Category: 2023

Lana Breedt

Lana Breedt – No day will ever be the same

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Lana Breedt gives us a rundown of a typical day in her life of having a child living with diabetes, though she states no day will ever be the same,

Lana Breedt lives with her husband, Maurits van der Horst, and their five-year-old son, Rudi in Port Elizabeth. Rudi has Type 1 diabetes.

Rudi’s diagnosis

It was March 2019 when Rudi was diagnosed with diabetes Type 1 at the mere age of 19 months. My husband, Maurits, and I were both unpleasantly surprised since neither of our families has a history of diabetes. We are one chaotic household at any given time, so the diagnosis added a whole bunch of curves to our rollercoaster.

Rudi just started nursery school and was still in nappies at the time. It started with what we initially thought was a tummy bug of some sort; I had to pick him up early from school a couple of times. It was strange since he was a very healthy kid from birth and going to the doctor was not the norm.

The nursery school has been incredibly supportive since his diagnosis and his class even celebrated World Diabetes Day with us last year. We are very fortunate that both our employers are very understanding as well and they know when we need to leave work right now.

The first year

The first year was a nightmare. We relied on blood measurements only and could not see the trend of his glucose levels. We used to test Rudi every two hours day and night, at home and at school.

My husband created an Excel spreadsheet for us and I manually updated the document weekly to see where we stood more or less. I would send the graph to Rudi’s paediatrician at the end of each week for feedback and he would then adjust Rudi’s insulin intake accordingly. Our first HbA1c test result was just above 10.

Diabetes devices a game changer

When Rudi got a little bigger in size, we started using the Freestyle Libre which did wonders for his little fingers. It made both our and the teachers’ lives a whole lot easier.

Even though we still had to get up every two hours at night, it felt like we could live a fairly normal life without feeling so exhausted every morning.

It was only when we got the Miao Miao Bluetooth extension that our entire ballgame changed. We don’t need to worry about manually measuring him anymore, since the app has an alarm that goes off when his glucose is going too high or too low. We receive the data on our mobiles, so we can monitor him from anywhere, anytime.

No two days will be the same

One sentence from the book, Type 1 Diabetes in Children, Adolescents and Young Adults, sums diabetes up very well: No two days will be the same.

We have a very strict routine we stick to even during school holidays. Our days don’t always go according to plan, but at least we have a framework to work from. The rest of the time we just make stuff up as we go along. Maurits understands and relies on science and I understand nutrition and rely on motherly instincts, so we make a great team.

A typical day

We get up between 4am – 5am Rudi sometimes sleeps slightly later, but that is rarely the case. Maurits will give Rudi his Optisulin between 5am – 6am.

At 6:15 Rudi gets his breakfast injection and then we wait for a good glucose reading before he eats. This is anything from 6:30 until 7am. We’ve had instances where it takes a really long time for his glucose to drop after a high night, and then he will only eat an hour after his injection.

Under normal circumstances, his main meals last around two hours. So, by the time I drop him off at school, his glucose levels are nearly at a stage where he needs to snack again. We have a WhatsApp group including three staff members from the school, Maurits and myself. I usually type the ready for snack message when I leave home and constantly keep an eye on his glucose while driving to work. When it is time, I just press the send button and Rudi will have his snack. It sometimes feels like all this kid does is eat.

School snack time

School snack time is between 9:30 and 10am. I don’t have the energy to pack his lunchbox at night, so I normally do this between 5:30 – 6am. It’s difficult to decide what to pack and what to leave out since his glucose varies so often. In the beginning, I was obsessed with carb counting, but after a chat with a dietician at one of the PE diabetes wellness meetings, my perspective changed completely. She told me to feed my child the rainbow. So, I do just that.

I pack small portions of fruit and vegetables in as many colours as possible along with something carby like popcorn. When he had a high night, I will replace this with something non-carb like droëwors and biltong.

Somewhere close to 11am, his glucose starts to drop again, and the teachers will either give him an apple or a protein bar, depending on how close to home time it is. We also rely on Super Cs for lows and keep rolls of it everywhere.

Lunch

For lunch, he has a sandwich with his flavour of the week (at the moment it’s honey) and a generous portion of protein along with a glass of milk.

During the afternoons we just play it by ear. I’m at home in the afternoons so it makes it easy for me to manage his glucose levels by finding something in the fridge or cupboard when necessary.

When he does go to aftercare, I pack him an entire bag of carb and non-carb snacks, along with his emergency kit consisting of protein bars and Super Cs.

Aftercare is at his school and I have contact with the teacher in charge. She sees that he eats the right things at the right time and is available on WhatsApp all afternoon as well.

Dinner

Just after Rudi was diagnosed, we followed a specific meal plan for supper and I had his menu planned at least a week in advance. After the aha-moment with the dietitian, all of that changed and he now eats what we eat. Even sushi and pizza. It’s a win-some, learn-some experience when it comes to his diet and we figure things out as we progress.

After the pyjama drill, we will either read stories or watch a movie. By about 8pm his blood glucose will be at a stable low and he then has a glass of milk as a nightcap. Ideally, the milk should last him until morning, but when it doesn’t, we give him milk with glucose powder to keep his blood glucose going. Occasionally we need to inject him because of high blood glucose, but he doesn’t even wake up for that anymore.

Rudi’s fourth diabetes anniversary

We recently celebrated Rudi’s fourth diabetes anniversary. It’s hard to imagine things without the sensor and Bluetooth device, but imagining a life without the support we get from friends, family, employers, paediatrician and his school is even harder.

Living with a six-year-old diabetic child is a 24-hour duty and you can’t afford to lose focus for one minute. Our latest HbA1c result was an incredible 6.6 for the second time in a row. It takes a lot of effort and hard work, but the reward is priceless. Looking back, I don’t think we’d ever thought we’d get this far.

