Can a Holistic Approach to Diabetes Reduce Risk?

Written by Dr. Steve Chaney on . Posted in Holistic Approach to Diabetes

The Role of Supplementation In Reducing Diabetes Risk

Author: Dr. Stephen Chaney

 

holistic approach diabetes doctors recommendDoctors usually discuss a holistic approach to diabetes with their patients.  But, that often isn’t the case for other diseases. Why do doctors recommend drugs rather than natural approaches for controlling and treating other diseases? In part, it’s because so many Americans would rather take a pill than change their diet or lifestyle. Many of our doctors have become so conditioned to that expectation from their patients they don’t even suggest diet and lifestyle changes.

That is our fault. We need to take responsibility for our health. Rather than just accepting whatever treatment our doctors suggest, we should partner with our doctors in designing the best treatment plan for us.

The other reason doctors often recommend drugs is that they are trained to base their decisions on evidence-based medicine. The Gold Standard for evidence-based medicine is, of course, a double blind, placebo controlled clinical trial. In those studies, a single component is compared to the placebo. That is easy to do when you are comparing a drug to a placebo. The drug either works better than the placebo, or it doesn’t.

 

Do Natural Remedies for Diabetes Work?

 

Of course, many of you are more interested in knowing whether holistic, natural approaches also work. That is a much more difficult question to answer.

Double blind, placebo controlled clinical studies are much more difficult to perform when you are looking at foods or nutrients. That’s because foods and nutrients are seldom effective by themselves. They interact with each other. It is the whole, rather than the individual components, that reduce the risk of diabetes and other diseases. Even worse, when you want to test the effectiveness of a holistic change in diet and lifestyle, how do you design a placebo?

holistic approach diabetes talkIt reminds me of an international cancer symposium I attended over 30 years ago as a young Assistant Professor. A world-renowned cancer expert gave a talk from main stage and concluded by saying “I can show you, unequivocally, that colon cancer risk is significantly decreased by a lifestyle that includes a high-fiber diet, a low-fat diet, adequate calcium, adequate B vitamins, omega-3 fatty acids, exercise, and weight control. But, I can’t show you that any one of them, by themselves, is effective.”

The question that came to me as I heard him speak was: “What’s the message that a responsible scientist or responsible health professional should be giving to their patients or the people that they are advising?” You’ve heard experts saying: “Don’t worry about the fat.” “Don’t worry about calcium.” “Don’t worry about B vitamins.” “Don’t worry about fiber.” “None of them can be shown to decrease the risk of colon cancer.”

Is that the message we should be giving people? Or should we really be saying what that doctor said many years ago – that a lifestyle that includes all those things significantly decreases the risk of colon cancer?

The problem is the negative studies you hear about, and your doctor hears about, are usually studies done with individual foods or individual nutrients. Those studies leave the impression that natural approaches don’t work. However, when you look at a holistic approach to diabetes, the answers are often much different.

 

Can a Holistic Approach to Diabetes Reduce Risk?

holistic approach diabetes reduceI created the diagram on the left for my book “Slaying the Food Myths” to represent holistic approaches to health. Simply put, diet, weight control, exercise, and supplementation all play a role in improving our health. It is that sweet spot in the middle of the diagram where we receive the optimal benefit. Finally, both diet and supplementation should also be holistic. No one food or nutrient will be effective by itself.

This is perfectly illustrated by a recent study (S.M. Kimball et al, Journal of Clinical & Translational Endocrinology, doi: 10.1016/j.jcte.2017.11.002 eCollection Dec 2017 ). If you just read the headlines, you would conclude the study was just about the effect of supplementation on the risk of developing diabetes. However, when you read the publication, you realized the study involves a lot more than supplementation.

The study was conducted by a non-profit wellness organization called Pure North S’Energy Foundation located in Calgary, Canada. They enrolled 188 middle-aged adults (ages 25-54 years) in the studies. Based on BMI measurements the participants were overweight, but not obese. They were followed for a two-year period.

Each of the participants met regularly with a health care professional who provided them with lifestyle advice. Specifically:

  • They were advised to increase fruit and vegetable intake and reduce processed foods.
  • If they had cardiovascular risk factors such as hypertension or hyperlipidemia, they were advised to go on the DASH diet.
  • They were advised to follow an exercise routine that was appropriate for their health status.

