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Diabetes Management

Diabetes Diet

Losing Weight the Easy Way

With all the attention this week being given to the FDA’s review concerning heart problems connected with Avandia, one of the major diabetes drugs, you may have missed the bad news for what could have been the first new prescription drug for obesity in more than a decade. Another FDA advisory panel voted against Qnexa, which Vivus Inc. developed.

In year-long clinical trials people who took the highest dose of Qnexa averaged a 10.6 percent weight loss. Those taking a placebo lost 1.7 percent of their body weight.

Unfortunately for Vivus and for people who want to lose weight, the side effects of Qnexa outweighed its benefits in the minds of most of the FDA’s panel members. These weren’t niggling concerns. They include the possibility that people taking Qnexa would be depressed and think suicidal thoughts, have their memory and concentration impaired, be at greater risk of kidneys stones, and could suffer from heart problems.

If the FDA still approves Qnexa in spite of the panel’s recommendation against it, this could be the easy way for the great majority of people with diabetes to lose the 10 percent of our weight that our doctors have told us that we need to do. Almost everyone who has type 2 diabetes is overweight. Our government’s statistics show that 85 percent of all American adults with diabetes are overweight.

If an effective weight loss drug is no longer an option for us, we could be left with our own resources. Still, I know that drugs we already have to control our blood glucose can also help some of us with type 2 diabetes to lose weight. I lost a lot of weight by taking Byetta, and friends of mine are achieving weight loss success with Victoza.

But since all drugs carry with them the risk of side effects, which is the FDA’s biggest concern, many of us would like to be taking as few drugs as possible. We can’t do it with with willpower alone, as Gina Kolata emphasizes in her book Rethinking Thin.

In 2007 I decided to do without drugs entirely and yet I lost even more weight. The strategy that I adopted was the only proven way, a very low-carb diet, very much like the one that Dr. Richard K. Bernstein has himself followed for years and has taught successfully to thousands of his patients with diabetes. By following the recommendations in his
book, Dr. Bernstein’s Diabetes Solution, I was able to bring my weight down from 170, when I started low-carbing in December 2007 to 151 last October.

But this year has been murder for my weight. In all my traveling since February I lost control. While I had no problem staying on a very low-carb diet, I ate too much fat and protein when eating out and wasn’t able to reliably check my weight on a daily basis so that I could immediate take corrective action. Consequently, my weight crept up as
high as 169 a few months ago.

Only by carefully watching what I eat and weighing myself every morning have I been able to start bringing it back down to where I am more healthy, feel better, and my clothes fit. Today my weight is down to 162, but I still have a way to go to reach my ultimate weight goal of 155.

I know that I’ll do it. I also know that we still don’t have any easy way to lose weight and to keep it off.

This article is based on an earlier version of my article published by HealthCentral.

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Diabetes Diet

Water Everywhere

It is especially important for those of us who have diabetes to drink a lot of water, as unexciting as it is compared with all the other beverages that we have available. So I do my best to make it a bit more exciting.

For starters, I filter all my tap water, even though Boulder, Colorado, where I live, has perhaps the highest rated water supply in the country. We are, after all, the only American city that owns its own glacier, and because it is melting so fast we have a lot of runoff!

Then, I keep a couple of canteens in the fridge all the time. Cold water tastes better to me, perhaps because it reminds me of drinking out of cool mountain streams, something that I could do when I was a kid.

Now, I often drink carbonated water. For years I bought plastic (and sometimes glass) bottles of the stuff at supermarkets. I tried all the brands of sparkling water and finally found one that I really like, Germany’s Gerolsteiner, and available only in high end markets, like Whole Foods. I dislike the most common brand available in restaurants, San Pellegrino.

But I got tired of the expense and trouble of carting cases of the stuff home every week and of the landfill waste. So, with the encouragement of one of my correspondents I invested in a device that carbonates my own water. A company called SodaStream makes it and delivers a new cartridge every couple of months when I need one. The water that it carbonates tastes every bit as good as the bottled stuff without all the disadvantages that that stuff has.

I drink it straight — as I am at the moment. Or I make sparkling lemonade with TrueLemon and stevia for a total of zero calories.

We can also flavor carbonated water with lots of different flavors. The SodaStream device comes with samples of many flavors, and the calorie-free ones include orange, berry, lemon-lime, diet root beer, diet pink grapefruit, and diet cranberry-raspberry. Another possibility are the many DaVinci flavors.

