Veronica Tift explains the importance of striving for hormonal balance and adds how body work and reflexology can aid in achieving this.

“Wow, this is a really cool song, who sings it?” I ask my teenage daughter innocently one afternoon on the car drive home. “I don’t know who sings it Mom. Why do you have to ask me questions about my music? Can you please just stop!” She then bursts into tears.

I sense this was not about the music and dropped the subject. When we got home, I quickly fed the teenager. I had heard that hunger can be a contributing factor to the madness that is puberty, and soon enough she emerged from her room a completely different human.

Later that day we had a conversation about the sudden shift in mood; she said she honestly just felt emotional and couldn’t actually figure out why. She felt she needed justification to cry in the moment. My question just gave her the excuse to burst into tears randomly, which is what she felt like doing.

Understanding puberty and these hormonal shifts has gone a long way in helping her understand that these are all normal and healthy ways in which her body communicates to her.

Hormones

Our hormones are doing a daily dance with our bodies; they control so many vital aspects of our everyday life. I like to think of them as spies, silently on a mission, passing messages to target cells in the body. We only really notice the spies if they start to go rogue, miss the target cell or disappear from their assigned mission all together.

To understand how to balance hormones, you first need to know what hormones are. They are chemicals that are produced in the body, they are like chemical messengers, that are released by the endocrine system. Hormones travel throughout the bloodstream to the cells and other organs not considered part of the endocrine system, such as the small intestine, and the stomach also release hormones.

Hormones control and influence fertility, growth, development, metabolism, immune system, gut health and mood. The human body is made up of more than 20 major hormones, with each one having a specific purpose and only effecting its own target cell.

Hormonal balance with body work

Reflexology and body work can help with hormonal balance, however, it all depends on the hormone that is out of balance.

In my practice, I see a lot of thyroid hormone imbalance; the two main thyroid hormones are T3 and T4. The thyroid, among other things, regulates metabolism and can have an effect on overall energy levels. Too much thyroid hormone, you have hyperthyroidism or too little called hypothyroidism. There are a number of different thyroid disorders.

In Malvina Bartmanski’s book, Autoimmune Survival Guide, she invites people who have thyroid issues to ask some real questions about how you speak up for yourself and express your thoughts and how you show up for your own needs. She encourages reflexology in her book, speaking to the ability to lower stress hormones and the healing effect it has on the body. The thyroid gland reflex is worked on the feet during a reflexology treatment as well as all endocrine glands, relaxation techniques are also used help with the improvement of circulation of hormones.

The hormone insulin

Insulin is the hormone necessary for the cells in your body to use glucose properly in your bloodstream. The reflexes that a reflexologist would work on the feet would be the pancreas as this is the endocrine gland responsible for the production of insulin. All endocrine glands are included in a treatment; the liver reflex and relaxation techniques to improve circulation of the hormones are also included.

Sweet balance of life

From a reflexology point of view, the pancreas injects mind, body and soul with sweet thoughts, the sweetness of life could be missing or the joy.

We also notice an imbalance in the reflex when someone is too sweet for their own good, or maybe they struggle to accept the sweeter things in life. Related to confidence, self-esteem and creativity, shock can negatively impact all of these and pancreas issues have been linked to trauma. Digesting life and creating a sweet balance of life can emotionally support the pancreas.

Most people only ever start paying attention to their hormones when they start going on their own unsanctioned missions in the body.

Releasing the kindness hormones

In David R. Hamilton’s book, Why the Woo Woo Works, he writes about what he calls kindness hormones, oxytocin being one of them, also called the hugging hormone it plays a role in social bonding. This amazing hormone protects the cardiovascular system and can have a counter effect on stress. Stress or even just thinking about stress makes your hormones respond, same goes for the kindness hormones. Reflexology and supportive body work help release kindness hormones.

Taking this brief look at hormones, you can see how hormone health has a significant impact on overall well-being. We need to care more about our hormone health, supporting them through eating a healthy diet, getting regular exercise and ensuring mental health is supported, helping the overall quality of life to be improved.

Check your hormones regularly

Maintenance is key; don’t wait for your hormones to be MIA before you pay attention to them. Take care of your body and it will take care of you. Being kind to yourself and understanding what is happening with life changes that influence hormones, like puberty and menopause, can also help. Speak to a healthcare professional if you need extra support.

