How do other cultures deal with diabetes?
August 23, 2012 4:02 AM   Subscribe

I recently discovered that I am well on my way to Type 2 diabetes. So I am taking the steps recommended by my docotor and everyone else: trying to lose weight, cut out sugar and simple carbs, etc. I am curious about cross-cultural recommendations for pre-diabetics. For example, perhaps some European countries seem to think that taking B vitamins can keep diabetes at bay? Or there is some folk wisdom that recommends using teaspoons of vinegar before (after?) meals to help regulate blood sugar? And yes, I realize that type 2 diabetes is much more common in the US than elsewhere. I'm hoping to steer this conversation away from "Americans are lazy gluttons" and more toward "here are some potentially helpful things to do that an American doctor wouldn't know to mention."
posted by Jane Austen to Health & Fitness (25 answers total) 13 users marked this as a favorite
I am American and I have dealt with the pre-diabetes issue.

After taking a nutritional class at my doctor's office, I came away with a fairly decent knowledge of how to control the issue... or so I thought.

I was discussing this on an email list I belong to and a Canadian woman told me that the Canadian and UK nutritional guidelines were a lot different. She had spent 20 years managing her husband's diet, and he was heavily involved in diabetes education.

The key difference was, say, I was taught that if you can't be bothered to look at labels and weigh your food, to use the plate method. This is because many people are so overwhelmed, that just getting them to cut back on starchy carbs like rice and pasta and fill 1/2 their plate with good veggies like greens or broccoli is a good step in the right direction.

But she pointed out that one really needs to measure and/or weigh portions, and pay attention to the glycemic index of foods. After all, how big is your plate? What if you pile the rice up high in the little section?

It was stressed to me that learning to manage diabetes, with nutrition, exercise, and meds (if necessary) was at least a year long process. And that adding exercise is one of the most important lifestyle changes you can make when you have pre-diabetes. I am pretty sure they did cover glycemic index in my class, but the main thrust of their education was: a carb is a carb is a carb, and my friend grew incensed at this, saying that is patently untrue and I needed to look at the glycemic index of everything I put into my mouth. So I think that's a huge difference between what my doctor's office was telling me and what they teach in other countries.
posted by Marie Mon Dieu at 5:26 AM on August 23, 2012 [2 favorites]

Folk wisdom rarely works, or else it wouldn't be just folk wisdom. Marie Mon Dieu is right- you have to learn and understand how sugars work through the body and what the glycemic index is and how to use it to eat more healthfully.

Also exercise and muscle mass retention/rebuilding.
posted by gjc at 6:25 AM on August 23, 2012 [2 favorites]

I am prediabetic and I found that the recommendations I got at an American clinic were way off in terms of the carb count I need to stay healthy. They were still recommending a meal that had 2-3 servings of carbs - they seemed like they knew that that was too much, but they couldn't bring themselves to actually tell people to give up bread/pasta. I've found my blood sugar stays much more stable when I stay below 20 grams per meal.
posted by chaiminda at 6:47 AM on August 23, 2012 [2 favorites]

According to my [American] endocrinologist, eating more fiber can you help you digest carbs more safely, somehow.
posted by 168 at 6:54 AM on August 23, 2012 [1 favorite]

Many diabetics, American and otherwise, hate the ADA's dietary recommendations. You might benefit from some of the online communities, like tudiabetes and dlife.
posted by kestrel251 at 7:06 AM on August 23, 2012

Eating more fiber can help you because it is carbohydrate in an undigestible form. Undigestible carbohydrate is not as bad as the digestible ones. This is why Dreamfields pasta can claim to be "low carb", it claims to be made of undigestible carbohydrate sources.

I recommend looking at the glycemic load of foods and not the glycemic index. Why not the glycemic index? Well, the glycemic index is a good start, but it can give you bad data for a number of foods, particularly some vegetables like carrots or beets which really don't give you much glycemic response in normal serving sizes.

I am not aware of any secret way that other cultures do better with diabetes - and definitely not any folk wisdom (there was very little diabetes around historically in most cultures!). I think it's pretty well accepted that other cultures do better with diabetes because of features of their culture that encourage a better diet and exercise.

This does not mean that Americans are lazy gluttons. It means that we live in a society that makes it very easy for us to get little exercise and eat a lot of junk food/simple carbohydrates and sugar. Take the same people and move them into a European society, or an Asian society, or an African society, and their diet and exercise would likely improve - things like diet and exercise on a societal level have a lot to do with how towns and cities are structured, transportation options, what meals are traditionally eaten, foods available in restaurants and in stores, what foods are subsidized in agriculture, and so forth.
posted by treehorn+bunny at 7:28 AM on August 23, 2012 [3 favorites]

According to my [American] endocrinologist, eating more fiber can you help you digest carbs more safely, somehow.

I believe this is because it extends the period of absorption so that you don't peak as high as you otherwise might.
posted by Kid Charlemagne at 7:35 AM on August 23, 2012

My mother is type 1 diabetic and we have a family friend who is type 2. The main difference from what I've seen compared to my Grandmother in Law in the US (who is also Type 2) is that the Australian doctors seem to focus a lot more on the GI (Glycemic Index) of food, though from a labelling point of view the GI is on the food label to help make things easier to work out.

