Keto And Diabetes Lifestyle Management

2019 Diabetes Standards May Agree to Discuss the Role of Low Carbohydrate Restrictions in Diabetes Management

Diabetes management is on the cusp of change. We’ve all heard or read anecdotal accounts in the press and on the web about people with diabetes reducing their A1c, normalizing their blood sugar, decreasing or eliminating medications and losing fat while following a low carbohydrate lifestyle. In the 2019 Standards of Medical Care in Diabetes-2019 published July of this year, the American Diabetes Association opened the door for discussion of the importance of macronutrient levels for all people living with diabetes.[1]

“Evidence continues to suggest that there is not an ideal percentage of calories from carbohydrate, protein, and fat for all people with diabetes. Therefore, more discussion was added about the importance of macronutrient distribution based on an individualized assessment of current eating patterns, preferences, and metabolic goals. Additional considerations were added to the eating patterns, macronutrient distribution, and meal planning sections to better identify candidates for meal plans, specifically for low-carbohydrate eating patterns and people who are pregnant or lactating, who have or are at risk for disordered eating, who have renal disease, and who are taking sodium–glucose cotransporter 2 inhibitors. There is not a one-size-fits-all eating pattern for individuals with diabetes, and meal planning should be individualized.”[2]

People with diabetes may be good candidates for a low carbohydrate ketogenic lifestyle.[3]  Although in the presence of severe or end-stage renal disease, people with diabetes would be best to discuss the benefits and risks of a ketogenic lifestyle with their practitioner.[4] The standard renal diet may be contradictory to a carbohydrate restricted diet.[5] Those on insulin and medications that promote insulin production are encouraged to use a glucose monitor with a blood ketone meter to regularly monitor blood sugars and ketones.  The emphasis is on staying in contact with your health care team to work at adjusting medications to a therapeutic level.[6]

Because our health and the presence of chronic conditions varies, it’s important to keep in mind that each person with diabetes be evaluated individually:

“Evidence suggests that there is not an ideal percentage of calories from carbohydrate, protein, and fat for all people with diabetes. Therefore, macronutrient distribution should be based on an individualized assessment of current eating patterns, preferences, and metabolic goals.”[7]

While many with diabetes have found a low carb diet helpful, there are other dietary approaches that have shown promise in people with diabetes such as the Mediterranean Diet or the Dietary Approaches to Stop Hypertension (DASH). Just eliminating processed foods, soda and sugars and eating closer to the source are modifications that offer great improvements.

“In addition, research indicates that low carbohydrate eating plans may result in improved glycemia and have the potential to reduce antihyperglycemic medications for individuals with type 2 diabetes…”[8]

We know so much about diabetes and yet, there is always something more to learn and new scientific questions to ask. Perhaps all along we’ve been asking the wrong questions about diabetes and the low carb life.

[1] American Diabetes Association. (2019) Diabetes Care: A Standards of Medical Care in Diabetes-2019. Volume 42, Supplement 1. https://care.diabetesjournals.org/content/42/Supplement_1/S4

[2] American Diabetes Association. (2019) Diabetes Care: A Standards of Medical Care in Diabetes-2019. Volume 42, Supplement 1. pp S4-S5,  https://care.diabetesjournals.org/content/42/Supplement_1/S4

[3] LowCarbUSA (October 1, 2019) Clinical Guidelines for Therapeutic Carbohydrate Restrictions. p 7 https://www.lowcarbusa.org/standard-of-care/clinical-guidelines/

[4] LowCarbUSA (October 1, 2019) Clinical Guidelines for Therapeutic Carbohydrate Restrictions. p 9 https://www.lowcarbusa.org/standard-of-care/clinical-guidelines/

[5] National Institute of Diabetes Digestive and Kidney Disease. (October 2016). Eating Right for Chronic Kidney Disease. https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/eating-nutrition

[6] LowCarbUSA (October 1, 2019) Clinical Guidelines for Therapeutic Carbohydrate Restrictions. p 7 https://www.lowcarbusa.org/standard-of-care/clinical-guidelines/

[7] American Diabetes Association. (2019) Diabetes Care: A Standards of Medical Care in Diabetes-2019. Volume 42, Supplement 1. Lifestyle Management p S48. https://care.diabetesjournals.org/content/42/Supplement_1/S46

[8] Ibid

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