Category Archives: Diabetes

Diabetes

Leave a Reply

Diabetes: An Avoidable Lifestyle Choice

I’ve been a family doctor for fifteen years, and one of the more dramatic changes I’ve noticed is a big spike in the incidence of prediabetes and diabetes, in all age groups. I had worked in China for ten years until last summer, and all us family doctors at my Beijing clinic weren’t surprised at all with the 2013 paper published in JAMA confirming the frightening reality in China: more than half of all adults in China now are prediabetic. Even worse, 11.2% have diabetes, giving China the dubious distinction of having the highest prevalence of diabetes in the world — higher than in the USA, an extraordinary statement given the far higher rate of obesity in the USA. As tomorrow, March 22  is American Diabetes Alert Day, I felt a timely urgency to share my advice on how to avoid this disease – or at least to slow it down.

It helps me to think of diabetes as a modern lifestyle disease, mostly caused by all developing countries’ gains in weight, less physical activity, and changes in diet. Diabetes now is a global pandemic. Tens of millions of people have diabetes, and many people are undiagnosed because they’ve never been tested. There are two types of diabetes, and type 2 diabetes accounts for 90 to 95 percent of diagnosed diabetes in adults.

Prediabetes concerns us doctors because it means you are at extremely high risk of developing diabetes in the next few years. Studies show that a prediabetic person has a 25% risk of developing diabetes within three years, and a majority within ten years. The greatest risk factor by far is overweight and obesity. Having a BMI under 23 is ideal, and a BMI of 25 increases your lifetime risk of diabetes by 600%. A BMI of 30 increases your risk by 4,000% — that’s 40 times the risk! That’s an extraordinary number which should worry us all, since in the USA over two thirds of adults are overweight and over a third are obese.

But here’s the good news: the crucially important message for everyone is that you have great control over whether or not you develop full diabetes. You should think of prediabetes as an early warning sign by your body, a major wake up call that whatever you’ve been doing to your body isn’t too healthy. Most people with prediabetes fit one or more of these three major risk factors: body mass index (BMI) over 25; lack of enough exercise; and unhealthy food choices as well as portion sizes.

So let’s say that you’re one of the many people who has prediabetes: what can you do right now to help? If you follow the three lifestyle steps below, you can lower your risk more than half! One of the most important public health research studies ever, the Diabetes Prevention Program, proved that lifestyle changes worked better than pills in reducing progression to diabtes. Lifestyle changes lowered a prediabetic person’s risk by 58% over three years — much better than the 31% improvement with a daily pill (metformin).

So what are these magic steps? Without further ado:

  1. Lose weight. Weight gain and obesity are the top causes of type 2 diabetes, and losing weight is now proven to be the most effective prevention. In the DPP study, the goal was to lose at least 7% of your body weight. Your goal should be to lose 5-10% of your body weight.
  2. Exercise. Exercise may not directly cause much weight loss, but exercising muscles absorb sugars much more effectively. This is why exercising is crucial to help control sugars, both in a prediabetic as well as in diabetics. How much exercise is enough? We usually recommend 150 minutes a week of moderate exercise, but any amount is better than nothing. Also, as I mentioned in an earlier column, shorter, more intense workouts can help as much as moderate exercise.
  3. Proper diet. Healthy food choices also are crucial to control your sugars. One of the most common misperceptions about diabetes and prediabetes is that it’s “a sugar problem” and you must cut down on sweets and desserts. The bigger culprit are total starches — pastas, breads, rice and potatoes. In all these cases, processed versions are never as healthy as the originals.

Here are a few quick tips on nutrition:

  • Brown is always better than white: Processed white bread and flour have lost all the nutritious fiber which helps regulate your bowels as well as your sugar spikes after a meal. If you love your carbs, at least try to switch to whole wheat pastas, breads and rice.
  • Portion control: Total calories are also important, as most likely you are taking in a bit more than you realize. These extra calories will get deposited as fat, which leads to more risk of diabetes.
  • Cut back on sodas, beer and juices: All of these are empty calories, full of processed sugars which stress out your liver and pancreas. These unhealthy carbs, especially in sodas, are a major cause of obesity and diabetes in both children and adults.

