“Type 2 diabetes is preventable.” That’s what an article published in Diabetes Care journal states. How? you may ask. The study’s answer was this: by lifestyle intervention. This article gives numbers on prevention of diabetes, but the same concept applies to those who already have the disease. Let’s see what will help not only in the prevention of diabetes but also the prevention of progression and help in reversing the problem.
The lifestyle interventions they studied involved four items: reduce body weight, reduce dietary and saturated fat, increase dietary fiber, and increase physical activity. They divided the individuals in their study into two groups, one that worked on the interventions and one that did not. The overall outcome was that the intervention group reduced their risk of diabetes by 58 percent as compared to the group that did not make the lifestyle changes.
A negative side to their study must be considered. This study measured the participants’ weight at one year and three years. They lost an average of ten pounds at the end of the first year but had regained 25 percent of it at the end of three years. The same sad aspect of numerous other studies on weight loss is that many participants regain some or much of their weight.
If you apply what you learn in this book, you will not regain weight. If you develop a proper eating lifestyle as you lose weight, you will be able to maintain that ideal weight for the rest of your life because you will have changed your eating habits. The less regained, the better the effectiveness at defeating diabetes. Our goal is going to be 0 percent regain. Never forget this study’s conclusion: Type 2 diabetes is preventable. It is preventable by lifestyle changes.
“If Only I Had Known”
So many patients say if only they had known their condition would end up the way it did, they would have changed their lifestyle habits years ago.
I will never forget this event when I was a surgical resident in training. An overweight diabetic patient was in the emergency room, lying on a stretcher with his left leg and foot exposed. I looked at the worst ulcer on an ankle and foot I had ever seen. Both of his legs were swollen, but the left was reddened up to his knee. The ulcer was so inflamed I had to wonder how long he had waited before deciding to come to the hospital. The yellow purulent material was slowly draining from the silver-dollar-sized ulcer.
The senior resident told me, “It’s going to take an above-knee amputation. If you take it off below his knee, the wound will never heal, and two months later you’ll be taking him back to the OR for a secondary above-knee amp.”
I remember hoping we could do a below-knee procedure, so the prosthesis would be much simpler, but the senior resident made sense. Even if we left the wound open, it would never heal. He was diabetic.
I kept wondering why that patient hadn’t decided to do something about his health before the arteries were so blocked with plaque that there wasn’t enough blood flow to keep his left leg alive. What makes one person decide to make changes to prevent having their leg amputated, yet another ends up in the emergency room wishing they had?
That emergency room event was years ago. I’m not sure the patient had known he could make lifestyle changes that would prevent his leg amputation. If he had known about all the medical research you’re reading, though, would he have changed the way he was living?
Unfortunately, it was too late for him to save his leg. Nothing he or we could do would save his arteries and allow his foot to survive. Don’t wait until that day when nothing whatsoever can be done to prevent such a catastrophe.
It’s All about Habits
We do so many things throughout the day because of habits. We’ve made a habit of what foods we eat. Our weight rises instead of falling because we haven’t developed the habit of exercising.
One of the main reasons people change habits is because some physical event gets their attention. Something must be done, and only they can make it happen.
One morning I looked at my phone and realized someone had called at 5:42 a.m. As I listened to the voice mail, I realized it was from a gentleman I had known for several years but had not kept up with recently. He was letting me know he was on his way to the operating room to have surgery on an artery in his heart. “I’m going to change a lot of what I do from now on. I’m not going to let this happen again” was his extremely serious statement to me as we talked later that day.
I remembered him being diabetic and overweight, and I knew he had tried to get his diabetes under control. He had lost some weight, changing his eating some, but mainly by what he called “moderation” of the bad foods. He regained the weight. It kept going through my mind that his situation was the main reason people change their lifestyles—they receive a wake-up call from their bodies and decide to listen to it.
I have a friend I see each winter because we have condo units next door to each other. Last year, he asked if I had a copy of my book Prescription for Life that he could read. He had experienced a health issue and had made the decision to change his lifestyle choices for eating, exercising, and weight control. He wanted to know the most effective way of doing it, one that medical research confirms. Of course, I gave him a copy of my book to begin his journey.
