RSS-Feed abonnieren
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.4103/2321-0656.140902
The role of celebrity diets versus medical nutrition therapy in type 2 diabetes
Corresponding Author
Publikationsverlauf
Publikationsdatum:
21. November 2018 (online)
- Abstract
- Introduction
- Celebrity Diets
- What is the Impact of Celebrity Diets?
- What is the Impact of Celebrity Diets in T2DM?
- Clinically Effective Sustainable Weight Loss
- Medical Nutrition Therapy (MNT) for Type 2 Diabetes
- Conclusion
- References
Abstract
With global obesity affecting 475 million people worldwide, the continued popularity of celebrity or fad diets is not surprising. Evidence for their sustainability and long-term positive benefits on weight loss and cardiometabolic risk is, however, limited. Modest weight loss of 5-10% in overweight or obesity is associated with improvements in blood lipids, glycemia, and insulin resistance. As overweight and obesity are the main risk factors for Type 2 diabetes (T2DM), medical nutrition therapy based on a balanced, reduced total energy diet, tailored to the individual, is recommended by the American Diabetes Association, Diabetes UK and transcultural diabetes-specific nutrition algrorithm (tDNA) guidelines.
#
Introduction
Nutrition guidelines worldwide promote diet and lifestyle management as the cornerstone of Type 2 Diabetes (T2DM) prevention and treatment.[1] Knowing which diet to follow, however, is confused by the abundance of “diet” advice fed to the general public by the media. This review discusses “celebrity” or “fad” diets and their impact on society in general and more specifically in T2DM, and questions whether there is a requirement for a special diet for treatment of T2DM.
#
Celebrity Diets
Celebrity or fad diets are by no means a new phenomenon. Indeed Carl Malmberg devoted a whole book to them in 1935 including chapters on the “Hollywood Diet” where devotees could expect to consume 22 whole grapefruit with Melba toast over an 18-day period and the “Rocine Eliminative Beauty Diet” where followers fasted for 10 days on lettuce alone or naturopath Dr Rocine′s own mysterious New Life Compound dissolved in water.[2] The 1930s also saw the publication of Woodyatt′s paper on dietary trends in diabetes.[3] In addition to reviewing nineteenth century diabetes “cures” based on consumption of milk or potatoes and an early twentieth century oatmeal cure, Woodyatt discusses the potential positive and negative effects of different ratios of macronutrients in the treatment of diabetes while suggesting that a level of undernutrition supports “the preservation of natural carbohydrate tolerance”.
Each year, the UK British Dietetic Association produces a top five of worst celebrity diets to avoid and in 2014, these included the “Breatharian”, “Biotyping”, “Gluten-Free”, “Alcorexia” and “Dukan” Diets.[4] One of the better known commercial diets, favored by celebrities and promoted in the media, is the Atkins Diet with book sales exceeding 45 million.[5]
#
What is the Impact of Celebrity Diets?
With numbers of obese and overweight adults globally estimated at 475 million and 1 billion respectively and latest available data indicating adult obesity levels of 35.9% in the USA and 24.8% in England, the vast number of commercially available miracle diets advertised in the media is hardly surprising.[6] [7] The factor that most celebrity diets have in common is their restrictive nature whether by restricting carbohydates (CHO) in favor of fat or protein (Atkins, Dukan), food calories for alcohol (Alcorexia), foods containing gluten (Gluten-Free), defined foods based on dieter′s blood group (Biotyping) or all forms of nutrition (Breatharian). When calories consumed equal energy expended from a combination of basal metabolic rate (BMR), thermic effect (energy required to absorb and digest food) and physical activity, weight is maintained (energy balance). Therefore, any diet that promotes negative energy balance by means of energy restriction will, over time, result in weight loss irrespective of macronutrient composition. Side effects, however, may include lack of energy (Alcorexia, Atkins, Dukan), liver disease, and other alcohol-related illness (Alcorexia), constipation and bad breath (Atkins, Dukan) or, in the most extreme restrictive diet, dehydration, malnutrition, and ultimately death (Breatharian). Restrictive diets which cut out food groups may also necessitate vitamin and mineral supplementation (Atkins, Dukan, Biotyping).[4] [8]
Evidence to establish long-term safety and efficacy of fad diets is limited although two independent randomized controlled trials (RCTs) found that healthy obese subjects following a low-CHO/high-protein/high-fat diet (such as the Atkins) lost more weight in the short term than their counterparts who followed a high-CHO/low-fat (conventional) weight loss diet although weight loss at 1 year was similar.[9] [10]
#
What is the Impact of Celebrity Diets in T2DM?
