American Diabetes Association releases new nutritional guidelines

The American Diabetes Association recommends all people living with diabetes make nutrition therapy a part of their diabetes treatment plan, but emphasizes that there is no single eating pattern that is best for everyone, according to a position statement published online Oct. 9 in Diabetes Care.

This position statement replaces the nutrition therapy recommendations for the management of adults with diabetes published in 2008. The 2013 statement provides a set of recommendations based on review of recent scientific evidence. It calls for all adults diagnosed with diabetes to eat a variety of nutrient-dense foods in appropriate portion sizes as part of an eating plan that takes into account individual preferences, culture, religious beliefs, traditions and metabolic goals.

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"Just because you have been diagnosed with diabetes does not mean you can no longer enjoy the foods you love or your cultural traditions," said Alison Evert, MS, RD, CDE, coordinator of diabetes education programs at the University of Washington Medical Center, Diabetes Care Center. "Ideally the person with diabetes should be referred to a registered dietitian or participate in a diabetes self-management education program, soon after diagnosis. An important goal of nutrition therapy for adults with diabetes includes the collaborative development of an individualized eating plan with ongoing support to promote health behavior change."

In choosing an appropriate eating plan, people with diabetes should be sure to consider individual metabolic goals, such as their glucose and lipid levels and blood pressure, the statement notes.

The new guidelines also note that there is no conclusive evidence of an ideal amount of carbohydrate intake for people with diabetes. However, the authors suggest that whatever carbohydrates are eaten should come from vegetables, whole grains, fruits, legumes and dairy products, over other sources that contain added fats, sugar or sodium. Likewise the evidence remains inconclusive for an ideal amount of total fat intake. Fat quality (eating monounsaturated and polyunsaturated fats and avoiding trans fats and saturated fats) appears to be more important than quantity, the authors note, although individuals working to manage their weight should still eat even good fats in moderation.

The new recommendations also state:

People with diabetes should limit or avoid intake of sugar-sweetened beverages (from any caloric sweetener including high fructose corn syrup and sucrose) to reduce risk for weight gain and worsening of cardiovascular risk profile.
The recommendation for the general population to reduce sodium to less than 2300 mg per day is also appropriate for people with diabetes, with additional reductions individualized for those who have high blood pressure. Studies show most Americans eat far more sodium than they should.
People with diabetes do not benefit from use of omega-3 (EPA/DHA) supplements for the prevention or treatment of cardiovascular disease. The recommendation for the general public, to eat fatty fish at least 2 times (2 servings) per week is also appropriate for people with diabetes.
There is no clear evidence of benefit from vitamin or mineral supplements for people with diabetes who do not have underlying vitamin or mineral deficiencies. Nor is there evidence to support the use of cinnamon or other herbs or supplements for the treatment of diabetes.