The soaring rate of sugar disease comes with a brutal price tag: lives, limbs, poor health and high hospital bills. Celeste McGovern looks at evidence-based ways to put the epidemic in reverse.
It has been called "the biggest epidemic of the 21st century".1 If you don't have diabetes or know someone with it now, it's likely you eventually will. The prevalence of diabetes, now affecting more than 420 million people across the globe,2 has quadrupled in the past 20 years and continues to soar. It is expected that one person in 10—or 642 million—will be diagnosed with diabetes by 2040.
Your body and brain ordinarily run on sugar as fuel for all of their functions, but too much sugar in the bloodstream can be damaging—even fatal.
In both forms of diabetes, type 1 and type 2, decreased insulin results in symptoms including increased thirst, frequent urination, weight change, fatigue and blurry vision, among others.
But those living with a diabetes diagnosis and symptoms do not need to feel overwhelmed and afraid of their disease forever. The 4.5 million Brits and 20 million Americans with a diabetes diagnosis (and the millions more estimated to have pre-diabetes or undiagnosed diabetes) can take control of their condition. Many type 2 diabetics are living proof that the disease can be reversed, sometimes in under 30 days, and type 1 diabetics are able to dramatically reduce their insulin dependence and cut their risks. In fact, a rare few have even challenged the orthodox medical view that being free of insulin altogether is impossible (see box, page 35).
To take control of your blood sugar and put your diabetes in the back seat, here are the top five factors to consider.
Despite all the diabetes diets and conflicting information—eat carbs, don't eat carbs, eat fats, eat zero fat, don't eat at all —fast— most patients who have beaten type 2 diabetes on various diets undergo significant weight loss.
The single biggest risk factor for diabetes is obesity; even if some type 2 diabetics don't appear to be overweight, they may be packing dangerous levels of fat on the inside, around their organs.
This was the case for Michael Mosley, a doctor and television presenter who discovered he had type 2 diabetes in 2012. Rather than go on medication to control his blood sugar, he decided to experiment with 'intermittent fasting.' He lost 9 kg by restricting his calorie consumption to 600 a day on two days of the week, eating normally on the other five days. On this "5:2 diet" that he invented, he reversed his diabetes in short order—under 12 weeks.
Mosley's book, The Fast Diet (2012) detailed the science behind intermittent fasting at the time and helped thousands of people put their diabetes behind them.
Cassie Greensmith from Leicester lost over 40 kg in 10 weeks on the diet, and after just two weeks was told that her blood sugar levels were under control and she could stop injecting insulin.
"In the third week, I had my first period in five years," Greensmith told the Daily Mail. "After 10 weeks, I was down to 136 kg and, to my amazement, I fell pregnant with twins. I'm 100 per cent certain I have these little girls only because of the diet."
Diabetes researchers at Newcastle University have been conducting experiments that show why calorie-restricted diets (800 calories a day) in the short-term can lead to dramatic weight loss; they shrink fat and shunt internal fat packed around the liver and pancreas away from these organs, allowing for rapid improvement in insulin production and blood sugar levels, which in turn lets diabetics come off their medications.
In a recent study, the Newcastle team under Prof. Roy Taylor recruited 30 people with type 2 diabetes, who had the condition from eight to 23 years. They were put on the same low-calorie diet—consuming no more than 700 calories a day—and they lost an average of 14 kg over eight weeks. None regained weight in the following six months.
Twelve of the 30, all of whom had diabetes for less than 10 years, successfully reversed the condition during the eight-week diet and were still free of the problem six months later. During that six-month period, another participant also reversed his diabetes.
The participants lost weight but remained obese. "This supports our theory of a personal fat threshold," said Prof. Taylor. "If a person gains more weight than they personally can tolerate, then diabetes is triggered, but if they then lose that amount of weight, then they go back to normal."4
Cut sugar, cut carbs
The most dramatic and consistent success stories, if you look deeper, include big dietary changes to facilitate cutting the calories.
Mosley's diet takes the "Mediterranean" approach. For example, it totally eliminates junk food and drastically cuts carbs like bread and pastas while increasing vegetables, protein and healthy fats like those in nuts, butter, live yoghurt, avocadoes and olive oil.
