Breaking News: The Society of Metabolic Health Practitioners Releases Landmark Position Statement on Therapeutic Carbohydrate Reduction for Type 1 Diabetes

The Society of Metabolic Health Practitioners (SMHP) has officially released a groundbreaking position statement advocating for therapeutic carbohydrate reduction (TCR) as a pivotal dietary strategy for managing Type 1 Diabetes (T1D). Published in the Journal of Metabolic Health, this statement underscores TCR’s transformative potential for glycemic control, reduction of diabetes complications, and overall health improvement for individuals with T1D.

This consensus, developed through a rigorous modified Delphi methodology involving a diverse panel of 15 leading experts, represents a call to action for clinicians, researchers, and patients to re-evaluate traditional dietary guidelines for T1D. Supported by compelling scientific evidence and clinical observations, the SMHP’s position highlights TCR as a safe, effective, and sustainable intervention for individuals of all ages living with T1D.

The SMHP recommends broad clinical access to TCR interventions, advocating for individualized support and respect for patient autonomy in dietary choices. This comprehensive position statement aims to bridge the gap between traditional practices and emerging evidence, fostering a paradigm shift in diabetes care.

The Science Behind the SMHP’s Position on TCR for T1D

Therapeutic Carbohydrate Reduction (TCR) focuses on reducing daily carbohydrate intake to levels that minimize glycemic variability and optimize blood glucose management. The SMHP’s position statement emphasizes that TCR is not just an alternative dietary approach but a scientifically supported intervention with the potential to improve key health metrics for individuals with T1D.

Key Challenges in Current T1D Management

Traditional nutritional therapies for T1D, which emphasize carbohydrate counting and high-carbohydrate meal plans, have shown limited success in achieving optimal glycemic control. Data cited in the position statement reveal stark challenges:

• Only 21% of adults with T1D in the United States meet the American Diabetes Association’s (ADA) HbA1c target of less than 7.0%.
• HbA1c levels in pediatric and adolescent populations are typically even higher, indicating poorer glycemic control.
• High glycemic variability is a significant predictor of complications such as retinopathy, cardiovascular disease, and kidney disease.

These findings highlight the limitations of standard high-carbohydrate diets, which often require complex insulin regimens and lead to frequent glucose excursions.

TCR: A Transformative Approach

The SMHP’s position advocates for TCR as a solution to the persistent challenges of T1D management. TCR involves reducing carbohydrate intake to less than 130 grams per day, with variations such as:

• Low-Carbohydrate Diets (LCDs): 50-130 grams of carbohydrates per day.
• Very Low-Carbohydrate Diets (VLCDs): 20-50 grams of carbohydrates per day.

These dietary patterns prioritize nutrient-dense whole foods, including non-starchy vegetables, healthy fats, and high-quality proteins, aligning with the ADA’s broader recommendation to minimize processed foods and added sugars.

Evidence Supporting TCR’s Efficacy

The position statement draws on extensive observational and interventional studies that highlight TCR’s benefits:

Improved Glycemic Control

• HbA1c Reduction: A pivotal observational study involving over 300 individuals adhering to a VLCD reported mean HbA1c levels of 5.67%, far below the traditional targets for T1D. Participants also experienced low adverse event rates and reduced insulin requirements.

• Postprandial Stability: TCR’s focus on low-glycemic foods minimizes post-meal glucose spikes, providing a more predictable and stable glycemic profile.

Reduction in Insulin Requirements

By reducing dietary carbohydrate intake, TCR decreases the need for large bolus insulin doses. This reduces the margin for error in insulin administration and the risk of hypoglycemia.

Long-Term Sustainability

The SMHP emphasizes that TCR is sustainable when implemented with flexibility and personalized support. Structured meal plans and practical resources ensure that individuals can maintain adherence over the long term.

Addressing Misconceptions About TCR

The SMHP position statement directly addresses common concerns regarding TCR:

• Nutritional Adequacy: TCR emphasizes nutrient-dense foods to meet essential dietary requirements. Studies confirm that well-planned TCR diets provide sufficient vitamins, minerals, and fiber.
• Cardiovascular Health: Concerns about increased dietary fat intake are countered by evidence showing that TCR improves lipid profiles, including reduced triglycerides and increased HDL cholesterol.
• Feasibility: By offering phased-in approaches and individualized guidance, TCR accommodates diverse patient needs and preferences.

Implications for Clinicians and Patients

The SMHP’s position statement encourages healthcare professionals to consider TCR as a viable option for T1D management. It calls for:

1. Increased Awareness: Clinicians should educate themselves on the evidence supporting TCR and discuss it as an option with their patients.
2. Access to Resources: Providing patients with access to meal planning tools, recipes, and continuous glucose monitoring can enhance TCR’s effectiveness.
3. Research Advocacy: The SMHP advocates for more randomized controlled trials to expand the evidence base for TCR in T1D.

About the Authors

The Society of Metabolic Health Practitioners (SMHP) Position Statement on Therapeutic Carbohydrate Reduction (TCR) for Type 1 Diabetes was developed by a distinguished group of experts in the fields of metabolic health, diabetes care, nutrition, and clinical research. Each author brings a unique perspective and depth of knowledge, contributing to the comprehensive and evidence-based recommendations presented in the statement.

The authors include:
Dr. Tro Kalayjian, MD – Greenwich Hospital/Yale New Haven Health, United States
Beth J. McNally, MS, CNS, LDN – Private Practice Nutritionist, Kingston, Ontario, Canada
Dr. Matthew W. Calkins, MD – Atrium One Health, United States
Dr. Mark T. Cucuzzella, MD – West Virginia University, United States
Dr. Robert Cywes, MD, PhD – Private Practice Doctor, Florida, United States
Hayden Dikeman – Department of Biology, Emory University, United States
David T. Dikeman – Department of Biology, Baylor University, United States
Dr. Evelyne Bourdua-Roy, MD – Private Practice Doctor, Quebec, Canada
Sarah M. Rice, MSc – Private Research and Editing, South Africa
Dr. Ian Lake, MBBS – Private Practice Doctor, United Kingdom
Dr. Laura A. Buchanan, MD – Toward Health, United States
Douglas B. Reynolds – Society of Metabolic Health Practitioners, United States
Mirian Kalamian, EdM, MS, CNS – Private Practice Nutritionist, Montana, United States
Dr. Eric C. Westman, MD – Duke University, United States

This team represents a multidisciplinary collaboration, incorporating perspectives from clinical practice, academic research, and patient-centered care. Their shared commitment to improving outcomes for individuals with Type 1 Diabetes through Therapeutic Carbohydrate Reduction (TCR) ensures this position statement is both comprehensive and actionable.

Conclusion: A Call to Action

The release of the SMHP’s position statement marks a pivotal moment in the evolution of T1D management. By advocating for therapeutic carbohydrate reduction, the SMHP offers hope to individuals struggling with the challenges of traditional dietary approaches. With its robust evidence base, practical guidance, and focus on individualized care, TCR represents a transformative opportunity to improve health outcomes and quality of life for those living with T1D.

Clinicians and patients are encouraged to explore the SMHP’s position statement in full, fostering informed decisions and collaborative approaches to diabetes care. Together, we can embrace innovation and ensure that evidence-based practices like TCR become accessible to all who can benefit.

Download the Position Statement on Therapeutic Carbohydrate Reduction for Type 1 Diabetes:

https://journalofmetabolichealth.org/index.php/jmh/article/view/100