The number of people with diabetes is seemingly increasing unabated without a break. India, the “diabetes capital of the world”, will continue to witness an immense surge in cases in the near future too. According to several studies, India had over 69 million diabetic individuals as of 2015, and the number is said to reach 98 million by 2030 (Courtesy – India Today). With these many lives at stake, it is high time we think about the potential burden of reducing these numbers by treating the disease.
More About Diabetes as a Disease
Diabetes is a never-ending disease that occurs when the pancreas makes less or no insulin in the body. Insulin is a hormone made by the pancreas, that acts like a key to let glucose from the food we eat pass from the bloodstream into the cells in the body to produce energy. All carbohydrate foods are Broken down into glucose and then absorbed into blood. Insulin helps glucose get into the cells. Not being able to produce insulin or use it effectively results in raised glucose levels in the blood (known as hyperglycemia). Over a period of time, high glucose levels in the blood leads to inflammation in the internal organs of the body, damages them and can ultimately cause failure of these inflamed organs. The normal blood sugar range is less than 140 mg/dL (7.8 mmol/L).
|Target Levels by type||Upon waking||Before meals (pre-prandial)||Atleast 90 minutes after meals (post-prandial)|
|Non-Diabetic*||–||4.0 to 5.9 mmol/L||Under 7.8 mmol/L|
|Diabetes Type 2 (adult)||–||4 to 7 mmol/L||Under 8.5 mmol/L|
|Diabetes Type 1 (adult)||5 to 7 mmol/L||4 to 7 mmol/L||5 to 9 mmol/L|
There are three types of diabetes, namely, Type 1, Type 2 & Gestational.
Type of Diabetes
Diabetes Type 1 can develop at any age but occurs most frequently in children and adolescents. When you have type 1 diabetes, there is complete absence of insulin, which means that you need external insulin to maintain blood glucose levels under control. Type 1 diabetes is caused mostly due to genetic reasons, birth abnormalities and high progression of type 2 diabetes
Diabetes Types 2 is more common in adults and accounts for around 90% of all diabetes cases. When you have type 2 diabetes, your body produces less insulin or it does not make good use of the insulin that it produces. The main cause of Type 2 diabetes method is sedentary lifestyle and unhealthy eating habits. Over time people with Type 2 diabetes will require diabetes medications and/or insulin to keep their blood glucose levels under control. Obesity is the most powerful risk factors for the development of type 2 diabetes.
Gestational Diabetes (GDM) is a type of diabetes that consists of high blood glucose during pregnancy and is associated with complications to both mother and child. GDM usually disappears after pregnancy but women affected and their children are at increased risk of developing diabetes type 2 later in life.
The Increased Incidence of Obesity
The incidence of obesity in adults and children is increasing globally. Obesity is a preventable diseasethat plagues all the countries of the world. It has previously been considered a problem of developed nations, however, this disease also affects the developing countries. Human obesity is associated with the development of complications such as cardiovascular disease, stroke, depression, and type 2 diabetes which are spreading rapidly across poor and middle-income countries.
The Connection between Diabetes and Obesity
There is an alarming rate of progression of obesity in the country. The ADA (American Diabetic Association) has stated that around 70% of women and 60% of men who are pre-diabetic or the diabetic are always obese. So, this quite clearly shows the incidence of the disease starts at obesity. If you want to talk about science, in overweight individuals, the amount of non-esterified fatty acids, glycerol, body hormones, cytokines, pro-inflammatory markers, and many more components are increased. This increase will reduce the production of insulin in the body. This can lead to an increase in the body’s blood sugar level which needs to be controlled by medications and proper diet. If the condition progresses it may cause insulin resistance in the long run and the body may not be able to control the blood sugar level even after taking insulin.
So, will all obese people end up with diabetes?
Not really! not all obese people end up with diabetes. However, the risk is alarmingly high. According to the study published by NIH (National Institute of Health), Indians have displayed a high predisposition to develop the incidence of diabetes due to their low levels of high-density lipoprotein. So, given a case with obesity and bad genetics, you can picture yourself knocking on the doors of diabetes.
Furthermore, studies are showing the early onset of diabetes in the young population of the country. A longer disease duration points towards more health complications, less life expectancy, and a never-ending financial burden. Additionally, there is “clinical inertia” for the management of pre-diabetic patients. The inadequacy of information and lack of guidelines will rev up a pre-diabetic patient to end up having diabetes. According to ICMR the obesity related type 2 diabetes was 19 million in 1995 to 66.8 million in 2015 according to the International Diabetes Federation. These figures are predicted to increase to 123.5 million by 2040.
How to deal with the potentially epidemic proportions of diabetes?
Knowing that obesity has its chain linked to diabetes, fighting them both is prudent. As health educators, we need to talk about the possible advantages of healthy lifestyle interventions and the importance of incorporating physical activity in the prevention and possibly the treatment of diabetes. With proper diet and weight loss, it can be a manageable process to improve insulin sensitivity. Getting to the ideal body weight and decreasing the free fatty mass of the body can get the blood sugar levels of the body under control. Eventually, this can lead to a reversal of diabetes and a fit and healthy life can ensue. To sum up, weight loss might be the only door to mitigate the catastrophic numbers of diabetes induced early mortality.
