Type II Diabetes

Forty years ago, when I was a Physician Assistant Student with the Emory University program, the family practice group of students did our clinical year at the Medical Center in Columbus, Georgia with the family practice residents going through their training there. One of the teaching physicians was a specialist in endocrinology. I remember him telling us at that time, “if we can get type II Diabetics down to, or near, ideal body weight, they will not need any medication to control their diabetes, only diet and exercise control”.

I am now a retired Physician Assistant, but I still try to keep up with what is going on in the medical field. I recently read an article on Medscape.com written by Mitchel L. Zoler, PhD that says the same thing that we were told back then. The title of the article is “Primary Goal in Type II Diabetes Should Be Weight Loss”. His article states that if a Type II diabetic can lose 15% of their body weight, it would go a long way to maintaining control of their diabetes.

The basic problem with Type II diabetics is that with obesity comes insulin resistance. There is insulin available, but the resistance interferes with the insulin moving the sugar into the cells. Over time, the islet cells of the pancreas simply wear out, in layman’s terms. Then the patient has start insulin injections daily in order to control the blood sugar.

So, if you are a type II diabetic and don’t want to start taking insulin injections in the future, control your food intake, do your daily walk around the block, and lose the weight.

Metabolic Syndrome: As Deadly as Cancer

An Epidemic spreading across the United States is as deadly as cancer. Parkinson’s Disease, Lung Cancer, Colon Cancer, AIDS and other diseases make headlines, but Metabolic Syndrome receives little notice. Metabolic Syndrome increases the risk for stroke and heart attack, erectile dysfunction, type II diabetes, and some studies suggest that obesity, a prime factor in development of Metabolic Syndrome, increases the risk for colon and breast cancer.

“The Metabolic Syndrome is a newly recognized entity,” says Dr. A. O. Rifai, M.D., who specializes in hypertension, nephrology, and metabolic syndrome in Panama City, Florida, “and is as deadly as cancer for the following reasons. Cardiovascular disease is the number one killer in the United States, and hypertension is the number on cause of death worldwide, 12%. That means that for 12 out of 100 people who die in the world today hypertension is the number one risk factor, and the number on risk factor for hypertension is metabolic syndrome.”

Obesity, defined as a Body Mass Index (BMI) greater than 30, is calculated by using a BMI calculator that can be found on several web sites that can be found by a Google search. The higher the BMI above normal, the greater your risk for the metabolic syndrome. Lifestyle habits leading to obesity include unhealthy food choices combined with a general lack of fitness in adults and children.

“Metabolic Syndrome”, according to Dr. Rifai, “is a combination of interrelated conditions presenting as a disease process”. Those conditions are obesity, hypertension, high cholesterol and hign blood sugar, with obesity being the initiating factor.

Metabolic Syndrome ws less common in earlier generations because our grandparents and parents we more active. Today we drive everywhere, even short distances. We park near the door at the grocery store or mall rather than further out and walking. The foods we eat are much different such as fast foods, processed foods, high fructose corn syrup, trans-fats, and refined sugars. We now recognize their tendencies to cause illness and contribute to the metabolic syndrome.

“The luxuries of life have reduced our metabolic expenditures,” say Dr. Rifai, “causing metabolic syndrome to become a much more prevalent disease process. The luxuries of life combined with the newer foods have expressed themselves now. The body does not metabolize these food well.”

Treating the metabolic syndrome is complex and requires cooperative efforts between the health care provider and the patient.

“Treatment of the metabolic syndrome is an intense weight reduction lifestyle,” says Dr. Rifai. “If you tell me that I have high cholesterol, high blood pressure, and diabetes, and you are going to treat those, but I continue to eat anything I want, then we are not treating the metabolic syndrome, just the metabolic abnormalities. So, the treatment for metabolic syndrome is intense dietary and exercise intervention. The patient must do his or her part.”

A weight reduction lifestyle consists of two components, healthy eating to decrease calorie intake, combined with daily exercise to burn more calories. Taking in just 500 calories daily more than you burn will cause you to gain one pound per week.

Healthy eating means changing the types of food you eat. Eat more high volume, low calorie foods such as fresh fruits and vegetables, whole grains, protein and fiber rather than low volume high calorie foods such as fast food and desserts. At mealtime, control your portion size. A portion of meat, whether beef, pork, chicken, or fish, is three ounces, about the size of a deck of cards; a portion of vegetables is one cup, about the size of a tennis ball, and a portion of starchy vegetables like rice, potatoes and pasta is one-half cup, or about half the size of a tennis ball. Use a salad plate for your meal to help limit the portion size, and no second helpings. Use an APP like “My Fitness Pal” to track your food and exercise.

