Ryan Bradley, ND, MPH is a doctor of naturopathic medicine in San Diego, CA. Diabetes is an area of both research and clinical specialization for Dr. Bradley. He practices integrative care for diabetes and heart health as the Director of the Center for Diabetes & Cardiovascular Wellness at the Bastyr University California.
Turning Over a New Leaf in the New Year
Happy New Year! New Year’s is a time for reflection and introspection about years past and anticipation of years to come - a time we wish to change the way we feel, act, interact, and believe. In essence, many of us desire change in how we live the one life with which we are gifted. Yet there are limited sources of good information and advice on how to live healthful lives. Do you refer to the newest diet book? The most recent expert opinion? The most recent research? Advice from friends and family? If I want to make changes, which are the most important? I hope this article helps decipher the basics about diabetes and helps you prioritize making changes you are considering. Remember you are the master at the switch, so choosing to live differently is something only you can do - and this gives you a lot of power!
What is diabetes?
Diabetes, whether type 1 or type 2, is a condition of long term elevations in blood sugar far above the normal level. About 80% of people with diabetes have type 2 diabetes, a condition associated more strongly with lifestyle than type 1. Type 1 diabetes has been historically considered a disease of the young, while type 2 diabetes was thought to be a disease of adults. This is changing now - young people are developing type 2 diabetes at alarming rates and some adults with diabetes are now known to develop some signs of type 1 diabetes.
What causes diabetes?
Type 2 diabetes is less associated with antibodies and is more associated with the development of resistance to insulin.
Diabetes is caused by a combination of factors including genetics and lifestyle. Type 1 diabetes is an autoimmune condition in which the body makes antibodies against its own insulin-producing cells in the pancreas. Insulin is a hormone required to move sugar from the blood stream and into the body organs and muscles; without insulin blood sugar stays very high.
Type 2 diabetes is less associated with antibodies and is more associated with the development of resistance to insulin. Visualize a locked door with sugar on one side (in your bloodstream), trying to get through (into your cells). Normally you can put a key (insulin) into the lock (insulin receptor) and go right through. But with insulin resistance is it as though someone put chewing gum in the lock! In addition to insulin resistance, a reduction in insulin production and release also occurs in type 2 diabetes. There is still controversy in the medical community regarding which comes first, the chicken or the egg, or in this case insulin resistance or reduced insulin secretion. Regardless the end result is the same: blood sugar that is too high!
What can I do to improve my health with diabetes?
One of the first things I recommend to people with diabetes is to learn about diabetes and understand the condition well. Then focus on all the things you can do at home to improve your health. In the medical literature this is referred to as self-management but I prefer self-care.
Important elements of self-care:
Blood Sugar Monitoring
Why should I exercise?
What if one change would reduce your risk for heart disease, stroke, and cancer, reduce your blood sugar, elevate your mood, improve your self-esteem, make you stronger, and help you feel younger? How much would you pay for it? Sound like a miracle supplement? The supplement is exercise and it can be free.
Everyone with (and without) diabetes should be active and exercise frequently.Exercise is truly a miracle cure. If we go back to the image of the locked door - imagine suddenly new doors without locks emerging on the wall between your blood stream and your cells. This is what happens when you exercise: suddenly your body needs less insulin to move sugar from your blood stream to your tissues.
Everyone with (and without) diabetes should be active and exercise frequently.
All exercise is beneficial, including active work around the house or in the yard, however some people benefit from rigorous aerobic exercise that raises the heart rate. The heart is a muscle and, just like the muscles in your arm, without work the muscle gets lazy. Resistance exercise like strength training is also beneficial and appears to especially improve the way your body lowers blood sugar after you eat.
Tips for activity and exercise
Find activities you enjoy. Spend time to try new classes at local community centers or gyms. Enjoying exercise is critical to staying with it.
Use a personal trainer, physical therapist, exercise physiologist, your doctor, or trained health coach to help design a program that will help you meet your goals- including reducing pain if this is an issue for you- and to keep you on track to reaching your goals.
When you can’t get out to exercise, find ways to stay active. Walking a few blocks to work or to the store, standing instead of sitting, take the stairs instead of the elevator, getting up to stretch and move all count toward activity.
