Over the last 8 episodes we have learned much about what diabetes is and what causes it.  We have also learned about the consequences of diabetes on various organs of the body – on major blood vessels with effects on heart and brain; and on smaller blood vessels, with effects on organs like kidneys, eyes and nerves.

ALSO READ : Turning the Tide – Understanding Diabetes (part 8)

But knowing about the disease and its progress is only a wake-up call.  So many of my patients either have pre-diabetes or diabetes, or they have family and friends who are diabetic.  It is frightening how common diabetes is in our community.  I’m sure caring for diabetics is a large part of the work of our GPs and specialist physicians.  The problem is that the patients we treat are not getting better.  They are not getting rid of their diabetes.  All medical care can do is hopefully slow down the progress – the relentless pathway to heart disease, strokes, and other life-threatening consequences.  Is there no way that we can turn the ship around and return to improved health?  Many doctors will tell their patients that diabetes is not a curable disease.  They will say that as a chronic disease it can only be better managed and controlled – like arthritis or high blood pressure or kidney failure.

But there is good news.  Lifestyle medicine practitioners are proving through scientific research and through clinical experience that diabetic sufferers don’t have to stay a victim of either your genes or your circumstances. 

There is much that you can do to arrest, reduce or even reverse the destructive ravages of diabetes – but also so many other chronic lifestyle disease through the same interventions.  It is almost like there is a magic formula for revitalisation of the human organism.

There is no doubt that the incidences of these lifestyle diseases such as diabetes, obesity, high blood pressure, high cholesterol, etc is rising at a frightening rate.  It is also obvious that the cause is not a deficiency in metformin or statins in our diets.  It is also abundantly clear that traditional societies generally have very low incidences of diabetes, high blood pressure, heart disease and cancer.  They do often suffer from the effects of infectious diseases though, so although western medicine has reduced the ravages of infectious disease, it has not done much to reverse the ravages of chronic lifestyle diseases.

The key to understanding the lifestyle factors responsible for diabetes and other chronic disease is to study the most long-lived population groups around the world.  These are found in what was identified by Dan Buettner as the Blue Zones.  In these pockets of the world people consistently live to their late 90’s or early hundreds and often stay active and involved in their communities right up to the end of their lives.  The areas he identified were Ikaria in Greece, Okinawa in Japan, Sardinia in Italy, Loma Linda in California and the Nicoya Peninsula in Costa Rica.  The common factors in all these areas is a diet rich in fruits and vegetables, unrefined carbohydrates, lots of legumes, and minimal animal products.  They also are very active and have excellent community support structures.  Finally they have purpose for life – strong spiritual beliefs and religious behaviours.

One of those groups – Seventh-day Adventists living in Loma Linda, California have been thoroughly researched for the last 40 years by a team of researchers at Loma Linda University.  A diet that is predominantly plant-based has been found to be the most consistent factor in increasing longevity and protecting against diabetes, heart disease and cancer.  Adventists who eat more animal products have higher rates of these diseases, and live shorter lifespans, compared to those who eat a predominantly plant-based diet with lots of fibre, inherent vitamin C and other vitamins and minerals and more unprocessed foods.  These studies are some of the most-quoted articles in the field of preventive health care, because they are large prospective population studies.  See the link.

Here is a short video of a brief presentation of the findings by the chief investigator – Prof Gary Hopkins:

Last week I attached a link to a review article published in the Journal of Geriatric Cardiology, by Dr Michelle McMacken and Sapana Shah, entitled “A plant-based diet for the prevention and treatment of type 2 diabetes”.  Here is the link again: This is the abstract (summary) of that article:

“The prevalence of type 2 diabetes is rising worldwide, especially in older adults. Diet and lifestyle, particularly plant-based diets, are effective tools for type 2 diabetes prevention and management.

Plant-based diets are eating patterns that emphasize legumes, whole grains, vegetables, fruits, nuts, and seeds and discourage most or all animal products. Cohort studies strongly support the role of plant-based diets, and food and nutrient components of plant-based diets, in reducing the risk of type 2 diabetes. Evidence from observational and interventional studies demonstrates the benefits of plant-based diets in treating type 2 diabetes and reducing key diabetes-related macrovascular and microvascular complications. Optimal macronutrient ratios for preventing and treating type 2 diabetes are controversial; the focus should instead be on eating patterns and actual foods. However, the evidence does suggest that the type and source of carbohydrate (unrefined versus refined), fats (monounsaturated and polyunsaturated versus saturated and trans), and protein (plant versus animal) play a major role in the prevention and management of type 2 diabetes. Multiple potential mechanisms underlie the benefits of a plant-based diet in ameliorating insulin resistance, including promotion of a healthy body weight, increases in fiber and phytonutrients, food-microbiome interactions, and decreases in saturated fat, advanced glycation end-products, nitrosamines, and heme iron.”

This is pretty intense.  Over the next few weeks we will look at aspects of diet that are involved in both cause as well as prevention or reversal of diabetes – things like the role of carbs, fats, protein, fibre in our diets – then we will look at exercise and how that can influence diabetes management.

Fasten your seatbelts for some perhaps bumpy ride as we discuss some of the controversies in the field of nutrition and dietary recommendations out there.  Sometimes the controversy gets quite heated – especially between the low-carb, high fat camp and the high-carb, low fat advocates.  Hopefully we can explore these issues with minimal heat and more light!

To a week of hope for reversing your diabetes, or that of your friends and family.

Dave Glass

David Glass graduated from UCT in 1975. He spent the next 12 years working at a mission hospital in Lesotho, where much of his work involved health education and interventions to improve health, aside from the normal busy clinical work of an under-resourced mission hospital.

He returned to UCT in 1990 to specialise in obstetrics/gynaecology and then moved to the South Coast where he had the privilege of, amongst other things, ushering 7000 babies into the world. He no longer delivers babies but is still very clinically active in gynaecology.

An old passion, preventive health care, has now replaced the obstetrics side of his work. He is eager to share insights he has gathered over the years on how to prevent and reverse so many of the modern scourges of lifestyle – obesity, diabetes, ischaemic heart disease, high blood pressure, arthritis, common cancers, etc.

He is a family man, with a supportive wife, and two grown children, and four beautiful grandchildren. His hobbies include walking, cycling, vegetable gardening, bird-watching, travelling and writing. He is active in community health outreach and deeply involved in church activities. He enjoys teaching and sharing information.

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