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Experts say a 5:2 intermittent fasting diet can help some people with type 2 diabetes. Tetra Images/Getty Images
  • A study from China suggest that a 5:2 intermittent fasting diet with meal replacement may be helpful for people with type 2 diabetes.
  • Researchers reported that participants on the eating plan had better glycemic control and weight loss at 16 weeks compared to those on diabetes medications.
  • Experts say the 5:2 diet is an option for people with type 2 diabetes, but it may not be suitable for everyone.

A 5:2 intermittent fasting diet with meal replacements may be helpful for people with type 2 diabetes.

A study published today in the journal JAMA Network Open reports that following such an eating plan can improve glycemic control as well as short-term weight loss.

“In this randomized clinical trial of 405 adults, the 5:2 meal replacement approach achieved better glycemic control at 16 weeks compared with metformin and empagliflozin,” the study authors write.

“5:2 meal replacement may serve as an initial lifestyle intervention for patients with type 2 diabetes, providing an alternative to the use of metformin and empagliflozin medications,” they added.

The study involved 405 adults in China who had obesity or were overweight. The participants had been diagnosed with type 2 diabetes within the previous year.

The participants were randomly allocated to either receive metformin, empagliflozin or a 5:2 meal replacement eating plan for a 16-week period. All of the participants were also given guidance on exercise, diet and diabetes education every four weeks.

Those in the 5:2 meal replacement group had two non-consecutive days each week in which they used meal replacements. Meal replacements are prepackaged food or beverages that may be used to give energy in place of a usual meal.

On the meal replacement days, the participants had one meal replacement instead of eating three regular meals. This amounted to an intake of 500 calories for women and 600 calories for men.

On the other five days, the participants in the 5:2 group were encouraged to monitor their calorie intake but eat whatever they wanted for breakfast and lunch. At dinner they then had a meal replacement.

The researchers reported that those in the 5:2 meal replacement group showed the greatest reduction in average HbA1C blood glucose levels over three months. Those in this group also had greater weight loss than the other two groups with a significant reduction in both waist and hip circumference.

Dr. Marilyn Tan, an endocrinologist at Stanford University in California who was not involved in the study, says intermittent fasting may be beneficial for some people with type 2 diabetes.

“There has been significant interest in intermittent fasting or time restricted eating for type 2 diabetes, and many studies have shown a benefit. The metabolic benefits may be due to both the specific timing of the eating and also reduced caloric intake. Many patients also find intermittent fasting to be more sustainable than other popular diets because the focus is more on timing rather than diet content,” she told Medical News Today.

“Extreme diets that are very restrictive in content can be difficult to follow long term and can lead to nutritional deficiencies, so the fact that the intermittent fasting diets focus less on dietary content often makes them more sustainable,” Tan added. “There’s no one size fits all diet for diabetes and it’s critical that whatever diet one chooses is sustainable long term. Many people can follow a more restrictive diet in the short term, but if they go off the diet, glycemic control and weight often revert to the prior state.”

More than 38 million people in the United States have diabetes and of those 90% to 95% have type 2 diabetes.

Risk factors for type 2 diabetes include being 45 or older, having a family history of diabetes, being overweight, and being physically inactive.

Type 2 diabetes can be managed with exercise and healthy eating. Insulin and diabetes medications may also be used to manage blood glucose levels.

Dana Hunnes, PhD, a senior dietitian supervisor at RR-UCLA Medical Center in Los Angeles who was not involved in the study, says diet is an important factor for a person living with type 2 diabetes.

“Diet and eating/meal patterns do matter quite a lot for someone with type 2 diabetes. What we eat can increase inflammation and make us more insulin resistant, have higher blood sugars, or it can lower inflammation, improve our insulin sensitivity, and make us require less insulin or less medication to help control glucose levels. So, what we eat, when we eat it, how we eat it, can make a difference,” she told Medical News Today.

The American Diabetes Association recommends those with diabetes use the “diabetes plate” as a framework for building meals.

This involves beginning with a 9-inch plate and filling half with non-starchy vegetables. Another quarter of the plate should be made up with lean protein and the final quarter should be made up of quality carbs that can include whole grains, fruits, starchy vegetables, or low fat dairy.

Tan notes that while those in the 5:2 meal replacement group experienced weight loss and glycemic control benefits, meal replacements may not be be a long-term solution.

“Meal replacements usually provide fairly accurate calorie counts and can help restrict carbs and calories. However, they don’t necessarily help patients with a long term solution to real life situations. It’s much easier to follow a specific diet when one is in isolation. However, once you throw social and work situations, travel/vacation, special events, etc, into the mix, patients still need tools to navigate these solutions. For most people, it’s neither financially sustainable nor satisfying to stay exclusively on meal replacements long term,” she said.

Grant Brinkworth is a professor and director of research at Diabetes Australia. He told Medical News Today that people living with type 2 diabetes should consult with their doctor about the best method for them to attain sustainable weight loss and diabetes management.

“There is no one approach to losing weight that suits every person with type 2 diabetes. It is established that type 2 remission can be achieved through significant weight loss, although remission is not possible for everyone. What method a person uses to achieve sustainable weight loss is a personal decision and it is recommended that this decision is made in consultation with a healthcare professional,” said Brinkworth, who was not involved in the study.