New Review of Macronutrients for Diabetic Nutrition

For years, the legacy of the ADA (American Diabetes Association) and the ADtA (American Dietetic Association) (now staking the claim to the name Academy of Nutrition and Dietiecs (AND)) dietary recommendations have held up, arguing that diabetics should follow a high carb, low fat diet. The flag for this fight was handed off from the ADA to AND, but the individuals involved pretty much remained the same (a group of old guard non scientists with representation from industry).

The latest incarnate of their recommendations can be read in the JADA article "The Evidence for MNT for Type 1 and Type 2 Diabetes in Adults". I read through it and found it terribly flawed, just like its predecessor. And we continue to get flawed dietary advice based on this work. This is the core substantiation that is used to educate us on appropriate nutrition for managing our diabetes.

But the cracks may be widening. The latest salvo appears in the Diabetes Care issue with the article "Macronutrients, Food Groups, and Eating Patterns in the Management of Diabetes, A systematic review of the literature, 2010" Key findings on carbohydrates seem in total opposition to the AND assessment above.

Low Carb Findings (Up to 30% of calories from carbs)

In studies reducing total carbohydrate intake, markers of glycemic control and insulin sensitivity improved, but studies were small, of short duration, and in some cases were not randomized or had high dropout rates. Serum lipoproteins typically improved with reduction of total carbohydrate intake but, with the exception of HDL cholesterol, were not statistically greater than with the comparison diet. The contribution of weight loss to the results was not clear in some of these studies.

Moderate (40-65% of calories/carbs) to High (> 65%) Carb Findings

RCTs presenting information on moderate- and high-carbohydrate diets are diverse in terms of fat and protein content as well as length of study. Only two RCTs found significant differences in A1C between groups, with one study finding significantly lower A1C with the higher-carbohydrate diet only in a subgroup analysis, and the other study finding significantly lower A1C with the lower-carbohydrate diet. In terms of CVD risk factors, LDL cholesterol improved more with a high-carbohydrate diet in one study, whereas two studies found TGs improved more with a lower-carbohydrate diet.

Based on this assessment, it seems like a no brainer. The results suggest clear improvements in blood sugar control and no identified lipid problems with low carb diets. But no research seems to support the effectiveness of high carb diets. It doesn't really help your blood sugar control and it doesn't help your lipids either. The key argument has always been that low carb diets are a CVD risk because of adverse affects on lipids. Even if you believe the lipid hypothesis, this suggestst that low carb diets are heart healthy.

What do you all think of this? Is it progress? Will Hope Warshaw read it and understand it? Will it help lead to more progressive diet assessments and recommendations?

In either case, for those of you who have to deal with nutritionists and dieticians, print this journal article out. If you get harrassment from your medical team about following a low carb diet, you can pull this study out and show them that you are following a diet with some compelling evidence behind it.

Tags: ADA, Carbohydrates, Controversy, Diet, Evidence, Nutrition

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Replies to This Discussion

Permalink Reply by Judith on February 2, 2012 at 6:24pm

Thanks, Moon. I seem to be simple-minded on the carb counting issue. Early on after I found Bernstein, I dispensed with all the percentage crap that confuses me and stuck with # of carbs. I did figure out then how much protein and fat I need in relation to that. But I could still skip the % calculations with that in mind. It's so easy this way!.....

Permalink Reply by Judith on February 2, 2012 at 6:10pm

6 times my lo-carb necessities, but we are all different, Maurie......blessings....

Permalink Reply by acidrock23 on February 2, 2012 at 5:15pm

Interesting review! Thanks for posting it!

I think that doctors should discuss food as medicine more regularly. I may joke about "jelly beans PRN" but most of my docs have been like "if you want to talk about food, see a dietitian" and even, when I was in the 225-30 lb range, better than I had been but having lost some weight and wanting to lose more, the dietitian was like "eat more carbs..."

Permalink Reply by dragonfly on February 3, 2012 at 5:27am

I am really new to all this. That being said, low carb should be WHOLE FOODS. Vegetables and lower glycemic fruits. Proteins & Fats paired w/ vegetables. REAL FOOD. These lower daily BGL. Healthy fats w/ vegies-such as olive oil w/ broccoli w/ chicken. Fats & protein slow digestion.Reduce or eliminate grains. Weight loss will commence. Energy levels rise.Readings stabilize.Real food usually has 5 or less ingredients. An apple is an apple.

Permalink Reply by Judith on February 3, 2012 at 12:23pm

You are definitely on your way, dragonfly! But we all have to eat to our meters. Apples spike me horribly. Berries in small amounts work fine. For a diabetic, an apple is a very complex food to consider!......

Permalink Reply by dragonfly on February 3, 2012 at 4:10pm

Thanks Judith! I agree w/ eating by your meters 100% ! I only meant apple is a whole food.Aspargus.Green beans. Simply single ingredient food. I love pineapple & can only pair w/ protein such as peanut butter or turkey or I spike right up! :D

Permalink Reply by MegaMinxX on February 3, 2012 at 5:53pm

Hi Dragonfly - totally agree with you, and I try to focus on 'good carbs' rather than 'low carb'.
I've recently read several books by Joel Fuhrman and changed my focus to Whole/Real Foods. I eliminated most grains and white carbs, and I think that was a bigger factor in improved BG/A1C than the reduction of total carbs. I also pair my carbs with good fats and proteins, and find I can now enjoy several servings of fruit/day. Love apples with peanut butter, and sometime a chunk of dark chocolate !

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