Category Archives: Diabetes

Obesity: What Really, Truly, Definitely Works To Lose Weight?

In my sixteen years of family medicine, I think the most frustrating disease I treat is obesity. It’s frustrating because as a doctor I feel great compassion for these patients, trying so hard to lose weight, and yet I feel almost shameful that as a primary care physician I can’t offer much in terms of medicines to help. And now that I’m back in the USA after ten years in China, I’m very concerned that America’s struggle is even worse, with more than two thirds overweight or obese. So now, driven to seriously tackle this epidemic, I’ve scoured the literature for the most up-to-date, evidence-based advice on losing weight. Please feel free to print and share this.

Surgery

Let me jump right in to perhaps the most controversial point: I think that many, many more people should consider weight loss surgery. It literally is the most effective way not only to permanently cause weight loss, but it also literally can put diabetes in remission, lower your overall death rates, and lower your heart disease risks. A huge percentage of people can stop taking diabetes medicines after surgery. Don’t believe me? Feel free to read up on it, including a 2015 meta-analysis from JAMA, and the Cochrane library review from 2014. There are three major options:

  • Sleeve gastrectomy: This involves stapling off much of the stomach, leaving around 25% of the stomach. Average weight loss is 56%. This is now the most popular of the three.
  • Roux-en-Y gastric bypass: This is the most radical surgery, with the most complications, but also the most effective, with a weight loss up to 67%
  • Adjustable gastric banding: This involves putting a flexible silicone band around the top of the stomach, which essentially limits intake of food and makes you feel full with less food. The average weight loss for this is 44%, less than the other surgeries, and is now less commonly done.

Of course there are risks to these surgeries, and weight loss is disappointing for many afterwards. But in general, this is a far, far better option than the usual lifestyle struggles leading to maybe 10-20% loss at the most, with many gaining the weight back, and still having diabetes and other diseases. In fact, a recent 5-year study comparing weight loss surgery to lifestyle interventions showed a clear winner in the surgery group, with far more people losing much more weight, as well as putting diseases like diabetes in remission — totally stopping insulin injections and diabetes pills.

I seriously hope many people, especially in the high-risk categories, make an appointment with your local bariatric surgery teams and just talk with them, to discuss your options. If you’re in my Swedish system here in the Seattle area, you can sign up for their weight loss seminar (phone 206-215-2090, email swedishwls@swedish.org) and hear them out.

In terms of who should consider bariatric surgery, the current recommendations are:

  • Everyone — and I mean everyone — with a BMI (Body Mass Index) over 40, even without any other medical conditions, should consider bariatric surgery.
  • Anyone with a BMI 30-40 with diseases such as diabetes, high blood pressure, high cholesterol, sleep apnea, or severe arthritis, can also greatly benefit. Insurance companies usually would cover it if your BMI is over 35.

Do you know your BMI? A BMI over 25 is overweight, over 30 is obese. Here’s a calculator:

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Prescription Medicines

My second main point, and perhaps even more controversial among physicians, is that prescription medicines can also help with weight loss. There now are four prescriptions and one OTC supplement which actually are FDA approved for weight loss, and these expanding choices are encouraging for us family physicians on the front lines. Most work by decreasing your hunger urges. All have side effects, of course, and weight loss varies from 7-12% on average, and people often regain the weight after stopping. But since even a 5% reduction in weight loss can greatly help reduce risks for diabetes, heart disease and arthritis, I think these are definitely worth considering, and I’m using more and more of these in my practice. I strongly suggest interested people (and doctors) read the 2016 meta-analysis in JAMA, comparing all five. The summary graph is here:

JAMA-weight-loss
Source: JAMA. 2016;315(22):2424-2434

The take-home message from this review is as follows:

  • The medicine phentermine/topiramate (Qsymia) is the most effective at weight loss, with side effects in the middle of the pack. This is currently my first choice for many. But one side effect is severe: birth defects, so all younger women have to take birth control and get monthly pregnancy tests while on this.
  • The combo medicine naltrexone/bupropion (Contrave) was less effective than Qsymia, with more side effects, and also some debate about its safety with heart disease.
  • The OTC medicine orlistat (Xenical/Alli) is the least effective, but has relatively fewer severe side effects (stomach issues), and also is the only one available without a prescription. You take it with each meal, and it decreases fat absorption.
  • The diabetes medicine Liraglutide (Saxenda) is second most effective for weight loss, but has the most side effects. But it’s certainly a great option for those who have type 2 diabetes.
  • Lorcaserin (Belviq) has the least side effects but was second to last in effectiveness.

