Written by Dr. Tanya Wylde, ND
In order to raise awareness of National Diabetes Awareness Month I challenge you and your family to be sugar free for the last three weeks of November! Yep, that means, no simple sugars such as deserts, chocolate, baked goods, sugar in your coffee, packaged foods sweetened with sugar, etc. I also challenge you to avoid all refined carbohydrates (breads, pastas, white rice, and sugary breakfast cereals) and to exercise daily! It may be a little difficult to live the recommended lifestyle of someone with type 2 diabetes (T2DM) given that you may have a big bag of candy left over from Halloween so either give your treats away or have someone hide them somewhere.
Essentially I am asking you to “live in the shoes” of a person with T2DM for 3 weeks to gain some perspective on how they are taught to live every day. In completing this challenge you will be healthier and more aware of everything that contains sugar! Making healthy food choices for you and your family will help you prevent the onset of all chronic diseases such as T2DM, obesity, heart disease and strokes. You will also get fewer colds and flus since sugar suppresses your immune system! Haven’t you ever noticed children seem to get sick after Halloween!?!
Through this challenge, it’s not necessary to prick your finger every morning to check your fasting blood sugars but keep in mind that this is what someone with diabetes needs to do! Further in this blog I will talk about some easy tests you or your family members can get at our office to assess your risks of developing diabetes and to assess how your body is handling sugar.
Avoiding sugar completely for a 3 weeks and exercising every day may sound challenging but in doing so, you will improve your overall health, possibly shed a few pounds and likely feel very good since sugar really is unhealthy for all of us, not just diabetics! For you, this is a choice, but for a diabetic, it isn’t. If a diabetic wants to keep their vision, have healthy blood pressure, nerves, kidneys and circulation they need to avoid foods high in sugars all the time and not just for 3 weeks. For a diabetic, sugar is poison. When an uncontrolled diabetic eats sugar or refined carbohydrates, the sugar sticks to the red blood cells making the blood thick like maple syrup and very difficult to travel through the arteries causing a reduction in healthy circulation, resulting in damage to very important parts of the body such as the nerves, kidneys and eyes and in severe and uncontrolled cases, resulting in lost vision, failed kidneys, lost limbs, heart disease and strokes.
Diabetes is one of the most common chronic diseases in Canada.[i] Close to 2.4 million Canadians aged one year and older were living with diagnosed diabetes (either type 1 (T1DM) or type 2 (T2DM) as of 2009.i This represented approximately 6.8% of the population and approximately one in 11 Canadians.(i) There are probably many more undiagnosed diabetics and/or in the pre-diabetic range (on the verge of diabetes) as well.
To clarify, there is often a genetic component to both T1DM and T2DM diabetes, however whereas T2DM can be prevented with a healthy lifestyle and usually occurs later in life, T1DM can’t be prevented with a healthy lifestyle and usually occurs earlier in life. Someone with T1DM still needs to eat healthy and exercise but because they have no insulin hormone (which makes the healthy and unhealthy sugars we eat usable by our brains, muscles, organs and tissues) they have the added task of injecting themselves with insulin multiple times per day. If a person with T2DM “misbehaves” by not following a healthy lifestyle and doesn’t respond to medications, they can end up destroying their pancreas (the organ that produces and secretes insulin) and then will also develop T1DM and need to inject themselves daily with insulin. This month we should all remember and be grateful to the Canadian physician, Frederick Banting and his medical student Charles H. Best who discovered the injectable form of insulin in 1921 since this has saved many lives![ii]
We all have the potential to develop diabetes, but this is especially true for those with a family history of this disease. My father had T2DM so I’m well aware of the serious complications that can occur in an individual with uncontrolled T2DM including, very sadly, death. When I think of him and his struggles, it is a good reminder for me that I don’t need to satisfy any sugar cravings that I get. I find that if I don’t eat any sugar for at least 3 weeks straight (the time it takes to develop a new habbit) then I actually develop distaste for it. This may simply be the power of my mind but many of my patients who have completed this challenge often agree. So this is why I challenge you to do the same. Complete avoidance seems to be the easiest way to keep sugary items out of the diet for most, since one little piece often triggers an appetite for more. I don’t know about you but a little chocolate leads to more chocolate so I just don’t eat any. I prefer to get my antioxidants elsewhere, in the form of matcha green tea and blueberries.
