Best Exercises for Diabetes & Pre-Diabetes

If you have diabetes or pre-diabetes, you’ve probably heard from your physician about the importance of a good diet and regular exercise. Consistent body movement (which goes beyond walking to the fridge) will help boost energy, better manage blood sugar levels, reduce insulin needs, manage stress, improve your mood and promote better sleep. If you’re like me and have glucose management issues, the temptation to sit on the couch after a long day is often overcome by my uplifted mood and energy level after a brisk walk or workout.

So here are some of the best exercises to engage in.

Aerobic dance

Dancing not only provides a physical workout but boosts your memory with the mental work required to remember steps and sequences. Have you tried Zumba? It’s a form of dance that’s a fun way to increase physical activity, lower blood sugar and reduce stress. In this study, a 16-week Zumba dance class program improved markers of health and fitness in Type 2 diabetic or overweight women. Here’s a beginner 20-minute Zumba workout to try: 

Cycling

Did you know that diabetes is a predictor for osteoarthritis? In this study, the findings showed a strong correlation between Type 2 diabetes and development of severe osteoarthritis. Another common risk with diabetes is diabetic neuropathy which damages nerves causing joint pain. So for those with joint pain, choosing low impact exercise like cycling can help you get the movement without straining your joints. If you have a bike and a decent path around the neighborhood, this is a fun exercise to enjoy with a partner. I prefer to ride on flat roads and gradually increase the length of time on the bike but if you’re up for the challenge, try a hill or two! Here are 10 popular bike trails in North Carolina: https://www.visitnc.com/story/hVVj/popular-north-carolina-bike-trails-cycling-routes    

Pilates

Pilates is a form of exercise that is performed on a mat (or equipment) to promote muscular strength, stability, endurance and low-impact flexibility. According to this study, 12 weeks of Pilates training improved glycemic control in older women with Type 2 diabetes. The beauty of Pilates is that you don’t need any fancy equipment to get the benefits and you can do this at home in the comfort of your living room. Here’s a 25-minute beginner workout to try:

Swimming

This is one of the most joint-friendly activities with maximum aerobic benefit as it works your heart, lungs and muscle without putting pressure on your joints. This study demonstrated the reduction in HbA1c levels in patients with Type 2 diabetes after 8-12 weeks of aquatic exercise. So whether it’s freestyle, backstroke, breast stroke, water aerobics or jogging in place, find a pool nearby and jump in!

Tai Chi

This centuries-old Chinese martial art utilizes slow, flowing exercises with movement, meditation and rhythmic breathing. This analysis of 14 research studies showed that Tai Chi can effectively reduce blood glucose and HbA1c markers in Type 2 patients with diabetes. New to Tai Chi? How about this 15-minute sunrise Tai Chi (or whenever you are up) to start your day?

Walking

You may have heard that being sedentary is as bad as smoking for your health. One of my favorite activities is walking as it can be done just about anywhere and the only equipment required is a good pair of sneakers. In this analysis of 81 studies, there was a strong correlation between physical activity and decreased risk of Type 2 diabetes. All subtypes of physical activity were beneficial whether it was vigorous or low intensity. The Standards of Medical Care of Diabetes recommends 150 minutes of aerobic exercise per week. So aim for 30 minutes of brisk walking 5-6 times per week and bring a pet or a friend along for company. If you are walking on the treadmill, find a good Netflix show to indulge in – I’ve often walked over an hour on the treadmill because I was so engrossed in the show that I didn’t realize how time had passed!

Weightlifting

Resistance training and other strengthening exercises help build muscle mass but also increase the number of calories burned. According to this study, 10 weeks of resistance training has shown to increase resting metabolic rate and reduce visceral fat, resting blood pressure and HbA1c. Don’t have weights at home or have a desire to venture out to the gym?  No problem – resistance bands are also effective in improving glycemic control according to this study. I have a set of these at home – they come in a set and are easy to carry when traveling.

Yoga

Yoga is one of the perfect exercises for diabetes. It incorporates fluid body movements to build flexibility, strength and balance while lowering stress and improving mental function. This study demonstrated the feasibility of yoga as a complementary therapy with significant reductions in HbA1c and improved blood glucose and psychosocial factors in patients with Type 2. You don’t have to pay for a class or join a gym to enjoy yoga as there are a plethora of free options. Here is one of my favorite channels:

6 Companies That Are Taking Telemedicine By Storm

As with much of our “new normal,” consumers’ newfound telehealth habit won’t be going anywhere. Demand for telemedicine is expected to rise by 38% over the next five years as more and more patients become eager to take advantage of the convenience of digital healthcare.

