We continue to have an epidemic of type II diabetes and its impact on health is dramatic, imposing tremendous demands on our medical system and leading to very significant compromises in physical functioning. The paradox is that this common medical condition is mostly preventable through lifestyle change and most integrative medicine practitioners are able to provide helpful guidance in just how to alter our lifestyle to prevent type II diabetes. Type I diabetes is a substantially different condition as is gestational diabetes. One of the most formidable challenges has to do with behavioral change; just how is it that we can be change agents to help people to move beyond the discussion and act in a way that prevents this disease? Here is some recent research that may be helpful to those of you who are interested in preventing or correcting this disease. This information addresses both primary prevention and secondary prevention measures. 

 

Some 2015 research indicated that almost half of US adults have type II diabetes or prediabetes. Researchers looked at more than 25,000 participants from the National Health and Nutrition Examination Survey (NHANES) study. Results from the 2011 – 2012. Indicated that up to 14% of adults have diabetes while 38% had prediabetes. Interestingly, of those with diabetes, 36% went undiagnosed. African-Americans, Hispanics, and Asians had the highest disease rates. Importantly, researchers pointed out that trends in diabetes rates tended to mirror obesity rates, a major risk factor for diabetes. 

The cost of diabetes medications is very significant, and can cost up to $10,000 per year, per person. Researchers looked at the per capita medical spending of people with and without a diabetes diagnosis over a four-year period. Those people with diabetes increased their costs by $1000-$15,000 per capita. Out-of-pocket costs for those with diabetes were 2.5% higher than those without diabetes. Diabetes drugs are more expensive than any other traditional prescription, probably due to branded products, most notably insulin. 

Also, if you suffer from multiple chronic medical conditions such as diabetes, heart disease, or stroke, you increase your risk of dying prematurely. Researchers looked at mortality rates in the Emerging Risk Factors Collaboration Study for 689,300 participants and compared these to almost  

500,000 participants from the UK Bio Bank. Those with diabetes, heart disease and stroke history had up to four times the mortality rate compared to those with one or two of these conditions. Participants who were over 60 years old with two or three of these conditions had reductions in life expectancy of 12 to 15 years. 

A three-year-old girl was diagnosed with type II diabetes! Her family had a history of obesity but not diabetes. At home her diet was one of unrestricted calories and fat. She had a high body mass index and a hemoglobin A1c of 7.2. Her treatment consisted of an aggressive nutrition intervention and medication; she was able to gradually stop her medication, drop her A1c to  5.3 and lost 25% of her weight. 

REF: 1) Shakiba P, Frost A. ‘Per capita health care spending on diabetes: 2009-2013.’ Health Care Cost Institute. 2015. 2) Menke A, Casagrande S, Geiss L, Cowie CC. ‘Prevalence of and trends in diabetes among adults in the United States, 1988-2012.’ JAMA. 2015. 3) Emerging Risk Factors Collaboration, Di Angelantonio E, Kaptoge S, et al. ‘Association of cardiometabolic multimorbidity with mortality.’ JAMA. 2015. 4.) Yafi M, Collins K.

 ‘A toddler with type 2 diabetes. Case-study presented at: European Association for the Study of Diabetes Annual Meeting;’ September 17, 2015: Stockholm. 

Saturated fat appears to impair both insulin secretion and insulin action, both being primary contributions to type 2 diabetes. A rather profound research finding is that by the age of 20 we likely have all of the insulin producing beta cells in our pancreas that we are ever going to have; secondly, if we lose these beta cells we may lose them for good. Thirdly, autopsy studies show that by the time type II diabetes is diagnosed we may have already killed off half of our beta cells, the insulin producing cells in our pancreas. So, when these human beta cells are exposed to saturated fat, they can start dying off at a significant rate. Also, the uptake of bad cholesterol, LDL, can also cause this beta cell death issue because of free radical damage. 

So, eating regimens high in saturated fat not only cause obesity and insulin resistance, but also increase the levels of circulating free fats in the blood called NEFAs (non-esterified fatty acids) that cause beta cell death and may also contribute to progressive beta cell loss in type II diabetes. These toxic fats are mainly found in meat and dairy products; chicken and cheese are the two main sources in the American diet. Interestingly, the plant-based fats found in olives, nuts, and avocados appeared not to be toxic. Also, these same saturated fats are especially damaging to liver cells, resulting in the formation of fatty liver disease.  So, in the treatment of type II diabetes, if we cut down significantly on the consumption of saturated fat from animal-based foods, there may be much less need for all the excess insulin. And, it appears to be clear that even independent of weight issues, alcohol use and exercise levels, the incidence of diabetes is significantly related to the proportion of saturated fat in our blood, in our diet. 

