People with diabetes have difficulty eating due to metabolic abnormalities and insulin resistance, so they need to pay more attention. Today we will talk about the dietary issues that everyone is most concerned about and how to adjust them. I will give you a comprehensive explana

People with diabetes have difficulty eating due to metabolic abnormalities and insulin resistance problems. They need to pay more attention. Today we will talk about the dietary issues that everyone is most concerned about and how to adjust them.

I will give you a comprehensive explanation on carbohydrates from three aspects: actual practice, authoritative guidelines and medical literature.

Carbohydrates , referred to as carbohydrates, provide energy, are nutrients, and have special physiological effects. The various sugars, dietary fibers, and starches we usually talk about are carbohydrates. The various staple foods we eat are foods rich in starch.

There are two types of carbohydrates

Absorbable carbohydrates: monosaccharides , disaccharides , polysaccharides

Non-absorbable carbohydrates: such as dietary fiber

The carbohydrates mentioned in this article refer to absorbable sugars and starches, excluding dietary fiber.

How many carbohydrates should people with diabetes eat every day?

The currently widely used classification of carbohydrate intake is the recommendation of Dr. Feinman and his colleagues in the Department of Cell Biology, State University of New York Medical Center in the United States [1]:

Very low carbohydrate diet : 20 per day To 50 grams of carbohydrate intake (or <10%>

Low carb diet : 50 to 130 grams of carbohydrate intake per day (or <10%>

Medium carb diet : 130 to 230 grams of carbon water intake per day (or 26% to 45% of total energy provided by carbon water per day)

High carbohydrate diet : More than 230 grams of carbon water intake per day (or 45% of total energy provided by carbon water per day)

Very low carbon water Diet (less than 50 grams of carbohydrates per day)

is ketogenic diet , a dietary method that causes the body to produce excessive ketone bodies . It was originally used to treat epilepsy in children, and is used by a few people to lose weight and control blood sugar.

Acetoacetate, β-hydroxybutyrate and acetone produced by the decomposition of fatty acids in the liver are collectively called ketone bodies and are the products of fat decomposition.

If you have no idea about ketone bodies, diabetic ketoacidosis may have been heard of. The acute complication of diabetes is caused by too little carbohydrate absorption and excessive increase in ketone bodies.

Low-carbohydrate diet (50-130 grams of carbohydrates per day)

Ketone bodies will also increase significantly, which is common in strenuous exercise, pregnancy reactions, malnutrition, hunger, dieting, fasting, light fasting and certain disease states.

Diabetic starvation ketosis is caused by insufficient carbohydrate (energy) intake.

Medium carbohydrate diet (130-230 grams of carbohydrates per day)

High carbohydrate diet (more than 230 grams of carbohydrates per day)

The daily diet of most people, as well as the Mediterranean diet, DASH (Deshu diet), low GI slow carb diet, etc. Both are within these two ranges, and ketone bodies are normal.

After seeing this, I think you may have made a preliminary judgment on how many carbohydrates are reasonable to eat every day.

Next, let’s take a look at the carbohydrate intake recommended by domestic and foreign dietary guidelines.

What the Dietary Guidelines say

" Dietary Guidelines for Chinese Residents " recommends: The energy supply ratio of carbohydrates accounts for 50-65% of the total energy throughout the day.

"Dietary Guidelines for Diabetes 2017" recommends that the energy supply ratio of carbohydrates accounts for 45-60% of the total energy throughout the day.

"Chinese Diabetes Medical Nutrition Treatment Guidelines (2013)" recommends: the energy supply ratio of carbohydrates throughout the day is 45%-60%. If the carbohydrate source is low GI food, the energy supply ratio can reach 60%.

"Dietary Guidelines for Adults with Diabetes" WS/T 429-2013 recommends: Carbohydrates account for 50%-60% of the total energy throughout the day, and choose more low-GI/low-GL foods.

"Dietary Guidelines for Americans (2010)" recommends: the energy supply ratio of carbohydrates throughout the day is 45-65%.

The U.S. Food and Nutrition Board recommends a dietary nutrient allowance (RDA) of at least 130 grams of carbohydrates per day for normal adults to ensure that glucose serves as the main energy source for brain cells.

It can be seen from this that authoritative guidelines and medical consensus recommend that the lower limit of the carbohydrate-to-water energy supply ratio of the diabetic diet (and normal people as well) is 45% and the upper limit is 65%.