If you suspect you might have any imbalance in your hormones, please have them checked regularly.

References

https://www.drneilspiegel.com/blog/6-important-hormones-and-their-roles-in-your-body

E-motion, energy in motion messages of the body; Sue Ricks – Barney Books 2016

Why the Woo-Woo Works; David Hamilton PH.D – Hay House 2021

The language of the feet; Chris Stormer – Hodder Education 1995, 2007

The Autoimmune Survival Guide; Malvina Bartmanski – Bookstorm 2023

Ruth Hull the complete guide to reflexology second edition Lotus publishing.

https://www.hubermanlab.com/topics/hormone-health

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Dr Paula Diab breaks down the various reasons that people living with Type 2 diabetes may constantly feel tired.

Living with Type 2 diabetes

Living with Type 2 diabetes (T2D) is indeed a challenge. Daily life can also present quite a few challenges. Put them together and you often end up with the perfect storm. Just recently I had a patient come to see me about her diabetes that was out of control by her own admission. She went into great detail about how she wasn’t sleeping well, was constantly tired and all the problems that she was dealing with. Not five minutes into the consultation and I was already exhausted as well!

I heard about the ladies at her work who order cake on a Friday that she is unable to enjoy with them. I heard about her washing machine that had packed up and how she had to hand wash all her clothes until she was able to get the repair company to collect the machine and fix it. Then, I heard about her cat that needed to go to the vet; her brother who was out of work who she was sending daily meals to; her car that needed new tyres and the new pharmacist that wouldn’t give her the correct needles on her script. I was exhausted listening to all these problems and initially wondered what on earth they had to do with her diabetes management.

Her stories had everything to do with her diabetes

Her fatigue was not only a physical fatigue from working hard and not sleeping well coupled with financial stressors, but it was a symptom of a far deeper problem.

Diabetes distress is commonly expressed by people as fatigue and it’s estimated that almost half of people with diabetes will experience it at some stage of their life. Usually, this occurs at the diagnosis of diabetes but can also become a problem at various crossroads on the journey of diabetes or when the stress of life and the stress of diabetes intersect to cause havoc.

Diabetes is a complex condition to manage and requires a high level of patient involvement, affecting all aspects of daily life and including complicated treatment regimens and frequent healthcare visits, not to mention the financial burden of a chronic disease.

Life too, comes with many curve-balls and unexpected challenges and if the correct support isn’t available, the results can be overwhelming. As tired as I was feeling halfway through the consultation, I can only imagine the mental and physical fatigue all these challenges must have been causing the patient.

Understanding fatigue in Type 2 diabetes

This case highlights some of the struggles experienced by people living with diabetes but there is often good reason for fatigue in diabetes that does require further medical investigation and management.

Remembering that T2D is a chronic condition characterised by insulin resistance, where the body’s cells don’t respond effectively to insulin. This leads to elevated blood glucose levels and eventually a decrease in the production of insulin from the pancreas. Multiple, interconnected problems may be the cause of fatigue in someone with diabetes.

Fluctuating blood glucose levels

One of the main factors contributing to fatigue in T2D is the fluctuation of blood glucose levels. When blood glucose levels are too high, the body struggles to efficiently transport glucose into cells for energy production. Conversely, when levels drop too low, the brain and muscles may not receive adequate energy, leading to fatigue.

In addition, the body becomes used to certain blood glucose levels and a significant change (either drop or rise) in these levels can have a significant adverse effect. For example, a person who is used to glucose levels around 10mmol/L may start feeling symptoms of hypoglycaemia at a level of 5mmol/L. They may feel hungry, thirsty, tired and even start shaking. However, someone who is used to levels of 5 – 7mmol/L on a regular basis, may not feel these same symptoms until they reach levels <3.0mmol/L.

Recent research is promoting the maintenance of stable blood glucose levels as being as important as average readings. Whereas we used to aim for an HbA1c < 7%, we are now looking at spending 70% of the day in range and having a co-efficient of variation <36%. What this means is that instead of aiming for a specific target and having varying glucose levels to get you there, rather aim to spend most of the day in range and have as little variation as possible.

