In its recently published Consensus Report (April 18, 2019)[1] the American Diabetes Association emphasized that Medical Nutrition Therapy (MNT) is “fundamental in the overall Diabetes management plan” [2], but what exactly is Medical Nutrition Therapy?
According to the report, the National Academy of Medicine defines Medical Nutrition Therapy (MNT) as ‘the treatment of a disease or condition through the modification of nutrient or whole-food intake’ [1].
In contrast, The Dietary Guidelines for Americans (DGA) “provides advice for healthy Americans ages 2 years and over about food choices that promote health and prevent disease [3]. The Consensus Report says (pg. 2) that The Dietary Guidelines for Americans (DGA) 2015-2020 “provide a basis for healthy eating for all Americans and recommend that people consume a healthy eating pattern that accounts for all foods and beverages within an appropriate calorie level”, but for people with Diabetes;
“recommendations that differ from the DGA are highlighted in this report”.
That means that the eating patterns listed in the American Diabetes Association’s new Consensus Report knowingly differ from the Dietary Guidelines for Americans because they are Medical Nutrition Therapy used in the treatment of a disease (i.e. Diabetes).
The Consensus Report outlines several eating patterns that are effective to varying degrees for achieving different Diabetes-related management goals, including HbA1C reduction, weight loss, lowered blood pressure, improved lipids (higher HDL-c, lower LDL-c), lower triglycerides (TG), but says that low carb eating patterns show the most evidence for blood glucose control [1].
As outlined in the previous article, the Consensus Report includes among the choices of Medical Nutrition Therapy various eating patterns, including a low carbohydrate eating pattern and very low carb (keto) eating pattern and the various eating patterns with their different potential benefits are summarized below [1];
Role of a Registered Dietitian and Healthcare Team in Providing Medical Nutrition Therapy
The Consensus Report highlights (pg. 2) that it is the role of a Registered Dietitian/ Nutritionist (RDN) to provide Medical Nutrition Therapy (MNT), but that other members of the healthcare team (physicians, nurses and pharmacists) can and should complement this with evidence-based guidance (pg. 2);
“To complement diabetes nutrition therapy, members of the health care team can and should provide evidence-based guidance that allows people with diabetes to make healthy food choices that meet their individual needs and optimize their overall health.”
The Consensus Report specifies that the essential components of Medical Nutrition Therapy are;
“assessment, nutrition diagnosis, interventions (e.g., education and counseling), and monitoring with ongoing follow-up to support long-term lifestyle changes, evaluate outcomes, and modify interventions as needed.”
…and that the goals of Medical Nutrition Therapy (from Table 1 [1]) are ;
“To promote and support healthful eating patterns, emphasizing a variety of nutrient-dense foods in appropriate portion sizes, in order to improve overall health and specifically to:
â—‹ Improve A1C, blood pressure, and cholesterol levels (goals differ for individuals based on age, duration of diabetes, health history, and other present health conditions. â—‹ Achieve and maintain body weight goals â—‹ Delay or prevent complications of diabetes
To address individual nutrition needs based on personal and cultural preferences, health literacy and numeracy, access to healthful food choices, willingness and ability to make behavioral changes, as well as barriers to change
To maintain the pleasure of eating by providing positive messages about food choices, while limiting food choices only when indicated by scientific evidence
To provide the individual with diabetes with practical tools for day-to-day meal planning
The Consensus Report also states that the Registered Dietitian/Nutritionists (RDN) is the preferred member of the health care team to provide diabetes MNT and to lead an inter-professional team;
“The unique academic preparation, training, skills, and expertise make the RDN the preferred member of the health care team to provide diabetes MNT and leadership in inter-professional team-based nutrition and diabetes care.”
…but implied in this is that the whole healthcare team needs to work in concert together to choose and customize an eating pattern to the individual’s metabolic needs and personal preferences.
Remember, if you have pre-diabetes or Diabetes (Type 1 or Type 2) and are following any of the eating patterns outlined as Medical Nutrition Therapy (including a low carb or very low carb (ketogenic) eating pattern, then it is understood that these will not be like the food groups and portions of the “food pyramid” of The Dietary Guidelines of Americans because they are therapeutic diets for the treatment of a disease.
If you have been diagnosed as pre-diabetic or as having Type 2 Diabetes (T2D) and would like some professional support to work on reversing the symptoms through a low carbohydrate or very low carbohydrate eating pattern, I can help. I don’t believe there is a “one-sized-fits-all” approach to either of these and will work within you needs to design an individual plan just for you.
You can learn more about my services including individual hourly appointments and sessions as well as packages above under the Services tab or in the Shop.
If you have questions, please feel free to send me a note using the Contact Me form above and I will reply as soon as I can.
To your good health!
Joy
Here are the links to other articles that I wrote about the new ADA Consensus Report:
April 25, 2019 – ADA: Brain’s need for glucose can be fulfilled by
April 23, 2019 – ADA includes use of a Very Low Carb (Keto) Eating Pattern in New Report
April 19, 2019 – New ADA Report: reducing has intake has most evidence for improving blood sugar
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LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the ”content”) are for information purposes only. The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything you have read or heard in our content.
References
- Evert, AB, Dennison M, Gardner CD, et al, Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report, Diabetes Care, Ahead of Print, published online April 18, 2019, https://doi.org/10.2337/dci19-0014
- https://www.nap.edu/catalog/9741/the-role-of-nutrition-in-maintaining-health-in-thenations-elderly.
- Dietary Guidelines for America, https://health.gov/dietaryguidelines/dga95/9DIETGUI.HTM