preventing & reversing type II diabetes

The following outline is copied from my PowerPoint presentation. You are welcome to read and use, but any commercial use is strictly copyrighted to Steven Masley, M.D.: This information is not intended for medical decision making. Always consult your own physician who knows your personal medical history before making medical decisions.

PREVENTING AND REVERSING TYPE 2 DIABETES
Steven Masley, M.D., C.N.S.

MY GOALS FOR THIS PRESENTATION ARE TO
• Explain why people develop Type 2 diabetes
• Share how food and activity choices prevent and reverse Type 2 diabetes
• Review vitamins that treat but don’t reverse diabetes
• Empower you to succeed in making critical lifestyle changes

THE HOLISTIC APPROACH
• Integrate the best therapies to prevent & reverse diabetes (INTEGRATIVE MEDICINE)
– Cutting edge dietary changes
– Medications
– Enhancing activity levels
– Supplementing with supplements

“ADDING” GREAT TASTING FOOD and FUN ACTIVITIES IS WHAT THIS PROGRAM IS ALL ABOUT !
WHAT IS DIABETES?
• Diabetes mellitus is a chemical imbalance with high sugar levels in the blood and urine
– Diabetes (large urine volume) mellitus (tastes like honey)
– Diabetes (large urine volume) insipidus (tasteless)
• Characterized by excessive thirst, urination, fatigue, and accelerated aging

WHAT IS THE DIFFERENCE BETWEEN TYPE 1 AND TYPE 2 DIABETES
• Type 1 diabetes occurs when your body doesn’t make insulin
– Type 1 diabetes is a disease
– Type 1 diabetes untreated can cause immediate death
• Yes, a few people have a mixture of type 1 and type 2 diabetes (2-3% of diabetics)
• Type 2 diabetes occurs when your body doesn’t respond to high blood sugar and high blood insulin levels

TYPE 2 DIABETES
• Type 2 diabetes reflects a lifestyle that does NOT match genetic make-up
• People at risk of Type 2 diabetes often have superior genes to survive famine, and do well with endurance activities
• People with famine survival genes do poorly with inactivity and an unhealthy diet

SYNDROME X
• Type 2 diabetes is “part” of syndrome X
• Syndrome X is related to
– Insulin resistance (may define Syndrome X)
– Type 2 diabetes
– HTN
– High cholesterol, Low HDL, High Triglycerides
– Apple shape (central obesity)

MAGNITUDE OF DIABETES
• 1 in 4 adults is at risk of developing Syndrome X
• In the USA, 16 million people have type 2 diabetes, about 6% of Americans, and ~ 800,000 people will be diagnosed this year
– Nearly 20% of people > 65 have diabetes
• After retirement, people do less and eat worse
• The prevalence of type 2 diabetes is increasing rapidly
– This increase corresponds with a hyperactive fork and a hypoactive foot

DIABETES ACCELERATES AGING
• When your body’s proteins are sugar coated, they burn more quickly
• As diabetes control worsens, you feel older immediately with fatigue
• With poorly controlled diabetes, you see damage to specific organs

DIABETES TARGETS SPECIFIC ORGANS
• Heart attacks & Brain strokes (69% of diabetics die of cardiovascular disease)
• Kidney failure (Leading cause of kidney failure in the USA)
• Poor circulation and amputations
• Poor immune function and frequent infections
• Increased pain from swollen nerves
• Blindness (Leading cause of blindness in the USA)

WE NEED A PARADIGM SHIFT IN HOW WE TREAT DIABETES
• Medications are clearly helpful, but meds don’t reverse diabetes
– Meds lower blood sugar levels
• Doctors don’t control type 2 diabetes, people with type 2 diabetes do
– Doctors can help treat the symptoms of type 2 diabetes, and use treatments to reduce but not eliminate the risk of events
• Activity and dietary changes make people feel “great” and reverse type 2 diabetes

THERAPY GOALS
• Increase insulin sensitivity
• Improve blood sugar levels (Measured by HgbA1C levels)
• Increase activity
• Improve dietary intake
• Control cholesterol level
• Control blood pressure
• Prevent problems with regular diabetic health care maintenance

