The powerful – but cautious – American Diabetes Association has announced thatit now supports low-carbohydrate diets for people with diabetes who want to loseweight.
In its 2008 Clinical Practice Recommendations, the ADA acknowledges increasingevidence that low-carb diets are as effective in leading to weight loss as dietsthat focus on lowering fat intake.
Previously the ADA had been reluctant to support low-carb diets, citing a lackof "sufficient scientific evidence." But now, according to Ann Albright, PhD,RD, president of the ADA's Health Care & Education group, "The evidence isclear that both low-carbohydrate and low-fat calorie restricted diets result insimilar weight loss at one year." But she added that the ADA is not endorsingeither of these weight-loss plans over any other weight loss method.
The ADA's "Standards of Medical Care in Diabetes—2008" document states thatthere is now evidence that the most important determinant of weight loss is nota diet's composition, but whether the person dieting can stick with it. It alsonotes that some people will find it easier to follow a low-carb diet whileothers will find a low-fat, restricted-calorie diet easier to follow.
The ADA is recommending that because people who follow low-carb diets are likelyto replace calories from carbohydrates with calories from fat and protein, theyshould monitor their lipid profiles. Also, diabetes patients with kidney diseaseshould be aware that high-protein diets can worsen kidney problems.
Reactions from CDEs
Diabetes educators have welcomed the news, noting, however, that the ADA wasslow in getting there. "I was thrilled to finally see the ADA come around towhat many of us have known and seen in our patients for some time," saysDiabetes Health's clinical editor Joy Pape (RN, BSN, CDE, WOCN, CFCN). "Iunderstand that they have to wait for the evidence, but it's too bad so manypeople with diabetes had to wait so long before they could be taught somethingthat can really help them."
Karen LaVine, RN, CDE, who works for a disease management company, LifeMastersSupported SelfCare in Albuquerque, N.M., says, "It's about time. Hopefully thisannouncement will open the door a little further on low-carb diets. The ADA isacknowledging 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 personcan stick with a diet is more important than the diet's theme. "This makes mehopeful that medical nutritional therapy will now truly be based onindividualized plans that take the nuances of each person with diabetes intoconsideration.
"That would be far better than just playing lip service to the idea ofindividual differences and continually recommending pretty much the same foreveryone."
Judi Wilcox, RD, LDN, CDE, a registered dietician at Memorial Regional Hospitalin Hollywood, Fla., says that in view of the fact that "both low carbohydrateand low fat diets are shown to promote weight loss, now is the time to forpractitioners to end the debate and to allow patients to have an active role inchoosing a low-carbohydrate diet. The diets do work and should be recommended asa viable option for weight loss." She says low-carbohydrate diets are aneffective option for weight loss which has been shown to help improve insulinresistance, delay the onset of diabetes and help prevent complications.
Wilcox adds that the ADA recommends that low-carbohydrate diets should be usedfor one year and that patients should have their lipid profiles, renalfunctions, and, in cases of neuropathy, protein intake routinely monitored."Individualized medical nutrition therapy should be administered by a certifieddiabetes educator or registered dietitian to teach a low carbohydrate diet thatincludes foods high in fiber and low glycemic index foods."