A high road scenario for diabetes reversal
There is a growing body of research that suggests that one of the world’s most devastating illnesses, diabetes, can be reversed. Medical and nutrition experts Prof Tim Noakes and Dr Neville Wellington and actuary Sarah Bennett told attendees at the recent 2019 Actuarial Society of South Africa Convention that the first step towards the high road scenario to diabetes reversal was to ‘know your status’ insofar insulin resistance. Their message coincides with World Diabetes Day which is observed 14 November each year.
“Every person should ‘know their status’ on the insulin resistance continuum as there are consequences to consuming high levels of carbohydrates when you are insulin resistant,” said Prof Noakes. “Those consequences include hypertension, obesity, metabolic syndrome, type 2 diabetes mellitus, infertility, acne, gallstone disease, gastro-oesophageal reflux disease, osteoporosis, osteoarthritis and even cancer”. Bennett observed that 75% of diabetics in a typical medical scheme population had an HbA1c greater than 6,5% and 44% had triglycerides above 1,7. High triglycerides are a marker of both insulin resistance and a high carbohydrate diet. The goal is to achieve an HbA1c of 5,7% or better and triglycerides of less than 1.
Bennett explained how diabetes is typically viewed as an irreversible condition leading to rapid deterioration in health status. This belief has resulted in a narrow focus by the medical and pharmaceutical sectors on managing diabetes to maintain the sufferer’s health. However, new evidence suggests that diabetes can be reversed. The American Diabetes Association (ADA) recently published revised diabetes lifestyle management guidelines that acknowledge research that indicates that low carbohydrate eating plans may result in improved glycaemia and have the potential to reduce anti-hyperglycaemic medications for individuals with type 2 diabetes.
The publication of Year 2 of the Virta Health study supports these findings. “Long term effects of a novel continuous remote care intervention including nutritional ketosis for the management of Type 2 diabetes: A 2-year non-randomised clinical trial” by Hallberg, Volek, Phinney et al tracks the outcomes of diabetics on a low-carb high-fat (LCHF) diet. Dr Wellington confirmed that he was successfully treating diabetics with LCHF diets in Medicross, Kenilworth in Cape Town. In addition, he was involved with The Noakes Foundation in developing training for doctors on treating diabetes with low carbohydrate eating plans through Nutrition Network.
The Noakes Foundation’s community initiative, Eat Better South Africa, has shown that a low carbohydrate lifestyle is sustainable within under-resourced communities which are most affected by poor diet and a lack of dietary education. Positive health changes are experienced within just a couple of weeks.
According to Dr Wellington, many of his patients have benefited from changing to low carbohydrate lifestyles in managing their diabetes. Many diabetics under his management have reduced their medication, HbA1c and triglyceride levels. And some have achieved reversal as defined in the Virta Health guidelines. He provided a more detailed description on measuring insulin resistance and explained that insulin resistance is best overcome by reducing the intake of carbohydrates. Prof Noakes outlined his vision for a high road scenario for diabetes reversal as follows:
- Everyone will know their insulin resistance status in the same way they know their HIV status;
- Those with insulin resistance will improve their health by cutting carbohydrates from their diets;
- Treating doctors, specialists and dieticians will be aligned in dietary advice given to those with insulin resistance;
- LCHF will be a recognised, generally accepted treatment regime in South Africa, as recognised by the ADA guidelines;
- LCHF will be accessible to South Africans from all cultural backgrounds and all income levels;
- 90% of Type 2 diabetics will not be on insulin (as they are eating correctly);
- All HbA1c results will be below 6.5 (or ideally below 5.7);
- All triglycerides will be below 1.7 (or ideally below 1);
- The Department of Health’s ‘Healthy Lifestyle campaign’ will provide dietary advice that takes insulin resistance into account;
- Government and private sector will unite to make nutritious, sugar free, carb free foods widely available;
- The National Health Insurance fund and medical schemes will promote widespread behaviour change through consistent messaging, diabetic self-management, education and support and creating an enabling environment;
- Diabetic admissions will be substantially reduced through proper management of the disease;
- Prevalence of chronic disease (measured by those registered for chronic medication) will reduce, not only for diabetes, but for all other conditions relating to insulin resistance; and
- Society and big business will support those with insulin resistance by making sugar and carbohydrates less ubiquitous.
Drawing a parallel with the HIV / AIDS epidemic, Bennett issued a call to action to actuaries to influence behaviour change in product design, assist in modelling the diabetes epidemic and actively lobby government to promote healthy eating. This could make the high road scenario a reality for South Africa in the years to come.
Stokes Media Group
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