Tag Archives: obesity

Diabetes 101: What you need to know for American Diabetes Month.

Diabetes is among the fastest-growing health conditions in the United States. Over 30 million adults have diabetes, with 1.5 million new cases each year. If you include prediabetes, which tends to lead to diabetes if untreated, over 115 million Americans are affected. Fortunately, most cases of diabetes can be treated or prevented through healthy eating, weight control, and regular exercise.

Since November is American Diabetes Month, this seems like a good time to raise awareness about the prevention, treatment, and consequences of this serious medical condition.  If you want to learn more about diabetes, a great place to start is American Diabetes Association. This is also the topic of my Health & Fitness column in the Aiken Standard this week.

diabetes


Diabetes mellitus is a metabolic disorder characterized by high blood glucose (sugar) caused by a lack of insulin production or impaired insulin action. The lack of insulin production can be caused by an autoimmune disorder that damages the pancreas. This typically occurs during childhood, as in type 1 or “juvenile” diabetes, but it can occur in adults, a condition called latent autoimmune diabetes of adulthood (LADA). For both types, injected insulin is required to control blood glucose.

More commonly, diabetes is caused by the body’s cells not responding to the insulin that is produced, a condition called insulin resistance. This is called type 2 diabetes and is thought to be caused by some combination of obesity, particularly excess abdominal fat, and physical inactivity.

Diabetes can be diagnosed based on a fasting blood glucose test, taken 8–12 hours after a meal, usually in the morning. Another test is an oral glucose tolerance test in which blood glucose is measured for two hours after drinking a special beverage containing glucose. This measures the body’s response to glucose. The hemoglobin A1C test is a long-term measure of blood glucose control. This is important because the higher the hemoglobin A1C level, the greater the risk of diabetes complications.

For most diabetics, the main treatment goal is to control blood glucose level to prevent serious complications including nerve damage, blindness, infection and amputation, heart attack, and stroke. This is typically accomplished through a combination of diet, exercise, and medications, with varying degrees of success. But “curing” diabetes is rare, so most patients require continued treatment.

Exercise is important for blood glucose control because exercise causes an increase in the uptake of glucose into cells and can improve glucose tolerance and insulin sensitivity. In addition, exercise has the added benefits of promoting weight loss and improving strength and fitness. Both aerobic and strength training are recommended, with a minimum goal of 30 minutes per day, every day.

Meal planning involves selecting healthy foods to help maintain consistent blood glucose levels while meeting energy needs for exercise and other activities. The dietary recommendations for preventing and treating diabetes are almost identical to the general recommendations for good health: Emphasize whole grains, fruits, vegetables, legumes, and low-fat meat and dairy and reduce unhealthy fats, added sugars, and salt. The diet should also promote weight loss and weight maintenance, especially for overweight patients. The glycemic index (GI), a measure of how much a food raises blood glucose, can be helpful in dietary planning, but it is not the only meal planning tool that should be used.

Proper diet, blood glucose testing, medication use, and regular exercise can improve blood glucose control, reduce the risk of other health problems, and improve quality of life in diabetics. In those with prediabetes these efforts can delay the progression to diabetes and may even result in a return to normal blood glucose. In fact, diet and exercise have been shown to be more effective than medications in preventing diabetes. Plus, these lifestyle changes lead to weight loss and improved fitness, benefits that no medication can match.


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Fat: More than skin deep

Everyone knows that fat is where the extra calories you eat end up and the reason your clothes fit too tightly. Body fat, or adipose tissue, is an efficient way to store excess energy. When you eat more calories than you expend, the extra energy can be stored as fat. Body fat is essential for storing extra energy, something that allowed our caveman ancestors to survive times when food was scarce. Beyond simply storing energy, research also shows that fat plays an active role in health and disease. This is the topic of my Health & Fitness column in the Aiken Standard this week.

waist circumference


Some fat is stored beneath your skin, which you can feel when you “pinch an inch.” This is called subcutaneous fat, and it is what most people think about when they think of body fat. It is also the fat that people see change when they gain or lose weight. But you also store fat in other places in your body, which can have important health effects.

Subcutaneous fat is stored between the skin and muscle and may or may not be distributed evenly throughout the body. Some people tend to store fat in their hips and thighs while others store it in their upper body. Much of this is determined by genetics, which also influences where fat is lost during weight loss.

Fat is also stored beneath the muscle wall in the abdomen. This is called visceral fat because it surrounds the intestines and other internal organs. Visceral fat is known to be associated with a greater risk for diabetes, high blood pressure, and heart disease than subcutaneous fat. This is in part due to the chemical signals called adipokines that are released from visceral fat and have effects on other organs and tissues resulting in insulin resistance and inflammation.

