Low-carb diets have consistently been shown to lower blood sugar and improve other health markers in people with diabetes.
However, certain higher-carb diets have also been credited with similar beneficial health effects.
For example, some studies on low-fat vegan and vegetarian diets suggest that this way of eating may lead to better blood sugar control and overall health (27, 28, 29, 30).
In a 12-week study, a brown rice-based vegan diet containing 268 grams of total carbs (72% of calories) lowered people’s HbA1c more than the standard Korean Diabetes Association diet containing 249 grams of total carbs (64% of calories) (30).
An analysis of four studies found that people with type 2 diabetes who followed a low-fat, macrobiotic diet containing about 70% of calories from carbs achieved significant reductions in blood sugar and other health markers (31).
The Mediterranean diet has also been shown to improve blood sugar control and provide other health benefits in individuals with diabetes (32, 33).
However, it’s important to note that these diets weren’t directly compared to low-carb diets, but rather to standard, low-fat diets often used for diabetes management.
In addition, there aren’t as many studies on these diets as there are on low-carb diets. While they may be effective for certain people, more research is needed to confirm these findings.
How to Determine Optimal Carb Intake
Although studies have shown that many different levels of carb intake may help control blood sugar, the optimal amount varies by individual.
It is worth repeating that diets containing 20–50 grams of carbs per day have been studied the most and typically produce the most dramatic results in diabetics.
However, in addition to keeping blood sugar levels within a healthy range, it’s important to eat the amount of carbs at which you feel best, as well as that you can realistically maintain in the long term.
Therefore, figuring out how many carbs to eat requires some testing and evaluating to find out what works best for you.
To determine your ideal carb intake, measure your blood sugar with a blood glucose meter before a meal and again one to two hours after eating.
The maximum level your blood sugar should reach is 139 mg/dL (8 mmol/L) in order to prevent damage to blood vessels and nerves.
However, you may want to aim for an even lower upper limit.
To achieve your blood sugar goals, you may need to restrict your carb intake to less than 10 grams, 15 grams or 25 grams per meal.
Also, you may find that your blood sugar rises more at certain times of the day, so your upper carb limit may be lower for breakfast than lunch or dinner.
In general, the fewer carbs you consume, the less your blood sugar will rise and the less diabetes medication or insulin you’ll require to stay within a healthy range.
If you take insulin or diabetes medication, it’s very important to speak with your doctor or health care provider prior to reducing your carb intake so that your dosage can be adjusted to prevent low blood sugar.
Bottom Line: Determining the optimal carb intake for diabetes management requires testing your blood sugar and making adjustments as needed based on your response, including how you feel.
Take Home Message
Based on the evidence to date, conventional recommendations that diabetics should consume at least 45% of their daily calories from carbs appear misguided.
Multiple studies have shown that a daily carb intake of 20–150 grams, or between 5–35% of calories, not only leads to better blood sugar control but may also promote weight loss and other health improvements.
Therefore, a carb-restricted approach may be your best bet to keep your blood sugar within a healthy range.
However, even among people with diabetes, some individuals can tolerate more carbs than others.
Testing your blood sugar and paying attention to how you feel at different carb intakes can help you find your own personal range for optimal diabetes control, energy levels and quality of life.
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