Indeed, the lifestyle changes Holly made—including daily walks and replacing her chocolate snack-cake stash with fresh fruit— worked pretty quickly, improving her blood sugar in just a few months. Even better, when Holly got pregnant again two years ago, she didn't develop gestational diabetes. "I'm definitely holding the line against the disease."
Tens of millions of Americans are in Holly's shoes—at risk for type 2 diabetes, dangerously high blood sugar that develops when the cells throughout your body resist insulin, the hormone that helps you absorb and use blood sugar. But so many people who are at risk aren't aware of it, and even if they are, don't know what to do.
According to the Centers for Disease Control and Prevention, an estimated 57 million Americans now have pre-diabetes—above-normal blood sugar that can lead to diabetes. Another 47 million have metabolic syndrome—a step before pre-diabetes, when blood sugar is OK but insulin resistance is developing. Women, thanks to genetics and hormones, are more at risk, with a 50% higher chance than men of developing pre-diabetes. But here's the amazing thing: Diet, exercise and other lifestyle changes really do work. Big-time.
In the landmark Diabetes Prevention Program that followed more than 3,000 women and men, people with pre-diabetes lowered their odds for developing full-blown diabetes 58% by making healthy tweaks to their diet, exercising for 30 minutes on most days and losing a little weight. In fact, the changes worked even better than medication.
"Weight loss, exercise and a healthy diet attack diabetes on all fronts," says Osama Hamdy, MD, medical director of the Obesity Clinical Program at the Harvard-affiliated Joslin Diabetes Center in Boston. "When you lose weight, you shed abdominal fat, the type that triggers insulin resistance," Dr. Hamdy explains. "Exercise also makes your muscle cells more sensitive to insulin, and fruits, vegetables and whole grains help cool off the chronic inflammation involved in diabetes. No drug can do all that."
The evidence is so strong that researchers at the Harvard School of Public Health think that healthy habits could prevent 90% of type 2 diabetes cases. But the key is taking protective steps long before a doctor says you're headed for trouble. To help you do just that, our experts took the four main strategies of the Diabetes Prevention Program and created a four-week plan for you to follow—no major overhaul necessary.
Week 1: Move!
Your goal: Thirty minutes of activity such as walking, riding an exercise bike, swimming or doing a workout DVD at home most days of the week, plus strength training (lifting weights, using resistance bands) two to three times a week. How to do it:
Think 10-10-10. Ten minutes of stretching in the morning, a brisk 10-minute walk at lunch, and 10 minutes of strength training in the evening every day adds up to 3 1/2 hours a week of exercise—an hour more than people in the Diabetes Prevention Program did. And the short bursts really work. One British study showed that very short, high-intensity workouts on exercise bikes improved insulin resistance by 23% in just two weeks.
Put it on your calendar. If you prefer 30-minute sessions, take time on Sunday night to pencil them into your calendar on at least five days each week, says exercise physiologist Heather Nettle, MA, of the Cleveland Clinic department of Sports Health and Orthopaedic Rehabilitation. "Then tell your family, 'This is my time to exercise. Unless something major happens, I don't want to be interrupted.' Scheduling makes it more formal, and you might even find that your kids or spouse will remind and support you."
Strength-train while you watch TV. Devote commercial time to a few muscle-building (and maintaining) moves. "We all start to lose muscle mass in our 30s. The more you have, the more calories you burn around the clock and the better you absorb blood sugar," Dr. Hamdy says. Try crunches, modified push-ups (on your hands and knees), squats and lunges, Nettle suggests. "Aim for two to three strength-training sessions per week for the best results." For a few quick routines, go to WomansDay.com/Strength.
Pick up your pace with the talk test. Once you've got a regular workout going, kick it up a notch. When Harvard School of Public Health researchers tracked more than 70,000 nurses for 6 years, they found that those who exercised vigorously were half as likely to develop diabetes as those who didn't. "Aim for a moderately intense pace, where you can hold a conversation fairly easily but if you started singing, you'd be out of breath," suggests Nettle.
Week 2: Stop Portion Distortion
Being overweight doubles your odds of developing diabetes, and if you're very overweight or obese your chances triple. The key to keeping the scale steady—or losing weight if you need to—is to practice portion control. "Eating less means retraining your brain, your stomach and your expectations so you know what a healthy portion looks like—and how it feels when you eat it," says Laurence Kennedy, MD, chairman of the Endocrinology, Diabetes and Metabolism Department at the Cleveland Clinic.
Measure. Use measuring cups and spoons to check portions before you eat. Sounds like a pain, but after you do this a few times you'll be able to eyeball it. (But remeasure monthly to make sure you're not inching toward overdoing it.)
