Discovering I had diabetes was the start of a long journey for me. At the age of 51, work had become an increasing burden. Despite my medication, my blood glucose was erratic and I was tired all the time and fell to sleep easily. If I read anything, I might doze off before a few pages. If I drove, after an hour on the road I could suddenly become sleepy. I knew I had only 5 minutes to pull over. I had to limit my driving so as not to be a danger to myself or anyone else. There then came a great opportunity. My employers wanted volunteers for redundancy. It was a generous package coupled with a good pension. I felt I had no choice but to take it.
Over the two years since diagnosis, I had reduced my HbA1c from 10.2% (very poor) to 7.3% (within guidelines). The main contribution to this was choosing lower glycaemic foods, avoiding all soft drinks, and taking the tablets my doctor prescribed. My doctor commented that an HbA1c of 7.3% was good, but at my age, I should be able to improve on that. He reasoned that the longer you can keep better control, the longer you can stave off the horrible complications, and a greater number of treatment options are available. Of course, he was quite right, but he was unable to tell me how to do it!
I remember thinking, “what was the best thing I could do?” It had to be weight loss. I topped to scales at about 300 pounds. At five foot ten inches, that put my BMI in the morbidly obese category. I cast around for a while looking at various options, tried a few things, but nothing seemed to work. Then quite by chance, a relative gave me a book on how to lose weight. She told me that her and her husband had tried it, but could not do it. Up until then, I had only read technical literature and did not realise how many books were devoted to diet and health. I remember thinking to myself; the book would probably tell me to eat fewer calories and less fat. This was not something with which I was comfortable. As I read, the text seemed unbelievable, it told me to curtail carbohydrate and eat all the fat and protein I wanted. I thought it seemed so outrageous and so different from anything else I had read; I just had to give it a go. What was the book? It was Atkins (an early version). It was about a year before Atkins became a craze in the UK. Within a few days, I had lost ten pounds in weight and proceeded to lose weight steadily until after five months I reached 250 pounds. It is true: Atkins is difficult to sustain. I switched to my own maintenance phase, which suits me better, but regained ten or so of the pounds I had lost.
The result was excellent, but it was the initial impact that startled me. I followed the diet as accurately as I could. That meant some things that people often forget are part of Atkins. He specifies one litre of salad every day and five portions of vegetables. That is a lot of greenery. Some time earlier, I had tried the “cabbage soup” diet. This diet caused me to lose a stone (fourteen pounds) in a week, but it was impossible to sustain the diet for any longer than that, and the weight soon returned. However, I was quite fond of cabbage soup and it has the advantage retaining all the nutrients. This was an easy way of conforming to Atkins “veggies”. Atkins also specified a supplement programme. He sold the supplements himself, but specified their contents. I worked out how to match it with local suppliers. Atkins also specifies exercise, which is why I started swimming. Atkins required me to learn how many carbohydrates were in things. Some things came as quite a shock. Cheese has virtually no carbohydrate! However, what really staggered me was the effect on blood glucose. Within 5 days, it had dropped to the near normal range, and I did not need medication. After three months, my regular blood test showed my HbA1c was 5.5%! My doctor thought I was cured!
That was four years ago now. During that time, I gradually moved into the low GL diet. I discovered it myself, before the diet gurus. In addition, to keep my glucose in the near normal range needs tablets, but at a much lower dose than I was taking originally. My HbA1c now runs at about 6.5%, the lower end of the guideline range for people with diabetes.
Apart from the dramatic effects on blood glucose, nearly all of my other symptoms have gone. My concentration is very good. I can read, study and drive for hours without a hint of tiredness.
All of this made me wonder. Why did Atkins receive such bad press? After all, I had derived so many benefits from following Atkins, what could possibly be wrong with it? After about a year of trying my own research and wandering round in circles, I decided to sign up for the Nutritional Therapy course with Kevala. I’m currently only half way through, so not all the “secrets” are known to me.
Would I recommend Atkins to someone with type2 diabetes?
