Type 2 diabetes can be very easily and effectively managed with slight changes to lifestyle, diet or whatever the source is proposing and it can also, in most circumstances, be resolved permanently.  In fact, it seems that almost anything that takes you away from our modern junk-food, immobile and stressed lifestyle can contribute to improving type 2 diabetes.

Below is some information about the most compelling ways I’ve read about to improve and possibly even cure type 2 diabetes.

What is type 2 diabetes?

To kick off take a quick reminder read of my diabetes introductory post.  Diabetes is caused when the body can’t take control of elevated glucose levels and handle the glucose correctly, storing it appropriately for use as energy later on.

Unlike type 1 diabetes, where the body is unable to produce insulin that triggers the storage process for glucose, type 2 diabetics produce insulin but their bodies are unable to use the insulin correctly – they are insulin resistant.  As a result of this they still don’t process and store the glucose and the glucose is allowed to build up and flood the system.  Essentially, the insulin isn’t triggering those GLUT4 molecules in the cells, telling them to latch onto glucose and both turn it into a storable form and take it to the correct storage facilities (the liver and muscles).

If you didn’t read the introductory post that I wrote on diabetes and which I linked to in the first paragraph of this section then you might want to go and read it now to find out what happens to people when they get a long-term build-up of glucose in their blood.

Cause of type 2 diabetes

Knowing what causes type 2 diabetes is difficult to put your finger on.  While Wikipedia lists all sorts of causes of type 2 diabetes I disagree with the spirit of the list.  For me the reality is that it could most simply be summarised as “living the Western life”.  If you eat a western diet (plenty of grains, wheat, sugar and so on) and live the western lifestyle (stress, inactivity etc) then you are quite possibly storing up the possibility of becoming insulin resistant.

Grain-based foods like pasta - are they to blame?

Why is that?

The short answer is that your body will become insulin resistant when it is made to handle massively elevated glucose levels day-in, day-out, for weeks, months and years and the system is therefore flooded with insulin all the time.  It stops knowing how to respond to the insulin – it can’t be on high alert all the time.

Some western living conditions, such as stress, which are known to contribute to metabolic derangement, can cause the body to go into this state faster, but really we need to look at what is causing the body to be permanently flooding with insulin and the answer is found in the typical western diet which consists of not only the obvious culprit, sugar, but also contains plenty of wheat.

Excessive wheat consumption causes spikes in glucose and, correspondingly, spikes in insulin every time you consume it.  It has been shown to produce a “belly” on people (there’s your obesity cause of type 2 diabetes) and it has also been linked to metabolic syndrome and problems with testosterone levels, all of which are listed on Wikipedia as potential causes of type 2 diabetes.  In fact, wheat consumption is starting to be linked with a huge number of western diseases, many of which are in turn linked with diabetes.

So is there any actual evidence to directly link wheat consumption with diabetes?  Well, it might be circumstantial evidence, but Robert Paterson took some time to look at the percentage of the US population with diabetes and the pattern of wheat consumption over the years.  The results are very compelling and strongly implicate wheat consumption as one of the main causes of diabetes.

Of course you could decide to believe all the many other studies suggesting that foods like red meat cause type 2 diabetes, but these are generally observational studies where other dietary factors are poorly controlled or recorded.  To take that on the other side, you could similarly argue that Robert Paterson’s connection is purely assumption or coincidence and that something else is at work here.

You may also be from the camp that believes that high fat diets cause diabetes, but Robb Wolf  and Denise Minger very squarely put to bed any belief that the latest study showing this is reliable.  Not only did carbohydrate levels also increase notably in the experiment’s “high-fat diet” but Robb also brings the reader’s attention to a separate study with a high-fat ketogenic diet (low, cyclical carb intake) that showed benefits related to type 2 diabetes complications.

Curing type 2 diabetes

Based on the belief that the principle cause of type 2 diabetes is over-exposure to high glucose-creating carbohydrates such as sugar, grains and, more specifically, wheat, the basic cure should be removal of those foods from the diet.  At first this may only be a controlling measure and it may take years of keeping these out of the diet before a person’s body stops being flooded by insulin and learns to respond correctly to insulin when it does get the odd burst.  Over time the individual may completely recover so that they are no longer insulin resistant.

