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Diabetes Diet Therapy and Carbohydrate Restriction Diet (Low-Carbohydrate Diet): Recent Changes in the Positions of the American Diabetes Association (ADA) and the Japan Diabetes Society (JDS)
Koji Ebe1,2, Michael Wood1iD*, Hiroshi Bando1,3iD
1Japan Low Carbohydrate Diet Promotion Association (JLCDPA), Kyoto, Japan
2Takao Hospital, Kyoto, Japan
3Tokushima University / Medical Research, Tokushima, Japan
Corresponding Author: Michael Wood ORCiD
Address: Takao Hospital, 3 Umegahata Hatamachi, Ukyo Ward, Kyoto, 616-8265, Japan.
Received date: 11 April 2026; Accepted date: 14 May 2026; Published date: 21 May 2026
Citation: Ebe K, Wood M, Bando H. Diabetes Diet Therapy and Carbohydrate Restriction Diet (Low-Carbohydrate Diet): Recent Changes in the Positions of the American Diabetes Association (ADA) and the Japan Diabetes Society (JDS). Asp Biomed Clin Case Rep. 2026 May 21;9(2):76-79.
Copyright © 2026 Ebe K, Wood M, Bando H. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium provided the original work is properly cited.
Keywords: Low-Carbohydrate Diet, Carbohydrate Restriction, Medical Nutrition Therapy, American Diabetes Association, United States Department of Agriculture, Dietary Guidelines, Japan Diabetes Society, Type 2 Diabetes
Abbreviations: LCD: Low-Carbohydrate Diet; CR: Carbohydrate Restriction; MNT: Medical Nutrition Therapy; ADA: American Diabetes Association; USDA: United States Department Of Agriculture; JDS: Japan Diabetes Society; T2D: Type 2 Diabetes
Abstract
The American Diabetes Association (ADA) has undergone a significant evolution in its stance on carbohydrate-restricted diets for diabetes management. Prior to 2008, the ADA largely rejected low-carbohydrate approaches. From 2008 onward, it progressively acknowledged their short-term efficacy for weight loss, extended this recognition to 2 years by 2011, removed time limits in the 2013 consensus report, and by 2019 explicitly positioned low-carbohydrate eating patterns as among the most studied and viable options for adults with type 2 diabetes (T2D). This supportive position has remained consistent through 2025.
In parallel, the newly released United States Department of Agriculture (USDA) Dietary Guidelines for Americans 2025–2030 reflect a paradigm shift toward higher protein intake (1.2–1.6 g/kg), emphasis on whole foods, restriction of processed foods and added sugars, and inclusion of healthy fats, aligning closely with core principles of low-carbohydrate diets. In contrast, the Japan Diabetes Society (JDS) maintained a long-standing focus on calorie restriction with relatively high carbohydrate intake from 1969 onward, only recently softening rigid macronutrient ratios. Japanese clinicians pioneered practical carbohydrate restriction in the early 2000s, with accumulating clinical reports and evidence supporting its safety, including data on physiological ketone body elevation during pregnancy and in newborns. These developments indicate growing international convergence toward more flexible, individualized, and carbohydrate-aware dietary strategies in diabetes care.