Sunday, December 20, 2015

The Holidaze

Over the past month…
Really the last three months, it’s been ALL about studying.  I recently took my CDE exam (certified diabetes educator) and PASSED!!  I will start off by saying that an exam doesn’t make me a CDE, however, I now have the credentials showing that I am.  I have been at the Diabetes Research Institute, DRI, for almost two years now.  When I first started there I set out a lot of goals that I wanted to achieve and becoming a CDE was definitely on the list.  During the first year I  was learning a lot and had to slow down on what I thought I’d accomplish in my first year (the master’s is still on the list, there was/is  a period of adjustment that had to happen) and I’ll be honest, my type A personality kind of took over thinking I could do it all.  Diabetes is a complicated disease – Type 1 and Type 2.  There are many myths associated with the disease and one being that if you’re overweight you’ll get diabetes (Type 2).  Not true.  Not every overweight person has diabetes.  Does it increase your risks?  Absolutely.  But diabetes is more complicated than that.  Take a look at this picture of your organs affected by diabetes.  It’s not just your pancreas!

So when we’re treating someone with diabetes it takes a lot of teaching to help people understand what all is functioning/not functioning in their body.  People with diabetes many times don’t have the sensation of feeling full – their gut hormone is not functioning 100%.  If there is at least this understanding, this allows me to teach my patients at least better ways to put together meals that will help to make them feel full.  First and foremost, everyone should eat as if they had diabetes.  The problem is that people don’t.  We are a society on carbohydrate overload and we need to start cutting back.  Just look at breakfast as an example.  Cereal.  Maybe the worst food ever created (yep I said it).  1 cup of regular Cheerios has 20 grams of carbohydrate.  A real serving size might be more like 3 cups worth (or more depending on the individual, let’s be honest).  3 cups = 60 grams of carbohydrate and that’s not including the milk that is added.  An average meal for a female should consist of just 45 grams of carbohydrates and men up to 60 grams.  The problem with cereal is that being that it’s almost all carbohydrate and virtually no protein (Cheerios did just get in trouble for their claim that their “protein” cereal had more protein than the regular Cheerios) you’re hungry all over again in just under an hour!

In the world of digestion protein keeps you fuller longer, so you need protein at each meal AND we need to lessen the load of carbs at each meal if you have diabetes or don’t have diabetes.  And just for the record, I picked what is believed to be a cereal that is “healthier” than others.  I have another cereal in my office to use as an example that in it’s one cup serving has 39 grams of carbs.  That’s ludicrous.  Just saying.  (If you had 3 cups worth along with a cup of milk that totals ~130 grams of carbs, what is the total grams of carbs needed for some people in a WHOLE day!)

Back to studying for the CDE.  The hardest part for me was learning all of the drugs and their mechanism of action.  I typically have an hour with a patient and obviously as a dietitian I need to educate them on the food as that’s a critical component in diabetes self-management.  I realized when I started studying the only way I was going to learn the drugs would be to include them in my counseling.  So as a patient came in, I knew what medications they were on and then would ask if they wanted to know why they were on what they were on.  ½ did, ½ didn’t.  But that was my in.  If they did want to know I explained to them exactly why they were on the medicine they were on.  The repetition helps, but in all honesty that’s they only way I was able to learn and commit to memory the medications.  It then would allow me to segway in to teaching the patients about food and how it’s all interrelated. 

I really do aim to teach patients as they come in on what their needs are for that day.  I had a patient come in the other day with an insulin pump.  She had her settings in the pump but had no idea what they were or how to navigate her pump to see what they were.  I explained to her that an insulin pump is great, but she’s the brains behind the pump and in order to obtain better blood sugar control she needed to understand her settings.  She was only testing her blood sugar two times per day and we focused on increasing the frequency of her checks as that too allows her to make sure she’s correcting an elevated blood sugar and not just staying high all day.  In that hour, sure I talked a little bit about food (it always returns to the food!) but we spent the majority of our session focusing on the barriers of why she wasn’t testing and what we could do to help her bolus 15 minutes prior to her meals – something so simple but so critical in helping her to have better blood sugar control.  I’m supposed to talk with her tomorrow and see how her weekend went with checking her blood sugar levels as well as if her current settings are working at the ratios they are set & if she’s been able to bolus ahead of meals. 

