sábado, 12 de octubre de 2013

Overweight and Obese Women Are Equally Capable of the Impulse Control That Lean Women Exhibit


Publication Date: 10/9/2013
Dieters call it willpower; social scientists call it delayed gratification.
It’s the ability to delay an immediate reward in favor of a bigger future reward, for example, having a slimmer body in a few months versus the hot fudge sundae now. Previous studies have shown that overweight and obese people have a harder time delaying gratification, so they are more likely to forego the healthy body later on in favor of eating more calorie-dense foods now.
But University at Buffalo research recently published in the journalAppetite now shows that behavioral interventions that improve delay of gratification can work just as well with overweight and obese women as with lean women.
“This research is certainly welcome news for people who have struggled to lose weight, because it shows that when people are taught to imagine, or simulate the future, they can improve their ability to delay gratification,” says renowned obesity expert, Leonard H. Epstein, PhD, SUNY Distinguished Professor in the UB School of Medicine and Biomedical Sciences, who was senior author on the research.
The research is part of a field called prospection, the process by which people can project themselves into the future, by mentally simulating future events.
Some of the most famous research done on delay of gratification includes experiments done at Stanford University in the 1960s and 1970s, where children were given an opportunity to either eat a single snack, such as a marshmallow now, or, if they waited a period of time, they could be rewarded with multiple snacks. Follow-up studies found that in general, those who were able to wait were more responsible and successful in their adult lives.
Epstein notes that many people have difficulty resisting the impulse for immediate gratification. Instead, they do something called delay discounting, in which they discount future rewards in favor of smaller, immediate rewards. This tendency is associated with greater consumption of highly caloric, ready-to-eat foods. It has been speculated that if people could modify delay discounting, they would be more successful at losing weight.
“Now we have developed a treatment for this,” says Epstein. “We can teach people how to reduce delay discounting, where they learn how to mentally simulate the future in order to moderate their behavior in the present.”
The UB researchers evaluated how much delay discounting participants engaged in using a hypothetical test that promised different amounts of money available either now or in the future. While the amount available in the future remained $100, the amount available immediately decreased during each test, eventually falling as low as $1.
Participants were then asked to think about future events that would occur during the time periods involved in the monetary test. So if they were choosing between $95 now and $100 in six months, they would be instructed to think about the most vivid event that would be happening to them six months from now, for example, a birthday party.
A control group was asked, instead, to think during the monetary test of vivid scenes from a Pinocchio story they had read.
The UB researchers found that those who engaged in the future thinking exercise were able to reduce delay discounting and that there were few differences between the lean and the overweight and obese women.
The study looked at 24 lean women and 24 overweight and obese women, all of whom underwent several behavioral assessments to determine differences in each person’s motivation level, their perspective on time and how much they sought out fun and responded to rewards.

In a study published earlier this year, Epstein and his colleagues demonstrated that overweight and obese women ate less when they were imagining themselves in enjoyable future scenarios and reduced their inclination to engage in delay discounting.
“In the current study, we show that episodic future thinking works equally well in overweight and obese women in comparison to lean women,” says Epstein. “That’s important since several studies have shown that overweight/obese women are more impulsive. The fact that projecting oneself into the future and imagining future scenarios works equally well for lean and overweight/obese women is important for designing interventions to reduce impulsive decision making in women who need to lose weight.”

Researchers: Life without Insulin is Possible


Publication Date: 10/7/2013
Several millions of people around the world suffer from insulin deficiencies. Insulin is a hormone, secreted by the beta cells in the pancreas, which plays a major role in the regulation of energy substrates such as glucose. This insufficiency, primarily caused by diabetes (types 1 and 2), has lethal consequences if it is not treated. As of now, only daily insulin injections allow patients to survive.

Several millions of people around the world suffer from insulin deficiencies. Insulin is a hormone, secreted by the beta cells in the pancreas, which plays a major role in the regulation of energy substrates such as glucose. This insufficiency, primarily caused by diabetes (types 1 and 2), has lethal consequences if it is not treated. As of now, only daily insulin injections allow patients to survive. This approach, however, brings on serious side effects. Thanks to their research, which was published in the journal Cell Metabolism, the University of Geneva (UNIGE) scientists identified the underlying mechanisms, proving that life without insulin is possible, and paving the way for new diabetes treatments.

While life without insulin was inconceivable, a group of researchers, led by Roberto Coppari, professor in the Department of Cell Physiology and Metabolism at UNIGE, has just demonstrated that insulin is not vital for survival. By eliminating this dogma, scientists are now considering alternatives to insulin treatment, which poses many risks to patients. An error in dosage may cause hypoglycemia, i.e., a decrease in the level of glucose in the blood, which can lead to a loss of consciousness. In addition, about 90 percent of patients over 55 who have been undergoing treatment for several years develop cardiovascular disease due to elevated levels of cholesterol brought on by the lipogenic properties of insulin.

