ADA 130 g/d of digestible carbohydrate
- From: Jefferson <Jefferson@xxxxxxxxxxx>
- Date: Tue, 15 Jul 2008 21:30:07 -0400
What exactly is the source of the ADA 130 g/d of digestible carbohydrate
recommendation?
"THE LOW-DOWN ON CARBOHYDRATES
Carbohydrates, which include sugars and starches, provide energy to the
cells of the body, particularly the brain. This report sets the first
RDA for total carbohydrates for adults and children at 130 grams per
day. Most people typically exceed this daily amount, with the median
intake of energy yielding carbohydrates ranging, depending on age, from
approximately 200 to 330 grams per day for men and 180 to 230 grams per
day for women. However, individuals who adhere to extremely
low-carbohydrate regimes may not be getting enough carbohydrates from
the food they eat.
While certain populations that live on a high-fat, high-protein diet
containing only minimal amounts of carbohydrate (e.g., Alaska and
Greenland natives, Inuits in Canada, and indigenous people of the
Pampas) appear to suffer no adverse health or longevity effects, the
amount of dietary carbohydrate that provides for decreased risk of
chronic disease in humans is unknown. There may be subtle and
unrecognized health problems caused by a very low-carbohydrate diet
among populations that are not genetically or traditionally adapted to
such a diet. Of particular concern in Western, urbanized societies are
the long-term consequences of a diet sufficiently low in carbohydrates
to cause chronically increased production of keto acids. Such a diet may
result in bone mineral loss, high blood cholesterol concentrations, and
increased risk of kidney stones and urinary tract deposits. It also may
affect the development and function of the central nervous system.
While the acceptable range for carbohydrates is 45 to 65 percent of
total calories, the report suggests that no more than 25 percent of
total calories come from added sugars. Unlike natural sugars, such as
lactose in milk and fructose in fruits, added sugars are incorporated
into foods and beverages during production and processing. The suggested
maximum level is based on trends that show that people whose diets are
at this level of added sugars or above are more likely to have poorer
intakes of important essential nutrients. While supplements may
compensate for poor eating habits to some degree, the report stresses
the benefit of getting needed nutrients from the foods we eat. This is
because natural foods are chemically complex and likely to contain other
healthy nutrients as yet unknown. See the table below for a summary of
acceptable macronutrient distribution ranges." Source: Institute of
Medicine: Dietary Reference Intakes: Energy, Carbohydrate, Fiber, Fat,
Fatty Acids, Cholesterol, Protein, and Amino Acids -
http://www.iom.edu/Object.File/Master/4/154/MACRO8pgFINAL.pdf
In this document which may be the "report brief"
(http://www.iom.edu/CMS/4154.aspx) there is no scientific references
given based on any study, however there were two groups with their
members listed: PANEL ON DIETARY REFERENCE INTAKES FOR MACRONUTRIENTS
and SUBCOMMITTEE ON UPPER REFERENCE LEVELS OF NUTRIENTS.
Support for the ADA 130 grams of digestible carbohydrate per day from
the Nutrition Recommendations and Interventions for Diabetes
A position statement of the American Diabetes Association -
http://care.diabetesjournals.org/cgi/content/full/31/Supplement_1/S61
is the Institute of Medicine: Dietary Reference Intakes: Energy,
Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino
Acids. Washington, DC, National Academies Press, 2002
"Diets low in carbohydrate (and therefore high in fat) may be associated
with greater weight loss in the short term but have not been
demonstrated to result in greater weight loss after 1 year than diets
with more balanced proportions of fats and carbohydrates (26,27). [...]
The cardiovascular efficacy and safety of low- or moderately
low–carbohydrate diets in diabetes have not been well studied.
Very-low-carbohydrate diets (e.g., those that restrict carbohydrate
intake to <130 g/day) are not recommended for patients with diabetes
because ample intake of fruits, vegetables, grains, legumes, and low-fat
dairy products provides vitamins, minerals, fiber, and protein." Source:
Primary Prevention of Cardiovascular Diseases in People With Diabetes
Mellitus: A scientific statement from the American Heart Association and
the American Diabetes Association -
http://care.diabetesjournals.org/cgi/content/full/30/1/162
"Objectives: This study was designed to compare the effects of an
energy-reduced, isocaloric very-low-carbohydrate, high-fat (VLCHF) diet
and a high-carbohydrate, low-fat (HCLF) diet on weight loss and
cardiovascular disease (CVD) risk outcomes.
Background: Despite the popularity of the VLCHF diet, no studies have
compared the chronic effects of weight loss and metabolic change to a
conventional HCLF diet under isocaloric conditions.
