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Of all the illnesses in industrial society, diabetes takes the greatest toll. Over 100,000 people die from complications of diabetes each year. Another million lose quality of life due to metabolic syndrome. Diabetes adds $246 billion to the annual cost of healthcare in the U.S. Yet diabetes remains avoidable, treatable, and reversible.
Diabetes matters. One in three children born today is projected to develop the condition, based on current trends.[i] This condition already afflicts over a quarter of a billion people worldwide, including 25 million Americans. Within the U.S., insulin resistance and prediabetes (also known as metabolic syndrome and syndrome X) affect another 79 million adults.[ii] Accelerated rates of heart, vascular, and brain diseases, cancer, vision loss, impotence, and amputations are among diabetes-induced complications. Of every three people with diabetes, two will die early of heart disease or a stroke. Today, diabetes is the major cause of heart disease & stroke as well as being the seventh most common cause of death ii and yet, diabetes is both preventable and treatable, as detailed in this article.
Diabetes epidemiology confirms that millions of people are overfed yet undernourished, overstimulated and underactive, overstressed and underadapted. Ironically, diabetes is "famine in the midst of feast."
In essence, diabetes is a defect in converting blood sugar into energy. The defect in type 1 diabetes is due to a failure of insulin production by the pancreas, the endocrine gland that is also the source of digestive enzymes. In Type 2 diabetes, the defect is due to an abnormal response to insulin, in which the cells of the body are unable to take up the glucose they need for basic metabolic functions. This causes high levels of blood sugar that cannot be used effectively. In both types, impaired glucose uptake occurs, although the mechanisms are different.
In this article, we'll look at some less appreciated antecedent or causal factors in diabetes, including:
- Acid-forming diets and other causes of cellular metabolic acidosis
- Delayed allergies (hypersensitivities) that burden immune and repair systems
- Glycemic load as an effective measure of how foods affect blood sugar
Acid-Alkaline Balance and Diabetes
Research at the Health Studies Collegium indicates that acid-forming diets have a key role in chronic and autoimmune illness, including diabetes. Over the past two decades, studies from our group have defined our approach to acid-alkaline balance and confirmed great promise through application of the Alkaline Way.
The Alkaline Way is a comprehensive program that encompasses what people eat and drink, think and do. While the primary focus in this article is on dietary aspects of the program, this approach also includes stress management and restorative physical activity, meaningful work, healthy relationships, and engagement with the community and environment. We have found that the more stress an individual experiences, the greater the body's immune burden and metabolic acid production.
Diet is another major source of metabolic acidity. When the diet provides insufficient minerals to buffer metabolic acids, the alkaline reserves of the cells can be gradually depleted, often over decades.[iii][iv] Buffering-mineral deficits can result in chronic intracellular metabolic acidosis. Excess cell acid shuts down energy production and impairs the ability to safely remove toxins from the cell.
Acid-forming diets are those with more than 25 percent of calories from fat and more than 75 grams of total daily protein intake[v]. When fat and protein intake increases above the body's needs, there is a reduction in both dietary fiber and essential nutrients.[vi] This leads to a state of being overfed and undernourished.
The Alkaline Way approach to nutrition is designed to neutralize the extra metabolic acids produced in the body daily, by providing adequate levels of minerals and other biochemical buffers. A metabolically alkaline diet is composed of foods that have a buffering effect on cellular chemistry.[vii] This can be different from the food's ash residue chemistry.[viii] For example, citrus fruits are alkalinizing because the process of metabolizing them generates more than twice as much bicarbonate buffer as there is acid in the food.[ix] This means that citrus fruit and similar foods are acidic before consumption, yet alkaline-forming in the body.
Our approach includes a health-promoting, nutrient-dense, and fiber-rich diet along with targeted supplementation, based on the needs of the individual.[x] Priority is given to locally vine-ripened, organic, or biodynamic sources of foods. Mineral-rich 'hard' water and herbal beverages made with this water complete the program.
