Читать книгу Diabetes Weight Loss: Week by Week - Jill Weisenberger - Страница 6
ОглавлениеAll that healthful eating we’ve been talking about starts with a good breakfast, so this week you’ll learn why it’s so important and how to put one together in no time. We’ll cover more tips to trim calories, build on your walking program, and make use of your food record.
Rush! Hurry! Go! There’s no time for breakfast!
Hey, not so fast! A little planning will help you get a balanced morning meal lickety-split. You may wonder why you should eat breakfast when you’re trying to lose weight. It’s simple; skipping meals causes people to overeat. Eating breakfast is a critical strategy for weight loss and the prevention of weight regain, though many who skip breakfast have the misguided notion that it saves them calories. Many of those who are certain that they are not eating more calories overall when they skip breakfast really are. Among participants in the National Weight Control Registry (NWCR)—a listing of thousands of people who have lost at least 30 pounds and kept if off for at least one year—78% eat breakfast every day. Additionally, eating breakfast is associated with healthier cholesterol levels, better insulin sensitivity, and greater intakes of several vitamins and minerals, including potassium, calcium, iron, and vitamin C.
If you’re worried that eating in the morning will raise your blood glucose, you’ll be delighted to see how eating may actually push those morning numbers down. Morning blood glucose levels are largely regulated by hormonal factors and the actions of your liver. While sleeping, your cells use up the glucose from your dinner or evening snack, so the liver sends more glucose into the blood. Often in type 2 diabetes, the liver doesn’t recognize that there is ample blood glucose available, so it sends more out. Eating a food with carbohydrate tells the liver that you are no longer fasting, so it stops releasing extra glucose.
Breakfast in a Scramble
• Start your day with a piece of fruit, if the thought of eating in the morning makes you queasy. Eventually add other food groups.
• Get organized the night before.
— Pack a peanut butter and banana sandwich and a cup of low-fat milk to go.
— Measure out dry cereal and store it in the refrigerator with a cup of low-calorie yogurt and a plastic spoon to take with you.
— Prepare your own trail mix of dry whole-grain cereals, dried apricots, dried cherries, and other favorite dried fruits. Pair with a cup of yogurt, or if you want to avoid more carbohydrate, grab a tiny container of cottage cheese, or a cheese stick to round out this speedy breakfast.
• Keep a few meal-replacement bars and drinks on hand for when all else fails. Keep some at home and at work.
— Pick those with at least 3 grams of fiber, 10 grams of protein, no more than 3 grams of saturated fat, and about 250–400 calories. See Week 13 for more information about meal replacements.
• Make a smoothie with nonfat Greek yogurt and frozen fruit. Eat it at home or take it with you. See the recipe for Mixed Berry Smoothie in the Appendix.
• Stock up on dry and cooked whole-grain cereals. If you prefer long-cooking oats, prepare several servings at once. Store the
leftovers in the refrigerator in serving-size containers.
• Early in the week, make several hard-boiled eggs. In the morning, grab one, along with toast or fruit or both.
• Scramble eggs with diced peppers and onions. Wrap them in a tortilla or place between two halves of an English muffin.
• Combine any three food groups such as grains, lean meat, and fruit, if you don’t like traditional breakfast foods,
• Eat last night’s leftovers.
Cheryl S’s Story
I always thought I was too busy to eat breakfast, and I thought that skipping breakfast would mean less calories overall. But, that wasn’t true. Eating breakfast has helped me control my blood glucose better and has kept me from getting so hungry that I eat whatever is convenient. What’s really surprising is that I feel SO much better. Now I plan ahead to get my breakfast ready while I’m getting ready for work. I even keep some things in the freezer for days when I’m in a hurry. Eating regularly throughout the day is one of the best things I can do for myself.
Eating behavior expert Brian Wansink, Ph.D., author of Mindless Eating: Why We Eat More Than We Think We Eat (Bantam Dell, 2006), argues that on average Americans eat about 30–35% more than they think they do. Even the most aware individuals eat about 20% more than they realize. If you think you aren’t influenced by the size of a dish, you probably are, he says. When nutrition science professors and graduate students were given various sizes of ice cream scoops and bowls to serve themselves at a party, those with the larger dish served up to 127 more calories compared with those with the smaller dish. That amount increased further when they had both the larger dish and the larger scoop. Even students and professors who know lots about food and what they are eating can be misled!
