Diabetes Mellitus (DM) is today one of the main health problems worldwide, so today we celebrate World Diabetes Day, a date that since 1991 tries to remember and raise awareness about the alarming increase of this pathology in our global health.
Within the triangle of the Diabetes management (Exercise, Diet and Pharmacological Treatment) has written everything: Restrictive diets, routines without any foundation, superstitions, physiological misunderstandings and a long list of guidelines that rather than approaching a healthy approach, they put at risk our integrity. That’s why today, and to celebrate this world day nothing better than to review the scientific evidence
What is Diabetes Mellitus?
It is a disease that is characterized by a deficit (can be total or partial) of Insulin. Insulin is a hormone secreted by our pancreas that ensures that the tissues of our body obtain the sugar that is available in the blood.
When this hormone is not produced in sufficient quantity, hyperglycemia originates, which, maintained over time and in the long term, causes the involvement of small and large blood.
This maintained hyperglycemia is associated with alterations in multiple organs in the long term, especially in the kidney, the eyes, the nervous system, the heart and the blood vessels themselves. In addition to these chronic complications, we can find if the management of the disease is not correct, some acute complications such as hypoglycemia or ketosis.
How to know what recommendations or evidence to follow?
The recommendations in public health are based on evidence that supports them, this accumulation of knowledge is done through scientific studies. In this way, for something to be extremely recommendable, it must be based on studies of maximum evidence.
Level of Evidence:
Ia: Based on a meta-analysis of controlled, randomized, well-designed trials.
Ib: Based on controlled and randomized trials.
IIa: Based on controlled studies well designed without randomization.
IIb: Based on the study not completely experimental but well designed (cohorts).
III: Based on well-designed non-experimental descriptive studies (correlation, cohorts …)
IV: Based on opinions of committees, clinical experiences or prestigious authorities.
These levels of evidence translate into degrees of recommendation:
Degrees of recommendation
A: Based on Evidence I. Extremely recommended.
B: Based on Evidence II. Favorable recommendation
C: Based on Evidence III. Favorable but not conclusive recommendation.
D: Based on Evidence IV. Consensus
What recommendations should be followed for the Diabetes Management?
The Diabetes Care magazine published last month an update of the recommendations for the management of Diabetes from the point of view of Nutrition. This positioning replaces that of 2008 and therefore updates the scientific evidence that supports each of the recommended guidelines.
It is extremely recommended for people with Diabetes Mellitus:
- Nutritional treatment for both types (either type 1 or type 2 diabetes) as an essential component in the overall treatment.
- Follow an individualized nutritional treatment, preferably with a family dietary record and with all the treatment elements available at home.
- Weight loss in those with DM2 and overweight/obesity by reducing energy intake and a healthy diet.
- Weight loss involves positive effects such as improvement of blood glucose, blood pressure, dyslipidemia.
- Assess the number of carbohydrates and the availability of insulin as the key factors when preparing the dietary plan.
- Minimize the consumption of foods rich in sugar to avoid moving from the diet to other foods with more nutritional interest (with more density of nutrients of interest).
- It is NOT recommended to reduce protein intake despite having associated kidney disease since it does not alter the glomerular filtration of the kidney.
- The evidence DOES NOT support supplementation with omega-3 fatty acids for the prevention of cardiovascular problems in people with diabetes.
- It is NOT recommended routine supplementation of antioxidants such as Vitamin A, E or C, as it has no efficacy and its long-term safety is not guaranteed.
It is recommended for people with diabetes:
- Maintain the carbohydrate intake constant in time and quantity, for those people with fixed amounts of insulin.
- Follow a healthy diet, knowing that there is NO ideal ratio of macronutrients for all people with Diabetes (Proportion of Carbohydrates, Proteins, and Fat).
Calculate and count the number of carbohydrates to ingest is key to the control of blood glucose.
- Consume healthy sources of carbohydrates, prioritizing the presence of vegetables, fruits, whole grains, legumes and dairy products; thus reducing other sources, especially if they contain added sugar, fat or salt.
- The substitution of Sucrose by Fructose produces a better control of blood glucose (if the same amount of energy is consumed)
- Limit or eliminate the consumption of sugary drinks to reduce the risk of gaining weight and increase the risk of cardiovascular diseases.
- Use sweeteners to limit the intake of total calories and carbohydrates.
- High-protein carbohydrate sources should not be used to treat or prevent hypoglycemia. Since it increases the insulin response without increasing blood sugar.
- The quality of the ingested fat is more important than the quantity.
- The Mediterranean Diet is a better dietary pattern controlling glycemia and the risk of cardiovascular diseases than the alternative diet low in fat and high in carbohydrates. (In DM2)
- An increase in foods with omega-3 fatty acids (EPA and DHA) is recommended due to its cardioprotective effects.
- Eat fish at least twice a week (especially bluefish)
- Reduce your intake of sodium below 2300 mg/day
- For people with Diabetes and Hypertension, the reduction of Sodium should be individualized.
It is recommended (but not conclusive) for people with diabetes:
- Adapt dietary plans especially to the elderly with DM2 and who have other additional health problems.
- Substituting foods with a high glycemic index for others with a low glycemic index may help to control glycemia slightly.
- There is NO specific amount of carbohydrates that should be consumed.
- There is NO exact amount of protein to be ingested for people who, in addition to DM, do not have an associated kidney disease.
- And there is NO ideal amount of fat to ingest, this guideline must be individualized.
- Follow the same recommendation for intake of saturated fat and trans fat as the rest of the population.
- Reduce LDL cholesterol if you have dyslipidemia (plant sterols can help this reduction in amounts between 1.6-3g / day)
- There is no evidence to support the supplementation of vitamins and minerals in people with diabetics without any deficiencies.
- And there is NO evidence to support regular supplementation such as Chromium, Magnesium or Vitamin D to improve the control of glycemia.
- There is NO evidence to support the use of cinnamon or other herbs in the treatment of diabetes.
- Control alcohol consumption, this also places diabetics at increased risk of late hypoglycemia, especially if you take insulin.
The recommendations show the great importance of the individualization of the diet, with evidence that pushes that the simple generalized treatments (that usually include “Cajon diets” or “predefined diets”) are not supported by the scientific evidence.
These recommendations emphasize more than ever the importance of a person who is in charge of the adaptation of a dietary plan to a person with Diabetes.
This plan, in addition to considering the whole family and personal reality, can be done through a consumption of foods available in the market.
Supplementation as a general rule is NOT recommended, while the presence of fruits, vegetables, legumes, whole foods and a good lipid profile in fat intake (with special attention to bluefish) is essential for the management of this disease.