Diabetes (Greek, “to pass through”) mellitus (Latin, “honeyed” or “Sweet”) is a condition characterised by elevated levels of blood glucose. There are various forms of diabetes (Type-1, Type-2, and Gestational), but we focus this article on Type-2 diabetes, which accounts for ~95% of the global diabetes health burden.
Diabetes is a lifestyle disease, and its prevention, management, and even reversal can be substantially supported through lifestyle interventions.
Understanding Diabetes
A useful starting point towards managing diabetes is to understand the underlying biological process of glucose metabolization:
- After we eat, the process of digestion converts carbohydrates in the diet into glucose, which is released into the bloodstream
- In response to elevated glucose, the pancreas releases a hormone called insulin in the blood
- Insulin is carried to various parts of the body, and binds to receptors in various types of cells - e.g., muscle cells, fat cells, liver cells
- Insulin triggers a signaling mechanism that allows these cells to withdraw glucose from the blood
- As blood glucose levels fall, so does the secretion of insulin by the pancreas to maintain an equilibrium level of blood glucose.
In people with Type-2 diabetes, the liver, muscle and other cells that are supposed to remove glucose from the bloodstream fail to do so effectively because of a disruption in the insulin signaling mechanism. This disruption can be caused by multiple factors, but a leading cause is excessive fat, especially visceral fat, which releases cytokines that interfere with insulin signaling. Which is why people with obesity have a 8x higher risk of contracting Type-2 diabetes!
In response to high blood glucose because of reduced absorption by cells, the pancreas get a signal to produce even more insulin. Over time, this increased demand for insulin can reduce or even exhaust the insulin producing capacity of the beta cells in the pancreas. When this happens, the body’s ability to withdraw blood from glucose is further impaired.
Health complications arising out of diabetes
Diabetes means persistently high blood glucose, which damages blood vessels, nerves and eventually various organs:
- The starting point of health complications of diabetes is glycation, where glucose molecules bind to proteins or fats, forming Advanced Glycation End-products (or AGEs). AGEs damage the lining of blood vessels, causing inflammation and narrowing of these.
- Damaged blood vessels become susceptible to plaque buildup, leading to the hardening and narrowing of arteries (atherosclerosis), and increasing the risk of cardiovascular conditions such as heart attack and stroke
- Damages to blood vessels in the kidneys impairs the kidneys’ ability to filter blood. At advanced stages, this leads to kidney failure (diabetic nephropathy), and needs to be managed via dialysis / kidney transplantation.
- High blood sugar damages nerves throughout the body (diabetic neuropathy) and the blood vessels that supply the nerves, and can cause symptoms such as numbness, pain, digestive issues, sexual dysfunction, other autonomic problems
- Blood sugar at elevated levels compromises blood vessels in the retina, which may lead to leakage of blood into the eyes (macular edema), and if untreated, permanent blindness (diabetic retinopathy)
- Damage to blood vessels in the brain, inflammation and stress arising out of diabetes increase the risk of depression, anxiety and cognitive decline, and eventually Alzheimer’s
- A wide range of other health conditions such as poor blood flow to the extremities, infections, skin diseases, hearing loss, gum disease, digestive problems, bone and joint health
Nutritional / Lifestyle interventions to prevent and manage diabetes
A range of nutritional strategies and other lifestyle interventions can be deployed to reduce the risk of contracting diabetes, and its effective management.
Nutrition to minimize spikes in blood sugar
- Fiber: slows digestion and the release of glucose into the bloodstream, leading to a slower and steadier increase in blood glucose
- Fat: Dietary fat slows down the digestive process, which delays carbohydrate absorption and helps prevent rapid glucose spikes. Consumption of healthier mono- and poly-unsaturated fat can moderate blood glucose spikes without contributing to the body's store of visceral fats
- Protein: Replaces carbohydrates in the diet while providing the necessary calories. Proteins are processed by the body differently – they get broken down into amino acids and peptides rather than glucose
- Low-glycemic carbohydrates – complex carbohydrates, such as those found in whole grains, legumes and starchy vegetables like sweet potato, whose conversion into glucose happens at a slower pace
- Micronutrients such as jambosine (found in jamun seeds) inhibit enzymes that break down complex carbohydrates into simple sugar, thereby moderating the increase in blood sugar after eating
- Minimization of intake of sugar / simple carbs, which are easily processed and absorbed into the bloodstream faster
Nutrition and exercise to increase insulin sensitivity / reduce insulin resistance
- Omega-3 fats have anti-inflammatory effects that increase insulin sensitivity
- Magnesium helps regulate insulin action and glucose uptake in cells
- Chromium plays a role in carbohydrate metabolization and enhances insulin sensitivity
- Vitamin-D improves insulin sensitivity and glucose metabolism
- Folate supports metabolic processes and may improve glucose metabolism
- Zinc controls inflammation, which can contribute to insulin resistance
- Alpha-Lipoic Acid (an antioxidant found in spinach, broccoli, tomatoes) reduces oxidative stress and improves insulin sensitivity
- Minimization of sodium, which contributes to increased insulin resistance
- Exercise enhances the body's response to insulin
Nutrition to increase insulin production / improve pancreatic health
- Antioxidants reduce oxidative stress and its impact on beta cells in the pancreas
- Omega-3 fats reduce inflammation and benefit pancreatic health
- Magnesium supports insulin production and helps protect beta cells from oxidative damage
- Vitamins B3 and B6 support pancreatic function and insulin production
- Zinc is important for insulin synthesis, storage and release; and has antioxidant properties which protect beta cells from damage
Nutrition to shed fat / lose weight
- Calcium helps reduce body fat, which in turn reduces cytokines and helps maintain insulin sensitivity
- Vitamin D supports fat loss
- Polyphenols, e.g., catechin in green tea, have fat burning properties
- B-vitamins support the breakdown of carbohydrates and fats
- Probiotics / healthy gut microbiome is linked to reduced abdominal fat
Diabetes is a challenging condition but also one which can be prevented or managed substantially through lifestyle interventions, especially at early stages of the condition, pre-empting the emergence of many downstream life-threatening health conditions.