When most patients are told they have diabetes, their physicians briefly discuss lifestyle changes they need to make and then write a prescription for medication to help get their blood glucose down to within a normal range. Most patients take the medicine, follow up on their glucose levels, and then feel satisfied that they’re “controlling” their sugar. I asked a diabetes specialist why the lifestyle changes aren’t discussed in more detail with new diabetic patients. His response was to the point.
He explained that, first, most diabetic patients simply will not commit to changing their habits to take care of their glucose problem. If a doctor gives them medication, that’s good enough for them. Most are overweight and don’t exercise. They don’t have the necessary desire to lose weight or exercise or change their diet.
Second, neither he nor any other doctor has the time to detail for each patient how they can change their lifestyle. It takes time to explain what diet to follow and why exercise is so necessary to reach their ideal weight.
Those were the two reasons the physician gave me for why diabetics primarily rely on medication rather than lifestyle changes. I wondered, What if a physician did take time to explain these things? That’s why I wrote this book. The lifestyle changes you can make will help you gain control not only of your glucose level, but also of your overall health. Your physician may not have the time to coach you, but this book will get you started on the right path.
Let’s take the first explanation—that individuals simply will not commit to doing what it takes to make changes to their lifestyle.
I understand that most diabetic patients think it’s simpler to just take medicine. That’s probably how I would respond in such a situation. But if your doctor had the time to explain what’s taking place in your body and outline precise lifestyle changes that both address blood sugar levels and help you avoid multiple health problems down the road, you would look at the situation differently.
I believe the more someone understands what’s going on medically, the more likely they’ll do what it takes to protect their health. The more knowledge and the more understanding they have about what’s going on in their body when they have diabetes, the more likely they are to begin making changes that can make a difference.
That’s exactly what happened to me one day when I read a medical article that encouraged me to consider changing my diet to prevent a medical problem.
My Revelation
That morning I had operated on a patient with blockage buildup in his left carotid artery, which had resulted in a stroke. He had been referred to me so I could remove the blockage and prevent further strokes. His carotid artery was 95 percent blocked and needed to be cleaned out.
I felt so proud of the success of the procedure. I had made a two-and-a-half-inch incision in his neck just beside his trachea; had dissected out the carotid artery, which was about the size of my index finger; and felt the plaque that had caused the decreased flow of blood to that side of his brain. From the outside of the artery, the blockage felt almost as hard as bone. I placed a clamp above and below the blockage and made a longitudinal incision to open the artery. The plaque was very firm, and it almost filled the cavity of the artery. I cleanly dissected it out from the lining of the vessel, flushed out the artery, and closed it with a fine suture. Such an operation is one of the most satisfying procedures a surgeon can perform.
That same afternoon I read an article in a medical journal about similar blockages. What it said made me commit to a change in my lifestyle—not eating my most favorite food.
I hadn’t really thought about it before, but I considered it my job to clean out the arteries, not to teach patients how to prevent blockages in the first place. At least that was my mentality. I was saving patients from another stroke, and that was extremely satisfying, but the article pointed out that the biggest culprit behind such plaques is deposits of LDL cholesterol (the bad cholesterol we’ll talk about later) within the wall of the artery. I knew that, but I hadn’t dwelt on it. The article went on to say that saturated fat was the fat Americans ate the most that resulted in such blockages.
Then I read a statement that jumped out at me. Americans get the most saturated fat from cheese. It’s not that cheese has more saturated fat than all other foods, but that we eat so much of it that the cumulative effect gives us more such fat than any other food. The cause of such blockages was something I had been doing to myself for years.
I could not believe what I was reading. I had just performed an operation I felt so good about, yet now I realized what I was doing to my own arteries. I reminded myself that cheese was my one favorite food. All my patients knew it was my favorite, and every Christmas gifts of cheese and cheeseballs completely filled my office desk.
I thought about that piece of plaque I had removed from the man’s artery just hours ago, and I decided from a medical standpoint that I should never eat another bite of cheese in my life, that I had to kill the desire for it and break the habit. At that moment, I made that commitment, that promise to myself. That one medical article had awakened me to what was going on in my body and what I needed to do about it. I smiled as I closed the medical journal and placed it on my desk. I realized if I continued eating cheese after knowing what it could do to me, I would be foolish. I knew I was smarter than that, and that was the last of my cheese eating.
The next Christmas, I placed all my cheese presents on the office kitchen table and informed the staff they shouldn’t eat them, but if any of them were foolish, they were welcome to do so. When I walked back into the kitchen an hour later, all the cheese was gone, but I didn’t ask anyone to confess.
Busy doctors may not have the time to go over everything patients need to change, so like my colleague, they simply prescribe medication; encourage patients to exercise, eat properly, and lose weight; and then send them on their way. But because you’re reading this book, I feel sure you won’t fall into the first category of patients that physician told me about—the patient who won’t commit to making those lifestyle changes.
