Action:

• Increase uptake of glucose from the blood (taken with meal or after meal)
• Reducing glucose production by liver
• Mild appetite suppressant

Side effects:

• Nausea
• Diarrhoea
• Upset stomach
• Metallic taste in mouth

Action:

• Stimulate pancreas to release insulin and lower blood glucose levels

Side effects:

• Weight gain
• Skin rashes
• Gastric upsets
• Jaundice

Action:

• Slow down digestion of carbohydrates (taken just before meal)

Side effects:

• Flatulence
• Bloating
• Diarrhoea

Action:

• Increase effect of insulin (taken any time; slow onset, may take 1 to 2 months)

Side effects:

• Weight gain
• Fluid retention

Action:

• Stimulate pancreas to release insulin (taken before meal)

Side effects:

• Blurred vision
• Gastrointestinal upset
• Constipation
• Diarrhoea
• Nausea

Action:

• Slows stomach emptying (injectable 1 hour before morning or evening meals; may be used with metformin, sulfonylurea, TZDs)
• Slow down release of glucose from the liver
• Increase insulin release

Side effects:

• Nausea
• Vomiting
• Diarrhoea
• Dizziness
• Headache
• Feeling jittery
• Acid stomach

Action:

• Slows down release of glucose from liver (taken orally any time; may be prescribed with sulfohylureas)
• Increase insulin released

Side effects:

• Respiratory tract infection
• Stuffy or runny nose
• Sore throat
• Headache

Always use your medications as directed.  If you miss a dose or accidentally take two doses, monitor your blood sugar level closely.  These medications are rarely prescribed for pregnant women with gestational diabetes.  Insulin treatment is recommended when these medications cease to be effective.

Low glycaemic index diets are more effective than other conventional weight loss diets possibly because low glycaemic index diets keep you feeling fuller for longer. That way the tendency to snack between meals is less.

Another explanation for this phenomenon is that eating low GI foods elicit less insulin production from your pancreas. With less circulating insulin, less sugar storage and fat production takes place. In essence, what you are doing is powerfully shifting the hormonal balance within your body toward less storage of fat. This results in the reduction in the percentage of body fat, thus facilitating weight loss!

Take the simple rice for instance; did you know that their glycaemic indexes vary considerably? Who would have guessed that the carbohydrate from your unsuspecting Jasmine rice (GI – 109) hits your blood stream faster than your table sugar (GI – 100)!

Check out the table below:

Glycaemic index of various types of rice

For further information, click one of the following links: Glycaemic Index and also How To Stop Your Sugar Cravings.

Research by the Australian Bureau of Statistics reveals that since the late 1980’s life expectancy has increased by 6 years for men and 4 years for women, with men living until 79 while women until 83.7 years. This is good news indeed!  Unfortunately this does not mean we are healthier than previous generations!  Quite on the contrary, we are actually just sick for longer.  That was the message during the Australian Lifestyle Medicine Association Conference held in Sydney last month.
They say Australia is the lucky country.  However, the fact remains that despite a decade of unprecedented wealth, limitless choices, advanced healthcare, we are not as “well” as we should be.  We are staring down the barrel of a chronic disease crisis of unprecedented proportion.  Obesity, heart disease, stroke, type 2 diabetes and cancer are leading causes of preventable death.
To date, the health impact of overweight and obesity are yet to be experienced in this country.  Our current health infrastructure is ill-equipped to handle the fast rising “tsunami”.  So what should we do about this burgeoning problem?  The answer is not to have more doctors to meet the needs of a rapidly ailing population.  Instead, we have to take responsibility for our health.  The onus is on each of us to make sure we keep as healthy as possible by making life-enhancing lifestyle changes.
Did you know that during World War II, health improved in the general population in England?  This was because the English were forced to a basic daily diet of wholemeal bread, potatoes and home-grown vegetables.  Eggs, milk, butter, salt, sugar and meat were strictly rationed.  Food restrictions actually brought on unexpected health improvement!
During the Australian Lifestyle Medicine Conference, Professor Garry Egger echoed the same view when he spoke about the inverse relationship between the state of the economy and population health. He showed a graph depicting predictable improved state of health with each economic crisis over the last century.  It is ironic that improved economic conditions is consistent with bad health outcomes.  This is a clear sign that we are victims of excesses or “the good life”.
What do you think?  What active steps are you taking to improve your state of health?

