Look Ahead to Threat of Diabetes ?

By Pam McLoughlin

In theory at least, Memorial Day is all about looking back, reflecting on the courage and sacrifice that purchased and protects our way of life. In practice, there seems to be a comparable commitment to the unofficial launch of summer, and stuffing ourselves at backyard barbecues. In light of that, it may be prudent to devote some attention to looking at the threats that lie ahead, as well as the past. The toll of war is a terrible thing, as we are reminded on almost a daily basis in our news from Iraq. But the war we all wage with our innate vulnerabilities and the enemies of our health — infectious disease, and increasingly chronic disease — exacts a far greater toll, and knows no peace.

The last great flu pandemic of 1918, for instance, caused more deaths than every war fought in the 20th and 21st centuries combined. Heart disease has claimed even more.

Prominent among our new-age enemies is diabetes, an explosive epidemic that already represents the fourth-leading cause of death in the United States, with potential to move up those ranks. And just as wars of the military variety are being fought with new weapons in new ways, the threat of diabetes has emerged on new fronts, in new guises.

When I went to medical school, I learned about two kinds of diabetes: juvenile onset and adult onset. Less than a generation ago, “adult onset” diabetes was a condition almost exclusive to overweight, sedentary, middle-aged adults; and it was bad enough.

In the time since my training, we have renamed “adult onset” diabetes “type 2,” because it is now a condition of children, too. In a mere 20 years we have witnessed the transformation of a chronic disease of midlife into a pediatric epidemic.

But this is not the worst news from this front. An organization called the National Cholesterol Education Program Adult Treatment Panel issues expert guidance to clinicians in the treatment of risk factors for heart disease. Their guidelines essentially equate diabetes with heart disease because the presence of the one so reliably implies the threat of the other.

So the writing is on the wall. If children 7 and 8 are getting “adult onset” diabetes, and diabetes is a certain indication of heart disease risk, then it stands to reason that adolescents will become vulnerable to angina and heart attack. I have heard one case to date of a 17-year-old boy undergoing triple coronary bypass. For now, that’s rare enough to be noteworthy and horrifying, but that was once true of adult-onset diabetes in children, too.

What makes all of this particularly tragic is that we know how to prevent this toll, if not altogether at least nearly so. There is widespread consensus among experts that by applying what we already know, we could prevent as much as 90 percent of type 2 diabetes, by far the more common variety.

We have medication that can help do this job. In a clinical trial called DREAM, the drug Avandia reduced diabetes occurrence in high- risk individuals by 60 percent. In the Diabetes Prevention Program, an older and apparently safer drug, metformin (Glucophage) prevented progression to diabetes in 30 percent of subjects.

But we can do better than medication. In that same Diabetes Prevention Program, the combination of a sensible, balanced diet (i.e., based mostly on vegetables, fruits, whole grains, lean meats, nuts, seeds, beans, and other foods close to nature), portion control and moderate physical activity cut diabetes rates by 58 percent, just about as good as the most potent drugs we have, minus the side effects or cost. Several other trials have replicated this same benefit.

And just last week, the medical journal Lancet published a paper, based on a diabetes prevention study in China, showing that a healthy lifestyle is the gift that keeps on giving. Adults at high risk for diabetes participated in a six-year study of diet and physical activity that began in the 1980s. The Lancet authors found that their risk of diabetes was still roughly 40 percent less 14 years after the study ended! Learn a bit about eating well and being active, in other words, and it can help shield you from diabetes for decades.

The most obvious risk factors for type 2 diabetes are a family history and a big belly. This is true of kids as well as a adults, so assess your family with a loving but realistic eye. If you want to get technical, use a tape measure around your middle at the level of you navel; more than 35 inches in a woman or 40 inches in a man signifies increased risk. Other risk factors are obvious only with a doctor’s help — elevated blood pressure, a low HDL cholesterol and high triglycerides.

The primary defense against type 2 diabetes is weight loss, achieved by eating well and being active — not a quick fix. Be sure to make this a family affair, because everyone is vulnerable, so everyone needs protection. Specific defense against diabetes comes from soluble fiber in oatmeal, beans, lentils, apples and berries and from monounsaturated fats in olives, avocados, nuts, seeds, olive and canola oils. Physical activity, at least 30 minutes a day, is protective whether weight is lost or not.

Memorial Day certainly warrants some reflection on the past, our reverence and respect for sacrifices made on our behalf. But by looking ahead at threats that loom and can be prevented, we might avoid unnecessary sacrifices in the future. Perhaps one of the important ways to honor those who defended our way of life is to defend our own lives so we may live to enjoy the benefits purchased with the blood of patriots. Viewed that way, applying what we know to take care of ourselves and prevent diabetes might seem less of a chore and more of a duty.

By all means enjoy the barbecue; just save a little room for some food for thought.

Dr. David L. Katz can be reached at www.davidkatzmd.com.

(c) 2008 New Haven Register. Provided by ProQuest Information and Learning. All rights Reserved.