It seems grossly unfair, during a month where love comes in the form of chocolate, caramel and candy-shaped hearts, to talk about diabetes. But unlike diseases that strike as a result of bad luck, bad genes or environmental factors not of our own making, the most common form of diabetes is largely a result of our bad habits. Physicians and natural medicine practitioners alike point to a healthy diet and regular exercise as the best preventive for type 2, or adult-onset diabetes.
But before we talk about all the things we’re doing wrong, it’s important to clarify that not all diabetes is preventable, and not all forms are the patient’s own doing.
The two most common forms of diabetes are types 1 and 2, with the prevalence of type 2 far outpacing type 1. Type 1 diabetes occurs when the body fails to produce insulin, the hormone that helps the body process sugars and carbohydrates. This is the more serious, but less-common form, usually diagnosed in adolescence. Type 1 diabetics are insulin-dependent, meaning they must self-administer daily insulin injections or wear an implantable insulin pump, monitor their blood-glucose level and keep a strict watch on their diet. Unmanaged type 1 diabetes can result in serious complications, including organ failure, blindness, amputation, coma and death. In what promises to spell huge relief for insulin-dependent diabetes, recently patented oral sprays and inhalants could soon replace shots or pumps.
More than 90 percent of people with diabetes have type 2, which typically strikes in the mid-40s, and occurs when the body doesn’t manufacture enough insulin, or the cells that break down glucose don’t recognize the insulin required to process sugars. Type 2 sufferers experience symptoms such as excessive thirst, appetite and urination as well as fatigue, reduced mental clarity and sometimes even blurry vision. Advanced, untreated type 2 diabetes can increase the likelihood of heart and kidney disease, stroke, nerve damage and various other complications.
Though insulin and oral medication are sometimes required to manage type 2, most physicians will initiate treatment by making changes to the patient’s diet and exercise program. However, Dr. David Perlmutter, neurologist, nutritionist and medical director of the Perlmutter Health Center in Naples, says that for patients with advanced type 2, immediate drug therapy is necessary. "If a patient comes in with an [extremely elevated] blood-sugar level at 220, we can’t wait around for weight loss," he says.
The American Diabetes Association estimates that there are about 21 million Americans with diabetes, but fewer than 15 million have been diagnosed. Another 54 million have pre-diabetes, or elevated blood sugar levels that haven’t gotten high enough to sound any warning bells for type 2. Unless you regularly exercise and are not overweight, you’re a candidate for pre-diabetes or type 2 diabetes. The American Diabetes Association’s Web site offers a simple but unnerving quiz. At 41 years old, 20 pounds overweight and engaging in only minor physical activity, I am at high risk for type 2 diabetes. And that’s without a family history of the disease. If I reduce my weight by just 10 pounds, I reduce my risk by half. If I add regular exercise into the mix, my risk goes down to zero.
Though the risk test is a very basic screening tool, it points to the galling truth that type 2 diabetes is a preventable disease, caused by our own inactivity and diets heavy in processed sugars and flours. "Obesity is the main risk factor for developing the disease," says Dr. Charles Kilo, director of the diabetes education program at Anchor Health Centers in Naples. So, lose weight, and the diabetes will go away, right? Guess again. Though the symptoms can be controlled with diet and exercise, "the metabolic defect that develops as a result of poor diet and obesity never disappears," says Kilo. "If the patient gains back that 30 pounds, his symptoms will return."
Several different studies point to the alarming growth rate in the prevalence of type 2 diabetes. Between 1997 and 2002, there was a 47 percent increase in the number of people in the U.S. diagnosed with type 2. Although Kilo says that the increase in diagnoses is partly due to greater awareness of the disease, the real culprit is obesity. A 2001 study predicts that one in three U.S. babies born in the year 2000 will develop type 2 diabetes in his or her lifetime.
"Diabetes is almost an illness created by the food industry," says Vicki Chelf, Sarasota cookbook author, radio host and nutritionist. "We wouldn’t see this kind of diet if humans ate the kind of [foods] they were meant to eat." Too much refined sugar, in packaged cookies, cake mixes, candy and drinks and too many "bad carbs," in the forms of white flour, white rice and pasta, overload our systems with sugar faster than we can produce the insulin to break it down.
Chelf is quick to distinguish between good and bad carbohydrates. "It’s the refined carbs that are bad," she says. "But the fiber in whole grains helps to regulate blood sugar and slow down the digestion of carbohydrates. Slow digestion is the key to keeping blood sugar more stable."
This health writer admits to taking a lot of health and wellness advice with a grain of salt. But learning that I could neglect my body to the point that I develop a preventable, irreversible disease is certainly a wake-up call. And all but a minority of us—the 36 percent of the population not overweight—are at risk. As Kilo points out, "it’s best to be aware of the proactive steps we can take, and how our actions now can affect us—for better or worse—in the long run."