World Diabetes Day

Today is World Diabetes Day – happy diabetes day to my fellow (and female) diabetics the world over. May your blood sugars be stable for today at least. No hypos or hypers are allowed…

Who knows what the next year will bring? There have been lots of exciting developments in the diabetes world over the last 12 months – from the first hybrid insulin delivery system to the NHS’s decision to offer flash glucose monitoring, to the identification of a new biochemical ‘signature’ as a potential early indicator of type 1 diabetes onset, we edge closer than ever before to understanding and properly managing this condition.

One piece of news I spotted recently that has implications for all of us (and is relatively easy to do) was research that has shown that people with type 1 diabetes who are more active have a lower risk of premature death than those who don’t exercise.

Diabetes.co.uk reported that the Helsinki study. It followed 2,639 people with type 1 diabetes, 310 of them had diabetic kidney disease. They were followed up eleven years later. During the course of the research, some 270 people diets. In the least active group, the death rate was 14.4 percent. Only 4.8 percent died in the group who performed more exercise. Activity seemed to benefit patients who had kidney disease and those who didn’t.

The lead study author, Der Heidi Tikkanen-Dolenc from the University of Helsinki and Helsinki University Hospital, said: “Doctors have always prescribed physical activity for their patients with type 1 diabetes without strong evidence. Now we can say that in patients with type 1 diabetes, physical activity not only reduces the risk of diabetic nephropathy and cardiovascular disease events but also premature mortality.”

Keeping active is a challenge in this day and age. Our governments and big business have unwittingly conspired to create a world where the default way to live is a sedentary one where cheap, nasty junk food is all-too-readily available. Being active and exercising often takes a lot of effort, unlike populations who lived years ago who were active because they had to be.

But the message that exercise can help prevent premature death IS a powerful one. Let’s celebrate World Diabetes Day with a walk!

Pic thanks to maxipixelfreepictures.com

 

Kris Kresser: Why has the American approach to heart disease failed?

Why Has the American Approach to Heart Disease Failed?
on April 18, 2017 by Chris Kresser 

Tsimane 2

A recent New York Times article correctly suggests that diet and lifestyle changes are far more effective ways to prevent and treat heart disease than statins and stents. But what diet, and what lifestyle? Is it as simple as avoiding “artery-clogging saturated fat,” as the author suggests? Read on to find out why the American approach to heart disease has really failed.
Jane Brody wrote an article in The New York Times called “Learning from Our Parents’ Heart Health Mistakes.” She argues that despite decades of advice to change our diet and lifestyle in order to reduce our risk of heart disease, we still depend far too much on drugs and expensive procedures like stents.
She says:
Too often, the American approach to heart disease amounts to shutting the barn door after the horse has escaped.
To support this argument, she refers to a recent paper published on the Tsimane, an indigenous population in the Bolivian Amazon. The study found that the rate of coronary atherosclerosis in the Tsimane was one-fifth of that observed in the United States (and the lowest that has ever been measured). Nearly nine in 10 Tsimane had unobstructed coronary arteries and no evidence of heart disease, and the researchers estimated that the average 80-year-old Tsimane has the same vascular age as an American in his mid-50s.
I certainly agree with Ms. Brody so far, and her analogy that the American approach to heart disease amounts to shutting the barn door after the horse has escaped is spot on.
The problem is what comes next, as she attempts to answer the question of why the Tsimane have so much less heart disease than Americans:
Protein accounts for 14 percent of their calories and comes primarily from animal meats that, unlike American meats, are very low in artery-clogging saturated fat. [emphasis mine]
Does saturated fat “clog” your arteries?
Artery-clogging saturated fat? Are we still using that phrase in 2017?
As I’ve written before, on average, long-term studies do not show an association between saturated fat intake and blood cholesterol levels. (1) (I say “on average” because individual response to saturated fat can vary based on genetics and other factors—but this is a subject for another article.)
If you’re wondering whether saturated fat may contribute to heart disease in some way that isn’t related to cholesterol, a large meta-analysis of prospective studies involving close to 350,000 participants found no association between saturated fat and heart disease. (2)

Does saturated fat really “clog” your arteries?

