Everyone knows Type 2 diabetes is caused by bad foods. Everyone also knows you can reverse Type 2 diabetes by eating the right foods if you work hard enough to not give in to temptations.
Everyone is wrong.
A Complex Disease
Type 2 diabetes is a metabolic disease and there is no way to “reverse” it—although it can be put into remission. “It’s not just about insulin and body fat,” says Meghan McLarney, nutritionist and certified diabetes nutrition educator at Nebraska Medicine.
During her rotations as a student, McLarney kept encountering people with a diagnosis of Type 2 diabetes who “felt guilty about the disease,” she says. “The disease and the people are misunderstood. Everybody is blaming each other, but it’s a super-complex disease with a strong genetic component.” She adds that those affected often do not feel supported or get information they need due to assumptions—internal and external—that the disease is uncontrolled because of their eating habits.
“Portion control alone will not fix diabetes,” McLarney says.
While diet is a primary treatment for the disease, it should be individualized to fit the person and their blood sugar management.
“For example, a low-carb diet might be good for a person who only has blood sugar spikes when they eat high-carb meals but it won’t make an impact on blood sugars for a person who has trouble with sugars rising overnight—that person might respond better to weight loss or a daily walk but not see a big benefit from a strict low-carb diet.”
“There is more than one way to treat Type 2 diabetes,” she continues. “And there is not one ‘diabetes diet.’” Recent research suggests that people with Type 2 diabetes may have issues with their brain not receiving the signal quickly enough that they’re full from a meal, causing them to overeat. If that’s the case, it’s not the overeating that causes the Type 2 diabetes, but rather the Type 2 diabetes that causes the overeating.
“It’s part of your DNA,” McLarney says.
Typically, patients receiving a diagnosis of Type 2 diabetes are encouraged to exercise more, eat smaller portions, reduce their intake of sugar and simple carbs, and increase their intake of vegetables and fruit. The goal is to control blood sugar, and while many patients turn to high-protein diets (or even high-fat ones, such as the ketogenic diet), McLarney says that diets “wear people out.”
“Avoid all-or-nothing and instead think long term. Talk to a diabetes educator to make sure any diet you want to try is safe for you.”
McLarney says patients over the age of 40 often find weight loss to be “an uphill battle,” adding “It’s harder to lose weight because our metabolism slows down with age.” Weight loss helps control Type 2 diabetes because it typically involves exercise, which actively uses blood sugar as energy, she explains.
“If someone found a dietary cure for diabetes, I’d be working with those people. It’s not fair to say it’s simple.”
McLarney says that within Type 2 diabetes, there are different “types,” making it impossible to make one blanket dietary suggestion appropriate for all people with the diagnosis. There are eight possible metabolic problems with Type 2 diabetes, called the Ominous Octet. “You might have one of the eight, or you might have all eight,” she says.
For adults over 60, the challenges and risks from diabetes become even greater. McLarney says there are unique factors involved for this age set, and encourages them to seek more frequent assessment of their nutrition and medical care.
“Older adults need the same amount of vitamins, minerals, protein, carbohydrates, fats, and fluids as they did in younger years,” she says. “But overall calorie needs are decreased.” This is why it’s easy to lose muscle mass, strength, and overall nutrition status when trying to lose weight.
McLarney recommends meals that include carbohydrate foods high in nutrients—Greek yogurt, beans, whole grains, low-fat milk, and high-fiber fruits such as strawberries and pears are excellent choices.
Because some medications influence the absorption of vitamin B12, it’s also important to take supplements. Those with vegan and vegetarian diets are especially at risk for a B12 deficiency, so McLarney says regular screenings of B12 status are important.
She adds that depression and mental status changes are more likely in older adults with vitamin deficiencies, as well as older adults with diabetes. For this reason, they should be regularly screened for both.
Another special concern for older adults is hypoglycemia, also known as low blood sugar (defined as any number under 70). Cognitive deficits among older adults have been associated with increased risk of hypoglycemia, and, conversely, severe hypoglycemia has been linked to increased risk of dementia.
McLarney says it’s important to know that a normal part of healthy living is talking with someone about your struggles, and this is especially important with a chronic disease. She says there are programs at the Engage Wellness Center at UNMC for anyone who needs help managing their diabetes.
For her part, McLarney says she takes a holistic view with her patients, asking them about their lifestyles before making recommendations. “It’s a health literacy issue explaining what their role is instead of blaming them. We have to make an effort in healthcare to ask not just how people eat, but how they learn and think.”
Visit unmc.edu/engage for more information.
This article first appeared in the May 2019 edition of 60PLUS in Omaha Magazine. To receive the magazine, click here to subscribe.