NB: Professor Egger is also the Director, Centre for Health Promotion and Research, Sydney, and author of ‘Health, ‘ill-th’ and economic growth: Medicine, environment and economics at the cross-roads’, a soon-to-be published paper in the American Journal of Preventive Medicine.

Not all fatness indicates disease risk. Not all leanness indicates lack of disease risk. So what is the one factor that is a potent indicator of disease risk? It is an inflammatory process called metaflammation, para-flammation or smouldering inflammation. This condition appears to be inextricably linked with individual lifestyle behaviours like:

1. poor diet
2. inactivity
3. excessive exercise (modern endurance events)
4. inadequate sleep (due to deprivation, insomnia or sleep disorders like sleep apnoea)
5. mental states like anxiety or depression
6. environmental stressors
7. excessive alcohol
8. smoking

Markers of inflammation are expressed through a range of immune mediators such as cytokines, chemokines, adipokines, myokines and transcription factors. Recently, C-reactive protein has gained more attention than NFkB, TNF alpha and Il-6 but overall, these are common markers used to identify unhealthy inducers of metaflammation. It seems, the lifestyle-related inducers listed above are associated with oxidative stress, insulin resistance and eventual development of disease states.
Regularly consuming high glycaemic foods or large quantities of highly processed carbohydrate foods leads to inflammation and aging of cells. As Professor Jennie Brand Miller, world leading authority on the glycaemic index puts it very simply, “High GI foods lead to high inflammatory markers due to oxidative stress. What happens is that the high glucose load overwhelms the power-house (mitochondria) in the cell causing lots of free radicals to be generated. This leads to death of the mitochondria and eventual cell death.” In essence, aspire to eat like traditional natives and regularly choose low GI foods.
Regular moderate level physical activity, approximately ½ to 1 hour per day most days of the week is anti-inflammatory. Getting 8 hours of good quality sleep daily is also vital. It appears that the “stress-like’’ effects of sleep deprivation and the accompanying hormonal changes are associated with obesity.
In an advanced society like ours, mental states associated with stress, anxiety and depression seem to generate acute inflammatory responses accompanied by elevated levels of cytokines. Smoking also elicits a parallel reaction. Both of which are linked to degenerative diseases.
In a nutshell, the maintenance of a disease-free state lies squarely in our hands. Health is about consistently choosing pro-life behaviours through good nutrition, exercise, good quality sleep, relaxation and powerfully choosing joy-filled states. What are your views? Please post you comments below.

Foods containing pungent flavour are often rich in sulphur content. These foods not only are great mould deterrents, they also play vital roles in DNA repairs. Cruciferous vegetables like broccoli, garlic and onions are sulphur rich and powerful inducers of protective enzymes like superoxide dismutase and glutathione peroxidase. They are also high in indoles and can inhibit colorectal, bladder, lung, mouth, throat, stomach and breast cancers.

Cruciferous vegetable are particularly rich in isothiocynates.  Isothiocyanates have amazing anti-aging properties; this is because they are potent inhibitors of enzymes that promote glycation.  Glycation occurs when oxidation of sugars coating the surface of proteins like collagen result in the formation of Advanced Glycated Endproducts – AGEs. As the name implies, AGEs literally cause premature aging with the formation of saggy, wrinkly skin.  Note that any external signs of aging are accompanied by the aging of  internal organs as well.  The external and internal are never mutually exclusive. 

This aging process is even more pronounced in diabetics as AGEs form more quickly with elevated blood sugar levels.  It is not uncommon for a diabetic diagnosed at the age of 30 to have a physiological age of 75 by the time they reach the chronological age of 60.  It is a well-known fact that accelerated aging comes with poorly controlled blood sugar levels.  Hence, to reduce age-related cell damage, diabetics should tuck into large quantities of these vegetables to decelerate the glycation process and its accompanying premature aging.
In conclusion, these vegetables protect you from DNA damage, stimulate cancer cell death (cell apoptosis) and keep you looking and feeling young. Why would you not eat heaps more of them daily?