Laurelle Williams is the Editor at Word for Word Media. She graduated from AFDA with a Bachelor of Arts Honours degree in Live Performance. She has a love for storytelling and sharing emotions through the power of words. Her aim is to educate, encourage and most of all show there is always hope. Feel free to email Laurelle on editor@diabetesfocus.co.za

MEET OUR EDITOR

Laurelle Williams is the Editor at Word for Word Media. She graduated from AFDA with a Bachelor of Arts Honours degree in Live Performance. She has a love for storytelling and sharing emotions through the power of words. Her aim is to educate, encourage and most of all show there is always hope. Feel free to email Laurelle on editor@diabetesfocus.co.za

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Hair loss

Hair loss and diabetes

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Dr Louise Johnson explains the connection of hair loss in people living with diabetes.

The average human normally sheds 50 to 100 hairs per day according to The American Academy of Dermatology. Losing hair is part of the hair lifecycle. As one hair is shed, another replaces it. The hair follicle is a complex mini organ that produces hair from terminal differentiated cells called keratinocytes. On average, a human has between 2 and 5 million hair follicles of which 100 000 are on the scalp. But there is a difference between shedding hair and hair loss.

The hair follicle

The growth of the hair follicle can be divided into three phases:

  1. Anagen (growth)

Anagen growth is the active phase in which the hair follicle takes on its onion shape and works to produce the hair fibre. This phase lasts between two and six years. During this phase, rapid cell division occurs in the hair bulb. In addition, new hairs begin to protrude from the scalp.

  1. Catagen (transition)

Catagen is a transitional phase that last two to four weeks.

  1. Telogen (rest)

This phase last three to five months and is the resting phase.

Hair loss

Excessive hair shedding can occur during times of stress or after pregnancy. This is not the same as hair loss which is referred to as alopecia, occurs when something stops the hair from growing. This falls into three categories:

  1. Androgenetic alopecia
  2. Alopecia areata
  3. Telogen effluvium

Androgenetic alopecia

This is characterised by male pattern baldness and can happen to both males and females due to hormonal changes. The incidence varies across races, but its prevalence increases with age, visibly affecting 57% of women and 73.5% of men who are at least 80 years old.2

Alopecia areata

This develops when the immune system attacks the hair follicle and can be associated to Type 1 diabetes since it’s an autoimmune disease.

Telogen effluvium

This is due to a response to stress.

Is hair loss a symptom of diabetes?

Hair loss can occur in both Type 1 and Type 2 diabetes. In Type 1 diabetes there are often other autoimmune diseases associated. Alopecia areata is one where antibodies attack the hair follicle which leads to hair loss. Hashimoto thyroiditis is another autoimmune disease which causes dry skin and hair loss due to an underactive thyroid gland.

In Type 2 diabetes, cortisol levels (stress hormone) can be high due to insulin resistance. Excess cortisol can disrupt the hair follicle leading to hair loss.

In a 2019 study1, it was shown that in Type 2 diabetes of African origin were associated with increased risk of central scalp hair loss. There may be a genetic factor to central hair loss.

Clinicians should also screen women with central scalp hair loss for Type 2 diabetes if they are not yet diagnosed. Whether successful treatment of Type 2 diabetes might protect African women from central scalp hair loss remains to be determined.

In long-standing diabetes, both Type 1 and Type 2, there is often microvascular (small vessel) damage which leads to impaired blood flow to the affected area as well as less nutrients and oxygen. This can be seen in eye, kidney, feet and hair. Typically seen in patients with peripheral neuropathy (lower leg loss of sensation due to nerve damage), the hair growth on the lower leg is reduced or absent.

Medication can also contribute to it. In patients taking metformin it’s important to monitor the vitamin B12 and folate levels. This can be diminished which would cause impaired hair growth.

Management of hair loss in diabetes

  1. Good glucose control is important. Make sure that your average blood glucose (HbA1c) is below 7% or the target that your healthcare practitioner suggests.
  2. Healthy eating, exercise and stay hydrated.
  3. Make sure your thyroid levels, vitamin B12 and folic acid levels are normal. Also remember to check iron levels since iron carry red cells and oxygen. If not replace as needed.
  4. Get enough sleep.
  5. Be gentle when washing and brushing your hair.
  6. Seek medical help early.
  7. In cases where it interferes with quality of life, a wig or hair prosthesis should be considered until the hair grows back.

References

  1. Coogan P.F. Traci n et. al. “Association of type 2 diabetes with central scalp hair loss in a large cohort of African American women” Int. Jour of women’s dermatology, 5(2019) p 261 – 266
  2. Gan DCC, Sinclair RD “Prevalence of male and female pattern hair loss in Maryborough.” J Investig Dermatol Symp Proc. 2005;10(3)184-9
Dr Louise Johnson

MEET THE EXPERT

Dr Louise Johnson is a specialist physician passionate about diabetes and endocrinology. She enjoys helping people with diabetes live a full life with optimal quality. She is based in Pretoria in private practice.

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The miracle treatment

The miracle treatment: insulin

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Insulin has been available for a century and has gone from poorly defined animal insulin to pure and precisely controlled formulations. Dr Louise Johnson tells us more about this miracle treatment.

History of insulin

The discovery of insulin, the miracle treatment, is attributed to a group at the university of Toronto, Canada. In 1922, a 22-year-old physician, Frederick G Banting, worked in a laboratory to test his idea that pancreas extracts will reduce blood glucose levels in diabetic dogs. Banting was assisted by a student, Charles Best. This led to the first successful test of insulin in a 14-year-old boy, Leonard Thompson.

In January 1922, this boy with diabetes received the first dose of purified animal insulin and his life was saved. Leonard Thompson lived another 13 years to be 27 years and he passed away due to bronchopneumonia.

What is insulin?

Insulin is a hormone produced by the beta cells of the pancreas called the islet cells of Langerhans, in a response to reduce blood glucose. It works on cellular level to allow sugar to enter each cell by opening a channel in the cell. Glucose enters the cells and is used inside the cell to produce energy. The organs that are highly insulin dependent are the muscle, liver and fat.

Who needs insulin?

All living creatures needs insulin for uptake of glucose to be used as a source of energy.

Insulin is the primary treatment for people living with Type 1 diabetes since they have no endogenous or own insulin. They were previously called insulin-dependent diabetes mellitus (IDDM).

People with Type 2 diabetes, previously called non-insulin-dependent diabetes mellitus (NIDDM), also requires insulin at some time during their disease. As time progresses, the amount of the beta cells of the pancreas diminish and a supplementation with once-daily insulin, called basal insulin, is needed.

