ADA Calls for New Dietary Guidelines for Diabetes, Simple and Realistic

In 1917, drinking whiskey and coffee was recommended to starve diabetes. The whiskey's purpose, of course, was to keep the patient comfortable.

Since then, dietary guidelines for diabetes have undergone many changes to incorporate new knowledge and to accommodate shifts in culture and lifestyle. Prior to 1994, the American Diabetes Association (ADA) attempted to come up with a diet prescription - the ideal diet for keeping diabetes under control. Realizing that this diet didn't work for most folks, in 1994, the ADA shifted emphasis to setting practical nutritional treatment goals with carbohydrate and fat restriction based on food assessments.

ADA dietary guidelines are changing again, announced Marion J. Franz, MS, RD, of the International Diabetes Center in Minneapolis, at the ADA's 60th Annual Scientific Sessions in San Antonio. This time, guidelines are changing to evidence-based recommendations backed by scientifically sound studies. A Task Force on Management of Diabetes has been established to review current recommendations against the scientific literature and to remove or add recommendations based on supporting scientific evidence.

To be released later this year, ADA Dietary Recommendations 2000 will include specific recommendations for type 1, type 2, and gestational diabetes as well as for preventing or delaying the onset of diabetes in people considered at high risk. The new recommendations will be used to develop consumer-friendly information that equates food values to daily requirements or limitations, enables people to customize their nutritional requirements based on individual lifestyle and helps them evaluate popular diets in relation to their disease and dietary needs and restrictions.

"Recommendations must be realistic," said Frantz. "If we tell people to add back 50 grams of fiber, we need to tell them what that means -- how much oatmeal that is -- but not expect them to eat unrealistically large portions everyday to comply." Elizabeth Mayer-Davis, PhD, MS, RD, of the University of South Carolina, suggested that the amount of fat intake should vary according to activity level. "People who are physically active can stand more fat. It's about how the body uses food for energy -- your overall energy metabolism."

Jackie Boucher, MS, RD, CDE, who is developing patient information for ADA on trendy diets, contended that consumers are frustrated. About 67 million Americans overeat and are looking for immediate gratification. "They want easy answers, not to have to think too hard about it," she said. Boucher pointed out that the six most popular diets today are low in carbohydrates and high in protein. Noting that a high-protein diet has been associated with kidney problems, she emphasized that researchers have not looked at the long-term consequences of this diet in people with diabetes. Dr. Mayer-Davis also pointed out that a low-carbohydrate, high-protein diet is also high in fat. "Seventy-five percent of people with diabetes die of heart disease," she said. "The last thing we want is people with diabetes eating a high-fat diet."

"All diets encourage a diet mentality: 'If you do this, you'll lose weight'," continued Boucher, adding that fad diets usually aren't successful because people have trouble sticking with them. Successful weight loss, she stressed, involves eating less fat, increasing physical activity, eating smaller portions, monitoring progress and practicing stress management techniques. Mayer-Davis added: "People on fad diets can psychologically become binge eaters. Something happens to appetite, and they no longer know when it's appropriate to eat, when to start eating and when to stop eating. They're constantly preoccupied with food."

Although a complete list of new recommendations is not yet available, Jean-Louis Chiasson, MD, a task force member from the University of Montreal, noted that new recommendations will incorporate the Federal Drug Administration's new classification of carbohydrates, which attempts to simplify carbohydrate terminology and eliminate the Glycemic Index because it's too complex for diabetes patients to understand and use.