India is the diabetes capital of the world and if this situation continues, we would be in a far worse position than previously. We’ve come across multiple clinical treatments for diabetes including medications, insulin injections, and more. But none of them are going to help in solving our hopes to reverse diabetes and be free from the disease. Hence, individuals nowadays are resorting to more natural ways and alternate treatments to control the disease. There have been multiple diabetes reversal/remission cases where people have stayed in remission for years together. The most effective ways for remission include eating a low-calorie/low-carbohydrate diet, doing physical activity regularly, sleeping well, and trying to lead a stress-free life. Besides all these, there are many other natural ways which are followed by different individuals as a means to the end problem-controlling diabetes. Making use of natural medications and foods to address diabetes is a wonderful way to keep a tab on the disease. But never make use of complementary treatments without having the right knowledge and guidance to go ahead. Some of the best-acclaimed and well-proven ways to naturally control blood sugar levels include the following: Shed Away Extra Kilos: Losing weight is one of the best ways to keep diabetes at bay. A study by the American Diabetes Association (ADA) shows that losing even 7-10% of the body weight helps the progression of the disease in pre diabetes people. Individuals with diabetes can be sure of controlling blood sugar levels by losing even 5-7% of their body weight. Obese/overweight individuals must follow a strict diet and exercise regularly to lose weight and benefit from controlled blood glucose levels. Exercise Regularly: Staying physically active and exercising regularly are necessary for a healthy life generally. Exercise has ample benefits including weight loss, increased sensitivity to insulin levels, and lower blood sugar levels. Stick to doing different exercises including aerobic, resistance, strength training, and others for overall fitness. Make Healthy Eating Choices: Try including as much as plant-based foods as possible. Fill your plate with 50% of vegetables while the other half should consist of whole grains, pulses, proteins, and healthy fats. Choose smart carbs and avoid unhealthy fats in your everyday diet plan. Never succumb to fad diets as their long-term benefits are unproven. Even otherwise, portion control and quality food choices are the key to a healthy eating pattern. Include Specific Foods in the Diet: India is a country renowned for alternative treatments using herbs and Ayurvedic approaches. But we have not given much priority to our native foods nor have valued them. Maybe it’s time to revisit such foods and reap benefits. The American Diabetes Association (ADA) suggests that there is no clear evidence showing that consuming herbs and supplements would benefit people with diabetes without having additional conditions. Still, consuming the below-mentioned ones might benefit individuals with diabetes: Aloe vera: There have been various studies identifying the benefits of aloe vera including its benefit in repairing the beta cells producing insulin, lowering blood glucose levels and in fact, HbA1c levels, and also increasing insulin levels. The anti-oxidant and anti-inflammatory properties of the plant are believed to aid in such benefits. Cinnamon: Having a sweet taste, this spice is profoundly popular among diabetics for this reason mainly. There have been a couple of studies showing that cinnamon could aid in lowering blood glucose levels and increasing insulin sensitivity but we need further studies to prove the same. Until then, it is suggested that you discuss with a healthcare professional before going for cinnamon supplements. Fenugreek: A bitter-tasting seed, fenugreek has been used since ages in Indian cuisine. The presence of fiber and other ingredients help in slowing down the digestion of carbs and sugar. Some people consume the seed in powder form, some boil water with fenugreek and drink it, and some others use the natural seed for cooking purpose. Though we do have some research showing that fenugreek might help in managing blood sugar levels, additional supporting evidence is needed to prove concrete relevance. Gymnema: A magic herb from the Indian subcontinent, Gymnema, also called as the ‘the sugar destryoer’ is predominantly used in Ayurvedic medicinal preparations. Some studies have shown a link between obesity, diabetes, and gymnemic acid. The acid is said to have anti-sweet nature thereby preventing sugar absorption. The leaf is sold in the form of tea, leaf extracts, and so. But before consuming any of these, discuss with a healthcare expert as its consumption increases the chances of hypoglycemia, if not monitored properly. Jamun: Some research show that both, the fruit and seeds of jamun are potent sources of protecting us from hyperglycemia and are also effective in regulating blood sugar and insulin levels. Apple Cider Vinegar: Previously linked to weight loss, apple cider vinegar is now showing advantages for diabetes also. The vinegar has shown promising results in a couple of research studies regarding management of diabetes. Though we don’t have strong evidence supporting it, there is no harm in consuming apple cider vinegar in moderation. Ensure Adequate Magnesium and Chromium Levels: There have been numerous studies trying to figure out the relationship between magnesium and diabetes but none have been conclusive. But, scientists do say that insufficient magnesium levels might lead to insulin resistance and insufficient insulin secretion. Evidence also shows that lower magnesium levels might lead to diabetes complications and diets rich in magnesium (such as leafy greens, avocados, whole grains, pumpkin seeds, etc.) help in lowering diabetes-related risk. Chromium too likewise might help in increasing the action of insulin. Though chromium’s link in controlling blood sugar levels have been studied for decades, there isn’t conclusive evidence for the same. Include a generous serving of fruits, vegetables, nuts, brewer’s yeast, beef, and grains to supplement the body with chromium. Other Factors: Besides the ones mentioned above, there are a couple of other factors that help in controlling blood sugar levels. Those include:
Bottomline Herbs, supplements, and natural foods can only complement your active lifestyle and healthy eating habits in controlling diabetes. They can never be a total replacement or substitution for whole foods, exercises, and medications. Even if you plan to incorporate any of the supplementary foods, it is always better to consult a dietitian/healthcare professional beforehand—this is mainly because there might be interactions between the supplements and the medications taken sometimes leading to dangerous consequences.
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Insulin is indispensable to the body for producing energy through the foods that we eat. There is a proper balance between insulin and blood sugar levels generally but there are instances where this hormone doesn’t do its job efficiently leading to overproduction of the insulin hormone—this process, known as insulin resistance, is the root cause behind the occurrence of type 2 diabetes.
Functioning of Insulin Basically, insulin functions as given below:
When the cells of the fat, liver, and muscles aren’t able to take up glucose effectively, it results in insulin resistance. Even if there is improper response from the cells, there is no problem until pancreas keeps producing insulin to keep blood sugar levels in the healthy range. But, excessive resistance to insulin from the cells results in increased blood sugar levels, which consequently result in pre diabetes or type 2 diabetes. Reasons for Insulin Resistance In any patient, diagnosing the problem is the toughest part and once this is done properly, administering medications is easier. It is the talent of the physician to come up with the right diagnosis for treating the patient. Likewise, in our case, understanding the reasons behind the occurrence of insulin resistance helps us solve half the problem. After this, all that remains to be done is addressing the reasons and coming up with the right solution. The primary causes behind insulin resistance include:
Currently, researchers also think that stress levels and some factor (could be a hormone) produced by fat tissues could lead to insulin resistance. Researches & Studies On Treating Insulin Resistance There have been multiple researches and studies that have come up with different solutions for treating insulin resistance. One study focused mainly on overweight/obese postmenopausal women administering them with dietary interventions, exercise plans, and a combination of both. Significant improvement in insulin resistance was seen in those groups following a diet plan with or without exercise. In another study, obese participants were put into one of the two groups randomly—either the control group or the intervention group that exercised thrice a week for between 50 and 70 minutes. Results showed that the intervention group showed positive results with reduced subcutaneous and visceral adipose tissue reduction with no changes found in the control group. On the whole, the study was a clear proof that there was significant improvement in weight loss effects and insulin resistance levels with authentic lifestyle interventions. Yet another research on insulin resistance to bring in exercise and lifestyle interventions as the primary solutions for treating it was taken up by the American Medical Association (AMA) and American College of Sports Medicine (ACSM). ‘Exercise is Precision Medicine’ for insulin resistance was the mantra of this study. The research suggested that exercise helped improve insulin sensitivity but a combination treatment protocol is necessary to address the symptoms and cause of the disease and deal with problems relating insulin resistance. Treatment Protocol for Addressing Insulin Resistance Issues All the studies, the underlying causes behind insulin resistance and the risk factors clearly show that lifestyle interventions that include an active lifestyle, everyday exercise, a well-balanced diet plan, sufficient sleep, and yoga/meditation are more than enough to address the problems of insulin resistance and resolve the problems relating to diabetes. There are some health companies that advocate their treatment plan of building 300+ protocols for dealing with insulin resistance. The number is humongous and we don’t have the slightest need to even know what these 300 protocols include. We have more than enough data and study results proving without doubt that all we need is the help of a dietitian/nutritionist to come with a low-calorie diet, a doable exercise regimen, and simple lifestyle interventions to sort out problems relating to insulin resistance. Building such big-numbered protocols, making a big deal of something that’s easy to treat, and seeking attention with big terminologies is a great way to advertise and publicise. But, this is only a strategy to lure clients and tempting them to invest more on something unnecessarily. Insulin resistance can be treated by:
Conclusion All these strategies are sure-shot ways to curb problems related to insulin resistance and keep diabetes under control. Ensure proper blood sugar levels by combining all these tactics and doing them in a diligent manner every day. Never do this by yourself but get in touch with a reputed dietitian/nutritionist to plan your lifestyle modification and incorporate a well-balanced diet plan as a way to fight diabetes. Diabetes is a disease that needs constant monitoring to keep it under control. We’ve heard of different ways in which this condition might be diagnosed including blood glucose monitoring, continuous glucose monitoring, etc. The physician asks individuals to take fasting blood sugar test, post-prandial test, HbA1c test, random test, and so on. Each of these have their unique methodology but serve a single purpose—to figure out the blood glucose levels in the body and confirm whether or not diabetes is under control.
Spikes in Glucose Levels Often, individuals hesitate to go for a blood test after some function or vacation fearing spikes in blood glucose levels as a result of indulging in various delicacies and failing to perform physical activity. In people with diabetes, there are higher chances of blood sugar spikes after meal consumption. That’s where the post-prandial blood glucose test comes of assistance. The American Diabetes Association (ADA) recommends that we measure blood glucose levels before eating a meal (using a glucometer) and some 1-2 hours after the meal. Follow this routine for a week or so noting down all the numbers, the diet that you consume, physical activity performed, and anything else that you feel could affect the glucose ranges. Don’t forget to mention the portion sizes and the carbs quantity and variety consumed through the meals. Analyze the trend and understand when the levels vary drastically, meaning the numbers are way below or above the recommended ranges of 180mg/dL or below. In normal people, anything under 140mg/dL is acceptable. But why do we always say that spikes in sugar levels occur just after mealtime? The answer becomes obvious once you understand the internal process that’s happening. Any food consumed, especially carbohydrates, is digested by the stomach/small intestine and gets converted into glucose. As a result, the pancreas secretes insulin which helps in transporting the glucose to different cells in the body. But this mechanism happens smoothly only in normal individuals who don’t have diabetes. People with diabetes either suffer from over-secretion or under-secretion of insulin as a result of which the glucose is either not transmitted throughout the body or doesn’t get processed properly. Basically, the timing is all mixed up in individuals with diabetes. While in normal individuals, the insulin secreted starts acting immediately and finishes its work as quickly as it started, in those with diabetes, it takes more than 15 minutes to start functioning, around 1.30 hrs to peak, and around 4 hours to finish its work. The release of a hormone called amylin helps in preventing the food from reaching the small intestine quickly to ensure nutrient absorption but in diabetics, as amylin is not produced or is produced in small quantities, there is no restriction in the food’s movement to the small intestine. Hence, the food is not only digested rapidly but this combination of slower insulin and faster food movement causes spikes in blood glucose levels immediately after meal consumption. Managing the Blood Sugar Spike After Meals To get the blood sugar levels under control, we need a couple of solutions that assist in bringing down the spikes quickly instead of long-term ones that take time. Some ways to manage the glucose spike include:
Major Contributors Toward Blood Sugar Spikes
Hit The Iron Rod While it’s Hot Individuals with diabetes are prone to experiencing spikes in blood sugar levels. With proper care such as lifestyle changes, a well-balanced diet, medications (if needed), and exercise, it is possible to control such high sugar levels. Besides the above factors, smoking and dehydration can also possibly contribute towards higher blood sugar levels. Hence, it is always better to quit smoking and drink enough water. Without regulating sugar spikes, there is always some room for complications. In the long term, it might lead to cardiovascular problems, risk of dementia, and brain-related problems too. It doesn’t stop with this but affects the quality of life of individuals. To avoid these, discuss with your physician and come to the right decision regarding medications taken and the lifestyle changes that you incorporate in your daily routine. Rice has been a staple food across Asian countries. Our ancestors consumed everything from rice and sugar to refined flour and coconut oil. But, presently, there have been numerous concerns and warnings raised over the consumption of various foods especially after processed foods have taken over our eating habits. The do’s and don’ts do make sense when we are living in an era where movement has become minimal, eating habits have taken a reverse gear, and people are leading a sedentary lifestyle. Such restrictions make even more sense when we are talking about people with diabetes as the carbohydrate content in certain foods play a predominant role in determining their GI value.