Diabetes is a chronic disease.  This means it is progressive and people who have it generally have it for life.  Initially, when a person is pre-diabetic, lifestyle changes involving appropriate diet and exercise are enough to keep blood glucose levels in the healthy range.  But as the disease progress, medication will be prescribed to keep sugar levels down.  In time, even this will fail to achieve normal blood sugar levels and insulin injections (up to 6 a day) will be prescribed.

In this article,  I will discuss the 5 classes of tablets commonly prescribed for diabetics and their side effects. I hope after reading this article, you will have a better understanding of what options are available to you, how appropriate your medication is for you and the alternatives you could choose from if your current medication is inappropriate.

Essentially the 5 classes of diabetic tablets can be categorised as follow:
1. Biguanides
2. Sulphonylureas
3. Thiazolidinediones
4. Meglitinides
5. Alpha glucosidase inhibitor

Most newly diagnosed diabetics are prescribed biguanides. Biguanides are also called metformin. Metformin acts by reducing the release of sugar from your liver, slowing down absorption of sugar from you intestine and making your body more sensitive to the hormone insulin. Metformin tablets are taken with meals and may present side effects like nausea, diarrhoea and metallic taste in the mouth. You will not gain weight with this medication but may lose some weight which is a real bonus! Long term usage of metformin can cause vitamin B12 deficiency so you will need to remind your doctor to test you B12 levels regularly to make sure that you are not deficient. If you are, you will need supplements or B12 injections on a regular basis.

The second class of drugs is the sulphonylureas. Sulphonylureas are taken before meals and can cause hypoglycaemia or low blood sugar levels making you feel faint so you must have lollies or sweet drinks available for when you experience a ‘hypo’. These drugs can cause weight gain. Not such a good thing as most diabetics are also overweight. Diabetics with poorer sugar control are often prescribed sulphonylureas in combination with the biguanides (expect to take more and more drugs if you sugar control is poor).

Thiazolidinediones act by lowering your blood sugar and increasing the effect of insulin on your muscles and fat cells. They increase your body’s sensitivity to insulin. These drugs can be taken any time of the day and may cause small weight gain but they seem to have the added bonus of redistributing fat from you tummy to your thighs! Good for trimming your waist!

Meglitinides act by stimulating the pancreas to release more insulin. They are taken just before meals and are quick acting. Possible side effects are hypoglycaemia, gastric upset and abnormal liver function tests. Regularly stimulating the pancreas to release more insulin can place a ‘strain’ on the beta-cells cause negative health outcomes. Meglitinides are great for individuals with erratic eating patterns like shift working nurses and factory workers.

Arcabose (alpha glucosidase inhibitor) are taken before meals and act by slowing down carbohydrate digestion and absorption. The side effects like bloating, diarrhoea and flatulence are quite unpleasant. However, with all these unpleasant side effects, weight loss is natural. A good bonus!

I hope this article demystifies the commonly prescribed drugs for your health condition. If you are experiencing any unpleasant side effects, it might be wise to change your medication. Please do not hesitate to ask if you have any questions or wish to post a comment below.

Australians are among the fattest people in the world. This has caused a host of chronic diseases to develop. A cluster of some of the above-mentioned conditions is commonly called metabolic syndrome. It is often said that obesity is harder to cure than cancer! For over 10 years, it has been known that obesity is directly associated with inflammation.

More and more experts are seeing body weight or fat as potential ‘markers’ of other health problems, like cancer, heart disease and diabetes. Low grade form of inflammation commonly called metaflammation seems to result from certain lifestyle behaviours. Some of these behaviours are responsible for making us fat.

