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Invited Commentary
October 14, 2013

Moving Dietary Management of Diabetes Forward

Author Affiliations
  • 1Departments of Medicine and Public Health Sciences, Loyola University Chicago, Maywood, Illinois
  • 2Department of Medicine, Johns Hopkins University, Baltimore, Maryland
JAMA Intern Med. 2013;173(18):1692-1693. doi:10.1001/jamainternmed.2013.8094

Type 2 diabetes mellitus is a nutritional disease with genetic and environmental cofactors. The goals of nutritional management of type 2 diabetes should include maintaining near-normal plasma glucose levels without risking hypoglycemia, controlling blood pressure and weight, and avoiding the complications of kidney and cardiovascular disease.

Unfortunately, dietary recommendations for individuals with type 2 diabetes have been quite varied and often contradictory over time. John Rollo, a surgeon general in the Royal Artillery of the British Army in 1797, first prescribed a diet composed mainly of animal products, particularly old, rancid meat, but no fruits and vegetables.1 Consequent improvement in glycosuria with this diet may have been due to weight loss itself rather than avoidance of carbohydrates. Severe carbohydrate and caloric restriction for type 2 diabetes management was endorsed by others, such as Frederick M. Allen, who introduced the “Allen Starvation Treatment” in 1914.2 This diet provided only 10 g/d of carbohydrates. Subsequent ketosis with this diet was managed by excessive water consumption and adding alkali or even alcohol to the diet.

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