To support this it is worth considering the experience of Jeff O’Connell (author of Sugar Nation).  Jeff believes that while he had a genetic propensity for type 2 diabetes he was also the classic skinny-fat build, carrying more body fat than was immediately visible.  Jeff managed to get control over his diabetes by cutting out the refined carbohydrates in his diet and moving to a low carbohydrate diet.

Peter at Hyperlipid is also in agreement with this as a solution to type 2 diabetes.  In fact, it sounds very much like a low carbohydrate and/or a paleo diet could be the solution for many type 2 diabetics if you wanted to put a name on the diet.  Unsurprisingly, there’s even a study (D Klonoff: The Beneficial Effects of a Paleolithic Diet on Type 2 diabetes and other risk factors for cardiovascular disease.  J Diabetes Sci Technol. 2009; 3(6):1229-1232) supporting the paleo diet as a solution.

Oh, and we’re not the first to think of this either.  In The Starvation Treatment of Diabetes, some doctors record how they were very effectively treating and controlling diabetes with a low carbohydrate diet before 1916!

The problem with the medical practice – a brief rant

I get thoroughly frustrated by the modern medical establishment’s proposed diet for diabetics.  They generally prescribe regular intake of “healthy grains” such as oats, at a level that seems to be much higher than the successful levels documented in The Starvation Treatment of Diabetes, although on the plus side they do tell people to remove sugar from their diet.  The logic seems to be to keep the glucose levels in the blood level constant and avoid spikes of blood sugar that can’t be controlled.

This is not a cure, it’s a way to maintain the current diabetic status without it getting worse.  Unfortunately there is a general belief that humans must have carbohydrates to provide essential energy to live on a daily basis and so this diet for diabetics is finding a way to provide this carbohydrate intake without excessively fluctuating blood glucose levels and creating corresponding insulin spikes.

I’ve written before that this belief in carbohydrate being essential for day-to-day living is inaccurate.  Human’s need glucose as essential energy only to run the brain and for significant muscular efforts.  It’s not actually that big a requirement.  All other energy can come from fat and I therefore think it is really important for any type 2 diabetic to learn to effectively utilise fat as a fuel source so that they can remove their dependency on carbohydrates.

Other ways to improve type 2 diabetes

There are plenty of other ways to help improve type 2 diabetes, in particular through improving insulin sensitivity.  I’ve pulled together a couple of particularly well-recognised ideas below.

Exercise

Most people who practice resistance training (lifting weights) know that it is particularly good for increasing insulin sensitivity.  The reason for this is that the exercise uses up glycogen stores in the muscles and the body is subsequently attuned to want to process glycogen correctly and refill those stores straight after exercise.  Note that this is not “exercise” as a stroll around the block or a 5 minute jog on the treadmill, this is “exercise” as a serious muscle-fatiguing activity.

Shift some big weights to improve insulin resistance

Some really good reading on this subject comes from Charles Poliquin who explains in part one of a series on insulin resistance and body composition that large volume and high intensity work will be the most effective at improving insulin sensitivity.

Coincidentally, Charles also flags up in the same article a study linking decreased testosterone levels in men with increased incidence of type 2 diabetes.  Since heavy resistance training can increase testosterone levels (as can reducing wheat consumption, by the way) this puts a double-tick in the resistance training box.

Supplementation

Vitamin D is a bit of a wonder-vitamin.  It has been shown to improve all sorts of things, however Dr Briffa did a great article recently showcasing a systematic review of 8 different studies (Mitri J, et al. Vitamin D and type 2 diabetes: a systematic review. Eur J Clin Nutr. 2011 Jul 6. doi: 10.1038/ejcn.2011.118).  As Dr Briffa points out while the evidence from a single study of vitamin D (such as a study done by PR von Hurst and published in the British Journal of Nutrition in 2011) would be interesting there is always a risk that something other than the vitamin has caused the changes.  Once you bring together evidence from 8 studies then the link between high vitamin D levels and improved insulin sensitivity.

Vitamin D - all hail the great vitamin!