One must remember that type2 diabetes can have multiple causes, and what works in one case, may not work in another. However, I am now a firm believer in ancestral diets and whole foods. Virtually every food I eat is as close to “whole” as I can make it. The Atkins diet could benefit many people because it is close to the ancestral diet. However, it has several shortcomings that I am aware of, and there may be more. Excessive meat consumption can strain the body. Meat, unless organic, comes with toxins concentrated in its fats. Poorly cooked meat (eg barbeques, char-grilled) can cause toxins to form. Pesticides in vegetables need to be avoided. Atkins does not address the issue of too much salt. Processed meats must be avoided for this reason. Atkins does not address the issue of fat balance. Fats need to be consumed in proper balance, organic sources obtained and not over-heated. Atkins is overly restrictive on fruit and probably overly restrictive on carbohydrate. However, all of these things can be corrected. On the plus side, Atkins eliminates refined carbohydrate, wheat and milk, all of which can have negative effects.
The one thing that I learned from Atkins was appetite and hunger control. I used to have an enormous appetite and could eat until absolutely stuffed. A high meat diet to some extent curbs that, and I found myself eating much less. Atkins advocates eating only until pleasantly satisfied. I ate set portions. Usually I was not hungry when starting to eat, but hungry by the time I has finished. I found the hunger abated after about half an hour after meals. This half hour period gradually reduced until it was not there at all. Having learned there was nothing to fear from hunger, I lost the desire to eat until stuffed. I think this is the Atkins secret: eventually you eat less, but more of the right kinds of foods, such as vegetables. This concept has stayed with me for four years now and I am always careful not to over eat. (Although I do have a portion of Christmas pudding in white sauce following Christmas dinner!)
If anyone asks me now, I generally point him or her at the “GL Diet” by Nigel Denby. No one argues about this diet, and as a registered dietitian, he has based it on sound principles. However, nothing beats a custom diet based on an individual consultation with a Nutritional Therapist.
Sunday, 13 May 2007
Friday, 16 March 2007
Strategies to keep blood glucose low
There are two main short-term strategies to keep blood glucose as low as possible in type2 diabetes. One is exercise and one is diet. Losing weight is another long-term strategy.
Exercise uses energy. This then makes the cells of the muscles consume energy and require more glucose. As previously explained, in type2 diabetes glucose cannot enter cells because the insulin being produced is ineffective. However, our bodies are made of trillions of cells. Some cells will be able to accept glucose and some will not, with a wide range in between. Exercise creates a demand for glucose. Cells that recognise insulin will tend to remove glucose from the bloodstream and so lower blood glucose levels. Those cells that cannot use glucose will use fat instead, or substances derived from fat. That means, if you are overweight, as is nearly everyone with type-2 diabetes, exercise will help burn off a little fat. Other main advantages of exercise are to help move lymph through the body, and that helps remove toxins, keeps the cardiovascular system exercised, helps with digestion and helps build muscle. Extra muscle creates more cells that use more glucose.
One must be very careful about the choice of exercise. If you have not exercised for years, it is best to take it steady. Nearly everyone can walk and this is the best way of starting. If you go down to the gym and start pounding away, you could be asking for trouble. People are always telling you that exercise does not count unless it is brisk. That is rubbish; any form of exercise is beneficial as long as you do not over-exert yourself. It is always best to build exercise into your daily routine. Walk whenever and wherever you can. Take the stairs, not the lift. Walk to the shops instead of driving. Play with the kids and have fun. Wash your own car, do housework, just generally get moving. Walking, more that any other form of exercise, releases endorphins. These promote a feeling of well being. People often remark that their thinking improves with walking. So if you have something complicated you need to resolve, try walking to help you. Often a walking or exercise partner can really help. You can walk and talk for miles and just not notice how far you’ve gone.
People tell me that they do not have time for exercise, but I say make time. Try going to bed half an hour earlier. You can then arise half an hour earlier for exercise!
If you have been a couch potato for years, take it steady. Your muscles may need breaking in gradually and your joints could be vulnerable. Choose an appropriate exercise, one that you like so that it can be fun. I chose swimming, and now swim a mile nearly every day. It is relaxing. When I started, it took me 85 minutes to swim a mile, but it now takes me only 55. If you swim breaststroke, be careful with the lateral forces on your knees. Also, light weight lifting is a good way to build muscle and use energy.
Always consult a health care professional before adopting any exercise programme. Also bear in mind the following motto: “Little and often, never overindulge”.
Dietary management is critical to glucose control. Whereas exercise can help remove glucose from the blood, diet is what causes it to rise in the first place. Although the above motto is equally applicable to food, I shall be taking a much deeper look at food. Food and its effects on the body are very complex subjects.