Type 2 diabetes is partly genetic, so no matter how healthy you are, it still may be inevitable. But these above steps are always good advice for all of us. Another great thing about these healthy life changes is that they also dramatically reduce your risk of heart disease, many cancers, and early deaths from all causes.

Don’t get discouraged — you have control over the next steps!

 

This post was originally published on my new blog atMyFamilyHealthGuide.com. Please follow my new blog! (and my Facebook page

Half of China Has Prediabetes

World Diabetes Day 世界糖尿病日
World Diabetes Day 世界糖尿病日

My family medicine colleagues and I recently have noticed an alarming increase in our patients’ blood sugar levels testing high for diabetes and prediabetes, so much so that we figured it must be a lab error. But our lab confirmed these indeed were accurate, and now a recent paper published in the esteemed Journal of the American Medical Association confirms the frightening reality in China: more than half of all persons in China now are prediabetic. Even worse, 11.2% have diabetes, giving China the dubious and unwanted distinction of having the highest prevalence of diabetes in the world. This is now higher than in the USA, an extraordinary statement given the far higher rate of obesity in the USA. As November 14th is World Diabetes Day, I felt a timely urgency to share my advice on how to avoid this disease – or at least to slow it down.

It helps to think of diabetes as a modern lifestyle disease, mostly caused by all developing countries’ gains in weight, less physical activity, and changes in diet. Diabetes now is a global pandemic. Tens of millions of people have diabetes, and many people are undiagnosed because they’ve never been tested. There are two types of diabetes, and type 2 diabetes accounts for 90 to 95 percent of diagnosed diabetes in adults.

Diabetes is a disease caused by your body losing the ability to properly digest and use sugars and starches in your foods, thus leading to high levels in your blood. Too much glucose floating around your bloodstream for many years can cause many toxic problems to your organs if not treated — especially with your eyes, kidneys and lower legs. For example, diabetes is the leading cause of kidney failure, non-traumatic lower-limb amputation and new cases of blindness among adults in much of the world. Diabetes also raises your risk of heart disease and some cancers.

Prediabetes concerns us doctors because it means you are at extremely high risk of developing diabetes in the next few years. Studies show that a prediabetic person has a 25% risk of developing diabetes within three years, and a majority within ten years. The greatest risk factor by far is overweight and obesity. Having a BMI under 23 is ideal, and a BMI of 25 increases your lifetime risk of diabetes by 600%. A BMI of 30 increases your risk by 4,000% — that’s 40 times the risk!

The crucially important message for everyone is that you have great control over whether or not you develop full diabetes. You should think of prediabetes as an early warning sign by your body, a major wake up call that whatever you’ve been doing to your body isn’t too healthy. Most people with prediabetes fit one or more of these three major risk factors: body mass index (BMI) over 25; lack of enough exercise; and unhealthy food choices as well as portion sizes.

So let’s say that you’re one of the half of China who has prediabetes: what can you do right now to help? If you follow the three lifestyle steps below, you can lower your risk more than half! One of the most important public health research studies ever, the Diabetes Prevention Program, proved that lifestyle changes worked better than pills. Lifestyle changes lowered a prediabetic person’s risk by 58% over three years — much better than the 31% improvement with a daily pill. The three most important lifestyle tips are:

  1. Lose weight. Weight gain and obesity are the top causes of type 2 diabetes, and losing weight is now proven to be the most effective prevention. In the DPP study, the goal was to lose at least 7% of your body weight. Your goal should be to lose 5-10% of your body weight.
  2. Exercise. Exercise may not directly cause much weight loss, but exercising muscles absorb sugars much more effectively. This is why exercising is crucial to help control sugars, both in a prediabetic as well as in diabetics. How much exercise is enough? We usually recommend 150 minutes a week of moderate exercise, but any amount is better than nothing. Also, as I mentioned in an earlier New York Times column, shorter, more intense workouts also can help.
  3. Proper diet. Healthy food choices also are crucial to control your sugars. One of the most common misperceptions about diabetes and prediabetes is that it’s “a sugar problem” and you must cut down on sweets and desserts. The bigger culprit are total starches — pastas, breads, rice and potatoes. In all these cases, processed versions are never as healthy as the originals.

