Ask Dr Willis
Question: I am now approaching 48 and am putting on weight. Both my father and brother have diabetes and I would like to make sure that I do not get it. Can you advise me on the best foods to eat and perhaps you may know some tests I can have to find out if I am prone to the diseased?
Answer: Many nutritional doctors believe that Type 2 Diabetes is reversible and that controlling blood sugar with drugs and Insulin is not the answer and can actually increase your risk getting a heart attack or dying. In a report in “The New England Journal of Medicine,” Walter Willett, MD, PhD, and his colleagues from the Harvard School of Public Health, demonstrated that 91 percent of all Type 2 diabetes cases could be prevented through improvements in lifestyle and diet.
The diabetes epidemic along with the obesity epidemic is accelerating. Type 2 diabetes, or what was once called adult onset diabetes, is an increasing worldwide epidemic affecting nearly 100 million people and over 15 million Europeans. We are seeing increasing rates of Type 2 diabetes, especially in children, which has increased over 1,000 percent in the last decade and was unknown before this generation. One in three children born today will have diabetes in their lifetime. Yet this is an entirely preventable lifestyle disease.
High insulin levels are the first sign of a problem. The high insulin leads to an appetite that is out of control and increasing weight gain around the waist. High levels of insulin are warning signs - they precede Type 2 diabetes by decades.
Insulin resistance, when the body becomes resistant to the effects of insulin, is the main cause of the disease. When your diet is full of empty calories, an abundance of quickly absorbed sugars and carbohydrates (bread, pasta, rice, potatoes, etc.), the body slowly becomes resistant to the effects of insulin and needs more to do the same job of keeping your blood sugar even. If you have a family history of obesity (especially around the belly), diabetes, early heart disease, or even dementia you are even more prone to this problem.
Insulin resistance and the metabolic syndrome associated with it is often accompanied by increasing central obesity, fatigue after meals, sugar cravings, high triglycerides, low HDL, high blood pressure, problems with blood clotting, as well as increased inflammation. These clues can often be picked up decades before anyone ever gets diabetes and may help you prevent diabetes entirely.
Most people know about the common complications of diabetes such as heart attacks, strokes, amputations, blindness, kidney failure and nerve damage. Some may even know that it increases your risk of dementia and cancers and can cause impotence. Most people, however, do not realize that insulin resistance or pre-diabetes can be just as bad causing heart attacks, strokes, dementia, cancer and impotence decades before you get diabetes. In fact many people with pre-diabetes never get diabetes but they are at severe risk just the same.
Our bodies were adapted to a nutrient-dense, low-sugar, high-fibre diet rich in omega 3 fats so when we eat out of harmony with our genes, we turn on genes that promote diabetes. Arizona’s Pima Indians are a good example. They were thin and fit 100 years ago, living on a diet of over 70 percent carbohydrates. They ate high-fibre, unprocessed plant foods and they had no diabetes or obesity. Now, in just one generation, they are nearly all obese and 80 percent have diabetes by the time they are 30 years old! That is because they are eating food that turns on all the wrong gene messages - foods like sugar, trans fats, white flour, and processed foods.
Diabetes and pre-diabetes ARE reversible. New science shows that it is possible, through an aggressive approach of lifestyle, nutritional support and occasionally medications.
It is important to diagnose Type 2 diabetes early. In fact, all doctors should aggressively diagnose pre-diabetes long before diabetes occurs and before any damage is done to your body. Damage begins with even slight changes in insulin and blood sugar. Unfortunately, there is a continuum of risk from slightly abnormal insulin and blood sugar to full blown diabetes.
In a recent study, anyone with a fasting blood sugar of over 87 was at increased risk of diabetes. The lowest risk group had a blood sugar less than 81. Most doctors are not concerned until the blood sugar is over 110, or worse, over 126, which is diabetes. Therefore, I recommend early testing with anyone, like yourself, who has a family history of Type 2 diabetes, central abdominal weight gain or abnormal cholesterol. Do not wait until your sugar is high.
The tests I recommend include the following:
1. Insulin glucose challenge test with 2-hour glucose challenge, 75 grams measuring fasting, 1 and 2 hour blood sugar AND insulin. Your blood sugar should be less than 80 fasting and never rise above 110 or 120 after one to two hours. Your insulin should be less than 5 fasting and should never rise above 30 after one to two hours. I recommend this test for everyone over 40 and for anyone with any risk of insulin resistance, even children.
