The Evolution of Low-Carb Nutrition for Diabetes: From John Rollo to Contemporary Support.

1. John Rollo: The pioneer of low-carb diets for diabetes (1797)

John Rollo, a British army surgeon, is credited with one of the earliest recorded uses of low-carb diets to treat diabetes. In 1797, he documented his treatment of two patients using a diet primarily composed of meat, fat, and minimal carbohydrates. Rollo’s approach was groundbreaking, as it recognized the impact of carbohydrate restriction on managing symptoms of diabetes, particularly reducing the excretion of sugar in urine—a common measure of diabetes control at the time.

2. Frederick William Pavy: Advancing the low-carb concept (late 19th century)

Dr. Frederick Pavy, an English physician and contemporary of Claude Bernard, was another early advocate of dietary management in diabetes. Pavy emphasized carbohydrate restriction, promoting a diet rich in protein and fat while minimizing sugars and starches. His work further cemented the idea that low-carb nutrition could effectively manage diabetes, long before the discovery of insulin.

3. Elliott P. Joslin: Early 20th century advocate for diet control (early 1900s)

Dr. Elliott P. Joslin, a prominent figure in diabetes care, is often associated with the development of diabetes management protocols in the early 20th century. Joslin advocated for a “starvation diet” (extremely low-calorie, low-carb diet) before the advent of insulin, which aimed to control blood sugar levels and prolong the lives of diabetic patients. While harsh by modern standards, Joslin’s emphasis on carbohydrate restriction was instrumental in demonstrating the impact of diet on diabetes management.

4. Russel Wilder: Introducing the ketogenic diet (1921)

Russel Wilder, a physician at the Mayo Clinic, is credited with developing the ketogenic diet in 1921, originally as a treatment for epilepsy. However, the diet’s principles—high fat, moderate protein, and very low carbohydrate—were also relevant to diabetes management. Wilder recognized the ketogenic diet’s potential to stabilize blood sugar levels, reduce insulin requirements, and improve overall metabolic control in diabetes patients, laying the groundwork for its therapeutic use in diabetes.

5. The shift away from low-carb diets: The insulin era (1920s – 1970s)

With the discovery of insulin in the 1920s, dietary management of diabetes shifted dramatically. Insulin allowed for more dietary flexibility, leading to a reduction in the emphasis on carbohydrate restriction. As the medical community focused more on insulin therapy, low-carb diets became less prominent, though they were never entirely forgotten, especially among those seeking alternatives to pharmaceutical interventions.

6. Renewed interest in low-carb diets: The 1990s – 2000s

As the prevalence of type 2 diabetes surged worldwide, interest in low-carb diets re-emerged. Researchers and clinicians began to explore the benefits of carbohydrate restriction once again, particularly in controlling blood sugar levels, reducing insulin resistance, and facilitating weight loss in patients with type 2 diabetes. Studies consistently showed that low-carb diets could achieve significant improvements in glycemic control and metabolic health markers.

7. American diabetes association (ADA) endorses low-carb diets (2019)

A significant milestone in the low-carb movement occurred in 2019 when the American Diabetes Association (ADA) officially endorsed low-carbohydrate diets as a viable option for managing type 2 diabetes. This endorsement marked a major shift in mainstream diabetes care, as the ADA acknowledged the robust evidence supporting low-carb approaches in improving blood glucose levels, reducing medication dependence, and promoting weight loss.

8. Diabetes Australia recognizes low-carb diets as best practice (2023)

Following the ADA’s endorsement, Diabetes Australia released a position statement recognizing low-carb diets as a best practice for managing type 2 diabetes. This endorsement highlighted low-carb diets as a safe and effective nutritional strategy, particularly in reducing the need for medications, enhancing patient quality of life, and offering a sustainable approach to blood glucose management.