Diet & exercise: what they can do for Type II diabetes: your lifestyle can bring on diabetes. And your lifestyle is the key to overcoming it, too.

Type II diabetes is becoming more and more common. However, there's encouraging news on how to manage this disease better if you already have it--and ways to avoid it if you don't.

To begin, Type II (also known as adult-onset diabetes) accounts for 95 percent of diabetes cases in the United States. Now there's solid evidence that patients themselves hold the key to improving their health, and that the improvements they experience are often dramatic.

In a groundbreaking study at the University of South Carolina's Norman J. Arnold School of Public Health in Columbia, researchers have found that lifestyle intervention focusing on exercise and modest weight loss worked nearly twice as well as medication did.

The study involved a cross section of the population that included 45 percent non-Whites. "Many of the non-White groups have much higher risk of Type II diabetes, so it was clearly important to include them," says researcher Elizabeth Mayer-Davis, an associate professor of epidemiology at the university. "We had African-Americans, Hispanics, Native Americans, and Asian-Pacific Islanders included in the project. And the interventions worked just as well in the non-White groups as they did in the White groups."

Many of the study's participants have a family history of diabetes, she says, and this is one of the reasons some of them were willing to take part. They were hoping "there might be some benefit to themselves and to their families as well."

There were three goals for the intervention group--to lose weight, to get dietary fat down to about 25 percent of calories, and to get the activity level up "to about 30 minutes a day of moderate activity like brisk walking on at least most days, five to seven days a week." Some people did a bit more exercising than that, she adds; others did a bit less.

The results of the intervention were so favorable that even though the study was originally designed to last four years, it was stopped after three--an

entire year early.

Jules Oaklander, D.O., a family physician in Miami, Florida, has had similar experiences with his patients, many of whom are from Jamaica, the Dominican Republic, and Latin America.

"When they come to the United States," Oaklander says, "most of them start eating a lot of the standard American diet"--including fast food and junk food--"and become obese. They develop diabetes, and they develop hypertension and then go on to have heart attacks and strokes and kidney failure. Diabetes is very, very high in these people.

"First, we have to treat the diabetes," he continues. "That's of utmost importance. So we have to put them on some medication, in some cases insulin directly." And he gives them literature on a vegan diet.

He also recommends that his patients exercise. "They just have to do a 30-minute walk every day. That's it. They don't have to join a gym or buy fancy equipment. They can just stand in front of their TV and watch the news and just jump up and down for 30 minutes. Really, that'll do it." And exercising indoors, he says, takes away the weather as an excuse not to do anything.

In his 40 years of practice he's found that when his patients follow his advice, "there's a tremendous difference in what happens with their diabetes. I mean, we're able to lower or discontinue the medication, their weight comes down, their cholesterol comes down, their sugar comes down, and they do very well. In some cases weight loss alone can make diabetes disappear. There's no question about that."

But what about those patients who have a family history of diabetes?

Although he doesn't unequivocally rule out such a history, he does have this observation: "I find out that the mother weighed 300 pounds, and the father was 280 pounds, and the sister was 200 pounds, and the strong family history of diabetes was not a genetic thing. It was just that they ate too much, and they were obese. Because they don't know any different--if their mother had it and their sister had it, they all had it--they call it a family history. But in actuality, they've been eating things that are bad for them from the very beginning."

When a patient loses weight, the amount doesn't have to be huge to be of benefit, says Mayer-Davis. For the intervention group in the University of South Carolina study, the average weight loss was from 10 to 15 pounds. "That's one of the best pieces of news here, which is to say that you don't have to become a different person." As little as a loss of 5 to 10 percent of total body weight makes a difference. "If you're 300 pounds, 5 percent is only 15 pounds," she says. "And that was the amount of weight loss that was shown to be so effective."

It's important, too, she continues, for people to understand "that they don't have to start looking like the people on the magazine covers, especially when you're talking about magazines that deal with exercise and fitness. They have these people in spandex and whatever, and it really can be very discouraging. The reality is that it is a very moderate weight loss that has wonderful benefits.

"There's one other point I'd like to make that I think is important," she adds. "A lot of the burden of diabetes occurs in older age groups, over age 60. And sometimes there's sort of a feeling that if you are older, then don't bother with weight loss--that type of thing. But in the diabetes prevention program the benefit for people over 60 was tremendous. There was a 71 percent risk reduction for people over 60 with this moderate lifestyle. It's important, if you think about it, because if you have somebody who's 65 years old, they easily could live another 20 years, and you want that time to be of good quality and of good health. So I think it's important for people to get that take-home message--that even in people over 60 this lifestyle intervention markedly reduced risks for diabetes."

Regular exercise is an important part of managing Type II diabetes, and it helps keep weight down, says W. Stuart Tucker, M.D., an endocrinologist at Eastover Internal Medicine in Charlotte, North Carolina. When patients don't exercise, "it's a vicious cycle. You don't exercise; you gain weight. You get deconditioned. The weight and the deconditioning make it harder to exercise."

Patients (especially sedentary ones) need to begin gradually with exercise and build up, he continues. And the type of exercise a patient does depends on any other health issues that may be present. Patients who are otherwise healthy, he advises, "should start off walking. The usual guideline there is that if they're walking so fast that they can't talk to somebody, they're working too hard. If they can start off with walking five or 10 minutes on flat ground and eventually get up to 45 minutes going up and down hills at a faster pace, that's where they need to be. It may take them six months to get there."

But what about people who have difficulty walking? "For folks who can't walk," says Dr. Tucker, "for example, they have arthritis in their hips and knees, water aerobics is a great way to exercise." This is often offered at YMCAs, YWCAs, and senior centers. And usually at such places, he adds, instructors are attuned to the special issues some patients may have.

He suggests, too, that a physical therapist can outline a plan for an individual's particular needs and capabilities. For some people, "an exercise bike or an elliptical trainer or rowing machine--even a StairMaster--may be more convenient and better tolerated than walking."

Some sources, including the American Diabetes Association, recommend that diabetics check their blood sugar levels before, during, and after exercising. Is this really necessary, and won't it discourage people from exercising?

"Yes, it could be a discouragement," Dr. Tucker agrees. "On the other hand, it probably is relatively important to do it periodically. That doesn't mean every single time, but you should be aware what your blood sugar response is to exercise."

Once a week or possibly even once a month might work if you're a steady exerciser and your blood sugar is under good control, he says. The reason it's important to check blood sugar in relation to exercise, he adds, is this: "You don't want to have your diabetes go out of control, with your sugar too high or too low, provoked by exercise. If you're a diabetes patient and you go to an exercise session and then you drive home at lunchtime or late in the afternoon (particularly if you're on medication) it's going to be important to know what your blood sugar level is. It's a good insurance policy to check it." You don't want to be hypoglycemic or threatening hypoglycemia while you're driving.

So what effect do a healthy diet, moderate weight loss if you're overweight, and exercise have on Type II diabetes? Simply this: If you already have Type II diabetes, they can help you control it. If you're on medication, they may help reduce the amount you need or eliminate it altogether. And if you don't have Type II diabetes, they may just keep you from ever having it.

Peggy Rynk writes on health topics from Charlotte, North Carolina.