With the inundation of information surrounding diets, it can
be overwhelming to choose the “best” one. While Nutrition is extremely
individualized, and personalization surrounding Food as Medicine is becoming a crucial
population tenet, it is critical to create sustainable principles that people
will follow to achieve improved quality of life, especially when compounded
with a chronic disease like Diabetes Mellitus. For the purpose of this article,
we will focus on type 2 diabetes (T2DM), which is a consequence of poor
lifestyle choices (diet and lack of physical activity) that leads to insulin
resistance. The purpose of this article
is to discuss three popular diet styles and how they may assist with the
management of Diabetes Mellitus.
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.
First, we must ask ourselves, what is the ketogenic diet? While there is no formal definition, the concept is essentially a very-low carbohydrate, high-fat diet. In literature, the ketogenic diet can either be denoted as an absolute amount of grams of carbohydrates per day (i.e. 50 g/day) or it can be relative (i.e. 5-10% of total Calories should come from carbohydrates).
Biologically, your body runs primarily on carbohydrates, especially the brain. If you restrict carbohydrates, then your body must use an alternative fuel to run efficiently. Subsequently, the body switches fuel and 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 and thus restricting carbohydrates would be serendipitous. The idea is that by switching to burning fat primarily, you do not have to rely as much on insulin swings to bring in carbohydrates. Does the science confirm this? Let’s dive in.
To begin, ketones themselves are very acidic. As your body switches to burn ketones, there is an adaptation period that can result in what is known as the “keto flu”. During this process, you can feel brain fogged, fatigued, and nauseated. It is a downside to the ketogenic diet, and it can last for a few weeks in some cases.
Research has shown that the ketogenic diet (20-50g/day of carbohydrates) has improved blood values associated with T2DM. 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 negative effects to the ketogenic diet. As with any topic there are some methodology questions to consider when analyzing these studies. Usually, these studies are short in duration (<1 year), there are high drop-out rates from the participants, lack of control groups for other diets, protein and Calories are not equated for which can impact satiety and metabolism, and varying population groups. Furthermore, it is rare that the ketogenic diet is superior to other diets from a practical standpoint. Lastly, literature has demonstrated that even by not spiking insulin, people can still have an increase in inflammatory markers and cholesterol and there may also be deficiencies in key nutrients like fiber.
Overall, the ketogenic diet can be an effective tool for managing T2DM. It is important to be cautious with your approach and take the necessary measures to ensure you are adhering to the diet safely and effectively.
The Paleo diet is an ideology to eat more like our ancestors did in the times of hunter-gatherers with minimal processed foods. The diet emphasizes foods like meats/seafood, fruits and vegetables, nuts/seeds/oils and restrict grains (i.e. barley, corn, oats), legumes (i.e. beans, peanuts lentils), dairy, and artificial ingredients.
There is limited research on the effects of the Paleo diet on diabetes. There is evidence that a Paleo diet can improve cholesterol, HDL, Insulin sensitivity, fasting blood glucose and A1C. However, compared to a traditional American Diabetes Association recommended diet, the differences between the two diet schemes were not statistically significant.
The Paleo diet evidence is subject to similar limitations as the keto diet such as short duration, low statistical power, unmatched nutrients like fiber that promote satiety, and insignificant differences. The paleo diet may be more expensive and also lead to deficiencies in key nutrients like calcium.
Whole30 is a rapid lifestyle transformation that is not for the faint of heart. It is 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. Cutting out key nutrients can cause deficiencies in fiber, calcium, and vitamin D. Another main pillar of this diet is if you reintroduce foods, you will know which ones you should limit or continue to avoid. While it does not require Calorie counting, it is extremely restrictive. For those who have trouble adhering to diets, it may not be the best way to begin a lifestyle journey.
There have been no independent clinical trials on this diet, so there is no validation as to whether this diet is effective. According to U.S. News, Whole30 was voted one of the worst diets to follow. Further, experts rated this diet only 2/5 in diabetes management.
Due to its restrictive nature and lack of credible substantiation, it is recommended that another option be chosen before trying Whole30. Incorporating the elements of this diet, such as including more healthy fats and lean protein are great, but being zealously restrictive in other areas can cause regression back to old habits.
In summation, there are a million ways to dissect the “Nutrition cat”. The key to success is finding a lifestyle that is safe, sustainable, and adherable. Objective measurement through lab values and bio-feedback mechanisms (i.e. body composition) can eliminate arbitrary guessing and make you a smart consumer. Find what makes you happy and something that you would enjoy doing. Small, incremental adjustments can add up to large overall changes.
Disclaimer: This information is educational only and not providing healthcare recommendations. Please see a healthcare provider.