Diabetes Reversal
UNIT 2 |
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The Good News for Diabetics
Plant-based over Low-Carb diet Dietary Patterns and Risks Plant-based diets to lower Risk for Diabetes Can Everyone Disarm Diabetes Why Plant-based Foods are Protective Article Review Video on Demand Review |
OBJECTIVES:
- Describe the effect of Plant-based over Low-Card diet in Diabetes
- Identify possible dietary patterns and risks
- Discuss how Diabetes can be reversed
- Explore the relation of different types of food sources to Diabetes risk
- Brenda Davis, RD. Kick Diabetes Essentials.
- Bolla AM, Caretto A, Laurenzi A, Scavini M, Piemonti L. Low-Carb and Ketogenic Diets in Type 1 and Type 2 Diabetes.
- Neal Barnard, MD. Physicians Committee of Responsible Medicine
- Michael Greger, MD. Nutrition Facts
The Good News for Diabetics
Much of what you hear or read about diabetes is riddled with myths, and misconceptions. Here are few encouraging truths about diabetes, right up front.
- Diabetes is not a death sentence. A diagnosis of type-1 diabetes or type-2 diabetes does not mean a person will have to die earlier than his peers who do not have diabetes. While it's true that the risk for death among people with diabetes is about twice that of people without diabetes of similar age, the individual's lifestyle choices about diet and physical activity can have a tremendous influence on his health, well-being, and longevity. And the lifestyle option is often much better than the drug option. If well-informed choices is made, diabetes doesn't have to affect how healthy a person is, how good he feel, and how long he live. In fact, as a consequence of following a healthy lifestyle, there's a good chance he'll be able to live even longer than his peers who don't have diabetes, despite his diabetes!
- Having diabetes does not mean a person will have awful complications. Diabetes diagnosis does not mean will eventually go blind, require dialysis, and suffer the trauma of amputations. The commonsense lifestyle changes can drastically reduce and often eliminate such complications.
- Diabetes is not primarily genetic disease. Because your parents had diabetes does not mean you will, too. The only certainty is that is you live your life the way your parents did, you'll increase your chances of getting diabetes yourself and suffering the way they did.
- Type-2 diabetes is not something you catch like flu. While it's true that over 1.5 million new cases of adult diabetes will be diagnosed each year, almost all of these people developed their chronic disease through the foods they ate and other lifestyle choices, all of which were totally within their control.
- A diagnosis of type-2 diabetes does not mean you will have to take large doses of medicine for the rest of your life. Medications, including large doses of insulin, should not be the basis for diabetes care. Although some diabetes medicines can be effective and helpful, they are usually overprescribed, and often unnecessary, provided the patient is willing to make important lifestyle changes. A majority of our patients on Lifestyle Intervention program significantly reduce or eliminate at least some of their diabetes medicines - including their insulin - after just a short time. This is true even for people with type-1 diabetes: They must take some insulin in order to live, but for most of these patients, less insulin leads to better health. We also find that patients are able to reduce or eliminate many of their other medicines such as for cholesterol and high blood pressure. There is no magic pill or secret cure for diabetes; the power comes from the choice the patient make each day.
- It is not best to place diabetes management solely in the hands of your doctors. It is important for patients to take responsibility for their disease. An educated, proactive patient will work cooperatively with an encouraging doctor, jointly making key decisions for conquering the disease.
- Diabetes is not uncontrollable. Studies are showing that 90 to 95 percent of patients' health outcomes are attributable to lifestyle factors. Even type-1 diabetes, though it's not curable, can be made much easier to live with through wise lifestyle choices.
Plant-based over Low-Carb Diet
Low-carb diets, particularly ketogenic diets, do reduce the need tor insulin and do lower and stabilize blood glucose, However, they do not reverse insulin resistance. In fact, if people who eat a low-carb diet are challenged with a load of carbohydrate (such as a bowl of oatmeal), they tend to have huge spikes in blood glucose because they remain as insulin resistant. Of course, any strategy that produces sufficient weight loss will improve markers of diabetes. However, weight loss can be achieved by eating almost any combination of foods, just as long as an adequate caloric deficit is produced.
So although there are wildly divergent methods of producing weight loss and improving glycemic control, it makes sense to opt for the way that will best minimize health risks over the long term. It seems wise to select a pattern of eating that reduces the chances of developing heart disease, cancer, intestinal disorders, hypertension, and other lifestyle-induced diseases. Plant-based diets are associated with the greatest longevity and the lowest rates of chronic diseases of all dietary patterns. They maximize the most protective dietary components and minimize those that are the most pathogenic.
There is, for starters, no evidence that ketogenic diets are conducive to, or even compatible with, human health across the lifespan, or longevity. To date, every population group around the world found to experience remarkable vitality and longevity has a dietary pattern in which whole, nutrient-rich plant foods predominate, the very opposite of ketogenic. Vitality and longevity even in the last of the planets hunter-gatherers, or foragers, is similarly linked to a plant-predominant, high-carbohydrate diet.
There is, as well, the inconvenience factor of being on a "diet" for the rest of ones life. The argument for ketogenic diets reeks of fad because, like all fad diets, the benefits derive from eliminating most of the foods most people around the world like to eat. While such diets are likely to be harmful to the health of people, they are certain to be devastating for the fate of the planet. The clamor for ketogenic diets is at odds with every trend necessary to preserve our aquifers, wild places, biodiversity, and climate. So maybe a diet low in vegetables, fruits, whole grains, beans, lentils, nuts and seeds, a diet low in antioxidants and phytonutrients and devoid of fiber could be good for you in spite of it all.
There is, as well, the inconvenience factor of being on a "diet" for the rest of ones life. The argument for ketogenic diets reeks of fad because, like all fad diets, the benefits derive from eliminating most of the foods most people around the world like to eat. While such diets are likely to be harmful to the health of people, they are certain to be devastating for the fate of the planet. The clamor for ketogenic diets is at odds with every trend necessary to preserve our aquifers, wild places, biodiversity, and climate. So maybe a diet low in vegetables, fruits, whole grains, beans, lentils, nuts and seeds, a diet low in antioxidants and phytonutrients and devoid of fiber could be good for you in spite of it all.
Dietary Patterns and Risk
Overall dietary patterns have been carefully examined by researchers. Those patterns that are more plant-based consistently come out as being the most highly protective against both prediabetes and type 2 diabetes. In 2011, a research group from Spain released an extensive review of diabetes and dietary patterns. The study authors concluded that along with the maintenance of ideal body weight, the promotion of a prudent diet (characterized by a higher intake of plant-based foods and a lower intake of red meat, meat products, Sweets, high-fat dairy products, and refined grains) or a Mediterranean dietary pattern rich in olive oil, fruits, and vegetables, including whole grains, pulses (legumes), nuts, and low fat dairy products and allowing moderate alcohol consumption (mainly red wine) appears to be the best strategy for decreasing diabetes risk. The observational studies reviewed in this report found two categories of foods clearly associated with elevated diabetes risk: animal products and processed foods. This includes red meat, processed meat, high-fat dairy products, packaged foods containing trans fats, fried foods, soft drinks, and foods high in refined carbohydrates (such as white flour and sugar). The dietary factors most strongly associated with decreased risk were plant-based foods or food components, such as vegetables, fruits, whole grains, and fiber.
