Have you been told that you have diabetes or pre-diabetes? Did that news startle you? Scare you? Maybe you know someone who has diabetes with some uncomfortable complications and you are nervous about whether that will happen to you.
Given the standard protocols, it is likely that you have been told that weight loss is the first thing that you need to do to help control your diabetes. It is also likely that you have tried to lose weight in the past, and have been relatively unsuccessful at keeping it off over the years. This may leave you justifiably worried that you won’t be able to follow your doctor’s orders.
Guess what? You can control your diabetes without any focus on your weight!
In fact, it is more helpful to do the proactive things I am going to talk about in this post than it is to just lose weight. Of course, it’s true that some people’s weight does change when they start doing things to help control their blood sugar. But, this is not always the case. Regardless, the point here is to take the focus of the weight as the primary factor. One last note before we start to dig into ACTION, if you are unsure what your diabetes related diagnosis means, please see my post about the basics of diabetes to get oriented.
Here are five simple actions you can take to help manage your diabetes in a balanced way
1. Check your glucose levels regularly!
This can be a pain, literally. Most of us don’t like to poke ourselves several times a day, but doing so can give you a lot of information about your body and how you react to different foods, exercise, stress, etc. Knowing this information gives you a lot of control over your health. Ideally, particularly in the beginning, it is helpful to check your blood glucose in the morning, about an hour and/or two hours after meals (by two hours after a meal, you want to see that your glucose is going down) and before bed.
If you are a information oriented person, this will probably be easy and interested, but it is beneficial for everyone.
Ideal is not always achievable, but checking morning and evening should be bare minimum. Many of us eat similar things daily, so if you can persist for a month or so taking your glucose after meals, often you will start to see patterns around certain foods, or times of day when foods are more or less helpful for keeping your blood glucose lower and more steady.
Information is so powerful!
2. Move your body!
Movement and exercise is a very important component to blood glucose management. Exercise helps our cells become more sensitive to insulin, particularly our muscle cells. Even after we stop exercising, our cells are more able to accept glucose, thus lowering blood sugar levels.
3. Don’t fear food!
Often, an initial reaction to a diagnosis of diabetes is fear, particularly around food. Suddenly, you find yourself terrified to even look at a piece of bread or a pastry. There are a variety of things that will affect your glucose levels and food is only one of them. Eating a variety of foods, including fiber regularly, as well as fat and protein, will help your body slowly digest starches and more simple carbohydrates.
While it is important to be aware of how many carbohydrates (not including low carbohydrate vegetables) you are consuming at any given time, as they can cause peaks in glucose levels, it does not mean that you can never have another piece of cake at a birthday or enjoy some of your favorite foods. It may take some time, but finding peace with foods, and not being scared of them, will actually help your health in general and your diabetes specifically.
4. Focus on other healthy habits!
Stress, lack of sleep, dehydration, inactivity, and dieting can all affect your glucose levels. Now, none of us live in a utopia, but spending time to make sure we are getting enough sleep and water is important. Stress will always be there, but finding ways to manage it can help it not hurt your health. I mentioned how important movement is in the first point, but it is important enough to mention twice!!
Dieting is going to be the first thing that many people go to, because their doctor has told them to lose weight. Dieting, particularly calorie restrictive diets actually can cause more stress on our bodies, which can, in turn, make it more difficult to manage blood glucose levels.
I am going to repeat myself by saying that finding peace with food is incredibly healthful, and healing.
5. Take your medication!
If your doctor has prescribed a medication for you, take it as directed and follow up with your doctor regularly to determine if adjustments need to be made. Diabetic medications are often used to help maintain blood glucose, but to be effective, other behaviors need to be adapted to help them work best.
All of these things can be done regardless of size and regardless of whether or not you lose weight.
It is also important to remember that having diabetes is not your fault. Every one of our bodies have strengths, vulnerabilities, and challenges. This is a challenge for your particular body and you do have control over how you respond by taking care of your precious body. So, give yourself a hug or a pat on the back and remember that.
