Diabetes and Dietary Changes

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In this discussion, diabetes refers to diabetes mellitus. Other forms of diabetes (such as diabetes insipidus) are not included.

People with diabetes cannot properly process glucose, a sugar the body uses for energy. As a result, glucose stays in the blood, causing blood glucose to rise. At the same time, however, the cells of the body can be starved for glucose. Diabetes can lead to poor wound healing, higher risk of infections, and many other problems involving the eyes, kidneys, nerves, and heart.

There are two types of diabetes mellitus. Childhood-onset diabetes is also called type 1, or insulin-dependent, diabetes. In type 1 diabetes, the pancreas cannot make the insulin needed to process glucose. Natural therapies cannot cure type 1 diabetes, but they may help by making the body more receptive to insulin supplied by injection. It is particularly critical for people with type 1 diabetes to work carefully with the doctor prescribing insulin before contemplating the use of any herbs, supplements, or dietary changes mentioned in this article. Any change that makes the body more receptive to insulin could require critical changes in insulin dosage that must be determined by the treating physician.

Adult-onset diabetes is also called type 2, or non-insulin-dependent, diabetes. With type 2 diabetes, the pancreas often makes enough insulin, but the body has trouble using the insulin. Type 2 diabetes responds well to natural therapies.

Dietary changes that may be helpful: The relationship between eating carbohydrates and type 2 diabetes is a complex issue. While eating carbohydrates increases the need for insulin to keep blood sugar normal, diets high in total carbohydrates do not necessarily increase the risk of type 2 diabetes.1 2 Researchers have found that diets very high in sugar may worsen glucose tolerance in nondiabetic animals3 and humans.4 However, the amount of sugar used in these studies in proportion to other foods is much larger than is typically found in human diets.

Years ago, one researcher reported an increase in diabetes among Yemenite Jews who had migrated from a region where no sugar was eaten to one in which they ate a diet including sugar.5 However, other factors, such as weight gain, may explain the increased risk of diabetes that occurred in this group.6 Other studies have found no independent relationship between sugar intake and the development of glucose intolerance.7

Eating carbohydrate-containing foods, whether high in sugar or high in starch (such as bread, potatoes, processed breakfast cereals, and rice), temporarily raises blood sugar and insulin levels.8 The blood sugar-raising effect of a food, called its “glycemic index,” depends on how rapidly its carbohydrate is absorbed. Many starchy foods have a glycemic index similar to sucrose (table sugar).9 People eating large amounts of foods with high glycemic indices (such as those mentioned above), have been reported to be at increased risk of type 2 diabetes.10 11 On the other hand, eating a diet high in carbohydrate-rich foods with low glycemic indices is associated with a low risk of type 2 diabetes.12 13 14 Beans, peas, fruit, and oats, have low glycemic indices, despite their high carbohydrate content, due mostly to the health-promoting effects of soluble fiber.

Diabetes disrupts the mechanisms by which the body controls blood sugar. Until recently, health professionals have recommended sugar restriction to people with diabetes, even though short-term high-sugar diets have been shown, in some studies, not to cause blood sugar problems in people with diabetes.15 16 17 Currently, the American Diabetic Association (ADA) guidelines18 do not prohibit the use of moderate amounts of sugar, as long as the goals of normalizing blood levels of glucose, triglycerides, and cholesterol are being achieved.

Most doctors recommend that people with diabetes cut intake of sugar from snacks and processed foods, and replace these foods with high-fiber, whole foods. This tends to lower the glycemic index of the overall diet and has the additional benefit of increasing vitamin, mineral, and fiber intake. Other authorities also recommend lowering the glycemic index of the diet to improve the control of diabetes.19

A high-fiber diet has been shown to work better in controlling diabetes than the diet recommended by the ADA, and may control blood sugar levels as well as oral diabetes drugs.20 In this study, the increase in dietary fiber was accomplished exclusively through the consumption of foods naturally high in fiber—such as leafy green vegetables, granola, and fruit—to a level beyond that recommended by the ADA. No fiber supplements were given. All participants received both the ADA diet (providing 24 grams of fiber per day) and the high-fiber diet (providing 50 grams of fiber per day), for a period of six weeks. After six weeks of following each diet, tests were performed to determine blood glucose, insulin, cholesterol, triglyceride, and other values. When glucose levels were monitored over a 24-hour period, participants eating the high-fiber diet had an average glucose level that was 10% lower than participants eating the ADA diet. Insulin levels were 12% lower in the group eating the high-fiber diet compared to the group eating the ADA diet, indicating a beneficial increase in the body’s sensitivity to insulin. Moreover, people eating the high-fiber diet experienced significant reductions in total cholesterol, triglycerides, and LDL (“bad”) cholesterol compared to those eating the ADA diet. They also had slight decreases in glycosylated hemoglobin, a measure of chronically high blood glucose levels.

