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DIABETES Is on Its Way! PDF Print E-mail
Written by Jeff Novick, M.S., R.D.   
Thursday, 21 June 2001 16:21

Move over Heart Disease, DIABETES Is on Its Way!

Jeff NovickDr. Laurie J. Goodyear, an assistant professor of medicine at Harvard Medical School in Boston, Massachusetts, is predicting a “worldwide explosion” in type 2 diabetes, largely due to poor food choices and inactivity. 16 million Americans suffer from diabetes, and the epidemic is growing at a rate of 625,000 newly diagnosed cases each year.

Dr. Gerald Bernstein, a past president of the American Diabetes Association (ADA) and an endocrinologist with Beth Israel Medical Center in New York City, estimates that over the next 25 years, the number of Americans with diabetes will rise to 50 million from the current 16 million. Among adults, diabetes is the leading cause of blindness, kidney failure, limb loss, a major cause of heart disease and the sixth leading cause of death.

DiabetesThe cost of treating people with diabetes will amount to about $1 trillion annually, with patients with type 2 diabetes accounting for the bulk of these costs. The CDC put the annual cost of treating diabetes (90%-95% of people with diabetes have type 2, with type 1 diabetes accounting for the remainder) at $98 billion in 1997, the latest year for which data are available. Those costs include doctor visits, medications and hospitalization in addition to indirect costs such as short-term disability and premature death.

While there is no cure for diabetes, diet and exercise are often enough to control the disease and prevent complications. “Diet and exercise are keystones to treatment,” Dr. Michael M. Engelgau, a medical epidemiologist with the CDC’s division of diabetes, said. “In some cases, it may be all that’s needed.”

In fact, it has long been known that exercise helps control type 2 diabetes and Dr. Laurie J. Goodyear says that regular exercise would help stave off this explosion by preventing insulin dysfunction in the first place. While it has been unclear why exercise is so effective in controlling diabetes, a recent study is providing a better understanding of why and how exercise works in controlling blood sugar.

According to Dr. Goodyear, exercise appears to increase the activity of a substance called AMP kinase, which causes muscle to take up and use more glucose, or blood sugar.

Blood sugar is elevated in people with type 2 diabetes because their bodies fail to properly use insulin, a hormone that is key to blood sugar control. Insulin and exercise, according to Goodyear, use different “pathways” to spur glucose uptake, explaining why “exercise works when insulin does not.”

Typically, diabetics are first put on a treatment regimen of exercise and a low-fat, low-calorie diet. The next step is to prescribe oral medications. Although it is “easier to give patients a pill,” Goodyear, said, the longer they can be kept off drugs, the better.

To be effective, however, exercise needs to be part of a regimen that includes dietary changes, Goodyear explained. She called it a “crime” that some insurance plans do not cover care by a diabetes specialist trained to manage all aspects of care.

Well, knowing how effective exercise can be in controlling diabetes, how many diabetics stick to their exercise plan or even exercise at all?

A recent study (Preventive Medicine 2000; 30:407-414) found that most patients fail to sustain such health-promoting behaviors as exercise long enough to see results, and many diabetics do not even initiate attempts to improve their health.

“Given the devastating effects of diabetes complications, one might expect that those diagnosed with this disease would be motivated to make greater efforts than the general population to control their weight, to improve eating habits, and to increase their level of physical activity,” write Dr. Faryle Nothwehr and Tim Stump of the Indiana University Center for Aging Research in Indianapolis.

Some obese people even find their diabetes goes away when they lose weight. Even a modest weight loss — 5% to 10% of body weight — can improve symptoms. But according to their report in the May 2000 issue of Preventive Medicine, many people with type 2 diabetes do not attempt to lose weight. And among those who initiated weight-loss measures, many quit within 4 years. Investigators reviewed data from the Health and Retirement Study, a national survey of health behaviors. Their review included 733 people between 50-62 years with type 2 diabetes. About 86% of diabetics were overweight or obese.

