With so many types of diets being promoted online and on social media, a leading dietitian says flexibility is more sustainable than a rigid diet plan.

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Joyce Patterson, MPH, RDN, BC-ADM, CPT is a registered dietitian and a diabetes care and education specialist at Michigan Medicine in Ann Arbor, U.S., and she says the science points to a balanced approach.

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“We live in a world full of messages to restrict, eliminate, and fast, and misconceptions related to diet trends are common, such as macronutrient or supplement needs,” she explains. For example, the war wages over fats versus carbs, or eggs come in and out of favor every couple of years, and the media and food manufacturers exploit such information to drive what people think about nutrition and increase sales.

“The sheer number of products and programs claiming to ‘reset your metabolism’ or ‘cleanse’ your system indicates that many people are interested in the science. However, few receive comprehensive and reliable nutrition education and cannot discern between marketing ploys and good science. They make food choices and purchase decisions based on minimal or misleading information.”

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What are some diet trends?

In her new book, Think Like A Dietitian, Patterson reviews various diet trends, unpacking the myths around each and where the barriers to success lie.

“For many, diet culture has shaped their relationship with food. From the parental influences of their childhood to the virality of social media today, these beliefs can be deeply ingrained.”

Patterson highlights that many popular diets are based on minimal scientific evidence, but the ketogenic diet and intermittent fasting are highly studied and debated among nutrition researchers and clinicians.

Research cited in the book has shown the ketogenic diet offers short term benefits in rapid weight loss and metabolic disorders including diabetes, but Patterson says there are not enough long‑term studies to determine the long‑term safety of the regimen.

Similarly, the various forms of intermittent fasting have also shown potential as treatments for obesity and cardiometabolic disorders, but for alternate‑day fasting or prolonged fasts, more studies are needed to assess its long‑term safety.

“When certain diets show promising findings in research, many well‑meaning, non‑nutrition clinicians will be quick to recommend these approaches,” Patterson explains. “From low fat to low carb to fasting, the most popular diets are ironically the most restrictive. It is no wonder they tend to be the most unsustainable.”

In ketogenic diets, the initial water loss in the first week alone can show changes on the scale. However, studies also repeatedly show evidence of weight loss in various other eating patterns—regardless of macronutrient composition—without one proving to be more superior to others. In regard to weight loss maintenance, Patterson explains that “research continues to show little difference when comparing various dietary patterns for long-term weight loss.”

What are the issues with diet trends?

“A common practice is that people will apply certain features of a diet, instead of the actual dietary pattern that was researched. Without proper guidance, people may end up practicing unhealthy behaviors that put their health at risk.”

Patterson points out that diet culture can also push people down a path of overly-restrictive eating.

“Not all people push nutrition down the priority list,” she explains. “In fact, some are so aware of their choices that they control themselves straight into hunger. They know their way around a grocery store and leave no package unturned, scanning and comparing nutrition labels.

“While mindfulness is a key tenet in healthy eating, calories and certain food groups have been vilified by diet culture. Whether people are counting calories, carbs, fat, sodium, or other nutrients, the interpretation is often ‘less is more’. Instead of focusing on healthy food choices and overall balance, some people get caught up in the minutiae of nutrients. They feel food is something to be avoided, as opposed to being the fuel that provides power, strength, and protection.”

Following diet trends can also create an attitude which Patterson calls ‘all-or-nothing’. She explains: “Many people are pretty savvy when it comes to diet trends. They keep up with the latest trends and are willing to try new things. They become familiar with terms like ‘macros’ or ‘alkalinity’ or ‘ketones’. When they put their minds to it, they are able to lose weight rather quickly. They know how to slim down for a wedding or a cruise or a beach vacation. When they’re ready, they dive right in and see results.”

However, Patterson explains that when something unexpected happens, such as a social event, a family issue, a health concern, or a stressful event, often these ‘all or nothing’ dieters hit an inevitable plateau, become frustrated, and give up.