Are “clogged arteries” the cause of heart disease?
Moreover, as Peter Attia eloquently and thoroughly described in this article, the notion that atherosclerosis is caused by “clogged arteries” was shown to be false many years ago:
Most people, doctors included, think atherosclerosis is a luminal-narrowing condition—a so-called “pipe narrowing” condition.  But by the time that happens, eleven other pathologic things have already happened and you’ve missed the opportunity for the most impactful intervention to prevent the cascade of events from occurring at all.
To reiterate: atherosclerosis development begins with plaque accumulation in the vessel wall, which is accompanied by expansion of the outer vessel wall without a change in the size of the lumen. Only in advanced disease, and after significant plaque accumulation, does the lumen narrow.
Michael Rothenberg also published an article on the fallacy of the “clogged pipe” hypothesis of heart disease. He said:
Although the image of coronary arteries as kitchen pipes clogged with fat is simple, familiar, and evocative, it is also wrong.
If heart disease isn’t caused by “clogged arteries,” what does cause it?
The answer to that question is a little more complex. For a condensed version, read my article “The Diet-Heart Myth: Why Everyone Should Know Their LDL Particle Number.”

For a deeper dive, read Dr. Attia’s article.
Here’s the 15-second version, courtesy of Dr. Attia:
Atherosclerosis is caused by an inflammatory response to sterols in artery walls. Sterol delivery is lipoprotein-mediated, and therefore much better predicted by the number of lipoprotein particles (LDL-P) than by the cholesterol they carry (LDL-C).
You might think that I’m splitting hairs here over terminology, but that’s not the case. It turns out that this distinction—viewing heart disease as caused by high LDL-P and inflammation, rather than arteries clogged by saturated fat—has crucial implications when it comes to the discussion of how to prevent it.
Because while it’s true that a high intake of saturated fat can elevate LDL particle number in some people, this appears to be a minority of the population. The most common cause of high LDL-P in Americans—and elsewhere in the industrial world—is almost certainly insulin resistance and metabolic syndrome. (I explain why in this article.)
And what is one of the most effective ways of treating insulin resistance and metabolic syndrome? That’s right: a low-carbohydrate, high-fat diet!
News flash: diets high in saturated fat may actually prevent heart disease.
Perhaps this explains why low-carbohydrate, high-fat diets (yes, including saturated fat) have been shown to reduce the risk of heart disease.
For example, a meta-analysis of 17 low-carb diet trials covering 1,140 obese patients published in the journal Obesity Reviews found that low-carb diets were associated with significant decreases in body weight, as well as improvements in several CV risk factors, including decreases in triglycerides, fasting glucose, blood pressure, body mass index, abdominal circumference, plasma insulin, and C-reactive protein, as well as an increase in HDL cholesterol. (3)
(In case you’re wondering, low-carb diets in these studies had a null effect on LDL cholesterol: they neither increased nor decreased it.)
Saturated fat is a red herring.
Instead of focusing so much on saturated fat intake, which is almost certainly a red herring, why not focus on other aspects of the Tsimane’s diet and lifestyle that might contribute to their low risk of heart disease?

For example:
They are extremely active physically; Tsimane men walk an average of 17,000 steps a day, and Tsimane women walk an average of 15,000 steps a day—and they don’t sit for long periods. Ms. Brody does mention this in her article.
They don’t eat processed and refined foods. We have been far too focused on calories and macronutrient ratios and not enough on food quality. We now know that hunter–gatherers and pastoralists around the world have thrived on both high-carbohydrate, low-fat diets (like the Tsimane, who get 72 percent of calories from carbohydrate) and low-carbohydrate, high-fat diets (like the Masai and Inuit).

But what all hunter–gatherer diets share in common is their complete absence of processed and refined foods.
Perhaps if we stopped focusing so much on the amount of fat and carbohydrate in our diet and started focusing more on the quality of the food we eat, we’d be better off.
And of course we also need to attend to the many other differences between our modern lifestyle (which causes heart disease) and the ancestral lifestyle (which prevents it), including physical activity, sleep, stress, light exposure, play/fun, and social support.
The Tsimane study illustrates exactly why an evolutionary perspective on diet, lifestyle, and behavior is so important. It helps us to generate hypotheses on what aspects of our modern way of life may be contributing to chronic diseases like atherosclerosis and gives us ideas about what interventions we need to make to prevent and reverse these diseases.

