New Danish study: Dietary guidelines for diabetics have been misleading for decades
Diabetes is spreading with epidemic proportions, and an alarmingly high number of people are affected by metabolic syndrome, an early stage of diabetes that causes insulin resistance, elevated cholesterol, hypertension, and enlarged waist circumference. Ever since the 1970s, diabetics have been advised to stick with a low-fat diet consisting of bread, potatoes, and other carbohydrate sources. However, a new Danish study reveals that it is best to cut back on your carbohydrate intake. The new message to diabetics supports research from other parts of the world. Diabetics and people with sensitive blood sugar should focus on eating a diet with fewer carbohydrates, more protein, and more healthy fats. They should also make sure to get enough chromium, vitamin D, and magnesium, all of which are nutrients that support the body’s blood sugar levels. Furthermore, vitamin B12 and Q10 are important for those, who take diabetes medication and cholesterol-lowering drugs (statins).
According to the National Institute of Public Health in Denmark, the number of type 2 diabetics will have grown to 430,000 by 2030. The Danish Health Authority says that up to 85% of those, who have recently been diagnosed with diabetes, are overweight, which shows that diets play a key role. It appears, however, that the dietary advice presented for decades by the health authorities and the Danish Diabetes Association has not managed to bend the curve. On the contrary.
A typical diet, as suggested by the health authorities, features oatmeal or bread for breakfast, crispbread for an in-between meal, lunch consisting of ryebread and low-fat cold cuts, dinner with lean meat and potatoes, and fruit for snacks. There is even an allowance for sugar, provided one’s daily intake does not exceed 50 grams, which, incidentally, is rather generous. In other words, type 2 diabetics are advised to follow the same dietary guidelines as others, which means getting around 60% of the energy from carbohydrate sources, while limiting fat intake and generally eating a diet rich in fibers and greens. Many people may be hard-pressed to adhere to these recommendations and could even be likely to consume too many carbohydrates from fruit, sweetened yoghurts, light food products, chips, candy, cookies, ketchup, juice, soft drinks, wine, and other concealed sugar sources. If you consume too much sugar it burdens your pancreas and liver. You may eventually develop insulin resistance with impaired cellular glucose uptake. This sets the stage for metabolic syndrome and type 2 diabetes.
Insulin resistance, metabolic syndrome, and type 2 diabetes may result in the following:
The benefits of fewer carbohydrates and more fat and protein
The new Danish study was carried out at Bispebjerg Hospital in collaboration with Aarhus University and The Department of Nutrition, Exercise and Sports (University of Copenhagen). The remarkable study results defy the traditional dietary advice issued by health authorities and the Danish Diabetes Association through decades.
A total of 28 type 2 diabetics took part in this 12-week study. For six weeks, the patients received a traditional diabetic diet with a high (60%) carbohydrate content. For another six weeks, they consumed a diet with limited carbohydrate content, and more fat and protein. In this diet, 40% of the energy came from fat, 30% came protein, and 30% came from carbohydrate.
The patients received the two types of diet in random order.
This well-controlled study showed that a diet with less carbohydrate, more protein, and a moderately increased fat content resulted in the following positive health effects in type 2 diabetics:
- Improved glycemic control (ability to regulate blood sugar levels) by lowering glucose levels after eating
- Reduced levels of glycated hemoglobin (HbA1c), which gives a clear picture of the average blood sugar levels over a period of several weeks/months
- Reduced fat in the liver and in the blood
- Generally beneficial for type 2 diabetics, even if it is not accompanied by weight loss
New diet recommendations for diabetics and for preventing diabetes
The Danish study recommend that diabetics choose non-starchy vegetables. For instance, regular potatoes can easily be replaced with sweet potatoes, cabbage, and other bitter vegetables. Diabetics should also minimize their intake of grains and sugar (white flour, pasta, bread, candy, juice etc.) and choose natural ingredients instead of industrially processed foods. They should also focus on getting enough protein and healthy fats with all their main meals.
Thure Krarup, the main author, who is a Chief Physician at the Department of Endocrinology at Bispebjerg Hospital, calls the study results remarkable. The study shows that the dietary guidelines that have been used for diabetics so far, may be incorrect. Further studies are warranted, however, before we can be absolutely positive. The study is published in the science journal Diabetologica.
Nonetheless, this study is just one of many scientific studies published over the years that show the same thing. Back in 97, John Yudkin, a British professor, demonstrated that large quantities of sugar were bad for you. But he was ignored by the health authorities and the food industry.
