Question 1
After reading this meta-analysis, would you as a dietetic professional recommend a carbohydrate restricted diet to your diabetic (particularly type 2) patient as a way to achieve a healthy weight loss? Explain your reasoning.
posted by Lauren @ 2:29 PM
28 comments
28 Comments:
The meta-analysis seemed to show no significant weight change due to this diet restriction so I do not think this would necessarily be the best reason to recommend a restricted carbohydrate diet to a patient. Since the current research lacks sufficient long term analysis, I would not yet recommend such a drastic diet change (for any reason) despite some of the findings presented in this article. I also feel that severely restrictive diets more often than not only work temporarily, thus resulting in the same initial problems.
I would recommend a slightly lower CHO diet, not necessarily a restricted CHO diet. Even though the research does not prove that weight loss is an outcome, it does show that blood sugars and other labs like Triglycerides were significantly improved. That alone would show that a lower CHO diet does provide some benefit, but on the other hand we know that it should not be severely restricted. Everyones body is very different, meaning that the nutrient composition ideal for everyone is also different. For that reason I would recommend for some individuals a lower CHO diet, slightly higher protein, but I would also focus on increasing heart healthy fats. Of course it would take time to figure out the ideal diet for an individual, but it would be worth the work in the end for them if their health improved.
I would recommend a slight carbohydrate restriction to a Type 2 Diabetic patient who wanted to lose weight. I think that many times patients eat way too many carbohydrates; reducing this is an easy way for them to cut simple calories and also help control their blood glucose levels. Research shows that a carb-restricted diet improves glycemic control (as measured by the HbA1C) and triglyceride levels. While recommending a carbohydrate-restricted diet, I would also give them tips on other ways to cut more calories out of their day, and encourage activity to help them widen that calorie deficit.
I would not likely recommend a lower carbohydrate diet unless the present client was consuming an inappropriate amount of carbohydrates. From my experience most patients with Type 2 Diabetes are clueless on what is a carbohydrate. So I don't think they are going to be able to understand that they need to eat less and will result in poor compliance due to the fact that people do not like to be restricted.
Instead I would focus on educating the client on healthy carbohydrates, healthy sources of protein and fats and I would focus on helping them to balance their intake throughout the day.
Also, I realize that this is a meta-analysis but I am really skeptical of the results that found low carb diets reduced triglyceride levels. This just doesn't make sense to me. Typically low carb dieters replace their lost carbohydrates with protein sources that are high in saturated fat and are inherently consuming more fats as well. So I am really intrigued to learn if there is a study that looks at this specific phenomena as it doesn't seem to be logical.
Karlie,
I agree with you in that most people probably do eat way too many carbs to begin with, so to them a carb restricted diet may actually be a normal carb diet! A slightly restricted card diet does show evidence of improved lab values thus it would be worth it, and like you said you could point out other ways in which they could cut calories to achieve weight loss.
I don't think that I would restrict all carbs, but only those that are proven to show drastic spikes in blood glucose. Most type 2 diabetic patients are probably overeaters and sweet eaters. By restricting (not eliminating) simple carbs, I think that this will help control portioning and will help the client keep motivation by having then as a "treat" (like they used to be considered). I think that if you restric whole grain carbs, you are limiting the amount of fiber a patient can receive. As long as the diabetic patient is consuming high fiber carbs and eating less simple carbs, I think this would work inconjuction with part of the picture of achieving a healthy weight. More than restrict my patient from any foods, I would recommend that they eat variety of fruits and vegetables, whole grains, lean proteins, oils, and low fat dairy products. I think if they are filling up with more veggies and "healthy" foods, they will have less time to consume simple sugars
JoAnna,
I agree with you that I think it might be more beneficial to educate the client on restricting certain types of carbs rather then total carbohydrates in general.
I also agree with Steph and Karlie though that maybe a carbohydrate restriction wouldn't really be bad since people are already consuming over the recommended amount anyway.