I couldn’t believe my eyes a year later. I hardly recognized him. All his excess fat had disappeared, his face and neck were almost skinny, and he looked ten to twelve years younger. He made me feel the proudest I had felt in a long time. He’d not only made the decision to change, but the commitment to change. When I asked him what changes he’d made, it was simple. He had changed his habits. Now he didn’t even want the foods he once craved.
People do make dramatic lifestyle changes so they don’t have to go through an amputation like that man in the emergency room and wish they had made changes years earlier. Or they undergo a stent procedure that wakes them up to the need to do something.
Yet another reason people change is that they read and acquire wisdom about what they can do to prevent problems with their future health. In terms of motivation, that is the most challenging impetus for people to change, but it is the best one.
Gaining the knowledge for defeating diabetes and committing to do whatever it takes is the key. Developing proper habits prevents you from having to go through a complication of diabetes, an associated arterial problem with your heart or your brain, or a blockage in the large artery to your leg that forces you to undergo an amputation.
Make the commitment to change before you experience a medical problem. Understand what happens to thousands of diabetics who rely only on their medication to fight the disease. Realize the associated risk factors that affect your arteries to your heart, brain, and legs as well as to every organ of your body.
I hope this book will be your number one reason for changing your lifestyle habits. It would be great to know that you’re learning what’s going on in your body, plus what you can do to make a difference. Knowing that would make me feel fantastic, especially if I don’t have to get a call from you at 5:42 in the morning.
How to Drop Bad Habits for Good Ones
Recently a lady who was obese told me she had to change her life because she was constantly miserable and going down a slippery slope. Her eating habits were terrible. She kept a bowl of candy on her desk for anyone to take a sample, but she ended up eating at least half of the supply herself. She was diabetic and on blood pressure medication, “but the medication isn’t controlling my pressure very well,” she said. She had wanted to lose weight and get on a healthy diet several times before, but she’d never been successful. Yet something inside her made her realize it was time to change, this time for good.
We are all like this lady, at least in some ways. We want to do so many things, but we just don’t get organized enough to accomplish them.
Bad habits are difficult to change. It’s hard to stop sitting on the couch watching television and form the habit of personal exercise five to six days a week. It’s difficult to quit the eating habits that have made us overweight and instead develop the habits of proper eating.
I see many individuals who want to improve their health. Most everyone has that desire, but very few have the commitment to get it accomplished. Why is that? What does it take to finally realize you need to do something to change the dreaded road you’re on? How do you change bad habits for good ones?
The problem is, desire is of the mind and requires no action. Commitment is of the heart and does require action. But the fact that you’re reading this book says something inside you knows you want to change the direction of your life, and you’re ready to commit.
I learned a secret years ago that answers how to change bad habits into good ones. It’s a bit of wisdom that has stood the test of time for me. I hope it will do the same for you.
When I began the difficult road of medical school, I rented an apartment from Mrs. Avery. Her husband had died of a heart attack eight years prior, and since then she had surrounded herself with medical students. We were not yet physicians, but I assumed she felt safer with us there. The rent was cheap, the accommodations were clean, and best of all, my two roommates and I were left alone in quiet. I remember choosing the corner room with its big bed and a large antique desk. I assumed the desk was something out of Mr. Avery’s insurance office.
The first night of studying my notes from that day’s anatomy class, sitting at that desk, I noticed something written and underlined, most likely by Mr. Avery, in the upper right-hand corner of the old felt pad: Set your goals high. I remember thinking if I wanted to become a doctor, I was going to have to set some goals and commit to them. I had been accepted into medical school toward the end of the list because my grades weren’t as good as many other applicants’. I knew I was at a point in my life where I had to make a decision that was going to determine the rest of my days.
I wrote on the felt pad too: Major goal—become a doctor. Underneath, I put: Intermediate goal—make an A in Anatomy. Below that I printed: Immediate action goal—study every minute.
