Diet & Fitness with Special Notes for Diabetics

“Life itself is the proper binge.” Julia Child

Fruit and Vegetables

Fruit and Vegetables

If you are looking for a way to improve your fitness and general wellbeing, this article is for you. If you are a diabetic, this article may save your life, since the advice given by the health authorities worldwide is almost universally out-of-date and in some cases positively harmful. If you don’t believe me, read on and decide for yourself. My view is you have to choose your experts carefully: too many are just serving time until retirement, or are simply too busy to keep up-to-date with their subjects properly. Medical advances in particular tend to be a good generation behind the times, and the care of diabetes is undoubtedly an area suffering from this problem. I have separated the extra info for diabetics out from the general advice, since it won’t be relevant for all readers, but the whole article should be relevant to all readers if you are interested in improving your general health.

Disclaimer: I am not qualified to give medical or dietary advice, or indeed any other type of advice, so if it all goes pear-shaped, or if you do, remember you must be responsible for yourself and monitor your outcomes yourself. See a good doctor if you haven’t exercised for a long time or if you are planning on going on some extreme diet scheme (which I don’t recommend: slow and steady wins the race, I believe).

Quick Links

Step 1: The Mind * Step 2: The Body * A Note for Diabetics * Exercise Routine * Step 3: Food * Atkins Summary * Sample Meals * Choosing Food * A Word About Fat * Appendix: Notes for Diabetics * Links

I suppose many of us have tried to lose weight and failed. I know I have. That seems to be normal. The typical mantra, “eat less, exercise more,” while obviously true, equally obviously seems to be an almost unattainable goal to most people, given the results they obtain. The commonly recommended low fat, high carbohydrate diet seems to produce similarly dismal results.

But, I seem to have succeeded at last. Not only have I lost my surplus weight, it seems to be staying off and I am much fitter than I have been since I was a teenager. So, I thought I would take the time to describe what I have done. Maybe something similar will work for you too, if that is what you want.

Pretty much, I started from scratch, deliberately not paying attention to the “eat less, exercise more” people since that method had always failed me in the past for two simple reasons: I couldn’t bring myself to eat less for more than a short time, and it was too much effort to exercise more. But, I found a way of doing both, long-term and painlessly.

The method involves three stages:

  • The Mind – getting your mental approach correct for you; motivation; attitudes;
  • The Body – burning more calories;
  • The Food – eating less without getting hungry.

Skip the first two and you might as well not bother with the third. In fact, if you are going to try to apply my method to yourself, I suggest you don’t even bother going on a “diet” until the first two are well and truly in place. But you can if you like, of course.

Step 1: The Mind

Key words: go slow, habits, lapses, emotions, conditioning, self-esteem.

Most people do exactly what is necessary to prevent their diets from working right from the outset. They leap right in to some ridiculously strict regime, starve themselves silly, then beat themselves up when their willpower inevitably cracks under the strain. How to avoid this? Simple: don’t do it. Note: until you do think that is simple, and fully understand what I describe below, you are not ready to move on to Steps 2 or 3. Seriously: don’t waste your time until your mental approach is ready and these concepts are well understood. You already know the results of not doing this from your previous dietary efforts, I’m sure.

I knew I needed to lose some weight pretty much right from the time I started putting it on in the first place, but 20 years later, I was still overweight. My efforts limited the extent somewhat, but could not be said to have it under proper control. I became diabetic, presumably brought on by the surplus weight and a diet too rich in carbohydrates. Eventually, the threat of impending health problems caused by the diabetes, in turn caused by the weight, scared me enough to get me looking seriously for a method. I found two in particular, both quite good, it seems to me, although I followed neither exactly: Dr. Atkins’ New Diet Revolution, and The Metabolic Diet: The revolutionary diet that explodes the myths about carbohydrates and fats. Atkins’ diet is much criticised, I think unfairly, but it certainly works for those who actually read the book and follow his rather precise instructions. In case you don’t know, his diet is based on the idea of reducing the carbohydrates (sugars, starches (mainly potato, rice, pasta and bread) and fruit juices) that you eat. His theory about why it works (reducing the body’s typical insulin requirements) may be right or it may be wrong, but the results have been proven in normal people. Of course, many people, who haven’t got their mental attitude sorted out, don’t read it, or decide to eat no carbohydrates even though he makes it clear that you must eat some, they skip his other instructions such as the ones about multivitamin/multimineral supplementation, or the fact that the induction phase should only last two weeks with rare exceptions, then they want to sue his company when they get ill. There used to be stories about such people in the newspapers all the time. Duh! Anyway, more about Atkins later.

The Metabolic Diet is written by an ex-world champion weightlifter and introduces the concept of the “carb load”. Both Atkins and Pasquale suggest that burning fat is the thing to do in a diet, since after all it is fat the typical dieter is trying to lose, and both authors do it by reducing the carbohydrates in the diet, forcing the body to burn other substances instead (fat and protein), but Pasquale feels that the body should have a carbohydrate booster about once a week, and maybe after a workout as well, as the carbohydrate causes the body to produce insulin, and that insulin helps to build muscles by feeding protein (amino acids) to the muscle cells. Strong muscles help the body to burn calories faster, and in type 2 diabetics they also help the body to mop up surplus glucose from the blood. They make you look better and feel better too. His method, assuming it works, is to assist the exerciser to build up muscles a little more easily than might otherwise be the case. It is unproven, as he candidly admits, but sounds like it might be true. It also has the probable virtue of preventing the body from adapting to a fixed regime and resisting the diet (as bodies tend to do), because every few days, you change the regime, then change it back again. Nice one!

Why am I telling you this? So that you know where I’m coming from. Also, these diets are still open to abuse by people who don’t know how to diet (that is, people whose mental approach is all wrong). They prescribe a method which, as with all other diets I have seen, encourages an unsuccessful approach to dieting based on strict adherence to some regime. Such an approach doesn’t suit me, and my bet is that it doesn’t suit an awful lot of people. Of course, it suits some. But if it suits you, why are you fat?

My method is The Lazy Way To Diet (TM) because that’s me. If that’s you too, read on.

I don’t know how to describe a more appropriate mental approach to this process in a carefully structured way, so I’ll just dash off the points as they occur to me. I may rewrite it all in a slicker fashion one day, but for now, let’s just get the info onto the page!