In 2014, a team of experts rom the Harvard School of Public Health released a comprehensive review that examined the evidence surrounding the prevention and management of diabetes. Dietary factors associated with increased risk were excessive energy intakes leading to overweight or obesity, higher intake of saturated and animal fat, carbohydrate-rich foods with a high glycemic index and load, refined grains sugar-sweetened beverages, high iron stores, and low vitamin D status. Frequent consumption of red meats, especially processed red meats (such as bacon, sausages, and hot dogs), was strongly associated with higher diabetes risk. Intake of green leafy vegetables lowered risk, as did intake of whole fruits (such as apples, blueberries, and grapes). Dairy product intake was associated with a moderately lower diabetes risk, with yogurt intake being more beneficial than other dairy products. Consumption of nuts, especially walnuts, was associated with reduced diabetes risk. The authors concluded that the most healthful dietary patterns for diabetes prevention and management are typically rich in whole grains, fruits, vegetables, nuts, and legumes; and are lower in refined grains, red and processed meats, and sugar-sweetened beverages.
In 2014, a team of experts rom the Harvard School of Public Health released a comprehensive review that examined the evidence surrounding the prevention and management of diabetes. Dietary factors associated with increased risk were excessive energy intakes leading to overweight or obesity, higher intake of saturated and animal fat, carbohydrate-rich foods with a high glycemic index and load, refined grains sugar-sweetened beverages, high iron stores, and low vitamin D status. Frequent consumption of red meats, especially processed red meats (such as bacon, sausages, and hot dogs), was strongly associated with higher diabetes risk. Intake of green leafy vegetables lowered risk, as did intake of whole fruits (such as apples, blueberries, and grapes). Dairy product intake was associated with a moderately lower diabetes risk, with yogurt intake being more beneficial than other dairy products. Consumption of nuts, especially walnuts, was associated with reduced diabetes risk. The authors concluded that the most healthful dietary patterns for diabetes prevention and management are typically rich in whole grains, fruits, vegetables, nuts, and legumes; and are lower in refined grains, red and processed meats, and sugar-sweetened beverages.
The 2018 Clinical Practice Guidelines for Nutrition Therapy (Diabetes Canada reviewed the scientific literature on dietary patterns and diabetes risk. The patterns most consistently associated with reduced risk were Mediterranean diets, vegetarian diets, DASH diets, the Portfolio Diet, and the Nordic diet (a combination of Mediterranean, DASH, and National Cholesterol Education Program dietary patterns). In all of these diets, emphasis is placed on whole plant foods: vegetables, fruits, legumes, whole grains, and nuts and seeds. Some recommend moderate amounts of low-fat dairy products and fish; some suggest the addition of olive oil. Others suggest the use of vegetable protein rather than animal-protein sources. All advocate for low intakes of meat, especially red and processed meats, relined carbohydrates, and sugar-sweetened beverages.
In 2016, an innovative Harvard study that looked at specific plant-based dietary patterns and risk was published. In this report, researchers examined different types of plant-based diets to ascertain which would be most protective. They used data from the Nurses' Health Study and the Health Professionals Follow-Up Study, including over 130,000 individuals. They created a healthful plant-based diet index (hPDI), in which nutritious plant foods (whole grains, fruits, vegetables, nuts, legumes, vegetable oils, tea, and coffee) received positive scores, while less-nutritious plant foods (fruit juices, sweetened beverages, refined grains, potatoes, sweets, and desserts) and animal products received negative scores. They also created an unhealthful plant-based diet index (uPDI) by assigning positive scores to less healthy plant foods and negative scores to healthy plant foods and animal products. The hPDI was associated with a 45 percent reduction in diabetes risk, although this dropped to 34 percent when adjusted for body mass index. The uPDI was associated with a l0 percent increase in diabetes risk, even after BMI adjustment. Plant-based diets are well recognized by scientists as being the dietary patterns associated with the greatest reduction in type 2 diabetes risk. The plant-based diets that are most protective are those that rely on whole plant foods as their foundation.
Plant-based Diets to Lower Risk for Diabetes
There is no controversy: People who eat mainly plants suffer less type 2 diabetes. The most impressive evidence to date comes from the Adventist Health Study-2 (AHS-2) and the Taiwanese Buddhist studies. In the AHS-2, compared to health-conscious nonvegetarians, vegans had the lowest odds of having diabetes, followed by lacto-ovo vegetarians, pesco-vegetarians (who occasionally eat fish), and semi-vegetarians (who occasionally add meat). Data was adjusted tor all confounding variables except body mass index (BMI). However, when BMI was also adjusted for, the differences were still remarkable. When the participants who did not have diabetes were followed for two years, the odds of developing diabetes (when adjusted for all factors, including BMI) was lowest among vegans.
In 2014, a research group from Taiwan published findings that compared diabetes rates in health-conscious Taiwanese Buddhist volunteers who consumed vegetarian (near-vegan) or omnivorous diets. Alter adjustments for age, BMI, education, family history of diabetes, physical activity, smoking, and alcohol consumption, vegetarian (near-vegan) diets lowered risk by 51 percent in men, by 74 percent in premenopausal women, and by 75 percent in postmenopausal women. In 2018, almost three thousand Taiwanese Buddhists who were free of diabetes were followed for a median of five years to see who would develop diabetes. Consistent intake of vegetarian diets was associated with a risk reduction of 35 percent, while converting from a nonvegetarian to a vegetarian pattern was associated with a risk reduction of 53 percent.
In 2008, an AHS-2 study reported that participants who consumed meat weekly were 29 percent more likely to develop diabetes. Participants who consumed any amount of processed meat were 38 percent more likely to develop diabetes, and those who had long-term adherence to a diet that included at least weekly meat intake was associated with an increase in risk of 74 percent. Even after controlling for weight (body fatness) and weight change, weekly meat intake increased diabetes risk by 38 percent.
In 2014, a research group from Taiwan published findings that compared diabetes rates in health-conscious Taiwanese Buddhist volunteers who consumed vegetarian (near-vegan) or omnivorous diets. Alter adjustments for age, BMI, education, family history of diabetes, physical activity, smoking, and alcohol consumption, vegetarian (near-vegan) diets lowered risk by 51 percent in men, by 74 percent in premenopausal women, and by 75 percent in postmenopausal women. In 2018, almost three thousand Taiwanese Buddhists who were free of diabetes were followed for a median of five years to see who would develop diabetes. Consistent intake of vegetarian diets was associated with a risk reduction of 35 percent, while converting from a nonvegetarian to a vegetarian pattern was associated with a risk reduction of 53 percent.
In 2008, an AHS-2 study reported that participants who consumed meat weekly were 29 percent more likely to develop diabetes. Participants who consumed any amount of processed meat were 38 percent more likely to develop diabetes, and those who had long-term adherence to a diet that included at least weekly meat intake was associated with an increase in risk of 74 percent. Even after controlling for weight (body fatness) and weight change, weekly meat intake increased diabetes risk by 38 percent.
Can Everyone Disarm Diabetes?