I just make sure to cut off my water supply by dinner time. I already make enough trips to the bathroom at night.

Drinking a lot water is the single diet recommendation that all the health experts agree on. They do differ on the amount that they recommend.

Loren Cordain, professor of exercise physiology at Colorado State University in Ft. Collins, Colorado, and the author of the important book, The Paleo Diet, points out that our paleolithic ancestors drank nothing but water. While paleolithic sounds like it was a long time ago, it was only about 10,000 years before now — the time just before the agricultural revolution — and that’s a blink of an eye in terms of human evolution.

Barry Popkin, professor of nutrition at the University of North Carolina at Chapel Hill, and the author of The World is Fat, emphatically recommends that we drink nothing but water. And lots of it.

But it isn’t true that the U.S. government recommends drinking at least eight glasses of water a day. That is an old urban myth, as I wrote in my first book What Makes My Blood Glucose Levels Go Up…and Down? Dr. Jennie Brand-Miller, Kaye Foster-Powell, and I co-authored this book together to explain the glycemic index, and the water section was one that I wrote.

When we are thirsty, water remains our best choice. Even when we are hungry, having a drink of water is a great idea. It can help us feel fuller and therefore make us less likely to overeat. This goes a long way toward keeping our blood glucose levels where we want them to be.

This article is based on an earlier version of my article published by HealthCentral.

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Psychosocial

True Immortals

A few days ago I received a rather unusual compliment, sent in an unusual way. True Immortals has got to be science fiction, but presents itself as being real. At least I think that it has to be science fiction.

The apparent narrator, supposedly named Glenn, admitted on a post earlier this month that he has diabetes. “That means it’s hard to keep my blood sugar under control, even with nine kinds of medication,” Glenn says. “I’ve had it since I was little, and it’s taken its toll. At the bottom of my mind there’s a hope that if we make contact with immortals we’ll discover some way not to die.”

Meanwhile, Glenn is doing everything he can to manage his diabetes. “I work with an endocrinologist, a cardiologist and a renal specialist, and I also see a holistic doctor and use supplements.” And he exercises.

But it was Glenn’s next sentence that really grabbed my attention. “I read mendosa.com like it was the Bible.”

“Because I do all this, I’ve held up longer than my specialists expected.” Now Glenn is worried that he won’t life long enough until “we learn how to overcome disease and death and stay healthy forever.”

A big part of me wonders if Glenn and the other people who believe that we can live forever are overly optimist. The other part of me believes that we can never be too optimistic. Better to think positive thoughts like those people who believe in immortality on earth than to wallow in negativity.

Maybe those who believe in true immortality are irrational. But my guess is that they will live longer than the naysayers among us, all the while taking better care of their bodies and having a happier life, no matter how short or long it is.

This article is based on an earlier version of my article published by HealthCentral.

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Psychosocial

Natural Vitality

“Often when we feel depleted, we reach for a cup of coffee,” says Dr. Richard Ryan, a professor of psychology at the University of Rochester, “but research suggests a better way to get energized is to connect with nature.”

He is the lead author of a series of studies that the Journal of Environmental Psychology just published in this June 2010 issue. I asked him to send me a PDF of the full-text of his research report, “Vitalizing effects of being outdoors and in nature,” and he did. You can find the abstract online.

Instead of coffee, I restore my energy by going out for a hike. In fact, one of the most popular parts of my website is my blog of photo essays, “Fitness and Photography for Fun.”

Certainly, physical activity makes us feel better. Staying fit is indeed one of the four legs that those of us with diabetes have to keep our blood glucose levels down in the normal range (the other three legs are diet, reducing stress and inflammation, and usually taking oral medication or insulin).

Over the years I have written many articles extolling the benefits of exercise. Some of those articles say how much better I feel after going out for a hike.


Nature This Morning

That’s all true. But these new studies for the first time have teased out the effects of being out in nature alone from the feel-good effects that we get from physical activity and from the socializing that we often get at the same time.

Dr. Ryan and his co-authors were able to separate out the effects of nature alone. To do so they conducted five separate experiments with 537 of the usual suspects — college students.

What they found was so clear, Dr. Ryan says, that “being outside in nature for just 20 minutes in a day was enough to significantly boost vitality levels.” The Journal of Environmental Psychology article defines vitality as having physical and mental energy giving us a sense of enthusiasm, aliveness, and energy.

