Remarkable Results Of A Diabetes Wellness Intervention – By Author Brenda Davis

Intro

so i want to shift a little bit to tell you about the results of of the work that i’ve done in the marshall islands and so the marshall islands for those of you that that aren’t familiar with them are right here in this little red circle about 2 300 miles uh southwest of hawaii and sort of between hawaii and australia in the middle of the pacific with nothing anywhere close to them for thousands of miles in any direction uh they they are 82 degrees uh uh at about at pretty much every um every you know 100 feet below the surface of the water at every part of the year it’s a very tropical climate and in the marshall islands diabetes is a state of emergency the marshallese have among the highest prevalence of diabetes and the highest death rates from diabetes globally so they’re always in the top three it seems to be in terms of diabetes rates in 2019 the rates among adults was were 33.8 percent i don’t know the rates of prediabetes but i would guess that the the either diabetes or pre-diabetes would probably be close to 80 percent half of all the surgeries on the islands are amputations due to diabetes there are oh and also there’s no dialysis in the marshall islands if your kidneys start to fail if you’re rich enough to go to hawaii you can get dialysis if not you die and most people just die so it’s it’s just absolutely uh it just gut-wrenching uh it’s so sad 80 years ago uh diabetes was pretty much non-existent in the marshall islands uh people were slim they were physically active and they lived off the land so what did they eat well they

What did they eat

ate whatever they could gather or catch so they they obviously they caught fish and gathered probably seaweeds and there were it’s a coral reef so there’s not a lot of good soil but plenty of coconuts breadfruit bananas green leaves uh and and something called pandanus you see this fruit down here uh whoops i pressed the wrong thing down here this is um a fruit that you just suck the juice out of you can’t eat it it’s uh it’s too hard and fibrous to actually eat but it’s a really important source of of some of the phytochemicals and and carotenoids so

How have the diets changed

how have the diets changed why all the diabetes now well the little girl on the left this she was eating this at about 6 30 in the morning on her way to school a bottle of pepsi and a popsicle there’s no no concept of nutrition people think if they have a full belly they’re well nourished um lunch and dinner are white rice and and meat of some sort spam or or barbecued chicken or something like that the meal over here that you see this is um a a meal from a funeral would be a birthday meal it would be any sort of celebration meal but this one was at a funeral and you can see chicken rice white bread and ham white doughnut white soda biscuits and and then on the bottom left this was a birthday party for a one-year-old these bins are all processed meat this is luau it’s a number one ingredient is high fructose corn syrup these are all the parts of the animals we don’t want like turkey tails which are mostly fat and they’re cheap and the children’s favorite snack is ramen noodles with kool-aid powder sprinkled on top ramen noodles are cheap and i can remember once seeing a child eating this and they were sprinkling white powder on their noodles and i said to the marshallese person next to me what are they sprinkling on their ramen noodles and they said oh that’s a cinemato a cinemato is pure msg so ramen noodles kool-aid powder and msg and as you can imagine a dietitian couldn’t design a diet to induce diabetes more efficiently than the diet the marshallese people have adopted it is the saddest thing in the world these are cheap foods readily available fairly non-perishable and there are too many people on the island on the main island right now to be self-sufficient using island food they can’t they have to import food we went into the the martial islands and i mentioned the diabetes by design to do some research to see if we could get this epidemic turned around and we went in and and we had five overlapping cohorts we had control group and and an intervention group and everybody that ended up in the control was allowed to be part of the intervention after they were a control so that they could experience the benefits as well and i can tell you within a week or two what happened to individuals who started to receive healthy food and daily exercise just blew my mind i would have never believed it could happen that quickly people that couldn’t walk across a room for 10 or 20 years were walking without pain people that said their brain had been foggy for 10 or 15 years all of a sudden they said it’s like my brain cleared out just pain that they had experienced in their arms and so forth it was disappearing so quickly and you know this diet in the marshall islands maybe five grams of fiber a day if they’re lucky five or six or seven uh of course our diet was a little higher than that and um they were they you know the changes they were starting to go to the bathroom every day and many of them were going to the bathroom once a week or once every two weeks

