Читать книгу Diabetes Weight Loss: Week by Week - Jill Weisenberger - Страница 4
ОглавлениеWeek 1 addresses the most basic skills you need in order to start losing weight that you can keep off forever. You will learn that calories rule, about the importance of keeping records, that there is more than one way to eat healthfully, and how to get active.
With so much talk about fats and carbohydrate in the media and among friends, the simple calorie gets neglected. In fact, many people don’t fully understand what a calorie is, and many people ignore them completely. Technically, a calorie is a unit of energy. We need calories from food to run our bodies, just like a car requires energy from gas in order to operate. If we take in more energy than we need, it gets stored as fat and we gain weight. The only way to lose weight is to consume fewer calories than the body uses. Fats and carbs are important, but they are not what matters most when it comes to your weight.
The amount of calories your body needs depends on many things: your weight, the amount of muscle and fat you have, your activity level, genetics, and more. This number is neither good nor bad; it’s just a number. Think of it the same way you consider the yards of fabric you need to cover your windows or the number of bricks you need to build a house. Different types and sizes require different amounts.
You don’t have to count calories to drop pounds, but it’s important to know your approximate calorie needs so you can decide how particular foods and their portions fit into your eating plan. Visit ChooseMyPlate.gov, a site created by the U.S. Department of Agriculture (USDA), where you’ll enter your age, weight, and activity level to learn how many calories you need to lose weight. Generally, women require 1,200–1,800 calories per day for weight loss, and men need about 1,600–2,400 calories per day. As a rule of thumb, most women should not consume fewer than 1,200 calories per day, and men should stay at 1,600 calories or more.
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To lose one pound of fat, you must cut back or burn an extra 3,500 calories.
Make a few simple changes daily to start whittling away calories. Below are a few ideas for trimming your plate, and you‘ll find more specific suggestions during Week 5. Incorporating these simple changes into your daily routine will help you get to your goal.
• Pare down your meat and starch servings 10–20% by leaving several bites on your plate or by serving yourself just a little less.
• Cook with a little less oil. Use a little less salad dressing or use a low-calorie salad dressing.
• Spread more mustard than mayonnaise.
• Trade in a large bagel for a medium-sized English muffin.
• Switch from whole milk to low-fat or nonfat milk.
• Eat reduced-fat cheese, yogurt, and sour cream in place of the regular versions.
• Drink coffee and tea without sugar.
• Drink water or other zero-calorie beverages instead of soda, punch, or fruit juice.
• Remove chicken skin.
• Trim the fat from red meats.
• Bake, broil, or grill instead of frying.
To learn more about the calories in your foods, refer to food labels, pick up a pocket-sized calorie counter at the bookstore, and visit websites like ChooseMyPlate.gov and MyFoodAdvisor.com.
Although calories directly affect weight, monitoring fats and carbs is also important to your health. As a general rule, you should be able to consume at least 45 grams of carbohydrate at each meal with no more than a 40-mg/dl rise in blood glucose from your first bite at a meal until two hours later. If you need additional diabetes medications, or if you do not currently take any medications and find that you’re having trouble with your blood glucose, talk with your doctor or nurse. You need balanced meals to lose weight healthfully, enjoy your food, and prevent the complications of diabetes and other health problems, so keep tabs on your blood glucose and adjust your carbohydrate intake as needed.
Example
Sample Meal Containing about 45 Grams of Carbohydrate
2 slices whole-wheat bread (30 grams) with sliced chicken, reduced-fat cheese, roasted red peppers, lettuce, tomato, onion, and mustard
1 medium peach (15 grams)
Unsweetened iced tea, artificial sweetener if desired
Blood glucose before eating: 103 mg/dl
Blood glucose two hours after the first bite: 138 mg/dl
138 mg/dl – 103 mg/dl = 35 mg/dl
This is acceptable because the change in blood glucose is less than 40 mg/dl.
Food records work. Writing down your food intake can double your weight-loss success, according to research funded by the National Institutes of Health. In a study of nearly 17,000 people, those who recorded their daily calorie intake lost twice as much weight as those who kept no records. The simple act of recording your food choices increases your awareness and makes you accountable to yourself. Grab a notebook or buy a journal and get started. Look at the example below to see how it’s done. There’s a blank food record in the Appendix.