Insulin resistance

Insulin resistance, the main underlying pathological cause of T2D, means that the body’s cells don’t respond as effectively to insulin. This can reduce the uptake of glucose by cells, depriving them of a crucial energy source. As a result, you may experience persistent tiredness. If your muscles, don’t receive energy, your body becomes weak. If your brain cells lack energy, they too become slow and fatigued.

Chronic inflammation

Exciting new data has shown the association of T2D with chronic low-grade inflammation and immune dysregulation. The constant activation of the immune system and inflammation are certainly factors which can contribute to feelings of tiredness.

Compromised sleep quality

Sleep and diabetes often form a proverbial vicious cycle of problems. Uncontrolled glucose levels can keep you from a sound night’s sleep, which in turn can raise cortisol levels and further increase glucose levels. Associated conditions, such as sleep apnoea and restless leg syndrome, can also cause sleep interruption.

Poor sleep can contribute to daytime fatigue, creating a cycle that perpetuates tiredness.

Sleeping tablets can assist in the short-term to induce a good pattern of sleep but generally, the underlying cause should be addressed rather than relying on long-term sedative medications.

Co-existing conditions

Some people with T2D often have other health conditions, such as hypertension and cardiovascular disease, which can independently contribute to fatigue. The cumulative burden of managing multiple health conditions can take a toll on energy levels. These need to be actively managed and optimised so as to reduce the burden of complications.

Mental health factors

The emotional and psychological impact of living with a chronic condition like T2D can’t be overlooked. Stress, anxiety, and depression are common companions of diabetes and can contribute to feelings of fatigue. These conditions need careful and sensitive management and shouldn’t be tagged as an add-on to an already complicated diabetes consult. Chronic medication may be indicated but usually works best in conjunction with regular psychotherapy and lifestyle intervention.

Managing fatigue in Type 2 diabetes

As with most aspects of diabetes, addressing fatigue requires a holistic approach that considers both lifestyle modifications and medical interventions:

• Blood glucose management

Regular monitoring and management of blood glucose levels are fundamental. Unfortunately, these behaviours form the cornerstone of any management plan in diabetes and can’t be avoided. Incorporating a well-balanced diet, regular physical activity and remaining adherent to medication is vitally important. Monitoring of blood glucose levels and ensuring levels remain as stable as possible will contribute greatly to lessening feelings of fatigue.

• Physical activity

Not only does regular exercise release hormones in the brain that combat fatigue, but it also provides a physical release of energy and improves insulin sensitivity. Blood glucose levels become more regulated, energy levels are enhanced, and a more restful sleep occurs when the body is physically tired.

• Healthy diet

The importance of a well-balanced diet is crucial. Choose foods that are rich in fibre, organic nutrients and low-GI carbohydrates where possible. Lower GI carbohydrates (oat/bran cereals, pasta, sourdough bread) will release energy over a longer period of time and prevent the spikes in glucose levels that occur with higher GI foods (processed cereals, white rice, white bread, etc).

The addition of fat and protein in the correct quantities as well as a good serving of fresh vegetables can also have an extremely beneficial effect on drawing out metabolism and keeping glucose levels more stable.

Opt for fresh, home-grown and unprocessed foods. Get rid of junk food completely; just throw it out. Reduce snacks as much as possible and sit down and enjoy your meals if possible.

Regular, planned meals rather than a daily binge and snack-attack as soon as you return home in the evenings go a long way to improving glycaemic control and preventing the glucose surges that cause fatigue.

• Adequate sleep

Prioritising good sleep hygiene is essential for managing fatigue. Establish a consistent sleep routine, create a comfortable sleep environment, and address sleep disorders with the guidance of healthcare professionals who are specifically trained.

Don’t rely on sleeping tablets in the long-term unless absolutely necessary. Treat the underlying cause, whether it’s getting the correct device to combat sleep apnoea, finding the right medication for neuropathic pains or simply gaining better glucose control.

• Stress management

This is probably the most difficult factor to manage. Life is stressful and there is no getting away from it. Chronic stress can exacerbate fatigue and impact blood glucose levels. But try to find the time to investigate a suitable technique that works for you; it may be mindfulness, meditation or relaxation exercises. Perhaps it’s just connecting with friends, spending time nurturing your spiritual self or dedicating time each day to unwind and disconnect.

