Dec. 14, 2022 -- Forget about counting calories. People with type 2 diabetes can lose weight and keep their blood sugar under control by eating a low-carb, high fat diet.

This is according to a new study that found this type of diet did more to help patients with type 2 diabetes than a high-carbohydrate, low-fat diet. And this was true no matter how many calories the person ate. 

These findings were based on a randomized, controlled trial, and the results were published in the journal Annals of Internal Medicine this week. 

The trial looked at 185 patients with type 2 diabetes, for whom low-calorie diets are often recommended to help people lose weight and improve glycemic control, a medical term referring to the typical levels of sugar in a person’s blood.

The trouble with this common recommendation, the investigators wrote, is that it often leads to hunger, so few patients stick to it.

“Therefore, calorie-unrestricted diets may be a better alternative to achieve long-term maintenance,” wrote study author Camilla Dalby Hansen, MD, of the University of Southern Denmark, and colleagues.

Study Methods and Results

In the new study, the participants were randomly assigned to one of two diet-based groups. Twice as many participants were put into a group that ate the low-carb, high-fat diet and the other participants were assigned to the high-carb, low-fat diet for 6 months. No calorie restrictions were placed on either group.

Patients’ weight, blood sugar control, and other health measures based on lab tests were evaluated at the beginning of the study, at 3 months, and at 6 months. The final analysis included 165 patients.

While patients in both groups lost weight, those in the low-carb, high fat group lost, on average, about 8 pounds more than those in the other group.

The low-carb, high fat diet was linked to improved blood sugar control, but it also led to slightly higher LDL, or what doctors consider to be bad cholesterol levels. 

“I believe we have sufficient data to include [low-carb, high-fat] as one of the diet options for people with type 2 diabetes,” Hansen said in a written comment.

But she predicted that some patients would still struggle to stay on it in the real world.

“The LCHF diet can be difficult for some people to follow,” Hansen said. “It is a bit more expensive, and it can be difficult to comply to in social gatherings simply because our society is not suited for this type of diet.”

The Magic of Unrestricted Calories

Jay H. Shubrook, DO, a diabetologist and professor at Touro University California, offered a similar view.

“When you start to fiddle with the diet, it affects not only the person, but all the people they eat with, because eating is a communal experience,” Shubrook said in an interview.

“What’s magic about this study is because it wasn’t calorie restricted, I think it made it a little bit more flexible for people to continue,” Shubrook said.

He said he thinks patients will need a fair amount of coaching and education about food choices in order to lose weight on a diet without calorie restrictions.

Show Sources


Annals of Internal Medicine: “Effect of Calorie-Unrestricted Low-Carbohydrate, High-Fat Diet Versus High-Carbohydrate, Low-Fat Diet on Type 2 Diabetes and Nonalcoholic Fatty Liver Disease.”

Camilla Dalby Hansen, MD, University of Southern Denmark, Odense. 

Jay H. Shubrook, DO, diabetologist, professor, Touro University California, Vallejo. 

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