November 8, 2013

ADA Ditches Diet, Now Has Food Plans

The American Diabetes Association (ADA) has done something right. They have dropped the word “diet” from their medical nutrition therapy prescription. Instead, they are focusing on overall eating patterns and patient preference. They are using “eating plans” or “eating patterns” in place of diet. This is according to Alison B. Evert, MS, RD, CDE, coordinator of diabetes education programs at the University of Washington Medical Center, Seattle.

Now it will be interesting to see if the American Association of Diabetes Educators (AADE) and the Academy of Nutrition and Dietetics (AND) follows. Because AND is supported heavily by Big Food, I sincerely doubt that there will be any change in their modus operandi.

I can understand why Ms. Evert would recommend a patient being referred to a registered dietitian (RD) as soon as possible following a diabetes diagnosis. This is the way they get people set up on a high carbohydrate/low fat (HCLF) diet when the new person with diabetes has not learned about other food plans. Once they learn about other food plans, they will be less likely to follow the mandates of the RD. At least she does recognize that the referral is often delayed.

From the number of registered dietitians and certified diabetes educators on the committee that wrote the 2013 Nutrition Therapy Recommendations (this is a PDF file), it is understandable why some policies are deemphasized and others are promoted. Several statements in the published recommendations are reflective of the monopolistic attitude of the AND and their attempt to become the only recognized source of nutrition information.

One idea not mentioned in any previous guidelines is a guide for coordinating food with different types of oral glucose-lowering agents and both fixed-dose and basal-bolus insulin regimens. These were included so that clinicians would have some talking points that are evidence based.

Because RDs and CDEs do not like low carbohydrate food plans it is not a surprise that this statement was included, "A lot of the studies on low-carb didn't meet our criteria for inclusion due to factors such as high dropout rates."

Then the following was stated, “As for other macronutrients, the document advises that foods containing unsaturated fats (liquid oils) be substituted for those higher in trans- or saturated fat and that leaner protein sources and meat alternatives are preferred. Often, nutrition therapy isn't given the priority that it should have… It's a lot easier to write a prescription than to have a dialog with the patient about eating behaviors."

Some of the points are good sense and there is some good information when it is carefully analyzed.

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