The news arrived as my fianc, Peter, and I were prepping a dinner of creamy pesto linguine and crunchy ciabatta bread, with pistachio gelato for dessert. My blood sugar was higher than normal, my nurse practitioner told me. She was nice about it, but warned me that I should make dietary changescut down on sweets and foods with a heavy carb load. Never had a dinner plate seemed so foreboding.
She told me my hemoglobin A1c test (one of the ways to test for diabetes) had revealed that my blood sugar was in the prediabetic range. The results shouldnt have surprised me. I have a family history of diabetesa great-grandmother lost her footso while part of me had been waiting for these results, most of me preferred to pretend I was immune. I grew up on deep-fried foods, and I dont love cooking. I have a sweet tooth that could make a dentist cry. Plus, Peter is a fantastic cook who fries up the worlds best breakfast potatoes. And lately, between obligatory work and non-obligatory Instagram scrolling, Id grown increasingly sedentary.
So I saw the call from my NP as the equivalent of a warning that Id been speeding (instead of a ticket, or the loss of my license). When she told me to come back in a few months, I decided to go to the equivalent of driving school.
The first thing I learned was the scary stuff: Untreated diabetes can result in stroke, kidney disease, and loss of vision along with at least eight different skin conditions, most of which involve itching. About half of diabetics will suffer from neuropathy, nerve damage that begins with tingling at the extremities and can progress to conditions that require amputation, as my great-grandmother came to know far too well.
Then I looked into why certain (delicious) foods are a problem: The human body breaks down carbohydrates, including beans, corn, and oats as well as my friends pasta and sugarinto glucose, which enters the bloodstream. The pancreas creates the hormone insulin, which escorts glucose to the heart, brain, muscles, and tissues, where its burned as fuel. But for me, along with 88 million other American adults on the prediabetes-to-diabetes spectrum, the pancreas cant keep up, and it doesnt produce enough insulin. As a result, unchaperoned glucose is free to wreak havoc in the bloodstream.
My prediabetes diagnosis meant my blood sugar levels were higher than average, but werent yet in the diabetic range. For the most part, prediabetes and diabetes are preventable and even reversible, says Marilyn Tan, M.D., chief of the Stanford Endocrine Clinic. Long-term studies have shown how effective diet and exercise changes are, says Rita R. Kalyani, M.D., a diabetes specialist at the Johns Hopkins University School of Medicine and a former chair of the American Diabetes Associations clinical guidelines committee.
Theres a catch, though: The standard lifestyle advice doesnt work for everyone. In her 20s, Dr. Tan was surprised to find that she herself was prediabetic despite walking 20,000 steps a day and watching her carbohydrate intake. Apparently her family history was too much to overcome. Sometimes, despite their best efforts, people cant fully reverse abnormal numbers, Dr. Tan says. Could I reverse mine?
Dont put off a test. During COVID-19, it's more important than ever for those with a family history of diabetes or risk factors for it to get tested and treated. As an underlying condition, diabetes increases the risk of hospitalization and death for those who get the virus. Ask your doctor about options.
Changing eating patterns is critical for reversing the progression of diabetes, but theres not a one-size-fits-all diet, Dr. Kalyani says.
Friends who had successfully managed a prediabetes diagnosis raved about high-fat, low-carbohydrate diets, and a study published this year seems to back up such anecdotal evidence: It found that this way of eating was associated with reduced blood sugar levels and greater weight loss. I stripped almost all carbohydrates from my dieta sugar addict going cold turkey (literally). I was tired, thirsty, and agitated. But to my genuine amazement, after four days, the cravings ceased. I looked at my teen sons peanut-butter-and-extra-jelly sandwich and did not want one (or two) for myself.
Other patients succeed with a fat- and protein-heavy keto or Atkins diet, Dr. Tan says, or sometimes intermittent fasting or a vegan diet. Celeste Thomas, M.D., a diabetes specialist and an assistant professor at the University of Chicago, likes the Mediterranean diet, which includes generous portions of fruits and vegetables, beans, and olive oil along with moderate portions of fish, chicken, and cheese.
Lora Shinn
One of the reasons a variety of diets can work is that blood sugar responses to different foods may vary by individual, Dr. Tan says, so she recommends that people test how their blood sugar reacts to specific foods. Like a dutiful student embarking on a science experiment, I got a prescription for a continuous glucose monitor. You wear it on your arm for 14 days, and it connects with an iPhone app that frequently retrieves blood sugar data and stores it.
The results were fascinating. A favorite snack of mineair-popped popcorndidnt do much to my blood sugar. (Hooray for this experiment!) But my blood sugar went sky-high when I ate a handful of corn chips or a cup of Peters breakfast potatoes. (Wait, I hate this experiment!) Two tablespoons of honey-flavored natural yogurt were as bad for my blood sugar as a scoop of ice cream. Small amounts of whole grains such as farro provoked a lesser response than white rice. Good news, though I said a silent, sad farewell to white rice. These differences could be explained by the glycemic index (GI), an imprecise yet helpful tool for managing blood sugar. Higher-GI foods have a greater and faster impact on blood sugar. Popcorn is lower on the index, while potatoes are high. The index isnt perfectit doesnt account for individual differences based on portion size or ways a food might be cooked. But overall, I discovered that my blood sugar spiked when I ate high-GI foods.