Metabolic Acidosis Precedes Prediabetes
A recent Japanese study addressed the question of optimal diet. Researchers at the National Institute of Health and Nutrition in Tokyo traced the effects of metabolic acidosis on cardiovascular and metabolic risks.[xi] The study assessed the health of more than 1,000 female Japanese dietetic students 18 to 22 years of age, and found that a high intake of protein and low levels of minerals resulted in metabolic acidosis. The research reported that acid-forming diets were associated with an increase in cardiometabolic risks due to:
- Elevated blood pressure
- Elevated total cholesterol and LDL cholesterol
- Increased body-mass index (BMI) and waist circumference
These markers are also among the top five risk factors for prediabetes. This implicates an acid-forming diet as a primary cause of prediabetes. Doctors now track prediabetic insulin resistance with five related criteria: high blood sugar (hyperglycemia), visceral obesity (based on height-to-waist ratio, with a BMI of 30 or above considered obese), elevated triglycerides, low HDL cholesterol, and high blood pressure. Each of these criteria is also a risk factor for cancer.[xii]
Self-Testing for Alkaline Status
Metabolic acidosis indicates a lack of minerals such as potassium, magnesium, and zinc, which are needed to buffer and safely remove excess acids from the body. As mineral stores are depleted, risk of damage to the kidneys and urinary tract increases.
At night, while we sleep, the body routinely concentrates excess acids for excretion.[xiii] This capacity varies based on toxin load and individual ability to produce energy and inactivate and excrete toxins.[xiv] You can track your own acid-alkaline status using special, color-reactive test strips. Using this test to assess the first urine of the morning provides a surprisingly good measure of metabolic acidosis, the body's mineral reserves, and its acid/alkaline state.[xv] Only the first urine after six or more hours of rest is useful in measuring metabolic acidosis risk. At all other times, there are numerous influences on urine pH—including the degree and intensity of mental or physical work, as well as dietary factors—that affect the relevance of the outcome.[xvi]
Use only high-sensitivity pH 5.5-8.5 test strips. A value of 7.0 indicates neutrality, neither acid nor alkaline.[xvii] Healthy first morning urine pH should be in the range of 6.5 to 7.5.ix Values below that range are considered acidic, and values above it are alkaline. A neutral or slightly acidic urine pH after rest indicates that the overall cellular pH is appropriately alkaline because the small amounts of metabolic acids have been concentrated for easy excretion.
Allergies, Sensitivities, and Diabetes
Allergies are potentially another underlying factor in diabetes. Both acute allergies and delayed allergies (hypersensitivities) describe possible immune responses to specific foods, chemicals, or contaminants. For decades, the conventional approach to allergy has focused on immediate allergic reactions, which are triggered by immunoglobulin E (IgE) antibodies (think E for emergency). These antibodies are a form of "ammunition" that our bodies use when needed to protect us against microbes and allergens.
IgE antibody reactions can trigger a harmless case of hives or life-threatening anaphylactic shock. Eight types of food account for over 90 percent of these immediate, intense IgE-mediated allergic reactions—milk, eggs, peanuts, tree nuts, fish, shellfish, soy, and wheat.[xviii] A recent study in the U.S. showed an 18 percent rise in the prevalence of food allergies in children in the decade from 1990 to 2000.[xix] These immune reactions increase the metabolic acids produced in the body.
Within integrative medicine, doctors have also focused on the role that delayed hypersensitivities can play in chronic health issues. Typically, these sensitivities are caused by immunoglobulin G (IgG) reactions. Plasma cells are the antibody factories that produce short-term (IgM), long-term (IgG), and mucosal (IgA) antibodies. Long-term antibody memory may be protective and helpful, or reactive and harmful, depending on the individual's state. When we are healthy, our homeostatic, self-rebalancing mechanisms induce beneficial, neutralizing antibodies. When we are distressed, harmful, symptom-provoking antibodies can form.
Delayed sensitivities tend to increase the level of repair deficit within the body, resulting in higher levels of inflammation. This contributes to such diverse conditions as joint diseases, eczema, and digestive disorders. Since these reactions are delayed, the symptoms only become apparent hours to weeks after exposure. Consequently, it is difficult (and nearly impossible at times) to identify reactive substances based on history alone.
