Diets & Diabetes

Written by: Alegria Benzaquen

It’s always challenging to resist the allure of the latest diet and trend, whether you're scrolling on Instagram and chance upon another recipe for keto brownies or overhearing your friends discuss intermittent fasting in class. The truth is, for people with diabetes, diet is consistently at the forefront of our concerns. As a type one diabetic, grappling with a chronic disease centred on diet can be frustrating, even if you are the healthiest person in the world. However, there are numerous diets out there, often making promises and guarantees that we all know are not realistic. Let’s delve into some of the most common diets and their advantages for diabetics.

Keto: Let's begin with the keto diet. This diet earns its name because it induces a state called ketoacidosis. Ketoacidosis occurs when the body is unable to utilise carbohydrates for energy, prompting it to break down fats and proteins instead. The breakdown of fats and proteins produces a substance called ketones (Diabetic Ketoacidosis - Symptoms & Causes - Mayo Clinic, 2022). Ketones are acidic and can lead to a state of metabolic acidosis, known as ketoacidosis. Individuals on the keto diet are restricted to a maximum of 50g of carbs a day, potentially dropping as low as 20g of carbs a day (Cissn, 2023). Carbohydrates are found in small amounts in various vegetables, meats, and dairy products. Those on the keto diet typically steer clear of carb-heavy foods to avoid surpassing the daily carbohydrate limit (Diabetic Ketoacidosis - Symptoms & Causes - Mayo Clinic, 2022). This diet proves effective for weight loss because the body resorts to fat stores for energy, resulting in weight reduction. For type 2 diabetics, who are not entirely insulin-dependent, this has proven to be an effective way to reduce or even eliminate the need for antihyperglycemic medication such as metformin. However, for type 1 diabetics, adhering to this diet can lead to serious medical complications and potentially fatal consequences. In individuals completely reliant on insulin, ketoacidosis can progress to diabetic ketoacidosis, a life-threatening condition and a medical emergency (Diabetic Ketoacidosis - Symptoms & Causes - Mayo Clinic, 2022). While lower-carb diets have at times shown benefits for people with type 1 and type 2 diabetes, the keto diet cannot serve as a substitute for antihyperglycemic agents in type 1 diabetes as it may for type 2 diabetes (Cissn, 2023).

Intermittent Fasting: While many diets concentrate on what you eat, intermittent fasting focuses on when you eat. This diet entails a series of fasts ranging from 12 to 48 hours. The most common practice is the 8/16 fast, which involves an 8-hour window for eating and a 16-hour-long fast (Intermittent Fasting: What Is It, and How Does It Work?, 2023). This approach also includes alternating between normal eating days and fasting days. Intermittent fasting operates through a method known as metabolic switching. Metabolic switching occurs when the body depletes its glucose stores and turns to fat stores for energy, resulting in overall fat loss (Intermittent Fasting for Weight Loss in People With Type 2 Diabetes, 2023). To maintain a normal body weight, a person will consume their usual daily meals, and the energy from those meals will be utilised throughout the day. For weight loss, the energy needed must surpass the energy used, commonly referred to as a caloric deficit or negative energy balance. Intermittent fasting has demonstrated some benefits for Type 2 diabetics, particularly those with weight loss goals (Intermittent Fasting for Weight Loss in People With Type 2 Diabetes, 2023). It can enhance insulin sensitivity, control snacking, and help manage meal times for more accurate management. However, for type 1 diabetes, its benefits haven’t been proven. Individuals with type 1 diabetes face a high risk of hypoglycemia due to continuous insulin therapy, necessitating a consistent meal schedule and snacking based on glucose levels to maintain normal glucose levels (Intermittent Fasting: What Is It, and How Does It Work?, 2023). While it is not impossible to practise intermittent fasting while maintaining normal glucose levels, it presents a challenge with minimal benefits.

Juice Cleanse: Juice cleanses are a prevalent and popular diet trend, offering an excellent way to consume more fruits and vegetables than one might typically intake. However, this poses a concern for many diabetics. Juice cleanses are not recommended for those with diabetes due to their high glycemic index (Ld, 2019). The glycemic index measures the impact of carbohydrates and glucose on blood glucose levels. Consider two items, a glass of orange juice and a wrap, both containing 30g of carbohydrates. Because of the presence of protein and fats in the wrap, glucose absorption will be slower, resulting in a less significant impact on blood glucose levels. Conversely, the glass of juice, devoid of any fats or proteins, will cause a substantial spike in glucose levels due to its high and concentrated sugar content. Juice cleanses are not advisable for patients with diabetes (Ld, 2019).

Despite the plethora of diets and trends, the gold standard for nutrition for both type 1 and type 2 diabetics has consistently been a balanced diet comprising 15-20% protein, less than 35% fat, and 45-60% carbohydrates, along with 25-50g of fibre/day. Emphasis should be placed on foods with a low glycemic index (Diabetes Diet: Create Your Healthy-eating Plan, 2023). In the realm of diets, finding the right balance is key for diabetes management. So, let's stick to the recipe of moderation and personalised nutrition for a healthier journey ahead.

References:

Cissn, R. M. M. (2023, November 7). The Ketogenic Diet: A detailed beginner’s guide to keto. Healthline. https://www.healthline.com/nutrition/ketogenic-diet-101

Diabetes diet: Create your healthy-eating plan. (2023, April 13). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes-diet/art-20044295

Diabetic ketoacidosis - Symptoms & causes - Mayo Clinic. (2022, October 6). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/diabetic-ketoacidosis/symptoms-causes/syc-20371551# Intermittent fasting for weight loss in people with type 2 diabetes. (2023, November 21). National Institutes of Health (NIH). https://www.nih.gov/news-events/nih-research-matters/intermittent-fasting-weight-loss-people-type-2-diabetes

Intermittent Fasting: What is it, and how does it work? (2023, September 29). Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/wellness-and-prevention/intermittent-fasting-what-is-it-and-how-does-it-work

Ld, A. H. R. (2019, April 8). Is juicing safe and healthy if you have diabetes? Healthline. https://www.healthline.com/nutrition/juicing-for-diabetics