“Most people have no symptoms at all,” says Richard Bergenstal, MD, past president of the American Diabetes Association and executive director of the International Diabetes Center in Minneapolis. “Only about 25 percent have vague symptoms that you wouldn’t associate with diabetes. The problem is, the longer diabetes is undiagnosed, the more at risk you are of cumulative exposure to high glucose levels. Just because you don’t have symptoms doesn’t mean it’s not doing harm.”
More than 25 million Americans over 20 have diabetes. Nearly 25 percent of Americans are estimated to have elevated blood sugar levels that may lead to diabetes, but only four percent realize it.
But there’s good news, says Bergenstal. Unlike many diseases, type 2 diabetes is largely preventable, and with the right changes in diet and lifestyle, most people can treat diabetes without any other intervention.
Diabetes Defined
Diabetes mellitus is characterized by elevated blood sugar levels, either chronic or recurring. Left untreated, over time it can lead to kidney failure, blindness, heart disease, coma, and death.
There are two kinds of diabetes. Type 1, or insulin-dependent diabetes, usually starts in childhood or early adolescence. It’s caused by an autoimmune response that damages the part of the pancreas responsible for creating insulin—a hormone that helps cells absorb glucose and use it as fuel. When glucose builds up in the blood, it can damage the heart, blood vessels, nerves, eyes, and kidneys. Type 1 diabetes isn’t treatable by diet and lifestyle changes alone, but can be managed with regular shots of insulin and frequent blood glucose monitoring.
Type 2 diabetes is far more common and usually occurs in people over the age of 40. Unlike type 1 diabetes, where the body stops producing insulin, in type 2 diabetes the pancreas is still able to make insulin, but can’t produce enough to meet the body’s needs. Also, the body’s cells are unable to use insulin properly, a condition known as insulin resistance.While type 2 diabetes has a strong genetic component, it’s thought to be caused mainly by lifestyle factors, including unhealthy diet, obesity, lack of exercise, inadequate sleep, and stress. In other words, it can be prevented and, in most cases, treated without drugs or medical intervention. The key is consistency, says Theresa Garnero, APRN, BC-ADM, MSN, CDE, author of Your First Year with Diabetes.
“Don’t try one or two quick-fix changes that you’ll only be able to stick with for a couple of weeks,” she says. “Follow a variety of do-able, realistic practices in diet and lifestyle that you can keep up with over the long run.” Read on for 10 sane, healthy habits you can start right now to prevent or manage diabetes.
>> 1. Lose a little weight
Excess weight is one of the greatest risk factors in diabetes, but you don’t have to get seriously skinny: shedding only seven percent of your body weight can reduce your risk by 58 percent. Even as little as a five percent reduction in weight also makes a significant difference.
Why does weight matter? “Excess weight blocks the action of insulin,” Bergenstal says, “and losing weight makes the cells more receptive to the actions of insulin.” In addition, he says, if you’re overweight for too long, it starts to wear on the pancreas. When that happens, not only will you have insulin resistance, you’ll also be unable to make as much insulin as you need to normalize blood sugar.
As anyone who’s tried (repeatedly) to shed pounds knows, it’s often easier said than done. “That’s because the calories-in, calories-out is only part of the story,” says Terry Grossman, MD, author of Transcend: Nine Steps to Living Well Forever. “All calories are not created equal; calories in the form of sugars and starches raise insulin and encourage your body to hold on to fat. For most people, especially for diabetics, the first step is cutting back rather sharply on the amount of simple sugars like fruit juice, white rice, potatoes, and pasta. They’re counterproductive to weight loss.”
Slimming foods include lean protein, high-fiber fruits and vegetables, and moderate amounts of healthy fats, says Grossman. And instead of sugar, try small amounts of stevia, a sweet-tasting South-American herb. It’s safer than alternative sweeteners, Grossman says, and may even help control blood glucose.
>> 2. Move more
Studies have consistently shown that people who exercise regularly have a lower risk of diabetes: that applies for very modest workouts as well as more strenuous activities. In one study, people who exercised four hours a week, or about half an hour a day, reduced their risk of diabetes by 80 percent—even without losing weight. Other studies have found similar results.
You don’t have to run a marathon to reap the benefits. “If you can tolerate vigorous exercise, you’ll see more effects, especially in terms of cardiovascular health,” says Bergenstal. “But if you can’t, don’t let that stop you. The point is to move your body, even if you’re not necessarily raising your heart rate.”
Aim for about 30 minutes of movement, five times a week, says Bergenstal. If 30 minutes seems out of reach, break it into manageable segments: spending 10 minutes walking briskly in the morning, 10 minutes on your lunch hour, and 10 minutes walking around the block after dinner will yield the same benefits.
To make movement consistent, work activity into your daily life: run errands on your bike, park several blocks away from movie theaters or shopping malls and hoof it the rest of the way, go up and down a flight of stairs at a brisk pace for 10 to 15 minutes. And make exercise part of your social life, with walking groups or salsa lessons.