Record your intake as you go through the day, even if you have to use scratch paper and rewrite it or tape it into your journal later. Don’t wait until the end of the day to jot everything down. It’s easy to forget what you’ve eaten or to fall a few days behind. Waiting may also mean that it’s easier to give in to temptation. Having to reach for your journal and a pencil will make you mindful of the five French fries you could grab from your spouse’s plate and all of the other mindless nibbles that add up to quite a lot over time. Each day, review your food record and try to learn from it. Look for patterns of overeating or mindless munching. Then, take steps to do better tomorrow.
Bill K’s Story
I keep a very detailed Excel spreadsheet that captures time of meal, blood glucose, medications, carbohydrates, calories, and more. I know this sounds like a bit too much documentation for many who are struggling with diabetes, but the more information you can share with your medical team, the better they can help you. And by documenting my carb and calorie intake, I can determine how much I can eat at each meal so I don’t exceed my prescribed intake.
A lot of people ask, “How many carbs should I have each day or how much fat should I eat to lose weight? What diet is best?”
The truth is that there’s probably no best diet. Some people have very strong opinions, but there are good arguments for many diet plans. Some people lose weight and manage their blood glucose on very-high-carbohydrate vegetarian diets. Others eat meat with most meals and prefer less carbohydrate. Some people use the glycemic index or another ranking method to help them select food. The plan you choose must be one that works with your life and your preferences, but it must also include a variety of wholesome foods from the various food groups, with special attention to including whole grains and a variety of colorful fruits and vegetables. Additionally, you’ll need to tweak your diet periodically based on your blood glucose levels, cholesterol, blood pressure, and other health markers.
The USDA and U.S. Department of Health and Human Services jointly publish their Dietary Guidelines for Americans every five years and provide helpful nutrition information and recommendations for all Americans. The 2010 edition includes four healthful meal patterns (which are described in the Appendix), including USDA meal patterns, vegetarian and vegan adaptations, and the DASH (Dietary Approaches to Stop Hypertension) eating plan. A fifth meal pattern, the Mediterranean eating style, is also featured in the Dietary Guidelines for Americans. You can learn more about the Mediterranean diet at Oldways (www.oldwayspt.org) and in The Mediterranean Diabetes Cookbook by Amy Riolo (American Diabetes Association, 2010). In short, the Mediterranean diet includes fruits, vegetables, and whole grains at most meals. Beans and fish are important sources of protein, and nuts, seeds, olives, and olive oil provide good-for-you fats. Cheese and yogurt are eaten regularly, but in small amounts, and herbs and spices—not salt—season foods. If you haven’t done so yet, now is a great time to see a registered dietitian (RD) for an individualized diet plan. Visit eatright.org to find an RD in your area.
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If you choose to use the glycemic index to help plan your meals, keep in mind that it’s best to use it in conjunction with another meal-planning method, such as carb counting. You can learn more about the glycemic index at www.glycemicindex.com or by reading The Low GI Shopper’s Guide to GI Values 2011: The Authoritative Source of Glycemic Index Values for 1200 Foods, by Dr. Jennie Brand-Miller and Kaye Foster-Powell.
If you’re not already active, it’s time to start. Assuming you’re relatively healthy, you can begin walking. If you’re unsure, have complications of diabetes, or want to begin something more vigorous than walking, get the go ahead from your health care team first.
Physical activity is perhaps the best medicine available. It makes weight loss easier by burning extra calories. It also improves blood glucose control and cholesterol levels, lowers blood pressure, reduces the risk for heart disease and other chronic diseases, relieves stress, and improves quality of life. Guidelines issued jointly by the American Diabetes Association and the American College of Sports Medicine call for individuals with type 2 diabetes to engage in brisk walking, or other moderate to vigorous aerobic exercise, at least three times per week for a total of 150 minutes or more and to engage in strength training exercises two to three times a week. Don’t jump right in. If you’re not used to strenuous activity, start off slowly. For example, take several 5-minute walks over the day.
