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Nutrition for Obesity and Diabetes (Diabesity)

Nutrition for Diabese

nutrition for obesity and diabesity and diabetes. Prevent Obesity and Diabetes

Nutrition for Obesity and diabetes (Diabesity) is primarily focused on restricting calories. However, most diabese people (obese people with diabetes) find it difficult to continue with the prescribed diet.

Nevertheless, nutrition plays a very important role and some form of dietary intervention is usually required in patients with obesity and diabetes.

What is Diabesity?

The term “Diabesity” is known as a condition in which diabetes and obesity occur simultaneously within an individual. The incidences of diabetes and obesity are increasing rapidly throughout the world and the main cause of this lies in lifestyle and dietary habits, apart from genetic vulnerability.

There has been a six-fold increase in the number of adults with obesity in the past 40 years and an increase in the number of individuals with diabetes will reach 642 million by 2040.

What is Diabesity? (Or Dibesity)

Diabetes, obesity, and their associated complications are a major threat in developing and under-developed nations.

Diabetes is a condition known to be a slow poison and dietary measures are the most manageable and effective solution to diabetes onset, in addition to obesity.

diabetes plus obesity is diabesity or dibesity
The figure shows the interconnection of diabesity with obesity and diabetes

Diabetes and Obesity are the hallmarks of the condition, however, you can also have other symptoms and signs as mentioned here:

  • Abdominal obesity
  • Dyslipidemia (low HDL, high LDL, and high triglycerides)
  • High blood pressure
  • High blood sugar (fasting above 100 mg/dL, Hb1Ac above 5.5)
  • Systemic inflammation
  • Increased Blood Clotting

What is Metabolic Syndrome, Insulin Resistance Syndrome or Syndrome X?

What causes Diabesity:

Generally, when we talk about the causes we jump to diabetes and obesity. While the main cause of diabesity is poor dietary habits, lack of exercise, physical inactivity, etc.

When your diet is full of empty calories and abundant in sugars, liquid calories, simple carbohydrates, refined grains (like bread, pasta, and rice), your cells slowly become resistant to the effects of insulin.

As a result, greater levels of insulin are required to do the same job of keeping your blood sugar normal. All of this leads to a condition known as Insulin Resistance.

Symptoms of High Insulin Levels; Insulin Resistance

Higher insulin levels worsen insulin resistance. The body does not respond to the effects of high insulin levels. Insulin resistance has been associated with various diseases and premature aging. Individuals with insulin resistance are prone to develop cardiovascular diseases, stroke, dementia, and even cancer.

How can you prevent yourself from Diabesity?

Although diabesity is increasing very rapidly, there is no doubt that diabetes and obesity are the significant causes of mortality in most nations.

But it can be prevented and even reversed by diet therapy. Over the past few decades, it has been controversial, many doctors and health care professionals denied that such serious disorders could be cured by diet therapy.

How to Prevent Yourself from Diabesity (Diabetes and Obesity)

During the past few years with advancements in Nutritional Sciences, it is now believed that diet and lifestyle changes can make a big difference.

You do not necessarily need to take medications or go through surgeries to treat diabesity.

nutrition for obesity and diabetes and diabesity

The different diabesity management strategies include the following interventions:

Nutritional management of Diabesity:

The diet plays a very significant role in the prevention and control of diabetes and obesity. The

dietary regulations are more than the simple reduction of energy expenditure. Some of the dietary recommendations include:

  • Low Carbohydrates:

    • Low-carbohydrate diets focus on reducing the total intake of carbohydrates. In a low-carbohydrate diet, carbohydrate intake is limited to less than 20 g to 120.
    • Limited intake of simple sugars in the form of sucrose and high-fructose corn syrup is suggested because of concerns that these sugars are rapidly digested and are fully metabolized.

Low Carbohydrate Diet

A daily diet should contain less than 40% carbohydrates 50 – 100 gm/day
Foods not containing Carbohydrates
  • Foods rich in Proteins and low in Carbohydrates:
    • Meat, Poultry, Fish, Shellfish, nuts, cheese, eggs, and seeds
  • Foods that are rich in fats and low in carbohydrates:
    • Oils, Butter, Olives, and Avocados
  • Vegetables with minimal amounts of carbohydrates:
    • Salads, Cucumber, Broccoli, and Squash
Avoid these diets Rice, Pasta, and Bread
Weight loss Low Carbohydrate diets have been associated with marked weight loss (about 11.4 kgs over six months have been reported).
Effect of low carbohydrate diet on glycemic control HbA1C reduced by 1.4% in six months.
Cardiovascular effects A low carbohydrate diet reduces triglyceride levels and increases HDL levels.
Weight Regain Weight regain is rapid and may occur within six months.
Challenges with low carbohydrate diets
  • Important nutrients may become deficient.
  • Lipid levels need to be monitored especially when carbohydrates are replaced with a fat diet.
  • Kidney functions should be monitored if protein intake is increased.
  • Low Glycemic Index Diet:

