ADA Diet

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KCP012: Why The American Diabetic Association (ADA) Diet Is Killing You

Terms In This Episode (1:01):

Before we dive into to day’s topic, let’s examine the following terms or definitions so that you have a clear understanding of just exactly what is that we will be talking bout.

Standard American Diet (SAD) – The standard American diet or SAD diet, also known as “The Western Pattern Diet”. It is a diet or eating pattern that contains high amounts of red meat, dairy products, and eggs. On Average the typical SAD diet is comprised of about 50% carbohydrates, 15% protein and 35% fat. It is this high concentration of carbohydrates which are then processed and turned into glucose by your liver that puts you at risk for developing diabetes, metabolic syndrome, cardiovascular disease, and morbid obesity.

American Diabetic Association Diet (ADA) – There is no official 1800 or 2000 calorie ADA diet. What the ADA does recommend is a calorie restricted diet based on their “My Plate Method’ and or the Diabetic Choices Diet. The my plate method promotes the simple idea that your plate should be divided into three distinct portions. According to the American Diabetic Association website this means that for each meal, the calories from your plate should contain 25% carbohydrates from grains and starchy foods, 25% from protein, and 50% from non-starchy vegetables. The Diabetic Choices Diet is based on the concept of food exchanges or choices. Each day depending on your prescribed caloric range, you can have a certain number of starches, meats, vegetables etc. Keep in mind these recommendations are current as of 2017, and come straight from the ADA website.

Eating Patterns – An eating pattern is a term used to describe the foods or groups of foods that a person chooses to eat on a daily basis over time. Some of the eating patterns listed on the ADA website include: Mediterranean, vegetarian or vegan, low carbohydrate, low fat, and the low sodium or DASH (Dietary Approaches to Stop Hypertension) diet. While the ADA does not specifically promote any of these eating patterns, they recognize that each may be a viable option for treating type 2 diabetes. Regarding eating plans the ADA states “Studies show there are many different eating patterns that can be helpful in managing diabetes. In the long run, the eating pattern that you can follow and sustain that meets your own diabetes goals will be the best option for you.” So while you may use any one of these, or other eating patterns, you would still use the ‘My Plate’ or ‘Diabetic Choices Diet’ while eating these types of foods or foods from these food groups.

 

Main Topic (5:44):

So you have just left your doctor’s office and you have been told that your hemoglobin A1c is greater than 7%. That you have uncontrolled type 2 diabetes. Your doctor had written you a prescription for an oral anti-diabetic medication, and gave you some information regarding the disease, and scheduled you an appointment with a diabetic education nurse and or dietician. When you get home you begin researching diabetes and come across the 1800 or 2000 calorie ADA diets and various diet plans. What I did find on the ADA website are two different, but similar diets endorsed by the ADA to teach diabetics how to control their blood sugars. The first is known as ‘My Plate’, the second is the Diabetic Exchange or Choices diet. Plans such as:

The University of Michigan (1,800 calorie My Plate Diet)

The University Of Southern Alabama College Of Medicine (1,800 calorie Diabetic Choices Diet).

The United States Department Of Agriculture (USDA) ‘Dietary Guidelines For Americans.’ The most recent 8th edition of the USDA recommended dietary guidelines covers the years of 2015 – 2020 and can be downloaded for free from the internet. If you are interested in checking them out, and you can find a link for them in the show notes on my website www.ketoconfidential.net.

What is important about the USDA dietary guidelines is that they have created a specific range of caloric intake for men, women, and children based not only on age, but activity level. These daily caloric intakes range from 1,000 to 3,200 calories per day. On page 77 of the USDA dietary guidelines is the following statement. “The total number of calories a person needs each day varies depending on a number of factors, including the person’s age, sex, height, weight, and level of physical activity. In addition, a need to lose, maintain, or gain weight and other factors affect how many calories should be consumed….Estimates range from 1,600 to 2,400 calories per day for adult women and 2,000 to 3,000 calories per day for adult men ”.

So, if you are a physician, medical professional, or organization and your diabetic patients or clients are obese and you think that they need to lose weight, the easiest thing to do is get a copy of the USDA dietary recommendations go to Table A2-1, ‘ The Estimated Calorie Needs per Day, by Age, Sex, & Physical Activity Level‘ on page 77 and cross reference your patients age with their activity level and the chart will give you a suggested amount of calories that your patient or client should eat each day.

