How to lower your A1C

January 20, 2021

Reviewed for medical accuracy by Magdalena Chavez, PA-C.

Diabetes is a common disease that affects approximately one out of every ten Americans.  And prediabetes, a state of higher risk of getting diabetes or cardiovascular disease, is present in almost one in three Americans. With such high-risk factors, it is important to test and focus on your blood sugar levels to help prevent complications from diabetes in your future. That is where your hemoglobin A1C levels are incredibly important.

Your hemoglobin A1C numbers show the average blood sugar levels from the past two to three months. These numbers offer the most in-depth picture of your risk of complications from diabetes. The most effective way to avoid contracting this disease is by finding threats early and adjusting your lifestyle accordingly.

It is a good idea to test your hemoglobin A1C at least once a year depending on your family history and other risk factors.   If you already have a diagnosis of diabetes, this should be checked every three to six months so you can figure out the best way to proceed.  Just because you have high numbers doesn’t mean you can’t still lower your A1C and begin a healthier lifestyle. Stop diabetes in its tracks with a treatment plan from your doctor to lower your blood sugar numbers.  This will have a positive effect on your overall health and help you continue a full and happy life.

What is the A1C test?

Before you can begin lowering your hemoglobin A1C, it is helpful to fully understand what hemoglobin A1C is referring to. It is a blood test taken at any time that is the primary way to diagnose diabetes mellitus type 1 and type 2. The hemoglobin in your blood can be coated with sugar which means it is glycated.

In fact, the test may also be referred to as glycated hemoglobin, hemoglobin A1C, or HbA1C. No matter what the title, higher blood sugar levels are not a good sign and can indicate an increased risk of diabetes. This can occur in adolescents or adults depending on different factors like body weight and diet.

Reasons for Testing

There are a few different reasons why you may go in for an A1C test. Perhaps it is a precautionary test to see what your levels look like and diagnose prediabetes. Or maybe your doctor suspects you have diabetes and wants to confirm the results. This will usually include two A1C tests on different days or an additional diabetes test such as a fasting glucose level.

Lastly, it is important to track A1C levels as a diabetic patient. This is the best way to know if a treatment plan and your lifestyle changes are working effectively. So whether you’re taking the first step to diagnose your condition or taking the 500th step in your diabetes management, tracking your A1C will be an important part of your journey.

Reading Results

So you understand what A1C numbers are, now you need to understand how to read the results. A normal level that doesn’t indicate the risk is under 5. 7%. For individuals whose A1C is between 5.7% and 6.4%, you are considered prediabetic and will need to begin monitoring your levels.

Any level of 6.5% or higher is diagnostic or diabetes, and patients who need to speak with a health care provider about different ways to manage the problem. Depending on your age and other risk factors, your doctor will set a goal A1c for you, usually close to 6.5% or 7.0%.

Of course, these numbers are the standards and averages. As with anything in medicine, every individual is different. Depending on your numbers, you may make slight adjustments to these levels. Your weight, age, and other healthy lifestyle factors will affect your own personal journey and the implications of your A1C levels.

Implications of Results

No matter what test you’re taking, some of the most stressful moments are waiting for the results. Once your tests are read and you know the amount of sugar in your blood, you can start your diabetes management plan. If your numbers are normal and healthy, you have nothing to worry about. But once they start creeping into prediabetic or diabetic range, it is time to get serious about lowering your A1C.

How to Lower Your A1C

Depending on the results of your A1C test, it may be time to start looking for ways to lower your numbers and change up your daily routine to avoid a diabetes diagnosis. Just know there is no immediate, one-size-fits-all solution to lowering your numbers. It takes diligent lifestyle measures and an introduction of new, healthy habits to lower blood sugar levels. However, a one-time high A1C level does not mean all hope is lost. You have the opportunity to turn things around and avoid a diabetes diagnosis or serious diabetes-related complications. Let’s look at some of those tips for lowering A1C below.

Make a diabetes plan.

The first step on any health journey is making a detailed plan. Speak with your doctor to make a diet plan, find ways to exercise, and how to cut out sugars and carbohydrates, especially simple carbohydrate like those found in white bread, pasta, rice, and potatoes. This will help you prepare for what needs to be done mentally and physically.

Because your blood sugar levels are often affected by what you eat and how you exercise, those will be big parts of your plan. You are more likely to stick with significant differences to your diet and daily activity if you make it easy for yourself. Meal plan and find workout buddies to keep you motivated. Set specific goals so you can reward yourself when you reach them. All this and more will help you stay committed to your journey of lowering your A1C.

If you’ve been officially diagnosed with diabetes, a plan will be essential for how you will manage your disease. You’ll need contact information for your doctors and the nearest emergency car in case something goes awry. You’ll need a plan and understanding of how to work your at-home equipment for testing your glucose at home on your own.

Change your diet.

A healthy diet is one of the best ways to lower your A1C levels. If you’re trying to cut sugar out of your bloodstream, it is a good first step to work on cutting it out of your diet. This can happen in a lot of different ways. For one, your carbs can have the greatest impact on your blood sugar. You don’t need to cut out carbohydrates completely, but consider going to carbs that are higher in fiber like whole grain products rather than those filled with starch.

You’ll want to start reevaluating your serving sizes. Try to increase vegetable intake and lean proteins rather than red meats. Fruits may seem like a good snack, but they can also be high in sugar. Try to avoid processed foods as they usually have higher sugar amounts and can heighten your blood glucose. Another good rule of thumb is always taking in fewer calories than you can burn. Your medical provider, a diabetic educator, or a dietitian can help you make a plan that will work to lower A1C levels and get you on the right track to a healthier lifestyle.

Adjust how you track your diet.

A big part of changing your diet is how you actually track your food intake. You may need to adjust this when it comes to lowering your A1C. Perhaps you were already on a food plan, but you were focused on counting calories or doing a specific plan like intermittent fasting or Keto. A healthy diet to lower A1C levels may require you to count sugar intake or lower your carbohydrates instead. Be ready to track what you are eating more diligently because it will become all the more important for your health and your bloodstream.

Start measuring in the kitchen.

Oftentimes your health and diet can be fine, but you have a problem with overindulging. Sure, fruit is good for you, but when you’re having sugary items in bulk, it can affect your glucose levels. It may be time to bring measuring cups and scales into your kitchen. Portion control becomes essential for blood sugar control. When you are eating more than your body can process, it leads to a rise in A1C. Start training your body to only need the correct amount of food and stop craving those bigger, unhealthy portions.

Focus on losing the right amount of weight.

Diabetes can be a result of obesity or being overweight. For this reason, one of the ways to lower your A1C and fight off diabetes is weight loss. However, you don’t need to drop a ton of weight to affect your blood glucose level. Usually, doctors will recommend losing around 10% of your current weight. While you may have other goals for yourself or for other health reasons, you start to see a difference in your own insulin lowering your blood sugar and A1C levels. Set a weight loss goal and it will directly impact your A1C goal and help with diabetes control.

Increase your exercise.

Diet is great but in order to make a true change, you need to pair it with regular exercise. This doesn’t mean you need to start a rigorous program where you are in the gym for two hours every day, but a gradual increase in your activity will help lower your A1C. When your muscles are working, they use up sugar. This lowers the build-up of glucose in the bloodstream and can help with high blood sugar levels.

Going out for a daily walk can be step one toward truly making a difference. Once you get some sort of a routine down, it can also be beneficial to add in some strength training. This is where your muscles get to work and require that extra energy and sugar to function properly.  And, more muscle mass will help you to continue to burn up sugar even when you are at rest. If you can make this increase in exercise a regular part of your weekly routine, there has been a tremendous amount of research to indicate that your A1C levels will decrease.

Keep track of your medications.

If you are a diabetic patient, you probably already have a regiment of medications and lifestyle adjustments to deal with your diabetes. When you get your A1C test, you are basically tracking to see if your treatment plan is working effectively. The best way to lower your A1C in this scenario is to keep up with your medications.

Your doctor prescribed those meds for a reason, so if you aren’t taking them exactly as you were told, it can cause an increase in your A1C levels. This is incredibly important when you already have diabetes because the management of your disease is the best way to avoid extreme complications like nerve damage, cardiovascular disease, and skin conditions. Your diabetes treatment is important, so don’t slack on your meds.

Only use useful supplements.

A pill that may not be prescribed is a supplement. Many of these vitamins promise they’ll lower your A1C, but you need to be careful about who you can trust. There isn’t much research and exact data out there to actually promise a lowering of your numbers. Before you commit to any “miracle pills,” consult with a health care provider to find out if supplements will actually be useful for you.

Stay diligent.

The best tip overall for lowering your A1C is to stay diligent. Because your levels are measured as an average of two to three months, it can take time for you to see a real difference. That doesn’t mean your efforts aren’t yielding positive results. Improving your health and lowering your A1C will only help lead to a happier, fuller life. Commit to these lifestyle changes and find ways to reinvest in yourself and your health. The benefits will help you to lower your A1C and protect your vital organs including the heart, kidneys, eyes, and nervous system.

Reviewed for medical accuracy by

January 20, 2021

Magdalena Chavez, PA-C

Magdalena Chavez, PA-C is a recipient of several awards, including the UT Southwestern Dean’s Scholarship and Schermerhorn Service Award. She enjoys establishing long-lasting relationships with her patients and believes in responding sensitively to their needs. Magdalena is married and has two children. Outside of the office, she enjoys cooking, running, water sports, playing piano, and singing with her church choir. She practices family medicine in Bedford, TX. She is accepting new patients.

Managing Diabetes: Six Healthy Steps with the Most Benefit

About 17.7 million Americans with

diabetes

take medications—pills, injections, or both—to help keep their blood sugar
within a healthy range, according to the Centers for Disease Control and
Prevention. That’s important, and it’s important to take medication as
prescribed, but don’t stop there. People with diabetes are two to four
times more likely to have heart disease or a stroke than those without this
chronic condition, according to the American Heart Association.

“It’s very important to take care of your heart health too,” says Johns
Hopkins diabetes expert

Rita Rastogi Kalyani, M.D., M.H.S. “Making smart choices every day can help.” Kalyani recommends starting with these six critical steps today.

Extra pounds? Lose a little. You don’t have to be a “biggest loser” or get an “extreme makeover” to enjoy big weight-loss benefits if you have diabetes. In a nationwide study of 5,145 people with type 2 diabetes, those who shed just 5 to 10 percent of their weight (for someone weighing 175 pounds, that’s a loss of 9 to 17.5 pounds) were three times more likely to lower their A1C (a test of long-term blood sugar control) by 0.5 percent, a significant drop. They were also 50 percent more likely to lower their blood pressure by 5 points and twice as likely to lower their triglycerides by 40 points compared with those whose weight remained the same. 

Say yes to fiber-rich foods. When people with diabetes increase the fiber in their diet, they can potentially lower blood glucose over a period of 12 weeks or less, according to a major review of 15 studies. Most people—with or without diabetes—don’t get the recommended 21 to 38 grams of fiber daily. (The American Diabetes Association suggests that diabetics should aim for 14 grams of fiber for every 1,000 calories consumed in a day.) Those who participated in these studies increased their intake by an average of 18 grams a day—the amount in a bowl of higher-fiber breakfast cereal plus a couple of extra servings of vegetables. Whenever you can, choose vegetables, whole grains, and fruit over sugary treats and bread, rolls, and other foods made with refined grains. 

Get moving. Starting a regular exercise routine can help people with diabetes lower their A1C by an average of 0.3 to 0.6 percentage points. “Aim for 30 minutes of aerobic exercise—such as walking, riding an exercise bike, or swimming—at least five days a week,” Kalyani suggests. Add two to three light strength-training sessions a week and you’ll build muscle, which uses blood sugar for fuel. In one notable study of 251 people with diabetes, those who participated in aerobic exercise and strength-training every week for nearly six months saw their A1C fall by nearly 1 percent—a drop big enough to reduce risk for diabetes-related microvascular complications by a substantial 35 percent.  

Know your ABCs—and beyond. “Because your risk for heart disease is higher with diabetes, it’s smart to see your doctor regularly for checks,” Kalyani says. Have your:

• A1C tested as often as your doctor recommends
• Blood pressure checked at every visit
• Cholesterol tested once a year 

In addition, your doctor should check your feet at every visit. You also need an annual eye exam and a yearly kidney-function and urine microalbumin test. Have an annual flu shot and stay up-to-date with your pneumonia vaccine too, Kalyani recommends. And in general, “Talk with your doctor about what you need,” she says.  