    • The glycemic index (GI) is a measure of the increase in plasma glucose level 2 hours after ingesting carbohydrate in food compared with a reference food such as glucose that contains an equivalent amount of carbohydrate.
    • The GI measures the postprandial response of different carbohydrates: consumption of high-GI foods relatively raises blood glucose more than medium- or low-GI foods.
Glycaemic Index Value Glycaemic Index Ranking
0–55 Low
56–69 Medium
70 or more High
    • Foods with a low glycemic index can help control diabesity. A meta-analysis that included 11 studies of patients with Diabetes Mellitus who followed a low-glycemic diet for less than 3 months to over 6 months showed a significant reduction of HbA1c (6 studies had HbA1c as the primary outcome, HbA1c weighted mean difference −0.5%; 95% CI, −0.8 to −0.2; P = .001) [Ref].

Oats for Diabetes: Health Benefits, Glycemic Index, and Recipes

    • Five studies reported on parameters related to insulin action, and 1 showed increased sensitivity measured by the euglycemic-hyper insulinemic clamp in a low-glycemic diet (glucose disposal 7.0 ± 1.3 mg glucose/kg/min) vs a high-glycemic diet (4.8 mg glucose/kg/min ± 0.9, P < .001) [Ref].
  • Low Fat Diet:

    • In order to reduce weight and achieve a Normal BMI (18.5-25), one needs to cut the extra calories. A lot of complications arise merely due to the increased body weight which means increased fat and reduction in its metabolism.

How is Olive Oil Better Than Other Oils? Health Benefits 

    • A low-fat diet includes approximately 50g fat for a 1500 kcal diet. In which saturated and trans-fat is <10%. The PUFA’s and MUFA’s present in unsaturated fats and oils reduce insulin sensitivity.
    • The mechanisms by which they reduce insulin sensitivity include modifications of the cell membrane composition, gene expression, and enzyme activity.
    • Fatty acids also promote inflammatory cytokines and induce endothelial dysfunction. The type of fat rather than its total amount plays a role in glycemic control and cardiovascular disease risk.

Low Fat  Diet

The daily diet should contain less than 30% of daily Calories

Foods not containing high fats
  • Whole Wheat, Rye, Pita, Breads
  • White rice, Oats
  • Muesli
  • Bulgur
  • Most fruits and Vegetables
Avoid these diets Saturated and Trans fats
Weight loss Low Carbohydrate diets have been associated with a weight loss of about 5.3 kgs over six months (11% in a year).
Effect of a low-fat diet on glycemic control Minimal effect on HbA1C
Cardiovascular effects Lipid levels need to be monitored for dyslipidemias.
Weight Regain Weight regain has been reported to be around 4% in two years
Challenges with low-fat diets
  • It is difficult to differentiate the type of fat-containing diet.
  • Saturated and trans fats are difficult to avoid.
  • The Mediterranean Diet:

    • The Mediterranean diet focuses mainly on the moderate ingestion of monounsaturated fats such as olive oil (30% to 40% of daily energy intake), legumes, fruits, vegetables, nuts, whole grains, fish, and moderate ingestion of alcohol.
    • A study of 259 overweight (mean BMI 31.4) patients with diabetes found a mean weight loss of as much as 7.4 kg at a steady state after 12 months [Ref].

The Mediterranean Food (Breakfast, Snacks, Lunch, and Dinner) 

    • A systematic review of 5 randomized clinical trials of obese adults (N = 998) showed that sustained weight loss (up to 12 months) was greater in the Mediterranean diet compared with a low-fat diet (range of mean values: −4.1 to −10.1 kg vs 2.9 to −5.0 kg), but similar to a low-carbohydrate diet (4.1 to −10.1 kg vs −4.7 to −7.7 kg) [Ref].
    • This diet also has a positive impact on glycemic control and has been shown to reduce the incidence of Diabetes.

