Diabetes From a Personal Point of View

The dates of some experiences can be imprinted on one’s memory for a long time. I don’t think I’ll ever forget the day that my son was diagnosed with type 1 diabetes at 8 years of age. He had been excessively thirsty for a few days, and was drinking a lot of water. A couple days prior to his diagnosis, I remember him coming home from school and telling me in amazement that he went to the bathroom twenty times that day! My husband and I scoured the internet looking for any other explanation than the one that we knew was most obvious. In medicine, they have a saying: If you hear hoof beats it’s probably a horse, not a zebra. This means that what is most obvious is most likely. In our case it was a horse, type 1 diabetes.




When I was a nutrition student learning about diabetes, I struggled to get my mind around all that was necessary to manage the disease. Diet, medication and physical activity are all very important in controlling diabetes, and none of it is simple. I am still learning how complex diabetes management is every day. My son is now a 15 year old athlete. He has risen to the challenges of diabetes better than many adults would have. He knows how important physical activity is for his blood sugar management, and after trying several different sports he found a sport that he loves, rowing. Diabetics used to be discouraged from participating in sports because of the risk of low blood sugar. Now, we view physical activity and athletics as an important part of keeping a diabetic person healthy throughout life. The advent of the insulin pump has allowed us to fine tune the delivery of insulin such that athletics is not considered as dangerous as it used to be.



Since my son has been diagnosed with diabetes on March 16, 2004 he has had several seizures related to low blood sugar, all of them occurring during sleep. He’s always recovered relatively quickly from them, and was alert enough to drink juice to bring his blood sugar back up. His most recent seizure on July 7, 2010 was different. By now, my other children are well versed in their brother’s diabetes management. My 13 year old daughter has helped me administer juice to her brother and witnessed the multiple daily finger pricks to check blood sugar and injections of insulin. On this warm day in July, she frantically called us at work to let us know that our son was having a seizure. I left for home grateful that she would be there to give him juice. While I was en route she tested his blood sugar and administered glucagon, a quick acting sugar to help raise blood sugar in unresponsive diabetics. When I arrived the situation had not improved. Another injection of glucagon failed to bring him around. I was relieved when my husband, a physician, arrived home to help, but nothing that we did brought our son back to his normal mental status. We called 911.



I’m happy to say that my son has made a full recovery and the only lasing effect from this day was his inability to train athletically for about a week due to headaches from a lumbar puncture that was part of his hospital evaluation. We replay the events leading up to this day and try to figure out what contributed to it. I never expected my son to have a seizure that we couldn’t bring him out of. I now wonder if we should have been better prepared to understand how different the needs of a diabetic athlete are compare to other athletes and other non-athlete diabetics. I’ve since learned that to correct for a low blood sugar, a diabetic athlete can require twice as much carbohydrate as a non-athlete diabetic. I’ve also learned that dehydration can impact a diabetic athlete differently than a non-diabetic athlete. I never wanted to understand as much about diabetes as I do now. My experiences with my son have motivated me to learn as much as I can about this disease to help him and other diabetics, athlete and non-athlete alike, to take control of their lives!

No Free Refills!

I'm often asked by people if they can eat all they want of a certain food. Perhaps vegetables or fruit? What about diet soda? You're not going to like what I have to say, but there are no free refills when it comes to healthy eating. In fact the notion of "free refills" perpetuates mindless eating. There is and should be a limit to what we consume. By eating all that we want, we tend to overeat (think about the last time you ate at a buffet). Shouldn't we stop and evaluate our level of hunger before eating more?

Hara hachi bu is an Okinawan expression that means eat until you are 80% full. This was traditionally practiced by the Okinawans who were among some of the longest lived people on the earth. Their diet consisted mostly of  vegetables, whole grains, fruits, legumes including soy foods, fish and very little amounts of meat. Sadly, younger generations of Okinawans may not live as long as their elders because they seem to prefer a more western diet, with a nice helping of western diseases to boot.

As a 15 year old athlete, my son has a healthy appetite. I'm fortunate that he likes most foods and with a dietitian for a mother, he gets more than his fair share of vegetables, whole grains and legumes. He often desires second or third helpings. I'll ask him if he's still hungry before digging in a second time. His reply has often been, "well, I'm not full." I don't believe that fullness should be the gauge that we have had enough to eat, but rather absence of hunger. Fullness is the gauge that we have overeaten. This is food for thought in a world of overabundance. It takes real discipline to practice hara hachi bu when we are being bombarded by food advertisements that make us want to eat more with excessive portion sizes on every street corner. A mere 100-200 hundred calories a day extra can prevent us from obtaining weight loss, and over time promote weight gain. It's something to think about when you want to eat more because something tastes good, but you are no longer hungry.