If you’d like a companion on your path to health, including support in managing diabetes in an realistic way, please visit my practitioner page to learn more about my practice and to schedule an appointment. I look forward to meeting you!
Diabetes is a hot button issue in our society. It can be accompanied by fear, panic and almost always plenty of misunderstanding. For instance, many people are unaware that there are two types of diabetes with different causes, thus different ways of treating them. People are also sometimes misled to believe that eating any sugar or being fat is a contributing cause of diabetes – simply not true. In the next two posts, I will attempt to correct some of these misunderstandings. First…
Here is a quick primer to dispel some of the myths around diabetes.
Diabetes, officially known as diabetes mellitus, which breaks down etymologically as “sweet urine.” Fun fact, they at one time a test for diabetes included tasting someone’s urine. As a doctor, I can say I am glad we have other ways to test for diabetes in contemporary times. The name makes sense, though, since in both types of diabetes mellitus there are high levels of glucose (sugar) in the blood, which then is passed through the kidneys into the urine when it gets too high.
The reasons behind WHY there are high blood glucose levels are what help us determine which type of diabetes a person is working with.
First, some basics. Glucose is the basic form of energy that every cell in our body uses for energy, and the brain prefers to use glucose for energy above anything else, like fatty acids. Glucose is found in every type of food aside from fat and animal protein. It is a very important thing for our bodies to have. It is so important, in fact, that our body has a way to create glucose when we need it.
Our liver can store excess glucose as glycogen and when we have not eaten in a while, for example, when we are asleep, our liver releases some of the glycogen so that our glucose does not get too low. Our bodies like things to stay in certain ranges, not too high, and not too low. Now, for the pancreas, which is a very important part of the glucose regulation process.
The pancreas is an organ that is located on the left side of our abdomen toward the bottom of our rib cage.
It has cells in it, beta islet cells, that produce insulin. Insulin is a hormone that basically provides a key to the cells to let glucose in. Without the key, the glucose cannot get into the cell and the cell doesn’t have energy. If this lasts too long, the body basically starts to starve, even though there is plenty of glucose around. This is the situation in diabetes of both types.
The first type, type 1 diabetes mellitus (DM1) is caused by an autoimmune reaction to the pancreas.
Essentially, the body decides that the beta islet cells are invaders and starts to kill them off! As you can imagine, without those important cells, there is little to no insulin being made. Without the insulin, the glucose does not have a way to get into the cells and the cells start to starve. DM1 is typically diagnosed in children, but it can also be discovered in adults.
In this case, the person will find that they are hungry and thirsty all of the time. They will also find themselves urinating a lot, because their body is trying to get rid of all that extra glucose. They often start to lose significant amounts of weight. If this situation is left untreated it can cause coma and death. Fortunately, it is often caught, and adequate treatment is available. Treatment involves injecting insulin, replacing what the body is not making itself. It is a lifelong condition to manage, and can be a big challenge, but many type 1 diabetics live long, healthy lives.
The second type, type 2 diabetes mellitus (DM2), is caused by a resistance of the cells to insulin.
In this situation, the pancreas is generally working well, but when it tries to use the key to get the glucose into the cells, the lock has been changed. It takes more keys to get the right fit, so insulin and glucose levels can slowly rise over time as the body tries to compensate. It can take years, or even decades for the body to stop being able to compensate well and let glucose levels stay high. This is why the majority of people are diagnosed with DM2 as adults.
Initial treatment often includes lifestyle changes, particularly exercise to increase the body’s sensitivity to insulin.
Also, many people are instructed to lose weight, but research does not back weight loss itself as curative or helpful in the long term for type 2 diabetics. Thin people can also get DM2, and everyone can support the control blood glucose levels through behavior changes and/or medication.
Pre-diabetes is a condition that has become popular to diagnose. What it generally means is that the person’s blood glucose is higher than what is considered normal, but not in the official diabetic range. Pre-diabetes does not mean that one will automatically become diabetic. It does, however, provide an opportunity to focus on behavior changes that will support healthy glucose regulation in the body. Again, in conventional medical scenarios, people are often told to lose weight to manage the situation.