The definition of a CDE, “is a health professional who possesses comprehensive knowledge of and experience in diabetes management, prediabetes, and diabetes prevention.”  I’m proud to say I passed the test and am a CDE; however, knowledge goes beyond test taking.  There were many questions that I could’ve added an answer “E” to because there wasn’t really a “best answer”.  I’m in a place where not a day goes by that I don’t learn something knew or see something knew…all making me an even better CDE J
So as I was studying my days and nights away, Thanksgiving happened and now Christmas is just 5 days away!!  So it’s that time of year again when we gather with friends and family to celebrate the holidays.  The holidays are filled with lots of tasty food, seasonal goodies, and cheer that can/may result in a few extra pounds that can wrap around your middle. 

Dangerous pounds!  Research shows that most adults will gain a few pounds over the holidays.  Not only will they gain a few pounds but they’ll also lose one or two of those added pounds, and then usually hold onto at least one pound each year.  This slow and steady weight gain creeps up on us over the years and can lead to adults becoming overweight by middle age.
You can take pleasure in the holidays and enjoy delicious foods.  The holidays shouldn’t be a time of deprivation; no one wants to face Thanksgiving, Christmas, Hanukkah, or any holiday party without being able to enjoy their favorite foods.  The key is having a plan so that you can avoid the annual trap of gaining weight.  Here are a few tips that will help you this holiday season:

·        Keep up your regular physical activity.  Make sure to get in a good workout on the day of the party or event.  NO excuses! 

·       Eat a small, nutritious snack before leaving for the party.  Sometimes we show up to the party famished.  A small snack will help take the edge off of your appetite and allow you to resist the hors d’oeuvres, saving your calories for the meal.

·       Watch your alcohol calories – they add up fast!  Alternate alcoholic beverages with non-calorie beverages such as sparkling water.

·        Look over all the food offerings before you decide what you are going to eat.  If there are foods that you love but know are decadently rich, just sample a tasting portion.

·        Eat slowly and savor every bite.

·        Don’t linger around the food table!  Move to another location that is less tempting.

·        Portion control and moderation are the keys to success (our eyes are always bigger than our stomachs!)

Remember that social gatherings during the holidays are a time to embrace and give thanks for our family and friends.  Spend less time focused on food and more time enjoying the camaraderie of your loved ones.  Holiday time does not need to be synonymous with weight gain.  Make this your year not to gain those few extra pounds that you adamantly proclaim to lose on New Year’s Day.  Happy Holidays!


Sunday, November 22, 2015

Type 1 Diabetes

Diabetes Awareness Month -
November is American Diabetes Month®.  Earlier this month I wrote a blog to help decipher common myths associated with Type 2 Diabetes.  Today’s focus will be on Type 1.  So what is Type 1 (insulin-dependent or juvenile) Diabetes?  Type 1 Diabetes can occur at any age, but most commonly is diagnosed from infancy to the late 30s.  In this type of diabetes, a person’s pancreas produces little or no insulin.  The causes are not entirely known, but scientists believe the body’s own defense system (the immune system) attacks and destroys the insulin-producing cells in the pancreas.  People with type 1 diabetes must inject several times every day or continuously infuse with insulin through a pump. 

Symptoms – may occur suddenly, however, the process may have been going on for some years:

·         Extreme thirst

·         Frequent urination

·         Drowsiness, lethargy

·         Sugar in urine

·         Sudden vision changes

·         Increased appetite

·         Fruity, sweet, or wine-like odor on breath

·         Heavy, labored breathing

·         Stupor, unconsciousness
If you think that you or someone that you know has these symptoms, call a doctor immediately.  Drink fluids WITHOUT SUGAR, if able to swallow, to prevent dehydration.  (If there is not enough insulin to get glucose into the cells to use for energy, the body turns to an alternative source of energy, and burns fat.  Ketones are a waste product of the body using fat for energy and if ketone levels get high, this can lead to a serious medical situation call diabetic ketoacidosis (DKA).  There are an estimated 29 million Americans with diabetes; about 3 million have Type 1.  This smaller proportion of people with type 1 might be part of the reason that the condition is so misunderstood.
Here are a few common tales that we’ll set the record straight and help gain a better understanding of type 1 diabetes:
Tale:  You must have OD’d on sugar to get type 1 diabetes.