Who’s a candidate for these prescription medicines? The FDA says that anyone with a BMI over 30, regardless of any illnesses, and also those with BMI 27-20 with risks (the usual ones mentioned above) could benefit from trying these medicines, at least for three months to see if you can get to 5% weight loss. If you do, great! Keep going! Hopefully your insurance will cover the cost (many do not). (NOTE TO DOCTORS: it’s much cheaper to order the combination medicines Contrave and Qsymia separately, as two prescriptions).

Besides these medicines, I should also mention metformin. This common prescription medicine for type 2 diabetes also has the great side effect of weight loss, and while the overall loss is less than 5% in the studies, and thus is not FDA-approved for weight loss, it’s still a fantastic first choice for pre-diabetic people who are overweight. The famous Diabetes Prevention Program showed how even after ten years, the overweight group who took metformin 850 mg twice a day had an impressive 18% reduction in developing diabetes. (That’s impressive, but not nearly as impressive as the 34% risk reduction in the group that stuck to lifestyle changes: weight loss of 7%, 150 minutes a week of exercise, and diets focused on fewer calories and less fat.)

Diets

And now we finally arrive at the third controversial issue: diets. There’s so much overwhelming confusion out there, but I like to simplify it a lot by saying that it’s not so much what you eat, but how much you eat. In other words, calorie restriction is key. If you want to lose a pound a week, you need to eliminate 500 calories each day. This is basic biochemistry. (check out your specific needs using my weight loss calculator at the top right of this article). If you can do this daily calorie restriction, especially by decreasing simple carbs, great! Keep going!

But there’s an interesting newer option you may have heard about, called intermittent energy restriction (IER; the 5:2 diet). This has been trendy since 2013, with a BBC documentarybest selling book, and a British study showing how a twice a week regimen of cutting your calories (especially carbs) had similar or better results for insulin resistance and body fat than the group that followed daily calorie restriction. When we fast, even if only for 12-16 hours (nothing between dinner and lunch the next day), insulin resistance improves and fat starts to get reabsorbed. A recent review of all IER studies showed that the evidence for IER is promising — but still premature to fully endorse, with much more to learn about which pattern is most ideal, as well as long-term effects. Also, people who aren’t overweight and are trying this actually have a lot more side effects than benefits.

Otherwise, in terms of “diet”, it’s just overwhelming out there for people searching for the “right one”. An excellent review article this year does detail quite convincing evidence that a low-carb high-fat Atkins-style diet not only reduces the hunger urge, but also has clear benefits in insulin resistance, cardiac markers, and weight loss. The DASH diet really does help to lower blood pressure and weight, and the Mediterranean diet also seems to help with heart disease and some weight loss.

But again, the main issue for all of this diet talk is to focus not on food categories, but food quantity. It’s simple biochemistry: you have to have less energy intake to lose weight. Or you could increase energy output, which leads us to:

Exercise

For decades, the usual doctor spiel is to get 150 minutes a week of moderate exercise. But that hasn’t really translated into any meaningful changes nationally, has it? So here’s where another trendy (uh oh) regimen is gaining popularity, mostly because the growing research is impressive. It’s called High Intensity Interval Training (HIIT), and it basically means you go all out for 30-60 seconds on any activity, getting to maximum exertion, then take a few seconds break, then do another all-out effort, etc etc. You do this 15 minutes tops, twice a week only (typically). Check out an example in the image below from a New York Times article about a 7-minute workout, which I also blogged about in my New York Times column in China. This HIIT routine is great because it requires zero fancy equipment, and you can do it absolutely anywhere. Click here to access the online workout app.

The 7 Minute Workout. Source: New York Times

Supplements, Diets and Herbals:

This topic is actually less controversial for me, mostly because there’s an easy answer: most of those supplements have almost no hard evidence that they work well. I’m not confident enough about recommending any of the trendy ones, and that includes CLA, chromium, 5-HTP, and garcinia. I’m sure many of you are already taking some of these. You’re welcome to read the evidence, including some excellent supplement reviews by the Natural Medicines Database (paid);  The Encyclopedia of Natural & Alternative Treatments (free); The Cochrane Library; and The National Center for Complementary and Integrative Health (NCCIH).

