Low-carb diets get a seat at the table

Glucometer and fresh vegetables on wooden cutting board

Tides change slowly in medicine.

Very slowly.

But the good news is that they do change. The American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD) recently published their 2018 consensus paper on the management of type 2 diabetes. What’s the big change? They finally acknowledge low-carb diets as a safe and effective treatment option. This is based on a review of the evidence since 2014.

ADA: 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)

The consensus statement deviates from other guidelines in that it does not specify one specific way of eating. Rather, it acknowledges the individualized nature of nutrition and contains statement such as:

There is no single ratio of carbohydrates proteins, and fat intake that is optimal for every person with type 2 diabetes.

They reference the Mediterranean diet as the most effective, but include the DASH diet, vegetarian diets and now a low-carb diet as acceptable alternatives. Interestingly, they define low carb as less than 26% of calories from carbs, so they aren’t specifically referring to ketogenic diets as used in the studies from Virta Health.

On the one hand, this is fantastic news. The ADA and EASD can no longer ignore the data supporting low-carb nutrition. That should pave the way for more doctors freely using low-carb diets with their patients. That will lead to more success, more physician knowledge, and thus perpetuate more use. Hopefully the end result will be a safer, more effective treatment of type 2 diabetes.

The bad news in this consensus is that dietary intervention was listed on half of one page. The remainder of the 27-page document was almost entirely devoted to prescription drugs. The drug-first bias of these societies is palpable, but that shouldn’t keep us from celebrating this initial step with them acknowledging low-carb diets. We just can’t be satisfied and let it stop here.

The ultimate goal is for individual providers and patients across the globe to realize that low-carb diets can prevent and reverse diabetes without the use of medications. Nutrition can serve as first line and last line treatment for the vast majority of individuals with diabetes.

That is the big victory I am hoping for. In the meantime, I will quietly celebrate the smaller victory and thank the ADA and EASD for acknowledge the benefits of low-carb diets. Onward and upward.

Thanks for reading,
Bret Scher, MD FACC

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8 comments

  1. Linda Smith
    I was just told yesterday, by a layman, Please comment. QUOTE:
    Since the Keto diet gained traction, Emergency Rooms/Departments throughout the US have seen a big spike in the number of Heart attacks and Cardiac Arrest victims in the younger, fitter age group category. The thing they have in common... Keto diet. When you force the body to create energy from fat, and overfeed the body fat, the body will store that fat on the heart muscle itself, wanting to preserve energy sources for later, since you're starving the body of it's preferred energy source... carbs. The heart muscle stores the fat in the coronary arteries, which then get blocked and cause heart attack or heart arrest. What has been most amazing to doctors, though, is how quickly those coronary arteries are getting blocked in "fitness geeks", because of the Keto diet. In just a couple of years on Keto, a fit athlete can die of a complete coronary artery blockage, with no previous history of heart disease. I don't know this from some documentary. I know it from the doctors at the ER.
    Reply: #6
  2. Francoise
    Really? Any hidden agenda? ....
  3. Carol
    I wonder if the missing piece is arterial calcification? Not caused by Keto but by undiagnosed high insulin in their previous life and things like low k2, low magnesium etc and exacerbated by over exercising. In the case of my husband, a lifetime of gut disbiosis has depleted k2 and now he has scarey levels of arterial calcification....but all other markers except fasting insulin were good. He has now tightened up his Keto and is doing well. Until Drs understand, Keto will be wrongly accused of lots of things.
  4. TeriL
    I think there are quite a few who oversimplify keto as “eat all the fatty food you want” and that may be causing the trouble. It’s probaby true that if one eats nothing but a ton of fat that would present problems, but that’s not the keto diet.
    I have done keto according to the guidelines for the past three months and my bp and cholesterol numbers are down, as well as blood sugar at 90.
    Keto isn’t dangerous, ignorance is! But we all already know that.
  5. Teresa Roper
    After7 months and losing almost 60 pounds (30+to go) I am off 6 meds and now only take synthroid. My blood work last week came back perfect as did my ECG. I had the ECG because for the first time in 51 years, last May, they took me off all my heart meds. My cardiologist has started to look into Keto as he says my results speak volumes!!
  6. Peter Biörck Team Diet Doctor
    Hi Linda!

    Can you link to any article describing this?

    I was just told yesterday, by a layman, Please comment. QUOTE:
    Since the Keto diet gained traction, Emergency Rooms/Departments throughout the US have seen a big spike in the number of Heart attacks and Cardiac Arrest victims in the younger, fitter age group category. The thing they have in common... Keto diet. When you force the body to create energy from fat, and overfeed the body fat, the body will store that fat on the heart muscle itself, wanting to preserve energy sources for later, since you're starving the body of it's preferred energy source... carbs. The heart muscle stores the fat in the coronary arteries, which then get blocked and cause heart attack or heart arrest. What has been most amazing to doctors, though, is how quickly those coronary arteries are getting blocked in "fitness geeks", because of the Keto diet. In just a couple of years on Keto, a fit athlete can die of a complete coronary artery blockage, with no previous history of heart disease. I don't know this from some documentary. I know it from the doctors at the ER.

  7. James DownUnder
    Long and fearful on the rhetoric, but abysmally short on proof / references
  8. Linda
    Peter, that's the problem. There are no references except to doctors in the ER. She has said nothing else.

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