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Mastering Diabetes Naturally

I have been listening to the Food Matters Total Wellness Summit online and one of the interviews was with the two authors of the New York Times bestselling book Mastering Diabetes. Cyrus Khambatta and Robby Barbaro have degrees in nutritional biochemistry and public health (respectively) and are both Type 1 diabetics with firsthand experience on the nutrition protocol they researched and found to be optimal for reversing insulin resistance.

Based on their research, the authors promote a primarily plant-based diet with emphasis on whole foods with nominal good fats.

Here are the highlights:

  • Key contributing factors for diabetes in the western world, especially for Type 2 diabetes:
    • There is a lot of misinformation and also too much information that is conflicting which breeds apathy for the consumer and lack of motivation to make changes. It’s important to note that both forms of diabetes (Type 1 or 2) are unified by insulin resistance.
    • The American living environment is not set up for success – we have too many options at restaurants and easy access to unhealthy fast food. The bulk of grocery stores are dominated by packaged and processed foods and this has become the norm for the American public. That is why heart disease, diabetes and cancer are growing exponentially. Also, healthy food requires HARD work and it’s much easier for us to grab fast, processed junk food.
    • Food matters and is the biggest problem as we are so far away from the norm of what a healthy diet should be.
  • The authors found, when conducting research on how to create and reverse insulin resistance in rats, they needed to be fed a high saturated diet. It was not sugar (glucose, fructose, sucrose) but fat, particularly saturated fat. This really surprised me as I’ve always thought that sugar was the culprit in diabetes. And here’s why…

  • When dietary fat gets eaten, the triglycerides (the fat molecule) is broken down by enzymes secreted by the liver or pancreas to liberate fatty acids. These fatty acids get absorbed by the small intestine and then go into the blood into particles called chylomicrons. These chylomicron particles deliver dietary lipids to adipose tissues which is the enzymatically and mechanically safe place to store the fat where it can be used after days, weeks, or months.  However, with higher and more regular amounts of fat eaten in the standard western diet, there is no more room in the adipose tissue to store the fat so it pushes it to the liver and muscle for storage. The muscle and liver are designed only to store small amounts of fat and oxidize the fat when needed. Eating too much saturated fat overwhelms the cells in the liver and muscle tissue so as a protective mechanism, they respond by blocking the fat, glucose and amino acids that are coming in. And this is where insulin resistance starts.

  • Insulin is the master anabolic hormone which means it assists in the body’s building process. When insulin is present, it sends the signal to replicate and take up energy from the blood. If you slow down the effectiveness of insulin, you will also slow down the rate at which the fuel gets into the tissues. This slowdown or blocking of insulin is a self-protective mechanism set up by the liver and muscle to deal with the excess fat that is in the body. So, as soon as the insulin resistance mechanism is initiated inside the liver and muscle, it makes it hard for carbohydrates to be utilized as a fuel. For example, if you eat a ketogenic, high fat, low carb diet and then have a banana, the muscle and liver will reject the glucose from the banana as it is still working on oxidizing the fats it has stored. As a result of this, glucose from the banana cannot exit the blood easily and accumulates in higher concentrations. So, for an insulin resistance person on a classic high fat diet (Atkins, keto, Paleo), it’s not abnormal for their glucose reading to shoot up past 200 upon eating a banana. The banana is labeled as the culprit but really it’s the fat that the body cannot process.

  • Insulin resistance is caused by the accumulation of excess saturated fat in tissues that are not mechanically or enzymatically designed to store large quantities of fat.

  • Overweight people have a high propensity for insulin resistance and diabetes because they have a lot of stored fat.

  • Fat has gotten a bad rap in some dietary circles and it’s important to note that not all fats are created equal. Fat is essential for regulating hormones, for brain health and satiety but certain fats are better than others.