With these important (if a little dry) basics under our belt, we can move on to action! In my next post, I will talk about 5 options to help with glucose control that do not have a weight loss focus. If you’re interested in coming to talk to me about how we can work together to manage your blood glucose levels, please do not hesitate to reach out!
Autumn is in full swing! As we start to spend more time indoors and in close proximity to each other, the chances of getting sick go up. It probably isn’t the best idea to go hang out in the cold rain to avoid the extra contact with germs, so we definitely need turn to other options that can help prevent illness!
The fact is, we are all exposed to a variety of viruses every day. Most of the time, most of us have no problem fighting off a minor viral invasion, our immune systems are incredible. The extra contact with others, rich foods, alcohol, and stress of returning to school and approaching holiday season all have a tendency to reduce our immune system’s ability to fight off illness. These are the perfect reasons to pay attention to the strength of your immune system during the fall and winter.
An easy, and tasty, way to support your immune system is Elderberry
Black Elderberry (Sambucus nigra) and Elder flower have been used historically to support the body in defending against viral illness. It actually helps strengthen the cell membranes of our bodies against viruses, preventing them from multiplying. It also increases the immune function in our bodies so that when we are exposed to viruses, our body is ready to fight them. While having a strong immune system does not mean you will never get sick, it does mean you are less likely to get sick, and more likely to have any sickness be short.
The best thing about elderberry is that it tastes great! Kids and adults alike will have no problem taking this daily during the cold and flu season. It doesn’t have any known side effects, drug interactions, and is safe for kiddos to take. *
I recommend 2 droppers-full of tincture (or glycerine tincture for kids) or a tablespoon of syrup daily during the fall and winter. The tincture or syrup is tasty to take directly, but it can be added to teas or juice. My favorite way to take elderberry is to put it in hot water with some lemon and honey. It is a delicious hot drink and a nice way to wake up on cold mornings, or calm down before going to bed. Dried elderberries can also be delicious, supportive additions to granola, yogurt, or eaten by themselves. You can get this at Watershed, or at most well stocked natural foods stores.
If you do get sick, continue to take the tincture, but increase the frequency to 2 times per day. Also remember to be sure to wash your hands frequently, drink plenty of liquids, rest, and go see your Naturopath!
A reminder for hand washing: No need to use anti-bacterial soap. Regular soap is perfect. The key is to rub your hands together for at least 30 seconds with the soap. Singing “Happy Birthday” is the right amount of time and it is an easy way for kids (and adults) to wash for the right amount of time.
*Note to pregnant women: There has been some research that indicates that the immune system of pregnant woman may overreact to the flu virus, so while elderberry is considered safe during pregnancy, ceasing it’s use if you start to get sick is a good idea to avoid increased overreaction to the flu virus. “Study: Pregnancy Causes Surprising Changes in How the Immune System Responds to the Flu.”
Many of us know the feeling of sadness that can descend when it is dark and grey outside. I grew up in a very sunny place and first experienced this feeling during my second winter in Portland. It was definitely a challenge at first to figure out the best way to deal with the lack of sunlight for so long, but I was told it was possible. I also fully understood what people meant when they talked about Seasonal Affective Disorder, or SAD. It certainly makes one sad, or worse.
If you are like me, you might find yourself wanting to stay home in the evenings, or even on weekends, out of the wind and rain. This is not an unreasonable thing to want to do. Not many of us really enjoy being cold and damp! However, it can serve to isolate during a time when one might already feel sad or isolated.
The fact that there is less sunlight is also a challenge. Our bodies thrive on sunlight. In the PNW, it isn’t just the lack of sunlight that can cause problems, but the angle of the sunlight. The angle is simply not allowing us to get the same benefit from what little sun we do get to see as we would in the summer.
Why does the lack of sunlight affect many of us this way?