Here are a few quick tips on nutrition:

  • Brown is always better than white: Processed white bread and flour have lost all the nutritious fiber which helps regulate your bowels as well as your sugar spikes after a meal. If you love your carbs, at least try to switch to whole wheat pastas, breads and rice.
  • Portion control: Total calories are also important, as most likely you are taking in a bit more than you realize. These extra calories will get deposited as fat, which leads to more risk of diabetes.
  • Cut back on sodas, beer and juices: All of these are empty calories, full of processed sugars which stress out your liver and pancreas. These unhealthy carbs, especially in sodas, are a major cause of obesity and diabetes in both children and adults.

Type 2 diabetes is partly genetic, so no matter how healthy you are, it still may be inevitable. But these above steps are always good advice for all of us. Another great thing about these healthy life changes is that they also dramatically reduce your risk of heart disease, many cancers, and early deaths from all causes.

Don’t get discouraged with this prediabetes diagnosis — you have control over the next steps! Even if you already have diabetes, you could maybe avoid that second or third medicine, especially insulin injections, if you followed those above lifestyle steps and especially lost 5-10% of your weight.

 


This is a revised update from my recent article; a Chinese version will be published in my regular column in the New York Times Chinese edition

I Have Prediabetes: Now What?

If you are reading this, you or a loved one have probably been told by your doctor that you have abnormally high sugar levels. The doctor may have called it Impaired Fasting Glucose or Impaired Glucose Tolerance, but both of those are just fancy medical words for prediabetes. This means your blood test results for sugars (glucose) were above normal but below actual diabetes range. For the most common test, the fasting glucose test, prediabetes results are 5.6-6.9 mmol/L (100-124 mg/dL). Prediabetes is extremely common; 35% of people in the USA are diagnosed with prediabetes.

What Is Diabetes?

prediabetes overweight obesity exercise diet copyright US CDCDiabetes is a disease caused by your body losing the ability to properly digest and use sugars and starches in your foods, thus leading to high levels in your blood. Too much glucose floating around your bloodstream for many years can cause many toxic problems to your organs if not treated — especially with your eyes, kidneys and lower legs. For example, diabetes is the leading cause of kidney failure, non-traumatic lower-limb amputation and new cases of blindness among adults in the United States and much of the world. Diabetes also raises your risk of heart disease and some cancers.

It may help to think of diabetes as a modern lifestyle disease, mostly caused by all developing countries’ gains in weight, less physical activity, and changes in diet. Diabetes is a global epidemic. Tens of millions of people have diabetes, and many people are undiagnosed because they’ve never been tested. There are two types of diabetes, and type 2 diabetes accounts for 90 to 95 percent of diagnosed diabetes in adults.

Why Is Prediabetes So Concerning?

Prediabetes concerns us doctors because it means you are at extremely high risk of developing diabetes in the next few years — but you still have great control over preventing any more progression! This is crucial for you to understand, so let’s say it again: you have great control over whether or not you develop full diabetes. You should think of prediabetes as an early warning sign from your body, a major wake up call that whatever you’ve been doing to your body isn’t too healthy. Most likely, you fit one or more of these three major risk factors:

  • Body mass index (BMI) over 25 (Don’t know your BMI? Use this BMI calculator)
  • Lack of enough exercise (not sure how much is enough? Read this)
  • Food choices and portions not ideal (for food tips, read here)

How Great Is My Risk of Progressing to Type 2 Diabetes?