A simple way to tell if you have excess visceral fat is to measure your waist circumference. If it is greater than 36” for females or 40” for males, you are at risk. This is especially true if you aren’t able to pinch much fat around your waist, which suggests you have less subcutaneous fat and more visceral fat. Keep in mind that this isn’t foolproof, and a high waist circumference doesn’t always mean excess visceral fat, but it’s a good indicator.

Fat can also accumulate inside the liver, a condition is called fatty liver disease. You might expect this to be the result of eating too much fat in your diet, but a more common cause is too much sugar. When you eat excessive amounts of sugar, the liver can turn it into fat. This is especially true if the sugar is fructose, which is found in many artificially sweetened foods and beverages as high fructose corn syrup. When the liver converts fructose to fat it damages the liver and can lead to inflammation, cirrhosis, and liver failure.

The bottom line is that excess fat anywhere is unhealthy, but some forms of fat are particularly dangerous. Losing weight and body fat can reduce the negative effects of body fat. Improving your diet to reduce sugar intake is important for weight control and to minimize liver damage. Exercise also plays an essential role in reducing or reversing some of the negative effects of excess fat so you should strive to be more active every day regardless of your body weight.


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Santa’s exercise plan for functional fitness and health

Since Christmas is only a few days away our attention is naturally focused on one person: Santa Claus. Have you ever wondered how Santa gets in shape for his yearly sleigh ride to deliver gifts to good boys and girls around the globe? Like many elite athletes, Santa does not publicly discuss his training or his fitness. There are certainly no published studies that report his one repetition maximum strength or his maximal oxygen uptake. Given this lack of information, I attempted to make an educated guess about Santa’s training, fitness, and health. This is the topic of my Health & Fitness column in the Aiken Standard this week.

santa


By all accounts, Santa is overweight. While we don’t know his body mass index, he would probably be considered obese. Furthermore, he appears to have a large waist circumference, indicating a high level of visceral fat. This suggests that Santa is a high risk for type 2 diabetes, high blood pressure, and heart disease. This combination can lead to a heart attack and, possibly, death at a relatively young age.

But Santa has avoided this fate, and seems to be living a healthy life. His secret, no doubt, is regular exercise. There is good evidence that maintaining a high level of physical activity can “undo” some of the negative effects of obesity and can reduce the risk of death in people who are obese (and everyone else).

Like many athletes, Santa trains in the “offseason” to get ready for his annual Christmas Eve journey. Santa’s training likely includes endurance, strength, and flexibility exercises. In order to visit every home around the world in one night, Santa moves quickly. This suggests that he has a high maximal aerobic capacity as well as good endurance. This is a result of both high-intensity interval training and long-duration, lower intensity training, similar to what a marathon runner might do. Evidence for his good aerobic fitness is shown by the fact that he flies away from each home with a hearty “ho, ho, ho.” If he were out of shape, he would be too short of breath to speak, much less give such a robust farewell.

Santa must also dedicate training time to improving his strength. His sack of gifts is certainly very heavy and he repeatedly carries it up and down chimneys. In addition to traditional weight lifting, Santa probably also engages in plyometric training, which involves explosive movements that develop muscle power. Santa must also have good flexibility in order to squeeze through narrow spaces and move quickly without pulling a muscle. This is the result of stretching and, likely, other exercises such as yoga.

Santa is also educated about sports nutrition. The cookies and milk you leave for him are more than a reward for delivering gifts at your house. The carbohydrates (sugar) in the cookies help Santa maintain his blood glucose to delay muscle fatigue. Some research suggests that combining carbohydrates with protein is even more effective, so the glass of milk is a good addition. Of course, Santa could have a specialized sports drink, but that doesn’t make for such a good story.

We can learn an important health lesson from Santa. Even though he is overweight, through regular exercise, Santa has reduced his risk of health problems and maintained his fitness at a level that allows him to complete his necessary activities. Like Santa, all of us can benefit from being physically active, whether we are overweight or not. He would likely be healthier and be able to perform his job better if he lost weight, but I’m not about to tell Santa what to do!


Nutrition, exercise, and health information can be confusing. 
But it doesn't have to be that way.
What can I help you with?
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Tomorrow is Healthy Lunch Day. Here’s why it matters and why you should do it every day.

