Lifestyle Changes to Prevent and Treat Diabetes

A healthful plant-based diet can help to cure Type II diabetes if you already have it, or help to protect you from developing diabetes in the first place. People who eat the healthful plant-based foods — vegetables, fruits, whole grains, beans, nuts and other seeds — are far better protected than those who eat the “unhealthful” plant-derived foods, such as refined grains, fried potatoes and sugar-added foods (Diabetologia, April 8, 2022).

For this Diabetes Prevention Study from Harvard, researchers used data on 8,827 participants in three prospective studies: the Nurses’ Health Study, the Nurses’ Health Study II, and the Health Professionals Follow-Up Study. The authors applied numbers to foods to rate diets on the basis of a food’s ability to help control blood sugar levels. The higher the healthful plant-based diet index score, the less likely a person was to develop diabetes. Foods were classified as:
• healthful plant-based foods, including whole grains, fruits, vegetables, nuts, legumes, vegetable oils, and unsweetened tea and coffee
• unhealthful plant-based foods, including bakery products and other refined grains, fruit juices, potatoes, sugar-sweetened beverages, and any foods with added sugar
• animal-based foods, including animal fats, dairy, eggs, fish, meat and other animal products.

An earlier study called the DIRECT trial found that 46 percent of 149 diabetics who were not on insulin became non-diabetic through a one-year, plant-based weight-loss program (Lancet, Feb 10, 2018;391(10120):541-551). Those who lost 33 pounds or more were most likely to go into remission. Two years later, one third of those in remission kept the extra weight off and remained cured of their diabetes (Lancet Diabetes Endocrinol, May 2019;7(5):344-355).  Diabetics in the DIRECT study, who followed a strict 800-calorie-per-day diet and lost a lot of weight, were also able to lower their high blood pressure (Diabetologia, May 31, 2021:10.1007/s00125-021-05471-x). Many of these patients were able to stop taking all blood pressure medications, as long as they did not regain their lost weight and their blood pressure and blood tests for diabetes remained normal.

Liver Fat More Important than Total Weight in Reversing Diabetes
Researchers found that weight loss reversed Type II diabetes in participants whose weight {body mass index or BMI) was in a moderate range (BMJ, July 7, 2021;374:n1449). The authors believe that lowering levels of fat around the liver is more important than just lowering body weight. The vast majority of diabetics are insulin-resistant, which means that their livers don’t respond to insulin. When blood sugar levels rise, the pancreas releases insulin which lowers blood sugar by driving sugar from the bloodstream into the liver. However, if the liver is full of fat, it does not accept the sugar and drives blood sugar levels even higher to cause diabetes.

Who Is At Risk for Diabetes?
According to the U.S. Centers for Disease Control and Prevention (CDC), more than 29 million North Americans have diabetes, and at least 25 percent of these people do not know they have it. Another 86 million adults (one in three) have pre-diabetes and thus are at high risk for dementia, heart attacks, cancers, nerve damage, blindness, deafness and the many other side effects of diabetes. People most likely to develop diabetes are those who:
• have a family history of diabetes
• are overweight
• store fat primarily in the belly, rather than the hips
• have small, narrow hips
• have triglycerides >150
• have low levels of the good HDL cholesterol (<40 mg/dL)
• have a fasting blood sugar greater than 100 mg/dL
• have a blood sugar over 145 mg/dL two hours after eating
• have a HBA1c greater than 5.5 (HBA1c is a blood test that measures how much sugar is stuck on cells and predicts cell damage from high blood sugar levels)
• have a fatty liver (shown by abnormal liver blood tests and a sonogram of the liver)
• have small particle HDL and LDL cholesterol
• have high blood pressure
• smoke
• take more than one alcoholic drink a day or binge drink
• have small muscles
• do not exercise
• in men, a thick neck or male pattern baldness
• in women, excess hair on the face or body, or have diabetes during pregnancy

Four types of drugs used to prevent heart attacks increase diabetes risk: statins, niacin, thiazide diuretics, and beta blockers (Am Heart J, April, 2014:421-428). If you are taking any of these drugs, discuss this with your doctor.

Lifestyle Changes to Prevent or Treat Diabetes
Type II diabetes shortens lives by causing high blood pressure, strokes and heart attacks, and many types of cancers (Circulation, 2019;139:2228–2237). If you have any of the risk factors for diabetes listed above, you should start a diabetes prevention program that includes:

• avoid all sugared drinks including fruit juices
• severely restrict all sugar-added foods and other refined carbohydrates
• restrict fried foods
• avoid red meat (blocks insulin receptors)
• avoid processed meats
• avoid smoking and being around smokers
• avoid alcohol or take no more than one drink a day
• lose weight if overweight
• eat a wide variety of vegetables, fruits and other healthful plant-based foods
• keep hydroxy vitamin D above 30 ng/mL
• exercise

My Recommendations
If your blood sugar level is greater than 145 mg/dL one hour after you eat a meal, you are diabetic and can suffer all the serious side effects of that disease, even if your fasting blood sugar level is normal.
• If you have any of the signs of diabetes listed above, start the diet and lifestyle changes immediately. People who already have diabetes can become non-diabetic if they follow these lifestyle changes rigorously and permanently.
• Whatever your age and weight, you can help to protect yourself from developing diabetes by following these same rules.