Ask Dr. Lo: Type 2 Diabetes

by Dr. Thomas K. Lo Type 2 diabetes (T2D) is a growing epidemic that afflicts more than twenty-nine million people in the United States today. Sadly, most diabetics feel helpless and clueless about how to reverse their condition. Another concern is that many of those with T2D are not even aware they have diabetes, and 90 percent of those who have a condition known as prediabetes are not aware of their circumstances, either. Most people do not realize that T2D is a preventable disease and can be reversed. I will focus on T2D in this article, as it is different from Type 1 diabetes, dubbed “juvenile onset diabetes,” affecting around 1 in 250 Americans. Occurring in individuals younger than age twenty, it has no known cure. In type 1 diabetes, your own immune system ravages the insulin-producing cells of your pancreas. Type 1 diabetics need to be supplemented with insulin for the rest of their lives, as failure to do so will rapidly result in death. Type 2 diabetes occurs when the body produces insulin, but it doesn’t work well—it is unable to process glucose appropriately or lower glucose levels effectively due to insulin resistance. T2D used to be referred to as “adult-onset” diabetes, but it is becoming more common in children and teenagers, as well as adults of all ages. It now accounts for 90-95 percent of all diabetes. Glucose (the end product of carbohydrate digestion) is needed for cells for energy and growth. Insulin helps glucose enter cells for either oxidation (burning) or storage (of excess glucose as glycogen in the liver). With insulin resistance, glucose cannot properly enter cells. Instead of the cells using glucose as fuel, it builds up in the bloodstream, leading to hyperglycemia (high blood sugar). For a while, the pancreatic beta-cells pump out more insulin to compensate for the added demand, so blood sugar levels stay under control. However, eventually, the pancreas cannot keep up and the body tips over into diabetes. As insulin output falls, blood sugar climbs. T2D is now defined as an epidemic. The definition of T2D has changed over the years. For example, in the 1970s, a fasting blood sugar over 140 resulted in a diagnosis; in 1997, it was decided that a fasting blood sugar over 126 was diabetes. That “little” alteration converted over 1.6 million people into diabetics. Medical treatment guidelines have also changed strikingly since the 1980s. People with T2D are at risk for developing many complications. Some of the complications include: heart disease, vascular disease (including hypertension, heart attack, stroke), poor circulation (causing problems such as foot ulcers), eye damage (retinopathy that can lead to blindness), kidney disease (progressing to kidney failure), bone fractures, arthritis, various types of cancer, increased inflammation without resolution, poor wound healing, dental disease, loss of cognitive function, and neuropathy (nerve damage). In the beginning stages of diabetes, many people have no symptoms or mild symptoms that aren’t suspected of being diabetes. Symptoms may include: increased thirst, increased hunger, increased urination (especially at night), sores that don’t heal, fatigue, unaccounted for weight loss, and blurred vision. Glycated hemoglobin (HbA1c), a measure of long-term average blood sugar, was previously used only to monitor glucose control, but is now used to diagnose diabetes. Also, “the optimum HbA1c seems to vary between patients.” A glucose tolerance test is usually used and/or random glucose, fasting glucose, and two-hour glucose concentrations after an oral glucose (a refined sugar) challenge. Although T2D was thought to involve genetic components, it is becoming clear that if genes are involved, it is epigenetic modifications—factors that turn genes on or off—that create the tendency. Epigenetic influences are primarily environmental, including diet, chemical exposures, medications, sedentary lifestyle, family history of diabetes, high blood pressure, and so forth. However, the leading cause of T2D is excess weight or obesity— being overfed but undernourished, over-agitated but underactive. Approximately 80 percent of people with T2D are overweight or obese. Eating too much (often due to inadequate nutritional value of the foods—really nonfoods) results in more fat storage as subcutaneous fat (beneath the skin) and visceral fat in and around organs and tissues, such as the liver, heart muscles, and digestive tract. Notable, “excess