Sarah Hallberg, a professor of medicine at Indiana University and an obesity expert, has championed a low carbohydrate diet with increased fat. In her TED talk, viewed more than 1.5 million times, she tells viewers to ignore the outdated advice still given to diabetics by public health officials and most mainstream doctors, which is to help themselves to carbohydrates in the forms of pasta, rice, bread or potatoes at every meal.
"We are essentially recommending that they eat exactly what is causing their problem," says Hallberg. "Because at its root, diabetes is a state of carbohydrate toxicity. We can't get the blood sugar into the cells, and that causes a problem in the short-term, but the long-term consequences are even greater. Insulin resistance is essentially a state of carbohydrate intolerance."
Fats are the only macronutrient that doesn't raise blood sugar, she says. And we don't actually need to eat carbohydrates because our body will make them itself through a process called gluconeogenesis when it needs to. As Medical Director of the Medically Supervised Weight Loss Program at Indiana University, Hallberg has seen hundreds of people come off their diabetes medications. Her top recommendations include:
• If it says 'lite' or 'low-fat', avoid it.
• No grains. No potatoes. No sugar.
• Eat real food. Real food doesn't usually come packaged.
Researchers from Lund University in Malmo, Sweden, who studied the diet of 26,930 people, aged between 45 and 74, for 14 years, found that the sources of fat in a person's diet may be more important than the overall fat content. While total fat intake wasn't related to the risk of developing diabetes in this population, the participants who ate the most high-fat dairy products (equivalent to eight or more portions a day) had a 23 per cent lower risk of developing type 2 diabetes compared to those who ate the least amounts of high-fat dairy.
In the same study, high meat consumption was linked to an increased risk of diabetes overall, but fat did not appear to be the underlying cause of this connection. On the contrary, people eating high-fat meats had a 9 per cent raised risk for diabetes, while the risk rose to 24 per cent among those who ate low-fat meats.5
That may explain the success some diabetics have on raw vegan diets. While forgoing the meats and creams, these diets contain plenty of nuts, seeds, and avocadoes, but still eliminate most carbohydrates in the forms of pasta, breads, rice and potatoes. The 2009 documentary Simply Raw follows six diabetics eating a raw vegan diet for 30 days. All of them see dramatic drops in blood sugar levels and reduce their medications, including one, Kirt Taylor, who completely reversed a diagnosis of type 1 diabetes, the kind that is supposedly insulin dependent for life.
Both types of diabetes are thought to be related to a dysfunctional immune system that overproduces inflammation. Hundreds of studies have linked diabetes to increased production of inflammatory markers called cytokines—proteins that control inflammation.6
While it may be worth keeping a food journal to help determine which ones produce any symptoms in your own body, here are some of the most common trigger foods to cut from your diet:
Refined sugar. White sugar, brown sugar, corn syrup, fructose syrup, even juices, raw honey and maple syrup can cause spikes in blood sugar levels that put your body into an insulin deficit. When blood sugar is high, the body generates free radicals, tiny rogue molecules that pinball through the body, damaging cells and igniting the inflammatory response.
Trans fats. These partially hydrogenated fats found almost exclusively in processed foods, are manufactured using high heat and pressure and added to increase shelf-life and stabilize flavour in foods like bread, cookies, margarine, and sauces. Research confirms their ability to promote inflammation in the body and interfere with glucose metabolism.7,8
Gluten and casein
Gluten in wheat and other grains and casein in conventional cow's milk can both cause intestinal inflammation, and many people find that eliminating these two ingredients is linked to rapid weight loss or disappearance of symptoms. Intolerance to both may cause systemic inflammation, manifesting as anything from fatigue to skin rashes. William Davis, cardiologist, and author of the best-selling Wheat Belly (Rodale, 2011), has described how one mother of a 12-year-old type 1 diabetic watched her son go off insulin entirely when they switched to a low-carb diet and eliminated all products containing gluten.
Aspartame. Although diabetics are often advised to consume "diet" products containing chemical sweeteners like aspartame, not only have studies repeatedly shown that artificial sweeteners are linked to weight gain, insulin resistance and heart disease in humans,9 but animal experiments (which may not apply to us) have connected this aspartame-induced insulin resistance to impaired learning and memory.10
Diabetes is another disease that may be preventable by having plenty of "good" bacteria in our intestines, researchers have discovered.
