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.

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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

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Latest Article

Is Our Microbiome Affected By Exercise?

Posted November 6, 2018 by Dr. Steve Chaney

Microbiome Mysteries

Author: Dr. Stephen Chaney

is our microbiome affected by exerciseIn a recent post,  What is Your Microbiome and Why is it Important,  of “Health Tips From The Professor” I outlined how our microbiome, especially the bacteria that reside in our intestine, influences our health. That influence can be either good or bad depending on which species of bacteria populate our gut. I also discussed how the species of bacteria that populate our gut are influenced by what we eat and, in turn, influence how the foods we eat are metabolized.

I shared that there is an association between obesity and the species of bacteria that inhabit our gut. At present, this is a “chicken and egg” conundrum. We don’t know whether obesity influences the species of bacteria that inhabit our gut, or whether certain species of gut bacteria cause us to become obese.

Previous studies have shown that there is also an association between exercise and the species of bacteria that inhabit our gut. In particular, exercise is associated with an increase in bacteria that metabolize fiber in our diets to short chain fatty acids such as butyrate. That is potentially important because butyrate is a primary food source for intestinal mucosal cells (the cells that line the intestine). Butyrate helps those cells maintain the integrity of the gut barrier (which helps prevent things like leaky gut syndrome). It also has an anti-inflammatory effect on the immune cells that reside in the gut.

However, associations don’t prove cause and effect. We don’t know whether the differences in gut bacteria were caused by differences in diet or leanness in populations who exercised regularly and those who did not. This is what the present study (JM Allen et al, Medicine & Science In Sports & Exercise, 50: 747-757, 2018 ) was designed to clarify.  Is our microbiome affected by exercise?

 

How Was The Study Designed?

is our microbiome affected by exercise studyThis study was performed at the University of Illinois. Thirty-two previously sedentary subjects (average age = 28) were recruited for the study. Twenty of them were women and 12 were men. Prior to starting the study, the participants filled out a 7-day dietary record. They were asked to follow the same diet throughout the 12-week study. In addition, a dietitian designed a 3-day food menu based on their 7-day recall for the participants to follow prior to each fecal collection to determine species of gut bacteria.

The study included a two-week baseline when their baseline gut bacteria population was measured, and participants were tested for fitness. This was followed by a 6-week exercise intervention consisting of three supervised 30 to 60-minute moderate to vigorous exercise sessions per week. The exercise was adapted to the participant’s initial fitness level, and both the intensity and duration of exercise increased over the 6-week exercise intervention. Following the exercise intervention, all participants were instructed to maintain their diet and refrain from exercise for another 6 weeks. This was referred to as the “washout period.”

VO2max (a measure of fitness) was determined at baseline and at the end of the exercise intervention. Stool samples for determination of gut bacteria and concentrations of short-chain fatty acids were taken at baseline, at the end of the exercise intervention, and again after the washout period.

In short, this study divided participants into lean and obese categories and held diet constant. The only variable was the exercise component.

 

Is Our Microbiome Affected By Exercise?

is our microbiome affected by exercise fitnessThe results of the study were as follows:

  • Fitness, as assessed by VO2max, increased for all the participants, and the increase in fitness was comparable for both lean and obese subjects.
  • Exercise induced a change in the population of gut bacteria, and the change was comparable in lean and obese subjects.
  • Exercise increased fecal concentrations of butyrate and other short-chain fatty acids in the lean subjects, but not in obese subjects.
  • The exercise-induced changes in gut bacteria and short-chain fatty acid production were largely reversed once exercise training ceased.

The authors concluded: “These findings suggest that exercise training induces compositional and functional changes in the human gut microbiota that are dependent on obesity status, independent of diet, and contingent on the sustainment of exercise.” [Note: To be clear, the exercise-induced changes in both gut bacteria and short-chain fatty acid production were independent of diet and contingent on the sustainment of exercise. However, only the production of short-chain fatty acids was dependent on obesity status.]

 

What Does This Study Mean For You?

is our microbiome affected by exercise gut bacteriaThere are two important take home lessons from this study.

  • With respect to our gut bacteria, I have consistently told you that microbiome research is an emerging science. This is a small study, so you should regard it as the beginning of our understanding of the effect of exercise on our microbiome rather than conclusive by itself. It is consistent with previous studies showing an association between exercise and a potentially beneficial shift in the population of gut bacteria.

The strength of the study is that it shows that exercise-induced changes in beneficial gut bacteria are probably independent of diet. However, it is the first study to look at the interaction between obesity, exercise and gut bacteria, so I would interpret those results with caution until they have been replicated in subsequent studies.

  • With respect to exercise, this may be yet another reason to add regular physical activity to your healthy lifestyle program. We already know that exercise is important for cardiovascular health. We also know that exercise increases lean muscle mass which increases metabolic rate and helps prevent obesity. There is also excellent evidence that exercise improves mood and helps prevent cognitive decline as we age.

Exercise is also associated with decreased risk of colon cancer and irritable bowel disease. This effect of exercise has not received much attention because the mechanism of this effect is unclear. This study shows that exercise increases the fecal concentrations of butyrate and other short-chain fatty acids. Perhaps, this provides the mechanism for the interaction between exercise and intestinal health.

 

The Bottom Line

A recent study has reported that:

  • Exercise induces a change in the population of gut bacteria, and the change was comparable in lean and obese subjects.
  • Exercise causes an increase in the number of gut bacteria that produce butyrate and other short-chain fatty acids that are beneficial for gut health.
  • These effects are independent of diet, but do not appear to be independent of obesity because they were seen in lean subjects but not in obese subjects.
  • The exercise-induced changes in gut bacteria and short-chain fatty acid production are largely reversed once exercise training ceases.

The authors concluded: “These findings suggest that exercise training induces compositional and functional changes in the human gut microbiota that are dependent on obesity status, independent on diet, and contingent on the sustainment of exercise.”

For more details and my interpretation of the data, 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.

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