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ADA's 130 Daily Grams of Carbs Criticized

Posted: Thursday, July 03, 2008

Twenty-four diabetes doctors and researchers from the United States, Canada, the United Kingdom, Finland, Sweden and Portugal have published a study criticizing: 1. The American Diabetes Association (ADA) assertion that diabetics should consume no fewer than 130 mg of carbohydrates daily and 2. The European Association for the Study of Diabetes (EASD) statement that low-carb diets are "not justified."

"Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: time for a critical appraisal" proposes that the time has come to rethink the current approach to treating type 2 diabetes and metabolic syndrome through low-fat diets.

In the study, the authors propose that there is now enough clinical evidence that low-carb diets improve glycemic control and reduce insulin fluctuations and that they are at least as effective as low-fat diets in helping weight loss. They further state that carbohydrates, not fat, put people with diabetes at increased risk of cardiovascular disease.

The authors suggest that greater acceptance of low-carb diets as an effective, justifiable treatment for some people with diabetes will give doctors and other healthcare providers greater flexibility in helping patients manage the disease.

Current nutritional approaches to metabolic syndrome and type 2 diabetes generally rely on reductions in dietary fat. The success of such approaches has been limited, and therapy more generally relies on pharmacology.

The argument is made that a re-evaluation of the role of carbohydrate restriction, the historical and intuitive approach to the problem, may provide an alternative and possibly superior dietary strategy. The rationale is that carbohydrate restriction improves glycemic control and reduces insulin fluctuations, which are primary targets.

Experiments are summarized showing that carbohydrate-restricted diets are at least as effective for weight loss as low-fat diets and that substitution of fat for carbohydrate is generally beneficial for risk of cardiovascular disease. These beneficial effects of carbohydrate restriction do not require weight loss.

It is time to reappraise the role of carbohydrate restriction. "Although pessimism exists in the medical community on the efficacy of any diet in the treatment of diabetes 2 and MetS, the success of carbohydrate restriction for many practitioners and individual patients mandates that we should determine how this approach can be consistently and effectively employed." Finally, while no systematic study of clinical practice has been done, anecdotal evidence suggests that carbohydrate restriction is a common clinical recommendation for diabetes. We believe that there is a need to codify these recommendations in light of current evidence.

Basic biochemistry, clinical experience and an evolving understanding of metabolic syndrome support the need for evaluation of the efficacy and safety of carbohydrate restricted diets for the treatment of type 2 diabetes. The fact that carbohydrate restriction improves markers of cardiovascular health, even in the absence of weight loss, sensibly removes historical objections to the dangers of this approach. A critical re-appraisal could form the basis for an alternative for those patients for whom current recommendations are not successful.

Finally, the point is reiterated that carbohydrate restriction improves all of the features of metabolic syndrome.

Original Study: Journal of Nutrition and Metabolism June 2008

Source: Diabetes In Control: Original Study: Journal of Nutrition and Metabolism June 2008