At the beginning of the study about 80% of the people said they were on a diet to control their blood sugar, and more than half said they were trying to lose weight. Women reported these behaviors more often than men, researchers note. Two thirds of diabetics exercised and more than three quarters said they did not smoke when the study began. Men were more likely to smoke than women.

Over time, many people abandoned healthy behaviors. For example, nearly a third of those who were on a special diet at the outset had quit, although some who were not on a diet initially had begun one at follow-up.

About 44% of those who were trying to lose weight when the study began had abandoned their efforts. The authors note these individuals gained weight over time while those who sustained weight loss efforts lost weight. Further, more individuals who exercised at the outset had quit than were continuing to exercise after 4 years, investigators found.

And now, the scenario is even getting worse. The epidemic of diabetes among adults is now spreading to children and the potential consequences are immense. A child who is overweight and is diagnosed with diabetes may die a premature death in middle age. Over the years, they may develop heart disease and/or kidney failure. Arterial disease may cost them their sight, or a limb.

And, this is a very real scenario for the increasing number of American children who are being diagnosed with type 2 diabetes. This rise in type 2 diabetes cases in young people has led experts to label the disease an emerging epidemic. Health experts blame the trend on burgeoning rates of obesity among children and adolescents during the past three decades.

Until recently, the disorder was known as adult-onset diabetes because it occurred mostly in men and women over age 50. Type 1 diabetes, which requires insulin treatment, was thought to be the only form of the disease that occurred in children and adolescents. But the past 20 years has seen a steady rise in the number of children and adolescents who are diagnosed with type 2 diabetes.

“If you go back 20 years, about 2% of all cases of new onset diabetes (type 2) were in people between 9 and 19 years old. Now it’s about 30% to 50%,” noted Dr. Gerald Bernstein.

The trend has profound implications for the long-term health of America as many children go undiagnosed. While more and more young people are showing up in their doctor’s offices with symptoms, it still does not occur to many physicians to run a diagnostic blood test, since the disease is still considered rare among children. But because symptoms can only be controlled after a diagnosis is made, many children are at risk for serious medical complications.

“All of this is preventable if you control blood sugar, but in order to do that you have to know that the disease is present,” said Bernstein. For instance, a boy who develops type 2 diabetes in his teens and is left untreated will have problems with his eyes, kidneys, lower extremities and heart by the time he reaches his early 30s.

Indeed, the emerging epidemic of type 2 diabetes among children reflects a trend in the population at large (no pun intended). Recently, the Centers for Disease Control and Prevention (CDC) issued a report chronicling a 70% rise in the number of 30- to 39-year-old adults with the disorder between 1990-1998. Over the same period, rates of the disease rose by 50% among those aged 40 to 49, and by 31% among those aged 50 to 59, according to the report.

Problems have been simmering for decades as Americans have continued to put on weight. Researchers estimate that nearly half of all adults are overweight and nearly one-fifth are obese, or at least 30 pounds overweight.

Likewise, about 11% of the nation’s 6- to 17-year-olds were overweight in 1998, compared with about 5% in 1970. As young people continue to gobble up sweets and fatty foods, researchers expect to see type 2 diabetes more frequently in children. Other risk factors besides obesity include race, ethnicity and low socioeconomic status. Blacks, Hispanics and Native Americans are at greater risk than whites, partially due to greater consumption of processed foods. Research has also shown that these populations may be genetically predisposed to obesity due to slower metabolisms, a trait that has evolved over thousands of years.

But while a thrifty metabolism is useful when there is little food to go around — as in prehistoric times — it is a recipe for chronic disease in modern-day America, where there is enough food to provide each person with about 3,800 calories a day, said Dr. Marion Nestle, director of the department of Nutrition and Food Studies at New York University. Most adults, she said, need between 2,000 to 2,500 calories a day to survive.

“The surplus makes the food system competitive and food companies must sell food by getting people to eat more...or seek new audiences for their products — i.e., children,” Nestle said. “That’s why marketing to children has become so fierce. The pressure to eat more and to eat more often fosters obesity; obesity fosters diabetes.”