Conclusion

Fatigue in Type 2 diabetes is a multi-faceted issue involving physiological and psychological factors. Perhaps in understanding the mechanisms behind this single symptom, people with T2D will feel empowered to start addressing some of the concerns and seek adequate help.

It’s impossible for a diabetologist to pay the vet bill, fix the washing machine, repair the car tyres and argue with the pharmacist about which needles are required and why. However, it’s completely possible to lend a listening ear.

Breaking down some of the stressors, identifying which need urgent attention and which can be side-lined can be very helpful strategies. If fatigue is due to any of the diabetes-related scenarios discussed above, then treating the root cause of the problem is going to give the best outcome.

However, if fatigue is more related to be a symptom of diabetes distress, then compounding the problem with additional demands of tight glycaemic control is not going to help.

Sometimes, these curveballs do all arrive at the same time. I often use the analogy of a juggler with too many balls in the air. A good suggestion is to concentrate on just a few important balls, allow some to drop and pick them up when you can. Concentrate on self-care first and get the basics right. Utilise the skills of the entire diabetes team and seek appropriate help where needed.

Diabetes isn’t a disease that can be treated with a bi-annual 15-minute visit to renew a script. A comprehensive approach that includes blood glucose management, lifestyle modifications, and emotional well-being is essential for improving overall quality of life. And if digesting all of that does make you feel tired…at least you know you’re not alone.

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Esteé van Lingen expands on what nutrients are and the difference between macronutrients and micronutrients.

Nutrition is a fundamental aspect of your life, influencing your health, energy levels and overall well-being. The food that you eat provides your body with essential nutrients (substances that provides nourishment essential for the maintenance of life and for growth) that are crucial for various functions in the body. Nutrients can be categorised into two main groups: macro- and micronutrients.

Macronutrients: energy providers and building blocks

Macronutrients are nutrients that your body requires in large quantities to provide you with energy, support growth and development and maintain overall health. There are three primary macronutrients: carbohydrates, proteins and fats.

• Carbohydrates

These are the body’s primary source of energy. This can be found in various starches. Examples include grains (bread, pasta, pap, barley, quinoa, cereals etc), fruits, vegetables (especially starchy vegetables: corn, pumpkin, potatoes, sweet potato), legumes (beans, lentils, chickpeas) and dairy products.

When consumed, carbohydrates are broken down into glucose, which is used as a source of fuel for your cells.

Carbohydrates also play a crucial role in brain function and support physical activity.

• Proteins

Proteins are essential for building and repairing tissue, as well as producing enzymes, hormones and other vital molecules. Protein is found in meat, chicken, poultry, fish, eggs, dairy products, legumes, nuts and seeds as well as plant sources like soya and tofu.

Amino acids, the small building blocks that make up protein, are used by the body to synthesise new proteins and perform various other functions.

• Fats

Often also referred to as lipids, are essential for energy storage, insulating your organs and maintaining the health of cell membranes as all cell membranes consist of fat and the type of fat you consume, will determine how well the cell will let through nutrients into the cell and let waste out of the cells. Fat is also important when it comes to absorbing fat-soluble vitamins (A,D,E,K).

Healthy fats are found mostly in plant-based foods, such as avocadoes, nuts, seeds, olives, olive oil as well as in fatty fish, such as salmon, mackerel, pilchards, sardines and trout.

While unhealthy fats are mostly found in animal-based foods, such as processed foods (foods not in its natural form). For example, crumbed, battered, sausages, nuggets, Schnitzel, etc.) as well as fat on the meat, chicken skin and also fried foods. For example: takeaways (chips, fish, samosas, etc).

Macronutrients provide the body with kilojoules (calories) which are the measurements of energy. Carbohydrates and protein provide about 17 kilojoules (kJ) per gram while fats offer more energy at 38 kJ per gram.

The balance of these macronutrients in your diet can greatly influence overall health and body composition. For example, a diet high in carbohydrates can provide quick energy, but in excess can lead to weight gain especially when it’s not combined with an active lifestyle or exercise. A diet high in fat (especially unhealthy fats) can contribute to heart disease.

