Diabetes Type 2: Facts & Lifestyle-based Treatments and Prevention

*Photo credit www.reviewsmemos.com

The following information is about type 2 diabetes and describes how prevalent the problems is, who should get screened for the disease, and what you can do to prevent or treat it. 

The healthy lifestyle changes described here are healthy for everyone, not just those with or at risk of diabetes.

The great thing about healthy lifestyle changes is that they’re in your hands—no prescription needed! (Though, if you are diagnosed with diabetes and told to take a medication by your doctor, you should.)

Lifestyle changes can help those with diabetes cut down their need for many medications and are always a good idea unless you’ve been specifically told by a doctor not to make them.

I have also included a link to a patient handout that I created with the same information written below in case you’d like to print it out for you or someone you know. Any healthcare professionals reading this are welcome to print the handout and give to their patients free of charge and without asking permission. (If you do use it, please do send a message if you find it helpful!)

TYPE 2 DIABETES: Facts & Lifestyle-based Treatments

What IS diabetes: Diabetes refers to a group of diseases that cause your body to mishandle your blood sugar, resulting in high blood sugar. If left untreated, or not properly treated, high blood sugars can damage nearly all of the organs in your body.

Facts about Type 2 Diabetes:

• Approximately 1 out of every 10 people in the US have diabetes,¹ but
• More than 1 in 4 people with diabetes (8 million people in the US) don’t know that they have the disease.²
• Diabetes is the 7^th leading cause of death in the US.²

The good news is that diabetes is treatable with a combination of lifestyle changes and other treatments prescribed by your doctor.

For some people diagnosed with diabetes early on, the disease can even be reversed with the lifestyle changes described below!

Who is at risk and should be screened for Type 2 Diabetes?3

• 45 years old and older
• Overweight or obese (Body Mass Index of 25 or greater)
• Anyone with a first-degree relative who has diabetes
• Those who do not exercise regularly
• Women with a history of diabetes during pregnancy, who have delivered a baby weighing more than 9 pounds, or who have polycystic ovarian syndrome
• High blood pressure
• High cholesterol
• Vascular or heart disease
• Anyone with a history of elevated blood sugar or pre-diabetes
• If you have excessive thirst, frequent urination, blurry vision, extreme hunger or unexplained weight loss. 

How do I get screened?

For most people, all that is required is a simple blood test—you don’t even have to be fasting.

Other conditions that people with Type 2 Diabetes are at risk of:

Depression
Heart disease

Stroke

Vascular disease

Kidney disease

Overweight
Obesity

High blood pressure

High cholesterol

Nerve disease (neuropathy)

Eye disease

Bone disease
Sleep apnea

Hearing trouble

Fatty liver disease

Gum disease

Memory problems

Cancer 

Reversing Type 2 Diabetes & Preventing Complications with Lifestyle Changes

The lifestyle changes recommended to treat diabetes and prevent complications are the same healthy lifestyle recommendations for everyone. Enlist those you care about to make healthy lifestyle changes with you—everyone wins!

1. Eat a Healthy Diet

• Follow the Harvard School of Public Health’s Healthy Eating Plate recommendations http://www.hsph.harvard.edu/nutritionsource/healthy-eating-plate/ :

o   Make ½ of your plate vegetables and fruits (white potatoes don’t count)

o   Make ¼ of your plate whole grains

o   Make ¼ of your plate healthy proteins including beans, fish, nuts, or poultry.

o   Use healthy oils (those liquid at room temperature) and avoid trans fat found in partially hydrogenated oils

o   Drink water, coffee, or tea; skip sugary drinks; limit dairy to 1-2 servings per day.

2. Maintain a Healthy Weight

• This means that a tape measure around your waist, at the top of your hip bones, across your belly button measures less than 40 inches for men, or 35 inches for women.
• Alternatively, you can measure your height and weight, then input that information into this online body mass index calculator http://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm . A healthy body mass index is 18.5-24.9.

3. Engage in Regular Physical Activity

• Minimum exercise recommendations are as follows, but you get more benefit by doing even more! 

o   150 minutes of moderate-intensity activity (e.g. brisk walking) per week —OR— 75 min. vigorous-intensity aerobic activity (e.g. running) per week

                                                   —PLUS—

o   Strength training of all major muscle groups 2+ days per week

•      Go to http://www.cdc.gov/physicalactivity/basics/adults/ for more details.

4. Don’t smoke

• If you smoke or use tobacco ask your doctor, go to www.smokefree.gov, or call 1-800-QUIT-NOW for help quitting. 

5. Moderate your alcohol intake

• If you don’t drink, don’t start.
• If you do drink, women should drink no more than 1, and men should drink no more than 2, standard-sized drinks per day (one 12 oz. can of beer, 5 oz. glass of wine, or 1.5 oz. “shot” of spirits).