So what happens when your doctor or dietician thinks you need to lose more weight? It is really quite simple, they tell you to reduce the number of calories that you eat each day by about 400 – 600 calories or around 18 – 20% of your total dietary intake. So if you were currently eating 2,400 calories a day, the doctor would simply move down to the next column and suggest you eat 2,000 or less a day. Pretty simple right?

So why is there such a focus on the number of calories you eat each day rather then the number of carbohydrates you eat each day? The primary reason is that most medical professionals and the ADA believe that the reason that you are overweight is because of the amount of calories that you consume each day. This is the same reason that many big pharmaceutical companies that produce anti-diabetic medications as well as companies such as Weight Watchers and Jenny Craig promote calorie restricted diets. These diets are then printed and freely distributed to hospitals, doctors offices, and clinics labeled by these companies or organizations as the 1800 or 2000 Calorie Diabetic Diet’ which often gets referred to as the ADA 1800 or 2000 calorie diet.

It’s really that simple. I see our diabetic educators give this type of dietary information to diabetic patients all the time prior to discharging them home. In fact, I actually had this type of brochure given to me not only at my doctor’s office, but also when I went to my first diabetic education class. And to be honest, at the time, I thought it was an ADA approved diabetic diet. But, the reality is, these calorically restricted diets are not officially endorsed by the ADA. And if the ADA does not endorse these 1800 and 2000 calorie diets, the next questions is what are the ADA’s actual dietary recommendations. That’s what we are going to look at next. Two specific, but different eating methods that are officially endorsed by the ADA. The first is the ‘My Plate’ method, and the second is the Diabetic Choices Diet.

The ADA ‘My Plate’ Method (13:47)

The ‘My Plate’ method is touted as a simple way for diabetics to make food portion control easy. The idea is that if you make it easy, then the patient will be compliant with the ADA’s dietary recommendations. While it it true, the ‘my plate’ method is a quick and simple way to prepare your plate and control your portion size, it is still a poor dietary tool for type 2 diabetics. Let me rephrase that “if you want to reverse your type 2 diabetes, then the ‘my plate’ method will never work for you. Why you ask? Because the my plate method contains way to many carbohydrates each meal to get you into a state of nutritional ketosis.

Let’s examine the nutritional information regarding the ‘my plate’ servings. According to ‘Diabetes Forecast‘, the official magazine of the ADA. They list the ‘My Plate’ nutritional information as follows. A ½ cup of cooked or 1 cup raw starchy vegetables (1 serving) = 15 grams of carbohydrates,

a ½ cup of fruit (1 serving) = 15 grams of carbohydrates, a ½ cup of dairy (1 serving) = 12 grams of carbohydrates, and 1 serving of fat = 5 grams of fat.

So, I ran some rough numbers based on the recommendations on the ADA website using the ‘My Plate’ example. If you carefully measure out the recommended portions as proposed by the ADA each day you would be eating about 108 – 130 grams of total carbohydrates for three meals and two snacks, and 123 – 145 grams of carbohydrates a day for three meals and three snacks.

The following free downloadable copy of the ‘Create Your Plate’ brochure produced by the ADA. At the bottom of the brochure they recommended the following book ‘What Do I Eat Now, A Step-By-Step Guide to Eating Right With Type 2 Diabetes‘. If you followed just the meal recommendations in this book you would be consuming 135 – 180 grams of carbohydrates per day following the 45 – 60 gram meal recipes. Or 195 – 210 grams of carbohydrates using the 65 – 70 gram recipes. These numbers do not however include the two snacks that are recommended by the ADA, so you need to add an additional 30 grams of carbs to the total daily intake bring them to a total of 165 – 210 grams of carbohydrates per day for the 45 – 60 gram meal recipes. Or 225 – 240 grams of carbohydrates for the 65 – 70 gram recipes.

If 50% of the energy from the SAD comes from carbohydrates. And you were to eat 1,800 calories a day. That means that 900 calories of the SAD is made up of carbohydrates. To determine the number of grams of carbohydrates we divided 900 calories by 4, because each gram of carbohydrate contains 4 calories, that comes out to 225 grams of carbohydrates per day. Wow, that’s pretty close to the 165 – 210 grams of carbs for the 45 – 60 gram carb per meal plan. And as good as or better than the 225 – 240 grams of carbs per day for the 65 – 70 gram carb meal plan recommended in the book ‘What Do I Eat Now, A Step-By-Step Guide to Eating Right With Type 2 Diabetes‘.

