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HEALTHY LIFE: DIABETES
November 11, 2012
Breaking the cycle
— with Type 2 diabetes, diet, exercise changes can overrule genetics
By SHANNON O. WELLS
Pamplin Media Group
I
van Watts’ mother was a Type
2 diabetic. For years, that
knowledge didn’t keep him
from indulging his passion for
hot fudge sundaes and similarly
high-caloric tasty treats.
“Quite frankly, I’d go off on a
binge and eat some things I shouldn’t
eat — sugar and pies — that type of
thing,” he said.
But eventually, his body stopped
agreeing with his high-sugar-and-
empty-calories tastes.
“It acted like alcohol in my sys-
tem,” he says. “I found myself getting
drunk — at least that’s the way I felt.
Not being a drinker, I had a hard time
understanding what was going on.”
Diagnosed in his early 70s with the
same condition fromwhich his moth-
er suffered, the Cedar Hills man re-
luctantly incorporated directives
fromhis doctor tomodify his diet and
engage in physical exercise. While he
knows what can be gained by these
changes, it’s often a challenge to fol-
low through.
“You can actually diet your way
out of it,” he says of Type 2 diabetes.
“What you eat is extremely impor-
tant.”
When it came to keeping diabetes
at bay, Watts’ sweet tooth proved
stronger than his knowledge of family
medical history. But when those ge-
netically predisposed to diabetes take
control of lifestyle choices early in life,
it’s usually within their power to stop
the diabetic cycle from continuing.
“Regardless of your genetic predis-
position — but it’s more important if
you are— lifestyle improvements can
benefit your health,” says Dr. Leon-
ard Bertheau, medical director of the
Adventist Health Medical Group’s
Diabetes and Endocrine Center. “If
you have a genetic predisposition,
you should be more apt to improve
your lifestyle to decrease your likeli-
hood of getting it.”
Rejected inheritance
As patients are used to hearing
from their doctors, diet and exercise
— reductions in the former and in-
creases in the latter — are the key
lifestyle changes that make a big dif-
ference in avoiding diabetes as well
as reversing its influence once it’s
been diagnosed.
Unlike Type 1 diabetes, an autoim-
mune disorder in which a malfunc-
tioning pancreas fails to produce nec-
essary insulin, the more common
Type 2 is a metabolic disorder that
leads to high glucose levels and insu-
lin resistance — the inability of cells
to respond adequately to normal in-
sulin levels.
Although Type 1 requires the deli-
cate daily ritual of insulin injection,
it’s Type 2 that’s more likely to pass
genetically from one generation to
the next.
“Type 2 has a stronger genetic
component than Type 1,” Bertheau
says.
And the higher the number imme-
diate family members diagnosed, the
greater the chance of their offspring
becoming diabetic. In most cases,
however, a genetically predisposed
person of healthy weight — body
mass index (BMI) of 25 or lower —
who eats a reasonably healthy, low
caloric-intake diet, is not destined to
be a Type 2 diabetic.
“It’s usually not the healthy, fit per-
son,” says Dr. Elizabeth Stephens, an
endocrinologist in the Medical Edu-
cation Department at Portland Provi-
dence Medical Group Northeast. “It’s
the person for whom the (healthy)
lifestyle is more challenging where
their genes put them at risk.”
Smart changes
But positive changes in diet and
exercise clearly pay off.
Stephens cites findings from the
Diabetes Prevention Program, a fed-
erally funded study of 3,234 people at
high risk for diabetes. The study re-
vealed a 5-to 7-percent weight loss
— 10 to 14 pounds for a 200-pound
person — slowed development of
Type 2 diabetes by improving the
body’s ability to use insulin and pro-
cess glucose.
Participants in the lifestyle inter-
vention group—those receiving indi-
vidual counseling and motivational
support on effective diet, exercise,
and behaviormodification—reduced
their diabetes risk by 58 percent.
“Pre-diabetes is manageable with
lifestyle changes,” says Stephens,
who admits she takes a different tack
when it comes to exercise. “It scares
people off. I focus on activities they
can incorporate into their daily life:
taking the stairs, parking further
away, things that are easier to do
than exercising at the gym.”
Quantity and quality of sleep is an-
other important factor.
“Sleep is a huge one,” she says.
“Sleep deprivation has a huge impact
on metabolic rates, food cravings,
cortisol levels fromstress. It has a big
impact on food choices as well as
physiology.”
Caloric intake
When it comes to eating, becoming
diabetic — contrary to widely popu-
lar belief — is not necessarily about
consuming sugary snacks.
“It’s about the obesity,” Bertheau
says. “The epidemic is dramatically
changing. It’s not just sugar content
per se, it’s the calories — the preva-
lence of high-calorie foods that are
plentiful and cheap.”
A high-carbohydrate, low-protein
diet —which the proliferation of pro-
cessed, pre-packaged foods makes
very convenient — is simply not the
way to go.
“The worst-case scenario is to eat
or two meals a day that are very high
in carbs,” he says. “That’s the perfect
recipe for weight gain. The best case
is to eat six small snacks (throughout
the day) that are low in carbs and
high in protein.”
Exercise is fundamental, but like
Stephens advocates, it doesn’t have
to be a radical transition.
“If you’re not exercising, start,”
Bertheau says. “Walk for two min-
utes, five minutes. After that, on a
weekly basis start increasing the
amount you’re doing. You don’t need
real aggressive exercise.
“Walking is plenty, but every day
you should get up to 30 to 60 min-
utes,” he adds.
Diabetes doctor decides to set an example
Descrbing his former self as “morbidly obese,” Dr.
Leonard Bertheau, got tired of not living the lifestyle
he preached to his patients.
“I figured I’d better be a good role model for pa-
tients,” the 42-year-old Vancouver, Wash., resident
says.
Bertheau, the medical director of the Adventist
Health Medical Group’s Diabetes and Endocrine
Center, adopted enough diet and exercise changes
this year to drop 80 pounds.
“My A1c (hemoglobin) levels and fasting blood
sugar levels went back to normal,” he says, “and I
just erased my chances of getting diabetes.
“In my journey,” he admits, “it was a lot easier to
lose weight through diet restriction” than exercise.
Fortunately, Bertheau was able to arrest his con-
dition before it developed further.
Genetically predisposed patients whose fasting
blood-sugar and A1c levels are measured at diabetic
levels can reverse their condition, he notes, but the
diagnosis remains.
“There’s a predisposition, a tendency there, and
you want to be diligent, be on top of it. You still have
to toe the line, watch it and monitor blood-sugar lev-
els,” he says. “But with correct lifestyle modifica-
tions, you can have your blood sugar levels go to
normal without any medications. It’s possible, but
not a guarantee.”
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