Abstract
Among the dietary recommendations which have been called into doubt recently as universally valid are: levels of cholesterol and saturated fats to be kept as low as possible, fructose as the proper sweetener for diabetics, 5-6 meals per day, the necessity of a second dinner and the necessity of carbohydrates (44-60% of the overall energy intake) in a diabetic's diet. Dietary cholesterol has a minimal influence on blood cholesterol, which why limiting its intake is disappearing from dietary recommendations.
A larger content of saturated fats in the diet can lead to an elevated level of blood lipids, but their negative impact on cardiovascular morbidity and mortality has not been proved. From the recent Prospective Urban Rural Epidemiology (PURE) study (Lancet, 2017) we can, to the contrary, conclude that a higher intake of saturated fats is associated with a lower risk of overall mortality and lower risk of stroke, while a higher carbohydrate intake is associated with a greater overall mortality.
Fructose has a low glycaemic index, but its higher consumption is associated with a risk of liver steatosis and insulin resistance. For obese patients and type 2 diabetics on a reduction regimen it is more efficient to consume a lower number of larger meals than a higher number of smaller meals.
Very early breakfast is not suitable for patients with a polymorphic melatonin receptor gene (MTNR1B), which is present is almost a third of the population. In type 1 diabetics treated with basal analogues, the second dinner is usually a source of higher glycaemia before sleeping and unless there is physical activity involved, it should be skipped or covered for by fast-acting insulin.
A correctly set up low-carbohydrate diet is one of the options for a safe dietary treatment of type land type 2 diabetics.