Diet & Lifestyle in Type 2 Diabetes - Ask a Nutritionist

Transcript:

LEAH: Hello and welcome to Dishing Up Nutrition's “Ask a Nutritionist” podcast brought to you by Nutritional Weight and Wellness. My name is Leah Kleinschrodt. I'm a Registered and Licensed Dietitian and we're thrilled to be celebrating 20 years of Dishing Up Nutrition, discussing the connection between what you eat and how you feel while sharing practical real life solutions for healthier living through balanced nutrition.

So we wanted to just thank you for your support and listenership over the years. Let's get started with today's show. So today I will be answering a question that we received from one of our Dishing Up Nutrition listeners. Now this listener says, “Is type 2 diabetes caused by diet or not enough of a balanced diet/lifestyle?

So thank you for that question. It's a really great question. And it's a simple question, but unfortunately, like most things, it's not a simple, straightforward black and white answer. So I want to start off with just a few quotes from a research paper. This was published in the journal, Current Nutrition Reports, back in 2014.

So it's a little older, but I think very pertinent still today. And the title of that paper is called “Diet, Lifestyle, and Genetic Risk Factors for Type 2 Diabetes”, a review from the Nurses’ Health Study 2, and Health Professionals Follow Up Study.

Do genetics play a role in type 2 diabetes?

So in this particular report, the authors write, “Type two diabetes is caused by both environmental and genetic factors, as well as gene environment interactions.” And they also go on to say that examining the genes of these cohorts of people, they have found some really fascinating discoveries about specific genetic variants for type two diabetes. However, “The identified common variants explain only a small proportion of overall diabetes predisposition.”

So I thought those couple of quotes summed it up really well and there's a lot more to that paper if people are interested in reading that. But if we just try to interpret some of that language that they used here, we can kind of drill down and say that some people's genetic blueprints may predispose them to be at that higher risk of developing type 2 diabetes.

However, just because we've been handed a blueprint, that doesn't mean that's exactly how we have to build our house. So, if you've ever maybe built a house before or moved into a new home, if you were building a house where you were given this blueprint that showed that you were missing three windows in your house, it wouldn't be the ideal situation to just accept those missing windows and try to make do, especially here where it gets pretty cold during the winters.

And you certainly wouldn't want to make the situation worse by watering your garden and then spraying water through that hose into those missing windows and just again making the whole situation worse. You'd probably want to do some research, choose the highest quality windows that you could, and then either install them yourself or hire somebody to do that.

So we can apply that same line of thinking to our health blueprints. We may have been handed a less than ideal blueprint. Maybe we had some missing bits and pieces here and there, but we humans are very smart and very capable and very resourceful.

What is type 2 diabetes?

So we have the ability to modify and fine tune our blueprints so our bodies actually work in the best way possible and we can live full and healthy lives. So, if we break this down even a little bit more, I'm going to go into what exactly is type 2 diabetes. I'm not going to do a huge deep dive here, but just lay some groundwork.

We know type 2 diabetes is a chronic disease, so it's something that comes on over time. And this is where the cells in the body progressively become more resistant to the signals from insulin. So if you've heard our show a time or two, you've run across this term insulin resistance, and that's exactly what we're talking about.

Insulin's job is to grab sugar from the bloodstream and escort it into our cells, but when we do things that cause our body to have a lot of sugar on board, and we'll get to that in just a minute, our bodies have to make a lot of insulin to compensate for that sugar. And over time, when we're swimming around in this extra sugar and extra insulin for a long time, our cells eventually start to become resistant to insulin.

They just stop responding to insulin as well as they used to. And eventually, we get to the point where insulin can't keep up with the amount of sugar that's in the bloodstream, and that's when our blood sugar numbers start to rise. And that's the part that usually gets picked up on a lab test.

So, you go in, say, for your annual physical, and you see a fasting glucose number that's now over 100, or we get a hemoglobin A1C test that's done, and now it's 5.7 or maybe it's even a little bit higher, and that's the cutoff, that 5.7 is the cutoff for prediabetes.

