“You don’t have to be great to start, but you have to start to be great”- Zig Ziglar
I owe a couple of really great people full credit for this blog post. I had such great intentions of writing every week, then I went to the South Pacific, school started for the kids again and I started taking 2 Masters classes so the blog fell by the wayside. Has this happened to you? Is there stuff you want to do, but there is always something in the way, something pulling your attention or something stopping you? That is why I absolutely love the quote above by Zig Ziglar…”You don’t have to be great to start, but you have to start to be great”. Only by starting will we truly know how great we can be.
Today is a great day to start. Why wait till next week, till next month, till next year? Are you looking to start exercising, start making better choices, start eating better, start getting more sleep or start working on stressful relationships?
Clearly, I am not the only one who needs a kick in the pants to get started. We all do from time to time and having a great community of people around us is essential.
So….Don’t Wait!!
Time to start being great.
Look for another blog post this week about stress and the horrible effects it has on our body as well as its risks to our health.
You’ve heard of diabetes, but what exactly is pre-diabetes and why does it matter? Many conditions begin to manifest themselves before they result in end organ damage. The job of wellness promotion and disease prevention is to recognize that prior to all of a sudden developing a disease, there is a “pre” period. So if there is a period prior to developing a disease, then there is a period to make some changes and potentially prevent that disease.
Though many diseases, including type 2 diabetes have genetic predisposition, it does not mean that diabetes is built into your genetic code. Think of DNA (the genome) as the blueprints and directions on how to make a house while epigenetics (the epigenome) are like the contractor who can decide to change those plans and put in an extra window or two. Epigenetics do not change your DNA, but they do alter how the DNA is utilized and can turn certain genes on or off, giving a different phenotype (the observable characteristics). Check out this fact sheet from the National Institute of Health’s, National Human Genome Research Institute for further discussion of epigenetics. I just wanted to introduce the idea, because what we do or do not do to our bodies changes our epigenome, which then changes the expression of our DNA. Just more evidence that lifestyle really is important when it comes to living well.
As a reminder, type 2 diabetes mellitus is a disease in which we have abundant insulin (at least at first), but we are insulin-resistant, meaning our tissues are not using insulin correctly. Almost all of our cells use glucose for energy and require insulin to get glucose into the cells. If the tissues cannot utilize that insulin, glucose cannot get into the cells, resulting in high levels of sugar in the blood stream and little in the cells that need it. The kidney filters our blood stream and when there is a high level of sugar in the blood, the kidneys help to get rid of it. As the kidneys get rid of sugar, excess water goes with it; this is why a person would have symptoms of frequent urination, thirst (from dehydration), dry skin (fluid moving out of cells to balance the high sugars) and fatigue (just not enough energy).
For just a second, think of a science experiment you may have done as a child; making sugar crystals by putting sugar into water and making a supersaturated solution. The sugar crystalizes on the string as the water evaporates and voila, there you go, Rock Candy! Now, think about that same science experiment happening in your cells and tissues. Certainly the process is more complex, but I hope you are starting to see the point. Too much sugar can wreak havoc on all of our body systems. Think of all the tiny blood vessels as those strings with the sugar on them. Where you find those tiny vessels, you find the long term complications from uncontrolled diabetes: kidney failure, blindness, and nerve damage (numbness and tingling in fingers and toes).
So….if we know that according to the CDC and American Diabetes Association, there are 29.1 million Americans with diabetes and there are 1.4 million Americans diagnosed every year. Shouldn’t we do something about it? As a nation we spend $250 billion dollars every year with newer estimates over $300 billion. I ask you, how can we sustain this? Shouldn’t we focus on prevention, rather than trying to care for this after the fact?
Pre-diabetes essentially is having an elevated blood sugar that is outside the normal, but not quite high enough to meet the definition of diabetes. We find that people can have elevated blood sugars for years before they are officially diagnosed with diabetes and are already beginning to show signs of the long term complications.
I recently heard a radio ad that prompted me to write on this topic. The radio ad was asking you to count your risk factors on your hands and as I listened further it provided the website DoIHavePrediabetes.org. You can go to this website and check out your risks.
Risk factors for pre-diabestes and subsequent diabetes (from CDC website):
age, especially after 45 years of age;
being overweight or obese;
a family history of diabetes; having an African American, Hispanic/Latino, American Indian, Asian American, or Pacific Islander racial or ethnic background;
a history of diabetes while pregnant (gestational diabetes) or having given birth to a baby weighing nine pounds or more;
being physically active less than three times a week
You can change the course of your life and prevent illness. There are many resources for lifestyle changes and the government is well aware that we need to change our focus from reactive to proactive when it comes to health and wellness.
