Higher protein diet plus resistance exercise aids weight and fat loss in type 2 diabetics

Where weight and fat loss is concerned, I favour a relatively low-carbohydrate, high-protein diet on the basis that such diets generally outperform low-fat, carb-rich diets traditionally advocated for weight loss. A lower-carb diet I think may have particular advantages for diabetics because, well, they have difficulty handling carbohydrate as a result of impaired insulin function (insulin resistance) and/or insufficient insulin.

There is a certain logic to the notion that diabetics should be careful consuming the very food type (carbohydrate) they have difficulty dealing with. However, not everyone agrees. You can see here how Diabetes UK (the leading diabetes charity in the UK) specifically recommends against carbohydrate restriction on the basis that:

• glucose from carbohydrate is essential to the body, especially the brain

• high fibre carbohydrates, such as wholegrains and fruit, also play an important role in the health of the gut

• some carbohydrates may help you to feel fuller for longer after eating

However, glucose can be made from other elements of the diet (e.g. protein) which makes the absolute requirement for carbohydrate none at all. Also, wholegrains are generally rich in insoluble fibre which has been shown to be quite irritant to the gut compared to soluble fibre found plentifully in fruits and vegetables. But if diabetics are looking for a heathy source of fibre, why not point them to green veg, say, rather than carb-loaded fruit. And it might be true that carbohydrates can help people feel fuller for longer, but protein has been found to be the most sating macronutrient and doesn’t cause wild swings in blood sugar levels (as many wholegrains do) either.

Getting back to weight loss, it appears that aerobic exercise is not particularly effective here (see here for more about this). That is not to say that aerobic exercise is a waste of time – it most certainly is not in my opinion (it just does not do much to shift surplus pounds).

In recent years there has been increasing interest in the idea that resistance exercise (e.g. weight training) can help fat loss and improve body composition. See here for a previous post about a relevant study.

I was interested to read about a recent study in which resistance exercise was tried in a group of obese type 2 diabetics [1]. Individuals either performed resistance exercise (3 days a week) or no exercise for 16 weeks. Each of these groups were further subdivided into groups eating either a conventional high-carbohydrate diet, or a lower-carb, higher protein diet. The make-up of these diets was as follows:

Conventional diet carb/protein/fat: 53/19/26

Higher protein diet carb/protein/fat: 43/33/22

The diets were ‘energy-restricted’ (about 1400 and 1700 calories a day for women and men respectively).

So, in effect, this study had four groups:

1. Conventional diet no exercise

2. Conventional diet plus resistance exercise

3. Higher protein diet no exercise

4. Higher protein diet plus resistance exercise

The participants were assessed in a variety of ways including weight loss, fat mass loss and waist circumference.

Overall, the group eating higher protein lost more weight and fat and saw greater reductions in their waist circumference too. However, these differences were much more marked when comparing the groups who were exercising.

Weight loss for exercisers in the conventional and high protein groups was an average of 10.5 and 13.8 kg respectively

Fat loss for exercisers in the conventional and high protein groups was an average of 7.9 and 11.1 kg respectively

Waist circumference reduction for exercisers in the conventional and high protein groups was an average of 11.3 and 13.7 cm respectively

Looking at the results as a whole, it’s clear that the group that did the best with regard to these measurements was the one eating less carb, more protein, with resistance exercise on top.

References:

1. Wycherley TP, et al. A High Protein Diet With Resistance Exercise Training Improves Weight Loss And Body Composition In Overweight And Obese Patients With Type 2 Diabetes. Diabetes Care 11th February 2010 [epub ahead of print publication]

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12 Responses to Higher protein diet plus resistance exercise aids weight and fat loss in type 2 diabetics

  1. Chris 16 February 2010 at 3:10 pm #

    AFAIK – resistance exercise will upregulate insulin sensitivity. I am guessing that the lower the circulating insulin level the quicker it can be cleared and so the more readily fat stores can be accessed.

  2. Gary 16 February 2010 at 10:02 pm #

    If you diet without physical activity you lose lean tissue mass which is exactly the most metabolically active component of your body. Big mistake

    Add the right activity to the program. Resistance training and bingo your body preserves its muscle.

    This equation is exactly why many dieters find it hard to keep the weight off once they discontinue diets. But every time they go on a diet they risk losing more muscle.Ahhh…don’t do it.

    Ladies shouldn’t be concerned about developing big muscle either. As high reps with low weight won’t build big Arnie type muscles. You may see more tone but thats just usually due to improved circulation and blood pump in the muscle.

    The other advantage of resistance training is it tends to help you produce more growth hormone at night. Especially if you don’t eat high carb snack before bed. Growth hormone has major advantages in preserving muscle and aiding fat metabolism. Which is why I recommend any of my patients to follow this kind of activity.

  3. Jamie 17 February 2010 at 12:46 am #

    I agreed with Gary’s comments right up until he started talking about lifting low weight & high reps in order to avoid getting big muscles, and using the dreaded ‘toning’ word!

    This is a myth that continues to persist. In actual fact, the biggest driver of muscle mass when lifting is total volume. Total volume can be defined as; sets x reps x weight lifted x number of exercises. Any one or all of those variables can be manipulated to keep volume high or low.

    Let’s look at body builders who have figures that most women typcially want to avoid. Body builders will typically train in a 3-6 set range, using 8-12 reps, for a moderate to heavy weight, for a large number of total exercises for that muscle group per session. If this sort of volume is combined with a favourable hormonal profile (either endogenous or exogenous), then there will be a high degree of muscle hypertrophy.

    If we take a woman lifting a lighter weight over 15-20 reps, for 3 sets, & still likely over a high number of exercises (as typically given out by most muppet gym instructors), then their total volume can still be moderately high, and, if they have a hormonal profile that allows them to ‘bulk up’, this high rep approach will still do it (albeit likely via slow twitch fibre hypertrophy rather than fast twitch).

