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Medical Forum / Diseases and Disorders / Diabetes / April 2006ADA Dietary Advice Explored [Long]
I've been critical of the ADA dietary recommendations for some time. In this NG, we hear lots of statements about diets, from ADA to Atkins to South Beach, but I've always gone along with the popular preconceptions here, and never had the intellectual curiosity to actually check the *details* of what the ADA said. As a result of the recent threads criticising the ADA, I finally ginned up the gumption to actually do an analysis of their current guidelines as they appearrd *TODAY* on http://www.diabetes.org/nutrition-and-recipes/nutrition/foodpyramid.jsp If you look at that page, you will see that they break down various foods into "Food Groups". They give examples of serving sizes and which groups they consider various foods fall into. Typical pyramid stuff. I took their recommendations and created a spreadsheet. I got nutritional information from the USDA website. I broke down the data into what seemed to me to be useful categories, and did some simple calculations. Based on the result, I'm reporting that their recommendations are: 47.5% of kcalories from Carbs 33.0% of kcalories from Protein 14.0% of kcalories from Fats (don't blame me that it doesn't all add up to 100%) Since the ADA isn't throwing any grant money my way, for simplicity's sake I chose the first component listed by them under each category. None of us eats this way, so there is no statistical integrity here. There are just too many variables. I arbitrarily chose a slice of 7-grain/whole grain bread for the Starch group. I chose cooked broccoli for the veggies and fruit cocktail in water for the fruit. For the meat group I picked Beef Sirloin Steak, and 1% non-fortified milk for the milk category. You can certainly get different results by choosing different foods or attempting to create some algorithm for the mixed foods that people actually eat. Also, the ADA specifies ranges of servings, and I did try to accommodate this concept. Interestingly, they say that people eating the low range in each category will be eating a 1600 kcal diet. My figures show this to actually be about 938 kcal. Our numbers for the high range differ, too. The ADA says people who eat the high range diet will get about 2800 kcal, and my figures show 1586. I refuse to comment on the potential for disingenuity here. Perhaps I have made a logical error. For those of you given to an appreciation of pedantry, my results are below. Sane readers may now click "Next". I gotta get a hobby......... Jim ===================================================================== Fundamental to understanding the following is the concept of values for a serving, which were derived from the ADA site. For instance, the USDA site defines a slice of 7-grain bread as weighing 28g. But there are things other than carbs, protein and fat in a slice of bread, most notably water. You will see that I broke a serving down into Net carbs, protein and fat. Then I multiplied those amounts by both the high and low daily serving recommendation. Next, I figured the the kcals from each macronutrient, as well as the percentage of total kcals. Add them all up, and you get the numbers above. I hope the formatting holds up. Grains and Starches Choose 6-11 servings per day Serving sizes are: 1 slice of bread Per Serving (USDA) wt (gr) 26 kcal 65 CHO gm 12.06 Fiber gm 1.7 Net CHO gm 10.36 CHO % 39.8% PRO gm 2.6 PRO % 10% FAT gm 0.99 FAT % 3.8% low high % Num of Servings/day (ADA) 6 11 Tot gm/day 156 286 Tot kcal/day 390 715 Tot CHO/day (gm) 62.16 113.96 Tot CHO kcal/day 248.64 455.84 63.8% Tot PRO/day (gm) 15.6 28.6 Tot PRO kcal/day 62.4 114.4 16.0% Tot FAT/day (gm) 5.94 10.89 Tot FAT kcal/day 53.46 98.01 13.7% Vegetables Choose at least 3-5 servings per day. A serving is: ½ cup cooked (broccoli) Per Serving (USDA) wt (gr) 78 kcal 22 CHO gm 3.95 Fiber gm 2.6 Net CHO gm 1.35 CHO % 1.7% PRO gm 2.32 PRO % 3.0% FAT gm 0.27 FAT % 0.3% low high % Num of Servings/day (ADA) 3 5 Tot gm/day 234 390 Tot kcal/day 66 110 Tot CHO/day (gm) 4.05 6.75 Tot CHO kcal/day 16.2 27 24.54% Tot PRO/day (gm) 6.96 11.6 Tot PRO kcal/day 27.84 46.4 42.18% Tot FAT/day (gm) 0.81 1.35 Tot FAT kcal/day 7.29 12.15 11.04% Fruit Choose 2-4 servings per day A serving is: ½ cup canned fruit (Mixed fruit cocktail in water) Per Serving (USDA) wt (gr) 118.5 kcal 38 CHO gm 10.08 Fiber gm 1.2 Net CHO gm 8.88 CHO % 7.5% PRO gm 0.5 PRO % 0.4% FAT gm 0.06 FAT % 0.1% low high % Num of Servings/day (ADA) 2 4 Tot gm/day 237 474 Tot kcal/day 76 152 Tot CHO/day (gm) 17.76 35.52 Tot CHO kcal/day 71.04 142.08 93.5% Tot PRO/day (gm) 1 2 Tot PRO kcal/day 4 8 5.3% Tot FAT/day (gm) 0.12 0.24 Tot FAT