Table of Contents
- 1 With Intermittent Fasting
- 1.1 Diabetes 101
- 1.2 From Prediabetes to Type 2 Diabetes
- 1.3 Conventional Treatment of Type 2 Diabetes
- 1.4 Lifestyle Changes – Diet and Exercise
- 1.5 Conclusion
- 1.6 Share this:
With Intermittent Fasting
April 19, 2016
Type 2 diabetes is generally categorized as a progressive, chronic lifelong condition that affects the way your body metabolizes sugar. http://www.mayoclinic.org/diseases-conditions/type-2-diabetes/home/ovc-20169860 Even though this is true for Type 1 diabetes, is it true for type 2 diabetes? It is quite apparent that the answer is no.
type 2 diabetes is not a chronic and progressive disease and can in most cases be prevented as well as reversed/cured with lifestyle changes alone, with little or no medication, and in particular, with the addition of two powerful aides: intermittent fasting and high intensity interval training (HIIT). We review some of the latest scientific research on type 2 diabetes. We also analyze the benefits of intermittent fasting and how it can help with type 2 diabetes. For a better understanding of high intensity interval training and its significance to type 2 diabetes please refer to: THE BEST EXERCISE FOR TYPE 2 DIABETES PATIENTS.
In simple terms, “diabetes” refers to a condition which results in high levels of sugar in the blood. In type 1 diabetes this happens because of the body’s inability to produce sufficient insulin. In type 2 diabetes it happens because the body becomes resistant to the effects of insulin and eventually can not produce sufficient insulin. Even though they are very different, in both cases the body’s ability to use glucose as fuel is impacted.
Type 1 or “early onset” diabetes is caused by an autoimmune process in the body causing the immune system to destroy the insulin-producing cells in the pancreas. The pancreas is unable to make sufficient insulin. Insulin allows the cells to turn the glucose in the blood into energy. Without sufficient insulin, the glucose builds up in the blood. If left untreated this condition will cause death from a hyperglycemic coma. The condition of type 1 diabetes is manageable with the use of insulin injections, and is also known as “insulin-dependent” diabetes. There is currently no known cure.
Type 2 or “late onset” diabetes is caused because the cells in the skeletal muscle, liver and fat become resistant to insulin and are unable to use it effectively, even though the pancreas is producing generally too much insulin. The pancreas makes more and more insulin to compensate for the inefficiency, but eventually it can not keep up and the glucose builds up in your blood. This condition is both preventable and reversible.
From Prediabetes to Type 2 Diabetes
Prediabetes refers to a condition where blood glucose levels are higher than normal, but not yet high enough to be considered type 2 diabetes. Almost 50 per cent of those with prediabetes develop type 2 diabetes. http://www.diabetes.ca/about-diabetes/prediabetes
Prediabetes and type 2 diabetes have become epidemic due to sedentary lifestyles and worsening diets that are too high in sugars and sugar-forming foods such as carbohydrates. According to the World Health Organization, the incidence of diabetes has nearly tripled: from 108 million in 1980 to 422 million in 2014. http://www.who.int/mediacentre/factsheets/fs312/en/
Insulin resistance occurs when there are problems with the insulin receptors on the cell or actions inside the cell; it is like a lock being defective or a door being jammed. Essentially, the insulin receptors become overwhelmed and start breaking down. Not enough glucose is shuttled into the cells, and too much glucose remains in the bloodstream.
Insulin resistance causes the pancreas to compensate by making more and insulin, which leads to hyperinsulinemia – high blood insulin. Type 2 diabetes occurs when the pancreas can no longer compensate by secreting the large amounts of of insulin required to keep blood sugar at normal levels.
Conventional Treatment of Type 2 Diabetes
The conventional approach to treating prediabetes and type 2 diabetes involves several phases. Unfortunately, it is predicated on the mistaken belief that type 2 diabetes is a progressive, chronic lifelong condition.
Patients are first told to change their lifestyle – diet and exercise – to reduce the body’s need for insulin and to lower insulin levels. Because these lifestyle changes are extremely hard to implement and there is generally little support to help patients make the necessary changes, it seldom works.
Healthcare professionals are aware that few patients will make the necessary lifestyle changes and so, right off the bat, some will prescribe, along with lifestyle recommendations, oral medications. Other healthcare professionals will wait until the prescribed lifestyle changes have failed to prescribe the oral medications.
There are currently more than 10 classes of diabetes drugs, each of which aim to lower blood glucose in a different way. The primary goal of these drugs is not to cure/reverse the causes of prediabetes or type 2 diabetes; their goal is to mask/manage the symptoms. They are often prescribed in combination with each other or with insulin therapy. http://www.everydayhealth.com/type-2-diabetes/guide/treatment/
When lifestyle changes and oral medications have failed to manage the symptoms, as they quite often do, it is time for insulin therapy. According to Diabetic Living, between 30 and 40 percent of those with type 2 end up taking insulin therapy.