In Type 2 diabetes with insulin resistance where more insulin is needed, supplementation would also be required. The treatment of Type 2 diabetes always included diet, exercise, metformin, other antidiabetic agents such as incretins, SGLT2 inhibitors and sulphonylureas. When the HbA1c is above 7.5% on these regimens’ insulin supplementation is needed.

How do miracle treatment injections work?

Insulin is injected in the subcutaneous fat layer (just beneath the skin) on the abdomen, upper thigh, arm and buttocks. Once injected in the subcutaneous layer, it’s not immediately absorbed in the bloodstream. The insulin molecule first dissociates into dimers and monomers before being absorbed.

Insulin initiation

Patients with Type 1 diabetes require insulin immediately and usually multiple daily dosages to cover both mealtime and sleeping glucose levels. This regime is called basal-bolus insulins.

The preferred method on insulin initiation in Type 2 diabetes will be to add a once-daily long-acting insulin when needed. If glucose targets are not met, then a mealtime insulin or bolus insulin will be added according to the need.

Types of insulin

  1. Basal insulin therapy
  2. Bolus insulin therapy
  3. Premixed insulin
  4. Concentrated insulin
  5. Inhaled insulin

  1. Basal insulin therapy

Manipulating various side chains of the insulin molecule has permitted availability of long-acting insulin, such as glargine, determir and degludec (Lantus, Basaglar, Optisulin, Toujeo, Tresiba).

These long-acting insulins are peak less with a long duration of action. Basal insulin slows the production of glucose from the liver. In a fasting state this will maintain glucose homeostasis.

In general, basal insulin is administered once-daily in 24-hour cycle at the same time every day. It’s important that basal insulin should always be administered regardless of food intake as this serves as the background insulin normally secreted by the pancreas.

NPH insulin (Protophane) is one of the oldest basal insulin and because of its shorter lifespan needed to be injected twice a day. It has been available since 1964. The primary advantage of NPH is financial as it is typically less costly than the newer long-acting insulins. The downside of NPH is that it does make a small peak which can lead to hypoglycaemic events.

  1. Bolus insulin therapy

Bolus insulin is rapid-acting insulin that can be given before meals to reduce mealtime peaks of sugar. The combination of basal and bolus insulin is a flexible regime.

The newer short-acting insulins are called analogues (Novorapid, Apidra, Humalog, FiAspart). Analogues differ from human preparation (regular insulin) by small substitutions in amino acid chains which in turn prevent formation of polymers or hexamers.

The onset and peak action of rapid-acting insulin analogues more closely resemble endogenous (own) human insulin secreted in response to a meal.

Due to the fact that it is rapid-acting insulin, it can be given before, during or directly after a meal. The mealtime dosage of insulin can be calculated according to the amount of carbohydrates in the meal. Patients with a varying appetite can increase, decrease or omit the mealtime insulin according to the carbohydrates in the meal.

  1. Premix insulin

Premix insulin preparations is a combination of short-acting and intermediate/long-acting insulin in a fixed ratio. Although this provides convenience for some and may be appealing to those who refuse to inject more than twice a day, it does not allow for flexibility in mealtime or changes in the ratio of short to long-acting insulin doses.

An example is Novomix which is a fix combination of 70% NPH (protophane) and 30 % Novorapid. Another example is Ryzodeg which is a combination of 70 % degludec (Tresiba) and 30% insulin aspart (Novorapid). The numbers expressed in the ratio after the insulin refer to the percentage of insulin in the premix solution. An example is Humalog 25 which has 75 % long-acting and 25% short-acting insulin.

  1. Concentrated insulin

Insulin that is two to three times more concentrated than the normal U 100 insulin is now available. The available concentrated insulin in South Africa is glargine U300 (Toujeo).

The positive effect of more concentrated insulin is that the volume that is needed to inject is smaller in patients that are severe insulin resistant and need high volume insulin.

Humalog U500 is a short-acting concentrated insulin that is available on special request in severe insulin resistant patients that need more that 200 units per day.

  1. Inhaled insulin

The least often used preparation is human insulin inhalation powder (Alfrezza), however this is not available in South Africa. It’s administered at the beginning of a meal. Lung function must be assessed before initiation and after six months and thereafter yearly. It’s contraindicated in patients with lung disease and asthma.

Insulin sliding scale

Although commonly utilised in hospitals when patients are acutely ill, it’s not recommended as a routine method of insulin management. The reason for this is that it causes extreme fluctuations of glucose values which are far worse than continuous slightly elevated blood glucose. The best method to use short-acting insulin is via carbohydrate counting before meals.

Side effects of the miracle treatment

Hypoglycaemia

The most severe side effect is hypoglycaemia. It’s important that all diabetic patients on medication know how to treat the symptoms of low blood sugar. Usually if glucose is below 4.0 mmol, 15 gram of carbs is indicated. This can be in the form of a small fruit juice.

It’s important that all diabetic patients on insulin have a glucagon hypo kit at home for their spouse or parent to administer should the patient not respond. Always recheck the glucose after an episode of hypoglycaemia and try to establish the cause. If hypoglycaemia occurs frequently speak to your doctor for a thorough evaluation.

Weight gain

It was clearly shown in the UKPDS study that patients on insulin gain 5 to 8kg over a 10-year period. To prevent weight gain, try to limit carbohydrates and prevent hypoglycaemia. Should you pick up weight speak to your doctor. Remember that underactive thyroid disease can be associated with diabetes.

Lipodystrophy

Lipodystrophy is hardened fat tissue. This happens when you are injecting on the same place every time and it causes poor insulin absorption. To prevent this from happening, it’s important to rotate the injection sited daily

Insulin has now been available for 100 years and this miracle treatment for diabetes has saved many lives and prevents many complications if used correctly. Remember that insulin is not the enemy but in persons with diabetes, it’s your best friend.

Dr Louise Johnson

MEET THE EXPERT

Dr Louise Johnson is a specialist physician passionate about diabetes and endocrinology. She enjoys helping people with diabetes live a full life with optimal quality. She is based in Pretoria in private practice.

