How Not to Die from Diabetes
February 26, 2019
This month’s article is How Not to Die from Diabetes from our series covering the work of Dr. Michael Greger, MD.
What Causes Diabetes?
After about age 20, we may have all the insulin-producing beta cells we’re ever going to have in our pancreas, and so if we lose them, we may lose them for good. Autopsy studies show that by the time type 2 diabetes is diagnosed, we may have already killed off half of our beta cells.
You can do it right in a Petri dish. Expose human beta cells to fat; they suck it up and then start dying off. A chronic increase in blood fat levels is harmful, as shown by the important effects in pancreatic beta cell lipotoxicity. Fat breakdown products can interfere with the function of these cells, and ultimately lead to their death.
And not just any fat; saturated fat. The predominant fat in olives, nuts, and avocados gives you a tiny bump in death protein 5, but saturated fat really ramps up this contributor to beta cell death. Saturated fats are harmful to beta cells; harmful to the insulin-producing cells in our pancreas. Cholesterol too. The uptake of bad cholesterol, LDL, can cause beta cell death as a result of free radical formation.
Diets rich in saturated fats not only cause obesity and insulin resistance, but the increased levels of circulating free fats in the blood, called NEFAs, non-esterified fatty acids, cause beta cell death and may thus contribute to progressive beta cell loss in type 2 diabetes. And this isn’t just based on test tube studies. If you infuse fat into people’s bloodstream you can directly impair pancreatic beta cell function, and the same when we ingest it.
Type 2 diabetes is characterized by defects in both insulin secretion and insulin action, and saturated fat appears to impair both. Researchers showed saturated fat ingestion reduces insulin sensitivity within hours, but these were non-diabetics, so their pancreas should have been able to boost insulin secretion to match. But insulin secretion failed to compensate for insulin resistance in subjects who ingested the saturated fat. This implies the saturated fat impaired beta cell function as well, again within just hours after going into our mouth.
Increased consumption of saturated fats has a powerful short- and long-term effect on insulin action, contributing to the dysfunction and death of pancreatic beta cells in diabetes.
And saturated fat isn’t just toxic to the pancreas. The fats, found predominantly in meat and dairy—chicken and cheese are the two main sources in the American diet—are almost universally toxic, whereas the fats found in olives, nuts, and avocados are not. Saturated fat has been found to be particularly toxic to liver cells in the formation of fatty liver disease. You expose human liver cells to plant fat, and nothing happens. Expose liver cells to animal fat, and a third of them die. This may explain why higher intakes of saturated fat and cholesterol are associated with nonalcoholic fatty liver disease.
By cutting down on saturated fat consumption we may be able to help interrupt this process. Decreasing saturated fat intake may help bring down the need for all that excess insulin. So either being fat, or eating saturated fat can both cause that excess insulin in the blood. The effect of reducing dietary saturated fat intake on insulin levels is substantial, regardless of how much belly fat we have. And it’s not just that by eating fat we may be more likely to store it as fat. Saturated fats, independently of any role they have of making us fat, may contribute to the development of insulin resistance and all its clinical consequences. After controlling for weight, and alcohol, and smoking, and exercise, and family history, diabetes incidence was significantly associated with the proportion of saturated fat in our blood.
So, what causes diabetes? The consumption of too many calories rich in saturated fats. Now just like everyone who smokes doesn’t develop lung cancer; everyone who eats a lot of saturated fat doesn’t develop diabetes—there’s a genetic component. But just like smoking can be said to cause lung cancer, high-calorie diets rich in saturated fats are currently considered the cause of type 2 diabetes.
How to Prevent Prediabetes from Turning into Diabetes
In just one decade, the number of people with diabetes has more than doubled. According to the Centers for Disease Control and Prevention, by 2050, one out of every three of us may have diabetes. What’s the big deal?
Well, the consequences of diabetes are legion: the #1 cause of adult-onset blindness, the number one cause of kidney failure, and the number one cause of surgical amputations. What can we do to prevent it?
