Discussion:
ADA Dietary Advice Explored [Long]
(too old to reply)
J.C. Hartmann
2006-04-04 07:55:57 UTC
Permalink
I've been critical of the ADA dietary recommendations for some time. In
this NG, we hear lots of statements about diets, from ADA to Atkins to
South Beach, but I've always gone along with the popular preconceptions
here, and never had the intellectual curiosity to actually check the
*details* of what the ADA said.

As a result of the recent threads criticising the ADA, I finally ginned
up the gumption to actually do an analysis of their current guidelines
as they appearrd *TODAY* on
http://www.diabetes.org/nutrition-and-recipes/nutrition/foodpyramid.jsp

If you look at that page, you will see that they break down various
foods into "Food Groups". They give examples of serving sizes and which
groups they consider various foods fall into. Typical pyramid stuff.

I took their recommendations and created a spreadsheet. I got
nutritional information from the USDA website. I broke down the data
into what seemed to me to be useful categories, and did some simple
calculations.

Based on the result, I'm reporting that their recommendations are:

47.5% of kcalories from Carbs
33.0% of kcalories from Protein
14.0% of kcalories from Fats

(don't blame me that it doesn't all add up to 100%)

Since the ADA isn't throwing any grant money my way, for simplicity's
sake I chose the first component listed by them under each category.
None of us eats this way, so there is no statistical integrity here.
There are just too many variables.

I arbitrarily chose a slice of 7-grain/whole grain bread for the Starch
group. I chose cooked broccoli for the veggies and fruit cocktail in
water for the fruit. For the meat group I picked Beef Sirloin Steak, and
1% non-fortified milk for the milk category.

You can certainly get different results by choosing different foods or
attempting to create some algorithm for the mixed foods that people
actually eat. Also, the ADA specifies ranges of servings, and I did try
to accommodate this concept. Interestingly, they say that people eating
the low range in each category will be eating a 1600 kcal diet. My
figures show this to actually be about 938 kcal. Our numbers for the
high range differ, too. The ADA says people who eat the high range diet
will get about 2800 kcal, and my figures show 1586. I refuse to comment
on the potential for disingenuity here. Perhaps I have made a logical error.

For those of you given to an appreciation of pedantry, my results are
below. Sane readers may now click "Next".

I gotta get a hobby.........

Jim

=====================================================================

Fundamental to understanding the following is the concept of values for
a serving, which were derived from the ADA site. For instance, the USDA
site defines a slice of 7-grain bread as weighing 28g. But there are
things other than carbs, protein and fat in a slice of bread, most
notably water. You will see that I broke a serving down into Net carbs,
protein and fat. Then I multiplied those amounts by both the high and
low daily serving recommendation. Next, I figured the the kcals from
each macronutrient, as well as the percentage of total kcals. Add them
all up, and you get the numbers above. I hope the formatting holds up.


Grains and Starches Choose 6-11 servings per day Serving sizes are:
1 slice of bread

Per Serving (USDA)

wt (gr) 26
kcal 65
CHO gm 12.06
Fiber gm 1.7
Net CHO gm 10.36
CHO % 39.8%
PRO gm 2.6
PRO % 10%
FAT gm 0.99
FAT % 3.8%

low high %
Num of Servings/day (ADA) 6 11
Tot gm/day 156 286
Tot kcal/day 390 715
Tot CHO/day (gm) 62.16 113.96
Tot CHO kcal/day 248.64 455.84 63.8%
Tot PRO/day (gm) 15.6 28.6
Tot PRO kcal/day 62.4 114.4 16.0%
Tot FAT/day (gm) 5.94 10.89
Tot FAT kcal/day 53.46 98.01 13.7%


Vegetables Choose at least 3-5 servings per day.
A serving is: ½ cup cooked (broccoli)

Per Serving (USDA)

wt (gr) 78
kcal 22
CHO gm 3.95
Fiber gm 2.6
Net CHO gm 1.35
CHO % 1.7%
PRO gm 2.32
PRO % 3.0%
FAT gm 0.27
FAT % 0.3%

low high %
Num of Servings/day (ADA) 3 5
Tot gm/day 234 390
Tot kcal/day 66 110
Tot CHO/day (gm) 4.05 6.75
Tot CHO kcal/day 16.2 27 24.54%
Tot PRO/day (gm) 6.96 11.6
Tot PRO kcal/day 27.84 46.4 42.18%
Tot FAT/day (gm) 0.81 1.35
Tot FAT kcal/day 7.29 12.15 11.04%


Fruit Choose 2-4 servings per day
A serving is: ½ cup canned fruit (Mixed fruit cocktail in water)

Per Serving (USDA)

wt (gr) 118.5
kcal 38
CHO gm 10.08
Fiber gm 1.2
Net CHO gm 8.88
CHO % 7.5%
PRO gm 0.5
PRO % 0.4%
FAT gm 0.06
FAT % 0.1%

low high %
Num of Servings/day (ADA) 2 4
Tot gm/day 237 474
Tot kcal/day 76 152
Tot CHO/day (gm) 17.76 35.52
Tot CHO kcal/day 71.04 142.08 93.5%
Tot PRO/day (gm) 1 2
Tot PRO kcal/day 4 8 5.3%
Tot FAT/day (gm) 0.12 0.24
Tot FAT kcal/day 1.08 2.16 1.4%

Milk Choose 2-3 servings per day
A serving is: 1 cup non-fat or low-fat milk

Per Serving (USDA)

wt (gr) 246
kcal 101
CHO gm 13.68
Fiber gm 0
Net CHO gm 13.68
CHO % 5.6%
PRO gm 9.74
PRO % 4.0%
FAT gm 0.61
FAT % 0.2%

low high %
Num of Servings/day (ADA) 2 3
Tot gm/day 492 738
Tot kcal/day 202 303
Tot CHO/day (gm) 27.36 41.04
Tot CHO kcal/day 109.44 164.16 54.2%
Tot PRO/day (gm) 19.48 29.22
Tot PRO kcal/day 77.92 116.88 38.6%
Tot FAT/day (gm) 1.22 1.83
Tot FAT kcal/day 10.98 16.47 5.4%