I knew I was going to have to change the study habits I had in college. I enjoyed college by doing a lot of things other than studying. Sitting at that desk, I made the commitment to make my immediate action goal for that day to study every minute I was out of class except for eating. I studied that night until midnight. The next evening after dinner at the fraternity house, instead of playing a relaxing game of ping-pong or watching football previews on television, I went straight to my room and began studying, again until midnight. That weekend I drove to my future wife’s parents’ house and studied all Saturday afternoon. After dinner, I studied only until ten rather than twelve, but I had my commitment in order.
The commitment I made that first evening in medical school is the same commitment I want for you. The immediate action goal of making myself study as hard as I could that weekend was what determined whether I would become a doctor.
Once I set those goals, I never thought of changing them. No matter how bad the odds became, I never played with the idea. I believe that initial step of commitment is the reason I succeeded in becoming a physician. Studying became a habit.
I encourage you to make a similar decision about your desire to defeat your diabetes. Set it as a major goal, and never change it. Your intermediate goals may be anything from losing weight to exercising, but I remind you that your immediate action goal is the deciding factor. Your immediate action goal is what you’re going to do about it today. At the end of today, you’ll know whether you’ll be successful in eating the proper foods, following your personal exercise program, and reaching your ideal weight because you’ll know whether you’ve made the commitment.
Setting Goals for Success
Defeating diabetes presents many challenges. Each one must be identified and met with a plan. Your major goal is defeating diabetes. Depending on what other health risk factors you have, you will set several intermediate goals to accomplish. Your success will ultimately depend on how well you handle your immediate action goals on a day-to-day basis to develop the habits that will lead to success.
Every day you will choose whether you’re going to exercise, whether you’re going to take your “exercise medicine.” You’ll decide whether you’re going to avoid a certain food. You’ll take daily steps to reach your goal weight. Your main goal in weight loss is not losing the weight, but even more important, maintaining that goal weight number when you get there. I encourage you to set goals for what you want to accomplish.
Then write them down. If you write down what you plan to do, your goals are much more likely to be reached. Write down your goal weight on a sticky note and place it on your bathroom mirror. Write out your personal menu for each meal for a week. Write down when and where you’re going to exercise each day and what that exercise will be and what clothes and running shoes you’ll wear. Write down what you’re going to do the next time you want a snack. (More about this soon, but detail what you’ll do for the ten minutes after that snack desire hits you: what non-caloric drink you will consume, whom you will call, or what book you will pick up to read instead of eating that snack.)
I encourage you to give it a try. Write down your major goal and each intermediate goal you need to accomplish, as well as how you’re going to react immediately today to accomplish the lifestyle habits you need to form.
Just remember, as I have learned, that writing them down is almost like magic.
When do you plan to exchange bad health habits for good health habits? Will you wait for a major event like a heart attack, or being told you must be placed on insulin, or the first time your doctor starts you on high blood pressure medication, or when someone you know is just beginning to have symptoms of Alzheimer’s?
With events like these, you’d probably at least consider changing your lifestyle habits. One example is the lady who teared up when she told me her doctor informed her she was diabetic and that the damage to her arteries was equivalent to having a first heart attack. Or the gentleman who wanted to know what to do because he had just had his first stent placed in an artery of his heart. He wanted to prevent ever having another one placed or ending up with a full-blown heart attack.
Both these people wanted to change their daily habits. Both realized they had to develop new habits that would make them healthier with a better quality of life. They both realized the way they had been living needed changing. The good news is you don’t have to experience something bad before deciding to change your habits, but you do have to evaluate what habits you’re going to need to change to successfully defeat your diabetes.
Most of what we do that’s not good for us we do out of habit—making poor food choices, sitting on the couch watching television, buying the wrong foods, snacking too much. Habits are addictions. You fight those addictions by changing your habits to the point your good lifestyle choices become new habits. You start small with your changes, but the key is to beat the desire for a bad habit. Unless the desire is controlled, you’ll eventually return to your old ways.
In most medical journal reports on weight loss, the follow-up numbers consistently show a 25 percent to 50 percent regain. People regain weight because desire wasn’t beaten. Because foods can be addicting, you’ll continue to desire certain foods unless you abstain from them completely for a certain period. The only way you can gain control of an addiction is by abstaining. You can develop the habit of not eating certain foods. Tomorrow you’ll wholeheartedly avoid some of the foods you crave today because you’ll realize what they’ve been doing to your health.