Many experts believe that being overweight or obese contributes to diabetes. This is because healthy volunteers have induced type2 diabetes by becoming overweight, and then reversed it by taking weight off. Also nearly everyone with type 2 diabetes is overweight or obese, including me! Therefore the experts believe that if you lose weight, your diabetes could reverse. Nothing in life is that simple. I believe that metabolic disturbance causes both weight gain and eventually type2 diabetes. It is only by correcting the metabolic disturbance that both might be reversed. Theories abound as to what causes the metabolic disturbances in the first place and there may be multiple causes requiring multiple interventions. Not only that, the causes may be unique to an individual. The bottom line is that losing weight on its own may not correct diabetes because there are more complex causes that need to be corrected as well. Unfortunately, the metabolic disturbances are precisely the reason for weight gain. That, and what we can euphemistically call positive calorie balance (eating too much and using too little!).
The challenges that face most of us with type2 diabetes are managing blood glucose on a daily basis and developing a long-term strategy to lose weight and correct underlying metabolic disorders. The key to these is the correct exercise and diet programme and possibly something I have not yet mentioned: detoxification.
Exercise uses energy. This then makes the cells of the muscles consume energy and require more glucose. As previously explained, in type2 diabetes glucose cannot enter cells because the insulin being produced is ineffective. However, our bodies are made of trillions of cells. Some cells will be able to accept glucose and some will not, with a wide range in between. Exercise creates a demand for glucose. Cells that recognise insulin will tend to remove glucose from the bloodstream and so lower blood glucose levels. Those cells that cannot use glucose will use fat instead, or substances derived from fat. That means, if you are overweight, as is nearly everyone with type-2 diabetes, exercise will help burn off a little fat. Other main advantages of exercise are to help move lymph through the body, and that helps remove toxins, keeps the cardiovascular system exercised, helps with digestion and helps build muscle. Extra muscle creates more cells that use more glucose.
One must be very careful about the choice of exercise. If you have not exercised for years, it is best to take it steady. Nearly everyone can walk and this is the best way of starting. If you go down to the gym and start pounding away, you could be asking for trouble. People are always telling you that exercise does not count unless it is brisk. That is rubbish; any form of exercise is beneficial as long as you do not over-exert yourself. It is always best to build exercise into your daily routine. Walk whenever and wherever you can. Take the stairs, not the lift. Walk to the shops instead of driving. Play with the kids and have fun. Wash your own car, do housework, just generally get moving. Walking, more that any other form of exercise, releases endorphins. These promote a feeling of well being. People often remark that their thinking improves with walking. So if you have something complicated you need to resolve, try walking to help you. Often a walking or exercise partner can really help. You can walk and talk for miles and just not notice how far you’ve gone.
People tell me that they do not have time for exercise, but I say make time. Try going to bed half an hour earlier. You can then arise half an hour earlier for exercise!
If you have been a couch potato for years, take it steady. Your muscles may need breaking in gradually and your joints could be vulnerable. Choose an appropriate exercise, one that you like so that it can be fun. I chose swimming, and now swim a mile nearly every day. It is relaxing. When I started, it took me 85 minutes to swim a mile, but it now takes me only 55. If you swim breaststroke, be careful with the lateral forces on your knees. Also, light weight lifting is a good way to build muscle and use energy.
Always consult a health care professional before adopting any exercise programme. Also bear in mind the following motto: “Little and often, never overindulge”.
Dietary management is critical to glucose control. Whereas exercise can help remove glucose from the blood, diet is what causes it to rise in the first place. Although the above motto is equally applicable to food, I shall be taking a much deeper look at food. Food and its effects on the body are very complex subjects.
Many experts believe that being overweight or obese contributes to diabetes. This is because healthy volunteers have induced type2 diabetes by becoming overweight, and then reversed it by taking weight off. Also nearly everyone with type 2 diabetes is overweight or obese, including me! Therefore the experts believe that if you lose weight, your diabetes could reverse. Nothing in life is that simple. I believe that metabolic disturbance causes both weight gain and eventually type2 diabetes. It is only by correcting the metabolic disturbance that both might be reversed. Theories abound as to what causes the metabolic disturbances in the first place and there may be multiple causes requiring multiple interventions. Not only that, the causes may be unique to an individual. The bottom line is that losing weight on its own may not correct diabetes because there are more complex causes that need to be corrected as well. Unfortunately, the metabolic disturbances are precisely the reason for weight gain. That, and what we can euphemistically call positive calorie balance (eating too much and using too little!).