Choosing To Eat Rice with Diabetes Despite the availability of clinical treatments and medications, the diet consumed and the physical activity performed have a major role in keeping our blood sugar levels under control. Many a time, we’ve been suggested to eat foods with a low GI value to keep the total carbs intake under control—this is because carbohydrate-rich foods have the natural tendency to spike blood glucose levels instantly. Those not having a track over their eating habits are at a serious risk over multiple health concerns including heart disease, foot infections, and more. Rice occupies over 20% of the total calorie consumption being the staple food not only in Asian countries but also in African countries. In such a scenario, is there a feasibility for individuals to skip eating rice or reduce its portion intake? Moreover, is it necessary to forego the intake of rice altogether if you suffer from diabetes? The General Advice Over Rice There have been abundant research and studies showing that consumption of high GI foods have the potential to increase the risk of diabetes risk. White rice has a high glycemic index (GI) value (around 64) which means that it can cause increase in blood sugar levels. A study by the British Medical Journal and the Harvard School of Public Health (HSPH) proved that individuals consuming too much of white rice are at an increased risk of diabetes—this means that if you have prediabetes, it is better to be conscious about the rice intake levels. Another study called the Prospective Urban Rural Epidemiology (PURE) did a multi-country research on over 1,00,000 individuals. The results clearly showed that higher consumption of white rice was linked to an increased risk of diabetes, especially in South Asia. All these clearly prove that white rice consumption elevates the risk of type 2 diabetes in individuals. Alternatives to White Rice White rice is the most popular of all but there are different varieties of rice that could be chosen as a better alternative to this. For instance, these days many individuals choose to include quinoa, millets, brown rice, barley, buckwheat, or red rice in their daily diet. While choosing some type of rice, it’s essential to pick a variety that packs ample nutrients and has a lesser GI value. Maybe a cup of cooked brown rice or long-grain rice could be a smart choice as these contain vitamins, nutrients, and fiber besides having a GI value around 55. Traditionally, mankind was used to consuming hand-pounded rice, barley, rye, and maize but now these have been replaced by highly polished white rice. Study results show that substituting white rice with unpolished brown rice decreases glycemic response by 23% and fasting insulin response by 57%. But the major problem is that most individuals are not satisfied with brown rice consumption as it’s not too appealing nor easy to chew and eat. But what makes brown rice a healthy alternative to white rice? It’s mainly because brown rice retains the nutrient-rich germ and bran layer while shelling off its hard out part only. But a word of caution, as brown rice can have high arsenic levels if grown in arsenic-rich areas. Still, the micronutrient and fiber content are higher making it comparatively healthier for people with type 2 diabetes. The Bottomline Rice is not our enemy and people with diabetes aren’t advised to stop the intake of rice altogether. It’s the portion sizes that play a pivotal role in determining the role of white rice in triggering diabetes risk. Instead of filling the plate with 75% of rice, cut it down to 25% and fill the rest with fresh veggies and pulses. Diet quality is important—eating a variety of foods that’s enriched with nutrients including vegetables, fruits, whole grains, nuts, and proteins is healthy for the body. Keep diabetes away by staying healthy and eating a well-balanced diet that’s low in sugar, salt, and fat. Eat rice in moderation, split carbs intake through the day, and choose half the grains as whole grains to enjoy a serving of white rice during the meal. Coma is a commonly-heard terminology where the individual is in an unconscious state for a prolonged duration due to various reasons. But not many are familiar with the term ‘diabetic coma’ nor even aware of its existence.
Diabetic coma is also an unconscious state where the individual isn’t responsive to the surrounding. It is a life-threatening condition that’s generally caused due to too high or too low blood glucose levels. The person is alive but that’s it—there is no response to any kind of stimulation and poses great risks. All these are indeed frightening but with proper steps and precautions it is possible to avoid this condition altogether. Warning Signs/Symptoms The onset of diabetic coma includes having very high blood sugar levels of 600 mg/dL or more resulting in severe dehydration. More commonly affecting people with type 2 diabetes, under this condition, the blood is thicker than usual ketones are not present in the urine—this condition is known as diabetes-related hyperosmolar syndrome. In those with type 1 diabetes, the blood sugar levels fall below 250mg/dL or even lower sometimes. Called as diabetes-related ketoacidosis, the body starts using fatty acids instead of glucose for energy with the presence of ketones in the urine and bloodstream. As the condition is the result of hypo- or hyperglycemia, the symptoms are also different accordingly. The individual has symptoms of high or low blood sugar levels before the onset of diabetic coma. Hypoglycemia-related Symptoms
Hyperglycemia-related Symptoms
Humans are used to habits and so are our pain-enduring skills. Similarly, having diabetes for a long time can lead to a condition called ‘hypoglycemia unawareness’ where there are no signs/symptoms indicating a drop in the blood glucose levels. But, generally the person feels thirsty continuously and urinates frequently. So, if there are any signs of changes in the sugar levels, it is better to get yourself tested immediately to avoid further complications. Causes of Diabetic Coma The chances of diabetic coma is greater in individuals with type 1 diabetes due to hypoglycemia or ketoacidosis (due to diabetes). But, the condition might occur in individuals with type 2 diabetes also majorly due to hyperosmolar syndrome compared to hypoglycemia or ketoacidosis. Other contributing factors for diabetic coma include consumption of alcohol, medications such as steroids diuretics, or heart medications, illnesses, surgery, improper diabetes management leading to haphazard blood glucose levels, trauma, illegal substance use, careless handling of insulin doses, and kidney failure. Treatment Protocol The treatment agenda mainly depends on the cause of the condition. If very low blood sugar levels are the cause of the problem, the patient is given IV fluids, insulin, and administered glucagon to reverse the effects of insulin. In case of high blood sugar levels, administering IV fluids, supplements such as phosphate, potassium, and sodium, and insulin helps in treating the patient. Are There Possibilities of Preventing the Disease? Common sense does tell us that maintaining blood glucose levels in admissible ranges is the best way to avoid the occurrence of any drastic conditions. Some ways in which we can avoid diabetic coma include:
Besides these, it is always better when friends and family members are aware of what must be done in times of need. For this, keep them informed about the symptoms of high/low blood sugar levels. Conclusion When left unnoticed or untreated, diabetic coma can result in permanent brain damage and death. During times when the blood sugar levels don’t rise beyond 70 mg/dL even after treatment, it is better to call your healthcare provider. Precaution is always better than cure. So, note down early signs of changing sugar levels and take necessary steps to bring them under control. Eat meals regularly, take medications as per doctor recommendations, know what to do once the symptoms start, and doubly care for yourself when ill to avoid any dangerous consequences of the disease. Alcohol, in general, is harmful for health and it’s a universal truth. But, what kind of impact it has on blood sugar levels is a very big question mark that needs careful deliberation. These days, most individuals are social or occasional drinkers. Having diabetes doesn’t make a tremendous difference in such cases—this is mainly because drinking is a rarity with such people. But, for those who consume alcoholic beverages regularly, once diagnosed with the disease, it is commonly seen that diabetics reduce their intake by more than 50% compared to other adults. Why so and what’s the advantage of restricting its intake on blood sugar levels?
Question Yourself The American Diabetes Association (ADA) recommends that you ask the three below-mentioned questions to yourself:
Internal Changes that Result After Alcohol Consumption It is a well-known fact that alcoholic beverages have no nutritional value but only add empty calories to the body that can significantly increase the waistline. Overweight/obesity is a grave risk factor for diabetes. But, what’s not so well-known is the fact that these beverages can also be overloaded with sugar. A pint of the drink contains up to 5-6 tbsp of sugar which is the ultimatum given by the World Health Organization (WHO) for a day’s consumption of sugar. Overconsumption of alcohol not only increase glucose levels but also can result in alcohol-related diabetes. The liver keeps producing glucose which is sent to the bloodstream. In this way, the chances of a low sugar level are minimized. But consuming alcohol rattles out the whole process—the breaking down of alcohol in the liver results in the formation of substances which block the glucose production. Due to this, the blood glucose levels fall considerably increasing the risk of hypoglycemia. This problem is common in occasional drinkers who suffer from fatigue and light-headedness. In regular drinkers, the entire process of glucose production, the hormones that regulate it, and effectiveness of insulin are affected resulting in higher blood glucose levels. A single drink might not have a debilitating effect on the overall sugar levels but anything more than that can raise blood sugar levels, especially beverages such as beers, wines, and sherries. The levels rise and in some time, they drop steadily (this often occurs while sleeping) resulting in hypoglycemia. Is It a Safe Bet to Drink in Small Quantities? Sometimes, there is a possibility that the alcohol you drink interacts with some medications. Hence, even before starting to think about drinking, it is recommended that you meet with the doctor and ensure that the alcohol doesn’t interfere with any of your medical conditions or the medicines that you consume. Besides affecting insulin levels, diabetics consuming alcohol are at an increased risk of high triglyceride levels, diabetic nerve problems, cardiovascular diseases, and diabetic eye disease. Individuals with diabetes can drink but with a few do’s and don’ts: Do’s
Don’ts
The Bottomline Though individuals with diabetes needn’t give up on alcohol completely, it is always recommended to minimize alcoholic intake for you own health. It’s no hazard in enjoying a drink or two but do it with proper guidelines and in moderation. Alcoholic intake might be off the limit for some individuals and this can be understood only if you discuss with your healthcare provider. Try to choose the beverage wisely—maybe a light beer, a dry wine instead of a sparkling wine, and the right mixers. Though one glass of wine might not ruin the health immediately, for some individuals, especially those suffering from diabetes-related long-term problems, it is better to avoid alcohol consumption altogether. Occasional consumption of alcoholic beverages doesn’t put individuals at high risks but moderate/regular (more than 2-4 drinks) consumption affects blood sugar levels badly. Even otherwise, these drinks are overloaded with calories intensifying weight gain chances which once again is a risk factor for diabetes. So, just go for the occasional cocktail or wine, follow the tips and tricks to stay fit, and keep blood glucose levels under control eventually. Once a diabetic, always a diabetic—this has been the presumption of most patients and even the common man. One of the main reasons for this is because not more than 2% of those with type 2 diabetes (T2D) enter spontaneous remission. When the numbers are not so encouraging, the clinical paradigm still remains that T2D is non-reversible. Maintaining a standardized blood glucose level and adhering strictly to sugar-free and starch-free diets is the current recommendation. Such practices are helpful in maintaining normal glycemic levels but don’t aid in curbing T2D advancement nor promote its remission.
