November 2012 Issue

Reversing Type 2 Diabetes With Natural Therapies
By Constance Brown-Riggs, MSEd, RD, CDE, CDN
Today’s Dietitian
Vol. 14 No. 11 P. 28

Experts examine whether alternative approaches can cure the disease or at least send it into remission.

John couldn’t seem to quench his thirst no matter how much water he drank. With his wife’s encouragement, he scheduled an appointment with his primary care doctor. A few days later, his doctor called him back into the office and told him, “You have severe type 2 diabetes.”

Like many people who receive an unexpected diabetes diagnosis, John was frightened. He started surfing the Internet and reading as much as he could about the disease. Unfortunately, the information only left him reeling with more questions than answers. To make matters worse, his doctor prescribed medication that made him hypoglycemic.

John spoke to several friends who had different health problems that had been either cured or treated by a doctor of naturopathy. He decided to schedule an appointment with the same doctor.

At his first visit, the naturopathic doctor told John he’d be “off medication and free of diabetes in three months.” John left the doctor’s office with instructions to eat a low-carb diet. He’d been on a low-fat diet for years because of heart problems, but while he’d cut the fat, his meals included many highly processed foods. His new diet included “a lot of salads and healthful, organic foods.” He was given several whole food supplements that he says were “simple to mix and tasted good.”

After two months under the care of the naturopath, John returned to his primary care doctor to discover that his hemoglobin A1c had dropped from 8.9% to 4.9%—a nondiabetic range. For eight months and counting, he’s been off all his diabetes medication. His last A1c reading was 5.1%. With the help of his naturopath, John seems to have reversed his diabetes.

Rising Epidemic
According to the Centers for Disease Control and Prevention (CDC), from 1980 through 2010, the number of American adults aged 18 and older with diagnosed diabetes more than tripled—soaring from 5.5 million to 20.7 million. Moreover, the diabetes epidemic shows no signs of slowing down, affecting 25.8 million people in 2011. Another 79 million adults have prediabetes, putting them at greater risk of developing type 2 diabetes down the road, according to the CDC.

Diabetes is a costly disease, placing a high financial burden on the patient and the healthcare system. If poorly managed or left untreated, it can cause blindness, loss of kidney function, and conditions that require the amputation of digits or limbs. The CDC reports that it’s also a major cause of heart disease and stroke and the seventh leading cause of death in the United States.

The bottom line is that diabetes can be bad news—but this doesn’t have to be the case. Interventions can prevent or delay the disease in people with prediabetes. The Diabetes Prevention Program (DPP), a large study of people at high risk of diabetes, has established a prevention plan that’s both feasible and cost-effective. The DPP showed that weight loss and increased physical activity reduced the development of type 2 diabetes by 58% during a three-year period.

But what about people who’ve already been diagnosed with type 2 diabetes? Can their diabetes be reversed? Is it possible to cure diabetes with natural therapies? And moreover, what actually constitutes a reversal of the disease? The key to answering these questions begins with the pathophysiology of type 2 diabetes.

What Is Type 2 Diabetes?
Diabetes is a group of diseases characterized by elevated blood glucose levels due to defects in insulin secretion, insulin action, or both. According to the American Diabetes Association (ADA), type 2 diabetes usually begins with insulin resistance. For those people whose bodies resist insulin, the pancreas secretes extra insulin to maintain normal glucose levels. As the condition progresses, insulin production gradually decreases and eventually reaches a level of deficiency that can no longer maintain blood glucose in the normal range. But how type 2 diabetes presents and progresses can vary considerably, as noted by the ADA, and methods of treatment can vary from patient to patient.

Alternative vs. Conventional Medicine
One way to approach diabetes is to use integrative holistic medicine, also known as alternative medicine, a medical specialty that focuses on caring for the whole person, treating and preventing disease, and empowering patients to create conditions for optimal health, according to the American Board of Integrative Holistic Medicine.

This modality can be contrasted with the emphasis of conventional medicine, which is to cure or mitigate disease, as reported by the American Holistic Health Association. For example, a conventional practitioner will follow an established algorithm for diabetes management that includes a medically established protocol centered on monitoring blood sugar and prescribing medications to balance it. An alternative medicine provider takes a personalized, whole-person approach that may include a prescription for changes in diet and exercise habits, stress reduction, and other lifestyle considerations. (The table below offers a comparison of alternative medicine with conventional medicine.)

The concept of whole-person medicine is gathering increasing support in the nutrition and dietetics profession, as evidenced by the 2,550-member Dietitians in Integrative and Functional Medicine (DIFM) practice group of the Academy of Nutrition and Dietetics (the Academy).

