Healthy U — November 2017 by Times Record

Volume 1, Edition 10, November 2017

Diabetes Fort Smith doctor discusses proactive approach Staying on track during the holidays Preparing for this yearâ&#x20AC;&#x2122;s flu season Are you getting enough sleep?

HEALTHYU Contents VOLUME 1, EDITION 10 | NOVEMBER 2017

12-13 Diabetes management Fort Smith doctor encourages proactive approach

6 Think healthy during the holidays You can enjoy delicious foods without overdoing it

22-23 20-21 Are you getting enough sleep? Anxiety, depression can contribute to insomnia

Medical directory Access to the area’s leading medical providers by category so readers can easily find contacts for their areas of need.

about

Publisher Crystal Costa

HEALTHYU

Editor Mardi Taylor

Healthy U is a monthly publication of the Times Record, focusing on issues of health and wellness for the River Valley area. It publishes the third Saturday of every month. For more information: ccosta@swtimes.com

Contributing Writer Carole Medlock Photographers Brian Sanderford, Jamie Mitchell Production Manager Christy Morrison ADVERTISING Sales Manager Julie Newman

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NOVEMBER IS

National Diabetes Awareness Month Mercy Fort Smith offers education, programs on disease By Jennifer Cook Mercy

When November comes around, minds quickly turn to thoughts of holidays, family gatherings and bountiful feasts. However, for nearly 30,000 certified diabetes educators in the United States, the month of November signifies diabetes awareness. National Diabetes Awareness Month is designated to support, inspire and help Americans stay informed about a disease that more than 30 million people face. Diabetes affects all ages and backgrounds. We all know someone who has diabetes. The question remains, “How do we tackle the diabetes epidemic?” Jenna Siebenmorgen, MS, RD, LD, CPT, a registered dietitian and diabetes educator at Mercy Hospital Fort Smith, said Mercy can help patients understand the disease and make meaningful changes. “As health-care providers, we must work together to promote and provide reliable, evidence-based education in an engaging and supportive environment. Doing so allows the patient to step into the driver’s seat and take control of managing their disease,” she said. Awareness leads to education. Education leads to prevention, reduced complications and saved lives. Uncontrolled diabetes affects the cardiovascular system, increasing one’s risk of heart disease and stroke, kidney disease, blindness and amputations. Diabetes educators of Mercy Hospital Fort Smith are committed to getting the word out about diabetes education. Diabetes Self-Management Training classes are held for anyone with a prediabetes or diabetes diagnosis: Gestational, Type 1 or Type 2. The Diabetes Self-Management Training program is available by physician referral only and is a covered

If you are looking for healthy menu options to add to the holiday table, consider this recipe from Diabetic Living.

2 slices bacon ¼ cup chopped walnuts 2 cloves garlic, minced

Green Beans with Bacon & Walnuts

1/8 teaspoon crushed red pepper

Ingredients

12 ounces thin fresh green beans, trimmed

Directions

1 small red sweet pepper, seeded and cut into strips

benefit by Medicare and most health insurance plans. The program consists of two separate classes that are led by a certified diabetes educator

In a large saucepan, cook green beans and sweet pepper in enough boiling water to cover for 3 minutes; drain. In a large skillet, cook bacon over medium

and a registered dietitian. Small group or individual settings are available. The program is certified through the American Diabetes Association.

heat until crisp. Using a slotted spoon, remove bacon from skillet, reserving 2 tablespoons of the drippings in skillet (discard the remaining drippings). Drain bacon on paper towels. Crumble bacon; set aside. Add green beans-sweet pepper mixture, walnuts, garlic, crushed red pepper, and ¼ teaspoon salt to the reserved drippings in skillet. Cook and stir about 5 minutes or until beans are tender and walnuts are lightly toasted. To serve, sprinkle with crumbled bacon. Servings per Recipe: 6 Nutrition Facts per Serving: 106 calories, 9 grams fat, 156 mg sodium, 6 grams carbohydrate, 3 grams ﬁber, 3 grams protein.

If you or your physician have questions about the program or referral process contact (479)314-6722.

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Children with type 1 diabetes often

MISDIAGNOSED More Content Now

It is a common scenario: your child is nauseous, vomiting and very tired. It could be the flu, and that’s probably all it is. But it could also be Type 1 diabetes, a condition where the body does not produce a hormone, insulin, which it needs to get energy from food. Unfortunately, Type 1 diabetes is often not considered until your child is severely ill. Such was the case for Samantha Willner. Willner, now 26, was diagnosed with Type 1 diabetes when she was only 18 months old. Her doctors diagnosed her illness after multiple hospitalizations and several misdiagnoses of the flu. “I was very thirsty, urinating all the time and losing weight,” Willner says. “My mom was told it was the flu, but I kept getting worse. She brought me back to the doctor and insisted they re-evaluate me. It took three different visits over a week and a half to discover that I had Type 1 diabetes. My blood sugar was almost 700. It was a miracle I survived, as many children die in this situation.” About one in every 600 children in the United States develops Type 1 diabetes. While the disease accounts for only about 10 percent of diabetes cases in the country, it’s one of the most common chronic diseases in children. While Willner’s experience was traumatic, it’s not out of the ordinary. Thus, there are nonprofit organizations, such as Beyond Type 1 who make it their mission to drive awareness around this life threatening condition. Too often, children with Type 1 diabetes end up in the emergency room with soaring blood sugar levels. 4

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This serious condition is called diabetic ketoacidosis, or DKA. It occurs when the cells of a person with diabetes do not receive the glucose they need for energy, and start to burn fat and muscle instead. When this happens, leftover molecules called ketones are produced, and ketones begin to poison the body. This, in combination with extreme dehydration, can lead to diabetic coma, or even death, if not caught and treated in time. DKA can

cause emotional burden on caregivers and family members, as well as a financial burden on the family and healthcare system. And it’s all too common: based on a recent survey performed by the T1D Exchange, 41 percent of people with diabetes were in DKA when they were diagnosed. The good news, however, is that DKA is completely preventable. A simple urine test or finger prick are used to diagnose the condition. That’s why Willner is

dedicated to raising awareness about Type 1 diabetes and DKA. Symptoms of Type 1 diabetes that most often go undetected can come on quickly, and should be brought to a doctor’s attention as soon as possible. Early symptoms may include increased thirst or a very dry mouth; frequent urination; extreme hunger; and unintended weight loss. Furthermore, a child may be in DKA and See TYPE 1, 5

