World Diabetes Day: The role of an LCHF lifestyle in proper diabetes management
The Noakes Foundation is pleased to recognise World Diabetes Day this year and to create awareness surrounding diabetes management, while supporting under-resourced communities in the process by empowering them through nutritional education programmes to eat better, to get better. Though this is not a day of celebration amidst the festive season.
Diabetes has been likened to that of an epidemic, and rightfully so. The World Health Organisation (WHO) has recorded that the global prevalence of both diabetes type 1 and type 2 rose from 108 million people in 1980 to 422 million in 2014. They further stated that diabetes incidences have been rising at a rapid rate in low and middle-income countries, while high income countries are less affected. It has been projected that by 2045 at least 700 million people will be living with diabetes. Unfortunately, a large number of individuals will not be aware of their diabetic status, which puts them at a greater risk of developing a number of adverse health conditions associated with diabetes.
The festive season is upon us, and with that the idea of gorging on all the fantastically prepared family meals and treats, as required by tradition. You may be thinking “I’ve been good all year, I can treat myself to sugary delights and carb-heavy goodies galore!”, but one should remember that diet plays a huge role in the management and control of diabetes. There has been a constant debate over the diet of diabetic patients, yet there is currently more talk about the issue and no real answers from the greater scientific community and governments. So, why are we not seeing more light being shed on the topic of diet when it is obviously very important?
Historically, one of the first recorded cases of diabetes mellitus (DM) was discovered in an Egyptian manuscript dating back 3000 years, thus putting DM among the oldest diseases known to mankind. Diabetes first got its name around 81-133AD from Araetus of Cappodocia, an ancient Greek physician. By 1675 the sweet smell in the blood and urine of patients was noted and Mellitus, meaning honey sweet, was added to the name by English-born Dr Thomas Willis. It was only many years later that a distinction between Type 1 and Type 2 diabetes was established. In 1936 it became clear that Type 1 and Type 2 diabetes were different to one another and should therefore be treated differently. Research and awareness surrounding the disease has increased tremendously since its first discovery, and the steady march to a cure is still ongoing.
Although there is no current cure, there are a number of lifestyle changes that one can adopt to manage the symptoms and possible complications that could arise due to the disease. One prominent method is to adopt a healthy diet and to exercise regularly. Generally, a diet low in carbohydrates and sugar has been promoted for the control of blood glucose levels in Type 2 diabetes mellitus (T2DM) patients as carbohydrates are primarily recognised as the main macronutrient responsible for increasing blood glucose levels. Still, so many diabetic patients are hooked to carbohydrates and are pushed to take diabetic medicine to manage their symptoms rather than creating a healthy diabetic strategy to control, or reverse, the disease. By only taking diabetic medicine and neglecting diet and exercise, the patient is still at a higher risk of developing long-term health complications, such as high blood pressure, cardiovascular disease, nerve damage and Alzheimer’s disease. Unless dietary modification and regular physical activity is seriously considered as a conventional method to improve symptoms, diabetes symptoms will worsen and the risk for other complications will increase. Unfortunately, many medical professionals are apprehensive to promote an LCHF diet in their practises. It is currently standard practice for physicians to first administer antidiabetic medication and send patients on their way home, and not support patients in healing their underlying conditions that can contribute to further problems with other more innate means, such as diet and exercise.
Jayne Bullen (COO of The Noakes Foundation, MD of Nutrition Network, Co-founder of Eat Better South Africa) says “The current consensus that diabetes is a progressive and, in effect, terminal disease is the biggest ethical injustice of our time! It is one that we owe our children to address actively so they do not suffer from the same degree of misinformation and are not dished out a life trajectory of pharmaceutical treatment for a dietary problem.”
Diet has been a controversial and much discussed topic when it comes to diabetes. A possible reason for the ongoing debate is that there is limited research available as to the amounts of the main macronutrients, carbohydrates, protein and fat, needed and the type of fat that should be consumed by a diabetic individual. The latter being poorly understood at this point in time.
A community-based study conducted in 2020 saw to investigate the effects of a low carbohydrate, high fat diet in participants already diagnosed with T2DM. The researchers observed how a LCHF diet may influence the glycemic control and body weight of participants over a 3 month period. The cohort study was conducted using 124 participants. Those involved were split up, where 49 individuals were prescribed an LCHF diet and were of similar age (57.3±10.2 years) and were considered overweight (characterized as a BMI≥25 kg/m2). The LCHF group was compared to a usual care (UC) group of 75 individuals, which were of similar age to one another (63.1±10.9 years). The UC group were encouraged to consume a normal diet and to continue with their prescribed diabetic care medication. The participants in the LCHF group were advised by the primary endocrinologist to discontinue the use of sulfonylurea drugs, a common class of antidiabetic drugs used to increase the secretion of insulin from pancreatic beta cells, if in use, and to lessen insulin doses by 30%–50% to prevent the occurrence of hyperinsulinemia. The LCHF diet that was approved consisted of unprocessed meats, poultry, fish, eggs, low-carb nuts, seeds, non-starchy vegetables, high fat dairy and healthy fats. However, they were asked to consume no more than 20 g of carbohydrates per day, 20%–25% of total calories of protein and the recommended fat intake of 65%–70% of total calories per day. Participants were not restricted to the amount of calories consumed in a day, but asked to eat only when feeling hungry. The previous recommended dietary allowances were described in Hallberg et al.
