Diabetes affects 1.1 million Australians and costs the country $14 billion dollars annually. The latest research into type 2 diabetes shows that for some people, it’s actually possible to put diabetes into remission through healthy eating.
Diabetes is a disease that develops when the body either stops producing the hormone insulin or when the insulin that it produces is not working properly. Insulin acts like a key to open the doors to the cells to let in glucose from the blood. Glucose is a form of sugar used in the body’s cells for fuel and to perform all different kinds of work. Diabetes has been around for many thousands of years, but was relatively uncommon until the last few decades of the twentieth century. It is now reaching what some people consider to be global pandemic proportions. The International Diabetes Federation estimates show that just under one in 10 adults, or 382 million people, have diabetes. This is expected to rise to 592 million people by the year 2035.
There are three main types of diabetes: type 1, type 2 and gestational. Whatever type of diabetes you have, one of the foundations of successful management is healthy eating and drinking. While there are a few differences between the way the different types are managed, the basic principles are much the same.
Type 1 diabetes
In type 1 diabetes, the pancreas no longer produces insulin. While the exact reason for this is unknown, it is thought that the body’s immune system is tricked into attacking and destroying most, if not all, of the insulin-producing beta cells in the pancreas. People with type 1 diabetes must take some form of insulin every day by either injection or a pump.
Around 10 in 100 people with diabetes have the type 1 form. It occurs most commonly in childhood and adolescence, but can also develop later in life.
Type 2 diabetes
In type 2 diabetes, the pancreas is able to produce insulin, but either it does not produce enough to meet all of the body’s requirements or the body’s cells no longer respond to its effects due to insulin resistance. The exact cause of type 2 diabetes is also unknown and it is likely that there are different causes for different people.
Initially, people with type 2 diabetes can often manage their condition with a healthy diet and an increase in physical activity. However, as time passes, the majority end up requiring oral medications, and some people even end up having to use insulin.
Some risk factors for type 2 diabetes that can be influenced by lifestyle are: being overweight or obese (especially around the abdomen), having a poor diet and being physically inactive. Risk factors that we are unable to change include: our family history, ethnic background and advancing age.
Pregnant women who develop insulin resistance and subsequent elevated blood glucose levels are said to have gestational diabetes. It usually occurs around the twenty-fourth week of pregnancy. Once the baby has been born, gestational diabetes usually goes away, but it is a sign that you are at increased risk of developing type 2 diabetes later in life.
Women with gestational diabetes are typically able to manage their condition with a healthy diet and some moderate exercise. However, insulin or oral medications are required in some cases.
Around one in 20 women develop gestational diabetes during pregnancy. It is more common in women who are over the age of 30, and women who are from certain ethnic backgrounds, such as Asian, Australian Aboriginal, Indian, Maori, Mediterranean and Pacific Islander.
Insulin resistance means that the insulin the pancreas is producing is not working as effectively as it should. It’s a bit like a jammed door — more pressure is needed to open it. The pancreas then needs to produce more insulin to move glucose (and other nutrients) from the blood into the muscles, organs and tissues so they can function normally.
People with pre-diabetes (also known as ‘impaired glucose tolerance’ or ‘impaired fasting glycaemia’) have higher than normal blood glucose levels, but the levels are not high enough for a diagnosis of diabetes. In other words, people with pre-diabetes are in the grey area between having normal blood glucose levels and developing type 2 diabetes. If you have been diagnosed with pre-diabetes, think of it as an early warning, because it indicates that you are at high risk of developing type 2 diabetes.
There is strong evidence that losing a moderate amount of weight (around 7.5% of your body weight), improving your diet and increasing your physical activity levels can prevent pre-diabetes developing into type 2 diabetes. Nearly six out of 10 people can stop this from happening by taking these preventative steps.
There are many reasons why type 2 diabetes rates are increasing, but it’s not all bad news.
The older you are, the greater your risk of developing type 2 diabetes because your pancreas, along with other vital organs, wears out with advancing age. Also, the slow but steady weight gain that occurs over the course of a lifetime slowly increases insulin resistance. So, perhaps surprisingly, increasing diabetes rates are a sign of our recent success as a species in increasing life expectancy.
Increasing mechanisation of the home, the workplace and transport has dramatically decreased the average level of physical activity in both the developed and developing world over the last few decades. This trend has helped liberate many people from tedious, back-breaking work, and helped provide us with more leisure time. However, it has also led to a decrease in muscle mass, an increase in body fat and associated insulin resistance, increasing the risk of developing type 2 and gestational diabetes.
Food and nutrition
Around the globe, increased participation of both men and women in the workforce has led to an increased reliance on processed, pre-prepared meals and foods that are eaten away from home. While these meals and foods are undoubtedly convenient and tasty, many are based on highly refined ingredients and they are often energy dense, but nutrient poor.
