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Reversing Diabetes: Medications and Lifestyle

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Reversing Diabetes: Medications and Lifestyle

According to the CDC, more than 37 million people in the United States have diabetes, and most diagnosed cases (90-95%) are type 2 diabetes. Diabetes is a disease in which the body’s ability to use glucose (its primary energy source) is impaired due to a problem with insulin, the hormone produced by the pancreas that allows glucose to move into the body’s cells. Whereas a deficiency of insulin production occurs in type 1 diabetes, typically in children and adolescents, there is no deficit of insulin production in type 2 diabetes. The latter condition develops for several reasons, but one of the primary problems is that the body’s cells become resistant to insulin and are thus unable to utilize it to move glucose into cells. Blood sugar levels will be increased in both conditions. Over time, diabetes can cause serious health problems such as heart disease, kidney disease, vision loss, and amputations. Definitely not an illness you’d want to get if you can prevent it. The good news is that you can prevent it, at least the type 2 version.

The reason type 2 diabetes is preventable is that it, like many other chronic conditions, is a disease of lifestyle. That’s correct—type 2 diabetes develops due to an unhealthy lifestyle. There are several studies showing that making healthy lifestyle changes can prevent this condition. Moreover, one group of researchers wanted to examine both a lifestyle-intervention program and a prescription diabetes medication called metformin and their effects on preventing or delaying the development of this disease.

Their article appeared in the New England Journal of Medicine (N Engl J Med 2002; 346:393-403). They performed a study in which they enrolled 3234 participants that did not have diabetes and split them into three groups. One group was given metformin; the second group was the lifestyle-intervention group, and the third group was assigned a placebo pill. The individuals in the lifestyle-intervention group consumed a healthy, low-calorie, low-fat diet to maintain a weight reduction of 7 percent and performed moderate-intensity exercise for at least 150 minutes per week.

The results of the study were fascinating. Compared to the placebo group, the incidence of diabetes was 31 percent less in the metformin group. However, the really captivating part was that the incidence of diabetes in the lifestyle-intervention group was 58 percent less than in the placebo group. So, a healthy lifestyle was better at preventing type 2 diabetes than a commonly prescribed diabetes medication—and without any adverse side effects!

Always remember that treating your body well and providing it with healthy foods will significantly lower your risk of developing lifestyle-related diseases.

Health Habits

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Is there any health behavior that you have ever considered changing?

Perhaps you have been thinking about your diet or the amount of physical activity you give yourself.

Have you ever felt that your current health habits may not be the best for you, but you never really have “gotten around to” changing things?

Just a question to reflect upon. Believe me; I understand how busy we can be and how often life can get in the way of, well, life.

When you are ready, remember that it doesn’t have to take drastic changes. Simply making one slight adjustment a few times a week and then building upon that can have tremendous positive effects over time. For example, add a single serving of fresh fruit to your day three times each week for two weeks. Or perhaps replace your afternoon candy bar with an apple three times a week and slowly increase over time.

When you are ready, give it a try.

Let me know how it goes for you.

Is Your Food a Risk Factor?

In my last post, I spoke about how coronary artery disease can be considered a food-borne illness. I discussed how the modern Western diet, filled with fried foods, processed foods, meats, oils, and dairy, contributes so much to the development of heart disease. Moreover, there is an abundance of data demonstrating this connection. For me, even though the data is there, I don’t need it to appreciate that the foods we eat are harming us. I see this demonstrated every day I go to work. I care for many people suffering from diabetes, hypertension, heart disease, cancer, and stroke. Maybe you do as well. Do you have family or friends living with one or more of these illnesses? They are indeed diseases of lifestyle.

Reflecting on my work as an Emergency Medicine physician, I began thinking about how I evaluate a patient with chest pain. In the Emergency Department, we certainly try to make a diagnosis whenever we can with the resources at our disposal. At a minimum, however, we need to do our best to ensure that no immediate life or limb-threatening process is occurring in a patient, and the questions we ask a patient are often a critical part of our evaluation.

Getting back to the patient with chest pain, there are several conditions that we need to assess for, including coronary artery disease, which may be causing an acute decrease in blood flow to part of the heart. While interviewing the patient, we ask many questions about their symptoms as well as their risk factors for heart disease. Typical risk factors include diabetes, hypertension, high cholesterol, cigarette smoking, and obesity. Then I began to ask myself: why don’t we ask about a person’s diet? It is clear that what a person eats can either contribute to or protect from heart disease. Perhaps in the future, a person’s diet should be officially added to the list of heart disease risk factors. Moreover, raising the subject of diet may allow us to create awareness and educate our patients on this essential component of health and wellness.

A Food-Borne Illness

As an Emergency Medicine physician, when I hear the term “food-borne illness,” it immediately conjures images of people with vomiting and diarrhea secondary to consuming undercooked or spoiled food contaminated with bacteria or their toxins. However, I recently learned of a new usage of this term. In his article, “Is the Present Therapy for Coronary Artery Disease the Radical Mastectomy of the Twenty-First Century?” Dr. Caldwell Esselstyn ascribes a new meaning to the phrase “food-borne illness,” referring to coronary artery disease as this type of illness. According to the CDC, coronary artery disease (CAD) is the most common type of heart disease in the United States. It is the narrowing and blockage of blood vessels supplying blood to the heart, which can eventually lead to heart attacks. The CDC also states that in the United States, over 20 million adults over age 20 have CAD and that someone has a heart attack every 40 seconds.

Those are some pretty frightening statistics. But luckily, doctors have treatments for heart disease. We have an armamentarium of medications as well as procedures such as coronary stents and coronary artery bypass surgeries. These are remarkable advances that are lifesaving for those that are having a heart attack. However, as Dr. Esselstyn states, “…none of the present therapies targets the cause: the Western diet.” Yes, our Western diet—filled with processed foods, fried foods, meats, oils, and dairy. He describes cultures that consume a plant-based diet in which CAD is almost non-existent. Moreover, the converse is also true. When plant-based cultures adopt a Western diet, guess what? Yes, that’s right, they develop CAD. Thus, it seems as though heart disease really is a food-borne illness.

History also teaches us this lesson. Between 1939 and 1945, Norway was occupied by Nazi Germany. During this time, the Germans removed all animal livestock, forcing the population to subsist on whole grains, legumes, fruits, and vegetables. Following this, deaths from heart attacks and strokes fell. When the war ended, and animal products became available again, deaths from these illnesses rose to prewar levels. Thought-provoking, isn’t it?

In his article, Dr. Esselstyn mentions a study he conducted on very ill patients with CAD that he placed on a plant-based diet. These patients have thus far been followed for twenty years, and the results are fascinating. A plant-based diet not only stopped the progression of heart disease but even reversed it! Yes, reversed it. Furthermore, this study and its follow-up showed that people with CAD would stick with dietary changes for decades. If provided with an understanding of the link between diet and disease, I believe that people will want to take control of their own health and give themselves the opportunity to be better.