Nuchia Foods Corporation

Diabetes Care 25:1869-1875, 2002

© 2002 by the American Diabetes Association, Inc.

Hi, just so that you don’t get lost in this study you can find Whitham et al. (1654-P) and her discussions on Chia Seeds in about paragraph 15, Whitham speaks on Chia/fiber/salvia hispanica l and its effects on diabetes. This is really good stuff. All the other information is great as well. This is a good all around study. Good reading. Homer L. Hartage, www.nuchiafoods.com

Diabetes and Nutrition

Zachary T. Bloomgarden, MD

Abbreviations:ADA, American Diabetes Association • CHD, coronary heart disease • CHO, carbohydrate • CVD, cardiovascular disease • DPP, Diabetes Prevention Project • UKPDS, U.K. Prospective Diabetes Study

This is the first in a series of articles covering the 2002American Diabetes Association Annual Meeting, which was held San Francisco, 14–18 June 2002.

Nutrition recommendations

Marion Franz (Minneapolis, MN) discussed the process used for the “evidence basing” approach for current American Diabetes Association (ADA) nutrition recommendations (1). “We have made some progress,” she pointed out, comparing the starvation treatment used in 1917 (composed of whiskey mixed with black coffee) with our current approaches. “There are many ways of approaching medical nutrition therapy” for persons with diabetes, she stated, which requires assessment of the individual’s goals and her/his ability to comply with a given recommendation. “The gold standard of research in nutrition has generally been a study in which food is provided to the subjects so that you can know what is being consumed,” she stated, but such studies are necessarily short in duration, and therefore may not be completely applicable to the “real world,” and must be extended by studies implemented in free-living subjects. Also, many questions have not been addressed in persons with diabetes and must be extrapolated from studies in persons with other conditions.

Franz referred to the studies on fiber as examples. Early studies showed a great deal of benefit, but “there are many variables. People lost weight, they changed the percentage of macronutrients, medications were changed, and yet all the benefit was ascribed to fiber.” More recent studies of high-fiber load approaches show only equivocal evidence, with benefit at fiber levels exceeding 50 g daily, far above the level of 20 g daily that can be attained in realistic circumstances, that has not been shown to be associated with improvement in lipids, glycemia, or insulin resistance. With newly diagnosed type 2 diabetes, she stated, lifestyle change leads to a fall in HbA_1c of 2%, and with existing type2 diabetes, falls of 1% can be expected. These changes can be seen over 6–12 weeks, a realistic timeframe for intervention. As Franz pointed out, “At three months, if an individuals had made all the changes that they were willing or able to make [and had not a shown fall in glycemia], then, obviously, medicationswould need to be changed.” She recommended this approach ratherthan using one “ADA diet,” since “handing out these diet sheets to people is rarely effective”; more individualized medical nutrition therapy should be undertaken. Furthermore, althoughweight loss is the ideal, we should not consider this essential, and we should realize that changes in eating habits and exercise without weight loss may be beneficial. Additionally, even small amounts of weight loss, by 5–7%, can improve metabolic parameters in the short term, and “we don’t know what happens in the long term.” It appears that the “total quantity of carbohydrate [CHO] is more important than the source of the CHO,” and that sugars are not less desirable than starches. “Adding protein does not slow the rate of absorption,” she stated, and protein also does not prevent late hypoglycemia, so that this common recommendation is no longer accepted. Micronutrient supplementation is now considered “unlikely to be beneficial,” with the exceptions of calcium and folic acid. One should not consider a patient to “fail” with diet and exercise, but simply that at a given point medications need to be added or changed. Finally, nutrition therapy is now reimbursed by most health insurers, and this should not be seen as a barrier to nutrition counseling for patients.

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