About diabetes – part 1

There are 3 main types of diabetes mellitus:

  • Type 1 Diabetes: results from the pancreas failing to produce enough insulin
  • Type 2 Diabetes: a condition of defective insulin signalling
  • Gestational Diabetes: a condition where women without previously diagnose diabetes exhibit high blood glucose levels during pregnancy.

When insulin isn’t produced or acts ineffectively, glucose remains circulating in the blood, leading to a condition known as hyperglycemia. Long term hyperglycemia can result in the dysfunction and failure of various organs and systems, including the eyes, kidneys, nerves, heart and blood vessels.

The key players in diabetes are the pancreas and the liver.

The pancreas is both an endocrine and exocrine gland.

Exocrine means that it’s a gland that release its contents through a tube from inside to outside the body. It helps with digestion by producing important enzymes that break down food, which allows the body to absorb the nutrients.

The endocrine function primarily involves the secretion of the 2 primary hormones relevant to diabetes management: insulin and glucagon.

Insulin increases the storage of glucose, fatty acids and amino acids in cells and tissues and is considered an anabolic hormone. Insulin is a key player in the storage and use of fuels within the body.

Disorders in insulin production and signalling have widespread and devastating effects on the body’s organs and tissues. Glucagon is a peptide hormone produced by alpha cells in the pancreas. The pancreas releases glucagon when blood sugar levels fall too low. It opposes the action of insulin by raising the concentration of glucose in the blood.

Dietary carbs are not essential, however, the body needs glucose. The brain typically needs about 130 gr of glucose every day. Not all glucose has to come from the diet because the liver has the ability to synthesise it.

The liver serves as a warehouse for glucose storage and production. It can also produce fatty acids under certain conditions.

As blood glucose and insulin levels increase, the liver increases its absorption of glucose. Glucose is stored as glycogen. The amount of glycogen stored depends on circulating insulin and glucose levels. When blood glucose levels drop, insulin production falls. The shortage of insulin signals the liver to release its assets by sending glucose back into the blood to keep the body nourished.

When carb intake is restricted, it lowers blood sugar and insulin levels. As insulin levels fall and energy is needed, fatty acids leave their respected fat cells and enter the bloodstream. From here they’re taken up by specific cells and metabolised. Ketone bodies are molecules created in the liver, that are pushed into the blood stream where they’re utilised by skeletal and heart muscles cells as fuel. Also, the brain begins to use ketones as an alternate fuel source when blood levels are high enough to cross the blood-brain barrier. When this happens a person is said to be in nutritional ketosis.

Ketogenic diets are very popular because they suppress insulin and that seems to be very effective in the treatment and management of obesity and T2D. However the severe restriction of carbs (often below 30 gr) may increase the potential for hypoglycaemia of people with T1D.

Lipogenesis is creating fat within the body from glucose or other substrates. It takes place mostly in the liver. Lipogenesis occurs in the liver during times of calorific excess and overfeeding. The liver converts excess glucose to fatty acids. These fatty acids can be stored in the liver or transported via lipoproteins (carriers) to muscle and fat tissue for future fuel use or storage. The ratio that is stored or used is highly dependent on energy intake vs. energy expenditure.

In a healthy liver, insulin halts the production of glucose and instead promotes glycogen storage or generates fatty acids during times of energy excess.

The liver of a person with T1D has no internal break system. Insulin deficiency allows glucose production in the liver to go uncontrolled leading to hyperglycaemia and ketoacidosis if unmanaged. When there’s not enough insulin available, glucose cannot enter the cells for use as energy. Therefore the liver produces even more glucose in an attempt to provide energy for the starved cells, but because insulin is not available, none of this glucose can enter the cells. It builds up and starves the cells even further. Consequently, administration of insulin medication is needed to facilitate the entry of glucose into cells.

Insulin increases glucose uptake in the liver by facilitating the creation of glycogen and decreases glucose output.

Prolonged elevations in insulin that result from an energy surplus increase the body’s ability to produce fat via the process of lipogenesis.

Source:

Phil Graham: Diabetic Muscle

Psychology of Supplements

What is a dietary supplement?

