As Americans continue to pack on the pounds, doctors are seeing a surge in weight-related health problems. An increasingly common condition that now affects about 40% of American adults is prediabetes, characterized by blood glucose (sugar) levels that are higher than normal but not yet at diabetic levels. People with prediabetes are five to 15 times more likely to develop full-blown diabetes than people without this condition.

These are alarming statistics. Diabetes has serious potential consequences, including blindness, kidney failure, erectile dysfunction, heart failure, stroke... as well as nerve damage and circulation problems that can necessitate amputation.

Good news: Diabetes and its devastating consequences often can be prevented-by reversing prediabetes.

How The Disease Progresses

There are two main types of diabetes. With type 1 diabetes, the body's immune system attacks the pancreas, impairing or destroying its ability to produce insulin, the hormone that helps cells absorb glucose and convert it to energy. Prediabetes and body weight generally are only minor contributors to type 1 diabetes.

In contrast, the development of type 2 diabetes-which accounts for about 90% of all diabetes cases-is greatly influenced by prediabetes and excess weight. An obese person In contrast, the development of type 2 diabetes-which accounts for about 90% of all diabetes cases-is greatly influenced by prediabetes and excess weight. An obese person is 80 times more likely to develop type 2 diabetes than a person of normal weight. With type 2 diabetes, the pancreas usually does produce insulin, but the body's cells cannot use it properly. A person generally passes through several stages on the way to developing type 2 diabetes. What happens...

When we eat, the amount of glucose in our blood rises, alerting the pancreas that it needs to produce insulin. Excess fat, nutritional deficiencies and the stress hormone cortisol interfere with cells' ability to accept and use insulin, leaving excess glucose in the blood. When this happens, a person is said to have insulin resistance.

Sensing that the insulin is not doing its job, the pancreas churns out even more. But since the cells cannot accept the excess insulin, it remains in the blood, along with the excess glucose. When blood glucose levels reach a certain point (as measured with blood tests), the condition qualifies as prediabetes... and if levels climb higher still, it qualifies as diabetes.

High blood glucose levels cause many of the complications of diabetes, including damage to the kidneys, nerves and eyes. However, in the years during which prediabetes and diabetes are developing, a bigger problem is high blood insulin.

Reason: Insulin helps produce muscle but when insulin levels get too high, the hormones instead promotes formation of visceral fat, which in turn makes insulin resistance even worse. Insulin elevations also increase production of triglycerides and cholesterol, which clog arteries... of C-reactive protein, which promotes damaging inflammation... and of cortisol, which contributes to various diseases.

What the Tests Should Tell Us

Too many doctors use antiquated guidelines for interpreting test results, then tell patients all is well when, in fact, the patients are at risk. I urge you to ask your doctor for the specific results of your tests and compare them with my guidelines below, which I have based on the most recent evidence. You may spot a warning sign that your doctor missed.

Fasting glucose test. Routinely given at annual checkups, this test involves fasting for at least eight hours (optimally 12 hours), then having blood drawn to measure glucose levels.

Do You Have Prediabetes?

If you are age 65 or older, you are at increased risk for prediabetes regardless of the characteristics described below. For this reason, you should ask your doctor about receiving a fasting glucose test.

If you are under age 65, answer the following questions. Speak to your doctor about receiving a fasting glucose test if you score 5 or higher.

Age                  Points              Heart Rate            Points         High Blood Pressure

20-27 ...............0                             (Beats per minute)                   No ..................0

28-35 ...............1                       Less than 60 ...............0                 Yes ..................1

36-44 ..............2                        60-69 .........................0          Body Mass Index (BMI)

45-64 ..............4                        70-79 ..........................1           Less than 25 ........0

        Sex                                     80-89 .........................2           25-29.9 .................2

Male ................3                        90-99 .........................2           30 or greater ........3

Female ............0                      Greater than 100 ....4

Family History of Diabetes

No ...................0

Yes ..................1

To determine your heart rate, place the tips of the first two fingers lightly over one of the blood vessels in your neck or the pulse spot inside your wrist just below the base of your thumb. Count your pulse for 10 seconds and multiply that number by 6.

