Protein- The Diabetes Management Macro

The prevalence of Type 2 diabetes is rising rapidly in middle- and low-income countries. It has become a global epidemic, with approximately 422 million cases worldwide. [1] 

Dietary choices play a pivotal role in insulin resistance. This is especially true in an aging, more sedentary population. Consumption of high calorie foods like fast food meals, animal fats like meat, sugar-loaded beverages is increasingly at a fast pace. This is the primary contributor to the increasing rates of type 2 diabetes worldwide.[2] Lifestyle changes, particularly diet, can be highly effective in preventing, treating, and even reversing (remission) type 2 diabetes. [3]-[6]  

Protein and Diabetes Management- 

Protein, an element found in our food and beverages, is the molecule of life. It is the main functional component of cells in the body. Adequate levels of protein are essential. It is true that too little protein causes muscle loss. However, the idea that too much protein causes kidney damage is a misconception when it comes to diabetes management. This myth has been proven false. Protein helps in managing diabetes in a healthy way. [11]  

Lifestyle changes like healthy eating, physical activity, weight and stress management help prevent the onset of type 2 diabetes. Studies have shown up to 67% reduction in the risk of diabetes by reducing energy intake through portion control. Additionally, reducing dietary fat and saturated fat and increasing dietary fiber help manage blood sugar fluctuations better.[11] 

How does Protein help manage Diabetes?  

Although there's an overlap between the strategies used to manage type 1 and type 2 diabetes, attaining optimal weight while maintaining glycemic control is considered crucial for type 2 diabetes. The management of type 2 diabetes majorly revolves around the carbohydrates (quantity & type). Protein is often sidelined as there are not many studies supporting the role of protein in managing diabetes.  

Here is how protein helps in diabetes management-  

Weight management: 

Insulin resistance is one of the major concerns for people with type 2 diabetes. Being overweight is a critical factor causing insulin resistance. Over 75% of adults with diabetes are overweight. Almost half of this population meets the criteria for obesity. 

Studies have shown improvements in insulin sensitivity which contributes to a weight loss of around 7-10% in people with Type 2 diabetes. [11] 

Some diabetes medicines, such as insulin, insulin booster, and insulin sensitizers, could make it harder to lose weight because they can cause changes in your blood your blood sugar levels [14]. 

High protein low calorie diets improve several factors related to heart health. [15] In an interventional study, which followed a diet plan based on 40-45% calories from carbohydrates, 20-30% from protein and <35% from fat, it was found that there was a decrease in the HbA1C levels from 7.5-6.6 % and an average weight loss of 11kgs after 12 weeks (about 3 months). Blood pressure, LDL cholesterol, and TGs (triglycerides) also lowered. [17] 

Preventing muscle loss: 

People suffering from diabetes often undergo lean muscle loss due to the inflammation and stress. This is especially true for older adults as their food intake is low. Adequacy of protein ensures maintenance of lean body mass.  

Building higher muscle mass helps prevent diabetes. High muscle mass lowers the risk of diabetes as it improves insulin sensitivity. [7] 

Increases Satiety and thermogenesis: 

Protein is more filling as compared to carbohydrates and fats. High protein diets are linked to increased thermogenesis and increased energy expenditure. These speed up the metabolic rate, which in turn, helps with weight loss.[8] 

Plant-based protein for diabetes management: 

Studies show that type 2 diabetes is lower among those following plant-based dietary patterns compared with omnivores and even semi-vegetarians. Low BMIs are protective against type 2 diabetes and are more commonly observed in people who consume a plant-based diet. [17]  

Consuming more whole plant-based foods helps to automatically minimize the consumption of animal fats and proteins. Animal protein and animal fats have also been related in both metabolic as well as large cohort studies to worsen insulin resistance and increased incidence of type 2 diabetes. [18]  

 Sources of Plant Protein- 

• Millets
• Nuts (peanuts, almonds, cashews)
• Green peas
• Soy and soy-based products

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RECOMMENDED PROTEIN INTAKE: 

Currently, protein intake recommendations are based on an individual's assessment as well as taking other health conditions and their effects into account, such as the degree of glycemic control, the existence of kidney disease, overweight and obesity, and the patient's age. 

