PREVENTION OF DIABETES

Gabe Mirkin, M.D.

Generally, the risk of developing diabetes increases with age. The disease
can also affect women during pregnancy, leading to complications for both
mother and child. Certain population groups, notably indigenous Australians
and some ethnic groups, have higher rates of diabetes.
Many cases of Type 2 diabetes could be prevented or delayed through
simple lifestyle changes that lower the risks of diabetes and other chronic
diseases, such as cardiovascular diseases and cancer. These risks include
excess weight, poor diet, inactivity, smoking and too much alcohol

A study from George Washington University shows that the drug,

Glucophage, and a diet low in refined carbohydrates can prevent diabetes in
many people who would otherwise become diabetic.
Diabetes damages cells by causing blood sugar levels to rise too high after
meals. Moderate elevations in blood sugar don't cause much damage. The
drug, Glucophage, helps prevent blood sugar levels from rising too high after
meals. It is extremely safe except for people with kidney damage, and can
sometimes cause diarrhea.
You can also prevent diabetes by avoiding foods that cause high rises in
blood sugar. All people who store fat primarily in their bellies, have high
blood triglycerides or low levels of the good HDL cholesterol, have a strong
family history of diabetes, or women who have cysts on their ovaries, should
eat a diet that restricts bakery products, pastas, fruit juices, and sugaradded foods. Many will also benefit from taking Glucophage. See report
#D222.
Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New
England Journal of Medicine, 2002, Vol 346, Iss 6, pp 393-403. WC Knowler, E BarrettConnor,
SE Fowler, RF Hamman, JM Lachin, EA Walker, DM Nathan. Knowler WC, George Washington
Univ, Ctr Biostat, Diabet Prevent Progarm Coordinating Ctr, 6110 Execut Blvd, Suite 750,
Rockville,MD 20852 USA

WHOLE GRAINS PREVENT DIABETES

Gabe Mirkin, M.D.
A study from Harvard School of Public Health shows that people who do not
eat whole grains are at increased risk for developing diabetes. The Health
Professionals Follow-up Study followed 43,000 doctors who did not have a
history of diabetes or cardiovascular disease, for 12 yeas from 1986 to 1998.
Of the 43,000 doctors, 1197 developed diabetes. Researchers then adjusted
the data for causes of diabetes, such as age; physical activity; cigarette
smoking; alcohol consumption; family history of diabetes; and fruit,
vegetable, and energy intake. They found that the relative risk of type 2
diabetes in whole grain eaters was half that of those who didn't eat whole
grains.
The difference between eating whole grains and foods made with ground-up
grains (flour) is that you have a high rise in blood sugar after eating bakery
products and pastas, and a much slower and shallower rise in blood sugar
after eating whole grains. The authors conclude that: "In men, a diet high in
whole grains is associated with a reduced risk of type 2 diabetes. Efforts
should be made to replace refined-grain with whole-grain foods." See report
#D222.

DIET PREVENTS DIABETES

Gabe Mirkin, M.D.
A study from Harvard Medical School shows that eating a diet low in refined
carbohydrates and meat can protect people from getting diabetes.
People are at high risk for diabetes when they eat a diet loaded with meat,
French fries, high-fat dairy products, and refined carbohydrates such as
bakery products, pastas, desserts and other sugar-added foods. People are at
low risk for diabetes when they eat lots of vegetables, fruits, fish and whole
grains. Not everyone who eats a high-fat, high refined carbohydrate diet gets
diabetes. Those with good genes are protected, but if you have a genetic
susceptibility to diabetes, you can protect yourself from developing the
disease by eating lots of plants the way you find them in nature and
restricting refined carbohydrates in bakery products, pastas, sugar added
foods, and sweets. You souls also avoid being overweight and exercise
regularly. See report #D222.

TREATMENT OF DIABETES
Gabe Mirkin, M.D.
The treatment of diabetes has changed dramatically over the last year and
some doctors are harming their patients by not keeping up with the latest
guidelines. The United Kingdom Prospective Diabetes Study (UKPDS) showed
that tight blood sugar control can prevent blindness, deafness, heart attacks,
strokes, kidney failure, amputations, impotence, burning foot syndrome and
other complications of diabetes.
The primary goal of treating diabetes is to get the blood test HBA1C to
normal. When you eat, your blood sugar level rises. If it rises too high, sugar
sticks to cells and can never get off. Sugar stuck on cells is converted to a
poison called sorbitol that destroys the cells. This is what causes all the
complications of diabetes. If a diabetic can keep HBA1C in the normal range,
he is no more likely to suffer the horrible side effects of diabetes than a
person who is not diabetic.
The first rule is to avoid the foods that cause a high rise in blood sugar.
Second, the doctor must do a blood test called C peptide to see if person can
produce insulin. If the C peptide is above 1, that person's pancreas makes
insulin and the odds are overwhelming that the person should not be on
insulin. Nobody should take insulin unless he needs it, because insulin
constricts arteries to cause heart attacks and it also causes obesity. If a
person has a normal C peptide, signifying that his body makes insulin, he
should not be put on insulin.
If his HBA1C is above 6.5, signifying that his diabetes in out-of-control, he
should be put on other drugs. Glucophage (metformin) is taken before meals
to prevent blood sugar levels from rising too high after meals. Actos or
Avandia make the cells more sensitive to insulin so less insulin is required.
Other drugs to cause the pancreas to make more insulin. Most doctors start
with all three types of drugs, strict dietary control and an exercise program.
As the HBA1C blood test returns to normal, the drugs are removed one at a a
time.
If a diabetic cannot be managed with these three drugs, the doctor should
add the exciting new injectable LANTUS insulin that is given at night and
lasts for 24 hours. If you are a diabetic and your HBA1C is not below 6.2, you
may want to get a second opinion on your management because you are at
high risk for serious side effects such as a heart attack, stroke, blindness,
deafness, kidney failure, impotence or burning foot syndrome. See report
#D222.