Personally I’d much rather have my patients focus not on supplements but on calorie restriction. I’d also rather give them one of the prescription medicines above, which all have more evidence than any supplement.

If you must choose a supplement, at least you could try that OTC Orlistat with meals. And you could also consider soluble fiber such as blond psyllium. Used especially for constipation, it also helps lower cholesterol, control diabetes a tiny bit, and also help a bit with weight loss. You’d take it with food, and it absorbs fat from that meal. In fact, it’s now recommended that Orlistat users also take blond psyllium with each dose of Orlistat, as it prevents some of those unfortunate gastric effects.

Yogurt is also one of my favorite recommendations, not just for the way the probiotics help our microbiome and immune system, but also because the literature shows that yogurt helps to manage weight loss and waist circumference. I actually prefer higher fat than the low fat versions, and adding fresh fruit to non-sweetened yogurt is a great way to start your day. Add a pack of instant oatmeal, microwaved with soy milk, and you’ve got a healthy and filling breakfast.

Stand Up!

Did you know that sitting all day at work literally is harmful to your health? Recent data, including this 2015 meta-analysis of sedentary lifestyles, shows that the more you sit, the higher your risks for heart disease, obesity, diabetes and overall death rates. I just ordered a standing desk for my office! Here are more tips on how not to be a couch potato.

Use Smaller Plates

Americans definitely have suffered “portion distortion” over decades, as sizes for all types of food creep up and up. Remember how soda machines used to carry 12 ounce cans, and now all have 20 ounce bottles? How about a small popcorn at the movies? If we can’t control these external factors, at least at home we can control portion size, and one interesting step is to replace all of your usual large dinner plates with smaller plates, like the appetizer or salad plates. Recent studies, including the 2016 meta-analysis, do show that when people switch to smaller plates, they actually eat less. How easy is that?

Keeping It Off

It’s actually not super hard to lose weight — it’s keeping it off that’s the problem for most. Unfortunately, that’s a totally normal problem because our “hunger hormones” ghrelin and leptin reset to a new balance when we gain weight, and when we lose that weight, that hormone imbalance doesn’t reset well to the lower weight, and it thinks “I’m starving!” and compels you to eat more. Some tips to control this include healthy carbs, fiber, yogurt and protein (and not a high fat diet). Also, getting a good night’s sleep literally helps to reset those hunger hormones (that’s one reason why people with sleep apnea are at risk for gaining weight).

And for those who are in the higher obese categories with BMI over 35 or 40, gastric bypass surgery actually can permanently improve some of that hunger urge. How? Removing the top of the stomach in these surgeries removes the stomach tissues that secrete grehlin; less grehlin = less hunger signals = less eating = weight loss. That’s another important reason why I urge people to consider weight loss surgery.

My Bottom Line

After writing this article, I personally feel much more empowered as a doctor to help my patients lose weight. There are a lot more options than I had realized, and I’m definitely giving all of my overweight patients this article, and I look forward to working closely with my patients to help them lose weight in a healthy and permanent way. And hopefully I’ve helped you, as well!

Good luck!

Diabetes: Healthy Lifestyle Choices Are Key

I’ve been a family doctor for fifteen years, and one of the more dramatic changes I’ve noticed is a big spike in the incidence of prediabetes and diabetes, in all age groups. I had worked in China for ten years until last summer, and all us family doctors at my Beijing clinic weren’t surprised at all with the 2013 paper published in JAMA confirming the frightening reality in China: more than half of all adults in China now are prediabetic. Even worse, 11.2% have diabetes, giving China the dubious distinction of having the highest prevalence of diabetes in the world — higher than in the USA, an extraordinary statement given the far higher rate of obesity in the USA. As this epidemic spreads,  I felt a timely urgency to share my advice on how to avoid this disease – or at least to slow it down.

It helps me to think of diabetes as a modern lifestyle disease, mostly caused by all developing countries’ gains in weight, less physical activity, and changes in diet. Diabetes now is a global pandemic. Tens of millions of people have diabetes, and many people are undiagnosed because they’ve never been tested. There are two types of diabetes, and type 2 diabetes accounts for 90 to 95 percent of diagnosed diabetes in adults.

