Savvy Diabetic

Does Every Diabetic Diet Have to Include Carbs?

2008-12-29T11:56:00.000-08:00

If you are a diabetic, your doctor or nutritionist may have told you that your diabetic diet must contain adequate carbohydrates, despite the fact that diabetes is a disease all about your blood sugars being too high and carbohydrates raise your blood sugars, because "your brain has to have 130 grams of glucose" every day. While it is true that your brain is a unique organ that can only burn glucose, other organs being able to use nutrients for energy, your body can get those 130 grams from foods that will not raise your blood sugars.

In the "old days," the only way most diabetics could measure their blood sugars was with little strips of paper they dunked in their urine. If the paper turned blue, then blood sugars were too high and they needed insulin. If the paper did not turn color, then blood sugars were not too high, but there was no way to tell whether they were normal or low.

To protect their diabetic patients against the dangers of hypoglycemia and insulin shock, they recommended every diabetic eat carbohydrate. Hypoglycemia can be immediately fatal, as in the case of a diabetic in insulin shock driving into a utility pole. High blood sugars were fatal only slowly, so eating carbs was better than not.

In modern times, however, diabetics can measure their blood sugars more precisely, so the old "insurance" of eating carbs with every meal is not necessary (unless, of course, you are taking too much insulin or too much medication). The human brain can get the glucose it needs in many ways that do not require eating sugary, carb-loaded foods.

The liver can convert up to 58 per cent of the protein you eat into glucose, slowly enough that it does not raise blood sugars, but fast enough to provide energy to the brain. About 10 oz (280 grams) of protein foods every day is enough to provide your brain with the energy it needs. If you just eat a measly half-ounce (15 grams) of carbohydrate at every meal, say a great big salad or one slice of bread, you still get all the carbs you really need. And if you eat the salad instead of the bread, you keep your blood sugars low while getting other important nutrients.

If you eat all the carbs recommended by the American Diabetes Association diet, you will go through a daily cycle of sugar high (as all the "healthy" carbs are converted to glucose) followed by adrenal crash, every single time you eat. Keeping your carbs to a minimum, even less than the 130 grams recommended by doctors before glucose meters or the 400-500 grams on the ADA diet, will keep your blood sugars and your brain on an even keel throughout the day.

Is Gestational Diabetes Really Diabetes?

2008-12-29T11:55:00.000-08:00

Sometimes when women are diagnosed with high blood sugars during pregnancy, that is, with gestational diabetes, their doctors are so casual that they could wonder whether gestational diabetes is really diabetes. After all, some doctors say, you will probably be fine after you deliver, just keep your sugars in control for the time being. The problems is that uncontrolled blood sugars during pregnancy can be the first sign of a kind of diabetes that is neither type 1 nor type 2 called LADA.

While obstetricians will insist that expectant mother's keep their blood sugars in check, after delivery the follow up care for women who have gestational diabetes is usually minimal. There might be one HbA1C reading to make sure it's below 7, and maybe a finger stick or two to make sure the fasting sugars aren't too high. One or two "clean" tests and the diabetes case is closed.

The problem is that women who get gestational diabetes tend to be "blood sugar impaired," but not fully diabetic. Some research published in late 2008 found that women who have diabetes during pregnancy have most but not all of the same genes found in type 2 diabetics of both sexes. They will have normal fasting blood sugars because their beta cells get around to churning out enough insulin to take care of the glucose released from food at night, but they do not make enough insulin to keep blood sugar levels low in the 2-3 hours after meals.

High post-prandial, or "after-meal," sugars can do just as much damage as high fasting sugars, but most doctors never test for them. Over time they can poison the remaining beta cells so that they stop making insulin, leading to diabetes that is only detected after it has done damage.

And, just as some women who have an Rh+ blood type have trouble bearing an Rh- baby, sometimes pregnancy triggers a series of autoimmune reactions that cause a kind of diabetes known as LADA (latent autoimmune diabetes in adults). It's something like juvenile diabetes in adults (and I have it, myself, obviously not because I got pregnant, which would no doubt get me an appearance on Oprah). Both men and women can get the condition, initiated most often by pregnancy in women or a viral infection in men.

Fasting blood sugars are fine because the pancreas retains its ability to produce some insulin, slowly. It just can't produce enough insulin quickly to keep blood sugars down after meals. The problem is, those high blood sugars after meals eventually "burn out" beta cells so blood sugars are high all the time.

If you are a new mother who had gestational diabetes, what should you do? To make sure you don't have LADA or type 2 diabetes that just happened to begin when you became pregnant, test your blood sugars about 2 hours after you eat, at least 3 or 4 times. If you get a reading of over 200 mg/dl (11 mM), first, make sure you didn't just happen to have sugar on your hands. But if you get two readings over 200 mg/dl, see your doctor about follow-up care.

What Can You Do About Retinopathy?

2008-12-29T11:53:00.000-08:00

If you have been diagnosed with diabetic retinopathy, what can you do?

The standard medical recommendation for diabetic retinopathy is laser coagulation surgery. What most diabetics do not realize until after the procedure is, laser surgery tiny blind spots in the filed of vision of the affected eye. As its name suggests, laser coagulation coagulates the proteins in targeted blood vessels. Those areas of the retina no longer receive light, and there is also reduction in night vision and color perception.

But there is a reliable, non-surgical approach. The very best thing any diabetic can do to reduce the risk of and even reverse retinopathy is to keep blood sugars down. This means, preferably, keeping blood sugars low not just every morning, but after meals, too.

The United Kingdom Prospective Diabetes Study, running from 1977 to 1997, studied 5,200 people with type 2 diabetes. By the standards of the time, diabetics who kept their blood sugars down to an average of 165 mg/dl (corresponding to an HbA1C of about 7) were considered to achieving “tight control.” Just keeping HbA1C, however diabetics managed to do it, reduced the risk of both diabetic changes to the retina and kidney disease by 25 per cent.

And if diabetics also managed to keep their blood pressure down to an average of 144/82, which by current standards is still “high,” the risk of diabetic changes to the retina dropped by 47 per cent. A much better approach to treating diabetic retinopathy is “tight control” of blood sugars. Nothing you can do does more for eye health that controlling both blood sugars and blood pressure.

And nothing in blood sugar control, at least from the standpoint of preserving vision, is more mportant than avoiding corn syrup and other high-fructose sweeteners. Especially during times of emotional stress, adrenalin-related hormones and high levels of fructose in the bloodstream can synergize to induce high blood pressure, high cholesterol, and high triglycerides, all of which are harmful to the eye. Fresh fruit has one advantage over fructose sweeteners: The fructose in fruit is absorbed more slowly because of the fibers and pectin in the fruit. Diabetics who cannot tolerate fructose sweeteners may be able to tolerate small amounts of fruit.

Some supplements also help. The most useful supplements are inexpensive and free of side effects.

The cells of the retina use magnesium to store energy in the form of ATP, and without magnesium, they cannot use glucose. Diabetics of European descent who have retina damage usually are magnesium-deficient, but diabetics of African descent who have retina damage usually are not. This means that not everybody will be helped by taking a magnesium supplement.

Magnesium citrate and magnesium tartrate are best absorbed. Don’t overdose. Magnesium supplements, like the namesake Milk of Magnesia, can cause diarrhea.
Magnesium supplements will not do you any good if you do not get your B vitamins. Vitamin B6 (pyridoxine) is essential for transporting magnesium into the cell.

Vitamin C supports the production of collagen that keeps the blood vessels in the retina in their normal courses. The retina uses vitamin C to make collagen and hang blood vessels in much the same manner as carpenters hang sheet rock on a wall. All diabetics are at risk for vitamin C deficiency even if they get a lot of vitamin C foods in their diets, but just 100 milligrams a day can be enough to slow down retina changes.

The jury is still out on vitamin E. Researchers at the Joslin Diabetes Center and Harvard found that really high doses of vitamin E in the form of alpha-tocopherol, up to 1,800 milligrams a day, could not just prevent retina changes, but even reverse them. The drawback is, taking that much vitamin E can interfere with various medications you take for your circulatory system. Ask your eye doctor before you start a high dose.

OPCs (oligomeric proanthocyanidins) like the ones found in grape seed extract protect collagen from injury from high blood pressure. They stop a collagen-destructive enzyme. Bilberry works in a simlar manner, and ginkgo may help color vision in milder cases.

What Causes Retinopathy?

2008-12-29T11:51:00.000-08:00

Five or ten years after the onset of diabetes, many diabetics begin to notice that their vision is just a little fuzzy. They may think they need new glasses, but the changing lens does not help. In far too many cases the visual impairment is diabetic retinopathy, a condition caused by uncontrolled high blood sugars and high blood pressure that can lead to blindness if left untreated.

Diabetic retinopathy can strike both type 1 (insulin-dependent) and type 2 (initially non-insulin dependent) diabetics. There are two types of the disease.

The more common, less serious form of the disease is known as background, nonproliferative, or simple retinopathy. This kind of retina damage is due to increased “leakiness” in the microscopic capillaries providing blood supply to the eye. There can be tiny sites of hemorrhage, swelling, or “oozing,” tiny aneurysms in the retina. Where the blood vessels leak, the visual field is impaired.

The second, less common, and more serious form of the disease is known as proliferative or malignant retinopathy. (The term “malignant” here refers to the severity of the condition, not to any danger of cancer.) Proliferative retinopathy, new blood vessels start growing forward from the retina into the fluid filling the eyeball. There can be scarring, and the fibers supporting the new blood vessels obscure the fall of light onto the retina where images are received and processed to be sent to the brain.

Both kinds of diabetic retinopathy result from a process called glycoslylation. Most diabetics are familiar with glycosylation from the measurement of glycosylated hemoglobin, of HbA1C. When blood sugars stay high, red blood cells eventually become “caramel coated.” They stick to the linings of blood vessels, and the injury slows the flow of blood, which in turn triggers the growth of misplaced, competing, microscopic blood vessels.

One of the risk factors for retinopathy diabetics are seldom warned about is high homocysteine. It’s a special risk factor for any diabetic who has kidney damage. And the damage done by too much homocysteine is compounded by high LDL or low HDL.

And if there’s any dietary additive that can bump up the risk of retinopathy even more than sugar, it’s the sweetener sorbitol. In diabetics and non-diabetics alike, sorbitol is a byproduct of the breakdown of blucose. In non-diabetics, sorbitol can be turned into fructose and flow into circulation. In diabetics, sorbitol, whether a byproduct of burning glucose or absorbed from the bloodstream, stays in the cell. The cell takes in water to dilute the sorbitol and swells, interfering with normal circulation. Sorbitol causes problems all over the body, but especially in the eye.

Gastroparesis: The Common Complication Most Diabetics Don't Know About

2008-12-29T11:49:00.000-08:00

Since you were diagnosed with diabetes, have you noticed that you have a problem with belching, bloating, and feeling full? A nagging pain you can’t quite identify in the upper abdomen, or heartburn that antacids can’t help? If you do, you might be suffering from diabetic gastroparesis, the most common complication of diabetes that most diabetics don’t know anything about.

