Are you overweight? Start now on lifestyle and nutritional therapies to help stave off diabetes.
WITH the number of diabetics jumping from one in seven (2006) adult Malaysians to one in five (2011), there must be something terribly wrong in our diet and lifestyle that has caused this seemingly unstoppable problem.
Perhaps a comment by a patient of mine who was living overseas for five years (2006-2011) gives the underlying clue.
She said that upon returning, she was surprised to see that many of her friends had become fat or obese.
Sure enough, the statistics did show that the prevalence of overweight/obese adults ballooned from 43% to 60% during that period.
There is a direct correlation between overweight/obesity and diabetes, such that the risk of anyone with a BMI of 25 (overweight by World Health Organisation guidelines) is about 10%; a BMI of 30 (obese), 30%; and a BMI of 35 and above (severe obesity), 90%!
So, if you are overweight or obese, this should be an incentive to slim down.
While many doctors and the drug companies are busy talking about yet more "advanced" anti-diabetic drugs to "control" blood glucose, I would like to emphasize lifestyle, diet, nutritional and natural therapies to prevent and reverse the disease.
I have already written about the improvement, and even reversal, of diabetes by a nutrient-dense, high-fibre, low saturated fat, whole-food (legumes, fruits, vegetables and whole grains) diet combined with exercise and weight loss.
Studies on these have been published in medical journals, but very few are aware of them, compared to the awareness of drugs that control diabetes.
For example, studies showed that the Pritikin Diet (one such low-fat, high-fibre, whole-food diet) dramatically lowered serum triglyceride, C-reactive protein (a marker for inflammation and heart disease), LDL-cholesterol and blood pressure, and promoted weight loss in most people observing the diet diligently.
It improved insulin sensitivity and lowered serum insulin levels. In diabetics, it improved blood sugar regulation, and reduced or completely eliminated the need for anti-diabetic drugs (see References).
Several large studies have also shown that it is possible to prevent diabetes by the same strategies. For example, in the DPP Trial involving over 3,000 subjects with impaired glucose tolerance (a precursor stage to overt diabetes), the diet and exercise method was able to reduce the progression to diabetes by 58% (compared to the controls), which was even higher than the 31% achieved by those who took the drug metformin, and continued with their usual diet and lifestyle.
The study was done over a period of nearly three years.
Insulin resistance
The strategy to reverse or cure diabetes should be threefold.
The first is to restore the body's sensitivity to insulin. Insulin resistance (the opposite of sensitivity) is the basic problem in type 2 diabetes.
In the early stages of the condition, blood glucose levels are maintained by increasing the production of insulin. Doctors will not detect this unless they also monitor insulin levels as part of the routine evaluation of their patients.
Then, glucose levels start rising despite the raised insulin levels. This is the pre-diabetic stage.
Finally, the glucose levels become so high that the patient becomes overtly diabetic.
The persistent high insulin levels unfortunately, also cause damage to the beta cells of the pancreas, which secrete insulin. This further compounds the problem, as insulin production is soon impaired.
Many type 2 diabetics will ultimately require insulin injections, and they will require relatively high doses compared to normal insulin levels in healthy people because of insulin resistance.
The first-line medication for type 2 diabetes is metformin, and its major action is improving insulin sensitivity. Exercise (especially building muscles), weight reduction and many nutrients also improve insulin sensitivity.
Many nutrients have been shown in scientific studies to improve insulin sensitivity. These include almonds, alpha lipoic acid, chromium, cinnamon, curcumin (turmeric), grapefruit, oatmeal, omega-3 (polyunsaturated fatty acids), vitamins D and K, and many more.
Unlike the refined carbohydrates, unrefined complex carbohydrates protect against insulin resistance.
If you are healthy, ensuring your diet includes these foods/nutrients should help you stave off the metabolic syndrome and diabetes.
If you already have the disease, you will need higher doses, and should consider supplementation.
Reducing calorie intake
The second strategy is to reduce glucose and fat intake.
As the body has problems managing glucose (and fats), despite higher insulin levels, it is best to reduce the workload in order to help the body cope with this unhealthy situation.
A nutrient-dense, low-calorie diet allows us to maintain good health, as has been shown in many studies.
Very-low calorie diets (but not lacking in nutrients, ie only calorie restriction) have repeatedly been proven to extend the lifespan of animals of several studied species. It is reasonable to expect similar benefits in humans.
Studies have shown that under controlled conditions where subjects consume an equal number of calories, a high-carbohydrate diet induces insulin resistance faster than a high-fat diet.
However, when they are allowed to eat on their own (with no control over the amount of calories consumed), it was found that those who preferred high-fat diets fared worse.
