Diabetes is growing faster now than at any point in human history, yet despite this doctors continue to prescribe low carbohydrate diets, a strategy that is often viewed as the most effective nutrition approach for optimal diabetes health.
On the surface, this appears to make sense because low carbohydrate diets often result in rapid weight loss, reduced A1c values, and decreased blood glucose.
However, more than 85 years of research has clearly demonstrated that low carbohydrate diets cause insulin resistance, the behind-the-scenes condition that complicates and worsens all forms of diabetes (1–30).
A growing body of evidence now shows that diets low in fat and high in unrefined carbohydrates from fruits, vegetables, beans, lentils, and whole grains are remarkably effective at reversing insulin resistance in patients with type 1 diabetes, prediabetes, and type 2 diabetes (20–25,31–42).
Insulin resistance results from the accumulation of fat in tissues that are not designed to store fat, mainly in your liver and muscles (2,3,9–14,16–18,27,43,44).
When you eat a low carbohydrate diet high in fat and protein, fatty acids are burned for energy, however they also accumulate in tissues like your muscle and liver.
Low carbohydrate diets are the easiest way to develop insulin resistance. In the research setting, scientists induce insulin resistance and diabetes by feeding laboratory animals a low carbohydrate diet high in fat and protein.
These animals gain weight, develop severe insulin resistance, and show early signs of diabetes in as little as 8 weeks (1,45,46,46–52).
Yes, you read that correctly.
How could this be the case?
Doctors are quick to prescribe low carbohydrate diets because they result in immediate weight loss, improved blood glucose control, reduced cholesterol, and reduced blood pressure.
However, in the long term, research shows that low-carbohydrate diets high in fat and protein including meat, dairy products, eggs, fish, and oil actually worsen diabetes health, increase cancer risk, increase cholesterol, increase atherosclerosis, harden blood vessels, and increase all-cause mortality (53–60).
The original research on low-fat, plant-based, whole-food diets to treat type 2 diabetes began more than 85 years ago.
Between 1930-1960, Dr. Rabinowitch was the first to demonstrate how to reverse type 2 diabetes by feeding patients a low-fat, plant-based, whole-food diet high in unprocessed carbohydrates.
Dr. Rabinowitch showed that eating fat-rich foods diminishes your ability to consume carbohydrate-rich foods. He successfully demonstrated that he could significantly improve insulin sensitivity using a low-fat, plant-based, whole-food diet, however critics argued that it only worked because his diet was also low in calories.
In the 1970s, Dr. Anderson followed these studies in which he fed patients with type 2 diabetes a low-fat, plant-based, whole-food diet containing sufficient calories to prevent weight loss.
In his groundbreaking study, he required that patients eat large amount of plant-based foods in order to prevent them from losing weight.
Without losing a single pound, patients were able to discontinue their insulin use after only 16 days by simply substituting low-fat plant foods for high-fat foods (20,35).
More recent evidence from Dr. Neal Barnard at the Physicians Committee for Responsible Medicine (PCRM) demonstrates that low-fat, plant-based, whole-food diets are highly effective for weight control, improved blood glucose, reduced cardiovascular disease risk, and improved insulin sensitivity (31–34,37,41).
These studies clearly show that when fat intake is reduced to less than 15% of total calories, insulin becomes extremely effective, kicking carbohydrate metabolism into high gear.
In our practice as nutrition and fitness coaches for people with type 1 diabetes, prediabetes, and type 2 diabetes, we find that the most successful way to reverse insulin resistance is to eat a diet containing less than 15% of total calories from fat, which means avoiding animal products like meat, poultry, fish, and dairy products, as well as even what have been deemed “healthy” fats like olive oil and coconut oil.
We help clients construct meals centered around whole carbohydrates from fruits, vegetables, plant starches (potatoes, squash, corn, brown rice, quinoa), beans, lentils, and peas, and amla (Indian gooseberries), and teach them to avoid processed carbohydrates from breads, crackers, cereals, and pastas.
Our clients lose weight without even trying, gain energy, and are able to minimize their oral and injectable medication needs in a matter of months.
I developed type 1 diabetes at the age of 22, and followed a low carbohydrate diet for the first year following my diagnosis. Plagued with low energy, bad breath, and hard-to-control blood glucose, I decided to try switching to a low-fat, plant-based, whole-food diet.
