November is designated American Diabetes Month. That said, this is an opportune time to reflect on the rather grim state of affairs, while making a concerted effort through lifestyle to improve the current situation.

Diabetes affects the lives of 30 million Americans. This accounts for 9.4% of the population, most of whom are either undiagnosed or inadequately treated. Diabetes is the seventh leading cause of death in the United States. The economic burden in those afflicted is enormous.

That’s the present situation. Here’s what we can expect in the future: The prevalence of the disease will increase by 54% to more than 54.9 million Americans between 2015 and 2030.

IT DOESN’T HAVE TO BE THIS WAY! 

As an integrative cardiologist practicing functional medicine, these numbers astound me. The situation is indeed grave, and it’s getting worse. Why are we spiraling out of control? This is not rocket science. It’s all about lifestyle; poor diet, time management and lack of exercise.

Many of you might recall the heart healthy diet of the 1990’s, espoused by the US government, the American Heart Association and others. I’m talking about the proverbial high carb, low fat diet. Remember that dated food pyramid from 1992 with the overstuffed bread basket at the base, and fats, “to be used sparingly”, at the top? 

WHAT HAPPENED? The country got fatter and diabetes skyrocketed. A new word evolved entitled diabesity.

I’m always asked what is the best treatment for diabetes. My answer is always the same: PREVENTION

Diabetes is a serious disease with devastating consequences. It’s a major risk factor for heart disease.70% of diabetics will suffer a heart attack or stroke in their lifetime.

Other diabetic complications include blindness, kidney disease, too often leading to dialysis, nerve damage to the lower limbs (neuropathy), and gastrointestinal motility disorders. 

The link between diabetes and cancer is now firmly established. Diabetic women are especially at risk. Women with diabetes are 27% more likely to develop cancer when compared to healthy women. By contrast, men with diabetes are 19% more likely to develop cancer than healthy men.

Although the two diseases are seemingly independent of each other, it is becoming increasingly evident that people with diabetes are more likely to develop Alzheimer’s disease. The actual cause of the association is unclear but many think it is related to insulin resistance.

Insulin resistance is what we see in type 2 diabetes (formerly known as adult onset diabetes), prediabetes and metabolic syndrome. When the body fails to recognize its own insulin, it responds by producing more insulin, a state known as hyperinsulinemia. Too much insulin is toxic to the heart, the brain and other organs.

Getting back to prevention, we must address the diet, the obesity   factor and lack of exercise. As long as these are unchecked, insulin levels will remain high, and prediabetes will evolve into frank diabetes.

The first order of business is to know your risk. Remember that there are many diabetics and prediabetics who have no knowledge of their status. Obtaining your fasting blood sugar isn’t enough. To get a more complete idea you need to know your Hemoglobin A1c, which is more or less an indicator of how well your blood sugar has been controlled over a three month period. A normal level is between 4% and 5.6%. A level from 5.7% to 6.4% is considered prediabetes. A value above 6.4% denotes frank diabetes.

A fasting insulin level is also worthwhile to obtain, since it is the best determinate of insulin resistance. In some cases a 2 hour glucose tolerance test is helpful.

Once you know your actual risk you can formulate a therapeutic plan. What I recommend is working with an integrative physician practicing functional medicine. Here’s why: a traditional physician, even an endocrinologist may skim over the various lifestyle measures and go straight to medications. Drugs do plan an important role in management of diabetes, but rarely do they need to be a first step.

What about diet?  I have never believed that one diet fits all. However, when it comes to prediabetes and diabetes, a low carb diet is a must. Call it low glycemic, paleo, ketogenic, or anything in between, a diet low in starchy carbs is paramount. All my patients are given a 1 sheet indicating the glycemic index of the most commonly eaten carbs. Many are surprised to learn that a baked potato ranks nearly as high as table sugar on the glycemic scale.

What do you eat in place of carbs for energy? The answer is healthy fat. It doesn’t have to be as extreme as in a ketogenic diet, though that can be a viable option. Carbs are way overrated in my book when it comes to energy utilization.

How important is exercise? It’s essential. Weight loss following a low carb diet along with exercise is the winning combination when it comes to breaking the cycle of insulin resistance and poorly controlled diabetes. 

What about supplements? These can be quite useful, and I use them frequently in my practice as an adjunct to a healthy diet and exercise. The goal is to convert insulin resistance into insulin sensitivity.

One example is alpha lipoic acid. Several studies have shown that it can reduce insulin resistance, improve blood sugar control, and ease symptoms of painful neuropathy from nerve damage, as well as lowering the risk of diabetic retinopathy.

To give you an example, here are two products that I have personally formulated: 

  1) Glucowise which contains alpha lipoic acid, chromium picolinate, vanadium, and cinnamon, along with various vitamins and minerals.  

  2)Glucowise Plus which contains all of the above in addition to a unique herb Berberine which can be quite useful in lowering blood sugar as well as lowering both cholesterol and triglyceride levels. It may even lower blood sugar levels similar to the drug metformin.

There is quite a lot we can do to prevent and even reverse diabetes. It requires work and commitment but it’s doable. I’m not undermining the use of medications in the treatment of this disease. They clearly have their place, but they don’t need to be on the front line, assuming the disease is caught early enough.

Let me leave you with an actual case study: AS is a 66 year old male with hypertension and Stage 4 (severe) kidney disease. His baseline HgbA1c was 7.4%. Because many of the diabetic meds adversely affect renal function, AS was left with 2 options; either shoot himself with insulin or make dietary changes.

In a span of three months he dropped his level to 5.4%, which is below that of a prediabetic. How did he do it? He cut out essentially all starchy carbs in his diet; bread, pasta, potatoes and rice. Along the way he lost 20 pounds.

While we celebrate American Diabetes Month, let us all consider the role of early detection and lifestyle changes. It can clearly make a difference.

Remember, be your own medical advocate by staying in the driver’s seat when it comes to your health. 

Yours in health and wellness,

Howard Elkin,MD, the Medical Advocate