TYPE 1 Continued from 4

should go immediately to the emergency room if he or she is experiencing: • Nausea, vomiting or abdominal pain. • Difficulty breathing. • Fruity odor on breath. • Extreme fatigue. • Dry or flushed skin. • Difficulty paying attention, or confusion. “I have heard, too many times, about the death of a child who was sent home by medical professionals after being diagnosed with the stomach flu or a virus,” says Tom Karlya, author of the Diabetes Dad Blog. “I have held parents who were crying uncontrollably because their child’s T1D diagnosis was missed, costing their life. Many more end up in hospitals in full blown DKA. It’s not a matter of who is at fault, it is a matter of society joining together to make sure it does not happen again. In just about every case, the result could and should have been avoided.” Like Karlya and many other passionate members of the diabetes community, Willner wants parents to trust their instincts, talk openly with their health care providers and maintain a positive outlook. “I’m so grateful that my mom pushed to find the right diagnosis — she saved my life. If you’re a parent with a child who has diabetes, please know there is no reason he or she can’t live a normal, wonderful, fulfilling life.” Willner attributes her ability to manage her diabetes based on her experiences and her support system — she’s active in the diabetes community. She also notes her confidence has grown since starting on her tubeless Insulin pump, the Omnipod Insulin Management System, which has unique features that benefit her everyday life and help her control her diabetes. “Managing diabetes is so different from when I was diagnosed. The technology that is available today allows us to have so much more freedom,” Willner says. “The Omnipod System has made me feel empowered, independent and better able to control my diabetes. It’s really possible to find a treatment

“I have heard, too many times, about the death of a child who was sent home by medical professionals after being diagnosed with the stomach flu or a virus. I have held parents who were crying uncontrollably because their child’s T1D diagnosis was missed, costing their life. Many more end up in hospitals in full blown DKA. It’s not a matter of who is at fault, it is a matter of society joining together to make sure it does not happen again. In just about every case, the result could and should have been avoided.” Tom Karlya author, Diabetes Dad Blog

option that works with your life.” Ultimately, education and awareness can lead to proper diagnosis of diabetes and potentially save a life. Raising awareness of diabetes symptoms that can typically be mistaken for the flu could help prevent stories like Willner’s. For more information about the Omnipod System and how to better manage diabetes, visit www.myomnipod.com and talk with your doctor. HEALTHYU

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Think healthy during the holidays More Content Now

The holidays are approaching, and with them come buffets, sweets and food-laden tables. You can think of that as temptation or realize that you have the power to make good-for-you choices, whether you’re managing diabetes or aiming for healthy eating in general. The American Diabetes Association has simple recommendations for enjoying delicious foods and good nutrition during the holidays and beyond. As part of American Diabetes Month, the Association is focusing on eating well. It is a theme that makes any holiday gathering manageable and sets a great new foundation for the new year ahead. Here are some tips: • Enjoy the party, but don’t overdo it. Eat slowly and really enjoy a few 6

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of the foods that are special to you this time of year. If you’re counting carbohydrates and calories as part of your diabetes management plan, think about devoting your carbs to what you like best — and skipping the rest. For example, if you want dessert, cut back on foods such as dinner rolls or stuffing and “spend” your calories and carbs on a small serving of pie. Remember, moderation is key — so stick to small portions and skip seconds. • Bring your favorites. Offer to bring your favorite healthy dish to share. If you’re counting carbs, check your recipe’s nutrition facts so you know how many grams are in one serving as well as the proper serving size. At some gatherings, it’s best not to mention a dish is “healthy” and let the flavor speak for itself; or perhaps the folks at your gathering may appreciate a card that notes the nutrition facts. • Drink in moderation. Alcohol can

add significant calories to your holiday intake — and, if you use insulin or sulfonylureas, complicate keeping blood glucose levels in the safe range. Keep your alcohol consumption to no more than one drink if you’re a woman and two drinks if you’re a man. Avoid high-calorie mixed drinks that include sugary soda or juice. Opt for sugar-free mixers instead. For insulin and sulfonylurea users, it’s important to check blood glucose levels during and up to 24 hours after drinking alcohol and to treat any lows. • Stay active. Think of physical activities during the holidays as a chance to spend quality time with friends and loved ones. Use your extra time away from work or school to exercise — or to participate in a local holiday walk or run. Start a game of pick-up football with family in the yard or take a walk after eating. • If you overindulge, get back on

track. If you eat more than you planned for, don’t think you’ve failed. Focus on enjoying the company of those around you. Then, the next day, get back on track by gifting yourself with healthy eating, regular exercise and monitoring blood glucose levels as directed, if that’s part of your diabetes care routine. • Focus on what matters. The holidays are a time to slow down and catch up with your loved ones, so remember to focus on your friends and family, not the food. Play games together, volunteer or spend time outdoors. Great memories don’t have to be made only at the dinner table. Apply the tips above for healthy, happy holidays ... and a great start to new year ahead. To find more tips on eating well and healthy recipes your entire holiday crowd can enjoy, visit DiabetesForecast.org/ADM.

Where it hides and how much is too much

Sugar can be confusing

Family Features

Sugars are one of the most important health conversations today. A diet filled with too many added sugars is associated with weight gain, type 2 diabetes and heart disease. According to the 2005-10 National Health and Nutrition Examination Survey, the average American consumes an average of 20 teaspoons a day, significantly more than the 6-9 teaspoons recommended daily by the American Heart Association. Sugar can mean different things to different people, which not only adds to the confusion, but can quickly derail even your best intentions as you try to make the right choices for your family. The difference between added and naturally occurring sugars

Many nourishing foods such as fruits, vegetables, certain whole grains and dairy products contain what are known as naturally occurring sugars; these are simple carbohydrates that are naturally present in a food’s biological structure. For example, the lactose found in milk is a sugar, as is the fructose in fruit. In contrast, added sugars are those sugars or sweeteners you add in your kitchen — adding sugar or honey to a recipe or onto your breakfast cereal, for example — as well as sugars and sweeteners that are added to a variety of products by food manufacturers. Added sugars are often used to enhance taste and flavor, of course, but can also be included for other reasons, such as to prevent spoiling think summer jams — or assist in fermentation, such as in baking. “Working with the Florida Department of Citrus, I’ve seen firsthand how much confusion there is around this topic for many families,” said registered dietitian Kate Geagan, author of “Go Green Get Lean.” “Yet while too many added sugars can fill your diet with ‘empty calories,’ naturally occurring sugars are found in some of nature’s most nutrient-rich packages, delivering a bevy of benefits such as vitamins, minerals, antioxidants and more.” An 8-ounce glass of 100 percent orange juice, for instance, has no added sugar. Beyond being an excellent source of vitamin C, it’s a good source of folate, especially important for women of childbearing age, as well as potassium, a vital mineral which helps nerves and muscles communicate and can help offset the effects of too much sodium in the diet. In fact, the FDA recently announced it will add potassium to the Nutrition Facts Panel because many Americans are falling short. The benefits don’t stop there, though. A glass of 100 percent orange juice also delivers magnesium, vitamin A and niacin. Plus, it’s a significant source of hesperidin, an antioxidant that research suggests may have heart, blood pressure and cognition benefits, as well as reduce inflammation and oxidation. Furthermore, one glass counts as one serving (1 cup) of fruit to help you meet the 1.5-2 cups per day recommended by the Dietary Guidelines for Americans. HEALTHYU

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Why diabetics should get tested for kidney disease More Content Now