We will continue to explore this topic on my blog as I am very passionate about it, just think if we could prevent or significantly decrease the incidence of diabetes we would all be better off.
Things you can do:
Maintain a healthy weight
Lose weight if you are overweight, even 10 to 15 pounds is significant for reducing risks
Increase physical activity. This doesn’t have to be exercise, just get active by walking more, taking the stairs, stand at your desk instead of sit, count your steps, etc.
Eat healthier. We are eating for life, so give yourself the benefit of wholesome delicious ingredients. This is not a diet and it is NOT punishment.
Decrease highly processed foods, these generally have a lot of sugars, saturated fats and chemicals.
Quit smoking. I know it is hard, but try. I’m sure you have tackled hard things in your life. As Winston Churchill said.. “If you’re going through Hell, keep going.”
There are so many opinions and controversies on carbohydrates, wheat, full fat diets, vegan, Paleo, etc. Don’t worry, we’ll address these and much more.
I’ll be going on a trip to Australia, New Zealand and Fiji and will be away for a couple of weeks. I’ll write more when I get back and hope to share some insights about what other countries are doing to maintain a healthy lifestyle.
Thanks for stopping by and always, Live Well!
References
Epigenomics Fact Sheet from the National Human Genome Research Institute. https://www.genome.gov/27532724/epigenomics-fact-sheet/
Facts about Type 2 http://www.diabetes.org/diabetes-basics/type-2/facts-about-type-2.html?loc=db-slabnav
About Diabetes. World Health Organization http://www.who.int/diabetes/action_online/basics/en/index3.html
2014 National Diabetes Statistics Report http://www.cdc.gov/diabetes/data/statistics/2014StatisticsReport.html
Statistics about Diabetes http://www.diabetes.org/diabetes-basics/statistics/
Yes, it is me. I was a prior sugarholic! Anyone else want to fess up to this? I have exercised and have been active all my life but like many of you, I LOVE to eat and previously the sweeter the better. A few years ago, when my family and I first moved to Alaska, we noticed the price of things was much higher than back home. So rather than buying birthday cakes and cupcakes, I would make my own. I got really good at making my own butter cream icing and fondant. I didn’t necessarily feel bad and didn’t think there was anything wrong with this.
I was never a big regular soda drinker, but really loved Diet Coke and would drink several a day. We would buy in bulk at Costco and run out before the next shopping trip. So what happened? When and why did things change? Well as you come to know me better, you will find out that I would never ask anyone to do something I was not willing to do myself. So recommending that patients cut out sugar seemed such a simple task. You know it is bad for you, so just cut it out. Not so easy, right? So when I looked at how much sugar/ artificial sweeteners I was taking in, I knew I had to make a change. The other thing that really bothers me is the craze of artificial everything in our food. Is there some connection with the health of the world and the artificial ingredients, flavors and colorings we ingest every day? So I have been on a mission to eliminate what I call “the chemicals” in our food. Why can’t we eat real natural food that is delicious without a bunch of additives?
So now that you know that this is something I’ve personally dealt with….let’s talk sugar and changes to food nutrition labels.
You may have heard of the article that discusses the obesity rates in the United States that was published this week in The Journal of American Medical Association (JAMA) (1). This study analyzes data from the National Health and Nutrition Examination Survey (NHANES) and shows that the prevalence of obesity in adults from 2013 to 2014 was 35% in men and 40.4% among women and the rate of class 3 obesity (body mass index of 40 to 49.9) was 5.5% in men and 9.9% in women, which is an increase in the rate of obesity for women, but not for men.
As for children and teens, the obesity rate decreased for children ages 2-5 but really did not change much for other age groups in the analysis 1988-1994 through 2013-2014 (2). Not great news considering the increased national attention to increasing physical activity and changes to the school lunch program.
So what? How does this affect us? What do we do with this information? Is there any hope to this epidemic of obesity, heart disease, diabetes, stroke, heart failure and cancer?
Per the National Center for Health Statistics in 2014, the estimated life expectancy for men is till age 76.4 and for women till age 81.2 (3). So statistically we are living longer, however, that does not mean we are living better. It is estimated that about 75% of the chronic diseases we face are lifestyle related. This means how we eat, exercise, relax (or don’t), sleep (or don’t) and play can and truly does affect our health outcomes.
Again, I ask…what to do? Do you wait for the government to do something or do you take a personal approach to improve or maintain your health?
