Achieving health and happiness through evidence-based nutrition

 

Nikola Hamilton

MSc GLobal Public Health Nutrition

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Medical Disclaimer: The information provided on this site is intended for your general knowledge only and is not a substitute for professional medical advice or treatment for specific medical conditions. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Furthermore, it is important to work closely with a qualified healthcare provider when starting any new exercise regimen, diet or treatment as dietary adjustments may alter medication needs or have other effects on physical health.
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Type II Diabetes Mellitus

What is Type 2 Diabetes?

After consuming a carbohydrate, our bodies break it down into glucose, or sugar, and deposits it into our bloodstream. A hormone called insulin then transports this sugar into our cells, where it can be used as energy. This mechanism can be thought of as a lock and key. Each cell contains a keyhole that responds solely to insulin. Insulin functions as the key, opening the membrane to allow sugar inside. Without a key, the sugar remains locked outside the cell wall.

Type 2 diabetes typically arises when there is a problem with this system1. The “keyhole” essentially becomes clogged with fat, preventing insulin from opening the cell membrane and depositing its sugar. The result? Sugar continues to circulate throughout the bloodstream, starving our cells of energy.

Diagnosis

Type 2 diabetes is diagnosed by measuring the amount of glucose that is circulating in the blood.

When glucose enters the bloodstream, it binds to hemoglobin and becomes known as hemoglobin A1C. By measuring the amount of A1C in the bloodstream after fasting for 8 hours, you can determine whether or not the “lock and key” function is working properly or if excess sugar is left circulating in the blood. Elevated A1C levels indicate that blood glucose levels have been elevated over the past 2-3 months and inform the following diagnoses:

Prediabetes: A1C greater than 5.7 but less than 6.5%

Diabetes: A1C greater than 6.5%


A diagnosis can also be confirmed by testing blood glucose levels after 8 hours of fasting:

Prediabetes: Blood glucose levels are above 100 but less than 126 mg/dL

Diabetes: Blood glucose levels are greater than 126 mg/dL

Risk Factors

Although type 2 diabetes has a genetic component, evidence suggests that DNA alone does not cause this disease to develop. Rather, type 2 diabetes is largely affected by diet and lifestyle choices. Being overweight, particularly in the abdominal region, heightens your risk substantially2. In fact, 60-80% of patients with type 2 diabetes are obese3. Studies demonstrate that weight loss resulting from regular exercise and dietary changes reduce risk of type 2 diabetes by 58%. For adults over 60, this number increases to 71%!

Other important risk factors for developing type 2 diabetes include physical inactivity, high cholesterol, hypertension, a history of cardiovascular disease, smoking, meat consumption, polycystic ovary syndrome, and a previous diagnosis of gestational diabetes mellitus.

The Effect of Diet

Meat consumption alone serves as a risk factor for developing type 2 diabetes, which may be due to its association with increased body weight, specifically in the abdominal region. Furthermore, meat consumption increases inflammation, cholesterol levels, and risk of cardiovascular events, all risk factors for type 2 diabetes.

The following components, found in meat, specifically elevate the risk of developing type 2 diabetes:

  • Meat provides a form of iron known as heme-iron, while plants provide non-heme iron. Heme-iron accumulates in the body and decreases insulin sensitivity.

  • Advanced glycation end products are harmful elements created by cooking meat. These compounds increase inflammation, cellular aging, risk of cardiovascular events, and diabetes risk.

  • Nitrates, found in processed meats, are strongly linked to type 2 diabetes.

  • The fats found in animal products, coconut, and palm oil are saturated fats. Saturated fats are inflammatory and increase insulin resistance.

  • The amino acid L-carnitine , found in red meat, transforms into trimethylamine N-oxide (TMAO) when it reaches the gut. TMAO substantially increases risk of cardiovascular disease and type 2 diabetes.

  • Fish contains concentrated levels of toxins, due to the high level of toxins found in our water systems. This may be why 1 serving of fish a week significantly increases risk of developing type 2 diabetes.

     

In contrast, plant-based diets significantly reduce risk of type 2 diabetes. A study that followed over 130,000 participants for 20-30 years found that plant-based diets reduced risk of developing type 2 diabetes by 20%. Diets that were both plant-based and centered around whole, unprocessed foods reduced risk by 34%! Another analysis of 14 studies involving over 50,000 participants found that regardless of genetic risk, meat consumption was significantly associated with higher insulin concentrations and fasting glucose levels. Diets rich in plant-based foods, on the contrary, significantly lower glucose levels and risk of type 2 diabetes,

Prevention, Treatment, and ... Reversal?

If type 2 diabetes is not controlled, it can result in urinary tract infections, dehydration, falls, poor wound healing, kidney failure, and hyperosmolar syndrome, a metabolic condition unique to diabetic individuals that causes seizures and even death. Diabetes is also the number one cause for blindness and limb amputations, and decreases lifespan by 10 years, on average. It is therefore imperative to control the disease.

