What the American Diabetes Association Says About Low-Carb Diets
Quick answer: The American Diabetes Association's recent consensus reports and Standards of Care list low-carbohydrate eating as one of several acceptable patterns for adults with diabetes or prediabetes, when it's individualized. Its 2019 nutrition report goes further and says reducing total carbohydrate has the most evidence for improving blood sugar. That's a long way from "dangerous fad." It's also a long way from "keto cures diabetes," and none of it replaces working with your own doctor on medication.
On this page
- The four documents, in plain English
- What "one of several options" means
- What the ADA does not say
- What the research says
- KetoDick's take
- When to involve your doctor
- Key takeaways
- Related
The four documents, in plain English
If you're reading headlines about "the ADA's position on keto," these are the documents behind them. Here's what each one states, as summarized on our evidence page.
| Document | Year | What it states | Link |
|---|---|---|---|
| ADA consensus report: Nutrition Therapy for Adults With Diabetes or Prediabetes (Evert et al.) | 2019 | Cutting total carbohydrate has the most evidence for improving blood sugar; low-carb patterns are one of several options | doi.org/10.2337/dci19-0014 |
| ADA Standards of Care in Diabetes, section 5 | 2025 | Several eating patterns, low-carb among them, are acceptable when individualized | doi.org/10.2337/dc25-S005 |
| ADA + EASD consensus: Management of Hyperglycemia in Type 2 Diabetes (Davies et al.) | 2022 | Lists low-carb eating patterns among the nutrition approaches for weight and blood-sugar management | doi.org/10.2337/dci22-0034 |
| Diabetes UK nutrition guidelines (for comparison) | 2018 | Low-carb diets can be effective short-term for weight and blood sugar; no single ideal macronutrient ratio | doi.org/10.1111/dme.13603 |
The Standards of Care are updated every year. The 2026 edition's link didn't resolve when our evidence page was built, so the 2025 section is the one cited here.
What "one of several options" means
It means the ADA doesn't pick a single winning diet. Several patterns are on the table, low-carb among them, and the right one is the one that fits the person, their health, their culture and what they'll actually keep eating. "Individualized" is doing a lot of work in that sentence.
It does not mean low-carb is grudgingly tolerated. The 2019 report singles out reducing total carbohydrate as having the most evidence for improving blood sugar. For something that gets called a fad, that's a strong endorsement of the underlying idea.
And it does not mean any particular version of keto is required or recommended. A low-carb pattern in these documents is a range, not a 20-gram rule.
What the ADA does not say
A few things people claim the ADA says, which aren't in what our evidence page summarizes:
- That keto is dangerous for everyone. The documents accept low-carb as an option. Risks are about the individual, especially medication (see below).
- That keto reverses or cures diabetes. The documents talk about improving blood sugar and weight, not cures.
- That you should do it without supervision. "Individualized" in a medical guideline means with your care team.
- That a strict ketogenic diet is the default. It's one option among several, and the evidence pages don't summarize a specific carb number from these documents.
If you see a headline that goes further than this in either direction, check whether it links to the actual report. See reading studies.
What the research says
The guideline wording rests on trials like these, all on the evidence page:
- Blood sugar and medication can change a lot. In a non-randomized study, 262 people with type 2 diabetes in a low-carb intervention went from an A1c of 7.6% to 6.3%, lost about 12% of body weight, and used less diabetes medication than 87 people in usual care (Hallberg et al., 2018). Non-randomized means the groups chose their care, so it's encouraging, not proof.
- Weight over a year is close to other diets. In DIETFITS, 609 adults lost 6.0 kg on healthy low-carb and 5.3 kg on healthy low-fat at 12 months, not significantly different (Gardner et al., 2018).
- Lipids are mixed. The National Lipid Association says low- and very-low-carb diets aren't superior for long-term weight loss, lower triglycerides, raise HDL and have a variable effect on LDL (Kirkpatrick et al., 2019).
Put together: low-carb is a legitimate, evidence-backed option for blood sugar, roughly tied with other healthy diets for long-term weight, with lipids worth watching.
KetoDick's take
He doesn't discuss the ADA in his videos, and he's careful about diabetes. In his exercise video he says he hasn't done the research on how exercise interacts with diabetes, so he stays out of it (video f119qGyJ7AY).
What he does share is his own story. He started keto for blood sugar, not weight: home readings put his fasting glucose in the pre-diabetic range, while his post-meal readings were normal (video cTGYIFOTPl8). He reports his fasting glucose trending down within his first month (video cTGYIFOTPl8), and later says he took his readings from "pretty much diabetic levels to almost normal levels in a month" (from the video, xyEZL0HuejI). That's one person's home meter, not a diagnosis, and he presents it that way.
The point of overlap with the ADA is the one that matters most: blood-sugar changes on low-carb can be fast, which is exactly why medication needs supervision.
When to involve your doctor
If you have type 1 or type 2 diabetes, or prediabetes, involve your doctor before you start, not after. Insulin and some other diabetes medications can push blood sugar too low once carbs drop, and doses may need to come down quickly. KetoDick also says that with diabetes, pre-diabetes or any kidney issue, a very dark ketone strip is a doctor question (video GojQvo_2GS0). Bring the ADA documents above to your appointment if it helps the conversation; they're your doctor's own professional guidance.
Key takeaways
- The ADA lists low-carb eating among acceptable patterns for adults with diabetes, when individualized.
- Its 2019 report says reducing total carbohydrate has the most evidence for improving blood sugar.
- None of this says keto is a cure, or that a strict 20 g version is required.
- Blood sugar can change fast on low-carb. Medication changes need your doctor.