High-fiber supplements, such as psyllium,21 22 guar gum (found in beans),23 pectin (from fruit),24 oat bran,25 and glucomannan26 27 have improved glucose tolerance in some studies. Positive results have also been reported with the consumption of 1–3 ounces of powdered fenugreek seeds per day.28 29 A review of the research revealed that the extent to which moderate amounts of fiber help people with diabetes in the long term is still unknown, and the lack of many long-term studies has led some researchers to question the importance of fiber in improving diabetes.30 Nonetheless, most doctors advise people with diabetes to eat a diet high in fiber. Focus should be placed on fruits, vegetables, seeds, oats, and whole-grain products.

Eating fish also may afford some protection from diabetes.31 Incorporating a fish meal into a weight-loss regimen was more effective than either measure alone at improving glucose and insulin metabolism and high cholesterol.32

Vegetarians have been reported to have a low risk of type 2 diabetes.33 When people with diabetic nerve damage switch to a vegan diet (no meat, dairy, or eggs), improvements have been reported after several days.34 In one trial, pain completely disappeared in 17 of 21 people.35 Fats from meat and dairy also contribute to heart disease, the leading killer of people with diabetes.

Vegetarians also eat less protein than do meat eaters. The reduction of protein intake has lowered kidney damage caused by diabetes36 37 and may also improve glucose tolerance.38 However, in a group of 13 obese males with high blood-insulin levels (as is often seen in diabetes), a high-protein, low-carbohydrate diet resulted in greater weight loss and control of insulin levels, compared with that of a low-carbohydrate diet.39 Switching to either a high- or low-protein diet should be discussed with a doctor.

Diets high in fat, especially saturated fat, worsen glucose tolerance and increase the risk of type 2 diabetes,40 41 42 43 an effect that is not simply the result of weight gain caused by eating high-fat foods. Saturated fat is found primarily in meat, dairy fat, and the dark meat and skins of poultry. In contrast, glucose intolerance has been improved by diets high in monounsaturated oils,44 45 which may be good for people with diabetes.46 There is often difficulty in changing the overall percentage of calories from fat and carbohydrates in the diets of people with type 1 diabetes. However, modifying the quality of the dietary fat is achievable. In adolescents with type 1 diabetes, increasing monounsaturated fats relative to other fats in the diet is associated with better control over blood sugar and cholesterol levels.47 The easiest way to incorporate monounsaturates into the diet is to use oils containing olive oil. However, those who are overweight need to be aware—olive oil is high in calories.

Should children avoid milk to prevent type 1 diabetes? Worldwide, children whose dietary energy comes primarily from dairy (or meat) products have a significantly higher chance of developing type 1 diabetes than do children whose dietary energy comes primarily from vegetable sources.48 Countries with high milk consumption have a high risk of type 1 (insulin-dependent) diabetes.49 Animal research also indicates that avoiding milk affords protection from type 1 diabetes.50 Milk contains a protein related to a protein in the pancreas, the organ where insulin is made. Some researchers believe that children who are allergic to milk may develop antibodies that attack the pancreas, causing type 1 diabetes. Several studies have linked cows’ milk consumption to the occurrence of type 1 diabetes in children.51 52 53 54 However, other studies have failed to find such a link.55 56 One study even reported a protective effect of higher intake of dairy products on diabetes risk in children.57 One reason for the conflicting results of the research may be that different genetic strains of cows’ milk protein (casein) are associated with different levels of risk.58 Some children who drink cows’ milk produce antibodies to the milk, and it has been hypothesized that these antibodies can cross-react with and damage the insulin-producing cells of the pancreas.59

Immune problems in people with type 1 diabetes have been tied to other allergies as well,60 and the importance of focusing only on the avoidance of dairy products remains unclear.61 Preliminary studies have found that early introduction of cows’ milk formula feeding increases the risk of developing type 1 diabetes, although contradictory results have also been published.62 63 A study of Finnish children (including full-term children with diabetes) showed that early introduction of cows’ milk formula feeding before three months of age (vs. after three months of age) was associated with increased risk of type 1 diabetes.64 This research supports abstaining from dairy products in infancy and early childhood, particularly for children with a family history of type 1 diabetes. Recent research also suggests a possible link between milk consumption in infancy and an increased risk of type 2 (non-insulin-dependent) diabetes.65

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