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Nutrition as the epicentre and denominator in diabetes reverse code

Chukwuedozie Francis Nwachukwu*

Department of Biochemistry/ Forensic Science, Faculty of Science, Nigeria Police Academy, Wudil Kano State

*Corresponding author

*Chukwuedozie Francis Nwachukwu, Department of Biochemistry/ Forensic Science, Faculty of Science, Nigeria Police Academy, Wudil Kano State

Abstract

Diabetes is a complex and chronic condition traditionally regarded as incurable. However, emerging perspectives suggest the possibility of reversing the condition. This study explores the role of dietary interventions in managing diabetes. POLAC community received awareness on diabetes dimensions. Twenty volunteers underwent fasting glucose (FG) screening, with the diagnostic threshold at 126 mg/dL. FG was on four separate occasions. Among the 17 participants with at least one occurrence of hyperglycemia, six met the criteria of consistent hyperglycemia across all four measurements and enrolled for dietary treatment. Participants were monitored over ten days with four glucose measurements after meals. FG levels before meals were as the 0-minute baseline. Subsequent FG and random (bedtime, with a threshold of 200mg/dL) glucose concentration assessments were on portion-controlled diets (360±60g) consumed at specified 8-hour intervals for seven days. Body mass index (BMI) was determined using height and weight measurements before and after the intervention. All six participants exhibited hyperglycemia on four occasions. Certain meals, such as bread with tea and fried yam, caused postprandial glucose levels exceeding 200 mg/dL. Similarly, meals like Amala, Semolina, and Akpu triggered hyperglycemia in specific participants. By the 6th and 7th days, none of the participants exhibited fasting hyperglycemia. Significant reductions (glucose levels) were from the 4th day onward compared to baseline (P<0.05). Random (glucose levels) were normalized for all participants except one. BMI values decreased from pre- to post-intervention. The results indicate that dietary interventions can effectively reduce blood glucose levels and BMI, potentially disrupting the progression of diabetes.

Keywords: Diabetes, Dietary intervention, fasting glucose, random glucose and Body Mass Index

Introduction

Whole plant-based diets have a positive impact on health. Food (diet) is central to health [1]. In the globe, diet risk fuels 11 million deaths and 255 million disability annually [2]. Quality diet mitigates metabolic syndromes of any. Hence, the alterations that pave the development of metabolic syndromes reset to the basics. Whole grains, legumes, fruits, vegetables, and nuts have health benefits [3] and signify food as the epicenter and denominator in the plausible prevention and reversible Diabetes code [4]. The number of food-insecure diabetic individuals is increasing [5]. Unfortunately, caregivers oblivious to patients' lack of access to suitable diets are incapacitated in addressing the matter [6].

Diabetes is a severe, long-lasting illness characterized by a raised glycaemia level connected to the impact of anomalous β-cell biology on insulin function [7]. It is a disease of affluence but common among the poor and the rich in developing and developed countries [8]. It is driven by nutrition transition, increasing inactivity, and a sedentary lifestyle. The diabetes epidemic is comparable to the obesity epidemic, and the latter is among the factors driving the development of Diabetes [9, 4]. As obesity is plausibly reversible [10-11], addressing it could provide the opportunity to limit the spread of diabetes current trends. However, obesity rates continue to climb [12]. Diet has relevance in developing and reversing diabetes mellitus and its driver- obesity [13].

Evidence-based education emphasizes diet and nutrition as pivotal for individual diabetes [14]. As such, nutrition is the common denominator of Obesity and Diabetes [15]. Lifestyle changes, with emphasis on diet, could be excellent in effectiveness for the prevention and treatment and, in the long-run reversion of type 2 diabetes [16-17], is the research emphases. Nevertheless, the Westernized diet and others may accelerate the growth of diabetes in the context of rapid nutrition transition. However, reversibility should not be confused with the curability of diabetes, though it would be interesting to say cure. Reversing diabetes gives nearly the same benefit as a cure. Many old-schooled or worse treatments believed in erroneous dichotomy. They teach that drugs are exclusive in the management of diabetes. It worsens with time. Yet Hippocrates opined: eat food as drugs or drugs as food. The choice is free.

