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DIABETES

GENERAL RESEARCHLIFESTYLE

HOW TO NAVIGATE EFFECTIVELY WITH THE INTERMITTENT FASTING

IF simply involves switching between fasting and eating on your normal schedule.
This method could help you manage your weight and ward off chronic diseases if monitored and done effectively.

BASIC CONCEPTS
Before going into this practice, it is important to know what it entails.
Some basics to know:
– you have to skip one meal
– you can still have your favourite healthy meal while fasting
– you can drink water while fasting
– you can have no-calorie beverages while fasting. Examples include coffee, green or black tea.

So for everyone that has heard about IF or has practised it before, normally, you would skip breakfast while fasting, because it feels easier.
-But, according to a research carried out by USDA economic research service, it was noticed that skipping dinner, reduced more daily calories and lowered diet quality the least when compared to skipping breakfast or lunch.
-Also note that your night fast should be longer than 2 hours and shorter than 24 hours

TYPES OF IF
There are basically 3 popular types of IF:
– 16:8 method
– 5:2 method
– eat-stop eat method.
Others include OMAD, and warrior diet.

16: 8 METHOD

5:2 METHOD

EAT-STOP-EAT METHOD
This method involves fasting for 24 hours twice or thrice a week.
– Fasting for 24 hours would lead to a metabolic shift and ause your body to use up fat
– But staying off food for 24 hours might lead to binging and overconsumption.

IF AND YOUR HORMONES
– IF positively affects the human growth hormone (HGH), especially when done adequately. These hormone levels increase when you do IF, and higher levels of this hormone facilitate fat burning and muscle gain.
– IF also increases the amount of norepinephrine in our bodies which help to breakdown body fat and facilitate it use for energy
– intermittent fasting decreases androgen markers (i.e., testosterone and the free androgen index (FAI)) while increasing sex hormone-binding globulin (SHBG) levels in premenopausal females with obesity.
– fasting may prove to be a valuable tool for treating hyperandrogenism in females with polycystic ovarian syndrome (PCOS) by improving menstruation and fertility.

BENEFITS
– WEIGHTLOSS: A 2014 review of scientific literature found that IF can cause 3–8% weight loss over 3–24 weeks, which is a significant amount. Also, participants lost 4-7% of their waist circumference.
– CAN REDUCE INSULIN RESISTANCE: IF can help reduce insulin resistance. According to research, it can help reduce blood sugar by 3–6% and fasting insulin levels by 20–31%.
– HEART-HEALTH: IF may help to reduce bad cholesterol, and blood triglycerides.
– OXIDATIVE STRESS: IF may help reduce inflammation (a key factor in disease processes) and oxidative stress.
– BRAIN HEALTH: may increase the brain hormone brain derived neurotrophic factor (BDNF) and may help in the growth of new nerves. it also may help prevent alzemheirs
– DECREASE IN APPETITE: according to research, time-restricted fasting (16 8), decreased mean ghrelin levels, increased fullness in participants, and decrease the desire to eat.
Also, in the first 12 hours of fasting, there is a slight increase in ketone bodies, this helps in appetite suppression.

POSSIBLE DOWNSIDES
– Malnutrition: if not done properly, intermittent fasting could lead to serious malnutrition. some very vital micronutrients and electrolytes might be lacking in your diet if not monitored.
– Dehydration: during a fast, your body tends to release water and salt via the urine. if this water isn’t replenished, you get dehydrated.
– Bad breath: during fasting, fat is used up majorly as fuel. fat metabolism leads to acetone formation which can affect your breath
-fatigue and low energy: when fasting, especially if you are not adequately monitored, with an inadequate intake of calories, you tend to be fatigued due to a low intake of calories
5. Headaches and lightheadedness: this is most common in intermittent fasting and occurs within the first few days especially if you’re a newbie.
6. Hunger and cravings: normally you’d feel hunger cues during your fasting. they tend to be heavier if you don’t do it well.
Most of these side effects should disappear in 2 weeks,

TIPS TO NAVIGATE EFFECTIVELY
• Know your nutrient needs
• Always incorporate proteins into your eating window
• Know your energy requirements
• Always stay hydrated
• Avoid overeating/undereating
• Maintain a balanced diet
• Try out the different types of IF
• Keep track of your journey
• Adapt a suitable workout routine
• Plan meals
• Speak to a registered dietitian

WHO SHOULD NOT BE ON IF?
• If you are underweight
• If you have a history of an eating disorder
• If you are pregnant
• If you are breastfeeding
• If you are on insulin (type 1)
• Anyone with immunosuppression
• Transplant patients
• Chronic kidney diseases
• Poorly controlled diabetes (unless an endocrinologist is involved).
• Adolescents and kids
• Elderly (muscle mass)

SUMMARY
The intermittent fasting pattern of eating is quite a beneficial one with side effects that can easily be managed. But, it is important that you are monitored by health practitioners before delving into this type of diet.
Also, before starting, be sure of the type of fast that would suit your lifetyle and schedule.