The majority of people can disarm diabetes, though not everyone. If someone has sustained too much damage to their pancreas to produce sufficient insulin, their diabetes may be chronic regardless of which dietary pattern they follow. They may overcome insulin resistance, reduce lipotoxicity, overcome inflammation and oxidative stress, and reestablish a healthy gut microbiome, yet their blood sugars won't completely normalize. Preliminary evidence suggests that in the face of huge insulin demands, beta cells can become overwhelmed and go into a dormant or resting state. In most cases, it appears that these cells can be turned back on when insulin sensitivity is restored and insulin demands are diminished. This means that in many people with diabetes, beta cell function can be recovered. Generally, the degree of achieved weight loss is the main determinant of remission. However, the longer a person has the disease, the more challenging complete reversal becomes.
In people who have had the disease for a long time, a greater degree of weight loss appears to be necessary for reversal than is needed in people who have developed the disease more recently. It can be devastating to make sufficient lifestyle changes to reverse insulin resistance only to discover that your pancreas is too damaged to reverse your diabetes. No matter how brilliantly your diet is designed and how physically active you become, if you're in this group, you'll require injected insulin for the rest of your life because your pancreas function can no longer meet your body's insulin needs. However, regardless of your insulin production, overcoming insulin resistance itself will dramatically improve your health and quality of life. Restoring your body's insulin sensitivity reduces your risk tor many conditions, including heart disease, hypertension, certain types of cancer, and dementia. Overcoming insulin resistance also means that you will need the lowest possible insulin doses, which effectively reduces your risk for the most dreaded complications of diabetes.
In people who have had the disease for a long time, a greater degree of weight loss appears to be necessary for reversal than is needed in people who have developed the disease more recently. It can be devastating to make sufficient lifestyle changes to reverse insulin resistance only to discover that your pancreas is too damaged to reverse your diabetes. No matter how brilliantly your diet is designed and how physically active you become, if you're in this group, you'll require injected insulin for the rest of your life because your pancreas function can no longer meet your body's insulin needs. However, regardless of your insulin production, overcoming insulin resistance itself will dramatically improve your health and quality of life. Restoring your body's insulin sensitivity reduces your risk tor many conditions, including heart disease, hypertension, certain types of cancer, and dementia. Overcoming insulin resistance also means that you will need the lowest possible insulin doses, which effectively reduces your risk for the most dreaded complications of diabetes.
Why Plant-based Foods are Protective?
Research points convincingly to the success of vegan diets in helping people disarm diabetes, but why? Are all plant foods beneficial, or are some better than others: What specific factors in these foods make them so effective for overcoming insulin resistance the answers lie not only in what vegan diets contain but also in what they eliminate.
Protective Effects of Plant-Based vs Low-Carb Diets
Protective Dietary Factors |
Health Effects |
Presence in Plant-based Diet |
Presence in Low-Carb Diet |
Fiber |
Improves gut microbiome; prevents constipation and other GI disorders; reduces risk of colorectal cancer, gallstones, cardiovascular disease, diabetes, and overweight. |
High. Plants are the only sources. Legumes and grains are the most concentrated sources. |
Low. The only sources are the limited plant foods included. Richest dietary sources (legumes and grains) are excluded. |
Phytochemicals |
Antioxidant and anti-inflammatory action. Block tumor formation; reduce inflammation; eradicate carcinogens; fight viruses, bacteria, and fungi; and protect blood vessels. |
High. Plant foods are the only sources. |
Low to moderate, depending on degree of carbohydrate restriction. |
Plant enzymes |
Help turn certain phytochemicals into their active forms; may aid digestion. |
High. Concentrated in raw sprouted plant foods. |
Variable, depending on degree of carbohydrate restriction and inclusion of raw sprouted foods. |
Antioxidants |
Protect against free radicals and oxidative stress; potentially reduce risk of artery damage, cancers, arthritis, cataracts, stroke, and other diseases. |
High. Most whole plant foods are rich sources, so almost everything consumed will contribute to overall intake. |
Variable. Intake depends on inclusion of plant foods, herbs and spices, coffee, cocoa, and tea. Animal products contain smaller amounts. |
Pre- and probiotics |
Support a healthy gut microbiome, protect against pathogens, boost nutritional status, reduce cancer risk, keep the intestinal wall healthy, support immune function, reduce inflammation, promote healthy body weight, and support brain function. |
Probiotics: variable, depending on use of fermented and cultured foods. Prebiotics: high. Prebiotics come exclusively from plant foods, such as beans, whole grains, and some vegetables and fruits. |
Probiotics: variable, depending on use of fermented and cultured foods. Prebiotics: low to moderate, as the only sources (plants) are restricted. |
Plant sterols and stanols |
Reduce cholesterol absorption from the gut, lowering total and LDL cholesterol. Blunt inflammation pathways. |
Variable. Depending on intake of high-fat plant foods (such as nuts, seeds, avocados, wheat germ, and vegetable oils) and other plant foods, such as sprouts. |
Variable. Depending on intake of high-fat plant foods (such as nuts, seeds, avocados, wheat germ, and vegetable oils) and other plant foods such as sprouts. |
Macronutrients (carbohydrate, protein, and fat) |
Provide energy, help with building and rebuilding of body tissues, and provide structure and function |
Variable: Whole-food, plant-based diets provide a healthful balance of macronutrients. Plant-based protein is associated with disease risk reduction. Carbohydrates from whole plant foods are consistently protective to health. Unprocessed plant-based fats are associated with disease risk reduction. Omega-3 fats must be included. |
Low-carb diets provide an unhealthy balance of macronutrients. In practice, animal-protein intake often exceeds healthful limits. Unrefined carbohydrate and fiber is too low. Intake of healthy fats is generally more than adequate; disproportionately high in saturate fat. |
Micronutrients |
Vitamins and minerals perform hundreds of roles. They support tissue and bone growth and repair, heal wounds, boost immune function, convert food into energy, and participate in essential chemical reactions. One measure of nutritional adequacy is nutrient density - the amount of vitamins and minerals (and sometimes other protective factors, such as fiber0 in a food. |
High. The most nutrient-dense foods are green leafy vegetables, followed by other vegetables, fruits, legumes, fish, nuts and seeds and grains. |
Low to moderate. One of the concerns about low-carb diets is nutritional deficiencies. The food with the lowest nutrient density is concentrated fat (which is almost devoid of vitamins and minerals). Fried foods, cheese, meat, and eggs also have low nutrient density. |
Pathogenic Effects of Plant-Based vs Low-Carb Diets
Pathogenic Dietary Factors |
Health Effects |
Presence in Plant-based Diets |
Presence in Low-Carb Diets |
Trans-fatty acids |
Increase risk of cardiovascular disease, diabetes, and other chronic diseases. They are the most damaging fats of all. |
Zero or low. Plant-based diets minimize processed foods that contain manufactured trans-fatty acids and eliminate animal products, which may contain natural trans-fatty acids. |
Low to moderate. Although foods containing manufactured trans-fatty acids are minimized or excluded, fatty animal products with natural trans fats are generously consumed. Although less harmful than manufactured trans fats, both impair insulin sensitivity and increase oxidative stress. |
Excessive saturated fat |
Increases total and LDL cholesterol and risk of cardiovascular disease; impairs insulin sensitivity. |
Low. Plant-based diets are generally the only diets that meet the recommended limit of 5-6 percent saturated fat to reduce heart disease risk. |