Diabetes mellitus is a public health crisis threatening the economic development of all nations, particularly developing countries [15], indeed a substantial burden on health care [7, 18-20]. It is one of the leading causes of disability and death globally [21-22]. The researcher considers mindful food choices and portion sizes as a way to discontinue the epidemic trend of diabetes. Diet for therapeutic purposes of the research scope could be cumbersome when multiple individuals are involved. The researcher is optimistic about the best result if tailored to an individualized diet, hence the individualized diet approach to mitigate diabetes. Health is wealth; the research speculates that if you eat food that spikes blood sugar levels meal after meal, day after day, and week after week, you do much more harm than set the stage for diabetes: you also set it for cancer, heart disease, and others. The research would be significant to diabetes as it aims to reverse this condition through food appraisals. The research novelty is the individualized and mindful portion approaches.

Materials and Methods

Materials: Accu Isaw, electronic balance, and standiometer were from the accredited distributor at Chriscare Medical Devices Nigeria Limited. Foodstuff, pot, and cooking gas were from the local market.

Methods: Orientation: Through campaigning on Diabetes mellitus awareness, Police Academy Staff received proper orientation on the dangers of living with diabetes mellitus and were oblivious to it. The campaign slogan is Diabetes mellitus makes a comic of health. Among the staff, volunteers who consented to the research aim were selected based on the research scope (individualized approach to diabetes mellitus management).

Participants' selection: Twenty volunteered staff (40 years old and above) underwent screening modality for hyperglycaemic testing. Fasting glucose concentration of 126 mg/dl and above on four separate occasion alongside confessed/reported evidence of diabetes was considered suitable for the research. The participant names were coded in alphabets (A, B, C, D, E, F, G, H, I, J, K, L, M, N, O P, Q, R, S, and T) to conceal their identity (for confidentiality). The results were considered pilot hyperglycaemic preliminary testing of 20 participants. Six participants (B, D, G, K, N, and S) fulfilled maximally the research requirement. The selected participants received a personalized/tailored feeding ratio with plasma glucose parameters monitoring.

Experimental design on tailored diet: The research method involves controlling the feeding ratio and managing portion sizes. The feeding ratio was individual routine feeding behavior. The participant's feeding was on several foods of different glycemic indexes and carbohydrate loads from the routine food. The capillary venous blood concentration was determined in the morning after 10 hours overnight fast and called a baseline. Afterward, the participant had the morning food on wholesome foods / minimally processed from the list of usually fed foods, and the plasma glucose concentrations were measured at 30-minute intervals of four times (8 pm-10 am). These 30-minute intervals were for the determination of the glucose homeostasis challenges through the food spike on glucose blood concentration. This procedure was ten times, all in the morning, to select the seven foods with the lowest impact on glucose concentration. The food selected was for portion control. In food portion control, the food-designed for participants' customization. The participant was tested on different food portions to ascertain commendation quantities and acclimatized to it. The following determined food portion size of 360±60g became adopted and spread across one week of morning and evening foods. The feedings between 8 to 11 am are for morning food. The feeding intervals were at least 8 hours apart. The evening meals run between 4- 7 pm. There was no night food. Water was drunk liberally.

Ethical consideration and sampling: The selected participant gave oral consent after the procedure was explained and understood. Maintaining the confidentiality of information is a top priority and these assurances were given to them. The research was in agreement with POLAC Guidelines on the use of humans for experimental purposes.

Statistical analysis: The data presentation was as mean and percentages. It was further subjected to Fischer LSD post hoc test using the SPSS Genstat Release software package version 20. Differences between means would be considered significant at p < 0.05.

Figure 1

Figure 2: Occasions of hyperglycaemia

Figure 3: Pre-analytical and analytic Body Mass Index

Table 1:Participant B morning postprandial blood glucose concentrations (mg/dl) in two hours.

Min. IT= Minutes Intervals, %= percentage increase in glucose concentration

Brd + tea= Bread with tea, Ama + Sup= Amala with soup (Amala= yam with bark flour), Bns porrid= beans porridge, Brdfrt + bns= Bread fruit and beans porridge, Yam porrid= Yam porridge, Frd ym = fried yam, Gar + sup= Gari with soup, YmB porrid= Yam and beans porridge, KdBns porride= kidney beans porridge

Number bearingh has value above 200mg/dl glucose concentration.

Table 2: Participant D morning postprandial blood glucose concentrations (mg/dl) in two hours.

