2008 ADA Clinical Recommendations Support Low-Carbohydrate Diets

For the first time, the American Diabetes Association (ADA) has come out in support of low-carbohydrate diets for people with diabetes who want to manage their weight. Recommendations cite importance of restricted calorie intake for diabetics wanting to manage their weight.

The ADA voiced its support of low-calorie or low-carbohydrate diets in its newly published 2008 clinical practice recommendations. The recommendations include a statement recognizing the increasing evidence that weight-loss plans that restrict carbohydrate or fat calorie intake are equally effective for reducing weight in the short term (up to one year).   (See this week’s Item#3 )

The recommendations are intended to help physicians guide their patients in diabetes prevention and management.
Prior to the release of the 2008 recommendations, the ADA did not support low-carbohydrate diets for diabetes management due to a lack of evidence supporting their safety and effectiveness.

Because people following low carbohydrate diets may replace calories from carbohydrate with fat or protein, the recommendations also include monitoring the lipid profile (blood fats, including cholesterol and triglycerides) of patients on such diets. High protein diets may also worsen kidney problems. Therefore, it is also recommended that patients with kidney disease be counseled about appropriate intake of protein and that their kidney functions be monitored carefully.
Whether a person can stick with a diet is more important than the diet’s theme, according to the association. Low-carbohydrate and low-calorie diets are equally effective in helping people lose weight over a year.

The recommendations continue to support sustained, moderate weight loss and increased physical activity for people who are overweight, obese, living with diabetes or at risk for becoming diabetic.

"The risks of overweight and obesity are well-known. We recognize that people are looking for realistic ways to lose weight," Ann Albright, president of health care and education for the ADA, said in a prepared statement. "The evidence is clear that both low-carbohydrate and low-fat calorie restricted diets result in similar weight loss at one year. We’re not endorsing either of these weight-loss plans over any other method of losing weight. What we want health-care providers to know is that it’s important for patients to choose a plan that works for them, and that the health-care team support their patients’ weight-loss efforts and provide appropriate monitoring of patients’ health."

The 2008 recommendations state that all adults who are overweight and have an additional risk factor for diabetes should be tested for diabetes or pre-diabetes.

According to the U.S. Centers for Disease Control and Prevention, people who have pre-diabetes can avoid diabetes if they lose 7 percent of their body weight and get more than 150 minutes of activity a week.

Developing and maintaining a disaster kit for diabetes self-management is also included in the new recommendations, along with revised guidelines for care of diabetes in older adults.

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DID YOU KNOW:
Dark Chocolate May Not Be As Healthy As First Thought: Eating dark chocolate rich in flavanols* might be good for your heart, but gaining this potential health benefit can be tricky, according to an Editorial in this week’s issue of The Lancet. Last month, a study in Circulation showed that dark chocolate that is rich in flavanols induced coronary vasodilatation and improved coronary vascular function in 11 heart-transplant recipients compared with patients taking a cocoa-free control chocolate. Other studies have also shown that dark chocolate has cardiovascular benefits. But, “there is a catch,”  some chocolate manufacturers remove the flavanols, which are bitter, from the darkened cocoa solids, so that even dark-looking chocolate can have no flavanol, and thus no health benefit. Consumers are also kept in the dark about the flavanol content of chocolate because manufacturers rarely label their products with this information. And even if falvanols are present the editorial warns, “the devil in the dark chocolate is the fat, sugar, and calories it contains.” To gain any health benefit those who eat a moderate amount of flavanol-rich dark chocolate would have to balance the calories by reducing their intake of other foods, claims the editorial.

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