A Delphi consensus-based guideline for the implementation of therapeutic carbohydrate reduction in metabolic disorders

Abstract

Metabolic disorders represent a growing global health burden, with a high percentage of adults demonstrating some features of metabolic dysfunction. The Society of Metabolic Health Practitioners recognised the need for a consensus guideline for the implementation of therapeutic carbohydrate reduction (TCR), which is increasingly used in clinical practice. This document updates a 2019 expert panel-derived statement by incorporating new evidence and applying a formal consensus methodology. This guideline was developed using a structured Delphi consensus process with predefined agreement thresholds. The steering committee reviewed and expanded the 2019 document during an initial round (pre-Delphi, round 0), after which panel feedback informed substantial structural revision and integration of comments, resulting in a redrafted version that formed the basis for subsequent consensus rounds. Statement development was informed by a targeted, non-systematic review of human studies from research databases. Given the heterogeneous and evolving evidence base, no formal evidence grading framework was applied. After three rounds of feedback and iterations an anonymous survey was conducted. This Delphi consensus-based guideline provides practical, evidence-informed recommendations for the implementation of TCR in metabolic disorders. Consensus was achieved across key domains relating to the implementation of TCR in metabolic disorders. A whole foods TCR approach is nutritionally sufficient and may be tailored to a wide range of cultural and personal preferences, focusing on protein, healthy fats from whole foods, and vegetables. Therapeutic carbohydrate reduction is safe and effective for a range of metabolic disorders. Adaptation effects are generally mild, short-lived, and easily managed, and long-term adherence is both possible and enjoyable. Further research is required to refine application across diverse populations and clinical contexts.