ADA, spelled I-D-I-O-T

I was roaming through the American Diabetes Association website looking for their nutritional recommendations to see if they had changed lately. There were no real nutritional recommendations that could me made sense of on their site, but I did find their most recent Position Statement, published in Diabetes Care in August a year ago.

What a load of nonsense.

Let’s start out with their statement of purpose:

The purpose of this statement is to review the important role of weight management in the prevention and management of type 2 diabetes and to describe strategies for achieving and maintaining a healthy body weight through lifestyle modification. The use of weight loss medications and bariatric surgery in the management of obesity will not be discussed in this document.

Sounds reasonable enough. Most patients with type II diabetes are overweight so it makes sense to coming up with a strategy for helping these patients lose weight. Unfortunately, this is about the only paragraph in this entire Position Statement that does make sense.

I take that back, there is another paragraph that makes sense, but before we look at it, lets look at the ADA’s take on the low-fat diet:

A low-fat (e.g., 25—30% of calories from fat) diet is considered the conventional therapy for treating obesity. Data obtained from obese persons who were successful at maintaining long-term weight loss, diet intervention trials designed to decrease the risk of cardiovascular disease, and randomized controlled trials that evaluated diet therapy for obesity indicate that decreasing dietary fat intake (to 25—30% of total calories) results in decreased total energy intake and weight loss.

Okay, here’s the other paragraph that makes sense:

Data regarding the long-term effect of a very-low-fat diet ( 15% of total calories from fat) on weight loss are limited because few studies have successfully achieved this level of intake. Additionally, in some diabetic patients, the concomitant increase in carbohydrate intake can exacerbate the dyslipidemia (elevated triglyceride, low HDL cholesterol levels) frequently associated with insulin resistance/type 2 diabetes.

Did you catch that last sentence, the one about carbs causing elevated triglycerides and lowered HDL? It’s not that they’re ignorant about the effects of carbohydrates on triglycerides and HDL; here is the proof that they do know.

Now comes an interesting admission:

Recently, there has been increased interest in the use of low-carbohydrate diets as potential therapy for obesity. The results of five randomized controlled trials in adults found that subjects randomized to a low-carbohydrate, high-protein/high-fat diet ( 25—40% carbohydrate) achieved greater short-term (6 months), but not long-term (12 months), weight loss than those randomized to a low-fat diet ( 25—30% fat, 55—60% carbohydrate). The data from these studies also found greater improvements in serum triglyceride and HDL cholesterol concentrations, but not in serum LDL-cholesterol concentration, in the low-carbohydrate than the low-fat group. In addition, glycemic control was better with low-carbohydrate than low-fat diet therapy in subjects who had type 2 diabetes. Data from a study conducted in overweight adolescents found that altering dietary glycemic load by reducing both total carbohydrate content (45—50% of energy intake) and consuming low—glycemic index foods resulted in more weight loss when compared with a conventional low-fat (25—30%) diet.

With the ever-present caveat:

Additional research is needed to clarify the long-term efficacy and safety of low-carbohydrate diets, particularly in patients with diabetes.

Do these people realize that the same can be said of low-fat diets? There has never ever been a single long-term study showing the efficacy of the low-fat diet, but they seem never compelled to point out that additional research needs to be done before recommending low-fat diets.

Up until the last 20 years or so, the fat consumption of the American diet in terms of that idiotic measurement percent of energy was about 45-48%. And that’s for as long as records have been kept. During this long time period that rates of obesity and type II diabetes have stayed about the same. Once fat as a percentage of energy dropped into the 33-35% range, thanks to the recommendations of the ADA and other fellow travelers, we’ve seen the rates of obesity and diabetes skyrocket. I would say that this is plenty of epidemiological evidence to cast plenty of doubt on the efficacy of the low-fat diet.

After the Position Statement discusses the low-fat diet, then spends plenty of time detailing all the ways in which the low-carbohdyrate diet has been shown to be superior in numerous studies, what kind of diet do you think the ADA recommends for diabetic patients?

The low-carbohydrate diet?

Think again.

We recommend that the macronutrient content of the diet be based upon current dietary guidelines from the American Diabetes Association, the American Heart Association, and the National Cholesterol Education Program (NCEP)-Adult Treatment Panel (ATP III). [There is obviously safety in numbers] These recommendations are based on current evidence regarding the effects of dietary intervention to reduce several coronary heart disease risk factors, including hypertension and elevated LDL cholesterol concentration, which is an important consideration in patients with type 2 diabetes because of their increased risk of cardiovascular disease.

And what are the macronutrient recommendations of the ADA and all these other groups?

In terms of percentage of total calories

Protein 15%
Fat 25-35%
Carbohydrate 50-60%

Then they add:

These recommendations may require modification, however, as new information is generated from additional diet intervention studies.

Pardon me?

What about all the studies mentioned in their own paper about the superiority of the low-carbohydrate diet. Are these people on something?

Let’s look at this a little more closely. Assuming that the average weight-loss diet would be somewhere in the neighborhood of 1500-1600 calories per day, the 50-60% carbohydrate recommendation would come in at around 800 calories as carb per day. 800 calories calculates to 200 grams of carbohydrate, which is ONE FULL CUP OF SUGAR in terms of the body’s metabolic ability to deal with it.

A blood of a person with a normal blood sugar has about ONE TEASPOON of sugar dissolved in it. These people are asking patients with diabetes to deal with an additional one cup of sugar per day.

MAJOR NEWSFLASH

Diabetes is a disease of TOO MUCH sugar in the blood. Who, in their right mind, would try to treat it by prescribing even more sugar? The American Diabetes Association, I guess.

And they wonder why everyone is fat and the incidence of type II diabetes is galloping along?

Could it have anything to do with their contributors?

Please note: I reserve the right to delete comments that are offensive or off-topic.

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