An interview with Stephanie Dunbar, MPH, RD, director of nutrition and medical affairs at the American Diabetes Association
What is the “ADA Diet”?
Actually, there’s no such thing! What we do promote are some general guidelines. For more than 15 years now, ADA has recognized that people with diabetes should eat in a way that helps them reach their blood glucose, cholesterol, blood pressure, and weight goals. For some, this means a relatively higher-carbohydrate diet, and for others, the diet may be lower in carbohydrate. We don’t recommend specific target numbers when it comes to carbohydrates, protein, and total fat. On the other hand, we do think people should limit how much saturated fat, cholesterol, trans fat, and sodium they eat—all for heart health.
OK, but what does that all mean in practice?
We recommend people who are just starting out on the road to healthy eating begin with what’s known as the “plate method.” The idea is that you fill half your plate with nonstarchy vegetables, a quarter of the plate with foods high in protein, and the other quarter with either whole grains or starchy vegetables. To this, you can add a side of fruit and a serving of low-fat dairy. It’s a simple approach that can help with portion control. But it’s also just a starting point, and people may want to alter the portions to better meet their own needs. Much of finding your best meal plan is trial and error. Managing diabetes is for life, so it is important to find your own eating style that you can live with. And if that doesn’t include at least some of your favorite foods, well, how likely is it that you’re going to stick with it
Why should people with diabetes eat a mix of protein, carbs, and fat?
Even though everybody talks about foods as being “carbs” or “protein,” foods actually contain a mixture of nutrients. For example, vegetables provide carbohydrates and protein. Nuts contain fat but also protein and small amounts of carbohydrate. You want to eat a variety of foods to get a nutritionally balanced diet from vitamins, minerals, and fiber. Having a mixture of carbohydrates, protein, and fat also helps to keep you full and may also help to blunt the effect of certain foods on blood glucose. For example, adding a tablespoon of peanut butter to an apple makes for a more satisfying snack. Plus, the healthy fats in peanut butter will also tame the apple’s effect on your blood glucose level.
How does the ADA come up with the recommendations it makes?
We have committees of experts who review the scientific literature and make recommendations. We then assign all of those recommendations different levels based on how strong the science is to support them. So, for example, since there’s a large body of research saying that monitoring carbohydrate is a key strategy in managing blood glucose, that gets an “A” level of evidence.
Why doesn’t the ADA make changes to its recommendations more often?
You mean, every time you hear about the latest study on your local news channel? It all comes back to the scientific research. Not all research is of a good quality. The best studies are usually very expensive, and it is difficult to do studies controlling what people eat. Sometimes, a study that lasts only a week may show great results, but follow-up studies of longer duration don’t show the same thing. We are careful not to make or change recommendations because of one piece of research that might not stand the test of time.