This is a bold question and has a slightly complicated answer. Diabetes Type 2 is a result of some genetic predisposition and lifestyle factors associated with our Western lifestyle and diet. We can’t cure this per se, but we can well and truly reverse it and maintain the control over our lifetime. This blog seeks to explore some of the more modern thinking and research and aims to give you choices regarding the care of your diabetes. I do not explore medications in this blog, but look at lifestyle changes that we can all make to assist in our self-management of Pre-Diabetes and Diabetes Type 2
Key facts (From World Health Organisation – WHO)
• The number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014.
• The global prevalence of diabetes among adults over 18 years of age has risen from 4.7% in 1980 to 8.5% in 2014.
• Diabetes prevalence has been rising more rapidly in middle- and low-income countries.
• Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation.
• In 2016, an estimated 1.6 million deaths were directly caused by diabetes. Another 2.2 million deaths were attributable to high blood glucose in 2012.
• Almost half of all deaths attributable to high blood glucose occur before the age of 70 years. WHO estimates that diabetes was the seventh leading cause of death in 2016.
• Healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use are ways to prevent or delay the onset of type 2 diabetes.
• Diabetes can be treated, and its consequences avoided or delayed with diet, physical activity, medication and regular screening and treatment for complications.
• In 2019 The American Diabetes Association has released a consensus recommendation that for those with prediabetes and type 2 diabetes (1 in 3 Americans) low carb is the best option for improving glucose control.
Diabetes is a disorder of sugar metabolism and people with diabetes have too much sugar in their blood stream. There are 2 main sorts of diabetes, Type 1 and Type 2. Type 1 is caused by a deficiency of insulin (a hormone that controls sugar level in the blood). This usually occurs in young people and is often acute in onset and requires specialised care. This article will not cover this type of Diabetes. Type 2 Diabetes used to be called maturity Onset Diabetes and is usually related to our Western lifestyle and diet. It is a condition that presents as an Insulin resistance and the secondary high blood levels of Glucose. We are now seeing this in children as young as 8 and will soon be seeing it in younger children as well. There is another form of diabetes that occurs in pregnancy called gestational diabetes, but we won’t talk a lot about this in this article either.
Type 2 Diabetes is reversible!
This is not what we believed for many years but there are many people now who have significantly decreased or even ceased their anti-diabetic medications. The current thinking has been that Type 2 Diabetes is a progressive disease and that it is irreversible, but new evidence is emerging that this is not true anymore.
There are 3 main ways that we can reverse Type 2 Diabetes.
1. Bariatric surgery (weight loss surgery), there are a few options available here and the Diabetes reverses as the weight decreases. People who have this surgery can eliminate diabetes completely, but there are significant potential side effects and, if you try hard enough, you can “cheat” the surgery and consume very energy dense foods or even stretch the stomach back up again! This is an option that works very efficiently but is difficult for patients to maintain the huge early weight loss in to the long term in many cases.
2. Severe calorie restriction with a low-fat diet associated with large amounts of exercise. This is what most Health Professionals have preached for the last 50 years. It works, but only in a small percentage of people and is not sustainable or successful for most who try this. This has been the standard advice for many years and obviously doesn’t really work for most of our diabetic population
3. Low Carb, High Fat Diet. There is more and more evidence occurring that this sort of diet seems to work very well for Diabetes Patients. It is not just the weight loss that people get with this diet, but positive metabolic changes that occur at the same time. (eg for the same number of Calories taken in in a Low-Fat diet as opposed to a Low Carb, High Fat (LCHF) diet, the LCHF people burn more energy than those on the Low-Fat diet). This is what this blog will explore. Exercise is optional with this way of eating, when you exercise, this lets you eat more food and obviously has cardiovascular and other health benefits. Some people combine this with intermittent fasting and we will explore this in another blog.
So back to Diabetes Type 2. How do you know if you have this? The common symptoms are lethargy (tiredness), Polydipsia (excessive thirstiness) and Polyuria (Passing urine frequently). It is usually associated with being overweight or obese, and there are often other illnesses that can occur, such as high blood pressure, heart disease, fatty liver disease, blindness and arthritis to name a few. Many people have their Diabetes type 2 diagnosed with a routine blood test (looking for glucose in the blood) or a urine test (looking for glucose in the urine). In previous times Doctors would taste the patient’s urine, tasting for the sweetness of diabetes. Thank goodness we have better ways of testing now!
Diabetes is classically treated with diet (standard diet is still based on carbohydrates, unfortunately) and exercise first, followed by a variety of oral medication (tablets) and then moving on to Insulin or other injections later if/when required. Insulin is a hormone that very efficiently stores excess sugar as fat and so will often lead to a steady spiral downwards towards the various complications of Diabetes.
