Effective Lifestyle Changes for Type II Diabetes

For over 25 years, my wife and l have had the fortunate experience of being associated with a small lifestyle-change center in rural Alabama. Some of our first patients were Type ll diabetics, (non-insulin dependent diabetes mellitus), and since we were convinced that a total vegetarian (vegan) diet was the most healthful one for most of the degenerative diseases, it was only natural that it would become the cornerstone of our treatment.

We were encouraged by some of the early work done by Nathan Pritikin,¹⁾Barnard RJ et al. Response of non-insulin dependent diabetic patients to intensive program of diet and exercise, Diab Care 5(4): 370-4, 1982. Drs. Jack Davidson of Atlanta, Rex Clements of Birmingham, and James Anderson of Lexington, Kentucky. None of them used a total vegetarian diet (even Pritikin allowed a small amount of animal products), but their work seemed to indicate that we were on the right track. And the benefits we could see in our patients confirmed this.

Recently, the concept that Type II Diabetes is basically a continuum has gained favor.²⁾Felber JP, Acheson JK, Tappy, L, From Obesity to Diabetes. Chichester, West Sussex, England: John Wiley & Sons, 1993.
DeFronzo, R Insulin resistance, a multifactorial disorder. Lecture, Medical Grand Rounds, University of Alabama in Birmingham, 1992. It begins with increasing weight, decreasing physical exercise, with ensuing insulin resistance, followed by increasing carbohydrate intolerance and finally overt diabetes mellitus (with of course some genetic factors). This concept has helped to formulate a program of treatment, as well as hope for prevention for this scourge of the modern world. Our method of treatment involves the following:

1. Short-term, judicious fasting
2. Vegetarian diet composed of mostly natural, unrefined high fiber, low-fat foods, with an abundance of raw foods
3. Regular exercise as tolerated.

Fasting

I have been surprised to find comparatively little in the medical literature about fasting in type II diabetes. Both physicians and patients seem to have a fixed aversion to fasting a diabetic.³⁾There are in the meantime a few studies available on the subject, for example:
Li C, Sadraie B, Steckhan N, Kessler C, Stange R, Jeitler M, Michalsen A. Effects of A One-week Fasting Therapy in Patients with Type-2 Diabetes Mellitus and Metabolic Syndrome – A Randomized Controlled Explorative Study. Exp Clin Endocrinol Diabetes. 2017 Oct;125(9):618-624. doi: 10.1055/s-0043-101700.
Li C, Ostermann T, Hardt M, Lüdtke R, Broecker-Preuss M, Dobos G, Michalsen A. Metabolic and psychological response to 7-day fasting in obese patients with and without metabolic syndrome. Forsch Komplementmed. 2013;20(6):413-20. doi: 10.1159/000353672.
Studies on intermittent fasting and diabetes are more common, and skipping supper can be a very effective measure to control type II diabetes. Yet type II diabetes patients are exceptionally resistant to ketacidosis, and will respond readily to a short-term fast.⁴⁾McCarty MF Maturity onset diabetes– toward a physiological appropriate management. Medical Hypotheses; 7(10):1265-85, 1981 More than fourty years ago, Dr. Jack Davidson of Emory University reported on a small group of obese adult diabetics who were taking over 100 units of insulin a day, but still had fasting glucose levels of 300-500 mg/dl.⁵⁾Internist Reporter,3:1, 1977.