When we have a greater sense of vitality we not only have more energy to do the things that we want to do but were are also more resilient to physical illnesses. “One of the pathways to health may be to spend more time in natural settings,” he says.

I’m not knocking physical activity. Most of us who have diabetes need to get up and out a lot more. If you aren’t getting out yet, this beautiful late spring weather is a great time to start. I’m saying that getting our physical activity outdoors in nature gives us two for the price of one.

This article is based on an earlier version of my article published by HealthCentral.

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Diabetes Basics

Are You a Noncompliant Diabetic?

Does it make you angry by my asking if you are a noncompliant diabetic? I didn’t mean to do that by asking you that in the title of this essay. I just wanted to grab your attention.

Getting angry is as unproductive as called us noncompliant or a diabetic. In fact, a new study in Hormones and Behavior shows that when we get angry, our heart rate and arterial tension increase along with other psychobiological changes. So please relax and read on.

No doctor ever dared call me noncompliant, but plenty have labeled me a diabetic. Those terms don’t make me angry — any more. But I don’t like them at all and am doing my best to stomp them out.

As a writer, words are important to me. As a positive person I try my best to avoid these “negative cues.”

This morning a friend mentioned another negative cue that health professionals sometimes use to describe the way we lead our lives. I hadn’t thought of this before, and that conversation is what prompted this essay.

“How are you managing your diabetes?” is the common clinical phrase that they throw at us. While to speak of managing doesn’t appear negative on its face, it really is. It focuses on our burden.

Likewise, I talk all the time about controlling diabetes. I’m now going to try to stop doing that.

The positive way to ask the question is whether we are living our lives boldly and fully. That’s a lot more than a dry, narrow emphasis on management or control.

Six years ago I first wrote about these and other “incorrect diabetes terms” at www.mendosa.com/incorrect_terms.htm in an article with that title. I wrote there that many people who have diabetes actively resist being labeled as a diabetic, as if we were an illness. A correspondent writes, “What I give as an example to doctors and other technical people is: If a person has hemorrhoids, does that make that person one?”

If you have diabetes but aren’t a diabetic or a hemorrhoid, I think that you might enjoy exploring my earlier article about the other words and phrases that our language would be better off without.

This article is based on an earlier version of my article published by HealthCentral.

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Diabetes Diet, Exercise For Diabetes

Weight Control Registry

The National Weight Control Registry is the best guide we have showing us how people actually lose weight and keep it off. These are the people who have succeeded in a major weight loss program and in keeping off the pounds.

Diabetes doctors typically tell us to loose 10 percent of our body weight. I know from my own experience that this helps to control our blood glucose level. And I know too that getting down to a normal body mass index, or BMI, is even better for maintaining a low A1C level.

The National Weight Control Registry started in 1994 and now tracks more than 5,000 people. And because I am one of them, the people at the registry sent me a copy of a publication that summarizes their findings as thanks for returning a one-year questionnaire. The article, “Long-term weight loss maintenance,” appeared in the American Journal of Clinical Nutrition.

To be included in the registry, people have to be at least 18 and have kept off at least 30 pounds for a year or more. I reached that milestone four years ago. And a couple of years ago my friend Gretchen Becker encouraged me to share my results with the registry.

I haven’t seen any statistics about how many of the people included in the registry have diabetes. But I know that my weight loss strategies have been different from most. Using Byetta got me started with my weight loss program, and a very low-carb diet intensified it.

Most people, however, say that they have lost weight by following a low-calorie, low-fat diet. Without question, weight loss means a low-calorie diet. Almost certainly, following a diet of any sort is also a key to success. In fact, participants who maintained a consistent diet during the week and year after year were much more likely to maintain their weight than those who varied their approach.

Other keys include:

Eating breakfast every day, followed by 78 percent of registry members.

High levels of physical activity. Fully 94 percent report that they get more exercise now than they did before they lost weight, and 90 percent report that on the average they exercise an hour a day. Walking is the most common activity, reported by 78 percent of the participants.

Regular weighing. More than 44 percent report that they weigh themselves at least once a day.

I know from my own experience that when my scales broke in February just before I went on a long trip that not weighing myself regularly was disastrous for my weight. In a three-month period I gained 12 pounds and am now fighting to take them off.

The really good news is that it gets easier. People who successfully maintained their weight loss for two to five years had a much greater chance of long-term success.

This article is based on an earlier version of my article published by HealthCentral.

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