GeorgeBMac

The results of the recently published DPPOS study show that lifestyle changes significantly reduce the chances for acquiring Type 2 diabetes in those at high risk for the disease.

The lifestyle changes studied were a "low fat" (25% fat) diet and 150 minutes of moderate exercise each week. However, as reported: "Another analysis found that weight loss was the main predictor of reduced risk for developing diabetes". So most likely, the lifestyle changes may have been just the means to the end -- which is lower body fat.

In any event:
What are the main findings of the DPPOS?
After an average of 10 years’ follow up, intensive lifestyle changes aimed at modest weight loss

•reduced the rate of developing type 2 diabetes by 34 percent compared with placebo.
•reduced the rate of developing type 2 diabetes by 49 percent in those age 60 and older compared with placebo.
•delayed type 2 diabetes by about 4 years compared with placebo.
•reduced cardiovascular risk factors.
•reduced hemoglobin A1c (A1C) and fasting glucose compared with placebo. The A1C test gives information about average blood glucose levels for the past 2 to 3 months.

The study was begun in 1996 under the title DPP and continued in 2002 under the title of DPPOS ("Diabetes Prevention Program Outcomes Study"). A Q&A on the trial are published here:

Questions & Answers about the Diabetes Prevention Program Outcomes (DPPOS) Study

eja_ bottecchia

As a Type 2 diabetic, with a 5.7 A1c, I agree 100% with the study's finding.

I only wish I had had that information 20 years ago.

GeorgeBMac

Wow!
.... THAT deserves a medal! (or at least a longer, healthier, happier life!)

And, yes, I know what you mean about "knowing that 20 years ago", My father died almost 50 years ago from a sudden heart attack that was probably brought on by high blood pressure. At the time, he knew that he had high blood pressure and he did his best with it, but the knowledge (and drugs) that we have today simply were not available to him back then.


For myself, I have had the same high blood pressure for the past nearly 20 years. For most of that time I controlled it pretty well with medication. But, I am currently managing it equally as well with life style changes that we just were not much aware of back while he was alive. Yes, we gave credit to eating well and being fit (obesity was not much of an issue back then), but we didn't know much about their connection to the 'traditional' western diseases...


So, what are they going to be saying about us 20-50 years from now?

wolfchild

Diabetes has become a worldwide problem, it's not just North America and western diet.. I was reading somewhere that way back in 1985 only about 30 million people worldwide had diabetes, fast forward to 2014 and there are now almost 300 million people worldwide who have the disease... The causes must be more then just an unhealthy North American diet.
India has the highest number of people with diabetes at 50 million, China 43 million, USA at 26 million...Pacific islands has 18% of adult population with diabetes, followed by Arabic countries: UAE, Saudi Arabia, Kuwait, Oman, Bahrain which has about 17% of adult population with diabetes...What gives ??

eja_ bottecchia

Well, there are two possible explanations for the worldwide spread of diabetes. One is, of course, better testing. It is so easy to use modern testing techniques, nor more peeing on a test strip to get BG results.

The other explanation is that Western style (read USA) diets are spreading worldwide. When Parisians are now eating Big Macs and KFC, you know that there is a problem.

As noted above my A1c is now, n the average, 5.7. I have cut my weight down to 190 (following a spike up after my recent angioplasty). Eating better, eating smaller portions (no super sizing for me) and exercising on a regular basis have helped more than any of the meds I previously took.

We can live healthier, it just takes a little work and forethought.

GeorgeBMac

Yes!

And, diabetes is arguably one of THE nastiest of diseases as it leads to things such as: infections, amputations, circulatory issues, neuropathies, kidney failure, blindness and, oh yeh, heart disease...

When I first started working in a hospital I was shocked when I realized that fully half of my patients on the med-surg floor were in there due to complications of diabetes...

So, it's not only a health problem -- it's a budget problem too. SOMEBODY has to pay for all of this!

Dunbar

I was listening to Doctor Radio and one of the endocrinologists said fatty liver disease is something they are seeing more and more and appears to be on the rise. You have to force feed ducks to get foi gras!

wolfchild

About 180 billion dollars per year in USA alone...Worldwide about 380 billion dollars.

eja_ bottecchia

Truth!

People don't die from diabetes. People die from the complications arising from diabetes.

