Tag Archives: diabetes prevention

March 12, 2016 · 2:00 AM

Nearly Half of Adults in California Have Prediabetes

The actual figure is 46%, according to researchers at UCLA. The LA Times has the story.

“Our genes and our environment are kind of on a collision course,” said Dr. Francine Kaufman, the former head of the American Diabetes Assn., who was not involved with the research. “It’s not stopping.”

The problem with prediabetes is that it often evolves into full-blown diabetes. It’s also associated with increased risk for cardiovascular disease such as heart attack and stroke. The Times article says “up to 70% of those with prediabetes develop diabetes in their lifetime.” I’d never heard that vague number before; I say vague because “up to 70%” could be anything between zero and 70. It’s more accurate to note that one in four people with prediabetes develops type 2 diabetes over the course of three to five years.

Prediabetes is defined as:

  1. fasting blood sugar between 100 and 125 mg/dl (5.56–6.94 mmol/l), or
  2. blood sugar level 140–199 mg/dl (7.78–11.06 mmol/l) two hours after drinking 75 grams of glucose
Most adults with prediabetes don't know they have it

Most adults with prediabetes don’t know they have it

How To Prevent Progression of Prediabetes Into Diabetes

  • If you’re overweight or obese, lose excess fat weight. How much should you lose? Aim for at least 5% of body weight and see if that cures your prediabetes. For instance, if you weigh 200 lb (91 kg), lose 10 lb (4.5 kg).
  • If you’re sedentary, start exercising regularly.
  • Cut back on your consumption of sugar-sweetened beverages, other sugar sources, and other refined carbohydrates like wheat flour.

Steve Parker, M.D.

 

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September 23, 2013 · 1:33 AM

Book Review: The Heart Healthy Lifestyle – The Prevention and Treatment of Type 2 Diabetes

I just finished an ebook, The Heart Healthy Lifestyle: The Prevention and Treatment of Type 2 Diabetes by Sean Preuss, published in 2013. Per Amazon.com’s rating system, I give it five stars (I love it).

♦   ♦   ♦

This is an invaluable resource for 1) anyone recently diagnosed with type 2 diabetes or prediabetes, 2) those who aren’t responding well to their current therapeutic regimen, and 3) type 2 diabetics who want to reduce their drug use.

Strength Training Helps Get Excess Blood Sugar Out of Circulation

Strength Training Helps Get Excess Blood Sugar Out of Circulation

Mr. Preuss is a fitness trainer who has worked with many type 2 diabetics. He demonstrates great familiarity with the issues diabetics face on a daily basis. His science-based recommendations are familiar to me since I reviewed many of his references at my blog, Diabetic Mediterranean Diet.

Like me, Mr. Preuss recognizes the primacy of lifestyle modification over drug therapy for type 2 diabetes, as long as drugs can safely be avoided or postponed. The main lifestyle factors are diet and exercise. Too many physicians don’t spend enough time on these, preferring instead to whip out the prescription pad and say, “Here ya go. I’ll see you in three months.”

I have gradually come to realize that most of my sedentary type 2 diabetes patients need to start a work-out program in a gym where they can get some personal attention. That’s Mr. Preuss’s opinion, too. The clearly explained strength training program he recommends utilizes machines most commonly found in a gym, although some home gyms will have them also. His regimen is easily done in 15-20 minute sessions two or three times a week.

He also recommends aerobic activity, such as walking at least several days a week. He recommends a minimum of 113 minutes a week of low intensity aerobic work, citing evidence that it’s more effective than higher intensity effort for improving insulin sensitivity.

I don’t recall specific mention of High Intensity Interval Training. HIIT holds great promise for delivering the benefits of aerobic exercise in only a quarter of the time devoted to lower intensity aerobics. It may be that it just hasn’t been studied in type 2 diabetics yet.

I was glad to see all of Mr. Preuss’s scientific references involved humans, particularly those with type 2 diabetes. No mouse studies here!

Another strength of the book is that Sean tells you how to use psychological tricks to make the necessary lifestyle changes.

The author notes that vinegar can help control blood sugars. He suggests, if you can tolerate it, drinking straight (undiluted) red wine vinegar or apple cider vinegar – 2 tbsp at bedtime or before carbohydrate consumption. I’ve heard rumors that this could be harmful to teeth, so I’d do some research or ask my dentist before drinking straight vinegar regularly. For all I know, it could be perfectly harmless. If you have a definitive answer, please share in the comments section below.

