Sugar, Diabetes and You

Think back to the last 20 years of nutrition recommendations. 

Remember low-fat?  Low carb?  Fruit cleanses?  Blueprint cleanse?  Jenny Craig?  Weight Watchers?  South Beach?  Atkins?  Mediterranean?  Zone Diet? 

I could go on for quite awhile. 

And it appears the books keep coming. 

In one of my latest reads, however, I stumbled upon some disturbing facts, myths, and data that I could not help but pass along.  Jeff O'Connell, a diabetic himself, has unleashed some powerful, unavoidable summary of studies, quotes from doctors, and statements from once-reputable organizations in an informational book called Sugar Nation.  Within this book, I found myself obligated to share a few things:, including the book and and where it can be found on Amazon.com.

And, 25 Facts that give us a better picture of diabetes, blood sugar, and the myths surrounding both

25 Facts about Sugar and Diabetes

1)      A combination of lifestyle changes (dietary adjustments, exercise and the resulting weight loss) reduced diabetes incidence by 58% in the Diabetes Prevention Program.  Metformin, a ‘superstar’ diabetes drug, reduced the incidence by only 31% in the study, completed in 2003. 

2)      The American Diabetic Association (ADA) tells diabetics to never consume less than 130 grams of carbohydrates per day, and according to their position statement, anything lower will literally starve the brain and central nervous system. 

a.       I routinely (at least 2x per week) consumer less than 100g of carbohydrates per day.  So far my brain and central nervous system aren’t starving. 

3)      The ADA’s menu at their annual conference included low-fat or fat-free versions (meaning increased sugar or sugar substitutes) of dressings, cream cheese, yogurt and mayo. 

4)      Fat has virtually zero impact on blood sugar.  None. 

5)      People with diabetes have high blood sugar levels because their body cannot move sugar into the appropriate cells.  This is caused by the pancreas not releasing enough insulin OR the specific cells not responding to insulin (or both).  [Nothing about fat dysfunction in the description of diabetes.  Re-read #3 and 4, and scratch your head like I did.] 

6)      A 32 ounce Gatorade has 55 grams of simple sugars in it.  G2, the low-carb alternative, has 20 grams of simple sugars.  

7)      Insulin and other growth factors produced in response to carbs affect hormones in the skin, thickening pores.  Once the pores seal off, they fill with oil and become infected, also known as acne. 

8)      Researchers have found that male pattern baldness in those before the age of 30 are more likely to be in the early stages of diabetes than men with thick hair. 

9)      Type II diabetes affects 285 million people worldwide, and this doesn’t include those who have it but aren’t diagnosed.  One person develops diabetes every 5 seconds, increasing the number of people worldwide with diabetes by 17,000 per day, or 7 million a year. 

10)   The World Health Organization (WHO) expects the number of people with diabetes worldwide to double by 2030.  That number: 570 million. 

11)  Diabetics who are obese, but who are at least moderately fit, have a much lower death rate than diabetics who are normal but unfit.  (Lesson: fitness for the win!)

12)   The breakfast of champions?  At a breakfast hosted by Diabetes Australia (Australia’s version of the ADA), meal choices included orange juice (22 grams of sugar per 8 ounces), a variety of cereals, various breads, baguettes, and pine nut pancakes with wild honey.  Also served were egg-whites and grilled tomatoes.  Total carb count from one serving of each course (orange juice, small bowl of cereal, 1 pine nut pancake and piece of toast: between 200 and 250 grams of carbs.  

13)  In 2006, researchers at the University of North Carolina published a study in the American Journal of Clinical Nutrition, highlighting their survey of all 126 United States Medical schools.  They found that only 30% of them required students to take a dedicated nutrition course, and 80% of the instructors surveyed said students were being underserved with nutritional science.  (Who you go to for nutritional information: your doctor.  Who you should go to: your Nutritionist/dietician or Trainer).