Min. IT= Minutes Intervals, %= percentage increase in glucose concentration

Brd + tea = bread with tea, Sem + sup= semolina with soup, Bns porrid = Beans porridge, Brdfrt +bns = Bread fruit and beans porridge, Ym porrid =Yam porridge, Frd ym = fried yam, Gar +sup= Gari with soup, Ano + sup = akpu na ogwu with soup (akpu na ogwu= minimal processes cassava), Kdbns porrid= kidney beans porridge.

Number beraingh has value above 200mg/dl glucose concentration

Table 3: Participant G morning postprandial blood glucose concentrations (mg/dl) in two hours.

Min. IT= Minutes Intervals, %= percentage increase in glucose concentration

Brd + tea= bread with tea, Apku + sup= Akpu with soup (Akpu= processed cassava), Bns porrid= Beans porridge, Brdfrt +bns= Bread fruit and beans porridge, Ym porrid =Yam porridge, Frd ym = Fried yam, Gar + sup= Gari with soup, Ano + soup = akpu na ogwu with soup, (akpu na ogwu= minimal processed casssave), Kdbns porrid= kidney beans porridge.

Number beraingh has value above 200mg/dl glucose concentration.

Table 4: Participant K morning postprandial blood glucose concentrations (mg/dl) in two hours.

Min. IT= Minutes Intervals, %= percentage increase in glucose concentration

Brd + tea= bread with tea, Akpu + sup= Akpu with soup (Akpu= processed cassava), Bns porrid= Beans porridge, Brdfrt +bns= Bread fruit and beans porridge, Ym porrid=Yam porridge, Frd ym= fried yam, Gar +soup= Gari with soup, Ano + soup = akpu na ogwu with soup (akpu na ogwu= minimal processed cassava), Kdbns porrid= kidney beans porridge.

Number bearingh has value above 200mg/dl glucose concentration.

Table 5: Participant N morning postprandial blood glucose concentrations (mg/dl) in two hours.

Min. IT= Minutes Intervals, %= percentage increase in glucose concentration

Brd + tea= bread taken with tea, Tuwo + sup= tuwo with soup, Bns porrid = Beans porridge, Brfrt +bns = Bread fruit and beans porridge, Ym porrid =Yam porridge, Frd ym = fried yam, YmFl + sup= Yam flour with soup, Kdbns porrid= kidney beans porridge.

Number bearingh has value above 200mg/dl glucose concentration.

Table 6:Participant S morning postprandial blood glucose concentrations (mg/dl) in two hours.

Min. IT= Minutes Intervals, %= percentage increase in glucose concentration

Brd + tea= bread with tea, Sem + sup= Semolina with soup, Bns porrid= Beans porridge, Brdfrt +bns= Bread fruit and beans porridge, Ym porrid=Yam porridge, Frd ym= fried yam, Gar +soup= Gari with soup, Akpu + soup= akpu with soup (Akpu= processed cassava), Kdbns porrid= kidney beans porridge.

Number bearingh has value above 200mg/dl glucose concentration.

Table 7:Fasting glucose levels, after 1hr.30 minutes at wake-up time.

Numbers bearingh has glucose concentration above normal fasting level

Numbers bearing ⃰ is significantly difference at P<0.05             

Table 8:Random glucose concentration (mg/dl) at night bed time.

Numbers bearingh has glucose concentration above normal fasting level

Numbers bearing ⃰ is significantly difference at P<0.05.

Table 9: Meals (g) at two interval per day for one week 

Results

The results of this study are in Figures (1to 3) and Tables (1 to 9). Figures 1, 2, and 3 are the pilot preliminary glucose test, fasting plasma glucose concentrations, and pre-analytical and post-analytical Body Mass Index. Tables 1 to 6 represent the morning postprandial blood glucose spike intervals, measured every 30 minutes over four periods, for the six participants. Tables 7 and 8 are the one-week fasting and random glucose concentrations. Table 9 shows meal sizes at specified time intervals of 8 hours per day over one one-week period.

