Patients with blood sugar irregularities are usually advised by the doctor to adopt a healthy diet and do some exercise. They resolve to take action, procrastinate and their blood sugar continues to rise along with their weight, blood pressure and other markers of metabolic syndrome. These patients progress to a lifetime regime of pharmaceutical medicines which contributes to the patient’s declining health with a barrage of side-effects.

It seem that we too-readily accepts this model of symptoms management when the science tells us that nutrition alone can be a powerful medicinal force. For instance, The Lancet published in 2017 a paper demonstrating the power of dietary change when compared to the normal standard of care in 49 primary care practices in Scotland and the Tyneside region of England. In this study, a large group of type 2 diabetics had their anti-diabetic and anti-hypertensive drugs stopped on day one of a twelve month trial, which featured a radical change of diet, and almost half of this intervention group achieved remission (46%). In addition, weight loss of 15 kg or more was observed in 24%.

This result was achieved with a total meal replacement formula of the type used earlier by the same scientists to treat severe obesity.¹ The strategy comprised a diet of ‘(825–853 kcal/day; 59% carbohydrate, 13% fat, 26% protein, 2% fibre) for 3 months (extendable up to 5 months if wished by participant), followed by structured food reintroduction of 2–8 weeks (about 50% carbohydrate, 35% total fat, and 15% protein), and an ongoing structured programme with monthly visits for long-term weight loss maintenance.’

Exercise was also taken into account but to begin with participants were encouraged to continue their normal routine during the total diet replacement phase. When food was reintroduced, step counters were provided along with recommended exercise strategies to help participants achieve up to 15,000 steps per day.

‘Remission varied with weight loss in the whole study population, with achievement in none of 76 participants who gained weight, six (7%) of 89 participants who maintained 0–5 kg weight loss, 19 (34%) of 56 participants with 5–10 kg loss.’

The results were impressive although achieved by harsh means using marked calorie restriction, which indicates how hard it actually is to reverse the effect of years of a sedentary lifestyle nourished by energy-dense factory foods. Similar good results in improving glycaemic control, serum triglyceride, blood pressure, LDL and BMI, can also be achieved using a Ketogenic diet which has even less carbohydrate than a calorie-restricted, low-GI diet.^2–4 The authors of the Lancet study concluded: ‘our findings confirm that type 2 diabetes of up to 6 years’ duration is not necessarily a permanent lifelong condition.⁵

Actually, one of the best maintenance dietary patterns to prevent remission and encourage health and longevity would be a Mediterranean-style diet. The traditional Mediterranean (Med) diet is primarily a plant-based diet characterised by a high consumption of olive oil, vegetables, legumes, grains, fruit and nuts. A moderate amount of dairy, fish and animal meat is added to this diet along with wine, coffee and herbal teas. This is the kind of diet a naturopath would recommend to a modern urban clientele who did not actually request a vegetarian or vegan diet.⁶

Mind you the Med diet was once virtually vegan for up to six months of the year, if you observed the strict religious calendar, but the normal version provides more than enough benefit. ‘Vegetarian dietary patterns were associated with lower body mass index, lower prevalence and incidence of diabetes mellitus, lower prevalence of the metabolic syndrome and its component factors, lower prevalence of hypertension, lower all-cause mortality, and in some instances, lower risk of cancer.⁷

I certainly don’t share the phobia of saturated fat or dietary cholesterol, but that is because I only eat a moderate amount of meat and dairy, organic if possible. It is not a so-called ‘prudent’ dietary pattern which translates into a low-fat ideological version of the Med diet where healthy fats are replaced by omega-6 inflammatory fats and trans fats. This phobia was largely created by the food industry, agribusiness and pharmaceutical companies for commercial reasons. The problem is not fats per se but excess factory fats and refined carbs in the context of a modern urban diet which ‘warm up’ inflammation and oxidative stress.⁸

A group of researchers published the results of a Spanish trial in support of this traditional high-fat Med diet in 2014. In this trial a low-fat diet was compared to a contemporary Med diet supplemented with either extra-virgin olive oil or nuts. Compared to the low-fat control group, both supplemental groups achieved marked reductions in blood pressure, fasting blood glucose and cholesterol after just 1 year. The energy intake derived from fat in the two groups showing improvement was in fact 43%.⁹ A better focus for radical dietary reduction would be sucrose and high fructose corn syrup—a sugar-free diet with the exemption of fruit and honey.^10,11

The large epidemiological ATTICA study of people living in the north of Greece in fact demonstrated that adherence to the traditional Mediterranean Diet circa 1950s and 60s, as well as plenty of exercise, was inversely associated with type 2 diabetes. Modern Greece, according to the 2001 census, actually shows a prevalence of diabetes amounting to 7.6% in men and 5.9% in women, a perfect example of a target population that consumes typical urban factory foods, as well as those foods recommended by health authorities (canola, margarine, synthetic sweeteners), who would benefit from the same naturopathic advice.^12,13

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Disclaimer: this article is intended for the purpose of general education only, and is not a substitute for diagnosis, treatment advice, or a prescription that is given in a consultation with a qualified physician.

References:

1. Lean M, Brosnahan N, McLoone P, et al. Feasibility and indicative results from a 12-month low-energy liquid diet treatment and maintenance programme for severe obesity. Br J Gen Pract J R Coll Gen Pract 2013;63:e115-124.
2. Yancy WS, Foy M, Chalecki AM, Vernon MC, Westman EC. A low-carbohydrate, ketogenic diet to treat type 2 diabetes. Nutr Metab 2005;2:34.
3. Westman EC, Yancy WS, Mavropoulos JC, Marquart M, McDuffie JR. The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus. Nutr Metab 2008;5:36.
4. Pérez-Guisado J, Muñoz-Serrano A, Alonso-Moraga A. Spanish Ketogenic Mediterranean Diet: a healthy cardiovascular diet for weight loss. Nutr J 2008;7:30.
5. Lean ME, Leslie WS, Barnes AC, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet Lond Engl 2017;
6. Lee Y, Park K. Adherence to a Vegetarian Diet and Diabetes Risk: A Systematic Review and Meta-Analysis of Observational Studies. Nutrients 2017;9.
7. Orlich MJ, Fraser GE. Vegetarian diets in the Adventist Health Study 2: a review of initial published findings. Am J Clin Nutr 2014;100 Suppl 1:353S-8S.
8. Giugliano D, Ceriello A, Esposito K. The effects of diet on inflammation: emphasis on the metabolic syndrome. J Am Coll Cardiol 2006;48:677–85.
9. Doménech M, Roman P, Lapetra J, et al. Mediterranean diet reduces 24-hour ambulatory blood pressure, blood glucose, and lipids: one-year randomized, clinical trial. Hypertens Dallas Tex 1979 2014;64:69–76.
10. Lustig RH. Fat Chance: The bitter truth about sugar. London: Fourth Estate; 2013.
11. Ravnskov U. The Cholesterol Myths: Exposing The Fallacy That Saturated Fat And Cholesterol Cause Heart Disease. Washington, DC: New Trends; 2000.
12. Panagiotakos DB, Pitsavos C, Chrysohoou C, Stefanadis C. The epidemiology of Type 2 diabetes mellitus in Greek adults: the ATTICA study. Diabet Med J Br Diabet Assoc 2005;22:1581–8.
13. Georgoulis M, Kontogianni MD, Yiannakouris N. Mediterranean diet and diabetes: prevention and treatment. Nutrients 2014;6:1406–23.