Most people think that when people get diagnosed with diabetes, that’s it, they’re destined to get progressively worse, take more meds and suffer bad health. That’s simply not the case!
While diabetes is not reversible from a diagnostic standpoint (once a person has it, they have it), diabetes can be reversible from a physiological standpoint in many. That is, a person can work to gain excellent control of their blood sugar levels, keeping them within a normal healthy range so that they are functioning like a non-diabetic person.
Research shows this is true and in our experience with members and subscribers, people are achieving this everyday, even if they’ve had diabetes for 20 years!
NOTE: The majority of the research that follows is around type 2 diabetes treatment. It’s important to differentiate ‘reduction of diabetes risk’ from ‘diabetes treatment.’ These are often lumped into the same category but they are two very different concepts. Here our main focus of research is on diabetes treatment.
Blood Sugar & A1C
BLOOD SUGAR: Blood sugar is a measure of glucose/ sugar in the blood at any one time. Throughout the day blood sugar can fluctuate in response to numerous factors, mainly food but also exercise, stress, sleep, medications and so forth. The body is designed to maintain blood sugar levels in a healthy range. And it is well established that diabetics and prediabetics work toward the goal of having blood sugar levels in range (being well controlled) because high blood glucose levels cause damage to cells and vessels throughout the body, which can lead to health complications.
A1C: A1C is a blood test that provides an average blood sugar measurement for the past 2-3 months. It’s a more accurate measure than blood sugar because it can’t be influenced by meals a person has had today or the day before. A1c is provided as a percentage and the normal range is 4-6%. Though in some diabetic patients, a higher level of 7-8% may be more realistic. The goal is to encourage a person to work toward normal healthy range.
- Nutrition therapy can help people with type 2 diabetes reduce A1c levels by 0.5—2% (1).
- Lifestyle intervention provides a 58% risk reduction for diabetes diagnosis in people with prediabetes (2).
The above link leads to a summary of American Diabetes Association dietary treatment guidelines for adults with type 2 diabetes and how DMP aims to meet, and assist providers and healthcare professionals to meet those guidelines.
While there is no one-size-fits-all diet, the ADA Standards of Medical Care in Diabetes: 2017 concludes that: “Nutrition interventions should emphasize a variety of minimally processed nutrient-dense foods in appropriate portion sizes as part of a healthful eating pattern and provide the individual with diabetes with practical tools for day-to-day food plan and behavior change that can be maintained over the long term.”
Here at DMP, we educate people about whole food intake:
- A high intake of non starchy vegetables
- The inclusion of lean protein sources
- Choosing monounsaturated fat as the predominant dietary fat
- A moderate intake of lower carb fruits
- Along with nuts, seeds, dairy products and other whole foods
However, while it is true that there is no one specific diet that a person with diabetes/ prediabets “should” eat (we are all individuals and will eat slightly different things based on our food preferences), emerging evidence continues to demonstrate that a lower carb diet helps people obtain great results.
- Decreasing blood glucose
- Lowering A1C
- Decreasing cholesterol
- Increasing HDL
- Increasing weight loss
General Dietary Research +
Low Carb Vs. Low Fat/ High Carb Diet Research
New table of research and summaries to come…
Weight Loss & A1C Diets Comparison
Source: Sandouk Z, et al. Diabetes with obesity: Is there an ideal diet? Cleveland Clinic Journal of Medicine. 2017;84(1):S4-14.
The main nutrient that influences blood glucose and insulin is carbohydrates. It is well acknowledged that while the type of carbohydrate is important the amount has the greatest impact upon blood sugar and insulin response.
Since this is the case, monitoring carbs/ carb counting remains a key strategy for people to achieve good control.
American Diabetes Association acknowledge that “studies examining the ideal amount of carbohydrate intake for people with diabetes are inconclusive.”
Emerging evidence continues to demonstrate that a low carbohydrate approach is an effective way to control diabetes, consistently producing the following results:
- A1c reduction
- Immediate drop in fasting glucose levels
- Lower medication use
- Lower risk of hypoglycemia
- Decreased triglycerides and increased HDL
The ADA, Diabetes Australia and Diabetes UK now acknowledge that a low carb dietary pattern can help with diabetes management, a big change since 2015 when they were all largely against this dietary pattern.
How Many Carbohydrate Should People Eat?
In 2015, Feinman RD, et al., established a definition of carbohydrates in the diet:
- Very low carb ketogenic diet: 20-50 g per day. Below 10% intake of 2000 calorie diet.
- Low carbohydrate diet: Below 130 g per day. Below 26% total energy intake.
- Moderate carbohydrate diet: 26-45% total energy intake << Research shows these don’t perform as well as lower carb diets
- High carbohydrate diet: Above 45% total energy intake << Current recommendations that haven’t been helping people gain control
Anything below 130 grams per day is considered a low carbohydrate diet. However, lower intakes of 50 to 80 grams per day can provide additional benefits for A1c control (refer to low carb studies above).
In a 1600 calorie diet, the carb/protein/fat ratio of an ideal low carb diet breaks down as follows:
- 10-20% Carbs: 40-80 g/ d
- 20-30% Protein: 80-120 g/d
- 40-60% Fat: 70-110 g/d
Or at a slightly higher carb intake:
- 25% Carbs: 100 g/ d
- 20-30% Protein: 80-120 g/d
- 40-50% Fat: 70-89 g/d
Low Carb Diabetes Research +
Carbohydrates and Heart Disease
Fat & Cholesterol
Over the years we’ve all been led to believe that eating fat is bad, so we’ve been pushed toward eating low fat diets. But unfortunately, low fat diets are higher in carbs and sugar, which is not ideal for people with type 2 diabetes/prediabetes. And as emerging evidence continues to appear, we are learning more about the important role of fat and cholesterol, along with the need to change our perspectives on their intake.
Research on Fats +
Investigations into the role of cholesterol have gained more attention in recent years.
In 2015, the Dietary Guidelines Assessment Committee (DGAC) released preliminary updates on revisions that were recommended to the American Dietary Guidelines.
Their preliminary statement about cholesterol:
“Cholesterol. Previously, the Dietary Guidelines for Americans recommended that cholesterol intake be limited to no more than 300 mg/day. The 2015 DGAC will not bring forward this recommendation, because available evidence shows no appreciable relationship between consumption of dietary cholesterol and serum cholesterol… Cholesterol is not a nutrient of concern for overconsumption.”
The Academy of Dietetics and Nutrition “supports the DGAC in its decision to drop dietary cholesterol from the nutrients of concern list and recommends it deemphasize saturated fat from nutrients of concern, given the lack of evidence connecting it with cardiovascular disease.”
And as for fat…”The Academy suggests that HHS and USDA support a similar revision deemphasizing saturated fat as a nutrient of concern. It appears that the evidence summarized by the DGAC suggests that the most effective recommendation for the reduction in cardiovascular disease would be a reduction in carbohydrate intake with replacement by polyunsaturated fat.”
Research on Cholesterol +
Protein improves satiety and hunger signals and makes up part of a healthy balanced diet. People with type 2 diabetes and prediabetes should be encouraged to eat healthy protein from lean meats, poultry, game, eggs, nuts, seeds and dairy products.
According to the American Diabetes Association, “research is inconclusive regarding the ideal amount of dietary protein to optimize either glycemic control or CVD risk. Some research has found successful management of type 2 diabetes with meal plans including slightly higher levels of protein (20–30%), which may contribute to increased satiety.”
Research on Protein +
We hope you find this research useful in your pursuit to help people with type 2 diabetes and prediabetes gain better outcomes.
If you know of further research that would contribute to our collection, please contact us.