Lazy Consequence

Between pupils that learn in Aristoteles found a very lazy.

When warned by the teacher, he proposes the reason, "What must i do? I don't have willpower to read, and doesn't has patience towards exhaustion with saturation learn. "

Then, Aristoteles say to the pupil that lazy, "If such, have no other way for you later except you must patient face misery and idiocy."

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Dare formerly, skilled new

"Only they are that dare to fail can reaches success." (Robert F. kennedy)

I the can it only prepare coffee or boil water, but final i can has also restaurant. That is because, i have courage.

Moment i speak in lecture entrepreneurship at faculty of economics a special province yogyakarta private university, i am interrogating student universities, "what a to be that entrepreneur has know-how formerly?"

I am taste, this is good question. Question same ever also descend upon my brain, that is moment i am new begins to be entrepreneur. Moment this question me inverts in them, yata a large part student university says: " necessary skilled formerly, new dare to begin effort. "

i am their answer taste can not be imputed. they are inclined use rational brain. while follow me, to be entrepreneur, we must dare formerly begin effort, new afterwards has know-how. not on the contrary, skilled formerly, new dare to begin effort.

because, i see in indonesia, this is sebenarya a lot of unemployment by dozens has certain know-how. but, they don't have courage begins effort. finally, know-how that has what that memperolehnya moment school or work previous, final a lot is not maked use. That is a pity.

Such as those which i am natural self, moment open king essence field restaurant effort. I say in them, that then bright i can not make delicious field dish. I am getting field dish. But i don't know the flavor everything that make dish delicious. I say in them, "i the can it only prepare coffee or boil water. That mean to what? i can has restaurant effort, because i have courage.

So also, moment i am formerly open guidance effort learns primagama (instution that help student in their study). I am never teach or be tentor in other place. Even i am never be employee at company another person. But, i embolden self to open effort. Because, i have a notion, if we don't have know-how, so many people other skilled at the areas can be our effort partner.

Therefore for me, above all courage formerly open effort. Whatever the kind, whatever the name. Because, actually, to be entrepreneur, know-how is not all. But courage begin effort that's that must we have beforehand.

Many examples, one who successful be manager, but obvious not yet sure successful as entrepreneur. On the contrary, somebody at beginning begin effort without has know-how manajerial, but he has courage begins effort, a lot obvious success. This latest kind person is besides has courage, also want to develop soul entrepreneur. By because that's i guess, soul entrepreneur, must we get up or we are form since beginning.

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The Basics: Diabetes and Prediabetes and Why They Are on the Rise - 9

Under Beating Diabetes

Lifestyle and Type 2 Diabetes

You can see now why lifestyle is so important in causing (and potentially preventing) type 2 diabetes. During the same time that our lifestyle has changed, type 2 diabetes has transformed from a disease that was barely recognized to one that affects 8 percent of the entire adult population, 13 percent of those older than forty, and 20 percent of those older than sixty-five. Being obese substantially increases the risk of developing diabetes, but even being a little bit overweight increases the chances of developing diabetes.

Similarly, our sedentary lifestyle, independent of obesity, increases the risk of developing type 2 diabetes. Inactivity leads to imnlin resistance and prediabetes, both of which lead to type 2 diabetes. Some of the pernicious effects of inactivity are secondary to obesity, but inactivity also makes our muscles less sensitive to the effects of insulin.

In addition to advancing age, being overweight or obese, and inactivity, inheritance plays a large role in diabetes. Although all of the specific genes that underlie obesity, the metabolic syndrome, and diabetes have not been identified, it is clear that the risk of developing these conditions and diseases is inherited. But how can we explain the widespread inheritance of diseases, the effects of which are so devastating? How would Darwin explain the natural selection process that leads to diabetes? The widespread inheritance of risk for obesity, diabetes, and the insulin resistance that underlies much of type 2 diabetes does make sense according to a theory called the "thrifty gene hypothesis." Until just a few centuries ago, human beings lived in peril of famine. During times of famine, "thrifty" genes that decreased energy expenditure were highly advantageous to human survival: because the energy people took in was small, and because of difficulty in finding food, burning less energy protected people against starvation.

