Food & Fitness After 50: Do you have pre-diabetes? Now what?

prediabetes-FNLWhen my friend and colleague,  Jill Weisenberger, published a new book on prediabetes, I couldn’t wait to interview her and ask her to answer questions that adults 50+ have when told they have high blood sugar levels and prediabetes.

Jill is an internationally recognized nutrition and diabetes expert. She is the author of the four books including the best-selling Diabetes Weight Loss, Week by Week and the new Prediabetes: A Complete Guide. Jill has a private practice in Newport News, VA. She is a freelance writer and a consultant and spokesperson to the food industry, as well as a panelist for the US News & World Report Best Diet Rankings. You can follow her on Twitter and Facebook.

How important is it for adults over 50 to get their blood sugar checked? What is the best way to get it checked….doctor, health fair, etc?

With each birthday, we have an increased risk of developing prediabetes and type 2 diabetes. Typically, healthcare providers screen for diabetes and prediabetes around age 45. Your provider may screen you earlier if you’re overweight, have fatty liver disease or heart disease risk factors such as high blood pressure or abnormal cholesterol levels.

It’s a simple blood test. If it comes back abnormal, your provider will take a second measurement to verify the first one. If you are screened at a health fair, be certain to understand the results and follow up with your healthcare provider.

Test Prediabetes Diabetes
Fasting Plasma Glucose 100 – 125 mg/dl > 126 mg/dl
2-hour OGTT (oral glucose tolerance test) 140 – 199 mg/dl > 200 mg/dl
Random plasma glucose in an individual with symptoms of diabetes such as excessive thirst and urination Not done to diagnose prediabetes > 200 mg/dl
A1C 5.7 – 6.4 % > 6.5%

Some people think that if they don’t have any symptoms, they don’t need to see a doctor or get blood work…what would you say to that?

You’re breaking my heart! Sadly, there are 70 million adults in the US who have prediabetes and don’t know it. And that’s precisely because there are no symptoms. If you randomly count out 9 adults who you spend time with, three of them are likely to have prediabetes. That’s how common the problem is. Only about 10% of people with the disorder know that they have it.

What is prediabetes and can diabetes be halted if you have prediabetes?                                                                                            

If your blood sugar level is higher than normal but lower than diabetes, you have prediabetes. This is how we define and diagnose prediabetes. But, prediabetes (like type 2 diabetes) is much bigger than a blood sugar problem.

The two things going on with prediabetes are insulin resistance and the loss of some of our insulin-producing ability. It’s a nasty double whammy. The body is stubborn and resists the action of insulin. Because of this, the pancreas pumps out extra insulin. Early on in the course of the disorder, that extra insulin is enough to tamp down blood sugar levels to the normal level. No one has any idea that there’s a problem. But over time, the body can’t produce enough insulin to make up for the body’s resistance. That’s when blood sugar levels first increase. That’s prediabetes. As time goes on, if the insulin resistance continues, there’s likely to be further loss of insulin-producing ability. Then blood sugar levels rise more, and we have type 2 diabetes.

Other problems associated with insulin resistance, prediabetes and type 2 diabetes include blood vessel dysfunction, fatty liver, chronic inflammation, high blood pressure, abnormal cholesterol, heart disease, stroke, and even some types of cancer.

Because the problem is progressive, the best opportunity for a reversal is right this minute. There is some amount of urgency here because of the continued loss of insulin-producing capacity. Every day, your window of opportunity closes slightly. Without lifestyle changes, 37% of people with prediabetes are likely to progress to full blown type 2 diabetes within 4 years and most will have the diagnosis within 10 years.

Many people think every chronic disease is genetic and that there nothing they can do to prevent a disease like type 2 diabetes. What is the reality?

There are both genetic and environmental factors at play. We can’t change our genes, but we can do so much to improve our health and lower our risks of many chronic diseases, including prediabetes and type 2 diabetes. There are conditions that have lifestyle solutions that include diet, physical activity, sleep and more. And this is exactly what I cover in Prediabetes: A Complete Guide.

Many older adults think carbs must be eliminated if their blood sugar is high…can you explain why carbs are needed and what are the “best” carbohydrate foods?

Especially in the prediabetes stage, I really shy away from emphasizing carbohydrates. Instead I put the focus on the quality of the food. Instead of asking yourself if this food is high-carb or low-carb, ask yourself if this is a wholesome, health-boosting food. Other than having lots of carbohydrates, lentils and lollipops don’t have much in common!

Interestingly, there are several carb-containing foods that improve insulin resistance or lower the risk of type 2 diabetes. I always recommend oats, barley, lentils, beans, yogurt, nuts, and fruits, especially berries.

Can you explain why there is really not such thing as a “diabetic diet?” 

As science has progressed, we’ve learned that there are many ways to a healthy plate, a healthy body weight, and blood sugar management. So again, the emphasis should be on food quality. However, once in the diabetes stage, we do have to put some limits on carbohydrate intake. This is when I help my clients become carb aware. I try so hard to keep them from being carb phobic. But regardless, food quality really matters.