Certain food choices and lack of activity are now known to contribute notoriously to ‘metaflammation’. According to studies, merely changing or reducing weight without adopting all aspects of lifestyle changes aimed at reducing inflammation are doomed to fail in the long run. To achieve better overall health outcomes, all aspects of lifestyle that contribute to reducing inflammation should be adopted.
Sleep is a factor that is largely neglected in our modern society. We now know that less than 7 hours sleep a day has been shown to raise inflammatory makers. This is related to psychological stress which has been known to cause pro-inflammatory responses. Chronic stress causes a chronic rise in stress-related hormones like cortisol and the concurrent reduction in the ‘feel-good’ hormones – endorphins. Chronic stress and depression are directly associated with metaflammation. Metaflammation leads to numerous disease states as a result of insulin resistance! In other words, science has shown that you can sleep yourself and relax yourself slim! Wow, how awesome is that? If you did nothing else but get good quality sleep and adopt deep relaxation, you could be a few kilograms lighter than you are now! How is that for good news?

Hence the winning formula for keeping trim involves a complete lifestyle overhaul combining:
1. Good sleep
2. Stress management (so you have little or no stress in your life)
3. Plenty of exercise – take every opportunity to move!
4. Good solid ‘anti-inflammatory’ diet filled with back-to-basics ‘earth foods’
5. No smoking

All of these health-enhancing factors have not changed since the time of Hippocrates. How remarkable is that? These 5 simple factors make up the entire prevention armoury. They say the more things change the more they stay the same, this must be one of those things!

1. Thou shalt nurture your spirit
How much time do you spend each day nurturing yourself? Do you do something each day that makes you smile or inspires you so that you feel good about yourself? When was the last time you laughed so hard that you cried? Remember how it was when you were a child and there was no holding back? Life was filled with infinite possibilities and you were free to create whatever you wanted in your mind’s eye? You were courageous and your view of the world was simple. You never wasted a moment on the past and you approached the future fearlessly and you were always deeply engaged in the present moment. How has the world changed since you were a child? Probably not that much but you have changed and complicated everything. What happened? When was the last time you spent time day dreaming and smiling to yourself? Nourishing your spirit is the first step to successful long term weight loss. How do you nourish your spirit each day? If your answer is, “No, I am too busy to engage in such nonsense.”, think again, you might be missing out on some of the finest things in life that money cannot buy – loving yourself and being happy. Start by asking yourself what are the things in your life you would love to do that make you happy and relaxed? Make a list and be sure to include some of these activities in your busy schedule everyday.

2. Thou shalt eat wholesome, natural foods
“When you sit to dine with a ruler, note well what is before you and put a knife to your throat if you are given to gluttony. Do not crave his delicacies, for that food is deceptive” Proverbs 23:1-3
Even in biblical times, there were clear warnings about the dangers of rich foods! How much processed foods do you eat in the day? How much of these foods come carefully wrapped in lovely paper wraps, boxes, tins, plastic bags, cartons, PVC bottles and glass bottles? All with mandatory food labels on them indicating the amounts of macronutrients and calories per serve or per 100g portions. We have an obsessive ‘love affair’ with rich foods that is threatening the health of the entire Western world. How often do you go back to basics and eat the “foods of the earth” as they were meant to be eaten – unprocessed, raw! The dietary guidelines clearly state you must eat 5 serves (cups) of uncooked vegetables and 2 serve of fruits each day and 4 serves of calcium-rich foods (like two small tubs of yoghurt and two glasses of low fat milk). Imagine if this was the foundation of your daily eating plan, how much more other foods can you include in your diet? I’d dare to say not much more as you would be too full to eat too much more of anything else. That makes weight loss a breeze!

3. Thou shalt have a trim tummy
How big is your tummy? Excess abdominal fat is not only ugly but also a serious risk factor to your health. There are two types of abdominal fats namely subcutaneous and visceral fat. The former refers to fat under the skin and on top of the abdominal muscles while the latter refers to fat found beneath your abdominal muscles, surrounding your vital internal organs. Visceral fat is much more dangerous than abdominal fat as this fat can enter the liver from these abdominal stores and cause “insulin resistance”. Insulin resistance signals the pancreas to produce more insulin in the vain effort to push circulating blood sugars into cells. This often sets up a viscous cycle leading to the use of drugs that supply even more insulin. A large quantity of circulating insulin is associated with high blood pressure, diabetes, heart disease, stroke, sleep apnoea, certain cancers and degenerative diseases! How much does your waist measure? Get the tape measure out right now and measure yourself across your belly button. Men with waist measurements greater than 94cm and women with waist measurements greater than 80cm are predisposed to chronic diseases! Take action now to reduce your waist before it is too late.