    I have spent several years working with elite female track cyclists (sprinters – think Victoria Pendleton [whom I haven't worked with, but would certainly love to! ;) ] ). The goal with these athletes is to get them strong & powerful, whilst keeping their body weight relatively low so that they have a high power to weight ratio. To do this, we again manipulate the volume equation. When they first started, they needed to build some muscle mass as they were too light. They were put through a 12 week hypertrophy block where they lifted heavy over a large number of sets, in a low rep range (to allow them to keep the weight heavy), and over a limited number of lifts (typcially one lift per session). This saw these average height women go from low 50′s (kg) to high 50′s in their weight. When hypertrophy was no longer required, the volume was bought down by lowering the set number, but not the weight.

    These women were VERY ‘toned’ but by no means bulky. And they were very strong… squating 160kg+ & deadlifting 120kg+… not bad for 58kg, 165cm women. And they would get numerous comments about how ‘toned’ they were from other women who would prance around the gym doing multiple reps with their 5kg dumbbells. They never got the link.

    With reference to Johns post, I can look at the sprinters I worked with & can tell you that these cyclists lifted heavy, hardly did any high volume aerobic work (compared to endurance cyclists), did a quite a bit of anaerobic work (most intervals are less that 60s), sat around lots & did little in between training sessions, and consumed lots of protein. And they were by far leaner than both their sedentary & endurance trained counterparts (but were not always bigger than the enduracne riders as you might expect). And for the most part, they could at least foot it with the endurance riders in all but the very long races (the sprinters could win in most races up to about 5km).

    Want to stay lean? Eat fat & protein, eat minimal carbs, lift heavy, sprint lots, & don’t over do the aerobic work.

  4. john 19 February 2010 at 8:23 am #

    great post ,i also think protein food and some more exercise can do good to weight loss.

  5. Daisy 20 February 2010 at 9:01 pm #

    This is all so confusing. And worrying. What can a 50 yr old mother with a diabetic father, demanding job, kids and husband actually do? Is it really feasible to lift weights at home? And if so, how heavy & how often? All the advice online is vague and/or scary…any concrete tips gratefully received. Thanks.

  6. Tanya 21 February 2010 at 12:49 pm #

    Hi John

    Just wondered what you think of this article re fat and cholesterol?

    http://www.msnbc.msn.com/id/35058896/ns/health-heart_health//

    Yet more evidence that low fat/high carb isn’t on the right track I think!

  7. Tina 25 February 2010 at 11:01 pm #

    I have followed Barry Sears “Zone” dietary system. He has worked with elite athletes for decades and has defined the “zone” as the “metabolic state in whch the body works at peak efficiency.

    Dr. Sears was first inspired by “the zone” many athletes experienced (for usually a few brief minutes) where they felt “that near-euphoric state of maximum physical, mental, and psychological performance”. When I was in high school track, I first experienced this feeling for myself where I felt like I could run forever. Unfortunately, it only lasted a few seconds. Dr. Sears wanted to know how we, the human race, could experience this feeling 24 hours a day.

    He discovered that by balancing our hormone and insulin levels, we could reach this goal; and the answer to achieve this balance was found in the foods we eat. There are “no magic potions, pills, herbs, or mantras…you must treat food as if it were a drug. You must eat food in a controlled fashion and in the proper proportions.”

    He found that 3 grams of protein to 4 grams of carbohydrates created this balance. His book “Enter the Zone” discusses the science and statistics behind this calculation. He also specifically discusses Type 2 Diabetes.

    In a small pilot study in 1994, he compared two groups, one who followed the Zone-favorable diet (3g protein to 4g carbs) and the other who followed the ADA (American Diabetes Assoc.) dietary recommendations (1g protein to 3g carbs). The results showed a significant reduction in glycosylated hemoglobin, fasting insulin, triglycerides, blood pressure and cholesterol levels for those who followed the Zone-favorable diet plus they averaged a weight loss of 1 pound of excess body fat per week. The results in the ADA group showed an increase in insulin, triclyceride, and total cholesterol levels with no weight loss. An earlier study at the University of Naples, Italy showed similar results for patients in a metabolic ward who were strictly fed a Zone-favorable diet.

    Dr. Sears also discusses the effect of the Zone diet on other diseases and conditions ie. HIV, Cancer, Heart Disease, Chronic Conditions, etc.

    When I followed this program combined with daily aerobic exercise, I felt wonderful. I was never tired, had lots of energy, had improved concentration and memory, and I had reached a point where I could not lose weight. I had lost 15lbs until my body had reached it’s balance. Continuing with the program helped me maintain my weight and did not result in losing too much.

    I wish to express my gratitude to Dr. Briffa and his staff for this blog. I wish there were more people like him and Dr. Sears who promote healthy living and who work so hard to improve our daily life.

    Thank you.

  8. Betty D 1 March 2010 at 3:09 pm #

    I am grateful for the low carb teaching I first read in your ‘Carb Crash’ article in the Observer. It was more like the diet which I started in 1953. Then I was given three rations of butter and cheese. I’m not sure if meat was still rationed then but three times the amount non-diabetics received was normal during rationing.

  9. cbarnard 6 August 2010 at 9:05 pm #

    Very informative article and comments. We are learning more and more about how to take care of our fitness needs. Certainly good trainers will look at your health, fitness levels, and goals.

    I certainly believe that there are a number of exercises using your own body weight that can be done at home that will help a person lose weight and tone their body.

    Diet is obviously important and there is so much information out there people can easily become confused. It is important to do your research carefully but the greatest challenge is to take consistent action over time. That is what trips up 95% of the people.

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