The Diabetes EpidemicDecember 2000
By Angela Pirisi
Blaming the obesity epidemic
Researchers see a causal link between Type II diabetes and the obesity epidemic, and the latter's prevalence is growing at an equally alarming rate. According to the latest national statistics, over 50% of US adults are overweight (body mass index of 25 and up)3 and approximately one fifth of the population is considered obese (body mass index of 30 and up).4 Obesity trends have marked an increase from 12% in 1991 to 17.9% in 1998.5 The trouble with these growing numbers is that obesity is the strongest environmental risk factor for non-insulin-dependent diabetes mellitus. Obesity threatens with health risks of its own, including the predisposition to diabetes. A 1999 Centers for Disease Control and Prevention report suggests that overweight and inactivity were to blame for 300,000 premature deaths in the US, second only to tobacco-related deaths.6 Data collected from the Third National Health and Nutrition Examination Survey demonstrates that people under age 55 with a body mass index of at least 40 are most likely to have Type II diabetes and gall bladder disease, and that the prevalence ratios are higher among younger than older adults.7
So what's the connection between fat and blood-glucose levels? Excess weight increases the body's demand on insulin, putting pressure on pancreatic beta cells to produce more of the hormone, until basically the supply can’t meet the demand and the body becomes insensitive to insulin. Studies have also shown that obesity increases levels of free fatty acids in the body, which may impede the body’s insulin metabolic clearance. Obesity has also been related to hormonal abnormalities, namely elevated cortisol and estrogens and waning androgens, both of which act to regulate fat when operating at proper levels.
The most disheartening part about diabetes is that it isn’t a disease that one can merely blame on chance, or even genetics. By the same token, the fact that diabetes is preventable through a number of modifiable lifestyle lends hope to what otherwise could be depicted as the 21s century plague. Changes to eating and exercise habits, and modest weight loss (under 10 pounds) have all been shown to dramatically reduce the risk of diabetes. Finnish research results were recently presented at the American Diabetes’ Association’s 60th Annual Scientific Session in June 2000, which showed that intensive lifestyle modification reduced the incidence of Type II diabetes by 58% in people at high risk of developing the disease.
The Finnish Diabetes Prevention Study was conducted at five clinics, and tracked 523 adults over a five-year period (1993-1998), whose average age was 55, and on the verge of developing diabetes (measured by impaired glucose tolerance, which is an early warning sign of diabetes). The subjects were divided into two groups: 265 of them received frequent and consistent dietary advice, individual exercise assessment and program plan, and supervised exercise at least three times per week; the control group had a yearly meeting with a nutritionist and physician, and was encouraged to do more exercise of their own volition. Results showed that 22% of the control group developed diabetes after four years in the study, but only 10% of the intervention group got it. The latter also lost an average of 4.2 kilograms (9.24 pounds) within the first study year, while the controls lost only 0.8 kilograms (1.76 pounds).
Another study carried out by investigators at the University of Minnesota in Minneapolis found that postmenopausal women who exercise regularly (moderately to vigorously over four times per week) cut their risk of diabetes in half.8 The research involved a questionnaire mailed out to 41,000 women, ages 55-69, to assess their risk of diabetes relative to exercise habits over the next 12 years.
Likewise, research from Yale University illustrated that the benefits of exercise can never come too late. They showed how moderate-intensity aerobic exercise (e.g. walking) improves glucose tolerance in older, healthy adults, even without any weight or fat loss.9 Investigators put a group of 16 men and women over 60 on a four-month exercise program. Nine of them were instructed to exercise on a mini-trampoline for 60-minute periods four times per week. The remaining seven participants, who served as controls, were given a less intensive physical program comprising supervised stretching and yoga. Researchers took measurements, before and after the study, of abdominal fat, plasma glucose and fasting concentrations of free fatty acids, as well as administering an oral glucose tolerance test. The cardiovascular training caused a 24% drop in free fatty acid in the nine participants, irrespective of adipose fat measurements remaining unchanged. The control group, however, didn’t show any changes or benefits in terms of improved glucose tolerance. Biological age, coupled with increased body fat, and decreased physical activity, can lead gradually to increased glucose intolerance. Besides the training having a significant effect on free fatty acid levels, the researchers also found that the exercise effects weren’t short-lived, as there was still an evident improvement three days after the training period.
The answer seems almost too simple, and it’s the health message conveyed for dodging most chronic diseases: eat less, lose weight and exercise. But that has been a huge challenge for most people and much easier said than done, as any dieter will attest. Dieting is an equivocal act with a backlash effect, in that once you cease a controlled eating and exercising regimen, there is a looming risk of gaining all the weight back again, and then some. The catch about low-calorie diets is that they prompt your body to reserve more of its fat energy for fear of not getting enough through food consumption. It does so by slowing down the basal metabolic rate—which is the rate at which your body burns calories when at rest. A slowed basal metabolic rate is one of the main reasons why some strict dieters seem to plateau in their weight loss efforts and can’t shed any more pounds despite remaining on a fat-restricted diet. The aftermath of this change is that, once the diet is over, and normal calorie consumption resumes, the body continues to burn off energy at the newly established sluggish metabolic rate. And because, as physics would have it, every action has an equal and opposite reaction, now that it’s burning off fewer calories, it means that pounds are regained at a higher rate.
In the following article, we present some natural ways to help prevent and treat adult-onset (Type II) diabetes.
- Diabetes Care 23:1278-1283.
- Newsweek 2000;9: 40-47.
- Int J Obesity 1998;22:39-47.
- JAMA 1999;282:1519-1522.
- JAMA 1999;282:1519-1522.
- JAMA 1999;282:1530-1538.
- JAMA 1999;282:1523-1529.
- Amer J Pub Hlth 2000;90:134-138.
- J Am Geriatr Soc 1998 Jul;46(7):875-879.