In less than 6 months, I reduced my insulin use by 40% while eating more than 900 grams of carbohydrate per day (more than many people with diabetes will eat in a month).
All too often, doctors and people with diabetes attempt to eat carbohydrates without dropping their overall fat intake, which results in high blood glucose and weight gain.
This may make you believe that high-carbohydrate foods are causing the spike, but this is only the case if your overall dietary fat intake is also high.
As I mentioned earlier, the true culprit underlying high blood glucose is insulin-resistance, caused by muscle and liver cells clogged with fat.
The evidence is clear – both low carbohydrate diets and low-fat diets will result in weight loss and reduced insulin use. Those seeking short-term weight loss may benefit from a low carbohydrate diet.
However, the increased risk for more severe diabetes, as well as cancer cardiovascular disease, and all-cause mortality greatly outweigh the short-term improvements in blood glucose.
For those seeking stable long-term weight loss, reduced chronic disease risk, and greater longevity, a low-fat, plant-based, whole-food diet is the clear evidence-based choice.
1. Wang C-Y, Liao JK. A Mouse Model of Diet-Induced Obesity and Insulin Resistance. Methods Mol Biol Clifton NJ. 2012;821:421–33.
2. The Fat of the Matter: How Dietary Fat Effects Blood Glucose [Internet]. [cited 2016 Mar 6]. Available from: http://www.mendosa.com/The-Fat-of-the-Matter-How-Dietary-Fat-Effects-Blood-Glucose.htm
3. Itani SI, Ruderman NB, Schmieder F, Boden G. Lipid-Induced Insulin Resistance in Human Muscle Is Associated With Changes in Diacylglycerol, Protein Kinase C, and IκB-α. Diabetes. 2002 Jul 1;51(7):2005–11.
4. Boden G. Role of fatty acids in the pathogenesis of insulin resistance and NIDDM. Diabetes. 1997 Jan;46(1):3–10.
5. Boden G, Shulman GI. Free fatty acids in obesity and type 2 diabetes: defining their role in the development of insulin resistance and β-cell dysfunction. Eur J Clin Invest. 2002 Jun 1;32:14–23.
6. Long Z, Zhang X, Sun Q, Liu Y, Liao N, Wu H, et al. Evolution of metabolic disorder in rats fed high sucrose or high fat diet: Focus on redox state and mitochondrial function. Gen Comp Endocrinol. 2015 Oct 20;
7. Sesti G, Federici M, Hribal ML, Lauro D, Sbraccia P, Lauro R. Defects of the insulin receptor substrate (IRS) system in human metabolic disorders. FASEB J. 2001 Oct 1;15(12):2099–111.
8. Russell WR, Gratz SW, Duncan SH, Holtrop G, Ince J, Scobbie L, et al. High-protein, reduced-carbohydrate weight-loss diets promote metabolite profiles likely to be detrimental to colonic health. Am J Clin Nutr. 2011 May 1;93(5):1062–72.
9. Galgani JE, Moro C, Ravussin E. Metabolic flexibility and insulin resistance. Am J Physiol Endocrinol Metab. 2008 Nov;295(5):E1009-1017.
10. Roden M. How free fatty acids inhibit glucose utilization in human skeletal muscle. News Physiol Sci Int J Physiol Prod Jointly Int Union Physiol Sci Am Physiol Soc. 2004 Jun;19:92–6.
11. Roden M, Price TB, Perseghin G, Petersen KF, Rothman DL, Cline GW, et al. Mechanism of free fatty acid-induced insulin resistance in humans. J Clin Invest. 1996 Jun 15;97(12):2859–65.
12. Silveira LR, Fiamoncini J, Hirabara SM, Procópio J, Cambiaghi TD, Pinheiro CHJ, et al. Updating the effects of fatty acids on skeletal muscle. J Cell Physiol. 2008 Oct;217(1):1–12.
13. Shulman GI. Cellular mechanisms of insulin resistance. J Clin Invest. 2000 Jul;106(2):171–6.
14. Griffin ME, Marcucci MJ, Cline GW, Bell K, Barucci N, Lee D, et al. Free fatty acid-induced insulin resistance is associated with activation of protein kinase C theta and alterations in the insulin signaling cascade. Diabetes. 1999 Jun;48(6):1270–4.