Exercise as a means to control blood sugar is also pushed with my family friend using mainly diet and exercise (she walks twice a day) while my GMIL who is of a similar age really just wanted to get onto tablets so she could keep eating pretty much the same way. Now these could be personality differences more than cultural as it's a pretty small sample, well and the fact that the town my mother and family friend live in has amazing weather with lots of lovely beach walks, so exercising is easier .

As for folk remedies things I've seen work are hot hot showers to lower blood sugar levels. Things she's been told by other people that my Type 1 mother has been told will cure her diabetes as people seem to think type 1 and type 2 are the same, she's ignored them as she'd rather do what her specialist with years of experience tells her to do are, a paleo diet, cinnamon tablets, calcium. She went vegetarian for a while for moral reasons and she says her sugar levels where easier to control when she ate lots of veggies, but she got very anemic so had to end that.
posted by wwax at 7:42 AM on August 23, 2012

In a BBC documentary last year, it was suggested that for many people weekly 3-minute high intensity training (HIT) can help with insulin sensitivity.

Somewhat sceptical I went off and dutifully did my four weeks of HIT, making a grand total of 12 minutes of intense exercise and 36 minutes of gentle pedalling. I then went back to the lab to be retested.
The results were mixed. My insulin sensitivity had improved by a remarkable 24%, which was extremely satisfying, but my aerobic fitness had not improved at all.

The presenter in question was Dr. Michael Mosley, as discussed in this recent thread.
posted by Jakey at 7:44 AM on August 23, 2012 [1 favorite]

For the information you're looking for, one useful term might be "ancestral health," which includes folklore and older traditions relative to food, health, etc. The Weston A. Price foundation has some interesting articles, including information specific to diabetes management (although with all health info on the internet, apply skepticism).

I also really like the blog Whole Health Source, by researcher Stephen Guynet, and he has a number of articles up already on metabolic syndrome, including insulin resistance/pre-diabetes, including information from traditional nutrition.

Also, as an aside, there's some evidence that Dreamfields Pasta isn't actually that different from regular pasta, at least in terms of how it affects blood glucose.
posted by pie ninja at 8:00 AM on August 23, 2012 [3 favorites]

Look into metformin some studies say it reduces the chance of becoming diabetic by 30%. Could help with the weight loss too. Google results for metformin prediabetes
posted by ill3 at 8:06 AM on August 23, 2012

I'm Type II and went on 10 Day Vipassana meditation course. One of the pleasant side effects of that was dropping 10-15 pounds and getting my blood sugars in normal range (waking up between 90-100).

Meals were strictly vegetarian, though one could eat as much as they wanted. There was no dinner, only a piece or two of fruit at 5pm, along with tea or water. Exercise consisted of just walking, maybe a mile or two a day. Otherwise, most of the day was spent sitting and meditating. Oral meds, metaformin were the only medication taken, though previously I had need a daily shot of Levemir to help keep the numbers in line. The only real problem that I noticed was that I tended to spike more highly after a meal than usual.

Once the course was over, I continued eating in a similar fashion (but added some meat back in) and kept dinner to something light, while doing virtually no exercise. Numbers stayed low and weight has been slowly sliding off.
posted by Brandon Blatcher at 8:10 AM on August 23, 2012 [4 favorites]

Please investigate ketogenic diets and consider the idea that complex carbs can be removed from the diet as well. As far as I (IANAD) can tell, a very-low-carb (non-starchy vegetables only), high-fat, moderate-protein diet pretty much instantaneously cures actual, full-blown Type II diabetes.

To get to the international angle, LCHF is all the rage in Sweden now.
posted by callmejay at 8:17 AM on August 23, 2012 [2 favorites]

posted by callmejay at 8:17 AM on August 23, 2012

Best answer: Both biotin (vitamin B7) and cinnamon have shown some benefit for treating diabetes. I don't know of any studies regarding their use in prevention.
posted by zinon at 9:31 AM on August 23, 2012

" I realize that type 2 diabetes is much more common in the US than elsewhere. " -- you'd be surprised; it's pretty common in India, China, Japan, and Korea as well, if I recall correctly. Older diets in Japan (a lot less rice and a lot more vegetables and fish) were more successful at holding down diabetes rates, but things changed... This article about the Okinawan diet suggests that it could help reduce occurrence of diabetes.

Some Japanese people have told me that eating bitter melon is helpful.

Good luck!
posted by wintersweet at 9:43 AM on August 23, 2012 [1 favorite]

Seconding the interval training and Weston A Price / Whole Health Source comments above. In addition to that, resistance / weight training also increases insulin sensitivity and [may help prevent diabetes]( Compound lifts like squats, pressing, and rowing will help more than isolation machines because they work more muscle harder.
posted by Earl the Polliwog at 11:30 AM on August 23, 2012 [1 favorite]

Oh gosh, I've been redditing too much.

