In DIABETES – Endocrine Hotspots February 2018 Edition

In Diabetes
Over the years, several diet programs have had their share of the limelight such as the Atkins, South Beach, and Paleo diets for weight loss. Recently, two diet programs have received attention: the ketogenic diet and intermittent fasting.


Any diet approach can lower fasting blood sugar and HbA1c (your 3-month average blood sugar) compared to no diet at all. Low-carbohydrate or ketogenic diets are the most effective in lowering HbA1c, followed by the Mediterranean diet. For lower fasting blood sugar, the Mediterranean diet is ranked as the most effective. There are very limited studies on intermittent fasting in patients with diabetes. One study suggested improvement in self-monitoring blood sugar levels, but it was only a small, short-term study.

Lowering of carbohydrate content in your diet did not result in a larger weight loss compared to other diets. Intermittent fasting also did not result in a larger weight loss. At the end of the day, if you eat less calories than your usual food intake, then you will lose weight.

In patients with diabetes, hypoglycemia or low blood sugar is always a concern. Symptoms of hypoglycemia include weakness, cold sweats, palpitations, tremors, or in severe cases, loss of consciousness. Remember that you are taking medications designed to lower your blood sugar. Carbohydrates are broken down to sugar in the body for use as fuel. Reducing carbohydrate intake may result in lower blood sugar for your body to use as fuel. Intermittent fasting may also produce symptoms of hypoglycemia due to prolonged periods of no food intake. Your medications for diabetes may need to be adjusted if you are considering doing these diet programs. Make it a point to consult your doctor prior to starting any of these diet programs.

It is very hard for the scientific community to study which diet will truly work best for you. There are a lot of things that we need to take into consideration when it comes to diet. Food intake varies across cultures. The amount and type of carbohydrates are also different. The most common carbohydrate in the Philippines is rice. In other countries, it is bread. There are also differences in food preparation. Another word of caution, there is still not enough evidence that these diet programs will work in the long run. For those who want to try it, they can do so but only for a short time (less than 1 year) and with proper doctor or dietician supervision.

When it comes to diet programs, there is no “one-size-fits-all”. Even if a diet program is hugely popular, it does not mean that it is a good fit for you. Some programs are called fad diets because their popularity may rise and fall. Diet trends may change. Talk with your doctor and nutritionist to discuss a meal plan that is tailored for you, and takes into account your other illnesses and health goals.

Eat less if you want to lose weight. There is still no optimal macronutrient composition with regards to diet. Low-carbohydrate versus low-fat diet has been the subject of debate for years. Whatever the breakdown is, at the end of the day you have to eat less than what you are used to.

Lifestyle modification is a way of life. It is not a short-term or an intermittent thing. Think of healthy diet and exercise as an additional maintenance pill. If you don’t do it every day, you do not get the full benefit. Making healthy food choices should be a way of life. Lifestyle modification is an essential pillar not just for obesity or diabetes but many other diseases as well, making it a valuable tool for good health.


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What is PCEDM?

The PCEDM is a sub-specialty society of the Philippine College of Physicians, a founding member of the ASEAN Federation of Endocrine Societies, and a member of the International Society of Endocrinology.

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