Our biological clock and brain chemicals, or neurotransmitters, are very sensitive to sunlight, or the lack thereof. When there is less light, our circadian rhythms can shift causing our internal clock to get out of balance. This can lead to feelings of depression. Also melatonin production is thrown off due to the decrease in light. Our daily schedules have us getting up in the dark and going to bed in the dark. When our melatonin is not being produced properly, it can disrupt our sleeping patterns, making us sleepy or awake at inappropriate times. Additionally, serotonin, a neurotransmitter that lifts our mood, can drop during the winter due to a lack of sunlight.
As you can see, the sun is central to how we feel psychologically. It also can affect how we feel physically, which affects our moods, creating quite a circle of events.
Fear not, however
There are things that you can do during the winter to help reduce the symptoms of SAD. Future articles will spend more time on nutritional, naturopathic, physical, and chinese medicine solutions to the complex of disorders that can emerge during this time of year. I would like to focus on ways that you can support your mood mentally, spiritually, and socially.
One, very simple, option to support your health during this time is to invest in a light box. A light box simulates sunlight and can go a long way toward maintaining all of the brain functions that are affected by sunlight. It is easy to use and makes a big difference in the depression many of us feel during this time.
Another way for many of us to improve our moods is to be around other people. For extroverts, this will feel pretty obvious, but even introverts can benefit from social interaction with one or two close friends. Many of us prefer to stay home out of the cold and wet. If you have a strong support system of people who are going to stay home with you, this is a perfect time to consider doing fun indoor activities together.
Putting together a puzzle, playing games, cooking healthy and warming meals, or even talking to one another can be very supportive. These things will keep your mind engaged. The connections with others doing things you enjoy boosts your neurotransmitters, like serotonin, dopamine, and oxytocin, and improves your mood. If you live alone, or with people you don’t do fun things with, consider setting up meetings between friends to do fun things together. Again, this can be a big group or a small one, depending on your preferences.
Meditation is also a great way to support our brains during the dark time of the year.
Even if you do not have a formal meditation style, simply sitting quietly and taking deep breaths in the morning and evening can help to center your body and mind. Praying or using gratitude lists can also help us focus on positive things and let our brains take a break from feeling icky.
If you already see a counselor or therapist, this time of year is the perfect time to be proactive and make sure you are going regularly to talk. Adding an additional appointment or two to your normal schedule might be helpful. If you do not have someone professional to talk to, it is worth considering.
Talking to a therapist does not mean you are “crazy.” In fact, talking to a professional who can listen and offer helpful suggestions is a great way to handle the challenges we all face in life. When it comes to SAD, a counselor can help you come up with strategies to work through or cope healthily with depressive feelings.
If this is your first experience dealing with SAD, it might be scary and feel beyond your control. Making small changes and being kind to yourself will help you through this first winter. If you have dealt with SAD for years, remember that putting support into place in the summer and early fall is incredibly helpful. It might not in the forefront of your mind when you are floating on the river in the sunlight, but it can make a huge difference when the darkness comes.
Always remember that it is important to reach out to professionals for help when things seem overwhelming. The sunlight will return. I promise.
Almost everyone has heard of the Body Mass Index (BMI). It is one of the common metrics doctors use when judging how healthy we are. Schools calculate it to identify children who are “obese.” You can find it commonly discussed in all kinds of media.
But, what exactly is the BMI and what does it mean to our health?
The BMI is a calculation of height and weight in relation to each other. The calculation is: weight / height². If using metrics (kilogram / meter²) it’s as simple as that. If you’re using English or Imperial measurements (pound / inches²) then you multiply your total by 703.
The range of values is categorized according to particular standards, and labels are given to the resulting categories.
Current guidelines are:
- Underweight <18
- Normal weight 18-25
- Overweight 26-29
- Obese 30+
First calculated by Adolphe Quetelet in 1830, a Belgian mathematician, to try to describe the “average man”, it was meant to be used as a statistical device, not as an individual health indicator.The main thing the BMI does not show is how healthy or unhealthy that person may be. For example, Tom Cruise has a BMI of about 26, in the overweight category, and Sylvester Stallone is considered obese with a BMI of 37. These two stars spend a lot of time and money to stay in shape and healthy – so we need to go beyond BMI to understand health, at least in these cases.
