May 30--After testing at the Cherokee Nation revealed Charla Nofire was pre-diabetic, she joined a program to head off the disease.
"They gave us a book to list what we ate, count our calories and fat grams, and weigh in," said Nofire of Sallisaw. "I think I did fairly well. I lost 25 pounds, and my blood pressure and blood sugar both came down."
Nofire, 38, said her doctor told her he wished more of his patients were as proactive as her. The health care professionals at the Cherokee Nation made exercise part of her three-month program.
"They told us to get at least 30 minutes each day," she said. "It's difficult when you work and come home tired. But I have two boys, and we would go down to the track and things like that. I don't think there would have been any weight loss without the exercise."
Aggressively lowering cholesterol and blood pressure levels in adults with type 2 diabetes may possibly reverse hardening of the arteries -- atherosclerosis -- according to research supported by the National Heart, Lung, and Blood Institute.
Atherosclerosis is the No. 1 cause of heart disease and can lead to heart attack, stroke, and death.
The three-year study of 499 participants is the first to compare two treatment targets for LDL ("bad") cholesterol and systolic blood pressure levels, key risk factors for heart disease, in people with diabetes.
Nofire said the most important lesson was learning she had the power to stop diabetes.
"You really can control it," she said. "You can actually do something about it."
In the Stop Atherosclerosis in Native Diabetics Study (SANDS), approximately one-half of the participants (247) were asked to lower to standard levels their LDL cholesterol and blood pressure, while the other half (252) aimed for more aggressive lowering of LDL cholesterol and systolic blood pressure.
All participants were Native Americans 40 years or older (average age of 56) who had diabetes, high blood cholesterol, and high blood pressure but no history of heart attack or other evidence of heart disease. The study was conducted at four clinical centers in southwestern Oklahoma; Phoenix, Ariz.; northeastern Arizona; and South Dakota.
All participants continued to receive their medical care, including diabetes management, dietary and exercise counseling, and smoking cessation, from their health care providers with the Indian Health Service. Like the National Institutes of Health, the Indian Health Service is part of the U.S. Department of Health and Human Services.
During the three-year study, participants were examined by study clinicians one month after enrollment, then every three months, to assess their blood cholesterol and blood pressure levels and general well being. Food and Drug Administration-approved blood pressure and cholesterol medications were added and adjusted as needed to help participants achieve their treatment goals.
The same medications were available to participants in the standard and the aggressive treatment groups. Participants were also encouraged to follow lifestyle approaches to help meet their blood pressure and cholesterol treatment targets, such as following a heart-healthy eating plan, being physically active, maintaining a healthy weight, and not smoking.
An estimated 21 million Americans have diabetes and 284,000 die from it each year. Sixty-five percent of the deaths are related to cardiovascular causes.
Dr. Jamie Daugherty, who practices family medicine with the Cherokee Nation's Three Rivers Health Center, said diabetes and heart disease are interrelated.
"Diabetes is considered a disease of the small blood vessels; it causes the most damage to the small vessels. That's why it's a danger to the heart, brain, eyes and kidneys."
Daugherty said that having high blood sugar prevents oxygenated blood from circulating to all the parts of the body where it is needed.
"By keeping diabetes under control, those events are not set in motion," she said. "I tell my patients all the time that diabetes is not necessarily forever. It is treatable. I have several patients who have been able to stop all their diabetes medications."
Tahlequah dietitian Lois Fladie with Tahlequah City Hospital said the most reliable ways to control cholesterol and blood pressure are diet and exercise.
"We talk about the body as having all these parts and systems, but it's all connected; it's all one thing," she said. "The first thing a person needs to do is definitely get professional assistance that is specific to that person."
Fladie said proper diet and exercise not only help the body but are "stress releasers" that can lead to better and clearer thinking.
"We need to eat foods lower in fat," she said. "That doesn't mean you can't have occasional fatty food, just don't eat them every day. And you need omega-3 essential fatty acids from sources like salmon and olive oil. Watch your sodium intake, and definitely eat vegetables daily."
Exercise doesn't have to be a complex arrangement at the gym, Fladie said. It can be a simple as walking or swimming. Before beginning a vigorous exercise plan, first check with health care or fitness professional.
"Exercise at least 30 minutes and up to an hour of regular walking so that your heart rate is increased," Fladie said. "If it's difficult to walk then get into the water and do some swimming."
A big part of getting healthier is understanding more about the food you eat and the exercise you do. It's also vital to commit to a lifestyle change.
"You have to make a decision and combine it with a plan," Fladie said. "Re-plan your day. Once you make a decision, for example if you're out walking, you'll have a chance to say 'Hi' to your neighbors."
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