A Growing Problem
What if I said just by looking at you, I could tell whether you had an elevated risk of heart disease, stroke, and diabetes? I wouldn’t need to take a blood test or know your cholesterol level. I wouldn’t need to know any facts about your lifestyle or diet. I wouldn’t need to take a family history. In fact, I wouldn’t need to say a word to you. All I would need to do is give you a quick glance. What I would be doing is checking your waist size. How big you are around the middle now is a harbinger of health problems down the road.
To be more precise in my diagnosis, of course, I would use a tape measure. Think about it, though. In this age of high-tech medicine, of CT scans and MRI machines, a tape measure may be the best diagnostic tool we have to predict your risk of heart disease, stroke, and diabetes. That’s because your waist size shows how much abdominal fat your body is carrying. Abdominal fat, it turns out, is a killer.
How large a waist is dangerous? According to the National Obesity Forum, a waistline of thirty-five inches or more for women and forty inches or more for men should sound the alarm. That’s because people who are large around the middle—with a so-called apple-shaped body—tend to have more fat not just on the outside, but more importantly surrounding and choking the internal organs. People who have fat on their thighs or buttocks—pear-shaped bodies—have more of their fat stored just under the skin. Not surprisingly, having more visceral fat—fat stored around the internal organs—is far more dangerous. Put simply, a big stomach is much worse for your health than big hips. Men are more likely than women to be apple shaped, although visceral fat is also a risk for postmenopausal women.
As a doctor, I am always looking for ways to actually show people what all that extra abdominal fat is really doing to the body. That is why I was so fascinated by an exhibit traveling the globe with specially treated human cadavers. It is called Body Worlds: The Anatomical Exhibition of Real Human Bodies, featuring more than two hundred human specimens ranging from entire bodies to individual organs. A German named Dr. Gunther von Hagens took cadavers donated by individuals from all over the world. The skin has been removed so you can see the bones, tendons, muscles, nerves, blood vessels, and healthy and diseased organs. All of the natural fluids in the body have been replaced with a flexible plastic, a process invented by von Hagens and dubbed plastination. The process is designed to stop decay after death, offering some truly unique and somewhat gruesome views of the human body.
One body in the exhibit has been sliced down the middle, from head to foot. Others are posed playing chess, running, jumping, fencing, kicking a soccer ball, and swinging a baseball bat. One body is even posed atop a preserved horse. Seeing these skinless “plastinates” posed as if performing ordinary activities is both shocking and fascinating.
More than 16 million people have seen Body Worlds in Europe and the United States. In an effort to find out how I might live longer, I decided I should see the specially preserved cadavers firsthand. I caught up with the Body Worlds exhibit at the Franklin Institute Science Museum in Philadelphia. The goal of Body Worlds is to promote healthy lifestyles, and it is easy to see why it might work.
Because you can peer into the wonderful complexity of the human body, you can see the differences in the bodies on display. There is a cadaver of a person who weighed 580 pounds near someone who weighed 140 pounds. The difference is truly striking. The first thing that hits you is all the extra weight that person carried around. It’s not surprising, for example, that this body had an artificial knee. The wear and tear of all that extra weight takes its toll on the joints, which have not evolved to carry around excess pounds.
Then you look at the organs. You can actually see the fat on the liver of the overweight cadaver. A fatty liver won’t work as well as a healthy one, and that will affect the body’s ability to flush out toxins and deal with the waste products of the body’s metabolism. Even the heart is not immune. It is immense: three or four times normal size. Fat has gotten into the heart tissue itself, weakening it. Fatty buildup in arteries also makes people more prone to blockages, causing heart attacks.
Looking at the bodies in Body Worlds left me with a lasting impression and little doubt in my mind that globs of fat around the midsection are far more dangerous than simply causing your pants to be snug. That is the bad news.
This book, however, is about chasing life, so I have good news as well. Fat around the waist appears to be the easiest to lose, far easier than fat on the hips or buttocks. In fact, a study at Duke University Medical Center found a brisk half-hour walk six times a week could stop the waistline from expanding any further. If you can find time for even more exercise, you could actually start to reduce the visceral fat. It goes without saying that doing no exercise resulted in increased abdominal fat and about 4 pounds a year of weight gain.
