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The recent report by the Centers for Disease Control and Prevention (CDC) is certainly alarming: it says that the number of Americans with diabetes will double or triple in the next forty years. If they're right, we'll see up to 1 in 3 of all Americans affected. The vast majority of these new cases will be Type 2 diabetes: people whose bodies continue to make insulin for regulating their blood sugars, but their bodies don’t use it properly.
Those who are already at a higher risk of developing type 2 diabetes include people who are older and with a family history of the disease, as well as being African American or Hispanic. Even so, Type 2 diabetes most commonly develops in those who are overweight or obese.
The authors of the CDC study looked at population data from the 2000 census as well as 2007 U.S. Census Bureau estimates. They considered estimated mortality rates, migration and birth statistics through 2050 and combined this with CDC statistics on the incidence rates of diabetes in the U.S. from 1980 through 2007. Using this information, the researchers arrived at estimates of the number of Americans who might be affected by diabetes over the course of the next 40 years.
They look at a number of scenarios in projecting future diabetes rates, ranging from such things as lower increase of death rates in diabetics to more aggressive prevention strategies. Depending on certain factors, Dr. Boyle and his colleagues project that between 21% and 33% of our population will be diagnosed with some form of diabetes. Interestingly, Dr. Boyle's team published a similar report in 2001, and their worst case projections for 2010 were for fewer cases of diabetes than we are seeing now . This makes their worst case scenario of one third of Americans being diabetic even more worrisome.
In spite of this report I believe that the news is not all bad. While this increase in diabetes is directly related to the rise in overweight and obesity in America, the good news is that in the last few years a lot of quality research has been done that shows the way to prevention. In short, people can avoid diabetes.
How can you keep from being part of these statistics? Change your lifestyle.
That statement sounds simple, and at some levels it is. The research shows that small changes in your regular diet can have a tremendous impact on your overall health. For instance, studies of those adopting a Mediterranean diet have a dramatic reduction in their weight, future illness and early death. This doesn't mean that you can only eat Greek salad and hummus. It simply means adopting the food profile of those in Mediterranean countries.
There are nine basic principles. Eat more vegetables, fruits and nuts, whole grains, healthy oils and fats and fish (especially the fattier fish). Eat less red meat and dairy (and that means consuming processed dairy, like cheese and yogurt, not milk for drinking). Drink alcohol only in moderation. The best part is that "more" or "less" doesn't take very much.
For example, for a woman eating a 1,500 calorie diet this means only eating about 9 ounces of vegetables per day for the average woman. Here is the Mediterranean diet broken down by each category and their amounts:
|Food Category||Average Per Day|
|Vegetables||More Than 8.9 ounces|
|Legumes (i.e., peas, peanuts, beans)||More Than 1.75 ounces|
|Fruits & Nuts||More Than 7.7 ounces|
|Dairy (cheese & yogurt)||Less Than 6.9 ounces|
| Cereals (whole wheat, bran, oatmeal,
brown rice, quinoa)
|More Than 8.9 ounces|
|Lean Meats||Less Than 3.25 ounces|
| Fish (especially fatty fish like tuna,
salmon, halibut, mackerel, cod)
|More Than 0.75 ounces|
Drinking between one and two alcoholic drinks per day (if you choose to drink) and using more of the good quality unsaturated fats, such as olive oil, than saturated fats (such as butter) also helps protect you from future health problems.
Many of your favorite recipes will fit well into a Mediterranean style diet. Chili made with lean meat and chock full of beans, onions and peppers is a good example. Red Beans and Rice, Blackened Redfish and Taco Salad are all part of a Mediterranean Diet. With a few tweaks like using whole grain ingredients, it's easy to make Tuna Noodle Casserole, Kung Pao Shrimp, Sloppy Joes and pizza (yes, pizza!) great for you and great tasting.
More importantly, not only can this pattern of eating help prevent health problems, it is clear that by following a Mediterranean style diet, over 50% of those who are diagnosed with diabetes can avoid needing to take medication to control their condition. In some cases diabetes can even be reversed.
The more extensive the lifestyle change, the better the results. In the recent Look Ahead trial, researchers showed that intensive lifestyle changes can produce long lasting weight loss along with improving fitness, control of blood sugar and reducing the risk of heart attack in individuals with Type 2 diabetes.
As a physician, I don't like bad news for my patients. But when it is followed by a good solution I always feel better. I am concerned by these projections, but at the same time I'm encouraged, because the chef in me understands that we have great solutions to these problems right in our own kitchens: eating great foods.
Eat well, eat healthy, enjoy life!
Timothy S. Harlan, M.D.
Arch Intern Med. 2010;170(17):1566-1575
Ann Intern Med. 2009;151:306-314
N Engl J Med 2003;348:2599-608.
Last updated: 11/08/10