Simple Steps to Lower Your Risk of Type II Diabetes

Simple Steps to Lower Your Risk of Type II Diabetes

Making a few lifestyle changes can dramatically lower the chances of developing type 2 diabetes. The same changes can also lower the chances of developing heart disease and some cancers.

Control Your Weight
Excess weight is the single most important cause of type 2 diabetes. Being overweight increases the chances of developing type 2 diabetes seven fold. Being obese makes you 20 to 40 times more likely to develop diabetes than someone with a healthy weight. (8)

Losing weight can help if your weight is above the healthy-weight range. Losing 7 to 10 percent of your current weight can cut your chances of developing type 2 diabetes in half.

Get Moving
Inactivity promotes type 2 diabetes. (16) Every two hours you spend watching TV instead of pursuing something more active increases the chances of developing diabetes by 14 percent. (17) Working your muscles more often and making them work harder improves their ability to use insulin and absorb glucose. This puts less stress on your insulin-making cells.

Long bouts of hot, sweaty exercise aren’t necessary to reap this benefit. Findings from the Nurses’ Health Study and Health Professionals Follow-up Study suggest that walking briskly for a half hour every day reduces the risk of developing type 2 diabetes by 30 percent. (18, 19) More recently, The Black Women’s Health Study reported similar diabetes-prevention benefits for brisk walking of more than 5 hours per week. (20)

This amount of exercise has a variety of other benefits as well. And even greater cardiovascular and other advantages can be attained by more, and more intense, exercise.

Tune Up Your Diet
Four dietary changes can have a big impact on the risk of type 2 diabetes.
1. Choose whole grains and whole grain products over highly processed carbohydrates.
There’s a growing body of evidence that diets rich in whole grains protect against diabetes, whereas diets rich in refined carbohydrates lead to increased risk. In the Nurses’ Health Studies I and II, for example, researchers looked at the whole grain consumption of more than 160,000 women whose health and dietary habits were followed for up to 18 years. Women who averaged two to three servings of whole grains a day were 30 percent less likely to have developed type 2 diabetes than those who rarely ate whole grains. (21) When the researchers combined these results with those of several other large studies, they found that eating an extra 2 servings of whole grains a day decreased the risk of type 2 diabetes by 21 percent.
Whole grains don’t contain a magical nutrient that fights diabetes and improves health. It’s the entire package—elements intact and working together—that’s important. The bran and fiber in whole grains make it more difficult for digestive enzymes to break down the starches into glucose. This leads to lower, slower increases in blood sugar and insulin, and a lower glycemic index. As a result, they stress the body’s insulin-making machinery less, and so may help prevent type 2 diabetes. (22) Whole grains are also rich in essential vitamins, minerals, and phytochemicals that may help reduce the risk of diabetes.
In contrast, white bread, white rice, mashed potatoes, donuts, bagels, and many breakfast cereals have what’s called a high glycemic index and glycemic load. That means they cause sustained spikes in blood sugar and insulin levels, which in turn may lead to increased diabetes risk. (22) In China, for example, where white rice is a staple, the Shanghai Women’s Health Study found that women whose diets had the highest glycemic index had a 21 percent higher risk of developing type 2 diabetes, compared to women whose diets had the lowest glycemic index. (23) Similar findings were reported in the Black Women’s Health Study. (24)

2. Skip the sugary drinks.
Like refined grains, sugary beverages have a high glycemic load, and drinking more of this sugary stuff is associated with increased risk of diabetes. In the Nurses’ Health Study II, women who drank one or more sugar-sweetened beverages per day had an 83 percent higher risk of type 2 diabetes, compared to women who drank less than one sugar-sweetened beverage per month; drinking one or more servings of fruit punch per day doubled the risk of diabetes. (25)

The Black Women’s Health Study, which followed 59,000 African American women for 10 years, found a similar link between sugary soft drinks and type II diabetes. (26) The study also suggests that fruit drinks—such as Kool Aid, fortified fruit drinks, or juices—are not the healthy choice that food advertisements often portray them to be: Women in the study who drank two or more servings of fruit drinks a day had a 31 percent higher risk of type 2 diabetes, compared to women who drank less than one serving a month.
How do sugary drinks lead to this increased risk? Weight gain may explain the link: In both the Nurses’ Health Study II and the Black Women’s Health Study, women who increased their consumption of sugary drinks gained more weight than women who cut back on sugary drinks. (25, 26) Several studies show that children and adults who drink soda or other sugar-sweetened beverages are more likely to gain weight than those who don’t, (27, 28) and that switching from these to water or unsweetened beverages can reduce weight. (29) Even so, however, weight gain caused by sugary drinks may not completely explain the increased diabetes risk. There is mounting evidence that sugary drinks contribute to chronic inflammation, high triglycerides, decreased “good” (HDL) cholesterol, and increased insulin resistance, all of which are risk factors for diabetes. (30)

