If type 2 diabetes were an infectious disease, it is said we would be in the midst of an epidemic. This problematic disease is striking an ever-growing number of adults. With the rising rates of childhood obesity, it has become more common in youth, especially among certain ethnic groups. The good news is that prediabetes and Type 2 Diabetes are largely preventable. About 9 in 10 cases in the U.S. can be avoided by making lifestyle changes. These changes can also lower the chances of developing heart disease and some cancers. In this article, we will look at diet as a means to prevent and regulate T2DM.

1. How does what you eat affect you?

According to the Centers for Disease Control and Prevention, one out of every three American adults has prediabetes; that is 86 million people. Without intervention, up to one-third of them will go on to develop type 2 diabetes within five years

Is everything lost? Not at all! Lifestyle changes can help. While excess body fat is a recognized risk factor for diabetes (and weight loss is an important way to lower risk), specific diet patterns and foods seem to decrease or increase risk, independent of weight. The latest research suggests that diabetes risk (as well as the risk of heart disease and stroke) is largely influenced not by single nutrients but by specific foods and overall diet patterns.

Poor diet quality may influence weight and metabolic risk independent of calories: Different types of foods have different effects on satiety, glucose-insulin responses, liver fat synthesis, fat-cell function, craving and reward responses in the brain, and the creation of visceral fat.

2. So, which foods lower the risk of getting Type 2 Diabetes?

We will discuss in some detail everyday food that might either aid in the prevention of diabetes or accelerate your progress towards it. When you are making the decision of what to eat, choose wisely.

1. Choose high-fiber, slow-release carbs

Carbohydrates have a big impact on your blood sugar levels—more so than fats and proteins—so you need to be smart about what types of carbs you eat. Limit refined carbohydrates like white bread, pasta, and rice, as well as soda, candy, packaged meals, and snack foods. Focus on high-fiber complex carbohydrates—also known as slow-release carbs. They are digested more slowly, thus preventing your body from producing too much insulin.

2. Eat more plant foods.
   Minimally processed plant foods such as fruits, non-starchy vegetables, legumes, and nuts/seeds are consistently linked to better cardio-metabolic outcomes, including decreased diabetes risk.
3. How about proteins?
   While they have been studied to different extents, meat, poultry, eggs, fish, and dairy protein sources appear to impact diabetes risk differently.

In their 2011 meta-analysis, Pan and colleagues determined that red meat consumption, particularly processed red meat, is associated with an increased risk of type 2 diabetes and suggested that substituting one serving of nuts, low-fat dairy, and whole grains per day for one serving of red meat would lower diabetes risk by 16% to 35%.

4. Are fats bad for you?
Most research on fats typically looks at their impact on cardiovascular, not diabetes, risk, and fats’ association with diabetes risk is in need of clarification. Recent evidence suggests that the quality of fats consumed in the diet is more important than the total quantity of dietary fat. Some researchers point out that the source of fat is important, and possibly confounding, in studies looking at total fat intake and health effects. Although some results are controversial, it’s important to be aware of and keep an eye on emerging research. Some recent study findings include the following:

• A Mediterranean dietary pattern, which is relatively high in monounsaturated fats, may help prevent type 2 diabetes.
• High vegetable fat intake may decrease type 2 diabetes risk in females.
• Intake of high-fat, but not low-fat, dairy products is associated with a decrease in type 2 diabetes risk.
• EPA+DHA seems to provide neither harm nor benefits with regard to diabetes development. The omega-3 fatty acid ALA (alpha-linolenic acid) may be associated with modestly lower risk.10

Since fat is calorically dense (9 kcal/g as opposed to 4 kcal/g for protein or carbohydrate), it’s often the focus of weight-loss diets.

5. Should you take beverages?
   What to drink is a choice we make every day. It is important to get into healthy drinking habits.

• 100% fruit juices are generally considered safe, as long as the serving is kept to one a day.
• Both coffee (caffeinated and decaffeinated) and tea are associated with a lower risk of diabetes.
• There’s strong evidence that moderate alcohol use is associated with lower diabetes risk across diverse populations, but people who don’t currently drink alcohol shouldn’t be encouraged to do so, and drinkers should limit themselves to up to two drinks per day for men and one to 1.5 for women.

