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:
- 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.
- 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.
- 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
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