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Preventing Diabetes

March 2009

Preventing Diabetes

Q: I have been following the Miami Mediterranean diet to reduce my risk of heart disease. I read somewhere that this diet may be helpful for those with high blood sugar and diabetes. Can you tell me more about this?

A: I’m glad to hear that you’re following the healthy Miami Mediterranean diet. In my practice, I’ve found that patients who adopt the diet, along with lifestyle changes such as exercise and stress reduction, are healthier and happier. Studies have long proven that a Mediterranean-type diet reduces the risk of cardiovascular disease, and it also has been linked to protection against some cancers. But now there’s more good news: a new study published in the British Medical Journal shows that eating a traditional Mediterranean diet regularly may reduce the risk of developing type 2 diabetes by as much as 83%!1

The results of this study are astonishing. Previous research has shown the benefits of a Mediterranean-type diet for reducing insulin resistance. But earlier studies were not as large as this new one which, for four-and-a-half years, followed 13,380 Spanish university graduates who had no history of diabetes. At the study’s conclusion, it was found that the participants who most strictly adhered to the diet had a lower risk of developing type 2 diabetes. And from that large population, only 33 cases of type 2 diabetes were documented.

How well one adheres to a Mediterranean-type diet appears to be the real key to successfully lowering the risk of developing type 2 diabetes, and even preventing it. In addition to closely monitoring the types of foods that study participants ate, researchers rated each person on how well they adhered to the diet. Those with the highest adherence to the diet reduced their risk of developing type 2 diabetes by 83% over those with the lowest adherence. And, according to the scale of 1 to 10 used to measure adherence, researchers found that a mere two-point increase on the adherence scale correlated to a 35% reduction in diabetes risk.

Here’s an interesting fact: Among those with better adherence to the diet were people with the greatest number of risk factors for developing type 2 diabetes. These were people who were expected to have a higher incidence of the disease, yet they, too, showed lower risk. This suggests that a Mediterranean-type diet has substantial potential for type 2 diabetes prevention.

The study’s findings are truly good news because diabetes is a major problem in the United States and worldwide. Type 2 diabetes has significantly increased in industrialized countries due to the toxic Western diet and lifestyle and the population’s expanding girth. According to the American Diabetes Association, nearly 24 million adults and children in the US have diabetes. The disease contributed to approximately 224,000 deaths in 2002—and that number could be low, as studies have shown that diabetes is generally under-reported on death certificates.2 Regularly consuming a Mediterranean-type diet can be a big step toward bringing this epidemic under control.

Diabetes is also a major drain on the health care system in both dollars and resources. The costs of treating the disease itself and what it leads to—heart attacks, strokes, hospitalization—are staggering and can financially cripple or bankrupt families. We have a health care crisis in America and the diabetes epidemic is definitely a major contributor to it.

I’m sure you’re wondering how the Mediterranean diet helps prevent and control diabetes. I’ll explain, but first I’ll discuss what diabetes is, what causes it, and why reducing the risk of developing the disease is so important.

Understanding Diabetes

Diabetes is a chronic, progressive disease in which insulin—a hormone that converts sugar, starches, and other foods into energy—is not properly produced or utilized in the body. Medically, it is defined as fasting blood sugar in excess of 125 mg/dL. There are several types of diabetes. Type 1, in which the body fails to produce insulin, is found mainly in childhood. The causes are theorized to be autoimmune or viral. Type 2 diabetes is the most common and is largely the result of lifestyle choices, primarily obesity, lack of exercise, and the consumption of unhealthy foods. It used to be called adult-onset diabetes, but now it is called type 2 diabetes, because unfortunately, adolescents are also getting the disease in increasing numbers. The third type is known as gestational diabetes, which women sometimes develop during pregnancy. Usually this type goes away after pregnancy; however, roughly 50% of women with gestational diabetes will develop type 2 diabetes within five years of giving birth.

Understanding Diabetes

I’ll focus my discussion on type 2 diabetes, since it is the subject of this new study. What is the mechanism of type 2 diabetes? Digestion converts sugars in food into glucose, a form of sugar that is the body’s primary fuel. Insulin, which is a hormone produced and released by the beta cells of the pancreas, enables glucose to pass from the bloodstream into the body’s cells to be used for the body’s energy requirements. Unused glucose is stored in liver and muscle cells as glycogen. As glucose levels in the body decrease, glycogen converts back to glucose to be used as fuel when necessary. However, if insulin resistance develops, normal amounts of insulin no longer produce a normal insulin response. Glucose won’t be absorbed as well by the cells that need it, and it won’t be stored properly in the liver and muscles. The level of glucose in the blood remains high. The pancreas responds by trying to produce more insulin, but this can eventually overtax the beta cells, which can’t keep up with the process of producing more insulin to handle the excess glucose. The beta cells themselves can become dysfunctional, producing less insulin (insulin deficiency) while blood glucose levels continue to rise. This can eventually lead to beta cell apoptosis, or programmed cell death.

Studies have shown that obesity and the highly processed American diet leads to a state of chronic low-grade inflammation. Inflammatory proteins interfere with insulin receptors, leading to insulin resistance. Obesity or lifestyle choices that increase inflammation in the body help create the conditions that favor the development of type 2 diabetes.

Diabetes can cause serious, long-term complications such as kidney disease, neuropathy, and blindness. It also significantly increases the risk of death from cardiovascular disease, heart attack, and stroke. A major study published in 1998, the Finnish East West Trial, showed that if you have type 2 diabetes, you actually have the same risk of heart attack as someone who has already had a heart attack.3 That’s why diabetes is considered a coronary heart disease risk equivalent. Even worse, the risk of cardiovascular disease can even be raised by a pre-diabetes condition associated with insulin resistance called impaired fasting glucose.4 This is signaled by a blood sugar measurement greater than 100 mg/dL— generally 100-125 mg/dL—and it is a warning sign of the impending development of diabetes.

Treatment for type 2 diabetes typically involves medication to lower blood sugar. There are many drugs available, including insulin and drugs that are costly and have side effects. One particular antidiabetic drug called rosiglitazone (Avandia®) has been in the news recently for increasing the risk of heart attack.5 Considering the complications and dangers of diabetes and the risks of some of the drug treatments, it truly is great news to learn that you can lower your risk of developing the disease by 83% in a completely natural way, without taking medication.1 I want to stress, however, that I’m not saying medications should not be used, as there are situations where medication is appropriate. But medication shouldn’t be used as a substitute for lifestyle changes. People can be their own worst enemy and want to use medication just so they can abuse lifestyle. They often reason that if they take insulin or pills, it’s a license to continue eating the wrong foods or to overeat. This is never the way to treat type 2 diabetes. The best use of medication is to take it in addition to making the proper lifestyle changes. The hope is that lifestyle changes will improve the condition enough so that one is no longer labeled as diabetic, so that it is possible to stop taking the medication.

“A new study published in the British Medical Journal shows that eating a traditional Mediterranean diet regularly may reduce the risk of developing type 2 diabetes by as much as 83%!”