Diabetes and Nutrition

Nutrition recommendations

Marion Franz (Minneapolis, MN) discussed the process used for the “evidence basing” approach for current American Diabetes Association (ADA) nutrition recommendations (1). “We have made some progress,” she pointed out, comparing the starvation treatment used in 1917 (composed of whiskey mixed with black coffee) with our current approaches. “There are many ways of approaching medical nutrition therapy” for persons with diabetes, she stated, which requires assessment of the individual’s goals and her/his ability to comply with a given recommendation. “The gold standard of research in nutrition has generally been a study in which food is provided to the subjects so that you can know what is being consumed,” she stated, but such studies are necessarily short in duration, and therefore may not be completely applicable to the “real world,” and must be extended by studies implemented in free-living subjects. Also, many questions have not been addressed in persons with diabetes and must be extrapolated from studies in persons with other conditions.

Franz referred to the studies on fiber as examples. Early studies showed a great deal of benefit, but “there are many variables. People lost weight, they changed the percentage of macronutrients, medications were changed, and yet all the benefit was ascribed to fiber.” More recent studies of high-fiber load approaches show only equivocal evidence, with benefit at fiber levels exceeding 50 g daily, far above the level of ∼20 g daily that can be attained in realistic circumstances, that has not been shown to be associated with improvement in lipids, glycemia, or insulin resistance. With newly diagnosed type 2 diabetes, she stated, lifestyle change leads to a fall in HbA_1c of ∼2%, and …