American Diabetes Association & Low Carb
Did the ADA Just Admit Low Carb Diets Are a Treatment for Diabetes?
Quietly, and without fanfare, on October 4, 2018 the American Diabetes Association (ADA) and the European Association for the Study of Diabetes published a joint statement entitled “Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)” to update the prior position statements, published in 2012 and 2015, on the management of type 2 diabetes in adults. To be clear, this joint statement was not specifically addressing a Keto diabetes regimen but does include low carb diabetes treatment.
The online version of this low carb diabetes report was published ahead of the print addition which will soon appear in the journal Diabetes Care. The stated goals for all treatments are to limit the complications of diabetes and improve quality of life.
The new joint diabetes management statement now includes low carb diets in their recommendations for treatment of Type 2 diabetes. This is a major departure from previous diabetes management protocol, and in our humble opinion, it’s a huge step forward.
There is no mention of low carb diets being used to reverse diabetes, which would have been even more amazing. (We wrote about the clinical trials and treatment being used by Verta Health that has these outcomes.) Still, just the inclusion of low carb diets by the ADA is a major step in the right direction.
Information about low carb diets and diabetes is found on page 12 of the statement, well behind the recommendations for prescription medications, as are all recommendations for Medical Nutrition Therapies.
Don’t let the ADA burying the lead fool you. This is a huge for step forward for the general population to begin understanding the effect of a low carb or keto diet on diabetes.
First, these are evidence-based recommendations, using randomized clinical trials (the gold standard of scientific experiments) that were run between 2014 – 2018.
Check out some of the references in the paper to the benefits seen in trials of low carb diets and diabetes:
“…(P)eople with new-onset diabetes assigned to a low-carbohydrate Mediterranean eating pattern were 37% less likely to require glucose-lowering medications over 4 years compared with patients assigned to a low-fat diet.” (Source)
“Low-carbohydrate diets (<26% of total energy) produce substantial reductions in HbA1c at 3 months (25.2 mmol/mol, 95% CI 27.8, 22.5 mmol/mol [20.47%, 95% CI 20.71%, 20.23%]) and 6 months (4.0 mmol/mol, 95% CI 26.8, 21.0 mmol/mol [20.36%, 95% CI 20.62%, 20.09%]), with diminishing effects at 12 and 24 months; no benefit of moderate carbohydrate restriction (26–45%) was observed.” (Source)
Let me translate that:
- Less medication needed when eating a low carb diet.
- Improved blood markers when eating a low carb diet.
- Moderate carbohydrate restriction doesn’t get the job done.
Awesome! Low carb (25% or less of total calories) has clinical benefits but moderate carb (26-45% of total calories) does not. Just talking about that difference between low carb and moderate carb diets is profound in the world of diabetes treatment.
Second, this is mainstream medicine discussing the benefits of low carb diets side-by-side with other, conventional Medical Nutrition Therapies. They are presented on the same footing and given the same consideration. For something that has been marginalized by the medical community for decades, this is a big step towards a healthier population eating a low carb diet.
So did the ADA endorse the Keto Diet for diabetes?
No. The research cited only focused on low carb, with no consideration of fat intake. Also, the standard used to be considered low carb was carbohydrate intake less than 26% of daily calories. Compared to ketogenic diets, which usually keep carb intake somewhere around 5-10% of daily calories, that is still relatively high. However, for the Standard American Diet, that is a huge reduction and enough to see some health benefits and weight loss.
If you’ve been Keto for long, you know from personal experience that without higher fat intake, cutting your carbs is torture. What makes the keto diet so much easier (after you get into ketosis) is the combination of low carb and high fat.
The ADA and many medical professionals will not change their stance overnight, and they won’t shout it from the rooftops when they do. That would be announcing that their endorsement of high carb, low fat diets for the last several decades was wrong and was a primary contributing factor to the obesity epidemic and diabetes. Making an abrupt about-face on nutrition recommendations would be a PR nightmare.
So they include a caveat, “There is no single ratio of carbohydrate, proteins, and fat intake that is optimal for every person with type 2 diabetes.” We’re all for the idea that there is no one right way, and every individual has different needs. Other diets they give a nod to include Mediterranean, DASH (Dietary Approaches to Stop Hypertension), low glycemic, high protein, and vegetarian diet. Nowhere in the release did they specifically discuss the Ketogenic Diet.
It’s fascinating to see that the most clinical references discussed are related to low carb and/or low carb Mediterranean diets. That’s a keto win!
Finally, and this is the big one, recommendations from the ADA provide sanction to low carb diets as treatment for Type 2 diabetes. Doctors can now prescribe low carb diets to their patients without the stigma of “bucking the system.”
Doctors are understandably hesitant to go against what they have been told for decades are the accepted best nutritional practices. Plus most doctors don’t get a lot of nutritional education, except what comes from journals like these. Being given the go ahead to include a low carb diet in acceptable practices to treat diabetes opens the doors for doctors who have seen the empirical evidence but needed the reassurance of clinical research and the endorsement of a recognized professional body.
Inclusion in a position statement from the ADA shows that the benefits of low carbs diets are making headway with the mainstream medical community. As more and more doctors prescribe low carb for their patients, more people will start experiencing the power of taking control of their own health. And we’ll all be healthier for it.
We believe that for most people, a low carb, high fat ketogenic diet is the most achievable and sustainable way to achieve weight loss and improved health markers.
Should you try the Keto Diet to treat Diabetes?
Not without the support of your medical professional. As you know, diabetes is a serious medical condition that can lead to severe complications up to and including death. In addition, if following a keto diet is successful in controlling your blood sugar (which our experience suggests will be the case), you will need to work closely with your medical professional to adjust your medications as your need for them lessens.
If you and your medical professional do decide to try the Keto diet, we are happy to help you be successful under the supervision of your doctor. We have many keto articles to help you grow your keto knowledge, dozens of keto recipes, and even a keto meal plan designed to be the easiest way to get into ketosis fast.
I am not licensed dietitian nor medical professional. I never prescribe diets. I only share what has worked for me and what I have seen work for others. You should consult your medical professional before making any major changes in the way you eat.