He stopped the insulin abruptly, put them on a total fast except for water, and checked their glucose levels at least 3 times a day. In all but one or two cases, the glucose levels dropped below 100 mg/dl within two to five days, with no ill effects. Most could then be maintained without insulin, on a spare diet, with blood glucose levels markedly better than before the fast. In addition to eliminating caloric intake for the period, Davidson felt that short-term fasting helped to ”reset” the insulin receptors, or at least made them more efficient. Since then, Davidson reports that he has successfully treated over 3000 overweight hyperglycemic non-ketotic patients with a one-week total fast, followed by a low-calorie diet.⁶⁾Davidson (1971 – 1977) treated over 3,000 overweight hyperglycemic non-ketotic individuals with a 1-week total fast and a follow-up low-calorie diet No deaths occurred during the short-term fast, and this therapy was more successful in lowering group mean plasma glucose levels than was either sulfonylurea or insulin therapy. Bar and Roth (1972) showed that an increased serum insulin level decreased the number of insulin receptors on insulin-sensitive cells and that fasting and weight loss decreased the serum insulin level and increased the number of insulin receptors. The 1986 NIH Consensus Development Conference on Diet and Exercise in type II diabetes recognizes fasts of several days duration in the therapy for type II diabetes as safe and effective. Davidson, JK Diet therapy for NID diabetes mellitus. in: Davidson, JK, ed Clinical Diabetes Mellitus, a Problem Oriented Approach. 2nd ed. New York, NY Thieme Medical; :190, 1991.

We have used this technique to good advantage in many cases, being able to eliminate insulin in most. Glucose monitoring is essential during the total fast, because of the rare patient in whom the blood levels begin to rise rather than fall, signaling true insulin dependency and impending ketoacidosis. Fasting is also quite helpful in controlling the appetite and in initiating and maintaining weight-loss.

In addition, we have found that fasting for a short period—usually a day or two a week, non-consecutively—is quite useful for most obese Type II diabetics. It is especially worthwhile if the patient can be seen early in his disease course; often the blood glucose will return to normal and remain so.

It is important to realize that after even a fairly short fast, there will be almost inevitably a ”rebound” of elevated blood glucose levels, often for several days. Patients and physicians may become discouraged to see significantly elevated levels in the post-fast period; but if they are persistent in continuing the program with periodic short fasts, they will be rewarded, in nearly every case, with marked improvement in blood sugar. We have seen patients that would require several months before glucose levels “settle down,” but in most cases, monitoring of glycosylated hemoglobin (HbA1C) levels will show progressive improvement.

Vegetarian Diet

Many researchers (7,8) have confirmed the benefits of a high-fiber unrefined carbohydrate diet.⁷⁾Kiehm TG, Anderson JW, Ward K, Beneficial effects of a high carbohydrate, high fiber diet on hyperglycemic diabetic men. Am J Clin Nut 29(8): 895-9, 1976.
Simpson, HCR, et al. A high carbohydrate leguminous fibre diet improves all aspects of diabetic control Lancet 1(8210): 1 5, 1981. It promotes satiety, gives a more slow, gradual carbohydrate absorption (called ”lente carbohydrate” by one author),⁸⁾Jenkins DJ, Jenkins AL. Nutrition principles and diabetes A role for “lente carbohydrate” Diab Care 18(11). 1491-8, 1985. and has a beneficial effect on elevated blood lipids and hypertension.⁹⁾O’Donnell MJ, Dodson PM. The non-drug treatment of hypertension in the diabetic patient. J Hum Hypertension 5(4),287-94, 1991. James Anderson of Lexington, Kentucky, has been a leading proponent of this type of diet.¹⁰⁾Anderson JW, Geil PB. New perspectives in nutrition management of diabetes mellitus. Am J Med 85 (5A):159-65, 1988.
Anderson JW, Smith BM, Geil PB. High- fiber diet for diabetics, Safe and effective treatment. Postgrad Med 88 (2):157-68, 1990. He has recommended a small serving of beans with each meal for his diabetics because of the high soluble fiber content.

