Spokane Journal of Business

Lifestyle changes can help reverse pre-diabetes

Weight loss is key for some to turn back insulin resistance

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Do you have difficulty losing weight? Do you have high cholesterol or high blood pressure, or have you been told you have pre-diabetes? What if I told you that you could prevent your heart attack and prevent diabetes? And what if you learned it could be accomplished through lifestyle changes?

About 1 in 3 adults and 1 in 5 adolescents in America have insulin resistance, also known as metabolic syndrome, or pre-diabetes. Insulin resistance causes blood sugar, or blood glucose, to become high in many people. This progresses to diabetes if lifestyle changes are not undertaken.

Many people with insulin resistance will become diabetics in the next five to 10 years. According to the most recent National Diabetes Statistics Report from the Centers for Disease Control and Prevention, 13% of U.S. adults and 27% of Americans aged 65 or over had diabetes in 2018.

Insulin resistance is typically caused by genes that are turned on under certain conditions, most commonly due to weight gain in the liver. Many people with insulin resistance aren’t considered obese. The genes are often turned on in those who are considered to be ideal body weight but have exceeded their personal fat threshold in their abdominal fat, and fat overflows to the liver and accumulates there. These people were typically thin in their 20s and have gained weight but are still within the range considered ideal body weight.

This is in contrast to others who seem to have limitless fat storage capacity in the tissues just under the skin and never develop insulin resistance despite being severely obese.

The National Cholesterol Education Program ATP III and International Diabetes Federation Guidelines both define a diagnosis for metabolic syndrome as meeting three or more of the following five criteria:

•Abdominal obesity, defined as a waist circumference greater than or equal to 40 inches in males and 35 inches in females.

•Serum triglycerides on your cholesterol panel greater than or equal to 150 or taking medication for elevated triglycerides.

•Serum HDL cholesterol on your cholesterol panel less than 40 in males and less than 50 in females or taking medication to lower HDL cholesterol.

•Blood pressure greater than or equal to 130/85 mmHg or taking medication to treat high blood pressure.

•Fasting blood sugar greater than or equal to 100 mg/dL or taking medication for elevated blood sugars.

People with insulin resistance have essentially built up a tolerance to insulin.

Insulin is like the key that unlocks the door to the liver and muscle cells. Once the door is open, blood glucose can enter the cell. This is a vital process because blood glucose is the main source of fuel for our bodies. With insulin resistance, the key doesn’t work very well and fewer cell doors unlock; therefore, glucose cannot enter the cells at the appropriate rate. As a result, the body tries to compensate by making more insulin. If the process continues long enough, it causes a rise in blood sugar and the excess insulin can have detrimental effects on the body.

Insulin resistance, if not reversed, eventually can result in Type 2 diabetes, which is the most common type of diabetes in the U.S.

Other, perhaps less known, consequences include heart disease, polycystic ovary syndrome, fatty liver disease that can progress to cirrhosis, gout, and increased risk for some cancers. Think of insulin resistance as the stock of a plant and each disease it causes as the individual leaves coming off the stock. Cut down the stock and you reverse all of the diseases. If you treat each disease with medications alone, you never treat the root of the problem.

Metabolic syndrome is a reversible condition for many people. To maximize treatment results, health interventions should be tailored to an individual's schedule, lifestyle, and potential barriers. Although weight loss, diet, and exercise are key lifestyle changes to focus on, the human body is complex; other areas to consider include hydration, sleep, stress reduction, and blood sugar monitoring. Additionally, a medication called metformin may be considered under certain circumstances.

Weight loss is the key to reversing insulin resistance. Multiple studies have proven this. We know from studies done on diabetic patients in the U.K., led by Dr. Roy Taylor, that insulin resistance of the liver can be reversed for some people in just seven days with a specific very low-calorie diet.

Some diabetic patients can potentially reverse their diabetes with Dr. Taylor’s method. Odds are highest in patients with a history of diabetes for less than four years. In those who have had diabetes for at least 10 years, odds are lower, but still possible. These patients achieved remission by losing an average of 33 pounds. If you are ideal body weight, you don’t have as much weight to lose. If you can lose 10% to 15% of your body weight and still stay in the ideal body weight category, your insulin resistance potentially can be reversed. 

In general, a low carbohydrate, low calorie nutrition plan rich in vegetables and lean proteins lowers blood sugar and aids in weight loss. The Carb Manager app, for example, calculates the number of net carbohydrates, protein, fat, and calories in food and can assist with meal planning. In addition, limit high-sugar and diet beverages, processed foods, and sugar-based sweets. Work with your provider to develop a customized meal plan that works for you.

Insulin resistance in the muscle can be improved moderately with exercise. According to the American Heart Association, practical, regular, and moderate exercise, such as brisk walking, for at least 2.5 hours a week for overall health can help. 

According to the National Academies of Sciences, Engineering, and Medicine, women should drink a minimum of two liters of water per day and men should drink a minimum of three liters. Hydration requirements vary and some people are on fluid restrictions due to kidney or heart issues, so check with your provider.

According to the American Academy of Sleep Medicine, there are clear associations between inadequate sleep and adverse health outcomes, such as depression, weight gain, obesity, diabetes, heart disease, and stroke. Additionally, adults who typically sleep less than seven hours per night have an increased risk of premature death. Children and adolescents have increased sleep requirements and as people age, their sleep requirements decline. Work with your provider on sleep hygiene methods if you are experiencing insomnia.

The impact of stress on illness and weight gain is largely unknown and likely underappreciated. Stress promotes fat storage and increases the risk of insulin resistance and its resultant sequela. In addition, chronic stress often leads to increased food consumption, especially unhealthy foods.

It is beneficial for pre-diabetics to learn how different foods affect their blood sugar levels by checking their blood glucose before eating a meal and two hours after. People quickly discover the impact of various foods on their blood sugar levels and ideally, make dietary changes based on this information.

Because of its effectiveness, low cost, and long-term safety, the American Diabetes Association recommends consideration of metformin for prevention of diabetes in some high-risk individuals under age 60. Many have success with Metformin if it is coupled with lifestyle changes.

Education is the key to prevention and healthier living. Although many Americans are insulin resistant, most are unaware of this fact. Through lifestyle changes, insulin resistance can be reversed and diseases such as diabetes, heart disease, and some cancers can be prevented.

Wellness is a journey of striving toward progress rather than perfection. Team with your health care provider to work toward a healthier you.

Jessica Blackwell, a family nurse practitioner, owns eVillageHealth. She can be contacted at 509.960.6527, or through her website at www.evillagehelath.com.


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