Public Health Collaboration Conference 2018: a great success for Lifestyle Medicine

I was delighted to attend and speak at the third PHC conference in London this year.  We met at the Royal College of General Practitioners in London on the sweltering weekend of the Royal Wedding. Apart from superb international speakers we were treated to low carb, high protein food, such as one would typically eat on a ketogenic diet. Instead of picking at our dinners as we often have to do with mass catering  we could eat the whole lot. Great!

Dr Peter Brukner from Australia started off the weekend with a review of what was happening in the low carb world. There are more and more reports coming out describing the advantages of ketogenic and low carb diets to different groups of people but the establishment are fighting back viciously as can be seen by the attack on Professor Tim Noakes in South Africa.  Indeed if his defence lawyers and expert witnesses had not worked for free he would be bankrupt.  This is a terrible way to wage war on doctors who are acting in the best interests of their patients.

Dr Aseem Malhotra also described bullying tactics that had been used against him when he was a junior doctor and first becoming publicly engaged in the low carb debate. I have been subjected to this as well.  Professor Iain Broom showed that the proof that low carb diets are superior to low fat diets goes back 40 years.

Dr Zoe Harcombe gave us an explanation of how the calories in- calories out idea just doesn’t add up. The well known formulas about how many calories you need to avoid to lose weight don’t work in practice because of the complex compensatory mechanisms we have to avoid death from starvation.  How you put this over to patients and give them useful strategies for weight loss and blood sugar control was explored by Dr Trudi Deakin.

Food addiction is a real issue, at least it is for the majority of the audience in attendance, who answered the sort of questions usually posed by psychiatrists when they are evaluating drug addiction.  Unlike drugs, food can’t entirely be avoided but ketogenic diets are one tool that can be used to break  unhealthy food dependence. This worked for presenter Dr Jen Unwin who at one point had a really big thing for Caramac bars.  I haven’t seen these in years but they did have a unique taste.

Dr David Unwin showed clearly that fatty liver is easily treatable with a low carb diet.

Dr Joanne McCormick describes how her fortnightly patient group meetings are making change accessible for her patients and how many GPs in the audience could broach the subject in a ten minute consultation.

The website Diabetes.co.uk will shortly be starting up a type one educational programme online that all are welcome to join. I discussed the issue of what blood sugar targets are suitable for different people and how they can achieve this with dietary and insulin adjustment.

Dr David Cavan spoke about reversing diabetes in patients in Bermuda. Although Bermuda looks idyllic the reality is that good quality food is about five times as expensive in the UK as it is all shipped in. Many inhabitants work their socks off but barely cover their costs and cheap sugared drinks and buns are their staple diet. Despite these setbacks he managed to persuade a lot of diabetic patients to ditch the carbs and this had favourable results even after the educational programme had stopped.

A cardiologist Dr Scott Murray described the effects of metabolic syndrome on the heart and really why sticking stents in diseased arteries is too little, too late. He is convinced dietary change is needed to reverse and prevent heart disease. This is the first time I have been told that certain types of heart failure and atrial fibrillation are direct effects of metabolic syndrome on the heart.

The importance of exercise for physical and mental well being was not neglected and we had Dr Zoe Williams describing the great benefits that even the minimum recommended exercise can produce.

Dr Simon Tobin and Tom Williams spoke enthusiastically about Parkrun. This is a free event that runs every Saturday morning in parks all over the world. You can choose to walk, jog or run the course.

Claire McDonnell-Liu is the mother of two children who have greatly benefited from a ketogenic diet. The conditions are urticaria and epilepsy.  Although NHS dieticians do help families with childhood epilepsy who want to use a ketogenic diet, they can’t do it unless drugs have failed, as this is NICE guidance. I wonder how many children would benefit in fit reduction without side effects of drugs if this guidance was changed?

This was a fabulous conference with a positive enthusiastic vibrancy. Thanks to Sam Feltham for organising this event especially since he has become a new dad as well.

The Public Health Collaboration are putting all the talks on You Tube.

I was interviewed about diabetes and women’s health issues for Diabetes.co.uk and Diet Doctor and these interviews and many others will be available for you all to see to improve your lives with diabetes.

 

 

 

Half Marathon – Diabetic Training Progress

Diabetes Diet Emma with her 10k medalMutters to self—so why did you enter a half-marathon you eejit? Because it was January, and the said run was in nine months’ time. Distance from something is the equivalent of wearing beer goggles. Everything looks do-able when it’s months away.

Anyway, the experts recommend you try a few other races to keep motivation levels up so I entered the Vale of Leven 10k, which took place this morning (Saturday 2 June).