REF: 1) J Cao, X X Feng, L Yao, B Ning, Z X Yang, D L Fang, W Shen. ‘Saturated free fatty acid sodium palmitateinduced lipoapoptosis by targeting glycogen synthase kinase-3β activation in human liver cells.’ Dig Dis Sci. Feb,2014.  2) A K Leamy, R A Egnatchik, J D Young. ‘Molecular mechanisms and the role of saturated fatty acids in the progression of non-alcoholic fatty liver disease.’ Prog Lipid Res. 2013 Jan.

 

We continue to see a lot of diabetic retinopathy, the leading cause of blindness in American adults. And, even with intensive diabetes treatment, with frequent insulin injections, implantable insulin pumps and the like, the best we can offer is usually just a slowing of the progression of the disease. However, a half century ago Dr. Walter Kempner, a renowned physician – scientist demonstrated that we can halt the progression and even reverse this retinopathy with a simple but potent plantbased diet consisting of white rice and fruit. with strikingly favorable results: a rapid reduction in blood pressure, rapid improvement in kidney failure, eye pressure, heart failure and other manifestations of this previously fatal illness. 

Kempner started out using his plant-based ultra-low sodium/fat/cholesterol/protein rice diet to reverse kidney and heart failure, but assumed it would make diabetes worse. He expected a 90% carbohydrate diet would increase insulin requirements, however the opposite proved to be true. He just took the next 100 patients with diabetes that walked through his door that went on the rice diet for at least three months, and their fasting blood sugars dropped despite a drop in the insulin they were taking. But this is what blew people away: 44 of the patients had diabetic retinopathy, and in 30% of the cases their eyes improved. Diabetic retinopathy had been considered a sign of irreversible destruction. We've since learned that though dietary means alone, we can reverse the blindness. But instead of learning, current traditional medicine seems to have forgotten! 

Ref: 1) W Kempner. ‘Scientific publications by Walter Kempler. Volume II: Radical Dietary treatment of vascular and metabolic disorders.’ 2014. Gravity Press; 2) W Kempner.’ Radical dietary treatment of hypertensive and arteriosclerotic vascular disease, heart and kidney disease, and vascular retinopathy.’ GP. 1954 Mar; 3) E H Estes, L Kerivan. ‘An archaeologic dig: a rice-fruit diet reverses ECG changes in hypertension.’ J Electrocardiol. 2014 Sep.  

 

The prevention of diabetes is obviously a critical issue given that it is the number one cause of adult onset blindness, the number one cause of kidney failure, and the number one cause of surgical amputations; it is  often preceded by a condition called prediabetes where the  person has a blood sugar level higher than normal, but not high enough for a diagnosis of diabetes. Research has shown that lifestyle interventions are more effective than popular diabetes medications, like metformin, in reducing the incidence of type II diabetes. So, diet and exercise in combination are a very powerful means of addressing this disease, but, people must actually do it and we must all have a clear understanding of exactly what dietary interventions are effective; it is very important that we have the fiber and nutrients present in whole plant foods as the primary aspect of our eating. If we look at the population group who consumes the healthiest eating regimen, a whole food plant-based eating plan, they do not get diabetes! Researchers in Stockholm Sweden demonstrated that a higher intake of whole grains is associated with decreased risk of deteriorating glucose tolerance including progression from normal glucose tolerance to prediabetes by mechanisms likely tied to effects on insulin sensitivity. Another interesting study stated that we should focus on increasing omega-3 fatty acids, soluble fiber and phytosterols, all of which can be found together in flaxseeds; consuming about 2 tablespoons of ground flaxseed a day decreased insulin resistance, the hallmark of prediabetes. 