Meat and Meat Substitutes Choose 4-6 oz per day divided between
meals Equal to 1 oz of meat

Per Serving (USDA)

wt (gr) 28
kcal 51
CHO gm 0
Fiber gm 0
Net CHO gm 0
CHO % 0.0%
PRO gm 8.57
PRO % 30.6%
FAT gm 1.62
FAT % 5.8%

low high %
Num of Servings/day (ADA) 4 6
Tot gm/day 112 168
Tot kcal/day 204 306
Tot CHO/day (gm) 0 0
Tot CHO kcal/day 0 0 0.0%
Tot PRO/day (gm) 34.28 51.42
Tot PRO kcal/day 137.12 205.68 67.2%
Tot FAT/day (gm) 6.48 9.72
Tot FAT kcal/day 58.32 87.48 28.6%

TOTALS:

low high %
Tot kcal/day 938 1586
Tot CHO/day (gm) 111.33 197.27
Tot CHO kcal/day 445.32 789.08 47.5%
Tot PRO/day (gm) 77.32 122.84
Tot PRO kcal/day 309.28 491.36 33.0%
Tot FAT/day (gm) 14.57 24.03
Tot FAT kcal/day 131.13 216.27 14.0%

====================================================
Julie Bove
2006-04-04 08:58:17 UTC
Permalink
"J.C. Hartmann" <***@meadecom.com> wrote in message news:***@giganews.com...

<snip>
Post by J.C. Hartmann
You can certainly get different results by choosing different foods or
attempting to create some algorithm for the mixed foods that people
actually eat. Also, the ADA specifies ranges of servings, and I did try
to accommodate this concept. Interestingly, they say that people eating
the low range in each category will be eating a 1600 kcal diet. My
figures show this to actually be about 938 kcal. Our numbers for the
high range differ, too. The ADA says people who eat the high range diet
will get about 2800 kcal, and my figures show 1586. I refuse to comment
on the potential for disingenuity here. Perhaps I have made a logical error.
<snip>

I know what you mean. While I did find the Exchange Plan to work well in
figuring the amount of carbs I could eat, it didn't work out for me
calorie-wise. When I was on a diet that should have been 1800 calories per
day, it was really only about 800-900, depending on what I ate. I was
eating a vegetarian diet at the time and most of the veggies I was eating
were the lower calorie ones. I found that I had to add more fat to the diet
in order to achieve weight loss.
--
See my webpage:
http://mysite.verizon.net/juliebove/index.htm
Temujin
2006-04-04 13:41:59 UTC
Permalink
I've always thought that the ADA recommendations were way too high on
the carbs. They seem to be based on the old "Heart Healthy" diet, on
the theory, I suppose, that diabetics die of heart attacks. But it's
pretty hard to control bg's when you're eating seven pieces of bread
per day, and it's the high bg's that ruin our hearts (among other
things) in the first place. From following posts on this group, it
seems to me that nobody here is eating 47.5% of their diets in carbs.
Doesn't the ADA pay any attention to the latest research?
Peter
2006-04-04 19:07:43 UTC
Permalink
Post by Temujin
I've always thought that the ADA recommendations were way too high on
the carbs. They seem to be based on the old "Heart Healthy" diet, on
the theory, I suppose, that diabetics die of heart attacks. But it's
pretty hard to control bg's when you're eating seven pieces of bread
per day, and it's the high bg's that ruin our hearts (among other
things) in the first place. From following posts on this group, it
seems to me that nobody here is eating 47.5% of their diets in carbs.
Doesn't the ADA pay any attention to the latest research?
Is it that their advice was formulated years ago for type 1s on the
additional assumption that they have excellent control through use of
insulin? It's just never been updated for (a) type 2s who may not get good
control through drugs alone and (b)much less for pre-diabetics who rely
entirely on diet and exercise. I'd bet that lazy old advice is actually
killing people.

Peter
Temujin
2006-04-04 19:35:51 UTC
Permalink
Post by Peter
I'd bet that lazy old advice is actually
killing people.
Peter
It's at least making a lot of people really really thirsty
morris
2006-04-04 20:03:40 UTC
Permalink
Thanks for bringing this up, JIm. I hadn't really looked at this in a
while, either, so I took a quick look. Worth noting that the site says
in several places, including twice on the food pyramid page, that "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," or similar wording to that effect. So the Pyramid is
presented as a rough guideline rather than as an absolute plan for
everyone.

Even so I went through a quicker set of calculations than you did and
came up with a diet very similar in carb content to what the Joslin
Diabetes Cener recommends for obese individuals--that is 40% calories
from carbs based on the following assumptions using the examples they
listed in various categories:

*15 grams of carbs per serving of grains and starches and fruits,
* 5 grams of carbs per veggie serving, and
*12 grams of carbs per dairy serving.
*I assumed that their total calorie range of 1600 to 2800 might be
correct for that pyramid.

They say,

grains and starches----6-11 servings
vegetables--------------- 3-5 servings
fruits-----------------------2-4 servings
milk and dairy------------2-3 servings

for the low range (1600 calories) that works out to

grains and starches 6 servings or 90 g carbs
vegetables 3 servings or 15 g carbs
fruits 2 servings or 30 g carbs
milk and dairy 2 servings or 24 g carbs
Total carbs 159 g carbs, or 636 calories which is 39.75% of 1600
calories

And for the upper range (2800 calories) that works out to:

grains and starches 11 servings or 165 g carbs
vegetables 5 servings or 25 g carbs
fruits 4 servings or 60 g carbs
milk and dairy 3 servings or 36 g carbs
Total carbs 286 g carbs, or 1144 calories which is 40.85% of 2800
calories

That is certainly a lot less than 55% calories from carbs, which is I
guess what they used to recommend a ways back before I was diagnosed.
Even so, their current line is that they do not recommend a specific
diet plan for anyone, that individual factors are paramount , and that
a diet plan should be developed with a dietician. In fact whenever
someone posts on the message board there that they tried the ADA plan,
sometimes followed by a statement that that they then switched to low
carb, the moderator posts and asks where they got the idea that there
was such a thing as an ADA plan. The original poster always comes back
to say well they thought that was the ADA plan because a dietician gave
it to them. When they specify what that plan was, the details vary
quite a bit, and the forum moderator clearly states that the ADA does
not believe that a one-size-fits-all nutrition plan is desirable or
even possible.