4. Thou shalt be active
Do you make an effort to move at least 30minutes a day? If you cannot exercise for 30 minutes, just combine 3 lots of 10minutes of moderate to intense exercise. That will also do. This is the bare minimum to maintain basic fitness levels. They say you get out of life what you put in. So, for the extraordinary result you so desire try the following: for example, if your office is located on level 9 of a high-rise building, it will take approximately 10-15 minutes to walk up the stairs of the building. Do this 4 times a day (when you arrive, go out for lunch, return from lunch and when you go home). It will easily total 1 hour of exercise! How easy is that? Get the “hot bod” you have always wanted without even trying! Who needs to go to a gym regularly? If you do nothing else but this, I assure you, you will not recognize yourself after one year. Transforming your activity naturally leads to transforming your food choices and the result will be phenomenal.

5. Thou shalt drink alcoholic beverages in moderation only
Men should not drink more than 4 standard drinks and women not more than 2 standard drinks a day. The house wine you get at your restaurant is almost 2 standard drinks. A can of beer constitutes 1.5 standard drinks. How many and how often are you drinking? Do you have two alcohol-free days a week? Alcohol has more than twice as many calories as fat. Naturally the more you drink the fatter you will be!

6. Thou shalt eat until you are comfortably full
How often do we stuff our faces till we cannot walk? Is it three times a year – at Christmas’, New Years’ and on your birthday? If that is all then it is not a problem. If it happens 3 times a day then you have a serious over-eating disorder at hand, you have to seek professional help. A psychologist or dietitian specializing in eating disorder would be my first port of call. Take a moment today to go internally and feel your body cues. You will know it when you are comfortably full, that is about 7/10 full. That is the point you should stop eating and walk away from the table. Practice this everyday at every meal. I would be very surprised if you do not lose some weight or even a lot of weight without changing anything else!

7. Thou shalt stay hydrated
Most people do not drink enough fluid in the day. Ideally we should aim for 8 glasses of fluid or 2 liters of fluid a day. Next time you feel “hungry”, pause for a moment and ask yourself if you are really hungry or thirsty. Often thirst is mistaken for hunger and you end up eating excessively.

8. Thou shalt eat slowly
How fast are you eating? Studies have found that the speed at which someone eats their food is often directly proportional to their body size. The faster you eat the more likely you are to be over weight. Tonight when you sit down to have dinner, watch the wall clock and check how much time you take to eat. You should take at least 20 minutes - chew your food thoroughly before swallowing. If you take 30 minutes to eat that is even better. It tells me you are practicing mindful eating and most likely enjoying your food and much less likely to overeat and get heart burn. The act of chewing food thoroughly tends to make one feel more satisfied and fuller.

9. Thou shalt eat at the table
How often do you eat on the run? Do you eat all edible morsels from your children’s leftovers? Do you eat a Mars bar at the bus stop because you felt ‘peckish’? Would you polish up a slice of cheese, half a leftover poppet of fruit juice, 5 snakes, 3 biscuits and ½ a packet of chips on the run and discount them as part your caloric intake because they were not eaten at the dining table? Well, if you are serious about losing weight, stop eating on the run at once and have 3 main meals a day properly at the dining table!

10. Thou shalt not eat when overly hungry
How often do you come home from work in the late afternoon and plunder your refrigerator and pantry? Do you feel so hungry that you can eat every edible morsel in your path? Well, stop pronto when you are in that state. Drink a glass of water and eat a fruit like an apple (something that requires a lot of chewing before swallowing to starve off the hunger pangs), regroup and then start planning a proper dinner. That way you are less likely to overeat and choose unhealthy food choices.
 
Conclusion
So these are the ten commandments for effective weight management. What do you think? Have you had your own experiences of what works for you? Which parts do you find easier and which ones harder? Any area you would like me to expand on in a future article?
Please leave me a comment below.

