Diabetic diet
A diabetic diet is a diet that is used by people with diabetes mellitus or high blood sugar to minimize symptoms and dangerous complications of long term elevations in blood sugar (i.e.: cardiovascular disease, kidney disease, obesity).
Among guideline recommendations including the American Diabetes Association (ADA) and Diabetes UK, there is no consensus that one specific diet is better than others.[1][2] This is due to a lack of long term high quality studies on this subject matter.[1][2]
For overweight and obese people with diabetes, the most important aspect of any diet is that it results in loss of body fat.[1][2] Losing body fat has been proven to improve blood glucose control and lower insulin levels.[1][2]
The most agreed-upon recommendation is for the diet to be low in sugar and refined carbohydrates, while relatively high in dietary fiber, especially soluble fiber. Likewise, people with diabetes may be encouraged to reduce their intake of carbohydrates that have a high glycemic index (GI), although the ADA and Diabetes UK note that further evidence for this recommendation is needed.[3][4][1][2] However, in cases of hypoglycemia, they are advised to have food or drink that can raise blood glucose quickly, such as a sugary sports drink, followed by a long-acting carbohydrate (such as rye bread) to prevent risk of further hypoglycemia
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Specific diets
Low-carbohydrate diet
Further information: Low-carbohydrate diet § Diabetes
For type 1 diabetics, there is a lack of definitive evidence of the usefulness of low-carbohydrate diets due to limited study of this topic.[1][10][11] A recent meta-analysis found only nine papers that had adequately studied the implementation of low carbohydrate diets in type 1 diabetics as of March 2017.[11] This review found that low carbohydrate diets consistently reduced insulin requirements but found inconsistent results in regard to the diet's effect on blood glucose levels.[11] 3 studies found significant decreases in HbA1c on low carbohydrate diets while 5 found that HbA1c levels were stable.[11] This review as well as the ADA consensus statement suggests that low carbohydrate diets may be beneficial for type 1 diabetics but larger clinical trials are needed for further evidence.[1][11]
A low-carbohydrate diet gives slightly better control of glucose metabolism than a low-fat diet in type 2 diabetes.[12][13] In a 2019 consensus report on nutrition therapy for adults with diabetes and prediabetes the American Diabetes Association (ADA) states "Reducing overall carbohydrate intake for individuals with diabetes has demonstrated the most evidence for improving glycemia (blood sugar) and may be applied in a variety of eating patterns that meet individual needs and preferences.", it also states that reducing overall carbohydrate intake with low- or very low- carbohydrate eating plans is a viable approach.[14]
The ADA say low-carbohydrate diets can be useful to help people with type 2 diabetes lose weight, but that these diets were poorly defined, difficult to sustain, unsuitable for certain groups of people and that, for diet composition in general".[15] Overall, the ADA recommends people with diabetes develop "healthy eating patterns rather than focusing on individual macronutrients, micronutrients, or single foods". They recommend that carbohydrates in a diet should come from whole food sources such as "vegetables, legumes, fruits, dairy (milk and yogurt), and whole grains"; highly refined foods and sugary drinks should be avoided.
Vegan/vegetarian
Further information: Veganism, Vegan nutrition, and Vegetarianism
Although vegan and vegetarian diets can vary greatly in the type of food consumed as well as the macronutrient profile of the diet, they are often lumped together in the context of the scientific literature since they are both considered plant-based diets. Like any other diet's impact on diabetes, the most important factor is the resulting loss of overall fat mass.[1][2] Both vegan and vegetarian diets have been shown to be beneficial for weight loss in comparison to the standard American diet.[1][16] For type 2 diabetics, the focus of a vegetarian or vegan diet should be maintaining a level of caloric intake that results in fat loss, adequate protein consumption, adequate consumption of compounds that are most bio-available in animal products (i.e. vitamin B-12, iron, creatine), and whole food carbohydrate sources that are lower in glycemic index.
The Academy of Nutrition and Dietetics maintains that well formulated vegetarian and vegan diets can be healthy and nutritionally adequate for people of all ages.[17] The American Diabetes Association notes that the use of vegetarian or vegan diets for diabetes have had inconclusive results in the literature.[1] Two meta-analyses showed small improvements in HbA1C; whereas, one of the two found that the diets resulted in weight loss and improvement in cardiovascular risk factors
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Low glycemic index diet
Further information: Low-carbohydrate diet
Lowering the glycemic index of one's diet may improve the control of diabetes.[18][19] This includes avoidance of such foods as potatoes cooked in certain ways (i.e.: boiled and mashed potatoes are higher GI than fried) and white bread.[20] Lower glycemic index carbohydrate sources include vegetables, legumes, and whole grains that contain higher fiber content and are digested and absorbed into the blood stream more slowly than refined carbohydrates.
High fiber diet
Further information: High fiber diet
The ADA recommends a level of fiber intake consistent with the Dietary Guidelines for Americans 2015–2020 (minimum of 14 g of fiber per 1,000 kcal).[1][21] However, there is some evidence that higher intakes (daily consumption of 50g of fiber and higher), can result in small improvements in blood sugar levels.[22][23][24][25] The ADA cautions that higher intakes may cause digestive issues such as “flatulence, bloating, and diarrhea.”[1]
Timing of meals
For people with diabetes, healthy eating is not simply a matter of what one eats, but also when one eats. For insulin dependent diabetics, when they eat depends on their blood sugar level and the type of insulin they take (i.e.: long-, medium- or quick-acting insulin). If patients check their blood glucose at bedtime and find that it is low, for example below 6 millimoles per liter (108 mg/dL), it is advisable that they take some long-acting carbohydrate before retiring to bed to prevent night-time hypoglycemia.[citation needed] Night sweats, headaches, restless sleep, and nightmares can be a sign of nocturnal hypoglycemia, and patients should consult their doctor for adjustments to their insulin routine if they find that this is the case.[26] Counterintuitively, another possible sign of nocturnal hypoglycemia is morning hyperglycemia, which actually occurs in response to blood sugar getting too low at night. This is called the Somogyi effect.
In relation to type 2 diabetes, eating most food earlier in the day may be associated with lower levels of overweight and obesity and other factors that reduce the risk of developing type 2 diabetes.[27] The ADA notes that several studies have shown benefit of intermittent fasting on blood sugar control.[1] However, these studies were relatively small and short in duration and further study is warranted.[1] There were also different protocols for fasting which makes comparisons across studies more difficult.[1]
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