There have been a couple of long-term studies and researches that have focused primarily on diet management and lifestyle changes to put diabetes into remission. One of those prominent studies is the DiRECT study (Diabetes Remission Clinical Trial) which clearly shows that weight loss is a very effective way to halt diabetes progression and stalk its effects. The study also showed that following a low-calorie or a very-low calorie diet (LCD or VLCD) is a sure shot way to lose weight efficiently and also sustain the lost weight in the long run by following certain eating habits and dietary interventions. LCD Interventions Offer Beneficial Diabetes Remission Effects Before going into any of the details, let’s start by understanding what is meant by a low calorie diet. An LCD is nothing but consuming between 800 and 1200 calories per day. It is a short-term approach to weight management which should not be followed as a lifestyle change forever. During this tenure, the individual following the LCD is given meal replacements such as shakes and soups, or very small portions of the normal foods that we eat everyday. The diet is usually followed for around 12 weeks after which normal food is reintroduced slowly in small proportions until the normal routine is reached. Such a plan seems easy and doable but practically, following it diligently needs much will power and not all individuals can pursue one. It is always better to consult your doctor and get a green signal for the LCD before venturing into one. If approved, once again it is smart to get the advice of a dietitian/nutritionist to plan the LCD according to your body type, requirements, and health conditions. Recommendations by ADA and EASD for LCD The DiRECT study result showed that almost 50% participants entered diabetes remission and almost a third of them maintained the remission state after 24 months. The effect of remission was directly proportional to their ability to sustain weight loss. Impressed with such results, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) have suggested the use of low-calorie diets for patients suffering from type 2 diabetes for achieving remission and diabetes control. Not all individuals can enter diabetes remission and there are a couple of factors that must be fulfilled for being eligible for it. For instance, the individual should maintain HbA1c levels below 6.5 for at least six months continuously and should not be using medications to control diabetes. Until now, the standard care of treatment has not focused mainly on reversal which makes us wonder whether this type of treatment is the best one. But of late, we have a number of studies repetitively emphasizing on the success of LCDs, VLCDs, and carbohydrate restriction (LC). But, most of these have shown that remission is possible for short-term (for 2-5 years) beyond which we do not have clear results on sustaining the remission successfully. The DiRECT study is still in process to understand whether or not long-term remission could be successful and we hope that the picture becomes clearer after this. Still, presently our hope is that LCDs and VLCDs do offer a remedy for diabetes and with sustained weight management efforts and we can keep diabetes under remission—there have been individuals who have maintained the remission for more than 10-15 years. Knowing More about LCDs When we have been eating a specific number of calories until now, suddenly reducing the intake by more than 50% or more has a greater impact on the body. For instance, there are a couple of side effects due to a low-calorie diet including headache, constipation, and dizziness. Continuing an LCD might sometimes lead some people into hypos and hence, keeping tab on blood glucose levels regularly and changing medications might become necessary. Before starting to follow any diet plan, it is better to speak to your doctor and understand whether or not the diet plan satisfies all the nutrient requirements, take glucose tests often, and get in touch with a dietitian to get a custom-made diet plan. Such a plan not only helps people lose weight, which in turn helps manage diabetes, but also assists in maintaining normalized HbA1c levels and blood glucose levels. Conclusion Until now, individuals involved in the DiRECT study and those administered with LCD by ADA and EASD do think that the LCD meal plan is really hard to follow and keep up with, needs ample motivation, and the meal replacements might be quite expensive to many. A total-diet replacement offers better results for T2D remission for a couple of years. We are at a threshold where diabetes could become the greatest health threat if we don’t exert much effort to curb its rise. Given a choice, many individuals would surely opt for reversal and hence, educating people about the availability of diabetes remission is necessary. When reputed organizations such as the ADA and the EASD advise individuals to follow an LCD for diabetes remission and control, what’s the use of CGM, accu-chek, precision nutrition, and other stuff that complicate things without providing the necessary solution? Let’s stick to the basics—a well-balanced diet plan, lifestyle modifications, good sleep, reduced stress, and a daily dose of meditation/yoga to keep diabetes under control. Obesity is a concerning issue globally and its impact is even more on diabetes. Statistics show that almost 85% of individuals with type 2 diabetes(T2D) are either overweight or obese. Doctors and healthcare professionals are well-aware of the debilitating effect of obesity in enhancing the risk of diabetes but the same awareness is required among individuals as well.
Beta cells in the pancreas lose their ability to make insulin when there is excess fat accumulation around the pancreas. Such fat accumulation affects the production and use of insulin by the body increasing the risk of T2D by 20 times. We are naturally inclined to quote lack of willpower as a primary reason for obese/overweight people to not lose weight but the reasons are much more cruel and come with an ulterior motive. Have you ever thought why pasta, ice creams, candies, and other junk products have more publicity and advertisements than our healthy millets, whole grains, and pulses? Corporate profit is the driving factor behind the obesity epidemic, companies have a 500 billion dollar sales annually in selling fatty, sugary, and salty foods that are addictive and have taken ultimate control of our food habits. It’s high time we realize that it was not until a couple of decades back that obesity has became a concern, the number of diabetes cases have increased, and the consumption of high-fructose corn syrup went up by 1000%. Almost 20-70% less expensive than regular sugar, corn sugar was the standard replacement in the beverage industry, breads, yogurt, ketchup, and more. With the steady rise in the consumption of processed meats, carbohydrates, and soft drinks in the 20th century, the number of diabetics has also increased from 50 million to 400 million in just a few decades. Statistics project a 150% increase in cases by 2050. So, where do you think the problem lies? All these information and data prove without doubt that the food we eat and the lifestyle we adapt play a huge role in diabetes and obesity risk. Reputed health organizations believe that we would become an obesogenic society in not less than ten years. It’s high time we address this obesity issue, deal with the concerns, tackle the junk addiction, and get out of this mess to evade metabolic disorders including diabetes that occur as its side effect. Important Causes of Diabetes Weight gain and obesity are the most important risk factors of type 2 diabetes. So, if the patient is overweight/obese, it is indispensable that the individual focuses on losing weight. By doing this, blood glucose levels are normalized. But we cannot stop with this. It is necessary to address the root cause of diabetes, insulin resistance, and correct this problem to bring about diabetes reversal. For more details about achieving diabetes reversal and to understand the four key steps involved in the process, please visit the website www.firsteatright.com. Even a 5% weight loss improves pancreatic beta-cells function and sensitivity of liver and skeletal muscles to insulin. Further weight loss takes care of the adipose tissue disturbances. There are studies providing better results with reduced diabetes risk when participants pursued an intensive lifestyle intervention compared to consuming medications such as metformin. Tackling Weight Loss Physical activity is an absolute necessity for weight loss but doesn’t exist as the primary concern here. Focusing more on dietary changes is of foremost importance for successful initial weight loss. To maintain this weight loss, it is advisable to enrol in a weight management program. To lose weight or maintain the lost weight, get in touch with reputed dietitians/nutritionists who provide weekly guidance, monitor dietary behavior, and regular exercise schedules. The nutritionist/dietitian gives expert guidance recommending a low-calorie-diet or a very low-calorie diet depending on the individual’s body condition and requirement. With continuous monitoring, adequate sleep, practice of yoga/meditation, individuals are surely bound to lose weight and become fitter. Conclusion According to studies, the more obese an individual, the lesser number of gene variants required to increase their risk of diabetes as these people are already under the physiological impact of obesity and insulin resistance. Diet, exercise, and behavioral strategies must be enforced to achieve desirable weight loss which is easier said than done. But, losing weight has emotional and physical advantages—considerable weight loss reduces HBA1C levels, balances blood glucose levels, sometimes helps people discontinue medication, and even puts diabetes into remission. Reduction of waist line means less abdominal fat deposit and hence, there is minimal adipose tissue deposit around the pancreas and liver thereby minimizing the risk of insulin resistance. Wouldn’t it be a dream-come-true if a diabetic becomes a non-diabetic, at least for some specific period of time? That’s what the DiRECT trial is all about. The phenomenon where individuals with type 2 diabetes become non-diabetics is called ‘diabetes remission.’ In diabetes remission, most individuals become free from medications and enjoy normal blood glucose levels. Let’s look into the details of this trial to get a clearer picture about diabetes remission.
DiRECT Trial An open-ended, controlled trial that had participants from primary care practices all over UK, DiRECT trial included only those who suffered from type 2 diabetes for less than 6 years. The primary focus of this trial was to understand whether or not a structured, intensive, weight-management program was an effective treatment method for type 2 diabetes. The interventions used included withdrawing any use of antidiabetes and antihypertensive drugs, replacing the diet completely (an 825-853 kcal/day formula diet for around 12-20 weeks), reintroducing foods in a stepped manner (2-8 weeks), and providing support for sustaining the weight loss. The results at the end of the 12-month period showed that almost 50% of the participants achieved remission freeing themselves from diabetes and stopping antidiabetes drugs. Almost a third of the participants sustained remission at 24 months. The extent of remission was purely based on the extent to which the participants sustained weight loss. Though not a ‘panacea’ of treatment, this trial provides a new dimension to approaching type 2 diabetes treatment. It motivates individuals to make diet modifications and lifestyle changes right from an early stage of diagnosis. The trial aims to help patients free themselves from the limitations placed by diabetes on their daily living and reduce the risk of diabetes-related complications. Besides weight loss, DiRECT helped participants improve several conditions including psoriasis, allergies, and symptoms of irritable bowel syndrome. NHS-sponsored Low-calorie Programs The positive results of the DiRECT trial motivated NHS to provide free access to a low-calorie-diet program for 5000 people across England. The participants here were provided with a 3-month total-diet replacement products that included shakes and soups. All normal meals were completely replaced with a 900-calorie/day replacement foods for up to 12 weeks. During this period, they were motivated to increase their exercise levels alongside support provided for the same. Once weight loss was achieved, solid foods were reintroduced periodically and weight-loss maintenance guidance was done. The DiRECT trial is still in an ongoing phase and the participants would be monitored for a 7-year period totally to understand how individuals are able to maintain weight loss and remission. A Word of Caution Never try doing such low calorie diets on your own and it is never recommended to go into this mode as a quick fix for weight loss and diabetes correction. All the participants in the DiRECT trial as well as the NHS-funded low-calorie-diets were guided by expert healthcare professionals right through the program. There were a number of participants who found this experience challenging—a word of caution here, this type of weight loss and remission is not for all. Get in touch with a dietitian/nutritionist, seek medical support and then decide to go on a weight-loss program (if needed) to achieve diabetes remission. The DiRECT team is testing yet another trial called RETUNE where normal-weight people with diabetes can achieve remission. Dietitians play an integral role in all these trials following up on all the three important phases—total diet replacement, food reintroduction, and weight loss management. The team is yet to figure out the benefits of diabetes remission in protecting individuals against diabetes-related complications in the later stages of life. Conclusion The DiRECT trial and the NHS-funded program clearly confirm that weight loss and diet modifications are crucial for controlling and putting diabetes into remission. There have been individuals who have been in remission for more than 15 years with diet changes, physical activities, and lifestyle modifications. When this is clearly evident, what’s the need for minute-by-minute monitoring of blood glucose levels, going around with CGM, or having an accu-chek handy unless the situation demands? Let’s simplify the course of action and reap beneficial results with straightforward plans and executions. Never pay heed to humongous promises that showcase stuff in a mammoth way unnecessarily. How would you feel if someone monitors your activities 24*7 all through the day? Intruding? Irritating? Eerie? That’s how many feel toward Continuous Glucose Monitoring (CGM) too. CGM automatically tracks blood glucose/sugar levels all through the day and night giving off an alarm when the glucose levels are too high or low. Besides this, it is possible to enter the meal details, exercise duration, and medications taken. All these data can be downloaded to the computer/smartphone and in some models, erratic changes are instantly sent to the partner, parent, or doctor’s device alerting for immediate attention.