2. The hemoglobin A1C is an important measure of glycated hemoglobin, which can be an early indicator of sugar problems. It measures sugars and proteins combining into glycated proteins called AGEs (advanced glycation end products), like the crust on bread, or the crispy top on a crème brûlée. These create inflammation, oxidative stress throughout the body and promote heart disease and dementia and accelerating aging. The hemoglobin A1C should ideally be less than 5.5. Anything over 6 is considered diabetes.
3. Lipid profiles are important. An HDL or good cholesterol level under 60 and triglycerides over 100 should make you suspicious of insulin resistance. An HDL under 40 and a triglyceride level over 150 usually means diabetes.
4. An NMR lipid profile identifies the size of your cholesterol particles. With insulin resistance or Type 2 diabetes, you develop small LDL and HDL cholesterol particles. They are much more dangerous than larger particles and lead to increased risk of atherosclerosis or heart disease.
5. High sensitivity C-reactive protein is a measure of inflammation, one of the classic conditions that is both the cause and result of insulin resistance and diabetes. It should be less than 1 and is often associated with diabetes. In fact, anyone with a high C- reactive protein has a 1,700 percent increased risk of getting diabetes.
6. Homocysteine is often abnormal in people with diabetes. It is a measure of folic acid deficiency. It should be between 6 and 8.
7. Fibrinogen measures your risk of clotting, which can cause heart attacks and strokes. It is also a sign of inflammation and is associated with insulin resistance and diabetes. It should be less than 300.
8. Ferritin levels are often elevated. It is a non-specific marker of inflammation associated with diabetes. It also can mean an overload of iron in the body. It should be less than 150.
9. Uric acid should be less than 6. Higher levels indicate problems with insulin resistance. This can lead to gout, which is related to insulin resistance and Type 2 diabetes.
10. Elevated liver function tests result from insulin resistance. This is the major cause of fatty liver and elevated liver function tests in this country. This is entirely due to sugar and carbohydrates in our diet that cause fatty liver, liver damage and even cirrhosis.
These are tests any doctor can perform and are usually covered by your health insurance, if you have one.
The key to preventing and reversing insulin resistance and diabetes is to eating in a way that balances your blood sugar, reduces inflammation and oxidative stress and improves your liver detoxification. This is a way of eating that is based on a whole foods diet that is high in fibre, rich in colourful fruits and vegetables and low in sugars and flours, with a low glycaemic load. It is a way of eating that includes anti-inflammatory, antioxidant and detoxifying foods. It includes plenty of omega-3 fats and olive oil, soy products, beans, nuts and seeds. All these foods help prevent and reverse diabetes and insulin resistance. This is the way of eating than turns on all the right gene messages, promotes a healthy metabolism and prevents aging and age-related diseases like diabetes and heart disease.
Here are more specifics.
- Eat protein for breakfast every day, such as whole omega-3 eggs, a soy protein shake or lean low fat meat.
- Eat something every 4 hours to keep your insulin and glucose levels normal
-·Eat small protein snacks in the morning and afternoon, such as a handful of almonds.
- Finish eating at least 2 to 3 hours before bed. If you have a snack earlier in the day, you will not be as hungry, even if you eat a little later.
Controlling the glycaemic load of your meals is very important. You can do this by combining adequate protein, fats, and whole-food carbohydrates from vegetables, legumes, nuts, seeds, and fruit at every meal or snack. It is most important to avoid eating quickly absorbed carbohydrates alone, as they raise your sugar and insulin levels. Whilst travelling two handfuls of almonds in a zip-lock bag make a useful emergency snack. You can eat them with a piece of fruit.
Remember, real food is the best. Choose from a variety of the following real, whole foods:
- Choose organic produce and animal products whenever possible.
- Eat high-quality protein, such as fish - especially fatty, cold-water fish like salmon, small halibut, herring and sardines and shellfish. Cold-water fish such as salmon, halibut and cod contain an abundance of beneficial essential fatty acids, omega-3 oils that reduce inflammation. Smaller fish are lower in toxins such as mercury. Avoid tuna and swordfish steaks. Canned wild salmon is a great “emergency” food.
- Eat up to eight omega-3 eggs a week.
- Create meals that are high in low-glycaemic legumes such as lentils, chickpeas, and soybeans. These foods slow the release of sugars into the bloodstream, which helps prevent the excess insulin release that can lead to health concerns like obesity, high blood pressure and heart problems.
- Eat a range of fresh fruits and vegetables teeming with phytonutrients like carotenoids, flavonoids and polyphenols, which are associated with a lower incidence of nearly all health problems, including obesity and age- related disease.
- Eat more low-glycaemic vegetables, such as asparagus, broccoli, spinach, cabbage and Brussels sprouts.