GeorgeBMac

So, we are spending $180b a year because people either don't know or don't care that that they could prevent this (and other) chronic diseases with some relatively simple life style choices? Well, maybe not "simple". Look at the 'discussions' we have had in these forums on what constitutes a healthy diet. And, even the authors of this study called their changes (such as 150 minutes of weekly exercise) "intensive"...

In addition, I have seen it estimated that 80% of our health care dollars go towards preventable chronic diseases (such as diabetes) which has triggered massive debate on how to pay for those treatments and who should pay (or even IF anybody should pay). Yet, the simplest solution costs NOTHING! Just eliminate those diseases with effective lifestyle changes (not just the minor tweaks most health care agencies recommend).

Whether you agree with his diet or not, I think most people on this forum would agree with Caldwell Esselstyn when he says:
' Why do we consider splitting somebody's chest open "conservative treatment", but living a healthy lifestyle as "Intensive" or "extreme" '?

So, we are bankrupting ourselves promoting human suffering...
... Does anybody see any thing wrong with that picture?

Brianj0101001

As someone that's gone from a plump couch potatoe to a happy, reasonably fit cyclist in the span of a year, its definitely something I've thought about, and not just in the last year.

All the medical interventions, ranging from pills to stomach stapling, are all passive and reactionary. Get fat, get sick, and then get treatment.

I remember the "fat me", thinking over the last 2 decades, "Would be great to start exercising, get in shape, stop eating so much junk", and then I'd go back to the couch and eat more chips and do nothing about my looming fatness.

It takes a lot of discipline to change, and the society around us, our friends and family included, are either willing or unwilling saboteurs. As a fat person, I didnt hang out with healthy people and follow their habits, I hung out with my fellow chubbies, emulates their habits, and we all got collectively chubbier.

it meant the loneliness of ditching many of my friends. As the pounds came off, we failed to find common ground that didnt leave one or both of us uncomfortable. It also meant distancing myself from unhealthy family (one morbidly obese uncle who's recently had stomach stapling actually told me "Don't lose too much weight, that's not healthy"). Most of my family has tried at one point or another to talk me out of my "insanity".

my new friends in the cycling world get it, I don't have to explain it to them. We're all out there every week trying to better ourselves, get fit, and stay healthy. And when I go out to eat, everyone at the table is getting salad, modest portions, etc.

its crazy now to look at all the sedentary fat people, that I used to be just like, and simultaneously be able to relate to them deeply and personally AND not understand them any more. I still consider myself fat. My fellow cyclists get that, but don't judge. They see the effort I'm putting in, and the improvements I'm making as the months pass.

its just incredible to see how widespread the damage is becoming, the rate of childhood obesity and diabetes, etc.

GeorgeBMac

Yes, I have experienced much of the same. But I do find that it becomes easier as I settle into my new life and new dietary regimen and become more comfortable and secure in it. If nothing else, it's easier to 'just say no' to those addicted to our American processed food diet. Well, it's easier, but still not easy.

And, yes, I have found friends, even friends who are trying to lose weight tell me not to lose 'too much'... One told me I had lost too much already -- even though my BMI shows that I am still a tad overweight. I think the American dial has swung to where fat is associated with health and fit and trim with frailty and illness.

My wellness physician thinks I should weigh the same now as when I was in high school. My friends think he is giving me bad advice.

Brianj0101001

I can look in the mirror and tell for myself that I'm still fat. And that's been my sanity check. I also have "before" pictures as I've progressed through my "reinvention", and I can see the fat coming off, I can see the muscle definition cycling and other exercise has given me.

and its very encouraging.

I actually can't tell by the scale anymore. The muscle growth has obscured the number. But my pants keep getting looser!

chasm54

Almost all of the countries you mention have an obesity problem. Not sure about China, but then again, there are an awful lot of Chinese. Certainly urban India, the Pacific Islands, and the oil-rich Middle-Eastern countries have far too many fat people.

Losing weight and spending less time sitting down (except on a bike, of course!) seem to be the big factors in avoiding, or in some cases even curing, type 2 diabetes.

ModeratedUser150120149

Fits with the AA mantra. If you want to change your life you have to change what you do and your friends. Although it has been confirmed with studies a person doesn't need much more than a trip to the super store or mall to see that post-high school people tend to group together by their size and attractiveness. Fat people tend to be with fat people and the converse.

