Diabetes: Have We Got it All Wrong?
Updated: Jul 15, 2020
Diabetes: Have We Got it all Wrong?
In the United States, 1 in every 3 people are diabetic or pre-diabetic. Despite the millions of dollars poured into diabetes research and education, the rate of diabetes continues to rise. It’s clear that both our understanding and clinical management of the diabetes is failing the public. What are we getting wrong?
A Pill for Every Ill
Like most chronic diseases, diabetes is managed with a variety of blood glucose-lowering medications. While prescriptions drugs can be an effective treatment at first, drugs become less effective as the disease progresses and health complications become unavoidable. In addition to dealing with the side effects of these medications, total recovery from diabetes using drug therapy has never been reported.
There’s an alternative treatment to medication: lifestyle medicine. Lifestyle medicine is the use of a whole food, plant-based dietary lifestyle, exercise, restorative sleep and stress management as a primary therapy for the treatment and reversal of chronic disease. In contrast to drug therapy, which has never been shown to reverse diabetes, lifestyle medicine shows more promise.
Evidence suggests that changes to diet and lifestyle, in particular the adoption of a plant-based diet, can prevent and, if needed, reverse type 2 diabetes. If a pill could do what a plant-based diet does for diabetes reversal, it would become a multi-billion-dollar drug overnight. So, why isn’t a plant-based diet the primary treatment of care?
The most honest answer is that our current medical system profits off sick people- not too dead, but also not too alive. Plants don’t make money for the pharmaceutical industry; patented pharmaceutical formulas do. And as a doctor, where is the profit in giving your patients a prescription for fruits and vegetables? Statin drugs and weight loss surgeries are much more profitable. Even if doctors wanted to discuss lifestyle changes with their patients, doctors may not have the time or the nutrition background to do it.
Diet culture has failed
It’s common for medical professionals to advise their diabetic patients to eat a low carbohydrate diet. This dietary approach seems to make sense; carbohydrates increases blood glucose levels, which stimulates insulin production in the pancreas. When carbohydrates are avoided, blood glucose levels stay within a normal range, making the condition easier to predict and manage.
There are three glaring problems with this line of thinking.
Low carbohydrates diets do not treat the underlying cause of type II diabetes, insulin resistance. When intramyocellular lipids, or fat accumulates inside a muscle cell, the communication between insulin and the muscle cell is blocked. No matter how much insulin the pancreas produces, glucose cannot enter the cell to be broken down and used for energy. This is a typical case of insulin resistance.
Eating less carbohydrates results in eating more fat, which makes insulin resistance worse. Just ask a scientist how they induce insulin resistance in rats; feed rats a diet low in carbohydrates and high in fat and rats develop insulin resistance in as little as 8 weeks. We know that high fat diets cause insulin resistance due to MRI technology that allows us to observe what goes on inside cells after fat enters the blood steam. Within 3 hours of a high fat meal we can detect levels of insulin resistance. When the fat content of a meal is lowered, the cells quickly become more sensitive to insulin. You may have thought that refined sugar is the main cause of insulin resistance, but excess saturated fat from animal-based food is significantly worse. Muscle cell exposure to high levels of saturated fat like palmitate, from meat, dairy and eggs, not only leads to severe insulin resistance, it also increases free radical production and impairs mitochondrial dysfunction. It should be noted that saturated fat from plant foods, such as nuts, olives and avocados does not have the same effect on insulin sensitivity as saturated fat from animal-based foods.
Low carbohydrate diets restrict entire food groups which make them difficult to sustain. Avoiding carbohydrates for even a few days may leave you feeling hungry, deprived, lethargic and fatigued. This is because glucose is our body’s main fuel. Our brain, central nervous system and red blood cells require glucose to function well. Medical professionals spend so much time striking the fear of eating carbohydrates into their patients. Yet a diet rich in complex carbohydrates, such as whole grains, tubers and fruit reduces the risk for type II diabetes. Unlike simple carbohydrate foods, such as white bread and white rice, complex carbohydrates contain more vitamins, minerals and fiber, which means they take longer to digest and have less impact on blood glucose levels. Complex carbs are not a food group to be scared, but rather a food group to embrace.
Plant-based diets could be the best medicine of all
“If a pill could do what a plant-based diet does for diabetes reversal, it would become a multi-billion-dollar drug overnight. “
A study from 2002 showed that a diet rich in fruits and vegetables and low in saturated fat treats diabetes better than drug therapy. The study compared one group assigned to take metformin to another group that was assigned a plant-rich diet and regular exercise. Those taking metformin lowered their risk of getting diabetes by 31%, while those who changed their diet in addition to exercising lowered their risk by 58%, compared with those taking a placebo. This study proved that plants are powerful, but how does a plant-based diet measure up to the diet prescribed by the American Diabetes Association?
A 2009 randomized control study provided the answers to this question. In the study, one group was instructed to eat a conventional diabetes diet (15-20% protein, <7% saturated fat, 60-70% carbohydrate, <200mg/day cholesterol) with a 500-1000 calorie deficit. The conventional diet included animal-based foods. The other group was instructed to eat a plant-based diet (10% fat, 15% protein and 75% carbohydrate) and asked to avoid animal products, oils, fried products, avocados, nuts and seeds. The plant-based group was not prescribed a calorie deficit.