Read food labels. The label tells you the portion size, the number of calories in the portion, the number of calories from fat, protein, and carbohydrate, all information that is important if you are going to keep track of what you are taking in.

Taking in calories is much easier than getting rid of calories. An average piece of pie contains about 400 calories, and it takes only a few minutes to eat, maybe a little longer if we are visiting at the same time. Burning those same 400 calories takes about one hour of BRISK walking. Think about all the little things that you munch during your day, and the calories you are taking in. Compare that to the exercise you do to burn off the excess. Do they balance? Or, are the calories in more than the calories out?

Exercise is very important in the treatment of metabolic syndrome. Studies by the American Heart Association show that regular exercise, thirty minutes of moderate paced walking, three to five days a week improve the cardiovascular tone and decreases the risks of metabolic syndrome. Start slowly and gradually increase the length of time and intensity of the exercise. You’re not sixteen anymore, and it will take time to build up to the level of exercise that you need to do daily. Many people stop exercising because they start too vigorously and think they can’t do the exercise and quit. Take it easy in the beginning and gradually build up to the level you need to accomplish your goal. Marathon runners don’t start by running marathons. They start by running around the block, gradually increasing their duration and intensity until they can go the distance.

According to Dr. Rifai, any increase in activity can help. “Park far away from the mall entrance and walk in, walk a flight of stairs instead of taking the elevator, just walk around the neighborhood,” he says. “Be more active, walk a little faster, and eventually you will have the energy to do more.”

Metabolic syndrome is a serious disease for both adults and children, and obesity is the greatest risk for metabolic syndrome. It is a deadly epidemic, and the patient must be as involved in the treatment as the health care provider. Without a combined effort, the treatment will not work.

No One Should Die of Colon Cancer Today

My grandfather died of colon cancer in 1960 when I was fourteen. He got sick, went to the hospital, and died within six weeks, leaving a big hole in my life. That was normal then because there was no way to diagnose colon cancer early.

Today things are much different. Colon cancer can be diagnosed almost as easily as skin cancer because colon polyps of the type that can become cancer can be seen with a colonoscope, removed, and treatment begun as needed.

According to Dr. Chris Wells of the Digestive Disease Center in Panama City, Florida, colon cancer can be found and treated with a cure rate of at least 85% today. Why not 100%? Because some people, even with symptoms put off examination until it’s too late. Others may develop the cancer at an age much younger than what is considered the normal risk age and have advanced disease before they are examined.

The key to finding and treating colon cancer is early detection. Patients with symptoms should be evaluated as soon as possible. The Mayo Clinic patient information site list the following symptoms that should be evaluated: a change in bowel habits, rectal bleeding or blood in your stool, persistent abdominal discomfort, a feeling that your bowel doesn’t empty completely, weakness or fatigue, or unexplained weight loss.

Everyone is at risk for colon cancer, but some are at greater risk than others such as people over age 50, a family history of colon cancer in parents or siblings, African-Americans, people with chronic inflammatory bowel disease such as ulcerative colitis or Chron’s Disease, low fiber high fat diet, obesity, smoking and alcohol consumption all have an increased risk of colon cancer.

Early detection of colon cancer is the key to successful treatment. Routine screening should begin at age 50, age 40 for those with risk factors. Any of the listed symptoms should prompt you to visit your doctor for evaluation or to make an appointment with a gastrointestinal specialist for evaluation. As part of a healthy lifestyle, get regular check-ups to look for any hidden disease before it lets you know it is there. Only with early detection and treatment can we truly say that no one should die of colon cancer today. © 2019 Guy A. Crawford, PA, retired

The Calorie Balance

When it comes to taking control of your weight the two things to consider are calorie intake versus output. It’s all about the calorie balance!

Calories are not some form of gremlin that live under your bed and sneak out at night to put weight on you. Calories are simply a measurement of energy. For a scientific explanation, a nutritional calorie is the energy it takes to raise one liter of water one degree centigrade.

You take in calories when you eat or drink anything but water, and you use calories when you exercise, do work, or just simply live. The energy used resting, sleeping or in a coma is called the Basal Metabolic Rate, or BMR. That’s the starting point to determine your calorie needs for the day. BMR calculators are available on line.