The pilot glucose concentrations among participants (Figure 1) were high (glucose concentration above 125mg/dl) once in four participants (A, E, O, and T), twice in two participants (P and R), thrice in three participants (C, F, and H) and four-times in six participants (B, D, G, K, N, and S). Three participants did not have glucose concentrations above 125mg/dl). Aside from these three participants, others have at least one occasion of glucose concentration above 125mg/dl (Figure 2). There is a reduction in body mass index among participants (from the pre-analytical to the post- analytical), as in Figure 3. The two-hour meal postprandial glucose concentrations were above 200mg/dl in five meals of participants (B and G) and four meals of the remainder (Table 1 to 6). Two meals (Bread + tea and fried yam) caused two two-hour postprandial glucose concentrations above 200mg/dl in all participants (Table 1to 6). The three meals- Amala (Table 1), Semolina (Tables 2 and 3), and Akpu (Tables 2, 3, and 4), caused two-hour postprandial glucose concentration above 200mg/dl in participants. The remainders have a two-hour postprandial glucose concentration of less than 201mg/dl. The percentage (%) change in the postprandial glucose concentration was highest in Bread with tea (99) from participants B and G (Tables 1 and 3) and lowest in Akpu na ogwu (13) from participant G (Table 3). The one-week fasting plasma glucose concentration (Table 7) was consecutively above 125 mg/dl in all the participants from the first to the third day. The participant's (K) and (G, K, S) plasma glucose concentrations were above 125 mg/dl on the fourth and fifth days. All participants' glucose concentrations were below 126mg/dl in the sixth and seventh weeks. The glucose concentrations on the 4th, 5th, and 6th day significantly differed from the 1st day at P<0.05 (Table 7).

In the random plasma glucose testing (Table 8), the plasma glucose concentration above 200mg/dl was only on the first day at Participant B. The rest of the participants were below 200mg/dl. The meal sizes (Table 9) of the largest and smallest portions were 420 and 360 g in the morning and a flat of 300g in the evening. The glucose concentrations were significantly different in all the days, with the 1st day at P<0.05 (Table 8). The feeding time varies from 8 to 11 and 4 to 8 in the morning and evening. The time interval per day was 8 hours in each day.

Lifestyle intervention- food portion size control at premeditated intervals is a basic approach for all persons with type 2 diabetes [23]. It becomes imperative for tailored food monitoring as the metabolism of the food components is the much-affected biochemical parameter, and treatment progress focuses on the improved metabolism of fuel components from food. Put differently, body utilization of food components is a progress indication. The researcher developed a food decision support strategy that predicts how dietary choices and portion sizes affect glycaemia.

Glucose concentration is for decision-making on non-diabetic, prediabetes, and diabetic states of individuals or groups, hence glucose determination of the twenty participants to establish their glycaemic status and define their condition (Fig, 1). Six participants, on account of four occasions of glucose concentration above 125 mg/dl (Fig. 2), were considered diabetic. It has been in previous reports [24] as confirmation of diabetes but with slight variation in their glucose cut-off and number of measurements making diabetes. The global mean of fasting plasma blood glucose cut-off of normal glucose concentration is a wide variation [25] as the cut-off is a lesser concentration (99mg/dl), maybe due to the requirement of stricter regulation and calls for effective prevention interventions. The foods, in the researcher's opinion, are effective therapy for diabetes and its sequelae.

Food type, degree of being processed, and portion size are glucose-hiked up factors. Bread with tea hiked up glucose concentration in all the participants, revealing glucose response from the impact of processed food. Food loses its fiber through processing, and fiber shields the quick glucose rush from digested food rushes and accumulates in the blood. Quaker oats, even as a processed food, did not cause glucose spikes above 200 mg/dl in all the participants. Other studies have revealed that oats or oat-rich foods strike a reduction in postprandial blood glucose and insulin levels [26-27]. Quaker oats have low glycaemic index and carbohydrate loads but are incredibly fiber-rich [28]. Fiber content is a factor in reducing glucose spikes. Aside from the glycemic index of food, carbohydrate load is a factor in the impact food has on blood glucose concentration. Again, oat proteins stimulate the release of insulin, an additional effect [29].

Among the staple foods (Amala, Akpu, Akpu na ogwu, and Tuwo), Akpu na ogwu spiked less and is the least processed, though the glucose spike did not reduce below 200 mg/kg. The research opined that carbohydrate load is partly a responsible factor. In addition, local processing, as in Akpu, would have been the consequence of why kapu na ogwu spike less glucose than others. Akpu na ogwu is minimally processed. Among these groups, it has the highest fiber content. Garri, yam porridge and breadfruit may have impacted less blood glucose because of the method of preparations [30]. Fried yam spike glucose beyond 200mg/kg in all the participants (Table 1 to 6), whereas the same does not apply to yam prepared differently, which is consistent with the exertion of Hodges et al. [30]. Low glycaemic index diets produce a lower postprandial blood glucose response [31], unlike the high glycaemic index food. It may be why these foods (Amala, Akpu, Akpu na ogwu, and Tuwo), spike postprandial glucose concentrations higher than 200mg/kg.