Studies show that a prediabetic person has a 25% risk of developing diabetes within three years, and a majority within ten years. The greatest risk factor by far is overweight and obesity. Having a BMI under 23 is ideal, and a BMI of 25 increases your lifetime risk of diabetes by 600%. A BMI 0f 30 increases your risk by 4,000% — that’s 40 times the risk! You can find out more of your risk of diabetes and heart disease by filling out this online risk calculator.

How Can I Prevent Diabetes?

If you follow the three lifestyle steps below, you can lower your risk more than half! One of the most important public health research studies ever, the Diabetes Prevention Program, proved that lifestyle changes worked better than pills. Lifestyle changes lowered a prediabetic person’s risk by 58% over three years — much better than the 31% improvement with a daily pill. The three most important lifestyle tips are:

  • 1. Lose weight. Weight gain and obesity are the #1 causes of type 2 diabetes — and weight loss is the #1 way to reverse and control it.  The great majority of Americans are at major risk of diabetes, as 69% of Americans are overweight or obese. In this DPP study, the goal was to lose at least 7% of your body weight. Your goal should be to lose 5-10% of your body weight.
  • 2. Exercise. Exercise may not directly cause much weight loss, but exercising muscles absorb sugars much more effectively. This is why exercising is crucial to help control sugars, both in a prediabetic as well as in diabetics. How much exercise is enough? We usually recommend 150 minutes a week of moderate exercise, but any amount is better than nothing. Also, recent research shows that shorter, more intense workouts also can help (click here to read more about this high intensity interval training).
  • 3. Proper diet. Healthy food choices also are crucial to control your sugars. Diabetes and prediabetes isn’t so much a sugar problem, it’s a starch and carbs problem, as well as total calories. In other words, you shouldn’t just be thinking, “I need to cut down on my sweets and sugars.” No, the bigger culprit are total starches — pastas, breads, rice and potatoes are the main culprits. In all these cases, processed versions are never as healthy as the originals. A few quick tips:
    • Brown is always better than white: White bread and flour has lost all the nutritious fiber which helps regulate your bowels as well as your sugar spikes after a meal. If you love your carbs, at least try to switch to whole wheat pastas, breads and rice.
    • Portion control: Total calories are also important, as most likely you are taking in a bit more than you realize. These extra calories will get deposited as fat, which leads to more risk of diabetes.
    • Cut back on sodas, beer and juices: All these are empty calories, full of processed sugars which stress out your liver and pancreas. These unhealthy carbs, especially in sodas, are a major cause of obesity and diabetes in both children and adults.

Type 2 diabetes is partly genetic, so no matter how healthy you are, it still may be inevitable. But these above steps are always good advice for all of us. Another great thing about these healthy life changes is that they also dramatically reduce your risk of heart disease, many cancers, and early deaths from all causes.

Can Medications Help Me?

diabetes exercise overweight obesityOne prescription medicine in particular, called metformin, can help prevent a prediabetic from developing full diabetes. In the DPP study above, metformin reduced the prediabetic patients’ risks by 31%. That’s pretty good — but not nearly as good as lifestyle changes! Metformin may be especially helpful if you are very overweight (BMI over 35), if you are under 45 years old, or if you are a woman with a history of high sugars during pregnancy.

If metformin is a good choice for you, don’t ever forget that lifestyle changes, at any time in your life, are far more important than any medicine. Even if you have diabetes, it will always be important to reach for those health goals.

What About Natural Medications or Herbs?

Some foods and supplements may benefit you, but some popular ones may not be as effective as you’ve heard — especially selenium. For the most evidence-based advice, read this excellent medical review here.

When Should I Get Retested?

A prediabetic patient should get their glucose tested once a year. One other test, the HbA1c, measures your glucose levels over the previous three months and often is helpful as a second test. People with diabetes usually get this HbA1c tested every three months.

In Summary

Don’t get discouraged with this prediabetes diagnosis — you have control over the next steps! Even if you already have diabetes, you could maybe avoid that second or third medicine, especially insulin injections, if you followed those above lifestyle steps and especially lost 5-10% of your weight.

What Resources Can Help Me?

There is a wealth of information from the American Diabetes Association.

