type 2 diabetics
Posted By _Dr John Briffa_ On February 16, 2010 @ 12:12 pm In
_Diabetes/Metabolic Syndrome_, _Exercise and Activity_, _Food and
Medical Politics_, _Healthy Eating_, _Low-Carbohydrate/Carbohydrate
Restriction_, _Unhealthy Eating!_, _Weight Loss_ _
<http://www.drbriffa.com/blog/2010/02/16/higher-protein-diet-plus-resistance-exercise-aids-weight-and-fat-loss-in-type-2-diabetics/print/#comments_controls>_
Where weight and fat loss is concerned, I favour a relatively
low-carbohydrate, high-protein diet on the basis that such diets
generally outperform low-fat, carb-rich diets traditionally advocated
for weight loss. A lower-carb diet I think may have particular
advantages for diabetics because, well, they have difficulty handling
carbohydrate as a result of impaired insulin function (insulin
resistance) and/or insufficient insulin.
There is a certain logic to the notion that diabetics should be careful
consuming the very food type (carbohydrate) they have difficulty dealing
with. However, not everyone agrees. You can see here how Diabetes UK
(the leading diabetes charity in the UK) specifically [1] recommends
against carbohydrate restriction
<http://www.diabetes.org.uk/Guide-to-diabetes/Food_and_recipes/Eating-well-with-Type-2-diabetes/About-carbohydrate/>
on the basis that:
• glucose from carbohydrate is essential to the body, especially the
brain
• high fibre carbohydrates, such as wholegrains and fruit, also play
an important role in the health of the gut
• some carbohydrates may help you to feel fuller for longer after eating
However, glucose can be made from other elements of the diet (e.g.
protein) which makes the absolute requirement for carbohydrate none at
all. Also, wholegrains are generally rich in insoluble fibre which has
been shown to be quite irritant to the gut compared to soluble fibre
found plentifully in fruits and vegetables. But if diabetics are looking
for a heathy source of fibre, why not point them to green veg, say,
rather than carb-loaded fruit. And it might be true that carbohydrates
can help people feel fuller for longer, but protein has been found to be
the most sating macronutrient and doesn't cause wild swings in blood
sugar levels (as many wholegrains do) either.
Getting back to weight loss, it appears that aerobic exercise is not
particularly effective here (see [2] here
<http://www.drbriffa.com/blog/2009/08/12/does-exercise-promote-weight-loss-no/>
for more about this). That is not to say that aerobic exercise is a
waste of time - it most certainly is not in my opinion (it just does not
do much to shift surplus pounds).
In recent years there has been increasing interest in the idea that
resistance exercise (e.g. weight training) can help fat loss and improve
body composition. See [3] here
<http://www.drbriffa.com%20http://www.drbriffa.com/blog/2007/09/17/weight-training-found-to-lead-to-fat-loss-in-women/>
for a previous post about a relevant study.
I was interested to read about a recent study in which resistance
exercise was tried in a group of obese type 2 diabetics [1]. Individuals
either performed resistance exercise (3 days a week) or no exercise for
16 weeks. Each of these groups were further subdivided into groups
eating either a conventional high-carbohydrate diet, or a lower-carb,
higher protein diet. The make-up of these diets was as follows:
/Conventional diet carb/protein/fat: 53/19/26/
/Higher protein diet carb/protein/fat: 43/33/22
/
The diets were 'energy-restricted' (about 1400 and 1700 calories a day
for women and men respectively).
So, in effect, this study had four groups:
/1. Conventional diet no exercise/
/2. Conventional diet plus resistance exercise/
/3. Higher protein diet no exercise/
/4. Higher protein diet plus resistance exercise/
The participants were assessed in a variety of ways including weight
loss, fat mass loss and waist circumference.
Overall, the group eating higher protein lost more weight and fat and
saw greater reductions in their waist circumference too. However, these
differences were much more marked when comparing the groups who were
exercising.
/Weight loss for exercisers in the conventional and high protein groups
was an average of 10.5 and 13.8 kg respectively/
/Fat loss for exercisers in the conventional and high protein groups was
an average of 7.9 and 11.1 kg respectively/
/Waist circumference reduction for exercisers in the conventional and
high protein groups was an average of 11.3 and 13.7 cm respectively/
Looking at the results as a whole, it's clear that the group that did
the best with regard to these measurements was the one eating less carb,
more protein, with resistance exercise on top.
*References:*
1. Wycherley TP, et al. A High Protein Diet With Resistance Exercise
Training Improves Weight Loss And Body Composition In Overweight And
Obese Patients With Type 2 Diabetes. Diabetes Care 11th February 2010
[epub ahead of print publication]