PCOS can occur at any age. Insulin resistance tends to rise naturally at puberty. Symptoms of PCOS vary tremendously from individual to individual. Examples of symptoms are: irregular / infrequent menstrual cycles, infertility,  acne, acanthosis nigricans (rough dark-coloured skin around neck and armpits), heavy body- hair, hirsutism, stubborn body fat, inexplicable tiredness with acute drop in blood pressure on standing up or with exercise, post-meal low blood sugar levels, sleep apnoea and general reduced stress threshold.  Do you have any combination of these symptoms?  If you do, make an appointment to see your doctor.

Diet, exercise and medication are prime tools for successful management of PCOS. It is imperative that a good structure involving adequate exercise, low glycaemic index eating plan and right medication be put in place to assist PCOS sufferers to rebalance hormones (insulin, luteinizing hormone, testosterone), improve insulin sensitivity and significantly reduce symptoms of PCOS.

What are low glycaemic index foods? They are fundamentally foods containing carbohydrate that breakdown slowly to release sugar (glucose) into the bloodstream gradually. Choosing low glycaemic index (GI) foods will lower your insulin levels. And lowering insulin levels will enhance fat burning and reduce fat storage. Naturally this will assist weight loss! Examples of low GI common foods are:

Glycaemic Load = (GI x carbohydrate per serve) / 100

Food items with high carbohydrate content have high glycaemic load.  Large scale studies from Harvard University indicate that frequent consumption of high GL and high GI foods appear to be synonymous with adverse health outcomes.  

Drugs, metformin and thiazolidinediones, are commonly prescribed for enhancing insulin sensitivity in the treatment of PCOS. Please note that metformin may interfere with vitamin B12 absorption, so it may be necessary to have regular blood tests to ensure vitamin B12 levels are good.  In B12 deficiency of this nature, consuming B12-rich foods like meat, dairy products, fish, shellfish and poultry may not be sufficient to correct the problem.  Monthly injections of vitamin B12 subcutaneously or intramuscularly should be considered.  In severe cases of hirsutism, drugs that block the effect of male hormone – testosterone, like spiranolactone and finasteride are also prescribed.  Oral contraceptive pills (i.e. Dianette) are also often prescribed to increase circulating oestrogen levels and suppress ovarian function. 

In summary, medical management of PCOS lies in lifestyle modification with low GI diet, exercise and pharmacological treatment. In most cases, this lifestyle change has to be life long.

Footnote: For more information on glycaemic index go to http://www.glycemicindex.com/

Many diabetics erroneously think that they should avoid tropical fruits as they will raise their blood sugar levels. Well this is not true.

No doubt some of these fruits may be high in Glycaemic Index (i.e. GI>70) such as watermelon. But watermelons are actually quite low in carbohydrate content so consuming one cup of chopped watermelon is unlikely to raise your blood sugar level too much.
Whole fruits are nutrient-rich, low in kilojoule, high in fibre, rich in antioxidants and a great source of carbohydrates. Fruits contain many vitamins and minerals, in particular vitamin C, folate and potassium. Australians are encouraged to eat at least two serves of fruit a day.
Listed below are some common fruits, their Glycaemic Indexes and their corresponding Glycaemic Loads. Carbohydrates that break down quickly during digestion have high GI (i.e. GI>77) as the glucose from the digestion of these carbohydrates enters the blood stream quickly resulting in high blood sugar response. Conversely, carbohydrates that break down slowly enter the bloodstream gradually, leading to a low GI value (i.e. GI<55). Foods that are low in Glycaemic Index show much flatter blood sugar response when eaten and this has the effect of increasing insulin sensitivity when regularly consumed. Diabetics are encouraged to include these foods frequently in their diet for better blood sugar control.
Glycaemic Load = carbohydrate content * Glycaemic Index / 100 (the lower the Glycaemic load the lower the blood sugar level rises).

Following is a list of common fruits and their Glycaemic Indexes -

Rhubarb, grapefruit, lemon, lime, passion fruits, strawberries, blueberries, mulberries, black berries, boysenberries and gooseberries contain little or no carbohydrate and do not impact on blood sugar levels. Hence, they can be freely consumed in large quantities without any adverse effects.

So in conclusion, to be healthy, eat a wide variety of fruits!