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What diet works best to manage diabetes?

Rarely is an intervention or diet the ‘best’ approach. There are many approaches, each of which would differ based an individuals life history, genetics, environment and lifestyle.The ProblemSince we are talking about diabetes, one thing is fairly certain - refined sugar, processed and preserved foods are a big no no.As these foods typically deplete intestinal health, result in higher glycemic responses, and require insulin to be released quickly in large amounts - they are best avoided. Thats a given for diabetics and for the prevention against diabetes.These foods actually cause diabetes through the development of insulin resistance > pancreatic exhaustion > need for supplementary insulin. Thats Type II Diabetes, in a nutshell.The no no’s also act covertly in the pathology of Type 1 Diabetes. Put simply - they slowly deplete the diversity and composition of the microbiome in our GI tracts, and subsequently damage the lining of the intestines, causing it to leak. T1D is an auto-immune condition which occurs in those who are genetically susceptible, expressed by this phenomena; causing the pancreas structural and functional harm - there you have it - T1D.A ‘leaky gut’ has been found to be a developmental pathway in the progression of both T1 & T2 diabetes.Solution(s)If we look to address the problem at the root, we find that the underpinnings of diabetes are a leaky gut, subsequent insulin resistance, and pancreatic insufficiency.So, the state of the microbiome and intestinal health are a key focus in preventing and treating diabetes, whatever diet that may be.Interestingly, everyones blood sugar response varies from consumption of the same foods. Foods which have been rated on the glycemic index to spike blood sugar may not do so to the same severity for another person.A study found that People eating identical meals present high variability in post-meal blood glucose response.This has been attributed to the unique composition of your own personal microbiome - the various strains and concentrations of bacteria, fungi and other critters which handle your food, digestion, immunity…..blah blah blah - point is they are important beyond belief!What seems to be the case is that discrepancies in the microbial community actually produce a less favourable blood sugar response to carbohydrate based foods especially.The very same study went on to develop an algorithm to predict individual post meal blood sugar responses based on several factors:Meal content (e.g., energy, macronutrients, micronutrients)Daily activity (e.g., meals, exercises, sleep times)Blood parameters (e.g., HbA1c%, HDL cholesterol)QuestionnairesContinual Glucose Monitoring (CGM)Microbiome featuresThe predictor, which accounted for the person specific variables above, was found to accurately predict post meal glucose responses to meals. This was validated by a second group of 100 participants, demonstrating the algorithms validity.Personalised dietary measures, based on the algorithm were found to lower post meal glucose responses and even alter the composition of the microbiome!In light of this, we may need to personalise our dietary choices based on the current state of our gut bacteria, encouraging it to slowly shift to a supportive composition, lowering the severity of blood sugar responses after meals.Two other important factors in developing diabetes are also stress and circadian disruption - certainly worth consideration alongside diet.Besides the person specific diet outlined above, a gut healing protocol with removal of all refined and processed foods should clear up a leaky gut and microbial imbalances (dysbiosis). Such include Autoimmune Paleo, Whole 30, Gaps Diet, Elimination Diet - any diet that focuses on removal of ALL processed, preserved, refined and artificial foods and provides supportive foods which support intestinal healing, lower inflammation and increase microbial diversity and composition.Video illustration of your unique blood sugar responses to foods:Ketogenic DietsSince the measures outlined above may be fairly inaccessible to most of us currently, we may turn our attention to a diet which has demonstrated significant efficacy for the treatment of T2D.This diet pretty much eliminates the need for large amounts of insulin to be secreted as very little carbohydrate is eaten, and I mean very little ~ <20gr/day.Since fat is used as >75% of calories, it becomes the primary source of fuel, which doesn't need require insulin for metabolism or storage.Fats are actually an incredibly good source of fuel, and burn efficiently in the form of ketone bodies as opposed to glucose. When fat burning pathways are optimised (developed through abstinence from carbs) you actually burn body fat for fuel which is a far more efficient and plentiful source of energy.In any case, ketogenic diets have become very popular for weight loss and have even been shown to reduce/eliminate the need for medication in T2D due to significantly better glycemic control.Ketogenic diets significantly improve/reverse insulin resistance also known as ‘carbohydrate intolerance’ (the underpinnings of T2D).There have even been reports of study participants who no longer required insulin, and achieved dramatic weight loss within a few weeks when in a state of ketosis.It is fairly clear that markedly reducing carbohydrates, moderating protein and supplying generous fats favourably affects metabolism, reducing insulin resistance and in some cases, the continual dependence on exogenous insulin (T2D).I would certainly encourage anyone who is interested to read more on ketosis and the microbiome.Here are a few places to start:Diet Doctor - Making low carb simpleHigh Intensity Health - The Best of Fitness, Nutrition and Functional MedicineChris Kresser

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