kcal/day 1.08 2.16 1.4% Milk Choose 2-3 servings per day A serving is: 1 cup non-fat or low-fat milk Per Serving (USDA) wt (gr) 246 kcal 101 CHO gm 13.68 Fiber gm 0 Net CHO gm 13.68 CHO % 5.6% PRO gm 9.74 PRO % 4.0% FAT gm 0.61 FAT % 0.2% low high % Num of Servings/day (ADA) 2 3 Tot gm/day 492 738 Tot kcal/day 202 303 Tot CHO/day (gm) 27.36 41.04 Tot CHO kcal/day 109.44 164.16 54.2% Tot PRO/day (gm) 19.48 29.22 Tot PRO kcal/day 77.92 116.88 38.6% Tot FAT/day (gm) 1.22 1.83 Tot FAT kcal/day 10.98 16.47 5.4% Meat and Meat Substitutes Choose 4-6 oz per day divided between meals Equal to 1 oz of meat Per Serving (USDA) wt (gr) 28 kcal 51 CHO gm 0 Fiber gm 0 Net CHO gm 0 CHO % 0.0% PRO gm 8.57 PRO % 30.6% FAT gm 1.62 FAT % 5.8% low high % Num of Servings/day (ADA) 4 6 Tot gm/day 112 168 Tot kcal/day 204 306 Tot CHO/day (gm) 0 0 Tot CHO kcal/day 0 0 0.0% Tot PRO/day (gm) 34.28 51.42 Tot PRO kcal/day 137.12 205.68 67.2% Tot FAT/day (gm) 6.48 9.72 Tot FAT kcal/day 58.32 87.48 28.6% TOTALS: low high % Tot kcal/day 938 1586 Tot CHO/day (gm) 111.33 197.27 Tot CHO kcal/day 445.32 789.08 47.5% Tot PRO/day (gm) 77.32 122.84 Tot PRO kcal/day 309.28 491.36 33.0% Tot FAT/day (gm) 14.57 24.03 Tot FAT kcal/day 131.13 216.27 14.0% ==================================================== <snip> > You can certainly get different results by choosing different foods or > attempting to create some algorithm for the mixed foods that people [quoted text clipped - 5 lines] > will get about 2800 kcal, and my figures show 1586. I refuse to comment > on the potential for disingenuity here. Perhaps I have made a logical error. <snip> I know what you mean. While I did find the Exchange Plan to work well in figuring the amount of carbs I could eat, it didn't work out for me calorie-wise. When I was on a diet that should have been 1800 calories per day, it was really only about 800-900, depending on what I ate. I was eating a vegetarian diet at the time and most of the veggies I was eating were the lower calorie ones. I found that I had to add more fat to the diet in order to achieve weight loss.  SignatureSee my webpage: http://mysite.verizon.net/juliebove/index.htm I've always thought that the ADA recommendations were way too high on the carbs. They seem to be based on the old "Heart Healthy" diet, on the theory, I suppose, that diabetics die of heart attacks. But it's pretty hard to control bg's when you're eating seven pieces of bread per day, and it's the high bg's that ruin our hearts (among other things) in the first place. From following posts on this group, it seems to me that nobody here is eating 47.5% of their diets in carbs. Doesn't the ADA pay any attention to the latest research? > I've always thought that the ADA recommendations were way too high on > the carbs. They seem to be based on the old "Heart Healthy" diet, on [quoted text clipped - 4 lines] > seems to me that nobody here is eating 47.5% of their diets in carbs. > Doesn't the ADA pay any attention to the latest research? Is it that their advice was formulated years ago for type 1s on the additional assumption that they have excellent control through use of insulin? It's just never been updated for (a) type 2s who may not get good control through drugs alone and (b)much less for pre-diabetics who rely entirely on diet and exercise. I'd bet that lazy old advice is actually killing people. Peter >I'd bet that lazy old advice is actually >killing people. >Peter It's at least making a lot of people really really thirsty Thanks for bringing this up, JIm. I hadn't really looked at this in a while, either, so I took a quick look. Worth noting that the site says in several places, including twice on the food pyramid page, that "For a healthy meal plan that is based on your individual needs, you should work with a registered dietitian (RD) with expertise in diabetes management," or similar wording to that effect. So the Pyramid is presented as a rough guideline rather than as an absolute plan for everyone. Even so I went through a quicker set of calculations than you did and came up with a diet very similar in carb content to what the Joslin Diabetes Cener recommends for obese individuals--that is 40% calories from carbs based on the following assumptions using the examples they listed in various categories: *15 grams of carbs per serving of grains and starches and fruits, * 5 grams of carbs per veggie serving, and *12 grams of carbs per dairy serving. *I assumed that their total calorie range of 1600 to 2800 might be correct for that pyramid. They say, grains and starches----6-11 servings vegetables--------------- 3-5 servings fruits-----------------------2-4 servings milk and dairy------------2-3 servings for the low range (1600 calories) that works out to grains and