Methods: A total of 88 abdominally obese adults were randomly assigned
to either an energy-restricted (~6 to 7 MJ, 30% deficit), planned
isocaloric VLCHF or HCLF diet for 24 weeks in an outpatient clinical
trial. Body weight, blood pressure, fasting glucose, lipids, insulin,
apolipoprotein B (apoB), and C-reactive protein (CRP) were measured at
weeks 0 and 24.
Results: Weight loss was similar in both groups (VLCHF –11.9 ± 6.3 kg,
HCLF –10.1 ± 5.7 kg; p = 0.17). Blood pressure, CRP, fasting glucose,
and insulin reduced similarly with weight loss in both diets. The VLCHF
diet produced greater decreases in triacylglycerols (VLCHF –0.64 ± 0.62
mmol/l, HCLF –0.35 ± 0.49 mmol/l; p = 0.01) and increases in
high-density lipoprotein cholesterol (HDL-C) (VLCHF 0.25 ± 0.28 mmol/l,
HCLF 0.08 ± 0.17 mmol/l; p = 0.002). Low-density lipoprotein cholesterol
(LDL-C) decreased in the HCLF diet but remained unchanged in the VLCHF
diet (VLCHF 0.06 ± 0.58 mmol/l, HCLF –0.46 ± 0.71 mmol/l; p < 0.001).
However, a high degree of individual variability for the LDL response in
the VLCHF diet was observed, with 24% of individuals reporting an
increase of at least 10%. The apoB levels remained unchanged in both
diet groups.
Conclusions: Under isocaloric conditions, VLCHF and HCLF diets result in
similar weight loss. Overall, although both diets had similar
improvements for a number of metabolic risk markers, an HCLF diet had
more favorable effects on the blood lipid profile. This suggests that
the potential long-term effects of the VLCHF diet for CVD risk remain a
concern and that blood lipid levels should be monitored. (Long-term
health effects of high and low carbohydrate, weight loss diets in obese
subjects with the metabolic syndrome; http://www.anzctr.org.au; ACTR No.
12606000203550)." Source: Metabolic Effects of Weight Loss on a
Very-Low-Carbohydrate Diet Compared With an Isocaloric High-Carbohydrate
Diet in Abdominally Obese Subjects -
http://content.onlinejacc.org/cgi/content/abstract/51/1/59
"Results: Data from 45 relevant publications were found to January 2005.
Lower glycemic index (GI) diets reduced both fasting blood glucose and
glycated proteins independently of variance in available and unavailable
carbohydrate intakes. Elevated unavailable carbohydrate added to
improvements in both blood glucose and glycated protein control. These
effects were greater in persons with poor fasting blood glucose control.
No effects were seen on fasting insulin <100 pmol/L; above this, study
numbers were few but consistent with prevention of hyperinsulinemia in
some but not all overweight persons. Insulin sensitivity according to a
variety of measurement methods was improved by lower GI, higher
unavailable carbohydrate interventions in persons with type 2 diabetes,
in overweight and obese persons, and in all studies combined. Fasting
triacylglycerol in addition to body weight reduction related more to
glycemic load than to GI. Glycemic load reduction by >17 g glucose
equivalents/d was associated with reduced body weight.
Conclusions: Consumption of reduced glycemic response diets are followed
by favorable changes in the health markers examined. The case for the
use of such diets looks compelling. Unavailable carbohydrate intake is
equally important." Source: Glycemic response and health—a systematic
review and meta-analysis: relations between dietary glycemic properties
and health outcomes - http://www.ajcn.org/cgi/content/abstract/87/1/258S
A Google search for the Institute of Medicine: Dietary Reference
Intakes: Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol,
Protein, and Amino Acids resulted in 10k finds - http://tinyurl.com/5dkgxc
Citations related to the Institute of Medicine publication in other
sources - http://tinyurl.com/58pzy9
previous alt.support.diabetes thread -
http://tinyurl.com/6ohcx7
In one post Alan S said, "I'm interested in any links to scientific
research papers that may provide evidence for ANY specific minimum
healthy level of carb intake - or if such a threshold exists at all.
I have been searching without success to find the original paper or
papers supporting that official 130gm position." Hopefully that kind of
information is available in the Institute of Medicine: Dietary Reference
Intakes: Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol,
Protein, and Amino Acids. Washington, DC, National Academies Press,
2002. I searched S A I L O R: Maryland's Public Information Network
(http://tinyurl.com/5tumko) and it was not listed. Perhaps someone else
can find it in their library.
Frank
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