“Dancing is ideal,” says Garnero. “There’s something about moving to music, losing yourself in the lyrics, and spending time with friends that not only helps insulin levels, but also reduces stress and increases joy.”
>> 3. Chill out
Type A personalities take note: being keyed up is deadly for diabetics. “Stress causes the release of hormones that impact insulin,” says Barnard. “It also affects sleep, and destroys resolve to eat in a healthful way. If you’re on a deadline, stressed out, and rushing to get your work done, food is not a priority: you’ll eat whatever you need to get through the day.”
When you’re stressed, the body goes into a fight-or-flight response, releasing hormones and mobilizing glucose from the liver, muscles, and stored fat to help you respond to a dangerous situation, Grossman says. In prehistoric times, those hormones and additional blood glucose would allow you to run from danger or fight an attacking animal: you’d use them up in the process. But modern stress rarely involves physical danger, so the hormones and glucose hang around rather than being used up, and impact blood sugar levels for hours after the stressful event.
If you’re keyed up, natural anti-stress relievers can help:
—Get a massage: it may lower your glucose levels and can also treat diabetic neuropathy, nerve damage characterized by numbness, tingling, and pain.
—Try biofeedback: it’s been shown to help diabetics manage blood sugar.
—Zen out: practicing mindfulness meditation can reduce stress and depression, lower blood pressure, and improve glucose response.
>> 4. Enjoy the occasional glass of wine
Some studies suggest alcohol consumption can improve insulin sensitivity in people without diabetes, and moderate consumption may reduce the risk of diabetes by up to 30 percent.
Why does alcohol work? Besides the insulin-balancing effects, it may help keyed-up folks downshift. “Most people aren’t well-equipped to deal with stress, and a glass of wine might help them chill out,” says Garnero.
But there’s some controversy around those findings. “While alcohol may reduce the risk of heart disease, it increases the risk of breast cancer and some other cancers,” says Neal Barnard, MD, president and founder of the Physician’s Committee for Responsible Medicine and author of Dr. Neal Barnard’s Program for Reversing Diabetes. And alcohol can upset blood sugar up to 24 hours after drinking, says the American Diabetes Association.
If you do drink, “Keep it moderate and intermittent—about the equivalent of two or three glasses of wine a week,” Barnard says. Other tips: avoid sugary drinks or those mixed with sodas, sip slowly, mix alcoholic beverages with club soda or carbonated water, and never drink on an empty stomach. And if you’re not a drinker, don’t start, says Bernard. Find other ways to lower your risk.
>> 5. Clean up your cleaners
Are your dishwashing soap and dryer sheets increasing your risk of diabetes? A recent study found people who had the highest urine levels of phthalates—chemicals found in fragrances and perfumes, as well as soft plastic packaging, nail polish, and cosmetics—were nearly twice as likely to develop diabetes. Phthalates belong to a group of compounds known as endocrine disruptors that can alter the production of certain hormones, including insulin.
This new study is the latest addition to ongoing research on endocrine disruptors and other environmental toxins that promote obesity, disrupt appetite controls, upset hormones, and alter metabolism. A landmark study in 2002 found that the obesity epidemic paralleled a dramatic increase in environmental chemicals, and researchers suggest that those chemicals may be contributing to the diabetes epidemic as well. Phthalates are only one class of these chemicals: bisphenol-A (BPA)—in plastic wrap, water bottles, canned foods and many other products—is also associated with increased risk of diabetes.
What can you do? In general, choose natural cleaning products, stay away from chemical fragrances, and avoid plastic food storage containers, water bottles, and tin cans. And when you’re choosing personal care products, says Mark Hyman, MD, “Look at the ingredients: if you wouldn’t eat it, don’t use it.” Choose natural soaps, toothpaste, cosmetics, and other personal care products that are free of artificial fragrances and chemicals.
>> 6. Drive by the drive-through
It’s deadly for diabetics. In one long-term study, people who ate fast food more than twice a week had twice the rate of insulin resistance as those who drove through the drive through less often.
Fast foods are high in calories, sugar, and refined carbohydrates, says Hyman. This floods the body with a continual stream of glucose and increases the risk of insulin sensitivity. They’re also loaded with unhealthy fats, a significant but less-acknowledged risk factor for diabetes, says Barnard. If you’re ordering burgers, you’re increasing your risk even further: in one study, women who ate red meat five times a week or more had a 29 percent higher risk of diabetes than those who ate it less than once a week.
And fast-food meals, like most processed foods, are high in endocrine disruptors like added hormones, pesticides, and chemicals. “We know from studies that people who have higher levels of pesticides and chemicals in their system also have a higher risk of diabetes and insulin resistance,” Hyman says.
If you do eat out, skip the drive through and stick to healthier choices at sit-down restaurants.
>> 7. Emphasize green tea
Findings have been mixed, but two recent studies suggest that caffeine may protect against diabetes. A large study found that heavy coffee drinkers (those who drank six or more cups a day) reduced their risk of diabetes by up to a 54 percent. Drinking one to three cups a day had little effect, and decaf coffee offered no protection.
Tea drinkers may enjoy similar protection—in one study, people who drank at least four cups of tea a day had a 16 percent lower risk of developing diabetes than non-tea drinkers.
