The Glucose Club's Blog

Posted 1st July, 2010 in "Wellbeing" from Sydney Morning Herald

http://www.smh.com.au/lifestyle/wellbeing/big-food-and-you-rules-for-a-healthy-life-20100701-zp5p.html

Would you have thought a can of Coke and a "97% fat-free" yoghurt had the same amount of sugar in them? If you didn't, well that's OK - you're not alone. This article looks at how "healthy" diets and "healthy" foods can be doing us more harm than good!

"Michael Pollan is desperate to end our addiction to processed food. Jon Henley hears why

Michael Pollan, tall, fit, not quite skinny but very definitely lean, is holding a fruit yoghurt in one hand and a Coca-Cola in the other.

"So," he says, "which do you think, per 100 grams, contains more sugar?"

The Coke, I reply. Duh.

"Wrong," he says. "The yoghurt. And look, it's low-fat. Isn't that great? We're getting fat on low-fat food."

It's a nice illustration of Rule Nine in Pollan's magnificently sensible new book, Food Rules.

Along with such gems as "Don't eat anything your great-grandmother wouldn't recognise as food" and "Don't get your fuel from the same place your car does", Pollan recommends that you "Avoid food products with 'lite' or 'low-fat' or 'non-fat' in their names."

His reasoning: if you remove the fat from a foodstuff, it doesn't necessarily make it non-fattening.

Certainly not if the producer ratchets up the sugar content to compensate.

In fact, Pollan notes, since Americans began producing low-fat food products, they have been consuming up to 500 extra calories a day. Brilliant.

Pollan, an award-winning author, journalist and campaigner, is on a mission.

Food Rules is, in effect, a condensation of his previous work: much of the science behind these 64 deliberately catchy injunctions towards a healthier diet ("The whiter the bread, the sooner you're dead") has already been expertly dissected in his earlier books The Omnivore's Dilemma and the US bestseller In Defence of Food.

The rules spring from two facts.

The first is that people who eat what Pollan defines as a western diet ("lots of everything except vegetables, fruits and whole grains") tend to suffer from western ailments: obesity, type 2 diabetes, cardiovascular disease and cancer.

The second is that people who eat more traditional diets - including those of certain indigenous peoples - that, by the lights of western food science, might be considered way too high-fat, high-carb or high-protein, do not tend to suffer from these diseases.

In other words, people can thrive on a wide variety of foods and diets, with one major exception: the diet most of us in the west are now eating.

So why are we eating our way to death?

Because for big food manufacturers, the western diet is payday, every day.

"The more a food is processed, the more profitable it gets," says Pollan, who refers to these products as "edible food-like substances".

And that status quo is not challenged by modern food science, which is all about identifying the "good" and "bad" nutrients in processed foods and tinkering with them - by lowering the fat, for example, or fortifying the vitamins - rather than questioning the value of processed food products in the first place.

"We don't talk about food any more," says Pollan.

"We talk about nutrients, omega-3, antioxidants, saturated fats, polyphenols. And so we play into the hands of the food marketers."

This all has the crushing logic of truth.

But can we do anything about it?

Pollan has little faith that Big Food will change voluntarily: legislation will be needed, he fears, although he takes heart from the Obama administration's victory on healthcare reform in the US.

"Pretty soon," he explains, "the insurance industry is going to realise that we have to tackle obesity and type 2 diabetes.

"They might even come out in favour of taxes on soft drinks. And once we see one powerful industry pitted against another, then we might see progress."

The complication of food has been under way for a long time now.

After agriculture became more productive following the second world war, "corn and soy and wheat and rice got cheaper - and the only way to make money out of them was to process them.

"A sort of arms race started to make food more complicated: don't buy flour, buy cake-mix; don't buy cake-mix, buy cakes.

"Don't buy oats, buy Cheerios; not Cheerios, cereal bars."

Is that process reversible?

It may have to be, Pollan argues, as we start running out of fossil fuels.

Big Food as it exists today is, patently, not sustainable.

Pollan is sure we can produce enough real food, but fossil fuels will have to be replaced by manpower.

"Organic farms are wildly productive," he says, "but a lot more labour-intensive.

So convincing is Pollan's logic that you wonder where it all came from.

