Does drinking alcohol raise or lower blood sugar? The latest nutritional therapy guide will answer all your questions

Endocrinologists often hear complaints like this from diabetic patients. For example, the types of food they can eat are restricted after being diagnosed with diabetes, it is difficult to plan their daily meals, and they are unclear about their daily energy supply.

Similarly, even though endocrinologists are well aware that medical nutritional therapy is the basis of comprehensive treatment of diabetes and is an indispensable measure for prevention and control at any stage of the diabetes course, and that the focus of implementation is to adjust the supply of energy and nutrients, in actual clinical work, doctors still face difficulties in personalized treatment of diabetic patients.

The "Guidelines for Medical Nutritional Therapy of Diabetes in China (2022 Edition)" released this year describes the impact of nutrition-related factors on diabetes, helping clinicians solve the problems of medical nutritional therapy.

1. Energy

Question 1: What is the appropriate energy range for diabetic patients?

Individualized energy balance plans should be designed for patients with diabetes to achieve or maintain an ideal body weight while meeting nutritional needs in different situations (B, strong recommendation). The daily energy supply for adult patients with diabetes is shown in Table 1.

Table 1 Daily energy intake for diabetic adults [kJ/kg (kcal/kg)]

Note: According to the evaluation standard of body mass index (BMI) proposed by my country, BMI≤18.5 kg/m2 is underweight, 18.5 kg/m2<BMI<24.0 kg/m2 is normal weight, 24.0 kg/m2≤BMI<28.0 kg/m2 is overweight, and BMI≥28.0 kg/m2 is obese.

Question 2: Do low-calorie/very-low-calorie diets help manage blood sugar in people with diabetes?

1. In the short term (<1 year), a low-calorie diet can help manage weight and blood sugar in overweight/obese patients with diabetes (A, strong recommendation).

2. In the short term, a very low-energy diet can help improve indicators such as glycated hemoglobin, insulin resistance, and body weight in diabetic patients (C, weak recommendation), but patients may develop complications such as hypoglycemia. It is not recommended to follow a very low-energy diet for a long time (C, strong recommendation).

Question 3: What are the effects of intermittent energy restriction/continuous energy restriction on glucose and lipid metabolism and body weight in patients with diabetes?

Both intermittent energy restriction and continuous energy restriction are beneficial for blood sugar and weight management in overweight/obese diabetic patients. Intermittent energy restriction is more advantageous than continuous energy restriction in weight management (B, weak recommendation).

2. Carbohydrates

Question 4: What effect does the amount of carbohydrate intake have on blood sugar control, insulin levels and risk factors for complications?

The daily carbohydrate energy supply ratio for diabetic patients should be 45% to 60% (B, strong recommendation). A carbohydrate-restricted diet is beneficial to blood sugar control in diabetic patients in the short term (within 1 year) and can slightly improve triglyceride and high-density lipoprotein cholesterol levels, but no long-term benefits have been found (B, weak recommendation). It is not recommended for patients with type 1 diabetes to choose a very low-carbohydrate diet (C, strong recommendation).

Question 5: Does carbohydrates from different food sources have any effect on controlling blood sugar, insulin levels, and complications and their risk factors?

Replacing some refined grains with whole-grain carbohydrates is beneficial for the control of blood sugar, triglycerides, and body weight (B, strong recommendation).

Question 6: What effect does the content and source of dietary fiber (not supplemented or added) have on blood sugar control and complications?

A high-fiber diet (25-36 g/d or 12-14 g/1000 kcal), especially ensuring soluble dietary fiber intake (10-20 g/d), helps control blood sugar in diabetic patients and reduce all-cause mortality (B, strong recommendation).

Question 7: What effects do specific carbohydrates (sucrose, fructose) have on controlling blood sugar and insulin levels, etc.?

It is not recommended for patients to routinely add sucrose. Isoenergetic replacement/increase of part of the carbohydrates in the diet with sucrose (30-50 g) does not affect blood sugar control or insulin sensitivity (C, weak recommendation); isoenergetic replacement of carbohydrates with high doses of added fructose > 50 g has the risk of increasing triglycerides (C, weak recommendation).

3. Fat

Question 8: What is the recommended daily intake of total dietary fat and various fatty acids for diabetic patients?

It is recommended that total dietary fat energy supply account for 20% to 35% of total energy. The quality of fat is more important than the proportion, and the intake of saturated fatty acids and trans fatty acids is limited. It is recommended that the intake of saturated fatty acids should not exceed 12% of total energy, and trans fatty acids should not exceed 2%. Polyunsaturated and monounsaturated fatty acids should be appropriately increased to replace some saturated fatty acids (B, strong recommendation).