  • Go slow: First, don’t be obsessed with speed. Unless yours is a short-term medical emergency case, look to the long-term. Think about losing maybe a kilo (a couple of lbs) a month, no more. Why? Because it is easy. It also takes long enough that your new habits have time to become just that: habits.
  • Habits: Mentioning habits brings me to a most important point. If you are to maintain any successes, you must realize and accept that you are not embarking on a diet, you are changing your lifestyle, permanently. If you want to lose weight permanently, then it should be obvious that any changes you make to your lifestyle must also be permanent. So get used to the idea before you start. It turns out anyway that making and keeping these changes is pretty easy, since we can take advantage of human nature: pretty much any pattern of behaviour that we can keep up for about six weeks becomes a habit. In other words, it becomes part of who we are. It becomes, in a word, automatic. You no longer have to think about it, or apply effort to maintain it. This also explains why it is so important to go slow: so you can maintain those relatively easy, tiny changes in your lifestyle long enough for them to become automatic. And that, in a nutshell is how my method works. You make small changes, and expect little to come of it. After a month or two, you begin to see a slight benefit maybe, and by then it will have become something of a habit, so you make another small change or two, and so on, whenever you feel that you can. Over time, you gently push your lifestyle in the direction you want it to go, hang on to the small changes for a few weeks, and Hey, Presto! It has become the new you. You deliberately avoid pushing yourself too hard. Whenever you feel you can push a bit more, then do so, but only a little bit, and see how it goes. When you feel the need to ease off a bit, or even a lot, then do that too, briefly.
  • Lapses: Accept them as part of the process. I have been doing this for, at the time of writing, nearly two years. I have had excellent results, and yet, even now, I only stick to my lifestyle changes about 80% of the time – that is, about 4 times out of 5 that I need to make some lifestyle choice. So, don’t worry about it. It works anyway. I will also say that at the beginning, I probably only succeeded in sticking to my plans less than half of the time. It still worked (but less so). Gradually, I pushed my lifestyle in the direction of succeeding more often and to a greater degree… understand? Above all, never, ever, tell yourself off for failing to stick with the plan. The plan allows for failures and detours, because the plan is designed for humans, who as a species couldn’t stick to a plan if you paid them, so as I say, accept it. Accepting it means that when you fail, you shrug and think, “Oh, well, maybe next time.” Then, you don’t worry about it any more. It is all part of the process. OK? Think of it as something that moves in waves, as natural phenomena often do. Sometimes it is easier, sometimes it is more difficult. Your job is to take advantage of the easy times, and not forget what you’re up to during the difficult times so you can go back to your plan afterwards. If it helps, go to the seaside when the tide is coming in, and, as the Easterners say, meditate on that. Watch the tide coming in: the waves wash up the beach, retreat, return maybe just a little further, retreat, make a little more progress, and so on. That is how it works. Be glad when it happens and just persist when you can. It is enough. It is the method.
  • Emotions: You will succeed more if you can perceive the process in a positive light emotionally. In the past, whenever I tried to diet or exercise, I felt miserable about it. Why? I was doing what I thought was right, and trying to achieve my goals, so why did it make me feel bad? I analysed the feelings, and eventually decided that the predominant feeling was one of being punished. The feeling I was giving myself, by trying to be strict with myself, was that I was punishing myself. I felt hard-done-by and deprived. Unsurprisingly when you think about it, with those feelings, the behaviour I was trying to promote was impossible to maintain. I suspect most dieters have experienced this. Our emotions are designed to tell us when we are doing something wrongly and it is all but impossible for most of us to go against such messages, as indeed it should be. So, the key was to change how I felt about what I was doing. How? I had to “re-frame” the concept of diet and exercise. That means, I had to think about it differently. To do this, I had to explain to myself, as if I was a child or something, just what I wanted to think and feel about it. Sounds crackers, I know, but it works. To do this, you have to get the feeling right, so that the diet and exercise feels right to you emotionally while you are doing it. For me, I explained to myself that I was not punishing myself; I was doing this because I love myself and my body, and so obviously I want to do what is best for me and my body, to take care of it and help it to get fitter. Whenever I started feeling a bit miserable about the diet or exercise that I was doing (usually precisely while doing them), I simply reminded myself of all of the above, i.e., I am doing this because I love myself and my body, and so I want to do what is best for me and my body, to take care of it and help it to get fitter. Getting the feeling tone right while saying it to yourself is vitally important as well: don’t just say it, feel it too: say it to yourself (silently in your mind is OK) in a loving and caring tone, perhaps as if to a child: you must love yourself, or else! Normally when people try to persuade themselves of things, they say something like, “You idiot! What are you thinking? I want to get fitter, darn it!” Obviously, the feeling tone is negative, so you generate negative feelings about the changes you want to make and, naturally, your built-in self-protective systems avoid doing it. Saying it to yourself with a positive, loving, caring feeling tone is fundamental to getting such changes to stick. What I found was that after a couple of weeks of reminding myself of my reasons in this way whenever the unwanted feelings arose, the reminders became increasingly redundant: the new attitude was there already, automatically, from the start. Now, I only need to remind myself of it very occasionally – maybe once a month or so, and only momentarily at that. I had, I suppose, achieved a new understanding of the process, and taught it to myself. Weird, but it works. Also, it is totally crucial to the success of the whole process: if you don’t feel right about it, you are likely to have real problems maintaining it. I suppose this should be obvious, but I must say I haven’t seen it mentioned elsewhere in this sort of context: our cultural understanding of human nature is pretty dismal in my view. Anyway, it is also worth mentioning that the feelings you get may differ from mine and the message you may need to give yourself may differ too, but I would expect the message above to work in most cases. Whenever you recognise the negative feelings, take action to cancel them with the message you want to send to yourself, in a loving and gentle way. For me, the negative feelings arose most strongly when I was exercising: physical effort very definitely felt like punishment to me! “Depriving” myself of some foods did too – but more about food later.
  • Conditioning: This process of gradual change and slow habit forming, and indeed re-framing your thought patterns, as it turns out, is really very basic human psychology. The official word for it, as far as I know, is “conditioning.” You are quite simply training yourself in new habits, in much the same way as you might train a dog to sit on command. But, being human, we need to be a bit more psychological about it, as we have language-using minds that complicate matters, necessitating, for example, the explaining to ourselves verbally and emotionally what we are doing and why as described above. I think it is worth mentioning that this conditioning process is pretty much what lifestyle and motivational gurus such as Anthony Robbins teach as well. For what it is worth, I can say that I have been to one of his seminars, and I know people who have been on others of his, and in all our opinions, they are very expensive, and very good.
  • Self-Esteem: The struggle to maintain most diet and exercise systems meets another huge obstacle most of the time: low self-worth, made worse by failure. Let’s face it, being fat and unfit would be quite a burden to just about anybody’s self-esteem, since they are almost certainly not conforming to their own conception of how they should be. Therefore, they judge themselves negatively. Of course. That is how self-esteem works: do you pass your own tests? Yes, or no? Yes, and your esteem goes up, no and it goes down. Ultimately, it is that simple. Well, guess what? Starting out very slowly, going for easy, long-term targets, expecting frequent backsliding and lapses (the waves going out), persisting oh, so gently, on and on, and on, just pushing a little, most of the time… soon turns your self-esteem around. As you see yourself actually doing what you set out to do, however slowly, with however many lapses (which you have allowed for in your plan), your self-judgement tests get passed instead of failed. The process actually becomes emotionally easier and easier as time goes on and as the small successes begin to add up to larger and larger ones. Not only will you begin to look and feel physically better, but your emotional balance and confidence will improve as well. It becomes a self-reinforcing virtuous circle of more and more success, affecting not just this one area of your life, but other areas as well (you can use similar methods, suitably adapted). If you want to work on your self-esteem directly, seek out books and audio programmes by Nathaniel Branden such as Six Pillars of Self Esteem. They can be a little dry and academic in tone, but those I have read or listened to are nevertheless very good and to the point. I also should mention that the process of sending messages to yourself in a loving manner described above under “Emotions” is also likely to help your self-esteem too, as you learn to love yourself more in the process: a very handy by-product, I think! As your self-esteem improves, it acts as a built-in reward for the successes you’ve been achieving and it improves your motivation, confidence and your whole life experience as you go and helps to make the getting fitter process increasingly easy as you continue with it.

I would suggest reading and re-reading the above section about the Mind at least five times, maybe more, over the next couple of weeks or so, to reinforce the learning. There is quite a lot in there and it is worth not accidentally forgetting something that could turn out to be crucial for you and your process.

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Step 2: The Body

So now you’ve got your mind sorted out (you have, haven’t you?) it is time to sort out your body. No, not food (not yet): exercise.

Yes, exercise. The dreaded “e” word. So, you really, really, don’t want to exercise. I know. It is inconvenient. It looks stupid. It is (insert your own best excuse in here). Sure. You don’t want to be a “gym rat” like those idiots you see when you pass your local health centre. You want to integrate it into your normal activities so you don’t notice it. I know. Above all, you know it will make you feel terrible physically and emotionally while you do it, and indeed afterwards when you fail to do it properly or keep up with your programme. Right?