However, according to the thrifty gene hypothesis, genes that protect us during famine make us vulnerable when food is plentiful. An adaptive response has become maladaptive. Put another way, genes that protected our primate ancestors for nearly a million years have made our species vulnerable in the past few hundred years because, for most of us, food has become readily available and the need to do hard physical work has been reduced. The consequences of this maladaptive response are profound. Obesity, diabetes, and metabolic syndrome-and the cardiovascular disease that accompanies them-represent the major public health problems not only in the Western world but increasingly in Asia, Africa, and South America. The inherited propensity to develop type 2 diabetes emerges when unhealthy hfestyle changes and obesity come into play. If a person with a genetic risk for type 2 diabetes doesn't become obese, the disease may never develop.

We cannot change our "thrifty" genes, but we can change our lifestyle. Moreover, there is now hard data-most notably from the multicenter Diabetes Prevention Program study-showing that lifestyle changes really work. You don't need to eat only certain types of foods or train for a marathon. Very simple changes that nearly anyone can make are clinically proven to protect against the metabolic syndrome, prediabetes, and diabetes. The rest of this book will tell you what those changes are and show you how to incorporate them into your life.

Source: David M. Nathan, M.D. and Linda M. Delahanty, M.S., R.D, Beating Diabetes: The First Complete Program Clinically Proven to Dramatically Improve Your Glucose Tolerance, The McGraw-Hill Companies, Inc. (2005)

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The Basics: Diabetes and Prediabetes and Why They Are on the Rise - 8

Under Beating Diabetes

How Our Lifestyle Has Made Us Vulnerable to Diabetes

In 1985, an estimated 30 million cases of diabetes existed worldwide. This number increased to 177 million in 2000 and is estimated to rise to at least 370 million by 2030, almost all from type 2 diabetes associated with aging, obesity, and inactivity. In the United States, the numbers of cases of diabetes and obesity have risen in parallel. Diabetes and prediabetes affect IS million and almost 40 million persons, respectively, and the metabolic syndrome affects almost 25 percent of the U.S. population.

It is all too easy to ascribe these alarming statistics to the increased numbers of the very obese and the very old. But only about 2.3 percent of the population is severely obese and only 3.3 percent of the population is older than eighty-small percentages. The major public health problem is not caused by very large or very old people. Most cases of diabetes and prediabetes are caused by the ever-increasing population that is overweight or only modestly obese. The fraction of the U.S. population in 2000 that was overweight (defined as a body mass index, or BMI, between 25 and 30) increased to almost 35 percent, and the fraction that was obese (BMI of 30 or greater) increased from 13 percent in 1960 to almost 31 percent in 2000. (See sidebar on measuring your BMI.) Thus, the fraction of the U.S. population that is either overweight or obese has risen to an astounding 65 percent.

Are You a Healthy Weight? Measuring Your BMI

Body mass index, or BMI, is a convenient measure of whether your weight is appropriate for your height. Because taller people will weigh more than shorter people, the calculation takes your weight (in kilograms), divides it by your height (in meters squared), and comes up with a measure in kg/m2. The calculation can also be performed if you know your weight and height only in pounds and feet and inches, respectively (see Table 1.4).

The BMI provides a measure of weight for height; it does not provide a direct measure of obesity, meaning who has excess body fat. Nevertheless, for the vast majority of people, a high BMI (between 25 and 30 is defined as being overweight, and 30 or above is considered obese) is synonymous with having too much body fat. Rarely, bodybuilders and other trained athletes may have "excess" weight and a high BMI that is composed not of fat but of muscle. For most of us, this is not the case.

Estimating Your Body Mass Index (BMI)

You can use Table 1.4 to estimate your body mass index. First, select your weight (to the nearest ten pounds) in one of the columns across the top. Then move your finger down the column until you come to the row that represents your height. Inside the square where your weight and height meet is a number that is an estimateof your BMI. For example, if you weigh 160 pounds and are five feet seven inches, your BMI is 25.


Industrialized Society Disease in the "Third World"

The changes in lifestyle in North America and Europe have occurred slowly over centuries, but today we can see those changes as in time-lapse "photography." Take for example the island of Nauru, in the Central Pacific. Until the 1950s, Nauru island lifestyle consisted of very limited subsistence farming as well as fishing. Diets were largely composed of fish, island vegetables, and plantains. The people were largely cut off from the outside world, and there was little in the way of industry.

Around 1960, investors recognized that Nauru's phosphate-rich soil held great financial potential as fertilizer. By 1976, the small population of Nauru was one of the wealthiest in the world. The toil of farming and fishing disappeared in a single generation. Motorbikes and cars replaced walking as the common mode of transportation, imported food was sold in the grocery stores, and electric appliances and televisions became commonplace.

