If you are one of the many Americans with diabetes choosing to exercise, good for you! This can benefit you in many ways including reducing your hemoglobin A1c (an indicator that gives insight to blood sugar levels over a three month period), increase insulin sensitivity, and decrease risk for heart disease. Here are some recommendations from the American College of Sports Medicine for diabetics to keep in mind while exercising.
Check your blood sugar before exercise. If blood sugar is above 250 mg/dL, do not exercise until the level comes below 250 mg/dL. If blood sugar is less than 100 mg/dL, have a snack containing 10 to 20 grams of carbohydrate.
Keep an exercise log. On this log, record your pre-exercise blood sugar level, the time of day, medication/insulin administered, type of exercise, duration of exercise, and intensity level. Over time, this will help you to gain a better understanding of how certain types of exercise impact your blood sugar level.
Plan ahead. Knowing what type of exercise and how much you will do can help you to adjust any medications and insulin. Also, carry a 10 to 15 gram carbohydrate snack with you to eat/drink approximately every 30 minutes.
Adjust insulin dosages. Short- or rapid-acting insulin can be reduced by 50% to avoid hypoglycemic episodes. Be sure to get your doctor’s approval for this.
Exercise with a friend. This is especially important when beginning an exercise routine until blood sugar response is better known.
Wear a diabetic identification tag. Hopefully this would never be needed, but you wouldn’t drive a car without insurance, so don’t exercise without your tag! If something were to happen, this would help you to receive better care by anyone attending to your needs.
Wear comfortable shoes appropriate for activity. This helps to prevent injury.
Check your feet! Always do this whether you exercise or not. However, it is probably even more pertinent after exercise. You need to look for sores or any irritated spots and show them to your doctor if they occur.
American College of Sports Medicine. Guidelines for exercise testing and prescription, 5th edition. Baltimore: Williams & Wilkins: 2006.
Wednesday, May 26, 2010
Monday, May 24, 2010
Go ahead, eat the chocolate!
You liked that title, didn’t you? Sometimes we all get a craving for something less than healthy. If you think about it for days in and days out, aren’t you going to go crazy? You’re human and you shouldn’t be deprived of all of the things you love! In fact, I believe that when we deprive ourselves and feel deprived, we go overboard at some point eating more than “just a nibble” of our favorite, unhealthy foods.
If you are eating healthy 90% of the time, there is no reason that you can’t partake in a little indulgence here and there. Maybe if you let yourself have a little nibble of what you really enjoy, you won’t feel the need to go overboard because you know you can have it again soon. It all goes back to the old saying “everything in moderation”.
I just want to be clear that I’m not saying that is okay to eat a huge bowl of ice cream, quarter pounder cheese burger, French fries, and a bag of chips all in one day. This would be considered "going overboard". I’m just talking about small indulgences that satisfy your cravings. So, go ahead and enjoy!
If you are eating healthy 90% of the time, there is no reason that you can’t partake in a little indulgence here and there. Maybe if you let yourself have a little nibble of what you really enjoy, you won’t feel the need to go overboard because you know you can have it again soon. It all goes back to the old saying “everything in moderation”.
I just want to be clear that I’m not saying that is okay to eat a huge bowl of ice cream, quarter pounder cheese burger, French fries, and a bag of chips all in one day. This would be considered "going overboard". I’m just talking about small indulgences that satisfy your cravings. So, go ahead and enjoy!
Friday, May 21, 2010
A More In-Depth Explanation of Why Eating Often is Beneficial
Recently, a question came up from a reader on another website (go here to read the full post) about the validity that you should eat 3-6 meals daily. This individual referred to an article written in The New York Times touting that there is really no benefit to eating frequently. Instead of responding, knowing full well that some people just have their minds made up, I decided to post on my blog giving information to back up the reasoning behind frequent meals.
