Given that almost 20 million people are diabetic and another 70 million have prediabetes (a condition that leads to diabetes if left untreated), it’s likely that you or a loved one is living with this disease.
With November marking the observance of American Diabetes Month, now is a good time
to better understand diabetes and what you can do to lower your risk. The good news is that you can delay or prevent the onset of Type 2 diabetes by making behavioral changes that lead to weight loss.
Your Daily Habits Matter
Making positive lifestyle changes such as losing weight, engaging in daily physical activity, quitting smoking, controlling blood pressure, and lowering cholesterol levels, can reduce your risk of developing Type 2 diabetes.
In fact, The Diabetes Prevention Program (DPP), a government funded study, showed that adults with prediabetes, who lost just 5% to 7% of their body weight plus exercised 30 minutes a day, reduced their risk of developing Type 2 diabetes by 58%. In participants that were aged 60 and older, the risk dropped by 71%!
The dietary changes you can make today to lower your risk of developing Type 2 diabetes include cutting back on sweetened beverages, eating plenty of fruits & veggies, consuming more whole grains, and limiting your total fat, saturated fat & trans-fat intake. Making these healthy choices will help you to maintain a healthy weight, a key consideration when it comes to diabetes management.
Cut Back on Sweetened Beverages & Juice
The #1 source of added sugars in the American diet is sweetened beverages like soft drinks, energy drinks and sports drinks. Juice may sound better but it’s not because it’s a concentrated source of sugars. All of these beverages rapidly raise blood sugar levels which over time can lead to insulin resistance. Plus, they are calorie dense, which leads to weight gain.
Tips: Choose filtered or bottled water. Coffee and tea are fine but if you must add sugar, add just a teaspoon or less! Use artificial sweeteners sparingly or try natural alternatives like Truvia made from stevia. Choose a piece of fruit instead of fruit juice.
Increase Consumption of Fruits & Vegetables
Only 14% of adults and 10% of adolescents consume at least 2 servings of fruit and 3 servings of vegetables daily. These foods are nutritionally dense and assist in weight maintenance. Higher fruit and vegetable intakes also help maintain healthy cholesterol levels, impacting your risk for cardiovascular disease.
Tips: Replace a bagel with cream cheese with non-fat, plain Greek yogurt topped with fresh fruit; instead of a sandwich, order a salad topped with grilled chicken; avoid the afternoon cookie and eat an apple with peanut butter; at dinner, swap rice, pasta or potato, with two veggies; treat yourself at dessert with fresh fruit and a small piece of dark chocolate.
Choose Whole, not Refined Grains
Refined grains which include bread, pizza, desserts, pasta, chips, crackers and cereal are the mainstay of today’s diet. The problem? Due to their lack of fiber, refined grains are broken down quickly in the digestive tract. This leads to a rapid rise in blood glucose levels, followed by a rapid rise in insulin.
As the name implies, whole grain products use the bran and fiber in whole grains. This extra roughage helps slow the breakdown of carbohydrates allowing a gradual release of glucose and insulin into the bloodstream.
Tips: Foods that are made from whole grains must be labeled “whole” or “whole grain” before the grain’s name e.g., whole grain wheat. Be sure to carefully read labels. For examples of whole grain brands/products, check out the Whole Grains Council’s website.
Limit Total Fat, Saturated Fat & Transfat Intake
Reducing fat intake is prudent given the role it plays in obesity and cardiovascular disease. Consuming more fats in the diet adds extra calories and promotes weight gain. Saturated fat and trans-fat intake is associated with elevated cholesterol levels, a risk factor for cardiovascular disease. Red meat, even lean cuts, along with dairy products contains a fair amount of saturated fat. Most packaged, processed foods contain trans-fat which is commonly listed at “partially hydrogenated soybean (or corn) oil”.
