Why I Changed my Mind About Low Carb Diets as a Registered Dietitian


Is a keto diet healthy? Is a low carb diet healthy? Today I wanted to share with you all a series of powerful events that led me to be more open to low carb diets as a Registered Dietitian. If you didn’t already know, all dietitians are required to have the same education in three major categories: clinical nutrition, community nutrition, and food service management. The Academy of Nutrition and Dietetics prescribes the information every dietitian learns and the competencies they must achieve to become registered. The rigorous education, supervised practice, and national exam that are required to earn the title of Registered Dietitian ensure that the public receives high quality, evidence based nutrition services. This process is absolutely essential to protect the public from the myriad of nutrition misinformation that could cause major harm in certain circumstances. However, it makes dietitians very skepical and closed minded when it comes to certain dietary approaches. I was too, until I experienced how life-changing low carb diets could be for some of my patients- even though they initially went against my recommendation to eat more carbs!

As dietitians, we are all wary of “Fad Diets,” and pray that the public won’t fall victim to each next diet craze. Unfortunately, many people are drawn to unsustainable diets based on promises of quick results, and they end up cycling through each diet that comes along without making any sustainable habit changes. When it comes to weight loss, research has shown us that any diet can work in the short term- whether it be low fat, low carb, Mediterranean, Vegetarian, et cetera. The biggest problem is that most people don’t have the support necessary to make the lifestyle changes that are needed for long term success. More on that in a future post… Since the Keto diet for weight loss is the most recent diet craze, I initially cautioned people against it. It eliminates several food groups, leading to the potential for nutrient deficiencies, not to mention the unsustainability of avoiding many of peoples favorite foods indefinitely. With rising popularity, research is starting to come out on some of the metabolic benefits of ketogenic diets, including improvements to insulin resistance and symptoms of PCOS. Again, this could be a topic of a whole separate post. This post is about two remarkable patients who changed their lives and opened my mind to the possibility of sustainable, healthy low carb diets.

Rachel was determined to “beat the ‘betes”

The first patient, I will call Rachel. Rachel’s best friend had just been diagnosed with diabetes, and she joked to Rachel that she would be the next one to “get the ‘betes.” She was right. Rachel was soon hospitalized for blood sugars over 400, and diagnosed with Type 2 Diabetes. Her HgA1C was over 13%. (The normal range for A1C is under 5.6%.) Rachel made a decision before she came to see me that she was going to turn her life around to avoid the complications of diabetes. She began avoiding all carbs two weeks before she had her first appointment with me. I gave her individualized recommendations for the amount of carbs she should eat per meal based on the American Diabetes Association and Academy of Nutrition and Dietetics standards, which were much higher than the amount she was currently eating. She was deathly afraid of developing complications from diabetes, which can include diabetic neuropathy, loss of eyesight, amputation of limbs due to infection, and even kidney failure. Rachel was determined to “beat the ‘betes,” as she put it. She was also afraid of carbs. Her relationship with food was one based on fear. I encouraged her that it was ok to incorporate healthy carbohydrates into her diet, like fruit, whole grains, and starchy vegetables. She cautiously reincorporated some of these foods, but felt most comfortable keeping her total carbohydrate intake low.

She also felt great eating low carb! Her fasting blood sugars consistently declined week over week, and she stated she had more energy because she wouldn’t have “sugar crashes,” like she used to when eating high amounts of processed foods and added sugars. After 3 months, she decided to start exercising consistently to build on her healthy habits. She continued to eat low carb and exercise consistently over the next 3 months. I provided education and counseling weekly, then bi-monthly, and finally monthly over the course of a year for her. After 6 months of eating a healthy, balanced, low carb diet with the last 3 months including regular moderate exercise, her A1C was 5.6%. SHE NO LONGER HAD DIABETES in terms of her A1C. She was ecstatic! Over the year that I saw Rachel, she lost 30# and maintained that weight loss, decreased her A1C from over 13% to 5.6%, and most importantly, built habits that she enjoyed and could maintain for a lifetime. This was the first time I had seen the power of a low carb diet.

Eating low carb does not have to mean sacrificing flavor! Image courtesy of  The Lazy Artist Gallery

Eating low carb does not have to mean sacrificing flavor! Image courtesy of The Lazy Artist Gallery

The next experience was even more powerful. When Mark came to see me, he had already developed complications from Type 2 Diabetes. Although he didn’t know it before, his blood sugars had been elevated long enough to cause diabetic neuropathy. He had constant shooting pains in his feet and legs. When he finally went to the doctor and was diagnosed with diabetes, he was determined to eat healthy to avoid more complications. He too started avoiding almost all carbs before he even saw me, and was cautious to incorporate more. After meeting weekly and learning about a variety of nutrition topics from fiber to healthy fats, he was excited to be able to have some of the healthy carbs he had eliminated. Mark began eating small amounts of brown rice, switching his whole family over from white rice. He also started making the breads in his house with whole wheat flour. He worked on eating more vegetables and drinking more water. He felt so much better, and he was happy to find a balance of carbs that kept his blood sugars in a healthier range.

Mark’s fasting blood sugars also declined week over week, until they were consistently in a non-diabetic range. One day he came into my office and told me that he was no longer having the shooting pains in his feet and legs. HE HAD REVERSED HIS DIABETIC NEUROPATHY! He was almost in tears. “I never thought that would go away! I just thought it would always be that way,” he said. He had taken control of his blood sugars, energy, and health. Instead of feeling trapped by the diagnosis of diabetes, he now felt empowered that he could enjoy his favorite foods AND feel great.

Since working with Rachel and Mark, I have seen countless others choose a healthy low carb lifestyle and have excellent health outcomes. While I don’t think a low carb diet is the best option for everyone, for those who could benefit from reduced carb intake, like those with diabetes, it can be absolutely life-changing! I am so grateful to have had these experiences that opened my eyes to low carb diets. I feel that it has expanded the range of people I can help build habits that support their health and make them feel good every day. My mission is to help as many people as possible with nutrition, and being able to offer a balanced, low carb option helps me do that as a Registered Dietitian!