Such possibilities are of course a boon in today’s world, but for “who” is the very big question mark here. Reputed diabetes associations, health organizations, and medical institutes are repeatedly conveying the message that CGM isn’t for everyone. But, neither do individuals pay heed to this nor do some health apps or companies abide by this. In this present world, diabetes reversal has become a mantra for all and people are ready to go to any level to control diabetes. Taking advantage of such situations, we have multiple companies trying to allure individuals with new-technology devices and measurement possibilities, one of which is CGM. CGM takes a blood glucose reading every 5-15 minutes but they can never become a substitute for measuring blood sugar levels with a glucose meter. Using a CGM isn’t the solution to tackle Type 2 Diabetes (T2D)—even top-class diabetes organizations stand by this, suggesting its use mostly for patients with:
It is purely up to the doctor to recommend the use of CGM to improve quality of life of the patient. Are some organizations trying to manipulate the individual here by coming up with diet plans, lifestyle modifications, and exercise schedules based on CGM-related data? They even offer accucheck devices to keep a tab on sugar levels frequently. But, on the other hand, the use of CGM is permitted only with a physician’s prescription. Moreover, it is expensive compared to glucose meters which doesn’t make it affordable to all and insurance coverages aren’t available for this most times. Sometimes, CGM needs ample practise and training to use it in the correct way. Research Findings Irrespective of whether or not an individual with T2D takes insulin medications, there aren’t much research evidence scientifically expressing the advantages of using CGM for T2D compared to Type 1 Diabetes (T1D) patients. Even in those T2D patients with hypoglycemia, the use of CGM hasn’t shown any concrete advantage in decreasing the risk of hypoglycemia. Yet another long-term study which focused on HBA1C levels showed no significant difference in quality of life or improved A1C levels between individuals using CGM and self-monitoring over a 6-month period. Using CGM is Like Allying with the Downside CGM is unnecessary for individuals unless advised by the doctor. It is not only a waste of resources and expenses but has the potential to disrupt the quality of life of the individual using it: Alarm Anomaly: The ring of the alarm in case of abnormally high glucose levels is a blessing in disguise but the same becomes annoying when it rings incessantly due to maintained higher sugar levels for a couple of hours. It can be turned off but not remembering to turn it on can become a problem during some emergency situation. Allergy Attack: As the device has to be worn continuously, some people face allergy-related problems with the CGM sensor adhesive. Adds More Stress: Knowledge might be power but the same can be troubling when there is too much data at hand. Availability of glucose levels every 10 minutes forces many individuals to have a look at them, in turn increasing their stress and anxiety levels when the numbers aren’t right. Are you going to run to the doctor requesting for a dose change when the sugar levels rise slightly? Will you change the dinner menu just because the CGM data is not stable? All these are necessary for T1D patients but seem irrelevant for T2D individuals who need to focus on long-term goals and work toward it. Never go for too much diabetes-related information else it will affect your mental health badly. Conclusion A device chosen to ease health issues and regulate better body health shouldn’t become the root cause for mental stress, anxiety, and increased BP levels in due course. Relying upon the doctor for monitoring blood glucose levels regularly, following the tips and tricks suggested by the nutritionist/dietitian for lifestyle modifications and weight loss (if needed), getting enough sleep, and avoiding as much stress as possible are more than sufficient when the individual has T2D without any complications mentioned above. The necessity for CGM in T2D patients who don’t take insulin is minimal and there is ongoing research on the benefits of CGM for T2D patients. Until we have conclusive evidence, it is advised strongly not to use such technological devices that complicate rather than complying with your needs. Rather, choose simple but result-oriented steps to achieve diabetes reversal. Diabetes control thrives mainly on restricting dietary intake, exercising regularly, and getting into an active lifestyle. Every food consumed contains different nutrients and belongs to some definite food group. We must make wise food choices to stay healthy and keep diabetes under control. One of the foremost recommendations for this include minimizing the intake of carbohydrate-rich foods while including more of vegetables and legumes that have minimal carb content.
Glycemic Index (GI) Glycemic index is a value that’s present only in foods having carbohydrates. For instance, foods such as meat, oils, and fats don’t have a GI value but can still affect the blood glucose levels in some other way. Glycemic Index is nothing but the rate at which different foods increase the blood glucose levels in the body. GI numbers rank various carbohydrate-containing foods depending on the speed at which our sugar levels increase and decrease. Foods are segregated as low, medium, and high GI foods. High GI foods are those which are absorbed and digested rapidly while low GI foods take ample time to be absorbed and digested. High GI foods are recommended for consumption after a session of intense exercise training only. A numerical score between 1 and 100 is assigned to foods based on their ability to affect glucose levels with pure glucose given a score of 100. Highly processed foods generally have high GI numbers while foods with abundant fibre content take up lower GI scores. Connecting the Dots Between GI and Diabetes People with diabetes are always asked to stick to a rigid diet plan avoiding sugary items, many fruits in particular, and processed foods. Also, medical physicians, dietitians, and nutritionists recommend diabetics to choose foods with low GI to have good control over blood sugar levels. It might not only help mitigate spike in sugar levels in the body but can also help in weight loss, yet another way in which diabetes can be managed. Various factors such as processing (removing the bran and germ increases GI), physical form, ripeness of produce, fibre content, and fat content of different foods play a prominent role in determining the GI value. The American Diabetes Association has tabulated the GI values of various foods under the name “International Table of Glycemic Index and Glycemic Load Values.” For instance, foods such as barley, quinoa, pasta, oatmeal, most veggies, walnuts, sunflower seeds, mushrooms, apples, and skim meal have low GI. Foods such as baked potatoes, french fries, candies, white-flour pasta, white basmati rice, sugary beverages, and white bread have high GI. In fact, the ADA in the year 2011 published “Standards of Medical Care in Diabetes” where it states that: “Monitoring carbohydrate intake, whether by carbohydrate counting, exchanges, or experience-based estimation, remains a key strategy in achieving glycemic control. For individuals with diabetes, the use of the glycemic index and glycemic load may provide a modest additional benefit for glycemic control over that observed when total carbohydrate is considered alone.” Glycemic Response Glycemic response to any food is the effect of the food on blood sugar levels after consuming it. Consuming any food results in spike in blood glucose and insulin levels soon after eating but the levels drop to fasting levels in course of time. The spike difference is vastly seen in case of foods rich in carbohydrates. The glycemic response after a meal depends on the type of food consumed with the carbohydrates. For instance, combining a low GI food with a high GI food alters the blood sugar levels in a controlled way. To measure the glycemic response after consuming different foods, it is necessary to measure the blood sugar levels every time. The underlying question is whether or not pricking the skin for blood or even CGM is necessary. The answer is a strict no. Firstly, it is only carbs that have a GI value and when a low-carb diet is recommended for individuals with diabetes, there is not the slightest need to measure and monitor glycemic response on a day-in-day-out basis. Secondly, we have standard GI values for different foods and it is good enough to avoid eating high GI foods to maintain blood sugar levels. Obviously high GI foods would generate an undesirable glycemic response which doesn’t seem right. Thirdly, we have ample research data showing that a low GI diet works as an effective tool to reduce the risk of lifestyle diseases. Many of these studies show that altering the glycemic response of any diet could not be used as the only strategy for lifestyle changes but only as a part of the overall tool for a well-balanced diet plan. Summary Making use of the GI value is a valuable means to compare the carbohydrate content of various foods. Many companies might come up with various propagandas about time-to-time measure of glycemic response. Choosing low/medium GI foods is the smart approach to control blood sugar levels and when we have done this correctly, the response would automatically be controlled and stay under desired values. The ADA suggests that the total amount of carbohydrates in any food rather than its GI has a stronger impact on the body’s blood sugar levels—this brings us to another important point which is portion control. Pick the right foods in the right proportions to eat nutrient-rich meals and stay healthy. For this, getting in touch with a nutritionist/dietitian is critical as we can plan a wholesome diet that takes care of GI values but still fulfils the various nutrient requirements of the body without compromising on any food group. Our body breaks down carbohydrates into glucose for providing energy for the day’s activities. Once this process is done, the pancreas perform their job of secreting insulin which helps cells to absorb glucose. One fact is clear from this—the carbs that we consume raise blood glucose levels in the body and hence, the type and quantity of carbs consumed play a pivotal role in increasing/decreasing sugar levels.
Too high glucose levels, also known as hyperglycemia, might be due to overindulgence in carbs, the inability of the body to produce enough insulin to process the carbs, or even due to the ineffective reaction of the cells to the insulin released. Sometimes, there are individuals who suffer from hypoglycemia or low blood glucose levels which might be because of insufficient carbohydrates consumption or due to medication imbalances. Why Choose a Low-Carb Diet for Diabetes? Now that we have some idea about carbohydrates and their role in elevating glucose levels, it is evident that designing a diet plan playing around carb numbers is helpful in controlling diabetes. It’s true that carbohydrate processing is not much effective in individuals with diabetes. Studies also show that low carbs are highly effective against managing diabetes. Cutting down carb consumption helps in stabilizing blood glucose levels and also reduces the chances of diabetes-related risk factors such as weight gain and heart disease. These are potent reasons for choosing a low-carb diet, isn’t it? Customize Carbohydrate Intakes Very high or very low intake of carbs is dangerous to our body. So, what is the right number? This is the most tricky part as there is no specific number like our BP levels or diabetes range here. The right carbohydrate level varies for each person based on quite a few important factors such as age, sex, physical activity performed, and body size. Besides this, the blood sugar levels and the medications consumed impact the much needed carbs intake for your body. Firstly, carbs doesn’t equate to sugars. There are three types of carbs namely sugar, starches, and fiber which together comprise the ‘total carbohydrates’ that’s seen commonly on food labels. It’s up to the individual to choose the right carbs wisely and add better health to our body. For instance, going for a very low carb diet without the proper guidance of a nutritionist/dietitian might result in vitamin or mineral deficiencies. Choose foods that are abundant in fiber and nutrients while being low in unhealthy sugars and sodium. Fiber: The meal should consist of these mostly. Unprocessed, whole, and non-starchy vegetables such as cauliflower, broccoli, kale, tomatoes, cucumber, and lettuce are abundant in fiber and nutrients. Ensure that they take up at least half the food plate. The American Academy of Nutrition and Dietetics recommends that men and women consume 25 and 38 g of fiber respectively. Starches: Being a diabetic, there is not the slightest need to give up on fruits which belong to starchy carbohydrates. Fruits including all types of berries, apples, cantaloupes, melons, and guavas are a great choice as they are packed with fiber. No fruit is off the limit for diabetes but the catch here is to consume them in a controlled way spacing the intake throughout the day. Starchy veggies like potatoes, plantains, yam, pumpkin, and green peas must be taken in moderation. Include a small portion of pulses such as chickpeas, kidney beans, lentils, and black beans along with the brown rice, whole wheat foods, whole grain pasta, and oatmeals. All these together must take up a quarter of the food plate. Nuts are high in fats but full of nutrients like fiber, unsaturated fats, folate, and vitamins. Never fail to make a handful of nuts a daily part of the meal plan. Sugars: It is always better to reduce the consumption of sugary foods that are rich in processed carbs and sugars. Intake of sugar-added beverages including soda, sweet juices, sweetened teas, refined flour including white rice and bread, sugary cereals, and bakery snacks such as pastries, candies, chips, and cookies must be minimal. A low-carb diet should include around 130 grams or lesses of carbohydrates. Hence, rather than playing around with the food choices on your own, it is better to take guidance from a medical authority to plan them. Pick and choose some foods, slowly reduce the carb intake and analyze the changes in blood glucose levels for the foods consumed. Dairy is a part of the daily intake but the recommendation of milk and other dairy products purely depends on the individual and his/her needs. Sometimes, dietitians/nutritionists recommend non-fat dairy to control weight gain in people with diabetes but mostly, a small portion of dairy is needed for fulfilling the required calcium and protein needs. Lactose-intolerant people going for dairy alternatives should ensure that the products are calcium-fortified and unsweetened. Lean meats and seafood rich in omega-3 fatty acids such as prawns, salmon, and sardines are the right picks. Being good sources of proteins, these seafoods satisfy hunger hormones and also keep cholesterol under control. The Bottom Line A low-carb diet consists more of veggies with proteins and healthy fats in moderation. The glycemic index and value of foods present in this diet is low. When carb-rich foods are replaced with low-carb foods and healthy fats, the chances of controlling diabetes are higher. But, diet alone doesn’t bring significant changes. Combining physical activity, sleeping well, and reducing stress are key elements of keeping diabetes under control. But never stop eating carbohydrates completely as they are the powerhouses of energy. Failing to consume enough carbs cab bring about deleterious effects on the body including dehydration, dizziness, fatigue, and other disorders. Plan the food choices and quantity of food intake with your medical team and keep updating them on the progress regularly to reap good results. Every individual is designed uniquely and there is no denial regarding that. Our basic necessities remain the same but our metabolic rates, functionality, energy levels, and nutrition requirements differ person-to-person. Eating healthy food, including ample green leafy veggies, and having enough fruits, nuts, and pulses is mandatory for all. The catch here is the quantity of foods and the type of foods. Eating a balanced diet remains a thumb rule for staying healthy but one must understand that there is no one-size-fits-all approach when it comes to planning diets and maintaining an active lifestyle.