The target for many patients with type 2 diabetes is to consume 1.5-2 g/kg i.e., 20–30% of total calories as protein for patients with normal kidney function. This much protein can help with glycemic management, satiety, and the maintenance of lean body mass during weight loss in those with diabetes and prediabetes, as well as meeting the higher protein needs of older adults. [11] 

CONCLUSION

Consuming a high protein diet can prevent and help manage diabetes as it supports weight loss, provides prolonged satiety, and prevents insulin resistance. Thus, consuming adequate protein based on your individual body needs is essential. Plant-based protein provides additional benefits as it is low on saturated fats and high in fibre and other micronutrients. Whole foods containing natural ingredients like Prolicious Products www.prolicious.com could be the best protein solution way forward. 

REFERENCES 

1. World Health Organization Diabetes Fact Sheet. 
2. Ley SH, Hamdy O, Mohan V, et al. Prevention and management of type 2 diabetes: dietary components and nutritional strategies. Lancet. 2014; 383:1999–2007 
3. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002; 346:393–403.  
4. Lim EL, Hollingsworth KG, Aribisala BS, et al. Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia. 2011; 54:2506–2514.  
5. Barnard ND, Katcher HI, Jenkins DJ, et al. Vegetarian and vegan diets in type 2 diabetes management. Nutr Rev. 2009; 67:255–263.  
6. Barnard RJ, Jung T, Inkeles SB. Diet and exercise in the treatment of NIDDM. The need for early emphasis. Diabetes Care. 1994; 17:1469–1472. 
7. Srikanthan P, Karlamangla AS. Relative muscle mass is inversely associated with insulin resistance and prediabetes. Findings from the third National Health and Nutrition Examination Survey. J Clin Endocrinol Metab. 2011 Sep;96(9):2898-903. doi: 10.1210/jc.2011-0435. Epub 2011 Jul 21. Erratum in: J Clin Endocrinol Metab. 2012 Jun;97(6):2203. PMID: 21778224. 
8. Paddon-Jones D, Westman E, Mattes RD, Wolfe RR, Astrup A, Westerterp-Plantenga M. Protein, weight management, and satiety. Am J Clin Nutr. 2008 May;87(5):1558S-1561S. doi: 10.1093/ajcn/87.5.1558S. PMID: 18469287. 
9. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002; 346:393–403.   
10. Barnard ND, Katcher HI, Jenkins DJ, et al. Vegetarian and vegan diets in type 2 diabetes management. Nutr Rev. 2009; 67:255–263. 
11. Amy P Campbell, Tia M Rains, Dietary Protein Is Important in the Practical Management of Prediabetes and Type 2 Diabetes, The Journal of Nutrition, Volume 145, Issue 1, January 2015, Pages 164S–169S, https://doi.org/10.3945/jn.114.194878 
12. American Diabetes Association. Standards of medical care in diabetes—2014. Diabetes Care, 2014; 37: S14–80 
13. Tabák AG, Herder C, Rathmann W, Brunner EJ, Kivimäki M. Prediabetes: a high-risk state for diabetes development. Lancet. 2012 Jun 16;379(9833):2279-90. doi: 10.1016/S0140-6736(12)60283-9. Epub 2012 Jun 9. PMID: 22683128; PMCID: PMC3891203. 
14. Evert AB, Boucher JL, Cypress M, Dunbar SA, Franz MJ, Mayer-Davis EJ, Neumiller JJ, Nwankwo R, Verdi CL, Urbanski P, Yancy WS Jr; American Diabetes Association. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care. 2013 Nov;36(11):3821-42. doi: 10.2337/dc13-2042. Epub 2013 Oct 9. PMID: 24107659; PMCID: PMC3816916. 
15. Ajala O, English P, Pinkney J. Systematic review and meta-analysis of different dietary approaches to the management of type 2 diabetes. Am J Clin Nutr. 2013 Mar;97(3):505-16. doi: 10.3945/ajcn.112.042457. Epub 2013 Jan 30. PMID: 23364002. 
16. Hamdy O, Carver C. The Why WAIT program: improving clinical outcomes through weight management in type 2 diabetes. Curr Diab Rep. 2008 Oct;8(5):413-20. doi: 10.1007/s11892-008-0071-5. PMID: 18778592. 
17. Tonstad S, Butler T, Yan R, et al. Type of vegetarian diet, body weight, and prevalence of type 2 diabetes. Diabetes Care. 2009; 32:791–796. 
18. Mcmacken M, Shah S. A plant-based diet for the prevention and treatment of type 2 diabetes. J Geriatr Cardiol. 2017 May;14(5):342-354. doi: 10.11909/j.issn.1671-5411.2017.05.009. PMID: 28630614; PMCID: PMC5466941.