In addition, the subjects were divided into two groups:

  • Group 1 received a liquid vitamin D3 supplement consisting of 1,000 IU of vitamin D/drop. The dosage they received was individualized so that each subject received enough vitamin D to bring their blood levels of 25-hydroxy-vitamin D to an optimal level of >100 nmole/L.
  • Group 2 received the vitamin D plus 600 mg of EPA and EPA, plus a very comprehensive multivitamin. In addition to the nutrients found in most multivitamins, their formulation contained carotenoids such as lutein and lycopene, polyphenols from wine grapes, N-acetyl cysteine, coenzyme Q10 and a host of other phytonutrients.

[Note: This supplement is not commercially available. However, I would not recommend it if it were. There appears to be little scientific rationale for the amounts of some ingredients.]

In short, all the subjects were put on a holistic diet and lifestyle program ( a holistic approach to diabetes ). Groupe 2 also received what I would consider a holistic supplement. Here were the results of the study.

  • Neither group had significant weight loss or weight gain.
  • Serum 25-hydroxyvitamin D increased significantly in both groups (the vitamin D supplementation was effective).
  • HbA1c levels (a measure of blood sugar control) worsened slightly in Group 1 and improved slightly in Group 2.

However, those were average values. Individual subjects had much more significant changes in HbA1c. In fact, based on changes in HbA1c levels:

  • 16% of Group 1 participants and only 8% of Group 2 participants progressed from normal blood sugar control to either prediabetes or diabetes.
  • 8% of Group1 participants and 44% of Group 2 participants improved from prediabetes or diabetes to normal blood sugar control.

The authors of the study concluded: “The results suggest that nutrient supplementation may provide a safe, economical, and effective means for lowering diabetes risk. Further examination of this potential via randomized controlled trials is warranted.”

 

The Role of Supplementation In Reducing Diabetes Risk

holistic approach to diabetes supplementationThis is a single study and needs to be confirmed by future studies. However, if this study is confirmed, it has some interesting implications:

  • It suggests a holistic approach to supplementation may be effective at decreasing diabetes risk.
  • The holistic approach to supplementation was coupled with a holistic diet and lifestyle change in this study. We cannot assume that supplementation alone would have been effective in reducing diabetes risk.
  • Since both Groups 1 and Group 2 included diet and lifestyle changes, we can conclude that the holistic diet and lifestyle changes in this study were not sufficient to reduce diabetes risk. Holistic supplementation was also required.
  • The reason that diet and lifestyle changes did not affect diabetes risk in this study was most likely the failure to include a weight loss component. Multiple studies have shown that weight loss reduces diabetes risk.

 

The Bottom Line:

 

A recent study looked at the effect of a holistic diet, lifestyle and supplementation intervention on diabetes risk.

All participants in the study met regularly with a health care professional who provided them with lifestyle advice. Specifically:

  • They were advised to increase fruit and vegetable intake and reduce processed foods.
  • If they had cardiovascular risk factors such as hypertension or hyperlipidemia, they were advised to go on the DASH diet.
  • They were advised to follow an exercise routine that was appropriate for their health status.

The subjects were divided into two groups:

  • Group 1 received a liquid vitamin D3 supplement consisting of 1,000 IU of vitamin D.
  • Group 2 received the vitamin D plus 600 mg of EPA and EPA, plus a very comprehensive multivitamin containing carotenoids such as lutein and lycopene, polyphenols from wine grapes, N-acetyl cysteine, coenzyme Q10 and a host of other phytonutrients.

Over a two-year period:

  • 16% of Group 1 participants and only 8% of Group 2 progressed from normal blood sugar control to either prediabetes or diabetes.
  • 8% of Group1 participants and 44% of Group 2 participants improved from prediabetes or diabetes to normal blood sugar control.

This is a single study and needs to be confirmed by future studies. However, if this study is confirmed, it has some interesting implications:

  • It suggests a holistic approach to supplementation may be effective at decreasing diabetes risk.
  • The holistic approach to supplementation was coupled with a holistic diet and lifestyle change in this study. We cannot assume that supplementation alone would have been effective in reducing diabetes risk.
  • Since both Groups 1 and Group 2 included diet and lifestyle changes, we know that the holistic diet and lifestyle changes in this study were not sufficient to reduce diabetes risk. Holistic supplementation was also required.
  • The reason that diet and lifestyle change did not affect diabetes risk was most likely the failure to include a weight loss component. Multiple studies have shown that weight loss reduces diabetes risk.

For more details, read the article above:

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Trackback from your site.

Comments (2)

  • Kathy Brauer

    |

    Group 2 received the vitamin D plus 600 mg of EPA and EPA, plus a very comprehensive multivitamin.

    Should that be EPA and DHA? Not too pick, but checking my assumption.