As you have already learned, chasing life means lowering your risk of heart disease, stroke, and diabetes. These are the biggest killers in most developed countries, but if you follow some fairly simple steps, we can cut your risk dramatically and greatly extend your life. Unlike many books out there, I won’t make you the false promise of a magic formula, and I will demand your full participation. But trust me—the payoff will be well worth it. The first step is to start today—I mean right now.
True, you may be decades away from any chance of heart disease or stroke, but remember, the way you live now will most certainly have an impact on your health in the future. Diabetes is a good example. Type 2 diabetes used to be synonymous with adult onset, but now, because of poor choices at a very young age, we are seeing this type of diabetes in grade school children. More about that later.
HEART HEALTHY
We know more about heart disease today than ever before. Heart disease is the number-one killer in the United States, accounting for 2.4 million deaths, according to the most recent figures available. That’s 1 in every 2.7 deaths, or almost 2,500 Americans a day. That’s more than the next four leading causes of death combined (cancer, chronic lower respiratory diseases, accidents, and diabetes). Of course, this is nothing new. Since 1900, heart disease has caused more deaths than any other cause every year except 1918, when the worldwide flu pandemic swept through the United States. Unfortunately, heart disease shows no signs of going away anytime soon.
Some 71 million Americans now suffer from one or more types of cardiovascular disease, more than two-thirds of them under the age of sixty-five, according to the 2006 statistics from the American Heart Association.
Heart troubles tend to get worse with age. For example, high blood pressure hits a little more than 20 percent of Americans in their forties, 60 percent of Americans in their sixties, and 80 percent of Americans in their eighties. African Americans are more likely to be affected. Researchers have found that the stiffness of blood vessels increases as we age, when flexible fibers are replaced with less flexible collagen and calcium. This process thickens the interior wall of the blood vessels and raises blood pressure. Researchers are now trying to figure out ways to stop this vascular aging. Exercise helps. Arterial stiffness is inversely related to physical fitness.
From remarkable medications to invasive procedures, doctors have become good at treating heart disease. But as we chase life, it is important to get control of the risk factors to your heart before you are ever diagnosed with full-blown heart disease. This is especially true if you have a family history of heart troubles. Yes, you want to start off with a visit to your doctor’s office, but you want to go armed with knowledge. Here are some of the basics: Make sure you know your family history well. Pay attention to any unusual pain in your chest, especially if it’s crushing or radiating into your jaw or arm, so you can tell your doctor about it. If you have ever had your blood pressure checked or had an electrocardiogram (EKG) in the past, make sure you take that information with you, as well as previous cholesterol readings. This can save you a lot of time in the doctor’s office and make sure you are off to a good start. Too often, I have heard stories of a patient whose first symptom of heart disease is a heart attack. And, given that one-third of all heart attacks are fatal, it is often both a surprising and disastrous outcome. Obviously, you want to catch potential problems like high cholesterol, cardiac arrhythmias, and atherosclerosis—a buildup of plaque in the arteries—before they reach the critical stage. Sometimes it’s not as easy as it sounds. Former President Bill Clinton experienced eight years of executive health care while in the White House. Still, that wasn’t enough to stave off life-threatening heart disease just four years later, when he went under the knife to have heart bypass surgery. “I really think it probably saved my life,” Bill Clinton told me, speaking not about the bypass operation he had but about the test—an angiogram—that first showed that the arteries feeding blood to his heart were dangerously blocked. “If people have a family history there, and high cholesterol and high blood pressure,” Clinton said, “they ought to consider the angiogram.”
Good advice? Yes and no. An angiogram is the gold standard of heart tests, and in Clinton’s case, it picked up a problem that all his previous stress tests and EKGs had missed. But an angiogram is not something to be taken lightly. It involves injecting a dye directly into the blood vessels of your heart through a catheter that has been threaded into your chest from an artery in your groin. By taking X-ray images of the dye, doctors can get a pretty clear picture of where blood is flowing freely and where there are constrictions.
But angiograms are not risk-free. In about one case out of one thousand, according to Dr. Richard Stein, associate chairman of medicine at Beth Israel Medical Center in New York City, there are complications—including, in rare cases, strokes. For patients who have never had any symptoms (such as the chest pains and shortness of breath that Clinton experienced) and whose stress tests are normal, the risks outweigh the benefits, says Stein.
