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Diabetes
Part 2: Dietary and Lifestyle Changes

Part 1  Part 3

 

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Know your Sugars
Dietary changes that may be helpful: People with diabetes cannot properly process sugar. Although short-term high-sugar diets do not cause blood sugar problems for diabetics,1 2 3 sugar is not necessarily innocent. Research shows that sugar causes diabetes in animals.4

The fiber in carbohydrates may help protect against diabetes. Most sugar comes from low-fiber foods, while high-fiber foods are often low in sugar. Therefore, eating more sugar usually means decreasing fiber—probably a mistake for diabetics. When whole foods, such as beans, whole raw fruit, and pasta, are compared with processed sugary foods, the high-sugar foods increase blood sugar more than the whole foods.5

Most doctors of natural medicine recommend that diabetics cut intake of sugar from snacks and processed foods. The best replacements for low-fiber, high-sugar foods (such as fruit juice) or starch (such as white bread) are high-fiber, whole foods.

Information on diabetes is found in three parts:
 
Part 1: Introduction
Part 2: Dietary and Lifestyle Changes
Part 3: Dietary Supplements and Herbs
High-fiber supplements, such as psyllium,6 7 guar gum (found in beans),8 pectin (from fruit),9 oat bran,10 and glucomannan,11 have improved glucose tolerance in some studies. Good results have also been reported with the consumption of 1–3 ounces of powdered fenugreek seeds per day.12 13 A review of the research revealed that the extent to which moderate amounts of fiber help people with diabetes in the long term is still unknown, and the lack of many long term studies has led some researchers to question the importance of fiber in improving diabetes.14 Nonetheless most doctors advise people with diabetes to eat a diet high in fiber. Focus should be placed on fruits, vegetables, seeds, oats, and whole-grain products, although psyllium and glucomannan supplements also help in some studies.

Eating fish also may afford some protection from diabetes.15 See Part 3 of the Diabetes section for information about fish oil supplements and diabetes.

Vegetarians have been reported to have a low risk of NIDDM.16 When people with diabetic nerve damage switch to a vegan diet (no meat, dairy, or eggs), improvements have been reported after only several days.17 In one study, pain completely disappeared in seventeen of twenty-one people.18 Fats from meat and dairy also cause heart disease, the leading killer of people with diabetes. 

Vegetarians eat less protein than meat eaters. Reducing protein intake has lowered kidney damage caused by diabetes19 20 and may also improve glucose tolerance.21 Switching to a low-protein diet should be discussed with a nutritionally oriented doctor.

Monounsaturated oils may be good for diabetics.22 The easiest way to incorporate monounsaturates into the diet is to use olive oil. However, those who are overweight need to be careful—olive oil is high in calories.

Should children avoid milk to avoid IDDM? Countries with high milk consumption have a high risk of IDDM.23 Animal research indicates that avoiding milk affords protection from IDDM.24 Milk contains a protein that is related to a protein in the pancreas, the organ where insulin is made. Some researchers believe that children who are allergic to milk may develop antibodies that attack the pancreas, causing IDDM. Most, but not all, studies indicate that children with IDDM drink cow’s milk at an earlier age than other children.25 Children with IDDM may have high levels of antibodies that attack milk protein.26

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Immune problems in people with IDDM have been tied to other allergies as well,27 and the importance of focusing only on the avoidance of dairy products remains unclear.28 Nonetheless, until more is known, most doctors of natural medicine recommend abstaining from dairy products in infancy and early childhood, particularly for children with a family history of IDDM. Recent research also suggests a possible link between milk consumption in infancy and an increased risk of NIDDM.29

Lifestyle changes that may be helpful: Most people with NIDDM are obese.30 Excess abdominal weight does not stop insulin formation,31 but it does make the body insensitive to insulin.32 Excess weight even makes healthy people pre-diabetic.33 Weight loss reverses this problem.34 NIDDM improves with weight loss in most studies.35 36 37

Being overweight does not cause IDDM, but it does increase the need for more insulin. Therefore, people with IDDM should achieve and maintain appropriate body weight.