So if the total amount of carbohydrates consumed is the primary cause for the rise in your blood sugar as the ADA proposes, then why do they not endorse the ketogenic diet which promotes carbohydrate restriction to control your type 2 diabetes. In fact, the numbers indicate that a 1,800 calorie diet using the recommended ‘My Plate’ method is not really any better than a 1,800 calorie SAD diet that contains about 50% carbohydrates. Which I admit is not what I expected. And I ran the numbers a couple of times just to make sure they were right.

The Diabetic Exchange Diet (23:07)

The concept is relatively simple. The “diabetic choices” diet, groups foods into six different categories. Such as starches, fruits, vegetables, milk, meat and meat substitutes, and fats. One serving in a particular group is called a “choice”. Each serving in a choice group contains about the same amount of carbohydrates, protein, fat, and or calories as another choice. One serving of starch or fruit contains 15 grams of carbohydrates, one serving of milk contains 12 grams of carbohydrates, one serving of lean meat contains 7 grams of protein and only 1 – 3 grams of fat, and one serving of fat contains 5 grams of fat.

The number of exchanges or choices you can have each day depends on….you guessed it, the number of calories you are allowed to eat. According to the book ‘The Ultimate Diabetes Meal Planner: A Complete System for Eating Healthy with Diabetes‘, the diabetic “choices” method supplies about 1,800 – 2,500 calories per day depending on the foods selected. In fact, the description of the book which is sold on the ADA website, states “Ultimate Diabetes Meal Planner includes weekly plans for breakfast, lunch, dinner, and snacks, along with detailed recipes that make using the 16-week meal plan easy. The overall calorie count—based on 1500, 1800, 2000, 2200, or 2500 daily calories—lets you choose the right diet, whether you’re looking for weight loss or just healthy living.

I addition, step two in the ‘How To Use This Book’ section of the ‘Ultimate Diabetes Meal Planner’ reads as follows “During the meeting with your healthcare team, you should ask how many calories you should be eating per day. The meal plans in the Ultimate Diabetes Meal Planner fall into four daily calorie levels: 1500, 1800, 2000, and 2200 calories per day. Find out which of these levels works best for your health needs.

Looking for more information, I downloaded an 1,800 calorie Diabetic Choice sample menu from the University Of Alabama College of Medicine just how many carbohydrates are in an 1,800 calorie diabetic choice diet. The University Of Alabama sample menu consists of: 8 starches, 3.5 fruit, 3 milk, 5 vegetables, 6 meats, and 5 fat servings which comes out to 197.5 grams of carbohydrates. The typical 1,800 calorie SAD diet in my previous example contained 225 grams of carbohydrates, which means there is only a difference of 27.5 grams of carbohydrates between the 1,800 calorie SAD diet and the 1,800 calorie Diabetic Choice diet. I will be honest, I never thought these two diets would contain such similar amounts of carbohydrates.

But what about fat? We know that healthy fat not only supplies calories, but is a necessary part of making us feel full helping to curb our appetite. Unfortunately both the ‘My Plate’ and the Diabetic Choice diet are low fat diets. Again I quote from the ‘Ultimate Diabetes Meal Planner’ “None of the recipes in The Ultimate Diabetes Meal Planner contain more than 3 grams of saturated fat and most contain no trans fat. Fat packs more calories per gram than any other nutrient, so if you are aiming to lose weight, it is especially important to lower the amount of fat in your daily meals”.

Yes, fat contains more then twice the calories than carbohydrates, but it is the consumption of healthy fats in the diet that is the cornerstone of the ketogenic diet. Because you eat a diet that is low in carbohydrates, your body begins to burn stored fat. In turn, because the calories you do eat are high in fat you have high levels of satiety which means that overall you eat less calories. Not because you are restricting calories, but simply because you are not hungry. Through the power of ketosis, you are able to tap into your stored fat reserves which then causes you to lose weight. This can never happen while you are eating the ‘My Plate’ or Diabetic Choice Diets. You will never be able to get into a fat burning state eating this amount of carbohydrates.

