New research suggests that when it comes to lowering your risk of diabetes, the more changes you make to your diet and lifestyle, the better.
Led by Jared Reis at the National Heart, Lung and Blood Institute, scientists report in the Annals of Internal Medicine that people can lower their risk of developing diabetes by as much as 80% if they adhere to a combination of lifestyle changes: exercising more, not drinking as much alcohol, quitting smoking, avoiding obesity and eating high-fiber, low-fat foods.
Although the advice sounds familiar, the new study is the first to demonstrate the effect of combining all the recommendations together. Previous studies have shown that losing weight or eating healthier can independently help reduce the risk of diabetes, but this study is the first to show the potential cumulative benefits of making multiple lifestyle changes.
The study involved more than 207,000 men and women aged 50 to 71 who were enrolled in the National Institutes of Health (NIH)–AARP Diet and Health Study. The participants were all healthy and free of heart disease, cancer and diabetes at the start of the study in 1995-96. When they joined, the volunteers filled out questionnaires about their lifestyle and diet, including what they ate, how much they weighed, how physically active they were, and whether they smoked or drank alcohol. The researchers tracked them for nearly a decade to see who developed diabetes.
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Reis and his team then divided the volunteers into low- and high-risk groups, depending on their responses to the lifestyle questions. People included in the low-risk diet group, for example, were those who ate foods with a low glycemic index (that is, foods that don’t cause a sharp a spike in blood glucose levels, which can impair the body’s ability to break down the sugar with insulin), more unsaturated as opposed to saturated fats, higher fiber and lower trans fats.
Women in the low-risk alcohol group drank no more than one alcoholic beverage a day; men drank no more than two. The low-risk physical activity group got at least 20 minutes of exercise three or more times a week. People whose BMI fell into normal ranges were considered low risk in terms of weight.
Each low-risk lifestyle habit was associated with a reduction in diabetes risk. Among men, those who were normal weight had a 70% lower risk of developing diabetes over 10, compared to those were overweight or obese. For women, the reduction in risk was 78%.
For men, the next most influential factors were not smoking and exercising regularly: non-smokers had a 24% lower risk of diabetes than current smokers or those who quit less than 10 years ago, and men who reported being physically active enjoyed a similar reduction in diabetes risk, compared with more sedentary men.
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For women, avoiding overindulgence in alcohol was an important factor in reducing diabetes risk: those who drank just one glass or less a day had a 37% lower risk, compared with women who drank more. And being physically active also helped women avoid diabetes; those who exercise regularly were 23% less likely to develop the disease than those who didn’t.
What was more intriguing was how much the participants were able to lower their diabetes risk when they combined many of these healthy lifestyle habits. A man who ate a high-fiber, low-saturated fat diet and exercised regularly, for example, had a 28% lower risk of diabetes than his counterpart who ate less healthily and spent more time on the couch. If that man was also a non-smoker, his risk of diabetes dropped by 32%; if he also cut back on his alcohol, his risk fell by 39%. If he maintained a normal weight on top of everything, his overall risk of developing diabetes was 72% lower than his peers who adhered to none of the healthy lifestyle behaviors.
The numbers were even more impressive for women, who, by combining all five lifestyle factors, were able to lower their risk of developing diabetes by 84%.
While there are effective medications to treat diabetes, it’s encouraging news that standard lifestyle modifications such as losing weight, eating right, exercising, quitting smoking and drinking in moderation can significantly lower the risk of the disease. Not everything, it seems, needs to be treated with a pill.
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Alice Park is a writer at TIME. Find her on Twitter at @aliceparkny. You can also continue the discussion on TIME’s Facebook page and on Twitter at @TIME.