Monitor blood sugar at home too. Be sure to check your blood sugar levels as often as your doctor recommends. Testing blood glucose at home can give you and your doctor a better idea of how well your medications are working as well as their side effects and other risks, and how your diet and exercise habits are affecting your blood sugar levels, Kalyani says. Of course, more isn’t always better; some people with diabetes can safely be tested every six months without monitoring at home, so talk with your doctor about what’s right for you.

Quit smoking. Nearly one in six people with diabetes are smokers. Tobacco use boosts your risk for heart disease, stroke, blood sugar control problems, vision loss, nerve damage, kidney problems, and even amputation, according to a study review published by the CDC. If you’ve tried to quit in the past, make another attempt. Counseling or a support group plus nicotine-replacement products and medications to help control nicotine cravings can help.

Definitions

Whole grains: Grains such as whole wheat, brown rice and barley still have their fiber-rich outer shell, called the bran, and inner germ. It provides vitamins, minerals and good fats. Choosing whole grain side dishes, cereals, breads and more may lower the risk for heart disease, type 2 diabetes and cancer and improve digestion, too.

Blood glucose: Also referred to as blood sugar, the primary energy source for the cells in your body. Blood glucose levels rise after meals and fall the longer you’ve gone without eating. Your blood glucose level is a measure of how much glucose you have in your bloodstream. A normal fasting blood glucose level is between 70 and 100 mg/dl (milligrams per deciliter of blood).

A1C Test: A blood test used to diagnose and monitor diabetes. By measuring how much glucose (also called blood sugar) is attached to the oxygen-carrying protein in your red blood cells, this test gives you and your health-care provider a picture of your average blood glucose levels over three months. A normal result is below 5.7 percent. If you have type 2 diabetes, you should have this test done twice a year to check if your blood glucose is under control.

5 Tips for Lowering Your A1c in Diabetes

(Editor’s note: Everyone’s diabetes is different, and what works for one person may not be right for another person. Work with your health care professional to determine what A1c goal is right for you and what treatment plan will best help you reach it.)

If you have diabetes, the idea of lowering your A1c to a number less than 7.0 may seem impossible without acquiring some sort of diabetes management obsession. Diagnosed with type 1 diabetes (and Celiac disease) when I was a teenager, I’m here to tell you, it isn’t. While I certainly don’t want to give the impression that it’s a simple or easy goal to obtain, I’ve been able to maintain an A1c of 6.0 for most of my adult life mostly by following a proven path of tried-and-true strategies. 

How to Lower Your A1c

By far the most helpful thing for me in maintaining a 6.0 A1c has been to structure my nutrition so I’m eating fairly low-carb throughout the day and “save” my carb servings for dinner or dessert. This way, managing my blood sugars in a tighter range requires significantly less effort than if I were to eat more carbohydrates earlier in the day.

Here, a few other guidelines I live by:

1. Care about the quality of food you eat

This simple principle is terribly important. Consuming a diet that is made mostly of real food — whole food — that you chopped and prepared and cooked yourself will have the greatest impact on your blood sugars and your sensitivity to insulin, whether you’re type 1, type 2, or have prediabetes.

You don’t have to be a brilliant chef to cook delicious food in reasonable amounts of time on a reasonable budget. But you do have to be willing. Start by taking a closer look at how much of your current food choices are highly processed; these are the first ones you’ll want to cut out or find whole-food substitutes for. Then dive in, learn, take your time — and enjoy it! Your blood sugars will thank you for the effort.

2. Find an activity you enjoy and become more active in it 

You don’t have to be an athlete or a hardcore Cross-Fitter to benefit from exercise. Just walking 30 minutes a day will have a powerful effect on your overall sensitivity to insulin and your blood sugar levels. I used to be a competitive powerlifter — training, setting records, and challenging my body taught me a lot about balancing my blood sugars during intense training.

Image credit: iStock user vgajic

Today, I’m a mother to a 7-year-old and a 4.5-year-old. While I get my more intense workouts in when they are at school, I take them with me on daily dog walks, too. I periodically mix in some light strength-training with hand weights, too.

In order to see results at your next doctor’s appointment, the key is to make it a real habit most days of the week. You don’t even necessarily need to leave the house; buy a couple pairs of dumbbells and just move while you watch your favorite TV show every night! Keep it simple and realistic.

3. Check your blood sugar more frequently and adjust your medications

If you’re currently frustrated with your A1c level, it’s probably time to start checking your blood sugar more often — particularly between meals.  If you recall that the blood sugar range of 100 to 152 mg/dL is essential to a 6.0 A1c, that means that your blood sugar needs to be in or below that range before you eat and after you eat as much as possible. (Editor’s note: There is no evidence that an A1c under 6.5 protects people with diabetes any more than an A1c between 6.5 and 7.0.)

Checking your blood sugar more often will help you determine if your insulin doses or diabetes medications need to be adjusted with your doctor’s guidance. Even a 1-unit increase in your background/basal insulin dose can have an incredible impact on your blood sugars. The little details matter!

Related:

4. Sleep with in-range blood sugars

If your blood sugar is above that 100 to 152 mg/dL range for the 8 hours of the day you’re asleep, it might result in a higher A1c than you’re aiming for since your overnight blood sugars are one-third of your total blood sugars per day.

If you’re currently going to bed with high blood sugars, then it’s time to take a closer look at your evening medication doses and food choices. And the same goes for if you often wake up with high blood sugars in the morning.

5. Pre-bolus your insulin doses

This applies only to those who take insulin, but it’s crucial. Most of today’s fast-acting insulin is designed to begin working in the body approximately 15 minutes after injecting. This means that when you’re eating a meal that contains anything over 10 grams of carbohydrate, you’ll want to wait at least 5 or 10 minutes if not 15 minutes between injecting your insulin and eating in order to let the insulin keep up with the rate at which your body is digesting those carbohydrates.

Meals high in both fat and carbs are a little trickier, and may need a delayed dose of insulin.

Amy Hess-Fischl, MS, RDN, LDN, BC-ADM, CDCES, a certified diabetes care and education specialist and member of our Editorial Board, notes that sometimes dosing up to 30 minutes before a meal may be needed to reduce the spike after certain meals. “This is very individualized, though,” she says.

These may sound like guidelines you’ve heard a hundred times before, but the truth is that the secret to achieving your A1c goal isn’t a secret at all. It’s about the straightforward basics of good diabetes management. If trying to apply all five steps right now is overwhelming, pick two you feel the most positive about and start from there.

Updated on: 11/16/21

Diets That Lower Hemoglobin A1C Test Results

Controlling the amount of carbs you eat at each meal helps control blood sugar.

Image Credit: Image Source/DigitalVision/GettyImages

If you’re concerned about blood sugar, your doctor may order a hemoglobin A1C test. This test measures average blood sugar over the past three months. It is primarily used as a test for people with diabetes.

If your A1C level is elevated, you can improve it by following the same type of diets that people with diabetes follow to help with blood sugar management. These diets include carbohydrate counting, the diabetes exchange diet and a plan called Create Your Plate.

Hemoglobin A1C 101

The A1C measures the attachment of glucose to hemoglobin, which is the protein in your red blood cells that carries oxygen throughout your body. It is measured as a percentage, and the higher the percentage, the higher your blood sugar.

A normal A1C is 5.7 percent or less. An A1C between 5.7 percent and 6.4 percent is a sign of prediabetes, a risk factor for the development of type-2 diabetes, and indicates that your average blood glucose, or eAG, is about 126 milligrams per deciliter. An A1C of 6.5 or more usually means you have diabetes, and your blood sugars are averaging more than 126 milligrams per deciliter.

Carbohydrate Counting

Carbohydrate-containing foods, including starches and grains, fruits, milk and yogurt, have the most impact on blood sugar. Controlling the level of carbs you eat at each meal helps keep blood sugar under control. Carbohydrate counting is a diet system aimed at helping you control carb intake.

On the diet, you eat a specified number of grams or servings of carbs at each meal. Your doctor or dietitian can help you determine carb amounts, but it generally ranges from 45 to 60 grams, or three to four servings of carbs, at each meal.

A 15-gram serving of carbohydrate is equal to one slice of bread, 1/3 cup of rice or pasta, a 4-ounce piece of fruit, 1 cup of milk or 1/2 cup of peas. For health and balance, each meal should include a source of protein, healthy fat and a nonstarchy vegetable — for example fatty fish or chicken cooked in olive oil and mixed greens or steamed broccoli.

The Exchange Diet

The diabetes exchange list is another meal-planning tool that helps control blood sugar to lower A1C levels. The exchange system groups foods together based on similarities in nutritional content, including carb, protein, fat and calories. This way foods within each group can be exchanged to help with meal planning.

Food groups include starches, fruits, milk, meat and meat alternatives, vegetables and fat. When meal planning, you can exchange 3/4 cup of unsweetened cold cereal with 1/2 cup of cooked oatmeal at breakfast. Your diet plan allows you to have a set number of exchanges from each food group each day. As with carb counting, food exchanges should be evenly distributed among meals and snacks for better blood sugar control.

Create Your Plate

For some people, counting carbs and exchanges can make meal planning too complicated, especially if you’re newly diagnosed with diabetes. The American Diabetes Association suggests a simpler meal planning technique to aid in blood sugar control and help improve A1C levels called Create Your Plate. This diet uses your dinner plate to help control carbs and calories.

First, divide your plate in half, then divide one of the halves in half again to create three sections. Fill the largest section with nonstarchy vegetables, such as broccoli or green beans, one of the smaller sections with a healthy starch such as sweet potatoes or brown rice and the other smaller section with a lean protein such as salmon or tofu. Round out your meal with a small serving of fruit or a serving of milk or unsweetened yogurt.

How to Lower A1c Levels

When you have been diagnosed with Type 2 Diabetes it is important that you keep your A1c levels low or close to the optimal range of 5.5 percent to keep your diabetes under control.

To do this effectively. The first step is simply to decide that you want an optimal A1c level, and set that as an ongoing goal to reach. Without having it as a goal to reach, one soon forgets about it, or one may not take it as seriously and not be focused enough to reach it.

The next step is to educate yourself about A1c nutrition, and how you actually can lower your A1c levels without having to take synthetic drugs that might not be so healthy for you in the long run. And at the same time create an environment where you live where snacks and junk food daren’t available to tempt you.

There are various ways to assist with your A1c levels. The best method is to consume a natural diet high in fiber, and to support your habits with our Lysulin supplements.

The best A1c diet is a natural whole foods diet. Whole foods are also called one-ingredient foods like for an example an apple. An apple only consists of the apple. There are no other ingredients, and it is also not processed. Other examples of whole foods are vegetables, salads, fruit, seeds and nuts etc. Basically all natural foods that haven´t been processed or added to in any way.

Make sure you construct your A1c diet in a way that you get enough fiber. Getting enough fiber is an excellent way to help lower your A1c levels. It also helps with digestion, promotes bowel health, and protects against bad cholesterol, also known as LDL (low density lipoprotein) reducing your risk of heart disease.

Fiber is also good for weight management. It may also help curb your appetite, and because it stays in your stomach longer, you may find it easier to maintain your weight.

Below are some foods that will help boost your fiber intake:

• Chia seeds
• Nuts
• Almonds
• Pecans
• Sunflower seeds
• Lima beans
• Raspberries
• Oranges
• Broccoli
• Flaxseeds
• Lentils
• Oatmeal
• Pearled Barley

On average, we are only consuming 28 grams of fiber per day at the standard reference diet of 2000 calories per day. That is much too little, and we are missing out on all the good natural health benefits fiber bring.

Men under 50 years of age should strive to have 38 grams of fiber per day. And woman under 50 years of age should strive for 25 grams of fiber per day.

Exercise is Important to Optimize Your A1C Levels

Exercise is important to keep your A1c levels at their best, and should be part of every diabetics routine.

Regular exercise such as low-intensity walking for half an our daily is great, and is some of the best exercise for type 2 diabetics. By walking gently and taking notice of your surroundings, you naturally get out of your mind; out of thinking mode, and it is a wonderful way of de-stressing as well as getting a gentle exercise that helps your muscles absorb blood sugar and lower your glucose levels.