But some experts caution against using these findings to indulge heavily. Many studies show that caffeine can upset glucose levels in people with diabetes, and can lead to insulin resistance in people who don’t have diabetes, increasing their risk of developing the disease.
“Six cups is a lot of coffee,” says Garnero. “You have to wonder about the impact of that much caffeine on sleep, blood pressure, and stress levels.”
If you’re a coffee or tea drinker, you may not have to give it up—but proceeding with caution is probably the best advice. Green tea is a better choice: a recent study suggests it can stop high blood sugar and protect against kidney damage.
>> 8. Eat like a rabbit
Increasing your intake of fruits and vegetables can dramatically protect against diabetes: in one study, people who ate the most leafy greens lowered their risk by 14 percent.
“When you build your diet from plant foods, you reduce your risk of diabetes,” says Barnard, “partly because they’re high in fiber, and partly because they’re low in fat and calories. In our studies, we showed that people who ate a vegan diet had a slightly faster metabolism after meals.”
Plant foods are high in fiber, which slows the release of dietary glucose and increases the body’s sensitivity to insulin. Beans are especially protective: in one study, eating beans and legumes reduced diabetes risk by 40 percent. Fruits and vegetables are also high in diabetes-fighting nutrients like magnesium and chromium. Ways to eat like a rabbit:
—Keep pre-cut carrot, red pepper, and celery sticks for ready-to-grab snacks, and serve fresh fruit instead of sugary treats for dessert.
—Double portion size for vegetable sides, and have them steamed or lightly sautéed. If you’re having pasta, double the sauce and cut the pasta portion in half.
—Sprinkle salads with kidney beans, add lentils to any soup, or purée white beans with olive oil and garlic for a fast sandwich spread.
—Have a big salad every day, topped with vinaigrette—in one study, people who ate leafy greens dressed with oil and vinegar lowered their blood sugar levels after meals.
>> 9. Hit the snooze button
Adequate sleep is crucial to prevent and manage diabetes. In one study, researchers found that sleeping less than six hours a night doubled the risk of diabetes. Other studies have found that a sleep deficit decreases the amount of insulin released and upsets blood sugar balance.
Why is shut eye so essential? If you’re sleeping too little, your nervous system is on red alert, says Garnero, which interferes with hormones that regulate blood sugar. “It appears that when you don’t sleep enough, there’s a preference for eating more refined carbohydrates,” says Bergenstal. “It’s also logical that if you’re not sleeping well, the likelihood that you’re exercising and leading an active lifestyle is decreased.”
But getting too much sleep also increased risk of diabetes, probably because it’s a sign of undiagnosed sleep apnea—a condition marked by abnormal pauses in breathing or abnormally shallow breathing. If you snore, wake up gasping, or feel unrested even after adequate sleep, get tested for apnea, says Bergenstal.
Otherwise, head to bed earlier, says Garnero. Practice good sleep hygiene: don’t watch television or read in bed, keep activities calm for several hours before sleeping, don’t eat late at night, and block light with heavy curtains. If you’re still having trouble snoozing, try gentle sleep-promoters, like chamomile, valerian, or passion flower.
>> 10. Get supplemental support
In addition to diet and lifestyle changes, a handful of supplements may also help prevent or manage diabetes. Some to consider:
—Gymnema sylvestre, an Ayurvedic herb, helps delay the absorption of glucose into the blood, curbs sugar cravings, and stimulates the pancreas to release insulin.
—Fenugreek, a seed commonly used in Indian cuisine, slows glucose absorption and stimulates insulin release, and may also reduce diabetic neuropathy.
—Chromium, a trace mineral, helps reduce blood sugar levels and improve insulin sensitivity.
—Vitamin D improves the body’s ability to use insulin and helps the function of pancreatic cells that produce insulin. Make sure you have the basics covered, says Hyman. In addition to 2,000 to 4,000 mg of vitamin D, he also recommends a good quality multivitamin and 1,000 mg of fish oil twice a day.
Meals to Heal Diabetes
If you’re new to diabetes, planning meals can be tricky. The key, according to the American Diabetes Association, is to focus on filling your plate with non-starchy vegetables, adding smaller portions of starches and meat, and supplementing with healthy oils. Here are a few ideas:
Breakfast
>>Spinach, mushroom, and goat-cheese omelet; sweet potato hash browns
>>Chipotle-black bean burrito with grilled peppers and avocado; pineapple cubes
>>Raspberry-peach smoothie with low-fat yogurt and protein powder
Lunch
>>Grilled chicken whole-grain wrap with tomatoes and yogurt-dill sauce
>>Baby spinach salad with tuna, walnuts, pears, and raspberry vinaigrette
>>White-bean and quinoa salad with avocado, yellow peppers, olives, and basil vinaigrette
Dinner
>>Black-bean burgers with chipotle mayonnaise and baked sweet potato fries
>>Roast chicken breast with lemon-pepper rub and garlicky sautéed kale
>>Green-tea poached salmon with asparagus and red peppers
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