If the number of calories consumed are balanced by the number of calories used during a day your weight remains stable. If you take in more than you use the excess is converted for long term storage as FAT. The opposite of this happens if you use more than you take in. Some of the stored energy is broken down and used.

For example, a BMR of 1593 calories a day means that doctors would need to give a comatose patient that many calories daily in IV fluids and tube feedings to fuel the bodily functions and maintain the current weight. But, someone awake, alert, up and moving around, needs more calories to fuel their daily activities.

Again, there are calculators on line to help you determine your calorie needs each day to reach your goal weight in a selected time. A good weight loss rate is 1-2 pounds per week. That doesn’t seem like much, but how would you like to be 52 or104 pounds lighter this time next year?

Calories are easy to come by, far easier today than they were a couple of generations ago. In the days of our parents and grandparents, the only things that came from the store were commodities such as sugar, flour, coffee, and some meats. Other foods came from the family garden, grown, picked and canned. Labor and energy were used to obtain most foods.

Today there is a grocery store, convenience store, or fast food restaurant on every corner. Intake calories are available, plentiful, and cheap. Sometimes it seems that the fast food industry is in a competition to see which can pack the most calories into one meal at the cheapest price.

Combine the abundance of available calories and the many ways we have to avoid burning calories such as motorized vehicles, labor saving tools and devices, children using computers and video games rather than active play, and it’s not surprising that obesity and poor physical fitness rates are at an all time high.

What can you do to help yourself avoid becoming obese and out of shape? First, know how many calories you take in each day. Most of that information is found on food labels, or you can check internet sites. Keep track of serving sizes. If a serving is one cup and you eat two cups, you just doubled your calories for that item. Manage the intake.

At the same time, increase the calorie output by increasing your daily exercise. Walk to the corner and back once or twice daily. Slowly increase the amount and duration of the exercise. If you try to do what you did at age sixteen, you will probably hurt yourself, or tire out quickly and quit. Consistency is the key. Marathon runners don’t start by running marathons, they start by walking around the block, then gradually increase their distance and duration until several months later they are going the distance.

With discipline, patience, and consistency, you can take control and balance the calories.

This blog is intended for information purposes only and should not be considered Medical Advice. Discuss with your doctor any personal medical conditions, dietary changes or exercise programs before making any lifestyle changes.
©2016 Guy A. Crawford

Taking Control of Your Health

Most everyone wants to live better and healthier. Like many things in life, wants and wishes do not make things come true.

Doctors and other health professionals can help by giving advice and guidance, but they can’t make the changes that you need to make a difference. Only you can do that, one day at a time, one meal at a time, one walk at a time. No excuses, no put offs, no delays. If you are going to change, then change. As my mother used to say, “If wishes were horses, then beggars would ride.” Only putting in the time and effort will show results.

What does taking control really mean? It means that you have to control the variables in your life rather than letting those variables control you. It means that each day you have to do the things that you need to do, moving toward good health rather than doing the same things you have done for years. The AA definition of insanity is “doing the same thing over and over while expecting a different result”. It doesn’t work.

Taking control means acknowledging that you are harming yourself by your own actions or inaction then making the changes to improve the situation. I’m sure that most of you know someone who says things like, “I know I need to eat better and get some exercise” but they never really start doing it. Maybe you say that to yourself.

Taking control takes effort! Taking control means getting out of your comfort zone and developing new routines, new habits. Sometimes taking control means making new friends, associating with different people. Your old friends like you the way you are, and may try to keep you from becoming the new you.

Taking control takes time. Changes won’t come overnight. In an earlier post I mentioned that establishing new habits takes 66 days to become routine. Sixty-six days seems like a long time, but that 66 days will pass whether you stay the same or change.

It’s all up to you. Stay where you are or take control and make the change to a healthier lifestyle.

Hazards of Obesity

Why all the worry about obesity? In years past Overweight or obese people were considered healthy. But many health problems are associated with being overweight, and the more overweight, the greater the health risk.

Obesity is now classified as a disease by the American Medical Association. The cost of obesity and related illness to the health care system is about $3.5 BILLION annually. Let’s look at some of the health problems associated with obesity.

Heart disease – Most people who are overweight also have poor physical conditioning. The foods that makes us overweight or obese contribute to high cholesterol and triglycerides (fat) in the blood. The cholesterol and fat are deposited on the walls of the arteries resulting in plaque that limits blood flow to the heart muscle. Eventually the artery becomes completely blocked preventing blood from flowing to the muscle down stream. Without adequate blood flow, the muscle starts to die. If the blockage occurs in a small artery of the heart it’s a warning that bigger things are yet to come. If the blockage is in one of the major coronary arteries the results are catastrophic, frequently with sudden death.

