Low-carbohydrate diet may eliminate the need for medication in type 2 diabetes

• Beta cells are pancreatic cells responsible for producing and releasing insulin, a hormone that helps control blood sugar levels.

• A recent study indicates that adults with mild type 2 diabetes could improve their beta cell function by adopting a low-carb diet.

• Experts are concerned about the sustainability of the low-carb diet, but offer tips for success and alternative, evidence-based ways to improve beta cell function.

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

People with type 2 diabetes have a poor beta cell response to blood sugar. This may be, in part, caused by excessive carbohydrate consumption.

The combination of beta cell insufficiency and insulin resistance stimulates the development and progression of type 2 diabetes.

Approximate one in 10 Americans has diabeteswith 90-95% of these cases being type 2, making it one of the most common and largely preventable chronic diseases in the United States.

While lifestyle changes have proven prevent or delay type 2 diabetesresearchers continue to study beta cells to improve understanding and treatment.

Now, a new study suggests that a low-carb diet could improve beta-cell function in adults with type 2 diabetes.

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

The findings are published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism.

How diet affects beta cell function in type 2 diabetes

This randomized controlled trial included 57 black and white male and female adults aged 35 to 65 years with “mild” type 2 diabetes.

They had a hemoglobin A1c (HbA1c) less than or equal to 8.0% and a body mass index (BMI) between 25 and 50.

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

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

They wanted to see if a low-carb diet would improve the response of 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 the registered dietitian.

The researchers used hyperglycemic clamp and oral glucose tolerance tests to examine the participant’s beta cell function and insulin release at the beginning and end of the 12-week diet period.

During the dietary intervention, two participants in the higher-carb group and one in the lower-carb group resumed their METFORMIN drugs, and their data were included in the results.

Low-carbohydrate diet may improve beta-cell function in mild type 2 diabetes

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 andinitial (fast) and peak beta-cell responses that were twofold and 22% greater, respectively, compared to those on a high-carbohydrate diet.

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

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

In contrast, white adults had a 48% greater improvement in peak beta-cell response than those on a high-carbohydrate diet, a difference not seen in black adults.

The study authors propose that the varied responses to dietary intervention observed between races may be due in part to biological differences in beta cell function.

Black adults may exhibit a greater 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 type 2 diabetes to stop medication and enjoy eating meals and snacks that satisfy them energy needs while improving beta-cell function, a result that cannot be achieved with drugs.”

How might a low-carb diet improve beta-cell function?

The study found that insulin sensitivityor how efficiently the body uses insulin, has not changed much with dietary interventions. So it is unlikely that changes in insulin sensitivity were the reason for the improvements in beta-cell response specific to the low-carbohydrate diet.

In other words, the improved beta cell responses were probably due to things other than changes in insulin sensitivity.

More research is needed, though Today’s medical news talked to Thomas M. Holland, MD, MSa physician-scientist and assistant professor at the RUSH Institute for Healthy Aging, RUSH University, College of Health Sciences, who was not involved in the study, to gain a better understanding of how a low-fat diet carbohydrates could improve beta cell function.

He explained that:

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

How to make a low-carb diet more sustainable

Holland pointed out that “a carbohydrate-restricted diet can be beneficial for the management of type 2 diabetes, but adherence, particularly among older adults, can be challenging.”

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

• incorporating flexibility in carbohydrate intake, prioritizing whole, unprocessed or minimally processed foods rich in fiber and nutrients

• adding variety and making the diet enjoyable

• monitoring blood sugar levels regularly, especially when adjusting or reducing medications under the guidance of a healthcare provider

• consultation with a healthcare provider is to ensure that the diet aligns with individual health needs.

“While a ketogenic (very low-carb) diet can be effective if followed correctly, under the guidance of a dietitian or physician, a significant concern is the potential for rebound effects when reintroducing carbohydrates,” Holland warned.

He explained that these rebound effects can cause “substantial weight gain and pressure on islet beta cells to ensure adequate insulin production,” which can lead to negative health outcomes.

MNT also spoke to Sheri Gaw, RDN, CDCESa registered dietitian, board certified diabetes care and education specialist and owner of The Plant Strong Dietitian, who was also not involved in the study.

Similarly, she recommends choosing high-fiber, low-carb foods to make low-carb diets easier to sustain because “fiber helps slow digestion and increase satiety.”

She recommended foods such as:

Other diet and lifestyle changes to improve beta cell function

“A low-carb diet may work for some people with type 2 diabetes, but not for everyone,” Gaw said, stressing that there is no one-size-fits-all approach.

For those for whom a low-carb diet isn’t ideal, Holland highlighted other science-backed diets and lifestyle changes that can improve beta-cell function:

See the original article on Today’s medical news