Regular moderate intensity exercise and adherence to the Mediterranean diet may help in type 2 diabetes prevention and control.
Type 2 diabetes is a condition where a hormone called insulin can no longer regulate the movement of blood sugar, or glucose, into cells. As a result, glucose remains in the blood where it damages blood vessels and organs. This increases the risk for secondary complications such as heart disease, blindness, kidney problems, amputations and nerve damage. Individuals with diabetes are also more likely to suffer from depression.
In the famous Diabetes Prevention Program Study individuals at risk for diabetes who engaged in regular exercise and adhered to a low fat, high fiber diet were 34% less likely to develop type 2 diabetes whereas patients taking an anti-diabetic medication lowered their risk by 18%1. Fortunately for individuals who have already developed diabetes, lifestyle changes can aid with the management of this condition.
THE HEART HEALTHY MEDITERRANEAN DIET
Individuals with type 2 diabetes are 2 times more likely to develop heart disease so it is important to protect this vital organ in addition to managing glucose levels.
The Mediterranean Diet refers to the general pro-heart diet consumed in areas around the Mediterranean Sea. This diet is characterized by:
- A high consumption of fruits and vegetables
- A lower consumption of red meats
- Low fat and yogurt sources of dairy
- Protein sources from legumes or from lean animal sources such as chicken or fish
Carbs don’t have to be the Enemy!
Carbohydrates, or carbs, are allowed! Shunning all carbs from your diet may not be the best approach for a diet change because they can be an important source of fiber and help keep you full. The key, however, is to opt for complex carbs rather than simple carbs. Complex carbs come from sources like legumes, vegetables, breads and pastas; and simple carbs are found in sodas, candies and chocolate (think of simple carbs as ‘simple sugar’). It is also helpful to opt for whole wheat breads and pastas because they are higher in fiber, which will help keep you full longer and prevent over-eating and giving in to junk food cravings.
Tip: If you do find yourself daydreaming about Candyland, try fulfilling your cravings with fruit.
Not all Fats are Created Equal
Fats can be categorized as unsaturated and saturated. Saturated fats usually come from animal sources such as meat, cheese, butter and ice cream, but can also come from non-animal sources like coconut and palm oil. These types of fats are considered ‘unhealthy’ because they are chemically ‘less fluid’ and ‘more stiff’ than unsaturated fats. To put this in perspective, imagine if the cells of your heart were made up of stiff cells versus more fluid and movable cells.
The primary fat source in the MD is from olive oil which is an unsaturated fat. Other sources of unsaturated fat that you can include in your diet include fish, nuts and legumes.
Tip: Use olive oil-based dressings and try replacing butter sticks with non-hydrogenated margarine. Hydrogenation is the process that makes an unsaturated fat a saturated fat. Hydrogenated fats are often found in desserts and pastries.
Wine and Dine
The MD also often includes red wine (no more than 1 glass/day for women and 2 glasses/day for men). Moderate consumption of red wine is associated with healthy cholesterol levels, and lowered risk of cardiovascular disease. Red wine contains antioxidants which help protect against high blood pressure and clogged arteries.
Tip: Don’t overdo it! A high consumption of alcohol has the opposite effect and can actually increase your health risk.
FEEDING YOUR MUSCLES
Remaining physically active is an important aspect of diabetes care. Although the thought of starting an exercise program may be intimidating for individuals who are relatively inactive, small steps can result in large gains in health.
Start Small but Go Often
To reap the health benefits of exercise for diabetes, it’s not about going hard, but about going often. Muscle contraction stimulates the movement of sugar from the blood into muscle cells without a need for insulin (i.e. this mechanism is insulin-independent).Furthermore, exercise improves the sensitivity of insulin (i.e. your insulin will work better). This improvement in insulin sensitivity often lasts for 24-48 hours meaning that if you exercise most days of the week, you can improve your blood sugar levels and insulin sensitivity.
All it takes is 20-30 minutes of activities such as brisk walking, swimming, raking leaves or water aerobics on most days of the week. Activities can be done continuously (i.e. one bout of 30 minutes) or throughout the day (e.g. 10 minute-bout, 3 times a day). But, remember, you need to regularly monitor your blood sugar levels to prevent drastic reductions in blood glucose levels (i.e. less than 5 mmol/L).
Feed your Muscles-Hit the Weights
Since glucose is the main energy source for muscles and muscle contraction can draw in glucose without insulin, the more muscle you have and use, the more glucose you will remove from the blood.
The best way to promote muscle growth is through resistance training exercises with free weights (e.g. dumbbells) or weight machines. Start by:
- Performing 10-15 repetitions of an exercise such as a bicep curl for one set
- Progress to 2 sets of 10-15 repetitions after a few weeks
- Progress to 3 sets of 10-15 repetitions at a heavier weight a few weeks after that
Be sure to incorporate as many muscle groups as possible (e.g. shoulders, biceps, chest, back, legs etc.) and let muscles groups rest for 48 hours before continuing with your resistance training exercises.
Tip: Bring a buddy! If you are new to resistance training, it is important to bring a friend that can both help you stay motivated, but can also help ‘spot’ you and make sure you don’t hurt yourself.
Improving Cardio-respiratory Fitness
Cardio-respiratory fitness refers to the ability of your heart and lungs to work to bring oxygen and nutrients to the body. People with better cardio-respiratory fitness are less likely to have heart disease and tend to live longer.
The best way to improve this type of fitness is through aerobic exercises that are continuous, rhythmic and use the same large muscle groups for at least 10 minutes. Aerobic exercises such as walking or swimming also help promote:
- Weight loss (which helps improve glucose control)
- Healthy circulation (important in the prevention of diabetes-related amputations)
- Good mood (aerobic exercises release ‘feel-good’ chemicals in the brain that can help manage depression)
- Healthy sexual functioning
Tip: Don’t force yourself into something you won’t enjoy. If you really don’t like cycling, but prefer swimming, then swim. Find an activity you can at least put up with and keep at it. Starting to exercise can be challenging but the longer you stick to it, the better it gets.
Note: It is important to continue to monitor blood glucose levels. Speak with a doctor before making drastic changes to your diet or starting an exercise program.
Source: 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009 November 14; 374(9702): 1677–1686. doi:10.1016/S0140-6736(09)61457-4