Reading one article made me commit to changing my lifestyle. My hope is that this book will inspire you to make that same commitment. Read and reread certain points that apply directly to you as you take on the challenge to do all you can to defeat diabetes. I believe you will look at your life a little differently once you know medically what is going on in your body as a diabetic, and what you can do to address the problem.
I can assure you, your doctor would love to have the time to teach you what medical research says about preventing or curing diabetes. Think of the time you spend reading this book as a conversation with your physician, explaining what’s going on in your body and the specific changes you can make to improve your health.
Let this book help you make the lifestyle changes to prevent, delay, or improve diabetes, whichever stage you may be in. It will teach you changes you can make in your everyday life that will protect you from the health problems directly associated with diabetes. You will learn the significant effect diabetes has on your arteries, your heart, and your brain.
Two things are possible. One is that diabetes can be prevented, and two, that you can recover completely from type 2 diabetes.
It’s More Than Sugar
Diabetes has impacts beyond simply not getting the glucose from the blood into the cells. The Centers for Disease Control points this out, showing many physical problems related to our arteries are associated with diabetes. Diabetes is listed as a separate risk factor for arterial disease. Additionally, one of the serious diseases that increase our chance of dying from a heart attack or stroke is high blood pressure. The CDC reports that 71 percent of diabetics have high blood pressure with a reading greater than 140/90. We’ll talk later about how to read those numbers.
Another associated risk to your arteries feeding your heart is the role your cholesterol plays. The CDC report showed that 65 percent of diabetics have an increase in their “lethal,” bad LDL cholesterol or were being treated for such. With bad LDL, you almost double your risk of heart attack and increase your risk for stroke one and a half times.
As we get to what you can do to prevent or reverse diabetes, don’t forget all these additional problems associated with your arteries. You must address them as well.
Medical research points to two other major factors in defeating diabetes in addition to what you eat: weight loss and exercise. When you commit to weight loss and exercise, you increase the odds you will defeat diabetes. We’ll review some of this research, so you can understand from a medical perspective why losing weight and exercising are essential for your success.
Learning about the relationship between diabetes and your heart and arteries will explain why the nurse I mentioned in the introduction to this book shed tears when her doctor told her being diagnosed as diabetic was the same as being told she had just had her first heart attack.
The Two Main Risk Factors in Developing Diabetes
Some of the best studies to evaluate how you can defeat diabetes are where the participants don’t have diabetes—yet. These studies evaluate people who have what is called impaired glucose tolerance or are labeled prediabetic. They have higher-than-normal glucose but their numbers aren’t high enough to be termed diabetic. Researchers follow them for several years to see who progresses to a diagnosis of diabetes. Some of the participants will make lifestyle changes and some won’t. Then, after a period of time, the study will show whether lifestyle changes helped prevent diabetes. These studies provide excellent lessons for every diabetic.
One such study is reported in the New England Journal of Medicine. The research shows that obesity and physical inactivity are the two main determinants of progression to the diagnosis of diabetes. In this book you’ll learn the specifics of how to combat these two risk factors, and it’s interesting to know you can begin making changes right now to reduce those risks. In this study, the incidence of diabetes was reduced remarkably by losing weight and exercising. Even in people who didn’t lose significant weight, exercise alone played a noteworthy role in the prevention of the impaired glucose progressing to full-blown diabetes.
Keep reading; you’re going to learn how to fight both of those determinants.
The Relationship between Weight and Diabetes
Being overweight or obese may account for 80 to 85 percent of the risk of developing type 2 diabetes. Some studies suggest that obese people are up to eight times more likely to develop type 2 diabetes than those with a BMI of less than 22. One reason, it is thought, is because excess abdominal fat causes fat cells to release substances that cause inflammation around the cells that accept glucose. This relates to the insulin resistance. Researchers think this inflammation is a primary cause of the swelling within the keyhole that blocks the insulin key from fitting into the lock to unlock the cell door, which then allows the glucose to enter the cell normally.
Even diabetic organizations don’t adopt just one diet, although most groups agree that following a weight-reducing diet plan will enhance weight loss. The most frequent recommendation most international organizations give for diabetic patients is to achieve and maintain a body mass index of less than 25, and we’ll talk more about BMI indicators. But such a BMI places you in the normal range of body weight for your height.
The good news is that a 5 percent reduction in body weight followed by regular, moderate-intensity exercise could reduce your type 2 diabetes risk by more than 50 percent.
The bad news is pointed out in an article in the Journal of the American Medical Association. The report stated that less than 20 percent of diabetics try to lose weight by eating fewer calories and exercising. That is a sad, sad statement. If someone knows what the problem is and doesn’t do anything about it, they are traveling down the wrong road.
Weight loss is a “must” in defeating diabetes, but more is required. Other lifestyle changes go along with reaching your ideal weight. We will get into specifics later, but I want to preview some of the medical research to show you what you can do today to improve your condition.
You can read many opinions about what foods to eat. Some say to eat mainly fats and avoid carbohydrates, and some studies do show that avoiding carbohydrates will result in not having to take as much insulin.
