In today’s era, the economy is developing rapidly, technology is changing rapidly, and our lives have changed radically. You can always see everywhere: where there is an elevator, we will not take the stairs, where we can reach by car, we will not walk, electric bicycles have replaced human bicycles, the subway, buses and roads are busy cell phone party, even the household chores have been simplified a lot, there are sweeping robots to free our hands ……
The most important factor that affects the state of our health, in addition to genetic and environmental factors, is our lifestyle. type 2 diabetes, hypertension, hyperlipidemia, fatty liver, obesity and other metabolic diseases are all closely related to poor diet and exercise habits. Because of this, lifestyle modification is an important tool to prevent and treat these diseases. When it comes to dietary interventions for diabetes, I believe we can all say a few things: “eat less and eat more”, “reduce the amount of staple foods”, “stay away from sweets”, etc. However, is this true? However, is this true?
How about eating less and more meals?
Is meal replacement just a fashionable pursuit?
Is there any harm in not eating breakfast?
How much better to eat breakfast or dinner?
These daily eating problems make us question how to eat is healthy? Just like the development of science and technology, the diabetic diet treatment has also produced some new ideas and breakthroughs under the rigorous work of scientists. Today, we will talk to you about the new ideas of diabetic diet therapy.
New Concept 1 – The Excitement of Food Restriction Therapy Continues
Diet therapy, also known as medical nutrition therapy, is one of the most important strategies for the prevention and treatment of diabetes. The general principle of diabetic diet therapy is to control the total energy intake, distribute various nutrients in a reasonable and balanced manner, and take into account individual dietary preferences to achieve metabolic control goals.
One of the dietary therapies that has a long history, but has only been emphasized in this century, is food restriction. As the name implies, food restriction therapy refers to the voluntary restriction of calories eaten under the guidance of a medical professional, without causing malnutrition, so that the person who restricts his or her diet can be physically, psychologically and spiritually enhanced, and achieve the purpose of treating and preventing diseases and maintaining a healthy body.
Food restriction therapy, as a classic means of dietary intervention, takes various forms. According to the degree of calorie restriction, it can be divided into: general calorie restriction (25-40% reduction in calorie intake from the previous level), very low calorie restriction (<800kcal/d); according to the different nutrients restricted, it can be divided into fat restriction, carbohydrate restriction, protein restriction, and ketogenic diet; according to the length of restriction, it can be divided into long term diet, alternate day restriction (one day restriction (one day restricted diet, one day normal diet, alternating), 5+2 restricted diet (5 days in a week normal diet, any two days controlled diet, intake 500-600kcal/d), the latter two can be classified as intermittent restricted diet.
The endocrinology department of our hospital has accepted more than 200 patients with food restriction since the introduction of food restriction therapy in December 2012. Patients with newly discovered type 2 diabetes can stay away from medications and easily keep their blood glucose at the target by restricting food, together with lifestyle changes after discharge from hospital. Patients with pre-diabetes found on physical examination have happily moved into the normal queue by restricting their diet and have lost the “diabetic” hat in their hands. Some patients who have had diabetes for three or five years have also seen their insulin or oral medication doses reduced significantly after restricting their diet.
In regard to food restriction therapy, foreign scholars as well as our research have confirmed that food restriction can reduce weight, waist circumference, blood pressure, blood sugar, improve blood lipids and increase insulin sensitivity; after food restriction, changes in three indicators in human body – ketone bodies, insulin-like growth factor 1 and sex hormone-binding globulin – are the reasons why food restriction can improve metabolism, reduce tumor risk and delay aging. The changes in three indicators – ketone bodies, insulin-like growth factor1, and sex hormone-binding globulin – after food restriction are possible mechanisms by which food restriction exerts its effects on improving metabolism, reducing tumor risk, and delaying aging.
New concept 2 – Meal replacement diet, fashionable and effective
Meal replacement, what is it? Perhaps you have not heard of this term, but you have always heard of compressed cookies. The idea of meal replacement originated in the West, and the compressed cookie can be considered as its prototype. Current meal replacement products include meal replacement bars, soups and powders, which are used to replace some or all of the traditional meals. Each meal replacement contains 200-400kcal energy and certain trace elements, usually used to replace 1-2 meals, so that the whole day calorie intake control in 800-1500kcal.
The quiet introduction of meal replacement products is mainly to meet the needs of those who want to lose weight, but do not want to endure hunger. The essence of meal replacement is to reduce calorie intake, but it has unique advantages: high fiber, low calorie, easy to satiate; can effectively control the amount of food and calories, easy to consume; balanced nutrition, significant effect; good patient compliance, help maintain weight without rebound.