The primary goal of insulin therapy, like the oral medications, is to manage the symptoms of type 2 diabetes by compensating for the lack of insulin production.
Neither the oral medications nor insulin therapy aim to deal with the primary problem of insulin resistance and do not tackle the underlying causes: hyperinsulinemia and insulin resistance.
Side Effects of Oral Medications and Insulin Therapy
Potential side-effects of some of the most common type 2 diabetes oral medications, include:
- Sulfonylureas: low blood sugar, upset stomach, skin rash or itching, weight gain
- Biguanides/Metformin: sickness with alcohol, kidney complications, upset stomach, tiredness or dizziness, metal taste
- Alpha-glucosidase inhibitors: gas, bloating and diarrhoea
- Thiazolidinediones: weight gain, risk of liver disease, anaemia risk, swelling of legs or ankles,
- Meglitinides: weight gain, low blood sugar http://www.diabetes.co.uk/features/diabetes-medication-side-effects.html
The side-effects of insulin therapy are:
- weight gain
- low blood sugar
- sexual dysfunction
As if this was not bad enough, the newer classes of type 2 diabetes drugs, with names like GLP-1, DPP-4, SLGT2, have even scarier side-effects: pancreatitis, pancreatic cancer, urinary infections, thyroid cancer, gastrointestinal issues, and renal and gallbladder problems. https://www.drugwatch.com/2014/05/12/increasing-side-effects-diabetes-drugs/
When you consider that these drugs are usually prescribed in combination, you really have something to be worried about.
The Big Gun – Weight-Loss Surgery
When drugs have failed to manage/mask the symptoms of type 2 diabetes the medical system’s last resort is weight-loss surgery. There are many types of weight-loss surgery, known collectively as bariatric surgery, with gastric bypass being the most common type. Gastric bypass and other weight-loss surgeries make changes to your digestive system to help you lose weight by limiting how much you can eat, or by reducing the absorption of nutrients, or both. In effect, such procedures produce weight loss the way that diet and exercise, when undertaken conscientiously, would do.
The good news is that weight-loss surgery works for weight loss, and the research shows significant improvements in type 2 diabetes following the surgery. For example, a 2015 observational study which followed 5,225 bariatric patients for one year after surgery found that 62% of the gastric bypass patients improved to the point that they were able stop insulin therapy. http://www.ncbi.nlm.nih.gov/pubmed/25573879
The bad news is that weight-loss surgery comes with lots and lots of potential risks, both of a short-term and long-term nature.
Short-term risks associated with weight-loss surgery include:
- Excessive bleeding
- Adverse reactions to anesthesia
- Blood clots
- Lung or breathing problems
- Leaks in your gastrointestinal system
- Death (rare)
Longer-term risks include:
- Bowel obstruction
- Dumping syndrome, causing diarrhea, nausea or vomiting
- Low blood sugar (hypoglycemia)
- Stomach perforation
- Death (rare)
To sum up, the healthcare system deals with type 2 diabetes with token efforts at lifestyle changes, then puts significant effort into prescribing oral drugs and insulin that aim to manage/mask symptoms. And if that fails, the last resort is surgery, which works quite well to promote weight loss, but comes with a significant risk.
Lifestyle Changes – Diet and Exercise
Given the many risks associated with drugs and surgery, why not give lifestyle changes, diet and exercise a chance? It has been well established that lifestyle changes have a significant impact on the development of type 2 diabetes. Three large randomized controlled studies showed that individuals at risk for developing type 2 diabetes significantly improved their conditions by lifestyle changes alone. Two studies showed a 43% reduction in the development of type 2 diabetes: http://www.ncbi.nlm.nih.gov/pubmed/18502303 http://www.ncbi.nlm.nih.gov/pubmed/17098085
and one study showed a 34% reduction http://www.ncbi.nlm.nih.gov/pubmed/19878986
Intermittent Fasting the Secret Weapon
Given that the primary problem with calorie restriction dieting is that few people will stick with it long term, we are fortunate to have an effective alternative. Fasting in one form or another has been around for as long as humans, sometimes as a consequence of having limited access to food, and sometimes due to religious or spiritual beliefs. It is easy to see that we evolved to be able to function without food for extended periods of time, and it is not hard to argue that fasting may in fact be more “natural” than eating three meals a day “on a schedule”.
