By Dr. Mercola
An Epoch Times article recently lamented the lack of discussion surrounding diabetes across the globe. During June 2015, for instance, there were more than 16,000 news articles focused on cancer and more than 7,000 discussing HIV/AIDS.
Diabetes was mentioned in just 5,000 news articles, despite the fact that nearly 30 million Americans have diabetes while 86 million have pre-diabetes, a precursor to the full-blown disease.1
"Who's talking about diabetes?" the article asks… well, World Diabetes Day is on November 14, which the International Diabetes Federation describes as a "year-long campaign to reflect on the realities of dealing with a chronic condition."2
In addition, I have long made a point to discuss diabetes frequently because this disease is one of the greatest health threats facing the US and much of the world. It also happens to be one of the easiest to treat using lifestyle modifications, which is why spreading the word is so incredibly important.
Type 1 and Type 2 Diabetes Are Not the Same…
First I want to clarify that when I say diabetes is treatable with lifestyle changes, I'm referring to type 2 diabetes. In type 1 diabetes, your body's own immune system destroys the insulin-producing cells of your pancreas, resulting in a complete deficiency of the hormone insulin.
This deficiency of insulin is why type 1 is called "insulin-dependent" diabetes — because more often than not, type 1 diabetics must give themselves supplemental insulin.
Type 1 is an autoimmune disease, and it's relatively uncommon, affecting about 1.25 million Americans (out of the total 30 million with diabetes).3 It usually occurs in people before the age of 20. There is no known cure. Type 2 diabetes is by far the more common form of the disease, affecting 90 percent to 95 percent of diabetics, and is typically preventable and nearly 100 percent curable.
If you have type 2 diabetes, your body is producing some insulin but is unable to recognize insulin and use it properly. This is an advanced stage of insulin resistance. The largest analysis of health trends around the world from 1990 to 2013 revealed a striking rise in diabetes.4
The data spanned 188 countries and revealed a 45 percent increase in diabetes prevalence from 1990 to 2013. In the US, the rise was even more striking – 71 percent.
However, the majority of the rise was due to type 2 diabetes, which is closely related to obesity, another condition that's been on the rise globally. Diabetes, once ranked as the No.10 cause of disability worldwide, is now No. 7…
Diabetes is linked to many complications, from heart disease and kidney damage to eye problems and hearing impairments. Most all of its complications are due to underlying insulin resistance, which is a foundational cause in many cases of chronic disease.
The Epoch Times article suggests more people aren't talking about type 2 diabetes because there's a stigma that "it's your fault" if you're diagnosed. I would counter that this isn't an issue of placing blame – it's an issue of empowerment.
We need to talk about type 2 diabetes so that anyone who's diagnosed is aware that they have the power to change the future course of the disease… and likely become diabetes-free.
Diet and Exercise Work Better Than Drugs to Prevent Diabetes – Even in Those at High Risk
During the three-year Diabetes Prevention Program study, lifestyle interventions were found to be more effective than the diabetes drug metformin at preventing or delaying the development of diabetes.
The study involved more than 2,700 people who were overweight or obese and had elevated blood sugar levels, which means they were at high risk of type 2 diabetes. A recently published follow-up study monitored the group for 15 years – and lifestyle interventions were still more effective than metformin at preventing diabetes.5
After the initial three-year study, those who made dietary changes and exercised at moderate intensity for 15 minutes daily were 58 percent less likely to develop diabetes compared to a placebo group. Those taking metformin were 31 percent less likely to develop the disease.
After 15 years, those who made lifestyle changes were 27 percent less likely to develop diabetes, while those in the metformin group were 18 percent less likely, compared to placebo.6
Further, women in the lifestyle group were also less likely to display microvascular complications, which are changes in the tiny blood vessels of the kidney and retina, and nerve damage associated with diabetes. Study author professor David M. Nathan of the Massachusetts General Hospital in Boston told Reuters:7
"The lifestyle intervention was more powerful in preventing or delaying diabetes development during the original three-year Diabetes Prevention Program and remains more powerful over the entire 15-year study."
Why Do Americans Keep Getting Fatter?
It's important to realize that type 2 diabetes is not the result of insufficient insulin production. It's actually the result of too much insulin being produced on a chronic basis, primarily from eating a high-carbohydrate, low-fat diet.
This overwhelms and "deafens" your insulin receptors, hence the term "insulin resistance." It's the chronically elevated insulin levels that make your body "resistant" to understanding the signals sent by the insulin. This also occurs with leptin, and most overweight or obese individuals have some degree of insulin and leptin resistance.
One of the best predictors of type 2 diabetes, in turn, is being obese or overweight. Americans have been getting steadily fatter for decades.
