Give me sugar…
Diabetes
An epidemic
How many people have diabetes and what is it’s impact?
If your doctor tells you that your sugar level is high, that should scare the pants off of you! Diabetes will be the epidemic of the 21st century. At current rates, 1 in 3 Americans will have diabetes by 2050. In 2015, 30.3 million Americans were diagnosed with diabetes. And get this–around 85 million more are at risk to get it. So if the US population was 321 million in 2015, every 1 in 3 people have or are at risk for diabetes. In 2015, diabetes was the 7th leading cause of death. Of those who have diabetes, 1 in 4 don’t even know they have it. Lastly, the cost to society in lost work and health care is about $245 billion a year.
I get that diabetes is everywhere but what is it? There’s a few types right?
There are several types but two are common. Basically, when you eat sugar (carbohydrates) it enters your bloodstream. Sugars are an efficient form of energy for your body and insulin is used to get the sugar into your cells. Type I diabetes is when you don’t make insulin and sugar builds up in your bloodstream. Type II diabetes is when you make insulin but the insulin becomes less and less effective at getting the sugar into your cells. Both lead to high blood sugar levels which wreaks havoc with a capital “H” on your body.
If 100 diabetics ate the “mediterranean diet” with an emphasis on nuts and olive oil, 1 heart attack or stroke could be stopped every few years.
Lifestyle and heart attack prevention
But I like donuts and cookies and don’t want to change. Why should I worry about getting diabetes?
Higher blood sugar than normal in the body is very damaging. It can lead to strokes, dementia, vision problems, infections of the mouth, heart attacks, kidney loss, blockages in the blood vessels, and damage to the nerves causing numbness and tingling in the arms and feet. Once you get diabetes, it’s not a matter of if these things happen…just when.
Does diabetes cause heart attacks?
What is the risk of diabetes and a heart attack? Frankly, if you have diabetes, your risk is similar to someone who has already had one. Heart disease is the leading cause of death in diabetics.
If I am a diabetic, can lifestyle changes prevent a heart attack?
To be honest, the data is mixed in regards to lifestyle and heart attack reduction. One study got overweight and obese diabetics to eat less, exercise >175 minutes/weekly, and lose weight. After nearly 10 years, the study was stopped because there was no effect on heart attacks in the group that lost weight and exercised. One problem with the study was that the group that exercised and lost weight had fewer people taking good heart and cholesterol medications compared to the non-exercise/weight loss group which may have messed up the results.
Can lifestyle changes prevent me from getting diabetes?
Another study in people with high blood sugars but not yet diabetic, showed that weight reduction, and moderate exercise (150hrs/week) was BETTER at preventing diabetes over a diabetes medications called Metformin. Chalk another victory up for lifestyle, right?
Is there a specific type of exercise that can prevent heart attacks in diabetics?
There’s no study specifically looking at exercise and heart attack prevention in diabetics. However, there is a neat study looking at treating diabetes with exercise. They found that in order to lower the average blood sugar effectively, that one had to lift weights AND do aerobic activity (Not one or the other). The amount of exercise they did was 150 minutes of moderate intensity aerobic exercise, and the weight training was 2 sets of upper body weights and 3 sets of lower body weights, lifting the weight 8-12 times.
Is there a particular diet to prevent heart attacks and strokes in diabetics?
Thankfully, the data is good. A Mediterranean diet not only prevents heart attacks and strokes but also helps prevent the onset of diabetes. The diet consists of fruits, vegetables, fatty fish, legumes, white mean, nuts, olive oil while discouraging soda, commercially baked foods, fat spreads, and red/processed meats.
For every 1% increase in HgbA1c (average blood sugar) the rate of heart attacks increases by 21%.
If you've had a heart attack or stroke...
What if I’m a diabetic and have had a heart attack? What can I do to prevent another one?
One of the best studies to answer this questions is one that followed thousands of people over a 5 year period for smoking status, cholesterol numbers, blood pressure and hemoglobin A1c. What they discovered was both “no duh” and surprising. In general the more risk factors that were under control, the less likely a person was to have a heart attack (No duh!). The surprising conclusion was that treating blood pressure <130mmHg seemed to cause MORE death. Two studies have shown NO benefit of lowering blood pressure <130mmHg in diabetics (study 1, study 2). The ideal systolic blood pressure seems to be 130-140mmHg in diabetics.
Woah! Lower blood pressure is not better in diabetics? What about my HgbA1c? Is lower better?
Another surprising finding from the study was that getting the HgbA1c <7.0% was associated with a slightly higher rate of death as well. Surprising because you’d think that the lower the blood sugar the better. We know from another study in diabetics with heart disease that getting the HgbA1c <6.0% led to more death and heart attacks than in people who had their HgbA1c kept between 7.0-7.9%. This second study was actually stopped early because of this unexpected finding. So just like with blood pressure, lower may not be better.
In Summary
Diabetics should:
1). Eat a plant based diet with nuts and olive oil.
2). Do aerobic and strength training exercise.
3). Keep systolic blood pressure between 130-140mmHg
4). Maintain your HgbA1c around 7.0%
5). Take a statin cholesterol medication.