The hypocaloric diet in type 2 diabetes - déjà vu

Abstract

Dietary modification is considered a cornerstone in the management of diabetes superimposed upon which are pharmacological therapies as required. The value of hypocaloric diets in reducing and eliminating glycosuria was extolled in the pre-insulin era. A common feature of the nutrient balance of these diets was restriction in the availability of carbohydrate. Herein we review the use of diet as therapy in the past and discuss the rationale for hypocaloric dietary management of type 2 diabetes in the 21st century, drawing comparisons with bariatric surgery and considering why weight loss is particularly difficult for overweight and obese individuals with type 2 diabetes.

Intermittent fasting: a dietary intervention for prevention of diabetes and cardiovascular disease?

“…42 Original treatment regimens were based upon intermittent starving as opposed to restricting calories 43,44 a harsh regime that must have challenged adherence. Despite the seemingly strict nature of the fasting days intermittent fasting has a generally good adherence record and can cause significant reductions in body weight in individuals with obesity, 45-46 suggesting that this is a clinically relevant therapeutic approach.…”

Is there an optimal diet for patients with type 2 diabetes? Yes, the one that works for them!

“…There is an abundance of literature examining the effectiveness of various dietary interventions and approaches, including “fad diets”, for weight management and impact on metabolic and cardiovascular markers and outcomes in obese individuals with and without diabetes. 3,65,66 This area is a minefield to interpret due to reciprocal changes in macronutrient composition, differences in degree of energy restriction, confounding with changes in physical activity, additional effects of behavioural change intervention, difficulty in accurately measuring dietary intake particularly over extended periods, and differences between highly controlled studies and free living studies to name a few of the challenges. Despite this three things are very clear.…”

“…The earliest dietary treatment for T2DM, prior to the availability of antidiabetic agents, was to restrict carbohydrate in the hope of reducing the demand on endogenous insulin. 3 Even in the 1970’s Truswell et al reported from a survey of clinics in the United Kingdom that 92% of overweight people with T2DM were prescribed a low carbohydrate diet. 4 Around this time research groups were starting to experiment with high complex or unrefined carbohydrate diets that were lower in total fat, higher in polyunsaturated fats and included large quantities of fibre (up to 105g per day).…”

Hypocaloric, plant-based oatmeal interventions in the treatment of poorly-controlled type 2 diabetes: A review

“…In short, there is evidence that rigidly hypocaloric diets may be beneficial in the treatment of type 2 diabetes. Dietary restriction leads to fast reductions in hyperglycemia and allows for marked improvements of insulin sensitivity and the insulin response to feeding (Day and Bailey, 2012; Malandrucco et al, 2012). Short-term dietary oatmeal interventions are strictly hypocaloric (between 800 and 1400 kcal per day, depending on the amount of oats used), and this might be one of the main factors explaining their beneficial effect in the treatment of poorly-controlled type 2 diabetes.…”