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energy

Your 24-hour plan to get more energy

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Monique Marias shares a constructive 24-hour plan to get more energy every day.

The modern era requires you to move at the speed of light, to get things done and meet your targets. This is exciting but can also be exhausting. To do your best, you need to be the best versions of yourself to prevent burnout, fatigue and despair.

Your energy levels need to be sustained throughout the day. Energy drinks might give you an immediate lift, but it will soon wear off, leaving you feeling sluggish and drained. How do you then maintain your energy levels? By implementing a 24-hour plan that will boost your energy levels and keep you motivated throughout the day.

Increase your energy levels on a daily basis

  1. Sleep well

Good quality sleep is critical for good health and overall quality of life. It’s important to get enough sleep as well as quality sleep. By getting enough sleep and prioritising good sleep habits, you can support your immune system and reduce your risk of infections and illnesses, such as cardiovascular problems and diabetes.

Monitor your sleeping habits; get to bed at roughly the same time each night, as well as waking up around the same time each morning. You need to train your body and mind to slow down; do specific things before getting to bed that will let your mind and body know its time to settle in. This can include listening to relaxing music, turning the lights off, reading, or drinking a warm drink to help you relax.

  1. Stay hydrated

One of the symptoms of dehydration is fatigue. Make a point of staying hydrated during the day (this excludes the cups of coffee you’re drinking). The amount of water you need varies based on factors like your body weight, activity level, and climate. However, a general guideline is to aim for at least 8-10 glasses of water per day, and more if you are physically active or in a hot climate.

Find a rhythm that works for you, whether that is having one large bottle that you need to finish by the end of the day or having multiple glasses of water throughout the day. You can also add different fruits to change the flavour, if this helps you drink more water. Healthy options include lemon, ginger, cucumber, mint and different forms of berries.

By staying hydrated and drinking plenty of water and other fluids, you can support your immune system and reduce your risk of infections and illnesses.

  1. Eat balanced meals

Eating a balanced diet that is rich in nutrients is essential for maintaining a healthy immune system. A balanced diet provides the body with the vitamins, minerals, and other nutrients that it needs to function properly which improves your immune system and aids in maintaining healthy blood glucose levels.

This means including foods from multiple food groups: whole grains, lean protein, fibre-rich fruits and vegetables, and fat-free or low-fat dairy. Choose foods with a low glycaemic index (where sugar content is broken down by your body at a slow rate), such as whole grains, nuts, bananas, grapes, apples, peaches, beans, peas, and leafy greens.

  1. Get moving

Regular exercise can help to reduce stress levels and support immune function. In addition to these immune-boosting benefits, regular exercise has many other health benefits, including improving cardiovascular health, reducing the risk of chronic diseases like obesity and diabetes, and improving mental health and mood.

Not everyone has time in their schedule for daily exercise sessions, but it’s important to keep moving. This is especially important if you have a job that is mostly desk-bound. Make a conscious effort to stand up regularly, walk around and do stretches. If you have access to a smart watch or an app on your phone to track your steps, set your daily target for 8000 steps per day. Having a visible reminder will help with motivation and keep you focused to meet your daily goal.

If you have a water dispenser at work, combine your walking with drinking water, get up every hour and walk to the dispenser and refill your glass. If your daily routine allows for exercise, all the better.

  1. Control your stress

Stress can weaken the immune system and increase the risk of infections and illnesses. Chronic stress can also have long-term effects on the immune system, increasing the risk of chronic diseases like heart disease, diabetes, and autoimmune disorders.

The first step is to identify aspects in your daily life that cause you stress and the second step is to find ways to reduce it or control the situation. Break it down to stress at work and stress in your private life, then look at what you can control and what is out of your control; focus on the aspects that are within your control.

Learn to delegate tasks at work and to say no and prioritise tasks that need to be completed urgently and what can wait until the next day. Find ways that reduce your stress, such as exercise, hobbies, meditating or spending quality time with friends and family.

We all experience times that are more stressful than others, but if you know how to identify your triggers, and you have implemented ways to deal with it in your daily routine, it becomes easier to fall back on those techniques that will help you relax.

  1. Do something fun

Do something you enjoy, every day! Know what makes you happy and make a conscious effort to do small things each day that leaves you feeling happy and energized at the end of the day. This can include cooking a hearty meal, exercising, checking in with a friend or family member, buying yourself flowers, learning something new or listening to a podcast. This doesn’t have to be a long activity, 10-15min is enough to give you that mental boost.

  1. Use caffeine sensibly

Many people rely on their morning cup of coffee to get them started, whereas others rely more heavily on their caffeine boost to get them through the day. It’s wise to remember; the more you drink coffee, the more you need to give you the same level of stimulation. Studies have also shown a negative impact on anxiety levels when used in excess. It can also adversely affect your mood and increase insomnia, and these all impact on your ability to maintain healthy lifestyle choices that will increase your energy levels.

Caffeine in itself isn’t harmful and can definitely give you that much needed boost but use it in moderation. Try to not exceed three cups a day, don’t drink coffee late in the afternoon and try to alternate the time of day that you drink coffee so that your body doesn’t become dependent on that “kick” the same time every day.

  1. Light up your life

Daylight queues the brain that it’s time to get up, time to be active and get things done. The more natural light you are exposed to, the easier your brain adjusts to the routine. Where possible, ensure that natural light enters your workspace as much as possible.

Studies have also shown that blue-enriched white light improves alertness, positive mood, work performance, concentration, and irritability. If you have a desk lamp at the office, switch the globe to blue-enriched white light bulbs. If your office space doesn’t allow for you to alter the light-type, go outside at least three times per day for short periods. Not only will you be exposed to some helpful vitamin D, but you will also get moving.

  1. Be mindful

This aspect should form part of all the above steps you take on a daily basis. Mindfulness involves focusing on the present moment and accepting your thoughts and feelings without judgment. This can help to reduce stress and promote feelings of calm and relaxation. The more you are aware of your surroundings, your stressors, what brings you joy and what your dreams are, the easier it’s to manage the days that are more stressful and appreciate the good days even more.

