According to a recent Nutrition Action newsletter, 15% of adults in the United States have diabetes. Add another 38% who have prediabetes (8 out of 10 don’t even know it). The addition of these elements means that one in two adults has harmful blood sugar levels.
Fortunately, many cases can be prevented and, in some individuals, even reversed.
Basics of Diabetes
Understanding the basics of diabetes progression is important and the following description from December’s Nutrition Action newsletter provides a succinct summary
Insulin acts as a key that allows blood sugar (glucose) to enter cells in the body, where it can be burned for fuel or stored.
But in some people, the key cannot open the lock.
To compensate for this “insulin resistance”, the pancreas pumps more and more insulin, but it’s not enough to prevent blood sugar from reaching “prediabetes levels”. After years of trying to keep up, the pancreas begins to break down and blood sugar reaches the “diabetic” range.
The above describes the most common type of diabetes (type 2). In type 1 diabetes (accounting for about 5% of diabetes cases), the body’s immune system destroys the ability of the pancreas to produce insulin
In 2002, a national study (the Diabetes Prevention Program, DPP) published the results of a three-year study of 3,234 people who had been assigned to one of three groups. One group received an intensive lifestyle intervention while the other groups received either a diabetes drug called metformin or a placebo.
Of note, “the lifestyle intervention group reduced their risk of type 2 diabetes by 58% and metformin reduced the risk by 31% compared to those who received a placebo,” according to Dana Dabelea, professor of epidemiology and pediatrics at the University of Colorado.
The two-part lifestyle intervention “…focused on reducing dietary fat intake and promoting at least 150 minutes of physical activity per week, with a goal of weight loss of about 7%,” says Dabelea.
The DPP’s message is that if you lose weight, you will significantly reduce your risk of diabetes.
Additional details for the study are noted in the reference section at the end of the column.
Additional studies such as the Finnish Diabetes Prevention Trial and the Da Qing Diabetes Prevention Study have shown similar results.
Prediabetes is not trivial
The Centers for Disease Control and Prevention (CDC) notes that “without weight loss and moderate physical activity, 15-30% of people with prediabetes will develop type 2 diabetes within five years.”
The important goal is to reverse prediabetes and bring blood sugar back to normal. Otherwise, excessive blood sugar can damage the smallest blood vessels in the eyes, kidneys, nerves, heart, and other parts of the body.
Dabalea explains that the damage can start early. “The DPP and numerous other studies have shown that the risk of retinopathy, nephropathy, neuropathy, and cardiovascular disease increases when blood sugar levels are in the prediabetes range.”
The DPP study provided good news in that a third of the participants lowered their blood sugar to normal levels during the three-year trial.
Moreover, according to Dabalea “They had a 50% lower risk of diabetes in 10 years” And they had a lower incidence of microvascular and cardiovascular complications.
Follow a healthy diet
The most recent advice from the American Diabetes Association (ADA) is that “…we should all cut back on added sugar and refined grains and eat plenty of non-starchy vegetables.” Additionally, the ADA has recommended “whole foods over highly processed foods” and, for people with diabetes, reducing carbohydrates to control blood sugar.
The elephant in the room, according to Christopher Gardner, a professor of medicine at Stanford University School of Medicine, is poor-quality carbs.
This includes refined grains, added sugar, fruit juices, potatoes and other starchy vegetables which make up almost 40% of our calories.
A Gardner study tested the effectiveness of a “well-formulated ketogenic diet versus a ‘Mediterranean plus’ diet with 33 people with prediabetes or diabetes over 12 weeks and then switching to the other diet for 12 weeks. followed by 12 weeks of eating whatever they wanted.
The main point for Gardner in reference to the results of the study is noted in the following excerpt:
I don’t think it’s a wash. I don’t think there’s any reason to get rid of legumes, grains and fruits when so many recommendations from the American Heart Association, the World Health Organization and others promote it. The evidence in favor of a keto diet does not invalidate this advice, even for people with diabetes.
Take the time to better understand the risks of diabetes and prediabetes and develop a plan of action. Small steps can go a long way towards a better quality of life by adopting a healthy lifestyle.
Thanks to the Nutrition Action newsletter for the valuable content in today’s column.
Additional reference informationnot
See the DPP study which is available for review by the National Library of Medicine at ncbi.nlm.nih.gov
If you’re not sure if you’re at risk, take the test online at cdc.gov or ask your healthcare provider for a blood glucose test.
A printed version of the Prediabetes Risk Test is also available at cdc.gov/diabetes.
See the following link for practical information and suggestions for a meal plan using the Mediterranean diet: dailyhealth.com.
Mark Mahoney has been a registered dietitian for over 35 years and completed postgraduate studies in public health at Columbia University. He can be reached email@example.com.
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