Healthy Plate By Joslin, Maybe Not So Healthy

If you are a follower of the ADA food plan, you will enjoy the Joslin healthy plate. If you need to gain some weight, you will love the Joslin healthy plate. Does this tell you what you need to know about the Joslin healthy plate?

It is not as interactive as a person would like and in fact is rather rigid in options, as you would expect a registered dietitian to be because of being a proponent of BIG Food. I attempted to get a variance to help with weight loss, but everything I tried came up the same when I wanted Joslin healthy plate to do the calculations. If I were to follow the plan, I could figure on gaining approximately 5 pounds per month. Some weight loss plan!

Even using a meal plan that you may have and then following this route would not let you have fat or products containing fat. This shows that unless you use their high carbohydrate – low fat (HCLF) foods, you will not even be able to have a balanced meal that you might like to eat. Yes, those with diabetes that are able to consume the HCLF without causing spikes in their blood glucose levels can eat this. For the majority of people with type 2 diabetes, the Joslin healthy plate food plan will not be one that you will find satisfactory.

I can only surmise that the American Association of Diabetes Educators (AADE) and the Academy of Nutrition and Dietetics (AND) has been more influential in reminding their members to follow certain guidelines instead of allowing any deviation from positions not supported by BIG Food.

While the American Diabetes Association (ADA) does now support other food plans including low carbohydrate – high fat (LCHF), the AADE and AND will not allow what the ADA allows. These two groups will continue to loose support among the patient population for their rigid position.

Joslin SEEMS a Fan of AACE Algorithm

It seems that we are going to be continually bombarded with the American Association of Clinical Endocrinologists (AACE) Diabetes Algorithms. This time it is the Joslin Diabetes Center trumpeting the algorithms. The author of the Joslin blog tells us what we know and that is that the algorithms are for practitioners, both the endocrinologists and primary care physicians (PCPs). And yes, most people with diabetes are cared for by a primary care physicians, but that means they will have one diabetes medication stacked on another.

If things hold true, many of the diabetes patients will be kept on oral medications for too long a time as A1c's rise. The algorithms recommend moving to insulin, but many PCPs are very hesitant to move diabetes patients to insulin because they are also afraid of hypoglycemia.

I admit that the following statement by the Joslin blog author has me concerned and wondering why they are agreeing that diabetes is progressive. “They also place greater emphasis on the use of medication early in the pre-diabetes stage of the disease. Including medications as a concomitant part of treatment from the beginning, acknowledges both the difficulty of lifestyle therapy and the progressive nature of the disease.” This disagrees with the statement of Dr. Anne Peters from the University of Southern California, “The authors have eliminated hemoglobin A1c as part of the diagnostic criteria for prediabetes and don't describe in much detail how to decide when to treat somebody with prediabetes. There is no current US Food and Drug Administration-approved medication for the treatment of prediabetes.”

This tells me that Joslin is not afraid to use diabetes medications “off label” and with metformin being economical, this may be acceptable, as most insurance companies will not reimburse for pre-diabetes medications. The fact that Joslin considers diabetes progressive should concern every patient at Joslin, and especially if you are working to prevent progression to complications.

Joslin also apparently follows the American Diabetes Association guideline of 7% as the ideal A1c level and this also indicates that they consider diabetes progressive and that there is no means to prevent this – how very depressing. I can agree with the statement that A1c needs to be individualized for the elderly that are having other disease or comorbid problems, but they don't say this. They only say the target A1c needs modification based on individual risk factors and circumstances. Then the blog concludes with the statement, “Prevention of hypoglycemia is paramount when developing a treatment strategy for patients.”

There are so many issues left unsaid and others that are hinted at, that one needs to wonder who sets policies at Joslin and then if anyone follows these policies, if any exist. In the last few months, more conflicting comments have appeared in Joslin's blogs and in other sources. Then they refuse to identify the person writing the blog by saying the blog is by Joslin Communications.