BLOOD SUGAR CONTROL GOALS
HgbA1C
< 6 is normal
< 7 is good control
> 8 is bad control

Fasting Blood Sugar
< 110 is normal
< 140 is good control
> 180 is bad control


LABORATORY and EXAM GOALS
• HgbA1C
– under 6 = normal (<5.8 mg/dl in most labs)
– under 7 = good control
– over 8 = seriously bad control, NEEDS Rx
• Urine protein (not leaking protein = Nl microalbumin)
• Cholesterol screening (normal cholesterol level)
• Blood pressure < 130/85
• Foot sensation intact (to a nylon monofilament)

IMPROVING INSULIN SENSITIVITY
• Choose foods that improve insulin sensitivity
• Add exercise daily (involving your physician)
• Avoid tobacco: smoking reduces insulin sensitivity
• Consider supplements, they are “supplemental” to a healthy diet

TELL PEOPLE WHAT TO CUT?
BALANCED DIET. BALANCED HEALTH
• “ADDING” healthful foods is the centerpiece of my program
• Limiting fat intake is only a small part of a healthy diet
• Choosing the best types of fat and carbohydrate are more important than cutting fat

PROVIDE HEALTHY, TASTY MENUS FOR PEOPLE TO EAT
ADD SPECIFIC FOODS

GARLIC:
Herb or Wonder Spice? *
• Decreases LDL levels, 9% with a clove/day (not seen with steam distilled extract)
• Slightly increases HDL levels
• Decreases clot formation
• Lowers systolic BP, 5-6 mm Hg
• Improves immune function
• Decreases oxidation
• Kills cancer cells in the lab

GARLIC USE
• Garlic should be crushed
• Allowing alliinase (an enzyme in garlic) to convert alliin to allicin, which is the active agent
• Allicin is then converted to polysulfides which provides the aroma and plausible therapeutic benefits
• Don’t overcook or deodorize
• Commercial products quantitate alliin content (which is not the active agent)

LEGUMES:
A wonder food!
• Lower LDL levels *
• Raise HDL levels
• Control blood sugar and insulin levels
• Suppress appetite
• Associated with decreased cancer risk (especially soy products)
Chili with Cornbread
Bell Pepper, Black Bean, and Cilantro Paté

SOY PRODUCTS
• Soy protein
– lowers total cholesterol and LDL cholesterol with a small increase in HDL cholesterol
• Soy isoflavones (genistein, etc.)
– improve endothelial function
– decrease clot formation
– are associated with reduced cancer risk, especially breast and prostate cancer

WE ARE NO LONGER LIMITED BY PLAIN-OLD-TOFU

SOY PRODUCTS ARE EASY TO ADD TO YOUR DIET
Scrambled Tofu
LIMIT FAT INTAKE
AND
CHOOSE HEALTHY FATS
In Diabetes care

“The type of fat we choose is more important than how much fat we eat,” Steven Masley, MD

CHOOSE THE BEST TYPES OF CARBOHYDRATES
CARBOHYDRATES
• Carbohydrates provide most of the nutrients, minerals, antioxidants, and almost all the fiber in our diet
• Eating fewer carbohydrates means loosing nutrients

CARBOHYDRATES PROVIDE FIBER. FIBER IMPROVES GLUCOSE CONTROL
• Increasing fiber intake (healthy carbohydrate intake) improves blood sugar levels, lowers insulin levels, and lower cholesterol levels
• Great fiber sources include:
– Fruits and Vegetables
– Oatmeal, Barley, Quinoa, Wild Rice, Whole wheat pasta
– Beans and Soy Products
– Fiber supplements are also helpful

PROTEIN / CARBOHYDRATE RATIOS
• In clinical trials, protein/carbohydrate ratios do not impact diabetes rates. Further, total carbohydrate intake is unrelated to acquiring diabetes
• There is NO evidence from clinical studies that we need more protein
• Eating HIGH GLYCEMIC INDEX carbohydrates increases the risk of developing Type 2 Diabetes

