Actually Preventing Diabetes (February 3, 2015)

We’re plagued by a number of chronic degenerative diseases these days, and one that is increasing rapidly in prevalence and thus as a cause of disability and death is diabetes. But that’s not the reason I chose this topic today, even though mortality due to diabetes is almost as great as that attributed to medical errors. The reason is because diabetes is relatively easy to prevent. Actually PREVENT. So you never even get it. That’s HUGE.

This is good, because diabetes is very nasty. Diabetes results from disorders in insulin, which is a small hormone produced by the pancreas to push sugar into the body’s cells. When that system malfunctions to the point that the blood runs consistently high levels of sugar (above 140 mg, where normal is 100-110 mg), that’s diabetes. Not only are the body’s cells malnourished because they aren’t getting the glucose they need, but the long-term high level of blood sugar is damaging all by itself, particularly to the linings of the blood vessels which have plenty to deal with already without this added burden. Like hypertension, there are no symptoms early on with chronic high blood sugar, so it is easy to neglect or ignore. And -- again like hypertension -- its real problems happen down the road, after the permanent damage has been done. Better to not ever have to deal with it at all.

And it so happens that not only is it fairly easy to take action against this scourge – scourge, I say! – said preventative action is very effective. Between 70% and 90% of people who are in the high-risk group for diabetes (which is people who are overweight and sedentary) who do these two things will not become diabetic after all. SEVENTY PERCENT! That means if you have 100 people who are expected to get diabetes because they are in the high-risk category, and they all take the following steps, at least 70 of them will not get diabetes after all. That’s like practically all of them. That’s YOU (and me).

This also works even if you are already pre-diabetic (have fasting blood sugar of 126-140 mg). In fact, it probably works even better. In one study of a group of pre-diabetics, those who lost 10% of their body weight within six months had an EIGHTY-FIVE PERCENT less chance of being diagnosed with diabetes in the next three years. (The ones who only lost 5-6% still had a fifty-four percent less chance – very respectable.) So read on, friend.

Here’s step 1 – “Stay within a healthy weight.” (I’ll bet you knew that that would be one of them.) The key concept here is “healthy" weight, NOT “ideal" weight. “Ideal” is nice in weight like it is in everything else, but it’s not required to prevent this particular disease. Getting to the target of this weight chart is all that’s required:

Height              Weight (lbs)                Height                  Weight (lbs)
(no shoes)       (no clothes)                (no shoes)           (no clothes)
  
4'10"                       119                             5'8"                         164
4'11"                       124                             5'9"                         169
5'0"                         128                             5'10"                       174
5'1"                         132                             5'11"                       179
5'2"                         136                             6'0"                         184
5'3"                         141                             6'1"                         189
5'4"                         145                             6'2"                         194
5'5"                         150                             6'3"                         200
5'6"                         155                             6'4"                         205
5'7"                         159

So “not overweight” is QUITE good enough. People who are not overweight have only half the incidence of diabetes as those who are overweight. Do not be discouraged if you think that you will never get into your prom clothes again. You don't have to. In fact, you may not even need to reach your target weight as long as you lose 5-12% of your current weight. Hah!

Regular exercise pushes that success rate up even further. Those who are a healthy weight and ‘engage in regular exercise’ have a 70% lower risk of diabetes than those who are overweight and simply lumping around. “Regular exercise” has the usual definition – 2.5 hours of moderate walking or the equivalent per week. Resistance exercise will do the trick too. In fact, if you add resistance exercise to the aforementioned “regular exercise”, you may get additional benefits.

Many of these figures are from Observational studies, from surveys of large numbers of people, and they are useful but not ideal because studies that are Interventional – where you make a bunch of people do something and see how it works – are much better than observational ones. Cause and effect is always questionable in an observational study, for two reasons:

• You can’t be sure that A is actually CAUSING B, just because you're finding them together, or even if you find them in sequence. Correlation doesn't establish causation. A good example of this is the lovely old southwestern Native American belief that the movement of trees and bushes creates the wind -- because out West you can see the plants moving well before you feel the wind yourself.
• Even if you establish that A causes B, it doesn't mean that you will change your health status by moving yourself into the A group. Again, there might be another factor involved, and you are taking a logical leap that historically often lands you in the ditch. People who eat one salad a week and have superior health might just eat a lot more vegetables all the time and are deriving the benefits from that. 

In this case, though, observational and interventional studies get the same results, which is excellent. So you can safely figure that if you’re overweight and manage to lose 5-10% of your body weight, no matter what that weight is, and even if you can't get down to your "normal" weight, you’re in good shape. Especially if you can get out and walk a half hour or more a few times a week as well.

Like so many health and medical issues that largely result from our bad behavior, we feel like if we aren’t being really REALLY “good” that we’re going to get ill and that somehow we deserve it. This is not true. Avoiding disease often requires relatively minor changes. Not getting sick is not the same thing as optimum health, of course, but it's better than a lot of other things.If you can avoid illness that’s at least a step in the right direction. And then the next step becomes easier.

There are people for whom regular exercise and normal weight isn’t sufficient to avoid issues with high blood sugar. For them, dietary management and supplements might be helpful. Sometimes REALLY helpful. I’ll go over some of that next week.

--dr. diane holmes
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