Dodging Diabesity

As obesity becomes America’s biggest health menace, all that excess poundage is
fueling a surge in diabetes and related maladies. This phenomenon, now referred
to as diabesity, threatens to overwhelm the entire healthcare system. The choice
is simple: Either fashion an anti-diabetes lifestyle—or get caught in the crush.

By Lisa James

July 2006

The numbers are grim. According to the federal government, 73 million Americans—nearly a third of the population—either have diabetes outright or are well on their way down that road. And many of them are totally unaware of the danger they’re in because diabetes is a stealth disease in which excessive amounts of glucose (blood sugar) does its dirty work quietly over decades, sometimes until a damaged heart or kidney goes critical or a seemingly minor foot infection results in a battle to avoid amputation. But more often people learn they have “the sugar” after visiting the doctor for excessive fatigue or thirst, or after routine bloodwork reveals high glucose levels.

It’s no accident that the danger posed by diabetes grows as the national waistline expands. Obesity is actually fueling the diabetes epidemic, to the extent that this double terror now has its own name—diabesity. “More and more people are becoming aware of the linkage between obesity and diabetes,” says Francine Kaufman, MD, director of the Comprehensive Childhood Diabetes Center at Childrens Hospital in Los Angeles, professor at the Keck School of Medicine/USC and author of Diabesity (Bantam Dell). “Policy makers, and healthcare and public health authorities, are aware of the progression from one to the other.”

Diabetes occurs in two main forms. In type 1 the body’s immune system attacks cells in the pancreas that produce insulin, which shepherds glucose (blood sugar) from the bloodstream into cells. Without natural insulin, glucose reaches unhealthy levels—defined as a fasting blood-sugar count of 126 mg/dl or more—which can only be controlled by injected insulin. As type 1’s old name, juvenile diabetes, would indicate, this disorder usually starts in childhood.

Type 2 (originally called adult onset diabetes) arises when cells stop responding to insulin (a condition called insulin resistance), and insulin and glucose levels rise together. Type 2 is the one linked to obesity and lack of physical activity, and is generally controlled by a combination of diet, exercise and medication. Sometimes the pancreas works so hard to produce excess insulin for such a long time that the insulin-generating cells burn out; the unfortunate victim then develops type 1 diabetes on top of type 2 and must add injections to his or her daily regimen. Both types can lead to a whole host of complications including limb loss and blindness.

One reason for the change in terminology is that what used to be called adult onset diabetes is now being seen in younger and younger patients, thanks to the wave of childhood obesity that has swept the US. “In my center about 1,700 children have type 1 and 250 have type 2. But of all of our new-onset cases, 25% are now type 2,” Kaufman explains. “Virtually all of the children with type 2 are overweight or obese.”

Deadly Apples

In some folks fat is stowed under the skin, including the skin of the thighs and buttocks. This subcutaneous fat gives an individual a bottom-heavy pear shape that, while perhaps distressing to that person, has little effect on health.

But the abdominal fat that gives its wearer an apple shape . . . now that’s another story. These deposits, known as visceral fat, are “more metabolically active than subcutaneous fat—and more dangerous,” says Kaufman, who explains that abdominal fat is more likely to spill into the liver (where it can cause fatty liver disease) and pancreas. What’s more, this fat can migrate to muscle cells; when that happens, those cells “can’t respond properly to insulin, so the muscle doesn’t take up sugar normally or metabolize it as efficiently as it should.” In addition, overstuffed fat cells may release hormones that produce insulin resistance.

Excess belly fat (defined as a waistline of 39 inches and up) is one of the markers of metabolic syndrome (formerly known as syndrome X), a set of bad-health indicators that also includes insulin resistance as well as high cholesterol, triglycerides (blood fat) and blood pressure. Not surprisingly, the metabolic syndrome, which affects more than 25% of all adults, is a major cause of cardiovascular disease. Like obesity, it is linked to a diet rich in the sugary, highly refined foods that we just can’t seem to stop eating in mass quantities.

Insulin resistance itself paves the way for pre-diabetes (or impaired glucose tolerance), defined as a blood-sugar reading that falls between 100 and 126 mg/dl. Some people call sugar readings in this range “just a touch of diabetes,” like they were just let off the hook. In reality pre-diabetes is a warning sign that calls for immediate action: “Research increasingly indicates that impaired glucose tolerance . . . is accompanied by serious health risks and should be treated carefully (even if diabetes doesn’t develop),” write Michael Murray, ND, and Michael Lyon, MD, in How to Prevent and Treat Diabetes with Natural Medicine (Riverhead Books).

Whipping Blood Sugar into Shape

Paring down your midsection’s “apple” through smart eating can drop blood sugar dramatically. The best way to start: Taking a good look at what you’re eating right now. “The conscious act of writing down everything you eat is a surprisingly effective weight-loss technique,” says Dr. Anne Peters, author of Conquering Diabetes (Plume). Keeping a food log helps you find ways to cut mindless calories (like the three or four chocolates you swipe from the receptionist’s candy jar every afternoon); you also learn if you’re really hungry or simply “lonely, bored or depressed,” as Peters puts it.

Some health practitioners recommend a low-carbohydrate diet for diabetes prevention, but that doesn’t mean gorging on meat. Harvard researchers found that women aged 45 and older who ate red meat frequently had a 29% increased risk of developing diabetes; loading up on bacon, hot dogs and other processed meats raised risk by 43% (Diabetes Care 9/04). Instead, make dining a colorful experience by selecting produce in rainbow colors: green lettuce, red peppers, orange carrots. (For an extra splash of flavor, dress those vibrant veggies with a little vinaigrette—vinegar actually helps manage blood sugar.) Produce also contains plentiful stores of fiber, which moderates both glucose and cholesterol levels.

Specific nutrients have been found to help stymie diabetes development. For example, women who ingest the highest amounts of calcium and vitamin D have been found to run the lowest risk of type 2 diabetes, according to scientists who looked at data on nearly 84,000 participants in the Nurses’ Health Study (Diabetes Care 3/06). Evidence indicates that high doses (800 IU daily) of vitamin E may help improve liver function and reduce free-radical damage among overweight adults with pre-diabetes. The professionally supervised use of glucose-lowering supplements is another option.

No matter how healthy your diet is you’ll never overcome diabesity without exercise; it not only helps you wear away that spare tire but also gives your insulin the oomph to keep glucose moving. You don’t have to spend hours slaving away in a gym—30 minutes three times or more a week will help, although daily movement is even better. For best results, pick two or three activities you enjoy, such as biking, playing tennis or golfing sans cart, and rotate them on a regular basis to avoid boredom.

Paradoxically, it turns out that time spent at complete rest is about as important as time spent on the move. Recent studies link sleeplessness to increased insulin resistance, which makes sense once you realize how important that nightly snooze is to proper hormone production. Shoo away insomnia by avoiding waker-uppers like caffeine and late-night eating, and by establishing a regular bedtime/waketime pattern. Some people find herbs such as passionflower and valerian or nutrients such as 5-HTP and melatonin helpful in bringing on sleep.

For all the bad news Kaufman remains optimistic that diabesity can be overcome. “We are starting to make a lot of changes—look what has happened in schools [where soda has been banned]. Insurers are beginning to give incentives to providers and patients who improve health status,” she says. “I think we are going to make it because we have no other option.” Take that as a motto for your own health.

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