Very high. Saturated fat varies from 20-50 percent of total calories. The upper limit for saturated fat in a 2000 kcal diet is about 22 grams based on the upper limit of 10 percent set for the general population. A typical low-carb diet providing 70 percent of calories from fat could easily contain over 90 grams of saturated fat. |
Refined carbohydrates |
Increase risk of overeating and obesity, promote fatty liver, increase insulin resistance and diabetes risk, and adversely affect blood lipids and cardiovascular disease risk. |
Low to moderate. Most plant-based diets promoted for disease risk reduction dramatically reduce refined carbohydrates and rely on whole plant foods. However, some permit the use of white rice and some white flour. |
Zero to very low. As carbohydrates are limited primarily to vegetables, refined carbohydrate foods are eliminated. |
Excessive animal protein |
Consistently linked to increases in all causes of mortality and increased risk of heart disease, diabetes, and several cancers. |
Zero to very low. Most plant-based diets exclude animal protein, although some allow 5-10 percent. Excessive intake is not an issue. |
High. Low-carbohydrate diets are generally high animal-protein diets. Many contain 20-25 percent of calories from protein, which has been associated with increased mortality and disease risk in many scientific studies. |
Excessive sodium |
Increases risk of hypertension and cardiovascular disease, osteoporosis, and some cancers. People with diabetes who have poor blood glucose control are at very high risk for cardiovascular disease with high sodium intakes. |
Variable, depending on sodium added to foods and use of condiments and processed foods. |
Variable, depending mostly on sodium added to foods and use of condiments, as well as use of processed meat and cheese. |
Chemical contaminant |
Increase oxidative stress, fuel inflammation, disrupt hormones (obesogenic), damage vital organs, damage DNA and the central nervous system, and increase risk of diabetes and other chronic diseases. |
Low to Moderate. Pesticide residues from conventional produce can be contributors. Organic foods contain much less. Very low in heavy metals (except for arsenic in rice), drugs given to animals, and persistent organic pollutants (POPs), such as PCBs, DDT, and dioxins. |
Moderate to high. POPs become more concentrated as they are moved up the food chain, with the most in fish and meat. Heavy metals are highest in fish, shellfish, meat, and dairy products. Heavy metals are concentrated in fish and chicken. Hormones, antibiotics, and antimicrobial agents come mainly from meat, poultry, dairy, and fish. |
Products of high temperature cooking |
Increase risk of cancer, diabetes, Alzheimer's disease, and other chronic conditions. Promote oxidative stress and inflammation. |
No heterocyclic amines. Presence of polycyclic aromatic hydrocarbons varies with cooking methods: higher with dry heat and high temperatures. Acrylamides vary with use of potato products (especially when cooked with dry heat or fried) AGEs vary but are generally low. |
Heterocyclic amines are generally high, formed with high-temperature cooking of meat, poultry, and eggs. Polycyclic aromatic hydrocarbons vary; higher with dry heat and high temperatures, especially frying. Acrylamides are generally low, as most of the concentrated sources are potato products. AGEs are generally high, most concentrated in processed meats. |
Heme iron |
Oxidative stress, Increases risk of insulin resistance, metabolic syndrome, diabetes, cardiovascular disease, and some cancers. |
Zero to very low. Only present in diets containing meat. |
High. |
Neu5Gc |
Induces inflammation and diseases triggered by inflammation. |
Zero to very low. Only present in diet containing meat. |
Variable. Increases as red meat increases. |
TMAO |
Induces inflammation, contributes to plaques formation and kidney disease. |
Zero to very low. Only formed with meat consumption or intake of fish. |
High. Formed with meat consumption or direct intake from fish. |
Endotoxins |
Associated with inflammation, insulin resistance, diabetes, and obesity. |
Low. Animal products are the primary sources. |
Moderate to high. Found in the outer cell membranes of gram-negative bacteria. Come from the breakdown of gut bacteria or food bacteria (meat, poultry, and dairy products). |
Research has clearly demonstrated that healthful lifestyle choices can change the expression of our genes, turning off disease-promoting genes and turning on disease-preventing genes. With the appropriate choices, experts estimate that we could prevent 90 percent of type 2 diabetes, and there is strong consensus that diet is the priority. Adopting healthy diet and lifestyle choices after the onset of type 2 diabetes can change the course of the disease and, in some cases, reverse it altogether.
So what is it about eating plants that gives people an advantage? There are two factors that are crucial: (1) Plant-based diets maximize the dietary components proven to be protective to human health, and (2) plant-based diets minimize the dietary components that are known to be harmful.
Part of the reason people eating plant-based diets are protected is because they are less likely to be overweight or obese. However, it's the inherent nutritional profile of plants that affords the lion's share of the protection. The dietary components that are most strongly tied to risk reduction are concentrated in plants. These dietary components help protect against obesity, insulin resistance, inflammation, oxidative stress, lipotoxicity, glucotoxicity, and dysbiosis. They essentially disable the key drivers of the disease. Consequently, they not only protect but also improve outcomes and increase the chances of recovery. There are a number of these protective dietary components that are particularly notable.
Fiber
This indigestible part of plants helps control blood sugar, lowers blood cholesterol, keeps the gastrointestinal system healthy, encourages a health-supportive mix of gut bacteria, and aids with weight loss by staving off hunger. All whole plant foods contain fiber; it provides their shape and structure. Animal flesh foods, dairy products, sugar, and oil provide none.
Multiple studies have demonstrated an inverse relationship between fiber intake and diabetes risk - the more fiber you eat, the lower your risk. Once recent meta analysis of seventeen studies, including almost five hundred thousand participants and over nineteen thousand incident cases of type 2 diabetes, reported a 6 percent decrease in diabetes risk for every 2 grams of fiber consumed. Diabetes risk was reduced as follows:
Multiple studies have demonstrated an inverse relationship between fiber intake and diabetes risk - the more fiber you eat, the lower your risk. Once recent meta analysis of seventeen studies, including almost five hundred thousand participants and over nineteen thousand incident cases of type 2 diabetes, reported a 6 percent decrease in diabetes risk for every 2 grams of fiber consumed. Diabetes risk was reduced as follows:
|
|
Although data wasn't provided for people who consumed higher amounts, we can do the math. A person eating a whole-foods, plant-based diet would easily consume 50 grams of fiber per day. If we consume a 34 percent risk reduction for 35 grams, this would mean adding an extra 15 grams of fiber. Based on the general estimate of 6 percent per 2-gram increase, risk reduction would be about 79 percent (34 + 15/2 x 6). This figure is very similar to the actual risk reduction reported in people who eat a 100 percent plant-based diet.
Higher fiber intakes have also been associated with better outcomes for people who have diabetes - weight loss improved glycemic control, better insulin sensitivity, and a healthier gut microbiome.
Higher fiber intakes have also been associated with better outcomes for people who have diabetes - weight loss improved glycemic control, better insulin sensitivity, and a healthier gut microbiome.
Phytochemicals
Thousands of protective phytochemicals (plant chemicals) cut the risk of type 2 diabetes and enhance the potential for effective dietary treatment. Phytochemicals accomplish these tasks by reducing inflammation and oxidative stress, improving the balance of gut microbiota, improving fasting blood glucose and insulin sensitivity, preventing weight gain, slowing or reducing carbohydrate absorption, stimulating insulin secretion from the pancreas, activating insulin, and promoting insulin signaling.
