The powerful - but cautious - American Diabetes Association has announced that it now supports low-carbohydrate diets for people with diabetes who want to lose weight.

In its 2008 Clinical Practice Recommendations, the ADA acknowledges increasing evidence that low-carb diets are as effective in leading to weight loss as diets that focus on lowering fat intake.

Previously the ADA had been reluctant to support low-carb diets, citing a lack of "sufficient scientific evidence." But now, according to Ann Albright, PhD, RD, president of the ADA's Health Care & Education group, "The evidence is clear that both low-carbohydrate and low-fat calorie restricted diets result in similar weight loss at one year." But she added that the ADA is not endorsing either of these weight-loss plans over any other weight loss method.

The ADA's "Standards of Medical Care in Diabetes—2008" document states that there is now evidence that the most important determinant of weight loss is not a diet's composition, but whether the person dieting can stick with it. It also notes that some people will find it easier to follow a low-carb diet while others will find a low-fat, restricted-calorie diet easier to follow.

The ADA is recommending that because people who follow low-carb diets are likely to replace calories from carbohydrates with calories from fat and protein, they should monitor their lipid profiles. Also, diabetes patients with kidney disease should be aware that high-protein diets can worsen kidney problems.

Reactions from CDEs

Diabetes educators have welcomed the news, noting, however, that the ADA was slow in getting there. "I was thrilled to finally see the ADA come around to what many of us have known and seen in our patients for some time," says Diabetes Health's clinical editor Joy Pape (RN, BSN, CDE, WOCN, CFCN). "I understand that they have to wait for the evidence, but it's too bad so many people with diabetes had to wait so long before they could be taught something that can really help them."

Karen LaVine, RN, CDE, who works for a disease management company, LifeMasters Supported SelfCare in Albuquerque, N.M., says, "It's about time. Hopefully this announcement will open the door a little further on low-carb diets. The ADA is acknowledging that if low carb works for somebody, they should go for it. They're taking a good, pragmatic approach."

Pape says that although she has personally been a proponent of lower-carb plans, her experience leads her to agree with the ADA's statement that whether a person can stick with a diet is more important than the diet's theme. "This makes me hopeful that medical nutritional therapy will now truly be based on individualized plans that take the nuances of each person with diabetes into consideration.

"That would be far better than just playing lip service to the idea of individual differences and continually recommending pretty much the same for everyone."

Judi Wilcox, RD, LDN, CDE, a registered dietician at Memorial Regional Hospital in Hollywood, Fla., says that in view of the fact that "both low carbohydrate and low fat diets are shown to promote weight loss, now is the time to for practitioners to end the debate and to allow patients to have an active role in choosing a low-carbohydrate diet. The diets do work and should be recommended as a viable option for weight loss." She says low-carbohydrate diets are an effective option for weight loss which has been shown to help improve insulin resistance, delay the onset of diabetes and help prevent complications.

Wilcox adds that the ADA recommends that low-carbohydrate diets should be used for one year and that patients should have their lipid profiles, renal functions, and, in cases of neuropathy, protein intake routinely monitored. "Individualized medical nutrition therapy should be administered by a certified diabetes educator or registered dietitian to teach a low carbohydrate diet that includes foods high in fiber and low glycemic index foods."