Tuesday
Apr142015

What The Hell Is Diabetes And Why Should I Give A Damn?

In part 3 of our what the hell is...? series, I'd like to take a look at one of the most common dietary conditions around. Diabetes. What it is and how we can reverse it?

Wikipedia tells me that 387 million people have the condition as of 2014. This means two things: firstly that approximately 1 in 12 people globally have the condition, which leads me to my second (and more important point), that many MANY people will be interested in reading this article.

 Finally, my quest for Kardashian level fame will be complete.

Delusions of grandeur aside, what is diabetes? How do we avoid it in the first place? And if we have it, what can we do to fix it?

 

What is diabetes as a condition?

Diabetes comes in two main flavors. These are somewhat unhelpfully called:

  • Type 1 diabetes (about 10% of the population)
  • Type 2 diabetes (Making up the rest)

Why? Because scientists are terrible at naming things. That's why.

To understand the difference between these two versions of diabetes, we first need to look at a hormone called insulin and how it operates, as understanding it underpins diabetes as a condition.

 

What is insulin?

Insulin is a hormone who's main job it is to tell the body to bring sugar from the blood stream, into the cells themselves. So when you eat carbohydrate and this ends up in your circulatory system as sugar, insulin is there to get it from the blood, into the cell where it is then used for energy.

A key relationship to understand is that, when blood sugar goes up after eating, insulin also goes up to take that sugar into the cell. Simple as that.

 

What is insulin sensitivity?

It's helpful at this juncture to think of the insulin hormone as a kind of 'signal' that the body can hear. When people speak about 'insulin sensitivity', they are referring to your ability to hear this signal. So there is a scale here:

When the body cannot hear the insulin signal, the sugar cannot get into the cells and starts to build up to dangerous concentrations in your blood stream. The body notices this and continues in vain produce more insulin, but to no avail, the body's ability to hear it is effectively going deaf.

Now, just to be clear, everyone in the world is on this continuum. From the very insulin sensitive to the very insensitive, and at a certain point on that scale doctors say that anyone beyond this point has type 2 diabetes.

Why that point? Well it is somewhat arbitrary, but the medical community need a number at which to say, "we need to have a medical intervention", and they chose this level of persistently high blood sugar as that number (click this link to see more).

* Feel Free to ignore this section but...

I don't want to confuse anyone but, a further hallmark of Type 2 diabetes that the above diagram doesn't cover, is a decreased production of insulin. However this doesn't really matter for our purposes, because this is believed to be caused by the heightened blood sugar in effect switching some of the pancreatic beta cells that produce insulin "off". So it's a follow on consequence of the "not very sensitive to the insuin signal" issue we have been talking about already.

The only reason why I mention this is because medically speaking, type 2 diabetes is defined as a combination of both insulin resistance and reduced insulin production. It doesn't change anything at all with regard to the dietary strategy we should take, but I would be misrepresenting the condition if I didn't mention this fact.

We are focusing on the beginning of that sequence of events, because it is the first domino that falls to cause the rest. If you're keen then you can find out more information about this area of research in the following journal article, though it is a scientific paper and a dense read.

Source: Chutima Talchai et al. (2012). Pancreatic β Cell Dedifferentiation as a Mechanism of Diabetic β Cell Failure. Cell. 150 (6), 1223–1234.

Why is this happening?

Imagine for a moment that you're one of those people who listen to really REALLY loud music on your headphones while on the Underground. You know, the ones who put it up so much that you can still hear it, loud and clear, half a tube carriage away.

MY DUBSTEP SONGS ARE SO GOOD - EVERYONE MUST HEAR THEM

This will eventually damage your hearing (frankly - you deserve it). You then need to turn the volume up a bit more to compensate. This in turn damages your hearing more, meaning you need to turn the volume up even more. If we continue this process, you eventually cannot hear very well at all and this is pretty much what happens with your body and insulin.

When you frequently eat a diet that is high in simple carbohydrates (also known as high GI), your body is effectively playing the insulin signal on loud all the time. Eventually, like your ears, your cells can't hear the signal properly and as a result fail to take the sugar from the blood to the cells. The body then turns up the volume as much as it can and produces yet more insulin, but this just makes the situation worse, as the cells becomes even more deaf to the insulin signal.

 

And all of that is just Type 2 Diabetes!

How is type 1 different? Pretty simple actually. A type 1 diabetic is someone who produces no insulin at all. So both cases the fundamental problem arises from a difficulty in hearing an insulin signal, but with type 1 the body cannot hear the signal, because, well... there isn't a signal.