*****

I hope this is helpful to you all.  Hopefully it at least gives you some ideas of some potential avenues to try out if you are a type 2 diabetic or know someone who is.  In particular I really do strongly recommend reading the first part of The Starvation Treatment of Diabetes for anyone who tries to claim that they absolutely must follow the guidelines and eat numerous small meals with plenty of “healthy grains” each day.  Doctors were successfully treating diabetes through several days of starvation before slow increases in various foods except fat where the intake level makes up most of the caloric intake.

Related posts:

1. Type 1 diabetes
2. Type 1 diabetes: a possible cure
3. Diabetes: an introduction

What is diabetes?

The commonly-known diabetes is in fact short for diabetes mellitus.  A surprise to me was that there are actually other diseases with “diabetes” in their name which don’t have anything to do with the group of diabetes diseases that most people think of when you say “diabetes” – the group which we’re looking at here.

Diabetes mellitus is made up of a group of metabolic diseases which are all characterised by high blood sugar.  For the purpose of this series I am focussing on types 1 and 2, but it is worth being aware that diabetes is not restricted to these.

Frequent insulin injections can become a way of life for type 1 diabetics (image courtesy of Jill A. Brown)

Different types of diabetes

Here is a quick run-down of some of the types (thanks to Wikipedia):

• Type 1 (formerly known as insulin-dependent or juvenile diabetes):  the body fails to produce insulin.  It is recognised as an auto-immune disease.  I’ll explain a lot more about type 1 next week.
• Type 2 (formerly known as non-insulin-dependent or adult-onset diabetes):  whil the pancreas produces insulin, the cells don’t use the insulin properly.  Again, there will be plenty more on this in a couple of weeks.
• Gestational diabetes:  some pregnant women have high blood glucose levels during pregnancy when they haven’t previously had diabetes.  It could be a precursor to type 2 diabetes, but most often resolves after delivery.
• Congenital diabetes:  genetic defects to the insulin secretion.
• Steroid diabetes:  induced by high doses of glucocorticoids – these are not the same steroids as the anabolic steroids used by bodybuilders.
• Monogenic diabetes:  hereditary forms of diabetes caused by mutations in an autosomal dominant gene.
• Cystic fibrosis-related diabetes.

That’s just a taster so, as you can see, almost any disease that is characterised by elevated blood sugar levels is “diabetes mellitus”.

Symptoms of diabetes

The classic symptoms of diabetes are:

• Polyuria – frequent urination (in children this is noticeable if bedwetting recommences),
• Polydipsia – increased thirst,
• Polyphagia – increased hunger,
• Weight loss (most common with undiagnosed type 1 diabetics) (1)

Another symptom which is often how diabetes is spotted in older people is significant changes in eye strength.  Someone I knew was tested and found to have type 2 diabetes after a routine eye examination revealed an unusually profound improvement in short sightedness.  I suppose older individuals may not report other classic symptoms to their doctor, believing that they are simply caused by aging.

If those symptoms are missed then diabetes can lead to more serious conditions or symptoms such as diabetic ketoacidosis (not the same as ketosis) which is often characterised by nausea, vomiting, dehydration and lethargy (1).  If left untreated there is also the risk of things like nonketotic hyperosmolar coma (sometimes known as diabetic coma), cardiovascular disease, chronic renal failure and retinal damage.

How insulin works – why we don’t all have high blood glucose

When we consume carbohydrates these are broken down by the initial digestive processes into free glucose which is absorbed into the blood stream.  When the pancreas senses the elevated levels of glucose in the blood, it responds by releasing the hormone insulin from the pancreas’s beta cells where it is created.

Insulin is a powerful hormone which is best known for its regulation of blood sugar but is, in fact, a general nutrient-storage hormone.  It is involved in the storage processes for other nutrients and the pancreas responds in a similar way to other triggers, such as elevated amino acid levels (2, pp.51-52). 

The insulin indicates to the body where nutrients should be stored, therefore regulating our body’s maintenance and repair at the cellular level.  In the case of elevated blood glucose, the insulin activates blood glucose transport molecules known as GLUT4 which are found in cell membranes and the GLUT4 facilitates the absorption of glucose by the liver (2, pp.63-64).  A recap of glucose storage can be found in my article about different carbohydrate sources.