That’s why there has been so much attention given lately to a noninvasive test called electron beam computed tomography (EBCT). It uses a burst of X-rays to show how much calcium has been deposited in the coronary arteries—a good measure of how much plaque has accumulated there. In a study published in the Journal of the American College of Cardiology, more than half of 1,119 patients who passed their stress tests had high calcium scores in subsequent EBCTs, suggesting significant hardening of the arteries.
Getting an EBCT is not the end of the story. If you get a high calcium count, you will still need an angiogram so your doctor can tell precisely where your arteries are blocked. But EBCTs are spotting a lot of hidden heart disease. Although some insurance companies are reluctant to pay for this new test, its use is growing rapidly, and it may eventually become part of the standard heart workup. This is something you may want to talk to your doctor about if you have a strong family history of heart disease or have other reasons for concern.
There has also been a lot of interest in a new sort of blood test called C-reactive protein (CRP). President Bush has his checked regularly, and it is extraordinarily low, which means to him (and his doctors) that he is at very low risk of having a heart attack. At medical cocktail parties nowadays, it seems cardiologists are talking about CRP the way they used to talk about high-density lipoprotein (HDL) and low-density lipoprotein (LDL), and for good reason. Two recent reports from the New England Journal of Medicine suggest that CRP may be just as important a risk factor for coronary artery disease and heart attacks as LDL—and maybe more so. CRP is a protein secreted by the liver in response to inflammation, and over the past several years, it has become apparent to experts that inflammation is a big part of heart disease. CRP seems to play a role in damaging artery walls, making them more prone to the buildup of fatty plaques that can rupture and block the vessels that feed the heart. Sure enough, studies have shown that high CRP levels, signaling active inflammation, are significantly associated with heart problems. So what can you do about it? Well, doctors know statins can reduce inflammation. So cardiologists from Brigham and Women’s Hospital in Boston put 3,745 patients who had experienced heart attacks or severe chest pain on statins and later measured their levels of both LDL and CRP. It turned out that patients who ended up with low CRP levels were less likely to have heart attacks or die than were those whose CRP levels stayed high—whether or not their LDL levels went down. This was in many ways a landmark study, showing that CRP reduction is at least as important as cholesterol reduction. The second study, performed at the Cleveland Clinic Heart Center, also tracked cardiac patients, but instead of looking at heart attacks, the researchers measured actual plaque buildup. The patients whose CRP level dropped the most while taking statins saw their plaques get smaller—again, independent of what happened to their LDL level. There is no question that CRP will continue to become increasingly important, and it now makes sense for anyone who’s at risk for heart disease to be evaluated. It’s a simple blood test that any lab can do, and while it might not be covered by all insurance companies, it costs $15 at most.
Still, for us life chasers, I want to start with the basics so we may never need these medications, tests, or operations. It comes down to working out harder, sleeping more soundly, and being very particular about what and how much you eat.
Exercise
Exercising is the first simple step toward lowering your risk of heart disease. If you become leaner and fitter, your risk of heart disease and stroke goes down. It’s that simple. Not exercising raises your risk of coronary artery disease as much as high blood pressure, high cholesterol, or smoking, according to a study published in the Journal of the American Medical Association. You also know that focusing on losing that abdominal fat makes a world of difference. So in addition to such aerobic activities as running, stair climbing, or perhaps walking on a treadmill, you want to do some targeted, core exercises to work off that abdominal fat. As you gradually add even small amounts of weight training to your program, you will start to see the abdominal fat melt away. And here is an added benefit: it will also likely help you get critically important, quality sleep at night.
Sleep
Chronic lack of sleep has been linked with heart disease, among other health problems. A number of studies have linked sleep with appetite and weight control. One study, involving more than one thousand people between the ages of forty-five and seventy-five, found the body mass index (BMI) of participants actually increased as their sleep time decreased. I know it seems counterintuitive, but it turns out the less you sleep, the more your overall metabolism changes, conserving energy and fat. So lack of sleep makes your fat that much harder to lose and thus contributes to heart disease. In another study, researchers restricted young, healthy adults to four hours of sleep a night for six days and found some remarkable, measurable hormonal changes that could lead to overeating. The study subjects actually developed decreased levels of leptin, an appetite suppressant. And to make matters even worse, they had increased levels of ghrelin, a hormone that stimulates appetite.