Fact:  No one knows the exact cause of type 1 diabetes.  Researchers are still trying to get a clear picture about genetic and environmental factors that might play a role.  The one thing we DO know is that it’s NOT brought on by too much sugar.  Oh, and they CAN have desserts (more on that later).
Tale:  Could it come from getting a vaccine as a kid?
Fact:  Scientists have NOT found a link between vaccines and type 1 diabetes.

Tale:  You put on too much weight.  That’s what caused it.
Fact:  Weight is not to blame for this disease.  Obesity and inactivity are big risk factors for type 2 diabetes and many other health problems, but there’s no connection to type 1.

Tale:  You have the “bad” kind of diabetes.
Fact:  This is often a common comment in my ‘Diabetes Made Simple’ class.  There is no “good” kind of diabetes, nor is it a matter of being better or worse.  Type 1 and type 2 diabetes are different, and therefore have to be managed as such. 

Tale:  Do you really think you should be eating that?!
Fact:  People with type 1 diabetes can eat or drink anything they want as long as they take the right amount of insulin to balance out the carbohydrates.  Now as a dietitian I’m always teaching patients, type 1 or type 2, healthy, balanced eating.  It’s not a free for all when it comes to desserts.  However, people with type 1 diabetes should not be made to feel that there are foods that they shouldn’t eat.  They can and should.  I had a 7-year old child in my office recently diagnosed (spunky as all get out) ask me, “Can I have cake on my birthday?”  I promptly responded, “Of course you can!”  She then followed up with her spunkiness and told me that she had lots of friends and they have birthdays too.  Can she have cake on their birthdays?  I of course had to outwit this 7-year old and proceeded to ask how many friends did she have??  She wanted me to tell her she could have cake every day!!  I explained to her that cake is exactly that, meant for special occasions and she really shouldn’t be having sweets every day (and that other kids her age shouldn’t be either). 
Tale:  It’s probably not a good idea to play sports.
Fact:  Jay Cutler, Ryan Reed, Gary Hall Jr – all athletes with Type 1 diabetes.  If you pay attention to how you feel and closely watch your blood sugar levels adjusting as you need to, you can stay safe and play any sport you want to.  Kids blood sugar levels during practice might react differently than during their actual game (adrenaline can make their blood sugars elevate), so I always tell my patients to know that they can actually have different reactions from practice versus game day – the key is to always be monitoring and aware.

Tale:  You were feeling so good last week.  Why are you having so much trouble this week?  Don’t you have it all figured out?
Fact:  Managing diabetes can change daily.  Many things, including stress, hormones, periods of growth, and illness, can cause your blood sugar levels to swing out of control.  These ups and downs don’t mean you’ve done anything wrong.  Even if you stick to your meal plan and follow the same schedule daily, these other factors can affect your blood sugar levels.  Again, managing diabetes is a daily job and it’s not something that can be forgotten about – it takes effort daily.
Tale:  When can you stop the insulin?  Shouldn’t you be cured by now?
Fact:  People with type 1 diabetes make NO insulin and taking insulin keeps them alive.  They must have it, but it doesn’t make the disease go away.  There is no cure, but there have been lots of advances.  And as the research continues, there have been advances in treatment of diabetes as well as technology – insulin pumps, continuous glucose monitors and, someday, maybe even an “artificial pancreas”. 
Here's some of the latest research being conducted at the Diabetes Research Institute:

 Diabetes can be a complicated disease as it can affect all areas of your life.  However, it shouldn’t keep you from doing anything you put your mind to.  You can eat what you want, play whatever sport you want, get pregnant, and travel the world…you simply have to be aware of your blood sugar levels and begin to think like a pancreas.   I always tell my patients that while they self-manage their diabetes daily, it’s important to have a nurse educator, endocrinologist, and dietitian that can help support you.  We’re there to help interpret your numbers, help adjust basal rates, and remind you that you’re doing an amazing job!! I have been working at the DRI for almost 2 years now.  I can tell you that I’ve been forever changed from the kids (and adults) that I’ve met. 

