Dietary changes are worth the effort
By David Dunaief, M.D.
Lifestyle modifications are the most effective way to tackle Type 2 diabetes and its complications. Many in the medical community agree that a combination of diet and exercise is the best approach. However, American Diabetes Association (ADA) guidelines recommend that patients with new onset disease start by combining lifestyle changes with the medication metformin.
The thinking behind this approach is that too many patients fail on diet alone, and it’s important to reduce glucose (sugar) levels as soon as possible. According to the guidelines’ authors, for most individuals with Type 2 diabetes, lifestyle interventions fail to achieve or maintain metabolic goals, either because of failure to lose weight, weight regain, progressive disease or a combination of factors (1).
I agree that it is not easy to change your lifestyle, but I also think that, for highly motivated patients, the benefits far outweigh the challenges. Not only can we treat this disease, but we can also prevent its complications, such as heart disease, which are so difficult to treat with medications.
Type 2 diabetes is caused in large part by poor nutrition. Yes, some people have a higher propensity than others, but if compliant on a diet regimen, you can dramatically reduce your risk. And, while medications may help manage diabetes, they also have varying degrees of undesirable side effects. With lifestyle modifications, though, there are only positive effects.
What type of diet regimen may be used to prevent Type 2 diabetes?
The regimen that has achieved the best results is a plant-based diet rich in vegetables, beans and legumes, nuts and seeds, whole grains and fruits. It also may include animal products with an emphasis on fish. This is a diet that emphasizes good fats, those with lots of omega 3 fatty acids, and is low in saturated fat. The data suggest that antioxidants, such as carotenoids, which can be found in multiple foods in this diet, play an integral role in preventing the disease (2).
A randomized clinical trial, called the PREDIMED study, published in the journal Diabetes Care in January 2011, showed that a Mediterranean-type diet, such as described above, reduced the risk of Type 2 diabetes by 52 percent, when compared to a low-fat diet (3). The incredible part was that these results were seen over a short four years, with negligent weight loss among the trial groups. In other words, the Mediterranean-type diet’s effects extend beyond a change in body mass index.
An observational study showed that those with the highest compliance with a Mediterranean-type diet had a dramatic risk reduction for developing diabetes of 83 percent (4).
What about treatment?
A study published in the American Journal of Clinical Nutrition showed a low-fat vegan diet had twice the effectiveness in lowering glucose levels, compared to the traditional ADA diet (5). Both groups lost about the same amount of weight. Again, it shows that there is more than just weight loss involved in effective dietary regimens for this disease.
Can we reverse Type 2 diabetes?
In a study I authored in collaboration with Dr. Joel Fuhrman and the University of Pennsylvania Medical Center, results showed that 62 percent of participants who followed a high-nutrient density diet, similar to the Mediterranean-type diet, achieved normal glycemic (sugar) levels (6). Thus, they became nondiabetic.
Even more impressive, participants were able to reduce the number of overall medications from four to one and discontinue all of their diabetic medications, except for one participant. Of those with high blood pressure, the mean blood pressure was normal at the last data point of the study. There was also significant improvement in the lipid profiles of participants.
These are very positive results for both prevention and treatment of Type 2 diabetes and its complications. The caveat is that it is not easy and takes highly motivated individuals. However, the results are well worth the effort.
(1) Diabetes Care 2018 Jan; 41(Supplement 1): S73-S85. (2) Am J Clin Nutr June 2003 77(6):1434-1441. (3) Diabetes Care 2011(34):14-19. (4) BMJ. 2008 Jun 14;336(7657):1348–1351. (5) Am J Clin Nutr May 2009 89(5):1588S-1596S. (6) Open Jnl Prev Med Aug 2012 2(3):364-371.
Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.