CARL, A SIXTY-SIX-YEAR-OLD OBESE MAN WITH TYPE 2 DIABETES, BEGAN OUR six-month clinical Daniel Fast study with a fasting* blood glucose (sugar) value of 229 mg/dL. To better understand what Carl’s glucose level means, consider the reference ranges in table 6.1.
Table 6.1: Fasting Blood Sugar Ranges
|
Normal/Healthy |
<100 mg/dL |
Normal values typically fall between 70 mg/dL and 99 mg/dL. |
|
Pre-Diabetes |
100–125 mg/dL |
This does not mean that you will develop diabetes, but your risk of doing so is higher than if your blood sugar was less than 100 mg/dL. |
|
Diabetes |
=126 mg/dL |
If your fasting blood sugar is =126 mg/dL, you technically have diabetes; this may be confirmed more than once and/or by using more than one type of diagnostic test. |
Based on these measurement standards, it’s obvious that Carl’s value of 229 mg/dL was exceedingly high. But after just three weeks on a traditional Daniel Fast diet, his fasting blood glucose dropped by 21 percent to 180 mg/dL. Still high, but a significant improvement from where he started. After three months, his blood sugar dropped to 145 mg/dL, and by the end of six months, it was down to 107 mg/dL. That’s a 53 percent reduction in just six months based solely on a change in diet. We also measured an important variable that indicates how well the hormone insulin was functioning in Carl’s system. His value improved by 66 percent — absolutely remarkable! And Carl’s results are not unique. Others with type 2 diabetes who have participated in our studies have experienced similar results, providing compelling evidence about the healing power of food.
WHAT EXACTLY IS DIABETES?
Diabetes is a metabolic disease in which the body does not properly process the food you eat (particularly carbohydrates) for use as energy. The result is an elevation in blood sugar, which may be due to a variety of causes. Diabetes is typically diagnosed with three routine lab tests:
1. Fasting blood glucose: This test indicates what your blood sugar is at the time the blood is drawn. A value exceeding 125 mg/dL confirms a diagnosis of diabetes.
2. Hemoglobin A1c: This test indicates how well your blood sugar has been controlled during the several-week period prior to the measurement. A value exceeding 6.4 percent confirms a diagnosis of diabetes.
3. Oral glucose tolerance test: You consume a 300-calorie syrupy drink designed for the test, and your blood glucose (and possibly insulin) is measured at intervals for two hours afterward. If your body is unable to appropriately lower the sugar in your blood by the end of two hours, you may be classified as having pre-diabetes or diabetes. A value exceeding 199 mg/dL confirms a diagnosis of diabetes.
Tests for diabetes focus on sugar in the blood because blood sugar is regulated by the hormone insulin. Individuals with diabetes have one of two insulin problems (or perhaps both):
1. The inability to produce insulin due to cell damage. There is an autoimmune destruction of the pancreatic beta cells (the cells responsible for producing insulin). This is the problem for those with type 1 diabetes.
2. The inability to appropriately utilize insulin. This is typically the problem for those with type 2 diabetes.
Insulin is a hormone with multiple functions, but, specific to our discussion here, it regulates blood sugar levels within a fairly narrow range (70–99 mg/dL when fasting). It does this by transporting blood sugar into tissue cells (such as muscles), where the sugar is either used as an energy source or stored for later use. When insulin production or utilization is impaired, sugar in the blood can’t be properly removed or utilized by tissue cells. As a result, sugar accumulates in the bloodstream and fails to reach body cells that are starved for energy. The result is twofold: First, the excess blood sugar can become chemically modified and cause severe damage to blood vessels. Second, the lack of sugar reaching the target tissues leads to decreased energy production and the feeling of fatigue.
Individuals with diabetes are treated with insulin injections and/or take medications that mimic insulin or make tissues more sensitive and responsive to insulin. Certain nutritional supplements may also prove helpful in controlling blood sugar. (See “Are Dietary Supplements Beneficial for Type 2 Diabetes?” on page 62.)
While there are other forms of diabetes besides type 1 and type 2 (for example, gestational diabetes, which is related to pregnancy), type 2 diabetes represents 90 to 95 percent of all cases and is considered a lifestyle disease. That is, the onset and progression of this disease are largely dependent on lifestyle choices — dietary patterns and activity levels.
WHY IS DIABETES SUCH A PROBLEM?
Type 2 diabetes is a significant and growing problem worldwide. The World Health Organization estimates close to 346 million cases,13 with roughly 80 percent of people with diabetes living in low- to middle-income countries. The facts about diabetes in the United States are just as disturbing:14
• Approximately 18.8 million people have been diagnosed with type 2 diabetes.
