Food as medicine is the new buzzword as researchers have found that type-2 diabetes can be put completely into remission with dietary interventions alone.
Or is this really a very ancient concept going back to Hippocrates, the father of Western healthcare? More than two thousand years ago he called for food to be used as medicine as the first port of call.
Researchers point out that in the US 1.4 million adults are every year newly diagnosed with type-2 diabetes, and that most of them can achieve complete remission by a change of lifestyle alone; that means dietary interventions and exercise after starchy meals.
This is great news for those suffering from diabetes; it means not having to inject themselves or take medicines that are expensive and have side-effects of their own.
Diabetes has a high degree of mortality; the inflammation of the lining of capillaries caused by chronically raised blood glucose reaches to every cell in the body. In particular the threat of heart disease and stroke soars in those suffering from the disease; but it can be completely reversed without medication.
Of concern is the resistance of patients to make these lifestyle changes, choosing rather to stabilise their blood-glucose with medical intervention. Researchers again confirm that neither oral drugs or insulin can bring about remission; it is simply palliative.
Are we addictive to refined carbs or is it simply habit? We get up in the morning, add sugar to our coffee and quickly swallow a bowl of highly glycemic cereal. Providing zero satiety that means our bodies are demanding a cola and cookie by mid-morning.
Added to that we would usually move immediately to the car and a desk-bound job; chronically raised blood glucose can be expected within a decade and full blown diabetes after twenty years.
What will take it turn this lifestyle around?
It may appear cynical but it is apparent that food companies are hell-bent at extracting the best parts from grains in particular, processing them and then selling them to us at fifteen times the price.
In South Africa, 100% whole-grain grits costs R4/kg direct from the farmer. Fresh corn on the cob is around R20 per kilogramme.
But highly refined cornflakes from which most of the nutrients have been extracted costs R60/kg.
The strategy of researchers who found that type 2 diabetes can be reversed was centred on whole foods. That means turning one's back for ever on cornflakes for breakfast and enjoying perhaps a bowl of grits, known in South Africa as mealie-meal.
Researchers found that diabetics could achieve complete remission if the they returned to a plant-based diet. That would not mean eating no meat or dairy products, but the inclusion of a great many fruits, salads and vegetables that they previously eschewed; and legumes for protein.
There was a high level of consensus that very low carbohydrate diets increased the risk of significant adverse events.
Very low was not defined but probably would mean less than 20g of carbohydrate per day; roughly that of one slice of bread. This would put a patient into ketosis, not undesirable, but should be under the careful management of a clinician skilled in prescribing food as medicine.
Fasting in one of its many forms is recommended; the simplest is just to make a longer period between meals.
So time-restricted fasting for example would mean eating dinner by 6pm and enjoying your grits or steel cut oats and blueberries after 8am; and preferably even later. A 15 hour gap is ideal.
The longevity diet recommends what they call fasting-mimicking. Plant based meals, very low in refined carbs and protein but higher in fat tricks the body into thinking that you are going without food apparently.
They specifically recommend however that the elderly should not go on a low protein diet; it is associated with loss of muscle mass and frailty.
A fifteen minute walk after lunch is recommended, and in fact that should be the case after any starchy meal. A return to hiking as a pastime would do one a power of good too.
Of course swimming and cycling and one of many other forms of exercise would be just as good.
For breakfast half a cup of a whole-grain cereal such as cooked steel cut oats or grits is recommended, fruit such as apple or blueberries and some vegetable protein.
Our recommendation is Eggs Florentine, perhaps including some green beans. On half a slice of 100% wholemeal toast is an option if you can find it but that is unlikely unless your bake it yourself; you won't find it supermarkets.
Eggs are out, or are they in? They are one of the few sources of vitamin B12; a deficiency causes a particularly pernicious form of anaemia.
The usual commercial breakfast never tasted as good as this food as medicine.
For lunch, a vegetable soup and a dark-green leafy salad is recommended with many different coloured vegetables. An added protein could be some legumes like hummus, or even a small piece of cheese. For a starch new potatoes or one slice of artisan sourdough bread would be good examples of whole food as medicine; corn on the cob too.
Make lunch your main meal.
Dine like a pauper not later than 6p.m. Dark green leafy vegetables like broccoli would be idea with a small helping of starch, perhaps a sweet potato, butternut or pumpkin. Fish or free-range chicken would be ideal, with red meat perhaps once or twice a week. Legumes like beans or peas would be excellent alternatives for protein of plant origin.
It's important to have some liquid before dinner; rather than a beer choose a herb tea of sorts. This oats milk infusion is one of my favourites, but there are dozens to choose from.
Half a glass of wine, spirit or even a little dry mead with your meal is an option rather than before dinner; the alcohol is rapidly absorbed making you tipsy and being turned in the liver into triglycerides.
Using food as medicine means you are needing these nutrients daily just as you would need metformin or insulin. Making such a drastic change as this is likely to be very difficult. Our recommendation is to take it one step at a time; choose one and don't add another until you have been completely successful incorporating that. This is for life.
In no particular order of merit, these are the steps to consider; choose the easiest first.
Work hard at food as medicine when you are at home. On high and holy days, don't binge, but go out and enjoy yourself.
Food as medicine is increasingly finding its way into mainline care. Success in entirely dependent on patients who are willing to ring in these intensive changes and are determined to adhere to them; it's a whole life-long change of lifestyle.
The longer you have been diabetic the less likely you will be able to achieve full remission; however your blood glucose would be far more stable when choosing whole foods, mostly of plant origin. You will need far less medication.
Choose life; look to food as medicine over drugs for complete remission. It will be a whole new way of living. Quite soon you will find it tastes much better than commercial meals.
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