What happens if a person has diabetes?

I will cover the mechanics of how this insulin-based process breaks down for diabetics in the next couple of weeks, as the different problems with the process define the different forms of diabetes.  However, a question that struck me was why does it matter if we have elevated blood glucose levels?

To answer this I strongly recommend that you read Robb Wolf’s Paleo Solution, pages 63 to 71, for the step-by-step walk through of the complete destruction which occurs but I’ll try to summarise it in simple terms here.

Protein is a fundamental building block for the body, it is what our cells (and therefore our tissues) are made of.  The problem is that protein reacts with free glucose, oxidising the protein and creating a toxic substance known as “advanced glycation end products” (AGEs).  To protect against this our bodies also produce enzymes to undo the AGEs, so usually everything should be fine. 

Usually the insulin would keep our blood glucose levels in check by indicating to, and enabling, the body to store the sugar.  If, for whatever reason, this system breaks down and the body doesn’t put the glucose into storage, the level of free glucose circulating in the blood will rise unchecked.  Unfortunately there is only so much good work the AGE-defeating enzymes can do, so if the system is constantly flooded with free glucose and as a result also floods with AGEs the AGEs will accumulate.  

Why does it matter if our bodies become flooded with (toxic) AGEs?  Well, AGEs can damage proteins (essential building blocks for the body), enzymes (essential to run the body), DNA (telling cells what they do) and hormone receptor sites on the surface of cells.  Since these are the things that ultimately drive the symptoms of aging we get “older” a lot faster and earlier.  Not only that, but AGEs can also kill the beta cells which produce the insulin and the GLUT4 molecules – the essential equipment to stop this happening in the first place – so it ends up making everything much more permanent (2, p70).

So how widespread is diabetes?

A global study of diabetes carried out for the World Health Organisation (3) suggested that in 2000 2.8% of the global population had diabetes and the number of people with diabetes was expected to double by 2030 (partly due to the increase in the population aged over 65 years).  However, when you read the study there is a good chance that these numbers are wrong. 

The percentage was worked out by using data from a limited number of countries and extrapolating to cover the global population.  For example, the data for the Netherlands was extrapolated to cover 13 European countries, including Germany.  There was no data available for developing countries so they assumed that the same relative risks applied and extrapolated existing data to cover the developing countries.  I believe that many developing countries, where diets and lifestyles differ significantly to the Westernised world, may not have diabetes to the same extent and the widely acknowledged risk factors may not be correct.

Despite the implication that this percentage may be overstated, a response to the study and return response by the original authors (4) concluded that this percentage could actually be significantly understated, at least for the Westernised countries.

Either way, this is a significant number of people and a good reason to understand diabetes!

 *****

Bibliography

1. Cooke D and Plotnick L: Type 1 Diabetes Mellitus in Pediatrics.  Pediatr. Rev. 2008; 29:374-385
2. Wolf, R: The Paleo Solution: the original human diet.  Victory Belt Publishing 2010
3. Wild S, Roglic G, Green A, Sicree R, King H: Global prevalence of diabetes – estimates for the year 2000 and projections for 2030.  Diabetes Care 2004; 27:1047-1053
4. Rathman W, Giani G: Response to Global prevalence of diabetes: estimates for the year 200 and projections for 2030.  Diabetes Care 2004; 27:2568-2569

Related posts:

1. Type 1 diabetes
2. Type 2 diabetes
3. Type 1 diabetes: a possible cure

• Omega 3 and 6 ratio
• Acid-base balance
• Different carbohydrate sources

I’m explaining why these are areas to look at when planning your diet and why, in particular, they matter to Chris with his muscle and strength gaining goals.

For the final instalment I am going to briefly address the issue of how different carbohydrate sources are processed by the body and how this should impact on our pre-workout carbohydrate choices.

Are all carbohydrates created equal?

Not really.  When I was first introduced to the principles of carbohydrate in relation to weight training, I learned that carbohydrates provide the glycogen energy source that is stored in the muscles.  Weight training and anything else that uses your muscles uses up these stores and then you need to take in more carbohydrates to replenish these glycogen stores.