  • There are 3 main classes of fat:
    • Trans fats come from partially hydrogenated oils and are created from a chemical hydrogenation process to turn the oil into a more shelf-stable solid. There is ample evidence now that trans fats increase atherosclerosis and risk of diabetes. Products that contain trans fats include cakes, pies, cookies, biscuits, breakfast sandwiches, crackers, microwave popcorn, cream filled candies, doughnuts, ready-to-use dough, dairy and non-dairy creamers and vegetable shortening. It’s best to avoid any type of trans fat but it’s in so many products so read the label carefully.
    • Saturated fat is known to be the biggest culprit in insulin resistance because it is very abundant in the western diet; mainly in red meat, white meat, dairy, cheese, coconut oil, medium chain triglycerides oil (from coconuts) and plant-based foods like avocados, nuts and seeds, and olives. It’s safer than trans fat but we eat way too much of it. In the old days, it was hard work to get nuts from trees and out of their shells. Now you can buy giant packages of shelled, roasted nuts for easy snacking from your recliner. The same goes for meat – the mechanization of the industry has made it way too easy for us to buy and consume it. And factory farmed meat has a high omega-9 to omega-3 fatty acids ratio so the balance is way off compared to grass fed meat.  
    • Unsaturated fats – Mono-Unsaturated Fatty Acids (MUFA) and Poly-Unsaturated Fatty Acids (PUFA) – have missing hydrogens in their structure due to one or more carbon-carbon double bonds and have a different biological function than saturated fats. These fats are signaling molecules and not used for energy. They regulate the fluidity of the membrane and as a result, MUFAs and PUFAs can actually improve insulin sensitivity. A meta-analysis study showed that substituting 10% of calories of saturated fat with MUFA/PUFA can drop cholesterol by 25 points. Still, it’s not recommended to consume these fats in high quantities either.

The quantity of fat in your diet has a big influence on promoting insulin resistance. When you become insulin resistant, you increase the overall chronic disease risk including diabetes, non-alcoholic fatty liver, kidney disease, Alzheimer’s and heart disease.

  • There’s been a lot of good press and research about the Mediterranean diet; but that doesn’t give you the license to eat tons of olive oil. Remember that olive oil is still ‘mechanically processed through extraction’ so it is ideal to eat the olives and less of the oil.

  • One recommendation is to lower overall oil/fat intake no matter what type it is. The authors claim that less oil/fat over time will make you more metabolically flexible. Biomarkers like post-meal glucose, triglycerides, blood pressure and HbA1c can be lowered just by limiting oil/fat consumption.

  • Aim to eat less animal fat and more fat from a natural source in its whole form. There are only so many olives, avocados or coconuts you can eat but it’s easy to drench olive oil, avocado oil and coconut cream into drinks and dishes.

  • If you take out the fat, can you add more carbs and fruit? Yes, because fat inhibits glucose uptake so lowering it will enable carbs to be metabolized more readily. But remember that the type of carbs you eat are also important.

  • There are four classes of food that contain carbs and can be eaten in a low fat environment: fruits, starchy veggies (potatoes, yams, squashes), legumes (beans, peas, lentils), and whole grains (quinoa, oat, millet, sorghum, faroe, buckwheat). In general, eat whole carbohydrates NOT refined foods.

  • As for juicing, stick to greens and herbs so you can get the nutrients without eating excess fiber. Fruit should be eaten in whole form.

  • There is ample research on lowering the risk of diabetes with fruit consumption but it must be eaten in its whole form.

So, in summary, “eat the rainbow”, stick to whole foods with minimal processing, and reduce saturated fat intake. Sounds simple right? If you have insulin resistance or bordering on it, this could be the right strategy for you.

For more details, check out their book, Mastering Diabetes.

How to Prepare for the COVID Vaccine

With vaccine availability now broadening to more groups, you may be wondering what steps you can take to prepare yourself for the shot(s). In this blog, I’ll describe some do’s and don’ts to consider. It’s important to note that these are not short-term solutions but ways to reach optimal health which will support the vaccine response and also protect you from illness.  

Stay away from processed foods

In this peer-reviewed study conducted by the Environmental Working Group, it’s been shown that a food preservative known as tert-butylhydroquinone (TBHQ), commonly used in packaged foods like Pop-Tarts, Rice Krispies Treats, Cheez-Its and over 1,000 processed foods, has been found to harm the immune system. Unfortunately, chemicals like TBHQ were approved by the FDA decades ago and there has been no re-assessment of the safety of food chemicals. So, it’s “buyer beware” and all the more reason to stay away from processed foods and eat WHOLE.   

Eat an anti-inflammatory diet

Although there is not enough research to support that anti-inflammatory foods can make the COVID vaccine more effective, in general, it’s a good idea to eat a healthy diet. This earlier study found that increased fruit and vegetable intake improved immune function and antibody response to the pneumonia vaccine. Eating whole foods like vegetables, fruits, nuts, seeds, fish and grass-fed meats with minimal processed foods will generate less inflammation in the body and over the long term, improve immune responsiveness. Also, vegetable oils like corn and soybean oils which are prevalent in processed foods are pro-inflammatory and should be avoided. So, now is a good time to change your habits to “clean eating” to reap the benefits all year long. Here is my earlier blog on some inflammation-fighting super herbs which can be added to your diet.

