November is Diabetes awareness month.
Diabetes is often referred to as a lifestyle or non-communicable disease meaning that it develops due to lifestyle factors like diet and exercise, rather than contracted via a particular bacteria or virus. It’s often (but not always!) associated with other lifestyle diseases like obesity, high cholesterol, and high blood pressure, because similar lifestyle patterns tend to cause more than one of those problems.
The Role of Insulin
When you eat anything containing carbohydrates, your body breaks the carbohydrates down into simple sugars (through a few different processes, depending on the type of sugar) and releases them into the bloodstream as glucose. Consistently elevated high blood sugar is dangerous and insulin is released to guide the glucose into your muscles, liver, brain, and fat cells.
Glucose bring stored in the fat cells is how the body stores energy between meals, preventing the need to be constantly eating. If you continuously store more glucose than you use, you will gain weight, but the system of storing glucose in fat cells isn’t inherently dangerous.
Each type of diabetes involves a challenge with insulin regulation leading to high blood sugar.
Those with Type 1 Diabetes don’t produce insulin due to an autoimmune disease in the pancreas. When carbohydrates are consumed, they are unable to lower the dangerously high levels of blood sugar, and they have no way to store that glucose for later.
Type 2 Diabetes occurs when the body produces sufficient or excessive insulin, but the cells and tissues are insulin resistant and unable to respond effectively to insulin signaling. The pancreas responds by releasing more insulin which temporarily forces the muscle, fat, and liver cells to accept the glucose. Eventually, the pancreas can’t make enough insulin to force the body into accepting the glucose. The excess glucose is the bloodstream fails to get stored, and remains in the bloodstream eventually rising to dangerous levels.
Women with gestational diabetes struggle with similar issues as those with Type 2, but the situation is temporary, occurring only during pregnancy.
The chronically high blood sugar eventually leads to many degenerative concerns including numbness/tingling, vision loss, slow wound healing, and even the need to amputate limbs.
Causes of Insulin Resistance
Although eating excessive carbohydrates and storing more glucose than the body needs can contribute to insulin resistance, there are also many modern lifestyle factors that set the stage for a decreased tolerance to the glucose these carbohydrates eventually become.
Muscle tissue is one of the major storage areas for glucose. Insulin stores glucose as glycogen in the muscles, which is used for bursts of sudden movement.
Depleting glycogen stores in the muscles makes room for more glucose to show up and fill them again. Each time the muscles need to refill their glycogen stores, glucose is taken from the bloodstream. Exercise helps keep blood sugar levels down and reduce insulin resistance.
Modern lives are often very sedentary and thus glycogen stores are never depleted. The muscles in turn resist the insulin signal when blood glucose levels are high.
For physically active people or those living in hunter-gatherer societies, a higher-carbohydrate diet poses less of a problem as the muscles are constantly replacing the used glycogen. For sedentary individuals, that same diet might be dangerous, not because the carbohydrates themselves are ‘bad’ but because the lifestyle context changed.
Lack of sleep reduces insulin sensitivity by affecting hormones involved in insulin regulation. Sleep deprivation raises levels of the stress hormone cortisol. Cortisol keeps your blood sugar high. In times of imminent danger this is important but as a chronic, constant state of living, it becomes a cause for concern.
Poor sleep also damages the beta cells in the pancreas that produce insulin. This in turn can cause digestive issues, which then further contribute insulin resistance.
Excess Belly Fat
Research suggests that abdominal fat cells in particular are biologically active. Fat can be thought of as an endocrine organ or gland, producing hormones and other substances that can profoundly affect health. Excess body fat, especially abdominal fat, disrupts the normal balance and functioning of these hormones.
These and other biochemicals are thought to have deleterious effects on the insulin sensitivity of cells, blood pressure, and blood clotting.
Inflammation contributes to insulin resistance and is a prominent factor in diabetes and related diseases. Being sedentary, gut problems, and sleep deprivation all cause inflammation along with many other modern diet and lifestyle factors including
- Excessive Omega-6 fats, and/or insufficient Omega-3s. In terms of food, this means too much industrial seed oils, and not enough fish.
- Too much refined sugar and processed, nutrient-poor foods.
