Diabetes Self-Management Blog

On Friday, December 28, the American Diabetes Association (ADA) issued its 2008 Clinical Practice Recommendations, which are a set of guidelines that help health-care providers treat people with diabetes based on the most current scientific evidence. One key change in this year’s recommendations is the inclusion of low-carbohydrate diets as an option for people with diabetes who are trying to lose weight.

According to the “Medical Nutrition Therapy” section of the new guidelines, “either low-carbohydrate or low-fat calorie-restricted diets may be effective in the short-term (up to 1 year)” for weight loss in people with diabetes. This statement represents a significant reversal from the ADA’s former position on low-carbohydrate diets. For instance, the agency’s 2007 recommendations stated that such diets were not recommended for the treatment of overweight/obesity—even in the short term—because their long-term effects were unknown and they did not seem to provide better maintenance of weight loss than low-fat diets over the long term. But in a press release that accompanied the publication of the 2008 recommendations, the ADA has stated that “there is now evidence that the most important determinant of weight loss is not the composition of the diet, but whether the person can stick with it, and that some individuals are more likely to adhere to a low carbohydrate diet while others may find a low fat calorie-restricted diet easier to follow.”

In the same press release, ADA President of Health Care & Education Ann Albright, Ph.D., R.D., stated that “We’re not endorsing either of these weight-loss plans over any other method of losing weight.” More important, she said, is that people with diabetes choose a weight-loss plan that works for them, and that their health-care team supports their efforts and monitors their health accordingly.

Indeed, the ADA’s new guidelines lay out specific instructions for monitoring the health of people who are on low-carbohydrate diets. Because people following these eating plans may replace calories from carbohydrate with fat or protein, the ADA recommends that health-care providers monitor their lipid profiles (including cholesterol and triglyceride levels). Because extra protein in the diet may make kidney problems worse, the ADA also recommends that people with nephropathy have their kidney function monitored and be counseled about including the correct amount of protein in their diets. Finally, the new recommendations point out that providers may need to adjustment the blood-glucose–lowering drug therapy of people who reduce their carbohydrate intake.

The “low-carb vs. low-fat” diet debate has been raging in the diabetes community for some time. On our own blog, David Spero addressed it in his post “Carbs vs. Fats—Who’s to Blame?”—he argued in favor of low-carbohydrate diets, and many readers shared comments detailing their own experiences with them. Jan Chait, who favors the low-fat approach for her needs, responded with her own post on the subject, “Fitting Diabetes Into Your Lifestyle.” The ADA’s revised recommendations reflect the growing evidence that either approach, combined with regular physical activity, can be an effective choice for those who need to lose weight.

Some other changes present in this year’s Clinical Practice Recommendations include new guidelines on maintaining a diabetes “disaster kit” to be used in case of emergency; revisions and additions to treatment recommendations for older adults with diabetes and children and adolescents with Type 1 diabetes; a new section on Type 1 diabetes and hypothyroidism; and new emphasis on statin drug treatment for lipid level management and ACE inhibitor or ARB drug treatment to treat high blood pressure and nephropathy.

The ADA’s full annual Clinical Practice Recommendations were published in a supplement to the January 2008 issue of the journal Diabetes Care. You can find a summary of the revisions to the Clinical Practice Recommendations here and a summary of the full “Standards of Medical Care in Diabetes—2008″ here.

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Comments
  1. I an 49 and found out in May 2007 I have diabetes and have since been on an “eat what gives you good blood glucose numbers diet.” I test a lot more than was recommended (2 times a day was suggested I test 5-6) My diet has mostly been very little starch, but lots and lots of low glycemic veggies, so I hate to call it low carb… it’s just low starch. I really don’t monitor fats or meat particularly. In 6 months my cholesterol dropped 40 points to 152, my triglycerides are in the normal range for the first time in my life, I have lost 50 pounds (about 100 to go)and have an A1C of 5.6. All those years of low fat diets…yo-yo…yo-yo and then I cut out pretty much all breads, pasta, most sweets and numbers come way down!!! My goal is to have lost 100 lbs by my 50th birthday next October…and get off my bloodpressure and diabetes meds! Perpetual monitoring is not easy…but I want to live healthy to 100!

    Posted by babney |
  2. Three months ago I was diagnosed with borderline diabetes. Happened to pick up an excellent book “Overcoming Runaway Blood Sugar” by Dennis Pollock. Mr. Pollock is a low-carb advocate.
    Using some of his advice and a few weeks of constant glucose testing….I have lost 35 pounds just by giving up bread and sugar.
    I was amazed when I went on the ADA’s web site and saw what they advocated as healthy eating for diabetics. If I had followed their diet plan….I know from my glucose testing…I would be a full-fledged diabetic!!!
    We are all different…but common sense and self-testing will tell you if eating lower carbs is for you.
    Good health to you all.