Other types of exercise that are great for lowering your A1c levels include:

• Aerobic exercise
• Weight training
• Swimming
• Biking

Any exercise that gets your heart pumping, your blood flowing, and your sweat going is good for diabetics. But be sure not to do too strenuous exercise as that will put stress on your body, and you don’t want that. You want to exercise in a way so you feel good and energized afterwards, and not more stressed and worn out.

Tracking your Progress

You can easily track your progress of your A1c levels yourself. Self test your A1c levels once a month to see if you are on track, with A1c Now home test kit.

Plant-Based Diets: Can They Be Too High in Carbs for Diabetes?

Published in Partnership with 

For more commentaries like this one, visit https://www.dietitianpros.com/dietitian-download

Author:

By Anne Danahy MS RDN

It’s no secret that eating more plants is good for everyone’s health. The nutrients and antioxidants they provide protect cells from oxidative damage and inflammation. That may in turn, reduce the risk of developing many chronic diseases, including diabetes.

However, people with prediabetes or diabetes often ask whether diets that restrict animal protein are a good choice for managing blood sugar, or are they too high in carbohydrates? Here’s a look at some current research and recommendations for patients regarding vegetarian and vegan diets.

Research on Diabetes and Vegetarian Diets

Vegetarian diets can range from vegan, which restricts all animal foods, to those which include eggs, dairy, and occasionally fish or chicken. All types of vegetarian diets can have health benefits. In particular, research suggests that compared to people who eat more animal foods, and especially meat, vegetarians and vegans have a lower risk of developing diabetes.

• In a study on nearly 3,000 Buddhists, those with a lifelong adherence to a vegetarian diet had a 35% lower risk of developing diabetes.¹

• Research on Seventh Day Adventists, who commonly follow various vegetarian diet patterns, shows that this population has 45% of diabetes rates compared to the general public. In addition, a study that followed 8,400 Seventh Day Adventists for 17 years found that among those who ate meat just once per week, the risk of developing diabetes increased by 29%.¹

• A more in-depth look into the Adventist population and their different types of vegetarian diets found that vegans had the lowest risk of developing diabetes. They were followed by lacto-ovo vegetarians, then pesco-vegetarians, and finally, semi-vegetarians who ate meat occasionally, but not daily.²

• Research on diabetes management also supports the use of both vegan and vegetarian diets. A meta-analysis that looked at five studies on vegans and one on lacto-ovo-vegetarians found that both types of diets reduced A1c levels over an average 24-week period.³

• Finally, a small study on 93 Asian people with diabetes compared the effects of a brown-rice vegan diet, which provided an average 76% of calories from carbohydrates and a Korean Diabetes Association diet, which averaged 64% carbohydrate. While both improved A1c levels, researchers found the vegan diet to be slightly more effective, with a more considerable reduction in A1c levels after 12 weeks.⁴

Carbohydrates in Plant-Based Foods

Often, vegetarian and certainly vegan diets are higher in carbohydrates than those that include more animal protein. However, studies have found that after adopting a vegetarian or vegan diet, glycemic control often improves, and in many cases, patients can decrease or discontinue their diabetes medication.¹

There are several mechanisms by which vegetarian and vegan diets are effective in preventing and managing diabetes. They tend to promote weight loss, especially visceral fat, which improves insulin sensitivity. In addition, they’re often rich in soluble fiber, which slows glucose absorption. Plant foods are also high in micronutrients especially magnesium, which is associated with improved glucose metabolism.

It’s important to remind patients though, that not all carbs are created equal. The benefits of all types of vegetarian diets come from whole eating foods versus processed foods. As dietitians are aware, French fries, chips, and mac and cheese are vegetarian foods, but not beneficial for glycemic control. Thus, to achieve the benefits of a vegan or vegetarian diet, it’s essential to incorporate a wide range of vegetables, fruits, legumes, nuts, seeds, and whole grains in their unprocessed forms.

Portion size, variety, and balance are also important considerations on a plant-based diet. Whole foods often work in synergy to provide health benefits. Consuming a variety of foods at each meal ensures not only ensures a broader range of nutrients, but also a lower glycemic index and glycemic load.

Meal Planning Tips for Patients

Patients with diabetes, or who are at risk, and who are open to following a vegan or any vegetarian diet should be encouraged to do so. Still, remind them that the most effective diet to manage their glucose is one they can stick to for the long term. The following points can help patients plan healthier meals and snacks:

• Encourage them to focus on adding foods rather than subtracting. Work toward incorporating more plant foods at each meal and snack, while minimizing meat first and other animal products next.

• Always aim for a whole foods diet and limit processed, packaged, and fast foods as much as possible.

• Eat the rainbow. Educate patients about macronutrients and ways to incorporate a variety of plant foods into meals and snacks. Doing so provides lots of color for the antioxidant health benefits, along with the right balance of protein, carbs, and fat for satiety.

• Even though plant proteins like soy also contain carbohydrates, the amino acids and other micronutrients they provide can improve insulin sensitivity and glycemic control.¹

Finally, remember the golden rule – there is no one-size-fits-all diet. That also applies to plant-based diets. If patients feel too restricted or unable to enjoy themselves when eating out, it’s OK to add animal proteins in as needed. The bottom line should be more plants, higher quality animal proteins as desired, and more balance.

References:

1. Olfert MD, Wattick RA. Vegetarian Diets and the Risk of Diabetes. Curr Diab Rep. 2018;18(11):101. Published 2018 Sep 18. doi:10.1007/s11892-018-1070-9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6153574/
2. Tonstad S, Butler T, Yan R, Fraser GE. Type of vegetarian diet, body weight, and prevalence of type 2 diabetes. Diabetes Care. 2009;32(5):791-796. doi:10.2337/dc08-1886. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2671114/
3. Pawlak R. Vegetarian Diets in the Prevention and Management of Diabetes and Its Complications. Diabetes Spectr. 2017;30(2):82-88. doi:10.2337/ds16-0057. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5439360/
4. Lee YM, Kim SA, Lee IK, Kim JG, Park KG, Jeong JY, Jeon JH, Shin JY, Lee DH. Effect of a Brown Rice Based Vegan Diet and Conventional Diabetic Diet on Glycemic Control of Patients with Type 2 Diabetes: A 12-Week Randomized Clinical Trial. PLoS ONE. 2016;11(6).https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4890770/

Rationale for the Use of a Mediterranean Diet in Diabetes Management

Recent estimates point to the stark reality that one in three people will have diabetes by 2050.¹ As the epidemic of diabetes continues to grow, educators aim to help those with diagnosed diabetes live healthier lives.

To date, much evidence-based information exists on how to help our patients reduce their health risks and potentially add quality years to their lives. Both lay and professional publications often emphasize managing the ABCs—A1C, blood pressure, and cholesterol—for optimal diabetes management. The American Diabetes Association (ADA) recommends lowering A1C to < 7%, controlling blood pressure to < 130/80 mmHg, and controlling LDL cholesterol to < 100 mg/dl (< 70 mg/dl for those with diagnosed cardiovascular disease [CVD]) to reduce the risk of microvascular and cardiovascular complications.²

Although these recommendations have not shifted greatly over the years, diabetes management in the population continues to be less than optimal. Data from the National Health and Nutrition Examination Survey of 2001–2002 indicated that an estimated 53% of individuals with diabetes failed to attain target blood pressure levels, and 50.2% were not at goal for A1C.³ Given these statistics, it is not surprising that death from coronary heart disease (CHD) and the risk of having a stroke is two to four times greater in adults with diabetes than in those without diabetes.⁴

Nutrition therapy and regular physical activity are the cornerstones for managing A1C, blood pressure, and cholesterol, and treatment for each has its own set of nutrition guidelines. Although there is some overlap in the recommendations, nutrition guidelines can be complex and confusing to people with diabetes who are often working to manage their diabetes in combination with other health risks. For example, nutrition recommendations often require an individual have advanced skills, such as label reading or data interpretation (e.g., calculation of carbohydrate intake, and, for those using insulin, correction factors or insulin-to-carbohydrate ratios).

These may be important considerations given a recently published article pointing to the under-recognized issue of numeracy, or the ability to use and understand numbers, in diabetes management. White et al.⁵ found that misinterpretation of food labels was common and occurred even for those with adequate health literacy. Because there are multiple nutrition guidelines (some of which are unclear or conflicting), it is understandable that diabetes clinicians often find patients confused about their nutrition therapy and ultimately about what foods to eat.

The purpose of this article is to discuss national guidelines for the treatment of blood glucose, blood pressure, and cholesterol, including both similarities and differences. A Mediterranean diet, based on a centuries-old eating pattern, is proposed as an eating plan that integrates key elements from nutrition therapy recommended to treat each of these three risk factors.

Nutrition Therapy Recommendations

It is helpful to begin with a discussion of nutrition therapy for A1C, blood pressure, and cholesterol. The ADA’s diabetes nutrition recommendations focus mainly on carbohydrate monitoring to manage blood glucose.² No limits or specific ranges are given for carbohydrates; rather, the method of monitoring carbohydrates can be tailored to patients’ individual preference or level of understanding (e.g., carbohydrate counting, exchanges, or experience-based estimation). In addition, the ADA recommendations emphasize reducing saturated fat to < 7% of overall calories and minimizing trans fats to prevent or treat heart disease.²

Lifestyle modifications, with a particular emphasis on food and nutrition, are recommended for anyone who is not at goal for blood pressure (i.e., who has a blood pressure ≥ 130/80 mmHg for an individual with diabetes). The Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommends adopting the Dietary Approaches to Stop Hypertension (DASH) eating plan,⁶ which is rich in fruits and vegetables, includes some low-fat dairy products, and calls for sodium intake of ≤ 2.4 g/day. This diet also calls for moderation of alcohol (no more than two drinks per day for men and one drink per day for women, with one drink defined as 12 oz of beer, 5 oz of wine, or 1.5 oz of distilled spirits [e.g., whiskey]). Following the DASH style of eating has demonstrated reductions in blood pressure similar to those of treatment with one anti-hypertensive medication.⁷

The Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III [ATP III]) presents guidelines for cholesterol management to reduce the risk of CHD or future events.⁸ ATP III recognizes diabetes as a CHD risk-equivalent, and as discussed previously, cholesterol management is a high priority in the treatment of diabetes. The nutrition recommendations within the guidelines, known as the Therapeutic Lifestyle Changes (TLC) diet, provide percentile recommendations for macronutrients to reduce risk.⁸ Although the guidelines are succinct, this approach makes it difficult to interpret the guidelines for both clinicians and patients (i.e., specific recommendations depend on personalized calorie goals and require nutrition label-reading skills).

Table 1 provides the specific details of the TLC diet recommendations. Of note, total fat is provided in a range of 25–35% of total calories to reflect consumption of different types of fats. People are allowed to eat more fat as long as most of the fat comes from healthier sources (e.g., monounsaturated and polyunsaturated fats), limiting the amount of saturated and trans fats. Unique recommendations within the TLC diet include options to add stanols/sterols (2 g/day) and increased soluble fiber (10–25 g/day) to maximize LDL cholesterol lowering.

Although some duplication does exist among the nutrition guidelines (e.g., recommendations for fruit, vegetable, alcohol, and saturated and trans fat consumption), there are some inconsistencies. What if there were one nutrition strategy that could target all three parameters (blood glucose, blood pressure, and cholesterol), keeping it simple for both health professionals and patients? More importantly, what if this single set of nutrition recommendations could be explained in simple terms (e.g., foods that people eat) and would not require advanced skills (e.g., label reading, calculations)?

The Mediterranean diet may be such a solution. It captures elements of both the TLC and the DASH diets and provides more tangible recommendations (e.g., “Eat more fruits, and limit red meat” vs. “Limit intake of saturated fat to < 7% of overall calories”). Essentially, the Mediterranean diet, by design, affects blood glucose, blood pressure, and cholesterol management, making it an intriguing choice for diabetes clinicians and their patients.