INCREASED INCIDENCE OF DIABETES

IN LAST 10 YEARS
Gabe Mirkin, M.D.
In the last ten years, the incidence of diabetes in San Antonio, Texas has
risen rapidly, probably due to increased intake of foods made from bakery
products and pastas. This study reflects what's happening throughout North
America.
Diabetes that starts in later life is usually caused by inability to respond to
insulin, rather than having low levels of insulin. Before insulin can do its job
of driving sugar from the bloodstream into cells, it must first attach to hooks
on cells called insulin receptors. When cells are full of fat or you eat too much
fat, cells lose insulin receptors, so insulin can't find its docking receptors.
Late-onset diabetes is usually caused by eating too many calories and
gaining too much weight. Many people try to restrict fat and cholesterol in
meat and chicken, and substitute bakery products and pasta. They end up
eating more calories, gain weight and become diabetic. Everyone should eat
more whole grains, beans and vegetables, and restrict foods made with flour
or added sugars. See report #D222.

DIAGNOSING DIABETES
Gabe Mirkin, M.D.
A recent paper from Indiana University shows that the present way to
diagnose diabetes deprives many people of treatment.
The most commonly used way to diagnose of diabetes depends on having a
fasting blood sugar above 126 mmol/L, or 180 mmol/L two hour after eating.
This is not reliable. The side effects of diabetes are caused by blood sugar
levels rising too high after meals, causing sugar to stick to cells. Once stuck
on a cell, sugar is converted to a poison called sorbitol that causes heart
attacks, strokes, blindness, deafness and kidney damage. The test to
measure how much sugar is stuck on cells is called HBA1C. If HBA1C is high,
a person is headed for the side effects of diabetes, no matter whether you
call this diabetes or not. This study shows that the current recommendations
for the diagnosis of diabetes are denying proper treatment to many patients.
See report #D222.

FATS DO NOT RAISE CHOLESTEROL IN

YOUNG DIABETICS
Gabe Mirkin, M.D.
Researchers in North Adelaide, Australia report that high blood levels of the
bad LDL cholesterol and triglycerides in diabetics are caused by eating a diet
high in carbohydrates, not fat.
Diabetic children with the highest blood levels of triglycerides and the bad DL
cholesterol ate the most carbohydrates and the least saturated fat, and have
the highest levels of HbA1C, a blood test that measures a diabetics
susceptibility to nerve damage, kidney failure, heart attacks and stokes.
This study shows that diabetics should avoid foods that cause the highest
blood sugar rises after meals, that cause the highest blood levels of HBA1C.
It is more important to avoid foods made from flour and with added sugar,
than to avoid sources of saturated fats such as meat, chicken and whole-milk
dairy products. According to his study, a diabetic diet should avoid bakery
products, pastas, and foods with added sugars.

NUTS REDUCE RISK OF DIABETES

Gabe Mirkin, M.D.
A report from the Nurses Study from Harvard School of Public Health shows
that eatiing nuts or peanut butter may help to prevent diabetes in women.
83,818 apparently healthy women have been followed for 16 years, and 3206
have developed diabetes. Those who eat nuts five times per week were far
less likely to develop diabetes. Those who were overweight, smoked, or
drank alcohol regularly were at increased risk for diabetes.
You increase risk for diabetes by having a high rise in blood sugar after
meals, particularly after eating too much refined carbohydrates found in
bakery products, pastas, and sugar-added foods. Nuts do not cause a high
rise in blood sugar because they are loaded with polyunsaturated and
monounsaturated fats. Eating nuts with along other foods may slow the rise
in blood sugar caused by those foods as well. However, since a pound of
peanuts contains more than 200 grams of fat and 2800 calories, the authors
recommend that you substitute reasonable portions of nuts for refined grain
products, meat or processed foods; do not just add nuts to your present diet.
See report #D222.

WHO IS PRE-DIABETIC?
Gabe Mirkin, M.D.
A study from Sweden shows that many people discover that they are diabetic
only after they have had a heart attack. Researchers recorded blood sugar
levels in men who had had heart attacks and then did sugar tolerance tests
at discharge and three months later. They found that 40 percent had
impaired sugar tolerance tests three months later. This suggests that 40
percent of people who have heart attacks are diabetic, even though they may
not know it. The authors recommend that all people with heart attacks be
tested for diabetes (1).
You can tell if you are at high risk for diabetes if you store fat primarily in
your belly. Pinch your belly; if you can pinch an inch, you are at increased
risk and should get a blood test called HBA1C. Having high blood levels of
triglycerides and low levels of the good HDL cholesterol that helps prevent
heart attacks also increases your risk for diabetes. When you eat sugar or
flour, your blood sugar rises too high. This causes your pancreas to release
insulin that converts sugar to triglycerides, which are poured into your
bloodstream. Then the good HDL cholesterol tries to remove triglycerides by
carrying them back into the liver, so having high blood levels of triglycerides
and low blood levels of the good HDL cholesterol are both individual risk
factors for diabetes.
High blood levels of insulin constrict arteries to raise blood pressure, so many
people who have high blood pressure are also prediabetic. High insulin levels
also constrict the arteries leading to your heart to cause heart attacks
directly. People with insulin resistance have an increase in small, dense, lowdensity lipoprotein (LDL) cholesterol, which is more likely to cause heart
attacks than the large, buoyant regular LDL cholesterol. High levels of insulin
also cause clotting to increase your risk for heart attacks. You can help to
prevent diabetes and heart attacks by avoiding sugar and flour, exercising
and eating lots of vegetables.