Blog: Treating Type 2 Diabetes – What Common Advice Misses
Dr Sean Wheatley, MSc, PhD; Science and Research Lead at X-PERT Health.
Sean.Wheatley@xperthealth.org.uk
If you have type 2 diabetes, you have probably been told to lose weight. That advice is not wrong — but it may be incomplete.
Last month’s blog, available here, examined the causes of type 2 diabetes. Most importantly, it suggested a slight change to how we think about it. This month, we outline what this might mean for how we think about treating type 2 diabetes, including the possibility that some useful options are often missed.
N.B. This blog focuses on lifestyle-based treatments. There are, of course, medications that can be helpful. It is beyond the scope of this blog to discuss them, though.
Tri-cycle Hypothesis – A (Very) Brief Recap
I won’t repeat the detail of last month’s blog, but the gist is that issues in the liver, pancreas and muscles all contribute to the development of type 2 diabetes. Taking steps to reduce or remove any of these issues can therefore help to improve its management.
Reassuringly, there are multiple options for trying to address these issues.
Treatment Implications
Effective treatments for type 2 diabetes can help to lower blood glucose levels, reduce the need for medication, and even help some people to achieve remission. This can reduce the risk of complications being experienced, both in the short- and long-term.
To address the issues outlined in last month’s blog (i.e., in the “tri-cycle hypothesis”), there are three key lifestyle-based treatment strands:
- Reducing body fat.
- Reducing carbohydrate intake.
- Increasing muscle mass.
Fat loss is often the focus of existing treatments, and approaches that reduce carbohydrate intake are increasingly popular (though still, arguably, underused). Building muscle mass is rarely a priority, though. This may be missing an opportunity.
Each of these options is discussed further below. Importantly, though, any (or all) of these treatment options can be used together.
Strand 1 – Fat Loss
Losing body fat can lead to there being less fat stored in the liver, pancreas and/or muscles. This helps to address the issues mentioned earlier (and explored in last month’s blog). Most importantly, it means they can carry out their role in managing blood glucose levels more effectively.
Options for Losing Fat
Improving the Quality of Your Diet
Making changes to your diet tends to be the best way to reduce body fat. There are lots of different approaches to this, though we generally recommend focusing on what is eaten rather than just how much.
Importantly, improving the quality of your diet can help to reduce hunger. This makes it easier to stick to your new eating pattern. Specific tips for doing this include:
– Trying to avoid ultra-processed foods as much as possible, and choosing minimally processed foods instead. As a rule of thumb, foods with five ingredients or fewer tend to be minimally processed. Especially if you recognise the ingredients as being natural).
– Build your meals around one or two portions of protein. Examples of a portion of protein include 85g chicken or red meat, 100g fish, three eggs, or 200g pulses or lentils (all weights are cooked weights).
The Role of Physical Activity
On its own, physical activity is not usually the best way to lose weight. Ultimately, you can’t outrun a bad diet!
However, physical activity can be particularly good at helping to reduce the amount of fat that is stored around your middle. This can help to reduce fat storage in your liver and pancreas, even if total weight does not change much. It therefore helps to address some of the underlying causes of type 2 diabetes.
Other Practical Tips
A range of other practical suggestions are outlined in our “What I Need to Know” leaflet on weight loss, which can be accessed from here.
The full range of these leaflets, which includes an introduction to a range of different dietary approaches which can help with weight loss, can be accessed from here.
Strand 2 – Reducing Carbohydrate Intake
Reducing carbohydrate intake can have a number of benefits, including that it can help with fat loss. In relation to the tri-cycle hypothesis though, the most relevant additional benefit is that it means the pancreas doesn’t have to work as hard.
When less carbohydrate is consumed, less insulin is produced. This allows the pancreas more time to rest, which can help to improve how well it works.
Reduced insulin levels can also reduce fat storage and insulin resistance in the liver and muscles too. Consuming less carbohydrate can therefore have benefits for all three of the cycles introduced before.
Guidance on Reducing Carbs
“Reducing carbs” might mean experimenting with a low carbohydrate dietary approach, or it might just mean having fewer (and/or smaller) portions of carbohydrate than you have been.