Smoking
If you smoke, you should stop. If you don’t smoke, please don’t start. It’s amazing that with all the information out there about the horrible health consequences of breathing in cigarette smoke, an estimated 1.4 million Americans start smoking each year (half of them under eighteen). You must know the association between smoking and cancer, but those nasty nicotine-delivery devices also result in an estimated doubling or tripling of your risk of dying from coronary artery disease, according to the American Heart Association. I am not going to preach about cigarettes, although I recently learned not enough doctors counsel their patients to quit. Let me simply say that everything else in this book is null and void if you continue to smoke or ever start.
Nutrition
There are certain foods that appear to help protect against heart disease. I call them “power foods,” and you should try to incorporate as many as you can every day into your diet. A large-scale study found a diet high in fruits and vegetables and low-fat dairy products; with moderate amounts of fish, poultry, and nuts; and low in red meats, sweets, and sugary drinks lowered blood pressure by as much as seventeen points in people with high blood pressure. And that was within just two weeks. In case you ever thought simple changes to your diet wouldn’t amount to much, think again. Cholesterol also dropped within that same time period.
Despite this straightforward antidote, the statistics collected by the American Heart Association are extremely worrisome. For example, four in five men and nearly three in four women do not get the recommended five servings of fruits and vegetables a day. A third of our calories come from fat, and our diets are low in whole grains. Our daily fat consumption is about 75 grams, the equivalent of three McDonald’s Quarter Pounders with cheese. In a very real way, we are by and large what we eat—fat.
Eating a fatty diet is so easy in the United States. Fast food restaurants, vending machines, and gas station marts offer up food that is high in fat. Even hospitals are offering fatty fare. A study commissioned by the Center for Science in the Public Interest found cafeterias at eighteen of the nation’s top hospitals were serving foods prepared with partially hydrogenated vegetable oil, the biggest source of artery-clogging trans fat in the American diet.
Heart Disease Power Foods
• Fruits, especially strawberries, blueberries, and bananas
• Vegetables, including tomatoes, spinach, eggplant, and okra
• Low-fat dairy
• Legumes such as lentils, chickpeas, and lima beans
• Fish, especially such oily fish as tuna, mackerel, and herring
• Poultry
• Nuts, including almonds and walnuts
• Whole grains
Here are some heart-healthy foods: such oily fish as tuna, mackerel, and herring, which contain omega-3 fatty acids, can significantly lower the risk of dying of heart disease, according to the American College of Cardiology.
Eating foods containing soluble fiber, such as oat bran and legumes, has been shown to lower total cholesterol and LDL (bad) cholesterol. Blueberries may have a similar effect. Lycopene, found in tomatoes and tomato products, such as ketchup and tomato juice, may also lower cholesterol and reduce the risk of heart attack, although results from a number of studies are not consistent. Okra and eggplant have also been shown to lower cholesterol, as long as they are not fried. Adding strawberries to your diet could lower your systolic blood pressure.
One study found eating cereal fibers later in life lowered the risk of cardiovascular disease. This is one area in which Americans really fall short. The recommended daily intake is 25 grams, but we are averaging about 15.
A heart risk you don’t often hear about comes from the amino acid homocysteine. Elevated levels of homocysteine in the blood increase the risk for such cardiovascular diseases as coronary artery disease, stroke, and blood clots. That’s true even for people with normal cholesterol levels. In fact, high homocysteine levels account for an estimated 10 to 20 percent of cases of coronary artery disease and pose as big a threat as high blood pressure and hypertension. Fortunately, there appears to be a simple dietary fix.
Adding folic acid, or folate, to your diet decreases the homocysteine levels in the blood, which should in turn lower the risk of heart disease and stroke. How do you increase your folic acid intake? The simplest sources of folic acid are fortified breakfast cereals and folic acid supplements. Green, leafy vegetables, such as spinach, are rich in folic acid, as are citrus juices and legumes, such as lentils, chickpeas, and lima beans. In addition, heavy drinkers, cancer patients, and pregnant women all need extra folic acid in their diets.
