Sunday, December 1, 2019

Retrospective #288: Type 2 Diabetics: 10% Protein “May Not Be Enough”


The Medscape Multispecialty article headline 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.” I am in complete agreement and have written about it numerous times including in Retrospective #130, “How Much Protein Should You Eat?”
What reconnected me to the subject this time was the specific mention of 10% 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, because mother’s milk has more than 10% saturated fat to help in brain development. That assumes, that the USDA figures that after 2 years your brain stops developing. It does NOT! (Current research suggests it’s 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 carbs.
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 one “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 calories a day that government still recommends everyone eats is a 60% CARBOHYDRATE diet. 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, 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 from the 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,” the lead author said.
The reason: “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, and protein metabolism,” she said, adding, “Studies have shown that older adults with diabetes have greater losses in muscle mass and strength over time.”
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. That was comforting to me. My own diet 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 I allow for supper (25g). That’s also why I take a small dose of metformin with supper, to suppress gluconeogenesis, including any that results 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. They’re also the most ketogenic. If I eat keto (Very Low Carb) virtually all the time, I never experience hunger.
Meal
Calories
Fat
Protein
Carbs
K/G ratio
Breakfast
375
31
20
4
2.1
Lunch
375
35
15
0
3.3
Supper
450
34
25
11
1.5
Total
1200
100
60
15
2.0
Percent
100%
75%
20%
5%
≥1.5

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