THE TYPE OF CARBOHYDRATES YOU EAT IMPACTS BLOOD SUGAR CONTROL AND APPETITE
• Foods that produce blood sugar and insulin level surges stimulate hunger, weight gain, and increase bad LDL cholesterol levels
– Produce and legumes control appetite and blood sugar levels
– Refined sugars, fluffy breads, potatoes, puffed grains (rice) increase blood sugar levels

GLYCEMIC INDEX
(Blood sugar index)
• The glycemic index refers to the increase in blood sugar level that occurs after eating foods with carbohydrate

IMPROVE CHOLESTEROL LEVELS > CHOOSE FOODS TO LOWER CHOLESTEROL
• Eat legumes (beans) daily
• Add garlic
• Lower total fat intake
• Choose “healthy fats” (nut products, canola and olive oil, soy products)
• Add fiber (2 tsp Metamucil daily works)
• Medications work! Talk to your doctor about reaching cholesterol targets.

CHOLESTEROL TARGETS
• Total Cholesterol / HDL ratio
– Less than 4 is good
– It is very difficult to control cholesterol if you don’t also control your blood sugar levels
• LDL level
– Under 130 mg/dl is the healthy target
– With diabetes, aim for a LDL level near 100
• Triglycerides (TG)
– Under 150 is normal, over 800 is a problem requiring therapy
– TG control is very difficult without glucose control

INCREASE HDL LEVELS
• Prolonged, regular aerobic exercise helps to raise HDL levels in many patients (Mechanism may be through improved insulin activity with exercise)
• Moderate Alcohol Intake Raises HDL levels (Max 1-2 servings per day)
• Garlic and Onion Intake Raises HDL levels slightly (3-5%)
• Soy intake increases HDL levels 2-3%
• Choose low-glycemic carbohydrates*

ALCOHOL INTAKE
• Moderate alcohol intake decreases risk of cardiovascular disease in diabetics (Circulation 2000;102:494-499)
• More than 2 drinks per day is harmful to everyone’s health, especially diabetics
• Wine has a much lower glycemic index than beer (maltose has a GI of 152)
• If your HgbA1C is over 8, you likely should not drink any alcohol until your glucose level is controlled
Low Glycemic Carbohydrate Intake is Associated with Improved Total Cholesterol / HDL Ratios* Frost et al., The Lancet 1999;353:1045
• Choose the type of carbohydrate when substituting carbohydrates for fat
• Picking “whole grains” isn’t enough
• Glycemic index appears to have more impact on HDL than fat intake

OXIDATION IMPACTS DIABETES
• LDL cholesterol is oxidized into plaque
• Oxidation fosters vasoconstriction and poor artery wall function
• Artery wall plaque rupture leads to clot formation and events
• Clot formation increases during oxidative stress

REDUCE LDL OXIDATION
• Add fruits and vegetables. Five-a-day is the minimum, 7-10 servings daily is better
• Add garlic, herbs, and spices daily
• Limit fat intake
• When choosing fats, pick monounsaturated fats (avocados, nuts, olive oil and canola oil )
• Dietary Vitamin E intake is inversely associated with the risk of MI in people with CAD on an Anglo diet (200 to 400 IU daily)
• If you drink alcohol, choose red wine, one serving/day (The type of alcohol intake has not been shown to decrease event rates)
Plant Pigments Have Greater Antioxidant Activity than Vitamin E

DECREASE CLOT FORMATION
• Avoid saturated and polyunsaturated fats; simply substituting PUFA’s for saturated fats may increase clotting *
• Garlic and alcohol intake decreases clotting
• Vitamin E decreases clotting (But don't take extra Vitamin E if you require cholesterol medications without consulting your physician)
• N-3 fatty acids (omega-3 fats) decrease clot formation.

