Intensive lifestyle modification has been shown to effectively delay or prevent diabetes.
Medical Nutrition Therapy delivered by a registered dietitian is associated with hemoglobin A1c (HbA1c) reduction
Weight loss
Weight reduction is beneficial in:lowering insulin resistance by
- lowering hepatic glucose production
-
lowering cardiovascular morbidity in part by producing a more
favourable lipoprotein profile - decreased LDL and VLDL levels and
increased HDL levels
Encourage people to:
- increase their consumption of foods that are high in fibre, such as wholegrain bread and cereals, beans and lentils, vegetables and fruit
- choose foods that are lower in fat and saturated fat, for example, by replacing products high in saturated fat (such as butter, ghee, some margarines, or coconut oil) with versions made with vegetable oils that are high in mono-unsaturated fat
- choose skimmed or semi-skimmed milk and low-fat yoghurts, instead of cream and full-fat milk and dairy products
- choose fish and lean meats instead of fatty meat and processed meat products (such as sausages and burgers)
- grill, bake, poach, or steam food instead of frying or roasting (for example, choose a baked potato instead of chips)
- avoid food high in fat such as mayonnaise, chips, crisps, pastries, poppadums (papads), and samosas
- choose fruit, unsalted nuts, or low-fat yoghurt as snacks instead of cakes, biscuits, bombay mix, or crisps
Modest weight losses of 5-10% have been associated with significant improvements in cardiovascular disease risk factors (ie, decreased HbA1c levels, reduced blood pressure, increase in HDL cholesterol, decreased plasma triglycerides) in patients with type 2 diabetes mellitus. Risk factor reduction was even greater with losses of 10-15% of body weight.
A study by Lazo et al attested to the benefits of lifestyle intervention, which aimed at a minimum weight loss of 7%, on hepatic steatosis in patients with type 2 diabetes. Since there is no known treatment for nonalcoholic fatty liver disease, a weight loss strategy may help to prevent progression to serious liver damage.
The ADA finds the use of nonnutritive sweeteners have the potential to reduce overall calorie and carbohydrate intake if substituted for caloric sweeteners.
Diet Options:
Reduction in fat (saturated fats, trans fats, cholesterol) intake in diabetic patients is aimed at decreasing cardiovascular disease risk by reducing plasma cholesterol and low-density lipoprotein (LDL) cholesterol levels. The ADA guidelines find a variety of eating patterns are acceptable for the management of type 2 diabetes and prediabetes including Mediterranean, plant-based diet & DASH diet.
Mediterranean-style diet
Esposito et al reported greater benefit from a low-carbohydrate, Mediterranean-style diet than from a low-fat diet in patients with newly diagnosed type 2 diabetes mellitus. In a single-center, randomized trial, 215 overweight patients with newly diagnosed type 2 diabetes mellitus who had never been treated with antihyperglycemic drugs and whose HbA1c levels were less than 11% were assigned to either a Mediterranean-style diet or a low-fat diet.
After 4 years, participants assigned to the Mediterranean-style diet had lost more weight and had demonstrated more improvement in some measures of glycemic control and coronary risk than had participants consuming the low-fat diet; 44% of patients in the Mediterranean-style diet group required antihyperglycemic drug therapy, compared with 70% of those in the low-fat diet group.
Servings of fish at least two times (two servings) per week as a form of omega-3 fatty acids, because of their beneficial effects on lipoproteins, prevention of heart disease, and association with positive health outcomesMonounsaturated fatty acid (MUFA) may benefit glycemic control and CVD risk factors and is an effective alternative to a lower-fat, higher-carbohydrate eatingVegan Diet
Plant-based diets have been shown to have a positive effect in both the prevention and treatment of type 2 diabetes in several clinical trials and are particularly effective for weight loss.
Plant sterols intake to block intestinal absorption of cholesterol and lower total plasma LDL cholesterol percentage, if intake is around 2 g/d. In North America vegetable spread Becel Proactiv contains plant stanols and sterols and would be preferable over butter or ghee.
