Diabetes has become a worldwide public health problem, and the problem is even more serious in mainland China.
As the country with the largest number of diabetic patients in the world, about 141 million adults (aged 20-79) have diabetes, which means that 13% of adults in China are diabetic [1].
Dietary patterns play a vital role in diabetes management, and a reasonable dietary pattern can effectively control blood sugar, prevent and reduce the risk of diabetes complications.
The question is, what is a reasonable eating pattern?
Too long not to look
The latest studies have found that the ketogenic diet, the Mediterranean diet, the moderate carbohydrate diet, and the low glycemic index diet are all effective in controlling blood sugar.
However, the ketogenic diet still needs to be supported by high-quality research, and friends who want to try it are best to consult a doctor or clinical dietitian first.
The health benefits of the Mediterranean diet are widely recognized, and those who need to control their blood sugar can try it with confidence.
Research from China
Researchers from the School of Public Health, Shanghai Jiao Tong University School of Medicine, based on 42 randomized controlled trials, compared the effects of 10 dietary patterns on blood sugar control in patients with type 2 diabetes.
The paper was published in the internationally renowned journal Nutrients.
Image from: References[2]
10 dietary patterns were selected
Based on a series of rigorous criteria, the researchers finally selected 42 randomized controlled trials published between 1993 and 2022, such as the minimum intervention period of 6 months, the average age of participants ≥ 18 years, the diagnosis of type 2 diabetes based on internationally recognized standards or ADA (American Diabetes Association) criteria, and the main outcome included at least one of glycosylated hemoglobin (HbA1c %) and fasting blood glucose (mmol/L).
In these 42 randomized controlled trials, the investigators identified 10 dietary patterns:
Low-carb diet
Carbohydrate intake is less than 25% of total energy intake.
Moderate carbohydrate diet
Carbohydrate intake accounts for 25%-45% of total energy intake.
Ketogenic diet
Carbohydrate intake accounts for 5%-10% of total energy intake, with the remainder provided by fat (70%-80% of total energy intake) and protein (1 gram per kilogram of body weight, 10%-20% of total energy intake) [2-3].
Low-fat diet
Fat intake is less than 30% of total energy intake, protein intake is 10%-15% of total energy intake, and cereal intake is high.
High-protein diet
Protein intake accounts for 25%-35% of total energy intake.
Mediterranean diet
Eat a variety of micro-processed whole wheat breads, whole grains or other legumes as a staple food, eat plenty of vegetables, olive oil, nuts are the main sources of fat, nuts and fruits as daily desserts, small or moderate consumption of dairy products, moderate consumption of fish, poultry and eggs, and less consumption of red meat (once a week).
Vegetarian/vegan diet
No meat and fish, no vegan diet and no other animal products.
Low glycemic index diet
Most carbohydrates come from foods with a low glycemic index, such as oats, whole-grain bread, and legumes such as peas.
Recommended diet
Some dietary recommendations based on ADA guidelines include choosing nutrient-dense and low-processing carbohydrates, adequate dietary fiber intake (at least 14 grams of dietary fiber per 1000 kcal) when intaking carbohydrates, choosing more non-starchy vegetables, fruits, legumes, whole grains, and dairy products, minimizing foods containing added sugars, and avoiding sugary beverages (including fruit juices) [2,4].
Regular diet
Do not make any changes to the regular diet as a control group.
The sugar control effect is great
The researchers compared the effects of the above 10 dietary patterns on blood sugar control and found:
The 3 most effective dietary patterns for controlling glycosylated hemoglobin: ketogenic diet, Mediterranean diet, low glycemic index diet.
The 3 most effective dietary patterns for fasting blood sugar control: moderate carbohydrate diet, low glycemic index diet, and ketogenic diet.
The effects of glycosylated hemoglobin and fasting blood glucose were clustered, and the results showed that the effects of ketogenic diet, Mediterranean diet, moderate carbohydrate diet, and low glycemic index diet were all relatively good [2].