What Is Exercise?
A complete exercise program consists of each of the following components.
Aerobic: activities that use large muscle groups and cause you to breathe heavily as you take in more oxygen; improves fitness of the heart and lungs; good for burning calories • Walking, swimming, jogging, biking, skating, dancing, cross-country skiing
Strength: activities that use repeated movements against resistance; builds and tones muscle; increases strength • Weight lifting, resistance bands, pushups, lunges, sit ups
Flexibility: increases ability of a joint to move through a full range of motion • Stretching, yoga, Pilates
Balance: strength, flexibility, and other activities that improve coordination and help you prevent falls • Standing on one foot, sitting on an exercise ball, yoga
The table below shows the approximate number of calories burned by individuals with different weights. Get moving!
Using a Pedometer
Walking is a favorite exercise among people who want to lose weight. Increase your motivation by using a pedometer. A pedometer is a handy little device that you carry in your purse or pocket or clip to your pants that counts each and every step you take while you are wearing it.
• Expect to spend about $30.00 for a reliable pedometer. Some are very fancy and have lots of additional functions, but the only must-have feature is its ability to count steps.
• Start off with the pedometer clipped to your waistband above the center of your knee. To check its accuracy and to find the best placement, set your pedometer to zero. Wiggle and bend a little. A good pedometer will measure steps only, not twists and turns. Next, with your pedometer still set at zero, walk exactly 100 steps. If your pedometer registers between 90 and 110 steps, consider it accurate. If it appears to be inaccurate, move it to other places on your waistband and continue checking until you find the right spot. If your pants roll down at the waistband or are very loose, try turning the pedometer inward so it faces your body. If moving the pedometer to various places doesn’t make it count your steps accurately, you should return it and select a different brand.
• Wear your pedometer all day for several days to determine your average number of steps. Then set a goal to increase your average number of steps by 500 to 2,000 steps daily. A typical long-term goal is 10,000 steps per day.
Exercising with Diabetic Eye Disease or Nerve Disease
Though the benefits of being active are almost always greater than the risks, some complications of diabetes may restrict your choice of activities. If you have proliferative retinopathy (eye disease), then exercises that increase blood pressure (such as high-intensity aerobics and weight lifting and activities that jar the head or place the head below the level of the heart) may damage your eyes further. Check with an ophthalmologist for advice before beginning any exercise routine.
Peripheral neuropathy (nerve disease) can cause numbness, pain, and weakness in the hands and feet. Though physical activity can help prevent or ease neuropathy, if you have a foot injury or ulcer, talk to your doctor about appropriate exercises and avoid weight-bearing activities, such as walking and dancing. Stick to swimming and biking and take extra care to protect your feet. If you have autonomic neuropathy, which affects the heart, lungs, stomach, intestines, bladder, or genitals, you must obtain physician approval and receive specific guidance before exercising.
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Whenever you exercise, especially if you are alone, wear a medical ID bracelet or carry identification that states you have diabetes and lists your medications and an emergency contact. If you can, carry a cell phone and blood glucose meter as well.
Some diabetes medications, as well as other medications such as prednisone, certain antidepressants, and beta-blockers, may make weight loss difficult. If you’re taking one of these or another you think may cause weight gain, ask your health care provider to review your drugs. Perhaps you can take an alternate medication or lower your dose. No matter what, don’t make changes without discussing it first with a member of your health care team.
WEEK 1 ACTION STEPS
Select from the following goals or steps, modify them, or create your own. Choose the ones that are important to you while being careful not to overwhelm yourself with more than you can handle. This week I will:
Make 2 SMART goals.
Record my food intake and activity daily.
Learn my calorie needs at www.ChooseMyPlate.gov. My calorie needs are ____________________________________________________________.
Use a calorie-counting book/website to estimate my intake.
Decrease my calorie intake in the following ways:____________________________________________________________ ____________________________________________________________
Learn more about the Mediterranean diet by visiting www.oldwayspt.org.
Speak to my health care provider about beginning an exercise program.
Increase my weekly physical activity by 45 minutes.
Determine my baseline daily steps by wearing a pedometer.
Other:____________________________________________________________
