The potential ramifications: Millions of people more susceptible to heart disease, dementia, infections, amputations and blindness. Lowering your risk for diabetes is relatively simple and terribly important. Because dealing with some of its effects once you are its victim can be much more complicated.

Signs of Trouble

"Approximately one in four individuals over the age of 60 has type 2 diabetes, which is a remarkable statistic," says Gerald Shulman, MD, of the Howard Hughes Medical Institute at Yale University. "And, if you add impaired glucose tolerance [a condition that often leads to diabetes], you're talking about 40% of the population."

The economic burden of this epidemic is staggering, estimated at about $100 billion a year and growing.

If you never exercise, carry around a substantial amount of stomach fat and have seen your weight climb significantly over the years, you are among the people at higher risk for diabetes.

These lifestyle habits eventually render your body unable to efficiently process blood sugar. In technical terms, researchers investigating how the body uses and misuses blood sugar have identified what they have called "syndrome X" or "metabolic syndrome," a condition that puts you at high risk for both diabetes and heart disease.

If you have three or more of the following signs, you now have metabolic syndrome and, unless you change the way you live, may eventually suffer diabetes (Circulation 7/14/03):

* Fat around your middle

* High blood pressure

* High triglycerides (blood fats)

* Low level of HDL ("good" cholesterol)

* High fasting blood sugar

In a study of more than 6,000 men in Scotland, having three of these metabolic problems almost doubled the risk of heart disease and more than tripled the risk of diabetes. If you have four of these risk factors, your risk of heart disease just about quadruples, and your diabetes risk skyrockets almost 25 times.

Insulin Resistance

The cells in your body get the energy they need to survive when they take sugar out of your blood and oxidize it along with fatty acids. Normally, insulin, a hormone-like substance released by the pancreas, speeds the absorption of blood sugar by the cells. When your pancreas cannot make insulin at all or makes too little, you suffer what is called type 1 or juvenile diabetes. This condition is usually treated by taking insulin.

But if your pancreas secretes what should be enough insulin for glucose absorption, and your cells are still unable to take sufficient sugar from your blood, you have what is called type 2 or adult-onset diabetes.

Understanding exactly why cells develop difficulties in taking sugar out of the blood and using it for energy has long troubled medical investigators. This condition, before it develops into full-blown diabetes, is called insulin resistance. Researchers have now linked it to malfunctioning mitochondria, the little structures in cells that make the energy that keeps cells functioning.

Scientists have long known that, as you age, you become more susceptible to diabetes. And when researchers compare the mitochondria in young people with those found in the cells of the elderly, they find that older mitochondria are more sluggish.

Making Energy

The mitochondria within the cells oxidize glucose and fatty acids to make energy. (They accomplish this in a complicated metabolic action called the Krebs cycle.) Difficulty with this process, or insulin resistance, can occur when fat and fatty acid waste products accumulate in your liver and muscle tissue.

"We hypothesized that there were two routes to this type of fat accumulation," says Dr. Shulman. "One is that the fat cells might release more fatty acids to be delivered to muscles and/or defects in mitochondrial oxidation might then lead to the accumulation of these fatty acids."

Research confirms that fatty molecules probably collect in muscle cells because the mitochondria's ability to burn fat breaks down over the years. On average, mitochondrial activity dips about 40% in older people.

Dr. Shulman thinks that the final coup de grace in the development of diabetes from insulin resistance takes place when the mitochondria malfunction in the insulin-producing cells of the pancreas.

Although Dr. Shulman says that more research is needed to understand why mitochondrial function slips with age, he recommends keeping your mitochondria from slacking off by exercising. Studies now show that regular physical activity can probably increase the mitochondria in your muscles by activating release of an enzyme called AMP kinase. "...an encouraging note in this study is that-since we've shown that exercise leads to more mitochondria by activation of [the enzyme] AMP kinase-by staying active, the elderly might...maintain mitochondrial content and head off such health problems," says Dr. Shulman. "This is yet another reason for seniors to maintain an active lifestyle," he adds.

Maitake for Metabolic Syndrome

Another natural way to fight the metabolic syndrome is with an extract of the maitake mushroom (Grifola frondosa). The extract, called sx-fraction, is attracting research investigating its ability to help the body manage blood sugar more efficiently. In one study, five people with diabetes improved their blood sugar levels with sx-fraction (Diab Med 2001; 18).

This research found that taking maitake sx-fraction is often accompanied by drops in blood glucose levels ranging from 30% to 63%. According to Mark Kaylor, PhD and Ken Babal, CN, in Syndrome X and SX-Fraction (Woodland), "...Studies have demonstrated that whole maitake or its fractions are potent agents for improving 'diabetic conditions.'"

Take the Whole Grains Home

Eating a daily dish of whole grains, like whole wheat and brown rice, can also reduce your risk of diabetes (AJCN 8/22/03). In a twelve-year study of more than 40,000 men between the ages of 40 and 75, researchers found that those who ate three servings of whole grains a day cut their risk in half.

The researchers found that even overweight people lowered their chances of diabetes by eating whole grains and exercising.

Consuming more magnesium also helped; whole grains contain amounts of this mineral missing in refined-grain foodstuffs. Magnesium improves insulin response.

In an age of junk food, our simple taste for sugar and refined grains may threaten our health. Yet, your defense against this scourge is no further away than simply eating more fibrous foods and going for a simple, everyday walk.