For instance, one study found the average American's body mass index (BMI) was 2.3 points higher than that in 1988 (even though BMI is not the best measurement tool, it can still help reveal a trend). The Atlantic summed up several theories as to why Americans keep gaining weight:8
- Environmental chemicals
- Prescription drugs
- Changes to our microbiomes
- Less non-exercise activity
Diet undoubtedly plays a role as well. Added sugars and processed fructose, in particular, are primary drivers of metabolic dysfunction that can lead to both obesity and type 2 diabetes.
Refined fructose is actually broken down very much like alcohol, damaging your liver and causing mitochondrial and metabolic dysfunction in the same way as ethanol and other toxins.
It also causes more severe metabolic dysfunction because it's more readily metabolized into fat than any other sugar. A recent meta-review published in the Mayo Clinic Proceedings found that once you reach 18 percent of your daily calories from added sugar, there's a two-fold increase in metabolic harm that promotes pre-diabetes and diabetes.9
Type 2 Diabetes at 3 Years Old: What Obesity Is Doing to Kids
Overweight and obesity are growing not just among US adults but among children, too. A new study published in the New England Journal of Medicine highlighted the consequences of excess weight in youth, particularly in those with severe forms of obesity.10
The more obese a child became, the greater their markers for heart disease and diabetes became. For instance, levels of HDL cholesterol fell, blood pressure and triglyceride levels rose, as did hemoglobin A1C levels, which are a marker of diabetes.
Obese boys, in particular, were especially at risk of markers for heart disease and diabetes. Study author Asheley Cockrell Skinner of the UNC School of Medicine told Forbes:11 "Kids with very severe obesity are about twice as likely as those with lower levels of obesity to display risk factors."
Research presented at the annual meeting of the European Association for the Study of Diabetes included a case study of the youngest toddler to be diagnosed with type 2 diabetes (on record). The US girl is just 3 years old and weighed about 77 pounds.
Fortunately, after six months of dietary changes and increased activity, she lost nearly 20 pounds, no longer needed diabetes medication, and her blood sugar levels returned to normal. Dr. Justin Warner, diabetic lead at the Royal College of Paediatrics and Child Health, told BBC News:12
"The fact that this child's blood sugars returned to normal after she lost weight demonstrates that this was obesity related but also that you can change your risk by changing your lifestyle… We haven't seen a child that young with diabetes yet in the UK. But it is a worry. People don't tend to see the fact that obesity in children means you are storing up health problems for the future."
Telling Children to 'Sit Still' May Be Harming Their Health
Researchers decided to study a small group of girls (aged 9 to 12 years) to determine if excessive sitting is as detrimental to their health as it appears to be to adults. In adults, sitting for hours leads to constricted arteries in your legs, which impedes blood flow, raises blood pressure, and contributes to the development of heart disease over time.13
Does the same hold true among children? At the start of the study, all of the girls had healthy arterial function. However, after sitting for three hours, playing on tablets or watching movies, there was a "profound" reduction in vascular function.14
Arterial dilation fell by up to 33 percent in the girls, which is alarming since a 1 percent decline in vascular function is known to increase heart disease risk by 13 percent in adults.15 There were some encouraging findings. The girls' artery function had returned to normal a few days later when they returned to the lab. And when the sitting time was interrupted by a gentle 10-minute cycling session, no decline in vascular function was recorded. Still, no one knows what effect sitting for hours day after day has on kids' health, so it's best to encourage your kids to stay active.
Pesticide Exposure Increases Diabetes Risk
Obesity and overweight are strongly associated with diabetes, but they're not the only risk factors. A systematic review of 21 studies, presented at the annual meeting of the European Association for the Study of Diabetes in Stockholm, Sweden, revealed that pesticide exposure may increase your diabetes risk.16 Exposure to any type of pesticide studied increased diabetes risk (both type 1 and type 2) by 61 percent. Risk of type 2 diabetes, in particular, was increased by 64 percent. While all the chemicals raised the risk, some did so more than others. The pesticides most linked to diabetes include:
Chlordane Oxychlordane Trans-nonachlor DDT DDE Dieldrin Heptachlor HCB
How Type 2 Diabetes Is Linked to Alzheimer's Disease
Diabetes could easily be called pre-cancer or pre-heart disease, because the insulin resistance underlying it is damaging to all of your body's tissues… including that of your brain. In fact, research published in the journal Neurology suggests type 2 diabetes may contribute to the development of beta-amyloid plaques and tau-protein tangles often seen in Alzheimer's disease.17 MRI brain scans of people with type 2 diabetes revealed they had more thinning in the brain's cortex (a region with the highest nerve cell concentration).
