Secret #30 is excerpted from Part Five: Exercise Secrets found in my new book about what has worked well for long-time diabetes survivors: 50 Secrets of the Longest Living People with Diabetes by Sheri Colberg, PhD, and Steven V. Edelman, MD (November 2007). Check my Web site (www.shericolberg.com) for more details or to order this book online.
Excess body weight is associated with a greater risk of many health problems, and even though it may not be the direct cause of all of them, losing body fat or maintaining your body weight are considered important goals, and exercise plays an important role in reaching these goals. For example, regular physical activity can prevent you from developing type 2 diabetes in the first place or reverse pre-diabetes, even if you’re at higher risk for either health condition. Moreover, weight loss can also help control diabetes in many individuals, regardless of what type of diabetes they have.
In a recent reanalysis of the Diabetes Prevention Program (designed to prevent type 2) published in Diabetes Care in the fall of 2006, weight loss was most directly correlated to a decreased risk of developing the disease. Likely more importantly, weight loss was predicted by how much exercise people did, and only the ones who continued to exercise after the trial ended were able to maintain their new, lower body weights. Although exercise can’t prevent type 1 diabetes, it can prevent a condition dubbed “double diabetes” by reversing or preventing an insulin-resistant state (more common to type 2) in sedentary individuals with type 1, making it easier for them to effectively control their diabetes and prevent acute and long-term health complications.
When it really comes down to it, where you store excess body fat is more important than how much you have. Visceral fat stored deep within your abdomen (the proverbial “beer belly”) is the worst type of body fat with regard to diabetes control because it makes your insulin work less effectively. Luckily, both moderate aerobic exercise and resistance training (done even only twice a week) can result in losses of visceral fat that dieting alone doesn’t cause. What’s more, you can be fit regardless of your body weight and gain almost all of the associated health benefits of having a higher fitness level without struggling to lose weight and keep it off simply by choosing to be regularly physically active.
Keeping your weight down is not the only cure for decreased insulin action (you can be thin and insulin resistant or fat and have good insulin action), but the behaviors that help you keep your weight in a more normal range (like regular exercise) are likely what are going to benefit your diabetes control the most. For Zach Barneis, going on a strict diet after his type 2 diabetes diagnosis and losing about thirty-five pounds in six months kept him off of insulin for a long while, and exercise played an important part in his being able to lose the extra weight. Likewise, Robert Mandell says, “When I was diagnosed with type 2, my doctor told me to lose weight. I actually controlled my diabetes for about the first fifteen years with diet and exercise alone, and I lost twenty pounds. I was walking and jogging five days a week and covering about five miles a day.”
Dick Bernstein contends that your body fat will not break down in the presence of insulin. Insulin responses can vary greatly from person to person (or none at all is produced in type 1 individuals), but more refined carbohydrate foods (which are low in dietary fiber) evoke a stronger and/or more rapid insulin reaction. Consumption of natural fiber with carbohydrates can reduce the extreme blood sugar reactions described above. Low-fat diets cause quicker digestion and absorption of carbohydrates in the form of sugar. By adding some fats to the diet, digestion and absorption is slower, and the insulin reaction is moderated. Perhaps a third to a half or more of our population is unable to process carbohydrates —sugars and starches— effectively? In many people it’s due to genetics, with lifestyle contributing to the condition. This can be termed insulin resistance, or IR. Like many problems, IR is an individual one, affecting different people different ways. You must determine if you are carbohydrate intolerant, and if so, to what degree. Blood tests will only diagnose the problem in the later stages, but the symptoms may have begun years earlier.
As we now know, insulin has many functions. While it can’t get glucose into the muscle cells efficiently when muscle becomes insulin resistant, insulin still performs its other tasks, including converting carbohydrates to fat and storing them in fat cells, along with inhibiting stored fat from being released and used as a fuel for the body. In a normal person, as much as 40 percent of the carbohydrates eaten may be converted to fat, depending on your calorie intake. If you’re insulin resistant, that number may be much higher. As a result, when you have to take higher insulin doses or your body has to release more to cover food intake, it’s much more likely that you’ll store extra body fat as a result.
So, if you desire to lose weight, eating few carbs that require either greater release or doses of insulin will make it easier to lose weight. “A low-carb diet, in addition to lowering your blood lipids and your blood glucose, will also help you stay thin,” he confirms. Other individuals have also noticed that they start gaining weight if they take too much insulin. “I do limit my carbs because then I find that I can take less insulin and don’t gain weight,” says Barbara Baxter, while Jo Allen attributes her weight staying down all of her adult life to the fact that she doesn’t eat desserts (which would indeed require higher doses of insulin). Marc Blatstein also realizes that he’s been gaining too much weight for good health. “I have gone through periods where I didn’t watch the portions,” he admits, “and I gained weight. In the past six years, I’ve gained thirty pounds, but now I am aggressively working to shed this extra baggage by watching my portion control.” Larry Verity, too, experiences changes in his weight with higher insulin doses, so he tries to keep his daily insulin as low as possible to prevent excess weight gain. Experiencing frequent hypoglycemia that has to be treated can also cause you to gain weight, so preventing excessive lows is better for this reason alone (not to mention all the other ones).
Dan Spinazzola also says that vanity helps with his weight management. He has a thirty-eight-inch rule. “If my pants get tight,” he says, “I refuse to buy a pair with a thirty-nine- or forty-inch waist.” In the past year, he has lost about twelve pounds total, which he attributes to a combination of using Byetta and having a positive mental attitude. Dr. Sheri has a similar rule about her clothing. “I refuse to buy a larger size of anything.” To this day, she still fits in the same clothes that she wore at the end of high school and throughout her college years, and her weight has remained stable—plus or minus five pounds—the entire time. Even during each of her three pregnancies, she exercised throughout and watched her food intake so that she was back to her normal weight within eight weeks following each one. Many other long-timers with diabetes, like Gladys Dull, Dee Brehm, and Jo Allen, have retained their svelte figures throughout their lives, largely due to their diligence in controlling diabetes with diet and exercise. “I know I’d be a lot heavier if I didn’t have diabetes,” agrees Natalie Saunders. Thus, having diabetes just gives you another good reason to watch your weight and prevent the common, but not inevitable, middle-age spread.