1. To be clear, I stated in my post that a minimum of 3 meals should be eating each day. The studies mentioned by The NY Times compared 3 meals to 6 meals. I do not believe that eating only 3 meals is detrimental; however, less than 3 meals is damaging. Not only for the reasons of increased fat storage and depletion of glycogen, but also because people overeat when they are deprived for long periods during the day. I have seen this in practice over and over again. I have had hundreds of patients who go all day without eating, and then tell me that they are so ravenous by the end of the day that they eat everything they can find. I have had some patients find that they are consuming several thousand calories in the evening. So yes, while the end result is calories in versus calories out, a) you are more likely to metabolize more calories per day with more frequent meals; and b) people who eat less than three times per day, typically eat more calories than they need in a day in one or two sittings.
2. Magazines, Newspapers, and other media present the research how they would like to present it. There is always a way to take portions of a study out of context and bend it to appear how you would like it. The people who write these articles are not always qualified to interpret research and advise others on it. Sometimes, the articles are written simply for “interesting reading”. To decide whether or not to take heed, check their credentials.
2. I did take a look at The NY Times article and the research that it was referring to. Notice that the author also mentioned a scientific study that did, in fact, show a metabolic advantage to eating small frequent meals. ( Jenkins, Wolever, Vuksan, Brighenti, Cunnane, Rao, Jenkins, Bucklye, Patten, Singer, et al. Nibbling versus gorging: metabolic advantages of increased meal frequency. N Engl J Med. 1989 Oct 5;321(14):929-34.) Part of the story is that, in science, many studies will be conflicting, so it takes a lot of analysis and MANY scientific studies before conclusions can really be drawn. To be honest, after looking at all three of the studies mentioned in the article, I don’t believe any of them were well designed. They all include an extremely small amount of subjects and they all look at different outcomes. Unfortunately, I was also unable to pull up the entire studies; however, looking at the abstract is much more telling than a line or two in The NY Times. However, I have a few more comments on the two studies that “disproved” the need for small frequent meals. One of the studies gave every subject the same amount of calories. Everyone surely does not have the same caloric needs; therefore, you will have some people consuming more than necessary and others consuming less. How can you conclude anything from that? The other study was only conducted for two weeks and it did, in fact, show a decrease in fat oxidation. Overall, it looks like better studies need to be completed.
3. Regardless of the fact that the above-mentioned studies were really not conducted well, classic studies do show that resting energy expenditure is, in fact, decreased during prolonged periods of not eating. In the first 24 hours of starvation, glycogen stores are depleted, so there is no “fat melting away”. Glycogen is stored with water, so when glycogen is used up, water loss occurs. This leads to…….weight loss! But not fat loss! Fat loss occurs in the later stages of starvation. In the early stages of starvation, fat is preserved. (Barton. Nutrition support in critical illness. Nutr Clin Pract 9: 127. 1994) Another study shows that resting metabolic rate does drop by as much as 15% within 2 weeks of inadequate food intake. (Ravussin, Swinburn. Effect of caloric restriction and weight loss on energy expenditure. In: Wadden TA, Van Ittalie TB (eds.) Treatment of the Seriously Obese Patient. New York: Guilford Press, 1992.)
4. When you are not eating often, you can think of insulin release like hills and valleys. This is unfortunate because it causes large fluctuations in blood sugar, which is not healthy for organs. Also, when insulin is peaking due to a large influx of food after fasting, fat storage is promoted.
Hopefully this post helped to clear up any possible confusion!
1. To be clear, I stated in my post that a minimum of 3 meals should be eating each day. The studies mentioned by The NY Times compared 3 meals to 6 meals. I do not believe that eating only 3 meals is detrimental; however, less than 3 meals is damaging. Not only for the reasons of increased fat storage and depletion of glycogen, but also because people overeat when they are deprived for long periods during the day. I have seen this in practice over and over again. I have had hundreds of patients who go all day without eating, and then tell me that they are so ravenous by the end of the day that they eat everything they can find. I have had some patients find that they are consuming several thousand calories in the evening. So yes, while the end result is calories in versus calories out, a) you are more likely to metabolize more calories per day with more frequent meals; and b) people who eat less than three times per day, typically eat more calories than they need in a day in one or two sittings.
2. Magazines, Newspapers, and other media present the research how they would like to present it. There is always a way to take portions of a study out of context and bend it to appear how you would like it. The people who write these articles are not always qualified to interpret research and advise others on it. Sometimes, the articles are written simply for “interesting reading”. To decide whether or not to take heed, check their credentials.