Leptin Leads to an Essential Discovery
Researchers from UNIGE's Faculty of Medicine conducted experiments on rodents devoid of insulin, to which they administered leptin, a hormone that regulates the body's fat reserves and appetite. Thanks to the leptin, all the subjects survived their insulin deficiency. Using leptin offers two advantages: it does not provoke hypoglycemia and it has a lipolytic effect. 'Through this discovery, the path to offering an alternative to insulin treatment is emerging. Now we need to understand the mechanisms through which leptin affects glucose level, regardless of insulin level,' explains Professor Coppari.

The studies were able to verify whether the neurons involved in the mediation of leptin's anti-diabetic action in healthy mammals played a similar role in rodents suffering from an insulin deficiency. The results showed that this was not the case. In fact, to the scientists' surprise, GABAergic neurons located in the hypothalamus were identified as the main mediators of leptin's action on glucose level in the context of insulin deficiency. These neurons' influence on glucose had never been considered substantial before.

Additionally, the researchers detected the peripheral tissues that are affected by leptin during insulin deficiency. They consist mainly of the liver, the soleus muscle, and brown adipose tissue, which could be directly targeted by future treatments.

Through this discovery, scientists now know where to look for the answer to an insulin-free diabetes treatment. Understanding the functioning and effect of leptin on the body will enable scientists to identify the areas of the body that are involved, and ultimately the molecules that will form the basis of a new treatment.

Type 1 Diabetes and Exercise - 8 Important Points


 By Clara Schneider, MS, RD, RN, CDE, LDN | 10/7/2013

It has been a few years since I met the Olympic swimmer Gary Hall, but the memory is very vivid in my mind. You see, at the time my son was a young teenager swimming on a league team located at a nearby U.S .Army facility. By all accounts not up to an Olympic level, but his swimming dictated our family activities. I also remember two boys with type 1 diabetes on the team trying like my son to win blue ribbons if possible, but also enjoying every aspect of loving their sport. My favorite activity was standing on the side of the pool every Saturday morning, cheering for all the swimmers. My top heroes (of course besides my son) in the athletic world were and still are the three swimmers: Gary Hall and those two young boys.

Meeting Mr. Hall was wonderful for me. It was at the American Diabetes Association Convention. I know there is absolutely no way that he would remember me, but the occasion was an event where his doctor and Mr. Hall discussed his training and managing his type 1 diabetes. I couldn’t get over how lean he was. Here he was a handsome young man with 10 Olympic medals. He was also very gracious. I know my two young friends would love to have his autograph, which he gave with a smile and also for me a hug. What an inspiration! After meeting him, Gary Hall’s picture hung in my diabetes center for the years I directed our program. I would point to the picture when asked if people with type 1 diabetes can exercise and replied, “Yes, of course, with your doctor’s approval.”  “Just look at the picture of Gary Hall,” I would add, “he has type 1 diabetes and worked hard to win 10 medals in the Olympics!”

To my knowledge my other two heroes never went on to the Olympics. They did have a lot in common though with Mr. Hall. They loved their sport and worked hard to keep their diabetes under good control.
 

What are the steps all people with type 1 diabetes should follow so exercise is enjoyed and done safely?

 

Step 1: Think about the kinds of exercise that is necessary for your life and also the exercises you would like to learn, participate in or get better at. Make a list. Items on it may be things like:

- Walk the dog.
- Housework including vacuuming, making beds, and other chores.
- Gardening and lawn work
- Starting a swim program
- Ice hockey
- Soccer
- Cardio-class or yoga at the local community center

Remember this is your list. How are you planning to exercise?

Step 2: Research your exercise. What are the time-periods you are going to devote to exercise? Perhaps you need to walk the dog for 20 minutes 2 times a day. Maybe you are going to join a ice hockey club get up at 4 a.m. for a one-hour practice five days a week and then again at 7 p.m. two days week because that is the ice time your team has. You also plan to play in one-two games over the weekend. Write down the time blocks.

Step 3: See your physician and talk about your lists. Will you be cleared for the exercise? What precautions should you take? Some of these things are the same as everyone else like proper protective gear in sports, but gloves and knee pads may also be appropriate for activities like gardening. What types of foot gear is needed for your exercise? Discussions with your healthcare team may include proper fitting shoes and socks made to keep the feet dry. Talk about taking proper care of your feet to avoid blisters and trauma. Besides wearing a medical ID, what are some important discussion points you need to address with your medical team that are unique to people with type 1 diabetes and exercise?
 