I read a pertinent vinegar study out of the University of Arizona from 2010 and reviewed it at one of my blogs. The most effective dose of vinegar was 10 g (about two teaspoons or 10 ml) of 5% acetic acid vinegar (either Heinz apple cider vinegar or Star Fine Foods raspberry vinegar).  This equates to two tablespoons of vinaigrette dressing (two parts oil/1 part vinegar) as might be used on a salad.  The study authors also say that “…two teaspoons of vinegar could be consumed palatably in hot tea with lemon at mealtime.”

The diet advice herein focuses on replacement of a portion of carbohydrates with proteins, healthy oils, and vegetables.

I highly recommend this book. And sign up for Mr. Preuss’s related tweets at @HeartHealthyTw.

Steve Parker, M.D.

Disclosure: Mr. Preuss gave me a free copy of the book, otherwise I have received no monetary compensation for this review.

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November 19, 2012 · 7:45 AM

What Causes Type 2 Diabetes?

“Beats me. I teach math!”

I have no simple answer for you, unfortunately.

You can lower your risk of type 2 diabetes significantly by avoiding overweight and obesity, by exercising regularly, and by choosing the right parents.  These provide clues as to the causes of diabetes.  The Mediterranean diet also prevents diabetes.

UpToDate.com offers a deceptively simple answer:

Type 2 diabetes mellitus is caused by a combination of varying degrees of insulin resistance and relative insulin deficiency. [Insulin is the pancreas hormone that lowers blood sugar.] Its occurrence most likely represents a complex interaction among many genes and environmental factors, which are different among different populations and individuals.

So, what causes the insulin resistance and relative insulin deficiency?

Understanding the pathogenesis [cause] of type 2 diabetes is complicated by several factors. Patients present with a combination of varying degrees of insulin resistance and relative insulin deficiency, and it is likely that both contribute to type 2 diabetes. Furthermore, each of the clinical features can arise through genetic or environmental influences, making it difficult to determine the exact cause in an individual patient. Moreover, hyperglycemia itself can impair pancreatic beta cell function and exacerbate insulin resistance, leading to a vicious cycle of hyperglycemia causing a worsening metabolic state.

The UpToDate article then drones on for a several thousand words discussing mouse studies, various genes, free fatty acids, adiponectin, leptin, amylin, insulin secretion, insulin resistance, impaired insulin processing, insulin action, body fat distribution, inflammation, various inflammatory markers, low birth weight, high birth rate, prematurity, etc.  More excerpts:

Increased free fatty acid levels, inflammatory cytokines from fat, and oxidative factors, have all been implicated in the pathogenesis of metabolic syndrome, type 2 diabetes, and their cardiovascular complications.

Insulin resistance may, at least in part, be related to substances secreted by adipocytes [fat cells] (“adipokines” including leptin adiponectin, tumor necrosis factor alpha, and resistin).

Type 2 diabetes most likely represents a complex interaction among many genes and environmental factors.

That’s the simplest answer I can give now.

Steve Parker, M.D.

Reference: “The Pathogensis of Type 2 Diabetes Mellitus”  by David K McCulloch, MD, and R Paul Robertson, MD, at UpToDate.com, updated June 2012, and accessed November 19, 2012.

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January 23, 2012 · 3:14 AM

Can Diabetes Be Prevented?

Not Paula Deen

Paula Deen’s recent announcement of her type 2 diabetes got me to thinking about diabetes prevention again.  If you’re at high risk of developing diabetes you can reduce your risk of full-blown type 2 diabetes by 58% with intensive lifestyle modification.  Here’s how it was done in a 2002 study:

The goals for the participants assigned to the intensive lifestyle intervention were to achieve and maintain a weight reduction of at least 7 percent of initial body weight through a healthy low-calorie, low-fat diet and to engage in physical activity of moderate intensity, such as brisk walking, for at least 150 minutes per week. A 16-lesson curriculum covering diet, exercise, and behavior modification was designed to help the participants achieve these goals. The curriculum, taught by case managers on a one-to-one basis during the first 24 weeks after enrollment, was flexible, culturally sensitive, and individualized. Subsequent individual sessions (usually monthly) and group sessions with the case managers were designed to reinforce the behavioral changes.

Although the Diabetes Prevention Program encouraged a low-fat diet, another study from 2008 showed that a low-fat diet did nothing to prevent diabetes in postmenopausal women. 

I don’t know Paula Deen.  I’ve never watched one of her cooking shows.  She looks overweight and I’d be surprised if she’s had a good exercise routine over the last decade.  I’m sorry she’s part of the diabetes epidemic we have in the U.S.  I wish her well.  Amy Tenderich posted the transcript of her brief interview with Paula, who calculates her sweet tea habit gave her one-and-a-half cups of sugar daily).