Phytochemicals also add glorious color and flavor to plant foods. Like fiber, phytochemicals are plentiful in plants but absent from animal products. Examples of phytochemicals known to afford protection are curcumin in turmeric, capsaicin in hot chiles, gingerol in ginger, resveratrol in grapes and berries, genistein in soy, and quercitin in onions.
Phytochemicals also add glorious color and flavor to plant foods. Like fiber, phytochemicals are plentiful in plants but absent from animal products. Examples of phytochemicals known to afford protection are curcumin in turmeric, capsaicin in hot chiles, gingerol in ginger, resveratrol in grapes and berries, genistein in soy, and quercitin in onions.
A review of curcumin and diabetes reported improvements in inflammation, oxidative stress, hyperglycemia, insulin sensitivity, hyperlipidemia (high blood lipids), and beta cell dysfunction or death. In addition, curcumin ameliorates many of the complications of diabetes, including neuropathy, neuropathy (kidney damage), and vascular disease. Capsaicin has been reported to suppress inflammation, improve insulin resistance and glucose tolerance, and improve blood lipids. A meta-analysis of ten studies reported a significant beneficial effect of ginger on blood glucose control and insulin sensitivity in people with type 2 diabetes. Resveratrol may improve glucose control, decrease insulin resistance, protect pancreatic beta cells, improve insulin secretion, and reduce oxidative stress and inflammation. Genistein, derived from soy, has been shown to protect pancreatic beta cells and reduce obesity-related low-grade inflammation. Quercetin, a key phytochemical in onions, berries, apples, and other vegetables and fruits, exhibits positive effects on gene expression, fat metabolism, and inflammation and reduces the risk of obesity. It has also been shown to stimulate glucose uptake and reduce glucose production in the liver. in human studies, quercetin decreases the signs and symptoms of neuropathy.
Plant Enzymes
Raw plant foods contain enzymes that help to convert specific phytochemicals into their active forms. The most plentiful sources of these important plant enzymes are raw cruciferous and Allium vegetables. For example, an enzyme called myrosinase in cruciferous vegetables (such as arugula, broccoli, Brussels sprouts, cabbage, cauliflower, collards, kale, kohlrabi, radishes, turnips, and watercress) helps to convert a group of phytochemicals called glucosinolates into an active form called isothiocyanates. The active compounds help us process and eliminate harmful substances. Another enzyme called alliinase in Allium vegetables (such as chives, garlic, leeks and onions) converts a phytochemical called alliin to allicin, its active form. Allicin has antimicrobial, antiviral, and antifungal properties. It lowers cholesterol and fights inflammation. The enzymes myrosinase and alliinase are released in plants when the food is chopped, mashed, blended, or chewed. Once released, the conversion of phytochemicals into their active forms begins. Cooking foods destroys some or all of these enzymes, depending on how long they are cooked and the temperature used. Although we have not yet identified enzymes in other plant foods that serve in this capacity, this is a relatively new area of research, so we can expect others may soon be discovered.
Antioxidants
Common antioxidants that protect from free radicals and oxidative stress are vitamins C and E, selenium, carotenoids, and flavonoids. The most concentrated sources of antioxidants are colorful vegetables, fruits, herbs, spices, legumes, whole grains, nuts, and seeds.
One recent review reported that carotenoids enhance insulin sensitivity and protect the body from long-term complications of diabetes, including nephropathy and nervous system and eye abnormalities. Another review reported that insufficient dietary antioxidants, such as beta-carotene, vitamin C, and vitamin E, can induce oxidative stress and inflammation, especially in people who are obese. Oxidative stress, in turn, induces beta cell dysfunction, insulin resistance, and complications of diabetes.
One recent review reported that carotenoids enhance insulin sensitivity and protect the body from long-term complications of diabetes, including nephropathy and nervous system and eye abnormalities. Another review reported that insufficient dietary antioxidants, such as beta-carotene, vitamin C, and vitamin E, can induce oxidative stress and inflammation, especially in people who are obese. Oxidative stress, in turn, induces beta cell dysfunction, insulin resistance, and complications of diabetes.
Pre- and Probiotics
prebiotics are food for beneficial bacteria, stimulating their growth and activity. The best sources are plants with indigestible sugars, such as asparagus, bananas, chicory, garlic, leeks, onions, and sweet potatoes. probiotics are beneficial bacteria that come in foods or supplements. The richest plant sources are sauerkraut, tempeh, miso, certain fermented beverages, naturally fermented vegetables, nondairy yogurts, and nut cheeses. Probiotics also can be taken as supplements. Prebiotics and probiotics can improve your community of gut microbes, which can reduce chronic inflammation, improve insulin sensitivity and insulin signaling, and control blood sugar. Eating foods with plenty of polyphenols can increase the population of good bacteria and reduce some particularly nasty bugs. Great sources include grapes, blueberries, cocoa, broccoli, almonds, and onions.
Omega-3 Fatty Acids
Omega-3 fatty acids, particularly the long-chain omega-3 fatty acid EPA (and DHA to a lesser extent), have impressive anti-inflammatory action. Alpha-linolenic acid (ALA) appears to have antiobesity effects, and all three omega-3s appear to improve insulin secretion and insulin sensitivity. These fatty acids are produced by microalgae (which is cultured for supplements) and are found in fish or produced internally from plant omega-3s in chia seeds, flaxseeds, hemp seeds, and walnuts.
Plant Sterols
With favorable effects on health, plat sterols are most concentrated in nuts and seeds (and their oils, avocados, and legumes (especially chickpeas, kidney beans, lentils, peas, soybeans). Lesser amounts are found in vegetables (especially cruciferous vegetables, such as Brussels sprouts, broccoli, and cauliflower, as well as corn, dill and parsley), fruits (especially oranges, and passion fruit), and whole grains. Although research is limited and often done using supplements rather than foods, plant sterols and stanols may reduce blood lipids, markers of oxidative stress and inflammation, and improve endothelial function.
Vegetables and Fruits
Studies consistently demonstrate that higher intakes of vegetables and fruits are associated with lower rates of types 2 diabetes. In the EPIC-Norfolk study, compared with participants in the bottom 25 percent (quartile) of intake, risk was reduced by 81 percent for those in the highest quartile, 66 percent for those in the second highest quartile, and 30 percent for those in the second lowest quartile. In a recent study from China, compared to the lowest quartile of fruit and vegetable intake, the risk of type 2 diabetes in women was 34 percent lower in the highest quartile of intake, 50 percent lower in the second highest quartile, and 9 percent lower in the second lowest quartile of intake. A meta-analysis of ten studies reported that for every serving of vegetables consumed per day, type 2 diabetes risk was reduced by 7 percent. For every 0.2 serving of green leafy vegetables per day (equivalent of 1/3 cup or 50 ml), risk was reduced 13 percent. Finally a meta-analysis of thirteen studies reported a minor risk reduction for type 2 diabetes of 2 percent with vegetable intake, although risk dropped a 7 percent risk reduction for the highest versus lowest fruit consumers, and risk fell by 10 percent when intakes reached 7-10.5 ounces (200-300g).