Wrong. If you really think that, then re-read the section about The Mind above, thinking specifically about how it can apply to exercise while you are reading it. If you don’t want to re-read it all, at least look at the list of the key words: go slow, habits, lapses, emotions, conditioning, self-esteem. Think about them.

What’s that? “Go slow?” Hmm… there’s a clue there, isn’t there? Yep: go for very minor improvements over a long time. Push yourself, but very, very gently. If you find that you are feeling bad physically, such as breathing a bit more heavily than feels OK, then you are probably overdoing it, so ease off! If after some exercise or other you find it takes ages to get your breath back, well, take ages, and maybe don’t push quite so hard next time. It is important to know that you will get improvements in your physical health without pushing yourself hard. Sure, many people go to the gym and work like crazy, but it isn’t necessary for non-athletes. Any exercise will result in some improvements over time, and giving yourself plenty of time is fundamental to this method. Forget about achieving quick results. Don’t even try for them. As long as you are improving your health, however slowly (within reason), that will most likely work out very well for you over a year or two. And, as your body gets fitter, lo and behold! You will be able to work harder anyway, eventually. Working too hard has another disadvantage, anyway, apart from tiring yourself out and feeling unpleasant: you might be more likely to injure yourself and that could keep you out of action for weeks or even months.

If you are seriously unfit, or feel that you are, then, if you are able, start out with maybe a 10-minute walk twice a week. Five minutes if that is all you can manage. Your doctor may be able to advise you on where exactly to start if you’re not comfortable with how to begin. Decide for yourself what will work for you. This walk should be as brisk as you feel you can manage without making you breathless. You might break out in a light sweat unless the weather is really cold. When you feel you can, extend the walk to 15 or 20 minutes, or make it three times a week, or both: this is the level most experts consider to be the absolute minimum amount of exercise any person will begin to gain lasting benefit from. Maybe make it every other day if you can. If you want to, get a heart-rate monitor and have a look at the American Heart Association site, which tells you what sorts of targets to aim for. If you are unfit, it is probably worth the money for a cheap wristwatch/belt monitor so you can be sure you aren’t working too hard. A simpler test is that you should be able to hold a conversation without getting breathless. If you have difficulty maintaining the pace just because you find it a bit boring, then take a personal stereo and play some good marching music: disco, house and dance music in particular, with their driving, continuous beats at 60/120 or so beats per minute, are excellent for this as are some driving rock tunes that can get the adrenaline pumping. Slow romantic ballads and New Age music just don’t cut it for this purpose, I’m afraid. Classical can be OK if it is exciting enough.

If the walk isn’t challenging, you are probably fit enough to go to a gym or devise your own exercise routine. And if you don’t fancy the gym, there are plenty of alternatives: walking; swimming; tennis; football; badminton; volleyball (including beach volleyball!); dancing; even jogging and running (eventually): pretty much anything that gets you moving (and I don’t mean driving a car). You can do traditional exercises too, of course. Be warned, though, that many advances have been made in recent years and numerous exercises that were once thought to be good for you (such as sit-ups) are now considered to be dangerous if not done in a specific way. Therefore, I recommend that if you are thinking of something like this that you go to a good gymnasium for at least a couple of months to get some training from the professional instructors there. Around here, you can join a gym for around £50, plus about £30 a month. Some have a pay-as-you go system whereby you pay about £5 per session instead. They all seem to offer basic health and fitness assessments, whereby the instructors will listen to your goals and try to tailor a programme especially for you, with “free” reviews every couple of months. For example, I told them that I wanted to bring my blood glucose levels under better control, and I didn’t want to work too hard because my motivation was weak and I believed that if the exercise made me feel too uncomfortable I would have difficulty maintaining it. They came up with a suitable programme involving a mix of aerobics and resistance exercises, set at fairly easy levels at first, which they increased at each 8-weekly review as my fitness improved. As this is a lifestyle change, I am still going to the gym two years later, and in my mind I consider that I will still be going to the gym forever, or as long as I live, or can, as the case may be. (I have switched to exercising outside the gym now, but the lifestyle change as such is for life). If you can’t or won’t go to the gym but are prepared to exercise elsewhere, well, the Internet is your friend and you could do worse than start here for information about weights and here for aerobics. If you still feel that you can’t bring yourself to exercise, forever, then go back to The Mind section and spend a bit more time getting yourself used to the idea. You probably need to condition yourself to this novel notion and it is not surprising that it could take a while (six weeks?) of thinking about it before you are ready to start. But do think about it: hold the idea in your mind, and come back to it often. Try to become accustomed to the idea of your exercising, simply by thinking about it often and perhaps making plans relating to it and indeed explaining to yourself in a loving manner just what it is all for and considering how to get started. See yourself going to the gym (or doing whatever form of exercise you think you might manage – playing tennis, swimming, cycling and so on). Keep seeing yourself doing these things for a few days or weeks until you have grown accustomed to the idea. You will find that it is an easy way to get used to a ‘new you’ beforehand. It takes a bit of time, but it works. And because it works, it actually takes less time that trying things that don’t work, like forcing yourself to go, for example. That is how I conditioned myself and it certainly worked for me.

Those two categories I mentioned above, weights and aerobics, also sum up the two types of exercise you will need to be doing however you decide to go about getting them into your life. “Aerobic” exercise is for the cardiovascular system, that is, your heart and circulatory system. Aerobic exercise is all about sustained effort such as walking, cycling, swimming, running and so on. This sort of exercise raises your heart rate and keeps it up for a time, typically, half an hour twice a week at least, once you are up to that basic minimum level of fitness. This form of exercise reduces your risk of heart attack, burns calories, reduces fat and generally helps you to feel fitter when performing simple daily activities such as walking up stairs (after a time you will find that you no longer get particularly breathless when doing such things).

The other sort of exercise, using either free weights or machines that offer resistance to your muscle-building efforts, is “resistance” exercise, which strengthens your main muscle groups. The point of this is not just to make you stronger and better-looking, although it does this, it also reduces your body fat percentage by gradually increasing the proportion of your body that is muscle, and it increases your metabolic rate causing your body to burn more fat than before, because fit muscles burn more calories than unfit ones. A virtuous circle again. Note that as muscles weigh more than fat, your weight can actually go up while you are building muscle and reducing fat, but in this case it is not a bad thing for your health and you will end up looking better too, as your body tones up and your shape changes. You might consider getting a body fat measuring device such as an electronic meter or callipers, just to make sure that it isn’t an increase in fat that is causing any weight gain. If you do then remember that these gadgets are not all that accurate and you may have to take the average of several readings over time to get a fair idea of what is going on. If in doubt, swap a couple of your normal meals for salads: that always seems to shed a bit of weight for me.

Whatever exercises you do, it is important that you do them well. By that, I mean that you should do them in the proper manner: what the athletes call “good form.” This reduces the risk of injury and improves the benefits of the exercises too by ensuring that the specific muscles the exercise is supposed target are actually the ones that get exercised the most. It might help to think of the exercise as an art form, and as you exercise you are creating physiological art, so naturally you will want it to be good art. Well, it works for me, anyway! 🙂 Find a way to think about it that works for you and your good form will increase your benefits accordingly.

