What does type II diabetes mellitus mean?
It has been presumed that the symptomology of the disease (type II diabetes mellitus) was first recorded in 1550 BC by the Egyptians (Ahmed, 2002, p. 373). Araetus of Cappodocia (81-138 AD) “used the Greek word diabetes, literally meaning to run through or siphon” when describing the excessive flow of urine within individuals inflicted with the disease (Ahmed, 2002, p. 373). According to Ahmed (2002) Avicenna, an Arab physician (960-1037 AD) “emphasized the idea of sweet taste of urine” when describing his patients with diabetes (p. 373).
Thomas Willis, a physician in London, rediscovered the “sweetness of urine in diabetic patient’s” in 1675 (Ahmed, 2002, pg. 374). With his new discovery he added the Latin term “mellitus, literally meaning honey sweet to the Greek diabetes to describe the disease” (Ahmed, 2002, pg. 374). Type II Diabetes mellitus, also known as type II diabetes, literally means sweet urine which is due to the kidneys excretion of sugar from the blood.
What is type II diabetes?
Type II diabetes is a disease characterized by elevated blood glucose levels (Center for Disease Control and prevention [CDC], 2017a. According to the CDC (2017a) most of the food we eat is turned into glucose that our bodies use for energy. The pancreas, an organ that lies near the stomach, makes a hormone called insulin to help glucose get into our cells. When you have diabetes, either your body doesn’t make enough insulin or can’t use its own insulin well which causes sugar to build up in the blood stream.
It is important to understand that our bodies, our muscles, our brain, and our organs all use glucose for energy. Our body runs on glucose as explained above.
Isn’t type II diabetes called adult-onset diabetes?
Yes, previously diabetes was considered a disease that only middle aged and older adults were diagnosed with. In recent years the prevalence of the disease has been increasing in children and young adults. According to Hannon, Rao, & Arslanian (2005) in recent years “overweight and obesity is the most important risk factor for the development of type 2 diabetes mellitus in youth” (p. 473).
What is prediabetes?
The Center for Disease Control and prevention (2017b) and the American Diabetes Association (2014) state that prediabetes is when individuals have elevated glucose levels but are not within the ranges of those with diabetes. Therefore these individuals are classified as having prediabetes. These ranges and cut off values are needed to understand how diabetes is diagnosed.
Each test has a specific range in which blood sugar levels need to fall between to issue a diagnosis. For prediabetes to be diagnosed, A1C levels the results need to be between 5.7% and 6.4%; Fasting Plasma Glucose 100 mg/dl to 125 mg/dl; and Oral Glucose Tolerance Test 140mg/dl to 199mg/dl.
How many people are affected by type II diabetes and pre-diabetes?
According to the Center for Disease Control and Prevention ([CDC], 2017a) “more than 30 million Americans have diabetes (about 1 in 10)” and those living with prediabetes is estimated to be approximately “84 million American adults-more than 1 out of 3…” (CDC, 2017b). According to the UnitedHealth Group “based upon current trends, 52 percent of the U.S. adult population could have prediabetes or diabetes by 2020” resulting in approximately 3.4 trillion dollars spent on diabetes management (2010, p. 4).
Below Jeff Novick, Registered Dietitian at the McDougall Center explains the current Diabetes Trends in America and how lifestyle changes can help reduce the risk of becoming diabetic.
An analogy of Insulin Resistance and Intramyocellular Lipids?
According to the CDC (2016b) most of the food we eat is turned into glucose, or sugar, that our bodies use as energy. The body’s natural fuel source is glucose (sugar) not fat, especially saturated and trans fat. While the body can run on table sugar (sucrose) which is found in processed foods such as soda and candy, it does best with complex carbohyrdates. With this general understanding we can begin to understand the development of diabetes.
Glucose (sugar) cannot enter our muscle cells directly. It needs a key (insulin) to get in. After eating food, blood glucose levels rise and beta cells signal the release of insulin. Insulin attaches to glucose within the blood allowing glucose to enter the muscle cell. The cell (door) is locked until insulin opens it allowing glucose to be absorbed. But individuals with increased levels of circulating blood glucose, fat droplets (lipids) have plugged the cell where glucose is supposed to enter via insulin. Intramyocellular lipids, or fat within the muscle cells, increases insulin resistance. Below is an example of how intramyocellular lipids causes insulin resistances.
*Intramyocellular lipids. Intra = Inside, myo = muscle, cellular = cell, lipids = fat. Intramyocellular lipids mean fat within muscle cells.
In the following clip from VegSource.com, Jane Esselstyn explains intramyocellular lipids and the role in the development of type II diabetes in individuals. She provides a visual demonstration of the same concept referred to above.
Removing fat from the diet can help manage blood glucose levels. Without addressing the cause of high blood glucose levels, it is difficult to address the issue. In the case of insulin resistance prediabetes/diabetes there are two ways to better manage blood glucose levels.
- As research has pointed out, physical activity (exercise) can help manage Intramyocellular lipids by utilizing the fat contained within the muscle cells. While physical activity, light walking, and riding a bike are recommended, this attempt does not address the underlying cause of the disease which is excess fat in the diet. It does, however, address the symptoms, one of which is high blood glucose levels. Exercise can be seen as a temporary fix. While exercise addresses the problem, it does not address the underlying cause of the disease. If no dietary modifications are made (removing fat from the diet), the muscle cells revert to their previous state (excess fat contained within the muscle cell) and insulin resistance returns.