Legumes
Not only are legumes the richest dietary sources of fiber, but these protein powerhouses also have a very low glycemic index and are sources of a wide variety of bioactive compounds, such as phytochemicals and plant sterols. Studies consistently show that soybeans and other legumes improve insulin sensitivity and produce significant reductions in HOMA-IR (a measure of insulin resistance). On comprehensive review detailed the mechanisms of action, including antioxidant activities, increased glucose transporter levels, inhibition of adipogenesis (fat deposits), and improved gut microbiota.
One study of legume intake in over 150,000 participants in India reported that daily legume intake resulted in a 54 percent reduction in risk of type 2 diabetes in women and a 38 percent risk reduction in men (although the finding in men was not statistically significant). Weekly legume intake was associated with a 49 percent risk reduction in both men and women (all figures were adjusted for confounding variables, including BMI). In the Shanghai Women's health Study, risk of developing type 2 diabetes was 38 percent lower in those with the highest quintile of legume intake and 47 percent lower in those with the highest quintile of intake. A large meta-analysis reported a 13 percent risk reduction for the highest versus lowest soy consumers and a 26 percent risk reduction in women.
One study of legume intake in over 150,000 participants in India reported that daily legume intake resulted in a 54 percent reduction in risk of type 2 diabetes in women and a 38 percent risk reduction in men (although the finding in men was not statistically significant). Weekly legume intake was associated with a 49 percent risk reduction in both men and women (all figures were adjusted for confounding variables, including BMI). In the Shanghai Women's health Study, risk of developing type 2 diabetes was 38 percent lower in those with the highest quintile of legume intake and 47 percent lower in those with the highest quintile of intake. A large meta-analysis reported a 13 percent risk reduction for the highest versus lowest soy consumers and a 26 percent risk reduction in women.
Whole Grains
While refined grains are commonly associated with increased risk of type 2 diabetes, whole grains are consistently associated with reduced risk. In meta-analysis of sixteen studies, every three servings of whole grains per day was associated with a 34 percent risk reduction. In a second meta-analysis of sixty-six studies, participants consuming three to five servings of whole grains per day had a 26 percent lower risk of type 2 diabetes than those who rarely or never consumed whole grains. In a third meta-analysis of thirteen studies, a 23 percent risk reduction was reported in the highest versus lowest whole-grain consumers. Each serving of whole grains resulted in a 13 percent risk reduction. A recent Danish study reported that for every whole-grain serving, type 2 diabetes risk was reduced by 11 percent for men and 7 percent for women.
Nuts
A recent study from the Middle East of almost two thousand participants reported that people consuming at least four servings, each serving being 1 ounce (30g), of nuts per week had a 53 percent lower risk of diabetes than those consuming less than one serving per week, when the data was fully adjusted for confounding variables. In a meta-analysis of eighteen studies, each serving per day of nuts reduced the risk of type 2 diabetes by 20 percent, although this effect was reduced when adjusted for BMI.
Seeds
Although there are few studies looking at the association between seed consumption and type 2 diabetes, it makes sense that there would be more impressive findings with seeds than with nuts based on their nutrient profile (more fiber, essential fatty acids, and trace minerals than nuts). A 2017 study reported that 1 ounce of chia or flaxseeds favorably affected blood glucose response, with chia being slightly more effective than flax.
Western Diet
Just as there are dietary components that are protective against diabetes, there are components that can be pathogenic, increasing risk or accelerating the disease and its complications. There are a number of specific "fiends" in foods that are associated with both promotion and progression of diabetes.
Refined Carbohydrates
Although carbohydrates have been vilified in the popular press, the amount of carbohydrate in someone's diet does not appreciably influence diabetes risk. Rather, it is the quality of carbohydrates that determines health outcomes. Refined carbohydrates with a high glycemic index and glycemic load are particularly problematic, while carbohydrates intrinsic to whole plant foods are protective. Refined carbohydrates have been stripped of fiber and other protective components. They are consumed as sugars (such as white or brown sugar or syrups) or as sugars that are a major component of sweet items (such as beverages, candies, jams, jellies, and gelatin-based desserts), starches (such as sugar and white flour in cakes, pies, and cookies). Refined carbohydrates promote overeating and obesity, fuel inflammation, impair immunity, promote insulin resistance, increase blood sugar levels and triglycerides, and contribute to nonalcoholic fatty liver disease (NAFLD).
Trans-Fatty Acids
Trans fats are the most damaging fats in the diet. They're formed when fats are turned from liquid oils to solids during hydrogenation (adding hydrogen under pressure). A 2018 study of US adults reported that those with the highest intakes of trans-fatty acids (from all sources) had more than double the risk of type 2 diabetes compared with those eating the least. Trans fats increase insulin resistance, adversely affect glucose metabolism, boost LDL (bad cholesterol) and triglycerides, and decrease HDL (good cholesterol). The main sources are shortenings and processed and deep-fried foods containing partially hydrogenated oils.
Saturated Fat
Although saturated fat is present in all whole foods, it is most concentrated in animal products and tropical oils. Generally, the more solid a fat is at room temperature, the greater the percent of the total fat that is saturated. Approximately 11 percent of the calories in most American diets come from saturated fat, with low-carbohydrate diets often containing 20 percent or more. The US Dietary Guidelines recommend that saturated fat account for less than 10 percent of total calories. Only 29 percent of Americans achieve that goal. According to the American College of Cardiology and the American heart Association, people who are at high risk for heart disease 9such as individuals with type 2 diabetes) are advised to limit saturated fat to not more than 5-6 percent of total calories. Saturated fat is associated with insulin resistance, inflammation, reduced insulin secretion from the pancreas, and increased blood cholesterol levels.
Food sources that contribute the highest amounts of saturated fat in the US are dairy cheeses and desserts, pizza, processed meats, grain-based desserts (made with ingredients such as butter, eggs, and coconut oil), burgers, cow's milk, eggs, butter, and potato chips. Although tropical oils contain a higher percentage of calories from saturated fat than animal products, total intake from these oils has traditionally been much smaller. This is beginning to change with the rise in popularity of coconut products and tropical oils used in place of partially hydrogenated fats in processed foods . Fifty to 87 percent of the fat in tropical oils is saturated, with coconut oil being at the highest end of this range. This compares to over 60 percent in dairy, about 40 percent in meat, 30 percent in chicken, and 20-30 percent in fish. The fat in plant foods (with the exception of tropical oils) ranges from 10-20 percent saturated.
Products of High-Temperature Cooking
Cooking at high temperatures can generate products of oxidation that are damaging to human health. These substances contribute to oxidative stress and inflammation and can contribute to the development and progression of disease, including diabetes. The most notorious are heterocyclic amines (HCAs), polycyclic aromatic hydrocarbons (PAHs), and advanced glycation end products (AGEs).
HCAs are chemicals that are formed when meat, poultry, and fish are subjected to high temperatures, particularly with grilling, frying, or cooking with dry heat. They're not present in plant foods because the formation of HCAs requires the presence of the amino acids creatine or creatinine, and these compounds are found only in animal tissue. HCAs have been linked to increased diabetes risk, whether the source is red meat or chicken. In a recent study of over 138,000 individuals, the risk of developing type 2 diabetes was 28 percent higher in those eating meat cooked with an open flame or at high temperatures more than fifteen times a month compared with those eating it less than four times a month.