8 Important Points about Type 1 Diabetes and Exercise

 

Point 1: Do I need to adjust my insulin amounts for the activities I choose?How should I do that? Serious athletes may use a pump to regulate their needs for various levels of insulin. When insulin is needed before exercise, it is recommended to inject into subcutaneous tissue that is distal to the exercising muscle. (1) Many people with diabetes have a decrease in their blood sugar although there are people that “go high” with intense exercise. It is important to ask how to adjust your insulin based on your individual needs. It is important to think ahead to avoid hypoglycemia or hyperglycemia.

Point 2: Discuss when you need to test your blood glucose. With all activity is important to test blood glucose before, during and after the activity.  Ask your physician how often you should be testing. Ask what blood glucose readings you should strive for during all three time periods. The exercises you have on your list may affect your blood glucose levels differently. Common recommendations are to have a blood glucose level of at least 100mg/dl before exercising. Is this high enough for you? What does your doctor recommend? If your activity is intense, what should your levels be after exercise? By testing after you exercise you can see the trends of your values and if you need to treat to prevent lows or highs. Exercise can lower your blood sugar for up to 24 hours. (2)

Point 3: What blood glucose and ketone levels indicate that you should not exercise?  General recommendations for people with type 1 are to test blood glucose before exercising. If the levels are above 250 mg/dl but below 300 mg/dl, test for ketones. If ketones are present, do not exercise. The Joslin Diabetes Center recommends: “If there are no ketones present and blood sugars are 300 or more, test within 5-10 minutes of beginning exercise. If your blood sugar is dropping, you may continue. If it is not dropping, stop exercising.” (3) Ask your healthcare team if these guidelines are for you. Also ask for insulin administration and fluid guidelines to help regulate your blood glucose. Test frequently and according to your physicians recommendations. Ask your physician if she/he will write an order for additional strips. Check with your insurance to see what will be paid for.

Point 4: Will your meter readings be affected by factors such as temperature? Know that meter values are influenced by altitude and temperature. If you participate in winter sports, know that circulation to the skin is diminished in the cold. Blood glucose readings taken from the fingertips are not as affected as those taken from other sites. You may see a lag time in your blood sugar of up to an hour at these sites. Normal lag time for alternative sites is 15-30 minutes. (4)  Also know the temperature limits to your meter. Discuss with your healthcare team techniques to keep your meter at the proper temperatures and if you will need to change your meter based on its ability to function. Hints like carrying your meter in the upper inside pocket of your coat may help. Diabetes Forecast has an excellent table of meter limits (both high and low) located here. The guide lists temperatures using the Fahrenheit scale. The equation to compute these values to the Celsius scale, if needed, can be found here.

Point 5: What should I do to take care of my hydration (fluid) needs? The usual rule is to drink fluids before, during and after exercise. A person exercising needs to replace fluids lost from perspiration and to keep hydrated. (5) Recommendations for hydration before and during exercise presented at the Canadian Diabetes Association Professional Conference in 2004 suggests drinking 250ml (approximately 1 cup) of fluid 20 minutes before exercise, and continuing with an additional 250ml for every 20-30 minutes of exercise. (6) Ask your healthcare team what your fluid goals are. Ask what fluids are recommended for you to consume.

Point 6: Discuss how carbohydrates should be consumed before, during and after your exercise. Carbohydrates are usually recommended as part of a meal three-four hours before competitions or one-three hours before exercise. One-hour before competition it may be suggested to drink a sports beverage with 1-2 grams of carbohydrate per kg of body weight. One kg is equal to 2.2 pounds. More carbohydrates needed during exercise are dependent on your blood glucose readings. After exercise it may be suggested to consume slow-acting carbohydrate to protect against post-exercise late-onset. (7) Ask your medical team what is right for you. During exercise you should always have access to a source of simple carbohydrates to handle your blood glucose if it is going low. Discuss with your medical team convenient options.

Point 7: What should I do if I am part of a team to help me keep safe? If you are part of a team or your child with diabetes is part of a team, the National Athletic Trainers' Association (NATA) recommends having a diabetes care plan for practices and games. The care plan is put in place so the appropriate people will know how to take care of the special needs of the athlete with diabetes. For more information, click here.

Point 8: Is there any special equipment I should discuss with my health care team? You may want to consider special equipment based on the exercise you are considering. In swimming, one may want to explore the possibility of a waterproof pump. Other sports may have special needs as well. Explore the possibilities with your healthcare provider.

Exercise should be part of every person’s day. If you have type 1 diabetes, make sure you learn more about the exercise you want to do. Discuss with your medical team if the exercise is something that you can do safely. Maybe some of you with type 1 diabetes reading this article will end up with an Olympic medal or two or even 10 like one of my heroes. All of you should find something that is healthy to participate in like all of my heroes! Do not forget to follow their recommendations of your medical team. Please share with all of us at DiabetesCare.net the exercise you participate in and how you handle any special problems with type 1 diabetes.


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