One of my patients came to see me recently because of weight loss. His blood sugar was normal half a year ago. But he is at high risk for diabetes because his mother also has diabetes. Blood test confirmed his fear: his sugar is three times the normal limit. He has no classic signs of diabetes: frequent thirst, frequent hunger and frequent urination. But he succumbed to one the silent epidemic in the US now: diabetes.

There are three common misconceptions about diabetes. 1) Chinese has low incidence of diabetes because of our healthy diet. 2) Eating less sugar can decrease incidence of diabetes. 3) People in their 30’s (thus young) do not have to worry about diabetes.

In fact, Chinese has higher incidence of diabetes than white people despite we may eat “healthier”. 8% of Chinese living in the US actually have diabetes, compared with 4% of white. That is one in every 12 Chinese in the US. About 100,000 residents in Beijing had a recent health screening. About 20% actually had a pre-diabetic condition called Impaired Fasting Glucose. These people have a 10 times increase chance of developing diabetes than those who do not have Impaired Fasting Glucose. That is why I screen diabetes among all my patients. People in their 30’s, even though they may consider themselves healthy or too young to have diabetes, has recently found to have a 75% increase in incidence of diabetes since 1990. Overall, diabetes in the US increases by 33%. It is a silent disease at the beginning, before it causes heart attack, stroke, blindness, kidney failure, and limp amputation. Diabetes is the leading cause of death, dialysis, amputation, and heart attack in the US. 70% of patient with diabetes died from cardiovascular disease.

How can one prevent this deadly disease? New England Journal of Medicine published a landmark study last year demonstrating a dramatic decrease in incidence of diabetes in patients with pre-diabetic condition. Intensive lifestyle changes with the goal of reducing weight by 7% through a healthy diet and exercising for 2.5 hours per week, such as walking, for about 30 minutes a day, decreased incidence of diabetes by 58%. Another article published at the same journal in 2001 showed that after 16 years of follow-up of more than ninety thousand nurses, overweight or obesity was the single most important predictor of diabetes. Lack of exercise, a poor diet, current smoking, and abstinence from alcohol use were all associated with a significantly increased risk of diabetes. The conclusion is that the majority of cases of type 2 diabetes could be prevented by the adoption of a healthier lifestyle.

Decreasing amount of sugar we take in everyday is only part of the healthy diet. I usually tell my patients my essence of healthy diet can be summarized with five fingers. Number one on my list is rice. Rice can be quickly converted into simple sugar after a meal and causes a surge in both blood sugar and insulin, a major hormone in sugar control. One patient of mine had been diagnosed with diabetes twice in the past had his sugar normalized in just one month by cutting his rice intake by half and rice soup by half. He simply substitute the rice with lots of vegetable and moderate amount of fish and chicken. Everything else he does the same. Number two is bread. The white bread we brought from supermarket is made from very finely ground flour and is again quickly converted into simple sugar after eating. One may substitute that with whole wheat bread, especially those that are stone ground. Number three is noodle. One of my diabetic patients quickly found out if he eats Chinese noodle, sugar can go up as high as 300 (goal is <140). If he substitutes that with spaghetti (Italian noodle), sugar is only around 140. That is because Italian noodle is absorbed much slower than Chinese noodle, which is again very finely ground. Number 4 is sugar. When talking about sugar, people tend to think the sugar they put into their coffee or the sugar used in cooking. But as a matter of fact, we live in a very “sugary world”. The cake we buy tends to have more sugar than floor. The juice we drink has tons of sugar. The soda is sugar water in disguise. The cookies, donuts, chocolate, or candies are all sugar surrounding us. One is much better off eating apples, orange, cherries, or peaches. Those fruit actually increase your sugar minimally after eating. Number 5 is potato. A very interesting experiment done recently found that potato increases the sugar most among all the food tested. So avoid it if you can. Sweat potato, in contrast, increases sugar only half as much as potato.

People who has family member with diabetes, those who are consider obese (body mass index >27, calculated by dividing body weight in kilogram with the square of height in meter), or those who has high blood pressure, high cholesterol or impaired fasting glucose, have particular high risk of developing diabetes. Please remember the five groups of food I mention above and exercise in moderate intensity for about 30 minutes a day. Quick smoking if you smoke. As always, preventing a disease is much more desirable than treating one, especially something as deadly as diabetes.

Note:

  • Glycemic Index (GI): This is the index used to judge how quickly glucose rises in the blood after a certain food is consumed. As a general guide, consumption of food of lower GI tends to have a less surge of insulin, thus a lower work-load for the Pancrease. Also, consumption of predominantly low GI can lead to weight loss and less chance of developing diabetes. If the blood sugar level after consuming 100g of white bread is set as GI of 100, then the highest GI goes to baked potato: 135. For comparison, corn flakes: 119. Brown rice: 96. White rice: 83. Sweat potato: 70. Spaghetti: 65. Ice cream, yogurt, whole milk, and apple: all around 50. Red lentil: 43. Soya Bean: 20.
  • Body Mass Index (BMI): index designed to judge whether people is over or under weight. It is calculated by dividing body weight in kilogram with the square of height in meter. You can try to calculate your own BMI to see if you fit into the following category: BMI<20: underweight; BMI 20-25: ideal; BMI 25-27: overweight; BMI 27-30: obese; BMI>30: morbid obesity.
  • Fasting Blood Sugar Test: this is to test the glucose level in the blood after fasting overnight (nothing by mouth except a little bit of water). When the level is >125, is called diabetes. Between 110 and 125: impaired fasting glucose. Even when the level is less than 110, the level of blood glucose level is still informative of how well the body is controlling the sugar. The closer to 110 the greater the chance of developing Impaired Fasting Glucose and Diabetes.