An Urgent Need for Diabetes Prevention
The onset of both Type 1 and Type 2 Diabetes occurs at all ages. The U.S. Department of Health and Human Services estimates that about one in four U.S. adults aged 20 years or older—or 57 million people—had prediabetes in 2007. Older adults are at higher risk for the development of Type 2 Diabetes due to the combined effects of increasing insulin resistance and impaired pancreatic islet function with aging. Of Americans age 65 and older, approximately 25% have diabetes and approximately 50% have pre-diabetes. The vast majority of these cases are Type 2. Type 1 affects less than 1/2% of the population. Compared to older adults without diabetes, diabetics have higher rates of coronary heart disease, hypertension, dementia, urinary incontinence, accelerated muscle loss, neuropathic pain, and premature death. Diabetes is now the seventh leading cause of death in the U.S.
Early Intervention for Dramatic Quality of Life Benefits
The American Diabetes Association recommends that testing to detect prediabetes and Type 2 Diabetes be considered in all adults without symptoms who are overweight or obese and have one or more additional risk factors for diabetes. Risk factors include having a parent, brother, or sister with diabetes, having high blood pressure, having a history of cardiovascular disease, as well as other risk factors. People who are without risk factors should see their doctor for testing at age 45. Studies indicate that early lifestyle interventions for at-risk patients lower the probability of developing the disease by 58%, and these interventions can have dramatic quality of life benefits.(1)
Genetic Risk Panels for the Earliest Possible Identification of Those at Risk
At The Harlin Center, as a routine, we assess each patient’s genetic risk for Type 2 Diabetes, for both lean and overweight subtypes. We examine approximately 500 genes, covering five metabolic mechanisms. The risk scores from these five gene panels allow us to further stratify patients into different precision medicine subtypes. This combined with blood biomarkers, gut microbiota data, and BMI facilitates the creation of a precision medicine plan for either diabetes preventions or diabetes care and reversal. This screening facilitates the earliest possible identification of those at risk.
Diabetes, also known as diabetes mellitus, is defined by an elevated blood sugar, or hyperglycemia. Normally, the body breaks down the sugars and carbohydrates we eat into a form of sugar called glucose. Glucose is the main fuel for every cell in our bodies. It is transported to the cells via the bloodstream. But we need insulin, a hormone, in our bloodstreams to take the glucose into our cells where it is used for energy, or stored in fat cells, muscle cells, or the liver for later use. Insulin is produced by the ß cells (beta cells) in the islets of Langerhans in the pancreas. When our cells do not get enough insulin, or our cells are insulin resistant and unable to take up glucose, glucose builds up in the bloodstream, resulting in elevated blood sugar.
Diabetes Root Cause — or Etiology
Research has found many associations between development of diabetes and lifestyle choices, environmental exposures, and genetics. This is true for both Type 1 (T!DM) and Type 2 (T2DM). T1DM is due to autoimmune ß-cell destruction, usually leading to total insulin deficiency. People with T1DM experience much greater glycemic variability than those with T2DM. This variability is associated with a higher risk of hypoglycemia — low blood sugar. T2DM is typically thought of as due to insulin resistance. Yet, the progressive loss of ß-cell insulin secretion is typically concurrent. The degree of insulin resistance and insulin deficiency is likely to be different in each patient and is likely to vary during the course of the disease. The hyperglycemia found in T2DM due to insulin resistance can be treated, and even reversed in many cases, with nutrition and lifestyle interventions. Early detection and treatment can prevent or delay additional loss of ß-cell function.
Diabetes Care and Reversal of Type 2 Diabetes
At The Harlin Center, we take a very patient-centered approach. This is particularly true for our patients with diabetes. Optimal management requires a close working relationship with the patient. Treatment plans are created with the patient based on his/her individual preferences and goals. Diabetes is a metabolic disease, and therefore diet is at the forefront of diabetes management, Type 2 Diabetes reversal, and diabetes prevention. Treatment plans include weight management (ideally including calorie restriction for overweight patients), time-restricted eating, specific foods to add to one’s diet and foods to avoid, dietary supplements, and specific probiotics based on your microbiome analysis. The treatment plan also includes an exercise regimen, stress management techniques, and a sleep hygiene protocol. However, patients with diabetes can find it challenging to resist tempting calorie-dense foods, keep up with their exercise regimen, manage their stress, and monitor their blood sugar on a regular basis. So we take an active role in supporting our patients — in helping direct day-to-day decisionmaking, planning, monitoring, problem-solving, and de-stressing.
