Activity and Exercise Move Move Move

We've talked about how easy it is to eat too much. Now let's talk about how easy it is to exercise too little and what you can do about it. As we discussed in Chapter 3, changes in physical activity have been incorporated into three of the four major studies that have successfully prevented the development of diabetes in vulnerable populations. Only one of the studies included exercise as an individual component the other two combined a program of increased physical activity with a lifestyle...

Golden Beet and Yukon Gold Gratin

Makes 4 servings (1 cup per serving) Cooking spray 2 cloves garlic, minced 1 cup sliced (V4-inch) Yukon gold potatoes (about V2 pound) V2 golden beet, cut into V4-inch slices 1V2 tablespoons salt (omit if on a low-sodium diet) Preheat the oven to 350 F. Spray a 6 X 8 X 2 baking pan generously with cooking spray and then sprinkle the minced garlic on the bottom of the pan. Alternate layers of potatoes and beets, seasoning each layer with salt and pepper and pouring a few ounces of evaporated...

How to Change Your Eating Behavior

Chances are you've tried to change your diet in the past and have found it difficult. It is difficult, and we don't mean to suggest anything otherwise. But our experience with the DPP lifestyle-change program has been that lots of people can be successful. The diet and exercise program was developed by a lifestyleintervention committee, a multidisciplinary team of professionals including dietitians, behavioral psychologists, diabetes experts, and exercise physiologists who reviewed the evidence...

Introduction

Like many diseases, diabetes is caused by our genes and our personal environment, which is created by our lifestyle. We cannot yet modify our genes, but we can modify our lifestyle. Here at Harvard and in medical centers around the world, we and many colleagues have conducted studies involving thousands of people who were at risk for developing diabetes or who had diabetes. That research proved that changes in lifestyle changes that anyone can make have enormous power both to prevent and to...

Lemon Infused Pistachio Sliced Chicken over Mixed Greens

Makes 4 servings (1V2 cups salad and 4 ounces chicken per serving) 3 4 cup cornflakes 2 tablespoons pistachios, toasted 2 teaspoons grated lemon rind V2 teaspoon salt (omit if on a low-sodium diet) V2 teaspoon black pepper 4 (4-ounce) skinless, boneless chicken breast halves Combine cornflakes, pistachios, lemon rind, V4 teaspoon of the salt, and V4 teaspoon of the pepper in a food processor pulse until coarsely ground. Place crumb mixture in a shallow dish. Place each chicken breast half...

Negative Labeling

Some people constantly stick negative labels on themselves and 102, their efforts. Any error or slip becomes a reason to be self-critical. Instead of noting, I didn't exercise this week, a negative labeler would think, I'm fat and lazy, or, I'm such a failure I knew I couldn't do it. The remedy do not translate a slip in behavior into self-criticism or a character flaw. Try saying, One slip isn't the end of the world. Slips are normal and to be expected. I'll get back on track now.

Right FoodCombination Diets

The right-food-combination diets do not focus on emphasizing or avoiding one type of food, such as fat or carbohydrates. Rather, they are based on other theories. Some of the popular right-food-combination diets are the Zone Diet, the Eat Right for Your Type Diet, and Dr. Phil's Ultimate Weight Solution. The Zone Diet promises that if you eat small meals with the correct ratio of protein, carbohydrate, and fat, then you will balance your hormones and insulin so that your body works at peak...

Sample Meal Plans for and Calories

Adapted from the DPP Lifestyle Intervention Manual, available at bsc.gwu.edu dpp manualsb .htmlvdoc and the Diabetes Prevention Program (DPP) Research Group, The Diabetes Prevention Program (DPP). Description of Lifestyle Intervention, Diabetes Care 2002 25(12) 2165-71. Adapted from the DPP Lifestyle Intervention Manual, available at bsc.gwu.edu dpp manualsb .htmlvdoc and the Diabetes Prevention Program (DPP) Research Group, The Diabetes Prevention Program (DPP). Description of Lifestyle...