starches 6 servings or 90 g carbs vegetables 3 servings or 15 g carbs fruits 2 servings or 30 g carbs milk and dairy 2 servings or 24 g carbs Total carbs 159 g carbs, or 636 calories which is 39.75% of 1600 calories And for the upper range (2800 calories) that works out to: grains and starches 11 servings or 165 g carbs vegetables 5 servings or 25 g carbs fruits 4 servings or 60 g carbs milk and dairy 3 servings or 36 g carbs Total carbs 286 g carbs, or 1144 calories which is 40.85% of 2800 calories That is certainly a lot less than 55% calories from carbs, which is I guess what they used to recommend a ways back before I was diagnosed. Even so, their current line is that they do not recommend a specific diet plan for anyone, that individual factors are paramount , and that a diet plan should be developed with a dietician. In fact whenever someone posts on the message board there that they tried the ADA plan, sometimes followed by a statement that that they then switched to low carb, the moderator posts and asks where they got the idea that there was such a thing as an ADA plan. The original poster always comes back to say well they thought that was the ADA plan because a dietician gave it to them. When they specify what that plan was, the details vary quite a bit, and the forum moderator clearly states that the ADA does not believe that a one-size-fits-all nutrition plan is desirable or even possible. Morris > I've been critical of the ADA dietary recommendations for some time. In > this NG, we hear lots of statements about diets, from ADA to Atkins to [quoted text clipped - 210 lines] > > ==================================================== Funny I just figured out something interesting about how these messages display. I don't know if you have this choice getting these messages through usenet, but in the Google interface you have the choice between a fixed font or a proportional font. When I first looked at Jim's original message that started this thread, all of the clolumns in his charts looked jumbled--misaligned--until I switched to the fixed font, and now his columns line up perfectly. My little charts lined up perfectly before, when I was viewing in proportional fonts, but now that I switched to fix font, my columns look jumbled.. Perhaps when we present little tables like these, we should say which style font they were written in and thus are most readable in. Perhaps in the newsgroups you receive messages in the font in which they were written, in which case this should not be an issue. > Funny I just figured out something interesting about how these messages > display. I don't know if you have this choice getting these messages > through usenet, Usenet is where your newsreader gets the posts from. It's not a way to view them. One view is that Google is just a parasite off Usenet. > but in the Google interface you have the choice between > a fixed font or a proportional font. When I first looked at Jim's [quoted text clipped - 8 lines] > in the newsgroups you receive messages in the font in which they were > written, in which case this should not be an issue. Priscilla Okay then, do your newsreaders display the messages you receive in t he same font in which they are written? Or is that a funciton of how you have defaulted your incoming mail from news groups? My point was that by displaying a message in the font that the message was written in, or in the case of a "fixed" font by viewing those messages in any fixed (width) font, we can avoid any problems reading misaligned columns when people post charts and tables of data. Morris > Okay then, do your newsreaders display the messages you receive in t he > same font in which they are written? Or is that a funciton of how you [quoted text clipped - 4 lines] > messages in any fixed (width) font, we can avoid any problems reading > misaligned columns when people post charts and tables of data. Most newsreaders allow one to set what font will be used for composing or displaying. Priscilla > Okay then, do your newsreaders display the messages you receive in t he > same font in which they are written? Or is that a funciton of how you [quoted text clipped - 4 lines] > messages in any fixed (width) font, we can avoid any problems reading > misaligned columns when people post charts and tables of data. My newsreader lets me choose which font and what size I see posts in. It doesn't matter what the poster chooses, just what I want to see. SignatureAF > In fact whenever someone posts on the message board there that they tried the ADA plan, sometimes followed by a statement that that they then switched to low carb, the moderator posts and asks where they got the idea that there was such a thing as an ADA plan. The original poster always comes