Can Type 2 Diabetes Be Prevented?

How do I prevent type 2 diabetes?

If you have a close relative with type 2 diabetes (the kind that usually develops in adulthood), you are at risk for developing diabetes yourself.

1. The most important way to avoid developing diabetes is to pay close attention to nutrition and exercise and to maintain a healthy weight. The particular food groups you eat may not be as important as how many calories you consume. Once obesity develops the risk of type 2 diabetes goes way up.


2. Exercise not only helps prevent obesity but the muscle you develop through exercise helps your body to metabolism blood sugar. This lowers your diabetes risk.


3. Recent studies have shown that some medications used at the first sign of high blood sugar can prevent or delay the onset of type 2 diabetes. Among these medications are acarbose (Precose) which blocks absorption of carbohydrates from the intestine, rosiglitazone (Avandia) which makes the body more sensitive to insulin, and orlistat (Xenical or Ali) which blocks absorption of fat from the intestine. These drugs are not yet approved by the FDA for the purpose of preventing type 2 diabetes.  For each individaul with prediabetes only a health care professional can determine if such medication is appropriate.



Gary Pepper, M.D.

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Xenical for Weight Loss. Beware What You Wish For.

The FDA recently approved the weight loss medication Xenical (orlistat) for over the counter sales. Xenical has been available by prescription for several years and has been used by doctors in the United States to aid in weight loss programs. This medication works by blocking the intestinal absorption of the fat (triglycerides) in food. If fat is not absorbed in the intestine it passes right out of the body in the stool. Since fat contains about twice the number of calories per portion as protein and carbohydrate, by using Xenical every day a person can expect to lose a substantial number of consumed calories, initially losing weight at up to a pound or two per week. Studies of long term use of Xenical show that in those who can tolerate Xenical for a year, total weight loss is more likely to be in the range of about 5 to 10 pounds above that seen on diet alone.

What’s the downside of Xenical, you may wonder? Do you recall a few years back when a major company tried to market potato chips with a new kind of indigestible fat known as Olestra? The idea was that you could eat these potato chips guilt free because all the fat calories you get with regular chips pass right through you without being absorbed. This is the same principal as using Xenical then eating those regular potato chips. Why hasn’t this great idea worked out? Was it the taste, cost or texture of the product? No. It was the nasty side-effects of having all that undigested fat hit your colon. Soon after eating Olestra potato chips, diarrhea and “anal seepage” are the flip side of guilt free eating. Anal seepage occurs when liquid fat just runs out of your backside without your ability to stop it, except in your underwear. Try to image a vegetable oil enema.

Scientific studies show that using Xenical can help lower weight and cholesterol levels. In our opinion, these types of studies demonstrate just how unrealistic scientific studies can be. In clinical practice some doctors report the success rate of using Xenical may be as low as 1 in 5 people. These physicians will tell you that almost everyone who tries it, even with careful counseling about the best ways to avoid the embarrassing side-effects, finds it difficult to tolerate this medicine. We can only image the chaos about to occur in offices, buses, subways, airplanes, theaters around the country when undigested fat begins to hit the colon of first time Xenical users. We warn you not to stand in the way of these people as they head to the toilet!

Other considerations for those who use Xenical is that it can cause deficiency of certain vitamins, particular vitamins A, D, E and K. Taking a multivitamin several hours separated from Xenical has been recommended for this reason. This weight loss drug may interfer with the absorption of certain medications like thyroid hormone and cannot be used by individuals with a variety of bowel or liver diseases.

With these cautions in mind we at wait to hear from our members about their thoughts and possibly even their personal experiences using Xenical or Olestra containing products. All we can say about the prospect of a country about to experiment with Xenical is….Wowza!

Only you and your own doctor can decide what is the best treatment for you. The comments made here by the staff at are purely for educational purposes and are not meant to guide you in the treatment of any condition or illness.

Gary Pepper, M.D., FACP

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