Diabetes and Macros: Low-Carb vs. High-Carb Explained

What’s the best macronutrient profile for diabetes? Well, it depends on what your goals are. Today I’m going to share the macro breakdowns of 3 common diets for diabetes, along with the pros and cons of each so that you can determine the best approach for you.

The Best Macronutrient Profile for Diabetes? Diets Compared

My name’s Robby. I’m living with type 1 diabetes and for the past 12 years I’ve been a diabetes coach for people living with type 1 diabetes, type 2 diabetes, and everything in between. I have personally tried all of the diets and their respective macronutrient profiles, and I’ll also share with you my personal experience in addition to what the peer-reviewed evidence on each of these approaches shows.

ADA Diet / Mediterranean Diet

For the purposes of this article, I’m lumping the American Diabetes Association’s recommendations along with what is referred to as the Mediterranean diet, because they’re very similar. This is the first approach that we’ll be assessing and comparing today.

The macro breakdown is 40-55% carbohydrate, 15-20% protein, and 25-40% fat.

These diets emphasize moderate carb intake, lean protein, and healthy sources of fat like avocado and olive oil. It’s essentially a slightly healthier version of what most people already do. So if you want to make small swaps and changes, it’s a good place for you to start. However, the outcomes will probably be small too – which shouldn’t be a big surprise. A moderate diet gives you moderate results.

If you’re looking for small steps that will improve your health and don’t take a lot of effort, this is a good path. It’s unlikely that you’ll reverse the disease through this approach, but you’ll have better blood glucose control, a slightly lower A1c, and a lower risk of complications like neuropathy as well as secondary conditions like heart disease.

When I was using this approach, I was eating the healthiest ingredients I knew of at the time. Organic free-range chicken, whole grain breads, lots of organic vegetables cooked in extra virgin olive oil, and I was even into raw milk for a while. But despite paying a lot of money for the highest quality food, my diabetes numbers didn’t improve that much.

The thing about this macro breakdown is that it is relatively high in both fat and carbohydrates, and as you’ll see here shortly, the biggest results come from picking a side in that regard.

Low-Carb (Keto, Carnivore)

The second approach that I’m going to cover is a low-carb approach. There is obviously a range of just how low to go with your carb intake, with the farthest end of the spectrum being a full carnivore diet.

A low-carbohydrate diet typically means eating less than 100g of carbohydrate per day, with carbs being less than 30% of your overall daily intake.

If you’re taking a keto approach, which is when you really get the bang for your buck with cutting carbs, then your macro breakdown is around 5-10% carbohydrate, 20-30% protein, and 70-80% fat. And a carnivore diet takes the carb count as close to zero as possible.

Ketogenic diets have been shown to be effective for weight loss and improving diabetes metrics such as lowering A1c. 

However, the results are not necessarily better than what can be achieved through other methods. For instance, a 2017 meta-analysis of 32 studies found that energy expenditure and fat loss were greater with low-fat rather than low-carb diets. 

And, a 2020 debate of ketogenic diets determined that while ketogenic diets do often produce rapid weight loss and a lower A1c, the diet is often unsustainable and has other negative effects such as raising cholesterol levels and lowering fiber intake, which create health issues in the long run. The authors concluded that other diets can produce the same results with greater overall safety and sustainability.

If you love meat and high fat foods, and wouldn’t miss eating things like potatoes, rice, bananas, and mangos, then maybe this diet could work for you! You wouldn’t be reversing the root cause of diabetes, but you’d be doing the next best thing which is removing the factor that causes your blood sugar spikes.

I can personally say that I never had a flatter line on my CGM than when I was doing a super low-carb diet. …But I can also say that I’ve never felt worse in my life. I got what they call the “keto-flu”, where you feel super sluggish and have brain fog. I had no energy and I even blacked out a few times. That wasn’t worth it for me, so I ultimately decided to try a different route.

So, overall, a super low-carb diet can produce certain results you’re seeking to support your diabetes health, such as weight loss and a lower A1c – but it is often hard to maintain and can come with some major downsides. Your call!

Mastering Diabetes Method

The third and final approach I’m going to talk through with you today is basically the opposite of a ketogenic diet. Rather than being on the far end of low-carb and high-fat, it’s the far end of low-fat and high-carb.

This is a low-fat, plant-based, whole food diet, and the macro breakdown is 70-80% carbs, 10-15% protein, and 10%-15% fat.

Like the ketogenic diet, this dietary approach is associated with weight loss, better blood glucose control, and a lower A1c. How it differs, other than the obvious of getting to eat things like fruits and whole grains, is that this approach reverses the root cause of diabetes.

Rather than just removing the surface-level symptoms by not eating anything that your body turns into glucose, a low-fat, plant-based, whole food diet unclogs the intramyocellular lipid from your cells that blocks insulin signaling, so that you restore insulin sensitivity. This is what makes it possible for you to eat 75% of your diet in the form of carbs, and actually use LESS insulin than you did before.

This is where I’ve personally landed. It was an easy decision for me because I LOVE fruit and I feel amazing eating this way. I have tons of energy – so much that I actually did 3 full ironman races one year! And my blood sugar, my A1c, my insulin sensitivity, and my weight, all stay in an optimal range. 

Conclusion

So there you have it. Three macronutrient breakdowns and how they can affect your diabetes.

Of course, the outcomes you achieve from a diet are about much more than the macronutrient breakdown. The foods that you eat to achieve those macro percentages matter.

That being said, it IS a helpful tool to use when you’re crunching your own personal health equation to best support your diabetes. Numbers don’t tell you everything, but in this case they do tell you a lot.

If you want to try eating lots of carbs like me and using a low-fat, plant-based whole food approach to your diabetes, I have a whole archive of videos and articles teaching you how, plus tons of stories of people who have used this approach to reverse their diabetes and get their life back.

I recommend starting with this one next!