Diabetes rates are rising, in fact it is now considered an “epidemic” in the medical community. The American Diabetes Association reports that:
- 23.6 million Americans have diabetes
- 57 million Americans are pre-diabetic
- 1.6 new cases of diabetes are reported each year
- For those over age 60, almost 1 in 4 have diabetes
- Diabetes is the 7th leading cause of death
- Diabetes increases heart attack risk and 68% of diabetes related death certificates report heart related problems
- 75% of adults with diabetes will develop high blood pressure
- Diabetes is the leading cause of blindness, kidney failure and nervous system disorders
- Diabetes costs $174 billion annually
Diabetes is a well-established problem and a multi-billion dollar industry. It is medically characterized by Fasting Blood Glucose higher than 126 mg/dL , which ranges between 100-125 mg/dL are considered pre-diabetic and ranges below 99 mg/dL are considered normal. Studies are finding that a fasting blood glucose below 83 mg/dL is actually a better benchmark, as risk of heart disease begins to increase at anything above that.
IMPORTANT: There is a difference between Type 1 diabetes (an autoimmune condition) and Type 2 diabetes (lifestyle related). This article refers specifically to Type 2 diabetes.
Some medical professionals use an Oral Glucose Tolerance Test (OGTT) to test for diabetes. If you’ve ever been pregnant and had to drink the sickeningly sweet sugar cocktail and then have blood drawn, you are familiar with this one. Basically, a patient is given 50-75 grams of glucose in concentrated solution and his blood sugar response is measured. I’m not a fan of this test because no one should be ingesting that much concentrated glucose, and the test is not a completely accurate measure. (Just a side note: if you are a drinker of the “Big Gulp” drinks or large amounts of soda, you are putting your body through a similar test each day! Eventually, your body will respond, probably with something like “Fine, you want diabetes, I’ll show you diabetes!)
A OGTT glucose of less than 140 ml/dl is considered normal, with 141-199 being pre-diabetic and levels above 200 mg/dL considered full-blown diabetes. From my research, I believe that OGTT blood sugar levels above 140 mg/dL , especially regularly, can increase risk of vision problems, cancer, stroke and cardiovascular disease, even without an official diabetes diagnosis.
It’s obvious that diabetes is a big problem, but what causes it? Some would have you believe it is genetics, other claim a lifestyle or dietary cause…what is it really? Let’s go back to the biology…
Biology 101: Sugar, Carbohydrates, Insulin and Fat
Any food that you ingest is processed and metabolized by the body. Food is broken down into the various building blocks the body needs, and what cannot be metabolized or used is processed and removed by the liver. Protein and fats are used for muscle and tissue regeneration and other processes in the body. Carbohydrates are typically a fast fuel for the body, but when more are eaten that the body immediately needs, they must be stored. A simple explanation from a previous post:
Any form of carbohydrate is eventually broken down by the body into glucose, a simple form of sugar. While the body can use glucose for fuel, levels that exceed what is needed are toxic to the body. In the long run, that whole wheat muffin, cup of millet, or bowl of oatmeal turns into the exact same thing as a cup of soda, a donut or a handful of candy.
The problem is, glucose is actually toxic if it is just floating around in your bloodstream, so that body has a defense mechanism. Any glucose that is not immediately used is stored as glycogen in the liver and the muscles. This would be all well and good except that your body has a limited number of glycogen receptors. When these are full, as they almost always are in inactive people, the body only has one option left: to store all the excess glucose as saturated fat within the body.
To make matters worse for the inactive, carb addict, when the body senses glucose in the bloodstream, the pancreas releases a hormone called insulin (perhaps you’ve heard of it?) to signal the body to store the glucose as glycogen. If the glycogen receptors are full and it can’t do this, the body thinks that the cells didn’t get the message and releases even more insulin.
When this happens for a period of time, the cells start to become resistant to the presence of insulin, causing a vicious cycle. The body then releases even more insulin, trying desperately to get the cells to uptake the toxic glucose. The presence of excess insulin in the bloodstream is also toxic and further damages the receptors on these cells. Eventually, the insulin allows the glucose access to your fat cells to get it out of the bloodstream. In other words- Fat isn’t stored as fat in the body- Sugar (from carbohydrates) is stored as fat!
So, there you have it: excess sugars and carbohydrates increase insulin levels, and when this happens over a period of time, weight gain and insulin resistance occur. Seems pretty simple, right? If only it were… there are other confounding factors involved.
Grains, Sugars and Omega-6 Oils
These three are the axis of evil in the nutrition world. They are all new introductions to the human diet, especially in the forms they are most eaten in (processed flour, table sugar and High Fructose Corn Syrup and vegetable oils).As we already know, grains (especially in a highly processed form) not only raise insulin levels but can damage the lining of the gut, even in those with no official celiac disease. Grains also cause inflammation in the body and can initiate an immune response.
