Clinical Guidelines

Dr. Adele Hite has coordinated the effort to get this clinical guidelines document to the point where it is publishable.  Her efforts have been nothing short of miraculous.  We have formed a board of advisers made up of experienced clinical practitioners and experts in the field to help us get this work done.  Currently this board consists of Prof. Tim Noakes, Dr. Gary Fettke, Dr. Stephen Phinney, Dr. Georgia Ede, Dr. Bret Scher, Dr. Robert Cywes, Dr. Eric Westman, Dr. Will Yancy, Franziska Spritzler, Dr. Laura Saslow, Dr. David Cavin and Dr. Brian Lenzkes. 

Work is now underway to generate condition-specific addenda for these Clinical Guidelines.  It is clear that for certain chronic diseases the general intervention is not always enough.  Nuances and caveats often exist that can make the intervention more successful.  We will be starting with an addendum for Type 2 Diabetes.  After that we will start focusing on cardiovascular disease, neurological disorders, and all the other chronic diseases for which this protocol is appropriate.

This Clinical Guidelines document will be updated from time to time as the science evolves.  If you download or print this document out it is imperative that you return to this page regularly to ensure that you have the latest version.

CLICK HERE for the downloadable pdf.

Clinical Guidelines - Carbohydrate Reduction General Intervention v1.1


Give us your ideas and feedback on these Clinical Guidelines.  Make sure you read through the other comments to make sure you are not duplicating anything and add your new comment at the end.


Posted by Jane Jewell on December 28th, 2018 at 20:50

If patients are on insulin or sulfonylureas when beginning a low-carbohydrate diet, it is likely
that does will need to be reduced immediately to prevent hypoglycemia.

Change does to dose.

Posted by Doug Reynolds on January 10th, 2019 at 05:01

Thanks, Jane!

Posted by Laura Doty on January 6th, 2019 at 07:46

At our metabolic center we always check insulin at baseline, and then repeat it in 3 months, then 6 months. It can give helpful information in terms of presence of insulin resistance, can help to educate and motivate the patient about their current level of health and what may be contributing to weight gain, and it can be followed over time and seeing it decrease can be very rewarding for the patient and provides information about the effect of the dietary and lifestyle changes.

Posted by Doug Reynolds on January 10th, 2019 at 05:02

Thanks, Laura, we will submit this to the panel

Posted by Linda Anegawa on May 11th, 2019 at 19:37

This is fantastic! So appreciative of this important work.

Section 6.2 Regarding management of hypertension – at our program, we typically halve the doses or discontinue diuretics with the start of any very low carb intervention. We also advise patients to monitor BP at a bare minimum of once daily and/or before taking doses of any medications. Patients are instructed to call the care team with any SBP < 120 + orthostatic symptoms, or any SBP < 100.

I'm wondering if brief mention of these topics in the context of low-carb therapeutic interventions might be useful, as well:
(1) Obesity pharmacotherapy
(2) The unique needs of pre-and post-surgical bariatric patients
I have material if there is interest. Thank you!

Posted by Doug Reynolds on May 12th, 2019 at 13:10

Glad you have found it so useful, Linda. We will forward your suggestions to the panel of advisers!

Posted by Chris County on May 12th, 2019 at 08:54

4.5.1 Inpatient
Change to, “implemented in an inpatient setting.”

Posted by Doug Reynolds on May 12th, 2019 at 13:11

Thanks for your comment, Chris. We will forward your suggestion to the panel of advisers!

Posted by Ari on May 13th, 2019 at 02:07

In paragraph 2.6 about trans-fats, please make a clear distinction between natural ruminant transfats (healthy) vs. industrial, via hydrogenation generated transfats (unhealthy).

Posted by Doug Reynolds on May 13th, 2019 at 06:05

Thanks for your comment, Ari. We will forward your suggestion to the panel of advisers!

Posted by Don Wilson on May 20th, 2019 at 16:26

Typos/suggestions: sections: 4 – “knowledgeable determined”, 4.5.1 should be “inpatient”, 6.2 has note to be removed, 7.1, “if changes in those markers [is] a goal.” Missing [is].

Posted by Doug Reynolds on May 21st, 2019 at 09:02

Thanks for your comment, Don. We will forward your suggestions to Adele and the panel of advisers!

Posted by Beverly Williams on May 21st, 2019 at 13:30

On Page 1, under 2. Background and definitions, Line 3 …Dr. William Harvey, who prescribed (a) [not as] diet that restricted starches…

I found that one of the items that I found that needed correction/clarification has already been identified by Doug Reynolds. (Page 14 Clinical Guidelines, Line 9 …”if changes in those markers (are) [to match a plural subject] a goal.”

In the last paragraph on this same page:

Pharmacists…monitoring and education patients with… (either 1. or 2.)

1. complex pharmaceutical regimen(s)
2. (a) complex pharmaceutical regimen.

Thank you for providing us with the ability to participate in the preparation of this draft. I sincerely hope that more doctors will become aware of this tool to use in treating patients, outside of the traditional ADA way. My husband who is a severely overweight, out of control, diabetic completely disregards my advice on healthy eating. He ignores the fact that I have been researching diabetes for at least 45 years because of the strong genetic factor of diabetes in my own family. I have been following the keto way of eating for about 6 months and I know that it works!

Posted by Doug Reynolds on May 22nd, 2019 at 05:25

Thanks for your comments Beverly and it is a total pleasure. Responses like this are the reason we keep doing this. I have a huge problem with my mother developing dementia and refusing to listen so I feel your pain. I hope both of them see the light as the momentum around this builds and we can save both of them!

Posted by Beverly Williams on May 21st, 2019 at 13:41

Excuse my typo:

Pharmacists…monitoring and education patients with… (either 1. or 2.)

Should read:

Pharmacists…monitoring and educating patients with…(either 1. or 2.)

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