Naturopathic Approach to Diabetes
Before becoming a naturopathic doctor, I wanted to specialize in Type 2 Diabetes and metabolic medicine more broadly. Diabetes is a disease that affects everyone, and my pathophysiology professor in naturopathic medical school referred to it as the “mother of all diseases.” At the time, I didn’t understand why he said that. Hopefully, I can convey what he was referring to in this blog post. I have been dreading this post because there is no simple way to explain a holistic medicine approach. To best explain, I will focus on five key concepts that you need to understand. First of all, what is diabetes? Diseases need definitions so that we are all on the same page. There are two definitions of diabetes: Traditional definition – a fasting blood glucose level of 126mg/dL or higher, and newer definition – having a hemoglobin A1c of 6.5% or above. To understand the second definition, you need to understand the big problem with diabetes: glucose reacts with the cells of your body, which ultimately damages them. Your body uses glucose for fuel, but too much glucose damages cells throughout your entire body. The hemoglobin A1c test looks at how much glucose is attached to the hemoglobin A1c protein; that’s why it is always a percentage. Once 6.5% of your hemoglobin A1c protein has a glucose molecule attached to it, you meet the criteria for diabetes.
Concept #1: Diabetes starts well before you're diagnosed
As we age, our bodies change and so do our dietary needs. In our younger years, we may have indulged in sweet treats like pancakes for dinner with a milkshake and cotton candy without worrying about the impact on our glucose levels. However, as we approach our mid- to late-30s, we need to be more mindful of what we eat. Usually we become more sedentary than we were during our teenage years. Our body composition begins to shifts, and we gain adipose tissue, which means more fat and usually lose some muscle mass. Over time, our bodies become more and more insulin resistant. This insulin resistance leads to elevated glucose levels that take longer to return to normal. This condition can be frustrating and worrying, especially when we’re told that it might be genetic. Medication might be prescribed to help manage blood sugar levels, but often people seek additional guidance from experts who can offer personalized advice. That’s where I come in – as a helpful assistant, I can provide you with resources and support to take charge of your health and wellbeing.
Concept #2: Risk factors for diabetes need to be managed
In the earlier example, we have discussed four main factors that influence our health. While age is not something we can change, we can still make some modifications in our body composition, especially in fat and muscle mass, as well as increase physical activity levels which can significantly impact our overall blood glucose regulation. While some may believe that supplements or botanicals can help them achieve their goals, it is important to note that lifestyle modifications are key. Though supplements do exist that can help improve our metabolism, it is still essential that we prioritize the following lifestyle changes: shedding fat mass, adding or maintaining muscle mass, and increasing physical activity. By incorporating these practical steps into our everyday lives, we can positively impact our bodies ability to metabolize glucose.
Concept #3: There are lots of paths to insulin resistance.
There are multiple reasons why the body starts to struggle with managing glucose levels. Doctors used to think that people with diabetes all had low insulin levels, but the opposite is true. Their insulin levels are usually through the roof. The problem is insulin resistance. Diabetic cells do not respond to elevated insulin levels, so glucose does not go into the cells. Instead, it stays in the bloodstream, causing damage by attaching itself to cells throughout the entire body.
Muscles directly lower insulin through a process called non-insulin glucose transport. Additionally, using muscles burns glucose for fuel and improves insulin sensitivity.
Fat is also inflammatory. I’m not telling people to hate their bodies or trying to make anyone feel bad about their size, but a question I often ask patients is, “How much did you weigh in senior year of high school?” Usually, I assume that they have not gained significant amounts of muscle since that time. Therefore, if someone tells me that they weighed 140 pounds in senior year of high school and now they weigh 180 pounds, then I assume that 40 pounds of weight gain is almost all fat. These fat cells act like a 24-hour inflammation factory that contributes to insulin resistance.
Concept #4 - Control your diabetes by any means necessary
Because diabetes is the mother of all diseases, and it has the potential to damage every cell in your body, I believe in getting it under control as soon as possible. However, most patients do not take this advice. Every second your glucose is too high it can cause damage. Technically, it takes decades of dysregulation to reach diabetes. Years in advance, you can see a patient’s glucose level climbing to 200 mg/dl after eating and staying there for hours before finally returning to normal. This is not diagnostic of diabetes, but it can still cause damage at the cellular level. Therefore, addressing early dysregulation is ideal. By the time you are diagnosed, it’s late in the game. Therefore, I usually recommend working on lowering your A1c and fasting glucose while also taking what your primary care doctor has prescribed. In time, you should be able to wean off the medication. I realize most patients do not take this route with me, but I try to minimize this as much as possible.
Concept 5# - Diabetes is complicated
I’m honestly in the camp that believes diabetes is a problem caused by modern living. Our genes were not designed for this environment. In the past, our ancestors often went weeks without a good meal and had to be able to add 10 or 20 pounds of fat quickly when food became plentiful. Maintaining glucose levels during scarcity and gaining weight rapidly is what our genes are accustomed to. Modern lifestyle not only provides an abundance of calories but also refined glucose that is quickly absorbed into our bloodstream. Many patients just want to eat whatever they please, but diabetes is genuinely a modern living problem. If you want to prevent or reverse it successfully, you must abstain from some of the comforts of modern living.
In conclusion, chronically elevated blood glucose levels don’t have to be your fate. Diets, supplements, exercises, and other factors can help lower glucose levels. Mental stress, reactive oxygen species, toxins, and sleep deprivation also play a role, but addressing them all would require a book-length discussion. I just want to let patients and potential patients know that there is hope.