Diabetes is a lifelong condition and there is, as yet, no cure. One of the reasons why we haven’t found a cure is that all types of diabetes are extremely complicated, and we don’t yet fully understand what causes them. However, billions of dollars are spent around the globe each year in trying to find out more about how our bodies work, what goes wrong when we develop diabetes, and how we can prevent, delay or cure it.
While we haven’t yet found a cure, we know how we can prevent or at least delay the development of type 2 diabetes; it can be put in to remission in people who have been newly diagnosed if they are able to lose a significant amount of body weight and keep it off. We use the word ‘remission’ rather than ‘cure’ because diabetes may return years later, either due to people slowly regaining weight or simply due to advancing age.
Clinical trials show that around 1 in 8 people can put type 2 diabetes into remission for 2 to 10 years by losing a significant amount of body weight as a result of following a healthy lifestyle.
Clinical trials into preventing type 2 diabetes
Over the last couple of decades, clinical trials have been conducted around the world to see if people with pre-diabetes can prevent or at least delay the development of type 2 diabetes. As well as returning blood glucose levels to the normal range, one of the primary goals of the trials has been to modestly reduce body weight — by between 5 and 10 per cent of a person’s weight.
The weight loss was typically achieved through a moderate reduction in kilojoules (around 2000 kJ less each day) as part of an overall healthy eating plan. The plan was reduced in fat (25 to 30 per cent of kilojoules), low in saturated fat (7 to 10% of kilojoules) and high in dietary fibre (at least 3.5 g for every 1000 kJ consumed). Participants were also advised to do at least 150 minutes of moderate intensity activity each week (e.g. five 30-minute sessions of brisk walking) to assist with their weight loss and to decrease their insulin resistance.
Clinical trials in people with pre‐diabetes have found that nearly 6 out of 10 can prevent the development of type 2 diabetes.
A review of all the diabetes prevention trials that have been conducted so far was recently published, incorporating over 8000 people from around the world. The review found that lifestyle interventions could decrease the risk of people with pre-diabetes from developing type 2 diabetes by over 50 per cent, which is a huge reduction.
Clinical trials in people with type 2 diabetes have found 1 in 8 people can put type 2 diabetes into remission for between 2 to10 years by losing weight by healthy eating and regular physical activity.
In addition, there is very strong evidence from observational studies that healthy, low-glycaemic index (GI) and low-glycaemic load (GL) diets may decrease the risk of developing diabetes by up to 45 per cent. Observational studies are studies measuring the lifestyle habits of large groups of healthy people for 5 to 20+ years. Because these kinds of studies do not prove cause and effect, research is currently underway that will help conclusively prove whether or not low-GI and low-GL diets can prevent the development of type 2 diabetes.
Women who have had gestational diabetes are at a significantly increased risk of developing it again with subsequent pregnancies, and of developing type 2 diabetes later in life. Advice for preventing type 2 diabetes is relevant to women who have previously had gestational diabetes and want to prevent it from happening again.
Managing gestational diabetes
Because pregnancy lasts around 9 months, and gestational diabetes is typically diagnosed around 6 months, it cannot be reversed as such. However, gestational diabetes can be managed through a careful combination of healthy eating and moderate, regular physical activity, and in some cases insulin or medication.
Once the baby is born, gestational diabetes usually goes away. If you have another baby, you are
at greater risk of developing gestational diabetes. Advice for preventing type 2 diabetes is relevant to women who want to avoid developing gestational diabetes again.
Until recently, most health professionals would have agreed that type 1 diabetes cannot be prevented. However, current research shows that the increasing rates of type 1 diabetes that have been seen in recent years in Australia and the UK may be due to an increase in the number of children and adolescents who are more sensitive to environmental factors, rather than genetic factors. This means that the potential role of lifestyle in the development of type 1 diabetes needs to be carefully considered.
One of these environmental factors is growing rates of insulin resistance at an earlier age due to our increasing rates of overweight and obesity, and increasingly sedentary lifestyles. There are also some potential environmental triggers such as diets low in omega-3 fats and vitamin D, or diets with a high GI, certain infant feeding practices, or factors that affect an individual’s microbiome. It is important to note that these lifestyle factors are yet to be proven risk factors, and that other factors such as bacterial and viral infections are equally likely triggers of type 1 diabetes that are also being investigated.
Tips for those at risk of type 1 diabetes
While research that links lifestyle factors to the development of type 1 diabetes may provide hope
to some parents who have children at increased risk, much more research is needed before we can make any strong recommendations. However, most of the dietary factors discussed here are not that difficult to adopt and may have health benefits for the whole family even if research eventually shows that they do not help prevent type 1 diabetes.
• prevent children and adolescents from becoming either overweight or underweight
• help them to eat sufficient foods and drinks to grow and develop normally
• ensure regular physical activity is an important part of the whole family’s life
• enjoy one or more serves of fatty fish like salmon, herring or sardines at least three times each week
• enjoy healthy high-fibre foods and limit highly processed and preserved foods
• enjoy fermented milk products like plain yoghurt.
For more information about diabetes, contact Diabetes Australia, 1300 136 588.