What is diabetes?
Diabetes is a condition that prevents the body from properly using energy from food. It occurs when the pancreas does not produce insulin, or when the pancreas produces insulin, but it is resisted by the body.
Diabetes explained in simple words
Many people have heard of diabetes, but most people don't know exactly what diabetes really is. When we eat food,it is broken down in glucose or sugar. Even though many health experts harp on not having too much sugar in the diet, you do need some glucose to help regulate your metabolism and give you energy.
During digestion, glucose moves through the body through the blood stream to feed your cells. To be able to transfer the Blood sugar into the cells, your body needs insulin, which is made by the Pancreas and released into the blood stream.
The problem happens when you have too much blood sugar in your body compared to the amount of insulin your pancreas is providing.
If you're body is not making enough insulin to keep up with the amount of sugar in your bloodstream, or if your body is having trouble making insulin, the glucose in the blood remains there and causes your blood sugar levels to elevate. If it continues, even after monitoring your diet, you will develop diabetes.
Types of Diabetes
Although there are three main types of diabetes, there is also a stage before diabetes called pre-diabetes. Pre-diabetes, also known as Impaired glucose tolerance is a condition where your Blood sugar level elevates to a level higher than the normal range for most people, but is still low enough not to be considered diabetes.
People who have pre-diabetes are at risk of developingType 2 diabetes later in life if they do not monitor their condition carefully.
People who have been diagnosed with pre-diabetes can help keep from progressing to a full blown diagnosis of Type 2 diabetes by watching their weight, exercising and eating the right foods.
The first main type of diabetes is Type 1 diabetes,an Auto immune disease where the pancreas produces very little insulin or no insulin at all. People who get Type diabetes are usually under the age of 20, usually presenting itself when the person is a child or young adult.
Some scientists believe that Type 1 diabetes is a genetic condition where the cells of the Pancreas are attacked and then stop functioning. Others feel the disease may be caused by a virus that prompt the immune system to begin attacking the pancreas.
Because the pancreas cells that produce Insulin are destroyed, people who develop Type 1 diabetes will have the disease for life and will need treatment in the form of insulin shots or an insulin pump.
In addition to insulin therapy, exercise and careful attention to diet is necessary to prevent fluctuations of blood sugar.
Type 2 diabetes is normally found in people who are overweight as they get older. Although it is sometimes called adult onset diabetes, in some country, such as the United States, more children and young adults are being diagnosed with Type 2 diabetes because they are not getting enough activity.
About 90 percent of all cases of diabetes are Type 2 diabetes. The difference between Type 1 and Type 2 diabetes is that with Type 2 diabetes the pancreas does not produce enough insulin or the body does not properly use the it.
Type 2 diabetes is sometimes considered a lifestyle disease because it is normally triggered by living a fairly sedentary life, being overweight and not participating in exercise. However, age is a factor as well as heredity. If a parent or sibling develops Type 2 diabetes later in life, a person has greater chances to getting Type 2 diabetes as well.
The third main type of diabetes is gestational diabetes,which is a condition that women can get when they are in the second trimester of pregnancy. About 4 percent of all pregnant women will develop gestational diabetes. Unlike Type 1 and Type 2 diabetes, gestational diabetes will disappear after the baby is born.
When a woman has an occurrence of gestational diabetes during pregnancy, she is more likely to have it again in the next pregnancy and putsthe woman at a higher risk of developing Type 2 diabetes later in life. The older a woman is when she is pregnant, the higher the risk of developing gestational diabetes during pregnancy.
Facts and Figures
Diabetes has become an alarming global problem in recent years. According to the International Diabetes Foundation (IDF), the number of people diagnosed with diabetes in the last twenty years has risen from 30 million to over 246 million, or approximately 7.3 % of the world population, with North America have the highest percentage. The Middle East and some countries in the Caribbean have seen as much as 12-20% of the population being diagnosed as well.
There are many theories as to why the number of cases of diabetes has risen. One reason is that while the United States has been collecting data on diabetes for many years, other countries have only begun to realize the importance of this data and how diabetes affects its population. On one level, this will account for the staggering rise in cases that are now reported. However, this is not the only reason.