Morris
Post by J.C. Hartmann
I've been critical of the ADA dietary recommendations for some time. In
this NG, we hear lots of statements about diets, from ADA to Atkins to
South Beach, but I've always gone along with the popular preconceptions
here, and never had the intellectual curiosity to actually check the
*details* of what the ADA said.
As a result of the recent threads criticising the ADA, I finally ginned
up the gumption to actually do an analysis of their current guidelines
as they appearrd *TODAY* on
http://www.diabetes.org/nutrition-and-recipes/nutrition/foodpyramid.jsp
If you look at that page, you will see that they break down various
foods into "Food Groups". They give examples of serving sizes and which
groups they consider various foods fall into. Typical pyramid stuff.
I took their recommendations and created a spreadsheet. I got
nutritional information from the USDA website. I broke down the data
into what seemed to me to be useful categories, and did some simple
calculations.
47.5% of kcalories from Carbs
33.0% of kcalories from Protein
14.0% of kcalories from Fats
(don't blame me that it doesn't all add up to 100%)
Since the ADA isn't throwing any grant money my way, for simplicity's
sake I chose the first component listed by them under each category.
None of us eats this way, so there is no statistical integrity here.
There are just too many variables.
I arbitrarily chose a slice of 7-grain/whole grain bread for the Starch
group. I chose cooked broccoli for the veggies and fruit cocktail in
water for the fruit. For the meat group I picked Beef Sirloin Steak, and
1% non-fortified milk for the milk category.
You can certainly get different results by choosing different foods or
attempting to create some algorithm for the mixed foods that people
actually eat. Also, the ADA specifies ranges of servings, and I did try
to accommodate this concept. Interestingly, they say that people eating
the low range in each category will be eating a 1600 kcal diet. My
figures show this to actually be about 938 kcal. Our numbers for the
high range differ, too. The ADA says people who eat the high range diet
will get about 2800 kcal, and my figures show 1586. I refuse to comment
on the potential for disingenuity here. Perhaps I have made a logical error.
For those of you given to an appreciation of pedantry, my results are
below. Sane readers may now click "Next".
I gotta get a hobby.........
Jim
=====================================================================
Fundamental to understanding the following is the concept of values for
a serving, which were derived from the ADA site. For instance, the USDA
site defines a slice of 7-grain bread as weighing 28g. But there are
things other than carbs, protein and fat in a slice of bread, most
notably water. You will see that I broke a serving down into Net carbs,
protein and fat. Then I multiplied those amounts by both the high and
low daily serving recommendation. Next, I figured the the kcals from
each macronutrient, as well as the percentage of total kcals. Add them
all up, and you get the numbers above. I hope the formatting holds up.
1 slice of bread
Per Serving (USDA)
wt (gr) 26
kcal 65
CHO gm 12.06
Fiber gm 1.7
Net CHO gm 10.36
CHO % 39.8%
PRO gm 2.6
PRO % 10%
FAT gm 0.99
FAT % 3.8%
low high %
Num of Servings/day (ADA) 6 11
Tot gm/day 156 286
Tot kcal/day 390 715
Tot CHO/day (gm) 62.16 113.96
Tot CHO kcal/day 248.64 455.84 63.8%
Tot PRO/day (gm) 15.6 28.6
Tot PRO kcal/day 62.4 114.4 16.0%
Tot FAT/day (gm) 5.94 10.89
Tot FAT kcal/day 53.46 98.01 13.7%
Vegetables Choose at least 3-5 servings per day.
A serving is: ½ cup cooked (broccoli)
Per Serving (USDA)
wt (gr) 78
kcal 22
CHO gm 3.95
Fiber gm 2.6
Net CHO gm 1.35
CHO % 1.7%
PRO gm 2.32
PRO % 3.0%
FAT gm 0.27
FAT % 0.3%
low high %
Num of Servings/day (ADA) 3 5
Tot gm/day 234 390
Tot kcal/day 66 110
Tot CHO/day (gm) 4.05 6.75
Tot CHO kcal/day 16.2 27 24.54%
Tot PRO/day (gm) 6.96 11.6
Tot PRO kcal/day 27.84 46.4 42.18%
Tot FAT/day (gm) 0.81 1.35
Tot FAT kcal/day 7.29 12.15 11.04%
Fruit Choose 2-4 servings per day
A serving is: ½ cup canned fruit (Mixed fruit cocktail in water)
Per Serving (USDA)
wt (gr) 118.5
kcal 38
CHO gm 10.08
Fiber gm 1.2
Net CHO gm 8.88
CHO % 7.5%
PRO gm 0.5
PRO % 0.4%
FAT gm 0.06
FAT % 0.1%
low high %
Num of Servings/day (ADA) 2 4
Tot gm/day 237 474
Tot kcal/day 76 152
Tot CHO/day (gm) 17.76 35.52
Tot CHO kcal/day 71.04 142.08 93.5%
Tot PRO/day (gm) 1 2
Tot PRO kcal/day 4 8 5.3%
Tot FAT/day (gm) 0.12 0.24
Tot FAT kcal/day 1.08 2.16 1.4%
Milk Choose 2-3 servings per day
A serving is: 1 cup non-fat or low-fat milk
Per Serving (USDA)
wt (gr) 246
kcal 101
CHO gm 13.68
Fiber gm 0
Net CHO gm 13.68
CHO % 5.6%
PRO gm 9.74
PRO % 4.0%
FAT gm 0.61
FAT % 0.2%
low high %
Num of Servings/day (ADA) 2 3
Tot gm/day 492 738
Tot kcal/day 202 303
Tot CHO/day (gm) 27.36 41.04
Tot CHO kcal/day 109.44 164.16 54.2%
Tot PRO/day (gm) 19.48 29.22
Tot PRO kcal/day 77.92 116.88 38.6%
Tot FAT/day (gm) 1.22 1.83
Tot FAT kcal/day 10.98 16.47 5.4%
Meat and Meat Substitutes Choose 4-6 oz per day divided between
meals Equal to 1 oz of meat
Per Serving (USDA)
wt (gr) 28
kcal 51
CHO gm 0
Fiber gm 0
Net CHO gm 0
CHO % 0.0%
PRO gm 8.57
PRO % 30.6%
FAT gm 1.62
FAT % 5.8%
low high %
Num of Servings/day (ADA) 4 6
Tot gm/day 112 168
Tot kcal/day 204 306
Tot CHO/day (gm) 0 0
Tot CHO kcal/day 0 0 0.0%
Tot PRO/day (gm) 34.28 51.42
Tot PRO kcal/day 137.12 205.68 67.2%
Tot FAT/day (gm) 6.48 9.72
Tot FAT kcal/day 58.32 87.48 28.6%
low high %
Tot kcal/day 938 1586
Tot CHO/day (gm) 111.33 197.27
Tot CHO kcal/day 445.32 789.08 47.5%
Tot PRO/day (gm) 77.32 122.84
Tot PRO kcal/day 309.28 491.36 33.0%
Tot FAT/day (gm) 14.57 24.03
Tot FAT kcal/day 131.13 216.27 14.0%
====================================================
morris
2006-04-04 20:12:38 UTC
Permalink
Funny I just figured out something interesting about how these messages
display. I don't know if you have this choice getting these messages
through usenet, but in the Google interface you have the choice between
a fixed font or a proportional font. When I first looked at Jim's
original message that started this thread, all of the clolumns in his
charts looked jumbled--misaligned--until I switched to the fixed font,
and now his columns line up perfectly. My little charts lined up
perfectly before, when I was viewing in proportional fonts, but now
that I switched to fix font, my columns look jumbled..