Diabetes is the number one cause of kidney failure in the United States. However, if you are among the 50 percent of Americans who have diabetes or prediabetes, you are not destined for kidney failure. There are several things you can do to protect your kidneys and prevent serious and life-threatening consequences. “Diabetes-related kidney disease is silent and develops long before symptoms appear,” says Dugan Maddux, MD, vice president for kidney disease initiatives, Fresenius Medical Care North America. “That’s why people living with diabetes should be screened for kidney disease regularly. Identifying kidney disease early creates the opportunity to slow its progression and preserve kidney function.” Diabetes causes a buildup of sugar (glucose) in the blood. Over time, uncontrolled glucose damages kidney tissue and negatively impacts kidney function, allowing the build-up of wastes and fluids in the body. About 30 percent of people with Type 1 diabetes and from 10 to 40 percent with Type 2 diabetes will develop kidney disease. The good news is there are a number of things people living with diabetes can do to help prevent or slow the progression of kidney disease. Control your diabetes by eating healthy, staying active and regularly monitoring your blood sugar. Get tested for chronic kidney disease regularly: • At least once a year 8

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your blood should be tested for estimated glomerular filtration rate (eGFR), which shows how well your kidneys are filtering your blood; and your urine for albumin to creatinine ratio (ACR), which indicates if you have protein in your urine, meaning your kidneys are not healthy. • At least twice a year your A1C levels should be tested. A1C is your average blood glucose level over three months. Your doctor will help determine your goal. • Frequently have your blood pressure evaluated to be sure it’s lower than 140⁄90. High blood pressure not only causes kidney problems, but can be a sign that you have kidney disease.

• Blood pressure medication: Angiotensinconverting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) can control your blood pressure and slow kidney disease. Other blood pressure medications such as beta blockers and calcium channel blockers may also help. • Intensive insulin therapy: This aggressive therapy involves more frequent monitoring and tight control of blood glucose levels. It can be challenging, but research shows it may prevent or slow progression of kidney disease in people with Type 1 diabetes by 50 percent. • Avoiding high-protein diets: Processing protein

makes your kidneys work harder, so people with — or at risk for — kidney disease might be told to avoid a high-protein diet. A dietitian can help you determine the amount of protein you should eat. Getting started on an effective treatment plan as soon as possible helps preserve kidney function and may prevent kidney disease or slow its progression. If your kidneys do fail, you have options. Your health care team can help with education and decisions about treatment for kidney failure which may include having dialysis treatments in your own home or at a local clinic, and you may also explore

the possibility of a kidney transplant. “Good medical care and healthy lifestyle choices can help prevent kidney disease, which is why it’s important that people with diabetes work closely with their doctors and their multidisciplinary care team to get tested and treated and stay as healthy as possible,” Dr. Maddux says. “At Fresenius Kidney Care and by extension through our partners, we understand how chronic diseases such as diabetes and kidney disease affect people’s lives and we are dedicated to supporting patients so they can continue to live and thrive.”

FDA OKs continuous blood sugar monitor without finger pricks By Linda A. Johnson The Associated Press

U.S. regulators have approved the first continuous blood sugar monitor for diabetics that doesn’t need backup finger prick tests. Current models require users to test a drop of blood twice daily to calibrate, or adjust, the monitor. The pain of finger sticks and the cost of testing supplies discourage many people from keeping close tabs on their blood sugar, which is needed to manage insulin use and adjust what they eat. Abbott’s new FreeStyle Libre Flash Glucose Monitoring System, approved Wednesday by the Food and Drug Administration, uses a small sensor attached to the upper arm. Patients wave a reader device over it to see the current blood sugar level and changes over the past eight hours. Most of the 30 million Americans with diabetes use standard glucose meters, which require multiple finger pricks each day and only show current sugar level. More-accurate continuous glucose monitoring devices are used by about 345,000 Americans. But most don’t do the finger pricks to calibrate them and may get inaccurate readings, said Dr. Timothy Bailey, who helped test FreeStyle Libre.

Sponsored Content

Q: I have been told that diabetics have a greater risk of hearing loss. Is this true? The National Institutes of Health (NIH) conducted a study that showed hearing loss is about twice as common in adults with diabetes than with those who do not have the disease. Also, experts say that one in three people with diabetes will develop hearing loss? ;W _Pa Q[ Q\ \PI\ LQIJM\M[ I‫ ٺ‬MK\[ PMIZQVO TW[[ ZQ[S'

ABOUT THE AUTHOR:

This photo provided by Abbott Laboratories demonstrates the use of the company’s FreeStyle Libre ﬂash glucose monitoring device. The Food and Drug Administration has approved the device, which continuously monitors diabetics’ blood sugar levels without requiring backup ﬁnger prick tests. Current models require users to test a drop of blood twice daily to calibrate, or adjust, the monitor. [ABBOTT LABORATORIES VIA AP]

“We’re able to lower blood sugar safely” with this technology, said Bailey, director of the Advanced Metabolic Care and Research Institute in California. He receives consulting fees from various diabetes device makers. Too-high blood sugar levels can damage organs and lead to heart attacks, strokes, blindness and amputations. Very low blood sugar can cause seizures, confusion and loss of consciousness. Abbott’s device was approved for adults with Type 1 or Type 2 diabetes and should be available in pharmacies

within months. The company, based near Chicago, did not disclose the price of the reader or the sensors. Abbott’s system can’t be used with an insulin pump, a device worn against the skin that allows users to inject insulin as needed, but the company is planning improvements to eventually enable that. Rival Medtronic this spring launched a device in which the insulin pump automatically responds to blood sugar changes recorded by the sensor and either withholds or injects insulin as needed.

Jerry Richards, ACA, BC-HIS Graham Hearing 1005 Lexington Ave. Fort Smith 479-783-5250 2708 N. Broadway Poteau, OK 918-649-0223

Research suggest that hearing loss in diabetics is due to poor circulation. Elevated blood sugar levels can damage JTWWL ^M[[MT[ \PMZMJa ZML]KQVO JTWWL Æ W_ \W KMZ\IQV IZMI[ and subsequently cause damages to the structures of the inner ear which are highly vascularized and do not have I JIKS]X []XXTa WN JTWWL Æ W_ <P][ PMIZQVO TW[[ KW]TL be the result of permanent damages to the blood vessels in the inner ear. The American Diabetes Association theorizes that a person with a higher percentage of glycated PMUWOTWJQV WZ ) K XW[[M[[M[ I OZMI\MZ ZQ[S WN LM^MTWXQVO hearing loss in the future. ,QIJM\M[ PI[ JMMV ILLML \W I TWVO TQ[\ WN XW\MV\QIT ZQ[S NIK tors for developing hearing loss including genetics, aging, noise exposure and ototoxic medication. Diabetes-related PMIZQVO KWUXTQKI\QWV[ \MVL \W [\ZQSM MIZTQMZ \PIV W\PMZ ZQ[S factors. Otolaryngologist Yuri Agrawal from Johns HopSQV[ =VQ^MZ[Q\a M`XTIQVML ¹0MIZQVO [PW]TL JM KWV[QLMZML a diabetes-related complication. Our research suggests a dose-response relationship. Having higher A1c results UMIV[ I OZMI\MZ ZQ[S WN PMIZQVO TW[[ I[ _MTT º AW] KIV TW_MZ aW]Z ZQ[S WN LM^MTWXQVO LQIJM\M[ Ja M`MZKQ[ ing regularly and maintaining a balanced nutritional diet. ,WQVO [W _QTT SMMX aW]Z ) K TM^MT[ TW_MZ IVL _Q\PQV \PM ZMKWUUMVLML ZIVOM[ )T[W I^WQL \WJIKKW ][M I[ [UWS QVO QVKZMI[M[ \PM ZQ[S WN KIZLQW^I[K]TIZ LQ[MI[M _PQKP KIV N]Z\PMZ KWUXW]VL aW]Z ZQ[S NWZ PMIZQVO LIUIOM 1N LQI betes is already present, moderate your blood glucose levels with insulin or oral medication, whichever is required based on the type of diabetes. Reducing diabetic-related PMIT\P KWUXTQKI\QWV[ KIV UQVQUQbM \PM ZQ[S WN LM^MTWXQVO other health problems, including hearing loss.

