Monday, January 2, 2012

It's That Time Again . . .

The rows of candy in the Seasonal Aisle will be replaced with Diet Food, mostly toxic. The media will be full of diet advice, mostly wrong. The bookstores (what few are left, but that's another story) will move the newest Miracle Diet books to the front of the store, each one promising to reveal a simple secret that will make the pounds drop off like magic. The gym will be packed.

It only lasts a month. Then the shelf at the grocery store will be full of chips and dips for SuperBowl parties, at least in the USA, you won't have to wait in line for a treadmill at the gym. The Miracle Diet Books will be shelved with all the other, failed, diet books, as it becomes clear that this year's magical secret is no better than last year's.

People with diabetes, of course, don't have the luxury of dieting only for 2 weeks in January. We have to watch what we eat year-round because we can't afford to let high blood sugars ravage our bodies. But as I've explained elsewhere, people with diabetes are also normal human beings, and that means that a certain amount of the time we are going to eat things that aren't good for us, overdo it, and pack on a few pounds over holidays.

The critical thing for us to master is not that we never eat anything that is off plan, but that, when we do, we learn how to get back on track as soon as we realize things are getting out of control.

A few hours over 200 mg/dl (11.1 mmol/L) won't make you go blind, give you a heart attack, or take out your kidneys. Neither will a few weeks. Most people who develop the classic diabetic complications do so after years of exposure to blood sugars way over 140 mg/dl (7.7 mmol/L)--the level that appears to be the upward limit of safety. Details HERE.)

But as many of us have learned the hard way,those harmless hours of high blood sugars have a way of turning into weeks and months, sometimes without our noticing it, and when that happens, those damaging years aren't far behind.

So it's good practice to clean up our act every now, and this January period right after the holidays is a great time to do it.

As always, our primary focus should be first on bringing our blood sugars back to where we know they should be. Most people at this time of year diet for weight loss, but weight loss is not what preserves the health of people with diabetes, no matter how many times you may have heard this said.

What preserves our health is keeping our blood sugars as close to the normal range as possible. That means staying under 140 mg/dl (7.7 mmol/L) and, if possible, ended up under 120 mg/dl a few hours after we finish a meal. Lower is better if we can do it without experiencing hypos (defined, technically, as blood sugars under 70 mg/dl (3.9 mmol/L)).

After you've gotten your sugars into control, you might also decide to drop some weight which may happen on its own if you're new to cutting back on carbs, but which will likely require some calorie restriction if you are an old hand at it.

Modest weight goals work better than ambitious ones. Set a goal you can achieve in a month, which may be anywhere from three to ten pounds depending on your size, and then set a new goal at the end of the month rather than setting a grandiose goal ("I'm going to lose 80 lbs!") which is much harder to attain and much easier to depress you after the first enthusiasm wears off.

If your blood sugar has been running a bit high lately or your occasional snacking has turned into round the clock eating, you will run into some known problems when you cut back. For starters, you're likely to be very hungry. Fortunately, the physiological component of your hunger is entirely due to the change you are making in your blood sugar and should be gone within a day or two once you get back on track. Remind yourself that if you can get through two days of eating the way you want to eat it will become a lot easier.

The other problem you'll run into is temptation. There is something about seeing some food we have decided not to eat that makes us immediately crave it. If that food is always in our field of vision, it can become very hard to withstand the urge to eat it. Diets that rely on willpower can be very short diets. So plan ahead to eliminate as much temptation as possible. Here are some suggestions I've found helpful. Please post your own in the comments section.

1. If it's not there, you can't eat it. Rid your home of any food that you find hard to resist. A common diet disaster pattern is eating perfectly all day, only to come home and blow it all by snacking on junk as the evening progresses. So throw out, or give away the items you end up pigging out on. If they aren't there, you might think about eating them, but you won't be able to eat them. This sounds idiotically simple, but the world is still full of people who try to diet with fridges full of ice cream.

