In recent years, what we know about diabetes has changed, with an improved understanding of the fundamental causes behind the condition. Although there is a genetic link to diabetes, which predisposes individuals to Type 2 diabetes, this risk is exacerbated by poor diet and lifestyle. Genetic defects found so far account for only a low percentage of all Type 2 diabetes cases (1) and really only increase the risk, rather than determining the development of the condition.
Diet and exercise
Type 2 diabetes is completely manageable and even reversible, but surprisingly there are many people who accept or ignore their condition, with a complete lack of interest in doing anything about it. To get Type 2 diabetes under control and even overcome simply takes a change in lifestyle - it seems a small price to pay to add 10-20 years onto one's lifespan, as well as avoiding severe disability, limb amputation and blindness.
Reversing Type 2 diabetes is not a new idea. Back during World War II, Professor H P Himsworth noted that when food shortages removed the white flour, white sugar and excessive meat protein and fats from the typical British diet, the death rate from diabetes fell 50%. More recently, a five year longitudinal Swedish study, consisting of 41 Type 2 diabetes patients and 181 glucose intolerant individuals, used an initial six month pilot program constituting dietary changes and an increase in physical exercise (2). The results showed normalisation in glucose tolerance in more than 50% of individuals, a 10-14% increase in glucose uptake directly contrasting to the control group, which deteriorated a further 5-9 %. More than 50% of the diabetics were found to be in remission after five years. This demonstrates that long term diet and exercise intervention is successful in the treatment or prevention of Type 2 diabetes and insulin resistance (2).
The clearest evidence that Type 2 diabetes is reversible is following bariatric surgery (3). The normalisation of plasma glucose concentration follows within days of surgery, long before major weight loss has occurred (4,5). Additionally, improved control of blood glucose in Type 2 diabetes, by moderate energy restriction, has been demonstrated (6,7). A study of 11 people with Type 2 diabetes put on eight weeks of a 600 kcal/day diet showed normalisation of both beta cell (the cells that store and release insulin release) function and hepatic insulin sensitivity. This was associated with decreased pancreatic and liver triacylglycerol stores. The abnormalities underlying Type 2 diabetes are reversible by reducing dietary energy intake (8).
It is widely accepted that obesity is a major risk factor for the development of Type 2 diabetes (9), which is generally associated with a reduction in insulin resistance. Around 70-80% of diabetic patients, are considered to be overweight or obese (10), with just a 5-8kg increase in weight doubling a person's risk for developing the disease, while a weight gain of 20kg quadruples the risk (11). For women with a body mass index (BMI) of 35kg/m², their risk of diabetes increases 92-fold (as compared to those with an average healthy BMI of 23kg/m2), while for men with the same BMI the risk increases 42-fold.
Further evidence exists that not only body weight is important, but also how the fat is distributed around the body. Visceral fat and a high waist to hip ratio, have been associated with higher incidence of Type 2 diabetes (12,13). Interestingly, the reversal of the diabetic condition occurs before any significant weight loss, which suggests other underlying conditions.
Importance of Exercise
Including more day-to-day exercise, is crucial for sufferers of Type 2 diabetes. It improves the body's sensitivity to insulin, which is already in short supply, or difficult for the body to utilise (14). Not only does exercise help improve the diabetic condition, it can help reduce the risk of developing Type 2 diabetes. A Harvard University study on the exercise habits of more than 70,000 women, showed that a 40 minute walk every day reduced the risk a notable 40%, and with a longer walk the risk could be decreased by an even larger percentage (15).
Chronic exercise also helps to increase blood flow, which is important to help reduce the risk of neuropathy, a common neurological disorder associated with Type 2 diabetes (16). In addition, studies have shown that a short term reduction in daily physical activity negatively affects insulin sensitivity (17).
