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Diabetes Developments - A blog on latest developments in diabetes by David Mendosa

New Nutrition Recommendations

September 3rd, 2006 · 4 Comments

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The American Diabetes Association’s nutrition recommendations just came out, and I am disappointed.

This ADA position statement for 2006 updates the 2004 recommendations. The organization’s nutrition recommendations are the most influential – and controversial – recommendations that the ADA makes.

My disappointment with the new nutrition recommendations is not because I don’t like them or the people who wrote them. The co-chairs of the writing panel are John P. Bantle, professor of medicine in the division of endocrinology and diabetes at the University of Minnesota, and Judith Wylie-Rosett, professor of epidemiology and population health at the Albert Einstein College of Medicine. Both are top experts in the field, and Dr. Bantle was my main source for “The Fructose Puzzle”.

The reason for my disappointment is that I had hoped that the nutrition recommendations could stir up some debate here. The best way to do that is to write a vicious, negative attack.

This I cannot do. The 2006 nutrition recommendations are comprehensive and, as far as I am able to judge, sound. They are an improvement to the 2004 recommendations.

Judge for yourself. The recommendations are freely available online.

It’s a long document broken down into recommendations not only for people with diabetes but also for preventing diabetes, preventing complications, and for other groups, like pregnant women and older adults. It covers everything from the mix of carbohydrates, protein, and fat to alcohol and to micronutrients like antioxidants, minerals, and herbs.

It recommends even less saturated fat – no more than 7 percent of total calories – than the 2004 recommendation of up to 10 percent. It also recommends that we limit our dietary cholesterol to less than 200 mg per day – less than that in one large egg. This too is a tighter limit than the previous general recommendation of less than 300 mg per day.

Weight loss gets a good share of attention. So to does exercise.

But if there is anything here that will stir people up it is how many carbs that the ADA thinks we should eat. Even before the full recommendations appeared in the September issue of Diabetes Care, one cynical blogger had already begun the attack.

One of the strongest new recommendations is against a very low-carb diet, such as that recommended by Dr. Richard K. Bernstein. His diet allows no more than 42 grams of carbohydrate per day. By comparison, the new position statement says that we really should not restrict our total carbs to less than 130 grams per day. This provides 520 calories.

The ADA’s rationale for this is clear. “Low-carbohydrate diets might seem to be a logical approach to lowering postprandial glucose,” the 2006 recommendations state. “However, foods that contain carbohydrate are important sources of energy, fiber, vitamins, and minerals and are important in dietary palatability. Therefore, these foods are important components of the diet for individuals with diabetes.”

I’m not one to argue with this recommendation. When I went on Byetta, I thought that I was going on a very low-carb diet. But when I carefully calculated my daily carb intake on an Excel spreadsheet for about five weeks, it averaged about 130 grams per day.

Generally, the position statement agrees with the Institute of Medicine’s Dietary Reference Intakes that 45 to 65 percent of our calories should come from carbohydrates. Fat should provide 20 to 35 percent, and protein from 10 to 35 percent.

What I like most about the new nutrition recommendations is the much greater acceptance of the glycemic index than in any previous nutrition recommendations of the American Diabetes Association. It cites, for example Jenny Brand-Miller’s meta-analysis of low glycemic index diets that on average reduce A1C levels by 0.4 percent.

Even better, the recommendations say that “low-glycemic index foods that are rich in fiber and other important nutrients are to be encouraged.” There is some benefit, the recommendations conclude, to consider the glycemic index and glycemic load of foods as well as the total carbohydrate load.

“Foods with low glycemic indexes include oats, barley, bulgur, beans, lentils, legumes, pasta, pumpernickel (coarse rye) bread, apples, oranges, milk, yogurt, and ice cream,” the 2006 recommendations state. “Fiber, fructose, lactose, and fat are dietary constituents that tend to lower glycemic response.”

Since I have recommended low glycemic index diets for years in spite of opposition from the American Diabetes Association, these recommendations are music to my ears. So you won’t find me attacking the ADA’s 2006 nutrition recommendations.

Still, I know that followers of low-carb diets can be persistent and persuasive in their beliefs. So I expect that even if I don’t attack the new recommendations, others are more than willing to take on that task.

This is a mirror of one of my articles that was originally published on Health Central.

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4 responses so far ↓

  • 1 DJ Rainer // Jul 8, 2009 at 9:43 am

    Have you noticed a glycemic “spike” after eating beans? Dr. Bernstein lists beans on his “no-no” list, presumably based on empiric evidence.

  • 2 David Mendosa // Jul 9, 2009 at 8:31 am

    Dear DJ,

    Beans are in general rather low glycemic and as such they don’t spike our blood glucose level very much. That’s why I ate a lot of beans when I was on a low-glycemic diet.

    But they certainly have a lot of carbs! That’s why Dr. Bernstein and I avoid them now.