Treatment primarily involves monitoring blood glucose levels. Patients are advised to eat a diet that prevents A1C levels from spiking.

Metformin (a biguanide, which was actually developed from french lilac!), remains the most effective pharmaceutical for enhancing glycemic control. Metformin increases insulin sensitivity and modestly reduces mortality risk without promoting weight gain. However, metformin also disrupts vitamin B12 absorption, leading to a B12 deficiency in 30% of patients. This serious deficiency results in depression, fatigue, neuropathy, and cognitive impairment. Gastrointestinal disturbances are also commonly reported.

No other medications are recommended for glucose control due to their lack of proven benefit and potential to cause dangerous side effects. Insulin may be used only if a patient is symptomatic, unwilling to make lifestyle modifications, already taking 2g of metformin a day, or unable to take metformin. However, research does not demonstrate that insulin provides any benefit other than short term symptom control. In fact, insulin may reduce quality of life, increase the risk of mortality from a cardiovascular event, and increase the incidence of severe hyperglycemia (high blood sugar).

However, patients diagnosed with type 2 diabetes should not need to rely solely on pharmaceuticals for insulin control.

As diet and lifestyle choices play a large role in disease development, it is possible to prevent type 2 diabetes in the first place. Because type 2 diabetes typically develops when fat blocks insulin receptors (the “lock and key mechanism”), it is no surprise that exercise and body weight reduction are of utmost importance. The American College of Endocrinology and The American Association of Clinical Endocrinologists encourage the use of plant-based diets to achieve this. Beyond their weight loss benefits, plant-based diets provide heightened protection against type 2 diabetes and increased insulin sensitivity. One beneficial mechanism appears to be fiber, which is found only in plant foods. Fiber decreases blood glucose levels after eating and improves glycaemic control in patients with type 2 diabetes while animal products do the opposite. Eating steamed chicken breast with white rice, for example, actually increases blood insulin levels more than the white rice alone.

Most importantly, while pharmaceuticals may treat the symptoms of this disease, a low fat, plant-based diet centered around unprocessed foods can actually reverse type 2 diabetes!

Carbohydrate Restriction

Mainstream disease management involves carbohydrate restriction. To analyze this, we need to start by understanding what a carbohydrate is and how the nutritive content of a food is determined.

Now that you understand what a carbohydrate is, you can probably see the dangers of a low-carb diet. In fact, research shows that a low-carbohydrate diet is the least healthy diet you can follow . . . even as a diabetic! Restricting carbohydrates may also impair cardiovascular function and cause long-term weight gain, both of which increase your risk of obesity and type 2 diabetes. A metaanalysis involving 272,216 participants found that strongest avoidance of carbohydrates increased risk of death by 30%, compared to those who ate the most carbohydrates. Avoiding carbohydrates actually causes your body to react more significantly to them. One study found that patients who avoided carbs for one week increased their blood sugar spike by five fold when they ate carbohydrates again! So even though type 2 diabetes reduces the body’s ability to control sugar levels, sugar is not what caused the diabetes to develop*, and therefore should not be avoided. It was fat blocking up the lock. It’s important not to confuse the symptoms (high blood sugar) with the disease.

Remember that sugar is not the culprit here; sugar is actually a good thing. It’s our primary source of energy. If you avoid sugar, your diabetes doesn’t go away . . . because sugar is NOT the problem. Take it away and your body is left without fuel (which is why fatigue is a symptom that helps doctors diagnose diabetes). So instead of depriving your body of energy, diabetes can be cured by finding a way to get that sugar back into the cells.

Analogy:

Imagine your fill up your car one day, but you discover that the gas isn’t getting into your car’s engine. Do you try to run the car without gasoline? No. You ungunk the pipes or fix whatever the problem is, and then continue to use the fuel your car demands: gasoline. Well, your body is no different. It demands sugar as it’s primary energy source; you just need to ungunk that keyhole. 

Glycaemic Control

Glycemic response measures how much a certain food elevates your blood glucose levels. So while carbohydrates aren’t inherently bad for us, those which elevate our blood sugar rapidly are not great. This is depicted by the red curve in the image. The blue curve depicts carbohydrates with a low glycemic response.

 

Generally, processed and refined carbohydrates have a high glycemic response. These include refined grains, fruit juices, and free sugars (e.g. white sugar, brown sugar, maple syrup, agave syrup, honey). White potatoes and bananas, unfortunately, also have a high glycemic response and should therefore be minimized if you have type 2 diabetes. A basic guideline should be to replace all white, refined grains with whole grains, bananas with dark colored fruits (think berries!), and potatoes with sweet potatoes.

Are you at risk of diabetes or have you been diagnosed with pre-diabetes?