15. Savage DB, Petersen KF, Shulman GI. Disordered Lipid Metabolism and the Pathogenesis of Insulin Resistance. Physiol Rev. 2007 Apr 1;87(2):507–20.
16. Randle PJ, Garland PB, Hales CN, Newsholme EA. The glucose fatty-acid cycle. Its role in insulin sensitivity and the metabolic disturbances of diabetes mellitus. Lancet. 1963 Apr 13;1(7285):785–9.
17. Hirabara SM, Silveira LR, Abdulkader F, Carvalho CRO, Procopio J, Curi R. Time-dependent effects of fatty acids on skeletal muscle metabolism. J Cell Physiol. 2007 Jan;210(1):7–15.
18. Yu C, Chen Y, Cline GW, Zhang D, Zong H, Wang Y, et al. Mechanism by which fatty acids inhibit insulin activation of insulin receptor substrate-1 (IRS-1)-associated phosphatidylinositol 3-kinase activity in muscle. J Biol Chem. 2002 Dec 27;277(52):50230–6.
19. Anderson JW. High carbohydrate, high fiber diets for patients with diabetes. Adv Exp Med Biol. 1979;119:263–73.
20. Anderson JW, Ward K. Long-term effects of high-carbohydrate, high-fiber diets on glucose and lipid metabolism: a preliminary report on patients with diabetes. Diabetes Care. 1978 Apr;1(2):77–82.
21. Rabinowitch IM. Effects of the High Carbohydrate-Low Calorie Diet Upon Carbohydrate Tolerance in Diabetes Mellitus. Can Med Assoc J. 1935 Aug;33(2):136–44.
22. Rabinowitch IM. EXPERIENCES WITH A HIGH CARBOHYDRATE-LOW CALORIE DIET FOR THE TREATMENT OF DIABETES MELLITUS. Can Med Assoc J. 1930 Oct;23(4):489–98.
23. Rabinowitch IM. THE PRESENT STATUS OF THE HIGH CARBOHYDRATE-LOW CALORIE DIETS FOR THE TREATMENT OF DIABETES. Can Med Assoc J. 1932 Feb;26(2):141–8.
24. Rabinowitch IM. OBSERVATIONS ON THE SIGNIFICANCE OF THE CHOLESTEROL CONTENT OF THE BLOOD PLASMA IN DIABETES MELLITUS. Can Med Assoc J. 1933 Feb;28(2):162–8.
25. Kempner W, Peschel RL, Schlayer C. Effect of rice diet on diabetes mellitus associated with vascular disease. Postgrad Med. 1958 Oct;24(4):359–71.
26. Delarue J, Magnan C. Free fatty acids and insulin resistance. Curr Opin Clin Nutr Metab Care. 2007 Mar;10(2):142–8.
27. Martins AR, Nachbar RT, Gorjao R, Vinolo MA, Festuccia WT, Lambertucci RH, et al. Mechanisms underlying skeletal muscle insulin resistance induced by fatty acids: importance of the mitochondrial function. Lipids Health Dis. 2012;11:30.
28. Wang P-Y, Kaneko T, Wang Y, Tawata M, Sato A. Impairment of Glucose Tolerance in Normal Adults Following a Lowered Carbohydrate Intake. Tohoku J Exp Med. 1999;189(1):59–70.
29. Xiao C, Giacca A, Carpentier A, Lewis GF. Differential effects of monounsaturated, polyunsaturated and saturated fat ingestion on glucose-stimulated insulin secretion, sensitivity and clearance in overweight and obese, non-diabetic humans. Diabetologia. 2006 Apr 5;49(6):1371–9.
30. Boden G. Fatty acid-induced inflammation and insulin resistance in skeletal muscle and liver. Curr Diab Rep. 2006 Jun;6(3):177–81.
31. Barnard ND. Dr. Neal Barnard’s Program for Reversing Diabetes: The Scientifically Proven System for Reversing Diabetes Without Drugs. Rodale; 2006. 290 p.
32. Barnard ND, Cohen J, Jenkins DJA, Turner-McGrievy G, Gloede L, Green A, et al. A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a randomized, controlled, 74-wk clinical trial. Am J Clin Nutr. 2009 May;89(5):1588S–1596S.