Over 312 million people worldwide have T2DM.[11] Overweight and obesity are the main predisposing factors for T2DM and modest weight loss may improve hypertension, blood glucose and/or blood lipid control.[12] Evidence, however, to support use of celebrity diets in T2DM is minimal.
A 2-year RCT (n = 419) found no difference in post-prandial glycemia or weight loss in T2DM patients who followed a high-protein (such as the Atkins) or high-carbohydrate diet although participants in the high-protein group found adherence to the diet difficult.[13]
While limited duration studies have demonstrated improved hemoglobin A1c (HbA1c) and reduced requirements for oral hyperglycemic medication in T2DM patients who followed a very-low-CHO ketosis inducing diet, this was not reflected in a longer term RCT which found no significant improvement in HbA1c in the low-CHO (Atkins) or high-CHO-low-fat (conventional weight loss) study arms after 1 year.[13] [14]
The UK Nutrition Society advise patients with diabetes or pre-existing kidney disease to exercise caution with high-protein diets, whereas Diabetes UK highlight the lack of evidence for long-term safety and efficacy of low-CHO diets (Atkins, Dukan) while warning of the increased risk of hypoglycemia.[15] [16]
#
Clinically Effective Sustainable Weight Loss
Celebrity diets generally lure dieters with a promise of rapid weight loss resulting in unrealistic expectation and yo-yo dieting.[17] [18] Government guidelines for overweight/obesity commonly recommend adopting diet and exercise “lifestyle changes” with a more sustainable goal of 5-10% weight loss.[19] [20]
A recently published 24-month weight loss RCT (n = 442 middle-aged obese women) found that weight loss ≥10% from baseline (but not ≤10%) was associated with significant reductions in cardiometabolic risk with improvements in triglycerides, glucose, insulin, and insulin resistance together with improved cardiopulmonary fitness.[21]
#
Medical Nutrition Therapy (MNT) for Type 2 Diabetes
Evidence-based T2DM nutrition guidelines from the American Diabetes Association (ADA), Diabetes UK and the more recently published transcultural diabetes-specific nutrition algorithm (tDNA), recommend sustainable weight loss in overweight and obesity to improve glycemic control and reduce diabetes-associated risk.[22] [23] [24] The various guidelines agree that weight loss should be achieved by reducing total energy intake while following a healthy, balanced diet and exercise program. While ADA and Diabetes UK adopt a flexible approach to overall macronutrient composition, the tDNA follows a more structured methodology based on 2008 ADA guidelines and recommends use of diabetes-specific formulas as part of a weight loss meal plan.[25] All the guidelines concur that nutrition therapy should be tailored to take into account individual risk factors, personal and cultural beliefs, patient lifestyle, and willingness to make changes.
#
Conclusion
While the long-term efficacy and safety of celebrity diets is disputable, weight loss of 5-10% in overweight or obese adults is associated with improvements in cardiometabolic health and glycemic control. Health-care professionals should familiarize themselves with local and national guidelines for healthy eating and MNT enabling them to provide tailored diet and lifestyle advice to their T2DM patients that is effective and sustainable. Ideally patients should be referred to a dietitian specializing in diabetes for individualized nutrition advice.
How to cite this article: Scrivens SD. The role of celebrity diets versus medical nutrition therapy in type 2 diabetes. J Soc Health Diabetes 2015;3:61-3.
Source of Support: Nil.
#
#
Conflict of Interest
None declared.
-
References
- 1 Clinical Guidelines Taskforce. Global Guidelines for Type 2 Diabetes. Brussels: International Diabetes Federation; 2012
- 2 ODSAA - One Damn System after Another. In: Malmberg C. editor Diet and Die?. New York: Hillman-Curl Inc; 1935: 88-95 Available from: http://babel.hathitrust.org/cgi/pt?id=coo.31924003489162;view=1up;seq=1 [Last accessed on 2014 Feb 05].
- 3 Woodyatt RT. Round table conference on diabetes mellitus: Dietary trends. Bull N Y Acad Med 1934; 10: 335-346 Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1965642/pdf/bullnyacadmed00881-0007.pdf [Last accessed on 2014 Feb 27].
- 4 BDA News. Top 5 worst celebrity diets to avoid in 2014. Birmingham: British Dietetic Association; 2013
- 5 Astrup A, Meinert LarsenT, Harper A. Atkins and other low-carbohydrate diets: Hoax or an effective tool for weight loss?. Lancet 2004; 364: 897-899
- 6 International Association for the Study of Obesity [Internet]. London: International Association for the Study of Obesity; Available from: http://www.iaso.org/resources/aboutobesity/ [Last accessed on 2014 Feb 19].