back to say well they thought that was the ADA plan because a dietician gave it to them. ++++++++++++++++++++++++++++ Dunno what's happening, but I couldn't get Morris' post to quote - I just want to say that then the ADA ought to put some serious marketing into sorting that impression out. Nicky. SignatureA1c 10.5/5.4/<6 T2 DX 05/2004 1g Metformin, 100ug Thyroxine 95/74/72Kg >>In fact whenever > [quoted text clipped - 11 lines] > > Nicky. It is the ADA guideline from which they formulate the plan. Since they severely limit protein and fat, what do you *think* their guidelines call for? Susan >x-no-archive: yes > [quoted text clipped - 19 lines] > >Susan See my response to Morris. No need to guess: Fat: 25-35%, including <7% saturated and 0% trans-fat. Protein: ~10% Carbohydrates: 55-65%, not less than 130gm daily. Cheers, Alan, T2, Australia. d&e, metformin 2x500mg SignatureEverything in Moderation - Except Laughter. >"For >a healthy meal plan that is based on your individual needs, you should >work with a registered dietitian (RD) with expertise in diabetes >management," Hi All Thanks Morris, and Jim. We hear that repeatedly. In effect, it allows the ADA to appear to be saying "we are only suggesting - go see the experts". So, that begs the question - what is the training on diabetes care that the registered dieticians receive, and who or what sets the guidelines for that training? To save those who don't want to read it all, regardless of what contradictory advice is on the various web-site pages, guidelines published in 2006 by the ADA for dieticians are: Fat: 25-35%, including <7% saturated and 0% trans-fat. Protein: ~10% Carbohydrates: 55-65%, not less than 130gm daily. To see how I came to that, read on. I did some googling on dietician's courses and syllabi. There was limited detail on the web, but this is an example of several: http://www.worldwidelearn.com/continuing-education/dietitian-ceu.htm In the "diabetes" section we find: "Diabetes * 2004 Update: American Diabetes Association Diabetes Nutrition Recommendations * Type 2 Diabetes in Youth: Rising to the Challenge * Type 1 Diabetes and Exercise" That, or an earlier version of it was common to most of the sites I found. So, to be fair, let's not go back to 2004. Let's look at the latest version of "American Diabetes Association Diabetes Nutrition Recommendations" which are used by those registered dieticians. If you were a registered dietician, living in a litigious society and wanting advice from a revered authority that would stand up in court, would you use any other source? The name has changed slightly, but you'll find them at http://care.diabetesjournals.org/cgi/content/full/29/suppl_1/s4 Diabetes Care 29:S4-S42, 2006 © 2006 by the American Diabetes Association, Inc. POSITION STATEMENT ORIGINAL ARTICLE Standards of Medical Care in Diabetes2006 Read them in detail. There are a few surprises. But there are also a few unsurprising disappointments. Specifically on carbs/fat/protein ratios, some snippets: "Low-carbohydrate diets are not recommended in the management of diabetes. Although dietary carbohydrate is the major contributor to postprandial glucose concentration, it is an important source of energy, water-soluble vitamins and minerals, and fiber. Thus, in agreement with the National Academy of SciencesFood and Nutrition Board (41), a recommended range of carbohydrate intake is 4565% of total calories. In addition, because the brain and central nervous system have an absolute requirement for glucose as an energy source, restricting total carbohydrate to <130 g/day is not recommended." <snip> "Dietary intake of protein is similar to that of the general public in individuals with diabetes and usually does not exceed 20% of energy intake. Intake of protein in this range may be a risk factor for the development of diabetic nephropathy (42). Based on studies in patients with varying stages of nephropathy (4244), it seems prudent to limit protein intake in those with diabetes to the RDA (0.8 g/kg), which would be ~10% of total calories." <snip> "The most recent guidelines from the National Cholesterol Education Program recommend that total fat be 2535% of total calories and saturated fat <7% (34). Guidelines from the American Heart Association also recommend that saturated fat be <7% in those with diabetes, given their increased risk of CVD (45,46). Intake of trans fat should be minimized." Those are very specific. Now, let's put those together. Fat: 25-35%, including <7% saturated and 0% trans-fat. Protein: ~10% Carbohydrates: 45-65%, not less than 130gm daily. But, if the maximum protein is 10%, and maximum fat is 35%, then by subtraction, the minimum carbohydrate must be at least 55%. One becomes a little concerned at the expertise of the people who derived these numbers if something as simple as that escaped them. That's elementary school "sums" level. So, the real guidelines published in 2006 by the ADA for dieticians are: Fat: 25-35%, including <7% saturated and 0% trans-fat. Protein: ~10% Carbohydrates: 55-65%, not less than 130gm daily. PS. Some of the syllabi were scary. For example, try the required texts for Utah State University Dietetic Internship http://ce.usu.edu/intern/files/uploads/clinicalnutrition/SyllabusClinical.pdf Syllabus Clinical Nutrition NFS 6250; NFS 6260 Required Texts: Mahan L.K., Escott-Stump S.: Krauses Food, Nutrition and Diet Therapy. 