The statistics are clear: diabetes is a quiet but rising epidemic. Over 29 million Americans have diabetes, and about 25% of these individuals aren’t aware they have it. Plus, over a third of American adults—totaling over 80 million people—have prediabetes, a less severe condition that paves the way to diabetes.
This health crisis isn’t going away. Study after study predicts that diabetes will only become more pervasive over time, as more people—including young people and children—are diagnosed.
In this article, we’ll first cover the basic facts about diabetes. Then we’ll delve into the effect of body composition (including fat and muscle) on diabetes. Finally, we’ll cover recommendations and science-supported information about living healthily to prevent and/or manage diabetes!
When an individual has diabetes, their body cannot properly produce insulin; blood sugar that is too high or too low can lead to negative health effects. The reasons why this happens differ depending on the type of diabetes in question.
In Type 1 diabetes, the pancreas does not produce enough insulin. Most of the time, Type 1 diabetics need to control their glucose levels with lifelong insulin therapy.
Type 2 diabetes develops after your pancreas produces insulin in frequent outbursts too often. Over time, cells eventually become less sensitive to insulin. Consequently, they become “comfortably numb” to your body’s signals that there are excess blood sugar levels in your body. This leads to a condition called insulin resistance. Type 2 diabetes can be managed or prevented by changing your lifestyle, exercise, and diet habits.
90 to 95 percent of all recent cases of diabetes are likely to be type 2 diabetes. This form of diabetes is linked to obesity, lack of exercise, high insulin resistance, and poor dietary habits.
The Connection Between Body composition and Diabetes
The body needs a balance of lean body mass (LBM) and fat mass to function optimally and maintain positive health. However, this balance can be disrupted in overweight and obese individuals because of excess fat.
Most people think the goal for overweight individuals should be to lose weight. But this mindset overlooks a larger and more important picture. Overweight individuals should focus on improving body composition by reducing fat mass while maintaining or increasing LBM.
Better-balanced body composition can reduce your risk of diabetes and other obesity-related disorders—and it can have a positive effect on your metabolism.
Metabolism refers to breaking down foods to supply energy for the maintenance and repair of current body structures. When you consume food, your body breaks it down into its elemental components and then directs each piece to where it needs to go.
But diabetes is a metabolic disorder—meaning the way it changes your body makes use of the nutrients in food, in such a way that your cells cannot use digested glucose for energy.
How? It all comes back to insulin. Without access to insulin, glucose can’t get into your cells, so it ends up lingering in your bloodstream. When the glucose can’t make its way out of the bloodstream, it will build up. All that excess blood sugar may then be converted to triglycerides and stored as fat. And with this increase in fat mass, hormone imbalances or systemic inflammation may occur or persist, increasing the risk for many other diseases or conditions.
A buildup of fat and diabetes are both associated with increased risk for heart attacks, stroke, kidney disease, nerve damage, skin infections, and eye problems. Diabetes can even result in an impaired immune system, which, combined with poor circulation to the extremities, increases the risk of wounds and infections, sometimes even leading to amputation of the toes, foot, or leg(s). In far too many cases, diabetes creates complications that eventually lead to death.
Why the Location of Body Fat Can Increase Your Risk
Your fat can be stored subcutaneously or viscerally, also known as subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT). Subcutaneous fat lies under the skin, is pinchable, and is visible. It’s also the fat that you generally see changes when you improve your body composition with cardiovascular and resistance training.
Defining visceral fat is straightforward: it’s excess intra-abdominal fat. VAT can’t always be seen directly. But below the surface, it wraps itself around major organs, making it more dangerous to your health. VAT is more strongly associated with metabolic syndrome and diabetes than subcutaneous fat.
Recently, a study was released that focused on the role that visceral fat mass plays in type 2 diabetes. Part of their findings showed correlations between various body measurements and risk for diabetes/prediabetes:
That orange line designates visceral fat, and it proved to be the single best predictor of both conditions.
The interesting thing about visceral fat is that it actively contributes to the state of our health because it acts like an organ in your body. Instead of contributing to your health like most organs, however, it actively works against it. This is because visceral fat produces cytokines, protective substances that are secreted by your immune system, however, excess cytokine production causes inflammation and increases the risks of cardiovascular disease, and negatively affects the cells’ sensitivity to insulin, further contributing to diabetes.
With fat cells, size matters in VAT’s case. Metabolic issues related to obesity were related to changes in fat cell size instead of fat cell number. Those with higher visceral fat were found to have enlarged fat cells, creating a greater propensity for those large fat cells to keep growing. Enlarged fat cells can increase the cell’s secretion of inflammatory cytokines, which may explain the link between obesity and insulin resistance.
What contributes to the increase of visceral fat? While your gender and genetics have an influence, a sedentary lifestyle with a lack of physical activity, a poor diet with excess calories from processed foods high in saturated fat and carbohydrates, stress, smoking, and poor sleep habits all highly contribute to your disease risk.
The Connection Between Lean Body Mass and Diabetes
Many are already aware of this connection between high-fat mass and diabetes. However, researchers have recently focused on another aspect of body composition as it relates to diabetes risk: Lean Body Mass. Many studies have already shown strong links between Type 2 Diabetes (T2D) and low lean body mass.
A large component of our LBM is our skeletal muscle mass—the muscles used for posture and movement. Unfortunately, diabetes is not only more common in those with less muscle, it can have negative effects on existing muscle.
There are three main muscle characteristics that Type 2 Diabetes affects: fatigability, strength, and mass.
What is Muscle Fatigability
Muscle fatigability refers to the rate at which your muscles become weaker after exercise or movement, and the time it takes for them to recover or return to their full power.