2. I did take a look at The NY Times article and the research that it was referring to. Notice that the author also mentioned a scientific study that did, in fact, show a metabolic advantage to eating small frequent meals. ( Jenkins, Wolever, Vuksan, Brighenti, Cunnane, Rao, Jenkins, Bucklye, Patten, Singer, et al. Nibbling versus gorging: metabolic advantages of increased meal frequency. N Engl J Med. 1989 Oct 5;321(14):929-34.) Part of the story is that, in science, many studies will be conflicting, so it takes a lot of analysis and MANY scientific studies before conclusions can really be drawn. To be honest, after looking at all three of the studies mentioned in the article, I don’t believe any of them were well designed. They all include an extremely small amount of subjects and they all look at different outcomes. Unfortunately, I was also unable to pull up the entire studies; however, looking at the abstract is much more telling than a line or two in The NY Times. However, I have a few more comments on the two studies that “disproved” the need for small frequent meals. One of the studies gave every subject the same amount of calories. Everyone surely does not have the same caloric needs; therefore, you will have some people consuming more than necessary and others consuming less. How can you conclude anything from that? The other study was only conducted for two weeks and it did, in fact, show a decrease in fat oxidation. Overall, it looks like better studies need to be completed.
3. Regardless of the fact that the above-mentioned studies were really not conducted well, classic studies do show that resting energy expenditure is, in fact, decreased during prolonged periods of not eating. In the first 24 hours of starvation, glycogen stores are depleted, so there is no “fat melting away”. Glycogen is stored with water, so when glycogen is used up, water loss occurs. This leads to…….weight loss! But not fat loss! Fat loss occurs in the later stages of starvation. In the early stages of starvation, fat is preserved. (Barton. Nutrition support in critical illness. Nutr Clin Pract 9: 127. 1994) Another study shows that resting metabolic rate does drop by as much as 15% within 2 weeks of inadequate food intake. (Ravussin, Swinburn. Effect of caloric restriction and weight loss on energy expenditure. In: Wadden TA, Van Ittalie TB (eds.) Treatment of the Seriously Obese Patient. New York: Guilford Press, 1992.)
4. When you are not eating often, you can think of insulin release like hills and valleys. This is unfortunate because it causes large fluctuations in blood sugar, which is not healthy for organs. Also, when insulin is peaking due to a large influx of food after fasting, fat storage is promoted.
Hopefully this post helped to clear up any possible confusion!
Wednesday, May 19, 2010
Cross-training is important....
1. To prevent boredom. Let’s face it; sometimes you need a little change! By switching up your workout often, hopefully you can keep interesting.
2. To prevent injuries. Because your body is moving in different ways with various types of exercise, so do your joints and muscles. Variation gives certain parts of your body a little rest and; therefore, decreases your risk for injury.
3. To make you a better athlete and make you more fit. Working muscles differently allows you to strengthen your “weakest link”, if you will. Always exercising the same way will only strengthen certain muscles, and only in a particular way. Changing up your routine allows you to challenge your muscles.
4. To possibly get you through a weight-loss plateau. When you exercise in one mode, whether it is running, walking, or riding your bike, your body becomes very efficient at that task. Challenging your body to a different type of exercise may allow you to burn more calories.
5. To find your favorite types of exercise. You never know if you’ll like something until you try it. You may just find out that you like biking better than running. However, you’ll never know if you only run!
2. To prevent injuries. Because your body is moving in different ways with various types of exercise, so do your joints and muscles. Variation gives certain parts of your body a little rest and; therefore, decreases your risk for injury.
3. To make you a better athlete and make you more fit. Working muscles differently allows you to strengthen your “weakest link”, if you will. Always exercising the same way will only strengthen certain muscles, and only in a particular way. Changing up your routine allows you to challenge your muscles.
4. To possibly get you through a weight-loss plateau. When you exercise in one mode, whether it is running, walking, or riding your bike, your body becomes very efficient at that task. Challenging your body to a different type of exercise may allow you to burn more calories.
