ADA Issues New Nutritional Guidelines

American Diabetes Association (ADA) New Guidelines Stress Individualized Meal Planning That Fits a Diabetics Food Preference and Lifestyle

Evidence is still limited regarding the impact of various eating patterns on health outcomes in people with diabetes and does not support one eating pattern over another, according to an American Diabetes Association position statement published online ahead of print in Diabetes Care. The update replaces the last version of the recommendations, which were published in 2008.

“Whether you prefer a Mediterranean, vegetarian, or lower-carbohydrate eating plan is less important than finding an eating pattern that fits your food preferences and lifestyle, can be consistently followed, and that provides you with the nutrition you need for good health,” said coauthor of the position statement Jackie Boucher, MS, RD, LD, CDE, Vice President for Education, Minneapolis Heart Institute Foundation.

The ADA recommends that all adults with diabetes eat a variety of minimally processed, nutrient-dense foods in appropriate portion sizes as part of an eating plan that takes into account individual preferences, culture, religious beliefs, traditions and metabolic goals.

“Ideally the person with diabetes should be referred to a registered dietitian or participate in a diabetes self-management education program, soon after diagnosis. An important goal of nutrition therapy for adults with diabetes includes the collaborative development of an individualized eating plan with ongoing support to promote health behavior change,” said coauthor Alison Evert, MS, RD, CDE, Coordinator of Diabetes Education Programs at the University of Washington Medical Center Diabetes Care Center.

“The committee thoroughly reviewed the research conducted over the last decade about what nutrition therapy interventions are effective in people with diabetes,” Ms. Evert explained.

Updates from the 2008 Position Statement

“A major difference [from the 2008 position statement] is that this current statement eliminates the information regarding pre-diabetes altogether and only focuses on meal planning (or Medical Nutrition Therapy) for type 1 and type 2 diabetes,” commented Amy Hess-Fischl, CDE, RD, a diabetes educator and program coordinator for the Teen and Adolescent Diabetes Transition Program at the University of Chicago’s Kovler Diabetes Center.

Another major difference is that the updated report includes a new eating patterns section “since people eat food and not single nutrients such as carbohydrates, protein, and fat,” Ms. Evert said.

“The position statement delved into the most recent research regarding nutrition goals and diabetes, supplements, herbs, and other nutrients,” Ms. Hess-Fischl said. “The statement does include a easy to read table of all the current evidence coinciding to various topics: optimal mix of macronutrients (just like the previous statement, there is no ideal mix of protein, fat, and carbohydrates); dietary fiber (the same recommendations as the general public: ~25 g for females and 38 g for males per day); herbal supplements (no clear evidence or benefit).  This is a handy tool for healthcare professionals as an overview of the recommendations,” she said.

“This paper arrived at the same conclusion as previous ones: meal planning with diabetes should be individualized, preferably provided by a registered dietitian. The update adds new research which aids in the continuance of the recommendations that I have been discussing with the patients I see,” Ms. Hess-Fischl said.

Highlights of the Recommendations

The following are a few highlights from the practice guidelines: 

  • People with diabetes should limit or avoid intake of sugar-sweetened beverages (from any caloric sweetener including high fructose corn syrup and sucrose) to reduce risk for weight gain and worsening of cardiovascular risk profile.
  • Like the general population, people with diabetes should reduce sodium to less than 2,300 mg per day, with additional reductions individualized for those who have high blood pressure.
  • Evidence does not support use of omega-3 (EPA/DHA) supplements to prevent or treat cardiovascular disease in people with diabetes. The recommendation for the general public, to eat fatty fish at least 2 times (2 servings) per week is also appropriate for people with diabetes. 
  • There is no clear evidence of benefit from vitamin or mineral supplements for people with diabetes who do not have underlying vitamin or mineral deficiencies.
  • Evidence currently does not support the use of cinnamon or other herbs or supplements for the treatment of diabetes.
  • Evidence remains inconclusive for an ideal amount of carbohydrates or total fat intake.
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