Knocking Out Diabetes

If type 2 diabetes is left untreated, or not well managed, the consequences can be devastating. It risks damage to the blood vessels, heart, liver, kidneys and eyes. It can increase the risks of Alzheimer’s disease. It can lead to amputation, and even death.

But there is hope. Experts say that the numbers of type 2 diabetes cases are so high and climbing so fast due largely to our modern diet; this means the disease and its severity are mostly within our control. Recent research has found that with attention to lifestyle and diet alone, these numbers can be reduced, and future cases prevented. In some cases, we could even be able force the illness into remission.

Here is the latest research on type 2 diabetes and diet. There are some actions you can take to help reduce your chances of developing it, and if you have already been diagnosed, how to maintain control.

What It’s All About

It starts with sugar. Cells throughout your body need it, in the form of glucose, as fuel in order to function. But for the glucose to get past the cells’ membranes, it needs a ‘key’ to get in. Insulin is that key. When a person has type 2 diabetes, their body produces enough insulin, at least at first (unlike in type 1 diabetes, when the pancreas fails to produce much or any insulin). But though they produce insulin, their body is ‘resistant’ to it. The insulin key doesn’t work. The cells have trouble recognizing insulin and resist the call to open up. When glucose can’t get where it’s needed, it circulates in the blood, acting as an inflammatory agent, slowly, relentlessly causing damage.

How Can I Have Diabetes?

Although Michael at first ignored his increased hunger and thirst, some weeks later he began getting dizzy, and decided to see his doctor. His diagnosis: type 2 diabetes. And his was a serious case. His blood glucose level, tested after he had fasted overnight, was above 300 mg/dL (normal fasting levels are below 100 mg/dL; see page 66). Left untreated, that amount of circulating glucose, over time, would wreak havoc throughout his body. His doctor immediately admitted him to the hospital where he was prescribed insulin, an injectable treatment reserved for advanced cases.

Michael’s case is a classic one. Because his symptoms were so subtle he dismissed them. As well as hunger and thirst, early symptoms can include fatigue, weight loss, frequent urination, blurry vision. And sometimes, there are no symptoms at all. Because symptoms often aren’t alarming, explains

Dr Rozalina McCoy, MD, of the Mayo Clinic in Minnesota, USA, younger people will ignore them. But the damage continues. His diagnosis shocked Michael. However, he soon learnt that his diet, which included a lot of processed food, white bread and sweets, wasn’t healthy. He hadn’t realized his lifestyle put him in such danger.

“Usually, younger people will have worse blood glucose control, and be harder to manage,” says McCoy. “For a young person to have enough insulin resistance to develop type 2 diabetes, it must be a severe case.” And that’s true, even with milder symptoms. If Michael wanted to avoid serious long-term complications, his doctor explained, he needed to completely change his lifestyle.

Diet and Diabetes

For decades, when recommending dietary changes to combat type 2 diabetes, doctors focused on reducing sugar and other carbohydrates. But researchers have now found it’s not enough to simply cut out sugary foods; ultra-processed foods (those convenience foods that so many of us with busy lives rely on for sustenance) also contribute to the illness, as recently reported in a French study published last year in the European Journal of Public Health.

The riskiest of these processed foods, surprisingly enough, was found to be processed meat: salami and sausages, for example. And, perhaps more surprisingly, a Spanish review and analysis of earlier studies also published in 2019 found that meat in general—the mainstay of the low-carb diets that many with type 2 diabetes have followed—also appears to both promote the illness and make it worse.

But what does meat have to do with blood sugar? Our cells’ membranes are comprised, in part, of fat, which comes from what we eat. “So, if we eat a lot of meat, then we end up eating a lot of fat that will make our cell membranes more rigid,” explains Dr Hana Kahleova, MD, a consultant endocrinologist at the Institute for Clinical and Experimental Medicine in Prague. “And if they become more rigid, the insulin receptor embedded in the cell membrane cannot function properly.” In other words, the cells become ‘insulin resistant’.

By contrast, says Kahleova, the fats in olives, nuts and seeds make the cell membrane more pliable, and as a result, their insulin receptors function better. Michael committed to eating healthier foods, substituting whole grains and vegetables for his former poor diet choices. He exercised more. After a few months, his blood glucose had come down enough for him to switch from insulin to metformin, a diabetes medicine in pill form that is typically used for milder cases.

Study after study confirm this relationship between meat and type 2 diabetes. Oddly enough, that still holds true for leaner meats. A 2017 meta-analysis of numerous earlier studies found a strong association between eating any kind of meat, including lean cuts, and type 2 diabetes. Meanwhile, this and other studies found eating whole grains was protective and, when included in a diet that relied on fruits, vegetables, dairy and minimizing sugar, lowered risk of developing diabetes by 42 per cent.