Gretchen Reynolds: You are never too old to give up on exercise

cyclist robert marchand

At the age of 105, the French amateur cyclist and world-record holder Robert Marchand is more aerobically fit than most 50-year-olds — and appears to be getting even fitter as he ages, according to a revelatory new study of his physiology.

The study, which appeared in December in The Journal of Applied Physiology, may help to rewrite scientific expectations of how our bodies age and what is possible for any of us athletically, no matter how old we are.

Many people first heard of Mr. Marchand last month, when he set a world record in one-hour cycling, an event in which someone rides as many miles as possible on an indoor track in 60 minutes.

Mr. Marchand pedaled more than 14 miles, setting a global benchmark for cyclists age 105 and older. That classification had to be created specifically to accommodate him. No one his age previously had attempted the record.

She was particularly interested in Mr. Marchand’s workout program and whether altering it might augment his endurance and increase his speed.

Conventional wisdom in exercise science suggests that it is very difficult to significantly add to aerobic fitness after middle age. In general, VO2 max, a measure of how well our bodies can use oxygen and the most widely accepted scientific indicator of fitness, begins to decline after about age 50, even if we frequently exercise.

But Dr. Billat had found that if older athletes exercised intensely, they could increase their VO2 max. She had never tested this method on a centenarian, however.

But Mr. Marchand was amenable. A diminutive 5 feet in height and weighing about 115 pounds, he said he had not exercised regularly during most of his working life as a truck driver, gardener, firefighter and lumberjack. But since his retirement, he had begun cycling most days of the week, either on an indoor trainer or the roads near his home in suburban Paris.

Almost all of this mileage was completed at a relatively leisurely pace.

Dr. Billat upended that routine. But first, she and her colleagues brought Mr. Marchand into the university’s human performance lab.

They tested his VO2 max, heart rate and other aspects of cardiorespiratory fitness. All were healthy and well above average for someone of his age. He also required no medications.

He then went out and set the one-hour world record for people 100 years and older, covering about 14 miles.

Afterward, Dr. Billat had him begin a new training regimen. Under this program, about 80 percent of his weekly workouts were performed at an easy intensity, the equivalent of a 12 or less on a scale of 1 to 20, with 20 being almost unbearably strenuous according to Mr. Marchand’s judgment. He did not use a heart rate monitor.

The other 20 percent of his workouts were performed at a difficult intensity of 15 or above on the same scale. For these, he was instructed to increase his pedaling frequency to between 70 and 90 revolutions per minute, compared to about 60 r.p.m. during the easy rides. (A cycling computer supplied this information.) The rides rarely lasted more than an hour.

Mr. Marchand followed this program for two years. Then he attempted to best his own one-hour track world record.

First, however, Dr. Billat and her colleagues remeasured all of the physiological markers they had tested two years before.

Mr. Marchand’s VO2 max was now about 13 percent higher than it had been before, she found, and comparable to the aerobic capacity of a healthy, average 50-year-old. He also had added to his pedaling power, increasing that measure by nearly 40 percent.

Unsurprisingly, his cycling performance subsequently also improved considerably. During his ensuing world record attempt, he pedaled for almost 17 miles, about three miles farther than he had covered during his first, record-setting ride.

He was 103 years old.

These data strongly suggest that “we can improve VO2 max and performance at every age,” Dr. Billat says.

There are caveats, though. Mr. Marchand may be sui generis, with some lucky constellation of genes that have allowed him to live past 100 without debilities and to respond to training as robustly he does.

Lifestyle may also matter. Mr. Marchand is “very optimistic and sociable,” Dr. Billat says, “with many friends,” and numerous studies suggest that strong social ties are linked to a longer life. His diet is also simple, focusing on yogurt, soup, cheese, chicken and a glass of red wine at dinner.

But for those of us who hope to age well, his example is inspiring and, Dr. Billat says, still incomplete. Disappointed with last month’s record-setting ride, he believes that he can improve his mileage, she says, and may try again, perhaps when he is 106.