I would recommend a restricted carbohydrate diet, as a step toward weight loss. The restricted diet would not be recommended indefinitely and would hopefully be replaced with a more manageable and tolerable diet as time progressed. According to the meta-analysis the restricted carbohydrate diet was valuable in decreasing fasting glucose, HbA1c, and triglycerides. Even if this restricted diet was not successful in weight loss it did decrease blood sugars and triglycerides. Perhaps weight loss should not always be the focus with type II dm. Low carbohydrate diet would potentially result in lowering required insulin and suppressing their appetite; both of which would help with long term weight loss and maintenance.
I would maybe recommend a slight carbohydrate restriction, but not a strict restriction. We do not yet have a good grasp on the long term effects of restricted CHO diets on cardiovascular health and other adverse effects of the restricted diet have been noted. These include increased uric acid levels in gout patients and possible glomerular hyperfiltration effecting renal function of diabetes patients. I would encourage patients to watch their empty calorie intake and recommend whole foods to ensure good nutrition.
Katherine McCullah
Joanna, I agree with you that we should not restrict whole grain carbs due to the fiber content, as well as other nutrients otherwise not obtained from refined grain products or fats/protein. I also agree that if the client is eating more healthful and nutrient dense foods, they will have less room for sweet alternatives and it may be easier for them to reduce the quantity of these high calorie choices.
Katherine McCullah
I would not recommend a very restrictive carbohydrate diet for type 2 diabetic patients. I feel that they should watch their carb intake or restrict slightly. I think that patients should concentrate on their fruit and vegetable intake for weight loss. By eating more fruits and vegetables instead of the high fat items, weight loss will be more successful. By watching their carbohydrate intake (not severely restricting) patients will see improved glycemic control and improved cholesterol labs. Exercise is also an important part of weight loss for type 2 diabetics.
Vanessa,
You made an excellent point on not recommending a drastic diet change. When i think of a 'restrictive' diet, I usually think of a drastic diet change. This type of diet would obviously be difficult for some people. I agree that these 'restrictive' diets would only work temporarily.
-Shanell
Even though the current research study examined CHO restriction for diabetic patients and discovered some positive effects, as a dietitian, I would not recommend a restricted CHO diet for weight loss. Yes, there was a strong relationship between lower CHO diets and improved triglyceride, fasting glucose, and A1C levels. However, I believe more studies are needed to truly back these results. The ADA does not recommend CHO <130 g/d and for good reason. The brain and CNS need glucose to function most efficiently, and the fiber, vitamins, and minerals in complex carbohydrates are essential and very beneficial in the diet. I agree that simple carbohydrate foods should be reduced in the diabetic patient's diet, but restricting CHO levels to below 45% of daily kcals is not a good idea. Educating the pt on topics such as heart healthy fats, lean protein, and the right carbs will be essential for the dietitian to carry out.
I would not recommend a strict carbohydrate diet, but I would consider reducing carbohydrate intake. The amount of carbs. would depend on the patient, everyone is different. It is important to treat the patient according to his or her needs. A slight carbohydrate restriction could possibly lower triglyceride levels, helping drastically. Educating on an overall healthier, balanced diet, possibly increasing complex carbs. and decreasing simple carbs. and including exercise would be optimal.
Samantha McCoy
Shanell- I liked what you said about focusing more on fruits and vegetables. Many people are lacking in this area of the diet. Increasing complex carbs. and decreasing simple carbs. should be more of the focus. Replacing typical high fat snacks, with more fruits and vegetables could be the aid some people need in weight loss. I also liked how you mentioned exercise, a crucial need for all.