  • Nearly 27% of American adults age 65 or older have diabetes (overwhelmingly type 2)
  • Half of Americans 65 and older have prediabetes
  • 11% of U.S. adults (nearly 26 million) have diabetes (overwhelmingly type 2)
  • 35% of adults (79 million) have prediabetes, and most of those affected don’t know it

I think excessive consumption of concentrated sugars and refined carbohydrates contribute to the diabetes epidemic.  Probably more important are overweight, obesity, and physical inactivity.

The Mediterranean diet has also been linked to lower rates of diabetes (and here).  Preliminary studies suggest the Paleo diet may also be preventative (and here).

Greatly reduce your risk of type 2 diabetes by eating right, keeping your weight reasonable, and exercising.

Steve Parker, M.D.

PS: Paula, if you’d like a copy of Conquer Diabetes and Prediabetes: The Low-Carb Mediterranean Diet, have your people contact my people.

Reference:  Diabetes Prevention Program Research Group.  Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin.  New England Journal of Medicine, 346 (2002): 393-403.

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January 3, 2011 · 2:00 AM

Mediterranean Diet Prevents Diabetes – Again

Spanish researchers report that the Mediterranean diet reduced the risk of developing diabetes by 50% in middle-aged and older Spaniards, compared with a low-fat diet. 

Over 400 people participated in a trial comparing two Mediterranean diets and a low-fat diet.  Over the course of four years, 10 or 11% of the Mediterraneans developed type 2 diabetes, compared to 18% of the low-fatters.  One of the Mediterranean diets favored olive oil, the other promoted nut consumption.

We’ve seen previously that the Mediterranean diet prevents diabetes—not all cases, of course—in folks who have had a heart attack.  It also reduced the risk of diabetes in younger, generally healthy people in Spain.

So What?

The study at hand is not ground-breaking.  It enhances the body of evidence that the Mediterranean diet is one of the healthiest around.  I suppose another way to look at this study would be to say that the low-fat diet caused diabetes.

Learn how to move your diet in a Mediterranean direction at Oldways or the Advanced Mediterranean Diet website. 

Diabetics and prediabetics should consider the Low-Carb Mediterranean Diet; otherwise look into the Advanced Mediterranean Diet if you need to lose weight.

Steve Parker, M.D.

Reference:  Salas-Salvado, Jordi, et al.  Reduction in the incidence of type 2 diabetes with the Mediterranean diet: Results of the PREDIMED-Reus Nutrition Intervention Randomized Trial.  Diabetes Care, epub ahead of print, October 7, 2010.  doi: 10.2337/dc150-1288

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April 9, 2010 · 2:00 AM

Prediabetes Ignored Way Too Often

Only half of Americans with prediabetes take steps to avoid progression to diabetes, according to a recent report in the American Journal of Preventive Medicine.

Prediabetes is defined as:

  1. fasting blood sugar between 100 and 125 mg/dl (5.56–6.94 mmol/l) or
  2. blood sugar level 140–199 mg/dl (7.78–11.06 mmol/l) two hours after drinking 75 grams of glucose

Prediabetes is a strong risk factor for development of full-blown diabetes.  It’s also associated with increased risk for cardiovascular disease such as heart attack and stroke.  One of every four adults with prediabetes develops diabetes over the next 3 to 5 years.  The progression can often be prevented by lifestyle modifications such as dietary changes, moderate-intensity exercise, and modest weight loss.  

Investigators looked at 1,402 adult participants in the 2005-2006 National Health and Nutrition Examination Survey (NHANES) who had fasting blood sugar tests and oral glucose tolerance tests diagnostic of  prediabetes.  

The researchers estimate that 30% (almost one out of every three) of the adult U.S. population had prediabetes in 2005-2006, but only 7% of them (less than one in 10) were aware they had it.

Only half of the prediabetics in this survey reported attempts at preventative lifestyle changes in the prior year.  Only one of every three prediabetics reported hearing about risk reduction advice from their healthcare provider.

People, we’ve got to do better! 

My fellow physicians, we’ve got to do better!

The U.S. Centers for Disease Control and Prevention predicts that one of every three Americans born in 2000 will develop diabetes.  The great majority of this will be type 2 diabetes.  You understand now why James Hirsch, author of Cheating Destiny, calls diabetes America’s leading public health crisis.  I agree.

Steve Parker, M.D.

