What is the Biggest Health Threat Today?

The prevalence of abnormal blood sugar levels (with or without a diagnosis of diabetes) is increasing at epidemic proportions, especially in the USA. Today, the Centers for Disease Control (CDC) notes that 96 million US adults have prediabetes (a fasting blood sugar level greater than 100 mg/dL). That is 38% of all adults and more than 50% of everyone after age 60.

Prediabetes has become the biggest health threat in our country today.

Another 37 million Americans have diabetes (a fasting blood sugar level more than 126 mg/dL), meaning that 123 million adults have abnormal blood sugar control.

Abnormal blood sugar control is the #1 risk factor for developing:

• Heart disease
• Alzheimer’s disease
• Diabetes
• Renal Failure
• Amputations

And is also a top cause for developing cancer.

Despite its importance, we don’t read or hear about prediabetes in the news very often. Part of the confusion is that it has several names, and we hear little bits about each:

• Prediabetes
• Metabolic Syndrome
• Insulin Resistance
• Syndrome X

Over the years, I have come to realize that most of my patients view blood sugar control as a yes or no—either they have diabetes or they do not. Yet, prediabetes is nearly as harmful as diabetes and far more common.

Why Is Prediabetes so Dangerous?

The term metabolic syndrome, which is synonymous with prediabetes and insulin resistance, helps to clarify why abnormal blood sugar control is so deadly. To have metabolic syndrome, you need three of the following criteria to qualify, and often they all occur together.

1. Expanding waistline (more than 40 inches in men and more than 35 inches in women)—Guys: your pants size is typically 3 inches less than your waistline.
2. Fasting blood sugar level more than 100 mg/dL
3. High blood pressure (BP more than 130/85)
4. Low HDL cholesterol (less than 40 mg/dL in men and less than 50 mg/dL in women)
5. High triglycerides (more than 150 mg/dL)

Plus there is a 6th sign of metabolic syndrome that is just as harmful as the above, which is:
6. High inflammation (a high-sensitively C-reactive protein level more than 1.0 mg/dL)

The bottom line is that prediabetes has a dreadful impact on your blood sugar control and can disrupt your blood pressure, cholesterol levels, waistline, triglycerides, and inflammatory markers. With these combined problems, it can give you a heart attack, lead to Alzheimer’s disease, or kill you prior to it progressing to diabetes.

As a side note, the earliest sign of prediabetes is insulin resistance. Insulin is the hormone that lowers blood sugar levels, pushing glucose from the bloodstream into cells. When cells stop responding to insulin signals, the body makes more insulin, and insulin levels become elevated, which is called insulin resistance.

Over several years of elevated insulin levels, the cells become even more resistant to insulin’s signals and blood sugar levels increase and become elevated, with a fasting glucose level greater than 100 mg/dL.

Different organizations list different levels for a normal fasting insulin level, but many would agree that an optimal and healthy fasting insulin level should be less than 5 mcU/mL and the range for an elevated fasting insulin level varies from more than 10 to more than 20 mcU/mL.

So What Causes Prediabetes and Insulin Resistance?

The irony is that the change in the modern American lifestyle over the last 50 years is the primary cause for this epidemic:

• We eat more sugar and refined carbs
• We eat less fiber from fruits, vegetables, beans, and nuts
• We are far less active
• I believe our stress levels are higher, too

While some people are more genetically prone to prediabetes than others—our genetics are not causing this epidemic. While super common today, it was a very rare condition 50 years ago, and our genes have not changed at all during this time.

How Can You Prevent and Reverse Prediabetes and Type 2 Diabetes?

The good news is that I’ve helped hundreds of patients and thousands of followers reverse abnormal blood sugar levels without using medications—in fact, in one of my first clinical trials, I was able to show that people with advanced type 2 diabetes (HgbA1C levels more than 8.0 who were on multiple diabetic drugs, including insulin injections) can make the right lifestyle steps, reverse this process, gradually wean off their medications, and keep their blood sugar levels completely normal—yet they had to continue those lifestyle changes for this to work long term.

It is essential for people taking diabetic drugs who want to make these beneficial transformations to gradually wean them off their diabetic medications with the help of their medical team. If you are taking blood sugar, cholesterol, and blood pressure medications—you should do this only with supervision and assistance from your healthcare provider.

The keys to success are the following:

1. The right foods
2. The right activity
3. Stress management
4. Meeting your nutrient needs

And if you are overweight and follow these steps, it is very likely you will lose weight, too.

