Complications of Diabetes and Fostering Lifestyle Change

Type II diabetes is a lifestyle oriented condition which, in many cases, is tied directly to obesity, poor dietary choices, and lack of exercise. While there are pharmaceutical treatments available, they do not offset many of the complications of diabetes nor do they foster proper lifestyle changes which can eliminate the need for medications. Acupuncture, herbal medicine, and other alternatives are used extensively in the treatment and management of diabetes and related complications. With diabetes rates rising, however, and the immense personal suffering and expense from complications there is a responsibility among practitioners to communicate the importance of the changes and commitments the patient will have to make to maintain their health.

In my clinic, I often have patients come in and when they check diabetes on the intake form I ask them about it. They will often say, “well I 'had' diabetes”, but now I take medicine and it is “fine” or “under control” - or even “I don't have it anymore.” Unfortunately it is not that easy and that mindset is a product of poor understanding of the condition and of western doctors prescribing medications too early in the process without working with the patient to make appropriate changes. Dr. Rob Andrew recently quoted in the BBC News story about a diabetes study he spearheaded had this to say:
 

“there is quite clear guidance that says when you're first diagnosed, you should have the opportunity to concentrate on lifestyle, then if that doesn't work the next stage is medication.”

What his study saw, however, was that over 1 in 3 people were found to be put on medication nearly immediately after being diagnosed. The argument for this by many physicians is that people will not make the required changes. Well the truth is that even when they are on medication the majority of people will still need to make the lifestyle and dietary changes to work with the medications effectively and to avoid complications. Because of our role as CAM practitioners who generally spend more time with our patients and communicate information at this level, we share some responsibility for communicating the need for lifestyle change.

As we know, the end stages of advanced diabetes are not good and many patients do not understand this well. Accordingly, their impetus to adjust their lifestyles and diet is not present. Even with medication, complications are still prevalent and many of them, unfortunately, are irreversible after a certain amount of damage has been done.

What Are The Complications of Diabetes?

Heart and Blood Vessel Disease (stroke, heart attack, etc.)
Vision Loss (partial to total blindness possible)
Kidney Failure (possibly requiring lifetime dialysis, or a kidney transplant)
Foot Problems (painful neuropathy, loss of limbs possible)

As practitioners we work with tools such as acupuncture, herbal medicine, tai chi, etc. that have all been shown in clinical practice and within medical studies to help treat and manage diabetes and all related complications. Dietary guidance is important and while we have our recommendations with food-grade herbs and items drawn from TCM dietary theory to help balance the stomach/spleen systems, patients should also be consulted to see a registered dietitian (which are widely available and most often covered under insurance). With our current world of processed and packaged foods there are many hidden calories, fats, and sugars that people are completely unaware of.

What Should We Be Recommending?

Eliminate Soda Drinks

Because soda drinking is so prevalent and so harmful from a health perspective, we usually start with counseling patients to eliminate soda drinks from the persons diet. When we say this to patients in our clinic many inevitably say “well I switched to 'diet' soda” so I'm ok there. We feel, and as various studies have confirmed, that these are worse for people than the non-diet versions. A study published in diabetes care journal comprised of 6800 men and women aged 45-84 years found that those who drank diet soda at least once a day had a 36% greater relative risk for incident metabolic syndrome and a 67% greater relative risk for incident type 2 diabetes vs nondiet soda drinkers. The researchers couldn't say why, but the evidence was clear. We know from a Chinese Medicine perspective too much of the sweet flavor will damage the stomach/spleen system and contribute to diabetes. From a chemistry perspective the sweet chemistry (i.e. not real sugar) in these drinks appears to disrupt the insulin response damaging the bodies natural ability to work with natural sugar substances. Ultimately, the evidence is clear enough that patients should be counseled to stay away from soda.

Dietary Change

A good study to look at dietary influences on diabetes, and many other conditions, is the “Norfolk Study.” This study was conducted with residents in Norfolk, England aged 40-79 years over a period of 4 years. It looked at a variety of lifestyle and dietary issues to try to find what the most common causes were for the development of diabetes. In short, they found that an energy dense diet predicted diabetes more than all the other factors together - medical/family history, poor lifestyle choices, smoking, alcohol, etc. They found that those who were least likely to develop diabetes consumed significantly more fruit, vegetables, and alcohol, and less meat, soft drinks, and a lower percentage of energy from fat.

In our clinic we counsel people on what we call our “eat like a human diet” (previous article here). In general if people eat a range of whole foods, smaller amounts of higher quality meats, avoid processed foods and concentrated sugars, and go for a 20 minute walk every day they will do as well as they can. For all the millions of books and articles, this appears to be good straightfoward advice.

Exercise

Along with dietary change people will need to exercise. A simple walking program is a good place for many to start with and is easy to incorporate. As practitioners you might even consider starting a walking group in your area. As an acupuncturist and Tai Chi instructor, I am partial to recommending Tai Chi and/or Qi Gong to many patients. Tai Chi is more than just “exercise” it appears – this based on the number of health promoting effects that have been shown time and time again in clinical research. For diabetes one study showed that Tai Chi decreases HbA1c levels and increases the Th1 reaction (important mechanisms within diabetes), and another showed a significant fall in blood glucose levels and significant improvements in other indicators of the metabolic syndrome with 1/3 of the participants no longer even meeting the criteria for metabolic syndrome after just 12 weeks.

What we can see from all of this is there are relatively easy changes that people can make (if properly counseled), some with tremendous health benefits. To be more clear, with a small amount of effort on the part of the patient not only can the need for diabetes medications be eliminated but there is good evidence that they can become even healthier and offset any number of health conditions and cancers.

While many of us are not registered dietitians and will not get into detailed diet programs and the like, we are responsible for communicating what we can and helping our patients find the care and plans that will help them for years to come. We have a rare opportunity in many of our practices to know our patients well and to have time to share valuable information with them. Keeping in mind the damaging and expensive complications from diabetes, we should use this time wisely and offer what guidance we can.

Articles, Studies Referenced & Useful Links:

• Diet Soda/Diabetes Link
• Medscape Diabetes Norfolk Study
• Diabetes Drugs Given Too Soon
• Regular Tai Chi Chuan exercise improves T cell helper function of type 2 DM patients with an increase in T-bet transcription factor and IL-12 production (study)
• Preliminary study of the effect of Tai Chi and Qigong medical exercise on indicators of metabolic syndrome and glycaemic control in adults with raised blood glucose levels (study)
• Chinese Medicine/Acupuncture Treatment Protocols for Diabetes
• Traditional Chinese Medicine (TCM) Dietary Theory Section