Perhaps when we present little tables like these, we should say which
style font they were written in and thus are most readable in. Perhaps
in the newsgroups you receive messages in the font in which they were
written, in which case this should not be an issue.
Priscilla H. Ballou
2006-04-04 20:43:26 UTC
Permalink
Post by morris
Funny I just figured out something interesting about how these messages
display. I don't know if you have this choice getting these messages
through usenet,
Usenet is where your newsreader gets the posts from. It's not a way to
view them. One view is that Google is just a parasite off Usenet.
Post by morris
but in the Google interface you have the choice between
a fixed font or a proportional font. When I first looked at Jim's
original message that started this thread, all of the clolumns in his
charts looked jumbled--misaligned--until I switched to the fixed font,
and now his columns line up perfectly. My little charts lined up
perfectly before, when I was viewing in proportional fonts, but now
that I switched to fix font, my columns look jumbled..
Perhaps when we present little tables like these, we should say which
style font they were written in and thus are most readable in. Perhaps
in the newsgroups you receive messages in the font in which they were
written, in which case this should not be an issue.
Priscilla
morris
2006-04-04 21:41:53 UTC
Permalink
Okay then, do your newsreaders display the messages you receive in t he
same font in which they are written? Or is that a funciton of how you
have defaulted your incoming mail from news groups?

My point was that by displaying a message in the font that the message
was written in, or in the case of a "fixed" font by viewing those
messages in any fixed (width) font, we can avoid any problems reading
misaligned columns when people post charts and tables of data.

Morris
Priscilla H. Ballou
2006-04-04 21:43:09 UTC
Permalink
Post by morris
Okay then, do your newsreaders display the messages you receive in t he
same font in which they are written? Or is that a funciton of how you
have defaulted your incoming mail from news groups?
My point was that by displaying a message in the font that the message
was written in, or in the case of a "fixed" font by viewing those
messages in any fixed (width) font, we can avoid any problems reading
misaligned columns when people post charts and tables of data.
Most newsreaders allow one to set what font will be used for composing
or displaying.

Priscilla
Alice Faber
2006-04-04 22:41:27 UTC
Permalink
Post by morris
Okay then, do your newsreaders display the messages you receive in t he
same font in which they are written? Or is that a funciton of how you
have defaulted your incoming mail from news groups?
My point was that by displaying a message in the font that the message
was written in, or in the case of a "fixed" font by viewing those
messages in any fixed (width) font, we can avoid any problems reading
misaligned columns when people post charts and tables of data.
My newsreader lets me choose which font and what size I see posts in. It
doesn't matter what the poster chooses, just what I want to see.
--
AF
Nicky
2006-04-04 21:48:08 UTC
Permalink
Post by morris
In fact whenever
someone posts on the message board there that they tried the ADA plan,
sometimes followed by a statement that that they then switched to low
carb, the moderator posts and asks where they got the idea that there
was such a thing as an ADA plan. The original poster always comes back
to say well they thought that was the ADA plan because a dietician gave
it to them.

++++++++++++++++++++++++++++
Dunno what's happening, but I couldn't get Morris' post to quote - I just
want to say that then the ADA ought to put some serious marketing into
sorting that impression out.