• Seven million people are believed to have undiagnosed diabetes.
• Seventy-nine million people are estimated to have pre-diabetes.
• Close to two million new cases of diabetes are diagnosed each year.
While the problem of diabetes plagues all states, as with obesity, the highest incidence rates are in the southeastern part of the Unites States. And in most of these states, it afflicts more than 10 percent of the population (compared to the national average of about 8.3 percent). In those twenty years or older, the impact of diabetes is about the same in men and women. The prevalence of diabetes in different ethnic groups in the US is shown in table 6.2 (p. 58).15
The incidence of diabetes also increases significantly as people get older. Close to 15 percent of those over age forty-five and 27 percent of those over sixty-five have diabetes.16 And consider these alarming projections from the CDC:17 “As many as one in three U.S. adults could have type 2 diabetes by 2050 if current trends continue. Approximately one in ten U.S. adults has type 2 diabetes now.”
Many of the problems of diabetes are linked to obesity — in particular what is known as “central obesity,” or carrying excess fat in the abdomen. As discussed in chapter 5, obesity is strongly associated with the development of type 2 diabetes. Make no mistake — if you routinely eat a high-calorie diet comprised of processed foods, white-flour products, simple sugars, and saturated fat, there is a very good chance that one day your doctor will tell you that you have type 2 diabetes. Your likelihood of developing type 2 diabetes also increases if your lifestyle is largely sedentary and you carry a significant amount of body fat around your midsection. This applies to children as well as adults. If we fail to help our children develop healthy eating habits and stay physically active, their risk of suffering lifelong health issues increases significantly.
WHAT CAUSES BLOOD SUGAR TO BECOME ELEVATED?
When you eat carbohydrate-rich foods, especially processed foods, high amounts of sugar enter the bloodstream. The body senses the rise in blood sugar and initiates a complex sequence of events to get it back under control (see figure). The process goes something like this:
1. The pancreas secretes insulin into the bloodstream in an attempt to remove the sugar — the greater the blood sugar, the more insulin secreted.
2. Insulin binds to insulin receptors on the surface of cells (cell membrane).
3. A complex series of signals occur inside the cell that activates a family of proteins called “glucose 4 transporters,” or GLUT4.
4. GLUT4 proteins move from inside the cell (intracellular space) to the cell membrane and allow for sugar (glucose) to enter the cell from the bloodstream.
5. The GLUT4 proteins move back into the intracellular space and glucose is now available within the cell to be metabolized for energy.
This whole process is extremely complex and highlights the human body masterpiece that God created.
Any problems with one or more of the steps can lead to a spike in blood sugar. For example, your body may not produce adequate insulin. Or the insulin produced may not bind correctly to the insulin receptors. The post-receptor signaling may be faulty. There may not be adequate GLUT4 available. Or GLUT4 is available but does not move from inside the cell to the surface of the cell. These are some of the reasons why someone with diabetes can have a high blood sugar level.
Despite these facts about diabetes, many people continue to disregard or downplay their risk of developing the disease. They reason, “If I get diabetes, I’ll just have to take pills or, in the worst case scenario, insulin injections. That’s not so bad.”
But here’s the truth. Taking medications doesn’t prevent the disease from causing debilitating health consequences, including toe, foot, or leg amputation; impaired eyesight or blindness; complications with pregnancy; kidney disease; and heart disease. Type 2 diabetes is also associated with multiple forms of cancer because cancer and diabetes share some of the same risk factors, including obesity and inflammation. The health consequences of diabetes are alarming.
TABLE 6.2 Diabetes Incidence by Ethnic Group
|
Ethnic Group |
Percent Diabetic |
|
Non-Hispanic Blacks |
12.6 |
|
Hispanics |
11.8 |
|
Asians |
8.4 |
|
Non-Hispanic Whites |
7.1 |
CONTROLLING TYPE 2 DIABETES RISK AND PROGRESSION
If you aren’t yet 100 percent convinced that taking action to reduce your risk of developing type 2 diabetes is important for your health, consider what it could cost you. For starters:
• Routine visits and co-pays/coinsurance to your primary-care doctor.
• Routine visits and co-pays/coinsurance to an endocrinologist (a specialist who treats diabetes).
• Routine visits to a variety of other specialists you will likely need to see to care for diabetes-induced conditions such as cardiovascular disease, eye disease, and kidney disease.
• Medication costs (oral hypoglycemic agents and insulin) and supplies (blood glucose test strips, lancets, needles). The average monthly costs range from $20 up to a few hundred dollars depending on medication and supplies and insurance.
