- With Mayo Clinic nutritionists
Jennifer Nelson, M.S., R.D. and Katherine Zeratsky, R.D.
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Jennifer Nelson, M.S., R.D. and Katherine Zeratsky, R.D.
Katherine Zeratsky and Jennifer Nelson
Jennifer K. Nelson, M.S., R.D., L.D., C.N.S.D.
Jennifer Nelson is your link to a better diet. As specialty editor of the Food & Nutrition Center, she plays a vital role in bringing you healthy recipes and meal planning."Nutrition is one way people have direct control over the quality of their lives," she says. "I hope to translate the science of nutrition into ways that people can select and prepare great-tasting foods that help maintain health and treat disease."
A St. Paul, Minn., native, she is certified by the National Board of Nutrition Support Certification, has been with Mayo Clinic since 1978, and is director of clinical dietetics and an associate professor of nutrition at Mayo Clinic College of Medicine.
She leads clinical nutrition efforts for a staff of more than 50 clinical dietitians and nine dietetic technicians and oversees staffing, strategic and financial planning, and quality improvement. Nelson was co-editor of the James Beard Foundation Award-winning "The New Mayo Clinic Cookbook." She has been a contributing author to and reviewer of many Mayo Clinic books, including "Mayo Clinic Healthy Weight for EveryBody," "The Mayo Clinic Family Health Book" and "The Mayo Clinic/Williams Sonoma Cookbook." She contributes to the strategic direction of the Food & Nutrition Center, which includes creating recipes and menus, reviewing nutrition content of various articles, and answering nutrition questions posed to Ask a Specialist.
Katherine Zeratsky, R.D., L.D.
As a specialty editor for the Food & Nutrition Center, Katherine Zeratsky helps you sort through the facts and figures, the fads and the hype to learn more about nutrition and diet.A Marinette, Wis., native, she is certified in dietetics by the state of Minnesota and the American Dietetic Association. She has been with Mayo Clinic since 1999.
She is active in nutrition-related curriculum and course development in pediatrics at Mayo Clinic Rochester and nutrition education related to the physiology and recommended intakes for premature infants.
Other areas of interest include breast milk and formula safety, neonatal feeding, and nutrition for breast-feeding mothers.
She graduated from the University of Wisconsin-Madison, served a dietetic internship at the University of Iowa Hospitals and Clinics, and worked as a registered dietitian and health risk counselor at ThedaCare of Appleton, Wis., before joining the Mayo Clinic staff.
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Nutrition-wise blog
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Feb. 3, 2009
Part 2: For those with diabetes — there's more to it than carbs
By Jennifer Nelson, M.S., R.D. and Katherine Zeratsky, R.D.
I'm glad to see the responses — and the strong opinions expressed thus far — to last week's blog.
Indeed the January 2008 "American Journal of Clinical Nutrition" analysis of diets from the Diabetes Control and Complications Trial presents striking findings that challenge some long-held assumptions. The study showed that diets lower in carbohydrates — and higher in total fat and saturated fat — resulted in need for higher insulin doses and worse glycemic control in people with type 1 diabetes. The study did not look at those with type 2 diabetes.
It's worth stepping back and looking at some nutrition basics. Diets are constructed by varying the amounts of four calorie-providing nutrients: carbohydrates, protein, fat and alcohol. Reducing one component — for example carbohydrates — results in the need to adjust the others to meet calorie needs.
In this study, people following lower-carbohydrate diets consumed higher amounts of fat and saturated fat. The substitution of fat calories — especially saturated fat — for carbohydrate calories resulted in significantly poorer control of blood glucose and need for higher insulin dose. Conversely, diets lower in total fat and saturated fat — and higher in carbs — were associated with better control. The authors refer to previous studies that also point to saturated fat as a possible mechanism behind the need for increased insulin and poorer control in the long run.
Intuitively we think that lowering carbohydrates should result in better control of diabetes. But what we may have overlooked is that by making this change we could end up increasing the intake of other nutrients with potentially adverse effects. For those with type 1 diabetes, this study makes the case that there's more to it than carbs: We also need to pay attention to fat and saturated fat.
More research is needed. How many carbs? How much fat? What about protein and alcohol? Moderate amounts for all? How do various foods fit into these diets and what is the result of the types of carbs (fiber) and fat (saturated, mono and polyunsaturated) that we eat? And what about vitamins, minerals and other nutrients? Furthermore, do different diets have different effects on control of type 1 and type 2 diabetes?
I believe wholeheartedly that there is no "one diet that fits all." It's important for those with diabetes to work with their health care providers to achieve optimal glycemic control — and to follow a healthy diet that's tailored to their needs.
Finally, to those who noted that 45% of calories from carbohydrates is not the definition of a low-carb diet, I agree. You'll notice that we've changed the title of the blogs to reflect this. However, the surprising thing in this study was that the mild reduction in carbs resulted in people eating diets that had enough total and saturated fat to require more insulin.
26 comments posted
- Delahanty LM, et. al. Association of diet with glycated hemoglobin during intensive treatment of type 1 diabetes in the Diabetes Control and Complications Trial. American Journal of Clinical Nutrition. 2009;89:518.
- Djousse L, Gaziano JM. Egg consumption in relation to cardiovascular disease and mortality: The Physicians' Health Study. American Journal Clinical Nutrition. 2008;87:964.
26 comments posted