14)  The average American takes in 2,157 calories per day, according to US government survey data, and 50% of those calories come from carbohydrates, accounting to 262 grams of carbs per day.  If the average American follows the 3 meal per day plan, each meal is LOADED with 87 grams of carbs PER MEAL. 

15)   A metabolic stress test, used to gauge how the body responds to sugar intake, uses 75 grams of sugar as its ‘excess’ dose.  This is one of the tests used to diagnose diabetes.  (Perhaps they should re-evaluate excess?)

16)   The other ADA, the American Dietetic Association, has corporate sponsors, including Coca-Cola, Pepsi-Co, Kellogg’s, General Mills, and Mars. 

17)  The US government calls for Americans to represent their daily calorie intake with 45-65% carbohydrates. 

18)   Sad but true: Type-II Diabetes used to be called adult - onset diabetes.  But because it strikes children so often, it’s no longer called ‘adult-onset’. 

19)  In 1993, the New England Journal of Medicine published the results of a large study called the Diabetes Control and Complications Trial.  Type I diabetics who had undergone intensive glucose-control therapy were found to have less vascular damage to the small blood vessels than the diabetics receiving conventional treatment.  This ‘new’ treatment protocol began in the 1920’s. 

20)  Insulin helps the body metabolize sugar in the blood (aka glucose).  What isn’t needed from diet for immediate energy can normally be stored in muscle tissue and the liver (called glycogen).  Limited storage space forces the liver to turn excess into triglycerides after becoming body fat. 

21)   People with insulin resistance dispose of carbohydrates by converting them to fat.  Insulin resistance occurs when insulin tries to find places to store glucose as fuel, but is rejected in its attempt, leaving glucose stranded.  As a result, more insulin is needed to help produce a certain amount of energy from glucose.

22)  Of the 224 million adults in the US, more than 80 million have insulin resistance severe enough to make them prediabetic.  But some in the group of 80 million, who are prediabetic despite their thin, healthy appearance, will die from heart complications prematurely.  A heart attack is a diabetic-type complication. 

23)  In 2007, the US spent $12.5 billion on diabetic prescriptions, surpassed only by sales of cholesterol drugs.  This amount is still double the amount spent in 2001. 

24)  In the most current position statement regarding carbohydrates and diabetes on their website, the American Diabetics Association states: ‘There is little evidence that total carbohydrate intake is associated with the development of Type II diabetes.  Further, a stronger association has been observed between total fat and saturated fat intake and Type II diabetes.’ 

25)  Elevated blood sugar levels correlate with greatly increased risk of heart disease (#1 killer of Americans).  Diabetics are 2x as likely as non-diabetics to suffer a heart attack. 

Run Smarter. Period.

Two weeks ago I started my new running program, with a workout plan, a running plan, and a well thought-out warm up and corrective exercise list.

But I forgot something so simple.

So simple, when I actually paid attention to this detail, I dropped almost 20 seconds per mile off of my long slow distance (LSD) run.  And I ran an extra mile!


Before I spill the dirt, here are the details comparing the runs:

Date	Distance	Calories	Elevation	Avg HR	Max HR	Time	Avg Mile
8-Aug	8.0	1113	257	178	192	1:12:59	9:02:00
15-Aug	8.5	1179	398	165	189	1:19:20	9:22:00
22-Aug	9.0	1245	279	168	185	1:17:55	8:39:00

So what was the difference?  GU!  Gu, an electrolyte and carbohydrate supplement, rapidly refuels your energy stores (I will spare you the gory details on glycogen and sugar usage during exercise), and by consuming this 15 minutes before my run, and about 30 minutes in, I was able to hold off the dreaded 'bonk'.

This, and carrying a water bottle, made a HUGE difference, and kept me running strong, even until mile 9, when I ran a 7:54 final mile.  Let me make this clear: I have never run more than 7 miles up until 3 weeks ago, and my previous best for a 7 mile run was a 9 minute mile.  Now, I'm running 20 seconds faster and 2 miles farther, just because of smarter hydration and nutrition tactics. 

