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Many patients with cardiometabolic syndrome or diabetes are at increased risk for related health concerns, including vision impairment, renal dysfunction, podiatric concerns, and dental disease. Going beyond a singular focus on glycemic control may be necessary to help patients achieve the health outcomes they find most meaningful.

A functional medicine approach can help control glycemic indices, and it may also help reduce many related health issues. In Kristine Burke, MD’s, functional medicine practice, not only did 75% of program participants enjoy normalization of their A1c and blood sugar numbers, but many patients were also able to taper off and eventually stop their diabetes medication(s). Watch her describe the diabetes reversal program:

A 2023 bibliometric analysis suggests that in recent years, the prevalence of diabetes has been increasing, leading to an increase in the incidence of diabetic retinopathy (DR), which is now considered a worldwide public health concern.¹ According to the International Diabetes Federation (IDF), in 2021, 537 million people aged 20-79 years had diabetes, accounting for 10.5% of the global population in this age group. Studies show that 22.27% of diabetes patients suffer from DR, and the prevalence of DR in diabetic individuals over a 10-year period may reach 60%.¹ The worldwide prevalence of diabetes is estimated to increase to 700 million by 2045, with approximately 160 million of those individuals projected to have comorbid diabetic retinopathy.³

Nutrient Considerations

While medications can normalize glucose numbers, research suggests that diet-based approaches may also be helpful.^6-11 A 2021 study evaluating the dietary intake of patients with type 2 diabetes (T2D) found that plasma levels of carotenoids were significantly lower in patients with diabetic retinopathy as compared to diabetic patients with no vision impairment and the control group.⁷ Dietary intake of several nutrients, including zeaxanthin, lycopene, α-carotene, and β-carotene, were markedly lower in the patients with diabetic retinopathy, suggesting a potential connection between carotenoids and the progression of retinopathy.⁷ As a precursor to vitamin A, β-carotene, along with lutein and zeaxanthin, has been shown to attenuate oxidative stress in ocular tissue in all populations, and in diabetic patients, it may slow the progression of cell apoptosis and mitochondrial dysfunction and reduce inflammation.⁸

A range of different dietary approaches may help patients achieve T2D remission, including low carbohydrate dietary interventions, intermittent fasting, and ketogenic and Mediterranean diets.^9-13 The dietary approach should be one which the individual can maintain for the long term.⁹ IFM’s Cardiometabolic Food Plan is a tool that contains the resources and information for clinicians to work with patients to help them transition to healthier eating patterns that support cardiac and metabolic health. It is designed for patients at risk of or already diagnosed with cardiovascular disease or metabolic conditions, which share many underlying causes, including increased inflammation, insulin resistance, and stress. The plan has the following features:

• A modified Mediterranean diet, focusing on the heart-healthy elements
• A low glycemic impact
• Personalized, targeted calorie recommendations
• Blood sugar balancing
• High fiber, low simple sugars
• Balanced, quality fats
• Condition-specific phytonutrients

The Cardiometabolic Food Plan is just one of several therapeutic food plans available as part of IFM’s Toolkit.

Exercise and Lifestyle Considerations

For some patients, exercise and nutrition interventions may outperform medications. In a 2020 study published in The Lancet, researchers found that intensive lifestyle intervention led to significant weight loss at 12 months and was associated with diabetes remission in over 60% of participants and normoglycemia in over 30% of participants.¹³ Study participants were aged 18-50 years, had a short diabetes duration (≥3 years), and had a BMI of 27.0 kg/m² or more. The intensive lifestyle intervention comprised a total diet replacement phase, in which participants were given specially formulated, low-energy diet meal replacement products followed by gradual food reintroduction combined with physical activity support and a weight-loss maintenance phase involving structured lifestyle support. The authors say that the provision of this lifestyle intervention could allow a large proportion of young individuals with early diabetes to achieve improvements in key cardiometabolic outcomes, with potential long-term benefits for health and well-being.¹⁴

In another recent study, reduction in glucose-lowering medications was achieved by 47 participants (73.5%) in the lifestyle group compared to only nine participants (26.4%) in the standard care group.¹⁵ The lifestyle intervention consisted of an aerobic training program along with a dietary plan for achieving a BMI of less than 25.¹⁵ In a separate study, participants with poor glycemic control who undertook a multidisciplinary lifestyle regimen enjoyed significant improvements in hemoglobin A1c, BMI, waist circumference, and blood pressure up to two years after study completion.¹⁶

Functional Medicine Considerations

Many functional and integrative clinicians have had patients with T2D who have lost that diagnosis as a result of sustained lifestyle modifications. IFM provides clinicians with tools to help their patients adopt healthy lifestyle practices, such as eating more high-quality foods that are rich in phytonutrients and increasing physical activity. Learn more about cardiometabolic conditions and clinical applications that support your patient’s health journey at IFM’s upcoming Cardiometabolic Advanced Practice Module (APM). The module will help clinicians understand the physiology underlying cardiometabolic syndrome and cardiovascular disease, new approaches to effective assessments and treatments, and how to integrate these lifesaving tools into practice.

