exercise – Lifestream Clinic

Blood Sugar Regulation and Diabetes

What causes diabetes? Why is blood sugar regulation so important?

To answer these questions, we are going to talk about sugar, or more specifically glucose, its role in the body, how the body controls the amount of glucose in the blood, and how dys-regulation causes insulin resistance and then ultimately, diabetes.

First, we will establish some base knowledge about what kinds of carbohydrates exist and what happens when we eat them. There are several kinds of carbohydrates categorized by their structure and how quickly they get digested and absorbed from the GI tract into the blood stream. Simple carbs are small molecules made of one or two sugars and are quickly broken down and absorbed. Complex carbs have three or more sugars linked together and are therefore more complex in structure and slower to digest. Fiber is a complex mesh of carbs that cannot be digested by the enzymes made in the human body and pass through without getting absorbed. They don’t change your blood sugar directly; however, they work to slow down the absorption of other sugars present at that time. Usually a carb-rich food such as pasta or a piece of pizza has several kinds of carbohydrates all getting digested at once. However, all carbs, once fully digested are broken down into three kinds of sugars: glucose, fructose, and galactose. These sugars are absorbed and enter your bloodstream and head right to the liver where the fructose and galactose gets converted into glucose. Once glucose enters the blood, insulin is released from the pancreas which allows glucose to enter into the cells to be used as energy. (Note: Keep in mind that glucose is not the only thing that controls the release of insulin, other substances can as well, but for this purpose, we are talking about glucose’s control of the release of insulin). Foods richer in complex carbs and fiber will help to slow the digestion and therefore the absorption of the sugars in to the blood which allows insulin to be released and offered to the cells steadily instead of all at once.

Glucose is the preferred source of energy for most of the cells in your body. It is necessary to function and live. Your body will make its own glucose if it doesn’t get supplied (during times of fasting or starvation) or it will adapt to use other nutrients for energy such as fats or proteins. Glucose in the cells in the right amounts is not the problem. The problem is when there is excess glucose in the blood or inside the cells. Persisting “hyperglycemia” or too much glucose in the blood can cause damage and disease progression to occur. Too much glucose inside the cells can also cause problems as well.

Let’s talk now about diabetes as a disease and how it can develop…

There are two main types of diabetes: type 1 and type 2. Type 1 diabetes is an autoimmune disease in which a person’s immune cells attack the cells in the pancreas that secrete insulin. Therefore, someone with type 1 diabetes produces little or no insulin and must regularly provide their body with insulin. For individuals with type 2 diabetes, the issue lies in the cells in the rest of your body that don’t respond to insulin like they should. For the purpose of this post, we are going to mainly be talking about type 2 diabetes as a lot of the risk associated with type 2 is lifestyle related.

Before progressing to type 2 diabetes, a condition called insulin resistance usually occurs first. Although the cause is not completely understood, there are several mechanisms in other cells in the body that are dependent on insulin to supply it with energy that can get disrupted or impaired as a result of chronic high blood sugar. This causes a further increase in blood glucose because the cells are not taking the glucose from the blood like they should when insulin is present. As a result of continual high blood glucose, the body continues producing more insulin to try to get it lowered. Eventually, the cells in the pancreas that make insulin can get stressed and eventually die. This further decreases the body’s ability to make insulin leading to bigger increases in blood glucose. Long-term consequences of high blood glucose are damage to tissues and proteins in the body such as your heart, kidneys, brain, eyes, and nerves, and increases to your risk for developing other diseases such as cardiovascular disease, neuropathy, and premature death. Pre-diabetes is usually diagnosed before diabetes and is based on various tests that measure the glucose levels in the blood.

You might be asking what can be done to prevent this?

Lifestyle (diet, physical activity, stress levels, etc.) is not the only factor but is a large factor in the development of type 2 diabetes. Other factors such as body weight, genetics (family history of diabetes), age, race, and ethnicity can impact your risk for developing type 2 diabetes.

Current evidence is showing promising outcomes with lifestyle interventions in preventing or delaying the development of diabetes. Interventions with diet and exercise particularly have significantly decreased diabetes risk.

