(The problem from the above comes when people take guidelines intended for well people and apply them to people with chronic illness, and vice versa. This unfortunately happens a lot in medicine.)
This paper is a good overview of how to think about nutrition for various populations, via the #Food4Thought18 series.
Unlike the previous paper in the series that I just read (Just Read: Dietary fat and cardiometabolic health evidence, controversies, and consensus for guidance (written by the team of non-usual collaboratorsâ€¦)), I don’t know how often this group of authors collaborates.
I know and visited Will Yancy, MD, (@DrWillYancy) recently at the Duke Diet and Fitness Center (@DukeDFC), and was really impressed with what I saw (Just Read and Just Visited: Duke Diet and Fitness Center and Management of Type Diabetes With a Very Lowâ€“Carbohydrate Diet â€“ More reasons I love this century)
The Most Important Question, The One That’s Not Being Asked in Medicine (yet)
What is the best dietary approach? Is it possible to achieve remission of type 2 diabetes with lifestyle behaviour changes or is it inevitably a condition causing progressive health decline?Forouhi NG, Misra A, Mohan V, Taylor R, Yancy W. Dietary and nutritional approaches for prevention and management of type 2 diabetes. BMJ [Internet]. 2018 Jun 13;k2234. Available from: http://www.bmj.com/lookup/doi/10.1136/bmj.k2234
Physicians, mostly trained in the 20th Century (that’s changing…) were typically not that diabetes is progressive, or “manageable” at best, but not reversible.
This narrative from my conversation with an author about this phenomenon says it all – we are simply not programmed to think any other way than glass half-empty. Glass half-full-ers (or 3/4 full-ers) rejoice :).
The Reality that Diabetes is Reversible
Again, an important statement for this century
Secondly, it is now recognised that dietary advice for both the prevention and management of type 2 diabetes should converge, and they should not be treated as different entities (fig 1). However, in those with type 2 diabetes, the degree of glycaemic control and type and dose of diabetes medication should be coordinated with dietary intake.Forouhi NG, Misra A, Mohan V, Taylor R, Yancy W. Dietary and nutritional approaches for prevention and management of type 2 diabetes. BMJ [Internet]. 2018 Jun 13;k2234. Available from: http://www.bmj.com/lookup/doi/10.1136/bmj.k2234
There’s now a diagnosis code in the UK for Diabetes in Remission
This is the biggest news for me in this paper.
..a â€œdiabetes in remissionâ€ code (C10P) is now available in the UK.Forouhi NG, Misra A, Mohan V, Taylor R, Yancy W. Dietary and nutritional approaches for prevention and management of type 2 diabetes. BMJ [Internet]. 2018 Jun 13;k2234. Available from: http://www.bmj.com/lookup/doi/10.1136/bmj.k2234
Therapeutic Nutrition and Approaches to Reversing Diabetes
There’s a lot here, and I can tell the influence of the scholarly work of the authors, which is extensive. The things that caught my eye:
- Exoneration (more or less, in couched physician terms) of unprocessed red meat (“evidence of possible harm because of the development of type 2 diabetes is less consistent and of a smaller magnitude”)
- A more charitable view of the flexibility of the ADA Guidelines than I perceive from my read of the 2018 Guidelines. From my read, the 2018 guidelines are not that flexible, when the entire section is read. I’ll post on the later; my opinion is that it still has inherent biases toward a one-size-fits-all view based in 20th Century thinking. Feel free to check my assessment by reading this section yourself, starting page 47 or so.
- A fairly rigorous/vigorous discussion of low fat and low carbohydrate dietary approaches.
Depending on one’s bias the discussion of these issues could be perceived as winning or losing.
Glass 3/4-ers only speak of things winning, so my assessment is “the future is winning/won.”
I say that because this is what has happened in the past and it’s the wrong direction.
Reminder of my disclosures, potential conflicts
In the spirit of the discussion at #Food4Thought18, my disclosures are below. Panelists were asked to state what they eat as well. I eat low-carbohydrate, real food, and was formerly on a low-fat, calorie restricted diet, as a formerly fat and currently normoglycemic LGBTQ human.
Forouhi NG, Misra A, Mohan V, Taylor R, Yancy W. Dietary and nutritional approaches for prevention and management of type 2 diabetes. BMJ [Internet]. 2018 Jun 13;k2234. Available from: http://www.bmj.com/lookup/doi/10.1136/bmj.k2234
As always, feel free to check my work in the comments or via social media or the contact form. More information is better.