One much neglected aspect of good form is cooling down after aerobic exercises. For example, many people, after walking or running for 20 minutes on the treadmill, just punch the stop button and step off. This is very dangerous and can cause a heart attack on the spot. You can’t tell these people, because unasked-for advice is seldom welcome, but at least you know now. The reason is that when you are exercising hard, your heart is pumping hard to supply all your body with oxygen. However, what is little realized is that your other muscles are also pumping hard, and they too help to pump blood around the body, assisting the heart with its labours. If you stop suddenly, your body’s oxygen demands are still high for a minute or so, but your heart is no longer getting that extra help from the other muscles so it has to try and pump harder still. But if you have been exercising too close to your limits, you might find that your heart can’t pump any harder and you could faint or have a heart attack. The solution to this is to slow down over the course of a couple of minutes. All the aerobic machines, if they are any good and have been set up correctly, will terminate their programmes with a cool-down phase where they run more slowly or at an easier level for a minute or two, so just carry on at the slower/easier pace for one or two minutes and save yourself a potential crisis. If you are sensitive to these things, you will know if you are slowing down too quickly because you will feel your heart begin pounding harder as you ease off: don’t slow down any more for a bit! If you have to stop suddenly for some reason, at least take a few deep breaths to supply extra oxygen (not too much or you could hyperventilate and faint from that instead), or run on the spot or something for a few seconds at least.

The other sort of cool-down that is needed is stretching the muscles after exercising. The main benefits of this are a (possible) improvement in flexibility as stronger muscles can tend to shorten a bit over time if not stretched; and a reduction in aches and pains over the next couple of days while your muscles rebuild and strengthen themselves after the exercise session. This is less essential than the aerobic cool-downs, but it is one that most gyms will tell you about. For some reason, they don’t seem to know about the importance of the aerobic cool-downs around here; certainly they have never explained it to anyone in my hearing. Stretches are often recommended for warming up too, but there is little evidence that it does much good, and it may reduce your sensitivity to pain as well, thus increasing your risk of injury. It is a controversial question in some circles, anyway. Do them if you feel that they benefit you but be aware that your sensitivity to pain from the exercises may be reduced slightly. I stretch beforehand if the particular muscle to be exercised is feeling a bit stiff.

Another aspect of form I see much neglected is not to “bounce” or bend your body to assist with any exercises. For instance, if stretching to touch your toes, don’t stretch further by bouncing or you are very likely to injure your back (in this case). If lifting a weight, don’t jerk various parts of your body about to make the lift easier: keep your body still and try to use only the target muscle group and the necessary secondary muscles. Keep your back straight, lift with your leg muscles, don’t bend over to pick things up or put them down (especially weights) and so on. Make it a point to learn about good form and do it, for your own protection. Like many other skills, exercise is one that can be done badly, but you will suffer badly too, if you do it that way. In general, the key is to listen to your body, all the time. You can trust it to tell you if you are going wrong: any twinge or strain or pain when doing something is a strong hint: you are close to doing too much, or you are doing it incorrectly. Experiment if necessary, but correct the error immediately. If you are getting too breathless, ease up. And so on. Pay attention.

Finally, never, ever, exercise if you are feeling unwell, even if you only have a mild cold. Not only could you pass it on to others if you are at a gym, but it can make the infection do you serious damage. Viruses in particular are the culprits here. It seems that if you exercise while you have a virus infection, it can encourage the virus to attack the heart muscle, something that they don’t generally do so much. A weakened heart muscle is something you definitely don’t want. And, if you weaken it, then go and do your normal cardiovascular routine next session – you could seriously overdo it without realising it, and have an attack. The advice I have seen is to leave it at least a week after your resting heart rate has returned to its normal level before returning to exercising, and resume at a lower level than you left off until you see how it goes. It may take you a couple of weeks or more to get back to where you were.

To measure your resting heart rate, try to see what it is on waking, before you move. That could be a bit difficult. Otherwise, try and measure it at various times (preferably by wearing a measuring device – they are quite cheap these days, available from sports or electronics goods shops) and take the lowest reading. When your body is fighting an infection, you will find your heart rate is raised significantly. Don’t go back to exercising until a week after it has returned to its previous level (or very close to it, if it looks like it isn’t going to go back that low).

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A Note for Diabetics

If you are diabetic, especially type 2, know that fit muscles help to take glucose out of your bloodstream without the use of insulin. Also, your insulin resistance goes down for two or three days after exercise so your insulin will work better and your general blood glucose levels will improve over time (such as your fasting level and your HgA1c). Levels after a meal will drop back to normal more rapidly too, after a time (and you can always go for a brisk walk to bring them down even more rapidly if you’ve let them get too high at some point). Your serum lipid (blood fat, cholesterol) levels may improve too, depending also on your diet. There is more information for diabetics of all types here (Part 1 of 5 – the links to the others are near the bottom of that page). I will put some info and links at the end of this article that you may find useful too. If you are a type 1 diabetic, be warned that exercise can actually raise your blood glucose levels to a dangerous degree very rapidly and you must not do it unless you fully understand why it happens and how to manage it without going either hypo or hyper (blood glucose levels too low or too high, respectively). Consult with your doctor and read the recommended books. Type 1 diabetics are not usually overweight in the first place, however, although it can happen if they take lots of insulin because they eat lots of carbohydrates. I imagine there could be other causes too. If you are type 2, exercise (except when unpleasantly stressful) will usually lower your blood glucose levels, and if you take medication or insulin for your condition, beware of going hypo (glucose too low): take a source of rapid glucose with you just in case. If you don’t take medication or insulin, it is unlikely that exercise will be able to push your blood glucose down to dangerously low levels, but if your body isn’t used to it, it might find it more difficult to handle at first (especially if your diabetes isn’t all that well controlled as yet), so take a source of glucose with you as well, until you know how your body responds. Note that it only requires a small amount to correct such a problem: a couple of mouthfuls of Lucozade for example, or a couple of dextrose tablets, or a non-diet “Touch of Fruit” drink which has only a few grams of sugar per 100g, and so on. Coca-Cola and similar non-diet drinks are good too, but “sugar” isn’t as fast as glucose or dextrose and you might as well take the fastest, at least at first, to be on the safe side. Also, people suffering from hypertension might want to avoid that sort of drink as they typically contain caffeine, a notorious wind-up drug. Fruit juice works too, of course, and might be a healthier alternative. Again, only a small amount is likely to be needed at a time.

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Whether you are diabetic or not, unless you really do find it necessary, or you are getting a bit over-tired, you don’t particularly need to be providing yourself with extra carbohydrates when you exercise, as the point is to get your body to burn fat. If you provide it with carbohydrates to burn instead, it will in most cases burn them preferentially (raised insulin levels, caused by eating, especially by eating carbohydrates, suppresses fat burning).

Perhaps I should finish this section with a sample beginners’ exercise programme, gymnasium-style. Don’t be scared off by this! It looks like a lot, and it is, but if you can get yourself to do it you will benefit enormously. If you can’t, then OK, at the very least get walking or something, daily, preferably after meals to keep your blood glucose levels down (if you’re diabetic). Maybe also get some little hand-weights, or use a water bottle, and exercise your arm muscles too. With exercise, it is a case of even a little helps, and as you do some, you become capable of doing more.

You will need to adapt the routine below to your own circumstances and ideally will get advice from a trained professional and your doctor before beginning. For example, if you are very unfit, you might just do a short walk as I suggested earlier, and perhaps add more of the aerobic exercises to your routine as your health improves. Similarly with the resistance exercises, do low weights, low numbers of repetitions or fewer sets, as defined below. Whether you want to get advice or go to a gym or go swimming, dancing, maybe a bit of yoga, at least start slowly and listen to your body at all times. It knows better than your brain just what it can and can’t manage.