PHAs are a group of several hundred chemically related compounds that are formed by the incomplete burning of organic substances, including foods that are heated to temperatures above 30 degrees F (176 degrees C). The most concentrated dietary sources are grilled or charred meat, poultry, or fish: grain products; fats and oils; and sweets. Although grain products cooked with dry heat or grilling can contain relatively high levels, whole grains that are soaked, sprouted, boiled, or steamed are negligible sources. In a recent study of over 8,600 participants, the risk of developing type 2 diabetes was 73 percent higher in those with the highest quintile of exposure (top quarter of the participants) compared with those in the lowest quintile of exposure (bottom quarter of the participants).
AGES are harmful end products of fat oxidation or the Maillard reaction (browning of foods that occurs when sugars combine with amino acids). They are also produced within the body during sustained hyperglycemia (clevated blood glucose). AGEs are associated with oxidative stress, decreased glucose-stimulated insulin secretion, insulin resistance, and beta cell damage. The main sources are broiled, seared, or fried meats, especially processed meats, other grilled or fried foods; butter; margarine; and roasted nuts. Fructose forms AGES at a more rapid rate than glucose.
HCAs are chemicals that are formed when meat, poultry, and fish are subjected to high temperatures, particularly with grilling, frying, or cooking with dry heat. They're not present in plant foods because the formation of HCAs requires the presence of the amino acids creatine or creatinine, and these compounds are found only in animal tissue. HCAs have been linked to increased diabetes risk, whether the source is red meat or chicken. In a recent study of over 138,000 individuals, the risk of developing type 2 diabetes was 28 percent higher in those eating meat cooked with an open flame or at high temperatures more than fifteen times a month compared with those eating it less than four times a month.
PHAs are a group of several hundred chemically related compounds that are formed by the incomplete burning of organic substances, including foods that are heated to temperatures above 30 degrees F (176 degrees C). The most concentrated dietary sources are grilled or charred meat, poultry, or fish: grain products; fats and oils; and sweets. Although grain products cooked with dry heat or grilling can contain relatively high levels, whole grains that are soaked, sprouted, boiled, or steamed are negligible sources. In a recent study of over 8,600 participants, the risk of developing type 2 diabetes was 73 percent higher in those with the highest quintile of exposure (top quarter of the participants) compared with those in the lowest quintile of exposure (bottom quarter of the participants).
AGES are harmful end products of fat oxidation or the Maillard reaction (browning of foods that occurs when sugars combine with amino acids). They are also produced within the body during sustained hyperglycemia (clevated blood glucose). AGEs are associated with oxidative stress, decreased glucose-stimulated insulin secretion, insulin resistance, and beta cell damage. The main sources are broiled, seared, or fried meats, especially processed meats, other grilled or fried foods; butter; margarine; and roasted nuts. Fructose forms AGES at a more rapid rate than glucose.
Trimethylamine N-oxide (TMAO)
Trimethylamine N-oxide (TMAO) is an inflammatory compound that is formed in the body during the metabolism of primarily carnitine (red meat being the main source) or choline (eggs are the main source). Trimethylamine (TMA) is first produced by gut bacteria and then delivered to the liver, where enzymes convert it to TMAO. TMA and TMAO can also be consumed directly from fish. High-protein or high fat diets increase TMAO production, as do Western diets. Some vegetables (especially cruciferous vegetables, such as broccoli) and pistachios appear to reduce TMAO production. In addition, people eating plant-based diets appear to have far lower amounts of TMA-producing bacteria in their guts than people eating omnivorous diets.
TMAO has been linked to the prevalence of and poor prognosis in cardiovascular disease. It promotes vascular inflammation, plaque formation, and endothelial dysfunction. People with type 2 diabetes or chronic kidney disease have higher levels of TMA-producing bacteria. TMAO may also exacerbate impaired glucose tolerance and inhibit insulin signaling in the liver, thereby increasing risk or complications associated with the disease.
TMAO has been linked to the prevalence of and poor prognosis in cardiovascular disease. It promotes vascular inflammation, plaque formation, and endothelial dysfunction. People with type 2 diabetes or chronic kidney disease have higher levels of TMA-producing bacteria. TMAO may also exacerbate impaired glucose tolerance and inhibit insulin signaling in the liver, thereby increasing risk or complications associated with the disease.
Neu5Gc
This particular sugar molecule is produced in most mammals and found on their cell surfaces. Humans are an exception, completely lacking the ability to produce Neu5Gc, but it can be incorporated into human cells through the consumption of muscle meats, organ meats, and some dairy products. Neu5Gc has been associated with inflammation and cancer, and preliminary evidence suggests it may negatively affect endothelial function and aggravate atherosclerosis. As people with diabetes are at risk for these diseases, limiting or avoiding Neu5Gc may prove beneficial.
Endotoxins
Although the evidence is limited, endotoxins may induce obesity and insulin through an inflammation pathway. Endotoxins are complex molecules composed of fats and sugars (lipopolysaccharides) that are found in the outer membranes of particular types of bacteria (gram-negative), such as E. coli. They can come from gut bacteria or from dead bacteria in food. The most significant dietary sources are ground meat (such as hamburger), dairy products (such as yogurt, cheese, and ice cream), and chocolate.
Heme Iron
Heme iron is a highly absorbable form of iron that is present in animal products, such as meat, poultry, and fish. A recent review of the scientific literature reported a positive association between dietary heme iron, serum ferritin (iron stores), and risk of type 2 diabetes, A meta-analysis of nine studies reported a 73 percent increased risk for serum ferritin in participants with the highest versus lowest (top versus bottom fifth) intake. Three recent meta-analyses reported a 28-33 percent increased diabetes risk in people consuming the highest amounts of heme iron versus those with low intakes.
Excessive Sodium
An estimated 50-75 percent of people with type 2 diabetes have hypertension, with rates highest among obese adults. Diabetes and hypertension are a lethal combination, dramatically increasing the risk for heart attack or stroke and the chances of developing kidney or eye diseases. Sodium intake is positively associated with hypertension risk. Although no direct link between sodium intake and diabetes risk has been established, one study reported an almost two fold increase in diabetes risk tor those who regularly add salt to meals compared with those who never add salt.
A Japanese study of over 1,500 participants reported that in individuals with type 2 diabetes those eating the greatest amount of sodium had over double the risk of developing cardiovascular disease (CVD) compared with people eating the least. In addition, those with an HbA1C of 9 percent or above had an almost tenfold increase in CVD. American Heart Association recommends that people at risk for cardiovascular disease, including everyone with diabetes, limit sodium intake to 1,500 milligrams per day. The most concentrated sources of sodium are processed foods, which contribute about 75 percent of average intakes.
A Japanese study of over 1,500 participants reported that in individuals with type 2 diabetes those eating the greatest amount of sodium had over double the risk of developing cardiovascular disease (CVD) compared with people eating the least. In addition, those with an HbA1C of 9 percent or above had an almost tenfold increase in CVD. American Heart Association recommends that people at risk for cardiovascular disease, including everyone with diabetes, limit sodium intake to 1,500 milligrams per day. The most concentrated sources of sodium are processed foods, which contribute about 75 percent of average intakes.