“Life happens. And it will happen again and again. These are perhaps the most impactful challenges that people encounter because they are recurring and inevitable. They may be accompanied by an emotional burden such as stress or worry. Or the episode may be followed by feelings of guilt or failure, especially for those whose self‑efficacy was low in the first place. If it happens repeatedly, the cost of the effort may seem to outweigh the benefit, leading to a complete cessation of action. All too often, this cycle of regression repeats itself,” she explains.

What should we do instead?

“In my experience, I find that many diet trends are effective not because they are novel, but because they are similar,” Patterson says.

Research and Patterson’s experience both suggest that most diets work because regardless of whether it monitors calories, carbs, fat, protein or points, it usually follows that some of these basics are applied: added sugar and ultra‑processed foods are limited; plant foods increase; portions are controlled.

“With every new study, there is a new headline, causing whiplash among patients and health professionals alike,” she explains. “Therefore, erring on the side of balance and variety can be a safe way to maneuver some of these controversial and ever‑changing topics.”

Patterson suggests that following an ‘80/20’ rule is more sustainable, acknowledging that dietary perfection is an impractical approach.

“Specifically, this rule of thumb suggests that people follow dietary recommendations 80% of the time, and not to worry about the other 20%, factoring in convenience, enjoyment, and social interactions.

“One of the most important experiences that a dietitian can share is that perfection is not only unattainable but also unnecessary. Even centenarians often admit to some lifelong indulgences.

“A healthy diet does not have to be all-or-nothing. The occasional treat is not harmful. However poor choices in excess can increase risk for nutrition-related disease,” she explains.

Many type 2 diabetes patients lack potentially life-saving knowledge about their disease

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Scientists found that many people with type 2 diabetes know little about their condition, indicating a need to improve communication about the disease
Scientists found that many people with type 2 diabetes know little about their condition, indicating a need to improve communication about the disease

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The body’s inability to produce enough insulin or use it effectively often results in type 2 diabetes (T2D), a chronic disease affecting hundreds of millions of people around the globe. Disease management is crucial to avoid negative long-term outcomes, such as limb amputation or heart disease. To counteract adverse consequences, patients must have good knowledge about the day-to-day management of the disease. 

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A team of Portuguese researchers has now assessed the number of patients—both insulin-treated and untreated—who have this crucial knowledge about T2D. They published their findings in Frontiers in Public Health.

“Our main motivation was to contribute to the reduction of the existing disparity in the knowledge that diabetic patients have regarding their disease,” said first author Prof Pedro Lopes Ferreira, director of the Center for Health Studies and Research of the University of Coimbra. “With this study we evidenced the need to improve the disease knowledge of type 2 diabetic patients.”

Knowledge levels vary widely

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To assess diabetes knowledge, the researchers used a knowledge test developed for people with type 1 or type 2 diabetes. Among other questions, the test includes sections about nutrition, signs and symptoms, and medication control. 1,200 people with diabetes participated in the study, of whom almost 40% were insulin-treated. The rest of the sample adhered to specific diets with some of them additionally taking non-insulin oral antidiabetics, while others relied on diet alone.

The results showed that many participants (71.3%) could answer food-related questions correctly, and that more than four out of five respondents demonstrated good knowledge of the positive impact of physical activity. More than 75% of respondents also knew about the best method for testing blood sugar levels.

In other areas, however, the researchers found that knowledge was severely lacking. For example, when asked which food item should not be used to treat low blood sugar levels, only 12.8% of participants answered correctly. The lowest percentage (4.4%) of correct answers was on a question concerning the symptoms of ketoacidosis, a potentially life-threatening, late-stage T2D complication.

 “One of the main reasons for this disparity in knowledge is probably the behavior of health professionals and the areas that are prioritized when informing patients,” Lopes Ferreira explained.

