Summary of Diabetes and Lifestyle Interventions to preventing, managing and reversing the condition.
This is the last in the series on Diabetes. We have covered much ground over the last almost 4 months. But sometimes we lose the plot in the mass of information. So today we are just going to present a summary of the important points – the take home messages, that hopefully we can all implement – those with diabetes, and all the rest of us who have the potential to develop diabetes if we are not careful.
ALSO READ : Turning the Tide – Understanding Diabetes (part 14)
Definition:
Diabetes mellitus is a disease of abnormally raised blood sugar. Type 1 diabetes is caused by failure of the pancreas to produce insulin due to the body attacking the cells that are responsible for this hormone. Type 2 diabetes is by far the most common and is caused by insulin resistance – or insensitivity of the muscle and liver cells to normal levels of insulin.
What causes insulin resistance?
There is a genetic predisposition to insulin resistance. People of Asian origin, Pacific islanders, and Middle-eastern people are particularly prone to this condition. However by far the most common cause of insulin resistance is dietary lifestyle. As the pandemic of obesity increases, so too does the incidence of insulin resistance and eventual diabetes.
Some health professionals claim the cause is excessive carbs (carbohydrates) and seek to limit all carbohydrates from the diet. And although carbohydrates are the main source of blood sugar, good evidence suggests that insulin resistance is not necessarily the result of excessive intake of carbohydrates and sugar.
Good scientific evidence over the last 15-20 years has shown that the main driver of insulin resistance is excessive fat globules within muscle and liver cells – cells not designed to have fat within them. The main cause of this is excessive fat in the diet – from fried foods, fast foods, snacks, fatty meats, cheese and eggs.
Lack of exercise also contributes to this condition. So you can’t imagine a more likely scenario for insulin resistance and consequent diabetes than being a couch potato snacking away at fatty foods.
Consequences of diabetes:
Diabetes is the main driver of many of the life-threatening conditions affecting particularly Western societies, but increasingly around the world, as the Western diet and lifestyle spreads.
These include
Ischaemic heart disease (heart attacks) and strokes
Peripheral vascular disease leading to chronic ulcers on feet and gangrene
Kidney disease and liver disease
Eye conditions leading to eventual blindness
Cancer
Dementia and Alzheimer’s
Apart from the health risks, there are also enormous costs in doctor’s visits, medications, hospitalisations, special diets, special devices for monitoring diabetes and helping with ambulation and mobility.
And most of these can be prevented or reversed by just such simple things as a healthful diet and exercise, stopping smoking and losing weight!
Treatment of Diabetes.
Doctors are well trained in the pharmaceutical management of diabetes both type 1 and type 2. Type 1 requires insulin injections on a regular basis to maintain healthy blood sugar levels. Type 2 diabetes is treated medically with various medications, and eventually insulin may be required if the pancreas starts to fail.
Dieticians are trained in managing the dietary interventions. However over the years dietary advice has changed – from a diet that doesn’t look much different from what most health-conscious people normally eat, to current national recommendations for increase in all fruits and vegetables, whole grains and legumes (like beans and lentils). Ingestion of “foods” like refined carbohydrates – snack foods, white bread and buns, cool drinks, sweets, ice cream are strongly discouraged.
Most lifestyle medicine specialists go a step further and recommend an emphasis on whole-food, plant-based low-fat diets. Why would they do this? Because both experience as well as sound research has shown that this is the most effective way of not only preventing and controlling diabetes, but also reversing insulin resistance. And a low-fat diet can begin to reverse insulin resistance in as little as 48 hours. Although type 1 diabetics will alway need insulin, insulin resistance can even affect insulin-dependent diabetics, and a whole-food plant-based, low-fat diet can dramatically improve their energy levels and control of the diabetes.
It is common these days for even health professionals to promote a ketogenic diet (high fat, low carb diet). There is no doubt that blood sugar levels, and even HbA1c levels (the measure of long term sugar control) can go down. But as we have mentioned before, long term studies show that a ketogenic diet increases all cause mortality – which includes conditions like heart attacks, strokes, kidney failure, auto-immune diseases, Alzheimer’s and cancers.
Exercise is an important aspect of lifestyle management of diabetes. 30 minutes per day of walking or moderate to strenuous physical exercise per day, or 1 hour 3 times per week makes a huge difference to control of insulin resistance and diabetes.
Dietary fibre also has been shown to moderate absorption of sugar. That is why whole foods are so much better to eat than refined foods, in which the carbohydrate has been stripped of its slow-release capsule.
Stopping smoking is a major risk reduction strategy for diabetes and its complications. We know that smoking causes vasoconstriction and high blood pressure. We know that tobacco smoke has thousands of harmful chemicals, including carcinogens. We know that smoking is strongly associated with heart disease, strokes, and cancers of lung, mouth, throat and bladder. We know that smoking dramatically increases the risks of chronic lung disease like emphysema and chronic bronchitis. We have covered the process of stopping smoking in these blogs in the past, and I would be happy to offer advice to anyone who is keen to stop if you contact me.
Reversal of obesity and overweight has also a profound effect on managing diabetes. Many of the drivers of obesity and overweight are the same drivers of diabetes, so when we reverse obesity we are also correcting lifestyle factors causing diabetes.
Here is a very detailed yet understandable article that covers everything you need to know about insulin resistance and reversal of diabetes. In fact if you go to the website masteringdiabetes.org you will find a host of useful articles and videos on the blogs for free. If you can afford to you can also get personalised coaching from experts.
I would be happy to share with you a whole host of resources – whether you are a medical professional eager to improve the health of your patients, or if you are a patient suffering from diabetes. Please contact me by email – dglass@venturenet.co.za or at my practice 0396821414.
On the 2nd of June 2019, together with a team of passionate volunteers, we will be hosting a free “Eating for Life Expo” at South Coast Mall in Shelly Beach.
This is the first time this has ever been done in South Africa to my knowledge. At registration you will be offered measurement of you body mass index (BMI), and a short questionnaire of your knowledge of causes of lifestyle diseases will be obtained. Then there will be a series of 9 large posters, each manned by a volunteer who can run through with you the information that addresses the most common lifestyle conditions in South Africa, and rational interventions. We will be showing many short video clips of interventions. One-on-one discussion about how you can implement the interventions will be available. Further interventions through free seminars will be offered. Please plan to come along and catch the vision of healthy living.
To health and vitality.
Dave Glass
Dr 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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