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					                   10
                 easy ways
                    to get
                   healthy
                 right now
                   by tracey
                  Neithercott


                  SMALL
                  STEPS,

                 BIG
cj burtoN/veer




                 chAnGES
                                        Big ambitions don’t always yield big results.
                                        Just ask anyone whose pursuit of healthy eating started with a ban on
                                        carbs and fat and ended wrist-deep in a pile of cheese fries. If you have
                                        diabetes—and type 2, in particular—you may have been told that you
                                        need to make some pretty major lifestyle changes. Well, easier said than
                                        done. “Many of us find that the bigger the change, the bigger the fall,”
                                        says Robert Maurer, PhD, a clinical psychologist with the David Geffen

                      D i a b e t e s    F o r e c a s t   |   s e p t e m b e r   2 0 0 8                          61
 School of Medicine at the University of California, Los Angeles, and
 author of One Small Step Can Change Your Life: Using the Japanese
 Technique of Kaizen to Achieve Lasting Success. According to Maurer,
 substantial change is more easily attained when you take small, slow
 steps toward your goal. “What you’re really trying to do is build a
 lifetime habit. You can do this by doing things every day, even one                   had higher A1Cs than those who
 minute a day,” he says.                                                               had a long, restful slumber.
    Below are 10 ways of baby stepping toward better health. Don’t                        Small step: When life gets busy,
 try them all at once; making too many changes at the same time can                    sleep is often the first thing to go.
 be overwhelming. Begin by picking one or two you can do without                       Because going to bed an hour ear-
 too much effort, and watch how pacing yourself can turn even the                      lier is brilliant in theory but hardly
 biggest hurdles into major successes.                                                 ever possible, try setting a super-
                                                                                       easy goal. Maurer suggests going
                                                                                       to bed one minute earlier than
                                                                                       your normal bedtime. Getting one
                                       What that means for you: Adding                 extra minute of sleep may sound
     1                                 little bursts of activity to your
                                       day—delivering a message to
                                                                                       silly, but, Maurer says, “you want
                                                                                       to make sure the step you take is
 Big idea: exercise more               your colleague in person instead                so ridiculously small that you’re
    Why it matters: Studies have       of by e-mail or picking the stairs              100 percent sure you can do it.”
 shown again and again that physi-     over the elevator—can make a                    If you can realistically alter
 cal activity can do more than just    big difference.                                 your bedtime by, say, five or
 help you lose weight. It can im-       Try this: each time you find
                                                                                       10 minutes, go ahead.
 prove your cholesterol, reduce                    yourself glued to the                Try this: this month, move your
 stress, prevent osteoporosis, lower   tube, exercise during one set                               bedtime up by one
 your blood pressure, help you         of commercials. Within a month,                 minute—or five, if you want.
 sleep, boost your immune system,      increase your workouts to                       Next month, shift the time by
 and give you more energy. Plus,       two commercial breaks.                          another minute or two, and
 when you engage in physical ac-                                                       repeat each month until you
                                                                                       reach your goal.
 tivity, your muscles use glucose
 for energy, reducing your blood
 glucose levels. Exercise also in-
                                           2
 creases your insulin sensitivity,
 which means you’ll need less insu-
                                       Big idea: Get more sleep
                                          Why it matters: You need sleep
                                                                                              3
 lin to get glucose to your cells.     to recharge your body. Cutting                  Big idea: eat healthy
    Small step: When researchers       your nightly rest short by even                    Why it matters: Eating good-
 at the Mayo Clinic studied how        a couple of hours could impact                  for-you foods can boost your
 thin people burn calories, they       your decision-making and work                   health in many ways, including
 found that they incorporate           performance, increase your                      reducing your chances of develop-
 more random spurts of ac-             risk of high blood pressure and                 ing heart disease. Modifying your
 tivity (including actions as                  depression, or make you                 diet with healthier fare could also
 seemingly insignificant as                    gain weight. And in a                   help you lose weight and better
 fidgeting) into the day than                 2006 study published in                  control your diabetes.
 their heavier counterparts                       the Archives of Internal                Small step: Upping your meals’
 do. Thanks to all of that                        Medicine, researchers                nutritional value sounds like an
 spontaneous exercise,                                 found that people               easy idea until you’re face-to-face
 the lean group burned                                 with type 2 diabetes            with a box of jelly doughnuts call-
 350 more calories                                   who reported short-               ing your name. Instead of shocking
 per day than the                                  ened periods of sleep               your system by totally upending
 overweight set.                                    or poor sleep quality              your diet, start with small changes