Equipping patients with knowledge

The researchers found that the use of medication was one factor that impacted T2D knowledge. The percentage of correct answers was 51.8% for non-insulin treated patients, and 58.7% for patients using insulin. Looking at socioeconomic and demographic factors, being younger than 65 years, having a higher education, not living alone, and following a specific diet had a positive impact on disease knowledge.

The researchers said that their results highlight the need to improve T2D knowledge about certain aspects of the disease, for example blood sugar monitoring, which can help to avoid spikes in blood sugar levels that are associated with acute and chronic complications. Knowledge gaps within individual sections of the test are also something that needs to be addressed urgently, the team pointed out.

They also stated that studies with even more participants could help to better understand the role of the socioeconomic and clinical determinants of the disease. “We focused on patients’ own knowledge of their disease, rather than disease management being based solely on biological indicators. We hope that the results obtained will allow professionals to change the way they inform patients,” Lopes Ferreira concluded.

Rising focus on ‘inceptor’ as a type 2 diabetes therapeutic target

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Insulin-producing beta cells in the islet of Langerhans.

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Insulin-producing beta cells in the islet of Langerhans.  CREDIT Helmholtz Munich | ©Erik Bader

Research targeting the insulin-inhibitory receptor, called inceptor, unveils promising avenues for beta cell protection, offering hope for causal diabetes therapy. A novel study in mice with diet-induced obesity demonstrates that the knock-out of inceptor enhances glucose regulation, prompting its further exploration as a drug target for type 2 diabetes treatment. These findings, led by Helmholtz Munich in collaboration with the German Center for Diabetes Research, the Technical University of Munich, and the Ludwig-Maximilians-University Munich, drive advancements in diabetes research.

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Targeting Inceptor to Combat Insulin Resistance in Beta Cells

Insulin resistance, often linked to abdominal obesity, presents a significant healthcare dilemma in our era. More importantly, the insulin resistance of beta cells contributes to their dysfunction and the transition from obesity to overt type 2 diabetes. Currently, all pharmacotherapies, including insulin supplementation, focus on managing high blood sugar levels rather than addressing the underlying cause of diabetes: beta cell failure or loss. Therefore, research into beta cell protection and regeneration is crucial and holds promising prospects for addressing the root cause of diabetes, offering potential avenues for causal treatment.

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With the recent discovery of inceptor, the research group of beta cell expert Prof. Heiko Lickert has uncovered an interesting molecular target. Upregulated in diabetes, the insulin-inhibitory receptor inceptor may contribute to insulin resistance by acting as a negative regulator of this signaling pathway. Conversely, inhibiting the function of inceptor could enhance insulin signaling – which in turn is required for overall beta cell function, survival, and compensation upon stress.

In collaboration with Prof. Timo Müller, an expert in molecular pharmacology in obesity and diabetes, the researchers explored the effects of inceptor knock-out in diet-induced obese mice. Their study aimed to determine whether inhibiting inceptor function could also enhance glucose tolerance in diet-induced obesity and insulin resistance, both critical pre-clinical stages in the progression toward diabetes. The results were now published in Nature Metabolism.

Removing Inceptor Improves Blood Sugar Levels in Obese Mice

The researchers delved into the effects of removing inceptor from all body cells in diet-induced obese mice. Interestingly, they found that mice lacking inceptor exhibited improved glucose regulation without experiencing weight loss, which was linked to increased insulin secretion in response to glucose. Next, they investigated the distribution of inceptor in the central nervous system and discovered its widespread presence in neurons. Deleting inceptor from neuronal cells also improved glucose regulation in obese mice. Ultimately, the researchers selectively removed inceptor from the mice’s beta cells, resulting in enhanced glucose control and a slight increase in beta cell mass.

Research for Inceptor-Blocking Drugs

“Our findings support the idea that enhancing insulin sensitivity through targeting inceptor shows promise as a pharmacological intervention, especially concerning the health and function of beta cells,” says Timo Müller. Unlike intensive early-onset insulin treatments, utilizing inceptor to enhance beta cell function offers promise in alleviating the detrimental effects on blood sugar and metabolism induced by diet-induced obesity. This approach avoids the associated risks of hypoglycemia-associated unawareness and unwanted weight gain typically observed with intensive insulin therapy.

