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Are meal replacement products good for patients with Type 2 diabetes?

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The 2013 Canadian Diabetes Association’s Clinical Practice Guidelines included the use of meal replacement products for the first time. Now they are seen as a possible useful weight management tool.

By Shelley Diamond, BScPhm

Illustration by Martin Bregman

The guidelines acknowledge that for people with type 2 diabetes, substituting meal replacement products for regular food at one to two meals per day can help with weight management. This in turn can result in improved blood glucose levels as well as a reduction in antihyperglycemic medication.

Why are meal replacement products a good choice for some people struggling with weight reduction strategies?

Meal replacement products have the following benefits:
• Removal of food choice and avoidance of bad food selections
• Premeasured amount of food with a known caloric content, thus negating the need to measure or weigh meals or to estimate portion sizes
• Easy and effective way to get the recommended micronutrients, which can be a challenge for some popular diet plans over time
• Easy option on the run that requires little or no preparation and cleanup

Is there any evidence that meal replacement products work?

Several studies demonstrate the benefits of using meal replacement products for weight loss. One key study by Heymsfield SB et al showed that at one year, there was a 7-8% weight reduction using the meal replacement plans compared to 3-7% for those using natural food.

Another well-known study, Look AHEAD, also showed that those who had most closely followed the meal replacement regimen were four times more likely to have reached the study’s 7% weight loss goal than those who used the fewest meal replacements.

Are there any limitations of meal replacement products?

Relying on replacement products on a regular basis may interfere with learning to alter healthy eating patterns such as selecting appropriate portion size. As well, these products over time can become monotonous for those who like variety in food. In addition, some meal replacement products are formulated with sugar alcohols that may cause bloating and diarrhea.

What to look for in a meal replacement product

Most products include a balance of protein, fat, and carbohydrate (including fibre), as well as a substantial level of the daily requirements of essential vitamins and minerals.

• Review the carbohydrate content as some may have a smaller amount than provided with regular eating and may require adding extra foods to make up for the difference
• Aim for low saturated fat and no trans fat
• Include the sodium content in the total daily intake
• Determine the calories in a serving size (usually 190-250 calories)

Additional recommendations for your patients

1. Use meal replacement products as part of a comprehensive multidisciplinary weight management program.
2. Monitor blood glucose levels, since when starting to use a meal replacement product, blood glucose patterns may change. In addition, adjust diabetes medications as required.
3. When using meal replacement products, consider adding a 100-200 calorie snack (e.g. fruits and nuts) at breakfast, lunch or as a snack.
4. For long-term weight maintenance, consider meal replacement products combined with exercise to help get back on track for patients who start to regain weight.

In summary, meal replacement products may be a useful weight management tool to improve outcomes, in conjunction with conventional weight loss plans. With your advice on how to use them optimally and suggested monitoring, chances of successful weight management can become a reality.

Pharmacist Shelley Diamond is president, Pedipharm Consultants, and co-founder/president, Diabetes Care Community Inc.