To determine your BMI, consult the National Heart, Lung and Blood Institute website, (search BMI).

Problem: The range generally accepted as "normal"-from 65 milligrams per deciliter (mg/dL) to 99 mg/dL-is much too broad.

Evidence: A study published in The New England journal of Medicine found that men with a fasting blood glucose level of 87 mg/dL had almost twice the risk of developing diabetes as did men whose level was 81 mg/dL or less. My guidelines...

• Optimal-76 mg/dL to 81 mg/dL

• Nonnal-82 mg/dL to 85 mg/dL

• At risk-86 mg/dL to 99 mg/dL

• Prediabetic-100 mg/dL to 125 mg/dL

• Diabetic-126 mg/dL and above

Though most doctors do not order it routinely, you can ask your doctor to have your insulin levels checked as part of your fasting glucose test. These results are not used to officially diagnose diabetes, but they do provide additional information about your risk. Although the generally accepted guidelines put the normal range for blood insulin levels at six micro-international units per milliliter (mcU/ ml) to 35 mcU/ml, I think this range is far too wide to be meaningful. My guidelines...

Optimal-7 mcU/ml or less

• At risk-8 mcU/ml to 10 mcU/ml

• Prediabetic-11 mcU/ml to 25 mcU/ml

• Dangerous-above 25 mcU/ml

• Oral glucose tolerance test with glucose and insulin levels. A more accurate way to measure blood insulin levels, this test requires fasting for 12 hours and having blood drawn... then drinking a glucose solution and having blood drawn again after one, two and up to three hours. Many medical doctors fail to order this test because they are unaware that it dramatically improves the ability to identify prediabetic patients. I often order this test for patients who are overweight, have a strong family history of diabetes or have a history of elevated fasting glucose levels even if their most recent fasting glucose test results appeared normal. In this way, I have diagnosed type 2 diabetes in several patients whose fasting glucose results did not suggest any problems. My guidelines for blood drawn at the two-hour point...

• Normal-blood glucose below 140 mg/ dL. .. or insulin levels at or below 55 mcU/ml.

• Prediabetic-blood glucose of 140 mg/dL to 159 mg/dL, or an increase in glucose of 50 mg/dL or more within one hour... or insulin levels at 56 mcU/ml to 90 mcU/ml.

• Dangerous-blood glucose of 160 mg/dL or higher... or insulin levels above 90 mcU/ ml.

• Hemoglobin AlC (HbAlc). This blood test indicates damage to blood proteins caused when glucose binds to the oxygen-carrying hemoglobin in red blood cells, creating free radicals (harmful negatively charged molecules). Results are expressed as a percentage. A British study involving 10,232 adults indicated that HbA1c results accurately predict health problems, including heart attacks (for which prediabetes and diabetes are risk factors). For each 1% rise in HbAlc, study participants' heart attack risk increased by 20%. My guidelines...

• Nonnal-4.5% to 4.9%

• At risk-5.0% to 5.6%

• Prediabetic-5.7% to 6.9%

• Diabetic-7.0% or higher

Steps To Take To Preempt Prediabetes

Fortunately, there is a lot you can do to prevent prediabetes-or even to reverse it if you have it.

1. Lose excess weight. This is without question the most important step. To determine if you are at a healthful weight, calculate your body mass index (BMI), a ratio of your weight to the square of your height (for a free online BMI calculator, go to www.nhlbi.nih. gov and search "BMI calculator"). BMI of 30 or higher indicates obesity and a strong likelihood of developing prediabetes or diabetes... BMI between 25 and 29.9 puts you at risk for prediabetes. If necessary, a holistic doctor or nutritionist can help you devise a personal weight-loss plan.