My perspective changed radically when I worked in a lab and in the same time frame got a better look at just who Type 2 diabetics were and what they did. Mostly they have a self induced disease they will not do anything about. Society in general, rather than helping them take responsibility for their disease has decided to enable the bad behavior. It has gotten so bad that in many places if you are a normal person you are out of place.

Yes, there are exceptions, very few exceptions, but basically Type 2 Diabetes is caused by poor behavior and society's willingness to let the people with that behavior push responsibility off to others. As that societal norm spreads around the world so does the diabetes epidemic spread. All this is aided by the tremendous amount of money to be made off treating this largely self-induced disease.

IARide4Fun

WOW, that is me too. I was diagnosed in February. I have picked up the pace in my riding. My pants barely stay on and the doc says that I am only down 10 pounds. I was a little disappointed. But my body must be changing with the added riding.

GeorgeBMac

I find the same: Nothing scientific, just my own experience: Namely, diet mostly reduces weight while cycling mostly reduces my waist size. I particularly saw that when I was off the bike for 3 or 4 weeks with a muscle sprain -- my weight held the same or declined a little while my waist size increased. Then, once I got back on the bike, my waist size came back down again.
... Again, nothing scientific, just my own experience.

But, I think science agrees that exercise and good nutrition work differently.

And, most believe that belly fat is the prime trigger for insulin resistance, diabetes, heart disease and other nasty stuff. So, cycling does help -- even if it doesn't bring down overall weight.

Black wallnut 

IMHO they keep missing the target. It is not Fat that makes us fat. It is not diet that controls BG. It is exercise that controls. Part of the reason for the increase in numbers is the ever spiraling downward the level where people are diagnosed.

I'll not say 20 years ago but surely 10 years before my diagnosis I was warned by my Dr. and like most I did nothing. Then I was diagnosed close to the time that I purchased my first bike. A year later I was in worse condition. That was a wake-up for me and I made changes, small ones to diet huge ones to exercise. Cycling became an every day thing with time, distance and speed increasing ever since. My A1c after becoming serious about cycling and losing only some weight but still in the morbidly obese bracket was way below what was considered good control. 5.2-5.1 while 7.0 is considered control. Sure weightloss has played a part and this last February I started a much more serious effort at losing weight. I'm 30 pounds +/- down this year and off all but my BP meds. What I do not do is avoid fat in my diet. I ride so that I can eat and still lose weight. Well I'd ride anyway because I love it. Perhaps when i reach my goal weight which keeps changing to lighter and lighter.

The fact remains that diabetes is a much more complicated than some of you are claiming. There are lots of skinny people with it. There are lots of fat people who never get it. I'm not discounting the environmental factors however it is genetic and some populations (races) are at higher risk. Some folks can eat enormous amounts of food and not get fat, most of us can't. My father has never been fat and taught me my ice cream habit which is a serving is the size of a cereal bowl, he other times will have cereal as a late evening snack and yet he is not diabetic nor has he ever been fat.

GeorgeBMac

Yes, all good points...

It is amazing how little we know about the human body and its physiology. And, equally amazing just how complex both of those things are...

But it also seems that a lot of the points you are referring to relate back to mitochondria and how "well" they are able to convert glucose into ATP. And, while we seem to have a pretty good handle on the chemical reactions that take place, we don't know much about how to make that process more efficient or effective. But, we do know how to make it less effective: get a big screen TV and take a statin.

Rollfast

I don't follow the it's all their fault theory, as I had lost 102 pounds and was on the high school track doing 10-15 miles a day when I was diagnosed. Diabetes is caused by a problem with the pancreas that leads to poor quality or not enough insulin production, PERIOD.

It is not strictly an obesity created disease nor are all obese people automatically going to get it.

As a Type II diabetic diagnosed in about 1996 I am a bit taken aback by the lack of proper knowledge and just plain nonsensical stuff getting tossed around in this thread.

Now, it is true that losing the weight and other lifestyle changes can actually end the diabetic condition but it's not true for everyone. If this is just going to degenerate into a rant about how fat people are getting without more physical facts and less onerous opining then what is the point?

dave5339

I am an insulin dependent type II diabetic now because I was stupid and didn't accept the diagnosis when it was made in 2003 and continued to make bad lifestyle/eating choices.

