National Diabetes Day is November 14th! Diabetes is a topic that is near-and-dear to many of us at Naturally Inclined Health, and in my opinion, not something that gets talked about enough. So, this month, we're going to dive into the details of what diabetes is, why it is problematic and what a naturopathic doctor (ND) can do to support something with diagnosed diabetes, or someone who is looking to prevent it.
According to the Government of Canada's latest 2014 stat, 3.0 million Canadians are living with diabetes mellitus. This number is continuing to follow an increasing trend. Approximately 90% of these people have type 2 diabetes, and the other 10% have type 1 or other types of diabetes (e.g. gestational diabetes). The common theme in all types of diabetes mellitus is an inability to properly regulate the amount of sugar (glucose) in your blood, leading to high blood sugar levels. With this comes an increased risk of heart disease, stroke, kidney disease, and loss of nerve function. Before we talk about the different types, a quite physiology lesson is in order.
Diabetes Physiology 101
The body's system for regulating blood sugar is highly complex and intricate - it is incredible to say the least. Here is a very basic summary on how it works:
When you consume something that has carbohydrates (carbs) in it, these carbs are absorbed into the bloodstream, raising your blood sugar. Because your body likes to keep the sugar levels in the blood within a tight range, it has to act to get that sugar out of the blood, and into cells where it can be used for energy. This is where insulin comes in - your pancreas, a large organ near your stomach, has many jobs, one of which is to produce insulin and glucagon. A simple analogy to explain how insulin works is that it knocks on the doors of the cells to say "hey, open up and let some sugar in", allowing sugar to go from the blood into the cells. Glucagon does the opposite - it is released when the blood sugar is low, telling organs such as your liver to release some of their stored sugar back into the bloodstream.
Okay, now that we understand how insulin works, let's talk about different types of diabetes. Many people think that type 1 is "insulin-dependent" diabetes, and type II is "non-insulin dependent", but this isn't quite right. Both type 1 and 2 diabetics can require insulin - the difference really lies in the underlying physiology.
Type 1 diabetes: This is a condition of low insulin, where the pancreas greatly reduces or stops producing insulin. The result is the body cannot get sugar into the cells, and the blood sugar stays high and the cells starve. The most common (but not only) cause of this is an autoimmune attack on the pancreatic cells. For most people, this shows up in childhood, however there are some cases where it develops later on in life. Most people with type 1 diabetes must take insulin in order to survive.
Type 2 diabetes: This is a condition of too much insulin, but the insulin is ineffective! To start, the pancreas generally produces insulin just fine. The problem is when it arrives at the cells and "knocks at the door" - no one answers. As a result, the sugar doesn't effectively enter the cells so the blood sugar stays high. The cells are actually low in glucose, and tell the body to produce more insulin. The result is the pancreas over produces insulin, but the insulin isn't able to do its job. This is where the term "insulin resistance" comes from. If this continues for a long time, the pancreas can become worn out and stops producing insulin. Eventually the person may have to take insulin to manage blood glucose levels, similar to a type 1 diabetic.
Gestational diabetes: this is when a woman who doesn't have diabetes develops high blood sugars while pregnant. This can affect the health of the mother and baby. It often resolves after birth but does increase the mother's risk of developing diabetes later in life. Women are screened for gestational diabetes during routine pregnancy care.
Why It Matters
What happens to your body when your blood sugar is consistently high? Honestly, it isn't great. Sugar in the bloodstream is highly "oxidative", meaning it has the capacity to cause a lot of damage. It can cause damage to blood vessels and nerves, which creates a host of downstream problems. In effect, it creates a state of widespread inflammation throughout the body. Long-term and/or unmanaged elevated blood sugars leads to damage in many major organs such as kidneys, brain, eyes, and heart. Complications from diabetes can be quite severe including blindness or limb amputation and can be life threatening. I don't share this information to scare anyone, but only to highlight just how impactful blood sugar is on your overall health. The good news is that this is preventable! Diabetes is treatable.