Artificial Sweeteners
Although artificial sweeteners are often considered allies for people with type 2 diabetes, research suggests that they may have significant adverse health effects. In a large meta-analysis including seventeen studies, people wh0 always or almost always used artificial sweeteners had an 85 percent increased risk of type 2 diabetes compared with those who never or rarely consumed them. when results were adjusted for BMI (body fatness), there was still a 33 percent increase in risk. Artificial sweeteners have been shown to induce glucose intolerance through changes to the gut microbiota, so their use in people with diabetes is not advised.
As you go down the list of pathogenic dietary components, you will quickly notice that they are concentrated into two categories of foods: highly processed foods and animal products. These pathogenic factors have been linked to insulin resistance, inflammation, oxidative stress, dysbiosis, hormonal imbalances, high blood cholesterol levels, and hypertension. By minimizing or avoiding these components, you will maximize your disease-lighting capacity.
Animal Products and Processed Foods
Not surprisingly, intakes of specific animal products and processed foods are consistently associated with increased diabetes risk. Let's review the most recent evidence.
Red Meat
In a review of fifteen studies, red meat was associated with a 21 percent increased risk in the highest versus lowest consumers. Each 5.5-ounce (100-g) portion increased risk by 17 percent. Another review of thirteen studies was associated with a 22 percent increased risk in the highest versus lowest consumers.
Processed Meat
Processed meat is strongly and consistently asosciated with an increased risk of type 2 diabetes, as well as an increased risk of type 2 diabetes, as well as an increased risk of heart disease, cancer, and mortality. A review of eleven studies reported a 39 percent increase in diabetes risk for high versus low consumption of processed meat. Another review of fourteen studies reported a 27 percent increased type 2 diabetes risk for highest versus lowest consumers. For each 1.75-ounce (50-g) serving, risk was increased by 37 percent.
Poultry
Studies regarding poultry intake are less consistent than those tor red or processed meat. A recent study from Singapore reported a 1 Percent higher risk for participants in the highest versus lowest intake quartiles. It is interesting to note that this association disappeared when it was adjusted for heme iron intake, which suggests that heme iron was largely responsible for its adverse effects. One study reported a 22 percent increase in type 2 diabetes risk tor the highest quartile of consumers of chicken that had been cooked with an open flame or at high temperatures. Another study reported an 81 percent increase in risk of gestational diabetes in women consuming more than one serving of fried chicken per month.
Fish
In a review of nine studies, fish intake was associated with a 3 percent increase in type 2 diabetes risk in the highest versus lowest amount of fish consumption. In another meta-analysis of sixteen studies, the risk increased to 4 percent for the highest versus lowest fish consumption and to 9 percent for each additional daily 5.5 ounces (100 g) of intake, but the findings were not statistically significant. Generally a strong positive association was reported for fish intake and risk of type 2 diabetes in American studies, while an inverse association was reported in Asian studies. It is possible this could be explained by differences in methods of preparation or the type of fish consumed. For example, in China, stewing. braising, steaming, and quick stir-frying are the usual cooking methods, while grilling, barbecuing, broiling. pan-frying, and roasting are more widely practiced in Western countries. The study reported a 68 percent higher risk of gestational diabetes in women consuming at least one serving of fried fish per month compared to those consuming none. Fish with higher mercury content may also increase diabetes risk and adversely affect beta cells.
Dairy Products
Although research on the consumption of dairy products and diabetes has been mixed, a few studies have examined the risk associated with specific dairy subgroups. A study of more than 112,000 adults with prediabetes or recently diagnosed diabetes reported a 2 percent decrease in risk of prediabetes for every 100-gram serving of skimmed or fermented dairy products, such as low-fat yogurt and cheese. However, the risk of highest tertile (highest third) of full-fat dairy product consumption, by 8 percent for every 5-ounce (150-g) serving of milk, and by 5 percent for every 3.5-ounce (100-g) serving of nonfermented dairy. An earlier large, systematic review examined the evidence for the association of dairy consumption to the risk of cardiovascular-related outcomes, including type 2 diabetes. Low-fat dairy products and yogurt were associated with a reduced risk of type 2 diabetes, while high-fat milk and its products and fermented dairy had a neutral association. Another large review and meta-analysis of twenty-one studies reported a 9 percent reduction in type 2 diabetes risk in the highest versus lowest dairy consumers. For every 7-ounce (200-g) serving, risk fell 3 percent. However, the risk reduction was only observed in Asian and Australian studies, not in American or European studies.
Refined Grains
A meta-analysis and review of fifteen studies reported a 6-14 percent increased risk of type 2 diabetes in participants consuming 7-14 ounces (220-400g) of refined grains per day, although the risk was not increased with lower intakes. In a meta-analysis of four studies, the pooled diabetes risk was 55 percent higher in Asian populations consuming the highest versus lowest amounts of white rice and 12 percent higher among Western populations consuming the highest versus lowest intakes. It is important to note that in Asian populations consumption is three to four servings (1.5-2 cups/375-500ml) per day, while Western intakes are one to two servings (0.5-1 cups/125-250ml) per week. In the total population, type 2 diabetes risk increased by 11 percent for each serving of white rice consumed per day. In a study of 1,776 Chinese adults, intake of bread and noodles (not including rice noodles) was associated with almost 2.5 times the increased risk of diabetes, while the intake of coarse grains resulted in a 73 percent risk reduction. In a study examining the quality of carbohydrates consumed, higher carbohydrate intakes were not associated with diabetes risk. However, the highest versus lowest quintiles of starch (refined grains) intakes were associated with a 23 percent increased risk, while the highest versus lowest quintile of fiber intake was associated with a 20 percent risk reduction. Participants with the highest starch to cereal-fiber ratio (such as refined versus whole grains) had a 39 percent inereaseci diabetes risk.
Sugar-Sweetened Beverages
A review of ten studies reported a 30 percent increase of type 2 diabetes risk for the highest versus lowest consumers of sugar-sweetened beverages. Each serving of 1 can (250 ml) increased risk by 21 percent. A second review of eleven studies reported a 26 percent increased risk of developing type 2 diabetes in the highest versus lowest consumers of sugar-sweetened beverages (most often one to two Servings per day in the highest consumers).
Fast Foods and Fried Foods
Western dietary patterns rich in last foods and tried foods are consistently associated with increased risk of chronic disease, including type 2 diabetes. In a study of Western-style fast-food consumption in Singapore, participants with the most frequent intake of fast foods (two or more servings per week) had a 27 percent higher risk of developing diabetes and a 56 percent higher risk of dying of coronary heart disease. Another study from Sweden reporting on food environments and diabetes risk in over tour million individuals found that relative to individuals whose access to whole foods did not change, those who moved into areas that had more health-harming food outlets (such as fast-food restaurants) developed almost a fourfold increase in risk of developing type 2 diabetes. Among those who did not move, living in an area that increased access to health-harming food outlets was associated with a 72 percent increased risk of diabetes. In a large study of over fifteen thousand women, those who consumed fried foods more than seven times a week were at more than twice the risk of developing gestational diabetes than women who did not consume them. Consuming fried foods one to three times a week was associated with a 13 percent increased risk, and consuming them four to six times a week was associated with an increased risk of 31 percent.
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