Type 2 diabetes is a complex condition, but considering the bond between diet, lifestyle, weight and glycaemic control, everyone with an expanded waist should understand the basics of how lifestyle can control or even avoid or reverse most cases of T2D.
In a nutshell, T2D is a condition in which sugar in the blood is continually elevated. This is because sugar in our blood (primarily from carbohydrates consumed) can’t pass to our cells where it is needed, and where it will be ‘safe’. This is due to insulin is not working in T2D, known as insulin resistance (IR). Therefore, the pancreas must work extra hard to overcome this resistance. Typically, over time the beta cells in the pancreas ‘wear out’ producing less and less insulin. Often, people having lived with T2D for many years, require insulin injections, and they need much more than people with Type one diabetes, due to their IR.
In people without diabetes, blood glucose concentrations are maintained within narrow limits, balancing the three main pathways: glucose released from the liver, intestinal absorption of glucose from food, and large-scale glucose uptake into muscles and fat cells. But for those with T2D, blood sugar is always high, and this is very damaging to the body. Sensitive cells such as those in the eye, kidney and nervous system are damaged in the early stages. Over time the cells of the vascular system are also injured, leading to circulatory problems and cardiovascular disease. Therefore, the key for those with T2D, is to control blood sugar below the non-toxic level (42mm/l for those currently testing).
These two failures (IR and deterioration of the pancreas) typically worsen as the disease progresses, because they develop into a vicious cycle (more IR means more insulin is required, but higher insulin levels lead to increased IR). For years, this pattern of deterioration was considered inevitable. However, it is now known that this is incorrect, and T2D in most cases can be controlled and even reversed (put into permanent remission) by changing dietary and activity patterns.
When we eat a meal, our digestive system swiftly determines the main macronutrient concentration of the food we have just eaten, and an appropriate release of the digestive enzymes ensure the absorption of fats, carbohydrates and protein can occur. When we eat foods that are high in carbohydrate content (pasta, rice, potatoes, wheat, grains, cereals and of course all sugary foods and drinks), lots of amylase is produced so that these can quickly be converted into glucose. This swifty travels into the bloodstream, which is of course very problematic for people that cannot process sugars in the blood. In simple terms, people with T2D are glucose intolerant.
There are two dietary approaches that have been shown to be consistently effective in putting T2D into remission:
- Very low-calorie diets (around 600kcals/day).
- Low carbohydrate diets (50-100g or between 10 – 20% of daily energy from carbohydrates).
Whilst the low-calorie diets are very effective, it is assumed that they work because they reduce glycaemic load on the body. Therefore, it is equally as effective to modify the diet and dramatically reduce carbohydrate content to achieve the same result. Low carbohydrate diets typically also lead to weight loss which is thought to be an important contributor to the reduction in IR. Clearly weight reduction (in those that are overweight) is also extremely important for reducing the risk of other metabolic disorders and diseases such as cancer and cardiovascular disease.
Muscles are the largest organ in the body, and when ‘sensitised’ to insulin, can remove vast amounts of sugar from the blood. A sedentary life accelerates T2D by desensitising muscles to insulin. Furthermore, with less movement comes lower volume of muscle (skeletal muscle in particular) to achieve this most vital metabolic process. Therefore, the case for exercise and maintaining a good musculature in the control of T2D cannot be overstated.
The evidence is now abundantly clear, that for most people at risk of T2D, the previously accepted steady decline into full type 2 diabetes, with all the accompanying health complications and psychological trauma is not inevitable. Furthermore, for those already living with T2D a reversal of the condition is achievable particularly in the most recently diagnosed cases. By adopting the two approaches discussed above, for most people, this will be sufficient to reduce IR and miraculously restore beta-cell function, thus normalising blood-sugar control.
If you are living with diabetes, before making any dramatic lifestyle changes, you should first speak with your GP or diabetic health professional and discuss your intentions.
(This is a guest blog post by Alan Jackson MSc, author of Weight Wisdom: A Lighter Way of Thinking. See weightwisdom.co.uk)