Just Read: Lifestyle Management, Standards of Medical Care in Diabetes 2019, American Diabetes Association (behavior, a little less strange – low carbohydrate eating now included)

2018.05 Low Carb and Low Carbon - Ted Eytan MD-1001-659
2018.05 Low Carb and Low Carbon – Ted Eytan MD-1001-659 (View on Flickr.com)

I had noted previously that non-adherence to the latest evidence around nutrition has resulted in strange behavior on the part of nationally respected organizations, who do things like endorse sugar sweetened cereals and pure fruit juice, or advise the consumption of high amounts of dietary carbohydrate in the setting of dietary carbohydrate intolerance. Some of this may be related to visible conflicts of interest.

I recently read the 2019 Standards of Medical Care in Diabetes and see there has been a change in approach, which I’m calling a little less strange, and quite welcome. I clipped the relevant pages in the slide above, and what they contain are:

The statement:

For people with type 2 diabetes or prediabetes, low-carbohydrate eating plans show potential to improve glycemia and lipid outcomes for up to 1 yearAmerican Diabetes Association. Standards of Medical Care in Diabetes 2019. Diabetes Care [Internet]. 2019 Jan 1 [cited 2019 Mar 31];42(Supplement 1).

As well as

  • Studies by Saslow, et al and Hallberg, et al, referenced for the first time
  • Relaxation of the sodium restriction for people with diabetes
  • Relaxation of the fat restriction for people with diabetes

And also

  • Visible, declared conflicts of interest on the part of the authors

This is a very significant change.

The People we Went to Medical School to Serve are now Leaders in Controlling their own Health and Life Destiny

Also worth noting, the current CEO of the American Diabetes Association is the first CEO to have diabetes herself. I find that both remarkable and impressive. It’s also evidence that the people we went to medical school to serve are leading in controlling their own health and life destiny. I like that, and I like being in a century where this is happening 🙂 .

See: “5 Things I Wish Someone Told Me When I First Became CEO of The ADA”, With Tracey Brown

2018.05.30 Low Carbohydrate Meetup, Washington, DC USA 457
2018.05.30 Low Carbohydrate Meetup, Washington, DC USA 457 (View on Flickr.com)
2018.10.24 Low Carb and Low Carbon 573
2018.10.24 Low Carb and Low Carbon 573 (View on Flickr.com)


  • American Diabetes Association. Standards of Medical Care in Diabetes 2019. Diabetes Care [Internet]. 2019 Jan 1 [cited 2019 Mar 31];42(Supplement 1).
  • McKenzie AL, Hallberg SJ, Creighton BC, Volk BM, Link TM, Abner MK, et al. A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes. JMIR Diabetes [Internet]. 2017 Mar 7 [cited 2017 Mar 13];2(1):e5. Available from: http://diabetes.jmir.org/2017/1/e5/
  • Saslow LR, Daubenmier JJ, Moskowitz JT, Kim S, Murphy EJ, Phinney SD, et al. Twelve-month outcomes of a randomized trial of a moderate-carbohydrate versus very low-carbohydrate diet in overweight adults with type 2 diabetes mellitus or prediabetes. Nutr Diabetes [Internet]. 2017 Dec 21;7(12):304. Available from: http://www.nature.com/articles/s41387-017-0006-9


Great timing! Last night I reviewed Sarah Hallberg’s TEDx https://www.youtube.com/watch?v=da1vvigy5tQ, and though I’d seen it years ago (probably due to you?) this time it rang loudly, clearly, and newly in these ears … perhaps because of having ingested Big Fat Surprise and >The Case Against Sugar since then (both thanks to you).

I came here to ask if your view on any of it had evolved, particularly the implied indictment of the ADA’s apparently “strange” (nice word, hm) advice. And I land right on this.

My other reason to visit is to see what you think about this new (last year) $40 test of one’s insulin resistance. The author seems sober and clear-headed, with wonderment akin to yours about “strange” advice, but I haven’t heard a word about this test in the year since its launch.

New Test for Diagnosing Insulin Resistance Could Turn the Tide Against Diabetes

Hey Dave,

I don’t really want to comment on new diagnostic tests. There are other readily available measures of insulin resistance that are easily obtained from a standard lipid panel – see Just Read: Estimating Insulin Sensitivity using common lab values (HDL, TG, BMI) – The Single Point Insulin Sensitivity Estimator (SPISE).

Has my view evolved? It’s been strengthened on the one hand, and it’s made me curious on the other. I get to meet people who have reversed their diabetes on their own, which is amazing, (talk about #LetPatientsHelpThemselves !) and also people who can’t wean off of carbohydrates. Both are normal human conditions. More than what the advice is, I’m still concerned about the medical profession’s ability to listen to the human experience and learn from it. This is very similar to what is happening in LGBTQ health in my experience (Why Doctors should meet patients (and each other) where they are: My intersection of #LGBTQ , #LCHF, and #LetPatientsHelp). Oh and one more thing – what’s also amazing is meeting family physicians and other medical specialists who tell me the passion in their work is re-ignited by their ability to reverse diabetes, the thing we were all told couldn’t be done. This is a great space and time to be in,


Thank you for your generosity in pasting links to other helpful content.

Funny, as I think of looking up my previous lab values and doing my own calculation I feel like I might be doing something dangerous or weird! Yeah, me. People are funny.

…and as a result you may now know more about cholesterol tests than many physicians. How’s that for #LetPatientsHelp or as I like to say, sometimes the patients are actually right 😀

Ted Eytan, MD