The numbers are worse than estimated earlier. A recent study by the UCLA Center for Health Policy Research found that more than half the adults in California have pre-diabetes (46 percent) or diabetes (nine percent). Among those who have pre-diabetes, about 70 percent develop diabetes in their lifetime. Also, according to statistics available from the Centers for Disease Control, the number of United States adults diagnosed with diabetes almost quadrupled from 1980 to 2014 (from 5.5 million to 21.9 million).
While these statistics are alarming, diabetes is not a new disease. It was described over 3,000 years ago in the ancient texts of ayurveda among a group of urinary disorders called prameha. Even before urine and blood tests for glucose were developed, sages and vaidyas (physicians) in India had observed and documented signs and symptoms of prameha—like burning sensation of the feet, excessive thirst, weight gain, sweet taste in the mouth, and ants being attracted to urine. They also noted that its pathogenesis was due an to increase in kapha dosha from excessive consumption of sweet and heavy foods like newly harvested grains and sugar products. Sedentary habits are also a major cause of prameha, according to ayurveda.
In the last couple of generations our lifestyles have become increasingly sedentary with the convenience of motorized transportation and a large scale shift from farm and blue collar work to desk-bound occupations. Comfortable couches and electronic entertainment also promote inactivity during our leisure hours. This, coupled with an abundance and overconsumption of food, especially foods rich in carbohydrates, has created a perfect storm for the rising incidence of insulin resistance and Type 2 diabetes today.
From Carbohydrates to Blood Glucose
Most of the carbohydrates we consume get digested into glucose and other simple sugars, some faster than others. Glucose is then absorbed into the bloodstream and transported to various cells with the help of the hormone insulin. There it is stored temporarily and utilized for our energy needs. This would be fine, except that we are much less physically active now, and before burning the stored glucose we tend to eat another meal rich in carbohydrates, and then yet another. This imbalance between intake of carbohydrates and their utilization overwhelms the organs that store glucose, making them resistant to insulin. As a result, our body’s natural mechanism that regulates glucose concentration in the blood starts to fail, and the levels of glucose and insulin both begin to rise.
Insulin resistance is a metabolic dysfunction that underlies Type 2 diabetes and many associated disorders like central obesity (belly fat), hypertension (high blood pressure), and dyslipidemia (elevated triglycerides and low levels of HDL cholesterol). This cluster of abnormalities is called metabolic syndrome.
If blood glucose is elevated, it causes microscopic damage to various blood vessels in the body. Over time this damage accumulates and leads to serious complications like heart disease, stroke, loss of vision, kidney disease, peripheral neuropathy, diabetic ulcers, and amputations.
Addressing the Underlying Cause
To optimally manage Type 2 diabetes, the underlying causes of insulin resistance have to be addressed. The main cause is an imbalance between carbohydrate consumption and its utilization.
Although some people have a genetic predisposition to diabetes, lifestyle plays the major role in this metabolic dysfunction for most. So its management by medicines alone is not effective. Unless diet and physical activity are improved significantly, most diabetics find that their condition gets progressively worse, requiring higher and higher doses of medicines, and ultimately insulin shots. Most are afflicted by multiple complications.
To reverse this progression of insulin resistance and diabetes, ayurveda recommends a three-pronged approach of (1) food as medicine, (2) regular physical activity, and (3) medicines.
Food as Medicine
Out of these three, choosing the right foods is most important and effective. This means restricting carbohydrate consumption dramatically to reduce the glucose that will be absorbed into the blood. Check with your doctor before making dietary changes, though, especially if you are taking oral anti-diabetic medicines or insulin to manage blood glucose.
You may wonder: don’t we need glucose for energy? Yes, but our bodies can also utilize fat for energy. Since fats don’t raise glucose or insulin levels, they are a preferable energy source for diabetics.
Moreover, even a modest amount of fat in each meal increases satiety, curbs sugar cravings, and provides a steady supply of energy between meals. After a couple of weeks of carbohydrate restriction, as your insulin levels drop, you start burning body fat for energy. You find that your waistline starts reducing.
So, restricting carbohydrate intake and substituting it with healthy sources of fat helps to correct insulin resistance.
Start by cutting down on major sources of carbohydrates like sugars (cane sugar, brown sugar, jaggery, palm sugar, agave nectar, maple syrup, high fructose corn syrup, and any processed food that contains them), grains (white rice, brown rice, wheat, quinoa, oats, barley, amaranth, sorghum, corn, millet), most fruits (or fruit juices or dried fruits), starchy vegetables (potato, sweet potato, taro root, parsnips, yam), alcoholic drinks, and sweetened beverages. Your carbohydrate intake will then be mainly from leafy greens and non-starchy vegetables.
Simultaneously add fats from natural and healthy sources. These are fruits (avocado, coconut, olives); tree nuts (almonds, walnuts, pecans, pistachios, macadamia nuts, Brazil nuts, hazelnuts, pine nuts); seeds (chia, hemp, flax, sesame, pumpkin, poppy, sunflower); nut butters (almond butter, peanut butter); oils (sesame oil, olive oil, coconut oil, avocado oil); dairy fat (ghee, butter, cream, half-n-half); coconut milk; and cold water fish (salmon, sardines). One type of fat that you should completely avoid is trans fat (partially hydrogenated vegetable oil), which has been linked to high blood pressure, obesity, and heart disease.