• Sick leave and personal days away from work can result in lost productivity and thousands of dollars in lost wages.
• Diminished earning capacity due to time away from work for medical treatment, long-term disability, or forced early retirement due to health problems.
The collective economic burden of diabetes borne by the United States health-care system is significant, accounting for $245 billion in total costs in one year recently.18 This includes $176 billion for direct medical costs and $69 billion for indirect costs such as disability, work loss (lost productivity), and premature mortality. The average annual medical expenses for those with diabetes is estimated to be 2.3 times higher than what health costs would be without diabetes. These statistics include only diagnosed cases. When factoring in the additional costs of undiagnosed diabetes, pre-diabetes, and gestational diabetes, the cost in the United States approaches $300 billion a year. This is a 37 percent increase in just five years, from $218 billion.19
Not only are the economic consequences distressing but the picture is even darker when we consider the damage to the body caused by diabetes:
• Diabetes is the seventh leading cause of death in the United States,20 contributing to close to 230,000 deaths annually.21 With the number of diagnosed cases increasing, this number will continue to grow.
• Diabetes is associated with a variety of macro-vascular diseases such as coronary artery disease, high blood pressure, stroke, and intermittent claudication (a condition that causes pain in the legs when walking or even standing). About 75 percent of those with diabetes die of some form of heart or blood vessel disease.22
• Diabetes is strongly associated with micro-vascular diseases that affect the eyes and lead to blindness, advanced kidney disease, nerve damage, and infection that can result in amputation. Diabetes is also associated with erectile dysfunction — a significant concern for many men.
These are more than statistics for me because I (Rick) know people who have suffered these terrible consequences. Several years ago, a man named Ed, who had poorly controlled diabetes, participated in a clinical study I was involved in. During the four-month study, Ed underwent two toe amputations. In another study, a forty-two-year-old man named David was unable to walk for more than a hundred yards without suffering severe leg pain due to complications of diabetic neuropathy. In early 2002, when Chrissy and I were preparing for our wedding ceremony, our pastor asked if he could use a very large type font on his version of the wedding program. He explained that he had diabetes and was going blind because of his failure to take care of himself over the years. Our wedding was just two months away, and he wasn’t sure he would still be able to see by then. These are real problems suffered by real people.
Although diabetes is a costly and often debilitating disease, type 2 diabetes and the complications are largely avoidable if we simply adopt a lifestyle of regular physical activity and healthy eating. For most of us, it is just that simple.
THE DANIEL FAST AND DIABETES
We strongly believe the Daniel Fast eating plan offers significant benefits to those with type 2 diabetes as well as those who are at risk for developing the disease.* In fact, the preliminary results of our studies have been so striking, we are now interested in conducting studies focused exclusively on the Daniel Fast and diabetes.
Why does the Daniel Fast work well for those with type 2 diabetes? In short, because it stabilizes blood sugar levels by providing the body with healthy, fiber-rich, nutrient-dense food. For most of us, an ideal diet maintains stable blood sugar — avoiding highs and lows — which leads to positive effects for almost everyone. Benefits are body weight reduction, more efficient insulin action, and improvement in energy levels and mood. We can maintain stable blood sugar levels by:
• Consuming small but frequent meals. This means avoiding long gaps between meals by eating a small meal every two to three hours.
• Consuming macronutrient-balanced meals, which include small amounts of protein, carbohydrate, and fat. We’ll talk more about macronutrients in chapter 11.
• Consuming nutrient-dense meals. No empty calories! Nutrient-dense foods have a high ratio of nutrients to calories. They contain the highest possible levels of quality protein, carbohydrate, fat, vitamins, and minerals for the least amount of calories.
• Consuming an abundance of fiber. Fiber is found in a variety of foods, including whole grains, fruits, vegetables, and beans.
HOW DOES EXERCISE IMPACT TYPE 2 DIABETES?
Beyond a proper diet, regular exercise is the single best thing you can do to prevent the onset or control the progression of type 2 diabetes.† Exercise has many health benefits. Studies indicate that those who are more physically active are far less likely to develop diabetes. Exercise may act as a preventive strategy:
1. Exercise involves energy expenditure that may lead to weight loss — and body mass is linked to the risk of developing type 2 diabetes.
2. Exercise can increase muscle mass, making more muscle available as a storage depot for blood sugar (carbohydrate).
3. Exercise improves insulin sensitivity, so less insulin is needed to perform the job.
4. Exercise improves multiple aspects of the post-receptor signaling cascade, allowing GLUT4 to move to the cell surface to take blood sugar into the cell.