Type 2 Diabetes – The greatest cause of Type 2 Diabetes is obesity. At one time Type 2 Diabetes was called Adult Onset Diabetes, but now, with the increase in childhood obesity, more children are being diagnosed with Type 2 Diabetes. Forty years ago when I was a student, one of our instructors, an endocrinologist, told us that if we could get our “adult onset” diabetics down to ideal body weight no medication would be needed to control the blood sugar. At that time we didn’t know why, but now we do. With obesity comes insulin resistance. The islet cells of the pancreas secrete insulin, the hormone that moves sugar from the blood into the cells. Obese persons, develop a resistance to the insulin blocking the movement of sugar from the blood into the cells. Over time the pancreas wears out and can no longer make insulin. Then insulin shots are required. The first and preferred treatment for Type 2 Diabetes is weight loss to ideal body weight through diet control and exercise. If this is done early enough insulin injections can be prevented.

Obstructive Sleep Apnea – Obstructive Sleep Apnea (OSA) is frequent pauses in breathing while sleeping. This causes micro awakenings during the night preventing adequate rest, resulting in excessive daytime sleepiness. OSA is much more common in obese and overweight persons, and can in turn lead to greater weight gain and obesity.

Osteoarthritis – The greatest risk for degenerative or Osteoarthritis is living long enough to get it. It’s a disease of aging. There are a couple of things that can increase your chances of developing, or having a more severe case of osteoarthritis. One is something we can’t do much about, getting older. The other is how much we weigh.  Being overweight puts more stress on the weight bearing joints.

Cancer – Risk for colon, pancreatic, breast, and gallbladder cancer raises with obesity, sedentary lifestyle, and diabetes, all of which are common in patients who live an unhealthy lifestyle.

Liver disease – NASH (Non Alcoholic Steatohepatitis) or fatty liver disease is now recognized as the second leading cause of liver cirrhosis, behind excessive alcohol intake, and can lead to liver cancer.

Through changes to a healthier lifestyle you can decrease your risk of disability and early death.

This blog is intended for information purposes only and should not be considered Medical Advice. Discuss with your doctor any personal medical conditions, dietary changes or exercise programs before making any lifestyle changes.

©2015 Guy A. Crawford





One Pound a Week

One pound a week is a good weight loss goal. By strict dieting you can lose more than that, but losing more than one pound a week has some drawbacks. Sudden drastic changes and too rapid weight loss can make it difficult to continue your program, lead to loss of muscle or lean tissue rather than fat, and increase the risk of developing gallstones.

What is one pound a week? One pound a week is 500 calories a day. If you take in just 500 calories a day more than you burn you will gain one pound a week. The opposite of that is true, if you burn 500 calories a day more than you take in you will lose 1 pound a week.

What is 500 calories? 500 calories is three pieces of candy each hour from a bowl on your desk during an eight hour day. That would be 500 calories that you probably wouldn’t even remember eating.

Burning calories takes a lot more time and effort than eating them. The average piece of pie, a nine inch pie cut into 8 equal slices, is about 400 calories. Eating the piece of pie takes about 3-4 minutes depending on how much talking you are doing at the time. To burn off those 400 calories takes walking 4 miles in one hour, or 15 minutes per mile. Most people can’t walk 4 miles in an hour, so they would have to walk twice as long.

Add those extra calories to your meals and you can see where you could easily gain a pound a week. It’s what I call a creeping weight gain. You don’t feel like you are eating much, but you notice your clothes fitting tighter, or you step on a scale and see a weight gain and ask yourself, “Why am I gaining weight? I don’t eat anything!”

Save the high calorie desserts and snacks for special occasions. Regularly eat high volume low calorie foods such as lean mean, low starch vegetables rather than low volume, high calorie foods like fast foods and desserts. Exercise regularly to increase the efficiency of you metabolism. Aim for a weight loss goal of 1 pound each week. By doing that you will make changes that you can stay with.

Make changes slowly. If you change too much all at once, you and your body will rebel against the changes and you probably won’t stick with them. Know what you are taking in by educating yourself on proper nutrition and exercise. Always see your health care provider to discuss diet and exercise changes.

It takes time, thought and commitment to change your lifestyle, but 500 calories a day, one pound a week can make a big difference in your life.