When I was rotating through orthopedic surgery during my surgical training program, the number two surgeon on the staff was in his forties and had smoked most of his life. He decided to quit smoking, and he enrolled in a program where he gradually cut down on the number of cigarettes he smoked every week. As time went on, he announced that he was down to three cigarettes a day. The next week he only smoked two per day, and finally the ultimate Friday came when he was to smoke his last cigarette.
We all gathered around and watched as he inhaled each draw. With his last puff, he tilted his head back and slowly blew out the smoke through his nostrils. He smashed the tip of the last cigarette into a small ashtray, and we all applauded and congratulated him. His smile was the biggest I had ever seen on him.
The problem was he had not beaten the desire for nicotine. The next Tuesday he lit another cigarette. By the end of the next week, he was back to smoking his routine pack a day.
Individuals have told me they were going to eat red meat only once a week. “Just on Saturday evenings,” they would say. Or that they were going to eat dessert just once a week—as a reward for cutting out desserts. The problem is they retained the desire for the saturated fat or the sugary treat. The once-a-week plan never works permanently.
To lose weight and never regain it, you must beat the desire for the foods that put excess weight back on. It takes about two months, sixty days, of abstaining, for that desire to begin to fade. But once you reach that mark, it will become easier and easier to maintain that new habit you want to form. You take small steps to develop healthy habits, but you must defeat the desire factor as well, or you will never develop the right habits to defeat diabetes.
You not only have to beat the desires of your old habits, but you must replace them with desires for new good habits. With foods, it won’t be enough to simply avoid that sugary dessert you have such a desire for now. You’ll need to develop the habit of abstinence to the point you won’t even want a single bite of it because you know what it will do to your health.
You will look at exercising the same way you look at taking medicine. If your doctor gives you a prescription for your health, you take it like clockwork. Look at exercise as taking medicine. Few people enjoy jogging or walking or most exercise routines, but when you realize how essential it is, you’ll go through your exercise program the same way you take your medicine—routinely. Develop the habit of taking your “exercise medicine” five to six days a week. Before long, you will do it out of habit. You’ll begin to react automatically to your new eating plan and exercise routines.
To change your lifestyle to one that can control your blood sugar, lose any excess weight, maintain the loss, and develop an exercise program, you will have to make some changes in your life. Some people will have many bad habits to replace with new ones. Others will need to only fine-tune what they’re already doing. Whichever group you fit into, you can develop systems you can rely on automatically. You can’t go through the rest of your life making decisions about which food you’re going to avoid at each meal or whether you’re going to exercise. Instead, you’ll practice eating the right foods and exercising regularly out of habit.
Habits control our lives, so begin changing any bad habits you have to good habits today.
Habits to Live By
A habit is an unwritten rule. We follow them every day of our lives without thinking about them. We do them automatically, and if we don’t make decisions and commitments to change them, we’re going to aimlessly float down the river of life as it naturally flows.
If you’re in that diabetic river, you can’t afford to drift along. Steer your boat in the proper direction. If you don’t make new rules for yourself, the old rules will lead to more problems, like high blood pressure, high cholesterol, a heart attack, or a stroke—not to mention eye problems and kidney difficulties or Alzheimer’s.
Develop the right eating habits. Period. You don’t want to have to decide whether to eat right every time you sit down to eat. You don’t want to have to think twice. Eat a certain breakfast every day, out of habit. Eat certain lunches, out of habit. And for dinner, you may decide between three or four choices, but they will all be healthy and habitual. You will eat based on your new habits. If you form the right eating habits while you’re losing weight, when you get to your ideal weight, you won’t have to change a thing. Even better, you’ll maintain that goal weight the rest of your life—out of habit. It works the same way with exercise. Exercise will become routine.
One morning I called a friend who had been overweight at one time and had developed the habit of exercising five days a week. When he answered the phone, he told me he was at the airport headed overseas for five days. He had risen early to get in his exercise on the treadmill and had his running gear packed so he wouldn’t miss any days of exercise. Exercise became his habit the same way you will create eating and exercise habits to defeat your diabetes.