Sunday, November 8, 2015


Movember – Trying to Change the Face of Men’s Health

They’re sprouting up everywhere, moustaches on men’s faces, around the world!  During the month of November, “Movember” uses the power of the Mo (slang for moustache).  Movember helps raise money and awareness to help combat men’s health issues: prostate and testicular cancer, poor mental health, and physical activity.  Getting the right screening test at the right time is one of the most important things a man can do for his health.  Screenings find diseases early, before you have symptoms, when they’re easier to treat.  The tests you need are based on your age and your risk factors.  Take control of your health and look after yourself.
Prostate Cancer

Prostate cancer is the second most commonly diagnosed cancer in American men (after skin cancer).  1 in 7 men will be diagnosed with prostate cancer in their lifetime.  In 2015, an estimated 220,800 American men will be diagnosed with prostate cancer.  It tends to be a slow-growing cancer, but there are also aggressive, fast-growing types of prostate cancer.  Screening tests can find the disease early, sometimes even before symptoms develop, when the treatments can be more effective. 
Know the Risk Factors in developing the disease:

Family History – A man with a father or a brother who developed prostate cancer will be twice as likely to develop the disease.
Ethnicity – There is an increased occurrence in black African and Afro-Caribbean males.

Symptoms, Testing, and Treating –
There are not always symptoms associated with prostate cancer.  In fact, many times it is first detected at routine check-ups.  However, here are some symptoms that might indicate the presence of prostate cancer: 

·         A need to urinate frequently, especially at night

·         Difficulty starting urination or holding back urine

·         Weak or interrupted flow of urine

·         Painful or burning urination

·         Difficulty in having an erection

·         Painful ejaculation

·         Blood in urine or semen

·         Frequent pain or stiffness in the lower back, hips, or upper thighs
If you are experiencing any of these symptoms, it is important for you to contact your doctor.  The following tests are recommended to detect prostate cancer early on (before the disease progresses):

·       The Digital Rectal Exam (DRE) – The DRE involves the doctor inserting a gloved finger in the anus, where it is possible to feel part of the surface of the prostate.

·       The PSA blood test (PSA) – The PSA blood test looks for the presence of a protein in the blood that is produced specifically by prostate cells.
Depending on the results of these tests you may be referred to a specialist for a biopsy – the only way to determine if cancer is present.

Testicular Cancer
This uncommon cancer develops in a man’s testicles, the reproductive glands that produce sperm.  Most cases occur between ages 20 and 54.  The American Cancer Society recommends that all men have a testicular exam when they see a doctor for a routine physical (even if you feel fine, it is still important to see your health care provider to check for potential problems).  Men at higher risk (a family history or an undescended testicle) should talk with a doctor about additional screening. 

Symptoms, Testing, and Treatment – Men may experience few or no symptoms of testicular cancer.  Here are some important symptoms to be on the lookout for:
·         Swelling or a lump in either testicle (usually painless)

·         A feeling of heaviness in the scrotum

·         Change in the size and shape of the testicles

·         Aches or pain in the lower abdomen or groin

·         A sudden build-up of fluid in the scrotum

·         Pain or discomfort in a testicle or in the scrotum

·         Enlargement of tenderness of the breast tissue
Regular self-examination of the testicles is important for young men.  Just like women are recommended to self-examine their breasts for breast cancer, doctors advise regular self-exams in men, gently feeling for hard lumps, smooth bumps, or changes in size or shape of the testes.  Self-examination can help find any changes in the testes EARLY on. 

Colorectal Cancer
Colorectal cancer is the second most common cause of death from cancer.  Men have a slightly higher risk of developing it than women.  The majority of colon cancers slowly develop from colon polyps: growths on the inner surface of the colon.  After cancer develops it can invade or spread to other parts of the body.  The way to prevent colon cancer is to find and remove colon polyps before they turn cancerous. 

Tests for Colon Cancer -
Screening begins at age 50 in average-risk adults.  A colonoscopy is a common test for detecting polyps and colorectal cancer.  A doctor views the entire colon using a flexible tube and a camera.  Polyps can be removed at the time of the test.  A similar alternative is a flexible sigmoidoscopy that examines only the lower part of the colon.  Some patients opt for a virtual colonoscopy – a CT scan – or double contrast barium enema – a special X-ray – although if polyps are detected, an actual colonoscopy is needed to remove them.

Skin Cancer
The most dangerous form of skin cancer is melanoma.  It begins in specialized cells called melanocytes that produce skin color.  Older men are twice as likely to develop melanoma as women of the same age.  Men are also 2-3 times more likely to get non-melanoma basal cell and squamous cell skin cancers than women are.  Your risk increases as lifetime exposure to sun and/or tanning accumulates; sunburns accelerate risk.