1.  C Li, et al. Surveillance of certain health behaviors and conditions among states and selected local areas—Behavioral Risk Factor Surveillance System, United States, 2009. Centers for Disease Control. Surveill Summ. 2011 Aug;60(9):1-250.

 2. Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. Atlanta, GA: U.S. Department of Health and Human Services; 2014.

3. DK McCulloch, et al. Screening for type 2 diabetes mellitus. Up-to-Date, Literature review current through Sept 2015. http://www.uptodate.com/contents/screening-for-type-2-diabetes-mellitus?source=search_result&search=screening+for+diabetes&selectedTitle=1%7E150#H18058884

Chef Michelle Hauser, MD, MPA © 2015

Tips for Eating Healthy On the Go

"I don't have time to eat healthy."

"This week is really busy.  I'll have to try to eat better next week."

"Someday when I'm less busy, I'll eat better."

"That (healthy thing) takes too long to cook."

It's time to throw those excuses out the window! Check out the interview in this month's, Harvard Health Letter with Kathy McManus, Director of the Department of Nutrition at Brigham and Women's Hospital in Boston and me about our Tips for Eating Healthy On the Go.

Save time with a Smoothie

Photo credit: thelemonbowl.com

If you feel inspired by the "Try a Smoothie" section, here is one of my favorite smoothie recipes. It's a great meal replacement or workout recovery drink. In addition to the nutrition information shown below, this smoothie contains 5 times the recommended minimum intake of omega-3 fatty acids! This is due largely to the chia seeds, which are one of the richest sources of omega-3s.  Chia seeds have nearly 9 times the omega-3s by weight that salmon does!

Chia Seeds

Photo credit: dineoncampus.com

Michelle's Favorite Smoothie

1 cup unsweetened soymilk
1-1/2 Tablespoons chia seeds
1/2 banana
3 scoops (or 1-1/2 servings) protein powder (I use vanilla-flavored soy protein from Trader Joes or Whole Foods)
1 handful frozen mango or pineapple
1 handful frozen strawberries
1 handful frozen blueberries
1-2 Tablespoons of honey, agave, sugar or Splenda (sweeten to taste)
2 kale leaves (large ribs removed) or 2 large handfuls fresh spinach, optional
Water (about 1/2 cup)

1. Blend soy milk and chia seeds until chia seeds are pulverized and the mixture appears a white with a bunch of black specks.  This only takes a few seconds in a commercial blender, but takes 1-2 minutes in a common household blender.

2. Add remaining ingredients and blend until smooth.  Add enough water to blend and make the smoothie the thickness and consistency you want.  Sweeten to taste.  I use 1 Tablespoons sweetener, but many people like it a bit sweeter.

3. Pour and serve.  As long as you're OK eating this with a spoon, you can keep it for up to a day in the refrigerator. The chia seeds soak up a lot of the liquid if left to sit.

Yield: Two 12-16 ounce servings

Smoothie nutrition facts per serving

*If you use Splenda or other non-calorie sweetener, subtract 8g of carbohydrates and 32 calories per serving from the nutrition facts above (i.e. 28g carbs, still 9g fiber, and 269 calories per serving). 

Adding Extra Protein to the Diet

Earlier this week, I was interviewed by Heidi Godman of the Harvard Health Letter and the Harvard Health Blog about adding extra protein to the diet in a effort to lose weight.  This comes on the heels of a study published in the Journal of Nutrition Education and Behavior showing that middle-aged women commonly believe adding protein to the diet is a solid weight-loss choice. I would like to add a correction to one misquote - "unprocessed" and "unrefined" carbs should be replaced with "minimally processed."  Grains (aka. carbs or carbohydrates) in their completely unprocessed form are often difficult to digest and laborious to deal with in the kitchen. Opting for minimally processed to improve both of these factors is a good way to go. The full post is below and can also be found at Harvard Health Blog:

Photo credit: lisamasson.photoshelter.com

Extra protein is a decent dietary choice, but don’t overdo it

POSTED MAY 01, 2013, 3:14 PM

Heidi Godman, Executive Editor, Harvard Health Letter

Diet-wise, I was good yesterday. I had a scrambled egg with salsa for breakfast; spinach salad with grilled chicken for lunch; a handful of almonds for a snack; a small piece of salmon, broccoli, and brown rice for dinner; and fruit for dessert.

I say “good” because I like to limit my carbohydrates to one meal a day—dinner, in this case. It makes me feel better than having carbs throughout the day. I’m not following any particular diet, but just trying to eat in what I think is a healthy way. That means having more protein-based meals than carb-based meals. It turns out I’m not alone.