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The ‘silent’ liver disease Growing epidemic associated with diabetes, obesity More Content Now

By the time you finish reading this article, 14 American adults will have been newly diagnosed with diabetes. Thirty-three percent of Americans are obese, and by 2030, this rate is expected to rise to 50 percent. Nonalcoholic Fatty Liver Disease (NAFLD) is a growing epidemic associated with diabetes and obesity. NAFLD is a chronic liver disease characterized by the build-up of extra fat in the liver cells that is not caused by alcohol use. While it is normal for the liver to contain some fat, certain people accumulate extra fat. Left untreated, the accumulation of fat in the liver can progress to a more severe form of NAFLD called Nonalcoholic Steatohepatitis (NASH). NASH is fatty liver with inflammation (tissue injury). Over time, the buildup of fat in the liver causes the liver cells to become damaged. In some patients, this eventually leads to liver fibrosis (scarring) and cirrhosis (severe scarring), which results in other health complications, including liver failure, liver cancer and even death. The exact cause of NASH is unknown, but known risk factors include type 2 diabetes, obesity, insulin resistance, high cholesterol and high blood pressure. NASH has become known as the “silent” liver disease. Many people with risk factors likely have NASH but 10

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are unaware because they may experience minimal to no symptoms. NASH can progress for years or decades undiagnosed. “NASH is an underappreciated, yet serious health concern that warrants more public attention,” says Dr. Stephen Harrison, one of the world’s leading experts studying NASH. “If you suspect you might have NASH, it’s important to speak with a healthcare provider about your options for managing the condition.” Here are some facts about NASH

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1. As the rates of diabetes and obesity continue to climb, the incidence of NASH will rise, as well. 2. More than 10 percent of the global adult population is estimated to be living with NASH. 3. At least one-third of Americans are estimated to have NAFLD and approximately 6 million have progressed to NASH. 4. Of the more than 400 million obese adults worldwide, approximately 75 percent are likely to have NAFLD and up to 20 percent have progressed to NASH.

5. By 2020, NASH is expected to become the leading cause for liver transplantations in the U.S. Diagnosis

In many patients NASH can exist with no symptoms and normal blood tests. If you have diabetes, obesity, high cholesterol, insulin resistance, and/or high blood pressure, you may have NASH and should talk to your doctor and request further evaluation. Your doctor may order special tests and a liver biopsy to diagnose NASH and the amount of liver scarring.

Treatment options

The current standard of care for NASH involves lifestyle counseling with diet and exercise. There are no approved therapies for the treatment of NASH. Enrolling in a clinical trial

New treatment options are being investigated in clinical trials. Clinical trials are essential to advancing medicine and play an important role in getting new drugs approved to treat a particular condition. To learn more about an ongoing clinical trial for NASH, visit www. nash-study.com.

A clean plate By Melissa Erickson More Content Now

You might notice you just can’t eat like you used to. Spicy chili may disagree with your tummy, or your taste buds may not feel as receptive as they once were. One thing is certain: Your body’s nutritional needs change as you age. To help folks understand their dietary needs, nutrition scientists at Tufts University with help from the AARP Foundation recently updated MyPlate for Older Adults, giving the icon a face-lift to colorfully depict the five basic food groups. “MyPlate for Older Adults is intended to help people improve the quality of their diet in terms of foods and nutrients. It was not designed to help people track calories or use for weight control,” said Alice Lichtenstein, director of the Cardiovascular Nutrition Laboratory at the Jean Mayer USDA Human Nutrition Research Center on Aging at

Tufts University near Boston. “It is never too late to make smart changes in your diet. Shifting toward healthier food choices can improve symptoms or decrease risk for developing chronic diseases such as type-2 diabetes, hypertension and heart disease — all of which are more common in older than younger adults,” Lichtenstein said. Watch calories

In general, nutritional requirements are similar across age ranges except for calcium and vitamin D, which are higher in older adults, Lichtenstein said. The big challenge “is that caloric needs decline with increasing age, which means we need less food to maintain a stable weight,” Lichtenstein said. Your food choices are more important to ensure you body is getting enough nutrients. “We advise everyone, particularly

Better-eating guidelines for older adults

older adults, to select nutrient-dense foods. That means foods that have a high concentration of nutrients per serving,” Lichtenstein said. “For example, using some fresh spinach in a salad in place of iceberg lettuce, eating deeply colored vegetables and fruits in place of apples and pears (although they are good choices some of the time). The darker the flesh of the fruit or vegetable, generally, the higher the nutrient content.” Load up on fruits and veggies

Looking at MyPlate for Older Adults, half of it is covered by fruits, vegetables, healthy oils and herbs. Produce — fresh, frozen or even lowsodium canned — provides nutrients to fight heart disease, certain cancers, diabetes, obesity and more. “For fruits and vegetables, take advantage of season varieties and the excellent bags of frozen produce now available in the markets. Have vegetable oils in the house and use them

for food preparation and in things like salad dressings. With regard to herbs the suggestion is to use them in place of salt to reduced sodium intakes,” Lichtenstein said. Go whole-grain

To ensure you’re getting enough fiber, choose whole grains over refined. “Read labels and within each category, including pasta and bread, select products which list whole grain as the first ingredient. There are lots of good choices available these days,” Lichtenstein said. Protein should be lean

“Choose a variety of protein-rich foods and those with lower fat contents, including lean meat over heavily marbled meat, nonfat and low-fat dairy products in place of full fat. Consider non-meat sources of protein occasionally such as nuts and nut butters, tofu, beans. I would suggest experimenting — there might be new foods that turn out to be hits,” Lichtenstein said.