Sugars raise insulin levels, and over extended periods of time, damage the pancreas and cause insulin resistance, a precursor for diabetes. Fructose is the top offender in the sugar world, as it is recognized as a toxin the body and has no proven benefit to the body. Fructose is immediately taken to the liver, where it must be processed, and some doctors now suggest that this may be a large factor in development of fatty liver disease. Excess sugar in the bloodstream also increases the release of cortisol and adrenaline (more on those in a minute), slows the immune response, decreases necessary Leptin levels and promotes fat storage. There are various types of sugar and sweeteners, and while all should be limited, some are worse than others:
- Glucose-Found in almost all carbohydrates and a precursor to glycogen, which the body needs for energy. It should be limited, but is ok in moderation, especially for healthy individuals
- Fructose- A toxic substance that the body does not need in any amount. If consumed, it should be from fruit and not sources like High Fructose Corn Syrup, which greatly increases risk of the above problems from sugar.
- Sucrose- What we know as table sugar. It has a 1:1 ratio of glucose to fructose and creates an insulin response in the body. Should be limited or avoided.
- High Fructose Corn Syrup- Highly concentrated fructose that is dangerous to the body. Should be avoided
- Honey, Maple Syrup, Agave, Molasses, etc- Natural sweeteners that still contain high levels of fructose. Should be consumed only in moderation by healthy individuals with good insulin sensitivity.
- Sugars in fruit- Fruit contains a lot of natural sugar, and while most are ok in moderation, their juices should be avoided as they are concentrated sources of sugar and raise blood glucose and insulin. Best fruit sources are those high in antioxidants and comparatively low in sugars, such as berries.
Omega 6 oils are also a relatively new addition to the diet, making their appearance in the early 1900s. Oils in this category include vegetable, canola, cottonseed, soybean, corn, safflower, sunflower, etc. Consumption of these oils increased in the 1950s when they were promoted as a “healthy” alternative to saturated fats (they weren’t). Research is now showing that consumption of these oils increases risk for obesity and can damage thyroid function. They contribute to insulin resistance and inflammation, further aggravating the poor pancreas.
Omega-6 fats should be consumed in ideally, a 1:1 ratio with Omega-3 fats. Most Americans consumer a ratio closer to 20 or 25:1, greatly increasing risk of diabetes and obesity.
Stress, Toxins and the Adrenals
Since the body functions as a whole, it is logical that when one hormone or part of the endocrine system is suffering, the other would be affected as well. This is the reason behind the recent research linking high stress levels to diabetes and other health problems. Most people think of stress only in the mental context (as in, “I’ve got a million things to do, I’m running late and I don’t have time to get anything done… I’m so stressed”) but stress can be physical, psychological, emotional, or mental and can be triggered by many factors including:
- Lack of sleep
- Poor diet
- exposure to toxins
- outside stress
When stress occurs, whatever the source, the hypothalamus signals the adrenals to release cortisol (and adrenaline). These hormones are life-saving in true “fight or flight” situations like running away from a charging animal or hoisting a car off a small child, but they cause big problems when they are regularly produced in excess. Excess cortisol can contribute to hormone imbalance in the body since the body uses hormones like progesterone to manufacture cortisol. Excess cortisol absent of a charging animal can also interfere with the body’s ability to regulate blood sugar, reduce fat burning ability, raise insulin, suppress thyroid function and cause gain in belly fat.
Even stress from lack of quality sleep for just a few nights can elevate cortisol, decrease insulin sensitivity and elevate blood sugar. Most moms have probably felt the hangover-like effects of this during the first weeks of caring for a newborn.
Genetic factors do play a role in any disease, but I put this factor last for a reason. Genetic predisposition to a given disease will increase the chances of getting the disease, but not in a vacuum. People with a strong predisposition to liver disease manage to avoid it, and some with a family history of heart disease remain heart-attack free. Even studies among identical twins show that in most cases, twins will get the same diseases, even in different environments, but sometimes they don’t. This means there are other factors involved (see above).
It was once assumed that environmental factors took generations to affect a gene change, but research is now finding that a bad enough toxin or environmental stress can alter genes in a single generation. While genes can pre-dispose us to disease, the disease will only present itself in the presence of factors like toxins, poor diet or stress. A predisposition to diabetes, for instance, might be activated from toxins in foods, pesticides, herbicides, chemicals, or from a poor diet, especially when any of the above factors are also present.
In other words: genetic predisposition can increase your odds of a disease, but genetics alone won’t necessarily give you the disease without other factors. If you know you have genetic predisposition to a given disease, you should certainly be more careful about taking steps to maintain health and prevent it.
