I've been a family doctor for 15 years, and one of the more dramatic health changes I've noticed in that time is the big spike in prediabetes and diabetes, in kids and adults. Until last summer, I had worked in China for 10 years, and the family doctors at my Beijing clinic weren't surprised by the 2013 paper published in JAMA confirming the frightening reality in China: More than half of all adults are now prediabetic. Even worse, 11.2 percent have diabetes, giving China the dubious distinction of having the highest prevalence of diabetes in the world -- higher than even the U.S.
This is extraordinary, given the far higher rate of obesity in the U.S. I’d like to share my advice on how to avoid this disease – or at least slow it down.
A global pandemic
It helps me to think of diabetes as a modern lifestyle disease, caused mainly by three factors in developing countries: diet changes, less physical activity and weight gain. Diabetes now is a global pandemic. Tens of millions of people have diabetes, and many are undiagnosed because they’ve never been tested. There are two types of diabetes, and Type 2 accounts for 90 to 95 percent of diabetes diagnosed in adults. For this post, I’ll focus on Type 2 diabetes.
Prediabetes also is a big concern for doctors. If you have it, you are at extremely high risk of developing diabetes in the next few years. Studies show that a prediabetic person has a 25 percent risk of developing diabetes within three years, and that most people with prediabetes will have it within 10 years.
Weight plays the biggest role
The greatest risk factor by far is being overweight or obese. Having a body mass index under 23 is ideal. A BMI of 25 increases your lifetime risk of diabetes by 600 percent, and a BMI of 30 increases your risk by 4,000 percent — 40 times the risk of someone who is not overweight! That's another extraordinary number that should worry us all, since more than two-thirds of adults in the U.S. are overweight and more than a third are obese.
Top risk factorsBut here's the good news: You have great control over whether you develop diabetes. You should think of prediabetes as an early warning sign by your body, a wake-up call that whatever you’ve been doing to it isn’t too healthy. Most people with prediabetes have one or more of these three risk factors:
- A BMI over 25
- Lack of enough exercise
- Unhealthy food choices and portion sizes
Lower your risk by more than half
So let’s say you’re one of the many people who has prediabetes: What can you do right now to cut your risk of 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 work better than pills in reducing progression to diabetes. These changes lowered a prediabetic person’s risk by 58 percent over three years — much better than the 31 percent improvement with a daily pill (metformin).
So what are these magic steps? Without further ado:
- Lose weight. Weight gain and obesity are the top causes of Type 2 diabetes, and losing weight is the most effective preventive measure. In the diabetes study, the goal for participants was to lose at least 7 percent of their body weight. Your goal should be to lose 5 to 10 percent.
- 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, for people with prediabetes and those with diabetes. 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.
- Proper diet. Healthy food choices also are crucial to control sugars. One of the most common misperceptions about diabetes and prediabetes is that “a sugar problem” is to blame and that you must cut down on sweets and desserts. The bigger culprit is total starch consumption — including pastas, breads, rice and potatoes. For all of these foods, 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 of the nutritious fiber that helps regulate your bowels and sugar spikes after a meal. If you love your carbs, at least try to switch to whole wheat pastas and breads and brown rice.
- Portion size matters: Total calories are also important, and you might be eating a bit more than you realize. These extra calories will get deposited as fat, which leads to more risk of diabetes.
- Sugary drinks pack on calories: Soda, juice and beer are packed with empty calories, full of processed sugars that stress our liver and pancreas. These unhealthy carbs, especially in sodas, are a major cause of obesity and diabetes in children and adults.
Reducing the risks of other diseases
Type 2 diabetes is partly genetic, so no matter how healthy you are, it still may be inevitable. But these steps are always good advice for all of us.
Another great thing about these healthy life changes is that they also dramatically reduce the risk of heart disease, many cancers and early deaths from all causes. Don’t get discouraged — you have control over the next steps!
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