American Diabetes Association – Giving Conflicting Advice

As a Certified Diabetes Educator, I keep up with reading the published standards from the “leading” diabetes organizations (doesn’t mean I agree with them, but I read them).  In reading the most recent published standards from the American Diabetes Association, I was surprised to find their official position statement on healthy eating is nearly IDENTICAL to mine (yep!)  It is as follows:

“To promote and support healthful eating patterns, emphasizing a variety of nutrient dense foods in appropriate portion sizes, in order to improve overall health and specifically to:

  • Attain individualized glycemic (blood glucose), blood pressure and lipid goals
  • Achieve and maintain body weight goals
  • Delay or prevent complications of diabetes.”

Why was I so surprised to read this?  Because almost nothing that they teach to the public aligns with their OWN position statement! 

I want to analyze this position statement very closely because, as I said, it so closely mimics with what I teach, namely 1. EAT REAL FOOD (without overeating) and 2. EAT TO YOUR METER.  It SEEMS like the ADA is completely on target with this position statement.

So why do I NOT support the ADA?

It’s not the position statement that is the problem.  It is how the ADA’s advice is completely contradictory to it.  Let’s take a closer look at this statement, and then we will see how closely (or should I say NOT closely) the ADA lives up to it’s own position on healthy eating…

“NUTRIENT DENSITY”

Ok, we all remember my #1 rule right?  EAT REAL FOOD.  That is what they seem to be saying here as well.  Choose the most nutrient-dense foods you can find.  Why?  Because if you eat nutrient-poor foods, you will have to eat a LOT more food overall to make sure that you are getting adequate nutrients.  By choosing nutrient-dense foods, you get “more bang for your buck.”  Nutrient density is SO IMPORTANT.  I once read that if a person were to eat by the old USDA food pyramid, (with its base of UP TO 11 SERVINGS of processed, refined, nutrient-devoid foods like: bread, pasta, cereal and crackers), they would have to consume approximately 27,000 calories per day to meet their nutrient needs.  Well, I honestly don’t know how to verify that, but let’s take an average daily intake of 2,000 calories with up to 11 servings of nutrient poor food.   Yes, you would either need to eat MUCH more food to get your nutrients, or pick better quality foods.  (Now I know we don’t use this food pyramid anymore, but the MyPlate is not much better, only in a different format.)  CLEARLY, nutrient density is KEY.

So, how do you translate that?  EAT REAL FOOD.  Eat food that doesn’t sit on the shelf in a box or bag (or even most cans).  Eat food that either has NO label or one that has less than a handful of ingredients, all of which you can identify.

However, contrary to their position statement, the ADA continues to encourage large amounts of sugary and starchy carbohydrates in each meal (3-5 servings of them), along with processed and refined high carb snacks (like baked chips and light popcorn)…and don’t even get me started on their dessert suggestions (see below).  Certainly not nutrient dense foods.

“APPROPRIATE PORTIONS”

So, what about “portion sizes?”   Does anyone HATE the words PORTION CONTROL as much as I do?  How many of you think of this image when you hear “portion control.”

A close cousin to “portion control” is “EVERYTHING IN MODERATION.” (My article HERE.)  In other words, it’s ok to have junk, just have “small portions” or eat it in “moderation” (whatever that is.)  “Moderation” means nothing, because everyone’s idea of what moderation is completely different.  This guy may feel like he is eating his pancakes in moderation, because he used to eat twice that much, lol!  But you get the point, the word moderation is useless.

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Enjoy this comical video on “serving sizes.”  LOL!

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We all know that people are going to occasionally eat things that are bad for them, but this should be left to their personal choice, NOT ENCOURAGED.

To me, a better way of saying portion control is saying: “eat only when you are hungry” and “don’t overeat.”  How can someone figure out a portion size for you if they don’t know what it takes to fill you up?  In other words, eat to YOUR satisfaction level, but don’t eat until you have to loosen your belt.

“GLYCEMIC CONTROL”

Next up, attaining glycemic control.  There is nowhere that the ADA is further away from its own position statement than when it comes to glycemic control.  First of all, the targets set for glycemic control are arbitrary at best, extremely harmful at worst.  With glycemic targets of up to 130 at fasting and up to 180 post meal, the ADA is NOWHERE NEAR helping people attain TRUE glycemic control, since normal fasting blood sugar is <90 and normal post meal blood glucose is below about 110-120.  You simply cannot state that you care about glycemic control and place targets  that are typically DOUBLE that of normal blood sugar.  Many, many studies show SIGNIFICANT increased risks of heart disease, strokes, kidney disease, cancer, alzheimer’s, brain shrinkage, blindness and amputations just increasing from an A1c of 5% to 6%.  By the time most people are diagnosed with diabetes (A1c of 6.5%), they already have significant metabolic disease and complications.  So, why promote an A1c of up to 7% as “glycemic control?”

