samedi 21 octobre 2017

When D2 patients will discover le LCHF diet?

Diabetes and Low-Carb Diets

Guidelines May Be Changing Soon

Diabetes is s disorder of carbohydrate metabolism. This means that the body is not able to use sugars effectively, and glucose builds up in the blood. These high levels of blood glucose cause many of the complications we associate with diabetes.It might be logical to assume that reducing carbohydrate in the diet would be helpful in a disorder where the body has trouble processing it. Indeed, many people with diabetes find that this is the case, and some doctors are having great success using low carbohydrate diets to treat diabetes. However, the standard recommendations for diabetics include a diet that is relatively high in carbohydrate. Although clearly these recommendations help some, many people with diabetes and prediabetes find that (sometimes from the beginning and sometimes after a year or two) a low-carb diet is the only dietary routine that enables them achieve stable blood glucose.
They become confused, if not bewildered, to find that their physicians and dietitians would prefer that they take more medication rather than reduce carbohydrate.

Potential Changes in ADA Recommendations

Up to this point, the American Diabetes Association, while admitting that "the best mix of carbohydrate, protein, and fat appears to vary depending on individual circumstances," has been reluctant to recommend significant carbohydrate restriction for a number of reasons. These include concerns that the diet is too difficult to follow, and that increasing fat and protein in the diet may cause health problems. However, there is mounting evidence that a low-carbohydrate diet can be helpful to Type 2 diabetics in a variety of ways, including weight loss, reduction of blood glucose, an often dramatic decrease in triglycerides, and other health benefits. Additionally, longer-term studies are so far not showing the ill effects that were feared.Each year in January, the ADA publishes new dietary and other treatment guidelines for diabetes, intended to reflect advances in the scientific understanding of how best to treat diabetes. Although the final wording of the 2008 document has not been fully decided upon, Dr. Judith Wylie-Rosett, co-chair of the writing panel for the ADA's 2007 Nutrition Recommendations, has indicated that, "there is growing recognition that a variety of diets including low carbohydrate diets, can achieve weight loss. The importance of controlling carbohydrate intake to improve postprandial blood glucose is also recognized." Although Dr. Wylie-Rosett is understandably hesitant to guess at the ADA's exact final wording for the 2008 update, she does think that it will reflect the growing indications that low-carbohydrate diets can be helpful to some diabetics.
This potential change is consistent with ADA guidelines and goals which have stressed finding a diet that works for each individual for weight control and blood glucose control. At a May 2007 conference of The American Society of Bariatric Physicians, Dr. Wylie-Rosett spoke of low-carb diets as an "off label use" of diet for diabetes -- in other words, although the ADA was not endorsing them, if a low-carb diet was achieving the goals set by the ADA, it was within the bounds of the guidelines.

Goals of Dietary Recommendations for Diabetes

According to the 2007 position statement of the American Diabetes Association, the primary goals of medical nutrition therapy for diabetes are:
  1. Normal blood glucose, blood lipids (cholesterol and triglycerides), and blood pressure -- or as close as possible to these.
  2. Prevention of complications associated with diabetes
  3. "To address individual nutrition needs," according to such factors as motivation and cultural preferences.
  4. "To maintain the pleasure of eating by only limiting food choices when indicated by scientific evidence."
Note that a low-carb diet can potentially address the first three goals very well. In study after study, people have improved blood glucose, blood lipids, and blood pressure by reducing carbohydrate in their diets. Since blood glucose control is the most important element in preventing complications of diabetes, the second goal is addressed. Motivation is vital when it comes to controlling blood glucose by diet, but many people have proved that eating a low-carbohydrate diet in a healthy way can be achieved and sustained.I applaud a greater range of dietary advice being available to health care professionals working to help people with diabetes find a diet which best serves them and leads to greater health. We in the low-carb community will anxiously await the opportunity to read the final version of the new ADA guidelines in the January 2008 issue of the journal Diabetes Care.
American Diabetes Association. "Nutrition Recommendations and Interventions for Diabetes." Diabetes Care. 30:S48-S65 (2007)
Nielsen, Jorgen, Joensson, Eva. "Low-carbohydrate diet in type 2 diabetes. Stable improvement of bodyweight and glycemic control during 22 months follow-up." Nutrition and Metabolism. 06/14/2007
Stern, Linda, et al. "The Effects of Low-Carbohydrate versus Conventional Weight Loss Diets in Severely Obese Adults: One-Year Follow-up of a Randomized Trial." Annals of Internal Medicine. 140/10 (2004)
Wylie-Rosett, J., Albright, AA, et al. "2006-2007 American Diabetes Association Nutrition Recommendations: issues for practice translation.." Journal of the American Dietetic Association. Aug;107(8):1296-304.(2007)
Wylie-Rosett, Judith. Conference Presentation, "A Review of the American Diabetes Association Recommendations for Dietary Carbohydrates" at the Eastern Regional Obesity Course of the American Society of Bariatric Physicians; Nutrition and Metabolism Workshop. May 5, 2007
Wylie-Rosett, Judith. Personal Communications. November 2007

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