Self Monitoring Recording Your Weight Loss Progress

The first step to self-monitoring is to put your weight loss goals on paper. Identify your current weight and 5 percent, 7 percent, and 10 percent weight loss targets and record them on your weight loss graph. Weigh yourself on a reliable scale at the same time of day and in the same clothing (either naked or in your underwear, if you're self-conscious) because your weight can fluctuate by several pounds over the course of the day. Ideally, you should weigh yourself in the morning before eating...

Tips for Avoiding Dieting Pitfalls

The first tip for avoiding pitfalls is to not think about being on a diet, because being on a diet implies that someday you will be off the diet. It is better to convey to yourself and others that you are working on trying to change your lifestyle to eat healthily and be more active. Some of the best advice on how to avoid dieting pitfalls, or in other more positive words how to change your lifestyle to lose weight and keep it off, comes from Helen McGrane, one of the DPP participants. She...

Type and Type Diabetes

The two main forms of diabetes are called type 1 and type 2 diabetes. Although they have different causes and, to a great extent, affect different categories of people, they share three main features. First, type 1 and type 2 diabetes are both characterized by metabolic abnormalities that include high levels of blood sugar in the circulation, as well as increased levels of other nutrient breakdown products that are released from their storage sites. See Table 1.1. Second, decreased insulin...

Why Diabetes and Metabolic Syndrome Matter

The ultimate impact on health of type 2 diabetes and metabolic syndrome is through cardiovascular disease. The cluster of features associated with type 2 diabetes or the metabolic syndrome is a highly potent recipe for heart disease and stroke. People with type 2 diabetes or the metabolic syndrome have at least a two-to fivefold increased risk of cardiovascular disease. The relative risks are even higher in women with diabetes compared with their counterparts who are nondiabetic. In addition,...

Medication to Prevent Diabetes

The Diabetes Prevention Program study tested not only the impact of lifestyle. It also tested the value of a medicine, metformin, in preventing diabetes. Metformin is a medicine that is commonly used to treat diabetes. It works primarily by decreasing the amount of sugar made by the liver and by reducing insulin resistance. 139 As reviewed in Chapter 2, type 2 diabetes develops gradually. In the years that it is developing, but before it causes symptoms or blood test abnormalities that lead to...

Why Weight Is Important to Diabetes Prevention and Treatment

Now you know the immutable math of energy balance. Actually, 26, you probably knew it all along. The good news is that you can use this math to your advantage to develop effective ways to achieve and maintain a healthy weight. In Chapter 1, we briefly described how being overweight alters the way the body metabolizes food, which can lead to high blood-sugar levels. So careful attention to weight is a key part of any diabetes prevention or treatment program. This book will describe a proven...

How Our Lifestyle Has Made Us Vulnerable to Diabetes

In 1985, an estimated 30 million cases of diabetes existed worldwide. This number increased to 177 million in 2000 and is estimated to rise to at least 370 million by 2030, almost all from type 2 diabetes associated with aging, obesity, and inactivity. In the United States, the numbers of cases of diabetes and obesity have risen in parallel. Diabetes and prediabetes affect 18 million and almost 40 million persons, respectively, and the metabolic syndrome affects almost 25 percent of the U.S....

Lifestyle Changes to Treat Type Diabetes and Associated Diseases

If you have type 2 diabetes, it should come as no surprise that lifestyle has a major impact on your diabetes especially your blood-sugar control and that lifestyle changes can have a beneficial effect. As explained in Chapter 1, type 2 diabetes represents the end of a long and somewhat complicated road on which insulin resistance, or decreased insulin sensitivity, and the inability to make enough insulin contribute to rising blood sugars. At first, blood-sugar levels begin to rise slightly...

How People with Type Diabetes Successfully Manage Their Diabetes

The tricks to successfully managing type 1 diabetes and maintaining the near-normal blood-glucose levels necessary to stay 48, healthy are paying attention to your daily schedule, understand ing the effects of your lifestyle on blood sugars, and adjusting your insulin to maintain blood-sugar levels in the range you and your health-care team agree is right for you. Maintaining some consistency in mealtimes and meal sizes will help during the early stages of adjustment however, as time goes on...

