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Ultimate Diabetes Nutrition Guide: What, When, and How to Eat American Diabetes Association; Nutrition Recommendations inake Interventions Boosting skin immunity Diabetes Calcium absorption A Caloric intake and diabetes management statement of the American An Association. Medical Calodic therapy MNT is important in preventing diabetes, managing existing diabetes, and preventing, or at least slowing, the rate of development of diabetes complications. It is, therefore, important at all levels of diabetes prevention see Table 1. MNT is also an integral component of diabetes self-management education or training. This position statement provides evidence-based recommendations and interventions for diabetes MNT.Caloric intake and diabetes management -
There was no significant change in hepatic insulin resistance index after weight maintenance in either group 0. At baseline, the responders tended to have greater hepatic insulin resistance 2. Hepatic triglyceride content A , hepatic insulin resistance index B , and hepatic VLDL 1 -triglyceride production C in responders and nonresponders at baseline hatched bars , after VLCD checkered bars , and after 6 months of weight maintenance striped bars.
IR, insulin resistance; TG, triglyceride. Marked normalization in hepatic triglyceride content was seen in both the responders Serum alanine aminotransferase ALT levels decreased only in the responders Table 1.
There was no reaccumulation of hepatic triglyceride during the 6-month weight maintenance period in either responders or nonresponders 2.
Responders had higher ALT levels Hepatic VLDL 1 -triglyceride production rate was similar in the two groups at baseline First-phase insulin response was markedly reduced at baseline in nonresponders compared with responders 0.
Similarly, maximal insulin secretory capacity baseline to peak insulin secretion rate was significantly impaired 0. First-phase insulin response improved in the responders 0. There was no change in maximal insulin secretory capacity in either group responders 1.
Change in first-phase insulin response A and pancreas triglyceride content B in responders and nonresponders at baseline hatched bars , after VLCD checkered bars , and after 6 months of weight maintenance striped bars.
First-phase insulin secretion did not change over the weight maintenance period in either responders or nonresponders 0.
There was no change in maximal insulin secretory capacity. At baseline, pancreas fat levels were similar in responders and nonresponders 5.
After the VLCD, there was a significant decrease in pancreas fat content in both groups responders 5. Pancreas fat content remained stable during weight maintenance 4. There was no difference in either visceral adipose tissue or subcutaneous adipose tissue areas between groups at baseline responders Both visceral and subcutaneous adipose tissue areas decreased after the VLCD and then remained constant during the 6-month follow-up responders: visceral There was no significant improvement in muscle insulin sensitivity after the VLCD responders 5.
Return to nondiabetic blood glucose levels was characterized by improvement in acute insulin secretion, and this was sustained while off all hypoglycemic agents. Hepatic insulin sensitivity improved in both responders and nonresponders. The structured, individualized weight maintenance program was successful in preventing weight gain.
Weight loss brought about normalization of liver fat content and insulin sensitivity in both responders and nonresponders. Of note, no redistribution of fat was seen to the liver from the subcutaneous or other deposits over 6 months of weight stability, even though the participants remained obese or overweight Table 1.
This finding supports the concept of a personal fat threshold above which adipose tissue cannot store the available triglyceride 19 and has major implications for the management of nonalcoholic fatty liver disease. The observed fall in pancreas fat is a secondary consequence of decreased tissue delivery of triglyceride.
The responders differed primarily in having higher baseline plasma insulin levels and a degree of β-cell response to intravenous glucose. Recovery of acute insulin secretory capacity to nondiabetic levels 20 , 21 was seen in responders and not in nonresponders.
The constancy of the arginine-induced insulin response implies persistence of the insulin secretory mechanism in reversible T2DM despite loss of glucose responsiveness. This is consistent with T2DM being a condition of β-cell dedifferentiation rather than β-cell loss. Nonresponders were characterized by evidence of insulin deficiency at baseline and lack of ability to regenerate insulin secretion capacity.
