Thursday, June 13, 2013

Conquering Type 2 Diabetes: Diet

In the first blog in this series we went over the basic outline for this series.  In this first part of the series we discuss dietary changes.  Most of the books that deal with treating Type 2 diabetes with diet tend to recommend eating basically the same types of food but in smaller quantities.  I don't mean that these books don't recommend changes, they do.  What I mean is that rather than regular bread they tell you to eat whole grain bread.  Rather than white rice they tell you to eat brown rice.  Rather than white pasta you should eat whole grain pasta.  The problem is, there really is no significant difference between any of these switches.  While they may have a minor effect on your blood glucose level, they really aren't getting at the problem.  When you are looking to repair your metabolism you need to look at food from a completely different perspective.  Not only do you need to be concerned with he sustenance you are providing to yourself, you need to look at how what you eat affects the inhabitants of your gut.  I am talking about the gut bacteria that make up your gut microbiota.

Research in to the microbiota

Clinical research tends to go in waves and currently clinical research seems to be swarming in on an area of research that was once thought to be the ramblings of charlatans and quacks.  Ten years ago you could fit all of the research studies on gut dysbiosis and gut bacteria in to a small binder, now there are thousands of ongoing research projects every year discovering more and more about the link between the inhabitants of our gut and health conditions ranging from autism to Type 2 diabetes.  There is a very strong link between Type 2 diabetes and the inhabitants of your gut.  It's so strong that within a few days of having gastric bypass surgery, patients' blood glucose control normalizes and this effect is thought to partially mediated by a rapid change in the gut microbiota(1).  Since this area of research is in it's infancy, there are certainly no hard rules written in stone but we can see some trends

How a leaky gut contributes to Type 2 Diabetes

I have discussed the relationship between a leaky gut and Type 2 diabetes multiple times on this blog.  Rather than rehash it all, you can go here to see the pathology behind how a leaky gut contributes to Type 2 diabetes.  When your intestinal barrier is compromised, LPS leaks in to the bloodstream and causes insulin resistance.  In addition, sometimes overeating certain types of foods can cause pathogenic bacteria who have LPS as a part of their plasma membrane to overgrow in the gut.  LPS shouldn't be in the bloodstream so it is up to your immune system to take care of the invader.  In the meantime, repairing the gut lining will close off the supply of LPS and take some of the burden off of the immune system.  The best way to repair the gut lining is to commission some of your friends in the microbiota to do the job, a group of friends called bifidobacteria.

Bifidobacteria are a species of bacteria in your gut that provide quite a service to you.  In exchange for a little bit of fiber, they ferment that fiber in to a short chained fatty acid called butyric acid(2).  Butyric acid is used by the cells of your intestines to heal damage to the gut lining.  While most people look to take probiotics to re-inoculate their gut, your best bet is to provide prebiotics.  Probiotics are the actual strains of bacteria while prebiotics are the substrate these bacteria ferment, aka their food.  Whether or not the probiotics make it through the acidic contents of the stomach is up for debate while the prebiotics are indigestible by humans so they most certainly do.  In addition, just dumping strains of bacteria will do nothing if they don't have food.  Not only will they not survive and just be flushed out in your feces, they'll have no way of making butyric acid and, therefore, no way of healing your gut lining.

The best dietary approach to healing your gut

Healing your gut is an important step in conquering Type 2 diabetes.  Most people go on a very low carbohydrate diet which can yield some results, but this is normally an indirect relationship.    When most people reduce carbohydrates, they accomplish this by eliminating processed foods.  Processed foods are typically high in sugar or other refined carbohydrates.  I would even consider whole grain breads, cereals and pastas in this group because the limited fiber content in the whole grain varieties don't even come close to making up for everything else that's in them.  Your goal should be to eliminate all processed foods for a couple of months and to eat lots of plants in the form of fruits and vegetables.  This will provide lots of fiber for the good bacteria to ferment and heal your gut while at the same time eliminating the sugar that tends to feed the bad bacteria.  This is by far the best and fastest way to turn the ship around with Type 2 diabetes and re-establish proper blood glucose regulation.

Even if you decide that this approach is too extreme, you should increase the amount of vegetables you eat and limit processed foods as much as possible.  Look at your gut as a battle ground with two opposing sides waging war.  On the one side you have the troops who are helping you by manufacturing nutrients and repairing your gut lining and on the other you have the troops who are trying to wreak havoc in your digestive tract and trying to gain access to your bloodstream.  You want to provide more reinforcements/food to the good guys so that they can win the war and help maintain your health and avoid Type 2 diabetes.

Is this change for life? 

While avoiding processed foods is a good practice, once you fix a leaky gut and restore a proper balance of good bacteria in your gut you should be able to indulge in some processed foods provided you are also getting gut healing veggies in as well.  There is probably a tolerable dose of processed foods you can get away with eating that won't immediately impair your blood glucose control and return you to the land of Type 2 diabetes.  This dose is probably specific to the individual and will depend on how robust your immune system is, how good your digestion is, and on your age as it affects the other factors.  There is also a genetic component as well.


In the war against Type 2 diabetes, you should focus on what goes in to your mouth as reinforcements for the battle.  If you focus on providing more reinforcements to the bacteria that provide a benefit to you and less to the bacteria that can cause problems, you should be able to win the war.  Once you fix your gut lining and establish a good balance of good bacteria that is beneficial to you, you may be able to indulge in foods that previously threw your blood glucose out of whack provided you maintain a constant supply of reinforcements for the good guys.

Part 1 -Overview
Part -Lifestyle