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Fort Smith doctor talks diabetes management Healthy eating and exercise are key, Khorassanizadeh says By Carole Medlock Contributing Writer

Even though having diabetes presents a significant challenge, medical professionals say there are steps that patients can take to make the disease more manageable and prevent complications at the same time. Khorassanizadeh Dr. Rahim Khorassanizadeh, a boardcertified physician in endocrinology and internal medicine, said patients with type 1 diabetes can limit carbohydrates, get consistent exercise and check their sugars regularly to maintain a healthy lifestyle in spite of their disease. Khorassanizadeh explained patients with type 1 diabetes have an autoimmune disorder in which their body does not produce insulin. Doctors most often use insulin injections to treat this form of the disease. Another type of diabetes, type 2 diabetes, happens as, over time, the body becomes resistant to insulin. Khorassanizadeh said the resistance is caused by exposure to sugar and that most patients diagnosed with this type of diabetes are overweight. There are many different medications that can be used to treat type 2 diabetes: medicines that focus on insulin sensitivity, compensating for the insulin a patient does not make. However, diet, exercise and the shedding of excess weight actually can reverse this type of the disease, 12

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Khorassanizadeh said. Type 1 diabetics are typically diagnosed early in life; the disease is not a result of lifestyle or diet and most patients find out they have the disease as children. However, Khorassanizadeh said this type of diabetes can also present in patients later, which is referred to as LADA, Latent Autoimmune Diabetes in Adults. So, older patients can also be diagnosed with type 1 diabetes. Khorassanizadeh said symptoms of diabetes before diagnosis can include fatigue, low energy, darkening of the skin, dry mouth and frequent urination, although he says patients may not necessarily

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have any of the symptoms. In children, he said weight loss may be the most noticeable symptom. He added that parents can talk to their primary care physician and investigate further if they notice any of the indicators. An A1C blood test is typically used as a screening for diabetes. The test measures blood sugar over a threemonth period. The A1C test can also be used in the management of the disorder. Khorassanizadeh said if the screen shows a patient to be pre-diabetic, there are treatments that can help that patient from developing the disease. Although there can be

complications as a result of diabetes, Khorassanizadeh said he chooses to focus on the treatment of the disease with his patients rather than possible complications. But, he said that possible difficulties include kidney failure, cardiovascular disease and retinopathy. To avoid complications from more common illnesses, Khorassanizadeh said doctors recommend for patients with diabetes to get a flu shot yearly and to be vaccinated against pneumonia. The state of Arkansas has 15 percent of its population diagnosed with diabetes compared with just 9 percent in the United States. And,

Khorassanizadeh said there are as many as 800,000 prediabetics in Arkansas that have not been diagnosed yet with the disease. Promoting healthy practices for children can prevent them from developing diabetes later in life, Khorassanizadeh said. He said parents should keep in mind that even though something seems healthy, it may be high in sugar, as are many fruits and fruit juices. He encouraged parents to check sugars and carbohydrates and make good choices for their children. Khorassanizadeh has been at Sparks Clinic Family Practice for two years.

Manage your diabetes and your mental health More Content Now

Managing diabetes is as much a mental game as a physical one. People with diabetes live with the daily burden of taking medication or insulins, monitoring blood sugar, eating healthy, getting regular physical activity, and often experiencing physical symptoms of low and high blood glucose. In addition to this, they need to be vigilant for a serious condition that often is seen simultaneously with diabetes and frequently goes undiagnosed: depression. Multiple studies show people with diabetes are at higher risk of depression. One study found 11 percent of people with diabetes experience major depression, and of those nearly a third are clinically depressed, according to research published in the Diabetes Atlas. Further, studies show about 45 percent of all diabetes patients have undiagnosed depression. People coping with psychological issues and diabetes also don’t feel they’re getting the support they need; the DAWN2 study found that while 52 percent of health-care professionals said they regularly asked patients with diabetes how their lives were affected, just 24 percent of people with diabetes reported they were being asked this by their health care providers. “People with diabetes must manage their disease 24/7, 365 days a year, mostly on their own or with the help of a parent or caregiver. That constant need for attentiveness can lead to increased stress,” says Alicia McAuliffe-Fogarty, a clinical health psychologist and vice president of lifestyle management team at the American Diabetes Association (Association). “Medical providers are trained to help people manage the medical aspects of their disease, but they may not have as much knowledge about the impact psychosocial factors can have on the mental health of people living with diabetes.” The Association recommends everyone living with diabetes have a mental health professional as part

of their health care team. “Everyone is different, so it’s important people with diabetes get individualized, patient-focused care that includes a mental health component,” McAuliffe-Fogarty says. In addition to care from a mental health provider, people with diabetes can take steps to manage their own mental health, including: • Manage stress — Stress can affect your blood sugar. When you are upset or feeling stressed, your body makes stress hormones that can make your blood glucose go up and make diabetes harder to manage. Stress can also make it harder to think about taking care of yourselfyou may eat too much or not enough, you might not exercise, or you may forget to take your medicines. Trying to figure out how to manage stress is important — from deep breathing, to listening to music, or enjoying a hobby. Figure out what works for you.

• Find a support network Living well with diabetes requires support, so do your best to surround yourself with friends, family and trusted health providers. You can also find support through online or in-person support groups, where you will find others who understand the challenges and triumphs of daily diabetes management. • Give yourself a break — Yes, managing your diabetes well can be the difference between life and death. But dwelling on that aspect of the disease, and putting undue stress on yourself every day, doesn’t do you any good. Instead, focus on the fact that diabetes management is just like anything else in life — there will be good days and bad days. Don’t add stress to your life by expecting perfection from yourself. • Set reasonable goals — You need room to learn and grow in your diabetes management. Baby

steps and small changes — such as adding physical activity and making healthier food choices can set you on track for success, while not stressing you out with unrealistic expectations. McAuliffeFogarty advocates the S.M.A.R.T approach to goal-setting: Specific, Measurable, Achievable, Realistic and Time-bound. • Have a stellar health-care team — Diabetes management requires a team approach, and you should have health care professionals such as an endocrinologist, dietitian and primary care physician on your team. It’s important to also have a mental health professional on your team. He or she can provide initial and continuous mental health assessments, from diagnosis and throughout your diabetes journey. To learn more about diabetes management, and the relation between diabetes and depression, visit diabetes.org. HEALTHYU

NOVEMBER 2017

DON’T LET

PREDIABETES TURN INTO THE REAL THING Lifestyle changes may be the key to prevention By Gabriella Boston Special to The Washington Post

Almost 90 million Americans have it, but even though the condition can carry long-term life-threatening consequences, they may have no clue. What is it? Prediabetes — which, in up to 30 percent of cases, can lead to full-blown Type 2 diabetes within five years, according to the Centers for Disease Control and Prevention. But don’t give up, not so fast. “It’s not a doomsday message, and it doesn’t mean you have to turn your whole world upside down because you’re prediabetic,” says Renu Mansukhani, a doctor at the National Center for Weight and Wellness in Washington. “Even just small lifestyle changes can make a big difference,” Mansukhani says. We’ve asked experts in the field what you - if you are in this pretty common prediabetic category - can do through lifestyle changes to significantly reduce your risk of developing diabetes. First, Mansukhani says, if you get a blood test back that indicates you are prediabetic, talk to your doctor about what it means and

