Diet and Type-2 Diabetes StudyAccording to the Centers for Disease Control (CDC), 13% of U.S. adults have diabetes. Incidence increases with age and reaches 26.8% for Americans aged 65 years or older.[1] Almost all healthcare providers agree that diet is important for managing diabetes and for reducing the risk of co-morbidities which include cardiovascular disease and related events. Unfortunately, research shows that a minority of diabetics achieve glycemic control with diet.
A recent study might provide some inspiration for type-2 diabetics to pay more attention to diet. Participants in this nonrandomized crossover study were adults who had type 2 diabetes, required insulin, had a BMI of at least 27, and A1C levels between 6.5 and 9.5.
Fifteen participants were enrolled in a 4-week trial with sequential one-week phases:
Baseline, Dash 1, WFPB and a second week of the DASH diet
The diets were all ad libitum (subjects could eat as much as they wanted) and meals were provided.
First, a description of the two intervention diets:
Dietary Approaches to Stop Hypertension (DASH) does not require the elimination of any food but rather emphasizes consumption of more fruit, vegetables, whole grains, and low-fat dairy, while intake of saturated fat and sugar are reduced.
A whole foods plant-based diet (WFPB) emphasizes beans, whole grains, and fruits and vegetables; and minimizes or excludes animal foods, added fats, and added sugars.
Both diets have been shown in previous studies to lower blood pressure,[2] [3] plasma cholesterol,[4] [5] and blood sugar.[6] [7] Long-term adherence to a WFPB diet has been shown to result in atherosclerotic regression, reduction in angina and reduced risk of cardiac events in people who have been diagnosed with severe coronary artery disease.[8] [9]
Results:
Twelve of the fifteen subjects completed the study. One subject dropped out due to an unexpected surgery; one due to a car accident; and one subject started a new job and could not continue the weekly assessments.
Total calories were lower during all three intervention phases as compared to the baseline diet. By the end of the DASH 1 phase, total daily insulin requirements were 24% lower than baseline. By the end of the WFPB phase, total daily insulin requirements were 39% lower than baseline. When the DASH diet was resumed, insulin requirements increased 15% from the end of the WFPB week.
Average daily blood sugar was 22–24% lower with both intervention diets as compared to baseline, but the WFPB diet resulted in the lowest fasting blood sugar.
Insulin resistance decreased by 30.0% during DASH 1 and 49% during the WFPB diet. Insulin resistance during DASH 2 remained 28% lower than baseline. Insulin sensitivity was 17% higher at the end of DASH 1, 38% higher at the end of the WFPB diet, and then decreased almost to baseline by the end of DASH 2.
Weight decreased during all three phases, with a 3% lower weight at the end of the third week compared to baseline. Total, HDL, and LDL cholesterol were all lowest at the end of the WFPB week and total and LDL cholesterol significantly increased upon returning to the DASH diet.[10]
Conclusions:
Both DASH and WFPB diets, without calorie or portion restriction, result in significant and rapid reductions in insulin requirements for insulin-dependent type-2 diabetics. Subjects consuming these diets also experienced decreased total and LDL cholesterol; and lower leptin, weight, and c-reactive protein (a marker for inflammation). It is not possible to completely isolate the effect of each diet since there were carryover effects from week to week. But a pattern was observed: the benefits from the DASH diet were significantly greater when subjects switched to a WFPB diet. When the DASH diet was resumed, the benefits began regressing back toward baseline.
Limitations:
This was a small study, but one of the advantages of small studies is that researchers often can better control variables. For example, in this study meals were provided, which may not have been practical or affordable with more participants.
The breadth of the effect is a counter for the small study size. It is much easier to find effects in larger studies with hundreds of subjects, but often these differences are statistically significant but clinically meaningless. In this case, the effect was not just statistically significant, but clinically very meaningful. The short follow-up time is also a limitation, but the results were significant and immediate, and such results might incentivize people to continue to adhere to better diets in order to improve their health.
Bottom line: More plant food intake leads to better health and the more plant food consumed, the better the outcomes.
A recent study might provide some inspiration for type-2 diabetics to pay more attention to diet. Participants in this nonrandomized crossover study were adults who had type 2 diabetes, required insulin, had a BMI of at least 27, and A1C levels between 6.5 and 9.5.
Fifteen participants were enrolled in a 4-week trial with sequential one-week phases:
Baseline, Dash 1, WFPB and a second week of the DASH diet
The diets were all ad libitum (subjects could eat as much as they wanted) and meals were provided.
First, a description of the two intervention diets:
Dietary Approaches to Stop Hypertension (DASH) does not require the elimination of any food but rather emphasizes consumption of more fruit, vegetables, whole grains, and low-fat dairy, while intake of saturated fat and sugar are reduced.
