Doctor...Can't I Just Take A Pill (Part 1)
Refined diet best treatment for potential eye complications
I have previously written about the benefits of the so-called "Mediterranean diet" for people with diabetes, attempting to make the case that a predominantly plant based diet, consisting of anti-inflammatory, low glycemic index vegetables, nuts whole grains and plentiful fiber is ideal for optimizing blood glucose levels and minimizing the risk of eye (and other) complications. When I discuss this strategy with my patients, though, I often see a disappointed and/or glazed look in their eyes; after all, changing our eating habits is very difficult. One straight-talking patient recently asked me a question with which I think a lot of other patients can relate: "Doc, can't I just take a pill?"
When I first heard this question, my gut reaction was to cry "No!" But after remembering my mother's advice to take a deep breath and think before speaking, I drew the following diagram:
I explained that high blood sugar levels lead to high sugar (glucose) levels inside of specific, insulin-independent cells, which are found predominantly within blood vessels. Once inside the cell, glucose causes production of harmful ‘free radical' molecules which then enter the cell nucleus and lead to the production of inflammatory proteins (‘toxic biochemicals') that damage the cell, leading to blood vessel complications like diabetic retinopathy, , kidney disease, nerve disease and heart disease. These same chemicals are naturally produced in small quantity by normal cell metabolism, but increase significantly when glucose levels inside the cell rise.
I went on to explain that there are two basic strategies to prevent or minimize such complications: (1) keeping blood sugar levels as close to normal as possible through diet, physical activity, and medications (analogous to turning off the faucet on an overflowing bathtub in order to keep the floor from being ruined) and (2) ramping up the cell's natural anti-oxidant defense systems or otherwise neutralizing the toxic, inflammatory chemicals produced by the cell nucleus (analogous to quickly mopping up water that has already overflowed in order to protect your bathroom floor). An anti-inflammatory diet makes sense to me, I said, because it assists with both of these processes.
Less refined carbohydrate, fewer calories, and fiber translates into a smaller rise in blood sugar levels after eating (A.K.A. ‘post-prandial hyperglycemia') and more level blood sugars throughout the day (A.K.A. ‘decreased glycemic variability'), which means that less glucose enters susceptible cells in the retina, kidney and nerves resulting in less production of inflammatory proteins that injure those cells and, over time, cause complications. Similarly, diabetes medications that lower blood glucose levels by various mechanisms (increasing insulin production, making muscle and liver tissue more sensitive to the effects of insulin, slowing down digestion) and exercise, which allows insulin dependent cells to more effectively absorb excess glucose from the bloodstream, also effectively ‘turn off the faucet.'
Moreover, the anti-inflammatory diet helps ‘mop up' toxic biochemicals produced by the cell nucleus since it contains a host of anti-oxidant, anti-inflammatory and anti-clotting compounds (e.g. so-called, plant based ‘phytochemicals'). In addition, such a diet also decreases the number of free radicals generated by normal cellular metabolism in the absence of elevated glucose levels, providing a sort of cushion for extra free radicals created when blood and cellular glucose levels are too high.
At this point, my very patient patient scratched his head and repeated his query which, in my enthusiasm to help him understand why the anti-inflammatory diet makes so much sense, I had unfortunately neglected: "Doc, can't I just take some sort of a pill?"
"I'm glad you asked me again," I said. "There is no magic bullet but, in addition to diet, exercise, and taking your prescribed diabetes medications, there are a few pills that you might want to consider – ones that give you a bigger, tougher, more effective mop".
To Be Continued.
For more information on diabetic eye disease, consult Dr. Chous' book Diabetic Eye Disease: Lessons From a Diabetic Eye Doctor, Fairwood Press, Seattle, 2003.
Read more about Dr. Chous here.
Visit Dr. Chous' website here.
NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.
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