Although there are many ways that you can boost energy levels, you need to find a rhythm that works for you; pick sustainable tasks and make it a habit. Some days might be easier to sustain your energy levels, other times might be more challenging, and that is when you need to fall back on healthy habits to sustain you. Once these habits form part of your healthy lifestyle, it will be more sustainable, and you will see better results.

References

An Official American Thoracic Society Statement: The Importance of Healthy Sleep. Recommendations and Future Priorities | American Journal of Respiratory and Critical Care Medicine (atsjournals.org)

NATURALLY BOOST YOUR IMMUNE SYSTEM: A DETAILED GUIDE – Outdoor Adventure (ribosomellc.com)

https://www.wikihow.com/Get-More-Energy

https://www.health.harvard.edu/energy-and-fatigue/9-tips-to-boost-your-energy-naturally

https://medicalnewstoday.com/articles/321938#2.Do-some-light-exercises

The Relationship of Caffeine Intake with Depression, Anxiety, Stress, and Sleep in Korean Adolescents – PMC (nih.gov)

The Effect of Coffee and Caffeine on Mood, Sleep, and Health-Related Quality of Life | Journal of Caffeine Research (liebertpub.com)

Blue-enriched white light in the workplace improves self-reported alertness, performance and sleep quality on JSTOR

Monique Marias is a registered social worker at the ClaytonCare Group which provides in-patient care to medically complex patients on a sub-acute level. She has specialised in physical rehabilitation for in-patients for 13 years, and has a passion to assist people to understand and manage their diagnoses and the impact on their biopsychosocial well-being.

MEET THE EXPERT

Monique Marais is a registered social worker at Care@Midstream sub-acute, specialising in physical rehabilitation for the past 11 years. She has a passion for the medical field and assisting people to understand and manage their diagnoses and the impact on their bio-psychosocial well-being.

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Body Stress Release

Body Stress Release

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Kathy Heapy educates us on the benefits of Body Stress Release.

What is Body Stress Release?

Body Stress Release (BSR) is a unique, gentle and non-invasive health profession that originated in SA over 30 years ago. According to many client testimonials received over the years, BSR has served to make a difference in the lives of people around the world.

This complementary technique that works in co-operation with other forms of healthcare has a supportive role to play and may provide relief from pain and discomfort for those struggling with health challenges, ranging from mild discomfort and vague symptoms to diagnosed conditions.

BSR is a health practice that limits itself to its own area of expertise, locating and releasing of body stress. It’s not involved in diagnosis or treatment of any medical conditions, thus does not duplicate medical services. BSR has thus always enjoyed a co-operative relationship with medicine and enjoy receiving referrals from the medical fraternity who entrust their patients to us in a complementary role.

The benefits

BSR may enhance quality of life and is suitable for all ages, from the very young to the elderly. Facing daily onslaughts of mental, emotional, mechanical and chemical stress may have a negative impact on your body as it was designed to handle some stress, but as stress accumulates over time, the stress overload becomes locked in.

This may contribute to symptoms such as neck and back pain, pins and needles, postural distortion, muscle weakness, headaches/migraines, indigestion/heartburn, restless sleep, fatigue, numbness, stiffness, to name but a few.

Body stress overload is a powerful factor that may undermine health and well-being in a myriad of ways and may underlie and aggravate many health problems.

How does it work?

You lie down fully-clothed. The practitioner performs a series of pressure tests using the feet as a bio-feedback monitor. Using a light but definite pressure in the indicated direction releases the sites of body stress which may assist to improve and stimulate nerve communication.

We often find that after a BSR session, some clients report back that they had the best sleep ever, felt an emotional lightness, became aware of a greater mental clarity, or felt a surge of enthusiasm for life.

Diabetes case studies

In Gail Meggersee, BSR co-founder’s book, Self-healing with Body Stress Release Unlocking Stored Tension, she includes a case study submitted by a BSR Practitioner about two gents, Maarten and Graham titled: Diabetes: Revival in the 60s.

“After one BSR session, Maarten’s indigestion had improved so much he could hardly believe it. After six weeks of BSR the feeling in his feet had returned completely, no more pins and needles or numbness. Graham’s lower back pain improved considerably.

After about two years after their first BSR appointments, they came into the practice room laughing like two little excited boys. They told their story: at their annual check up with their physicians, she tested their urine samples with the ‘sugar sticks’, declared them to be faulty, and took out a new box of sticks. These were evidently not working either, so she took blood samples and sent them off to the pathology lab for testing.

The results

The results of these tests astonished everyone. Maarten and Graham, no longer had Type 2 diabetes. Their doctor was confused, but they were delighted. They said they knew BSR had assisted their bodies to heal themselves of their chronic condition.

Their cases illustrate some basic principles of BSR; tension stored in the lower back may adversely affect the functioning of the legs and feet.  Such tension may remain locked into the body for decades. By releasing the body stress, the body is assisted to heal itself in more ways than one would have imagined, in both cases the capacity of the pancreas to produce adequate insulin had been revived.

The evidence in these cases would not have been quite as conclusive if:

  • Only one of them had had diabetes.
  • They had not lived together and eaten the same diet.
  • They had not both come regularly for BSR maintenance.

“Their faith in BSR was sealed and they continued with the sessions. Ten years later, they appeared at least 10 years younger than when I first met them. They enjoyed regular exercise and had even improved their eating habits to a degree.”

How many sessions are needed?

Initially three sessions are recommended; for example – day 1, day 4 and day 11. This allows the body to go through necessary adaptations as the body adjusts to lines of tension being released.

At your initial session your practitioner will take your full medical history and during the consultation will also share with you on how to sit, sleep and bend correctly thus working with the natural bio-mechanical design of the body.

He/she will then guide you with regards to suggested intervals between sessions going forward, depending on individual case requirements. Maintenance sessions are usually looked forward to by our committed clients who recognise the value of self-care, and we often find a close friendship develops between the emphatic practitioner and client over time. Should a client be too weak to visit their practitioner, they may enquire about house visits in the comfort of their own home.

To find a dedicated BSR practitioner close to you, visit bodystressrelease.com

Kathy Heapy left the travel industry in 2010 as she always had a yearning to work with people in a healing capacity. After only her second BSR session, she decided to apply for the annual practitioner course held at the BSR Academy. She currently runs a successful Body Stress Release practice at a wellness centre in Midrand, Gauteng and looks forward to a continuation of a fulfilling and enriching future, assisting folk with a compassion and a sincere belief that BSR can offer hope in their world.

