Lifestyle Medicine Is the Standard of Care for Prediabetes

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Lifestyle modification is considered the foundation of diabetes prevention. What dietary strategies should be employed, and why don’t more doctors use them?

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For people with prediabetes, lifestyle modification is now considered the cornerstone of diabetes prevention. Diet-wise, that means individuals with prediabetes, or diabetes diabetes, should aim to reduce their intake of excess calories, saturated fat, and trans fat.

Too many of us consume a diet with too many of these solid fats as well as added sugars. Thankfully the latest dietary guidelines aim to shift consumption towards more plant-based foods.

Lifestyle modification is now the foundation of the American Association of Clinical Endocrinology guidelines, the European Diabetes Association guidelines, as well as the official standards of care for the American Diabetes Association. Dietary strategies include reduced intake of fat, and increased intake of fiber, meaning unrefined plant foods, including whole grains.

That’s based on research like this. We’ve known eating lots of whole grains has associated with reduced risk of developing type 2 diabetes. This recent study took it further, demonstrating that whole grain consumption may also protect against prediabetes in the first place.

To help prevent diabetics from dying, recommendations should focus on the reduction of saturated fat, cholesterol, and trans fat intake (that’s code for meat and dairy, eggs, and junk food), and increases in omega 3’s soluble fiber, and phytosterols, all three of which can be found packaged in flax seeds, for example, an efficient but still uncommon intervention for prediabetes. They found that about 2 tablespoons of ground flax a day decreased insulin resistance, which is the hallmark of the disease.

So if the standards of care for all the major diabetes groups says that lifestyle is the preferred treatment for prediabetes because it’s so safe and highly effective, why don’t more doctors do it?

Unfortunately, the opportunity to treat this disease naturally is often unrecognized. Only about 1 in 3 patients report ever being told about diet or exercise. Possible reasons for not counseling patients include lack of reimbursement, lack of resources, lack of time, and lack of skill.

We’re just not teaching doctors how. The inadequacy of clinical education is a consequence of the failure of health care and medical education to adapt to the great transformation of disease from acute to chronic. Chronic disease is now the principal cause of disability, consuming three quarters of our sickness-care system. Why has there been little academic response to the rising prevalence of chronic disease?

Maybe it’s because doctors aren’t getting paid to do it. Attempting to change to a rational chronic care model is practically unthinkable in the absence of a radically changed compensation model. Why haven’t reimbursement policies been modified? One crucial reason may be a failure of leadership in the medical profession and medical education to recognize and respond to the changing nature of disease patterns. How far behind the times is the medical profession?

A report by the Institute of Medicine on medical training concluded that the fundamental approach to medical education has not changed since 1910.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to Etrus and Evan-Amos via Wikimedia Commons, PublicDomainPictures via Pixabay, and Elizabeth Tov.

For people with prediabetes, lifestyle modification is now considered the cornerstone of diabetes prevention. Diet-wise, that means individuals with prediabetes, or diabetes diabetes, should aim to reduce their intake of excess calories, saturated fat, and trans fat.

Too many of us consume a diet with too many of these solid fats as well as added sugars. Thankfully the latest dietary guidelines aim to shift consumption towards more plant-based foods.

Lifestyle modification is now the foundation of the American Association of Clinical Endocrinology guidelines, the European Diabetes Association guidelines, as well as the official standards of care for the American Diabetes Association. Dietary strategies include reduced intake of fat, and increased intake of fiber, meaning unrefined plant foods, including whole grains.

That’s based on research like this. We’ve known eating lots of whole grains has associated with reduced risk of developing type 2 diabetes. This recent study took it further, demonstrating that whole grain consumption may also protect against prediabetes in the first place.

To help prevent diabetics from dying, recommendations should focus on the reduction of saturated fat, cholesterol, and trans fat intake (that’s code for meat and dairy, eggs, and junk food), and increases in omega 3’s soluble fiber, and phytosterols, all three of which can be found packaged in flax seeds, for example, an efficient but still uncommon intervention for prediabetes. They found that about 2 tablespoons of ground flax a day decreased insulin resistance, which is the hallmark of the disease.

So if the standards of care for all the major diabetes groups says that lifestyle is the preferred treatment for prediabetes because it’s so safe and highly effective, why don’t more doctors do it?

Unfortunately, the opportunity to treat this disease naturally is often unrecognized. Only about 1 in 3 patients report ever being told about diet or exercise. Possible reasons for not counseling patients include lack of reimbursement, lack of resources, lack of time, and lack of skill.

We’re just not teaching doctors how. The inadequacy of clinical education is a consequence of the failure of health care and medical education to adapt to the great transformation of disease from acute to chronic. Chronic disease is now the principal cause of disability, consuming three quarters of our sickness-care system. Why has there been little academic response to the rising prevalence of chronic disease?

Maybe it’s because doctors aren’t getting paid to do it. Attempting to change to a rational chronic care model is practically unthinkable in the absence of a radically changed compensation model. Why haven’t reimbursement policies been modified? One crucial reason may be a failure of leadership in the medical profession and medical education to recognize and respond to the changing nature of disease patterns. How far behind the times is the medical profession?

A report by the Institute of Medicine on medical training concluded that the fundamental approach to medical education has not changed since 1910.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to Etrus and Evan-Amos via Wikimedia Commons, PublicDomainPictures via Pixabay, and Elizabeth Tov.

Doctor's Note

I hope my work is helping to fill the gap that medical professionals are not getting during training about preventing and treating chronic disease. That’s actually how this all started. I would make trips to Countway at the beginning of every month in medical school to read all the new journal issues. I felt I had a duty to my patients to stay on top of the literature. But hey, since I’m doing so much work, might as well share it! So what started as an email newsletter morphed into a medical school speaking tour into a DVD series and then now all online for everyone.

For more on preventing and treating prediabetes/diabetes, see:

For more on lifestyle medicine:

And for insight into the sad state of nutrition in medical training, Doctors Know Less Than They Think About Nutrition and Medical School Nutrition Training.

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