New ADA Standards of Medical Care Includes Low Carbohydrate Diet

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Introduction

The American Diabetes Association (ADA) has released its Standards of Medical Care in Diabetes (2020) [1]. This update reinforces the April 2019 Consensus Report, emphasizing that there is no “one-size-fits-all” eating pattern for diabetes management. Instead, the ADA underscores that Medical Nutrition Therapy (MNT) must be individualized to the patient.

The ADA explicitly recommends that all people diagnosed with diabetes be referred to a Registered Dietitian (RD/RDN). Research indicates that MNT delivered by an RD is associated with a decrease in HbA1C of between 0.3% and 2.0% for those with type 2 diabetes [3].

Macronutrients and Eating Patterns

The 2020 Standards reiterate that there is no ideal percentage of calories from carbohydrates, protein, and fat. Macronutrient distribution should be based on an individualized assessment of metabolic goals and personal preferences. Notably, the ADA continues to recognize a low-carbohydrate eating pattern as a healthful and helpful option for controlling blood glucose [6-8].

“The Mediterranean-style, low-carbohydrate, and vegetarian or plant-based eating patterns are all examples of healthful eating patterns that have shown positive results in research.” [1]

Definitions from the Consensus Report: A low carbohydrate pattern is 26–45% of total calories from carbs. A very low carbohydrate pattern (ketogenic) is defined as 20–50g of non-fiber carbs per day.

Safety and Clinical Guidance

While low-carbohydrate plans show potential to improve glycemia and lipids for up to one year [13-17], the ADA advises regular reassessment of sustainability. Currently, a low-carbohydrate pattern is not recommended for women who are pregnant or lactating, individuals with disordered eating, or those with renal disease. Additionally, caution is advised for patients taking SGLT2 inhibitors due to the potential risk of ketoacidosis [11-12].

Final Thoughts

The 2020 Standards confirm that a well-designed low-carbohydrate diet is considered both healthful and helpful for the second year in a row. As an RD, I am encouraged to see the ADA supporting these evidence-based options, and I hope to see similar updates from Diabetes Canada in the near future.

More Info?

If you would like more information about individualized Meal Plans and MNT, you can learn about me and the Comprehensive Dietary Package that I offer.

To your good health!

Joy

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References

  1. American Diabetes Association. Facilitating Behavior Change and Well-being to Improve Health Outcomes: Standards of Medical Care in Diabetes—2020. Diabetes Care 2020;43(Suppl. 1):S48–S65. https://doi.org/10.2337/dc20-S005
  2. Evert AB, Dennison M, Gardner CD, et al. Nutrition therapy for adults with diabetes or prediabetes: a consensus report. Diabetes Care 2019;42(5):731–754. https://doi.org/10.2337/dci19-0014
  3. Franz MJ, MacLeod J, Evert A, et al. Academy of Nutrition and Dietetics nutrition practice guideline for type 1 and type 2 diabetes in adults. J Acad Nutr Diet 2017;117(10):1659–1679. https://doi.org/10.1016/j.jand.2017.03.022
  4. Esposito K, Maiorino MI, Ciotola M, et al. Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy. Ann Intern Med 2009;151(5):306–314. https://doi.org/10.7326/0003-4819-151-5-200909010-00004
  5. Boucher JL. Mediterranean eating pattern. Diabetes Spectr 2017;30(2):72–76. https://doi.org/10.2337/ds16-0063
  6. Sainsbury E, Kizirian NV, Partridge SR, et al. Effect of dietary carbohydrate restriction on glycemic control in adults with diabetes. Diabetes Res Clin Pract 2018;139:239–252. https://doi.org/10.1016/j.diabres.2018.02.026
  7. van Zuuren EJ, Fedorowicz Z, Kuijpers T, Pijl H. Effects of low-carbohydrate- compared with low-fat-diet interventions on metabolic control. Am J Clin Nutr 2018;108(2):300–331. https://doi.org/10.1093/ajcn/nqy096
  8. Snorgaard O, Poulsen GM, Andersen HK, Astrup A. Systematic review and meta-analysis of dietary carbohydrate restriction in patients with type 2 diabetes. BMJ Open Diabetes Res Care 2017;5(1):e000354. https://doi.org/10.1136/bmjdrc-2016-000354
  9. Rinaldi S, Campbell EE, Fournier J, et al. A comprehensive review of the literature supporting CDA recommendations for plant-based diets. Can J Diabetes 2016;40(5):461–467. https://doi.org/10.1016/j.jcjd.2016.02.011
  10. Pawlak R. Vegetarian diets in the prevention and management of diabetes and its complications. Diabetes Spectr 2017;30(2):82–88. https://doi.org/10.2337/ds16-0057
  11. U.S. Food and Drug Administration. FDA Drug Safety Communication: SGLT2 inhibitors warnings.
  12. Blau JE, Tella SH, Taylor SI, Rother KI. Ketoacidosis associated with SGLT2 inhibitor treatment. Diabetes Metab Res Rev 2017;33(5):e2924. https://doi.org/10.1002/dmrr.2924
  13. Saslow LR, Daubenmier JJ, Moskowitz JT, et al. Twelve-month outcomes of a randomized trial of a moderate-carbohydrate versus very low-carbohydrate diet. Nutr Diabetes 2017;7(12):304. https://doi.org/10.1038/s41387-017-0006-9
  14. Hallberg SJ, McKenzie AL, Williams PT, et al. Effectiveness and safety of a novel care model for the management of type 2 diabetes at 1 year. Diabetes Ther 2018;9(2):583–612. https://doi.org/10.1007/s13300-018-0373-9
  15. van Wyk HJ, Davis RE, Davies JS. A critical review of low-carbohydrate diets in people with type 2 diabetes. Diabet Med 2016;33(2):148–157. https://doi.org/10.1111/dme.12964
  16. Meng Y, Bai H, Wang S, et al. Efficacy of low carbohydrate diet for type 2 diabetes mellitus management. Diabetes Res Clin Pract 2017;131:124–131. https://doi.org/10.1016/j.diabres.2017.07.006
  17. Tay J, Luscombe-Marsh ND, Thompson CH, et al. Comparison of low- and high-carbohydrate diets for type 2 diabetes management. Am J Clin Nutr 2015;102(4):780–790. https://doi.org/10.3945/ajcn.115.112581
  18. Thomas D, Elliott EJ. Low glycaemic index, or low glycaemic load, diets for diabetes mellitus. Cochrane Database Syst Rev 2009;(1):CD006296. https://doi.org/10.1002/14651858.CD006296.pub2
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