7. Western and Chinese medicine nutrition and food restrictions for diabetes

Maintaining healthy target blood glucose levels is key in managing T2DM. Integrative health care, along with self-care through wise food choices, appropriate physical exercise and medical Qigong is a synergistic approach to managing T2DM that can lead to better quality of health and better quality of life.

It is important to work with one's primary care physician to monitor one's A1c and to determine one's target blood glucose levels [48]. Working with a nutritionist to select an appropriate diet and with a Chinese medicine practitioner for support with specific Chinese medicine nutritional recommendations, acupuncture and Chinese herbal medicine that fits one's pattern differentiation, is a holistic approach that can bring more balance to the body. Qi cultivation through the practice of medical Qigong self-care exercises can increase one's vitality and internal, energetic awareness to help a person make dietary and lifestyle changes toward better health.

Generally in both western nutrition and in Chinese medicine nutrition, recommendations for healthy eating for people with T2DM include eating a variety of healthy foods in regular meals while being mindful of portion sizes [49]. Eating small meals at regular times helps to regulate blood sugar and to avoid high spikes in glucose levels after a big meal followed by a drop in blood sugar if a meal is skipped.

The U.S. Department of Health and Human Services and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) offer helpful guidelines entitled "Diabetes Diet and Eating" with suggestions about what to eat, how much to eat and when to eat and they also recommend to those with T2DM to take any necessary medications prescribed by their primary care physicians in order to keep diabetes in check and to prevent diabetic complications [48].

An approach currently being studied by researchers is the very low-calorie diet (VLCD) and its potential to reverse T2DM [50]. A prospective, longitudinal, single-center study published in 2016 showed that people with T2DM who followed a VLCD with total energy intake at 624–700 kcal/day for 8 weeks achieved fasting blood glucose of <7 mmol/L and continuing remission of diabetes for at least 6 months [50]. Data suggests a potential for the reversal of T2DM; however, questions remain about the possibility of long-term, sustained recovery from diabetes [19, 50].

From a Chinese medicine perspective, in addition to moderating portion sizes in order to not overeat, moderation in diet also involves the careful harmonization of the five tastes (sweet, salty, sour, bitter and pungent) and the selection of as much balanced variety as possible in one's daily diet [23]. The more colors one sees on one's plate, the more likely it is that the meal is meeting the nutritional needs of all the organs. It is generally advisable to avoid eating the same foods over and over again because one can miss out on important nutritional benefits that come with eating a diverse range of foods. In addition, the overeating of certain foods leads to imbalances. Eating too many sweet foods damages the spleen (pancreas). Overeating salty foods damages the kidneys and the heart. Eating too many pungent or acrid and spicy foods leads to internal heat which consumes the yin and can worsen diabetes [23].

Food prohibitions in Chinese medicine are focused on not exacerbating a person's specific pattern differentiation [23]. For example, someone with spleen (pancreas) Qi deficiency and dampness would be encouraged to limit or avoid sugar, fatty foods, dairy, raw foods, cold foods and cold drinks in general (e.g., cold salads, smoothies) and instead to have cooked foods like whole grains such as Job's tears, barley, brown rice, millet, quinoa and teff, proteins that are lean, cooked vegetables rather than cold salads and to drink warm liquids in order to aid digestion.

If a person has too much heat in the stomach, foods that are hot in nature should be avoided such as chillies, lamb, alcohol, coffee, garlic and onions [25]. When there is yin deficiency, one should also take care to not eat foods that are overly hot or overly cold or overly drying [25]. If a person has Qi and blood stagnation, foods that are overly cloying, heavy, or difficult to digest should be avoided because they can worsen stagnation. Overeating and emotional eating can also cause stagnation, so a relaxed and positive frame of mind is important while eating [47]. One should avoid eating when feeling irritable or angry, eating while working or multitasking, eating on the run, or eating heavy meals late in the day, or eating too late at night in order to prevent stagnation [47]. It is helpful to eat the main meal earlier in the day to allow adequate time for optimal digestion and to make mealtime a peaceful time for the benefit of all the organs [47]. In the evening, the body's organs naturally start to transition into a rest and restore mode and eating late at night disrupts this process and weakens organ function. If one is hungry late at night, a light, low-carbohydrate, sugar-free and protein-rich snack such as a handful of seeds and a warm glass of water or hot herbal tea can curb hunger and prevent a glucose spike [20].