10th or 11th Ed. Philadelphia, PA: WB Saunders; 2000 American Dietetic Association and American Diabetes Association. Exchange Lists for Meal Planning. Chicago, IL: American Dietetic Association and American Diabetes Association; 1995. Purchase one copy in English version and one Spanish version ($2.50 each at www.eatright.org). Charney P, Malone A: ADA Pocket Guide to Nutrition Assessment, American Dietetic Association, 2004. Food-Medication Interactions, 13th edition. PO Box 204, Birchrunville, PA 19421-0204. Holli B, Calabrese R: Communication and Education Skills for Dietetics Professionals (4th Edition). Williams & Wilkins. Cheers, Alan, T2, Australia. d&e, metformin 2x500mg SignatureEverything in Moderation - Except Laughter. Hi Alan, Thanks for pointing us towards that paper. Here are a couple of things you did not quote from the same section of it: "Recommendations * People with diabetes should receive individualized MNT [medical nutritional therapy] as needed to achieve treatment goals, preferably provided by a registered dietitian familiar with the components of diabetes MNT. * Both the amount (grams) of carbohydrate as well as the type of carbohydrate in a food influence blood glucose level. Monitoring total grams of carbohydrate, whether by use of exchanges or carbohydrate counting, remains a key strategy in achieving glycemic control. * The use of the glycemic index/glycemic load may provide an additional benefit over that observed when total carbohydrate is considered alone." "MNT involves a nutrition assessment to evaluate the patient's food intake, metabolic status, lifestyle, readiness to make changes, goal setting, dietary instruction, and evaluation. To facilitate adherence, the plan should be individualized and take into account individual cultural, lifestyle, and financial considerations. Monitoring of glucose and A1C, lipids, blood pressure, and renal status is essential to evaluate nutrition-related outcomes. If goals are not met , changes must be made in the overall diabetes care and management plan." "Regulation of blood glucose to achieve near-normal levels is a primary goal in the management of diabetes, and thus, dietary techniques that limit hyperglycemia following a meal are important in limiting the complications of diabetes. Both the amount (grams) and type of carbohydrate in a food influence blood glucose level. The total amount of carbohydrate consumed is a strong predictor of glycemic response, and thus, monitoring total grams of carbohydrate, whether by use of exchanges or carbohydrate counting, remains a key strategy in achieving glycemic control." And, directly relevant to the question raised in this discussion: "For those individuals seeking guidance regarding macronutrient distribution, the DRIs [dietary reference Intake] may be helpful The DRI report recommends that to meet the body's daily nutritional needs while minimizing risk for chronic diseases, adults (in general, not specifically those with diabetes) should consume 45-65% of total energy from carbohydrate, 20-35% from fat, and 10-35% from protein (41). Although numerous studies have attempted to identify the optimal combination of macronutrients for those with diabetes, it is unlikely that any one such combination of macronutrients exists. The best mix of carbohydrate, protein, and fat appears to vary depending on individual circumstances." If 45-65% of clalories from carbohydrates is the right proportion for the non-diabetic population, and "monitoring total grams of carbohydrate, whether by use of exchanges or carbohydrate counting, remains a key strategy in achieving glycemic control" it is fairly easy to see how the dieticians who look at this paper might recommend, as my CDE did 3 years ago, that I consume about 30-33% of my calories from carbohydrates. She did not put in those terms, but recommended 45 grams of carbs at 3 meals plus 1-2 snacks with 15 grams of carbs in a total 2000 calorie diet, which works out to those percentages. The technique of testing after meals to determine how particular foods affect blood glucose. was stressed for fine