The minerals we get in our food also affect our heart health. The National Health and Nutrition Examination Surveys, which involved nearly ten thousand men and women whose eating habits were charted for two decades, revealed that those who had the lowest potassium levels in their diet had a 28 percent greater risk of stroke than those who consumed more potassium-rich foods. The Honolulu Heart Program, which studied seven thousand men, found those with the highest magnesium intake had a 45 percent lower risk of heart disease than did those who consumed the least.
Good sources of potassium include bananas, baked potatoes, orange juice, raisins, prunes, and spinach. Sources of magnesium include bran cereal, oat bran, shredded wheat, brown rice, almonds, hazelnuts, almonds, spinach, okra, lima beans, and bananas.
In a year-long study conducted by the University of Toronto, something called the portfolio diet showed cholesterol-lowering properties that rivaled the blockbuster cholesterol drugs known as statins. The diet allowed for no meat, eggs, poultry, fish, or dairy. Foods were picked based on their ability to lower cholesterol a little. Together, they lowered cholesterol a lot. What was it? Participants in the study ate a mostly vegetarian diet also rich in soy foods, almonds, and fruit. They also ate whole grains and beans, and they used healthy oils and margarine made from plants.
Another study found omega-3 fatty acids, which I talked about in chapter 5, reduced the chance of dying of heart disease more than statins.
STATINS, SUPPLEMENTS, AND OTHER DRUGS
Dr. Steve Nissen, a cardiologist at the Cleveland Clinic, told me we are almost to the point in the United States where we should put the class of cholesterol-lowering medications called statins in the drinking water. “The medications are that good,” he added. I am pretty sure he was exaggerating somewhat, but not that much. Nissen is not alone. Many doctors consider statins a true wonder drug.
Truth is, most people do not rely on dietary changes, but instead take drugs to lower their cholesterol. An estimated 20 million Americans now take cholesterol-lowering statins. One of these drugs, atorvastatin (Lipitor), is the best-selling drug in the world. Despite their popularity and their effectiveness at lowering cholesterol, you should try lowering your cholesterol through dietary changes before you take one of these drugs—unless you’re cholesterol is dangerously high.
Not everyone is enthusiastic about the widespread use of statins to prevent heart disease. Dr. John Abramson, who teaches primary care at Harvard Medical School, argues in his book Overdo$ed America that statins are widely overprescribed, thanks to a recommendation made in 2001 by an influential panel of experts. The guidelines they published suggested increasing the number of Americans who qualify as having cholesterol levels high enough to warrant statins from 13 million to 36 million, and doctors have largely followed these recommendations. But Abramson argues that the gradual buildup of plaque in the arteries caused by cholesterol is not the main cause of heart attacks. Rather, he says, it is when a small area of plaque breaks open, triggering first a blood clot and then a heart attack. The cause of these “fractures” is not known.
Abramson recommends prescribing statins for people who already have coronary artery disease, but not for patients with only moderately elevated cholesterol levels, and he says a number of large trials back him up. Despite his criticisms, there appears to be no letup in the number of prescriptions written for statins.
Before you start taking statins, be aware that the drugs have rare but significant side effects. The drugs can cause muscle weakness and raise liver enzymes.
More than 20 million Americans take aspirin to help prevent heart attacks and strokes. Aspirin’s benefits as an anticlotting drug have been known for decades, but the latest research suggests that the situation is not as clear-cut as once believed.
For starters, recent studies suggest from 1 million to more than 8 million of these aspirin users do not get the drug’s anticlotting benefits. They are aspirin-resistant and will not reduce their chances of heart attack or stroke by taking the drug. The findings do not affect people who take aspirin for inflammation or pain.
Most doctors who advise their patients to take aspirin do not test for aspirin resistance, although new tests make it easier than ever to do so. The alternative to aspirin to lower the risk of heart attack or stroke is a popular antistroke drug called clopidogrel bisulphate (Plavix), which is far more expensive.
In addition to resistance, there appear to be some differences in the way men and women respond to aspirin. A ten-year study of healthy women found taking low-dose aspirin did not prevent first heart attacks in women younger than sixty-five. Aspirin does help men under sixty-five. In fact, one study of healthy men showed taking an aspirin pill every other day reduced their risk of heart attack by 44 percent.
Because aspirin can cause bleeding, doctors recommend only men and women at risk for heart disease take aspirin for this purpose. Risks include a family history of heart disease, high blood pressure, or diabetes. Anyone over sixty-five is also considered at risk for heart disease.
