Nutritional Therapy for strengthening Immunity in Diabetes

World Health Day provides an opportunity to raise awareness on some important health issues like communicable and non-communicable diseases. Non - communicable diseases such as diabetes, cancer, cardiovascular diseases – arguably represent the biggest threat to health worldwide¹. When it comes to Diabetes, India is the second most affected country in the world after China². One in six people (17%) in the world with diabetes is from India².

Diabetes and related conditions such as gestational diabetes mellitus (GDM) and diabetes fatigue syndrome (DFS)affect the patient’s immune system.^3,6,7  Evidence suggests that balanced and adequate nutrition with minerals, proteins, and antioxidants, contributes to strengthening immunity.⁴ This article reviews the role of nutritional therapy, particularly protein intake on building immunity in diabetics.

Diabetes-related complications and immunity
Diabetes is a major public health concern that affects around 8.9% of the adult population in India.^3,8   Evidence suggests that diabetes impairs the patient’s immune system through the following mechanisms.³

• Defects in phagocytosis
• Dysfunction of immune cells
• Reduction in cytokine production
• Failure to kill pathogens

Fatigue is a common complaint in patients with diabetes. Fatigue and diabetes share a bidirectional relationship, both feeding and deteriorating each other, thereby generating the vicious cycle of DFS. It was found that disease-related fatigue is associated with impaired immune function.^7,9
Diabetes during pregnancy or GDM is a prevalent problem of pregnancy, often characterized by glucose intolerance and enhanced insulin resistance. Besides, the condition also significantly affects the immune system.⁶

Impact of DFS and GDM on patient’s immunity(Table 1)^6,7
Table 1: Effect of GDM and DFS on various immune functions. (Adapted from Hab et al., 2019, Sifnaios et al., 2019)

Nutritional therapy to maintain immune function in diabetes
Nutrition therapy is the cornerstone adjunctive treatment in diabetes patients. People with poorly controlled glycemic levels may have a higher risk of micronutrient deficiency and a thereby higher risk of a weak immune system.¹³ An adequate diet containing protein, fiber, low fat, minerals, and vitamins not only controls blood glucose levels but also helps in strengthening immunity.^4,11-12
Role of Nutritional therapy in building immunity
Nutrients, including macro and micro-nutrients, have shown a significant impact on the development of the immune system.
Protein
Protein is the skeleton of the body’s defense systems; various immune functions depend on the production of active protein compounds. Evidence suggests that protein metabolism plays a vital role in the development of innate and acquired immunity against infections.⁴
Amino acids or protein help in building immunity by regulating:¹⁴

Owing to the association between protein and immune function, consumption of protein hydrolysates could help in managing altered immune response and problems associated with it.¹⁵
Fiber
Dietary fiber improves immune function and prevents various diseases including diabetes. It acts as prebiotics that promote the growth of beneficial bacteria such as bifidobacteria and lactobacillus in the intestine. These microorganisms produce short-chain fatty acids and activate the immune system by affecting natural and specific immunity.^4,11
Fat
Fat acids also have immunomodulatory properties:⁴

• Linoleic acid: Reduces allergic sensitization
• Poly-unsaturated fatty acids: Control cellular immune responses and reduces inflammatory reactions.

Micronutrients

Micronutrients play a vital role in maintaining immune system function (Figure 1). Their deficiency negatively affects immune functions and increase the risk of infection.¹⁶

Figure 1: Overview of the role of micronutrients in developing immune system(Adapted from Maggini et al., 2018)¹⁶


Conclusion
Nutrients such as protein, fiber, and micronutrients play an important role in developing immunity; therefore, their intake could help in managing diabetes and related complications.^4,16
World Health Day reminds us that we all have a role to play – individually to replace unhealthy lifestyle choices with healthy ones and collectively to raise awareness of NCDs, to advocate for policies and regulations that support health-promoting behaviors.
References

1. World Health Day: Taking the fight to NCDs. https://www.mottmac.com/views/world-health-day-taking-the-fight-to-ncds. Website visited on 30th March 2021.
2. www.wikipedia.org. Diabetes in India. Website visited on 30th March 2021.
3. Berbudi A, Rahmadika N, Cahyadi AI, Ruslami R. Type 2 Diabetes and its Impact on the Immune System. Current diabetes reviews. 2019 Oct;16(5):^442-449.
4. Karacabey K, Ozdemir N. The effect of nutritional elements on the immune system. Journal of Obesity and Weight Loss Therapy.2012 Nov;2 (9):152.
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6. Sifnaios E, Mastorakos G, Psarra K, Panagopoulos ND, Panoulis K, Vitoratos N, Rizos D, Creatsas G. Gestational diabetes and T-cell (Th1/Th2/Th17/Treg) immune profile. in vivo. 2019 Jan;33(1):31-40.
7. Haß U, Herpich C, Norman K. Anti-Inflammatory Diets and Fatigue. Nutrients. 2019 Oct;11(10):2315.
8. International Diabetes Federation. IDF center of education [Internet][Cited 2020 June 18]. Available from https://idf.org/our-network/regions-members/south-east-asia/members/94-india.html/.
9. Kalra S, Sahay R. Diabetes fatigue syndrome. Diabetes therapy. 2018 Aug; 9(4):1421-1429.
10. Kim C. Gestational diabetes: risks, management, and treatment options. International journal of women's health. 2010Oct;2:339-351.
11. Anderson JW, Baird P, Davis RH Jr, et al. Health benefits of dietary fiber. Nutr Rev. 2009 Apr;67(4):188-205.
12. Gannon MC, Nuttall FQ, Saeed A, Jordan K, Hoover H. An increase in dietary protein improves the blood glucose response in persons with type 2 diabetes. The American journal of clinical nutrition. 2003 Oct 1;78(4):734-741.
13. Evert AB, Dennison M, Gardner CD, Garvey WT, Lau KH, MacLeod J, Mitri J, Pereira RF, Rawlings K, Robinson S, Saslow L. Nutrition therapy for adults with diabetes or prediabetes: a consensus report. Diabetes Care. 2019 May;42(5):731-54.
14. Li P, Yin YL, Li D, Kim SW, Wu G. Amino acids and immune function. British Journal of Nutrition. 2007 Aug;98(2):237-252.
15. Kiewiet MB, Faas MM, De Vos P. Immunomodulatory protein hydrolysates and their application. Nutrients. 2018 Jul;10(7):904.
16. Maggini S, Pierre A, Calder PC. Immune function and micronutrient requirements change over the life course. Nutrients. 2018 Oct;10(10):1531.