Diet and Diabetes
In diabetes, the cells of the body cannot
get the sugar they need. Glucose, a simple sugar, is the body’s main fuel.
It is present in the blood, but in diabetics it cannot get into the cells
where it is needed. When diabetes starts in childhood (insulin-dependent
diabetes), it is due to an in adequate supply of insulin, the hormone
which ushers sugar into the cells of the body. Without insulin, the cell
membranes keep sugar out. This form of diabetes is also called Type I or
childhood-onset diabetes. When diabetes begins in adulthood
(non-insulin-dependent diabetes), it is not due to an inadequate supply of
insulin. There is plenty of insulin in the bloodstream, but the cells do
not respond readily to it. Sugar cannot easily get into the cells, and it
backs up in the bloodstream. This form is also called Type II or
adult-onset diabetes. In the short run, diabetics may experience episodes
of labored breathing, vomiting, and dehydration. In the long run,
diabetics are at risk for heart disease, kidney problems, disorders of
vision, and other difficulties.
The old approach to diabetes was to focus
on eliminating refined sugars and foods that turned into sugars—starches,
breads, fruits, etc.—from the diet. The rationale was based on the fact
that diabetics’ urine contains sugar. Unfortunately, with all of the
complex carbohydrates eliminated, fat and protein are all that is left in
The new approach focuses more attention on
fat. Fat is a problem for diabetics. The more fat there is in the diet,
the harder time insulin has in getting sugar into the cell. Exactly why
this occurs is not clear. But what is clear is that minimizing fat intake
and reducing body fat help insulin do its job much better. Modern diabetic
treatment programs drastically reduce meats, high-fat dairy products, and
oils. At the same time, they increase grains, legumes, and vegetables. One
study found that 21 of 23 patients on oral medications and 13 of 17
patients on insulin were able to get off of their medications after 26
days on a near-vegetarian diet and exercise program.1 During two- and
three-year follow-ups, most diabetics treated with this regimen have
retained their gains.2 The dietary changes are simple, but profound, and
they work. Low-fat, vegetarian diets are ideal for diabetics.
There is a second essential component to
managing diabetes. Through regular exercise, the need for insulin
injections can often be reduced, and oral medications often become
unnecessary. This holds true not only for people with
non-insulin-dependent diabetes, but also to some extent for those with
insulin-dependent diabetes. Exercising muscles have a voracious appetite
for fuel. When an individual is engaged in regular aerobic exercise, the
sugar is able to enter the cells without the need for as much, or perhaps
While people with non-insulin-dependent
diabetes can often eliminate medications when their weight is reduced and
foods and exercise are better controlled, those with insulin-dependence
will always need a source of insulin. The cause of insulin-dependent
diabetes remains elusive. Several recent studies have implicated cow’s
milk consumption as a possible contributor.3,4 When milk consumption
patterns were examined across various nations, there was a very strong
correlation with the incidence of insulin-dependent diabetes. It may be
that milk proteins cause an autoimmune reaction in which the body
mistakenly attacks its own insulin-producing cells. Even so, a good diet
and regular exercise can minimize the amount of insulin these diabetics
require. This is especially important given their tendency toward
complications, heart disease, and other blood vessel problems that are
much more common in diabetics. So it is doubly important to keep fit and
to keep dietary fat to a minimum.
Diabetics are shortchanged by the diet most
doctors give them. The typical American Diabetes Association (ADA) diet is
still high in fat. The ADA diet limits the amount of butter, eggs, and so
forth, but it contains about 300 milligrams of cholesterol per day and
about 30 percent fat.
This fact sheet is not intended as a
comprehensive program for diabetes. If you have diabetes, consult your
doctor and tailor a program for your needs. But it is important to
recognize that, for many, diabetes is a disease that need never occur. In
most cases, diabetics can manage their disease much better with a food
plan that gets most of its calories from complex carbohydrates while
minimizing fats. At the same time, regular, vigorous exercise helps
insulin work optimally.
1. Brand JC, Snow BJ, Nabhan GP, Truswell
AS. Plasma glucose and insulin responses to traditional Pima Indian meals.
Am J Clin Nutr 1990; 51(3):416-20.
2. Barnard RJ, Massey MR, Cherny S, O’Brien
LT, Pritikin N. Long-term use of a high-complex-carbohydrate, high-fiber,
low-fat diet and exercise in the treatment of NIDDM patients, Diabetes
3. Scott FW. Cow milk and insulin-dependent
diabetes mellitus: is there a relationship? Am J Clin Nutr 1990;51:489-91.
4. Karjalainen J, Martin JM, Knip M, et al.
A bovine albumin peptide as a possible trigger of insulin-dependent
diabetes mellitus. N Engl J Med 1992;327:302-7.