This post is written by Osama Hamdy, M.D., Medical Director, Obesity Clinical Program, Director of Inpatient Diabetes Management at Joslin Diabetes Center, Assistant Professor of Medicine at Harvard Medical School. Dr. Hamdy is also the Director of theWhy WAIT program where he works with people to improve their diabetes management through weight loss.
This post is a continuation of Dr. Hamdy’s previous discussion on the history of the “diabetes diet.”
Medical Nutrition Therapy (MNT) means using nutrition as a potent diabetes management tool. MNT not only plays a major role in preventing and treating type 2 diabetes but also helps in preventing many diabetes complications.
Increasing the absolute protein intake to 1.5–2 g/kg (or 20 to 30 percent of total caloric intake) during weight reduction has been suggested for overweight and obese patients with type 2 diabetes and normal kidney function. Increased protein intake does not increase plasma glucose, but actually increases the insulin response and results in a significant reduction in A1C.
In addition, a higher dietary protein intake reduces hunger, improves satiety and limits lean muscle mass loss during weight reduction using a reduced calorie diet and increased physical activity.
It is preferable to calculate protein intake for patients with diabetes as grams per kilogram of body weight and not as a fixed percentage of total energy intake to avoid protein malnutrition when a calorie-restricted diet is used. A protein intake of 0.8–1 g/kg should only be recommended for patients with diabetes and chronic kidney disease. Other patients with diabetes should not reduce protein intake to less than 1 g/kg of body weight.
High protein, low carbohydrate energy restricted diets became the most effective tool for weight management in patients with diabetes. In the Why WAIT (Weight Achievement and Intensive Treatment) Program, developed at the Joslin Diabetes Center for diabetes weight management in clinical practice, a high protein-low carbohydrate (30 percent protein [1.5–2 g/kg] and 40 percent carbohydrates) energy–restricted diet was tried within a multidisciplinary diabetes weight management program for 12 weeks.
Patients who completed the program lost an average 24.6 pound (−10.3 percent of their body weight). Their waist circumference decreased by an average 3.6 inches. Almost 82 percent achieved the target A1C of less than 7 percent.
At the same degree of weight loss, a high-protein weight-reduction diet may have, in the long term, a more favorable effect on the cardiovascular risk profile than a low-protein weight-reduction diet in patients with type 2 diabetes. Controlled energy intake, in association with a moderately elevated protein intake, may represent an effective and practical weight loss strategy.
You should know that patients with diabetes lose around 1 pound of their muscle mass every year as they age, and eating a diet lower in protein without exercise speeds muscle mass loss. So to maximize the benefits from protein on your muscles, you should do a good amount of strength or resistance exercise. Bigger muscles are naturally more sensitive to insulin. They also maintain your metabolism at higher rate, which was found to help people with diabetes to maintain weight loss on long-term.