Lifestyle and Type Diabetes

You can see now why lifestyle is so important in causing (and potentially preventing) type 2 diabetes. During the same time that our lifestyle has changed, type 2 diabetes has transformed from a disease that was barely recognized to one that affects 8 percent of the entire adult population, 13 percent of those older than forty, and 20 percent of those older than sixty-five. Being obese substantially increases the risk of developing diabetes, but even being a little bit overweight increases the...

The Diabetes Prevention Program

With support from the National Institute of Diabetes, Digestive and Kidney Diseases of the National Institutes of Health, a group of clinical investigators from around the United States developed a program with the goal of preventing diabetes and put that program to a scientific test. The Diabetes Prevention Program, or DPP as it was called, involved 3,234 people who did not have diabetes but who were at high risk for developing diabetes. The DPP was the largest study of lifestyle changes to...

Special Issues for People with Diabetes

If you have diabetes you need to be careful of certain things. Your Feet All people with diabetes need to take extra-special care of their feet. Neuropathy (one of the long-term complications of diabetes that affects the nerves in your feet) may affect your ability to sense minor trauma. This can be compounded by decreased circulation and structural changes of the foot. Even minor repetitive trauma from weight bearing and poorly fitting shoes can lead to abrasions, blisters, and callus...

Type Diabetes The Twentieth and Twenty FirstCentury Epidemic

For years, type 2 diabetes was called adult-onset diabetes because it usually begins later in life. In recent years, however, as more children have become heavier at earlier ages, type 2 diabetes has increasingly been seen in teenagers and young adults. Of all peo- ple with diabetes, more than 90 percent have type 2 diabetes. Unlike type 1 diabetes, the development of type 2 diabetes is strongly influenced by lifestyle. There are two underlying causes of type 2 diabetes. One is the development...

Blood Sugar and Insulin The Basics

You need to know a little about normal metabolism to understand how so many of us are developing prediabetes and then diabetes. Metabolism represents the body's processes that direct energy into storage, such as in fat, or into fueling normal growth, development, and physical activity. Carbohydrates (including complex starches and simple sugars), fat, and protein are the three nutrient groups in our diet that provide the energy and building blocks for metabolism and growth. Carbohydrates and...

Healthy and Unhealthy Proteins

There are not really healthy and unhealthy proteins like there are healthy and unhealthy fats. But there are foods rich in protein that are bad for you because they also are rich in unhealthy fats for example, red meats and protein-rich foods that are good for you because they do not contain unhealthy fats. So picking your source of protein is very important. Keep in mind that in general it is difficult to increase protein in your diet without increasing fat, and vice versa. The amount of...

Mixed Mesclun Greens and Apple Salad

Makes 4 servings 1 cup apple mixture and 1 cup greens per serving 1 teaspoon olive oil Dash of salt 2 cups chopped Granny Smith apple 1 cup chopped Braeburn apple 2 slices turkey bacon, cooked in a pan or on a panini grill and 4 cups mixed salad greens a mesclun mix works well Combine all the dressing ingredients in a small bowl and stir well with a whisk. Combine cheese, apples, and bacon in a separate bowl. Drizzle the dressing over the apple mixture and toss gently to coat. Divide the greens...

Self Monitoring Recording Your Food Intake and Activity

Research has consistently shown that people who keep a log of their daily food intake tend to underestimate calorie and fat intake by at least 20 percent. So, if you record 1,000 calories of food in one day, it's likely that you've probably eaten closer to 1,200 calories or more. It's not that most people are being dishonest when they keep a food log rather, individuals often underestimate portion sizes and tend to forget to write down everything especially if they try to think back and record...

Stuffed Clams

Makes 4 servings 2 stuffed shells per serving 8 clams in shells, scrubbed 1 pound Fresh parsley leaves optional for garnish Place clams in a large bowl, and cover with V2 cup cold water. Sprinkle with cornmeal, and let stand for 30 minutes. Drain and rinse. Bring 2 cups water to a boil in a large dutch oven. Add the clams cover and cook for 4 minutes or until shells open. Remove the clams from pan, reserving 1 cup of cooking liquid discard any unopened shells. Let clams cool. Remove meat from...