THE RIGHT FOOD PLAN FOR CARDIOMETABOLIC PATIENTS

Exploring functional medicine through the lens of a patient case 

The Diet, Nutrition, and Lifestyle Journal helps patients track daily choices

References

1. Xiao H, Tang J, Zhang F, et al. Global trends and performances in diabetic retinopathy studies: a bibliometric analysis. Front Public Health. 2023;11:1128008. doi:3389/fpubh.2023.1128008
2. Rodríguez-Gutiérrez R, Montori VM. Glycemic control for patients with type 2 diabetes mellitus: our evolving faith in the face of evidence. Circ Cardiovasc Qual Outcomes. 2016;9(5):504-512. doi:1161/circoutcomes.116.002901
3. Teo ZL, Tham Y-C, Yu M, et al. Global prevalence of diabetic retinopathy and projection of burden through 2045: systematic review and meta-analysis. Ophthalmology. 2021;128(11):1580-1591. doi:1016/j.ophtha.2021.04.027
4. Boulin M, Diaby V, Tannenbaum C. Preventing unnecessary costs of drug-induced hypoglycemia in older adults with type 2 diabetes in the United States and Canada. PLoS One. 2016;11(9):e0162951. doi:1371/journal.pone.0162951
5. Abdelhafiz AH, McNicholas E, Sinclair AJ. Hypoglycemia, frailty and dementia in older people with diabetes: reciprocal relations and clinical implications. J Diabetes Complications. 2016;30(8):1548-1554. doi:1016/j.jdiacomp.2016.07.027
6. Liu H, Wang F, Liu X, et al. Effects of marine-derived and plant-derived omega-3 polyunsaturated fatty acids on erythrocyte fatty acid composition in type 2 diabetic patients. Lipids Health Dis. 2022;21(1):20. doi:1186/s12944-022-01630-0
7. Shalini T, Jose SS, Prasanthi PS, Balakrishna N, Viswanath K, Reddy GB. Carotenoid status in type 2 diabetes patients with and without retinopathy. Food Funct. 2021;12(10):4402-4410. doi:1039/d0fo03321a
8. Johra FT, Bepari AK, Bristy AT, Reza HM. A mechanistic review of β-carotene, lutein, and zeaxanthin in eye health and disease. Antioxidants (Basel). 2020;9(11):1046. doi:3390/antiox9111046
9. Brown A, McArdle P, Taplin J, et al. Dietary strategies for remission of type 2 diabetes: a narrative review. J Hum Nutr Diet. 2021;35(1):165-178. doi:1111/jhn.12938
10.  Sharma SK, Mudgal SK, Kalra S, Gaur R, Thakur K, Agarwal R. Effect of intermittent fasting on glycaemic control in patients with type 2 diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials. touchREV Endocrinol. 2023;19(1):25-32. doi:17925/ee.2023.19.1.25
11.  Massara P, Zurbau A, Glenn AJ, et al. Nordic dietary patterns and cardiometabolic outcomes: a systematic review and meta-analysis of prospective cohort studies and randomised controlled trials. Diabetologia. 2022;65(12):2011-2031. doi:1007/s00125-022-05760-z
12.  Jooste BR, Kolivas D, Brukner P, Moschonis G. Effectiveness of technology-enabled, low carbohydrate dietary interventions, in the prevention or treatment of type 2 diabetes mellitus in adults: a systematic literature review of randomised controlled and non-randomised trials. Nutrients. 2023;15(20):4362. doi:3390/nu15204362
13.  Jing T, Zhang S, Bai M, et al. Effect of dietary approaches on glycemic control in patients with type 2 diabetes: a systematic review with network meta-analysis of randomized trials. Nutrients. 2023;15(14):3156. doi:3390/nu15143156
14.  Taheri S, Zaghloul H, Chagoury O, et al. Effect of intensive lifestyle intervention on bodyweight and glycaemia in early type 2 diabetes (DIADEM-I): an open-label, parallel-group, randomised controlled trial. Lancet Diabetes Endocrinol. 2020;8(6):477-489. doi:1016/s2213-8587(20)30117-0
15.  Johansen MY, MacDonald CS, Hansen KB, et al. Effect of an intensive lifestyle intervention on glycemic control in patients with type 2 diabetes: a randomized clinical trial. JAMA. 2017;318(7):637-646. doi:1001/jama.2017.10169
16.  Sbroma Tomaro E, Pippi R, Reginato E, et al. Intensive lifestyle intervention is particularly advantageous in poorly controlled type 2 diabetes. Nutr Metab Cardiovasc Dis. 2017;27(8):688-694. doi:1016/j.numecd.2017.06.009