Beyond Metformin: Managing Type 2 Diabetes Holistically
As a naturopathic doctor, my life and livelihood revolve around teaching people how to make long-lasting and manageable lifestyle changes to combat a wide variety of diseases from women's health conditions to autoimmunity. I have found there are few conditions that respond to the naturopathic paradigm of medicine as well as type 2 diabetes and metabolic syndrome. Why would this be?
Type 2 diabetes, unlike its counterpart type 1 diabetes, occurs as a response to an accumulation of different factors that are a result of lifestyle choices. In type 2 diabetes, cells of the body become "resistant" to a hormone called insulin. Insulin's job is to escort blood sugar into most cells of the body so the cells can create energy. However, when blood sugar is chronically elevated, the cells become "skeptical" of the presence of insulin and develop a resistance to it, leading to cells who are unable to produce energy in sufficient amounts and exacerbating the the problem of high blood sugar. This process becomes a vicious cycle in a hurry.
What type 2 diabetics should realize is that their cells didn't mutiny and decide one day to become insulin resistant. They also didn't become "Metformin deficient." Diseases that conventional medicine doesn't have an explanation for are called "idiopathic," and type 2 diabetes is not one of them! There is a long list of factors that have the potential to contribute to the development of type 2 diabetes, including but certainly not limited to genetics, poor diet, and lack of exercise. Other, more insidious causes like environmental exposures to certain toxins, hormonal imbalances, widespread, chronic inflammation, and mitochondrial dysfunction are problems that I attempt to uncover and address in all my clients, especially diabetics.
In my opinion, simply writing a prescription for a drug like Metformin which improves cell sensitivity to insulin and decreases the liver production of blood sugar and telling a patient to "diet and exercise," is doing them a gigantic disservice. Many times, my clients don't really know what "diet and exercise," even mean as they apply to their condition. Not only that, but many of my clients tell me that the limited dietary advice that they do manage to get is outdated, like being told that restricting caloric intake and eating a low-fat diet is all they need to do. I can't even begin to describe how much that frustrates me!
When it comes to lifestyle-based medicine, few approaches compare to a full, 1-2 hour long naturopathic health intake and assessment. There is no "one size fits all," method to approaching disease in my practice. However, there are several foundational approaches type 2 diabetics can take to get control of their health and decrease their reliance on drugs.
1. Dietary approaches for managing blood sugar
The advice that is still given to diabetics looking to take control of their own health through diet is outdated and frankly, a little scary. Take a look at this recipe. I found this on Mayo Clinic's website, a highly reliable and trustworthy medical resource. The recipe, found under the heading "Healthy Recipes," was developed by a registered dietician.
Folks, there's no getting around this. It's a milkshake. Sure, it's made with soy milk and "fat free ice cream," (as if fat is the problem with ice cream) but it's still a MILK SHAKE. It boasts no less than 420 calories and a whopping 83 grams of carbohydrates (read: sugar.) At their first office visits, my diabetic clients are almost invariably confused about what to eat, and I don't blame them one bit.
When I develop a diet for my diabetic clients, I have several major goals in mind. Of these, the most important is this: DECREASE BLOOD SUGAR
How can this be done through diet? By eating things that don't contain sugar. Almost sounds unrealistically simple, doesn't it? Encouraging a diabetic to eat a low fat diet is ludicrous, because there are only 3 categories of macronutrients: carbohydrates, fat, and protein. There is only so much protein a person can realistically expect to eat in one day, and your body doesn't typically use calories from protein for energy. It does use carbohydrates and/or fats. Therefore, if someone is eating a low fat diet, what are they naturally eating more of? Carbohydrates, of course.
Carbohydrate calories from stuff like bread, pasta, and grains are turned into sugar by the body. This bears repeating because when most people think of "sugar," they are thinking of candy, cookies, cake, and other sweets. While it is beneficial to avoid these sources of simple sugar, it is imperative that diabetics understand that ANY carbohydrate that is "starch-based," like pasta, is turned into THE SAME SUGAR that the sugar from candy bars is turned into in the body. Physiologically, your body doesn't care where the sugar came from, because it all has the same effect: raising blood glucose and adding to insulin resistance.
The foundational diet I recommend to all my diabetic clients is a modified paleolithic, "cave man" diet that emphasizes fibrous (non-starchy) veggies FIRST, healthy fats like avocado, olive, and coconut SECOND, and lean meats THIRD. Starchy carbohydrates are eaten very sparingly. Why do I recommend this particular diet? Because the research supports it.
Take a look at these great websites for more information about the paleo diet:
2. Exercise as medicine
Let's reiterate two major goals for combating diabetes: lower blood sugar and improve cell sensitivity to insulin. Wouldn't it be outstanding if there was a therapy that addressed both? Surprise, there is! It's called exercise! What happens when we exercise? First, cellular demand for glucose goes up, to give energy to the working muscles. This demand makes the cells more sensitive to insulin, and causes the cells to use up blood sugar quickly. Not only that, but exercise done consistently over a period of time also combats the body's tendency to hang on to excess adipose (fat) tissue. Decreasing obesity has been shown to increase insulin sensitivity. I'm a huge believer in "time efficiency" at the gym. Kiss those slogging, 45 minute elliptical workouts goodbye, and check out HIIT, or high intensity interval training, and circuit training. Both of these workout modalities should be done 2-3 times per week each, and only take about half an hour or less to complete.
3. Quality sleep improves insulin sensitivity
Studies show that sleep disorders like sleep apnea increase insulin resistance, and that quality sleep improves insulin sensitivity. So what if you aren't sleeping? Unlike diet and exercise, getting quality sleep isn't something you can just force yourself to do! Good sleep hygiene is an essential first step. Take a look at these simple sleep interventions. If they don't work, you might consider seeing a Naturopathic doctor to help optimize your sleep.
4. Foundational nutritional supplementation
Many of my clients ask me if I believe supplements should be taken "forever." This is one of those "yes and no" answers. My goal as an ND is to always give supplements as a beneficial addition to lifestyle changes like diet. I don't believe supplements should ever be used as a "stand alone," as many pharmaceuticals tend to be. Rather, supplements help speed healing, mitigate symptoms, and add nutritional value to limited diets. That last part is where foundational supplements come into play. It is my opinion that even individuals who eat extremely healthy diets don't get ALL the vitamins and minerals they need from food alone. Why? Because our modern food quality ranges from "decent" to "terrible." Supplements like the following should be considered as long-term interventions for any chronic disease state.
-A quality multivitamin
-Omega-3 fish or flaxseed oil
-A quality probiotic
5. Botanical medicine for lowering blood sugar
Botanical medicine is an excellent modality for type 2 diabetics and something I am often thankful I have training in. Botanical, or herbal medicine is what humans had access to in the days before drugs. While not as well-studied as their pharmaceutical counterparts, botanicals are nevertheless effective, inexpensive, and exhibit a very low tendency to cause side-effects. Some of my favorite botanicals to use in my diabetic clients are:
(For dosage, please feel free to email me at firstname.lastname@example.org)
People with chronic conditions like diabetes shouldn't be made to feel like their lives are at the mercy of their condition or that pharmaceuticals are the only answer. My goal is to empower my clients to take control of their own health. To start your journey, click one of the links below!