Informed by scientific evidence, this group of RDs provides integrative and functional medical nutrition therapy (IFMNT) based on two principles: Each client has a unique genetic make up, and each client functions in an environment with internal and external factors that influence interactions between the mind, body, and spirit.

Conventional medical nutrition therapy (MNT), an intervention within the Nutrition Care Process (NCP) and Model, is defined by the Academy as “nutritional diagnostic, therapy, and counseling services for the purpose of disease management, which are furnished by a registered dietitian or a nutrition professional.”

The NCP is a systematic approach to providing high-quality nutrition care. It’s used in MNT and is at the core of IFMNT. The NCP consists of four distinct, interrelated steps: nutrition assessment, diagnosis, intervention, and monitoring/evaluation.
Using the NCP provides a framework for the RD to individualize care, taking into account the patient’s needs and values and using the best evidence available to make decisions.

Diabetes Management
Practitioners agree that nutrition is the cornerstone of diabetes management, and that a range of nutrition intervention strategies can be used to meet the metabolic goals and individual preferences of the person with diabetes. However, there are significant differences in the approach and methodologies used by alternative and conventional practitioners to manage the disease. One difference is in terminology. When is remission really remission?

John’s naturopath, Susan DeLaney, ND, RN, from The Wellness Alliance in Carrboro, North Carolina, considers diabetes to be reversed when an individual is no longer dependent on medication to maintain blood glucose levels within a fairly normal range. Kathie Madonna Swift, MS, RD, LDN, owner of Swift Nutrition and author of The Inside Tract: Your Good Gut Guide to Great Digestive Health, describes reversal of diabetes as “restoring function and bringing the body back into glycemic balance.”

The goal of MNT is to achieve and maintain blood glucose levels in the normal range or as close to normal as is safely possible. Patients who meet this goal are described as being in control.

Conventional vs. Alternative Nutrition Recommendations

Carbohydrates
Conventional: A dietary pattern that includes carbohydrates from fruits, vegetables, whole grains, legumes, and low-fat milk is encouraged for good health. Carbohydrate intake should be monitored using carbohydrate counting or experienced-based estimation. The Recommended Dietary Allowance for digestible carbohydrates is 130 g/day, which will provide a sufficient amount of glucose needed to fuel the central nervous system without reliance on glucose production from protein or fat. Using foods with a low glycemic index that are rich in fiber and other important nutrients is encouraged.

Alternative: DeLaney encourages her patients to avoid all wheat products “due to the increased glycemic response.” She says wheat products contain “irritating phytochemicals such as lectins and glutens.”

Sheila Dean, DSc, RD, LD, CCN, CDE, owner of Palm Harbor Center for Health & Healing in Palm Harbor, Florida, places her patients on a carbohydrate-controlled meal plan with minimally processed carbohydrates, which she refers to as “clean carbs.”

Protein
Conventional: For individuals with diabetes and normal renal function, protein recommendations are the same as healthy individuals: 15% to 20% of calories.1

Alternative: DeLaney’s meal plan calls for protein and fat at each meal to “slow the glycemic response.” She encourages wild fish but permits hamburger and pork chops. Swift, a member of the DIFM dietetic practice group, encourages her patients to follow a “plant-centric, gluten-free” diet, and she includes wild fish on the menu.

Fiber
Conventional: People with diabetes are encouraged to consume a variety of fiber-containing foods, such as legumes, fiber-rich cereals, fruits, vegetables, and whole grain products.1

Alternative: DeLaney instructs her patients to consume eight to 10 servings of vegetables and fruits per day. “Beneficial plant nutrients and added fiber slow the glycemic response,” she says.

Before making any fiber recommendations, Dean has her patients tested for “pancreatic insufficiency.” She believes people with pancreatic insufficiency should be given digestive enzymes along with fiber, “otherwise the fiber will just bloat them up, and they’ll be quite unhappy,” she says. Dean uses a glucomannan fiber supplement for her patients with type 2 diabetes.

Fat
Conventional: People with diabetes are asked to limit saturated fat to no more than 7% of total calories, minimize trans fat intake, and limit dietary cholesterol to 200 mg/day. Two or more servings of fish per week are recommended for their cardiovascular health.1

Alternative: “I’m a fat-atarian,” says DeLaney, who tells her patients to avoid low-fat foods. She encourages them to eat whole-fat dairy products, egg yolks, butter, olive oil, and avocado. “Restoring healthful fats to our diets as well as eliminating trans fats and all refined oils that help deplete our fat and vitamin stores will help nourish the body and reduce the need for diabetes medication.”

Dean recommends fish oils because “they have a similar mechanism of action as PPAR [peroxisome proliferator-activated receptor] agonists such as metformin,” she says.