Micronutrients: the essential nutrient helpers

Micronutrients are the essential vitamins and minerals that your body requires in smaller quantities compared to macronutrients. However, these tiny powerhouses are critical for numerous bodily functions and overall health. Some common micronutrients include vitamins (A, Bs, C, D, E and K) and minerals (calcium, iron, magnesium and zinc).

• Vitamins

These organic compounds play a variety of roles in the body. For example, vitamin C is known for its immune-boosting properties, while vitamin D is essential for bone health as well as plays a role in immunity. Different vitamins are found in various food sources, such as fruit, vegetables, dairy products and meats.

A deficiency in vitamins can lead to various health issues, including scurvy (lack of vitamin C), rickets (lack of vitamin D) and beriberi (lack of vitamin B1).

• Minerals

Minerals like calcium, iron and potassium are inorganic nutrients that are essential for maintaining proper bodily functions. Calcium is crucial for strong bones and teeth. Iron is needed for oxygen transportation in the blood and potassium helps regulate blood pressure. Minerals are found in a variety of foods, with sources ranging from dairy products and leafy greens to lean meats and legumes.

Micronutrients are often involved in metabolic processes, acting as little helpers in the forms of coenzymes and cofactors that enable enzymes to function correctly. They also support growth, immune function and the maintenance of healthy skin, eyes and bones. An inadequate intake of micronutrients can lead to various health issues, including anaemia (iron deficiency), osteoporosis (calcium deficiency), and scurvy (vitamin C deficiency).

What is the difference between these two nutrients?

Quantity

The primary distinction between macronutrients and micronutrients is the quantity required by the body.

Macronutrients are needed in larger amounts, typically measured in grams or kJ/calories whereas micronutrients are required in much smaller quantities, often measured in milligrams or micrograms.

Energy content

Macronutrients provide the body with energy in the form of kJ, while micronutrients don’t contribute to caloric intake. The energy content of macronutrients is significant in terms of maintaining energy balance and body weight.

Types

Macronutrients are categorised into three main types: carbohydrates, protein and fats; each serving specific functions in the body. In contrast, micronutrients encompass a wide range of vitamins and minerals, each with its unique roles.

Food sources

Macronutrients are commonly found in foods such as grains, meat, vegetables and dairy products. In contrast, micronutrients are distributed throughout the food supply, with specific vitamins and minerals often associated with specific food groups. For example: vitamin C is found in citrus fruits, calcium is abundant in dairy products.

Roles in the body

Macronutrients primarily provide energy and structural components such as amino acids for protein synthesis. Micronutrients are involved in various metabolic and regulatory processes, acting as helpers or playing essential roles in specific bodily functions.

Measurements

Macronutrients are typically measured in grams with recommended daily allowances (RDAs) or dietary reference intakes (DRIs) established to help meet your macro needs.

Micronutrients are measured in smaller units, such as milligrams or micrograms, and have their own recommended daily allowances.

How do you balance macro- and micronutrients in your diet?

A well-rounded diet should include an appropriate balance of macro- and micronutrients to support overall health and well-being. Here are tips for achieving this balance:

1. Eat a variety of foods. Consuming a diverse range of food groups and colours ensures you receive a broad spectrum of macros and micros. Different foods offer various vitamins, minerals and macronutrient ratios.
2. Ensure that you get the correct balance of carbohydrates, protein and fats to suit your needs and your lifestyle.
3. Pay attention to portion sizes. Be mindful of portion sizes to avoid overconsumption of macronutrients, especially if you are trying to manage your weight. Use nutritional labels and food scales to ensure you consume the correct portions as well as learn to read and understand labels.
4. Consider your needs. Your age, gender, activity levels, health status and stress levels can influence your macro- and micronutrients requirements. Consult a registered dietitian to tailor your diet to your specific needs.
5. Plan balanced meals. When prepping meals, strive to include a source of each macronutrient along with variety of foods rich in micronutrients, such as fruits, vegetables and whole grains. These can also be distributed in different amounts throughout the day. For example: fruits as snacks or consuming grains instead of processed carbohydrates.
6. Supplement if necessary. In certain situations, such as vitamin or mineral deficiencies, your healthcare provider may recommend supplements to ensure you meet your micronutrient needs. It’s called supplements for a reason; it should supplement a balanced diet and not take over the work of unhealthy diet and lifestyle.