Every physician has explained to overweight diabetics what steps need to be taken to get to a proper weight. Sometimes we realize we’re wasting our time as well as the diabetics’ because they don’t have the desire to change. If you’re reading this book, you’ve already proven you have the desire to change. But there’s much more to making changes than simply the desire to change. I’ll say it again: Desire is of the mind and requires no action. Commitment is of the heart and does require action.
A significant part of your defeating diabetes will center on two major factors beyond the foods you eat: weight loss and exercise. I know you have the desire to lose the weight and to exercise, and when you commit to attacking weight loss and exercising, the odds are in your favor to defeat diabetes.
Willpower is a good initial step for something you desire to do, but unless you transform willpower into new habits, you’ll eventually fall back into your old habits. Willpower usually lasts only from that last cigarette smoked on Friday until the following Tuesday, when your desire overcomes your willpower to the point of smoking a whole pack.
Beat the desire.
Triggers for Making Change
Being overweight is the number one factor to address as a diabetic. As I mentioned before, over 80 percent of diabetics fit into this category. I have talked to numerous individuals about losing weight. Some honestly desire to lose weight because something has happened to make them ready to commit to change. Others “want to” lose weight, but because a special event is coming up this next weekend, they assure me they will start first thing Monday morning. (I don’t say anything to them, but the thought that runs through my mind is tell that to your mother; she might believe you.)
I read an article that said people who have succeeded in losing weight and keeping it off made the commitment to do so from the beginning. A study reported on in the American Journal of Clinical Nutrition tied the success to a “triggering event” that almost forced the individual to decide they were going to lose their excess weight. This study consisted of people who had been successful in losing their excess weight and able to maintain the weight loss for at least a year. Eighty-three percent of them reported a trigger event that began their weight loss, and that event was the encouraging factor that allowed them to continue permanently on that lifestyle of better eating and more exercise.
It’s interesting to see what those triggers were. The most commonly reported event was a medical mishap. The next most common trigger was an individual realizing they had reached an all-time high in weight. The third most common trigger was looking at a picture of themselves or looking in the mirror and realizing how they looked.
One of these triggers made them decide they had to make a change, and that trigger continually lingered in their minds for years to come. The medical mishap triggers were having a heart attack or seeing someone in the family have one. Or having a stent placed in one of the arteries of their heart. Or a doctor telling the person what was going to happen if they didn’t lose their excess weight. In this report, they found the people who had the medical triggers were more successful in losing weight and maintaining that weight loss than those who’d had any of the other triggers. Their conclusion reminds us that “the period following a medical trigger may be an opportune time to initiate weight loss to optimize both initial and long-term weight loss outcomes.”
Sometimes people do need a jolt, like a heart attack or being told they have diabetes or high blood pressure or seeing a loved one show the first signs of Alzheimer’s. Others can learn from reading about what’s going to happen unless changes are made. My mother had a favorite expression she taught us boys. She said we didn’t have to wait until something bad happened to us before making the decision to change our ways and do right. She wanted us to learn from her wisdom rather than waiting for something bad to happen before we decided to avoid the bad and do the good. My mother reminded us many times: “experience is a dear teacher—fools learn by no other.”
Often, a time of crisis is the beginning of a downhill spiral, the first domino that causes the second and third to tumble. The initial domino may be your diabetes, but the second is high blood pressure, and then a third is a stent placed in an artery of your heart, followed by a full-blown heart attack or stroke. This is the tumbling effect. I don’t know where you presently stand, but if a medical crisis has occurred, you must consider what is to come unless you begin taking preventive action. If you have had any of the above triggers, you should commit to change immediately.
But if you have not had to experience any of the above, I want this book to become a trigger, without having to physically go through such a disaster.
The biggest compliment I could ever get would be being told this book has taken the place of a medical trigger. Don’t wait until you have that first heart attack. Don’t wait on being told in the emergency room that you’re going to have to have a stent placed in an artery in your heart. When you look in the mirror, you’re looking at a person who can change your life. You don’t have to stay on the road you’re on.
You can begin today by believing in yourself. Believe you can lose weight. Believe you can get moving. Believe you can change your eating habits and form new ones. Believe it can happen.