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Nutrition is a major concern in diabetic patients. In fact, according to the American Diabetes Association (ADA), diabetic patients often ask themselves after receiving their diagnosis: "What can I eat?".
Nutrition Tips for Type 2 Diabetes
This is for good reason, because there is strong evidence for support of nutritional therapy and counseling as an important aspect of diabetes management. Not to mention its efficiency in terms of health and costs.
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Nutritional therapy and counseling can help patients manage their weight, maintain their glycemic goals, improve their blood pressure and other cardiovascular risk factors, but the ADA stresses that there is no need for universal approach for diabetic patients. Instead, dietary recommendations should be patient-specific based on comorbidities, health status, cultural background and other factors.
According to the ADA, a variety of diets are acceptable for managing type 2 diabetes, with a focus on non-starchy vegetable consumption, reduced added sugars and refined grains, selection whole foods rather than processed and reducing the overall intake of carbohydrates.
Although various diets are recognized as acceptable, it is particularly interesting to examine the safety of some of the latest health trends that patients are likely to question.
Intermittent fasting can be defined in different ways: fasting daily for 16 hours, eating for the remaining eight hours (defined here), or eating normally five days a week and limiting caloric intake. during the other two. Overall, the IF involves alternating between fasting and eating periods and puts more emphasis on when you eat than what you eat. you eat.
Many studies in diabetic patients show that IF is beneficial for weight loss, although the effect on blood glucose and drug needs varies from study to study.
How it works
Bret Scher, MD, certified cardiologist and medical director of Diet Doctor, believes that the IF is sometimes beneficial for patients with type 2 diabetes.
"When you do not consume calories, your body is in a completely different metabolic state," says Dr. Scher at Florence Health. "You start burning your own fat as fuel and you start to break down that insulin resistance because your body is not getting that excess glucose anymore. It can thus manage its blood sugar more effectively and the level of insulin drop. "
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These eating habits can also address the root cause of diabetes, rather than just giving patients drugs to lower blood sugar. "The optimal treatment for diabetes is not only lowering blood sugar levels, but also reversing this insulin resistance," said Dr. Scher.
What are the risks?
Of course, there are certain risks, especially in patients taking antidiabetic drugs that lower blood sugar levels. "People with type 2 diabetes who are not on medications or on metformin are not at increased risk of lowering blood sugar levels. They should not be so worried, "says Dr. Scher.
IF is also not recommended for people with a history of eating disorders, very thin or undernourished women, pregnant or breastfeeding women. But to be sure, providers must closely monitor any patient to whom they recommend.
Low carbohydrate diet and ketogenic diets
Research has shown that ketogenic diets reduce the need for drugs and reduce A1C levels. In addition, studies have shown that these eating habits lowered blood pressure and triglycerides, among other health benefits.
How does Keto work
Why? When a patient is on a particular ketogenic diet, he or she absorbs calories mainly from proteins and fats. Thus, the body does not consume glucose to fuel fat stores or ketones to fuel fuel, according to Dr. Scher. This lowers glucose levels, improves insulin sensitivity and eventually, decreases insulin levels.
"We are conducting trials that show a real reversal of the diagnosis of type 2 diabetes: patients give up their drugs, normalize their blood sugar levels and reverse diabetes, which drugs do not do and it does not work. is not something that standard diabetes diet has already been shown to do, "says Scher.
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More general diets, low in carbohydrates (consuming less than 100 grams of net carbohydrate per day) may yield similar results, but the strongest evidence currently is related to the ketogenic diet, which involves lower carbohydrate intake, specified Dr. Scher. The exact amount of carbohydrates that people can consume while staying in ketosis will vary from one person to another, but just about everyone will be ketosis by consuming less than 20 grams of net carbohydrate a day .
What are the risks?
The risks are the same for these diets as for FIs, for example when patients are malnourished, have a history of eating disorders, or are taking antidiabetic drugs that lower their blood sugar levels. "Otherwise, ketogenic and low carbohydrate diets are definitely safe for patients with type 2 diabetes," says Scher.
As with IF, it is important for diabetic patients to adopt a low carbohydrate and ketogenic diet only after consultation with a qualified health professional, to assess and minimize risks, and to ensure a healthy diet.
If these plans do not fall within your competence as a health professional, you can help patients access quality nutrition therapy by connecting them to a nutritionist dietitian with extensive knowledge of diabetes care, according to the ADA recommendations.
Nutrition Therapy for Adults with Diabetes or Prediabetes: A Consensus Report, Diabetic treatments.
The effect of short periods of caloric restriction on weight loss and glycemic control of type 2 diabetes, Diabetic treatments.
Intermittent fasting in type 2 diabetes and the risk of hypoglycemia: a randomized controlled trial, Diabetic medicine.
The effects of intermittency versus continued energy restriction on glycemic control in type 2 diabetes; a pragmatic pilot test, Diabetes Research and Clinical Practice.
Not so fast: Advantages and disadvantages of the latest diet trend, Harvard Health Publishing.
Effects of low-carb dietary interventions compared to low-fat diet interventions on metabolic control in people with type 2 diabetes: a systematic review including GRADE assessments, The American Journal of Clinical Nutrition.