Here are some dietary and lifestyle considerations for diabetes prevention:

Diet composition:
Like we discussed above, diet composition itself can affect how quickly your blood sugar rises and therefore how hard your pancreas has to work in order to make enough insulin. If you eat a diet composed of lots of simple carbs and little complex carbs and fiber, then the carbs that you eat will cause a sharp rise in blood sugar and a sudden need for lots of insulin. This can be taxing on your pancreas long-term. Eating carb-rich foods high in fiber and complex carbs like whole grains, some fruits, and most vegetables will help to slow the absorption of sugar into the blood to prevent a sharp rise in blood sugar.
Eating a lower carb diet is usually advised for those with pre-diabetes or diabetes to help manage the disease and their medications. It is not necessary for those just trying to prevent the development of diabetes as it may not be sustainable long-term. Choosing the right kinds of carbs and the composition of the rest of your meal is more important.
In addition to fiber, protein and fat are complex molecules that help to slow the digestion and absorption of sugars. Choosing a meal or snack that is balanced with whole grains, fruits, healthy fats, and protein will likely help balance your overall blood sugar.

Helpful:
– Complex carbs like whole grains, fruits, and vegetables
– Fats, proteins, and carbs at every meal and snack

Not as helpful:
– Too many simple sugars in one setting
– A lot of simple sugars, or even complex carbs without protein or fats

Amount of Food:
Too much overall energy intake can lead to increases in body weight which is a risk factor for developing diabetes. Having excess energy, in the form of carbs, proteins, or fats, can result in the same response of insulin resistance in the body’s cells.

Helpful:
– Eating the right amount of calories

Not as helpful:
– Eating too many calories overall

Physical Activity:
Regular exercise has been shown to improve blood sugar regulation and control in individuals, help prevent weight gain, and maintain overall energy balance. It is good to start slow and gradually add in more exercise in order to prevent injury. The currently recommendations are 150 minutes of exercise per week, or just 30 minutes, 5 times a week.

Other lifestyle factors:
There are many other factors such as stress (positive or negative), illness, dehydration, etc. that can influence your blood sugar. Overall, do your best to manage and control what you can and let everything else go. Worrying about things you cannot control is not beneficial!

Conclusions:
While there are so many factors at play in the development of type 2 diabetes, weight loss for overweight individuals, adequate exercise, and a balanced diet has been shown to be helpful to decrease your risk for developing type 2 diabetes. Seek the advice and counsel of your healthcare provider to figure out what you can do today to help lower your risk for developing diabetes.

Exercise and Heart Health

Welcome to the last installment of our exercise series. Exercise and heart health.

We are closing out our exercise series on one of the benefits that people often think about which is cardiovascular health. However, usually the extent of the benefits of “cardio” that people are aware of are limited to keeping the heart muscle healthy. However, exercise has also been shown to improve other factors such as blood cholesterol and risk for heart disease.

Let’s focus first though on how keeping the heart muscle healthy and strong is beneficial for your health. Physical activity, especially in the form of aerobic activities such as running, swimming, etc., helps increase the body’s ability to consume more oxygen, improve the pumping of blood throughout the body which increases oxygen levels, and improves the body’s utilization of the oxygen once it gets there. Oxygen is a very important currency in the body. Without oxygen, the body cannot create the energy that it needs to function properly. Lack of exercise has been associated with inefficient oxygen utilization in body tissues as well as reduced blood flow. Furthermore, maximum blood flow in the body seems to be dependent on age and physical activity. Maximum blood flow is desirable so that you can get blood to all of your body’s tissues so that oxygen can be delivered and waste products cleaned up. This allows us to be able to do our daily activities with less fatigue, effort, and pain than should be expected.

Secondly, exercise helps to improve your blood cholesterol profile. A combination of healthy foods (low in saturated and trans fat and high in omega-3’s and fiber) and exercise can make a big difference in decreasing your risk for heart disease. We are going to focus on the physical activity aspect though. For a quick refresher, remember that LDL is the “bad” cholesterol because it deposits lipids in your blood vessels which increases your risk for heart disease. HDL is the “good” cholesterol because it picks up cholesterol from your blood vessels and takes it back to the liver.
There are several proposed reasons by which we see an overall improvement of blood cholesterol in individuals who complete regular aerobic exercise. The first reason is an increased consumption of the lipids in the blood for energy. Another reason is an increase in an enzyme called lipoprotein lipase (LPL) which takes triglycerides out of the blood to be used in the cell or stored or used for energy.

