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Diabetes and Low-Carb Diets

A Low-Carb Approach is Within ADA Guidelines

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Updated August 05, 2012

It might be logical to assume that reducing carbohydrate in the diet would be helpful in a disorder where the body has trouble processing it. Indeed, many people with diabetes find that this is the case, and some doctors are having great success using low-carbohydrate diets to treat diabetes. There have been times in the history of the American Diabetes Association (ADA) when the organization discouraged diabetics from following a low-carb approach to weight loss and blood glucose management. However in the past few years they have changed this stance, and low-carb eating is now considered to be one of the options open to people with diabetes and prediabetes.

Weight Loss

Weight loss targeting 7% of body weight is recommended for all who are overweight or obese if they have diabetes or are at high risk for it. (This amount of weight reduction has been shown both to help prevent diabetes and to improve the outlook for those who are already diabetic.) The American Diabetes Association's "Standards of Medical Care in Diabetes-2012" says "either low-carbohydrate, low-fat calorie-restricted, or Mediterranean diets may be effective in the short-term (up to 2 years)." Then it says "For patients on low-carbohydrate diets, monitor lipid profiles, renal function, and protein intake (in those with nephropathy), and adjust hypoglycemic therapy as needed." This indicates that there remains some caution about recommending carbohydrate reduction. It's probably worth noting that the statement says that recommendations for monitoring are not based on "evidence" (as most of their recommendations are), but on "expert opinion". The part about adjusting medications is very important, as reducing carbohydrate in the diet will almost inevitably mean that less medication will be needed.

Bariatric surgery is also an option for adults who are obese (BMI greater than 35) and diabetes "especially if the diabetes or associated comorbidities are difficult to control with lifestyle and pharmacologic therapy".

The other weight loss recommendation is that "Physical activity and behavior modification are important components of weight loss programs and are most helpful in maintenance of weight loss." For diabetes prevention, a minimum of 150 minutes of moderate activity per week is recommended.

Blood Glucose Control

  • The current ADA recommendations of the role of diet in diabetes management are as follows, quoting from the statment:
  • The mix of carbohydrate, protein, and fat may be adjusted to meet the metabolic goals and individual preferences of the person with diabetes.
  • Monitoring carbohydrate, whether by carbohydrate counting, choices, or experience-based estimation, remains a key strategy in achieving glycemic control.
  • Saturated fat intake should be <7% of total calories.
  • Intake of trans fat should be minimized.
  • It is recommended that individualized meal planning include optimization of food choices to meet recommended daily allowance (RDA)/dietary reference intake (DRI) for all micronutrients (vitamins and minerals.
The indication that carbohydrate monitoring is a "key strategy" for managing diabates, and that the amount of carbohydrate in the diet should be individualized demonstrate that if a person finds that a low-carb diet is optimal for regulating their blood glucose, that is totally within bounds of ADA recommendations. But many diabetes educators and health care professionals appear not to endorse this. Why might this be? In 2012 I spoke with some people at the ADA to try to clear this up.
Source:

American Diabetes Association. Standards of Medical Care in Diabetes-2012. Diabetes Care. January 2012 vol. 35 no. Supplement 1 S11-S63.

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