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Tailored diet. This is the rule for anyone who comes to terms with diabetes. But there are important news, in general terms, that emerge from the ADA (Amedican Diabetes Association) congress and can turn into useful advice. To summarize them here are the advice of Olga Vaccaro, full professor of Endocrinology, Federico II University of Naples at the Federico II University Hospital.
The insulin revolution
“Before the discovery of insulin, the nutritional therapy of diabetes basically concerned type 1 diabetes and consisted of a severe reduction of carbohydrates and calories (starvation diet or fasting diet) this allowed children with diabetes to survive for some time, but with serious consequences on nutritional status and growth – explains the expert. With the discovery of insulin (about 100 years ago) we switched to diets more consistent with the nutritional needs of the body, increasing the calorie and carbohydrate content. Around the 1950s, the need for greater ‘liberalization’ of the diet was recognized to make it more similar to that of non-diabetic people and to encourage adherence using the principle of the “exchange list”, i.e. the possibility of replacing foods with each other. with similar nutrient composition “.
Then came the research on carbohydrates and the metabolic effects of different foods, as well as those on the negative role of dietary fats. And we come to today: “they are considered acceptable percentages of carbohydrates from 45 to 65% of the caloric share – resumes the expert. A more modern nutritional approach is centered on foods, rather than nutrients, since it has been understood that the metabolic effects of a food are not only explained by the sum of the nutrients that compose it, but are also modulated by the matrix in which these nutrients are contained. .
Combining different foods together also helps to modulate metabolic effects, which is why today great importance is given to the dietary ‘model’ as a whole. Models such as the Mediterranean one based mainly on unprocessed plant-based foods and olive oil have proven to be healthy for the treatment of diabetes and cardiovascular prevention and are also the most sustainable from the point of view of environmental impact.
Based on current knowledge, the nutritional therapy of diabetes must represent a global approach to the health of the person (e.g. treatment of diabetes, but also prevention of cardiovascular diseases and other chronic degenerative diseases), it must also be economically accessible for people and ecologically sustainable “.
The important thing is to personalize
However, we cannot and must not think in general terms. Also and especially if the person with type 2 diabetes is taking medications. Because both the response to therapies and to the diet are linked to individual factors (anthropometry, hormonal structure, genetic heritage, intestinal microbiota, etc.). “The same diet does not have the same effects on all people – continues the expert. Several studies have shown that people exposed to the same food have a different metabolic response (eg post-prandial levels of glucose, lipids, insulin, etc.) and even the same person, exposed to the same meal on different occasions, has metabolic responses different.
There is therefore more and more talk of personalized nutrition. It can be used, for example, in the treatment of congenital diseases of metabolism, due to known genetic defects which generally affect only one gene. However, the great variability of the metabolic response to food is controlled by genetic factors involving a multiplicity of genes, not all of which are known, and is also powerfully modulated by lifestyle and other environmental exposures.
At the moment the knowledge on the determinants of this great biological variability is not sufficient to allow a precise identification of the different ‘metabotypes’ and a large-scale clinical application. The study methodologies available to us are still inadequate and more precise methods must be developed to measure revenues and effects ”.
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