Here are some tips for incorporating exercises into your life to improve heart health:
– High-impact aerobic exercise: running, walking, tennis, or other sports are great forms of exercise to get your heart rate up and get those benefits from cardio.
– Low-impact aerobic exercise: swimming and biking are great forms of exercise that provide less impact on your bones and joints, and can cause less injuries while still giving you the same benefits.
– Strength training: using free weights, resistance bands, or just your body with exercises such as squats, push-ups, planks, etc. helps to increase muscle strength, reduce excess fat, and also contributes to improving blood cholesterol.

All this being said, there are some factors relating to risk for heart disease that are uncontrollable such as genetics or your age. You could do all the right things and still find yourself with cardiovascular issues in the future. Still, you can only do what you can with what you know now. You might think that it’s too late to try and make changes like these in your life, but it’s not! Decide today to make a change! Make sure to talk to your doctor before making a change though!

Sources:
https://www.nhlbi.nih.gov/health/heart/physical-activity/benefits#:~:text=When%20done%20regularly%2C%20moderate%2D%20and,levels%20in%20your%20blood%20rise.
https://www.ahajournals.org/doi/full/10.1161/01.CIR.0000048890.59383.8D
https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000866
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6379287/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC150384/
https://lipidworld.biomedcentral.com/articles/10.1186/s12944-017-0515-5
https://www.ncbi.nlm.nih.gov/books/NBK537040/
https://www.hopkinsmedicine.org/health/wellness-and-prevention/3-kinds-of-exercise-that-boost-heart-health
https://health.clevelandclinic.org/does-exercise-lower-cholesterol/
https://www.betterhealth.vic.gov.au/health/healthyliving/cycling-health-benefits#:~:text=Cycling%20is%3A,high%20levels%20of%20physical%20skill.
https://www.nhlbi.nih.gov/health/heart-healthy-living/risks#:~:text=Risk%20factors%20for%20heart%20disease&text=Some%20risk%20factors%20cannot%20be,steps%20for%20your%20heart%20health.

Exercise and Bone Health

How can exercise improve my bone health and help be age better?

One of the hallmarks of aging is decreasing bone density. You reach your peak bone density around the age of 30, and it decreases a certain amount every year after that. Our bones are always going through a renewal process involving removing old bone cells and regenerating new ones. Both of these processes are going on at the same time, but as you age, the process of regenerating bone decreases resulting in an overall decrease in bone density instead of maintaining or increasing bone density. The cells that regenerate bone make collagen and other non-collagen proteins. The collagen is what provides bone its strength and resistance to deformation. There are also changes in the structure of the collagen in the bone as we age that lead to increased stiffness and brittleness. Lots of other factors such as genetics, hormones, peak bone mass earlier in life, drugs or medication use, other medical conditions, nutrition, and yes, even physical activity can impact bone mass.

We all know that our bones get more brittle and are more likely to fracture as we get older which is why so many people shy away from physical activity as they get older because they don’t want to hurt themselves.

The question is, how do you prevent further excessive loss in bone mass as you age?

You can’t control all of these factors leading to where you are now, but you can do something moving forward!

Exercise is a great way to help increase bone density as you age. Certain kinds of exercise can help to stimulate the generation of new bone cells. Bone responds to something called “mechanical loading” (which is muscle contraction or bearing weight) by increasing bone formation. The increase in bone formation is proportionate to the amount of mechanical loading or strain put on the bone. Furthermore, including rest periods in-between the periods of time where strain is present (more of a dynamic workout situation) increases the bone formation even more. Exercises that induce strain that is unlike normal strain put on the bone (think multidirectional jumping or versus walking or running) induces the formation of bone. Another reminder, like all processes in the body, certain nutrients are necessary for optimal function. Therefore, adequate protein, calcium, and vitamin D is necessary to experience the full benefits of exercise for bone health. Furthermore, hormonal status and function is important to maintain good bone health.