tuning whatever recommendations you were working on. All of which worked very well for me-I only had to slightly modify the numbers she gave me--mostly for breakfast. As I posted earlier on this or another thread, this was in a Diabetes Education Program which the ADA certifies meets standards of excellence and which it refers people in my area to fromtheir web site. Just today, a poster on the ADA board who had recently taken classes. referred to the ADA diet, and explained that by that she meant 30 grams per meal, with 2 15 gram snacks per day. Even though the ADA does not say it has a "diet plan" people are coming away for many of the classes they have approved with the right ideas. I think it is fair to judge them as much by their current practice as by their theory. It could well be that the educators are ahead of the website makeover, which is ahead/behind the theoretical underpinnings and position papers. Morris > >"For > >a healthy meal plan that is based on your individual needs, you should [quoted text clipped - 137 lines] > Cheers, Alan, T2, Australia. > d&e, metformin 2x500mg >Hi Alan, > >Thanks for pointing us towards that paper. > >Here are a couple of things you did not quote from the same section of >it: You're right. I didn't quote them - it's a long paper. I always suggest people read the full paper as you did. So - which part do you think the dieticians are using as a base? Which part do you think is appearing in the training syllabus? Don't ask me - ask your dietician. Cheers, Alan, T2, Australia. d&e, metformin 2x500mg SignatureEverything in Moderation - Except Laughter. > Hi Alan, > Thanks for pointing us towards that paper. > Here are a couple of things you did not quote from the same section of > it: > "Recommendations > * People with diabetes should receive individualized MNT [medical > nutritional therapy] as needed to achieve treatment goals, preferably [quoted text clipped - 4 lines] > grams of carbohydrate, whether by use of exchanges or carbohydrate > counting, remains a key strategy in achieving glycemic control. But you don't have to do that if you use a meter. You simply identify what's causing the spikes and eat less of it until the spikes go down. > * The use of the glycemic index/glycemic load may provide an > additional benefit over that observed when total carbohydrate is > considered alone." And you don't have to consider that if you use a meter, because the meter will guide you more accurately in the right direction than the tables in any book could do, because they're averages and YMMV. > "Regulation of blood glucose to achieve near-normal levels is a primary > goal in the management of diabetes, and thus, dietary techniques that [quoted text clipped - 5 lines] > exchanges or carbohydrate counting, remains a key strategy in achieving > glycemic control." Well, yes, but once again, this whole complicated strategy is simplified if you simply "eat to your meter". That will inevitably lead you towards a healthier diet because it will cause you to reduce the micronutrient-low dense high glycemic index carbs, and shift you towards more colourful lower carb vegetables, plus more protein and fats. They (ADA) suggest the meter is for fine-tuning a diet chosen from their various complex recommendations which demand a lot of bookwork and adding up. But what if your meter tells you, as it did me, that eating the amount of complex starchy carbs they suggest is far too much for my BG levels? That's not fine tuning. And why all this complexity of counting up calories? I haven't a clue how many calories I eat and I don't care. I begin by eating as much as seems to satisfy me. Then if I find myself putting on weight I eat a bit less. I can't understand why this extremely useful tool, the personal blood glucose meter, is relegated to such a minor position in their diabetic diet management. It's as though they don't really trust BG meters. SignatureChris Malcolm cam@infirmatics.ed.ac.uk +44 (0)131 651 3445 DoD #205 IPAB, Informatics, JCMB, King's Buildings, Edinburgh, EH9 3JZ, UK [http://www.dai.ed.ac.uk/homes/cam/] > > Hi Alan, > [quoted text clipped - 16 lines] > But you don't have to do that if you use a meter. You simply identify > what's causing the spikes and eat less of it until the spikes go down. A little too simply in this case. Eating to your meter is a fine phrase but it doesn't tell the big picture when it comes to one's overall health. One could eat nothing but cheese every day and their meter would tell them "you're doing great" but what would that do to their total health? > I can't understand why this extremely useful tool, the personal blood > glucose meter, is relegated to such a minor position in their diabetic > diet management. It's as though they