SOURCES:
-https://www.hopkinsmedicine.org/health/wellness-and-prevention/intermittent-fasting-what-is-it-and-how-does-it-work
– https://www.healthline.com/nutrition/6-ways-to-do-intermittent-fasting
– https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3680567/
– https://pubmed.ncbi.nlm.nih.gov/31525701/

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GENERAL RESEARCH

3 REASONS YOUR BLOOD SUGAR FLUCTUATES

Blood sugar readings can be fickle; and this is regardless of whether you were just diagnosed recently, or you’ve been diagnosed over a long period of time.

Apart from the fact of its fickleness, it is also very important that it is always in check and managed well

Proper blood glucose management can help to prevent you from potential diabetes complications like nerve damage, kidney disease, vision problems, heart diseases and stroke

Learning how different habits and factors can cause blood sugar to fluctuate can help you prepare for, and predict fluctuations

It is important to note that some of these factors are out of control; even though you stick to your medications and diet, your blood sugar will still tend to fluctuate.

But that doesn’t mean it cant be prepared to defend against those fluctuations. Keep reading to see factors that could affect blood sugar and what to do about them.

1. DEHYDRATION: sounds awkward right? Well, being dehydrated and having diabetes are co-related. When your body is short of enough fluid supply, the sugar in the cells tends to be high concentrated and this leads to hyperglycaemia.

To make things worse, high blood glucose leads to excessive urination, which can in turn increase dehydration.

So, if you have been diagnosed with diabetes, it is in your interest to stay hydrated always, especially with water.

  • 2. SOME MEDICATIONS AFFECTS BLOOD SUGAR: apart from your oral drugs to help manage diabetes, some other over-the-counter drugs you’re on can alter glucose readings.

Drugs used to treat inflammatory conditions, autoimmune disorders, and asthma can cause a spike in blood glucose.

3. DAWN PHENOMENON: you might have experienced this one time or the other when your blood sugar levels spike at early mornings even if you did so well with your drugs and diet the previous night.

It might just be dawns phenomenon: your body releases cortisol during 2am-8am, and this hormone has a way of making your body less sensitive to insulin.

You should check with your doctor if this continues regularly.

Apart to inadequate management and abuse of oral glycaemic drugs, some other factors might be influencing your blood sugar readings

You have noticed that your crossed all your T’s and dotted all your I’s and still? Just maybe, these factors are involved.

SOURCES:
– https://www.everydayhealth.com/type-2-diabetes/symptoms/surprising-causes-of-blood-sugar-swings/
– https://www.cdc.gov/diabetes/library/spotlights/blood-sugar.html
– https://www.mayoclinic.org/diseases-conditions/diabetes/expert-answers/dawn-effect/faq-20057937#:~:text=The%20dawn%20phenomenon%2C%20also%20called,a.m.%20%E2%80%94%20in%20people%20with%20diabetes.
– https://www.ncbi.nlm.nih.gov/books/NBK430893/

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LIFESTYLE

IS INTERMITTENT FASTING THE NEW GO-TO DIET TRICK?

It seems like the trend now is fasting, we’ve come a long way in the nutrition space and there has been so many takes on how to lose weight or help with some chronic diseases.
So the question is: will fasting help me lose weight, manage diabetes and other chronic diseases?

Absolutely! It would, but is it sustainable and convenient?
Is it suitable for everyone? What are the merits and demerits of fasting?
These are the questions we’ll love to use this article to answer, but before then;

WHAT IS INTERMITTENT FASTING?
Intermittent fasting, also known as intermittent energy restriction is any schedule for meals that involves a cycle between voluntary fasting and non-fasting periods. It can include an alternate day fasting, periodic fasting or daily time restricted fasting.