Exercise helps decrease body fat38 and improves insulin sensitivity.39 Exercisers are less likely to develop NIDDM.40 People with IDDM who exercise require less insulin.41 However, exercise can induce low blood sugar or even occasionally increased blood sugar.42 Therefore, diabetics should never begin an exercise program without consulting a healthcare professional.

Moderate drinking in healthy people improves glucose tolerance.43 44 45 46 However, alcohol worsens glucose tolerance in the elderly47 and in diabetics.48 Diabetics who drink have a high risk for eye49 and nerve damage.50 Until more is known, people with diabetes should avoid alcohol. For healthy people, light drinking will not increase the risk of diabetes, but heavy drinking will, and should therefore be avoided.

Diabetics who smoke are at higher risk for kidney damage,51 heart disease,52 and other diabetes-linked problems. Smokers are more likely to become diabetic.53 It is important to quit smoking.

Continue reading Part 3: Dietary Supplements and Herbs

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Introduction to Diabetic
Dietary Supplements
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References:

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3. Loghmani E, Rickard K, Washburne L, et al. Glycemic response to sucrose-containing mixed meals in diets of children with insulin-dependent diabetes mellitus. J Pediatr 1991;119:531–37.
4. Wright DW, Hansen RI, Mondon CE, Reaven GM. Sucrose-induced insulin resistance in the rat: modulation by exercise and diet. Am J Clin Nutr 1983;38:879–83.
5. Lettle GJ, Emmett PM, Heaton KW. Glucose and insulin responses to manufactured and whole-food snacks. Am J Clin Nutr 1987;45:86–91.
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7. Rodríguez-Morán M, Guerrero-Romero F, Lazcano-Burciaga G. Lipid- and glucose-lowering efficacy of plantago psyllium in type II diabetes. Diabetes Its Complications 1998;12:273–78.
8. Landin K, Holm G, Tengborn L, Smith U. Guar gum improves insulin sensitivity, blood lipids, blood pressure, and fibrinolysis in healthy men. Am J Clin Nutr 1992;56:1061–65.
9. Schwartz SE, Levine RA, Weinstock RS, et al. Sustained pectin ingestion: effect on gastric emptying and glucose tolerance in non-insulin-dependent diabetic patients. Am J Clin Nutr 1988;48:1413–17.
10. Hallfrisch J, Scholfield DJ, Behall KM. Diets containing soluble oat extracts improve glucose and insulin responses of moderately hypercholesterolemic men and women. Am J Clin Nutr 1995;61:379–84.
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13. Raghuram TC, Sharma RD, et al. Effect of fenugreek seeds on intravenous glucose disposition in non-insulin dependent diabetic patients. Phytother Res 1994;8:83–86.
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20. Evanoff G, Thompson C, Bretown J, Weinman E. Prolonged dietary protein restriction in diabetic nephropathy. Arch Intern Med 1989;149:1129–33.
21. Gin H, Aparicio M, Potauz L, et al. Low-protein, low-phosphorus diet and tissue insulin sensitivity in insulin-dependent diabetic patients with chronic renal failure. Nephron 1991;57:411–15.
22. Garg A, Bananome A, Grundy SM, et al. Comparison of a high-carbohydrate diet with a high-monounsaturated-fat diet in patients with non-insulin dependent diabetes mellitus. N Engl J Med 1988;319:829–34.
23. Dahl-Jorgensen K, Joner G, Hanssen KF. Relationship between cows’ milk consumption and incidence of IDDM in childhood. Diabetes Care 1991;14:1081–83.
24. Coleman DL, Kuzava JE, Leiter EH. Effect of diet on incidence of diabetes in nonobese diabetic mice. Diabetes 1990;39:432–36.
25. Gerstein H. Cow milk exposure and type I diabetes mellitus. Diabetes Care 1994;17:13–19.
26. Karajalainen J, Martin JM, Knip M, et al. A bovine albumin peptide as a possible trigger of insulin-dependent diabetes mellitus. N Engl J Med 1992;327:302–7.
