Rising to the Challenge
Diabetes used to be a fixed sentence: If you had type-1 you faced a lifetime of insulin injections, innumerable health problems, and the prospect of an early death; type-2 simply arrived with old age, along with arthritis and high blood pressure. These days, children as young as 6 have type-2 and many seniors face diabetes-related dementia. Learn how you can sidestep the ravages of the disease through diet and lifestyle changes.
When I was growing up in the 1950s, I watched a constant stream of TV westerns, but in real life it was diabetes, not outlaws, that had me surrounded.
Every member of my immediate family, excluding me, had the disorder. My mother and sister had type-1 diabetes, and later in life, my father was diagnosed with type-2, as was my maternal grandmother, Molly. My Dad’s sister, Thelma, was a “brittle” type-1, meaning her blood sugar swung wildly between low and high. She ultimately died of diabetes complications, as did Mom, also a brittle diabetic whose disorder ravaged her heart. Other casualties include Dad’s uncle Jake, who was blinded by type-1 before succumbing to it in his early 50s, and my fraternal cousin Danny, who struggles to control his type-2.
Diabetes is now tearing through the nation the way it has torn through my family. The federal Centers for Disease Control and Prevention (CDC) estimates that some 20.8 million Americans—about 7 percent of the population—are diabetic. Contrary to other health trends, diabetes is killing more people, too. Diabetes-related deaths have jumped by 45 percent since 1987, even as the death rates from heart disease, stroke, and cancer have slowed.
No mystery why, though. The diabetes epidemic—really a type-2 epidemic—is the demon spawn of junk food, channel surfing, and Internet surfing, which have long since replaced healthy food and physical activity in many American lives. The increase in type-2 diabetes correlates with America’s obesity epidemic almost as closely as thunder follows lightning. From 1991 to 2001, a CDC study found, diagnosed diabetes increased by 61 percent and obesity rates grew by 74 percent. Connecting the dots is simple because most people with type-2 diabetes, by far the most common form, are overweight.
Diabetes rarely announces itself with dramatic symptoms, so about a third of type-2s go undiagnosed. And because they’re not being treated, they could be blindsided later in life by diabetes’ serious complications. That sobering list includes kidney failure, nervous system damage, blindness, high blood pressure, hardening of the arteries, heart attack, stroke, lower limb amputations, gum disease, and pregnancy complications including birth defects.
But diabetes isn’t a death sentence or even a sentence to a compromised life. With training and diligent attention to your blood sugar levels, insulin doses, and diet, you can manage your type-1 diabetes and live a long, healthy life. Type-2 diabetes is easily prevented, and if battled aggressively in its early stages, can be completely reversed. As a reader of this publication, you’re closer to unlocking the secret to avoiding or curing type-2 than most Americans, because the lifestyle factors that help ward off the disease are largely things the holistic community has been practicing for decades.
What is diabetes?
My late friend and mentor Tex Toomer, a natural healer of Gullah extraction, used to call diabetes “sugar diabetes.” That’s a pretty good shorthand description, because having diabetes means that your blood sugar levels are abnormally high. The challenge in treatment is to normalize those levels and keep them there so you can sidestep the often terrible complications.
The disease comes in three sweet flavors. Here they are, in order of prevalence.
••Type-2 diabetes. Some 90 to 95 percent of diagnosed diabetics have type-2, which appears to develop from a nasty convergence of genes and lifestyle. If you’re genetically predisposed, poor diet, lack of exercise, or too much weight can cause the body to misuse the crucial hormone insulin. Made by the pancreas, insulin converts sugar and other food into the energy we use for movement, growth, healing, and other functions. It does this by moving glucose from the bloodstream into the individual cells, which means that insulin determines blood sugar levels. When the body doesn’t make enough insulin, blood sugar can rise to a pathological level—i.e., diabetes. Type-2 is commonly called adult-onset diabetes, and while age is a risk factor, the disease also occurs in children. In fact, that’s happening to a greater degree than ever as American kids become more overweight and less active.
