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North Korea bans smoking in public places - will it help Kim kick the habit?
North Korea bans smoking in public places - will it help Kim kick the habit?
https://ift.tt/3p0QflX November 06, 2020 at 01:23AM https://ift.tt/1R552o9
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Type 2 diabetes: Which medication is best for me?
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If you are living with type 2 diabetes, you certainly are not alone. One in 10 people in the US has diabetes, according to the CDC. However, despite considerable progress in diabetes treatment over the past 20 years, fewer than half of those with diabetes actually reach their target blood sugar goal.
In part, this may be because doctors can be slow to make changes to a patient’s treatment plan, even when a patient’s treatment goals are not being met. One reason for this may be the overwhelming number of medications currently available. And yet, waiting too long to adjust treatment for type 2 diabetes can have long-lasting negative effects on the body that may raise the risk of heart and kidney disease and other complications.
What is type 2 diabetes?
Type 2 diabetes is a chronic disease where the body’s ability to use glucose or sugar as fuel is impaired. Our bodies produce a hormone called insulin which enables sugar from carbohydrates in food we eat to reach the cells and be used as energy. In type 2 diabetes, insulin’s ability to do its job is compromised, and over time the body actually produces less of it. This means less sugar in the cells for fuel, and more sugar in the blood where it can’t be used. Having high levels of blood sugar over time can cause damage to vital organs like the heart, kidneys, nerves, and eyes.
Some risk factors that predispose people to developing type 2 diabetes, such as genetics and age, are not modifiable. Other risk factors, such as being overweight or having obesity, can be altered. This is why losing 5% to 10% of one’s baseline weight by healthful eating and physical activity remains the backbone of type 2 diabetes management.
Most diabetes medications effectively lower blood sugar
The blood sugar goal for most adults with diabetes is an A1C of below 7%. (A1C is a measure of a person’s average blood sugar over a period of about three months.) In many people, diet and exercise are not enough to reach this goal, and one or more medications may be needed. Metformin is a tried and tested medicine that has been used for many decades to treat type 2 diabetes, and is recommended by most experts as first-line therapy. It is affordable, safe, effective, and well tolerated by most people.
When metformin does not adequately control blood sugar, another medication must be added. It is at this point that doctors and patients must choose among the many drugs and drugs classes available to treat type 2 diabetes. In general, for people who are at low risk of heart disease or have no history of diabetic kidney disease, most diabetes medications that are added to metformin effectively reduce blood sugars and can lower A1C to under 7%.
So, how to choose a medication? Each person with diabetes has their own goals, needs, and preferences. Before choosing a medicine, it is important to ask some relevant questions: Is my blood sugar at goal? Is this medicine affordable? Do I have heart or kidney disease? What are the side effects? Is it a pill or injection, and how often is it taken?
Regardless of which treatment is selected, the American Diabetes Association Standards of Care recommends reassessment of diabetes control every three to six months, followed by modifications to treatment if needed.
Newer diabetes medications: Weighing benefits and risks
Lately, newer treatment options for type 2 diabetes — glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose cotransporter-2 (SGLT2) inhibitors — have been heavily advertised. These newer drug classes lower blood sugar and also have cardiovascular and kidney benefits.
GLP-1 receptor agonists are drugs that lower blood sugar after eating by helping your body’s insulin work more efficiently. All drugs in this group except one are self-injected under the skin, either daily or weekly. Several of them, such as liraglutide (Victoza), semaglutide (Ozempic), and dulaglutide (Trulicity), have been shown to lower the risk of cardiovascular disease in people who are at high risk for it, or who have pre-existing heart disease. They also promote weight loss. Some people who take GLP-1 receptor agonists may have side effects such as nausea and vomiting, and in very rare cases pancreatitis.