Divide your plate. Another way to make sure you're eating the right amount: Fill half of your plate with vegetables (with little or no added fats, oils, breading or sauces). Use one-fourth for meat or a non-meat protein such as beans, eggs or tofu, and one fourth for a grain or starchy vegetable such as brown rice or a small sweet potato.
Wait 20 minutes after eating. "This is how long it takes for your brain to register the 'I'm full' message," explains Susan Iannicca, MS, RD, a diabetes educator at the Cleveland Clinic. "If you're not satisfied after that, have another serving of vegetables."
Week 3: Hello, Fiber
Whole grains, fruits, vegetables and other high-fiber foods protect against diabetes by filling you up for fewer calories, slowing the natural rise in blood sugar after a meal, and providing nutrients such as magnesium and chromium. Research proves it: In a recent study, women who ate the most fruit were 34% less likely to have metabolic syndrome; those who had the most vegetables cut their risk by 30%. Another large study revealed that people who got the most fiber from grain products such as bread and cereal (and obviously whole grains are best) were 27% less likely to develop diabetes. You need about 25 grams of fiber per day.
Visualize your goal. Every day, aim for three servings of whole grains (one serving = a slice of bread or 1/2 cup brown rice), 2 cups of fruit (one medium apple or orange is about 1 cup) and 2 1/2 cups of vegetables. "It adds up faster than you think—a salad with grilled chicken, field greens and cherry tomatoes could contain 3 cups of vegetables," Iannicca notes.
Have at least two servings of fruits and/or vegetables at every meal. This will make reaching that 25 grams a no-brainer. Double up at dinner by serving an extra vegetable—even if it's an appetizer, like sliced red pepper strips, carrots and zucchini.
Check the Nutrition Facts label. Make sure breads and cereals have at least 3 grams of fiber per serving. Five grams is even better. Take a look at the ingredients list, too: A whole grain like rolled oats or whole-wheat flour should be first.
Week 4: Fix Your Fats
There's the good—poly- and monounsaturated fat—and the bad—saturated and trans. Your mission is to cut the amount of saturated fat to less than 7% of your total calories (that's about 14 grams or less a day for a 2,000-calorie diet) and have the good fats in moderation. "People think that when it comes to diabetes, their first concern should be sugar. But looking at the quantity and quality of fat in your diet, rather than focusing on sugar, is what leads to weight loss, which lowers your risk of getting diabetes," says Peragallo- Dittko. In real-life terms, here's what 14 grams of saturated fat (the upper limit of what you want to eat in a day) boils down to: a small fast-food cheeseburger and a vanilla shake—or two glasses of 1% milk, two slices of lowfat Swiss cheese, a small hamburger made with extra-lean ground beef, 1/2 cup lowfat ice cream and 2 scrambled eggs. Be sure to read all labels carefully for saturated fat gram counts: As you can see, even "healthy" foods have it.
Snack strategically on nuts. They're an excellent source of the "good" monounsaturated fats, which some research shows may protect against diabetes by reducing low-grade inflammation, making cells a little more insulin-sensitive and even helping with healthy insulin production. Pairing a small handful of nuts (1/4 cup or less) with a piece of fruit or a small bowl of sliced raw veggies gets good-for-you monounsaturated fats into your diet without going overboard.
Cook with olive or canola oil. Rich in monounsaturated fats, these oils are a smart swap for butter, which is packed with saturated fat. Just watch how much you use: One tablespoon has 120 calories.
Switch to lowfat or fat-free dairy. The calorie and fat savings can be dramatic. An 8-oz glass of whole milk has 8 grams of saturated fat; lowfat (1%) has just 2.5 grams and fat-free (skim) obviously has none. If you drink two glasses a day, switching to fat-free could save you 16 grams of saturated fat.
Keep the (lean) beef. Choose cuts labeled "extra lean"—the USDA's designation for meat with less than 2 grams of saturated fat in a 3 1/2-oz serving. Leanest cuts include eye of round, top round and bottom round. Skip fattier ones like ribs, ribeye, spare ribs and brisket. But remember that the leanest beef still has more fat than skinless poultry, so be sure to limit it to only one or two times a week.
Sidestep "stealth fat" in chicken and turkey. Trimming the fat and removing the skin from a chicken breast cuts saturated fat in half. If you're buying ground turkey instead of ground beef, be sure it's turkey breast; regular ground turkey and some turkey products may contain fattier dark meat and even turkey skin, which raises the fat content as high as some ground beefs. Look for types that say "light meat," "white meat," or "breast" on the ingredients list.
You have the power to lower your risk for diabetes. Visit WomansDay.com/Diabetes on November 9, 2010 at 1 p.m. EST for Your Anti-Diabetes Action Plan, a conversation between Landcruisers health director Amy F. Brightfield and Deneen Vojta, MD, Senior Vice President of the UnitedHealth Center for Health Reform and Modernization.