Lifestyle plays a major part in why some people get diabetes over others, which is why Type 2 diabetes contributes to at least 90-95% of the increase of diabetes in the world population. The increased westernization of developing countries has changed the pattern for which many countries live each day. The time to prepare healthy foods has been cut down by lack of time due to more work pressure, contributing to a less active lifestyle as well. When lack of activity is combined with not eating healthy, nutritious meals the danger of Type 2 diabetes is increased. Genetics also plays a part in cases where people have Type 1 diabetes, but that only contributes to 5-10% of the cases worldwide.
Here are some facts about diabetes:
1. Currently there are over 260 million people worldwide with diabetes.
2. At the currently rate, by 2025 more than 418 million people will be diagnosed with diabetes.
3. 65,000 new cases of diabetes are diagnosed each year.
4. 80 years after the discovery of insulin, there are still many people around the world who either cannot access insulin on a regular basis or at all.
5. Diabetes can damage the many organs including tissue of kidneys, eyes, peripheral nerves, vascular tree, eyes (causing blindness) and be the cause of loss of limbs in the lower extremities due to poor circulation.
6. Type 2 diabetes is preventable in approximately 80% of all cases, making prevention a high priority in fighting against worldwide diabetes.
7. More than half of all people who are diabetic don't even know they have diabetes.
Alternative vs. Conventional Medicine
One way to approach diabetes is to use integrative holistic medicine, also known as alternative medicine, a medical specialty that focuses on caring for the whole person, treating and preventing disease, and empowering patients to create conditions for optimal health, according to the American Board of Integrative Holistic Medicine.
This modality can be contrasted with the emphasis of conventional medicine, which is to cure or mitigate disease, as reported by the American Holistic Health Association. For example, a conventional practitioner will follow an established algorithm for diabetes management that includes a medically established protocol centered on monitoring blood sugar and prescribing medications to balance it. An alternative medicine provider takes a personalized, whole-person approach that may include a prescription for changes in diet and exercise habits, stress reduction, and other lifestyle considerations. (The table below offers a comparison of alternative medicine with conventional medicine.)
The concept of whole-person medicine is gathering increasing support in the nutrition and dietetics profession, as evidenced by the 2,550-member Dietitians in Integrative and Functional Medicine (DIFM) practice group of the Academy of Nutrition and Dietetics (the Academy).
Informed by scientific evidence, this group of RDs provides integrative and functional medical nutrition therapy (IFMNT) based on two principles: Each client has a unique genetic make up, and each client functions in an environment with internal and external factors that influence interactions between the mind, body, and spirit.
Conventional medical nutrition therapy (MNT), an intervention within the Nutrition Care Process (NCP) and Model, is defined by the Academy as “nutritional diagnostic, therapy, and counseling services for the purpose of disease management, which are furnished by a registered dietitian or a nutrition professional.”
The NCP is a systematic approach to providing high-quality nutrition care. It’s used in MNT and is at the core of IFMNT. The NCP consists of four distinct, interrelated steps: nutrition assessment, diagnosis, intervention, and monitoring/evaluation.
Using the NCP provides a framework for the RD to individualize care, taking into account the patient’s needs and values and using the best evidence available to make decisions.
Practitioners agree that nutrition is the cornerstone of diabetes management, and that a range of nutrition intervention strategies can be used to meet the metabolic goals and individual preferences of the person with diabetes. However, there are significant differences in the approach and methodologies used by alternative and conventional practitioners to manage the disease. One difference is in terminology. When is remission really remission?
John’s naturopath, Susan DeLaney, ND, RN, from The Wellness Alliance in Carrboro, North Carolina, considers diabetes to be reversed when an individual is no longer dependent on medication to maintain blood glucose levels within a fairly normal range. Kathie Madonna Swift, MS, RD, LDN, owner of Swift Nutrition and author of The Inside Tract: Your Good Gut Guide to Great Digestive Health,describes reversal of diabetes as “restoring function and bringing the body back into glycemic balance.”
The goal of MNT is to achieve and maintain blood glucose levels in the normal range or as close to normal as is safely possible. Patients who meet this goal are described as being in control.
Conventional vs. Alternative Nutrition Recommendations
Conventional: A dietary pattern that includes carbohydrates from fruits, vegetables, whole grains, legumes, and low-fat milk is encouraged for good health. Carbohydrate intake should be monitored using carbohydrate counting or experienced-based estimation. The Recommended Dietary Allowance for digestible carbohydrates is 130 g/day, which will provide a sufficient amount of glucose needed to fuel the central nervous system without reliance on glucose production from protein or fat. Using foods with a low glycemic index that are rich in fiber and other important nutrients is encouraged.