What is the concept of carbohydrate energy supply ratio of 45-65%?

If you need 1500 kcal of energy every day and carbohydrates provide energy at 45%, then carbohydrates should provide 675 kcal of calories and require 168 grams of carbohydrates; if the energy supply is based on the upper limit of 65%, Carbohydrates should provide 975 calories and require 243 grams of carbohydrates.

How much food is this?

100 grams of steamed rice (1 small bowl) about 26 grams of carbohydrates

100 grams of steamed buns about 50 grams of carbohydrates

1 slice of bread about 10-15 grams of carbohydrates

1 medium egg about 1.5 grams of carbohydrates

1 box of 250 ml milk about 12 grams of carbohydrates

100 grams of apples is about 13 grams of carbohydrates...

Specific operation, 168 grams of carbohydrates is roughly like this:

3 small bowl of staple food, 100 grams of lean meat, 500 grams of vegetables

100 grams of apples, some soy products, some Condiments

25-30 grams of nuts, 1 egg, 1 carton of milk

Generally speaking, the daily energy requirement of adults is more than 1,200 calories, with a minimum carbohydrate energy supply ratio of 45%, which requires about 135 grams of carbohydrates, which is exactly the medium-carb diet pattern the lower limit.

Some people may ask, is a low-carb ketogenic diet bad?

Please remember that the ketogenic diet is a dietary pattern based on very low carbohydrates + high animal protein + high animal fat.

The ketogenic diet is very effective in controlling blood sugar, but it also faces many problems worthy of vigilance.

"The Lancet" published the research report "Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis " on August 16, 2018.

Researchers investigated the association between carbohydrate intake and mortality among 15,428 adults aged 45-64 years old in four communities in the United States and 432,179 participants in other cohorts.

25 years of follow-up showed:

1 There is a U-shaped relationship between the carbohydrate energy supply ratio and mortality. When the carbohydrate energy supply ratio is 50-55%, the risk of death is lowest.

2. A meta-analysis of 432,179 participants found that when the carbohydrate energy supply ratio was 40% and when the carbohydrate energy supply ratio was 70%, there was a higher risk of death, consistent with a U-shaped association.

3. Eating patterns based on low-carbohydrate diet + animal protein + animal fat, such as various meat sources, are associated with higher mortality.

4. A moderate carbohydrate diet + vegetable protein + vegetable fat-based dietary pattern, such as vegetables, nuts and whole grains, will reduce mortality.

The researchers believe these data suggest that low-carbohydrate diets based on animal foods should not be encouraged.

When limiting carbohydrate intake, plant fats and proteins can be added as a long-term method to promote health and longevity.

Ketogenic diet (very low-carb diet) feedback from those who have experienced it:

The American College of Physicians has released a research report on "Low-carbohydrate diet and all-cause-specific mortality". [2]

Dr. Teresa T. Fung’s team at the Harvard School of Public Health conducted a 20-year follow-up survey on 85,168 women (34 to 59 years old) and 44,548 men (40 to 75 years old) to conduct a prospective cohort study.

Meta-analysis shows:

Low-carbohydrate diets based on animal protein and fat are associated with higher all-cause (cardiovascular and cancer ) mortality.

Low-carbohydrate diets based on plant proteins and fats are associated with lower all-cause mortality (cardiovascular and cancer).

Ketogenic diet (very low-carb diet) feedback from those who have experienced it:

" British Medical Journal " published a research report on January 13, 2021, on patients with type 2 diabetes who followed a 6-month low-carb diet LCD (carbohydrate A systematic review and meta-analysis was conducted on the very low carbohydrate diet VLCD (carbohydrate <50>

researchers studied 23 data, involving 1,357 participants with type 2 diabetes, with an average age of 47-67 years old, and statistically analyzed the data at 6 months and 12 months.

Summary studies show that when adhering to a low-carb diet 6 months, patients lost weight, had significant improvements in triglyceride indicators and insulin sensitivity , reduced medication use, and had no significant differences in participants' quality of life.

But these benefits began to reverse at 12 months, with quality of life worsening with low-density lipoprotein cholesterol This finding is consistent with previous reviews and a recent systematic review of the cohort study showing that long-term low-carbohydrate diets are associated with associated with increased mortality.