5. Exercise increases the number of GLUT4 protein. More GLUT4 helps to bring more glucose into the cell.
Because exercise may have a profound effect on blood sugar, type 2 diabetics should always consult their physician before starting an exercise program. There are certain precautions to consider, such as monitoring blood sugar before, during, and after exercise by using a blood glucose meter, and having carbohydrates available if needed during or following exercise. Discuss these issues and others with your physician before beginning an exercise program.
† While those with type 1 diabetes will benefit from regular exercise (for reasons aside from blood sugar control), it should be understood that exercise will not prevent the disease, as the cause of type 1 diabetes is autoimmune related.
• Eliminating trans fats and limiting saturated fats, including animal fats, butter, margarine, and shortenings.
• Consuming little or no processed foods or refined carbohydrates.*
The Daniel Fast plan benefits people with diabetes because it does not restrict calories and calls for regular intake of food — nutrient-dense foods — throughout the day. More frequent meals stabilize blood sugar by minimizing spikes and troughs. This is important because frequent and significant spikes in blood sugar — often due to the ingestion of high-calorie, highly processed foods — likely contribute to impaired insulin action over time, which can lead to both the onset and progression of type 2 diabetes.
ARE DIETARY SUPPLEMENTS BENEFICIAL FOR TYPE 2 DIABETES?
Dietary supplements in general can be of benefit for those with diabetes. Beyond the commonly used supplements such as multi-vitamins and minerals and fish oil, other supplements can be useful for those with type 2 diabetes. For example, acetic acid, which is found in vinegar, has been reported to be beneficial in controlling blood sugar when 1–2 tablespoons of vinegar are taken before high-carbohydrate meals. But keep in mind, when considering supplements, that overall dietary intake and exercise will account for at least 90 percent of your success in maintaining optimal blood sugar control. Supplements can’t make up for a failure to eat right and exercise.
The following supplemental nutrients have been reported to have some merit:
blueberry bioactives
grape anthocyanins
cinnamon extract
phellodendron
crape myrtle (banaba leaf)
chromium (polynicotinate or picolinate)
Russian tarragon
green tea polyphenols (EGCG)
alpha lipoic acid
selected fiber supplements and other agents that slow carbohydrate digestion
As with most dietary supplements, some individuals may be helped more than others. That said, if you decide to experiment with dietary supplements believed to control blood sugar, it is important to discuss your plans with your physician. You should understand that the dosage of certain diabetic medications may need to be adjusted to account for the blood-sugar-lowering effect of some supplements. This adjustment should only be done under the direction of your physician.
While the Daniel Fast involves more frequent food consumption, the total calories typically are reduced because the foods are more nutrient dense but lower in calories. For example, a breakfast of oatmeal, fruit, and a soy protein powder drink not only contains fewer calories than a large bagel with cream cheese but is also more filling and much better nutritionally. Because the number of calories is generally lower when following the Daniel Fast plan, a person is likely to lose weight — and reduce the risk of diabetes.
Dietary fiber — especially in the form of legumes (beans, peas, lentils) — is also helpful for those with type 2 diabetes. In addition to providing a feeling of fullness, fiber acts to slow down the rate of absorption of foods — carbohydrates in particular — which assists in maintaining relatively stable blood sugar levels throughout the day. Dietary fat can do the same thing by essentially slowing the entry rate of glucose into the bloodstream. But it’s important to note that not all fats are equal. While essential fatty acids (omega-3 and omega-6 fatty acids found in certain fish, oils, nuts, and nut butters) can improve insulin sensitivity, saturated fats (mainly animal fats) can actually damage insulin sensitivity. The important thing to note about fiber and fats is that your blood sugar is controlled by more than just the sugar (the carbohydrates) you eat. The type of fat you eat matters.
The Daniel Fast eliminates all processed foods and simple carbohydrates, such as sugar, with the exception of the fructose, a simple sugar, contained in fruit.* Eating simple carbohydrates and processed foods can lead to rapid and massive spikes in blood sugar and insulin. Remember, insulin acts to reduce blood sugar when it rises after eating a meal. A large spike in blood sugar may lead to a large counterspike in insulin — which in turn may cause a massive fall in blood sugar and a feeling of fatigue an hour or two later.
For many young and healthy individuals, occasional blood sugar spikes do not appear to present an imminent problem — yet. However, for middle-aged and older individuals — especially those with problems processing blood sugar — blood sugar spikes can pose both short-term and long-term health concerns. In the short term, people may simply not feel very good. They feel tired, irritable, and moody. In the long term, regular and significant spikes in insulin can impair the sensitivity of insulin. It is no longer as effective.