- 7 Obesity Knowledge and Intelligence Team [Internet]. London:: Public Health England; Available from: http://www.noo.org.uk/NOO_about_obesity/adult_obesity/international [Last accessed on 2014 Feb 19].
- 8 Atkins.com [Internet]. Denver: Atkins Nutritionals Inc. c2014; Available from: http://www.atkins.com/Science/Articles—Library/Vitamins—Minerals/Don%E2%80%99t-Forget-to-Take-Your-Supplements.aspx [Last accessed on 2014 Feb 20].
- 9 Foster GD, Wyatt HR, Hill JO, McGuckin BG, Brill C, Mohammed BS. et al. A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med 2003; 348: 2082-2090
- 10 Stern L, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J. et al. The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: One-year follow-up of a randomized trial. Ann Intern Med 2004; 140: 778-785
- 11 World Health Organization. Diabetes Fact Sheet No 312. Geneva: WHO; 2013
- 12 American Diabetes Association. Standards of medical care in diabetes-2014. Diabetes Care 2014; 37: S14-S80
- 13 Krebs JD, Parry-Strong A. Is there an optimal diet for patients with type 2 diabetes?. Yes, the one that works for them!. Br J Diabetes Vasc Dis 2013; 13: 60-66
- 14 Davis NJ, Tomuta N, Schechter C, Isasi CR, Segal-Isaacson CJ, Stein D. et al. Comparative study of the effects of a 1-year dietary intervention of a low-carbohydrate diet versus a low-fat diet on weight and glycaemic control in type 2 diabetes. Diabetes Care 2009; 32: 1147-1152
- 15 Johnstone AM. Safety and efficacy of high-protein diets for weight loss. Proc Nutr Soc 2012; 71: 339-449
- 16 Diabetes UK [Internet]. London: Diabetes UK. c2012; Available from: https://www.diabetes.org.uk/About_us/What-we-say/Food-nutrition-lifestyle/Low-carbohydrate-diets-for-people-with-Type-2-diabetes/ [Last accessed on 2014 Feb 20].
- 17 Frost GD, Wadden TA, Vogt RA, Brewer G. What is a reasonable weight loss. Patients′ expectations and evaluations of obesity treatment outcomes?. J Consult Clin Psych 1997; 65: 79-85
- 18 Olson EA, Visek AJ, McDonnell KA, DiPietro L. Thinness expectations and weight cycling in a sample of middle-aged adults. Eat Behav 2012; 13: 142-145
- 19 NHS Choices [Internet]. London: The Department of Health; Available from: http://www.nhs.uk/Livewell/loseweight/Pages/start-losing-weight.aspx [Last accessed on 2014 Feb 25].
- 20 Centers for Disease Control and Prevention [Internet]. Washington DC: U. S. Department of Health and Social Services; Available from: http://m.cdc.gov/en/HealthSafetyTopics/HealthyLiving/HealthyWeight/LosingWeight/Introduction [Last accessed on 2014 Feb 25].
- 21 Dow CA, Thomson CA, Flatt SW, Sherwood NE, Pakiz B, Rock CL. Predictors of improvement in cardiometabolic risk factors with weight loss in women. J Am Heart Assoc 2013; 2: e000152
- 22 Evert AB, Boucher JL, Cypress M, Dunbar SA, Franz MJ, Mayer-Davis EJ. et al. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care 2014; 37: S120-43
- 23 Diabetes UK. Evidence-based nutrition guidelines for the prevention and management of diabetes. London: Diabetes UK; 2011
- 24 Mechanick JI, Marchetti AE, Apovian C, Benchimol AK, Bisschop PH, Bolio-Galvis A. et al. Diabetes-specific nutrition algorithm: A transcultural program to optimize diabetes and prediabetes care. Curr Diab Rep 2012; 12: 180-194
- 25 American Diabetes Association. Standards of medical care in diabetes - 2009. Diabetes Care 2009; 32: S13-S61
Corresponding Author
-
References
- 1 Clinical Guidelines Taskforce. Global Guidelines for Type 2 Diabetes. Brussels: International Diabetes Federation; 2012
- 2 ODSAA - One Damn System after Another. In: Malmberg C. editor Diet and Die?. New York: Hillman-Curl Inc; 1935: 88-95 Available from: http://babel.hathitrust.org/cgi/pt?id=coo.31924003489162;view=1up;seq=1 [Last accessed on 2014 Feb 05].
