Nutrition IV - Common Ailments in Clinic - Type II Diabetes

Question 1

Type II Diabetes

Answer 1

A metabolic condition whereby body cells become resistant to the effect of insulin, leading to hypoglycaemia.
* In the early stages, insulin levels are typically elevated signifying reduced insulin sensitivity by body cells
* As the condition progresses, the pancreas becomes less able to produce sufficient insulin to meet high demands
* Most people with type 2 diabetes are either overweight or obese and careful attention to dietary patterns and exercise levels are central to treatment
* Genetic influences are considered likely but an individual’s lifestyle is crucial to the disease process

Question 2

Causes and risk factors; Diet

Answer 2

Poor diet:
* High intake of refined carbohydrates, high GI (glycaemic index) and high GL (glycaemic load) foods
* Inadequate fibre (fibre can slow glucose absorption)
* Poor intake of antioxidant nutrients e.g. fruit and vegetables
* High intake of saturated fats and trans-fats
Glycaemic index = a measure of how fast and how much a food raises blood glucose, Glycaemic load = measures both the GI and how much carbohydrate is in the food

Question 3

Causes and risk factors; Weight

Answer 3

Weight:
* Increased risk in those who are overweight and obese, in particular, central adiposity
* Adipose cells in visceral fat are metabolically active and secrete inflammatory mediators including TNF-a and interleukin-6. These mediators increase systemic inflammation and decrease insulin sensitivity
* Over-eating highly-processed foods can result in increased adiposity, as does ‘mindless eating’ (not being fully present when eating and not listening to the body’s satiety signals).

Question 4

Causes and risk factors; Inactivity

Answer 4

Inactivity contributes to Type two diabetes.
* Exercise modulates the expression of inflammatory mediators involved in insulin resistance
* Increases the release of anti-inflammatory proteins such as adiponectin
* Increases GLUT4 protein expression, facilitating transport of glucose into the cell
* Supports healthy weight management and improves body composition (decreases adiposity)
* Improve cardiovascular health
Adiponectin = a protein hormone that improves insulin sensitivity

Question 5

Causes and risk factors; The microbiome

Answer 5

• Alterations in the microbiome (i.e. dysbiosis) have been shown to drive insulin resistance. Studies have shown that a plant-based fibre-rich diet increases insulin sensitivity, whilst a diet rich in animal food increases inflammatory mediators that can drive insulin resistance
• Stress (cortisol increases blood sugars)
• Persistent organic pollutants POPs such as pesticides can negatively impact insulin receptors

Question 6

General nutritional aims

Answer 6

General nutritional aims:

• Avoid refined foods, alcohol, caffeine (they disrupt blood glucose)
• Replace with organic, complex carbohydrates and fibre rich foods e.g. whole grains, quinoa, buckwheat, broccoli and cauliflower (rich in nutrients; slow the release of glucose into the bloodstream)
• Avoid high glycaemic index and high glycaemic load foods (cause spikes in blood glucose)
• Notes – not all low GI/DL L food is healthy and not all high GI/GL food is unhealthy! Work with your client to select quality foods
• For GI and GL calculations, visit: https://www.glycemicindex.com
• Include ample low GI/GL fruit and vegetables (preferably organic) which are nutrient-rich, anti-inflammatory and antioxidant-rich. E.g. berries, dark leafy greens, pomegranates, carrots, garlic, green tea
• Keep saturated fats (especially animal fat) to a minimum, avoid trans-fats and optimize essential fatty acids such as flaxseeds, Chia seeds, hemp seeds and oily fish to maintain cell membrane fluidity and reduce inflammation. Reduced membrane fluidity can cause reduced insulin receptor binding.
• Include protein with each meal to help stabilize blood glucose

Question 7

Chromium

Answer 7

Chromium: 200 – 1000 mcg / day as chromium picolinate
* Food sources:
o Broccoli
o Green beans
o Green beans
o Oats
o Whole wheat
o Turkey
o Beef
o Basil

• Functions:
  o A component of chromodulin – a protein that increases sensitivity of the enzyme tyrosine kinase.
  o This enzyme facilitates insulin receptor activity allowing glucose entry into the cell

Question 8

Magnesium

Answer 8

Magnesium: 500 – 1000 mg / day
* Food sources:
o Almonds
o Seeds
o Dark leafy greens
o Whole grains
o Legumes
* Functions:
o Deficiency is linked with poor glycaemic control and impaired insulin function
o Plays a role in pancreatic beta-cell function
o Intracellular magnesium helps regulate insulin action and glucose uptake

Question 9

Omega-3 fatty acids

Answer 9

Omega-3 fatty acids: 3-6g / day
* Food sources:
o Coldwater fish
o Chia seeds
o Hemp and flaxseeds and oil
o Walnuts
* Functions:
o Insulin resistance is strongly linked with inflammatory pathways that generate free radicals
o Omega-3 fatty acids reduce inflammation, protecting against insulin resistance

Question 10

Vitamin D

Answer 10

Vitamin D: 400 – 1000 iu / day
* Food sources:
o Mushrooms (Good sun exposure)
o Cod-liver oil
o Oily fish
o Egg yolks
* Functions:
o Vitamin D plays a role in the synthesis and secretion of insulin (activates transcription of the insulin gene)
o Increases cellular sensitivity to insulin
Transcription = the coding of a gene (recipe)

Question 11

Other considerations

Answer 11

• Cinnamon:
  o Increases in the sensitivity of insulin receptors, facilitating transport of glucose into the cells.
  o Add to soups, stews, curries, smoothies, drink as a tea
  o ¼ tsp cinnamon in a glass of water twice-daily
• Green tea:
  o Has powerful antioxidant properties
  o Protects against complications of diabetes including diabetic retinopathy