Saturday, October 26, 2013

The Nutrition Debate #155: Cowabunga, the ADA makes the turn


The American Diabetes Association (ADA) has just issued new nutritional guidelines for adults with type 2 diabetes, the first in 5 years, and I am ecstatic. I am so thunderstruck by this document, and what it represents, that I am at a loss to describe the breadth and scope in one column. The dimensions of this shift are great, and the more I think about it, the more excited I get. It may take a few weeks (and a few columns) for them all to sink in and for me to relate them to you. Here’s a first cut.

This Medscape Alert, authored by Miriam E. Tucker, sums is up nicely right off the bat (the World Series in Baseball started this week). Her lede is, “New nutritional guidelines from the American Diabetes Association focus on overall eating patterns and patient preference, rather than any particular dietary prescription.” Please pause and reread that. Let it sink in for a minute. “The authors intentionally avoid using the word diet,” Alison Evert, lead author, told Medscape Medical News.

“Throughout the document, we refer to 'eating plans' or 'eating patterns' rather than 'diet,'” Evert, MS, RD, CDE, told Medscape. “We want to work with patients and help them achieve individual health goals. A variety of eating patterns can help, and people are more likely to follow an eating plan that speaks to them," she said. Boy is that true! “Doctors and dietitians have long recognized that ‘diets,’ (or Way of Eating in VLC parlance), work best if you, the patient, like them.” To which I add, “And you are more likely to stick to it if you can lose weight without hunger and cravings…and feel great!”

“Indeed, the new evidence-based position statement…reviews the evidence for several popular eating plans, including Mediterranean style, vegetarian, low fat, low carbohydrate, and Dietary Approaches to Stop Hypertension (DASH), but does not recommend any specific one.”"Personal preferences (e.g., tradition, culture, religion, health beliefs and goals, economics) and metabolic goals should be considered when recommending one eating pattern over another," the statement says (emphases mine). From where I sit, with all “eating plans” “allowed” by the ADA, the ‘pros’ of VLC will stand out.

Remember, it was only a few decades ago that Robert Atkins, MD, was scoffed at and ridiculed. And it’s been only 11 years since Gary Taubes’s seminal piece, “What If It's All Been a Big Fat Lie,” was published in The New York Times. Then, after years of ‘anecdotal reports’ of the success of Low Carb eating on both weight loss and “metabolic goals,” in 2010 the ADA allowed that low carb dieting could be tried for a year but the long term safety of low carb eating was unknown, and then last year they allowed, maybe for two years… Well, they’ve decided. Low Carb is safe, folks. YOU can now pick the eating plan that works best for you, and the ADA says, “…we want to work with patients and help them achieve (their) individual health goals” because “nutrition therapy is a core tenet of diabetes management.” You can now choose the eating plan that works best for you, finally.

Of course, to get to this point the ADA had to construct a giant ‘workaround.’ Here’s how they did it. Starting with the 2008 guidelines, and in recognition of the growing controversy around macronutrient proportions (e.g., low-fat, high-carb vs. low-carb, high-fat), they ducked. It was a beautiful finesse. With respect to the current guidelines for each macronutrient – dietary fat, protein and carbohydrate – they declare that “the evidence is inconclusive…therefore, goals should be individualized.” That’s very convenient, courageous and a brilliant entrée to the new rationalization for the switch.

 It’s now carte blanche, folks. The only caveat - your eating pattern should consist of “nutrient dense foods in appropriate portion sizes to improve overall health.” Otherwise, choose your eating plan “based on personal preferences, (e.g., tradition, culture, religion, health beliefs and goals, economics) and metabolic goals…” In case this groundbreaking development is not clear to you yet, in the first paragraph this new nutrition guidelines statement declares definitively, “It is the position of the American Diabetes Association (ADA) that there is not a “one-size-fits-all” eating pattern for individuals with diabetes.  

It further urges “that each person with diabetes be actively engaged in self-management, education and treatment planning with his or her health care provider” since “for many individuals with diabetes, the most challenging part of the treatment plan is determining what to eat.” They got that right! And this: “Carbohydrate intake has a direct effect on postprandial glucose levels in people with diabetes and is the primary macronutrient of concern in glycemic management.” And this: “Monitoring carbohydrate amounts is a useful strategy for improving postprandial glucose control. Evidence exists that both the quantity and type of carbohydrates in a food influence blood glucose level, and total amount of carbohydrate eaten is the primary predictor of glycemic response.” We type 2s all know this, but I never expected to hear it from the ADA.
Their concluding statement: This “Position Statement” was produced for the ADA by the “Nutrition Recommendations Writing Group Committee,” which “disclosed all potential financial conflicts of interest with industry,” according to the report. “Members of this committee, their employers, and their disclosed conflicts of interest are listed in the ACKNOWLEDGEMENTS. The ADA uses general revenues to fund development of its position statements and does not rely on industry support for these purposes,” they say (emphasis mine). “This position statement was written at the request of the ADA Executive Committee, which has approved the final document,” they acknowledge. I say, “Congratulations to all.” This is a patient-centered manifesto.

2 comments:

  1. It all seems messed up and you really cannot figure out what is the reason behind these many diets. Well, they all may have special benefits for certain conditions. In general, I have seen that a diet high in lean protein is great for anybody.

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    1. I can see how it could be confusing, particularly if you have a special reason to diet, as for example a metabolic dysfunction such as diabetes, or even a proclivity to gain weight. If you do, the it would behoove you to make the effort to "figure out what is the reason behind these many diets," as I have -- and have tried to convey to my readers and followers.

      Good quality protein is essential to all diets; I do not prefer lean protein myself, because I want the fat, instead of carbohydrates, for energy. Dietary protein has many important functions, but energy is not one of them. Our metabolisms burn either glucose (from carbohydrates) or fatty acids (from fat) for energy.

      Thanks for reading and commenting, Kulwant.

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