Many runners think of 10k as nothing. Easy-peasy to train for and do. Not me. Mama Nature didn’t make me a natural runner. I plod. Sometimes a 4k feels like a Herculean struggle. I can walk long distances without finding it onerous or unpleasant. I should stick to that, right?

Mornings or Evenings?

Races mostly take place in the mornings too. I’m not a fan of morning runs. My blood sugars do weird zig-zaggy things at that time of day (see pic). I’d rather run at lunchtime or early evening when they’ve had time to settle down. Plus, there’s the whole ‘what to do I do about breakfast and insulin’ question.

Still, the day came round and I got up early. Are you familiar with west coast of Scotland summers? For the most part, they promise much and deliver little. This year, however, May has been unbelievably warm and sunny. Weather forecasters promised cooler weather and even rain, but it dawned bright and sunny once more.

Eeks. My ideal run takes place at about 8 degrees with drizzle and a strong wind behind me.

The run started at Moss O’Balloch next to Loch Lomond Shores and spectacular as far as scenery goes. Parts of the route were recycled so runners like me faced the depressing sight of the fast yins heading home as we puffed and panted our way past kilometres seven and eight.

Hanging out with the Back Pack

Ah well! Lisa Jackson who writes for Women’s Running and who has a fair few marathons and ultra-marathons under her belt talks about the joys of hanging out at the back of the pack. Crowds tend to cheer you on a lot more. The marshals, volunteers and people at the race were most encouraging.

Pain when it’s passed leaves an imprecise memory—thank god—so I remember struggling for the first two kilometres as they were uphill and then at the last bit where I speeded up to keep up with the one hour pacer. But the detail’s no longer there, just the relief and pride of finishing.

tee shirt and medal for a 10k runI’m a sucker for a goodie bag and this one included a tee shirt (too big, but they always are as they’re sized for men), a medal, a bottle of water and a Mars bar. Chivas sponsored the event, but sadly a wee nip wasn’t included.

First Finisher

It’s years since I’ve run in a race. You rely on the atmosphere to chivvy you on; the crowds shouting encouragement, so you keep running when you want to walk. Or crawl, in my case. This wasn’t a busy run—I’d guess 550 people—and the ability mixed. I channelled Lisa. Yes! It’s BRILLIANT to hang out at the back, or the second half of the group at least. According to the ticket I collected at the end, I finished 257th and the 22nd woman for my age group (senior vet, whit whit whit??).

For other diabetic geeks, my blood sugar when I got up this morning was 13.6 (oops). I took half a unit of fast-acting insulin to correct this and I took my basal insulin at 7.30am and knocked two units off the usual dose. To avoid working out food and insulin requirements, I didn’t bother with breakfast* and ate a Hike bar—Aldi’s own-brand protein bars, 25g carbs and 9g fibre—twenty minutes before starting. My blood sugar at that point was 10.6, so I took another half unit of fast-acting insulin. I didn’t test my levels immediately after finishing, but an hour later they were 9.6.

So, another three months and I run more than twice that amount. Ooh, ‘eck! I ran the 10k in 60 minutes and 53 seconds (I told you I was slow), which puts me on course for running the half in two hours-ish. Wish me luck!

 

*Don’t do this at home, kids. I have no nutritional or sports expertise related to type 1 diabetes or in general.

 

Running and Diabetes Part 2

Shoes and mini eggs. The Diabetes Diet
Yes, yes, I’ve been RUNNING, therefore I need carbs.

Runners don’t smile at you when you pass them—a sign, I always thought, of why you shouldn’t add running to your life.

Aye, that painful grimace tells you all you need to know… Running is a fool’s game; its rewards are not worth the pain. If you’re not built for distance slogging—i.e. Kenyan skinny—give anything other than a dash for the bus a miss.

Some foolish notion, however, made me take running up once more at the end of last year. And it was okay. I didn’t grin madly at people, but I got the runner’s high. Albeit, the buzz doesn’t last long enough to justify the effort you put in.

And I got to listen to a lot of podcasts. “This is learning by osmosis, EB!” I said to myself. I picked worthy ones, such as those designed to help me improve my writing career. If I just listened to what the gurus told me why bother putting any of it in place? The lessons would all filter through subconsciously. Sales would result! [Spoiler alert—not so far.]

Then I thought entering the Glasgow half-marathon would be fun. Which it was, in January—y’know, when it was months away. And now the end of April hurtles ever nearer and I’m no further forward than eight and a half kilometres (five miles), less than half the distance. Woe!