Diabetes & Diet It is a well-known fact that 80% of individuals entering diabetes or pre-diabetes stage are obese/overweight, and that’s the primary reason why doctors recommend losing weight for correcting HbA1c levels and maintaining blood glucose measures. Weight loss can be achieved through various methods and for diabetes especially, medical experts recommend following a low-calorie diet plan. Dietitians and nutritionists execute maximum caution and plan a well-balanced diet plan suiting the individual’s weight loss needs and BMI values. Combining this with regular exercise, enough sleep, meditation, yoga, and reducing stress is the best way to enter diabetes remission. Read more about diabetes remission and ways to do it by visiting www.firsteatright.com. Though a straightforward approach, there are health companies that publicize about making use of precision nutrition, CGM, and more to achieve diabetes remission. Let’s understand what is precision nutrition and whether or not it’s needed for controlling diabetes. Precision Nutrition Precision nutrition is nothing but coming up with targeted and effective diet interventions depending on the individual’s characteristics and body type. The person’s gender, age, lifestyle, race, weight, and other details are considered to derive a specific meal plan. The concept of precision nutrition gives the much-needed answer to ‘What can I eat to be healthy?’ It is indeed a novel field that’s got ample scope as it includes a customized approach involving genetics, microbiome, health history, and personal habits. But the primary question here is whether using precision nutrition presently in clinical settings is effective, and above all, necessary. A study from 2015 analysed the diet intake of 800 participants based on the data from gut microbiota and an algorithm pertaining to their dietary intake was formed. Using this algorithm, a personal diet plan was done and post-meal sugar levels significantly reduced in all. But the same team wondered whether the same outputs could be achieved in those individuals following a different dietary and lifestyle approach. Another paper in The American Journal of Clinical Nutrition dwelled into two types of continuous glucose monitors. All the participants were fitted with these monitors and the expectation was that both the devices provided similar blood sugar results. Sadly, both the monitors did not synchronize in their readings. For instance, one monitor reported that consuming bagel was better while the other one reported consumption of cereal as a preferred approach for the same individual. Such hazy results question the precision of precision nutrition and even makes one wonder whether mankind would be able to offer dietary choices based on this ideology. There is no denial that we might one day exist at the threshold where precision nutrition might be effective in dealing with health-related situation but now is not the time. Moreover, diabetes is a problem that could be combated using simple and effective measures that correct the basic problems relating to insulin resistance and blood glucose management. Current technology and study results don’t offer positive outcomes for using precision nutrition. We need ample research and studies to completely understand this approach and gauge whether it might prove to be beneficial. Choose to Use Precision Nutrition before it Proves to be Right? There have been a couple of studies and trials that show the potent benefits of precision nutrition in lowering blood glucose levels. But most of them are on a small scale, include a small number of participants, and there aren’t a considerable number of researches showing consistent results in this area. We need hi-tech technologies, expensive tools, and the results might vary depending on the type of tests used in various trials. Such difficulties and inconsistencies could affect the choices for personal recommendations. Until we have rock-solid proof for positive results, we cannot bring about dietary changes such as these as a replacement for our conventional intervention practices. Some key areas that clearly raise doubts regarding the effectiveness of precision nutrition include:
Precision Nutrition is Not as Precise as it Seems Despite technological advancements, an individual’s food choices depend greatly on a number of factors such as environmental factors, education, income level, lifestyle practices, and social support system. In reality, such factors impose a greater influence on what a person chooses to eat much more than genetic or biochemical measures. Going by this, focusing primary on what’s feasible for individuals must be the greatest priority. Never judge a book by its cover—just because we can measure the macro and micro nutrients of each food, it doesn’t mean that we keep giving little tweaks to the diet on a day-to-day basis. Even worse, just because we measure the CGM and keep getting values, we needn’t make diet modifications every couple of hours to the food that we eat. Some health companies boast about building 87+ parameters to build the nutrition database and coming up with individualized food plans. What’s the need for so much fuss when it all boil down to simply eating healthy food, including veggies and fruits, minimizing carbs, and keeping fats and proteins in balanced proportion? The foods remain the same, it’s the portion sizes and the types of foods chosen which impose greatest influence on our body’s health. For this, our weight, BMI value, health history, food preferences, and environment background are more than enough to plan the perfect diet plan for diabetes remission or control. Pocketing more bucks for diet plans based on precision nutrition, forcing individuals to use CGM, and even recruiting a big-sized team for tracking one person’s health is a gimmick. There is over high expectations from precision nutrition which is still in the infancy stages of development and research. In the future, after thorough research and deeper investigation, it might be possible for combining public health concerns with precision nutrition strategies. The field does seem promising but the biggest question is its potency to suit for all—the need for mammoth data collection and hi-tech use of latest equipment makes it a very expensive procedure. Hence, the government must also execute caution before investing too much in research over precision nutrition at the stake of public health. Disrupted Metabolism & Diabetes
Overindulgence in sugar intake, sedentary lifestyle, and heredity are some of the well-known causes of diabetes in layman terms. If we analyse the root causes of this disease scientifically, it is none other than disrupted metabolism. Often, we’ve heard the mention of the word ‘Metabolism’ in context with weight loss, but this term has a greater effect on the overall functioning of the human body. Metabolism is the process by which the body uses the food consumed to make energy which could be used immediately or stored for use later in the liver, body fat, and muscles. Disruption of this process leads to a metabolism disorder which could be due to the following reasons:
While controlling genes or probing into something that doesn’t have a root cause is impractical, we can always do our best regarding factors that could be corrected. For instance, diabetes is a metabolic disorder which is primarily due to factors such as stress, lack of physical activity, improper diet, and insufficient sleep. There are numerous research papers published worldwide expressing that changes in our diet and lifestyle are the main contributors of diabetes. Addressing the root cause is the need of the hour and that means siding with metabolic correction. Type 2 Diabetes results due to decreased sensitivity to insulin receptors which again is due to disrupted metabolic functioning in converting glucose to energy. Improving the body’s biochemical-physiological mechanism naturally leads to better control in diabetes levels. We can achieve metabolic correction by making diet modifications, ensuring sufficient hydration, and introducing dietary supplements. Reputed healthcare organizations and scientific papers keep repeating the four mantras for treating chronic metabolic diseases and these include: 1. Diet Changes 2. Physical Activity 3. Adress Stress 4. Enough Sleep When the potential for improving body healthy with simple tweaks is possible, why complicate stuff and panic individuals by encroaching them with fanciful terminologies such as artificial Intelligence or IoT for modifying participants’ lifestyle or monitoring day-to-day-changes? Attaching a piece of device to monitor a person’s health stats 24*7, all 365 days of the year might sound attractive but what’s the need for an external attachment in our body? It is admissible in the case of type 1 diabetes which might suddenly show erratic behavior, but using AI for type 2 diabetes (T2D) is unnecessary. There are some companies and health setups which promise changes in diet, exercise, and even meditation patterns depending on the AI and IoT-based data input. But, isn’t it funny for the doctor to keep analysing every single line of data for the slightest changes in eating pattern or sleep pattern and introduce newer changes? So, is the doctor going to suggest a 3-minute extra sleep or 5 more rounds of sit ups depending on the AI-based information? Even if he/she provides such modifications, isn’t it human nature to fret over such changes, succumb to more stress, and go back to the anxiety cycle that existed before starting the diabetes reversal/diabetes control journey? Let’s not complicate something that’s simple and straightforward. Don’t be lured by high-tech words or give into a treatment just because it’s different and high-end. What we want is long-lasting solution to treat diabetes or put it into remission and, this is feasible with proper guidance from nutritionists/dietitians who stick with the methods suggested above. Stop believing in those who try to brainwash minds with solutions based on AI-based data collection, minute-to-minute monitoring of blood glucose levels, IoT-based correction of diabetes, and more. All these are simply gimmicks to encash from individuals or to enforce false ideologies regarding diabetes. Start believing in yourself and your ability to control daily diet, exercise regularly, do yoga or meditation, and sleep soundly—contact a dietitian/nutritionist for simple modifications in food habits and practical exercise suggestions to go back to a healthy life with controlled diabetes or diabetes remission. Have you ever wondered where the sweetness in your chewing-gum and toothpaste comes from? No – for once, it’s not our favorite punching bag, sugar; rather it’s an artificial sweetener called xylitol. Also known as ‘wood sugar’, xylitol is a sugar alcohol (a type of sugar substitute) that is used to sweeten sugar-free candies, chewing gums, dental products like toothpastes and baking goods.
A lot of us may not know this, but about 38% of urban Indians consume artificial sweeteners every month. This is not hard to believe, considering that low-calorie or zero-calorie sweeteners are commonly used to replace sugar in many processed foods, especially diet soda and other soft drinks. Besides, those of us seeking to curb our sugar intake are invariably drawn towards foods marketed as ‘low sugar’, ‘no sugar’ or ‘sugar free’. Who doesn't know that the easiest way to enjoy sweet tea without using sugar is to pop in a packet of stevia or aspartame? Some practitioners also advise the use of artificial sweeteners in a bid to combat obesity and diabetes. Not surprisingly, the production of sweeteners like xylitol has increased manifold in the past 10 to 20 years. As responsible consumers, it is incumbent upon us to ascertain whether or not these artificial sweeteners are as healthy as they appear to be. Although they were previously considered safe, recent evidence to the contrary has made them targets of scrutiny and opposition. Sugar Alcohols The term ‘sugar alcohol’ is a misnomer, meaning a very misleading name, because these compounds are neither sugars nor alcohols. They are type of carbohydrates mostly derived from nature but also synthetically produced in certain situations. Sugar alcohols are commonly extracted from oats, birch , berries, sugarcane bagasse or corn husk. One can find them in many low-calorie or sugar-free foods like snack bars, ice creams, frostings, cakes, cookies and jams. Sugar alcohols are not included in the category of ‘added sugars’, which means that manufacturers are free to brand products containing sugar alcohols as ‘sugar free’. It is, however, easy to spot them on food labels (which, by the way, none of us read) as they always end with the suffix ‘-ol’, like lactitol, sorbitol, xylitol etc. Sugar alcohols differ from other groups of non-nutritive sweeteners (NNS) in the sense that they are metabolized in the body. However, these are only partially absorbed by the small intestine. Consequently, the amount of calories per gram obtained from sugar alcohols is up to 75% lesser than that of table sugar, while the intensity of sweetness is about the same. Additionally, they are broken down slowly during digestion, preventing sudden spikes in blood glucose and insulin levels. As stated earlier, until recently, sugar alcohols were generally regarded as safe, as they were mostly ‘natural’. In fact, the only objections against them were that they could potentially cause gastrointestinal problems. The slow digestion process allows gut bacteria more time to feed on carbohydrates, resulting in fermentation and excessive gas formation. This draws water into the large intestine, causing loose stools, diarrhea and abdominal pain. A serious eye-opener came with the 2023 study that linked high levels of erythritol in the blood to cardiac arrest, stroke and early death. Now, a new report published in the European Heart Journal shows similar findings related to xylitol. Xylitol found to increase risk of MACE The Cleveland Clinic conducted a survey on 3,000 people to analyze the effect of xylitol on our body. The subjects were asked to consume separately a xylitol-sweetened drink and another containing sugar. Their blood samples were then studied to compare the after-effects. It was observed that the platelet reactivity of a person was significantly enhanced immediately after downing the drink containing xylitol. A similar change was not seen in case of the sugar sweetened product. Platelets are tiny cells in our body that prevent blood loss by helping to clot blood at the points of injury. There seems to be some sort of a receptor on our platelets that instructs them to be more susceptible to clotting when it senses xylitol. The blood samples taken showed an abnormal increase in the efficiency of platelets. Xylitol had caused them to cluster together, leading to thrombosis (the fancy term for blood clots). These seemingly harmless blood clots could then travel up the blood vessels leading to the heart muscles, triggering a heart attack. Or they could travel to the arteries and veins in the brain, thereby obstructing blood flow and causing a stroke. It was concluded that large amounts of xylitol consumption heightened the risk of a major adverse cardiac event (MACE) within a period of three years. In view of such reports, the World Health Organization (WHO) has cautioned consumers against the use of artificial sweeteners for weight loss. These findings remind us of the need for more extensive research on the long term toxicity of low-calorie sweeteners that are increasingly becoming a part of our diets. At all times, it is best to consult a certified healthcare professional or dietitian before making any significant food choices. If not artificial sweeteners, then what? First sugar was bad. Now artificial sweeteners are bad too. So what do we do? There is no point in turning to jaggery, maple syrup, agave or honey; they’re just as bad as refined sugar when it comes to calories. Cutting down completely on everything sweet certainly seems like an ideal option, but it may not be realistic enough for many of us to implement. If you have an overactive sweet tooth the absolutely must be indulged sometimes, then fresh or frozen fruits make an excellent choice. Unlike refined sugar, which gives nothing but empty calories, fruits are loaded with benefits – fiber and vitamins, while also containing some amount of natural sugar. Combining a handful of cut mangoes or strawberries with yogurt, infusing water with slices of sweet lime or freezing cubes of pineapple for a chilled treat doesn’t sound like a bad option! What is Intermittent Fasting?
