Obesity – a hormonal disorder

Obesity – a hormonal disorder

Obesity, or having a BMI greater than 30, is becoming a more common health problem over the last few decades with about 40% of adults now dealing with this.  It is also a health problem that is stigmatized and the patient is frequently blamed for.  Everyone knows that if they just ate less and moved more they wouldn’t have this problem. Right? People are stereotyped as lazy and not watching what they eat.  Research shows that there are other things that contribute to patients having problems controlling their weight, besides eating too much. In fact it is common for obese people to eat fewer calories than their thinner friends, Dr. Jason Fung is a kidney doctor who believes that obesity is primarily a hormonal disorder, and not a caloric disorder.

Dr. Fung is the author of several books that have been talked about recently – including the “Obesity Code” and “the Complete Guide to Fasting” and most recently “the Diabetes Code”.  He has a program called Intensive Dietary Management which is available online to provide further support to people who are interested.

Insulin Resistance and increased insulin levels are what Dr. Fung believes has contributed to our obesity epidemic and what makes it harder for people to lose weight the longer they have been obese.

Hormones are molecules that move throughout the body and deliver messages to the target cell.  One of the main hormones involved in obesity is insulin.  Insulin is made in the pancreas and helps the body use energy and store excess energy for a time when it can be used – and thus causes weight gain.  If you decrease the amount of insulin you are exposed to, you can decrease the weight,

How can you decrease insulin levels?

Insulin levels are decreased by

  1. eating foods that don’t raise insulin as much – carbohydrates raising the insulin levels more than proteins or fats.
  2. decreasing levels of the hormone cortisol that increases in response to stress and
  3. decreasing insulin resistance 
  4. decreasing how often you eat. 

How can you treat obesity and reverse diabetes?

So to reverse this epidemic it may help to:

  1. reduce added sugar consumption.  Read labels.
  2. eat whole unprocessed foods.
  3. avoid refined grains like white flour to decrease insulin spikes.
  4. increase consumption of natural fats – healthy fats like avocados, walnuts, virgin olive oil, fatty fish – helps with feeling full by stimulating the fullness hormones peptide yy and cholecystokinin – and fats don’t raise insulin levels as much.
  5. improve stress control and sleep hygiene to decrease the stress hormone cortisol from stimulating insulin.  Try Tai Chi, yoga, meditation, massage and regular exercise to help with this.
  6. increase physical activity to improve insulin sensitivity of tissues.
  7. limit the bodies exposure to insulin by decreasing the frequency of meals. Insulin is released each time we eat so decreasing how frequently we eat decreases how often we are exposed. If cells aren’t as frequently exposed to insulin, then they will be come more sensitive to its effects and less will be produced. And decreased insulin helps with weight loss. 
  8. don’t drink diet soda or artificially sweetened things that increase insulin release even though they don’t contain calories.
  9. increase fiber – to help with digestion and decrease production of the hunger hormone ghrelin.

Dr. Fung recommends people consult with their physician to see if intermittent fasting is appropriate for them and to do lab work in order to monitor their treatment progress.  There are different protocols that people follow when fasting and it can be used with many different diets – although many people chose to pair it with a Keto diet to decrease exposure to foods that increase insulin levels. 

 

***Note *** This post, like all my other posts, is for general medical information only and is not to be taken as direct advice.  Please consult your personal physician for more information.

Diabetes – Diabetic Neuropathy and Tips for Healthy Feet

Diabetes – Diabetic Neuropathy and Tips for Healthy Feet

What is Diabetic Peripheral Neuropathy?

Diabetic Peripheral Neuropathy (DPN) is nerve damage that is caused by high blood sugar and triglycerides. It is unfortunately very common and up to half of all people with diabetes may struggle with diabetic peripheral neuropathy. DPN can cause people to have both pain and numbness and lead to severe problems like ulcers, bone infections, and even amputations. It can also cause problems with balance, problems walking, decrease muscle tone and lead to structural changes in feet. People may not always be aware that they can’t feel their feet enough to protect them – and this is why it is essential to have a diabetic foot exam at least once a year.

Pain

People with DPN have a burning, tingling, pins and needles sort of pain that is often worse at night or after being on their feet a lot. It is usually symmetrical and progresses from the toes up the legs over time. After a while, it can also affect the hands.

Numbness

If you can’t feel your feet, then it is harder to protect them. People with diabetes have problems sensing pressure, pain, and temperature at times. This can lead to foot sores developing. These sores can develop by stepping on something, friction or other causes. Once established they are then often hard to heal and have a higher risk of infection if the person’s blood sugar isn’t controlled. If the person is a smoker or has peripheral vascular disease, it can be especially hard to heal.

Sometimes people can have so much numbness that they may not be able to feel if they have a broken bone in their foot. This can lead to them walking on it and developing a problem called a Charcot foot – which could need surgery or even lead to amputation.

Unusually shaped feet may not fit right in shoes, which leads to an increased risk of ulcers and adverse outcomes. DPN can lead to other structural changes feet which can make it more common to get ulcers. Once people have one ulcer, they are more likely to get another one. If these sores aren’t tended adequately they can get infected, this infection can spread to the bone and lead to amputation. Treatment may involve removing dead/infected skin, staying off feet, using a special brace to care for it. Frequently patients will be under the care of a podiatrist or a wound care clinic to help care for foot sores. If your PCP refers you to one these specialists – please go!

Treatments:

While DPN can be very painful, there are treatments which your doctor may recommend for this nerve pain. Antidepressants – like amitriptyline or duloxetine, anticonvulsants – like gabapentin or pregabalin are effective and reducing pain and increasing function for people dealing with DPN. Physical therapy can help with strength and balance, and bed cradles can be used to keep blankets off feet during the night.

Tips for healthy feet:

  1.  Inspect your feet daily – use a mirror or ask someone to help if you can’t see. Check your whole foot – big toes, little toes, the ball of the foot, sides of foot, heel… 
  2. Bathe feet in lukewarm water every day
  3. Moisturize feet – but not between toes. Extra moisture can lead to infection. Feet can become drier because the nerves that control the oil/moisture in your feet aren’t working right anymore.
  4. Cut nails carefully – straight across, file edges if needed.
  5.  DON’T cut corns/calluses yourself – talk with your family doctor or podiatrist about it. If not appropriately treated these can turn into sores.
  6. Wear clean, dry socks – maybe diabetic socks.
  7. Wear socks and shoes all the time. Don’t walk barefoot
  8. Protect feet from hot and cold – wear shoes on the sand/sidewalk, test water with fingers before getting in the tub, no hot water bottles or heating pads to your feet.
  9. Look and feel in shoes before putting your feet in. You could walk all day with a pebble in your shoe and injure your foot without knowing it.
  10. Consider special shoes or orthotics – Buy them later in the day when feet are larger and break them in slowly.
  11. Stop smoking – smoking damages blood vessels and makes it harder to heal and dramatically increases your chance of amputation.

***Note *** This post, like all my other posts, is for general medical information only and is not to be taken as direct advice.  Please consult your personal physician for more information.

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