Sunday, July 28, 2019

Retrospective #162: The ADA’s Glycemic, Blood Pressure and Lipid Goals

When it was issued by the ADA in 2013, I was thrilled by their Position Paper, “Nutrition Therapy Recommendations for the Management of Adults with Diabetes.” It announced that “there is not a ‘one-size-fits-all’ eating pattern for adults with diabetes.” Importantly, the ADA said the nutrition recommendations were written at the request of the ADA Executive Committee, which has approved the final document.”
However, there is only so much one committee can do to turn the Titanic. This is an apt metaphor because we who have adopted a Western Diet are all in the same boat. If we stay on our present course, i.e., if we continue to eat the Standard American Diet (SAD) that we have been told to eat ever since the diet/heart hypothesis was first promulgated in the 1950s, we are going to die from one of the diet-related diseases of Western Civilization.
Think back - Ancel Keys made the board of the American Heart Association and the cover of Time magazine in 1961. In 1977, George McGovern’s Senate Select Committee’s staff produced the Dietary Goals of the United States. To say that Keys and McGovern were misguided would be an understatement of, well, Titanic proportions. They will be remembered as the principal enablers of the corrupt cabal of agribusiness, big pharma, and self-serving professionals in the medical societies and government agencies who continue to perpetuate this mess.
The ADA nutrition therapy committee was made up entirely of MSs, MPHs and PhDs who were all also RDs and/or CDEs. They represent just one voice in the ADA, on the nutrition therapy side. Their goal, it seems to me, was both admirable and realistic: increased flexibility to help patients by “individualizing” the therapeutic approach. It was a brilliant ‘workaround’ for the proscription on low-carb diets in previous iterations: low-carb nutrition therapy was first deemed “safe” for one year in 2008 and then later, for two years. Now, the time limit has been eliminated
So, with that as preface, what outcomes does the ADA think can be expected? What goals do they set their sights on achieving? How aspirational can they seem to be without appearing unreasonable? What goals do they set for glycemic control, and blood pressure and lipid improvements? The answer, sadly, is abysmal. But don’t blame the nutritoin committee. That was, as it should be, beyond the purview of their recommendations. Who then?
The ADA’s doctors. The goals the ADA hopes to achieve for the management of adults with diabetes are as follows:
1.        Attain individualized glycemic, blood pressure, and lipid goals. General recommended goals from the ADA for these markers are as follows:
·         A1C < 7%
·         Blood pressure < 140/80mmHg
·         LDL cholesterol < 100 mg/dl
·         Triglycerides < 150 mg/dl
·         HDL > 40mg/dl for men; > 50mg/dl for women
2.        Achieve and maintain body weight goals
3.        Delay or prevent complications of diabetes
And because of the recommended SAD, the ADA’s recommendations allow for even less ambitious goals “…based on age, duration of diabetes, health history and other present health conditions” than these already very lax goals.
So, the Titanic continues to sail on while “the band [the medical doctors] plays on.” By issuing new nutrition therapy recommendations, the RDs and CDEs “rearrange the deck chairs” – but will this make a difference or will it just be a futile exercise as our state of health continues to sink? Or, as individuals, can we “jump ship” and aspire to higher goals to control our diabetes (and blood pressure and blood lipids), “…through diet, mostly.” Yes, we can!
If you do work to control your type 2 diabetes “…through diet, mostly,” you can reasonably expect to “achieve and maintain body weight goals” and “delay or prevent complication of diabetes.” And you can achieve splendid lipids!
I have achieved and maintain a much higher health profile with a Very Low Carb Way of Eating (WOE): 75% fat, 20% protein and 5% carbohydrate. Triglycerides are particularly influenced by dietary carbs. My Trig/HDL ratio is 0.57, indicating a very low risk of CVD. Does you doc check this ratio for you? If not, he or she really should.

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