 

Repetitions and Sets

Exercises with weights are normally done in “repetitions” and “sets.” A “repetition” is one flex of the muscle in question, such as raising and lowering a weight once. A “set” is a group of repetitions. So, when you are doing an exercise, for example, a leg press where you push with your legs against a resistance, you might do two sets of 10 repetitions, taking from 30 seconds to five minutes to rest between the two sets, depending on how quickly your body recovers.

The routine below is given as an example only. It may look a bit daunting, but remember you are not going to be pushing yourself harder than you feel comfortable with at any time, right? Also, the exercising of one muscle doesn’t tire out the ones you are not using so it is not as bad as it looks: you can switch from one exercise to the next without too much trouble (you will probably want to rest for a minute or two between exercises even so, especially at first. I still do. When I get to the next machine I set it up as I want it and then sit there for a while until I am ready).

In theory, you would normally be advised to do all of the following twice a week at least, but you might want to break yourself into it more gently, depending on your general health and your mental and emotional attitudes. Whichever way you get started, increase the level of intensity and duration or weight as you get fitter. If you end up not improving after say 3 months on a given exercise, seek assistance if you don’t think you have reached your full potential or if you would like to do more. In the case of resistance exercises, if you seem to be getting weaker, reduce the number of sets or repetitions a little and see if that helps. You may be overdoing it so that your muscles are not having time to rebuild fully before you go at it again. If a given weight seems easy, increase it. If it is too difficult to start with, reduce it. If the resistance exercises are too much for you to recover from even so, split them into two groups exercising the lower and upper halves of your body on separate days. Change your exercise programme a little every couple of months as your body will get used to it and it is better for your health if you keep challenging it with new routines.

A Sample Beginners’ Exercise Routine (Two to Four Times a Week)

 

Warm up

  • Cycle 5 minutes at a low level of resistance, or walk briskly to the gym!
  • Possibly do some stretches.

 

Cardiovascular

  • Treadmill :10 minutes 5 km/h (3 mph);
  • Crosstrainer or ski machine (standing rotary/sliding legs with arms moving back and forth): 10 minutes low level;
  • Rotary arms (only if the previous machine doesn’t do the arms): 10 minutes low level;
  • Cycle: 10 minutes low level.

 

Resistance (free weights may be used instead of the machine exercises given here)

  • Shoulder Press: 2 sets of 10, 10kg;
  • Tricep Dip: 2 sets of 10, 10kg;
  • Leg Press: 2 sets of 10, 20kg;
  • Gluteus Press: 2 sets of 10, 20kg;
  • Chest Press: 2 sets of 10, 10kg;
  • Lat Pull-Down: 2 sets of 10, 10kg;
  • Seated Row: 2 sets of 10, 10kg;
  • Abdominal Roll: 2 sets of 10 (10kg if machine has weights);
  • Side Crunch/Oblique Curl: 2 sets of 10 (10kg if machine has weights);
  • Lower Back Extensions: 2 sets of 10 (10kg if machine has weights);

 

Cool Down

  • Cycle 5 minutes at a low level of resistance, or walk home briskly from the gym!
  • Do some stretches covering the muscle groups exercised before leaving the gym.

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Seems like a lot, doesn’t it? It will take a couple of hours, generally, but you will soon get used to it and believe me, you won’t suffer much provided you don’t push yourself too hard. Promise yourself that you will go easy on yourself and will ease up on any exercises that are giving you trouble. Once you are fitter, you will not need to go so easy, but at first, if you are anything like me, going easy is essential if only for psychological reasons!

For what it is worth, in my own exercise routine, I have settled on two sets of 12 repetitions for most exercises. For one or two, I seem to be able to manage three sets of 15, and in the case of the abdominal roll, two sets of 20, sometimes three sets. Vary them for yourself as suits your own body.

Why exercise? See the notes about fat, below. There’s no point in repeating it here!

Step 3: Food

Ah, yes… food. That staple of the diet and health industry. What can you eat? Answer: anything you like!

Yes, anything you like! The solution isn’t in avoiding certain foods so much as in portion control. That means, limiting the quantities of unsuitable foods, or eating them less often. Also, instead of actually eating less, you can substitute better foods for the ones you are limiting. That way, you can still eat plenty of food so you don’t go hungry and you still eat the things you like reasonably often so you don’t feel deprived.

I hope that sounds good to you. It has certainly worked for me.

If you know much about dieting, you may be wondering how, if you can eat plenty of food, you will be reducing calories enough to lose weight. After all, at the end of the day, you need to eat fewer calories, or burn more, if you are going to lose weight. Well, the answer seems to be two-fold. First of all, the exercises you are doing will be causing you to burn more calories, both during the exercise sessions and afterwards as your fit muscles will burn more even when you are resting. Secondly, with a suitable choice of foods, your appetite can be suppressed a little bit, resulting in you actually choosing to eat less without it requiring any effort on your part.

Now the scientific evidence about which foods are best for suppressing appetite is contradictory. Indeed, I get the impression that much of the science that has been done in the field of diet and weight control is pretty poor, which, no doubt, is part of the reason that much of the advice given by medical professionals and others simply doesn’t work or isn’t practical for mere humans and this no doubt does much to explain the obesity epidemic afflicting much of the developed world (along with our overeating and underexercising habits, of course). I actually consider the dietary advice that they give to diabetics is positively dangerous (suggesting that they base their meals around starchy foods when plainly their bodies can’t handle such meals properly), but who am I to contradict a trained professional, even though by ignoring them and going my own way I am one of the tiny minority of diabetics to have brought my weight and my diabetes under what I think of as pretty good control (described by my doctor as “excellent” control)? Pity they don’t usually include disclaimers like the one at the top of this article when they dispense their advice, isn’t it? Instead they seem to pretend that what they are saying is The Ultimate Truth. Well, it isn’t. I am telling you this not only to vent my spleen but to emphasise that what I am telling you is based upon my own, personal, experience. To what degree you can generalise it and apply it to yourself is (of course) entirely up to you to decide. This isn’t The Ultimate Truth either, but I am not pretending that it is. You must make up your own mind.

Basically I took some lessons from Dr Atkins’ diet plan, modified a bit with some occasional mild carb loading from the Metabolic Diet mentioned earlier, and modified some more because I am diabetic and carbohydrates are even more of a nuisance to me than to the average person. Also, not wishing to use too much willpower, I ignored Atkins’ very strict “Induction Phase” and went straight for the “Maintenance Phase” minus a little bit of food. In reality, I probably cut my calories by about 100 to 200 Calories per day from my normal level. But, I didn’t count Calories at all, and ate whenever I was hungry (and still do).

For those of you who don’t know the Atkins method, or have only read the nonsense that is in the mass media, here is a potted summary of what he says. Any mistakes and misinterpretations in this are my fault, not his, of course, but they are the ideas that I picked up and used, right or wrong.

Atkins Method Summary

Body fat is primarily deposited in response to carbohydrates eaten, not in response to fat eaten, since the body converts surplus carbohydrates into fat for storage, using insulin. Therefore, limiting the carbohydrates eaten should work better than a low fat diet. [MT – science has since shown that a moderate fat diet seems to work better than either a low fat or a high fat diet. It is also known that blood fat levels do rise after eating fatty foods. Furthermore, saturated fats in excessive quantities seem to be the worst culprits, while unsaturated fats are actually good for you. Hydrogenated or trans fats and oils are considered by many to be pretty much wholly harmful and should be avoided at all times by all people.]

The Atkins diet is not a high fat, high protein diet as such; it is a low carbohydrate diet. It can result in you eating more fat and protein though, not to mention fibre.

