Heal Thyself—Spotlight on Prediabetes

By Christie Aschwanden

When Karen Bouse was in her late forties, a series of puzzling dizzy spells sent her to the doctor’s office. It turned out the dizziness was linked to stress, but the blood tests her doctor ordered yielded an unpleasant surprise—Bouse was prediabetic.

Like most of us, Bouse was well aware of the epidemic of diabetes that’s been wreaking havoc with the health of some 18 million Americans. But she was taken aback to learn that another 41 million of us suffer from prediabetes—a condition that’s risky in its own right—and that she was one of them.

The problem of prediabetes, defined as overly high blood sugar (a fasting glucose level of 100 to 125 milligrams per deciliter or a two-hour glucose reading of 140 to 99), isn’t just that it’s the stepping-stone to the full-blown disease. A study of more than a million people published last January found that just being prediabetic was linked to developing, and dying from, several types of cancer. “And simply having blood sugar levels in the prediabetic range puts people at 50 percent greater risk of heart disease or stroke,” says Massachusetts General Hospital dietitian Linda Delahanty, author of Beating Diabetes.

For Bouse, now 62, these statistics hit close to home. Her diabetic mother had her first heart attack at age 56 and died at 62. Among her five siblings, Bouse is the only one who hasn’t either developed diabetes or suffered a heart attack.

That’s largely because she was lucky enough to have gotten tested early—something more of us should be doing, says endocrinologist Robert Rizza, president-elect of the American Diabetes Association. Since prediabetes lurks silently, most people who have it don’t have a clue they’re in danger. If you’ve been steadily gaining weight that you can’t seem to shed, don’t exercise regularly, have a family history of diabetes, or are over 45, you should have your blood sugar checked, then rechecked every three to five years.

And if it’s high, what then? At least there’s one bright spot in this dreary picture: Prediabetes can be reversed, without resorting to medication. Here’s what you need to do.

Get moving
One of the simplest ways to move yourself out of the prediabetic category is to, well, move.

A landmark study published in the New England Journal of Medicine in 2002 showed that building even a little exercise into your day (along with dietary changes, more about which later) can substantially cut blood sugar levels.

The trial, known as the Diabetes Prevention Program (DPP), enrolled 3,234 prediabetic people to examine whether diabetes could be prevented. The participants were assigned to one of three groups. One took the diabetes drug metformin, another group got a placebo, and the third started exercising and tweaked their diets.

The results were so dramatic that researchers stopped the trial early so that everyone in the study could take up the lifestyle program. People in the diet and exercise group reduced their diabetes risk by 58 percent—almost double the improvement seen in the drug group. The lifestyle intervention proved especially beneficial for people older than 60, lowering their risk by a whopping 71 percent. Most remarkably, nearly one-third of the people in the diet and exercise group actually reversed their prediabetes and dropped their blood glucose levels back into the normal range.

You need not take up marathon running or eat like a monk to see results like this. The changes prescribed started with just ten minutes of exercise, five times a week—usually walking briskly enough to be able to talk but not sing—and gradually moved up to 30 minutes per day, five times a week.

While the study showed that moderate changes can bring huge payoffs, there’s no reason to stop there, says Michael Lyon, a physician at the Canadian Center for Functional Medicine and author of How to Prevent and Treat Diabetes with Natural Medicine. “If a person were to work out quite vigorously for an hour most days, that would be far more protective.”

Cut the fat
The dietary changes in the study were also modest. “The main focus was on eating less fat,”says Delahanty, who worked on the study. That meant that the participants ate high-fat foods like pastries and cheese less often, or in smaller portions. Simply by doing this, most of them lost between ten and 15 pounds during the first six months of the study—and kept it off. “If they weren’t losing about a pound per week, then we added a calorie target as well,” she says.

Cut the sugar
Michael Lyon advises prediabetics to take their diets a step further by eating foods based on the glycemic index, such as the one described in The Low GI Diet by Australian researcher Jennie Brand-Miller.

The glycemic index (GI) ranks carbohydrates according to how quickly they raise blood sugar levels after eating. High GI foods, like table sugar and starchy foods, are quickly digested and absorbed, leading to spikes in blood sugar levels. Low-GI foods like whole grains and (most) vegetables are absorbed slowly, producing a more gradual rise. For more information, Lyon suggests checking out www.glycemicindex.com.

“Rule number one is to stay away from refined-flour foods,” says Lyon. Instead, pack your diet with fruits, vegetables, and whole grains. “Legumes are the perfect low-glycemic-index food because they contain lots of soluble fiber,” he adds.

Take the right supplements
While supplements aren’t backed by large-scale studies demonstrating their effectiveness, there’s reason to think some may be helpful, says Lyon. For instance, since elevated blood sugar spurs the body to use more omega-3 fatty acids, he suggests that anyone newly diagnosed with prediabetes take fish oil. He recommends beginning with 8 grams of the liquid oil per day or 2 to 3 grams of a supplement of EPA and DHA (the crucial ingredients in the oil), then tapering down to half that dose once blood sugar levels have steadied.

Next on his list of important supplements are 1,500 milligrams of calcium and 500 to 600 mg of magnesium per day. Diabetics are particularly prone to losing calcium through the kidneys, so it’s harder for them to keep calcium in their bones, says Lyon. Though it’s not clear that calcium loss also hounds prediabetics, taking supplements can stave off the deficiency in the first place. “And magnesium is important for maintaining insulin sensitivity and helping prevent hypertension,” Lyon says.

Antioxidants can also be useful, he says, because high blood sugar creates oxidative stress. Lyon is bullish on selenium (200 micrograms daily) as well as grapeseed or a high-quality green tea extract; both help regulate blood sugar. For his patients, a typical dose of grapeseed extract is 200 mg per day; of green tea extract, 250 mg per day.

He also advises his prediabetic patients to take chromium, which helps with glucose regulation; he recommends 400 mcg per day in the form of chromium picolinate.

The payoff
Fourteen years after being diagnosed with prediabetes, Bouse remains diabetes-free, despite her family history. Her doctor credits her success to the lifestyle changes she adopted after seeing her siblings fall ill and her oldest brother die. “When my brothers and sisters started dropping like flies, I knew I needed to take care of myself,” she says.

First she took up yoga to control her stress; then she bolstered her exercise program. For years now, she has hit the gym four times a week for a combination cardio and resistance workout that lasts an hour and a half.

She also drastically altered her diet. “I no longer eat gravy, and I haven’t had anything fried in years,” Bouse says. “Now I eat lean meat and fish that’s grilled, broiled, or roasted.”

After so many years, the changes have become second nature, and she intends for them to stay that way. “I want my grandkids to see me get old,” she says. “Really old.”

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