July 13, 2014

More on Nutrition for People with Diabetes

In the last blog, I covered eating patterns and started the macronutrients as covered in the October ADA dietary guidelines. Now I will write about protein and fat.

The macronutrient, protein. People with diabetes that don't have kidney disease might be surprised by this. There is no 'ideal' amount of protein that helps to improve blood glucose management, or even lowers the risk of heart disease. There are studies on both sides of this issue for both diseases and most are approached with a bias or what the author or funding agency is trying to prove.

The good news for those that have kidney disease do not have to follow a very low protein diet. More is the concern about malnourishment and the protein does not seem to affect the rate of progression of kidney disease. Even with all the hoop-la about red meat causing heart disease, it is more the highly processed meats that have an effect on the heart.

The macronutrient, fat. This section is more difficult and they are still trying to limit fat to a low fat diet. They of course want monounsaturated fats like olive oil and push vegetable oils. They are unanimous in eliminating trans fat as they should, but to curtail saturated fats with the evidence having been disproved still concerns me. I could agree if they had asked for moderation in the consuming of saturated fat.

The guidelines do say that there is no optimal mix of macronutrients. The statement is just made that evidence suggests that there is not an ideal percentage of calories from carbohydrate, protein, and fat for all people with diabetes; therefore, macronutrient distribution should be based on individualized assessment of current eating patterns, preferences, and metabolic goals.

Yet, they continue by saying it has been observed that people with diabetes eat about 45% of their calories from carbohydrate, 36–40% of calories from fat, and the remainder (16–18%) from protein. All this means is that the authors could care less about assessing people with diabetes and allowing them to have individualized eating plans. They are going to push for high carbohydrates.

They do cover omega 3 fatty acids and advise not to be taking fish oil supplements as there is no evidence that these help protect you from heart disease. The guidelines push the importance of getting your fish oils from food sources and that people eat at least two fish meals per week. This the guidelines say will help lower the risk of heart disease.

The dietary guidelines recommend that people who are 51 years of age, those who are African-American, or those that have high blood pressure, diabetes, or chronic kidney disease limit their sodium (salt) intake to 1500 milligrams (mg) per day. Restricting salt to this level is difficult and can make food unpalatable. Evidence does not support lowering salt level to this amount and the guidelines recommend capping salt intake at 2300 mg per day or the same recommendation as for the general public.

The guidelines do advise limiting alcohol as this can mask hypoglycemic symptoms and lead to problems for those on insulin. The guidelines also recommend high dietary fiber and liberal quantities of whole grains. Big Food is speaking here and for those on low-carbohydrate diets need to limit or eliminate wheat from their diets.

In rereading the guidelines for these two blogs, it has been interesting the conflicts in the advice given and how the leanings are still high-carbohydrate low-fat in nature.

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