To those who question why we shouldn't eat as many vegetables as we want, after all they are low in calories; I say sure, eat plenty of vegetables. Most people don't eat enough. But no food should be eaten unchecked. A recent article in the New York Times told of an 88-year-old woman who developed life threatening hypothyroidism from eating two to three pounds of raw bok choy daily for several months. She believed that it would help control her diabetes. Instead it suppressed her thyroid. This is an extreme example, but it shows that you can get too much of a good thing.

My challenge to you, try practicing hara hachi bu for a week. Be mindful about the food that you eat and stop eating when you are no longer hungry, but not full.

Diets Don’t Work? …Really?

Have you ever noticed how an idea gains popularity but the idea may not be true? Drinking eight cups of water a day is one such concept. It seems like a good idea, but there are many people who do fine drinking less and many people who need more. Another such idea is that diets don’t work. This is a common idea circulating within the nutrition community and one that I’m sure many “dieters” have also heard. The purpose of this idea is to move people away from the “dieting” mentality to encourage them to engage in healthy eating and lifestyle habits, and to become more aware of their bodily need for food. It also, unwittingly lays blame with the “diet promoting” community for the failure of dieting efforts.




As a practicing dietitian for 20 years I have to say that diets DO work! I’ve been witness to many people achieving their goals by following a specific dietary plan. The problem is that people can be limited by their ability to follow recommendations consistently. There are all sorts of reasons for this, too numerous to describe, but here are a few: emotional eating related to the need for comfort, lack of time to prepare meals due to social pressures, and medical problems (and medications) that change the body’s response to food.



Perhaps the first myth to dispel is that "diet" is a four letter word. It depends on how you look at it. The word “diet” as a noun describes a way of eating. All living creatures have a diet, ranging from the worms and bugs that birds eat to the broad variety of items my dogs eat – dog food supplemented with small rocks, twigs, shoes, undergarments and broccoli. Change diet into “dieting” and viola—it becomes a verb. This is how many of us are most familiar with the word. Dieting implies that we are doing something to change our eating regimen—not necessarily a bad idea. But when one “goes on a diet” they inevitable must “go off a diet” abandoning all the good changes that they previously made. It seems best to focus on the word diet as a noun to grasp the long term nature of what our commitment should be to a healthy diet. As long as we are living and eating, our commitment shouldn’t end.



Research conducted by the National Weight Control Registry showed that people can lose weight on ANY diet plan. So weight loss doesn’t seem to be the problem as much as weight maintenance. And weight is not maintained when the permanence of an eating regimen is not considered. As is the case with weight loss, there are many diets that are successful in improving other aspects of health. The Mediterranean diet is heart-healthy. The DASH diet lowers blood pressure, and has recently been shown to help prevent kidney stones. And there are many different diet manipulations that can improve intestinal function, reduce the risk of cancer, lower cholesterol levels and control blood sugar. Diets do work!



I agree with my colleagues who espouse the non-dieting approach, but don’t say that diets don’t work. Let’s go back to looking at the word “diet” as a noun and encourage each individual to choose the best diet to achieve and maintain their health.

Can Vitamin D Protect You From the Flu?

Vitamin D, termed the sunshine vitamin because it is produced by skin exposed to sunlight, has been in the news a lot recently. We are well familiar with the need for vitamin D to develop strong bones, but a rash of recent studies show that vitamin D also functions as an important regulator of immunity. Vitamin D deficiency is seen in many immune-mediated diseases such as Crohn’s disease, type 1 diabetes, multiple sclerosis, rheumatoid arthritis and asthma. Vitamin D deficient states have also been theorized to increase susceptibility to infections. Because vitamin D is mostly obtained from sunlight, blood concentrations of vitamin D decrease in the winter months, a time when influenza infections become more widespread.



A study released ahead of publication in the American Journal of Clinical Nutrition is one of the first clinical trials to report that vitamin D supplementation in school-aged children can decrease the incidence of influenza A. In this study, a randomized group of 334 children in Japan were given either 1200 IUs of vitamin D or a placebo over a four month period (December 2008 trough March 2008). The study showed a significant decrease in influenza A infection in the children who took vitamin D supplements. Vitamin D increases the production of antimicrobial proteins that inhibit some forms of the influenza virus, and vitamin D’s anti-inflammatory properties may also lessen flu symptoms.


