The Case For Carbohydrate Restriction in Diabetes

Dr. Rollo would recognize this

Dr. Rollo would recognize this

In 1797, Dr. John Rollo  published a book called An Account of Two Cases of the Diabetes Mellitus. Dr. Rollo was a surgeon in the British Royal Artillery. He discussed his experience treating a diabetic Army officer, Captain Meredith, with a high-fat, high-meat, low-carbohydrate diet. In case you don’t know, this was an era devoid of effective drug therapies for diabetes.

The soldier apparently had type 2 diabetes rather than type 1.

Rollo’s diet led to loss of excess weight (original weight 232 pounds or 105 kg), elimination of symptoms such as frequent urination, and reversal of elevated blood and urine sugars.  (Don’t ask me how they measured blood and urine sugar back then.)

This makes Dr. Rollo the original low-carb diabetic diet doctor. Many of the leading proponents of low-carb eating over the last two centuries—whether for diabetes or weight loss—have been physicians.

Carbohydrate Intolerance

Diabetes and prediabetes always involve impaired carbohydrate metabolism: ingested carbs are not handled by the body in a healthy fashion, leading to high blood sugars and, eventually, poisonous complications.

Diabetics and prediabetics—plus many folks with metabolic syndrome—must remember that their bodies do not, and cannot, handle dietary carbs in a normal, healthy fashion. In a way, carbs are toxic to them. Toxicity may lead to amputations, blindness, kidney failure, nerve damage, poor circulation, frequent infections, premature heart attacks and death, among other things.

What To Do About It

Diabetics and prediabetics simply don’t tolerate carbs in the diet like other people. If you don’t tolerate something, you have to give it up, or at least cut way back on it. Lactose-intolerant individuals give up milk and other lactose sources. Celiac disease patients don’t tolerate gluten, so they give up wheat and other sources of gluten. One of every five high blood pressure patients can’t handle normal levels of salt in the diet; they have to cut back or their pressure’s too high. Patients with phenylketonuria don’t tolerate phenylalanine and have to restrict foods that contain it. If you’re allergic to penicillin, you have to give it up.

Stretching actually doesn't do any good for the average person

Stretching actually doesn’t do any good for the average person

If you don’t tolerate carbs, you have to give them up or cut way back. I’m sorry. Alternatively, you could eat lots of carbs and take drugs to prevent the dangerous elevations in blood sugar they cause. We have 11 classes of drugs to treat diabetes. Unfortunately, the long-term side effects of most of them are not well-established. And they can get very expensive.

The American Diabetes Association recommends weight loss for all overweight diabetics. That tends to improve carbohydrate metabolism. The ADA’s 2011 guidelines suggest three possible diets: “For weight loss, either low-carbohydrate [under 130 g/day], low-fat calorie-restricted, or Mediterranean diets may be effective in the short-term (up to two years).”

If I were a diabetic eating over 200 grams of carb daily, I’d cut my carbs way below 130 grams initially, to 20–30 grams of digestible carb.  Then gradually increase carbs as tolerated, based on blood sugar readings. Ask your doctor what he thinks.

Steve Parker, M.D.



Filed under Carbohydrate

4 responses to “The Case For Carbohydrate Restriction in Diabetes

  1. coralf

    I wonder about this sometimes. I am on a ketogenic diet (20-25g carbs) per day and while it is clear from the changes in my body shape and my wonderful fasting glucose and drug free HBA1C levels (< 5.5) that this is the way to go there is no doubt that this diet makes your insulin insensitivity substantially worse.

    After 2 years on this diet, a loss of 17% of my body weight amounting to a loss of over 55 cm, and a B.M.I. of 25, you would think there would have been an improvement.
    A glucose tolerance test resulted in 19 mmol at the two hour mark!!!! That's way worse than when I was diagnosed and despite the four days I carbed up in preparation for the test.

    While I have no plans to change anything right now but I am most certainly looking for further information.

    • Hi, Coralf. Thanks for sharing.
      For American readers, blood glucose of 19 mmol/l = 342 mg/dl.
      I can understand your frustration at that number. I would take comfort in that hemoglobin A1c of < 5.5%. I can't say much else since I'm not your personal physician and don't know all the details of your case.


  2. coralf


    >>The general opinion in LC circles is that you need 150g of carbohydrate >>per day for three days before an oral glucose tolerance test.

    It was the article at the top of that link, “Physiological insulin resistance”, that made me “carb up” before the test. In my case however it clearly did not restore insulin sensitivity. It was good to read the article again though. I will read through the rest of the articles in that category.

    Thanks for the link