If so, make some drastic changes to your diet and lifestyle . . . and you can avoid this disease! First, if you are overweight, you need to lose weight to ensure your insulin can continue to function appropriately. Secondly, exercise regularly. Guidelines state that you should not be sedentary for more than 2 consecutive days. Exercise reduces blood glucose levels and improves insulin sensitivity36 37, regardless of whether or not the exercise actually causes weight loss. And most importantly, change your diet! Ditch the dairy, eggs, and meat and adopt a whole foods, plant-based diet! The stronger you adhere to this healthy lifestyle the more drastically you should see (and feel!) the results!

Have you been diagnosed with type 2 diabetes?

If so, get your chromium levels checked. Chromium appears to enhance insulin sensitivity, and patients with type 2 diabetes often have 25-30% less chromium in their blood than non-diabetic individuals.

Secondly, take a vitamin B12 supplement! T he average adult only needs 2.4 micrograms of B12 per day, so search for the lowest dosage at your local supermarket. Most supplements contain more than 2.4 micrograms and, although you won’t benefit from anything above 2.4 micrograms, there’s no need to worry. B12 is water soluble, meaning you cannot overdose on it. However, absorption can be difficult in pill form, so try a sublingual/ dissolvable pill or mouth spray.

Enhance your exercise regime (or start one!). Although the literature recommends no more than 2 consecutive days of inactivity, exercising daily will continue to improve your prognosis.

Dietary improvements have a profound and immediate effect on your metabolism. While you can make some moderate changes to improve your blood glucose levels, more serious dietary changes are needed to see more serious results.

Moderate improvements include:

  •  Adding amla powder, turmeric, chia, and flax to your breakfast routine.

  •  Opting for broccoli and carrots instead of chicken in your lo mein.

  •  Adding berries to your cereal

If you are serious about controlling and/or reversing your type 2 diabetes, you should transition to a low-fat, plant-based diet centered around whole foods. Up your fiber intake to around 40g per day and get rid of processed foods. By doing so, you should see improvements in your blood glucose control in as little as a week. If you decide to go this route, it is imperative to visit your doctor routinely as you will likely need to reduce your metformin dosage. Eventually, you may even need to go off of metformin completely.

Most likely ( though not always) you are also overweight and must lose weight to clear up the “lock and key” mechanism described above. Fortunately, transitioning to a whole foods, plant-based diet typically results in weight loss. However, it is also important to restrict high calorie plant foods, such as avocados, nuts, and oils, until a desirable weight is achieved.  Once weight is controlled, nuts and avocados can be reintroduced in moderation.

Evidence suggests that certain plant-based foods may speed up your recovery and enhance blood glucose control. These may be added into your low-fat, plant-based diet for enhanced efficacy:

  • Brewer’s yeast can reduce A1C levels and cause weight loss, specifically around the abdomen. Studies have found that 1⁄2 teaspoon every day for 2 months reduces A1C levels from 8 to 6.6 (almost nondiabetic!) in some participants.

  • Turmeric can lower A1C levels by reducing fats circulating in the bloodstream. Sprinkle powdered turmeric on

    all your food or throw some fresh turmeric into your smoothie or cup of tea!

  • Ground chia seeds cause weight loss, even though they are high in fat. Add 1-2 tablespoons to your food every day.

  • Ground flax seeds can blunt a blood sugar spike, improve insulin sensitivity, and cause weight loss. Add a tablespoon to your food every day.

  • Amla powder (i.e. indian gooseberry) has been shown to reduce blood glucose levels more effectively than

    pharmaceuticals! Consume about 3⁄4 teaspoon per day. You can find this on amazon.com.

  • Ginger can significantly lower A1C levels. Make a daily ginger infusion of hot water and 1⁄2 - 1 teaspoon of fresh ginger.

  • Berries reduce blood sugar spikes.

  • Ceylon cinnamon decreases fasting glucose levels and triglycerides, nut not A1C levels. Studies suggest that between 120 mg/day and 6g/day of ceylon cinnamon should be consumed for 4-18 weeks to see effects.

  • Ginseng can reduce fasting glucose levels and A1C levels.

  • Green leafy vegetables are inversely correlated with type 2 diabetes, likely due to their magnesium, fiber, and antioxidant content.

  • Vinegar reduces blood sugar spikes.

  • Beans reduce blood sugar spikes.

  • Whole grains are rich sources of fiber and magnesium, both of which enhance insulin sensitivity.

  • Resveratrol reduces insulin resistance, fasting glucose levels, and A1C levels. Resveratrol is found in peanuts, grapes, mulberries, raspberries, and blueberries.

Once you have achieved a healthy weight (a BMI between 18.5 and 25), you may add back in some nuts and avocados. Nuts are actually inversely correlated with risk of developing type 2 diabetes; 4 servings per week reduces risk by 13%. Oil, however, should not be reintroduced into your diet, as it is a highly processed food with little nutritive value. One tablespoon of oil contains 120 calories and 14 grams of fat!

And although you have now rid yourself of this disease (congratulations!), resist the temptation of reverting back to your old eating habits. These foods are what caused you to develop type 2 diabetes initially - why regress to eating the foods that didn’t love you back in the first place?