Until very recently in human history, sporadic or seasonal access to food was the norm. This explains why our livers and muscles store carbohydrates in the form of glycogen for quick access, and why we can also sustain ourselves for weeks at a time by drawing from our long term reserves: fat.
What is Intermittent Fasting?
Intermittent fasting is a term used to describe various diets that cycle between a period of fasting and non-fasting. It has been “trending” with endorsements from celebrities like Jimmy Kimmel, Benedict Cumberbatch and Hugh Jackman.
Intermittent fasting has been shown to help people not only lose weight as well or better than a low calorie diet, but also to help with many other health issues, such as type 2 diabetes, cancer and heart disease. It is important to remember that intermittent fasting is more a pattern of eating than a diet, and that it is easier to stay on it than a “diet”.
The three most common ways to practice intermittent fasting are:
- The 5:2 method where you fast for two days per week and eat normally during the remaining five days.
- Alternate-day fasting where you eat normally on one day and restrict yourself to 500 calories on the alternate day.
- The 16:8 method where you restrict your meals on a daily basis to eight hours per day by skipping either breakfast or dinner.
Intermittent fasting is easier to adhere to than standard calorie restriction diets for most people. http://www.ncbi.nlm.nih.gov/pubmed/23582559 Most diets fail because people do not follow the diet over the long term. Several studies have found that intermittent fasting is easier to follow than calorie restriction diets. As a result, more people are willing to stick with it and adapt more easily to an intermittent fasting routine. http://www.ncbi.nlm.nih.gov/pubmed/20815899
For example a 2012 observational study of 16 obese individuals found a high degree of compliance and significant weight loss. http://www.ncbi.nlm.nih.gov/pubmed/19793855
Intermittent fasting has been shown to reduce insulin resistance, which leads to a significant reduction in blood sugar levels. http://www.ncbi.nlm.nih.gov/pubmed/24789008 A 2015 study of 20 healthy males found that they not only lost significant weight, but that fasting is in itself sufficient to improve insulin sensitivity in healthy individuals. http://www.ncbi.nlm.nih.gov/pubmed/26155596
A 2014 study of individuals with chronic liver disease found that they lost weight and showed significantly improved symptoms with regard to liver disease. http://www.ncbi.nlm.nih.gov/pubmed/25546434 This is important because liver disease is a leading cause of death in type 2 diabetes. http://care.diabetesjournals.org/content/30/3/734.full
Another way that Intermittent Fasting could affect type two diabetes is its potential for reducing abdominal or visceral fat. This kind of fat is found under the abdominal muscle and around organs such as the intestines, liver and pancreas. It is different from subcutaneous fat, the kind of fat that you can pinch. A 2012 observational study of 732 obese participants concluded that abdominal fat was associated with more than a twofold increased risk of developing type 2 diabetes. http://jama.jamanetwork.com/article.aspx?articleid=1360863
Recently it has been shown that the primary cause of type 2 diabetes is the buildup of visceral fat in the liver and pancreas which prevents normal insulin action and secretion; both of which are reversible with weight loss. Importantly the tolerance of fat within the liver and pancreas varies widely depending on the individual and type 2 diabetes develops only when there is more fat than can be coped with. Fortunately, the reverse is also true and when the fat level drops below the individual threshold the diabetes reverses. http://www.ncl.ac.uk/magres/research/diabetes/reversal.htm
Several animal studies have shown the effectiveness of intermittent fasting for the reduction of visceral fat. http://www.ncbi.nlm.nih.gov/pubmed/23582559 Some preliminary human studies have shown that both calorie restriction diets and intermittent fasting result in weight loss, but that intermittent fasting results in a greater percentage loss of visceral fat. http://www.ncbi.nlm.nih.gov/pubmed/24993615
Oral medications and insulin therapy are effective to manage/mask the symptoms of type 2 diabetes but do little else. At best they are a stop gap measure and have numerous health risks. Weight-loss surgery helps in many cases, but also comes with numerous health risks.
Without question, lifestyle changes (diet in particular) work to prevent, reverse and cure type 2 diabetes. Unfortunately very few people are able to implement the required changes.
Intermittent fasting is helpful for people who are at risk of developing type 2 diabetes because it reduces insulin resistance and lowers blood sugar levels. Intermittent fasting is also a powerful weight loss tool because it helps you eat fewer calories, boosts your metabolism, and as a result is effective in losing weight and particularly belly fat, which is a significant factor in reversing type 2 diabetes.
Intermittent fasting is a relatively simple strategy to lose weight and maintain muscle mass because it requires very little behavioural change. This means intermittent fasting is simple enough that you will actually do it, and effective enough that it will make a difference.
Intermittent fasting or any lifestyle change should not be undertaken without first consulting with your healthcare providers.