Screening for Skin Cancer
The American Cancer Society and the American Academy of Dermatology recommend regular skin self-exams to check for any changes in marks on your skin including shape, color, and size.  A skin exam by a dermatologist or other health professional should be part of a routine cancer check-up.  Treatments for skin cancer are more effective and less disfiguring when it’s found early.

High Blood Pressure (Hypertension)
Your risk for high blood pressure increases with age.  It’s also related to your weight and lifestyle.  High blood pressure can lead to severe complications without any prior symptoms, including an aneurysm – dangerous ballooning of an artery.  But it can be treated.  When it is, you may reduce your risk for heart disease, stroke, and kidney failure.  The bottom line:  Know your blood pressure.
Screening for High Blood Pressure
Blood pressure readings are two numbers.  The first (systolic) is the pressure in your arteries when the heart beats.  The second (diastolic) is the pressure between beats.  Normal blood pressure is less than 120/80.  High blood pressure is 140/90 or higher, and in between those two is prehypertension.  How often blood pressure should be checked depends on how high it is and what other risk factors you have.

Cholesterol Levels
A high level of LDL cholesterol in the blood causes sticky plaque to build up in the walls of your arteries.  This increases your risk of heart disease.  Atherosclerosis – hardening and narrowing of the arteries – can progress without symptoms for many years.  Over time it can lead to heart attack and stroke.  Lifestyle changes and medications can reduce this “bad” cholesterol and lower your risk of cardiovascular disease.
Determining Cholesterol Levels
The fasting blood lipid panel is a blood test that tells you your levels of total cholesterol, LDL “lousy” cholesterol, HDL “healthy” cholesterol, and triglycerides (blood fat).  The results tell you and your doctor a lot about what you need to do to reduce your risk of heart disease, stroke, and diabetes.  Men 20 years and older should have a new panel done at least every five years.  Starting at 35, men need regular cholesterol testing.

Type 2 Diabetes
One-third of Americans with diabetes don’t know they have it.  Uncontrolled diabetes can lead to heart disease and stroke, kidney disease, blindness from damage to the blood vessels of the retina, nerve damage, and impotence.  This doesn’t have to happen.  When found early, diabetes can be controlled and complications can be avoided with diet, exercise, weight loss, and medications.

Screening for Type 2 Diabetes
A fasting plasma glucose test is most often used to screen for diabetes.  More and more doctors are turning to the A1C test, which tells how well your body has controlled blood sugar over time.  Healthy adults should have the test every three years starting at age 45.  If you have a higher risk, including high cholesterol or blood pressure or a family history, you may start testing earlier and more frequently.

Poor Mental Health
3 out of 4 deaths by suicide are men.  Anyone can be affected by poor mental health.  Many men might find it difficult to share their problems and feelings with others.  Many men might try to remain ‘strong and silent’ rather than get the support that they need.  It’s important to be proactive about your mental health and be aware of the risk factors and symptoms:
·         Family history of mental health problems

·         Drug and alcohol use

·         Serious medical illness

·         Isolation or loneliness

·         Unemployment, homelessness, conflict, or other stressful life situation
If someone that you know is at risk, encourage them to contact their doctor, a mental health professional or access support.   Take action, stay connected, and look after your mental health. 

Physical Inactivity: is the fourth leading risk factor for global mortality.  Sitting is the new smoking.  It’s killing us.  Being active is essential to prevent and reduce risks of many diseases and improve both physical and mental health.  Make time and MOVE more!!

The bottom line
Stop avoiding the doctor.  Routine physicals are meant to screen for diseases and assess the risk of future medical problems.  Take action to reduce your risks.  Start with healthy lifestyle choices – eat a healthy diet, stay physically active and quit smoking.  The impact of the changes now will be greater than you’ll ever know. 
Movember’s vision:  “have an everlasting impact on the face of men’s health.”

Sunday, October 25, 2015

November is American Diabetes Month®

Diabetes – Fact versus Fiction
November is American Diabetes Month®.  The vision of the American Diabetes Association is a “life free of diabetes and all of its burdens.  Raising awareness of this ever growing disease is one of the main efforts behind the mission of the Association.” 

Here are a few of the most recent statistics:
  • Nearly 30 million children and adults in the United States have diabetes.
  • Another 86 million Americans have prediabetes and are at risk of developing Type 2 diabetes.
  • The American Diabetes Association estimates that the total national cost of diagnosed diabetes in the United States is $245 billion.
Nearly one in 10 Americans has diabetes.  There are many myths that still remain.  I hear them in my office all the time.  Let’s set a few of these myths to rest and get the facts.