5. To find your favorite types of exercise. You never know if you’ll like something until you try it. You may just find out that you like biking better than running. However, you’ll never know if you only run!
Monday, May 17, 2010
Sensible Eating
There are so many factors that contribute to our overweight nation that it is really complex and no one aspect can be completely to blame. However, I do feel that one of the complex issues is that we don’t listen to our body to tell us how much and when to eat. We’ve all been there! We’re at a party; the chips and dip look awesome even though we’re not hungry. After dinner, we’re full, but the chocolate cake looks amazing, so we manage to find some room in our bellies.
I think everyone can relate to this at one time or another. I know I have certainly been in those situations myself. In order to lose or maintain weight, the above situations need to happen infrequently. Your body knows when and how much fuel you need; and it doesn’t cost anything for that special feature! Going from ignoring your body’s signals to being very aware may take some time. Here are some ideas to get you started.
1. Consider keeping a food journal. Not only should you write down what you’re eating, but also write down how hungry you were before you started and how satisfied, full, overstuffed, or still hungry you are when you finish. It is helpful to jot down your mood too. After a while, you’ll really start to see a pattern, which may be helpful in making a change.
2. Every 15 minutes, or sooner if you’re a fast eater, stop and ask yourself how full you are. If you’re not sure, give yourself a little break from eating so that your body has a chance to get the signal of whether you’re satisfied or still hungry.
3. Remember that getting that “satisfied” or “full” signal may take up to 20 minutes. If you’re eating very fast, it is a great idea to slow down so that your body can “talk” to you before you overstuff yourself.
4. Forget about reaching your “full” mark and aim for “satisfied”. In other words, think about eating until you are no longer hungry, but not until you need to unbutton your jeans or become uncomfortable. When you have reached that point, you have consumed more food than you need.
5. Don’t ignore hunger signals. Just like you shouldn’t over eat, you should also not avoid eating when you are truly hungry.
I think everyone can relate to this at one time or another. I know I have certainly been in those situations myself. In order to lose or maintain weight, the above situations need to happen infrequently. Your body knows when and how much fuel you need; and it doesn’t cost anything for that special feature! Going from ignoring your body’s signals to being very aware may take some time. Here are some ideas to get you started.
1. Consider keeping a food journal. Not only should you write down what you’re eating, but also write down how hungry you were before you started and how satisfied, full, overstuffed, or still hungry you are when you finish. It is helpful to jot down your mood too. After a while, you’ll really start to see a pattern, which may be helpful in making a change.
2. Every 15 minutes, or sooner if you’re a fast eater, stop and ask yourself how full you are. If you’re not sure, give yourself a little break from eating so that your body has a chance to get the signal of whether you’re satisfied or still hungry.
3. Remember that getting that “satisfied” or “full” signal may take up to 20 minutes. If you’re eating very fast, it is a great idea to slow down so that your body can “talk” to you before you overstuff yourself.
4. Forget about reaching your “full” mark and aim for “satisfied”. In other words, think about eating until you are no longer hungry, but not until you need to unbutton your jeans or become uncomfortable. When you have reached that point, you have consumed more food than you need.
5. Don’t ignore hunger signals. Just like you shouldn’t over eat, you should also not avoid eating when you are truly hungry.
Friday, May 14, 2010
Surviving the heat without ditching your exercise routine this summer...
If you have access to an air-conditioned gym, or have equipment in your home, you are set this summer! If not, you may need to be a little bit more creative to beat the heat. One way to stay in-doors and get some exercise is to visit your local mall, or other large building that you have access to, and walk there. If all else fails, here is a list of tips for surviving your exercise outside this summer.
1. Exercise in a pool.
2. Take advantage of the cool air in the mornings by exercising before work or school.
3. Always be sure to hydrate. If you will be out for a while, find places to hide water bottles so that you can grab them on your way. Personally, I prefer to wear one of those running belts that you can store several small water bottles in. These can be purchased at running stores and some athletic stores.
4. Know that it takes about 1 week of daily exposure to heat before your body adapts. This doesn’t mean you won’t mind the heat, but you’ll cope with it better. Losing this adaptation takes a very short time, so you have to continue exercising in the heat often in order to maintain your adaptations.