Here are some tips for maintaining bone health as you age:
– Maintain a healthy body weight: a body weight that is too high or too low can negatively impact bone health. Many don’t think about low body weight but that can negatively impact bone health as much as a higher body weight.
– Eat a healthy diet with adequate protein, calcium, and vitamin D. An adequate vitamin D status is required for optimum absorption of calcium in the gut, so it doesn’t hurt to eat both at the same time.
– Incorporate light weight-bearing aerobic activity: jumping, tennis, volleyball, hiking, etc. Remember to always start light and slowly increase.
– Incorporate light weight-bearing resistance training: Grab some small weights or use your body weight and do various exercises to increase your muscle strength and stability. Remember to always start light and slowly increase.
– Here is a website with some great exercises for increasing strength while maintaining stability:

https://americanbonehealth.org/exercises/
– Mix up your movement: Like we discussed above, dynamic exercise is best for increasing bone density. Create a workout plan with your doctors that changes up the types of exercises you are performing.

Remember to always talk to your doctor if you have or are at risk for a bone-related disease, are at risk for falling or fractures. It is always a good idea to run ideas past your doctor before trying to implement your own workout or diet plan.

Sources:
https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/bone-health/art-20045060
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3383520/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4402109/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5467150/#:~:text=At%20the%20apical%20surface%2C%20osteoblasts,proteins%2C%20including%20osteocalcin%20and%20osteopontin.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2991386/
https://pubmed.ncbi.nlm.nih.gov/15984409/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6179512/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6323511/
https://pubmed.ncbi.nlm.nih.gov/16680498/
https://www.osmifw.com/sports-medicine/bone-density-and-weight-bearing-exercise/

Exercise and Chronic Pain

Does exercise help or hurt my chronic pain?

Chronic pain is defined as pain that lasts for longer than 3 months. This is the time period chosen because it is beyond when normal tissue healing should occur. In the United States in 2021, an estimated 20.9% of people experienced chronic pain. This is a general term as other forms of chronic pain cause actual continued tissue damage such as cancer or osteoarthritis. Since there are such a wide variety of chronic pain syndromes with different causes, we won’t be diving into any of the specifics of those diseases.

When you experience constant pain that doesn’t go away, it is only normal to question whether or not exercise would be helpful for you. This pain can even begin to affect your daily life. Pain is never fun; therefore, it is our natural response to want to decrease the pain. Our natural instinct is to move less in order to try and reduce pain. It is counter-intuitive that exercise can help improve chronic pain. However, inactivity can also lead to other issues such as muscle atrophy (your muscles get smaller because they’re not being used), poor posture and stability, and other health problems. Fear is a common emotion experienced with chronic pain. Avoidance of certain behaviors or movements that caused pain in the past can invoke more fear and it becomes a vicious cycle. Fear of pain can become debilitating and perpetuate inactivity.

On another note, one of the proposed mechanisms for chronic pain is some kind of local or systemic inflammation. Scientific literature is showing that exercise can decrease systemic inflammation and in contrast, a sedentary lifestyle can even increase or contribute to inflammation. Consistent exercise is the most important thing, even if the sessions are short and of a lower intensity. Additionally, exercise can influence certain neurotransmitters and endogenous opioids (made by our own bodies) which promote the decrease and control of pain through pathways in the brain. Studies are also showing improved neuron regeneration after exercise which could help our nervous system respond better to pain signals. There is also a sensation where exercising a body part that does not hurt can help to decrease the pain in the area that does hurt. In additional to all of these benefits, exercise also helps to reduce fatigue, reduce excess weight, improve sleep, reduce anxiety and improve mood.

This being said, please make sure to talk to your doctor before trying to complete exercises if you are experiencing chronic pain. Figure out a plan that works for you and your specific condition.

If you’re wanting to increase your movement, here are a few non-intimidating forms of movement that you can slowly (and progressively, as possible) try to incorporate into your life:
– Leisurely walks of increasing length: Start slow and increase. For example, walk for 5 minutes, and rest and repeat. Walk for 10 minutes, rest and repeat. Etcetera.
– Stretching and yoga: Incorporating small amounts of stretching into your day can help to increase flexibility and mobility, especially at the beginning and end of the day and when you’ve been sitting for a while.
– Light core strengthening: Try getting an exercise ball and use that for various exercises. There’s no need to jump right into an intense amount of crunches.
– Incorporate more activity into your daily tasks. When you get up off a chair, sit down and get up a few more times. When you’re going up the stairs, redo a few stairs at the end. Sweep the floor more often than you need to.

