Preventing diabetes

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Wellness solutions from medicine's past, present and future
One in three Americans is now expected to develop this life-threatening condition. Simple, natural steps can keep it from happening to you.

The Cookie Monster's got some stiff competition: America is smack (snack?) in the midst of an obesity epidemic. Nearly two-thirds of the adult population is overweight or obese, according to a report in the Journal of the American Medical Association, and we're growing bigger every year.

What effect does this have? Start with the incidence of diabetes, which is skyrocketing and getting worse by the day. "It's paralleling the rise we see in obesity," says Michael T. Murray, N.D., co-author of How to Prevent and Treat Diabetes With Natural Medicine.

More than 18 million Americans already have diabetes, while another 20 million are in an early stage called "impaired glucose tolerance" or "pre-diabetes." Now, consider the prediction, issued by the federal Centers for Disease Control and Prevention, that one in three babies born in 2000 will eventually develop diabetes. It's not just your chubby Aunt Grace who's at risk, it's you, your spouse, your friends and your children.

Type 2 diabetes is a condition in which the body no longer uses the hormone insulin properly to convert food to energy. (Less than 10 percent of diabetes cases are type 1, formerly called juvenile-onset, in which the body fails to produce any insulin.) Getting diagnosed with diabetes doesn't just mean a lifetime of oral medication or insulin injections; it indicates a substantial chance of developing heart disease, kidney failure, poor circulation, and vision problems that can lead to blindness.

But with careful attention to diet and exercise, says Eugene J. Barrett, M.D., president of the American Diabetes Association, type 2 diabetes can be prevented or delayed in at least 70 percent of those at risk — and Murray says that number could be as high as 90 percent.

change your risk factor
Lifestyle changes can actually reverse the body's declining ability to use insulin. Losing excess weight and exercising regularly is what makes the difference, according to the Diabetes Prevention Program, a major clinical trial that was halted when the positive results became overwhelmingly apparent. The study involved 3,234 people with impaired glucose tolerance, which is where blood-sugar levels fall between normal range (139 mg/dl or less) and the range that warrants a diagnosis of diabetes (200 mg/dl or above).

In the study, reported in the New England Journal of Medicine, one group of subjects followed a healthy diet and got moderate exercise, such as brisk walking for 30 minutes five days a week; they were told to reduce their weight by at least 7 percent. After a three-year follow-up, the incidence of full-blown diabetes was reduced by 58 percent in this group and by 31 percent in a group taking the prescription drug metformin as compared with subjects taking a placebo.

the role of fat cells
How do extra pounds drive up your risk of becoming diabetic? "We used to think of fat cells as storage sites for excess calories," says Murray. "But they are metabolically and hormonally active."

Compounds secreted from fat cells, such as a newly discovered protein called adiponectin, can help control blood sugar and block hardening of the arteries, says Murray. Conversely, as the number and size of fat cells increase, the level of adiponectin can decline.

"The increase in diabetic risk really takes off at about a body mass index of 27," says Christopher Saudek, M.D., director of the Johns Hopkins Diabetes Center in Baltimore and co-author of The Complete Diabetes Prevention Plan. Body mass index is a measure of height to weight, with 25 or more considered overweight. If you are 5 feet 5 inches tall and weigh 162, or 6 feet and 199, your BMI is 27. (For a BMI calculator, see nhlbisupport.com/bmi/bmicalc.htm.)

For Asian Americans, studies have suggested that the risk begins at a body mass index of 24. Most people can aim for a BMI of 25 to minimize their risk, Saudek says, while 23 is a better target for Asian Americans.

the diet debate
All the experts agree that gradually reducing portion sizes and total calories and increasing whole grains and total fiber intake is a good start for weight loss. But defining the ideal diet sparks controversy.

The American Diabetes Association suggests reducing total fat, especially saturated fat, but doesn't specify a percentage of total calories for fat intake. And while some studies have found that moderate alcohol intake reduces the risk of type 2 diabetes, the ADA stops short of recommending it.

The ADA also views total carbohydrates eaten as more important than the glycemic index of foods. This is a ranking of how quickly your bloodsugar level will increase after you eat specific foods; the higher the index ranking, the faster your blood sugar will rise. Yet Murray, among others, advises paying strict attention to the glycemic index and a related measure called the glycemic load. (See "The Glycemic Solution," at left.)