The onset of type 2 diabetes is gradual, with most individuals progressing through a state of prediabetes, a condition now striking approximately 1 in 3 Americans, but only about 1 in 10 even knows it. Since current methods of treating diabetes remain inadequate, prevention is preferable, but what works better, lifestyle changes or drugs? We didn’t know until this landmark study was published in New England Journal of Medicine.
Thousands were randomized to get a good double dose of the leading anti-diabetes drug or diet and exercise. The drug, metformin, is probably the safest diabetes drug there is. Causes diarrhea in about half, makes 1 in 4 nauseous, about 1 in 10 suffer from asthenia, from the Greek meaning lack of strength, physical weakness and fatigue, but only about 1 in 67,000 are killed by the drug every year.
And it worked. Compared to placebo, in terms of the percentage number of people developing diabetes within the four-year study period, fewer people in the drug group developed diabetes.
But diet and exercise alone worked better. The lifestyle intervention reduced diabetes incidence by 58 percent, compared to only 31 percent with the drug. The lifestyle intervention was significantly more effective than the drug, and had fewer side-effects. More than three quarters of those on the drug reported gastrointestinal symptoms, though there was more muscle soreness reported in the lifestyle group, on account they were actually exercising.
That’s what other studies have subsequently found: non-drug approaches are superior to drug-based approaches for diabetes prevention. And the 50% or so drop in risk was not for people that actually improved their diet and lifestyle, but just for those instructed to improve their diet and lifestyle, whether or not they actually did it.
This is one of the most famous diabetes prevention studies. 500 people with prediabetes randomized into a lifestyle intervention or control group, and during the trial, the risk of diabetes was reduced by that same 50-60%, but only a fraction of the patients met the modest goals. Even in the lifestyle intervention group, only about a quarter were able to eat enough fiber, meaning whole plant foods, and cut down on enough saturated fat, which in this country is mostly dairy, dessert, chicken, and pork. But they did better than the control group, and fewer of them developed diabetes because of it. But what if you looked just at the folks that actually made the lifestyle changes, met at least 4 out of 5 of those wimpy goals? They had zero diabetes. None of them got diabetes. A 100% drop in risk.
Bottom line: Type 2 diabetes can be prevented by changes in lifestyle even in high-risk prediabetic subjects.
The fact, then, that type 2 diabetes, a largely preventable disorder, has reached such epidemic proportion is a public health humiliation.
Plant-Based Diets & Diabetes
Decades ago we started to get the first inklings that a plant-based diet may be protective against diabetes. Studies going back half a century found that those eating meat one or more days a week had significantly higher rates of diabetes, and the more frequently meat was eaten, the more frequent the disease. And this is after controlling for weight. Even at the same weight, those eating plant-based had but a fraction of the diabetes rates, and if anything, vegetarians should have had more diabetes just because they appear to live so much longer so had more time to develop these kinds of chronic diseases–but no–apparently lower rates of death and disease.
Fast forward 50 years to the Adventist-2 study, looking at 89,000 people and we see a stepwise drop in the rates of diabetes as one eats more and more plant-based, down to a 78% lower prevalence among those eating strictly plant-based. Protection building incrementally as one moved from eating meat, to eating less meat, to just fish, to no meat, and then to no eggs and dairy either.
We see the same thing with another leading killer, high blood pressure. The greater the proportion of plant foods, the lower the rates of hypertension. The same with excess body fat. The only dietary group not on average overweight were those eating diets composed exclusively of plant foods, but again this same incremental drop with fewer and fewer animal products. This suggests that it’s not black and white, not all or nothing; any steps one can make towards eating healthier may accrue significant benefits.
Followed over time, vegetarian diets were associated with a substantially lower incidence of diabetes–fewer new cases–indicating the potential of these diets to stem the current diabetes epidemic.
What about eating a really healthy diet with just a little meat? Or is it better to eat none at all? We have new insight this year from Taiwan. Asian diets in general tend to be lower in meat and higher in plant foods compared with Western diet, but whether a diet completely avoiding meat and fish would further extend the protective effect of a plant-based diet wasn’t known, until now.