Foods that do not raise Blood sugar levels
The complications of Diabetes Type 2 are myriad, but include increased risk of Heart Disease, Stroke, Kidney Disease, Peripheral Vascular Disease leading to amputations and Nerve Degeneration. Diabetic Patients are also much more susceptible to infections and these infections can be much more severe.
Reversing Diabetes Type 2
Because Diabetes Type 2 is a problem of insulin resistance, why do we persist in advising people to have a high carbohydrate and low-fat diet? The carbohydrates stimulate the production of insulin and then this in turn stores excessive carbohydrates as fat. This sounds counter-intuitive to me and I hope it does to you as well. A new way of thinking (with a significant amount of science behind it) has been emerging of the last few years. That is the Low Carbohydrate and High Fat (LCHF) way of eating. This has been shown to stabilise sugar levels and reduce the insulin levels in Type 2 Diabetes and reverse some of the requirements for medication as well. People feel better and their bodies respond in favourable ways as well.
Why is there so much resistance to a new way of eating? Unfortunately, there is little money to be made by “food” companies who have become so reliant on processing the food that we eat. “Real” food doesn’t require nutrition labels or boxes or other forms of packaging and has huge health benefits at the same time.
What is a LCHF or Ketogenic Diet?
LCHF and a more extreme version called Ketogenic Diet are ways of eating where we limit the amount of carbohydrate eaten on a day. (Usually less than 50g per day with LCHF and 20g per day for keto). The carbohydrate should be replaced by natural fats (from meat, eggs, olive oil, coconut oil, Butter, Avocado, etc).
The transition to this Way of Eating usually takes some supervision as people are often addicted to sugar and the withdrawal from this can be a bit unpleasant for a while. When I went off sugar myself, I had a week of headaches and shakiness. But then I felt a lot better after these effects wore off. The LCHF diet shifts your energy usage from Glucose to ketones and the main hormone from Insulin to Cholecystokinin. This is really a therapy for your Diabetes and should be considered as such, not as a diet. Weight loss may occur on this Way of Eating, but that is not the main aim with treatment of Diabetes, it is to get Glucose and Insulin under control, and then subsequently to reduce complications and perhaps even “cure” the Diabetes and get you on reduced or even no medications.
How do I start?
This is not a therapy to try by yourself. I would suggest making an appointment with your GP to discuss this. He or she may be dubious at first, but they may well be supportive of your choices anyway. Point them in the direction of some of the websites I have included below, which will help them to explore this Way of Eating. You always must work with your own Doctor, as they are really responsible for treating your Diabetes. Some Dietitians and Nutritionists may be able to assist as well, but always include your treating Doctor in any decisions made around this.
Some GPs and Endocrinologists will warn you away from this Way of Eating, but don’t be discouraged, try and find a LCHF friendly GP and make an appointment to discuss this and whether it may be suitable for you.
The first step often is to reduce and then cease added simple sugars, this sugar is added to coffee and tea, but is “hidden” in biscuits, cakes, processed foods etc. This is often the hardest step as sugar is highly addictive and you will likely go through a “withdrawal “in this phase. Withdrawal symptoms include headaches, shakiness and a feeling of unusual hunger. It will last for a week or so and then you will feel better in yourself. The next phase then is the shift to Low Carbohydrate and High Fat. This will be easier and should be easy to get there. The main issue is the psychological one of eating higher fat, because we have been trained to eat low fat for many years. The idea of leaving the fat on meats, eating butter, full cream dairy etc is sometimes difficult to get your head around. If you persist, you should see much better control of your BSLs and Diabetes tests will begin to normalise. A couple of added benefits are that you may well lose weight (although this is not the aim of the exercise), and you may well find that your brain works better as well. Some people report better control of thyroid disease, menopause, Polycystic Ovary Syndrome, skin rashes such as acne rosacea etc as well.
This diet is not all about meat and fat however. A lot of green leafy vegetables are eaten as well. The diet contains a wide variety of foodstuffs and you will find that you remain full for longer and often people will eat only 2-3 meals a day. There will be no need for snacks in between, but if there is, a small number of nuts, jerky, cheese etc will suffice. You will remain satiated, hunger is not part of this diet at all. The 2 basic rules are:
“Eat when you are Hungry” and “Stop eating when you are full”. Try it and see!
Dr Kevin Arlett
MBBS(QLD), FRACGP, FAICD
© Townsville & Suburban Medical Practice, 2019.