A “paresis” is paralysis and “gastro” refers to the stomach. Gastroparesis (gas-tro-par-EES-is) is a kind of paralysis of the upper digestive tract that causes a delay in emptying the stomach into the small intestines. Eventually afflicting up to 50 per cent of diabetics, this overlooked form of nerve damage typically occurs after a long period of poorly controlled blood sugars, at least 5 to 10 years. Not every diabetic who has this problem experiences all its symptoms all the time, but about half of bloating, constipation, diarrhea, nausea, and vomiting in diabetics may be related to this disease.

The way diabetes results in diabetic gastroparesis is by injury to the stomach’s “pacemaker.” The upper part of the stomach, the fundus, collects food and rink. The lower part of the stomach, the antrum, churns the food around in the acidic gastric juices until it is broken up into tiny fragments and ready for release to the duodenum, the forward part of the small intestine.

A healthy antrum releases food about 3 times a minute, its rate controlled by the vagus nerve, the same nerve that controls the speed of the heart. But when the vagus nerve is damaged by years of high blood sugars, it slows down the stomach. Food accumulates and the stomach has to rely more on stomach acids to break up food and gravity to push partially digested food further along.

So what can you do about gastroparesis? Number one, keep your blood sugars in check. Number two, chew thoroughly and use digestive enzymes, like bromelain, when you eat your food.

High-fat foods slow stomach emptying, and high-fiber foods are something you should avoid when symptoms are severe. Eating smaller meals more often may help, too, but you need to adjust insulin, if you take it. Certain South American herbs, like guarana and mate, aggravate gastroparesis, so be careful with energy drinks. Finally, and ironically, the anti-neuropathy drug Elavil (amitriptyline) makes gastroparesis worse.

Tips for Preventing Diabetic Foot Ulcers

2008-12-29T10:42:00.000-08:00

Are you at risk for diabetic foot ulcers? If you have the tingling, burning, or numb sensation in your feet caused by diabetic neuropathy, chances are, you are. But there is a great deal you can do to avoid diabetic neuropathy progressing to diabetic foot ulcers. Here are some easy but important tips.

To prevent diabetic ulcers, diabetics who have neuropathy in the feet, and diabetics in general, should:

Inspect feet and toes every day for any bruises, bumps, cuts, contusions, scrapes, or infections, including fungus infections like athlete’s foot. If you can’t look at your feet yourself, it is very important to find someone who can look at your feet for you.

Only use warm water, not hot, and mild soap (no Lava), to wash your feet. Test the temperature of the water by using your wrist before you immerse your heat. This will help prevent burns.

Dr. Robert Bernstein cautions against soaking your feet if you have diabetes. Too much exposure to water may loosen protective calluses. Dry feet carefully with a soft towel, and don’t forget to dry between your toes. It’s a good idea to wash your feet every day.

Before you put on your socks, make sure your feet are dry, but then moisturize with a foot cream, cold cream, lanolin, or petroleum jelly. Moisturize will keep the skin on the foot from cracking and letting infection in.

Be picky about your shoes. Make sure you get shoes with firm heels that support and stabilize. There should be plenty of room for your toes. Break news shoe in gradually, only an hour or two at a time.

There are open-toed sandals designed especially for diabetics, such Ambulator Conform Sandals. These sandals accommodate bunions, hammer toes, claw toes, and mallet toes, problems that are not unusual in diabetics’ feet.

Every time you see your primary health care provider, make sure he or she examines your feet. Do not hesitate to call if a sore on your feet is not healing well.

Try not to sit with your legs crossed. Crossing legs reduces blood flow to the feet.

Examine your shoes regularly to make sure they have not picked up any stones, tacks, nails, or street debris.

If your feet get cold at night, wear socks, but do not use heating pads, because diabetic neuropathy make prevent your feeling burns.

It’s OK to remove dead skin, but do not remove calluses covering a wound.

What Causes Diabetic Foot Ulcers?

2008-12-29T10:41:00.000-08:00

It’s the sign of advanced diabetes that diabetics dread, ulcers of the feet and lower legs. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDKD) has published estimated that one in six diabetics oeventually develop a foot ulcer, and 6 out of every 1,000 diabetics will undergo an amputation. Foot ulcers are most common in diabetics who have neuropathy, and neuropathy is most common in diabetics who have high blood sugars after meals, but normal or “OK” blood sugars in the morning. Letting blood sugars get too high during the day is a leading contributor to diabetic foot disease.

Before diabetics develop foot ulcers, they usually have diabetic neuropathy of the feet. This condition can manifest itself as a simple feeling like the foot is “asleep,” or maybe a tingling or burning sensation, usually worse at night. The condition can progress so that the feet feel the same way your mouth does after you get a shot of anesthetic at the doctor’s office, only the feeling never goes away.

Loss of sensation in itself is something diabetics can deal with, as long as they can see their feet. The problem comes when a diabetic does not feel a broken bone or notice an infection after a cut or a scrape. Clogged capillaries cannot carry immune cells to clear out infection, and gangrene can set in. Treating gangrene without surgery is not impossible, but it is very difficult.

Doctors at the Hospital General in Durango, Mexico have published a study that almost 95 per cent of their diabetic patients presenting foot ulcers suffer low magnesium levels. Another study found that low magnesium levels are associated with a 300 per cent greater risk of foot ulcers in type 2 diabetics. When diabetics take supplemental magnesium (something to be done carefully and in moderation, since, like Milk of Magnesia, magnesium supplements can cause diarrhea), modest improvement usually comes about in 3 or 4 days. It lasts as long as you take the supplement, or eat magnesium-rich foods like greens or spinach every day.

Trick Your Metabolism into Burning More Calories

2008-12-29T10:39:00.000-08:00

Diet experts and trainers almost always advise their clients to lose weight by the Law of Energy Balance:

To lose weight, you must burn more calories than you consume each day.
To gain weight, you must consume more calories than you burn each day.

The basic problem with this axiom, is that while calories count, they aren’t countable. The actual caloric content of food may vary 20-30 percent higher or lower than the caloric content listed in the nutritional tables. Some days you follow your diet and you exceed your calorie goals. Some days you follow your diet and you don’t consume enough calories.

The way to deal with this reality is not to ignore calories. It is to use them as a rough guideline—and there are actual benefits to the fact that nature counts calories with “fuzzy” math. The inherent variability of calorie content in whole foods—the calorie content of say, a Twinkie, is nearly constant—allows you to “cycle” your calorie intake.

When you first restrict your food intake, your body responds by producing fewer thyroid hormones so the smaller amount of food provided by your diet provides energy longer. If you restrict calories by just 500 calories a day for just 10 days, your resting metabolism will be 5-7 percent slower for six months.

If you eat a normal number of calories just one day in ten, however, your resting metabolism does not slow down. Adding back 500 calories for just one day does not slow your weight loss, but it keeps you from gaining weight back once you stop your diet.

How can you be sure you are cycling? One day in a week, increase your portion size by one-third or one-fourth for every meal you eat that day. Then go back to your diet plan the next day and for the rest of the week. Or, if you have trouble resisting certain “forbidden” foods, splurge once a week. Just make sure you only splurge once a week!

Whatever diet plan you choose, be sure to eat some carbohydrate foods and some protein foods at each meal. Proteins cannot be stored like carbohydrates. Your body needs some protein every time it uses carbohydrates. If you eat all carbs, your body has to strip protein out of muscle.

If you get no exercise at all, this effect may not be noticeable. If you exercise—and you should exercise—separating carbohydrates and proteins at mealtime will lead to slower weight loss and possible fat gain. Fiber-rich carbohydrates are absorbed gradually and stimulate the least release of insulin and the least storage of fat.

Lower Your Cholesterol by Eating Almonds

2008-12-29T10:38:00.000-08:00

Almonds are a high-fat food with the unexpected application of lowering cholesterol. Researchers at St. Michael’s Hospital in Toronto conducted an experiment involving twenty-seven men and women with high cholesterol who agreed to snack only on foods that the hospital provided for thirty days. One-third of the study participants sate a 150-calorie low-fat whole-wheat cookie three times a day, one-third ate a 150-calorie snack that contained equal calories from whole wheat and almonds three times a day, and one-third ate a 150-calorie snack that contained only almonds three times a day.

At the end of the month, none of the study participants had gained or lost weight. In the whole-wheat group, LDL cholesterol and total cholesterol levels were the same at the end of the study as at the beginning of the study, and the half-wheat/half-almond group experienced an average reduction of 4 percent in LDL cholesterol levels and 9 percent reductions in total cholesterol levels. Meanwhile, the almonds-only group experienced 8 percent reductions in LDL cholesterol and 12 percent reductions in total cholesterol.

A similar study at Louisiana State University, in which participants were given 400 calories in almonds a day for a month found reductions of 21 percent in LDL and 29 percent in total cholesterol. Researchers at the Commonwealth Scientific and Industrial Research Organisationin Australia found that almonds lower cholesterol even if they are consumed in candy, but by only 7 to 9 percent.

The beneficial effect of almonds on cholesterol seems to be due to their high content of unsaturated fat. Despite their high-fat content, eating almonds on a regular basis does not lead to weight gain. Nutritionists at Loma Linda University in California instructed a volunteer group of non-athlete men and women aged twenty-five to seventy-five who were not on a heavy exercise program to eat 320 calories in almonds in addition to their regular intake of food every day for a year.

Food diaries showed that participants ate more 50–150 total calories a day when they ate almonds, although most had a diminished appetite for other high-fat foods.

At the end of the year, participants were weighed and measured, and underwent blood tests. One of the surprising results of the study was that participants who were overweight when the study began lost weight, despite taking in more calories when they ate almonds. The only participants in the study who gained weight—by eating more calories—were the few who were underweight at the beginning of the study. Surprised by this result, the researchers did blood tests for the presence of plant lectins that confirmed that participants actually ate the almonds.

The cholesterol-lowering compounds in the almonds are the monounsaturated fatty acids found in the oil. Almond oil, which is available in grocery stores and can be used in place of other cooking oils or fats, also lowers cholesterol. Almond oil also contains vitamin E, which may reduce the oxidation of LDL cholesterol, a key event in the development of cardiovascular disease. Other nutrients important to cardiovascular health are found in the non-fatty part of the nut and, therefore, are not found in almond oil. The cholesterol-lowering effects of eating whole almonds are greater than those from the consumption of an equivalent amount of almond fat supplied as almond oil.

And that’s not all the benefits of almonds in heart health. Almond kernels are rich in the amino acid arginine, a dietary precursor for nitric oxide, which keeps blood vessels pliable and open. Almonds are a significant source of the trace element magnesium. A 2-ounce serving of almonds contains about one-third of the body’s daily requirements of this nutrient. (Even if you take magnesium supplement, you should eat some magnesium-rich foods such as almonds to provide a steady supply of the element to your body.) Almonds also contain cardioprotective copper in significant concentration.

Eat almonds raw or roasted. You might try almond butter as a substitute for peanut butter. Almond butter contains all the nutritional value of whole almonds. The oil in almond butter sometimes rises to the top of the jar, but you can just stir it back in before use.

