Low-Carb For Any Budget Patient Guide

Publication Date: February 3, 2020
Last Updated: April 3, 2023




I am a family doctor working in West Virginia, the state with the highest obesity and diabetes rates in America. I started my medical training in the 1980s, and since 1990, the incidence of both of these conditions have tripled: we now have an adult rate of type 2 diabetes close to 20% and obesity (BMI >30) well north of 40% in my state (with other states not far behind). Early in my career, until 2012, I was aware of these increasing rates but felt helpless and hopeless in how to help. The advice I was giving — eat less, exercise more, reduce fat, increase medications — often led to poor outcomes. As clinicians, we often viewed it as the patient’s fault for not “complying.” This was embedded in our training. The drugs I prescribed at best poorly managed these problems. I left the office fatigued and often felt as if we both had failed — myself and the patient.

A six month assignment in 2012 with the U.S. Air Force to re-design the running program changed my life. Realizing that obesity was a large driver of fitness test failures, I traveled to dozens of military bases asking whether anyone in the room had lost 50 lb and kept it off for a year. Usually a handful (or two out of about 100) would volunteer, and I would query what they did. From base to base, the answer was very similar: they had given up all bread and sugar or had done a paleo-type diet, which in those days was not paleo junk food. The food was mostly eggs, meat, fish, and vegetables, and a few even had the courage to say they had done “Atkins.”

I started reading about the history of obesity as well as the science. The early works of Gary Taubes in Good Calories, Bad Calories opened my mind to new ideas. These ideas were confirmed by the premier scientist Dr. Timothy Noakes in South Africa as we did a couple of courses together in his country. Paradoxically, at the same time, my blood glucose was in the prediabetic range since I was developing an insulin insufficiency type of diabetes. For many years I had been a runner, eating the traditional runner's diet of high carbohydrate and low fat. So I started a low-carb lifestyle myself. A short experiment with a continuous glucose monitor showed the dramatic response my body had to any form of carbohydrate whether it was fruit, starchy veg, cereal, any bread product, and undoubtedly the low-fat frozen yogurt. At the time I did not realize they were all basically the same thing: turned into sugars once they hit my system. For over ten years I have enjoyed every day free of medication, staying below the threshold for full diabetes.

I came back to my hospital at West Virginia University after this tour and immediately started implementing a low-carb option for patients with diabetes as we monitored their blood sugars in the hospital. The results were instantaneous and dramatic, and many staff started changing their own lifestyle and eating patterns. We even got sugary drinks out of the hospital for all patients, staff, and visitors. Since this time, millions around the world have been adopting a low-carb lifestyle, including many of my patients. These amazing people are not just managing the diabetes but rather putting it into remission and coming off their medications safely. Many other medical conditions such as blood pressure, lipid problems, joint pains and swelling, headache conditions, fatigue, skin and respiratory conditions, as well as a multitude of gastrointestinal symptoms, also seem to improve with this way of eating.

I’m often asked if this is an expensive way of eating. The short answer is definitely not. The first thing to look at is the savings you will have from all the junk food and fast food that tends to end up in your shopping cart and through your car window. Seasonal vegetables, especially the ones on sale, and local produce at the farmers market or from your own garden, are very affordable. We have a program here that doubles the value of SNAP (Supplemental Nutrition and Assistance Program) at Farmers' Markets. Extremely nutrient-dense natural foods high in essential fatty acids and proteins are not expensive if you can learn how to shop and cook. Look for less expensive varieties of chicken, pork, ground beef, and fish if you live near the sea. Eggs or cheese are incredibly nutrient-dense and inexpensive. Try new things and be a bit adventurous in your shopping and cooking. Break out of old patterns and see the effect in how you feel and the effects on health conditions. Imagine a life without dieting. It’s easy if you try.

It is a privilege to work with Dr. Kristie Sullivan on this guide. Kristie is a living example of how to restore health while engaging the family. She lives in a small town in the South where diabetes and obesity are undefeated. She has influenced hundreds of thousands through her books, YouTube videos, and weekly Facebook live sessions.

Note of Caution: When you reduce the carbohydrates in your diet, your blood sugar and blood pressure tend to improve rapidly and often dramatically, so if you are on medications for these conditions, please consult your physician about adjusting them.

To Restoring Your Health!

Mark Cucuzzella, MD FAAFP
Physician Department of Veterans Affairs
Professor West Virginia University School of Medicine
Diplomate American Board of Obesity Medicine