The Quality of ADA Dietary Advice

I was asked this question today on the ADA forum.

"Just what is low-fat/high-carb? My dietitian suggested 45-60 carbs per meal. That does seem like a lot sometimes. "

This was my reply on the Type 2 board.

"The USDA and the owners of this web-site (at least, they are again this week:-) have defined it pretty well here: Using the Diabetes Food Pyramid. Notice that fats of all types are right at the top, to be used minimally, and "bread grains and other starches" are at the base to be used in abundance.

That is associated with this other ADA web-page The Diabetes Food Pyramid: Grains & Starches which includes "The message today: Eat more whole grains! Whole grains and starches are good for you because they have very little fat, saturated fat, or cholesterol. They are packed with vitamins, minerals, and fiber. Yes, foods with carbohydrate -- starches, vegetables, fruits, and dairy products -- will raise your blood glucose more quickly than meats and fats, but they are the healthiest foods for you. Your doctor may need to adjust your medications when you eat more carbohydrates. "

I am departing for two months in a few days, so I will depart from my usual reticence on this subject on this forum.

In my lay opinion as a type 2 diabetic I think that the dietary information for type 2 diabetics on those pages, and on several associated pages, is the most dangerous and disgraceful dietary advice for type 2's that it is possible to give. In effect, it says that it's OK to eat food that you know will cause blood glucose spikes as long as you medicate to correct it. In fact, not just that it's OK but that it's healthier for you to do that.

It is made even more dangerous because the source is the most influential major authority in the world. I wrote about that a long time back, and little has changed since.

There has been a change of leadership at the ADA and many of the diabetics I know are hoping for changes in those guidelines."

Well, time will tell. I just hope that the changes occur within my lifetime; they may come too late for many.

Motivation, Likes and Dislikes

On all the various forums I read there is a recurring theme from newly diagnosed people of grief over a lost lifestyle. And not just from newly diagnosed people.

How many times do we read "I hate testing" or "I can't exercise" or "I don't like vegetables" or "I don't eat breakfast" or "I couldn't give up my [insert your favourite treat]" or "I only ever eat one big meal a day" or "I don't like cooking" or "I haven't got time to cook/exercise/whatever" or just "I don't like...".

Motivation is a strange thing. The carrot and the stick. Some of us say we do best on the positive; others find the negative more effective. In reality it's a mix of both. Many of us have found that the improvement in our overall health once we took control of our diabetes was quite dramatic and we promote that as a positive. It is. But let's be honest, how many of us used that as the motivator when we started?

"Hey! I've just been diagnosed with diabetes! Ain't it great! Now I can get fit!" Yeah, right. That wasn't me.

If we're honest, the real motivator for me, and I suspect for most of you, was fear. We each have our own phobias, but diabetes gives us such a wide range of choices that there is something there for all.

Stop here if you don't like nasty reminders.

Consider why you are reading about diabetes. The experienced people on all forums try to mainly be up-beat and supportive, but support can sometimes mean that a jolt of reality is appropriate.

Just a few for starters:
o Death from many possibilities, the most likely being heart attack.
o Blindness, usually from retinopathy.
o Neuropathy, including associated wound healing problems and possible gangrene and salami surgery or amputation.
o Nephropathy, kidney disease, dialysis.

Positive motivation is great. But the reality is that if we don't take control of our own diabetes management the negatives can creep up on us all too quickly. My personal negative motivator is blindness; as a leukemiac death no longer scares me; I think I can live with amputation, and from what I've read dialysis is not an enjoyable long-term lifestyle.

But I love reading, I love seeing the beauty and grandeur of nature, I enjoy watching TV, I love watching my grand-daughter grow and I enjoy writing so blindness scares the shit out of me.

It took me a while to accept that my past lifestyle likes and dislikes were no longer relevant. I had to discover new likes and dislikes, because I am in this for the long haul.

It's amazing what you can learn to like once you realise that your life, and the quality of that life, depends on it.

ACCORD, Foxes and Grapes

Of the stories I learnt as a child, the ones by an ancient writer named Aesop have often proven to be full of wisdom over the years.

Remember this one?

'One hot summer's day a Fox was strolling through an orchard till he came to a bunch of Grapes just ripening on a vine which had been trained over a lofty branch. "Just the thing to quench my thirst," quoth he. Drawing back a few paces, he took a run and a jump, and just missed the bunch. Turning round again with a One, Two, Three, he jumped up, but with no greater success. Again and again he tried after the tempting morsel, but at last had to give it up, and walked away with his nose in the air, saying: "I am sure they are sour."'



Going by the popular press and various responses in medical literature ACCORD appears to indicate to the experts that achieving normal HbA1c levels in long-term diabetics is obviously too hard for modern pharmacology without dangerous side-effects.

So obviously it can't be done. And obviously it isn't important any more.

Normal HbA1c has become a sour goal.

It never occurred to the fox to build a ladder or pile up some rocks.

It never seems to occur to the experts to review the traditional diet and lifestyle guidelines to see whether different ones may assist the HbA1c goal and reduce the medication levels and thus the side effects.

Years ago I also learnt a different lesson about goals. Good goals are set in concrete; plans to achieve them are drawn in sand.

I'll write more on ACCORD and it's interpretation in a few days.

Cheers, Alan

Everything in Moderation - Except Laughter