Further in this research, the fasting blood glucose concentrations of the six diabetic participants were at a wakeup time of one hour and thirty minutes (Table 7). The results showed a patterned reduction in glucose concentration, inferring the normalization of glucose concentration as food portion size control continues. The glucose stabilization in the normal range achieved in all participants on the 6th and 7th day showed food portion size in the range, and the time intervals used were helpful to the diabetic participants and normalized their blood glucose concentration. The body may (through food portion control) go to the metabolic calorie deficit. Calorie demand pushes the metabolic energy needs into retrieving calories from other sources, outside carbohydrates via gluconeogenesis [32] and glycogen (stored energy) via glycogenolysis [33]. This process is possible for survival strategies. Fats, as one source of calories, could be metabolized via beta-oxidation [34]. Perhaps the melting of those fats disrupting insulin action will improve insulin sensitivity. Melting this impediment (fats) may be reflected in the glucose restoration observed on the 6th and 7th day. It is the same with past studies on healthy food to prevent diabetes [14]. The researcher assumed diabetes is reverse (remission) since it is re-set from high glycaemia to normal glycaemia. It will simplify the healing of diabetic inflictions. This procedure (portion control) may delay the quick rushing of glucose into the bloodstream against slow glucose entrance into the cell. Blood glucose accumulation may not be possible in minimal processed with portion sizes of food.

The many problems of diabetes (complications) circle on blood glucose accumulation- biochemically hyperglycaemia. Because the food is minimally processed, there could be a lot of other factors beyond the melting of fat that promoted improved glucose concentration. It relates to insulin and other glucose homeostatic players. Kheriji et al. [35] linked diet relevance to type 2 diabetes, and it agrees with the research findings. All participants did not have blood glucose concentration in the normal range, at same day, which may reflect biochemical individuality and metabolic uniqueness, necessitating peculiarity for tailored treatments. The research opined that the glucose concentration restoration processes should be spontaneous to reverse diabetes.

As mentioned elsewhere, the problem of diabetes is prolonged hyperglycaemia. The findings in Table 8 describe the glycaemia at bedtime, called random glycaemia. Aside from B participant, all others have glycaemia within normal (less than 201mg/dl). In addition to the fasting glucose concentration among the same six participants, random glucose concentration were more on the normal range. The glucose concentration before bedtime is necessary for monitoring spikes before sleep. Glucose concentration in the random and fasted state of these six participants agreed with each per reprogramming of nutrient intake [36] and consequently to diabetes reverse- the normalization of the blood glucose and supported earlier exertion of reversing diabetes. The fact that significant were observed starting the fourth day through the seventh day for fasting and through the second day to seventh day showed that the method was effective within period. The research is optimistic that the new feeding protocol (feeding portion, time restriction control, and minimally processed natural foods) would maintain the diabetic reverse condition as long as there was no reneging of the new normal. Several authors have reported the potential for diabetes reversal [4-5]. Food portion size control and the timing intervals (Table 9) reduced blood glucose concentration. The effectiveness of diet in managing diabetes in the current research has connections to portion control and longer time intervals between meals that possibly improve insulin action. The results show the effectiveness of dietary plans in normalizing glucose concentration, proving the effectiveness of diet in managing diabetes. Diet is a source of fiber and others. Fiber content is a factor in glucose spike reduction [37-38]. They slow the release of glucose into the bloodstream. Quality Diets mitigate diseases of all kinds.

Conclusion

Research findings show the potential beneficial effects of diet on the interruption of the development of diabetes through improved insulin sensitivity, promotion of autophagy, and others. Blood sugar levels recorded at intervals routinely will enable the determination of the effects of certain foods and others on blood glucose levels. The result demonstrated dietary therapy's effectiveness in reversing diabetic conditions. It is time to fix and reset the broken health condition, recalling that good nutrition is one of the keys to a healthy life.

 Recommendation: This work should be replicated in other areas with larger population group.

Acknowledgment
The work hereby acknowledge the TET Fund for sponsorship of the work. The researcher is also grateful to the Nigeria Police Academy management, for the enabling environment.

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