Are you a victim of ‘hidden hunger’? Common diet mistakes ‘increase your risk of type 2 diabetes’

DIET plays a crucial role in preventing disease.

Time and time again, people with diets rich in vegetables and fruit have been found to have significantly lower risk of obesity, heart disease, stroke and certain types of cancer.

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And the same may be said for diabetes, with a new study linking 'hidden hunger' to development of the condition.

'Hidden hunger' is the presence of multiple nutritional deficiencies.

The term means a diet that may be high enough in calories and energy, but low in necessary nutrients.  

This lack of essential vitamins and minerals could increase the risk of type 2 diabetes, according to new research published in the open access journal BMJ Nutrition Prevention & Health.

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Genetic predisposition, various environmental factors, sedentary lifestyle, and unhealthy diet and obesity are all risk factors of type 2 diabetes.

To measure the global prevalence of nutrient deficiency in people with the condition, the researchers looked at research databases for relevant studies and pooled the data.

They looked at 132 studies, which involved 52,501, and published between 1990 and 2023.

Their analysis showed micronutrient deficiency among people with type 2 diabetes varied around the world, possibly due to diverse dietary habits, lifestyle habits, cultural practices, said the researchers.

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Overall, the global prevalence was 45 to 40 per cent in those who had type 2 diabetes complications.

Vitamin D was the most common micronutrient deficiency, affecting 60.5 per cent of those with the condition.

Vitamin D sources include oily fish and eggs.

Magnesium deficiency was also common, affecting 42 per cent, and iron deficiency was seen in 28 per cent of participants.

The former is found in foods like kale and brown rice, while the latter can be obtained from red meat, nuts and beans.

Deficiency in vitamin B12 - found in mostly animal foods like meat and dairy - was as common as 29 per cent, and higher among patients taking metformin - a medicine used to treat type 2 diabetes.

'Hidden hunger' was 49 per cent higher in women than in men, and highest among patients in the Americas.

"This systematic review exemplifies the double burden of malnutrition in action, whereby nutritional deficiencies and diet-related non-communicable diseases, such as type 2 diabetes, co-exist," said Shane McAuliffe, Visiting Senior Academic Associate, NNEdPro Global Institute for Food, Nutrition and Health, which co-owns the journal.

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"The treatment of type 2 diabetes often tends to focus on energy metabolism and macronutrients, but the identification of a higher prevalence of specific micronutrient deficiencies in those affected is a reminder that optimising overall nutrition should always be a priority.

"The findings should help to focus research and policy initiatives aimed at furthering our understanding of the causes and effects of these deficiencies and the potential for targeted and tailored interventions."

The researchers did caution it wasn't clear whether the micronutrient deficiencies preceded poor glycaemic control or was a consequence of it.

This means they can't say whether they are the cause of diabetes, or an effect of it.

They were also unable to draw comparisons between patients with type 2 diabetes and the general population.

Previous research has suggested micronutrients,  vitamins and minerals have a key role in type 2 diabetes development by potentially affecting glucose metabolism and insulin signalling pathways.

How to avoid hidden hunger

To avoid hidden hunger you should prioritise a balanced diet by eating a variety of foods from all food groups, including plenty of fruits, vegetables, whole grains, lean protein, and dairy products.

It's also worth looking at the best sources of vitamin D, magnesium, iron and vitamin B12 to include in your diet so you can avoid these deficiencies.

Vitamin D

Vitamin D plays an important role in the body by regulating levels of calcium and phosphate - nutrients needed to keep bones, teeth, and muscles healthy.

The vitamin has also been shown to help type 2 diabetes  by improving insulin sensitivity and reducing inflammation.

The best way to get vitamin D is when the body creates it from direct sunlight.

But it's also found in a small number of foods:

• Oily fish – such as salmon, sardines, herring and mackerel
• Red meat
• Liver (avoid liver if you are pregnant)
• Egg yolks
• Fortified foods – such as some fat spreads and breakfast cereals

The UK government recommends that people take a daily vitamin D supplement from October to March, when sunlight levels are at their lowest.

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Magnesium

Magnesium is a nutrient essential for healthy muscles, nerves, bones and blood sugar levels.

The best food sources are:

• Green leafy vegetables e.g. kale/spinach/cabbage/brocolli
• Nuts
• Brown rice
• Bread (especially wholegrain)
• Fish
• Meat
• Milk and dairy products

Iron

Iron is a mineral that's essential for many bodily functions, including oxygen transport, growth, and development.

Iron deficiency anaemia can affect hemoglobin A1c (HbA1c) levels, which are used to monitor blood sugar control. 

The best sources of iron include:

• Liver
• Red meat
• Beans, such as red kidney beans, edamame beans and chickpeas
• Nuts
• Dried fruit – such as dried apricots
• Fortified breakfast cereals
• Soy bean flour

Vitamin B12

Vitamin B12 deficiency helps with the production of red blood cells, nerve function, and DNA synthesis.

Vitamin B12 deficiency can occur in type 2 diabetes, primarily due to the common use of metformin, a medication used to treat the condition, which can interfere with the absorption of vitamin B12 in the intestines, leading to a deficiency even if dietary intake is adequate.

The best sources of B12 are:

• Meat
• Fish
• Milk
• Cheese
• Eggs
• Some fortified breakfast cereals

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Vegans can get vitamin B12 from fortified foods, supplements, and some plant-based foods.

Alongside poor diet choices, there are a number of other risk factors linked to type 2 diabetes...