3. So, In Summary…..

Eat more

• Healthy fats from nuts, olive oil, fish oils, flax seeds, or avocados
• Fruits and vegetables—ideally fresh, the more colorful the better; whole fruit rather than juices
• High-fiber cereals and bread made from whole grains
• Fish and shellfish, organic chicken or turkey
• High-quality protein such as eggs, beans, low-fat dairy, and unsweetened yogurt

Eat less

• Trans fats from partially hydrogenated or deep-fried foods
• Packaged and fast foods, especially those high in sugar, baked goods, sweets, chips, desserts
• White bread, sugary cereals, refined pasta or rice
• Processed meat and red meat
• Low-fat products that have replaced fat with added sugar, such as fat-free yogurt

4. How to eat healthy on a normal diet

It is easier to adopt a healthy eating lifestyle than to go on a diet. A good dietary pattern to lower diabetes risk would limit red and processed meats, refined grains, sweets and Soda, and emphasize plant foods like whole grains, nuts, fruits, and leafy green vegetables. Evidence supports including coffee, tea, yogurt, vegetable fats, and possibly cheese.

Working with a dietary pattern instead of focusing on individual nutrients or “superfoods” (or vilifying particular food groups) allows greater flexibility for you. It lets you choose foods you like at times that are convenient for you.

Given the health advantages of plant foods like leafy greens and whole grains and their association with reduced diabetes risk, you should ensure your diet pattern includes a healthy serving of them at all times.

References:

1. Today’s dietician (2017): Diabetes Management & Nutrition Guide: Foods and Eating Patterns for Diabetes Prevention. Retrieved from https://www.todaysdietitian.com/newarchives/0717p40.shtml

2. Harvard School of Public Health (2019): Simple Steps to Preventing Diabetes. Retrieved from https://www.hsph.harvard.edu/nutritionsource/disease-prevention/diabetes-prevention/preventing-diabetes-full-story/

3. Health Guide (2018): The Diabetic Diet. Retrieved from https://www.helpguide.org/articles/diets/the-diabetes-diet.htm

Of all the chronic diseases currently known to mankind, diabetes is the most common. The onset of diabetes starts years before it becomes full-blown and starts affecting one’s health. How can you know if you are on the path to being a full-blown diabetic? What can you do to arrest and reverse this process? In this article, we will discuss both the signs to look out for and the remedies.

1. What Is Prediabetes?

Prediabetes is a “pre-diagnosis” of diabetes—a warning sign of sorts. It happens when your blood glucose level (blood sugar level) is higher than normal but not high enough to be considered diabetes.

Prediabetes is an indication that you could develop type 2 diabetes (T2D) if you don’t make some immediate and lasting lifestyle changes.

During the prediabetes phase, your pancreas still produces enough insulin in response to ingested carbohydrates. The insulin is less effective at removing the sugar from the bloodstream, though, so your blood sugar remains high. This condition is called insulin resistance.

2. What are the indications that you might have it?

Diabetes develops very gradually, it could take up to several years. It follows that when you’re in the prediabetes stage, you may not have any symptoms at all. You may, however, notice that:

• you’re hungrier than normal
• you’re losing weight, despite eating more
• you’re thirstier than normal
• you have to go to the bathroom more frequently
• you’re more tired than usual

All of these symptoms are typically associated with diabetes, so if you’re in the early stages of diabetes, you may notice them.

3. Understanding the risk factors that could lead to prediabetes…

It is not very clear what exactly causes the insulin process to go askew in some people. There are several risk factors, though, that make it more likely that you’ll develop pre-diabetes. These are the same risk factors related to the development of type 2 diabetes:

• Weight: Being overweight (have a body mass index—a BMI—of higher than 25), increases your risk for developing prediabetes. This is especially true if you carry a lot of extra weight in your abdomen. The extra fat cells can cause your body to become more insulin resistant.
• Being inactive: This often goes hand-in-hand with being overweight. If you aren’t physically active, you’re more likely to develop prediabetes.
• Having a close family member with type 2 diabetes: Prediabetes has a hereditary factor. If someone in your close family has (or had) it, you are more likely to develop it.
• Race/ethnicity: Certain ethnic groups are more likely to develop prediabetes, including African-Americans, Hispanic Americans, Native Americans, and Asian Americans.
• Age: The older you are, the more at risk you are for developing prediabetes. At age 45, your risk starts to rise, and after age 65, your risk increases exponentially.
• Gestational diabetes: If you developed diabetes while you were pregnant, that increases your risk of developing prediabetes later on.
• Other health problems: High blood pressure (hypertension) and high cholesterol (the “bad” LDL cholesterol) increase your risk of getting type 2 diabetes.
• Polycystic ovary syndrome (PCOS) also raises the risk of prediabetes because it’s related to insulin resistance.