A whole foods plant-based diet (WFPB) emphasizes beans, whole grains, and fruits and vegetables; and minimizes or excludes animal foods, added fats, and added sugars.
Both diets have been shown in previous studies to lower blood pressure,[2] [3] plasma cholesterol,[4] [5] and blood sugar.[6] [7] Long-term adherence to a WFPB diet has been shown to result in atherosclerotic regression, reduction in angina and reduced risk of cardiac events in people who have been diagnosed with severe coronary artery disease.[8] [9]
Results:
Twelve of the fifteen subjects completed the study. One subject dropped out due to an unexpected surgery; one due to a car accident; and one subject started a new job and could not continue the weekly assessments.
Total calories were lower during all three intervention phases as compared to the baseline diet. By the end of the DASH 1 phase, total daily insulin requirements were 24% lower than baseline. By the end of the WFPB phase, total daily insulin requirements were 39% lower than baseline. When the DASH diet was resumed, insulin requirements increased 15% from the end of the WFPB week.
Average daily blood sugar was 22–24% lower with both intervention diets as compared to baseline, but the WFPB diet resulted in the lowest fasting blood sugar.
Insulin resistance decreased by 30.0% during DASH 1 and 49% during the WFPB diet. Insulin resistance during DASH 2 remained 28% lower than baseline. Insulin sensitivity was 17% higher at the end of DASH 1, 38% higher at the end of the WFPB diet, and then decreased almost to baseline by the end of DASH 2.
Weight decreased during all three phases, with a 3% lower weight at the end of the third week compared to baseline. Total, HDL, and LDL cholesterol were all lowest at the end of the WFPB week and total and LDL cholesterol significantly increased upon returning to the DASH diet.[10]
Conclusions:
Both DASH and WFPB diets, without calorie or portion restriction, result in significant and rapid reductions in insulin requirements for insulin-dependent type-2 diabetics. Subjects consuming these diets also experienced decreased total and LDL cholesterol; and lower leptin, weight, and c-reactive protein (a marker for inflammation). It is not possible to completely isolate the effect of each diet since there were carryover effects from week to week. But a pattern was observed: the benefits from the DASH diet were significantly greater when subjects switched to a WFPB diet. When the DASH diet was resumed, the benefits began regressing back toward baseline.
Limitations:
This was a small study, but one of the advantages of small studies is that researchers often can better control variables. For example, in this study meals were provided, which may not have been practical or affordable with more participants.
The breadth of the effect is a counter for the small study size. It is much easier to find effects in larger studies with hundreds of subjects, but often these differences are statistically significant but clinically meaningless. In this case, the effect was not just statistically significant, but clinically very meaningful. The short follow-up time is also a limitation, but the results were significant and immediate, and such results might incentivize people to continue to adhere to better diets in order to improve their health.
Bottom line: More plant food intake leads to better health and the more plant food consumed, the better the outcomes.
Reprinted from Wellness Forum Health
[1] Centers for Disease Control. National Diabetes Statistics Report 2020. Estimates of Diabetes and its Burden in the United States. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf
[2] Appel LJ, Moore TJ, Obarzanek E et al. "A clinical trial of the effects of dietary pattern on blood pressure. DASH Collaborative Research Group." NEJM 1997 Apr;336(16):1117-1124
[3] Berkow SE, Barnard ND. "Blood pressure regulation and vegetarian diets." Nutr Rev 2005 Jan;63(1):1-8
[4] Appel LJ, Sacks FM, Carey VJ et al. "Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial." JAMA 2005 Nov;294(19):2455-64
[5] Macknin M, Kong T, Weier A et al. "Plant-based, no-added-fat or American Heart Association diets: impact on cardiovascular risk in obese children with hypercholesterolemia and their parents." J Pediatr 2005 Apr;166(4):953-9,e1-3
[6] Azadbakht L, Fard NRP, Karimi M et al. "Effects of the dietary approaches to stop hypertension (DASH) eating plan on cardiovascular risks among type 2 diabetic patients: a randomized crossover clinical trial." Diabetes Care. 201 Jan(1); 34: 55-57
[7] Barnard ND, Cohen J, Jenkins DJ, et al. "A low-fat vegan diet improves glycemic control and cardiovascular risk factors in a randomized clinical trial in individuals with type 2 diabetes." Diabetes Care 2006 Aug;29(8): 1777-1783
[8] Ornish D, Scherwitz LW, Billings JH et al. "Intensive lifestyle changes for reversal of coronary heart disease." JAMA 1998 Dec;280(23):2001-2007