NOVEMBER 2017

whether you should retake the test, as false positives are common. If a second test comes back positive, Mansukhani suggests small, incremental lifestyle changes that will improve the condition for most people • but not all. • Game-changer: Balanced meals Having prediabetes doesn’t mean you can never eat a doughnut again, Mansukhani says. “But it might mean that you add one or two servings of the recommended five to nine servings of vegetables per day.” The idea is to eventually replace at least some simple

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carbohydrates (such as processed foods, fruit and milk products) with complex ones (whole grains, beans and vegetables), says Rebecca Scritchfield, a registered dietitian in Washington. “You want to get quality carbs with lots of fiber with each meal. Combine that with protein and fat, and you can avoid spikes in your blood sugar,” Scritchfield says. Still, she doesn’t suggest that you cut out fruit because it’s relatively high in sugar. “I recommend sticking to one to three servings of fruit per day, and if you’re really

concerned, you can look at the glycemic index and pick fruits with less sugar - like berries and kiwi,” she says. Fruit juices, though, should be avoided. They lack fiber and are high in sugar, a combination that often creates blood sugar spikes. So instead of a glass of orange juice, eat an orange and drink a glass of water, she suggests. Along with complex carbs such as vegetables (which should take up half your plate), your meal should have protein and fat, which will help you feel satiated and “stop you from overeating carbs,” says Scritchfield,

who suggests limited snacking while eating three equal-size meals per day. Mansukhani agrees that each meal should be a mix of carbs, fat and protein with a dose of fiber, as that helps with nutrient absorption. But this can be particularly challenging when it comes to breakfast, a traditionally carb-heavy meal, Scritchfield says. If you eat oatmeal, maybe add some protein powder. If you have a hard time stomaching a big breakfast, then split it into two meals (one at home and one at work). “Just be sure not to skip breakfast,” she says. • Game-changer: Exercise But there is another way — along with food changes, or by itself - to reduce the amount of sugar getting stuck in your bloodstream: Exercise. Because sugar is the No. 1 fuel that muscles use for movement, exercise helps lower blood sugar. “The big, overarching thing about exercise is that it is one of the most efficient ways to reduce insulin resistance [and lower blood glucose levels],” says Kyle Stull, a master instructor for the National Academy of Sports Medicine. Insulin is a hormone created in the pancreas that helps deliver sugar (from food) to the muscle cells (for movement). When insulin is resistant,

it is less effective in getting the sugar — the fuel — to the muscle cells. But with exercise, insulin becomes more sensitive, Stull says, and some studies show that blood glucose levels fall by as much as 15 percent or more after aerobic exercise. In fact, one study showed that just 20 minutes of moderate exercise could reduce diabetes risk by 46 percent. It has also been shown that exercise even without weight loss can reduce the risk significantly but that weight loss combined with exercise is even more effective. What kind of exercise is the most effective, and how much of it should we be doing? “Both aerobic and resistance training are valuable,” Stull says. The recommended amount of moderate aerobic training is 30 minutes per day, he says. You can also shorten the duration and up the intensity for similar improvements, he says. Resistance training has also been shown to help control blood sugar, and a benefit of resistance training is the building of lean body mass, leading to improved resting metabolic rate and weight loss. “The main thing is to do something,” Stull says. “Time is the biggest obstacle. But if you can just do 10 to 20 minutes, it will make a difference.” • Game-changer: Sustainable lifestyle What if you make all these positive changes and your blood glucose level still isn’t going down — and maybe it even goes up over time? “It’s not your fault,” Mansukhani says. “We know there is a group that doesn’t respond. In their case, medication might be necessary.” Some patients even undergo weightloss surgery to help deal with their increased risk, she says. Bear in mind that incremental lifestyle changes that encourage less stress, more sleep, healthier eating and more exercise have benefits beyond diabetes prevention. Remember, baby steps. “Don’t try to cut carbs completely you’re setting yourself up. But maybe choose an apple instead of an apple crisp or doughnut,” Scritchfield says. Gabriella Boston is a fitness trainer and freelance writer. She can be found at gabriellaboston.com. HEALTHYU

NOVEMBER 2017

Heavy smoking may lead to diabetes in blacks By American Heart Association News

He knows cigarettes are bad for him. He knows years of smoking cause the pain in his lungs when he runs up and down the basketball court. But Terrence Raper said he’s not quitting any time soon. “My health is not really a major concern of my own,” said the 29-year-old father of two from Arlington, Texas. The veteran of Iraq and Afghanistan started smoking in the Army about 10 years ago. Researcher Wendy White, Ph.D., hopes the work she does changes Raper’s mind. The scientist at Mississippi’s Tougaloo College has spent close to 15 years studying how smoking affects the health of black Americans. Results from a recent study she led suggest heavy smoking increases the risk of diabetes in blacks, who have higher rates of the disease compared to U.S. whites and Hispanics. For the study, the investigators selected nearly 3,000 people, mostly women, who did not have diabetes when they enrolled in the Jackson Heart Study, a large study of cardiovascular disease in African-Americans. The researchers looked at data from more than half of the people in the Jackson sample. The majority of subjects had never smoked when they signed up. Only 361 people smoked, and 119 of them were heavy smokers, meaning they smoked at least 20 cigarettes — or a pack — daily. White said the No. 1 finding is that smoking at least a pack a day may cause diabetes in blacks. Both diabetes and smoking are tied to cardiovascular disease. “We hear all the time about 16

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“One of the interesting things that we saw was that smoking was associated with increased amounts of fat within the abdomen. Visceral fat was higher in current smokers, and this is what we think is one of the potential mechanisms by which smoking may increase the risk of diabetes.” Michael E. Hall, M.D., a study co-author and an assistant professor of medicine in the division of cardiology at the University of Mississippi Medical Center in Jackson

smoking and lung cancer and other lung disease, but the risk with smoking and diabetes is there,” said White, the deputy director of the Jackson Heart Study’s Undergraduate Training and Education Center. The findings were presented in November at the American Heart Association’s Scientific Sessions. The link between smoking

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and diabetes is important, she said, because it is very damaging to the body and diabetics can lose limbs or have other complications. It’s also expensive to treat: The estimated medical costs of treating diabetes were $245 billion in 2012. The study statistics show 466 participants were diagnosed with new cases of diabetes between 2000 and

