Hong Kong doctor warns that cutting carbohydrates and increasing saturated fats may worsen metabolic health, emphasising individualised approaches based on personal fat thresholds and fat distribution rather than weight alone.
Many people trying to improve their blood sugar are cutting back hard on carbohydrates and leaning instead on low-carb or ketogenic diets built around fatty meats and other high-saturated-fat foods. But Hong Kong weight-management physician Xiao Jiejian says that approach can sometimes make metabolic health worse rather than better, with glycated haemoglobin rising and pancreatic function deteriorating in some patients. His warning draws on a wider body of research from the UK that has challenged the idea that diabetes is driven simply by eating too much carbohydrate.
Xiao says he has seen older patients who were advised to “eat less starch” replace rice, fruit and other carbohydrate sources with pork trotters, ribeye and other rich meats, only to return months later with poorer laboratory results. The point, he argues, is not that carbohydrates are harmless, but that eliminating them while increasing saturated fat may encourage fat to build up around the liver and pancreas, undermining the very organs that regulate glucose. That interpretation is consistent with the personal fat threshold hypothesis developed by Roy Taylor and colleagues, which suggests that diabetes emerges when a person’s safe storage capacity for fat is exceeded and the surplus spills into organs where it impairs insulin action.
The idea is important because it helps explain why body weight alone is an imperfect guide to diabetes risk. According to the research behind the personal fat threshold model, the point at which excess fat starts causing harm varies from person to person and does not track neatly with body mass index. In other words, someone who appears lean may still have a low tolerance for internal fat accumulation, while another person with a higher body weight may remain metabolically healthier for longer. That finding has become influential in discussions of type 2 diabetes because it shifts attention away from weight alone and towards where fat is stored.
Xiao’s practical advice focuses on reducing blood sugar after meals and limiting further fat accumulation around internal organs. He recommends eating protein first, then vegetables, and leaving rice or noodles until last, a sequence he says can reduce the post-meal glucose rise. He also advises a short walk after eating, noting that active muscles can take up glucose without needing as much insulin. Resistance exercise, even in simple forms such as squats or modified press-ups, may help by increasing muscle mass, which gives the body a larger store for glucose and may reduce the tendency for excess energy to be deposited as fat in the liver and pancreas.
He also cautions that anyone using diabetes medication or insulin should not change doses on their own, because combining a stricter diet with exercise can lower blood sugar quickly and raise the risk of hypoglycaemia. The broader message, backed by the UK research Xiao cites, is that diabetes management is more complicated than simply avoiding all carbohydrates. The quality of fat, the amount of muscle a person carries, and the body’s personal fat threshold all appear to matter. For people trying to manage weight or glucose levels, the safest course remains individualised advice from a clinician rather than rigid diet rules borrowed from social media.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
