All Diabetics Should Cut Out All Carbohydrate Foods? Dr Chan shares why he disagrees.

Why I Disagree With the "All Diabetics Must Cut Out All Carbs" Low Carb" Rule

I hear this said often. By well-meaning people. By advocates of low carbohydrate diets. By content creators who find that it makes a simple yet compelling case - carbs make blood sugar go up, diabetics have problem with high blood sugar therefore the solution is simple, all diabetics should cut out all carbs, simple. Really?

"All diabetes patients must stop eating, or drastically reduce, all carbohydrates."

It sounds decisive. It sounds clear. It sounds like good advice.

But I disagree with it.

Watch the short video below, or read on for my full explanation.

Are Carbs Really the Enemy for All Diabetics?

Let me offer you a comparison.

Saying that all diabetes patients must stop eating, or drastically reduce, all carbohydrates is the same as saying that all poor people must stop spending money on all things.

Can you see how that sounds? Quite ridiculous, isn't it?

A person who has less money does not have no money. They simply do not have as much as they would like, or as much as others. But they still need to spend. On the right things. On necessary things. On things that serve them well.

Taking money away entirely does not solve the underlying problem. And taking away all carbohydrates from every person with diabetes does not either.

The Problem With Telling All Diabetics to Cut All Carbs

"All diabetes patients must stop eating, or drastically reduce, all carbohydrates" 

There are three parts to this statement.

The first part of the statement is all diabetes patients. Regardless of whether someone has prediabetes. Regardless of whether their diabetes is mild or severe. Regardless of how well or poorly controlled it is. No exception. Every single diabetic.

The second part of the statement  is must stop or drastically reduce. Not about reducing appropriately, but a blanket "Stop altogether or drastically reduce"

The third part of the statement  is all carbohydrates. Regardless of whether they are refined or complex carbohydrates or not, regardless of whether they are high or low glycaemic index carbohydrates. regardless of whether they come from ultra-processed foods or whole foods. Does not matter. All carbohydrates.

When you lay spell out all three parts clearly, I would argue that it is self evident why the statement is problematic and should not be applied as a general recommendation for diabetics.

Every Person With Diabetes Is Different: What This Means for Carbs

Every person with diabetes is different.

I want to say that again. Every person with diabetes is different.

I often see patients in my clinic who are at very different stages of this condition. Some have prediabetes. Some have newly diagnosed Type 2 diabetes. Some have had it for twenty years. The severity of carbohydrate intolerance varies enormously from person to person. The degree of insulin resistance varies. The degree of beta cell dysfunction varies. Their overall state of health varies. Their other medical conditions vary. The medications they are on vary.

And their dietary habits vary too. Some patients are genuinely consuming far too many high glycaemic index refined carbohydrates. For them, significant reduction makes sense. But others are eating a fairly balanced diet. Their problem lies elsewhere. Telling them to cut out all carbohydrates does not address their real issue.

Not only that. Every person's food culture is different. Their access to different foods is different. What is realistic for one patient is completely impractical for another.

What a diabetic need and value the most is advice that takes into account their specific condition and circumstances.

What Carbs Should Diabetics Actually Reduce?

Let me be clear about what I am not saying. I am not saying carbohydrates do not matter. They do.

Cutting down on refined sugar matters. Reducing added sugar matters. Cutting down on ultra-processed food matters. Reducing excessive calorie intake matters. These are the foundational, non-negotiable steps. I agree with all of them fully.

But beyond that foundation, the answer depends on you. It depends on your specific situation. It depends on your severity, your pathophysiology, your overall health, your food culture, and your ability to sustain change over time.

For some patients, meaningfully reducing high glycaemic index refined carbohydrates will make a significant difference to their blood sugar control. That reduction should be appropriate to their situation. 

For others, the carbohydrate question is not even the most urgent thing to address first.

Ask better questions. Instead of asking whether all carbs must be cut, ask: what are my overall lifestyle and eating habits actually doing to my blood sugar? What changes are realistic and sustainable for me? What does my specific situation actually require?

Why Diabetics Need a Personalised Carb Plan, Not a Blanket Rule

When coaching my patients, I do not hand them a single rigid diet and tell them to follow it. I look at the whole person. I look at where they are, what they are eating, what is driving their poor blood sugar control, and what changes they can genuinely make and sustain.

Sometimes the most important change is reducing refined carbohydrates. Sometimes it is something else entirely. Stress. Sleep. Inactivity. Excessive calorie intake from fats, not carbohydrates. It depends.

This personalised approach is the key to helping each individual diabetic tackle their condition optimally. Overly simplistic, one size fits all recommendation, that does not take into account individual variability,  such as ""All diabetics should stop eating, or drastically reduce, all carbohydrates" is clearly unhelpful.

Learning About Reversing Type 2 Diabetes

If you have diabetes and are not as equipped with the essential foundational knowledge about reversing Type 2 diabetes as you should be, I have a structured online learning programme that you might find very useful. You can find out more through the link below.

Find out more about the Reversing Type 2 Diabetes: Essential Basics - Structured Online Learning Programme Here

About This Video

In this video, I challenge the sweeping claim that all diabetes patients must stop or drastically reduce all carbohydrates. I break the statement down into its three parts, use a practical analogy to show why it does not hold up, and explain why personalisation based on each patient's individual severity, pathophysiology, food culture, and overall health is the only approach that makes clinical sense.

