People all over the DOC talk a lot about ADA dietary guidelines. So I got a copy of the basics -- and it's not what I thought it was. Seems to me they are very flexible. But I don't know about the American Dietitians' Association, which is also called ADA, but sometimes ADtA. I'd really be interested in other people's input on this, especially Laura and Franzi!

F. Medical nutrition therapy
General recommendations

* Individuals who have prediabetes or diabetes should receive individualized medical nutrition therapy (MNT) as needed to achieve treatment goals, preferably provided by a registered dietitian familiar with the components of diabetes MNT. (A)
* Because MNT can result in cost-savings and improved outcomes (B), MNT should be adequately covered by insurance and other payors. (E)



Recommendations for management of diabetes
Macronutrients in diabetes management

*The best mix of carbohydrate, protein, and fat may be adjusted to meet the metabolic goals and individual preferences of the person with diabetes. (E)
*Monitoring carbohydrate, whether by carbohydrate counting, choices, or experience-based estimation, remains a key strategy in achieving glycemic control. (A)
* For individuals with diabetes, the use of the glycemic index and glycemic load may provide a modest additional benefit for glycemic control over that observed when total carbohydrate is considered alone. (B)
* Saturated fat intake should be <7% of total calories. (A)
* Reducing intake of trans fat lowers LDL cholesterol and increases HDL cholesterol (A), therefore intake of trans fat should be minimized. (E)

You can see the entire section at: http://care.diabetesjournals.org/content/34/Supplement_1/S11.full#s...
For more detail, see ADA's 2008Position Statement on nutrition at: http://care.diabetesjournals.org/content/31/Supplement_1/S61.full

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Franzi,

Wonderful that you're open to change. Many are dismissive or defensive without even giving it a chance.

Even if people don't go as low as Dr. B recommends, the ADA with their correspondingly high A1c to accommodate their carb guidelines is not a road to success. It's a disservice to millions of diabetics. A1c only tells part of the picture, of course, & standard deviation tends to be lower using lower insulin doses. We can't eat whatever because insulin dosing is far from a science. Another thing I learned from Dr. B is the importance of day-to-day dietary consistency. That helped me greatly.

Every person I've met felt far better & had better control significantly lowering carbs. It made no sense to me to eat carb dense food, but everywhere I read the same thing as if it were gospel. People can choose their own way when alternatives are presented. Problem is that alternatives aren't presented.

People freak at the mere idea of limiting carbs. They believe they'll be living on lettuce & meat & aren't told how varied & delicious low carb can be. They're not guided in finding options for high carb addicting food. All they perceive is that they'll be eating less, will be deprived & hungry. It's not necessarily less food. It's just different food. I was ravenous from high carb meals.

I was told low carb was unhealthy, but never given any scientific evidence why other than the starving brain myth. Saying something repeatedly doesn't make it true:)
MossDog,

Sorry this out of sequence, but there are only so many times replies to replies work & then comments end up anywhere.

Yep. People tend to read the headlines & ACCORD made headlines. The CDE hadn't read the study & she's far from alone. My endo at the time said the same & stories here from many others arguing with their doctors or feeling defeated over their improved A1cs.

Wish I'd had the experience of working with people like you & Franzi. Diabetes is isolating enough without encountering resistance & lack of support from professionals I depended on. I told them that I'd do whatever it takes. DKA scared me sufficiently to never want to go there again.
I totally agree with what's been said here about the majority of RDs. I just want to reiterate that there are exceptions (besides you guys :) ). When I mentioned that I was considering TAG to my CDE/RD, she cited a couple of studies from Johns Hopkins and Joslin and gave me recommendations as to how to count protein. They actually have a copy of Bernstein's book in their library - I've encouraged them to read it LOL. The older CDE/RD I met with spouted tons of info on LC and GL when I mentioned it - her face lit up. I know, I'm extremely fortunate! They are fine with me staying under 40 carbs most days. Of course there is the occasional piece of Boston Cream pie that I can't resist ;)
Agree Franzi. There are many in our profession (just as in ANY profession) who are close minded. The only way to change that is to educate them (they seem to need it as much as some PWD). I also notice it is sometimes the RD's who are a bit older who will resist that the most. Towards the end of my schooling my professors were getting more open on the low carb and that was right around the time the low fat vs low carb 2 year comparison came out.
Nice to hear people from the professional side, like Franzi and MossDog, being open minded.

I believe one day low carb will be accepted as a viable alternative, for the simple reason that it works. It may well be that only 10% will even consider it, but that 10% deserves the option to learn and try.
We should consider the professionals as individuals as well. I must admit that I consider myself pretty lucky with the ones I've had to deal with although some have been less than wonderful. When I was just learning about Bernstein from the ADA message boards, I asked my RD/CDE about him and she said something like - "He makes some good points". That may be faint praise but the response wasn't a villification by any means.

Maurie
I'm glad to hear that, Maurie.

I was unable to reply to some of the other posts in sequence, but just wanted to thank you for your candor regarding the problems you have (or have had in the past) with dietitians. Believe me, I am learning a lot from all of YOU! :)

And MossDog, I appreciate your input as an RD. It's great to see another dietitian with diabetes on this site. I think I've seen 3 or 4 in my short time here!
Natalie and BSC, your postings are wonderful! What a lot of NS findings!
As long as the AdtA comes up with so many NS findings, there will not be organizational proactive support for low carb and it will be up to individual dietitians who listen to their patients to encourage testing themselves. Perhaps they need to study online groups' experiences rather than design studies mathematically justifiable that cannot possibly produce Significant Findings.
It is difficult to produce research that challenges the primary, even basic, proportions of CHO in the diet and do so with the idea that one will get significant findings one way or the other. But it is easy to learn that one can test oneself after eating particular carb kinds and amounts and come up with what works for oneself.
VERY informative. After being diagnosed I met with a CDE and left more confused than ever. I found she had me eating more carbs than before! Then I found I had to eat more carbs to take insulin as my Dr. recommended. I had lost a quick 30 pounds before dx and gained them back in a matter of weeks, so I decided to make some changes. I started by checking in here to see what others had done.
It just made sense that I could maintain better control with less carbs AND less insulin. I eat about 100g ogff carbs per day and my bg runs between 95 and 130 most of the time. I do take about 6 to 8 units of insulin most days, but some days I don't use any other than my morning Lantus. So far I am very pleased with the results and how I feel I do have some highs and some lows, but nothing too extreme. I try new foods and sometimes splurge, but I splurge in moderation.
I should mention that I am motivated by complications. I have neuropathy and retinopathy and am fighting to do what I can with these issues. The ADA guidelines scare the hell out of me.
Gold star for the patient and mentor.

Maurie
Such an improvement! Great work.

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