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Impaired Glucose Tolerance
A condition in which blood sugar level is elevated
between 140 and 199 mg/ dl after a 2 hour glucose
tolerance test, but is not high enough to be classified
as diabetes.
Impaired Fasting Glucose
A condition in which the fasting blood sugar level
is elevated between 110 and 125 mg/dl after an
overnight fast, but is not high enough to be classified
as diabetes. TOP
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Comprehensive Program
Areas –
1, 2, 3 Points to Share With Patients.
Listed below are three positive areas to focus
on when developing a comprehensive program.
- Improve the Diet Quality
- Choose healthy
fats such as monounsaturated, omega 3
and polyunsaturated sources
- Choose the
right type of carbohydrates: whole grain
- Choose low
glycemic foods
- Eat a wide
variety of fruits and vegetables
- Choose more
plant proteins such as beans, legumes,
and nuts over animal protein
- Maintain a
Healthy Body Weight
Even 10 to 15 extra pounds can increase risk
of developing diabetes and cardiovascular
disease. A study published in the New England
Journal of Medicine showed that for women
with a body mass index (BMI) of 26, the risk
of coronary heart disease was about twice
the risk of women with a BMI of less than
21. The risk in men with a BMI of 26 was about
1.5 times the risk in men with a BMI or less
than 21. For the same comparison the risk
of type 2 diabetes was four times as high
in men and eight times as high in women.
- Exercise
- Exercise improves
blood glucose control as well as the cell’s
sensitivity to insulin, especially in
the muscles.
- Exercise
maintains a healthy body weight
- Consistent
exercise improves blood lipids and lowers
elevated blood pressure.
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Glycemic Index
ranks foods by how quickly they turn into sugar
in your body. The glycemic index will tend to
be lower in foods which are whole grain and non-refined
and are in the bean and legume family.
Glycemic load
is a different term, which accounts for the actual
amount of carbohydrate in a food, giving us a
better idea of the food’s overall effect on blood
sugar levels. The glycemic load is the amount
of carbohydrate in a food multiplied by the glycemic
index of that carbohydrate. This term takes into
account both the type and the amount of carbohydrate
into consideration.
A study from the Harvard School of Public Health
examined diet and exercise patterns of over 65,000
women from the Nurses Health Study. The study
concluded that eating low glycemic index foods,
such as broccoli and beans along with a diet higher
in complex cereal fibers can significantly reduce
the risk of type 2 diabetes. (10)
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| Examples of Low glycemic
Foods |
| Peanuts
14 |
Non-fat
yogurt 14 |
| Soybeans
18 |
Cherries
22 |
| Apples
38 |
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| Examples of High
glycemic Foods |
| Pretzels
83 |
Corn
Chips 72 |
| Vanilla
Wafers 74 |
Graham
Crackers 74 |
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Diabetes Affects
17 Million Americans
by Connie Guttersen, RD PhD,
author of the Sonoma Diet
Diabetes Affects 17 Million Americans.
Recent data from the Centers for Disease Control and Prevention
find that type 2 diabetes affects more than 17 million Americans
and is quickly growing to be one of our nation’s largest public
health problems. Over 200,000 people die each year of related
complications. Particularly at risk are the 5.9 million Americans
who are unaware that they have the disease. There is also
a large group of adults ages 40 to 74 who have a condition
known as pre-diabetes. Pre-diabetes means that the blood sugar
level is elevated but is not high enough to be classified
as diabetes. The United States Department of Health and Human
Services coined this term, “pre-diabetes”, in an effort to
educate the public on prevention, symptoms and treatment of
diabetes. In the past, the medical community referred to this
condition as impaired glucose tolerance and impaired fasting
glucose tolerance.
Another key term used to identify health risk associated
with diabetes is a condition known as metabolic
syndrome or more commonly known as insulin resistance.
It is the crossroad to diabetes and heart disease. The analysis
of the NHANES III data reveals that 47 million Americans,
or one out of five people in the U.S. are affected by metabolic
syndrome. Many of the characteristics of the metabolic syndrome
are risk factors for type 2 diabetes and heart disease. The
National Cholesterol Education Program provides guidelines
which diagnose metabolic syndrome when three of the risks
are met.
| Risk Factors for Metabolic
Syndrome |
| |
| Blood Pressure |
> 130 / 85 mg HG |
| HDL - Cholesterol |
< 40 mg/dl in men
< 50 mg/dl in women |
| Triglycerides |
> or equal to 150 mg/dl |
| Blood Sugar |
> 110 mg/dl |
| Waist Circumference |
> 40 inches in men
> 35 inches in women |
Diabetes Projected to Double by 2050
The number of
U.S. adults with diagnosed diabetes has increased 61% since
1991 and is projected to more than double by 2050. Primary
prevention has become a public health initiative. Studies
have concluded that the progression of pre-diabetes to diabetes
can be prevented or delayed. Two landmark clinical trials
(1,2,3), The Finnish Diabetes Prevention
Study and the U.S. Diabetes Prevention Program demonstrated
that sustained lifestyle changes with modest weight loss and
physical activity resulted in substantial reduction in diabetes
among older adults who were at very high risk for diabetes.
