Diabetes, nutrients & lifestyle interventions
7th Apr, 2022


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Jacqui Fahey (00:06): Welcome to Common Ground, a podcast series discussing new research and interesting projects in the field of complementary medicine. Hello, my name is Jacqui Fahey, Head of education at vital.ly 

vital.ly is a digital platform, a health professional resource, and a distribution service all in one.

Firstly, I'd like to begin by acknowledging the Gadigal people of the Eora nation as the traditional custodians on the land on which we gather here. I would also like to pay my respect to their elders both past, present and emerging.

Today on Common Ground I'll be speaking with Melanie Turner. Melanie is a naturopath with a master's degree in human nutrition, drawing from the latest research combined with ancient tradition, Melanie has made it her mission to teach people how to use food and herbs as medicine to manage illness and heal disease. Melanie lives by the motto that ‘food is the most powerful tool at our disposal’. Every meal is an opportunity to either undermine or increase health and vitality. Known as fermenting guru and gut health fanatic, Melanie has an in depth knowledge on gut disorders and how the gut relates to overall health. Melanie specialises in digestive health and cardio metabolic health, including diabetes, metabolic syndrome and weight loss.

Welcome to Common Ground Melanie.

Melanie Turner (01:28): Hi Jacqui. Thanks so much for having me.

Jacqui Fahey (01:30): What's your background Melanie and how did you come into specialising in diabetes and auto immunity?

Melanie Turner (01:38): Well I sort of started out my working life as a nurse, doing age care nursing, and then I studied naturopathy over a very long period of time given having kids and trying to make an income. So yeah I finally graduated in 2014 and then the year after I graduated, my youngest daughter was diagnosed with type one diabetes and that really just came completely out of the blue for us. So it was no genetic sort of history or anything and you know, she was kind of like the star in child in terms of child perfect childbirth breast had no issues. She'd been playing out in the dirt all her life and we lived in the country. So she had none of the normal sort of factors that you might consider as risk factors for type one diabetes. So, yeah that sort of propelled me into a lot of research in type one particularly, and also just autoimmune disease in general because obviously there's a lot of crossovers there and then it also just been researching a lot about type one diabetes of course, a lot of that crosses over into type two diabetes and then, yeah, so then that crosses over into weight loss and there you go.

Jacqui Fahey (03:05):

Yes. And so why is diabetes type one considered an autoimmune disease? What's the correlation link here?

Melanie Turner (03:14): Well, so type 1 diabetes the immune system attacks the beta cells in the pancreas. So they're the only cells that can make insulin. So when you, when they are destroyed by the immune system, then you can't make the body just cannot produce insulin. So then you have it an insulin deficit. And so, you know, that that can be life threatening if it's undiagnosed. So a lot of, you know, people that get diagnosed with type one diabetes will come into hospital in a pretty life threatening state. Like they'll be quite, you know, often in diabetic keto acidosis. It's a bit different to type two diabetes where really there's too much insulin and the body become resistant to it. And then type one is a deficit of insulin, there's none there. So the main symptoms of type one diabetes would be weight loss, increased thirst, that sort of thing and type two, obviously it's more a tied to weight gain.

Jacqui Fahey (04:24): I know you'll be focusing on type one diabetes today, but what is type 1.5 diabetes? You work with this?

Melanie Turner (04:33): Well actually type 1.5 is otherwise known as LADA. So that's ‘latent autoimmune in diabetes in adults’ is what that stands for and basically it's the same disease that's just occurring in an older population. So type one diabetes used to commonly be referred to as ‘juvenile diabetes’ and that's where a lot of people, you know, might still think of it as, but the most to update up to date term to use is type one diabetes and that's because it just helps dispel the myth, the misconception really that type one diabetes only occurs in children. So it can occur any time in life and I've seen lots of people who've been diagnosed into their teens and into adulthood. The difference I guess there is the disease progression can be a lot slower when it's diagnosed in adulthood because of the way the immune system works. So the blood sugars can just creep up over time whereas in children it's quite a dramatic drop of insulin, therefore, a dramatic increase of blood sugars. Whereas in LARDA you might see it gradually happen over time and so that can sometimes be misdiagnosed as type two. So if you've got someone that doesn't fit that type two picture, it might be worth investigating the possibility that it could be a type one LARDA.

Jacqui Fahey (06:07): Okay. Thank you for clarifying that. So with focus on type one diabetes, what herbs, foods, nutrients, and lifestyle intervention do you use in your clinical practice for supporting healthy blood sugar levels?

