American Diabetes Association: Help for Diabetics?

The American Diabetes Association was founded in 1940. Their mission is to prevent and cure diabetes and to improve the lives of all people affected by diabetes. Diabetes is a disease in which the body cannot metabolize blood sugar correctly, which leads to a buildup of excess sugar in the bloodstream. This excess sugar accelerates the symptoms of heart disease and damages other body systems.

Let’s take a look at what the American Diabetes Association recommends in terms of nutrition, and see if these policies can be trusted as the best advice for diabetic care.

On their website, the American Diabetes Association directs diabetics to eat between 45-60 grams of carbohydrates at each meal. Assuming a person eats three meals a day, this advice works out to telling diabetics to eat a minimum of 135 grams to a maximum of 180 grams of carbohydrates per day. Now, 180 grams of carbohydrates works out to 720 calories (1 gram of carb=4 calories). In a daily diet of 2000 calories, eating the minimum recommended carbs would set the daily percentage of carbs at 27% (540/2000) and the maximum carbs would be 36% (720/2000).

But in addition, the American Diabetes Association recommends that diabetics reduce their intake of saturated fat and cholesterol, and eat more non-starchy vegetables. Although non-starchy vegetables are lower in carb than cereal foods, they still do have carbs in them, so the ADA diet is actually about 55 percent carbohydrate, 20 percent protein, and about 25 percent fat, expressed in a ratio of 55:20:25.

Does the ADA Diet Help Diabetics Control Blood Sugar Levels?

Let’s determine whether this diet composition of 55:20:25 is good advice for helping diabetics with controlling their blood sugar, one of the most critical components of managing diabetes.

Below are the results of several scientific research studies done on the effects of diet on blood sugar:

  • In a 2004 study published in the Diabetes Journal, participants were given either the American Diabetes Association recommended a moderately high carb diet with a carbohydrate:protein: fat ratio of 55:15:30, or a low carb diet with a carbohydrate:protein: fat ratio of 20:30:50. The mean 24-hour serum blood sugar at the end of the ADA high carb diet was 198 mg/dl. The mean 24-hour serum blood sugar at the end of the low carb diet was 126 mg/dl. The low carb diet resulted in a drop of 36% in mean serum blood sugar as compared to the higher carb diet over the course of the study. Diabetes 53:2375-2382, 2004
  • Another metabolic ward study examined the effects of low carb, ketogenic (high fat) diet in obese persons with type 2 diabetes. Ten subjects were monitored while eating their usual diet for 7 days and then while on a very low carb diet for 14 days. Carbohydrate intake was reduced to 21 grams per day, but patients could eat as much protein and fat as they wanted and as often as they wanted. The final diet consumed was weighed and estimated to contain a daily average of 21 g carbohydrate, 151 g protein, and 164 g fat (This is a carbohydrate:protein: fat of 03:28:68). This represented a spontaneous reduction in caloric intake of 947 calories per day which resulted in a mean weight loss of 4.5 pounds over 14 days. During the low carbohydrate-diet period, mean fasting glucose (blood sugar) decreased from 135 to 113 mg/dl, a 16% drop between day 8 and 22, and 24-hour glucose and insulin concentrations decreased significantly. This reduction in blood sugar required a decrease in diabetes medication in 5 of the 10 patients. Ann Intern Med 2005; 142:403–11.
  • In another study, eighty-three subjects were randomly allocated to one of 3 weight-loss diets for 8 weeks and on the same diets in energy balance for 4 weeks. Each diet provided identical amounts of calories but differed in the amount of carbohydrate, fat, protein and saturated fat included. This was expressed in a ratio (Carb:Fat: Protein; %SF). The diets included a:
  • Very Low Fat (VLF) (70:10:20; 3%)
  • High Unsaturated Fat (HUF) = (50:30:20; 6%)
  • Very Low Carb (VLCARB) (4:61:35; 20%)