Other promising dietary responses include:
Maintaining complex carbohydrates while lowering fat may facilitate weight loss in those with impaired glucose tolerance, according to a study published this year in the Archives of Internal Medicine. During a 12-week program, subjects getting 63 percent of their calories from carbohydrates, 18 percent from fat and 19 percent from protein lost more weight than a control group whose intake ratio was 45/41/14. (The participants on the higher-carb, lower-fat diet who also exercised boosted their weight loss by 50 percent.)
Reducing fat and eliminating meat might even help those who already have diabetes reduce their medication use, according to the Physicians Committee for Responsible Medicine. In a small study published in Preventive Medicine, PCRM head Neal D. Barnard, M.D., and his colleagues followed diabetics on either a vegan diet (with less than 10 percent calories from fat) or a conventional diet that allowed poultry and fish (with less than 30 percent calories from fat). After 12 weeks, those on the vegan diet had a 28 percent drop in their fasting blood glucose, compared to a 12 percent reduction in the conventional group. Most of the vegans were able to reduce their medication too. The researchers are now repeating the study on a larger scale, and looking at the glycemic index as well.
Fish oil supplements are favored by Murray, In a small study reported in the British Journal of Nutrition, men who took 6 grams of fish oil daily saw an improvement in blood-glucose levels.
Getting enough magnesium may prove useful since the mineral helps several enzymes that regulate glucose levels. In a study published in Diabetes Care, researchers followed more than 127,000 men and women and found that the higher their magnesium intake, the lower the risk of type 2 diabetes. Those in the highest intake group took in about 373 milligrams a day. Food sources of magnesium include whole grains, nuts and green leafy vegetables; supplements are also available.
Make a mental shift along with a nutritional shift. Find something you can do to make these changes comfortable on a longterm basis. For example, talk about your new "life plan," not your diet.
a critical workout
There's no doubt about the other weapon against diabetes. "Exercise increases the sensitivity of the cells to insulin," says Murray. "It is critical in blood-sugar control."

In the HERITAGE Family Study (the acronym stands for "health, risk factors, exercise training and genetics"), overseen by the National Institutes of Health, 105 of the participants had metabolic syndrome, also known as syndrome X; these terms refer to a cluster of risk factors for diabetes, including glucose intolerance, high blood pressure, low levels of HDL (the "good" cholesterol) and excess fat in the abdominal area.

The subjects rode stationary bikes three times a week, boosting their time from 30 minutes to 50 minutes and increasing the intensity. After 20 weeks, 32 of the 105 had reduced their risk factors to the point where they were no longer classified as having metabolic syndrome.

Even without weight loss, exercise appears to improve blood-glucose levels in sedentary, overweight men, according to a study published last year in the journal Metabolism.

No one's saying you have to run a marathon, says Barrett. "Little things like using a step counter and walking and parking farther from where you work can help."

tribal genes
Can pre-diabetics just blame it on their DNA? "Genetics does play a role, but it's not the final answer," says Murray, citing the example of the Pima Indians. Research conducted for the past 30 years by the NIH has found that one-half of adult Pima Indians in this country have diabetes and 95 percent of those with diabetes are overweight. But of 35 tribe members who settled in a remote area of Mexico and followed an agrarian lifestyle (eating few processed foods), only three had diabetes and the population as a whole was not overweight.

Even those who are the most devoted to a regimen of exercise and healthful nutrition can be sabotaged by their genes. But tackling obesity improves the odds dramatically, says Murray. "If we take the steps necessary with our diet and lifestyle, there's no reason why almost anyone should develop type 2 diabetes."

More than 18 million Americans have diabetes — and nearly one-third of them don't know it. The signs are often missed because they seem harmless, reports the American Diabetes Association. Symptoms include: frequent urination, excessive thirst, extreme hunger, unusual weight loss, increased fatigue, irritability and blurry vision. To assess your risk, take the ADA'S online test at diabetes.org/risk-test.jsp.

MORE MIGHT BE BETTER, but both vigorous and moderate physical activity can reduce the risk of pre-diabetes, states a recent report in the International Journal of Epidemiology. In an evaluation of 5,000 subjects, researchers found that vigorous exercisers lowered their risk by 48 percent, moderate movers by 22 percent.

THE COST OF HEALTH CARE for adults with diabetes is at least $153 billion, according to the Diabetes Atlas report. More than 300 million people are expected to be diagnosed with diabetes by 2025, pushing direct health-care spending to nearly $400 billion.

Mulberry extract "contains a very effective alpha-glucosidase inhibitor along with other compounds that appear to improve blood-sugar control," says Michael Murray, N.D.

