If you’re not a woman, you probably know one. And you’re probably well aware of the “menopause” and the significant and life-altering changes that season can bring. For decades, hormone replacement therapy (HRT), primarily estrogen, has been a welcomed, effective, and dependable treatment for many of these problems. Then we were told that HRT posed a significant risk of breast cancer and even heart disease. Anxiety and confusion ensued, and many women stopped taking their medication, frequently upon the advice of their well-intentioned health-care provider. Now, thankfully, we know better. A large study published in JAMA found that there is no increase in cancer related deaths or all-cause deaths in women treated with HRT. In fact, some groups of women experience a favorable outcome with all-cause mortality. This is good news for the many women who have found relief with HRT, and for those who are experiencing the symptoms of menopause and are looking for help.
Now here’s some more good news, and something very challenging. We’ve talked in the past about the epidemic of diabetes in this country, and about the need to have it aggressively diagnosed and treated. Well, hear this loud and clear. Type II diabetes can be reversed. That’s right. Reversed. Not cured, but sent into a remission that can potentially last a lifetime. We’re not talking about type I, or insulin-dependent diabetes. That’s a different animal. Type II is the kind that develops later in life and is associated with predictable risk factors. Genetics are involved, to be sure. But even your chromosomes can be overcome to some extent. It appears that the main reason for the development of type II diabetes is insulin resistance. The cells of our bodies develop a decreasing response to insulin, requiring more and more insulin to be released, with less and less effect. Eventually, our pancreas gives up the ghost, and we become insulin dependent—requiring daily injections of the hormone, produced in a lab somewhere.
But back to insulin resistance. What do you suppose is the main cause of this? If you said lifestyle, you’d be right. Specifically poor dietary choices and inactivity that lead to obesity. At a certain weight, with excess body fat—especially that found in our trunk—any one of us can become a type-II diabetic. Pretty scary, but true. That’s where our genetics come into play, since that certain weight or degree of obesity varies among individuals. But obesity is the key—defined by a BMI of greater than 30. A BMI of greater than 40 would be classified as extreme obesity. Your BMI is a number you need to know. It’s easy to calculate by simply finding a table on the internet and plugging in your height and weight. If you’re overweight (and that would be the majority of us), you’re most likely developing some degree of insulin resistance. If you can reverse that, you can reduce your chances of developing diabetes. And if you’re already a diabetic, you can potentially achieve remission, come off your medication, and eliminate the significant complications that are associated with this disease.
But what kind of weight loss are we talking about? In a study published in Lancet, the authors found that this can happen with a reduction of around 10% of a person’s body weight. That can be a lot—20 pounds for a 200 pound man. But it can be done. And when it happens, good things follow. Lowered blood pressure, improved cholesterol, less back and knee pain, enhanced quality of life, and yes, reversal of insulin resistance and remission of diabetes. It takes an effort, and lifestyle changes. And it doesn’t happen overnight. A 10% reduction in a person’s weight should occur over a period of at least six months, and we shouldn’t be frustrated if it takes a little longer. The authors of this study recommend a low-carb Mediterranean diet with interspersed days of fasting (maybe one day every two weeks). This works, and if you’re serious about trying it, ask your healthcare provider to check an insulin level, and track your progress. Remission of type II diabetes. That would be something.
And the last piece of good news is for those of us who fall in that category of “extreme obesity”—a BMI of more than 40. We might be considering weight-loss (bariatric) surgery, or we might have already had it done. We’re learning more about the long-term effects of these procedures, and the good news continues to mount. We’ve known that obesity surgery provides rapid and effective metabolic changes that improve our blood pressures and can prevent diabetes. (Remember the link between obesity and insulin resistance.) But do these changes last? The answer is yes. In a large group of these surgically treated patients, their positive metabolic changes have persisted for more than ten years, and the clock keeps on ticking. This surgery isn’t for everyone, but it can be good news if we need it.
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