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For Your Patients – Musing about Health from an Expert on … Something

by Dr. Sheri Colberg, Ph.D., FACSM

Last month, I shared some strategies about managing body weight and diabetes that largely revolved around cutting back on medications that cause weight gain and trying others that help you lose weight. The problem is that there is more to managing diabetes and enjoying good health than just dropping a few pounds. Realizing that has led me to try to pull together everything I know about exercise, nutrition, and lifestyle changes from working in the diabetes field for over 20 years and teaching nutrition and exercise physiology to a variety of audiences.

To start with, when people ask me how important exercise is to longevity with diabetes, I tell them that the most important thing I learned when researching my 50 Secrets of the Longest Living People with Diabetes book is that the real secrets to living long and well are the same whether you have diabetes or not: regular physical activity, a healthy diet, stress management, adequate sleep, and emotional health.

Do I think that being regularly active should come first on the list? Absolutely. If you don’t use your muscles, over time you lose them, which is really bad for blood glucose control. Normally, you store most of the excess carbs that you eat in your muscles as glycogen. When your “tank” gets smaller due to both aging and inactivity, your blood glucose goes up and up (and more of it gets turned into and stored as fat). You also have to exercise regularly to keep the tank less than full, leaving room for more carbs to go in.

Over the years I have definitely changed the types of activity I tell people to do. As you age, doing any type of resistance training is the most critical thing you can do to retain your muscle mass — and it’s an activity that most people don’t get any of by just walking daily (although that’s good to do, too). You can do many exercises using only your body weight as the resistance (such as the infamous “planks”), and most core and lower body exercises double as balance training, which I have realized is critical to undertake as you age to prevent falls.

As for a healthy diet, how can anyone know what that really is comprised of? In the last 15 years of teaching nutrition for health, fitness, and sport and writing about healthy eating for people with diabetes, what’s “healthy” has changed more times than I can count1. Fat was out, but now it’s back in. Carbs were good, but now many are bad. Protein is the way to go…for the moment at least. It’s so confusing to the average person, especially with all the misinformation and outdated info available at your fingertips online. Based on all the research I have read, if I had to sum up healthy eating in one word, do you know what it would be?

If you guessed “fiber,” you’re right. Prevention of that pesky systemic inflammation that causes weight gain, insulin resistance, diabetes, heart disease, high blood pressure, and more all goes back to how much fiber you eat2. The latest line of research about where the inflammation comes from is all about the gut microbiota, or the bacteria that reside in our gut3. Normally, they can be very helpful to our health, providing us with critical vitamins (such as vitamin K) and keeping us thinner. We now know that the “good bacteria” proliferate when you feed them lots of dietary fiber naturally from a plant-based diet. As stated in a recent Diabetes In Control article on this topic, “Fermentable fibers are digested by intestinal bacteria, which turn them into short chain fatty acids such as butyrate and propionate. These fatty acids are then used by the intestinal walls to produce glucose…which is then released into the intestinal blood vessels and stimulates the brain to activate a series of defenses which help increase the feeling of fullness, while increasing the resting metabolism, and reducing hepatic glucose production.” An inflammatory state appears to arise when less supportive bacteria take over and create a leaky gut. Who knew that it was a simple as keeping your gut bacteria happy?

Seriously, just focus on eating 50 grams of fiber a day naturally through your diet by increasing your intake of fiber-filled, plant-based foods like veggies, fruits, legumes (like black beans and hummus — so good with baby carrots as a snack), and nuts and seeds and you’re likely to live a long and healthy life, lose weight, and be metabolically healthy. Yes, it’s that simple. Throw in some dark chocolate (70% or darker) as a natural anti-inflammatory producer4 — thanks again to your friendly gut bacteria — and you’re good to go. Eating that many natural plant foods will also provide you with all of the other micronutrients that people with diabetes are so likely to be deficient in (like magnesium) that affect metabolism.

Finally, managing your stress, sleeping enough, and keeping a positive outlook are all critical because they affect your ability to motivate yourself to do resistance training and eat more fiber. Try deep breathing exercises or a meditative exercise like yoga or tai chi, sleep 7 to 8 hours a night whenever you can, and remember to keep a smile on your face, even when you don’t feel like smiling. That’s all that 20 years of research boils down to! May your healthy gut bacteria have lots of offspring….

References:
  1. The Top 11 Biggest Lies of Mainstream Nutrition: http://authoritynutrition.com/11-biggest-lies-of-mainstream-nutrition/
  2. How High Fiber Diets Protect against Diabetes and Obesity: http://www.diabetesincontrol.com/index.php?option=com_content&view=article&id=15771&catid=1&Itemid=17
  3. Richness of Human Gut Microbiome Correlates with Metabolic Markers: http://www.nature.com/nature/journal/v500/n7464/full/nature12506.html
  4. Dark Chocolate: Has the Mystery Been Solved? http://www.diabetesincontrol.com/index.php?option=com_content&view=article&id=16159&catid=1&Itemid=17

Dr. Sheri Colberg is professor of exercise science at Old Dominion University and adjunct professor of internal medicine at Eastern Virginia Medical School. For more information, visit her web site at www.shericolberg.com.