Pre-diabetes: Are You at Risk?

//Pre-diabetes: Are You at Risk?

Pre-diabetes: Are You at Risk?

Diabetes is on the rise. Among adults in the United States the trend has gone from 10.8% in 1994 to 14.3% in 2012. What’s even more astounding is the prevalence of pre-diabetes. It has been reported that as much as 38% of the population has an abnormal response to insulin which results in an elevation of blood glucose and a condition known as insulin resistance. Individuals with insulin resistance have an increased risk of developing both pre-diabetes and type-2 diabetes.

The average American consumes 152 pounds of sugar and 146 pounds of flour per year. Could this have a correlation with diabetes? Yes! Waistlines are increasing because the sugars and refined grains that we consume increase insulin levels causing belly fat (or visceral fat) to accumulate around the organs. Insulin resistance then causes the elevation of blood sugar which increases that person’s risk of developing other serious health conditions, such as heart disease, stroke, cancer, diabetic eye disease, neuropathy, and kidney disease.

There are several ways to diagnose obesity and determine if one has visceral fat accumulation. A person’s BMI, or body mass index, is one measurement to take into consideration. BMI is a measure of body fat based on height and weight, and while it does not consider lean muscle mass, the measurement is still useful, with a recommended BMI of 25 or less. Waist circumference is another important indicator. Men should aim to keep their waistline circumference under 40 inches, and women should aim for 35 inches or less, with a waist-to-hip ratio (waist circumference divided by hip circumference) of less than 0.8. This reading in particular can be helpful in detecting those we call “skinny fat” – these people look thin but have a pot belly. All of these measurements taken together are good indicators of insulin resistance. The ultimate testing however includes glucose tolerance testing (fasting blood sugar and insulin levels) and/or hemoglobin A1C, which is a blood test that provides information about a person’s average levels of blood glucose over the past 3 months.

Something else to keep in mind is that all calories are not the same. A soda which has approximately 45 grams of sugar and 150 calories, causes a spike in insulin, whereas an apple and handful of almonds with the same amount of calories, does not. A 2007 study reported in the American Journal of Clinical Nutrition, demonstrated that certain types of carbohydrates, such as wheat and potatoes, up-regulated the genes for diabetes and inflammation in the abdominal subcutaneous fat, as compared to other carbohydrates like rye and corn, even though the caloric value was the same.

Sleep deprivation also increases insulin resistance. One study showed that adolescents who slept less than 8 hours per night had an increase in central fat and insulin resistance. Another study recently reported that for every 30 minutes of weekday sleep “debt” the risk of obesity and insulin resistance increased by 18% and 41 % respectively over a year.

Besides lowering the consumption of sugar and flour and improving sleep, what else can we do to improve glucose control? Research is strongly supporting all types of exercise like walking, running, biking, and swimming for regulation of blood sugar. Weight-training in particular increases lean muscle mass and metabolism long term, and increases a specific type of muscle (white muscle) that has been shown to lower blood sugar.

Newer studies show that there is a link between the microorganisms living in your digestive system, central obesity, visceral fat, and insulin resistance. Taking a prebiotic (dietary fiber that feeds the good bacteria) and consuming foods like kefir, yogurt, sauerkraut, and supplements with probiotics, may help reduce insulin resistance.

Here is a summary of some of my recommendations:

  1. Reduce sugars and processed foods, and lower or eliminate wheat products. Avoid at all costs high-fructose corn syrup which has a strong link to insulin resistance. Eat more of a plant-based diet, grass-fed meats, and fish that are high in Omega 3’s, like wild-caught salmon. Be aware if you have a food sensitivity to gluten or dairy as these are highly inflammatory and can add to visceral fat.
  2. Get an activity monitor and aim for 10,000 steps per day. This is a goal, but any amount of extra steps that you can take each day towards this goal can make a difference. Consider getting a personal trainer to help you with a weight-training program, or take a yoga class at least once to twice a week or practice at home.
  3. Create a comfortable sleep routine and climate, and make good sleep a priority. If sleep is poor, then ask your doctor for a sleep study to rule out sleep apnea.
  4. Take a daily probiotic and switch them around every few months. Consider a prebiotic as well, but know that a good plant-based diet feeds your good bacteria too.
  5. Take a few moments to practice deep breathing and meditation. Start a gratitude journal and write down something every day. This lowers stress hormones like cortisol, and thus lowers insulin resistance.
  6. Get your vitamin-D checked and supplement as needed. Take 2 grams of Omega 3’s per day if you don’t consume fish regularly. Other supplements that help reduce insulin resistance include chromium and alpha lipoic acid and magnesium.
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About the Author:

Lisa Lilienfield, MD
Lisa Lilienfield, M.D. is board-certified in family medicine and is a member of the American Academy of Medical Acupuncture. Dr. Lilienfield practices Acupuncture and Osteopathic Manipulative Medicine and has developed an expertise in both Women’s Health and Sports Medicine. Dr. Lilienfield also serves as a Clinical Assistant Professor at Georgetown University School of Medicine’s Department of Community and Family Medicine. To read Dr. Lilienfield’s complete bio, click here