The challenges that face most of us with type2 diabetes are managing blood glucose on a daily basis and developing a long-term strategy to lose weight and correct underlying metabolic disorders. The key to these is the correct exercise and diet programme and possibly something I have not yet mentioned: detoxification.
What is diabetes?
The first thing I wanted to do when diagnosed was to understand the disease. I found out later that understanding is essential to management. Type2 diabetes is normally progressive, that means it gets worse. The longer you can stall it the better. One day I hope to find something that will cure me, until then I have to live with it and not let it interfere with my quality of life.
Our food is composed of proteins, fats and carbohydrate. Each of these is a complex entity in its own right and our body deals with them differently. For now, I shall tell you a little about carbohydrate.
Carbohydrate is broken down in the digestive tract into types of sugar. Some are simple sugars (or monosaccharides), such as glucose, fructose and galactose, and others are disaccharides: commonly know as sucrose, lactose and maltose. Once absorbed into the bloodstream, the liver converts sugars to glucose to use as energy for the cells.
Your brain runs on glucose and it must have a constant supply to keep it going. Therefore, there is always a minimum amount of glucose needed in the bloodstream and the body carefully regulates its concentration. When you do exercise, you burn fuel. As the cells burn fuel, they call upon the blood to supply more glucose. The “preferred” fuel is glucose, although there are other types the body can use. When the cell needs more fuel, it creates (expresses in medical jargon) receptors at the cell surface, which take the fuel into the cell. The more fuel it needs, the more receptors are created. However, it is not quite that simple. These receptors have to be “activated” and to do that they need the hormone insulin in the blood. This a mechanism the body has for “sharing out” its glucose throughout the body and making sure energy goes to where it is needed. Diabetes occurs when this mechanism functions incorrectly. The effect is to leave too much glucose in the bloodstream. This has many consequences, which we shall examine later.
There are two main types of diabetes, but they are both characterised by glucose not being able to enter cells. The first form of diabetes discovered is now termed type1 diabetes. This is when the pancreas, the organ responsible for making insulin, stops making any, or is unable to make sufficient for the body needs.
In 1922, a team headed by Frederick Banting discovered and isolated insulin.
http://inventors.about.com/library/inventors/bldiabetes.htm
Before this discovery people with type1 diabetes lived at most for six months following diagnosis. This discovery of insulin changed that and now people can live for many years. It has to be injected into the fat stores (not into the veins) and depending on the type of insulin, its effects last for eight or so hours. Ingesting insulin is ineffective because stomach acid destroys it, although scientists are now finding ways around that.
Today, insulin insufficiency accounts for only 5% of the cases of diabetes. Type2 diabetes accounts for nearly all of the remainder. Type2 diabetes was once called “late-onset” diabetes or non-insulin dependent diabetes mellitus (NIDDM). However, we are now seeing the disease in children as young as 12 and so the more precise name. Type2 diabetes is insidious and creeps up on you without you noticing. It occurs because as in tye1, glucose cannot enter the cells, at least not quickly enough, but the reason is different. There is not a shortage of insulin; it is just that the insulin cannot activate the receptors in the cells. There are many theories about why this happens, but the causes remain elusive.
Therefore, whatever the type of diabetes, it leaves glucose in the bloodstream, but for different reasons. High levels of glucose in the bloodstream are damaging to all organs. Future health depends on keeping levels as low as possible.
There are many strategies to help avoid high blood glucose, and I shall be looking at them in future instalments.
Our food is composed of proteins, fats and carbohydrate. Each of these is a complex entity in its own right and our body deals with them differently. For now, I shall tell you a little about carbohydrate.
Carbohydrate is broken down in the digestive tract into types of sugar. Some are simple sugars (or monosaccharides), such as glucose, fructose and galactose, and others are disaccharides: commonly know as sucrose, lactose and maltose. Once absorbed into the bloodstream, the liver converts sugars to glucose to use as energy for the cells.
Your brain runs on glucose and it must have a constant supply to keep it going. Therefore, there is always a minimum amount of glucose needed in the bloodstream and the body carefully regulates its concentration. When you do exercise, you burn fuel. As the cells burn fuel, they call upon the blood to supply more glucose. The “preferred” fuel is glucose, although there are other types the body can use. When the cell needs more fuel, it creates (expresses in medical jargon) receptors at the cell surface, which take the fuel into the cell. The more fuel it needs, the more receptors are created. However, it is not quite that simple. These receptors have to be “activated” and to do that they need the hormone insulin in the blood. This a mechanism the body has for “sharing out” its glucose throughout the body and making sure energy goes to where it is needed. Diabetes occurs when this mechanism functions incorrectly. The effect is to leave too much glucose in the bloodstream. This has many consequences, which we shall examine later.