Prediabetes concerns us doctors because it means you are at extremely high risk of developing diabetes in the next few years. Studies show that a prediabetic person has a 25% risk of developing diabetes within three years, and a majority within ten years. The greatest risk factor by far is overweight and obesity. Having a BMI under 23 is ideal, and a BMI of 25 increases your lifetime risk of diabetes by 600%. A BMI of 30 increases your risk by 4,000% — that’s 40 times the risk! That’s an extraordinary number which should worry us all, since in the USA over two thirds of adults are overweight and over a third are obese.

But here’s the good news: the crucially important message for everyone is that you have great control over whether or not you develop full diabetes. You should think of prediabetes as an early warning sign by your body, a major wake up call that whatever you’ve been doing to your body isn’t too healthy. Most people with prediabetes fit one or more of these three major risk factors: body mass index (BMI) over 25; lack of enough exercise; and unhealthy food choices as well as portion sizes.

So let’s say that you’re one of the many people who has prediabetes: what can you do right now to help? If you follow the three lifestyle steps below, you can lower your risk more than half! One of the most important public health research studies ever, the Diabetes Prevention Program, proved that lifestyle changes worked better than pills in reducing progression to diabetes. Lifestyle changes lowered a prediabetic person’s risk by 58% over three years — much better than the 31% improvement with a daily pill (metformin).

So what are these magic steps? Without further ado:

  1. Lose weight. Weight gain and obesity are the top causes of type 2 diabetes, and losing weight is now proven to be the most effective prevention. In the DPP study, the goal was to lose at least 7% of your body weight. Your goal should be to lose 5-10% of your body weight.
  2. Exercise. Exercise may not directly cause much weight loss, but exercising muscles absorb sugars much more effectively. This is why exercising is crucial to help control sugars, both in a prediabetic as well as in diabetics. How much exercise is enough? We usually recommend 150 minutes a week of moderate exercise, but any amount is better than nothing. Also, as I mentioned in an earlier column, shorter, more intense workouts can help as much as moderate exercise.
  3. Proper diet. Healthy food choices also are crucial to control your sugars. One of the most common misperceptions about diabetes and prediabetes is that it’s “a sugar problem” and you must cut down on sweets and desserts. The bigger culprit are total starches — pastas, breads, rice and potatoes. In all these cases, processed versions are never as healthy as the originals.

Here are a few quick tips on nutrition:

  • Brown is always better than white: Processed white bread and flour have lost all the nutritious fiber which helps regulate your bowels as well as your sugar spikes after a meal. If you love your carbs, at least try to switch to whole wheat pastas, breads and rice.
  • Portion control: Total calories are also important, as most likely you are taking in a bit more than you realize. These extra calories will get deposited as fat, which leads to more risk of diabetes.
  • Cut back on sodas, beer and juices: All of these are empty calories, full of processed sugars which stress out your liver and pancreas. These unhealthy carbs, especially in sodas, are a major cause of obesity and diabetes in both children and adults.

Type 2 diabetes is partly genetic, so no matter how healthy you are, it still may be inevitable. But these above steps are always good advice for all of us. Another great thing about these healthy life changes is that they also dramatically reduce your risk of heart disease, many cancers, and early deaths from all causes.

Don’t get discouraged — you have control over the next steps!

I Have Prediabetes: Now What?

If you are reading this, you or a loved one have probably been told by your doctor that you have abnormally high sugar levels. The doctor may have called it Impaired Fasting Glucose or Impaired Glucose Tolerance, but both of those are just fancy medical words for prediabetes. This means your blood test results for sugars (glucose) were above normal but below actual diabetes range. For the most common test, the fasting glucose test, prediabetes results are 5.6-6.9 mmol/L (100-124 mg/dL). Prediabetes is extremely common; 35% of people in the USA are diagnosed with prediabetes.

What Is Diabetes?prediabetes overweight obesity exercise diet copyright US CDC

Diabetes is a disease caused by your body losing the ability to properly digest and use sugars and starches in your foods, thus leading to high levels in your blood. Too much glucose floating around your bloodstream for many years can cause many toxic problems to your organs if not treated — especially with your eyes, kidneys and lower legs. For example, diabetes is the leading cause of kidney failure, non-traumatic lower-limb amputation and new cases of blindness among adults in the United States and much of the world. Diabetes also raises your risk of heart disease and some cancers.

