The Diabetes Podcast

Episode 25 - The Case for Carbohydrates


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Carbs aren’t the villain. In this episode, we make the case for whole, fiber-rich carbs—especially for people living with diabetes. We break down keto history, why it can “work” short-term, and why most people aren’t actually in ketosis. We explain metabolic flexibility, the difference between ketosis and dangerous ketoacidosis (DKA), and why carbs from whole plants bring nutrients you can’t get anywhere else. We close with the three best-researched eating patterns for long-term health: Mediterranean, DASH, and Whole Food Plant-Based. Takeaway: Don’t avoid carbs. Reclaim them—by choosing whole, colorful, fiber-rich foods.

What You’ll Learn

  • Keto’s origin: a medical therapy for childhood epilepsy—not a weight loss plan.
  • Why early “keto weight loss” is often water, not fat (glycogen holds water).
  • Most “keto” diets aren’t true ketosis (and why that matters).
  • DKA vs nutritional ketosis: warning signs and when to seek care.
  • Metabolic flexibility: how to switch smoothly between fat and glucose for energy.
  • Why long-term low carb can reduce your ability to handle carbs later.
  • Fiber boosts natural GLP-1 for fullness and steady blood sugar.
  • 90% of protective phytochemicals come from carb-rich plant foods.
  • Why high saturated fat, animal-heavy low carb can raise LDL and heart risk.
  • The best evidence-based diets for diabetes and longevity include carbs:
    • Mediterranean
    • DASH (great if you also have high blood pressure)
    • Whole Food Plant-Based

Key Takeaways

  • Carbs are not the problem. Ultra-processed foods are.
  • Whole carbs deliver fiber, vitamins (B, folate), minerals (magnesium, potassium), and powerful phytochemicals.
  • For insulin users: long-term carb restriction can raise insulin per gram when carbs return—this is an adaptation, not failure.
  • Build metabolic flexibility with balanced meals and mixed exercise (aerobic + anaerobic).

Simple Action This Week

  • Step 1: Spot one ultra-processed food you eat daily (soda, pastry, chips, ice cream).
  • Step 2: Swap it for a high-fiber whole carb:
    • Soda → sparkling water with citrus
    • Chips → veggies and hummus
    • Pastry → whole grain toast with nut butter
    • Ice cream → frozen berries with plain Greek yogurt
    • Add 1/2 cup beans to a salad or soup

Helpful Terms

  • Low carb diabetes: managing diabetes on fewer carbs—don’t forget fiber-rich plants still matter.
  • Nutritional ketosis: mild, measured ketones from very low carb, high fat intake.
  • DKA (diabetic ketoacidosis): medical emergency—nausea, vomiting, fruity breath, fast breathing, extreme thirst/urination. Seek care now.
  • Metabolic flexibility: your body smoothly uses both fat and glucose for fuel.

Resources Mentioned

  • Mediterranean, DASH, and Whole Food Plant-Based eating patterns
  • Fiber and GLP-1 for fullness
  • Large studies linking plant-forward, carb-inclusive diets to longer life


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Disclaimer:

The information in this podcast is for educational and informational purposes only. It is not medical advice, diagnosis, or treatment, and it does not replace a one-on-one relationship with your physician or qualified healthcare professional. Always talk with your doctor, pharmacist, or care team before starting, stopping, or changing any medication, supplement, exercise plan, or nutrition plan—especially if you have diabetes, prediabetes, heart, liver, or kidney conditions, or take prescription drugs like metformin or insulin.

Results vary from person to person. Examples, statistics, or studies are shared to educate, not to promise outcomes. Any discussion of medications, dosing, or side effects is general in nature and may not be appropriate for your specific situation. Do not ignore professional medical advice or delay seeking it because of something you read or heard here. If you think you are experiencing an emergency or severe side effects (such as persistent vomiting, severe diarrhea, signs of dehydration, allergic reaction, or symptoms of lactic acidosis), call your local emergency number or seek urgent care right away.

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The Diabetes PodcastBy Empowered Diabetes