[9] Esselstyn CB, Ellis SG, Mendendorp SV, Crowe TD. "A strategy to arrest and reverse coronary artery disease: a 5-year longitudinal study of a single physicians’ practice." J Fam Practice 1995 Dec;41(6):560-568
[10] Campbell TM, Campbell EK, Peterson DR et al. "The acute effects of a DASH diet and whole food, plant-based diet on insulin requirements and related cardiometabolic markers in individuals with insulin-treated type-2 diabetes." Diabetes Res Clin Prac 2023 Aug;202:110814
[1] Centers for Disease Control. National Diabetes Statistics Report 2020. Estimates of Diabetes and its Burden in the United States. https://www.cdc.gov/diabetes/
[2] Appel LJ, Moore TJ, Obarzanek E et al. "A clinical trial of the effects of dietary pattern on blood pressure. DASH Collaborative Research Group." NEJM 1997 Apr;336(16):1117-1124
[3] Berkow SE, Barnard ND. "Blood pressure regulation and vegetarian diets." Nutr Rev 2005 Jan;63(1):1-8
[4] Appel LJ, Sacks FM, Carey VJ et al. "Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial." JAMA 2005 Nov;294(19):2455-64
[5] Macknin M, Kong T, Weier A et al. "Plant-based, no-added-fat or American Heart Association diets: impact on cardiovascular risk in obese children with hypercholesterolemia and their parents." J Pediatr 2005 Apr;166(4):953-9,e1-3
[6] Azadbakht L, Fard NRP, Karimi M et al. "Effects of the dietary approaches to stop hypertension (DASH) eating plan on cardiovascular risks among type 2 diabetic patients: a randomized crossover clinical trial." Diabetes Care. 201 Jan(1); 34: 55-57
[7] Barnard ND, Cohen J, Jenkins DJ, et al. "A low-fat vegan diet improves glycemic control and cardiovascular risk factors in a randomized clinical trial in individuals with type 2 diabetes." Diabetes Care 2006 Aug;29(8): 1777-1783
[8] Ornish D, Scherwitz LW, Billings JH et al. "Intensive lifestyle changes for reversal of coronary heart disease." JAMA 1998 Dec;280(23):2001-2007
[9] Esselstyn CB, Ellis SG, Mendendorp SV, Crowe TD. "A strategy to arrest and reverse coronary artery disease: a 5-year longitudinal study of a single physicians’ practice." J Fam Practice 1995 Dec;41(6):560-568
[10] Campbell TM, Campbell EK, Peterson DR et al. "The acute effects of a DASH diet and whole food, plant-based diet on insulin requirements and related cardiometabolic markers in individuals with insulin-treated type-2 diabetes." Diabetes Res Clin Prac 2023 Aug;202:110814
Excerpts from "What does the Bible say about Health"
How is your spiritual health?
We all look for wholeness in our lives. As Susie Larson says, "what happens in our souls, happens in our cells."
God made our immune system. Our immune system doesn’t wait until we get sick to start fighting or until we have a major threat in our life. It fights at the first sign of danger. As soon as it detects the slightest one-cell bacteria, that’s it!
A healthy lifestyle doesn't mean you are only eating well, but your mental and spiritual health are being fed as well.
Did you know that when you speak negatively about yourself, you give those words power that enters your consciousness, and it affects your DNA! Refuse to allow it to have a place in your life. Negative words will devour you.
Feeding our soul a healthy diet of Jesus is what helps us come alive spiritually, just like feeding our body a healthy diet helps us function at our best. This is stewardship of mind, body & spirit (and the heart). James Clear says “what gets rewarded gets repeated. Don’t reward behavior that you don’t want to see repeated. God made us stewards of everything, including our physical body.
Some science:
Trauma is an assault to the symphony of the body. It overwhelms the body’s intrinsic ability to self-regulate. This is regulated by the amygdala. If some of our body is not functioning, the body compensates and “holds” what is painful. It causes dis-regulation, but parts of our body cooperate to keep it going. This is what leads to disease. It also leads to depression, sadness, and anxiety. The chemistry of the brain becomes disrupted (neuroinflammation). We can become cut off from our body and live in our head (going through the motions). But the body and the soul remember.
What are you ignoring about your body and your health? What are the messages that your body is sending to you that you are not listening to? God speaks to us through our physical issues. We need to not only pray for healing, but pray that we can understand first, what God wants to address about our character. Ask him to “disrupt” your life by speaking honest and loving words to the most damaging issues in our lives.
A higher daily intake of fiber-rich fruit and vegetables is associated with lower incidences of anxiety in adults and, at the same time, greater happiness, higher life satisfaction, and greater social-emotional well-being.
