Most people assume you have to choose. Either you eat a vegetarian diet, or you eat low carb. Shashikant Iyengar has spent the last ten years proving that assumption wrong and he brought his story and his clinical experience to Nutrition Network this week for a conversation with clinical dietitian and scientific education specialist Azza Motara.
Shashi is a metabolic health coach, a Nutrition Network practitioner and lecturer, an SMHP accredited practitioner and the founder of Metabolic Health India. Nutrition Network has co-developed a vegetarian low carb training with Metabolic Health India, now open for enrollment. If you work with vegetarian clients, or you’re vegetarian yourself and wondering whether low carb is even possible for you, this conversation is the one to watch.
Watch The Full Conversation Here
An Accidental Diagnosis
Shashi’s own diabetes journey started the way so many do, by accident. Working in pharma at the time, he was tested at a diabetes detection camp, a common event in India and came back with a high number. A follow up lab test under his doctor’s guidance confirmed it. His HbA1c sat at 7.2 percent, his fasting glucose at 150 and his post-prandial reading at 252.
His doctor started him on metformin. But Shashi, drawing on his pharma background, knew where that road usually leads. Medications tend to accumulate over the years rather than disappear. So while taking metformin he started researching alternatives and came across low carbohydrate nutrition.
He adopted it quickly and adjusted his macros as he went, gradually increasing protein. Three months later his HbA1c had dropped from 7.2 to 5.2. He came off metformin after just two weeks, in consultation with his doctor, once his numbers confirmed he no longer needed it. Over the following months he tapered his carbohydrate intake further, eventually settling into a ketogenic range of around thirty to fifty grams of net carbs a day. His HbA1c held between 4.7 and 4.9 for six or seven years. More recently he has relaxed slightly, sitting at seventy to eighty grams of carbohydrate most days and an HbA1c around 5.0 to 5.3, moving in and out of ketosis rather than staying there permanently.
Ten years on, Shashi decided to check whether all that saturated fat had done him any harm. The results say otherwise. A CT angiography returned a calcium score of zero, meaning no calcification and no soft plaque. A carotid intima media thickness test showed normal blood flow too, with only a mild millimetre of thickening in the left carotid that may or may not be new. His ophthalmic and dental checks came back normal too.
Vegetarian patterns
Here’s the detail that makes his case particularly useful for practitioners working in India and for anyone advising vegetarian clients elsewhere. Shashi’s initial reversal, the drop from 7.2 to 5.2, happened on a lacto-vegetarian diet, meaning dairy but no eggs, meat or fish. He added eggs back around six or seven months in, once he recognised how much protein he was missing and now eats four to eight a day. For three or four months of the year, during religious festivals, he returns to a strict lacto-vegetarian pattern with no eggs at all and says his numbers hold up fine even then.
He’s quick to point out that a vegetarian pattern isn’t superior to one that includes animal foods. It simply narrows the choices available. But narrowed doesn’t mean impossible. One of his own clients, a neighbour who eats no eggs at all, has followed this approach for four years. Her creatinine improved from 2.4 to around 1.8 and her blood pressure medication dropped from four pills a day to one. “It is possible for many of us if we are determined,” as Shashi puts it. Metabolic health on a vegetarian diet is achievable with the right substitutions plus, in most cases, some B12 and vitamin D supplementation.
The Grain Problem
A recent study found that 62 percent of calories in the Indian diet come from carbohydrate, a figure linked to a 14 percent higher risk of newly diagnosed type 2 diabetes. Shashi says that number does a lot of the persuading for him in client conversations. Most Indian plates, he explained, run on rice, wheat or millet at every meal, sometimes with carbohydrate making up as much as eighty percent of what’s eaten, leaving very little room for protein.
