Lifestyle medicine is not optional for prediabetes—it is essential. In India, where resource limitations make chronic disease burdens overwhelming, diet and exercise backed by evidence and complemented by low-cost interventions like flaxseed offer a powerful, scalable solution to prevent diabetes and its complications.
Prediabetes—defined by elevated blood glucose levels below diabetic thresholds—is now recognised as an opportune window for intervention, especially in India where the burden is soaring.
Why Lifestyle First?
• Global guidelines from the American Diabetes Association, the American Association of Clinical Endocrinology, and the European Association for the Study of Diabetes uniformly prioritise lifestyle modification—diet, weight loss (even as little as 5%), and physical activity—as first-line therapy for prediabetes.
• The Indian Diabetes Prevention Programme (IDPP) showed that 30 minutes of daily brisk walking, combined with diet, reduced progression to diabetes by ~28%, comparable to metformin therapy.
Dietary Strategies That Work
Reduce:
• Added sugars, saturated fats, trans fats (commonly found in processed foods, fried snacks, animal products, & sweets).
• Eliminate local staples like maida-based snacks, fried street food, and refined oils.
Increase:
• Whole grains, legumes, pulses, vegetables, fruits – the cornerstone of Indian diets.
• Dietary fibre, both soluble and insoluble. ICMR guidelines recommend ≥25 g/day, ideally from unrefined sources.
Flaxseed (Alsi) as a Targeted Intervention
As Holistic students well know, I advise every student to add coarsely ground flaxseed to their multigrain flour.
• A 2022 meta‑analysis of RCTs found flaxseed supplementation improved fasting glucose, HbA1c, insulin, and HOMA‑IR in prediabetes and type 2 diabetes (SMD –0.392 to –0.284; all p < 0.05).
• A crossover trial in obese individuals with glucose intolerance showed a 35% drop in insulin resistance and reduced oxidative stress markers after daily flaxseed for 12 weeks.
• In Chennai, a 2023 trial at M.V. Hospital for Diabetes combined flaxseed (2 tbsp/day) with counselling and brisk walking—resulting in significant weight loss, HbA1c reduction (from ~7.75% to ~6.76%), and lipid improvements.
Physical Activity
• Regular aerobic exercise, resistance training, and physical labour reduce HbA1c and improve insulin sensitivity, often independent of weight loss.
• For South Asians, including Indians, an additional 10–15 minutes of moderate activity daily beyond global guidelines offers better metabolic outcomes.
• Recommended minimum: 150 minutes/week, with many Indian studies advising daily activity like brisk walking, yoga, or cycling.
Why Doctors May Struggle to Use Lifestyle Medicine?
- Despite global and national consensus, lifestyle counselling remains underused. Reasons cited:
- Lack of reimbursement, time, resources, or training in medical curricula.
- Medical education in India still heavily emphasises acute care over chronic disease management.
- A 2010 Institute of Medicine report (U.S.) noted medical training hadn’t fundamentally shifted since 1910—an issue echoed in Indian medical education environments.
Remission Is Now Possible
A recent DiaRem‑1 trial at PGI Chandigarh (2025) showed that with a structured diet, daily activity, and short-term medications, 31% of early T2DM patients achieved drug-free remission (HbA1c < 6.5%), highlighting the transformative potential of combined lifestyle and pharmacologic approaches, especially when initiated early.

Practical Takeaways
1. Screen early—especially among urban, high-risk groups—for HbA1c and fasting glucose.
2. Counsel on diet: promote plant-based staples—dal, millets, whole wheat, vegetables, fruits, minimal sweets or fried foods.
3. Encourage flaxseed: 1–2 tbsp ground (5–10g) daily, added to rotis, curd, or poha, improves insulin sensitivity and lipids.
4. Promote daily movement beyond formal exercise—household chores, walking to market, yoga, dance.
5. Educate doctors on lifestyle medicine, integrate it into outpatient routines, and advocate for policy reimbursement.
6. Capitalise on remission potential—early, structured intervention can reverse progression, saving lives and healthcare costs.
References
1. Prediabetes overview & lifestyle importance, Wikipedia (updated Jul 2025)
2. Indian Diabetes Prevention Program results (brisk walking, diet)
3. Meta‑analysis on flaxseed in prediabetes/T2DM (2022)
4. Rhee et al., crossover trial: HOMA‑IR reduction (~35%)
5. Chennai trial: flaxseed + lifestyle improved HbA1c & lipids
6. Physical activity recommendations for Indians & metabolic effects
7. Community remission trial (‘DiaRem‑1’) at PGI Chandigarh, Indian J Endocrinol Metab, 2025
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