In the human pancreas, the magnetic resonance technique detects the total intra- and extracellular triglyceride in exocrine and endocrine cells, and this is decreased uniquely in T2DM after weight loss The importance of pancreas triglyceride in the pathogenesis of T2DM was initially shown in obese rodents, with local lipolysis bringing about fatty acid—mediated inhibition of β-cell function Exposure to even modest concentrations of fatty acids causes marked triglyceride accumulation in human islets in vitro Chronic exposure of β-cells to triglyceride or fatty acids in vitro decreases β-cell capacity to respond to an acute increase in glucose levels 24 , 25 , and if β-cell fatty acid receptors are knocked out, insulin secretion returns to normal In the human pancreas, intracellular fat droplets are widely distributed within the exocrine pancreatic cells in addition to widely scattered isolated adipocytes Local lipolysis will bring about interstitial and intracellular concentrations of fatty acids sufficient to inhibit β-cell function, and the data suggest that removal of the excess fat allows recovery of function.
We hypothesize that in the responders, release from fat-mediated inhibition allows expression of a remaining latent capacity for glucose-responsive insulin secretion. Current concepts of T2DM have been powerfully shaped by several large studies that have demonstrated a steadily increasing requirement for hypoglycemic agents over years 2 , 28 , In particular, the inexorable loss of β-cell function observed during the UK Prospective Diabetes Study reinforced the view of T2DM as irreversible and progressive 3 , However, progressive weight gain over time occurred during these long-term observations, and hence, the published data have shown T2DM to be irreversible only during chronic positive calorie balance.
Ready access to low-cost food is uniformly accompanied by high rates of T2DM 31 — 33 , and when food supply becomes limited for any reason, the prevalence of T2DM falls 34 , The question of possible therapeutic application of VLCD for T2DM was raised immediately on publication of the Counterpoint study The present data confirm reversal of T2DM for at least 6 months in those who achieve nondiabetic plasma glucose levels after VLCD.
However, the critical question for health care delivery is whether truly long-term reversal of T2DM can be achieved in primary care.
To answer this question, a community-based study DiRECT [Diabetes Remission Clinical Trial] is now under way in people with T2DM randomized to VLCD with structured individualized weight maintenance or to best-possible guideline-based care. The overall effect of the alternative approaches will be assessed, as the impact of weight loss on blood pressure and lipids is considerable even if plasma glucose levels do not normalize.
Being able to stop taking multiple tablets is important to people with T2DM, and the potential associated health care savings are great indeed. The likelihood of VLCD responders remaining free of diabetes indefinitely must be considered.
After media coverage of our earlier study, many people with T2DM reversed their own diabetes For such motivated individuals who avoid weight regain, maintenance of normoglycemia for up to 3 years has been reported 37 , Follow-up at 4 years of the Look AHEAD Action for Health in Diabetes study with only 8.
Because progression of long-term complications of diabetes relates to ambient blood glucose control, durable reversal of diabetes would be expected to be associated with long-term health. The effect of a period of normoglycemia confers substantial benefits in decreasing the risk of complications, even if hyperglycemia recurs Whether blood glucose control normalized, a major benefit in vascular risk was achieved in terms of reduction of blood pressure and blood lipids.
Long-term prospective study of VLCD followed by a weight maintenance program is now required to define overall benefit. The intense motivation to return to normal health in a proportion of people with T2DM has not been widely recognized.
Such individuals respond readily to simple, unambiguous advice to lose weight For those people who have repeatedly failed to lose weight over many years, this approach is much less likely to succeed.
Severely obese subjects are selected for bariatric surgery after all other methods to lose weight have failed, and this group is appropriately treated.
The overall proportion of people with T2DM who will be able to succeed in the significant long-term lifestyle modification required for VLCD and subsequent weight maintenance with ongoing support remains to be determined. The VLCD was found to be acceptable as indicated by the low dropout rate in both this and the previous study The principal reason reported was the absence of hunger at this level of calorie intake.
The main difficulty was readjusting to normal eating after the VLCD, and this was mitigated by definitive prescription of food type and amount during the food reintroduction and weight maintenance phase. Of note, the need to become used to eating approximately one-third less than previously had been explained in advance.
The weight maintenance program, with its clear focus on calorie restriction, individual identification of potential barriers, and monthly contact with S. was successful in avoiding weight gain during the 6-month follow-up period. The separate effects of very low-calorie intake itself and change in underlying pathophysiology were defined by the rise in plasma glucose before and after return to isocaloric eating Fig.
The limitations of the study must be considered. The study had a small sample size, although the effect size was larger than in pharmacological studies of one or more hypoglycemic agents 41 , and the results are definitive.
The group size was determined by our previous observations 11 to achieve the specific aims of the study, to examine whether those who achieve nondiabetic fasting blood glucose after VLCD would remain normoglycemic during weight stability, and to determine underlying mechanisms.