He started out, he says, as more of a naturalist than a foodie, but was gradually won over by the notion that "what happens on our plate represents our most powerful engagement with the natural world".

He no longer eats junk food (though his teenage son does).

He acknowledges, though, that many of the exchanges he has about this issue "are with skinny people".

An interest in good food is, still, something of a middle-class preoccupation.

"But abolition, women's suffrage, those movements began as elitist too," Pollan says. "I won't be discouraged."

The Guardian"

Will free Lap-band surgery fix the obesity or diabetes epidemic?

Posted by Christine Armarego AEP

Yesterday the media headlines were “Free Fat Surgery”! It related to a story about a government report which makes recommendations to the Australian Government on how to tackle the obesity crisis that costs $58 billion last year.  

One of the recommendations is for gym memberships to be subsidized.  Now this is certainly a step in the right direction especially with the GFC forcing people to make decisions based on money in the short term rather than the cost to their health in the long term.  However for many of the clients we see in “The Glucose Club” they get greater benefit from more individualized sessions rather than simply purchasing a gym membership, as this doesn’t guarantee attendance or weight loss.  Having caring, supportive and educated Allied Health professionals available who understand behavior change and are experienced in designing individualized programs, specifically if the person has injuries or a chronic health condition will make weight loss more likely.  Also not every one is interested in going to a gym – what about out-door training or a pool membership?  The government could also consider increasing the number of Enhanced Primary Care plan sessions available from 5 to 10 per year, allowing for more personalized care of those at greatest risk of developing morbid obesity.

They also recommend that Bariatric or Lap-banding surgery be subsidized by the government.  While this type of surgery is beneficial to those who are morbidly obese and who cannot exercise, there still needs to be education on nutrition and exercise and assistance in how to change these lifestyle habits to prevent the person falling into old habits. Surgery is only half the battle and it’s surgery plus support through lifestyle changes that is successful.  And bear in mind surgery has it’s own risks, including unsuccessful or procedures that need to be repeated.

I think the main problem is that the report is looking at ways to reduce weight – but have forgotten that the science shows that being fit is more important than being thin – and that is where their focus should be!  Being fit improves your glucose and insulin interaction and prevents metabolic health problems such as diabetes. Feel free to leave your comments below!

Posted by Christine Armarego
Taken from http://www.sciencedaily.com/releases/2009/02/090212161819.htm

Fructose-sweetened Drinks Increase Nonfasting Triglycerides In Obese Adults

ScienceDaily (Feb. 12, 2009) — Obese people who drink fructose-sweetened beverages with their meals have an increased rise of triglycerides following the meal, according to new research from the Monell Center.
"Increased triglycerides after a meal are known predictors of cardiovascular disease," says Monell Member and study lead author Karen L. Teff, PhD, a metabolic physiologist. "Our findings show that fructose-sweetened beverages raise triglyceride levels in obese people, who already are at risk for metabolic disorders such as cardiovascular disease and diabetes."

Triglycerides are manufactured by the body from dietary fat and are the most common form of fat transported in blood. Although normal levels of triglycerides are essential for good health, high levels are associated with increased risk for atherosclerosis and other predictors of cardiovascular disease.

In the study, published online by the Journal of Clinical Endocrinology and Metabolism, Teff and her collaborators studied 17 obese men and women. Each was admitted two times to the Clinical and Translational Research Center at the University of Pennsylvania. On each admission, the subjects were given identical meals and blood was collected from an intravenous catheter over a 24-hour period. The only difference was the sweetener used in the beverages that accompanied the meals; beverages were sweetened with glucose during one admission and with fructose during the other.

Blood triglyceride levels were higher when subjects drank fructose-sweetened beverages with their meals compared to when they drank glucose-sweetened beverages. The total amount of triglycerides over a 24-hour period was almost 200 percent higher when the subjects drank fructose-sweetened beverages.

Although fructose increased triglyceride levels in all of the subjects, this effect was especially pronounced in insulin-resistant subjects, who already had increased triglyceride levels. Insulin resistance is a pre-diabetic condition often associated with obesity.

"Fructose can cause even greater elevations of triglyceride levels in obese insulin-resistant individuals, worsening their metabolic profiles and further increasing their risk for diabetes and heart disease," said Teff.