SGLT2 inhibitors like empagliflozin (Jardiance), canagliflozin (Invokana), dapagliflozin (Farxiga), and ertugliflozin (Steglatro) are also a newer class of medications that work by blocking your kidneys from reabsorbing sugar back into your body. They also have cardiovascular benefits, especially in those who have heart failure, and have been shown to slow the progression of diabetic kidney disease. Other benefits include lowering blood pressure and promoting weight loss. Use of these medications may increase the risk of genital yeast infections, especially in women. A rare but serious consequence of SGLT2 inhibitors is diabetic ketoacidosis, which is a medical emergency that can be avoided by stopping these medications in consultation with your doctor before major surgeries, or if you are ill or fasting.
While these diabetes medications certainly have more to offer than just improvements in blood sugar, they remain costly and inaccessible to many individuals. This is why it is essential to have an open and honest conversation with your doctor about what is most important to you and what aligns with your goals and preferences. Management of a complex disease like diabetes takes an entire team, with you being the key team member.
The post Type 2 diabetes: Which medication is best for me? appeared first on Harvard Health Blog.
Ask a Health Coach: Is Snacking Okay?
Hey folks! Erin Power is back for another round of Ask a Health Coach. This week she’ll be answering questions about beating the 3pm slump, what to eat when you’re hungry all the time, and strategies for speeding up a slow metabolism. Comment below with more questions or head over to the Mark’s Daily Apple Facebook Group.
Pete asked:
“I get so sleepy in the afternoons. In fact, sometimes, I actually have to take a nap. What can I snack on to beat my daily 3pm slump?”
Feeling a dip in energy mid-afternoon is so common, a lot of offices actually have a nap room. They also have boatloads of processed snacks, sugary coffee drinks, and vending machines to help you perk back up after your carb-laden lunch.
But just because it’s common, doesn’t mean it’s normal. Sure, you could be having a reaction to what you ate for lunch. Some food choices trigger a blood sugar spike and crash (think pasta, pizza, giant subs, a handful of candy).1 If this is the case with you, I have a better solution than doling out energy-boosting snack ideas…or napping.
- The lowest hanging fruit here is to manage your post-lunch sleepiness by swapping refined carbs for satiating and blood sugar stabilizing protein and fat. Maybe a Big Ass Salad or some leftover roasted chicken and veggies with butter. Even a handful of mixed nuts is better than a sandwich.
- It’s not always food related though. You have a natural drop in energy as part of human circadian biology. And it comes, you guessed it, about mid-afternoon. Knowing that your body has a built-in lull that happens around 3pm, the best thing you can do is anticipate it and plan accordingly. That means don’t schedule any overly draining tasks during that time. Instead, practice a little self-care and schedule in 15 minutes of stretching, walking outside, or listening to energizing music.
- Another possibility for your slump is mental drain. Even if your workday isn’t overly stressful, everything else in the world is right now, so again, cut yourself some slack and pay attention to how drained you feel on a daily basis. It could just be that by 3pm your brain (and your central nervous system) are so tapped that it signals a reset (i.e. you to take a nap). To avoid burnout, I like productivity apps like Focus Keeper. This one’s based on the Pomodoro Technique and breaks your day into 25-minute focus sessions, followed by 5-minute breaks.
- Of course, there’s always the possibility that you’re not breathing. And by “not breathing” I mean, you’re taking small shallow breaths that rob your brain of oxygen. Chances are you spend most of your day hunched over your computer, which compromises your breathing and your energy flow. Next time you feel that midday lull, think about the last time you took a good, deep breath, then sit up straight and take six slow deep breaths.
Test out any of these tips and my guess is you’ll feel better fairly quickly, no snack required.
Valerie asked:
“I’ve lost 40 pounds following the Primal Blueprint and have about 5 more to go. The problem is, I feel hungry all the time, so I either eat or try and white knuckle it! How do I tame my hunger?”