2012. Among past smokers and those who smoked less than a pack a day, the rate of new diabetes diagnoses was similar to those who never smoked. But the rate of new cases among smokers who consumed at least a pack a day was 62 percent higher compared to those who never smoked. A recent report from the Centers for Disease Control

and Prevention shows that American Indians and Alaska Natives are much more likely to smoke cigarettes than other race and ethnic groups. Hispanics and Asians have the lowest smoking rates. According to the CDC’s statistics, about 17 percent of whites and blacks smoke cigarettes. Black men are more likely to smoke than their white peers, but black women are less likely to smoke than white women. A diabetes diagnosis is more common among black adults than white and Hispanic adults. “One of the interesting

things that we saw was that smoking was associated with increased amounts of fat within the abdomen,” said Michael E. Hall, M.D., a study co-author and an assistant professor of medicine in the division of cardiology at the University of Mississippi Medical Center in Jackson. “Visceral fat was higher in current smokers, and this is what we think is one of the potential mechanisms by which smoking may increase the risk of diabetes.” Hall, a co-investigator on a project under the AHA’s Tobacco Regulation and Addiction Center, added: “Fat within the abdomen has several potential adverse effects which affect glucose. This fat causes alterations in hormones that regulate blood glucose and it may cause more inflammation.” Cardiovascular disease researcher Neha Pagidipati, M.D., said the study is helpful because there’s little

information about the link between smoking and diabetes in blacks. “I think this study was important because it looked at a very important and modifiable risk factor in a population that has generally been understudied in terms of cardiovascular risk factors,” said Pagidipati, a cardiology fellow at Duke University’s School of Medicine who was not involved in the study. The findings, however, don’t definitively show heavy cigarette smoking causes diabetes, she said, and scientists should look deeper into that relationship. “This is an important issue.” White said she would like to see health advocacy groups and federal agencies address the link between smoking and diabetes in education campaigns. She thinks aggressive messages that show the ugly side of smoking are effective. Hall, who has patients

who smoke, said doctors should talk to their patients about the smoking-diabetes connection. He said many smokers don’t quit until faced with a major health problem. Raper, a graduate film student, said he’s not worried about the damage smoking has done to his body. “I can’t control when I’m not going to be around. And whether I’m smoking or not smoking,” he said, “I don’t think really it makes much of a difference.” He’s tried quitting, and wants to before his 30th birthday — mainly because he wants to stop spending the $80 to $100 month on his cigarettes. Smoking campaigns generally don’t speak to him because he said scare tactics don’t work on adults. “You can stop kids from starting to smoke,” Raper said. “But getting somebody to quit at an older age is a completely different story.” HEALTHYU

NOVEMBER 2017

Avoid dangerous drug interactions By Melissa Erickson More Content Now

The pills you’re taking to keep you healthy have a chance of making you sick. That’s because people taking a multitude of medications are risking potentially dangerous drug interactions or could be limiting their effectiveness. “The more drugs you take, the more chances you have to experience a bad reaction,” said Dr. Milta Little, associate professor of geriatrics at Saint Louis University. “Drugs may not play well with each other, and problems can snowball for older adults who take five or more medicines.” As people grow older, they can develop a litany of health problems and see multiple specialists who prescribe various drugs to treat common conditions such as osteoporosis, high blood pressure, diabetes, heart disease, arthritis and memory loss. These can be in addition to overthe-counter medications, herbal supplements and vitamins one is taking at home. Polypharmacy

Polypharmacy is defined as taking five or more medications at the same time and is most common in older adults, Little said. “As a geriatrician who quarterbacks the health care of my patients, I think six medicines usually is too many, and studies have shown mortality is higher among patients who are taking 10 medicines,” she said. “I love to analyze medicines my patients are taking because reducing the number of drugs often makes them feel so much better. 18

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Many times, less is more.” It is not uncommon for Little to see patients who are on 20 to 30 medicines including supplements. “They think each medicine is doing good, but when you pile on the chemicals you increase the risk of a bad reaction,” Little said. “Because people are unique, one-size-fits-all guidelines don’t work. One 65-yearold man might look 45 while another appears much older. There’s a little bit of art to medicine.” Instead, Little advocates an annual medicine checkup, where patients ask doctors to assess the drugs they are

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taking, being mindful that vitamins, supplements and over-the-counter medicines count, too. “It’s critical that you’re your own medical advocate and that you know how your body reacts to medicines,” Little said. Here are some good questions to ask and things to bring to your next physical: • Keep a current list of medicines and dosages and bring it to discuss with your doctor. • Ask your doctor if you still need to be taking every medication. “Push back if they say, ‘Yes.’ Ask, ‘Why? What is it being used for and

how will it help me?’ ” Little said. • Understand what you’re taking. “If you have literacy or memory problems, bring someone with who can help,” Little said. • Use only one pharmacy to fill prescriptions. • Read and understand labels. Know the side effects

A medicine might address one problem but create another. For instance, antidepressants can cause frequent urination, which can lead to incontinence. Statins and blood thinners worsen frailty, which makes patients vulnerable to

more medical problems. An antidiuretic for blood pressure can worsen symptoms of gout, which is a form of arthritis. “Some older adults believe taking a pill will make them healthier, which is not always the case, particularly when they’re taking many pills for different health issues. Too many medicines can make older adults feel fatigued and undermine the quality of their lives,” Little said. “We have a lot of evidence that non-medical treatments, such as exercise, yoga and massages, work better in improving a person’s health.”

Preparing for this year’s flu season More Content Now

Every year, flu season arrives but the strain of flu differs, ebbing and flowing from mild to severe. The flu shot also changes annually, as the medical community seeks to anticipate just what strain of flu will hit the public. “It’s important to protect yourself and those around you. Everybody needs a flu shot,” said Dr. John Meigs, a family physician practicing in Centreville, Ala., and president of the American Academy of Family Physicians. For people who don’t like shots — and who does? — an exciting new way to deliver the flu vaccine has been created by researchers led by a team at the Georgia Institute of Technology and Emory University. This alternative to needle-andsyringe immunization could eliminate the discomfort of an injection as well as the inconvenience and expense of visiting a clinic. Just like slapping on a bandage, a sticky patch with 100 microneedles will painlessly penetrate the skin and transfer the flu vaccine as the needle tips dissolve within minutes. The patch is peeled away and discarded. “The skin is an immune surveillance organ. It’s our interface with the outside world, so it’s very well-equipped to detect a pathogen and mount an immune response against it,” said Dr. Mark Prausnitz, regents professor and J. Erskine Love chair in chemical and biomolecular engineering, Georgia Institute of Technology. “A person would not feel

the microneedles very much at all. In the clinical trial, some of the participants reported some redness and minor discomfort, but they did not feel the individual needles. The microneedle vaccine patch does not feel like being stuck with 100 needles at once,” said Dr. Seila Selimovic, director, National Institute of Biomedical Imaging and Bioengineering. Preliminary testing showed the flu patch was as safe and effective as traditional flu shots. About the same cost to manufacture as a flu shot,

the patch can dramatically reduce the cost of vaccination because it can be delivered for selfadministration without health-care workers overseeing the process. However, we’ll have to wait for the flu patch. “The microneedle vaccine patch was only a phase 1 clinical trial, and the team would need to design and conduct at least two additional phases of research, including a much larger trial, before the experimental microneedle vaccine patch would be approved for use,” Selimovic said.

