Diabetes mellitus is a metabolic disorder that is characterized by imbalances in insulin response leading to abnormal blood sugar levels. There are two types of diabetes mellitus: type 1 and type 2. Type 1 diabetes is an autoimmune disorder in which the body attacks and destroys the cells that are responsible for producing insulin. This causes a person to be at risk for hyperglycemia because without insulin, blood sugar levels cannot be adequately controlled. With this type of diabetes, there is no current cure and treatment is lifelong. Type 2 diabetes is a disease resulting from insulin resistance and altered insulin response. This type of diabetes generally occurs in those who are overweight or obese, with poor diet and lack of exercise being major risk factors in the development of the disease. 90-95% of all diabetes diagnoses are type 2 diabetes.
There are a multitude of risk factors that contribute to the development of type 2 diabetes, with a handful being attributed to dietary and lifestyle choices. Genetic risk factors for diabetes include older age, being part of a high-risk ethnic group such as African Americans or Hispanics/Latinos, a family history of the disease, and the presence of various conditions such as depression or PCOS. Lifestyle risk factors include being overweight or obese with a BMI of higher than 25 (with a high body fat %), a history of stroke or cardiovascular disease, high blood pressure, lack of physical activity, and frequent alcohol consumption. Dietary risk factors are perhaps the most influential factors, including frequent over-consumption of calories, a diet high in LDL and low in HDL, frequent consumption of simple sugar and high glycemic index foods, and lack of important nutrients for a healthy metabolism.
Type 2 diabetes occurs most commonly as the result of insulin resistance. When the body breaks down carbohydrates, the length of time it takes for glucose to be released into the bloodstream differs based on carbohydrate type. Complex carbohydrates break down more slowly, while simple carbohydrates break down rather quickly. The more quickly a carbohydrate is broken down, the more quickly blood sugar (blood glucose) levels spike. As blood sugar levels spike, insulin is released from the pancreas in order to shuffle this glucose where it is needed, such as into cells or into storage. When blood sugar spikes quickly, the pancreas must work harder to secrete insulin and rebalance healthy blood sugar levels again.
Over time, as we continue to eat food that rapidly spikes blood sugar levels, our cells begin to respond less and less to insulin – this is when we have reached insulin resistance. At this point, the pancreas constantly needs to secrete even more insulin to helps these cells utilize the glucose in the bloodstream. The cells in the pancreas can only continue to do this for so long until they can no longer meet the insulin needs of the body. When this happens, the body is no longer able to balance blood sugar levels and type 2 diabetes develops.
Muscle, adipose, and liver cells can all become insulin resistant, with each cell having a different effect on metabolism. Fat cells with insulin resistance cause elevated free fatty acids in the bloodstream, leading to high lipid levels. Muscle cells with insulin resistance are unable to use glucose as easily for energy, and have a hard time storing glucose for later use (as glycogen). Liver cells with insulin resistance are unable to regular glucose and glycogen pathways. The entire body becomes negatively affected by insulin resistance and not only can type 2 diabetes arise but so can other conditions, such as metabolic syndrome and high blood pressure.
Although type 2 diabetes cannot be cured once it has developed, new scientific studies are showing just how imperative lifestyle and nutrition changes are in halting the progression of the disease and potentially reversing the effects of insulin resistance.
One of the primary focuses of nutrition therapy for diabetics is glycemic control. Closely monitoring blood sugar levels can be achieved by becoming more aware of how different foods affect blood sugar, as well as having the tools on hand necessary to measure blood sugar levels when necessary. As mentioned above, complex carbohydrates with a low glycemic index tend not to raise blood sugar as quickly and drastically as simple sugars do.
⇒ The glycemic index is an index that we can use, along with the glycemic load, to determine the effect that a particular food has on blood sugar. High glycemic index foods rapidly raise blood sugar levels, while low glycemic index foods release glucose more slowly. As mentioned in our former article on carbohydrates, the glycemic index is just a reference point to use when choosing foods. The actual response that a food causes on blood sugar levels can be quite different depending on the individual, among other factors.
One of the best ways to achieve a healthy diet while watching blood sugar levels is to consume nutrient-dense whole foods.
