Among these are:
• Fruit should be limited or avoided.
• Soy has detrimental effects with diabetes.
• Plant fiber provides too many carbohydrates.
• Bariatric surgery is an alternative to lifestyle changes.
All of these statements are false. Let’s look at the evidence.
Fruit, whether whole fruit or fruit juice, has been thought of as taboo for those with diabetes. This is only partially true. Yes, fruit juice should be avoided because it does raise or spike glucose (sugar) levels. The same is not true for whole fruit.
Studies have demonstrated that patients with diabetes don’t experience a spike in sugar levels, whether they limit the number of fruits consumed or have an abundance of fruit. In a study published in The American Journal of Clinical Nutrition, whole fruit actually was shown to reduce the risk of type 2 diabetes.
In another study, researchers examined the impacts of different whole fruits on glucose levels. They found that berries reduced glucose levels the most, but even bananas and grapes reduced these levels.
That’s right, bananas and grapes, two fruits people associate with spiking sugar levels and increasing carbohydrate load. The only fruit that seemed to have a mildly negative impact on sugars was cantaloupe.
Whole fruit is not synonymous with sugar. One of the reasons for the beneficial effect is the flavonoids, or plant micronutrients, but another is the fiber.
In the Nurses’ Health Study and NHS II, two very large prospective observational studies, plant fiber was shown to help reduce the risk of type 2 diabetes. Researchers looked at lignans, a type of plant fiber, specifically examining the metabolites enterodiol and enterolactone.
They found that patients with type 2 diabetes have substantially lower levels of these metabolites in their urine, compared to those without diabetes. There was a linear, or direct, relationship between the amount of metabolites and the reduction in risk for diabetes.
The authors encourage patients to eat more of a plant-based diet to get this benefit.
Foods with lignans include flaxseed, sesame seeds, cruciferous vegetables, such as broccoli and cauliflower, and an assortment of fruits and grains. The researchers believe the effect is from antioxidant activity.
Soy and kidney function
In diabetes patients with nephropathy (kidney damage or disease), soy consumption showed improvements in kidney function. There were significant reductions in urinary creatinine levels and reductions of proteinuria (protein in the urine), both signs that the kidneys are beginning to function better.
This was a small, but randomized controlled trial (RCT) over a four-year period with 41 participants. The control group’s diet consisted of 70 percent animal protein and 30 percent vegetable protein, while the treatment group’s consisted of 35 percent animal protein, 35 percent textured soy protein and 30 percent vegetable protein.
This is very important, since diabetes patients are 20 to 40 times more likely to develop nephropathy than those without diabetes. It appears that soy protein may put substantially less stress on the kidneys than animal protein.
However, those with hypothyroidism should be cautious or avoid soy, because it may suppress thyroid functioning.
In a meta-analysis of bariatric surgery studies, the procedure illustrated better results than conventional medicines. During a 17-month follow-up period, 72 percent of surgery recipients went into diabetes remission.
However, after 10 years without proper management involving lifestyle changes, only 36 peRcent remained in remission, and a significant number regained weight. Thus, altering diet and exercise are critical to maintain long-term benefits.
There is still a lot to be learned with diabetes, but our understanding of how to manage lifestyle modifications, specifically diet, is becoming clearer. The take-home message is: focus on a plant-based diet targeting fruits, vegetables, beans and legumes.
And if you choose bariatric surgery, you need to make significant lifestyle changes to accompany it.