Toward a National Diabetes Reversal Strategy – Part 1

The type 2 diabetes epidemic is crushing the health and economy of all nations throughout the world.

In the US, one in three Americans are projected to get diabetes at some point, unless we find a way to turn the tide and start reversing this epidemic.

Currently, we can achieve remissions of type 2 diabetes in 3 ways. I would like us to consider how we can design a national strategy to dramatically increase the remission rates on a grand scale.

The most reliable method for achieving remission of type 2 diabetes is via “diabetes reversal surgery” (gastric bypass surgery for the purpose of diabetes remission). With gastric bypass surgery (usually accomplished via laparoscopic surgery) remission occurs in about 80% of patients with type 2 diabetes, typically within days or weeks. Remission occurs well before substantial weight loss occurs, apparently as a result of keeping ingested food from making contact with the duodenum (the first part of the small intestine). There are experimental procedures under development to further simplify the diabetes reversal surgery (making stomach shrinkage optional) and I believe the procedure will eventually be conducted endoscopically (via the oral cavity) rather than laparoscopically (via small abdominal incisions). The diabetes reversal surgery causes remission by a complex combination of multiple beneficial effects, and the long duration of the diabetes remission (probably one or more decades) is no doubt enhanced by major weight losses. There are potential complications of this type of surgery, and about one in 1000 patients may die from the procedure, although this varies depending on the skill and experience of the surgeon.

The second most reliable method for achieving remission of type 2 diabetes is via lapband surgery for weight loss. A band is placed to compress the stomach into a small pouch, which limits the amount of food one can comfortably eat at one sitting. The band can be tightened or loosened or removed altogether months or years after the procedure. Long-term weight loss in the 50 pound range is typical, and the type 2 diabetes often goes into remission once enough weight comes off. Remission is a direct result of the weight loss rather than a result of the complex beneficial hormonal and anatomical effects that reverse diabetes after gastric bypass surgery. The diabetes remission rate appears to be in the 80-50% range, depending on how much weight is lost and how long patient has had diabetes. There is every reason to believe the remissions are not as long-lasting as those resulting from gastric bypass surgery. However, the risk of serious complications is lower, and death risk is probably 10 times less than from gastric bypass surgery.

The safest path to type 2 diabetes remission is excess fat loss via lifestyle change, although it is less reliable than surgical remission methods. The weight loss required for remission is typically in the 35 to 50 pound range (10 to 20% of starting body weight), although long-standing diabetes (over 10 years) may not necessarily go into remission even if one loses all the excess body fat and gets into good shape. I suspect 75-80% of patients with type 2 diabetes could achieve remission if they could lose enough body fat and get enough exercise. Naturally, adherence barriers hinder the potential of lifestyle change, and the remission rates are closer to 25% in my own practice. Moreover, the remission duration is highly dependent on one’s ability to successfully maintain lost weight by maintaining the lifestyle changes in the long term.

So, given the enormous toll the diabetes epidemic, and the availability of these three options for diabetes remission, do you believe we should try to develop a national diabetes reversal strategy? If yes, then I would welcome any ideas you have about how to raise awareness and potentially promote diabetes reversal methods on a large scale.

- Michael Dansinger, MD

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Labels: diabetes, eating, fitness, food, gatric bypass, lapband, obestiy, weight loss

Five Essential Nutrients for a Great Workout and Recovery

Guest blogger Yishane Lee is the author of “The Athlete’s Palate: Renowned Chefs, Delicious Dishes, and the Art of Fueling Up While Eating Well” (Rodale), a cookbook for the gourmet endurance athlete.

Most athletes know that carbohydrates and protein are critical to fuel a workout and aid recovery after exercise. But beyond those nutrients, there are five essential nutrients to incorporate into your diet in order to make sure your body operates at its peak.

1. Anthocyanins

This antioxidant gives red, blue, and purple fruits and vegetables their color. It reduces inflammation and counteracts muscle damage that can be caused by working out and also improves cardiovascular function. Blueberries, strawberries, cherries, blood oranges, eggplant, and red grapes are all good sources of anthocyanins. Even the cocoa in dark chocolate contains this antioxidant.

