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The Diabetes Diet

January 6, 2009 Written by JP       [Font too small?]

Type 2 diabetes affects approximately 18 million men, women and children in the US, and that number is growing at an alarming rate. In fact, the Centers for Disease Control have recently classified type 2 diabetes as an epidemic because the number of people diagnosed has doubled between the years of 1990 to 2005. Why is this happening? Poor diet and lifestyle are thought to be the primary reasons. The fatter and more out of shape we become, the more likely were are to contract this potentially life-threatening disorder.

The Big Fat Lie

The good news is that Type 2 diabetes is also manageable. Sometimes medications are necessary to achieve that goal. But there are also dietary strategies that can help. And as far as diets are concerned, there is now a considerable amount of debate about which kind of diet is best to help keep diabetics healthy. Today I want to present the results of a recent study that compares two diet plans.

  1. A Low-Glycemic Diet (represented by the first pyramid) - A diet that utilizes certain lower-sugar fruits, non-starchy vegetables, whole grains, lean meats and low-fat dairy. The goal of such a diet is to focus on foods that are unlikely to cause significant fluctuations in one’s blood sugar levels.
  2. A Ketogenic Diet (represented by the second pyramid)This is a high-fat, moderate-protein diet. It allows for plenty of fatty sources of protein, certain vegetables, whole fat dairy and a minimal amount of fruits and grains. The goal of this diet is also to help keep blood sugar levels balanced.
  • A total of 84 overweight, type 2 diabetics were enrolled in the experiment. They all lived in a community setting, which allowed for strict control over their diet and subsequent testing.
  • Half of the group was put on a low-carbohydrate diet. The diet was limited to under 20 grams of carbs per day, but was not calorically restricted. In other words, no daily calorie limit was set.
  • The remaining half was placed on a reduced-calorie, low-glycemic diet. This diet aimed to limit carbohydrates to 55%. A caloric limit was set for this group. The goal was to eat about 500 calories less than what would be needed to maintain their weight.
  • Each group was provided with guidance about how to implement the diet and how to exercise. They were also given a nutritional supplement that contained: 200 mcg of vanadyl sulfate, 600 mcg of chromium glycinate and 200 mg of alpha-lipoic acid. All of these nutrients have been previously shown to improve insulin sensitivity and blood glucose control.
The Low-Glycemic Food Pyramid

The authors of this study, which appeared in the December 19th issue of Nutrition and Metabolism, designed the study in the following manner:

The primary outcome the researchers hoped to find was an improvement in blood sugar control by testing for a blood-bound substance called hemoglobin A1c (HbA1c). HbA1c provides a picture of how well (or poorly) blood sugar levels have been controlled over a 6-12 week period.

The Proof is in Not Having the Pudding

About 60% of the volunteers completed the 24-week study. Both the low-glycemic and the low-carb diets led to lower HbA1c and significant weight loss. But the low-carbers had a dramatically greater drop in both of these categories. In fact, the low-carb dieters had three-times the reduction in HbA1c and they lost about 30% more weight (approx. 22 lbs vs 15 lbs.). In addition, the low-carb, ketogenic diet also increased HDL (“good cholesterol”) significantly (about 13%), whereas the low-glycemic diet did not lead to any improvement in HDL levels. This may reflect a positive impact with regard to heart health. Both groups found a reduction in their blood pressure.

The Low-Carb Food PyramidBut, the biggest news is this: 95% of the low-carbers were able to stop taking diabetic medications by the end of the study! 62% of the low-glycemic dieters were also able to go medication-free by the study’s end. Pretty remarkable, isn’t it? Especially when you consider that some of these very medications can cause serious side-effects in and of themselves.

The authors offer this parting analysis, “Lifestyle modification using low-carbohydrate diet interventions are effective for improving obesity and type 2 diabetes, and may play an important role in reversing the current epidemic of ‘diabesity.’”

Many doctors still believe that eating large amounts of fat is harmful. And, in some instances, that may be true. But, here is one clear example that indicates the exact opposite.

Be well!

JP

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6 Comments & Updates to “The Diabetes Diet”

  1. Iggy Dalrymple Says:

    I’m a type 2 diabetic and I do well with whole grains at the base of my pyramid, however I concentrate on oats groats and hull-less barley. Oats is the highest protein whole grain and barley is the lowest glycemic grain. My breakfast is oat porridge, lunch is salsd with cold ocean fish, and supper is usually barley soup with turkey. Snack on nuts, seeds, and hot cocoa. My A1C is always <6.
    With exercise, I’ve lost 60+lbs. Have had to resort to taking niacin and krill oil to get my lipid ratio healthy.

  2. JP Says:

    The numbers don’t lie. If a diet with some whole grains suits your physiology … great! I’m just glad you found your path to wellness.

    I will say this however, if by “lipid ratio” you’re referring to low HDL then a lower carb approach would likely help with that. The biggest and most common lipid modifying effect of a healthy low carb diet is raising HDL cholesterol and lowering triglycerides.

    Excellent job on the 60+ pounds. We’re in the same club there. :)

    Be well!