Samantha McCoy
Annie-
I agree with you that a restricted carbohydrate diet would not be necessary since reduced calorie intake for weight loss would ultimately lead to less carbohydrate intake and also focusing on healthy choices, such as whole grains and appropriate portion sizes, would be more effective for weight loss maintenance. As for those that showed an improvement in TG levels with a low carb diet, I also question the meaning of these results and feel this could be due to the fact that they were on very high carbohydrate diets consisting of refined carbs--thus, emphasizing the importance of proper nutrition education for making healthier choices (ie/whole grains).
Annie,
I liked how you commented on your experiences on this matter. Through your rotation sites, you have seen diabetics on a level different from me as a first year intern. I think it was an excellent point you made that most diabetic patients do not really understand what a carbohydrate is, let alone which are better than others. As future dietitians, we will need to understand our patients' level of knowledge while keeping in mind our own vast knowledge of health, food, nutrition, and dietetics.
I would recommend a carbohydrate intake that was on the lower end of the recommendation made by the American Diabetes Association (45-65%), such as 45% of total calories from carbohydrates. The patient would still be recieving enough carbohydrates needed to fuel the brain and central nervous system. Also with a less severe restriction, the person is, as the article said, getting the needed water-soluble vitamins, minerals and dietary fiber found in carbohydrate sources. I would not however, recommend the <130 g/day that was also suggested.
For weight loss, I would first recommend a reduced caloric intake, with percentages of nutrient intakes based on those made by the American Diabetes Association. If weight loss can not be achieved, I would then consider recommending a reduced carbohydrate diet.
I would recommend eating less CHO's but not completely restricting them. Reducing the CHO intake did help the pt's in some area's but did not effect their weight loss. Their triglyceride levels were significantly reduced which leads me to believe the methods of preparation, or the carbs of choice were not the best selections made. I think a diet should be focused on all of the food groups. It depends on the individual, they may need to refrain from eating too many carbs, but may need to consume more vegetables. With diabetes carbohydrate intake is certainly a concern but you can't forget about the rest of the food groups.
I would not recommended a patient follow the typical low carb diets (that have below 130 grams of CHO/day) for weight loss. Diets below 130 grams in carbs may not provide the glucose fuel necessary for things like brain functions. I would tell a diabetic patient that a small reduction in the amount of carbs may help them better control their hyperglycemia but is not a method they should use to lose weight.
Step,
I agree. I don't think a dramatic restriction in CHO would be the way to go, but a slight reduction may show some benefits for diabetic clients when it comes to triglycerides.
Although carbohydrate restricted diets seem to show some potential for controlling blood glucose levels in patients with diabetes, I would not recommend it to my patient. More data is needed for the long term consequences of this type of diet. It is still being debated for its safety and adherence. Until long term data provides more detailed information on the subject I would continue giving traditional diabetes diet education.
I think I would recommend a carbohydrate restricted diet to one of my patients with type 2 diabetes. The data showed that for the majority a CHO-reduced diet improved glycemic control and changed lipid profiles. It would only be a short term thing and I would have them focus on eating complex Carbohydrates.
Steph,
I liked that you mentioned educating the patient on increasing their heart healthy fats. So many low CHO diets have people thinking that they can eat all the bacon and grease they want because it's low carb!
Results showed no significant relationship between weight loss and a CHO restricted diet, therefore I would not recommend such a diet for a diabetic patient. Since exercise has beneficial effects related to increased insulin sensitivity AND weight loss, I would first recommend a typical diabetic diet and exercise.
That last one was mine...guess I'm still figuring this out.
Emily
For me it would depend on what stage of DM my patient was in. If they were a newly diagnosed DM I don't believe I would do a carbohydrate restriction since the changing their diet at first will be hard enough. But if they have had DM for some time, I might consider a permanent change to a slight restriction of 45% that way they don't run such a high risk of deviating from their diet and gaining a more weight than they lost.
Tori McRoberts
Katherine,
I agree with your comments. Glucose is one of the main forms of energy that the body uses as fuel. A strict Restriction of carbs would cause the body to start breaking down protein for gluconeogenesis.
Tori McRoberts
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