FOOD GI GL
Soybeans, 14 1.6
cooked, ½ cup
Green peas, 5 2
fresh, frozen or boiled, ½ cup
Black beans, 45 5.7
canned, ½ cup
Kidney beans, 52 6.7
canned and drained, ½ cup
Baked beans, 48 10
canned in tomato sauce, ½ cup
Peach, 42 3
1 large
Peach, 38 4.5
canned in natural juice, ½ cup
Apple, 38 6.8
1 medium
Peach, 52 9.4
canned in light syrup, ½ cup
Banana, 55 17.6
1 medium
Multigrain bread, 43 4
unsweetened, 1 slice
Wonder enriched white bread, 73 7
1 slice
Water crackers, 78 14
3 (25 g)
Hamburger bun, 61 15
1 prepacked
Pita bread, 57 22
1 piece
Bran, 58 8
? cup
Oatmeal, 42 10
cooked with water, 1 cup
Froot Loops, 69 18
1 cup
Vermicelli, 35 15.7
cooked, 1 cup
Brown rice, 50 16
steamed, 1 cup
Macaroni and cheese, 64 19.2
packaged, cooked
Instant rice, 87 33
cooked, 1 cup
Ice cream, 38 5.7
low-fat French vanilla, 100 ml
Yogurt, 26 8
with fruit
Angel-food cake, 67 11.5
1 slice
Blueberry muffin, 59 24
1(80g)
Skittles, 70 38.5
62 g
Whole milk, 27 3
1 cup
Skim milk, 32 4
1 cup
Orange juice, 46 9.7
1 cup
Coca-Cola, 63 25.2
375 ml
Source: How to Prevent and Treat Diabetes With Natural
Medicine. Copyright © 2003 by Michael Murray, N.D., and
Michael Lyon, M.D. Published by Riverhead Books.
~~~~~~~~

By Kathy Doheny

10 ways to lose 10 pounds in 10 weeks
Excess weight spikes your risk for type 2 diabetes, but losing 5 percent to 7 percent of your total body weight can delay or prevent the disease. To shed weight slowly and sanely, aim for losing l pound per week by cutting out — or burning off — 500 calories per day.

Walk it off. With your doctor's OK, begin an exercise program. Brisk walking for 60 minutes five days a week is ideal. Depending on your size and pace, you can lose 1 pound's worth of calories after one week.
Drink more water. Thirst is often mistaken for hunger cravings. Many people tend to be chronically dehydrated, which makes them physically and mentally sluggish, and less able to exercise.
Eat less but more often. Eating smaller meals five or six times a day keeps your metabolism active and prevents you from getting hungry for high-fat snacks.
Parle Italiano? Order your pasta pomodoro (with tomato sauce), not Alfredo (with cream sauce).
A salad isn't healthy when it's drenched in fat. Wean off rich dressings by mixing in low-fat mayonnaise or mustard — or switch to balsamic vinegar and olive oil,
Save 300 calories each morning with a 2-ounce bagel instead of the 5-ounce giants from the deli. Trim another 70 calories by using fat-free cream cheese instead of regular.
Do you want fries with that? No.
Add one home-cooked meal a week. Restaurant meals are often packed with hidden fat and calories.
Avoid fat-free (and nutrition-free) desserts. As much as 80 percent of their carbohydrates come from sugar.
Replace your daily soda with water and you'll lose 1 pound a month.

The glycemic solution
Diabetics and pre-diabetics should avoid eating foods with a high value on the glycemic index (GI), such as white rice and sugary cereals, says Michael Murray, N.D. Even more important, he adds, is to pay attention to a measure called glycemic load (GL), which reinterprets the index based on portion size. For example, watermelon and white rice both have an index value of 72. But the amount of carbohydrate in a ½-cup serving of watermelon is only 6 grams, while 1 cup of rice has 36 grams. Therefore, watermelon ends up with a glycemic-load value of only 4.3, compared with a GL of 26 for the rice.

"When people start paying attention to the glycemic load," says Murray, "they start making healthier food choices and that's a step in the right direction for weight loss."

Murray suggests keeping your daily glycemic load below 150. The adjacent chart lists both the glycemic index and the glycemic load for some common foods. Certain categories have been omitted, such as nuts, seeds, fish, poultry and other meats; these foods are so low in carbohydrates that they have little impact on blood-sugar levels.

Generally, vegetables have the lowest glycemic load; coming in at 1.4 or less are 1 cup servings of asparagus, bell peppers, broccoli, Brussels sprouts, cabbage, cauliflower, cucumber, celery, eggplant, green beans, kale, lettuce, mushrooms, spinach, tomatoes and zucchini. The principal exception is the potato, which has a CL between 10 and 20, depending on the cooking method.

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