Also, I would emphasise that it is a low carbohydrate diet, NOT a no carbohydrate diet. Going without carbohydrates entirely can be fatal. Nevertheless, you can’t go far wrong by limiting (not necessarily eliminating altogether) the most carbohydrate-rich foods from your diet, i.e., sweets and confections of all sorts, potato, rice, pasta, bread, cereals and fruit juice. Add more vegetables, salad, fat, meat.

Rumours that high protein diets can damage kidneys are not supported by scientific studies, which only show that kidneys that already have damage can be compromised further by a diet that has too much protein in it. On the other hand, if you are diabetic and high blood glucose levels are the cause of your kidney damage, reducing your carbohydrate intake should reduce your blood glucose levels and may give your kidneys a chance to repair themselves. Ideally you will get your doctor’s approval for the experiment, and have the health of your kidneys checked fairly frequently while you go on the programme, to see whether they are getting better, or worse, or not. The results will tell you what to do. One thing to consider is not to add too much protein to your diet, I would imagine, especially at first. I can’t help you with that – I ate loads.

Take multivitamin and multimineral supplements while on the diet, especially in the early stages until you learn to balance your meals better.

Feeling a bit faint or light-headed in the first couple of weeks of the diet can be a symptom of your body converting from habitual carbohydrate burning to habitual fat burning. It can also be due to vitamin or mineral shortages, especially salt or potassium. Eating a banana is recommended (half a banana at a time if you are diabetic). If you have cut your carbohydrates too severely, think again.

Rather than starve yourself, reduce the quantity of starchy and sugary foods that you eat and replace them with leafy and other vegetables, meat, fish, dairy and other such foods. Never mind the fat content (within reason) as the low-fat propaganda, according to Dr Atkins, and at least one major scientific study, is wrong. From my own personal experience, I pretty much agree with him, but to be on the safe side I tend towards moderation rather than overload (although at least one meal a day tends to be rich in saturated fats with me, I nevertheless consider that this is not ideal. Hey, nobody’s perfect).

The typical overweight person will be eating from 200g of carbohydrates or more a day. Many eat well beyond this and much medical advice is aimed at getting these people to go below the relatively modest target of 300g a day. Try to reduce your levels, over time, to below 120g a day (more or less, depending on how well it works for you). Diabetics, try to go below 80g if you can (no more than 20g per meal, basically, if you want to keep your blood glucose levels within healthy limits, although this will vary depending on your own body and any medications you are taking: I find I need to keep it below 12g a meal to prevent my glucose level going above recommended limits). Use a glucose meter to figure out what works for you and if you are taking medications don’t cut the carbs too suddenly or you could risk going hypo: you may need to adjust your medication as you reduce the carbs and as your body gets fitter).

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Here is a summary of typical meals that I may eat in a day, then some general dietary advice amounting to a short list of foods that are in or out. Items marked with an asterisk, like this* are items dieters and diabetics should avoid or eat only in modest quantities as they tend to have a strong effect on raising their blood glucose levels (usually, this means the foods are rich in carbohydrates and are to be had in moderation by all dieters anyway). Items marked ** are to be most strongly avoided by diabetics and other dieters.

My Typical Meals

Breakfast

Sausage, egg, bacon x 2, burger (meat only, no bun**), vinegar, maybe some salt if I’m going to the gym later or if the weather is hot, tea, usually with milk*, no sugar**. If I cook the meal myself items are grilled and poached, or if I go to some greasy spoon café so they will be fried in seriously unhealthy oil of some sort. There are not many carbohydrates in this meal (although there may be some carbohydrate padding in the sausage) but it can raise blood sugar levels in diabetics nevertheless as the body converts protein to glucose to some extent anyway, but more slowly. Such a meal is often provided with baked beans* but these are rather carbohydrate rich and the sauce often has added sugar**. Mushrooms are a good alternative.

Lunch

McDonald’s Grilled Chicken Ranch Salad with dressing and a Bag of Fruit*. This meal consists of grilled chicken, five different types of salad leaf, some salad dressing*, bacon and cheese. The Bag of Fruit* contains apple* slices and grapes*. Total carbohydrates for the meal only 22g if croutons** are avoided, so a 30-minute brisk walk afterwards will help keep things under control.

Dinner

Another salad, usually, such as a Chicken Caesar Salad if I am eating at a suitable restaurant. Otherwise it can be with white fish such as cod, haddock or plaice (sometimes in batter** or breadcrumbs** – eat about half of the coating if you must, but try to eat no more of it than that after you get used to cutting down on such things a bit), or tuna, salmon, kippers, pilchards/sardines, cheese, ham, beef, lamb, liver, corned beef* and so on. The salad will hopefully be more than just lettuce, tomato and cucumber. Other items can include all sorts of legumes* such as peas* and beans*, also grated carrot*, coleslaw, beetroot, sweetcorn*, different types of leaves and herbs, various dressings*, lemon juice*, and so on. Potato** salad is to be avoided. In the more primitive type of café such as a transport café, I may have another breakfast, or cod with peas* and ask for salad instead of chips**. Most restaurants will happily swap chips for salad if you ask. Indeed, I have yet to find one that won’t.

Supper

A handful of nuts, a little fruit* maybe, or some yoghurt*.

* = in moderation only

** = strongly avoid

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You will see from the above that I eat some of the carbohydrate-rich foods I am telling you to limit, such as fruit, for example. These foods are healthy in moderation even for a diabetic such as myself. The point is to keep them under control, that’s all. Fruit juice** is too carbohydrate-rich and there are questions as to whether the human liver can metabolize it healthily without the healthy enzymes, micro-nutrients and roughage that comes with the actual fruit. Much of the advice that you will find online and from your local health service will tell you to eat more grains and starchy foods. This advice, I maintain, is an outrage, and very stupid, especially for a diabetic.

Food Choices

Foods to Mostly Avoid**

All sugary foods (such as jams, jellos and jellies, syrups, doughnuts, cakes, biscuits (that’s cookies for US readers) icing sugar, sugar, glucose syrup, high fructose corn syrup, any other syrup, fructose, frosted cereals, honey, ice creams and so on), cereals (corn flakes and so on), starchy foods (bread, pasta, rice, potato and similar substances), juices, non-diet soft drinks, cordials. Wholemeal products are better than refined, but not much better and are best avoided too. Confectionery. Batter, breadcrumbs. Most margarines (they are typically high in trans or hydrogenated fats). Pastries, puddings. Many packaged foods have added sugar: check the total carbohydrate level (not just the sugars) before buying any food items, if you are able.

Foods to Have Only in Moderation*

Muesli, porridge, beans, peas, sweetcorn, dressings and sauces, milk (low fat milk is the worst as it is higher in carbohydrates and the lack of fat makes it harder for your body to absorb the nutrients, especially the calcium), soya milk, yoghurt (check the sugar content), beer (except the low carb types), water biscuits, fish roe, taramasalata, nuts, butter. Suet and dumplings, foods labelled as suitable for diabetics, fruit in juice (but not in syrup), fresh fruit.

Foods to Eat Freely (Within Reason)

Salads and vegetables except those mentioned above and similar ones. Tomato, carrot, cabbage, etc. Coleslaw. Lettuce and similar leafy plants. Herbs, meat, eggs, fish, birds (chicken, turkey, duck, etc.), other animals, cheese, diet drinks if you must, artificial sweeteners (if you must and if you think they are safe), beverages (without sugar).

