New nutritional recommendations for type 2 diabetes

December 21, 2021

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Anyone who is obese, has not had diabetes for very long and has reduced their weight by 15 kilograms can greatly normalize their sugar metabolism and even get by without medication at times. This is a central statement in the updated practical recommendations of the German Diabetes Society (DDG) on the nutrition of people with type 2 diabetes. Further innovations: Strict guidelines for the intake of fat, carbohydrates and protein are outdated – instead, those affected can choose healthy eating patterns that suit their preferences.

Formula diets, low-carb and low-fat diets and intermittent fasting are recommended for weight loss, explains the DDG.

The DDG Nutrition Committee has evaluated all relevant studies since 2004 in order to revise the practical recommendations. As a result, there are no precise consumption specifications for individual micronutrients such as carbohydrates, fat and protein; The requirement to eat less protein with impaired kidney function is also outdated. “The recommendations for weight reduction and diet in type 2 diabetes are overall less complicated and more individual,” said DDG President Prof. Dr. med. Andreas New.

It is crucial to start the weight loss program early
The focus of the new recommendations is the finding that obese people can in principle completely suppress diabetes by reducing weight by at least 15 kilograms, a so-called remission. “The DiRECT study from England shows that 86 percent of the people who actually achieved a weight loss of at least 15 kilograms experienced diabetes remission”, reports Prof. Dr. med. Diana Rubin, who, as chairwoman of the DDG Nutrition Committee, played a leading role in drafting the new practical recommendations. “The prerequisite was a diabetes duration of no more than six years.”

In order to achieve this goal, those who want to lose weight can in principle choose from various methods. “We have found very good effects in the literature, for example for low-carb, a form of low-carbohydrate nutrition,” says Rubin. Low-fat diets are at least equal in effect in the medium term. “If no particular diet is to be used, then Mediterranean, vegetarian or vegan nutritional patterns are equally suitable for diabetes management,” adds the nutritionist. Intermittent fasting can also be used to reduce weight under medical supervision. “It is crucial that the weight loss strategy fits the preferences of the overweight person and can be implemented sustainably in everyday life,” says Rubin.

It has been proven that formula diets that work with meal replacements, mostly in powder form, also lead to rapid, high weight loss resulting in diabetes remission. A large study shows: Almost half of the overweight diabetes patients who initially followed a formula diet with a calorie content of 825 to 852 kcal per day for three to five months achieved remission. “The remission sometimes lasted longer than two years,” reports Rubin. If no form of nutrition is effective, bariatric operations are also very successful in bringing about diabetes remission.

Taking a quick walk after eating helps
The experts were unable to make any statements about the Nordic diet, the macrobiotic diet, the DASH and Paleo diet. “Too few studies are available on these relatively new nutritional trends,” explains Rubin. On the other hand, one thing is certain: regular physical activity even with low intensity – such as walking more quickly after meals – improves body weight regulation. “Taking a quick walk after dinner definitely helps you lose weight,” emphasizes the head of the Center for Nutritional Medicine at Vivantes Klinikum Spandau and Humboldt Klinikum Berlin.

The general rule is: “Anyone who consumes unprocessed, natural food is right,” summarizes Rubin. In addition, carbohydrates should preferably be consumed in the form of whole grain products, low-starch vegetables, legumes and nuts. “Oats contain particularly healthy carbohydrates that have a beneficial effect on blood sugar levels,” says Rubin. Sweetener in normal amounts is harmless, low-sugar fruit is particularly recommended with regard to the fiber content and moderate alcohol consumption is compatible with a good metabolic control.

Nutritional therapy can also be used by prescription via app
Overall, advises the panel of experts, nutritional therapy must be tailored to the individual. “It makes sense to use the individualized nutritional advice more intensively – whether in the consultation, by email or by phone,” says Rubin. An app that has been checked by knowledgeable experts and is available on prescription can also be helpful. “In any case, therapy should be offered as early as possible,” emphasizes Rubin.

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New nutritional recommendations for type 2 diabetes