Others say to make certain types of carbohydrates the majority of your diet. Again, we will get into specifics later, but note that there are good fats as well as bad fats and good carbohydrates as well as bad ones. Good carbohydrates are interwoven into fiber, which releases the glucose slowly, not triggering a massive release of insulin when they’re eaten. Then the bad ones, called refined sugars, are in foods such as pastries, donuts, and cakes, and are absorbed quickly with a spike in sugar levels, which causes the insulin battle to take place.
Fats fall into similar categories. Bad saturated fats affect the arteries of your heart and brain, which can result in a heart attack, stroke, or high blood pressure. Good fats, called monounsaturated and polyunsaturated fats, are found in fish, nuts, and olive oil, and they protect the arteries.
The type and quality of fat and carbohydrates are more important than the total amount of each. To start you thinking about the foods you will eat, a report in the Annual Review of Public Health points out that eating polyunsaturated and monounsaturated fat rather than saturated and trans fats plays an important role in controlling your diabetes. The report emphasizes eating whole-grain foods, which contain fiber, rather than refined-grain foods. Last, it emphasizes a diet rich in fruits, vegetables, whole grains, poultry, and fish, but encourages you to avoid red and processed meats, as well as refined grains, as in white breads.
Once more, we will get into the specifics for a proper diet later, but this gives you a framework to begin thinking about your eating habits.
This study also makes a point about the beverages we drink. The authors referenced a study that showed that frequent consumption of sugar-sweetened soft drinks of one serving or more per day is associated with a 40 percent increase in diabetes risk. What to do is a no-brainer if you’re diabetic. One twelve-ounce can of regular soda contains the equivalent of ten teaspoons of sugar. Never consume any calories from beverages.
This study affirms some lifestyle changes can place you into a low-risk group. These variables included a low BMI (body mass index of less than 25), a diet high in cereal fiber and polyunsaturated fat but low in trans fat and low glycemic load, as well as exercising moderately to vigorously for thirty minutes a day, most days of the week. It also shows that up to 91 percent of diabetes cases can be prevented with these lifestyle practices concerning weight, exercise, and diet.
Cement one of the study’s conclusions into your mind: obesity is the strongest risk factor for diabetes, and obesity control is clearly the key to diabetes prevention.
The key to your success, then, is maintaining your weight loss for the rest of your life. The Cochrane Collaboration addresses this issue in detail. It first presents a positive side, and then the extremely negative results found by different studies on weight loss in people who were prediabetic as well as those with a diagnosis of diabetes.
Researchers reviewed nine studies with a total of 5,168 participants. The follow-up ranged from one to ten years. Weight loss was successful initially and showed significant decreases in diabetes and associated problems. The study showed that weight loss and control must be key goals for people with diabetes, and that weight loss improves insulin sensitivity and glucose control as well as cholesterol levels and blood pressure.
The researchers quoted the American Diabetes Association’s recommendation that said, “Individuals at high risk for developing diabetes need to become aware of the benefits of modest weight loss and participating in regular physical activity.” The report went on to show that once you commit to your diet and exercise program, you can expect an average loss of 8 percent of your initial body weight over three to twelve months.
This study emphasized weight loss as the most important factor for diabetics to control their disease, showing that such loss resulted in a turnaround from insulin resistance to insulin sensitivity, with a resultant improvement in glucose control. With better insulin sensitivity, there was also a decrease in LDL cholesterol, blood pressure, and overall early mortality.
Quality of life is our goal, and these reports show a significant improvement in quality of life by not having to deal with the problems associated with diabetes and being overweight.
Then the report gives what I think is its most significant sentence: “However, these benefits are thought to be clinically meaningful only if weight loss is sustained over time.”
That is the point I want to emphasize. You will lose all the benefits you’ve gained if you don’t maintain weight loss. The beauty of this book’s plan is that it is easily sustainable for life. It’s not a fad diet; it’s a lifestyle you will live out of habit from now on. You will not regain weight because you’ll have overcome your desire for the wrong foods and set up a personal exercise routine. Because of what you know, you will run from your old ways of living.
Now for the sad side of their report. After reviewing several studies where diabetics lost weight but regained it, the Cochrane Collaboration concluded that weight loss and metabolic control were achieved, but not maintained. That conclusion is confirmed by numerous other studies that show at least half of all weight loss is regained within a year.
That is a real slap in the face that ought to get your attention. Unless you develop proper lifestyle changes as you lose your excess weight, you won’t maintain your weight loss.
To lose weight and maintain that loss, you must replace unhealthy habits with healthy ones. This means changing your future one step at a time, and in such a way that you can continue walking that same path for the rest of your life—out of habit, which is the main secret of this book. I’ll introduce you to what not to eat, as well as the significance of your weight when winning the battle with diabetes. When you reach the end of this book, you will know how to practice habits that will make it easy to succeed as you eat properly, follow your exercise plan, and lose weight.