Type 2 Diabetes: Are You At Risk?
What’s the latest?
Statistics released in May by charity Diabetes UK show that diabetes diagnoses have doubled in the last 15 years, and that a record 4.9 million people in the UK – and more than one-in-ten over-40s – are currently living with the condition. Studies also show that in 90% of cases, the cause of diabetes is down to an unhealthy diet and lifestyle. Unmanaged, diabetes can cause a host of problems – chronically raised blood sugar levels can damage blood vessels that supply oxygen to the body, raising the risk of heart attacks and strokes. Research also shows people with Type 2 diabetes suffer poor circulation to their extremities and high blood sugar levels can damage the kidneys. Diabetes can also cause nerve problems and affect eyesight.
What lifestyle factors are to blame – is it all down to obesity?
Yes and no. Dr Michael Mosley, GP and founder of The Fast 800, says that rising obesity levels are a significant factor in the rise in cases. “Rising cases of diabetes among British adults follows soaring rates of obesity. Britain is the fattest nation in Western Europe, with rates of obesity rising even faster than those in the US.” Dr Sarah Brewer, doctor and registered nutritionist, agrees, adding that women of a healthy weight are 27 times less likely to develop diabetes. “When you are overweight, fat builds up in your liver, causing it to produce too much glucose. Excess fat also spills over from your liver to your pancreas where it accumulates and switches off the genes that regulate insulin production. It’s this process that’s believed to trigger Type 2 diabetes,” she says. However, even if your BMI falls within the healthy range, you are still at risk, she explains. “You are also at risk if you have ‘skinny fat syndrome’. In this case, your BMI may appear healthy, but you carry excess fat around your internal organs. This visceral fat is metabolically active and leaks inflammatory chemicals directly into the blood, which can affect the liver and pancreas’ ability to process sugar.”
Does having a sweet tooth put you at an increased risk of diabetes?
There’s still an assumption that having a sweet tooth leads to diabetes, meaning those who don’t indulge in sugary treats regularly feel they are ‘safe’, but this isn’t the case. Although insulin is released by the body to regulate sugar in the blood, it doesn’t mean that if you give up sweets and chocolate, you’re guaranteed not to develop Type 2 diabetes. “Any refined carbohydrates – think white bread, white pasta and potatoes – will be quickly broken down into glucose in the body, sending a flood of sugar around your system,” explains Sarah. Being post-menopausal also puts you at an increased risk, says Michael. “As we age, our insulin receptors become less sensitive, which is why weight loss around and after the menopause can be harder. Women at this stage in life can have very high levels of insulin, which means your blood will be replete with glucose and fatty acids. Those with insulin resistance may find fat begins to infiltrate the liver and pancreas. Once there, it can wreak havoc with your insulin production, further upsetting your appetite and blood sugar, and increasing your risk of Type 2 diabetes.” You’re also at risk if you smoke or suffered with gestational diabetes while pregnant.
Are there other hormones that can make you more susceptible to diabetes?
Stress hormones may also play a role, according to Sarah. “A recent study assessed the personality traits of almost 140,000 post-menopausal women then followed them over a 14-year period, looking for links between emotional and physical health. Women with the highest levels of optimism were 12% less likely to go on to develop Type 2 diabetes than those who were naturally pessimistic. Those with the lowest scores for negative emotional expressiveness had a 9% reduced risk, while those with the lowest levels of hostility had a 17% lower risk of diabetes. These findings may be due to the effects of stress hormones which raise blood glucose levels and increase insulin resistance.”
Will losing weight help reduce your risk?
Experts agree losing excess fat will greatly improve your insulin production and help other cells – especially muscle cells – become less resistant to its effects, so glucose control improves. “For meaningful results, you need to lose at least 5% of your body weight,” says Sarah. “If you weigh 100kg, for example, this is equivalent to losing 5kg. A recent study found almost nine out of ten people with Type 2 diabetes who lost 15kg or more returned to normal glucose control. But even losing 1kg of excess fat can make a difference. If losing significant amounts of weight feels daunting, focus on small goals – 1kg at a time will still make a difference.”
Is there anything else you can do?