To fully understand type-2, you also need to understand the terms prediabetes and insulin resistance. Prediabetes sounds pretty much like what it is—a condition that will develop into type-2 if you don’t take steps to stop it. It usually starts 10 to 15 years before actual diabetes shows up and can lead to some of the same dangerous complications, especially heart disease.
By definition, if you have prediabetes, you also suffer from insulin resistance, which means your body’s cells don’t react to insulin as they should and therefore aren’t taking in as much glucose as they should—so the glucose remains in the blood, raising blood sugar to abnormal levels. The pancreas’ beta cells, which constitute its “insulin factory,” respond to the resistance by producing more insulin, but putting in all that overtime wears them down. If their workload isn’t normalized, the beta cells start burning out and dying. With fewer workers on the insulin production line, insulin output drops, which can lead over time to prediabetes and type-2 diabetes. In its early stages, the exhaustion of insulin-making ability is temporary and reversible, particularly if you make appropriate lifestyle changes. If not attended to, the damage becomes permanent.
If tests reveal that you have insulin resistance, don’t procrastinate long before getting your lifestyle act together. Even though type-2 diabetes may be slow to appear, insulin resistance signals that you’ve got worries right now. Multiple studies show that the condition doubles the risk of heart attack as early as 15 years before diabetes is diagnosed. Your risk of stroke increases as well.
••Type-1 diabetes. Type-2 diabetics can often avoid taking insulin and other medications if they reform their health behaviors. Type-1 diabetics don’t have that option. Their bodies don’t make enough insulin and never will. Type-1 results from an autoimmune disease, a “friendly fire” malfunction in which the body’s antibodies, which are supposed to kill invaders such as viruses, destroy parts of the body itself—in this case, those crucial beta cells. Essentially, the body gets confused, misidentifies its own beta cells as alien marauders, and starts producing antibodies to wipe them out. Eventually, beta cell deaths reach the point where the body no longer makes enough insulin to keep blood sugar in line. To survive, the sufferer must then take insulin from an outside source—forever.
••Gestational diabetes. A third type of diabetes, called gestational diabetes, affects pregnant women. To conserve sugar for the baby, mom’s placenta produces hormones that naturally increase insulin resistance, thus rerouting some of the sugar to her fetus that before pregnancy would have gone to mom’s cells. But the process can get sufficiently out of whack to bring on a temporary case of type-2 diabetes, which in pregnant moms is called gestational diabetes. Women are more likely to get this form of diabetes if they are overweight, have a family history of type-2, have polycystic ovarian syndrome, had a previous baby that weighed nine pounds or more, were more than nine pounds or under six pounds when they were born, lost a child at birth in an unexplained manner, gave birth to a child with a deformity, or are older than 29.
If gestational diabetes is properly diagnosed and treated, mom and baby should do just fine. If the diabetes is overlooked, however, mom’s increased blood sugar could cause the baby to grow abnormally large, increasing the risk for delivery problems, birth trauma, and death. In addition, 50 percent of women who’ve had gestational diabetes eventually develop type-2. Nor does baby always get away free. Because diabetes can be inherited, babies born to moms with gestational diabetes may develop diabetes later, especially if they were abnormally large or small at birth.
What to look for
If you’re looking for someone to blame for this troubling disorder, blame your ancestors—no, not your diabetic relatives who slipped you their genes when you weren’t looking, but the ancestors of us all, those inveterate shoppers we call hunter-gatherers. Many theorists believe that diabetes wasn’t originally a disorder but rather an adaptive response to the food scarcity that plagued hunter-gatherers on a regular basis. A diabetic metabolism stores calories more efficiently as fat, which the body can then burn as fuel when there are no critters to kill or berries to gather. But when all you need to do to gather food is open the fridge, and your idea of exercise is, well, opening the fridge, this adaptation can backfire and start making lunch of you instead.
