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.

Did you know that all tissues in your body can synthesize cholesterol from acetate? However, most of the cholesterol in your body is synthesised by your liver and then your intestine. The enzyme involved in the process is called HMG-CoA reductase.

The activity of HMG-CoA reductase can be powerfully lowered by well-known cholesterol lowering drug – Lipitor as well as a hormone in the body called glucagon. Conversely, HMG-CoA reductase can be powerfully stimulated by a hormone produced by your pancreas called insulin.
Metabolic syndrome is associated with insulin resistance or the ineffective use of insulin. This is linked to low grade inflammation in the body. Insulin resistance has a lot to answer for in the presentation of high serum cholesterol level.
High cholesterol levels can be powerfully reduced by adopting the following lifestyle changes:
1) losing excess body weight
2) choosing a low glycaemic index diet
3) increasing the percentage of lean body mass or muscles through exercise – specifically resistance training (this leads to reduction in HMG-CoA activity)
4) increasing consumption of omega-3 rich foods from fatty fishes and flaxseed
5) reducing intake of saturated fats from animal foods
6) increasing consumption of fruits and vegetables rich in polyphenols which are powerful anti-inflammatory agents
7) increasing consumption of nuts, seeds and legumes rich in micronutrients, fibre and vitamin E
increase consumption of plant sterols (plant sterols out compete dietary cholesterol for absorption and powerfully reduce overall cholesterol absorption)
9) increase fibre intake to 35-40g per day

Surprisingly, having a high cholesterol diet is not as deleterious to serum cholesterol levels as previously believed as high dietary cholesterol has the interesting effect of suppressing cholesterol synthesis by the liver. Also, assimilation or uptake of dietary cholesterol is relatively low as approximately 50% of dietary and biliary cholesterol is not absorbed from the intestine and excreted. This is good news indeed!
I hope the above highlights how a multi-prong approach can be adopted to powerfully reduce your cholesterol levels.
In conclusion, there is no single magic bullet for the reduction of serum cholesterol (the most commonly prescribed drug – Lipitor or statin, comes closest to the definition of a magic bullet but even this has its draw backs and significant side effects, a discussion fit for another article). For now, there does not appear to be one on the near future.

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.

If you have any 2 of the following risk factors, you are at risk of developing metabolic syndrome:
1. central obesity (waist > 94cm for white males, > 80cm for white females)
2. high blood pressure
3. high cholesterol / lipids
4. high blood sugar
5. non-alcoholic fatty liver disease

High blood sugar levels in our body are correlated with insulin levels. When one factor rises sharply, the other spikes to help normalise blood sugar levels. These insulin spikes are associated with insulin resistance. One very effective way of preventing insulin spikes is to choose a low glycaemic index diet.

You may ask what is glycaemic index?  It is a way of grading carbohydrate foods depending on how fast they get digested. A number is assigned to each individual food item based on their ‘sugar potency’.
1. Low GI foods have GI <55
2. Intermediate GI foods have GI between 55 and 70
3. High GI foods have GI > 70

Research on glycaemic index has shown that by choosing fibre-rich low GI foods at every meal, we can reduce our blood glucose levels quite effectively and enhance insulin sensitivity.  This helps stall the progress of metabolic syndrome and enhance weight loss. Please note that not all low GI foods are suitable for regular consumption as many high fat, high sugar foods like chocolates, ice-cream and toasted muesli are inappropriate for weight loss and reducing insulin resistance.

I have compiled a list of common low GI foods below for your reference. Try to include at least two items at each main meal:

Please note that low GI does not mean license to over-dose.  It is best to aim for 45-50g of carbohydrate at each main meal and not more.  Too much carbohydrates and kilojoules will increase body weight and sabotage your weight loss endeavours.

Do you have any questions or comments?  If you do, I would love to hear from you.

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/

In 2007, Professor Jennie Brand-Miller et al demonstrated in a simple but elegantly designed experiment to demonstrate the effect of alcohol (from beer, wine and gin) on blood sugar levels after a meal and found some astounding results.

This study found that alcohol has the potent ability to reduce blood sugar response after a meal. Of the 3 alcoholic beverages tested, wine was found to have the greatest blood sugar lowering effect (lowering the glucose score by 37%).

