by Daniel J. Schimmel, OD
This blog is for 3 types of people:
- Those who have diabetes.
- Those people who have a family history of diabetes but do not have the disease themselves.
- Individuals who are genetically predisposed to diabetes with no signs, symptoms or family history.
As a side note, these recommendations through scientific research hold true for many other diseases such as heart and vascular, dementia, alzheimers and certain cancers but I’d like to focus specifically on diabetes.
Let us first talk reality with some numbers. Please note that all of these numbers and recommendations are close approximations, as articles and journals may vary slightly. In 2016, about 29 million people had a diagnosis of type 2 diabetes and 76 million people were considered pre-diabetic. A 2014 report stated that diabetes was the leading cause of new cases of blindness in the age group 20 – 74 years of age. The National Eye Institute estimates that half of all Americans with diabetes have diabetic eye disease. Of those, nearly 5% have a sight-threatening disease. These rates are higher for African Americans, Latino, and Native Americans.
The list of diabetic complications is long and are none that anyone would choose to endure. Here are just a few complications for which diabetics have an increased risk:
- Periodontal disease
- Diabetic foot, which leads to neuropathy and difficulty walking. Diabetic foot is also the leading cause of non-traumatic foot amputation.
- Heart attack
- Eye complications
The good news is there are some things that can be done to decrease the likelihood of development. Type 2 diabetes is preventable and it accounts for 95% of all cases. These recommendations are easy to write or talk about but very difficult for someone to implement. Why? Because they deal with breaking old habits and learning new ones; lifestyle changes. The typical North American diet contains high amounts of processed, caloric dense food that offer little nutritional value and promote weight gain. If you go out to eat at a restaurant, the portion sizes are huge and growing. Children are consuming too many soft drinks and sugary beverages. Other foods that are high in carbohydrates include: bread, potatoes, pasta, corn, carrots, certain beans, fresh fruits (some worse than others such as grapes), breakfast cereals, sweets and alcohol. So you may find yourself asking, “What the heck can I eat?”
Make better diet choices. Healthier choices include fish, turkey, beef, pork, chicken, eggs, salads, and other vegetables. You can consume as much of these foods as you wish. Therefore, you will not get as hungry as you would when eating a high carbohydrate diet. Learn to read food labels for how many carbs are in a certain portion size. Adjust your portion size accordingly. You may need to alter this selection for other health or religious reasons, but the point is there are plenty of good choices that lead to a healtier life. You may not like them at first but you can always refer back to the complication list for motivation.
Next is physical activity. Here are some suggestions: 150 minutes of walking per week reduces the risk of developing type 2 diabetes by 58% over 4 years and 38 % in 10 years. Have a goal of 5,000 to 10,000 steps per day. Water exercises are easy on the body and provide a great workout. Sometimes you just have to be creative in thinking of exercising. You can sit in a chair and lift milk jugs every day for 20-30 minutes. I encourage you to start thinking of exercises you could easily perform instead of making excuses of why you cannot.
Weight is not always the primary issue. There are plenty of thin people with diabetes. However, the risk of developing diabetes increases 7 times in overweight people and 20-40 times in obese people. The primary issue is exercise and carbohydrate intake. Usually if you do exercise and watch your carbs, you will also lose weight. Losing 7% to 10% of your current body weight can reduce your chances of developing type 2 diabetes by as much as 50%.
Don’t forget the importance of a good night sleep. There is a 3-fold increase in developing impaired glucose tolerance with less than 6 hours of sleep and twice the risk if greater than 9 hours. Sufficient Vitamin D levels (53ng/ml) may reduce your risk by 80%.
Prevention starts at an early age. Children observe and learn their parents’ habits quickly and easily. So our duty is to teach them proper habits.
Finally, do what your doctor tells you to do. If you follow your doctor’s instructions and follow the tips mentioned above, you should see results. If you do not see improvement, ask your doctor why. Know your Hemoglobin A1C. This is a number generated at your doctor’s office, which is a three-month average of your blood sugar. It is the number to know and your gauge for better or, hopefully not, worsening of your disease. These guidelines have and are changing but a goal for young people of 6.5 to 6.0 A!C and 7.0 for older people is reasonable. Know what your doctor’s goal is for you. A 6.0 A1C is about an average of 120 blood sugar, 6.5 about 135, and a 7.0 about 150. A1C of 8 is about 180.
In summary, a greater adherence to a healthy (predominantly plant based) diet, regular physical activity, avoidance of smoking, and moderate consumption of alcohol reduces the risk of developing type 2 diabetes (16% reduction FOR EACH LIFESTYLE FACTOR). If you read about other diseases as mentioned above, they will all include the same advice for prevention or stabilization. So, we all have a choice. It takes motivation, determination, help from family and friends, persistence and patience.
To quote the first Indiana Jones movie, “choose wisely my son”.
Reference sources: National Institute of Health, National Eye Institute, wwweyeupdate.com, and The American Diabetic Association.