According to estimates, diabetes is positioned to become the leading public health epidemic of the 21st century. Worldwide, the incidence of diabetes has increased dramatically. Diabetes is expected to affect 350 million people by 2030, doubling from the 2000 level of 170 million. The greatest increase is expected to occur in the developing countries of Asia, Africa, and the Persian Gulf.
In the United States, the number of people with diabetes jumped from 5.6 million in 1980 to 20.9 million in 2010. Close to 27% of persons over age 65 now have diabetes. One in three Americans are predicted to develop diabetes by mid-century. The cost of treating diabetes in the U.S. will soon approach $200 billion per year. Diabetes threatens to overwhelm health care systems in this country and around the world. Diabetes is a major factor in the ongoing financial crisis caused by skyrocketing health care costs.
Modern medicine remains powerless in the face of this planet-wide surge. In a special 200th anniversary article in the New England Journal of Medicine (NEJM 2012; 367-1332/October 4, 2012) entitled “The Past 200 Years in Diabetes,” Dr. Kenneth Polonsky states: “…The pathway to cure has remained elusive. In fact, if one views diabetes from a public health and overall societal standpoint, little progress has been made toward conquering the disease during the past 200 years, and we are arguably worse off now than we were in 1812.”
Could it be that after billions in research and decades of effort, we are worse off now than we were two centuries years ago? Perhaps it is time to take stock and reassess. Perhaps a fresh approach is called for. Let us now examine diabetes from the macrobiotic perspective, beginning with the role of the pancreas.
The Role of the Pancreas
The pancreas is a flat shaped organ located on the left side of the body below the stomach. In its structure, function, and energy it is complementary to the liver, the large organ located opposite it on the right side. The pancreas, being lower in position and more flat than the liver, is classified as yang. The liver, being larger and more expanded, is comparatively yin. (Yang is the term used to describe smaller or more compact forms; yin is the term used to describe larger, more expanded forms.)
The pancreas is animated primarily by celestial force flowing down toward earth. This more yang force is stronger on the left side of the body. The descending colon is evidence of its influence. The liver, on the other hand, receives stronger upward energy. This more yin force originates with the rotation of the earth and is stronger on the right side of the body. Hence the ascending colon is located on the right. The primary forces of yin and yang create the organs and animate their respective functions.
This classification is essential and relevant to our understanding of the cause of diabetes as well as to the prevention and recovery from this disease.
Looking at the way in which these organs interact to regulate the level of glucose (sugar) in the blood will help illustrate this further. The metabolic sugar cycle is divided into stages:
1. Eating food
2. Digesting, or breaking carbohydrate down into glucose (simple sugar)
3. Glucose entering the blood
4. Pancreas releasing insulin
5. Glucose exiting blood and entering body cells.
The processes of eating, digestion, and the absorption of glucose by the bloodstream represent the yin or expansive phase of the cycle. Chewing and digestion are processes of breakdown and decomposition, in this case, breaking down more complex carbohydrates into simple sugar known as glucose. The release of insulin by the pancreas and the entrance of glucose into the cells are the yang or contractive phases in the cycle. The net result of the yin phase is a rise in blood glucose (sugar), while the result of the yang phase is a decrease in blood glucose. High blood sugar is yin, while low blood sugar is yang.
The pancreas performs a dual function. The acini cells secrete digestive enzymes, similar to saliva. On the whole, pancreatic digestive juice is alkaline and yang. It especially aids in the digestion of fats, which are yin. Scattered throughout the pancreas are about a million cell clusters known as the “islets of Langerhans.” The islets are a compact collection of endocrine cells that secrete the hormones that regulate the conversion of sugar into energy and hence the level of sugar in the blood.
The two primary endocrine cells are known as alpha cells and beta cells. The smaller and denser beta cells secrete the yang hormone insulin, which lowers blood sugar. Alpha cells, which are larger and more expanded, secrete the yin hormone glucagon, which has the effect of raising the level of sugar in the blood. As we saw above, on the whole the pancreas is a yang organ. The pancreas contains far more beta cells than alpha cells. The ratio of beta cells to alpha cells is approximately 85% to 15%, or about seven parts beta to one part alpha.
Insulin and Glucagon
Insulin and glucagon offer a perfect example of complementary balance. When blood sugar becomes elevated, the beta cells secrete insulin. Insulin causes glucose to enter the body’s cells, thus lowering the blood sugar level. It also signals the liver to bind glucose molecules for storage in the form of glycogen. The net result is a decrease in blood glucose.
Conversely, when the glucose level becomes low, the alpha cells secrete glucagon. This yin hormone signals the liver to break stored glycogen (yang) down into free glucose (yin), thus raising blood sugar levels.
