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Defending Against Diabetes

Type-2 diabetes has tripled in the last 30 years. We've also experienced a dramatic upsurge in obesity. Experts now use the term "diabesity" to make more people aware of the connection between these trends: Excess weight makes you more prone to type 2, and 80% of those who get the disease are overweight when they're diagnosed. Right now, more than 20 million Americans have blood sugar levels that are higher than normal but not yet in the diabetic range. Called "pre-diabetes" this condition can turn into the full-blown disease, especially in those who are overweight and under-active.

Your Best Defense is Offense

According to one encouraging study, making realistic changes to your diet and activity level can greatly reduce your chances of getting type 2 diabetes (1). The study looked at over 3200 people who were more likely to develop type 2 because their fasting blood sugar levels were too high. After being encouraged to eat a low fat diet and increase their physical activity, everyone was assigned to get specific diet and exercise advice, or the drug metformin (Glucophage) to lower blood sugar. Another group took a placebo.

The incidence of diabetes went down by 58% in people making lifestyle changes compared to those taking placebo. For those who got the drug, diabetes decreased by 31%. What's remarkable about these findings is not just that the lifestyle changes were better than the drug for preventing diabetes, but that the goals were modest enough to be reached by most people. The targets were to maintain a weight loss of at least 7% of initial body weight - that's only 10 lb for a 150 lb woman for example - and to do moderate physical activity for at least 2 hours weekly.

In a follow-up, the researchers looked at how the lifestyle and drug interventions affected study volunteers who had metabolic syndrome (MS) in addition to high blood sugar (2). The syndrome is defined as having 3 or more these characteristics: thick waist, high triglycerides, low HDL, high blood pressure or high fasting blood sugar. People with MS have a 5-fold greater risk for diabetes and are 3 times more likely to die of heart attack or stroke. Once again, the lifestyle changes were more effective than the drug in preventing people who didn't have MS from developing it. For those who already had MS, the lifestyle changes were better than the drug in helping the syndrome resolve.

Take Charge of Your Diet

Eating more fiber can help substantially. Fiber from beans, peas, oats, fruits and vegetables slow down digestion to help you feel fuller longer. They also slow the entry of glucose into the bloodstream, helping to dampen insulin output. Eating more of this fiber helps keep blood levels of LDL cholesterol in check as well. You'll also want heart-healthy fiber from whole grains, such as wheat cereals, bran and brown rice. Focus on getting at least 2-3 servings of fish weekly. High intake of omega-3s from fish correlates with a lower incidence of type 2, and supplemental amounts in the range of 2-4 grams daily have been shown to bring down elevated triglycerides (3). Even more importantly, omega-3s reduce the risk of death from coronary heart disease in diabetic women (4). Finally, it's wise to take a complete multi to ensure that you get enough of the many vitamins and minerals involved in insulin and glucose metabolism such as chromium, zinc, magnesium and various antioxidants.

Even if you already have type 2, trimming down and getting active can improve long-term blood sugar control. And that helps reduce the extra risks that come along with diabetes such as heart and kidney disease, nerve and vision problems, and even a greater chance of developing dry eye (5). So let's all resolve to have our blood glucose checked, tune up our diets and get moving. The rewards are well worth the effort!

References

1. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New Engl J Med 346:393-403, 2002.
2. Orchard TJ et al. The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: The Diabetes Prevention Program Randomized Trial. Annals Intern Med 142:611-19, 2005.
3. Krauss RM. AHA Dietary Guidelines. Revision 2000: A statement for healthcare professionals from the nutrition committee of the American Heart Association. AHA Reprint 71-0193.
4. Hu FB et al. Fish and long-chain omega-3 fatty acid intake and risk of coronary heart disease and total mortality in diabetic women. Circulation 107:1852-7, 2003.
5. Kaiserman I et al. Dry eye in diabetic patients. Am J Ophthalmol 139:498-503, 2005.