However, glucose from carbohydrates is actually stored in three different places.

1. Directly in the bloodstream for immediate use as energy.
2. In skeletal muscle as glycogen.
3. In the liver, again in the form of glycogen.

Jacket potatoes (and sweet potato) - a source of glucose

The liver and glycogen storage

The liver’s key function is to serve as our detoxification organ, breaking down environmental toxins, hormones and other toxic materials in the body and making them more water-soluble so that they can be flushed out of the body, either through urine or faeces.  Additionally, the liver not only stores glycogen but regulates release of glycogen and the subsequent glucose levels in the blood.

The liver itself doesn’t measure the glucose levels in the blood.  This role is carried out by the pancreas which then releases hormones to signal to the liver that it should release more or less glucose into the blood.  If more glucose needs to be released then the pancreas releases the hormone glucagen as a signal to the liver, if less glucose needs to be released then the pancreas releases insulin.  Diabetes occurs when this ability to produce insulin is impaired in the pancreas so that the pancreas cannot signal to the liver to stop releasing glucose.

The liver is capable of storing up to 10% of its volume in glycogen.  Once the liver’s glycogen stores are full, any carbohydrates being sent to the liver are converted to triglycerides.  These are long-chain fatty acids which break down insulin sensitivity and can lead to non-alcoholic fatty liver disease.  This is where the liver becomes marbled with fat and ceases to be able to carry out its normal detoxification roles, leading to a build-up of toxins in the body.

In actual fact, the liver can also synthesise glucose from certain amino acids, lactate and glycerol through the process of gluconeogenisis.  As such, there is no such things as essential carbohydrates, since the body is perfectly capable of producing these itself, provided you give it the right building blocks.

If you want an easy introduction to the way the liver stores glycogen and how an excess of liver-related carbohydrates can impact on the liver, Robb Wolf discusses this in detail towards the end of the first 10 minutes of Episode 9 of the Paleolithic Solution during which he is talking about dairy and inflammation.

Which carbohydrate sources are sent to the liver?

While carbohydrates should, theoretically, be stored in the order of bloodstream, skeletal muscle tissue then the liver, certain forms of carbohydrates go directly to the liver without first ensuring that the other sources are full.  

An easy way to divide these is between glucose and fructose.  

While fructose is a carbohydrate, it is processed in the liver (to convert it to glycogen for storage and then convert it to glucose to be released into the bloodstream once it is needed), whereas glucose is sent to the glycogen stores in the muscles first.

The problem with fruit as a pre-workout carbohydrate source

Fruit is a good source of carbohydrates but looking on Wikipedia, the chart of fructose/glucose ratio for common foods shows that some of the most commonly eaten fruits have very high ratios.  The two fruits we used to use as the primary carbohydrate sources in most of our pre-workout snacks, apples and pears, have ratios of 2:1. 

For workout carbohydrates we really want the glucose to be replenishing the skeletal muscle stores, so using something that is then stored in the liver is not ideal.

Blackberries - better than apples and pears but perhaps not great pre-workout nutrition after all

In addition, fructose apparently disappears from the blood twice as quickly as glucose.

I’ve got a few other concerns about high fructose intake too:

• too much fructose can eventually lead to diabetes;
• fructose is connected to higher oxidation and inflammation; and
• fructose bypasses the key rate-limiting step that controls how fast we convert sugars into energy.

What can I use instead?

The obvious choices are pasta, bread, rice and potatoes.  However, if you are on a paleo diet then these mostly come off the list.  For this reason, sweet potatoes and yams are tolerated by most athletes on the paleo diet as acceptable carbohydrate sources when consumed as part of the pre-workout food.

After one week of eating sweet potato Chris is already struggling with the sweetness of this and I’ve had to move him onto normal baked potatoes pre-workout.  This is certainly proving to be a big shift for us in our diet mindset and one of the biggest hurdles to overcome.

What do you do for workout-related carbohydrates – particularly if you are following a paleo diet?

Related posts:

1. Workout nutrition: protein, fat or carbohydrate?
2. Low carbohydrate diets
3. Blog-watch: low-carbohydrate diets