I’ve upped my game. The five miles feels like an achievement, seeing as I haven’t pushed beyond three in years. My training plan, thus, is add one kilometre every week to the big run and run another two 5ks a week. Do Pilates once a week to stop self seizing up.

As for tempo training, HIIT stuff and dragging myself up and down hills and all that other serious runner stuff, forget it.

Goal? Half-marathon completion, even if it means walking some of the distance.

Running with type 1 diabetes is challenging. Any endurance exercise is. As well as dealing with breathing, effort, aching legs and all that, we battle see-sawing blood sugars not only during the run but afterwards too.

Blood sugar levels that are too high make you tired and exercise will often send them soaring higher. When your sugar levels dip too low, tiredness happens too, you’re at risk of collapsing and you need to eat.

Picture of a Hike bar. The Diabetes Diet
Hike bars–great running fuel.

Here’s what I’ve learned…

  • The best runs are when I’ve had level blood sugars all day.
  • Hike bars—the Aldi cheap version of a protein bar—are brilliant running fuel. I have half of one before, half afterwards. The raspberry one is nicer than the cocoa one.
  • I’ve a talent for finding routes that are treadmill flat. And sticking to them.
  • A runner’s backpack is worth buying. I ran my last half-marathon, clutching a bag of jelly babies and my blood sugar equipment in my sweaty hand. If you’ve ever run holding something in your hand, you’ll know how irritating it is. By the end of the race, the jelly babies had morphed into a gelatinous mass.
  • Your Fitbit shows you getting fitter as the time I’m spending in peak heart rate zone has come down since I’ve started tracking the runs. It’s gratifying.
  • The Type 1 Run Podcast (mentioned here) is incredibly useful. It amuses me that I’ve had diabetes and exercised with it longer than most of the guests have been alive, but you’re on a lifelong learning curve when you have diabetes. I learn something from every guest.
  • I seem to run well the day after drinking. My body welcomes the chance of sweating it all out. As it leaves my body, the alcohol acts like petrol… Don’t do this at home though kids!

This time round, I’m planning a support crew. When I did the half-marathon ten years ago, I did the race with another runner, but had no-one waiting for me at the end or around the course. (Cue violins.) In September, I’ll have my husband and friends dotted at four-mile intervals, armed with food and water. And umbrellas for themselves. It’ll be late September, and this is Glasgow. Rain’s 95 percent guaranteed.

And is it too early to plan my post-race meal? Readers, I’m low-carb most of the time, but the minute I cross that finish line, I plan to fall face down on a ginormous plate of fish and chips, doused in salt and malt vinegar.

Only places that do light, crispy batter, crisp chips that are fluffy on the inside, home-made onion rings and mushy peas need apply.

Massive disclaimer here—my experiences are personal. They are not recommendations, especially the last one. On a serious note, endurance events can be dangerous, not just for people with diabetes, as this year’s London Marathon proved again.

 

Diabetes Athlete Survey

Are you physically active and do you have diabetes (of any type)? Now is your chance to share how you manage your diabetes regimen while doing a variety of activities! A new edition of Dr. Sheri Colberg’s book, Diabetic Athlete’s Handbook, is coming out in Spring 2019. Please complete the diabetic athlete survey at the link below no later than […]

via Do Diabetic Athlete Survey by May 15 — Dr. Sheri’s Blog

Diabetic Running

This is what I look like when I’m running (I wish!)

There are no prizes for guessing what topic The Diabetic Running Podcast covers… It’s my first diabetic-related podcast subscription, and heck, it’s a useful one.

I’m a long-time podcast fan. As an uncultured Philistine, I don’t find music interesting enough for long walks and runs. A podcast on the other hand can be funny, the News Quiz for example, or educational.

I found the diabetic running podcast on Instagram (@diabeticrunningpodcast). I’ve entered the 2008 Great Scottish Run, a half-marathon that takes place at the end of September. I ran it ten years ago, a great deal younger and on the pump at the time.

The Diabetic Running Podcast is hosted by Jon Foti, who was diagnosed with type 1 diabetes at age twenty-seven. I worked out I’ve been exercising with diabetes for longer than he’s been alive, but I still find the interviews useful and informative.

Exercise is tricky with type 1 diabetes, especially anything that lasts long than forty-five minutes. The Diabetic Running Podcast featured an interview with a type 1 from London, Emma Collins, who’s run the London and Berlin marathons. Her first experience, she said, wasn’t great. She’d been wrongly advised to skip her basal injection altogether on the day of the race, so she ran at a lot of it at levels of 20+ (360mg/dl).

