DR. MAYA ROSMAN EXPLAINS: THIS IS HOW YOU CAN PREVENT DIABETES THROUGH NUTRITION

The Ministry of Health recently published the 2023 Diabetes Status Report, and according to the data – one in three Israelis over the age of 65 has diabetes. This is a dramatic figure that illustrates how common the disease is, but it has long since ceased to be only a problem of old age.

Type 2 diabetes, which is mainly related to lifestyle, appears more and more among young people – against the background of rising obesity rates, diets high in simple carbohydrates, and lack of physical activity.

According to the World Health Organization, type 2 diabetes is a global epidemic, with a forecast of more than 600 million patients by 2045. Beyond the personal suffering, it is also a heavy economic burden: In Israel, the annual cost of treating diabetes patients is estimated at billions of shekels.

Why does obesity increase the risk of diabetes?

Excess fat, especially in the abdominal area, reduces the sensitivity of cells to insulin – the hormone whose role is to transfer sugar from the blood into the cells. When the cells are "resistant" to insulin, blood sugar levels rise, and this is the first step toward diabetes.

A large study published in Diabetes Care found that even moderate overweight – an increase of 5–7 kg above normal weight – already significantly increases the risk.

A meta-analysis published in The Lancet showed that 90% of type 2 diabetes cases are related to overweight and obesity.

But there is also good news: A weight loss of 5–10% significantly reduces the risk of developing the disease.

How does diabetes damage the heart – and shorten life?

High blood sugar over time damages the walls of the blood vessels and causes atherosclerosis.

As a result, the risk of heart attacks, heart failure, and stroke increases. Diabetics are at two to four times greater risk of cardiovascular disease compared to the general population.

But the damage does not end with the heart: Diabetes can also cause kidney damage (up to kidney failure), eye damage (diabetic retinopathy up to blindness), and nerve damage (neuropathy that causes pain, loss of sensation, and wounds in the legs).

A study published in the New England Journal of Medicine found that diabetics with poor blood sugar control lived an average of 6–8 years less than healthy people.

Why is abdominal fat particularly dangerous?

The fat in the abdominal area is called visceral fat – and it is hormonally “active.” The cells in the abdomen secrete inflammatory substances and cytokines that increase insulin resistance and promote heart disease, cancer, and fatty liver.

When we consume a lot of simple carbohydrates – sugar, white bread, rice – blood sugar levels spike. The body responds with increased insulin secretion. This excess insulin “instructs” the body to store fat, especially in the abdominal area.

Thus, a vicious cycle is created:

More sugar in the blood → more insulin

More insulin → more abdominal fat

More abdominal fat → further decrease in insulin sensitivity.

Can you get diabetes even at a normal weight?

Yes. Diabetes also has a genetic component, and it is influenced by age and lifestyle.

There is a phenomenon called TOFI – Thin Outside, Fat Inside: People who look thin on the outside but have a lot of internal abdominal fat, detected in imaging tests. They are also at risk for diabetes.

Still, overweight remains the most significant factor: A BMI over 25 increases the risk by 3–5 times, and obesity (BMI over 30) increases the risk by 7–12 times.

How much overweight is already dangerous?

Example of a woman 1.60 m tall:

Normal weight: 50–64 kg.

At 70 kg – an excess of 6–7 kg – the risk of diabetes already begins to rise.

At 80 kg – the risk is several times higher compared to normal weight.

At 95–100 kg – the risk can be 10 times higher or more.

Example of a man 1.75 m tall:

Normal weight: 63–77 kg.

At 85 kg – the risk begins to rise.

Above 100 kg – the risk is several times higher.

Beyond BMI, it is important to know that waist circumference is a critical measure:

Above 80 cm for women and 94 cm for men – already indicates increased risk.

Carbohydrates and fruits – what should you know?

The clear recommendation is to reduce simple carbohydrates – sugary drinks, pastries, white bread, and white rice. In contrast, complex carbohydrates such as legumes, quinoa, and oats are absorbed more slowly and contribute to satiety.

A study published in BMJ in 2020 showed that consuming whole grains (instead of refined, i.e., whole wheat bread or brown rice instead of white bread or white rice) reduces the risk of diabetes by about 29%.

These carbohydrates are much healthier, but if diabetes is already present – they too should be consumed in a measured and moderate amount – up to 2 servings per day including whole wheat bread count, and if possible, it is important to emphasize that completely avoiding carbohydrates will not harm your health.

Despite their benefits, excessive fruit consumption can raise blood sugar, since they contain fructose – a simple sugar that easily turns into abdominal fat.

The recommendation is to consume up to two servings of fruit per day, and even then, there are some guidelines:

1. Prefer those with a low glycemic index such as plums, peaches, apples, pears, and berries.

2. Consume fruits only in combination with protein or healthy fat, such as with yogurt or nuts or almonds, to stabilize sugar levels.

3. If you have diabetes, it is better to consume fruits combined with nuts in the morning hours, and not late in the evening.

How can type 2 diabetes be prevented?

Type 2 diabetes is a disease that in many cases can be prevented or at least significantly delayed.

Weight loss: Even a loss of 5–7% of body weight reduces by 50% the risk of progression from “pre-diabetes” to full diabetes.

Physical activity: 150 minutes of brisk walking or other moderate activity per week keeps sugar and insulin levels normal.

Mediterranean diet: Based on vegetables, legumes, fish, olive oil, and nuts – the PREDIMED study showed it reduces the risk of diabetes by about 30%.

Adequate sleep: Chronic lack of sleep increases the risk of insulin resistance.

Reducing ultra-processed food: Food high in sugar, white flour, and hydrogenated fats (trans) – significantly increases the risk.

For Dr. Maya Rosman’s course: How to improve health and how to lose weight in a sensible and reasonable way – click here.

2025-09-28T14:09:04Z