The dietary approach to managing diabetes that you hear about most often as one that describes a relationship between carbohydrates and fats in your diet is low-carb, high-fat, moderate-protein (or LCHF for short). So we’ll start with that.

Low-carb, High-fat, Moderate-protein (LCHF)

This approach is based on current scientific research as well as anecdotal experiences that have shown that diabetes symptoms can be reversed and blood glucose put in the normal non-diabetic range (4.0-5.6% A1C) as long as the patient maintains a low-carb high-fat dietary lifestyle. (More detailed information here.)

The definition of “low-carb” varies a lot, depending on what source you are consulting, and can be anywhere from 130 grams/day of carbs to 30 grams/day. Adventist Vegetarian Diabetics considers < 100g/day to be low-carb and < 50g/day to be very-low-carb, though many of us need to limit carbs to < 30g TOTAL (or < 20g NET) carbs. A very low-carb diet is one in which the percentage of calories from carbohydrates is 5-10%, protein is 15-20%, and fat is 70-80% of total calories.

A typical LCHF diet consists of a protein source (meat, eggs, cheeses, nuts and seeds) and a foundation of green leafy and cruciferous vegetables and other low-carb vegetables. It frequently omits all grains, legumes, starchy vegetables, and most fruit except for a few berries. Healthy dietary fats are from avocados, olives/olive oil, coconut oil, butter, heavy cream, and cheeses. LCHF may be applied to carnivore, “clean-meat” non-vegetarian, pescatarian, lacto-ovo vegetarian, or dietary vegan lifestyles.

In his book, The Diabetes Code, Dr. Jason Fung describes LCHF as low-carb healthy-fat. I like that description! It means that, in addition to low-carb (however you choose to define it), you eat enough healthy fat to keep you satiated and enough protein to provide necessary nutrients for cell growth and repair but not so much protein as to cause gluconeogenesis, which can contribute to an elevated blood glucose level. Dr. Fung is very clear about stating that diabetes is caused by too much sugar.

High-carb, Low-fat, Moderate-protein

The polar opposite of LCHF would be high-carb low-fat (HCLF) and is typical of a dietary vegan protocol. Proponents of this protocol typically call it “whole-food plant-based” (WFPB). While this implies dietary vegan, I would like to posit that WFPB can apply to any dietary lifestyle that (1) requires “real food,” that is, unprocessed foods, as much as possible, and (2) focuses on vegetables as a foundation of nutrients. A high-carb moderate-protein low-fat dietary protocol has to be dietary vegan in order to reverse diabetes.

The basic belief for this approach is that diabetes is caused by dietary fat. And, as such, proponents insist that fat should be no more than 30 grams/day and that fats must come from the whole food. Coconut is okay but not coconut oil, not even organic, virgin, unrefined coconut oil. Olives are okay but not olive oil. They also do not permit any processed foods.

There is no limit placed on the amount of carbohydrates. Rice, potatoes, and other starchy vegetables are allowed in any amount as long as they are not processed. There is no limit on legumes. There is no limit on fruits as long as they are a whole food. Fortunately, they do not allow juices of fruits or vegetables.

One interesting tidbit is that the WFPB proponents say that nuts/seeds should be eaten in small amounts because, otherwise, you’ll get too much fat. The proponents of LCHF say that nuts/seeds should be eaten in small amounts because, otherwise, you’ll get too much carbohydrate!

Low-carb and Low-Fat = Broken Seesaw

It’s very difficult for many people to accept that fats are okay for diabetics (within whatever individual calorie quota they have established for themselves). We have spent our lifetimes being bombarded by the food, pharmaceutical, and medical industries with the idea that fat is “bad” and carbs are “good.” It takes some serious thought—and research—to come to believe just the opposite. And many of you will never believe that high healthy fats are good for diabetics! Yet you can’t deny the proof that high amounts of carbohydrates are detrimental to diabetic health.

So I have seen many of you ask, “Why can’t I eat low-carb and low-fat?” That’s because you are defining low-carb and low-fat as being some specific amount of carbs or fat, not their relationship to each other. As you can see by the illustration above, you can’t have both low-carb and low-fat because that would create a broken seesaw!

Or if you put low-carb and low-fat on the same side of the seesaw, that would result in a very high-protein! And, without doubt, gluconeogenesis!

Low-carb, High-protein, Moderate-fat

Finally, there are some low-carb schools of thought that recommend low-carb, high-protein, moderate-fat. This is what Dr. Richard K. Bernstein recommends, as well as the original Atkins Diet. Of course, Dr. Bernstein also recommends a substantial exercise regimen! And if you are doing the amount and types of exercise that require a higher level of protein, this might be appropriate. But if you are not using all your dietary protein for cell growth and repair, you could easily experience gluconeogenesis.

Since I don’t get nearly as much exercise as I need for general health, I don’t consider low-carb high-protein as a viable option for me at all. However, if you are convinced that you should eat moderate-fat (and, thus, high-protein), and if you are able to do so without raising your blood sugars (due to gluconeogenesis), by all means, please do so.

Moderate Everything

Well, then, some will say, how about just “moderate everything”? First of all, this idea smacks of the terrible advice, “Everything in moderation.” Other reasons that “moderate everything” is a bad idea are that (in a 2000-calorie diet):

  1. 33% carbs would be way too high for a low-carb protocol (whether high-fat or high-protein).
  2. 33% fat would be too much fat for ADA (American Diabetes Association) compliance and way too much for high-carb low- or no-fat vegan.
  3. 33% protein would be too low for low-carb high-protein and too high for low-carb high-fat (could result in gluconeogenesis). It is also too high in protein for a high-carb low- or no-fat dietary vegan diet.

Nope, “moderation” is not a good idea!

High-carb and High-fat = SAD (Standard American Diet)

A diet with high carbs and high fat is typical of the Standard American Diet (SAD) or junk food. This protocol can be (1) Adventist non-vegetarian (hamburgers and beef hot dogs on buns, breaded fried chicken, French fries, ketchup, pizza, ice cream, doughnuts, etc.), (2) lacto-ovo vegetarian (veggie burgers and Big Franks on buns, French fries, ketchup, pizza, ice cream, doughnuts, etc.), or (3) vegan (ketchup, doughnuts, Oreos, and potato chips). Yes, there is such a thing as a junk food dietary vegan!

If you are still eating high-carb and high-fat, we hope you are at least taking your insulin and/or diabetes meds as prescribed and getting your A1C tested every 3 to 6 months (or as ordered by your doctor).

Perhaps, at some point, you will feel empowered to at least follow ADA dietary recommendations, which includes a limit to carbs and…wait for it…portion control! Following ADA guidelines may delay any diabetic complications and give you a few more years of life. And if you are okay with that, that’s all that matters.

A few of you, however, really are focused on reversing your diabetes symptoms and achieving/maintaining normal blood sugars (4.0-5.6% A1C) without diabetes medications and/or insulin. Some of you will do this by eating low-carb (with either high-fat or high-protein), whether you are Adventist non-vegetarian, lacto-ovo vegetarian, or dietary vegan. And some few of you will do this with a totally dietary vegan approach which is high-carb low- or no-fat.

Regardless of how you achieve normal blood sugars (without medications), the most successful approaches have these three things in common:

  1. You eat (or drink) no added sugar. Period.
  2. You eat only real foods that are in as close as possible to their natural state. This means almost no processed foods, especially highly refined carbohydrates. No fruit or vegetable juices.
  3. You eat no foods with trans fats (margarine, shortening, or vegetable/seed oils that are processed with high heat and chemicals).

Most importantly, you will “prove all things; hold fast that which is good”!