Meal replacement diets have significant advantages in maintaining weight, avoiding rebound, and improving the ability of patients to change their eating habits. In the very famous Look AHEAD study, scholars explored the effects of meal replacements on patients’ eating habits. Researchers found that in the meal replacement group, the proportion of low-fat diets increased, and a significantly higher proportion of subjects met dietary recommendations after 1 year than in the non-meal replacement group, and more importantly, 50% of patients with obesity or overweight type 2 diabetes were able to maintain a 5% weight loss for up to 8 years. These results suggest that meal replacements help patients develop good healthy eating habits, making the process of weight loss less painful and more palatable.
In a study of diabetic patients, 66 patients lost their body mass index from 40.1±6.6kg/m2 to 35.1±6.5kg/m2 and glycated hemoglobin from 7.4±1.3% to 6.5±1.2% after 12 weeks of meal replacement.
Meal replacement is not just a trendy word, it brings real results in weight loss, sugar reduction, and improved quality of life for obese people. If you want to control your weight, but have a hard time tolerating hunger, talk to your doctor and try meal replacement diets.
New Concept 3 – Limit your eating and abandon eating less and more
Why do people always say they have a hard time losing weight, even drinking water will make them gain weight. We know that water has zero energy, it does not provide us with half of the energy. So there is no scientific basis for “drinking water is fat”.
For diabetics, the traditional diet recommends eating smaller and more frequent meals to avoid excessive blood sugar fluctuations. There are also some empirical observations that people who eat fewer meals eat very little at each meal, while people who eat three meals a day will eat too much at the moment when the main meal arrives because of hunger, so eating fewer meals (three main meals + morning tea, afternoon tea and evening snack) will consume about 400-500kcal less than three meals a day. Therefore, eating fewer meals is considered to be good for controlling biochemical indicators such as weight, blood sugar and blood lipids.
However, is this really the case? In the medical field, the highest level of research evidence comes from large samples of randomized controlled studies. The empirical evidence obtained from the observational studies we just described is the weakest type of evidence. The only studies that have been done on dietary frequency and disease control in patients with diabetes are small randomized controlled studies. And the results from these studies are very inconsistent, with most concluding that eating fewer meals does not reduce weight or blood glucose any more than three meals a day or two meals a day, and some even finding better glycemic control in those who eat three meals a day.
In contrast, an animal study published in December 2014 in the top medical journal Cell Metabolism found that time-restricted eating prevented and reversed high-fat feeding-induced obesity and type 2 diabetes in mice, with effects proportional to the length of restriction. In this study, two groups of mice, one provided food for 24 hours and the other provided food for only 9-15 hours and did not eat the rest of the time, with no difference in total food intake between the two groups.
Of course, we need high quality clinical studies to verify the application of this result in the population. The above at least tells us that prolonging the fasting time and reducing the eating time is beneficial for the prevention and treatment of metabolic diseases such as obesity and type 2 diabetes. It is recommended for diabetic patients, unless to prevent the occurrence of hypoglycemia, to have three meals a day, at regular intervals. Which drink water also fat friends, think carefully, your staple food is not eaten, but you are not on hand snacks constantly?
The new concept 4 – divided meals to eat, breakfast is the main
Finally, let’s talk about breakfast and dinner distribution. Diabetic dietary intervention, not only need to focus on calorie intake, nutritional balance, eat a few meals, but also need to pay attention to the issue of when to eat.
There is an old Chinese saying: Eat a full breakfast, eat a good lunch, and eat a small dinner. It is very reasonable. Studies have found that breakfast or Chinese food-oriented people (meaning that the meal’s calories account for at least 33% of the whole day) do not increase the risk of obesity, while the risk of obesity for dinner-oriented people is twice that of breakfast-oriented people.
For patients who were already obese, when calorie-restricted weight loss was performed, the former had a more significant decrease in weight, waist circumference, blood pressure, blood glucose and, more importantly, a 33.6% decrease in blood triglycerides compared to a 14.6% increase in blood triglycerides in the latter when breakfast was the main meal.
Let’s look at an interesting foreign study. Europeans and Americans generally eat lunch late, often around one or two o’clock in the afternoon. Some scholars compared the effects of early lunch and late lunch (3 pm as the boundary) on body weight and glycolipid metabolism. They found that people who ate before 3:00 p.m. had better weight loss and glycolipid metabolism than those who ate after 3:00 p.m.
From the above, it is not difficult to conclude that diabetic patients, eat a hearty breakfast, three meals on time, and do not overly delay the point of eating, helps blood sugar control. And some people, because of the nature of work or life habits, mainly dinner, or even night meals, with the reversal of circadian rhythms, the brain and peripheral tissue biological clock is disturbed, the balance of glucose and lipid metabolism is broken. As a result, people who work long night shifts or stay up late have an increased risk of developing type 2 diabetes.