A recent scientific meta-study of the long-term consequences of eating low carbohydrate diets suggests that low carbohydrate diets may increase the risk of death from all causes if continued for a long time, but it isn’t clear from the study exactly what kinds of food the people studied (over a quarter of a million people) actually ate. The authors suggest that it may be OK if most of the protien in the diet comes from plant foods (presumably nuts, beans, legumes, cauliflower, spinach, broccoli, tofu, soya and the like), rather than from too much fatty meats. They add that this hypothesis has not been studied. They also said nothing about how much exercise these people took, and it could certainly affect the outcome if the majority of people studied were of fairly low general fitness, for example. In a way, this is another argument to avoid extremes, of course. And for diabetics, the risk from high blood glucose will almost certainly outweigh any possible risk from reasonable low carbohydrate eating anyway: most diabetics die prematurely from complications of the disease caused by frequent high blood glucose levels and massive over-storage of fat in the body (also related to high glucose levels).

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A Word About Fat

The low-fat mania is probably misguided according to Dr Atkins, and I agree, and at least one study supports this view. A high-fat diet probably isn’t too good either, if the fat is saturated fat (the sort found mainly in meat and milk products), since saturated fats are strongly correlated with cardiovascular problems (heart attacks, strokes, and so on). So, a moderate fat diet is, as mentioned earlier, probably the way to go. What “moderate” means to you, though, I can’t say. I am probably still eating too much saturated fat, but that is because I tend to eat out a lot and for breakfast especially, since I can’t have cereals and toast with marmalade or honey and cream, I tend to wind up choosing a traditional English breakfast instead. Nevertheless, this diet doesn’t seem to have done me any harm. Indeed, the evidence is quite clearly that it has done me good. I have lost a reasonable amount of weight: about 10kg (22lb or so) over the last 18 months, and my body fat percentage is (very slowly) drifting downwards as well. It is currently in the “acceptable” range for men of about 22%, having started around 25%. Even if the percentage had stayed the same, since I am exercising and therefore keeping my muscle mass up, the lost weight must be from burned up fat. Oh, and if you think that 10kg isn’t much for 18 months, remember, “slow and steady wins the race!” If you are not familiar with that saying, have a read of The Hare and the Tortoise, where it comes from. Anyway, go at a speed that suits yourself.

My mental model (unproven of course) about what the body does is that it will tend to try and conserve whatever you restrict. So, if you go on a low-fat diet and eat lots of carbohydrates (the standard medically approved diet), your body will detect the lack of fat and try to conserve it. Indeed, it is known that insulin, the hormone that helps your body metabolize carbohydrates, also suppresses fat burning. This is logical, since if your body has a ready source of energy in all those carbohydrates you are eating, why would it need to burn any fat? So, it doesn’t, in any significant amount, anyway, and shifting it therefore will prove exceptionally difficult. Insulin also converts any carbohydrates that are not burned… into fat, for storage.

On the other hand, there isn’t much the body can do to conserve carbohydrates, since they are stored as fat not as carbohydrates if they are not burned. So, a restricted carbohydrate lifestyle will help the body to burn fat.

Whether the theory is right or wrong, plainly, I have positive results in myself, so the method works, or can work, at least. However, if you have cardiovascular problems, or think that your arteries are well clogged up with surplus fat (and if you have a pot belly or a big bum, you might as well assume that they are), then you may want to proceed with some caution. Don’t eat too many saturated fats at first, or at least, cut the visible fat off any meats you eat. Other sorts of fat, as found in fish, nuts and so on, are very good for you, however, and are correlated with reduced risk of heart attacks, etc. So for you, maybe breakfasts of kippers and tomatoes, or pilchards or some such would be a better idea than the traditional English that I enjoy. You will need to experiment. If you are losing weight and you are exercising enough to gain a little strength and cardiovascular fitness, then you can be sure that you are losing fat. But if you are adjusting your food intake and not exercising, you may be losing muscle mass instead or as well, including from your heart, so you could be making yourself dangerously unfit. The exercising part of this sort of lifestyle is not optional for just this reason: your body burns muscle mass as well as fat (and carbohydrates) for energy whenever there is a shortage, so you need to exercise to at least replace the muscle mass – this also helps to prevent that scrawny-chicken look that non-exercising dieters often end up with as their muscles waste away along with the surplus fat. Exercising also burns calories and raises your metabolic rate, but that is not quite so important, although it does help, of course.

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Closing Thoughts

This is not a diet, I repeat. As I said at the beginning, it is a lifestyle. A permanent change to your way of living and eating. Make the changes slowly and continuously, backslide a lot but keep pushing a little all the time… and you can get there. Go for it!

I would be interested to hear your comments and results. Now here’s my closing thought:

“If you can’t do it by willpower, do it by stealth.” Martin Thompson.
 

Appendix: Notes for Diabetics

The following comes mainly from alt.support.diabetes.uk, an Internet newsgroup (a sort of discussion group or bulletin board) for diabetics interested in learning to control the disease or anyone wanting to find out more about it. Other groups well worth a visit include alt.support.diabetes and misc.health.diabetes. Also, alt.support.diabetes.kids is useful if you have diabetic children.

The original correspondent had been asking about how to help her diabetic husband, frequently getting blood glucose readings in the 15+ range [270 in US units], who was resisting doing anything to control his condition (a common response to it). This is an edited and extended version of my reply (one of many replies the original poster received). Values in square brackets, [], are the units used in the USA. Other values are SI units, used elsewhere.

You have been advised to cut starches (and substitute with salads) and I agree. But be warned that if you visit a doctor to ask about this, the doctor will probably give you the standard NHS advice which is to base his meals around… starches.

The doctors are *wrong* with this advice, in my opinion and in the opinion of most people in this forum who use a blood glucose meter to see the effects of those foods on their blood glucose levels. It takes one meal with and one without the starches and two simple blood glucose readings after an hour or two in each case to see the nonsense. It takes many meals and many tests to find a trend and determine a safe way to eat that works for you long-term. Many don’t like to contradict a qualified professional, but remember that nobody knows everything in this field as in many others (myself included!). It seems plain to me that more research is needed in this area. Anyway, the important thing is to be clear that you will be making up your own mind which way to jump on this, and that’s life, isn’t it? It is another reason people advise the use of a blood glucose meter: so you can figure out for yourself what is right for you and what is not.

This doesn’t mean you and/or your husband shouldn’t see a doctor: of course he at least should. But the doctor needs to be seen with brain in gear. The doctor can prescribe numerous medications that can help bring those BG (Blood Glucose) levels down rapidly if diet alone doesn’t do it. And they *do* need bringing down. I consider those levels not just high, but dangerous.

I should also add that the NHS’s beloved starchy food, low-fat diet *does* work for some people. Most diabetics find instead that a low starch (this is a low but emphatically non-zero carbohydrate), moderate (not low) fat diet easier and indeed more effective for them. Combined with an adequate level of exercise it can work very well and improves (reduces bad) blood fat levels better than the low-fat diet according to recent research. In making decisions, of course, a person is on his own, and reaps their own consequences. If the doctor’s advice is wrong, or if mine and that of others here is wrong, and you follow it, it is *your* responsibility and your husband’s. So get it right, whatever you think that may be.

To motivate your husband… see if you can get him to spend some time reading this forum occasionally. Tell him it is interesting. 🙂 He will learn from the answers to other people’s questions without risk of you de-motivating him by nagging.

You asked about levels…

Here is the data I have:

 

European Diabetes Policy Group Targets

(same as non diabetic people, blood glucose in mmol/l):The values in USA units are shown in square brackets, [ ].

Fasting (i.e., on waking): <6 (better <5.5) [<108, better <99]

1 hour after meal (after finishing eating): <8 (better <7.5) [<144, better <135]

2 hours after meal: <6.5 [<117]

 

From Diabetes UK:

“The recommended glucose levels for a person with diabetes to aim for are between 4 and 7 [72 and 126] before meals and no more than 10 [180] up to 2 hours after a meal. For someone who treats their diabetes with insulin, it is recommended that they make sure they are around 7 [126] before going to bed, in order to prevent a night time hypo occurring. Research has shown that keeping tight control of blood glucose levels along with having good blood pressure and cholesterol levels can help to reduce the risk of diabetes complications developing such as eye problems, kidney damage, nerve damage, heart disease and strokes.”