Mediterranean diet

The Mediterranean diet focuses on 30% to 40% calories from monounsaturated fats

Foods
  • Olive Oil
  • Fresh fruits and vegetables
  • Cereals
  • Beans, nuts, seeds
  • Less amount of dairy, red meat, and eggs
  • Wine moderately with meals
Weight loss Mediterranean Diet has been associated with a weight loss of about 7.4 kgs in a year
Effect of Mediterranean Diet on glycemic control HbA1C reduced from 0.4% to 0.6%. The incidence of T2DM is lower
Weight Regain Weight regain is less (about 0.5 kgs over two years.
Challenges with the Mediterranean Diet It has a slower weight loss but adherence is high.

Table summarizing the key aspects of current dietary recommendations:

Carbohydrate

 

Total carbohydrate: 45–60% total energy, influenced by metabolic characteristics

Vegetables, fruits, legumes, and cereal-derived foods preferred

Dietary fiber and glycemic index Naturally occurring foods rich in dietary fiber are encouraged

Ideally, dietary fiber intake should be more than 40 g/day (or 20 g/1000 kcal/day), half soluble (lesser amounts also beneficial)

Five servings/day of fiber-rich vegetables and fruit and four or more servings of legumes/week helps to provide minimum requirements

Cereal-based foods should be whole grain and high in fiber

Carbohydrate-rich low-glycemic-index foods are suitable choices, provided other attributes are appropriate

Sucrose and other free sugars If desired and blood glucose levels are satisfactory, free sugars up to 50 g/day may be incorporated into the diet

Total free sugars should not exceed 10% of total energy (less for those who are overweight)

Protein and renal disease Total protein intake at the lower end of the normal range (0.8 g/kg/day) for type 1 patients with established nephropathy

For all others, protein should provide 10–20% of total energy

Families Most recommendations are suitable for the whole family.
Alcohol Up to 10 g for women and 20 g for men per day is acceptable for
Special ‘diabetic’ or foods,  functional foods, and  supplements

 

Non-alcoholic beverages sweetened with non-nutritive sweeteners are useful

Other special foods not encouraged

No particular merit of fructose and other ‘special’ nutritive sweeteners over sucrose

source: Derived from the 2004 recommendations of the Nutrition Study Group of the European Association for the Study of Diabetes: Mann, J.I., De Leeuw, I., Hermansen, K., et al. (2004) Evidence-based nutritional approaches to the treatment and prevention of diabetes mellitus. Nutri Metab Cardiovasc Dis, 14, 373–94

Healthy amendments:

  • Diet, physical activity, and behavioral therapy designed to achieve 5% weight loss should be prescribed for overweight and obese patients with type 2 DM to achieve weight loss.
  • Diets that provide the same restricted calories but differ in protein, carbohydrate, and fat content are equally effective in achieving weight loss.
  • To achieve a weight loss of >5%, short-term (3-month) high-intensity lifestyle interventions that use very-low-calorie diets (≤800 kcal/day) and total meal replacements may be prescribed.

Semaglutide (Rybelsus, Ozempic, and Wegovy) for Diabesity

Here is a sample Diet Chart comprising of 1486 KCal/day:

Carbohydrates = 40% = 150g

Proteins = 25% = 93.75g

Fats = 35% = 58.3g

  Timing Food Items Calories
Breakfast 8:00 am 2 pieces of brown bread + 1 boiled egg 398
Brunch 11:000 am 1 Medium size Apple 80
Lunch 2:00 pm 1 medium-sized chapati with vegetable curry 242
Snack 5:00 pm 1 cup green tea + Digestive biscuits 142
Dinner 8:00pm 1 cup of boiled rice with two medium chicken steaks 534
Before bed 10:00pm 1 glass skim milk 90

Conclusion:

Medical nutrition therapy and a multidisciplinary lifestyle approach are the key components in managing weight and type 2 DM.

It is important to have appropriate calorie intake for weight management and glucose control goals.

Current trends favor the low-carbohydrate, low-glycemic, Mediterranean, and low-caloric intake diets, though there is no evidence that one is best for weight loss and optimal glycemic control in patients with obesity and type 2 DM.

Diabesity Or Dibesity: a Global Pandemic of Diabetes & Obesity

What do you think?

Written by Diabetes Doctor

I am an Internist practicing medicine for the last fifteen years. Over the years, I have learned that medicine is not about prescribing pills. True medical practice is helping people.
I do prescribe pills as well but the best results I get are when I motivate people to overcome their problems with little changes in their lifestyles.
Since most of my patients are obese, have diabetes, hypertension, high cholesterol levels, I am writing at dibesity.com when free.
Dibesity, I know the correct word is diabesity. Ignore this! Be with us.

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