Australian Diabetes Society Endorses Therapeutic Carbohydrate Reduction (TCR)

In a groundbreaking move, the Australian Diabetes Society (ADS) has released a new position statement on November 1, 2023, endorsing Therapeutic Carbohydrate Reduction (TCR) as a viable strategy for managing Type 2 diabetes. This significant development aligns the ADS with similar position statements from the American Diabetes Association (ADA), Diabetes Canada and Diabetes UK, showcasing a global consensus on the benefits of TCR.

Please note, Therapeutic Carbohydrate Reduction (TCR) is the clinical phrase for the mainstream use of Low-carb.

The ADS Position Statement:

The ADS Position Statement highlights that meaningful clinical benefits, such as weight loss, improved glycemic control, potential remission, reduced need for glucose-lowering medications, and lower blood pressure, can be achieved through Therapeutic Carbohydrate Reduction/Low-carb.

This echoes the findings of the ADA's 2019 Consensus Statement, which demonstrated thatlow-carbohydrate eating patterns, especially very low-carbohydrate (VLC) patterns, have been effective in reducing A1C levels, and Diabetes Canada 2020 Summary, which stated that lower carbohydrate diets have shown improvements in reducing insulin requirements, glucose variability, A1C levels, and weight loss.

Mechanistic Insights:

Carbohydrates play a crucial role in blood glucose levels and have the greatest impact on blood sugar levels as emphasized by Diabetes UK and the ADA. By reducing carbohydrate intake, the amount of glucose entering the bloodstream is limited. This reduction is particularly relevant for individuals on insulin therapy, as lower blood sugar levels necessitate less insulin. Scientific research, such as the work of Feinman et al. (2015), supports the idea that eating small amounts of carbohydrate is a valuable approach in diabetes management.

▶️Expanding the Scope:

While the ADS endorsement primarily focuses on Type 2 diabetes, the recognition of Therapeutic Carbohydrate Reduction/Low-carb's benefits opens the door for broader applications. This prompts the question of whether these position statements will extend to include recommendations for those diagnosed with Type 1 diabetes.

🥩Therapeutic Carbohydrate Reduction/Low-carb for Type 1 Diabetes:

Many families and adults managing Type 1 diabetes have already embraced a Therapeutic Carbohydrate Reduction/Low-carb nutrition strategy. To advance patient care, safety, and support, T1D Nutrition urges various diabetes associations and bodies to consider, recommend, and approve Therapeutic Carbohydrate Reduction/Low-carb for Type 1 diabetes management. The parallels between the impact of carbohydrates on blood sugar levels and the challenges faced by those with Type 1 diabetes suggest that Therapeutic Carbohydrate Reduction/Low-carb could be a transformative nutritional strategy.

👩‍⚕️ Reducing Carbohydrate, Reduces Blood Glucose and Insulin requirements, and Can Enhance Safety:

For those with Type 1 diabetes, insulin therapy is a requirement to managing the condition. Insulin therapy's most common side effect is hypoglycemia (McCall et al., 2012).

Efforts to reduce hypoglycemia have historically involved decreasing insulin doses, often leading to significant hyperglycemia (Seaquist et al., 2017). However, this was in the context of a high carbohydrate intake.

Although there have been significant improvements and developments in insulin types, as well as diabetes technology such as pumps and continuous glucose monitors (CGMs), the outcomes for those with Type 1 diabetes have not improved. (Foster et al., 2019)

Despite all the advancements in insulin and diabetes technology, it is the role of nutrition which has the potential for the greatest positive impact on Type 1 diabetes management and outcomes.

🔍Therapeutic Carbohydrate Reduction/Low-carb – The Missing Link to Improved Type 1 diabetes Outcomes

For individuals with Type 1 diabetes, reducing carbohydrate intake, through a Therapeutic Carbohydrate Reduction/Low-carb nutrition strategy tailored specifically to the management of Type 1 diabetes, decrease the amount of glucose entering the bloodstream, resulting in a reduced need for insulin. This combined reduction not only mitigates insulin's unpredictability as you are using less insulin, but also contributes to a safer environment, through a reduction of glucose variability minimizing the risk of life-threatening hypoglycemia.

Previous attempts to decrease hypoglycemia often resulted in unnecessarily high blood sugar levels as only administered insulin levels were reduced. However, by reducing carbohydrate consumption, there is a positive ripple effect, leading to blood sugar variability as insulin requirements decrease.

