Responsible Nutrition Advice: New ADA Guidelines Scrap the Word ‘Diet’ and Promote a Plant-Heavy Diet for Diabetes Management

by L Matthews on October 21, 2013

ADA guidelines for diabetes language

How we talk about food is hugely important in managing both physical and emotional health.

A number of recent medical papers have noted that reduced red meat consumption lowers the risk for type II diabetes and that cutting back on sugary food and soda/pop can help patients manage their condition more successfully. The new nutritional guidelines from the American Diabetic Association have beefed up (sorry, couldn’t resist) these recommendations, however, calling for an outright avoidance of sugar-sweetened beverages (SSBs) and switching to lean protein and meat alternatives. What’s more, they have studiously avoided using the word ‘diet’ in the guidelines.

Nutritionists everywhere know that their clients have diverse tastes and issues when it comes to choosing foods, be they sociocultural, medical, political, or otherwise. What this boils down to is that simply saying ‘go vegan!’ and handing over a list of ‘banned’ foods is pretty ineffective.

Nutritionists Wise Up

Instead of taking a reductionist approach, the ADA has wised up to the individuality of those with diabetes and is focusing on overall eating pattens and patient preferences instead of prescribing a one-size-fits-all diet. Indeed, lead author of the new guidelines, Alison Evert, MS, RD, CDE, has said that her and her colleagues have intentionally used these (presumably non/less-triggering terms) throughout the document. By recognising that patients approach food differently, they say, dieticians are more likely to be able to devise an eating plan that ‘speaks to them.’

“Nutrition Therapy Recommendations for the Management of Adults With Diabetes,” looks at a number of different eating plans – including Mediterranean style, vegetarian, low fat, low carbohydrate, and Dietary Approaches to Stop Hypertension (DASH). What it doesn’t do is tell all patients that one of these is best for everyone:

“Personal preferences (eg, tradition, culture, religion, health beliefs and goals, economics) and metabolic goals should be considered when recommending one eating pattern over another.”

Language in Public Health

As both a copywriter and a trained nutritionist, I regularly toy with wording, considering how subtle changes in phrasing can have a vastly different effect on how likely someone is to adopt a certain eating habit or lifestyle choice.

For example, if I’m writing an article on healthy school lunches for a general audience then I’m unlikely to use the word ‘vegan’ or to talk about animal ethics, focusing instead on the foods that are healthiest and satisfying for kids and easy for parents and guardians to prepare (and, oh, look, all those foods are plant-based). If, however, I’m writing copy for a company producing healthy vegan school lunches that is aimed at those already vegan then, yes, the word ‘vegan’ will feature pretty prominently. Then there’s the middle-road… the tricky demographic of those for whom ‘plant-based’ hits home but ‘vegan’ ostracises.

Words for Life

What I’m saying is that the subtlety of language and the science behind language responses is both fascinating and incredibly important when you’re quite literally dealing with life and death situations. To illustrate further: A member of my family who has some health issues has been eating lots of desserts (trifles and pies!) in an effort to put on some weight, so I was asked to step in with some advice from afar. In the meantime, their health visitor’s advice consisted of saying ‘eat what you want and as much as you want’ – and this to someone who has had more than one heart attack. Confused by how my advice differed from the sugar-fat-pie-based approach, said family member asked their doctor who was ‘right.’ The response, that we’re both right.

Now, as a language-lover and nutrition expert, I can appreciate that this is both true and a horrendous avoidance of professional responsibility.

My advice was to work to put on healthy weight with a low-glycaemic index diet, plenty of plant-based proteins, reduced intake of saturated animal fats and trans fats but good intake of healthy fats, and a focus on richly nutritious foods that are easy to eat and super tasty. Yes, all my suggestions were vegan but I didn’t use that word once (I know my audience!). Instead, I gave plenty of suggestions of easy things to eat when you have few teeth, little inclination to cook, and burnt out tastebuds. I also copied in other family members who can help prepare easy dishes and dips and so on to increase daily calorie count and interest in food.

Yes, I have a personal interest in helping this person feel better and regain the lost weight, but I also understand the difference between healthy weight gain and unhealthy weight gain. What’s more, I’m willing to take the two minutes or so that is required in order to explain that there is a difference between the two and that it matters. Could the doctor have responded better to the question of who was right and what to do? Most definitely. Did they need to start talking about prostaglandins, pro-inflammatory cytokines, lipoproteins, pancreatic beta cells, and cardiovascular disease factors? Nope.

ADA Guidelines – ‘A’ for Effort

Cater to your audience, but don’t shirk your responsibilities. If you don’t have the language or the skill-set, refer someone on because giving an incomplete answer can be dangerous. That’s why I like these latest guidelines from the ADA. They have chosen specific language with awareness of the simple but oft overlooked issues the word ‘diet’ can trigger, they have actually come out and said no more sugar-sweetened beverages (which is a big deal in terms of food politics but oh so important), and they are subtly encouraging a more plant-based diet but steering clear of any outright prescription espousing straight-edge veganism for all people with diabetes. They advise replacing foods high in trans- and saturated fats for those with unsaturated fats, and choosing meat alternatives and leaner protein sources (beans are pretty lean, you know).

Eee gads, they even have a section that summarises priority topics, specifically for clinicians with a two-minute window to help their patients make healthier choices in terms of diet and lifestyle. Yes, I often want public health guidelines to be more rigorous and comprehensive (I’m an idealist, hah!), but I recognise that people are wonderfully diverse and not all as immersed in food and nutrition and health as I am. So, a steady, studious, and responsible approach to management of diabetes is imperative and the ADA looks to be doing a pretty fine job of it with these new guidelines.

In an interview with Medsape, Dr. Evert said that “Often, nutrition therapy isn’t given the priority that it should haveā€¦ It’s a lot easier to write a prescription than to have a dialog with the patient about eating behaviors.” My favourite word in that sentence? Dialog. Yep, it’s missing a couple of letters but it’s definitely not missing the point.

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{ 1 comment… read it below or add one }

Mary December 15, 2013 at 09:49

Diet is not a bad word! That said, too many people are scared of the word and writing FOR your audience is important.

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