Many doctors are searching for ways to ethically increase their patient load and make clinical practice more rewarding professionally and financially. Have you ever considered specializing in health care and preventing chronic degenerative conditions before they can be recognized and measured quantitatively by medicine?

Sick care is practiced by recognizing and characterizing disease conditions (diagnosis). Once the diagnosis is pronounced, treatment is dictated by prevailing therapeutic procedures. However, until the disease process can be measured, there can be no acceptable procedures, hence the guesswork of prescribing drugs for symptoms with haphazard results at best.

Health care, on the other hand, is practiced by maintaining normal body functions. Deviations from normal are caused by only one factor: stress.

Hans Selye, M.D., was nominated for the Pulitzer Prize for Medicine in 1964 for his research on the effect of stress on the human body. His research found that the accumulative effects of stress are predictable. Not only is there just one problem to be solved in health care, there also are essentially only three kinds of stress: mechanical, emotional, and chemical (or nutritional). All you have to do is identify the stress and remove it and your patients who are not yet diseased will get well.

You may also have to provide proper nourishment for affected tissues to heal. As a chiropractor, you are already an expert at identifying mechanical stress. Emotional stress is beyond the scope of these articles and my expertise. That leaves nutritional stress and the subject of this month's column -- diabetes.

The term "diabesity" (diabetes + obesity) is increasingly being used to label the patients with Type II diabetes are overweight. Here are the current statistics according to the Centers for Disease Control and Prevention:

*** 17 million Americans have diabetes.

*** 90% of diabetics have Type II (diet-related) diabetes.

*** 60% of adults with Type II diabetes are overweight.

*** 97% of youths diagnosed with Type II diabetes are overweight.

Diabetes is the leading cause of adult blindness, kidney failure, non-traumatic amputations, heart disease, and stroke. Our goal, of course, is to prevent the onset of diabetes. The way to do that is to recognize the possibility that your patient has an Impaired Glucose Tolerance (IGT).

Medical practitioners have long referred to these patients as "borderline diabetics" meaning the patient has a blood glucose level that is higher than normal but not high enough to be classified as diabetes. These are the patients with whom you can best practice health care, thus preventing disease.

It is estimated that 20 million people in the United States have IGT and that the number is rising rapidly. It is further estimated that 50% of these people will develop Type II diabetes. That means there are more than a few in your practice and even more in your area could use your help.

Health and Human Services Secretary Tommy Thompson and American Diabetes Association President Christopher Saudek, M.D., are asking doctors to begin screening overweight patients age 45 and older for pre-diabetes. They state that patients with the following risk factors may develop IGT:

-- Family history of diabetes

-- Being overweight

-- Women who have gestational diabetes or have given birth to a baby weighing more than 9 pounds

-- People with steroid-induced hyperglycemia

-- Those with high blood pressure

-- Those with an abnormal lipid blood profile (low HDL cholesterol and high triglyceride levels)

-- Those with any of the above and a genetic predilection are particularly at risk. This includes African-Americans, American Indians, Hispanic/Latino Americans, Asian Americans, and Pacific Islanders.

Apparently most people with IGT will develop diabetes within 10 years unless they make modest changes in their diet and level of physical activity. Recommendations should therefore include reduced caloric intake and a regular program of walking for exercise. Blood pressure monitoring, weight control, and nutritional education are essential.

Nutritional education is a key point here. The experts are saying that excessive dietary intake of simple carbohydrates are the most common etiologic factor in obesity and should be reduced. Improved protein intake is highly recommended. Unfortunately, no attention is paid to curbing cravings and to a patient's ability to digest a given diet. These factors along with specific chiropractic findings will be presented in next month's column.

Medical experts are recommending that IGT screening should include glucose monitoring and fasting lipid profiles for those at high risk as indicated by their past health history. It is interesting to note they are not recommending prescription drugs for the condition. That puts you, as a chiropractor, in the picture for specializing in health care to increase professional and financial success.