ADA Diet Guidelines for 2020

The American Diabetes Association (ADA) has released is new guidelines for 2020. In section 5, titled Facilitating Behavior Change, under the heading Eating Patterns, Macronutrient Distribution, and Meal Planning they state the following:

Reducing overall carbohydrate intake for individuals with diabetes has demonstrated the most evidence for improving glycemia and may be applied in a variety of eating patterns that meet individual needs and preferences.

What does it mean then?

Eating a lower carb diet improves blood sugars better than any other diets they have looked at so far. And it can be done by people who are vegans, vegetarians, carnivores, etc. 

Lower carb is not keto. Keto may be right for some folks, but it can be dangerous for folks with blood sugar issues to just jump into. If you decide you want to try keto, you should slowly transition to it. Another good very low carb diet is the revised Atkins diet. (Keto is high fat, low carb and Atkins is high protein, low carb.)

See below for which diet I think you try first.

What it doesn’t mean.

It does NOT mean that all diabetics and people with blood sugar issues need to eat keto.

How low should you go?

If you are having issues with high blood sugars, first evaluate how many carbs you are eating now and go lower. (Unless you have an eating disorder, renal disease, or concerns about ketoacidosis.)

It is important to get a baseline first. Below I talk about how you can do that.

What are some guidelines for how many carbs I should eat?

The ADA report states that, “Most individuals with diabetes report a moderate intake of carbohydrate (44-46% of total calories).”

First, in my book , that is not a moderate intake of carbs. That is high intake.

I like to have clients start with what I consider to be a moderately low carb diet.. This will be anywhere from 15-30% carbs in their diet.

For someone on a 1500 calorie plan, this would be 56 to 112 grams per day.

For someone on a 2000 calorie plan, this would be 75-150 grams  per day.

Again, first evaluate where you are, then start going lower until you feel better and your blood sugars start dropping.

Is there a specific diet I should eat for reducing blood sugars?

I like to steer my client to a lower carb paleo diet to start with. I do this for several reasons.

  1. Vegetables are usually a large part of most recipes. No surprise that I think this is a great thing to add to your diet. But you do need to stick mostly with non-starchy vegetables to keep your carbs down.
  2. Paleo is grain-free. Grains are huge source of carbs for most folks and they are causing a lot of gut issues. It is best to avoid them in my opinion.
  3. Paleo is dairy-free. I find a lot of my clients have a food sensitivity to the proteins (casein or whey) in the dairy. Eliminating dairy for at least 6 weeks, then slowly reintroducing it can be very helpful. Doing a food sensitivity test is a great choice too. (Butter is a very healthy fat to be eating, but if a dairy allergy is suspected, then one should eat ghee.)
  4. Paleo removes legumes as well. Legumes can be a great food for some people, but in others it triggers digestive issues like bloating and gut pain. Again, removing it for a while, then reintroducing it can tell you if they will be a good food for you to eat.
  5. The best reason though is that there are so many DELICIOUS paleo recipes online. You won’t feel like to you have to sacrifice if you eat paleo.

There are also plenty of vegan and vegetarian paleo recipes online.

If they find that a lower carb paleo diet is not helping them meet all their goals, then I recommend they transition to a keto diet or the revised Atkins diet. (Keto is high fat, low carb while Atkins is high protein, low carb.)

How do I determine how many carbs I am eating?

This is actually pretty easy now. An app like MyFitnessPal will figure it out for you. They have tons of foods and meals already in their system. You can search by brand or even by recipe title. For instance, if you have a recipe you found online, you can search for “Taste of Home green bean casserole”.

The only issue I have found is if you make a lot of your own meals and don’t have recipes to use. In that case, you can use this handy Recipe Calculator to figure it out. You just put in the ingredients and the number of servings.

I am disappointed with some of the ADA recommendations.

They do mention several times that we need to work with people’s current eating habits as much as possible as they are not likely to make lasting changes. I think that is really short-changing people. Once a client starts to feel better, they are less likely to fall back into bad habits. If they do, they notice they don’t feel good and will usually adjust back to where they need to be.

We need to stop making excuses and being so wishy-washy. If you want to feel like crap, then no one can make you eat differently. If you want to feel better and have more energy and not need medications constantly, then make the changes and stick with them.

That’s my two cents on the new ADA guidelines.

Why Should You Work with A Nutritional Therapist?

A Nutritional Therapy Practitioner (NTP)can help you get started monitoring your blood sugar levels if you are not and give you guidelines and assistance for what is normal. They can guide you in how often to monitor them and how to tell if a food is triggering a high blood sugar response.

They can also help you with meal planning and figuring out how to start eating differently.

An NTP will also recommend some supplements that have a good track record for improving blood sugar regulation. And, if you are having other health issues, they can help you address those while working on blood sugar.

This is a three prong approach:

  • Monitoring blood sugars and learning what foods trigger them.
  • Meal planning and diet changes.
  • Supplements and nutrients to help replenish the body and support blood sugar regulation.


  • Keto is not the answer for everyone with diabetes or blood sugar issues.
  • Lowering carbs has the most evidence for improving blood sugars.
  • Figure out how many carbs you are eating now and start cutting back to see how you feel and see if your blood sugars start to drop.
  • Eating 15-30% of your diet in carbs is a good place to start.
  • If that does not help you meet your goals, consider Atkins or keto.
  • An NTP can guide you and help you on your journey.

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