So in a simplified way:

  • Type 2: A person is bad at hearing insulin (Their cellular ears don't work).
  • Type 1: A person is unable to play the insulin signal (Their headphones are broken)

The effect of both is similar, though the causes are different.

 

How do we fix this?

Type 1 is currently not curable. These people need regular insulin injections because their bodies cannot manufacture it - not nice, but it is the only current solution. However, there is some VERY exciting research using stem cells, indicating that a cure is maybe only a few years away and if they pull it off, you can expect a Nobel prize for medicine to follow shortly thereafter.

Type 2 on the other hand is something we can fix with some proven strategies, and yes type 2 is totally reversible. Though it requires more effort than simply taking a handful of pills each day (which in itself may explain it's pervasiveness).

How do we do this? Well if it's not obvious already, we need to do things that improve insulin sensitivity.

 

How do we improve insulin sensitivity?

Because type 2 diabetes is fundamentally an insulin sensitivity problem, brought on by frequent intake of simple carbohydrates. We therefore need to look at how avoid the simple sugars that are causing the problem.

Though there are many things that can improve a person's ability to hear the insulin signal (such as a periodised exercise program and effective magnesium supplementation), the most powerful factor is what you're eating on a consistent basis. As we have established already, poor eating habits are what got you into this mess, so eating habits are what will get you out of it!

But what kind of eating habits?

 

'Low Carb' vs 'Low GI'

Traditionally dietitians will recommend that you follow a  Low Glycemic (GI) Index diet (sometimes imprecisely referred to by them as a diabetic diet) to manage and reverse the effects of type two diabetes. I have a few reservations about this approach and I'd like to go throughout those first, before presenting the Low Carbohydrate diet as a better alternative.

 

Why the problem with a 'Low GI' diet?

Low GI diets DO work. They have been shown in clinical trials to be effective at controlling blood sugar levels in diabetics and therefore appear to be a good choice for the average type 2 diabetic to use. They are however very complicated to use, and this is a problem.

 

What do I mean?

We've all heard before about complex and simple carbohydrates. Complex ones take longer to digest and keep your blood sugar low. Simpler ones break down rapidly and spike your blood sugar high. You're always taught to favour brown rice over white, or whole grain bread over a French stick for this reason.

Therefore, on a Low GI diet, it is a good idea to eat most complex carbohydrates available, because this will allow your body the best chance to control it's blood sugar levels, and thereby improve your insulin sensitivity. But to do that, you need to know what the most complex carbohydrates are. So if i asked you the following...

Not sure? Well the Low GI Diet has an answer for that.

The Low GI diet categorises all carbohydrates on a 1-100 scale, whereby 100 represents the most simple carbohydrates like table sugar (sucrose) and the lower numbers represent more complex carbohydrates. The more complex a carbohydrate is, the lower it's number is. This allows us to be a lot more precise than simply saying "this is a complex carbohydrate" or "this is a simple carbohydrate". We can now say that Carbohydrate X is more complex than Carbohydrate Y.

This all sounds great... until you see this list of numbers.

Are you ready? Here is a small section of them...

 Try to remember all of that why don't you? - I certainly couldn't.

So as you can see, my principal issue with a Low GI diet, is that you need to have a really good memory and a near Zen like tolerance for digesting long lists of quite boring numbers, to fully understand and accurately implement it. This isn't a problem for scientists running a clinical trial in a nursing home, who can easily control what their patients eat, but it becomes a serious issue for the average person who doesn't always have this list to hand, or can't find a particular food item on it.

Basically, Low GI would be perfect for a diabetic Rain Man.

 

So why is a 'Low Carb' diet better?

The Low Carb diet is a much simpler alternative. Rather than relying on the meticulous categorisation of every carbohydrate available, the "Low Carb" diet instead limits the intake of dense carbohydrates wholesale. Hence the name "Low Carb".

 

Is it effective?

This method that has been clinically shown to be at least as effective when it comes to treating type two diabetics, as traditional Low GI diets.

A study published by the New England Journal of Medicine in 2003 ran an experiment that split a group of 132 obese patients into two groups. One half was fed a low fat calorie restrictive diet, the other was fed a low carb diet. The result?

"Taken together, our findings demonstrate that severely obese subjects with a high prevalence of diabetes and the metabolic syndrome lost more weight during six months on a carbohydrate-restricted diet than on a calorie- and fat-restricted diet. The carbohydrate-restricted diet led to greater improvements in insulin sensitivity that were independent of weight loss and a greater reduction in triglyceride levels in subjects who lost more than 5 percent of their base-line weight."