62                                D i a b e t e s   F o r e c a s t   |   s e p t e m b e r   2 0 0 8
                                                                                         good habit to get into,” says Janis
                                                                                         McWilliams, RN, MSN, CDE, BC-
                                                                                         ADM, an advanced practice nurse
                                                                                         at the University of Pittsburgh
                                                                                         Medical Center’s Diabetes
                                                                                         Institute. Establishing a routine
                                                                                         now could make it easier for you
                                                                                         to remember foot checks should
                                                                                         you develop neuropathy or other

Finding                                                                                  foot problems in the future.
                                                                                          Try this: set aside one day
ways to look                                                                                        a week for a foot
at life more                                                                             check. then, on the designated
                                                                                         day, look at your feet (checking
positively                                                                               the bottoms and between the
can improve                                                                              toes) before getting into bed.
                                                                                         the following month, increase
both your                                                                                your frequency to twice a week.
mental and
physical
well-being.                                                                                    5
                                                                                         Big idea: be happy
                                                                                             Why it matters: A recently
                                                                                         published study in the Journal
                                                                                         of the American Medical
you can easily achieve. “Each                                                            Association links having diabetes
meal, add something that’s healthy
for you, such as a piece of fruit
                                             4                                           with a greater incidence of de-
                                                                                         pression. And research published
with your hamburger and fries,”           Big idea: check your feet                      in a 2001 issue of the journal
says Maurer. At the start of each            Why it matters: If you have                 Psychosomatic Medicine shows
new month, add a new healthy item         nerve damage in your feet, you                 that depression not only makes it
to your meal. “What you’re hoping         may not be able to feel injuries               harder for people to control their
eventually is that the good foods         that would typically make you                  blood glucose, but it also increases
will win out.”                            yelp in pain. Ignore the injury                the risk of diabetes complications.
 Try this: integrate one fruit or
                                          for long enough and you could                      Small step: It’s sometimes hard
           vegetable—any variety          get an infection. People with                  to feel like a little ray of sunshine
that will excite your taste buds—         diabetes are also at an increased              when you’re dealing with a chronic
into your dinner each night. it           risk for foot blisters and ulcers.             illness. But finding ways to look at
doesn’t matter if you choose                 Small step: You take your shoes             life more positively can improve
raspberries or radishes, just pick        off every day, so why is it so dif-            both your mental and physical
a good-for-you food and make
it part of your meal. Next month,         ficult to squeeze in a foot exam?              well-being. Maurer suggests using
add another healthy food to               The simple answer is that many                 daily questions to remind your-
your supper. (but remember to             people just don’t think about it be-           self that there are plenty of things
account for the extra carbs.)             cause their feet are healthy. “It’s a          to be cheerful about. “The brain

                        D i a b e t e s    F o r e c a s t   |   s e p t e m b e r   2 0 0 8                                 63
 starts paying attention to the an-                                                       Small step: A few shakes of salt
 swer to these questions,” he says.
 “Eventually the brain … starts giv-
                                           6                                           on your chicken at dinner isn’t
                                                                                       going to put you over the edge,
 ing you things to be happy about.”    Big idea: cut out salt                          right? Wrong. Table salt has a lot
  Try this: start by asking yourself
                                          Why it matters: Having diabetes              more sodium than you might think
            “What am i grateful        ups your risk of high blood pres-               —and you probably already get too
 for, and what could i be grateful     sure, and eating too much sodium                much “hidden” salt from processed
 for?” one day during the week.        makes blood pressure worse.                     meat, soup, condiments, and even
 take time to reflect on the ques-     People with high blood pressure                 sweet-tasting food like instant oat-
 tion and answer honestly. at the      have a greater chance of developing             meal. At the same time, reducing so-
 beginning of the next month,
 ask yourself the question two         diabetes complications like kidney              dium can be difficult since it makes
 days a week.                          disease, heart attack, and stroke.              food more flavorful. A good first
                                                                                       step is to take the salt shaker off
                                                                                       the dinner table and opt for spices
                         A good                                                        instead. Learn to make smarter
                        first step                                                     supermarket buys, such as picking
                        is to take                                                     low-sodium soup over regular.