But dieting is hard you say…. I couldn’t agree with you more. We should STOP dieting!
Really, you heard me correctly… STOP Dieting.
Every diet has special rules, when you mess up and don’t follow the rules, frustration sets in. Because you had a bad day at work or a late night at a school function and go off the wagon, doesn’t mean you need to beat yourself up.
It seems the current trend is to eat naturally. If you haven’t heard of him before, I suggest you take a look at Michael Pollen and his book “Food Rules”.
Photo Courtesy of Amazon.com
This small easy to read book really helps to hammer out some easy to follow rules when it comes to food. One of my personal favorites is that “you can eat anything you want as long as you make it from scratch.” Let’s think about this…How often would you find yourself eating biscuits, donuts, ice cream, potato chips, M&Ms etc, if you had to make it all yourself.
The basic premise for most nutritionists and real life people is to try to eat nutrient dense whole foods while restricting less calorie dense items. What a minute..restrictions…sounds like a diet. No…restrictions are like common sense. You wouldn’t go outside in zero degrees with a bikini on, right? Is that a clothing diet or just common sense? What if you couldn’t limit your children’s time on electronic devices? Is that a parenting diet or just common sense? I think you understand what I am trying to say. Restrictions are a part of life. If you do anything without limits there will be consequences and we (all of us) must start to take responsibility. We are the masters of our domain and must make responsible choices everyday.
There are so many different “diet” choices and the reality is that you have a life to live, remember. At least until your late 70’s, some into the 80’s and some into the 90’s and above. So stop dieting and start living.
Thank you for visiting the blog, there is so much information I want to share and I hope we’ll grow and learn together. I’m excited to hear about your progress with last week’s commitment. Do you get in more physical activity? Have you set some goals yet? I hope you have, if not it is never too late.
I have been running all week, though one day I did just walk, in all honesty my legs were a little sore.
Will you commit to thinking before you eat this week? Consider eating wholesome foods and restricting highly processed and sugared foods? Did you know there will be new nutritional labels coming soon? Take a look at a food label, do you see total sugar listed in the top section (not the ingredient section)? We’ll talk about that next time.
Don’t forget to subscribe to Wellness Updates (top right of the blog) so you’ll be notified of new content and not miss out on the conversation.
Live Well,
Dr. A
References
1. Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. Trends in Obesity Among Adults in the United States, 2005 to 2014. JAMA. 2016;315(21):2284-2291.
2. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of Childhood and Adult Obesity in the United States, 2011-2012. JAMA. 2014;311(8):806-814.
3. Health United States, 2015. US Department of Health and Human Services Center for Disease Control, National Center for Health Statistics http://www.cdc.gov/nchs/data/hus/hus15.pdf#019
Exercise truly is better than medications. Name one medicine you can take with the following benefits:
Reduces depression
Decreases the risk of falls
Reduces the risk of early death
Reduces the risk of several cancers including colon and breast cancer
Decreases the risk of stroke, coronary artery disease, hypertension, diabetes and metabolic syndrome
Decreases all cause mortality (meaning all reasons for death)
And the following “nasty side effects”
Increases memory
Increases energy and functional fitness
Improves life expectancy, quality of life, sleep quality and bone density
Increases chance for weight loss and maintenance
When you get a chance, take a look at the Exercise is Medicine fact sheet. Exercise is Medicine (EIM) was formed by the American Medical Association (AMA) and the American College of Sports Medicine (ACSM) as an initiative with the purpose to “make the scientifically proven benefits of physical activity the standard in the U.S. healthcare system.” The vision is to assess every patient’s level of physical activity, determine if the patient is meeting the U.S. National Physical guidelines and provide patients with counseling to help meet the guidelines or refer them to community based resources.
Well now that you know this, why wait for the physician to tell you what to do? Are you active enough? Do you get the recommended amount of exercise? Did you know that there are guidelines for exercise?
The most current guidelines for physical activity are from 2008 and discuss the benefits of physical activity and what it means to be an active teen, adult and older adult.
The guidelines say for essential health benefits:
Adults should do at least 150 minutes (2 hours and 30 minutes) a WEEK of moderate-intensity activity,
Brisk walking, dancing, gardening, housework, etc.
OR 75 minutes (1 hour and 15 minutes) a WEEK of vigorous-intensity aerobic physical activity,
Running, walking up a hill, fast cycling, aerobics, swimming, etc
OR an equivalent combination of moderate and vigorous intensity aerobic activity
Kids should get at least 60 minutes of physical activity daily.