Almond milk also contains all of almonds’ nutrients. It’s made from ground almonds suspended in water and usually sweetened with rice syrup. Drink almond milk like milk or use to make fruit smoothies. Almond milk goes exceptionally well with apricots. There’s no lactose in almond milk, so you can drink it even if you are lactose intolerant.

Bitter Melon for Diabetes

2008-12-29T10:37:00.001-08:00

Bitter melon is cultivated in both India and China and in Asian immigrant communities around the world for food and medicinal uses. The medicinal properties of the plant are recorded in the Ben Cao Gang Mu, an ancient Chinese medical text. Traditional Asian medicine uses the juice of this bumpy gourd to treat colic, diabetes, and gout. Contemporary scientific testing with laboratory animals finds that a diet that is 1.5 percent bitter melon (the equivalent of a serving a day) reduces weight gain on high-fat diets by about 25 percent, reduces leptin levels by about 50 percent, and drastically reduces insulin levels.

The juice is also well documented for its ability to lower blood sugar levels, but since it lowers insulin levels rather than raising them, scientists believe that its effects are due to its changes in fat metabolism.

Bitter melon does not imitate insulin. Neither does it reduce the amount of fat absorbed into the bloodstream. It increases it. But at least in laboratory experiments with animals, the juice cancels out the effects of high fatty acid levels in the bloodstream so that they do not cause insulin resistance. It causes fat cells to use energy inefficiently so less fat is stored. Even though the melon juice lowers insulin levels and raises free fatty acid levels, the results of using juice on a regular basis are lower blood sugars, lower triglycerides, and lower weight.

Bitter melon is available in most Asian markets. When you buy the fresh product, look for one that is pale green or yellow (orange ones are too old). Slice the unpeeled fruit lengthwise, remove the seeds, cut it into thin slices, and steam or boil them until the fruit is tender enough to cut with the edge of a spoon.

Pickles in a Diabetic Diet

2008-12-29T10:36:00.001-08:00

Ancient Asian medicine taught that the cucumber detoxified the liver. Modern science has partially confirmed this property of the fruit. Experiments with laboratory animals confirm that cucumber protects liver cells against damage by the chemotherapy drug cyclophosphamide and the common pollutant benzo[a]pyrene. There may be a measurable extent to which diabetics would find raw cucumbers "detoxifying" in a diabetic diet, but to be honest, no scientific research conclusively confirms that benefit. There is just good reason to suppose the occasional fresh cucumber would be of benefit to diabetics who take multiple prescriptions.

That isn't to say there's no scientific research about the value of cucumbers in diabetic diets.

The more important health property of pickled cucumbers is their ability to offset the “whiteness” of white bread, white rice, and potatoes. Eating pickled cucumbers with these foods slows down the rate at which they release sugars into the bloodstream. Organic acids created in the pickling process also signal the pancreas not to release excess insulin, limiting the conversion of sugars into body fat. Fresh cucumbers do not have this effect.

How do you preserve the nutritional value of fresh cucumbers?

Cucumbers should not be washed until just before they are used. They do not have to peeled unless the peel has been waxed; scoring the peel with the tines of a fork tenderizes it. Older cucumbers may have bitter seeds that should be removed before serving. Yellowing of a dark-green skin means the entire cucumber has become bitter and should be discarded.

The simplest cucumber salad is a toss of peeled cucumber in vinegar. You can add basil, chile, chives, cilantro, curry powder, dill, fish sauce, garlic, oregano, peppers, plum sauce, rosemary, Tabasco, or Worchestershire sauce to taste to season the salad. Other vegetables, such as green onions, green peppers, jicama, purple peppers, red peppers, yellow peppers, or tomatoes and even chili peppers and peanuts are compatible with cucumbers, as are apple, mango, orange, papaya, and watermelon. You can make a creamy cucumber salad by adding sour cream or yogurt, but serve the salad quickly after adding any creamy ingredient.

Why Diabetics Should Love Leeks

2008-12-29T10:34:00.000-08:00

The leek is a member of the onion family that has green leaves hiding a white stem with a sweet and subtle flavor. Because farmers mound earth around leeks to keep sun away from the leaves to make the stem white, leeks always have to be washed very carefully. This labor-intensive crop is usually expensive, so you need to choose leeks carefully, making sure you get more of the edible white than the throw-away green.

The slightly sulfurous aromatics in the leek give it medicinal properties. S-methyl cysteine sulfoxide lowers blood sugars; I even know one newly diagnosed diabetic who reversed his condition by eating enormous quantities of leeks. The sulfoxide in leeks is not as effective as medication, but it has a beneficial side effect that medication does not.

This sulfur compound is an antioxidant. Laboratory tests show that it stops the oxidation reactions that turn cholesterol into clogs. You probably cannot eat enough leeks to reverse atherosclerosis, but leeks can be an important part of a heart-healthy diet. The catch is, you have to eat them relatively fresh. A leek will keep for months in the fridge, but S-methyl cysteine sulfoxide dissipates after about the first twelve weeks. For best nutrition, eat leeks when they are harvested, in the fall and early winter.

You do not need to wash or trim leeks until you are ready to cook them. When you take them out of the vegetable bin, trim off the root end and remove any hard leaves. Cut a vertical slit through the center of the leek from bottom to top. Leaving most of the leaves on the leek at this point will keep it from falling apart when you wash it. Wash the two halves of the leek very carefully, removing all sand and grit. When you have washed the leeks, remove the rest of the leaves and slice.

Undercooked leeks are usually tough. You should always cook leeks until a thin-bladed knife passes through them easily. Leeks are often served with chicken, especially in Scottish cooking.

Lowering High Homocysteine

2008-12-29T10:33:00.001-08:00

Homocysteine, like cholesterol, occurs naturally in the body and is not inherently toxic. Even if you could totally eliminate homocysteine from your body, you would not want to. Homocysteine is a byproduct of the chemical steps the body uses to transform methionine, an amino acid abundant in meat, fish, and dairy products, into S-adenosyl-methionine, better known as SAM-e. The linings of cells in the arteries and the brain are repaired by SAM-e.

When SAM-e has done its work, it becomes homocysteine. When there is enough of the B vitamin folic acid, the body transforms homocysteine back into methionine to restart the production of SAM-e, or it can transform it into carnitine, glutathione, or taurine, amino acids with other, well-known protective uses. When there is not enough folic acid, however, homocysteine becomes “stuck” in the biochemical cycle and accumulates.

Homocysteine itself is not toxic to the arteries or to the brain. The problem with having too much homocysteine is that the body simultaneously has too little SAM-e, carnitine, glutathione, and taurine. Depriving the brain of these protective chemicals accelerates the process leading to Alzheimer’s disease (AD).

The simplest way to get enough folic acid to prevent the accumulation of homocysteine is to eat fruits and vegetables. Five 3-1/2 oz (100 g) servings a day is enough. Folic acid is also abundant in certain Southern comfort foods, notably rice, black-eyed peas, and turnip greens, parbroiled rice and dried peas better than fresh, but fresh greens better than canned or frozen. Rice, black-eyed peas, lentils, and greens are relatively low in calories (provided they are not served with oil, butter, or salted pork), and very useful in homocysteine-lowering prevention diet.

Is a vegetarian diet best for lowering homocysteine?

It would be perfectly reasonable ask whether restricting consumption of foods high in methionine, mainly animal foods, adopting a vegetarian diet as well as the practice of intermittent fasting, would indirectly lower homocysteine. The answer seems to be no. A six-month controlled trial in Denmark found that people who ate largely vegan diets had no more luck at controlling homocysteine than people who ate considerable quantities of dairy products and meat. A study of Buddhist nuns in Taiwan found that life-long vegetarians had higher homocysteine levels than women who ate meat, probably because of a deficiency of another B-vitamin, B12.

Bran for Lowering Cholesterol

2008-12-29T10:31:00.002-08:00

When you eat a high-fat food, such as butter, ice cream, whipped cream, or, say, fried chicken, the contents of your digestive tract become “smoother” and more viscous. Sensitive cells lining your intestine detect a change in the fluidity of the food in your gut. They release a hormone called cholecystokinin. This hormone tells your brain that you have eaten a filling, satisfying food.

Bran does the same thing. The fibers in bran swell up with water and make the contents in your digestive tract “smoother.” The cells lining your intestine sense a change in the fluidity of the food being digested and release cholecystokinin, just as if you had eaten fat. Even though you have consumed relatively few calories, you feel full. Cholecystokinin also tells the nerves lining your stomach to “hold” the food longer so fats can be digested completely—even if there is little fat in the food because you have been eating bran.

This keeps your digestive tract from dumping a load of sugar into your bloodstream causing the sugar highs and sugar lows. Men and women, however, differ in their responses to cholecystokinin. Women are more sensitive to the hormone, and more likely to feel full after eating bran. Men are less sensitive to the hormone, and more likely to continue to want any food that is in sight.

You have to be careful about combining bran and high-fat foods, however. Fat “revs up” the liver to make a chemical called triacylglycerol. This chemical stores fat. Eating bacon and eggs tells the liver to make triacylglycerol to store any excess fat that may come along. (Of course, if you are, say, on Atkins and all you eat is one strip of bacon and one egg, there may not be any energy left over to store.) Eating a bran bagel also tells the liver to “rev up” to store fat.

If you eat the bran bagel with butter and cream cheese, and also have bacon and eggs, your fat storage system is going to especially primed to soak up those calories, more than if you ate just the bacon and eggs and cream cheese, and more than if you ate just the bran bagel. If you eat fiber, save the fatty foods for another time.

If bran stimulates the storage of fat, how can it lower cholesterol? The answer is, it doesn’t, if you are eating a high-fat diet. If you limit your consumption of fats, however, every time you eat bran your liver is a little less likely to “rev up” to store fat. After about six weeks of including oat or rice bran in a daily diet including five to nine servings of fruits and vegetables will raise your protective HDL cholesterol and lower the potentially destructive LDL cholesterol, usually in the range of 10 to 20 “points (mg/dl).

Wheat bran does not lower cholesterol. It raises it. The best bran for cardiovascular health is oat bran, which not only improves cholesterol but lowers blood pressure. If you eat an ounce and a half (45 g) of oats every day and you follow a low-fat diet, you can expect your upper number (systolic) pressure to fall up to 7 “points” (mm/Hg) and your lower number (diastolic) pressure to fall up to 10 points.

Reduction in blood pressure when you eat oats every day is greater than if you lose weight or take medication without eating oats. Scientists do not know why oat bran lowers blood pressure and other kinds of bran do not, but there seems to be something in the soluble fiber of oats that stops the production of insulin, which helps the kidneys eliminate salt without losing other minerals, which lowers blood pressure. A word of caution on eating oat bran: Don’t eat oat bran if you have gallstones. Eating oat bran stimulates the release of bile, and can make your gallbladder painful.