The lifestyle treatment program

and uh it scared them they thought there was something wrong with them when they were starting to go every day so it was very very interesting and so the lifestyle treatment program they were with us for four week days for about six hours a day at least for weeks one two four and six for weeks three five seven and eight they were with us in the evening for five hours and nine to twelve they had a weekly evening session and i’m gonna zip through this because i i don’t want to take too too much time with them but we did cooking classes we did shopping tours we taught them how to garden we brought in earth boxes we planted gardens in every quarter of the corner of the hospital grounds that we could we taught them to grow sprouts we did daily exercise classes we got them walking and if you do nothing else in terms of exercise for a person with diabetes walking after meals is powerful medicine it’s unbelievable the change it makes in people and so we did after every meal walking we did education sessions on everything food and nutrition gardening exercise stress management dental health eyes and feet you know all of that stuff this man was one of the hospital doctors and they called him the butcher and he was called the butcher because he was the surgeon that did the amputations and he himself as you can see is a pretty healthy specimen he just happened to be a vegetarian and he would come to our program to to tell people that the last thing on earth he wanted to do was amputations he said you know i would do anything to save your limbs but when you come to me after you know your your wounds have turned into gangrene and they’re you know your your leg is dead he said the only thing i can do to save your life is to cut your leg off so he was trying to to help them understand that process and so tell you a little bit about our results uh we saw fasting sugars drop about 71 points on average in the first two weeks by 12 weeks people were eating more of their own food and it was about 48 points but we saw by 12 weeks a reduction in a1c of almost two points and and crp came down about 1.2 points so our results were really quite good so what about the effort since this was in 2006 that we did this uh well uh we don’t we lost our funding of course we had a limited funding so we’ve shifted away from research to community action and we’ve created partnerships with the ministry of health and the and and the um republic of the marshall island government you can see there where we’re i’m i’m there with the um the president and and several other dignitaries speaking to children on world diabetes day we created a wellness restaurant to sustain the wellness center we had to bring in funds and so the restaurant has become really popular in the marshall islands and we have wonderful staff working there we do free lifestyle interventions for people in the marshall islands free exercise classes and i do go back periodically to lead interventions and in 2014 in measure we averaged i’m getting better at it we averaged fasting glucose drop in two weeks of almost 120 points in ebuy it was about 50 points and ebay is a tiny little island i think it’s point point one four of a square mile and fifteen thousand people it’s unbelievable um there is almost no produce on that island uh in 2016 we we did an intervention for people from bikini island where the um the atomic bomb testing was done after the second world war and in this group we got a fasting glucose drops on average of 63 milligrams per deciliter but we had 11 participants who had drops of over 100 milligrams per deciliter and this young man came in kicking and screaming he did not want to be there but his parents his mother was a former secretary of health who completely reversed her diabetes on this program she was in our first intervention and he and his dad came together and they became the biggest advocates of the program he did so well he he had a blood glucose drop that was well over 100 milligrams per deciliter and then in 2017 i i went in spent about a month there with a very dear friend a speech pathologist and we created a nutrition education curriculum for kindergarten to grade six for the public schools and trained every teacher in in the marshall islands so trying to start with the the children you know these people in the marshall islands are really pioneers of the pacific um the participants of these these programs have provided the marshallese a hope amid a very deep sense of hopelessness and that sense of hopelessness has been exacerbated by what’s happening in terms of climate change they will be the first place to go and it is absolutely devastating it’s the only home they’ve ever known so you can look up the marshall islands and some of the the reports that have been done it’s very very sad but these folks have proved that diabetes can be defeated we saw several people completely reverse their disease but can be defeated with healthy food and exercise they succeed despite poor quality of produce lack of resources they’re very poor they persevere amid mountains of spam ramen fried chicken and sticky rice in a very socially engaged culture they manage with very few gyms and no walking trails they’ve started you know when we first got to the marshall islands people didn’t walk at all they would be embarrassed to walk because it was a proof that they couldn’t afford a 25 cent cab ride now they have walk they have walks in the mornings and and walk-a-thons that get hundreds of people involved so things really have changed and people often ask me do you think this type of program could work at home and my answer is very simple if there is hope in the marshall islands giving given the barriers that they face of course there’s hope at home it should be a breeze for us by comparison but of course the the hope rests on demand from those affected integration of lifestyle medicine into our health care systems it’s got to be offered as a treatment option for people and that’s my hope that it will be in it fairly shortly you