Genetic predisposition to liver problems or certain autoimmune diseases often correlate to higher rates of diabetes. This is likely because proper insulin response is handled by the pancreas and liver, so problems here could affect the body’s normal response. Studies have linked certain autoimmune disease and leaky gut syndrome with higher instances of diabetes also, so this correlation is logical as well.
How do we fix it?
All of the above contributing factors don’t usually happen by themselves. Since the body functions as a whole, a problem in one area will usually correlate to problems in others. A combination of the factors above can be the catalyst for a full blown case of diabetes (or a lot of other diseases). While researchers often look at a single variable when trying to discover a cure for a disease, often the best approach is one that addresses the body as a whole. As with all diseases, the best cure is good prevention, but certain measures can help reverse disease once it has occurred.
Unfortunately, most people are not given the benefit of this approach. When diagnosed with diabetes, most people are told to avoid sugar (good step, not the solution). If the problem is bad enough, they are told to take medication to give the body insulin. The problem is, as we saw above, diabetes is a problem with the body’s regulation of insulin, caused by a resistance to insulin and an overproduction to remove toxic amounts of glucose in the bloodstream. Insulin is also dangerous if it is left circulating the the blood. Somehow, treating too much circulating glucose and insulin with more insulin doesn’t seem like the right approach…
It isn’t just keeping blood sugar levels down through insulin control that helps diabetes, but fixing the actual problem causing the diabetes. Addressing just one aspect of the problem (blood sugar or insulin) ignores all the other factors like poor diet, toxins, stress, gut problems, immune issues etc. Instead, this single focuses approach can contribute to the problem, making insulin resistance worse and eventually leading to insulin dependent diabetes when the pancreas shuts down completely. Many doctors and nutrition experts recommend the typical 6-11 servings of complex carbs from whole grain sources daily, suggesting that the fiber helps mitigate insulin response. As I have shown before, 6-11 servings of carbohydrates a day is bad for anyone, but is gasoline on a fire to anyone with an impaired insulin response.
Seven Steps to Help Your Body Recover from Diabetes
The good news (about time!) is that most individuals with Type II diabetes are able to reverse or dramatically mitigate their disease with the proper steps. If you’ve been around my blog much, you might be able to guess what I’m going to suggest:
- Get Insulin Problems Under Control- Diabetes is triggered by insulin resistance and regaining proper insulin sensitivity can help reverse the process. Limit consumption of sugars, grains and processed carbohydrates and focus on healthy proteins, fats and green veggies.
- Get Your Fats in Good Balance- Overabundance of Omega-6 fats in the diet is a contributing factor in diabetes. Pay attention to your intake of Omega-3 and Omega-6 fats and try to get them closer to a 1:1 ratio. For many people, supplementing with a good quality Omega-3 oil can help while dietary adjustments are being made. Avoid Omega-6 seed oils and their sources (these are used at almost every restaurant). Eat fatty fish like salmon and sardines for the Omega-3s.
- Fix your Gut- Not the beer gut, your intestines. Grains and toxins cause damage to the intestinal lining and facilitate leaky gut syndrome. Depleted beneficial bacteria in the gut caused by poor diet, antibiotic use or being bottle fed as a baby can make the problem worse. Remove the grains, avoid toxins whenever possible and take a high quality probiotic to help the intestines heal. As a note: some people will have continued damage to the gut with exposure to grains, especially gluten, as little as only every 10 days or even every 6 months.
- Exercise- Even the mainstream medical community recognizes the advantage of exercise, as it increases the muscles ability to use insulin and over time can help fix insulin resistance. All exercise isn’t created equal though and fortunately, smaller amounts of high intensity exercise have been shown to have a better effect on insulin levels (and weight loss) than an hour of daily moderate cardio. According to the Healthy Skeptic: “A pair of studies done at McMaster University found that “6-minutes of pure, hard exercise once a week could be just as effective as an hour of daily moderate activity“, according to the June 6, 2005 CNN article reporting on the study.” I recommend high intensity exercise anyway for its various health advantages, and it is great for diabetes control. too.
- Lose Excess Weight- Obesity and Diabetes often go hand in hand, and while the debate still rages on if one causes the other, studies show that losing weight can help mitigate diabetes, and also lowers your risk of getting it to begin with. Certain dietary and lifestyle improvements can help you lose weight and are beneficial for diabetes reversal as well.
- Reduce Stress- Stress raises cortisol and can lead to hormone imbalance, insulin issues and increases risk for certain types of disease. Work to reduce your sources of stress from lack of sleep, exposure to toxins, mental and emotional sources and poor diet. Getting quality sleep every night can help reduce stress hormone levels and is great for blood sugar.