Reference:  Geiss, Linda S., et al.  Diabetes risk reduction behaviors among U.S. adults with prediabetes.  American Journal of Preventive Medicine, 38 (2010): 403-409.

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December 14, 2009 · 5:59 PM

More Coffee, Less Diabetes

"Is the world shaking, or is it just me?"

Coffee drinking is associated with lower risk of developing type 2 diabetes, according to the current issue of Archives of Internal Medicine.  Tea and decaffeinated coffee seem to have the same effect.  Each additional daily cup of coffee reduced the risk by seven percent.

These beverages may have one or more phytochemicals that that alter blood sugar physiology.  [“Phyto” is Greek for “plant.”]  If the experts can figure out which chemicals are involved, it may lead to new drugs to prevent and treat diabetes 10 or 20 years down the road.

In the meantime, don’t feel too guilty about drinking two or three cups of coffee a day, especially if you have risk factors for developing type 2 diabetes.  Common risk factors are family history of diabetes, overweight, high-glycemic-index eating, and sedentary lifestyle.

Steve Parker, M.D.

Reference:  Huxley, Rachel, et al.  Coffee, decaffeinated coffee, and tea consumption in relation to incident type 2 diabetes mellitus: A systematic review with meta-analysis.  Archives of Internal Medicine, 22 (2009): 2,053-2,063.

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June 22, 2009 · 2:00 AM

Do Vitamin D and Calcium Supplements Cut Risk of Diabetes?

Cliffs of Dover: Pure White Calcium Carbonate

Cliffs of Dover: Pure White Calcium Carbonate

Several studies have associated vitamin D and calcium intake with lower risk of developing type 2 diabetes.  After reading that the Institute of Medicine in 2010 will probably increase the recommended amounts of vitamin D for every one, I decided to review the literature pertinent to diabetes.

Over the last 10 years, studies have associated low blood levels of vitamin D with a higher risk of cardiovascular disease, death, type 2 diabetes, some cancers, infections, autoimmune diseases, frequent falls in the elderly, and dementia.

The Institute of Medicine (in the U.S.) currently recommends 200 IU (international units) per day for people under 50, 400 IU for people 50-70, with an upper intake level of 2,000 IU per day.  I assume those amounts refer to a combination of food (or supplements) and the vitamin D your skin makes (but how do we know that?). 

The new recommendation is expected to be around 1,000-2,000 IU per day.  It’s quite difficult to get close to that just with food.  With adequate sun exposure, we can make some vitamin D.  But the dermatologists have scared us out of the sun with horror stories of skin cancer.  I’ve seen some tragic cases in my own patients.  Skin covered with sunscreen doesn’t make vitamin D.  It can be difficult to get enough sun exposure, especially at higher latitudes in winter

I reviewed scientific articles pertinent to tyepe 2 diabetes via PubMed and list the best ones for you below.   The evidence in favor of using vitamin D and calcium supplements to prevent diabetes is weak, but may be correct. 

I found nothing to suggest that high vitamin D and calcium intake (whether food or supplements) helps control established cases of diabetes. 

Take-Home Points 

If you want to prevent type 2 diabetes with supplements, 1000 IU of vitamin D and 800-1000 mg of elemental calcium daily might help.  The evidence is not strong.  It might help; it might not.  But it’s unlikely to hurt.  Check with your personal physician first.  More studies are needed.  Calcium supplements are routinely recommended by expert nutrition panels for people over 60 to prevent osteoporosis.  The vitamin D supplement may be healthy in other ways.

Who, in particular, might want to prevent type 2 diabetes?  People with . . .

I’m sufficiently convinced about the nondiabetic vitamin D benefits that I’m going to start taking 1,000 IU per day.

Steve Parker, M.D.,

References:

Pittas, Anastassios, et al.  The effects of calcium and vitamin D supplementatinon on blood glucose and markers of inflammatin in nondiabetic adults.  Diabetes Care, 30 (2007): 980-9896.

Chowdhurry, T.A., et al.  Vitamin D and type 2 diabetes: Is there a link?  Primary Care Diabetes, April 21, 2009 (Epub ahead of print).

Pittas, Anastassios, et al.  Vitamin D and calcium intake in relation to type 2 diabetes in women.  Diabetes Care, 29 (2006): 650-656.

Knept, P., et al.  Serum vitamin D and subsequent occurrence of type 2 diabetes.  Epidemiology, 19 (2008): 666-671.

de Boer, I.H., et al.  Calcium plus vitamin D supplementation and hte risk of incident diabetes in the Womens’ health Initiative.  Diabetes Care, 31 (2008): 701-707. (Epub January 30, 2008).

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