You’re not alone here Valerie. This is one of the most common challenges I hear from my clients. “I would have done better this week, but I was SO HUNGRY!” Common diet culture says you should eat healthy meals and snacks every 2-3 hours if you want to keep your blood sugar stable and keep hunger at bay.
My opinion? You shouldn’t have to feed your body every 3 hours to do either of those things. You also shouldn’t fear hunger. We’ve all been led to believe that hunger is bad — that it’s the one thing that stands between you and your weight loss goals.
Here’s the deal though. Hunger is actually a loving, protective signal from your miraculous body. It’s one of your most primitive survival mechanisms. It’s how your body makes sure you’re fueled sufficiently so that you can function properly.
The clients I work with claim to feel hungry “all the time”, which to me, indicates that they’re out of touch with their body. Sometimes it starts as a kid — if you’ve been told to finish your plate, regardless of whether or not you were hungry. And sometimes it’s in the ultra-processed foods you eat which unapologetically mess with your hormones. Certain foods inhibit your ability to recognize when you’re full — they literally confuse your brain into thinking you need to eat more.2
Sugar-free or “diet” foods aren’t any better. In fact, this study proved that sugar substitutes, although calorie-free, adversely affected the metabolism of participants, causing them to eat more.3Even a can of diet soda can increase your appetite because your brain thinks you’re getting something sweet, but your body never receives the energy it’s expecting.
My solution? Step one, ditch any processed or diet foods you’re consuming. That means ones labeled “healthy” or “low carb” or “low fat.” Step two, sit with your hunger next time you feel it and know that you’re okay. I promise you that you won’t starve. Even if you had zero pounds to lose, you’d still have access to thousands of calories in stored energy.
Feeling as if your only choices are to succumb to hunger and *fail* or really punish yourself and diet harder, aren’t good choices if you ask me. Work on trusting your body’s signals instead of fearing them.
Suzanne asked:
“Now that I’m in my 40’s, I can’t even eat a few fun-sized candy bars without seeing it on the scale in the morning. Any tricks for speeding up my metabolism?”
Chances are you could eat whatever you wanted as a kid. Fun-sized candy bars, heck, even a few full-sized candy bars wouldn’t impact your weight or your mood or mental clarity for that matter. As you mentioned, age has made it harder to indulge when you feel like it, and potentially a “slow metabolism” is to blame.
For those who don’t know, your metabolism is the system of the body that decides how fuel is used and has implications for weight management, energy, and more. The uneducated will tell you that the extra five pounds around your mid-section (or your brain fog, or blah feeling) is just a sign of getting older. They’ll say that because of your age, your metabolism has just naturally slowed down.
That is absolute BS in my book. I believe that over time, your metabolism does “forget” to effectively put fuel to use — and seems to just start storing it instead of burning it. But you can help your body remember by making some simple changes to what you eat and how you move.
The goal here is to become metabolically flexible. That means your metabolism gets to a place where it can effortlessly switch between burning carbs and burning fat — leaving more room for a few treats now and then. All those people who can “eat whatever they want”? Those people have excellent metabolic flexibility.
So how do you get metabolically flexible? Start by exercising. And not in a chronic cardio sort of way. Go for a daily walk, try some speed intervals, or add a weight training session here and there. Not only does this help you burn fat, it increases mitochondrial biogenesis, a key factor in reversing age-related loss of insulin resistance.4
Next up, get fat adapted. For a period of time, choose foods that are unprocessed and higher in protein and healthy fats. While you’re at it, cut out all snacks. Honestly, if you’re eating satiating foods, you won’t need them. While this might seem opposite of what you want right now (to eat candy without gaining weight), it will eventually allow you to indulge without the same consequences to your waistline.
Got thoughts on snacking? Metabolic function? Hunger pains? Share them in the comments below.
References
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3907653/
- https://pubmed.ncbi.nlm.nih.gov/15111494/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3772345/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1540458/
The post Ask a Health Coach: Is Snacking Okay? appeared first on Mark's Daily Apple.
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