Try to get 30 minutes of exercise per day as a starting goal.
Consider starting a walking club, find a weight training partner or checking out local community centers to build community while getting exercise.
Talk to your employer about starting an exercise program at work or allowing time for exercise in the workday. Many companies are starting exercise at work programs because they are paying a fortune for health insurance for their employees. If your company hasn’t started a program they are behind the times! In the long run, not having an exercise program will cost them more money!
Incorporate exercise at home between innings or at commercial breaks (if you have to watch TV). How many sit-ups can you do in a two-minute commercial break?
What about my diet?
Almost everyone I meet can improve some element of their diet and the New Year is the perfect time to make these changes! There is so much dietary advice available, but what should you believe? What is a carbohydrate anyway? Is plant fat the same as animal fat? What is the glycemic index and should I care? The “best” diet for someone with diabetes is still an area of intense research and therefore the medical community does the best it can to deliver the best advice while making it easy for people to understand. However, the diet plan that works for one person does not work for everyone.
First let’s talk about some basic nutrition:
1. Carbohydrates are one type of basic nutrient. Starchy foods like potatoes, rice and pasta, and also sweet foods like sugar and honey, are high in carbohydrates. Carbs come in two basic varieties: simple and complex. Simple carbohydrates are sugars and refined flours, while complex carbohydrates consist of starches and fiber. Fiber is a special form of carbohydrate because we don’t digest fiber and therefore it binds fat and sugar, slowing or blocking absorption of some fat and carbohydrate from our food. Carbohydrates, except the fibers that we cannot digest, are used in our body for energy and are stored in our liver and muscles for times when food becomes scarce.
2. Protein is another basic nutrient. Animal foods like meat, eggs and cheese are high in protein as are beans, nuts and whole grains. Protein is a building block of our muscle tissue and is required for essentially every biologic process in the human body. Our bodies are designed to also get energy from protein, i.e. we use it for fuel when carbohydrates are limited.
3. Fat is the third basic nutrient. Cooking oils, butter, animal fat on meat. and oils in nuts are typical sources of fat in the diet. Fat has more calories per gram than carbohydrates or protein, which is why fats are to be eaten sparingly.
The mistake most people make with weight loss is they go on a diet rather than fundamentally changing the way they eat.
Recently there has been a lot of attention on both low fat and low carbohydrate diets, but which is better? The answer may not be the same for everyone. Low carbohydrate diets can help with weight loss, but because the carbohydrates in the diet tend to get replaced with fat there is concern that over time the high fat diet will cause heart disease and possibly kidney damage. Low fat diets tend to be higher in carbohydrate, and therefore can cause blood sugar to rise. However recent studies suggest a low-fat vegan (no animal products) diet may be superior to conventional diet advice in diabetes. More research is needed.
So what should you do? The mistake most people make with weight loss is they go on a diet rather than fundamentally changing the way they eat. This is why most people regain the weight they lost very quickly once they stop the diet; they have not made lasting changes and the weight quickly returns. So my recommendation is to make lasting changes by doing the following:
Read labels and eliminate trans or partially hydrogenated oils.
Read labels and eliminate high fructose corn syrup.
Eat 6-8 servings of vegetables and fruit per day.
Learn to prepare whole grains and legumes by buying a Mediterranean diet cookbook or by subscribing to a whole foods cooking magazine (there are a few in print!)
Replace foods in a box with fresh foods purchased in the fresh foods section including the butchery, bakery, produce section, and local markets. Processed foods tend to be higher in salt, fat, and preservatives (can anything that comes in little colored packets really be called food?)
Replace red meat with cold-water fish and lean poultry (i.e. white meat); limit red meat consumption to once every two weeks (start with once a week and then reduce ideally to once a month!)
Replace fried, broiled or oven fried foods with steamed, poached, boiled, or baked foods.
Replace fatty spreads like mayonnaise, butter, and cream cheese with a little olive oil, avocado, or plant-sterol enriched spread.
Eliminate or limit refined sugars like white sugar, brown sugar, and honey
When you buy dairy products, choose low-fat dairy.
Nutrition is not just about food. Nutrition is also about your nourishment- your relationship with food and community. Starting a community potluck or a support group to help make diet changes can be a really helpful way to make diet changes that last - and create new community in the process. Eating is a sensuous experience to be enjoyed and savored with friends and family, adding to the nourishment of your body and your community.