Nutrient-Dense Whole Foods
A nutrient-dense diet is one that generally consists of a variety of whole foods that can provide more nutrient density per calorie. This means that you don’t need to eat as many calories to fulfill your daily nutrient needs. These types of foods are obviously preferable to foods that are high in calories and low in nutrients, such as many processed and junk foods. If you have diabetes, here are some examples of the best foods to build your diet around:
- Whole grains: brown rice, wild rice, quinoa, whole wheat, whole oats
- Lean protein: fish, poultry, beans, soy
- Non-starchy vegetables: asparagus, bean varieties, broccoli, carrots, cauliflower, mushrooms, greens
- Nuts and seeds: macadamia nuts, pistachios, cashews, almonds, sunflower seeds, pumpkin seeds, chia seeds
Whole grains are a complex carbohydrate that can provide long-lasting energy between meals. Lean protein sources can help keep blood lipid levels balanced. The majority of your plate for every meal, however, should be composed primarily of fresh, non-starchy vegetables. Nuts and seeds are plant-based snacks that not only contain heart-healthy fats, but can also keep you satiated between meals. Of course, fruits can also be a great snack or dessert, but they are more easily broken down by the body and may spike blood sugar levels. Stay away from sugar fruit juices and concoctions and instead aim to eat moderate amounts of whole fruits, which are still a wonderful source of fiber and other nutrients. And if you are truly in need of a sweetener for a treat every now and then, consider choosing from these 7 natural alternatives to sugar that may offer additional benefits in small amounts.
Because type 2 diabetes often develops as the result of a poor diet, people with type 2 diabetes can be at risk for certain deficiencies. When certain nutrient deficiencies cannot be corrected through diet alone, there are some nutritional supplements that have the potential to be beneficial in diabetes care. These nutrients can help to correct deficiencies and also support the body in balancing metabolism again. Moderate levels of antioxidant supplementation, such as with polyphenols, vitamin C, and ALA, may help to counteract inflammation that is common in obesity and diabetes. Minerals, such as magnesium, chromium, and zinc may accompany a daily multivitamin to boost metabolic support while dietary changes are being made. A high quality fish-oil supplement containing EPA and DHA can assist with favorably balancing lipid levels. If these nutrients cannot be met with dietary changes, finding high quality, organic supplements can support the body through its healthy change.
Caloric Restriction and Weight Loss
One final element of nutrition therapy for diabetes involves caloric restriction. In general, unhealthy, high-calorie can lead to weight gain and insulin resistance. A diet that restricts calories to a healthy extent can help someone with type 2 diabetes to lose weight, which in turn can have a cascade of benefits. Daily calorie goals should be calculated on an individual basis and with support from a medical professional.
The ideal goal of caloric restriction is not to constantly hawk over calories, but to understand the general calorie count of the foods you most often eat. Once you better understand which foods contain the appropriate calories (not more or less) to meet your daily needs, you will find yourself naturally losing weight as you make these foods a part of your diet. As little as a 5-10% reduction in body weight has been shown to improve blood glucose control, improve lipid levels and reduce inflammation. Paired with regular exercise, obese and overweight individuals can greatly improve their disease outlook and quality of life, reducing long-term risk factors in the process.
The prevention of type 2 diabetes can be achieved by eating a healthy nutrient-dense diet, exercising regularly, and paying attention to all of the foods that you put into your body. Once diabetes has developed however, it can be managed with lifestyle and nutrition therapy. The interventions mentioned above can be a great place to start when making changes after a diagnosis. The long-term goals of type 2 diabetes intervention is to maintain healthy blood sugar levels, reduce insulin resistance, improve lipid levels, and reach a healthy goal weight. The American Diabetes Association has a wide variety of articles and tools to help you through this transitional period to a healthier lifestyle. As always, your doctor and nutrition professional can both work together to choose the best treatment path for you.
Brown JE. Nutrition Through the Life Cycle. 5th ed. Stamford, CT: Cengage Learning; 2014.
Kohlstadt I, ed. Advancing Medicine with Food and Nutrients. 2nd Boca Raton, FL: Taylor & Francis Group, LLC; 2012.