An Issue of Nutrition and Diabetes

The article I've reviewed is called, "Nutrition Therapy Recommendations for the Management of Adults with Diabetes".  My decision to review this article is based upon interest in links with nutrition and chronic disease.  A National Center for Health Statistics study (Table 18) identified eight of the top ten killers in America as chronic diseases.  I've read multiple books that link the two and this article conducted a systematic review of 228 articles or studies.  The article goes fairly in depth about macro and micronutrients dietary percentages.

  The author found that most dietary recommendations greatly depend on the individual and recommended participating in medical nutrition therapy (MNT) administered through a Registered Dietician (RD), diabetes self-management education (DSME) program, and receiving diabetes self-management support (DSMS).  My favorite part of the article discussed eating patterns.  The patterns or diets reviewed were, Mediterranean-style diet, vegan diets, vegetarian diets, low-fat diets, and the DASH diet.  Another interesting part of the article was the breakdown of each of the macronutrients.  The article discussed carbohydrates, quality of carbohydrates, fiber and whole grains, resistant starch, fructose, sucrose, nonnutritive sweeteners, protein, fatty acids, saturated fats, plant stanols and sterols, micronutrients, and herbal supplements.  The study/article mentioned, what I think is a very important problem with today's approach to chronic disease care and states that many people with diabetes and their health care providers are not aware of the services available.  That statement is significant based on the prevalence of chronic disease faced by people all over the world.

The article was well researched and provided many goals and guidelines for the treatment of types one and 2 diabetes.  The first goal listed was to promote and support healthy eating patterns with a focus on nutrient dense foods.  The next goal was to meet glycemic, blood pressure, and lipid goals.  In the process of eating correctly, the next goal was to lose weight and maintain those accomplishments.  The final goal mentioned was to delay or prevent complications of the disease itself.

In order to have a successful nutritional therapy intervention, patients would need to be focused on the development of a sound nutrient dense eating pattern in order to lower glucose, blood pressure, and bring blood lipid levels into the normal range.

The article dissected individual macronutrients beginning with carbohydrates.  They broke down carbohydrates into multiple subgroups and reviewed several studies.  In four of the randomized clinical trials (RCT) there was no difference in the glycemic markers when patients followed low-carbohydrate vs. high carbohydrate diets.  They did note that the studies were small, of short duration, and had low retention rates.

The results of the study were predictable, the article concluded there is no standardized meal plan or eating habit that can be recommended for everyone.  Their conclusion was that each meal plan should be individualized to meet the need of the patient.  These results indicate more involvement in nutrition than what is currently happening.

My reaction to this article is really positive.  Over the past five years I've been dealing with hypothyroidism (Hashimoto's Disease), a prolactin producing pituitary tumor, pre-hypertensive blood pressure, Atrial Fibrillation (AFIB), chronic lipedema, and chronic fatigue syndrome.  Hashimoto's Disease is an autoimmune disease where your body creates antibodies that attack your thyroid.  So everything you thyroid regulates is no longer being controlled the way your body requires.  For instance, the thyroid controls your metabolism, body heat, growth, and development.  So the importance on having proper thyroid hormone levels is very important for good quality of life. My prolactin producing pituitary tumor is a condition called hyperprolactinemia.  Of the causes, I have a hunch it's due to my thyroid or lack thereof.  The AFIB cause hasn't been determined; however, my cardiologist did mention spinal alignment since my occurrences are random. I've spent many years studying about a connection between nutrition and hypothyroid, chronic fatigue, and hyper lipedema and how I could change my diet to improve my condition.  I've recently discovered the importance of nutrition through multiple books I've read over the past few years and firmly believe nutrition education and our current system of food production are a key factor in controlling or even eliminating chronic disease.  Overall, this article is right in line with my nutritional interests and its connection to chronic disease, as well as, the nutrition links with reversing chronic diseases.

I was very fortunate to stumble on this article/study.  My growing interests in nutrition and chronic disease are addressed in our course materials and so far I've found three chapters all relating to this article.  The first chapter I'd recommend reading asks the question, "Do People Choose Their Health".  This chapter puts the question at a population level and discusses the importance of diet and lack of physical activity as one of the main factors in mortality.  We can turn on any newscast and see whenever the topics are discussed good nutrition and exercise are always a part of the discussion.  Book stores are littered with diet and exercise books each claiming to have a secret to fat loss or good health.  Another topic of study in this chapter I feel plays an important role at reversing most chronic diseases is education.  While the government does study after study I feel the barrier exists in communicating to the public. The information is available, but how do we get the population to access and act upon it?  Dr. Schneider cites studies that claim schools are a good place to teach children about achieving good health.  I happen to agree with the statement; however, more studies are being conducted with follow up to see if the early education is equating into healthy lifestyles.

Another chapter in our textbook discusses psychological factors and how they affect healthy behavior.  Dr. Schneider links socioeconomic status, Health Belief models and Ecological models in order to design health promotion programs, which in my opinion, are a good roadmap to attack the obesity epidemic and associated diseases.  Socioeconomic factors have a large role in the ability of an individual to lead a healthy lifestyle.  Factors such as income, education, and occupation are all linked and have an effect on behavior. The health belief model focuses on the individual and what barriers prevent the person from attempting a change in lifestyle while the ecologic model looks at the environment that helps to contribute to unhealthy lifestyles.  This model starts at the interpersonal level and expands all the way to public policy.  Her recommended approach uses portions of both models for effective intervention to help influence positive changes in lifestyle.

My favorite chapter in her book discusses poor diet and physical inactivity.  This topic is one that I've found most interesting and important for treating chronic disease.  Many studies, TV programs, books, etc. have the same conclusions and outcomes by changing our eating habits and adding exercise to our lifestyles.  There will always be exceptions specifically those whose genetics play a major role.  We know eating healthy and exercising for most people will produce positive changes in body mass therefore improving lipid profiles, reducing risk factors for chronic heart disease, and reducing the need for insulin in type 2 diabetes.

During a visit my endocrinologist, we discussed the patient's role in treating diabetes. He informed me that a good percentage of the patients know the potential outcomes of having diabetes and yet fail to engage in assisting the doctor to lessen or even reverse the condition.  It's as if they want the medication to reduce the symptoms so they can continue with their destructive behavior leading me to believe there is a significant occurrence of patient apathy when it comes to improving ones health.  The study and Dr. Schneider's recommendations make for a good starting point.

References:

1. National Center for Health Statistics. Health, United States, 2016: With Chartbook on Long-term Trends in Health. Hyattsville, MD. 2017
2. Schneider, M. & Schneider, H. (2017), Introduction to Public Health (5th ed.), Burlington, MA Jones & Bartlett Learning

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