A dietary supplement is a product intended for ingestion that contains a "dietary ingredient" intended to add further nutritional value to (supplement) the diet. A "dietary ingredient" may be one, or any combination, of the following substances:

  • a vitamin
  • a mineral
  • an herb or other botanical
  • an amino acid
  • a dietary substance for use by people to supplement the diet by increasing the total dietary intake
  • a concentrate, metabolite, constituent, or extract

Dietary supplements may be found in many forms such as tablets, capsules, softgels, gelcaps, liquids, or powders. Some dietary supplements can help ensure that you get an adequate dietary intake of essential nutrients; others may help you reduce your risk of disease.

It should be noted that any claims a manufacturer or individual makes about a supplement might change its classification.

Researchers have also differentiated “nonvitamin, nonmineral supplements” (NVNM) as those primarily consisting of herbal, botanical, protein/amino acid, brewer's yeast, and shark cartilage and a variety of other plant-based and nonplant dietary supplements such as enzymes and fish oil.

In competitive sports specifically, there are both “accepted” and “illegal/banned” substances, including some supplements.

In an interesting quandary for the field of performance enhancement, many supplements marketed to athletes contain banned substances – either overtly or because of impurities in these supplements. Researchers bought supplements from 215 suppliers in 13 countries testing 634 nonhormonal supplements. A meaningful % of the supplements (14.8%) contained substances that would lead to a positive drug test.

Problems also abound for individuals who use supplements to achieve added weight loss and/or muscle gain (or improved recovery after workouts) from their exercise programs.

Considering a worldwide ongoing obesity epidemic, it is not surprising that many individuals are seeking new ways to lose weight. Supplements promise, though probably seldom deliver, a magic bullet of sorts: easy, hassle-free weight loss with little in the way of dietary sacrifice.

Athletes undoubtedly account for a large portion of those who use dietary supplements, and there are a variety of products that are marketed directly at competitive athletes. Elite athletes tend to take supplements more commonly than college or high school athletes, and women used supplements more often than men.

Considering elite Canadian athletes participating at the Atlanta and Sydney Olympics, respectively, prevalence rates of 69% and 74% were reported. Vitamin use was most common (58-66%), whereas nutritional supplements were used commonly (Atlanta: 35% men, 43% women, Sydney: 43% men, 51% women) often consisting of creatine, and/or amino acid supplementation. Based on results overal, it appears that supplementation increases with the competitive level of the sport and is somewhat higher for female athletes.

There are 3 specific categories: supplement use to build muscle for aesthetic purposes or body image concerns, and supplement use to lose weight for aesthetic purposes, body image concerns, or health.

There is a behaviouristic explanation possible for the use of supplements in that athletes' use may lead to reward contingencies (eg: more prize money), thereby driving future behaviour. Similarly, supplements that build muscle or promote weight loss could produce rewarding results. Also, there are undoubtedly social influences at work considering that coaches, parents, athletic trainers, and peers have been reported to be influential regarding the decision to take supplements.

Operant conditioning: focuses on the manner in which our behaviour and action are influenced by the outcomes that follow them. Derived from the behaviouristic research tradition, the sum of findings in this area dictate that some outcomes/stimuli strengthen the behaviour that preceded them, and others weaken the likelihood of the behaviour that preceded them. Outcomes that increase the likelihood of behaviour are known as reinforcers, and those that decrease the likelihood of behaviour are known as punishment. In the present context, prize money, praise from others, or rewards due to improved performance are reinforcers of the behaviour to take supplements. Because most legal supplements likely would not produce dramatic sport performance gains, muscle mass gains, or weight loss results, perhaps the best explanation for use is found in other theories. Behaviouralistic explanations, however, might be highly applicable considering the use of illegal substance such as steroid use.

When trying to change attitudes about whether supplements are good or bad, it is likely that some individuals are more persuasive than others. Individuals are more persuasive if they are seen as trustworthy or having pertinent expertise. The supplement industry often uses exactly such a strategy to help market their products. University research and “expert” sport and exercise nutritionists are increasingly being used to support the efficacy of performance enhancing, muscle building, or weight loss supplements. Consumers should consider, however, that a company may contract with 3 universities to test their products and report only the results of the positive outcomes in their advertisements.