The Mediterranean Diet

Researchers have used the term “Mediterranean diet” to describe a centuries-old eating pattern that includes mostly plant-based, nutrient-dense foods such as fruits, vegetables, legumes, nuts, and whole grains, with olive oil as the main fat source. Additionally, the Mediterranean-type diet includes foods rich in omega-3 fatty acids (usually eaten as fatty fish and walnuts), with limited amounts of red meat and other animal products (e.g., butter and other dairy foods).⁹ Moderate consumption of wine (i.e., one glass of wine per day for women, and two per day for men) with meals is generally indicated as a component of the eating pattern because there is a potential decrease in lipid peroxidation when dietary polyphenols (from wine) and oxidized fats are consumed in the same meal.¹⁰

Because the Mediterranean diet is meant to represent the eating patterns of all the countries bordering the Mediterranean Sea, use of this term in research is a misnomer; there is no one single diet that can represent all the economic, cultural, and religious differences that influence the eating patterns of all of these countries. Variations in Mediterranean food patterns make this issue particularly difficult to study, and contradictory results are often found in studies that focus solely on the component foods or food groups.¹¹ Yet researchers continue to classify this eating pattern as the “Mediterranean diet,” which is why the authors have used the term in this article.

To remedy this classification issue (i.e., variability in actual eating patterns within the Mediterranean region), researchers have developed Mediterranean diet scores or indexes.^12,13 These indexes attempt to assess adherence to a traditional Mediterranean-type diet in research to facilitate analyzing the eating pattern and any related health benefits as a whole. The common belief is that there are unknown, but potentially powerful, synergistic qualities of an overall Mediterranean-style eating pattern that may transcend the qualities of the individual foods within the eating pattern that are known to improve health.

Health Benefits and Evidence to Support the Use of a Mediterranean Diet in People With Type 2 Diabetes

The health benefits of choosing an eating pattern similar to the Mediterranean diet are numerous. Benefits specifically related to diabetes include reduction in overall mortality and mortality of CVD,¹⁴ prevention of diabetes, and improvement in glycemic control and cardiovascular risk in people with diabetes.¹⁵

Table 1.

Comparison of Daily Food and Nutrition Recommendations and Patterns from the DASH, Mediterranean, and TLC Diets

In a meta-analysis of 17 studies,¹⁵ the Mediterranean-type diet was found to improve fasting glucose and A1C levels for those with type 2 diabetes. In several studies,^16–18 the Mediterranean diet lowered fasting glucose levels in those with diabetes more than did low-fat diets.

The reason for lower fasting glucose levels may be related to the positive effect on insulin sensitivity that results from replacing saturated and trans fats with unsaturated fats.¹⁶ Specifically, a low-carbohydrate Mediterranean diet (35% carbohydrate, 45% fat [50% of which is monounsaturated fat], and 20% protein) demonstrated glycemic benefit compared to both a control diet and a traditional Mediterranean diet (both of which contained 40–55% carbohydrate, 30% fat, and 15–20% protein).¹⁹

One study by Esposito et al.²⁰ found that adherence to a Mediterranean-type diet decreased A1C levels and postprandial glucose levels measured independently by subjects in their natural environment. In addition, participants with the highest adherence to the Mediterranean diet had lower BMIs, waist-to-hip ratios, and prevalence of metabolic syndrome.

It is important to note that some studies may not separate the effects of the Mediterranean diet from other factors influencing outcomes, such as other risk factor management resources.¹⁵ Therefore, further studies are needed to clarify these issues.

In terms of diabetes prevention, an 83% lower risk of diabetes has been found among those who closely adhered to a Mediterranean diet.²¹ Furthermore, adherence to a Mediterranean diet, even without calorie restriction, seems to be effective in preventing diabetes among those at high cardiovascular risk.²²

The abundant use of olive oil, fruits, and vegetables in this pattern of eating leads to additional health benefits. Using monounsaturated fatty acids (MUFAs) such as those found in olive oil or polyunsaturated fats such as those in seeds instead of saturated or trans fatty acids reduces the risk of diabetes.¹⁶ The Mediterranean diet is also inversely associated with arterial blood pressure, and olive oil use specifically may be as important as fruit and vegetable intake for both systolic and diastolic blood pressure control.²³

The Mediterranean diet may even have positive effects on inflammatory markers²⁴ and may reduce the risk for peripheral artery disease.²⁵ Two outcome-based trials that included patients with diabetes demonstrated that a Mediterranean diet reduced cardiovascular and total mortality.^26,27

Practical Applications for Diabetes Clinicians

The Mediterranean diet, which is based on a traditional eating pattern, may be a simpler nutrition strategy that can help patients with diabetes achieve more optimal glycemic control and reduce the risk of complications. Before starting patients on this type of eating pattern, it is important to assess what particular meal-planning approach they currently use to account for carbohydrates (e.g., carbohydrate counting, exchanges, or experience-based estimation) in their daily eating pattern and to provide further education if needed. This is essential because patients will likely need to replace existing carbohydrates with healthier versions (e.g., fruits, vegetables, whole grains, and legumes) to adopt a style of eating similar to the Mediterranean diet and achieve their glycemic goals.

Explaining the Mediterranean-style eating pattern as a whole and then allowing patients to choose areas to focus on first is recommended to improve adherence. Specific areas that may be suggested for initial nutrition therapy include reducing the number of meals per week that feature red meat by substituting legumes or fish; increasing the amount of fruits and vegetables consumed; and replacing saturated fats with monounsaturated fats.

One study²⁸ conducted to assess the impact of a Mediterranean diet using exchanges for breast cancer prevention found that women who received fairly extensive counseling were able to increase the amount of monounsaturated fat in their diet with very little impact on their overall fat intake. They were also able to double their intake of fruits and vegetables. To increase adoption of Mediterranean diet principles, diabetes clinicians should provide specific examples of foods to include rather than focus on macronutrients or micronutrients as a group.²⁹

Conclusion

Ultimately, patients with diabetes need practical recommendations to help them choose healthier foods without an overly complicated process. Practical information can help patients increase their self-efficacy in eating healthier and better managing their diabetes. An eating pattern similar to the traditional Mediterranean diet can be integrated with existing national guidelines for the management of diabetes, blood pressure, and cholesterol. Existing data suggest that the Mediterranean diet has health benefits, including improved glycemic control and reduced cardiovascular risk,¹⁵ and may offer benefits to diabetes patients and clinicians alike in terms of palatability, ease of explanation and use, and promotion of improved health.

Footnotes

• Gretchen Benson, RD, LD, CDE, is the health care project manager, Raquel Franzini Pereira, MS, RD, LD, is the community project manager, and Jackie L. Boucher, MS, RD, LD, CDE, is vice president for education and a co-investigator for Hearts Beat Back: The Heart of New Ulm Project, at the Minneapolis Heart Institute Foundation in Minnesota. Ms. Boucher is also editor-in-chief of Diabetes Spectrum.

• American Diabetes Association(R) Inc., 2011

90,000 Effect of a diet high in milk and calcium on weight loss and appetite with energy restriction in overweight and obese adults: a randomized trial – European Journal of Clinical Nutrition

items

• Metabolic syndrome
• Diet therapy
• obesity

Abstract

Prerequisites / goals:

A diet rich in dairy and calcium (Ca) has been associated with improved body composition and reduced risk of type 2 diabetes in various ways.Our goal was to determine whether a diet high in dairy and Ca content improves weight loss and subjective appetite more than a diet low in dairy and calcium during energy restriction in overweight and obese adults with metabolic syndrome.

Subjects / Methods:

90,016 A total of 49 participants were randomized to one of two treatment groups: control (low milk, 700 mg / day Ca, -500 kcal / day) or Dairy / Ca (high milk, 1400 mg / day Ca, -500 kcal / day) for 12 weeks.Body composition, subjective assessments of appetite, food intake, plasma satiety hormones, glycemic response, and inflammatory cytokines were measured.

Results:

Control (-2.2 ± 0.5 kg) and Dairy / Ca (-3.3 ± 0.6 kg) had similar weight loss. Based on self-reported energy intake, the percentage of expected weight loss was higher with Dairy / Ca (82.1 ± 19.4%) than control (32.2 ± 7.7%; P = 0.03). Subjects in the Dairy / Ca group reported feeling more satisfied (P = 0.01) and having a lower dietary fat intake (P = 0.02) over 12 weeks compared to controls.Compared to controls, Dairy / Ca had higher plasma levels of peptide tyrosine-tyrosine (PYY, P = 0.01) during the food tolerance test at week 12. Monocyte chemoattractant protein-1 was reduced after 30 minutes with Dairy / Ca versus control (P = 0.04).

Conclusions:

In conclusion, a diet rich in milk and calcium was not associated with greater weight loss than controls. However, a moderate increase in plasma PYY concentration with an increase in milk / Ca intake may increase feelings of satisfaction and decrease dietary fat intake during energy restriction.

Entry

Intake of dairy products and calcium (Ca) have been linked in various ways to weight regulation and the risk of type 2 diabetes. ¹ Part of the variability is related to the study of low fat dairy products and / or Ca consumption in two different contexts, one of which is energy balance and weight maintenance and the other is energy restriction and weight loss. ^{1, 2, 3, 4} In addition, differences between studies may be due to differences in the type of dairy product (yoghurt and milk), total Ca intake, or Ca source.A threshold for Ca intake of 600–800 mg / day has been proposed for beneficial effects on weight regulation. ¹ In addition, whether elemental Ca supplementation in combination with increased dairy intake is effective for weight loss in humans remains to be seen.

Certain milk proteins (whey and casein) may improve satiety by increasing circulating appetite-regulating hormones, including glucagon-like peptide-1 (GLP-1). ^{5, 6} A recent 6-month study found decreased desire to eat and hunger during weight loss when participants drank milk, ⁷ although the mechanism remains unclear as there was no change in ghrelin or leptin.Likewise, a single meal study found no effect of dairy on GLP-1, ghrelin, peptide tyrosine-tyrosine (PYY), and cholecystokinin. ⁸ Ca may affect energy intake, as shown in a 15-week study in which Ca plus vitamin D supplementation reduced spontaneous fat intake, although this effect was only observed in a small population with very low Ca intake. ⁹ In addition to regulating appetite, dairy and / or Ca products can affect metabolic health through the activation of genes associated with metabolism; ¹⁰ increased excretion of fat with feces; ¹¹ and mediating the inflammatory response. ¹²

As reviewed by Teegarden and Gunther, ² , the evidence to support the hypothesis that dairy and / or dietary Ca affects appetite control and food intake remains inconclusive. Our primary goal was to determine if a diet high in dairy and Ca, obtained from both dairy and Ca supplements, would improve weight loss and appetite regulation during energy restriction (-500 kcal / day ).Specifically, we examined plasma glucose-dependent insulinotropic polypeptide, GLP-1, ghrelin, leptin, and PYY concentrations, and subjective appetite scores in overweight and obese adults with metabolic syndrome. Glycemic, insulinemic and inflammatory cytokine responses have also been investigated.

Subjects and methods

items

Forty nine men and women (BMI 27–37 kg / m2 ² ), 20 to 60 years old with metabolic syndrome were recruited from Calgary, AB, Canada.A total of 23 were randomized to control and 26 to Dairy / Ca (Supplementary Figure 1). To identify metabolic syndrome, the recommendations of the National Group for the Education of Patients with Cholesterol III were used. ¹³ Exclusion criteria: type 1 diabetes; type 2 diabetes treated with oral hypoglycemic agents or insulin therapy; hemoglobin A1c> 8%; liver or pancreatic disease; major gastrointestinal operations; pregnancy or breastfeeding; cardiovascular diseases; alcohol or drug addiction; milk allergy or lactose intolerance; using a diet, supplement, or exercise regimen designed to help you lose weight; body weight> 159 kg; use of fibrate or statin; chronic use of laxatives, antacids, Ca or vitamin D; or high consumption of Ca.A registered dietitian assessed typical Ca intake using verbal feedback. All enrolled participants had low dairy and low Ca (<700 mg / day) ^7.9 at baseline. All participants gave written informed consent. Ethical approval has been granted by the Calgary Conjoint Medical Research Ethics Council. This study was registered with ClinicalTrials.gov (NCT00564551). Calculation of power with α 0.05 and power 0.80 showed that a minimum of 18 participants per group would be required.

intervention

Prior to the intervention, participants visited a landmark that used motivational interviewing to encourage adherence. ¹⁴ Instructions were provided regarding the use of the meal scale, meal plans, and three-day meal records. Participants were randomized (random number generator; stratified by BMI and sex) to control or milk / Ca and received an individual meal plan that prescribed an energy deficit of 500 kcal / day.The control meal plans included one serving of dairy products (skim or 1% milk or yogurt) with a total calcium content of 700 mg / day. Dairy / Ca meal plans prescribed 3-4 servings of dairy (low-fat or 1% milk or yogurt) and included a daily calcium supplement of 350 mg (Cal-Chews, Jamieson Laboratories Ltd, Windsor, Oklahoma, Canada) with total Ca 00 1400 mg / day

An initial three-day meal record was completed by participants prior to the first meal tolerance test (MTT) to obtain a baseline energy requirement assessment. ¹⁵ This estimate has been updated using Mifflin-St. Jora’s equation and the activity factor. ¹⁶ Individual diet plans were developed to achieve an energy deficit of 500 kcal / day and were based on the Canadian Healthy Diet Guidelines (~ 30% fat, 20% protein and 50% carbohydrate). The main carbohydrates were whole grains, vegetables, and fruits. During the study food intake was measured using 3-day meal records at 3, 6, 9 and 12 weeks. Diet Analysis Plus 8 software was used for the analysis.0 (Thomson Wadsworth, Toronto, ON, Canada).