Question 9: Do people with diabetes need to limit their cholesterol intake?

The cholesterol intake of diabetic patients should not exceed 300 mg/d (B, weak recommendation).

Question 10: Is supplementation with omega-3 polyunsaturated fatty acids beneficial for patients with diabetes?

Supplementation with omega-3 polyunsaturated fatty acids helps lower triglyceride levels in patients with diabetes, but the effect on glycemic control is unclear (B, strong recommendation).

4. Protein

Question 11: What is the proportion of protein intake to total energy intake for diabetic patients with normal renal function? Does increasing protein intake help control blood lipids and blood sugar?

Protein intake should account for 15% to 20% of total energy for diabetic patients with normal renal function (B, strong recommendation). A short-term high-protein diet can help improve the body weight, blood lipids and blood sugar of overweight and obese diabetic patients (B, weak recommendation).

Question 12: What effects do whey protein and soy protein have on blood sugar and weight in diabetic patients?

Whey protein helps promote insulin secretion, improve sugar metabolism, maintain muscle content, and is more helpful in controlling weight in the short term (D, weak recommendation). Plant-based protein, especially soy protein, is more helpful in lowering blood lipid levels than animal protein (D, weak recommendation).

5. Vitamins and trace elements

Question 13: What effects does vitamin E supplementation have on diabetic patients?

Vitamin E supplementation may be beneficial for diabetic patients with Hp2-2 genotype, but its safety and long-term efficacy need to be studied (D, weak recommendation).

Question 14: What effects does folic acid supplementation have on diabetic patients?

Folic acid supplementation may be beneficial for blood glucose homeostasis and reduce insulin resistance (C, weak recommendation).

Question 15: What are the effects of vitamin D supplementation for people with prediabetes and diabetes?

There is no evidence that vitamin D supplementation in people with diabetes or prediabetes can delay the onset of diabetes or lower blood sugar (C, weak recommendation). In certain circumstances, high-dose vitamin D supplementation can slightly lower blood sugar, but routine vitamin D supplementation for the purpose of lowering blood sugar is not recommended (B, strong recommendation).

Question 16: What effect does combined multivitamin and mineral supplementation have on diabetic patients?

Combined supplementation of multivitamins and minerals may be beneficial to the blood sugar and lipid metabolism in patients with diabetes and obesity, but its effectiveness still needs further study (C, weak recommendation).

Question 17: Is chromium supplementation beneficial for diabetes?

Chromium deficiency may be related to the occurrence of diabetes, but there is no consistent evidence that regular chromium supplementation is beneficial for blood sugar and blood lipid control in diabetic patients (C, weak recommendation).

6. Sweeteners

Question 18: What effects do nutritive sweeteners have on blood sugar control, insulin, etc.?

Short-term intake of small doses of fructose sweeteners or allulose in adult diabetic patients does not increase postprandial blood glucose (D, weak recommendation). In diabetic patients with blood glucose control reaching the target, replacing glucose with xylitol has no significant effect on 2-hour postprandial blood glucose (C, weak recommendation).

Question 19: What effects do non-nutritive sweeteners have on blood sugar control, insulin, and body weight?

Non-nutritive sweeteners such as stevioside, sucralose, aspartame, and saccharin have no significant effect on glycated hemoglobin and body mass index in patients with diabetes (B, weak recommendation).

7. Alcohol

Question 20: What effects do alcohol and alcoholic beverages have on blood sugar control?

Alcohol is not beneficial for blood sugar control in diabetic patients, but drinking alcohol increases the risk of hypoglycemia in diabetic patients. Alcohol consumption is not recommended for diabetic patients (B, strong recommendation).

8. Phytochemicals

Question 21: What effect does phytochemical polyphenols have on blood sugar regulation in diabetic patients?

Phytochemical polyphenols may be beneficial for the prevention and treatment of diabetes and its complications (D, weak recommendation), and proanthocyanidins may be beneficial for blood sugar control (B, weak recommendation).

Question 22: What effects do soy isoflavones have on inflammation and complications in diabetic patients?

Soy isoflavones may be beneficial to blood sugar and blood lipids in male diabetic patients, and soy intake is negatively correlated with the risk of diabetes (D, weak recommendation).

References: Nutrition and Metabolic Management Branch of China Medical Health International Exchange Promotion Association, Clinical Nutrition Branch of Chinese Nutrition Society, Diabetes Branch of Chinese Medical Association, etc. Chinese Guidelines for Medical Nutritional Treatment of Diabetes (2022 Edition) [J]. Chinese Journal of Diabetes, 2022, 14 (9): 881-933.

Arrangement: Fu Yujie