Diabetes: It’s Not Just Sugar

In light of Diabetes Awareness Month, I can’t let this month pass without talking about Diabetes — particularly Type 2 Diabetes mellitus, which is the more common type. Diabetes is now an epidemic alongside obesity, that it would not come as a surprise if at least one of our parents have it. In fact, these two (diabetes and obesity) often go hand in hand. This pervasive chronic lifestyle disease has become among the top killers of our country and continues to rise in rank. The complications of diabetes is what makes it lethal. In fact, along with hypertension (high blood pressure), it is the leading cause of the increasing chronic kidney disease and dialysis population rate in the country as well. The first thing that comes to mind for most people when they hear of the word “diabetes” is undoubtedly sugar; that one who has diabetes has high blood sugar and that this is caused by excessive consumption of sugary food or carbohydrates. However, there’s more to the root cause of diabetes than just eating too much sugar. Diabetes is a disease borne from years of insulin resistance. That means, before one is diagnosed with the disease, insulin resistance has long been plaguing the body; it is the precursor for diabetes. Insulin is the hormone released by the pancreas to shuttle glucose into our cells to be processed into energy or stored as fat. Insulin resistance is the inability of cells in our body to respond to this hormone and therefore is unable to process and store energy. Thus, this leads to a problem in energy metabolism and cascades into further metabolic imbalances or compromises in other systems in our body. Insulin resistance essentially develops from accumulation of fat in our cells and organs, from eating a diet high in processed food, saturated fat and trans fat. As fat builds up in the cells, this dulls the cell’s sensitivity to insulin when it comes knocking on the cell’s door (receptors). This is why people with diabetes tend to have non-alco-

holic fatty liver disease as well. The problem with insulin resistance is that it causes glucose or sugar to remain in the blood and when it becomes highly concentrated, it will damage our nerves and blood vessels, causing the known complications such as nerve/sensation issues, vision loss, high blood pressure, and kidney damage. And ultimately, it’s these complications that lead a patient to mortality. This is the reason prediabetes or impaired fasting glucose and impaired glucose tolerance should be critically addressed as early as possible. So, who is at a high risk of developing this stealthy disease? Since this is a lifestyle disease, it definitely involves all the aspects of one’s lifestyle — diet, physical activity, sleep, and stress management. Being overweight or obese is certainly an obvious risk factor but studies have shown that Pacific Islanders/Asians are more likely to develop type 2 diabetes despite having a normal BMI (body mass index). So, just because you are within a healthy weight range, it does not completely exempt you from the risk of developing this disease.

DIET

Now, we know that sugar is not the only culprit to the development of diabetes. A diet high in trans fat and saturated fat from highly processed food (fastfood, canned goods, convenience food, instant noodles, processed meats, etc.) are what also greatly contribute to insulin resistance through its promotion of visceral fat or fat deposition in the abdominal area, especially in the liver as the liver is the site of energy metabolism and storage of fat. Eating a proinflammatory diet also causes gut dysbiosis or the imbalance of the gut microbiome (bacterial environment), which is also crucial for supporting the immune system and brain health. And when one has gut dysbiosis, it fuels the inflammatory status of an individual, causing further injury to one’s health by promoting destructive mechanisms in the body.

PHYSICAL INACTIVITY

Exercise has long been known for its health-promoting effects, regardless of weight loss. Of course, weight loss is recommended especially for people who are overweight and have diabetes, but it is also the insulin sensitivity-promoting effect of exercise that makes it among the most highly recommended intervention to address this disease.

SLEEP

Don’t ever take your sleep for granted. Research says that getting inadequate or poor quality sleep even just for a night could significantly boost insulin resistance as much as eating highfat foods for six months. This is most likely related to the effect of poor quality sleep on one’s hunger hormones.

STRESS

No matter how healthy you eat and how often you exercise, if you also don’t manage your stress, this is one big factor that can lead to diabetes. Elevated stress hormones called cortisol can trigger hunger hormones to be more active than needed, thus we experience “stress eating.”

SMOKING AND ALCOHOL

These are already all too familiar destructive lifestyle habits that are top contributors to many diseases such as heart disease, diabetes, and even cancer. So, as you have read, lifestyle management plays a key role in both the prevention and development of diabetes and being sugar-conscious is really just the tip of the iceberg. Diabetes is rising at an alarming rate so early prevention and detection are crucial to curbing this. Eat smart!