March 20, 2013

Recommendations for Management of Diabetes

I had to look carefully at this area, but again some minor changes. Sugar-sweetened beverages (SSBs) get the blame for obesity and type 2 diabetes. At least they did not change the recommended daily allowance (RDA) for digestible carbohydrate and left this at 130 g/day. This is still high for those in some low carb diets, but is much more realistic that the 200 to 230 g/day they used to recommend.

ADA does make this statement about the 130 g/day, “It is based on providing adequate glucose as the required fuel for the central nervous system without reliance on glucose production from ingested protein or fat. Although brain fuel needs can be met on lower carbohydrate diets, long-term metabolic effects of very low-carbohydrate diets are unclear and such diets eliminate many foods that are important sources of energy, fiber, vitamins, and minerals and are important in dietary palatability.”

Yes, if much of the information is taught to people with diabetes by dietitians from the Academy of Nutrition and Dietetics then we will be short of nutrients and the food will not be tasty. Other nutritionists not following the ADA, will work with people with diabetes to balance the nutrition or add supplements for those that are short. They will correctly assess the patients for their needs and work within what the patient will or will not eat and make sure that the patient understands what is happening and what is needed. They will not preach mantras and mandates at the patients.

In the next paragraph, they state the following, “Saturated and trans fatty acids are the principal dietary determinants of plasma LDL cholesterol. There is a lack of evidence on the effects of specific fatty acids on people with diabetes, so the recommended goals are consistent with those for individuals with CVD.” This means to me that they are aligning with the American Heart Association when they are talking about cardiovascular disease and do not want people with diabetes on any medium to high fat regimens. I would appreciate it if they were discussing Omega 3 versus Omega 6 and see if they can get the idea.

The medical nutrition therapy (MNT) is again emphasized and again it is to be taught by a registered dietitian who is knowledgeable and skilled in implementing nutrition therapy into diabetes management and education be the team member who provides MNT.Again, I say “no thanks,” I will get my nutrition advice elsewhere and avoid having an RD on my team.

The ADA does admit that there is no diabetes diet per se, and there is not a mix that applies broadly (no one-size-fits-all) enough and that regardless of the macronutrient mix; caloric intake must be in line with the individual weight management goal. They even say that metabolic status also applies, meaning lipid profile, renal function, and food preferences. While they don't list all the diets, they are saying that all need to be considered in managing diabetes. For ADA to admit this, means there maybe hope yet for other changes, but the patients need to maintain the pressure and hold their feet to the fire.

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