Preventing Diabetes: Brown is Always Better Than White

Now that even China has joined the worldwide diabetes epidemic, it’s crucial that we all truly understand how we could prevent this very preventable disease — at least for type 2 diabetes, which is the adult-onset diabetes mostly related to obesity and the “Western” lifestyle.

The key concept for diabetics is limiting carbohydrates — and that doesn’t only mean sugar. I see many diabetics who think they’re doing well because they’re “cutting back on sweets and dessert”, when the main diabetic culprit in their diet is the starch carbs from rice, pastas and breads.

One popular method of monitoring carbs is the glycemic index. This index is a ranking from 0-100 of how high a carbohydrate raises blood sugar levels after eating. Here’s a graph below showing the basic concept: a healthy food has a low glycemic index, which means the sugar levels in your body peak lower and slower, thus not stressing out your insulin-secreting pancreas. Unhealthy foods have a high glycemic index, where the sugar levels peak very high and very quickly. This stresses out your pancreas to make insulin, and it’s this chronic repeated stress of your pancreas that partly causes it to slowly fail, producing less insulin — and thus causing diabetes.

Glycemic index
Glycemic index

Think Brown

Following this GI list of foods, and tracking your foods, can honestly be quite cumbersome. Many believe that patients’ counting their carbs is a more effective tool. But in either case, I have an easy clue for everyone: think brown. Brown food is always better than the equivalent white food. What do I mean? I mean that white foods are quite unnatural; white rice and breads and pastas are finely processed versions of the original grains. And these original grains have the “brown” husks full of vitamins, oils, magnesium, fibers and other nutrients. In other words, brown rice is much healthier than white rice for many more reasons than just lowering risk of diabetes. The glycemic index of brown rice is 55, a bit lower than the 72 for short-grain white rice, which is the most common rice in China. Here’s more data which may convince you: a huge 2010 cohort study showed that switching from white to brown rice can lower your risk of diabetes by 16%. Switching to whole grains lowered risk even better, by 36%. That’s an enormous benefit!

Bread & Pastas: The Same Benefit

The same concept applies to white bread, which is made of finely processed flour and thus has lost its husk of nutrients and fiber. The GI of white bread is 70 (a GI over 70 is considered unhealthy), while whole grain breads have a GI of 51. Pasta, on the other hand, has a much better glycemic index than breads or rices, with a GI range from 43 to 61.

 

Diabetes and Obesity: Where Does Your Country Rank? Find Out Now.

It’s no secret that obesity, and its twin sister disease of diabetes, have become epidemics of every modernizing country. I’m now witnessing firsthand the expanding waistlines of Chinese people as they quickly adopt the “Western” diet. Unfortunately, diabetes is already a scourge here as well. But how does it compare to the US, or to other countries? And how does your country rank worldwide?

You can find out very quickly thanks to a fascinating, interactive graph from the Washington Post, which reviews every major country’s diabetes and obesity rates. They got the data from the Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group, which published a series of articles in the Lancet journal. It’s a fascinating chart. For example:

  • Diabetes rates: in 1980 for US men, 6.0%; for Chinese men, 10%. In 2008, for US men: 12.6%, for Chinese men, 9.6%. In the US, there’s a steady progression; in China, the numbers actually improved a while but again are climbing. I’m actually surprised that the percentages in China now are so close already to those in America; awareness of the disease here is much less than in the US. It’s believed that a large percentage of diabetics in China are not yet aware they have the disease.
  • Obesity rates: in 1980, in the US; in 2008 the average BMI for men is 28.5, for women is 28.3. In 2008, for US men is 25.5, women 25.0%.  For China, in 1980 for men, 21.6, women 21.9; in 2008, both are 22.9. (a BMI 25-30 is considered overweight, and over 30 is obese).

With the obesity rates, again the trend in the US is a very scary climb upwards; in China, the rate is rising much slower.

How does your country fare? Click here and find out. You can also go straight to the interactive graphs from the Collaboration Group. it takes a while to load, but their data is much richer and also includes blood pressure and cholesterol.