By John Messmer
Penn State Milton S. Hershey Medical Center
Penn State College of Medicine
An epidemic of cardiovascular disease is developing right now, but it won't be noticeable for another decade or two. This epidemic will result in death and disability for millions and increase the cost of health-care by billions. The good news is that it is mostly preventable, but we must begin to work on the problem today.
The problem is type 2 diabetes. There are more than 18 million diabetics in the United States today. Worse, the number of diabetics has more than doubled since 1980. Many diabetics are undiagnosed because there are no symptoms until damage has occurred, and this takes many years. There are more than 16 million people with impaired glucose tolerance or prediabetes. Prediabetics are not safe because damage to the heart and blood vessels begins in the prediabetic stage.
Type 2 diabetes does not require insulin until late in the course and has previously been a disease of adults. Good statistics are not yet available, but increasing numbers of teenagers with type 2 diabetes are being diagnosed. These children will face heart attacks, strokes, kidney failure and amputations in their 40s if the diabetes is not stopped. Because younger women are diabetic, there could be more birth defects and miscarriages because these risks are increased in diabetic pregnancies.
There is a very simple reason for this epidemic -- obesity. Type 2 diabetes is caused by obesity about 90 percent of the time. Those with type 2 diabetics in the family, particularly a parent or sibling, have greater risk. Latino, Native-American, African-American, Asian-American and Pacific Islander ethnic groups also have higher risk.
Diabetes alone is bad enough, but many diabetics also have dangerous cholesterol profiles. Typically there is too much triglyceride and not enough HDL or "good" cholesterol. While diabetics often have low levels of LDL or bad cholesterol, this is deceiving since the presence of increased glucose levels makes the LDL stickier and more likely to clog the arteries causing heart disease, strokes and poor circulation. Diabetes is so dangerous to the cardiovascular system that doctors treat diabetics as though they already have had a heart attack because they have as much risk as someone who has already had a heart attack.
Many diabetics smoke. That's about as dangerous as playing Russian roulette with three bullets instead of one. Diabetics who smoke scare doctors. Here's why: a 50-year-old nonsmoking man with slightly high cholesterol who is overweight but still does not have diabetes has a 10 year risk of heart disease of about 10 percent. (The lowest risk he could possibly achieve if everything were perfect is 2 percent.) If he develops diabetes, his risk increases to 16 percent. Add smoking and the risk is 25 percent. That's only the risk of heart disease -- smoking accelerates the damage to the blood vessels everywhere with added risks of stroke, amputations and erectile dysfunction even if the diabetes is mild.
How the diabetes problem be fixed? Diabetes can be prevented in most cases, or put off until later years, by maintaining a normal weight. Normal weight is a body mass index (BMI) of between 20 and 25. For a 70-inch tall man, that means less than 175 pounds; less than 160 pounds for a 67-inch woman. BMI can be calculated at http://nhlbisupport.com/bmi/bmicalc.htm
If someone already has diabetes or impaired glucose tolerance (prediabetes), his or her doctor probably has measured his or her fasting glucose, hemoglobin A1c and possibly glucose two hours after eating (2 hour postprandial). There are recommended goals for these tests that are associated with reduced risks of complications. The risks only are reduced, not eliminated, as long as blood sugars remain above normal. The American Diabetes Association says there is no safe blood glucose level that is still above normal. Only normal glucose returns risk to normal. For most diabetics and people at risk for diabetes, that means a normal BMI.
What is the best way to reach a normal weight? There are various diets and programs, medications and surgical approaches to weight loss, but which one is best? Although people can debate the relative merits of low-carbohydrate versus low-fat diet with or without medication or gastric bypass for weight loss, all successful programs have one common feature -- fewer calories. People who are overweight, like two-thirds of Americans, eat too much. It is not possible to become overweight any other way.
Start by eliminating foods that the body doesn't need -- snacks, desserts and second helpings. Do not substitute healthy foods, even fruit, for these -- people must eat less to lose weight. Next, reduce regular meal servings a bit. Remember to be consistent. If people cut back all week then eat more one day, they probably will not lose any weight and will likely become frustrated at the attempt. Read labels to see what has calories. Just because something is healthy does not mean it can be consumed freely. If it has calories, it counts. Exercise helps, but eating less is most important. More information on dieting is at http://live.psu.edu/story/6035
Type 2 diabetes is a disabling, deadly and costly disease that is preventable in most people. Maintain a normal weight. Start today to eat properly. During this holiday season, remember to give the gift of good health.