Testing for allergies varies with the type of antibody and the specific allergens that are being targeted. IgE antibodies relate to acute histaminic reactions, while IgG antibodies carry long-term memory of delayed immune reactions. IgG antibody tests measure the presence or absence of antibodies. However, these tests do not distinguish helpful from harmful antibodies. Newer, more predictive tests, such as lymphocyte response assays (LRAs), are recommended because they detect only reactive antibodies, which indicate a true burden on the immune system. The LRAs by ELISA/ACT are a breakthrough in functional testing for delayed allergic reactions because they target several different types of immune reactions that cannot be distinguished by standard antibody detection systems—antibodies, immune complexes, and direct T-lymphocyte responses.
Delayed Allergies and Diabetes
A study by the Health Studies Collegium evaluated the association between diabetes and sensitivities to foods and environmental allergens. When both insulin resistance and hypersensitivity develop, there is a major increase in the burden on the immune defense systems, as well as excess metabolic acid production. To evaluate stress on the immune system, participants were given an LRA by ELISA/ACT[xx] to identify reactivity to more than 400 substances. This testing has a greater than 97 percent reliability and reproducibility in blind split-sample tests.[xxi]
The study involved 27 participants with type 1 diabetes and 26 with type 2. In each group, half the patients were randomly selected to receive testing for delayed sensitivities. The controls for each group received no testing, but were provided with conventional diabetes nutritional counseling and asked to avoid a certain number of foods (without any specific knowledge of foods to which they might be reactive).
Once participants in the test group received the results of their evaluations for food and chemical causes of sensitivity, they were coached on how to develop a hypoallergenic, repair-stimulating, nutrient-rich diet. The diet was individualized to the needs of each participant. This meant eating a wide variety of whole foods, according to their preference, selected from foods shown to be non-reactive in their test. About 80 percent of the volume of food consumed consisted of alkaline-forming fruits, vegetables, and whole grains (see Figure 1).
Figure 1. Food and chemical effects on acid/alkaline body chemical balance [about here]
Intervention. For the group receiving antigen testing, support group meetings were held biweekly with qualified nutritionists who provided ongoing guidance to help participants implement their individualized nutrition plans. Supplements included antioxidants, vitamins, minerals, and essential cofactors.[xxii] Participants were also counseled on avoiding exposure to unusual or hidden sources of antigens from foods or environmental chemicals to which they were found reactive.
Control subjects attended separate support groups in which the nutritionists provided guidance consistent with American Diabetes Association (ADA) guidelines for controlling sugar consumption. Long-term glycemic control was assessed over the six-month study period in both groups, using a blood test for hemoglobin A1c (HbA1c) levels, a primary marker of diabetes.
Reactions. In most cases, antigen testing showed more reactivity in type 1 than in type 2 diabetics (see Figure 2). The single most common type of immune reactant was pasteurized cow's milk dairy products, which induced hypersensitivity in 69 percent of type 2 and 28 percent of type 1 diabetics. Food additives and environmental chemicals were other major causes of immune burden.
Figure 2. Delayed allergies in individuals with type 1 and type 2 diabetes.
(Evaluation by LRA from ELISA/ACT Laboratories at www.BetterLabTestsNow.com)
Type 1 Diabetics
- 11 of 14 type 1 diabetes test subjects reduced their HbA1c levels, thus achieving a level acceptable to the American Diabetes Association.
- Importantly, 6 of 14 type 1 test subjects had a reduction in HbA1c levels that was greater than 1 mg/dl, while only 3 of 11 control subjects had this degree of reduction.
Type 2 Diabetics
- The fall in average HbA1c levels was significant among type 2 diabetics—a more than 13 percent decrease vs. a less than 3 percent decrease in control subjects.
- Average insulin levels were reduced by 18 percent in test subjects compared with 12 percent in controls.