Myth:  Everyone who is overweight develops diabetes.
Fact:  Type 2 diabetes (which accounts for 90-95% of the cases) is much more common in people who are overweight.  Excess weight IS the strongest known risk factor.   Being overweight increases the chances of developing type 2 diabetes seven fold.  Losing 7 to 10 percent of your current weight can cut your chances of developing type 2 diabetes in half.  Losing any excess weight – and keeping it off – is the best defense against diabetes.  However, keep in mind that other factors play a role as well:  genetics, inactivity, age, and ethnicity.  The key is to know your numbers and know your risk – prevention is key! (With type 1 diabetes, the body’s immune system attacks part of its own pancreas.  Scientists are not sure why – more on Type 1 in a separate blog post).
Myth:  If your fasting blood sugar is 100 to 125 (called prediabetes), you will develop type 2 diabetes.
Fact:  Having prediabetes does not mean that you will develop diabetes.  The risk is there and the key is to make lifestyle changes in order to prevent or delay it from progressing to diabetes.  The scary fact is that many people come into my office with prediabetes and don’t know they have prediabetes.  There are three reasons this could be the case.  The first I call the “Charlie Brown” syndrome – it’s possible their doctor did tell them and all they heard was, “wah waaah wah wah”.  The second reason is that their doctor told them they have prediabetes and they’re in denial and last but not least is the patient was never told by their doctor.  86 million people have prediabetes.  This CAN be prevented or delayed from progressing to diabetes.  Know your numbers.
Myth:  People with diabetes need to eat special food.
Fact:  The irony is that everyone should eat healthy food.  It’s no different than what I recommend to anyone, diabetic or not.  As people are faced with a diagnosis of diabetes they’re simply more pressed to make immediate changes.    Healthy eating means having variety, balance, and moderation.  I teach people to limit their intake of sodium, saturated (and trans) fat, added sugars and refined grains.  I also teach people to place an emphasis on nutrient-dense foods, to increase their fiber intake, and begin to look at more whole foods and less processed (chemical enhanced) foods.  The key is to implement one change at a time and then move on to the next.  Healthy eating is a way of life, it’s not just a quick fix for a short period of time.

Myth:  Eating sweets is off-limits for people with diabetes.
Fact:  Variety, balance, and moderation.  EVERYONE should limit their intake of sweets, not just people with diabetes.  Indulging in too many sweets makes it more difficult for anyone to keep off unwanted pounds and leaves less room for the nutrient-rich foods the body needs.  This is what I tell my patients:  you know yourself, are you the kind of person who can have a piece of chocolate or are you the type of person that will have the whole chocolate bar?  Having sweets lying around the house can only set you up to fail if you’re the type to eat the whole chocolate bar.  The key is to allow for some of those moments with sweets and desserts, otherwise you’ll go overboard when you do see the desserts.  In people with diabetes I always try and explain that it’s important to have good blood sugar control.  Including these sugar-containing treats is possible with portion control and knowing their blood sugar levels – it’s called managing your diabetes.  I teach them that desserts are a part of life (especially as the holidays are approaching), however, desserts are not the fuel source your body needs to operate at full-strength capacity.  Always aim for the best fuel and keep the desserts in check.

