Position Statement - static.diabetesaustralia.com.au

1 Position Statement Low carbohydrate eating for people with diabetes August 2018. 1. 2. ABOUT THIS Position Statement . This Position Statement draws on the latest evidence and provides practical advice and information for people with diabetes considering a low carbohydrate eating plan. Diabetes Australia has developed this Statement in response to enquiries from people with diabetes, health professionals and the general public. 1. What is low carb eating? Low carbohydrate (low carb) eating refers Key points to diets or eating patterns that restrict carbohydrate intake, principally in processed 1. For people with type 2 diabetes, there and packaged foods and drinks such as is reliable evidence that lower carb cakes, lollies, chocolate, chips, ice cream eating can be safe and useful in lowering and sugary drinks; as well as breads, cereals, average blood glucose levels in the short grains, potatoes, fruits and sugar.

2 Usually, term (up to 6 months). It can also help when restricting carbohydrates, people eat reduce body weight and help manage a higher proportion of protein and fats such heart disease risk factors such as raised as those found in meat, chicken, eggs, oily cholesterol and raised blood pressure. fish, avocados, nuts, oils and butter. Some 2. For people with type 1 diabetes, a people choose to bulk up meals with low number of recent studies are reporting carb vegetables, such as cauliflower and benefits of lower carb eating, however zucchini. these studies are limited in their size When it comes to low carb eating, there is no and design and do not provide strong particular diet or standard approach. evidence of benefit.

3 Diabetes Australia believes high quality, large scale, longer- The Australian Dietary Guidelines provide term studies are necessary to further general healthy eating advice and are a establish the effectiveness and safety of good starting point for people wanting to low carb eating for people with type 1. improve their eating habits. However, there diabetes. is no one-size-fits-all approach to living well with diabetes. Everybody is different. 3. All people with any type of diabetes who wish to follow a low carb diet should In recent years, low carb eating has gained do so in consultation with their diabetes popularity within the general population. healthcare team. Some people have found it useful for achieving weight loss.

4 Low carb diets are 4. People with diabetes who commence popular because they are relatively easy to low carb eating should monitor their follow and heavily promoted in the media. blood glucose levels and, if necessary, talk to their doctor about the need to Low carb eating has also gained interest for adjust their diabetes medication to some people with diabetes as one option to reduce the risk of hypoglycaemia (low help lose weight and to assist in managing blood glucose). their blood glucose levels. 5. People with diabetes considering low carb eating are encouraged to seek personalised advice from an Accredited Practising Dietitian experienced in diabetes management. There are some practical considerations that need to be taken into account to ensure the eating plan is safe and enjoyable, provides adequate nutrition for general health, is culturally appropriate and fits into the person's lifestyle.

5 2. 6. People with diabetes considering 9. All Australians, including people who low carb eating should be aware of choose to follow a low carb eating plan, possible side effects (such as tiredness, should be encouraged to eat foods headaches and nausea) and seek proven to be beneficial to good health. advice from their health care team if These include whole fruit and vegetables, concerned. wholegrains, dairy foods, nuts, legumes, seafood, fresh meat and eggs. 7. Low carb eating may not be safe and is not recommended for children, 10. All Australians should be encouraged to pregnant or breastfeeding women, limit their intake of foods that are high in people at risk of malnutrition, people energy, carbohydrate or salt, including with kidney or liver failure, or those with a processed foods such as sugary drinks, history of disordered eating or some rare chips, cakes, biscuits, pastries and lollies.

6 Metabolic conditions. 8. People with type 1 diabetes may experience sudden drops in blood glucose levels and be at a higher risk of hypoglycaemia when following a low carb eating plan. They should talk with their diabetes healthcare team before starting low carb eating. 3. 1. Introduction Media coverage and public awareness Diabetes Australia regards healthy eating have helped promote the popularity of as a key issue for people with diabetes that various approaches to low carb eating in requires more research. We have developed recent years. this Position Statement based on current evidence and in response to enquiries from Healthy eating for people with diabetes people with diabetes, the general public and can encompass a wide range of eating health professionals.

7 Approaches. Healthy eating should assist a person with their diabetes management, For people with type 1 diabetes, there is provide adequate nutrition for a healthy not yet enough evidence to recommend life, be safe and enjoyable, culturally low carb eating for everyone. Low carb appropriate, sustainable and fit into the eating is not recommended for children person's lifestyle. (anyone under the age of 18) or for people with specialised nutritional requirements, as Diabetes Australia does not promote or outlined in section 5 of this Position Statement . encourage any single diet or eating plan We recognise that some people with type or any particular diabetes diet . Every 1 diabetes may choose to follow a low person with diabetes needs a personalised carb eating approach and they should approach and support to have the healthiest be supported in this.

8 We encourage these eating plan and this may change over their people to consult their diabetes healthcare lifetime with diabetes. team. Diabetes Australia relies on strong scientific For people with type 2 diabetes, recent evidence before making specific health and evidence has shown that, in the short term nutrition recommendations for people with (up to 6 months), lower carb eating can help diabetes or those at risk. Evidence is usually with the management of type 2 diabetes. based on the National Health and Medical However, this benefit is no longer evident after Research Council (NHMRC) hierarchy of 12 ,3 In addition to promoting weight- loss, reducing carbohydrate intake can Diabetes Australia believes that people with provide health benefits that include lowered diabetes should make their own, informed average blood glucose levels and reduced choices about their diabetes management risk of heart disease.

9 Some benefits can be (including eating plans) in consultation with achieved independent of the amount of their diabetes healthcare team. weight-loss ,4. We recognise that long-term studies can take years to be designed, conducted and published and, in relation to low carb eating for people with diabetes, we will continue to review and update our advice based on new evidence as it becomes available. 4. 2. Carbohydrates and diabetes Dairy foods (such as milk and yoghurt), fruit, What are carbohydrates? wholegrains and starchy vegetables are all nutrient-rich sources of carbohydrate and Carbohydrates are parts of food provide some protein, fat and fibre as well as our body breaks down into glucose vitamins and minerals.

10 The body uses these which it uses for energy. They include other nutrients to stay healthy and perform starches, such as those found in at its best. bread, potatoes and rice; as well as sugars, such as those found in fruit, Carbohydrates/sugars added in the making of foods or drinks are generally milk and yoghurt, sugary drinks, cakes, less healthy. There is often added sugar biscuits, pastries, icecream and lollies. in foods and drinks and in some cases, a lot of added sugar. This includes sugary drinks, cordials, lollies and many processed Carbohydrates/sugars are the major source foods. While these foods are also sources of energy for the body. However proteins of carbohydrate, they provide little, if any, and fats also provide a source of energy.