It may help to think of diabetes as a modern lifestyle disease, mostly caused by all developing countries’ gains in weight, less physical activity, and changes in diet. Diabetes is a global epidemic. Tens of millions of people have diabetes, and many people are undiagnosed because they’ve never been tested. There are two types of diabetes, and type 2 diabetes accounts for 90 to 95 percent of diagnosed diabetes in adults.

Why Is Prediabetes So Concerning?

Prediabetes concerns us doctors because it means you are at extremely high risk of developing diabetes in the next few years — but you still have great control over preventing any more progression! This is crucial for you to understand, so let’s say it again: you have great control over whether or not you develop full diabetes. You should think of prediabetes as an early warning sign from your body, a major wake up call that whatever you’ve been doing to your body isn’t too healthy. Most likely, you fit one or more of these three major risk factors:

  • Body mass index (BMI) over 25
  • Lack of enough exercise (not sure how much is enough? Read this)
  • Food choices and portions not ideal (for food tips, read here)

How Great Is My Risk of Progressing to Type 2 Diabetes?

Studies show that a prediabetic person has a 25% risk of developing diabetes within three years, and a majority within ten years. The greatest risk factor by far is overweight and obesity. Having a BMI under 23 is ideal, and a BMI of 25 increases your lifetime risk of diabetes by 600%. A BMI 0f 30 increases your risk by 4,000% — that’s 40 times the risk! You can find out more of your risk of diabetes and heart disease by filling out this online risk calculator.

How Can I Prevent Diabetes?

If you follow the three lifestyle steps below, you can lower your risk more than half! One of the most important public health research studies ever, the Diabetes Prevention Program, proved that lifestyle changes worked better than pills. Lifestyle changes lowered a prediabetic person’s risk by 58% over three years — much better than the 31% improvement with a daily pill. The three most important lifestyle tips are:

  • 1. Lose weight. Weight gain and obesity are the #1 causes of type 2 diabetes — and weight loss is the #1 way to reverse and control it.  The great majority of Americans are at major risk of diabetes, as 69% of Americans are overweight or obese. In this DPP study, the goal was to lose at least 7% of your body weight. Your goal should be to lose 5-10% of your body weight.
  • 2. Exercise. Exercise may not directly cause much weight loss, but exercising muscles absorb sugars much more effectively. This is why exercising is crucial to help control sugars, both in a prediabetic as well as in diabetics. How much exercise is enough? We usually recommend 150 minutes a week of moderate exercise, but any amount is better than nothing. Also, recent research shows that shorter, more intense workouts also can help (click here to read more about this high intensity interval training).
  • 3. Proper diet. Healthy food choices also are crucial to control your sugars. Diabetes and prediabetes isn’t so much a sugar problem, it’s a starch and carbs problem, as well as total calories. In other words, you shouldn’t just be thinking, “I need to cut down on my sweets and sugars.” No, the bigger culprit are total starches — pastas, breads, rice and potatoes are the main culprits. In all these cases, processed versions are never as healthy as the originals. A few quick tips:
    • Brown is always better than white: White bread and flour has lost all the nutritious fiber which helps regulate your bowels as well as your sugar spikes after a meal. If you love your carbs, at least try to switch to whole wheat pastas, breads and rice.
    • Portion control: Total calories are also important, as most likely you are taking in a bit more than you realize. These extra calories will get deposited as fat, which leads to more risk of diabetes.
    • Cut back on sodas, beer and juices: All these are empty calories, full of processed sugars which stress out your liver and pancreas. These unhealthy carbs, especially in sodas, are a major cause of obesity and diabetes in both children and adults.

Type 2 diabetes is partly genetic, so no matter how healthy you are, it still may be inevitable. But these above steps are always good advice for all of us. Another great thing about these healthy life changes is that they also dramatically reduce your risk of heart disease, many cancers, and early deaths from all causes.

diabetes exercise overweight obesityCan Medications Help Me?

One prescription medicine in particular, called metformin, can help prevent a prediabetic from developing full diabetes. In the DPP study above, metformin reduced the prediabetic patients’ risks by 31%. That’s pretty good — but not nearly as good as lifestyle changes! Metformin may be especially helpful if you are very overweight (BMI over 35), if you are under 45 years old, or if you are a woman with a history of high sugars during pregnancy.

If metformin is a good choice for you, don’t ever forget that lifestyle changes, at any time in your life, are far more important than any medicine. Even if you have diabetes, it will always be important to reach for those health goals.