Notice how the EDPG targets are stricter than the DUK targets. Stricter is probably better.

Blood glucose levels above 10 [180] generally mean sugars are spilling into the kidneys, which will damage them in time. Levels above 6.5 [117] may be high enough to slowly damage the eyes, the nerves, the sex organ, blood vessels, the skin, the heart… and so on. The body becomes prone to fungal and other infections, which can feed on the surplus glucose. Basically the whole body gradually breaks down. You don’t notice the damage for a few years, then something serious happens, like impotence, gout, a stroke, gangrene and amputation, partial blindness… Life expectancy is *much* shorter for uncontrolled diabetics, and life quality begins to deteriorate very sharply once the body can handle the strain no more. Some diabetics die a long, slow, lingering and *very* painful death (the pain comes from the nerve damage, among other things). It is one of the least pleasant ways to die. The good news is, it *can* be controlled. But… it requires that the person concerned be motivated rather than scared. Or, motivated *and* scared.

No doubt he is concerned that making the effort to control it will involve changes to his lifestyle that he doesn’t want to make. Of course. My suggestion, i.e., what worked for me, is to try making very small, incremental changes. Get used to them over the course of a month or so, then make some more, get used to them, and so on. As another reply hinted, you might be able to make a few dietary changes without him really noticing – swap the spuds for some salad now and then (maybe include just a couple of small new potatoes and some butter with it so he doesn’t get suspicious). Tee hee.

It takes a person about 6 weeks on average to get used to a change. Then he might even look forward to such meals, especially if you can vary them a lot. But, with me, introducing them all at once, and removing the old ones at once, would not have worked: too big a change. If he seriously feels that making the changes would be too difficult, then what I am suggesting, i.e., changing the occasional meal only, at first, could be the way to go. Over the course of a year, say, a lot of changes can happen, and no forcing or willpower will be required. If he just *has* to have that ice-cream or whatever, well, OK, he isn’t there yet. Maybe next month. Diabetes progresses very slowly, so there may be time. Anyway, the occasional *mild* splurge is probably good for a person.

Levels above 15 [270] can mean ketones are building up in the blood, which is dangerous, but I don’t know much about this, never having had to deal with such high levels. My understanding is that in some people, such a high level can be an immediate medical crisis, requiring intervention. I could be mistaken though. Others will advise. Symptoms of dangerously high levels (“hyperglycemia“) include irrationality, drunken-like behaviour and disorientation, possibly followed quickly by death if not treated properly (usually with insulin but medical advice should be sought quickly). Symptoms of not quite so high levels include frequent urination and thirst, dry skin, sore patches, fungal infections and worse as described earlier, and frequent hunger. The frequent hunger comes about often because the person’s blood glucose levels are fluctuating wildly up and down, and every time they race down too rapidly, the person has to eat to stop what could be a dangerous oncoming hypo attack.

Hypos, that is, “hypoglycemia” with blood glucose levels that are too low, are a more immediate danger for most diabetics, especially those who take medication to control their levels. Try to avoid going below about 2.8 at all times [50 in US units] as it can be fatal. Good levels are generally between about 4 and 5.5 [72 and 99]. A diabetic who is hypo must never be given insulin or glucose limiting medication, but should be given something sweet or carbohydrate rich immediately. Diet drinks are no good, but biscuits [cookies], confectionery, soft drinks, cereals, fruit and so on are fine (any of the otherwise restricted foods should be taken immediately, in other words). Symptoms of hypoglycemia include exhaustion, headaches/migraine, irritability, poor sleep, depression, a desparate urge to eat (which should be indulged a little and very quickly) and more. If it gets too bad, the person will become confused and semi-conscious, and could eventually pass out and may die. Typically, on going low or even just dropping rapidly whilst still currently actually high, your body will initiate a panic attack, which will go really quickly if you eat something to supply the missing carbohydrates (glucose). Diabetics who are prone to this usually carry some such snack with them at all times, or even proper medical solutions such as Hypostop. In diabetics who are accustomed to high levels, the panic attacks are likely to occur at higher levels and if this is you, you will need to bring your average levels down gradually over a few weeks so this only happens when it is supposed to (below about 4 [72]).

 

Food Types

When eaten, foods convert into glucose in the body at differing rates. The idea in choosing foods to eat is to have more of the slower stuff in the diet and less of the faster stuff. This minimises blood glucose levels overall. Exercise helps the body metabolise glucose as well. Excess body fat causes resistance to proper glucose metabolism and prevents your body lowering your glucose levels properly.

Quick acting Carbs:

100% of calories to Blood Glucose in 15-35 minutes (Table Sugar, Bread & Potatoes)

Slow Acting Carbs:

90-100% of calories to Blood Glucose in 30-95 minutes (Durum Wheat Pasta, Beans & most Fruit)

Protein:

60% conversion of calories to Blood Glucose in 180-240 minutes

Fat:

10-30% conversion of calories to Blood Glucose in 480+ minutes

It is worth pointing out that even the so-called “Slow Acting Carbs” are still too fast for most diabetics to handle other than in very small quantities.

 

Healthy Targets

These are the sorts of figures your doctor will be hoping to see when your regular medical checks come up.

The first figure is glycated haemoglobin. This is a sort of a weighted average of the blood glucose levels over the last three months, with extra emphasis given to the last few weeks.

Normal HgA1c: 4.5-6.5%

Normal blood pressure: 122/78 (best >100/60 & <130/80)

 

Fats:

  • Total Cholesterol: below 4.8 (normal is 4-5 but should always be below 6 nmol/l)
  • LDL: less than 3 (above 4 nmol/l = high risk)
  • HDL: above 1.2 (normal is 0.7-1.74 nmol/l, below 1 = high risk)
  • Trigycerides: below 1.7 (normal 0-2.8 but above 2.2 = high risk)

For HDL higher is better, for all the rest, lower is better. Get the doctor to test for all of these factors from HbA1c onwards so you can monitor them all and see how they improve (or not) over time.

 

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Links

Some further reading, if you have the stamina for it!

Dr Bernstein’s Diabetes Solution: Complete Guide to Achieving Normal Blood Sugars is another approach to dietary control of diabetes, written by a doctor who is a type 1 diabetic himself. Again, it restricts unnecessary carbohydrates in the diet and is highly recommended by those in the alt.support.diabetes newsgroup who have read it. You can read much of it online at the link given.

Jennifer’s Advice to Diabetics is worth reading for all diabetics who are looking for ways to control the disease. The main thrust of her advice can be summed up in three words: test, test, test. Her book, Blood Sugar 101: What They Don’t Tell You About Diabetes, I would strongly recommend to all diabetics (and give one to your doctor too if he gives you bad advice). It is short, easy read and yet totally up-to-date with all the latest science.

Tony Buzan’s The Power of Physical Intelligence: 10 Ways to Tap Into Your Physical Genius is a more general book, not about diabetes, but instead all about how to improve body and mind together in general, and gives a good alternative set of physical exercises that can be done at home with a minimum of special equipment (just some hand-held dumbells). It also describes which foods contain which essential nutrients, and backs up what I’ve said about starchy foods: he points out that the currently popular Food Pyramid used by doctors around the world was apparently devised by the grain industry to promote their products. Instead he puts vegetables at the base of the pyramid to be eaten the most. Starches are relegated to very modest doses near the top of the pyramid. This is how I eat, and how I advise you to eat.

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