Type 2Diabetes: Lifestyle and Diet

By Judith A DeCava, LNC, CNC. Nutritional News and Views, July/August 2014, Volume 18, No 4

Lifestyle is the foremost and often only cause of T2D. Studies show that intensive lifestyle intervention is very effective in preventing T2D and improving the health of people with diabetes. Early diabetes can be overcome. Because T2D “is largely rooted in reversible social and lifestyle factors, a medical approach alone is unlikely to be the solution”. Sadly, in “this respect, medicine might be winning the battle of glucose control, but is losing the war against diabetes.” Dr Osama Hamdy, MD, PhD, a medical director in Boston stated: “We’ve been treating diabetes for 40 years by adding more and more medications, with no big improvements. But if you act early,  keep the weight off, and maintain a healthy lifestyle, you can put this disease in remission forever”. Research supports “the idea that significant improvements in health may be attained through lifestyle adjustments”. A healthful diet and exercise have been shown to beat drugs for improving fitness, glycemic control, insulin sensitivity, blood fats and cardiovascular risk factors. Exercise quickly lowers blood sugar. When muscles are exercising, glucose and other nutrients can enter muscle cells even in the absence of insulin. Both aerobic and resistance (weight training) exercises reduce HbA1c, improve insulin resistance and glycemic control, increase muscle mass, decrease artery-wall thickening and reduce adiposity. Poor sleep patterns or sleep deprivation can impair glucose metabolism and lower control of blood sugar levels; improving sleep patterns improves long-term outcomes. Diet, exercise and improved sleep are all important for significant weight loss which improves glycemic control, insulin sensitivity and cardiovascular risk factors and lessens or eliminates the need for drugs to lower blood sugar, blood pressure and blood fats.

DIET. T2D is associated with modern processed-foods; it is rarely seen in cultures relying on a more traditional diet and way of life. Eating whole natural foods (predominantly organic and non-GMO) to optimize nutrient status can have profound effects. The quality and source of foods influence all biological systems involved in insulin resistance and T2D. Avoid: refined sugars like sucrose, corn syrup, high-fructose corn syrup; soda and other refined and highly-processed items including white rice, white bread, processed meats, refined salt, and the like. Artificial sweeteners disturb areas of the brain that control appetite and satiety and cause other imbalances. Include: plenty of fresh vegetables and fruit (restricting fruit does not improve glycemic control), legumes (lower glucose and insulin), whole grains, nuts and seeds (help glucose control, reduce HbA1c and LDL cholesterol), and dairy products (certified raw milk products, yogurt and aged cheeses are best; whey reduces post-meal blood sugar spikes). There is a direct link between fiber -soluble and insoluble- and the glycemic response to specific foods. Foods containing fiber are vegetables, fruits, whole grains and legumes; fiber supplements such as insulin or psyllium are also helpful. The recommended amount of fiber is 25 to 35 grams per day; few Americans consume that much. Many traditional cultures ate 3 to 5 times as much.

There is a huge difference between natural, whole nutrient-dense foods and refined, over-processed, bogus, chemicalized nonfoods. The latter are often loaded with added refined or artificial sweeteners and other refined carbohydrates, contain various artificial ingredients, are low in nutrients, low in fiber, usually digested quickly so fewer calories are burned, often contain altered or refined or fake fats, and tend to be addictive (leading to overconsumption). The American Diabetes Association recently updated its nutrition guidelines for diabetics. Rather than a one-size-fits-all diet, the new recommendations favor individualized  plans that take into account a person’s lifestyle and metabolic needs. Previously a diabetic diet dictated how many grams of carbohydrates, protein and fats that should be consumed each day based on the person’s weight. It is now conceded that there is no ideal amount of these nutrients for everyone and each person should have a dietary strategy that is best suited for him or her. Whole grains, fruits, vegetables, legumes and dairy products provide carbohydrates that are less likely to produce spikes in blood glucose levels. Foods and beverages that contain added refined sugars, refined grains, etc, are “more likely to cause fluctuations in blood glucose and they are often “empty calorie” foods that contribute little to nothing in the way of valuable nutrients”. No news to us.

Protein/Fat/Carbohydrates. Research results regarding high-protein, high-fat, or high-carbohydrate diets versus low-protein, low-fat, or low-carbohydrate diets vary. Some studies show that a low-carbohydrate, high-protein diet improves glycemic control, improves insulin sensitivity, increases plasma glucagon, lowers insulin and triglycerides. But fiber intake is low. Other studies find that low-carbohydrate Mediterranean style diets result in better glycemic control and less need for diabetic drugs than low-fat diets. Some studies show that high-carbohydrate, low-proein and moderate or low-fat diets improve glycemic control and insulin resistance. Low-fat vegetarian diets (that restrict refined sugars) can lower fasting glucose, weight, blood pressure, HbA1c, total and LDL cholesterol. Some research indicates that consumption of excess fat impairs insulin receptors. Other studies report that eating lots of red meat -especially processed meats- increases T2D risk. A low-fat, high-fiber diet may promote weight loss without causing unfavorable alterations in blood fats or glycemic conrol. Natural, unaltered fats (such as fish, nuts, unrefined oils, butter) can reduce blood sugar and insulin levels. Omega-3 fats are beneficial, no doubt because most people consume excessive omega-6 fats from refined vegetable oils and commercial meats that contain less omega-3s than pasture raised meats. Some research condemns saturated fats, others simply condemn high amounts of fats. There is research showing that either low-fat diets don’t cause adverse glycemic effects or do  cause adverse glycemic effects. Mary G Enig, PhD, explains that, in most studies, the actual amount of saturated or polyunsaturated or trans fats in diets is not measured. What occurs to people who eat a diet high in natural saturated fats compared to those eating a lot of refined vegetable oils is not explored. Saturated fats have no effect when appropriate comparisons are made.” T2D was unheard of a hundred years ago when people’s diets were rich in saturated fats. When people eat less saturated fat, they end up eating more detrimental trans-fats. Trans fats are being eliminated from processed foods but are often replaced by just-as-bad contrived fats. the amount of carbohydrates, protein and fat needed vary with the individual. “The nutrient composition of the diet should be individualized”.

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