Tomorrow is National Healthy Lunch Day, an event promoted by the American Diabetes Association to raise awareness about the need to make healthy choices at lunchtime. We all know that eating breakfast is an important way to start the day. What we may not appreciate is the role a good lunch plays in promoting good health, from helping with weight control to managing diabetes. A healthy lunch can also affect your focus and attention, helping your performance at work or school.


lunch

A healthy lunch is important for treating and preventing many health problems. Diabetes is a perfect example. Perhaps the most important aspect of managing diabetes is to control blood glucose levels throughout the day. Obviously, eating a meal will raise blood glucose. But eating a meal that is relatively low in carbohydrates, especially sugar [https://drbrianparr.wordpress.com/2016/02/29/sugar-and-your-health/], can provide energy without contributing to a spike in blood glucose. The glycemic index (GI) is a useful tool for selecting foods that have a lower impact on blood glucose. Keep in mind that the amount of carbohydrates you eat is important, too, so focusing only on GI isn’t enough. This is especially important for diabetics who take medications, including insulin, to help manage their diabetes.

The idea that eating lunch promotes weight loss sounds counterintuitive, but it works! Skipping a meal can lead to stronger feelings of hunger later in the day. And if you are hungrier you will likely eat more. So, an appropriate midday meal can help you eat less later in the day. Combined with regular exercise, eating appropriate meals and snacks is an essential aspect of weight loss and weight control.

Eating lunch provides energy and reduces hunger at a time when your breakfast is likely “wearing off.” This may help you feel more energetic and can enhance your attention, focus, and productivity. Of course, what you eat for lunch is as important as when you eat. Lots of sugar can make you feel sluggish, both physically and mentally. Unfortunately, added sugar is a big part of many restaurant meals and convenience foods, so the afternoon slump is a reality for many of us. Limiting sugar in both food and drinks can help you make healthier choices at lunch that can make you feel and work better in the afternoon.

“That afternoon slump you feel may be due to what you ate for lunch.”

A good lunch is especially important for children. In addition to providing energy to support growth and learning, lunch also presents an opportunity to teach children about healthy eating. This is critical since formal nutrition education isn’t part of the curriculum at most schools. Sadly, most school lunch programs provide meals that include too much added sugar and refined carbohydrates, inappropriate for growing and learning kids.

Many adults don’t fare much better with their lunch. For a lot of people, the two key criteria for lunch are that it is quick and convenient. And as we know, quick and convenient foods are rarely considered healthy, so this requires some effort to plan ahead and make careful choices.

What makes a healthy lunch? Pretty much the same recommendations for other meals also apply for lunch: low in added sugar and refined carbohydrates and high in fiber. Your lunch should include vegetables, fruit, whole grains, and protein, all of which are foods that can make you feel full longer. In the end, the effort and planning pay off by making you a healthier you!


Nutrition, exercise, and health information can be confusing. 
But it doesn't have to be that way.
What can I help you with?
 drbrianparr@gmail.com | http://twitter.com/drbrianparr

Telling the truth to yourself and hearing–no, expecting–it from others.

Earlier this week I wrote about the importance of being honest with yourself about your health. Unless you can honestly assess your own health and health behaviors, making meaningful changes simply won’t work. Living in denial about your weight or eating and exercise behaviors means that you can’t recognize what you need to change.

We should also expect others to be honest with us, too. While family and friends may be hesitant to voice their thoughts, especially about sensitive topics like weight, we should expect them to be supportive. And we should certainly expect medical professionals to tell us the truth about our health, even if we don’t want to hear it.

Unfortunately, many doctors, nurses, and fitness/wellness professionals are reluctant to bring up topics like weight for fear of offending a patient or client. This was expressed eloquently in a recent article in the New York Times.

While the goal should never be to offend or ridicule, I believe that health professionals should always bring up potential health issues and talk honestly about what people can do to improve their health.


Nutrition, exercise, and health information can be confusing. 
But it doesn't have to be that way.
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 drbrianparr@gmail.com | http://twitter.com/drbrianparr

Honesty is the best policy when it comes to your health

Have you ever justified your weight by saying you are “big-boned”? What about your eating and exercise habits? How often do you really eat out? How many days did you actually get to the gym last month? Are you being honest with yourself when it comes to your health? And are you asking others to be honest with you?

Being honest about your health is the topic of my Health & Fitness column in the Aiken Standard this week.


Being honest with yourself is essential for initiating health behavior changes and setting good goals. For example, someone who tells themselves they need to lose “a few pounds” may really need to lose much more and may not take their weight loss as seriously as they should. Convincing yourself that you are doing more exercise than you really are may mean that you won’t see the fitness or weight loss results you were expecting.

This type of self-deception is easy to do. Take body weight for example. The current standard for determining if you are at a healthy weight is body mass index (BMI), calculated from your weight and height (kg/m2). It requires a bit of math, so using a mobile app or online calculator is a good idea.

A BMI between 18.5 and 24.9 is considered normal, 25-29.9 is overweight, and if your BMI is 30 or higher, you are classified as obese. To put this in perspective, a BMI of 30 is equivalent to about 25–30 pounds of excess fat.