We humans suffer from a chronic aversion to hard work of any kind, and are always on the lookout for ‘easier’ ways to do things. Weight loss is no exception. While most of us understand the need to keep our weight under control, not so many of us are willing to go about the right way of achieving this. How hard it is to remember to exercise or to relinquish a favorite food that has suddenly been branded unhealthy! Sadly, doctors and dietitians are creatures utterly devoid of empathy. They make no effort to understand our pains, but go on preaching their health dogma. Thankfully though, the market rarely lets any demand – no matter how silly – go uncatered. Thus emerged the ‘fad diets’ with their plentiful promises of results at minimal effort. Intermittent fasting is one of them. Intermittent Fasting is a time regulated eating regime based on an alternation between periods of fasting and non-fasting. This could mean fasting every alternate day, periodically, or for a few hours every day. The most common type of intermittent fasting is the 16/8 practice in which people limit their daily food intake to an 8-hour time window, and fast for the remaining 16 hours. Consumption of only water and non-caloric beverages like tea or coffee is allowed in the period of fasting. This method is supposed to work by giving the body more time to burn calories. The mechanism is simple – after hours of going without food, the body runs out of ready sugar and begins to attack fat reserves, leading to weight loss. A lot of people find intermittent fasting easier to follow as compared to calorie restricted diets. This is because they are allowed a normal calorie intake as long as they restrict it within a particular time period – they don't have to bother about ‘what’ to eat as much as ‘when’ to eat. With this ease of following and a myriad of celebrity endorsements, intermittent fasting has garnered a lot of popularity worldwide. Until recently, it was believed that intermittent fasting could improve health by lowering blood sugar, blood pressure and cholesterol. It was also endorsed as an effective way to lose weight. Some studies have gone so far to say that it boosts memory and brain health. However, it is important to keep in mind that all these claims are backed only by short-term trials (the longest of them being only 1 year). This means that there is no conclusive evidence to suggest that intermittent is beneficial, or even safe in the long run. A New Study The American Heart Association (AHA) recently conducted a study to analyze the long-term effects of 8-hour time restricted eating. It was performed on 20,000 adults with an average age of 49 years. The study included data for NHANES participants who were at least 20 years old at enrollment, between 2003-2018, and had completed two 24-hour dietary recall questionnaires within the first year of enrollment. The participants were followed for a median duration of 8 years, with some being followed as long as 17 years. The researchers reviewed information about dietary patterns for participants in the annual 2003-2018 National Health and Nutrition Examination Surveys (NHANES) in comparison to data about people who died in the U.S., from 2003 through December 2019, from the Centers for Disease Control and Prevention’s National Death Index database. The results are quite thought-provoking. It was found that:
Future research is expected to reveal the exact biological mechanisms behind this association of time-restricted eating and adverse cardiovascular outcomes. Conclusion All this goes to suggest that while intermittent fasting may have its benefits, in the long run it adversely affects our health. Even before this study, medical practitioners have highlighted several drawbacks associated with this regime. It has been known to cause hunger, consumption difficulties, fatigue and dizziness. In the elderly, it has been linked to an increased risk of arrhythmia, stroke and diabetic ketoacidosis. The sharp fluctuations in blood glucose levels caused by it may lead to severe hypoglycemia, making it particularly fatal for diabetics on medication. Consequently, intermittent fasting is strictly not advised for children and teens under 18, pregnant and breastfeeding women, diabetics, those doing heavy physical work, and those with eating disorders. Additionally, an earlier study by AHA, though not specifically about intermittent fasting, found that time restricted eating does not prevent weight gain over time, or even yield better weight loss results than any other healthier alternative. It is necessary to educate ourselves of the health risks posed by any such regime before incorporating it in our lifestyle. As is seen in most cases, the benefits of these seemingly-lucrative practices are heavily outweighed by the potential hazards. When it comes to health, it is wrong to choose short-cuts. They may be easier but are rarely safer. The best option available to those seeking to lose weight or improve health is to follow a balanced diet, replete with all vital nutrients and plenty of exercise. The simple practice of eating large amounts of vegetables, fruits, fish, whole grains and cutting down on red meat and processed foods can work unacknowledged wonders. At all times, the most effective approach is to adopt personalized dietary recommendations, specifically curated in accordance with individual health status and latest scientific evidence. Diabetes is a physical disorder but it does have a vast impact on the emotional, psychological, and mental state of mind of individuals. Treatment for type 2 diabetes, until now, has been predominantly based on medications and clinical approaches. It’s only during recent times that focus has shifted toward lifestyle changes, diet modifications, and physical activity to keep blood glucose levels under control. In the last decade, we have been hearing the terminology ‘diabetes distress’ quite often which is the emotional distress occurring as a result of having to live with and self-manage diabetes amidst social stigma and personal stress. All these prove that diabetes management needs a holistic approach that balances physical, mental, and psychosocial care in individuals affected by the disease.
Relieving Stress Science has been constantly evolving and so is the field of medicine. Mankind has done an excellent job in bringing significant improvements to disease care and cure. At the same time, our focus now is also on mind-body therapies, alternative medicines, and mindfulness therapies to cure ailments. Mind-body medicine is a field that focuses on “the interactions among the brain, mind, body, and behavior, and on the powerful ways in which emotional, mental, social, spiritual, and behavioral factors can directly affect health.” Using this technique we can minimize stress and come up with solutions for chronic illness. One popular mind-body approach is Mindfulness-Based Stress Reduction (MBSR) that has a positive impact on people suffering from chronic illnesses including diabetes, anxiety, obesity, depression, hypertension, and more. Adapting MBSR for Diabetes Management Mindfulness is being aware of moment-by-moment thoughts, emotions, and physical feelings without any judgements. The technique, universally practiced worldwide, relies on meditation as its pillar of strength. Stress is one of the biggest causes of diabetes, though not many consider it to be as important as genetics, diet, or sedentary behaviour. Mindfulness is a tactical way to manage stress, anxiety, and depression helping individuals accept the way they feel instead of waging a war against their own emotions. Mindfulness-based techniques have proved to offer great support in diabetes management, enhance the clinical remedies associated with controlling blood glucose levels, and have an overall positive effect on both psychological and physical conditions of the body. Coupling Meditation & Mindfulness Been around for centuries, meditation focuses mainly on breathing techniques to relax the mind and the body helping individuals attain peace and calm. There are several researches and studies that support the incorporation of meditation practice in daily life to cope with diabetes. One research presented at the American Diabetes Association (ADA) conference proved that mindfulness-based meditation greatly benefitted diabetics as this practice provides relief against anxiety and depression, two symptoms commonly found in people with diabetes. Meditating daily provides control over emotions and mind, elevates positive vibes, decreases negative feelings, and improves coping skills helping people realize their sense of identity and self-worth. The Science Behind Meditation-based Treatment for Diabetes Meditation has a profound impact on the human brain, extending to the grey and white brain matter, cerebellum, brainstem, cortex, and the neural networks extensively. Research studies show that practicing meditation daily is effective against oxidative stress, decreases the production of the stress hormone (cortisol), and increases the secretion of antioxidant enzymes that preserve youth and good health. It also changes the brain functionally and structurally. Another study included coronary artery disease (CAD) participants and segregated them into two groups, the control group and the meditation group. At the end of the 6-month study period significant decrease in blood glucose and fasting serum insulin levels were observed in those who practiced meditation during the study period compared to the control group. One study included 60 participants segregating them into three groups namely A, B, and C. Participants in group A practiced Raja Yoga Meditation (RM), those in group B followed a controlled diet and performed regular exercise only, and those in group C combined RM, diet, and exercise. Though all three groups reaped benefits, participants in group C achieved better favourable HbA1C levels comparatively. The time duration is not a constraint here—it could be as short as 10 minutes to up to one hour or so. It’s been observed that meditating for 20 minutes a day relieves stress equivalent to sleeping for 6 hours. While the timeframe is entirely up to the individual’s choice, there have been companies and health centers that advertise the need for personalized meditation recommendations. Ironically, these organizations publicize that based on precision measurements, they fine-tune the meditation duration—such as decrease it to as low as 7-12 minutes. But, meditation is a universal practice that purely follows mindfulness techniques to relieve stress. When that’s the case, we are not bound to customize meditation timings, change the timings depending on precision values, or ensure precision in meditation duration depending on the individual. Just sit back, relax, meditate, and reap the benefits of this glorious technique that’s replete with benefits for the mind and the body. Conclusion Practice meditation to improve blood pressure and diabetes distress levels, achieve glycemic stability, and control weight besides achieving emotional balance. Research in the Archives of Internal Medicine showed that transcendental meditation practice helped diabetics control blood sugar levels, reduce insulin resistance, and lower blood pressure. Mindful meditation helps in making thoughtful decisions that include choosing what to eat wisely, ignoring desires to grab a piece of cake, and increasing the possibilities of going for a walk. Just like how regular exercise benefits the body, meditating regularly benefits the mind and must be a part of the diabetes self-management strategy. Before anything else, try practicing meditation regularly and then go into the nuances of time management. Never worry about short or long durations as you can meditate as per your time availability. Ignore the fine-tuning process without worrying about changing meditation durations based on rise or fall in blood sugar levels. White sugar is a killer and we all know about it. Not only diabetics but even all other individuals are recommended to stay away from white sugar for its list of ill effects on health. When such is the situation, it is natural that we start looking into alternative sweetening agents that could have lesser disadvantages and better taste. Frankly, no sweetening agent is 100% good for health nor recommended for inclusion. Each sweetener has got its list of pros and cons which puts us in greater trouble—it’s entirely up to the individuals to choose an agent that satisfies their taste buds and prevents guilt from creeping up.
What is Palm Sugar? An alternative to white sugar, palm sugar is a sweetener made from the sap/nectar of coconut palm trees. Commonly used in Asian, African and other tropical countries, palm sugar can be made from date or sugar palm trees as well. It’s known popularly under different names including jaggery, coconut palm sugar, palm jaggery, and more. Surprisingly, this sweetening agent has been in use for more than thousands of years in Asia but has become globally popular only recently because of its minimal processing, healthier nature, and lower glycemic index (GI). There are a number of evidences from published papers which clearly show that palm sugar has a GI value around 35. Nutritional Profile of Palm Sugar The carbohydrates and calorie content of palm sugar is exactly the same as normal sugar. Both of them contain sugar which is no surprise and this sugar is mainly carbohydrates containing glucose, fructose, and sucrose. The sugar proportion in cane and normal sugar is different and this is a key factor to consider. The sucrose content of palm sugar is comparatively lesser than many other sugars. Though sucrose is the primary content of palm sugar, it does contain glucose too in smaller proportions. One tablespoon of palm sugar contains 15g of carbohydrates, 15g of sugar, and 54 calories. It exists as a good source of nutrients such as potassium, zinc, copper, iron, and phosphorous. Why Palm Sugar Might be a Better Alternative to Sugar? Though any form of sugar is not healthy for the body, we all need some sugar and spice to add color to life. In that line, palm sugar is definitely a better alternative to many other sugars, especially our refined sugar. Some key factors that support this fact include:
Potential Disadvantages The high fructose content in palm sugar has the capability to shoot up blood sugar levels when consumed above recommended quantities. Overconsumption of the sweetener can have debilitating effects on the body resulting in heart diseases, increase in diabetes, weight gain, metabolic syndrome, obesity, and more. Though the GI value is lesser compared to white sugar, the American Diabetes Association (ADA) recommends that we treat palm sugar as an equivalent to white sugar owing to its similar carbs and calorie content. Also, general increase in the consumption of sugar leads to tooth decay, weight gain, obesity risk, heart problems, and even increase in stress levels. Hence, overconsumption of palm sugar also elevates the risk of such problems. Moreover, diabetics are naturally requested to minimize sugar intake, avoid all forms of processed sugars, and stick to fruits (in limited portions) for satiety. Hence, replacing white sugar with palm sugar doesn’t sound like a brilliant idea in the case of people with diabetes. But, choosing to make a pastry with palm sugar or indulging in a hot bowl of moong dal halwa made of some sweetening agent isn’t going to ruin everything in life. The Bottomline Any form of sugar has higher calories and lower nutrient content. There are biological research papers and materials which show that there is no need for added sugars in our diet when natural sugars can be consumed in the form of fruits and vegetables. There are also studies showing that around 80% of palm sugar is actual sugar compared to 100% sugar in white sugar. Hence, there is indeed a small benefit of doubt that proves that palm sugar is definitely a better choice than white sugar but only when consumed in moderation. Being mindful of what we eat, choosing natural fruits and veggies over sugar-based processed foods, and including sugar-based foods in moderation in the diet are some ways to monitor sugar intake and keeping it at bay. Getting in touch with a nutritionist/dietitian to plan a well-balanced diet that has more whole foods, less sugar intake, and modifying the lifestyle to keep diabetes under control is the best way to achieve good health. Did you get the beauty sleep last night? If not, then there are higher chances of being victimized by Type 2 Diabetes (T2D). Recommending individuals to sleep sufficiently to stay healthy and fit is easier said than done. In between busy work schedules, night shift jobs, household chores, and childcare not many are blessed to sleep well. Even if all these are managed, there are some others who binge watch series and movies these days. With such very many problems, getting a good night’s sleep is a luxury now.