Starting from the most common forms of diabetes and its precursors, here are the risk factors and symptoms to be concerned about. Insulin resistance affects the biggest slice of the population because you can have this condition not only without diabetes but even without prediabetes. Risk factors include being overweight (particularly if those extra pounds concentrate at your waistline), high blood pressure, a history of diabetes in your family, low HDL (good cholesterol), high triglycerides (fat in the blood), elevated fasting blood sugar, and protein in your urine. The more risk factors you have, the more likely they add up to insulin resistance.
Most of these same risk factors are associated with pre-diabetes and type-2, but there’s another set of factors to consider for these conditions. The list: being over age 45, a family history of type-2, a past heart attack, a history of gestational diabetes or polycystic ovarian syndrome, and little or no exercise.
Undiagnosed diabetics rarely experience symptoms, at first anyway. But should symptoms appear, the most likely ones include a frequent need to urinate at night and excessive thirst, as your body tries to make up for the fluids lost to excess urination. Dramatic weight loss, becoming infection-prone, slow healing and recovery from illness, frequent vaginal yeast infections in women, fatigue, blurry vision, and darkening skin under the arms and on the back of your neck can also signal diabetes. All of these occur because of high blood sugar levels and will disappear when your blood sugar is brought under control.
Should you have any of the risk factors or symptoms just mentioned, it would be smart to undergo testing, which involves basic blood work that your primary doctor can perform. The more risk factors and symptoms you have, the more seriously you should take this advice and the more often you should be tested.
Prevention and control
Even if you have prediabetes, you can keep full-blown diabetes at bay. The Diabetes Prevention Program (DPP) study, conducted in the US from 1997 to 2001, points the way. Participants who lost about five to 10 percent of their body weight, kept the pounds off, and did about half an hour a day of moderate exercise cut their risk of developing diabetes by 58 percent.
Commenting on the importance of that study, Yale’s David Katz, MD, a nationally recognized nutrition expert, says, “Nearly two out of three adults who would have developed diabetes did not because of eating a prudent diet rich in whole grains, fruits and vegetables, and lean protein sources; getting regular physical activity; and losing a little weight. We know what the power of that is and anyone who is at risk of diabetes should be steered in that direction as far as they are willing to go.”
Besides, what’s to lose? “There’s no downside to having a healthier lifestyle. There’s only an upside,” notes Ann Peters, MD, professor at the University of California Keck School of Medicine and author of Conquering Diabetes (Hudson Street Press, 2005).
Dramatic though they were, the DPP results didn’t surprise many experts. For example, it’s well-known that carrying extra weight increases insulin resistance. You still may be able to avoid diabetes if you lack the “diabetes gene,” but if you do have the gene, your beta cells may lose the battle to keep you supplied with insulin, and your blood sugar will soar straight to Diabetesland. Weight control is easier to talk about than do when you have insulin resistance, but eating less food and lower-calorie food along with some moderate exercise will produce results if you’re patient.
What you need to know about keeping the surplus pounds off is captured in the basic dictum “calories in, calories out.” In essence, any calories you don’t burn will make your jeans tight, so you need to match your calorie intake to your exercise level.
In fact, Richard Kahn, the American Diabetes Association’s (ADA) chief scientific and medical officer, says calories matter far more than specific foods. “Unless a food is high in saturated fat or excessively high in calories, which we know is detrimental, it’s not clear where the gray zone stops and the black-and-white zones begin.”
But that advice only pertains to weight control, not preventing or managing diabetes. It is now accepted that diabetics can consume all the same foods and drinks that the rest of us do, as long as they watch the amounts. Diabetics can even have sugar, once thought to be the diabetic equivalent of al-Qaida, as long as they compensate for it in the rest of their diet. Still, most experts, the ADA included, agree that certain foods make more sense than others where diabetes is concerned.