Fructose and glucose are forms of sugar found in both table sugar (sucrose) and high fructose corn syrup. Both fructose and glucose are present in lower concentrations in many fruits and vegetables. Although fructose tastes much sweeter than either glucose or sucrose, it typically is not used alone as a sweetener.

Future work will seek to determine how much fructose is needed to cause an increase of triglyceride levels when it is combined with glucose in beverages. Additional studies will explore the metabolic and health effects of long-term fructose intake.

In addition to her appointment at Monell, Teff serves as Associate Director for Translational Research at the Institute for Diabetes, Obesity & Metabolism, University of Pennsylvania School of Medicine.

Also contributing to the study were Peter Havel from the University of California, Davis and his colleagues Kimber Stanhope, Nancy Keim, and Bethany Cummings; Sean Adams, Ryan Grant, and Tamara Dunn from the USDA Western Human Nutrition Center; Joanne Grudziak from Monell; and Raymond R. Townsend from the University of Pennsylvania.

It’s always in the papers and on TV – Childhood obesity.  It’s in epidemic proportions and not much seems to be slowing it. The great concern is that over weight children lead to overweight adolescents and in turn overweight adults. According to David Menschik, MD, MPH, from Johns Hopkins University in Baltimore "It is generally accepted that increased physical activity, independent of weight status, has many healthful effects throughout the lifespan, including increased bone mineral density, improved lipid profile, increased cardiovascular endurance, improved glucose metabolism, increased muscle strength, and lower blood pressure. In adolescents, increased physical activity has been linked to lower tobacco and marijuana use, less television watching, higher fruit and vegetable consumption, less depression, closer relationships with parents, and decreased social marginalization.”

One study has found that adolescents who are regularly physically active show less risk of becoming overweight as young adults – doesn’t sound like rocket science right?  True, but the study shows some interesting relationships that might help people – teachers and parents alike, to take action and help to prevent their children falling into the overweight category. They found that each weekday that adolescents participated in Physical Education reduced the odds of being an overweight adult by 5%. This is a very clear indication of the importance of school-based activities.  How many PE sessions per week does your child or teen participate in?  

The authors are very clear about the regularity of PE sessions in maintaining normal adolescent body weight rather than weight reduction. Also they found that activities such as rollerblading, cycling, skateboarding and sports such as baseball, softball, basketball, soccer, swimming, and football were all associated with a lower prevalence of overweight as young adults. Activities such as gymnastics, dancing and jogging and walking didn’t show a strong relationship.  Perhaps it is the intensity, competition, duration and the capacity to participate in these activities in a local adult competition in a social setting that sets it over and above the second list.

Essentially the message seems to be that getting kids moving as a part of their everyday routine in sports or activities that they can continue into adulthood is the key to maintaining healthy weight and activity levels and schools seem to have a large role in this.  Other studies from the UK (Sacher et al 2006) specifically targeting children are working together with parents to give them the tools to help children change their eating and activity habits and theirs in the process.  They have shown significant decreases in waist circumference and body mass index and improvements in their hours of physical activity.

Posted by Christine Armarego
References:
1.Laurie Barclay, Désirée Lie, MD, Brande Nicole Martin Arch Pediatr Adolesc Med. 2008;162:29-33.
2. Sacher PM, Chadwick P, Kolotourou M, Cole TJ, Lawson M, Singhal A. The Mend RCT: Effectiveness on Health Outcomes in Obese Children. International journal of Obesity. 2007 31 S1

Becoming pregnant catapults you into a whole new world. There are so many things to consider, what name to choose, nursery colour scheme, what pram will suit all your needs and the all-important one do you tough it out and have a natural birth or do you cruise through with chemical support. So many things to consider and such little time! One thing that is rarely on people’s pregnant radar is how are your blood glucose levels going? Gestational diabetes is a very real concern for more and more women. Between 3 and 8% of pregnant women will go on to develop Gestational Diabetes in the second and third trimesters of pregnancy (around 24 to 28 weeks).

Gestational Diabetes is a temporary form of diabetes where women have difficulty managing their blood glucose levels. What causes it? Some of the hormones produced by the placenta are thought to interfere with the action of insulin (a hormone that carefully controls our glucose levels) so that the mother’s body becomes “resistant” to insulin. When the body becomes resistant to insulin, glucose levels no longer stay stable and tend to fluctuate.