Even with its potential to cause bleeding, aspirin is less likely to cause ulcers than Plavix, a recent study published in the New England Journal of Medicine found. Patients on Plavix suffered from ulcers more than twelve times as often as did people who took aspirin plus a heartburn pill. This countered the conventional wisdom that Plavix was safer for the stomach than aspirin.
An estimated 23 million Americans take vitamin E, many of them no doubt in an effort to prevent heart disease. As I noted in chapter 3, studies have not backed up the efficacy of this behavior.
DIABETES
Being overweight doesn’t only raise your risk of heart disease, it also puts you squarely in the crosshairs of diabetes. Diabetes is linked to a host of serious physical complications. They include heart disease, stroke, high blood pressure, blindness, kidney disease, gum disease, damage to the nervous system, and tissue death that can necessitate amputation. Diabetes has so many complications, it has been likened to the aging process itself. It is a disease that can shorten your life span and prematurely age your body. If you are serious about chasing life, you must try to prevent diabetes from ever taking hold in the first place and diligently control your blood sugar if it does.
An estimated 70 percent of your risk of diabetes in the United States comes from being overweight. Given the growing girth in this country, it follows that the number of diabetics in this country is skyrocketing.
The American Diabetes Association estimates 20.8 million Americans are now diabetic, with nine in ten of the cases being type 2 diabetes. With type 2 diabetes, the body does not produce enough insulin or does not properly use insulin, a hormone needed to convert sugars, starches, and other food into energy. Obesity complicates the situation by increasing both blood sugar levels and insulin resistance.
More than 6 million Americans don’t even know they have diabetes, according to the American Diabetes Association. Signs you are diabetic include increased thirst, hunger, fatigue, and urination (especially at night); also, blurred vision and sores that do not heal. If you are forty-five or older and overweight, you should get tested for diabetes. Your doctor will check your fasting blood glucose level. Make sure to ask about this if you are concerned.
You have a higher risk of diabetes if you are a minority, have a family history of the disease, have high blood pressure, have low HDL (“good”) cholesterol, or do not exercise much. Women who had gestational diabetes or gave birth to a baby weighing more than 9 pounds are also at higher risk.
In general, diabetes becomes more common as we get older, but the obesity epidemic in this country is putting more and younger adults at risk. Some 41 million Americans have a condition called prediabetes, in which blood sugar levels are higher than normal, but not high enough to warrant a diagnosis of diabetes.
As I wrote, the numbers appear to be even more troubling for this country’s minorities. The number of African Americans aged forty to seventy-four with diabetes more than doubled in the last decade, according to statistics reported in a federal health survey. The prevalence among blacks is now approaching twice that of whites. Hispanics, too, are disproportionately diabetic. The rate of diabetes among Hispanics is almost twice that of whites of similar age, according to the CDC.
The number of diabetics in the United States is expected to more than double in the next twenty years. By some estimates, one in four Americans will be diabetic in the year 2025.
Weight
Lifestyle plays a critical role in developing type 2 diabetes. Just like with heart disease, eating a healthy diet and exercising are crucial for avoiding diabetes. What’s more, waist circumference also appears to be a good predictor of type 2 diabetes. As with heart disease, waist circumference appears to be a better predictor than body mass index, or BMI. BMI is simply the ratio of your weight in kilograms to the square of your height in meters.
Even moderate weight loss combined with exercise can lower blood sugar and improve insulin sensitivity, helping to prevent the development of full-blown diabetes. According to one estimate, if you are overweight and lose 5 percent to 7 percent of your body weight through diet and exercise, you can cut your risk of getting diabetes by more than half. For example, if you weigh 250 pounds and lose just 12.5 pounds, your blood sugar level will go down and your insulin action will be improved.
Nutrition
In general, if you are at risk of getting diabetes, here are some simple tips. First off, you should really pay attention to portion control. Then, limit your fat intake to about 25 percent of your total calories. Also, eat more fruits and vegetables.
Here is something I found fascinating. A very low fat, vegetarian diet appears to be very beneficial for diabetics. More than a third of those who had been previously treated with insulin were able to stop the medication after switching to this diet. At the same time, blood sugar and cholesterol levels dropped. Researchers who tracked a group of more than twenty-five thousand Seventh-Day Adventists for twenty-one years found diabetes was lower among vegetarians than the others.
