February 29, 2016

I recently read a syndicated column by a medical professor in the newspaper regarding lifestyle changes needed to stave off pre diabetes and ultimately diabetes mellitus. The article gives a reasonable explanation of insulin function, but falls way short on any actionable strategies for change other than to exercise more, lose 5-10 pounds (how?) and eat a healthy diet.

How can we tell people such generalities and expect any real change? The three above statements have been said for years and the populace gets fatter and less healthy.

What people really need is concrete statements of actionable choices to prevent the diabetic onslaught not piled up generalities of thought.

Prediabetes is basically the state of metabolism where the function of the hormone insulin can not keep up with the volume of glucose in the blood stream. This then forces the level of glucose to rise in the blood until you have frank diabetes. As the blood sugars rise above 180mg/dl in the blood we start to develop the complications of diabetes in the form of glycation reactions where proteins and sugars crosslink and deposit causing cataracts, nerve damage, kidney damage and so on.

Clearly, the root cause of this is not exercise although exercise will help increase insulin sensitivity and metabolic rates. The root cause as the author leaves out of the article is the consumption of flour and sugar. A prescribed "healthy diet" means different things to different people and offers little advice for change.

To avoid the ravages of diabetes, the answer is hard and simple all at the same time. Avoid all added sugar and most flour based foods, period. The hard part is avoiding an addicting substance like sugar that lights up our brain like cocaine.

As I discussed in last weeks article, sugar and flour are a mess for humans metabolically. There is no reasonable way around this dilemma. Giving general weight loss advice like "just exercise more" means that the advisor has never seen an American football offensive lineman who exercises daily and vigorously and still weighs in at an unhealthy 350 pounds.

Let us stop kidding ourselves to believe that oversimplified and frankly unhelpful advice should be given for general mass consumption. I am routinely saddened by the patients that only exercise because they were told that this is the path to weight loss and when it does not happen they give up.

The best prescription for weight loss is multimodal:

1) Severely limit or preferably eliminate all added sugar and refined flour foods. They drive the insulin hormone causing fat cells to suck up the sugar making you hungry again. Bad cycle to be on.
2) Eat slowly and let your intestinal satiety signals get back to your brain.
3) Eat more healthy fats and protein. Especially fish, coconut oil, avocado, nuts and beans.
4) Move often and daily. Walk up stairs and shun the elevator. Perform sit-ups and pushups while watching your favorite show. Fidget. Stand when you could sit. Run when you could walk.
5) Sleep adequately for your age needs. See Volume 5, Letter 16 for details.
6) Relax and learn to manage your stress. Try yoga or prayer.
7) Drink lots of water until your urine is clear.
8) Eat more fiber. Especially prebiotic foods like artichokes, beans, asparagus, onions, leeks, oats, and so on.
9) Eat lots of plant foods like leafy greens, vegetables, and some fruits.
10) Be patient and consistent with your daily choices. Forgive yourself when you slip and try again quickly.

Targeted advice,

Dr. M