0 ADA Position Statement On Nutrition Therapy For Diabetes Carbohydrate

The American Diabetes Association (ADA) recently published their new Position Statement on nutrition therapy for people with diabetes:

Nutrition Therapy Recommendations for the Management of Adults With Diabetes, Diabetes Care, Published online ahead of print, 9 October 2013.

This post focuses on carbohydrate, specifically amount. Subsequent posts will address fat, protein, and other dietary considerations.

The Statement used a grading system to rate the evidence, evidence which formed the basis for their recommendations. A description of that grading system can be found in Table 1 of their Statement on medical care:

ADA Position Statement, Standards of Medical Care in Diabetes - 2013, Diabetes Care, January 2013

For convenience, Im including it here:

Table 1. ADA Evidence Grading System For Clinical Practice Recommendations (Grade, followed by description):

A

• Clear evidence from well-conducted, generalizable RCTs that are adequately powered, including:
  • Evidence from a well-conducted multicenter trial
  • Evidence from a meta-analysis that incorporated quality ratings in the analysis
• Compelling nonexperimental evidence, i.e., “all or none” rule developed by the Centre for Evidence-Based Medicine at the University of Oxford
• Supportive evidence from well-conducted RCTs that are adequately powered, including:
  • Evidence from a well-conducted trial at one or more institutions
  • Evidence from a meta-analysis that incorporated quality ratings in the analysis

B

• Supportive evidence from well-conducted cohort studies
  • Evidence from a well-conducted prospective cohort study or registry
  • Evidence from a well-conducted meta-analysis of cohort studies
• Supportive evidence from a well-conducted case-control study

C

• Supportive evidence from poorly controlled or uncontrolled studies
  
  • Evidence from randomized clinical trials with one or more major or three or more minor methodological flaws that could invalidate the results
  • Evidence from observational studies with high potential for bias (such as case series with comparison with historical controls)
  • Evidence from case series or case reports
• Conflicting evidence with the weight of evidence supporting the recommendation

E

• Expert consensus or clinical experience

________
Regarding carbohydrates, the panel gave these recommendations:

The amount of carbohydrates and available insulin may be the most important factor influencing glycemic response after eating and should be considered when developing the eating plan. Grade A

Monitoring carbohydrate intake, whether by carbohydrate counting or experience-based estimation remains a key strategy in achieving glycemic control. Grade B

For good health, carbohydrate intake from vegetables, fruits, whole grains, legumes, and dairy products should be advised over intake from other carbohydrate sources, especially those that contain added fats, sugars, or sodium. Grade B

Evidence is inconclusive for an ideal amount of carbohydrate intake for people with diabetes. Theore, collaborative goals should be developed with the individual with diabetes. Grade: C

Note that although the amount of carbohydrate may be the most important factor influencing blood glucose, the panel felt that evidence was insufficient to state a specific amount for all people with diabetes. Although some studies that investigated low-carb eating patterns showed better serum lipids and blood glucose control, many were small, of short duration, and/or had low retention rates which could bias results. As well, some studies showed no significant difference in lipid and glucose markers between low-carb and higher-carb diets.

Evidence suggests that there is not an ideal percentage of calories from carbohydrate, protein, and fat for all people with diabetes. Grade B

Macronutrient distribution should be based on individualized assessment of current eating patterns, perences, and metabolic goals. Grade E

The panel revealed that, on average, people with diabetes eat about 45% of their calories from carbohydrate, 36-40% from fat, and 16-18% from protein. However, diets with more or less carbohydrate, fat, and protein have been shown to be effective in managing diabetes. Those diets included the Mediterranean, DASH (Dietary Approaches to Stop Hypertension), plant-based (vegan and vegetarian), low-fat, and low-carbohydrate.

Reciting a chorus of this Statement, the panel stressed that individualization was key in determining an optimal mix of macronutrients. Health status (e.g. renal function and body weight) as well as food perences should be considered.
________

0 Carbohydrate source of energy in the body

Definition

     Carbohydrates come from the Greek word "glukus" which means "sweet". Hydrogen, carbon and oxygen compounds which are also the name of carbohydrates. They are the primary source of energy in the body. They are the perfect fuel our efforts.
     One class diagram carbohydrates into two families:
- Simple sugars: they are directly absorbed by the body. There are hydrolyzed by the salivary and digestive enzymes. This is particularly the case of monosaccharides such as glucose, fructose and galactose but also disaccharides.
- Complex sugars (polysaccharides): They will undergo further hydrolysis. This is the case of starch and glycogen, which is manufactured by our body (gluconeogenesis) and stored in the liver and muscles. Its sugar reserve rights.