Over several months, the researchers measured the participants’ weight, cholesterol, Hgba1c and triglycerides. Despite not being prescribed a calorie deficit, the plant-based group lost more weight, and achieved lower cholesterol levels and Hgba1c values compared to the conventional group. What’s incredible is that the plant-based group didn’t count carbohydrates, restrict calories, or portion meals and they still had better clinical outcomes than the conventional group. This likely because plant-based diets reduce calorie density by increasing fiber intake and reducing fat intake.
The results from this study as well as others were so impressive that in 2016 the Academy of Nutrition and Dietetics released a paper stating that diets free of animal products are appropriate for people at all stages of life- including pregnant women, athletes and infants. not only nutritionally adequate but have far-reaching health and environmental benefits. The authors of the paper concluded that plant-based diets are not only nutritionally adequate but have far-reaching health and environmental benefits as well.
The future of medicine is plant-based
“We know the answer, and it is not that complicated. To be healthy, eat high volumes of vegetables. The answer to disease is vegetables. But people don't want to hear, 'Eat vegetables.' They want pills to overcome the diseases caused by our dysregulated appetites,” said Joel Fuhrman, MD
The solution is so simple- it’s almost criminal. Eat more plants. The medical community feels this is too simple, too inexpensive, and not clinical enough to work. But the research has shown over and over again that plants work better than pills; it’s most cost-effective, low-risk intervention on the market.
The benefits of a plant-based diet go beyond diabetes. Plant-based diets address the bigger picture by also treating heart disease, obesity, hypertension, high cholesterol and inflammation. The advantages also extend to a reduced risk of cancer, the second leading cause of death in the US.
If medical professionals embraced plant-based diets as the primary modality of treatment for chronic disease, billions of dollars in healthcare costs could be saved and millions of deaths could be prevented. Some healthcare organizations are making incredible strides towards a more plant-based future. Kaiser Permanente was the first healthcare organization to promotes a plant-based diets for the prevention of chronic disease. Hospitals around the country are implementing plant-based programs and offering more plant-based menu items. Lifestyle medicine practices, such as the Ornish Lifestyle Medicine program and Montefiore Hospital’s Cardiac Wellness Program, are reversing chronic disease and being reimbursed for it. But, there’s a lot more work to do to move this movement forward.
Waiting for the healthcare system to embrace lifestyle medicine is not an option for those who need to make changes now.
Be open to change.
Be an action taker.
Be in control of your health.
If you’re thinking of adopting a plant-based diet to help manage diabetes, high blood pressure, and other chronic disease it’s important that you consult with a registered dietitian. Unlike nutritionists, registered dietitians are qualified to provide medical nutrition therapy to people with serious chronic issues.
Apply to work with a plant-based registered dietitian.
Find out if plant-based nutrition counseling is covered by your health insurance.
Barnard, Neal D, et al. “Vegetarian and Vegan Diets in Type 2 Diabetes Management.” Nutrition Reviews, vol. 67, no. 5, 2009, pp. 255–263., doi:10.1111/j.1753-4887.2009.00198.x.
Estadella, Débora, et al. “Lipotoxicity: Effects of Dietary Saturated and Transfatty Acids.” Mediators of Inflammation, vol. 2013, 2013, pp. 1–13., doi:10.1155/2013/137579.
Goff, L M, et al. “Veganism and Its Relationship with Insulin Resistance and Intramyocellular Lipid.” European Journal of Clinical Nutrition, vol. 59, no. 2, 2004, pp. 291–298., doi:10.1038/sj.ejcn.1602076.
Melina, Vesanto, et al. “Position of the Academy of Nutrition and Dietetics: Vegetarian Diets.” Journal of the Academy of Nutrition and Dietetics, vol. 116, no. 12, 2016, pp. 1970–1980., doi:10.1016/j.jand.2016.09.025.
Santomauro, A. T., et al. “Overnight Lowering of Free Fatty Acids with Acipimox Improves Insulin Resistance and Glucose Tolerance in Obese Diabetic and Nondiabetic Subjects.” Diabetes, vol. 48, no. 9, 1999, pp. 1836–1841., doi:10.2337/diabetes.48.9.1836.
Sparks, L. M., et al. “A High-Fat Diet Coordinately Downregulates Genes Required for Mitochondrial Oxidative Phosphorylation in Skeletal Muscle.” Diabetes, vol. 54, no. 7, 2005, pp. 1926–1933., doi:10.2337/diabetes.54.7.1926.
“Standards of Medical Care in Diabetes—2017 : Summary of Revisions.” Diabetes Care, vol. 40, no. Supplement 1, 2016, doi:10.2337/dc17-s003.
Sweeney, J. Shirley. “Dietary Factors That Influence The Dextrose Tolerance Test.” Archives of Internal Medicine, vol. 40, no. 6, 1927, p. 818., doi:10.1001/archinte.1927.00130120077005.
Trapp, C., and S. Levin. “Preparing to Prescribe Plant-Based Diets for Diabetes Prevention and Treatment.” Diabetes Spectrum, vol. 25, no. 1, 2012, pp. 38–44., doi:10.2337/diaspect.25.1.38.