Here's the link from above, fixed: May help prevent diabetes
posted by Earl the Polliwog at 11:32 AM on August 23, 2012 [1 favorite]

I've read that intermittant fasting can cure type II diabetes.

5-2 or Alternate Day Fasting might be some moderate fasting options for you.

But as always, check with your doctor before starting any new dietary restriction.
posted by j03 at 12:26 PM on August 23, 2012

Response by poster: OK, I don't want to lash out at the nice folks trying to help me on MeFi. But.

I was not looking for the same panoply of medical advice given to every fat person in America--suggestions of low carb diets, exercise, prescription medication. I'm not asking for double-blind peer-reviewed studies, either--folk wisdom is always taken with a grain of salt. And for these purposes I'm not sure that Australia even counts as a different culture, esp. since their work in the Glycemic Index studies seems to be the established medical protocol here, too. Let's assume, just for the purposes of this question, that I am a reasonably intelligent adult who has read a news article in the past decade.

In fact, maybe I should go back to the beginning and say that I'm just idly curious about diabetes in other cultures. I was looking for small anecdotal tidbits like the ones about bitter melon, and hot showers. And maybe I'll change my username to Bitter Melons.
posted by Jane Austen at 1:24 PM on August 23, 2012 [2 favorites]

Best answer: There is apparently something to the apple cider vinegar thing.
posted by Earl the Polliwog at 1:32 PM on August 23, 2012

Ok perhaps I can give a different answer. I run a nonprofit in sub-Saharan Africa as a volunteer thing, and one of the things that we do is hold eye camps. During screenings for the camp we encountered a girl living in one of the rural villages with cataracts, who had become completely blind. Obviously having cataracts as a 20 year old girl is not typical, so we had her brought in for the camp, and found that she was suffering from diabetes, which had caused the early cataracts.

Because of her blindness, she was not able to do anything around the house, and she would spend her days sitting around in the dark, not doing anything at all, just waiting to die. When the diabetes was diagnosed, we tried to arrange for her to have cataract surgery, but the ophthalmologists refused because her blood sugars were out of control. So she was admitted to the hospital and put on oral therapy (metformin) and given instructions on diet.

The diet instructions from the nurses at the hospital were that she must cut millet porridge, cassava, sweet potatoes and fruits out of her diet. They recommended that instead she switch to "Irish potatoes" (regular potatoes), rice, and plantain porridge. Her family was very distraught because they could not afford the more expensive food. As you know if you've researched glycemic index, this advice is nonsensical - although rice is relatively lower in glycemic index and millet porridge is relatively pretty high, potatoes are higher than sweet potatoes and cassava is one of the lowest options next to rice. And this girl clearly had problems far beyond the type of potatoes she was eating.

Her parents started to spend the money for her to eat rice, and she took up eating rice and greens for every meal, three times a day. Despite the insulin therapy, her blood sugars remained difficult to control, probably because she had had uncontrolled sugars for so long. Finally, we had her re-hospitalized to control the sugars temporarily and got her the surgery. A quote from the staff: "When we picked her up today I couldn't believe it was the same woman we delivered there four weeks ago; she'd put on some healthy weight, she was walking around with ease, able to see well, and smiling. When we put her in she moved like an old woman, in pain, stiff, unable to move fast or without assistance. She was smiling and laughing the rest of the way home. "

Of course, there is no cold chain for insulin in the village, and her parents could not afford to buy her the insulin she needed. Therefore, it is nearly inevitable that she will deteriorate again and that she will suffer an early death. It was hard to justify spending money to treat her at all, but the staff had become quite attached to her and were so joyful when she regained her sight (even temporarily).

Unfortunately I suspect that the fate of many children and young people in sub-Saharan Africa with diabetes still reflects what used to be true everywhere before insulin was purified.

"Children dying from diabetic ketoacidosis were kept in large wards, often with 50 or more patients in a ward, mostly comatose. Grieving family members were often in attendance, awaiting the (until then, inevitable) death.

In one of medicine's more dramatic moments, Banting, Best, and Collip [the scientists who first extracted and purified insulin] went from bed to bed, injecting an entire ward with the new purified extract. Before they had reached the last dying child, the first few were awakening from their coma, to the joyous exclamations of their families."
posted by treehorn+bunny at 3:41 PM on August 23, 2012 [2 favorites]

According to some guy I came across on the net and whose qualifications I have no clue about (disclaimed enough?), chana dal is very helpful for people with diabetes. And from personal experience, wow is it tasty. It has a buttery richness that other dals I've tried just don't.
posted by Lexica at 6:44 PM on August 23, 2012 [1 favorite]

Best answer: I've recently been reading up on the benefits of curcumin, a substance found in turmeric, found frequently in curries in the prevention of diabetes. Here's a link: link
posted by metaphorical at 7:04 PM on August 23, 2012

Best answer: In Mexico they use Nopalito (cactus) to control blood sugars.
posted by french films about trains at 1:19 PM on August 30, 2012

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