In turn, emotions may harm you: anger affects the liver, stress affects the heart & brain, worry affects the stomach, grief affects the lungs, fear affects the kidneys. When we speak ill of ourselves and attack ourselves, our brain goes into a stress response. This produces cortisol and insulin and triggers our body to store fat.
Come join the conversation!
Keep a lookout for the next free Bible Study!
Liz
The Scoop on Vitamin DWe need it, but what is the best way to get it? First things first, it is not a "vitamin", it is a hormone. Let's explore:
• Vitamin: Something the body needs but cannot produce. Must be procured from external sources (ideally food).
• Hormone: Something made by the body in one place that carries instructions needed in another, or several other places.
Fun Facts about Vitamins:
• There are 13 for humans
• 4 are fat-soluble
• 9 are water-soluble
Fun Facts about Hormones:
• There are about 50
• Produced in endocrine glands and tissues
• Some fat soluble, some water-soluble
Science about the D family:
• It’s a fat-soluble*, secosteroid (seco…steroid)
• The biologically active form is called calcitriol:
• 1,25-dihydroxycholecalciferol
* Means we can’t readily excrete excess
So, if D is a hormone, how is it produced in the body? It starts in the lower layers of the epidermis. When the sun meets our skin, UVB rays convert readily available 7-dehydrocholesterol into Vitamin D3. Then it’s off to the liver and the kidneys for “activating” (turned into 1,25-dihydroxycholecalciferol)
How much is enough?
Low D, first and foremost, is a sign you are not getting enough sun, not that you need to rush off to the pharmacy.
D is measured in I.U. (international units) when getting it from external sources. It's always good to keep daily intake under 4000 IUs.
Serum blood level tests, 25 (OH)D, (the OH stands for hydroxy), are known to be inaccurate. Different testing companies have different levels of what they call normal.
The minimum target is 20 ng/ml (nanograms per milliliter), The happy medium is 30 ng/ml. There is no additional benefit above this.
We can't overdose from sun exposure, although we could burn and that's not good either. Getting 10-20 minutes of sun around noon-ish, twice a week, will do. Darker skin colors require 3 to 10 times more. Sunscreens with harmful chemicals can cause collateral damage. If you are planning to stay in the sun longer, physical blocks are better. Think hats, sunglasses, rash guards, zinc or titanium oxide. And if you are worried about living in the northern climates with no sunshine in the winter, know that the D hormone produced in the body by the sun is stored in the liver and our fat cells. When our body needs it, it calls for it and activates it!
Taking too much of a Vitamin D supplement can cause nausea, vomiting, weakness, insomnia, nervousness, and more. Overdose of Vitamin D supplements can cause kidney damage. It can also increase the risk of cancer, heart disease, prostate cancer in men, and higher LDL cholesterol.
What are the benefits from getting our Vitamin D from the sun? It builds strong bones through managing your calcium levels, helps manage levels of magnesium and phosphate, has a role in cancer prevention, enhances immune system performance, enhances bone absorption of minerals, promotes healthy cellular growth, and reduces inflammation.
Remember, there are NO super foods or super supplements. Your Vitamin D level is low as a result of illness or not enough sunshine. Get your Vitamin D from the Sun, not tanning salons. It also naturally occurs in salmon, mushrooms, sardines and breast milk.
Supplementation should be the last resort. Our bodies are elaborately set up via highly sensitive biological systems to produce the exact right amount of Vitamin D we need at every moment. Fortified foods and pills have a one size fits all system with fixed dosages designed to provide too much or too little. And remember, Vitamin D is not water soluble, so if you ingest too much the body cannot readily correct via excretion the way that B vitamins and Vitamin C get excreted because they are water soluble. Our "cleansing organs" must purge us of something (excess Vitamin D in a synthesized hormone form) that we were never designed to get rid of. That puts undue stress and strain on them.
The vitamin supplement industry is highly monetized and "pharmaceutical-ized". The 2022 market for Vitamin D was $1.34 billion dollars. Marketers have taken advantage of bad diet and lifestyle habits and contributed to making us think that a handful of supplements a day will make us feel better.
Sitting in the sun is not bad. Research shows that women who avoid the sun have shorter lives. Avoiding the sun has similar risk factors as smoking. Sunshine deficiency may also contribute to decrease in insulin's responsiveness, Mutiple Sclerosis, and cardiovascular disease.
So, there you have it. I am sure that a lot of you have been told by your doctor that you NEED to take a supplement. This is not defensible with science, but the decision is always yours, once you know all the facts. The bottom line is to be an informed consumer!
