A new study out of Denmark, published in the Journal of the American Medical association, supports the power of diet and exercise to improve health in the face of chronic disease- in this case diabetes. We have ample evidence that healthy eating and consistent physical activity are essential components of long term health. In fact, along with stress management, keeping active and eating well are our primary tools to prevent disease. However, researchers are still investigating how lifestyle can be used as a first line treatment for disease.
The researchers followed 98 Patients with diabetes on medication (metformin).
Both groups received medical and lifestyle advice every three months for one year, the intensive lifestyle group also:
The intensive lifestyle group had better blood sugar control and lost more weight:
Medication for treatment of diabetes is often essential, however lifestyle improvements are an option and should be utilized regardless of the need for meds – as long as you are physically able. In some cases following a healthy eating plan and regular exercise can reduce medication or even eliminate the need all together.
Blood sugar control is a complex interaction many organ systems as well as exercise and diet – both the type of foods you eat and the quantity.
Combining exercise and dietary improvements will result in the largest improvements to your blood sugar control and overall health.
When a food craving arises, the typical response is either resistance or satisfying the craving. Both of these approaches tend to strengthen the craving.
Lets use ice cream as an example, a commonly craved food – it hits the taste receptors for sweet and fatty proving a sense of pleasure and enjoyment. After a long day at work, a busy night preparing dinner and getting ready for the next day, you are tired and depleted. Suddenly your mind is thinking of the ice cream in the freezer. Knowing that the ice cream isn’t a healthy choice for you, you may decide that you don’t need it and that you are still full from dinner. Maybe this is enough, maybe the craving goes away. More commonly the brain will remain fixed on the desire for the sweet food and you will either have to continue saying no until you fall asleep or as happens for many people, eventually give into the demanding thoughts.
Talking back to a craving- negotiating with it- tends to keep it around longer and give it more psychological impact. While feeding the craving with the desired ice cream may lead to habit formation. Have you noticed a desire for a sweet taste after meals? This is a habit borne out of your usual way of eating.
There is a middle way to react to cravings which does not rely on will power or negotiation and will not reinforce the craving. This approach uses a common mindfulness technique of being present with the sensations of the body and mind without judgement, which is summarized nicely with the acronym RAIN.
Recognize– awareness of what is going on is the first step to being able to choose how you react. When a craving arrises, take a pause and say to yourself “I am having a craving”. Often this never happens and we find ourselves finishing the ice cream then wondering when we made that decision.
Allow the craving to be there, don’t push it away. If we can’t allow it to be we can’t allow it run its course and disappear. This step requires you to not judge yourself for having a craving, know that this is just what the mind does and it is very human to have cravings. It’s not your fault, you aren’t a bad person for craving ice cream.
Investigate – what does the craving feel like in the body? You might notice tension in your chest, throbbing in your head, or heat. Feeling the sensation in the body helps to flip the experience from unpleasant to one of curiosity. This will also decrease the power of the craving and allow you to see it for what it is – physical sensations arising in the mind and body.
Noting- a continuation of the last step, here you will watch the craving rise and fall. This is where you can surf the urge, recognize that the cravings and sensations come and go. Each craving will likely be unique for you, some come and go quickly without much strength while others may persist and be very powerful.
This practice does not require that you never eat food in response to a craving. What it does do is give you more of a choice. If you do the RAIN exercise and then choose to eat, allow that to be ok. Avoid judging yourself if you can. You may find that eating a smaller portion of ice cream satisfies.
The RAIN practice is way to help you be with the craving and realize that it is made up of physical sensations and you can choose how to react to it. Instead of adding fuel to the fire of craving, you can allow it to burn itself out.
Dr Judson Brewer has done research on using this to help people quit smoking, you can learn more about his work here.
A study published in the New England Journal of Medicine in April 2017 cautions that if you lose weight, it is best to work hard to keep it off. Following 9,509 adults with heart disease over 5 years, the researches found those with the greatest variation in weight had the highest risk for disease and death. The average weight change was 3.8 pounds at each of 12 check-ins. The group with the greatest variation in weight (8.6 pounds) compared to the group with the lowest (2 pounds) had a 124% higher risk of death and their disease risk increased:
These weight changes aren’t dramatic and could be considered within the normal 5-10 pound range that most people maintain over their lives. However, this population already had a serious chronic disease, so the impact to their health was likely more severe with small changes in weight.
Why the Yo-Yo?