This was because those on high-fat diets usually consumed more calories. High-fat means calorie-dense (or energy-dense), as fat has double the calorie content of carbohydrates and proteins.
The type of fat also matters, as saturated and trans-fats gave the worse results in these studies.
Mono- and polyunsaturated fats are protective against harmful effects, but not if taken excessively (remember the calorie/energy factor).
So, it is important to restrict both refined carbohydrates and unhealthy fats from your diet to prevent and reverse diabetes. By doing so, you will definitely cut down the calories.
Unfortunately, the typical Malaysian diet is lacking in nutrients and fibre, but has plenty of refined carbohydrates (white rice, white bread, etc), unhealthy (saturated and trans/hydrogenated) fats, and unhealthy processed foods. You really have to be disciplined in choosing what you eat, if you are concerned about your health.
Refined carbohydrates also tend to have a high glycaemic index (ie raises blood glucose rapidly), compared to the healthier, wholesome unrefined complex carbohydrates.
The glycaemic load (index x amount consumed) determines the actual stress on your glucose management system. And don't forget that a bowl of polished white rice is equivalent (in calorie/glucose terms) to 20 teaspoons of refined sugar, even though the rice is not sweet!
Protect your body
The third strategy is to protect the body from the harmful effects of diabetes.
Most are familiar with the dangers of having too much glucose circulating in the blood, but many do not realize that the damage also results from another problem – while the blood is flushed with glucose, the cells in diabetic patients are actually starving as they have become resistant to the instructions of insulin to take in glucose.
Glucose is essential for energy production, and the cell's activities are slowed down or stopped because of the lack of energy.
This explains why diabetics are in fact, less energetic compared to healthy people, even though their glucose levels are much higher.
They are also prone to a myriad of health problems.
Because of the doubly unhealthy situation (glucose flooding the blood while the cells are starving), cells, tissues and organs are functioning sub-optimally, and are unable to cope with the assault from free radicals (produced by normal metabolism, plus more from the toxic environment and drugs), and invading germs (viruses and bacteria), yeast, fungi and parasites.
Diabetic patients require a lot of a wide range of vitamins, minerals, antioxidants, enzymes, co-enzymes, probiotics, amino acids, essential fatty acids, and possibly many others, if they want to remain healthy.
Some of the nutrients that improve insulin sensitivity are also cell protectors. Many powerful antioxidants and anti-inflammatory nutrients like curcumin (turmeric) and berries (which contain many types of phenols that make them the most powerful fruits in terms of antioxidant content), can help protect the tissues and organs in diabetic patients.
My experience in using these berries (in concentrated juice extract form) is that they also help in reducing blood glucose levels.
Diabetics will also benefit from taking glutathione-boosting supplements, as glutathione is the most important intracellular antioxidant.
They will also benefit from taking foods (eg kale, beetroot) or supplements that increase nitric oxide, which is important for good blood circulation, penile erection, immunity and many other functions.
Diabetics have low levels of both glutathione and nitric oxide.
Prevention!
The Government has announced that over 1.4 million Socso members 40 years old and above are entitled to a free medical examination.
This is an opportune time to screen a large portion of those at risk. I am sure this exercise will pick up many undiagnosed diabetics and hypertensives (and others suffering from "silent" diseases).
The doctors should also give adequate advice to those who are overweight/obese, and those with pre-diabetes and pre-hypertension as well, as these problems are much easier to reverse at the early stages.
The rest should also go for their checkup if they have neglected to do so.
References:
1. Barnard RJ, Ugianskis EJ, Martin DA, Inkeles SB. Role of diet and exercise in the management of hyperinsulinemia and associated atherosclerotic risk factors. Am J Cardiol 1992;69:440-4
2. Barnard RJ. Effects of life-style modification on serum lipids. Arch Intern Med 1991;151:1389-94
3. Barnard RJ, Wen SJ. Exercise and diet in the prevention and control of the metabolic syndrome. Sprts Med 1994;18:218-28
4. Roberts CK, Vaziri ND, Barnard RJ. Effect of diet and exercise intervention on blood pressure, insulin, oxidative stress, and nitric oxide availibility. Circulation 2002;106:2530-2
5. Knowler WC, Barrett-Connor E, Fowler SE, et al. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle interventions or metformin. N Engl J Med 2002;346:393-403
Dr Amir Farid Isahak is a medical specialist who practises holistic, aesthetic and anti-ageing medicine. He is a qigong master and founder of SuperQigong. For further information, e-mail starhealth@thestar.com.my. The views expressed are those of the writer and readers are advised to always consult expert advice before undertaking any changes to their lifestyles. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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