See the table from The World Health Organization below for examples of moderate and vigorous intensity exercise:
The GREAT news is that physical activity can be separated into intervals and do not need to be completed all at once, even short intervals count. It all adds up. A great book by Michelle Segar, No Sweat, discusses something called “Opportunities to Move” or “OTMs”. These opportunities all add up. She discusses how walking from the parking lot to the store is an opportunity as is taking several trips from the car to the house to bring your groceries inside. Stop thinking about exercise as work and consider it play or a reward for your body. This is a wonderful book that talks about our motivations. If you continually set yourself up in a vicious cycle, only to consider yourself a failure you need to read this. I have no financial interest in the book, I just think it is easy excellent reading that can help motivate us all and change our behaviors.
This February, Stanford Center on Longevity and TIME magazine released a survey of 2,300 adults showing that 77% of Americans want to live to 100. The problem is, as a society we are not putting our money where our mouth is. We are not prepared! Chronic disease, illness, stress and financial insecurity will keep us from reaching that goal. But, what if you lived in a “Blue Zone”? Take a minute and imagine a place where people lived to 100, where family is first and where better lifestyle habits are priority. Well, this is happening in the following communities: Ikaria, Greece; Okinawa, Japan; Ogliastra Region, Sardinia; Loma Linda, California and Nicoya Peninsula, Costa Rica. Author and National Geographic fellow, Dan Buettner, writes about Blue Zones in his book, “The Blue Zones”, “Thrive” and “The Blue Zones Solution” (www.bluezones.com). Dan lists 9 things, the “Power Nine” that each of the communities he studied had in common. If we all could do these 9 things, we’d be living in a “Blue Zone” and be living well.
Move Naturally: Live in a environment where you grow things, move within your home and walk/ bike to work or the store.
Purpose: Live with intention, what do you live for? Having a sense of purpose is “worth up to seven years of extra life expectancy.”
Downshift: Chronic inflammation can lead to stress, so have a routine that sheds it! Meditate, relax, take a nap, walk with friends, journal, appreciate the small stuff, etc.
80% Rule: repeat the phrase “Hara hachi bu“, go ahead, say it again “Hara hachi bu”. This is a reminder to stop eating when the stomach is 80% full. Imagine how much fewer calories we would consume if we followed this rule.
Plant Slant: Beans are the main source of diet and decrease meat intake in the Blue Zone. Those in Blue Zones ate only 3 to 4 ounces of meat (the size of a deck of cards) on average of 5 times per month.
Wine @5: moderate and regular wine intake of 1 to 2 glasses per day with friends/ food was important is the Blue Zone communities. Of course they can’t all be saved up for a weekend binge. And if you do not already drink, I am not recommending you start. Discuss that with your physician.
Right Tribe: Of course you probably have heard, “You can’t choose your family”. We do know you can choose your friends. The Blue Zone communities have social networks that support a healthy lifestyle. What if you could influence your friends and family to live like the Blue Zone? Think about the changes we could make if we all did that.
Community: Faith based communities are important in the Blue Zones. All but 5 of the 263 centenarians interviewed had a religious based community. I’m not saying you must do this, but could it be the faith itself or the social weekly interaction, you decide.
Loved Ones First: So many self help experts will say this. Is it true? In the Blue Zones, keeping aged parents and grandparents nearby helped not only the elders, but also the children, who where the caretakers, live longer.
So, this week, what can you commit to? Maybe you don’t live in a Blue Zone, but what if you made small steps in that direction, how would your life be different? I’d love to hear your comments.
Live Well,
Dr. A
Resources:
Buettner, Dan. The Blue Zones Solution: Eating and Living like the World’s Healthiest People: National Geographic Society, Washington, DC 2015. Print.
Hi, my name is Angela Alfaro MD and by training I am a family physician, by profession a doctor, teacher, listener and counselor and by passion a wife, a mother of 4 very active children and a wellness advocate.
Like many of you I have struggled with finding my passion and purpose in life, you may think that is odd, considering I am a doctor, but it is very true. We all struggle and have ups and downs but we all are working toward something. There are many sites on finding your passion and happiness and I will refer to those from time to time, this blog is not intended to replace those. This blog comes after years of thinking, worrying, writing and worrying some more, but not doing. Now is the time to do.
My passion for writing this blog comes from many experiences as a physician, as a mother trying to teach her children healthy habits and as a woman getting older and appreciating how important healthy aging is.
Before you roll your eyes, hear me out.
