pElAgUS' 

Diabetes is not reversible. And controlling your blood sugar with drugs or insulin will protect you from organ damage and death.

That is what the medical profession would have you believe.

But medication and insulin can actually increase your risk getting a heart attack or dying.

What you are not hearing about is another way to deal with this epidemic.

Today, I want to review in detail a new way to think about diabetes and next week I want to tell you exactly how to prevent, treat, and reverse it.

Let’s get started.

The diabetes epidemic is accelerating along with the obesity epidemic.

Type 2 diabetes, or what was once called adult onset diabetes, is an increasing worldwide epidemic affecting nearly 100 million people -- and over 20 million Americans.

We are seeing increasing rates of Type 2 diabetes, especially in children, which has increased over 1,000 percent in the last decade and was unknown before this generation. One in three children born today will have diabetes in their lifetime.

Yet this is an entirely preventable lifestyle disease.

In a report in “The New England Journal of Medicine,” Walter Willett, MD, PhD, and his colleagues from the Harvard School of Public Health demonstrated that 91 percent of all Type 2 diabetes cases could be prevented through improvements lifestyle and diet.

==> The Road to Diabetes Starts Early

Diabetes is often undiagnosed until its later stages. Insulin resistance, when the body becomes resistant to the effects of insulin, is primarily what causes diabetes.

When your diet is full of empty calories, an abundance of quickly absorbed sugars and carbohydrates (bread, pasta, rice, potatoes, etc.), the body slowly becomes resistant to the effects of insulin and needs more to do the same job of keeping your blood sugar even.

High insulin levels are the first sign of a problem. The high insulin leads to an appetite that is out of control, and increasing weight gain around the belly.

High levels of insulin are warning signs -- they precede Type 2 diabetes by decades.

Insulin resistance and the metabolic syndrome associated with it is often accompanied by increasing central obesity, fatigue after meals, sugar cravings, high triglycerides, low HDL, high blood pressure, problems with blood clotting, as well as increased inflammation.

These clues can often be picked up decades before anyone ever gets diabetes -- and may help you prevent diabetes entirely.

If you have a family history of obesity (especially around the belly), diabetes, early heart disease, or even dementia you are even more prone to this problem.

Most people know about the common complications of diabetes such as heart attacks, strokes, amputations, blindness, kidney failure, and nerve damage. Some may even know that it increases your risk of dementia and cancers and can cause impotence.

But most people don’t realize that insulin resistance or pre-diabetes can be just as bad causing heart attacks, strokes, dementia, cancer, and impotence -- decades before you get diabetes.

In fact many people with pre-diabetes never get diabetes, but they are at severe risk just the same.

==> Living in Harmony with Our Genes

We were highly adapted to a nutrient-dense, low-sugar, high-fiber diet rich in omega 3 fats. But when we eat out of harmony with our genes, we turn on genes that promote diabetes.

Take Arizona’s Pima Indians, for example.

They were thin and fit 100 years ago, living on a diet of over 70 percent carbohydrates. They ate high-fiber, unprocessed plant foods and they had no diabetes or obesity.

Now, in just one generation, they are nearly all obese and 80 percent have diabetes by the time they are 30 years old!

That’s because they are eating food that turns on all the wrong gene messages -- foods like sugar, trans fats, white flour, and processed foods.

==> Diabetes is Reversible: Diagnose Problems as Early as Possible

Diabetes and pre-diabetes ARE reversible.

New science shows that it’s possible, through an aggressive approach of lifestyle, nutritional support, and occasionally medications.

It is important to diagnose Type 2 diabetes early, but it is often not diagnosed until very late.

In fact, all doctors should aggressively diagnose pre-diabetes decades before diabetes occurs, and before any damage is done to your body. Damage begins with even slight changes in insulin and blood sugar.

Unfortunately, there is a continuum of risk from slightly abnormal insulin and blood sugar to full blown diabetes. This should be addressed as early as possible on the continuum.

In a recent study, anyone with a fasting blood sugar of over 87 was at increased risk of diabetes. The lowest risk group had a blood sugar less than 81.

Most doctors are not concerned until the blood sugar is over 110 -- or worse, over 126, which is diabetes. Therefore, I recommend early testing with anyone who has a family history of Type 2 diabetes, central abdominal weight gain or abnormal cholesterol.