3. Choose good fats instead of bad fats.
The types of fats in your diet can also affect the development of diabetes. Good fats, such as the polyunsaturated fats found in liquid vegetable oils, nuts, and seeds can help ward off type 2 diabetes. (31) Trans fats do just the opposite. (8, 32) These bad fats are found in many margarines, packaged baked goods, fried foods in most fast-food restaurants, and any product that lists “partially hydrogenated vegetable oil” on the label. Eating polyunsaturated fats from fish—also known as “long chain omega 3” or “marine omega 3” fats—does not protect against diabetes, even though there is much evidence that these marine omega 3 fats help prevent heart disease. (33) If you already have diabetes, eating fish can help protect you against a heart attack or dying from heart disease. (34)
4. Limit red meat and avoid processed meat.
People who regularly eat red meat have roughly a 20 percent greater risk of type 2 diabetes than people who rarely or never eat red meat. (35) It may be that the high iron content of red meat diminishes insulin’s effectiveness or damages the cells that produce insulin. Eating lots of processed meat can also increase your diabetes risk. (35) Red and processed meats are a hallmark of the unhealthful “Western” dietary pattern, which seems to trigger diabetes in people who are already at genetic risk. (36) So skip the steak, bologna, and ham. Nuts, seeds, beans, tofu, or poultry are much more healthful protein choices.

If You Smoke, Try to Quit
Add type 2 diabetes to the long list of health problems linked with smoking. Smokers are roughly 50 percent more likely to develop diabetes than nonsmokers, and heavy smokers have an even higher risk. (37)

Alcohol Now and Then May Help

A growing body of evidence links moderate alcohol consumption with reduced risk of heart disease. The same may be true for type 2 diabetes. Moderate amounts of alcohol—up to a drink a day for women, up to two drinks a day for men—increases the efficiency of insulin at getting glucose inside cells. And some studies indicate that moderate alcohol consumption decreases the risk of type 2 diabetes. (8, 38-43) If you already drink alcohol, the key is to keep your consumption in the moderate range, as higher amounts of alcohol could increase diabetes risk. (44) If you don’t drink alcohol, there’s no need to start—you can get the same benefits by losing weight, exercising more, and changing your eating patterns.

The Bottom Line: Preventing Type 2 Diabetes
They key to preventing type 2 diabetes can be boiled down to five words: Stay lean and stay active.

1. American Diabetes A. Economic Costs of Diabetes in the U.S. in 2007. Diabetes Care. 2008; 31:596-615.

2. Narayan KMV, Boyle JP, Geiss LS, Saaddine JB, Thompson TJ. Impact of Recent Increase in Incidence on Future Diabetes Burden: U.S., 2005-2050. Diabetes Care. 2006; 29:2114-2116.

3. Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010; 87:4-14.

4. Niniño AM, Heron, M.P., Murphy, S.L., Kochanek, K.D. Deaths, Final Data 2004. National Vital Statistics Report. Vol. 55. Hyattsville, MD: National Center for Health Statistics, 2007.

5. National Diabetes Statistics fact sheet: general information and national estimates on diabetes in the United States. U.S. Department of Health and Human Services, National Institute of Health.

6. Search for Diabetes in Youth Study Group. The Burden of Diabetes Mellitus Among US Youth: Prevalence Estimates From the SEARCH for Diabetes in Youth Study. Pediatrics. 2006; 118:1510-1518.

7. Total prevalence of diabetes & pre-diabetes. American Diabetes Association.

8. Hu FB, Manson JE, Stampfer MJ, et al. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med. 2001; 345:790-7.

9. van Dam RM, Rimm EB, Willett WC, Stampfer MJ, Hu FB. Dietary patterns and risk for type 2 diabetes mellitus in U.S. men. Ann Intern Med. 2002; 136:201-9.

10. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002; 346:393-403.

11. Knowler WC, Fowler SE, Hamman RF, et al. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009; 374:1677-86.

12. Tuomilehto J, Lindstrom J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001; 344:1343-50.

13. Lindstrom J, Ilanne-Parikka P, Peltonen M, et al. Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Lancet. 2006; 368:1673-9.

14. Pan XR, Li GW, Hu YH, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care. 1997; 20:537-44.

15. Li G, Zhang P, Wang J, et al. The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study. Lancet. 2008; 371:1783-9.

16. Rana JS, Li TY, Manson JE, Hu FB. Adiposity Compared With Physical Inactivity and Risk of Type 2 Diabetes in Women. Diabetes Care. 2007; 30:53-58.

17. Hu FB, Li TY, Colditz GA, Willett WC, Manson JE. Television watching and other sedentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in women. JAMA. 2003; 289:1785-91.

18. Tanasescu M, Leitzmann MF, Rimm EB, Hu FB. Physical activity in relation to cardiovascular disease and total mortality among men with type 2 diabetes. Circulation. 2003.

19. Hu FB, Sigal RJ, Rich-Edwards JW, et al. Walking compared with vigorous physical activity and risk of type 2 diabetes in women: a prospective study. JAMA. 1999; 282:1433-9.

20. Krishnan S, Rosenberg L, Palmer JR. Physical activity and television watching in relation to risk of type 2 diabetes: the Black Women’s Health Study. Am J Epidemiol. 2009; 169:428-34.

