Diabetes is a chronic disease affecting over 500 million people worldwide. While multifaceted, managing blood sugar levels is key to reducing complications. One approach to better blood sugar control involves very low carb diets, where less than 10% of total calories come from carbohydrates. This article explores very low carb diets for diabetes management and examines the bone broth diet as a specific example, detailing its potential benefits and risks.
Understanding Diabetes and Carbohydrates
In diabetes, the body's ability to process carbohydrates is impaired. Normally, carbs break down into glucose, entering the bloodstream. The pancreas releases insulin, enabling blood sugar to enter cells. In non-diabetic individuals, blood sugar remains within a narrow range. However, in diabetes, this system malfunctions, leading to potentially harmful high or low blood sugar levels.
There are two primary types of diabetes: type 1 and type 2, both potentially occurring at any age. Type 1 involves an autoimmune reaction that destroys insulin-producing beta cells, necessitating insulin injections for glucose uptake. Type 2 initially involves insulin resistance, where cells don't respond effectively to insulin, causing elevated blood sugar. The pancreas compensates by producing more insulin, but over time, beta cells can lose their ability to produce sufficient insulin.
Of the macronutrients, carbohydrates have the greatest impact on blood sugar due to their breakdown into glucose. People with diabetes may require larger insulin doses or medication when consuming high amounts of carbohydrates.
Very Low Carb Diets for Diabetes: An Overview
Numerous studies support the use of very low carb diets in diabetes management. In fact, before insulin's discovery in 1921, these diets were the standard treatment. Low carb diets can be effective long-term if followed consistently. One study showed that people with type 2 diabetes who adhered to a low carb diet for 6 months maintained good diabetes management even after 3 years. Similarly, individuals with type 1 diabetes who followed a carb-restricted diet saw significant improvements in blood sugar over 4 years.
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The ideal carb intake for people with diabetes remains a topic of debate. Some older studies showed significant improvements with carb restriction to 20 grams per day. Dr. Richard K. Bernstein, who has type 1 diabetes, advocates for 30 grams of carbs daily based on his own experience and patient outcomes. However, other research suggests that less restrictive low carb diets (70-90 grams of total carbs or 20% of calories from carbs) can also be effective. Individual responses to carbs vary, and needs are influenced by factors like age, weight, height, sex, and activity level.
The American Diabetes Association (ADA) emphasizes personalized meal plans that consider individual preferences and metabolic goals. They recommend consulting with a healthcare team to determine appropriate carb intake. Monitoring blood glucose levels before and after meals can help identify individual carb tolerance. The ADA's target blood sugar level 2 hours after a meal is below 180 mg/dL. Consistently high blood sugar levels can lead to complications like nerve or kidney damage. Pairing carbs with protein and fat slows glucose absorption, mitigating blood sugar spikes. A healthy low carb diet should prioritize nutrient-dense, high-fiber carb sources like vegetables, berries, nuts, and seeds.
Navigating Carbs: Fiber, Net Carbs, and Sugar Alcohols
In plant foods, carbs consist of starch, sugar, and fiber. Only starch and sugar raise blood sugar. Fiber, whether soluble or insoluble, doesn't break down into glucose and doesn't raise blood sugar. Net carbs can be calculated by subtracting fiber and sugar alcohols from total carb content. For example, 1 cup of cauliflower with 5 grams of carbs and 3 grams of fiber has a net carb content of 2 grams. Prebiotic fiber has even been shown to improve fasting blood sugar in people with type 2 diabetes.
Sugar alcohols, like maltitol, xylitol, erythritol, and sorbitol, are used in sugar-free products. Some, especially maltitol, can raise blood sugar levels. Therefore, caution is advised when using the net carb tool, as labels may not accurately reflect the impact of maltitol. The FDA and ADA do not endorse the net carb tool, and the ADA explicitly advises against using it for carb intake calculations in diabetes management. Focus on low carb, whole foods with plenty of nutrients. Pay attention to hunger and fullness cues.
Foods to Include and Limit on a Low Carb Diet
Foods to Eat Freely:
- Meat, poultry, and seafood
- Eggs
- Cheese
- Non-starchy vegetables
- Avocado
- Olives
- Olive oil, coconut oil, butter, cream, sour cream, and cream cheese
Foods to Eat in Moderation:
- Berries: 1 cup or less
- Plain, Greek yogurt: 1 cup or less
- Cottage cheese: 1/2 cup or less
- Nuts and peanuts: 1-2 ounces
- Milk: 1 cup or less
- Fruit other than berries: 1/2 cup or less
- Flaxseeds or chia seeds: 2 tablespoons
- Dark chocolate (at least 85% cocoa): 30 grams or less
- Winter squash: 1 cup or less
- Liquor: 1.5 ounces
- Dry red or white wine: 4 ounces
- Legumes: Include in daily carb count
Foods to Limit:
- White bread, pasta, refined cereal, corn, and other refined grains
- Starchy vegetables
- Juice, soda, punch, sweetened tea, etc.