Physical activity

Participants were instructed not to change their habits during the study. Exercise levels were quantified at baseline and at 12 weeks using Godin’s Leisure Score Index. ¹⁷

Physical characteristics

At the beginning and at 12 weeks, body composition was assessed using dual energy X-ray absorptiometry (DXA) (Hologic QDR 4500, Hologic, Inc., Bedford, Massachusetts, USA). Weight was measured using a balance bar scale at the start, at 3, 6, 9 and 12 weeks. Height, waist circumference and blood pressure were measured at the beginning and at 12 weeks.

MTT and blood sampling

At the beginning and at 12 weeks, a blood sample was collected in the morning after 12 hours of fasting. The participants then ate a standardized meal consisting of 50 g white bread, 50 g rye bread, 30 g cheddar cheese, 10 g butter, 20 g fruit jam, and 200 ml unsweetened orange juice (605 kcal; 56% carbohydrates, 11% protein, and 32% fat). ¹⁸ Postprandial blood samples were collected via an anti-abdominal vein cannula 30, 60, 90, 120 and 240 minutes after the first meal according to our previous protocol. ¹⁹

Plasma Analysis

Glucose was determined using Trinder assay (Stanbio Laboratory, Boerne, TX, USA). Concentrations of ghrelin (active), GLP-1 (active), glucose-dependent insulinotropic polypeptide (total), leptin, insulin, and PYY (total) were quantified using the Milliplex Human Intestinal Hormone Test Kit (Millipore, St Charles, MO, USA) …Concentrations of interleukin-1 beta (IL-1ß), IL-6, monocyte chemoattractant protein-1 (MCP-1), and tumor necrotic factor alpha were quantified using Milliplex human adipokine kits (Millipore). Calgary Laboratory Services (Calgary, AB, Canada) measured hemoglobin A1c.

Subjective appetite assessments

Subjective appetite sensations were assessed using 100 mm visual analog scales (VAS). 90,033 20 90,034 Weekly VASs were initially allocated to be filled by participants each week at home.Participants were asked to complete the VAS after meals, at the same time every week. In addition, each subject was asked to complete a VAS throughout the MTT. The questions took the form “How are you feeling?” or “How much do you think you can eat?” and were anchored “not completely” or “nothing at all” and “completely filled” or “a lot.”

statistical analysis

Data are presented as mean ± se and include only those who completed the test.Physiological indicators, food data and VAS data were analyzed using repeated measures ANOVA with Bonferroni correction (time (week 0 and week 12) and diet (control or dairy / Ca). Change from baseline was determined by subtracting the starting value from the end value and analyzing by analysis of variance Hormone and glucose concentrations during MTT were analyzed by two-way analysis of variance with repeated measures with Bonferroni correction (time (0-240 min) and diet) as variables or two-way analysis with week (0, 3, 6, 9, 12 weeks) and diet).The data were analyzed using the SPSS v. 17.0 (SPSS Inc, Chicago, IL, USA).

Results

Basic characteristics

90,016 Forty-nine people were enrolled, with 38 participants completing the study (Table 1). Reasons for dropout included pregnancy (n = 1), change in employment (n = 2), illness (n = 2), or personal (n = 6). There were no differences in baseline characteristics between groups (all: P> 0.05), with the exception of bone mineral density (P = 0.04; Table 1).Physical activity did not change during the study (P> 0.05).

Life-size table

Body Composition

Weight loss was -2.2 ± 0.5 kg and -3.3 ± 0.6 kg (P = 0.16) in the control and milk groups / Ca, respectively (table 1). The change in lean body mass (LBM) from 0 to 12 weeks was significantly different between groups (P = 0.03), with a slightly greater decrease in dairy / Ca content compared to controls (Table 1).Bone mineral content was significantly higher in Dairy / Ca compared to the control at week 12, and the change in bone mineral content showed a decrease in the control (-2.8 ± 9.6 g) and an increase (32.2 ± 12.9 d) in dairy products / Ca (P = 0.04; table 1).

Hormones of satiety and hunger

The change in total PYY area under the curve (tAUC) from baseline to week 12 was significantly greater for Dairy / Ca compared to control (P = 0.01; Figure 1a). During MTT, the change from baseline to week 12 was significantly greater for Dairy / Ca compared to controls at 0 minutes (P = 0.04), 30 minutes (P = 0.01), and 240 minutes (P = 0.01; Figure 1b).PYY, GLP-1, glucose-dependent insulinotropic polypeptide and ghrelin curves are shown in Supplementary Figure 2. At the end of the study, the change between GLP-1 concentration between baseline and 12 weeks at 240 min was significantly greater with Dairy / Ca (P = 0 , 02; Supplementary Figure 2B). There were no differences in leptin (Supplementary Figures 3A and D), although there was a positive correlation between adipose tissue and fasting leptin (r = 0.70, P <0.01) and total leptin area under the curve (r = 0.68, P <0.01).

Total delta area under the curve ( a ) and change from baseline for PYY in plasma ( b ) during 4-h MTT in participants taking control or dairy / Ca at week 0 and week 12. Values ​​represent are mean values ​​± se, n = 18 (control) and n = 20 (dairy / Ca). ○ Control, □ Dairy / Ca. * Differs from the control at the specified time, P <0.05.

Image at full size

Subjective appetite assessments

Dairy / Ca reported feeling “more satisfied” on weekly subjective appetite sensations (P = 0.01; Figure 2a).There was a significant relationship between the question of timing and diet (p = 0.03), and there was a significant relationship between the question “How comfortable do you feel?” where control felt less comfortable from baseline (63 ± 7 mm) to week 12 (45 ± 6 mm), and Dairy / Ca felt more comfortable at week 12 (59 ± 4 mm) compared to week 0 (50 ± 5 mm). At weeks 0 and 12, participants also performed VAS during MTT (Supplementary Chart 4), where ratings related to hunger, satisfaction, satiety, perceived consumption, and desire to eat something sweet, salty, or meat had a significant time effect. and fish (P <0.05).There were no dietary differences at week 12, although there was a trend (P = 0, 1) for greater completeness in Dairy / Ca compared to controls when scores were normalized for fasting scores.

Weekly subjective satisfaction rating ( a ) and regression analysis ( b ) showing the relationship between delta energy intake from week 0 to week 12 (kcal) and Ca (mg). In ( a) values ​​are mean ± se, n = 18 (control) and n = 20 (dairy / Ca).○ Control, □ Dairy / Ca. * Differs from the control at the specified time, P <0.05.B ( b ) regression is presented as R = 0.40, r ² = 0.16, df = 28, P = 0.027 .

Image at full size

Food consumption and feed efficiency

Energy consumption

Total energy consumption was significantly higher at baseline compared to weeks 3, 6, 9 and 12 (p <0.05; Table 2), but did not differ between groups.As expected, there was a decrease in daily energy intake throughout the study in both groups (Table 2; P <0.01). There was an effect of week (P <0.01) and diet (P <0.03) on fat intake. Both groups decreased their fat intake during the study, however, Dairy / Ca consumed less energy than fat compared to the control (P = 0.02). Expressed as a function of body weight, Dairy / Ca consumed less fat (0.58 ± 0.04 g / kg) compared to controls (0.78 ± 0.07 g / kg; P = 0.015).Using a self-reported reduction in energy intake, we calculated the percentage of expected weight loss achieved by subjects (observed weight loss / expected weight loss × 100). Dairy / Ca products achieved a higher percentage of expected weight loss (82.1 ± 19.4%) compared to controls (32.2 ± 7.7%; P = 0.03). The correlation between the percentage of expected weight loss and delta energy intake approached the value (r = 0.351; P = 0.086). Nutritional efficacy, classically measured as weight gain per unit of energy consumed in animal studies, ²¹ was similarly calculated in this study to record weight loss per unit of restricted energy intake.There was no significant difference (P = 0.35) between control (0.053 ± 0.012 g / kcal limited) and Dairy / Ca (0.100 ± 0.038 g / kcal limited).

Life-size table

Ca and vitamin D intake

Daily Ca intake during the study was significantly higher in Dairy / Ca compared to control (Table 2; P <0.001). Baseline dairy intake was similar between groups, but, as expected, was higher in Dairy / Ca compared to study controls.Vitamin D intakes at baseline and during the study were significantly higher for Dairy / Ca (P <0.05; Table 2). The relationship between delta energy intake from baseline to 12 weeks (kcal) and Ca intake (mg) was significant (R = 0.40, r ² = 0.16, df = 28, P = 0.027; Figure 2b). The value r ² implies that 16.3% of the variation in total energy consumption can be attributed to Ca consumption. There was no significant association between anthropometric parameters (LBM or body fat) and Ca intake (P> 0.05).

Glucose homeostasis and inflammation

The change in total glucose area under the curve from week 0 to week 12 was -111 ± 48.4 mmol / L 240 / min in Dairy / Ca and -23.3 ± 71.7 mmol / L 240 / min in the control, which did not differed (P> 0.05). No differences were found in fasting content or total area under the curve for insulin (Supplementary Figures 3C and F).

Fasting IL, tumor necrotic factor alpha, MCP-1 and IL-1 remained constant for 12 weeks (Supplementary Table 1).There was a significant decrease (P = 0.04) in baseline MCP-1 concentration after 30 minutes for Dairy / Ca (-18.7 ± 7.5 pg / ml) compared to control (4.6 ± 7.5 pg / ml) ).

discussion

A number of studies in humans and rodents have provided conflicting results regarding the role of dairy products and / or Ca in the regulation of body weight, appetite and glucose homeostasis. ¹ Our results show that, in the context of restricting energy intake, a diet rich in dairy and Ca produces a modest increase in plasma PYY concentration, an increase in subjective satisfaction scores, and a decrease in dietary fat intake, but does not accelerate weight loss compared to with a diet low in milk / calcium.