visceral fat and insulin resistance, were independently associated” with pre-diabetes and insulin and T2D. Excess stored fat may block an insulin-signaled glucose transporter that normally ferries blood sugar into the cells. Numerous toxins can play a role in causing or worsening T2D, such as inorganic arsenic, persistent organic pollutants (such as pesticides that accumulate in the environment), bisphenol A and phthalates (from plastics), dioxins, fresh-water contaminated with DDE (major breakdown product of DDT), and a number of organophosphate pesticides. Avoiding toxic exposures and periodic detoxification programs may help. Various drugs can increase T2D risk, including antidepressants, ADHD medications, and statins. Some drugs can worsen diabetes by interfering with insulin or blood sugar levels, including diuretics, over-the-counter decongestants, steroids (cortisone, prednisone), and beta-blockers. Others can alter the effects of diabetes medications. Gastric bypass surgery for the obese may lower blood sugar and eliminate the need for diabetes drugs. Nevertheless, nutrient deficiencies and other complications can develop. There are many antidiabetic drugs. Some stimulate the pancreas to produce more insulin; others work on the liver to decrease the amount of sugar released into the blood. Some “insulin sensitizers” attempt to make cells more sensitive to available insulin. Starch-blocking drugs slow carbohydrate digestion. The popular Metformin lowers blood fat levels and attempts to prevent the body from producing more sugar. Insulin lowers blood sugar, though this does not address the underlying cause of T2D. Actually, none of the drugs approach underlying causes; they don’t cure diabetes and can have many side effects. Lifestyle is the foremost and often only cause of T2D. Studies show that intense lifestyle intervention is very effective in preventing T2D and improving the health of people with diabetes. “Medicine might be winning the battle of glucose control, but is losing the war against diabetes,” stated Dr. Osama Hamdy, MD, PhD, a medical director in Boston. “We’ve been treating diabetes for forty years by adding more and more medications, with no big improvements. But if you act early, keep the weight off, and maintain a healthy lifestyle, you can put this disease in remission forever. A healthful diet and exercise have been shown to beat drugs for improving fitness, glycemic control, insulin sensitivity, blood fats, and cardiovascular risk factors. When muscles are exercising, glucose and other nutrients can enter muscle cells even in the absence of insulin. Poor sleep patterns or sleep deprivation can impair glucose metabolism and lower control of blood sugar levels; improving sleep patterns improves long-term outcomes.” Type 2 diabetes is also associated with processed-foods, so eating whole, natural foods to optimize nutrients status can have profound effects. Avoiding refined sugars like sucrose, corn syrup, high-fructose corn syrup, soda, and other refined and highly-processed items (including white rice, white bread, processed meats, refined salt, and the like) makes a big difference in turning around T2D. Also, ingesting artificial sweeteners disturbs areas of the brain that control the appetite and satiety and cause other imbalances. So, instead, include plenty of fresh vegetables and fruit (restricting fruit does not improve glycemic control), legumes, whole grains, nuts, and seeds. There is also a direct link between fiber—soluble and insoluble—and the glycemic response to specific foods. Foods containing fiber are vegetables, fruits, whole grains, and legumes; fiber supplements, such as insulin or psyllium, can also be helpful. The recommended amount of fiber is 25 to 35 grams per day. The American Diabetes Association recently updated its nutrition guidelines for diabetics. Rather than a one-size-fits-all diet, the new recommendations favor individualized plans that take into account a person’s lifestyle and metabolic needs. If you suffer from T2D diabetes or prediabetes and want to seek out an alternative to taking insulin, attend one of the free classes offered at The Nutritional Healing Center in Frederick to find out if our program is for you. For more information, or to register for class, please call 240-651-1650. Check out our website at www.doctorlo.com. We are located at 7310 Grove Road in Frederick. (Article sources: Nutritional News and Views Judith A. DeCava, LNC, CNC./ Dr. Mercola,DO.)