    Reply

    • Dr. Steve Chaney

      |

      Yes. Thanks for spotting the typo

      Reply

Leave a comment

Recent Videos From Dr. Steve Chaney

READ THE ARTICLE
READ THE ARTICLE

Latest Article

Can Plant-based Diets Be Unhealthy?

Posted September 10, 2019 by Dr. Steve Chaney

Do Plant-Based Diets Reduce Heart Disease Deaths?

Author: Dr. Stephen Chaney

 

plant-based diets vegetablesPlant-based diets have become the “Golden Boys” of the diet world. They are the diets most often recommended by knowledgeable health and nutrition professionals. I’m not talking about all the “Dr. Strangeloves” who pitch weird diets in books and the internet. I am talking legitimate experts who have spent their life studying the impact of nutrition on our health.

Certainly, there is an overwhelming body of evidence supporting the claim that plant-based diets are healthy. Going on a plant-based diet can help you lower blood pressure, inflammation, cholesterol and triglycerides. People who consume a plant-based diet for a lifetime weigh less and have decreased risk of heart disease, diabetes, and cancer.

But, can a plant-based diet be unhealthy? Some people consider a plant-based diet to simply be the absence of meat and other animal foods. Is just replacing animal foods with plant-based foods enough to make a diet healthy?

Maybe not. After all, sugar and white flour are plant-based food ingredients. Fake meats of all kinds abound in our grocery stores. Some are very wholesome, but others are little more than vegetarian junk food. If you replace animal foods with plant-based sweets, desserts, and junk food, is your diet really healthier?

While the answer to that question seems obvious, very few studies have asked that question. Most studies on the benefits of plant-based diets have compared population groups that eat a strictly plant-based diet (Seventh-Day Adventists, vegans, or vegetarians) with the general public. They have not looked at variations in plant food consumption within the general public. Nor have they compared people who consume healthy and unhealthy plant foods.

This study (H Kim et al, Journal of the American Heart Association, 8:e012865, 2019) was designed to fill that void.

 

How Was The Study Done?

plant-based diets studyThis study used data collected from 12,168 middle aged adults in the ARIC (Atherosclerosis Risk in Communities) study between 1987 and 2016.

The participant’s usual intake of foods and beverages was assessed by trained interviewers using a food frequency questionnaire at the time of entry into the study and again 6 years later.

Participants were asked to indicate the frequency with which they consumed 66 foods and beverages of a defined serving size in the previous year. Visual guides were provided to help participants estimate portion sizes.

The participant’s adherence to a plant-based diet was assessed using four different well-established plant-based diet scores. For the sake of simplicity, I will include 3 of them in this review.

  • The PDI (Plant-Based Diet Index) categorizes foods as either plant foods or animal foods. A high PDI score means that the participant’s diet contains more plant foods than animal foods. A low PDI score means the participant’s diet contains more animal foods than plant foods.
  • The hPDI (healthy plant-based diet index) is based on the PDI but emphasizes “healthy” plant foods. A high hPDI score means that the participant’s diet is high in healthy plant foods (whole grains, fruits, vegetables, nuts, legumes, coffee and tea) and low in animal foods.
  • The uPDI (unhealthy plant-based diet index) is based on the PDI but emphasizes “unhealthy” plant foods. A high uPDI score means that the participant’s diet is high in unhealthy plant foods (refined grains, fruit juices, French fries and chips, sugar sweetened and artificially sweetened beverages, sweets and desserts) and low in animal foods.

For statistical analysis the scores from the various plant-based diet indices were divided into 5 equal groups. In each case, the group with the highest score consumed the most plant foods and least animal foods. The group with the lowest score consumed the least plant foods and the most animal foods.

The health outcomes measured in this study were heart disease events, heart disease deaths, and all-cause deaths. Again, for the sake of simplicity, I will only include 2 of these outcomes (heart disease deaths and all-cause deaths) in this review. The data on deaths were obtained from state death records and the National Death Index. (Yes, your personal information is available on the web even after you die.)

 

Do Plant-Based Diets Reduce Heart Disease Deaths?

plant-based diets reduce heart deathsThe participants in this study were followed for an average of 25 years.

The investigators looked at heart disease deaths over the 25 years and compared people with the highest intake of plant foods to people with the highest intake of red meat and other animal foods. The results were:

  • People with the highest intake of plant foods and the highest intake of healthy plant foods (whole grains, fruits, vegetables, nuts, legumes, coffee and tea) had a 19-32% lower risk of dying from heart disease than people with the highest intake of red meat and other animal foods.
  • People with the highest intake of unhealthy plant foods (refined grains, fruit juices, French fries and chips, sugar sweetened and artificially sweetened beverages, sweets and desserts) had the same risk of dying from heart disease as people with the highest intake of red meat and other animal foods.