Natasha Hind: If you want to look like David Gandy, workout intensity is the key

 

david gandy

David Gandy is basically a real-life Bond character: he’s got the looks, the charm and his guilty pleasure is powerboat racing.

As can be expected of someone who’s had to sport tiny white trunks for a major fragrance commercial, the 37-year-old is also brimming with knowledge when it comes to fitness and health.

From a young age Gandy was very sporty, although for all the wrong reasons (“I’d usually get involved in sports to get out of school”, he tells us). As he entered his teens, he became more interested in nutrition and training, and his interest grew from there.

Nowadays, the model hits the gym between three and six times a week depending on his schedule and credits medium weights and supersets (where you do one set of exercise, followed by a set with a different exercise, without a rest between them) for his incredibly toned physique.

But his journey to get to where he is now hasn’t been without its setbacks – Gandy experienced rotator cuff injuries and back pain as a result of trying to lift the heaviest weights in a quest for the body he wanted.

“I’m still learning at the end of the day,” he reveals.

We caught up over tea in the Langham Hotel about his fitness routine, finding motivation to work out and his one love: Dora.

Let’s talk about fitness – what does your weekly gym routine consist of?

When I’m not training for something, I’ll go three or four times a week. When I’m training for a campaign or, for example, Light Blue (the Dolce & Gabbana fragrance advert) then I’ll go six days a week. I’m also a lot more conscious of my diet when I’m training for something specific.

With my schedule, it changes every day. I’m a late night trainer, so sometimes I’ll be in the gym from 9pm onwards for 60-90 minutes. It’s quite a strange routine but sometimes that’s the only time I can fit it in.

As I’ve gotten older, I’m steering much more away from heavy weights. I learned the hard way by stupidly trying to push two reps with the highest weight I could and injuring myself. Now I’m much more about using lighter weights, doing supersets and getting the form a lot more correct.

Sometimes I’ll do a week of heavy training to shock my muscles and then I’ll change it back. I also switch up my routine out of boredom because doing the same thing all the time is very repetitive.

What’s your ultimate piece of fitness advice?

A lot of guys come up to me and say ‘I’m constantly working out but I’m not seeing the results, why is that happening?’ and I tell them to look at form and nutrition.

If you’re not eating enough protein then you’re not allowing the protein to mend your muscles.

You tear your muscles every time you train and mend them with protein, which allows them to grow. If you don’t have that after you’ve worked out, you’re not going to see the results.

It’s also important to have an intense 30 or 45 minute workout rather than sitting around doing weights and having lots of breaks in between.

What do you eat after a workout

If I have time to make a meal then it’ll be lean chicken or turkey and salad or vegetables. Otherwise it’ll be a protein shake with a mixture of seeds, nuts and almond milk.

You obviously work very hard to maintain your physique. Have you ever felt self-conscious about your body?

Yes of course, that’s why I work out. I wanted to look a certain way and that’s why I hit the gym. I feel better from an energy point of view and because it makes me feel healthy and much more confident. It helps with my job obviously – if you’re in swimwear or underwear – but at the same time I do it just for myself.

People think I started working out for modelling, but I didn’t, I trained before that when I was at school and university. I didn’t have the body I wanted at the time so I worked hard to improve it.

What’s your approach to ageing and weight gain?

 

I used to be able to change my body very quickly, for example if I was training for something, it would take two weeks to get in shape, whereas now it’s a four week or six week training regime to achieve the same results. But that’s ageing and that’s how you have to adapt to stuff.

It’s the same science at the end of the day, if you’re not getting the results you want you just have to train a little harder.

What are your thoughts on dieting?

The definition of diet fads is about changing your whole lifestyle. There are a number of pieces of the puzzle to put together and if you just do that for, say, eight weeks to get ready for a holiday, within that one week your body will pretty much go back to how it was before. It’s going to regain fat very quickly.

To me, it’s all about continuing a healthy lifestyle – everything in moderation. You don’t have to cut everything out. It’s also about being nutritionally aware of what you’re eating and, still, a lot of people are nutritionally inept in many ways.