The vegetarian diet is the prototype high-fiber diet, beside providing other benefits. We add no visible fats to our patients’ diets, using small amounts of nut butters, with moderate amounts of nuts and ripe olives. Soy products are used liberally; various works seems to indicate that vegetable protein, especially soy protein, is protective against many of the complications of type II diabetes.¹¹⁾Messina M Lecture: Legumes and soybeans. an overview of health effects Third International Congress on Vegetarian Nutrition. Lorna Linda, CA, March 24, 1997.
Anderson JW. Lecture: Soy protein intake and risk of atherosclerotic cardiovascular disease, Third international Congress on vegetarian Nutrition, Loma Linda, CA, March 24, 1997.
D’Amico G, Gentile M., et al. Effect of vegetarian soy diet on hyperlipidemia in nephrotic syndrome. Lancet 335. 1131-34, 1992 Even those who have early kidney failure seem to do well on moderate amounts of soy protein. We use cooked and/or dry whole—grain cereals, with one or two fresh or canned fruits (sugar-free); whole grain breads; and soy or nut milks. An abundance of vegetables, cooked and raw, are provided. Suppers are light, consisting of whole grain breads, a small salad and/or soup, or perhaps a fresh fruit. If the patient is quite obese, we encourage elimination of suppers altogether.

Following the lead of Rex Clements of Birmingham, we have used foods high in myo-inositol in our patients with diabetic neuropathy, often with remarkable improvement within a few weeks.¹²⁾Clements RS, et al. Dietary Myo-inositol intake and peripheral nerve function in diabetic neuropathy Metab; 28(No.4) Suppl 1: 477-83, 1979. Clements has published a list of foods with their myo-inositol content; it is significant that animal products contain virtually none, while it is abundant in many plant products.¹³⁾Clements RS, Darnell B. Myo-inositol content of common foods: development of a high-myo-inositol diet Am J Clin Nutr 33: 1954-67, 1980.

Everyone is now familiar with the fact that most animal products are high in saturated fat and cholesterol, a condition not salutary for the diabetic. What is not so universally appreciated, however, is the fact that animal protein will raise cholesterol, due to an unfavorable lysine/arginine ratio.¹⁴⁾Sanchez A, Hubbard RW. Dietary protein modulation of serum cholesterol. in Friedman M,ed, Absorption and Utilization of Amino Acids, vol 11. Boca Raton, FL: CRC Press, Inc, 1989. 248-69.

With the vegetarian diet, the patient is virtually liberated from the task of counting calories and from the onerous exchange diets of a few years ago.

Exercise

Certainly, no one would disagree with the benefits of regular exercise in treatment or prevention of type II diabetes.¹⁵⁾Sanchez A, Hubbard RW. Dietary protein modulation of serum cholesterol. in Friedman M,ed, Absorption and Utilization of Amino Acids, vol 11. Boca Raton, FL: CRC Press, Inc, 1989. 248-69.
Effect of dietary and/or exercise intervention on incidence of diabetes in 530 subjects with impaired glucose tolerance from 1986-1992. Chung Hua Nei Ko Tsa Chih 34(2): 108-12, 1995. There is improvement in digestion. enhanced weight-loss, decrease in insulin resistance,¹⁶⁾The Da Qing IGT and diabetes study. Diab Care 20(4): 537-44, 1997.
Pedersen O, Beck-Nielsen H, Heding L Increased insulin receptors after exercise in patients with insulin-dependent diabetes mellitus, NEJM 301 (16). 886-92, 1980. increased utilization of glucose for metabolic needs, and a significantly enhanced feeling of well-being. The rub comes in patient compliance. Most of these patients are overweight, many seriously so, with concomitant musculo-skeletal as well as cardiovascular and other complications. Yet we find that with persistent coaxing, starting slowly and working up to a more vigorous level of exercise with time, most can accomplish noticeable benefits within a few weeks. A therapeutic pool, if available, is of great value in these patients, since water supports the limbs, making exercise much easier.

A stay of two or three weeks in the rural lifestyle center is especially helpful in this area, in introducing and reinforcing the essential lifestyle changes.

In summary, with the program outlined above, we have found very encouraging improvements in blood glucose, cholesterol, triglyceride and HDL cholesterol levels. Often borderline kidney failure has improved or returned to normal; symptoms of diabetic neuropathy have improved, sometimes dramatically; weight has decreased, and there has been a most gratifying overall clinical improvement. In most cases the use of insulin and oral hypoglycemic agents has been eliminated or markedly reduced. And finally, we feel that modifications of this program have significant possibilities in the field of prevention of type II diabetes.