Thursday, November 17, 2016

Curbing The Diabetes Trend

Diabetes is becoming more common in the United States. From 1980 through 2014, the number of Americans with diagnosed diabetes has increased fourfold (from 5.5 million to 22.0 million). (Source: CDC Website)
Over the past few years we’ve seen an increase in the incidence of diabetes.  Chronic diseases like this are a large factor in the dramatic rise in health care costs as well as the "cost" of human suffering.  Those with diabetes have health care costs that are 2.3 times the costs for care without diabetes.  Diabetes affects wound healing and every other body system. Unfortunately, diabetes education programs are often no more than training on sugar testing and how to inject insulin with a brochure to take home and read.  There is no doubt that knowledge of testing is important and the brochures have helpful information but the education does not go far enough.  Diabetes is the number one cause of non-traumatic amputations in the USA.  This is a terrible situation and we can do so much better. 

The statistics are sobering but there is a light at the end of the tunnel because the vast majority of type II diabetes can be improved or even reversed with lifestyle changes.  At the center of diabetes is the hormone insulin which is supposed to be released from the pancreas when sugar levels rise and helps the sugar to get into our cells for making energy.  Type I diabetics have a permanently damaged pancreas and are not able to produce adequate insulin so they rely on insulin pumps or injections of insulin to provide the insulin that is not made by their pancreas.  Type II diabetics still produce insulin but their bodies do not respond properly to the insulin.   They often have elevated levels of insulin because of the lack of response.  The still-elevated sugar levels stimulate release of more insulin driving the insulin levels higher and the response to insulin is quite poor.  They have trouble getting the sugar into their cells to make energy and as a result they are often hungry, lacking energy and have elevated sugar levels in their blood.  The increased appetite stimulates more food consumption which drives the insulin levels higher and a vicious cycle ensues.  Improved insulin sensitivity decreases the vicious cycle of overconsumption followed by spiking and plummeting sugar levels. Some improvements in insulin sensitivity can be achieved with some simple dietary changes and by adding in a walk after dinner.    Once the individual begins to see the positive changes from these simple changes then more changes can be made.

Everyone knows that sugar is bad for diabetics but what many people do not know is that rice, bread and pasta are just as detrimental to blood sugar control.  Newer research shows that wheat may be worse than sugar in raising blood levels.   In his book “Wheat Belly” Dr. William Davis outlines the changes in the wheat plant over the past years and how the changes are harmful to us.   Dairy products also promote much insulin secretion and should be avoided by individuals who are known to be insulin-resistant.  It is unfortunate that yogurt, cottage cheese and crackers are often touted as healthy snacks for diabetics.   Better choices would be low-glycemic vegetables such as peppers and broccoli, nuts and nut butters and other snacks containing healthy fats.  

Processed foods present another challenge in gaining control of blood sugars.  Nearly all processed foods have added sugars and “low fat” or ”fat free” foods are the worst with sugar added to replace the fat.  Processed foods are also deficient in fiber which is an essential nutrient.  Fiber slows the absorption of sugars and prevents the resultant spikes in insulin levels.  An article in September 2016 in the New York Times broke the news that the sugar industry likely manipulated research data to place the blame on fat for promoting heart disease.  The Journal Of The American Medical Association published an article about that as well.  The sugar industry and indeed the bottled beverage industry have for many years tried to push the focus to fat and as a result we have seen flawed dietary guidelines promoting a low fat diet.  

Dr. Robert Lustig addressed this in his 2008 presentation “Sugar The Bitter Truth” which is an excellent presentation and may still be available online.   He has since written several books and I have enjoyed reading them.   Dr. Mark Hyman has also written a number of excellent books on this subject and he gets more into the specific nutrient deficiencies that can contribute to insulin resistance.   His “Blood Sugar Solution” book has many useful quizzes to help individuals who may be suffering from diabetes. 
The focus needs be on reducing insulin levels and restoring insulin sensitivity.   Right now, most treatments look only at sugar levels so things like dairy and wheat products are still being recommended for consumption.   As seen in the above-mentioned research these items promote excess insulin release and insulin resistance so they should be limited or even eliminated to restore proper insulin function.  

These are just a few of the things that can be done to improve sugar control and working toward the reversal of Type II diabetes.  As the lifestyle interventions start working the patient can see changes in their sugar and lipid levels and resultant improvements in A1C levels.   With diligent adherence to the lifestyle changes recommended many patients may be able to control their sugar without medications.

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