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

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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.
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0 BackBone Care Keep your body position

BackBone Care - Spinal pain is often ignored. In fact, once the main supporting bone of the body was disturbed, pain attacks and impaired productivity. Not surprising considering the spine is a dynamic object that holds the load of each of our activity.

Later, Andi often disturbed pain in his left. The result of the scan at the hospital turned out to have bearing prominent in the neck so that pinch nerves. "The pain disappeared arise," he said.

The doctor suggested that the defective part is replaced with implants. However, he was worried because many people who say the high risk in a series of spine surgery. Hesitate to risk the operation, pain was forced to hold-resistant.

As two-legged creature that stands upright, the human spine is an extremely vital organ as it works to sustain weight loss. Spine bone covering the neck (cervical), the middle back (thoracic), and lower back (lumbar/waist).

The series of spine divided into segments and between segments of the joints and bearings are composed of layers of structure. Serves to protect the bearings so that in between the bones do not clash.

The muscles that support the spine helpful.

Spine surgeons from the Spine Center Hospital Ramsay Premier Bintaro, Lutfi Gatam, say, the load on the spine while sitting, working, and carrying enormous loads. Lightest load spine only when we sleep.

Complaints most disorders of the spine is generally in the form of pain on the bottom (low back pain).

"Complaints are dominant because most of our body weight fall at the bottom so easily injured," Lutfi said, while giving exposure in the Kompas daily of "Spinal Problems", last week.

Causes of spinal disorders include muscle disorders, broken bones, bearing a damaged (broken/torn), interference with the joint or a mixture of several factors for tumors, cancer, and infections.

In people with normal spinal structures, spinal problems often caused by the activity of motion and posture.

Risk factors that, for example, repetitive heavy lifting, bending, and excessive movement. Static posture, such as sitting too long, is also a risk factor. Overworked muscle contraction and occurs continuously so there is a complaint.

From: KOmpas.com