- Beer
- Desserts, baked goods, candy, ice cream, etc.
Sample Low Carb Menu (Approximately 42 grams of Digestible Carbs)
Breakfast: Eggs and Spinach
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- 3 eggs cooked in butter (1.5 grams of carbs)
- 1 cup sautéed spinach (3 grams of carbs)
- 1 cup blackberries (6 grams of carbs)
- 1 cup coffee with cream and optional sugar-free sweetener
- Total digestible carbs: 10.5 grams
Lunch: Cobb Salad
- 3 ounces cooked chicken
- 1 ounce Roquefort cheese (0.5 gram of carbs)
- 1 slice bacon
- 1/2 medium avocado (2 grams of carbs)
- 1 cup chopped tomatoes (5 grams of carbs)
- 1 cup shredded lettuce (1 gram of carbs)
- Olive oil and vinegar
- 20 grams 85% dark chocolate (4 grams of carbs)
- 1 glass of iced tea with optional sugar-free sweetener
- Total digestible carbs: 12.5 grams
Dinner: Salmon with Veggies
- 4 ounces grilled salmon
- 1/2 cup sautéed zucchini (3 grams of carbs)
- 1 cup sautéed mushrooms (2 grams of carbs)
- 4 ounces red wine (3 grams of carbs)
- 1/2 cup sliced strawberries with 1 tbsp unsweetened whipped cream (5 grams of carbs)
- 1 ounce chopped walnuts (6 grams of carbs)
- Total digestible carbs: 19 grams
Medication Adjustments and Additional Lifestyle Factors
Restricting carbs often lowers blood sugar, necessitating adjustments to insulin and other medication dosages by a doctor. In some cases, medication may be eliminated entirely. One study showed that 17 of 21 participants with type 2 diabetes were able to stop or reduce their medication when limiting carbs to 20 grams a day. Another study showed improved blood sugar management and reduced insulin use in participants with type 1 diabetes eating 25-75 g of carbs daily.
If insulin and other medications aren't adjusted for a low carb diet, there's a risk of hypoglycemia. Therefore, consulting with a doctor before starting a low carb diet is crucial for individuals taking insulin or other diabetes medications.
In addition to diet, physical activity improves insulin sensitivity. Resistance training and aerobic exercise are particularly beneficial. Quality sleep is also important, as insufficient sleep increases the risk of developing diabetes. One study found that people with diabetes who slept fewer than 6 hours or more than 8 hours per night had worse blood glucose management than those who slept between 6 and 8 hours. Stress management techniques like yoga, qigong, and meditation can also lower blood sugar and insulin levels.
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The Bone Broth Diet: A Specific Very Low Carb Approach
The bone broth diet is a specific type of very low carb diet that involves consuming bone broth alongside a diet rich in whole, unprocessed foods. It typically involves eating one to three servings of bone broth per day, five days per week, while restricting grains, gluten, soy, dairy, and sugar. Bone broth is a traditional stock rich in beneficial collagen, amino acids, collagen cofactors, and minerals. Proponents claim it results in quick weight loss, better skin, improved gut health, and decreased inflammation.
Potential Benefits of the Bone Broth Diet
- Weight Loss: Many people use the bone broth diet for weight loss.
- Reduced Inflammation: Sustaining high levels of inflammation long term is thought to be at the root of chronic conditions like heart disease, diabetes, and cancer. Thanks to its anti-inflammatory effects, the bone broth diet can help support gut health and protect against leaky gut syndrome.
- Improved Gut Health:
- Joint Pain Relief: If you suffer from chronic joint pain, swelling, or stiffness, adding bone broth to your routine may be beneficial.
- Anti-Aging Effects: Bone broth is great for slowing the signs of aging to keep skin healthy and hydrated.
The bone broth diet involves following a healthy diet five days per week and consuming only bone broth twice per week, similar to intermittent fasting. The diet should be followed for 21 days in total, with six days of bone broth fasting and 15 days of eating over the course of the entire plan. During the days that you do eat, you should consume one to three cups of bone broth per day as snacks and limit ingredients such as sugar, dairy, soy, grains, gluten, and processed foods.
Risks and Considerations of the Bone Broth Diet
For most healthy adults, the bone broth diet is safe and associated with minimal adverse side effects. To determine if the diet is right for you, try following a seven-day bone broth diet plan to see how you feel. However, the bone broth diet may not be right for everyone. Women who are pregnant and nursing, for example, should not follow the bone broth diet and should instead focus on consuming a well-rounded, nutrient-rich diet. While the bone broth cleanse diet can be beneficial for many, there are several bone broth diet problems that also need to be considered. The bone broth diet is also not recommended for women who are pregnant or breastfeeding, as well as those following a vegan or vegetarian diet. Additionally, keep in mind that not all bone broth is created equal, and it’s important to select a high-quality supplement to make sure you get the most bang for your buck. Alternatively, you can try making your own bone broth at home using a simple slow cooker recipe.