This may require taking a hard line with family members. Demand their support. If they argue that just because you are on a diet they shouldn't have to be, ask that they keep their junk food somewhere out of your sight. Even just putting snack foods in a cupboard instead of leaving them out on a counter where you see them every time you walk through the kitchen can make a big difference. Just remember, Monkey See, Monkey Eat.

2. Don't Watch TV Commercials. One major cause of diet stress turns out to be the ads on TV. Seeing food makes people hungry, and TV is full of closeups of pizzas and burgers and "endless" shrimp. One strategy that has worked for our family is to use the commercial breaks for mini exercise sessions. During the commercial breaks turn off the sound and do some pushups. Lift hand weights. Run a few laps around the house. I have a nice long, steep driveway which is just the right size for a few laps of brisk walking during my beloved Patriots games. You'll feel a bit silly, but you may be amazed at how much better you feel if you do this. Even better, turn off the TV entirely and read or do things online that don't expose you to food porn.

3. Set modest goals. I don't tell myself I'm going to eat perfectly for the rest of my life. Instead I say, "I'm going to eat perfectly for the next two weeks. Then I'll see where things are at and decide what to do next." What I usually do next is continue to eat reasonably, because two weeks of keeping things clean makes it much easier for me to continue. But for me, it's very important to maintain my feeling that I am in control, not the diabetes.

4. Eat Dull Food. Stephan Guyenet over at The Whole Health Source Blog has posted some interesting research over this past year about how the palatability of food tends to push us towards weight gain. I've found that it is often easier for me to diet when I eat the same predictable dull low carb foods for breakfast and lunch every day for a few weeks. When they become intolerable, replace them with other dull foods. Eggs and meat or cheese for breakfast, Fage yogurt and nuts for lunch, a big green salad with meat for dinner, are good examples. All too often when people start dieting they spend their time reading diet cookbooks and recipe web sites looking for ideas. This dwelling on food is the last thing you need to do. If you need to come up with recipe ideas for a new diet, do it before your diet starts. Then think about other things.

5. Do A Different Diet. If you're trying to lose weight, especially if your previous attempt hasn't worked out as well as you had hoped, rather than just reflexively reach for the newest diet doctor book with its promise of Miracle Weight Loss Secrets, take some time analyze what it was about your last diet that made it fail.

Was it that you didn't like the foods you ended up eating? If so, don't go back to eating those foods, but find other foods that you might like better to diet on. Did the diet make you hungry, even after the first week was over? If so, maybe you are past the point where diet alone can flatten your blood sugars to where you aren't hungry. Maybe it's time for metformin, or perhaps insulin.

If you haven't had your thyroid checked in a while, do, and make sure your doctor does more than a TSH test to determine if you are having thyroid problems. Diet alone is not enough to solve many metabolic problems. Hunger is a SYMPTOM. If cutting back on sugar and starch do not resolve nagging physiological hunger, it may be time to get help from an intelligent doctor.

Your issues with failed diets of the past may be different, so you need to figure out what it was that derailed you. Doing the same thing over and over again expecting a different result is the definition of futility. So figure out what didn't work for you and solve the problem it posed.

6. Hold Yourself Accountable. Post your weight or blood sugar goal and daily progress in the appropriate section of an online diet or diabetes support forum. If that is too exposed, log them into tracking software, like Fitday.com for diet or one of the diet and blood sugar tracking apps available for your smart phone.

Average your results every week and see if the trend is up or down. Weekly averaging of individual values for things like weight and post-meal sugars will give you a much better idea of how you are doing than just looking at the individual values that can be all over the place.

7.Investigate What You're Eating. One of the biggest reasons for diet failure turns out to be eating a lot more than you think you are eating. If you are trying to cut carbs, you need to learn about how much carbohydrate there is in every food you eat. Look it up online. Download diet software. Use an app.

And remember that the nutrition counts you read are always pegged to a specific weight or volume. Weigh and measure your food for a few days to see what you are really eating. If you are like most people you may find that you are eating between two and three times as much carbohydrate each day as you think you are and far more calories, too.

What are your tips? Add them in the comments section.

 

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