Sheri Colberg: Motivate yourself to exercise

From Diabetes in Control: Getting and Staying Motivated to Be Physically Active
Jan 4, 2020

Author: Sheri R. Colberg, PhD, FACSM

Every New Year all of the fitness clubs and gyms run specials to bring in new members, and they know—and even count on the fact that—most of those people will no longer be regularly attending classes or doing workouts by the time spring hits. How do you avoid becoming one of those exercise dropouts?
Even elite athletes have some days when they are not as motivated to exercise. You know those days—the ones when you have trouble putting on your exercise gear, let alone finishing your planned workout. For the sake of your blood glucose and your health, do not use one or two bad days as an excuse to discontinue an otherwise important and relevant exercise or training routine.
Here is a list of motivating behaviors and ideas for regular exercisers and anyone else who may not always feel motivated to work out:
Identify any barriers or obstacles keeping you from being active, such as the fear of getting low during exercise, and come up with ways to overcome them.
Get yourself an exercise buddy (or a dog that needs to be walked, you can borrow one!).
Use sticker charts or other motivational tools to track your progress.
Schedule structured exercise into your day on your calendar or to-do list.
Break your larger goals into smaller, realistic stepping stones (e.g., daily and weekly physical activity goals).
Reward yourself for meeting your goals with noncaloric treats or outings.
Plan to do physical activities that you enjoy as often as possible.
Wear a pedometer (at least occasionally) as a reminder to take more daily steps.  You can get free pedometer apps that turn your mobile into a pedometer.
Have a backup plan that includes alternative activities in case of inclement weather or other barriers to your planned exercise.
Distract yourself while you exercise by reading a book or magazine, watching TV, listening to music or a book on tape, or talking with a friend.
Simply move more all day long to maximize your unstructured activity time, and break up sitting with frequent activity breaks.
Do not start out exercising too intensely, or you may become discouraged or injured.
If you get out of your normal routine, and are having trouble getting restarted, take small steps in that direction.
As for other tricks that you can use, start with reminding yourself that regular exercise can lessen the potential effect of most of your cardiovascular risk factors, including elevated cholesterol levels, insulin resistance, obesity, and hypertension.

Even just walking regularly can lengthen your life, and if you keep your blood glucose better managed with the help of physical activity, you may be able to prevent or delay almost all the potential long-term health complications associated with diabetes.
From Colberg, Sheri R., Chapter 6, “Thinking and Acting Like an Athlete” in The Athlete’s Guide to Diabetes: Expert Advice for 165 Sports and Activities. Champaign, IL: Human Kinetics, 2019.
Sheri R. Colberg, Ph.D., is the author of The Athlete’s Guide to Diabetes: Expert Advice for 165 Sports and Activities (the newest edition of Diabetic Athlete’s Handbook), available through Human Kinetics (https://us.humankinetics.com/products/athlete-s-guide-to-diabetes-the), Amazon (https://amzn.to/2IkVpYx), Barnes & Noble, and elsewhere. She is also the author of Diabetes & Keeping Fit for Dummies. A professor emerita of exercise science from Old Dominion University and an internationally recognized diabetes motion expert, she is the author of 12 books, 28 book chapters, and over 420 articles. She was honored with the 2016 American Diabetes Association Outstanding Educator in Diabetes Award. Contact her via her websites (SheriColberg.com and DiabetesMotion.com).

 

Jovina cooks seafood: Stuffed sole fillets

Stuffed Sole Fillets
Stuffing Ingredients
4 large shrimp, peeled, deveined, tails removed, finely chopped
1 tablespoon olive oil
1 scallion, minced
1 medium garlic clove, minced
½ celery stalk, finely chopped
1 mini bell pepper, finely chopped
1 tablespoon fresh parsley, minced
1 tablespoon chopped chives
Salt and pepper
½ oz oyster crackers crushed (optional)
Fish
12 oz sole fillets
Lemon juice
Butter
Directions
Preheat oven to 400°F. Coat a baking dish just large enough to hold the fish with olive oil cooking spray.

Combine the filling ingredients in a medium mixing bowl. Spread the filling evenly over each fillet and add a few drops of lemon juice over the stuffing.

Roll each fillet, jelly-roll fashion, and skewer it with toothpicks and place in the prepared baking dish.

Dot each roll-up with butter and cover the baking pan loosely with foil. Bake for 10 minutes. Then remove the foil and bake for a further 10 to 15 minutes till the fish flakes with a fork so you know it is ready.

Stress may damage your immune response long term

Adapted from: Stress related disorders and physical health.  Song H. et al. BMJ 26 Oct 19.