Traditionally, Asian populations have had low rates of diabetes, but a diabetes epidemic has since emerged, and appears to coincide with increased meat, animal protein, and animal fat consumption, but the Westernization of Asian diets also brought along a lot of fast food and junk. So these researchers at the national university didn’t want to just compare those eating vegetarian to typical meat-eaters; they compared Buddhist vegetarians to Buddhist nonvegetarians eating traditional Asian diets. Even the omnivores were eating a predominantly plant-based diet, consuming little meat and fish, with the women eating the equivalent of about a single serving a week, and men eating a serving every few days. That’s just 8% of the meat intake in the U.S., 3% for the women. The question: is it better to eat 3% or 0%?
Again, both groups were eating healthy–zero soda consumption, for example, in any group. Despite the similarities in their diet, and after controlling for weight, family history, exercise, and smoking the men eating vegetarian had just half the rates of diabetes, and the vegetarian women just a quarter of the rates. So even in a population consuming a really plant-based diet with little meat and fish, true vegetarians who completely avoided animal flesh, while eating more healthy plant foods, had lower odds for prediabetes and diabetes after accounting for other risk factors. They wanted to break it up into vegan versus ovo-lacto like in the Adventist-2 study, but there were no cases at all of diabetes found within the vegan group.
When Drugs & Diets Don’t Lower Diabetes Deaths
Why do some drug-based strategies shorten the lives of diabetics and some diet-based strategies fail to decrease diabetes deaths?
People with type 2 diabetes are at elevated risk for a number of serious health problems, including heart disease, premature death, blindness, kidney failure, amputations, fractures, frailty, depression, and cognitive decline. And, the higher people’s blood sugars are, the more heart attacks and strokes they have, the shorter their lifespans, and the higher their risk of complications like blindness and kidney failure. So, a study was designed in which 10,000 diabetics were randomized into an intensive blood sugar lowering intervention, where they put people on 1, 2, 3, 4, or 5 different classes of drugs, with or without insulin, to drive blood sugars into the normal range. Of course, you’re not treating the underlying cause; they’re not treating the actual disease, but by lowering one of the effects of the disease by any means necessary, the hope was to prevent some of the devastating complications. How’d they do?
The intensive blood sugar lowering with drugs increased mortality. After reviewing mortality trends, they concluded that the harm associated with the increased rate of death outweighed any potential benefits and they stopped the study prematurely for safety reasons. They were successful in bringing people’s blood sugars down, but in trying to push people’s A1c under six, they ended up pushing people six feet under, perhaps due to the adverse effects of the very drugs used to treat the disease.
Even just injected insulin itself may promote cancer, obesity, and atherosclerosis, worsen diabetic retinopathy, and accelerate aging. Insulin therapy may promote inflammation in the lining of our arteries, which may help explain the results in this trial and other trials that showed the same thing: no reduction in so-called macrovascular complications, heart attacks, and strokes, with intensive blood sugar lowering. However, intensive therapy was associated with a 21% reduction in the development of microvascular complications like kidney dysfunction.
But any such benefits should be weighed against the increased risk of dying, increased weight gain, and increased risk of severe hypoglycemia in intensively-treated patients. So, trying to normalize people’s blood sugars with drugs may not be such a good idea.
It should be noted, though, that these trials relied virtually exclusively on drugs and did not include any serious effort at diet and lifestyle change.
Curing Painful Diabetic Neuropathy
Neuropathy, or damage to the nerves, is a debilitating disorder. Diabetes is by far the most common cause. Up to 50% of diabetics will eventually develop neuropathy during the course of their disease. It can be very painful, and the pain is frequently resistant to conventional treatments. In fact, there is currently no effective treatment for diabetic neuropathy. Clinicians rely on steroids, opiates, and antidepressants to try to mediate the suffering.