Those with type 2 diabetes also had higher tau levels, which suggests they also had more tau-protein tangles in the brain. Taken together, both of these changes are indicative of decreasing brain health. As reported by Diabetes in Control, the study's lead author suggested several theories that might explain the connection between type 2 diabetes and dementia, including Alzheimer's disease:18
"Chronic hyperglycemia can cause damage in the brain. Glycation of proteins is increased in type 2 diabetes, which may lead to tau-protein congregation. Chronic inflammation may also have a causative role. Systemic low-grade inflammation is a feature of diabetes and other diseases. Another possible link is obesity. Obesity, which is a leading risk factor for type 2 diabetes, has been linked to increased tau-protein pathology."
Research has also found new study found that problems with blood flow in the brain may develop in as little as two years in people with diabetes. That impaired blood flow appears to accelerate cognitive decline, lowering thinking and memory skills.19
The results aren't surprising, considering past research has shown diabetes ages your brain about five years faster than normal,20 as well as leads to accelerated losses in brain volume, especially gray matter.21 So it's become increasingly clear that preventing type 2 diabetes, as well as risk factors for the disease (like obesity), may reduce your risk of developing dementia later in life.
You Can Prevent, and Reverse, Type 2 Diabetes
While anyone can get type 2 diabetes, you are typically considered at highest risk if you are overweight or obese, sedentary, if you are a woman who had gestational diabetes, have family members with type 2 diabetes, or have metabolic syndrome.
However, all of these really have the same underlying root of insulin and leptin resistance. Type 2 diabetes represents the vast majority of all diabetics, and contrary to conventional medical and media teaching, it's nearly 100 percent curable through lifestyle changes alone.
The following nutrition and lifestyle modifications should be the foundation of your diabetes prevention and treatment plan. Also, make sure to monitor your fasting insulin level. This is every bit as important as monitoring your fasting blood sugar. You'll want your fasting insulin level to be between 2 and 4. The higher your level, the greater your insulin resistance and the more aggressive you need to be in your treatment plan, especially when it comes to altering your diet.
- Swap out processed foods, all forms of sugar — particularly fructose — as well as all grains, for whole, fresh food. A primary reason for the failure of conventional diabetes treatment over the last 50 years has to do with seriously flawed dietary recommendations. Fructose, grains, and other sugar forming starchy carbohydrates are largely responsible for your body's adverse insulin reactions, and all sugars and grains — even "healthy" grains such as whole, organic ones — need to be drastically reduced.
If you're insulin/leptin resistant, have diabetes, high blood pressure, heart disease, or are overweight, you'd be wise to limit your total fructose intake to 15 grams per day until your insulin/leptin resistance has resolved. This includes about 80 percent of Americans.
For all others, I recommend limiting your daily fructose consumption to 25 grams or less, to maintain optimal health. The easiest way to accomplish this is by swapping processed foods for whole, ideally organic foods. This means cooking from scratch with fresh ingredients.
Processed foods are the main source of all the primary culprits, including high-fructose corn syrup and other sugars, processed grains, trans fats, artificial sweeteners, and other synthetic additives that may aggravate metabolic dysfunction. Besides fructose, trans fat (NOT saturated fat) increases your risk for diabetes by interfering with your insulin receptors. Healthy saturated fats do not do this. Since you're cutting out a lot of energy (carbs) from your diet when you reduce sugars and grains, you need to replace them with something. The ideal replacement is a combination of:
- Low-to-moderate amount of high-quality protein. Substantial amounts of protein can be found in meat, fish, eggs, dairy products, legumes, and nuts. When selecting animal-based protein, be sure to opt for organically raised, grass-fed, or pastured meats, eggs, and dairy, to avoid potential health complications caused by genetically engineered animal feed and pesticides.
Most Americans eat far too much protein, so be mindful of the amount. I believe it is the rare person who really needs more than one-half gram of protein per pound of lean body mass.
Those that are aggressively exercising or competing and pregnant women should have about 25 percent more, but most people rarely need more than 40 to 70 grams of protein a day. To determine your lean body mass, find out your percent body fat and subtract from 100. This means that if you have 20 percent body fat, you have 80 percent lean body mass. Just multiply that by your current weight to get your lean body mass in pounds or kilos. The chart below shows some common foods and their protein content:
Red meat, pork, poultry, and seafood average 6 to 9 grams of protein per ounce.
An ideal amount for most people would be a 3-ounce serving of meat or seafood (not 9 or 12-ounce steaks!), which will provide about 18 to 27 grams of protein
Eggs contain about 6 to 8 grams of protein per egg. So an omelet made from two eggs would give you about 12 to 16 grams of protein.