Some of the study results were not as distinctly positive. A decrease in incidence of influenza B was not seen in this study. Various strains of flu have different mechanisms of infection within the body, and some may be more resistant to the effects of vitamin D. Children with asthma did not show a decrease in the occurrence of flu, but it is thought that asthma suffers are more prone to infection overall. Interestingly, the study showed that there were significantly less asthma attacks in the vitamin D supplemented group. Flu incidence was not decreased in the first month of supplementation; previous studies have shown that vitamin D supplements need to be taken for three months before blood concentrations reach a steady value. Therefore the optimal time to begin vitamin D supplementation would seem to be before the start of flu season. The skin loses its ability to make vitamin D from sunlight beginning in mid fall. Flu season typically peaks in November and April. Thus it has been recommended to supplement vitamin D from October through April.


Clearly, more research needs to be done to determine whether or not vitamin D supplementation can prevent the flu in larger, more diverse populations. We know that senior adults are more susceptible to influenza. Vitamin D requirements are also increased in this population as older skin is less efficient at making vitamin D. Overweight or obese individuals have also been shown to have low levels of vitamin D; one study showed that 1 in 3 women and 1 in 2 men were deficient in vitamin D. Though it has not yet been definitively determined that vitamin D supplementation prevents the flu, supplementation with up to 2000 IUs of vitamin D has been shown to be safe, and emerging evidence suggests that it may indeed help to prevent infection with some strains of the virus.

National Nutrition Month® 2010: Nutrition from the Ground Up

This March celebrates the thirtieth year of National Nutrition Month® whose purpose is to focus attention on healthy eating and physical activity habits to promote health and wellbeing in the American population. It’s difficult to compete in the current food environment with the message of health. You most likely won’t see any TV commercials or advertisements online or in print. But the message for this year resonates; “Nutrition from the Ground Up.”


I asked my family what this meant to them. This year’s theme brings to mind acres of plants growing in the sunshine with various shades of green and gold as far as the eye can see. My six year old daughter thought of butterflies. My mind met hers in a field of strawberry blossoms in May with butterflies fluttering in the air. The thought of foods grown using sustainable practices that are good for the environment and good for us comes to mind. Such practices encourage the butterflies and the bees to pollinate the plants, which then allow the fruits and vegetables to develop. The ground provides the nutrients for growth. So “Nutrition from the Ground Up” means caring for the earth that produces an abundant harvest to nourish us.

Another concept for this theme is the idea of gathering or foraging for food. Mushrooms, nuts, legumes, and wild berries are gathered in forests, groves and meadows and can often be found near the ground (nuts historically were collected on the ground after falling from trees). The nutrients these foods provide are varied with myriad health benefits. Although we are not gathering and foraging for these foods ourselves anymore, we should include them in our diets routinely to reap the health benefits that they provide. A variety of nuts provide heart-healthy fats to prevent heart disease and stroke; they range from omega-three polyunsaturated fats in walnuts to monounsaturated fats in cashews, almonds and peanuts. Legumes (peas, beans, lentils, and soybeans) are a wonderful combination of soluble and insoluble fiber with a good dose of protein; they help to manage blood sugar levels, which can help in the management of diabetes. Foraging for food also includes a level of physical activity. This physical activity used to be our way of life, but is now so greatly lacking on any given day. We should wander the ground again in our pursuit of health and vitality.

Perhaps the deepest issue here deals with something that is hidden under the ground. Like an iceberg, there is so much more to discover underneath. The iceberg analogy is one that I commonly use when describing the science of nutrition: what we currently understand about the interplay of nutrients on our health is only a small part of the story. Most of it is vast and hidden from view, despite all of our science. Dedication and patience is required to learn about the wonders yet undiscovered, just the same as the dedication and patience we must have in the pursuit of our health goals, whether they involve weight loss or disease management. “Nutrition from the Ground Up” speaks of discovery; finding a carrot buried deep within the ground, discovering how nutrients impact our health, and finding that healthier and happier person within ourselves.

Ask what “Nutrition from the Ground Up” means to you and your family.

To Weigh or Not To Weigh

Should you weigh yourself every day? Good question! We used to teach restraint with the bathroom scale. We thought that it was better to weigh only once a week so that you could see your progress over time and not be fixated on the slight fluctuations that happen in normal weight management. Well, data from the National Weight Control Registry (NWCR) show otherwise. People who are successful losing weight and maintaining weight loss, weigh themselves daily. The logic is that if (or when) you gain a couple of pounds, you will correct for that gain with more activity or decreased food intake. This is an important skill to master in weight loss and maintenance.

