Better diet against diabetes

 ‘There is no single optimal diet to prevent or treat diabetes. Many roads lead to Rome’, says Edith Feskens, a professor with the Nutrition and Health department. The Diabetes Fund recently stated it expects over 1.4 million diabetes patients in the Netherlands in twenty years, compared to the current number of 1.1 million.

Diet plays an essential part in treating diabetes types 1 and 2. A healthy eating pattern can also help prevent diabetes type 2, also known as late-onset diabetes. ‘With late-onset diabetes, a healthy diet and lifestyle can make the use of medication redundant’, Feskens says.

What diet works best depends, among other things, on the individual’s risk factors—for example, genetic predisposition, hypertension, a high cholesterol level or increased body weight. A relatively little-known diet called “DASH” appears to benefit people with hypertension. Feskens: ‘This diet consists of lots of vegetables and fruits, quite some dairy, which contains magnesium and calcium, and grains that contain potassium. The diet contains very little salt.’

The best advice that applies universally is still: stick to the food pyramid. Thus, eat lots of vegetables, fruits and fibres such as wholewheat grains. Don’t snack too much and beware of sugars and sweetened beverages, which includes fruit juices. Besides, it is essential to get sufficient exercise. ‘And, if you need to lose a substantial amount of weight, you may wish to follow a diet that restricts your calorie and carbohydrate intake for some weeks’, Feskens adds.

Personal preferences play a crucial role, Feskens stresses. ‘People will adhere to nutrition guidelines more easily if they are motivated.’ It is thus essential that recommendations are aligned with the individual’s lifestyle and personal preferences. ‘Many studies show that a Mediterranean diet with plenty of vegetables and fish and limited meat is beneficial. But not everyone likes olive oil.’

A healthy choice is often also a sustainable choice. ‘Following a vegetarian diet is no problem if you have diabetes. People are sometimes worried, but their concern is unfounded. Research shows that people who eat a lot of red meats such as beef, pork and lamb, as well as processed meat such as sausage, have an elevated risk of getting type 2 diabetes.’

Eating less meat also benefits the climate and environment, Feskens says. ‘Some people may be extra motivated to follow a specific diabetes diet if they are aware of the consequences their eating behaviour has in climate or animal welfare.’

Feskens and her colleagues at Human Nutrition in Wageningen conduct a great deal of research on the role of food in diabetes. Based on the most recent insights, they formulate recommendations for diabetes in collaboration with the Dutch Diabetes Federation. These guidelines aim to help health care professionals such as dieticians, health care practitioners and diabetes care specialists to provide unambiguous recommendations. ‘Some of these professionals completed their training years ago, while insights have changed. There are instances where a dietician recommends one approach, while the nurse recommends something different. This may confuse patients, which is why it is important to have a clear directive.’

The guidelines that have been released are very comprehensive and scientific. The most recent studies and meta-analyses that span multiple studies have been included, Feskens says. ‘The guidelines are not very concrete yet. We aim to further develop these with decision-making tools so that dieticians are provided with precise tools. Researcher Van Damme is involved in this further effort.'

Feskens began her research on nutrition and diabetes over three decades ago. Since then, there has been a significant shift in the research. ‘When I started out, we focussed on particular foodstuffs such as saturated fat and fibres. However, people don’t consume saturated fat, but, rather, meat, which also contains iron, or dairy, which is a source of calcium. Key is that people must eat a combination of healthy products and maintain a healthy diet to ensure they get enough nutrients on a daily basis.’

If the food contains a high number of calories, or energy, per gramme, this increases the risk of weight gain. The best approach is to eat food with a high nutritional density: food that contains many nutrients, Feskens stresses. ‘This applies universally, not just to prevent diabetes.’

Another development is that there is increased attention for personal healthcare, such as tailored advice from a dietician. Previously, patients suffering from type 1 diabetes who had to inject insulin, all followed the same diet prescribed by a physician. ‘There, too, we see a shift towards individual guidelines.’ Feskens notes that it is not yet possible to provide personal guidelines based on blood sugar levels or intestinal bacteria. ‘However, much is already known about the general prevention of diabetes.’