A good alternative to animal based protein is legumes. These health promoting foods which include beans, chickpeas and lentils are high in fiber and protein but low in carbs. They’re also good for diabetics. A recent study showed that eating just 1 cup a day of legumes helped Type 2 diabetics improve glycemic control (A1C values were reduced) and lower estimated heart disease risk because of a reduction in systolic blood pressure.
Nuts are also a great way to boost the nutrient content of meals. Importantly, regular consumption of nuts is associated with a lower risk of cardiovascular disease in women with type 2 diabetes.
Tips: Switch to non-fat or low-fat dairy products. To reduce transfat intake, limit your consumption of packaged, processed foods and replace with fresh fruits or veggies. On the occasion that you eat red meat, select pasture-fed beef and select the leanest cuts. New meat labeling laws makes it easy to determine the amount of total fat and saturated fat in many popular cuts of beef. Eat lean meats like deep, cold water fish and chicken (organic, farm-raised). Add nuts, seeds and beans to your diet to increase the protein content of meals. When buying canned beans, look for brands like S&W which offer 50% Lower Sodium products.
The lifestyle changes you can make today to lower your risk of developing Type 2 diabetes include engaging in physical exercise, limiting alcohol intake, not smoking, controlling blood pressure, and managing cholesterol & triglyceride levels.
Get Physically Active
Inactivity promotes Type 2 diabetes. Physical exercise not only keeps the bones and muscles strong, but helps you to achieve and maintain a healthy weight and control diabetes, elevated cholesterol levels and high blood pressure – all risk factors for heart disease. Vigorous physical provides a protective benefit by reducing insulin and related growth factors. Regular exercise can also slow premature cardiovascular aging in diabetes patients.
While the goal is to engage in 45 to 60 minutes of physical exercise on 5 or more days a week, you can do less and still benefit. In the Diabetes Prevention Program, participants lowered their risk of developing Type 2 diabetes by exercising just 30 minutes a day.
Tips: Start slowly and set reasonable goals. Enlist the support of a spouse, friend, or sibling to keep you on track. Hire a personal trainer to set up a program and hold you accountable for showing up.
Limit Alcohol Intake
The risk for Type 2 diabetes increases with alcohol intake. Drinking more than one drink a day for women or two drinks a day for men raises the risk for both diabetes and cancer.
Tip: Limit your alcoholic intake to one drink a day for women and two drinks a day for men (a drink is a can of beer, shot of hard liquor or 5 oz. glass of wine).
Stop Smoking or Never Start
Smokers are about 50% more likely to develop diabetes than non-smokers. Despite the negative health consequences, 18.4 percent of women and 21.6 of men smoke. Diabetics already have 2.5 times higher risk of having a heart attack than a non-smoker. If you have a hard time kicking the habit, keep this in mind: women who smoke increase their risk of having a heart attack 19 years earlier than non-smoking women.
Nicotine constricts your blood vessels and carbon monoxide can damage their inner lining, making them more susceptible to atherosclerosis. Smoking also increases the risk of blood clots forming in your arteries. Exposure to second hand smoke also increases your risk.
Quitting smoking is the most powerful risk factor you can control. By stopping, in just one year, you can cut your risk in half
Tips: November 15th is the Great American Smokeout, sponsored by the American Cancer Society. Check out the ACS’s website for ideas on how to quit now.
Control Blood Pressure
Women have a lower rate of high blood pressure than men up to age 45. From 45-64 years, women have about the same rate as men. But, after 65, women’s rate of high blood pressure exceeds that of men. About a third of adult women have high-blood pressure but in black women, almost half have this condition.
Controlling blood pressure is important as women with hypertension are 3.5 times more likely to develop coronary heart disease than women with normal blood pressure.
A proven way to lower your blood pressure is by following the DASH (Dietary Approaches to Stop Hypertension) diet. This heart healthy diet, promoted by the National Heart, Lung & Blood Institute (NHLBI), emphasizes fruits, vegetables, whole-grain foods and low-fat dairy products. The DASH diet is low in saturated and total fat and cholesterol and limits red meat, sweets, and extra sugars.