How does exercise help lower blood sugar levels?

Soooo many ways, but I’ll keep it brief. First, every single time that you exercise, you boost your body’s insulin sensitivity. Yes, I mean that. Every single time! And it can last from 2 to 48 hours!

Taking a walk after a meal helps lower blood sugar levels from eating. Strength training helps to build muscle and that means that there’s more place for blood sugar to go because muscle is a big storage bucket for blood sugar. All exercise matters, and it all counts. It all reduces insulin resistance.

Reducing sedentary time is also important. The American Diabetes Association recommends breaking up long periods of sitting with three minutes of light activity every half hour. You can walk to the water fountain at work, take your dog outside, do push-ups against the wall. It doesn’t matter, just do something.

I really like the section in your book on preparing for “lifestyle reset,” many people want to dive in head first without any forethought; can you mention why your tips can help someone get on track to a healthier lifestyle?

So many people just want to follow rules and make big changes right away. They think that willpower and discipline will steer them the right way. But no one has enough willpower and discipline to do what they need or want to do all of the time. We need skills, strategies and a plan much more than we need willpower. It smart to learn about setting goals and building motivation. It’s smart to identify the habits that help you and those that hurt you. The time you put into these things will help you in the long run. My experience tells me that simply rushing to change leads to temporary success and more on and off dieting.

Yellow under trees
Author, Jill Weisenberger

I encourage to check out Jill’s website for many great tips on good health and tasty recipes. Here is a link to a delicious easy lemon basil sauce, perfect for fish or seafood.

For more tips on eating well, moving well, and being well in your 50s, 60s, 70s, and beyond, see Food & Fitness After 50.

 

Food & Fitness After 50: Running Away from Diabetes

“What are you taking for your diabetes?” was the question Bill was asked when he had a physical exam for his employer’s insurance. He almost fell out of his chair and replied that he didn’t have diabetes, but the blood test showed otherwise. After a momentary “freak out,” his doctor said he could try changing his diet and start exercising but if that didn’t lower his blood sugar level than medication was on the horizon.

Bill Pratt 1Bill, now age 60, had that wake-up call 4 years ago. Today his blood sugar is normal, and diet and exercise did the trick. But, he had a lifetime of poor eating and sedentary behaviors to overcome.

Bill has always struggled with his weight; as a kid his not-so-nice nickname was “Fat Albert.” As an adult, his weight reached a high of 220 pounds and on his 5’10” frame, that equated to a body mass index (BMI) of 30.1, putting him in the obese category. (To learn if your BMI is in a healthy range, plug your height and weight into this online calculator).

After his diagnosis of diabetes, Bill started running 2 miles every day. Exercise is one of the pillars of diabetes management, with diet being the other. But, Bill said he “was afraid to eat so he just stopped.” His wife was concerned he would suffer from of malnutrition, so she called upon a neighbor, a former registered dietitian. (She was profiled in an early blog post; to read about her, click here.)

Bill said that today he is reminded to practice good health by thinking of the quote, attributed to baseball player, Mickey Mantle; “If I had known I was going to live this long, I would have taken better care of myself.”

His strategies for aging well include exercise. “Running is not only good to manage my blood sugar, it is a great stress reliever and my ‘epiphany’ time. I get my best ideas when my mind is free while running.” He has also come to appreciate the value of rest and a good night’s sleep. “I’m a proponent of the 20-minute power nap!” And, he also stays young at heart by learning from his sons, ages 29 and 26, who keep him abreast the latest trends, cool new music and bands, and exposing him to new influences that he would not otherwise get in his circle of friends.

His advice for others is to get and stay on a path to healthy aging by planning. “Planning when I can fit running into my day and what to eat helps me execute my wellness strategy.” This is great advice, too often we think we lack will power but what we really lack is advance planning as a tool to help us with weight loss or managing chronic diseases. This is summed up nicely in a tweet by registered dietitian, Jill Weisenberger:

Jills quote

Bill reminds us to take a hard look in the mirror and ask, “Am I living a sustainable lifestyle?” Bill’s answer four years ago was “no,” but today it is “yes.” He wants to be around for his wife, kids and future grandchildren. “Just be committed; that and have a supportive spouse like I do!”

 

 

 

Food & Fitness After 50: The Power of Prevention

I was first introduced to Connie when I heard her sing the national anthem in front of 10,000 dietitians at the opening session of the annual convention of the Academy of Nutrition and Dietetics. Her powerful voice and engaging on-stage presence made me want to get know my fellow dietitian. Fast forward many years later, and many more times performing the nation’s anthem (10 times more, to be exact) and I’ve come to admire her commitment to helping her patients get well and stay well, and her personal commitment to prevent a chronic disease that runs in her family.

