By Sheri Colberg, Ph.D., FACSM
Having diabetes increases the risk for a number of health problems. It also has the potential to rob an individual, on average, of more than twelve years of his or her life and to greatly reduce quality of life for more than twenty of those years!
A lesser quality of life can result from many physical ailments, but with diabetes, it often results from a compromised physical capacity, partial limb amputations, loss of mobility, chronic pain, blindness, chronic dialysis, and/or heart disease. For each of the 38.5 percent of average females born in the year 2000 or later predicted to develop diabetes, diabetes will cut her life short by 14.3 years if she is diagnosed by the age of 40 and reduce her quality of life for 22 of the years she does live.
These grim statistics are not meant to depress or frighten you as a health care provider, but rather to convince you that before that scenario becomes your patients’ future, your primary goal needs to become the prevention, reversal, or effective control of their insulin resistance and blood glucose levels. The good news is that the prevention of most diabetic complications is entirely possible with adequate blood glucose control, and most of the same strategies used to control diabetes and its complications will also reverse a prediabetic state and potentially prevent diabetes from ever occurring in the first place.
Is excess body fat the only culprit in insulin’s diminishing effectiveness? The diabetes epidemic is closely following on the heels of the obesity problem in the Unites States and worldwide. Undeniably, there is a link between excess body fat and some of these health problems that is not fully understood or defined, but since many people who are overfat are still insulin sensitive and have normal levels of blood fats, obesity is not necessarily to blame for everything. Many different factors can affect a person’s relative state of insulin resistance, and most scientists are guilty of incorrectly assuming that the co-existence of obesity with conditions such as high blood pressure, insulin resistance, and type 2 diabetes proves that excess body fat is their direct cause even though some evidence suggests otherwise. For instance, isolated fat cells (i.e., taken out of the body) can respond normally to insulin even when insulin action is impaired in the nondiabetic people the cells were taken from. Following endurance training without much weight loss, fat cells also become more responsive to insulin, as do muscle cells – and both types of cells are thought to contribute heavily to insulin resistance.
The latest research confirms that diabetic people do not have to lose significant amounts of body fat to be healthy. Is that to say, then, that there is no point in ever losing any weight or that it won’t benefit their health at all? Absolutely not! Losses of as little as 5 to 7% of body weight (10 to 14 pounds of fat for a 200-pound person) result in significant improvement in diabetes control in most individuals; however, it also proves that the obsessive focus placed on significant weight loss is unnecessary. In fact, people who continually lose and regain large amount of weight frequently end up fatter than ever, and with a greater risk of developing heart disease. Moreover, substantial weight loss is extremely ineffective as a diabetes treatment since very few (only 5 to 10%) dieters successfully lose and keep off extra body weight over time.
So, what’s the answer to living well with diabetes? It’s simple really: Becoming physically active. Late-breaking studies show that 90 minutes of weekly exercise alone reduces insulin resistance, independently of calorie restriction and/or weight loss in middle-aged men with prediabetes. Furthermore, diabetic participants in studies conducted by the Pritikin Longevity Centers who followed diets that were higher in fiber and complex carbohydrates, but very low in refined sugar, cholesterol, fat, and salt, and engaged in 30 minutes or more of daily exercise experienced remarkable results in only three weeks. Almost 75% of participants in the Pritikin study who had been taking oral diabetic medications were able to discontinue them, and close to 40 percent on insulin were also able to control their blood glucose levels without taking any. Although modest weight loss resulted from their change in lifestyle, their post-program body fatness was far from ideal after only three weeks, yet their diabetes control vastly improved.
Even if done just to prolong someone’s life, becoming physically fit is more than worth it, but there are numerous other reasons to do so. Being regularly active can reduce a person’s risk of certain cancers (e.g., colon, prostate, and breast), help lower blood pressure, prevent and reverse heart disease, reduce depression and anxiety, prevent osteoporosis, reverse prediabetes, and greatly lower the risk of developing diabetes. If someone already has diabetes, being active will make good diabetes control more attainable.
Why should anyone care about preventing or reversing such chronic ailments? Because they also have the potential to rob anyone of living well and of life. In fact, the more sedentary an individual is, the greater his or her risk of dying prematurely from any cause becomes. Even more important, though – at least in my opinion – is the increased likelihood of not feeling good while alive without physical fitness. Which of your patients could honestly say that he or she would really like spending the last twenty years of a diabetes-shortened life impaired by life-altering diabetic complications? Why risk the potential loss of living well with diabetes when anyone can prevent or minimize it and other chronic health problems simply by becoming more physically active?
Luckily, becoming “fit” doesn’t require a daily trip to the gym or doing physical activities that people normally abhor. It also doesn’t mean that an exerciser has to be able complete a marathon or a triathlon. But it does assume that each individual will work to achieve the capacity to physically accomplish whatever he or she wants to without becoming unduly fatigued – such as walking up a flight of stairs, picking up small kids or grandkids, working, running errands, volunteering, or doing other activities without stopping much to rest – sleep well at night, and still get up the next day and do it all over again.
Hopefully, you are no longer convinced that obesity necessarily or invariably causes a state of insulin resistance, type 2 diabetes, or even heart disease. While being overfat is not devoid of health risks, body fat loss alone is apparently neither a panacea nor a strict requirement. It is possible to be physically fit but still overweight and to live well with diabetes!
Next week, I will share Part 1 of Step 1 from my latest book, The 7 Step Diabetes Fitness Plan: Living Well and Being Fit with Diabetes, No Matter Your Weight (2006). For the younger generation, I have also written Diabetes-Free Kids: A Take-Charge Plan for Preventing and Treating Type 2 Diabetes in Children (2005), and type 1s and other insulin users, specific regimen changes by sport or activity are spelled out in The Diabetic Athlete: Prescriptions for Exercise and Sports (2001). Information about all of my books, my many articles, my research, and more is available on my web site: www.SheriColberg.com.
Tip for the day: Exercise generally results in slower weight loss than dieting alone, but with a greater loss of visceral (intra-abdominal) fat that contributes to insulin resistance.