I should also mention that I did 5 sets of Dumbbell incline bench and 5 sets of Barbell Rows before the run (and after my warmup).  In total, my workout was just over an hour an 45 minutes.

Gu and Accel-Gel, another type of sugar/carb supplement for endurance athletes, is available on Amazon, Vitamin Shoppe, or your local GNC for about $1.50 each, and in various flavors. 

Finally, My post-workout drink?  Endurox R-4.  Contains the proper 4-1 ratio of Carbohydrates to Protein for tired muscles that have worked LONGER than 60 minutes. 

Run smarter, then run harder.

-Coach Kev

Benefits of Cross-Training: The Real Story

In a recent NYT article, author Gina Kolata elaborates on the research regarding cross-training for sports.  Let's look at her argument and her view of the research that says that Cross Training (by her definition: cycling as a substitute for running or vice-versa) is NOT important and or beneficial for sports.  (NYT article HERE) 

1) Claim #1: "If you want to be a better runner, you have to run — regularly, consistently, and with a training plan that forces you to gradually increase your distance and speed. If you want to be a better cyclist, you have to ride and train according to the same principles. Same goes for swimming or any other endurance sport."   
Why this isn't true: If becoming a better ANYTHING in life was about doing something regularly, consistently, and with a plan, then life would be MUCH easier.  If you had to describe climbing a challenging mountain, it's simple: put one foot in front of the other.  But is it easy?  Many would say no.  This applies to running: doing something regularly and consistently, especially something with such a large injury risk as running (750 hops on one leg = one mile of running) and expecting to just do 'more' is foolish.  The details I used in the 21st Century Runner article are explicit in this: today's runners run SMARTER, not HARDER.  Increasing mileage alone is a 1980's recommendation from a coach that does not understand runners and the injury risk associated with it.  Increasing the variability from one run to the other (high-speed intervals to long slow distance runs) is the 21st Century recommendation to prepare muscles and joints for different stresses.  From shin splits, IT band friction syndrome, low back pain, muscle strains, plantar fasciitis and the dreaded 'runners knee', running is ANYTHING but low-stress and/or risk-free. 

 Above: a Runner's 'Band aid' for knee pain (aka cho-pat strap for patellar tendinitis/runner's knee)

2) Claim #2: "Lifting weights is just the opposite of cross-training (with cycling as a substitute for running, etc) — you do a few repetitions with the goal of increasing muscle strength and size. Yet in a review of published studies, Dr. Tanaka found that resistance training improved endurance in running and cycling. The effect occurred both in experienced athletes and in novices." 

Why this isn't 100% true: The smartest resistance training programs specifically created for running are not as Ms. Kolata says, with few repetitions and a goal of increasing muscle strength and size.  Rather, they are created with the knowledge that there is more than one muscle fiber type in the human body, and that all 3 should be stimulated in order to create a more powerful system that is not imbalanced.  For simplicity, we'll say there are 3 types of muscle fibers: Fast-twitch, medium-twitch and slow-twitch (technically known as Type IIb, Type IIa and Type I).  'Cross-training' (my definition: anything that will benefit the runner that doesn't include running) with resistance training workouts including movements that are not in the sagittal plane (as running is), that are geared towards the specificity of running, and including strength, mid-range endurance (or hypertrophy) and endurance programs, will most certainly improve performance (faster race times) and decrease injury risk (can we really measure this?).   Lifting weights is not ALWAYS few repetitions with a goal of increasing strength and size.  In fact, the best running programs will vary movement patterns and intensity (weight lifted) as per the specificity and requirement of the athlete or client.  In some phases, runners will need strength and power training, while in others, runners will need mid-range endurance (read: 10-12 reps) and endurance plus (15-25) depending on the movement pattern and workout. 
The problem with injury prevention?  We can't single-handedly isolate a workout program and its' association with lowering injury rates or improving performance.  HOWEVER, as renowned Physical Therapist Gray Cook says, the two biggest causes for injury are 1) the right side not agreeing with the left, or vice-versa) and 2) previous injury.  Training with an experienced Personal Trainer or Performance Coach who understands runners may face can help create personalized programs that can isolate specific weaknesses while integrating functional movements to reduce the disagreement between one side of the body and the other. 