What is insulin insensitivity? In simple terms, it means that insulin does not work as well as it used to. The glucose, or sugar, cannot be adequately removed from the blood. And with the blood sugar level still high, the body senses the need to secrete even more insulin in order to get the job done. But because the sensitivity between the insulin and specific receptors that interact with insulin in an attempt to ultimately lower blood sugar is impaired, the job still doesn’t get done. The result is elevated blood sugar (hyperglycemia) and elevated blood insulin (hyperinsulinemia) and body tissue cells that are not receiving glucose, a prime energy source. This is the reason diabetics often feel tired. Their muscles are not receiving the fuel they need to function properly. (See “What Causes Blood Sugar to Become Elevated?” on page 57.)
The Daniel Fast approach to eating is a powerful tool that not only limits the risk of developing type 2 diabetes but also helps in treatment by improving overall metabolic health and controlling blood sugar. A proper food plan is your first line of defense. Add to that the multiple benefits of increased physical activity and structured exercise. (See “How Does Exercise Impact Type 2 Diabetes?” on page 61.)
SO WHAT DOES THIS MEAN FOR YOU?
I started this chapter by describing the success of Carl, one of our past Daniel Fast study participants. You might be wondering if you could experience success with the Daniel Fast plan. Our answer is yes. Consider the results of Martha, another study participant who took control of her blood glucose in just three weeks while following the Daniel Fast. Martha was forty-one years old and not obese by BMI standards (her BMI was less than 30), but her body fat was about 30 percent. After her twenty-one-day Daniel Fast, her fasting blood sugar improved by 40 percent from a very high starting value of 330 mg/dL to an ending value of 198 mg/dL. Her insulin was functioning 23 percent more efficiently. Truly remarkable results in just three weeks — when the only change was to a diet of healthy, natural, nutrient-dense food.
Now back to you. If you have already been diagnosed with type 2 diabetes and are being treated, chances are you are familiar with some or most of what you read in this chapter. Our question is, “Are you adequately caring for yourself by putting into action the things you know are important?”
If you don’t have diabetes, or if much of the information was new to you, it’s likely stirred up concerns or questions about your health or your lifestyle choices. Perhaps you are now wondering if you have diabetes but haven’t been diagnosed. Or maybe you recognized yourself when you read about the risk factors for diabetes, such as being overweight or obese, carrying a significant amount of abdominal fat, living a sedentary lifestyle, or eating high calorie and sugary and fatty meals. Now you are wondering if you might be heading directly toward a diagnosis of type 2 diabetes.
If anything you read prompted concerns, this may be God’s invitation calling you to pay attention to the very real health risks knocking at your door. It could also be your invitation to begin a time of prayer and fasting, using the Daniel Fast as your method. By prayerfully submitting yourself to God and adopting a healthy way of eating, you will not only honor God but you’ll also honor your body — the temple of the Holy Spirit that God has entrusted to your care.
TURN YOUR THOUGHTS INTO ACTIONS
1Imagine yourself with a constant supply of energy throughout the day, with no highs and lows. Your blood glucose and insulin levels are stable. You are eating frequent meals and you feel better than you’ve felt in years. How different would this be from how you feel now?
2Eat five to six small meals every day. Never go more than three hours without eating.
3Consume small amounts of protein, carbohydrate, and fat at each meal. Split your plate into thirds — one part low-fat protein (plant- or animal-based), one part vegetable and/or fruit, one part whole grain (brown rice, barley, oats). Balanced meals are a necessity.
* A fasting blood glucose sample is collected first thing in the morning, with no food or calorie-containing beverages consumed in the preceding ten to twelve hours.
* While those with type 1 diabetes may also benefit, we have not yet included individuals with type 1 diabetes in our research studies. Because type 1 and type 2 diabetes have different causes, we cannot state with confidence that similar benefits would be obtained.
* Processed foods have been altered in some way, either for safety or convenience. While some processed foods (for example, pasteurized milk and flash-frozen fruits and vegetables) can be very healthy, most processed foods are not. This is because they contain many unhealthy ingredients — such as sodium, trans fats, corn syrup, sugar, additives, and preservatives. Boxed meal mixes, frozen dinners, and snack foods are typical examples of processed foods. Refined foods have been processed or altered to some degree and no longer are in their natural state. Very often, beneficial nutrients such as fiber, vitamins, and minerals are removed in the processing. White rice and white flour are examples of refined foods.
* Fruit contains fiber as well as a full complement of vitamins and minerals that may help in blood sugar control. This is why the Daniel Cure plan recommends several servings of fruit per day.