Dietary considerations can present a Hobson\’s choice in diabetes. Even when the intake is nutritious, assimilating it may be another matter. Then you also should deal with the onset of diabetic issues if you end up with an excessive amount of glucose or fat in your system. Too much carbohydrates in a meal, and its accompanying uncontrolled blood sugar levels can be damaging to many body tissues: from our eyes\’ lens, to neurons, small blood vessels, and even the kidneys. Fat can be a problem with increased incidences of atherosclerosis, large vessel disease and cardiac complications. Knowing all this, what would then be the proper macronutrient for diabetics? Enough medical literature exists to suggest that in diabetes, proteins are probably the best bet.
Proteins are the natural choice of the body when faced with diabetes. In uncontrolled diabetes, muscle protein is broken down into amino acids to be transformed into glucose by the liver. If left to fend for itself, this could create a commotion throughout the body. Since proteins have to produce enough energy to substitute for carbohydrates, proteins are broken down faster than they are made. Hence, the body is left with a protein deficiency; a situation with subtle but far-reaching implications on our body\’s critical functions. Importantly, for diabetics, a protein deficit has been shown to impair resistance to infections (Ganong WF). Replenishing the depleting protein stores is an important requirement of all diabetic diets.
The value of protein for diabetics is well recorded. The American Associations of Clinical Endocrinologists have made it clear that not much evidence exists to indicate that the patients with diabetes need to cut back their intake of dietary proteins. The AACE recommends that 10-20% of the calorie consumption in diabetes should come from proteins (AACE Diabetes Guidelines). There\’s even reason to believe that that is the only nutrient that doesn\’t increase the blood glucose levels for both the diabetics as well as healthy subjects (Gannon et al).
Nutrition therapy for diabetes has progressed from prevention of obesity or weight gain to improving insulin\’s effectiveness and contributing to improved metabolic control (Franz MJ). In this new role, a high protein diet (30% of total food energy) forms a very pertinent part of nutrition therapy. Obesity is one of the main causes of type II diabetes . Too much body fat aggravates insulin resistance and more insulin is needed to decrease blood sugar ranges as you increase in weight (Ganong WF). The clogging of the arteries with atherosclerotic plaques which is linked to numerous diabetic complications is another problem related to excess fat. Any method that may decrease body fat, decrease insulin resistance, and improve blood glucose control. Parker et al have also shown that a high protein diet decreased stomach and total fat mass in women with type II diabetes. Other research by Gannon et al. and Nuttall et al have verified that blood glucose levels and glycosylated hemoglobin (a marker of long term diabetic control) reduce after 5 weeks on a diet containing 30% of the entire food energy in the form of proteins and low carbohydrate content. It is speculated that a high protein diet has a favorable impact on diabetes because of the capacity of proteins and amino acids to stimulate insulin release from the pancreas. Thus, a high protein diet is not only safe in diabetes, but can be therapeutic, resulting in improved glycemic management, and decreased threat of problems related to diabetes.
But the benefits of a protein-rich diet doesn\’t end there. The component proteins that make up such a diet, if appropriately chosen, also provide other advantages. Dietary supplements containing proteins like whey and casein come highly recommended. Casein is a milk protein and has the ability to form a gel or clot in the stomach. This ability to form clots make Casein highly efficient in terms of nutrient supply. The clot is able to provide a sustained, slow release of amino acids into the blood stream, typically lasting for several hours (Boirie et al. 1997). This sluggish and steady release of nutrients synchronizes with the restricted amount of insulin that the pancreas creates because of diabetes. Hence, a casein-based protein supplement can doubtlessly increase the amount of energy that can be absorbed from every meal, and simultaneously decrease the necessity for medical interventions in order to regulate blood sugar.
Whey proteins and caseins also contain \”casokinins\” and \”lactokinins\’, (FitzGerald) which have been found to lower both systolic and diastolic blood pressure in hypertensive people (Seppo). In addition, whey protein forms bioactive amine within the intestine that promotes immunity. Whey protein accommodates an ample supply of the amino acid cysteine. Glutathione, which has strong antioxidant properties, also appears to be enhanced with the presence of cysteine; antioxidants are responsible in sweeping free radicals which cause cell death and plays a significant role in the aging process.
Thus, development of a protein supplement containing casein and whey can provide an apt high protein diet and its health benefits to individuals suffering from diabetes, obesity, and hypercholesterolemia.
The American Association of Clinical Endocrinologists. Medical guidelines for the management of diabetes. AACE Diabetes Guidelines, Endocr Pract. 2002; 8(Suppl 1).
Boirie, Y., Dangin, M., Gachon, P., Vasson, M.P., Maubois, J.L. and Beaufrere, B. (1997) Slow and fast dietary proteins differently modulate postprandial protein accretion. Proclamations of National Academy of Sciences 94, 14930-14935.
Counous, G. Whey protein concentrates (WPC) and glutathione modulation in cancer treatment. Anticancer Research 2000; 20, 4785-4792
FitzGerald RJ, Murray BA, Walsh D J. Hypotensive Peptides from Milk Proteins . J. Nutr. 134: 980S-988S, 2004.
Franz MJ. Prioritizing diabetes nutrition recommendations based on evidence. Minerva Med. 2004; 95(2):115-23.
Gannon et al An increase in dietary protein improves the blood glucose response in persons with type 2 diabetes. Am J Clin Nutr 2003; 78:734- 41.
Gannon MC, Nuttall J A, Damberg G. Effect of protein ingestion on the glucose appearance rate in people with type II diabetes. J Clin Endocrinol Metab 86: 1040-1047, 2001
Ganong W F. Review of Medical Physiology, 21st Ed. Lange Publications 2003
Ha, E. and Zemel, M.B. Functional properties of whey, whey components, and essential amino acids: mechanisms underlying health benefits for active people. Journal of Nutritional Biochemistry 2003; 14, 251-258.
Kent KD, Harper WJ, Bomser JA. Effect of whey protein isolate on intracellular glutathione and oxidant-induced cell death in human prostate epithelial cells. Toxicol in Vitro. 2003; 17(1):27-33.
Nuttall et al. The Metabolic Response of Subjects with Type II Diabetes to a High-Protein, Weight-Maintenance. J Clin Endocrinol Metab 88: 3577-3583, 2003
Parker et al. Effect of a High-Protein, High-Monounsaturated Fat Weight Loss Diet on glycemic Control and Lipid Levels in Type 2 Diabetes. Diabetes Care 25:425-430, 2002.
Seppo, L., Jauhiainen, T., Poussa, T. & Korpela, R. () A fermented milk high in bioactive peptides has a blood pressure-lowering effect in hypertensive subjects. Am. J. Clin. Nutr. 2003; 77: 326-330. Unger RH. Glucagon physiology and pathophysiology. N Engl J Med. 1971; 285:443- 449.
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