Energy balance is maintained when energy intake is equal to energy output. But this equation is not easy to achieve, in fact, it probably is never achieved on any one day. The best that research has been able to show is within 50 to 100 calories of input or output. So there is never a day when we burn 2000 calories and eat 2000 calories. Maybe we burn 2014 calories and we eat 2115 calories. And the next day we burn 2354 calories (we exercised that day) and we eat 2274 calories. And that's how it goes. We need a tool to be able to measure the effect that this has on our body. The scale is such a tool. Whether you hate it or not, it can keep you honest about what you are really doing.

My recommendation to my weight loss clients now is to start with weekly weights until about five pounds are lost. Then it's time to weight daily. I know how much work goes into losing weight and I want my clients to be successful and not regain lost weight. The key with monitoring weight is to weigh on the same scale at the same time of day, wearing the same clothing (it is best to wear no clothing or minimal clothing). Write it down in your journal (because writing everything down increases your chances of success) and move on. At the end of the week go back and look at your weights and write a summary of your progress. It may go something like this:

Started the week at 155.6 pounds. Weight went down to 154.3 by midweek. Ate Chinese food for dinner at the end of the week and noticed that weight went up to 155.1 pounds. Probably holding extra water from all the salt in the restaurant meal
the night before. Finished the week at 154.7. Lost almost one pound this week.

Now, weighing daily is not good for people who struggle with eating disorders. If you are aware of disordered eating patterns, you will require both diet and psychological/behavioral therapy and you will have recommendations made by eating disorder specialists. The rest of us need to stop hating the scale. When we hate the scale, we hate ourselves. It's just a number that helps us measure progress toward our goal. We expect to see drastic changes in a short amount of time, but research again shows us that those who are most successful with maintaining weight loss, lose weight very slowly, 1/4 to 1/2 pound a week. So when the scale tells you that you've lost 0.4 pounds in one week, feel confident that slow and steady wins the race!

The Value of a Training Buddy

My friend Linda hates to run. Linda and I train together. She told me this during one of our training sessions. I tolerate running, but can't say I love it either. I can manage one or two miles of interval running (preferring only one mile), but have never run long distances or entered any races. We train with another friend, Tim, who is a veteran runner. A while ago I decided that to continue to improve in physical fitness and to meet weight loss and management goals that people should continually challenge themselves. You have to do what you hate. So I made Linda run. She complained, but she did it. I wanted to quit too, but I did it also. We kept each other going. Tim kept challenging us and encouraged us to enter a 5K. We set the goal to run in the Jingle Bell Run in early December. We trained for a couple of months and we did it! It was a lot of fun! Our finishing times were not that great, but that wasn't our goal. While out shopping for new running shoes a while back, Linda expressed an interest in completing a 10K. OK, we can do that! We told Tim. Tim runs in a race almost every weekend during running season. Again Tim challenged us. How about running the Boilermaker 15K in Utica, NY in July? A 15K is a little more than we wanted to do, but I thought that we could do it (Linda was pulled along in this decision). We have plenty of time to train. Linda tolerates running now and is going out on her own. I think she even misses it when she can't get out for a run.

That's where Linda and I are right now. We're trying to get as much mileage under our feet as possible this winter. We spend two days training inside on the treadmill and as many days outside as we can considering the Rochester winters. Running long distances on the treadmill is agony. We'll run two miles and practice speed intervals on the treadmill. Linda hates this and doesn't see the point. Her 15 year old son tells her to stop complaining and to just do it. And she does. My goal is for us to complete the Boilermaker in 90 minutes. Ten minute miles seem easy for shorter distances, but we're running 9.3 miles. This is uncharted waters for us. Linda and I are now running five miles in an hour. This is beginning to seem easier to both of us.

Today, I met Linda in the bitter cold to go running. Sidewalks were not cleared and we had to run in the busy streets from time to time. We weren't sure how far we wanted to go today, but we both felt good during the run, despite not quite getting warm. We ran five miles, including a nice hill at the end of the run. Linda kept a good pace and we were both thrilled to be honked at by a gentleman driving by at the end of our run. Linda's goal now is to run six miles in an hour. That's a pretty good goal for someone who doesn't like running. I think Linda does like running now, she just doesn't love it! Hmmm...that sounds like another challenge.

Research shows us that when we engage in diet and exercise goals with other people our chances of success are greater. It's also important to set goals. Starting with small goals makes the challenge seem less difficult. But it's important to set new goals along the way, continually challenging ourselves. Humans are social and the camaraderie and encouragement that we receive from others can be tremendous. Conversely, others who do not share our goals can tear us down. Seek out those who will support you in your goals. I feel lucky to have Linda and Tim and the other friends who will be running and training with us! I'm really looking forward to putting many miles under my feet with good friends next to me!