Source: Frederick F. Samaha, M.D et al. (2003). A Low-Carbohydrate as Compared with a Low-Fat Diet in Severe Obesity. New England Journal of Medicine. 348, 2074-2081.

The authors went onto stress that they couldn't comment on the effectiveness of the diet beyond the six month study period and that how such a low carbohydrate diet affects cardiovascular disease outcomes also needs to be studied.

Humm... that could potentially be a worry. Let's examine lower carb diets and cardiovascular disease.

 

How safe is a Low Carbohydrate diet?

Fast forward three years to 2006, where again the New England Journal of Medicine published a study where the effect of low carbohydrate diets on cardiovascular disease was looked at over a twenty year period in 82,802 women. The study concluded that:

...diets lower in carbohydrate and higher in protein and fat were not associated with an increased risk of coronary heart disease in this cohort of women. When vegetable sources of fat and protein were chosen, these diets were related to a lower risk of coronary heart disease.

Source: Thomas L. Halton, Sc.D. et al. (2006). Low-Carbohydrate-Diet Score and the Risk of Coronary Heart Disease in Women. New England Journal of Medicine. 355, 1991-2002.

So, according to the collected information of these 82,000+ samples... nothing to worry about.

 

How do I implement a 'Low Carb' diet?

So the first thing to say is that stuff like meat, eggs and fish are 100% fine to eat with every meal. They will also stop you from over eating due to the strong effect they have on your hunger hormones.

It's all part of the plan!

Prepare them in any way you like as well, unless you are going to deep fry them, or coat them in breadcrumbs. Also, you should obviously go for less processed sources if you can, although this has no real benefit for resolving type two diabetes. Sausages taste great but... you know... health wise.

Next we move onto carbohydrates, where we need to make a broad distinction between Low Density Carbohydrates and High Density Carbohydrates, and I've made this handy table below to help clarify this for you.

"Low density carbohydrates" are so called because they contain very little carbohydrate per gram. Choosing these kind of carbohydrates with most meals, will allow your insulin hearing ability to return.

So eat a diet consisting of meat and low density carbs and you'll be laughing.

 

Frequently asked questions

Q: What about medication?

A: People who have type two diabetes take medication that is used to to help control their blood sugar levels. Though there are many kinds of drugs, the most commonly prescribed one is called Metformin. This drug reduces the amount of sugar produced by the liver (in a process called gluconeogenesis), reducing the amount of sugar in the blood and thereby helping improve insulin sensitivity.

Because we are already looking at using diet to reduce your blood sugar levels, switching to a low carbohydrate diet may involve you reducing the amount of Metformin you take. In fact, low carb diets can be so effective at controlling type 2 diabetes, that people often can eventually come off their medication all together. This can even happen in a matter of weeks.

I say this because although most people are perfectly fine when taking metformin on a Low Carbohydrarte diet (such as those in this study here), there is a low risk of hypoglycemic episodes occurring (very low blood sugar levles) . I have personally experienced it once before with a single client. It was unpleasant though not a severe episode, quickly remidied by having her drink an isotonic drink. Her GP subsequently recommended that she discontinue the medication and continue with the low carb diet. Despite this incident our training together was very successful and she was kind enough to write a testimonial that you can see on this page.

The moral this is to go and see your doctor if you are taking diabetic medication. Though if you're taking Metformin you'll probably be fine, but it's still always worth seeking professional advice - so please do that.

 

Q: What about my genetics? - diabetes runs in my family.

A: Okay, so there is a bit of a myth going around that diabetes is a genetically inherited condition. Let me be clear - IT IS NOT.

You may very well have a genome that makes you more predisposed to having problems with insulin sensitivity, but if you eat a healthy diet this will never become a problem. It's only when you have poor eating habits over a long time, that type two diabetes rears it's ugly head.

 

Q: What about Exercise?

A: Exercise is a very useful tool in improving insulin sensitivity. It is by no means as effective as dietary control, but it is nevertheless effective if used WITH an effective diet.

A great number of studies have shown that periodised weightlifting programs, as well as cardiovascular interval training, significantly improves insulin sensitivity in type two diabetics. Moderate aerobic exercise such as jogging and power walking when done daily has also shown to be beneficial.

Long story short. A good workout plan will accellerate your recovery from type 2 diabetes.

 

Concluding

So there you have it. Type 2 diabetes is totally within your power to fix. Should you get any questions about it, please fire them my way, but be sure to check with your doctor before making any changes to your strategy (there - I covered myself).

moral this is to go and see your doctor if you are taking diabetic medication. Though if you're taking metformin you'll probably be fine, but it's still always worth seeking professional advice - so please do that.

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