Exciting week on my end! Headed back up to the Guelph area this past Friday where my climbing partner and I spent the weekend catching up with my friends and climbing at the craigs in the area. We headed to Collingwood Wednesday, where we climbed at Metcalf so far- next stop is a craig called Devils Glen. We’ll finally make our way up to lionshead on Saturday, where we’ll meet with a few more friends for a fun time climbing and camping. We’ve been lucky enough to find refuge with friends up until now- come Saturday we’ll actually have to spend some time in the wilderness :p.
Here’s a picture of me at Lionshead from a few months ago- excited to get over there!
This article is quite long- given the topic, I wanted to be as thorough as I could be! I also opted to just publish this article onto my site instead of submitting it to the companies I work for- hope you guys like it!
Type 2 diabetes (T2DM) is an up and coming chronic disease that currently affects about 25.8 million people in the US, with about 1.9 million of those individuals under the age of 20. Approximately 35% of U.S. adults fall into the pre-diabetic range, while an estimate 12.0% have diabetes. When diagnosed midlife, T2DM is associated with a loss of 10 years off of lifespans and is associated with a fourfold higher risk for heart disease, which is responsible for up to 80% of the deaths in people with diabetes. On top of that, diabetes is a major risk factor for premature blindness, need for amputation and kidney failure. In 2010, diabetes accounted for 11.6% of the total health-care expenditure in the US. T2DM in Children is a new concept that has emerged over the last few decades, with most of the cases before-hand being type 1. Because diabetes is increasingly prevalent in younger individuals, it is expected to result in a devastating blow to the health of future working-age individuals. Are you or someone you know struggling with diabetes? Read on for more information and tips to help you on your road to recovery.
The control of blood sugar is essential for good health; both high (>7mM) and low (<4mM) blood sugar can be detrimental and potentially fatal. Blood sugar levels in healthy humans are tightly regulated to maintain about 5mM sugar concentrations throughout the day. Our muscles, fat cells, organs and brain (predominantly skeletal muscle) are responsible for the uptake of sugar following a meal via glucose transporters (GLUT4) at their cell membranes. This uptake is highly dependent on insulin stimulation which is released from the pancreas. Insulin stimulates the uptake of glucose at the cell membranes to lower blood sugar whereas glucagon promotes the release of glucose from the liver to increase blood sugar. Healthy blood sugars are maintained largely by the release of these two hormones.
How does diabetes happen? T2DM is a chronic and progressive beta cell (cells in the pancreas that release insulin) dysfunction that results in insulin resistance and hyperglycemia. The main risk factor for diabetes is too many daily calories, either through too little exercise or too much food (or both). When we chronically overeat or eat high glycemic diets, sugar is constantly being pumped into our blood. To deal with higher blood sugar, insulin is released from the pancreas to stimulate the uptake of glucose. When insulin is chronically released, eventually our tissues, specifically our glucose transporters, become less sensitive to insulin. At that point, our body becomes less capable of taking up glucose so blood sugar remains high; insulin resistance is the term for this condition. The net effect of high blood sugar is poor protein production, acidosis, etc. In this early stage of diabetes where reduced insulin sensitivity is present, hyperglycemia and insulin resistance can be reversed through a variety of interventions including a change in lifestyle or medication.
In terms of pharmaceutical treatment options, metformin and insulin are currently the only medicines approved by the US FDA for the treatment of T2DM in youth. Although insulin is effective at lowering blood sugar, it results in a need for future injections and a risk for hypoglycemia. Furthermore, insulin inherently improves the body’s ability for fat storage and protein production. Since obesity and high body fat are major factors for insulin resistance, insulin injections tend to feed into a vicious cycle that often prevents patients from improving and recovering. Metformin is a widely used drug that acts as a glucose sensitizer, suppressor of hepatic gluconeogenesis and glucose production with a low risk for long-term side effects. Although metformin is quite effective, reducing risks for diabetes by 31%, it is still less effective compared to lifestyle interventions.
With all of that said, here are 5 components to consider while undergoing a lifestyle intervention geared for diabetes prevention and treatment…
In terms of diet, recommendations include a reduction in portion sizes, fat and sugar, increases in fruit and vegetable consumption, and an elimination of high-sugar beverages. The key for insulin sensitivity improvements seems to be weight loss and overall lower caloric intakes. The percentage of daily macronutrients (e.g. fat, carbs, and protein) ideal for improvement is still unclear and there is evidence for improvements at just about any percentage. For example, high protein diets and high-fibre, low glycemic diets have been both demonstrated to improve satiety and insulin sensitivity. Fibre also effectively decreases total and LDL cholesterol and decreases inflammation and can be commonly found in plant-based foods (e.g. nuts, seeds, fruits, beans, lentils, flax, legumes, carrots, etc). Ketogenic, low-calorie diets have also been demonstrated to improve insulin sensitivity. With all of that said, too little evidence is available on the ideal levels of carbs, fat and protein in a diet to suggest macronutrient adjustments.
The case for vegetarian diets
Plant based diets have long been used for improving insulin sensitivity, weight loss and lowering risks for heart disease. Vegetarian diets are traditionally defined as the absence of meat but there are many variations including lacto-vegetarians (includes dairy), lacto-ovo-vegetarians (includes eggs and dairy), pesco-vegetarian (includes fish) and vegan (no animal products). Overall, vegetarians tend to be slimmer, at a lower risk for chronic diseases and have a greater longevity then omnivores. Epidemiological data supports the notion of diabetes prevention with plant-based diets. For example, vegetarians have been demonstrated to have overall lower fasting blood sugar, cholesterol and TAG levels, however results are confounded by the weight-loss associated with plant-based diets.
