Several health measures — including blood glucose levels and weight — improved.

For most people, there isn't a single "healthy" way to eat, although there are certainly healthy foods and eating patterns. However, for individuals with prediabetes, a low-carb diet might quickly reduce elevated A1C levels to a healthier range, according to a study published in JAMA Network Open.

While the study highlighted several benefits of low-carb eating for blood sugar control, Dr. Giulio Romeo, associate medical director of the Adult Diabetes Section at the Harvard-affiliated Joslin Diabetes Center, questions whether such a strict approach is practical in everyday life. "The study clearly shows that a low-carb — and in fact, a very low-carb — diet is effective in lowering A1C levels, which reflect blood sugar over the past three months," he says. "However, it may not be sustainable in the long term."

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Prediabetes affects an estimated 96 million American adults. This condition is marked by elevated blood sugar levels and increases the risk of developing type 2 diabetes.

Which foods were study participants asked to eat — or avoid?

This randomized clinical trial, regarded as the gold standard in scientific research, involved 150 older adults with untreated prediabetes or mild diabetes. All participants were overweight, with an average BMI of 35; nearly 75% were women, and 59% were Black. For six months, participants were randomly assigned to either a low-carb diet with frequent dietary counseling or their usual diet.

In the first three months, those on the low-carb diet had to limit their carbohydrate intake to below 40 grams per day—approximately the amount found in an English muffin and an apple. In the subsequent three months, their daily carb limit was raised to below 60 grams.

The researchers advised the low-carb group to focus on proteins and healthy fats by consuming non-starchy vegetables, fish, poultry, lean meat, eggs, olive oil, avocados, nuts, seeds, Greek yogurt, low-carb milk, and small amounts of cheese.

 They were instructed to limit or avoid other dairy products, fruits, legumes, beans, and grains. Throughout the study, low-carb participants received various foods, including olive oil, green beans, tomatoes, tuna, non-sugar sweeteners, nuts, and low-carb bars and shakes.

What did the study find?

All participants underwent blood testing three and six months into the trial. Compared to those eating their usual diet, participants taking the low-carb approach had greater improvements in A1C and fasting blood glucose levels at the six-month mark. They also lost an average of 13 pounds. Though modest, the A1C improvements represented nearly a 60% lower risk for developing diabetes within the next three years.

"The reduction in A1C was greater in participants who were white compared to Black, which is important to know," Dr. Romeo says. "By including a large number of Black participants, the study helps us to understand whether the response to a low-carb diet is comparable across race. In this trial, it did not seem to be."

Was the low-carb diet the only factor in better blood sugar control?

No, it's impossible to determine how much of the weight loss among low-carb participants contributed to improved blood sugar control, according to Dr. Romeo. Losing fat can help decrease insulin resistance, which means your body becomes more effective at using the insulin it produces. "This is definitely beneficial," he explains.