Weight is a combination of fat, bone, muscle, other tissues, and water.
The exact amounts of each are different from person to person and people of very different body compositions may have the same BMI. In other words, three different people may have the same BMI, but they may have different amounts of fat or muscle or be different heights or weights.
According to Linda Bacon in Body Respect, when she investigated why the United States lowered the BMI standards in 1998, in the absence of supporting research, she discovered:
“…that they got a lot of pressure to conform to international standards…the [World Health Organization] relied on the International Obesity Task Force (IOTF) to make the [BMI] recommendations. At the time, the two biggest funders of the IOTF were pharmaceutical companies that had only weight-loss drugs on the market.”
In the research, BMIs in the extreme ranges, very low or very high, are correlated with poorer health outcomes. Clear enough, right? Maybe not! Further analysis shows us that this simple correlation does not mean high BMIs themselves are the cause of poor health outcomes. Fitness, for instance, is a huge indicator of positive health outcomes, regardless of BMI.
The fact that we continue to use BMI to gauge individual health is a travesty. Health outcomes would improve significantly if BMI was completely thrown out and a weight-neutral emphasis on healthy habits was employed by health professionals. This is one of the reasons I practice Health at Every Size®. In my practice, I’ve learned that focusing on healthy habits has a much greater chance of creating states of wellness than intense focus on weight loss.
Many of us are concerned about our weight. We have tried diets, lifestyle changes, exercise, pills, and surgery, yet we don’t lose weight and keep it off.
Why is that?
It is because of something called a weight set point.
Our weight set point is the weight range that our bodies gravitate to in optimal conditions, usually a 10-20lb range. This set point is just like our temperature, our bodies try to maintain that weight fiercely. Studies have shown that when significant weight is lost, the body slows down our metabolism to conserve energy and when significant weight is gained, the body speeds up metabolism to use energy.
As a side note, there are different health conditions that can significantly affect weight, and likely the weight set point as well, but they will not be addressed in this article.
There are different factors that go into our weight set points.
Genetics can be significant, but environmental factors, prenatal environment, and others also have an influence. Generally, attempts to change the weight set point are ineffective. Around 5-10% of people seem to be able to change their weight significantly, though it is uncertain whether their set point has changed or if they are returning to a set point. Regardless, a change in weight beyond the set point is very difficult to maintain long term.
But all is not lost! If a weight change is desirable, there is good news and bad news.
The bad news? We don’t really know how to change set point permanently
Doctors, researchers, and others involved in the issue have been trying to get to the bottom of this for decades and have been largely unsuccessful. In fact, importantly, it seems that our set points inch upward the more we weight cycle and diet! That yo-yo dieting really is causing more problems than it is solving.
The good news? If you turn your focus to healthy habits, you can get healthier, whether or not your weight changes!
Healthy habits are definitely within our control. Eating foods that nourish our bodies, moving in ways that make our bodies feel good, getting sufficient, quality sleep, solid social support, and reduced stress are just some of the things that we can do to support our health.
It is important for our physical and mental health to shift our focus away from the scale or tape measure and work with our bodies, not against them. Healthy bodies will maintain a stable weight, and normal bodies come in a range of shapes and sizes. Healthy does not always equal “thin,” though our media culture obviously sends some different messages…
To learn more about my approach to healthy weight, you might want to take a look at my article about the Health at Every Size approach to healthcare. If you’re ready to implement a perspective like this, get on my schedule – I’m excited to work with you to find a healthy balance.
My biggest passion in medicine is definitely being an advocate for Health at Every Size® (HAES®), and generally looking at
health in a weight neutral way. I am so passionate about it this because I have observed that using weight loss as a goal actually creates a lower state of health and, ironically, more weight gain!
The reality is that using weight loss as the only goal enters people into an unhealthy cycle of weight loss and weight regain. This cycle can lead to poorer health in general, which, in turn, is blamed on the fatness, lack of willpower, or laziness.