“Since inceptor is expressed on the surface of pancreatic beta cells, it becomes an accessible drug target. Currently, our laboratory is actively researching the potential of several inceptor-blocking drug classes to enhance beta cell health in pre-diabetic and diabetic mice. Looking forward, inceptor emerges as a novel and intriguing molecular target for enhancing beta cell health, not only in prediabetic obese individuals but also in patients diagnosed with type 2 diabetes,” explains Heiko Lickert.

Red light can reduce blood glucose levels, says study

Red light can reduce blood glucose levels, says study
Red light can reduce blood glucose levels, says study

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The researchers found that 670 nanometres (nm) of red light stimulated energy production within mitochondria, the tiny powerhouses within cells, leading to increased glucose consumption. In particular, it led to a 27.7% reduction in blood glucose levels following glucose intake, and it reduced maximum glucose spiking by 7.5%.

While the study was conducted in healthy individuals, the non-invasive, non-pharmacological technique can impact diabetes control after meals, as it can reduce damaging fluctuations of blood glucose in the body that contribute to ageing.

The study also highlights the significant long-term consequences for human health, including the potential dysregulation of blood sugars posed by lengthy exposure to blue light. Given the prominence of LED lighting and the fact that LEDs emit towards the blue end of the spectrum with very little red, the authors suggest this may be a potential public health issue. The research has been published in the Journal of Biophotonics.

Mitochondria provide energy for vital cellular processes, using oxygen and glucose to produce the energy-rich nucleoside adenosine triphosphate (ATP). Previous research has established that long-wavelength light between approximately 650-900 nm (spanning the visible through to the near-infrared range) can increase mitochondrial production of ATP, which reduces blood glucose and also improves health/lifespan in animals. 

The authors Dr Michael Powner, Senior Lecturer in Neurobiology in the School of Health & Psychological Sciences at City, and Professor Glen Jeffery, Professor of Neuroscience in the UCL Institute of Ophthalmology, also say that this improvement in ATP production can cause signalling changes that are transmitted throughout the body.

They suggest that it may be mediating the abscopal effect, which refers to the phenomenon in cancer treatment where specific irradiation of a primary tumour can result in shrinkage of secondary tumours located in a different part of the body. Likewise, 670 nm light shone selectively on to the backs of mice in previous studies has been shown to result in improvements in ATP that improve symptoms in both a model of Parkinson’s disease and a model of diabetic retinopathy.

To explore the impact of 670 nm red light on blood glucose, the researchers recruited 30 healthy participants, who were then randomised into two groups: 15 in the 670 nm red light group, and 15 in the placebo (no light) group. They had no known metabolic conditions and were not taking medication.

Participants were then asked to do an oral glucose tolerance test and record their blood glucose levels every 15 minutes over the next two hours. People who received red light exposure 45 minutes prior to drinking glucose exhibited a reduced peak blood glucose level and reduced total blood glucose during the two hours. 

Dr Powner, who was the lead author of the study, said:

“It is clear that light affects the way mitochondria function and this impacts our bodies at a cellular and physiological level. Our study has shown that we can use a single, 15-minute exposure to red light to reduce blood sugar levels after eating.

“While this has only been done in healthy individuals in this paper, it has the potential to impact diabetes control going forward, as it could help to reduce potentially damaging glucose spikes in the body after meals.”

Professor Jeffery said:

“Sunlight has a balance between red and blue, but we now live in a world where blue light is dominant because although we do not see it, LED lights are dominant in blue and have almost no red in them. This reduces mitochondrial function and ATP production. Hence our internal environments are red-starved. Long-term exposure to blue light is potentially toxic without red. Blue light on its own impacts badly on physiology and can drive disrupted blood sugars that may in the long run contribute to diabetes and undermine health spans.