Education and Support — It’s What We Do
Understanding the etiology of diabetes can go a long way toward helping patients make the right day-to-day decisions. We educate patients about the role of hormones in appetite regulation and the challenges created for diabetics. (We’ll also educate you about some supplements and exotic foods that lower HgA1c, improve fasting glucose, lower glucose spikes, and improves your gut health.) Patients are also taught how to use self-monitoring blood glucose data to adjust their food intake, their exercise, or their pharmacologic therapy — to achieve their specific goals. We ask that each patient come in every 3 to 4 weeks to meet with our health coach, get weighed, measured, and blood pressure taken; assess progress and goals; discuss what is working and what’s not — as well as meet with Dr. Harlin to review medications and labs every few months. We have a nonjudgemental approach; we are here to support and educate our patients on proper management and care — on how to optimize their individual health outcome. We welcome spouses, family members, and caregivers to join us in these sessions.
Pre-diabetes, Inflammation, and the Western Diet
Inflammation is the hallmark of diseases known as the “diseases of affluence” — cancer, cardiovascular disease, and diabetes. There is a growing body of evidence indicating that chronic sub-clinical inflammation, as measured by inflammatory biomarkers such as C-reactive protein (CRP) and others, is associated with insulin resistance and pre-diabetes. Our calorie-rich, fatty, hyperpalatable Western diet is the principal culprit; it activates our immune system to become hyperreactive to inflammatory triggers.
Inflammation and Saturated Fat
The association between insulin resistance and saturated fats is widely accepted. Studies have shown that in diabetic patients, saturated fats create inflammation and insulin resistance, whereas unprocessed, unsaturated fats improve insulin sensitivity — such as the fats found in raw nuts. It is hypothesized that saturated fats in the diet cause mitochondrial dysfunction, which increases free radical production and impairs insulin signaling. (Mitochondria are the powerhouses in our cells which produce the energy cells need to survive.)
Inflammation and AGEs
Advanced glycation endproducts (AGEs) are found naturally in the body but are also found in animal products and processed foods. Diet-derived AGEs that are absorbed into the bloodstream are suspected to be a major source of biologically active toxins. AGEs are thought to stimulate chronic low-grade inflammation and promote oxidative stress and have been linked to the development of insulin resistance and diabetes, as well as other degenerative diseases.
Inflammation and High Fructose Corn Syrup
High fructose corn syrup (HFCS) is sweeter than sucrose, or table sugar. It started being added to processed foods in the late 1960s and is now found in the many hyper-palatable engineered foods. HFCS is commonly added to carbonated beverages, candy, baked goods, yogurt, cereals, salad dressing, and other processed foods. According to the USDA’s 2015 Dietary Guidelines for Americans, added sugar accounts for approximately 18% of a teenager’s calories per day. For adults, that number is 12%. That is roughly 50-60% more than we consumed in the early 1960s.
Research suggests that excessive dietary fructose interferes with appetite signaling hormones. Consumption of fructose has also been shown to increase several inflammatory markers, increase oxidative stress, and increase insulin resistance. The research is overwhelming; to preserve our health, we must choose our food conscientiously, be careful with the dietary habits we develop, and mindful of the examples we set for our children.
The growing epidemic of Type 2 Diabetes is one of the leading causes of premature morbidity and mortality worldwide and the benefits of early intervention cannot be underestimated. Our genetic risk screening identifies those most at risk for developing Type 2 Diabetes and our interventions are aimed at diabetes prevention and T2DM reversal.
Preventing diabetes mellitus requires a multifactorial approach targeting multiple modifiable risk factors. Our clinical care includes advanced biomarkers, which are used to assess insulin resistance, inflammation, and oxidative stress; an assessment of glucose tolerance and nutrient blood serum levels; dietary analyses and recommendations; exercise prescription; lifestyle education; microbiome analysis; individualized probiotic recommendations, as well as genomic analysis.
Precision Medicine for Pre-diabetes
At The Harlin Center, we have identified polygenic panels that contain approximately 500 genetic biomarkers related to increased susceptibility to developing Type 2 Diabetes. Having a tool to stratify patients according to risk is key to the success of any health management initiative. Our proprietary expert system provides such a tool. Our polygenic panels focus on genetic variations found to influence the development of glucose dysregulation.
We’ve collated a large body of research on preclinical diabetes and honed in on the findings that report preventive measures associated with genes regulating glucose homeostasis. With that foundation in place, we have developed a genomic-based program based on the principles promulgated by the NIH Diabetes Prevention Program (a major multicenter clinical research study) and designed a diabetes prevention program with an emphasis specific to your genetic makeup.
- Diabetes Prevention Program (DPP) Research Group., The Diabetes Prevention Program (DPP): description of lifestyle intervention. Diabetes Care. 2002 Dec;25(12):2165-71.