If the size of a dish can trick you into eating more, it can also trick you into eating less. Apply this concept to all aspects of eating and drinking. Will it be more satisfying to eat a 4-ounce steak on a 12-inch dinner plate or on an 8-inch salad plate? On the bigger plate, the steak looks like a child’s serving. Pull out your small dishes and glasses or buy some attractive new ones. Use nothing larger than a 9-inch plate for dinner, 1-cup bowls for cereal, ½-cup dishes for ice cream and other desserts, and 1-ounce shot glasses for M & M’s, jellybeans, and the like.
TIP!
Visit www.mindlesseating.org for more information about mindless eating and how to break free of it.
For weight loss, blood glucose control, and overall fitness, you should engage in both cardiovascular (aerobic) and strength-training exercises. If you have any doubts about beginning an exercise program, or about cranking it up a notch if you’re already active, talk to your physician first. If you started walking last week or just started wearing a pedometer, keep it up this week and do a bit more, if possible. Our emphasis this week is on cardiovascular exercise. Walking, swimming, biking, stair climbing, dancing, and other activities that get you breathing heavily for several minutes strengthen your heart. This type of activity aids weight loss by burning calories, giving you a boost in energy (this is why being tired is a poor excuse not to exercise), improving triglyceride and cholesterol levels, increasing insulin sensitivity, and lowering blood glucose levels.
You may feel overwhelmed with the recommendation to engage in at least 150 minutes of cardiovascular activity weekly. If so, take it slowly. Any amount of activity is better than none. Thirty minutes is better than 20, and 20 minutes is better than 10. Set SMART goals for exercise, just as you do for dietary changes. Examine where you are, where you want to go, and make strategies to get there. The best activity to pick is the one you enjoy, and the best time to do it is the time that works for you. For example, if exercising before bed makes it hard to relax into a good slumber, you might be more consistent if you exercise before dinner. Be sure to pick an indoor activity for bad weather days as well.
During exercise, you should work hard enough to improve fitness, but not so hard to hurt yourself. Warm up for a few minutes with some slow walking and some gentle stretches before beginning your aerobic activity. Do something similar after your activity. Adjust your intensity up or down to hit the range you are aiming for. As your fitness improves, add either a few minutes to your exercise routine or pick up the intensity a bit. Listen to your body and follow the pace that’s right for you.
Rate Your Exercise
A useful tool to help you judge your exercise is the Borg Rate of Perceived Exertion (RPE) Scale. It helps you assess your level of effort. The Borg Scale ranges from 6 to 20. Generally, a rating between 12 and 14 indicates a moderate level of intensity.
Here’s how you use it: while doing physical activity, rate how you perceive your level of exertion. Consider how strenuous the exercise feels to you, including your sense of exertion, effort, and fatigue. Focus on your whole body’s level of exertion, not just on any one part of your body. Then, choose the number on the scale that best represents how you perceive your level of effort.
The Borg Scale runs from 6 (no exertion at all) to 20 (maximal exertion). A 9 is “very light” exertion, such as an easy, slow walk. At 13, the effort is “somewhat hard,” the work is tiring but you can keep going on. For 15, you’re working out pretty hard, and at 17, the physical activity is strenuous and tiring. When you get up to 19, it’s hard to consider keeping up this level of exertion for any length of time.
It’s important to try to honestly assess your exertion level. Don’t think about how difficult you think the activity should be. Just scan your body and fairly assess how hard it is working. Honest assessments will yield the best results. For more information, check out this website: www.cdc.gov/physicalactivity/everyone/measuring/exertion.html.
Avoid Low Blood Glucose During and After Exercise
Both losing weight and becoming more active improve insulin action. If you use insulin or any of the pills that sometimes cause low blood glucose, exercising puts you at risk for hypoglycemia both during the activity and for as long as a full day later. To avoid exercise-induced hypoglycemia, follow these guidelines.
• Measure your blood glucose before starting to exercise. If it’s below 100 mg/dl AND if you take medications that can cause low blood glucose, you will need a snack of about 15 grams of carbohydrate or whatever amount is necessary to raise your blood glucose to 100 mg/dl. A small piece of fruit will usually do. If you take no diabetes medications, it is unlikely that you need a snack.