5. Be smart and follow heat advisories. Do not go out in the middle of the afternoon for a nice little run when it is 100 degrees. Listen to your weatherman (and your body!) and either go out during the coolest part of the day, or find an in-door place for walking or running.
6. Wear appropriate clothing for the weather and your sport. Do not overdress!
7. Use sunscreen. Just because you’re not laying by the pool doesn’t mean you can’t get a burn. Be good to your skin!
Have a great and fit summer!
1. Exercise in a pool.
2. Take advantage of the cool air in the mornings by exercising before work or school.
3. Always be sure to hydrate. If you will be out for a while, find places to hide water bottles so that you can grab them on your way. Personally, I prefer to wear one of those running belts that you can store several small water bottles in. These can be purchased at running stores and some athletic stores.
4. Know that it takes about 1 week of daily exposure to heat before your body adapts. This doesn’t mean you won’t mind the heat, but you’ll cope with it better. Losing this adaptation takes a very short time, so you have to continue exercising in the heat often in order to maintain your adaptations.
5. Be smart and follow heat advisories. Do not go out in the middle of the afternoon for a nice little run when it is 100 degrees. Listen to your weatherman (and your body!) and either go out during the coolest part of the day, or find an in-door place for walking or running.
6. Wear appropriate clothing for the weather and your sport. Do not overdress!
7. Use sunscreen. Just because you’re not laying by the pool doesn’t mean you can’t get a burn. Be good to your skin!
Have a great and fit summer!
Wednesday, May 12, 2010
Tempo Training For Better Fitness
If you are looking for another way to improve your fitness, you visited on the right day! Tempo training is most often referred to as a tempo run, but you can apply it to any type of cardiovascular exercise. Tempo training is great when you only have 20 or 30 minutes for a workout, and you want to get the most out of that time.
In order to complete a tempo training session, you should be running (or whatever your sport) at a pace that is pretty strenuous and doesn’t allow you to carry on much of a conversation. You should be able to speak, but not in complete sentences. Although you should be working hard, this is not “race speed” or the fastest you can possibly run. When you finish, you should feel some relief, be proud, and feel that you got a great workout. You should not be passing out, vomiting, or feeling like you won’t get off the couch for the remainder of the day. I hope that description helps to shed some light on the proper intensity at which this workout should be completed.
So how does this tempo training work? Well, you should be working at an intensity that forces your body to breakdown nutrients for energy anaerobically, or without oxygen. When this is happening, the byproduct of this particular energy pathway is called lactic acid or lactate. Everyone has a threshold at which they can no longer process energy aerobically, so they must move to this other anaerobic pathway (anaerobic glycolysis for those of you who want the exact terms!). This threshold is called the anaerobic threshold or lactate threshold. So, theoretically, when you are tempo training your body should be working at its lactate threshold.
The results of training in this manner are a higher lactate threshold and better running economy. In simple terms, you can run faster and more efficiently. This type of training can be done about once each week.
Questions?
In order to complete a tempo training session, you should be running (or whatever your sport) at a pace that is pretty strenuous and doesn’t allow you to carry on much of a conversation. You should be able to speak, but not in complete sentences. Although you should be working hard, this is not “race speed” or the fastest you can possibly run. When you finish, you should feel some relief, be proud, and feel that you got a great workout. You should not be passing out, vomiting, or feeling like you won’t get off the couch for the remainder of the day. I hope that description helps to shed some light on the proper intensity at which this workout should be completed.
So how does this tempo training work? Well, you should be working at an intensity that forces your body to breakdown nutrients for energy anaerobically, or without oxygen. When this is happening, the byproduct of this particular energy pathway is called lactic acid or lactate. Everyone has a threshold at which they can no longer process energy aerobically, so they must move to this other anaerobic pathway (anaerobic glycolysis for those of you who want the exact terms!). This threshold is called the anaerobic threshold or lactate threshold. So, theoretically, when you are tempo training your body should be working at its lactate threshold.
The results of training in this manner are a higher lactate threshold and better running economy. In simple terms, you can run faster and more efficiently. This type of training can be done about once each week.
Questions?
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