Sleep and diabetes are intangible. We are aware that overweight/obesity issues and a sedentary lifestyle can trigger diabetes but sleep is yet another important factor that has a powerful impact on sugar levels:
Sleep Deprivation & Insulin Resistance A majority of T2D patients suffer from insomnia or reduced sleep quality caused mainly due to very high (hyperglycemia) or very low (hypoglycemia) sugar levels during the night. Poor sleeping quality or sleep deprivation causes insulin resistance due to which the insulin hormone is improperly used resulting in elevated blood sugar levels. Also, individuals already suffering from high blood glucose levels find it troubling/annoying to go to sleep. There are a couple of reasons behind this:
On the contrary, oversleeping is also dangerous when it comes to diabetes. Sleeping for longer hours without eating or medications could result in irritation, sweatiness, and confusion while awakening the next day. Effects of Sleep Deprivation Sleep is the body’s way of relaxing both mentally and physically. The American Academy of Sleep Medicine and the Sleep Research Society recommends that every adult needs at least 7-8 hours of sleep to stay healthy, be active, and perform our chores efficiently. Sadly, many diabetics hardly sleep well for 5-6 hours which is devastating to their health. Research studies show that individuals with short sleep durations were at a higher risk of prediabetes compared to those sleeping for at least 7 hours. Incidentally, the effects of sleep deprivation is more pronounced in men than women. One study focused solely on men and found that sleeping for extended hours improved the body’s use of insulin and hence, reducing the risk of T2D. The direct effect of lack of sleep is spike in insulin resistance but the other effects such as trouble with weight loss, improper functioning of the immune system, increase in BP levels, and an urge to binge-eat junk food indirectly promote the risk of diabetes. Each of us require quality sleep to start a new day with energy. Loss of sleep disrupts the individual’s decision-making skills and might even lead to faulty food choices that includes picking calorie-rich foods that promote weight gain. Also, sluggishness exists in some people due to lack of energy which institutes a sedentary lifestyle. Get in touch with nutritionist/dietitians to correct lifestyle practices, lose weight, and stay healthy. There are higher risk of smoking and alcohol consumption in individuals lacking enough sleep. Such behaviors are extremely unhealthy, each being a ticking time bomb on disrupting blood sugar levels. There is also study evidence showing that diabetics who do not sleep well are at an increased risk of cognitive decline in their later stages of life. Tips That Befit a Good Sleep Given below are a couple of easy and practical ways in which individuals can improve their sleep quality.
It is a known fact that quality sleep is necessary for an active and healthy lifestyle. When it comes to people with diabetes, sleeping well becomes even more important to dissuade changes in blood glucose levels and other related issues such as increased risk of obesity. Failing to adhere to regular sleep schedules can result in further health-related problems. Hence, it is better to comply with the tips given above and sleep well for your well-being. Sleep hasn’t always been on our priority list, at least for the present generation. A good night’s sleep helps us successfully pull through a busy day. But, the advent of the Internet, social media obsession, and streaming platforms have ruined our sleep routines altogether. We sleep during early morning hours and get up around late afternoons during weekends or during weekdays, get as less as 5 hours of sleep daily. Such insufficient sleep has a range of disastrous outcomes including negative performance at school/workplace, increased risk of obesity, lack of clarity, and higher risk for illnesses resulting in death sometimes. Worldwide, more than 50% of the population complains about not sleeping well. It might seem like you are simply losing out on an hour of sleep everyday, but this accumulation can have the exactly same impact as going without sleep for an entire day. Though sleep duration and quality can differ worldwide, the notion regarding sleep remains the same—most individuals are dissatisfactory with their sleep duration. Many survive on consuming cups of coffee rather than reaching out for the required extra hour of sleep. While most prominent reasons for sleeplessness are self-induced, there are some reasons that lead to decreased sleep quality—sedentary lifestyle is one of those prominent reasons that impairs sleep quality of individuals. Ouch! Don’t Be a Couch Potato: Sedentary Lifestyle Affects Sleep Quality Sitting has become our way of life, especially with the IT industry ruling our lives. Our lifestyle demands that we sit for longer hours in a sedentary position daily. A sedentary lifestyle has never been accepted nor recommended for good health. Most of us are aware of the ill effects of a sedentary lifestyle which includes risk of obesity/overweight, elevated chances of diseases including diabetes, and decreased overall performance. But, besides all these, a sedentary lifestyle also has the ability to hinder sleep quality in an individual. Sedentary behavior includes a sitting/reclining posture with energy expenditure in minimum. A thorough research was conducted to find out the significant of such sedentary behavior on sleep quality and sixteen studies matched the research requirements. A meta-analysis of all the studies showed that sedentary behavior induced sleep disturbance and elevated the risk of insomnia. Such disturbances in sleep in turn affect the activeness quotient of individuals during the daytime. Another study divulged into the sleep routines of Korean adults. More than 2,00,000 participants were analysed for their sedentary lifestyle and its impact on their sleep quality. Results showed that compared to sleeping for lesser than 4 hours daily, leading a sedentary lifestyle and sleeping for more than 8 hours daily was linked to a greatly decreased sleep quality among both the genders. The study also showed that women had poorer sleep quality compared to men due to reasons such as menstruation, menopause, household chores, decreased leisure time, and pregnancy. As checked out by this research time, not only their study but many other studies also provide similar results associating between sedentary lifestyle and decreased sleep quality. ![]() Several other studies clearly show that low levels of physical exercise decreased sleep duration and quality. It is also derived from these research data that better sleep led to better sleep quality and regular physical activity improved sleep levels. Also, older individuals who expressed sedentary behavior for 8-11 hours daily suffered from greater risk of sleep-related problems. The Bottomline According to the Center for Disease Control & Prevention, every individual must pursue at least one moderate-intensity physical activity and do it for at least 5 times a week for 150 minutes. The other two days could involve muscle strengthening activity. Any person who doesn’t follow this schedule falls into the category of leading a sedentary lifestyle. Such a lifestyle decreases overall sleep quality which in turn affects quality of life. To avoid all these, why don’t we move more and lead an active lifestyle. Maybe, walk while talking over the phone, bring a close friend to walk together in the park, use the stairs instead of the elevator, and choose activity-based games. Even while working, make it a point to get up from the desk every 1 hour or so and do some stretching. Include innovative ideas to stand and work, make it a habit to move more everyday, and set a goal for yourself to achieve it. Else, you will end up with reduced sleep quality that not only disrupts everyday routine but also instigates the risk of various diseases including cardiovascular problems and immune problems. Individuals are comfort-seekers who love to indulge in the small pleasures of life and find happiness in the little things they do. We don’t feel good when our day-to-day routine is interrupted or when we have to go out of our way to fulfil some requirements. Beyond all this, when our health is disrupted, it not only affects our physical health but also brings unrest to our body. Any sort of health problems ruin our peace of mind and cause mood swings affecting not only the person involved but also others around him/her. The same holds good with diabetes, a disease that requires stringent lifestyle modifications and eating habits.
Stress is one of the risk factors for diabetes and the same could be an impact of the disease too. For instance, when someone with a sweet tooth is suddenly asked to give up on everything sugary, they are sure to become distraught. It is our feeling but in reality, let’s see whether glucose levels impact our mind and mood. Diabetes Steals Away Mental Health Stealthily There are times when each of the organs do their function, still the individual feels sick. That’s mainly because our body’s health is dependent on a multitude of factors including thoughts, attitude, feelings, and beliefs. The world is presently witnessing a sharp increase in depression rates and the hard fact is that people with diabetes are 2-3 times likelier to have depression compared to others. Also, the risk of poor mental health is double in case of women compared to men. We have different studies proving them too. A research study in 2020 showed that variations in mood and stress has a significant impact on blood glucose levels and glycemic variability. Another meta-analysis showed that depression is linked to hyperglycemia in diabetes and anxiety levels could be as high as 40% in those with diabetes. Generally, scientific research has shown that hyperglycemia is linked with anger and sadness while lower blood sugar levels (hypoglycemia) is linked with nervousness. We have a growing pile of evidence pointing toward the relationship between mood and blood sugar levels and haphazard glycemic levels reflect in poor mental health symptoms. Surprised? Don’t be, as our brain functions on glucose and variations in glucose bring variations in mental health. Some of the symptoms of low blood sugar that hinders the mood of an individual include hunger nervousness, anxiety, personality changes, problems with decision making, confusion, and irritability. High blood sugar levels can induce tiredness, an unwell feeling, and difficulties in concentration. Diabetes Distress Diabetes disrupts blood glucose levels and to keep it under control, people with the problem adapt to a disciplined lifestyle routine including a strict diet, regular physical exercise, and medications (if necessary). Hence, these might become overwhelming for the patient ruining their mental and emotional health. A condition called as diabetes distress can sometimes affect people with diabetes. Also called as diabetes-specific distress or diabetes-related distress, this might be a result of the agony involved in managing diabetes every day. There could be days when diabetics might feel lonely, discouraged, or even tired of caring for diabetes —a feeling of the disease controlling the patient rather than the individual controlling the disease might set in. Also, during some scenarios, there are chances of being affected by some side effect of diabetes despite every action taken to keep it under control. All such scenarios are potential risk factors for developing diabetes distress. The condition might affect even those who have been managing their diabetes in good condition for decades together. It has been witnessed that during any 18-month period, almost 33-50% of individuals with diabetes suffer from diabetes distress. Diabetes distress has the potential to affect 1 in 5 people with insulin-dependent type 2 diabetes, 1 in 6 people with non-insulin-dependent type 2 diabetes, and 1 in 4 people with type 1 diabetes. Some common symptoms of diabetes distress include:
Ways to Neutralize Diabetes Distress
Conclusion Variations in blood glucose levels affect your mind and mood disrupting both mental and physical health. Feelings play an important role in dealing with diabetes. If you doubt that you feel lonely, anxious, stressed, or irritated, it is better to share them with your family, friends, and healthcare provider. Otherwise, diabetes can strain your relationships with the people around you. Sometimes, it has even led people onto suicidal thoughts. Let’s not take it that farther but slay the demon before things go out of hand. So, when your loved ones are a part of diabetes management and start providing support, the communication between people become better and the chances of strain reduce considerably. An increase in quality of life of the individual decreases the strain imposed on mental health thereby promoting overall health. Diabetes mellitus thrives as one of the deleterious disease worldwide but a majority of the world’s population don’t have accessibility to diabetes care including the basic need of insulin as well. Diabetes is a disorder that needs constant lifestyle adaptations and regular monitoring to keep it under control. But, firstly, not many individuals come forward to get themselves tested, and even if they do, not many are cheerful enough to seek the guidance of a healthcare physician to maintain blood glucose levels with the help of medications whenever needed.