The data also revealed that I was hitting the fridge pretty hard in the evening. At night, the body breaks down sugar stored in the liver and energy stored in fat cells, Dr. Thomas explains. Adding more fuel in the form of crackers and cheese was overloading my bodys overnight blood sugar management system. Dr. Thomas suggests taking an 11- or 12-hour break from food at night to give the body a chance to do its work and catch up.
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I gained about five pounds over the course of my 14-day Lets eat all the foods! experiment and saw how sugar made my blood sugar shoot up and then crash. I was weirdly relieved when the experiment concluded. Afterward, my dinner plate generally consisted of organic meat and seasonal vegetables and fruit (I call my diet Lazy Keto). Peter and I adore Easy Keto in 30 Minutes by Urvashi Pitre (try the Chicken Biryani with Cauliflower Rice and Sichuan Pork with Bok Choy). In the morning, I love egg-topped ground- lupini-bean grits with kale smothered in garlic and olive oil.
Of course, it helps that Peter cooks a lot of these meals, and that being allowed one cheat meal a week lets me eat an enchilada or a doughnut. However, these dont taste as good as they used to, and the waves of fatigue I get afterward remind me why eating them is no longer an every-day choice.
Seven months and 12 lost pounds later, I met with my nurse practitioner for the big reveal. After I related all Id been doing but before I got my results, she told me I was missing a piece of the puzzle. Even if my test told me my blood sugar levels had returned to normal, I needed to add walking, yoga, or weight lifting to my daily routine.
Exercise has diabetes-management benefits beyond weight loss. In fact, even if weight loss hasnt happened yet, I tell my patients, Thats OK, because your body composition is changing with exercise, Dr. Kalyani says.
As you lose fat and gain muscle, that muscle becomes more sensitive to insulin, which can better reduce blood glucose. Exercise can help manage blood glucose levels for up to 48 hours beyond the activity itself, says Jill Kanaley, Ph.D., a professor of nutrition and exercise physiology at the University of Missouri who has conducted multiple studies with people who have prediabetes and diabetes. Exercising at least every other day provides ongoing benefits, but the benefits disappear after one goes 48 to 72 hours without exercise.
Clinical guidelines from the American Diabetes Association suggest exercising for at least 30 minutes a day, five days a week. If you have a strong family history of type 2 diabetes, it might be best to take it up a notch to 45 to 60 minutes a day, says JoAnn E. Manson, M.D., chief of the preventive medicine division at Brigham and Womens Hospital and a professor at Harvard Medical School. Studies also show that interrupting extended periods of sitting is beneficial, so your daily exercise minutes could include getting up at least once an hour to walk around.
The problem: Id never liked exercise. It made my knees and feet hurt, and to be totally honest, I got whiny. I was not alone: Some participants in Kanaleys studies at first insisted that they couldnt do it and that they could never walk fast, she says, but after two weeks or so, they got over the hump. The biggest surprise they experience is that they really want to walk now, she says. This was true for me. I started looking forward to my walks. I tried to move every 45 minutes to get in a few steps and got antsy when I didnt. I even started lifting weightsand it felt good.
I did it! My test results showed that my blood sugar was no longer in the prediabetic range. I wanted to celebrate with a pint of ice cream, but that was not how this worked. Once youre in the prediabetes car, you dont get out. You can reverse it for a while or for the long term, but youre still in the car. My pancreas will always be compromised.
Sometimes I wish I could take a pill to make all this go away. Studies are being conducted on whether vitamins or other supplements can improve glucose levels, but as Dr. Manson says, If you hope to pop a magic pill, its just not there. But those lifestyle modifications, she says, are like an elixir of health. No longer being prediabetic is a strange kind of liberation. I cant go back to the lifestyle I had before, but I dont want to as much as I thought I would. Its crystal clear how my choices can lead to a better, longer, and healthier life. Naturally, I have a lot of plans for itincluding having a (small) slice of my 80th-birthday cake.
About 10% of adults live with diabetes, but serious health disparities exist. Hispanic/Latinx adults are more than twice as likely as others to be hospitalized for end-stage kidney disease, according to data from the U.S. Department of Health and Human Services. Native American and Black adults are twice as likely as whites to die from diabetes. The damage is compounded by inequitable access to health care and discrimination from physicians, whether their bias is unconscious or conscious, research shows. Find support through the National Diabetes Prevention Program, run via local YMCAs and other partnerships.
This article originally appeared in the November 2020 issue of Prevention. Go here to join Prevention Premium (our best value, all-access plan), subscribe to the magazine, or get digital-only access.
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How to Reverse Prediabetes, According to a Woman Who Did It - Prevention.com