#### 7.1. TCM food for diabetes management

diet and with a Chinese medicine practitioner for support with specific Chinese medicine nutritional recommendations, acupuncture and Chinese herbal medicine that fits one's pattern differentiation, is a holistic approach that can bring more balance to the body. Qi cultivation through the practice of medical Qigong self-care exercises can increase one's vitality and internal, energetic awareness to help a person make dietary and lifestyle changes toward better

80 Chinese Medical Therapies for Diabetes, Infertility, Silicosis and the Theoretical Basis

Generally in both western nutrition and in Chinese medicine nutrition, recommendations for healthy eating for people with T2DM include eating a variety of healthy foods in regular meals while being mindful of portion sizes [49]. Eating small meals at regular times helps to regulate blood sugar and to avoid high spikes in glucose levels after a big meal followed by a drop in

The U.S. Department of Health and Human Services and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) offer helpful guidelines entitled "Diabetes Diet and Eating" with suggestions about what to eat, how much to eat and when to eat and they also recommend to those with T2DM to take any necessary medications prescribed by their primary care physicians in order to keep diabetes in check and to prevent diabetic complica-

An approach currently being studied by researchers is the very low-calorie diet (VLCD) and its potential to reverse T2DM [50]. A prospective, longitudinal, single-center study published in 2016 showed that people with T2DM who followed a VLCD with total energy intake at 624–700 kcal/day for 8 weeks achieved fasting blood glucose of <7 mmol/L and continuing remission of diabetes for at least 6 months [50]. Data suggests a potential for the reversal of T2DM; however, questions remain about the possibility of long-term, sustained

From a Chinese medicine perspective, in addition to moderating portion sizes in order to not overeat, moderation in diet also involves the careful harmonization of the five tastes (sweet, salty, sour, bitter and pungent) and the selection of as much balanced variety as possible in one's daily diet [23]. The more colors one sees on one's plate, the more likely it is that the meal is meeting the nutritional needs of all the organs. It is generally advisable to avoid eating the same foods over and over again because one can miss out on important nutritional benefits that come with eating a diverse range of foods. In addition, the overeating of certain foods leads to imbalances. Eating too many sweet foods damages the spleen (pancreas). Overeating salty foods damages the kidneys and the heart. Eating too many pungent or acrid and spicy

Food prohibitions in Chinese medicine are focused on not exacerbating a person's specific pattern differentiation [23]. For example, someone with spleen (pancreas) Qi deficiency and dampness would be encouraged to limit or avoid sugar, fatty foods, dairy, raw foods, cold foods and cold drinks in general (e.g., cold salads, smoothies) and instead to have cooked foods like whole grains such as Job's tears, barley, brown rice, millet, quinoa and teff, proteins that are lean, cooked vegetables rather than cold salads and to drink warm liquids in order to

foods leads to internal heat which consumes the yin and can worsen diabetes [23].

health.

tions [48].

aid digestion.

blood sugar if a meal is skipped.

recovery from diabetes [19, 50].

Chinese medicine food therapy for managing T2DM includes a very special food that doubles as a Chinese herb: Ku Gua, known as bitter melon or bitter gourd (Fructus Momordicae Charantiae). It has been used since ancient times in China, India and other parts of the world in the management of what we now call diabetes. Bitter melon contains antidiabetic substances: charantin which reduces blood glucose levels and polypeptide-p which is an insulinlike compound [51]. In Chinese medicine nutrition theory, bitter melon is considered to be bitter and cold and enters the spleen (pancreas), stomach and heart channels. Since bitter melon is thermally cold, people with pancreas Qi deficiency should be mindful to not overeat it since overeating cold foods can further diminish pancreas Qi. However, by adding warming ingredients (e.g., curry seasoning, chili powder and mustard seeds), savory dishes can be prepared that are less cold for the pancreas. For people with excess stomach heat, bitter melon clears stomach heat and by doing so also reduces excessive appetite and can aid in weight loss. Bitter melon can be consumed daily (250–300 g/day) as a juice or by boiling slices of it for several minutes and drinking the water as a tea [20]. People who are taking insulin should use caution when consuming bitter melon because of its additional effect on lowering blood glucose levels.

#### 8. Conclusion

Qigong exercise has shown promising results in clinical experience and in randomized, controlled pilot studies for affecting aspects of T2DM including positive associations between participation in Qigong and blood glucose, triglycerides, total cholesterol, weight, BMI and insulin resistance. Lifestyle changes with appropriate diet and exercise are paramount in managing T2DM. Regular Qigong practice as part of one's exercise routine can have a positive influence on one's awareness of behaviors that either contribute to or improve one's condition and can lead to helpful lifestyle changes, an overall sense of wellbeing and better health. Qigong exercises can play an important, synergistic role in integrative care with biomedical approaches and with acupuncture, Chinese herbal medicine and nutrition for managing T2DM.

## Author details

Guan-Cheng Sun<sup>1</sup> , Catherine Osgood2 \* and Harold Ryan Lilly1

\*Address all correspondence to: gsun@iqim.org

