Type II diabetes and obesity: An all-too-common combination

There are a few things which tend to go hand in hand with obesity - poor eating habits, a sedentary lifestyle, and diabetes. Yes, diabetes, specifically type II diabetes, which is also known as non-insulin-dependent diabetes or adult-onset diabetes.

According to the American Diabetes Association (ADA), there are four major risk factors for developing type If diabetes: 1) being 20 percent or more over your ideal body weight, or having a body mass index (BMI) of 27 or higher; 2) leading a sedentary lifestyle; 3) being over the age of 45; and 4) having a family history of the disease. Interestingly, the ADA reports that one in five Americans incorrectly believes that "eating too much sugar" is a major risk factor for diabetes.

History shows that diabetes and obesity go hand in hand

In a report entitled, "Weight loss - diets don't work; lifestyle changes do," the ADA tells us, "Diabetes is common in cultures in which obesity has been common for at least 20 years. Diabetes is rare in societies in which obesity is rare."

The report cites American Indians as an example, saying that before 1900, this group rarely got diabetes, but as they adopted a more modern lifestyle complete with processed foods and sedentary jobs, their rates of both obesity and diabetes soared. While obesity does not cause type II diabetes, it does predispose us to develop the disease and is, certainly, a major risk factor. Major indeed. The ADA reports that of the nearly 14 million people in the United States who have type II diabetes, approximately 80 percent were overweight before they developed the disease.

As to why obesity appears to be a risk factor for type II diabetes, it seems to decrease the body's ability to use insulin (a protein hormone produced in the pancreas which is important for regulating the amount of sugar in the blood). This is called "insulin resistance." When the body resists insulin, sugar (glucose) accumulates in the blood. Also, upper body obesity, particularly in the abdominal area, appears to be a greater risk factor for type II diabetes than does lower body obesity. In fact, both Arizona Pima Indians and South Asian Indians, both of whom have high rates of abdominal obesity, also have escalated rates of type-II diabetes.

While age and family history may be out of our hands, we do have at least some control over our body weight and activity levels. In fact, even if you already have type II diabetes, losing weight can help. According to an article which appeared in a 1997 issue of the journal Diabetes Care, even mild to moderate weight loss - as little as 10 to 20 pounds - can improve diabetes control. As for exercise, an article appearing in a 1998 issue of Clinical Diabetes by Alan O. Marcus, M.D., FACP, states, "All successful therapies for diseases associated with insulin resistance are founded on the association between insulin resistance and exercise." The message here again is moderation: strive for 30minute sessions five to seven times a week.

Diabetes and heart disease

It's a vicious cycle: Obesity is a risk factor for type-II diabetes; obesity is a risk factor for heart disease; type II diabetes is a risk factor for heart disease. Marcus reports that obesity is a contributing factor in 300,000 deaths per year. In particular, he says that obesity is associated with a 3-4 times greater risk of illness from diseases, such as stroke, heart disease, and diabetes.

Diabetes and chromium

Much has been written in recent years about the mineral chromium and its relationship to both diabetes and weight loss.

Diabetes. In a now landmark study, "Elevated Intakes of Supplemental Chromium Improve Glucose and Insulin Variables in Individuals With Type 2 Diabetes," Richard Anderson, Ph.D., and colleagues, wanted to see whether chromium supplementation "is involved in the control of type II diabetes."

Anderson, a lead scientist on trace minerals at the U.S. Department of Agriculture's Human Nutrition Research Center, in Beltsville, Md., enrolled 180 men and women who were being treated for type II diabetes. The participants were instructed to continue to take their normal medications and to not change their eating habits.

Anderson's group found that supplemental chromium had "significant beneficial effects" on glycated hemoglobin, blood sugar levels, insulin sensitivity, and cholesterol levels in "subjects with type II diabetes."

Weight loss. To look at the effect of dietary chromium on body composition, a randomized, double-masked, placebo-controlled study was carried out by Gilbert R. Kaats, Ph.D., and colleagues.

A total of 154 patients received a daily "dose" of either a dummy pill, 200 mcg. of chromium, or 400 mcg. of chromium. The participants were not provided with guidance for weight-loss, diet, or exercise. The results? Both the 200-mcg. and 400mcg. groups achieved "significantly higher positive changes in body composition improvement (BCI)." Fat intake and type II diabetes

There also seems to be a relationship between fat intake and type II diabetes. As we've heard before, Americans have a high ratio of omega-6 fatty acids in relation to omega-3 fatty acids. Some experts recommend an increase in the intake of omega 3's for both weight loss and diabetes. In his book, Fats That Heal Fats That Kill, Udo Erasmus, says, in regards to omega-3s and diabetes, "In part, diabetics suffer from functional essential fatty acid (EFA) deficiency. High sugar levels make EFAs present in fat tissues unavailable to our body.... EFAs given to diabetics have an insulin-sparing effect, indicating that the effectiveness of insulin depends on them. In fact, dietary [omega-3] fatty acids decrease the amount of insulin needed by diabetics."

So what's the fat connection, again?

Well, first off, excess consumption of poor-quality fats (sugary snacks, chips, ice cream, deep-fried foods) leads to an increase in body fat, if our exercise level is not high enough. As we know, obesity, then, predisposes us to develop type II diabetes. Second, excess sugar consumption places a burden on our organs, and our insulin resistance, leading to a boost in our glucose levels. Exercise, a wholesome diet, targeted supplements, and the right intake of essential fatty acids such as omega-3's from flax, fish and microalgae (DHA) - can help us get back on track.

One recent, sensible book on lifelong approaches to weight loss is: Your Fat Is Not Your Fault: How To Overcome Your Body's Resistance to Permanent Weight Loss by Carol Simontacchi, C.C.N., MS., and Margaret West (Tarcher/Putnam, 1997). Ed.

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REFERENCES

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American Diabetes Association. "Nutrition recommendations and principles for people with diabetes mellitus," Diabetes Care 20(1):S14-S17, January 1997.

American Diabetes Association. "America looks at serious diseases: what's on our minds?" Alexandria, Va., February 1997. American Diabetes Association. "Weight loss: diets don't work; lifestyle changes do," Alexandria, Va.

Anderson, Richard A., Ph.D., et al. "Elevated Intakes of Supplemental Chromium Improve Glucose and Insulin Variables in Individuals With Type 2 Diabetes," Diabetes 46:1786, November 1997. Erasmus, Fats That Heal Fats That Kill. Burnaby B.C., Canada: Alive Books, 1986. Gormley, James J. "Dietary chromium is safe and effective for good health," Better Nutrition 59(3):18, 1997. Kaats, Gilbert R., et al. Effects of Chromium. Picolinate Supplementation on Body Composition: A Randomized, Double-Masked, Placebo-Controlled Study," Current Therapeutic Research 57:747-756,October 1996. 1996. Marcus, Alan O., M.D., FACP. "Diabetes and obesity: developmental relationships and interventional strategies for successful outcomes," Clinical Diabetes 16(1):13-15, 1998.