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By: Dr. Wu Kuo-Pin
Diabetes is a common modern-day disease—as is obesity. Traditional Chinese medicine (TCM) believes that diabetes and obesity are closely related—usually due to improper diet leading to gastrointestinal damage and metabolic disorders—and that dietary conditioning for diabetics is vital.
A research review published in Diabetes/Metabolism Research and Reviews in 2018 summarized data from academic research on diabetes and obesity. Combining data from the United States and Europe, the risk of Type 2 diabetes in obese men was seven times higher than that of normal-weighted people, while the risk of Type 2 diabetes in obese women was 12 times higher.
In addition, a growing number of studies have also found that obesity is closely related to the risk of developing Type 1 diabetes. Recent studies are also concerned about the importance of metabolic functions provided by the intestinal flora, which may play a key role in obesity and diabetes. This is consistent with the TCM viewpoint that regards the gastrointestinal system as the de facto pathology center of diabetes.
Higher Diabetes Risk in People With Abdominal Obesity
TCM divides obesity into “real fat” and “puffiness” according to the patient’s constitution. A real fat physique is due to over-eating that exceeds people’s metabolic capacity. On the other hand, people who are puffy often say that “even drinking water makes them fat,” and they really don’t eat that much. This is caused by endocrine and metabolic dysfunction resulting in decreased metabolic capacity.
Intra-abdominal (visceral) obesity refers to the type of obesity in which body fat accumulates mainly in the waist and abdomen, resulting in waist size greater than 90 cm (38.6 in) for men, and greater than 80 cm (31.5 in) for women, with waist to hip ratio greater than 0.90 in men, and greater than 0.85 in women.
Among people with excessive body mass index and abnormal waist circumference, the risk of diabetes is increased significantly. A big belly indicates excess fat and white adipose tissue in the abdominal cavity and the viscera, which affects metabolic functionality and could lead to metabolic syndrome. Tagged as the “root of all evils,” obesity is closely related to diabetes, hypertension, lipid metabolism disorder, atherosclerosis, coronary heart disease, hyperuricemia, and is a trigger for many other diseases.
We can safely say that diabetes is caused by over-eating and what we are choosing to eat. According to TCM, the pathological center of diabetes is in the gastrointestinal tract, which indirectly causes damage to the auxiliary digestive system such as the liver, gallbladder, spleen, and pancreas.
Why Do Diabetics Lose Weight?
In ancient Chinese medicine, diabetes was called “three excesses and one deficiency.” The three excesses were excessive eating, drinking, and urinating, and the one deficiency was weight loss.
In individuals with diabetes, a lack of adequate insulin hinders the body’s ability to transport glucose from the bloodstream into the cells for energy. As a result, the body resorts to breaking down fat and muscle tissue to generate energy, leading to a decline in overall body weight.
So, due to the deficiency, it would seem that diabetic patients should be slim. But today, most diabetics are obese and do not possess the symptoms of the “three excesses and one deficiency” as in ancient times. Why is that?
One reason is that most diabetes is now detected at an earlier stage and obesity is believed to account for 80–85 percent of the risk of developing Type 2 diabetes. Thus it becomes impossible for some patients to lose weight before they have excessive eating, drinking, and urinating. Another reason is the effective control of symptoms using drugs. The immediate application of hypoglycemic drugs as soon as the “three excesses” symptoms appear is effective in suppressing the development of the “one deficiency.”
There are three reasons diabetics lose weight:
- Illness. When blood sugar levels are consistently elevated, the condition of “three excesses” emerges, eventually leading to the transformation into the state of “one deficiency.”
- Dieting. When some people learn they have diabetes, they may be hesitant about what to eat and drink, and may naturally lose weight.
- Drug side effects. Taking certain blood sugar-lowering drugs such as metformin for some time may result in weight loss.
9 Clues for Early Detection of Diabetes
What are the symptoms that trigger the alarm of possible diabetes?
Ongoing fatigue.
Unexplained weight loss.
Repeated infection, such as intractable vulvar itching, recurrent vulvar and vaginal fungal infections, or recurrent furunculosis (infection of hair follicles).
Impotence.
Polyuria (excessive urination) and polydipsia (excessive thirst).
Occasional positive urine sugar but normal fasting blood sugar.
Reactive hypoglycemia (drop in blood sugar after a meal). Palpitations, sweating, and tremors that occur when the stomach is empty.
Arteriosclerosis, coronary heart disease, and fundus (back surface of the eyes) lesions.
In the elderly, symptoms include unexplained sensory impairment, autonomic nerve dysfunction, urinary retention, urinary incontinence, lower extremity vascular disease, myocardial infarction, kidney disease, and stroke.
Principles in Diabetes Diet
- Avoid overeating and eating too fast
Stop eating when seventy to eighty percent full, and chew thoroughly.
- Soup first
If you’re having soup with a meal—have it first—this will increase satiety and help you to lose weight naturally. Soup after a meal can cause flatulence, and it is not good for digestion or metabolism.
- Balance meat and vegetables
Increase your vegetable consumption and reduce your meat intake. Aim to incorporate vegetables into most of your meals, striving for a balanced combination of both meat and vegetables.
- Eat protein first
Eat foods in the following order: meat (have less of it than vegetables), followed by vegetables (have more than meat), and finally starches. Digestive enzymes in the stomach are mainly used to digest fat and protein. Eating meat first will better utilize digestive enzymes and help in avoiding flatulence. Eating starch first is likely to make your blood sugar rise quickly. By eating in the order of meat, vegetables, and starch, your blood sugar will remain more stable, making it easier to lose excess weight.
- Eat the right kind of fruits at the right time
Include green and less sweet fruits in your diet, such as citrus, especially limes, lemons, peaches, kiwis, avocados, guava, etc. It is recommended to eat fruit after lunch and before dinner—since there is generally less activity after dinner it is difficult for the body to consume all the blood sugar before bedtime.
- Eat less for dinner
Try to eat less starchy foods at night and eat an overall smaller amount.
- Eat white rice and millet
Brown rice is fine only on occasion.
I have noticed in my clinical practice that when some diabetic patients eat staple foods like brown rice or five-grain rice long-term they end up with poor blood sugar control. As a result, they are more prone to qi deficiency, frailty, and even muscle loss, because eating the harder-to-digest brown rice consistently will consume too much energy from the spleen and stomach. According to TCM theory, “the spleen governs the muscles,” and when the spleen has insufficient energy, the bulk of muscles will also decrease.
I often advise diabetics to make their meal with half of white rice and half of Foxtail millet. The ancients believed that millet could cure diabetes, stabilize blood sugar, and help maintain good mental and physical strength.