How can we explain this amazing result? Well, it is possible that alcohol may inhibit the production of glucose from our liver. Also, alcohol seems to slightly increase insulin sensitivity resulting in less sugar circulating in the blood. This ability to create a flatter blood sugar response or curbing sugar ‘spikes’ is vital in the prevention of heart disease and the control of symptoms of metabolic syndrome.

Hence, moderate intakes of alcoholic beverages particularly – wine (100ml per day), could be an important part of a healthy diet! As Jean-Anthelme Brillat-Savarin said, “A meal without wine is like a day without sunshine.”

References

1. Brand-Miller J et al. Am J Clin Nutri 2007; 85:1545-51.
2. Brand-Miller j et al. Curr Atheroscler Rep 2007; 9:479-85.

Couscous Salad

In 2001, an anticancer drug hailed ‘a miracle’ was approved by the Food and Drug Administration Department (FDA). This drug is called Gleevec.

Gleevec seems to be able to arrest the formation of new blood vessels (angiogenesis) needed for cancer cell growth. Did you know that herbs and spices rich in fatty acids of the terpene family also act along the same lines as Gleevec?
Terpenes seem to stimulate cancer cell death (apoptosis) thereby limiting cancer cell growth, containing tumours. Armed with this knowledge, lets look at preparing a dish that is low in glycaemic index and rich in herbs.

The following recipe is prepared with couscous as the principal ingredient. Couscous has a glycaemic index of 61 and glycaemic load of 8.7. The glycaemic index of a food item measures how it affects your blood glucose level (low glycaemic index <55, 56<moderate glycaemic index<69, high glycaemic index >70). You can think of this as a number which represents the glycaemic/glucose ‘potency’.
In this instant, couscous is considered a moderately high glycaemic index food. Adding lemon and lime to couscous will reduce the glycaemic index of the meal as the acidity of these citrus will reduce the rate at which food goes into the small intestine from the stomach, thus lowering the rate of rise of blood sugar level even more. Achieving a flatter blood sugar response long term is the mainstay for management of insulin resistance. Studies have shown that frequently choosing low glycaemic index and glycaemic load food items in one’s diet will enhance insulin sensitivity and even prevent some cancers (preliminary studies seem to indicate that high insulin levels are associated with some tumours)!
Turmeric has powerful anti-inflammatory properties. Its absorption increases a thousand fold by adding olive oil and pepper in the recipe. The following is a low glycaemic index, ‘anti-inflammatory’ and terpene-rich meal. Enjoy!

Ingredients

Couscous, 1cup
Cherry tomatoes, ½ punnet
Chickpeas, 1cup (soaked, boiled and drained)
Cold pressed olive oil, 1 tablespoon
Mint, ½ a bunch
Parsley, ½ a bunch
Coriander, ½ a bunch
Lemon, ½ whole
Lime, ½ whole
Sugar, 1 teaspoon
Turmeric, 1 teaspoon
Water
Pepper
Chicken stock

Preparation

Put couscous in a bowl, pour boiling water and then add chicken stock and turmeric and set aside for 10 minutes. When liquid has been absorbed, separate couscous grains with a folk.
Add chick peas, tomatoes, mint, parsley, coriander, lemon, lime, sugar, pepper and cold pressed olive oil. Mix well and serve.

References

J. McMillan-Price, P. Petocz, F. Atkinson, et al., ‘Comparison of 4 diet of varying glycaemic load on weight loss and cardiovascular risk reduction in overweight and obese young adults; a randomised controlled trial’ Archives of Internal Medicine, 166(14), 2006: 1466 – 75.

G. A. Santisteban, J. T. Ely, E. E. Hamel, et al., ‘Glycaemic modulation of tumour tolerance in a mouse model of breast cancer’ Biochemical and Biophysical Research Communications, 132(3), 1985: 1174-9.

E. Weiderpass, G. Gridley, I. Persson, O. Nyren, A. Ekbom, H. O. Adami, ‘Risk of endometrial and breast cancer in patients with diabetes mellitus’ International Journal of Cancer, 71(3), 1997: 360-63.

C. A. Plouzek, H.P. Ciolino, R. Clarke, G. C. Yeh, ‘Inhibition of P-glycoprotein activity and reversal of multidrug resistance in vitro by rosemary extract’ European Journal of Cancer, 35(10), 1999:1541-5.