Cultivate a healthy microbiome

Recent studies suggest that a healthy gut microbiome can increase the immune response to vaccines by modulating immune function and acting as a natural vaccine adjuvant. So to support a diverse and healthy gut microbiome, aim for fiber-rich and fermented foods that will encourage the growth of beneficial bacteria. Greens, cruciferous vegetables, yogurts, kefir, kimchee, sauerkraut and kombucha are great options and should be eaten regularly. 

Reduce alcohol and get proper hydration

As good as alcohol may taste going down, in excess, it leads not only to dehydration but a hangover which could exacerbate your vaccination side effects. Excessive and frequent alcohol consumption can weaken your immune system and make you more susceptible to infections. So keep your drinking to a minimum and stick to non-alcoholic beverages the day before. In addition, make sure you have plenty of fluids to keep you internally moisturized for vaccine day.

Get adequate shut-eye

While there are no formal studies done on the COVID vaccine and sleep, it’s no surprise that the quantity and quality of sleep impact your immune system. So a good night’s sleep will help offset fatigue the next day and prepare your immune system for the shot.

Supplements ideal for balancing your immune system include:

  • Omega-3 Fatty Acids: These essential fatty acids are known for their anti-inflammatory, immune-modulating and possible antiviral effects and have been recently studied for their impact on COVID-19 prevention and immune dysregulation. I would suggest getting these fatty acids in whole food form (salmon, mackerel, anchovies, sardines are good options) but if you don’t think you are getting enough in your diet nor a fan of oily fish, you can opt for a supplement. Here’s one to try:

  • Vitamin C:  Recent evidence indicates that oral vitamin C (2-8g/day) may reduce the incidence and duration of the respiratory infection. In this study, the use of intravenous vitamin C (6-24g/day) has been shown to reduce mortality and ventilator time and is suggested as the adjunctive therapy for COVID-19. Here are two to try that have been third-party tested:
    • Powder form: https://www.vitacost.com/solaray-vitamin-c-powder
      If you don’t normally take vitamin C, start out with half a teaspoon first and gradually increase to avoid any trips to the bathroom. I prefer the powder form as it is inexpensive and I can dose as I need.
    • Liposomal form: More expensive but easy on the tummy:

  • Vitamin D3: Over the past year, it has been noted that people with low levels of vitamin D were more vulnerable to COVID-19 with higher morbidities. This recent study assessed the role of vitamin D in reducing the risk of COVID-19. Vitamin D is known to reduce the concentration of pro-inflammatory cytokines, increase levels of anti-inflammatory cytokines, enhance the production of natural antimicrobial peptides and activates defensive cells that could destroy COVID-19. Here are several in various dosages:

  • B-complex: A good B-complex can be a part of your arsenal for keeping the immune system healthy and fighting off inflammation. Although studies have not yet been done on COVID-19, this study has shown the influence of the B vitamins (B1,B2,B3,B5,B6 and B12) in lowering proinflammatory cytokines and increasing anti-inflammatory cytokines. Here are a couple to try:

  • Zinc: Commonly used to combat colds, zinc is known to bolster the immune system. In a study conducted in Spain, they found that patients who had higher levels of zinc were more likely to survive COVID-19 than those with lower levels. Here are several verified options:

Regardless of what precautions you take and preparations you make, however, the main thing to remember is that even after you’ve been fully vaccinated against COVID-19, you should keep taking precautions in public places like wearing a mask, staying 6 feet apart from others, and avoiding crowds and poorly ventilated spaces until we know more.

How American attitudes on telehealth have changed since the start of the pandemic

by Katie Adams

Before the pandemic, 56.40 percent of Americans did not believe they could receive the same level of care from telehealth compared to in-person care, but recent polling shows 79.85 percent of Americans now say it is possible.

Sykes surveyed 2,000 adults in March 2020 and March 2021 about their telehealth attitudes and experiences. Below are six more notable findings from the survey results, which were released April 6.

  1. In March 2020, 19.5 percent of Americans had a telehealth appointment, whereas 61.05 percent had in March 2021.

  2. In March 2020, 65.6 percent of Americans doubted the care quality provided in telehealth appointments, but in March 2021, 87.82 percent wanted to continue using telehealth services after the pandemic subsides.

  3. In March 2021, 85.52 percent of Americans said telehealth has made it easier to get the care they need.

  4. In March 2021, 64.05 percent of Americans said they would prefer to have parts of their annual physical conducted via telehealth.

  5. In March 2021, 51.64 percent of Americans said telehealth has allowed them to visit their physician more often.

  6. In March 2021, 31.26 percent of Americans said their healthcare costs have decreased since using telehealth.