Every year, the American Diabetes Association releases their update on the standards for Diabetes Care. I wanted to quickly summarize the nutrition recommendations from the ADA for 2015. This blog will focus on Type 2 Diabetes.
1. There is no prescribed ADA diet. It’s Medical Nutrition Therapy
One of the myths of diabetes nutrition advice is that there is a standard “ADA” diet. Wrong. Nutrition is highly personal and the ADA recommends individualized approach to nutrition. That being said, there are some “guidance” the ADA gives.
2. Nutrition is important to assist with weight loss
Weight loss is important in diabetes, especially those early onset and with pre-diabetes. However, again, there is not one “diet” the ADA recommends.
“A variety of eating patterns have been shown to be effective in managing diabetes, including Mediterranean-style (53,65), Dietary Approaches to Stop Hypertension (DASH)-style (66), and plant-based (vegan or vegetarian) (67), lower-fat (68), and lower-carbohydrate patterns (68).”
3. What about the Carbs?
This is where it gets more interesting. While many of the recommendations remain the same from 2014, there were some subtle changes made. Let’s list the recommendations first.
|Eating patterns and macronutrient distribution||• Evidence suggests that there is not an ideal percentage of calories from carbohydrate, protein, and fat for all people with diabetes B; therefore, macronutrient distribution should be based on individualized assessment of current eating patterns, preferences, and metabolic goals. E||B, E|
|• Carbohydrate amount and available insulin may be the most important factors influencing glycemic response after eating and should be considered when developing the eating plan.||A|
|• Monitoring carbohydrate intake, whether by carbohydrate counting or experience-based estimation, remains critical in achieving glycemic control.||B|
|• Carbohydrate intake from vegetables, fruits, whole grains, legumes, and dairy products should be advised over intake from other carbohydrate sources, especially those that contain added fats, sugars, or sodium.||B|
|• Substituting low glycemic−load foods for higher glycemic−load foods may modestly improve glycemic control.||C|
|• Individuals at high risk for type 2 diabetes should be encouraged to achieve the U.S. Department of Agriculture recommendation for dietary fiber (14 g fiber/1,000 kcal) and to consume foods containing whole grains (one-half of grain intake).||B|
|• While substituting sucrose-containing foods for isocaloric amounts of other carbohydrates may have similar blood glucose effects, consumption should be minimized to avoid displacing nutrient-dense food choices.||A|
|• People with diabetes and those at risk should limit or avoid intake of sugar-sweetened beverages to reduce risk for weight gain and worsening of cardiometabolic risk profile.||B|
Now the first five are pretty much the same from last year. But let’s look at a few of them in detail.
a. Carbohydrate intake from vegetables, fruits, whole grains, legumes, and dairy products should be advised over intake from other carbohydrate sources, especially those that contain added fats, sugars, or sodium.
This recommendation is the same from last year, but I highlighted the order, which is not alphabetical, but most likely priority based. So, I think most importantly, diabetics should get carbs first from vegetables.
b. Individuals at high risk for type 2 diabetes should be encouraged to achieve the U.S. Department of Agriculture recommendation for dietary fiber (14 g fiber/1,000 kcal) and to consume foods containing whole grains (one-half of grain intake).
This one is new. Before, the ADA recommended that diabetics should follow the USDA recommendation for fiber and whole grains. Notice now that it’s now those “individuals at high risk for type 2 diabetes” and makes no mention of those with diabetes.
c. People with diabetes and those at risk should limit or avoid intake of sugar-sweetened beverages to reduce risk for weight gain and worsening of cardiometabolic risk profile.
This one is the same from last year, but noticeably any recommendations re: fructose from fruit vs. other forms are absent. Not exactly sure the reasoning, but perhaps it was too complicated to understand, or that fructose in any form may not be ideal for diabetics?
4. What about Protein?
Really no change from 2014. But remember folks, protein can increase an insulin response. People tend to forget this, but interestingly doesn’t seem to cause a big glucose response.
5. What about Fats?
Really no change from previous, but in 2015, they did not separate out a MUFA/PUFA ration. Instead, the ADA just focused on the Mediterranean Diet.
“A Mediterranean-style eating pattern, rich in monounsaturated fatty acids, may benefit glycemic control and CVD risk factors and can therefore be recommended as an effective alternative to a lower-fat, higher-carbohydrate eating pattern.”
But remember, increase in Omega-3 intake is recommended too, especially found in fatty fish (salmon, mackerel, herring, etc).
“Increased consumption of foods containing long-chain omega-3 fatty acids (EPA and DHA), such as fatty fish, and omega-3 linolenic acid (ALA) is recommended”
“The consumption of fish (particularly fatty fish) at least two times (two servings) per week is recommended”
While there are no new groundbreaking new ADA guidelines in reference to nutrition, there are some subtle changes. The ADA understands that carbs are important to understand and is the main way to control glycemic response and that good fats such as found in fatty fish are important to ingest. De-emphasizing the recommendation of whole grains were a subtle but noticeable change from 2014.
1. Standards of Diabetes Care 2015-4. Foundations of Care: Education, Nutrition, physical activity, smoking cessation, psychosocial care and immunization. http://care.diabetesjournals.org/content/38/Supplement_1/S20.full
2. Standards of Diabetes Care 2014. Nutrition Therapy Recommendations for the Management of Adults with diabetes. http://care.diabetesjournals.org/content/37/Supplement_1/S120.full