DIABETES BREAKTHROUGHS
Life-Changing
When Michael Trailovici began feeling unusually hungry and thirsty, the 42-year-old editor didn’t imagine they could be symptoms of a condition, let alone a serious one. He didn’t see his doctor. That was in 1997. Today Michael, now 65, is one of approximately 416 million people around the world with type 2 diabetes. Nearly half of those are unaware of their condition. The disease is so prevalent that the World Health Organization is calling it an ‘epidemic’.
If type 2 diabetes is left untreated, or is not managed well, the consequences can be devastating. Risks include damage to the blood vessels, heart, liver, kidneys and eyes. It can also increase the risks of Alzheimer’s disease, and lead to amputation – and even death.
According to Diabetes Australia, an estimated two million Australians are at high risk of developing type 2 diabetes.
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 may even be able to 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 a 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 – this is unlike type 1 diabetes, when the pancreas fails to produce much or any insulin. But in type 2 diabetes, though they produce insulin, their body is ‘resistant’ to using it. The insulin key
doesn’t work. The cells have trouble recognising the insulin and resist the call to open up.
When glucose can’t get where it’s needed, it keeps circulating in the blood, acting as an inf lammatory agent, slowly but 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 16.7 millimoles of glucose per litre of blood (mmol/L). Left untreated, that amount of circulating glucose, over time, would wreak havoc throughout Michael’s body. Normal blood glucose levels will generally range between 4.0– 7.8 mmol/L.
His doctor immediately admitted him to hospital where he was prescribed insulin, an injectable treatment reserved for advanced cases.
Michael’s case is classic. Because his symptoms were so subtle he dismissed them. As well as hunger and thirst, early symptoms can include fatigue, weight loss, frequent urination and blurry vision. And sometimes, there are no symptoms at all.
Because symptoms often aren’t alarming, explains the Mayo Clinic’s Dr Rozalina McCoy, younger people will often ignore them. But the damage continues slowly.
Michael’s diagnosis shocked him. However, he soon learned that his diet, which included a lot of processed food, white bread and sweets, wasn’t healthy. He hadn’t realised his lifestyle put him in such danger.
“Usually, younger people will have worse blood glucose control and be harder to manage,” says Dr 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 step away from sugary foods. Ultra-processed and convenience foods also contribute to the illness, as recently reported in a French study published last year in the
The riskiest of these processed foods, surprisingly enough, was found to be processed meat: salami and hot dogs, 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 endocrinologist Dr Hana Kahleova. “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 Dr Kahleova, the fats in olives, nuts and seeds make the cell membrane more pliable, and as a result, insulin receptors function better.
Michael commit ted to eat ing healthier foods, substituting whole grains and vegetables for his former poor diet choices. He also 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 fruit, vegetables, dairy and minimising 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. A 2006
US study led by Dr Neal Barnard 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 kilojoules.
At the beginning of the study, participants had A1c (glucose) levels of 6.5 per cent (7.8 mmol/L) to 10.5 per cent (14.1 mmol/ L) per cent with an average A1c of about 8 per cent (10.1 mmol/L).
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 (6.5 mmol/L) and that meant their diabetes was, effectively, reversed.
“A reduction of that magnitude is bigger than you would see with typical oral medicat ions,” says Dr 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 200,000 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 most ly 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 like 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 ten per cent of your weight, 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.
OVER 65s TAKE NOTE
Everything that’s true for younger people with diabetes – diet and lifestyle – is also true for people aged over 65 with diabetes, 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 ai lments an older person has in addition to diabetes, the greater risk he or 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 hypoglycaemia 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 levels no higher than 10.1 mmol/L, says Dr McCoy. She says treatment needs to be individualised, so those 65 and over, with no other chronic conditions, would probably aim for 9.4 mmol/L. But generally speaking, aiming for a 10.1 mmol/L 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 kilograms, still needs only metformin, and feels great. And he enjoys a sense of accomplishment, knowing that he took control of his type 2 diabetes instead of letting it control him.
If you’re one of the mi l l ions 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 your diet and gett ing enough exercise can assure a better, healthier future. And if you’ve only recently been diagnosed, lifestyle and dietary changes might even lead to remission.
There is a lot you can do to take care of yourself today, to ensure a better tomorrow.