When the investigators looked at all-cause deaths over the 25 years:

  • People with the highest intake of plant foods and the highest intake of healthy plant foods had an 11-25% lower risk of dying from any cause than people with the highest intake of red meat and other animal foods.
  • People with the highest intake of unhealthy plant foods had the same risk of dying from heart disease as people with the highest intake of red meat and other animal foods.

What Else Did The Study Show?

The investigators made a couple of other interesting observations:

  • The association of the overall diet with heart disease and all-cause deaths was stronger than the association of individual food components. This underscores the importance of looking at the effect of the whole diet on health outcomes rather than the “magic” foods you hear about on Dr. Strangelove’s Health Blog.
  • Diets with the highest amount of healthy plant foods were associated with higher intake of carbohydrates, plant protein, fiber, and micronutrients, including potassium, magnesium, iron, vitamin A, vitamin C, folate, and lower intake of saturated fat and cholesterol.
  • Diets with the highest amount of unhealthy plant foods were associated with higher intake of calories and carbohydrates and lower intake of fiber and micronutrients.

The last two observations may help explain some of the health benefits of plant-based diets.

 

Can Plant-Based Diets Be Unhealthy?

plant-based diets unhealthy cookiesNow, let’s return to the question I asked at the beginning of this article: “Can plant-based diets be unhealthy?” Although some previous studies have suggested that unhealthy plant-based diets might increase the risk of heart disease, this study did not show that.

What this study did show was that an unhealthy plant-based diet was no better for you than a diet containing lots of red meat and other animal foods.

If this were the only conclusion from this study, it might be considered a neutral result. However, this result clearly contrasts with the data from this study and many others showing that both plant-based diets in general and healthy plant-based diets reduce the risk of heart disease deaths and all-cause deaths compared to animal-based diets.

The main message from this study is clear.

  • Replacing red meat and other animal foods with plant foods can be a healthier choice, but only if they are whole, minimally processed plant foods like whole grains, fruits, vegetables, nuts, legumes, coffee and tea.
  • If the plant foods are refined grains, fruit juices, French fries and chips, sugar sweetened and artificially sweetened beverages, sweets and desserts, all bets are off. You may be just as unhealthy as if you kept eating a diet high in red meat and other animal foods.

There is one other subtle message from this study. This study did not compare vegans with the general public. Everyone in the study was the general public. Nobody in the study was consuming a 100% plant-based diet.

For example:

  • The group with the highest intake of plant foods consumed 9 servings per day of plant foods and 3.6 servings per day of animal foods.
  • The group with the lowest intake of plant foods consumed 5.4 servings per day of plant foods and 5.6 servings per day of animal foods.

In other words, you don’t need to be a vegan purist to experience health benefits from adding more whole, minimally processed plant foods to your diet.

 

The Bottom Line

A recent study analyzed the effect of consuming plant foods on heart disease deaths and all-cause deaths over a 25-year period.

When the investigators looked at heart disease deaths over the 25 years:

  • People with the highest intake of plant foods and the highest intake of healthy plant foods had a 19-32% lower risk of dying from heart disease than people with the highest intake of red meat and other animal foods.
  • People with the highest intake of unhealthy plant foods had the same risk of dying from heart disease as people with the highest intake of red meat and other animal foods.

When the investigators looked at all-cause deaths over the 25 years:

  • People with the highest intake of plant foods and the highest intake of healthy plant foods had an 11-25% lower risk of dying from any cause than people with the highest intake of red meat and other animal foods.
  • People with the highest intake of unhealthy plant foods had the same risk of dying from heart disease as people with the highest intake of red meat and other animal foods.

The main message from this study is clear.

  • Replacing red meat and other animal foods with plant foods can be a healthier choice, but only if they are whole, minimally processed plant foods like whole grains, fruits, vegetables, nuts, legumes, coffee and tea.
  • If the plant foods are refined grains, fruit juices, French fries and chips, sugar sweetened and artificially sweetened beverages, sweets and desserts, all bets are off. You may be just as unhealthy as if you kept eating a diet high in red meat and other animal foods.

A more subtle message from the study is that you don’t need to be a vegan purist to experience health benefits from adding more whole, minimally processed plant foods to your diet. The people in this study were not following some special diet. The only difference was that some of the people in this study ate more plant foods and others more animal foods.

For more details on the study, read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

UA-43257393-1