a registered dietitian, board certified diabetes care and education specialist, and owner of The Plant Strong Dietitian, who was also not involved in the study.