Don’t wait until your sugar is high.

==> Testing for Insulin Resistance and Diabetes

The tests I recommend include the following:

1. Insulin glucose challenge test with 2-hour glucose challenge, 75 grams measuring fasting, 1 and 2 hour blood sugar AND insulin. Your blood sugar should be less than 80 fasting and never rise above 110 or 120 after one to two hours. Your insulin should be less than 5 fasting and should never rise above 30 after one to two hours. I recommend this test for everyone over 50, and for anyone with any risk of insulin resistance, even children.
2. The hemoglobin A1C is an important measure of glycated hemoglobin, which can be an early indicator of sugar problems. It measures sugars and proteins combining into glycated proteins called AGEs (advanced glycation end products), like the crust on bread, or the crispy top on crème brule. These create inflammation, oxidative stress throughout the body, and promote heart disease and dementia and accelerating aging. The hemoglobin A1C should ideally be less than 5.5. Anything over 6 is considered diabetes.
3. Lipid profiles are important. An HDL or good cholesterol level under 60 and triglycerides over 100 should make you suspicious of insulin resistance. An HDL under 40 and a triglyceride level over 150 usually means diabetes.
4. An NMR lipid profile identifies the size of your cholesterol particles. With insulin resistance or Type 2 diabetes, you develop small LDL and HDL cholesterol particles. They are much more dangerous than larger particles and lead to increased risk of atherosclerosis or heart disease.
5. High sensitivity C-reactive protein is a measure of inflammation, one of the classic conditions that is both the cause and result of insulin resistance and diabetes. It should be less than 1, and is often associated with diabetes. In fact, anyone with a high C-reactive protein has a 1,700 percent increased risk of getting diabetes.
6. Homocysteine is often abnormal in people with diabetes. It is a measure of folic acid deficiency. It should be between 6 and 8.
7. Fibrinogen measures your risk of clotting, which can cause heart attacks and strokes. It is also a sign of inflammation and is associated with insulin resistance and diabetes. It should be less than 300.
8. Ferritin levels are often elevated. It is a nonspecific marker of inflammation associated with diabetes. It also can mean an overload of iron in the body. It should be less than 150.
9. Uric acid should be less than 6. Higher levels indicate problems with insulin resistance. This can lead to gout, which is related to insulin resistance and Type 2 diabetes.
10. Elevated liver function tests result from insulin resistance. This is the major cause of fatty liver and elevated liver function tests in this country. This is entirely due to sugar and carbohydrates in our diet that cause fatty liver, liver damage, and even cirrhosis.

These are tests any doctor can perform and are covered by insurance. I have included the interpretation with my written blog so you can know exactly where you should be.

That’s all for today.

In next week’s blog, I will tell you how to prevent, treat, and even reverse diabetes. I have seen this hundreds of times in my patients and there is no reason you can’t achieve the same thing if you apply these principles.

Till then, remember what Michael Pollan said: “Eat food. Not too much. Mostly plants.”

Now I’d like to hear from you…

Have you been diagnosed with pre-diabetes or diabetes?

Have you been told that it is irreversible?

What steps have you taken to prevent diabetes?

Please let me know your thoughts by leaving a comment below.

To your good health,

Mark Hyman, M.D.

