Date: Thu, 1 Oct 92 10:54:35 EDT
From: wheeler@super.org (Ferrell S. Wheeler)
To: tms@cs.umd.edu
Subject: PCRM Diabetes



DIET AND DIABETES

     In diabetes, the cells of the body cannot get the sugar they need.
Glucose, a simple sugar, is the body's main fuel. It is present in the
blood, but in diabetics it cannot get into the cells where it is needed.
When diabetes starts in childhood (insulin-dependent diabetes), it is due
to an inadequate supply of insulin, the hormone which ushers sugar into the
cells of the body. Without insulin, the cell membranes keep sugar out. This
form of diabetes is also called Type I or childhood-onset diabetes. When
diabetes begins in adulthood (non-insulin-dependent diabetes), it is not due
to an inadequate supply of insulin. There is plenty of insulin in the blood
stream, but the cells do not respond readily to it. Sugar cannot easily get
into the cells, and it backs up in the blood stream. This form is also
called Type II or adult-onset diabetes. In the short run, diabetics may
experience episodes of labored breathing, vomiting, and dehydration. In the
long run, diabetics are at risk for heart disease, kidney problems,
disorders of vision, and other difficulties. 
     The old approach to diabetes was to focus on eliminating refined sugars
and foods that turned into sugars~starches, breads, fruits, etc.~from the
diet. The rationale was based on the fact that diabetics' urine contains
sugar. Unfortunately, with all of the complex carbohydrates eliminated, fat
and protein are the only things left in the diet. 
     The new approach focuses more attention on fat. Fat is a problem for
diabetics. The more fat there is in the diet, the harder time insulin has
in getting sugar into the cell. Exactly why this occurs is not clear. But
what is clear is that minimizing fat intake and reducing body fat help
insulin do its job much better. Modern diabetic treatment programs
drastically reduce meats, high-fat dairy products, and oils. At the same
time, they increase grains, legumes, and vegetables. One study found that
21 of 23 patients on oral medications and 13 of 17 patients on insulin were
able to get off of their medications after 26 days on a near-vegetarian diet
and exercise program.1 During two- and three-year follow-ups, most diabetics
treated with this regimen have retained their gains.2 The dietary changes
are simple, but profound, and they work. Low-fat, vegetarian diets are ideal
for diabetics.
     There is a second essential component to managing diabetes. Through
regular exercise, the need for insulin injections can often be reduced, and
oral medications often become unnecessary. This holds true not only for
people with non-insulin-dependent diabetes, but also to some extent for
those with insulin-dependent diabetes. Exercising muscles have a voracious
appetite for fuel. When an individual is engaged in regular aerobic
exercise, the sugar is able to enter the cells without the need for as much,
or perhaps any, insulin.
     While people with non-insulin-dependent diabetes can often eliminate
medications when their weight is reduced and foods and exercise are better
controlled, those with insulin-dependent diabetes will always need a source
of insulin. The causes of insulin-dependent diabetes remain elusive. A
recent study implicated cow's milk consumption as a possible contributor.3
When milk consumption patterns were examined across various nations, there
was a very strong correlation with the incidence of insulin-dependent
diabetes. It may be that milk proteins cause an autoimmune reaction in which
the body mistakenly attacks its own insulin-producing cells. Even so, a good
diet and regular exercise can minimize the amount of insulin these diabetics
require. This is especially important given their tendency toward
complications. Heart disease and other blood vessel problems are much more
common in diabetics. So it is doubly important to keep fit and to keep fats
in the diet to a minimum.
     Diabetics are short-changed by the diet most doctors give them. The
typical American Diabetes Association diet is still high in fat. The ADA
diet limits the amount of butter, eggs, and so forth, but it contains about
300 milligrams of cholesterol per day and about 30 percent fat.
     This fact sheet is not intended as a comprehensive program for diabetes.
If you have diabetes, consult your doctor and tailor a program for your
needs. But it is important to recognize that, for many, diabetes is a
disease that need never occur. Most who have it can manage it much better
with a food plan that gets most of its calories from complex carbohydrates
which minimizing fats. At the same time, regular, vigorous exercise helps
insulin to work optimally.

References:

1. Barnard RJ, et al. Plasma glucose and insulin responses to traditional
Pima Indian meals. Am J Clin Nutr 1990;51:416-20.
2. Barnard RJ, et al. Long-term use of a high-complex-carbohydrate, high-
fiber, low-fat diet and exercise in the treatment of NIDDM patients.
Diabetes Care 1983;6(3):268-73.
3. Scott FW. Cow milk and insulin-dependent diabetes mellitus: is there a
relationship? Am J Clin Nutr 1990;51:489-91.

Physicians Committee for Responsible Medicine
P.O. Box 6322
Washington, DC 20015
(202) 686-2210
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