Achievement Goal theory: within this theory, it is assumed that there are differences in the manners by which athletes judge their competence or success. Individuals who are task-oriented tent to judge their success on the basis of personal improvement, whereas those who are ego-oriented tent to judge their success on the basis of social comparison with others. Task-oriented individuals typically view personal ability as changeable and exhibit strong motivation regardless of their perceptions of competence. Those who are ego-oriented, tend to view ability as more static and are thus more likely to engage in questionable strategies to ensure winning and would be expected to engage in more frequent doping activities and perhaps a greater willingness to use supplementation strategies.

Body image and eating disorders: Obesity rates have dramatically increased over the past few decades, a similar increase in the ideal body size has not occurred in the female population. In fact, the “ideal” waist size for females may have become unhealthily small. Because of these 2 contradictory trends, it is no surprise that the use of supplements targeted at weight loss has increased dramatically during this same time period. The nation is getting heavier and feeling worse about it, especially the female segment. In one survey, research showed that among women at risk for eating disorders approximately 65% engage in frequent use of “diet pills”.

Adonis complex: There is an opposing set of preoccupation afflicting males termed the Adonis complex, which seems to be afflicting boys and men more specifically during the last few decades. These individuals may compulsively lift weights or exercise, engage in steroid abuse, elect to undergo plastic surgery, or suffer from eating disorders or body dysmorphic disorders, all in attempts to gain muscle mass, change fat distribution, or otherwise alter their appearance to some ideal.

In one of the seminal works in this area, Pop and colleagues interview 108 bodybuilders (55 steroid users and 53 non-steroid users) and found a higher than normal incidence of anorexia nervosa (2.8%) and a surprising incidence of 'reverse anorexia' (8.3%), with some of the respondents believing that they appeared small and weak despite their large, muscular appearance. The latter finding indicated that some of these bodybuilders exhibited unusual preoccupations with their appearance. Such pathological preoccupation with muscularity has been termed muscle dysmorphia. As an important link to potential supplement use or abuse, in Pope and colleagues' research all of the bodybuilders indicating muscle dysmorphia (then termed 'reverse anorexia') were in the sample of steroid users, and many reported that the symptoms of muscle dysmorphia were a factor that led to steroid use. As an indication of the degree of this obsession, individuals with this affliction have reported lifting weights for hours a day while sacrificing other areas of their lives. For example, some of these individuals reported earning degrees in business, law or medicine but did not pursue a career or gave up a career in these areas because they needed more time to lift weights. Recent research indicates that bodybuilders suffering from higher levels of muscle dysmorphia are more likely to experience body dissatisfaction, social physique anxiety, and use muscle-building or fat-reducing targeted supplements. At present there is some evidence that supplement use is greater among individuals with muscle dissatisfaction or muscle dysmorphia. It also appears that illegal supplement use may accompany muscle dysmorphia as data indicate that 1 million or more US males have used these substances primarily to promote muscle growth as opposed to performance enhancement purposes. Finally, it should also be noted that research find that some men have become preoccupied with fat, as opposed to muscle, and, in contrast to attempting to gain weight, may develop eating disorders. This suggests that body image concerns among males may drive some to attempt obsessively to build muscle mass whereas others may obsessively work to lose fat. In both cases it is likely that legal or illegal supplementation is a common means to achieve such goals. 

An abstract from "Psychology of Supplements in Sport and Exercise - Motivational Antecedents and Biobehavioral Outcomes" by Rafer Lutz and Shawn Arent

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Vitamins and minerals

Vitamins and minerals you need for your body to function properly.

Generally you can get all your vitamins and minerals from your diet, but there are certain cases when you need to supplement:

  • If you are vegetarian,
  • Eat a diet that's limited because of food allergies and intolerances,
  • Or if you have a disease or condition that doesn't allow you to digest or absorb nutrients properly.

Otherwise whole foods are a lot better sources than supplements as whole foods also contain a variety of nutrients your body needs - not just one. They also contain fibre that is important for digestion and they also contain phytochemicals that may help protect you against cancer, heart disease, osteoporosis or diabetes.