REF: 1) Centers for Disease Control and Prevention (CDC), ‘Awareness of prediabetes--United States, 2005-2010,’ MMWR Morb Mortal Wkly Rep. 2013 Mar. 2) Greger ,Michael: ‘How to Keep Prediabetes From Turning Into Diabetes,’ Online, June 2015. 3) Wirström T1, Hilding A, Gu HF, Östenson CG, Björklund A: ‘Consumption of whole grain reduces risk of deteriorating glucose tolerance, including progression to prediabetes.’ Am J Clin Nutr. 2013 Jan. 4) Hutchins AM et al. ‘Daily flaxseed consumption improves glycemic control in obese men and women with pre-diabetes: a randomized study. Nutr Res. 2013 May. 

So, as we look at the specifics of optimal nutrition for the prevention of diabetes, we find that nuts and beans are superb foods for the prevention and reversal of type II diabetes. Beans, and nuts (and seeds) are high in nutrients and low in glycemic load. These foods are quite high in fiber,  resistant starch, and nutrients, and are low in glycemic index. Nuts provoke a minimal glycemic response, which helps to prevent post-meal hyperglycemia, hyperinsulinemia, and AGE (advanced glycation end product ) production. One or 2 ounces of nuts a day is sufficient; nuts contain quite a few calories and some saturated fat but also contain plentiful monounsaturated fats which are quite healthy. Beans and other legumes are miracle foods ; the fiber and resistant starch not only reduce total the number of calories absorbed from beans, but are also fermented by intestinal bacteria into fatty acids that help to prevent colon cancer and several other cancers. Also see our article about legumes on the Wellness Warriors website: http://www.mywellnesswarriors.com/food-nutrition/essential-foods/legumes/  

REF: 1) Dunaief DM, Fuhrman J, Dunaief JL, et al: ‘Glycemic and cardiovascular parameters improved in type 2 diabetes with the high nutrient density (HND) diet.’ Open Journal of Preventive Medicine 2012. 2) Zahler, William, ‘Legumes’ http://www.mywellnesswarriors.com/food-nutrition/essential-foods/legumes/, Online, 2015. 

 

Type 2 diabetes may negatively affect brain activity, according to a study published in Neurology. Researchers followed 65 participants and monitored brain health; in particular, they paid attention to blood vessel flexibility in the brain. After two years, those with type 2 diabetes had decreased cerebral activity and experienced a decline in their cognitive abilities. Researchers suspect inflammation due to diabetes may restrict cerebral functions and promote cognitive decline. 

REF: Chung CC, Pimentel D, Jor’dan AJ, Hao Y, Milberg W, Novak V. ‘ Inflammation-associated declines in cerebral vasoreactivity  and cognition in type 2 diabetes.’  Neurology. 2015. 

 

This study demonstrated that if we decrease dietary fat from processed foods and animal-based foods and also increased consumption of complex carbohydrates (fruit, vegetables, legumes, whole grains, nuts and seeds and etc.), then those with type II diabetes can begin to reverse the disease. Researchers looked at the diets of 1,785 type II diabetes patients and found that an increase in dietary fat raised triglycerides, LDL cholesterol and HBA 1C levels. On the other hand an increase in consumption of complex carbohydrate lower all of these levels. Increasing fiber and lowering added sugar intakes also had positive effects on cholesterol and blood sugar levels. This was the first study to show that small changes in fat and complex carbohydrate intake affect metabolic risk factors significantly in type II diabetic patients. 

REF: Vitale M, Masulli M, Rivellese AA, et al. ‘Influence of dietary fat and carbohydrates proportions on plasma lipids, glucose control and low grade inflammation in patients with type 2 diabetes—The TOSCA.IT Study. ‘ Eur J Nutr. Published online August 25, 2015. 

Curcumin is the yellow pigment in the spices turmeric and curry powder. In a recent very welldesigned research study half of the participants received supplements containing curcumin and the other half received a placebo that looked the same, but was not. After nine months of treatment 16% of the subjects in the placebo group went on to get full-blown diabetes. In the curcumin  group they saw a significant improvement in fasting blood sugars, glucose tolerance, hemoglobin A1 C, insulin sensitivity, pancreatic insulin producing beta cell function, and insulin sensitivity! The antidiabetic effects of turmeric appear to be related to causing a decrease of fats in the blood, thereby enhancing the insulin signaling mechanisms. 

REF: L X Na, Y Li, H Z Pan, X L Zhou, D J Sun, M Meng, X X Li, C H Sun. ‘Curcuminoids exert glucose-lowering effect in type 2 diabetes by decreasing serum free fatty acids: a double-blind, placebo-controlled trial.’ Mol Nutr Food Res. 2013 Sep.