Doctor’s Tip: It’s important to diagnose and reverse pre-diabetes
There are two types of diabetes. Type 1 is an autoimmune disease that usually strikes at a young age and is not associated with obesity. Type 2 is more common and is usually related to “central obesity” (extra weight around the mid-section). Today’s discussion is about type 2 diabetes.
None of us wants to get diabetes, because it leads to the following complications:
• cardiovascular disease (heart attacks and strokes), the most common cause of death in the U.S.
• kidney damage, which can result in kidney failure.
• eye damage, which can result in blindness.
• nerve damage, which can result in chronic numbness and pain in the legs and feet.
Sadly, due to American obesity epidemic, type 2 diabetes is becoming more prevalent in adults and is even occurring in overweight children. And as we export the S.A.D. (standard American diet), type 2 diabetes is becoming a worldwide epidemic.
Type 2 diabetes is preceded by pre-diabetes, which unfortunately often goes undiagnosed for years. Measure your waist at the point of largest circumference, which is usually at your belly button (note that this is not your belt size). If you are a man and your waist circumference is 40 inches or greater, or if you are a woman and the measurement is 35 inches or greater (the cutoff is lower if you are Asian or East Indian), you almost certainly have insulin resistance/pre-diabetes. Even if your waist circumference is less than the cutoff numbers, you probably have pre-diabetes if you look at your naked profile in the mirror and see even a small “belly.”
If you have even mild central obesity, then you have what’s called visceral fat, which is fat around your internal organs (and often in your organs as well as your muscles and other tissues). Humans are not meant to have visceral fat, which causes insulin resistance (IR), meaning that your tissues can’t use insulin like they should. Your pancreas tries to compensate by pumping out more insulin, and eventually it wears out and diabetes is diagnosed.
The problem with pre-diabetes is that it causes the same complications that diabetes does. If caught early, pre-diabetes can be reversed through lifestyle modification and/or medications. Pre-diabetes is often not caught early because providers rely on the fasting blood sugar or A1C (a test that measures the blood sugar trend over the previous 3 months). A person can have pre-diabetes for years before the fasting blood sugar becomes alarming, and the A1C is a poor test for diagnosing diabetes or pre-diabetes (its value is monitoring people who have diabetes).
In their book “Beat the Heart Attack Gene,” Bale and Doneen point out that IR is the driver of 70 percent of heart attacks. If IR is a possibility, you should have a 2 hour glucose tolerance test, which involves fasting for 12 hours, drinking a 75 gram sugar load in the lab, and having a blood sugar drawn 1 and 2 hours afterwards. If the 1 hour value is greater than 124 or the 2 hour greater than 119, IR is present and needs to be treated aggressively and hopefully reversed. Another marker for IR is high triglycerides (150 or greater), especially if associated with low HDL ( “good cholesterol,” which should be greater than 40 in males and post-menopausal females; greater than 50 in pre-menopausal females).
Request a two-hour glucose tolerance test if you have any of the following conditions: central obesity (even mild); family history of diabetes or heart disease; heart disease yourself, especially history of a heart attack or stroke; even mild elevation of fasting glucose (normal is in the 70s or 80s or the very low 90s); high triglycerides and/or low HDL; hypertension; sleep apnea; or fatty liver disease (often manifested by mild-to-moderate elevation of liver tests on a chemistry panel).
The S.A.D. — which is high in animal products, oils, refined food and sugar — promotes obesity, pre-diabetes and type 2 diabetes. The best way to prevent and reverse these conditions is regular exercise and a plant-based, whole food (unprocessed) diet without sugar or added oil. If you’re not willing to make these changes, medications are available, but can have side effects and are much less effective.
Dr. Feinsinger, who retired from Glenwood Medical Associates after 42 years as a family physician, has a nonprofit Center For Prevention and Treatment of Disease Through Nutrition. He is available for free consultations about heart attack prevention and any other medical concerns. Call 970-379-5718 for an appointment. For questions about his columns, email him at firstname.lastname@example.org.
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