Participants consuming dairy / Ca products had weight loss that was similar in magnitude to control. This is consistent with data from Van Loan et al. ^{22 not} shows the difference in body weight or fat loss between diets low in milk or high in milk. Likewise, a recent meta-analysis found no differences in body weight changes between milk interventions and control groups. 90,033 3 However, 90,034, in subgroup analyzes, dairy products showed a decrease in body weight (-0.79 kg) in studies that impose energy restriction. ³ This is similar to the meta-analysis by Abargouei et al. ^4, who found no overall difference in the effect of dairy products on body weight, but found significant reductions in body weight and fat mass in the energy restricted subgroup. Although weight loss was not different in our study, the modest signs of improved appetite regulation with dairy products may have clinical implications. In the context of weight management for consumers, products that counter the physiological effects of energy restriction and the feelings of deprivation that accompany restriction are significant targets. ²³

In contrast to the decrease observed in controls, Dairy / Ca resulted in a moderate increase in PYY concentration during energy restriction. Attenuated PYY concentrations and blunted nutritional responses have been reported in obesity; ^24, whereas the administration of systemic PYY _{3-36 at a dose of 100-200 mcg / kg} reduced the motivation to seek high-fat food in a rodent relapse model. ²⁵ In addition, although PYY levels increase after Roux-en-Y gastric bypass surgery, weight loss caused by low-fat or low-carbohydrate energy restriction has been shown to reduce serum PYY levels.Although weight loss was not different in this study, it is possible that the modest increase in PYY levels and the spontaneous decrease in dietary fat intake seen with Dairy / Ca may help prevent the relapse of an inappropriate high-fat diet. ²⁵

Linear regression analysis shows that Ca intake (reflecting both dairy products and Ca supplements) was associated with changes in energy intake over 12 weeks.In contrast, there was no correlation between Ca intake and body mass index or body mass. This ratio suggests that participants who consumed more Ca also consumed more energy, but did not gain weight relative to the increased energy. This finding is consistent with Barr et al. [ ^28] who found that in older adults, those who drank three cups of milk a day did not gain the weight predicted on the basis of additional energy intake. We investigated this phenomenon by calculating the percentage of expected weight loss achieved by our patients.We acknowledge the limitations that self-evident reductions in energy consumption put into our calculations, but the percentage of expected weight loss achieved by Dairy / Ca was 2.5 times higher than in the control (82.1 vs. 32.2%). We also calculated a modified version of the feed efficiency. Despite the fact that they were double in numerical terms, we did not see a significant difference between Dairy / Ca (weight loss 0.100 ± 0.038 g / kcal limited) and control (weight loss 0.053 ± 0.012 g / kcal is limited).Calculation of feed efficiency in the traditional sense Thomas et al. ²¹ showed significantly lower feeding efficiency (weight gain mg / kJ consumed) in obese mice caused by diet fed skimmed milk powder (2, 3 ± 0, 1) compared to control (3, 5 ± 0, 1 ) and only high in Ca (3, 8 ± 0, 1), Explanation of the altered “efficacy” of diets rich in dairy and calcium may include increased excretion of fat in the faeces, increased fat oxidation ²⁹ , release of parathyroid hormone, suppression of circulating calcitriol ³² or potentially increased PYY concentration.

In ob / ob mice, Pittner et al. ³³ demonstrated that a 4-week pharmacological infusion of PYY reduced body weight gain without a concomitant decrease in total energy intake. Likewise, in humans, subcutaneous injections of PYY _3-36 produce a lipolytic effect. ³⁴ It is important, however, to determine whether physiological concentrations of PYY affect energy homeostasis. To this end, it has been shown that postprandial peak PYY concentrations are negatively associated with respiratory rate within 24 hours, and fasting PYY is negatively correlated with resting metabolic rate. ³⁵ Although it was not possible to establish a causal relationship in this study, the findings indicate the potential for increased fat oxidation at higher levels of endogenous PYY. ³⁵ In mice receiving a subcutaneous infusion of 1 mg / kg PYY _3-36 , it was similarly shown that respiration rate decreased during the dark cycle, although the effect was temporary.

When appetite was assessed subjectively, 12-week intervention scores were improved with Dairy / Ca.In particular, according to the weekly VAS, Dairy / Ca reported feeling more satisfied. Recently Gilbert et al. 90,033 7 90,034 showed that milk supplementation was associated with lower increases in craving and hunger during weight loss. The Ca-specific effect on appetite appears to be less pronounced given that only a small subgroup of subjects (n = 7 out of 63) with very low baseline Ca intake showed a spontaneous decrease in fat intake with Ca and Vitamin D supplementation. ⁹

Our results for LBM and inflammatory markers are in conflict with some, but not all, studies. With regard to LBM, several studies have shown a protective effect with high dairy content, ^{36, 37, at} while others have shown no difference. ²² A high proportion of BCAAs in milk proteins, in particular leucine, are thought to play a role in the regulation of muscle protein synthesis ³⁸ and help reduce LBM loss during energy restriction.Although no benefit was observed in our study for retention of LBM, an increase in bone mineral content in the Dairy / Ca group should be noted when compared to the slight decrease seen in controls. Weight loss due to energy restriction is a risk factor for rapid bone loss. ³⁹

With regard to inflammation, previous work by Zemel et al. In cages, rodents and humans. ^{40, 41} shows a decrease in inflammatory cytokines with an increase in dairy products.In particular, reductions in tumor necrotic factor alpha, IL6, and MCP-1 were observed in participants with metabolic syndrome who ate a diet high or low in dairy products. ⁴⁰ We did not observe any changes in IL6, tumor necrotic factor alpha or IL1ß, and MCP-1 only decreased in Dairy / Ca after 30 minutes during the final MTT. The difference in results may be related to the composition of the control diet in the two studies (Stancliffe et al. ⁴⁰ control diet consisted of prepackaged foods, some of which contained trans fatty acids) or significant weight loss. For example, in control mice with high Ca or high non-fat dry milk, diet-related differences in most inflammatory marker mRNA levels disappeared when body weight was included in the covariate. ²¹ The idea that weight loss stimulates the anti-inflammatory effects of dairy / Ca products is interesting in light of a study by Van Loan et al. ^22, which, like us, found no difference in body weight or differences in circulating cytokines.

Our study complements others designed to investigate high or low dietary Ca / Ca in the diet in free-living adults. We recognize that dietary Ca is not the same as dairy and we tested a portfolio style diet similar in principle to the diet developed by Jenkins et al. for cardiovascular diseases. ⁴² We have combined two biologically active food ingredients to maximize efficacy and to accommodate the assumptions that at the population level elemental Ca may be required, either as a supplement or fortified food, to achieve target Ca intake. ^{43, 44} Our research is limited in that we did not measure energy expenditure and fecal fat loss, and both of these would provide valuable information given the discrepancy we saw between energy intake and estimated weight loss.

In conclusion, a diet rich in dairy and Ca did not affect weight loss during the 12-week energy restriction period. However, Dairy / Ca produced a modest increase in circulating PYY in response to standardized food intake and was associated with reduced dietary fat intake and increased feelings of satisfaction.Given the demonstration that energy-restricted diets can reduce PYY levels ^27, Dairy / Ca’s ability to prevent this decline and cause moderate increases in PYY levels may be important in appetite regulation during weight loss. While the ability of Dairy / Ca to enhance weight loss during energy restriction is not supported by this study, the higher percentage of weight loss expected is intriguing and warrants further study of the effect of dairy / Ca on energy.

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Popular fast weight loss diets

Lean diet
Estimated potency: minus 4 kg per week.

The diet is designed for seven days, each of which is very strictly scheduled. The first is a liter of milk. The second – 500 g of cottage cheese and 800 ml of sugar-free juice (except for grape and banana). The third is fruit and a liter of still mineral water. The fourth – a dozen potatoes boiled in their skins and more juice.The fifth is one and a half kilograms of apples. Sixth – a pound of lean beef and juice. Seventh – only two liters of kefir.
Nutritionist’s opinion: Diet with a sharp restriction of calories. The average calorie content of the day is 750 – 800 kcal. This diet requires strong motivation. Dizziness, various autonomic disorders may occur. To reduce the risk of side effects, an additional intake of multivitamin complexes is recommended. It is advisable to carry out the diet under the supervision of a physician.
Kefir-buckwheat diet
Estimated effectiveness: minus 7-12 kg in one to two weeks.

In this case, buckwheat is not boiled, but only brewed: it is poured with boiling water at the rate of one and a half glasses of water per glass of cereal, well wrapped and left overnight. During the day, you can eat it as much as you like – without seasoning with spices, salt and sauces. And plus to drink a liter of 1% kefir. Between meals, it is allowed to add a couple of unsweetened fruits, cabbage salad, herbs, a spoonful of honey – so as not to break loose.And drink water, green or herbal tea in unlimited quantities (at least 1 liter per day).
Nutritionist’s opinion: A diet with limited fat, with a moderate reduction in calories. By adhering to this diet, you can maintain regular workouts, but reduce their intensity relative to the usual by 30%. It is difficult to sustain such a diet for a long time. Also, a deficiency of fat-soluble vitamins develops, stagnation in the gallbladder, osteoporosis, and other metabolic disorders.
Ten Day Protein Diet
Estimated potency: minus 10 kg, plus stronger muscles.

The very name of the diet suggests that it allows proteins, and in any quantity. Including fatty meat, sausage, bacon, eggs. And prohibits carbohydrates, and not only flour and sweet, but also any bread, absolutely all cereals, fruits and even some vegetables: carrots, potatoes, corn, beets. You can’t neither kefir with yoghurts, nor shrimp with squid, nor liver, nor nuts … From the little that is left, you can plan your diet for every day: the combination of products and the size of portions are entirely at your discretion.
M Nutritionist’s advice: Diet with restriction of carbohydrates. More suitable for people under 30. There may be rapid weight loss, especially in the first week. However, it is very difficult to adhere to this diet for a long time, while maintaining an active lifestyle and work activity. There is a high risk of headaches, irritability, anxiety, depression, mood disorders, sleep disorders, high blood pressure, constipation, or stool disorder.

Martin Katana Roller Coaster
Estimated Efficiency: With 40 minutes of fitness per day, 8–9 kg per week.

Designed for three weeks, each with only calories prescribed. Based on what you decide what you will eat on each specific day. The first three days of the first week, you need to keep within 600 kcal per day, the next four – 900 kcal. For the entire second week, we consume 1200 kcal daily. And on the third, we return to the first scheme.
Nutritionist’s opinion: A low-calorie diet option, respectively, the disadvantages are the same. The efficiency of this method is higher, i.e.because changes in nutrition are combined with the implementation of daily physical activity.

Dairy and Salad Diet
Estimated effectiveness: minus 5 kg per week.

Everything is extremely simple: you alternate the “milk” day and the “salad” day. In “milk” you can eat 500 g of low-fat cottage cheese and drink 1 liter of kefir. And in salad dressing – consume fruits and vegetables in any quantity and, as an option, in the form of salads, which can be seasoned with olive or vegetable oil (conditionally salad day).
Nutritionist’s opinion: This is an alternation of two classic fasting days during the week. However, it is more rational to spend a fasting day no more than once or twice a week. The most commonly used days are carbohydrate or protein days. Carrying out fasting days in a row for a long time will lead to loss of muscle mass, and as a result, to poor health, weakness. If this method of weight loss suits you most, then be sure to take multivitamins in parallel, physical activity must be reduced.

Japanese Diet
Estimated Potency: Up to 8 kg in 13 days.

The menu for this diet is very detailed for all 13 days. For breakfast, almost always – a cup of coffee with or without a crouton. Lunches and dinners are quite varied and involve portions of meat, boiled or fried fish, seasoned with raw and boiled vegetables, kefir, eggs, tomato juice. You can drink unlimited water between meals. Sugar and alcohol, flour and confectionery products are strictly prohibited.All dishes are cooked and eaten without salt, otherwise, as the authors of the diet say, it simply will not work. The result of the “Japanese woman” lasts for two or three years.
Nutritionist’s opinion: If you follow this diet for a long time, you can achieve solid results. But the problem is that it is very difficult to maintain the achieved result. You may experience constant hunger, dry skin, hair loss, and a disturbance in the digestive tract.

Pitfalls and Cons of Express Diets

• Weight is lost mainly due to water and returns quickly after completing the diet.
• Only very obese people seriously lose weight, but not those who weigh 65–70 kg.
• It is after express diets, including protein diets, that the skin sags most of all.
• They affect the gastrointestinal tract, liver and kidneys.
• Because of them, the metabolism slows down, it becomes more difficult to lose weight in the future.

Professional opinion Anna Nikitova, therapist, nutritionist, exercise therapy and sports medicine doctor, head of the “Rehabilitation fitness” division of the FizCult Sport club:
So, despite the variety of diets, it is very difficult to opt for any one, because.because each of them has many restrictions on the set of foods and diet. Also, they all have quite tangible disadvantages: their main drawback is that they are designed for short-term use, and therefore for a short-term result. The achieved weight is not maintained.
I believe – and my personal experience confirms this – that it is IMPOSSIBLE to achieve reliable long-term results with the help of ingenious diets.
In order to lose weight, you need to completely change your lifestyle.Losing weight is a whole complex of interrelated measures and rules that must be followed every day.
My overweight program is an integrated approach that allows a person to safely and comfortably change their habitual stereotype of nutrition and physical activity.
90,000 Effect of iron and erythropoietin treatment on A1C in patients with diabetes and chronic kidney disease

The Effect of Iron and Erythropoietin Treatment on the A1C of Patients With Diabetes and Chronic Kidney Disease
Source: https: // www.ncbi.nlm.nih.gov/pmc/articles/PMC2963485/

To study the effect of intravenous iron and erythropoietin stimulating agents (ESA) on glycemic control and A1C in patients with diabetes and chronic kidney disease (CKD).