The Diabetes Prevention Program proved that modest changes
in lifestyle can reduce the incidence of type 2 diabetes in
people with pre-diabetes by almost 60%. In this study, the
participants exercised at least 30 minutes per day and consumed
1200 to 1800 kcal per day to produce the weight loss and decreased
diabetes risk. The impact of these clinical trials is a timely
topic since the management of diabetes and its complications,
such as cardiovascular disease, amputation, blindness, and
renal failure imposes enormous medical and economic burden
on the country. Diabetes costs the nation nearly 132 billion
dollars a year. This is approximately 13,000 dollars per individual
on a yearly basis. (American Diabetes Association, 2002)
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Number of Persons with Diagnosed
Diabetes
in United States 1980 to 2000
Centers for Disease Control and Prevention
Dietary Fat & Diabetes Prevention.
Scientific evidence indicates that specific types of
dietary fat are important for preventing type 2 diabetes.
Monounsaturated fats, such as those found in olives and nuts
may be beneficial for glucose and insulin homeostasis, as
well as improving insulin sensitivity. (4,5).
Other studies have concluded that a high intake of saturated
fat and trans fat adversely affects glucose metabolism and
insulin resistance. (6) In another study,
a multicenter study of 162 healthy men and women showed that
a diet high in saturated fat (18% of the energy) decreased
insulin sensitivity when compared with a diet high in monounsaturated
fat (21% of energy) with the same total fat content. (7)
The mechanisms by which specific types of dietary fat affect
insulin sensitivity are not fully understood. One explanation
may be that the fatty acid composition of the phospholipids
in the muscle cell membranes is directly related to insulin
sensitivity. In addition, specific types of fatty acids in
the cell membrane could influence insulin action via altering
the insulin receptor binding or influencing the ion permeability
and cell signaling. In summary, changes in dietary fatty acid
composition alters the fatty acid composition of the phospholipids
in cell membranes, perhaps modulating insulin action and sensitivity.
Most of the clinical and epidemiological studies have observed
no effect of total fat intake on insulin sensitivity and risk
of type 2 diabetes. As for the effects of particular types
of fatty acids, past findings have been inconsistent. Much
of the inconsistency is due to the nature of the methodology,
duration of the study, and sample size. However, more recent
studies with better design do suggest that specific types
of dietary fat rather than total fat as percentage of energy
play an important role in the development of type 2 diabetes.
A ground breaking study, published by the Harvard School
of Public Health researchers in the Journal of the American
Medical Association further confirmed the protective effects
of monounsaturated fats against type 2 diabetes. (8)
This study followed 83,000 female nurses for 16 years. The
women in the study completed food frequency questionnaires
approximately every four years between the years of 1980 and
1996 and had no history of diabetes, cancer, or cardiovascular
disease. The results show that consuming one tablespoon of
peanut butter or a full serving of peanuts or other nuts (1
ounce), five or more times a week is associated with a 20
to 30% reduced risk of developing type 2 diabetes, respectively.
The relationship between consuming these monounsaturated sources
is linear; higher consumption provides a greater protective
effect. Further analysis of the Nurses Health Study, published
in a recent issue of Circulation: Journal of the American
Heart Association, found that eating fish regularly reduced
the risk of heart disease in diabetic women by as much as
64%. (9) This reduction was most evident
when the fish was consumed five or more times per week. It
is well known that fish oil or omega three fatty acids reduce
the risk of irregular heartbeats, decrease blood triglycerides
levels, improve function of blood vessels, and reduce blood
clot formation. These effects are particularly important for
reducing the risk of cardiovascular disease among individuals
with diabetes. The researchers of this study also concluded
that the association between the higher fish consumption in
diabetic women and better heart health can also be extended
to diabetic men. TOP
Age-Standardized Prevalence of
Diagnosed Diabetes per 100 Adult Population by State United
States, 2001
Centers for Disease Control and Prevention
Diabetes & American Youth
Even more alarming, is the new epidemic of type 2 diabetes
among American youth. Just ten years ago type 2 diabetes was
rare, by 1999 the rise in childhood type 2 diabetes is tenfold.
Virtually all children with type 2 diabetes are overweight.
The Centers for Disease Control and Prevention recently estimated
that 15% of all U.S. children and teenagers are overweight.
Researchers recommend that physical activity and healthy eating
habits along with better nutrition is the foundation to the
solution.
In summary we are up against alarming precedence of type
2 diabetes; however, on the positive side, it is a disease
which is highly responsive to positive changes in lifestyle
and diet. TOP
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