Poor diet is a major contributor to the leading causes of chronic disease and death in North America, including coronary heart disease, diabetes, hyperlipidemia, and stroke.[iii] As a naturopathic doctor I’ve had the pleasure of helping many determined patients come off of their medications for T2DM solely through the nutrition and exercise recommendations I have made and my patient’s persistence to become healthy. Below are some important clinical pearls I want to share with you while you live the lifestyle of a T2DM patient for three weeks. If you know anyone struggling with diabetes, please share this article with him or her too.
1. We know that exercising regularly can reduce our risk of developing chronic diseases such as diabetes[iv], but what kind of exercise works to really positively affect blood sugars?
Answer: Interval training
For best results perform bouts of higher intensity exercise mixed with lower intensity rather than continuous low intensity exercise since intervals of high intensity is more important than duration. In one study interval-walking training improved glycemic control for individuals with T2DM compared with continuous walking with equivalent energy expenditure.[v] Another study proved that intensity of physical activity is more important than duration of exercise in reducing risk of developing metabolic syndrome.[vi] Metabolic syndrome is the name for a cluster of risk factors that give rise to diabetes or heart disease including high blood pressure, high blood sugar, high triglycerides, low HDL (good cholesterol) and belly fat.iv
So no matter what exercise you enjoy (walking, running, biking, swimming etc.) make sure that you add some speed and intensity for about 1-3 minutes, then recover for 1-3 minutes and repeat.
2. Is it true that eating breakfast is really important for healthy blood sugars?
Yes, there is clinical evidence documenting the strong protective effect of breakfast consumption to prevent and/or treat obesity/T2DM and promote overall health in young people.[vii] This is only true if the breakfast is healthy!
So start your day with a healthy protein and fruits or vegetables. A nice example is a protein shake with a scoop of protein powder (hemp/whey/rice/pumpkin seed), almond milk (or other dairy-free milk), almond butter, blueberries and spinach blended in the blender or an egg omlette with baby spinach and kale with and a side of sliced cucumbers, avocado and tomatoes.
3. Is it true that brown rice is better than white rice when it comes to healthy blood sugars?
Yes, white rice white rice consumption has been linked to T2DM.[viii] It’s always best to choose brown rice over white rice since brown rice has more fiber, more vitamins and minerals and a lower glycemic index thus reducing the risk for type 2 diabetes! So always cook with brown rice and the next time you order take out at a sushi or Thai restaurant, ask for brown rice! Also important to note is that a patient taught me that most sushi restaurants mix sugar with their sticky white rice but you can ask them not to when you order sushi rolls. Bottom line always chose brown rice over white rice.
4. a) Is it true that a healthy diet can prevent chronic disease? b) What would I, Dr. Tanya, like to see in your shopping cart?
a) Yes, healthy food choices can prevent chronic disease. Not too long ago many conventional doctors felt that food had nothing to do with health. Studies have shown that many medical doctors’ knowledge and counseling about healthy diets are still lacking[ix]. Despite this it is common knowledge now that healthy food consumption lowers risk of chronic disease.vii Food can act as medicine and it can also act as poison, so stay on the outside aisles at the supermarket and purchase fresh produce rather than boxed, packaged foods and try and impress your fellow grocery store shopper’s by a shopping cart filled with nutritious foods!
b) I’d like to your shopping cart filled with: organic fresh dark green vegetables (kale, spinach, collard greens, romaine lettuce), organic root vegetables (sweet potatoes, turnips, rutabagas, beets, Yukon gold potatoes, red potatoes) organic fruits (frozen blueberries, raspberries, blackberries, fresh organic apples, oranges, nectarines), healthy grains (brown rice, quinoa, millet, oats), organic meats and poultry (chicken, eggs, bison, lean beef), wild fish (pacific salmon, sardines, light chunk tuna) nuts & seeds (pumpkin seeds, almonds, walnuts, sesame seeds, nut and seed butters), healthy oils (olive oil, pumpkin seed oil), organic low fat dairy (goat, cow, sheep) or dairy alternatives (almond milk, coconut milk). I don’t want to see any breads, deserts, pop or processed, packaged foods!
If you want to impress me with a picture of your healthy groceries, take a picture of what’s in your shopping cart and post it under the comments section!
5. If you have T2DM, you may have been prescribed a medication called “Metformin”. If you are on Metformin, what vitamin may you have difficulty absorbing?
