Sister Organisation SMHP Publishes Landmark Consensus Guideline on Therapeutic Carbohydrate Reduction
AMHS warmly congratulates our sister organisation, the Society of Metabolic Health Practitioners (SMHP), on the publication of an excellent new consensus guideline on implementing therapeutic carbohydrate reduction (TCR) in metabolic disorders.
The guideline has just been published in the Journal of Metabolic Health, the SMHP’s official open access journal, under the editorial leadership of Associate Professor Caryn Zinn.
Why it matters
TCR is increasingly used in clinical practice for conditions such as type 2 diabetes, obesity, metabolic syndrome and fatty liver disease, and is already recognised as an option by organisations including Diabetes Australia, Diabetes UK and the American Diabetes Association. What clinicians have needed is clear, practical guidance on how to put it into practice safely. This guideline delivers exactly that.
How it was developed
The guideline updates the SMHP’s original 2019 implementation guide using a formal Delphi consensus process. A multidisciplinary, international panel spanning general practice, endocrinology, cardiology, dietetics, psychiatry, surgery and academia worked through several rounds of review before a final anonymous vote. All 18 summary statements reached consensus, with 15 agreed unanimously. We’re delighted to see familiar names on the panel, including Dr Gary Fettke and Dr David Unwin.
What it covers
The guideline is a practical, clinician-focused resource covering:
- how to define and tailor carbohydrate reduction to individual goals
- contraindications and cautions, including kidney and liver disease, pregnancy and breastfeeding
- initial assessment and baseline tests
- managing adaptation symptoms and electrolytes
- adjusting diabetes and blood pressure medications safely
- follow-up, cultural considerations and long-term sustainability
Key conclusions
The panel agreed that a whole-food TCR approach is nutritionally sufficient and can be adapted to a wide range of cultural and personal preferences. It is safe and effective across a range of metabolic disorders, adaptation effects are generally mild and short-lived, and long-term adherence is both achievable and enjoyable. The authors also note that further research is needed in areas such as advanced kidney and liver disease, children and type 1 diabetes.
Read the full guideline
The full article is free to read: A Delphi consensus-based guideline for the implementation of therapeutic carbohydrate reduction in metabolic disorders
Citation: Rice SM, Buchanan LA, Calkins MW, et al. A Delphi consensus-based guideline for the implementation of therapeutic carbohydrate reduction in metabolic disorders. J. metab. health. 2026;9(1), a152. https://doi.org/10.4102/jmh.v9i1.152
This guideline is written for health professionals. Anyone on prescribed medication, particularly for diabetes or blood pressure, should speak with their doctor before making significant dietary changes.