DASH ( Dietary Approaches to Stop Hypertension ) Diet
primarily designed for patients with hypertension encourages greater intake of
- fresh fruits and vegetables
- fish - at least twice a week
- dietary and soluble fibre
- whole grains and protein from plant sources
- reduced in saturated fat and cholesterol.
For good health, carbohydrate intake from vegetables, fruits, whole grains, legumes, and dairy products are advised over intake from other carbohydrate sources, especially those that contain added fats, sugars, or sodium.
Trans-palmitoleate
In the Cardiovascular Health Study, phospholipid trans -palmitoleate levels were found to be associated with lower metabolic risk. Trans -palmitoleate is principally derived from naturally occurring dairy and other ruminant trans -fats. Circulating trans -palmitoleate is associated with lower insulin resistance, incidence of diabetes, and atherogenic dyslipidemia. Potential health benefits, therefore, need to be explored.
Isoflavones
Pasta enriched with biologically active isoflavone aglycons improves endothelial function in patients with type 2 diabetes mellitus and favorably affects cardiovascular disease risk markers. Richest source of isoflavonones are Soyabean products and Legume Seeds such as lentils, beans and peas
Advanced glycation end products
Food-derived, pro-oxidant, advanced glycation end products may contribute to insulin resistance in clinical type 2 diabetes mellitus and may suppress protective mechanisms. These are derived from high temperature cooked foods and tobacco products. Advanced glycation end-product restriction may preserve native defenses and insulin sensitivity by maintaining a lower basal oxidative state.
Physical Activity recommendations
Children aged 3-5 years: Should be physically active throughout the day to enhance growth and development.
Children aged 6-17 years: Sixty minutes or more of moderate-to-vigorous physical activity per day.
Adults: At least 150-300 minutes per week of moderate-intensity aerobic physical activityAll adults should decrease the amount of time spent in daily sedentary behavior. Prolonged sitting should be interrupted every 30 min for blood glucose benefits, particularly in adults with type 2 diabetes
Strong evidence demonstrates that moderate-to-vigorous physical activity improves sleep quality by decreasing the time it takes to fall asleep; it can also increase deep-sleep time and decrease daytime sleepiness.
Single episodes of physical activity promote improvements in executive function, to include organization of daily activities and future planning. Cognition (ie, memory, processing speed, attention, academic performance) also can be improved with physical exercise.
Regular physical activity reduces the risk of clinical depression, as well as reducing depressive symptoms and symptoms of anxiety.
Strong evidence demonstrates regular physical activity improves perceived quality of life.
Risk of diseases and conditions
Regular physical activity minimizes excessive weight gain, helps maintain weight within a healthy range, improves bone health, and prevents obesity, even in children as young as 3-5 years.
In pregnant women, physical activity helps reduce excessive weight gain in pregnancy and helps reduce the risk of developing gestational diabetes and postpartum depression.
Regular physical activity has been shown to improve cognitive function and to reduce the risk of dementia; falls and fall-related injuries; and cancers of the breast, esophagus, colon, bladder, lung, endometrium, kidney, and stomach. It also helps retard the progression of osteoarthritis, type 2 diabetes, and hypertension.
Yoga has been suggested as an alternative for severe diabetic patients who may be unable to participate in strenuous activity. The ADA guidelines recommend flexibility training and balance training 2–3 times/week for older adults with diabetes. Yoga and tai chi are acceptable practices to increase flexibility, muscular strength, and balanceINFORMATION & DISCLAIMER:
I obtained my primary medical education from India and post graduate MD in Family Medicine from the United Kingdom. After working in National Health Service, England for 15 years, I moved to Canada five years ago. As a Family Physician, I consider my speciality as engaging patients, interpreting medical information for them, guiding them through their health journey, promoting wise health choices and encouraging early detection and management of disease.
The information on this blog is accurate as per time of publishing. Scientific information and evidence changes dynamically and my opinions would change accordingly.
The recommendations on this blog are not prescriptions and any patients considering these should consult with a physician to check if these are applicable to their unique situation.Physician websites I commonly use for reference includePatient reference websites I commonly recommend to patients includehttps://patient.info/Patient confidentiality must be upheld at all times and any patients wishing to discuss specific medical scenarios on social media are requested to do so anonymously in 'third party' sense.
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