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    SlowFoodFast sometimes addresses general public health topics related to nutrition, heart disease, blood pressure, and diabetes. Because this is a blog with a personal point of view, my health and food politics entries often include my opinions on the trends I see, and I try to be as blatant as possible about that. None of these articles should be construed as specific medical advice for an individual case. I do try to keep to findings from well-vetted research sources and large, well-controlled studies, and I try not to sensationalize the science (though if they actually come up with a real cure for Type I diabetes in the next couple of years, I'm gonna be dancing in the streets with a hat that would put Carmen Miranda to shame. Consider yourself warned).

Diabetes meets ethnic foodways in new ADA series

Just in at my library are two new cookbooks from the American Diabetes Association. Indian Cuisine Diabetes Cookbook by May Abraham Fridel (©2017, ADA, Inc.)  and The Italian Diabetes Cookbook by Amy Riolo (©2016, ADA, Inc.)  are written by two food authorities in their respective home cuisines. The books are bright, they’re attractive, the food looks decent and authentic.

But what makes them “diabetes cookbooks”? What have they changed–or not–about the recipes and what was the ADA’s role other than simply publishing them? Above all, how helpful are they to an average diabetes or prediabetes patient?

Both books start out with an explanation of their food traditions and what’s generally healthy about them. Both include a variety of food categories for different meals, from appetizers or chaats to mostly-protein “main” dishes to mixed casserole-type dishes to salads, breads, soups, cooked vegetables, fruits, baked sweets and drinks. The Indian cookbook also includes some useful spice mixes and tips on how to handle them, and the Italian one includes some traditional menu choices and tips on choosing wine.

The recipes are generally very DASH Diet-able with an emphasis on a variety of vegetables, beans, whole grains, low-fat dairy, whole fruits and nuts, along with smaller portions of meat and cheese and less added sugar for desserts.

On a closer read, the adaptations to recipes mainly look like sane portion sizing for starches and sweets, reducing or substituting poly- and monounsaturated fats for some of the saturated fats, cutting down excess sugars in sweets and desserts, adding fruit and vegetables, and substituting almond flour and dried fruits for standard flour and sweeteners. The recipes are adjusted just enough to be low in sodium and saturated fat, reasonable on calories, total carbohydrates and added sugars. The portion sizes listed are smaller than what you’d get at an American restaurant or see on a magazine cover these days but they’re close to the amounts people traditionally serve.

So the nutrition stats are a general improvement compared with most current cookbook-style recipes for equivalent dishes, and it looks like the nutrition guides at the bottom of each recipe are relatively accurate given the ingredients. So far so good. If this was the ADA’s doing, I’m all for it.  But it seems obvious to me that it would be better to trust the ADA reviewers’ understanding of diabetes nutrition than either cookbook author’s.

I was surprised to find that the ADA let each of the authors go her own way on the introductions, and that the health explanations tend to be vague and cultural rather than practical. In the Indian cookbook, Fridel describes ayurvedic dietary principles rather than talking about nutrients. Riolo also veers off into a discussion of which appetizer traditionally goes with which first course and how to choose Italian wines in a way that doesn’t really have anything to do with target carb counts or  exchanges for a meal either.

You can discount or admire these things as you please, but you can’t really learn a lot from them diabetes-wise. They’re not really directed toward helping patients put together balanced, carb-controlled meals from the nutrition stats given with the recipes.

Moreover, the ADA’s particular nutrition stats system lists “carbohydrate exchanges” separately from “starch,” “fruit” “vegetable” and “dairy” exchanges, even though most of the ingredients that fall into those categories contain significant carbohydrates. All of them have to be counted for diabetes management.

It’s not clear why their system differs so much in this regard from the Academy of Nutrition and Dietetics’ standard “Choose Your Foods” exchanges system for carb count approximations. It works okay for figuring out standard servings definitions for the major food groups if you’re following the DASH Diet or USDA/HHS MyPlate plans, but it’s not really in keeping with the way endocrinologists and certified diabetes educators train Type I diabetes patients. It makes carb counting and carb planning for meals more complicated than it has to be. That can’t be a good thing.

Also, simply giving the nutrition and exchanges stats for each recipe as it shows up in the book is not the same as teaching a new patient how to carb count or set up a balanced plate. Most of the dishes are mixtures of carb-containing and noncarb-containing ingredients–casseroles, soups with beans, meat and vegetables, biryanis, meatballs containing breadcrumbs, and so on. Those are some of the most difficult foods to estimate carbs for by eye, and it’s not visually obvious–or discussed in any detail–what the authors and their nutrition consultants at the ADA did to adjust these specific recipes.  In this regard the ADA books are no worse than most “diabetes diet” cookbooks and magazine recipe collections, but they’re also not much clearer.

Beginners really would do better to start with the carb and noncarb foods separated on the plate, at least until they get a feel for what to count and how much food to serve.

What both of these books–and any others in the ADA series–could use is a short, clear explanation for how to work through the nutrition stats they give in each recipe and how to plan a nutritionally balanced meal around that dish to reach a target total amount of carbohydrate. A two-page standard ADA primer with a basic diabetes meal plan diagram, some suggested per-meal carb counts or carb exchanges, a balanced-nutrition plate à la ChooseMyPlate.gov,  examples of where to look in the recipes for serving sizes and how to create a full meal from them, how to add things up for a meal’s total carb, etc., would help a lot. It might also be helpful to point out how to rework the meal plan if someone wants more than the standard serving amount or takes second helpings.

All in all, these two cookbooks aren’t terrible as cookbooks, but they’re not nearly as helpful as they could be as diabetes guides.

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