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January 29. 2014 6:23PM

Newer medicines can help diabetics keep the weight off

While as many as 13 million people in the U.S. are diagnosed with diabetes, and its prevalence continues to increase worldwide, great advances in our understanding of it have been made. Before reviewing such advances, however, it is important to know the biology behind diabetes itself.

What is diabetes?

To understand it, Dr. Heath Meattey, M.D., endocrinologist at Core Endocrinology in Hampton, said one must realize that when food enters the body, it is processed and broken down into its basic parts, including glucose. “Glucose, or ‘blood sugar,’ is the most basic form of energy used by most cells in the body,” he said.

In order to reach the cells, glucose must be transported from the bloodstream by the hormone insulin. According to certified diabetes educator Mary Malloy, R.N., of Families First Health and Support Center in Portsmouth, diabetes occurs when this normally smooth movement of glucose slows down.

Not all types of diabetes are the same, as Type 1 diabetes is usually first diagnosed in juveniles or young adults. Dr. Tina Beaudoin, N.D., of New Hampshire Natural Health Clinic in Bedford, said this type results when the immune system mistakenly attacks the insulin-secreting beta cells in the pancreas. Beaudoin is a doctor of naturopathic medicine. Such doctors have been licensed as primary care doctors in New Hampshire since 1995. To become a licensed N.D., New Hampshire requires they graduate from an accredited naturopathic medical school and pass board examinations.

Typically occurring later in life, although not always, Type 2 diabetes represents approximately 90 percent of all cases worldwide and results from a gradual process in which the cells in a person’s body do not properly utilize insulin.

The last type, gestational diabetes, occurs during pregnancy. While Malloy noted that 10 percent to 20 percent of women may require medication, most can control their high blood glucose with exercise and diet. Citing new research, Dr. Beaudoin’s colleague, Dr. Meredith Murray, N.D., added that all pregnant women should be screened at 24 weeks even if there are no signs or symptoms.

Treatment and prevention

According to Dr. Meattey, many newer medications produce more favorable side effect profiles, including the avoidance of weight gain, reduction in unwanted side effects related to low blood sugar, and assistance with moderate weight loss. He said other recently developed tools allow for highly tailored insulin programs, including pump systems and continuous glucose monitors, which “help patients to track their blood sugar levels more closely.”

Diet is also important, as Dr. Beaudoin cited it as one of the most significant sources of exposure to Persistent Organic Pollutants (POPs), which are compounds (pesticides, solvents, industrial chemicals) that do not break down in the environment. “Research has found that individuals with the highest pollutant exposures had a 38 times higher incidence of diabetes,” said Dr. Beaudoin, who noted POPs bio-accumulate in the body. “POPs can wreak havoc in your body and may significantly contribute to insulin resistance and diabetes.”

She said one way to minimize exposure to POPs is to avoid the “Dirty Dozen,” which are 12 foods with the highest levels of pesticide residue, including apples, strawberries, grapes, celery, peaches, spinach, sweet bell peppers, nectarines (imported), potatoes, cherry tomatoes, and hot peppers. “Be sure to purchase organic versions of the ‘Dirty Dozen’ to significantly reduce your exposure,” she said.

For those with high cardiovascular disease risk, Dr. Murray cited a recent study that suggests a Mediterranean diet, enriched with extra virgin olive oil, may lower the risk of developing diabetes. “I would recommend talking with your physician or a nutritionist to see if it is appropriate for you,” she said.

In general, Malloy said people should avoid sugary drinks and increase their consumption of fruits, vegetables, and whole grains. “Some people who have moved to a plant-based, whole foods diet have been able to get off many, if not all, of their diabetes medications,” she said.

Lifestyle changes are equally critical, as Dr. Meattey said people can improve their diabetes or cure it altogether if they can exercise for a total of 2.5 hours per week and lose 5 to 10 percent of their body weight. “In addition, lifestyle improvements are the most attractive treatments for diabetes,” he added, “because they cost nothing, they have no harmful side effects, and they have no medication interactions.”

Myths

One myth is that people with diabetes cannot eat sweets, or should eat special diabetic foods. “The truth is that people with diabetes can eat any food in moderation and do not require any special sugar-free or ‘dietetic’ foods,” noted Dr. Meattey, who said a diagnosis also does not mean people cannot pursue certain jobs or activities.

“I have many patients with diabetes who travel around the world for both business and pleasure, who run marathons and complete triathlon events, while maintaining good control of their diabetes,” he said.

While acknowledging it can be controlled, Dr. Murray said it would be a mistake, however, for people to think diabetes is not serious. “Diabetes claims the lives of more people than from breast cancer and AIDS combined,” she said. According to Dr. Murray, other complications include cardiovascular disease, possible strokes, and damage to the retina, kidneys, nerves, and blood vessels.

For more information, visit www.diabetes.org, or consult your physician.


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