Chromium improves your blood sugar control
Besides aiming at a diet with a more optimal energy distribution, diabetics should also pay attention to getting enough chromium. This trace element is known to improve the effect of insulin. According to EFSA, there are several scientific studies where supplements of chromium yeast have been given to diabetics. For example, a three-month study was carried out with 36 patients that were given 200 micrograms of pharmaceutical-grade chromium yeast or matching placebo. The study is published in Biological Trace Element Research and shows the following improvements among the chromium-treated diabetics:
- Weight loss (1.3 kilos on average)
- Lowered blood glucose levels (levels went up in the placebo group, on the other hand)
- Increased insulin sensitivity (their insulin worked better)
Diabetes, metabolic syndrome, cholesterol-lowering medicine, and Q10
Diabetes and its early stage called metabolic syndrome are associated with elevated cholesterol levels, which are treated with cholesterol-lowering statins. These drugs work by blocking a liver enzyme that is also used by the body to synthesize Q10, so statins impair the endogenous Q10 synthesis. This is a problem, as Q10 is an essential co-enzyme that supports the energy turnover in all cells, and the inhibited endogenous production of this vital component tends to affect the organs that are most in need of energy such as the heart, the muscles, and the nerves. Typical side effects of statins include fatigue, difficulty with concentrating, and muscle pain. Other side effects may eventually develop as this decrease, because Q10, by virtue of its powerful antioxidant function, is a vital protector against oxidative stress.
Patients in statin therapy are routinely advised to take a 100 mg/day Q10 supplement as compensation for this loss. The body generally has difficulty with absorbing Q10, but there are special supplements with high-bioavailability formulas. Always look for preparations with documentation.
As mentioned earlier, it is also essential to treat the underlying cause of the elevated cholesterol levels, which is often linked to metabolic syndrome and type 2 diabetes. As shown in the new Danish study, reducing one’s carbohydrate intake (essentially the reason for the disrupted fat metabolism) is a good idea.
Vitamin D, magnesium, and diabetes
Lack of vitamin D, a widespread problem, increases the risk of diabetes. As part of a good prevention strategy and even as part of therapy, it is advisable to expose yourself to the sun during the summer period and to take a high-dosed vitamin D supplement in the winter. The insulin-producing beta cells of the pancreas have vitamin D receptors, and vitamin D is believed to be an essential component of the conversion from pro-insulin to insulin. Vitamin D receptors have been found in the hypothalamus, a part of the brain that helps control our appetite and metabolism. Studies also show that diabetics have difficulty with utilizing vitamin D, and magnesium is required to help the body activate vitamin D precursors from our diet, the sun, and from supplements.
Lack of vitamin D and vitamin B12 are linked to diabetic neuropathy
Research carried out by Christian Stevns Hansen, a Danish physician, links low blood levels of vitamin D and vitamin B12 with an increased risk of diabetic neuropathy, which is a serious complication of diabetes that increases your risk of morbidity, amputations, and death caused by failing circulation and certain other factors.
In its late stages, diabetic neuropathy cannot be reversed, but it is in its early stages, and it is even possible to prevent further progression. Type 2 diabetics already have an increased risk of lacking vitamin B12 because of their use of metformin that blocks the uptake of the vitamin.
Diabetics should therefore make sure to get enough vitamin D and vitamin B12.
Bispebjerg Hospital. Færre kulhydrater forbedrer type-2 diabetikeres evne til at regulere blodsukkeret. Nyhedsbrev 10. august 2019
Mads J Skytte et al. A Carbohydrate-reduced high-protein diet improves HbA1c and liver fat content in weight stable participants with type 2 diabetes: a randomized trial. Diabetologica. First online 23 Juli 2019
Lars Dahlager. Fire årtiers kostråd til diabetikere er forkerte. Politiken. 9. august 2019
Robert H. Lustig. Sickeningly Sweet: Does Sugar Cause Diabetes? Yes. Canadian Journal of Diabetes. 2016
J. Racek et al: Biological Trace Element Research: vol 109, 2006
David Mantle and Iain Hargreaves. Coenzyme Q10 and Degenerative Disorders Affecting Longevity: An Overview. Antioxidants (Basel) Published online 2019 Feb
Scott LaFee. Vitamin D Deficiency Linked to Greater Risk of Diabetes. UC San Diego Health. April 2018
Sylwia Wieder-Huszla et al. Relationship between Vitamin D3 and Metabolic Syndrome. Int J Environ Res Public Health. 2019
Anne Marie Uwitonze, Mohammed S Razzaque. Role of magnesium in Vitamin D Activation and Function. The Journal of the American Osteopatic Association. 2018
Christian Stevns Hansen. Almindelige vitaminer og mineraler er forbundne med alvorlige komplikationer hos diabetes patienter. Formidling af Ph.d. afhandlingen: Exploring new risk markers for diabetic cadiovascular autnomic neuropathy.
Pernille Lund. Sådan får du styr på dit blodsukker og din vægt. Ny Videnskab 2013
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