Diet and High Cholesterol

2008-12-29T10:31:00.001-08:00

The March 28, 1991 edition the New England Journal of Medicine printed a letter from the physician who had made a very unusual observation about diet and cholesterol. An 88-year-old man who lived in a retirement community complained only of loneliness since his wife’s death. He was in excellent health, articulate, well educated, and ate 20-30 soft-boiled eggs a day, as he had done for the past 65 years. His blood cholesterol levels measured between 150 and 200 mg/deciliter for 15 years. Clearly, in this man’s case, a high-cholesterol diet did not result in high cholesterol in the bloodstream. And if you think that case was unique consider this one.

I spent several years studying the research of an internationally renowned cardiologist, Demetrio Sodi-Pallares, who preferred to be called “Dr. Sodi.” Among Dr. Sodi’s more controversial concepts was his idea that high cholesterol was caused by too much salt in the diet rather than too much cholesterol in the diet.

A woman whose heart had been damaged by rheumatic fever was referred to Dr. Sodi for ongoing heart treatment. Her labs showed that she had at least three prominent metabolic problems. Her levels of T4, the thyroid hormone, were very low, 0.9 mcg. Her cholesterol and triglycerides were astronomically high. Total cholesterol was reported as 800 mg/dl. A healthy level is generally accepted to be 190 or lower. Her triglycerides were 4500 mg/dl. A healthy level is generally accepted to be 125 or lower.

At first, Dr. Sodi simply didn’t believe the lab. He sent the woman’s blood samples to two other laboratories for confirmation, and the numbers did not come back the same. One laboratory reported that triglycerides were 4339 and the other reported 4442. Although, as you will read later in this book, cholesterol and triglycerides do not in and of themselves clog arteries in most people, here was a person whose arteries were literally clogged with fat. Dr. Sodi decided that the need to lower lipids was urgent, and that correcting the thyroid problem could wait. No drugs then (or now) were designed to correct lipid levels that high and the only treatment seemed to be diet.

Over the decades of his practice—Dr. Sodi practiced medicine twelve hours a day every day for 67 years—the noted doctor had often successfully treated heart attack with diets that lowered the intake of sodium. Here was an opportunity to see if low-sodium diets might correct other conditions. Other doctors had been stumped. Since complete elimination of fat from the diet is practically impossible, Dr. Sodi decided also to take fat completely out of dietary consideration, not out of the diet itself, just from his thinking.

Dr. Sodi gave his patient novel instructions. Eliminate added salt from your diet. No canned soups, no pickles, no food made from mixes, only a half a teaspoon in a whole day added to food for taste. He showed her a sewing thimble. “This much salt and no more in any one day,” he said. Eliminate foods that are naturally high in sodium, a long list that in our era includes usually unsuspected sources of salt such as carrots, celery, and egg substitutes. And to see what was really causing high cholesterol and high triglycerides, Dr. Sodi also told his patient to consume two scrambled egg yolks (not the whites or an egg substitute, containing unacceptably high levels of sodium) every morning and to season her steamed vegetables every day with four ounces of unsalted butter! Dr. Sodi wrote no prescriptions. If this patient improved, it was not going to be because she had eliminated fat from her diet and it was not going to be because he had prescribed the latest and greatest medication. Dr. Sodi wished to spare his patient expense.

Two weeks later the woman came back to Dr. Sodi’s office for her labs. After adding fat (which, I emphasize, is not essential to Dr. Sodi’s method, it was only part of this test) and eliminating over 95 percent of the sodium in her diet, the patient had lowered her triglycerides from 4400 to 600 and her total cholesterol from 800 to 240. Dr. Sodi decided to continue the test. At this visit he instructed his patient, “Now go back to your original low-fat, low-cholesterol diet, but eat salty foods as you desire them.” At the follow-up visit triglycerides were back up to 2224, and the patient requested thyroid medication to relieve her fatigue. Dr. Sodi asked her to go back on the sodium-restricted diet for one month before he wrote the prescription. A month later the woman had renewed vitality and did not need thyroid medication. Her triglycerides were back up to 600, still too high, but drastically improved. Her cholesterol was once again 240.

In our age of almost universal fear of cholesterol, a level of 240 is considered too high—but compared to 800, it is an enormous improvement in the absence of medication. We now have drugs that can lower cholesterol from 240 to more acceptable levels, although we do not have drugs that reliably lower cholesterol from 800. More importantly to medicine, Dr. Sodi discovered that the diet he prescribed for recovery from heart attack had many unexpected applications. It was over 40 years later, before any other scientists published research on this method.

The July 2001 issue of the American Journal of Clinical Nutrition reported that people on the DASH (low-sodium, high-potassium) diet reduced their levels of total cholesterol by 13.7 mg/dL or 7.3 percent, and their levels of LDL cholesterol by 10.7 mg/dL or 9 percent. One of the authors of the study, Dr. Claude Lenfant [Note to Carol: Not L’enfant, it is Lenfant.], stated:

“Studies have proven the DASH diet to be beneficial for individuals with high blood pressure or those wishing to prevent high blood pressure. These latest findings provide strong evidence that individuals with high blood cholesterol can also benefit significantly from this eating plan. Physicians and their patients with heart disease can add the DASH diet to the armament of tools known to help lower a person's risk of coronary heart disease.”

Unlike Dr. Sodi’s experiment, the DASH studied involved lowering consumption of dietary fats. In the DASH study, 459 participants were randomly assigned to either the control diet, a diet enriched with fruits and vegetables, or the DASH eating plan. The DASH diet was also rich in vegetables and fruit, but was low in saturated and total fat and cholesterol and used low-fat dairy products. Both the fruits and vegetables diet and the DASH eating plan were higher in fiber and lower in white sugar than the control diet.

Indicators of heart health other than total cholesterol and LDL cholesterol did not improve. Levels of triglycerides, which may increase heart disease risk, were not significantly changed in participants on the DASH diet. DASH was associated, however, with an average decrease of 3.7 mg/dL, or 7.5 percent, of levels of high-density lipoprotein (HDL), the "good" cholesterol.

HDL at low levels (less than 40 mg/dL) is a CHD risk factor; at high levels (60 mg/dL or above), HDL is considered protective of heart disease. The drop was directly related to the individual's starting level of HDL. That is, HDL concentrations decreased more in people with higher HDL levels compared to individuals with lower levels. The researchers concluded that although this undesirable response to the DASH diet needs further study, overall, "the DASH diet affects coronary heart disease (CHD) risk favorably."

In a later study, however, the findings were not repeated. A study published in the journal Hypertension in February 2004 found that the DASH diet did not affect any of the measurements of cholesterol or triglycerides except one—reducing sodium lowered HDL or “good:” cholesterol.

However, this study only measured sodium consumption in a range from 2,000 to 6,000 mg per day, much more than Dr. Sodi recommended. It is possible that extreme sodium restriction might raise HDL cholesterol—or it might not. I simply do not know. The most recent research on diet and LDL cholesterol, the National Heart, Lung, and Blood Institute Family Heart Study, published in the American Journal of Clinical Nutrition in February 2004, links lower LDL cholesterol to higher consumption of fruits and vegetables, but not necessarily to lower sodium and higher potassium.

The bottom line for people with high blood pressure is, eating more fruits and vegetables definitely helps. The jury is still out on sodium restriction. You can, however, benefit from including greater amounts of fresh produce in your diet. Five servings a day (5-a-day), or, even better, nine servings of fruits and vegetables every day are your best dietary change for lowering cholesterol.

Who Should Avoid Salt to Lower Blood Pressure?

2008-12-29T10:28:00.002-08:00

Restricting sodium intake is most likely to help you if your blood pressure goes up when you are under emotional stress. Congestive heart failure, like angina, is especially likely to be relieved by sodium restriction if it is worse under stress. One of the reasons sodium restriction relieves angina is that it stimulates the kidneys to remove excess epinephrine (adrenaline) from circulation.

Research by the team Friberg, Meredith, Jennings, Lambert, Fazio, and Esler at the Baker Medical Research Institute in Australia found that the low-sodium diets begin to influence the kidneys’ handling of the “overflow” of epinephrine when consumption of sodium is about 2400 mg per day, about the level that doctors recommend. Their studies found that the same effect was found when consumption of sodium was as little as 300 mg per day, a more severe restriction in sodium than any doctor or nutritionist ever recommends. In either case, the rate at which the kidneys remove stress hormones from the bloodstream approximately doubled.

The important thing about the effect of sodium restriction on the kidneys’ ability to remove stress hormones from circulation is that while it reduces the amount of the hormones, it does not injure the heart’s ability to respond to them. Even if you are on a low-sodium diet, your heart will still beat faster when you are under intense stress, as in the instance when you need to bolt out the door as your house catches fire. But your heart is not under the constant stimulation of excessive stress hormones if you just cut out the salt.

Does High Cholesterol Cause High Blood Pressure?

2008-12-29T10:28:00.001-08:00

For most of us, our first experience with chronic illness is high blood pressure. Hypertension does not respect healthy lifestyles. Even people who maintain normal weight, exercise regularly, maintain healthy cholesterol levels, and eat a heart-healthy diet can be and frequently are diagnosed with the condition. In the United States, nine out of ten people will develop hypertension by the age of 60, and six out of ten eventually take high blood pressure medication.

If blood pressure readings are consistently higher than 160/110, doctors usually insist on prescription medication. But when blood pressure is between 120 and 160 systolic (the pressure generated when the heart beats) or between 80 and 94 diastolic (the pressure when the heart is at rest), the diagnosis is “borderline hypertension.” This condition of slightly elevated blood pressure can be treated with medication just to lower the numbers, or it can be treated with nutrition to correct its underlying causes.

Borderline hypertension is usually “essential” or “primary,” meaning it is not associated with an abnormality in a specific organ. Until a few years ago, the causes of essential hypertension eluded medical science, but recent research has revealed that this nearly universal health problem begins as with cholesterol—but not high cholesterol.

The human body produces two principal forms of cholesterol, bulky, low-density particles of cholesterol known as low-density lipoprotein, or LDL, and compact, high-density particles of cholesterol known as high-density lipoprotein, or HDL. LDL cholesterol is typically termed “bad” and HDL cholesterol is typically termed “good,” but actually both forms are necessary for the body. The larger LDL particles serve as a food for some of the body’s largest cells, the immune system’s macrophages, the cells that surround and engulf foreign and microorganisms (as well as LDL cholesterol itself).

The cholesterol particles are used by every cell in the body to make their protective linings, serving as “rain slicker” keeping their contents from dissolving in the watery bloodstream. Since they do not dissolve in water, they have to be attached to a transporter protein, apo-B. This protein has regions of positive and negative charge that allow it both to carry cholesterol and to be carried in the watery serum of the bloodstream.

For the bulky LDL cholesterol to be processed by cells, it has to be transported through the cell membrane. The cell membrane has to “unhook” LDL from apo-B and release the carrier protein back into the bloodstream. The detachment of LDL from its carrier molecule requires energy. If the cell is metabolically depleted by too much sodium, it cannot produce the energy it needs to bring LDL inside. On a tired cell, LDL parks on the outside of the cell.
The relatively bulky molecule of LDL in limbo on the surface of the cell is particularly vulnerable to attack by free radicals of oxygen. Without adequate levels of antioxidant free radical quenchers such as vitamin E, LDL cholesterol combines with oxygen to form lysophosphatidylcholine, better known by its acronym LPC. This chemical is the primary component of artery-hardening oxycholesterol, thickening artery walls and encouraging inflammation.