Even if you are not a vegetarian, increasing the number of fruits and vegetables and lowering the amount of saturated fat in your diet will help cut your chances of developing diabetes. As with heart disease, eating whole grains, nuts, soy proteins, and such cereal fibers as barley and oats appears to reduce the risk of diabetes. If you are confused about the best diabetic diet, you are not alone. You may have heard that foods ending in –ose (like lactose) or –ol (like sorbitol) are an absolute no-no. Well, that is not necessarily the case. And to take it one step further, you don’t have to restrict yourself to sugar-free foods only. Yes, you can eat sugar, even as a diabetic. As with most things, though, moderation is the key, along with sensible food choices.
First off, a couple of definitions. The –oses that you hear about are naturally occurring sugars; fructose, for example, is the sugar found in fruits. The –ols are the sugars found in alcohols. The reason diabetics pay so much attention to this is sugar and carbohydrates can be difficult to process. During digestion, a healthy person’s body converts carbohydrates from food into various sugar molecules. These sugars are further converted, mainly into glucose, the primary fuel used by the body. With the aid of insulin (a hormone produced by the pancreas), glucose enters cells to provide the body with energy.
But in people with type 2 diabetes, either the pancreas doesn’t make enough insulin, or the muscles and other tissue have become resistant to insulin, or both. As a result, sugar accumulates in the bloodstream, causing all sorts of problems, from fatigue to numbness to even kidney problems or blindness.
As a result, it was believed for most of medical history that a diabetic should avoid eating all sugars. But over the last decade, smart doctors and dieticians have challenged the traditional diabetic diet. What really seems to matter, it turns out, is how the diet overall incorporates carbohydrates. If you are someone concerned about diabetes, it is more important to pay attention to the type of carbohydrates you eat and the frequency with which you consume them than it is to avoid all sugars.
You can reduce your risk of diabetes by eating “better” carbohydrates. Carbs are the body’s main source of energy. They are sugar molecules and break down into glucose. Carbohydrates that break down more quickly cause a spike in blood sugar and can raise your risk for diabetes (and heart disease). Carbs that break down more slowly cause the smallest fluctuations in blood sugar.
Spikes in blood sugar are bad because they require your pancreas to produce a surge of insulin. Over time, spikes in blood sugar will cause our bodies to become less sensitive to insulin. The end result can be diabetes.
So what are “good” carbs? Carbohydrates are classified using a scale called a glycemic index. This scale measures how far and how fast our blood sugar rises after eating a certain food that contains carbohydrates. The scale ranges from 0, the healthiest carb, to 100, the least healthy.
Foods containing refined sugars and corn syrup have a very high glycemic index. For example, the average donut has a glycemic index of 76. Unfortunately, most Westerners eat far too many foods loaded with high glycemic carbs. Processed foods also tend to have a very high glycemic index. White bread has a glycemic index of 71 or more. French fries have a glycemic index of 75. By contrast, fruit like apples, oranges, and grapes have a low glycemic index, as do many beans. Brown rice, oat bran cereal, whole wheat bread and spaghetti tend to be in the middle.
If you want to check the glycemic index of a specific food, go to glycemicindex.com, a site run by scientists and dietitians at the University of Sydney. If you want to switch to a low glycemic index diet, the folks at the University of Sydney recommend eating breakfast cereals made from oats, barley and bran; eating bread made from sour dough, whole grains or stone-ground flour; reducing the amount of potatoes in your diet; and switching from white rice to basmati or brown rice.
Futurist Ray Kurzweil claims he has been able to cure his type 2 diabetes by eliminating all high glycemic carbs from his diet. He says cutting them out of his diet was easier than simply reducing the amount of high glycemic carbs in the food he ate.
“If you don’t stop eating starches and sugars as a significant part of your diet, you’re going to continue to have these cravings. If you really adopt a sharp reduction in those, the cravings go away,” Kurzweil told me in an interview.
I’m not recommending that you eliminate carbohydrates from your diet, just that you lower the glycemic index of the carbs you do eat.
The information given in The Joslin Guide to Diabetes: A Program for Managing Your Treatment and 16 Myths of a Diabetic Diet is based on these simple facts. According to experts at the well-known Joslin Diabetes Center, you can have a piece of cake on your birthday and go out to dinner. You just need to know how to count carbohydrates and sometimes limit certain foods. By the way, this advice is also useful if you simply want to lose weight.
