Physical Therapy and Low-Carb Diets

Jan 25, 2024

Physical Therapy and Low-Carb Diets

By Dr. Sean M. Wells, PT, DPT, OCS, ATC/L, CSCS, CNPT, Cert-DN

In recent years, low-carb diets have gained popularity as an effective approach to weight loss and improved health. Advocates praise the benefits, while critics highlight potential drawbacks. In our 3 course certification program, we dive deep into the topic of various diets to analyze their pros and cons. This blog post aims to delve into the advantages and disadvantages of low-carb diets to help physical therapists (PTs) educate their patients and avoid spreading misinformation.

Benefits of Low-Carb Diets:

1. Weight Loss:
One of the primary reasons people opt for low-carb diets is their potential to facilitate weight loss. By restricting carbohydrate intake, the body is prompted to burn stored fat for energy, leading to a reduction in body weight. While the data on this seems promising, long term studies show the weight loss may not be sustained and is truly pegged to the quality of the person's diet (see this JAMA study). 

2. Improved Blood Sugar Control:
Low-carb diets can be beneficial for individuals with diabetes or insulin resistance. Restricting carbs helps stabilize blood sugar levels, reducing the need for insulin and potentially lowering the risk of complications. In my experience, and coupled with data sets from those with diabetes, the quality of food matters here also. Often individuals see improvement in blood sugar and weight loss as they adopt low carb diets because they are removing ultra processed foods. A person may see similar benefits with a balanced diet but substituting the ultra processed foods with whole fruit and low-glycemic vegetables. 

3. Increased HDL Cholesterol:
Some studies suggest that low-carb diets may lead to an increase in high-density lipoprotein (HDL) cholesterol, often referred to as "good" cholesterol. Elevated HDL levels are associated with a lower risk of heart disease. Doctors of Physical Therapy (DPT) should be well aware that exercise is one of the best methods to boost HDL.

4. Appetite Control:
Many individuals report feeling less hungry on low-carb diets. The inclusion of protein and healthy fats can contribute to increased satiety, making it easier for people to adhere to their dietary plans. Again, we ultra processed, high carb junks foods are removed you often see in improvement in in the 3 Vs: volume, value, and velocity. Junk foods are easy to eat a lot (volume), are usually cheap (value), and can be eaten rapidly (velocity). There are foods that are high in carbs but also hold good volume, value, and velocity and these are usually whole plant foods like fruit, unprocessed whole grains and some vegetable. Protein and fat on a low carb diet may control your appetite but so does fiber. Meals that are rich in both protein and fiber are often more effective in controlling appetite (see NIH study). Combining these nutrients can enhance their individual effects on satiety, leading to prolonged feelings of fullness.

Drawbacks of Low-Carb Diets:

1. Nutrient Deficiency:
Restricting certain food groups, especially those rich in carbohydrates, may lead to nutrient deficiencies. Fruits, vegetables, and whole grains are important sources of essential vitamins, minerals, and fiber that may be lacking in low-carb diets. In my experience as a nutritionally focused PT, my clients on low carb diets often lack magnesium, fiber, and sometimes folate. As such, they often have difficulty with bowel movements and sometimes suffer with fatigue, muscle pain or cramping, or tingling. If these sound like physical therapy signs and symptoms that mimic other conditions, then you see the value in looking at patients' diets.

2. Keto Flu and Side Effects:
Transitioning to a low-carb diet, particularly a ketogenic diet, can cause side effects known as the "keto flu." Symptoms may include fatigue, dizziness, nausea, and irritability. These usually subside, but they can be challenging during the initial phase.

3. Social Challenges:
Following a low-carb diet can be socially challenging, especially when dining out or attending gatherings. Limited options may make it difficult to adhere to the diet, potentially leading to feelings of isolation or frustration. Another issue is the personality effects with diet identification. In other words, people have become entrenched in the notion that you are either high carb or low carb; vegan or ominvore; keto or high carb: ultimately what matters is finding a diet that works for your body, your movements, and that is focused on high quality, minimally process foods. As such, you can be a plant-based low carb dieter or a high carb omnivore. See this nice Harvard summary of the DIETFITS study which compared healthy low-fat and low-carb diets. Spoiler alert: after one year the participants lost the same amount of weight without counting calories!

4. Long-Term Sustainability:
Some critics argue that low-carb diets may be challenging to sustain over the long term. The restrictive nature of these diets can make it difficult for individuals to maintain healthy eating habits in the face of lifestyle changes or social pressures. Again, the best diet for long-term health results is one that focuses on high-quality, nutritious whole foods, mostly plants (fruits and vegetables), and avoids processed foods, flours, sugars, and unhealthy fats. See some of Kevin Hall's amazing work on weight regain and diet type: it is eye opening!

Low-carb diets offer various benefits, from weight loss to improved blood sugar control. However, potential drawbacks, such as nutrient deficiencies and social challenges, should be considered. It's crucial for individuals to assess their unique needs, consult with healthcare professionals, and make informed decisions about whether a low-carb diet aligns with their health and lifestyle goals. As with any dietary approach, moderation and balance are key to achieving long-term success. Physical therapists should be armed with a good understanding of how diets impact health, healing, and PT outcomes. Spreading misinformation can be harmful and ignoring nutrition altogether can lead to chronic health issues. As such, PTs should be educated on nutrition research, educate their patients, and refer to an RD or MD when appropriate.

If you like what you see here then know there is more in our 3 board-approved continuing education courses on Nutrition specific for Physical Therapists. Enroll today in our new bundled course offering and save 20%, a value of $60!

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Learn about the Top 5 Functional Foods to Fight Inflammation and Pain in Physical Therapy. 




Low-Carb Approaches for PTs, Nutrition Strategies in Physical Rehabilitation, Tailoring Diets to Patient Needs, Individualized Nutrition in PT, Impact of Diet on Recovery, Metabolic Considerations in Physical Therapy, Holistic Approaches to Rehabilitation, Applying Low-Carb Strategies in PT Settings, Evidence for Low-Carb Diets in Rehabilitation, Patient Education on Low-Carb Nutrition

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Disclaimer: The above article is written as an opinion piece and does not convey specific legal, medical, and/or practice act advice.  

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