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What is it? People with “pre-diabetes” have elevated blood glucose, but the level is intermediate, between normal and full-blown diabetes.

Diagnosis: Fasting blood glucose level from 100-125 (Note: below 100 is normal, and above 125 is diabetes). OR, “hemoglobin A1c test” (which measures the AVERAGE blood glucose over at least 2 months) between 5.7 and 6.4.

How common is it? Right now, more than 1 out of 3 Americans has pre-diabetes. The Centers for Disease Control and Prevention (CDC) estimates that by 2050, one out of every three of us will have full-blown diabetes. In the last 10 years, the number of people in the US with diabetes has more than doubled. This is mainly due to the epidemic of overweight and obesity.

Why worry about it? Unless people with pre-diabetes take steps to control their blood glucose, 15-30% will progress to full-blown diabetes within 5 years. And diabetes has very bad consequences if it’s not well-controlled. It is the number one cause in the US of adult-onset blindness, kidney failure, and surgical amputations; it also commonly leads to erectile dysfunction in men and increases the risk of heart attacks and strokes.

Who should be tested? Only one in ten people with pre-diabetes are even aware they have it. Everyone age 45 or above who is overweight or obese needs to be tested. In addition, overweight/obese adults under age 45 should be tested if they also have one or more of these risk factors:
- Habitual physical inactivity
- Family history of diabetes
- Have previously been diagnosed with “impaired fasting glucose”
- Members of certain ethnic groups: Asian-American, African-American, Hispanic/Latino, or Native American
- Have elevated blood pressure or hypertension
- Women who have had “gestational diabetes” or gave birth to child weighing over 9 pounds
- Have HDL (good type) cholesterol of 35 or below, OR have triglyceride level of 250 or above
- Have a history of vascular disease (includes heart attacks, and peripheral vascular disease)
- Women with polycystic ovary disease

How can it be treated (or better yet, prevented)? Many doctors just want to prescribe a pill, but what works better, lifestyle changes or drugs? Here are two videos by Dr. Michael Greger, of NutritionFacts.org, which address this question, plus short summaries.

VIDEO: How to Prevent Prediabetes from Turning Into Diabetes
Summary:
A large study of people with pre-diabetes found that eating whole plant foods and cutting down on saturated fat worked better than treatment with metformin (the most widely used drug for pre-diabetes) in preventing the development of full-blown diabetes.

VIDEO: Lifestyle Medicine is the Standard of Care for Prediabetes
Summary:
All the major medical societies agree that for people with prediabetes, lifestyle modification is now considered the cornerstone of diabetes prevention. Diet-wise, that means individuals with prediabetes should aim to reduce their intake of excess calories, saturated fat, and trans fat. The latest dietary guidelines aim to shift consumption towards more unrefined plant-based foods, including whole grains.

Only about 1 in 3 patients report ever being told about diet or exercise. Why don’t more doctors follow the recommendation to use lifestyle changes as the preferred treatment for prediabetes, given that it’s so safe and highly effective?

Doctors receive almost NO training in nutrition. A report by the Institute of Medicine on medical training concluded that the fundamental approach to medical education has not changed since 1910. Doctors generally do not like to talk about subjects they don’t understand. Another problem pointed out is that doctors are poorly reimbursed for counseling.

So, you should not rely only on your doctor for help in preventing, or treating prediabetes. The good news is that whole food, plant-based nutrition does a great job in treating prediabetes, without needing any medication at all.

BOOK: Reversing Diabetes... Excellent book by Dr. Neal Barnard about reversing diabetes using nutrition, not drugs.

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