There are two main types of diabetes, but they are both characterised by glucose not being able to enter cells. The first form of diabetes discovered is now termed type1 diabetes. This is when the pancreas, the organ responsible for making insulin, stops making any, or is unable to make sufficient for the body needs.
In 1922, a team headed by Frederick Banting discovered and isolated insulin.
http://inventors.about.com/library/inventors/bldiabetes.htm
Before this discovery people with type1 diabetes lived at most for six months following diagnosis. This discovery of insulin changed that and now people can live for many years. It has to be injected into the fat stores (not into the veins) and depending on the type of insulin, its effects last for eight or so hours. Ingesting insulin is ineffective because stomach acid destroys it, although scientists are now finding ways around that.
Today, insulin insufficiency accounts for only 5% of the cases of diabetes. Type2 diabetes accounts for nearly all of the remainder. Type2 diabetes was once called “late-onset” diabetes or non-insulin dependent diabetes mellitus (NIDDM). However, we are now seeing the disease in children as young as 12 and so the more precise name. Type2 diabetes is insidious and creeps up on you without you noticing. It occurs because as in tye1, glucose cannot enter the cells, at least not quickly enough, but the reason is different. There is not a shortage of insulin; it is just that the insulin cannot activate the receptors in the cells. There are many theories about why this happens, but the causes remain elusive.
Therefore, whatever the type of diabetes, it leaves glucose in the bloodstream, but for different reasons. High levels of glucose in the bloodstream are damaging to all organs. Future health depends on keeping levels as low as possible.
There are many strategies to help avoid high blood glucose, and I shall be looking at them in future instalments.
Wednesday, 14 March 2007
How serious is diabetes?
When you eat carbohydrate, most of it ends up as glucose in your bloodstream. Normally the body uses glucose for energy or stores it for later use. With diabetes, these things do not happen or take much longer than normal. The result is that glucose levels remain higher than is normal or desirable. Glucose, like sugar, is sticky. In high concentrations, it can stick in capillaries, preventing blood flow. This causes damage to eyes and peripheral blood vessels. Glucose can also damage all organs, but especially the liver, kidneys, pancreas, heart, brain and nervous system. It is the leading cause of blindness and at least doubles the risk of heart disease. Cuts that do not heal should be attended to immediately or else gangrene can develop. A friend of mine lost his foot by waiting two days before getting attention.
Before 1922, diabetes was a death sentence. People often died from the above “so-called” complications. Advances in medical science have made the disease controllable and with good management, prospects are good. It is critically important that whatever course of treatment you take that you consult your doctor and that you work with him or her. Your doctor is there to help you, and he will if you co-operate. Although I now use diet to control my diabetes, I still consult with my doctor on a regular basis. He is most helpful.
On holiday a couple of years ago, I stayed at a hotel where the proprietor had diabetes, but he could not be “bothered” with his medication. I told him in no uncertain terms that if he did that, he risked death and that he must see his doctor immediately. Sadly, he took no notice, and a year later he had been taken ill and died soon after. Yes, it is that serious!
Furthermore, there is no such thing as “a tough of sugar” or “mild” or “borderline” diabetes. All cases are potentially serious. If you have blood glucose disturbances, you need help from a trained healthcare professional.
Before 1922, diabetes was a death sentence. People often died from the above “so-called” complications. Advances in medical science have made the disease controllable and with good management, prospects are good. It is critically important that whatever course of treatment you take that you consult your doctor and that you work with him or her. Your doctor is there to help you, and he will if you co-operate. Although I now use diet to control my diabetes, I still consult with my doctor on a regular basis. He is most helpful.
On holiday a couple of years ago, I stayed at a hotel where the proprietor had diabetes, but he could not be “bothered” with his medication. I told him in no uncertain terms that if he did that, he risked death and that he must see his doctor immediately. Sadly, he took no notice, and a year later he had been taken ill and died soon after. Yes, it is that serious!
Furthermore, there is no such thing as “a tough of sugar” or “mild” or “borderline” diabetes. All cases are potentially serious. If you have blood glucose disturbances, you need help from a trained healthcare professional.
Subscribe to:
Posts (Atom)