27. Scott FWE, Norris JM, Kolb H. Milk and type I diabetes. Diabetes Care 1996;19:379–83 [review].
28. Atkinson, MA, Bowman MA, Kao K-J, et al. Lack of immune responsiveness to bovine serum albumin in insulin-dependent diabetes. N Engl J Med 1993;329:1853–58.
29. Pettit DJ, Forman MR, Hanson RL, et al. Breast feeding and incidence of non-insulin-dependent diabetes mellitus in Pima Indians. Lancet 1997;350:166–68.
30. Isida K, Mizuno A, Murakami T, Shima K. Obesity is necessary but not sufficient for the development of diabetes mellitus. Metabolism 1996;45:1288–95.
31. Casassus P, Fontbonne A, Thibult N, et al. Upper-body fat distribution: a hyperinsulinemia-independent predictor of coronary heart disease mortality. Arterioscler Thromb 1992;1387–92.
32. Karter AJ, Mayer-Davis EJ, Selby JV, et al. Insulin sensitivity and abdominal obesity in African-American, Hispanic, and non-Hispanic white men and women. Diabetes 1996;45:1547–55.
33. Park KS, Hree BD, Lee K-U, et al. Intra-abdominal fat is associated with decreased insulin sensitivity in healthy young men. Metabolism 1991;40:600–3.
34. Long SD, Swanson MS, O’Brien K, et al. Weight loss in severely obese subjects prevents the progression of impaired glucose tolerance to type II diabetes. Diabetes Care 1994;17:372.
35. Pi-Sunyer FX. Weight and non-insulin-dependent diabetes mellitus. Am J Clin Nutr 1996;63(suppl):426S–9S.
36. Wing RR, Marcuse MD, Blair EH, et al. Caloric restriction per se is a significant factor in improvements in glycemic control and insulin sensitivity during weight loss in obese NIDDM patients. Diabetes Care 1994;17:30.
37. Henry RR, Gumbiner B. Benefits and limitations of very-low-calorie diet therapy in obese NIDDM. Diabetes Care 1991;14:802–23.
38. Hersey III WC, Graves JE, Pollack ML, et al. Endurance exercise training improves body composition and plasma insulin responses in 70- to 79-year-old men and women. Metabol 1994;43:847–54.
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40. Helmrich SP, Ragland DR, Leung RW, Paffenbarger RS. Physical activity and reduced occurrence of non-insulin-dependent diabetes mellitus. N Engl J Med 1991;325:147–52.
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43. Kiechl S, Willeit J, Poewe W, et al. Insulin sensitivity and regular alcohol consumption: large, prospective, cross sectional population study Bruneck study. BMJ 1996;313:1040–44.
44. Facchini F, Chen Y-DI, Reaven GM. Light-to-moderate alcohol intake is associated with enhanced insulin sensitivity. Diabetes Care 1994;17:115.
45. Rimm EB, Chan J, Stampfer MJ, et al. Prospective study of cigarette smoking, alcohol use, and the risk of diabetes in men. BMJ 1995;310:555–59.
46. Stampfer MJ, Colditz GA, Willett WC, et al. A prospective study of moderate alcohol drinking and risk of diabetes in women. Am J Epidemiol 1988;128:549–58.
47. Goden G, Chen X, Desantis R, et al. Effects of ethanol on carbohydrate metabolism in the elderly. Diabetes 1993;42:28–34.
48. Ben G, Gnudi L, Maran A, et al. Effects of chronic alcohol intake on carbohydrate and lipid metabolism in subjects with type II (non-insulin-dependent) diabetes. Am J Med 1991;90:70.
49. Young RJ, McCulloch DK, Prescott RJ, Clarke PF. Alcohol: another risk factor for diabetic retinopathy? BMJ 1984;288:1035.
50. Connor H, Marks V. Alcohol and diabetes. A position paper prepared by the Nutrition Subcommittee of the British Diabetic Association’s Medical Advisory Committee and approved by the Executive Council of the British Diabetic Association. Human Nutr Appl Nutr 1985;39A:393–99.
51. Stegmayr B, Lithner F. Tobacco and end stage diabetic nephropathy. BMJ1987;295:581–82.
52. Scala C, LaPorte RE, Dorman JS, et al. Insulin-dependent diabetes mellitus mortality—the risk of cigarette smoking. Circulation 1990;82:37–43.
53. Rimm EB, Manson JE, Stampfer MJ, et al. Cigarette smoking and the risk of diabetes in women. Am J Public Health 1993;83:211–14.
 
 
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