When trying to lose weight, most people embark on a restrictive diet that is very different from how they usually eat. This often results in initial success, but once the novelty wears off or other aspects of life shift priorities, the weight gradually comes back on. This is the sad reality of dieting: nearly any diet will result in weight loss but most don’t lead to lasting change.
Do All Diets Fail?
The short answer is no. However, according to a study of all available research published in 2005, 20% of people are able to lose at least 10% of their initial body weight and keep it off for at least 1 year. One of the problems with this level of success is that most people want to lose more than just 10% – an achievable goal but one that may not result in dramatic changes to body shape. Modest change may end up feeling like a failure.
How to Avoid the Yo-Yo
Work the Relationship
Instead of dieting, choose an approach that addresses your relationship to food as well as how you eat. And think of this as a lifestyle change, not a temporary diet. Changing eating habits gives you a better shot at lasting change.
Focus on Maintenance
One key mistake dieters make is to give all their effort to the weight loss phase, leaving nothing left for how they are going to keep it off. The National Weight Control Registry is a database of “successful losers” who have lost and kept weight off for years: an average of 66 pounds for 5.5 years. Try these methods that characterize people on the registry:
Americans primarily make food choices based on price, flavor and convenience. While this has remained true over the past fifty years, several newer trends are emerging in our food culture. People are now choosing what to eat based on:
In Devoured: How What We Eat Defines Who We Are, Sophie Egan evaluates the latest food trends to get a deeper understanding of the American food psyche and why we eat the way we do. That is, how American values determine our eating habits.
While much has remained the same since the advent of industrialized and fast food in the 1950s, several emerging trends are reshaping how, what and when we eat. Egan identifies changes in how we define meals and our insatiable appetite for discovery and unique experience as pushing American eaters into new directions.
The changes in our eating habits are largely a result of our unstable food culture, something Michael Pollan so eloquently wrote about in Omnivore’s Dilemma. We are a nation of immigrants constantly reinventing ourselves and our food. The result is a freedom to combine foods and create new ways of eating. While this can be a strength in some ways, it leaves us vulnerable to the latest food fads, the idea that the “right way” to eat changes with each new nutrition headline or celebrity diet.
What is a meal?
Egan argues that our changing work environment is shifting how we eat away from three squares towards a more grazing approach. We are eating fewer meals together and snacking has become much more common. These types of food trends are often driven by several factors, one of which is always the food industry itself. You can see this in the expanding variety of places to purchase food: we fuel up while shopping for books, buying gas, in the work break room, or the hallways of schools and hospitals. Eating is no longer limited to the table, we are likely to also grab a bite in the car, walking down the street, and at the work desk.
“Between 1978 and 1996, calories consumed from dinner decreased 37 percent, and increased 16 percent from breakfast, 21 percent from lunch, and 101% from snacks. More than half of Americans now snack two to three times daily.”
The Health Impact
Egan connects our changing eating habits to increased nutrition related chronic diseases like diabetes, heart disease, stroke, and some cancers. Additionally, she provides a path to break out of the American eating norms. Her twelve word prescription:
“Work less and savor more. Make it real and stir the pot.”
Your bacteria are what you eat. Our intestines are home to the most numerous and diverse colony of bacteria in our body. These microscopic organisms play an active role in our health, producing chemicals that influence the function of the intestines and consequently nearly every organ system in the body- from the brain to the heart. Just like our cells, bacteria need nutrients and they get them from the food we eat.
Researchers are looking into the many ways bacteria influence our health, a recent Food Programme episode follows a British scientist to Tanzania, reporting on the diet and microbiome of the Hadza, one of the last remaining hunter gather communities. Their research shows that the microbiome adapts very quickly- it took two days of eating a traditional African diet to change the bacterial colony by 20%; and only a few days back on a common Western diet to reverse those changes.
So, if you are looking to improve the health of your gut flora, you will likely need to embrace lasting dietary change. Research like this indicates bacteria that have a positive impact on human health are the ones that live off of unprocessed, high fiber foods.
Our gut microbes evolved along with us, so it makes sense that what is healthy for the human body is likely healthy for them.
Complex carbohydrates provide nutrients to these health promoting bacteria:
While processed and refined carbohydrates starve the healthy bacteria and feed species which can damage the intestinal walls, causing inflammation and impairing immune function (the intestines are our largest immune organ):
Quality and variety matter
The traditional diet of the Hadza includes 500 different wild foods. These hunter gatherers regularly consume berries, tubers, honeycomb, and porcupine. Nutritional studies indicate that wild, uncultivated foods are higher in anti-oxidants and fiber while being lower in simple carbohydrates than their cultivated counterparts commonly consumed in industrial societies. Based on this diet, the Hadza have microbes in their gut that are extinct in western cultures and have 40% more diversity in their bacteria.