What to Avoid:

Avoid sugar, sweeteners, and refined carbohydrates. This refers to:

• table sugar
• corn syrup
• rice syrup
• agave syrup
• other forms of sugar

Plus any refined carbs, which include:

• white flours (including wheat, rice, oats),
• white rice
• mashed and baked potatoes, (boiled, small potatoes with the skin are ok)
• whole grain flour products such as whole wheat bread, crackers, and cereals
  (Many people are surprised that whole grain flour is included as a refined carb, yet eating a tablespoon of table sugar or a tablespoon of whole grain flour has the exact same impact on blood sugar levels—an unhealthy spike! Whole grain flour does have more nutrients than refined grain flour, but the jump in blood sugar and insulin levels makes the higher nutrient content irrelevant for someone with prediabetes or insulin resistance.)

What to Limit:

When eating unprocessed whole grains like steel-cut oatmeal or brown rice, please limit yourself to not more than a 1 cup (cooked) portion per meal, 1-2 times per day and combine them with an equal portion of fruit or vegetables, as eating whole grains cause a much higher jump in blood sugar and insulin levels than does eating fruits and vegetables.

Lastly, of the things to limit, for either whole grain or white flour pasta, be sure to limit yourself to not more than 1 cup of cooked pasta per meal (2 ounces of dry pasta equals 1 cup cooked), the smaller the portion the better.

So what should you eat more often?

• Eat far more vegetables, fruits, beans, and nuts. These unprocessed, natural foods provide a vast array of nutrients and vitamins, plus they stabilize blood sugar levels:
  a.  Fruit includes whole unprocessed fruit—but avoid fruit juice and limit dried fruit.
  b.  All vegetables are great, except the inside of large potatoes
  c.  Most people would be better off eating at least a quarter to a half cup of bean products daily—however, if you have symptoms after eating beans and are lectin intolerant, then avoid them, likely 5-10% of people appear to be lectin sensitive.
  d.  Nuts are a good source of nutrients and fiber. Aim to eat 1-2 ounces (1-2 handfuls) per day.
• Eat smart fats and smart proteins at each meal: Nuts, wild seafood, avocados, extra-virgin olive oil, avocado oil, and nut oils are essential to good health. For protein, enjoy cage-free, organically raised animal products. Or if you prefer a vegetarian/vegan lifestyle, skip eating them in favor of beans, tofu, organic yogurt, tempeh, and other vegetarian protein options.
  a.  You do not have to be totally vegetarian or vegan, but most of us should eat more vegetable sources of protein daily.
  b.  As a general rule, avoid processed meats like hot dogs, sausage, bacon, and other processed meats—unless they are organic and free of nitrosamines and other chemicals.

The Right Activity

Activity is essential for normal blood sugar regulation. An optimal recommendation would include:

• 30 minutes of an activity that raises your heart rate daily, such as a brisk walk, jogging, cycling, dancing, or use of exercise machines 5-6 days per week. Best is to pick a mixture of activities that you enjoy so that you’ll be more likely to do them more often.
• Walking or similar activities to reach at least 10,000 steps six days per week.
• Strength training 2-3 times per week, such as weightlifting, yoga, or a workout with elastic bands. If you have never done this before, you can avoid injury and optimize your results by initially working with a trainer.

If you have concerning medical conditions, always talk with your physician prior to changing or starting a new exercise routine.

Proactive Stress Management

Prolonged unmanaged stress raises cortisol levels which also raises blood sugar levels. A proactive routine helps to manage unwanted chronic stress, using techniques such as meditation, counseling, and the use of an app like HeartMath. Even 10-20 minutes per day can be very effective in managing stress, lowering stress, and improving blood sugar control.

Meet Your Nutrient Needs

1. Take a good quality multivitamin daily
   a. Not all multivitamins are the same. Two of my good quality favorites are:
   i. Designs for Health Twice Daily Multi
   ii. Thorne’s Basic Nutrients 2/day
2. Make sure you meet your needs for magnesium with good-quality magnesium
   i. Avoid magnesium oxide
   ii. Look for protein-bound magnesium, such as magnesium glycinate or magnesium chelate

 The Good News!

The good news is that you can prevent and reverse insulin resistance, prediabetes, and type 2 diabetes with a combination of these four steps.

For details on how to follow these steps and recipes to support you along the way, please read one of my latest books, The 30-Day Heart Tune-Up, The Better Brain Solution, and/or The Mediterranean Method.

I wish you the best of health!

Steven Masley, MD, FAHA, FACN, CNS

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