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Blindly following low-carbon diet is not advisable!
Scientific diet is of great significance to the blood sugar control and weight management of patients with diabetes , but what should be done makes the patients very confused. In recent years, especially the carbohydrate , which is the main source of our energy intake, has been often pushed to the forefront. Many studies have pointed out that excessive carbohydrate intake can lead to increased risk of diseases such as weight gain and diabetes. Therefore, many dietary patterns that control carbohydrate intake have emerged, such as extremely low-carb diet, Mediterranean diet, ketogenic diet ... So are these dietary patterns suitable for diabetic patients?
At this year's European Association for Research on Diabetes (EASD) conference, Professor Riserus from Sweden summarized suggestions for macronutrient intake for us. For the diet of diabetic patients, evidence from RCTh research, prospective studies, systematic review, meta-analysis and other studies were analyzed. He pointed out that it is necessary to emphasize the quality of the diet and recommend a balanced diet based on the intake of fat, carbohydrate, protein, , cellulose, saturated fat, and added sugar.
Carbohydrate Diet Recommendations
First, carbohydrates are an important macronutrient. Low-carb diets/high-carb diets (LCDs/HCDs) can ensure dietary fiber, sugars, saturated fats and protein intake (medium recommended strength).
Recently, in a systematic review and meta-analysis study on carbohydrate content in 2 diabetes diet management, 2178 patients with type 2 diabetes who randomly gave LCD (21-70g daily carbohydrate amount, or 30%-40% daily carbohydrate energy supply) or HCD diet were included for at least 3 months of observation.
study results show that compared with the HCD diet, the glycated hemoglobin (HbA1c) in the LCD diet group decreased by 0.09%, and the triglyceride decreased by 0.13 mmol/l. This study shows that the proportion of carbohydrate intake is not an important determinant of dietary management effectiveness, especially in studies that consider long-term follow-up (Figure 1) [1].
Figure 1 Systematic evaluation and meta-analysis of carbohydrate content in diet management of type 2 diabetes
In addition, extremely low-carb diet/ketogenic diet (VLC/KDs) (VLC: ≤50 g carbohydrate/day; KDs: Daily carbohydrate energy is ≤10%) is widely popular in many places. So is it suitable for patients with type 2 diabetes?
Studies have shown that a very low-carb diet/ketogenic diet (VLC/KDs) may reduce glycated hemoglobin and triglyceride levels in prediabetes or T2DM patients [2].
But Professor Riserus said that compared with other strategies, the evidence for the advantages of this study is limited, because there is a lack of evidence of extremely low carb intake in patients with type 2 diabetes and concerns about the safety of long-term follow-up studies, so does not recommend diabetic patients with very low carb intake in diet (moderate recommended intensity) .
If patients want to choose a low-carb diet or an extremely low-carb diet, they need support from professional and healthy personnel and need to pay more attention to your health status to ensure that they obtain sufficient dietary fiber, trace elements, and saturated fat intake requirements.
also has the following suggestions:
Recommend a diet high in diet (high recommended strength);
Dietary fiber intake should be 35g per day (4g dietary fiber per 1000 kilojoules dietary) (medium recommended strength);
Recommend the lowest processed whole grains, vegetables, nuts and fruits as sources of dietary fiber;
If the dietary intake is insufficient only , you can consider intake of foods rich in dietary fiber and fiber supplements;
recommends choosing low-glycemic index foods/low-sugar foods (medium recommended strength);
free sugar/added sugar intake should be less than 10% of the total energy intake;
non-nutritional sweeteners can be used to replace sugar in foods and beverages;
carbohydrate coefficient may be a useful way to determine meal time insulin dose.
fat intake recommendations
There are limited studies on fat intake in patients with diabetes. 's focus on fat intake is on the type of fat of the selected food, not just considering the total amount or relative amount of fat. The main suggestions for include:
Dietary fat should mainly come from plant-based sources, and some come from fish, including mono- and polyunsaturated fats, such as nuts, non-hydrogenated vegetable oil (low recommended strength);
saturated fat and trans fat intake should be less than 10% and the total energy account for <1%;>
After reducing the amount of saturated fat, you can choose plant-derived poly unsaturated fat , as well as mono-unsaturated fat such as nuts and non-hydrogenated vegetable oil as replacement (low recommended strength) [3].
Protein intake Recommended
Protein intake of patients with diabetes will be determined based on the patient's weight, age and kidney function (GFR).
Age <65>eGFR>60ml/min*1.73m2. If the patient's weight is stable/normal weight, it is recommended that the patient's protein intake account for 10-20% of the energy intake;
For patients over 65 years old, the protein intake increases to 15-20%;
For patients over 65 years old, the protein intake increases to 15-20%;
For patients who are overweight or obese, and eGFR>60ml/min *1.73m2, it is recommended that during short-term weight loss, protein intake is between 23% and 32% (up to 12 months);
For patients with moderate diabetic nephropathy (i.e., chronic kidney disease stage 3a: eGFR <>2) [4];
Therefore, choosing a reasonable and balanced diet is the basis of diabetes treatment and is also an indispensable measure for prevention and control at any stage of the diabetes course. Without a scientific meal plan, blindly following a low-carb or ketogenic diet will lead to a lack of important nutrients in the body, which will adversely affect your health.
Author of this article
Audit expert
References:
[1]Korsmo-Haugen HK,Brurberg KG,Mann J,Aas AM Carbohydrate quantity in the dietary management of type 2 diabetes:A systematic review and meta-analysis.Diabetes,obesitymetabolism (2019)21:15-27.10.1111/dom.13499
[2]Parry-Strong A,Wright-McNaughton M,Weatherall M,Hall RM,Coppell KJ,Barthow C,et al.Very low carbohydrate(ketogenic)diets in type 2 diabetes:A systematic review and meta-analysis of randomized controlled trials.Diabetes,obesitymetabolism(2022).10.1111/dom.14837
[3]Schwab U,Reynolds AN,Sallinen T,Rivellese AA,Risérus U Dietary fat intakes and cardiovascular disease risk in adults with type 2 diabetes:a systematic review and meta-analysis.Eur J Nutr(2021)60:3355-3363.10.1007/s00394-021-02507-1
[4]Pfeiffer AFH,Pedersen E,Schwab U,Risérus U,Aas AM,Uusitupa M,et al.The Effects of Different Quantities and Qualities of Protein Intake in People with Diabetes Mellitus.Nutrients(2020)12.10.3390/nu12020365
This article was first published丨Endocrine Channel in the medical community
Author of this article丨Attached physician of the Department of Endocrinology of Peking University People's Hospital Li Meng
Review expert丨Associate doctor of the Department of Endocrinology of Peking University People's Hospital Wu Jing
Editor-in-chief丨Cao Qian
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