Where can excess sugar come from that increases insulin resistance?

So if we circle back into that question, what, where does this extra sugar come from that drives that insulin resistance up? So this is again where that interplay of our genes and environment start to come into play. So I'd say probably for most people the main culprit is what are we choosing to put in our mouths? What are we choosing to feed our bodies? Our food choices are most likely the main culprit for most people that drives up blood sugars and also drives up those insulin levels.

For most people who are dealing with that insulin resistance, it's coming from a combination of too many carbohydrates, especially the more processed, ultra processed carbohydrates, like your pastas, bread, cereals, crackers, cookies, calories from soda, juice, alcohol, things like that.

And then we don't have those carbohydrates balanced with enough protein and healthy fats. So again, diet is probably one of the biggest drivers to those higher blood sugars and higher insulin levels, but there's of course other things. Lack of exercise or just lack of general daily movement is another contributor to insulin resistance.

Movement helps reduce insulin resistance

When we move our bodies and we move our muscles around a lot, we actually can take that sugar from the bloodstream and put it into our muscle cells without needing insulin to help it along, which is a good thing. That's what we want. Unfortunately, if we commute an hour to our jobs every day, sitting in the car, and we sit for eight hours a day at our jobs, and then we sit when we get home on the couch, all that, that sedentarism doesn't help our blood sugar levels at all.

And then it is up to insulin to do all the work for us. And again, we're trying to take some of that burden off of insulin and try to reduce that insulin resistance. So yes, our diet and our movement habits definitely play a role and there's other things that do play a role in there that kind of point that compass towards insulin resistance and type 2 diabetes.

Sleep deprivation can increase insulin resistance

And I don't want to dive deep into each one. I do, just for a minute, want to put a spotlight on chronic sleep deprivation being a big one. Because even one night of poor sleep can increase our blood sugars and start to put our bodies into that more insulin resistant state. So I know I've met with many clients over the years who have spent years and sometimes even decades not sleeping well, and then we have a lot of insulin resistance built up by that point.

You know, when we're sleep deprived and we're really tired and we lack our energy, we tend to seek energy from other places. One of those places being from our food and it tends to be more of those higher carbohydrate, higher sugar types of foods that we gravitate towards.

And lack of sleep also means we haven't had a chance to clean house on the inside. We haven't had a chance to repair and regenerate and just bring all of our hormones back into a more balanced state. So again, we just end up on this cycle of higher insulin and higher blood sugar levels.

And sometimes lack of sleep is a bad habit. It is more of a choice. Think like later bedtimes, too much screen time in the evenings and before bed, or just delaying bedtime. And sometimes lack of sleep comes from some underlying factors. So think like hormonal changes during perimenopause or menopause. Stress is a big one that could interrupt people's sleep. Having sleep apnea and even nutrient deficiencies can play a role in sleep.

So the long and short here is do what you can to fix your sleep. And we have done many, many shows on Dishing Up Nutrition about sleep, and we help clients day in and day out with their sleep issues, so there is a solution out there. Sometimes you just have to do a little bit of digging.

More factors that can increase insulin resistance: gut microbiome, stress, & toxins

And then lastly, a couple other things, something like an unhealthy gut microbiome can impact blood sugar and insulin resistance. Having chronic high stress and high cortisol levels can drive more insulin resistance. And there's even research correlating exposure to toxins in the environment, like BPA or phthalates or even pollution and having that correlation between more exposure to those things and having a higher risk of having type 2 diabetes.

So I think that maybe the short answer to that question is, yes, by far and away, our choices and our habits and the things that we do with the tools that we've been given are going to play the biggest role in whether we build up that insulin resistance enough to have type 2 diabetes. The good news is then that if we are in that situation, we actually have the tools and we have the ability to reverse that situation. I think that's the most empowering message of all, is that we have the power to undo some of the things that have been done and even undo some of those genetic predispositions.

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