A couple of weeks ago we shared four highlights from ADA Scientific Sessions focused around behavioral health. This week our focus is on other exciting developments: Did you know that ADA has updated their nutrition guidance? The summary, Nutrition Therapy for Adults with Diabetes or Prediabetes: A Consensus Report, was published in Diabetes Care, May 2019 and you can access it here.

Since the last nutrition guidance was published five years ago, evidence has continued to evolve around the impact of food and nutrition on diabetes management and overall health. 

Here’s what’s new…

#1 – Enhanced focus and guidance around prediabetes and the impact of lifestyle change to prevent or delay type 2 diabetes.

#2 – Evidence supporting that a variety of eating patterns and eating plans can help people with diabetes achieve metabolic goals and eat healthy. Individualization is important. There is not one “best” “one-size-fits all” approach. There are 8 different eating patterns acknowledged to be beneficial in managing type 2 diabetes:

• Vegetarian or Vegan
• Low fat
• Very low-fat (such as Ornish or Pritikin)
• Low carbohydrate
• Very low carbohydrate
• DASH (Dietary Approach to Stop Hypertension)
• Mediterranean style
• Paleo

No one pattern has emerged as being superior to the others. The first six in particular are beneficial for weight loss. The low carbohydrate and very low carbohydrate patterns have demonstrated the most evidence for lowering blood glucose, so if blood glucose is above target or one desires to try to reduce diabetes medications, adopting a low or very low carbohydrate eating pattern is a helpful option.

Four commonalities among all healthy eating plans include the following:

• Emphasize non-starchy vegetables
• Minimize added sugars and refined grains
• Emphasize whole foods over highly processed foods
• Replace sugar-sweetened beverages with water as often as possible. 

 #3 – Initial and ongoing support through individualized medical nutrition therapy (MNT) and diabetes self-management education and support (DSMES) make a difference. They are fundamental in diabetes management, not only at diagnosis, but during times of changing health status. Reported A1C reductions from MNT can be similar to or greater than what would be expected with treatment using currently available medication for type 2 diabetes. 

 #4 – The greater the weight loss, the greater the health benefits. In type 2 diabetes, 5% weight loss can help achieve health benefits, while 15% weight loss or more is the optimal goal when needed and can be feasibly and safely accomplished. For prediabetes the goal is 7-10% weight loss to prevent progression to type 2 diabetes. Keeping as much of the weight loss off over time is critical. Also noted is that more than 50% of people with type 1 diabetes have overweight or obesity. 

6 solution-focused swaps to put the new nutrition guidance into practice and answer the question “What Do I Eat?” Nutrition has long been recognized as the cornerstone for successful diabetes management. One of the most commonly asked questions when receiving a diagnosis of diabetes is “What can I eat?” (In fact, Tami wrote a book addressing just that, entitled What Can I Eat Now?  (The 3rd edition will be released in early 2020). We are particularly excited to see acknowledgement that a variety of approaches can “work”. Personal preferences and maintaining the pleasure in eating as much as possible (while achieving health goals) are high priorities in our perspective. Here are 6 solution-focused swaps to help put the nutrition guidance into practice. 

• Swap whole fruit in place of fruit juice.  Whole fruit has more fiber, is more satisfying, and will not raise blood glucose as quickly as the juice. A whole orange, for instance,has nearly three times more fiber than orange juice.      
• Swap infused water (a zero calorie alternative) in place of a sugar-sweetened beverage. One favorite combination is sliced lemon, sliced cucumber, and fresh mint. Place in a large pitcher, fill with ice, add water to the top, and chill for 2-3 hours to allow flavors to infuse.The longer the water sits, the stronger the flavors become. Infused water bottles accomplish the same thing in a portable fashion. 
• Swap unsweetened almond milk in place of dairy milk. Embrace a more plant-based option and save 10-11 grams carbohydrate per cup.
• Swap cooked spaghetti squash or zucchini spirals in place of spaghetti noodles. Get extra non-starchy vegetables and save 35 grams of carbohydrate per cup.
• Swap mashed avocado on a sandwich in place of mayonnaise. Get healthier fats, and embrace more plant-based and Mediterranean-style eating.  
• Swap quinoa or brown rice instead of white rice. Get a whole grain, more fiber with a plant based and DASH friendly option.. 

Eating healthy is a journey shaped by many factors. All food and beverage choices count. We encourage finding what works for you, and doing more of it! 

You can read our part 1 review of the ADA Scientific sessions focused on behavioral health here.

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