In DASH studies, participants following this eating plan not only lowered their blood pressure but the reductions came quickly – within 2 weeks. The greatest reductions in blood pressure came from a diet that reduced sodium intake to 1,500 mg or less per day, indicating the importance of reducing sodium intake to reduce high-blood pressure.
Given that the average sodium intake is 3,400 mg a day, everyone can benefit from making changes to their diet.
Tips: Since packaged, processed foods contain high amounts of sodium, reducing or limiting their intake will help you to reach this goal. Most condiments, soup, take-out food and restaurant food contain high levels of sodium. Be aware that sodium also shows up in surprising places like bread, cereal, cheese and desserts. Start reading labels to manage sodium intake!
Manage Cholesterol & Triglyceride Levels
Forty six percent of women have sub-optimal total cholesterol levels (above 200 mg/dL). Almost one-third have sub-optimal LDL cholesterol levels (above 130 mg/dL) and ten percent have sub-optimal HDL cholesterol levels (below 50 mg/dL).
Cholesterol is a waxy-substance that the body uses for a number of purposes. It is the starter material for the steroid hormones estrogen, testosterone and progesterone. Our bodies also synthesize vitamin D from cholesterol.
But, too much LDL or “bad” cholesterol and low levels of HDL or “good” cholesterol can lead to plaque build-ups that can block arteries and prevent blood flow. Low levels of HDL seem to be a stronger risk factor for women than men.
Triglycerides are a common type of fat in the body. High triglyceride levels are often accompanied with high levels of total cholesterol and LDL cholesterol. Research indicates that high triglyceride levels may increase the risk of heart disease more in women than in men.
From a dietary standpoint, it is important to limit your intake of saturated fat, trans fats and cholesterol because these unhealthy fats raise total cholesterol and LDL cholesterol thereby encouraging the development of atherosclerotic plaques. Trans fats are the worst because they are pervasive (read labels – anything that says partially hydrogenated is a trans fat) and pack a double whammy – they raise bad cholesterol and lower the good cholesterol.
The American Heart Association offers the following recommendations:
- Saturated Fat: Less than 7% of total daily calories
- Trans Fat: Less than 1% of total daily calories
- Cholesterol: Less than 300 mg a day for healthy adults; less than 200 mg a day for adults with high levels of LDL or “bad” cholesterol
If you consume around 2,000 calories a day that equates to less than 140 calories (about 16 grams) from saturated fat and less than 20 calories from trans fat (2.2 grams).
Get a Good Night’s Sleep
People who consistently get too little sleep, increase the risk of developing Type 2 diabetes. The reason? According to a small study, too little sleep impairs the fat cells to respond to insulin (insulin resistance). Fat cells obtained from participants, showed that nearly three times as much insulin was needed to activate an enzyme that plays a crucial role in regulating blood sugar.
Tips: Don’t let watching television get you into a rut of staying up late. Be careful of alcohol intake (limit to just one drink at dinner). If you have trouble falling asleep, don’t drink caffeinated beverages late in the day.
National Diabetes Prevention Program
Can’t do it on your own? The Centers for Disease Control’s (CDC) National Diabetes Prevention Program supports establishing a network of community-based, group lifestyle intervention programs for overweight or obese people at high risk for developing Type 2 diabetes. Key program partners include the YMCA and United Health Group. For more information and programs in your area, check out the CDC’s website.
David H. Rahm, M.D. is the founder and medical director of The Wellness Center, a medical clinic located in Long Beach, CA. Dr. Rahm is also president and medical director of VitaMedica. Dr. Rahm is one of a select group of conventional medical doctors who have education and expertise in functional medicine and nutritional science. Over the past 20 years, Dr. Rahm has published articles in the plastic surgery literature and educated physicians about the importance of good peri-operative nutrition.