It’s important to educate people. I haven’t eaten processed foods and meat for a good seven or eight years. The information is out there, you’ve just got to do the research. There’s no real excuse to not know what you’re talking about with regards to food.

You sound pretty healthy, do you ever eat biscuits?

I don’t generally eat them but, if I do, my family and I are fans of Rich Tea biscuits, which are actually quite healthy, and Jaffa cakes.

How do you motivate yourself when you can’t be bothered to hit the gym?

I think it’s important to always have a goal that will motivate you to go. For example, if you don’t want to run, book yourself in for a half marathon or a 10k in a few months time. That way you’ll be less likely to give up that run or convince yourself you’re not going to go today because there’s this idea in the back of your mind that you might make an utter fool of yourself on race day.

It doesn’t have to be running, it could be climbing a mountain, anything, you’ve got to prepare for it. It’s also kind of engrained in me to get up and go. I feel worse for not going to the gym. If I go, I feel motivated and energised.

Yes, it’s difficult to get down there sometimes but once I go I feel so much better.

What’s the weirdest thing that’s happened to you in the gym?

I split my finger open at the gym once. I dropped a weight on it and it split like a grape. Then I went up to the biggest trainer, he was built like a brick s**thouse, and he almost fainted because of the blood. Now I have a funny-shaped finger.

Also, a guy shouted ‘man, you’re on fire’ at me the other day because I was training hard. I was like, ‘yeh!’ – it really motivated me. It was slightly weird, because we’re all very English and like to put our heads down and not talk to each other, but he just wanted to shout something at me and I thought, great! Although now if he doesn’t say that every time I’m working out I’ll feel like I’m not working hard enough.

 

Natasha Hinde Huffington Post 9.7.17

Sheri Colberg: Joint health is critical to staying active

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Joint Health Is Critical to Staying Active

Diabetes in Control

Without properly functioning joints, our bodies would be unable to bend, flex, or even move. A joint is wherever two bones come together, held in place by tendons that cross the joint and attach muscles to a bone on the other side and ligaments that attach to bones on both sides of the joint to stabilize it. The ends of the bones are covered with cartilage, a white substance formed by specialized cells called chondrocytes. These cells produce large amounts of an extracellular matrix composed of collagen fibers, proteoglycan, elastin fibers, and water. Tendons and ligaments are also made up primarily of collagen.

Joints can be damaged, however, making movement more difficult or painful. Joint cartilage can be damaged by acute injuries (i.e., ankle sprain, tendon or ligament tears) or overuse (related to repetition of joint movements and wear-and-tear over time). Damage to the thin cartilage layer covering the ends of the bones is not repaired by the body easily or well, mainly because cartilage lacks its own blood supply.

Aging alone can lead to some loss of this articular cartilage layer in knee, hip, and other joints—leading to osteoarthritis and joint pain—but having diabetes also potentially speeds up damage to joint surfaces. Although everyone gets stiffer joints with aging, diabetes accelerates the usual loss of flexibility by changing the structure of collagen in the joints, tendons, and ligaments. In short, glucose “sticking” to joint surfaces and collagen makes people with diabetes more prone to overuse injuries like tendinitis and frozen shoulder (1; 2). It may also take longer for their joint injuries to heal properly, especially if blood glucose levels are not managed effectively. What’s more, having reduced motion around joints increases the likelihood of injuries, falls, and self-imposed physical inactivity due to fear of falling.

Reduced flexibility limits movement around joints, increases the likelihood of orthopedic injuries, and presents a greater risk of joint-related problems often associated with diabetes, such as diabetic frozen shoulder, tendinitis, trigger finger, and carpal tunnel syndrome. These joint issues can come on with no warning and for no apparent reason, even if an individual exercises regularly and moderately, and they may recur more easily as well (3). It is not always just due to diabetes, though, since older adults without diabetes experience inflamed joints more readily than when they were younger.

So what can you do to keep your joints mobile if you’re aging (as we all are) and have diabetes? Regular stretching to keep full motion around joints can help prevent some of these problems, and also include specific resistance exercises that strengthen the muscles surrounding affected joints. Vary activities to stress joints differently each day. Overuse injuries occur following excessive use the same joints and muscle in a similar way over an extended period of weeks or months, or they can result from doing too much too soon.

