The American Diabetes Association (ADA) has for the first time voiced its support of low-carbohydrate diets for weight management of people with diabetes. The endorsement was part of the ADA’s recently published 2008 Clinical Practice Recommendations, which are intended to guide diabetes health care providers.
In the past, the ADA has supported low-fat, calorie-restricted diets as a weight loss method and didn’t recommend low-carb diets because of a lack of evidence supporting their safety and effectiveness. The new guidelines state that both low-fat and low-carb diets are equally effective at helping people lose weight over a year. However, the ADA recommends that low-carb dieters make sure their blood lipids (cholesterol and triglycerides), kidney function, and medication levels are monitored.
“We recognize that people are looking for realistic ways to lose weight,” said Ann Albright, PhD, RD, president of health care and education for the ADA in a prepared statement. “The evidence is clear that both low-carbohydrate and low-fat calorie restricted diets result in similar weight loss at one year. We’re not endorsing either of these weight-loss plans over any other method of losing weight. What we want health care providers to know is that it’s important for patients to choose a plan that works for them, and that the health care team support their patients’ weight loss efforts and provide appropriate monitoring of patients’ health.”
The ADA’s announcement is a major breakthrough because the group is the first of major health organizations (such as the American Medical Association, American Heart Association, etc.) to give any support to low-carb diets. Yet, while long-time advocates of low-carb diets say the recommendations are a good start, they’d like to see them go further.
“We’re pleased that they’re willing to move away from an entrenched position and look at the science,” said Mary Vernon, M.D., C.M.D., chairman of the board, American Society of Bariatric Physicians, and author of Atkins Diabetes Revolution (Morrow, 2004). “But it’s not enough and it isn’t respectful enough of how effective this is as a change in patients.”
Vernon would like to see more recommendations about patient monitoring and continuing education for physicians. “Most doctors aren’t familiar with using this technique because they’ve been told not to do it up until now,” she said. “You have to be educated about how to use it.”
She warned that people with diabetes could experience bad outcomes if their doctors don’t have the right information. “If you drop your carbs and don’t change your medication, it’s very likely you’ll have too much medicine for your body and you’ll have side effects,” she said. “Then the diet gets blamed when it’s not the diet’s fault at all.”
Vernon would also like to see the ADA back off their restriction that people stay on low-carb diets for no more than a year. “What happens if, after a year, your blood sugars are good — should you quit?” she said. “We don’t take people off their medicine if it’s working. It’s not fair to hold this diet to a standard that nothing else is held to.”
1. American Diabetes Association. January 2008. Nutrition Recommendations and Interventions for Diabetes. Diabetes Care, Volume 31: S61-S78.