    Best regards,

    David

  • 3 elizabeth // May 31, 2013 at 1:25 am

    Hi Again !
    Its seems ridiculous not to recommend a lower carbohydrate diet.
    There is no clinical evidence that whole grains and legumes protect against anything,

    In human trials, increased wheat fiber intake has failed miserably to protect against colon cancer or adenomatous polyp formation[5].

    As a disease prevention strategy, the consumption of whole-grains fails miserably. Yeah, I know, you can cite a million-and-one epidemiological studies showing that whole-grains are associated with lower rates of every known ailment under the sun. However, a fundamental rule of science (that many PhDs evidently forget the minute they graduate) is that association is not the same as causation.

    Due to their uncontrolled nature, epidemiological studies are hopelessly prone to confounding from a vast array of variables.

    Controlled clinical trials, a far more reliable form of evidence, routinely show whole-grains to do a whole lot of nothing when it comes to disease prevention and amelioration.

    Legumes and grains have well documented anti-nutrient content. e.g effects of phytate, lectins, enzyme inhibitors, and the vitamin-blocking glucosides that exist in these foodstuffs.

    The high phytate content of whole grains binds to minerals such as iron, calcium, magnesium, and zinc in the gastrointestinal tract, significantly reducing their absorption by the body[6-8]. While they increase the dietary content of zinc, iron, magnesium and calcium when compared to refined grains, they also promptly increase the excretion of these minerals from the body. The end result is that overall mineral status improves only marginally, remains unchanged, or even worsens[7-12].

    If you want to increase your mineral intake, whole grains are a pretty poor way to do it. Far better choices would be fresh non-cereal, non-leguminous plant foods, mineral-rich waters (look for a high magnesium:calcium ratio), ionic mineral solutions , and highly bioavailable mineral supplements such as those complexed to citrate, picolinate, etc.

    The pitfalls of cereal grains don’t end with phytate. Thanks to pyridoxine glucoside, B6 from cereal grain products is absorbed with far less efficiency than that from animal foods[13].

    Researchers who fed young men different foods containing pyridoxine glucoside found that as dietary glucoside levels increased, the vitamin B6 status of the subjects decreased[13].

    Again, increased wheat fiber consumption merely worsens the situation; B6 from whole wheat bread is five to ten percent less available than that from white bread, and the addition of wheat bran to the diets of young men reduced the availability of B6 by seventeen percent[15,16].

    Cereal grains not only contain no detectable vitamin D, but also actively encourage deficiency of this important vitamin by impairing its absorption. It has long been recognized that high cereal grain consumption induces vitamin D deficiency in various animal species, including primates, our closest animal relatives[17,18]. By studying the fate of radio-labelled vitamin D, researchers observed significantly increased excretion of vitamin D in healthy human volunteers fed sixty grams of wheat fiber daily[19].

    Vitamin D deficiency is common, especially during the winter months. Professor Michael Hollick and his colleagues from the Boston University School of Medicine observed that a third of healthy Boston adults aged 18-29 were vitamin D deficient by the end of winter. The risk of deficiency rises in the elderly and among dark-skinned individuals; forty-two percent of African American women and eighty-four percent of black elderly folks throughout the U.S. were vitamin D deficient by the end of winter[20].

    Poor vitamin D status has been linked to increased risk of breast, prostate and colon cancers, osteoporosis and other bone disorders, Type 1 diabetes, arthritis, infertility, PMS, chronic fatigue and depression, Seasonal Affective Disorder, multiple sclerosis, musculoskeletal pain, and heart disease[20-34].

    The effect of cereal fiber on vitamin D absorption may help explain why purified phytate fights cancer in rodents while an equivalent amount delivered via cereal fiber has little to no effect.

    The numerous nutritional shortcomings of whole-grains may also help explain why the only randomized clinical trial to have ever examined the hypothesis that wheat fiber reduces CHD actually found a small increase in coronary and overall mortality[35].

    Lowered antioxidant defenses may have been a possible contributor: when type 2 diabetics consumed a low-wheat fiber diet and a high-wheat fiber diet containing bran-rich bread and breakfast cereal for three months each, LDL cholesterol oxidation was increased during the high-wheat fiber phase[36]. You can wax prosaic about manganese and copper all you like, but none of it even begins to change the fact that under tightly controlled conditions whole cereal grains show no positive effect; in fact, when they do exert a detectable effect it is typically negative.

    Given all the available evidence, I cannot consider the pro-whole grain hype as anything other than yet another bad joke promulgated by our clueless, corrupt, and industry lobby-influenced health authorities. It’s truly sad that university-educated PhDs like yourself are so easily taken in by such rubbish.

    http://www.direct-ms.org/pdf/EvolutionPaleolithic/Cereal%20Sword.pdf

  • 4 David Mendosa // May 31, 2013 at 6:25 am

    Thank you, Elizabeth. I certainly agree with you.

    Namaste,

    David

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