Diabetes: A Wake-Up Call! We Can Do Better – Part 1

By Dr. John Mishock, PT, DPT, DC

Approximately 30.3 million Americans, or 9.4% of the population, have Diabetes. Globally, diabetes prevalence has climbed from 108 million in 1980 to 425 million in 2017, with 640 million expected by 2040. (Uusitupa et al. Nutrients, 2019) From 1990-2019, the incidence of type 2 diabetes among people from 15-39 years jumped 56% in over 204 countries, with high obesity and sedentary living being the leading culprit. (Larkin, JAMA 2023) Twenty-five percent of all Americans age 65 and older have Diabetes. Even young people are affected by Diabetes, with 193,000 Americans under the age of 20 having the disease. The cost to manage and treat Diabetes is a staggering $327 billion annually. (CDC National Diabetes Stat Report 2017) In most cases, the answer to preventing and curing this dreaded disease is through nutrition and exercise.

How does Diabetes affect my body?
Diabetes has three types (Type 1, 2, and Gestational). Regardless of the type, your body breaks down food (carbohydrates) into sugar (glucose). Glucose is the fuel that every cell in the body uses for energy. For the cells to get glucose, insulin hormone (released by the pancreas) is needed. Insulin works like a door key opening the cell to allow body tissues to access glucose. With Diabetes, either your body doesn’t make enough insulin (Type 1) or does not efficiently use the insulin it produces (Type 2).

What are the symptoms of Diabetes?
Without glucose, the body cannot function well, leading to symptoms of fatigue, hunger, frequency of urination, increased thirst, weight loss, blurred vision, numbness, and tingling. As Diabetes progresses, it increases the risk of cardiovascular diseases, stroke, blindness, kidney failure, lower limb amputation, and dementia.

What is the underlying cause of Type II Diabetes?
Eighty percent of type 2 diabetes is due to being overweight or obese (Kumar, Ann Phys Rehabil Med, 2019). In the US, the incidence of obesity is on the rise, with 42% in adults and 21% in children (6-19-year-old). (Nhanes, CDC 2021)

What is the gold-standard treatment for Type II Diabetes?
According to the American Diabetes Association, diet and moderate-intensity physical activity/exercise are the first-line gold standard for preventing and treating Diabetes (Colberg S.R., Diabetes Care. 2016). Despite this recommendation, many pre-diabetic and diabetic patients are not receiving this advice, with 50% of adults never receiving the suggestion to exercise from their physician. (Booth et al. Compr Physiol. 2017).

What is the recommendation for exercise in the USA?
In 1995 the USA’s official activity guidelines were established of at least 30 min of moderate-intensity physical activity most days of the week. (Pate et al. Med J Am Med Assoc 1995) In 2020 the World Health Organization (WHO) and the Centers for Disease Prevention (CDC) established weekly guidelines on physical activity with 150-300 min of moderate-intensity and 75-150 min of vigorous-intensity physical activity per week. Two of those workout days should include resistance-exercise training.

In the USA, do we follow these exercise guidelines?
Despite the recommendations, most Americans are not following the exercise guidelines, with only 5% of US adults performing the recommended daily exercise. In children by age 15, there is a 75% decline in physical activity, with physical activity being less than 40 minutes per week. Seventy percent of kids stop playing sports by age 13, significantly reducing overall physical activity. Twenty-five percent of kids 6-17 report no physical activity (RWJF/Harvard School of Public Health, 2016. Balyi, Long-Term Athlete Development.)

How does the “Standard American Diet” affect Diabetes and health?
On top of the lack of physical activity is our poor food choices and “The Standard American Diet” (SAD). Greater than 60% of the American diet includes ultra-processed foods with high amounts of added sugar, fat, salt, hormones, antibiotics, and pesticides. There are over 400 chemicals approved as food additives in American diets. (Kahn, Whole Heart Soloution; Mozaffarin, Am Heart Assoc, 2019) Overeating with these high-energy-dense foods leads to the epidemic of obesity seen in the US and most industrialized countries.

How do poor nutrition and a lack of exercise affect other chronic preventable diseases?
Not only does the lack of exercise and poor diet predispose the individual to Diabetes, but it leads to many other preventable diseases such as; hypertension, cardiovascular disease, stroke, cancer, dementia/Alzheimer’s, and communicable disease (COVID-19) (Afshin et al. N Engl J Med. 2019). Eighty percent of heart disease, stroke, and type 2 diabetes are preventable, and 40-60% of cancers could be prevented with a healthy diet and exercise. Americans could save 75% of health care dollars by implementing healthy lifestyle changes. (Saphier, Make Am Heathy, 2020; NIH, 2016, Health line.com; Blue Zones of Health, 2019)

In Part 2, I will be a review of how diet, aerobic exercise, and resistance exercise can have a positive impact on diabetes and other chronic preventable disease. If you have diabetes or other chronic health conditions, “Try Physical Therapy 1st”! Starting an exercise program can be daunting, with many needing to learn how to start; Mishock Physical Therapy can help. Our Physical Therapists have a doctorate-level education and are experts in pain, body movement, and exercise. A short course of physical therapy with a transition into a home or gym program can get the diabetic patient back on track, enhancing the individual’s health and quality of life. Combine this with healthy eating, and diabetes can be controlled or even eliminated.

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