What exactly is prediabetes?

According to the CDC, 1 in 3 Americans over the age of 20 has prediabetes and for those over the age of 65, it’s 1 in 2. Up to 30% of those with prediabetes will develop type II diabetes within 5 years unless they make lifestyle changes including weight loss and increased physical activity.

30% of those with prediabetes will develop type II diabetes within 5 years Click To Tweet

What does prediabetes mean?

Though not recognized as an official medical diagnosis, prediabetes is a term used when a person’s fasting blood glucose (fasting plasma glucose) and hemoglobin A1c are higher than normal but aren’t high enough for a formal diabetes diagnosis. Fasting blood glucose and hemoglobin A1c are two tests doctors use to assess glucose control and diagnose diabetes. Normal fasting blood glucose is below 100, but diabetes isn’t typically diagnosed until fasting glucose reaches 126mg/dL or higher. Glucoses in between 100-125 are typically considered prediabetic results. For the hemoglobin A1c, normal results are 5.6% or below, while diabetes is typically diagnosed at 6.5% or higher, so someone with lab results in between 5.7-6.4% may be told he or she has prediabetes.

Fasting Blood Glucose levels

Screen Shot 2015-01-27 at 1.23.53 PM

A1C levelsScreen Shot 2015-01-27 at 1.21.35 PM

What are the symptoms of prediabetes?

Unfortunately, many people with diabetes or prediabetes don’t experience symptoms. Having your doctor run a fasting glucose, oral glucose tolerance test or a hemoglobin A1c is the best way to determine your current risk.

What are the risk factors?

Knowing the risk factors for developing diabetes is also helpful in preventing the progression of prediabetes to diabetes. Risk factors include age, gender, family history, physical activity level, body weight, pregnancy history and race.

Every decade over 40 increases your risk for diabetes and men are at higher risk than women. If your family history includes an immediate blood relative (parent or sibling), then your risk also goes up. If you’re getting less than 150 minutes of exercise per week and are overweight or obese, had gestational diabetes or birthed a baby weighing more than 9 pounds, those are additional risk factors. And while prediabetes rates don’t differ across racial groups, diabetes is most common in Native Americans and Alaskan Natives, then non-Hispanic blacks, Hispanics, Asian Americans and non-Hispanic whites respectively. Certain medications, like statins, and other health conditions like polycystic ovarian syndrome can also increase your risk for diabetes, so be sure to talk to your doctor about any concerns. Click here to take the American Diabetes Association’s risk assessment test.

How can I lower my risk for diabetes?

Fortunately there are many things you can do to take control of your health. Make sure your doctor is running a hemoglobin A1c so you know your results. Start exercising, aiming for at least 150 minutes a week, and get to a healthy body weight where your BMI is under 25. You can calculate your BMI by going here. Even losing just 10% of your current body weight can make a big difference! Make sure to eat lots of fruits and vegetables and limit refined carbohydrates like white rice, white pasta, sodas, sweet tea, crackers and desserts. Cut back on portions and find an activity you enjoy that gets you up and moving around. Feeling short on time? Research has shown three 10-minute walks a day can be just as effective as one 30-minute walk, so split up the time if needed. If you smoke, consider joining a tobacco cessation program. Put yourself in control of your health and be encouraged to know that you have the ability to change from having prediabetes to experiencing normal, healthy blood glucose levels.

prediabetes-inforgraphic

Is high fructose corn syrup worse than sugar?

Not a week goes by in the media without stories about potential health problems associated with high fructose corn syrup (HFCS). From brands like Yoplait to Heinz and Hunt’s, consumers are asking for the removal of the ingredient from products and companies are responding.

However, what do you really know about HFCS? Is it the main culprit when it comes to weight gain and metabolic problems or is there more to the story? In order to tackle this subject, let’s first look at HFCS and sugar at the molecular level.

Up close and personal: HFCS and sugar

Time for a little biochemistry: The kind of HFCS used in packaged foods and soda goes by the names HFCS 55 and HFCS 42. In the 55 variant, 55% of molecules are fructose and 42% are glucose. For HFCS 42, the breakdown is 42% fructose and 53% glucose. Both fructose and glucose are basic, simple forms of carbohydrates.

At the molecular level, high fructose corn syrup and sugar are nearly identical Click To Tweet

Why did I provide that molecular breakdown? Sucrose or sugar often replaces HFCS when brands swap ingredients and guess what? It has a 1:1 ratio of glucose to fructose, meaning that 50% of the molecules are fructose and 50% are glucose. At the molecular level, HFCS and sugar are nearly identical.

sucrose
This image shows the molecular layout of sucrose or sugar. 50% of it is fructose and 50% is glucose, making it a near mirror molecular image of high fructose corn syrup.

Research roundup: HFCS vs. sugar

Given that HFCS and sugar have a very similar glucose-to-fructose ratio, what does the nutritional literature have to say about the health effects of HFCS?

According to a 2008 study, “Sucrose and HFCS do not have substantially different short-term endocrine/metabolic effects.” Even when looking at other critical factors like appetite- and fat-related hormones, no difference has been found between sugar and HFCS.

A 2012 study that put subjects on a reduced-calorie diet noted that both the HFCS and sugar group lost similar amounts of weight and body fat, leading researchers to conclude the type of sugar in the diet was of no significance.

All these results are similar to a 2007 critical review in Food Science and Nutrition, which summed up its research saying, “The currently available evidence is insufficient to implicate HFCS per se as a causal factor in the overweight and obesity problem in the United States.”

The real nutritional culprit: excess carbohydrates

It may seem like I’m letting HFCS and sugar off the hook, but I’m not. What’s important to realize is that they’re both carbohydrates and because of their connection to “sweetness,” they shift the conversation away from something people need to be more aware of when it comes to their diet: too many carbohydrates elevates blood sugar.

Note how sugar consumption ramped up  in the early '70s. While sweetener choice has changed with time, one aspect has remained constant: Americans are eating more simple carbohydrates.
Note how sugar consumption ramped up in the early ’70s. While sweetener choice has changed with time, one aspect has remained constant: Americans are eating more simple carbohydrates. Image source: Austin G. Davis-Richardson (Wikipedia)

A diet composed of too many insulin-spiking carbohydrates has been implicated in the following health problems:

Too many insulin-spiking carbohydrates may lead to heart disease, diabetes and macular degeneration Click To Tweet

Making healthier choices

Elimination of foods containing HFCS is a great start to revamping one’s diet as HFCS is typically found in processed foods that contain artificial ingredients, little nutrient density, low fiber counts and hydrogenated vegetable oils.

But don’t be misled: eating the same amount of a food that uses sugar or a similar sweetener in the place of HFCS won’t lead to significant improvements in your health.

Instead, shop the perimeter of the grocery store, stocking up on fibrous fruits and vegetables like berries, avocados and broccoli, and protein sources like wild-caught salmon and grass-fed beef. It’s all about increasing the nutrient density of your food choices and being a more aware consumer.

Reviewed by Kristen Kizer, R.D.