Health Questions and Answers » Nutrition in Specific Diseases

What is the best general advice to give a patient with diabetes?

rtrafaelmd — Sun, 05 Aug 2007 05:00:07 +0000

Diet and exercise recommendations for diabetic patients should be similar to those for the general population, though it is more important for a diabetic patient to maintain a normal weight than it is for nondiabetics. A diet high in complex carbohydrate (with emphasis on fiber) and low in fat with some limitations on simple sugar and alcohol content is recommended for everyone but especially for diabetics. Consistency of food intake is also important, to avoid episodes of hyperglycemia. Excercise, which is important for everyone, is especially important for the diabetic patient. Sadly, recommendations for weight loss and exercise too often fall upon deaf in the adult-onset diabetic.

Is micronutrient supplementation important in diabetes?

rtrafaelmd — Sun, 05 Aug 2007 04:59:29 +0000

Supplementation of micronutrients is not recommended in diabetes. Physicians are often asked about chromium picolinate, a preparation found in health food stores, which has been sold as treatment for diabetes. Ok everybody should understand that chromium is a cofactor of insulin. When rats are given a synthetic diet that does not contain chromium, they develop diabetes. There is not reliable clinical test for chromium deficiency in humans. Studies of tissue levels of chomium have suggested that subclinical chromium deficiency may occur in the elderly. It has been suggested that chromium deficiency may be a cause of adult onset diabetes. However, it is difficult for a human on a normal diet to become deficient in chromium, and studies in which chromium has been given to diabetic patients have failed to show benefit. Therefore, chromium supplementation is not currently recommended.
Magnesium and zinc have been suggested as supplements but are not generally indicated. A patient with poorly controlled diabetes, especially one who is taking diuretics, may become deficient in magnesium, but n benefit has been shown from magnesium theray. It has been suggested that zinc supplementation might aid in the healing of leg ulcers, but evidence for this is lacking. It is certainly true that zinc deficiency can retard wound healing, but zinc deficiency is extremely rare.

Can people with diabetes drink alcohol?

rtrafaelmd — Sun, 05 Aug 2007 04:58:42 +0000

Yes, but there are certain danger specific to diabetes. Alcohol is a potent inhibitor of gluconeogenesis. Alcohol, especially when consumed separately from meals and without a carbohydrate (dry winw, whiskey and water, etc), can induce hypoglycemia. This is a practical concern in patients who are taking hypoglycemic agents such as insulin or sulfonylureas. The hypoglycemic effect of alcohol is less important when it is consumed with food. Diabetic patients obtain the same salutary effects of moderate alcohol intake as anyone else, such as increased HDL cholesterol and reduced coagulability. Alcohol in moderation is accepatable in most individuals with diabetes provided that it does not add execessive calorie content to the meal (e.g., 1-2 glasses of wine). An exception would be a patient with severe hypertriglyceridemia, bcause alcohol can worsen this condition.

What are dietary protein requirements in diabetes?

rtrafaelmd — Sun, 05 Aug 2007 04:57:29 +0000

Diabetic patients are advised to strive for a moderate protein intake. While it is true that protein turnover is increased in poorly controlled diabetes, this should not influence recommendations on dietary protein intake. When diabetes is controlled, protein metabolism becomes normal. The average dietary protein intake in the U.S. is 1.5gm/kg, which is in excess of the recommended daily allowance and may contribute to nephrosclerosis and osteoporosis. Studies have shown that restricting protein in patients with diabetic nephropathy reduces proteinuria. It is, therefore, prudent for diabetic patients to avoid high-protein diets. The diabetic diet should contain moderate amounts of protein, usually 15-20% of total energy.

Should individuals with diabetes be on low-fat diet?

rtrafaelmd — Sun, 05 Aug 2007 04:56:29 +0000

There has been a lot of debates about whether diabetic patients should consume a low-fat diet. It is nice that this controversy arises in a diabetic individual more than in nondiabetic population; bear in mind that low fat diet is still recommended for the prevention and treatment of coronary artery disease. A lot of studies have shown that when an isocaloric high-carbohydrate, low fat diet is compared with a certain patient whose diet higher in fat and lower in carbohydrate, the high carbohydrate diet tends to result in hypertriglyceridemia. So because of this the ADA hedge on the subject of fat content and state that diets moderately high in monounsaturated fat may be acceptable as long as saturated fat is restricted. The studies that show hypertriglyceridemia as a result of ingestion of a high carbohydrates diet were conducted in clinical research centers and may not be relevant to free living individuals, who tend to consume fewer calories when on a low-fat diet than when on a diet higher in fat. Therefore, it is best to recommend a high-carbohydrate (50-60% of calorie), low fat (20-30% of calories) diet for people with type 2 diabetes.

Should simple sugars be avoided in patients with type 2 diabetes?

rtrafaelmd — Sun, 05 Aug 2007 04:55:21 +0000

For many years, the official position of the ADA was that diabetic individuals should consume a low-carbohydrate diet and specifically avoid free sugar. A lot of studies and trials have shown that simple sugars in the context of a mixed meal have the same effect on blood glucose levels as compare to complex (CHO) carbohydrates. Sugar is an acceptable component of the meal plan. It is not necessary to restrict milk or fruit intake in patients with diabetes, as what other Medical Practitioner advice with their patients. It is important to consider the energy content of sugar-containing foods, though, so concentrated sweets should not be advised.

Do very low calorie diets have a place in the management of type 2 diabetes?

rtrafaelmd — Sun, 05 Aug 2007 04:45:47 +0000

Very low-calorie diets (VLCDs) have been used to achieve short-term weight reduction in patients with diabetes. These diets are appealing because of initial dramatic improvement in the metabolic profile. However, weight regain occurs in a high proportion of individuals. The long-term benefits of VLCDs are uncertain, and they should not be recommended for the management of type 2 diabetes.