Core recommendations for the 2017-18 flu season remain the same as last year: No nasal spray

Studies have found that the nasal flu vaccine, which is made from a weakened form of influenza as opposed to flu shots that are made from the dead virus, is largely ineffective, Meigs said. The Centers for Disease Control and Prevention recommends against using the spray, marketed under the name FluMist. Shot OK for egg-allergic

People with egg allergies can receive

an age-appropriate flu vaccine. The most common way that flu vaccines are made is using an egg-based manufacturing process, which has been used for more than 70 years, Meigs said. People with serious egg allergies should visit their family physician for a flu vaccine rather than getting it someplace else. Everyone should get one

The flu shot is advised for everyone 6 months and older and is especially important for the very young and old, for pregnant women, and for people with chronic illnesses or who are immunocompromised.

HEALTHYU

NOVEMBER 2017

Are you getting enough

SLEEP? More Content Now

Do you sometimes have trouble falling asleep? Do you occasionally spend the night tossing and turning? Do you often wake up feeling anything but refreshed? If so, you’re probably not sleeping well — or you may be suffering from insomnia, a symptom of stress, anxiety or depression, among other things, according to the National Sleep Foundation. An NSF poll found that 48 percent of Americans report insomnia occasionally, while 22 percent experience it every (or almost every) night. And it may come as no surprise that a lack of good sleep can have a very serious impact on your quality of life and your productivity at work. “Sleep is one of the fundamental requirements of life — and the worst effects of neglecting it are felt during the day, rather than during the night,” says Peter Hames, cofounder and CEO Big Health, the creator of Sleepio, a digital sleep improvement program. “Compared to good sleepers, poor sleepers are three times more likely to struggle to concentrate, twice as likely to experience a low mood, and more likely to be irritable,” he explains. People with insomnia are also more likely to miss more work or receive fewer promotions, the NSF says. “As a result, relationships can become strained, productivity reduced, and even general health put at risk. And long-term poor sleepers are more likely to suffer from a range of mental and physical health problems,” Hames says. We spoke with Hames to learn the 20

NOVEMBER 2017

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signs that you’re not sleeping well, and how it’s affecting your work success. Here’s what he shared: 1. You’re getting less done at work. “US employees with insomnia on average lost 7.8 days of work last year due to reduced productivity,” Hames says. ”From our own data working with employers, people say that poor sleep impacts their productivity 25 to 45 percent of the time, on average.” 2. You’re missing work due to illness. “Lack of sleep has been shown

to weaken our immune system and increase the likelihood of coming down with a cold,” he explains. Poor sleepers generally miss three more days of work each year than good sleepers. “Our data suggests that employees are missing three hours of work per week on average (in late starts, early finishes, and missed days) due to poor sleep.” Poor sleep has also been shown to lead to an increased likelihood of type II diabetes, cardiovascular

disease, obesity (by 50 percent), and alcohol dependence, Hames says. 3. You find the little things get to you. A lack of sleep can affect your mood and resilience, leading to greater irritability and a higher likelihood of becoming overwhelmed by small issues, says Hames. At work, this can have a serious impact on your relationships with colleagues, managers and clients. See SLEEP, 21

SLEEP Continued from 20

4. You spend a lot of time on Facebook and online shopping at work. Poor sleep has been shown to reduce self-control and increase the likelihood of â&#x20AC;&#x153;cyberloafing,â&#x20AC;? which is surfing Internet sites unrelated to work, he says. When you spend more time on sites like Facebook or Amazon, youâ&#x20AC;&#x2122;re spending less time working. 5. You find it difficult to think clearly. â&#x20AC;&#x153;Sleep deprivation has a noticeable impact on cognitive functioning, limiting innovative thinking, reducing working memory span by 38 percentÂ and increasing the incidence of false memories,â&#x20AC;? Hames says. This can be detrimental to your performance at work. 6. You make impulsive decisions. Have you been reaching for a brownie at lunch, when youâ&#x20AC;&#x2122;re normally very health-conscious? â&#x20AC;&#x153;Restricted sleep increases food intake and impairs our ability to resist food cravings,â&#x20AC;? he explains. And unfortunately, high-fat, high-sugar meals and snacks make us have low energy and tend to decrease our productivity, Lisa De Fazio, a healthy-lifestyle expert and registered dietitian, previously told Business Insider. 7. You feel very stressed. It is easy to see how stress negatively interferes with your ability to get or to stay asleep. Not being able to put your mind to rest at the end of a busy day is one of the most common causes of poor sleep. However, sleep and stress also interact in the other direction: during the day, following a poor night of sleep, you are significantly more likely to perceive experiences as being stressful â&#x20AC;&#x201D; and this can slow you down or distract at work. 8. You have less energy. If youâ&#x20AC;&#x2122;re feeling the need to take naps, thatâ&#x20AC;&#x2122;s probably a sign that youâ&#x20AC;&#x2122;re not getting enough sleep at night. If your sleep seeps into the daytime, it is likely that being awake will seep into your night, and this will only make your sleep worse. Low energy equals low

Tips Hames says if youâ&#x20AC;&#x2122;re not sleeping well, you should think about making your day â&#x20AC;&#x153;pro-sleepâ&#x20AC;? when youâ&#x20AC;&#x2122;re awake. What does this mean? â&#x20AC;&#x153;Try to get as much natural light as possible: It will not only help you feel more awake during the day, but it will signal to your body when itâ&#x20AC;&#x2122;s time to wind down at night.â&#x20AC;? And if youâ&#x20AC;&#x2122;re having problems falling or staying asleep during the night, avoid napping during the day, he adds. Another trick is to prepare well for bed. â&#x20AC;&#x153;Start relaxing and preparing for sleep at least 60 to 90 minutes before bed,â&#x20AC;? he suggests. â&#x20AC;&#x153;Stop any work or intense activity, donâ&#x20AC;&#x2122;t have any intense conversations, and spend some time doing other things before getting into the immediate pre-bed activities like brushing your teeth, putting your pajamas on, or setting your alarm clock. Go to bed only when you feel sleepy, not just tired out.â&#x20AC;? Finally, he says, keep in mind the number of hours of sleep you need varies from person to person. â&#x20AC;&#x153;Thereâ&#x20AC;&#x2122;s not a right or wrong amount.â&#x20AC;? Donâ&#x20AC;&#x2122;t assume you need the oftenrecommended 7-8 hours. â&#x20AC;&#x153;Although this is the average, everyoneâ&#x20AC;&#x2122;s different,â&#x20AC;? Hames says. â&#x20AC;&#x153;In fact a shorter, more compacted sleep may mean a better quality sleep.â&#x20AC;?

productivity. Itâ&#x20AC;&#x2122;s as simple as that. 9. You feel depressed or anxious. â&#x20AC;&#x153;Research has shown that sleeprestricted healthy subjects â&#x20AC;&#x201D; as well as patients free from psychiatric illness but with chronic sleep disturbance â&#x20AC;&#x201D; show impairments in emotional well-being such as depression and anxiety,â&#x20AC;? he says. When you feel anxious or depressed, youâ&#x20AC;&#x2122;re less likely to be motivated at work â&#x20AC;&#x201D; and you may call in â&#x20AC;&#x153;sickâ&#x20AC;? or take personal days more often.

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