                         the salt                                                       Try this: Declare one day a week
                                                                                                   Lunchmeat-Free Day.
                       shaker off                                                      scrap your sandwich of high-

                      the dinner                                                       sodium processed meat and pick
                                                                                       something healthier instead.
                       table and



                                            ✖
                          opt for                                                             7
                          spices
                         instead.                                                      Big idea: Floss daily
                                                                                          Why it matters: Research links
                                                                                       bacterial gum disease with poor
                                                                                       glucose control and an increased
                                                                                       risk of diabetes complications.
                                                                                          Small step: When you consider
                                                                                       the benefits of flossing—it’s the
                                                                                       best way to get rid of the plaque
                                                                                       between your teeth—you should
                                                                                       have no reason to avoid the simple
                                                                                       task. If you find it hard to remem-
                                                                                       ber, try incorporating the act into
                                                                                       your nightly routine.
                                                                                        Try this: begin by flossing one
                                                                                                  night a week after
                                                                                       you brush your teeth (consider
                                                                                                                              pete mcArthur/veer




                                                                                       the brushing your mental cue).
                                                                                       When flossing becomes routine,
                                                                                       tack on another day.


64                                D i a b e t e s   F o r e c a s t   |   s e p t e m b e r   2 0 0 8
                                                                                            10
                                                                                          Big idea: eat breakfast
                                                                                             Why it matters: Fill up on a
                                                                                          high-fiber breakfast each morning
     8                                                                                    and you could better regulate your
                                                                                          blood glucose, avoid midmorning
 Big idea: build a network                                                                cravings, protect against heart dis-
    Why it matters: If you survive                                                        ease and stroke, and lose weight.
 a heart attack, you’re half as likely                                                    The main reason: Skipping break-
 to have a second heart attack                                                            fast can lead to hunger, cravings,
 within a year if you have close                                                          and overeating later in the day.
 friends and family, says a 2004          interfering with that all-important                Small step: You may not be
 study published in the journal           sleep (see Big Idea #2). The jury is            hungry for breakfast, but training
 Heart. Maintaining a network of          still out on caffeine’s effect on dia-          your body to eat in the a.m. is
 friends you can count on can help        betes. A small 2008 study found                 important for weight control.
 you live longer in old age, too,         that drinking four or more cups of               Try this: Pick one day a week
 according to research published          coffee a day could increase blood                          this month to eat
 in the Journal of Epidemiology           glucose levels in people with dia-              breakfast—whether that means
 and Community Health.                    betes. Other research has found                 oatmeal at your desk or a ba-
    Small step: If you already have       a benefit to small amounts (i.e.,               nana and whole-grain cereal bar
 a close group of friends, count your     not a quadruple-shot venti latte).              in the car. after a month, add the
                                                                                          morning meal to another day of
 blessings and then give them a call.        Small step: The caffeine kick                the week. You’ll be much more
 Your schedule may be tight, but          you get from your morning cup                   resistant to the 11 a.m. vending
 make an effort to squeeze in one         is the only thing that will get you             machine run with a full stomach.
 visit or phone call per week or two.     going in the morning. And another
 Don’t have a close group of friends      three cups get you through the                  If these ideas sound too meager
 or family? Now is the perfect time       day. Sound like you? If so, you                 to make a difference, consider the
 to get social. Join a softball league,   may be getting too much caffeine.               big picture. “These small steps
 head to a community center for a         Instead of trying to quit cold                  are going to lead to a lifetime of
 once-a-week sewing class, or visit       turkey, start by subbing a cup                  habits. We encourage people to be
 an online diabetes forum or blog.        of decaf (or tea) for one cup of                optimistic about the long run and
  Try this: Pick up the phone and
                                          coffee. “You’re counting on the                 very gentle and patient with them-
            call one friend or family     body to make the leap on its own,”              selves,” says Maurer. “Don’t think
 member once this month. Next             Maurer says. “All you’re doing                  you’re going to have overnight
 month, up the ante by making             really is programming the brain                 changes. But be positive [about]
 two calls—or by scheduling               to do what you want it to do.”                  the lifelong changes you’re mak-
 some face-to-face time.                                                                  ing.” And resist dwelling on the
                                           Try this: Make your switch super
                                                     easy by buying decaf                 failures. “Don’t beat yourself up
                                          instead of regular just one day a               if you’re not perfect, if you have
     9                                    week. if you guzzle multiple cups
                                          of coffee a day, just replace one of
                                                                                          lapses, or make mistakes,” says
                                                                                          McWilliams. “It happened, let
 Big idea: cut back the coffee            those with the caffeine-free brew.              it go and start again.” The good
                                          Next month, trick your system
    Why it matters: Coffee is a           again by replacing a second cup.                news, says Maurer: “What the
 powerful drug, and if you’re drink-                                                      small step model does is make
 ing too much of it, it could be                                                          it almost impossible to fail.” A

66                                   D i a b e t e s   F o r e c a s t   |   s e p t e m b e r   2 0 0 8

				
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