- The second way to manage blood glucose levels is to remove high fat foods from the diet. By removing excess fat from the diet, primarily saturated and trans fat, found predominantly in meat and dairy products can help manage blood glucose levels. It should be understood that high levels of saturated fat can also be found in plant based-foods such as some nuts and oils like palm oil, palm kernel oil, coconut and coconut oil. Removing oils from the diet and keeping fats to a minimum (preferably less than 10 to 15%, but at least under 20%, of calories from fat) diminishes, stops, slows, or reverses the cascading and damaging effects that high blood glucose levels have within the body. In other words if fat consumption is kept to a minimum, fat cannot plug up the cells which then decreases insulin resistance and improves blood glucose levels.
In this video by Dr. Neal Barnard explains his research regarding Diabetes. Tackling Diabetes with a bold new dietary approach: Neal Barnard at TEDxFremont.
What does Cure, Remission, Prolonged Remission, Reversal, Prevention mean?
Diabetes is thought to be a preventable condition, but it is unclear if it can be cured. The words used to describe reversal of the disease are important. Therefore a plant-based diet could be thought of as a dietary management solution. What this means that making dietary changes could potential reverse the condition, however, if the lifestyle is not managed the disease state will return. If an individual falls back into old habits, old symptoms (or new symptoms) will/may come back. According to Taylor (2013) “It is now clear that type 2 diabetes is a reversible condition of intra-organ fat excess to which some people are more susceptible than others” (p. 267). Taylor uses the term, “reversible condition.” Others have also used the same term. Does the term used matter or is it the outcome?
According to a position paper written by Buse, et al., (2009) for the American Diabetes Association, a “cure may be deﬁned as restoration to good health” (p. 2133) however they further elaborated that “remission is deﬁned as abatement or disappearance of the signs and symptoms of a disease. Implicit in the latter is the possibility of recurrence of the disease” (p. 2133). Buse et al., (2009) acknowledge that “prolonged remission is complete remission that lasts for more than 5 years and might operationally be considered a cure” (p. 2133).
Maybe “cure” is not the word we should be using to describe those who no longer exhibit symptoms of the disease, though reversal of symptoms over time may be classified as a “cure”. Many researchers use the term “reverse.” According to Stevens, Lim, and Taylor (2013), “these data demonstrate that intentional weight loss achieved at home by health-motivated individuals can reverse Type 2 diabetes.” They further state that “diabetes reversal should be a goal in the management of Type 2 diabetes” (P. 135). Lim et al., (2011) have recognized that “the abnormalities underlying type 2 diabetes are reversible by reducing dietary energy intake” (P. 2506). Other researchers have concluded that high nutrient dense diets can effectively control the progression of type II diabetes by controlling glycemic levels. According to Dunaief, Fuhrman, Dunaief, & Ying, (2012) “the HND diet was very effective in controlling glycemic levels and cardiovascular risk factors” (p. 364).
According to Medline Plus (2016), to reverse is to initiate recovery from. Thus going back to a state in which diabetes did not occur is similar to remission, but reverse may also mean that the disease may reoccur. The word prevention, according to Medline Plus (2016), means to stop the occurrence of disease.
Diabetes may not only be a reversible disease, but could quite possibly be a preventable disease. Excess consumption of saturated and trans fat, only found in meat, dairy products, and edible oils to include, palm oil, palm kernel oil, and coconut oil as well as processed foods containing oils, leads to insulin resistant muscles, which leads to an insulin resistant pancreas, which over time leads to an insulin resistant liver. At some point the whole system crashes which leads to the development of type II diabetes.
McDougall’s Moments: Diabetes
That is why making healthier foods choices matters. By making healthier foods choices you have the ability to control what foods enter your body. You have the ability to choose which foods to consume. The mouth is the only inlet for food, and as the consumer you have the choice to consume healthy low fat choices such as fruits, vegetables, whole grains, beans, peas, and legumes or unhealthy high fat choices such as meat, dairy, cheese, eggs, edible tropical oils, and processed foods containing oils. The amazing thing is you have more control over the disease than you may have previously thought. Our food choices can effectively combat the disease process.
Each and every food choice individuals make can have a positive or negative impact our health. The choices made can directly impact our health outcomes. Choosing to avoid high fat foods has the potential to improve the quality of your life. Removing high fat meat, dairy, and oils can aid in the potential reversal of type II diabetes. Light to moderate exercise, such as walking, is encouraged but not mandatory. This is not to discredit physical activity’s role in the prevention and reversal of type II diabetes but focusing on the diet is the number one priority.
What about moderate consumption of animal-based foods? This brings us to the question of moderation. According to Trapp and Barnard (2010):
Patients diagnosed with hypercholesterolemia are usually advised to lower their intake of fat and cholesterol. Ornish states that these moderate changes in diet usually result in only modest reductions in LDL cholesterol levels. Similarly, asking people with diabetes to make moderate changes in nutritional intake (eg, “eat fewer carbs”; “remove the skin from chicken”; “get more exercise”) often achieves equally moderate results, which is one possible reason why 84% of those with type 2 diabetes require oral medications, insulin, or both (p. 158).
Therefore, promoting moderate consumption of meat, dairy, eggs, processed foods containing oils and tropical oils may not help you win the war against pre-diabetes and diabetes. The goal for all patients should be to reverse diabetes by reducing or eliminating the foods that have been shown to increase the risk of developing type II diabetes such as meat, fish, eggs, dairy products, and oils as well as processed foods that contribute to the progression of the disease. These foods have been shown to promote the progression of type II diabetes as well as heart disease dyslipidemia and obesity (Estadella et al., 2013, p.1). Severely restricting or eliminating these foods is the best thing you can do to improve your overall health.
Watch these other helpful resources on tackling and saying goodbye to diabetes:
Wes Youngbred, PhD, Author of: Goodbye Diabetes
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