Fiber is a broad category of nutrient that most industrial eaters are deficient in, averaging 15 grams per day in the US which is less than half the recommended amount. In contrast, a typical Hadza breakfast of a porridge like drink made from baobab fruit contains upwards of 40 grams of fiber. Foods provide a wide variety of compounds that qualify as fiber, each one contributing different nutrients that feed and support different bacteria.
Improve the health of your gut bacteria by following the age old advice of “eat the rainbow” of whole, unprocessed foods and your flora will give you lasting health benefits for years to come.
Ask yourself this question at your next meal. It is a very simple way to take a pause and check-in. You can do this in a number of ways:
This is an example of the approach that Andrea Lieberstein takes in her new book Well Nourished. Based on principles of mindfulness, this book guides you through a complete evaluation of the health of your life; using straight-forward exercises to increase awareness of patterns of thinking around food and consumption and so much more. Andrea takes a holistic view of nourishment, recognizing that we need to address the health of not just our physical body but also our social, intellectual, spiritual, psychological and emotional selves as well. Creating wellness in all these aspects of our lives helps us heal underlying issues that may be holding us back from accomplishing our goals. As she states:
“Practicing mindful awareness opens the door to experiencing the piece and spaciousness that are available to you as you identify with awareness the unchanging part of you, rather than over-identifying with the changing nature of your thoughts, feelings, struggles, and experiences. This helps free you from the part of yourself that struggles with food and eating and opens up the space to make true change.”
Just like the wellness program at the San Francisco Free Clinic, this is not a diet book. Instead you will be exploring, experimenting, and finding the right way for you to eat, move, think, and be in the world that supports your life of health and happiness. Using concepts like “beginner’s mind” to see your present moment experiences with a fresh perspective and an ever present intention of kindness towards your self to break free from the struggles we tend to spend much of our energy on.
This kind of deep change doesn’t happen quickly, nor does it fade quickly like most diets. Mindful awareness is a way to be in your body and relate to your mind that takes practice. Andrea provides worksheets and techniques for journaling, meditation, and nurturing social support to make it easier for you to succeed.
“This awareness helps to bring a sense of perspective in the challenging moments…and help connect us to our essential self.”
Do you struggle with:
If so, this book has a path to help you uncover the root of what is holding you back and a way to make daily changes in your habits, behaviors, and patterns of thinking to improve your relationship to food and your health.
The way we categorize body weight makes it appear that you have to fall into a certain range to be healthy. Based on BMI (an estimation of body fat based on weight in relation to height), it is officially know as “normal weight”. But is this true?
One way to evaluate this question is to look at what is going on inside the body. Last year I wrote about a study where researchers evaluated progressive weight loss in overweight people on markers of disease (inflammation, blood sugar control, abdominal fat); finding the largest improvement in the first 5% of weight lost. While the metabolic effect continued with further weight loss, the initial 5% was enough to make clinically significant improvements to health. This does not mean getting to a certain healthy weight. For example, if you weigh 200 pounds, losing 10 pounds will give you this result. Think of the lily pads floating in the pond, their health is dependent on what you can’t see; the health of the water underneath that nourishes them.
Additionally, studies of overweight people indicate that about half the increased risk for heart disease and stroke is due to these metabolic dysfunctions and half to excess body fat.
Another way to evaluate the relationship between body weight and health is to look at the correlation between disease and BMI. A study published in the New England Journal of Medicine this month analyzed data from 68.5 million people around the world and reported that 70% of deaths attributed to excess body weight (overweight or obese on the BMI scale) were caused by heart disease. This makes sense as heart disease risk increases with elevated blood pressure, cholesterol, and blood sugar- the metabolic dysfunctions common with excess body fat. In fact, the authors suggest that health promotion efforts should focus on reducing these risk factors and not on weight loss.
Why do they make this statement in an article showing the strong connection between excessive body weight and disease? They point to two key factors:
The reality is that while most people struggle with weight loss, success rates at controlling the internal markers of disease are much more promising.
So health is not dependent on a specific body size. While there is a strong correlation between increasing body weight and risk for disease and death, the number on the scale only tells you part of the story. How much you move, what you eat and how you manage stress in your life contribute more to your health than the number on the scale.
Here is one simple way to get started improving your metabolic health- the unseen factors that nourish your life.