Apart from the religious type of fasting, there are 3 main types of intermittent fast:
– 5:2 Diet: this type of fasting involves that you fast for 2 days per week and you’ll be allowed to take 25% of your daily caloric needs, while you eat normally for 5 days.
– Alternate day fasting: you have to skip a day and eat the other day. So, you eat on Monday and skip Tuesday, eat Wednesday and skip Thursday, and it goes om like that. You’re still allowed to just 25% of your normal daily calories per day In this type of regimen.
– Time restricted fasting: this type involves fasting for 8-12 hours of the day and eating during the remaining time frame. For this, you are not restricted to having just 25% of your daily calories. Apart from the above mentioned, there is the warrior diet also.

IS INTERMITTENT FASTING REALLY EFFECTIVE?
A study found that participants consumed 35% fewer calories and lost an average of 7.7 pounds (3.5kg) after alternating between 36 hours of fasting and 12 hours of unlimited eating over 4 weeks. For some studies, there was not any significant weight loss between the fasting group and moderate calorie group
There are quite a number of side effects of intermittent fasting especially when it is abused and they include: extreme hunger pangs, lightheadedness, reduced concentration, fatigue and nausea. All these put together might just make the regimen to be effective only for a short time.
Furthermore, people might tend to eat more than required on days that they are free to eat would result to no weight loss.

CAN I TRY GOING ON AN INTERMITTENT FAST?
For some groups, intermittent fasting is advised at all, you can still achieve your health goal without having to do marathon fasts
If you have diabetes, on routine medication, pregnant or breastfeeding, you should not do intermittent fasting.
You really should not go on a long fast, or skip meals so you would lose weight or manage your blood sugar levels. The caveat is that when your body doesn’t take in any food, obviously calories would be depleted and other nutrients, thereby leading to a decrease in blood sugar, so it is not magical

You can stick to healthy and mindful eating and still achieve perfect glucose levels and still lose weight without any type of side effects, so why go on a regimen with side effects?

SOURCES

https://www.healthline.com/nutrition/intermittent-fasting-guide
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5959807
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DIET THERAPY OF DISEASES

GASTROPARESIS

GASTROPARESIS

As a saying goes thus : “ to eat is human, to digest is divine; a number of people find it difficult to utilize their digestive tracts after enjoying a sumptuous meal. Really, it’s saddening to be afraid to eat that very delicious meal because you know you would probably be bloated or even constipated. So, what to do? 

Let’s take a look at this exciting digestive disorder called gastroparesis, shall we?

Gastroparesis (abbreviated as GP) represents a clinical syndrome characterized by sluggish emptying of solid food (and more rarely, liquid nutrients) from the stomach, which causes persistent digestive symptoms especially nausea and primarily affects young to middle-aged women, but is also known to affect younger children and males.

It’s thought to be the result of a problem with the nerves (vagus) and muscles that control how the stomach empties.

Sadly, If these nerves are damaged, the muscles of your stomach might become dysfunctional and the motility of food can slow down.

“While delayed emptying of the stomach is the clinical feature of gastroparesis, the relationship between the degree of delay in emptying and the intensity of digestive symptoms does not always match”. For instance, some diabetics may exhibit pronounced gastric stasis yet suffer very little from the classical gastroparetic symptoms of: nausea, vomiting, reflux, abdominal pain, bloating, fullness, and loss of appetite. “Rather, erratic blood-glucose control and life-threatening hypoglycemic episodes may be the only indication of diabetic gastroparesis. In another subset of patients (diabetic and non-diabetic) who suffer from disabling nausea that is to the degree that their ability to eat, sleep or carry out activities of daily living is disrupted gastric emptying may be normal, near normal, or intermittently delayed”. In such cases, a gastric neuro-electrical dysfunction, or gastric dysrhythmia (commonly found associated with gastroparesis syndrome), may be at fault.

DIABETES AND GASTROPARESIS 

Over time, diabetes can affect many parts of your body (especially nerves). One of those is the vagus nerve, which controls how quickly your stomach empties. “When it’s damaged, your digestion slows down and food stays in your body longer than it should”.

Although it’s more common in people with type 1 diabetes, people with type 2 can also get it.

From a study carried out by Phillips LK et al., 2015 : 

Glucose and gastric emptying: bidirectional relationship. The rate of gastric emptying is a critical determinant of postprandial glycemia. Glucose entry into the small intestine induces a feedback loop via CCK, peptide YY (PYY) and glucagon-like peptide 1 (GLP-1), which are secreted from the intestine in response to nutrient exposure. GLP-1 and gastric inhibitory polypeptide (GIP) induce the release of insulin, and GLP-1 inhibits glucagon secretion, which attenuates postprandial glycemic excursions. Amylin, which is co-secreted with insulin, also slows gastric emptying. At the same time, the blood glucose concentration modulates gastric emptying, such that acute elevations of blood glucose levels slow gastric emptying (effects are evident even within the physiological range) and emptying is accelerated during hypoglycemia.