MEET THE EXPERT

Kathy Heapy left the travel industry in 2010 as she always had a yearning to work with people in a healing capacity. After only her second BSR session, she decided to apply for the annual practitioner course held at the BSR Academy. She currently runs a successful Body Stress Release practice at a wellness centre in Midrand, Gauteng and looks forward to a continuation of a fulfilling and enriching future, assisting folk with a compassion and a sincere belief that BSR can offer hope in their world.

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Nutrition

Nutrition and mental health

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The connection between nutrition and mental health is quite technical. Nonetheless, the fact remains that a healthy diet equals a healthy mind. Dietitian, Ilze Roth, tells us more.

“The food you eat can be either the safest and most powerful form of medicine or the slowest form of poison.” – Ann Wigmore

Food provides the nutrients responsible for the energy and essential substances upon which all growth and development, as natural processes indicating progression, and survival depend.1

The traditional definition of nutrition from the study of nutrients in food and the body was extended in literature to include the “study of human behaviour related to food.” Researchers further affirm that nutritional components unrefutably influence certain health conditions, either positively or negatively, based on the diet-behaviour association.2

Scientific evidence across dietary- and nutrition-related research clearly indicates that the intake of food invariably influences the physiological functioning of the body, based on the underlying nutritional status of the individual.2

Importance of nutrition for brain functioning

The brain, as part of the central nervous system, is one of the smallest, yet most complex organs of the human body systems. It regulates your behaviour, perceptions, memories and is responsible for initiating all voluntary movements. The brain is the most metabolically active organ.3 Therefore, it relies on dietary intake for sufficient energy and is highly susceptible to dietary insufficiencies which may negatively impact the structure and function thereof.4

Dietary patterns either deficient or excessive in essential nutrients, negatively affects brain function and as a consequence mental health and behaviour.5

Dietary intake provides nutrients essential for various physiological functions including cell propagation, synthesis of DNA, metabolising hormones and neurotransmitter and are important elements of enzyme systems in the brain.6,2

Nutrition impacts brain function through creating stronger or weaker connections between neurons (known as synaptic plasticity) and influencing the hippocampus which regulates memory.7

The link between the gut and the brain

A study8 explains that the gut and brain link is established by the vagus nerve that originates in the brain stem and travels through the body to the gut, connecting it with the central nervous system. The vagus nerve untangles within the gut and penetrates the gut wall, which is essential in the digestion of food. This intricate connection is imperative to ensure bidirectional communication between the brain and the gut.

Through the gut-brain axis, it’s now possible to understand the impact of nutritional abnormalities on the brain’s functioning as your dietary intake is sensed by the neurons in your gut, sending messages to the brain to alarm the brain.7

Effect of poor nutrition on the brain

A Mahan and Raymond study8 defines human nutrition as “processes whereby cells, tissue, organs and the body as a whole obtain and use necessary substances to maintain their structural and functional integrity.”

Within this context, optimum nutrition can be determined by diet quality, measured by recording food patterns based on their alignment with national dietary guidelines and how diverse the variety of healthy choices is within core food groups or equivalent international groupings.10

Dietary patterns deficient in necessary nutrients, increases the risk of developing non-communicable diseases (NCD).11 A diet high in refined carbohydrates, saturated fat and salt can lead to deterioration in mental capacity and also influence behaviour and increased prevalence of NCDs.4,12

Enjoy a variety of foods

In South Africa, the Food Based Dietary Guidelines addresses poor diet quality and ensure optimum nutrition, physical and mental development, lowered NCD risk, health and well-being through all stages of life.13 The guideline Enjoy a variety of foods promotes dietary diversity as part of a healthy diet, to prevent NCDs.5

A balanced diet is central to support physical health, with scientific evidence propagating the Mediterranean diet as a good model. Evidence from interventional human studies indicates benefits of plant-based diets on individuals, suffering specifically from lifestyle-related diseases, including obesity, Type 2 diabetes, and inflammation.13 It’s therefore believed that a similar diet will be advantageous for optimal development and functioning of the brain.14

Research shows that the typical Western diet (WD) where the dietary pattern resembles a poor-quality calorie-dense diet, laden with saturated fat, refined sugars, sodium, increased consumption of fast foods, and a low intake of vegetables, resulting in low levels of folate, fibre, and omega 3 fatty acids.14,15

Multiple physical and psychological disorders are related to the persistent intake of a WD.16 According to the World Health Organization (WHO), 74% of all deaths globally are attributed to NCDs, including those associated with aging and diseases caused or influenced by the consumption of a WD, such as Type 2 diabetes, overweight, obesity, and cardiovascular diseases.17

The result of these dietary behaviours is not limited to increased prevalence of NCDs, but also deterioration in mental capacity.12 Furthermore, obesity and overweight are independent risk factors for stroke, mild cognitive impairment, and dementias, such as Alzheimer’s disease and vascular dementia.18

Healthy diet, healthy mind

As mentioned previously, researchers recognise the MeD as an eating pattern with the ability to protect against diabetes and to prevent heart disease. The common features include the consumption of nutrient-dense foods, especially encouraging greater amounts of fruit and vegetables, whole grains and omega-3 rich fish, lean meat, low-fat dairy products, nuts and legumes as well as the use of olive oil, canola oil and seed oils.2

Further to the MeD, the Dietary Approach to Stop Hypertension (DASH) diet has similar features and these two dietary approaches were fused to devise the MIND diet (an acronym that stands for the MeD-DASH intervention for neurodegenerative delay).

Recent research suggests that this approach assists in the effective reversing and protection against cognitive decline, thereby (also) reducing the risk of Alzheimer’s dementia.8

The MIND diet

The MIND diet highlights the following 10 groups of foods to include at regular intervals:

  • Whole grains
  • Green leafy vegetables
  • Other vegetables (carrots, peppers and broccoli)
  • Nuts
  • Berries
  • Beans or legumes
  • Fish
  • Poultry
  • Limited wine
  • Olive oil

In addition, the MIND diet emphasises five unhealthy food groups that should be minimised in your conquest to optimise brain functioning. These include:

  • Pastries and sweets
  • Red meat / processed meats
  • Cheese
  • Fried or fast food
  • Margarine

A graphic representation of the MIND diet and the portions and intervals at which the suggested food groups should be taken:19

Figure 1: Graphic representation of the MIND diet.