Doing moderate aerobic activity that is weight-bearing (like walking) will actually improve arthritis pain in hips and knees (4). People can also try non-weight-bearing activities, such as aquatic activities that allow joints to be moved more fluidly. Swimming and aquatic classes (like water aerobics) in either shallow or deep water are both appropriate and challenging activities to improve joint mobility, overall strength, and aerobic fitness. Walking in a pool (with or without a flotation belt around the waist), recumbent stationary cycling, upper-body exercises, seated aerobic workouts, and resistance activities will give you additional options to try.

Finally, managing blood glucose levels effectively is also important to limit changes to collagen structures related to hyperglycemia. Losing excess weight and keeping body weight lower will decrease the risk for excessive stress on joints that can lead to lower body joint osteoarthritis (5). Simply staying as active as possible is also critical to allowing your joints to age well, but remember to rest inflamed joints properly to give them a chance to heal properly. You may have to try some new activities as you age to work around your joint limitations, but a side benefit is that you may find some of them to be enjoyable!

References:

  1. Abate M, Schiavone C, Pelotti P, Salini V: Limited joint mobility in diabetes and ageing: Recent advances in pathogenesis and therapy. Int J Immunopathol Pharmacol 2011;23:997-1003
  2. Ranger TA, Wong AM, Cook JL, Gaida JE: Is there an association between tendinopathy and diabetes mellitus? A systematic review with meta-analysis. Br J Sports Med 2015;
  3. Rozental TD, Zurakowski D, Blazar PE: Trigger finger: Prognostic indicators of recurrence following corticosteroid injection. J Bone Joint Surg Am 2008;90:1665-1672
  4. Rogers LQ, Macera CA, Hootman JM, Ainsworth BE, Blairi SN: The association between joint stress from physical activity and self-reported osteoarthritis: An analysis of the Cooper Clinic data. Osteoarthritis Cartilage 2002;10:617-622
  5. Magrans-Courtney T, Wilborn C, Rasmussen C, Ferreira M, Greenwood L, Campbell B, Kerksick CM, Nassar E, Li R, Iosia M, Cooke M, Dugan K, Willoughby D, Soliah L, Kreider RB: Effects of diet type and supplementation of glucosamine, chondroitin, and msm on body composition, functional status, and markers of health in women with knee osteoarthritis initiating a resistance-based exercise and weight loss program. J Int Soc Sports Nutr 2011;8:8

 

In addition to my educational web site, Diabetes Motion (www.diabetesmotion.com), I also recently founded an academy for fitness and other professionals seeking continuing education enabling them to effectively work with people with diabetes and exercise: Diabetes Motion Academy, accessible at www.dmacademy.com. Please visit those sites and my personal one (www.shericolberg.com) for more useful information about being active with diabetes.

Whistle while you work

A_Day_in_the_Life_of_a_Wartime_Housewife-_Everyday_Life_in_London,_England,_1941_D2366

 

Physical exercise improves your sense of wellbeing but different intensities give different results.

Healthy adults were tested after doing various types of exercises and activities and compared how they felt.

Office work and driving a car were considered light intensity and were associated with  an improved mood.

Housework or walking  were considered moderate activities and not only improved mood but reduced pain, in those that suffered this.

Doing nothing reduced people’s moods.

Journal of Health Psychology doi:10.1177/1359105317691589

Adapted from article in Human Givens Vol 1 2017

Keep safe when cycling

cyclist

Reflective jackets are a great safety aid for cyclists riding in the dark, if they have them and  wear them consistently. A possible way to overcome a cyclists reluctance to wear the said jacket, say for example if they think to themselves, “I’ll be back before it gets dark or it’s too warm for my jacket” is to take the decision out of the equation.

Researchers have found that reflective tape attached to the rear frame of the bike and pedal cranks does the job of increasing visibility just as well as jackets do, but without any active behaviour required of the cyclist.

“Reflective tape is highly recommended to complement front and back lights in bicycle riding at night”, they conclude.

Human Factors, 2016, doi:10.177/001872081667145

Adapted from article in Human Givens Volume 24 No 1 2017