In people with normal blood pressure, oxycholesterol does not get a chance to damage arteries. A balanced immune system produces antibodies to LPC that keep it from accumulating in the linings of blood vessels. Antibodies to LPC perform the immune system’s equivalent of a surgical strike, dissolving the oxidized cholesterol before it can form artery-clogging plaques. In people with borderline high blood pressure, however, the immune system fails to produce the antibodies that clean up LPC. Their immune systems are forced to use the immune system’s equivalent of a battering ram, the macrophages.

These “cholesterol gobblers” surround and engulf LPC but become stuck in the intima, the inner lining of the artery wall. The intima slowly thickens and squeezes the artery so that blood pressure slowly increases. It is important to understand that the immune deficiencies that cause borderline high blood pressure do not affect the immune system as a whole. Only the antibodies to oxidized cholesterol are out of balance.

It’s also important to understand that everyone does not react to either high cholesterol or high sodium by developing high blood pressure. Combinations of factors, of which cholesterol and sodium are only the major part, determine the condition.

Diet, Diabetes, and Phantom Taste Perception

2008-12-29T10:26:00.000-08:00

The seldom-mentioned condition of phantogeusia is actually is a relatively common phenomenon. Phantom bitterness, a “bad taste in the mouth,” is the most common form of phantogeusia. Sometimes the bitterness is due to bleeding from sores in the gums or fissures in the tongue. Blood is bitter, and when the gums or tongue heal, the phantom bitterness disappears. People who drink “bitters,” such as beer, Angostura bitters, or aloe juice, can build up concentrations of bitter compounds in their bloodstream that enter the saliva; discontinuing the bitter drink resolves the phantom bitter taste.

Diabetics are also subject to phantogeusia, but in diabetes it is much more difficult to treat. When a diabetic has a constant bitter taste in the mouth, it is most likely due to diabetic damage to the chorda tympanic nerves of the tongue. This kind of phantom taste only goes away after blood sugars have been maintained at low levels for months or years.

The bad news is, the bitter taste stimulates appetite for sugar, and sugar damages the nerves. Overcoming diabetic phantogeusia requires enduring a long period of impaired taste. Neurological diseases produce phantogeusia of a wide range of tastes and smells. They are usually unpleasant, and the underlying condition must be treated medically.

There is one thing you can do about phantogeusia yourself. Eat foods that hold pleasant memories for you. The names and descriptions we give foods are very important. Researchers have found that at every stage of life, from infancy to old age, our ideas about food are shaped more by the names we give our foods than by the taste, texture, and aroma of the foods themselves. Our taste memories do not rely on the names for foods in a dictionary. Instead they rely on the expanded names of foods from our personal experience, whether it’s “the McDonald’s shake like the one I had that day I had a wonderful time with grandpa,” or “SOS (a euphemism for chipped beef on toast) like we got every day in the Army.”

Serve healthy foods in happy settings, and make sure everyone at the table knows what is being served. If you are attempting to stay or help a family member stay on a healthy diet, use familiar recipes, or at least familiar names, and serve memories when you serve food.

The Cheeseburger Manifesto

2008-12-29T10:24:00.000-08:00

Are there any real foods that diabetics actually like to eat that reverse the effects of diabetes? If you read the recent research literature on nutrition and diabetes literally, you would have to assume that the best food for diabetes is a grass-fed beef cheeseburger, on a whole wheat bun (but not two or three or four cheeseburgers at a sitting).

Really. Here's why.

Conjugated linoleic acids (CLAs) are a group of naturally occurring fatty acids predominantly found in milk and animal fat that have gained wide attention for their numerous health benefits. CLAs are found naturally in milk fat (normally about 5 mg of CLA per gram of fat, but ranging from 2 to 18 mg of CLA per gram of fat) and meat fat (particularly lamb (6 mg/g), beef (4 mg/g), and veal (2 mg/g).

The “trans-10, cis-12” form (also known as t10, c12-octadecadienoic acid), particularly abundant in cheese and hamburger, makes cells more sensitive to insulin and has the most to do with fat loss. CLAs in general act in exactly the same way on blood sugars as a group of drugs known as thiazolidinediones (TZDs), sold under the trade names Actos and Avandia.

CLAs, however, have very different “side effects.” Like the drugs, CLAs lower cholesterol as well as blood sugars. Unlike the drugs, CLAs reduce body fat and encourage weight loss, even if total calorie consumption stays the same. While there are many reasons not to commend cheeseburgers as a health foods (not the least of them being that more than one study has found that are, literally, addicting), the recent scientific evidence and the widespread reports of success of low-carb, high-meat diets suggests that foods containing CLAs deserve a second look.

In diabetes, CLAs are good fats, and trans- fats are bad fats. Analyzing data collected from 65,000 women, Harvard nutritionists found that consuming trans- or hydrogenated fats “substantially” raises the risk of developing type II diabetes.

These are the fats manufacturers add to products to make them smooth and stable at room temperature. At a meeting after the paper was published, one of the researchers in the study even called type II diabetes the “cellophane wrapper disease.” If it’s a tasty treat that stays fresh in a cellophane wrapper, it probably contains the additives that aggravate your risk of diabetes.

Eating foods that are rich in the right fats can lower blood sugars, but eating foods with a relatively low glycemic index, like a whole grain bun, can stop sugars from ever getting high in the first place. The sugars in foods with a high glycemic index are absorbed slowly and incompletely. The sugars in foods with a low glycemic index are absorbed quickly and completely. The higher the glycemic index, the higher your blood sugars. It’s no surprise that the glycemic indices of sugar, mashed potatoes, and white rice are high, but some of the index numbers for other foods are not what you would expect.

For instance, frozen French fries have a high glycemic index. If you make gourmet fries, however, you have a much healthier food. A good French fry requires peeling and cutting the potatoes yourself and soaking the fries for up to 3 days in ice water in the refrigerator. The soaking hydrates the potato so the fry cooks evenly, but the low temperature keeps the starches in the potato from breaking down. The result is a tender, tasty, never mushy fry.

Soaking also reduces the glycemic index of the fries so that your digestive system releases their sugars into your bloodstream more slowly than the sugars in whole wheat and almost as slowly as the sugars in bran or fresh fruit. If you take the time to make a really tasty and relatively healthy French fry, you will enjoy them more, but because the preparation involved, you will probably eat them less.

Similarly, all white rices are not created equal. Kalijira rice is a rice with very small grains and a delicate aroma and texture grown in Bangladesh. It is traditionally served with aromatic spices such as cardamom, cinnamon, and cloves. While it is excellent for pilafs and side dishes where the appearance of individual grains adds to the aesthetics of presentation, it is not the best rice for puddings, stuffings, or soups.

Importantly for health, kalijira rice has a high content of amylase sugars that give it a low glycemic index, that is, its sugars are released slowly by the digestive tract, making it a relatively healthy source of carbohydrate for diabetics who have room for rice in their meal plans, dieters, and endurance athletes.

And even the bun for a cheeseburger does not have the glycemic index you would expect. White bread has a high glycemic index, almost the same as sugar. A cheeseburger made with a white bread bun, hamburger, cheese, mustard, ketchup, and a pickle has about the same glycemic index as bran. The secret lies in the pickle. Pickled cucumbers have an ability to offset the “whiteness” of white bread, white rice, and potatoes.

Eating pickled cucumbers with these foods slows down the rate at which they release sugars into the bloodstream. Organic acids created in the pickling process also signal the pancreas not to release excess insulin, limiting the conversion of sugars into body fat. Fresh cucumbers do not have this effect.

I do not maintain that diabetics have to eat cheeseburgers or any of their ingredients for good health. There are good, vegan sources of CLAs. The key to controlling blood sugars is not so much what you eat, but how much you eat.

Are We Really What We Eat?

2008-12-29T10:23:00.001-08:00

A noted nutritionist once referred to nutrition as the Rodney Daingerfield of the healing sciences. Like the late Rodney Daingerfield, nutrition “don’t get no respect.” The fact that nutritional science is not respected by a large segment of the medical profession and is dismissed by not a small segment of the general population is due to the fallacy of the conventional wisdom of nutrition, summed up in the adage “You are what you eat.”

The fact is, we aren’t what we eat. And this is a very good thing. Let me give you an example from my personal experiences.

About twenty years ago, I spent a short time working at a clinic in a developing nation in Asia. We had a large bowl of white rice at every meal. For between-meal snacks, we had white rice steamed in banana leaves. White rice provided 80 to 90 percent of our daily calories. At least once a day, usually at breakfast, we’d also have a vegetable harvested from the courtyard (usually long green beans or sweet potato greens), a green banana perhaps, or an occasional piece of fruit picked fresh from the tree or a green papaya shredded for a salad. Every breakfast came with a nutritious spoonful of fish, rotted fish.

Tiny tilapia were left in open jars out in the sun until they completely disintegrated into fatty oil, so fatty that it effectively suffocated the bacteria that rotted it. The resulting fishy elixir was the main source of both fat and protein, except for the bugs that often found their way into the rice bowl.

Milk was virtually unknown in this part of the world. The only kind of milk you could get was instant, contributed by a US AID program. The locals referred to it as “that fine American white cement.” I never actually saw anyone drink it. (They fed it to pigs.) Although meat was available, it was seldom consumed.

An average family of six might consume a half dozen eggs a month and a chicken once a year, or two. Pork was strictly a banquet food, and seafood was sold to government buyers who traded it for foreign exchange. Since the country was in an economic crisis and under martial law, there was no imported food of any kind. Most Americans would regard the diet as primitive, but malnutrition (except for vitamin A deficiencies in infants and toddlers) was very rare.

Shortly before I returned to the States, I was the guest of honor at three banquets. My hosts spent a large part of their savings to feed the attendees at each of these banquets. Under such circumstances, one graciously eats what one is served.

Fresh fish was served at the first banquet. All kinds of fish had been caught in the middle of the night, sneaked past the harbor police, and wrapped in banana leaves and cooked over coals early in the morning. The scent of ginger and smoke was enticing. About a hundred people gathered around the long seafood-laden table. They all waited for me to eat the ceremonial first dish, a delicacy—a bowl of fish eyes.

I ate them. They were chewy. The other banqueters got the rest of the fish. I was only served the eyes, although my hosts did save me some sea bass with ginger from the leftovers. They sent it with me in the local equivalent of a doggie bag, made from banana leaves.

At the second banquet, my host had bought not one or two but twenty chickens. Twenty chickens equaled the lifetime consumption of poultry of many families. After an hour or two of chickens cackling in protest and feathers flying from the kitchen, the aroma of barbecued chicken filled the air. Once again, the community gathered at the table. And once again, a delicacy was placed before me—a bowl filled with twenty chicken beaks.