The effects of dietary pattern on glycosylated hemoglobin and fasting blood glucose were clustered, and the four types of glucose control in the upper right corner had better control effects. Image from Reference [2]
Ketogenic diet ever since?
The researchers used rigorous statistical analysis methods to ensure the reliability of the conclusions of this study as much as possible, so the conclusions of this study are still of reference value for patients with type 2 diabetes and people who need to control blood sugar.
However, it is undeniable that long-term studies on glycemic control in patients with type 2 diabetes are relatively limited, and the evidence is mostly of low to medium quality, and further large-scale, long-term, and well-designed randomized clinical trials are needed.
The health benefits of eating like the Mediterranean diet are well recognized, but the health benefits of the ketogenic diet require higher-quality long-term research to strengthen its credibility.
Before that, it is recommended that you try the Mediterranean diet, moderate carbohydrate diet, and low glycemic index diet, which are relatively safer and easier to adhere to.
If you have type 2 diabetes and want to try the ketogenic diet, it is best to do so under the guidance of a doctor or clinical dietitian.
Moreover, there is no one-size-fits-all diet for diabetic patients, and the specific diet should be individualized [4]. (Of course, this is more demanding for both the patient and the doctor.) ）
Don't forget the weight-loss-promoting effect
Weight loss is a major contributor to glycemic control.
The study found that mean reductions in glycosylated hemoglobin and fasting blood glucose levels were only significantly associated with average weight loss among participants. A meta-analysis has found that for every 1 kg of average body weight, glycosylated hemoglobin can be reduced by 0.1%[2].
In addition to the usual diet, the other nine dietary patterns were effective in reducing body weight, ranging from -6.26 kg to -2.06 kg, with the Mediterranean diet and the ketogenic diet being the most effective, with little difference between the two [2].
Many people with type 2 diabetes have obesity problems, and instead of sitting and struggling with which dietary pattern to adopt, it is better to take action, eat healthier, and increase physical activity.
The simple principle of eating carbs
When it comes to sugar control, the first thing everyone thinks of is carbohydrates.
It is true that carbohydrates are the most important dietary factor for elevated blood sugar, but sugar control is not simply about eating less carbs.
I'll help you Xi it again today.
Properly control your carbohydrate intake
For example, the 2023 diabetes care guidelines issued by the American Diabetes Association (ADA) do not specify the exact proportion or amount of carbohydrates consumed by diabetic patients, but emphasize the importance of balanced and moderate carbohydrate intake [4].
But not controlling it doesn't mean that you focus on carbs at every meal, shredded potato rice bowl, mashed potato noodles......
If your blood sugar is not at your target, or if your primary goal is to reduce glucose-lowering drugs, it is feasible to control your blood sugar by reducing your carbohydrate intake, and the ADA gives a relatively simple visual plate principle: 1/2 non-starchy vegetables, 1/4 protein, and 1/4 carbs [4].
Of course, the ADA also emphasizes that people with diabetes should pay attention to the quality of their carbohydrate intake.
Improve the quality of carbohydrate intake
Eat less or no simple carbohydrates ❌: candy, honey, fruit juice, as well as foods such as ice cream, drinks, cakes and other foods containing added sugar, refined white rice noodles and foods made from them, such as noodles, white steamed buns, white rice, etc.
Eat more nutritious complex carbohydrates ✅: whole grains rich in dietary fiber, vitamins and minerals (oats, brown rice, millet, corn, sorghum, buckwheat, barley, etc.), beans (red beans, mung beans, kidney beans, peas, chickpeas, etc.), potatoes (sweet potatoes, purple potatoes, potatoes, taro, yams, etc.), fruits and vegetables, and if you are a fruit, you can also choose apples, pears, strawberries, blueberries, etc. with a low glycemic index. [For more fruit glycemic index, see here: Fruit "Glycemic Rise" Ranking, Is Your Favorite on the List?】
Have you paid attention to your own eating patterns, and how do you eat in general?
Source: Dietitian Gu Zhongyi