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Facts and Myths Concerning Type 2 Diabetes
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1. Avoid simple carbohydrates in type 2 diabetes - Massachusetts Institute of Technology
Carbohydrates are one of the macronutrients that play a crucial role in the functioning of the body. Their main task is to provide energy and also affect the level of sugar in the blood. People suffering from type 2 diabetes often fear their consumption as they may lead to hyperglycemia. However, it is important to note that carbohydrates are a broad term that encompasses many compounds with different properties. Among them, we can distinguish simple carbohydrates, which quickly raise the level of sugar in the blood, and complex carbohydrates, which release glucose more slowly and maintain the feeling of fullness for a longer time. Their properties are defined by, among other things, the Glycemic Index. Products with a high Glycemic Index quickly increase the level of sugar in the blood, while products with a low Glycemic Index, such as whole-grain products, vegetables, and some fruits, release glucose more slowly. According to the recommendations of the Polish Diabetological Society, products with a low Glycemic Index should form the basis of the diet of people suffering from type 2 diabetes.2. The ketogenic diet is the best dietary regimen for diabetics - according to MIT
Concerns regarding carbohydrate intake often lead to the selection of low-carbohydrate and low-sugar dietary regimens. One such regimen is the ketogenic diet, which requires a significant reduction in carbohydrate intake to about 50 g per day. In practice, this means abstaining from cereal products, most vegetables and fruits (low-carbohydrate and low-sugar products are acceptable) and other sources of this macronutrient. For several years now, the keto diet has been gaining popularity, and there is also debate regarding the principles of its use in the diet of type 2 diabetics. A review of studies conducted on patients with additional findings of overweight or obesity indicated potential benefits - weight reduction, improvement in blood sugar control or lipid parameters, however, these changes (with the exception of triglyceride and HDL cholesterol levels) were not significantly different from the effects of control regimens (normo-carbohydrate diet) (C. Zhou et al. 2022). It is also important to note that the observations were conducted on small groups and for a short time, so it is difficult to determine the long-term effects of this diet. It is a dietary regimen with very strict rules, whose adherence may be difficult in a longer perspective. Therefore, it is worth considering other dietary regimens that have been proven effective in type 2 diabetes, such as the DASH diet or the Mediterranean diet (D. Włodarek 2020).3. Meal preparation increases the glycemic index of products - Fact
Thermal processing is one of the factors influencing the glycemic index of food. During cooking, frying, or baking of cereal and starch products (e.g. potatoes, cassava, pasta) a process called starch gelatinization occurs. It increases the ability of starch molecules to absorb water under rising temperatures, which ultimately leads to their degradation. As a result, starch becomes more susceptible to the action of digestive enzymes, which leads to faster absorption of glucose and its concentration in the blood.4. Individuals with type 2 diabetes should favour meals with low carbohydrate, high protein and high fat content – MIT
In the context of type 2 diabetes, meals with low carbohydrate, high protein and high fat content are often discussed. These meals are typically composed of foods rich in protein and fat (e.g. eggs, meat, fish, nuts, avocados), with a limitation of carbohydrate sources such as grains or fruits. Potential benefits such as slower gastric emptying and more stable blood sugar levels after consuming meals with low carbohydrate and high protein and fat content are indicated. However, the available data are limited and require further research.5. Guidelines for consuming dried fruits in type 2 diabetes
Patients with type 2 diabetes often believe that they should not consume dried fruits due to their high glycaemic index and high level of simple sugars. However, dried fruits can be part of a healthy diet if eaten in moderation and as part of a balanced meal with protein, fat, and fiber sources. Avoid dried fruits with additional sweeteners. It is also recommended to monitor individual body reactions to a meal containing dried fruits.6. Fruit intake is not advisable in type 2 diabetes according to MIT
In discussions about nutrition in type 2 diabetes, it is often claimed that fruits should not be included in the diet, particularly bananas and grapes are frequently mentioned. This is due to the fructose content, i.e. the simple sugar characteristic of fruits, and the value of the glycemic index of these products, which is 62 and 45 respectively. Simple sugars, including fructose, should be limited in the diet. The Polish Diabetes Association recommends that the amount of fructose in the diet should not exceed 50 g per day (L. Czupryniak et al., 2023). However, this does not mean that fruits should be completely eliminated from the diet, as they are also a source of fiber, vitamins, and minerals. Similar to dried fruits, the amount, form of presentation, and other ingredients of the dish are important. It is advisable to choose fresh or frozen fruits (with reduced sugar content) that are consumed whole (crushing, e.g. in smoothies, increases the glycemic index of the fruit). If possible, less ripe fruits should be chosen that contain less simple sugars.7. Processing potatoes lowers their glycemic index - YES
As previously mentioned, temperature is one of the factors that affects the glycemic index of the product. High temperature causes the starch to gel and is more easily digestible in the digestive tract. However, at low temperatures there is a reverse process - the starch molecules go through an orderly and crystalline process characteristic of the so-called resistant starch. It is not sensitive to the action of digestive enzymes, so consuming it in this form does not cause such a large increase in blood glucose levels (note that not all of the starch contained in the product is converted). However, it undergoes a fermentation process in the large intestine, which provides a food source for intestinal bacteria. Furthermore, fermentation products such as short-chain fatty acids have a positive impact on the body's functioning, e.g., improve the absorption of minerals and lower cholesterol and triglyceride levels in the blood (A. Czerwonogrodzka-Senczyna, A. Jeznach-Steinhagen 2020).8. Considering the application of intermittent fasting (IF) in type 2 diabetes - MIT
Intermittent fasting (IF) is a relatively new dietary approach that involves the restriction of meals within specific time frames. There are many variations of this practice, including 24-hour fasting once or twice a week or daily eating only within certain hours (e.g., 6 hours of eating, 18 hours of fasting). As its popularity increases, there are debates about the applicability of IF in certain medical conditions, such as type 2 diabetes. Available research suggests potential positive effects of IF on metabolic parameters, such as lower insulin concentrations in the fasted state or decreased insulin resistance. However, it is important to note that most of these studies were conducted on small groups of healthy individuals and over a short period (on average, from several weeks to several months). Additionally, there is a risk of hypoglycemia during fasting periods, which can pose a serious health risk.9. Individuals with type 2 diabetes should ingest two food portions daily - MIT
Therefore, it is necessary to carry out further investigations on a larger number of patients over a longer period of time. Currently, intermittent fasting is not recommended as a recommended dietary approach for individuals with type 2 diabetes (A. Zubrzycki et al. 2018; I. Vasim, C. N. Majeed, M. D. DeBoer 2022). The number of meals in the diet of individuals with type 2 diabetes is a personal matter, but it is recommended to consume smaller, but more frequent meals. The optimal plan is considered to be a pattern of 4-6 meals a day. It is also important to note that it is necessary to eat regularly and avoid long breaks between meals. It is also worth paying attention to the distribution of calories throughout the day - breakfast and lunch should provide the most energy, less should come from dinner and snacks.