Nicky.
--
A1c 10.5/5.4/<6 T2 DX 05/2004
1g Metformin, 100ug Thyroxine
95/74/72Kg
Susan
2006-04-04 21:58:16 UTC
Permalink
x-no-archive: yes
Post by morris
Post by morris
In fact whenever
someone posts on the message board there that they tried the ADA plan,
sometimes followed by a statement that that they then switched to low
carb, the moderator posts and asks where they got the idea that there
was such a thing as an ADA plan. The original poster always comes back
to say well they thought that was the ADA plan because a dietician gave
it to them.
++++++++++++++++++++++++++++
Dunno what's happening, but I couldn't get Morris' post to quote - I just
want to say that then the ADA ought to put some serious marketing into
sorting that impression out.
Nicky.
It is the ADA guideline from which they formulate the plan. Since they
severely limit protein and fat, what do you *think* their guidelines
call for?

Susan
Alan S
2006-04-04 23:46:47 UTC
Permalink
On Tue, 04 Apr 2006 17:58:16 -0400, Susan
Post by Susan
x-no-archive: yes
Post by morris
Post by morris
In fact whenever
someone posts on the message board there that they tried the ADA plan,
sometimes followed by a statement that that they then switched to low
carb, the moderator posts and asks where they got the idea that there
was such a thing as an ADA plan. The original poster always comes back
to say well they thought that was the ADA plan because a dietician gave
it to them.
++++++++++++++++++++++++++++
Dunno what's happening, but I couldn't get Morris' post to quote - I just
want to say that then the ADA ought to put some serious marketing into
sorting that impression out.
Nicky.
It is the ADA guideline from which they formulate the plan. Since they
severely limit protein and fat, what do you *think* their guidelines
call for?
Susan
See my response to Morris.
No need to guess:

Fat: 25-35%, including <7% saturated and 0% trans-fat.
Protein: ~10%
Carbohydrates: 55-65%, not less than 130gm daily.

Cheers, Alan, T2, Australia.
d&e, metformin 2x500mg
--
Everything in Moderation - Except Laughter.
Alan S
2006-04-04 23:45:12 UTC
Permalink
On 4 Apr 2006 13:03:40 -0700, "morris"
Post by morris
"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/SyllabusClinical.pdf
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 2x500mg
--
Everything in Moderation - Except Laughter.
morris
2006-04-05 03:22:55 UTC
Permalink
Hi Alan,

Thanks for pointing us towards that paper.

Here are a couple of things you did not quote from the same section of
it:

"Recommendations

* People with diabetes should receive individualized MNT [medical
nutritional therapy] as needed to achieve treatment goals, preferably
provided by a registered dietitian familiar with the components of
diabetes MNT.
* Both the amount (grams) of carbohydrate as well as the type of
carbohydrate in a food influence blood glucose level. Monitoring total
grams of carbohydrate, whether by use of exchanges or carbohydrate
counting, remains a key strategy in achieving glycemic control.
* The use of the glycemic index/glycemic load may provide an
additional benefit over that observed when total carbohydrate is
considered alone."

"MNT involves a nutrition assessment to evaluate the patient's food
intake, metabolic status, lifestyle, readiness to make changes, goal
setting, dietary instruction, and evaluation. To facilitate adherence,
the plan should be individualized and take into account individual
cultural, lifestyle, and financial considerations. Monitoring of
glucose and A1C, lipids, blood pressure, and renal status is essential
to evaluate nutrition-related outcomes. If goals are not met , changes
must be made in the overall diabetes care and management plan."

"Regulation of blood glucose to achieve near-normal levels is a primary
goal in the management of diabetes, and thus, dietary techniques that
limit hyperglycemia following a meal are important in limiting the
complications of diabetes. Both the amount (grams) and type of
carbohydrate in a food influence blood glucose level. The total amount
of carbohydrate consumed is a strong predictor of glycemic response,
and thus, monitoring total grams of carbohydrate, whether by use of
exchanges or carbohydrate counting, remains a key strategy in achieving
glycemic control."

And, directly relevant to the question raised in this discussion:

"For those individuals seeking guidance regarding macronutrient
distribution, the DRIs [dietary reference Intake] may be helpful The
DRI report recommends that to meet the body's daily nutritional needs
while minimizing risk for chronic diseases, adults (in general, not
specifically those with diabetes) should consume 45-65% of total
energy from carbohydrate, 20-35% from fat, and 10-35% from protein
(41). Although numerous studies have attempted to identify the optimal
combination of macronutrients for those with diabetes, it is unlikely
that any one such combination of macronutrients exists. The best mix of
carbohydrate, protein, and fat appears to vary depending on individual
circumstances."

If 45-65% of clalories from carbohydrates is the right proportion for
the non-diabetic population, and "monitoring total grams of
carbohydrate, whether by use of exchanges or carbohydrate counting,
remains a key strategy in achieving glycemic control" it is fairly easy
to see how the dieticians who look at this paper might recommend, as my
CDE did 3 years ago, that I consume about 30-33% of my calories from
carbohydrates. She did not put in those terms, but recommended 45
grams of carbs at 3 meals plus 1-2 snacks with 15 grams of carbs in a
total 2000 calorie diet, which works out to those percentages. The
technique of testing after meals to determine how particular foods
affect blood glucose. was stressed for fine tuning whatever
recommendations you were working on. All of which worked very well for
me-I only had to slightly modify the numbers she gave me--mostly for
breakfast. As I posted earlier on this or another thread, this was in
a Diabetes Education Program which the ADA certifies meets standards of
excellence and which it refers people in my area to fromtheir web site.

Just today, a poster on the ADA board who had recently taken classes.
referred to the ADA diet, and explained that by that she meant 30 grams
per meal, with 2 15 gram snacks per day. Even though the ADA does not
say it has a "diet plan" people are coming away for many of the classes
they have approved with the right ideas. I think it is fair to judge
them as much by their current practice as by their theory. It could
well be that the educators are ahead of the website makeover, which is
ahead/behind the theoretical underpinnings and position papers.

