Illustration by stephen cheatham for Reader's Digest International Edition
“Your blood sugar is too high. You have pre-diabetes.” When Gail Tudor heard her doctor say that in July last year, the 54-year-old U.K. wedding videographer was shocked. How could she? She had a normal body mass index of 24, and she followed the NHS-recommended diet low in fat and high in fruits, vegetables and healthy grains. Plus Gail, a mother of two who lives in Wales, was very active—skating, walking, kayaking, and more. Since she already did those things, her doctor said, it was unlikely she could reverse her path to Type 2 diabetes. She was offered a treatment plan including drugs, and was told that it was likely she’d need them for the rest of her life. “I couldn’t believe it,” Gail says. She determined to learn what else she could do to prevent diabetes from developing—without resorting to drugs.
Retired engineer Frank Linnhoff, 69, who lives near Bordeaux, France, knew his obesity and his family history put him at high risk of T2 diabetes. His father died aged 70 from kidney failure caused by the disease; his brother had a leg amputated at 45 because of it. Diagnosed with pre-diabetes a number of years earlier, Linhoff had tried his best to follow his doctor’s advice on diet and exercise, but still his weight climbed.
In January 2015, he was feeling so poorly he went for a blood test at a medical laboratory. The results showed his fasting blood glucose was sky high. He knew if he went to the doctor he would be diagnosed with diabetes. “I was so shocked that I was up all night, searching the Internet for answers,” he says. “My father and brother had failed to control their diabetes; I couldn’t have the same fate.” He was determined to pull himself back from the precipice.
In August 2015, at age 57, I, too, was told by my doctor that my fasting blood sugar was in the pre-diabetes range. Like Gail, I wasn’t overweight. My BMI was a healthy 23.7. I exercised three times a week and walked 10,000 steps every day. Moreover, as a health writer for more than 25 years, I had been following all the recommended dietary guidelines for three decades. What more could I do?
I began searching the medical literature for the most up-to-date facts and views. Pre-diabetes, I learned, is a warning flag of health troubles down the road for tens of thousands of men and women in Europe this year who will be told that they have it. An estimated one in three U.K. adults already do, and the International Diabetes Foundation estimates that in Europe, around five percent of adults, aged 20-79, are already living with impaired glucose tolerance and are at increased risk of developing diabetes. Pre-diabetes increases the risk up to ten times for developing eventual T2 diabetes with its dire rates of heart disease, stroke, blindness, nerve damage, kidney damage, and limb amputations. What’s more, damage to the body’s tissues and blood vessels can start well before full-blown T2 diabetes occurs.
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Often causing or accompanied by hyperglycemia, pre-diabetes is linked to a problem with the body’s insulin, a hormone that moves sugar out of the blood and into cells for energy use or storage as fat. When pre-diabetes occurs, higher and higher amounts are being churned out that no longer work as effectively, a process called insulin resistance. The result is that too much sugar is left circulating in the blood, which leads to higher blood sugar levels and the higher risk of Type 2 diabetes.
Soaring rates of T2 diabetes are a massive health problem, not only for the individuals facing its consequences, but for health systems burdened by the burgeoning numbers. According to the European Commission, an estimated 32 million Europeans have the disease within the European Union itself. Worldwide, rates have almost quadrupled since 1980. In the last decade alone, T2 diabetes rates in the U.K. have increased 65 percent, and, according to Diabetes U.K.’s 2016 report, if the current trends persist, by 2034 a staggering third of Britons will be obese, while T2 diabetes will develop in 10 percent of the population.
The good news is pre-diabetes is reversible with lifestyle changes. So the choice is yours. In fact, Gail Tudor, Frank Linnhoff, and I have all eliminated our pre-diabetes since our 2015 diagnoses and greatly improved our health. So have thousands of others.
If you or a loved one has been told you have pre-diabetes, here is what you need to know.
Who is at risk?