Insulin (yang) bonds with receptors on the cell membrane (yin).
The mechanism by which insulin facilitates the entry of glucose into the body’s cells can also be understood in terms of yin and yang. Cells consist of an outer cell membrane (yin) and an inner cell nucleus (yang.) Free glucose circulating in the blood is yin, while insulin, as we saw, is yang. Glucose is naturally repelled by the yin cell membrane; it needs a yang agent to facilitate transfer through the membrane and into the interior of the cell. This is accomplished by insulin. Insulin readily bonds with receptors on the cell membrane and passes through the membrane into the interior. The presence of insulin below the surface membrane changes the quality of the membrane. It now becomes yang and attracts and admits glucose.
What is Diabetes?
Diabetes occurs when the pancreas either does not produce enough insulin or when the body’s cells resist or reject the insulin that is produced. The result is high blood sugar, or hyperglycemia, which produces a number of symptoms and side effects, both immediate and long term. In his article Dr. Polonsky describes the disease as follows:
“Over the past two centuries, we have learned that diabetes is a complex, heterogeneous disorder. Type 1 diabetes occurs predominantly in young people and is due to selective autoimmune destruction of the pancreatic beta cell, leading to insulin deficiency. Type 2 diabetes is much more common, and the vast majority of people with this disorder are overweight. The increase in body weight in the general population, a result of high-fat, high-calorie diets and a sedentary lifestyle, is the most important factor associated with the increased prevalence of type 2 diabetes. Older adults are most likely to have type 2 diabetes, although the age at onset has been falling in recent years. Type 2 diabetes is now common among teenagers and young adults.
“We now know that insulin resistance is essential in the pathogenesis of type 2 diabetes, and that the disease results from both insulin resistance and impaired beta cell function.”
Both insulin resistance and impaired beta cell function are yin conditions, as are obesity and overweight. A primary cause of these conditions is the intake of strongly yin simple sugars, such as refined sugar, as well as refined carbohydrates like white rice and white flour. The continual intake of these extremes exhausts and depletes the beta cells. The result is either not enough insulin or insulin that is too weak to facilitate the transfer of glucose across the cell membrane. If insulin lacks strong yang power, it will not be able to bond with the cell membrane and enter the interior of the cell. Without insulin as a facilitator, glucose does not enter the cell but remains circulating in the blood, hence the high level of blood glucose characteristic of diabetes. This mechanism explains the onset of type 2 diabetes.
The mechanism of type 1 diabetes is a little different, albeit also extremely yin. T. Colin Campbell, PhD in The China Study, best describes the process:
“This devastating, incurable disease strikes children, creating a painful and difficult experience for young families. What most people don’t know, though, is that there is strong evidence that this disease is linked to diet and, more specifically to dairy products. The ability of cow’s milk protein to initiate type 1 diabetes is well documented.”
As Dr. Campbell explains, in some infants, cow milk proteins are not fully digested and small amino acid chains or protein fragments are absorbed by the small intestine. In the bloodstream the immune system identifies these fragments as antigens, or foreign proteins, and codes antibodies to destroy them. Some of these protein fragments are identical in form to insulin-producing beta cells. Antibodies produced by the immune system thus destroy both the cow proteins and the beta cells, taking away the child’s ability to produce insulin. The result is type 1 diabetes, an incurable lifetime condition.
Once again, we can understand this process in terms of yin and yang. Milk, a product of the yang animal body, is a powerfully yin secretion designed for growth. This is especially true for the milk of large mammals such as a cows. The intake of this strongly yin substance (often together with refined sugar) is largely responsible for the onset of type 1 diabetes.
Good Carbs vs. Bad Carbs
Carbohydrates come in two types: “simple” or “complex.” Simple carbohydrates contain just one sugar molecule (monosaccharide) or two sugar molecules (disaccharide.) Simple sugars demonstrate strong expansive force. These yin molecules enter the bloodstream very quickly. They cause a rapid spike in blood sugar. In contrast, complex carbohydrates consist of a chain of sugar molecules linked together. Their strong bonding force is yang. The body has to work harder to break down the links in the chain; hence they enter the bloodstream more slowly than simple sugars. The level of sugar in the blood remains more constant and steady. This distinction is crucial in understanding the effect of diet on diabetes.
Examples of simple carbohydrates include table sugar, honey, fruit, fruit juice, jam, and chocolate. They are often labeled “bad” because they are high in calories compared to their nutritional content and because of their effect on blood sugar. Complex carbohydrates are lower in net calories and are sometimes touted as “healthy carbs.” They include foods like whole grains, beans, whole grain bread and pasta, vegetables, especially sweet-tasting ones, and sea vegetables.