The results were telling. Those subjects on the VLCARB diet lowered their fasting insulin by 33%, compared to a 19% fall on the HUF diet and no change on VLF. The VLCARB meals also provoked significantly lower glucose and insulin responses at meal end than the VLF and HUF meals. All three diets decreased fasting glucose, blood pressure, and CRP, a measure of inflammation. The authors concluded that very low carb diets resulted in similar fat loss to the HUF diets, (which were low in saturated fat), but the VLCARB diets were more effective in improving triglyceride levels, increasing HDL-Cholesterol, and improving fasting and post-meal glucose and insulin concentrations. They noted that VLCARB diets may be useful in the short-term management of subjects with insulin resistance and high blood triglycerides. Nutrition & Metabolism 2006, 3:7

Does the American Diabetes Association’s diet recommendations help diabetics control blood sugar? Looks like the answer is no, it does not. The ADA recommends that diabetic’s blood sugar measurement before meals should be between 80 – 120 mg/dl and less than 170 mg/dl one to two hours after meals. According to the studies above, the higher carb diet that the ADA recommends does not target the levels they themselves recommend.

Analysis of Meal Recommendations

On their website, the American Diabetes Association nutritionist recommends the following guidelines for diabetics in designing a meal. She says to imagine a dinner plate and keep carbs (brown rice, whole-wheat pasta and 100% whole wheat bread) to no more than 1/4 of the plate at any meal. The non-starchy vegetables should fill 1/2 the plate. For the last quarter of the plate, add about 3 ounces of lean meat, chicken, or fish. She also says that a piece of fresh fruit or 1/2 cup of fruit salad for dessert, or even a “light” yogurt can be added for dessert. She recommends cooking with vegetable oils and cutting back on saturated fat.

If we analyze a typical meal using these guidelines, this is what we find:

  • Half of a 10.5-inch dinner plate works out to 35 square inches of space to fill with a nonstarchy vegetable. One can easily fit 2 cups of cooked yellow squash there – that’s about 18 grams of carb.
  • In one-quarter of the plate, there are about 15 square inches to fill. That could hold a cup of brown rice easily. That’s about 45 carbs.
  • The last quarter plate would hold 3 oz of lean meat. That’s about 18 grams of protein.
  • For dessert, a piece of fresh fruit – if we went with a medium orange, that’s another 15 grams of carb.
  • Finally, the ADA says you can cook your veggies and protein in vegetable oil. (Forget for the moment that vegetable oils are polyunsaturated, meaning the chemical structure is volatile and easily oxidizes in the presence of heat. This introduces cancer-causing free radicals into your food.) Sautéing 2 cups of squash would take about 1 T of canola oil. That’s about 14 grams of fat and 125 calories.

Here’s a table of this info: (note: one gram of protein or carb has 4 calories, one gram of fat has 9 calories.)

So this American Diabetes Association recommended meal composition includes 78 grams of carbohydrates, 15 grams of protein, and 14 grams of fat. The entire meal is about 510 calories. The carbohydrate:protein: fat calorie percentage ratio is 61:13:25.

According to the studies above, this meal composition would drive a diabetic patient’s mean glucose levels well above the recommended amount of 170 mg/dl after meals.

Diabetes is a disease characterized by too much sugar in the blood. What rational person would tell a diabetic patient to eat a diet that increases blood sugar? Ironically, the American Diabetes Association does exactly this.

A Better Meal for Controlling Blood Sugar

As you can see from the results of the studies mentioned above, it would be better for blood sugar control to have the following meal instead:

Total calories would be 610.5 and the carbohydrate:protein: fat calorie percentage ratio would be 16:25:60. According to the study results above, this meal would keep the blood glucose levels well under 126 mg/dl. In my opinion, the meal would also taste better and satisfy hunger, both factors which would help the patient stick to the diet, and consistently control blood sugar to recommended levels.

My question at this point is if the American Diabetes Association wants to help diabetics, why do they recommend a diet that studies have shown will elevate blood sugar beyond recommended levels?

I think this poster from the Nutrition and Metabolism Society says it more succinctly:

Resources for Further Reading


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