• Hypothyroidism(low thyroid function; not enough circulating thyroid hormone), and you have prediabetes, then your risk of developing T2D more than doubles in comparison to individuals with normal thyroid function.

4. How then can you know for sure?

You should visit your doctor who may want to test your blood glucose levels if you’re overweight (have a body mass index—BMI—of over 25) and if you have one or more of the risk factors listed above.

If your fasting blood test indicates that you have prediabetes, your doctor may want to do an A1C blood test. On the other hand, your doctor may skip the fasting blood sugar test and go straight to the A1C blood test, which provides information about your average blood sugar levels over a 3 month period. These results are stated as a percentage:

• Normal = below 5.7%
• Prediabetes = between 5.7% and 6.4%
• Diabetes = 6.5% or higher.

It is advisable to start testing your blood glucose levels every three years beginning when you’re 45, even if you are not overweight and do not have any of the risk factors. That will ensure you catch any anomaly at an early stage as the risk of developing prediabetes (and therefore type 2 diabetes) increases with age.

5. What then if you have prediabetes?

Serious lifestyle changes are effective in preventing type 2 diabetes after you’ve been diagnosed with pre-diabetes. Your doctor will give you advice on what you need to do, but here are some additional things you can do on your own…….

• Assess Your Food Choices:  Get a healthy food plan is to assure that you are controlling your blood glucose level by keeping it in a healthy, normal range. A registered dietitian (RD) or certified diabetes educator (CDE) can assist you in creating a meal plan. It should reflect your preferred foods and be contain foods that are good-for-your-blood-glucose-level. Your meal plan should be adjusted to be comfortable and satisfying to you, taking into account your overall health, physical activity, and what you like to eat.
• Exercise regularly:  During exercise, your body burns up more glucose, thus lowering your blood glucose level. Also when you exercise, your body doesn’t need as much insulin to transport the glucose; your body becomes less insulin resistant. Since your body isn’t using insulin well when you have prediabetes, lower insulin resistance is a very good thing.
  It is recommended that you do at least 150 minutes of moderate activity a week—that’s 30 minutes five days a week. You can get that through activities such as walking, bike riding, or swimming.
• Lose weight. If you are overweight, losing just 7 percent of your starting weight can help delay or prevent diabetes. That means if you weigh 200 pounds, losing 14 pounds can make a difference. Weight loss also helps lower your blood pressure and cholesterol levels.

• Metformin: Medication might be recommended for people who are at very high risk of developing type 2 diabetes after being diagnosed with prediabetes. According to the American Diabetes Association, metformin should be the only medication used to prevent T2D. It works by keeping the liver from making more glucose when you don’t need it, thereby keeping your blood glucose level in a better range.

6. Some good news….…

If you have prediabetes, you should know you are definitely not alone. In 2015, it was estimated that 84.1 million Americans age 18 and older suffered from this condition. That is a whopping 1 in 3 Americans!

Being prediabetic doesn’t mean you will certainly develop diabetes. It is, however, a warning of what could lie ahead. People with prediabetes have a higher risk of type 2 diabetes as opposed to someone with normal blood sugar levels.

Those chances increase if you don’t make any healthy changes to your diet or activity habits.

It is not all bleak though…. “It can be reversed and you can stop the progression to diabetes. You can take control of your health by making the right choices and actively monitoring your blood sugar to ensure you do not slip into a prediabetic state or develop into a full diabetic.

References:

1. Healthline (2018): Understanding Borderline Diabetes: Signs, Symptoms, and More. Retrieved from https://www.healthline.com/health/diabetes/borderline-diabetes-know-the-signs

2. Endocrineweb (2008): Prediabetes- How to prevent prediabetes from becoming type 2 diabetes. Retrieved from https://www.endocrineweb.com/conditions/pre-diabetes/pre-diabetes
3. WebMD: Prediabetes (Borderline Diabetes). Retrieved from https://www.webmd.com/diabetes/type-2-diabetes-guide/what-is-prediabetes#1
4. org(2019): Prediabetes. Retrieved from https://familydoctor.org/condition/prediabetes/