I want you to understand, I am not saying the ‘My Plate’ and Diabetic Choice Diets will not help you to lower your insulin levels. Any reduction in carbohydrates is going to have some effect, but the carb counts in these two ADA recommended diets is to high. What I am saying is neither of these diets will help you to reverse your diabetes, they simply contains two many carbohydrates to get you into the fat burning state of nutritional ketosis. Following these dietary plans will leave you dependent on insulin or oral diabetic medications for the rest of your life, and in my opinion that is not acceptable.

The ADA Position On Recommended Treatment For Type 2 Diabetes (32:04)

So, if the ADA believes that controlling or reducing the number of carbohydrates you consume each day is effective at reducing your blood sugar why hasn’t the ADA been more aggressive in adopting a more restrictive carbohydrate approach to managing type 2 diabetes? Why do they promote such high carbohydrate diets as the ‘My Plate’ method and the ‘Diabetic Choice Diet’ for type 2 diabetic patients. And lastly, why hasn’t the ADA adopted the ketogenic diet as a safe and effective way to treat type 2 diabetes?

According to the ADA position statement ‘Nutrition Therapy Recommendations for the Management of Adults With Diabetes.’ Type 2 diabetes is a progressive disease that will only get worse as you get older. That there is no specific cure or way to reverse your diabetes, that at best, you can only hope to minimize your complications. And I quote,“Due to the progressive nature of type 2 diabetes, nutrition and physical activity interventions alone without pharmacotherapy are generally not adequately effective in maintaining persistent glycemic control over time for many individuals. However, after pharmacotherapy is initiated, nutrition therapy continues to be an important component of the overall treatment plan.”

So how does the ADA actually gauge the effectiveness of their recommended treatment options? Well the gold standard for measuring the effectiveness of treatment modalities of type 2 diabetes is by measuring your hemoglobin A1c. Your hemoglobin A1c is the bio-marker that indicates the average amount of circulating blood glucose that you have in your blood stream over the last three months. In the United States, depending on the lab or clinic you use, a normal non-diabetic hemoglobin A1c is 4 – 5.6%. So if your HgbA1c is less than 5.6%, you are considered non-diabetic, a hemoglobin A1c of 5.7% – 6.4% indicates you are pre-diabetic, and a hemoglobin A1c of 6.5% or higher classifies you as diabetic.

According to the ADA, the World Health Organization (WHO), the Indian Health Services (IHS), and the center for Medicaid and Medicare Services (CMS) the recommended guidelines for a targeted glycemic goal in patient’s with type 2 diabetes is to reduce and maintain the patient’s HgbA1c to about 7%. The American Association Of Clinical Endocrinologists (AACE) recommend that physicians keep their patients HgbA1C around 6.5%.

Their standard of care is to regulate your HgbA1c so that it maintains a level of about 7% which still keeps you in the diabetic range. Why? Because they would rather use medications to keep you in a slightly higher A1c range, rather than implementing stricter dietary controls to help you reverse your diabetes. As far as the ADA is concerned, the best that you can hope for is to reduce the long term complications of the disease. This is the message that many diabetics hear. It it was the same message that was relayed to me by both my doctor and my diabetic educator when I was diagnosed with diabetes.

But here’s the thing….it is a LIE….Type 2 diabetes is reversable. I have reversed my diabetes by embracing the ketogenic lifestyle and adopting the ketogenic way of eating. My current hemoglobin A1c is 5.2%, before I started on the ketogenic diet my hemoglobin A1c was 7.1%. I have been able to stop taking my insulin, and I am off my blood pressure medications. But I am not alone, there are thousands of people who have reversed their type 2 diabetes just as I have with the ketogenic diet. But you will never be able to reverse your type 2 diabetes as long as you follow the dietary recommendations of the American Diabetic Association. I am sorry, that’s just the plain honest truth. I admit it took me along time before I came to this conclusion, and I am glad that I discovered this ketogenic way of living. I honestly believe that it saved my life, and it can save your life or the life of someone you love.

You’ve Got Mail (39:30):

If you have any feedback regarding anything you have heard in this or other episodes, or you just want to drop us a line with a question or two, or you just want to share your success story with us, you can send me an email at todd@ketoconfidential.net. Or you can give us a call at 469-526-3665 on your phone and leave me a voice mail that will be played in this segment of the podcast.

