Sep 08, 2006

The ADA Issues New Nutrition Guidelines

Katharine Davis

The American Diabetes Association (ADA) recently published new guidelines on medical nutrition therapy, or the use of diet to prevent or treat diabetes and diabetes complications. Published in the September 2006 issue of the journal Diabetes Care, the new guidelines are an updated version of guidelines from 2002 and 2004.

The new guidelines differ from the old in that they make specific recommendations for different groups of people, including people with prediabetes, women with diabetes who are pregnant or breast-feeding, older adults with diabetes, and people with complications of diabetes.

Some of the recommendations apply to everyone who has diabetes or is at risk of developing it. The ADA recommends that people with diabetes or prediabetes get individualized nutrition counseling from a registered dietitian. The guidelines also recommend regular physical activity to improve blood glucose control and help with weight loss or weight maintenance.

The recommendations include the following:

For people with diabetes or prediabetes who are overweight or obese

• Reduce calorie and fat intake with the goal of slow, steady weight loss.
• Don't follow a high-protein, low-carbohydrate, or other "fad" diet.
• For people who have trouble losing weight with diet and exercise alone, weight loss medications may help, and for very obese people, bariatric surgery may help.

For people with prediabetes

• Aim for moderate weight loss and regular physical activity.
• Aim for a fiber intake of 14 g or more for every 1,000 calories you eat. At least half of the grains you eat should be whole grains.

For people with Type 2 diabetes

• Follow an eating pattern that incorporates a variety of carbohydrate foods, including fruits, vegetables, whole grains, legumes, and low-fat milk. Eat a variety of foods that contain fiber.
• Don't follow a low-carbohydrate, high-protein, or other "fad" diet.
• Use carbohydrate counting, exchange lists, or another method to keep track of carbohydrate intake.
• To prevent cardiovascular disease, limit saturated fat intake to less than 7% of total calories, and limit cholesterol intake to less than 200 mg a day. Cut down on trans fat as much as possible.
• Women should limit alcohol consumption to one drink a day, while men should limit it to two drinks a day. If you drink alcohol, drink it with food.

For people with Type 1 diabetes

• Work with your health-care team to develop an insulin regimen that's coordinated with your eating and physical activity plan. If you're on fixed daily insulin doses, keep your carbohydrate intake consistent from day to day.
• Adjust mealtime insulin based on the amount of carbohydrate in the meal.
• Adjust insulin for planned exercise. For unplanned exercise, you may need to consume extra carbohydrate.

The following are some of the recommendations for specific groups of people with diabetes:

• Pregnant women should follow a meal plan that allows for appropriate weight gain. They should not lose weight, though a doctor or dietitian may recommend that some overweight or obese women restrict calories or carbohydrate intake to some degree.
• Older adults may benefit from a multivitamin supplement.
• People with kidney disease may need to reduce protein intake.
• People who need to lower their blood pressure should aim for less than 2300 mg of sodium a day and eat a diet high in fruits, vegetables, and low-fat dairy products.

For more information on the recommendations, talk to your doctor or dietitian. If you've never been to a dietitian before, ask your doctor for a referral. The dietitian will work with you to design a meal plan that takes into account your food preferences, blood glucose targets, and any other medical conditions you may have.

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