Conclusion

The improvement of poor-quality diets to combat cognitive decline and optimise brain functioning are thus reliant on the unified and synergistic nature of the diversity of single nutrients which transmutes into healthy dietary patterns.15

Behaviour change is a process and only possible through holistic and interdisciplinary nutritional interventions, considering the factors that influence dietary choice.13,15

References

  1. Ahmad, F., Hasan, H., Abdelhady, S., Fakih, W., Osman, N., Shaito, A., & Kobeissy, F. 2021. Healthy meal, happy brain: how diet affects brain functioning. Frontiers for Young Minds. [Online]. Available: https://kids.frontiersin.org/articles/10.3389/frym.2021.578214#:~:text=Proper%2C%20healthy%20nutrition%20can%20benefit,number%20of%20connections%20between%20neurons. [2 May 2023]
  2. Associate Parliamentary Food and Health Forum. 2008. The links betweeen and behavior. The influence of nutrition on mental health, London: The Associate Parliamentary Food and Health Forum. [Online]. Available: https://www.globalwellnessinstitute.org/wp-content/uploads/2018/04/FHF.pdf  [20 August 2020]
  3. Benton, A. 2010. The influence of dietary status on the cognitive performance of children. Molecular Nutrition and Food Research, 54(4): 457-470. [Online].Available: https://onlinelibrary.wiley.com/doi/full/10.1002/mnfr.200900158 [16 August 2020]
  4. Haapala, E.A., Eloranta, A.M., Venäläinen, T., Jalkanen, H., Poikkeus, A.M., Ahonen, T., Lindi, V. & Lakka, T.A. 2016. Diet quality and academic achievement – A prospective study among primary school children. European Journal of Nutrition, 56(7): 2299-2308. [Online]. Available: doi:10.1007/s00394-016-1270-5 [5 November 2020]
  5. Hassan, Z.A., Schattner, P. and Mazza, D. 2006. Doing a pilot study: Why it is essential? Malaysian Family Physicians, 1(2-3): 70-73. [Online]. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4453116/  [2 November 2021].
  6. Kontis, V., Mathers, C., Rehm, J., Stevens, G.A., Shield, K.D, Bonita, R., Riley, L.M., Poznvak, V., Beaglehole, R. and Ezzati, M. 2014. Contribution of six risk factors to achieving the 25×25non-communicable disease mortality reduction target: a modelling study. The Lancet, August, 384: 427. [Online]. Available:https://www.thelancet.com/action/showPdf?pii=S0140-6736%2814%2960616-4 [28 March 2018]
  7. Kroner, Z. 2009. The relationship between Alzheimer’s Disease and Diabetes: Type 3 Diabetes. Alternative Medicine Review, 14(4):375. [Online]. Available: https://altmedrev.com/wp-content/uploads/2019/02/v14-4-373.pdf [4 March 2023]
  8. Mahan, L. & Raymond, J. 2017. Krause’s food and the nutrition care procecss. 14th ed. Missouri: Elsevier.
  9. Margetts, B and Nelson, M. 2004. Design Concepts in Nutritional Epidemiology. 2nd ed. London: Oxford University Press.
  10. Medawar, E., Huhn, S., Villringer, A. & Witte, V. 2019. The effects of plant-based diets on the body and the brain:a systemic review. Translation Psychiatry, 9(226): 1-17. [Online]. Available:  https://doi.org/10.1038/s41398-019-0552-0   [8 August 2020]
  11. Millichap, G.J. & Yee, M.M., 2012. The diet factor in attention-deficit/hyperactivity disorder. Pediatrics, 129(330): 330-337.[Online]. Available: http://10.1542/peds.2011-2199   [2 September 2020]
  12. Naidoo, U. 2020. This is your brain on food. New York: Hachette Book Group.
  13. Nyaradi, A., Li, J., Hickling, S., Foster, J. & Oddy, W. 2013. The role of nutrition in children’s neurocognitive development, from pregnancy through childhood. Frontiers in Human Neuroscience, 7: 97. [Online]. Available:  http://dx.doi.org/10.3389/fnhum.2013.00097  [16 August 2020]
  14. Rapozo, M. 2022. What is the MIND diet. Pacific Neuroscience Institute. [Online]. Available: https://www.pacificneuroscienceinstitute.org/blog/education/what-is-the-mind-diet/[5 May 2023] Sizer, F.S. and Whitney, E.S. 2017. Nutrition Concepts and Controversies. Boston: Cencage Learning, GL-6, GL-14.
  15. Steyn, N. & Ochse, R. 2013. “Enjoy a variety of foods”: as a food-based dietary guideliine for South Africa. South African Journal of Clinical Nutririon , 26(30: S13 – S17.
  16. Tappenden, K.A., 2017. Krause’s Food and the Nutrition Care Process. In: Krause’s Food and The Nutritional Care process. 14th ed. Missouri: Elsevier, pp. 1-16.
  17. Tortoro, G and Derrickson, B. 2017. The brain and cranial Nerves. In: Tortora’s Principles of Anatomy and Physiology. Singapore: John Wiley & Sons, Inc., pp. 417-444.
  18. Vorster, H.H., Badham, J.B. & Venter, C.S. 2013. An introduction to the revised food based dietary guidelines for South Africa. South African Journal for Clinical Nutrition, 26(3): S5-S11.
  19. Wirt, A. & Collins, C.E. 2009. Diet quality – what is it and does it matter?. Public Health Nutrition, 12(120): 2473 –2492. [Onlilne]. Available: https://www.cambridge.org/core/journals/public-health-nutrition/article/diet-quality-what-is-it-and-does-it-matter/9E51F4F8539F8F5681F2EA4F0A2F74F3 [2 September 2020]
  20. World Health Organization. 2020. Non-communicable diseases. [Online]. Available at: https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases  [24 November 2020].
Ilze Roth is a registered dietitian. Her career experience as an educator, health and beauty therapist and hospitality expert prepared her for living her true passion in empowering people to live an optimal life of well-being through mindful nutrition practices. Ilze believes in a multidisciplinary approach to treatment and has a special interest in the gut-brain interaction, healthy eating practice in children, mental health, sports-nutrition, wholesome lifestyle management and oncology. As a former foodservice manager, she understands the importance of being realistic in the planning and practice of dietary guidelines, taking into consideration the unique circumstances, medical history and preferences of each individual.

