Health for life

The American Diabetes Association (ADA) recently published their new Position Statement on nutrition therapy for people with diabetes:

Nutrition Therapy Recommendations for the Management of Adults With Diabetes, Diabetes Care, Published online ahead of print, 9 October 2013.

This post focuses on fat. Previous posts focused on carbohydrate and protein. The carbohydrate post summarized the grading system that the ADA used to rate their evidence.

Keeping with their recommendations for carbohydrate and protein, the panel did not designate a particular amount of fat to consume. They noted that people with diabetes eat about 36-40% of their calories from fat - an observation, not a recommendation.

For people without diabetes, the Institute of Medicine states that an acceptable amount of fat to consume (acceptable macronutrient distribution range or AMDR) is 20-35%, and that there is "evidence for increased obesity and its complications [e.g. heart disease] at high intakes of fat." Echoing this, the ADA said:

"Individuals with diabetes should be encouraged to moderate their fat intakes to be consistent with their goals to lose or maintain weight."

Here are the ADAs grades for total fat intake:

Evidence is inconclusive for an ideal amount of total fat intake for people with diabetes; theore, goals should be individualized. Grade C

Fat quality appears to be far more important than quantity. Grade B

Regarding fat quality, the ADA recommended substituting saturated fat with monounsaturated and polyunsaturated fat: "PUFAs and MUFAs are recommended substitutes for saturated or trans fat."

In people with type 2 diabetes, a Mediterranean-style, MUFA-rich eating pattern may benefit glycemic control and CVD risk factors and can theore be recommended as an effective alternative to a lower-fat, higher-carbohydrate eating pattern. Grade B

Nuts and olive oil are good sources of monounsaturated fat.

Omega-3 fatty acids are polyunsaturated fatty acids or PUFAs. The panel perred omega-3-rich food over omega-3 supplements:

Evidence does not support recommending omega-3 (EPA and DHA) supplements for people with diabetes for the prevention or treatment of cardiovascular events. Grade A

As recommended for the general public, an increase in foods containing long-chain omega-3 fatty acids (EPA and DHA) (from fatty fish) and omega-3 linolenic acid (ALA) is recommended for individuals with diabetes because of their beneficial effects on lipoproteins, prevention of heart disease, and associations with positive health outcomes in observational studies. Grade B

The recommendation for the general public to eat fish (particularly fatty fish) at least two times (two servings) per week is also appropriate for people with diabetes. Grade B

About saturated fat, they said:

The amount of dietary saturated fat, cholesterol, and trans fat recommended for people with diabetes is the same as that recommended for the general population. Grade C

They note that the general population should be aiming for less than 10% of calories from saturated fatty acids (SFAs) and less than 300 mg cholesterol/day:

"The Dietary Guidelines for Americans, 2010 recommends consuming less than 10% of calories from SFAs to reduce [cardiovascular disease (CVD)] risk. Consumers can meet this guideline by replacing foods high in SFA (i.e., full-fat dairy products, butter, marbled meats and bacon, and tropical oils such as coconut and palm) with items that are rich in MUFA and PUFA (i.e., vegetable and nut oils including canola, corn, safflower, soy, and sunflower; vegetable oil spreads; whole nuts and nut butters, and avocado).

CVD is a common cause of death among people with diabetes. As a result, individuals with diabetes are encouraged to follow nutrition recommendations similar to the general population to manage CVD risk factors. These recommendations include reducing SFAs to less than 10% of calories, aiming for less than 300 mg dietary cholesterol/day, and limiting trans fat as much as possible."

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Recent research from the American Journal of Clinical Nutrition supplies more evidence that a low-fat vegan diet is better than a conventional diabetes diet for managing blood glucose and cholesterol.¹

People with type 2 diabetes were assigned to either a low-fat, vegan diet (49 participants) or a diet adhering to the 2003 American Diabetes Association (ADA) guidelines (50 participants).

After about a year and a half (74 weeks), members in both groups lost weight, but the difference between them wasnt significant: 4.4 kg (9.7 lbs) wt. loss in the vegan group, 3.0 kg (6.6 lbs) weight loss in the ADA group.

However, there was a significant difference between the groups in the following measures:

• Hb A1c:
  -0.40 for the vegan diet
  -0.01 for the ADA diet
  
  
• Total cholesterol (mg/dL):
  -20.4 for the vegan diet
  -6.8 for the ADA diet
  
  
• LDL cholesterol (mg/dL):
  -13.5 for the vegan diet
  -3.4 for the ADA diet

The authors concluded:

"Both diets were associated with sustained reductions in weight and plasma lipid concentrations. In an analysis controlling for medication changes, a low-fat vegan diet appeared to improve glycemia and plasma lipids more than did conventional diabetes diet recommendations."

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¹ A Low-Fat Vegan Diet And A Conventional Diabetes Diet In The Treatment Of Type 2 Diabetes: A Randomized, Controlled, 74-Wk Clinical Trial, AJCN, May 2009

Photo of vegan pyramid: Nutrispeak.com, the home page of Vesanto Melina, MS RD.

The American Diabetes Associations 68th Scientific Sessions are coming up. They begin this Friday, June 6th and run until Tuesday, June 10th. San Francisco hosts the conference this year.

Some background:

"The Scientific Sessions are held in June each year and provide an opportunity for members of the diabetes community from around the world to participate in the largest annual research and clinical meeting on diabetes. Sessions focus on the latest information in the areas of basic and clinical research and on the application of this information to clinical practice. The program includes symposia, oral and poster abstract presentations, interactive workshops, poster discussions, and other small group learning sessions."
- American Diabetes Association

The ADA has a glossy e-newspaper for the conference called Diabetes Dispatch. You can access it at:
68th Scientific Sessions Diabetes Dispatch

Below are the ADAs official bloggers for the Sessions:

Anita Manning, a retired senior medical writer for USA Today, at the American Diabetes NOW blog.


Tesch West, the 2007-2008 ADA National Youth Advocate, at her Tesch West Blog.
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Since we had the honor of an e-visit from the distinguished Dr. Neal Barnard, and in light of our previous post describing the suspension of the intensive blood glucose treatment arm (medication-based) of the large ACCORD trial, I present the findings of one of Dr. Barnards more recent studies - one that finds benefit without the use of drugs.

Barnard, et als study which appeared in the August 2006 issue of Diabetes Care,¹ found that people with diabetes who followed a low-fat, vegan diet saw improvements in HbA1c, body weight, BMI, waist circumference, total cholesterol, and LDL cholesterol that were significantly greater than improvements in a group following an ADA diet (which adhered to American Diabetes Association guidelines).

Participants (n=99) were followed for 22 weeks, at the end of which:

"Among participants whose diabetes medications remained unchanged throughout, A1C fell 1.23 points in the vegan group and 0.38 points in the ADA group (P = 0.01)."

"Body weight decreased 6.5 kg (14.3 lbs) in the vegan group and 3.1 kg (6.8 lbs) in the ADA group (P < 0.001)."

"Among those who did not change lipid-lowering medications, LDL cholesterol fell 21.2% in the vegan group and 10.7% in the ADA group (P = 0.02)."

A vegan diet includes grains, legumes, vegetables, and fruits, and excludes animal products. The vegan diet in this study also excluded added fats.



Click for larger.________
¹ A Low-Fat Vegan Diet Improves Glycemic Control and Cardiovascular Risk Factors in a Randomized Clinical Trial in Individuals With Type 2 Diabetes

Photo of vegan pyramid: Nutrispeak.com, the home page of Vesanto Melina, MS RD.