Reduce Screen Time
Several in-depth studies have reported screen and/or television-viewing time to be detrimentally associated with weight gain, abnormal glucose metabolism, metabolic syndrome and Type 2 diabetes. In a study of 2,761 women and 2,103 men, aged 30 years or older, sitting time was detrimentally associated with waist circumference, BMI, weight gain, two hour post-load plasma glucose, and fasting insulin in both sexes. Television viewing time was detrimentally associated with all metabolic measures (18). In a cross-sectional study of 8,357 adults, aged 35 years or more and free from diabetes, time spent watching television was positively associated with increased two hour plasma glucose, fasting insulin, and insulin resistance and pancreas Beta cell function in women.
These findings highlight the negative relationship of the sedentary behaviour of television viewing time and glycaemic measures, independent of physical activity time and adiposity status. This suggests an important role for reducing sedentary behaviour in the prevention of Type 2 diabetes (19).
Role of Toxins
Research has also indicated a link between the development of Type 2 diabetes and toxins, such as heavy metals, pesticides, plastic compounds including BPA, diesel exhaust, tobacco smoke, polycyclic aromatic hydrocarbons, hormones, radioactivity, viruses, bacteria and endocrine-disrupting chemicals. Organophosphate pesticides, including those used around the home, have been associated with weight gain and diabetes risk (20). In addition, studies have recently reported that small increases in urban air pollution can decrease insulin sensitivity in healthy subjects (21), suggesting that air pollution contributes to the metabolic syndrome and a progression to Type 2 diabetes. One suggested mechanism for this relationship is through changes to the gut microbiome and ecology (22).
Oxidative stress by free radicals has been shown to be a major factor in the complications that can arise with the disease, such as the tissue damage often seen in diabetic patients. Those with Type 2 diabetes with higher blood glucose levels will have a greater quantity of free radicals in their blood stream when compared no non-diabetic individuals. Additionally, diabetes sufferers have significantly lower levels of antioxidants that eliminate free radicals than normal. Many of the complications of diabetes come from advanced glycation endproducts (AGE), which occur when glucose cross links with proteins in the body, a process closely associated with the formation of free radicals.
Research on the antioxidants vitamins C and E, N-acetyl-Lcysteine (NAC) and alpha lipoic acid, have shown that they can improve diabetes by reducing the associated complications. When supplements of NAC, vitamins C and E or both were given to Type 2 diabetic mice, retained insulin secretions and decreased blood glucose levels were observed (23). Antioxidants may also be able to reduce the risk of birth defects in diabetic pregnancies by reducing oxidative stress. A study of 21,831 men and women over 12 years found increased blood levels of vitamin C may reduce the risk of developing diabetes by 62 per cent (24).
Additionally, numerous studies have demonstrated deficiencies of magnesium, vitamin C, the B complex vitamins and other minerals and antioxidants in diabetes. The micronutrients have been shown to increase the number of Glut 4 transporters so that muscle cells are more sensitive to insulin and take in more sugar from the blood, even at rest. Even when insulin is not present by signalling the Glut 4 transporters the sugar is taken into the cell.
Lipoic Acid and Coenzyme Q10
Lipoic acid has been used in Europe for more than 20 years in preventing and relieving complications of diabetes 25. German studies of diabetics with neuropathy showed that following lipoic acid treatment, patients were sleeping better, feeling healthier and fitter, and some were able to reduce their doses of insulin. In another study, lipoic acid was found to stimulate the regeneration of nerve fibres in diabetics, reducing the pain and numbness associated with neuropathy, as well as reducing AGE (glycosylated haemoglobin) damage in diabetic patients (25).
Coenzyme Q10 (CoQ10) is not only a vital component in the process of energy formation, it is also superbly placed for its powerful antioxidant function. In tandem with the other members of this protective system, CoQ10 suffices to keep oxidative damage to a minimum and improve cellular metabolism in diabetics. Many other supplements have also been shown to benefit diabetics including Vitamin D and Resvaratrol.
Minerals shown to benefit diabetics include chromium, vanadium and magnesium. Eating more magnesium-rich foods, like green leafy vegetables and nuts, may reduce the risk of Type-2 diabetes, as suggested by a meta-analysis of observational studies. For every 100 milligram increase in magnesium intake, the risk of developing Type-2 diabetes decreased by 15 per cent (26). The potential protective role of magnesium intake against the disease may be due to improvement of insulin sensitivity, and on glucose control, since magnesium can act as a co-factor for enzymes involved in the metabolism of glucose, and/or insulin secretion. Magnesium also has many anti-inflammatory and antioxidant properties.