MEET THE EXPERT

Ilze Roth is a registered dietitian. She believes in a multi-disciplinary approach to treatment and has a special interest in the gut-brain interaction, healthy eating practice in children, mental health, sports-nutrition, wholesome lifestyle management and oncology.

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low

What happens during a low?

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Daniel Sher discusses the psychological perspective behind what happens during a low: what happens in the brain and how are people with diabetes affected psychologically and behaviourally?

Low blood-glucose levels, or hypoglycaemia, is the most common side effect of insulin. Insulin use, as you probably know, is a life-saving treatment for people living with diabetes, especially people with Type 1 diabetes. People with Type 1 and Type 2 diabetes are at risk of low blood glucose.

How is the brain affected?

The brain, unlike other organs, doesn’t store glycogen. This means that the brain doesn’t have its own energy supply. Rather, the brain depends on glucose in the blood for fuel. In other words, when blood glucose levels drop, the brain is essentially being starved of energy and oxygen.

When blood glucose drops, the hypothalamus and brain stem sense the low, triggering a counter-regulatory response in the brain. The brain’s fight-or-flight system is activated; adrenaline and stress hormones (cortisol) are released. The liver is signalled to increase supply of glucose into the bloodstream and you suddenly find yourself feeling intensely hungry.

How is cognition (thinking) affected?

Research shows that multiple aspects of thinking become impaired during a low. In particular, the functioning of the frontal lobes is affected, with negative effects on multi-tasking and complex thinking/ problem solving. Processing speed and concentration also tend to be negatively affected.

This means that during a hypo, it’ incredibly difficult to perform any task that requires complex thinking. Fortunately, these effects are temporary. Importantly, though: research shows that these symptoms can persist for up to 75 minutes even after your blood glucose has come back to normal.

Please take a moment to let that sink in: the cognitive effects of a low can last for long after the low has been treated. How might this impact on a student writing an exam, a surgeon in the operating theatre or a teacher trying to teach a lesson?

We also know that the hippocampus, which is the brain’s memory centre, is vulnerable to low blood glucose. This means that studying during a low may well be a significant waste of time and energy. Rather use that time to fold your laundry and tidy your desk and return to your studies when your brain has the fuel it needs to learn and analyse.

Low blood glucose and anxiety

Sweaty palms. Heart palpitations. Dry mouth. Fear and irritability. Headache. Confusion. Trembling. A feeling of impending doom. Are these symptoms of anxiety or low blood glucose? Ultimately, these symptoms can be caused by both: there is a huge  overlap between hypoglycaemia and anxiety.

Why is anxiety such a common side effect of low blood-glucose? We have already discussed how the brain compensates for lows: the fight-or-flight response gets triggered, with adrenaline and cortisol being released. The side effect of all this is an anxiety response. Biology aside, lows are psychologically scary and uncomfortable and can be anxiety-provoking for this reason.

If you have ever been diagnosed with an anxiety disorder, though (such as generalised anxiety disorder or panic disorder), lows can represent a significant trigger that can set-off a course of other anxiety symptoms. For some people, the anxiety is there more often than not, which leads some to consistently run their glucose high to avoid the risk of lows. This is referred to in the literature as hypoglycaemia phobia and it’s a form of anxiety disorder that is specific to people with diabetes.

The extreme risks: coma, death and brain damage

This is not a pleasant topic to have to breach, but we need to be aware that bad hypos can take lives. A  study  of adults with Type 1, aged between 20 and 49 years, showed that 18% of male and 6% of female deaths happened due to hypoglycaemia.

Severe lows can also lead to longer term brain damage in certain cases, although fortunately the brain is fairly good at recovering from these events in most people. In children below the age of five years, however, the brain may be more vulnerable and, in these cases, severe lows with seizures can be associated with longer term brain damage.

Ending on a high note

Lows are inevitable: they happen as a result of exercise and insulin, factors which people who have diabetes need to thrive. However, the fear and trauma that surrounds this experience is significant for many people. It’s important to remember that bad lows can be avoided, through good planning, awareness and blood-glucose management.

References

 Graveling, A. J., & Frier, B. M. (2009). Hypoglycaemia: an overview. Primary Care Diabetes,

3(3), 131-139.

 Languren, G., Montiel, T., Julio-Amilpas, A., & Massieu, L. (2013). Neuronal damage and cognitive impairment associated with hypoglycemia: an integrated view. Neurochemistry international, 63(4), 331-343.

Laing, S. P., Swerdlow, A. J., Slater, S. D., Botha, J. L., Burden, A. C., Waugh, N. R., … & Keen, H. (1999). The British Diabetic Association Cohort Study, II: cause‐specific mortality in patients with insulin‐treated diabetes mellitus. Diabetic medicine, 16(6), 466-471.

 McNay, E. C., & Cotero, V. E. (2010). Mini-review: impact of recurrent hypoglycemia on cognitive and brain function. Physiology & behavior, 100(3), 234-238.

 McNay, E. (2015). Recurrent hypoglycemia increases anxiety and amygdala norepinephrine release during subsequent hypoglycemia. Frontiers in endocrinology, 6, 175.

 Page, S., Raut, S., & Al-Ahmad, A. (2019). Oxygen-glucose deprivation/reoxygenation-induced barrier disruption at the human blood–brain barrier is partially mediated through the HIF-1 pathway. Neuromolecular medicine, 21, 414-431.

MEET THE EXPERT

Daniel Sher is a registered clinical psychologist who has lived with Type 1 diabetes for over 28 years. He practices from Life Vincent Pallotti Hospital in Cape Town where he works with Type 1 and Type 2 diabetes to help them thrive. Visit danielshertherapy.com

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