Observational Studies The Difference Between Association and Causation

In an observational study, a group of people is examined either once cross-sectional study or over time longitudinal study . In a study of lifestyle or medications, for example, the scientists measure two things Exposures lifestyle practices or medications used over Health outcomes, such as diseases that develop The goal of observational studies is to identify associations between exposures and outcomes. For example, is smoking associated with lung cancer If the measurements of the exposures...

Lifestyle Behaviors Associated with Lower HbAc Level

Research from the Diabetes Control and Complications Trial DCCT , which studied intensive diabetes therapy three to four insulin injections per day or an insulin pump, testing blood-glucose levels at least four times per day, and trying to achieve blood-glucose levels as close to normal as possible , showed that four lifestyle behaviors were associated with lower hemoglobin Alc level Follow a consistent eating plan day to day. Try to eat about the same amount of carbohydrate at meals within ten...

Sample Shopping List

Check only the food items you need to follow your eating plan. Apricots Z Bananas Z Blueberries Cantaloupe Cherries Z Grapefruit Z Grapes Honeydew melon Kiwis Z Mangos Nectarines Oranges Z Papayas Z Peaches Pears Plums Z Raspberries Strawberries Tangerines Z Watermelon IZ Lean ground meat I Lentils I Lima beans IZ Low-fat cheese IZ Low-fat peanut butter I Low-fat yogurt I Pork tenderloin, loin IZ Salmon IZ Shrimp I Tofu IZ Tuna IZ Turkey _ Chicken Z Cottage cheese Dried beans and peas kidney,...

Chilled Couscous Salad

Makes 4 servings 1 cup per serving 1V2 cups no-salt-added chicken broth V2 cup uncooked couscous V2 cup seeded, chopped unpeeled tomato 3 4 cup chopped red bell pepper V3 cup chopped celery V3 cup seeded, chopped unpeeled cucumber V4 cup chopped green onions V4 cup chopped fresh parsley 2 tablespoons balsamic vinegar 1 tablespoon olive oil 1 tablespoon Dijon mustard V2 teaspoon grated lemon rind V4 teaspoon black pepper In a medium saucepan over high heat, bring broth to a boil. Stir in...

Zesty Pumpkin Custard

Makes 4 servings 0 2 cup per serving Vs cup sugar 1 tablespoon honey 3 4 teaspoon ground cinnamon V2 teaspoon ground allspice 6 ounces canned evaporated skim milk V4 cup reduced-calorie frozen whipped topping, thawed Preheat oven to 3250F. Combine first seven ingredients in a large bowl. Using an electric mixer, beat at low speed until smooth. Spoon V2 cup of the pumpkin mixture into each of four 6-ounce ramekins or custard cups. Place four ramekins in a 9-inch square baking pan add hot water...

Creamy Guacamole

Makes 4 servings 4 tortilla wedges and 2 tablespoons dip per serving 2 6-inch four tortillas, each cut into 8 wedges V2 cup peeled, cubed avocado V4 cup nonfat ricotta cheese 1 3 cup coarsely chopped onion 2 tablespoons coarsely chopped fresh cilantro 2 tablespoons fresh lime juice 1 tablespoon coarsely chopped jalapeno pepper V2 teaspoon salt omit if on a low-sodium diet Heat oven to 350oF. Place tortilla wedges on a baking sheet bake for 10 minutes or until crisp. Set aside. Place avocado and...

Weight Gain Myths

Now, with an understanding of the body's energy balance, let's look at some of the most common myths about the causes of 24, weight gain and weight loss and see how much truth is in each. I Don't Know How I Gain Weight I Eat Like a Bird. Next to the check is in the mail, this may be one of the most frequent and inaccurate statements out there unless the bird in question is a giant condor. The only way to gain weight is to eat food with more energy content than the energy that we expend....