Researchers have known for years that muscle fatigability increases with T2D. When people with T2D perform an exercise, their muscles lose power faster than those of a healthy person’s T2D reduces overall muscle strength. Even after adjusting for age, sex, education, alcohol consumption, lifetime smoking, obesity, and aerobic physical activity, people with T2D had less handgrip strength than people without it.
Not only do Type 2 diabetes patients have both reduced muscle recovery and strength, but they also start to lose muscle mass. The longer you have diabetes, the more muscle mass you tend to lose, especially in the legs.
As you can see, the raised blood glucose levels caused by diabetes and insulin resistance puts your muscles at a disadvantage for several reasons.
How to Manage Diabetes through Nutrition and Exercise
There are many strategies you can draw on to improve your health and prevent, or manage, diabetes.
The good news is that you don’t have to let diabetes affect your health. Individuals with Type 2 diabetes can manage their condition with proper diet and exercise, helping them to live long, fulfilling lives!
How Exercise Can Help You Manage Diabetes
A mix of cardio and strength training has been shown to help decrease your visceral fat levels while building and protecting your muscle.
Your muscle cells love glucose and need it to help feed those muscles with the energy they need to perform. Having a higher ratio of muscle mass is associated with lower insulin resistance and improved insulin sensitivity. It doesn’t matter if you’re lifting heavy weights or light weights — your muscles will still uptake the glucose out of your blood.
If weights aren’t your thing, try walking! Walking can improve your HbA1c levels, which is used to measure your average blood sugar from over 8-12 weeks. Walking requires no equipment and can be done anytime. As long as you’re exercising regularly, your efforts will be beneficial to insulin sensitivity that could persist for up to 72 hours after exercise in people living with diabetes, meaning these positive benefits likely extend beyond the exercise session even in healthy populations.
Let’s look at more research to guide exercise regimens. One study conducted with Japanese type 2 diabetic patients (already with insulin resistance and cardiovascular risk factors) aimed to better evaluate the characteristics of body composition in patients with type 2 diabetes.
In this study, instruction in exercise (which includes resistance training) was seen as a worthwhile treatment to prevent the continued degeneration of muscle.
A second study offers even better news, going beyond the prevention of degeneration of muscle (and the spiral of increased insulin resistance that comes with it). Diabetics who trained for 30 minutes a day, 3 times a week were shown to have increased glucose clearance because of their increased muscle mass. That’s because this increased muscle mass signaled to the body to release more insulin–lowering blood sugar.
Here’s research that’s even more bottom line: in diabetics, for each 10% increase in skeletal muscle index (ratio of skeletal muscle to body weight), there was an associated 11% increase in glucose sensitivity.
Combine these positive results from muscle-building with those derived from reduced visceral fat through regular cardio practice. Together, the evidence is compelling that you can benefit from improved body composition. And the best part about that is improved composition is directly under your control.
How to Manage/Prevent Diabetes Through Diet
If you ask the American Diabetes Association, there’s no such thing as the ultimate diabetes diet. Instead of following a strict diet regimen, the organization encourages everyone to opt for an eating pattern that fits their medical needs, lifestyle, and goals.
An eating pattern describes the foods or groups of foods that a person can eat on a daily basis. For a diabetic patient, managing blood sugar levels should be a major factor influencing diet decisions and eating patterns.
What makes plant-based effective in reducing diabetes risk?
A plant-based eating pattern relies mostly on plant foods, like leafy greens, high-fiber fruits, whole grains, nuts, seeds, and vegetables. Researchers believed that a whole-food, plant-based diet works in reducing the risk of Type 2 diabetes because it also helps improve insulin uptake, or effectiveness, through weight loss, reduction in saturated fat intake, promotion of healthy gut microbiome, and an increase in fiber consumption.
Will a plant-based diet help manage your blood glucose levels? Most likely, yes.
A study used and endorsed in the 2015–2020 Dietary Guidelines for Americans revealed interesting findings. For 20 years, researchers at The Harvard T.H. Chan School of Public Health used the findings of three prospective cohort studies in the country and collected dietary data.
The researchers found out that participants who consumed predominantly plant-based foods and minimal animal products lowered their risk for developing type 2 diabetes by 20 percent.
So does that mean that vegetarians are less likely to develop diabetes? Not necessarily.
The researchers emphasized that the study is not focused on vegetarian or vegan diets (which can include less healthy plant-based products, such as sweetened foods and beverages), but rather plant-based foods.
The Mediterranean Diet
If there’s one specific diet that highlights plant-based food minus the sugar-laden vegan or vegetarian meat substitutes, the Mediterranean diet is the way to go. In this type of diet, the emphasis is placed on whole grains, fruits, vegetables, legumes, nuts, herbs, spices, and healthy fats.
A 2015 systematic review of studies on the efficacy of a Mediterranean diet on the management of type 2 diabetes and prediabetic states concluded that the diet was associated with better blood glucose management than other commonly used diets (including a low-fat diet), suggesting that it is suitable for the overall management of type 2 diabetes.
Diabetes, Diet, and Exercise: Your Major Takeaways
Just as there’s no one-size-fits-all healthy diet, there’s no such thing as the ultimate diabetes diet. A plant-based diet that’s hard to stick to for one diabetic patient might be easy for someone else. Plus, you also have to consider culture, body types, and the presence or absence of other disease states. As always, talk to your doctor first before embarking on a quest to find your own “best diabetic diet.”
If you’re looking to offset the negative effects of diabetes (or prediabetes), taking your body composition into account is also a priority. Work with an experienced professional who can help determine your body composition and help you set goals to improve your body composition through diet and physical activity.
Remember that no specific diet or exercise regimen fits everyone and that the number on the scale is not always connected to your actual body composition and overall health. Focus on building muscle through exercise and keeping visceral fat low with a nutritious diet and you’ll be on the right track!