With that said, are there specific dietary components in vegetarian diets protective against disease? Vegetarian diets tend to include more fruits and vegetables, which are rich in phytochemicals, antioxidants and fibre and are consistently associated with a lower risk for diabetes and other chronic diseases. Vegetarian diets also tend to be low in omega-6 and saturated fat, which has been shown to have positive effects on blood lipids and insulin sensitivity. Excess iron sores, associated with meat consumption, has also been shown to promote insulin resistance. Reduced calorie intakes will happen naturally on a plant based diet through a lower fat content, lower energy density and higher overall fibre content, so calorie counting is not typically required in order to lose weight, which seems to be the key to improve insulin sensitivity.
Red and processed meat intake has been consistently linked with T2DM, heart disease and certain cancers. Red meat consumption is associated with a 42% higher risk for heart disease with each 50g/day. Furthermore, 50g/day has been linked with a 19% higher risk of diabetes and frequent processed meat intake was associated with a 41% higher risk for diabetes. The lack of meat in vegetarian diets may also be a contributing factor for insulin sensitivity improvements.
If you’re thinking of trying out a vegetarian diet, here are a few tips to make sure you do it in a healthy way. Firstly, since plant-based iron is less bioavailable than animal based iron, make sure you couple your iron sources (e.g. greens) with vitamin C rich foods (e.g. citrus fruits), which effectively increase their bioavailability. Vitamin B12 is almost only found in animal based products and deficiencies can result in serious health consequences. Supplementation with vitamin B12 is vital while on a vegetarian diet in order to avoid a deficiency. Lastly, vitamin D supplementation is important, especially in northern latitudes with less sunlight exposure or during the winter (important for everyone, not just vegetarians). Despite what many people think, protein is not a big concern for vegetarians and as long as a complete amino acid profile is consumed throughout the day, easily achieved through healthy servings of fruits, vegetables, nuts, seeds and legumes, we can get more than enough protein. If your still concerned or like the idea of adding protein to your shakes to boost satiety in between meals, head over to your local health store and check out the vegan protein supplements. Sunwarrior and Vega both make excellent protein supplements. My favorites are Sunwarrior’s Vanilla Warrior Blend and the Vega One French Vanilla shake.
Exercise results in improved insulin sensitivity, increased uptake at the muscle, and a reduced need for medication, having the greatest influences as the intensity of the exercise increases. In the Finnish Diabetes Prevention study, for example, participants enrolled did 30 minutes of exercise per day, lost weight, lowered their saturated fat intake and increased their fibre intake had a 58% lower incidence of diabetes after the trial. In the ‘Nurses’ Health Study and Physician’s Health Study, vigorous exercise almost halved risks for developing T2DM. Current guidelines recommend 150 minutes of moderate to vigerous aerobic exercise weekly, based on the large body of evidence that exercise helps prevent diabetes, heart disease and all-cause mortality. This recommended time has been demonstrated to reduce diabetes risks by 58%! High Intensity Training (HIT) seems to be extremely effective at inducing a number of changes at the skeletal muscle including fibre composition, angiogenesis and mitochondrial biogenesis, with the end result of significantly improved insulin sensitivity.
Getting started exercising can be a daunting task, especially if it’s been a while since you’ve hit the gym or been on that high school sports team. Rest assured, achieving that 150 minutes isn’t as hard as it seems, and once you get going you’ll only be happy with the improvements you see. The best way to go is to find something that you enjoy so you’ll stick to it! Intermurals are a great way to reconnect with your inner child, have fun and meet new people. Interested in some group classes? Most colleges and gyms offer some pretty stellar fitness classes that will have you fit in no time. Looking for a new sport? There are so many adult leagues available to get you started; it’s never too late to find a new passion (rock climbing anyone?)!
Social support has been shown to improve clinical outcomes, reduce symptoms and increase the commitment of patients to lifestyle interventions. Higher levels of social support have been associated with better glycemic control, more knowledge, better adherence to treatment and an overall improved quality of life. It is also helpful in accepting a diagnosis, adjusting emotionally and decreasing the stress associated with diabetes. On the flip side, a lack of social support is associated with a higher risk for complications and death. If you’re trying a lifestyle intervention, make sure you have the support you need to ensure your success. Let your family members, significant other or friends know that you need a little encouragement. Support groups may also be a good idea or even teaming up with others (e.g. friends or family) while doing these lifestyle changes.
Sleep deprived individuals reportedly have a 35% greater chance of gaining more than 5kg over the course of 6 years. Lack of sleep (less than 6 hours per night) alters our metabolisms in profound ways, the end results are dramatic; insulin resistance, decreased energy requirements, enhanced appetites and damaged immune systems. When treating diabetes, good sleep habits are essential! Getting to bed earlier can be hard at first but with time your body will adjust to this new routine. If your having a hard time falling asleep earlier, try dimming the lights in your home throughout the day and avoiding electronics within the few hours before trying to fall asleep. This includes TV, computers and data phones which all have bright screens. Avoiding bright lights before bedtime is an effective way to get you sleepier and more relaxed.
My last consideration would be to include some anti-diabetic food items into your daily routine. A few of my favorite options include green tea, turmeric, aloe, garlic, ginger and apple cider vinegar. Try incorporating a few of these items every day to help you on your way to better insulin sensitivity.
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