Cut carbs to 40% of your plate, swap rice with millets, jowar: This can lead to diabetes remission – The Indian Express

Over half of those who went on a low-carb diet were able to achieve remission – maintain the blood glucose levels without the use of medicines or insulin – with the proportion reaching as high as 77 per cent among those with “younger” diabetes of less than one year, found a general practice-based study recently published in the journal, “BMJ Nutrition, Prevention and Health.”
Reacting to the study, Dr Anoop Misra, Chairman of Fortis-CDOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, New Delhi, says a low or moderate carb diet with calorie restriction can help in better control of Type-2 diabetes and even remission, although the results have not been as spectacular among his patients.
Why do you say this general practice study shows a better remission rate than you see at your clinic? What has been your experience with low-carb diets?
The study shows that the patients of a general practice were advised a low-carb diet, 39 per cent of whom chose to follow it, were included in the trial and followed-up over a period of 33 months. Those who chose to follow the diet seem to be highly motivated individuals! We certainly do not see such high adherence among our patients.
See, we already know that a low-carb diet is beneficial in controlling the blood glucose levels in those with Type-2 diabetes. And, it is what we recommend to our patients – we ask them to change both the quantity and quality of carbohydrate they consume.
Over 60 per cent of a person’s diet consists of carbohydrates, varying a little across India. Our aim is to cut it to less than 40 per cent. What is easier to do is swap out the simple carbohydrates like rice and wheat flour for complex carbohydrates such as brown rice, millets, flour mixed with besan or jowar. And, it certainly helps in controlling the blood glucose level and achieves remission in some. Although, drugs should not be withdrawn for those who have had the disease for years or have very high blood glucose levels.
So, who is likely to achieve remission through such a low carb diet?
The ideal population for remission would be those who are obese and have been recently diagnosed with diabetes. If they lose the extra 15 – 20 kg, they can certainly reverse their diabetes. But, a person who has had the condition for say over 20 years, already has certain complications, is unlikely to see remission and it shouldn’t even be attempted.
Now, carbohydrate is one of the main components of our food and cutting it is difficult. In fact, it is difficult to maintain these diets in our social structures. There are so many festivals, events and weddings. At the moment, 90 per cent of my patients have bad sugar control and it is always as a result of some marriage or family function.
There are two groups of people that we have seen are likely to stick to the diet they have been prescribed – those who are in general very disciplined in their lives (and, they are likely to have lower sugar levels) and young, obese women who are about to get married.
Would the diet recommendations differ for new diabetics and those who have had it for long?
Yes. For new diabetics, we can go for a low carb or a moderate carb diet with calorie restriction. For a new diabetic who is motivated to reverse it, we can prescribe a low carb diet where only 25 per cent of their calories come from carbohydrates. We ask them to increase their intake of proteins.
For those not so motivated, a moderate carb diet, where 40 per cent of their calories come from carbohydrates, along with a calorie restriction, is beneficial. This is the middle road and more people are likely to stick to it.
As for the long diabetics, we do not suggest lowering calories because they are already low on muscles and bones.
All of these things – including health of the other organs – have to be considered before designing a diet. When we are cutting the carbohydrates, the question also arises what do we replace it with? We have to keep in mind that we cannot ask vegetarians to increase their protein intake to more than 30 per cent of their calorie intake. We can’t ask people to consume fats because they are likely to consume all the wrong kinds.
Can diabetics go on popular diets such as intermittent fasting or keto?
The results of the moderate carb diet that we prescribe are similar to what is seen with intermittent fasting in terms of weight loss and sugar control. When it comes to keto diet – with very low carb intake, probably about 10 per cent of the calories, and a high protein and fat intake – we do not have any study on its impact on the Indian population, so I cannot say.
It has certainly been shown to result in much more weight loss than the moderate carb diet or intermittent fasting. But it may mess up the liver. And, it cannot be sustained over long periods.
Any diet has to be individualised to a patient keeping in mind not just their diabetes status but the health of their liver, kidneys, heart, bones and so on. Also their individual preferences. So, it is better to design the diet in collaboration with their physician and nutritionist. There is also a proliferation of nutritionists who work independent of a patient’s doctors; they design plans not looking at this overall picture. That does not work. Designing the diet has to be a team effort.
Why Dr Misra? Dr Anoop Misra is the Chairman of Fortis-CDOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology in New Delhi. He has been an advisor to the Ministry of Health, the Indian Council of Medical Research (ICMR), and the Department of Biotechnology, offering his expertise on several issues related to diabetes and other non-communicable diseases. In the past two years, Dr Misra has published 40 papers on Diabetes and COVID-19 in top science journals.
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Anonna DuttAnonna Dutt is a health reporter with the Indian Express. She writes o… read more

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