During the study participants attended 4 different visits, whereby HbA1c levels, weight, lipid profile and fasting glucose were recorded. Upon conclusion of the study it was observed that the LCHF group lost significantly more weight than those in the UC group. There was an average change of −12.3 kg (p<0.001) from baseline within the LCHF group by the end of the program, yet the UC group actually increased in average weight by 0.5 kg (p=0.4) from baseline. Thus, the LCHF group saw a reduction of 11.9% total body fat by the end of the study. There was a radical reduction in HbA1c levels in the LCHF group when recording their results during the second visit, but remained fairly stable thereafter. By the end of the study the LCHF group had a mean HbA1c of 6.67% compared with a mean HbA1c of 7.8% in the UC group. Furthermore, there was a reduction in overall serum triglyceride levels, the LCHF group showed a significant reduction of −25.61±7.96 mg/mL, while the UC group showed quite the increase of +18.41±159.84 mg/mL. Once the study had concluded it was remarkably recorded that all of the patients in the LCHF group could either stop insulin treatment altogether (36.8%) or decrease the amount needed (63.2%) from baseline. However, only 5.1% of the UC group could cease insulin treatment and 8.1% were able to decrease the amount needed by the end of the study.
Eat Better South Africa (EBSA), the community outreach branch of The Noakes Foundation, along with PhD researcher, Georgina Pujol-Busquet, sought to ascertain the Effect of a low-carbohydrate nutrition education program on dietary choices and metabolic health in women from low-income South African communities. You can read more about the subject on the EBSA website here.
The Nutrition Network has recently introduced an interesting elective module offering, Diabetes Reversal, which will specifically focus on how Type 1 & 2 Diabetes may be successfully managed and, in the case of Type 2 Diabetes (T2DM), reversed using a Low Carbohydrate High Fat (LCHF) or ketogenic diet. The Nutrition Networks utilizes their extensive LCHF-friendly practitioners and network of lecturers, including NN Chief Medical Director Professor Tim Noakes, NN Medical Directors Dr Neville Wellington, Dr Hassina Kajee, and Dr Mark Cucuzzella, with a professor from West Virginia University School of Medicine, to bring you a comprehensive learning experience that focuses on the most current research available, analysis, and practical skills that already exist in the area of LCHF and the implementation of these strategies into clinical practices to aid patients in the management and treatment of diabetes. It is in the hope that through this module practitioners will gain the expertise necessary to confidently promote and prescribe the LCHF diet to help their patients thrive in the face of an otherwise devastating disease. You can read more about the Diabetes Reversal course by following the link.
The current research available is indicative of the relationship between diet and diabetes and should be considered as a forefront method in managing the symptoms and onset of the disease. Antidiabetic medication should only be incorporated as a last and necessary resort to manage symptoms of the disease should the patient be of high risk, and only be considered once healthy lifestyle choices have been practised. Prof Noakes has been quoted in saying “The key point is that the progressive decline of physiological and metabolic function is reversed. That’s what is important.” It is essential to prevent the further decline in normal bodily processes in diabetic patients in order to prolong life expectancy and reduce the occurrence of premature death in patients. It has been observed that a diet high in healthy fats and low in carbohydrates and sugars has a positive effect on the overall metabolic profile of diabetic individuals. By incorporating foods such as unprocessed meat, poultry, full fat dairy and non-starchy vegetables into your diet you can significantly decrease your risk of developing pre-diabetes or diabetes.
Ahmed, A. M. (2002). History of diabetes mellitus. Retrieved from Semantic Scholar: https://www.semanticscholar.org/paper/History-of-diabetes-mellitus.-Ahmed/c7a8108c08346f6fb68e6f83e628d9b484bb050f?p2df
Ahmed, S.R., Bellamkonda, S., Zilbermint, M. , Wang, J. & Kalyan, R.R. (2020). Effects of the low carbohydrate, high fat diet on glycemic control and body weight in patients with type 2 diabetes: experience from a community-based cohort, (2020, November 13) BMJ Open Diabetes Research and Care. Retrieved from BMJ Journals: https://drc.bmj.com/content/8/1/e000980
Diabetes. (2020, June 8). Retrieved from World Health Organisation: https://www.who.int/news-room/fact-sheets/detail/diabetes#:~:text=The%20global%20prevalence%20of%20diabetes,than%20in%20high%2Dincome%20countries
Mukhopadhyay, P. D. (2017, July 11). Low-Carbohydrate High-Fat (LCHF) Diet:Evidence of Its Benefits.Retrieved from Intech Open: https://www.intechopen.com/books/diabetes-food-plan/low-carbohydrate-high-fat-lchf-diet-evidence-of-its-benefits
Saeedi, P., Petersohn, I., Salpea, P., Malanda, B., Karuranga, S., Unwin, N., Colagiuri, S., Guariguata, L., Motala, A.A., Ogurtsova, K., Shaw, J.E., Bright, D. & Williams, R. (2019). Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition, Diabetes Research and Clinical Practice, Volume 157.
The Noakes Foundation weighs in: Type 2 Diabetes is a disease that is reversible through sustained carbohydrate restriction. (2020, February 28). Retrieved from The Noakes Foundation:https://thenoakesfoundation.org/uncategorized/the-noakes-foundation-weighs-in-type-2-diabetes-is-a-disease-that-is-reversible-through-sustained-carbohydrate-restriction
About the author
Shannon Mace has a BSc degree in Human Life Sciences from Stellenbosch University, she majored in biochemistry and physiology. She has a keen interest in metabolic physiology and hopes to further her studies in the subject. Shannon has joined The Noakes Foundation as a researcher, as well as an administrator. She looks forward to helping the foundation promote healthier living and happier lifestyles.