Dr. Kellyann: A Bone Broth Brand Overview
Dr. Kellyann is a brand that offers bone broth and collagen products. Dr. Kellyann's products receive an A- rating, recognized for customer service, quality ingredients, and value.
Quality
Dr. Kellyann uses grass-fed, free-range, or organic ingredients. Customer service is accommodating with a satisfaction-guaranteed return policy. The team received both liquid and powdered bone broths from Dr. Kellyann. Dr. Kellyann's customer service channels were accommodating and responded rapidly, with a generous satisfaction guaranteed return policy.
Value
Although pricey, Dr. Kellyann’s products have more protein per ounce than other brands, and the ingredient quality is high.
Brand Value
Dr. Kellyann’s innovative products, benefits to public nutrition, and doctor-created products led to an overall A- for brand value. Dr. Kellyann’s definitely benefits public nutrition-not only were they one of the first companies to provide high-quality bone broth and collagen products, but Dr.
Products
Dr. Kellyann offers a variety of bone broth and collagen-related products.
Liquid Bone Broth: Made with grass-fed and finished beef bones, carrots, celery, onion, apple cider vinegar, parsley, ginger, garlic, thyme, sea salt, peppercorns, and bay leaves.
Chicken Bone Broth Powder: Contains chicken bone broth powder, grass-fed bovine hydrolyzed collagen, natural flavors, cauliflower powder, salt, onion powder, garlic powder, minced green onion, parsley, reishi mushroom powder, and turmeric extract.
Collagen Coffee: A blend of 100% Brazilian coffee beans with 7g of grass-fed bovine collagen.
Cost and Protein Content Comparison
| Cost | Protein Content | |
|---|---|---|
| Dr. Kellyann | $0.89/oz (Liquid); $1.10/oz (Powder) | Liquid: 15g/serving (8oz); Powder: 16g per packet |
| Kettle & Fire | $0.39/oz | 20g/serving (16.9oz) |
| EPIC | $0.86/oz | 11g/serving (14oz) |
Fad Diets to Avoid
It's important to be aware of fad diets that lack scientific support and may be harmful. Some examples include:
- Whole30: A month-long regime that restricts many foods.
- Baby Food Diet: Replacing meals with baby food.
- Cereal Diet: Subsisting on a cereal-based diet.
- Gluten-Free Diet (without celiac disease): Restricting gluten without a medical necessity.
- Paleo Diet: Restricting grains, sugar, and dairy.
- Raw Food Diet: Eating primarily uncooked foods.
- TB12 Diet: Eliminating nightshade vegetables based on unsubstantiated claims of inflammation.
- Fruitarian Diet: Subsisting primarily on fruits.
- Freeganism: Relying on dumpster diving for food.
- Master Cleanse: Consuming only salt water, laxatives, and lemon water with cayenne and maple syrup.
- Juice and Soup Cleanses: Replacing meals with juice or soup.
- Wine and Eggs Diet: Supplementing a limited diet with wine and eggs.
- Tapeworm Diet: Ingesting tapeworms for weight loss.
- Apple Cider Vinegar Diet: Consuming apple cider vinegar before meals.
- Iodine-Rich Diet (for weight loss): Consuming excessive iodine.
- Alkaline Diet: Eating low-acid foods to alter body pH.
- HCG Diet: Supplementing a low-calorie diet with human chorionic gonadotropin.
- GM Diet: A restrictive one-week diet.
- Blood Type Diet: Eating based on blood type.
- Dubrow Diet: A plan that involves intermittent fasting and specific macronutrient ratios.
- Scarsdale Diet: A high-protein, low-carb diet for short-term weight loss.
- Atkins Diet: A very low carb diet that progresses through multiple phases.
- Ketogenic Diet: An extremely low carb, high-fat diet.
The Carnivore Diet: A Very Restrictive Approach
The carnivore diet is a very low carb diet consisting primarily of meat, fish, and animal products, such as eggs and low lactose dairy. Fatty cuts of meat are a key part of this diet to meet energy requirements. While very low carbohydrate diets contain less than 50 grams of carbohydrates per day from nonstarchy vegetables, the carnivore diet excludes all other foods, such as fruits, vegetables, legumes, grains, nuts, and seeds.
Potential Benefits and Risks
People on keto diets typically lose weight due to lower insulin levels, a diuretic effect, and a decreased appetite, which may be beneficial for those with type 2 diabetes. In 2020, researchers surveyed more than 2,000 adults who had been following a carnivore diet for 6 months or longer. Participants reported experiencing health benefits and high levels of satisfaction, along with few adverse effects. However, the carnivore diet may also pose some risks that could outweigh the benefits. Dietary fiber is an essential part of a healthy diet, yet it is mainly found in fruits, vegetables, and legumes. In fact, higher dietary fiber intake has been associated with a lower risk of type 2 diabetes. Additionally, the carnivore diet may have negative impacts on cardiovascular and renal health. A diet that is very high in saturated fats can also increase the risk of cardiovascular disease.