Myth:  Fruit is a healthy food.  Therefore, it is okay to eat as much of it as you wish.
Fact:  Yes fruit is a healthy food, but NO you cannot each as much of it as you wish.  Fruit does contain fiber and lots of vitamins and minerals.  However, fruit contains carbohydrates and therefore needs to be included as part of your meal plan, in a controlled amount.  Since beginning work at the Diabetes Research Institute, this is one change I’ve made – I’ve decreased the amount of fruit I eat and started to increase the amount of non-starchy vegetables I’m consuming.  Tough?  Yes.  Healthier for me?  Absolutely!  (p.s. Juicing, smoothie, and smoothie bowls as a trend needs to stop – the fiber is there but not functional and it tends to be a load of carbohydrates – EAT and CHEW your food.)
I’m always telling my patients to “know their numbers”  Here’s a chart to help explain your numbers:
If you have your fasting blood sugar checked routinely for your doctor visits, the fasting blood sugar should be less than 100 mg/dL.  If it is above 100 mg/dL this will be an indicator to have your A1c checked.  The A1c is a blood test that runs an average over the last three months of your blood sugar level – so while your fasting blood sugar could’ve been high it doesn’t necessarily indicate your overall control.  The A1c is the best test for verification.  An A1c between 5.7-6.4% indicates prediabetes and an A1c at 6.5% and over is diabetes.  This November, have yours tested so you can know your numbers.  Knowing if the first part of prevention.  Here are a few other tips to help reduce your risk:
Exercise moderately.  Aim for 150 minutes of exercise/week.  Inactivity promotes type 2 diabetes.  Working your muscles more often and making them work harder improves their ability to use insulin and absorb glucose.  This puts less stress on your insulin-making cells.  Long hours of hot, sweaty exercise aren’t necessary to reap this benefit.  Walking briskly for a half hour every day reduces the risk of developing type 2 diabetes by 30 percent.  Limit the time you spend sitting at work, at home, or in between.

Tune Up Your Diet  - Making a few dietary changes can have a big impact on the risk of type 2 diabetes.       
  1. Choose whole grains and whole grain products over highly processed carbohydrates.   Whole grains don’t have a magical nutrient that fights diabetes and improves health.  It’s the entire package – elements intact and working together – that’s important.  The bran and fiber in whole grains make it more difficult for digestive enzymes to break down the starches into glucose.  This leads to lower, slower increases in blood sugar and insulin, and a lower glycemic index.  As a result, they stress the body’s insulin-making machinery less, and may help prevent type 2 diabetes.  Whole grains are also rich in essential vitamins, minerals, and phytochemicals that may help reduce the risk of diabetes.
  2. Skip the sugary drinks and choose water.  water.                                                                       When it comes to diabetes, sweet beverages seem to be a double-whammy.  Their high-fructose corn syrup and other sugars increase the demand for insulin and have a high glycemic load.  The sugar you sip may add flab more than the sugar you chew.  Liquid calories don’t seem to lead to satiety and the reduction in subsequent food intake that you might have with solid calories.  It’s easy to take in a large amount so easily.  Think your drink.
  3. Include heart-healthy plant-based fats.                                                                                              The types of fats in your diet can also affect the development of diabetes.  Healthy  fats, such as the polyunsaturated fats found in liquid vegetable oils, nuts, and seeds can help ward off type 2 diabetes.  Trans fats do just the opposite.  These unhealthy fats are found in many margarines, packaged baked goods, fried foods in fast-food restaurants, and any product that lists “partially hydrogenated vegetable oil” on the label. 
If You Smoke, Try to Quit.                                                                                                                                        Smokers are roughly 50 percent more likely to develop diabetes than nonsmokers, and heavy smokers have an even higher risk.

Alcohol Now and Then May Help.                                                                                                                         A growing body of evidence links moderate alcohol consumption with reduced risk of heart disease.  The same may be true for type 2 diabetes.  Moderate amounts of alcohol – up to a drink a day for women, up to two drinks a day for men – increases the efficiency of insulin at getting glucose inside cells.  If you already drink alcohol, the key is to keep your consumption in the moderate range, as higher amounts of alcohol could increase diabetes risk.  If you don’t drink alcohol, there’s no need to start – you can get the same benefits by losing weight, exercising, and changing your eating patterns.

The bottom line to prevent type 2 diabetes:  Keep your weight – and especially your waist – under control, and spend more time on your feet than on your seat.

