How to prevent and control diabetes with diet and exercise

It's been called one of America's fastest-growing epidemics. In King County, the number of people with diabetes has doubled in the past decade. Nationally, more than 20 million people have developed the disease, an alarming number of them children.

Diabetes is a major risk factor for a whole host of serious diseases, including heart attack, blindness, kidney failure and can lead to limb amputations.

But one positive feature of this potentially deadly disease: Type 2 diabetes can be controlled or even prevented through healthy lifestyle choices.

What is diabetes? It's a disease in which a person's blood sugar — glucose — is too high. The hormone insulin helps glucose get into cells to give them energy. When insulin malfunctions, sugar accumulates outside the cells in the blood. This means that cells "starve" because they can't get energy, and the extra sugar goes to places it shouldn't — like the kidneys, nerves and eyes, causing damage.

There are two main types of diabetes. In Type 1, the body doesn't produce insulin. In Type 2, the body's cells are resistant to the effects of insulin or there isn't enough to go around. In the United States, 90 percent of diabetics are Type 2.

What can we do to prevent diabetes? The No. 1 thing is to exercise and keep a healthy weight. But even if your weight isn't ideal, you don't need to lose a lot to see results. In one well-designed study, people who combined 30 minutes a day of moderate exercise with 5 percent to 10 percent weight loss had 58 percent less chance of developing diabetes.

That means you don't have to lose a lot of weight or run marathons to drop your risk. Brisk walking, dancing or swimming once a day qualifies as moderate exercise.

Type 1 diabetes isn't usually considered preventable in the same way as Type 2. However, speaking from a holistic point of view, there are two interesting studies.

One large study from Finland suggests that infants who get enough vitamin D in the first year of life may be less likely to develop Type 1 diabetes. A second, large Australian study suggested that niacinamide, a form of vitamin B3, may be helpful in preventing Type 1 diabetes in high-risk children.

In fact, researchers are so interested in the second one that a large European study is now under way to explore the results.

How can we treat it? Type 1 diabetics require insulin for life, because they don't make it. That's why those prevention studies on niacinamide and vitamin D are so compelling.

For Type 2 diabetics, it depends. Some people can control their blood sugar by watching their diet and exercising, though often people need medication as well. Some also require insulin.

Some people ask me which is better for blood-sugar control — weight training or cardiovascular exercise? One well-designed study published in 2007 suggests that doing a combination of both is the best, though you will still see benefit with either one alone.

What about natural supplements to lower blood sugar? One simple thing to do to help lower blood sugar is to eat more soluble fiber. There are lots of sources of soluble fiber, including oats, barley, psyllium husk (Metamucil) and beans. It slows down the absorption of sugar from the intestine, and makes it easier to keep blood sugars under control after meals.

Many supplements are promoted for blood-sugar lowering. Two are bitter melon and chromium.

Two studies which combined chromium with standard medication suggest that it adds an extra boost to blood sugar lowering. This is still controversial, though, and the studies were small. There isn't much data on bitter melon, though it has been historically used for blood-sugar problems in Asia.

I do not recommend natural supplements as a substitution for conventional medical treatment, and I definitely recommend talking to your doctor about any supplements.

Does emotional stress affect blood sugar? Stress causes our bodies to think we are being attacked. As a result, it releases high amounts of "fight-or-flight" hormones. Their job is to mobilize lots of energy, including glucose, to help our cells respond to danger. In diabetes, though, there is a problem with insulin, so a lot of that glucose ends up accumulating in the blood instead.

It would make sense, then, that chronic stress would not be good for your blood sugar because your fight-or-flight hormones would be high all the time. This could lead to higher average blood sugars, and possibly, more medication.

Although there haven't been a huge number of human studies on this topic, one well designed study found that stress management dropped hemoglobin A1C (a long-term management of blood sugar) an additional 0.5 percent above the conventional approach. That is a small, but significant, amount.

Dr. Astrid Pujari is a Seattle M.D. with an additional degree as a medical herbalist; she practices at the Pujari Center and teaches as part of the residency programs at Virginia Mason and Swedish/Cherry Hill hospitals. All information is intended for education and not a substitute for medical advice. Consult your doctor before following any suggestions given here.