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.