Fat soluble vitamins:
Vitamin A / beta carotene
Helps with healthy vision, bone and tissue growth and reproduction. Vitamin A and thyroid are closely related. A deficiency in either can precipitate a deficiency of the other and ideally should be balanced. In too large amounts, however, vitamin A can suppress the thyroid and depress levels of other fat soluble vitamins - especially vitamin D.
Foods: liver, egg yolks, milk

Vitamin D / calciferol
Often called the sunshine vitamin because your skin produces it after being exposed to ultraviolet rays from the sun. It helps your body absorb calcium that is responsible for the normal development and maintenance of healthy teeth and bones.
To get vitamin D you need either sunlight or supplementation.

Vitamin E / tocopherol
It is an antioxidant that protects red blood cells and may play a role in immune function, DNA repair and other metabolic functions. It is also called the 'anti-sterility' vitamin as it opposes estrogen.

Water soluble vitamins
Vitamin C / ascorbic acid
It's an antioxidant that maintains healthy tissue and helps the body absorb iron. Also plays a role in wound healing, reducing stress and making one less susceptible to food allergies.
Foods: orange juice, ripe fruits

Vitamin B3 / niacin
It is one of the 8 B complex vitamins that helps your body convert food to energy. It also helps with blood circulation and improved blood cholesterol levels.

Vitamin B6 / pyridoxine
It is needed to help your body use protein, form red blood cells and maintain brain function. It facilitates amino acid utilisation, aids in calcium metabolism, supports the liver and helps regulate the facilitation and use of glycogen.
Foods: liver, egg yolk, milk

Vitamin B9 / folate / folic acid
It is important in red blood cell formation and for healthy cell growth and function. Very important during pregnancy for the developing fetus.

Vitamin B12
It has an essential role in red blood cell formation, cell metabolism and nerve function.

About minerals in the next post.

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Superfoods

Superfoods have the ability to tremendously increase the vital force and energy of one's body. They are an optimal choice to improve overall health:

  • boost the immune system,
  • elevate 'feel good' hormones, such as serotonin,
  • enhance stamina,
  • cleanse and fight free radicals,
  • lower bloating and inflammation.

Cacao – raw chocolate:

Is the highest antioxidant food on the planet. Number 1 source of antioxidants, magnesium, iron, manganese, and chromium. It is also high in theobromin (cardiovascular support) and anandamide ('feel good' chemical). Raw chocolate improves cardiovascular health, builds strong bones, is a natural aphrodisiac, elevates your mood and energy, and increases longevity.

Goji berries (wolfberries):

It contains 18 kinds of amino acids, up to 21 trace minerals, high amounts of antioxidants, iron, B and E vitamins, and many other nutrients.

Maca:

Increases energy, endurance, strength and libido.

Hemp seeds (eaten raw):

Contains 33% pure protein, and is rich in iron, amino acids, Vitamin E as well as Omega 3 and GLA.

Spirulina:

Provides a wast array of minerals, trace elements, phytonutrients and enzymes.

Bee products (pollen and honey):

Bee pollen contains nearly all Vitamin Bs, especially Vitamin B9 (folate), and all essential amino acids.

Honey in its raw, unfiltered and organic state, is rich in minerals, antioxidants, probiotics, and enzymes.

Camu berry:

It is the highest Vitamin C source on the planet. Great for rebuilding tissue, purifying blood, and enhancing immunity and energy. It is one of the best anti-depressants, immune building and eye-nourishing superfoods in the world.

Sea vegetables:

Rich in life-giving nutrients drawn in from the ocean and sun, sea vegetables help remove heavy metals, detoxify the body of radioactive iodine, provide numerous trace minerals, regulate immunity and decrease the risk of cancer.

Seaweeds are excellent for thyroid, immune system, adrenals and hormone function.

Medicinal mushrooms:

High in polysaccharides and immune-enhancing components, medicinal mushrooms like Shiitake and Reishi, are one of the most intelligent adaptogenic superfoods on the planet.

Cruciferous vegetables:

Such as broccoli, brussels sprouts, cabbage and cauliflower are high in antioxidants, and sulphur, which enhances the body's production of glutathione.

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