Food for Thought
Reactive foods and chemicals play a role in sustaining diabetes by triggering a chronically distressed immune state.[xxiii] Our finding of much higher immune reactivity to pasteurized cow's milk products among type 2 diabetics than among controls is of interest. A number of studies have reported an association between pasteurized milk consumption and insulin resistance.[xxiv],[xxv] Synthetic bovine hormones, commonly found in commercial milk, are an additional, separate risk factor.[xxvi]
In this study, we found that immune control was improved by reducing the immune load for the individual, providing sufficient nutrients, and reducing neurohormonal distress (by eliminating allergens such as cow's milk).
Rationale for a Non-Reactive Diet
Given the addictive properties of allergenic foods, testing for sensitivities becomes doubly important. With allergic reactions and sensitivities, an almost immediate sense of relief is experienced when an allergenic food is consumed, because the symptom-provoking antibodies are neutralized temporarily by the uptake of digestive antigens. Without specific awareness of delayed sensitivities, the individual may continue to regularly consume reactive foods. When people react to gluten or any fraction in wheat flour, the immune and metabolic consequences often cause spikes and dips in blood sugar.[xxvii],[xxviii] Diabetes and celiac disease are found in the same person more often than would be suggested by chance occurrence. Both often include autoimmune responses to gluten-containing grains, including wheat, barley, oats, kamut, teff, spelt, and rye, although the glutens in each grain are immunologically distinct.
One of the variables in these sensitivities is intestinal permeability (also known as leaky gut syndrome). Hyperpermeability is often due to maldigestion and repair deficits, and is now frequently linked to diabetes. Minimizing dietary allergens is an important step in reducing intestinal hyperpermeability through enhanced immune defenses and repair mechanisms.
Glycemic Load rather than Glycemic Index
A third important factor in diabetes is the level of carbohydrates in the diet. High-carb diets have been linked to diabetes in numerous studies, including research from the Harvard School of Public Health. Walter Willett and his team reviewed data from three major studies that lasted over five years and involved more than 150,000 health professionals.[xxix] The foods most predictive of diabetes in all the studies were refined carbohydrates—white bread, white rice, French fried potatoes, and sweetened carbonated beverages. These simple carbohydrates break down quickly and release glucose rapidly into the bloodstream without the nutrients needed to metabolize them, causing large fluctuations in blood sugar. Complex carbohydrates are broken down slowly during metabolism, providing the steady release of glucose without a rapid change in blood sugar levels.
The glycemic index (GI) is a measure of the effects of carbohydrates on blood sugar levels. All foods that cause a rapid rise in blood sugar levels have a high glycemic rating. In addition, the GI often reflects the nutritional value of food. Refined foods typically have a higher rating on the GI, and tend to be less nutrient dense, since the nutrients have been stripped away in the process of refining.
A GI rating of 70 or more is considered high, 56 to 69 is medium, and 55 or less is low. Comparing the glycemic ratings of foods in their natural state with those of the same foods after processing offers a series of nutrition snapshots. For example, corn flakes have an average glycemic rating of 81, while cooked sweet corn has an average rating of 52. Likewise, the rating for instant mashed potatoes is 87, while the rating for new potatoes is 54.[xxx] A healthier diet includes foods that have GI ratings of 55 or less. Foods that have lower GI ratings are described as "insulin sparing," because they raise blood sugar gradually and therefore require less insulin to process.
A major limitation of the index is the wide variability in reported food values across cultures and from one research team to the next. In addition, the degree to which a specific food raises blood sugar may vary from person to person, depending on the degree and type of immune reactivity. An example of this confusion is reflected in a series of articles on the glycemic index published by an Australian research team.[xxxi] In 2008, they took on the daunting task of correlating all the data on the index into a single set of guidelines.xxix Although the glycemic index they compiled was theoretically helpful, some of their findings were diametrically opposed to other research findings over the past several decades. For example, the tables developed by these researchers gave high ratings for whole grain wheat products and low ratings for refined pasta, the opposite of earlier versions of the index. The authors offered no explanation for this change. Their finding was in contrast to a large study from the Harvard School of Public Health, which reported that people who ate whole grains were 25 percent less likely to develop diabetes.[xxxii]
Another limitation is that the GI is most applicable to whole foods. It becomes less useful and even confusing when applied to processed foods and beverages. In addition, the index does not take into account portion size. Large servings of a food low on the index can represent a large glycemic load, indicating demand for insulin.