The fundamental diabetic prevention/management diet sticks pretty close to what we’ve come to know as basic holistic nutritional advice. Lots of fruits and veggies—although diabetics should stick to non-starchy vegetables like spinach, carrots, or broccoli and avoid starchy ones like potatoes, which rush sugar into the system. Whole grains instead of processed ones, because the former are, again, slower to increase blood sugar. Nonfat dairy products. Liquid oils for cooking instead of solid fats like margarine. Lean meats like skinned poultry. Omega-3 fatty acids from sources such as cold-water fish or flaxseed. Beans and lentils. Water, unsweetened tea, and the like instead of calorie-containing drinks such as soda, fruit punch, and coffee with milk and sugar. Modest portion sizes. And go light on high-caloric snack foods and desserts.
The diabetic diet follows principles that anyone with a rudimentary knowledge of healthy eating understands: low fat, low cholesterol, high fiber, few saturated or trans fats, lots of fresh foods, few processed foods. But it differs from other healthy diet formulations, such as a heart-healthy diet, in one important respect: the percentage of carbohydrates. Most nutritionists suggest that a healthy diet consist of 50 to 60 percent carbs. Diabetics should restrict themselves to only about 40 percent, says Peters, with the remaining 60 percent split equally between protein and fat. “I see a lot of people who eat a heart-healthy diet who end up with diabetes because they eat too many carbs,” she observes.
Peters also says that it’s important for diabetics to combine foods, even when snacking. Eating just carbs—for instance, an apple—can cause the blood sugar and insulin levels to spike. Better to mix that apple with some protein and fat—say, a little peanut butter—to slow the absorption rate, she feels. For similar reasons, diabetics should eat frequent, small meals rather than a few large ones that can dump too much sugar and insulin into the bloodstream at once.
Then there’s exercise, the other major component of a prevention or treatment plan. “Exercise is really critical,” says author Mark Hyman, MD, AltMed’s medical editor. “I have patients do strength training, and I try to get people up to 30 to 45 minutes of aerobics five to six times a week.” Peters pushes a similar regimen, noting that weight training helps compensate for the loss of lean body mass as you age. More muscle in turn helps control blood sugar.
Because stress can mess with the insulin response cycle, Hyman’s program also includes stress-reducing disciplines such as yoga and meditation. “Doing that consistently is very effective,” he says.
In recent years, several natural therapies have produced good results. Many experts, Peters included, are excited about the demonstrated ability of Byetta—a synthetic prescription drug developed from the toxic saliva of the Gila monster—to help regulate blood sugar control in type-2s. Peters also likes cinnamon as a supplement for blood sugar control—one teaspoon three times a day or the equivalent in capsule form. Other Peters’ recommendations: Bentofiamine (fat-soluble vitamin B1) and the antioxidant alpha-lipoic acid, neither of which lowers blood sugar, but they do help prevent diabetic complications affecting the nerves and heart.
If you like the supplement path and have plenty of shelf space in your cupboards, you may also want to consider the natural substances recommended by Ryan Bradley, ND, a naturopathic family physician and research fellow at Bastyr University, and neurologist David Perlmutter, MD, author of The Better Brain Book (Riverhead Trade, 2005). Bradley agrees with Peters’ choices, but he and Perlmutter are most excited about resveratrol, a compound found in red wine that has potent antioxidant and anti-inflammatory properties. Perlmutter believes that resveratrol explains the so-called French paradox—the fact that the French have low rates of obesity and cardiovascular disease despite a diet larded with cheeses, butter, chocolate, and, yep, wine.
“Resveratrol seems to protect tissues from being damaged in the presence of higher blood sugars,” he says. He believes that because of the protection it offers against diabetics’ dysfunctional metabolism, the substance may help prevent every major diabetic complication. In fact, it offers even more bang for your nutritional buck than that, he says, because it also mimics insulin in the body, which means it helps lower blood sugars all by itself.
