Asked by Bojie, Nigeria
Can early diabetes be controlled or completely stopped?
Dr. Otis Brawley
Chief Medical Officer,
American Cancer Society
Type 2 or adult-onset diabetes is one of the most significant threats to health today. Most cases are linked to the epidemic of obesity. The long-term consequences of diabetes include cardiovascular diseases such as stroke, heart attack and peripheral vascular disease. Diabetes is also a leading cause of blindness, kidney failure and leg amputation. Attention to diet, exercise and even a small weight loss can help someone with diabetes, or especially pre-diabetes.
This is a metabolic disease, meaning it is an issue of energy balance. In normal physiology, when the amount of food energy consumed, measured in calories, exceeds the amount of energy burned, the body converts and saves the excess energy as fat. Type 2 diabetes mellitus is a resistance to the hormone insulin, which causes sugar or glucose to enter muscle and organs of the body. For reasons that are poorly understood, some people's tissues become less sensitive to insulin as the body stores more fat. The results are a rise in blood sugar levels and the long-term consequences described above.
I prefer to think of diabetes as a disease with a white-to-black spectrum of severity and a broad gray area. For those who have pre-diabetes or even mild diabetes, one can take steps to move toward the lighter gray or white area of the spectrum, with small improvements in diet, small increases in activity and loss of just a few pounds. I am hesitant to say that diabetes is cured, but it can often be controlled, and one can return to normal blood sugars without the need for diabetes medicines, and the risk of diabetic complications are significantly reduced. This is rare and more difficult but not impossible for severe diabetics.
Many who progress to diabetes could have prevented it by maintaining a lower and not necessarily even a near-ideal body weight. For those who are overweight or obese with or without diabetes, an emphasis on good nutrition and physical activity is still a good investment. Obesity without diabetes increases the risk of heart disease and orthopedic injury, and is a risk factor for diseases including breast, prostate, colon and pancreas cancers.
I have to say that maintaining a normal body weight is difficult in today's society. Over the past 50 years, our society has increased its reliance on high-calorie fast foods. Also, food serving sizes have increased dramatically. As caloric intake has increased, the average person is walking less and getting less exercise as part of his or her normal daily routine. In the U.S., such things as suburban living without sidewalks and the phenomenon of the couch potato have created a "built environment" that is conducive to obesity.
In the early 1970s, 12 percent of American men and 17 percent of American women were obese. By 2006, 34 percent of men and 36 percent of women were obese. An additional 20 percent are overweight, but not so heavy as to be considered obese. Yes, more than half of American adults are overweight or obese. Among American children ages 6 to 11 years, 4 percent were obese in the early 1970s and 17 percent were obese in 2006. Interestingly, weight gain is a problem in Asia, Africa and Europe, though trends are not as dramatic as in the U.S.
Most organizations that have issued recommendations for maintenance of good health suggest that everyone consume at least five servings of fruits and vegetables per day. All people should consume more whole grains and less processed food. It is also suggested that healthy adults do moderate to vigorous physical activity for at least 30 minutes, at least five times per week. Children should engage in moderate to vigorous physical activity for at least 60 minutes, five times per week. Moderate exercise can be simply walking at a brisk pace.
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