The impact of this sudden and dramatic change in the lifestyle of the citizens of Nauru was profound. Before industrialization, obesity and diabetes were virtually unknown; however, by 1976, the average Nauruan was obese. The obesity and inactivity were a potent combination: 34.4 percent of the population had developed diabetes.

Source: David M. Nathan, M.D. and Linda M. Delahanty, M.S., R.D, Beating Diabetes: The First Complete Program Clinically Proven to Dramatically Improve Your Glucose Tolerance, The McGraw-Hill Companies, Inc. (2005)

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The Basics: Diabetes and Prediabetes and Why They Are on the Rise - 7

Under Beating Diabetes

Why Type 2 Diabetes Is Becoming More Common

If all of human history was represented by a twenty-four-hour day, the nineteenth and twentieth centuries would be the last twelve minutes of that day. Yet in that blink of a geological eye, our lifestyle has changed more than in the previous hundred thousand years. The implications of our current environment are still playing out, but we are already seeing adaptations to out new industrialized lifestyle that aren't necessarily good. Simply put, we're moving our bodies less, eating mote, and eating more of the wrong foods.

We're Moving Less: From Farm Worker to Couch Potato

The industrial revolution changed the type and amount of work we perform. Before the industrial revolution, most of us did labor-intensive, physically taxing work. Increasingly, machines have reduced the hard physical work we have to do. "I'm going to work" has a very different meaning now from the meaning it had one hundred years ago. Fewer and fewer of us perform physical labor, and more and more of us sit at desks for most of the day.

The clearest example of this shift in the work we do is in agriculture. In the 1700s, more than 90 percent of the U.S. workforce finned to grow their own food. Two hundred years later, automated, mechanized manufacturing has reduced the number of people working on farms to about 1 percent of the workforce. Instead of finning, more people became factory workers, building the tractors and other farm equipment that would streamline finning, making it more efficient and a less physically taxing way of life. Not only was a smaller fraction of the population engaged in farming, but farming had changed. The hard-featured, gaunt firmer of the Grant Wood painting was replaced, at least to some extent, by an overweight firmer driving an air-conditioned combine and single-handedly harvesting many acres of com or wheat in a day. Although the fraction of the population working as farmers in the United States has decreased by more than 90 percent since the founding of the nation, these farmers now raise enough food to feed much of the world.

Labor-saving devices-tractors, forklifts, assembly lines, riding mowers, snow blowers, vacuum cleaners, and paint sprayers-have made not only farming but all of our physical activities less demanding. Granted, these advances have left us with more time for leisure activity. But the vast majority of us are not playing more tag football, planting more tulip bulbs, or taking more walks around the block after dinner. Instead, we're watching television, playing video games, and surfing the Internet. Sedentary activities occupy far more hours of the day for most people than physical ones do.

A recent analysis of the National Human Activity Pattern Survey (NHAPS) paints a clear but startling picture of our culture. The NHAPS surveyed 7,515 adults between October 1992 and September 1994. Study volunteers were asked to record everything they did and for how long. Not surprisingly, people spent the most hours sleeping or napping (about eight hours per day on average). But during waking hours, the top six activities (based on the number of hours people spent doing them and energy burned) were driving a car, doing office work (filing, typing), witching TV or movies (at home or in a theater), taking care of children (feeding, bathing, dressing), doing activities while sitting quietly, and eating. On any given day, only 14 percent of the population spent any lime performing leisure-time physical activity (for example, swimming or planned "exercise").

While activity levels vary from person to person, it's clear that out world discourages movement. In addition to changes in the workplace and at home, schools have scaled back physical education programs (daily participation in high school physical education classes dropped from 42 percent in 1991 to 29 percent in 1999). Americans spend more time at work, albeit in sedentary jobs, when compared to other developed countries, which puts the squeeze on time that could be spent in physical endeavors. And between 1990 and 2000 the number of people who commuted for more than thirty minutes per day increased from roughly 20 percent to nearly 34 percent. Even when we do have free time, we tend to use it passively. According to NHAPS, adults spend nearly three hours per day watching TV or a movie, and nearly an hour and a balf each day on "activities performed by sitting quietly." As a culture, we're growing roots to the sofa.

