Kirstie Lithgow is a second year internal medicine resident at the Cumming School of Medicine in Calgary, Alberta.
It is standard care to start patients with type 1 and type 2 diabetes on a “diabetic diet” at the time of admission to hospital. However, some of the menu items offered as part of this diet are suboptimal for glycemic control. Many of the patients with diabetes for whom I have cared have independently raised this concern to me. These patients have specifically stated that their sugars are more labile during admission owing to some meals being higher in carbohydrate content than what they would typically consume at home.
I fully disclose that I have no formal training in nutrition or food sciences. Developing a province-wide hospital menu plan is a huge undertaking, and although I am sure there is room for improvement in many areas, I am admittedly not qualified to weigh in on this. However, one blatant deficiency I have noticed upon reviewing the diabetic menu plan at my institution is the inclusion of fruit juice as a beverage option. I recently contacted the executive director for food and nutrition services for my zone to express my concern. I was assured that the current menu was developed based on recommendations from Canada’s Food Guide, with a focus on providing consistent carbohydrate content with each meal. However, I did not receive a satisfactory explanation for why juice is provided on the diabetic menu.
As a training internist, I am often involved in the care of patients with type 1 and type 2 diabetes, as well as patients who are at risk for these conditions. Patients with a new diagnosis of diabetes or pre-diabetes are routinely counseled to eliminate fruit juices and other sugary beverages from their diets entirely as a first-line means of improving their glycemic control. I have educated many such patients that any nutritional value provided by fruit juice is far better obtained by consuming fresh fruit owing to its added fiber and less detrimental effect on blood glucose levels. As health care providers, I think it is our responsibility to support patient adherence to a diabetic diet while in hospital and to provide them with a template for acceptable food and beverage choices during their interaction with the health care system. Offering juice in hospital is propagating the message that it is an appropriate beverage choice for patients with diabetes; frankly, this is not acceptable.
Eliminating juice from inpatient diabetic menus would be simple to implement, improve patient care, and might even save money. I encourage you to advocate for this change by contacting the food services administration at your respective institutions.
Dr. Barbra Allen Bradshaw, MD FRCPC
This is a very important issue, and why I’m working with a large group of 2600 physicians in Canada who are learning about the impact that sugar, excess refined carbohydrates and processed food have had on our epidemic of nutritional diseases such as obesity, Type 2 diabetes and fatty liver. We are trying to impact Canada’s next dietary guidelines and have written a letter to Health Canada, which can be read and signed here (www.changethefoodguide.ca). Many of my colleagues are putting Type 2 diabetes into remission through dietary changes alone, by adopting a whole food way of eating. Quickly digested sugary food and drink items such as juice will only worsen blood glucose in people with diabetes or pre-diabetes (50% of the population), and improving upon this in the hospital setting will help patients manage blood glucose levels. It is our ethical responsibility to teach patients a way to control their disease by offering nutritious whole food options when in hospital. According to the Senate Committee report on Obesity in Canada, “Fruit juice is presented as a healthy item when it is little more than a soft drink without the bubbles”. I encourage every clinician or allied health provider to contact their own hospital leadership to discuss options to improve inpatient nutrition. This requires a grass roots movement to be successful.
Dr. Barbra Allen Bradshaw, MD FRCPC
Good pint, Kirstie. Although I personally think sugar in fruits is ok.
Anyway, we run a healthcare blog on Diabetes to encourage people to know the risks and make an effort – http://www.diabeteszone.org. We are conducting a conference on Feb 21, 2015 in in New Jersey and wanted to invite you. Drop me a mail if you are interested.