Weight Loss as a weapon to fight Diabetes
There are several factors that prove that weight loss is the most effective way to control diabetes. As you undergo an effective diet for weight loss, it helps improve the body’s health and becoming more insulin sensitive. A diet that is low on carbs helps reduce blood sugar levels and prevents sugar spikes.
Controlling weight gain promotes healthy and stable blood sugars and is proven to be a better solution than taking medication
The two effective ways to achieve effective weight loss through diet are Hypocaloric diet and the Very Low-Calorie Ketogenic Diet (VLCKD Diet). While Hypocaloric diet is conceptually about eating less, the VLCK Diet drills down more specifically on the components calorie intake and involvement of high biological value protein. Which one is more effective when it comes to controlling diabetes? Let us dig deeper.
More about Hypocaloric Diet
A hypocaloric diet is nothing but eating fewer calories than you burn in order to lose weight i.e. consume fewer calories than you spend. Under this diet, you need to adapt your diet according to your activities of the day. The focus is mainly on energy in versus energy out. You can achieve a hypocaloric state by eating less and exercising regularly.
Following a hypocaloric, or reduced-calorie, a meal plan can help you shed unwanted body weight. Using this type of meal plan helps you lose weight based on calories, rather than having to consume special “dietary” foods. Emphasizing lighter, nutritious foods, such as fruits and vegetables, allows you to eat more volume and stay healthy in the process. When choosing a hypocaloric meal plan for weight loss, consider your gender, activity level, and current calorie intake.
Examples of healthy foods in the protein group include lean meats, egg whites, poultry, seafood, and soy products. Nuts and seeds can be counted in the oils or protein group, and you may place legumes in either the veggie or protein group.
A sample of a Hypocaloric diet plan is shown below
Setback of a Hypocaloric Diet:
Although a popular form a diet, it can have several setbacks. It’s a fact that you limit the amount of fats and sugars you consume, but you are also limiting crucial vitamins and other nutrients which can affect immunity, cause a recurring feeling of tiredness and exhaustion. There is also a possibility of muscle loss and when this occurs, it can cause a relapse i.e. weight gain due to lack of crucial protein intake. Hence, it is important to have an expert guide you in this diet program should you consider it.
More about The Very Low-Calorie Ketogenic Diet (VLCK Diet)
The Very-low-carbohydrate Ketogenic diet or the VLCKD is a diet which involves an intake of 800 kilocalories or less energy intake per day. It is also known as a rapid weight loss diet where you typically lose an average of 10 kgs within a short time period as compared to other diets which may follow a ‘slow and steady’ method. A VLCK diet is primarily for severely or unhealthy obese people who must lose or wish to lose large amounts of weight as rapidly as possible in a safe manner.
In this diet, you will reach your target weight owing to the low intake of carbohydrates which will allow your body will enter a state of controlled ketosis and start to draw on its energy reserves (fat). This ensures that the weight you lose will be primarily stored fat.
Several years of research, have confirmed that the inclusion of high biological value protein in a VLCK Diet helps in the preservation of muscle mass because the fat stored in the body is targeted during weight loss while the protein minimize muscle loss. With more muscle, better the metabolism, improvement in the glucose usage and the insulin sensitivity.
How can we follow VLCK Diet?
The VLCK Diet should be guided by experts who are medically certified and have expertise in the ketogenic diet. Through expert guidance, you will be put into a diet program that is structured and promotes rapid weight loss. In addition, due to the inclusion supplements, it reduces nutrition deficiency and balance out the important nutrients that people tend to lack during weight loss. This type of diet is effective for people who are severally obese as well as those who suffer from Diabetes Type 2 which is brought out by Obesity.
A sample of a VLCK diet plan is shown below
Which is better, VLCK Diet or Hypocaloric Diet?
VLCK diet as part of a weight-loss method that includes lifestyle and behavioural change is a safe and well-accepted medical method for people who also suffer from Type 2 Diabetes when compared to the Hypocaloric diet.
When the body enters into a state of controlled ketosis with the VLCK Diet, it forms ketones which are produced by the liver from fatty acids when there is low calorie and restricted carbohydrate intake. Simply put it, your body will switch to breaking down fat for energy where fats are turned into a chemical called ketones. These water-soluble molecules produce short burst of energy that contribute in regulating hunger and maintaining energy levels.
The body typically needs ketones when there are low levels of insulin. Hence, it is crucial for an obese person who has or is at risk of diabetes to be medically supervised in the VLCK Diet. This enables him to be monitored to ensure there isn’t an over production of ketones and over a short period of time contribute towards the body’s natural process of producing insulin
Measuring ketone production can be done regularly with the keto strip test. The safe amount of ketones in urine varies among individuals and depends on their underlying health conditions.