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 Mauro
Di Pasquale's The Metabolic Diet. 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 are 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 you 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. 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 obviously 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 worked. 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. 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 a bit, 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. 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.
(Top
of page)
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. 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. 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 allow that I might switch to
exercising outside the gym at some point instead, of course, 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 too 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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of page)
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 HbA1c). Levels after a meal will drop back to normal more
rapidly too, after a time (and you can always go for a quick 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 at the end of this article that you may
find useful. 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. 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 will usually lower your blood glucose levels, and if
you take medication or insulin for your condition, beware of going
hypo: 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. You
will need to adapt it 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, 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. It might work for you though, so see what you
think.
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 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.
Exercise.
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. 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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OK. I will start off with a summary
of typical meals that I may eat in a day, then follow that with 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, but usually 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.
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.
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, 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.
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, artificial sweeteners (if you
think they are safe), beverages (without sugar).
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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 to to conserve carbohydrates as
they are stored as fat 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.
(Top of page)
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. Maybe post
them to the Tucana Forum, or e-mail me... I may add some blog
functionality to this page too at some point so you can type your
thoughts right here... 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 HbA1c: 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!
Tony Buzan's The Power of Physical Intelligence: 10 Ways to Tap Into Your Physical Genius
is all about how to improve body and mind together, 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.
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 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.
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