Researchers believe that the long-term effectiveness and safety of low-carb and very-low-carb diets are uncertain, and the level of evidence for short-term benefits is not high.

Feedback from those who have experienced the very low-carbohydrate diet (ketogenic diet):

Medical experts conducted a observational study and systematic review and meta-analysis on low-carb diet and all-cause mortality, aiming to clarify the impact of low-carb diet on mortality. and long-term effects on CVD (cardiovascular disease) incidence. [4]

researchers identified a total of 17 cohort studies for inclusion in the systematic review and meta-analysis. The patient samples participating in the studies ranged from 647 to 129,716. Most reports were published in Sweden and the United States.

Researchers pointed out that low-carbohydrate diets often lead to a reduction in dietary fiber and fruit intake, and an increase in the intake of animal-derived protein, cholesterol and saturated fat, which are all risk factors for cardiovascular disease.

Systematic reviews and meta-analyses show that in the long run, low-carb diets are significantly associated with a higher risk of all-cause mortality.

Low-carb ketogenic diet experience:

Why do authoritative guidelines and medical consensus recommend that the carbohydrate energy supply ratio is 45-65%, rather than a low-carb ketogenic diet. After seeing this, you may have more understanding. .

Because of this, based on more than ten years of experience in guiding people with diabetes and medical research, I do not support low-carb and ketogenic diets for people with diabetes. It will do more harm than good and cannot withstand the hassle.

If you are relatively young, whether to adopt a low-carb ketogenic diet depends on your own opinion. The content I explain is for reference only, not medical advice. I believe you will make your own judgment.

Is it good to eat smaller meals more frequently?

It is not recommended to eat small meals frequently with high-carbohydrate and high-sugar staple foods. Intake of carbohydrates will promote high blood sugar , pancreatic islets will be burdened more, and it will be difficult to monitor blood sugar even after eating.

With good sugar control, adding some low-sugar and low-carb foods in the morning or afternoon will have little impact on blood sugar. You can check out my article: Detailed explanation of eating small meals, frequent meals and three regular meals

How to manage blood sugar

It is simple to say, but in the short term, Master the appropriate intake of carbohydrates, eat regularly and quantitatively, exercise regularly and quantitatively, and have a regular schedule, and your blood sugar will not be much different.

In the long term, balanced nutrition, increasing dietary fiber intake, regulating visceral fat rate and related indicators, improving insulin resistance, and striving to correct metabolic disorders are all necessary and indispensable for preventing and controlling complications .

In addition, develop the habit of checking food and understand the glycemic index (GI), blood sugar load (GL) and nutritional content of various foods.

makes the food you eat more nutrient dense, raising blood sugar slower and taking a shorter time to raise blood sugar.

In many cases, good diet, nutrition, exercise and lifestyle management not only do not increase the number of drugs, but actually reduce the number of drugs.

After all, dietary therapy, nutritional conditioning, and exercise assistance are all important components of treatment.

Regarding other topics related to stabilizing blood sugar and preventing and controlling complications, stay tuned, I will explain them in subsequent articles.

References

[1] Taylor-R, Ramachandran A, Yang H Wˉˉ S, Forouhi NG-. Nutritional basis of type 2 diabetes remission BMJ2021;374:n1449doi:10.1136/bmj.n1449

[2] Teresa T. Fung, Rob M. van Dam, Susan E. Hankinson, et al. Low-carbohydrate diet and all-cause and cause-specific mortality: two cohort studies. An intern doctor. 2010;153:289-298. [Epub ahead of print on September 7, 2010]. doi:10.7326/0003-4819-153-5-201009070-00003

[3] Goldenberg J Z, Day A, Brinkworth G D, Sato J, Yamada S, Jonsson T, et al. Effectiveness and safety of low- and very-low-carbohydrate diets for remission of type 2 diabetes: a systematic review and meta-analysis of published and unpublished randomized trial data BMJ 2021;372:m4743 doi:10.1136/bmj.m4743

[4]Noto H, Goto A, Tsujimoto T, Noda M (2013) Low-carbohydrate diet and all-cause mortality: a systematic review and meta-analysis of observational studies. PLoS 1 8 (1): e55030. https://doi.org/10.1371/journal.pone.0055030

Article: Xianke nutritionist, health manager, founder of "Dangyoubang Food Bank", focusing on diabetes health management and Weight management.