This Swedish study of almost 145,000 brothers and sisters showed that any sort of anxiety or stress disorder was associated with an increased risk of life threatening infections, even when familial background, physical and psychiatric problems were adjusted for.

The study went on between 1987 and 2013. The stresses included post traumatic stress disorder, acute stress reaction, adjustment disorder and others. The patients were matched with healthy siblings when possible or matched comparative children from the general population.  They then looked for diagnosis of severe infection in the coming years such as sepsis, endocarditis, meningitis and other infections.

Severe infection rates per 1,000 person years were 2.9 for the stressed person, 1.7 for the healthy sibling, and 1.3 for the matched person in the general population.

They found that the effects were worse the earlier the age the diagnosis of the stress occurred.

Treatment with serotonin re-uptake inhibitors for PTSD seemed to reduce the negative effects on the immune system when given within a year of the stress diagnosis.

This research builds on information that PTSD produces more gastrointestinal, skin, musculoskeletal, neurological, heart and lung disorders.  Cardiac mortality has been found to be raised 27% and autoimmune disorder by 46%.

Why this happens could be due to the interplay between biological, psychological and social factors. Increased inflammatory response is considered by Song and colleagues to be a likely mechanism. Increased levels of interleukin 6, interleukin 1 beta, tumour necrosis factor alpha and interferon gamma have been found in those with PTSD.

PTSD has a heritability factor of 5-20% which is similar to what is found in families with depression.  It is likely to be polygenic.

Talking based therapies are generally even better for PTSD than drugs, so earlier intervention may have long term benefits not just on mental health, but physical health as well.

BMJ 2019;367:16036

Fitter, better, sooner

From BJGP May 2020 by Hilary Swales et al.

Having an operation is a major event in anyone’s life. There is a lot a patient can do to improve their physical and mental health before surgery that will improve their recovery and long term health.

Fitter, better, sooner is a toolkit was produced by the Royal College of Anaesthetists with input from GPs, surgeons and patients.

The toolkit has, an electronic leaflet, an explanatory animation and six operation specific leaflet for cataract surgery, hysteroscopy, cystoscopy, hernia, knee arthroscopy and total knee joint replacement.

These can be seen at: https://www.rcoa.ac.uk/patient-information/preparing-surgery-fitter-better-sooner

The colleges want more active participation with patients in planning for their care.

The most common complications after surgery include wound infection and chest infection. Poor cardiorespiratory fitness worsens post op complications. Even modest improvement in activity can improve chest and heart function to some extent.  Keeping alcohol intake low can improve wound healing. Stopping smoking is also important for almost all complications. Measures to reduce anaemia also reduce immediate and long term problems from surgery and also reduce the need for blood transfusion. Blood transfusion is associated with poorer outcomes particularly with cancer surgery. HbA1Cs over 8.5% or 65 mmol/mol causes more wound complications and infections.  Blood pressure needs to be controlled to reduce cardiovascular instability during the operation and cardiovascular and neurological events afterwards.

This toolkit is already being used in surgical pre-assessment clinics but access to the materials in GP practices will also help. After all, the GPs are the ones who are initially referring the patients for surgery, and improving participation early can only be helpful.

It is hoped that this initiative will result in patients having fewer complications, better outcomes from surgery but also from their improved lifestyle.

 

Jovina bakes low carb: Banana bread

Banana Bread
Ingredients
1 banana
1 and 1/2 cups + 1 tablespoon almond flour (ground almonds)
3 eggs
2 tablespoon unsalted butter, melted
2 teaspoons cinnamon
1 teaspoon baking powder
1/4 teaspoon salt
1 teaspoon vanilla extract
1/4 cup low carb sugar substitute
1/2 cup finely chopped walnuts plus 15 walnut halves
Directions
Preheat the oven to 350 degrees F.
Mash the banana with a fork.
Process the eggs together with the mashed banana and the melted butter with a hand
blender or hand mixer to a smooth dough.
Mix the dry ingredients in another bowl. Pour into the bowl with the egg and banana
mixture and stir well.
Add the chopped walnuts and fold into the batter.
Line an 8-inch bread/loaf pan with baking paper/parchment with the paper extending over the ends of the pan. Coat lightly with cooking spray. Pour in the bread dough into the pan and place the walnut halves in five rows across the top of the dough.
Bake the bread for 45 minutes or until an inserted knife comes out clean. Check the bread after 30 minutes. If the top is brown, cover it loosely with aluminum foil to prevent the low-carb banana bread from burning.
Let the banana bread cool and then lift out with the aid of the parchment paper. Cool completely before slicing.