• IF YOU ARE DIABETIC, OR AT ELEVATED RISK FOR CAD OR STROKE, TAKE AN ASPIRIN DAILY !
Diabetics Need to Increase Omega-3 fat Intake
Omega-3 Fats
• Lower triglyceride levels
• Improve insulin sensitivity
• Prevent blood clots from causing sudden death, heart attacks, and strokes

SOURCES OF OMEGA-3 FATS
• Flax (Ground flax seed better than oil)
• Seafood
• Soy products
• Nuts
• Green leafy veggies

ACTIVITY
ENCOURAGE REGULAR ACTIVITY
• A regular walking program is associated with 40% fewer cardiac events
• Benefits extend to regular walkers and to regular vigorous exercise
• The greatest benefit is shifting from sedentary to regular moderate activity
• If you can’t walk, swim or use a stationary bicycle

ENJOY A FITNESS PROGRAM
• You have the time--Who doesn’t have the time to be more productive?
• Monitor your pulse rate; don’t exceed 80% of your maximum heart rate
– (220 - your age = Your maximum heart rate; Aim for 60-70% of our maximum rate)
• Combine aerobic and strength training sessions for the best results

EXERCISE--THE FAST TRACK TO SUCCESS
• Aerobic exercise
– 45-60 minutes of moderate activity, and 6 times per week (Burning at least 2000 calories per week)
– Increases energy
– Increases efficiency and time
– Prevents pains and slow arthritis

STRENGTH TRAINING
(Resistance Exercise)
• Increases bone strength
• Protects joints from aging and arthritis
• Increases your capacity to burn calories during exercise; hence, increases baseline metabolism and improves weight control
• Produces Glutamine, an essential amino acid building block, which regenerates your antioxidant system
Add 3 strength training session per week, lasting 20-30 minutes each

IT IS NEVER TO LATE TO BE MORE FIT
• Inactive people can reverse the aging process
• Seniors over age 63 can increase aerobic power and conditioning with regular exercise
– 30-45 minutes of regular moderate to vigorous activity is the most helpful
– 20-30 minutes of mild activity is still beneficial

DIABETIC MEDICATIONS
• Diabetic therapies lower blood sugar levels
• Medications that improve insulin sensitivity are superior to medications that increase insulin production
• Please, don’t change your medical therapy without including your doctor in on your plan
• Medications complement lifestyle changes until you reach good, steady control

CAN IT BE DANGEROUS TO IMPROVE GLUCOSE CONTROL?
• YES, if you are on medication without monitoring your diabetes
• Be Safe!
– Include your physician on any dietary or activity changes you make if you are taking diabetic medication
– Monitor your blood sugar levels regularly

WITH ELEVATED GLUCOSE LEVELS (HgbA1C > 7.0)
• Insulin resistance rises as blood sugar levels increase
• At time of typical type 2 diabetes diagnosis, pancreatic beta cells have lost nearly 50% of their normal function
• Lifestyle therapy plus medications work better than either approach alone

AS GLUCOSE LEVELS BECOME TOXIC, (HgbA1C >8)
– During late stage diabetes (HgbA1C > 8, the liver overproduces glucose and insulin sensitivity plummets)
– This makes it initially difficult to control diabetes well with lifestyle changes alone
– Adding medication to improve insulin sensitivity initially permits blood sugar control to be amenable to lifestyle changes

DIABETIC MEDS WORK SYNERGISTICALLY
• If you don’t reach “good control,” (HgbA1C < 7) within three months on one medication, consider using 2-3 low dose medications together
– Different classes of medications work on different sites
– It is easier to reach a controlled state with medications that impact several factors involved in glucose control
• Muscle, liver, pancreas

ONCE BLOOD SUGAR IS WELL CONTROLLED (HgA1C <7.0)
• Work with your physician to wean off medications “IF” you’re committed to add activity (1-2 hours/day) & enhance your diet
• Supplements can help, but won’t fix any diabetic diagnosis
• Once controlled, relapse is common if you don’t continue what worked
– THE CURE IS STICKING TO WHAT NORMALIZED YOUR BLOOD SUGAR LEVELS
– YOU CAN’T CURE YOUR GENETIC MAKE-UP