I ate them. They were chewy. And once again, my serving was the choicest part of the bird, the beak, although I was also offered some steamed chicken feet in red pepper sauce just before dessert.

The third banquet was hosted by the local bishop and was to be held at a nearby restaurant. The official name of the restaurant was Ding Qua Qua, but locals laughingly referred to the restaurant as Ding Meow Meow. In an attempt to avoid being the recipient of yet another local delicacy, this delicacy one that purred, I politely asked the bishop’s assistant if he could arrange for the banquet to be at a restaurant where I could get a kosher meal.

The next evening, the bishop and his staff took me to the local pizza place. Since the economic crisis prevented imports, the pizza emporium had no cheese or wheat flour, so the cook made the pizza dough from rice flour. The round, rice cake pizza was topped with tomato sauce, green papaya, garlic, ginger, and the meal’s main event—whole baby squid, possibly purchased but probably purloined from a local fish vendor. Of course squid are not kosher, but they were certainly more holy and wholesome than kitty chow mein.

I ate them (the squid, that is). They were chewy.

After my adventures with whole foods in Asia, I am happy to report I did not grow fins or start breathing through gills. I do not crow in the morning and I have neither wings nor feathers. At last inspection, I have two arms, not ten tentacles. I’m not what I eat, and neither are you.

The role food plays in our lives is a lot like a lottery in which every participant is a winner. Any food we eat has nutritional value, even if it just the provision of empty calories, which are, as we tend to forget, essential to life. Our bodies are “hard wired” to honor the lives of the plants and animals that become our food by finding nutrition in a practically infinite number of ways. In and of itself, no food is junk. Some foods are more healthful than others.

The value of food to human health, however, doesn’t depend on the food as much as on ourselves. Physiologically, our bodies have to make a token investment in claiming their prize. A minimum level of basic nutrition is necessary for our bodies to extract a maximum amount of benefit from particular foods, but our own bodies determine the fate of our food. We aren’t what we eat. We aren’t even what we digest. Physically, we are what our bodies make from food.

Why Treating Gum Disease Is Both Difficult and Important

2008-12-29T10:20:00.000-08:00

Low-carb eating is especially important for any diabetic who has an infection. Despite your best efforts to keep your blood sugars in check, any infection, especially a kidney or bladder infection, can cause blood sugars to rise. Fortunately, rising blood sugars also serve as an early warning system for impending infections. If you notice that your blood sugars rise 24 hours before the onset of colds or flu, you can take zinc lozenges or Sambucol (an extract of black elderberries) to stop the colds or flu before they start.

Low-carb eating is especially important for diabetics who have gum infections. Frequent dental infections are a sign that blood sugars are poorly controlled, although dental infections also make blood sugars hard to control. If you have high blood sugars you cannot explain, and you are sure your medications are not out of date and your insulin (if you take it) is not contaminated, the very first place you should check for infection is your mouth.

First, check your gums to see if there is any swelling or redness. Gently press them to see if there is any tenderness to pressure. Put some ice water in your mouth for 30 seconds. If a tooth hurts, you more than likely have an infection.

See your dentist immediately. Your dentist can X-ray the parts of your mouth where teeth are sensitive and make sure you do not have a deep infection. Infected root canals are very common in diabetics and make blood sugar regulation very difficult until they are treated.

Foods that Make Controlling Blood Sugars Difficult

2008-12-29T10:19:00.000-08:00

As every diabetic learns very quickly, most carbohydrate foods require extra planning for successful use in a diabetic diet. Almost all grain products will raise blood sugars, increase insulin resistance, and make you fat—unless you follow the recommendations of later chapters in this book. For the short while it will take you to get your blood sugars under control, carbs are a no-no. This even includes items that are labeled “no sugar added” or “sugar-free” unless they truly contain no carbohydrate at all.

Foods that are labeled “sugar-free” are actually some of the most dangerous foods for diabetics. They may not cause tooth decay, but they certainly can raise blood sugars, typically 6 to 24 hours after they are eaten.

This is a partial list of the sugars you can find in “sugar-free” foods. All of them will raise blood sugar:

carob

corn syrup

dextrin

dextrose

dulcitol

fructose

glucose

honey

lactose

levulose

maltodextrin

maltose

mannitol

mannose

molasses

saccharose

sorbitol

sorghum

treacle

turbinado

xylitol

xylose

Fructose, the primary ingredient in high-fructose corn syrup and most abundant sugar in fruits, was once recommended as a sugar substitute for diabetics. A small amount of fructose, about the equivalent of a teaspoon (5 grams) of powdered fructose or the fructose content of a 3-1/2 oz (100 gram) apple, may be helpful to blood sugar control.

Fructose stimulates the liver take glucose out of the bloodstream to make glycogen. It also stimulates fat cells to take glucose out of the bloodstream to make fat—so fruit and fructose should be strictly avoided unless you know your overall food consumption is under control An apple a day can keep the diabetes doctor away only if you are careful not overeat.

Much more than 7.5 grams of fructose, however, has serious deleterious effects. Fructose-rich fruits stretch the lining of the small intestine and stimulate the release of glucagon raising blood sugars, but the fructose they contain does not use require insulin. Blood sugars go up even before the fructose is absorbed, and insulin is free to do the one job it does better than storing sugar, storing fat. Raisins and honey are about 40 per cent fructose. Just 8 or 10 raisins may be all a diabetic adult can process, or 1 fluid ounce (30 ml) of a fructose-sweetened soft drink is enough to trigger fat storage.

Even “innocent” foods like Chiclets and chewing gum deserve scrutiny. A single stick of gum contains 1 gram of carbohydrate. In an average-weight adult, this 1 gram of carbohydrate will result in a blood sugar increase of about 5 mg/dl. Chew a fresh stick every 30 minutes through the morning, however, and blood sugar goes up 50 mg/dl. In a child, this increase might be 200 mg/dl.

If you are diabetic and you choose to eat a high-carb or high-fructose food, do your blood sugar control a favor and at least choose to eat a small portion and wait to see if you are really hungry for more. Diabetics do not have to deny themselves al carbs at all times, but a nibble does less to a diet plan than a super-sized double helping.

Diabetes, Carbohydrates, and Weight Gain: The Big Fat Lie

2008-12-29T10:16:00.000-08:00

Fat is the bugaboo of the American diet. There’s no denying that nearly two-thirds of Americans and similar large numbers in Australia, Canada, and the UK are overweight. There is also no doubt that some fats are better than others. It is a myth, however, that dietary fat in and of itself is the cause of overweight, high cholesterol, or heart disease.

Most body fat for most people does not derive from dietary fat, but from carbohydrate converted to blood sugar and then stored in fat cells. Suppose you eat a platter of pasta. If you are not diabetic or you are doing a good job of controlling your blood sugars, your natural or injected insulin levels will rise to cover the flood of blood sugar entering the bloodstream about an hour after you eat your meal.

Every gram of blood sugar that is not burned or stored as glycogen in the liver (which maintains about a thousand-calorie “buffer” for the body’s short-term energy needs) is stored as fat. You can acquire more body fat from a 250-calorie fat-free oatmeal muffin than from a 3-1/2 oz (100 gram) steak.

But you say, really? The 250-calorie fat-free muffin contains about 50 grams of carbohydrate. If you weigh 150 pounds (68 kilos) and you don’t get any exercise after eating the muffin, your body uses about 20 grams of carbohydrate over the two hours after your meal for respiration, tissue growth and repair, making enzymes and hormones, digesting food, and other basal metabolic activities.

If you overeat carbohydrates only occasionally, your liver can store them as glycogen. The way the chemistry of the liver works, however, every molecule of glycogen, has to be stored with three molecules of water, and the carrying capacity of the liver is only a little over a pound (500 grams) of emergency carbs. And if the glycogen buffer in your liver is not full, the 30 grams of carbohydrate in the muffin are converted to about 120 grams of energy storage that goes right to your midsection.

What if you are diabetic? If you are a type II diabetic, the effects of carbohydrate on fat storage are magnified.

The bodies of type II diabetics still make insulin. In the early stages of the disease, type II diabetics actually make more insulin than people who do not have diabetes, but their bodies do not use it efficiently for moving glucose into cells.

Type II diabetic bodies are wonderfully efficient, however, at using insulin to move fat into fat cells. So overindulgence in carbohydrate sets up a vicious circle. Excess carbohydrate consumption triggers release of excess insulin. The insulin does a poor job of storing glucose, but it does a great job of storing fat. And the fatter you get, the more your cells resist the action of insulin for storing glucose. Less and less glucose gets pulled out of the bloodstream, but fat cells store more and more fat.

So, if you are diabetic, it's not a matter of any kind of lack of discipline if you are fat. Fat is a symptom of diabetes, not the other way around.

Type 2 Diabetes: The Vicious Circle

2008-12-29T08:17:00.000-08:00

Type 2 diabetes does not always require insulin injections, but this form of the disease is the more insidious. Type 2 diabetes is sometimes only diagnosed after it causes a serious complication, such as loss of sight or ulceration of a foot or leg. Like type 1 diabetes, type 2 diabetes has both a genetic component and an environmental trigger. And type 2 diabetes develops in a vicious circle of events.

Some people are born with a genetic defect—actually a genetic characteristic that confers greater likelihood of survival between conception and birth—that causes every cell in their bodies to react to insulin in an unusual way. The outer membrane of every cell in the body holds proteins that act as a lock for which insulin is the key. These receptors grasp insulin and take it inside the cell. In people who are prone to type 2 diabetes, cells reduce the number of receptor sites for insulin if the amount of insulin in the bloodstream increases. That is, if they body makes more insulin, cells change so that they are less, rather than more, able to respond to it.

When people with this genetic characteristic gain weight or become physically inactive or have to spend extended time recovering from illness or injury, a vicious cycle sets in. Increased body fat, especially over the abdomen, physically blocks the flow of blood to the fat cells that ordinarily store and convert sugar. Since glucose cannot reach fatty tissues, it remains in the bloodstream. The pancreas senses the additional sugar and makes more insulin. The additional insulin, however, causes fat cells to lose insulin receptor sites. Both sugar and insulin stay in the bloodstream, and cells lose still more insulin receptor sites, so the pancreas produces still more insulin.

Even when people have a genetic tendency toward type 2 diabetes and become overweight, however, diabetes is not necessarily inevitable. Vigorous daily exercise maintains circulation. If increased circulatory health keeps the blood flowing, the fat cells that use insulin to “catch” circulating glucose and turn it into fat can keep blood sugar levels normal. Alternatively, expanded muscle mass, also from exercise, enables muscle cells to use more glucose and also keep bloodstream glucose levels low.

But when overweight people with a hereditary tendency to diabetes become inactive diabetes results. Even while cells all over the body are losing their ability to respond to insulin, fat cells undergo changes that make them accumulate fats more readily but release them more slowly, compounding poor circulation caused by lack of exercise. As fat cells become “stuffed” with triglycerides, even if sugar reaches them, they cannot process it. Gaining weight becomes easier. The muscle cells are forced to do more and more of the work of keeping blood sugar levels normal, even while their own insulin resistance eventually forces them to use fats and their own proteins for fuel.

