Cutting rice to lose weight? Why your low-carb diet could be making diabetes worse

A patient came to me last month having lost eleven kilograms, with a worse HbA1c than the one she started with. She was proud of the weight loss. She had done, by her own account, everything right. No rice for dinner for seven months. One roti at lunch, then none. Her plate had shrunk to a bowl of sabzi, a little curd, and the quiet assumption that removing something is the same as treating something.

That is the Indian weight-loss trap. It has almost nothing to do with rice.

The warning against cutting carbohydrates completely is fair, but only because of that last word. I have never asked a patient to eat nothing but protein and fat, and I do not know a serious metabolic physician who has. What I ask is that the carbohydrate load come down in proportion to how much insulin resistance a person is carrying. That is a very different instruction from elimination, and it fails for a very specific reason when Indians attempt it alone.

Our plates are carbohydrate-dominant not by design but by absence. Protein was never really on them. So when the roti disappears, nothing arrives to take its place. The patient is not eating low-carbohydrate at that point. She is simply eating less food, and much of what she has lost is protein she could not afford to lose.

This is where the scale becomes actively misleading. Weight falls quickly when you subtract without substituting, and a meaningful share of what leaves is muscle. Muscle is the tissue that pulls glucose out of the bloodstream and holds it. Strip it away and you have built a body that is lighter, smaller, and less capable of handling sugar than before. It is the thin outside, fat inside pattern I see constantly in Indian clinics, and it explains why the weight returns within a year and brings a higher fasting glucose with it. The patient concludes that low-carbohydrate eating does not work for Indian bodies. What actually did not work was starvation wearing a low-carbohydrate label.

Meanwhile, we have spent a decade arguing about which carbohydrate. Brown rice or white, millets or wheat, jowar or bajra. Almost none of it changes outcomes as much as how much sits on the plate and what sits beside it. A carbohydrate eaten alone behaves differently from the same carbohydrate eaten after eggs, paneer, fish or meat, with ghee or butter in the cooking rather than a spoon of something refined.

So the correction is not to add rice back. It is to build the plate around protein and fat first, add resistance training so the muscle you keep has somewhere to put the glucose, and let the carbohydrate portion fall as a consequence rather than as a daily act of willpower. My patient did not need her roti back. She needed everything that was never on her plate to begin with.

(The author is the founder of Redial Clinic, New Delhi and a specialist in Metabolic Medicine and Diabetes Reversal)

The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.