Perlmutter and Bradley also extol the virtues of N-acetyl-cysteine (NAC), a precursor to a naturally occurring antioxidant called glutathione. “We know diabetics have lower levels of glutathione than people without diabetes,” says Bradley. “So it’s a question of finding a way to restore our antioxidant defenses.” In his practice, he’s seen improved insulin sensitivity with patients taking NAC and also a faster reduction in high post-meal blood sugars. Other natural substances on Bradley’s “good” list: pomegranate, goji berries, chromium, L-carnitine and acetyl-L-carnitine, and American ginseng. In addition to a general emphasis on omega-3 fatty acids, Perlmutter pushes supplementation with the omega-3 known as DHA.
These nutritional tweaks aside, the basic strategy for preventing and treating diabetes hasn’t changed much in a long time and is pretty much what any healthy lifestyle devotee would expect: Eat well and modestly, work out, and chill, baby. It’s kept me diabetes-free for 56 years, despite heavy genetic odds. And it should work for you, whether avoiding diabetes or taming it is your goal.
Glycemic Index vs. Glycemic Load
—Deirdre Shevlin Bell
The topic of carbs can send a diabetic’s head spinning. The old advice of avoiding blood-sugar spikes by opting for complex carbs over simple ones turns out to be too, well, simple. In recent years, experts have espoused the glycemic index—a rating of foods based on how quickly their carbohydrates turn into sugar in the body. Problem is, the glycemic index (or GI) doesn’t take into account how many of those carbohydrates a given food has. Watermelon, for instance, contains high-GI carbohydrates—giving it a high GI—but not enough of them to cause rapid elevations in blood sugar the way another food with a similar rating would. This system also doesn’t address portion size, so some people use it as license to overindulge on low-GI foods.
To determine the relative effect a portion of a certain food will have on your blood sugar, you need to look to GI’s partner: glycemic load (GL). This newer tool gives a more complete picture by putting GI in context. The GI, which we discussed in detail in our January issue, is measured on a scale of zero to 100. To calculate a food’s GL, you divide its GI by 100 and multiply that by the net carbs in a given portion of food. (Net carbs are the total carbohydrates minus the dietary fiber.) The new advice is to focus mostly on foods with a low GL (10 or below), eat moderate amounts of those with medium GL (11 to 19), and do your best to avoid high GL foods (20 or more).
If all that calculation gives you analysis paralysis, let the website www.glycemicindex.com do the math for you. Or try some of our low-GL suggestions below.
Keep in mind, however, neither GI nor GL provides everything you need to create balanced, nutritious meals. You still need to take into account total calories, protein, fat, and nutritional value.
Just as the wrinkles dancing around your eyes can unwittingly show off your sense of humor, scaly patches may reveal something about your blood sugar that you’d rather keep under wraps. Glucose levels gone wild for too long inhibit circulation, especially to the extremities, and can cause the skin to tighten, thicken, and become dehydrated. It can even cause blisters and scales to form between toes and fingers.
Some skincare ingredients can exacerbate the problem. “Avoid glycolic acid and other strong fruit acids, as they are too harsh for the skin,” warns Jeanette Jacqui, MD, a holistic dermatologist in Phoenix, Ariz. Also too strong: alcohol, iodine, Mercurochrome, salicylic acid, and benzoyl peroxide.
Alan Dattner, MD, a holistic dermatologist based in New York City, recommends lotions that are high in omega-6 fatty acids, essential fats that diabetics don’t produce well. Borage oil is the richest source of omega-6 fatty acids, but other appropriate plant oils include black currant seed and evening primrose oils.
For blisters and scales, reach for the tea tree oil, which fights fungal and viral infections. It’s especially helpful in killing candida, a yeast-like fungus prevalent among diabetics. Or look to garlic, which has antimicrobial properties and, when used in a natural gel form, can topically treat yeast infections, athlete’s foot, and jock itch. Before trying any of these solutions, consult your doctor. Apply the same care to what you put on your body as what you put in your body, and your skin will thank you for it.
The Ayurveda Approach
—Felicia M. Tomasko
Diabetes may seem like a twentieth century menace, but descriptions of it appear in ayurvedic texts from thousands of years ago. The Sanskrit term for diabetes mellitus, madhumeda, translates as “honey urine” because the ancient practitioners first diagnosed the disease by testing the patient’s urine to see if it, like honey, attracted ants.