- 3 Woodyatt RT. Round table conference on diabetes mellitus: Dietary trends. Bull N Y Acad Med 1934; 10: 335-346 Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1965642/pdf/bullnyacadmed00881-0007.pdf [Last accessed on 2014 Feb 27].
- 4 BDA News. Top 5 worst celebrity diets to avoid in 2014. Birmingham: British Dietetic Association; 2013
- 5 Astrup A, Meinert LarsenT, Harper A. Atkins and other low-carbohydrate diets: Hoax or an effective tool for weight loss?. Lancet 2004; 364: 897-899
- 6 International Association for the Study of Obesity [Internet]. London: International Association for the Study of Obesity; Available from: http://www.iaso.org/resources/aboutobesity/ [Last accessed on 2014 Feb 19].
- 7 Obesity Knowledge and Intelligence Team [Internet]. London:: Public Health England; Available from: http://www.noo.org.uk/NOO_about_obesity/adult_obesity/international [Last accessed on 2014 Feb 19].
- 8 Atkins.com [Internet]. Denver: Atkins Nutritionals Inc. c2014; Available from: http://www.atkins.com/Science/Articles—Library/Vitamins—Minerals/Don%E2%80%99t-Forget-to-Take-Your-Supplements.aspx [Last accessed on 2014 Feb 20].
- 9 Foster GD, Wyatt HR, Hill JO, McGuckin BG, Brill C, Mohammed BS. et al. A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med 2003; 348: 2082-2090
- 10 Stern L, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J. et al. The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: One-year follow-up of a randomized trial. Ann Intern Med 2004; 140: 778-785
- 11 World Health Organization. Diabetes Fact Sheet No 312. Geneva: WHO; 2013
- 12 American Diabetes Association. Standards of medical care in diabetes-2014. Diabetes Care 2014; 37: S14-S80
- 13 Krebs JD, Parry-Strong A. Is there an optimal diet for patients with type 2 diabetes?. Yes, the one that works for them!. Br J Diabetes Vasc Dis 2013; 13: 60-66
- 14 Davis NJ, Tomuta N, Schechter C, Isasi CR, Segal-Isaacson CJ, Stein D. et al. Comparative study of the effects of a 1-year dietary intervention of a low-carbohydrate diet versus a low-fat diet on weight and glycaemic control in type 2 diabetes. Diabetes Care 2009; 32: 1147-1152
- 15 Johnstone AM. Safety and efficacy of high-protein diets for weight loss. Proc Nutr Soc 2012; 71: 339-449
- 16 Diabetes UK [Internet]. London: Diabetes UK. c2012; Available from: https://www.diabetes.org.uk/About_us/What-we-say/Food-nutrition-lifestyle/Low-carbohydrate-diets-for-people-with-Type-2-diabetes/ [Last accessed on 2014 Feb 20].
- 17 Frost GD, Wadden TA, Vogt RA, Brewer G. What is a reasonable weight loss. Patients′ expectations and evaluations of obesity treatment outcomes?. J Consult Clin Psych 1997; 65: 79-85
- 18 Olson EA, Visek AJ, McDonnell KA, DiPietro L. Thinness expectations and weight cycling in a sample of middle-aged adults. Eat Behav 2012; 13: 142-145
- 19 NHS Choices [Internet]. London: The Department of Health; Available from: http://www.nhs.uk/Livewell/loseweight/Pages/start-losing-weight.aspx [Last accessed on 2014 Feb 25].
- 20 Centers for Disease Control and Prevention [Internet]. Washington DC: U. S. Department of Health and Social Services; Available from: http://m.cdc.gov/en/HealthSafetyTopics/HealthyLiving/HealthyWeight/LosingWeight/Introduction [Last accessed on 2014 Feb 25].
- 21 Dow CA, Thomson CA, Flatt SW, Sherwood NE, Pakiz B, Rock CL. Predictors of improvement in cardiometabolic risk factors with weight loss in women. J Am Heart Assoc 2013; 2: e000152
- 22 Evert AB, Boucher JL, Cypress M, Dunbar SA, Franz MJ, Mayer-Davis EJ. et al. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care 2014; 37: S120-43
- 23 Diabetes UK. Evidence-based nutrition guidelines for the prevention and management of diabetes. London: Diabetes UK; 2011
- 24 Mechanick JI, Marchetti AE, Apovian C, Benchimol AK, Bisschop PH, Bolio-Galvis A. et al. Diabetes-specific nutrition algorithm: A transcultural program to optimize diabetes and prediabetes care. Curr Diab Rep 2012; 12: 180-194
- 25 American Diabetes Association. Standards of medical care in diabetes - 2009. Diabetes Care 2009; 32: S13-S61