New Zealand is near the top of the list for countries with rampant levels of diabetes. Professor Jim Mann lays out the options for a nutritional approach to type 2 diabetes. 

Despite levels of diabetes and obesity reaching epidemic proportions in New Zealand, successive governments have failed to develop a national plan to manage and prevent these diseases. Several recent studies, highlighted in a previous Newsroom article and the latest UNICEF Innocenti report card, place New Zealand near the top of the list for this epidemic.

Public health researchers are calling on the Government to address the obesity and diabetes pandemic, in the same way it has listened and taken on board the need for urgent action with the Covid-19 pandemic.

Some solutions are staring us in the face. Dietary advice has been a cornerstone of treatment for people with type 2 diabetes for many years.  And now for the first time a dietary intervention has been shown to influence the structure of the pancreas and its potential to “recover” with appropriate changes to dietary habits. Based on this evidence, health experts want an urgent national campaign to implement tried and tested nutrition treatments as well as results of recent research.

Nutritional therapy for diabetes

Weight loss has long been known to improve overall blood glucose control. For those who require insulin treatment there’s also a need to monitor dietary carbohydrate to avoid blood glucose levels going too low or high. Reducing dietary saturated fats and sodium, along with increasing consumption of fibre-rich wholegrains and pulses, have the potential to lower cholesterol, blood pressure and blood glucose levels, all changes which would be expected to translate into long term health benefits.

Benefits of dietary fibre

Recent research published in 2020  provides  strengthened  evidence regarding the potential benefit of less-processed wholegrain foods on glucose levels.  In addition to the well-established beneficial effects on risk factors, there is now also direct evidence for the potential of dietary fibre to reduce the risk of developing diabetes in addition to reducing risk of complications and death in those with established disease.   

A series of large analyses of all  available evidence  clearly showed that those who chose fibre-rich diets have a 20% lower risk of developing type 2 diabetes than those consuming a low-fibre diet. However, an intake of at least 25 grams daily (well above the average intake of New Zealanders) is necessary to achieve appreciable risk reduction.

These researchers also found (in another review) that in people who had already developed diabetes, risk of premature mortality was reduced among high fibre eaters.

 These findings complement earlier research showing that, a diet high in fibre-rich foods, low in saturated fat and designed to reduce overweight, in conjunction with increased physical activity, radically reduce risk of progression to full blown type 2 diabetes in those with prediabetes.

New study shows total remission of type 2 diabetes with improved pancreas structure

It has always been assumed that diabetes, once it develops, can only be “controlled” rather than “cured”. Bariatric surgery or appreciable weight loss in type 2 diabetes can result in considerable improvement in blood glucose control to the extent that medication can be reduced or sometimes withdrawn.  However, it has been widely assumed that type 2 diabetes is a progressive disease. 

But now the DiRECT study in the UK has demonstrated total remission of type 2 diabetes, including the withdrawal of glucose lowering medications, for periods of up to 3 years. The intervention involved an initial period of marked weight loss (typically around 15kg) induced by using very low-calorie formula diets. This was followed by the gradual reintroduction of a conventional diet aimed to ensure long term weight maintenance. Remarkably, the majority of participants who reached the target weight loss achieved remission of type 2 diabetes. 

A recently published paper from the DiRECT study has further demonstrated the remarkable potential of this dietary intervention to influence the disease process. The researchers compared the appearance of the pancreas in responders with those who did not achieve their targeted weight loss. They showed that those who responded to the dietary intervention had a pancreas with a more regular appearance, and which contained less fat than the pancreas of those who did not achieve the targets. 

NZ Government action needed now

Diabetes has now reached epidemic proportions in New Zealand. Given the now overwhelming evidence demonstrating the benefit of dietary change to reduce the risk of developing diabetes at the population level, and of nutrition therapy to successfully treat those with prediabetes and diabetes, we ask why is nothing happening? 

Now that the evidence is clear, a national campaign to promote changes in eating habits, as well as measures at the local (DHB) level to ensure the availability of dietitians, nutritionists and other health professionals, are urgently needed.  The newly-elected New Zealand Government must take on board the imperative for action with regard to this epidemic of diabetes, as it has done in acknowledging the importance of tackling infectious disease.  

Professor Jim Mann is a Professor of Medicine at the University of Otago and the Director of Healthier Lives - He Oranga Hauora National Science Challenge.

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