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Lynette Lacock elaborates on how Type 2 diabetes can affect life expectancy as well offering advice to prolong your life.

What is Type 2 diabetes?

Our bodies need to do two things to regulate blood glucose. The pancreas needs to produce the right amount of insulin and the cells need to be able to react to this insulin to supply the cells with the fuel that we call glucose. If you have Type 2 diabetes, your body isn’t doing either of these effectively.

There is a genetic component to Type 2 diabetes and it can run in families, but the main cause is lifestyle choices. Being overweight, food choices and a sedentary lifestyle are all contributing factors. Not that long ago, it was called adult onset diabetes but due to the rise in childhood obesity there are now so many children with this type of diabetes that we can no longer use that phrase.

Symptoms of Type 2 diabetes

You may be experiencing symptoms that you didn’t even realise were being caused by diabetes. These symptoms can develop slowly, and you may not even be aware that you already have diabetes.

This is a good argument for frequent health checks. You can go into most pharmacies these days and pay a small fee to have you blood glucose checked. If you’re living with high blood glucose, your body is already suffering the negative effects without you even knowing.

If you’re having any of the following symptoms, please get tested.

• Always feeling tired
• Loss of weight
• Vision is blurry
• Sores take long to heal
• Frequent infections (urinary tract, chest, etc.)
• Tingling or numbness in extremities (usually a late sign)
• Needing to urinate often
• Thirsty all the time

Life expectancy with Type 2 diabetes

Before the discovery of insulin in 1921, the only treatment for diabetes was eating a diet low in carbohydrates and high in protein and fat. And this only extended your life by another year if you were lucky.

Today, we are fortunate that we have medications and monitoring devices to regulate blood glucose levels that help people with diabetes live a fuller life.

Medication and modern technology aside, diabetes is still the ninth leading cause of death worldwide. Someone with diabetes lives an average of six years less than someone without diabetes. This average can increase or decrease depending on lifestyle and other comorbidities.

People with Type 2 diabetes are also more at risk for developing coronary artery disease, cancer, hypertension and obesity. Having comorbidities, particularly uncontrolled comorbidities, can decrease your life expectancy.

How to increase your life expectancy

Unfortunately, there are factors that you have no control over that make you more susceptible to developing Type 2 diabetes, such as family history, race and age.

If you have a family member with diabetes, you have a higher chance of developing it as well due to the genetic component involved.  People of colour have a higher chance of developing Type 2 diabetes although we are not sure why. And, the risk for developing Type 2 diabetes increases as you age.

Factors you can change

It’s important to remain focused on the factors you can change:

• Weight – You need to maintain a healthy weight (BMI < 30).
• Activity level – Exercise, exercise and exercise, particularly if you have a sedentary job.
• Cholesterol – Follow a low-fat diet and have your cholesterol tested regularly. If you are prescribed medication, take it.
• Diet – Watch your caloric intake and avoid high-GI foods that are high in carbohydrates and sugar.
• Blood glucose regulation – Keep your blood glucose within normal range. Unregulated blood glucose plays havoc on your body and should be avoided.

Turn things around

Did you know that Type 2 diabetes is preventable? If you were diagnosed with prediabetes or insulin resistance you can turn things around by changing your lifestyle and possibly never go on to develop diabetes.

If you have already been diagnosed with Type 2 diabetes, you can still improve your life expectancy by making changes to improve your health. This will make it easier to regulate your blood glucose and avoid the damage to your body that uncontrolled levels can cause.

At first, it may be difficult to make these life changes and stay motivated. You may need extra support and encouragement. Fortunately Diabetes South Africa offers support and useful information through membership, literature and Diabetes Community Wellness and Support Groups that can assist in keeping you on track.

References

https://www.webmd.com/diabetes/type-2-diabetes

https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193

https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death

https://www.medicalnewstoday.com/articles/317477#life-expectancy

https://www.cdc.gov/diabetes/resources-publications/research-summaries/reaching-treatment-goals.html#:~:text=Life%20expectancy%20can%20be%20increased,than%20for%20people%20without%20it

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