Morris
Post by Alan S
On 4 Apr 2006 13:03:40 -0700, "morris"
Post by morris
"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.a
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,
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
http://www.worldwidelearn.com/continuing-education/dietitian-ceu.htm
"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.
"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
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/SyllabusClinical.pdf
Syllabus - Clinical Nutrition NFS 6250; NFS 6260
Mahan L.K., Escott-Stump S.: Krause's Food, Nutrition and
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 2x500mg
--
Everything in Moderation - Except Laughter.
Alan S
2006-04-05 07:24:26 UTC
Permalink
On 4 Apr 2006 20:22:55 -0700, "morris"
Post by morris
Hi Alan,
Thanks for pointing us towards that paper.
Here are a couple of things you did not quote from the same section of
You're right. I didn't quote them - it's a long paper. I
always suggest people read the full paper as you did.

So - which part do you think the dieticians are using as a
base?

Which part do you think is appearing in the training
syllabus?

Don't ask me - ask your dietician.




Cheers, Alan, T2, Australia.
d&e, metformin 2x500mg
--
Everything in Moderation - Except Laughter.
Chris Malcolm
2006-04-05 09:41:39 UTC
Permalink
Post by morris
Hi Alan,
Thanks for pointing us towards that paper.
Here are a couple of things you did not quote from the same section of
"Recommendations
* People with diabetes should receive individualized MNT [medical
nutritional therapy] as needed to achieve treatment goals, preferably
provided by a registered dietitian familiar with the components of
diabetes MNT.
* Both the amount (grams) of carbohydrate as well as the type of
carbohydrate in a food influence blood glucose level. Monitoring total
grams of carbohydrate, whether by use of exchanges or carbohydrate
counting, remains a key strategy in achieving glycemic control.
But you don't have to do that if you use a meter. You simply identify
what's causing the spikes and eat less of it until the spikes go down.
Post by morris
* The use of the glycemic index/glycemic load may provide an
additional benefit over that observed when total carbohydrate is
considered alone."
And you don't have to consider that if you use a meter, because the
meter will guide you more accurately in the right direction than the
tables in any book could do, because they're averages and YMMV.
Post by morris
"Regulation of blood glucose to achieve near-normal levels is a primary
goal in the management of diabetes, and thus, dietary techniques that
limit hyperglycemia following a meal are important in limiting the
complications of diabetes. Both the amount (grams) and type of
carbohydrate in a food influence blood glucose level. The total amount
of carbohydrate consumed is a strong predictor of glycemic response,
and thus, monitoring total grams of carbohydrate, whether by use of
exchanges or carbohydrate counting, remains a key strategy in achieving
glycemic control."
Well, yes, but once again, this whole complicated strategy is
simplified if you simply "eat to your meter". That will inevitably
lead you towards a healthier diet because it will cause you to reduce
the micronutrient-low dense high glycemic index carbs, and shift you
towards more colourful lower carb vegetables, plus more protein and
fats.

They (ADA) suggest the meter is for fine-tuning a diet chosen from
their various complex recommendations which demand a lot of bookwork
and adding up. But what if your meter tells you, as it did me, that
eating the amount of complex starchy carbs they suggest is far too
much for my BG levels? That's not fine tuning.

And why all this complexity of counting up calories? I haven't a clue
how many calories I eat and I don't care. I begin by eating as much as
seems to satisfy me. Then if I find myself putting on weight I eat a
bit less.

I can't understand why this extremely useful tool, the personal blood
glucose meter, is relegated to such a minor position in their diabetic
diet management. It's as though they don't really trust BG meters.
--
Chris Malcolm ***@infirmatics.ed.ac.uk +44 (0)131 651 3445 DoD #205
IPAB, Informatics, JCMB, King's Buildings, Edinburgh, EH9 3JZ, UK
[http://www.dai.ed.ac.uk/homes/cam/]
Kurt
2006-04-05 17:09:34 UTC
Permalink
Post by Chris Malcolm
Post by morris
Hi Alan,
Thanks for pointing us towards that paper.
Here are a couple of things you did not quote from the same section of
"Recommendations
* People with diabetes should receive individualized MNT [medical
nutritional therapy] as needed to achieve treatment goals, preferably
provided by a registered dietitian familiar with the components of
diabetes MNT.
* Both the amount (grams) of carbohydrate as well as the type of
carbohydrate in a food influence blood glucose level. Monitoring total
grams of carbohydrate, whether by use of exchanges or carbohydrate
counting, remains a key strategy in achieving glycemic control.
But you don't have to do that if you use a meter. You simply identify
what's causing the spikes and eat less of it until the spikes go down.
A little too simply in this case. Eating to your meter is a fine
phrase but it doesn't tell the big picture when it comes to one's
overall health. One could eat nothing but cheese every day and their
meter would tell them "you're doing great" but what would that do to
their total health?
Post by Chris Malcolm
I can't understand why this extremely useful tool, the personal blood
glucose meter, is relegated to such a minor position in their diabetic
diet management. It's as though they don't really trust BG meters.
Ssshhh. According to some in here the ADA is only concerned about
their corporate sponsors and so you'd think they'd push those meters!
:)

Best,
Kurt
Roger Zoul
2006-04-05 19:22:09 UTC
Permalink
Kurt wrote:
:: Chris Malcolm wrote:
::: morris <***@comcast.net> wrote:
:::: Hi Alan,
:::
:::: Thanks for pointing us towards that paper.
:::
:::: Here are a couple of things you did not quote from the same
:::: section of it:
:::
:::: "Recommendations
:::
:::: * People with diabetes should receive individualized MNT
:::: [medical nutritional therapy] as needed to achieve treatment
:::: goals, preferably provided by a registered dietitian familiar with
:::: the components of diabetes MNT.
:::: * Both the amount (grams) of carbohydrate as well as the type
:::: of carbohydrate in a food influence blood glucose level.
:::: Monitoring total grams of carbohydrate, whether by use of
:::: exchanges or carbohydrate counting, remains a key strategy in
:::: achieving glycemic control.
:::
::: But you don't have to do that if you use a meter. You simply
::: identify what's causing the spikes and eat less of it until the
::: spikes go down.
::
:: A little too simply in this case. Eating to your meter is a fine
:: phrase but it doesn't tell the big picture when it comes to one's
:: overall health. One could eat nothing but cheese every day and their
:: meter would tell them "you're doing great" but what would that do to
:: their total health?
::

One could add in the low starch veggiess and low sugar fruits and be just
fine healthwise. Eating to your meter will work when one attempts to employ
a reasonable plan that includes most of the truly low carb foods.