This blog is intended for information purposes only and should not be considered Medical Advice. Discuss with your doctor any personal medical conditions, dietary changes or exercise programs before making any lifestyle changes.

©2014 – Guy A. Crawford – All Rights Reserved

Your Lying Mind

Why do you think that it’s so hard to stick to the changes that we want to make in our lives? In my last post I said that it takes an average of 66 days for a change in lifestyle to become ingrained in our daily lives. I tell my patients it’s because your mind will lie to you.

When you begin a lifestyle change whether it be quitting smoking, eating healthy, or starting an exercise program, you have to change the lifestyle routines that are comfortable to your mind. You want to give up cigarettes, snacks, or fast food meals but your mind rebels against these changes. Your mind whispers to you, “Just buy another pack of cigarettes today and quit tomorrow,” or, “Just super size the meal today and start eating healthy tomorrow.” Sound familiar? It happens to all of us.

These are the blocks you must overcome to change your life. As long as you allow your lying mind a voice, you will not make the needed changes in your life. Change comes with recognition of what is going on and taking control. Every day that you have control the closer you get to your goal. Some people are strong enough to take control on their on, others need help from a support group, or medical intervention. But whether you go it alone, or with the help of others, you must overcome — your lying mind.

This blog is intended for information purposes only and should not be considered Medical Advice. Discuss with your doctor any personal medical conditions, dietary changes or exercise programs before making any lifestyle changes.

©2014 – Guy A. Crawford – All Rights Reserved

Making the Change to Healthy Living

Living a healthy lifestyle is fairly easy. Making the change to living healthy is the hard part. That’s why so many New Year’s resolutions fail, the resolver doesn’t make the full commitment of time to changing behaviors. Changing is a difficult thing for all of us to do. We are accustomed to doing certain things in our daily routine, and changing means becoming comfortable with a new routine.

When I was growing up there was a country comedian named Brother Dave Gardner. In one of his routines he said, “We do something once, twice, and the third time is addiction.” That is true in some cases, particularly bad habits. But, in a study conducted by Phillippa Lally and others for the European Journal of Social Psychology in 2010, it was shown that it takes an average of 66 days for new habits to become routine.

How many times do we actually give ourselves 66 days of changing eating, exercise and getting rid of other unhealthy behaviors before we slide back in to our old, comfortable routines. It takes time for new routines and habits to take hold and become the norm. The trick is to hang in there and become dedicated to making the change for the better.

There are many programs and aids to help you make the change. Some are good, some not so good. The important thing, though, is to set your mind and be diligent about following YOUR plan. Any plan can work if you work the plan.

This blog is intended for information purposes only and should not be considered Medical Advice. Discuss with your doctor any personal medical conditions, dietary changes or exercise programs before making any lifestyle changes.

©2014 – Guy A. Crawford – All Rights Reserved

Hello world!

Welcome to Healthy Lifestyles 101. I hope you find the information here interesting and relevant to your life and health. I have been thinking about this website/blog for several years, trying to decide just how I wanted to present the material. I finally decided to take my own advice and just do what I need to do, jump in and see where this takes me.I invite you to go along for the ride.

For the readers who don’t know me, let me give you some of my background, and why I am so interested in the subject of Healthy Lifestyles.

I am a retired physician assistant, graduating with the second class of PAs at Emory University in Atlanta in 1974. I have worked in emergency medicine, family practice in rural Alabama, the Federal Prison System providing health care to inmates, and organ procurement with the University of Florida Transplant program. The last 18 years of my career were spent in family practice and urgent care.

During these years I worked with many patients with health problems directly related to their lifestyle such as obesity, metabolic syndrome, alcohol and tobacco use. I have to admit that I indulged in some of these same unhealthy behaviors; however, I learned over the years that in order to get the most out of life I have to moderate the unhealthy aspects of living. I am not a “Health Nut,” but I believe that eating healthy, avoiding tobacco, limiting alcohol, and regular exercise will help keep me healthy and limit my risk for early death or disability.

Life is risky enough. After all, the number one cause of death is being conceived. Why increase the risk with unhealthy behaviors?

Over the next few weeks and months, I will address these subjects in detail with suggestions for how you can live healthy with some changes in your habits.

This blog is intended for information purposes only and should not be considered Medical Advice. Changes in diet and exercise routine should be made only after consultation with your primary health care provider.

© 2014 Guy A. Crawford – All rights reserved.