This was April of 2011.



This was a year later..



I'm still riding, eating healthy and my A1C is coming down. Unfortunately, I'll always be on insulin.

Don't be stupid with diabetes.

Semper Fi

GeorgeBMac

Yes, Type 1 starts as an auto-immune reaction destroys the insulin producing cells of the Pancreas.
But, Type 2 usually starts with insulin resistance and progresses to decrease the efficacy of the insulin producing cells of the Pancreas.

But, as I said, not enough is known about it and how and why it progresses at this point. Mostly what we have is clinical & epidemiologic evidence without a lot of in depth understanding of the underlying physiologic processes.

You are right that it is not a strictly obesity related disease. But it is mostly an obesity related disease. Generally, reduce the fat and you reduce the chances and impact of Type 2 diabetes. But it's not guarantee.

The same thing is true of breast cancer and heart disease. Obesity increases the odds of contracting it. Skinny reduces those chances. But it's not a guarantee -- especially after a lifetime of obesity.

But, in truth, it is not the obesity itself that causes those diseases. It is something that the obesity (mostly belly fat) triggers. But they don't know what that is - yet.

Sailor73 

I'd like to share my story:

I am a recently diagnosed Type 2 (3 months ago). I feel, comparatively, I was lucky to find out when I did because my numbers were not as bad as a lot of those I read about/ meet. I started with an a1c of 7.0, fasting glucose of 130. My LDL and HDL were good but my triglycerides were through the roof (225). I began Metformin 500mg twice a day. This was the final lightbulb for me to get my rear in gear as my father lost both his feet from not managing his type 2 and he basically lived on borrowed time his remaining 20 years.

Like most Type 2's, I was very active growing up (competitive cyclist in high school, avid backpacker, etc) but over the last 5 years serious stress from work and personal life kicked in and I turned to food as my emotional release. Deep down inside I knew I was going to end up a Type 2 but I was living in denial.

When I got diagnosed, my doctor recommended me to see a counselor to help with my emotional eating. I gotta say, for me, that was a vital piece to figuring this all out. I felt, for me, figuring out the emotional aspect as to why I was eating the way I was, was a key piece to begin exercising again. The other essential piece was to really understand food and nutrition. I met with a dietician who specialized in diabetes management and read everything I could. The more I read, the more I became frustrated with the American food system as a whole (but that's a rant for another thread).

Long story short, I took action. I immediately began exercising, eliminated all added sugar and flour, checked my sugar 3 times a day to figure out what worked with eating, increased low glycemic fruits and vegetables, and ate lean proteins. I left my job and now I'm a full time student, eliminated myself from stress that didn't need to be there and basically began to feel happy with who I am and who I want to be.

I had my 3 month blood work done and I'm happy with my progress. I lost 23lbs, a1c dropped to 6.1, fasting glucose 98 and my triglycerides dropped from 225 to 125. I still have more work to do but the numbers, and more importantly, my emotional health, are heading in the right direction.

Anyways, not sure why I chose this particular thread to get it all out but sometimes it feels like you're all alone in this and since others shared their experience, I figured I'd add mine.

Tom

dachshund

It seems to me that as people get larger, we start to accept larger people. I think there's less stigma attached to being huge, meaning obese or nearly so.

I have a cousin who's my age (late 50s) and who has developed several bizarre auto immune conditions. Every time I see her she's eating sugar, constantly. I believe she's taking lots of medicine so she can keep up the sugar, and cigarettes (now e-sigs). I've suggest she stop all the sugar, but the reverse logic goes, "I feel terrible, so I can justify doing the things that distract me from it. Pass me that jar of jelly beans." I had a weight problem in high school and I can imagine standing at the grocery store in front of all the colorful packaging, deciding on the best non-fat, best comfort / distracting food (laden with high fructose sugar.)

What turned me around? Eating real food including lots of salads. I can still picture that first salad I made my first year of college. The other thing that turned me around was realizing I'd never get a date at the size I was!

Mvcrash

Take some measurements. My youngin (an exercise physiologist) tells me that muscle is more dense than fat. you can lose fat, add muscle and not change your weight much, which is what happened to me.


Outstanding work!!!!! Hoooorah!!!!!