The Nutrition Debate #288: Type 2 Diabetics: 10% Protein “May Not Be Enough”

This Medscape Multispecialty piece headline (Anne Harding from Reuters Health Information) was actually, “10% Protein Diet May Not Maintain Muscles in Type 2 Diabetes.” The lede was, “New findings suggest it’s especially important for people with type 2 diabetes to eat enough protein.” This is a message with which I am in complete agreement. Regular readers will recall that I have written about it numerous times including in #130, “How Much Protein Should You Eat?”

What reconnected me to the subject this time was the specific mention of 10% (as not being enough protein). Ten percent protein is the exact amount of protein that the Nutrition Facts Panel on every packaged food product in the United States recommends that everyone eat. Our government’s one-size-fits-all dietary recommendations do not take into account the requirements of different cohorts of the population, excepting those under 2 years of age. In that case, you are allowed to eat more saturated fat (as is found in mother's milk) to help in brain development. After 2 years, I guess your brain stops developing – NOT. (Current research suggests age 25.)  And Type 2 diabetics should eat more fat, more protein, and many fewer carbohydrates than is recommended to the general population. EVERYONE, actually, should eat many fewer.

(Anyway, if you haven’t done the math, the RDA percentages on the side panel of packaged foods are based, as the USDA’s footnote says, on a 2,000 calorie a day diet (for a “woman of a certain age”) to maintain her weight. So, if a “serving” has say 30 carbs, that’s  10% of the RDA for carbs. Here’s how to figure it: 30 grams of carbs x 4 calories/gram of carbs = 120 calories, and 120 calories is 10% of 1,200. From this you can correctly conclude that the 2,000 calorie a day diet that the government recommends everyone eats is 60% carbohydrate. I’m not making this up folks!

Do the math yourself for proteins. If the panel lists the serving as 20 grams of protein, it will say that serving represents 40% of your RDA. Since protein has 4 calories per gram, 20 x 4 = 80 calories which is 40% of 200. And since 200 is only 10% of 2,000 (the total daily calorie allowance), 10% is the amount of protein that the government recommends you eat. Q.E.D.

By reverse math, the balance of your diet is supposed to be fats: 1,200 + 200 = 1,400; 2,000 - 1,400 = 600 calories for fat, and since fat has 9 calories per gram, 600/9 = 66.7 grams of fat. And 600/2000 = 30% fat in a 2,000 calorie diet.)

But I digress. The article cited above was written by Dr. Stephanie Chevalier, et al., of McGill University Health Center – Royal Victoria Hospital in Montreal and was published in Clinical Nutrition. “If it [a 10% protein diet] happens over a long period of time, this could lead to loss of muscle mass. That’s really an issue for our aging population,” Dr. Chevalier said.

The study, in organic biochemistry terms, “involved comparing two groups of obese men and women, all type 2 diabetics, eating isocaloric diets, one of 17% protein and the other 10%. “On a 10% protein diet, diabetic adults showed increased sensitivity to insulin suppression of proteolysis, but inadequate stimulation of protein synthesis, resulting in a low net nitrogen balance than similar patients who ate a 17% protein diet.” Okay, this is above my pay grade too.

The reason, put simply, is that “Insulin is required for the metabolism of all macronutrients, not just glucose, and people with type 2 diabetes have been shown to have insulin resistance to glucose, lipid [fat], and protein metabolism,” Dr. Chevalier told Harding. She added, “Studies have shown that older adults with diabetes have greater losses in muscle mass and strength over time.” The takeway for me is that Insulin Resistance applies to fat and protein metabolism too!

She concluded, “For now, it’s probably adequate for people with diabetes to eat diets containing 15% to 20% protein. Ten percent is definitely too low,” she said, definitively. That was comforting to me. My own diet, as my regular readers know, is 20% protein, 5% carbohydrate and 75% fat. My protein plan has been higher in the past (as high as 28%), and usually in fact is higher than 20% since I frequently eat more than the small portion of protein allocated for supper (25g). That’s also why I take a small dose of metformin at supper, to suppress any gluconeogenesis that may result from a larger portion. If you haven’t seen my “ideal” meal plan, this is what it looks like. The breakfast and lunch parts of the plan are always the easiest.

	Fat	Protein	Carbs	Calories	K/G
Breakfast	30	20	4	375	2.07
Lunch	35	15	0	375	3.31
Dinner	33	25	11	450	1.51
Total	98	60	15	1,200	2.02
Percent	75%	20%	5%	100%