Liz Fattore
Nurture Your Health
Licensed Food Over Medicine Professional
The objective of Nurture Your Health is to learn how to remain or become a healthy person, rather than to remain or become a sick patient. Most people do not pay attention to their health until they are sick. It is important to prioritize learning about health and investing time and resources in adopting the right diet, engaging in the right exercise, and paying attention to other factors that lead to optimal health. Make learning about health interesting and fun. Use this information to take control of your health and make better and informed decisions about what you eat, which lifestyle choices you make, and the medical care you receive.
This information is not a substitute for medical advice.
I talk often about forming and maintaining healthy lifestyle habits. This topic seems to cause anxiety because we find it difficult to find a place to start. These anxious thoughts make us feel out of control. We want the quick solution, but we know that there aren't any shortcuts.
We want solutions, but what we really need are attitudes. You don't need an easier life, but rather an attitude of perseverance. 1
Attitude precedes outcome. And attitude equals mindset.
I read recently that everything you do in life either lifts you up or tears you down. There are always things to be torn down and discarded, but your life is a treasure to be valued and protected.2 Yes, we have busy lives, which makes it all the more important to schedule in rest. I am not referring to falling into bed at night and passing out, exhausted. And it certainly is not laying on the sofa with the TV on and scrolling Facebook or Instagram.
I attended a sweet time of prayer this week and heard that rest is not inactive-it is a deep sweet restfulness of the soul. Depending on your family obligations, it can be anywhere from 3 hours a week, a day a week, two days a month, even a day a month. The important thing is to schedule it for yourself, just like you do your hair appointment. Persevere and protect this time for yourself until it becomes a habit.
Forming a healthy habit requires motivation for the outcome and motivation for the effort to achieve the outcome. Focus on the payoff. For example, getting up every day to go to work is a habit. The payoff is that you become known as a dependable person, you earn recognition, and you collect a paycheck. This is a good habit! And even when you don't have the motivation on a particular day to go to work, the habit is a default decision that serves you well.
Manipulate your environment to serve your habit. Schedule it into your planner so that eventually everyone knows that the 2nd Saturday of the month is mom's/dad's time to go for a long hike, read a book in a park, sit somewhere to journal, sit in a church to pray, or all of the above! Remember that good habits are formed the same way that bad habits are formed: repetition! Having scheduled, healthy, repetitions in your life is a good way to relieve the anxieties of day-to-day life. Having this healthy flow of the day-to-day helps equip you when life throws you a curveball because you will be more resilient. You will have the ability to bounce back because you remember how your healthy habits made you feel better. This applies not only to rest days but also to eating and exercise.
Teaching the Forming Healthy Habits class helps me stay on track as well. It's a daily practice!
Click on the below link if you need inspiration on dealing with anxiety.
Liz Fattore
Nurture Your Health
Licensed Food Over Medicine Professional
1. James Clear
2. Marsha Burns
Bean Burger
Batch cooking bean burgers is a great way of having a quick meal from the freezer. Pictured is my burger on a Dave's Killer Bread bun, with lettuce, tomato and mustard. Sometimes I use the Seedtastic bread from Aldi's or a whole wheat pita.
The key to making the burger is getting it to a consistency like ground meat so that it does not fall apart after baking. You can use any type of beans and seasonings that you like. If adding vegetables, which I recommend, use a low water vegetable like kale or broccoli. Spinach or Swiss chard will make it watery. The more veggies you put, the more of a powerhouse of a burger!
Having a food processor for pulsing the beans and vegetables is a bonus and makes the prep quicker and easier.
Ingredients:
2 cans beans drained (I like a combo of pinto, black or garbanzo)
1 bunch kale or broccoli
1 small carton mushrooms (optional)
1 small onion
3-4 cloves of garlic
2 cups cooked rice or quinoa, cooled
1-1/2 cups oat flour, chickpea flour or corn meal (or combo, or sub oatmeal)
2 tablespoons Dijon mustard
Spices: salt, pepper, cumin, turmeric
Instructions:
Pulse beans in food processor or smash with potato masher and place in large bowl. Pulse or chop all vegetables. Add remaining ingredients and knead together with your hands. Start adding the flour until you get a firm consistency. Place bowl in the refrigerator for about 2 hours. This makes your mixture easier to handle. Preheat oven to 400 degrees. Scoop out mixture using a 1/2 or 2/3 cup measuring cup, depending on how big you want your burger. Form burger and place on a large, parchment lined cookie sheet. Bake 20 minutes, flip burgers over, bake additional 10-15 minutes. Once cooled, individually wrap in wax paper and freeze. This recipe should make around 12 burgers.
