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Sansum Diabetes Research Institute
2219 Bath Street
Santa Barbara, CA 93105
E-mail: ljovanovic{at}sansum.org
Nutritional Management of Diabetes Mellitus and Dysmetabolic Syndrome is a book that reviews the proceedings of a program sponsored by Nestlé in Hangzhou, China, as part of the Nestlé Nutrition Workshop Series. This book's intent is twofold. First, it seeks to address lifestyle and nutritional issues to lessen the effect of diabetes mellitus. Second, it is intended to provide information to lessen or reverse the current trend toward an epidemic of diabetes mellitus, with its concomitant cardiovascular risks. Although the optimal diet with which to prevent and treat diabetes and the dysmetabolic syndrome has not been elucidated through the publication of randomized clinical trials, which are deemed to provide the highest level of evidence, there is sufficient general agreement that the nutritional recommendations of various international organizations are reasonable, and thus a consensus can be reached. This book contains the proceedings of the consensus conference.
The text is divided into 5 sections. The first section, entitled "The Dysmetabolic Syndrome," comprises 3 chapters. Perhaps the most difficult area for the clinician is to define the syndrome and thus devise a treatment. Therefore, the most important general section is the first chapter, which includes tables of definitions. It should be pointed out that some of the opinions in this chapter remain controversial. The commentary on the causes of the metabolic syndrome is not universally accepted, but the chapter is informative, and the material is intelligently presented. This section also includes an interesting discussion of traditional Chinese medicine in the treatment of diabetes. Here again, the table is very useful: it provides in one place a list of the herbs, with both the Chinese and the English names. In addition, there is a list of classic recipes and ingredients. For those whose patients ask questions about these Chinese medicines, this list is priceless.
Especially intriguing are the question-and-answer sections that follow each chapter, which serve to clarify and focus the discussion. Under the second section, on "The Glycemic Control of Carbohydrates," opposing opinions are presented, and the respective authors engage in healthy discussions. This dialogue is especially useful in setting a context for the information presented and in helping the reader to use the information in his or her own practice or research. The debate on the usefulness of the glycemic index appears to be decided in favor of the index. However, the point-counterpoint presentation allows the reader to make the appropriate conclusion.
Section 3 is entitled "Beyond Glycemic Control"; it focuses attention on the other important components of the dysmetabolic syndrome—specifically, lipids, antioxidants, and body weight. The section is summarized by a chapter comparing the psychosocial approach to diet and the choice of a specific diet. This is a good discussion on the approaches that help maintain patients on diets—certainly the most important feature of any diet for long-term weight loss.
The final sections—"Diabetes in the Life Cycle" and "The Role of Drugs and Diet Therapy"—contain excellent chapters. Wilkin presents a comprehensive discussion on the accelerator hypothesis, which essentially combines type 1 and type 2 diabetes under a single pathophysiologic process, with genetic variation being the underlying wild card. As with other material in this volume, there is still much controversy related to this topic, but the arguments made by Wilkin are clear and well-informed. The chapter entitled "Diet and Medical Therapy in the Optimal Management of Gestational Diabetes" especially intrigued us in view of our own work in the field of nutrition and pregnancy. Unfortunately, although the chapter is an excellent review of the pathophysiology of gestational diabetes, the single paragraph on nutritional therapy was superficial and did not outline specific caloric and carbohydrate recommendations but, rather, stated only that caloric and carbohydrate restriction is "experimental."
The book is nicely rounded out by the last chapter—a review of the nutritional recommendations of 6 major organizations, detailing the recommendations about which a consensus has been reached and those without a consensus. Here the clinician would be wise to copy the "Aims and Goals of Nutritional Advice" and post that table in the clinic for all to follow. Overall, this book provides an excellent review of certain aspects of the nutritional management of diabetes and the metabolic syndrome. It is not comprehensive, but that is not its intent, and it succeeds in its goal to guide and inform.
ACKNOWLEDGMENTS
Neither author had a personal or financial conflict of interest with respect to the book reviewed or any of the book's authors or editors.