What About Natural Medications or Herbs?

Some foods and supplements may benefit you, but some popular ones may not be as effective as you’ve heard — especially selenium. For the most evidence-based advice, read this excellent medical review here.

When Should I Get Retested?

A prediabetic patient should get their glucose tested once a year. One other test, the HbA1c, measures your glucose levels over the previous three months and often is helpful as a second test. People with diabetes usually get this HbA1c tested every three months.

In Summary

Don’t get discouraged with this prediabetes diagnosis — you have control over the next steps! Even if you already have diabetes, you could maybe avoid that second or third medicine, especially insulin injections, if you followed those above lifestyle steps and especially lost 5-10% of your weight.

What Resources Can Help Me?

There is a wealth of information from the American Diabetes Association.

Preventing Diabetes: Brown is Always Better Than White

As diabetes continues its pandemic across the world, it’s crucial that we all truly understand how we could prevent this very preventable disease — at least for type 2 diabetes, which is the adult-onset diabetes mostly related to obesity and the “Western” lifestyle.

The key concept for diabetics is limiting carbohydrates — and that doesn’t only mean sugar. I see many diabetics who think they’re doing well because they’re “cutting back on sweets and dessert”, when the main diabetic culprit in their diet is the starch carbs from rice, pastas and breads.

One popular method of monitoring carbs is the glycemic index. This index is a ranking from 0-100 of how high a carbohydrate raises blood sugar levels after eating. Here’s a graph below showing the basic concept: a healthy food has a low glycemic index, which means the sugar levels in your body peak lower and slower, thus not stressing out your insulin-secreting pancreas. Unhealthy foods have a high glycemic index, where the sugar levels peak very high and very quickly. This stresses out your pancreas to make insulin, and it’s this chronic repeated stress of your pancreas that partly causes it to slowly fail, producing less insulin — and thus causing diabetes.

Glycemic index
Glycemic index

Think Brown

Following this GI list of foods, and tracking your foods, can honestly be quite cumbersome. Many believe that patients’ counting their carbs is a more effective tool. But in either case, I have an easy clue for everyone: think brown. Brown food is always better than the equivalent white food. What do I mean? I mean that white foods are quite unnatural; white rice and breads and pastas are finely processed versions of the original grains. And these original grains have the “brown” husks full of vitamins, oils, magnesium, fibers and other nutrients. In other words, brown rice is much healthier than white rice for many more reasons than just lowering risk of diabetes. The glycemic index of brown rice is 55, a bit lower than the 72 for short-grain white rice, which is the most common rice in China. Here’s more data which may convince you: a huge 2010 cohort study showed that switching from white to brown rice can lower your risk of diabetes by 16%. Switching to whole grains lowered risk even better, by 36%. That’s an enormous benefit!

Bread & Pastas: The Same Benefit

The same concept applies to white bread, which is made of finely processed flour and thus has lost its husk of nutrients and fiber. The GI of white bread is 70 (a GI over 70 is considered unhealthy), while whole grain breads have a GI of 51. Pasta, on the other hand, has a much better glycemic index than breads or rices, with a GI range from 43 to 61.

 

Obesity and Diabetes: How Does Your Country Rank?

It’s no secret that obesity, and its twin sister disease of diabetes, have become epidemics of every modernizing country. I work in a family medicine clinic in China and am now witnessing firsthand the expanding waistlines of Chinese people, as they quickly adopt the “Western” diet. Unfortunately, diabetes is already a scourge here as well. But how does it compare to the US, or to other countries?

You can find out very quickly thanks to a fascinating, interactive graph from the Washington Post, which reviews every major country’s diabetes and obesity rates. They got the data from the Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group, which published a series of articles in the Lancet journal. It’s a fascinating chart. For example:

  • Diabetes rates: in 1980 for US men, 6.0%; for Chinese men, 10%. In 2008, for US men: 12.6%, for Chinese men, 9.6%. In the US, there’s a steady progression; in China, the numbers actually improved a while but again are climbing. I’m actually surprised that the percentages in China now are so close already to those in America; awareness of the disease here is much less than in the US. It’s believed that a large percentage of diabetics in China are not yet aware they have the disease.
  • Obesity rates: in 1980, in the US; in 2008 the average BMI for men is 28.5, for women is 28.3. In 2008, for US men is 25.5, women 25.0%.  For China, in 1980 for men, 21.6, women 21.9; in 2008, both are 22.9. (a BMI 25-30 is considered overweight, and over 30 is obese).