    Posted by breezinthru52 |
  3. After reading the article on 1/07/08 by Tara Dairman on carb vs fat, I concur 100 plus percent on the carb approach. I was 205 when the diabetes got full blown. My a1c was 10.5 at my initial discovery, after 2 months of intensely watching what I ate (keeping carbs very low) and exercising, I was able to loose 40 lbs and I have been able to maintain the same weight. I also exercise but keep in mind that the carbs were and are the bad guys. The ADA is being to clinical and antiquated in their understanding the eating habits-many of them do not have diabetes so they do not have first hand knowledge or experience in what really raises the blood sugar. Initially, I took reading 6 times a times a day to determine the effect of what I was eating to determine their effects. Maybe I wrong but I will bet a good meal on my statements on carbs-keep the carbs down, down.

    Posted by MRDELREY |
  4. What is A1c? the above articles have mentioned A1c as 5.6 and 10,2 so on. Is it possible to estimate it at home? If yes I woulk like to know the details on the procedure for home testing. Kindly enlighten me. Thanks
    G V Rao

    Posted by gvrao28 |
  5. Hi G V Rao,

    HbA1c, or A1c, is a blood test that gives an indication of your blood glucose control over the previous 2-3 months. To understand more about it, click on the “Diabetes Definition” of HbA1c or check out the article “HBA1C (What It Is and Why It Matters).”

    Posted by Tara Dairman, Web Editor |
  6. I was diagnosed as Type 2 Diabetic in May, 2006. I immediately started watching and counting carbs, fats, and calories and started exercising more than I was. I also cut out sweets, except “no sugar added” items. I also eat fruits for a sweet taste. I lost between 35 and 40 pounds and have kept my weight down. I do think watching carbs and exercising helps the most, though.
    dk

    Posted by dk |
  7. I am a dietitian with diabetes (type 1 diagnosed at age 42) and have never eaten the recommended ADA diet. I was having much trouble with hypoglycemia for 5 years before the diabetes and had to severely restrict my carbs. It made no sense to me to now eat more carbs than I was before the diagnosis. I eat smart carb-low glycemic load carbs only with plenty of vegetables, monounsaturated fats, poultry and fish. My cholesterol, etc…has always been perfect and I keep a good weight.

    I believe eating the way I do allows me to only take Lantus once a day with no mealtime insulin.

    Posted by d_a_hernandez |
  8. My concern about the low-carb diets is that they may be deficient in nutrients proven to improve health and longevity: fiber, minerals, vitamins, various phytonutrients.

    Vegetables, fruits, whole grains, and even judicious amounts of alcohol have been shown to be healthful in a balanced diet, such as the Mediterranean diet. That’s why the ADA does not approve of low-carb diets for usage in excess of one year.

    On the other hand, the traditional Mediterranean diet has been shown to reduce rates of cardiovascular disease, cancer, and dementia, while prolonging life.

    -Steve Parker, M.D.

    Posted by Steve Parker |
  9. Well for the ADA to do this it is like the Communist Chinese embracing Capitalism. When first diagnosed the dietitian for diabetics told me to eat muffins. I told her I never ate that junk before and I will certainly not eat it now. My first try with carb restrited diet resulted promptly in a gout attack. However the idea of limiting the amount of high glycemic index starches at each meal to 20 grams or less cannot be but wisdom.

    Posted by Calgary Diabetic |
  10. I was diagnosed in NOV 2007 and told to follow the ADA lifestyle by my dietitian and my doctors. When I questioned the diet of potatoes and desert, I was told that is was part of a healthy life and that only medications would lower my blood sugar. That did not make any sense to me and three months later on a low carb/high fat diet, I was down 35 pounds and my A1C was normal. I now need to find a new doctor that supports my decision to live a low carb lifestyle!

    Posted by Harrison from Little Rock |
  11. I am so confused as to what my number should be when I check my blood sugar on my meter…I am reading on the internet it should be under 130 fasting….but I thought the doctor told me 100? Mine is almost always between 105-120….. What number is correct?

    Posted by lesliep |
  12. I went in for a thyroid consultation recently and when I told the endocrinologist about some symptoms I had been having for the past several years whenever I have not eating enough “substantial” foods or too many sweets. He immediately told me that I needed to cut out starches and sugars from my diet and exercise 5-6 days a week. He did ask if my family had a history of diabetes (which they do), but he did not say any more than that. Do you think he may be hinting at diabetes with what he told me to do? He has not ordered any tests for diabetes…I kind of think he is focusing on the thyroid at the moment.

    Any info would be greatly appreciated. Thanks!

    Posted by ljindiana |
  13. Logged on today….very informative, i will sign up to receive newsletter.

    Posted by rozelo |
  14. I just started a low carb diet, and testing often: I can see how certain foods cause a spike in my post meal glucose levels, sometimes over 200, and am controlling my levels much better than before (140-160 post meals). I went on a low fat diet (30 gr. per day) and lowered my chol from 230 - 142 in 8 weeks, but no change in my glucose levels. For the first time I’m seeing lower fasting levels.

    Posted by John |
  15. I have been type 1 for almost 20 years and recently discovered the LC WOE. I am aware from reading Bernstein that my body now converts 57% of protein to carbs. So after a while I notice that my insulin requirements increase even while eating very low carb.

    Has anyone else experienced this?

    I am not really losing weight - down one day, up the next.

    Any ideas?

    Posted by Andrew |

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