33. Barnard ND, Katcher HI, Jenkins DJA, Cohen J, Turner-McGrievy G. Vegetarian and vegan diets in type 2 diabetes management. Nutr Rev. 2009 May;67(5):255–63.
34. Barnard ND, Cohen J, Jenkins DJA, Turner-McGrievy G, Gloede L, Jaster B, et al. A Low-Fat Vegan Diet Improves Glycemic Control and Cardiovascular Risk Factors in a Randomized Clinical Trial in Individuals With Type 2 Diabetes. Diabetes Care. 2006 Aug 1;29(8):1777–83.
35. Anderson JW, Ward K. High-carbohydrate, high-fiber diets for insulin-treated men with diabetes mellitus. Am J Clin Nutr. 1979 Nov;32(11):2312–21.
36. Jenkins DJA, Kendall CWC, Augustin LSA, Mitchell S, Sahye-Pudaruth S, Blanco Mejia S, et al. Effect of legumes as part of a low glycemic index diet on glycemic control and cardiovascular risk factors in type 2 diabetes mellitus: a randomized controlled trial. Arch Intern Med. 2012 Nov 26;172(21):1653–60.
37. Jenkins DJA, Kendall CWC, Marchie A, Jenkins AL, Augustin LSA, Ludwig DS, et al. Type 2 diabetes and the vegetarian diet. Am J Clin Nutr. 2003 Sep;78(3 Suppl):610S–616S.
38. Jenkins DJ, Jenkins AL, Wolever TM, Rao AV, Thompson LU. Fiber and starchy foods: gut function and implications in disease. Am J Gastroenterol. 1986 Oct;81(10):920–30.
39. Jenkins DJ, Kendall CW, Popovich DG, Vidgen E, Mehling CC, Vuksan V, et al. Effect of a very-high-fiber vegetable, fruit, and nut diet on serum lipids and colonic function. Metabolism. 2001 Apr;50(4):494–503.
40. Du H, Li L, Bennett D, Guo Y, Turnbull I, Yang L, et al. Fresh fruit consumption in relation to incident diabetes and diabetic vascular complications: A 7-y prospective study of 0.5 million Chinese adults. PLOS Med. 2017 Apr 11;14(4):e1002279.
41. Trapp CB, Barnard ND. Usefulness of vegetarian and vegan diets for treating type 2 diabetes. Curr Diab Rep. 2010 Apr;10(2):152–8.
42. Rosenfalck AM, Almdal T, Viggers L, Madsbad S, Hilsted J. A low-fat diet improves peripheral insulin sensitivity in patients with Type 1 diabetes. Diabet Med J Br Diabet Assoc. 2006 Apr;23(4):384–92.
43. Brehm A, Krssak M, Schmid AI, Nowotny P, Waldhäusl W, Roden M. Increased lipid availability impairs insulin-stimulated ATP synthesis in human skeletal muscle. Diabetes. 2006 Jan;55(1):136–40.
44. Hirabara SM, Silveira LR, Alberici LC, Leandro CVG, Lambertucci RH, Polimeno GC, et al. Acute effect of fatty acids on metabolism and mitochondrial coupling in skeletal muscle. Biochim Biophys Acta. 2006 Jan;1757(1):57–66.
45. Krogvold L, Edwin B, Buanes T, Frisk G, Skog O, Anagandula M, et al. Detection of a low-grade enteroviral infection in the islets of langerhans of living patients newly diagnosed with type 1 diabetes. Diabetes. 2015 May;64(5):1682–7.
46. Atkinson LL, McDonald-Dyck C, Benkoczi C, Finegood DT. Effect of chronic rosiglitazone, metformin and glyburide treatment on beta-cell mass, function and insulin sensitivity in mZDF rats. Diabetes Obes Metab. 2008 Sep;10(9):780–90.
47. Finegood DT, McArthur MD, Kojwang D, Thomas MJ, Topp BG, Leonard T, et al. Beta-cell mass dynamics in Zucker diabetic fatty rats. Rosiglitazone prevents the rise in net cell death. Diabetes. 2001 May;50(5):1021–9.