I often hear:
“The idea of Health at Every Size® is great! Except if someone is very fat or very thin. Then, that person definitely needs to change their weight significantly to be healthy.”
“Health at Every Size® is great…except for me, because I need to lose a lot of weight to feel good in my body.”
I also hear:
“I know this fat/skinny person who is really unhealthy…so HAES® doesn’t work.”
Here’s the thing about Health at Every Size®: it does not mean that everyone of every size IS healthy. It simply means that healthy habits can lead to good health, regardless of body size.
I’d like to share the basic tenets of HAES. Maybe this will help debunk some of these myths I so frequently hear. They are:
- Eating in a flexible manner that values pleasure and honors internal cues of hunger, satiety, and appetite.
- Finding the joy in moving one’s body and becoming more physically vital.
- Accepting and respecting the natural diversity of body sizes and shapes.
Generally, healthy habits include what many people would consider lifestyle changes. These include moderate exercise, eating a variety of foods that include plenty of fruits and vegetables, staying well hydrated, reducing stress, getting sufficient sleep, and engaging in supportive, healthy relationships.
These are just a few things that have been shown to support health, regardless of weight change. In fact, according to a study published in the Journal of Nutrition, people who focus on healthy habits (as opposed to mere weight loss) continue those habits over the long term and, thus, have improved health outcomes. Those who focused more purely on weight loss may stop their habits when weight loss slows, stops or reverses.
To be clear, the decision to pursue, or not pursue, weight loss , or even health, is an individual decision.
That said, it does help to know as many of the facts as possible to make the most educated health decisions, regardless of your current weight. I hope to share more about HAES on the blog, as well as in events at Watershed. If you’re interested in learning more about those events, you can join us on Facebook, or check our Schedulicity class calendar (just log in as if you are making an appointment, and you can browse available events).
Always feel free to reach out to me by email!
As the seasons change, our immune systems can be taxed by allergies, increased stress as we start doing more activities, and less sleep as the sun stays up longer each day. It is important to support our immune system so that we can fully enjoy the beautiful weather.
Here are six simple ways to support the immune system:
1. Incorporate garlic and onions in to your meals
Garlic and onions (part of the alium family) provide antimicrobial and immune support. They are delicious in a variety of dishes as well! One of my favorite ways to eat raw garlic is in guacamole.
2. Plenty of fruits and veggies
In the spring and summer, it becomes much easier to find fresh, inexpensive fruits and vegetables, particularly at farmers markets, which are often local as well. Frozen fruits and veggies are also great options as they are usually frozen shortly after being harvested. Fruits and vegetables provide a variety of vitamins and minerals that keep our bodies healthy and able to fend off all sorts of minor illnesses.
The sun is finally starting to come out regularly here in the Pacific Northwest and many of us naturally want to head outside. The vitamin D we get from sun exposure is very important to a variety of bodily functions, particularly the immune system. If you are spending a long time in the sun, be sure to use a high quality sunscreen, however short periods of time in the sun (10-15 minutes) can be enjoyed without sunscreen and allow our bodies to produce vitamin D.
4. Sufficient sleep
With that lovely sun lasting longer each day, we sometimes let our sleep schedules get thrown off. Making sure that you have a cool, dark room to sleep in, with few electronics, is an important part of getting good sleep. When your body is well rested, your immune system, like your brain, is at it’s best.
5. Reduce stress
Spring and summer can be full of fun, with hiking, boating, parties, etc taking up much of our time. Most of us still have work responsibilities and also may have children at home more often than normal. All of this can be a lot of fun, but it can also add a great deal of stress. Finding ways to relax and manage your stress is important. This can include just about anything that you personally find relaxing.
6. Hydrotherapy and Herbs
Hydrotherapy, such as warming socks, has been a staple for immune support and the resolution of mild illness for centuries. Herbs, such as echinacea, eleutherococcus, and ginseng, have also long been used to support the immune system before and during illnesses. Naturopathic doctors are great resources for these therapies.