Extra-virgin olive oil, nuts, and seeds are prominent sources of healthful fat on the Swift menu.

Vitamins and Minerals
Conventional: Vitamin and mineral supplements are provided only when deficiencies have been identified. Routine supplementation with antioxidants, such as vitamins E and C and beta-carotene, isn’t advised because of lack of evidence of their effects and concerns related to long-term safety.1

Alternative: “The reason I use food-based supplements is because they most closely help correct what I see as the problem: The food we’re eating is lacking in nutrients,” DeLaney says. “If their vitamin D is low, it tells me all their fat-soluble vitamins are low.” She uses cod liver oil along with high-vitamin butter oil to restore these deficiencies.

“I prefer a ‘food as medicine’ approach,” says Swift, who also recognizes the value of “therapeutic supplementation when prescribed thoughtfully” after a complete assessment.

Dean recommends her patients supplement with vitamin D “to help strengthen the cellular signals and replete the body.” She believes her patients respond to carb counting much better with nutrient supplementation. “There’s no one magical vitamin—it’s a symphony of nutrients that work together,” she says.

Physical Activity
Conventional: People with diabetes are encouraged to engage in at least 150 minutes of moderate-intensity aerobic activity weekly and resistance training at least twice per week.

Alternative: Keeping in mind the principles of patient-centered care and the need to exercise the body, mind, and spirit, Swift includes yoga and qi gong on her nutritional lifestyle prescription pad for diabetes care.

Dean uses a more traditional approach. She encourages her patients to purchase a pedometer and track their daily steps, adding 500 steps each week until they’re walking 10,000 steps per day.

DeLaney encourages 30 minutes of physical activity daily, leaving the type of activity up to the patient.

Can We Reverse/Cure Diabetes?
There’s much media hype about reversing or curing diabetes, and patients are confused regarding these terms. However, many practitioners agree that bringing an A1c level down from 8.9% to 4.9% is indeed reversing the disease process.

But is John “free of diabetes”? This is where the lines become blurred. Medically speaking, the term “cure” is usually associated with acute disease—a temporary medical condition, such as bacterial pneumonia, that can be cured with antibiotics. For diabetes, which is a chronic disease, it may be more accurate to use the term “remission” rather than cure. Particularly when considering the pathology associated with diabetes and the individual’s genetic predisposition, relapse is always possible. In a consensus statement issued by the ADA, the term remission is defined based on the following definitions:2

• Partial remission: maintenance of blood glucose below diagnostic levels (a prediabetes state) without diabetes medication for at least one year;

• Complete remission: normal blood glucose without diabetes medication for at least one year; and

• Prolonged remission: complete remission for at least five years.

Tips for Dietitians
It’s well understood that weight loss, healthful eating, and physical activity are important factors in preventing, managing, and reversing diabetes. Hope Warshaw, MMSC, RD, CDE, author of Diabetes Meal Planning Made Easy and other ADA publications, encourages RDs to be clear with patients when talking about reversing the disease.

“People need to understand the continuum of diabetes,” she says. “If they’re on an upward trajectory of insulin resistance and a downward trajectory of insulin production weight loss, healthful eating and physical activity will slow down the insulin-loss trajectory and improve insulin sensitivity.” But, she says, “If they gain weight back, the diabetes comes back.”

Remember that diabetes care is complex and goes beyond glucose control. Dietitians should continue to be “evidenced based but open minded,” says Patti Geil, MS, RD, FADA, CDE, coauthor of What Do I Eat Now? A Step-by-Step Guide to Eating Right With Type 2 Diabetes.

Dean says, “We can’t only focus on macronutrients. … We must be mindful and open to the role of micronutrients.”

Swift urges RDs to be informed and stay up-to-date as complementary and alternative medicine data evolves. Use a “whole systems, whole person” approach to health and healing. The Kripalu Center for Yoga and Health is a good place to start. “They have an outstanding program on diabetes care that’s multidisciplinary and integrative,” Swift says. You also can receive continuing education credits for attending.

— Constance Brown-Riggs, MSEd, RD, CDE, CDN, is the national spokesperson for the Academy of Nutrition and Dietetics, specializing in African American nutrition, and author of the African American Guide to Living Well With Diabetes and Eating Soulfully and Healthfully With Diabetes.

 

Naturopathic Food Plan

Basic Rules
• Avoid all wheat products.

• Eat protein and fat at each meal, three times per day.

• Eat eight to 10 servings of fruits and vegetables per day.

• Avoid all trans fats and processed foods, such as cookies, cakes, and potato chips.

• Consume olive oil, avocado, butter, seeds and nuts, whole-fat dairy products, cheese, and yogurt.