The ambulance crew who tested her blood glucose levels at the twenty-mile mark told her to give up, but she couldn’t bear to and ran on. For those of you without diabetes, running or exercising with high blood sugars is unbelievably difficult. Exercise makes you thirsty anyway and a high blood sugar sucks the liquid from your mouth and turns your muscles to lead. Kudos to Emma for continuing. We type 1s have a tendency to stubbornness.

What everyone Jon has interviewed so far has said is that exercise and type 1 diabetes is a matter of trial and error. What works for one person won’t work for another. For us, training for a half-marathon is not just about making sure we can run the distance.

It’s about experimenting with different boluses and basal rates, trying out different foods and drinks, and working out how adrenaline affects you to get it as right as you possibly can on the day of the run.

 

The Fitbit!

I’ve joined the Fitbit world. Having dipped my toe in the water via the Jawbone Up Activity tracker, I’m now the proud owner of a Fitbit.

My Up activity tracker vanished in January when the device fell out of the wristband. It must be somewhere in the house. Maybe the system thinks I’m dead thanks to my lack of movement. Hey ho! Anyway, by that point I reckoned I knew what you needed to do to cover 10,000 steps a day, and I was quite happy to live tracker-free.

I didn’t stare at my phone so much. My health didn’t take a nosedive, and the world didn’t end.

On Valentine’s Day, however, my husband gave me a Fitbit Charge 2, the reward for staying alcohol-free so far this year. To be honest, when he hinted the other week that he’d got me a pressie for my teetotal efforts, I thought he was talking about champagne. It always makes sense to reward your giving up something with the very substance you’ve been avoiding, hmm?!

And I was grateful and touched that he’d bothered. He’d done the research, he told me happily. This tracker is the all-singing, all-dancing one! It counts your steps, how often you climb up stairs (you should climb ten flights a day for good health, apparently), checks your heart beat, auto-recognises different exercises and monitors your sleep. You can add in a food tracker and monitor your calorie intake if you want to lose weight.

For someone who tends to obsessiveness, this is good and bad news. To prevent myself repeatedly checking my phone, I downloaded the app for Fitbit onto my tablet instead.

Exercise is very good for we folks with diabetes if you are able to be active. If you have type 2, you might be able to control the condition through diet and exercise alone. If you have type 1, exercise will mean you can reduce how much insulin you need to take overall, and it can be used with diet and insulin to keep your blood sugar levels in range.

At some point, perhaps activity trackers will be prescribed for people with diabetes? In the future, the Fitbit could include blood glucose monitoring, as a story earlier this year reported that Fitbit has just invested in a company that’s developing a minimally invasive glucose tracker. Imagine having all that information available in one place.

I, for one, would love that capability, so fingers crossed.

One Year of 10,000 Steps

I celebrated an anniversary earlier this month – one year of counting my steps every day. So, what has it taught me?

I’m very competitive – with myself. So, I have done at least 10,000 steps every day now for a year. I can’t bear to have a day where that doesn’t happen. I’ll get up early, if necessary, to walk.

I’m also boring about it. When I told my husband about the anniversary of doing those 10k steps, he said, “a year of hearing about it too”. My NY resolution is to stop going on about it.

A step counter does make you more active in general. If I’m doing housework, for example, I do it inefficiently. I don’t gather up all the stuff that needs to go upstairs or downstairs in one bundle. I take it up and down in a few trips. Going to the library, popping out for supplies from the shops, bringing in the bins…everything becomes an opportunity to add to the step count.

I’m a geek. The UP app is the one I use most on my phone. Have I done my steps yet? How does today compare to yesterday? What’s my average like for this week? The app also tracks your sleep, though that’s not quite as interesting.

You can use exercise instead of insulin. Proceed with caution here, my insulin-dependent friends. This is an individual thing that won’t work for everyone. But walks after lunch do the same job as insulin for me – sometimes.

Exercise won’t help you lose weight, but it will help you maintain. I’ve kept my weight consistent over the whole year, or at least I think it is as I don’t weigh myself. Everything in my wardrobe fits, though, and some of them date back more than ten years.

I feel better. Being active every day makes you feel TERRIFIC.

I’d definitely recommend one. I use the Jawbone Up, the basic model that costs about £5.99. I didn’t want a FitBit as they are much more expensive, and you need to charge them every five days, whereas my entry level tracker needs the battery replaced every two months. The Fitbit also seems invasive. I’m obsessive enough without something on my wrist bleeping at me if I haven’t moved for an hour or so.

Do you find exercise and activity helpful for the management of your diabetes?