Multiple studies show that for those who lead a sedentary lifestyle, the risk of Type 2 diabetes is higher. “Regular, heart-raising exercise appears to lead to improvements in your body’s insulin response and function,” explains Dr Alexandra Oliver, medical director for Bupa Health Clinics. “When you exercise, less insulin is required to keep your blood sugar level steady, meaning that staying active is crucial. Aim for at least 150 minutes of moderate intensity activity over the course of the week. Alternatively, do 75 minutes of vigorous intensity exercise or even shorter amounts at very high intensity, such as sprints or climbing the stairs. It’s also important to do some strengthening exercises at least twice a week – this could be heavy gardening or exercising with weights,” she says. As you get fit, aim to do more – ideally the equivalent of an hour’s brisk walking on most days.
What about diet?
It goes without saying that diet plays an integral role in preventing diabetes. Here, the experts share their golden rules…
THINK LOW-GI: “Cut back on foods that contain rapidly-digested carbs, which can cause glucose levels to rise, such as biscuits, cakes, pastries, white bread and potatoes. Instead, look to low-glycaemic index sources of carbs such as fruit, vegetables, wholegrains and pulses.” – Sarah
LOAD YOUR PLATE WITH GREENS: “Get out of the habit of basing meals around carbs. Instead, plan meals around vegetables, and then think what you can serve them with. Your plate should be half low-starch vegetables, such as green, leafy veg, one quarter lean protein and one quarter high-fibre wholegrains. Make sure protein is in there – it will keep you fuller for longer and keep blood sugar stable. Tinned sardines on wholegrain toast with a pile of steamed greens is a great lunch option, while a chicken traybake with roasted vegetables and a dollop of pesto makes for a speedy supper.” – Susan Saunders, author of The Age Well Plan
FILL UP WITH FIBRE: “Vegetables are your best friends if you’re trying to reduce your risk of Type 2 diabetes. They are a good source of fibre, and low levels of fibre have been linked to an increased risk of diabetes.” – Susan
DITCH FRUIT JUICE: “Research shows eating whole fruit rather than drinking the juice of the fruit may lower the risk of Type 2 diabetes. Scientists believe this is down to the high fibre content of fruit, which is removed during the juicing process. If you are craving something sweet, reach for high-fibre dates or a small amount of very dark chocolate.” – Susan
EAT AN APPLE A DAY: “Even though fruit contains natural sugars, most have a low to moderate GI index and don’t raise blood glucose levels excessively. One study found women who ate at least one apple per day were 28% less likely to develop Type 2 diabetes. Plums can also decrease blood glucose levels, and red and black grapes contain antioxidants that boost pancreatic insulin production.” – Sarah
DON’T SKIP BREAKFAST: “Breakfast kickstarts your metabolism, so you burn more glucose as energy. It also reduces food cravings, so you don’t overeat later in the day. People with Type 2 diabetes who eat breakfast seven days a week tend to weigh less than those who only eat breakfast three to six times per week. Just avoid breakfast cereals and cereal bars.” – Sarah
What are the signs you may be pre-diabetic?
Most people with Type 2 diabetes first go through a stage in which their insulin levels are high and their ability to handle glucose is poor, which can be identified as pre-diabetes. The term is not recognised by the World Health Organisation, but it’s widely used by medical professionals. If your waist size is increasing, if you suffer from fatigue, are constantly thirsty or need to go to the loo more than usual in the night, these could be signs you need to take action. “Also keep an eye out for darkened skin on certain parts of the body, such as your neck, armpits, elbows, knees and knuckles, which can be a sign of pre-diabetes,” says Alexandra.
If you are pre-diabetic, what can you do?
Michael, who lost more than 9kg and reversed his pre-diabetes seven years ago, says that if you have weight to lose, fasting can help. “Cutting calories to just 800 per day for 12 weeks can help you reverse Type 2 diabetes,” he tells us. “800 is the magic number – it’s high enough to be sustainable and give you all the nutrients you need while also being low enough to lead to rapid weight loss. The idea that fasting slows the metabolism is a myth. When your body is in a calorie deficit – i.e. 800 calories per day or less – not only do you lose weight, but your body responds to the stress of fasting by boosting hormone function to burn fat for energy and reducing insulin.” What you eat when fasting also matters, says Michael, who recommends looking to the Mediterranean diet for inspiration. “A diet high in vegetables, fruits, pulses, wholegrains, oily fish, lean meat and olive oil has multiple benefits and is naturally low in carbs and rich in nutrients.”
For more information visit TheFast800.com, SusanSaundersHealth.com, Bupa.co.uk and DrSarahBrewer.com
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