- Supplement- Supplements can help your body heal from diabetes, especially while your body works to gain proper insulin reactions again. Supplements often associated with helping diabetes symptoms and improving the disease are cinnamon, omega-3 fatty acids, alpha lipoic acid, chromium, coenzyme Q10, garlic, and magnesium
Monitoring the Problem As It Improves
Anyone with diagnosed Diabetes should consult a physician before making any changes to a diabetes regimen, and especially before changing medication dosages. That being said, improving your diet and eating the foods to help your body heal is your prerogative and your right. For the 65% of America that is overweight, including the 37% that are clinically obese, there is a good chance that many are operating in a pre-diabetic state, or may even have undiagnosed diabetes. Even those without any signs of disease can figure out their insulin levels by at home glucose testing.
I’ve done this for years and I do it each time I’m pregnant in place of the glucose test. It is a cheap and easy way to keep insulin levels in check and see how your body responds to certain foods. While I can offer general advice on the amount of carbohydrates that should be consumed, at home glucose monitoring allows you to know exactly what your body will and won’t handle.
What you need:
- A glucometer – One of those little finger prick machines that diabetics use to test blood sugar. The machine and the strips can be found at most large stores and drugstores.
- Test strips-Get the strips to go with the machine you buy. Be sure to look at the price of the machine and the strips. It is pretty easy to find an inexpensive machine, but the strips can get pricey.
- Small notebook to keep track of readings and food intake.
What to Do:
Once you have the necessary supplies, take readings of your blood sugar, according to the instructions on your meter, at the following times each day for a week:
- First thing in the morning before eating or drinking anything
- Before your normal lunch
- One hour after lunch
- Two hours after lunch
- Three hours after lunch
NOTE: Do not eat or drink anything else during the three hours of testing. You may be able to get an accurate baseline of your insulin response after only a few days, but a week provides more data. If you are already diabetic, you probably have close ideas on these numbers, but take readings at the suggested times anyway to figure out your baseline.
Other Important Steps
- Food Log- Keep an accurate food log of everything you eat and drink and the times during your week of testing your blood sugar. This will help you determine your reaction to specific foods. Don’t make any special effort to diet or eat healthy foods during this time as you want an indication of your normal reactions.
- Carbohydrate Spike Test-On one day of your blood sugar readings (after at least 2-3 days of testing) eat a food high in simple carbs at your test meal (a potato, rice, etc) along with any vegetables, but in the absence of any fats or proteins. This will test your basic glucose reaction to high levels of glucose not mitigated by fat. Record these numbers as usual. Important note: if you usually eat a low-carbohydrate diet, this number might seem higher than it should be. This is because of decreased tolerance to carbohydrates and is not a cause for concern.
- Determine Results-Based on your food log and blood glucose readings, note any specific foods that caused higher readings. I suggest imputing your food log into a website like fitday.com to give accurate analysis of your total carbohydrate, protein, and fat consumption and see which days were the best and worst for your blood glucose.
What Should Your Numbers Look Like?
Ideally, you want your numbers to be as follows:
- Fasting blood glucose below 83 mg/dL
- Pre-meal reading-below 90 mg/dL, or at fasting level
- 1 hour reading- under 140 mg/dL
- 2 hour reading-under 120 mg/dL (preferably under 100)
- 3-hour reading-back to pre-meal level
- No readings above 140 mg/dL
If you have readings higher than this, your body is not processing glucose optimally and you likely have some level of insulin resistance. Reduce the amount of carbs in your diet and remove processed foods entirely. Make sure you are getting good fats and proteins as well. Implement the “Seven Steps” above.
If you have readings on the high end of the pre-diabetic range or in the diabetic range (over 175-180 mg/dL at anytime) consider consulting with a specialist in addition to implementing the “Seven Steps” above.
Even if you don’t have any underlying glucose issues, testing your blood sugar occasionally will help you pin point which carbohydrates you tolerate well and which you don’t. It can help you have a better understanding of your body’s reaction to foods and take control of your health. It is also an accurate alternative to the pregnancy test for gestational diabetes, so talk to your doctor if you’d prefer to test yourself, though you may have to explain your reasons!
Research is constantly giving us more information on diabetes and the various factors that contribute to its steady rise in society over the last few decades. Since most theories on diabetes are just that- theories, research for yourself and figure out your best way or preventing or reversing diabetes. I’ve compiled the best of my own research above, but do your own, too! At the least, please consider making some positive changes to help keep yourself disease free (or become disease free).
Note: I am not a doctor and cannot take the place of your doctor. Before making any changes, especially to medication, consult your doctor or health care professional.
Do you struggle with diabetes? Have you overcome it?