Adirondack Sports May 2024

MAY 2024 25
NON-MEDICATED LIFE
Medicines are a mainstay of
American life and the healthcare
system not only because they are
perceived to work by the individuals
taking them, but also because their
benefit may be shown by the objective
assessment of scientific study.
Clinical research trials have shown
that some of the medicines of Western
science may reduce the risk of Type
2 diabetes, heart attacks, strokes and
cardiovascular death.
In the first 114 installments of the
Non-Medicated Life, certain dietary
practices and a healthy lifestyle have
been shown to accomplish naturally
for the majority of individuals most of
the benefits of medications in the prevention
and treatment of chronic medical
conditions. This is especially true
for prediabetes, a condition present for
several years prior to the development
of Type 2 (adult-onset) diabetes. This
is especially important as Type 2 diabetes
greatly increases the risk of heart
attacks and strokes, and nearly 75 million
Americans have prediabetes.
How do you know if you have prediabetes?
The easiest way to suspect you
may have this condition is to use family
history and body weight. If Type 2 diabetes
is present in ANY of your family
members, but especially first-degree
relatives – mother, father, sister or
brother – you are at risk. Additionally, if
you are overweight or obese, then you
are at risk. Overweight or obese may
be scientifically determined by using
body mass index (BMI) via a BMI calculator:
cdc.gov. Overweight is a BMI
between 25-30 and obese is a BMI
greater than 30.
If a suggestive family history or elevated
BMI (or both) are present, then
the next step to determining if you have
prediabetes is targeted blood tests. The
most important blood tests are a blood
glucose after a 12-hour fast – fasting
blood sugar (FBS) – and a test called
Lifestyle Strategies
for Preventing
Type 2 Diabetes
By Paul E. Lemanski, MD, MS, FACP
Editor’s Note: This is the 115th in a
series on optimal diet and lifestyle to help
prevent and treat disease. Any planned
change in diet, exercise or treatment
should be discussed with and approved
by your personal physician before
implementation. The help of a registered
dietitian in the implementation of dietary
changes is strongly recommended.
hemoglobin A1c (Hgb A1c). Additionally,
prediabetes may be determined at its
earliest stages – even without an elevation
of FBS or Hgb A1c – by identifying a
condition called metabolic syndrome. I’ll
describe each determination in turn:
If the FBS is greater than 99 mg/dl, but
less than 126, then this is the most common
test to suggest prediabetes. An even
more exacting way of determining prediabetes
is an elevated Hgb A1c. Hemoglobin
is an iron containing protein present in
red blood cells (RBCs) that binds oxygen
in the lungs and transports it to the tissues
of the body. By serendipity, hemoglobin
also binds glucose and the RBCs are permeable
to glucose. Hgb A1c, therefore, is
the percent of hemoglobin in the RBCs
bound to glucose. Hgb A1c less than 5.7%
is normal, Hgb A1c 5.7-6.4% is prediabetes,
and Hgb A1c greater than 6.4% is
diagnostic of Type 2 diabetes. Since RBCs
have a lifespan of three months, Hgb A1c
reflects the average blood sugar over the
preceding three months.
Both prediabetes and Type 2 diabetes
are metabolic conditions that reflect
insulin resistance. Insulin is a hormone
produced in the islet cells of the pancreas
that is released into the blood stream. The
insulin fits into a receptor on the surface
of the body’s cells that in turn activates a
“pump” that takes glucose from the bloodstream
and transports it into the cell. The
underlying metabolic derangement in
both conditions may be a change in the
shape of the receptor requiring increased
amounts of insulin to activate the pump.
This state of increased insulin may be
determined even before the blood glucose
is elevated by identifying metabolic
syndrome.
Metabolic syndrome is defined as any
three of the following conditions: 1) an
elevated fasting triglyceride (TG greater
than 150); 2) a reduced HDL cholesterol
(less than 40 in a male and less than 50 in
a female; 3) an elevated blood pressure
(BP) or on BP lowering medications; 4) an
increased abdominal girth at the umbilicus
(greater than 35 inches in female
and greater than 40 inches in male); and
5) an elevated FBS. It is apparent that if
any three out of five make the diagnosis of
metabolic syndrome, then an elevated FBS
need not be part of making the diagnosis,
thus allowing identification of prediabetes
even BEFORE blood glucose is elevated.
Once prediabetes is identified, there
are powerful lifestyle-based strategies to
prevent the progression to Type 2 diabetes
and even to reverse prediabetes.
Moreover, these strategies are not draconian
or overly restrictive and should be
achievable by most interested, reasonably
motivated individuals.
The first lifestyle-based strategy is
modest weight loss. In the diabetes prevention
program trial, the loss of only
5-7% of the body weight of an overweight
or obese individual with prediabetes
could reduce the development of Type
2 diabetes by 57%. For example, a 5’2”
female weighing 200 pounds would need
to lose only 10-14 pounds to powerfully
protect against the development of Type
2 diabetes, even though she was almost
60 pounds above her ideal body weight.
While this weight loss may be achieved by
caloric restriction, either by a change in
the composition of the diet or reduction in
the amount of food consumed or both, it is
a strategy many can successfully employ.
Alternatively, exercise – both aerobic- and
resistance-based – while monitoring and
holding caloric intake steady, can aid in
such modest weight loss.
The second lifestyle-based strategy
is time limited eating (TLE). While also
called intermittent fasting, TLE involves
consuming calories for only a set number
of hours a day and NOT taking in
anything caloric-either food or drink –
for the remainder of the 24-hour period.
Typically, TLE does not change the composition
of your diet or the amount you
consume. Rather, it is the timing of eating
that is important. On a so called 16/8 TLE,
you confine all calories consumed to an
8-hour period (generally, 12-8pm) and eat
or drink nothing caloric for the remainder
of the 24-hour period. Amazingly, with
this very simple and implementable
change, weight is reduced, abdominal
girth is reduced, blood pressure is
reduced, cholesterol is improved, and
blood sugar is reduced.
In summary, Type 2 diabetes is preceded
by several years of prediabetes
during which simple lifestyle-based
strategies can prevent progression to
Type 2 diabetes and even reverse prediabetes.
The first step in preventing
Type 2 diabetes is to identify prediabetes.
Concern should be raised by a
family history of Type 2 diabetes or the
presence of body mass index greater
than 25, or both. The next step is the
measurement of fasting blood sugar
and Hgb A1c. Finally, identifying the
condition called metabolic syndrome
may allow the identification of prediabetes
even before the elevation of blood
sugar. Once prediabetes
is identified,
modest weight
loss, exercise, and
time limited eating
are effective lifestyle-based
strategies
for preventing
type 2 diabetes.
Paul E. Lemanski, MD, MS, FACP
(plemanski3@gmail.com) is a boardcertified
internist practicing internal
medicine and lifestyle medicine in
Albany. Paul has a master’s degree
in human nutrition, he’s an assistant
clinical professor of medicine at
Albany Medical College, and a fellow
of the American College of Physicians.