Recipe(s) Of The Episode (44:15):

The holiday season is upon us, and we all need some quick and easy keto type snack or party foods so this week I will sharing with you my quick and easy keto version of deviled eggs, as well as my version of Chipotle’s Restaurants ‘Chipotle’s Honey Vinaigrette’ salad dressing that has been ketofied and that’s, well delicious. So let’s get started by making my delicious deviled eggs which not only taste fantastic, but only contain 0.4 grams of carbohydrates per ½ egg serving. To make these deviled eggs you will need:

12 eggs, boiled

¼ to ¾ cup of mayonnaise

2 tablespoons dill pickle relish

2 – 3 drops of liquid sucralose or 2 – 3 teaspoons of powdered keto sweetener

½ teaspoon onion powder

½ teaspoon garlic powder

¼ paprika

Add one cup of water to the bottom of your Instant pot or electric pressure cooker, then place the steamer basket and then one dozen eggs on top of the basket. Cook the eggs on 6 – 7 minutes. Then cover the release valve with a tea towel and release the pressure. Remove the eggs and place them in an large bowl containing ice and water and allow them to cool for 5 – 10 minutes. I use this method because it make perfect eggs every time and they are easy to peel. You can use other methods to cook your eggs, but if you have an electric pressure cooker and try this method, I guarantee you that you will never make boiled eggs any other way.

 

One you have cooled and peeled your eggs, you want to cut them in half length wise and remove the cooked yolks and place them in a bowl. Once you have removed all the yolks, place the boiled egg whites on a plate or deviled egg container and prepare your filling.

 

In order to make the filling, you are going to need to take a fork and mash the yolks filling until it takes on a crumbly texture, which is kind of hard to describe, but don’t worry, the yolks will become nice and creamy when you add the mayonnaise. Once you have mashed the yolks, add all of the dry ingredients and the dill pickle relish. Once these are incorporated you start by adding the mayonnaise ¼ cup at a time and blend it with your fork or a spoon.

 

Now, I do not want to say that making deviled eggs is an art form, but the amount of mayonnaise you use will determine the texture of the filling. If you like a creamier filling then you will need to use more. If you like a slightly more dense texture then use less. As for sweetener, this is a matter of personal preference and it is optional. We like over deviled eggs to have a slight sweetness. When I was a child my mother made deviled eggs with Miracle Whip, so to give my deviled eggs that same sweetness, but none of the carbs, I use dill pickle relish with 2 – 3 drop of liquid sucralose. You can however omit the sweetener. To finish up your filling you want to salt and pepper it to taste, again this is a personal preference, but if you want a good starting point then you can use ¼ teaspoon of each.

 

Once your filling is to your liking, it’s time to fill your eggs. In the restaurant we would use a piping bag with a star tip to make them nice and pretty. At home, I take a plastic zip lock type sandwich bag and fill it with a spatula making sure to close the top. Then you cut one corner off the bag and fill the cavity of each half of your egg whites. Sprinkle a little paprika on the top if you so desire for presentation and place them in the fridge until you are ready to serve them.

 

Nutritional Informational (½ Cup Mayo)

Total Recipe (24 ½ Egg Servings)

1695 Calories, 143 grams of fat, 73 grams of protein, 10 grams of carbohydrates

Per Serving (½ Egg)

70 Calories, 6 grams of fat, 3 grams of protein, 0.4 grams of carbohydrates

Nutritional Informational (¾ Cup Mayo)

Total Recipe (24 ½ Egg Servings)

2069 Calories, 185 grams of fat, 74 grams of protein, 10 grams of carbohydrates

Per Serving (½ Egg)

86 Calories, 7.7 grams of fat, 3 grams of protein, 0.4 grams of carbohydrates

Chipotle’s Honey Vinaigrette

The original Chipotle recipe calls for the use of honey, hence the name ‘Chipotle Honey Vinaigrette’. However my keto version substitutes liquid sucralose for the honey. When I originally created this recipe I used Splenda as my keto sweetener, so if you are new to the ketogenic way of eating and are on a limited budget, the Splenda will work just fine. You can of course use any sweetener you wish, in order to get the sweetness equal to 2 – 3 teaspoons of sugar. Using one chipotle chile makes this recipe mild, so if you like your dressing to have a little more heat then go for 2 chipotle chilies.