Alternative: DeLaney encourages her patients to avoid all wheat products “due to the increased glycemic response.” She says wheat products contain “irritating phytochemicals such as lectins and glutens.”
Sheila Dean, DSc, RD, LD, CCN, CDE, owner of Palm Harbor Center for Health & Healing in Palm Harbor, Florida, places her patients on a carbohydrate-controlled meal plan with minimally processed carbohydrates, which she refers to as “clean carbs.”
Conventional: For individuals with diabetes and normal renal function, protein recommendations are the same as healthy individuals: 15% to 20% of calories.1
Alternative: DeLaney’s meal plan calls for protein and fat at each meal to “slow the glycemic response.” She encourages wild fish but permits hamburger and pork chops. Swift, a member of the DIFM dietetic practice group, encourages her patients to follow a “plant-centric, gluten-free” diet, and she includes wild fish on the menu.
Conventional: People with diabetes are encouraged to consume a variety of fiber-containing foods, such as legumes, fiber-rich cereals, fruits, vegetables, and whole grain products.1
Alternative: DeLaney instructs her patients to consume eight to 10 servings of vegetables and fruits per day. “Beneficial plant nutrients and added fiber slow the glycemic response,” she says.
Before making any fiber recommendations, Dean has her patients tested for “pancreatic insufficiency.” She believes people with pancreatic insufficiency should be given digestive enzymes along with fiber, “otherwise the fiber will just bloat them up, and they’ll be quite unhappy,” she says. Dean uses a glucomannan fiber supplement for her patients with type 2 diabetes.
Conventional: People with diabetes are asked to limit saturated fat to no more than 7% of total calories, minimize trans fat intake, and limit dietary cholesterol to 200 mg/day. Two or more servings of fish per week are recommended for their cardiovascular health.1
Alternative: “I’m a fat atarian,” says DeLaney, who tells her patients to avoid low-fat foods. She encourages them to eat whole-fat dairy products, egg yolks, butter, olive oil, and avocado. “Restoring healthful fats to our diets as well as eliminating trans fats and all refined oils that help deplete our fat and vitamin stores will help nourish the body and reduce the need for diabetes medication.”
Dean recommends fish oils because “they have a similar mechanism of action as PPAR [peroxisome proliferator-activated receptor] agonists such as metformin,” she says.
Extra-virgin olive oil, nuts, and seeds are prominent sources of healthful fat on the Swift menu.
Vitamins and Minerals
Conventional: Vitamin and mineral supplements are provided only when deficiencies have been identified. Routine supplementation with antioxidants, such as vitamins E and C and beta-carotene, isn’t advised because of lack of evidence of their effects and concerns related to long-term safety.1
Alternative: “There as on I use food-based supplements is because they most closely help correct what I see as the problem: The food we’re eating is lacking in nutrients,” DeLaney says. “If their vitamin D is low, it tells me all their fat-soluble vitamins are low.” She uses cod liver oil along with high-vitamin butter oil to restore these deficiencies.
“I prefer a ‘food as medicine’ approach,” says Swift, who also recognizes the value of “therapeutic supplementation when prescribed thoughtfully” after a complete assessment.
Dean recommends her patients supplement with vitamin D“to help strengthen the cellular signals and replete the body.” She believes her patients respond to carb counting much better with nutrient supplementation. “There’s no one magical vitamin—it’s a symphony of nutrients that work together,” she says.
Conventional: People with diabetes are encouraged to engage in at least 150 minutes of moderate-intensity aerobic activity weekly and resistance training at least twice per week.
Alternative: Keeping in mind the principles of patient-centered care and the need to exercise the body, mind, and spirit, Swift includes yoga and gong on her nutritional lifestyle prescription pad for diabetes care.
Dean uses a more traditional approach. She encourages her patients to purchase a pedometer and track their daily steps, adding 500 steps each week until they’re walking 10,000 steps per day.
Dean encourages 30 minutes of physical activity daily,leaving the type of activity up to the patient.
Can We Reverse/Cure Diabetes?
There’s much media hype about reversing or curing diabetes, and patients are confused regarding these terms. However, many practitioners agree that bringing an A1c level down from 8.9% to 4.9% is indeed reversing the disease process.