don't really trust BG meters. Ssshhh. According to some in here the ADA is only concerned about their corporate sponsors and so you'd think they'd push those meters! :) Best, Kurt :: Chris Malcolm wrote: ::: morris <morrisolder@comcast.net> wrote: [quoted text clipped - 26 lines] :: meter would tell them "you're doing great" but what would that do to :: their total health? One could add in the low starch veggiess and low sugar fruits and be just fine healthwise. Eating to your meter will work when one attempts to employ a reasonable plan that includes most of the truly low carb foods. In fact, as long as you don't overdo the fruits, you might be able to minimize the testing, too. Oh, and it's not 100% clear to be that eating nothing but cheese would ruin someone's health (espeically if you take a multivitamin.). It would certainly seem to defy good sense, but it ain't proven. ::: I can't understand why this extremely useful tool, the personal ::: blood glucose meter, is relegated to such a minor position in their [quoted text clipped - 7 lines] :: Best, :: Kurt > Ssshhh. According to some in here the ADA is only concerned about > their corporate sponsors and so you'd think they'd push those meters! > :) I think some paid memebers of the ADA know where the butter from their bread comes from and might be averse to rocking the boat. Just speaking from personal experience, in my class the emphasis when it came to nutrition was clearly on carbs. I was taught to count grams of carbs, although I was offered the exchange way also, but not really taught to count calories. Perhaps that was because I was only five or ten pounds overweight then. And I was taught to test eafter eating, and introduced to the concept of eating to the meter, if not that exact phraseology. At least my dietician was not scared of the concept. I will concede, however, based on the posts that I read here in cyberspace, that there are other dieticians whose recommendations don't seem to make much sense at all. And yet I have also read posts from many people who got good professional advice that helped them greatly with their diet. Morris > > Hi Alan, > [quoted text clipped - 61 lines] > IPAB, Informatics, JCMB, King's Buildings, Edinburgh, EH9 3JZ, UK > [http://www.dai.ed.ac.uk/homes/cam/] > At least my dietician was not scared of the concept. I will concede, > however, based on the posts that I read here in cyberspace, that there > are other dieticians whose recommendations don't seem to make much > sense at all. And yet I have also read posts from many people who got > good professional advice that helped them greatly with their diet. That's the problem; it shouldn't be such a crapshoot as to whether one gets good advice or life threatening advice. Susan : Just speaking from personal experience, in my class the emphasis when : it came to nutrition was clearly on carbs. I was taught to count grams [quoted text clipped - 3 lines] : introduced to the concept of eating to the meter, if not that exact : phraseology. : At least my dietician was not scared of the concept. I will concede, : however, based on the posts that I read here in cyberspace, that there : are other dieticians whose recommendations don't seem to make much : sense at all. And yet I have also read posts from many people who got : good professional advice that helped them greatly with their diet. : Morris First of all, a lot depends on the state of your knowledge when yu first see a dietician. If you have no idea of what you should call a portion or serving and you don't know much about foods and have been eating, shall we say, unisely, you will be greatly improved in your understanding by seeing a dietician. When I want to the dietician, she go me counting carba, but also learning what is considered a portion size for protein (th eold palm of the hand, or deck of cards). She gave me carb amounts per meal-26 for breakfast, 30-45 for lunch and dinner adn one or two 15 gram snacks. later, when we were talking, she did reveal that she was thinking in terms of a 1200 calorie diet for me, as I had weight to loose, but just counting calories doesn't work well particularly for diabetics. I ultimately had to cut my carb below her recommendations to achieve and maintain good control, but I did learn a number of things from her. Wendy Morris, I did not see a dietician until in preparation for the pump. At that time I was already counting carbs for MDI. Starches were severely limited, and portion was highly stressed. She said that she did not include calories because if I did everything else (what I'd already been doing from what I learned here), then she could guarantee I would lose weight, which I did in the short time before injury and surgical procedures. She reminded me