Type 2 diabetes – the lifestyle prescription

Since the early 1980s, the prevalence of type 2 diabetes mellitus (DM) has doubled in Australians.

Type 2 diabetes is a chronic disease in which there are high levels of blood glucose. In people with type 2 diabetes, there is a problem with the way the body uses or makes insulin. Insulin is needed for the body to move blood glucose into the cells where it is eventually used for energy production. A key factor leading to diabetes is insulin resistance, resulting in the accumulation of glucose in the blood stream, a condition referred to as hyperglycemia (high blood glucose). This occurs slowly over time and is a condition commonly found in the overweight and more likely in the elderly. Often referred to as adult-onset diabetes, it is considered a lifelong disease. There is also a form of diabetes called type 1 diabetes, which occurs in children and younger adults; however, type 2 diabetes is by far the most common form of diabetes.

According to the World Health Organisation (WHO), seven percent of populations in Western or developed countries suffer from diabetes and estimates are that by 2025, without significant lifestyle modifications, the number of people with type 2 diabetes will double to around 300 million people worldwide. The ageing of populations and the effects of modernisation on lifestyle, especially through stress, lack of exercise and poor diet leading to weight increase, have resulted in a dramatic rise in the prevalence of diabetes globally. An Australian study has shown eight percent of men have type 2 diabetes and 6.8 percent of women; however, if we take into account the number of people with a pre-diabetic state (impaired glucose control) these rates rise to 17.4 percent and 15.4 percent respectively. Being pre-diabetic can be considered a wake-up call for good health – it means the conditions are present in the body for the development of type 2 diabetes, but there is a good chance these can be reversed.

The very good news is that type 2 diabetes is a chronic illness that can show significant improvement through the adoption of an integrated lifestyle approach. As with other chronic illnesses, this is where Integrative Medicine has an important contribution to make to diabetes treatment and prevention.

An assessment of overall lifestyle is the first step to responding to diabetes in an integrative way.

The risk factors for type 2 diabetes include: – Genetic disposition – Life stressors and/or depression – Diet and/or nutrition – Excess weight – Inadequate exercise –Inadequate sunshine and/or vitamin D deficiency – Smoking

Of these, obesity is perhaps the most common risk factor for diabetes and with 60 to 70 percent of Australian adults being overweight, it is not surprising that diabetes is so common in this country.

When diagnosed with diabetes, typical medical interventions may include advice to limit some types of foods (particularly high-sugar content foods), increase exercise and single or combined drug therapies based on prescription medicines that control the blood glucose levels, but do nothing to deal with the cause of the disease.

Integrative Medicine takes this one step further into an approach that has the purpose of modifying risk factors and can restore the body to achieve normal blood glucose without medication. By adopting an integrated approach, diabetes sufferers have a real opportunity to actively manage their condition and for some people this means a reversal of the diabetic condition. The same lifestyle principles are also highly effective for preventing diabetes, particularly in those who are pre-diabetic. But changes are required to lifestyles that are steady, sustained and lifelong.

There are many easy healthy lifestyle strategies to prevent or manage type 2 diabetes that you can start today:

Review diet and nutritional status – See a health practitioner who has dietary expertise for guidance. A Mediterranean-style diet has proven to be a good model for diabetic management. Low glycaemic index (GI) foods can be as effective as medication in improving glycaemic control in diabetes. The glycaemic index (GI) is a measure of how quickly the glucose in a food or drink is absorbed from the digestive system into the blood. The quicker this happens, the higher the GI. High GI foods increase the risk for diabetes, heart disease and cancer.

Some general principles proven to improve diabetes include:

Weight loss and/or waist reduction: – Consume less food at meal times – Consume less energy-dense and nutrient-poor foods and beverages, including soft drinks. – Reduce fat intake – Limit alcohol – Consume low glycaemic index (GI) foods. Read labels – low GI foods are generally those with a GI index less than 55. – Consume more fish, protein, fibre, complex carbohydrates, legumes, nuts, vegetables and fruits.

Exercise regularly: Physical activity is one of the key modifiable risk factors for diabetes. Just two hours walking (total) per week can significantly reduce mortality from all causes of disease, including diabetes. Activities such as walking, tai chi, yoga and so on, and try to increase physical activities in daily life – walk instead of driving where possible, take the stairs instead of the lift, ride a bike or walk the dog, walk with a friend for social interaction and exercise that is effective and enjoyable.

Engage in regular activities such as walking, tai chi, yoga and so on, and try to increase physical activities in daily life – walk instead of driving where possible, take the stairs instead of the lift, ride a bike or walk the dog, walk with a friend for social interaction and exercise that is effective and enjoyable.

Reduce stress and improve mood: Stress and depression influence hormone levels that in turn increase insulin resistance. Mild depression is two to three times more common in diabetics.

Maintain regular sleep patterns: At least six to eight hours per night is required. Both oversleeping and under-sleeping have been shown to increase the risk of developing diabetes. Environmental lighting, longer working hours, TV and computer usage has all been shown to negatively impact on sleep patterns.

Practice prudent sun exposure: Vitamin D deficiency plays an important role in insulin synthesis and secretion. Deficiencies may play a role in the causation of diabetes.

Reduce or quit smoking: Smoking increases the risk of type 2 diabetes by approximately 50 percent and this figure increases the more a person smokes. Smoking impacts on the pancreas, causes internal inflammation and increases abdominal fat – all factors that affect insulin resistance.

Benefits of nutritional or herbal supplements: A qualified health professional can guide you in appropriate supplementation.

Magnesium, zinc and chromium are often deficient in diabetics and can support insulin sensitivity. Recent research shows that vitamin C and fish oil may reduce diabetes complications.

Ancient Indian herbs such as: cinnamon, which enhances insulin sensitivity; gymnema sylvestre, which can suppress a sweet taste; and ginseng, which can improve diabetic control, may be useful.

A healthy diet and regular exercise is more effective at preventing type 2 diabetes than drug therapy alone, and each lifestyle modification made has a positive and synergistic effect on other risk factors and symptoms. 

An integrated approach is not only effective for diabetes, but will be protective against many other chronic diseases such as cancer and cardiovascular disease as well. Diabetes can be significantly influenced by a commitment to better health and wellbeing.

Professor Avni Sali is Founding Director of the National Institute of Integrative Medicine (NIIM). Sources: Kotsirilos, Vitetta, Sali. 2011 A guide to evidence-based integrative and complementary medicine, Elsevier, Sydney niim.com.au