Type 2 Diabetes used to be a somewhat marginal disease, but it is now an epidemic and one of the leading causes of death in Western countries such as the United States and Australia. In Australia alone, it is estimated that around 1 million people are living with diabetes, with many more who are pre-diabetic or yet to be diagnosed. Diabetes is said to be the fastest-growing chronic disease in Australia, growing at a rate faster than heart disease and cancer. Alarmingly, what was historically a disease only seen in adults, is now being widely observed in children too. This tells me that what we are doing to combat the disease is proving ineffective. At present, medical efforts focus on managing the disease, rather than applying comprehensive lifestyle changes that can, in many cases, be effective at reversing the disease. As such, I think it’s time to equip ourselves with the knowledge needed to truly prevent, and, if needed, reverse, this disease. We owe it to ourselves.
What is Type 2 Diabetes?
Type 2 diabetes results from the body’s inability to use insulin effectively. It is a progressive condition that prevents glucose from getting into muscle, where it’s needed for energy production and other important functions), despite the presence of insulin. This is called insulin resistance. Patients are typically required to take pills or non-insulin injections on a daily basis to help lower their blood sugar. Symptoms can be similar to those of Type 1 Diabetes but less marked if at all present, and usually include fatigue, blurred vision or constant thirst. As a result, the disease may go undiagnosed for several years, until complications have already arisen. When they finally do, the disease can cause debilitating complications such as the increased risk of developing cardiovascular disease,kidney disease, amputations and blindness.
While Type 2 Diabetes is more likely to occur in people with a family history of the disease, its recent growth has been linked to skyrocketing rates of obesity, poor diet, and sedentary lifestyles. As such, it has been dubbed a ‘lifestyle disease’. This is actually good news though, because in the same way poor lifestyle choices can contribute to causing the disease, healthy lifestyle choices have the power of reversing underlying causes and effects. Understanding how insulin resistance develops in the first place, empowers us in preventing and reversing the disease.
Sugar is not the only culprit
Raise your hand if you think sugar causes diabetes! You are not alone – because impaired blood sugar control affects both Type 1 and Type 2 Diabetes, people have long blamed sugar for rises in blood sugar levels. However, this is one of the biggest misconceptions about the disease, and one that is now widely refuted by diabetes associations and scientists around the world. They state that besides potentially contributing to weight gain, sugar is not directly responsible for insulin resistance (weight gain and a calorie surplus are major risk factors for Type 2 diabetes). So, if it’s not sugar, what are we eating these days that is causing the increased rates of Type 2 Diabetes?
According to research, the answer is fat. Not just the fat that we gain but the actual fat we eat. In particular, there are microscopic fat particles called intramyocellular & intrahepatic lipids (IMCL’s) present in muscle and liver cells which numerous studies have shown to cause insulin resistance. In other words, the build-up of microscopic fat caused by eating fatty foods, and particularly saturated fat, causes insulin resistance. With this insulin resistance, we develop an impaired ability to get glucose from the blood into our muscle cells. Therefore, elevated blood glucose or blood sugar is a symptom of the underlying insulin resistance, but not the cause. In addition to being overweight, eating a calorie surplus and eating a diet high in saturated fats, various studies have also implicated animal protein, heme iron (mainly from red meat) and isolated fructose in the development of insulin resistance and type 2 diabetes.
Given that Western diets are marked by unprecedented high intakes of meat and saturated fat, it isn’t surprising that rates of Type 2 Diabetes have increased so dramatically. In one study, researchers looked at data from 8,401 subjects over a 17-year period, finding those who consumed meat on an at least weekly basis had a 62% greater risk of developing diabetes compared to vegan subjects even with body weight and other lifestyle factors statistically controlled for. Evidence suggests that changes to diet and lifestyle, and in particular adopting a plant-based diet, is an effective tool for both preventing and managing Type 2 Diabetes. In fact, data from over 200,000 subjects in the 2016 Nurses Health & Health Professionals Follow-Up Studies found that plant-based diets rich in whole foods offered protection against the development of Type 2 Diabetes, reducing the risk by an incredible 34%. In 2018, the Rotterdam study looked at 6,789 subjects from the Netherlands, finding that even when BMI was controlled in all subjects, those who consumed a more plant-based diet were significantly less likely to develop insulin resistance and Type 2 Diabetes. So, a diet high in animal fats and highly processed foods increases your risk of developing Type 2 Diabetes whereas a diet rich in whole unrefined carbohydrates and low in saturated fats can reduce your risk.
