September 18, 2010

Too many carbohydrates

When I came across this (link now broken - area deleted from site), I needed to rein in my anger level. I am not surprised at the position taken, but some RD/CDE's (Registered Dietitians/Certified Diabetes Educators) just don't understand that when they give advice, they need to be more careful and sensitive to the person needing the advice. Many just state the old ADA position and leave it at that. Plus diabetes forums are a poor place to give dietary information, like carbohydrate advice, especially when what works for one person, may not work for another person, nor meet the dietary needs.

This then makes many people upset and sometimes very disrespectful of the “Title” of the person giving the advice. We know that there is a lot of education behind the title; however, the insensitivity with which advice is given leaves a lot to be desired.

While I have written about this problem before, people need to learn that asking for dietary and nutritional advice on a diabetes forum will often result in advice that may not work for them. Normally the recommended amount of carbohydrates is too high and people want to believe this, but soon discover that the recommended amount is above the level they can tolerate and still manage their diabetes.

I will admit that I am very distrustful of RD's, CDE's, and other titles that participate on diabetes forums recommending how many carbohydrates people should eat in a 24 hour time. I very seldom see recommendations below 200 grams of total carbohydrates. If you are testing before meal and after a meal (1.5 to 2 hours) with a difference of 40 points or less, then your body can tolerate that many carbohydrates. If the difference is greater, then you should seriously consider reducing the amount of carbohydrates.

I realize that this is mostly volunteer work for these RD/CDE's and therefore we should not expect more salient and sage advice. I also know that most diabetes forum members are looking for quick solutions for carbohydrate numbers.

Now dare I mention that carbohydrate numbers are not the end-all to management of diabetes? I wish this could be so as then life could be so much simpler as some RD/CDE's would like us to believe. While those of us with diabetes need to count carbohydrates and they help determine our meter readings before and after meals, too often they do cause us to forget to balance our nutritional intake of foods.

Many people often end up lacking essential nutrients and trace elements in what we eat because we concentrate too much on just the number of carbohydrates. We also need to remember our vitamins, minerals, and certain trace elements that make up a our daily needs. Without them, we end up with other illnesses, health problems, and we constantly are battling other wars with management of our diabetes because we neglected them.

Diabetes management does need vitamins, minerals, and trace elements to be effective. Often because of carbohydrate management, we need supplements to balance what our bodies need. Just a few that come to mind include vitamin B12 for those that have been on metformin for extending periods. Vitamin D3 for those who do not get outside enough or don't include foods high is this. There are others and especially trace minerals are often lacking from our daily nutritional intake.

While I will be the first to admit that nutrition is something that I often neglect. I am working by having more tests done to determine what I am missing, and adjusting my eating habits or by taking supplements to cover the areas that I am short in my nutritional food intake. Because the quantity of carbohydrates is important in my management of my diabetes, I will continue to count them, but I am striving to include more foods high in vitamins, minerals, trace elements, and other vital nutrients important to my health.
The last point is the caloric intake in the foods we eat.  Often the carbohydrate amounts are too high for some individuals and the calories are too high to assist people in losing the weight new diagnosed people often need to lose.  This is why we need to consider the ratio of protein, fat, and carbohydrates that is optimal for each person.

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