 Melanie Turner (06:21): Well, I guess really the most important factor in blood sugar control is really, it’s diet. And most leading health practitioners that will specialise or work closely with type one will agree that a low carb diet is really the best approach. So really look, you can have all the herbs and nutrients in the world but they're not going to be able to work against a high carbohydrate input with type one diabetes. So you really have to..... low carb is really the key. And the reason why that is because it follows the law of small numbers as what, how it was termed. And that was a concept that was first discussed by Dr. Bernstein and he's an American doctor who's lived with type one for over 80 years. And the basic tenant of the law of small numbers is that the less carbohydrate input you have, the more predictable the outcome will be because there's about a 30% margin of error when we're dosing for insulin. Dosing insulin for carbohydrates. That has to do with the there's lots of variabilities with counting carbohydrates. There's variabilities with insulin absorption when you're injecting insulin and the insulin timing variations. So it basically, as Dr Bernstein puts it, he says, ‘big inputs make big mistakes and small inputs make small mistakes’. So if you are eating low carb, you know, you're just basically getting off that blood glucose roller coaster. It just means people can keep in much better range so that they can achieve Hba1c’s and a good Hba1C, not just what you know, a good Hba1C might be 4% or 4.5 to 5% and all that mainstream medicine are aiming for is 7%. So, you know, they're really aiming very low for people with type one and that means that they're going to be much more likely to get complications and the on-flow effect of that is really big.

Jacqui Fahey (08:37): Could you explain for our listeners that are not for familiar with Hba1C, what that is?

Melanie Turner (08:43): Yeah. So the HbA1c, basically it gives you a bit of an average of what your blood sugar has been over a three month period. Now with type one diabetes, because people can go very low, sometimes it can be mistaken that if you've got a good HbA1c, that you've been having lots of hypoglycemic, or ‘hypo’s’  events throughout that three months. But if you are on low carb, what I've seen clinically that people when following a good low carb diet is that they can achieve a much more balanced blood sugar, which means they can achieve that HbA1c. So the average blood sugar over a period of time they can achieve that, like as a normal healthy person with a healthy pancreas. So, yeah, it's really the most important thing. And that's what I learned with my daughter is that, you know, so the poor thing was on so many herbs and all sorts of things, but really the diet is 90%.

Jacqui Fahey (09:53): No, you go. I was just going to ask you about what type of carbohydrates, your whole food carbs.

Melanie Turner (09:58): Yeah. So I would just, for people with type one, obviously this doesn't work for the general population. This is because these people have blood sugar regulation issues. You know, that you've got to take that into account. You can't just treat them like someone with a working pancreas because they're not. So yeah, so carbohydrates, I'd be just looking at your good leafy greens, your above ground vegetables, your proteins, your good fats and of course you can be as low carb as you want to be.

It all depends on what sort of control you can achieve with your blood sugars. So, you know, I see people that can tolerate some quinoa or, you know, they might dose with oats or something like that. And they're okay with it. Other people, no, it's just not worth the blood sugar spike that it gives them.

And they can dose all they want with insulin but if they're spiking up above 12 or up into the teens, it's just not worth it. So, yeah then other than that you're really looking at where the person is at with their disease or with their diagnosis. If I get people that have just been diagnosed, then I'd be really trying to focus on preserving beta cell function and modulating the immune system, just to try and slow the disease progression down. Because the best thing you can do really is have them, have their pancreas working for as long as you possibly can and get it to function. So one thing there that I would definitely recommend is vitamin D and just a recent study validated that we've been sort of using that for a while, but has been recent recently validated that the 50,000 IU daily has been shown to slow disease progression.

And so that's where I'd start. And also because vitamin D is also a great immune modulator and it also helps with glycaemic control and insulin sensitivity. So even if somebody was quite far down their diagnosis, I would still at least check their vitamin D and get them on, you know, maybe possibly 50,000IU but maybe less. Something I would add in is GABA, I would use GABA powder. It's also been shown to preserve beta function, beta cell function, and it's also an anti-inflammatory. It down regulates the immune attacks. So looking at immune modulation, preserving beta cell function and GABA can also be deficient in type one diabetes because it's also produced in the beta cells in the pancreas. And for those that might not know, GABA is an important neurotransmitter that's really important for, you know, mood and happiness basically. So, you know, it's a win-win because people with type one also can have an, an increased risk of mental health issues as well.

Jacqui Fahey (13:21): It's a good point with the GABA as well. Cause sometimes on low carb diet, sometimes the mental health just a little bit of imbalance there with the brain blood sugars. It can throw some people I've heard from some practitioners out there.

Melanie Turner (13:35): I haven't found that. So what I find is that, so because the body keeps such a tight regulation of blood sugar balance, so it's very unlikely that someone is going to go below 4.6, is if they're dosing their insulin correctly. So the only reason people would be going, having hypoglycemia if they were type one is, is because they made a mistake with the insulin. So if you are type one, and it's probably important to say this too, and you're thinking about going on a low carb diet, you really need to look at your insulin in ratios and things and your insulin dosing, because what I find clinically is that people generally not only do they not have to use as much insulin obviously for the carbohydrates they're eating because they're not eating as many so they don't dose as much insulin there for bolus insulin   . But the other thing is that their basal insulin will need changing too, because when you go on a low carb diet, you become more insulin sensitive. So you might find also that your basal insulin, what they sometimes call the background insulin that may need to be regulated down, you know, reduced as well. You need to really be confident that you can change. Most people manage their insulin requirements themselves, so that's good. People with type one are the absolute experts in their own disease.  So be able to do it but just something to be mindful of if there's ever any hypoglycemia, it always relates back to insulin, too much insulin. So yeah, I've never found that with mental health, with low carb diets.