DIAGNOSIS

Diagnosis of gastroparesis begins with a doctor asking about symptoms and past medical and health experiences (history), and then performing a physical exam. Any medications that are being taken need to be disclosed.

Tests will likely be performed as part of the examination. These help to identify or rule out other conditions that might be causing symptoms. Tests also check for anything that may be blocking or obstructing stomach emptying. Examples of these tests include:

  • a blood test,
  • an upper endoscopy, which uses a flexible scope to look into the stomach,
  • an upper GI series that looks at the stomach on an x-ray, or
  • an ultrasound, which uses sound waves that create images to look for disease in the pancreas or gallbladder that may be causing symptoms.

SYMPTOMS 

The digestive symptom profile of nausea, vomiting, abdominal pain, reflux, bloating, early satiety, and anorexia can vary in patients both in combination and severity.

Others may include weight loss/weight gain, constipation and/or diarrhea, wide glycemic fluctuations in diabetics, belching and bloating-again, developing soon after meal ingestion and lasting for hours-along with visible abdominal distention. The distention and bloating may push up against the diaphragm making breathing uncomfortable.

“A poorly emptying stomach additionally predisposes patients to regurgitation of solid food, as well as gastroesophageal reflux disease (GERD)”. The reflux may range from mild through to severe. GERD complications can create esophageal spasm (also called non-cardiac chest pain) and can add to the burden of chronic pain. In severe cases, reflux aspiration pneumonitis compounds the clinical picture.

CAUSES

Reports from one tertiary referral center found that out of their 146 patients with gastroparesis: 36% were idiopathic (unknown causes), 29% were diabetic, 13% were post-surgical, 7.5% had Parkinson’s disease and 4.8% had collagen diseases. Any disease of metabolic, neurological (psychiatric, brainstem, autonomic including sympathetic and parasympathetic or enteric), or connective tissue (autoimmune) origin has the potential to disrupt gastric neural circuitry.

Apparently, diabetes is the most common known cause of gastroparesis. It can damage nerves — including the vagus nerve, which regulates your digestive system — and certain cells in your stomach.

Other causes of gastroparesis include:

Related Disorders

A stomach motor disturbance known as “dumping syndrome” whereby food or liquids empty too quickly from the stomach can present with similar symptoms as are found in gastroparesis. Other disorders that may clinically present as gastroparesis (gastritis, gastric ulcers, pyloric stenosis, celiac disease, and GI obstructions) need to be ruled out.

TREATMENT 

You may find these tips helpful:

  • instead of 3 meals a day, try smaller, more frequent meals – this means there’s less food in your stomach and it will be easier to pass through your system
  • try soft and liquid foods, or even semi solid foods which are easier to digest. In severe cases, broths might be advisable. 
  • Masticate well before swallowing ( i tried to check how long it’ll take to carefully grind a spoon of rice and i got 21seconds; you should try eating slowly. winks).
  • drink non-fizzy liquids with each meal

It may also help to avoid certain foods that are hard to digest, such as apples with their skin on or high-fibre foods like oranges and broccoli, plus foods that are high in fat, which can also slow down digestion.

MEDICATIONS 

Use of drugs like domperidone, erythromycin, anti-emetics. Also note that these drugs might have side effects so it’s important to discuss with your doctor before using them. 

Domperidone should only be taken at the lowest effective dose for the shortest possible time because of the small risk of potentially serious heart-related side effects.

Other options like electric stimulation, botulinum toxin injections, a feeding tube, surgery

FOOTNOTE FOR DIABETICS

The nerves to the stomach can be damaged by high levels of blood glucose, so it’s important to keep your blood glucose levels under control if you have diabetes.

Your doctor alongside a dietitian can advise you about any changes you may need to make to your diet or medicine. For example, if you’re taking insulin, you may need to divide your dose before and after meals and inject insulin into areas where absorption is typically slower, such as into your thigh.

SOURCES: https://www.nhs.uk/conditions/gastroparesis/

https://rarediseases.org/rare-diseases/gastroparesis
https://aboutgastroparesis.org/signs-symptoms.html/diagnosis-tests.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6028327
https://www.webmd.com/diabetes/type-1-diabetes-guide/diabetes-and-gastroparesis#1
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