RESULTS FROM MY DIABETIC TRIAL
• 30% reduction in HgbA1C levels
• 20% reduction in Total cholesterol/HDL ratios
• >95% compliance in keeping current on recommended testing
• Weight loss varied from 50 lb loss to weight gain
– Average weight loss was 10-15 pounds
– Successful weight loss invariably included a regular exercise program

SUCCEED IN MAKING LIFESTYLE CHANGES
• Involve partners and family
• Monitor food choices
• Score your success at home and at restaurants
• Emphasize adding foods
• Add daily activity

ACQUIRE NEW SKILLS
• Buying/Shopping/ Food Label Reading
• Stocking
• Preparing
• Cooking
• Presenting
• Viewing
• Smelling
• Tasting
• Eating
• Cleaning
My approach is to give you easy-to-make, delicious, recipes that make you feel great!

NUTRIENT SUPPLEMENTS
• Supplements should be SUPPLEMENTAL to a healthy diet!
• Study after study shows that nutrient rich foods are superior to supplements

GET YOUR FIBER
• For diabetics, total fiber intake should reach 50 grams per day
– The American Diabetic Association recommends at least 24 grams daily
– Adding extra fiber lowers glucose, insulin, and cholesterol levels 10-15%
• New goal would be (N Engl J Med 2000;342:1392-8.)
– 25 grams of insoluble fiber
– 25 grams of soluble fiber

VITAMIN E DOSAGES
• 200 to 400 IU daily (Always talk with your physician before starting Vitamin E as it lowers HDL2 levels)
In particular, don't take Vitamin E if you are taking a statin or niacin medicine to lower cholesterol levels without talking to your doctor.
• Not proven, but might beneficial for diabetics at 200 IU daily, preferably from a mixed blend of natural tocopherols
• Caution if using with coumadin (Consult your doctor)

GET YOUR FOLIC ACID!
• Folic acid, 400 mcg daily
• Sources Include: One-A-Day Vitamins, Total cereal, or a healthy diet provides this daily
• High doses of folic acid are safe
• If your homocysteine levels are elevated, (>14) you may need 5-10 times this folic acid dosage

VITAMIN SUPPLEMENTS NEEDED WITH DIABETES
• Take a One-a-Day for B12, zinc, Vitamin D
• You’ll likely need to add:
– Selenium 100-200 mcg daily (Improves insulin action and glucose levels)
– Chromium 100 mcg daily (Improves insulin action, but only helps in deficiency state--common in diabetics)
– Vitamin C 500 mg daily

ADDITIONAL SUPPLEMENTS
• Ginseng, 200 mg daily extract, or 1-3 grams of American ginseng (panax quinquefolius)
– Improves glucose control, HgbA1C levels, and cholesterol profiles in diabetics
• Alpha Lipoic Acid, 600 mg daily
– Improves glucose control, and helps diabetic neuropathy
• Magnesium, 200-400 mg daily
– Improves blood pressure and decreases insulin resistance (may only work in deficiency)

GET YOUR MINERALS
• Ensure adequate calcium intake. Needs vary from 800-1500 mg daily. Assess your lifestyle, count up your dietary calcium intake, and supplement if need be.
• Ensure adequate magnesium intake, 200-400 mg daily
– Calcium/Magnesium comes in 500/250 or 400/200 mg tablets
• Ensure adequate zinc (15-25 mg) and selenium (100-200 mcg) intake

SUPPLEMENT SUMMARY
Evidence-based:
• One-a-Day (folic acid)
• Omega-3 supplement
• Chromium 100 mcg daily
• Ginseng 200 mg extract or 1 gram “panax quinquefolis” daily
• Selenium 100 mcg daily
• Fiber: 40-50 grams per day
Likely Helpful:
• Alpha lipoic acid 600 mg daily (in particular this is helpful for diabetic neuropathy symptoms, such as burning in your feet and legs)
• Folic acid 400 mcg daily
• Calcium & magnesium 500/250 daily
• Vitamin C 500 mg daily

THE BEST REASON TO FOLLOW THESE RECOMMENDATIONS IS THAT CHOOSING A HEALTHY LIFESTYLE MAKES YOU FEEL GREAT!