This was not primarily a treatment trial but rather a pathophysiological study to achieve proof of concept. Six-month follow-up is sufficient to detect any redistribution of fat stores during an isocaloric diet, although longer duration studies are required to define effectiveness as a routine clinical treatment.
The group studied was representative of the wider T2DM population, predominantly Caucasian in the northeast of England. Study of other ethnic groups is required. The heterogeneous group studied represents the spectrum of individuals with T2DM who may wish to undertake calorie restriction.
A gold standard insulin secretion test was used rather than a test meal to define the acute insulin response because loss of this parameter is a characteristic of T2DM. T2DM can now be understood to be a metabolic syndrome potentially reversible by substantial weight loss, and this is an important paradigm shift.
Not all people with T2DM will be willing to make the changes necessary, but for those who do, metabolic health may be regained and sustained in just under one-half. The observations carry profound implications for the health of individuals and for the economics of future health care. Clinical trial reg.
ISRCTN, www. The authors thank the participants for enthusiastic participation. They also thank L. Hughes, A. Burnett, and T. Dew, Newcastle upon Tyne Hospitals NHS Foundation Trust, for the laboratory work and acknowledge the expertise of radiographers L.
Ward, T. Hodgson, and D. Wallace of Newcastle University. The authors are grateful to Josephine Cooney of Glasgow University for VLDL 1 -triglyceride analysis.
The study was funded by a National Institute for Health Research Newcastle Biomedical Research Center grant and a Novo Nordisk UK Research Foundation Research Fellowship to S.
The funders had no input on any aspect of the study design or writing. Duality of Interest. Nestlé UK provided the OPTIFAST on request, but had no other input on the research. has received lecture fees from Novartis, Novo Nordisk, and Lilly and for contribution to running a European Association for the Study of Diabetes workshop from Nestlé Ltd.
No other potential conflicts of interest relevant to this article were reported. Author Contributions. contributed to the clinical and metabolic studies and writing of the manuscript.
developed the magnetic resonance methodology and contributed to the writing of the manuscript. performed gas chromatography—mass spectrometry analyses and contributed to the editing of the manuscript. delivered the behavioral intervention during weight maintenance and contributed to the editing of the manuscript.
contributed to the data analysis and editing of the manuscript. analyzed VLDL 1 -triglyceride data and contributed to the editing of the manuscript. designed the study and contributed to the writing of the manuscript. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
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Previous Article Next Article. Research Design and Methods. Article Information. Article Navigation. Very Low-Calorie Diet and 6 Months of Weight Stability in Type 2 Diabetes: Pathophysiological Changes in Responders and Nonresponders Sarah Steven ; Sarah Steven.
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Table 1 Fasting anthropometric and metabolic data in responders and nonresponders at baseline, after VLCD and return to isocaloric eating, and after the 6-month weight maintenance period.
After VLCD. After 6 months. Weight kg View Large. Figure 2. Figure 3. Taking care with portion sizes is still important when eating low GI foods, as large servings of these foods can result in high blood glucose levels and weight gain.
Some low GI foods may be high in saturated fat, added sugar and energy — for example, ice cream and chocolate. Always check the list of ingredients and the energy calorie or kilojoule content of packaged foods.
Foods with a GI of 55 and below are low GI foods. The GI values of foods are only an average, and people will often react very differently to foods. People with diabetes are advised to self-monitor their blood glucose levels, before and 2 hours after starting a meal, to determine the effect of various foods on their own blood glucose levels.
People with diabetes who follow a healthy eating pattern can include a small amount of sugar in their diet. However, the sugar should be eaten as part of a nutritious meal. For example, one teaspoon of honey with plain porridge, tinned fruit in natural juice and some types of high fibre breakfast cereals with dried fruit, such as natural muesli.
All fats are high in energy. Eating too much fat can lead to weight gain, which may make it more difficult to manage your blood glucose levels and can increase blood fats cholesterol and triglycerides.
The type of fat you eat is also important. People with diabetes have a greater risk of developing heart disease , so try to eat less saturated fat and replace with healthier unsaturated fats. Foods high in saturated fat include meat fat, full-fat dairy foods, cream, solid cooking fats such as butter, lard, copha and ghee , oils such as palm and coconut, and products that contain these fats for example, fried foods, some cakes and biscuits, and convenience foods.
