Low-carb works for diabetes – why don’t more doctors advise it?

By Marika Sboros

Diabetes treatment is quietly undergoing transformation.

Diabetes treatment is quietly undergoing transformation.

Here’s food for thought: low-carbohydrate diets are shown to work very well for people with type 2 diabetes. Growing evidence shows that low-carb, high-fat diets can reverse the symptoms of diabetes completely, allowing many diabetics to come off medication altogether.

Yet many doctors, dietitians and government health services, such as the National Health Service in the UK,  still don’t advise them. 

Why ever not, you might well ask?

The writer of a blog on a global diabetes community website, diabetes.co.uk, poses just that question – and suggests some answers:

For starters, throughout the 21st Century and most of the latter half of the 20th Century, the focus of the UK Department of Health’s dietary recommendations have been to follow a low-fat, so called “balanced” diet, says the writer who goes by his first name, Benedict.

He fingers official dietary guidelines that followed in the wake of  “food pyramid” the US Department of Agriculture developed. The pyramid advised lots of starchy carbohydrates and low-fat foods as the foundation of the diet, and was duly followed by the UK and most other English-speaking countries. It has gone through revisions over the years, but remains resolutely high-carb, low-fat, especially saturated fat.

For the wisdom of that high-carb, low-fat advice you just have to look at the results over decades: skyrocketing rates of obesity, diabetes and heart disease, to name but a few of the so-called non-communicable diseases (NCDs) that are epidemic across the globe.

What The FatAnd if you still think low-carb, high-fat (LCHF) diets are a fad for diabetes, New Zealand specialist Prof Grant Schofield puts that myth to rest. Schofield is co-author of a brilliant book, What the Fat. If you haven’t read it, I advise you to do so immediately.

He is also co-author of a paper in the New Zealand Journal of Medicine in April, titled Very low-carbohydrate diets in the management of diabetes revisited .

In it, the authors say that low-carb diets have been used to treat type 2 diabetes since 1797, and until the discovery of insulin in 1921, “carbohydrate restriction or severe energy restriction, or both, were the most reliable methods used to treat diabetes”.

In the paper’s abstract, the authors say the trend towards higher-carbohydrate diets for people with diabetes ” may have played a part in the modern characterisation of type 2 diabetes as a chronic condition with a progressive requirement for multiple medications”. In their paper, they introduce some of the evidence for very low-carbohydrate diets in diabetes management and discuss  common objections to their use.

One of the biggest reasons health organisations give for not recommending low-carb diets is lack of evidence on long-term safety. The problem with that argument, as Benedict points out, is that there wasn’t any evidence on long-term safety of high-carb, low-fat diets when they were first introduced either, and still isn’t any evidence available today. On the contrary. The global epidemics of NCDs, also known as diseases of lifestyle, suggests strongly that high-carb, low-fat diets are not safe for many people.


Benedict points to results of research into low-fat safety, including  from the US Women’s Health Initiative (WHI) Dietary Modification Trial in 1996 which reviewed, over an eight-year period, whether a low-fat diet would help women lose weight and protect against heart disease. He says with remarkable restraint that WHI results were “judged to be disappointing as the low-fat diet showed no evidence of helping with weight loss or in reducing incidence of heart disease”.

That brings him to another important question: when will official dietary recommendations “catch up with the science”?

Benedict says the American Diabetes Association released a position statement in 2013 recognising that a low-carb diet has benefits.

In the UK, Diabetes UK recently toned down its  advice, which was to eat plenty of starchy carbohydrates at each meal. It now has more of a focus on choosing an appropriate amount of carbohydrate based upon a number of factors such as age, activity level and whether you are looking to weight or need to improve your blood glucose levels.

However, like most diabetes associations worldwide, Diabetes UK is still “fat phobic” –  Benedict says it regards saturated fat as “a form of fat that should be avoided and make no distinction between the saturated fat found in dairy and meat and the saturated fat used in processed foods”.


He recommends a book, Reverse Your Diabetes, The Step-by-Step Plan to Take Control of Type 2 Diabetes by Dr David Cavan. Cavan treated diabetics for 20 years on the NHS and is now policy director at the International Diabetes Federation.

The book is a step in the right direction but a very small step. It can seem positively conservative compared to more radical low-carb approaches. Cavan steers readers away from very low-carb diets, despite growing evidence to suggest the benefits. Wortman and fellow Canadian physician and nephrologist Dr Jason Fung are just two who believe that very low-carb diets are the way to go.

Cavan also  supports the conventional 5-a-day portions of fruit and veg recommendation that still forms part of official dietary advice, though he does advise people to get their 5-a-day from veg rather than fruit. And he does at least defends dietary fat, which he says has had a reputation because “it is so easy to link the two and think that fat in food causes fat people”.