Sunday, October 4, 2015

The Toll of Sitting All Day

The Toll of Sitting All Day
Think about it for just one minute.  How many minutes a day do you sit? At work?  At home?  The drive for your commute?  Things that make you go hmmmm.  Well, more and more research is coming out to say that sitting is harmful to our health.  I wrote about this topic just last January.   Ned Levine termed the phrase, “Sitting is the new Smoking”.  He even wrote a book called, “Get Up” – a tale of how he came to the scientific conclusion that our chairs are killing us and what needs to be done in order to stop this threat.  He also happens to be the inventor of the treadmill desk – clever if I do say so myself.  And then just this week an article in the Wall Street Journal brought attention to this very same theme – the toll that sitting all day is having on our health – once again.  More and more people are talking about it and more and more research is studying the negative health effects of sedentary behavior.   There have been at least 35 diseases identified that if you spend all day sitting, are at an increased risk of developing:   diabetes, osteoporosis, cancer. 
Here are some general guidelines to help you avoid sitting too long:  For every half-hour working in an office, people should sit for 20 minutes, stand for eight minutes and then move around and stretch for two minutes, says Alan Hedge, a professor of ergonomics at Cornell University.  This is what I say to you Alan – it ain’t happening.  I have my patients scheduled for every hour.  If all my patients come in a day that’s seven hours of sitting, not to mention the charting that has to take place (ICD-10 should’ve merged better with ICD-9 codes, but that’s a different gripe for another day).  I’m pretty sure it’d look quite odd for me to stand during my session with my patients.  The only time I get to move around is when I’m teaching class.  So, it seems there is a bit of a predicament.  My only reprieve is if a patient doesn’t show.  I’m constantly getting up and moving around.  But to put his recommendations into practice is almost impossible and hence why we have such a problem on our hands.  Another way he terms it is this:  “People should get a combined two to four hours of standing and light activity spread throughout the workday.  The research also shows that aiming to stand for two minutes 16 times a day while at work could be an effective strategy for maintaining bone and muscle density.   Again, I won’t be able to get the two to four hours of standing, but this getting up for two minutes at a time, might be possible.  The bottom line:  break up your activity throughout the day. 

“Regular exercise doesn’t seem to compensate for the negative effect from sitting too much during the day”.  The article goes on to say that sitting causes physiological changes in the body, and may trigger some genetic factors that are linked to inflammation and chronic conditions such as diabetes and cardiovascular disease.  Whereas when one stands, it activates the muscles.  One area where this is of benefit is with glucose, if you stand and go for a walk the excess glucose doesn’t hang around in the bloodstream and instead will actually be absorbed in the muscles.  I tell my patients this all the time, “go for a walk after you eat lunch.  Get moving, get outside.  The change in environment does you good not only for better utilization of your glucose, but also because it’s been proven to help you to be more productive!”  Sitting at your desk and eating lunch is one of the worst things you can do! 
While the research is showing the negative effects that sitting has on our health, they are also looking at ways of how to get people to sit less.  The key is educating people and making sure they’re aware of the harmful effects.  Another strategy that worked was setting an alarm/reminder for when it was time to stand.   A few other helpful hints:  if you’re having a meeting with just one or two people, have the meeting on the go.  So instead of cooping yourself up in a stuffy conference room, make your next meeting a walking one.  Another helpful hint to parents with kids:  use the time that you’re at an athletic event to be on your feet instead of on your seat.  While it’s okay for you to watch some of their game, move around and use that time as possibly your exercise time – whatever you do, don’t sit for their whole practice. 

I used to have a 150 mile daily commute, 75 miles each way.  My work day was 6:30-6:30, 3 hours driving and then more sitting when in the office.  Sure my new job does require a lot of sitting, especially when all the patients come for the day, along with the charting.  But my commute is MUCH shorter than before and if I want to go out for a walk at lunch I can and often do.  While I’d love to say that I’ll be able to get a treadmill desk, the odds are that’s not happening.  I’m in the same predicament many of you are:  sitting is harming our health.   While the research keeps coming out to prove it, it makes all the sense in the world.  No need to scare us with the stats. 
This is where I challenge you to be mindful of your movements during the day.  Each day is different and no one knows what the day will hold.  When it comes to your work place environment if you know your job is more sedentary than others’ jobs, get up and get moving, as much as you can.  Many patients have told me that they just start working and “get in a groove” and don’t pay attention to the clock.  While I’m not asking that you break your concentration in the middle of a productive session, I am asking that you get up periodically and get the blood flowing.  Be mindful and move more.  I have a Fitbit.  When I first got it I thought I was going to use it primarily for my running.  I’d be able to track my pace, my distance, etc.  Where it’s really been the most helpful?  Tracking my day to day steps.  I challenge myself to get a certain amount of steps by a certain time of the day.  There have been times where I’ve been known to do a little jogging in place in my office in between patients.  You gotta do what you gotta do J  I’m able to tell by lunchtime if I’ve been up and moving as much as possible.  I take full advantage of the times when people don’t show for their appointments – I get up and walk around as much as possible.  And at least twice a week I go for a walk at lunch – I aim for more, but it’s recently been quite rainy here in the MIA.  Moving more and being mindful about your movements, that’s my challenge for you.