This was a prospective study of patients with type 2 diabetes and stage III or IV CKD who received intravenous iron (group A) and / or ESA (group B). During the study period, complete blood profiles were determined.Glycemic control was monitored using one-time glucose seven days a week as well as continuous glucose monitoring (CGM).

There were 15 patients in both group A and group B. A1C values ​​(95% CI) decreased in both groups (7.40% [6.60-8.19] to 6.96% [6.27- 7.25], P

Both iron and ESA cause significant decreases in A1C values ​​without altering glycemic control in patients with diabetes and CKD. Currently, regular capillary glucose measurements and concomitant use of CGM remain the best alternative measures of glycemic control in this patient population.

A1C is the most widely used and used method for assessing chronic glycemia in patients with diabetes. It is formed by the irreversible binding of glucose to hemoglobin during the life of an erythrocyte (1,2).

Patients with chronic kidney disease (CKD) are usually anemic for a variety of reasons, including functional or absolute iron deficiency and erythropoietin deficiency (3,4). Treatment of anemia in patients with CKD using iron replacement therapy and erythropoietin-stimulating agents (ESAs) has led to a significant improvement in the quality of life and correction of anemia without the need for blood transfusion (3-5).

There are several studies (6-9) showing a decrease in A1C in patients treated with ESA and iron. These studies are mainly in patients who have already received hemodialysis and patients without diabetes. It was assumed that the effect of decreasing A1C values ​​after any treatment is secondary to the formation of new red blood cells in the bloodstream, causing a change in the proportion from young to old cells, as well as from a change in the rate of glycation in the red cell (10, 11).

Despite this, a comprehensive analysis of the relationship between glycemic control and A1C changes in patients receiving both iron and ESA therapy has never been performed using reliable methods such as seven-point daily capillary glucose monitoring (7PGM) or the use of CGM devices. …Thus, any class effect that iron and ESA therapy may have on A1C values ​​could in fact represent a parallel change in glycemic control along with the current postulated physiological changes. In addition, the effect of the drop in A1C after these two therapies has not been well studied in patients who are not yet on hemodialysis.

This study therefore sought to establish how intravenous iron and ESA affect A1C values ​​in patients with type 2 diabetes and CKD, rather than hemodialysis.Vigorous blood glucose monitoring was performed throughout the study period to determine if the expected drop in A1C is a true reflection of glycemic control.

This was a prospective study of patients with type 2 diabetes and CKD stage IIIB or IV (assessment of glomerular filtration rate [Diet modification for renal failure] 15-44 ml / min per 1.73 m2), selected for treatment with intravenous iron and / or ESA from January 2009 to December 2009 inclusive.All patients attended one renal service in which the decision to initiate iron and ESA treatment was made by the attending physician.

The study consisted of two groups. The first group (group A) were patients selected for iron treatment according to clinical need, and the second group (group B) consisted of patients who were those who needed ESA treatment. Glycemic control in both patient groups was assessed during the month prior to treatment and again within a 4-week period 4 months after therapy.These assessments included measurement of A1C, seven-point glucose profiling (7PGM) three times a week, and CGM for at least 48 hours. Below is a more detailed account of the study methodology and patients.

All patients recruited for iron treatment had either absolute or functional iron deficiency as evidenced by serum ferritin values

All patients receiving ESA therapy had hemoglobin ≤10.5 g / dL and were considered iron, vitamin B12, and folate before initiation.Patients were considered iron-specific after serum ferritin values> 200 μg / L or received intravenous iron at least 6 weeks prior to ESA treatment. ESA treatment was given in the form of darbepoetin α at 750 ng / kg every two weeks and continued throughout the study period. The ESA dose was titrated monthly to achieve a target hemoglobin of 10.5-12 g / dL.

Patients with known hemoglobinopathy, with a history of blood transfusion or bleeding in the last 6 months, who were previously treated with ESA with renal replacement or with a previous transplant, were excluded from the study.

Patients in Groups A and B were equipped with an Abbott Freestyle Freedom Lite glucose sensor (Abbott Diagnostics, Maidenhead, U.K.). Patients were asked to perform 7 MPGs three times a week 1 month before starting treatment until the end of the study. 7PGM was defined as preliminary, 90 minutes postmortem and preliminary capillary glucose.

CGM was performed using a Medtronic CGMS Ipro continuous glucose recorder (Medtronic Minimed, Northridge, CA). Using this system, interstitial glucose levels were measured 228 times over a 24-hour period.The cavitation of the CGM readings was done based on the patient’s 7PGM over a similar period of time. All patients underwent CGM within 2-4 days. This was done before ESA and iron treatment and again at the end of the study.

7PGM and CGM results were downloaded from their respective counters for data analysis. CGM results included at least a successful 24-hour profile over a monitoring period with no gaps> 120 minutes. Diabetes control management was provided to patients and their healthcare professional.Glycemic control treatment was monitored throughout the study period.

Blood was collected from all patients for A1C and complete blood profile. All A1C measurements were performed using ion exchange chromatography using a Menarini HA-8160 A1C analyzer (A. Menarini, Berkshire, U.K.). It has been shown that there is no interference between carbamylated hemoglobin (present in uremia) and A1C using this analyzer (12). Patients in groups A and B had samples taken 1 month before starting therapy and again 4 months after starting treatment.

All data were tabulated using Microsoft Excel and statistical analyzes were performed using SPSS 16.0 using paired t-tests where appropriate.

Mean blood glucose (MBG) before and after treatment was calculated by taking the mean of the mean daily glucose values, where there were three more capillary glucose readings per day. Because glucose values ​​were measured more frequently over CGM periods, the results were weighted to ensure that each measurement was proportional to the reciprocal of the total number of measurements taken on the same day as in the study from the A1C study resulting from the mean glucose ( 13).

Data from previous studies were used to calculate the statistical power required to understand that iron previously had a stronger effect on A1C than ESA (6,14). Assuming the intra-subject change in A1C is Gaussian (15), nine patients should have found a 1.2% decrease in A1C in group A and 13 patients to find a 1.0% decrease in group B with 80% power. to α P

Fifteen patients (9 men, six women, all Caucasians, mean age 72 years [IQR 68-74], median albumin-creatinine ratio 6.3 [4.3-76.3]) agreed to participate in this study. Six patients controlled their diet and nine patients required insulin. The follow-up period was (mean ± SD) 16.4 ± 3.7 weeks.

This group included 15 patients (11 men, 4 women, all Caucasian, mean age 70 years [IQR 62-75], median albumin-creatinine ratio 9.3 [IQR 6.0-93.4]). Four patients were on diet, four on oral hypoglycemic agents, and seven on insulin. The duration of observation in this group was 17.3 ± 3.3 weeks.No patient received additional oral or intravenous iron therapy during the study period after starting ESA treatment.

No new therapies affecting glycemic control (eg, oral hypoglycemic agents, steroids, β-blockers) were initiated or modified during the study period in all patients.

CGM and 7PGM data included ~ 1,300 and 250 measurements per subject, respectively, for a total of 150,000 glucose tests throughout the study period.Using the 7PGM results, there is an average of 4.7 readings per day, of which 31% of the 7-point profiles were completed. The median CGM days were 6. The CGM results were retrospectively calibrated with 7PGM readings taken over the same period. MBG in both groups did not change over the study period. Their results are shown in Tables 1 and 2.

Patients on iron therapy

* Paired test t.

Patients on ESA

* Paired test t.

Despite the absence of changes in glycemic control in both groups, A1C concentrations decreased significantly (P

In the ESA patient group, there were seven patients (5 men, two women, mean age 72 years [IQR 62-79]) who received ESA treatment after iron treatment and eight patients (six men and two women, mean age 69 [61-74]), which only ESA received.All patients who also received iron received treatment for at least 6 weeks before starting ESA therapy.

Apparently, there was a slight trend towards ESA, which led to a further decrease in A1C after the initial fall due to iron (mean A1C value 7.3-6.9%, P = 0.36 after iron and 6.9-6 , 7%, P = 0.13 after ESA). In contrast, the group of patients receiving ESA therapy without iron decreased significantly in A1C from 7.3 to 6.5% (P = 0.02).

MBG has not changed in any of the groups (9.12 versus 9.21 mmol / L, P = 0.47 for ESA and iron versus 8.21 versus 8.26 mmol / L, P = 0.71 for ESA only), and there was a simultaneous increase in hemoglobin (9.6- 11.76 g / dl, P

ESA and intravenous iron are commonly used in the treatment of anemia in patients with CKD. Patients with diabetes and CKD have a higher prevalence of severe anemia compared to patients with CKD (16-18 years). Despite an increase in the use of ESA agents, recent data have shown that correcting anemia to hemoglobin levels greater than 12.5 g / dL in type 2 diabetic patients using this therapy did not result in an improvement in mortality, but rather in an increased risk of stroke.This must be carefully interpreted as the two groups received disproportionate amounts of intravenous iron. Indeed, in the placebo group, it was noted that there was an increase in hemoglobin levels with ESA agents. Therefore, best practice suggests that correction of functional and absolute iron deficiency should be obtained prior to initiating ESA (19). This is the first study to conclusively show that treatment with iron and ESA results in a drop in A1C that is independent of glycemic changes in patients with diabetes and stage IIIb and IV CKD.

Previous studies and case reports of nondiabetic patients with iron deficiency (10,11,20,21) and patients with type 1 diabetes in childhood and childhood (22) reported discordantly high A1C values ​​compared to glucose readings in previous studies and case reports. Correction of iron deficiency in all of these patient groups resulted in lower A1C values ​​in these patients, although monitoring of glycemic control in patients was not as robust compared to our study (using techniques such as fasting plasma glucose or two pre-readings per day). ).

Several studies have also shown a decrease in A1C concentration after ESA treatment in diabetic patients undergoing hemodialysis (7,8). Apart from one case report (23), there were insufficient data to support the class effect of this therapy in non-hemodialysis patients.

Nakao et al. (7) reported a drop in A1C in patients with nondiabetic infection with CKD on hemodialysis after ESA treatment. Compared to our results, the 1.2% drop in their study was much larger.A plausible explanation is that, in contrast to our study, iron therapy was given concurrently, which likely potentiated the A1C-lowering effect. In some patients in our study, both methods of treatment were used, and although this group showed a similar tendency for a combined decrease in A1C, this did not reach statistical significance.

Good glycemic control in patients with diabetes and CKD has been shown to be associated with better survival (24). Therefore, proper assessment of glycemic control is vital if this is achieved.Our study results show both statistically and clinically significant drops in A1C after iron and ESA treatment (mean 0.4% after iron and 0.7% after ESA) in the absence of altered glycemic control.

From a practical standpoint, the findings from this study highlight several issues with which diabetes management can be improved in patients with diabetes and CKD. This indicates that A1C may be unreliable and may fall after treatment with both iron and ESA therapy.It is very important that healthcare professionals are aware of the potential A1C fluctuations that may occur in this patient population. Alternative methods for measuring glycemic control, such as capillary glucose testing and CGM, should be used, and therapy should not be based on A1C alone. This is of particular relevance when considering glycemic targets in national, international, or health care services, such as the US quality and outcome framework, which almost exclusively uses A1C as the only metric by which treatment success is measured.

Glycidal albumin has been proposed as an alternative marker for representing glycemic control as it was noted to be similar (as opposed to A1C, which was higher) in patients with iron deficiency and pre-ESA compared with patients after therapy (8,20) … While this may be true, further research is still required, and it is even better that a better correlation between glycated albumin and glycemic control be used more widely.

The strengths of this study lie in the reliable management of glycemic control in patients.7PGM and CGMS were used in all patients, and glycemic control, treatment, and A1C values ​​were carefully monitored. However, this study is limited to its relatively small numbers, and while it was able to show that A1C values ​​fall with both iron and ESA, there was not enough to confirm whether the combined effect of both therapies had an additional A1C lowering effect compared to with one agent provided by one.