His fix is to add back what’s missing rather than simply subtract carbs. Paneer, Indian cottage cheese, is cheap, widely available and easy to make at home.. Drained yogurt offers another simple protein boost. He also referenced a study showing wheat, particularly the modern variety grown today, can spike blood sugar in people with type 2 diabetes even more than table sugar does, a finding that surprises almost everyone he shares it with. He sees this in his own data too. Rather than demanding an all or nothing switch, Shashi asks clients to cut their grain load by half, then by another quarter, while substituting in dairy protein or eggs. He also encourages a simple sequencing trick, eating vegetables and protein first and leaving any rice or roti until the end of the meal, which slows gastric emptying and blunts both the blood sugar spike and, in type 2 diabetes specifically, the insulin spike that follows.
Culture, Cost and Getting Buy-In
Around seventy percent of Indians identify as non-vegetarian, yet most eat meat, fish or eggs only once or twice a week and rely on grains daily, which is why Shashi treats most of the country as functionally vegetarian regardless of religious label. Dairy carries no religious restriction in India, unlike in the West where veganism has taken hold, so it becomes the easiest lever to pull with almost any client.
Cost is the honest objection he hears most and he doesn’t dismiss it: protein is genuinely more expensive than grain. But he also points out that many of the same clients who balk at the price of eggs or paneer spend freely eating out on weekends and that money spent on quality food now tends to be smaller than money spent later on medication and hospital visits, especially in a country where healthcare is largely paid out of pocket.
Reducing meal frequency helps on both fronts. Shashi has his clients move from three meals a day down to two, which saves money and frees up time for other things. He also recommends at least one twenty four hour fast a week once someone has spent a month adapting to low carb eating, sometimes extending to thirty six hours, though anyone on medication needs to check with their doctor first since certain diabetes drugs carry a real risk of hypoglycemia during a fast.
Supplements, hacks and a Cautious Medical Community
Nearly all of Shashi’s clients arrive deficient in vitamin B12 and vitamin D unless they’ve already been supplementing, something he attributes partly to low sun exposure and a dairy only vegetarian diet. Lab testing in India is refreshingly simple, home collection with no prescription needed and results back within a day, which makes it easy to test, correct and confirm a maintenance dose with a doctor. Magnesium is his personal favourite, largely for its effect on sleep and he varies the form depending on what a client needs, avoiding it only in cases of chronic kidney disease. He also recommends omega-3, either marine or algal for those avoiding fish and iron for women in particular.
Beyond supplements, he leans on a handful of low effort daily tools. A ten to fifteen minute walk after meals lowers blood sugar reliably and for clients who can’t walk, soleus push-ups, simply raising and lowering the heels while seated or standing, done in sets of fifty before and after eating, have produced drops of twenty to thirty points for some of his clients. He also flagged something practitioners don’t talk about enough, stress itself. Shashi described a day under heavy pressure at work when his post-breakfast blood sugar, normally back to baseline within an hour, stayed at 130 for seven straight hours despite an identical low carb breakfast.
Acceptance among Indian doctors is growing but still mixed, Shashi says. Some now refer patients to him directly, while others remain convinced high fat diets cause heart disease or high protein damages the kidneys. He points to the annual Metabolic Health India conference, now in its fourth year, as a sign that more physicians are willing to look at the evidence.
The Bottom Line
Shashi’s closing advice is simple enough for any practitioner to hand a new client, vegetarian or otherwise. Standard diabetes advice, swap rice for wheat and cut the sugar, doesn’t go nearly far enough. Fruit is nature’s candy and shouldn’t be treated as a free pass and whole grains still raise blood sugar regardless of how they are marketed. His starting point for anyone unfamiliar with low carb is to cut carbohydrate intake by half and replace it with protein, whether that’s paneer, eggs, dairy, meat or fish.
Ten years, one calcium score of zero and a stack of clients with their own turnaround stories later, Shashi’s case is hard to argue with. Being vegetarian and metabolically healthy are not mutually exclusive, they just take curiosity, creativity and planning around the plate.
The Vegetarian Low Carb training in collaboration with Metabolic Health India is now available, covering everything from endurance sport, women’s health, gut health, muscle building and more, alongside meal plans and recipes built for vegetarian kitchens. Presale pricing is available now.