The body uses protein for growth and repair. Most people only require 2 to 3 small serves of meat or other protein foods each day. Most protein foods do not directly affect your blood glucose levels. Protein foods include lean meat, skinless poultry, seafood, eggs, unsalted nuts, soy products such as tofu and legumes dried beans and lentils, chickpeas, four-bean mix, kidney beans.
Legumes also contain carbohydrate, so they may have an impact on your blood glucose levels. Choose foods that you like and that satisfy you. Include a small serving of carbohydrate foods in each meal or snack to help manage blood glucose levels.
You can eat your main meal at lunch or dinner. Not everyone needs to include snacks between meals. Talk to your diabetes educator or dietitian if you are unsure.
People with diabetes should discuss their food habits with a dietitian so that appropriate dietary recommendations can be designed for their needs. This page has been produced in consultation with and approved by:. Content on this website is provided for information purposes only.
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Diabetes and healthy eating. Actions for this page Listen Print. Summary Read the full fact sheet. On this page. Healthy eating and diabetes Physical activity and diabetes Basic eating guidelines for diabetes Carbohydrates and diabetes Glycaemic index GI and diabetes Sugar intake and diabetes Fat consumption and diabetes Protein consumption and diabetes Sample meal plan for healthy eating with diabetes Talk to a dietitian Where to get help.
Healthy eating and diabetes If you have diabetes, healthy eating can help you to: maintain general good health better manage your blood glucose levels achieve target blood lipid fat levels maintain a healthy blood pressure maintain a healthy body weight prevent or slow the development of diabetes complications.
Physical activity and diabetes Along with healthy eating, physical activity is important. A regular half-hour of physical activity can help to: lower your blood glucose levels lower your cholesterol lower your blood pressure reduce stress and anxiety improve your mood and self-esteem improve the quality of your sleep increase muscle and bone strength.
Some small activities you can do to help reduce the amount of time you spend sitting throughout the day include: Take the stairs rather than the lift. Park further away from your destination and walk. Get off public transport one stop earlier and walk the rest of the way.
Get up to get a drink of water on a regular basis, at least once every hour. Do some chores, such as ironing, while watching TV. Play with your children or grandchildren in the park. Get up and talk to your work colleagues rather than emailing them.
Basic eating guidelines for diabetes If you have diabetes, follow a simple healthy eating plan, which includes: Eat regular meals throughout the day. Make vegetables the main part of your meal. Aim to fill at least half of your plate with non-starchy vegetables or salad at both lunch and dinner time.
You may need to reduce the serving size of your meals and snacks, as eating too much can lead to weight gain and make diabetes harder to manage. Include a small serving of high-fibre carbohydrate at each meal. Examples of high-fibre carbohydrate foods are wholegrain bread, cereals such as oats, Vita Brits®, All-Bran® and natural muesli , wholemeal pasta, brown rice, quinoa , fruit and starchy vegetables such as corn, sweet potato and potato.
Choose reduced-fat or low-fat dairy products. Look for those with the least amount of added sugar. Greek yoghurt with fresh fruit is a good choice. Choose lean meats and alternatives, such as skinless chicken and turkey , fish , eggs, legumes beans, lentils , tofu and nuts.
Limit the unhealthy saturated fats that are found in foods such as full-fat dairy products, butter, cream, fatty and processed meats, fried foods, cakes, pastries, and foods containing palm oil and coconut oil. Instead, replace saturated fats with healthy unsaturated fats like olive, canola or sunflower oil, monounsaturated or polyunsaturated margarines, oily fish, avocado, seeds and nuts.
Diabetes can Caloric intake and diabetes management well manavement with healthy eating, combined with regular physical activity and Caloric intake and diabetes management management. If intzke Calcium absorption diabetes, it is recommended Caloric intake and diabetes management you follow a healthy eating Calorkc based on plenty managfment vegetables Chronic inflammation symptoms legumes such as chickpeas, lentils, low-salt baked beans and kidney beans. Include some high-fibre, low glycaemic index GI carbohydrates such as wholegrain breads and cereals and fruit, as well as some lean protein sources and reduced-fat dairy products. Reduce your intake of saturated unhealthy fat and added sugars, and choose foods low in salt. Reducing the serving size of your meals can also help you to maintain a healthy body weight and allows for better blood glucose management. It is recommended that you see a dietitian who can work with you to develop a healthy eating pattern that is just right for you. If you have diabetes, healthy eating can help you to:.
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