Carbohydrates

energy role

     Carbohydrates, essential for the functioning of the muscles and brain, is the source of energy quickly used by the body and are involved in protein anabolism. So carbohydrates are essentially energy role. Provided by the diet, they are broken down into glucose which will be distributed throughout the body. Part is stored as glycogen in the liver and muscles that serve as reserve.

Plastic role

    Some carbohydrates have a role called "constitution". They go into the composition of human body tissues: cartilage, Nucleic acids, mucus, antigenic substances.

Where do you find carbs?
     Carbohydrates are the most abundant in living matter organic constituents. Their main source is the plant community. They are mostly found in dried fruits, fresh fruits, cereals, bread, honey, whole sugar, tubers, milk, etc. ...
     Foods in which we find most of carbohydrates are:
- Pasta: 75% (75 grams of carbohydrates per 100 g of pasta)
- Pulses: 59%
- Bread: 50%
- Banana: 30%
- Rice: 22%
- Potato: 20%

Energy intake

     Our daily requirement of carbohydrates is 4 grams per kg of body weight per day. 1 gram of carbohydrate provides 4 calories or 17 kj.
     In a balanced diet, energy intake should include 50% carbohydrates. This represents an average of 220 to 250 grams of carbohydrates per day, two thirds of which serve the unique needs of the nervous system that is glucodépendant. The proportion of carbohydrates in the diet helps maintain carbohydrate reserves of the body (liver and muscle glycogen) to a stable level
500 g.

Special cases
  For athletes, carbohydrates should represent at least 55% of the total caloric intake. Sports performance are dependent on carbohydrate reserves of sports, and how they are managed. Any food strategy is put in place before, during and after sporting event.

     The premature infant, infants and children have higher than adult energy needs. Needs directly related ave growth. It is estimated that premature babies need 15 grams of carbohydrate per kg per day, we believe that 8-10 g per kg per day enough for children. At 4 years, its contribution must be rammené to 5 g per kg per day.

     The elderly retain an appetite for sweet foods but tend to reduce their intake of complex carbohydrates. We must therefore ensure that the daily intake of carbohydrate mostly come from complex carbohydrates.

Blood sugar
 The sugar is the amount of sugar in the blood. You should know that the concentration of sugar in the blood almost no changes, that is to say quon always between 0.8 g and 1 g of sugar in 1 liter of blood. Below this range, it is hypoglycemia, above, in hyperglycemia.

     When blood sugar rises, the pancreas into action by secreting its main hormone, insulin has the effect of lowering blood sugar levels to normal. The slowly absorbed carbohydrates cause a slow and gradual rise in blood sugar. In contrast, consumption of sugars often causes hyperglycemia with a relatively high insulin secretion that can trigger a reaction secondary hypoglycemia.

0 Carbohydrate Not Always Bad For the Body

People who are dieting to lose weight often avoid eating carbohydrates. That said, the food such as rice and bread is the culprit of obesity. In fact, there are also carbohydrates that are good for the body.

The average person consume 50-65% of carbohydrates in food. In fact, a healthy carbohydrate intake is between 45-65%. However, people often assume carbohydrate diet as a scourge and avoid it altogether. When they lose weight, they feel good psychologically.
In fact, when restricted, people who are on a diet but often break the rules. It quietly carbohydrate meals. As a result, they actually eat more than you should.

Carbohydrates keep your brain, red blood cell system, as well as improved immune function. These compounds as a source of fuel for the body.

There are a number of carbohydrate foods is beneficial for the body. The food has a lower caloric density than other carbohydrate sources.

It turns out not only carbohydrate derived from grain such as rice or wheat, but also fruits and vegetables. Mango, grapes, and dried fruit are a number of high carbohydrate. However, the three also contain fiber, minerals, and vitamins. Moreover, the amount of calories lower than bread and cereals