Re: Nutrition Recommendations and Interventions for Diabetes-2006
- From: Alan S <loralweightandcarbs@xxxxxxxxxxxxxxx>
- Date: Sat, 02 Sep 2006 01:22:23 GMT
On Fri, 1 Sep 2006 12:14:37 -0700, "Sarah"
<sarahpa1980@xxxxxxxxx> wrote:
This is a new position statement from the American Diabetes Association, it
is a major update of the previous position statement issued in 2002.
http://care.diabetesjournals.org/cgi/content/full/29/9/2140
Hi Sarah
You may find it interesting to go back to this thread
started by Jim Hartmann last April:
http://tinyurl.com/syxs2
I was among those who responded, noting this new positon
statement at that time. I'm basically lazy, so I'll repeat
that post below. Of course, if things have changed since
then I'm happy to be corrected. Morris is a nice guy who
dropped in here for a while; he is a regular on the ADA
forum.
http://tinyurl.com/oh7du
On 4 Apr 2006 13:03:40 -0700, "morris" wrote:
"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 Diabetes–2006
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 Sciences–Food and Nutrition Board (41), a
recommended range of carbohydrate intake is 45–65% 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 (42–44), 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 25–35% 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/SyllabusClin...
Syllabus – Clinical Nutrition NFS 6250; NFS 6260
Required Texts:
Mahan L.K., Escott-Stump S.: Krause’s 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 1000mg, ezetrol 10mg
--
Everything in Moderation - Except Laughter.
.
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