Diabetes nutrition therapy through the years

Source / information

Published by:

Source:

Maryniuk M; Warshaw H. Diabetes “diets” since the discovery of insulin – looking back, then into the future. Presented at: American Diabetes Association Scientific Sessions, April 25-29 June 2021 (virtual meeting).

Disclosure:
Warshaw reports that she is a consultant or freelance writer for Heartland Food Products Group, Insulet, LifeScan Diabetes Institute, Pendulum Therapeutics / The Ginger Network, and T1D Exchange. Maryniuk reports that she is a consultant for Arkray, Day Two, and Diabetes What to Know.

ADD SUBJECT TO EMAIL ALERTS

Receive an email when new articles are published on

Please enter your email address to receive an email when new articles are published on . “data-action =” subscribe “> subscribe

We could not process your request. Please try again later. If this problem persists, please contact customerservice@slackinc.com.

Back to Healio

So-called “diabetic diets” have come a long way since the discovery of insulin in 1921, but common themes that underlie many diets today were developed by registered dietitians more than a century ago, according to two speakers.

Melinda D. Maryniuk

“Diet is nothing new that we are just beginning to pay attention to” Melinada D. Maryniuk, M.E.d, RDN, CDCES, FADA, Senior Consultant at Melinda Maryniuk & Associates in Boston, said Healio. “As early as the 1920s, people were focusing on cultural foods and individualized diets for diabetes. As nutritionists, we pretend we’re doing this for the first time. It helps to look back in history and see that we have been given great work and that there are some things that we should learn from. “

Source: Adobe Stock

Diets before and after insulin

Prior to the discovery of insulin in 1921, regulating food intake – usually severely restricting carbohydrates and calories – was the only treatment for type 1 diabetes, Maryniuk said during a virtual presentation at the American Diabetes Association’s Scientific Sessions.

1915, Frederick M. Allen, MD, first wrote about “total dietary regulation” in the treatment of diabetes, noting that eating a very low-carbohydrate, low-calorie diet was the best way to “remove glucose from urine and extend life.”

The approach consisted of three steps:

• Strict calorie reduction for 1 to 4 days, with a diet alternating with coffee and whiskey (1 oz every 2 hours) until the urine was “sugar-free”;
• Preparation of “three times cooked vegetables” for 1 to 3 days; and
• Gradual addition of protein and fat to avoid rapid increases in glucose.

“Whiskey is not absolutely necessary – it only provides calories and ensures a pleasant well-being for the patient,” says the text.

Insulin has been touted as a “miracle cure” that enables children to eat enough calories to return to healthy weights. But even in the early days of insulin, Elliott Joslin emphasized the importance of the “treatment triad” for diabetes management: insulin, exercise and nutrition and the challenge of “getting all three to work together,” said Maryniuk. Joslin was a proponent of the weighted diet in the post-insulin era.

“It was very limited in terms of the foods allowed – how much grapefruit, how much orange, potato, oatmeal and cream you can have,” said Maryniuk. “In one of Joslin’s books, grapefruit and oranges were the only fruits recommended in the early years. It said, ‘What should a diabetic do when he gets an apple?’ The answer was, ‘Throw it away.’ ”

Joslin diets included lists of food values ​​that every clinician should memorize, Maryniuk said. Early plans were tightly structured, although the diet gradually became more adapted and individual, allowing for variations in amount and type of food. However, other clinicians recommended very different diet plans for diabetes and there was debate about the optimal diet plan for diabetes.

“I visited Camp Joslin several times as a new nutritionist in the late 1970s,” said Maryniuk. “I remember the boys taking their peaches from lunch, chopping off the pulp and weighing them on the gram scale until they got the exact amount they were prescribed, usually about 150 grams. And then I moved to Florida and their approach to meal planning at a diabetes camp there was so different. Healthy food was served family style, with children choosing what their appetites dictated. It was then that I realized that there is no one-size-fits-all approach to meal planning. “

Edward Tolstoi, MD, best known for advocating the “free diet,” recommended a diet that did not include a gram scale. People with diabetes could choose foods that were no different from those of other family members as long as the choices were healthy. Many other clinicians were pushing for carbohydrates to be increased as early as 1933 to allow for more normal lives, Maryniuk said.