But 20 years ago, a remarkable study was published on the regression of diabetic neuropathy with a plant-based diet. There are two types of diabetic neuropathy: a relatively painless type characterized by numbness, tingling and pins-and-needles sensations, and then a second form, which is painful with burning or aching sensations to the point of excruciating, lancinating—stabbing—pain. This paper concentrated on the painful type.
Twenty-one diabetics suffering with moderate or worse symptomatic painful neuropathy for up to ten years were placed on a whole food, plant-based diet along with a half-hour walk every day. Years and years of suffering and then, complete relief of the pain in 17 out of the 21 patients within days.
Numbness noticeably improved too. And the side effects were all good. They lost ten pounds, blood sugars got better—insulin needs dropped in half, and in five of the patients, not only apparently was their painful neuropathy cured, so was their diabetes: normal blood sugars and off of all medications.
And their triglycerides and cholesterol improved too. High blood pressure got better, in fact, gone in about half the hypertensives—an 80% drop overall in the need for high blood pressure medications within three weeks.
Now, this was a live-in program, where patients’ meals were provided. What happened after they were sent home? The 17 folks were followed for years, and in all except one, the relief from the painful neuropathy continued or improved even further. How’d they get that kind of compliance? Pain and ill health are strong motivating factors. One of the most painful and frustrating conditions to treat in all of medicine and 75% cured within days with a natural, nontoxic—in fact, beneficial—treatment, a diet composed of whole plant foods.
How could nerve damage be reversed so suddenly? It wasn’t necessarily the improvement in blood sugar control, since it took about ten days for the diet to control the diabetes, whereas the pain was gone in as few as four days. There are several mechanisms by which the total vegetarian diet works to alleviate the problem of diabetic neuropathy as well as the diabetic condition itself. The researchers’ most interesting speculation was that it could be the trans fats naturally found in meat and dairy and refined vegetable oils that could be causing an inflammatory response. They found a significant percentage of the fat found under the skin of those who ate meat or dairy consisted of trans fats, whereas those on a strictly whole food plant-based diet had none.
They stuck needles in the buttocks of people eating different diets, and nine months or more on a strict plant-based diet appeared to remove the trans-fat from their bodies. But their pain didn’t take nine months to get better; it got better in days.
More likely, it was an improvement in blood flow. Nerve biopsies in diabetics with severe progressive neuropathy have shown small vessel disease within the nerve. There are blood vessels within our nerves that can get clogged up. The oxygen levels in the nerves of diabetics were found to be lower than even the levels of de-oxygenated blood. This lack of oxygen within the nerves may arise from blockages within the blood vessels depriving the nerves of oxygen, presumably leading them to cry out in pain.
Within days, though, improvements in blood rheology, the ease of blood flow, on a plant-based diet may play a prominent role in the reversal of diabetic neuropathy. Plant-based diets may also lower the level of IGF-1 inside the eyeballs of diabetics and decrease the risk of retinopathy—diabetic vision loss—as well. But the most efficient way to avoid diabetic complications is to eliminate the diabetes, and this is often feasible for those type 2 patients who make an abiding commitment to daily exercise and a healthy enough diet.
Since the initial report of neuropathy reversal, the results have been replicated: significant improvements in numbness and burning. Why isn’t nutrition taught in medical school? The neglect of this important work by the broader medical community is nothing short of shocking and even unconscionable.
Although I only touched on a small amount of information regarding diabetes there is a relationship to Magnesium deficiency as well as Thyroid Dysfunction to name a few.
At Murray Avenue Apothecary we work with Diabetics every day, helping with compounded Rx Neuropathy creams, topical Magnesium, hormone balancing, and helpful OTC supplements like Sugar Manager to help with sugar cravings and blood glucose management. We also carry LabNaturals CBD products including a 500mg topical pain balm that may help improve neuropathy symptoms. Shop CBD online at LabNaturalsCBD.com and learn more about Murray Avenue Apothecary at MAApgh.com
Stop by the Apothecary today and get the help you need! We are here for you!
To Your Health,
Susan Merenstein, Pharmacist and Owner
Murray Avenue Apothecary