A high level of indolepropionic acid in the gut—which is produced by intestinal bacteria—appears to protect against the development of type 2 diabetes. This acid also helps the pancreas produce more insulin, which is used to break down sugars in food, researchers at the University of Eastern Finland have discovered.
They followed overweight patients who were not processing blood glucose properly for 15 years, about half of whom went on to develop diabetes during that period. Those who remained diabetes-free had higher levels of indolepropionic acid in their gut. The researchers also found that the participants who had the highest levels of the acid ate more whole grain and fibre, and fewer saturated fats.11
Antibiotics, which act like napalm on the microbiome population, have also been linked to a 1.5 times elevated risk of diabetes, according to researchers from the University of Copenhagen who analyzed the medical records of nearly all type-2 diabetics in Denmark.
Narrow-spectrum antibiotics seem to increase the risk slightly more than the broad-spectrum drugs, but there was a cumulative effect. Those who have had just one or two courses of antibiotics over the years probably don't face an increased risk, the researchers say.12
These findings alone can't rule out the possibility that the antibiotics don't cause the disease, but rather that pre-diabetic patients need the drugs more often. But other studies have added support to the proposed diabetes-microbiome link. For example, children with type 1 diabetes have 25 per cent less diversity in their gut microbiome population and an overabundance of a few pathogenic bacteria (Ruminococcus and Streptococcus species, for example).13
All this suggests that a gut's microscopic residents play a critical role in diabetes—and it also holds promise for probiotic therapies to reverse diabetes. Reviewing 17 randomized controlled trials, Chinese researchers found that probiotic use was linked with moderate improvement in insulin resistance.14
Technological advances could further expand the therapeutic potential of probiotics. Researchers at Cornell University discovered that certain intestinal cells of diabetic rats converted into cells that behaved like pancreatic cells after the animals had been fed probiotic bacteria engineered to produce a human protein. These insulin-producing cells were able to restore the rats' insulin capacity and helped to lower blood glucose levels by up to 30 per cent.15
Engineered probiotics that induce such changes are probably a long way from human consumption, and the results may not even apply to humans—but there are still plenty of good reasons for diabetics to increase their intake of good natural probiotics in the form of yoghurt, kefir, sauerkraut, kimchi and other fermented foods containing high doses of diverse friendly microbes.
Emerging evidence suggests vitamin D—the vitamin our skin manufactures from sunshine—plays a role in both type 1 and type 2 diabetes. A 2016 study of 141 children with type 1 diabetes showed that they had generalized vitamin D deficiency: the lower their levels of vitamin D, the worse their blood sugar levels and the greater their insulin requirements. But all these metabolic markers improved after vitamin D supplementation.
"Vitamin D supplementation improves glycemic control and should be considered as an additional therapy," the Italian pediatric researchers concluded.16
Another recent study by Harvard researchers found that people with the highest levels of the vitamin in their blood were only half as likely to develop type 1 diabetes as people with the lowest levels, suggesting many cases of this disease could be avoided if people had adequate levels of vitamin D.
Although the richest source of vitamin D is sunlight, we also get it from fish and dairy products. "It is surprising that a serious disease such as type 1 diabetes could perhaps be prevented by a simple and safe intervention," said lead researcher Kassandra Munger.17
Another 2015 study of children with type 1 diabetes measured their levels of vitamin D and HbA1C (a blood test that reflects long-term averages of blood sugar). Patients who were deficient in the vitamin (25OHD < 50 nmol/lit) were treated with 300,000 units of vitamin D3 and a calcium supplement (40 mg/kg/day) divided into two doses.
After three months, blood sugar levels were significantly reduced in children who took the supplement, leading the researchers to conclude that the "vitamin D3 supplement improves HbA1C in patients with type 1 diabetes and vitamin D deficiency."18
Type 1 vs type 2
Both type 1 and type 2 diabetes involve uncontrolled blood sugar levels, which are regulated by the hormone insulin produced by the pancreas, a small organ tucked behind the stomach.
Type 1 diabetes is believed to be an autoimmune disorder, in which a dysfunctional immune system has turned its attack on part of its host—in this case, beta cells in the pancreas that pump out insulin in response to sugar intake. Like most autoimmune disorders, people can be genetically predisposed to diabetes, but it is also related to exposure to environmental factors such as infection, early introduction of cow's milk,1 birth by cesarean section,2and other triggers.