You also need an adequate amount of protein (50 to 80 grams per day depending on your lean body mass) but not much more. Vegetarians and vegans can get this from beans, lentils, soy (tofu, tempeh, natto, edamame, soy milk), nuts, seeds, cacao beans, spirulina, cheese, and yogurt.
Making these changes in your diet requires sacrifice, but you don’t need to starve or feel deprived.
Think Outside the Thali
You may have to visualize a meal that’s quite different from what you’re used to eating.
Instead of grains make a green salad or cooked vegetable the staple. Add cheese, avocado, nuts, fish, chicken or other source of healthy fat and protein, enough to satisfy you, but not make you feel stuffed. Try dal, sambhar, or rasam in a bowl as a soup with a tablespoon of ghee, butter, or coconut oil.
Here’s a salad made with fresh, organic, seasonal greens and vegetables that can become a healthy and hearty part of your meals. It is packed with folates, beta carotene, potassium, fiber, and healthy fats, and contains only a small amount of slow-acting carbohydrates. It is colorful, flavorful, and satisfying.
On Your Feet
The second part of correcting this metabolic imbalance is regular physical activity. Regularity is more important than intensity of the exercise, and improves overall health, not just reduction of blood glucose.
Just spending more time on your feet moving around your home or office is itself a big improvement. Walking to the local store can help slow down the pace of a hectic day. If you go hiking in a nearby park you will breathe fresh air and connect with nature. Do what your heart desires, whether it is a bicycle ride, swimming, dancing, puttering around in your home garden, or playing with your grandchildren. Some people prefer working out in a gym on a regular schedule. Others may choose a soothing eastern practice like yoga asana, pranayama, or tai chi, which helps both body and mind.
Be spontaneous and vary your activities so that exercise becomes an enjoyable part of your day.
After you have optimized your lifestyle and your blood sugars have improved, you may still need to take medicines to lower and stabilize them further. Don’t stop taking medicines without consulting your doctor. Herbal medicines can be used to complement allopathic drugs.
There are many herbs used in ayurveda for prameha. An ayurvedic practitioner can evaluate you holistically and help you choose the best regimen for overall health.
Among the most studied herbs for prameha is meshashringi (Gymnema sylvestre), which enhances insulin secretion, improves lipid profile, and helps with weight loss. Its leaves are astringent and bitter in taste and help to balance kapha dosha. The heartwood of vijayasar (Pterocarpus marsupium) particularly helps to reduce postprandial hyperglycemia. It is often boiled with other herbs into a decoction.
Clinical trials of another plant, mamejjaka (Enicostemma littorale), have shown significant improvement in both fasting and postprandial blood glucose. Yet another versatile ayurvedic medicine is the heartwood of daruharidra (Berberis aristata), which lowers blood glucose through decreased gluconeogenesis and also reduces oxidative stress.
None of these herbs can compensate for the onslaught of a high carbohydrate diet, though. Nor can exercise, no matter how long you labor on the treadmill to burn the excess glucose.
Minimizing the intake of carbohydrates is essential for reversal of Type 2 diabetes. You may have to give up some foods you love, but you will develop a taste for other foods, which will help sustain these dietary changes.
The two most common hurdles to following this regimen are: a belief that you need to eat some grains for energy, and a deep-seated fear of fat. But after a few weeks when you see your blood glucose numbers going down, triglycerides dropping, belly fat reducing, improvement in blood pressure, and a sense of uniform energy and wellness, it will give you the motivation and confidence to continue.
Ashok Jethanandani, B.A.M.S., practices ayurveda in San Jose, Calif. He is a graduate of Gujarat Ayurved University, Jamnagar. www.classical-ayurveda.com.
The ideas and opinions expressed here are for educational purpose only. They are not intended to replace the advice of a physician or medical practitioner. Before beginning any diet program including any recommendations discussed here, it is recommended that you seek your physician’s advice.
lettuce, washed, spin dried, and chopped half a head, 100 g (red leaf, butter leaf, or romaine)
avocado: half, 75 g
cucumber, peeled if skin is thick, and diced: ½ cup, 50 g
red radish, sliced: 2 pieces, 50 g
basil or mint leaves: 6 leaves
Mix the ingredients and toss. Garnish with basil or mint leaves. Enjoy with some homemade dressing drizzled on top. For variety you may substitute other seasonal greens and vegetables. Some of my favorites are arugula, endives, jicama, celery, and red bell peppers. Pay attention to ensure that you are easily able to digest the raw foods you eat. Many people have trouble digesting raw vegetables like spinach, kale, chard, broccoli, and cauliflower, and should consume them in cooked form instead.
The oil, herbs, and spices in the dressing not only add to the taste, they help in easier digestion and more complete absorption of the beta carotene and other fat-soluble nutrients in the salad. Many commercial dressings contain vegetable oils processed with heat or chemicals. So it’s better to make small batches of dressing at home with the healthiest oils. Choose extra virgin, cold pressed, unrefined olive oil, avocado oil, or macadamia nut oil.
olive oil, extra virgin, cold pressed, unrefined: 12 tablespoons (3/4 cup)
juice of one lemon: 4 tablespoons (1/4 cup)
black pepper, coarsely ground:1 teaspoon
black salt: ½ teaspoon
Mix all the ingredients in a dressing mixer or a small glass bottle. Shake well before dispensing.