We're Eating More than We Need to: From Famine to Buffets

What Is a Calorie
The terms no carb, low carb, low fat, end high protein have all but elbowed the word calorie out of our vocabulary. In fact, few people even know what It means. A calorie is a measure of heat and reflects energy quantity or expenditure. The amount of energy contained in food is expressed in calories. Similarly, the amount of heat given off by your body is expressed as calories expended or "burned." Using this common term for heat, or energy allow us to calculate the balance between the amount of energy contained in food we eat and the amount of energy that we expend doing specific activities—or just lying around.

Because of the mechanization of farming, food is more plentiful and more affordable than ever before. For example, fish production and the available supply of vegecables per capita have doubled in the past thirty years, exceeding population growth. Despite the abundance of fresh produce, the fraction of total calories people derive from dietary fat and the consumption of saturated fat, both of which are associated with heart disease, remain highest in North America and Europe.

While the availability of large quantities of food is obviously not in itself a had thing, it has set the stage-or the table-for ovemutrition. That is, most of us take in more calories than we burn. Not only is there plenty to eat, hut we don't have to expend much energy to obtain a meal. The farmer's lifestyle, where every calorie consumed was balanced by a similar expenditure of energy to grow the food, has all but disappeared.

In other words, it isn't just the fast-food burger joint that's die problem. Most of the inconvenience and much of the work required to obtain and prepare food have been reduced. Very few of us hunt or farm for our next meal. Even fewer have to build and maintain a fire to cook, pump water by hand, or even wash dishes by hand. Supermarkets have made grocery shopping easier. One-stop shopping often includes conveyor belts that deliver the food into the trunks of our cars (or home-delivery services that bring food right to our doors). Freezers with large storage capacity decrease the frequency of shopping, microwave cooking makes food preparation faster and easier, and dishwashers make cleaning up nearly effortless. Vending machines and convenience stores also make access to food incredibly easy and require virtually no expenditure of calories. We no longer have to work-meaning to perform physical labor-to obtain or prepare our food.

But that's only half of this story. According to the Centers for Disease Control and Prevention, Americans are eating more than ever (see Table 1.2). Where do these excess calories come tram? It's not just what we eat but how much. Serving sizes have increased, both in the home and especially when eating out. Prepared foods such as Hungry-Man-sized TV dinners (a dangerous combination if ever there was one) and "single-serving" portions of prepared foods, such as soups, have almost doubled in size. Over the past twenty years, the size and caloric content of the average egg, bagel, muffin, preformed hamburger patty, and doughnut have grown by 20 to 50 percent. We have become accustomed to giant, economy-size packaging and portions.

On average, Americans eat one in three daily meals out of the home, and competition for customers has resulted in a virtual war to provide large quantities of relatively inexpensive food in fast-food and other restaurants. High-calorie meals abound in fast-food restaurants, an American invention of the 1950s. Hamburgers have become cheeseburgers, double cheeseburgers, double-bacon cheeseburgers, and "truck burgers" (with a fried egg on top). Steak restaurants offer sixteen-, twenty-four-, and even thirty-two-ounce steaks and prime ribs. A typical restaurant prime rib provides 3,410 calories-2,200 of them (or 65 percent) from fat. That's nearly all the calories you would need to survive nicely for two days. All-you-can-eat buffets, pizzas with cheese injected into the crust that come with a pastry dessert as a freebie on the side, and ninety-six-ounce sodas (which exceed the volume of the normal human stomach) are but a few other examples. (See Table 1.3)

We're Eating the Wrong Foods

Not only are we eating too much food, but too many meals contain the wrong kinds of food. Processed, high-fat, low-fiber foods with refined sugars are inexpensive and easy to quickly grab almost anywhere. Unfortunately, they make up a large part of the American diet and are loaded with saturated and trans fats, both of which are associated with atherosclerosis and heart disease. Even single-serving packages of potato chips, nuts, and cheese crackers routinely have 250 to 400 calories with 35 to 50 percent derived from fat. On a recent four-hour crosscountry flight, I was given a snack box that contained a 0.5-ounce bag of potato chips, 1.35 ounces of cheese crackers, a 0.5-ounce box of raisins, a 0.7-ounce package of cookies, and a chocobte bar. This totaled 500 calories-45 percent from fat (twenty-five grams of fat, six grains of which were saturated) and 48 percent (sixty grams) from carbohydrate. My total energy expenditure during the flight amounted to approximately 350 calories (1 sat in my seat with no physical activity other than the "work" of changing the movie).

Many of us eat fast food at least several times a week. Table 1.3 gives you a hint of what you're really getting for your dollar.