The glycemic load (GL) is a more advanced method of assessing the impact of carbohydrate consumption. GL takes the glycemic index into account but provides a fuller picture of what goes on in the body.[xxxiii] A GI value indicates how rapidly a particular food turns into sugar. In contrast, the GL includes how much of that food is being consumed, as well as what proportion is complex carbohydrates and how much is simple sugars. This provides a better prediction of blood sugar levels and metabolic stress from the food.[xxxiv] A GL of 20 or more is considered high, 11 to 19 medium, and 10 or less low. Foods with a GL of less than 10 are recommended. Foods with a GL above 20 should be avoided.
The Role of Fiber
Important and frequently overlooked, dietary fiber is also key to blood sugar management. Preferred fibers are unprocessed and comprised of 80 percent soluble or fermentable fiber and 20 percent insoluble or viscous fiber. The density of fiber-rich foods slows sugar release into the bloodstream. Thus, dietary fiber helps keep blood sugar levels constant. Good sources of carbohydrate with low GL ratings and high soluble and insoluble fiber content include dried peas, beans, and lentils. Fresh, low-starch vegetables that are ample sources of fiber include green beans, asparagus, most leafy greens, and cruciferous plants such as broccoli, Brussels sprouts, and cabbage. These foods lower blood sugar levels, improve insulin response, promote weight loss, and improve blood lipid levels. A low glycemic diet can also support measurable improvement in markers of inflammation such as high sensitivity C-reactive protein (hsCRP). These factors are all associated with lower risk of diabetes and cardiovascular disease.[xxxv]
Foods high in fiber also tend to provide more magnesium and antioxidants. Oat bran flour and barley are good examples of foods high in beta-glucan fibers. Beta-glucans are specialized complex carbohydrates that improve sugar and insulin responses in diabetics.
Most people can benefit from increased dietary fiber to improve digestive transit and to reduce cardiovascular and cancer risks through improved glycemic response. Elevated blood sugar decreases available repair factors. This leads to what is known as systemic inflammation, which can gradually damage blood vessels, increasing the risk of cardiovascular disease. A high-GL diet also promotes weight gain, typically increasing fat tissue around the midsection (belly fat). Belly fat can produce harmful estrogens that are associated with higher cancer risk.
The standard American diet tends to promote metabolic acidosis. This increases the level of acidity in our cells due to a corresponding insufficiency of minerals. The evidence is increasingly clear that acid-forming lifestyles induce degenerative, autoimmune, and chronic conditions. It is equally clear that a nutrient-rich Alkaline Way program is associated with increased resilience, health, and vitality.
Of all the illnesses in industrial society, diabetes takes the greatest toll. Over 100,000 people die from complications of diabetes each year. Another million lose quality of life due to metabolic syndrome. Diabetes adds $246 billion to the annual cost of healthcare in the U.S.1 Yet diabetes remains avoidable, treatable, and reversible. In an era with greater availability of nutrient-rich, organic, and biodynamically grown foods, it has become easier to choose "healthy" low-GL foods. The approach discussed here can effectively address both causes and effects of metabolic syndrome and diabetes.
About the Author
Russell Jaffe, MD, PhD, received his MD (with Senior Thesis Honors), and PhD in biochemistry and physiology from Boston University. He has held a United States Public Health Service Officer Commission and has served on the permanent senior staff of the NIH Clinical Pathology Department. He is board certified in both clinical pathology and chemical pathology. Dr. Jaffe is a Fellow of the Health Studies Collegium and Director of ELISA/ACT Biotechnologies, LLC, and PERQUE, LLC, in Ashburn, Virginia. He may be reached at 800-525-7372 x 5101 and by email at clientservices@ELISAACT.com or rjaffe@PERQUE.com.
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