- Psychological stress
- Environmental pollutants and prolonged chemical exposure
The Paleo Diet And Diabetes
When it comes to diabetes, the goal of a well-structured Paleo lifestyle is to address all the factors that contribute to insulin resistance – carbohydrate, diet and lifestyle
A Paleo diet focusses on nutrient-dense foods, avoiding processed ingredients, sugar, and grains, and is often, by default, lower in carbohydrate content than a traditional western diet. Research suggests that minimizing the number of carbohydrates, while consuming more foods that are lower on the glycemic index, such as non-starchy vegetables, may help more effectively manage blood glucose levels.
Several studies have been conducted to evaluate the effects of the Paleo diet on type 2 diabetes management, demonstrating the potential health benefits of the diet. It has been found that adhering to a Paleo diet is effective in lowering body weight and important blood markers in patients with type 2 diabetes. Eating a Paleo diet, even for a short period, can result in improved insulin sensitivity and lipid profiles.
Although low-carbohydrate diets have been shown to be particularly effective for people with insulin resistance, “low-carb” in these studies can be up to 40% carbs by calories, which is medium-high carb by Paleo standards.
Although some people might do very well on a very low carbohydrate or ketogenic diet, others might feel better with more carbohydrates, especially in the context of other anti-diabetic lifestyle factors.
Fats eaten together with a refined carbohydrate can also be problematic and poor-quality fats are legitimately dangerous: trans fats are inflammatory and do contribute to metabolic problems. However, studies have shown that a Mediterranean-type diet with lots of olive oil was actually better than a lower-fat diet for preventing Type 2 Diabetes and that in humans, saturated fat has no affect insulin sensitivity.
A lower-carbohydrate (40% or lower, not necessarily super-low), higher-fat diet may be helpful for most people. This is often where most people naturally fall when following a Paleo diet. Some people might feel best on a very low-carb diet, but not everyone needs to go there.
This still does not imply that carbohydrate consumption causes diabetes. It does mean that for people who are already metabolically sick, reducing carbohydrates can be a therapeutic option to treat the existing problem.
Further Benefits Of A Paleo Diet
A Paleo diet is also helpful for diabetes because it reduces or eliminates other foods that contribute to inflammation, including
- Soybean oil, canola oil, “vegetable oil,” and other industrial seed oils
- Trans fats
- Refined sugar
- Additives, preservatives and artificial ingredients
- Gut irritants (in grains and legumes)
A Paleo diet also emphasizes foods that help with healing from inflammation, healing the gut, and restoring insulin sensitivity, including
- Probiotic and fermented foods
- Bone broth
- Vegetables (vegetables contain important nutrients for insulin metabolism and fiber to effectively feed the gut microbiome)
- Well-sourced protein and healthy fats
Although a Paleo diet can help many people manage diabetes without any special modifications, a few changes can make the diet even more powerfully therapeutic for this disease. Those changes include:
- Limiting or avoiding higher-glycemic and tropical fruits, including dried fruit (dates, raisins, dried figs, dried apricots and the like), watermelon, pineapple, and mango.
- Avoiding Paleo friendly sweeteners like maple syrup, honey, sucanat, Muscovado/Barbados sugar, and molasses (or using them very sparingly).
- Consuming foods high in naturally occurring sugar or starch with an acidic ingredient (vinegars, lemon or lime) or with higher-fiber foods (above-the-ground vegetables), which lowers the glycemic response.
- Emphasizing fiber-rich foods, protein, and Paleo, nutrient dense sources of fat to help prevent blood sugar and insulin spikes and keep blood sugar levels at an even keel throughout the day
- Swapping out freshly-cooked potatoes for potatoes that have been cooked and then cooled down (re-heating them afterwards is fine); the cooling process increases their resistant starch content and lowers their glycemic index.
Pete’s Paleo has news – stay tuned for meals specifically formulated with these recommendations in mind to successfully support managing your diabetes.
Paleo also focuses on lifestyle choices like movement (even gentle exercise helps improve insulin sensitivity) getting adequate sleep and managing stress. A Paleo diet is also an effective weight management tool which helps with losing belly fat (an independent trigger of inflammation and insulin resistance).
Getting back to an ancestral or Paleo dietary approach is proven to be an effective strategy for improving blood sugar, insulin dysfunction, and outcomes in clients with diabetes. A Paleo is not a magical diabetes cure-all. The latest research into diet and diabetes, does, however, support a low to moderate-carbohydrate, nutrient-rich, fiber-rich Paleo-style diet over the standard recommendations along with the lifestyle focus on movement, sleep and stress reduction.