January 18, 2008

ADA Practice Recommendations - Take Action Now!

Don't take the health media's word on what this year's ADA Practice Recommendations say, read them yourself. They're online and full text is free:

ADA 2008 Practice Recommendations

The ADA, as touted earlier, now says it is okay to do a low carb diet for up to one year but only for weight loss. Unfortunately, they repeat the warnings that suggest this diet is a "high protein diet" that is harmful to the kidneys. This, of course, is not true as a well constructed low carb diet is a high FAT diet with about the same absolute amount of protein as a healthy standard diet.

The ADA is still obsessed with the idea that people with diabetes should eat a low fat diet with only 7% saturated fat.

Even worse, they still recommend 180 mg/dl as the post-prandial blood sugar target. That's a great target if you want neuropathy, since all the research shows it develops with exposure to blood sugars over 140 mg/dl.

And their recommendation for the ongoing diet for a person with diabetes is, you guessed it, "whole grains" and low fat. Which is a great way to keep their drug company sponsors selling drugs.

The main thrust of the ADA's diabetes treatment plan for Type 2s relies on the patient taking a ton of oral drugs. For Type 1s, they still recommend high carb diets, high insulin inputs, and lax A1c goals (which are all that is possible with that approach).

And though they now, in this position paper, finally admit that getting the A1c under 6% might be helpful, for reasons based on NO research I've ever seen they stress that the improvement in health made by dropping the A1c from 7% to below 6% is only, according to research, "small."

The only reason is appears "small" is that they never funded any research into the effects of lowering A1c below 7%. This is probably because doing so requires limiting carbohydrates to at a minimum no more than 120 g a day and for smaller people a lot less. With almost no studies you get almost no evidence. Duh.

The evidence of UKPDS is that the 7% A1c translates into a lot of blindness and neuropathy for people with Type 2 diabetes--far more blindness than is the case for people with Type 1 who have the same A1c. Despite this the ADA continues to tell Type 2s that the 7% A1c is all they need to achieve. Probably because with the drug regimens and high carb diets they promote they are all that is possible--though few Type 2s CAN achieve even a 7% A1c with high carb/oral drug regimens.

Here is the web page of the Chair of the committee that puts out these recommendations, Irl B. Hirsch. Faculty Profile
Dr. Hirsch has Type 1 diabetes, but like his brother who recently published a book, he appears to be fanatically anti-low carb and dedicated to the belief that people with diabetes should eat like "normal" people no matter what it does to their long term health or how many hypos they have driving.

If you have strong feelings about the new ADA recommendations, write to Dr. Hirsch expressing your concerns. Be sure to let him know what kind of diabetes you have, what kind of control you have, how long you've had that control, and what you've done
to get it. I'm going to.

Here's his email: ihirsch@u.washington.edu