This ADA position statement for 2006 updates the 2004 recommendations. The organization’s nutrition recommendations are the most influential – and controversial – recommendations that the ADA makes.
My disappointment with the new nutrition recommendations is not because I don’t like them or the people who wrote them. The co-chairs of the writing panel are John P. Bantle, professor of medicine in the division of endocrinology and diabetes at the University of Minnesota, and Judith Wylie-Rosett, professor of epidemiology and population health at the Albert Einstein College of Medicine. Both are top experts in the field, and Dr. Bantle was my main source for “The Fructose Puzzle”.
The reason for my disappointment is that I had hoped that the nutrition recommendations could stir up some debate here. The best way to do that is to write a vicious, negative attack.
This I cannot do. The 2006 nutrition recommendations are comprehensive and, as far as I am able to judge, sound. They are an improvement to the 2004 recommendations.
Judge for yourself. The recommendations are freely available online.
It’s a long document broken down into recommendations not only for people with diabetes but also for preventing diabetes, preventing complications, and for other groups, like pregnant women and older adults. It covers everything from the mix of carbohydrates, protein, and fat to alcohol and to micronutrients like antioxidants, minerals, and herbs.
It recommends even less saturated fat – no more than 7 percent of total calories – than the 2004 recommendation of up to 10 percent. It also recommends that we limit our dietary cholesterol to less than 200 mg per day – less than that in one large egg. This too is a tighter limit than the previous general recommendation of less than 300 mg per day.
Weight loss gets a good share of attention. So to does exercise.
But if there is anything here that will stir people up it is how many carbs that the ADA thinks we should eat. Even before the full recommendations appeared in the September issue of Diabetes Care, one cynical blogger had already begun the attack.
One of the strongest new recommendations is against a very low-carb diet, such as that recommended by Dr. Richard K. Bernstein. His diet allows no more than 42 grams of carbohydrate per day. By comparison, the new position statement says that we really should not restrict our total carbs to less than 130 grams per day. This provides 520 calories.
The ADA’s rationale for this is clear. “Low-carbohydrate diets might seem to be a logical approach to lowering postprandial glucose,” the 2006 recommendations state. “However, foods that contain carbohydrate are important sources of energy, fiber, vitamins, and minerals and are important in dietary palatability. Therefore, these foods are important components of the diet for individuals with diabetes.”
I’m not one to argue with this recommendation. When I went on Byetta, I thought that I was going on a very low-carb diet. But when I carefully calculated my daily carb intake on an Excel spreadsheet for about five weeks, it averaged about 130 grams per day.
Generally, the position statement agrees with the Institute of Medicine’s Dietary Reference Intakes that 45 to 65 percent of our calories should come from carbohydrates. Fat should provide 20 to 35 percent, and protein from 10 to 35 percent.
What I like most about the new nutrition recommendations is the much greater acceptance of the glycemic index than in any previous nutrition recommendations of the American Diabetes Association. It cites, for example Jenny Brand-Miller’s meta-analysis of low glycemic index diets that on average reduce A1C levels by 0.4 percent.
Even better, the recommendations say that “low-glycemic index foods that are rich in fiber and other important nutrients are to be encouraged.” There is some benefit, the recommendations conclude, to consider the glycemic index and glycemic load of foods as well as the total carbohydrate load.
“Foods with low glycemic indexes include oats, barley, bulgur, beans, lentils, legumes, pasta, pumpernickel (coarse rye) bread, apples, oranges, milk, yogurt, and ice cream,” the 2006 recommendations state. “Fiber, fructose, lactose, and fat are dietary constituents that tend to lower glycemic response.”
Since I have recommended low glycemic index diets for years in spite of opposition from the American Diabetes Association, these recommendations are music to my ears. So you won’t find me attacking the ADA’s 2006 nutrition recommendations.
Still, I know that followers of low-carb diets can be persistent and persuasive in their beliefs. So I expect that even if I don’t attack the new recommendations, others are more than willing to take on that task.