“Pre-1990, we all had incandescent lighting which was OK because it had the balance of blue and red similar to sunlight, but there is a potential health span time bomb in the change to LEDs in an ageing population. This can partly be corrected by spending more time in sunlight.”

Focus on patient experience can improve diabetes care.

Position statement reflects consensus of medical organizations and patient advocates
Position statement reflects consensus of medical organizations and patient advocates

Healthcare providers who treat diabetes need to think beyond the clinical numbers, such as solely focusing on a person’s glucose goals. Taking the patient experience into account can improve the quality of care and facilitate the attainment of treatment goals, according to a new position statement published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism.



The position statement reflects the consensus of two virtual roundtables the Endocrine Society held in 2022. Participants included representatives from the American College of Cardiology, American College of Physicians, American Diabetes Association®, Association of Diabetes Care & Education Specialists, Diabetes Technology Society, the U.S. Centers for Disease Control and Prevention, diabetes research organization dQ&A, and patient advocacy organizations DiabetesSisters, Close Concerns, and Taking Control of Your Diabetes.



More than 500 million people worldwide have diabetes, which occurs when the pancreas doesn’t make enough insulin or when the body can’t respond to insulin properly, resulting in high levels of glucose in the blood (blood glucose). Managing this chronic disease requires making lifestyle changes throughout life, which can be burdensome for people living with diabetes and their caregivers. Daily tasks such as blood glucose monitoring, dietary and exercise management, routine preventive care scheduling, and medication management must be overseen by people living with diabetes themselves.

Effective two-way communication between people with diabetes and their healthcare providers helps establish a shared understanding of the treatment plan and goals. Healthcare providers who take the time to explain treatment options and discuss potential barriers can improve patient satisfaction and clinical outcomes. In addition, healthcare providers need to consider each patient’s level of health literacy and cultural background when discussing treatment options.

“Many existing educational resources are available to help health care providers think through ways they can discuss diabetes treatment in a neutral and nonjudgmental way and practice using those strategies,” said Rita R. Kalyani, M.D., M.H.S., Professor of Medicine in the Division of Endocrinology, Diabetes, & Metabolism at Johns Hopkins University School of Medicine, who chaired the position statement and represented the Endocrine Society during the consensus roundtables. “However, in the ever-changing landscape of diabetes and its management, both health care providers and people with diabetes will continue to need new and evolving tools to help address the common challenges they face.”

People with diabetes face an elevated risk of developing depression, anxiety, and other mental disorders. This makes understanding the psychosocial impact of diabetes important. Addressing stressors in the health care setting and ensuring timely mental health referrals, when appropriate, can help individuals with diabetes feel more comfortable and help them participate more fully in their appointments and care.

Each section in the position statement begins with a common clinical scenario that illustrates key gaps in diabetes care. Readily accessible graphics and tools that health care providers can use to deliver patient-centred care are also included.

The position statement offers a framework for leveraging the experiences of people with diabetes to optimize health outcomes in several important areas, including:

  • Use of person-centred language in the health care setting
  • Ensuring referrals to diabetes self-management and support service programs are timely and accessible to all people with diabetes.
  • Effectively navigating available therapeutic options together and explaining complex regimens to people with diabetes to encourage them to take medication as prescribed.
  • Consider ways to adjust an individual’s treatment plan promptly if they aren’t meeting therapeutic goals to prevent therapeutic inertia.
  • Discussing strategies for assessment of hypoglycemia—low blood glucose episodes that can be dangerous—as well as prevention and treatment of hypoglycemia.
  • Improving cardiovascular and renal outcomes using newer therapeutic options.
  • Using telehealth in the appropriate clinical setting.
  • Using and incorporating diabetes technologies such as insulin pumps and continuous glucose monitoring systems into the diabetes management plan, when appropriate.