In addition, the diet that is often promoted by the ADA will IN NO WAY help people achieve true glycemic control.  (See some examples below)

Here is a confusing statement on the ADA website “In the past, people with diabetes were told to completely avoid sugar. Experts thought that eating sugar would raise blood glucose levels very high.  Research around this issue has shown that while the type of carbohydrate can affect how quickly blood glucose levels rise, the total amount of carbohydrate you eat affects blood glucose levels more than the type. Now experts agree that you can substitute small amounts of sugar for other carbohydrate containing foods into your meal plan and still keep your blood glucose levels on track.”

(That is similar to the calories in calories out theory where people claim that the TYPE of calorie is not that important, as long as you don’t exceed the NUMBER of calories you should have.  Nothing could be further from the truth.)

So let me get this straight,  30g of carbs from vegetables…

Will raise my blood sugar more than 27g of carbohydrates from, predominantly, sugar…

Anyone beg to differ?

Why is a diabetes organization ASSISTING people in figuring out HOW to replace their healthy foods in their meal plan with sugar?  How about we encourage healthy eating and leave the indiscretions to people’s own personal choice…you know, instead of encouraging it by using words like “portions” and “moderation.”  Why do they never say “use portion control on your broccoli” or “eat your salad in moderation.”  Because “portion” and “moderation” are just code words for junk.

“BLOOD PRESSURE, LIPIDS, WEIGHT CONTROL AND AVOIDING COMPLICATIONS”

Next up, blood pressure, lipid, and weight control, as well as avoidance of complications.  Well, if you don’t promote NORMAL blood glucose targets, you will not achieve ANY of these goals, PERIOD.  No need to comment further.  You must achieve true glycemic control in order to achieve any of these.

Ok ADA, so I agree with your entire position statement…so what’s the problem?

Let’s see if ADA’s advice matches their official position.

Recently, the ADA published a “diabetes friendly” sugar-laden dessert recipe on Facebook.  I will not get into too much detail about this because there are already two excellent articles HERE and HERE.  After the post, hundreds of people protested the recipe being called “diabetes friendly.”  There were so many negative comments that the ADA removed the post, not because they felt anything was wrong with the recipe, but because, as they stated, it “lacked context.”   The real reason is that the post was an utter public embarrassment of their advice.  (In the end, they still could not admit that their advice was bad.)

Let’s see if that “diabetes friendly” recipe measured up to their own standards:

Nutrient dense: the ingredients were rice, sugar, milk and sweetened condensed milk (or, in other words…sugar, sugar, sugar and sugar).  Oh yeah, it had cinnamon!  That will balance out the blood sugar after the 38g (nearly 10 spoonfuls) of sugar (wink wink).  Fail.

Portion control:  well, I gotta give it to you here.  The portion WAS controlled.  In fact, for 38g of carbs/sugar, only 1/4 cup of rice was split into 10 portions.  Now, I know rice swells, but not that much.  Can you imagine how SMALL the portion was, yet it still had 38g of carbs?  Score 1 point for portion control, lol!

Glycemic targets: Can even a person WITHOUT diabetes eat this recipe and maintain normal blood sugar?  Doubt it.  Fail.

Normal blood pressure, lipids, and weight control, as well as prevention of complications: once again, without glycemic control, these goals are not attainable.  Fail.

Here is another example.  Here is a page out of the American Diabetes Association’s Guide to Healthy Restaurant Eating written by Hope Warshaw, a Registered Dietitian with a Masters in Medical Science who is also a Certified Diabetes Educator and is Board Certified in Advanced Diabetes Management (bet you were wondering what all those acronyms meant…).

Folks, there is almost no one’s advice I would stay FARTHER away from than this woman’s advice.  She is TRULY a wolf in sheep’s clothing…and the worst kind because she is usually at the head of a major diabetes organization and a person in whose position we should rely on for helpful, accurate information.

So, here is one of her “healthy and hearty” choices for eating out (don’t worry about going somewhere and getting real food, like salmon and salad, just go to Dunkin’ Doughnuts)…simply choose TWO glazed cake doughnuts for 70g of carbs (sugar)!  As if one glazed cake doughnut wasn’t bad enough, she recommends two.

One question…what school did she study nutrition in?  To call two glazed cake doughnuts “healthy” is a crime that should be punishable by law for a nutritionist.  Once again, people are going to eat unhealthy foods at times.  But they are going to do it EVEN MORE if someone tells them they can have their doughnut AND good health at the same time (“have your cake and eat it too”, lol!)  How do you get SUPER healthy, eat a whole dozen?

So what is it ADA?  Do you want people to eat nutrient-dense foods that will help them control their blood sugar, weight and health markers and avoid complications?  Or are you going to keep promoting PURE JUNK as diabetes and heart friendly foods…we are getting confused!

What the ADA may not be aware of, is that there IS a small band of dietitians, nutritionists, diabetes educators, physicians and nurses who are actually upholding that position statement, DESPITE the ADA’s continued poor advice to the public.

It’s time that the ADA follows suit.