Important Dietary Changes
It is important to cut out animal and cooked/processed fats (especially margarine), swapping them for mono-unsaturated fatty acids, like those found in fresh extra virgin olive oil and omega-3 oils from both plants and fish. Increase your vegetable consumption, particularly raw vegetables and consume vegetable smoothies. A healthy diet containing a mix of vegetables, nuts and beans, has been shown to be particularly effective in regulating blood sugar and improving the diabetic condition. Similarly, fruits that improve the diabetic condition are pomegranates, blueberries, bitter melon and mulberry. Coffee, green and black tea, no sugar of course, have also been shown to be beneficial.
Herbs and spices are potent antioxidants, anti inflammatory and great sources of nutrients. The best evidence for efficacy is available for Coccinia indica and American ginseng. Other supplements with positive results include turmeric, Gymnema sylvestre, Aloe vera, Momordica charantia, nopal, parsley, holy basil, cloves, bay leaves and cinnamon. For example, 1, 3, or 6g of cinnamon per day reduces serum glucose, triglyceride, LDL-cholesterol, and total cholesterol decreases and glucose levels in Type 2 diabetics (27).
A daily supplement (200mg, 3 times/day) of extracts from Milk Thistle (Silybum marianum) significantly lowered fasting glucose levels by 15% in Type 2 diabetic patients. Milk Thistle was also found to have significant beneficial effects on glycosylated haemoglobin (AGE) levels, total cholesterol and LDL-cholesterol levels, and triglyceride levels in diabetics.
Additionally, supplementation with olive leaf polyphenols for 12 weeks significantly improved insulin sensitivity and pancreatic β-cell secretory capacity in overweight middle aged men at risk of developing the metabolic syndrome. The leaves of the olive plant (Olea europaea L.) have been used for centuries in folk medicine to treat diabetes (28). According to animal and in vitro studies, olive leaf polyphenols have antioxidant, hypoglycaemic, antihypertensive, antimicrobial, and anti-atherosclerotic properties (29).
Many studies have demonstrated that diabetes Type 2 can be reversed through diet and lifestyle changes. To reverse decades of damage more emphasis needs to be put on a highly nutritious eating program, improved digestion, and physical activity - it takes a lot to reverse 20 or 30 years of damage! In most diabetes programs little emphasis has been placed on good digestion. Heal the digestive system to allow nutrients to be absorbed and transported around the body. The digestive system is also one of the major sources of inflammation and oxidation in the body.
A few basic requirements to help with digestion are to eat more raw foods and supplement with digestive enzymes, prebiotics and probiotics. Probiotics have also been shown to reverse some of the conditions of diabetics. For example, one study demonstrated that probiotic treatment reduced the fasted insulin levels, but improved the insulin secretion upon glucose challenge, indicating an improved metabolic flexibility and restoration of normal glucose metabolism, and a potential beneficial effect on metabolic syndrome.
With today's understanding of the condition, there really is no excuse to suffer with Type 2 diabetes. With a common sense approach it is completely reversible. There are now more than 30 books and hundreds of websites written by medical professionals showing that diabetes can be reversed. In the Foreword to the book There is a Cure for Diabetes by Dr Gabriel Cousens, a leader in the field of reversing diabetes, Brian M Connolly writes, "I was able to go from a dangerously high Type-2 diabetic condition, with a glucose reading of 292, down to a diabetes-free reading of 113 in just 9 days". Recently I met John from Townsville who went from five insulin injections a day to being a non-diabetic in a few weeks. What is your excuse?
DISCLAIMER: Dr Peter Dingle is a researcher, educator and public health advocate. He has a PhD in the field of environmental toxicology and is not a medical doctor.
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Dr Peter Dingle (PhD) has spent the past 30 years as a researcher, educator, author and advocate for a common sense approach to health and wellbeing. He has a PhD in the field of environmental toxicology and is not a medical doctor. He is Australia’s leading motivational health speaker and has 14 books in publication.