Jacqui Fahey (15:31): Good, thank you for clarifying that. So in your clinical experience, have you found diabetics prone to pancreatitis or presenting with pancreatitis? If so, how do you approach this in your clinical practice?

Melanie Turner (15:46): Well, you know, to be honest, that's not something that I have seen in clinic with people or I don't actually hear it mentioned in the type one community very often. So it's probably something that you'd see more commonly in type two diabetes. And I think that's, it's a correlation there, but I probably should add there too that people with type one can also become, they can be prone to be to insulin resistance. So just as, you know, everybody who with diet and lifestyle can get type two diabetes, so type ones can also get type two diabetes if they have the same lifestyle factors. So they can have both type one and type two. But then they also, they also can become insulin resistant without the metabolic factors that you'd see in type two as well.

And we don't really know why that is, but I think my sort of pet theory on that is just because they're using synthetic insulin. So there's a possibility, you know, maybe the body's not recognising it as well as naturally made insulin or, you know, there's probably many things about the beta cells we don't understand that are, you know, not factored in with, it's not just insulin being lost. So yeah. We don't know, but yeah, it's not, it's not really not something that I see very often. But there is a type of diabetes called type three C diabetes that's linked to pancreatitis and that's actually where the pancreas not only stops producing insulin but it also stops producing digestive enzymes. And that can sometimes be an issue for people that have been diagnosed with type one, I've seen one person who had this and they still had so many digestive issues and then finally it was worked out that they had this type three C, which meant that they had to get on digestive enzyme supplementation for life.

Jacqui Fahey (17:57): Just talking further on diet, sugar free beverages. What are your thoughts about them?

Melanie Turner (18:05): Yeah, it's always a bit of a toss-up but definitely I wouldn't be recommending a lot of sugar of alternatives. Just generally, that's for everybody.  They can upset the microbiome and we know that as an autoimmune disease, type one diabetes has a correlation with an altered microbiome function. So you don't want to make that worse. But then on the other side of the coin, really the ultimate goal as I said before, for people with type one in terms of health outcomes is avoiding complications and that is tied to blood glucose control. So there's another really great naturopath working in the US, Jody Stanislaw, you might have heard of her, and one of the things she says is ‘no one dies from type one diabetes, they die from high blood sugars.’  So I would say use artificial sweetness sparingly, and just use the more natural ones like xylitol, erythritol, they're sort of better, you know, they're a better option. And look, personally, my personal experience with my daughter is that a bit of maple syrup is usually the easiest on blood sugars for us, but it really depends. I mean she had huge spikes on maltitol, which is supposed to be you know, a sugar free thing, but it could be to do with leaky gut, so you got to have a balance, it’s just a balance really.

Jacqui Fahey (19:53):

Well said. And you mentioned with the altered microbiome, do you mainly address that through diet or do you work with pre and probiotics at all?

Melanie Turner (20:03): Yeah and that’s one thing I would be very careful with in terms of the low carb diet, because it can be fibre deficient if you aren't balancing it out. So that's one of the risks. So you really need to make sure that you're having your good fibres in the forms of lots and lots of vegetables and prebiotics, like say things like slippery elm or partially hydrolysed guar gum, or just, you know, flax seeds are a great thing because they have a really great amount of fibre, they also have a good amount of protein and they’re low carbs. So yeah, just making sure you keep your fibre in. Probiotics, look if somebody was presenting to me, I might put them on some probiotics that have been shown to help with immune modulation, like maybe LGG or something like that. Obviously it always depends on how the person is presenting to you, and then the other issue, which is probably really important to point out is that because such a big percentage of the type one community are diagnosed as children, there's a big issue there with compliance. So you really have to get the best bang for your buck when it comes to kids, they’re not going to be able to take a lot of supplements and do a lot of really complicated things. So it's gotta be easy, so your food based is always best because that's going to be the easiest and then some key supplements that you know, are going to really give you good outcomes, the best outcomes.

Jacqui Fahey (21:50):

Good point. Well, Melanie thanks so much for sharing your wisdom and experience today on Common Ground.

 Melanie Turner (21:57): Yeah, thanks so much for having me.

Jacqui Fahey (21:59): Thanks for tuning into this episode today, we appreciate your support and feel free to leave us a review. We'd love to hear from you. Thank you.

Melanie Turner Naturopath

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