Combatting the disease
Traditionally, doctors have advised patients to restrict the intake of carbohydrates because they can experience poor glucose control when consuming carbohydrates, and blood sugar can temporarily improve on a low-carb diet. However, this is merely a band-aid solution that does not address the underlying cause of insulin resistance. A true cure would entail an increased ability to handle more carbohydrates.
We’ve known for quite some time that diets extremely low in calories that result in substantial weight loss can successfully reverse Type 2 Diabetes, essentially reducing or eliminating the need to inject insulin. However, doctors are now finding a low-fat, whole-food, plant-based diet can achieve the same outcome – without needing to count calories. Also, other than being low in saturated fat, these diets are high in fibre, antioxidants, and magnesium, all of which have been shown to promote insulin sensitivity.
One study placed 20 men with diabetes on either a high-carbohydrate, high-fibre plant-based diet or a conventional diabetes diet, while ensuring that no participants lost weight. After just two weeks, half of the men in the plant-based group were able to stop taking insulin completely, with the remaining subjects in the plant-based group reducing their need for insulin by an average of 60%- despite not losing any weight. The control group also experienced improvements, but nowhere near as much as the plant-based group. The importance of this study should not be overlooked – patients who had been living with diabetes for decades were able to substantially reduce or completely give up insulin injections in only two weeks. If we had a drug capable of such extraordinary results, it would no doubt make the headlines and a lot of money! Thankfully though, the benefits of a plant-based diet for sufferers of chronic diseases such as Type 2 Diabetes are being increasingly recognised by the medical community.
A powerful lifestyle choice
So, what do people consuming a low-fat whole food plant-based diet actually eat? For starters, the macronutrient breakdown looks something like: 70-75% carbohydrates, 15% protein, and 10-15% fat. By no means is this a free pass to gorge on refined bread and pasta though. Refined carbohydrates that have been stripped of fibre such as white bread, pizza and pasta, unfortunately, increase the risk of developing Type 2 Diabetes. The carbohydrates you want to consume come from fruits, vegetables, and unrefined grains such as quinoa, oats, brown rice and rye. Foods low on the glycemic index are favoured here. Pulses should also be given priority because they are great sources of fibre and protein. Importantly, people looking to reverse Type 2 Diabetes should obtain fats in limited amounts from whole plant sources such as avocados, nuts, and seeds, and avoid oils and other processed fats.
One great benefit of eating this way is the freedom to eat until satisfied without the need to count calories.
Because dietary changes are so powerful, people with diabetes should do so in consultation with their Doctor so that safe modifications can be made to medications only when appropriate.
Tips for Combatting Type 2 Diabetes
- Maintain a healthy BMI (18.5 to 24.9).
- Get blood pressure within the healthy range.
- Adopt a low-fat, whole-food, plant-based diet. Low fat means only 10–15% of your calories come from fat, of which 7% or less is saturated fat.
- Consume at least 30g of dietary fibre per day.
- Enjoy a diverse range of whole grains, legumes, vegetables, and whole fruits (avoid juices).
- Cook without vegetable oils, or considerably minimise use.
- Stick to whole food fat sources such as avocado, nuts and seeds in moderation. Avoid animal foods, which have much higher levels of saturated fat.
- Minimise or avoid packaged processed foods. Typically, these foods contain high amounts of saturated fats, refined sugars and calories with minimal micronutrients.
If you would like more information on this topic I suggest listening to the Plant Proof podcast episode with Cyrus and Robby from Mastering Diabetes
Words by Simon Hill, Nutritionist & Dr Michelle McMacken (MD)