Diet and Weight Loss
Type 2 diabetes doesn’t usually appear all of a sudden. Many people have a long, slow, invisible lead-in to it called prediabetes. During this period, blood sugar levels are higher than normal. However, they’re not high enough to cause symptoms or to be classified as diabetes. It’s still possible at this stage to prevent the slide into full-blown diabetes. Think of prediabetes as a wake-up call. Unfortunately, few people ever hear the alarm. A new report from the Centers for Disease Control and Prevention shows that among Americans age 20 and older, only 10% of those with prediabetes know they have it. Given that as many as 73 million Americans have prediabetes, that’s a lot of missed opportunities to prevent the ravages of diabetes. One reason many people don’t know that they may be headed toward diabetes is they’ve never had their blood sugar tested. This simple test isn’t part of routine preventive care, but perhaps it should be.
It’s easy to get swept up in the holiday season. This combination of religious and national celebrations can help keep the cold winter away. But the feasts and parties that mark it can tax the arteries and strain the waistline. By eating just 200 extra calories a day — a piece of pecan pie and a tumbler of eggnog here, a couple latkes and some butter cookies there — you could pack on two to three pounds over this five- to six-week period. That doesn’t sound like much, except few people shed that extra weight in the following months and years. You don’t need to deprive yourself, eat only boring foods, or take your treats with a side order of guilt. Instead, by practicing a bit of defensive eating and cooking, you can come through the holidays without making “go on a diet” one of your New Year’s resolutions.
Do you have trouble sleeping? If you’re carrying extra pounds, especially around your belly, losing weight and some of that muffin top may help you get better ZZZs. So say researchers from Johns Hopkins University School of Medicine, who presented their findings at this year’s annual meeting of the American Heart Association. In a six-month trial that included 77 overweight volunteers, weight loss through diet plus exercise or diet alone improved sleep. A reduction in belly fat was the best predictor of improved sleep. Among people who are overweight, weight loss can reduce sleep apnea, a nighttime breathing problem that leads to frequent awakenings. Exercise has also been shown to improve sleep quality. Despite what thousands of websites want you to believe, there are no exercises or potions that “melt away” belly fat. Instead, the solution is old-fashioned exercise and a healthy diet.
Many medical studies confirm what we know or suspect. Every once in a while, though, one surprises us, turning “conventional wisdom” on its head. That just happened with the sudden shutdown of a long-running diabetes trial called Look AHEAD (Action for Health in Diabetes). Begun in 2001 and scheduled to last another two years, Look AHEAD was designed to see if an intensive diet and weight loss program could reduce the number of heart attacks, strokes, and other cardiovascular problems in people with type 2 diabetes. An early peek at the data showed that the program had little apparent effect, and the investigators concluded it would be futile to continue. This does not mean that we should ignore diet and exercise in treating of type 2 diabetes. Instead, the details of the study results, which haven’t yet been published, are likely to reveal other explanations.
We tend to think of type 2 diabetes as a disease that afflicts people who are overweight. But it can also appear in people with perfectly healthy weights—and be more deadly in them. A study published in the Journal of the American Medical Association indicates that normal-weight people diagnosed with type 2 diabetes have double the risk of dying from heart disease and other causes than overweight people with diabetes. Such apparent “protection” by excess weight has been called the obesity paradox. It’s been seen with other conditions, like heart failure and end-stage kidney disease. That doesn’t mean gaining weight is a healthy strategy. Instead, it probably means that something else besides weight—like the amount of fat around the waist—may be contributing to the onset and severity of type 2 diabetes. These new findings underscore the importance of strength training for everyone, no matter what their weight.
Nicely timed for the 2012 Olympic Games in London, the British Medical Journal (BMJ) has published several articles revealing the “truth about sports drinks.” That truth is this: drink when you are thirsty and don’t waste your money or calories on sports drinks—choose water instead. Before the rise of sports drinks, athletes (and the rest of us) drank water when we exercised or got sweaty. How did we know when to drink, or how much? The way humans have known for eons—thirst. But as the BMJ team describes, sports drink makers spent a lot of money sponsoring less-than-rigorous research damning thirst as a guide to hydration and casting doubt on water as the beverage for staying hydrated. The bottom line is that thirst remains an excellent gauge of hydration, and plain old water is still the best way to replace lost fluid.
By offering the taste of sweetness without any calories, artificial sweeteners seem like they could be one answer to effective weight loss. The American Heart Association (AHA) and American Diabetes Association (ADA) have given a cautious nod to the use of artificial sweeteners in place of sugar to combat obesity, metabolic syndrome, and diabetes, all risk factors for heart disease. As with everything, there’s more to the artificial sweetener story than their effect on weight. One concern is that people who use artificial sweeteners may replace the lost calories through other sources, possibly offsetting weight loss or health benefits. It’s also possible that these products change the way we taste food. Research also suggests they may prevent us from associating sweetness with caloric intake. In addition, the long-term effects of artificial sweeteners on health have not been fully determined.
If you start an exercise program, it only seems fair that you should see your hard work reflected in lower numbers on the scale. If it isn’t, don’t despair—or quit exercising. You are still helping your heart, lungs, and every other part of your body. A study in the Journal of the American College of Cardiology looked at the effects of exercise and/or weight loss on cardiovascular health among more than 3,000 men and women who were initially overweight. As I write in the July issue of the Harvard Health Letter, those who exercised consistently and lost weight had the biggest reduction in heart attack risk over six years of follow-up. Exercising without losing weight and losing weight without exercising offered smaller benefits. Although exercise and weight don’t always move in the same direction, they are both important for health.
For people who are obese, the operation known as gastric bypass surgery has been hailed as something of a miracle. In addition to rapid weight loss, it can reverse diabetes and reduce the risk of heart disease. A new study reveals potential darker side—an increase in alcohol abuse. In a presentation at yesterday’s annual meeting of the American Society for Metabolic and Bariatric Surgery, researchers reported that almost 11% of nearly 2,000 men and women who underwent gastric bypass surgery (the most common type of obesity surgery) got in trouble with drinking by the second year after surgery. About 7% drank too much before the operation, representing a 50% increase. This finding shouldn’t steer people who could benefit from gastric bypass surgery away from the procedure. But it should prompt them—and their doctors—to be on the lookout for changes in alcohol use or abuse afterward.
Red meat hasn’t been getting very good press lately. Meat-heavy diets have been linked to increased risks of developing heart disease, diabetes, and some cancers. New findings from two long-term studies now indicate that eating lots of meat, especially processed meat, may also shorten your life. The new research involved nearly 125,000 female nurses and male health professionals, whose diet and health have been followed by Harvard School of Public Health researchers for more than two decades. Compared to eating less than one serving a day of red meat, adding one daily serving increased the chances of dying during the study period by 13%. (A serving is three ounces, about the size of a deck of cards). Red meat meant beef, pork, lamb, and hamburger. For every extra serving of processed meat (foods like hot dogs, bacon, and cold cuts), the increase was 20%.