Can a Rural Asian Diet Prevent and Treat Type 2 Diabetes?

The USA has seen a disturbing increase in obesity since the 1970s. This increase in body fat stores for the average Americans has led to a marked increase in the prevalence of type 2 diabetes mellitus (DM). In the 1970s, about 5 million Americans had type 2 DM compared to nearly 30 million today. As if that was not bad enough, there are also another 90 million Americans who have the insulin resistant metabolic syndrome. This metabolic syndrome is generally accepted as a pre-diabetic state and also called pre-diabetes. Exactly what is driving this obesity and type 2 DM epidemic has been a matter of debate for many years. In recent years, as the problem has continued to grow, we’ve heard from a few researchers, quite a few of scientifically-naïve clinicians, and a growing number of journalists turned wannabe nutritionist “experts” who claim that Americans are getting fatter and developing type 2 DM largely because the US Dietary Guidelines told Americans to reduce their intake of dietary fat and especially saturated fat. These “experts” blame the modest reduction in the % of fat calories (from about 40% to 34% of calories) and the modest increase in % carbohydrate calories inspired, perhaps in part by the US Dietary Guidelines starting in the 1970s, for the expanding American waistlines we’ve seen over the past half century in the USA. These “experts” tell us that excessive insulin release caused by diets higher in carbohydrate are largely responsible for excessive calorie intake and the resulting epidemic of metabolic abnormalities that culminate in type 2 DM. Is their thesis consistent with the preponderance of the scientific evidence?Perhaps not, according to Dr. George King, a professor at Harvard Medical School and the Research Director and Chief Science Officer at the Joslin Diabetes Center. Dr. King, who is Asian-American, has spent a lot of time in China and is well aware that China now has far more people diagnosed with type 2 DM than America and that the prevalence of type 2 DM is increasing even faster in China and other Asian countries than it has in the USA over the past two decades (or longer). However, in China, the growing waistlines and increasing prevalence of type 2 DM are not associated with an increase in dietary carbohydrate. In fact, in China the growing epidemic of overweight and type 2 DM has been associated with a marked increase in fatty animal products and refined oils, along with a large increase in the % of calories coming from fat. At the same time, traditional starchy foods like rice, wheat, beans, yams, and potatoes have been declining and so has the % of calories from carbohydrate. Indeed, it is in urban areas of China where people are getting heavier and developing type 2 DM in unprecedented numbers. In the rural areas of China, where people are still eating more starchy foods and a lot less animal products and fat, the prevalence of type 2 DM has become far lower than in the cities. At the Joslin Asian Clinic they are recommending a high-carbohydrate diet based more on traditional Asian foods than the high-fat, low-carb foods that Americans are being told to eat in place of whole grains and beans, particularly according to the Paleo-Diet mythologists, in order to lose weight and prevent or treat type 2 DM. For the past two decades, Dr. King and colleagues at the Joslin Diabetes Center have recommended what they call a Rural Asian Diet (RAD), that is composed largely of plant foods high in complex carbohydrates and fiber and very low in fat. They recommend this in order to prevent and treat type 2 DM. The RAD is 70% carbohydrate, 15% fat, and 15% protein and has 15g of fiber per 1000kcal. Could a high-carbohydrate, very-low-fat diet actually be useful for preventing and even reversing type 2 DM?In his new book, The Diabetes Reset, Dr. King talks about cutting edge research he and others at the Joslin Diabetes Center and in other research centers around the world are doing. The introduction of this book discusses the research showing how and why a typical Western diet promotes weight gain and insulin resistance and eventually leads to the development of type 2 DM. He explains what it is about a typical Western-style diet and lifestyle that is largely responsible for promoting weight gain, insulin resistance, and type 2 DM. On page 94 Dr. King states:

“My own research has identified this approach as a highly effective diet for reversing and preventing type 2 diabetes. Our clinical trial of this [RAD] diet found that it encourages weight loss even without any calorie restrictions.”

Dr. King’s book provides guidelines on five important blood tests that people need to determine whether they are headed towards type 2 DM or, if they already have it, on how good a job they are doing at controlling it. It also provides a checklist that all people with diabetes need to monitor their health and reduce the risk of diabetes complications. Dr. King and co-author Royce Flippin do an excellent job of explaining how and why type 2 DM is becoming so common not only in Asia and North America but in Europe, Africa, South and Central America, Australia, and nearly all Pacific Island populations too. They explain in general terms what cutting research not only at the Joslin Diabetes Center but also at research centers around the globe are telling us, not only how and why we have a pandemic of type 2 DM but also some of the most promising measures that people can take to prevent and also treat type 2 DM. The second part of the book walks people through a twelve-week step-by-step action plan to put all the cutting-edge research on the role of a healthier diet, exercise plan, and other lifestyle factors for improving the treatment of the metabolic syndrome and type 2 DM. Useful medical tests and the newest pharmacological and integrative medical options are all discussed. Cognitive behavioral strategies that have been shown to work in clinical trials such as the Diabetes Primary Prevention and the Look AHEAD studies are also discussed.Bottom Line: This book is highly recommended, not only for those with type 2 DM, but also for those at risk of developing it because of family history or a history of gestational diabetes. Indeed, the book would also be of great value for any MD, RD, psychologist, or exercise physiologist who deals frequently with patients/clients with the metabolic syndrome and type 2 DM.By James J. Kenney, PhD, FACN