Being overweight or obese, inactive, or from a family with a history of T2 diabetes makes you more likely to get a pre-diabetes diagnosis. Women—like Gail—who have had gestational diabetes (a type that affects women during pregnancy) are at much higher risk of eventually developing pre-diabetes or T2 diabetes. So are women who have given birth to a baby bigger than nine pounds—as I did 23 years ago. I also had a related condition that up to 20 percent of European women may have: a genetic, hormonal condition called Polycystic Ovary Syndrome (PCOS), which causes lowered fertility, potential weight gain and other symptoms. A key feature of PCOS, just like diabetes, is insulin resistance. “Insulin’s action is the key,” notes Dr. Jason Fung, a Canadian nephrologist whose majority of kidney failure patients have T2 diabetes. Dr. Fung has recently written the international bestseller The Obesity Code in which he describes how insulin, insulin resistance, and the stress hormone cortisol are the key hormonal triggers to T2 diabetes and obesity. To reverse them you need to address those triggers, Dr Fung says.
How is pre-diabetes diagnosed?
Since pre-diabetes generally has no symptoms, the way to detect it is by a blood-screening test, generally in one of three ways: 1) a blood sample called a Fasting Plasma Glucose, drawn in the morning before you have eaten anything, shows blood sugar between 5.6-6.9 mmol [100 -125 mg/dl—use whichever measure prevails locally]; 2) a blood sample after drinking 75 grams of a sweet drink (called a glucose tolerance test) shows blood sugar two hours later between 7.8 -11.0 mmol [140-199 mg/dl]; or 3) a test called a Hemoglobin A1c (a single blood test that reflects a 3 month avg of your blood glucose levels) averages between 5.7-6.4 per cent [39-46 mmol/mol]. Higher rates on all these tests mean full-blown T2 diabetes.
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Lose weight, but how?
It has been known for years that losing five to ten percent of your body weight—no matter how you do it—can reverse pre-diabetes for a time. But as we all know, most diets are hard to maintain and weight is eventually regained, sometimes more than was lost. With the weight gain and return to regular diet usually comes the return of poor blood sugar results.
But here is the new, somewhat controversial approach: Thousands of people like Gail Tudor, Frank Linnhoff and me have lost weight and reversed diabetes risk factors by cutting sugar and refined or starchy carbohydrates (bread, potatoes, rice, pasta, cereals, cookies, savory biscuits and cakes) out of our diets and upping the proportion of healthy fat.
All carbohydrates get turned into sugars by digestion in our body. That sugar then triggers the release of insulin. So reducing or eliminating most carbs to under 100g a day (or even as low as 20g) lowers the amount of sugar in the blood and thereby the need for insulin to respond to it, notes Dr. Fung. Doing so helps re-sensitize us to insulin. “Diabetes and pre-diabetes should really be called carbohydrate intolerance,” says Dr. Aseem Malhotra, U.K. cardiologist, advisor to the National Obesity Forum and a founding member and former science director of the U.K. “Action on Sugar” campaign to remove or reduce added sugars in all of our diets.
Low-carb diets have been around for years, but adding healthy fat is the new twist. Fats from dairy, nuts, fish and eggs (including the yolk) are healthy, whereas overconsumption of vegetable oils and trans fats can lead to chronic disease. A growing body of evidence shows our 30-year message to avoid fat has been misguided and fat instead is satiating, good for the heart and brain, and, compared to other food groups, has the least impact on insulin release.
Swedish diabetes researcher and head of internal medicine at Linkoping University Dr. Fredrik Nystrom agrees. His dietary advice: “Carbohydrate restriction in combination with the high fat Mediterranean diet [fish, some meat, vegetables, cheese, nuts, olive oil.]
A study published in June 2016 in The Lancet Diabetes & Endocrinology journal found that a high fat Mediterranean diet did not lead to weight gain—in fact men and women randomized to the higher fat group lost more weight and inches from their waist than the low fat group.
