Monday, August 12, 2013

Proper management of Type 2 Diabetes: Don't focus on calories and exercise

Type 2 diabetes is extremely prevalent in modern society.  Despite spending decades trying to get people to exercise more and eat less, the problem has only gotten worse.  Thirty years ago Type 2 diabetes was called adult-onset diabetes because people only developed it when they became adults.  The theory behind this is that people would go from an active lifestyle of playing with friends, playing sports, partaking in gym class, and walking from class to class when they were in school to jockeying a desk for forty hours a week once they started work.  In an effort to combat the problem, more people began counting calories and going to the gym to ward off to the disease.  It hasn't worked.

When you look at how Type 2 diabetes has changed, it is most certainly for the worse.  Not only are more people getting it, even children are being diagnosed with it.  Currently, proper management of Type 2 diabetes involves eating fewer calories and burning more calories through exercise. While most people would certainly be better off doing both, they shouldn't be where most of your attention is focused.  Most people would be better served taking the following advice first:

  • Eat more fruits and vegetables
  • Limit or eliminate all processed foods
  • Spend as little time as possible sitting
  • Get 10,000 steps per day
  • Get 8 hours of quality sleep every night

Eat more fruits and vegetables

Eating more fruits and vegetables helps on a few levels.  First, both are more nutrient dense than they are energy dense which means they have fewer calories per unit of volume.  By eating more fruits and vegetables, you will feel fuller on less food because they take up more room in the stomach.  Both are also good sources of fiber which will cause food to move more quickly through the digestive tract.  Soluble fiber also helps feed the beneficial bacteria in your gut that helps heal damage to your intestinal lining.  People with Type 2 Diabetes tend to consume fewer fruits and vegetables as well as fiber.

Limit processed food

Limiting or eliminating processed foods is important because processed foods tend to be more energy dense. This means you have to eat more to feel full because they tend to carry more calories per unit volume.  Most processed foods also tend to be very inflammatory to your intestinal lining.  Obesity and Type 2 diabetes are often referred to as inflammatory conditions so lowering the amount of inflammation you experience is a good idea.  Gluten, which is found in most processed foods, is bad because it can cause an immune reaction that causes blood glucose to run high because glucose gets conserved for the immune system.  This causes your body to increase insulin production and can damage the pancreas, a hallmark of Type 2 Diabetes.  For more of the science on this process, click here.

Reduce sitting time

Spending as little time siting as possible helps on a couple of fronts with Type 2 Diabetes management.  First, it helps you burn off some of the carbohydrates you eat and lowers your blood glucose.  Secondly, for as long as we have been studying the effects of sedentary behavior(hundreds of years), scientists have noted that sedentary behavior slows down the movement of food from your gastorintestinal tract.  The longer food stays in your GI tract, the more calories you will be able to extract from it.  In addition, being in a seated position for long periods of time causes poor genetic expression that increases the risk for Type 2 Diabetes as well as other poor health outcomes. For more of the science on this check out this blog.

Get 10,000 steps

Getting 10,000 steps a day is a general recommendation for good health put out by many health organizations including the American Heart Association as well as the American Medical Association.  It helps in basically the same way that reducing sitting time works.  I recommend people spread out their steps through the day and a recent study showed taking a 15 minute walk after very meal helped people with Type 2 Diabetes manage their blood glucose better than a single 45 minute walk.

Get 8 hours of quality sleep

Getting 8 hours of quality sleep per night is also a very important habit to have to manage Type 2 Diabetes.    Poor sleep can lead to poor blood glucose control and disturb many hormonal systems by disrupting circadian rhythms.  Even just a week of getting 6 hours or less of sleep per night can disrupt these rhythms, which is common for many people.  This article does a pretty good job of discussing the science behind this.


The purpose of this article is not to give you the impression that calories are not important or that you shouldn't exercise.  Calories are significant, but that doesn't mean counting them is an effective tool for managing Type 2 diabetes.  Exercise is an important component of any comprehensive health program, but you have to realize that your priorities should lie with the other 6 factors first.  Once you have successfully implemented those strategies, you can add exercise in to boost your results.  As for calorie counting...You can count calories if you choose, but if you are following the other 6 factors listed above, you probably won't have to.