The metabolic disruption caused by diabetes affects every cell of the body, but especially the eyes and nervous system. Unlike other tissues, the eyes, the brain, and the nerves do not have to rely on insulin transporters as their only way to receive glucose fuel.

When blood sugars are high, glucose pours into these tissues faster than they can use it, and toxic waste products build up. For this reason, especially in type 2 diabetes, the first obvious symptoms are usually psychological. Excess sugar “revs up” the brain so that many untreated type 2 diabetics appear slightly manic, with racing thoughts, racing speech, and a “go-go mind with a so-so body.” Having too little energy for too much to do is a good time to see a doctor to make sure you do not have diabetes.

Unexpectedly High Blood Sugars and the All-You-Can-Eat Effect

2008-12-29T08:10:00.001-08:00

Part of the peculiar biology of diabetes is a reaction called sometimes called the buffet effect, or the all-you-can-eat effect. Even the healthiest salad or a low-carb, high-soy Asian meal can cause drastic increases in blood sugars.

This is due to the fact that the small intestine contains receptor cells that release hormones into the bloodstream when they are stretch. The small intestine signals the pancreas that sugar is on its way and the body will need insulin to keep blood glucose levels from going too high. The larger the meal, the greater the stretching of the intestinal fibers, and the greater the amount of insulin the pancreas is required to produce.

Just to make sure that blood sugars don’t go too low, the pancreas also releases a hormone called glucagon that tells the liver to release some of its stored glycogen as glucose. This effect is caused solely by the bulk of the food consumed. Whether you eat a huge bowl of salad, a 24-oz steak, or a whole apple pie, the pancreas gets the same message to release insulin, plus some glucagon just in case the small intestine was sending a false alarm.

The trigger for this pancreatic response works the same way in diabetics and non-diabetics. Even if you just eat strictly low-carb foods, if you eat a lot of them, your pancreas gets the same message as if you ate a large meal of high-glycemic carbohydrate. The problem is, in diabetics, the pancreas gets the signal to release insulin and glucagon and can only release glucagon. A bowl of sawdust, if you could get it down, could cause a sharp rise in your blood sugars. A bowl of salad also does.

Even worse, the diabetic pancreas lacks the ability to secrete another hormone produced in this process, amylin. Amylin reduces the blood-sugar increases caused by glucagon, and works on the brain to signal that you have eaten enough. Your body is releasing sugar even when you have eaten a low-carb meal, and your brain is telling you to eat more!

The moral of this lesson is: Don’t stuff yourself! And equally important: There’s no such thing as a free food! Any solid food that your overeat can raise your blood sugars.

Hypoglycemia: What's the Significance of a Diabetic Feeling Drunk?

2008-12-29T08:09:00.001-08:00

The downside of really successful blood sugar control for most diabetics, especially type I diabetics, is the risk of hypoglycemia, sporadic low blood sugars that cause a variety of symptoms. A diabetic feeling drunk without even drinking is a red flag for potentially life-threatening hypoglycemia that requires immediate consumption of glucose.

Blood sugar goes up and down with medication, even the best medications. Blood sugars that run too low can be due to any one or more of a number of causes:

A sudden change from cool to warm weather, or traveling from a cold climate to a warm climate, or staying in an unusually warm room overnight.

Taking an unusually large amount of aspirin or allergy medication.

Drinking too much alcohol, especially before or during a meal.

Eating less than planned.

Taking too much insulin.

Taking insulin injections too close together.

Switching from an insulin pump to insulin injections without lowering the dose.

Taking too much diabetes medication.

Exercising too long without consumption of carbohydrate.

Recovery from an illness, such as a cold or flu, that caused temporarily higher insulin resistance.

Delayed digestion, which may be caused by eating an unusually low-glycemic index meal or a chronic condition called gastroparesis.

Most diabetics learn to recognize a specific feeling of a hypoglycemic episode setting in. Hunger is by far the most common symptom--but hunger is also a sign than cells aren't getting the glucose they need when blood sugars are too high. A diabetic feeling drunk may be in the midst of a hypoglycemic episode when other symptoms include these symptoms of low blood sugar levels?

Confusion.

Clumsiness.

Irritability or uncharacteristic nastiness.

Inappropriate laughter or joking, especially when drinking before a meal.

Anxiety.

Lightheadedness.

Tiredness.

Weakness.

Shouting for no apparent reason.

Waking up from sleep suddenly.

Talking or shouting in sleep.

Visual impairment, including hallucinations, seeingspots, double vision, and blurred vision.

Lesser ability to taste sweet foods (this is very temporary).

Cold, clammy skin, especially on the back of the neck.

Shallow breathing.

A combination of these symptoms with a diabetic feeling drunk is a good indicator of a hypoglycemic episode, but the way to know for sure is a finger stick for a reading with a glucometer.

And when there is hypoglycemia, it's important not to overcorrect. Even if you weigh 400 pounds (180 kilos), just 15 grams of glucose (that's half an ounce or 3 to 5 glucose tablets) is enough to stop an emergency.

Pure glucose is what your body needs and it's the best remedy for hypoglycemia. If you don't have glucose, a sugary (not diet) soft drink (half a can is enough) or a half a cup (120 ml) of juice usually does the trick. Just remember that alcohol and low blood sugars together are a real whammy for diabetics, and blood sugar testing with a glucometer always tells you for sure whether hypoglycemia is really the problem.

Insulin-Dependent Diabetes and Foreign Travel

2008-12-29T08:06:00.000-08:00

First time you've traveled by air since you were diagnosed with diabetes? Here are the basics every insulin-dependent diabetic needs to know before air travel.

Insulin-dependent diabetics should carry their insulin in a thermos in hand baggage on the plane. Diabetic travelers departing the United States and most other problems seldom have a problem with security inspections and are allowed to bring both insulin and syringes on board, but some airports in Europe have confiscated syringes from travelers not carrying a doctor’s prescription. In a pinch, you can probably explain that the labels your pharmacy put on the boxes your insulin came in are the same as a prescription. Diabetic travelers should also carry their glucometers so they will know for sure whether blood sugars are high, low, or normal, and every diabetic should carry glucose tablets or snacks at all times.

Generally speaking, it’s better to have blood sugars a little high than a little low when on board the plane. If you take “slow” insulin once a day, adjust the time of day you take your shot at your destination to match the time you take it at home. For instance, if you take slow insulin at 6 p.m. at home and you fly six time zones west, take your slow insulin six hours earlier (noon) while you’re on your trip. If you fly east, take your insulin later (although it’s usually OK to be late or early an hour on two). For instance, if you fly from Chicago to Moscow (nine hours east) and you usually take your slow insulin a 6 p.m., the ideal time to inject would be 3 in the morning. In those cases, early morning will probably be OK.

All diabetics need to carry diabetic identification at all times, whether a bracelet, necklace, or wallet card. Bracelets and necklaces are more likely to checked by emergency personnel. A wallet card is likely to be checked only if there has been an extreme emergency.

And if you live in a temperate or tropical climate and you are traveling to a more polar climate, get ready for unusual fluctuations in your insulin needs. Many adult diabetics with LADA or type II diabetes have some insulin production in their own bodies. Longer nights, for reasons scientists are just beginning to understand, sometimes increase that insulin production. If you live in Miami and you fly off to Norway, you may find that your sugars are lower than you would expect. Be sure to test your blood sugars even on the busiest travel days. You may enjoy your trip a whole lot more if you do.

Newly Diagnosed? Lower Your Blood Sugars 1-2-3

2008-12-29T08:04:00.000-08:00

If you are newly diagnosed with diabetes, lowering your blood sugars may seem like an impossible task. The fact is, however, nearly all diabetics can lower their blood sugars as easy as 1-2-3. You may see results in as little as a day, or a week, and you have to be willing to test your blood sugars regularly, but blood sugar control is possible.

Here's step number one. You'll find it very easy to follow:

Step 1. Continue eating whatever you have been eating, but write everything down.

Write down absolutely everything you eat for 24 hours, preferably with some note of portion size (grams, ounces, tablespoons, cups, gallons, whatever the measurement may be).

The next step requires you begin your blood sugar testing.

Step 2. Try to duplicate yesterday's food intake, taking your blood sugar before you have eaten anything in the morning, and one hour and then two hours after every meal.

If you nibble all day, just take fasting and three more blood sugar readings during the day.

Now take a look at how food affects your blood sugars. The thing about diabetes diets is, no one diet works perfectly for everybody. Some people are especially sensitive to sugars. Some people have a relatively slow digestion so their post-prandial or after-meal spikes are low, but their fasting sugars are high. Look at your data to see how the food you eat affects you.

Then begin to make small changes.

Step 3. Try small changes in the foods you have been eating and note the changes in your blood sugars.

Here the key term is small. Small changes are changes you can stick to, and changes that won't cause major fluctuations in blood sugars that lead to premature use of drugs or increases or decreases in drug dosage. There might be some small change in your diet that will lead to control for you, or there might not. But you will never know unless you test your diet and test your blood sugars.

How will you know when you have cut back carbohydrates enough?

Most doctors recommend keeping blood sugars at the following levels:

100 mg/dl (5.5 mM) or lower fasting
140 mg/dl (7.5 mM) or lower one hour after a meal
120 mg/dl (6.5 mM) or lower two hours after a meal

If you are over 55, or if you have had undiagnosed diabetes for a long time, you may want to take your blood sugars two or three hours after a meal. Some people digest carbohydrates more slowly and reach blood sugar peaks later.

Once you have attained your goals, you may want to try adding back carbohydrates in small amounts to see if you can keep you blood sugars down. Remember, small inputs lead to small errors in blood sugar control. Test, test, and test some more, and you will get your blood sugars lower.

Eat More Often, Weigh Less?

2008-12-29T07:58:00.000-08:00

One of the confounding results of diet research has been the discovery that eating more frequently seems to be associate with slimmer waists and lower weight. But Canadian scientists have found that, at least for women who have not reached menopause, eating more often has more to do with being "on the go" than any diet secret.

Researchers at the Faculty of Health Sciences of the University of Ottawa, the Department of Nutrition of the Université de Montréal, and the Montreal Diabetes Research Center tracked the eating habits of 85 women in their late 40's and early 50's who had not yet entered menopause. They found that women who ate more often also consumed more calories, but had:

Slimmer waists,
Lower BMI (body mass index),
Lower percentage body fat, and
Lower mass of body fat.

At first blush, it would seem that eating smaller meals more often helps you lose weight. When the clinical study participants' physical fitness was measured by equipment that computes peak oxygen expenditure (roughly, how much huffing and puffing the women needed to accomplish physical work), however, the most fit and active women were the ones with the slimmest weight and lowest body fat. Physical fitness explained all the differences in weight and body fat. And, it's important to emphasize, women who ate more often consumed more calories.

Nibbling really won't help you lose weight, but snacking won't hurt you if you're physically active. Just remember that you have to be active to avoid weight gain.