Diabetes Canada, in their 2020 position statement regarding Low Carbohydrate Diets for Adults with Diabetes echoed this sentiment by stating that “Research on lower-CHO diets have shown improvements in people with Type 1 diabetes, including lower A1C levels (average blood glucose levels over three months), reduced insulin requirements, less glucose variability, and weight loss.”

🥯Carbohydrates: Non-Essential Nutrients for Human Survival

As acknowledged by ADA (2019), carbohydrates are non-essential nutrients. By reducing carbohydrate consumption, a non—essential nutrient, and adequately adjusting insulin through the support of their health care teams, individuals with Type 1 diabetes can improve blood glucose control, HbA1C levels, reduce hypoglycemia risk, and enhance overall health outcomes and quality of life. (Lennerz, et al., 2018)

✅Conclusion:

The Australian Diabetes Society's endorsement of Therapeutic Carbohydrate Reduction/Low-carb for Type 2 diabetes marks a paradigm shift in diabetes management. As the world witnesses the coming together of global diabetes organizations supporting TCR, the hope is that these approaches will extend to include recommendations for individuals with Type 1 diabetes. The potential benefits are immense – from improved glycemic control to enhanced safety and quality of life. The era of personalized and effective diabetes management is on the horizon, guided by the transformative power of a Therapeutic Carbohydrate Reduction/Low-carb nutrition approach.

👉 For more information on how to successfully implement a Therapeutic Carbohydrate Reduction/Low-carb nutrition strategy specifically tailored for Type 1 diabetes, please visit:

https://www.t1dnutrition.com

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References:

Managing Type 2 Diabetes with Therapeutic Carbohydrate Reduction (TCR). (2023).
https://www.diabetessociety.com.au/.../Managing-Type-2...

Evert, A. B., Dennison, M., Gardner, C. D., Garvey, W. T., Lau, K. H. K., MacLeod, J., Mitri, J., Pereira, R. F., Rawlings, K., Robinson, S., Saslow, L., Uelmen, S., Urbanski, P. B., & Yancy, W. S. (2019). Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report. Diabetes Care, 42(5), https://doi.org/10.2337/dci19-0014

Low-carbohydrate diets for adults with diabetes. (2020).
https://www.diabetes.ca/.../Diabetes-Canada_Low-Carb-Diet

Introduction Position statement Low-carb diets for people with diabetes. (2021).
https://www.diabetes.ca/DiabetesCanadaWebsite/media/Advocacy-and-Policy/Advocacy%20Reports/Diabetes-Canada_Low-Carb-Diet_Lay-Summary_May-14-2020.pdf

Feinman, R. D., Pogozelski, W. K., Astrup, A., Bernstein, R. K., Fine, E. J., Westman, E. C., … Worm, N. (2015). Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base. Nutrition, 31(1), 1–13. doi: 10.1016/j.nut.2014.06.011
https://doi.org/10.1016/j.nut.2014.06.011

Foster NC, Beck RW, Miller KM, Clements MA, Rickels MR, DiMeglio LA, Maahs DM, Tamborlane WV, Bergenstal R, Smith E, Olson BA, Garg SK. State of Type 1 Diabetes Management and Outcomes from the T1D Exchange in 2016-2018. Diabetes Technol Ther. 2019 Feb;21(2):66-72. doi: 10.1089/dia.2018.0384. Epub 2019 Jan 18. Erratum in: Diabetes Technol Ther. 2019 Apr;21(4):230. PMID: 30657336; PMCID: PMC7061293.
https://doi.org/10.1089/dia.2018.0384

Lennerz BS, Barton A, Bernstein RK, Dikeman RD, Diulus C, Hallberg S, Rhodes ET, Ebbeling CB, Westman EC, Yancy WS Jr, Ludwig DS. Management of Type 1 Diabetes With a Very Low-carbohydrate Diet. Pediatrics. 2018 Jun;141(6):e20173349. doi: 10.1542/peds.2017-3349. Epub 2018 May 7. PMID: 29735574; PMCID: PMC6034614.
https://doi.org/10.1542/peds.2017-3349

McCall AL. Insulin therapy and hypoglycemia. Endocrinol Metab Clin North Am. 2012 Mar;41(1):57-87. doi: 10.1016/j.ecl.2012.03.001. Epub 2012 Apr 17. PMID: 22575407; PMCID: PMC4265808.
https://doi.org/10.1016/j.ecl.2012.03.001

Seaquist, E. R., & Chow, L. S. (2017). Hypoglycemia in Diabetes. JAMA, 318(1), 31. doi:10.1001/jama.2017.8075
https://doi.org/10.1001/jama.2017.8075