of Loretta as far as portion control, plus she taught to *eye* foods to an approximate 15 grams (we altered it to fit my ratio of 1:10 instead of the 1:15) for whenever I would be eating out. Not precise, but much better than pure guessing. Jim has been retired for two months now, and he has lost about eight or nine pounds eating what he prepares for me, cooking *much* smaller amounts to cut down on temptation for seconds. He measures mine, brings it to me, and that is it! We eat a lot of *green* vegetables that I can fill up on if desired, but it is very rare for me to want more than what he brings to me. So, yes, there are some good dieticians out there, and I happened to get one of them! Just had to toot her horn!!!! LOL Billie Signaturebh-wages at swbell.net ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ : Just speaking from personal experience, in my class the emphasis when : it came to nutrition was clearly on carbs. I was taught to count grams : of carbs, although I was offered the exchange way also, but not really : taught to count calories. : Morris > Thanks Morris, and Jim. > [quoted text clipped - 102 lines] > Protein: ~10% > Carbohydrates: 55-65%, not less than 130gm daily. The main concern for protein consumption relates to nephropathy. The ADA conservative position is based on diabetics with existing kidney (renal) problems. As long as kidney function is in a normal range by measures such as microalbumuria there is no reason to constrict protein level to 10% of diet. Section VI. B. (Nephropathy screening and treatment of the article) is more specific about the kidney issue. "To reduce the risk of nephropathy, protein intake should be limited to the RDA (0.8 g/kg) in those with any degree of (chronic kidney disease)CKD. (B level evidence/opinion) On the other hand, the poor blood glucose, blood pressure, and lipid control in most diabetics makes the ADA recommendation reasonable. Only 7.3% of diabetics have good control of all of these variables. (See table 6) "XI. STRATEGIES FOR IMPROVING DIABETES CARE - The implementation of the standards of care for diabetes has been suboptimal in most clinical settings. A recent report (24) indicated that only 37% of adults with diagnosed diabetes achieved an A1C of <7%, only 36% had a blood pressure <130/80 mmHg, and just 48% had a cholesterol <200 mg/dl. Most distressing was that only 7.3% of diabetes subjects achieved all three treatment goals." Just like some ADA recommends A1c goals of less than 6% on an individual basis, similar recommendations should be made for diabetics with normal kidney function. Therefore the ADA protein in diet recommendations do not need to be generalized to all diabetics. The typical 70 KG person at .8 grams per day amounts to 56 grams. Ten percent of calories from protein from the diabetes pyramid would amount to a range 160-280 calories or 40-70 grams. The more normal level of protein intake in the general population is closer to 20% or twice the level per KG or 80-140 grams. If this hypothetical 70 KG person's intake of protein was 140 grams the corresponding calories on a 2000 calorie diet would be 28% of the total. "The Diabetes Pyramid gives a range of servings. If you follow the minimum number of servings in each group, you would eat about 1600 calories and if you eat at the upper end of the range, it would be about 2800 calories." http://www.diabetes.org/nutrition-and-recipes/nutrition/foodpyramid.jsp Gannon and Nuttall are not the only researchers to investigate protein metabolism in type 2 diabetics. "CONCLUSIONS—Both dietary patterns resulted in improvements in the cardiovascular disease (CVD) risk profile as a consequence of weight loss. However, the greater reductions in total and abdominal fat mass in women and greater LDL cholesterol reduction observed in both sexes on the HP diet suggest that it is a valid diet choice for reducing CVD risk in type 2 diabetes. ... A total of 66 subjects with type 2 diabetes and no proteinuria were recruited ..." Effect of a High-Protein, High–Monounsaturated Fat Weight Loss Diet on Glycemic Control and Lipid Levels in Type 2 Diabetes - http://care.diabetesjournals.org/cgi/content/full/25/3/425 Other studies by the Australian group as well as others that have cited their articles. Parker+Noakes+Luscombe+Clifton - 88 finds - http://tinyurl.com/ozqfp There is some concern about high protein diets and bone loss, especially in women. See my posts in a thread that relates vitamin K and diabetics - http://tinyurl.com/jtdql. Frank Roy <snipped , a very good analysis of the ADA diet> Hi J.C. Hartmann , thank you very much for posting this. I planned to do the same , but never had enough courage to do it :) Gys |
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