2. Reduce body fat percentage. Apart from its effect on weight, excess body fat increases prediabetes risk. I measure a patient's body fat percentage with bioelectrical impedance, a painless test that involves placing electrodes on your hand and foot. For women, an ideal range is 21% to 24%... anything above 31% is risky. For men, ideal is 14% to 17%... above 25% is risky.

Self-defense: Build muscle and banish excess fat by doing 30 minutes of aerobic exercise, such as brisk walking, five days a week. .. plus 30 minutes of strength training twice weekly.

3. Eat right. Good dietary habits help to control weight... prevent spikes and drops in blood glucose levels... slow digestion, giving the pancreas time to produce insulin... boost energy, making it easier to exercise... and provide nutrients that optimize health.

• Eat three meals a day at regular times, keeping portions moderate. Never skip breakfast.

•Keep snacks small.

Options: Nuts, seeds, low-sugar protein drinks, vegetables or fruit.

• Include a small portion of protein at every meal.

Good choices: One or two eggs... 1.5 ounces of nuts... or three ounces of fish chicken, turkey or lean meat.

• Eat at least one or two servings of whole grains daily. For variety, try quinoa, couscous, and bread made with spelt or kamut flour.

• Avoid sugary foods, processed foods, trans fats (found in some margarines, baked goods and crackers) and saturated fats (in meats, dairy foods and many vegetable oils).

• Have at least two servings of fruits and three or more servings of vegetables daily.

4. Take appropriate supplements. Many manufacturers offer a "blood sugar control formula" that provides a combination of nutrients to help stabilize blood glucose and promote proper insulin function. Alternatively, you can follow the guidelines below.

If you are at risk for prediabetes, take...

• Chromium, a mineral, at 500 mi~ grams (mcg) daily.

• Pycnogenol (maritime pine extract) at 200 mg daily.

If you have been diagnosed with prediabetes, also take...

• Biotin (vitamin B-7) at 500 mcg daily.

• Alpha lipoic acid, an antioxidant, at 300 mg daily.

• Magnesium at 400 mg daily.

• Vitamin D at 1,000 international units (HJ) daily.

If you use diabetes medication, check with your doctor before taking these supplements-your medication dosage may need to be adjusted. These supplements are sold in health-food stores, generally are safe, rarely cause side effects and can be taken indefinitely. Ideally, however, your improved diet and more healthful lifestyle will decrease your risk for prediabetes or reverse the condition, so the supplements eventually will no longer be necessary.

For a complete guide on prediabetes, I recommend Stop Prediabetes Now, by Jack Challem and Ron Hunninghake, MD, from which the following checklist has been adapted. Check off all the risk factors that apply to you. If you have five or more checks, see your doctor-you may be at high risk for prediabetes.

I have...

• A brother, sister or parent with diabetes.

• A personal history of gestational diabetes (diabetes during pregnancy).

• A waist measurement of more than 35 inches (women) or 40 inches (men).

I have been diagnosed with...

• High blood sugar or insulin levels.

• High blood pressure.

• High cholesterol or high triglycerides (a type of fat in blood).

• Hypothyroidism (low thyroid hormones).

• Polycystic ovary syndrome.

• Carpal tunnel syndrome, Bell's palsy or gout (which may be linked to diabetes).

I often...

• Skip breakfast.

• Breakfast only on coffee and/or something starchy (bagel, muffin).

• Feel tired after meals, especially lunch.

• Nap during the day or early evening.

• Have trouble falling asleep at night.

• Have trouble getting up in the morning.

• Crave sweets.

• Crave starchy foods (pasta, pizza, bread).

• Snack late at night.

• Drink nondiet soft drinks daily.

• Have one or more sweet foods daily.

• Lack energy.

• Skip exercise.

• Feel thirsty.

• Urinate frequently.

• Have trouble maintaining an erection.

• Feel less interested in sex than I used to.

• Feel stressed, irritable or depressed.

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