But is John “free of diabetes”? This is where the lines become blurred. Medically speaking, the term “cure” is usually associated with acute disease—a temporary medical condition, such as bacterial pneumonia, that can be cured with antibiotics. For diabetes, which is a chronic disease, it may be more accurate to use the term “remission” rather than cure. Particularly when considering the pathology associated with diabetes and the individual’s genetic predisposition, relapse is always possible. In a consensus statement issued by the ADA, the term remission is defined based on the following definitions:2
• Partial remission: maintenance of blood glucose belowdiagnostic levels (a prediabetes state) without diabetes medication for at least one year;
• Complete remission: normal blood glucose without diabetesmedication for at least one year; and
• Prolonged remission: complete remission for at least fiveyears.
Tips for Dietitians
It’s well understood that weight loss, healthful eating, and physical activity are important factors in preventing, managing, and reversing diabetes. Hope Warshaw, MMSC, RD, CDE, author of Diabetes Meal Planning Made Easy and other ADA publications, encourages RDs to be clear with patients when talking about reversing the disease.
“People need to understand the continuum of diabetes,”she says. “If they’re on an upward trajectory of insulin resistance and a downward trajectory of insulin production weight loss, healthful eating and physical activity will slow down the insulin-loss trajectory and improve insulin sensitivity.” But, she says, “If they gain weight back, the diabetes comes back.”
Remember that diabetes care is complex and goes beyondglucose control. Dietitians should continue to be “evidenced based but open minded,” says Patti Geil, MS, RD, FADA, CDE, coauthor of What Do I Eat Now? A Step-by-Step Guide to Eating Right With Type 2 Diabetes.
Dean says, “We can’t only focus on macronutrients. … Wemust be mindful and open to the role of micronutrients.”
Swift urges RDs to be informed and stay up-to-date ascomplementary and alternative medicine data evolves. Use a “whole systems, whole person” approach to health and healing. The Kripalu Center for Yoga and Health is a good place to start. “They have an outstanding program on diabetes care that’s multidisciplinary and integrative,” Swift says. You also can receive continuing education credits for attending.
— Constance Brown-Riggs, MSEd, RD, CDE, CDN,is the national spokesperson for the Academy of Nutrition and Dietetics, specializing in African American nutrition, and author of the African American Guide to Living Well With Diabetes and Eating Soulfully and Healthfully With Diabetes.
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Naturopathic Food Plan
• Avoid all wheat products.
• Eat protein and fat at each meal, three times per day.
• Eat eight to 10 servings of fruits and vegetables perday.
• Avoid all trans fats and processed foods, such ascookies, cakes, and potato chips.
• Consume olive oil, avocado, butter, seeds and nuts,whole-fat dairy products, cheese, and yogurt.
• Eat 3 to 4 oz of nuts per day (eg, walnuts, almonds,pecans)
One to two eggs cooked as desired with nitrate-free, farm-raised bacon. For “Southerners,” grits and butter or whole-fat plain yogurt with nuts and fruit.
Salad with tomatoes, carrots, beets, onions, cucumbers, black olives, and “whatever else you desire.” Add pumpkin seeds, walnuts, and feta or goat cheese. Top with grilled chicken, tuna, or a hard-boiled egg. Dress with olive oil and vinegar or a lemon tahini dressing. Use mustard, garlic, or Italian seasonings to flavor the salad.
Wild Alaskan salmon, halibut, or sable fish and a grilled or roasted vegetable assortment. In the summer, try squash, peppers, onions, and mushrooms. In the fall and winter, try beets, carrots, onions, and potatoes. Also, brown rice, a sweet potato with butter, or corn on the cob.
Four squares of dark chocolate (containing 70% to 80% of cacao) eaten with walnuts, almonds, cashews, or pecans. Sliced fruit such as apples or pears with a slice of cheese and nuts or peanut butter.
Comparing Alternative and ConventionalMedicine
Based on the integration of allopathic (MD), osteopathic (DO), naturopathic (ND), energy, and ethno-medicine
Based on allopathic medicine
Primary objective of care
To promote optimal health and, as a by-product, prevent and treat disease
To cure or mitigate disease
Primary method of care
Empower patients to heal themselves by addressing the causes of their disease and facilitating lifestyle changes through health promotion
Focus on the elimination of physical symptoms
Evaluate the whole person through holistic medical history, holistic health score sheet, physical exam, lab data
Evaluate the body with history, physical exam, lab data
Primary care treatment option
Love applied to body, mind, and spirit with diet, exercise, environmental measures, attitudinal and behavioral modifications, relationship and spiritual counseling, bi