Take your blood pressure pills at night

Adapted from BMJ Take anti-hypertensives at night says study. Susan Major 2 Nov 19

Taking your blood pressure medication at night gives you better blood pressure control and nearly halves cardiovascular events and deaths compared to taking them in the morning.

This study was done on nearly 20 thousand patients with an average age of 60 for six years. The reductions in events included cardiovascular death, heart attacks, coronary artery revascularisation, heart failure and stroke.

Professor of cardiovascular medicine at Sheffield, Tim Chico said, ” As taking medications at bedtime poses little risk there is enough evidence to recommend that patients consider taking their medication at bedtime.”

Bariatic surgery doubles congenital abnormalities in babies

From BMJ 30 Nov 19

A retrospective analysis from Quebec of 2 million pregnant women who had delivered between 1989 and 2016 showed that offspring of women who had become pregnant after bariatric surgery had roughly twice the risk of birth defects compared to women who were not obese or who were obese but had not had surgery.

The defects were mainly heart and musculoskeletal defects.

My comment: This short report does not go into possible causes for this. You would have thought that the risk would have been reduced to the level of the non obese women. I wonder if nutritional issues have a part to play as after bariatric surgery long term vitamin supplements need to be taken. 

Jovina bakes low carb: Ricotta cheesecake

Ricotta Cheesecake
Makes one 8-inch square cheesecake, to serve 12
Cheesecake Ingredients
2 cups ricotta cheese
1 cup sugar substitute ( I use monk fruit)
1 teaspoon vanilla extract
6 eggs
Zest of 1 orange
Blueberry Topping
2 cups fresh or frozen blueberries (10 oz)
1/4 cup water
1 tablespoon lemon juice
3 tablespoons low carb sugar substitute
2 teaspoons cornstarch or arrowroot powder mixed with 2 teaspoons water
Directions

Preheat the oven to 375°F.
Grease an 8-inch square baking pan with butter or cooking spray.
In a medium bowl, stir together the ricotta and sugar. Add the eggs one at a time until well incorporated. Stir in the vanilla and orange zest. Pour the batter into the prepared pan.
Bake for 45 to 50 minutes, until set. Let cool in the pan on a wire rack for 20 minutes. Cover. Refrigerate overnight. Serve chilled with the blueberry topping.

Do you have a chronic disease or a long term condition?

Adapted from BMJ 23rd Nov 19. A chronic problem with language by Dr Helen Salisbury

Helen is a GP in Oxford she writes…..

Some years ago I was told the term “chronic disease” had been replaced by “long term condition”. When I asked my non medical friends about it, they thought that both “chronic” and “acute” both meant “severe”.  My comment: whereas they mean something more like “long lasting” and “short lasting” to a doctor.

So a chronic disease sounds like one likely to harm or kill you, whereas a long term condition sounds like something you live with but not die from. As doctors now copy patients into their letters, then perhaps we need to be more responsive to their beliefs?

Impaired renal function, from natural ageing is one of the problems that has arisen from the misunderstanding of the term “chronic kidney disease”.  It can cause people real worry because they imagine that they are a candidate for dialysis or death, yet they are unlikely to be affected symptomatically, nor is it likely to hasten death. Heart failure is another term that causes a lot of distress.

Sometimes doctors need to be precise in their speech and letters to each other so we can’t abandon all technical language.  Copying clinic letters to patients is good practice, even if patients sometimes struggle to understand them completely, because they have a record of the consultation and a chance to clarify the decisions made.

Sometimes we could use more lay terms to reduce confusion. Abandoning “chronic disease” is a good start.

 

 

Your brain needs 50g of glucose a day

Adapted from Richard Feinman’s Nutrition in Crisis 

We have all heard NHS dieticians and diabetologists telling us that we will die of brain failure or get severe brain damage when we go on low carb diets because the brain needs 130g of glucose a day.

We will typically remind them that the glucose does not need to be ingested since our livers are perfectly able to manufacture well over 130g of glucose a day, the process called gluconeogenesis.

Richard Feinman is a cell biologist and he has an even finer retort.

The 130g of glucose a day necessity was discovered by George Cahill. This was the amount of glucose that a brain uses in normal nutritional states. It is indeed the case that this glucose can be ingested or manufactured in the liver or both.

Under starvation conditions however, the brain will only use 50g of glucose a day.  In starvation, the utilisation of ketone bodies becomes more important for brain function.

Unfortunately, nutritionists picked up on the 130g of glucose a day message and have been repeating it ever since. Cahill is reported to have said that by the time he was aware of the simplified but inaccurate message, it was too late to stop it.

Thus, it is not always true that you need 130g of glucose a day for brain function and it is never true that this must be from dietary carbohydrate.

So, if you get the old chestnut thrown at you, you know what to say now!