Schedule an appointment online today with one of our doctors if you’re experiencing chronic pain!

Sources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5461882/
https://link.springer.com/chapter/10.1007/978-981-15-1792-1_16
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4530716/
https://www.cdc.gov/mmwr/volumes/72/wr/mm7215a1.htm#:~:text=During%202021%2C%20an%20estimated%2020.9%25%20of%20U.S.%20adults%20experienced%20chronic,(8.0%25)%20(5).
https://extension.usu.edu/heart/research/exercise-and-chronic-pain
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4993768/
https://www.va.gov/WHOLEHEALTHLIBRARY/docs/Moving-the-Body-in-Chronic-Pain.pdf

Exercise and the Brain

We all know that exercise can help us manage our weight, build muscle, and is generally good for us, right?

Did you know that exercise also helps improve your sleep, mood, thinking and judgment skills, and reduce your risk of some cancers, heart disease, neurodegenerative diseases, and other metabolic diseases such as diabetes and metabolic syndrome?

When we think of the benefits of exercise, improving brain health doesn’t usually come to mind. However, research is showing that regular aerobic exercise (otherwise known as “cardio”, the kind of exercise that gets your heart rate up) helps to improve memory and other learning process. In fact, it can preserve or even increase the volume of the areas of the brain involved with cognitive functions (particularly the hippocampus). Furthermore, exercise induces the creation of new neurons in the brain and more integrated neural networks. Muscle synthesis, as a result of exercise, can cause the release of certain molecules that modify neurotransmission in specific areas of the brain.

In addition to structural changes, exercise can also promote recovery after an injury and has anti-depressive effects. One reason for this could be is that exercise has been known to increase tryptophan (a type of amino acid) levels in the blood which is a precursor to serotonin. A lot of antidepressive medications attempt to increase serotonin as it has a relaxing, feel good effect. Exercise also increases blood flow to the brain and releases endorphins that help to improve mood by influencing pain and the body’s response to stress. Also contributing to this “feel good” effect is an increase in opioids made by the body as a result of acute exercise (a burst of exercise).

Acute, or short-term exercise, has also been shown to increase cognitive function and performance- more specifically motor skills and academic achievement. Studies show that exercise intensity greatly affects the responses that contribute to improved function.

You might be asking yourself this question, what is the best kind of exercise for my brain health?

The kind that you can get yourself to do regularly and enjoy. Sure, a mixture of aerobic (cardio) and resistance training (weight lifting) are beneficial in different ways, but if you absolutely hate both, maybe tennis is the way to go. Or biking. Or swimming.

Here are some tips for incorporating exercise into your life or finding ways of exercising that are enjoyable for you:
– Find an exercise buddy: Nothing is as fun if you’re doing it by yourself. Find someone else who is as committed to exercising as you are and will encourage you to exercise when you don’t want to.
– Be willing to try something new at least two times: Maybe you decide to try a new fitness class at the gym or a friend invites you to try something out with them like rock climbing or hiking. Maybe something goes wrong and you absolutely hated it. Try it at least one more time. There are always things that can randomly go wrong so give something two chances before giving up on it.
– Try mixing up your exercise routine: Doing the same thing over and over again can increase the risk of injury. Try doing a different activity or exercise routine each time you plan to workout this week.
– Choose activities that you enjoy so that your workout routine is sustainable. If you’re having trouble finding something you enjoy, keep trying new things until something sticks. Just don’t give up.

Sources:
https://medlineplus.gov/benefitsofexercise.html
https://www.nia.nih.gov/health/real-life-benefits-exercise-and-physical-activity
https://neurosciencenews.com/fitness-neuroscience-23228/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6770965/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2680508/
https://pubmed.ncbi.nlm.nih.gov/2678895/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2077351/#:~:text=Several%20lines%20of%20research%20suggest,function%20in%20the%20human%20brain.
https://pubmed.ncbi.nlm.nih.gov/22480735/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5928534/

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Blood Sugar Regulation and Diabetes

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