“Low carb” is usually classed as having less than 130 grams of carbohydrate per day. Many people choose not to track their carbohydrate intake this closely though, and see benefits simply by cutting out starchy and/or sugary foods and drinks*.
Importantly, there is plenty of evidence available to show that reducing carbohydrate intake is safe and can be effective for people with type 2 diabetes**.
Additional Support
Resources that can be helpful if you would like to reduce your carbohydrate intake include:
– The Freshwell Low Carb Project – this provides a range of useful tips and suggestions (e.g., at https://lowcarbfreshwell.com/going-low-carb/), including about foods which are good options when following this eating pattern. It is also available as a free App.
– Diet Doctor – this also provides a range of useful practical resources, including this article which outlines how to reduce the risk of some of the side effects people sometimes experience when they first adopt a low carb approach.
Strand 3 – Increasing muscle mass
Building muscle is rarely discussed as part of diabetes management, but it probably should be.
Taking steps to build and maintain muscle mass can have a range of benefits for health and wellbeing. Most importantly in relation to the tri-cycle hypothesis, having more muscle means there is a greater capacity for the body to store and use glucose. This reduces the amount of glucose that is left in the blood, which helps with the management of type 2 diabetes.
Having more muscle also increases metabolic rate (i.e., it makes the body burn more energy). This helps with weight management, which, as explored above, can have further benefits.
Importantly, when we say, “increasing muscle mass”, we don’t mean you need to become a bodybuilder. Any increase in muscle mass can have a positive effect, as can any reduction in muscle loss. This latter point is particularly relevant as we get older.
Tips for Building Muscle
The general recommendation is to try and take part in some muscle-strengthening activity at least twice each week.
This doesn’t have to mean lifting weights or going to the gym though. It can include body weight exercises (such as press-ups, sit-ups, lunges and squats), or even everyday activities such as carrying the shopping or doing the gardening. Anything that makes your muscles work against a resistance can be suitable.
Importantly, you should try to find some activities that you enjoy and that you can fit into your routine. Doing this will make it easier to regularly take part in these activities in the long-term.
Progression
Whatever activities are chosen, you should try to gradually increase the amount you do over time. This might mean lifting a slightly heavier weight this week than you did last, repeating the exercise/activity more times, or taking part in the exercise/activity for a little bit longer.
Ways to build up activity levels were explored in one of our previous blogs.
The Importance of Protein
If you want to support the growth and maintenance of your muscles, it is also important that you get enough protein. In line with the suggestion earlier in the blog, building your meals around one or two portions of protein will help with this.
Protein can also help with weight management and can be a suitable swap for some of the carbohydrates in your diet. Prioritising protein can therefore help with all three of the treatment strands outlined here!
So, What’s the Bottom Line?
Most people who are diagnosed with type 2 diabetes are told to try to lose weight. This is still good advice, but it is not the only option. Other approaches that can also help, but which are not always prioritised, include reducing carbohydrate intake and taking steps to increase muscle mass.
Reducing body fat, consuming less carbohydrate, and building muscle can all help to tackle the underlying causes of type 2 diabetes – specifically, issues in the liver, pancreas and muscles. This will improve its management and reduce the need for certain medications. In some cases, it may even help to put type 2 diabetes into remission. Importantly, any (or all) of these approaches can be used together.
* Examples of starchy foods include potatoes, rice, pasta, bread and breakfast cereals. Examples of sugary foods and drinks include jam, fizzy drinks, sweets, cakes, biscuits, and desserts; as well as foods with natural sugars, including fruit, milk, honey and yoghurt. Some suggestions for what these foods can be swapped for can be found at https://lowcarbfreshwell.com/going-low-carb/carbs-top-tips/.
** You should, however, discuss any plans to significantly reduce your carbohydrate intake with your healthcare team before you make them if you are taking any medication to help manage your diabetes and/or blood pressure. For more information on the use of low carbohydrate dietary approaches for people with type 2 diabetes, see our position statement on the subject.
