Protein Principles for Diabetes

Dietary considerations can present a Hobson's choice in

diabetes. Even when the intake is nutritious, assimilating
it can be another matter. Then there is the problem of
progression of diabetic complications if one ends up with
excess glucose or fat in the system. Excess
carbohydrates in a meal and the resulting uncontrolled
blood sugar levels can be detrimental to any number of
tissues, from the lens of the eye, to the neurons, small
blood vessels and the kidneys. Fat is also a problem with
increase incidences of atherosclerosis, large vessel
disease and cardiac complications. What then is the
appropriate macronutrient for the diabetic population?
Enough medical literature exists to suggest that in
diabetes, proteins are probably the best bet.

Proteins are the natural choice of the body when faced

with diabetes. In uncontrolled diabetes, muscle protein is
broken down into amino acids to be converted into
glucose by the liver. If left to fend for itself, this can
create a commotion within the body. Since proteins have
to supply enough energy to substitute for carbohydrates,
proteins are broken down faster than they are made. The
body ends up with a protein deficit, a situation with
subtle, yet far-reaching effects on normal body functions.
Importantly, for diabetics, a protein deficit has been
shown to impair resistance to infections (Ganong WF).
Replenishing the depleting protein stores is a vital
requirement of all diabetic diets.

Importance of proteins in a diabetic has been well

documented. The American Associations of Clinical
Endocrinologists have made it clear that not much
evidence exists to indicate that the patients with diabetes
need to reduce their intake of dietary proteins. The AACE
recommends that 10-20% of the calorie intake in
diabetes should come from proteins (AACE Diabetes
Guidelines). It is in fact believed that this is one nutrient
that does not increase blood glucose levels in both
diabetics and healthy subjects (Gannon et al).

Nutrition therapy for diabetes has progressed from

prevention of obesity or weight gain to improving insulin's
effectiveness and contributing to improved metabolic
control (Franz MJ). In this new role, a high protein diet
(30% of total food energy) forms a very pertinent part of
nutrition therapy. One of the most important causes for
type II diabetes is obesity. Excess body fat raises insulin
resistance and higher levels of insulin are required to
bring down blood sugars as the weight increases (Ganong
WF). Another problem with excess fat is the clogging of
arteries with atherosclerotic plaques that is responsible
for a wide range of diabetic complications. Any
mechanism that reduces body fat decreases insulin
resistance and improves blood glucose control. Parker et
al have also shown that a high protein diet decreased
abdominal and total fat mass in women with type II
diabetes. Other studies by Gannon et al. and Nuttall et al
have verified that blood glucose levels and glycosylated
hemoglobin (a marker of long term diabetic control)
reduce after 5 weeks on a diet containing 30% of the
total food energy in the form of proteins and low
carbohydrate content. It is speculated that a high protein
diet has a favorable effect in diabetes due to the ability of
proteins and amino acids to stimulate insulin release from
the pancreas. Thus, a high protein diet is not only safe in
diabetes, but can also be therapeutic, resulting in
improved glycemic control, and decreased risk of
complications related to diabetes.

The benefits of a high protein diet do not end here.

Individual protein components of such a diet, when aptly
chosen, can have other advantages as well. Dietary
supplements containing proteins like whey and casein
come highly recommended. Casein is a milk protein and
has the ability to form a gel or clot in the stomach. The
ability to form this clot makes it very efficient in nutrient
supply. The clot is able to provide a sustained, slow
release of amino acids into the blood stream, sometimes
lasting for several hours (Boirie et al. 1997). A slow
sustained release of nutrients matches well with the
limited amount of insulin that can be produced by the
pancreas in diabetes. A protein supplement containing
casein can thus increase the amount of energy
assimilated from every meal and, at the same time,
reduce the need for pharmacological interventions to
control blood sugar.

Whey proteins and caseins also contain "casokinins" and

"lactokinins', (FitzGerald) which have been found to
decrease both systolic and diastolic blood pressure in
hypertensive humans (Seppo). In addition, whey protein
forms bioactive amine in the gut that promotes immunity.
Whey protein contains an ample supply of the amino acid
cysteine. Cysteine appears to enhance glutathione levels,
which has been shown to have strong antioxidant
properties -- antioxidants mop up free radicals that
induce cell death and play a role in aging.
Thus, development of a protein supplement containing
casein and whey can provide an apt high protein diet and
its health benefits to individuals suffering from diabetes,
obesity and hypercholesterolemia.