It must be noted that Gestational Diabetes is very different to someone that had diabetes and then became pregnant. Gestational Diabetes is temporary and usually goes away after the baby is born.

Gestational Diabetes does leave you at risk of some other conditions. First of all women who develop Gestational Diabetes are at a greater risk (30 to 50%) of going on to develop Type 2 diabetes later in life. They are also thought to be of greater risk of developing pre-eclampsia (high blood pressure during pregnancy). In terms of the effect on the baby, babies are often born at a heavy birth weight and this is due to the high levels of insulin in the baby’s blood stream. High insulin levels turn the body into storage mode and leads to weight gain.
 
Who is at risk?
•    Women over the age of 35 years
•    Have previously had Gestational Diabetes
•    Have a family history of diabetes
•    Women who are overweight
•    Indigenous Australians, Polynesian, Chinese, Indian and Middle Eastern ethnic backgrounds

One of the most important factors that can prevent or control Gestational Diabetes is physical activity. Regular exercise helps to control blood glucose levels by increasing insulin sensitivity. In other words following exercise insulin works much better in the body. A recent study of 22,000 pregnant women found that women who performed regular physical activity prior to pregnancy were far less likely to develop Gestational Diabetes. Interestingly the same study showed that women who spent 20 h/wk or more watching TV were at greater risk of developing Gestational Diabetes than women who spent less than 2h/wk watching TV.

Not only is it a great idea to exercise before you fall pregnant but it is also important to remain physically active during the pregnancy. The American College of Sports Medicine recently released a statement providing clear evidence for the benefits of physical activity for both baby and mother. They showed that in addition to controlling blood glucose levels exercise during pregnancy had the following benefits:

•    Improved recovery from the birth
•    Improved posture
•    Stronger back muscles to reduce back pain
•    Improved sleep quality
•    Stress relief
•    Body weight management
•    Improved mood
•    Greater ability to cope with the demands of motherhood

However when you are pregnant there are some guidelines you need to follow to ensure that you are exercising correctly and safely, they are:

•    In the later stages of pregnancy your body starts to release a hormone called relaxin. This softens ligaments and obviously puts them at greater risk of injury. So avoid high impact jarring exercise in the later stages of pregnancy.
•    In the second trimester you often see changes in blood pressure, therefore avoid quick changes in body position, ie. Move slowly from lying/seated positions to standing.
•    In the past it was generally considered unwise to exercise at a heart rate above 140 beats per minute. However this advice does not take into account a number of things. First, it does not consider the fitness level of individuals. For example people who are athletes or were very fit before the pregnancy can exercise at a higher intensity then someone who is not very active. Secondly, it does not take into consideration a woman’s age, should the heart rate target for an 18 year old woman be the same as a 42 years old woman? The current advice around intensity is to go by how you feel. Women are recommended to work at a maximum intensity of somewhat hard, this means that you are working at an intensity that challenges you but is manageable. Of course always discuss and consult your medical professional before starting any exercise plan.
•    After about 4 months of pregnancy avoid lying on your back for long periods as the weight of the baby can compress the veins and arteries going to the heart.  
•    Be aware that as the baby grows your centre of gravity is shifted and may affect your balance.
•    Avoid letting yourself get too hot, don’t exercise in the heat or to the point where you are excessively sweating.
•    Most of all listen to your body and when it is telling you that you need a rest, take it!

Posted by Christine Armarego 14/1/09
Reference:
Zhang, C. Solomon, C.G. et.al A prospective study of pregravid physical activity and sedentary behaviours in relation to the risk of gestational diabetes mellitus. Arch Intern Med 2006 Mar 13; 166(5): 534-538.
 

One of the biggest challenges to a regular exercise routine is cold, miserable weather. We have all woken up early in the morning, strapped on the runners only to hear that freezing cold wind, suddenly the excuse board comes out and we convince ourselves to stay in bed. As summer rolls around and day light savings kicks in we tend to be more active and spend far more time in the sun. While we welcome the hot days and sunny weather, they do bring some significant dangers such as, skin damage and heat stress.  

Exercising in hot conditions is vastly different to exercising in cool conditions. When we exercise the body generates heat that it needs to get rid of, add hot weather to the mix and you can get a lot of heat building up in the body. When you have more heat being absorbed into the body than is lost you run the risk of heat stress.