Type 2 diabetes is a metabolic disorder that evolves from lifestyle factors such as diet and stress that "burn out" insulin receptors and create a state of insulin resistance and increased inflammation.
How Daniel beat type 1 diabetes
Daniel Darkes, 30, was diagnosed with type 1 diabetes after finishing a tour of duty in Afghanistan in November 2010. He began taking daily injections of insulin—20-30 units three times a day and a long-lasting injection of 10 units at night. Doctors confirmed that, as typical with type-1 diabetes, his body was producing the kind of autoantibodies that attack insulin-producing cells, leaving him with dangerously high blood sugar.
Darkes was otherwise fit and healthy, and had run races in the military. He kept up his running and by last year was preparing for ultra-marathons—training 100 to 150 miles a week.
In order to keep up with his body's demands for sugar, despite his diabetes, he was also carb-loading. "I would have a big bowl of pasta before bed," he says. "Potatoes or pasta at lunch. Carbs at breakfast. I was eating all the time."
Not the usual route for any diabetic to get well. But in defiance of all the conventional (and unconventional) medical wisdom, Darkes' blood sugar started to plummet.
"I was waking up in the night with hypoglycaemia—sometimes three or four times a night," he told WDDTY. He was sweating and had heart palpitations, and when he went to his doctor he was transferred to specialists, who began to wean him from his insulin. By January 2017, he was off of it completely.
Intrigued, his doctors referred him to the Diabetes Research Center at Washington University in St. Louis, Missouri, where researchers confirmed the presence of insulin-producing cells and ran numerous other tests to discover why they'd begun working again.
"They starved me for a good six hours before, and I spent about 30 minutes running at a constant speed to see if my brain went into a kind of shock, or starvation, mode, and sent signals down to the organs, i.e. my pancreas, which it did," he says.
"They reckon maybe the running shocked my immune system," he says. Or maybe it also had something to do with his vitamin D consumption. Darkes says he had been taking 10,000 IU of the vitamin daily, along with one cod liver oil tablet and 1 g of vitamin C, plus protein powder added to smoothies and shakes a few times a week.
The Missouri team is expected to publish Darkes' case as the "first ever" case study of type 1 diabetes reversal.
Supplements to stop diabetes
In addition to a low-carb diet, the following supplements have evidence for helping to regularize blood sugar and insulin sensitivity
Has a major role in maintaining insulin sensitivity and glucose regulation. Magnesium deficiency has been linked to type 2 diabetes and diabetic complications.1,2
According to one review of published research, for each 100 milligrams (mg) of magnesium consumed daily, the risk of diabetes decreases by 15 per cent.3
As food: whole grains, beans, nuts and green leafy vegetables may reduce the risk of type 2 diabetes.
As supplements: 250 to 600 mg of magnesium oxide/day.
It's counterintuitive, but the sweet stuff can be good for you. Researchers in Luxembourg found that people who ate more chocolate had lower insulin and liver enzyme levels, suggesting that the chocolate was protective against insulin resistance, which is seen as a precursor to type 2 diabetes and is also linked to heart disease.
Although some in the study were eating up to 100 g of chocolate a day, equivalent to a large bar, most ate just a square or so.4
The black cumin seed, Nigella sativa, is a traditional folk remedy for diabetes, and recent evidence from Saudi Arabia shows significantly improved glucose control in type 2 diabetics who took 2,000 mg of Nigella seed extract (a supplement called Bioextract, divided into four doses daily) for a year.5
Suggested daily dosage: 500 mg four times a day
Cinnamon bark has been long linked to diabetes control, and new evidence shows that it can also help patients considered 'pre diabetic' with the so-called metabolic syndrome. Positive effects on blood glucose levels, cholesterol, blood pressure and obesity have all been reported.6
As food: Sprinkle it liberally on desserts, coffees, and food.
As supplements: Up to 3,000 mg per day in divided dosages.
An "essential trace element" required to process carbs and fats, chromium also helps regulate blood sugar by working with insulin to help transport glucose into cells.
A 2017 review of 28 studies found that chromium supplements lowered blood sugar and improved cholesterol profiles in type 2 diabetics.7
As food: Broccoli, prunes, nuts, seafood and whole grains.
As supplements: Glucose Tolerance Factor Chromium or chromium picolinate.
Suggested daily dosage: Don't exceed 1,000 mcg a day of chromium supplementation because of potential toxicity.8