Brown vs. White Rice
Brown rice contains beneficial fiber, minerals, vitamins, and phytochemicals like beta-carotene. Milling and polishing brown rice removes most of its vitamins and minerals. It also strips away most of the fiber in brown rice. The fiber in brown rice and other whole grains slows the absorption of glucose and helps prevent diabetes. That is because the carbohydrate in whole grain fibers is yang and cohesive. The body has to work harder to break the links that bind the carbohydrate chains together.
Although the starch in white rice, white flour, and a baked potato is in the form of complex carbohydrate, the body converts this starch into blood sugar almost as quickly as it processes pure glucose. These foods cause a rapid rise in blood sugar and are classified as having a high glycemic index. The glycemic index classifies foods on how quickly and how high they raise the level of sugar in the blood in comparison to pure glucose.
As we have seen, a food like brown rice is digested more slowly. It doesn’t cause a rapid spike in blood sugar and is classified as having a low glycemic index. When brown rice is milled and refined by removing its bran and germ, its glycemic index rises. The same is true of whole wheat and other grains. Finely ground grain (yin or expansive) is more rapidly digested than coarsely ground grain (more contractive or yang), and has a higher glycemic index. The type of starch is also a factor in determining a food’s glycemic index. More yin starches, like those in potatoes, are rapidly digested and absorbed. Potatoes have a high glycemic index. More yang starches, like those in brown rice, are processed more slowly and have a low glycemic index.
Because of these factors, brown rice is being touted as a possible solution to the diabetes epidemic, especially in China and other rapidly developing countries. A January 2012 article from the Harvard School of Public Health entitled, “Can Brown Rice Slow the Spread of Type 2 Diabetes?” states:
“The worldwide spike in type 2 diabetes in recent decades has paralleled a shift in diets away from staple foods rich in whole grains to highly refined carbohydrates, such as white rice and refined flours. Now a group of researchers at Harvard School of Public Health (HSPH) aims to stem the tide by changing the color of the world’s rice bowl from white to more-nutritious brown.”
The announcement of a collaborative initiative to prevent the global diabetes epidemic by improving the quality of carbohydrate consumed follows an earlier study published on June 14, 2010 on the website of the journal Archives of Internal Medicine. In the study, HSPH researchers found that eating five or more servings of white rice per week was associated with an increased risk of type 2 diabetes, while a diet that includes two or more servings of brown rice was associated with a lower risk. The investigators estimated that the risk of type 2 diabetes could be lowered by 16% by replacing 50 grams of white rice (1/3rd of a typical daily serving) with the same amount of brown rice. Interestingly, replacing the same amount of white rice with whole wheat or barley was associated with a 36% lower risk.
“From a public health point of view, whole grains, rather than refined carbohydrates, such as white rice should be recommended as the primary source of carbohydrates for the U.S. population,” said senior researcher Frank Hu. “These findings could have even greater implications for Asian and other populations in which rice is a staple food.”
The Potential of Macrobiotics
Macrobiotic educators have for decades advocated an approach similar to the approach advocated by the Harvard School of Public Health. The macrobiotic diet may offer the most effective approach to the prevention of diabetes. Macrobiotics advocates avoiding milk and dairy products associated with type 1 diabetes. Human breast-milk is preferred for infants. Refined sugar and artificial sweeteners like high fructose corn syrup are not recommended. Macrobiotics recommends avoiding or reducing foods such as potatoes, white flour, white rice, and others with a high glycemic index. Instead, foods rich in complex carbohydrates and fiber like whole grains, beans, fresh vegetables, and sea vegetables are the foundation of the macrobiotic diet. These foods are associated with a lower risk of type 2 diabetes.
Moreover, the macrobiotic diet may prove an effective tool in the management of diabetes. In type 2 diabetes, successful management and recovery have been noted in persons adopting a macrobiotic way of eating. Persons with type 2 diabetes have experienced a marked reduction in the need for medication; some after only one or two weeks after beginning the diet. Some patients have eliminated the need for medication entirely while noting marked improvements in overall health. At the very least, macrobiotics is acknowledged as an effective tool in weight loss and weight management. Patients with type 1 diabetes have noted reductions in the need for insulin and a lessening of complications after adopting a plant-based macrobiotic way of eating. Macrobiotics can help these patients better manage their condition.
With the mounting evidence linking diet with the cause, prevention, management, and potential recovery from diabetes, the time has come for clinical trials of the macrobiotic approach. Macrobiotics could very well offer a solution to this 21st century epidemic.
The article is from Rice Field Essays by Edward Esko, Amberwaves Press, 2014.