Diet has the potential to be a powerful and cost-effective tool for treatment of type 2 diabetes mellitus (T2D). High-protein diets have shown promise for this purpose. The objective of this systematic review was to evaluate whether high-protein diets improve glycemic outcomes in people with T2D. We conducted a systematic search of literature published prior to 1 February 2018 to find clinical studies of high-protein diet patterns for treatment of T2D in human participants. A high-protein diet was defined as a diet with protein content greater than that of a typical diet in the United States (>16% of total energy as protein). Studies were excluded if weight loss >5% occurred or if no glycemic outcomes were measured. A total of 21 independent articles met our criteria and were included. Most tested diets had a protein content of around 30% of total energy. Many studies supported the use of high-protein diets for patients with T2D, but were limited by small size (n = 8-32) and short duration (1-24 wk). Randomized controlled trials tended to be larger (n = 12-419) and longer (6 wk-2 y), and had mixed results, with many trials showing no difference between a high-protein diet and control. Many randomized controlled trials were limited by low compliance and high dropout rates >15%. There were no consistent beneficial or detrimental effects of high-protein diets on renal or cardiovascular outcomes. Evidence was insufficient to recommend 1 type of protein (plant or animal) over the other. Our review suggests that interventions to improve compliance with diet change over the long term may be equally important as specific macronutrient recommendations for treatment of T2D.

Time-restricted eating (TRE) can facilitate weight loss, yet its effect on eating patterns remains unknown. Twenty adults with BMI ≥ 25 kg/m² underwent a 12-week randomized trial, examining the effect of an 8-h, time-restricted eating intervention on dietary patterns. Oral intake was documented using a smartphone. Dietary patterns, assessed as frequency of eating occasions (EOs) and types of meals/snacks and beverages, were compared between baseline (T0), early-intervention (T1), and end-intervention (T2). At T1 and T2, both groups had less EOs compared to T0, with greater reduction seen in the TRE group (−28%) than the non-TRE group (−12%) at T2 (p = 0.01 vs. non-TRE). Comparing T1 to T0, the TRE group documented less incomplete meals (−32.5%: p = 0.02), high quality snacks (−23.6%: p = 0.03), and low quality snacks (−36.6%: p = 0.004). Comparing T2 to T0, the TRE group documented less incomplete meals (−33.9%: p = 0.03), high quality snacks (−28.1%: p < 0.001) and low quality snacks (−51.2%: p < 0.001). Caffeinated beverage intake was reduced in the TRE group at T1 (−20.2%) and T2 (−28.8%) vs. T0, but remained unaltered in the non-TRE group. By using a smartphone application to document dietary intake, TRE significantly reduced the number of EOs, snacks, and caffeinated beverages, relative to baseline and relative to the non-TRE.

Increased prevalence of obesity may be due to an increase of being sedentary at work. Increasing non-exercise activity thermogenesis (NEAT) using walking workstations may increase total physical activity and promote a leaner physical body composition (or phenotype). The purpose of this study was to test whether walking slowly during work was sufficient to promote a leaner phenotype by increasing physical activity in sedentary desk workers without inducing compensation or a decrease in activity or energy expenditure during the nonworking hours. We conducted a prospective cohort study using a within-subjects crossover design. The design involved two phases each lasting 2 weeks: a treadmill exercise phase in which subjects used a walking workstation for 2.5 hours a day 5 days/week and a control phase in which subjects maintained their normal work activity. Twenty-five sedentary adults working at the Minneapolis VA Health Care System. We measured body weight, body composition, food intake, 24-hour physical activity, and self-reported physical activity with the International Physical Activity Questionnaire (IPAQ). Treadmill exercise caused a leaner phenotype (lean mass gain and fat mass loss) and significantly increased their 24-hour physical activity. Walking workstation use had favorable effects on physical well-being and mental focus and did not adversely affect productivity. Light treadmill exercise during work can increase physical activity and result in a leaner body composition. This is a potentially useful intervention to increase NEAT in the modern sedentary work environment.

Background . Coconut oil, a saturated fat comprised mostly of the medium‐chain fatty acid, lauric acid, has become increasingly popular over the past few decades due to its touted anti‐inflammatory, metabolic, and lipid‐lowering properties. There have been many studies with mixed results evaluating the effects of coconut oil consumption on lipid metabolism and cardiometabolic risk. However, the effects on glucose metabolism are less clear. There are few trials on the effects of coconut oil on glucose homeostasis but no case reports prior to the current one. Case . We present a case of a 66‐year‐old man with a history of type 2 diabetes managed with insulin who developed recurrent hypoglycemia and required reduction in insulin therapy quickly after consuming coconut oil supplementation. Conclusion . This is the first known case report of coconut oil supplementation in a diabetic patient on insulin resulting in hypoglycemia. Review of the literature shows that coconut oil supplementation can have a favorable effect on glycemic control, possibly through phenolic compounds mediating anti‐inflammatory effects. This effect is inconsistent throughout the studies reviewed, likely due to variations in types of coconut oil supplementation and scarcity of trials. Further research is required both in animal models and in humans before coconut oil intake is widely advised and popularized. This is especially true in patients with diabetes, who are at increased risk of cardiovascular disease, and in whom reduction in saturated fat intake is advised.

The ketogenic diet, which has become an increasingly popular diet, severely restricts carbohydrate intake to shunt metabolism towards fatty acid oxidation and production of ketones as a fuel source. There have been many studies illustrating the positive effects of a ketogenic diet in weight loss and other benefits; however, the long-term effects and potential adverse events of a ketogenic diet have not been well studied or documented in literature. There are a few case reports of ketogenic diet resulting in hypoglycemia. We report a case of hypoglycemia with a blood glucose of 39 mg/dL and ketosis in a 69-year-old woman who strictly followed a ketogenic diet for nearly one year. She presented with malaise, sugar cravings, and mental fogginess, and after intake of alcoholic beverages, was admitted to the hospital with hypoglycemia. She had elevated beta-hydroxybutyrate, and low insulin and C-peptide, all consistent with a starvation ketosis. This case illustrates that adherence to a ketogenic diet for a prolonged period of time, in combination with alcohol intake, can disrupt normal glucose homeostatic mechanisms and result in a significant degree of hypoglycemia. This pattern of hypoglycemia may not present with classic symptoms, most likely partly due to effects of the ketogenic diet on brain function. This case provides insight that supports the need to counsel patients about alcohol intake while on the ketogenic diet. More information is needed on long-term complications of the ketogenic diet on glucose homeostasis in the body as well as in the brain.