    JP

  3. Angie Says:

    You know, I read that in the 1920′s, the “diabetic diet” was essentially coffee, tea, nuts, eggs, meats and non-starchy vegetables… [read: low carb]

    Don’t ask me what compelled doctors to start advising otherwise!!!

  4. JP Says:

    Thanks, Angie!

    I think one of the biggest changes was the greater availability of grains and sugar. Lots of influence and money probably played a role in that shift, I’m afraid.

    Be well!

    JP

  5. JP Says:

    Update: Another herb (milk thistle) lowers inflammation, oxidative stress in diabetics …

    http://www.sciencedirect.com/science/article/pii/S0944711315000227

    Effects of Silybum marianum (L.) Gaertn. (silymarin) extract supplementation on antioxidant status and hs-CRP in patients with type 2 diabetes mellitus: A randomized, triple-blind, placebo-controlled clinical trial

    Aim: Diabetes is a serious metabolic disorder and oxidative stress and inflammation contribute to its pathogenesis and complications. Since Silybum marianum (L.) Gaertn. (silymarin) extract is an antioxidant with anti-inflammatory properties, this randomized clinical trial was conducted to evaluate the effects of silymarin supplementation on oxidative stress indices and hs-CRP in type 2 diabetes mellitus patients.

    Methods: For the present paralleled, randomized, triple-blinded, placebo-controlled clinical trial, 40 type 2 diabetes patients aged 25–50 yr old and on stable medication were recruited from the Iranian Diabetes Society and endocrinology clinics in East Azarbayjan (Tabriz, Iran) and randomly assigned into two groups. Patients in the silymarin treatment group received 140 mg, thrice daily of dried extracts of Silybum marianum (n = 20) and those in the placebo group (n = 20) received identical placebos for 45 days. Data pertaining to height, weight, waist circumference and BMI, as well as food consumption, were collected at base line and at the conclusion of the study. Fasting blood samples were obtained and antioxidant indices and hs-CRP were assessed at baseline, as well as at the end of the trial.

    Results: All 40 patients completed the study and did not report any adverse effects or symptoms with the silymarin supplementation. Silymarin supplementation significantly increased superoxide dismutase (SOD), glutathione peroxidase (GPX) activity and total antioxidant capacity (TAC) compared to patients taking the placebo, by 12.85%, 30.32% and 8.43%, respectively (p < 0.05). There was a significant reduction in hs-CRP levels by 26.83% (p < 0.05) in the silymarin group compared to the placebo group. Malondialdehyde (MDA) concentration significantly decreased by 12.01% (p < 0.05) in the silymarin group compared to the baseline.

    Conclusions: Silymarin supplementation improves some antioxidant indices (SOD, GPX and TAC) and decrease hs-CRP levels in T2DM patients.

    Be well!

    JP

  6. JP Says:

    Update 05/19/15:

    http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0126469

    PLoS One. 2015 May 15;10(5):e0126469.

    Coffee Consumption, Newly Diagnosed Diabetes, and Other Alterations in Glucose Homeostasis: A Cross-Sectional Analysis of the Longitudinal Study of Adult Health (ELSA-Brasil).

    INTRODUCTION: Observational studies have reported fairly consistent inverse associations between coffee consumption and risk of type 2 diabetes, but this association has been little investigated with regard to lesser degrees of hyperglycemia and other alterations in glucose homeostasis. Additionally, the association between coffee consumption and diabetes has been rarely investigated in South American populations. We examined the cross-sectional relationships of coffee intake with newly diagnosed diabetes and measures of glucose homeostasis, insulin sensitivity, and insulin secretion, in a large Brazilian cohort of middle-aged and elderly individuals.

    METHODS: We used baseline data from 12,586 participants of the Longitudinal Study of Adult Health (ELSA-Brasil). Logistic regression analyses were performed to examine associations between coffee consumption and newly diagnosed diabetes. Analysis of covariance was used to assess coffee intake in relation to two-hour glucose from an oral glucose tolerance test, fasting glucose, glycated hemoglobin, fasting and -2-hour postload insulin and measures of insulin sensitivity.

    RESULTS: We found an inverse association between coffee consumption and newly diagnosed diabetes, after adjusting for multiple covariates [23% and 26% lower odds of diabetes for those consuming coffee 2-3 and >3 times per day, respectively, compared to those reporting never or almost never consuming coffee, (p = .02)]. An inverse association was also found for 2-hour postload glucose [Never/almost never: 7.57 mmol/L, ≤1 time/day: 7.48 mmol/L, 2-3 times/day: 7.22 mmol/L, >3 times/day: 7.12 mol/L, p<0.0001] but not with fasting glucose concentrations (p = 0.07). Coffee was additionally associated with 2-hour postload insulin [Never/almost never: 287.2 pmol/L, ≤1 time/day: 280.1 pmol/L, 2-3 times/day: 275.3 pmol/L, >3 times/day: 262.2 pmol/L, p = 0.0005) but not with fasting insulin concentrations (p = .58).

    CONCLUSION: Our present study provides further evidence of a protective effect of coffee on risk of adult-onset diabetes. This effect appears to act primarily, if not exclusively, through postprandial, as opposed to fasting, glucose homeostasis.

    Be well!

    JP

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