How the body gets rid of heat?

Step 1. When your temperature starts to rise, more blood is pumped towards your skin to try and cool your blood down. This is why your skin gets redder in the heat.

Step 2. Once the blood gets near the skin it relies on the outside environment to take the heat away. Usually it is the air around our body that absorbs the heat. If we are in water it is the water that absorbs the heat.

Step 3. If this is not enough to cool us down the sweat glands kick in. You have about 4 million sweat glands over the surface of the body. When sweat comes in contact with our skin, the hot air makes the sweat evaporate and we get a cooling effect. The amount of sweat that is evaporated off our the skin depends on:
•    How much skin is exposed (the more skin you expose to the air the faster you cool down)
•    How humid the air is (When humidity is high, the air is saturated with water and the evaporation off your skin is reduced. A sign that sweat is not being evaporated is when you have beads of sweat rolling or dripping off you)
•    Speed of the air over the body (The quicker the speed at which the air moves over our skin the quicker the heat is lost. This is why fans cool us down more than still air.)

When you can't get rid of excess heat it starts to build up in your body and you are at risk of heat stress.
The signs of heat stress are:
•    Rapid pulse
•    Dry swollen tongue
•    Weakness
•    Light-headedness
•    Confusion
•    Clammy skin
•    Fatigue
•    nausea
•    Vomiting

What to do if someone has heat stress:
•    Move them to a cool area
•    Remove excess clothing
•    If conscious give them water to sip
•    Cool with cold compresses, rapid fanning and water

Here are some simple tips to follow in the summer months to protect against heat stress and skin damage.

1. Get your timing right: Avoid exercising in the hottest part of the day, this is between 11am and 3pm. Early morning or late afternoon is the best time to get active in summer.

2. Wear the right gear: Exposing lots of your skin to the environment helps to maximise evaporation however it leaves you at risk of sunburn. This problem has been solved by ASICS who have brought out an excellent range of exercise clothing that feature moisture wicking and breathable material to allow you to regulate your temperature better. They are also treated so that they have UV protection, equal to wearing SPF 15+ sunscreen. Is it essential to have good quality exercise clothing that will protect you from the sun’s damaging rays while keeping you cool. You will be able to find them in any good sports store.

3. Stay Hydrated: The most effective defence against heat stress is adequate hydration. Proper hydration levels help to maintain the right plasma volume in your blood to keep circulation and sweating at an optimal level. Before you head out to exercise is a great idea to consume 500ml of cold water 20 minutes (why cold water? Cold fluids are emptied from the stomach at a faster rate then fluids at body temperature). During exercise drink 250ml of water every 15 to 20 minutes. Don’t worry about drinking water while you are exercising, the absorption of water from the stomach is not retarded by exercise.

4. Keep it simple: Water is the best way to stay hydrated, consumption of drinks that contains concentrated simple sugars can actually slow down the rate at which fluid is absorbed from the stomach.

As we all know people with diabetes have to ensure that they look after their feet. This is essential during the warmer months. When exercising in warmer temperatures there is a great chance of your feet sweating. Sweaty feet are more susceptible to the following:

•    Increased friction between your feet and the shoe
•    Cracking and splitting of the skin especially between the toes
•    Fungal infections like tinea, as these love warm, wet and dark areas

In addition another hurdle is that in the heat feet tend to swell, especially as the day goes on. What this means is that in the summer months you are putting a larger foot in your shoes. This creates great rubbing and friction and more chance of foot damage.

Here are some foot wear tips for summer:

1.    Stay Dry: Regularly change your socks so that they stay dry during exercise. Also choose cotton rather than synthetic socks

2.    Air Out: After wearing them make sure you air and dry out your shoes

3.    Allow for the swell: When buying shoes in summer, buy them in the afternoon when your feet are at their most swollen

4.    Get the best: The quality of your shoes is not something you should compromise on. The premier exercise shoe for people with Diabetes is the GEL-Assist and GEL-Cardio by ASICS. They are specifically designed to meet the criteria put forward by Diabetes Australia. They have a one piece upper with no exposed stitching inside the shoe to minimise rubbing and friction.
Posted by Christine Armarego