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.
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.
ReplyDeleteI 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.
DeleteGood 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.
Excellent article! We will be linking to this great article on our site.Keep up the great writing. To get more informationonline pharmacy store from buy generic drug online from trusted pharmacy.
ReplyDelete