Vitamin B12 absorption may be impaired when a person is on the medication Metformin[x]. Vitamin B12 deficiency can cause peripheral neuropathy (damage to the nerves that supply the feet and hands)which can make you feel like you are walking on pins and needles. This can be confusing, since many people with T2DM already have peripheral neuropathy and this medication may compound the effects by impairing the absorption of this essential vitamin. So it’s always best to supplement with vitamin b12 if you are on the medication metformin and ensure your blood vitamin b12 levels remain optimal with a blood test.
6. What additional changes (beyond healthy nutrition and exercise) can pregnant women do to avoid gestational diabetes mellitus (GDM)?
a) Taking probiotics while pregnant has been found to reduce the risk of gestational diabetes mellitus (GDM). In the British-journal of nutrition they published a double-blind, placebo-controlled study on the use of probiotics in pregnant women and pregnancy outcome and prenatal and postnatal growth. They found that probiotics are safe in pregnancy and reduce the risk of gestational diabetes and the risk of delivering large/obese children.[xi]
b) Supplementing with “myo-Inositol”, (a type of b-vitamin) in pregnant women with a family history of T2DM may reduce the risk of GDM and delivery of macrosomia (large) babies.[xii]
7. What supplements have been proven to be effective in studies and in naturopathic practice for diabetes and the associated complications of diabetes?
First it’s important to note that a healthy diet and regular exercise (more specifically interval trainingv,vi) is more important than any supplement when treating a patient with T2DM. That said, the following supplements seem to have the most research behind them with regards to improving insulin resistance according to the national institutes of health: Alpha Lipoic Acid[xiii],[xiv],[xv], [xvi], Chromium[xvii], Omega-3 fatty acids[xv] and EGCG[xviii], [xix] (polyphenol from Green Tea).[xx] N-acetylcysteine(NAC)[xxi], Vitamin D3[xxii] and myo-inositolxv,[xxiii] are three other important supplements to consider for insulin resistance and complications associated with diabetes. Doses vary depending on the weight of the patient and degree of insulin resistance.
8. What tests can you get to assess your personal risk of diabetes?
1. At our office we offer a very comprehensive “functional medicine assessment” test to determine if you might have pre-diabetes called: PreD Guide through Genova Diagnostics.
This comprehensive test measures stages of pre-diabetes and progression toward Type 2 Diabetes Mellitus (T2DM) using metabolic and inflammatory biomarkers. Pre-D Guide focuses on the importance of early assessment and correction of risk factors.
For more information on this test, click HERE
2. We also offer the more standard blood test called HbA1C (aka glycated hemoglobin test) to determine if you have “pre-diabetes” or to determine how effective our treatment recommendations have been if we are monitoring your diabetes or pre-diabetes.
HbA1C basically tells us how much sugar has been bound to your red-blood cells in the last three months since red blood cells turn-around/recycle every 3 months! So if you ate well for a couple of weeks but “cheated” the rest of the time, this test will still pick up, sugar, sticky blood.
Some medical doctors will add this test to your annual physical exam and some will not. If you have pre-diabetes we will often measure this every 8-12 weeks to re-assess how you are doing with our recommendations!
If we need to assess you more frequently than this then we will assess our Fructosamine levels which is a less standard test but available to all doctors.
To learn more information on this test, click HERE
3. We also offer the standard diabetes assessment blood tests called Fasting Glucose & Fasting Insulin.
These tests will tell us if you are having a hard time controlling sugar in your body or if your insulin levels have gone down from a failing pancreas. However, sometimes if you are on the verge of developing diabetes (“pre-diabetes”), these tests might not be accurate especially if you ate really well for a few days prior to your blood test this is why we offer the tests seen above in part 1&2!
4. In addition to blood tests, we assess waist size, fat percentage using a Bioimpedance Analysis machine and measure Body Mass Index since these have all been individually associated with Type 2 DM. Oh and we know when you haven’t been following our recommendations…not by your results, but by your facial expression just before we run these last tests!!! LOL.