How Naturopathic Doctors Help
So, why see an ND if you have diabetes? (or, if you are worried about diabetes!) Naturopaths look at many areas of your health to get you metabolic health on track! Lets dive in:
Diet - Naturopathic doctors can help you understand how your diet can be best used to maintain healthy blood sugar levels. Dietary recommendations for diabetes are often vague, and frankly, outdated. An example of that is the common recommendation that diabetics should consume artificial sweeteners instead of sugar (e.g. choose diet soda instead of regular soda). However, research has shown that non-caloric artificial sweeteners actually promote glucose dysregulation by disrupting the bacteria that live in the gut. [1] There is also misinformation around carbohydrates; they are NOT all evil, even if you are diabetic. In fact, some may be helpful at helping manage blood sugar levels. There is also a lack of discussion about the value of plant-based diets. It is important to mention that diet doesn't just matter in type 2 diabetes. Sometimes type 1 diabetics are told they can eat whatever they want, as long as they take the right amount of insulin to compensate. This advice completely undermines the enormous impact diet has on overall health and wellness. When it comes to diet and nutrition, It is important to work with a healthcare professional who knows your case well because dietary suggestions should be specific for you. Recommendations for someone who has recently diagnosed with diabetes might not be safe or appropriate for someone with advanced or complicated diabetes. Recommendations should also relfect your other health concerns and goals.
Supplements - There are many supplements out there that are touted as beneficial for diabetes and reducing insulin resistance. Some of these might have a lot of value, benefit, and evidence to support their use; however, some might not be appropriate for you and could even be unsafe. There is no medical professional as well trained in the use of supplements as a naturopathic doctor. We use targeted supplements when safe and appropriate to do so to support diabetics.
Gut health - If you don't already know, let me be the first to tell you - naturopathic doctors are obsessed with gut health, and for good reason. It doesn't matter what your condition is, your gut needs a proper assessment. Diabetes is absolutely no exception to that. Inflammation and disruptions in the bacterial composition of the gut have been linked to diabetes (type I and II). Naturopathic doctors are primed to assess and treat gut health.
Did you know that celiac disease is significantly more common in type 1 diabetics? If you are a type 1 diabetic and you've never been screened for celiac disease, talk to your healthcare provider about testing options (or come see us at Naturally Inclined Health!)
Environmental toxins - It is easy to point a finger at diet, weight or lifestyle as to the reason why individuals develop diabetes, but did you know there is an overwhelming amount of research that shows that toxic burden in the body is a major contributing factor to the development of diabetes? [2] Some toxins that are linked to development of diabetes are phthalates, heavy metals such as arsenic, polycyclic aromatic hydrocarbons (PAHs), BPA, dioxins, and so on. Now, I realize those are just complicated chemical names that might not have meaning to you. To give you context, they are frequently found in household items such as candles, scented products, cosmetics, nail polish, menstrual hygiene products, foods, and so on. Naturopathic doctors can teach you about these toxins, where they are found, and how to avoid them. In addition, NDs can use advanced lab tests to assess for the presence of certain chemicals and/or metals and provide treatments to help remove/manage them.
Holistic healthcare - No physical medical condition happens in isolation from your mental and emotional health. Managing diabetes can be overwhelming, scary and confusing. Naturopathic doctors will check in with all aspects of your health and support you as a whole person.
Prevention - Diabetes doesn't develop overnight. Family history, dietary/lifestyle assessment, bloodwork, and other lab testing are all part of a comprehensive assessment a naturopathic doctor can do to achieve a baseline status of your glucose regulation and assess your risk.
Whether you are diabetic, pre-diabetic, or just concerned about diabetes, naturopathic doctors are trained to help individuals with this condition and its complications. We are trained to use diet, lifestyle, supplements, herbal medicine, acupuncture and I.V./injection therapy to support your specific needs. We make sure treatments are safe and appropriate for your condition and medication regime. If you have questions about naturopathic medicine and its approach to diabetes, contact Naturally Inclined Health!
References
Suez, J., Korem, T., Zeevi, D., Zilberman-Schapira, G., Thaiss, C. A., Maza, O., . . . Elinav, E. (2014). Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature, 514(7521), 181-186. doi:10.1038/nature13793
Crinnion, W. J., & Pizzorno, J. E. (2019). Clinical Environmental Medicine. Elsevier Health Science.
Cohn, A., Sofia, A. M., & Kupfer, S. S. (2014). Type 1 Diabetes and Celiac Disease: Clinical Overlap and New Insights into Disease Pathogenesis. Current Diabetes Reports, 14(8). doi:10.1007/s11892-014-0517-x