Question: I’ve recently learnt I’m prediabetic. I’m a very active, slim, 70-year-old male. How should I adapt my diet to get my blood-sugar level down?
Answer: Diabetes doesn’t discriminate. Whether you’re slim or overweight, active or inactive, the potential for diabetes exists. Uncontrollable factors, such as genetics, age, ethnicity and even the foetal environment in which you developed can increase the risk of developing the disease. Judging or apportioning blame to a person for their prediabetes diagnosis based on their body size is inaccurate and unhelpful.
Prediabetes is a biochemical state in which blood-glucose levels are above the defined normal range, but not yet high enough to meet the criteria for diabetes. The longer someone has diabetes, and the more poorly their blood sugar levels are controlled, the greater their risk of serious complications such as cardiovascular disease and nerve, kidney, eye or foot damage.
So, the goal with prediabetes is to stave off diabetes, or, ideally, return to normal blood-glucose levels. Each year, about 5-10% of people with prediabetes will develop diabetes. In the long term, up to 70% of people with prediabetes eventually develop type 2 diabetes. Conversely, 5-10% of people diagnosed with prediabetes revert to normal blood-glucose levels each year.
The standard advice for those with prediabetes is:
- Include at least 150 minutes of “moderate intensity” physical activity a week.
- Gradually lose weight to reach and maintain a body mass index within the healthy range.
- Increase intake of whole grains, vegetables and other foods high in dietary fibre.
- Reduce the total amount of fat in your diet.
- Eat less saturated fat.
Though official guidelines push the “lose weight” message, a number of health professionals question this advice, not least because long-term weight loss is considered to be impossible.
A 2015 review of weight-loss interventions among overweight and obese people with type 2 diabetes concluded that, “Weight loss for many overweight or obese individuals with type 2 diabetes may not be a realistic primary treatment strategy for improved control.”
More recently, the Look Action for Health in Diabetes trial found no reduction in cardiovascular events or deaths in those with diabetes who followed an intensive weight-loss regime compared with those who followed standard diabetes care.
Focusing on controllables, such as lifestyle, is likely to be the best approach. For example, altering the type and timing of your exercise may improve your blood-glucose control. Exercise improves insulin resistance for two to 48 hours, so exercising frequently for, say, 30 minutes a day, is preferable to one or two long exercise sessions a week. And, although moderate-intensity exercise such as brisk walking is great for preventing type 2 diabetes, resistance training such as lifting weights is also fantastic.
Eating less saturated fat and total fat is the official recommendation, but emerging research suggests there is no “one size fits all” for dietary patterns. The Primary Prevention of Cardiovascular Disease with a Mediterranean Diet study found that, after four years, participants assigned to that eating pattern were 52% less likely to develop type 2 diabetes than those assigned to a low-fat diet.
What healthy diets generally have in common is they contain more plant-derived wholefoods and fewer processed foods, which are high in salt and fat, particularly saturated fat. Foods that are particularly helpful for managing blood-glucose levels are nuts, berries, legumes and whole grains such as oats and barley.
So, simple changes such as replacing fruit juice with whole fruit, opting for an oat-based breakfast rather than refined cereal, adding nuts to a morning snack, or opting for fish instead of sausages are all examples of helpful tweaks. Ultimately, it’s about personalising your lifestyle so it works with your goals, food preferences, culture and finances.
This story originally appeared in the May 25-31, 2019, issue of the New Zealand Listener.