• If you are exercising at a very high intensity, doing interval training, or doing intense weight training, you may need a carbohydrate-containing snack both during and after exercise to help prevent hypoglycemia some hours later.
• Measure your blood glucose frequently before, during, and after exercise to learn how different activities uniquely affect you. Check whenever you feel like your blood glucose is low.
• Always carry a source of carbohydrate in case you experience hypoglycemia. Follow the Rule of 15 if your blood glucose ever drops below 70 mg/dl.
— If you have your blood glucose meter, use it. If your blood glucose is less than 70 mg/dl, or if you don’t have your meter but believe your blood glucose is low, consume 15 grams of carbohydrate. It’s best to use pure glucose in the form of tablets, gel, or liquid because it works quickly and contains a minimum of calories. Some good choices include:
2–5 glucose tablets (check the label for the proper dosage)
1 tube of glucose gel
2 tablespoons of raisins
4 ounces of regular soda or fruit juice
1 tablespoon of sugar or honey
1 cup of nonfat or low-fat milk
Do not use candy bars and desserts because they add calories, saturated fats, and work slowly. If that is all you have, however, use it.
— The second half of the Rule of 15 is to wait 15 minutes after treating before eating anything else or resuming activity. Measure your blood glucose again. If it’s still low, consume another 15 grams of carbohydrate.
— Recheck your blood glucose in another 15 minutes. Continue to treat with 15 grams of carbohydrate and recheck in 15 minutes until your blood glucose is back to normal.
— If your next meal is hours away, you may need a snack.
More from Bill K
Exercise is a big part of my diabetes management and weight-loss plan. Sometimes when I’d exercise, though, my blood glucose would go too low, which forced me to take in extra carbs to push it back into my target range. Weight loss is difficult under any circumstances, but being forced to eat to keep my blood glucose up was making it a lot harder. I worked with a certified diabetes educator, who is also a registered dietitian, to help adjust my insulin dose, so my blood glucose wouldn’t go too low. That did the trick. By reducing my insulin, I was able to eat less, which reduced my calorie intake. Weight loss is definitely achievable with persistence.
You’ve kept your food record for at least two weeks by now. Take some time to look at it carefully. What patterns do you see? Perhaps you’ve noticed that you eat mindlessly in front of the television or feel the need for sweets in the afternoon. Maybe you tend to take second and third helpings, even though you’ve had enough to eat. Do you eat too fast, without fully tasting your food? By monitoring your own behaviors and progress, you can identify problem areas and take note of the strategies that work for you and those that do not. Some people like to review their food record daily and to write notes about things they did well or not so well. Then, they set a goal for the next day. Other people prefer to reflect on their food records weekly. Do what you prefer and what works for you and put those SMART goal practices into action.
Frank P’s Story
I keep a food record with a computer program that calculates my intake of calories, fat, protein, and carbohydrates. This helps me see if I’m on track or falling away from my goals, and it helps me feel like I have some control. For example, if I see that I’m going to go over my calorie budget for the day, I can choose what to do. I can choose to eat different foods or eat less or hit the gym a bit harder to balance things out.
I’ve had a few AHA! moments. Sometimes I feel as if I haven’t eaten very much during the day, but then I see that the calories, fats, or carbohydrates were significantly higher than I thought they were. Usually in those situations, I realized I gave myself excuses for eating something earlier and only fooled myself. Keeping records helps me see what I’m really doing and guides me to make good choices.
WEEK 3 ACTION STEPS
Continue your current goals or rewrite them if necessary. Additionally, select from the following goals or steps, modify them, or create your own. Choose goals from the previous weeks if applicable. This week I will:
Continue the following goals: ___________________________________________________________ __________________________________________________________________ __________________________________________________________________
Record and reflect on my food intake daily.
Not skip any meals.
Keep the following foods on hand to make eating breakfast easier:___________________________________________________________ __________________________________________________________________.
Use a smaller plate for dinner and small dishes at other times.
Add 1,000 steps to my daily step goal.
Wake up 20 minutes earlier to fit in a few minutes of physical activity.
Pull out my old exercise DVDs.
Check my blood glucose before, during, and after exercise.
Carry a source of glucose with me when I exercise.
Other:___________________________________________________________.
