With the inundation of information surrounding popular diets, trying to choose the “best” one can be overwhelming. While nutrition is extremely individualized, adhering to a diet can help create sustainable principles that improve your quality of life, especially when compounded with a chronic disease like Diabetes Mellitus. For the purpose of this article, we’ll focus on Type 2 diabetes (T2DM), which is caused by an insulin resistance. The purpose of this article is to discuss three popular diet styles and how they may interact with the management of diabetes.
The ketogenic diet is one of the most popular diet trends today. It originated in the 1920s as a potential dietary solution for childhood epilepsy and, over the past several decades, has expanded in scope to weight loss, clinical health and even athletic performance.
While there’s no formal definition, the concept is essentially a very-low carbohydrate, high-fat diet denoted as a relative number (i.e. 5-10% of total calories should come from carbohydrates) or an absolute amount of grams of carbohydrates per day (i.e. 50 g/day).
Your body runs primarily on carbohydrates. If you restrict your carb intake, your body has to use an alternative fuel to run efficiently – thus, it begins to burn fat as its primary source. The fat converts to what are known as ketone bodies (named appropriately after their chemical structure) and utilizes them as fuel.
In theory, a ketogenic diet would be perfect for a diabetic. Since they have trouble regulating blood sugar, restricting carbohydrates would be advantageous, right? Does the science confirm this? Let’s dive in.
To begin, ketones themselves are very acidic. As your body switches to burn ketones, there’s an adaptation period that can result in what’s known as the “keto flu”. During this process you can feel brain fogged, fatigued and nauseated. It’s an unfortunate downside to the ketogenic diet, and, in some cases, it can last for weeks.
However, one research study has shown that the ketogenic diet (20-50g/day of carbohydrates) improved blood values associated with T2DM among 49 participants. These metrics include body mass index, waist circumference, HbA1C, blood glucose, cholesterol panel (total, HDL, LDL) and triglycerides.
Taking a balanced approach to the evidence, there are some methodology challenges to keep in mind when analyzing these results. Studies are typically short in duration (<1 year), have a high participant drop-out rate, lack control groups for other diets, don’t take protein and calories into account and have varying population groups. Furthermore, research has shown that even without spiking insulin, individuals can still have an increase in inflammatory markers and cholesterol as well as deficiencies in key nutrients like fiber.
Overall, the ketogenic diet can be an effective tool for managing T2DM though it’s important to be cautious with your approach and take the necessary measures to ensure you’re adhering to the diet safely and effectively.
The paleo diet is an ideology to eat more like our ancestors did during the times of hunter-gatherers. The diet emphasizes foods like meat, seafood, fruits, vegetables, nuts, seeds and oils, and restricts consumption of grains (i.e. barley, corn, oats), legumes (i.e. beans, peanuts lentils), dairy and artificial ingredients.
Unfortunately, there’s limited research on the effects of the paleo diet on diabetes. While there’s evidence that a paleo diet can improve cholesterol, HDL, insulin sensitivity, fasting blood glucose and A1C, when compared to a traditional American Diabetes Association recommended diet, the differences were not statistically significant.
Additionally, studies conducted on the paleo diet are subject to limitations similar to the keto diet: short durations, low statistical power, unmatched nutrients and more. The paleo diet may be more expensive and also lead to deficiencies in key nutrients such as calcium.
Whole30 is a rapid lifestyle transformation that’s not for the faint of heart. It’s designed to jumpstart or “reset” your body by eliminating grains, dairy, sugar, legumes and alcohol for 30 days. If you mistakenly put skim milk in your coffee, you start back at Day 1. It essentially promotes a low carbohydrate, healthy fats and lean protein diet, but be careful because cutting out key nutrients can cause fiber, calcium and vitamin D deficiencies. While it doesn’t require calorie counting, this diet is extremely restrictive. If you have trouble adhering to a diet, this one might not be the best choice for your wellness journey.
Since there haven’t been any independent clinical trials on this diet, there’s no validation as to whether it’s effective. According to U.S. News, Whole30 was voted one of the worst diets to follow. Further, experts rated it only 2 out of 5 in diabetes management. Due to its restrictive nature and lack of credible substantiation, it’s recommended to explore other options before trying Whole30.
Overall, the key to success is choosing a lifestyle that’s safe, sustainable and realistic to adhere to. Find a diet you believe in and that makes you happy. Objective measurement through lab values and bio-feedback mechanisms (i.e. body composition) can eliminate arbitrary guessing and help you make better decisions as a consumer. Remember, small, incremental adjustments can add up to large overall changes.
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Disclaimer: This information is educational only and not providing healthcare recommendations. Please see a healthcare provider.