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
Guide on type 2 diabetes