Ayurvedic physicians see type-2 diabetes as a disease involving an imbalance of kapha. One of the three doshas or physiological categories in the body, kapha governs the pancreas, stomach, throat, nose, tongue, fat, and lymphatic fluids. An imbalance can show up as excess weight gain, unquenchable thirst, inability to digest foods, and ultimately problems with nourishing the tissues and low functioning of the pancreas.
What would a practitioner recommend? Ayurveda employs dietary changes (no sweets, dairy, sugar, alcohol, fats, or breads), cleansing therapies (pancha karma and other detox techniques), lifestyle changes (less stress, more exercise), and meditation practices to quell anxiety and help you feel more committed to and centered in your life. Yoga practice can provide benefit by regulating hormones and metabolism and, coupled with other lifestyle changes, can regulate blood sugar. Modern studies have shown that the potent herbs we list here can lower blood sugar, improve insulin function, and regulate sugar metabolism.
Turmeric (Cucurma longa), the aromatic spice that lends a yellow tint to curry dishes and mustard effectively regulates blood sugar. Turmeric can be added to foods or taken in capsule form.
Fenugreek (Trigonella foenum-graecum) lowers fasting and post-meal blood glucose levels. Studies investigated powdered fenugreek baked into bread or muffins, or 15 grams made into a drink.
Shardunika’s (Gymnema sylvestre) name means sugar-destroyer because eating the leaf eliminates one’s taste for sugar. It’s one of the most-studied medicinal herbs for regulating blood glucose levels.
Bitter gourd, also known as bitter melon (Momordica charantia), is a bitter vegetable used in curries and other recipes. Traditional lore and modern studies both attest to its benefit in regulating blood sugar.
Researchers, in a round of connect-the-condition dots, have discovered a link between obesity, heart disease, and Alzheimer’s so strong that some refer to the illness as “type-3 diabetes.”
“The relationship of type-2 diabetes and Alzheimer’s is profound and supported by extensive peer-reviewed scientific research,” says David Perlmutter, MD, author of The Better Brain Book. Nearly 4.5 million Americans have Alzheimer’s, and that figure may triple in less than 50 years according to the Alzheimer’s Association. At the same time, more than 30 percent of adults in the US are obese, thus standing a greater chance of developing diabetes. Numerous studies indicate people with type-2 have double the normal incidence of Alzheimer’s. Another study out of Sweden’s Karolinska Institute found that even people with borderline diabetes—those with persistently high blood sugar levels—have a 70 percent greater risk of developing Alzheimer’s. Likewise, a research team at Kaiser Permanente discovered that the risk for dementia rises in people with higher blood sugar.
While the medical community doesn’t fully understand the link, it speculates that the poor circulation in diabetics causes vascular dementia, triggered by low blood flow to the brain. Researchers also believe brain damage can occur in diabetics due to inflammation caused by elevated insulin levels. Perlmutter recommends those at risk hedge their bets with these lifestyle changes: “Lose weight, take B vitamins, gain control over diabetes, take adequate antioxidant vitamins, engage in mentally stimulating activities, and exercise.”
10 Nutrition Basics
1. Eat a minimum of two fruits and three vegetables daily. Try different colors of produce to get a variety of important nutrients. 2. Eat 25 to 30 grams of fiber per day. 3. Use fat in moderation, and choose plant sources (olive and canola oil, peanuts, almonds, walnuts, and avocados) over animal fats. 4. Choose fresh foods and limit processed foods to maximize nutritional value and minimize sodium and trans fats. 5. Eat five balanced meals—three small ones and two snacks—spread out through the day. Don’t skip breakfast. Keep snacks to less than 150 calories each. 6. Don’t go off your plan when eating out. Skip “free” items like bread and chips. 7. Drink plenty of water. 8. Get some form of exercise daily. 9. Maintain a healthy body weight. 10. Be consistent!