Source: David M. Nathan, M.D. and Linda M. Delahanty, M.S., R.D, Beating Diabetes: The First Complete Program Clinically Proven to Dramatically Improve Your Glucose Tolerance, The McGraw-Hill Companies, Inc. (2005)

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The Basics: Diabetes and Prediabetes and Why They Are on the Rise - 6

Under Beating Diabetes

Why Diabetes and Metabolic Syndrome Matter

The ultimate impact on health of type 2 diabetes and metabolic syndrome is through cardiovascular disease. The cluster of features associated with type 2 diabetes or the metabolic syndrome is a highly potent recipe for heart disease and stroke. People with type 2 diabetes or the metabolic syndrome have at least a two to fivefold increased risk of cardiovascular disease. The relative risks are even higher in women with diabetes compared with their counterparts who are nondiabetic.

In addition, in the United States, type 2 diabetes is the major cause of blindness, kidney failure, amputations, and neurological complications, such as impotence. Type 2 diabetes decreases life span by an average of seven to twelve years.

Source: David M. Nathan, M.D. and Linda M. Delahanty, M.S., R.D, Beating Diabetes: The First Complete Program Clinically Proven to Dramatically Improve Your Glucose Tolerance, The McGraw-Hill Companies, Inc. (2005)

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The Basics: Diabetes and Prediabetes and Why They Are on the Rise - 4

Under Beating Diabetes

Type 2 Diabetes: The Twentieth-and Twenty-First-Century Epidemic

For years, type 2 diabetes was called adult-onset diabetes because it usually begins later in life. In recent years, however, as more children have become heavier at earlier ages, type 2 diabetes has increasingly been seen in teenagers and young adults. Of all people with diabetes, more than 90 percent have type 2 diabetes. Unlike type 1 diabetes, the development of type 2 diabetes is strongly influenced by lifestyle.

There are two underlying causes of type 2 diabetes. One is the development of inmlin resistance. This condition causes the tissues of the body to become less sensitive to the effects of inmlin As a result, sugar circulating in the blood does not leave the blood and enter the body's cells as easily. For the blood sugar to be lowered effectively and for the other "jobs" of insulin to be carried out, more inmlin is required. The second cause of type 2 diabetes is the inability to increase insulin to cope with increased demand. Inmlin resistance, decreased insulin secretion, or both can result in the development of type 2 diabetes.

Various factors contribute to insulin resistance: being over weight, advancing age, a sedentary lifestyle, an inherited susceptibility, and certain hormonal conditions such as polycystic ovary syndrome. We don't completely understand why insulin resistance develops, and there is probably more than one explanation, but recent research suggests that fat cells produce chemicals that cause tissues to resist the effects of insulin. More fat cells, as in obesity, make more of these chemicals. As a result, sugar can't move into cells and begins to accumulate in the blood, especially after meals. The rising blood-sugar levels drive the beta cells to produce mote and more insulin to help push the sugar into the cells where it is needed. And since rising blood-sugar levels also worsen insulin resistance, a vicious cycle begins.

An estimated forty million people in the United States have insulin resistance or prediabetes. They have minimally elevated sugar levels because the pancreas is able to keep making enough. insulin. However, in 25 to 50 percent, the pancreas, after many years of overwork, slowly loses the ability to maintain these high levels of insulin. It can still make insulin, but not enough to keep blood-sugar levels in the normal range. Over time, blood-sugar levels drift up, resulting in diabetes.

Sometimes, the elevated blood-sugar levels lead to the usual symptoms of diabetes that patients with type 1 diabetes develop: frequent and excessive urination, increased thirst, fatigue, and weight loss. However, in many people who progress from prediabetes to type 2 diabetes, the rise in blood-sugar levels is insidious and may not cause any symptoms. This helps explain why as many as one-third of the people who have type 2 diabetes don't even know that they have it and why the diagnosis is often delayed by as much as nine to twelve years. It is important to identify blood-sugar problems early on so that you can begin a program to prevent diabetes or if you already have it so you can begin to take care of it and prevent its complications. As with type 1 diabetes, tight control of blood-sugar levels is required to prevent serious and even life-threatening complications.

Source: David M. Nathan, M.D. and Linda M. Delahanty, M.S., R.D, Beating Diabetes: The First Complete Program Clinically Proven to Dramatically Improve Your Glucose Tolerance, The McGraw-Hill Companies, Inc. (2005)

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