In fact, as long as you don't overdo the fruits, you might be able to
minimize the testing, too.

Oh, and it's not 100% clear to be that eating nothing but cheese would ruin
someone's health (espeically if you take a multivitamin.). It would
certainly seem to defy good sense, but it ain't proven.




::: I can't understand why this extremely useful tool, the personal
::: blood glucose meter, is relegated to such a minor position in their
::: diabetic diet management. It's as though they don't really trust BG
::: meters.
::
:: Ssshhh. According to some in here the ADA is only concerned about
:: their corporate sponsors and so you'd think they'd push those meters!
:: :)
::
:: Best,
:: Kurt
Ozgirl
2006-04-05 22:40:45 UTC
Permalink
Post by Kurt
Ssshhh. According to some in here the ADA is only
concerned about
Post by Kurt
their corporate sponsors and so you'd think they'd push
those meters!
Post by Kurt
:)
I think some paid memebers of the ADA know where the butter
from their bread comes from and might be averse to rocking
the boat.
morris
2006-04-06 08:27:20 UTC
Permalink
Just speaking from personal experience, in my class the emphasis when
it came to nutrition was clearly on carbs. I was taught to count grams
of carbs, although I was offered the exchange way also, but not really
taught to count calories. Perhaps that was because I was only five or
ten pounds overweight then. And I was taught to test eafter eating, and
introduced to the concept of eating to the meter, if not that exact
phraseology.

At least my dietician was not scared of the concept. I will concede,
however, based on the posts that I read here in cyberspace, that there
are other dieticians whose recommendations don't seem to make much
sense at all. And yet I have also read posts from many people who got
good professional advice that helped them greatly with their diet.

Morris
Post by Chris Malcolm
Post by morris
Hi Alan,
Thanks for pointing us towards that paper.
Here are a couple of things you did not quote from the same section of
"Recommendations
* People with diabetes should receive individualized MNT [medical
nutritional therapy] as needed to achieve treatment goals, preferably
provided by a registered dietitian familiar with the components of
diabetes MNT.
* Both the amount (grams) of carbohydrate as well as the type of
carbohydrate in a food influence blood glucose level. Monitoring total
grams of carbohydrate, whether by use of exchanges or carbohydrate
counting, remains a key strategy in achieving glycemic control.
But you don't have to do that if you use a meter. You simply identify
what's causing the spikes and eat less of it until the spikes go down.
Post by morris
* The use of the glycemic index/glycemic load may provide an
additional benefit over that observed when total carbohydrate is
considered alone."
And you don't have to consider that if you use a meter, because the
meter will guide you more accurately in the right direction than the
tables in any book could do, because they're averages and YMMV.
Post by morris
"Regulation of blood glucose to achieve near-normal levels is a primary
goal in the management of diabetes, and thus, dietary techniques that
limit hyperglycemia following a meal are important in limiting the
complications of diabetes. Both the amount (grams) and type of
carbohydrate in a food influence blood glucose level. The total amount
of carbohydrate consumed is a strong predictor of glycemic response,
and thus, monitoring total grams of carbohydrate, whether by use of
exchanges or carbohydrate counting, remains a key strategy in achieving
glycemic control."
Well, yes, but once again, this whole complicated strategy is
simplified if you simply "eat to your meter". That will inevitably
lead you towards a healthier diet because it will cause you to reduce
the micronutrient-low dense high glycemic index carbs, and shift you
towards more colourful lower carb vegetables, plus more protein and
fats.
They (ADA) suggest the meter is for fine-tuning a diet chosen from
their various complex recommendations which demand a lot of bookwork
and adding up. But what if your meter tells you, as it did me, that
eating the amount of complex starchy carbs they suggest is far too
much for my BG levels? That's not fine tuning.
And why all this complexity of counting up calories? I haven't a clue
how many calories I eat and I don't care. I begin by eating as much as
seems to satisfy me. Then if I find myself putting on weight I eat a
bit less.
I can't understand why this extremely useful tool, the personal blood
glucose meter, is relegated to such a minor position in their diabetic
diet management. It's as though they don't really trust BG meters.
--
IPAB, Informatics, JCMB, King's Buildings, Edinburgh, EH9 3JZ, UK
[http://www.dai.ed.ac.uk/homes/cam/]
Susan
2006-04-06 12:54:31 UTC
Permalink
x-no-archive: yes
Post by morris
At least my dietician was not scared of the concept. I will concede,
however, based on the posts that I read here in cyberspace, that there
are other dieticians whose recommendations don't seem to make much
sense at all. And yet I have also read posts from many people who got
good professional advice that helped them greatly with their diet.
That's the problem; it shouldn't be such a crapshoot as to whether one
gets good advice or life threatening advice.

Susan
W. Baker
2006-04-06 17:32:56 UTC
Permalink
morris <***@comcast.net> wrote:
: Just speaking from personal experience, in my class the emphasis when
: it came to nutrition was clearly on carbs. I was taught to count grams
: of carbs, although I was offered the exchange way also, but not really
: taught to count calories. Perhaps that was because I was only five or
: ten pounds overweight then. And I was taught to test eafter eating, and
: introduced to the concept of eating to the meter, if not that exact
: phraseology.

: At least my dietician was not scared of the concept. I will concede,
: however, based on the posts that I read here in cyberspace, that there
: are other dieticians whose recommendations don't seem to make much
: sense at all. And yet I have also read posts from many people who got
: good professional advice that helped them greatly with their diet.

