Authored by Dr. Leland Jaffe; Associate Dean and Professor; Published on January 17th, 2024
Before we jump into this blog post, I want to share a book with you that has helped me and many of my patients learn about the root cause of prediabetes and type 2 diabetes (insulin resistance), and how to manage or reverse this condition through diet and lifestyle.
How Do We Define Prediabetes?
Let’s start by getting a bit technical: a prediabetes diagnosis is defined as a fasting plasma glucose of 100-125 mg/dL, a 2-hour oral glucose tolerance test of 140-199 mg/dL, or a hemoglobin A1C between 5.7 and 6.4%. It has been estimated by the Centers for Disease Control (CDC) in 2015 that approximately 84.1 million American adults > 18 years of age have prediabetes and only 11.6% of them were aware of their condition. This is very concerning, as the progression of prediabetes to type 2 diabetes is much greater without proper intervention through diet and lifestyle. It should be noted that patients with prediabetes and type 2 diabetes initially produce enough insulin in their body, it’s just not working properly.
Prevalence of Prediabetes in Our Youth
What’s even more concerning is that according to an article published in 2019 in the Journal of the American Medical Association (JAMA) Pediatrics, about 1 in 5 adolescents in the United States and 1 in 4 young adults have prediabetes. Once these young adults and adolescents are diagnosed with prediabetes, there is an increased risk of them developing heart disease and type 2 diabetes.
What Causes Prediabetes?
To be able to tackle this condition of prediabetes through diet and lifestyle, we must first discuss what causes this condition in the first place. Prediabetes primarily develops due to insulin resistance within the body. Insulin is a hormone produced in the pancreas with many functions, one of which is to allow glucose to enter cells to be either burned as energy or stored as glycogen for later use. As insulin resistance sets in, the glucose no longer can enter the cells and stays in the bloodstream, which causes the blood sugar level to rise.
Insulin Resistance – Let’s Dive A Little Deeper
The question we should be asking is what causes insulin resistance, and how can we avoid this. While this is a very complicated question, one simplified way to answer this is insulin resistance develops through the buildup of fats within our cells through a diet rich in unhealthy saturated fats, which no longer allow insulin to do its job of allowing glucose to enter. If we can understand the cause, then we should be able to address these lifestyle changes to lead to healthy blood glucose levels.
What Does The Evidence Suggest?
An article that was published in the New England Journal of Medicine in 2001 looked at 522 subjects with prediabetes and divided them into a control group that received standard-of-care and an intervention group that was counseled on achieving the following goals:
5 Goals To Aim For:
- 1. Weight loss of greater than 5% of their body weight
- 2. Fat intake less than 30% of their total daily caloric intake
- 3. Saturated-fat intake of less than 10% of their total daily caloric intake
- 4. Fiber intake greater than 15 g per 1000 kcal eaten during a day
- 5. Exercise for greater than 4 hours per week
What was most exciting about this study was that of the people in the intervention group who achieved at least 4 of these goals, none of them developed type-2 diabetes. These are the 5 goals that I currently recommend to my patients who are diagnosed with prediabetes. I can confidently tell them that if they reach 4 out of 5 of these goals then statistically speaking, they will NOT go on to develop type 2 diabetes.
What Does The ADA Suggest and How Do We Implement Those Changes?
Unfortunately, far too often when a patient is diagnosed with prediabetes, they are either not counseled properly on how to reduce their risk factors, or they’re just told to maintain a healthy diet and lose weight – without a detailed plan of how to implement these changes. According to the American Diabetes Association (ADA) position statement published in 2017, a variety of eating patterns exist for the management of prediabetes including the Mediterranean diet, DASH (dietary approach to stopping hypertension), and plant-based diets.
Whole Foods For the Win!
While these seem like three different diets with three different eating patterns, there are many more similarities than differences, as they all focus on an abundance of whole grains, vegetables, fruits, and legumes (complex carbohydrates). These dietary patterns also focus on an eating plan that’s focused on healthy monounsaturated fats, as compared to unhealthy trans and/or saturated fats, which we now know contribute to insulin resistance. The good news is that with the implementation of this type of dietary plan, reversing and preventing prediabetes is possible. Let’s dive into this a little deeper!
Recommendations for Prediabetic Patients
1. Embrace a Balanced Diet:
Prioritize whole foods: Base your meals on a variety of whole, unprocessed foods such as fruits, vegetables, lean proteins, and whole grains.
2. Manage carbohydrates:
Opt for complex carbohydrates with a low glycemic index to prevent rapid spikes in blood sugar levels. Include foods like quinoa, sweet potatoes, and legumes that have a lower glycemic index. Avoid simple carbohydrates such as white bread, candy, chips, and table sugar, as these are broken down in the body very quickly and absorbed, causing a spike in blood sugar.
3. Monitor portion sizes:
Be mindful of portion sizes to avoid overeating and help regulate blood sugar levels.
4. Choose the Right Fats:
Opt for healthy fats: Include sources of omega-3 fatty acids, such as fatty fish, flaxseeds, and walnuts. These fats have been linked to improved insulin sensitivity.
5. Limit saturated and trans fats:
Reduce intake of saturated and trans fats found in processed foods, fried items, and certain cooking oils.
6. Prioritize Protein:
Include lean proteins: Incorporate lean protein sources like poultry, fish, tofu, and legumes into your diet. Protein helps stabilize blood sugar levels and promotes a feeling of fullness.
7. Stay Hydrated:
Drink plenty of water. Adequate hydration is essential for overall health and can aid in maintaining stable blood sugar levels. Limit sugary beverages and opt for water or herbal teas instead. Adults should aim to drink about 3-4 liters of water per day – and this can be a good strategy to help keep you full as you attempt to lose weight.
8. Regular Physical Activity:
Engage in regular exercise: Physical activity plays a crucial role in managing prediabetes. Aim for at least 150 minutes of moderate-intensity exercise per week, such as brisk walking, cycling, or swimming.
9. Include strength training:
Incorporate strength training exercises to improve muscle mass and enhance insulin sensitivity. These activities help to maintain a healthy weight and reduce the risk of cardiovascular disease.
10. Manage Stress:
Practice stress-reducing activities: Chronic stress can contribute to insulin resistance. Explore activities like yoga, meditation, or deep breathing exercises to manage stress levels.
11. Enough Sleep:
Prioritize sleep: Aim for 7-9 hours of quality sleep each night. Not getting adequate sleep patterns can negatively impact insulin sensitivity and increase the risk of developing diabetes. Several studies have correlated sleep apnea/sleep deprivation with elevated blood sugar levels and insulin resistance.
12. Regular Monitoring:
Keep track of blood sugar levels: Regularly monitor your blood sugar levels to track progress and identify any potential concerns. This can be done through home monitoring or regular check-ups with healthcare professionals.
How Do You Reverse Prediabetes – Conclusion:
Reversing prediabetes and maintaining normal blood sugar levels is achievable through a holistic approach that encompasses dietary changes, regular physical activity, stress management, and healthy lifestyle habits. By adopting these strategies, individuals can take control of their health, reduce the risk of developing diabetes, and enjoy a better quality of life. Remember that even small changes can have a profound impact on your health and reduce the risk of chronic disease. It’s important to consult with your healthcare provider for personalized guidance and support on the journey to reversing prediabetes.