References

1. Olshansky SJ, Passaro DJ, Hershow RC, et al.A potential decline in life expectancy in the United States in the 21st century. N Engl J Med. 2005;352(11):1138-1145.
2. International Diabetes Federation. Diabetes prevention. Available at: http://www.idf.org/home/index.cfm?node=264. Accessed July 20, 2006.
3. Beckman JA, Creager MA, Libby P. Diabetes and atherosclerosis: epidemiology, pathophysiology, and management. JAMA. 2002;287(19):2570-2581. Review.
4. Wald NJ, Law MR. A strategy to reduce cardiovascular disease by more than 80%. BMJ. 2003;326(7404):1419.
5. Franco OH, Bonneux L, de Laet C, Peeters A, Steyerberg EW, Mackenbach JP.The Polymeal: a more natural, safer, and probably tastier (than the Polypill) strategy to reduce cardiovascular disease by more than 75%. BMJ. 2004;329(7480):1447-1450. Review.
6. Textbook of Functional Medicine, Gig Harbor, Wash: Institute for Functional Medicine; 2006. Chapter 7, page 60-61.
7. Reaven GM.The metabolic syndrome: is this diagnosis necessary? Am J Clin Nutr. 2006;83(6):1237-1247.
8. Grundy SM. Does a diagnosis of metabolic syndrome have value in clinical practice? Am J Clin Nutr. 2006;83(6):1248-1251.
9. Montonen J, Knekt P, Jarvinen R, Aromaa A, Reunanen A. Whole-grain and fiber intake and the incidence of type 2 diabetes. Am J Clin Nutr. 2003;77(3):622-629.
10. Garg A. High-monounsaturated-fat diets for patients with diabetes mellitus: a meta-analysis. Am J Clin Nutr. 1998;67(3):577S-582S.
11. Hu FB, Manson JE, Stampfer MJ, et al. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med. 2001;(11):790-797.
12. Pollan M. The Omnivore’s Dilemma. New York: Penguin Press; 2006.
13. Phillips C, Lopez-Miranda J, Perez-Jimenez F, McManus R, Roche HM. Genetic and nutrient determinants of the metabolic syndrome. Curr Opin Cardiol. 2006;21(3):185-193.
14. Jenkins DJ, Kendall CW, Marchie A, et al. Type 2 diabetes and the vegetarian diet. Am J Clin Nutr. 2003;78(3):610S-616S. Review.
15. Salmeron J, Hu FB, Manson JE, et al. Dietary fat intake and risk of type 2 diabetes in women. Am J Clin Nutr. 2001;73(6):1019-1026.
16. Gross LS, Li L, Ford ES, Liu S. Increased consumption of refined carbohydrates and the epidemic of type 2 diabetes in the United States: an ecologic assessment. Am J Clin Nutr. 2004;79(5):774-779.
17. Gannon MC, Nuttall FQ, Saeed A, Jordan K, Hoover H. An increase in dietary protein improves the blood glucose response in persons with type 2 diabetes. Am J Clin Nutr. 2003;78(4):734-741.
18. de Mello VD, Zelmanovitz T, Perassolo MS, Azevedo MJ, Gross JL. Withdrawal of red meat from the usual diet reduces albuminuria and improves serum fatty acid profile in type 2 diabetes patients with macroalbuminuria. Am J Clin Nutr. 2006;83(5):1032-1038.
19. Chandalia M, Garg A, Lutjohann D, von Bergmann K, Grundy SM, Brinkley LJ. Beneficial effects of high dietary fiber intake in patients with type 2 diabetes mellitus. N Engl J Med. 2000;342(19):1392-1398.
20. Triggiani V, Resta F, Guastamacchia E, et al. Role of antioxidants, essential fatty acids, carnitine, vitamins, phytochemicals and trace elements in the treatment of diabetes mellitus and its chronic complications. Endocr Metab Immune Disord Drug Targets. 2006;6(1):77-93. Review.
21. Henriksen EJ. Exercise training and the antioxidant alpha-lipoic acid in the treatment of insulin resistance and type 2 diabetes. Free Radic Biol Med. 2006;40(1):3-12. Review.
22. Coyne T, Ibiebele TI, Baade PD, et al. Diabetes mellitus and serum carotenoids: findings of a population-based study in Queensland, Australia. Am J Clin Nutr. 2005;82(3):685-693.
23. Jiang R, Manson JE, Stampfer MJ, Liu S, Willett WC, Hu FB. Nut and peanut butter consumption and risk of type 2 diabetes in women. JAMA. 2002;288(20):2554-2560.
24. Bhathena SJ, Velasquez MT. Beneficial role of dietary phytoestrogens in obesity and diabetes. Am J Clin Nutr. 2002 Dec;76(6):1191-1201. Review.
25. Klein S, Sheard NF, Pi-Sunyer X, et al. Weight management through lifestyle modification for the prevention and management of type 2 diabetes: rationale and strategies. A statement of the American Diabetes Association, the North American Association for the Study of Obesity, and the American Society for Clinical Nutrition. Am J Clin Nutr. 2004;80(2):257-263. Review.
26. Rosmond R, Dallman MF, Bjorntorp P. Stress-related cortisol secretion in men: relationships with abdominal obesity and endocrine, metabolic and hemodynamic abnormalities. J Clin Endocrinol Metab. 1998;83(6):1853-1859.