• Eat 3 to 4 oz of nuts per day (eg, walnuts, almonds, pecans)

Breakfast
One to two eggs cooked as desired with nitrate-free, farm-raised bacon. For “Southerners,” grits and butter or whole-fat plain yogurt with nuts and fruit.

Lunch
Salad with tomatoes, carrots, beets, onions, cucumbers, black olives, and “whatever else you desire.” Add pumpkin seeds, walnuts, and feta or goat cheese. Top with grilled chicken, tuna, or a hard-boiled egg. Dress with olive oil and vinegar or a lemon tahini dressing. Use mustard, garlic, or Italian seasonings to flavor the salad.

Dinner
Wild Alaskan salmon, halibut, or sable fish and a grilled or roasted vegetable assortment. In the summer, try squash, peppers, onions, and mushrooms. In the fall and winter, try beets, carrots, onions, and potatoes. Also, brown rice, a sweet potato with butter, or corn on the cob.

Snacks
Four squares of dark chocolate (containing 70% to 80% of cacao) eaten with walnuts, almonds, cashews, or pecans. Sliced fruit such as apples or pears with a slice of cheese and nuts or peanut butter.

— Source: Susan Delaney, ND, RN

 

No More Diabetes
By Kathie Madonna Swift, MS, RD, LDN

One of my patients, aged 58, had an initial hemoglobin A1c of 7.2%. She was taking oral hypoglycemic agents, statins, and proton pump inhibitors—the basic treatment for every diabetes diagnosis. The patient was 28 lbs overweight and worked long hours. She didn’t exercise, mostly ate a processed food diet, and was sleep deprived. The patient had a family history of diabetes, and ultimately her lifestyle expressed her genetic tendencies.

Implementing integrative and functional medical nutrition therapy, I helped the patient understand that she could reverse the trajectory she was on by making lifestyle changes—and that’s what she did. We engaged in shared decision making in our ongoing nutrition consultations. Over the course of one year, her physiology and health status changed for the better. Her A1c dropped from 7.2% to 5.6%, and she no longer required medications. She continues to adhere to her new lifestyle program and is confident she’ll remain free of a diabetes diagnosis.

Sample Menu
This is an example of what my patient eats on an average day:

Breakfast: smoothie containing 80% veggies, herbs, and spices and 20% fruit, with added nuts and seeds

Lunch: Collard green wrap with veggies, hummus, extra-virgin olive oil dressing, and avocado

Snack: Fresh fruit and a handful of nuts or seeds; occasionally dark chocolate

Dinner: Wild fish, green leafy salad with extra-virgin olive oil herb dressing, a colorful vegetable, starch (eg, sweet potato with skin) or gluten-free grain (eg, quinoa)

Beverages: Organic coffee in the morning; herbal or green tea during the day (occasionally with a drop of honey).

— Kathie Madonna Swift, MS, RD, LDN, is owner of Swift Nutrition, author of The Inside Tract: Your Good Gut Guide to Great Digestive Health, and a member of the Dietitians in Integrative and Functional Medicine practice group of the Academy of Nutrition and Dietetics.

 

References
1. American Diabetes Association, Bantle JP, Wylie-Rosett J, et al. Nutrition recommendations and interventions for diabetes: statement of the American Diabetes Association. Diabetes Care. 2008;31 Suppl 1:S61-78.

2. Buse JB, Caprio S, Cefalu WT, et al. How do we define cure of diabetes? Diabetes Care. 2009;32(11):2133-2135.

 

Comparing Alternative and Conventional Medicine

	Alternative Medicine	Conventional Medicine
Philosophy	Based on the integration of allopathic (MD), osteopathic (DO), naturopathic (ND), energy, and ethno-medicine	Based on allopathic medicine
Primary objective of care	To promote optimal health and, as a by-product, prevent and treat disease	To cure or mitigate disease
Primary method of care	Empower patients to heal themselves by addressing the causes of their disease and facilitating lifestyle changes through health promotion	Focus on the elimination of physical symptoms
Diagnosis	Evaluate the whole person through holistic medical history, holistic health score sheet, physical exam, lab data	Evaluate the body with history, physical exam, lab data
Primary care treatment option	Love applied to body, mind, and spirit with diet, exercise, environmental measures, attitudinal and behavioral modifications, relationship and spiritual counseling, bioenergy enhancement	Drugs and surgery
Secondary care treatment options	Botanical (herbal) medicine, homeopathy, acupuncture, manual medicine, biomolecular therapies, physical therapy, drugs, surgery	Diet, exercise, physical therapy, stress management

— Adapted from the American Holistic Health Association