If you add cheese, you need to calculate that protein in as well (check the label of your cheese)
Seeds and nuts contain on average 4 to 8 grams of protein per quarter cup Cooked beans average about 7 to 8 grams per half cup Cooked grains average 5 to 7 grams per cup Most vegetables contain about 1 to 2 grams of protein per ounce
- As much high-quality healthy fat as you want (saturated and monounsaturated). For optimal health, most people need upwards of 50 to 85 percent of their daily calories in the form of healthy fats. Good sources include coconut and coconut oil, avocados, butter, nuts, and animal fats. (Remember, fat is high in calories while being small in terms of volume. So when you look at your plate, the largest portion would be vegetables.)
- As many non-starchy vegetables as you want
- Exercise regularly and intensely. Studies have shown that exercise, even without weight loss, increases insulin sensitivity.22 High-intensity interval training (HIIT), which is a central component of my Peak Fitness program, has been shown to improve insulin sensitivity by as much as 24 percent in just four weeks.
- Improve your omega-3 to omega-6 ratio. Today's Western diet has far too many processed and damaged omega-6 fats, and is far too little omega-3 fats. The main sources of omega-6 fats are corn, soy, canola, safflower, peanut, and sunflower oil (the first two of which are typically genetically engineered as well, which further complicates matters). The optimal ratio of omega-6 to omega-3 is 1:1. However, our ratio has deteriorated to between 20:1 and 50:1 in favor of omega-6. This lopsided ratio has seriously adverse health consequences.
To remedy this, reduce your consumption of vegetable oils (this means not cooking with them and avoiding processed foods), and increase your intake of animal-based omega-3, such as krill oil. Vegetable-based omega-3 is also found in flaxseed oil and walnut oil, and it's good to include these in your diet as well. Just know they cannot take the place of animal-based omega-3s.
- Maintain optimal vitamin D levels year-round. Evidence strongly supports the notion that vitamin D is highly beneficial for diabetes. The ideal way to optimize your vitamin D level is by getting regular sun exposure or by using a high-quality tanning bed.
As a last resort, consider oral supplementation with regular vitamin D monitoring to confirm that you are taking enough vitamin D to get your blood levels into the therapeutic range of 50 to 70 ng/ml. Also, please note that if you take supplemental vitamin D, you create an increased demand for vitamin K2.
- Get adequate high-quality sleep every night. Insufficient sleep appears to raise stress and blood sugar, encouraging insulin and leptin resistance and weight gain. In one 10-year long study of 70,000 diabetes-free women, researchers found that women who slept less than five hours or more than nine hours each night were 34 percent more likely to develop diabetes symptoms than women who slept seven to eight hours each night.23 If you are having problems with your sleep, try the suggestions in my article "33 Secrets to a Good Night's Sleep."
- Maintain a healthy body weight. If you incorporate the diet and lifestyle changes suggested above you will greatly improve your insulin and leptin sensitivity, and a healthy body weight will follow in time. Determining your ideal body weight depends on a variety of factors, including frame size, age, general activity level, and genetics. As a general guideline, you might find a hip-to-waist size index chart helpful.
This is far better than BMI for evaluating whether or not you may have a weight problem, as BMI fails to factor in both how muscular you are, and your intra-abdominal fat mass (the dangerous visceral fat that accumulates around your inner organs), which is a potent indicator of leptin sensitivity and associated health problems.
- Incorporate intermittent fasting. If you have carefully followed the diet and exercise guidelines and still aren't making sufficient progress with your weight or overall health, I strongly recommend incorporating intermittent fasting. This effectively mimics the eating habits of our ancestors, who did not have access to grocery stores or food around the clock. They would cycle through periods of feast and famine, and modern research shows this cycling produces a number of biochemical benefits, including improved insulin/leptin sensitivity, lowered triglycerides and other biomarkers for health, and weight loss.
Intermittent fasting is by far the most effective way I know of to shed unwanted fat and eliminate your sugar cravings. Keep up your intermittent fasting schedule until your insulin/leptin resistance improves (or your weight, blood pressure, cholesterol ratios, or diabetes normalizes). After that, you only need to do it "as needed" to maintain your healthy state.
- Optimize your gut health. Your gut is a living ecosystem, full of both good bacteria and bad. Multiple studies have shown that obese people have different intestinal bacteria than lean people. The more good bacteria you have, the stronger your immune system will be, and the better your body will function overall. Fortunately, optimizing your gut flora is relatively easy. You can reseed your body with beneficial bacteria by regularly eating fermented foods (like natto, raw organic cheese, miso, and cultured vegetables).