Also, in case you are wondering, artificial sweeteners are not all the same. Be careful when you are selecting the best artificial sweeteners. “Sugarless,” “sugar-free,” and “no-sugar-added” can all have very different meanings that are important for diabetics. There are nutritive or caloric sweeteners, such as sugar alcohols, that add calories and affect blood glucose levels. Then there are nonnutritive or noncaloric sweeteners, such as aspartame, sucralose, saccharine, and acesulfame potassium, which, after extensive testing, are regarded as safe for the general public, including diabetics.
Controlling Diabetes
• Maintain a healthy weight.
• Eat a healthy diet containing plenty of fruits and vegetables.
• Exercise regularly.
• Limit your fat intake and control your portion sizes.
• Count your carbohydrates.
Today, with all we have learned about nutrition, diets, and carbohydrates, the diabetic diet has undergone an overhaul. It is probably better not to avoid all sugars altogether, but to think about eating a certain number of carbohydrates throughout the day—just not all at once. So, for example, you can have a few peanut M&M’s as long as you cut back on sugar elsewhere in your diet.
And so what about those –ols? On first blush, sugar alcohols may sound like a good thing for diabetics. After all, they are lower in calories than regular sugar, and the body absorbs them more slowly, resulting in a slower rise in blood sugar. Keep in mind, however, that foods containing sugar alcohols usually contain many other ingredients that contribute calories, and that sugar alcohols can have a laxative effect. So make sure to read all the ingredients when buying these foods. As you can see, there really is no such thing as an absolute diabetic diet, and diabetics don’t have to be relegated to eating boring and tasteless foods. Just follow some simple rules.
Future
There is no question that carrying around too much weight pushes us backward in our quest for longer life. If you are forty years old and even moderately overweight, say good-bye to more than three years of life. If you have crossed over into obesity, you will lose nearly a decade. Think about that—losing nearly ten years of life for what is a very fixable problem. First off, remember what happens too often in our food-rich, exercise-poor society. When you combine a lot of calories with a sedentary lifestyle, the pancreas needs to kick into high gear to produce enough insulin to dispose of the excess blood sugar. Over time, this excess blood glucose results in visceral fat. Eventually, this leads to an altered metabolic state in which you are producing very high levels of insulin, but the body is less sensitive to it. The result can be diabetes, high blood pressure, kidney disease, and heart disease.
Because food was not a sure thing in more primitive times, our bodies developed the ability to hang onto every calorie we consumed. In fact, there is an actual gene in our body, a sort of insulin receptor gene that is always telling our body to hang onto fat and store it in our midsection. This insulin receptor gene was great news when we were hunting and gathering our food. It protected us against starvation during a bad hunting season. Now that getting enough food is not a problem for most people living in the developed world, the insulin receptor gene has become a big problem. While our society has evolved, certain aspects of our bodies have not. But what if we could turn off this gene? What if we were able to help the body compensate for the high calories and couch potato lifestyle? What if we could help clear away the excess blood glucose before it was turned into fat—before we started down the road to obesity, diabetes, and heart disease? One day, we will likely have that ability. Scientists around the world are looking at how exactly this gene might be altered so that obesity and associated heart disease, stroke, and diabetes become things of the past. I get asked about the future a lot when I talk about health and fitness. It is true that in the coming years, science may be able to give us the potential benefits of eating a calorie-restricted diet without the pain. I promise you that when that day comes, I will make sure you know all about it. Luckily for you, we don’t have to wait for that day. Now that you have a better understanding of how heart problems, stroke, and diabetes develop, you can start making some simple changes in your everyday choices to help you chase life.
Paging Dr. Gupta
• Get rid of that apple-shaped midsection.
• Visit your doctor armed with knowledge. Know your family history and the tests you may need to detect heart disease and diabetes.
• If your cholesterol level is out of control, strongly consider switching to a healthier diet (that includes blueberries, tomatoes, okra, and eggplant) and a statin medication.
• Get plenty of sleep. It will help you lose weight.
• Eat smarter. Increase the amount of “power foods” in your diet.
• A little weight training could provide big results—and great abs.
• Know your CRP levels—it’s more important than you may think.