21. de Munter JS, Hu FB, Spiegelman D, Franz M, van Dam RM. Whole grain, bran, and germ intake and risk of type 2 diabetes: a prospective cohort study and systematic review. PLoS Med. 2007; 4:e261.

22. Ludwig DS. The glycemic index: physiological mechanisms relating to obesity, diabetes, and cardiovascular disease. JAMA. 2002; 287:2414-23.

23. Villegas R, Liu S, Gao Y-T, et al. Prospective Study of Dietary Carbohydrates, Glycemic Index, Glycemic Load, and Incidence of Type 2 Diabetes Mellitus in Middle-aged Chinese Women. Arch Intern Med. 2007; 167:2310-2316.

24. Krishnan S, Rosenberg L, Singer M, et al. Glycemic Index, Glycemic Load, and Cereal Fiber Intake and Risk of Type 2 Diabetes in US Black Women. Arch Intern Med. 2007; 167:2304-2309.

25. Schulze MB, Manson JE, Ludwig DS, et al. Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. JAMA. 2004; 292:927-34.

26. Palmer JR, Boggs DA, Krishnan S, Hu FB, Singer M, Rosenberg L. Sugar-sweetened beverages and incidence of type 2 diabetes mellitus in African American women. Arch of Intern Med. 2008; 168:1487-1492.

27. Ludwig DS, Peterson KE, Gortmaker SL. Relation between consumption of sugar–sweetened drinks and childhood obesity: a prospective, observational analysis. Lancet. 2001; 357:505–508.

28. Vartanian LR, Schwartz MB, Brownell KD. Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis. Am J Public Health. 2007; 97:667-75.

29. Ebbeling CB, Feldman HA, Osganian SK, Chomitz VR, Ellenbogen SJ, Ludwig DS. Effects of decreasing sugar–sweetened beverage consumption on body weight in adolescents: a randomized, controlled pilot study. Pediatrics. 2006; 117:673–80.

30. Malik VS, Popkin BM, Bray GA, DesprÄs JP, Hu FB. Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk. Circulation. 2010; 121:1356-64.

31. Riserus U, Willett WC, Hu FB. Dietary fats and prevention of type 2 diabetes. Prog Lipid Res. 2009; 48:44-51.

32. Mozaffarian D, Katan MB, Ascherio A, Stampfer MJ, Willett WC. Trans fatty acids and cardiovascular disease. N Engl J Med. 2006; 354:1601-13.

33. Kaushik M, Mozaffarian D, Spiegelman D, Manson JE, Willett WC, Hu FB. Long-chain omega-3 fatty acids, fish intake, and the risk of type 2 diabetes mellitus. Am J Clin Nutr. 2009; 90:613-20.

34. Hu FB, Cho E, Rexrode KM, Albert CM, Manson JE. Fish and long-chain omega-3 fatty acid intake and risk of coronary heart disease and total mortality in diabetic women. Circulation. 2003; 107:1852-7.

35. Aune D, Ursin G, Veierod MB. Meat consumption and the risk of type 2 diabetes: a systematic review and meta-analysis of cohort studies. Diabetologia. 2009; 52:2277-87.

36. Qi L, Cornelis MC, Zhang C, van Dam RM, Hu FB. Genetic predisposition, Western dietary pattern, and the risk of type 2 diabetes in men. Am J Clin Nutr. 2009; 89:1453-8.

37. Willi C, Bodenmann P, Ghali WA, Faris PD, Cornuz J. Active Smoking and the Risk of Type 2 Diabetes: A Systematic Review and Meta-analysis. JAMA. 2007; 298:2654-2664.

38. Djousse L, Biggs ML, Mukamal KJ, Siscovick DS. Alcohol consumption and type 2 diabetes among older adults: the Cardiovascular Health Study. Obesity (Silver Spring). 2007; 15:1758-65.

39. Rimm EB, Chan J, Stampfer MJ, Colditz GA, Willett WC. Prospective study of cigarette smoking, alcohol use, and the risk of diabetes in men. BMJ. 1995; 310:555-9.

40. Koppes LL, Dekker JM, Hendriks HF, Bouter LM, Heine RJ. Moderate alcohol consumption lowers the risk of type 2 diabetes: a meta-analysis of prospective observational studies. Diabetes Care. 2005; 28:719-25.

41. Conigrave KM, Hu BF, Camargo CA, Jr., Stampfer MJ, Willett WC, Rimm EB. A prospective study of drinking patterns in relation to risk of type 2 diabetes among men. Diabetes. 2001; 50:2390-5.

42. Mukamal KJ, Conigrave KM, Mittleman MA, et al. Roles of drinking pattern and type of alcohol consumed in coronary heart disease in men. N Engl J Med. 2003; 348:109-18.

43. Joosten MM, Grobbee DE, van der AD, Verschuren WM, Hendriks HF, Beulens JW. Combined effect of alcohol consumption and lifestyle behaviors on risk of type 2 diabetes. Am J Clin Nutr. 2010. Apr 21 Epub ahead of print.

44. Baliunas DO, Taylor BJ, Irving H, et al. Alcohol as a risk factor for type 2 diabetes: A systematic review and meta-analysis. Diabetes Care. 2009; 32:2123-32.


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: