Diabetes and Exercise

Diabetes affects more than 20 million Americans and a staggering 6 million Americans go undiagnosed. Many sufferers are diagnosed with Diabetes Mellitus meaning, "Sweet Honey Flowing."

There are two types of Diabetes Mellitus, type one and type two. Type one is due to an autoimmune response that destroys the pancreatic beta cells. This stops the production of insulin, and creates hypoglycemia (low blood sugar). Because these individuals cannot produce their own insulin they must rely on an external source to supply the much needed hormone. Type one Diabetes only effects 5-10 percent of all diabetics. It is also characterized as a disease that effects individuals in their younger years, once labeled "juvenile diabetes."

Type two is the most prevalent in society today, and this article will focus it's attention on exercise for the type two diabetic. (There is a "prescription" for type one, as well) In 80 percent of the cases the individual is considered to be obese. Obesity is defined as a waist circumference of 100 cm men (approx. 40"), and 85 cm for women (approx. 35".) Other measurements that define obesity are body fat reading that are greater than 25% for men, and 30% for women. (ACSM) (It is interesting to note that 58% of Americans want to loose weight, and only 21% are trying.) Type two diabetes is best impacted by diet modification, exercise and oral medications. Only 40 percent of type two diabetic require insulin injections. It seems lifestyle modification is key.

Many believe that because they do not eat sugar that the are not at risk for diabetes. This is not necessarily true. Diabetes is a disorder that is developed due to a condition referred to as insulin resistance. With insulin resistance there is glucose available in the blood stream from the food you eat, but this glucose is denied access into the cells/muscle tissue to produce energy. The insulin receptors on the cell do not let the glucose in- they are insulin resistant. The sugar builds in the blood steam until it reaches a levels where it damages small vessels, usually the eyes, kidneys and other smaller vessels. Factors that increase the risk of type two diabetes are obesity, older age, family history, and physical inactivity. (American Diabetes Association 1994)

Physical inactivity is an essential part in the prevention, and management of diabetes. An effective exercise program contains various components, such as periodized cardiovascular training, comprehensive resistance training (or strength training), personalized flexibility training, balance and proprioceptive/movement based training, core training, and nutrition. While this may look a little overwhelming, think of it as a goal. Something to be achieved a little at a time. The best and easiest way to start is by walking, and revamping the diet. The emphasis should be on reducing excess weight, lowering cholesterol, lowering triglycerides, and eliminating processed foods (white flour, white sugar, processed meats, and processed foods containing trans-fats ( such as bakery items)). This can be done in baby steps, remember it is a process.

A walking program is a great way to get moving, and instigate positive change. It is something that can be done every day, and it is something that can be done progressively, meaning you can add small easy, achievable challenges to a walking program. The suggested guidelines for cardiovascular training for an individual with type two diabetes is a program consisting of five to seven days a week of activity using the larger muscles groups (ie walking, jogging, bike riding, low/non-impact movement (even dancing!!)- optimally the individual would use a variety of modalities to cross train the muscle groups) for 40- 60 minutes per day. Remember, this is the goal. (While it may be intimidating at first, remember- this is what you are building up to!! Smaller sessions are accumulative, also.)

The intensity level should be rather easy to start, progressing to a faster pace, or even a slight incline, where the exerciser becomes somewhat breathless. If the person is using a heart rate monitor (highly encouraged, you can "see" how hard you are working, and you can "see" how you progress.) you would be working at 50-60% of your maximal heart rate to begin with, working your way gradually to 60-70% of your maximal heart rate. High intensity intervals are not recommended, as there is a risk of further elevation of blood glucose (Gordon, 1995: Hornsby, 1995) Remember, these guidelines can also be goals to aspire to! Small steps are often the best placed ones.

In addition to cardiovascular activity the ACSM (American College of Sport Medicine) and the ADA (American Diabetes Association) recommends activities to build muscle, as well as burn calories. Cardiovascular activity is a great way to burn calories. Strength training, or resistance training, is a great way to build up skeletal muscle to help overcome the problem of insulin resistance. The ADA suggests strength training three times per week, targeting all muscle groups. They suggest a progression up to 3 sets of 8-10 repetitions, using a weight that cannot be lifted more than 8-10 times.(Diabetes Care June 2006) Once again, this is a progression. It is not recommended to work out to exhaustion. Also, limit isometric contractions to lessen exercise induced blood pressure elevations. (ACE Clinical Exercise Manual Exercise Training for Special Populations, Larry Verity, PhD, F.A.C.S.M.)

In conjunction with the strength training protocol, a proper flexibility program should be implemented. Such a program would address chronic postural issues, and muscular imbalances. Paying careful attention to not stretch muscles that do not need to be stretched. A proper flexibility program can be done at home on a daily basis and can actually be used to aid in stress management.

Other considerations for exercising diabetics related to blood glucose variations. One such condition is called "hyperglycemia.' This condition usually arrises when the blood glucose levels are not being well controlled. Poor control would indicate glucose levels of 250mg/dl, and higher, prior to exercise, in which the exercise session would be postponed. It is suggested that you should see your physical if the situation does not improve.

Another glucose relate problem to watch for in an exercising diabetic program is hypoglycemia, or low blood sugar. In this case the individual would experience dizziness, instability, nervousness, confusion, and even possibly loose consciousness. A good way to reduce the risk of experiencing hypoglycemia would be exercising mid-morning, after a balanced breakfast. It is suggested that exercise does not take place for at least one hour before the exercise session, and preferably not injected into an area of the body that will be used in the exercises. It is essential to monitor blood glucose, self-blood monitoring, before any activity. Exercise should be performed when the reading is between 100-250 mg/dl. If the level is lower, a carbohydrate snack should be consumed.

Other recommendations for exercising type two diabetics are:

1) Check with your physician before starting any type of an exercise program. Make sure that there are no additional considerations. ( ie hypertension or small vessel diseases.)

2)Keep a daily log which indicated time of day, blood glucose level, type of activity, intensity of activity, snack requirements (if any), and any other details that may be revalent.

3) Always self-blood monitor!!

4)Plan your exercise sessions. This should help determine if a snack will be required.

5)Always exercise with a partner. This is your support system in the event of hypoglycemia, or other complications. You should work with a partner until it is clear what the glucose response will be for that particular activity.

6) Always wear Diabetes I.D.

7)Always wear good shoes to minimize foot irritation. They should not be too loose, or too tight. To prevent foot irritation use Vaseline on the feet, and wear the socks inside out.

8) Modify calories intake accordingly on days of exercise, and following physical activity. Self-blood monitoring can help you modify your intake of calories, if needed. Insulin requiring diabetics can prevent latent post exercise hypoglycemia by monitoring their blood sugar levels carefully. Other factors are to be considered before starting an exercise program. Always check with your physician before starting any program.

Diabetes does not have to be life sentence. With proper control, healthful eating and an enjoyable exercise program life can be full of wonderful experiences! Grasp onto life, find things you love do do that are new challenges, and do them! The human body is so remarkable, fire it up to your true potential, and start living!!

The Emotional Side Of Eating, Summer Eating Tips, Good Fats For Weight Loss

You pick up the phone, it's been a tough day, call up a friend and say, "Let's go for pizza, I't been a doozy!! (Or something like that.)." Sound familiar. Or you run ( as close as you get to running) to the vending machine when your last phone call at work puts you over the edge. Habits, ingrained habits, of an emotional eating response to situations in life.

As a young child, often we are "rewarded" with "treats" in conjunction with either a) a celebration of a positive occasions (special occasions, being obedient to the parent, social events)or b) the parent wants us to adhere to their requests, or to "cheer us up" when a situation has soured. We come to relate to food as a reward, or a comforter. Food and emotions become intertwined. Triggers develop that we are not eve n cognitively aware of. Eating from urge versus necessity.

How many times have you eaten something out of a "feeling' of commitment, versus a feeling of need or hunger? How many times have you eaten something because you were in a bad mood...? How many times have you stuffed your words, and thoughts, and sat down to a sugary snack, trying to "sweeten" the mood? These emotional and social cues have been instilled in us from a very young age. These feelings often dictate to us what we "feel" is acceptable- versus what is truly necessary.

So how do we overcome these ingrained patterns? How do we overcome emotional patterns that we have had for so long? Like any other thing you wish to overcome firstly you need to acknowledge you need to overcome it. Acceptance of a problem can sometimes be the biggest hurdle to overcome.

Often the best way to realize a problem is to see the evidence of it. Food journaling is a great way to get a handle on diet issues. Persons who journal are more successful long term "losers," than non-journalers. I believe it is because writing makes you more aware of "patterns" of eating. There is also a greater accountability. This allows for "realizations" not experienced without being mentally involved in the eating process. By recording the food, quantity of food, the time the food was consumed, emotions and situations linked to eating (hunger, anger, fear, fatigue, frustration, boredom, habit (time of day) joy, celebration, social outing) we can begin to understand our habitual patterns that produce the cycles of eating without need. At this point maybe we can begin to focus on the emotion(s), outside of the food issue.

I know from my own personal experiences that I have had problems with "emotional eating."

Often out of fearful feelings (not sure about the future, not sure about my finances, not sure about my friends, not sure about whatever job I had at the time, not feeling accepted by others.) General life insecurities. These would "send" me into a negative cycle. Usually, I would start with some drinks, to cheer me up. This would lead to less than healthy food choices (Naturally, I was dieting and under-nourished, already.) Now, breaking my "diet" I would feel even worse about myself. I consumed more out of this feeling of depression. Negative cycle. These cycles can be dangerous, they can lead to severe eating disorders. I myself, became bulimic. Over run by self- doubts and fear. Emotions controlled my eating. This dangerous cycle ran my life from my first year of University through to my late thirties.

These are learned from a very young age. My mother also had an eating disorder. Therefore, I thought many of our "eating rituals" were normal. She was ruled by her emotions, and alcohol. She had a sickness of spirit that overcame her physical well being. She sought after some form of perfection that was never achievable. When I grew up I sought after the very same thing. This is something that is learned and passed from generation to generation. Parents have a very key role in educating their children in proper foods, proper food timing, the correct manners to decline unnecessary foods that can contribute to diseases of the body and spirit. Any parent with a disorder needs to address it, and work on finding a higher ground, not to pass this message on to their children. Young children are often led to mimmick the parents. They learn what they see, and are very impressionable up to the age of twelve.

Eating disorders, and their counterpart emotional issues, manifest themselves in many ways. Not everyone becomes bulimic (thank God). Other manifestations of inappropriate emotions, and relationship with food are in being overweight, obese, severely underweight (anorexic), over exercisers/achievers, judging others in their food habits, eating differently alone than with others, thinking about food all the time, there is zero variety in your diet, and habitual eating (time of day dictates eating versus actual hunger. This shows a detachment from natural patterns.)

Many of these disorders have physiological impacts, effecting hormonal balance and neurotransmitters in the brain. They are hard to overcome. It can be done, though. As stated earlier, you must be willing to admit there is a problem. You must own it. Not in a negative way, though. Negative emotions are part of the issue. Remember, this is a negative cycle that needs to be reversed.

The change has to start with your view of you. Find something positive, focus on that. One small thing you know in your heart of hearts is good! We were all created with special gifts, and special purposes. Look at your gifts. Look outside of yourself for purpose. You may need to change some things in your life, do it. Get out of the box!! Get rid of the negative that is literally "eating you alive." What I did was rediscovered the passions of my youth, before I was overcome with the negatives- fitness and God. I found a better state of physical and spiritual being. This is a good recipe. We are not only physical beings, we are spiritual beings. We are not one dimensional, and cannot live one dimensionally either. We need to nurture our "whole" selves more. I have learned to appreciate myself more, and my God given abilities, appreciating my creator more. I spend my time studying and focusing outside of me. My life does not revolve around me, and my needs like it used to. I have also come to appreciate my experiences more, good and bad. There really is no such thing as a bad experience, it is all in how you apply it to your life. How YOU can use IT, for the betterment of this world. Bitterness doesn't hurt anyone but the one who is bitter. We all must walk away from self and self doubts and self- centered attitudes. Your very life and health depends on it!!

Often when we first change our habits it is a struggle. We have not clearly learned what is good for us. We eat often from habits learned. I wanted to include some other good food options in this post/article. The dispute about good fats and bad fats continues on. These are examples of good clean, natural fats that will prolong good health, and help you lose weight. Naturally, all these should be eaten in moderation. Just because something is "good for you," doesn't mean you need to eat huge quantities.

1) Almonds/almond butters are an excellent source of Vitamin E, and antioxidant (fights free radicals.) 2 Tablespoons, small handful are one serving size. Great as a snack with an apple.

2)Avocados contain 20 vitamins and minerals. It is a great source of potassium to regulate blood pressure. Wonderful instead of mayonnaise on whole grain wraps, also on whole grain crackers.

3)Dark Chocolate, more specifically cocoa from organic ground, defatted cocoa beans. The more natural the better. These beans contain antioxidant properties.

4)Flaxseed oil is the best plant source for Omega 3 fatty acids, critical for good health. These type of fatty acids are critical for heart health, cancer prevention and alzheimer prevention.

Put 1 tablespoon of cold-pressed ( kept cold AT ALL TIMES) in a smoothy for breakfast, blend well.

5)Natural Peanut Butter, I like Marathon Nutter Butter At Dingy Docks here in town. Peanut butter contains vitamins E and B6 (important for immune system health.)

6)Olive oil instead of butter, or other oil choices. Olive oil is better if it is greener in color, containing more antioxidant properties. Extra virgin olive oil is recommended. Also, remember that oil oil, just like other quality oils, looses it's antioxidant value when it is heated. Use broth for cooking.

7)Sunflower seeds and oils are great for flavor and hunger control. They contain B vitamins and are great for fighting inflammation. They are also wonderful on salads, only about 2 tablespoons, though.

8)Walnuts are also powerful Omega 3 rich nuts. They too prevent inflamation which has been linked to many diseases, heart disease, cancer, alzheimer's. I love these on my oatmeal in the morning. 2 Tablespoons is one serving.

Last week we looked at quick lunch tips. This week we are going to focus on BBQ meals, and quick summer dinners.

SMART BBQ DOGS

Smart Dogs (Tofu), or Nitrate Free Dogs (Nitrates have been linked to many forms of cancer, they are in most, if not all, processed meats. Nitrate Free dogs are available here in town at Dingy Dock's )

Whole Grain buns, or wraps. (I like wraps, they are fun and don't fall apart.)

Veganaise ( also available at Dingy Docks), tomato, and low sodium pickles.

Mixed Greens, whole sweet baby peppers, cut thinly, cucumbers, red onion, sunflower seeds toped with raspberry walnut vinegar dressing.

3 bean salad

Watermelon

FOR THE MEAT EATER

4oz chicken breast, serving size (Dingy Dock's has fantastic organic, pre-sized chicken breasts, reasonable priced in their freezer. Great flavor.)

Marinade these overnight in Teryaki

Mushrooms

Baby tomatoes

Baby sweet peppers

Red onion

Skewer and BBQ

Arugala and baby greens salad with oranges, red onions, walnuts and balsamic vinegar drizzled on top. Top with small amount of goat cheese.

BURGER TIME!!

Try a veggie burger!! They are available at Dingy Docks and at Von's

Add a little Newman's Own Bean and Corn Salsa

WILD N WONDERFUL

4oz Wild Salmon, grilled

8-12 asparagus spears

1/4 cup Near East Tabloule (Prepared with olive oil, baby tomatoes, cucumbers, lemon, and olives) (Von's)

1/4 cup of Soy Licious Chocolate "nice" cream

Summer is here!! Don't let your new found life interfere with enjoying all that is good. You will find the more you practice good healthy habits, the easier they are to follow, and the easier many other things will become because of the extra care you take for yourself, and the others around you. Have a GREAT summer!!