With the obesity rates, again the trend in the US is a very scary climb upwards; in China, the rate is rising much slower.

How does your country fare? Click here and find out. You can also go straight to the interactive graphs from the Collaboration Group. it takes a while to load, but their data is much richer and also includes blood pressure and cholesterol.

Diabetes and Natural Supplements: Which Work? Which Don't?

What natural supplements and medicines work to prevent or lessen diabetes? We know that the Western-prescribed medicines such as insulin injections and metformin pills are extremely effective, but wouldn’t it be great, and much healthier for us, if we could focus on more natural therapies? Fortunately, with diabetes, there are quite a few healthy approaches for everyone, from healthy people to pre-diabetics and diabetics.

So, What Works?

There’s a good free review from Cardiovascular Therapeutics from last year, titled “Nutraceuticals in Diabetes and Metabolic Syndrome“. Also, my favorite natural medicine website, the Natural Medicines Database, yet again has a wonderful, free article on natural medicines for treating diabetes. This group provides an essential service for docs and consumers: they review all the best research and offer evidence-based advice on natural medicines — what works and what doesn’t work. At the bottom of their article is a nice summary graph, and here is a snippet:

Natural Medicines For Diabetes
Natural Medicines For Diabetes

There Is No Wonder-Supplement

First, the graph implies that there is as yet no officially “Effective” and “Likely Safe” natural medicine. In fact, nothing reviewed is assessed to be either “effective” or “likely effective.” The best they can state — at least,  in terms of evidence-based research — is a series of therapies that are “Possibly Effective” and “Likely Safe”. This includes psyllium (fiber), guar gum, magnesium, oat bran, and soy. Antioxidants in general such as vitamin C or E do not have strong evidence that they help with diabetes, although alpha-lipoic acid may help, especially with diabetic neuropathy. And a bunch of popular supplements are still in the “Insufficient Evidence” columns — including coenzyme Q10.

The neutraceutical review above also mentions that vitamin D and calcium may also lower risk for diabetes. I already recommend vitamin D for other reasons, so people can consider this as an added benefit.

Selenium: Do Not Use!

One surprising finding that may people don’t know is that selenium, which previously was considered good for diabetes, actually is now considered bad. Not only is it not effective, but it actually can make your diabetes worse. This latest data definitely has not made the rounds of consumer products, as almost all “diabetes” combination-herbs products such as Nature’s Bounty “Diabetes Support Pack” (available in China) still include selenium. So, if you use those expensive herbal pills, the benefits of the cinnamon and chromium may be offset from the harms of selenium — thus not helping you at all. It’s hard to say this conclusively, since all of these formulations are different, but it’s something you should consider before purchasing such combo pills.

My Bottom Line

I think those of you who are diabetic, or pre-diabetic, before considering spending your hard-earned money on any supplements, should first take care of what I mentioned last week are the most effective natural ways to help diabetes — weight loss, exercise and diet. Do not waste your money on multi-pill-pack diabetes supplements if you’re not aggressively getting your weight down 5-10%, or exercising. If you are doing these far more important steps but still have problems, it’s not a terrible idea to try the most effective natural methods:

  • Fiber in all forms, including as oat bran, has the strongest evidence to lower your sugar load ~14-20% each meal
  • Chromium (and cinnamon) have some evidence of effectiveness — you could consider trying for 3 months and stopping if you see no improvement
  • Magnesium may help, but diet forms are much more effective than in a pill
  • Vitamin D and calcium supplements may help lower your risk — I previously mentioned doses here
  • Vinegar with meals also lowers your sugar load ~20%
  • The popular Chinese vegetable bitter melon (kugua) can lower that meal’s blood sugar load
  • Soy may help a bit — and in general, soy milk is healthier than cow’s milk, so why not switch? Better yet, make your own soy milk
  • Antioxidants don’t seem to help much with diabetes, but are still a powerful concept — but you should get these from a good diet, not pills
  • Selenium does not work!

Other Resources

I already mentioned that the Natural Medicines Comprehensive Database is a great start for those of you looking for evidence-based, trustworthy reviews on natural medicines. You can also use the U.S. National Library of Medicine’s PubMed Dietary Supplement Subset, a search engine focused on top research regarding natural medicines — including Chinese medicines.