2. Choline

This nutrient, grouped with the B vitamins, is important for liver and cellular function, the metabolism of fat, and cardiovascular health. Higher choline levels in the body have been linked to better endurance and performance in marathoners. Find choline in egg yolks, soy products, sesame seeds, flaxseeds, wheat germ, peanuts, chicken liver, beef, and pork.

3. Omega-3 Fatty Acids

These heart-healthy essential fats that improve cholesterol levels, keep arteries flexible, and regulate blood pressure also fight joint pain by reducing inflammation. Boost your intake by eating wild salmon and other fatty fish, soy, and certain oils and nuts, like walnuts.

4. Potassium

This mineral is critical for balancing salt and electrolyte levels that can get out of whack with exercise. When fluid and electrolyte levels are unbalanced, you can feel weak and your muscles may cramp. Potassium occurs in all plant and animal foods, provided they are not processed. Reach for fresh fruits such as bananas and oranges, as well as milk and yogurt, leafy greens such as spinach and arugula, and baked potatoes.

5. Vitamin D

Known as the “sun vitamin,” this nutrient works in concert with calcium to create strong bones. It also lowers the risk of heart disease, cancer, and diabetes, and can help improve athletic performance, prevent injury, and lead to faster recovery. Your body gets the vitamin from sun exposure but supplements and food sources can also help. Look for D-fortified cereal and bread, canned fish (tuna, salmon and sardines), and milk, cheese, and other dairy products.

Why Fiber Is Important

Consuming foods that are high in fiber has always been recommended by health professionals. However, it is rarely explained why fiber is so important. It is one of the most accessible dietary supplements that was at one time abundant in the Western diet. However, the mass production and consumption of animal products has resulted in smaller portions of fiber intake.

What Does Fiber Do for You?

Fiber works its magic mainly in the gastrointestinal tract–either by helping vitamins, minerals and other chemical compounds absorb into your system or by moving food along for healthy digestion. 

There are two types of fiber: soluble and insoluble.

• Soluble fiber: (oranges, apples, pears, strawberries, raisins, cranberries, oats, broccoli, legumes, etc.) Fiber in this state is easily digestable. This enables it to aid in nutrient absorption.  
• Insoluble fiber: (wheat, popcorn, lentils, sunflower seed, dried fruit especially prunes, granola, carrots, celery, etc.) This fiber cannot be digested by the body and acts primarily by moving food along inside the body. This helps maintain healthy bowels and prevents such afflictions as constipation, irritable bowel syndrome (IBS) and other digestive concerns. Think of insoluble fiber as a street cleaner for your colon–sweeping out all the residual waste.

Cholesterol

Cholesterol is usually the poster child for the benefits of fiber. Studies show over and over that cholesterol levels drop dramatically per each gram of fiber intake.

Weight Loss

By simply eating more fiber, both soluble and insoluble, it is highly likely that the body will react by making you feel more satiated or full. If you are trying to lose weight, consuming fiber can make the task that much easier. Soluble fiber specifically has been shown to slow down fat absorption and actually aid in the removal of fat through the intestines.

Heart Helper

As stated, fiber reduces cholesterol which in turn reduces stress on the heart. Long-term studies have found that men who consumed 30 grams of fiber per day reduced their risk of heart attack by 1/3 compared to those who consumed 15% or less. In fact, it has been shown that for every 10 grams of fiber that you consume, the risk is reduced by 17%. Therefore, at 30 grams of fiber per day, heart disease is reduced by 51%.

Cancer Killer

By moving waste along, the risk of accumulated waste is reduced therefore lowering toxicity that can often lead to rectal cancer.

Breast cancer can sometimes be caused by high amounts of estrogen, which fiber can bind to and remove from the body. The liver sends estrogen surplus to the intestines where it comes in contact with fiber. A compound known as butyrate is mass produced, consuming the estrogen and reducing its re-absorption into the system.

Where Is Fiber?

Basically, any food that is not derived from an animal contains fiber. Fruits, vegetables, legumes and grains are the top four sources. Eat about 30 grams per day if you think you haven’t been getting enough fiber. This is a good, slow start. The gas and stomach cramps that fiber sometimes causes may be discouraging side effects, but eating fiber at slow intervals and drinking plenty of water can help alleviate these symptoms.