The International Food Information Council Foundation reports that 50% of consumers are interested in including more protein in their diets and 37% believe protein helps with weight loss. A study in the May/June 2013 issue of the Journal of Nutrition Education and Behavior found that 43% of women surveyed are using the practice of eating more protein to prevent weight gain, and this strategy was associated with weight loss.

But just because people are doing something doesn’t make it healthy. I asked Dr. Michelle Hauser, a clinical fellow in medicine at Harvard Medical School and a certified chef and nutrition educator, if it’s a good idea to eat extra protein and cut back on carbs.

“If you’re eating more protein but you have a good mix of fresh fruits, vegetables and whole grains to make up the rest of it, that’s fine,” Dr. Hauser told me. One of the advantages of eating more protein-rich foods is that people who do it also tend to eliminate overly processed carbohydrates, such as white breads and prepackaged foods like cookies and crackers. Such foods are rapidly digested and turned into blood sugar, and tend to be low in healthful nutrients.

But it isn’t necessary to eliminate all carbohydrates and focus only on protein. Such an eating strategy may have a short-term payoff for weight loss, but it may also come with some long-term risks.

Understanding protein

Protein is a critical part of our diet. We need it to build and repair cells, and make healthy muscles, organs, glands, and skin. Everyone needs a minimum amount each day. The Institute of Medicine recommends 0.8 grams of protein per kilogram of body weight. For someone who weighs 150 pounds, that means 54 grams of protein per day. Another guideline is to make sure at least 15% of your daily calories come from protein.

How might more protein and fewer carbs in the diet make a difference for weight loss or weight control? “Protein takes more energy for you to digest than refined carbohydrates, and also gives your body a feeling of satiety,” says Dr. Hauser. Low-carb diets have been shown to help some people lose weight.

But over the long term, too much protein and too few carbohydrates may not be the healthiest plan. This kind of eating pattern has been linked to an increased risk of developing osteoporosis. That’s because digesting protein releases acids into the bloodstream. The body neutralizes these acids with calcium—which can be pulled from bone if necessary. Eating too much protein also makes the kidneys work harder. In healthy people, this usually doesn’t pose a problem. But those with kidney disease or diabetes (which is associated with kidney disease) need to watch their daily protein intake so they don’t overload their kidneys.

Depriving yourself of carbohydrates can also affect the brain and muscles, which need glucose (the fuel that comes from digesting carbs) to function efficiently. The fiber delivered by some carbohydrate-rich foods help bowels move. And remember that healthy sources of carbohydrates, such as fruits, vegetables, and whole grains, come with a host of vitamins, minerals, and other nutrients.

Making wise protein choices

It’s okay to cut back on carbs and eat more protein, but make sure you’re also getting some carbs in your daily diet. “If you take any healthy diet, 40% to 60% of calories should come from minimally processed carbs,” says Dr. Hauser. For someone on a 2,000 calorie-a-day diet, 40% would be 800 calories or 200 grams of carbs. (Note to self: increase servings of carbohydrates.)

But there are good carbs and bad carbs, as well as good proteins and bad proteins. Foods that deliver whole, unrefined carbs, like whole wheat, oats, quinoa, and the like, trump those made up of highly processed wheat or other grains. Lean meats, poultry, seafood, and plant sources of protein like beans and nuts are far more healthful than fatty meats and processed meats like sausage or deli meats.

The good-bad thing can be confusing, so Dr. Hauser suggests a few simple principles.

Pick the healthful trio. At each meal, include foods that deliver some fat, fiber, and protein. The fiber makes you feel full right away, the protein helps you stay full for longer, and the fat works with the hormones in your body to tell you to stop eating. Adding nuts to your diet is a good way to maintain weight because it has all three.

Avoid highly processed foods. The closer a food is to the way it started out, the longer it will take to digest, the gentler effect it will have on blood sugar, and the more nutrients it will contain.

Choose the most healthful sources of protein. Good protein-rich foods include fish, poultry, eggs, beans, legumes, nuts, tofu, and low-fat or non-fat dairy products.

Photo credit: mybodyhealth.net

These three strategies fit in with the Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets. The DASH diet includes 2 or fewer servings of protein per day, mostly poultry or fish. “The Mediterranean diet uses protein from fish as a centerpiece of a meal, and other meats as more of a component of a meal,” says Dr. Hauser.

I had to ask if it’s important to spread carbs throughout the day or if it’s okay to limit them to one meal, the way I do. “If it makes you feel better to eat carbs at one meal a day versus spreading them throughout the day, that’s fine. You can scatter the carbs as you see fit,” says Dr. Hauser.

So I learned that while I was “good” yesterday when it came to eating, I now know that I can be better.