Connie  is a registered dietitian who is also a certified diabetes educator . She is the author of The African American Guide to Living Well with Diabetes, and her new book, Diabetes Guide to Enjoying Foods of the World, will be available soon (information is available on her website.)

Connie Brown RiggsConnie’s personal commitment to eating well, moving well, and being well stems from her desire to prevent diabetes. “Diabetes affects family members on both sides of my family and that inspired me to not only become an expert in diabetes, but to practice what I teach by leading by example.” Connie says she had always done a little bit of exercise, but as she approached her mid-60s she ramped up her activity by hiring a personal trainer for twice weekly strength workouts and does cardio work three times a week. She says, “I am running away from diabetes!” She loves challenging her mind and body in her strength and conditioning workouts. Her latest challenge was to set a goal to complete 1,000 feet of “Jacob’s Ladder.” This Jacob’s Ladder is not the biblical ladder that connects earth to heaven, but rather a tough workout combining aerobics on a stair stepper with power, balance, and agility. “When I set the challenge, I could barely do 100 feet, but I made 1,000 feet with hard work and persistence.” Connie finds it motivating to be able to perform feats “that some younger people cannot do in the gym!” Check out Connie lifting 155 pounds at age 66!

Connie says that it is hard to keep up her fitness routine when she travels, but that traveling isn’t an excuse to abandon working out. While many hotels have great fitness centers, it isn’t always easy to get to the gym at 5 AM when morning meetings start at 6 or 7 AM. Connie found a solution; she packs a travel hula hoop. She says, “I have been known to rearrange hotel furniture to find a spacing for hooping.” She also uses apps on her phone to download workouts that she can do on the road. But, she also says the goal with exercise is “persistence, not perfection.” She tells people not to beat themselves if they miss a workout, but instead take the very next opportunity to move it.

Thanks for inspiring us with your story, Connie, and making me want to hit the gym…now!

Chris Rosenbloom and Bob Murray  are the authors of Food & Fitness After 50. It is available on Amazon.Chris and Bob at video shoot 9.21.17

 

It is also available from The Academy of Nutrition and Dietetics.

Food & Fitness After 50: How to Age Well While Living with a Chronic Disease

Meet Mike, a 64-year old artist who weighs the same as he did when he was in high school. How many of us can say that? Many of us over 50 live with chronic diseases, but Mike has been dealing with a serious disease since he was diagnosed with Type 1 diabetes 34 years ago, at the age of 30. Most of you have heard of diabetes, but did you know that only 5% of the people with diabetes have Type 1? In this form of diabetes, no insulin is produced so Mike must give himself multiple daily insulin shots to survive. Insulin acts like a key to allow glucose (sugar) to enter cells to produce energy. Without insulin, his blood sugar can reach dangerously

food 72
Illustration by Mike

high levels, while his cells starve because they can’t use glucose. (Fun fact: Prior to 1982, insulin was produced from the pancreas of cows or pigs; it wasn’t a very efficient process. To get 8-ounces of insulin, 2 tons of pig pancreas had to be processed. In 1982, genetic engineering (or GMO, if you’ve heard of that term) produced the first purified insulin from bacteria for human use. The technique is called recombinant DNA and the genetically engineered insulin has greatly reduced allergic reactions from cow or pig insulin. It is a modern medical miracle for those with diabetes.) For those who want to know more about all types of diabetes, the American Diabetes Association is a great resource (American Diabetes Association).

The pillars of management for Type 1 diabetes are insulin, diet, and activity. So, how does Mike eat and stay active to manage diabetes?

“I eat as good as I can,” he says, but doesn’t follow the old school notion of a diabetes diet. He counts carbs to help him adjust his insulin dose to match food intake. He eats peanut butter toast most mornings, but is trying to add more protein to his breakfast. He keeps his snacks simple and healthy; a small apple, pear, or handful of raisins and nuts. He has learned that portion size is key to managing his blood sugar levels.  As for meals, he “can make a whole meal out of a steamed bunch of broccoli.” He enjoys a couple of beers most days, with his favorite food, peanuts. He doesn’t eat a lot of meat, but gets protein from nuts, beans, rice, and fish, especially sardines (a good source of omega-3-fats). “I want to eat as healthy as I can to manage my blood sugar and avoid the complications of diabetes. I want to be around for a long time so I can hang out with my 4-year old grandson and watch him grow.”

Mike doesn’t belong to a gym or “exercise” in the way many of us do; he gets his exercise by walking and biking because he doesn’t own a car. “Biking to the grocery store is great exercise because I carry the groceries home in my backpack; I’m not tempted to buy things I don’t really need.” He also sees house and yard work as exercise. “Scrubbing floors and using an old-fashioned push mower to cut the grass” is seen, not as a chore, but as exercise.

Mike’s goal is simple: “feel good, not gross.” I’d say he is meeting his goal!

Chris Rosenbloom and Bob Murray’s new book, Food & Fitness After 50, is available for pre-order through Amazon (preorder link).