: Morris

First of all, a lot depends on the state of your knowledge when yu first
see a dietician. If you have no idea of what you should call a portion or
serving and you don't know much about foods and have been eating, shall we
say, unisely, you will be greatly improved in your understanding by seeing
a dietician. When I want to the dietician, she go me counting carba, but
also learning what is considered a portion size for protein (th eold palm
of the hand, or deck of cards). She gave me carb amounts per meal-26 for
breakfast, 30-45 for lunch and dinner adn one or two 15 gram snacks.
later, when we were talking, she did reveal that she was thinking in terms
of a 1200 calorie diet for me, as I had weight to loose, but just counting
calories doesn't work well particularly for diabetics. I ultimately had
to cut my carb below her recommendations to achieve and maintain good
control, but I did learn a number of things from her.

Wendy
Billie
2006-04-08 13:42:46 UTC
Permalink
Morris, I did not see a dietician until in preparation for the pump.

At that time I was already counting carbs for MDI.

Starches were severely limited, and portion was highly stressed.

She said that she did not include calories because if I did everything else (what I'd already
been doing from what I learned here), then she could guarantee I would lose weight, which I did
in the short time before injury and surgical procedures.

She reminded me of Loretta as far as portion control, plus she taught to *eye* foods to an
approximate 15 grams (we altered it to fit my ratio of 1:10 instead of the 1:15) for whenever I
would be eating out. Not precise, but much better than pure guessing.

Jim has been retired for two months now, and he has lost about eight or nine pounds eating what
he prepares for me, cooking *much* smaller amounts to cut down on temptation for seconds. He
measures mine, brings it to me, and that is it! We eat a lot of *green* vegetables that I can
fill up on if desired, but it is very rare for me to want more than what he brings to me.

So, yes, there are some good dieticians out there, and I happened to get one of them! Just had
to toot her horn!!!! LOL

Billie
--
bh-wages at swbell.net

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

"morris" <***@comcast.net> wrote in message news:***@i39g2000cwa.googlegroups.com...
: Just speaking from personal experience, in my class the emphasis when
: it came to nutrition was clearly on carbs. I was taught to count grams
: of carbs, although I was offered the exchange way also, but not really
: taught to count calories. : Morris
:
Jefferson
2006-04-06 01:30:01 UTC
Permalink
Post by Alan S
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,
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
http://www.worldwidelearn.com/continuing-education/dietitian-ceu.htm
"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.
"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
Fat: 25-35%, including <7% saturated and 0% trans-fat.
Protein: ~10%
Carbohydrates: 55-65%, not less than 130gm daily.
The main concern for protein consumption relates to nephropathy. The
ADA conservative position is based on diabetics with existing kidney
(renal) problems. As long as kidney function is in a normal range by
measures such as microalbumuria there is no reason to constrict protein
level to 10% of diet. Section VI. B. (Nephropathy screening and
treatment of the article) is more specific about the kidney issue. "To
reduce the risk of nephropathy, protein intake should be limited to the
RDA (0.8 g/kg) in those with any degree of (chronic kidney disease)CKD.
(B level evidence/opinion) On the other hand, the poor blood glucose,
blood pressure, and lipid control in most diabetics makes the ADA
recommendation reasonable. Only 7.3% of diabetics have good control of
all of these variables. (See table 6) "XI. STRATEGIES FOR IMPROVING
DIABETES CARE - The implementation of the standards of care for diabetes
has been suboptimal in most clinical settings. A recent report (24)
indicated that only 37% of adults with diagnosed diabetes achieved an
A1C of <7%, only 36% had a blood pressure <130/80 mmHg, and just 48% had
a cholesterol <200 mg/dl. Most distressing was that only 7.3% of
diabetes subjects achieved all three treatment goals." Just like some
ADA recommends A1c goals of less than 6% on an individual basis, similar
recommendations should be made for diabetics with normal kidney function.

Therefore the ADA protein in diet recommendations do not need to be
generalized to all diabetics. The typical 70 KG person at .8 grams per
day amounts to 56 grams. Ten percent of calories from protein from the
diabetes pyramid would amount to a range 160-280 calories or 40-70
grams. The more normal level of protein intake in the general population
is closer to 20% or twice the level per KG or 80-140 grams. If this
hypothetical 70 KG person's intake of protein was 140 grams the
corresponding calories on a 2000 calorie diet would be 28% of the total.
"The Diabetes Pyramid gives a range of servings. If you follow the
minimum number of servings in each group, you would eat about 1600
calories and if you eat at the upper end of the range, it would be about
2800 calories."
http://www.diabetes.org/nutrition-and-recipes/nutrition/foodpyramid.jsp

Gannon and Nuttall are not the only researchers to investigate protein
metabolism in type 2 diabetics.

"CONCLUSIONS—Both dietary patterns resulted in improvements in the
cardiovascular disease (CVD) risk profile as a consequence of weight
loss. However, the greater reductions in total and abdominal fat mass in
women and greater LDL cholesterol reduction observed in both sexes on
the HP diet suggest that it is a valid diet choice for reducing CVD risk
in type 2 diabetes. ... A total of 66 subjects with type 2 diabetes and
no proteinuria were recruited ..."

Effect of a High-Protein, High–Monounsaturated Fat Weight Loss Diet on
Glycemic Control and Lipid Levels in Type 2 Diabetes -
http://care.diabetesjournals.org/cgi/content/full/25/3/425

Other studies by the Australian group as well as others that have cited
their articles. Parker+Noakes+Luscombe+Clifton - 88 finds -
http://tinyurl.com/ozqfp

There is some concern about high protein diets and bone loss, especially
in women. See my posts in a thread that relates vitamin K and diabetics
- http://tinyurl.com/jtdql.

Frank Roy
GysdeJongh
2006-04-04 20:10:35 UTC
Permalink
"J.C. Hartmann" <***@meadecom.com> wrote in message news:***@giganews.com...

<snipped , a very good analysis of the ADA diet>

Hi J.C. Hartmann ,
thank you very much for posting this.
I planned to do the same , but never had enough courage to do it :)

Gys
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