Gail Tudor started the low carb/high fat (LCHF) approach in July last year; by May this year she had lost more than 14 lbs—mostly within the first three months, even though weight loss was not her intention—and her blood sugar had returned to healthy ranges, her pre-diabetes under control. Frank Linnhoff, who started LCHF in January 2015, has lost more than 20 lbs and his blood sugar is now normal—and so is his blood pressure. I started the diet in autumn 2015 and after seven months had lost ten pounds and had my blood glucose return to normal. Better yet, the food is delicious and satisfying.
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Does it work for everyone?
No long-term studies have yet been published and most countries’ diabetes associations are taking a wait-and-see approach. But a ground swell of vocal medical experts and scientific researchers, a growing body of research and tens of thousands of individuals who have tried it now endorse the LCHF approach as safe and effective. Some of the growing evidence includes:
In January 2015, 26 international medical experts advocated carbohydrate restriction as the first approach to managing diabetes and pre-diabetes in an article published in the journal Nutrition.
In May this year, the online U.K. diabetes forum diabetes.co.uk announced that as part of a study where 120,000 people had signed up for its ten-week low carb/high fat program, the majority reported improved blood glucose and weight loss on the diet.
For almost a decade, Swedish GP Dr. Andreas Eenfeldt has been counseling his pre-diabetes, T2 diabetes, and obese patients to switch to a low-carb, high-fat diet. “In weeks and months they got better, their diabetes reversed and they could get off drugs,” said Dr Eenfeldt, who in 2007 started a non-commercial Swedish website, dietdoctor.com. In 2010 his book Low Carb High Fat Food Revolution became a Swedish bestseller and was translated into eight languages. In 2011, he started the English dietdoctor.com site. Dietdoctor.com, which now gets two million visits a month, has more than 300 testimonials of health transformations on LCHF. Gail, Frank, and I were all helped in our transformations by the website. Frank, along with the LCHF diet, is now cycling, dancing, enjoying life and celebrating his return to good health. “I felt so bad in January 2015. I never thought that just a year later I would feel so wonderful. “
What else can you do?
Exercise: Our muscles act like a sponge to sop up glucose in the blood. The more we move them, the more they soak up. It doesn’t have to be training for a marathon. Gail, who uses a home blood glucose monitor, has noticed that all she needs to do is walk around her house or up and down her stairs to bring her blood sugar levels down a few points. Most experts recommend 30 minutes of low stress movement daily—try to fit in a brisk walk if you’re unable to keep your body moving with other activities.
Improve sleep quality: In recent years, the link between poor sleep quality, insomnia, and sleep deprivation have all emerged as risk factors for both weight gain and increased risk of diabetes. Getting seven to eight hours of good quality sleep reduces the risk. Some tips for a better sleep include not having TV, cellphones and laptops in the room, keeping pets off the bed, minimizing alcohol before bedtime, keeping the room cool, wearing earplugs and having a relaxing regular sleep routine.
Stress reduction: Stress increases the body’s hormone cortisol (insufficient sleep raises cortisol too), which in turn can raise blood sugar levels. Chronic stress may increase insulin resistance, leads to abdominal weight gain and increase the risk for pre-diabetes and T2 diabetes. “Reducing stress is vitally important,” notes Dr. Fung. Some tips to reduce chronic stress include mindfulness meditation, yoga, massage and relaxing exercise.
I was fortunate. As a health writer, I immediately understood the dangers of a pre-diabetes diagnosis. Over the last year, since my wake-up call, I have focused on making all these lifestyle changes, restricting carbs and sugar in my diet, lifting weights, walking everywhere and getting a good night sleep. I’ve lost a total of 13 lbs to date, and I’ve kept them off. I bought a blood glucose monitor and check my blood sugar regularly. I am now always in the healthy range. In fact, I actually feel lucky that I got that pre-diabetes scare: it has helped me improve my health and avoid T2 diabetes.
As Dr. Andreas Eenfeldt says, “We really need to spread this knowledge so that more people can benefit from it—and act accordingly to improve their health.”