Tag Archives: Obesity

Most Mainers at risk for, or has diabetes

Does 48% scare you? Those are some pretty good bettin’ odds. That’s better than the overall odds at winning in Blackjack. The 2014 CDC data found 37% of Maine residents have prediabetes. Over 11% or 137,413 have diabetes and 36,000 of those people don’t even know they have it. Now that is really scary. How can people live with the common symptoms of uncontrolled blood sugars like yeast infections, extreme fatigue, erectile dysfunction, thirst and peeing all the time without going to their medical provider and complaining? Do people with these symptoms really think that life can’t get any better than that?

Metabolic Syndrome or Prediabetes- Reversible

metabolic syndromePrediabetes goes by several different names:  Metabolic syndrome, Syndrome X, and impaired fasting glucose are all names used for prediabetes. If you have central obesity, high blood pressure and unhealthy cholesterol, there’s a good chance you are on the road to diabetes. More specifically, if you have 3 of the 5 conditions to the left, you have prediabetes. Those odds of developing Type 2 diabetes are even greater if you have a family history of diabetes, had gestational diabetes, are older or are African-American, Hispanic, Asian, Alaska native, or Native American. You can see why the odds go up with each factor.  And just to clarify, type 1 and type 2 diabetes are really two different diseases with different causes. Type 1 diabetes is an autoimmune disease associated with sudden changes in insulin production whose cause is not associated with lifestyle changes. Type 2 diabetes is a preventable disease. You can learn about your odds here and talk to your healthcare provider.

A Prediabetes Diagnosis Should Imply A Sense of Urgency

Once prediabetes becomes diabetes, the insulin producing beta cells of the pancreas quit working – some say as much as 50%. When the pancreas can’t meet the needs of the body not only do blood sugars rise, but other metabolic changes occur, particularly with fat metabolism. The higher blood sugars and lipid levels damage the blood vessels of the body. That’s why diabetes is really heart disease with a sugar problem. Complications of poorly managed diabetes are a result of nerve and vascular damage leading to blindness, stroke, heart disease, kidney failure, and amputation. These severe complications happen over time with earlier patient reported symptoms of depression, nerve pain in the extremities, frequent infections, sexual difficulty and a change in quality of life.

Let’s Stop Diabetes

Diabetes costs Mainers $1.6 billion every year. The costs are for treatment of severe complications like hospitalizations for heart disease and stroke, amputations and prosthetics, surgery to prevent blindness and dialysis. Wouldn’t it be wonderful if we could shift that money from end-of-life treatment to early detection, education and support?

Our healthcare system is changing. Where fee-for-service was the standard of care, outcome-based results is now the gold standard. Our health care system is now a team of medical providers, nurse practitioners, physician assistants, population health nurses and medical assistants all with the aid of health informatics and data analysis. Healthcare is doing a much better job with managing chronic disease but is still weak on prevention. There is not a financial incentive yet to focus on that. The days of our medical provider being the sole conductor of our healthcare are over.  The new reality is that we need to play a proactive role in our own health.  Blood sugar levels often get overlooked. There were many times in my previous job when patients saw me for health education, unaware that they had prediabetes or diabetes. Things do get missed.

What You Must Do

Prediabetes develops over time. Blood sugar levels rise over many years and don’t suddenly hit the 100 mg/dl threshold. When I first became a certified diabetes educator the level was at 110 mg/dl, but lowering it provided earlier intervention.  Everyone should have a fasting blood glucose level done annually, especially if they have a family history of diabetes, are sedentary or overweight. And once it is done, get the results and know the significance of those results. There is support if you need it!

Barbara is a certified diabetes educator and health coach. She would love to help with any health questions and can be reached through her facebook page.

Breaking The Weight Barrier: Set Point

Set PointHave you lost weight in the past only to regain all of it and perhaps a bit more?  You are not alone, most dieters regain their weight.  Our body has a genetically determined set point for weight it wants to maintain.  The Set Point for weight is an internal physiological system.  It involves hormones that work on the brain to regulate hunger and satiation.

The Physiological Feedback Loop

Leptin is a protein made by fat cells that signals the brain that the body is full.  Along with insulin, another hormone released when we eat, our body has a physiological mechanism for maintaining weight homeostasis or set point.  According to ObesityAction.org, we have a body fat thermostat that influences our appetite.  When weight goes up, more insulin and leptin are released, reducing appetite.  When weight goes down, insulin and leptin levels decrease, increasing appetite.  A gradual weight gain over time can raise the set point making it difficult to lose weight, especially when one feels constantly hungry.

In a WebMD interview with Robert Lustig, MD, a member of the Endocrine Society’s Obesity Task Force, he states that “Leptin is the way your fat cells tell your brain that your energy thermostat is set right”.   He goes on to say that with obesity, despite the high levels of leptin, the brain does not get the message to slow down eating.  He talks about the brain thinking it is in a “starvation mode” because it is not getting the leptin message:

 “The leptin is being made by the fat cells, the fat cells are trying to tell the brain, ‘Hey, I don’t need to eat so much,’ but the brain can’t get the signal. You feel hungrier and the reward doesn’t get extinguished. It only gets fostered, and so you eat more and you keep going and it becomes a vicious cycle. If your brain can’t see the leptin signal, you’re going to get obese.”

Lustig calls this “leptin resistance” and believes that it is caused by insulin resistance:  impaired ability for the body to recognize insulin.  He believes the best way to address insulin resistance is to not let insulin levels get high in the first place, by reducing sugar intake.