[i] Diabetes in Canada: Facts and figures from a public health perspective (2011, December 15th) Retrieved from: http://www.phac-aspc.gc.ca/cd-mc/publications/diabetes-diabete/facts-figures-faits-chiffres-2011/chap1-eng.php#DIA
[ii] Rogers, Kara. Who really discovered insulin. Encyclopedia Britanica Blog. (2011, July 29) Retrieved from: http://www.britannica.com/blogs/2011/07/discovered-insulin/
[iii] Lin JS, O’Connor E, Whitlock EP, Beil TL. Behavioral counseling to promote physical activity and a healthful diet to prevent cardiovascular disease in adults: systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2010; 153: 736-750
[iv] Hitt, Emma, PhD. Fitness in Middle Age Lowers Risk for Future Chronic Disease. Arch Int Med. (2012, August 28th). Retrieved from: http://www.medscape.com/viewarticle/769889?src=mpnews
[vi] Denise Mann. Fast Walking May Slash at Heat Disease, Diabetes. (2012) Retrieved from:http://www.webmd.com/heart/news/20121008/fast-walking-may-slash-heart-disease-diabetes
[vii] Leidy, Heather J. The Benefits of Breakfast Consumption to Combat Obesity and Diabetes in Young People Am J Lifestyle Med. 2013; 7 (2); 99-103.
[viii] Hu, Emily. White Rice Consumption and risk of type 2 diabetes: meta-analysis and systematic review. British Medical Journal. (2012, March 15th). Retrieved from:http://www.bmj.com/content/344/bmj.e1454
[xi] Luoto, Raakel et al. Impact of maternal probiotic-supplemented dietary counselling on pregnancy outcome and prenatal and postnatal growth: a double-blind, placebo-controlled study. British Journal of Nurition. (2010). Retrieved from:http://www.nutrociencia.com.br/upload_files/artigos_download/impact%20of%20maternal%20probiotic-supplemented.pdf
[xii] D’Anna, Rosario MD. Et al. myo-Inositol Supplementation and Onset of Gestational Diabetes Mellitus in Pregnant Women With a Family History of Type 2 Diabetes. Diabetes Care. 2013; 36 (4): 854-857.
[xiii] JacobS,RuusP,HermannR,etal.Oraladministrationof RAC-alpha-lipoicacidmodulatesinsulin sensitivityinpatientswithtype-2diabetesmellitus:aplacebo-controlledpilottrial. FreeRadicBiol Med 1999;27:309-314.
[xiv] Melhem MF, Craven PA, Liachenko J, DeRubertis FR, Alpha Lipoic Acid attenuates hyperglycemia and prevents glomerular mesangial matrix expansion in diabetes: J Am Soc Nephrol, 2002 Jan;13 (1):108-16.
[xv] Udupa A, Nahar P, Shah S, Kshirsagar M, Ghongane B. A comparative study of effects of omega-3 Fatty acids, alpha lipoic Acid and vitamin e in type 2 diabetes mellitus. Ann Med Health Sci Res. 2013 Jul;3(3):442-6. doi: 10.4103/2141-9248.117954
[xvi] Cappelli V, Di Sabatino A, Musacchio MC, De Leo V. [Evaluation of a new association between insulin-sensitizers and α-lipoic acid in obese women affected by pcos.]. Minerva Ginecol. 2013 Aug;65(4):425-433
[xviii] Wu, Anna H. Effect of 2 month controlled green tea intervention on lipoprotein cholesterol, glucose, and hormone levels in healthy postmenopausal women. Cancer Prev Res (Phila). 2012 March; 5(3): 393–402.
[xix] Bahadoran, Zahra Dietary polyphenols as potential nutraceuticals in management of diabetes: a review. J Diabetes Metab Disord. 2013; 12: 43.
[xx] National Institutes of Health. Diabetes and CAM: A focus on Dietary Supplements. (2009, June) Retrieved from: http://nccam.nih.gov/health/diabetes/CAM-and-diabetes.htm
[xxi] Ozkilic AC et al. The role of N-acetylcysteine treatment on anti-oxidative status in patients with type II diabetes mellitus. J Basic Clin Physiol Pharmacol 2006; 17(4):245-54
[xxii] Belenchia AM, Tosh AK, Hillman LS, Peterson CA. Correcting vitamin D insufficiency improves insulin sensitivity in obese adolescents: a randomized controlled trial. Am J Clin Nutr. 2013 Apr;97(4):774-81.
[xxiii] Artini PG, Di Berardino OM, Papini F, Genazzani AD, Simi G, Ruggiero M, Cela V.Endocrine and clinical effects of myo-inositol administration in polycystic ovary syndrome. A randomized study. Gynecol Endocrinol. 2013 Apr;29(4):375-9
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