3) The Claim "Dr. Willem van Mechelen, head of public and occupational health at VU University Medical Center in Amsterdam, looked at data on injuries in runners and tried to tease out the factors that were linked to them. And he concluded that the only way to prevent running injuries is not to run."
Why this isn't true: While Dr. Mechelen's abstract of running injuries and the meta-analysis provided awareness to the dangers of running, his statement never included what Ms Kolata stated:: The only way to prevent running injuries is not to run.  Instead, he stated:  "The prevention of sports injuries should focus on changes of behaviour by health education."  Unfortunately, Ms. Kolata jumped to conclusion and interpreted this falsely.

My recommendations:

The prevention of sports injuries, especially in running or cycling, is simple (not easy): running and cycling are repetitive injuries that place athletes at a high risk of injury (running because of repetition, cycling because of posture), so this statement should help clarify prevention 101: Train to run, don't run to train.  For example, a smarter (not HARDER) summary of Training to Run:

• As most coaches know, running is a poor choice of activities for calorie burning (~100 calories burnt per mile?  That's a lot of miles for not a lot of calories burned) 
• Training for running includes multiple planes, including lunges, deadlifts, squat variations, hip extensions, along with dynamic upper body pulls, pushes, and torso twists
• Training for running includes multiple running workouts, also featured previously in an article I did HERE, to stimulate multiple energy systems that are used during a race (for instance: hill workouts increase both the anaerobic ability of the runner, but also prepare the achilles for a larger stress than normal workouts on flat surfaces do). 
• Training for running includes an awareness that running is a KNEE-DOMINANT activity, so hip dominant movements are going to help increase glute contribution during stride (one of the glute medius' primary function during gait is to prevent the pelvis from dropping to the other side) and prevent other muscles' unprepared (and stressful) contribution to the movement pattern to continue running. 

Runner's left hip significantly lower than her right, indicating glute medius weakness

IN SUMMARY:  Running, although simple in description (one foot in front of the other with multiple stride lengths depending on the goal), is as complex a sport as any, and needs a complete understanding of the benefits, risks, training programs, and injury potential.  In this case, Ms. Kolata and Dr. Mechelen are close to helping runners perform better and decrease injury, but most may take away that they need to run more frequently and more distance and to avoid cross-training.  Both author and scientist are far from understanding the prescription to help runners with performance-enhancing activities  and decreasing injury risk in athletes.  The question remains: When it comes to training runners, why aren't successful runners and their trainers and coaches being questioned for their modalities and methods?  Relying on scientists in a lab setting, as proven above, is part of the equation, but putting together the minds of the scientist and practitioner will prove much more rewarding in the future. 

3 Essential Running Workouts

Recently, in my newly discovered zest for running, I've taken some time to research and practice some of the workouts needed to improve performance as a runner.  In addition to these articles (21st Century Runner, Simple Cardio Options, Part I, Simple/Complex Cardio Options, Part II ), there are a couple pieces of the running puzzle that can help you put together a program.  If you're thinking of running anywhere between a 5K to a marathon, you need to know and practice these 3 basic workouts, but only after you know one key piece of information:

Running Schedule

Someone, quick. Call a Doctor.

I just signed up for a 9.3 Mile Race.  And 4 other Races in the next 4 months.

Apparently, my signs and symptoms are leading me to the following conclusion: the Running bug bit me (again).

You see, I really do not enjoy running.  I enjoy sprinting, lifting, and doing other athletic pursuits that involve competition. Still, I have coached so many runners, from recreational to competitive marathon runners, that putting together a list of recommendations for a beginning runner is easy (Article HERE). 

But as with golf, I find myself continually intrigued by the relationship between running, golf and life.  There are lessons we must learn in life, lessons we must apply so that any mistakes will only be mistakes of the past, and lessons for our future.