Resetting The Set Point

Dr George Blackburn, Associate Director of the Division of Nutrition at Harvard Medical School, discusses in his book, Breaking Through The Set Point:  How To Finally Lose The Weight You Want And Keep It Off, how to lower one’s set point.  Based on Set Point theory developed by Bennett and Gurin, Blackburn recommends a combination of physical activity and dietary changes.  He believes that people should lose weight gradually and maintain it for at least six months in order to reset their set point.  He has observed that rapid weight loss results in rapid weight gain.  He also observes that after someone has lost 10% of their weight, the body starts to conserve calories.  He has found that if someone can maintain the weight loss for six months, the set point will be reset and more weight can be lost if desired.

Looking At What Works

The National Weight Control Registry, a registry that tracks individuals who have lost 30 pounds or more and have kept it off for a year, lists common behavior patterns.  94% of these individuals increased their physical activity with 90% of them exercising for an hour on average a day.  98% have changed their eating habits eating a lower calorie, lower fat diet and 78% eat breakfast daily.  You can read more individual success stories here.

Making Sustainable Lifestyle Changes

Although dieting can get someone into that bikini quickly, I believe finding a broader purpose for losing weight is going to give more lasting motivation and sustainable results.  Excess weight tends to creep on over many years, so it should come off gradually – no more than a half pound or pound a week.  I believe the focus should be on getting healthy, not losing weight which connotes something negative about the process.  Personally, I believe in finding a daily exercise plan that can work throughout the seasons whether it’s walking outside, having personal equipment or videos, or going to the gym.  I believe in eating a diet high in fruits, vegetables, lean protein and no refined grains or processed food.  I believe it requires looking at habits and finding good substitutes for unhealthy habits.  I believe it’s making small permanent changes at a pace that seems natural and interesting.  I believe it starts with an attitude of curiosity and adventure, that ends with better health and satisfaction.

Barbara writes a biweekly blog to help inform and empower people to live healthy lives.  Please “share” her articles and “like” her facebook page to help spread the word

It’s About Inflammation, Not Your Weight!

We are our own harshest critics when it comes to our weight.   Appearance is usually the motivator for losing weight, but often times that is not enough to make the weight loss stick.  There is a stronger motivator but it is not as visible.  Shifting the focus from weight to the burning fire within your body is the best reason and the one that will give you the greatest payback.

Testing For Inflammation

What if your focus is on reducing the slow burning up of our body by inflammation?  This is what leads to the slow destruction of our organs and interferes with our ability to function at our best. fire It leads to chronic disease like heart disease, diabetes, dementia, depression and cancer.  Even though we may not “feel” inflammation, there is a strong likelihood that it is there if any of these diseases are present.  It can be tested for by checking C-reactive protein (CRP) in the blood.  Generally there is no CRP in the blood.  The presence of CRP is an indication that you have inflammation.  This is not a routine test because it is not disease specific and can lead to a plethora of further testing to identify the source of inflammation. There is also a more sensitive test, the high-sensitivity c-reactive protein or hs-CRP that can be done to test specifically for heart disease.  Results greater than 3 mg/L indicate high risk for cardiovascular disease.

Instead of going through the expensive testing assume that if you are obese with a BMI greater than 30, are feeling tired, are not getting adequate sleep, are being treated for heart disease, diabetes, high cholesterol, GERD or depression, there is a strong likelihood that there is inflammation.  How about making small changes that can smother the burn, soothe your organs and restore your energy?

Smothering the Burn of Inflammation

Instead of focusing on the scale, make your goal smothering the fire.  Let’s break it down into actions you can take starting tomorrow.

  1. Walk for 10 minutes several times every day.  Walk fast enough to breath a little hard and swing your arms.  Doing this for ten minutes after a meal can diminish the rise in blood sugars and insulin levels that often occur after eating.  Large swings in blood sugars and insulin levels can lead to weight gain.
  2. Take the stairs whenever you have a chance.  No more elevators unless it’s greater than three floors.
  3. Set a sleep schedule time and get a minimum of seven hours of sleep.  We know adequate sleep helps fat metabolism.  Too much fat, especially around the belly, is the fuel for inflammation.
  4. Avoid toxins from things like mercury (choose low mercury fish from below), excessive alcohol, and pesticides.
  5. Eliminate allergens that may be contributing to asthma and bowel disorders.  Lactose and wheat are fairly common ones.
  6. Eat fewer processed foods and whole fat dairy that are full of the inflammatory-causing trans and saturated fats.
  7. Eat more high Omega 3 foods:
  • Fish – particularly sardines, striped bass, wild salmon, herring and anchovies.
  • Eat two tbsp. of ground flax seed daily.  You can put it in hot cereal (after cooking), add it to sauces or put it in a smoothie.
  • Eat two tbsp. of walnuts daily- this makes a perfect topping for oatmeal or yogurt.
  • Eat one serving of either Brussels sprouts, kale, spinach and watercress daily.

8.  Eat more foods high in antioxidants like kidney and pinto beans, berries-especially blue berries, and artichoke hearts.

Try gradually adding these actions to your daily routine, be mindful of your energy level and see what wonderful things will happen one month from now.  Instead of your body burning up, your body and mind will be more stable and alert and you will notice some of those clothes fitting much better as a byproduct without even focusing on your weight!