What You Should Know about ADA’s New Nutrition Report
The American Diabetes Association (ADA) recently published an updated nutrition consensus report in the May issue of Diabetes Care. The report includes recommendations for managing and preventing diabetes, prediabetes, and complications from diabetes such as heart disease, kidney disease, and gastroparesis. This is an update to the 2014 nutrition position statement. Let’s dive into some of the highlights from this report.
What to Eat
It’s time to ditch the term “diabetes diet”. There is not one diet that works for everyone with diabetes. We are all different with different food preferences and access to food. But there are a few factors that all healthy eating patterns include. ADA recommends that all people with diabetes:
- Emphasize nonstarchy vegetables-think about making at least ½ your plate nonstarchy vegetables for lunch and dinner. Nonstarchy vegetables include leafy greens, broccoli, peppers, cauliflower, asparagus, tomatoes, cucumber, and more. Plan meals around the vegetable and think of protein and grains or starch as the sides.
- Decrease intake of added sugar and refined grains-eat less foods that contain added sugar and choose whole grains over refined grains like white flour and white rice.
- Choose whole foods over processed foods-whole foods are simply single ingredient foods that are loaded with nutrients.
Which Eating Pattern to Follow
There is strong research supporting a variety of eating patterns to manage diabetes. It’s your choice to do what works best for you and your needs. ADA doesn’t recommend a specific eating pattern or amount of carbohydrates, protein, or fat. These nutrients vary greatly with different eating patterns. Below is a table adapted from the report summarizing eating patterns and their potential benefit. Remember that all nutrition research is not perfect, and the eating patterns listed could include other individual benefits.
|Eating Pattern||Potential Benefits|
|A1C reduction||Weight loss||Lower Triglycerides||Lower LDL||Increased HDL||Lower blood pressure||Diabetes Prevention|
|Low and very-low carbohydrate||✅||✅||✅||✅||✅|
|Vegetarian or vegan||✅||✅||✅||✅|
|Dietary Approaches to Stop Hypertension (DASH)||✅||✅||✅|
A Mediterranean-style eating pattern was shown to reduce risk of heart disease. A paleo eating pattern was also reviewed and had mixed results on A1C, weight, and lipids.
ADA does emphasize a decrease in carbohydrates, stating “Reducing overall carbohydrate intake for individuals with diabetes has demonstrated the most evidence for improving glycemia and may be applied in a variety of eating patterns that meet individual needs and preferences”. The bottom line is that eating patterns should be individualized.
Diet and Complications
To both prevent and manage complications, ADA recommends:
- Replacing saturated fat (animal fat, butter, cream) with unsaturated fat (olive oil, nuts, seeds, avocado) to reduce cholesterol and decrease risk of heart disease.
- Replacing foods higher in carbohydrates with foods lower in carbohydrates and higher in fat may improve glycemic control, triglycerides, and increase HDL cholesterol.
- Control sodium intake and aim for <2300 mg per day.
- Eat one serving (3.5 ounces cooked) of fish at least two times per week. Fatty fish such a salmon, tuna, trout, herring, sardines, and mackerel contain more omega-3 fatty acids that work to prevent heart disease.
Know Your Nutrition Resources
If you feel like you need some guidance for an eating pattern, see a registered dietitian nutritionist. Medical nutrition therapy (MNT) is a vital resource for diabetes management. MNT is individualized nutrition education and counseling provided by a registered dietitian nutritionist. ADA recommends that everyone who has diabetes receive MNT. MNT has been shown to reduce A1C up to 2%. That’s as much as some medications reduce A1C.
Another type of diabetes education is diabetes self-management education and support (DSMES) which is done in a group or individual setting. Both MNT and DSMES are important in preventing and managing diabetes complications. Medicare and many other insurers cover MNT and DSMES for people with diabetes.
ADA recommends that all people with prediabetes receive MNT or join a local or virtual Diabetes Prevention Program. Being part of a Diabetes Prevention Program has been shown to reduce risk of developing diabetes by 58%.
- People with type 1 or type 2 diabetes-seek out MNT and DSMES through ADA or AADE
- People with prediabetes-MNT and/or Diabetes Prevention Program
What you eat matters. Healthy eating a huge part of managing diabetes. There are many different eating patterns that could work for you. Learn more about this by working with your healthcare team and developing a personalized eating pattern.
by Christine McKinney, RD LDN CDE