Nutrition for People with Diabetes

In covering the new nutrition guidelines (a PDF file) from the ADA (American Diabetes Association) from last October, I was more than a little harsh because of the registered dietitians on the guideline committee. Yes, the guidelines are developed by a select committee of nutrition experts and the guidelines are evidence-based. Much of the evidence is from randomized clinical trials, but some is called expert opinion or expert consensus if we are to believe that is possible in dietary nutrition. When many of the authors of the ADA nutrition guidelines are beholden to Big Food and Big Ag, one must wonder if personal 'expert' opinions were not injected in the guidelines.

There are some new concepts not in prior guidelines. This may be the most positive aspect to come out of the 2013 guidelines.

Eating patterns. This has not been discussed in guidelines before and for people with diabetes, this is a milestone in change. Be recognizing that there are many types of eating patterns, this makes individualizing a meal plan more realistic. The types of meal plans include:

• The DASH (Dietary Approaches to Stop Hypertension) eating plan
• The Mediterranean-style eating plan
• Vegetarian and vegan diets
• Low-fat diets
• Low-carbohydrate diets

This allows room for other eating plans and making people with diabetes feel more relaxed about their food plan. Just because a friend may like a vegan diet, does not mean that your personal preferences have to be the same. It is your personal food plan that is important to you. It will make your likes and dislikes, cultural background, religion, economic situation, and glycemic goals more important for your eating pattern.

Macronutrients. These are carbohydrate, protein, and fat.

Carbohydrate – I have been one to criticize the American Diabetes Association for promoting high carbohydrate diets, but I need to consider that with the new guidelines that their promotion has changed.

Until I see the Academy for Nutrition and Dietetics (AND) stop promoting Big Food, the people with type 2 diabetes will still need to be very careful in what the registered dietitians are promoting in the number of carbohydrates they recommend. Many are still promoting 60 grams of carbohydrates for each meal and 15 to 25 grams of carbohydrates for snacks. One that I heard about recently was promoting almost 280 grams of carbohydrates per day. Most of us with type 2 diabetes cannot consume that many and will gain weight rapidly doing this.

Many of the registered dietitians have switched to promoting percentages to mask the number of carbohydrates they are promoting. They have been recommending that it is up to the individual, but they still promote a higher percentage of carbohydrates. With most type 2 diabetes patients needing to lose weight (about 85 percent), reducing the number or percentage of carbohydrates consumed is the most efficient method and if possible adding exercise to this.

Another trick dietitian's use is alternating between grams of carbohydrates and percentage of carbohydrates to confuse those they are supposedly teaching. But more often, they are just issuing mandates and mixing the terms in to make it sound like they are individualizing the treatment for you.

The two following paragraphs are typical examples of the language used to make the type 2 patient think they are doing what is best for them.

“There’s a considerable amount of space in these recommendations devoted to lower-carb eating plans and some of the research does, indeed, show positive effects of lower-carb eating patterns, particularly in terms of weight loss. However, the authors of the guideline do point out that one of the downsides with low-carb diets is that there isn’t a standard definition of “low carb.” The authors describe “very low” carbohydrate intake as being from 21 grams to 70 grams of carbohydrate per day and “moderate” carbohydrate intake as comprising between 30% and 40% of total calories. But there’s no general consensus about this.”

“The recommendations also, for the first time, recommend limiting the intake of sugar-sweetened beverages. Monitoring carbohydrate intake, whether by counting carbs or watching portions, is still considered an effective means of controlling blood glucose. And substituting low-glycemic-index carbohydrate for high-glycemic-index carbohydrate may modestly improve glycemic control.”

Since there are no existing guidelines for the different carbohydrate levels, I only offer these as a suggestion from a previous blog. If you believe differently, I have no objection, but please be consistent and follow your personal chart. I will have more in the next blog for protein and fat.