The Exchange Lists for Diabetes Meal Planning booklet was first published in 1950 by the Academy of Nutrition and Dietetics, ADA, and the US Public Health Service Diabetes Branch to address the need to standardize food values ​​and terminology and to simplify nutritional messages. As early as 1950, individualized plans were highlighted that “meet the special needs of the person with diabetes,” said Maryniuk.

Keys to individual plans

Today the message of individualized nutritional therapy has become central, Hope Warshaw, MMSc, ​​RD, CDE, BC-ADM, FADCES, said during the presentation in which she shared nutritional history from the 1980s to the future. Findings from the UK Prospective Diabetes Study (UKPDS), US government food and nutrition policies, and the role of registered dietitians and registered nutritionists in driving the field have put the focus on a critical need for person-centered care, Warshaw said.

Hope Warsaw

“While over the years since the 1980s, macronutrient recommendations – particularly carbohydrates and fat – have been revised and recommendations on what types of fat to consume and not to be consumed have been added, one consistent message is to include all elements of a person’s lifestyle, schedule and eating habits.” , Warshaw, owner of Hope Warshaw Associates, LLC, a nutrition and diabetes consulting firm based in Asheville, North Carolina, told Healio.

That message is even stronger in the ADA’s Consensus Report on Nutritional Therapy 2019, which says that individual nutritional needs are based on personal and cultural needs, reading and writing skills, numeracy skills, access to healthy food, willingness and ability to change behavior, and understanding a person’s barriers should be based.

“In 2013, another important statement was added to the ADA dietary recommendations to guide our recommendations,” said Warshaw. “That means, after medical advice, you try to maintain the joy of eating and only limit the choice of food if this is indicated by scientific knowledge.”

Changing eating habits is challenging, said Warshaw; Clinicians should strive to work with people where they are and how they eat. She outlined four “common denominators” of healthy eating habits that were highlighted in the 2019 Consensus Report:

• Emphasize the consumption of non-starchy vegetables;
• Minimize the consumption of added sugar and refined grains;
• Choose whole foods over highly processed foods; and
• Replace sugar-sweetened drinks with water as often as possible.

“Today there is a lot of interest in food, nutrition and eating habits,” Warshaw told Healio. “I assume that with continued interest and exploding research in this area, new knowledge for the general public as well as for people with different types of diabetes will influence future orientation. Areas to be observed are the role of the gut microbiome in glycemic dysfunction and potential management, precision nutrition for diabetes care, optimization of artificial intelligence and machine learning to relieve management, and optimized strategies and programs, such as online coaching platforms, to support necessary changes in behavior to achieve positive results. ”

perspective

Back to top

Alison Evert, MD, RD, CDCES

This session was a fantastic summary of the evolution of the evidence base that has shaped medical nutritional therapy for diabetes over the past 100 years. We couldn’t imagine two better registered diabetes nutritionists that we could present on the subject.

The RDN team member usually has the luxury of customizing the nutrition plan for people with diabetes and prediabetes. At my facility, a new appointment at RDN takes 1 hour, follow-up appointments usually take 30 minutes. It is very difficult to individualize a diabetic nutrition plan when the busy family doctor tries to answer the question, “What can I eat?” In a typical 20-minute return visit. There are so many important things that must be done during These dates are carried out which often overshadow the possibilities for lifestyle change.

Unfortunately, referrals to the RDN for medical diabetes nutrition therapy sessions or training in diabetes self-management continue to be underutilized. We know from research that unless the person with diabetes receives continued support, it is difficult to sustain a lifestyle change over time. Often times, if an RDN with knowledge and experience of diabetes management is not on the diabetes care team, the person with diabetes may only have a short answer, a patient information brochure on the subject, or a recommendation for one that may not be evidence-based.

Alison Evert, MD, RD, CDCES

Manager, nutrition and diabetes education programs

University of Washington neighborhood clinics

Disclosure: Evert does not report any relevant financial information.

ADD SUBJECT TO EMAIL ALERTS

Receive an email when new articles are published on

Please enter your email address to receive an email when new articles are published on . “data-action =” subscribe “> subscribe

We could not process your request. Please try again later. If this problem persists, please contact customerservice@slackinc.com.

Back to Healio

Scientific meetings of the American Diabetes Association

source https://dailyhealthynews.ca/diabetes-nutrition-therapy-through-the-years/