Related Reading

• Can Type 2 Diabetes Be Reversed? Dr Chan answers
• Case Studies: Diabetes Reversal and Remission Through Lifestyle and Diet
• What Is Prediabetes? A Call to Action
• Reversing Type 2 Diabetes: Essential Basics — Structured Online Learning Programme

Full Video Transcript

The following is the full transcript of the video above.

All diabetes patients must stop eating or drastically reduce all carbohydrates. What do you think? Hello, I'm Dr. Chan.

In this episode of overcoming diabetes, the topic we are going to cover is this statement here. All diabetes patients must stop eating or drastically reduce all carbohydrates. What do you think? True or false?

I disagree with this statement because saying that all diabetes patients must stop eating, must drastically reduce all carbohydrates, is the same as saying that all poor people must stop spending money on all things. Quite ridiculous, isn't it?

But let's break this statement down into the key parts. The first part of it is all diabetes patients, regardless of the severity of their condition. Regardless of whether their carbohydrate intolerance is very severe or very mild, regardless of their insulin sensitivity and their insulin production, or diabetes patients whether they are pre-diabetic, whether they have mild diabetes or they have severe diabetes. The statement here is all, anybody, everybody with diabetes must stop, must drastically reduce eating all carbohydrates, all diabetes patients, regardless, no exception. Would you agree with that?

Next, the second part of this statement is all diabetes patients must stop or drastically reduce, meaning that it is very very low carbohydrates or even stop eating carbohydrates altogether. Do you agree or do you disagree?

The next part of this statement is this: all carbohydrates. All forms of carbohydrates, regardless of whether they are refined carbohydrates, whether they are complex carbohydrates, regardless of whether the carbohydrates come in ultra-processed form or they come in the form of whole foods. The statement says all carbohydrates, any and every form of carbohydrates. So with regards to this statement, would you agree or disagree?

For me, I disagree. I totally disagree. I'm using this statement for discussions because this is a very common sweeping statement that many advocates of low carb diet tend to be pushing across, that all diabetes patients regardless of the severity of their diabetes must stop, must drastically reduce not just appropriately reduce, all forms of carbohydrates.

So I disagree because saying that all diabetes patients must stop eating, must drastically reduce all carbohydrates, is the same as saying that all poor people must stop spending money on all things. Quite ridiculous, isn't it? That even people who are poor doesn't mean that they have no money, but just that they do not have as much money as others or not as much money as they would like to have, but they will still need to spend money on appropriate things, on things that are critical, on things that are beneficial, on things that are useful. How many of you agree with my analogy here?

So likewise for diabetes patients, depending on their severity of the condition, depending on their current dietary intake habits, they might need to appropriately reduce especially the intake of high glycaemic index, high GI, refined carbohydrates. But we should not have a blanket sweeping statement to advocate and to tell all diabetes patients they must stop eating, they must drastically reduce all carbohydrates. Because that is the same. That's akin to saying all poor people must stop spending money on all things.

The key learning point is this: that every person with diabetes is different. There's no one size fits all. That a person with diabetes may have a different severity of their condition, can be very mild to very severe. Every person with diabetes is different in the form of, in the degree of, in the predominance of the pathophysiology, whether they are predominantly insulin resistant or they are predominantly having beta cell dysfunction or deficiency of insulin production, or both. Every person with diabetes is different in terms of their overall state of health, in terms of whether they have other medical conditions. Every person with diabetes may be on different kinds of medications, different kinds of treatments. Every person with diabetes may have currently different dietary preferences, different dietary food culture, and also may not have the same dietary problems in the form of maybe they're having excessive carbohydrates or maybe they are not having excessive carbohydrates. And every person with diabetes is different in terms of their ability, in terms of their access to healthy food, the food that they should be taking.

So we need to be cognisant of, mindful of, that every person with diabetes is different. This is an important point that we need to consider whenever we prescribe or recommend a particular diet to anybody. And since every person with diabetes is different in so many different aspects, the needs of the management of, in the treatment of, including treatment in the form of lifestyle and dietary optimisation and change, is different for different people with diabetes and that should be personalised.

So if you have diabetes, can I encourage you, on top of doing the obvious stuff like cutting down on refined sugar, cutting down on added sugar, cutting down on ultra-processed food, and cutting down on excessive calories, the obvious foundational stuff, other than that, the rest of what you should eat, how you should eat, your dietary patterns that you should aim and strive towards, that should be personalised, individualised, based on your severity of your condition, your pathophysiology, your state of health, your medical conditions, your medications, and especially your dietary preference and your food culture and your ability, your access to different kinds of foods.

I just wanted to use this statement to highlight this very important point that everybody is different. Let us not shove down the throat of every diabetic patient a specific recommendation or dietary recommendation that is good for a particular person. It does not mean that it is good for everybody.

For those who are new here, let me introduce myself. I'm Dr. Chan. I'm a medical doctor from Singapore. Other than being a doctor, I'm also a trainer, a coach, and for a period of time, I was also the full-time head chef of a restaurant that I operated from 2014 to 2019, which I used as a living classroom to teach, to educate, to encourage people to look at food as medicine. My passion is in helping people to improve their lifestyle, improve their diet so as to use that as medicine to better control, better combat, reverse their diabetes, their cardiovascular disease and other lifestyle-related chronic diseases. And I do that through one-to-one coaching, through workshops, through webinars, and through online courses. If you need to know more about me, I shall leave the link to my website in the description somewhere in this video.

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