48. Unger RH, Orci L. Diseases of liporegulation: new perspective on obesity and related disorders. FASEB J Off Publ Fed Am Soc Exp Biol. 2001 Feb;15(2):312–21.
49. Unger RH. Lipotoxicity in the pathogenesis of obesity-dependent NIDDM. Genetic and clinical implications. Diabetes. 1995 Aug;44(8):863–70.
50. Unger RH, Zhou YT. Lipotoxicity of beta-cells in obesity and in other causes of fatty acid spillover. Diabetes. 2001 Feb;50 Suppl 1:S118-121.
51. Pick A, Clark J, Kubstrup C, Levisetti M, Pugh W, Bonner-Weir S, et al. Role of apoptosis in failure of beta-cell mass compensation for insulin resistance and beta-cell defects in the male Zucker diabetic fatty rat. Diabetes. 1998 Mar 1;47(3):358–64.
52. Zhou YP, Cockburn BN, Pugh W, Polonsky KS. Basal insulin hypersecretion in insulin-resistant Zucker diabetic and Zucker fatty rats: role of enhanced fuel metabolism. Metabolism. 1999 Jul;48(7):857–64.
53. Kahn HA, Phillips RL, Snowdon DA, Choi W. Association between reported diet and all-cause mortality. Twenty-one-year follow-up on 27,530 adult Seventh-Day Adventists. Am J Epidemiol. 1984 May;119(5):775–87.
54. Orlich MJ, Singh PN, Sabaté J, Jaceldo-Siegl K, Fan J, Knutsen S, et al. Vegetarian Dietary Patterns and Mortality in Adventist Health Study 2. JAMA Intern Med. 2013 Jul 8;173(13):1230–8.
55. Levine ME, Suarez JA, Brandhorst S, Balasubramanian P, Cheng C-W, Madia F, et al. Low protein intake is associated with a major reduction in IGF-1, cancer, and overall mortality in the 65 and younger but not older population. Cell Metab. 2014 Mar 4;19(3):407–17.
56. Song M, Fung TT, Hu FB, Willett WC, Longo VD, Chan AT, et al. Association of Animal and Plant Protein Intake With All-Cause and Cause-Specific Mortality. JAMA Intern Med. 2016 Aug 1;
57. Rohrmann S, Overvad K, Bueno-de-Mesquita HB, Jakobsen MU, Egeberg R, Tjønneland A, et al. Meat consumption and mortality--results from the European Prospective Investigation into Cancer and Nutrition. BMC Med. 2013;11:63.
58. Djoussé L, Gaziano JM. Egg consumption in relation to cardiovascular disease and mortality: the Physicians’ Health Study. Am J Clin Nutr. 2008 Apr;87(4):964–9.
59. Noto H, Goto A, Tsujimoto T, Noda M. Low-Carbohydrate Diets and All-Cause Mortality: A Systematic Review and Meta-Analysis of Observational Studies. PLoS ONE [Internet]. 2013 Jan 25 [cited 2014 May 9];8(1). Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3555979/
60. Fung TT, van Dam RM, Hankinson SE, Stampfer M, Willett WC, Hu FB. Low-carbohydrate diets and all-cause and cause-specific mortality: Two cohort Studies. Ann Intern Med. 2010 Sep 7;153(5):289–98.
If you've ever tried a low carbohydrate diet, tell us about your experience in the comments below.
Cyrus Khambatta earned a PhD in Nutritional Biochemistry from UC Berkeley after being diagnosed with type 1 diabetes in his senior year of college at Stanford University in 2002. He is an internationally recognized nutrition and fitness coach for people living with type 1, type 1.5, prediabetes and type 2 diabetes, and has helped hundreds of people around the world achieve exceptional insulin sensitivity by adopting low-fat, plant-based whole foods nutrition.
How to Overcome Food Using…Food – the Adam Sud Story
High Carb Foods Proven To Reverse Insulin Resistance and Type 2 Diabetes
The Foolproof Way to Lose 80 Pounds and Reverse Prediabetes — John’s Story
Cholesterol Lowering Foods: The Power is on Your Plate
How to Reduce Metformin Dosage Using Your Food as Medicine – Lucie’s Story
Order Lab Tests Online: Diabetes, Heart, Liver, Kidney, Thyroid, and Inflammation