What about my stress?
Some of you are probably thinking this article is causing stress because I am suggesting changes that are difficult to consider making and you are not sure when you will find the time. Time is one of the most stress-inducing elements of our day. Along with money, time moves by us quickly often leaving us feeling like we are left behind. So when we approach a stress management plan, it is important to first reflect on the sources of stress in our lives and visualize making active choices to change our situation.When I am discussing stress reduction with patients, many say they do not have the time. Yet with further questioning they realize they have hidden pockets of time they don’t use well. Stress reduction is not necessarily an activity, but a state of mind. For example, commuting to work in the morning can be a time for stress reduction rather than causing stress. Instead of listening to the traffic report and the world news, classical music or inspirational CDs can be listened to instead. Driving can be a time to focus intention on breathing, being present with yourself and your surroundings - if you make it so!
For people with diabetes, making choices to not exercise, not eat well, or not focus on rest and relaxation may reduce more joyful experiences.
Similarly people spend many hours watching television, playing video games and watching movies. I often ask patients to think critically about these activities and ask themselves whether these activities are really what they enjoy in life. In my conversations with friends, colleagues, and patients, I frequently discuss the joy I receive from my community - sharing food, being outside observing nature, spending time with family sharing stories and memories - these experiences are joyful and bring enrichment to life. Does television bring more of these experiences into life or take them away? For people with diabetes, making choices to not exercise, not eat well, or not focus on rest and relaxation may reduce more joyful experiences.
Take a few moments and think about when you are the happiest. Are these times with friends and family? When you are healthy and full of energy? When you share conversation or experiences with new people? When you feel rewarded for hard work you have done? When you have time to dive deeply into a book or into an activity you enjoy? These times are critical for health in life. Spend time in reflection to find moments in life that are filled with joy. Be present with this joy, let it fill you and then begin to think about how you can make active choices to bring more of it into your life!
Tips for easy stress reduction
Be present. Face decisions one by one when you can do something about them. The mental “hamster wheel” will occupy your thoughts and distract you from important decisions at hand. Try to calm it down by asking yourself if you can change the situation at this very moment. If the answer is no, your mental energy is being wasted on a situation out of your control.
Be mindful. Thinking about how your actions and decisions help or hinder those around you can help reduce tensions and ease decision-making.
Be patient. Urgency is a state-of-mind that can be eased by efficiency.
Spend time in Nature. Nature has lessons to teach all of us. This may sound flaky, yet there is a harmony in nature that we can learn from. Nature regenerates and recovers, adapts and blends, suffers and heals. Flow, harmony and beauty abound in the natural world and it is our choice to be a part of it or separate ourselves from it.
Breathe. An old mantra I teach to patients is “The Mind controls the Body, and the Breath controls the Mind”. Breath is considered the universal life force in some cultures. Filling your lungs and exhaling deeply helps ease anxiety, internal tension, lowers blood pressure, regulates heart rhythm, and increases mental alertness.
Ask for help. Your friends, family, faith community, and health care team can help you by listening and identifying resources in the community. Sometimes life is hard yet there really is no need to shoulder the whole burden yourself.
Self-monitoring of Blood Sugar
How does your body respond?
Knowledge is power. Self-monitoring of your blood sugars leads to knowledge about how different foods, food combinations, exercise, and stress influence your blood sugar. Frequent monitoring helps identify patterns and then gives you power to make changes to improve your health. Combining self-monitoring with a diary of food choices, stress, and exercise can lead to quicker identification of your patterns!
I recommend three daily checks as a minimum including a first morning fasting, two hours after a large meal and right before bedtime. More frequent checking based on your doctor’s recommendations may be necessary especially if you take extra insulin with your meals.
There are elements of our health that we have no control over. Yet in diabetes there are many elements of your health that you control, including your diet, your exercise, your stress management, and your blood sugar monitoring. Altering your diet instead of dieting, identifying and acting on opportunities to be more active, being present in life prioritizing joyful activities, and learning how your choices impact your blood sugar are all achievable steps to bring more wellness into your life, allowing you to bring more wellness into the lives of others. Happy New Year.