Diabetes: Individualized Diet & Microbiome: A Need For Revision

Type 2 diabetes is a multi-factorial condition characterized by chronically elevated blood glucose. While a wide variety of different dietary strategies have been trialed, studied and evaluated, there is a greater need to develop more targeted and individualized dietary treatments, tailored to each patient. Metabolic Type Nutrition is a type of evaluation of dietary and metabolic traits and characteristics, that directs clinicians and patients towards the identification of an optimal individualized diet. Despite having a long clinical track record of efficacy of several decades, no known scientific research studies have been conducted on Metabolic Typing or Metabolic Type Nutrition, for type 2 diabetes.

Dietary Discrepancies & The Need for Diet Tailored to Individual Type of Metabolism

Clinical Biases & Experiences – After 17 years of experience in the practice of nutritional therapies, it is quite clear that there is no single diet that will be ideal for each person. The correct dietary approach, which I define as producing an optimal level of fitness, can vary drastically from person to person. I’ve witnessed opposite dietary approaches serve to stabilize, and in some cases reverse disease. Even in cases where 2 people are diagnosed with the same disease, the correct dietary approach has shown to be opposite. This reality is pronounced among type 2 diabetics.

Indeed, the literature reports on the effects of a wide range of dietary approaches for Type 2 diabetes:

• 2017 meta analysis of 13 RCT’s finds Vegetarian Diet is associated with reduced T2D risk (1).
• 2013 meta analysis of 20 RCT’s finds: Low Glycemic Index Diets, Mediterranean Diets, and High Protein Diets all are effective for managing cardiovascular risk factors among Type 2 diabetics (2).
• Keto vs. Low fat diet: 2020 meta analysis of 14 studies found high fat/ketogenic diets outperformed low fat diets for: better glycemic control for diabetics, greater weight loss, greater improvements in HDL levels (3).
• Very Low Carb Ketogenic Diet (VLCK) compared to control diet in Type 2 Diabetes, 2022 meta analysis: 8 studies reviewed. Compared to the controlled diets, VLCK led to a greater reduction in A1C after 3 months, lower triglyceride levels, greater HDL levels, and greater reduced usage of anti diabetic drugs, for up to 12-months (4).
• Very Low Calorie Low Fat Diet Vs. Vegan Diet in Type 2 Diabetes – 2022 meta analysis involving 16 studies. Vegan diets were not associated with statically significant improvements in BMI or A1C. Vegan diets did result in reduced LDL levels. Very low calorie diets significantly improved A1C, and fasting glucose (5).

To date, there is no line of scientific research that can accurately predict what type of dietary approach should be used for each individual patient. This represents a major flaw in the manner in which most scientific research is conducted. Typically studies are conducted whereby a group of people undergoes the same intervention, or are assigned to a control group. If the intervention is successful, it is based upon the improvement of various end points of the group, not necessarily individuals within the group.

From a clinical point of view, the objective should be to find the therapies and interventions that works for each patient. Clinicians cannot think in terms of treating group trends. They have to treat individual patients. This represents a major limitation to applying scientific research to clinical applications. From a clinical perspective, an intervention will either: work, not work, or have no effect. Knowing this, it is fundamental to develop systematic methods for individualizing treatment on a per-patient basis.

Metabolic Typing or Metabolic Type Nutrition

For 17 years I’ve used a system of evaluation and application known as the metabolic typing method, and it has repeatedly shown to be the single most effective and important means to identifying the correct diet for any individual. The method is typically so simple, that typically, a correct analysis can be done in less than 5 minutes, by simply asking the correct questions. This approach is a beginning, not an end to learning how to eat correctly for your body. It is amazing to me that very few people know about this approach, even though it has been around for several decades. It is also amazing to me that to date there are no scientific methods to studying this approach, let alone for understanding the obviously different dietary needs that exist in the human population.

An individual will occupy one of 3 basic metabolic types, or states. These are referred to as: carb type metabolism, protein/fat type metabolism, or mixed type metabolism. The basic dietary template for each of these 3 types are quite different, and can be identified through very fundamental metabolic traits. 17 years of clinical experience with a lot of people has shown that this approach works well, and can be further customized, based upon individual needs (food sensitivities, fitness levels, preexisting conditions, etc.). For people with type 2 diabetes the stakes are higher, and identifying the client’s metabolic type is a high priority.

A person with type 2 diabetes can thrive on the correct type of diet, or they can completely fall into despair with the wrong type of diet. The fact that distinctly different diets with distinctly different macro-nutrient ratios have all been shown to benefit diabetes is direct evidence that there is a great need to study the individual differences that determines and predicts which dietary approach is more efficacious and appropriate for each patient.

Mediterranean diets, vegetarian diets, high protein diets and high fat, low carb ketogenic diets ALL have been shown to benefit type 2 diabetes risk factors, despite each being distinctly different dietary approaches. But do these diets all have the same beneficial effects on every person? I argue, absolutely not. What is more interesting and important to grasp is that these metabolic traits can change at any point in time.

This means that ‘Person A’  may have a high need for increased dietary fat and protein intake at one period of their life. However, this need can change and ‘Person A’ may have a high need for lower fat intake, and higher plant food intake, during another period in their life. These longitudinal changes within an individual’s metabolism are real, they exist, and no one is studying it.

Microbiome & Reverse Epidemiology: The Elephants in The Room

Accumulating microbiome research has yielded large amounts of data regarding gut microbial balance and its relationship to health and various diseases. Microbial balance directly affects our immunity, our neurology, and our metabolism. However, this data is far from linear. For example, microbial phyla that are associated with health metrics in one population can also be associated with disease metrics in a different population. For example, in the autoimmune disease, Lupus (SLE), there is a trend towards a lower Firmicutes to Bacteroidetes ratio, and that improvement of this ratio (i.e. increasing Firmicutes relative to  Bacteroidetes) is associated with improved SLE disease activity scores (6). For type 2 diabetes however, quite the opposite has been observed. In diabetes research, the Firmicutes to Bacteroidetes ratio is elevated, and that reduction (decreasing Fircmicutes relative to Bacteroidetes) is associated with improvement in diabetes, including reduction of obesity (7, 8, 9). Among diabetics, elevations in cholesterol, high homocysteine, obesity and high blood pressure are all risk factors for heart disease. Yet among patients with Lupus, having high cholesterol, high blood pressure, obesity and hyperhomocysteinemia all become protective factors for heart disease risk (10).

This reverse epidemiology reveals the non-linear reality that lies at the heart of health and disease. Unless scientific research is able to target variables, biomarkers and trends at a patient-centric level, accumulating data will always appear contradictory, and difficult to apply.