Diabetes or prediabetes? How to be proactive with diet, exercise – Tallahassee Democrat

According to a recent Nutrition Action newsletter 15 percent of adults in the United States have diabetes. Add another 38 percent who have prediabetes  (with 8 out of 10 not even knowing it). Adding these together means one in two adults with harmful blood sugar levels.
Fortunately many cases can be prevented and, in some individuals, even be reversed.
Understanding the basics of how diabetes progresses 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 the body’s cells, where it can be burned for fuel or stored.
But in some people the key can’t open the lock.
To compensate for that “insulin resistance,” the pancreas pumps out more and more insulin, but it’s not enough to keep blood sugar from creeping up to “prediabetes levels. After years of straining to keep up, the pancreas starts to fail and blood sugar reaches the “diabetes” range.
The above describes the most frequent type of diabetes (type 2).  In type 1 diabetes (accounting for about 5 percent of diabetes) the body’s immune system destroys the pancreas’ ability to make insulin
In 2002 a nationwide study (the Diabetes Prevention Program, DPP) published results from a three year study of 3,234 individuals 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.
It was noteworthy that “the lifestyle intervention group reduced their risk of type 2 diabetes by 58 percent and metformin reduced the risk by 31 percent compared to those who got 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 weight loss target of about 7 percent,” says Dabelea.
The message of the DPP is that if you lose weight, you’re going to substantially 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 had similar results.
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 return blood sugar levels to normal.  Otherwise excess blood sugar levels can damage the tiniest blood vessels in the eyes, kidneys, nerves, heart and other area in the body.
Dabalea explains that the damage can start early. “The DPP and many other studies have shown that the risk of retinopathy, nephropathy, neuropathy and cardiovascular disease increases when blood sugar is in the prediabetes range.”
The DPP study provided some 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 percent lower risk of diabetes 10 years down the road” And they had a lower incidence of microvascular and cardiovascular complications.
The most recent advice from the American Diabetes Association (ADA) is that “…we should all cut back on added sugar and refined grain and eat lots of non-starchy vegetables.” In addition, the ADA recommended ‘whole foods over highly processed foods,” and for those with diabetes, reducing carbohydrates to keep blood sugar under control.
The elephant in the room, according to Christopher Gardner, professor of medicine at the Stanford University School of Medicine is the low quality carbs.
This includes refined grains, added sugar, fruit juice, potatoes, and other starch vegetables that make up nearly 40 percent of our calories.
A study by Gardner 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 switch to the other diet for 12-weeks followed by 12 weeks of eating whatever they wanted.
The bottom line for Gardner in reference to the study’s results 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 them. The evidence in favor of a keto diet doesn’t overturn that advice, even for people with diabetes.”
Take the time to better understand the risks of diabetes and prediabetes and make a plan to act.  Small steps can go a long way to a better quality of life through practicing a healthy lifestyle.
Thanks to the Nutrition Action newsletter for valuable content in today’s column.
Check out the DPP study which is available for review through the National Library of Medicine at ncbi.nlm.nih.gov
If you’re not sure if you’re at risk, take the online test at cdc.gov or ask your health care professional about getting a blood sugar test.
A print version of the Prediabetes Risk Test is also available at cdc.gov/diabetes.
Check out the following link for some practical information and suggestions for a meal plan utilizing the Mediterranean Diet: everydayhealth.com.
Mark Mahoney has been a Registered Dietitian for over 35 years and completed graduate studies in Public Health at Columbia University.  He can be reached atmarqos69@hotmail.com.

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