- Berries, cherries, peaches, plums, rhubarb, pears and apples are optimal fruits. Cantaloupes and other melons, grapes and kiwifruit are suitable but they contain more sugar.
- Focus on anti-inflammatory foods, including wild fish and other sources of omega-3 fats, red and purple berries (these are rich in polyphenols), dark green leafy vegetables, orange sweet potatoes and nuts.
- Eat more antioxidant-rich foods, including orange and yellow vegetables, dark green leafy vegetables (spinach, etc.), anthocyanidins (berries, beetroots, grapes, pomegranates), purple grapes, blueberries, bilberries, cranberries and cherries. In fact, antioxidants are in all colourful fruits and vegetables.
- Include detoxifying foods in your diet, such as cruciferous vegetables (broccoli, green cabbage, Brussels sprouts, cauliflower), green tea, watercress, cilantro, artichokes, garlic, citrus peels, pomegranate, and even cocoa.
- Season your food with herbs such as rosemary, ginger and turmeric, which are powerful antioxidants, anti-inflammatories, and detoxifiers.
- Avoid excessive quantities of meat. Eat lean organic or grass-fed animal products, when possible. These include eggs, beef, chicken, pork, lamb and ostrich.
- Garlic and onions contain antioxidants, enhance detoxification, act as anti-inflammatories and help lower cholesterol and blood pressure.
- A diet high in fibre further helps to stabilize blood sugar by slowing the absorption of carbohydrates and supports a healthy lower bowel and digestive tract. Try to gradually increase fibre to 30 to 50 grams a day and use predominantly soluble or viscous fibre (legumes, nuts, seeds, whole grains, vegetables and fruit), which slows sugar absorption from the gut.
- Use extra virgin olive oil, which contains anti-inflammatories and anti-oxidants, as your main cooking oil.
- Soy products such as soy milk, soy beans and tofu are rich in antioxidants that can reduce cancer risk, lower cholesterol and improve insulin and blood sugar metabolism.
- Increase your intake of nuts and seeds, including raw walnuts, almonds, macadamia nuts and pumpkin and flax seeds.
- And yes, chocolate can be healthy, too! Choose only the darkest varieties and eat only 2 to 3 ounces a day. It should contain at least 70 percent cocoa.
You also need to decrease (or ideally eliminate) your intake of:
- All processed or junk foods.
- Foods containing refined white flour and sugar, such as breads, cereals (cornflakes, Frosted Flakes, puffed wheat and sweetened bran cereal, flour-based pastas, doughnuts, croissants and pastries.
- All foods containing high-fructose corn syrup
- All artificial sweeteners (aspartame, Sorbitol, etc.) and caffeine
- Starchy, high-glycaemic cooked vegetables, such as potatoes, corn, and root vegetables such as swede, parsnips and turnips.
- Processed fruit juices, which are often loaded with sugars. Try juicing your own carrots, celery and beetroots, or other fruit and vegetable combinations, instead.
- Processed canned vegetables (usually very high in sodium)
- Foods containing hydrogenated or partially hydrogenated oils (which become trans fatty acids in the bloodstream) such as most crackers, chips, cakes, sweets and biscuits, doughnuts and processed cheese
- Processed oils such as corn, safflower, sunflower, peanut and canola
- Red meats (unless organic or grass-fed) and organ meats
- Large predatory fish and river fish, which contain mercury and other contaminants in unacceptable amounts, including swordfish, tuna and shark.
- Dairy - substitute unsweetened, gluten free soymilk, almond milk or hazelnut milk products.
- Alcohol - limit it to no more than 1 glass of red wine per day.
Another reason why varicose veins can develop is due to the pressure the growing uterus puts on the pelvic veins and the inferior vena cava - a vein on the right hand side of the body. This increases the blood pressure in the veins of the legs, which can cause varicose veins. The problem is exacerbated as the pregnancy progresses and the baby gets bigger. Other factors, such as a family history of varicose veins and being overweight, can also increase the risk. Estimates suggest that about 40% of pregnant women develop varicose veins but by being aware of the risk of varicose veins it is possible to reduce the chance of getting them or minimise the effects if you are affected.
It is true that there has not been a lot of research into this area but women have been dying their hair during pregnancy for a long time and there has been no link found between dying hair and causing harm to the baby. The chemicals found in modern hair dye are not thought to be highly toxic, either to the mother or the baby and the method by which you or your hairdresser dyes your hair means that there is little chance of a high level of the chemicals being absorbed by the body anyway. However, the less contact the dye has with your scalp, the less chance you have of the chemicals being absorbed, so streaking and frosting of the hair is less risky than having a full colour on your hair. 