There is also research that indicates that a healthy, meatless diet might also reverse diabetes. In a 2006 study by Dr Neal Barnard, MD, adjunct Professor of Medicine at the George Washington University School of Medicine in Washington, DC, and his team of researchers divided people with type 2 diabetes into two groups. One was put on a completely plant-based diet and the other group was instructed to follow the American Diabetes Association (ADA) diet, which included animal products. Those on the plant-based diet were allowed to eat as much as they wanted. No limits. Those on the ADA diet had restricted calories.

At the beginning of the study, participants had A1c (glucose) levels of 6.5 to 10.5 per cent with an average A1c of about eight per cent. After 22 weeks, among those who adhered to the plant-based diet, with no changes in their medication, A1c had been reduced by an average of 1.48 percentage points, versus only 0.81 percentage points for the ADA group. For some on the meatless regimen, their A1c levels dropped to 5.7 per cent and that meant their diabetes was, effectively, reversed. “A reduction of that magnitude is bigger than you would see with typical oral medications,” says Barnard.

That’s not to say that all those who try veganism will reverse their diabetes or avoid getting it in the first place. A 2016 study of about 2,00,000 people, age 25 and up, by Harvard researchers suggests a possible reason why: it’s not enough just to go animal product-free. It has to be a healthy diet, too. People who ate a mostly vegetarian diet based on healthful foods had a 34 per cent lower risk of developing diabetes. But people who ate a mostly vegetarian diet that included unhealthy foods—sweetened drinks, fruit juices, refined grains, potatoes and sweets—had a 16 per cent increased risk of developing diabetes.

Diabetes is strongly associated with obesity. Being even a little overweight can increase the risk. But losing weight, early in the disease, can sometimes reverse it, even if you just lose 10 per cent of your weight, where it’s been found to reverse diabetes for up to five years.

What about the low-carb and keto diets that are popular today—can they play a role in managing the disease? Yes—with caveats. Low-carb diets can sometimes result in rapid weight loss and with it, a reduction in high blood sugar. When followed for no more than three months, the benefits could be worth the risks. But for long-term diabetes management, such diets can increase risk because of the diets’ reliance on animal products.

Older Diabetics Take Note

Everything that’s true for younger people with diabetes—diet and lifestyle—is also true for age 65-plus diabetics, except for one very important difference. If you have type 2 diabetes, are older, and have other serious chronic conditions, intensive or aggressive treatment can lead to significant problems. The more ailments an older person has along with diabetes, the greater risk she faces from bouts of severe hypoglycaemia (big drops in blood sugar) that can lead to increased risk of heart disease, falls and bone fractures—even death.

Even lesser instances of hypglycaemia brought on by aggressive treatment can decrease the quality of life while not offering much, if any, benefit. That’s one reason why older people who have other serious, chronic conditions are usually better off trying to keep A1c no higher than 8 per cent, says McCoy. Treatment should be individualized, so, those 65 and over, with no other chronic conditions, would probably aim for a A1c of 7.5. But generally speaking, aiming for an A1c of 8.0 instead of trying to keep it lower after age 65 with other illnesses leads to better outcomes.

Don’t Let Diabetes Win

Today at 65, Michael Trailovici is a trim 78 kilos, still needs only metformin, and feels great. And he enjoys a sense of accomplishment, knowing that he took control of the disease instead of letting it control him. If you’re one of the millions who’ve been diagnosed with the illness, you’ve heard the dire warnings. But the good news is how much you are in control of what happens.

Changing one’s your diet and getting enough exercise can assure a better, healthier future. And if you’ve only recently been diagnosed, lifestyle changes might even lead to remission.

Diabetes Risk Factors

• Being overweight or obese or carrying more weight in the abdomen (a waistline of 101.6 or more centimetres for a man, or 88.9 centimetres for a woman).
• A diet heavy on sugar, especially sugar-sweetened drinks; processed foods; and/or meat, especially processed meat
• Taking statins
• Family history of type 2 diabetes
• African, Asian, American-Indian, Hispanic or Pacific Islander descent

About Blood Tests

• Two different tests are used to determine the level of glucose (sugar) in your blood.
• The fasting glucose test in people without diabetes should ideally be lower than 100. If fasting glucose is above 125, it signals diabetes.
• The A1c test measures the average amount of sugar in your bloodstream over the past three months. A measurement of 5.7 per cent or lower is normal and at 6.5 per cent or above it indicates diabetes.
• The target for most people under age 65 with diabetes is less than 7 per cent and for younger people, less than 6.5 per cent.