Intravenous iron and ESA are increasingly common treatments for anemia in patients with CKD and diabetes.The present study confirmed that the reported changes in A1C after these treatments were indeed independent of changes in glycemic control; therefore, care should be taken when interpreting A1C and managing glycemia based on this measurement alone. At a time when self-monitoring of blood glucose is discouraged, especially in non-insulin-treated patients (25), regular capillary glucose measurements and concomitant use of CGM, if available, seem essential to accurately assess glycemic control in this patient population.

Clinical trials reg. no. ISRCTN52414847, www.isrctn.org.

The cost of publishing this article was covered in part by fees per page. Therefore, this clause must refer to “advertising” pursuant to 18 U.S.C. Section 1734 is solely to indicate this fact.

No potential conflicts of interest were reported pertaining to this article.

J.M.N. participated in the design of the study, researched and analyzed the data, and wrote the draft manuscript.He also works at the Michael White Research Center and at Hull York Medical School, Hull. The entertainer was responsible for research and discussion of research results. S. B. also participated in assisting with conceptualization and discussion of research findings, and reviewed the final manuscript. They both work for the Kidney Department at Hull Royal Infirmary, Hull, USA, and work for the Hull and East Yorkshire National Health Service Trust. E.S.K. and S.L.A. participated in the design of the study.They analyzed the data, rewrote the manuscript, and contributed to the discussion. E.S.K. works in the Department of Clinical Biochemistry and works for the Hull and East Yorkshire National Health Service Trust. S.L.A. works at the Michael White Research Center and works at Hull York Medical School.

Portions of this study were presented at the 46th Annual Meeting of the European Association for the Study of Diabetes, Stockholm, Sweden, 20-24 September 2010.

90,000 Most Effective Weight Loss Diets: Diet at Home

The most effective diet for fast weight loss: a selection of the best systems and techniques with descriptions, rules, advantages, possible difficulties and contraindications.

The most effective diet for weight loss at home

Deciding to lose weight, women revise their diet. There are two options: to balance the diet and exercise regimen, and bring the weight back to normal in the mode of minus 0.5-2 kg per week, or lose weight quickly on one of the extreme, but effective diets. Which option do you like best? Many girls choose quick ways to lose weight, because they really want to see results in a few days!

However, fast effective diets have a downside: the results are short-term.The pounds lost through starvation are returned as quickly as they left. In addition, extreme weight loss methods are almost disposable. They help you lose weight one or two times. But over time, they stop working. This is due to the fact that periods of acute calorie deficit are stressful for the body, and gradually it “learns” to resist it. Therefore, more and more girls do not prefer extreme methods of weight loss, but a healthy balanced diet that guarantees long-term results.

But sometimes you still need to lose weight quickly: before sports competitions, special dates or events. The list of requirements for some professions indicates the norms of weight, and if you are knocked out of the standard, only a quick and effective diet can solve the problem. We have collected the most popular diet plans to help you lose 5-10 extra pounds. But use reasonable care! Severe dietary restrictions can have side effects.

TOP-5 of the most effective diets

The easiest and fastest way to lose a few pounds at home is mono-diets.They have several disadvantages: the monotony of dishes, causing a deficiency of vitamins and minerals, the rapid return of lost kilograms, the need to consult a doctor. And yet they are among the most effective express weight loss diets.

Kim Protasova

Suitable for those who love vegetables and can easily do without meat. The diet, compiled by Protasov, is designed for 5 weeks. It is built on raw vegetables with a small addition of fermented milk products.The menu looks something like this:

• breakfast: unsweetened coffee, low-fat yogurt, apple;
• second breakfast: cucumbers with homemade cheese;
• lunch: tea, apple, salad with grated cheese;
• afternoon snack: carrots, lettuce, apple;
• dinner: boiled egg, tomatoes with herbs and kefir.

Diet for the lazy

Sometimes there is no time for cooking and complex recipes. The good news is that there are effective, no-culinary diets.The main principle of the “lazy” diet: before meals you need to drink 2 glasses of clean warm water. Necessarily only warm! The bottom line is simple: warm water will extinguish the feeling of hunger, at the same time, preventing overeating.

As part of this method to quickly reduce weight, you need to eat three times a day, there are practically no restrictions on products. Although it is better to refuse sweets, fatty and fried foods, as well as alcohol and carbonated drinks.

Buckwheat

With this mono diet, you can lose up to 10 kg per week.However, buckwheat porridge should not be boiled, but steamed. Because of this, it becomes not so tasty, but it helps to reduce weight. First, rinse the cereals, pour boiling water and wait until the grains swell completely. This takes a long time, so you need to steam the porridge in 12 hours. It is best to do this in the evening. Add a little salt, spices, a spoonful of soy sauce to buckwheat.

Divide the resulting amount of cereal into 5 meals and eat during the day. The last meal should take place no later than 5 hours before bedtime.Drink a glass of water half an hour before meals. You can also drink unsweetened green tea. But you should not abuse this effective diet, otherwise you risk “earning” diseases of the gastrointestinal tract.

Ducan’s Diet

This is a protein diet that is based on an almost complete rejection of carbohydrates. Pierre Dukan assured that you can eat like that all the time, diversifying the menu. And yet, the diet created by Dukan is not suitable for everyone, but only for those who need to lose 10 kg or more, and who are ready to wait a month or longer for results.

The transition to a carbohydrate-free diet takes place in several stages. First, you completely skip carbohydrates, replacing them with protein. Then alternate between vegetables and protein to stabilize your weight. Then you can introduce carbohydrates into the diet a little, but their share should still not exceed 10% of the total number of products.

The simplest diet

Mono-diets are not suitable for everyone: it can be difficult to sustain them due to the monotony of the diet, a sharp reduction in the amount of carbohydrates, the need to search for special foods.But there are ways to lose weight without a lot of difficult cooking conditions.

Our Best Diets

Kefir diet

One of the most popular options for emergency weight loss is the kefir mono diet. It is not easy to withstand it, but there are no difficulties with planning a diet and a meal schedule. The bottom line is that you drink 1.5 liters of kefir per day, even if it is fatty, and that’s it. So you can lose up to 5 kg per week. However, it is impossible to sit on one kefir for more than 3-5 days, otherwise the body will begin to suffer from exhaustion.

Fast weight loss regimen

Severe food restriction is effective in the short term. Therefore, sitting down on one kefir or buckwheat porridge, you need to be prepared for the fact that the lost kilograms will quickly return. But you can rebuild your own diet so as to reduce weight and fix it at the same level, plus or minus 2 kg. To do this, you should eat fractionally: not in large portions three times a day, but in small doses 5 times. You will also have to give up all high-calorie foods:

• carbonated sweet drinks;
• alcohol;
• desserts;
• fried and baked potatoes;
• fatty red meat;
• sausages and sausages;
• cereals, instant breakfasts;
• fast food;
• muffins and other baked goods made from white wheat flour.

The basis of the diet should be fresh vegetables and fruits, lean fish and white meat, cereals with the exception of white rice. It is helpful to keep a food diary, taking into account all meals, even the smallest ones. You should also calculate the daily calorie intake for your weight and lifestyle, subtract 300-500 units from it, and adhere to exactly this calorie content.

Effective ways to lose weight

In addition to the listed methods of emergency weight loss, there are others.

Diet for 5 days effective

“Ladder” – a method of losing weight by 3-8 kg in 5 days. It relies on five steps of nutrition, equal to 5 days of the week:

1. Cleansing Day: Fasting with regular drinking of pure water.
2. Recovery: you can eat fermented milk products.
3. Energetic: you need to please the body with glucose with the help of raisins, honey and other natural products.
4. Building: at this stage we eat protein.
5. Fat-burning: you need fiber, which saturates and satisfies the feeling of hunger.

The Most Effective Weekly Diet

The easiest way to reduce weight in a week is with a diet of one buckwheat porridge and kefir. Yes, it turns out monotonously, but you lose up to 5 kg. Buckwheat should be cooked in the same way as for the buckwheat method: steamed, not boiled. We drink up to 1.5 liters of low-fat kefir per day.

Effective 10-Day Diet

The essence of the super diet for weight loss: you can eat only one product in an amount of up to 1 kg per day.Weight loss lasts up to 10 days, so you can reduce about 8 kg. However, doctors warn that although this method helps to reduce weight, it is not safe for health. Therefore, at the first sign of malaise, you need to see a doctor. And to avoid getting sick, stick to these principles:

• choose natural products;
• Eliminate fatty, sweet, smoked, red meat, alcohol from the diet;
• Create a meal schedule and stick to it;
• Reduce the amount of salt you consume with food.

Food options that work for this weight loss method are boiled potatoes, fresh cabbage, boiled beets, and raw carrots. Fresh cucumbers, apples and boiled rice are also recommended. You can arrange “kefir” and “milk” days.

You can also try a vegetarian diet. This is a safer option, but you will lose up to 3 kg. The essence of the method is to eat only vegetables and fruits, refusal from all other dishes, including cheese, eggs and milk.

Diet for 2 weeks effective

For fourteen a bit, you can try an extreme way to lose weight, which consists in almost completely refusing to eat. You need to eat very little healthy food so that you don’t feel full. You will be constantly hungry, you will lose the main kilograms in the first week of fasting, then the rate of weight loss will slow down.

However, this diet is not suitable, to put it mildly, for everyone.Fasting is stressful for the body, and two weeks of undernourishment has a host of side effects. Therefore, we recommend a less radical way to normalize body weight: the already familiar diet of one product for one day. It can be stretched for 14 days, the main thing is not to forget to drink up to 2 liters of water a day and alternate foods.

Diet effective for losing weight for a month: product menu

The BeFit service offers a ready-made weekly diet and a menu of healthy products that help to normalize weight.We have developed a balanced and tasty food, you will not only lose weight, but also enjoy healthy and delicious food. The result will be better if you combine a healthy diet with exercise.

The most effective weight loss diets

There are three types of ways to reduce body weight: harsh, cleansing and gentle. We advise, unless absolutely necessary, not to resort to harsh methods, because they have many side effects. But if you need to lose weight urgently, you can try this option: a complete rejection of high-calorie foods and the transition to a low-calorie diet.The maximum calorie content of the daily diet is 1300 calories. To avoid the constant feeling of hunger, you need to divide the food into 7-8 meals.

A more gentle option: the cleansing method, which consists in avoiding animal products, as well as fried, fatty and smoked foods. They should be replaced with vegetables, fruits, grains, low-fat dairy products. But even in this case, it is important to eat in small portions 5 times a day.

A sparing diet is the easiest to endure, it is designed for weight loss within a month.There are no strict restrictions, but high-calorie foods, fast food, desserts, baked goods, sugary and carbonated drinks should be completely eliminated. We also refuse fatty, fried, smoked. Instead, we eat black and yeast-free bread, slightly stale unsweetened buns, butter, celery, milk, vegetables and fruits. You can also eat grains, legumes, lean meats, and fish. We drink green tea, kefir, fruit juices. But not from packs, but squeezed out with your own hands!

Secrets of an easy diet

To lose weight, it’s important to stay motivated: keep your goal in mind.Also try to make this period enjoyable: do not isolate yourself, communicate, walk in the fresh air, play sports. Do not forget to drink at least 2 liters of pure mineral water per day, eat in small portions, and then the dietary diet will be easier to perceive.

Reviews and results of those who lost weight

Many girls have tried the diet from BeFit. Their experience confirms: the transition to a balanced diet is a direct road to a fit, beautiful figure!

Reviews of doctors and specialists

Doctors remind: the rate of weight loss, safe for health, is 0.5-1 kg per week.You can lose weight by 2 kg per week without consequences for the internal organs, but a faster pace is stress for the body. It does not pass without a trace, resulting in endocrinological disorders and diseases of the gastrointestinal tract. Plus, being addicted to strict diets can be trapped in an eating disorder. It can be expressed both in compulsive overeating, and in the fear of eating something harmful.

Therefore, doctors advise not to starve, but to balance your diet so that the body receives all the necessary nutrients.If you want to lose weight, the calorie deficit should be light. Research has shown that it is safe to cut your diet by no more than 25% of your current serving.

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