For people with prediabetes, lifestyle modification is considered “the cornerstone of diabetes prevention.” Diet-wise, this means individuals with prediabetes or diabetes should aim to reduce their intake of excess calories, saturated fat, and trans fat. Too many of us consume a diet with too many solid fats and added sugars. Thankfully the latest dietary guidelines aim to shift consumption towards more plant-based foods.
Lifestyle modification is now the foundation of the American Association of Clinical Endocrinology guidelines, the European Diabetes Association guidelines, and the official standards of care for the American Diabetes Association. Dietary strategies include reducing intake of fat and increasing intake of fiber (meaning unrefined plant foods, including whole grains).
The recommendation to consume more whole grains is based on research showing that eating lots of whole grains is associated with reduced risk of developing type 2 diabetes. New research even suggests that whole grains may protect against prediabetes in the first place.
According to the American Diabetes Association’s official standards of care (which you can see in my video Lifestyle Medicine Is the Standard of Care for Prediabetes), dietary recommendations should focus on reducing saturated fat, cholesterol and trans fat intake (meat, dairy, eggs and junk food). Recommendations should also focus on increasing omega 3’s, soluble fiber and phytosterols, all three of which can be found together in flax seeds; an efficient, but still uncommon, intervention for prediabetes. In one study, about two tablespoons of ground flax seed a day decreased insulin resistance (the hallmark of the disease).
If the standards of care for all the major diabetes groups say that lifestyle is the preferred treatment for prediabetes because it’s safe and highly effective, why don’t more doctors do it? Unfortunately, the opportunity to treat this disease naturally is often unrecognized. Only about one in three patients report ever being told about diet or exercise. Possible reasons for not counseling patients include lack of reimbursement, lack of resources, lack of time, and lack of skill.
It may be because doctors aren’t getting paid to do it. Why haven’t reimbursement policies been modified? One crucial reason may be a failure of leadership in the medical profession and medical education to recognize and respond to the changing nature of disease patterns.
“The inadequacy of clinical education is a consequence of the failure of health care and medical education to adapt to the great transformation of disease from acute to chronic. Chronic disease is now the principal cause of disability, consuming three quarters of our sickness-care system. Why has there been little academic response to the rising prevalence of chronic disease?”
How far behind the times is the medical profession? A report by the Institute of Medicine on medical training concluded that the fundamental approach to medical education “has not changed since 1910.”