The diabetes rate has more than doubled since the 1980s—highly prevalent in low and middle income countries compared to high-income countries. Such high rates not only show the dreadfulness of the disease but also imply the presence of severe obesity/overweight rates around the world. Untreated diabetes can potentially result in blindness, amputation of the lower limb, stroke, heart attack, and even kidney disease. For this, the foremost requirement is that all individuals possess the knowledge to get themselves tested regularly and get onto the treatment regimen once diagnosed with the disease. But that’s all we can do as individuals. Beyond testing and consultation, it’s not the individual’s duty to seek access to diabetes care. While people in high-income countries have complete access to all components of diabetes care, there are some countries where even the basic care isn’t of good quality or diabetes care remains totally inaccessible for most. While this lack of access can be a threat to controlling blood glucose levels in type 2 diabetes patients, the inaccessibility to insulin becomes life threatening for individuals with type 1 diabetes. Insulin Remains Inaccessible Even After 100 Years The history of insulin bores great surprises. While the scientists who discovered insulin were warm hearted to sell the patent for just one dollar to benefit the people worldwide, businesses have made insulin production a multi-billion dollar business thereby making it out of reach for most individuals. The development of therapeutic insulin in 1921 was a big breakthrough in medical history until now saving millions of lives but the discrepancies brought about by its costing nature and unavailability to all questions the position of diabetics worldwide. Insulin is the cornerstone for diabetes care especially for people with type 1 diabetes. It helps save the lives of millions, makes diabetes a manageable disease for more than 10 million people with type 1 diabetes and reduces the risk of kidney failure, amputation problems, and blindness in more than 50 million individuals with type 2 diabetes. But sadly, every one of two individuals needing insulin for treating type 2 diabetes don’t get it. There are more than 520 million people with diabetes, almost 16% more than the numbers shown in 2019. Three multinational companies control 90% of the insulin market hiking their prices consistently. 80% of diabetics live in low-/middle income countries such as Africa and Asia which are unable to keep up with the rising rates of insulin demands, especially when the rates are also quite high. According to the World Health Organization (WHO), almost 1.6 million deaths occur annually due to diabetes. Such numbers don’t pose a burden to the individual solely but also affect the country’s healthcare system. World Diabetes Day, Theme of the Year: Access to Diabetes Care The underlying aim is to prevent the occurrence of type 2 diabetes and cure type 1 diabetes. There are various remission programs including low-carb programs and lifestyle modifications suggested to reverse or keep diabetes into remission. Such programs clearly prove that it’s possible for at least 1 of 4 diabetes-affected individuals to reduce or stop using insulin at one year of program. There are also programs developed for type 1 diabetes individuals. Type 2 diabetes which was once thought as a progressive, chronic condition which lasts a lifetime has now become a reversible one. But, individuals must take every action possible to incorporate these—bring about lifestyle modifications, exercise regularly, correct food habits, and sleep well to minimize the risk of diabetes and control blood glucose levels. The theme for World Diabetes Day 2021-2023 is access to diabetes care. We need to focus primarily on two things mainly: to reduce the cost of insulin to make it more accessible to individuals in low-/medium-income countries. Next, focusing on reversing diabetes to reduce burden on healthcare costs. The Bottomline The centenary year of insulin discovery could be used in a very unique way to bring about meaningful changes to the lives of people suffering from diabetes. Diabetes, from an epidemic stage has become a pandemic of unrecognised proportions resulting in extremely high premature mortality and morbidity rates. Besides diagnosing and enabling diabetes care, the world must focus on reducing the risk of the disease by pursuing a healthy lifestyle, seek the recommendation of dietitian/nutritionists to follow a well-balanced diet, and exercise regularly. Above all, access to the right information is power—let’s stop spreading misinformation through electronic media and help in propagating correct information that helps individuals improve their quality of life. Don’t be swayed away by the term ‘sugar alcohols,’ as these are nothing but sweeteners that resemble the structure of sugar molecules and alcohol molecules. Also known as ‘polyols,’ sugar alcohols are carbohydrates that are naturally present in some fruits and vegetables. These are commonly used as sugar substitutes and have become very popular among not only those with diabetes but also other individuals wanting to lose weight, keep a count on their calories, and those watching out for general health. But, it is always better to consult a dietitian/nutritionist and get their approval whether or not it is safe for use for your health.
Carbs & Calories Though some imagine these sugar substitutes to be calorie-free, in reality, they contain about one-third to half the calories compared to normal sugar. Hence, they are termed as low-calorie sweeteners (LCS) instead of considering them as zero-calorie substitutes. Polyols can be anywhere between 25 and 100% as sweet as sugar without the equivalent calories and negative consequences such as tooth decay or increased blood sugar levels. It is predominantly because they take their sweet own time converting into glucose and require negligible or no insulin for metabolizing. Potential Advantages of Sugar Alcohols Due to their slow processing ability, sweets and candies containing sugar alcohols are a welcome treat to those with higher blood glucose levels as these individuals can consume such treats in moderation while maintaining their glycemic levels under control. Also, there are no potential hazards of tooth decay here as the bacteria present in the mouth don’t feed on these sugar substitutes. Being low-digested carbs, when you consume any product with sugar alcohols, it is not completely absorbed by the small intestine but gets passed through to the large intestine where the bacteria take care of it—yet another advantage here as these substitutes are proud of contributing to the growth of good bacteria. All these make them one of the most-preferred sugar substitutes among diabetics as well as health-conscious individuals. Potential Disadvantages of Sugar Alcohols There’s no great harm in adding sugar alcohols to foods in limited quantities, but consuming them in larger quantities might result in digestive issues including gas, diarrhoea, and more. It might even trigger worse symptoms in those suffering from irritable bowel syndrome (IBS). For those familiar with the acronym FODMAP, P here stands for polyols, and hence, individuals with IBS are recommended to consume a low-FODMAP diet. There have even been instances where doctors have prescribed sugar alcohols as laxatives for some people. Eating foods with sugar alcohols multiple times daily might upset the tummy and during such times, it is better to find an alternative sweetening agent. Also, though sugar alcohols are low in calories they are no magic pill for weight loss. Eating them in excess could lead to calorie addition. The American Diabetes Association suggests taking sugar alcohols in moderation without consuming them excessively. Do You Read the Nutrition Label? Anyone trying to cut down on calorie or sugar intake would grab at the very first opportunity of reading the nutrition label in food packages. There are many food packages that come with the labelling ‘sugar-free’ or ‘no added sugars.’ But remember that even such foods might contain fats, sugars, and carbohydrates. If you look closely, the Nutrition facts would list sugar alcohol as one of the components of total carbohydrates and also its quantity present. If the food has only one or two sugar alcohols, they would be mentioned clearly. Some popular sugar alcohols include sorbitol, xylitol, mannitol, isomalt, maltitol, lactitol, erythritol, and hydrogenated starch hydrolysates (HSH). Sugar Alcohols Vs Artificial Sweeteners There are various substitutes for sugar and two popular ones are sugar alcohols and artificial sweeteners. Both are not the same with the primary difference being that while artificial sweeteners contain zero calories, sugar alcohols might contain around 2 calories per gram. Another major difference is that artificial sweeteners have no carbohydrates and don’t pose any risk to increase in glycemic levels. But, sugar alcohols do contain carbs and could have some effect on blood sugar levels. Artificial sweeteners leave you with extreme sweetness being hundreds of times sweeter than normal sugar. There are many food companies that combine both sugar alcohols and artificial sweeteners in preparing various food products to enhance their sweetness levels. The Bottomline Generally, sugar alcohols are not used in everyday food preparation at homes but find a place mostly while making processed foods at factories. Most foods that have a label as ‘sugar-free’ mostly contain sugar alcohol and these include candies, chewing gums, soft drinks, energy bars, frostings, jams, ice creams, and cookies. As they don’t pose any risk to our teeth, sugar alcohols are used in the preparation of toothpaste and mouthwash as well. These substitutes might be a smart pick for those with diabetes as they not provide taste but also improve gut health. But, as they contain calories and carbs, it is best to consume foods with sugar alcohol in moderation to stay healthy and maintain blood sugar levels under control. Weight loss has always been the mantra for treating type 2 diabetes and this treatment protocol has worked magically. But what about people in normal weight ranges? Firstly, are they victimized by diabetes and secondly, if the answer is yes, would we suggest the same weight loss treatment method for such people to achieve diabetes remission or control? Let’s unravel the mystery. Obesity/overweight does increase the risk of type 2 diabetes (T2D) but 5-15% (the numbers are still climbing) of individuals with T2D are in the normal weight ranges. Researchers feel that rather than blaming obesity for the cause of T2D it is, in fact, because the individual is too heavy for his/her body irrespective of the BMI number. Every person has a ‘personal fat threshold’ above which the chances of developing T2D increases. While there have been various contemplations about the cause of T2D in normal people, an ongoing research program called Reversal of Type 2 Diabetes upon Normalization of Energy Intake in the Non-obese (ReTUNE) trial is looking into whether weight loss in normal weight people can help with diabetes remission. In this study, the normal-weight participants were given a low-calorie diet (800 calories/day) for two weeks after which they were supported with maintaining the weight. The same procedure was conducted thrice and the results were amazing:
The results undeniably show that excess fat has a debilitating role in controlling the occurrence and remission of diabetes. Fat accumulation around the liver prevents normal insulin functioning while in the pancreas, it stops insulin production by beta cells both of which pave way for T2D. A JAMA study showed that slightly obese/overweight people with reasonable weight sizes (in turn, reasonable belly fat) had better diagnosis compared to normal weight individuals suffering from bigger waists and at a greater risk of death. Besides body fat and waistline, another important factor triggering T2D is muscle mass. Muscles help in burning sugar and hence, higher the muscle mass lesser the quantity of sugar that’s converted to fat. Let’s get this straight—a BMI of 30 and above needs immediate action irrespective of waistline but when the BMI range is between 18.5 and 29.9, waist size plays a key role in elevating the risk of diabetes. Increased waist size means increased belly fat (visceral fat) and this in turn means increased risk of T2D. The height of a person has an impact on waist size. The maximum waist size permissible for a person is the number got when we divide the height by 2. For example, the maximum waist size permitted for a 5 feet (60 inches) tall person is 30 inches. Generally, women should have a waist size below 32 inches and men 35 inches or below. It is clearly understood that the cause behind T2D in normal weight people is beta-cell dysfunction or fat deposition around the liver and pancreas due to which insulin secretion becomes a problem. Some effective ways to control or put diabetes into remission in such individuals include:
If Eating Healthy is Special, then Of Course, Diabetes/Diabetes Reversal Needs a Special Diet11/10/2022 Never go near sweets, avoid eating those starchy potatoes, stay away from white rice—these are
some of the commonest phrases we have heard from people around us in connection with diabetes and diet. Friends, family members and colleagues advice out of goodwill but don’t you think that food-related suggestions and diet alterations are a doctor’s department? Why play the doc and block out an individual’s choices? In reality, “there is no special diet for people with diabetes or those aiming for diabetes reversal”, and, this is not simply a theory but an authentic declaration by Diabetes UK, which exclusively deals with diabetes. Time and again, we have heard of several reasons lurking behind the occurrence of diabetes, one of which is overweight/obesity. Losing even 5% of the body weight has a humongous benefit on the health of the individual. Living in a world thriving on fad diets and fanciful packaged products, there are umpteen ways to gain or even lose weight. But the actual concern is whether or not the chosen path is healthy. Choosing the right foods to eat goes a long way towards aiding weight loss, reduces the risk of type 2 diabetes, and makes an individual feel better in all ways. So, rather than picking a particular diet plan or eliminating food groups altogether, let’s look at it from a practical perspective. With so many choices available, why don’t we create a well-balanced diet with the right types of foods in the right proportion to keep us healthy with diabetes? The key to eating with diabetes is eating smaller portions, picking more of healthy foods, consuming less of processed foods, and munching on something healthy every few hours to stabilize blood-sugar levels.
Choosing a healthy diet mainly includes picking a variety of healthy foods from all the food groups in varying proportions to make it a balanced diet. The bigger plates, bowls, and cups are another factor for oversized waistlines. Cut down on portion sizes (which vary based on your age, sex, gender, and activity levels) to improve weight loss effects, take a bite of your favorite pastry occasionally, or don’t fret about eating that extra roti once a while, but never give up on eating healthy foods regularly. Understand, there is no special meal plan or a couple of foods that bring down sugar levels magically. It is a perfect blend of all foods that assist in reducing diabetes levels and keep the body in a healthy state. |
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Dr. Nafeesa Imteyaz of First Eat Right clinic, is the Best Dietitian Nutritionist in Bangalore. Best Dietitian Nutritionist in Pune. Best Dietitian Nutritionist in Hyderabad. Best Dietitian Nutritionist in Chennai. Best Dietitian Nutritionist in Mumbai. Best Dietitian Nutritionist in Delhi. Best Dietitian Nutritionist in Kolkata.