ADA Releases First Food Guidelines Tailored to Medical Categories

28/08/06 Whether you're trying to prevent diabetes, better manage your disease or slow complications from developing, the American Diabetes Association (ADA) has developed specific guidelines to help you choose the right meal plan to get you to your goals.

Published in the September issue of Diabetes Care, the ADA's revised medical nutrition therapy recommendations update statements published in 2002 and 2004 using the most recent scientific data available. For the first time, the guidelines categorize medical nutrition advice according to a person's medical condition, breaking out recommendations for people at high risk for diabetes; managing existing diabetes; and trying to prevent or slow the rate of development of diabetes complications. Specific recommendations are also included for people with type 1 diabetes, pregnant or nursing mothers with diabetes, older adults, and those living in long-term care facilities or managing acute illnesses such as kidney disease.

"When you're talking about diabetes, there is no 'one size fits all' diet," said Ann Albright, PhD, RD, President-Elect, Health Care & Education, American Diabetes Association. "For people with diabetes and those at risk for type 2 diabetes, medical nutrition therapy should be tailored to a person's specific health issues and personal preferences to help maintain optimum health by controlling blood glucose levels, blood pressure, cholesterol, and other risk factors. We hope these recommendations will help people make better choices about what they eat and how they live to maximize their chances of staying healthy."

The recommendations emphasize the importance of sustained, moderate weight loss for people who are overweight or obese and increased physical activity for all people at risk for or living with diabetes. They also pointedly ask people with diabetes to avoid fad diets, such as those that promote extreme low-carbohydrate or high-protein intake.

"There is no evidence that these diets are successful at helping people keep weight off once they lose it, and there are ample concerns about the fiber, vitamins, and minerals people give up when they severely restrict their diet, say by sharply limiting carbohydrate intake," said Dr. Albright. "Fad diets come and go. We want people to be provided with sound nutrition advice that will help them in making choices for maintaining good health for the long term."

For people who are at risk for diabetes, the guidelines call for a diet high in fiber and nutrient-rich foods (14 grams of fiber for every 1,000 calories), with whole grains making up half of all grain intake. In emphasizing the importance of weight loss, they note that medications may be useful for some individuals if combined with lifestyle changes, and that for the very obese, weight loss surgery has shown considerable health benefits. They also caution people who use meal replacements to lose weight that research finds the weight loss is only maintained as long as people stay on the meal replacement plan. Exercise is recommended independent of weight loss because studies show it helps lower blood glucose levels, increases insulin sensitivity, and improves cardiovascular risk factors regardless of whether the person loses any weight.

For people who already have diabetes, the nutrition guidelines are more specific. They include carbohydrates from fruits, vegetables, whole grains, legumes and low-fat milk; eating fiber-rich foods; keeping saturated fats to less than 7 percent of total caloric intake; eating at least two servings of non-fried fish per week; limiting trans fats; and restricting cholesterol intake to less than 200 mg/day.

The recommendations note that there is no evidence that type 1 diabetes can be prevented through medical nutrition therapy. They also caution that, while there is not yet sufficient evidence to include guidelines for children at risk for or living with type 2 diabetes, it is reasonable to assume the same general advice given to adults would benefit children. Studies looking specifically at how medical nutrition therapy affects children are currently underway.

Diabetes Care, published by the American Diabetes Association, is the leading peer-reviewed journal of clinical research into the nation's fifth leading cause of death by disease. Diabetes also is a leading cause of heart disease and stroke, as well as the leading cause of adult blindness, kidney failure, and non-traumatic amputations.