Diabetes Self-Management Blog

If you like to keep up with the latest and greatest in diabetes, you might like to know that last October, new nutrition recommendations for adults with diabetes were issued by the American Diabetes Association (ADA). Medical standards of care are issued every year by ADA, but nutrition guidelines only change every few years or so.

What’s in these recommendations, anyway, and how might they apply to you? First, it’s important to understand that a select committee of nutrition experts spends countless hours combing through the literature, responding to queries, and debating with each other until the guidelines are finished. This is no fly-by-night process. It takes a long time and careful consideration.

Second, these recommendations are what we call “evidence-based.” This means that anecdotal “evidence” (like, “my aunt took cinnamon and cured her diabetes”) is not a part of these recommendations. Much of the content is based on the gold standard: randomized clinical trials. Some is based on what’s called “expert opinion” or “expert consensus.” I write this because undoubtedly, many people will disagree with these recommendations or claim that ADA doesn’t know what it’s talking about. But it’s hard to argue with good science.

What’s new?
There are a few new concepts and changes in these 2013 recommendations. I’m highlighting several of them here.

Eating patterns. These guidelines are the first time that the concept of “eating patterns” has been introduced. This is a term that describes combinations of different food groups to characterize the relationship between nutrition and health. ADA (and dietitians, in general) recognizes that there are many different types of eating patterns and that many of these can certainly be appropriate for people with diabetes. These include:

• The DASH (Dietary Approaches to Stop Hypertension) eating plan
• The Mediterranean-style eating plan
• Vegetarian and vegan diets
• Low-fat diets
• Low-carbohydrate diets

What does this mean for you? I’ve said it before and I’ll say it again: There is no one eating pattern (diet) that is right for everyone with diabetes. Period. If you do well with a lower-carb eating plan, great! But your neighbor may not do or feel the same. Personal preferences (likes and dislikes, culture, religion, economics) and metabolic goals are what should drive one’s eating pattern.

Macronutrients. These are carbohydrate, protein, and fat. What’s new with them?

Carbohydrate: I often hear people (including health-care professionals) deride ADA for promoting high-carb diets. That’s not the case. In fact, for several years now, ADA has stopped recommending a specific percentage of calories from carbohydrate. Surveys indicate that most people with Type 2 diabetes consume about 45% of calories from carbohydrate (and roughly 16% to 18% of calories from protein and 36% to 40% of calories from fat), but there’s no evidence to support that this is the “right” amount of carb for people with diabetes. The reality is that some people do well with a higher-carb intake and some with a lower-carb intake. Once again, it boils down to the individual. Ideally, that individual would meet with a dietitian or other qualified health-care professional and together determine the “right” carbohydrate percentage for him or her.

There’s a considerable amount of space in these recommendations devoted to lower-carb eating plans and some of the research does, indeed, show positive effects of lower-carb eating patterns, particularly in terms of weight loss. However, the authors of the guideline do point out that one of the downsides with low-carb diets is that there isn’t a standard definition of “low carb.” The authors describe “very low” carbohydrate intake as being from 21 grams to 70 grams of carbohydrate per day and “moderate” carbohydrate intake as comprising between 30% and 40% of total calories. But there’s no general consensus about this.

The recommendations also, for the first time, recommend limiting the intake of sugar-sweetened beverages. Monitoring carbohydrate intake, whether by counting carbs or watching portions, is still considered an effective means of controlling blood glucose. And substituting low-glycemic-index carbohydrate for high-glycemic-index carbohydrate may modestly improve glycemic control.

I’ll let you mull this all over for the week, and then next week, I’ll write more about the other macronutrients and what the deal is with sodium. Stay tuned!


  1. Amy, thanks for posting this. I was aware that the ADA has relaxed their nutrition guidelines, but I still think that it is a cop out. And I still have trouble understanding the argument that there is no one diet for diabetics.

    The reality is that carbs raise blood glucose for all diabetics and high blood glucose is bad. End of story! Why continue to recommend something that is bad?

    Sure, I understand that some diabetics do not want to have restrictions on their diet, but to have the ADA say that is OK is malpractice in my opinion. The ADA should be recommending best practices, not what people want.

    Posted by OldTech |
  2. Just a question, what is a Diabetes Educator, and what is a diabetic nutritionist?

    I have been trying to deal with type 2 for 20 years and I have yet to figure out what these people do, and who would pay for their services.

    Posted by Karl B. |
  3. I give up on this whole business - Obamacare and now the diet. Obamacare wants to get rid of us old people, we can’t get the supplies we need or they are going to cost now. My glucometer is unreliable but we are limited to what we can have and I can no longer get the one I had - thanks to Obamacare. Stress is bad for us but the government is doing their best to give us stress.
    Now the diet is changing so who is really important. Surely not us diabetics.

    Posted by Ferne |
  4. OldTech,
    I totally agree with you.

    Posted by Dot |
  5. Thanks OldTech. I don’t represent the ADA, but as I mentioned in my posting, they base their guidelines on scientific evidence. Studies show that many different types of “eating patterns” can be helpful for people with diabetes, which is why they no longer take a stance on what the “ideal” diet should be for people with diabetes. I suppose it may seem like a cop out, but again, based on the literature, there isn’t proof that any one particular eating plan is going to work for everyone with diabetes.

    Posted by acampbell |
  6. Hi Karl B,

    A diabetes educator is a health-care professional (nurse, dietitian, pharmacist, doctor, social worker, exercise physiologist…) who helps people who have diabetes or who are at risk for diabetes achieve behavior change for better outcomes, such as a lower A1C or a reduced risk for complications. Many diabetes educators are certified, and have the credential “CDE” (certified diabetes educator), which means that they have passed a qualifying exam. Some have another credential, BC-ADM, which stands for “board-certified in advanced diabetes management.” Diabetes educators work in hospitals, clinics, doctor’s offices, pharmacies, home health care agencies, and community settings, for example. Health-care plans, including Medicare, generally cover a certain number of diabetes education hours (called diabetes self-management education). Contact your health plan to find out what is covered. A diabetic nutritionist isn’t a formal term, but many registered dietitians (with the credential RD or RDN) are also diabetes educators. If you are interested in meeting with a dietitian for your diabetes, ask if the dietitian has the CDE credential or at least has experience in working with people who have diabetes. Diabetes nutrition education is covered under the benefit of Medical Nutrition Therapy and is covered by most health-care plans, including Medicare.

    Posted by acampbell |
  7. I think there is a lot of confusion about carbohydrates. The old method of separating starch,starchy vegetables,vegetables and the “all you can eat” vegetables ie tomatoes, cucumbers, lettuce etc. made more sense and was easier to manage. We have to be aware of the micronutrients of the carbohydrates we eat. For example I have a friend who count carb in proteins, but consumes mostly starches and starchy vegetables. It is very confusing.

    Posted by Lupie Barton |

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