Ostensibly, diet and exercise are crucial to weight loss. As mentioned earlier, studies have also shown that exercise can help to stabilize blood glucose, the primary goal of diabetes treatment, and make the cells more responsive to insulin. Obesity and inactivity appear to increase the cells’ resistance to insulin.

Health experts suggest the only way to reverse the trend and avoid the medical complications and healthcare costs is to put America’s kids on a diet and encourage physical activity. According to Dr. Arlan Rosenbloom, a pediatric endocrinologist in Gainesville, Florida, diet and exercise could reduce the rate of type 2 diabetes in children by 60% to 80%.

This prescription could be difficult to fill in a country that does not seem to value physical education class, down from 42% in 1991. In addition, many have canceled after-school activities at a time when they are needed the most.

“Physical education needs to be mandatory and fun,” Rosenbloom said. “We need after-school programs for non-athletes, a much greater investment in group physical activity, and we need to encourage families. That’s where churches and community centers come in.” These initiatives, he said, are investments in the future health of America’s youth.

In addition to boosting health, such initiatives could save considerable amounts of healthcare dollars. The CDC put the annual cost of treating diabetes (90%-95% of people with diabetes have type 2, with type 1 diabetes accounting for the remainder) at $98 billion in 1997, the latest year for which data are available. Those costs include doctor visits, medications and hospitalization in addition to indirect costs such as short-term disability and premature death.

And a final note on diabetes.

As many of you know, we are in a state of carbo-phobia in this nation. A recent flood of best-selling diet books have all blamed many of the current health problems in America, including diabetes, on an excess intake of carbohydrates. These books recommend that people switch from a diet high in carbohydrates to a diet high in animal protein and animal fat. And as most people like to hear “good news about their bad habits,” many people, unfortunately, have been buying these books and embarking on these low-carb high-protein diets.

However, the problem is mainly a problem of lack of activity and excess weight. Additionally, in regard to carbohydrates, the problem is NOT carbohydrates in general, but refined and processed carbohydrates. These carbs are low in fiber and very high in calorie density. The answer isn’t eliminating carbs, but dramatically reducing and/or eliminating refined, processed carbs.

A study published last September in the American Journal of Public Health shows that women who ate a diet rich in whole grain, especially whole grain cereal, like oatmeal, significantly reduced their risk of developing diabetes.

Researchers from Harvard looked at the diets of more than 75,000 women over 10 years. They discovered that women who consumed the highest amounts of whole grain in their diets had the lowest risk of type 2 diabetes. Eating one cup of cooked oatmeal 2-4 times a week was linked to a 16% reduction in risk for type 2. Eating one cup of cooked oatmeal 5-6 times a week has been linked to a 39% reduction in risk for type 2 diabetes.

In addition, a study published in the New England Journal of Medicine (2000; 342:1392-1398, 1440) found that diabetics can significantly lower their blood sugar and even reduce their need for medication by eating lots of fruits, vegetables and high fiber grain (the equivalent to seven to eight servings of fruit and vegetables and three of high fiber whole grain).

Other studies have also shown how effective a well-planned low fat, high carbohydrate, high fiber plant-based diet can be in overcoming diabetes. In a study of 652 participants, conducted on participants at the Pritikin Longevity Center, 39% of adult-onset diabetics on insulin left the Pritikin Program insulin-free; 70% of the diabetics on oral agents left the program free of these medications. Participants who continued the program stayed off the medications (Diabetes Care, 17:1469,1994 & 2:268, 1983).

So, we are facing an incredible health epidemic that is already exploding in our nation, even amongst our children. Not only do we need to take action ourselves, we need to be concerned with the health of the children around us.

The solution is very effective and inexpensive:


  • Engage in 30-60 minutes of physical activity every day.
  • Maintain a healthy weight. If you are overweight, lose weight.
  • Eat a diet predominantly of whole, natural, unrefined, unprocessed plant foods that are low in fat and animal products.

©Copyright 2001. All Rights Reserved. Health Science is the publication of the National Health Association. This article reprinted from the Summer 2001 issue.


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