¾ cup olive or canola oil

¼ cup red wine vinegar

1 – 2 chipotle pepper’s

2 – 3 drops of liquid sucralose or (2 – 3 teaspoons Splenda)

1 teaspoon salt

½ teaspoon adobo sauce

½ teaspoon garlic powder

½ teaspoon cumin

½ teaspoon oregano

½ teaspoon black pepper

Combine all the ingredients in a pint mason jar, then take your immersion or stick blender and place it in the jar and puree the ingredients for about 10 – 15 seconds. That’s all there is to it. If you do not have a stick blender, then you can combine all ingredients in a food processor and process to puree chipotle pepper and combine all the ingredients. With the food processor still running drizzle in the oil until the salad dressing becomes an emulsion.

Total Recipe – Calories 131, fat 11 grams, protein 0.7 grams, carbohydrates 9 grams

1 Tablespoon – Calories 8.1, fat 0.68 grams, protein 0.04 grams, carbohydrates 0.56 grams

So there you have it, my version of Chipotle’s ‘Chipotle Honey Vinaigrette’. I really like this dressing, and it has become one of my favorites. Making it with one chipotle makes it more wife friendly, as my wife does not care for too much heat, and she thinks Chiptole’s version is a little hot. Personally, I like it made either way. That’s the great thing about making your own dressings and condiments, it gives you total control to use the type and amount of ingredients you wish.

Links From This Episode:

Dr. Jason Fung and Megan Ramos’s Intensive Dietary Management (IDM) Website

The Intensive Dietary Management (IDM) Podcast

Dr. Eric Westman’s Healthy Eating And Living (HEAL) Clinics Website

 

References:

Carbohydrate Counting & Diabetes: What Is Carbohydrate Counting? National Institute Of Diabetes and Digestive and Kidney Diseases, June 2014. Accessed December 1, 2018.

Diabetes Diet: Create Your Healthy-Eating Plan? www.mayoclinic.com, Accessed December 1, 2018

Diabetes: Meal Plan Ideas, 1800 Calories Per Day. University Of Michigan Comprehensive Diabetes Center. Last revised 11/13/2015. Accessed November 17, 2018.

Gray, Alison, RD, Nutritional Recommendations For Individuals With Diabetes. Comprehensive Endocrinology Textbook. Last revised May 31, 2015.

Hamilton, Lara, RD, CDE, Foods For Your Plate: Healthy Foods to Fill Your Plate. Diabetes Forecast Magazine, November 2015.

Higgins, Jaynie, AC, CPT, Groetzinger, The Ultimate Diabetes Meal Planner: A Complete System for Eating Healthy with Diabetes, The American Diabetes Association, 2009-16.

Hirsch, Irl B. MD, The Death Of The 1800-Calorie ADA Diet, Clinical Diabetes, April 2002.

Phinney, Stephen M.D., Volek, Jeff, Ph.D. (2011). The Art And Science Of Low Carbohydrate Living. Beyond Obesity LLC.

Phinney, Stephen M.D., Volek, Jeff, Ph.D. (2011). The Art And Science Of Low Carbohydrate Performance. Beyond Obesity LLC.

Ross, Tami RDN, LD, CDE, MLDE, Geil, Patti MS, RDN, LD, CDE, MLDE, FAND, FAADE, What Do I Eat Now? A Step-By-Step Guide to Eating Right With Type 2 Diabetes 2nd Edition, The American Diabetes Association, 2009-15.

Spritzler Franziska, RD, CDE, How Many Carbs Should A Diabetic Eat?, Healthline Red, November 16, 2016.

Tan, Evelyn PharmD, Polello, Jennifer MHPA, MCHES, and Woodard, Lisa PharmD, MPH, An Evaluation of the Current Type 2 Diabetes Guidelines: Where They Converge and Diverge, Clinical Diabetes 2014 July; 32(3): 133-139.

The ADA Diet Myth, Diabetes Forecast, The Healthy Living Magazine, March 2011.

The Sad Consequences of the Standard American Diet (SAD). www.atkins.com, Accessed November 20, 2018.

The 1800 Calorie Meal Planning Guide For Diabetics, University Of Southern Alabama College Of Medicine. Accessed November 10, 2018.

What Are Trans Fats? American Heart Association, Accessed November 28, 2018.

Wheeler, Madelyn MS, RDN, FADA, FAND, CD, Food Lists For Diabetics Get An Update: Nutrition Guides Offer New Items and replace “Exchanges” with “Choices”. Diabetes Forecast Magazine. June 2014.

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