OCT 2015 - NON-MEDICATED LIFE
By Paul E. Lemanski, MD, MS, FACP
Editor’s Note: This is the 67th in a series on optimal diet and lifestyle to help prevent and treat disease. Any planned change in diet, exercise or treatment should be discussed with and approved by your personal physician before implementation. The help of a registered dietitian in the implementation of dietary changes is strongly recommended.
Medicines are a mainstay of American life and the healthcare system not only because they are perceived to work by the individual taking them, but also because their benefit may be shown by the objective assessment of scientific study. Clinical research trials have shown that some of the medicines of Western science may reduce the risk of heart attacks, strokes and cardiovascular death while others may reduce certain types of cancer.
In the first 66 installments of the Non-Medicated Life, informed diet and lifestyle have been shown to accomplish naturally for the majority of individuals, many, if not most of the benefits of medications in the treatment of chronic medical conditions. Moreover, informed diet and lifestyle as a medical intervention may accomplish such benefits at lower risk for side effects and at a lower cost. This is especially true for the prevention of type 2 or adult onset diabetes, which is in large part a lifestyle based disease.
In the last 15 years there has been a 30% increase in diabetes driven primarily by a lack of exercise, a consumption of too many calories, and a consequent increase in body weight. Currently there are approximately 25 million Americans with diabetes and there are 45-60 million at risk for the development of diabetes. Those at risk are converting to diabetes at 11% per year; in ten years there will be upwards of 75 million Americans with diabetes less the ones who die. As those with diabetes are at increase risk for heart attacks, strokes, kidney failure and blindness, all reasonable efforts to preventing this disease should be explored.
In order to prevent diabetes, it is first necessary to identify those at risk. From the perspective of personal and family history, individuals who are overweight or obese, especially those with a family history of diabetes are at risk. Women with a history of gestational diabetes are at risk.
More quantitatively, individuals with an elevated fasting blood sugar (>100 mg/dl) or an elevated three-month average blood sugar (Hgb A1C between 5.7 and 6.4, inclusive) are at risk. These are routine blood tests that can be done through your primary care physician and are a good first step in risk assessment.
Additionally, those with a condition called metabolic syndrome (Met S) are at risk. To determine if one has Met S it is necessary to also have the results of a recent fasting cholesterol profile. Metabolic syndrome is defined as three of the following five risk factors: 1) elevated fasting blood sugar or elevated Hgb a1c; 2) elevated triglycerides >150 mg/dl (a type of blood fat); 3) depressed good cholesterol or HDL (<40 for males and < 50 for females; 4) a diagnosis of HBP or systolic BP > 135 and diastolic BP >85; and 5) increased abdominal circumference measured at the belly button (>35 inches in a female and >40 inches in a male). Those with metabolic syndrome are at three times the risk for the development of diabetes.
Once risk is identified, fortunately, clinical research trials have shown that simple interventions can dramatically decrease the risk and may prevent the development of diabetes. Changes in lifestyle including a reduction of body weight in those overweight or obese, daily exercise, and a change in dietary composition can reduce new cases of diabetes. In one landmark study, weight loss of 15 lbs. reduced new cases of diabetes by as much as 58% over three years, and 32% over ten years of follow up. In another, the institution of Mediterranean diet – emphasizing vegetables, legumes, whole grains and small amounts of meat, reduced new cases of diabetes without weight loss. Finally, in a meta-analysis of ten studies, moderate, daily exercise, such as brisk walking, decreased the incidence of diabetes by 31%, and the reduced incidence was present even after adjustment for body weight. These results suggest that exercise itself – in the absence of weight loss – can reduce new cases of diabetes.
Implementation of these strategies, while not necessarily easy, is totally within the control of the individual. You need not become a marathon runner or actually achieve a normal body weight. Moreover, the method of weight loss or the choice of exercise is not critical to success. Cutting out sweets, sugar laden soft drinks, second helpings, and dessert can begin the process. Any reasonable diet restricting calories will work for initial weight loss. Either the Mediterranean diet cited above or Weight Watchers diet works well for maintenance of the loss. Exercise such as walking has a low risk for injury and can be broken up into two 15-minute sessions per day, or a tracking device such as a pedometer may be used to document the total steps a day that you can get in the normal course of daily activity. I recommend working up to 10,000 steps a day as optimal.
Using the above strategies over the course of six to eight weeks, it should be possible to lose ten to 15 lbs. A repeat fasting blood test can determine if more weight loss or exercise is needed. Many times even a modest loss of weight and some daily exercise may be all that is needed to bring fasting blood sugars down under 100, bring Hgb A1c values under 5.7, lower triglyceride levels under 150, and lower blood pressure. Once blood work is normal the maintenance of body weight and exercise is needed to continue to prevent diabetes and periodic blood tests can confirm protection.
In summary, type 2 diabetes is a preventable cause of death and disability. In order to prevent diabetes it is necessary to identify those at risk. Personal as well as family history is important and fasting blood tests can help to fine tune risk assessment. Once risk is identified changes in diet composition, modest weight loss, and a daily exercise such as walking may be all that is needed to prevent diabetes – and the numerous medications required for its treatment. Preventing diabetes in this way may be seen as an important way to help ensure living a Non-Medicated Life.
Paul E. Lemanski, MD, MS, FACP (firstname.lastname@example.org) is a board certified internist at the Center for Preventive Medicine, Capital Care Medical Group in Albany. He is medical director of the Department of Community Medicine and Population Health at Capital Care Medical Group. Paul has a master’s degree in human nutrition; he is an assistant clinical professor of medicine at Albany Medical College and a fellow of the American College of Physicians.