Diabetes Diet

R2 謝宜庭
89% were unaware of
the opportunity to use
an alternative diet
1) Non-starchy
vegetables

2) Minimize added sugars

and refined grains

3) Whole foods over

processed foods
Consider health
status, skills,
resources, food
preferences, and
health goals.
Traditional dietary guidelines
● 45–65% calories from fibre-rich carbohydrate,
● 20–35% from fat
● 15–25% from protein
Alternatives

The Mediterranean style

Low-carbohydrate
Vegetarian or plant-based
Mediterranean

● Level B evidence
(fair evidence)
● Reduce diabetes
risk even without
weight loss.
Why
● Reduced inflammation
● Improved insulin sensitivity
● Postprandial glucose response
● Extra virgin olive oil may attenuate the early postprandial
glucose response
● Plant-based: fruits and vegetables
● Whole grain
● Minimally processed food
● Limited sweets: fresh fruits, nuts
● High-quality fats: olive oil (30-40%)
● Low to moderate dairy intake:
○ mainly cheese and yogurt
● Protein:
○ Seafood, red meats and eggs in small
amounts with low frequency
● Alcohol:
○ Wine in low to moderate amounts with meals
● Herbs and spices: instead of salt
Mediterranean V.S. Low-fat
● Instruction every month for 1 year,
than every 2 months
● Mediterranean (Energy restricted)
○ Whole grains, 41-44%
○ >30% from fat
● Low-fat (Energy restricted)
○ Whole grains, 50-54%
○ < 30% from fat
○ < 10% from saturated fat
● Encourage physical activities (175
min/week)
After 4 years ...
Reviews
地中海 vs 一般DM飲食

低碳地中海 vs 低脂飲食

低碳地中海 vs 一般地中海 vs 一般DM飲食

隨便吃地中海 vs 一般DM飲食

地中海 vs 一般DM飲食
● MED diet delayed the need for glycemic drug
● MED improves HbA1C
● MED may reduce weight
● Effect of the MED diet goes beyond weight
reduction
Low-carbohydrate
Postprandial
glucose and
insulin levels
5% Weight loss
associated with
reduction in HbA1c of
0.6–1.0%
Most individuals with diabetes report a moderate intake
of carbohydrate (44–46% of total calories)
Reducing overall carbohydrate intake for individuals with
diabetes has demonstrated the evidence
Who has the most carbs?
86.1 29.1 59.4
● 5 studies: very low, 10% carbs (<50g)
● 5 studies: low, <26% carbs (<130g)
● 15 studies: moderate, 26%- 45% carbs (<225g)
● To compensate for a reduced carbohydrate intake
○ Protein, Fat, or Both
10% 26% 54%
3 Months
6 Months
12 Months
Low-carbs (<40%) v.s. Low-fat (<30%)
HbA1C
● Improved
through out
● Difference
diminished
over time
TG
HDL
LDL
Interpretations
● HbA1C seems to improve more with the low-carb diet in a short term
● Little to no difference in the 2 diets in terms of HbA1C after 2 years
● HbA1C returned to baseline value after 2 years ⇒ Poor Compliance!!
● Substitution of PUFA by saturated fat can increase LDL, but substitution of
carbs by saturated fat has little effect on LDL
● Low-carb diet is not superior in terms of body weight loss, waist
circumference, and quality of life
● 3 studies compared the very-low carb diet with the low-fat diet, and the results
did not deviate from others
carbohydrate-restricted diets (<45% of total daily energy)

high carbohydrate diets (>45% of total energy)

10 RCTs, followed for 1 year

● Reduced HbA1C by 0.34% more in low-carb within 6 months
○ No effect after 12 months
○ Due to the decrease of diet adherence

● Reduced medication in low-carb group

● No significant difference in BMI, body weight, waist

circumference, LDL
Problems of low-carb diet
● Inconsistency
● Drop out rate
● Compromised physical performance
● Risk of hypoglycemia
Not recommended to
● Women who are pregnant or lactating
● People at risk for disordered eating
● People who have renal disease
● It should be used with caution in patients taking SGLT-2 inhibitors due to the
potential risk of ketoacidosis
Vegetarian or Plant-based
Encourages whole, plant-based foods and discourages meats, dairy products and
eggs as well as all refined and processed foods
Possible mechanisms
● Intakes of fibre

● lower intakes of saturated fat

● higher intakes of nonheme iron and reduction in iron stores

● higher intakes of vegetable protein in the place of animal protein

● higher intakes of antioxidants and plant sterols

Low-fat vegan v.s. Conventional diet
60-75% from carbohydrates 50% from carbohydrates

15% from protein 20% from protein

10-25% from fat 30% from fat
+/- low-fat yogurt per day
<7% saturated fat
+/- vitamin B12 supplement
<200 mg cholesterol
● Improved fasting blood glucose
● Improvements in A1C levels
● Oral hypoglycemic medication discontinuation
● Improvements in body mass index (BMI), body weight and waist circumference
● Reduction in total cholesterol
● Decreased low-density lipoprotein cholesterol
● Decreased non-HDL cholesterol
● Increased quality of life scores and decreased depression
5 vegan studies and 1 lacto-ovo-vegetarian study

Follow for 4 to 74 weeks (average 23.7 weeks)

HbA1C

The reduction in A1C levels via PBD intervention

was approximately half metformin.
Fasting Plasma Glucose
Type 1 DM

● Protein intake: 1.2 → 0.3 g/kg/d

● CCR: 1.48 → 0.13 ml/min
● Urine protein : 5.2 → 2.8 g/day
● Cholesterol: 254 → 165 mg/dL
● Blood glucose: 166 → 131 mg/dL
Problems
● No long-term RCTs
● A majority of the trials used a restrictive vegan diet
● Major difficulties
○ Family influence
○ Preference for meat
○ Meal-planning skills

● Insufficient calcium, vitamin D, vitamin B12, protein, iron, riboflavin and zinc
● EPA and DHA
66% of the patients were willing to follow a PBD
for 3 weeks if support were provided.
Conclusion
● Low-fat or low-carb diet
● High quality of food
Thank you ~