Let’s say your BMI puts you in the obese category, suggesting you should lose weight. But then you think about an article you read about how BMI isn’t accurate because you can be considered obese if you have excess muscle, not fat. And then there was the story on the news suggesting that it is okay to be obese as long as you are physically fit. So, maybe you don’t need to worry about your weight!

See how easy it is to tell yourself that you don’t really need to lose weight? In reality, BMI is an accurate method of assessing your body fatness; the inaccuracies reported in the news almost always involve athletes or people with lots of muscle mass developed through physical labor. Be honest…is that really you? It’s also true that people who are fit and fat can be healthier than people who are thin and sedentary, but it requires a lot of exercise to reach that level of fitness. Again, are you really that fit?

Probably the best test is to take a good look in the mirror and be honest about what you see. Try to “pinch an inch” of fat around your belly. One inch isn’t necessarily a problem, but take notice if you can pinch a handful of fat. Measuring your waist circumference (or looking at your pants size) can give you the same information. People who have a high BMI because of extra muscle, like athletes, have thin waists. If your waist circumference is greater than 35 inches ( women) or 40 inches (men), you have excess fat.

This honesty also applies to others, including your doctor. Many physicians are reluctant to discuss weight and weight loss with their patients, and many patients don’t want to hear what they interpret as a personal attack. Don’t be one of those patients! Ask your doctor for an honest assessment about your weight and the impact it might have on your health.

This is a real problem. According to one report, only 39 percent of obese people surveyed had ever been told by a health care provider that they were obese.     To help combat this problem, the American Medical Association has developed resources to help physicians better communicate with patients about their weight.

Making changes to diet and activity habits is a difficult process, to be sure. Telling yourself that you don’t need to make them only delays getting started and can lead to poor health in the meantime. When it comes to your health, honesty is the best policy!


Nutrition, exercise, and health information can be confusing. 
But it doesn't have to be that way.
What can I help you with?
 drbrianparr@gmail.com | http://twitter.com/drbrianparr

What children gain and lose over the summer

Summer vacation is a rite of passage for children. Long summer days to play, go to camp, and relax are an important part of growing up. But many educators and health professionals are concerned about what gets lost, and what gets gained, when kids are away from school.

Kids playing outdoors


Summer learning loss is a real concern. It is estimated that children lose, on average, two months of reading skills and one month of overall learning over summer break. Those losses must be made up when school starts again in the fall, so teachers spend about six weeks re-teaching material that was covered in the previous grade. That is six weeks that children are not learning at grade level, which certainly has an impact on achievement over time.

Not all kids are affected equally. Much of the disparity in summer learning losses falls along socioeconomic lines. Some children have more opportunities than others to continue learning over the summer through formal educational programs and camps and informal encouragement to read.

To address this issue, many institutions implement summer “school” through classes, on-line learning programs, and encouraging reading at home. Some target the students who need them the most while other programs are instituted for all children. In fact, all three of my kids are completing online learning programs this summer.

Learning losses are not the only concern with an extended break from school. Many children gain more weight over the summer than during the rest of the year. Furthermore, fitness gains made during the school year are frequently lost over the summer. While poor nutrition and a lack of activity in schools is a real concern, many children get more exercise and eat better at school than they do at home. Being at home over the summer can lead to poor eating habits—too much unhealthy food or not enough food in general—and lack of chances to be active.

This is important because the combination of poor nutrition, physical inactivity, and obesity has physical, psychological, and social consequences for children that frequently persist into adulthood. Overweight and obese children are at increased risk for type 2 diabetes, high blood pressure, heart disease, and even stroke – conditions usually associated with adulthood. Even if an overweight child does not have these conditions now, he or she is likely on that path. In fact, many experts predict that children born today will be the first generation in history to have a shorter lifespan than their parents due to obesity-related diseases that begin in childhood.

Children who are overweight are also more likely to suffer other consequences including lower self-esteem, social functioning, and academic performance. Overweight children are also less likely to play sports or participate in other forms of physical activity, which creates a cycle leading to poorer health and, potentially, poorer academic success.

Now that school is almost out for the summer, this is a critical time of year to focus on good nutrition, physical activity, and continued reading and learning to help prevent a summertime slump in health and academics. Schools can only do so much, so adults should model good diet, activity, and reading behaviors themselves. A good place to start is by turning off the TV and reading a book or going outside to play. It’s something all of us—adults and children—will benefit from.


Nutrition, exercise, and health information can be confusing. 
But it doesn't have to be that way.
What can I help you with?
 drbrianparr@gmail.com | http://twitter.com/drbrianparr