Source:

Karine Duval, Irene Strychar, Marie-Josée Cyr, Denis Prud'homme, Rémi Rabasa-Lhoret and Éric Doucet Physical activity is a confounding factor of the relation between eating frequency and body composition American Journal of Clinical Nutrition, Vol. 88, No. 5, 1200-1205, November 2008.

Can You Really Lose Weight on a High-Fat Diet

2008-12-29T07:55:00.001-08:00

Can you really lose weight on a high-fat diet? Recent research from Denmark says the answer is yes, but it won't be easy to keep the weight off once you stop.

A team of researchers from four Danish medical facilities did a six-month study of enhanced-fat, low-fat, and calorie-reduced diets to see not only how successful dieters were at losing weight and keeping it off, but also how their diets affected cardiovascular risk factors and blood sugars. Their test subjects were aged 25 to 35.

All dieters lost weight, and all dieters regained some weight when they stopped dieting. The amount of weight regained was lower among dieters who had followed low-fat diets or a high-fat diet in which the added fat came from olive oil and fish. Dieters who just ate less of their regular high-fat diets regained the most weight when they stopped their portion control.

There was also a difference in cholesterol levels. The lowest cholesterol was found in the group that ate the most fat, and the highest cholesterol was found in the low-fat dieters.

This may seem counterintuitive, but there's a reason why. The human body makes most of its own cholesterol, and "flushes" the excess away through the bile. The more mono-saturated fatty acids (like those in olive oil) you consume, the easier it is for the excess cholesterol your body makes to be removed with bile salts.

And the group that ate the most healthy fat had the lowest insulin levels. Increased insulin levels is often a prelude to insulin resistance that leads to diabetes.

So a dash of olive oil for dressing your diet salad seems to be a good idea. Just be forewarned that of all the approaches to losing weight, adding healthy fat seems to be hardest plan to stick to. But if you have any risk factors for diabetes, it's probably the best.

Source: Anette Due, Thomas M Larsen, Huiling Mu, Kjeld Hermansen, Steen Stender and Arne Astrup Comparison of 3 ad libitum diets for weight-loss maintenance, risk of cardiovascular disease, and diabetes: a 6-mo randomized, controlled trial American Journal of Clinical Nutrition, Vol. 88, No. 5, 1232-1241, November 2008.

Green Tea for Cholesterol

2008-12-29T07:52:00.000-08:00

To be honest, I've become kind of burned out by all the hype about the health benefits of green tea. Recently, however, I came across a study of green for cholesterol in kids, however, that's really worth passing on.

Nowadays there is pretty general acceptance of the idea that green tea has remarkable health benefits, and there is growing evidence that it is an essential element in the best diets for high cholesterol, notably for children with high cholesterol.

A team of medical researchers at the Nippon Medical School in Chiba (Japan) gave 40 volunteers either 500 milligrams of green tea catechins (that’s the equivalent of drinking 6 or 7 cups of green tea a day) or a placebo for four months . The scientists found that in the green tea group at the end of the twenty-four week trial:

Total cholesterol was essentially unchanged,
Triglycerides also were unchanged,
LDL cholesterol stayed the same, but

The fraction of LDL particles that had been attacked by free radicals and oxidized into a form that cause plaques in the lining of arteries fell nearly 18 per cent. Since it is oxidized LDL cholesterol that actually clogs arteries, green tea is more effective in heart health than beta-carotene, vitamin A, vitamin C, or vitamin E.

Green tea may also help children with high cholesterol. The journal Obesity reports that Japanese children who were given a drink containing 576 milligrams of green tea catechins once a day for six months lowered LDL and blood pressure and enjoyed slimmer waistlines while continuing normal bone and muscle growth.

And if that is not enough, there is evidence that for people who eat a high-fat diet, green tea acts as a cholesterol-blocker. Green tea attacks the very causes of high cholesterol, keeping cholesterol from ever entering circulation. The catechins in green tea mix with the cholesterol so that it clumps and is excreted rather than absorbed. They do not interact with essential n-3 fatty acids and fat-soluble vitamins. Good fats in, bad fats out.

The easiest way to get your catechins is to take a supplement, but many people prefer to brew their own green tea. Here’s what you need to know to brew a heart-healthy green tea:

Green tea develops a full flavor and releases the most catechins if it is brewed at about 140 degrees F (80 degrees C). Black tea, in contrast, is usually brewed in water that is almost boiling. You make the catechins unavailable if you add milk to hot green tea (although green tea ice cream typically has a high catechin content). Loose green tea has a higher catechin content than bagged green tea.

Most of the complaints about green tea center on its taste, or lack thereof, but you can be creative. In addition to the well-known green tea ice cream (which is not really on any list of heart-healthy foods), it is possible to add anywhere from a pinch to a teaspoon of loose green tea to burgers, omelets, salads, smoothies, soups, sauces, oatmeal, and even burritos. The benefits of green tea start at about four cups a day, so start there!

Eggs and Cholesterol

2008-12-29T07:51:00.000-08:00

I have a confession to make. I like eggs. From my head down to my legs. So it's possible I am biased on this topic. But here's my thinking on eggs and cholesterol.

The relationship between eggs and cholesterol is not what most people have been led to believe. Not only do eggs not always raise cholesterol, sometimes they lower it.

About one-third of the population is unusually sensitive to the cholesterol in egg yolks. Medical researchers at the University of Connecticut gave a population of men and women over the age of 50 either three eggs a day or an equivalent serving of cholesterol-free egg substitute. None of the participants in the trial was on any medication to lower cholesterol

Among the two-thirds of the participants in the trial who were not especially sensitive to the cholesterol in egg yolks, eating three eggs a day not only did not raise cholesterol, total cholesterol went down. In the majority of test participants, eating three eggs a day slightly lowered LDL cholesterol and triglycerides, and slightly increased HDL cholesterol. Conversely, eating an equivalent amount of egg substitute caused slight increases in LDL, total cholesterol, and triglycerides, and a slight decrease in the beneficial HDL.

In the one-third of the participants the researchers labeled hyper-responders, the opposite occurred. For this smaller group, eating three eggs a day raised cholesterol, but in a heart-healthy way. LDL levels increased, but the additional LDL was the larger, less clogging variety of LDL. HDL levels also increased, and also were the larger, less dangerous particles. Moreover, eating eggs increased bloodstream concentrations of eye-protective lutein and zeaxanthin.

Eggs have a similarly unexpected effect on cholesterol levels in overweight men. One study found that when eggs are consumed with a high-carbohydrate meal, they seem to accelerate the release of sugars from the carbohydrate, but also to accelerate the release of insulin from the pancreas. The extra insulin “covers” the extra glucose released from digestion. The problem is, insulin stores fat as well as sugar, so eating eggs with carbohydrates seems to increase weight gain.

Another study found that eating eggs as part of a low-carbohydrate diet, on the other hand:

Reduces body weight,
Increases insulin sensitivity,
Increases HDL-C cholesterol, the kind of “good” cholesterol that “catches” other cholesterol particles so the liver can remove them from circulation,
Increases adiponectin, a hormone that fights atherosclerosis, and
Reduces C-reactive protein, a marker of arterial inflammation,

also in tests conducted with overweight men.

A study of 9,734 men and women aged 25 to 74 at the Zeenat Qureshi Stroke Research Center of the University of Medicine and Dentistry of New Jersey found that eating more than 1 egg a day does not significantly raise the risk of either heart attack or stroke.

Since 2000, even the American Heart Association has recognized that Cholesterol-rich foods that are relatively low in saturated fatty acid content (notably, egg yolks, and, to a lesser extent, shellfish) have a (small) effect on LDL. The effects of dietary cholesterol on plasma LDL levels appear to be greater at low versus high levels of cholesterol intake. In other words, for most people, if you consume more cholesterol, your body just uses it faster.

The exceptions to this rule seem to be male doctors and female nurses. The widely publicized Physicians Health Study reported in April 2008 that male doctors who ate more than one egg a day were more likely to suffer heart attack or stroke, especially if they were diabetic.

The study also found that doctors who ate the most eggs also were older and fatter. They ate less breakfast cereal but more vegetables. They were more likely to smoke and drink and less likely to get regular exercise. It is just possible that excessive consumption of eggs was only part of a pattern of excessive consumption of everything else in this group of 21,337 middle-aged male doctors—do you suppose?

For most of us, eggs are not heart-harmful, and if you avoid excess sugars, they are heart-healthy. If you do not have familial hypercholesterolemia or some other rare condition causing excessive cholesterol, regular consumption of eggs is likely to have a beneficial effect on your triglycerides, LDL-C, and HDL.

The Latest Lies about Statins for High Cholesterol

2008-12-29T07:49:00.000-08:00

"Game-changing."

"Paradigm-shifting."

"A colossal breakthrough."

These are just a few of the phrases used to describe the recently published study led by a Brigham and Women's Hospital researcher purporting to show that, in patients with normal cholesterol but high levels of inflammation, the use of Crestor (a new-generation statin drug), should reduce the rates of heart attack, stroke, and death, and all for a mere $100 per month per patient, or up to $30 billion a month to the drug manufacturer should treatment eventually be extended to essentially all adults everywhere.

There's just one problem with this headline-grabbing story. The study didn't show what the mainstream media seems to believe it showed. And even the scientists themselves admitted that their drug seemed to increase the risk of diabetes.

There's so much wrong with the reporting that this is going to be a very long post. I'll start with the obvious. The publicists for the study would have us believe that it proved that Crestor is practically candy for everyone, but the study limited its work to a very select group.

They studied Crestor in older people. The median age in the study was 66, which is to say, half of study participants were older.

Study participants also were somewhat overweight. Their median BMI was 28.3. That's about 192 pounds (88 kilos) for a man who's 5'9" (180 cm) or 165 pounds (75 kilos) for a woman of 5'4" (163 cm).

And most of the study's participants were "prediabetic." The median HbA1C was 5.7%. Endocrinologists do not all agree, but an HbA1C of 5.7% can indicate undiagnosed diabetes.

But most importantly, the study group had elevated blood pressure. While the elevation was slight, a median 134/80, that's enough to suggest a risk for heart disease.

So the Crestor study didn't focus on healthy people.

It also excluded people with the complaints many 50- and 60-somethings have: thyroid disease, any use of hormone replacement therapy, any indicator of kidney or liver abnormality, anyone with diagnosed high blood pressure, anyone with any autoimmune disease, and any with a history of drug abuse or alcoholism. In other words, the researchers were looking for senior citizens with beginning diabetes or heart disease but no other complaints--and how many people even over 50 don't have some ongoing medical condition?

The next thing to look at is results. The study conveniently lists "any myocardial infarctions" and "non-fatal myocardial infarctions." What it does not list is "fatal myocardial infarctions," but you can compute that by subtracting "non-fatal myocardial infarctions" from "total myocardial infarctions."

There's a reason the scientists did not list that figure.

Among the 8901 people not taking Crestor, six died of a heart attack. Among the 8901 people who did take Crestor, nine died of a heart attack.

How many people had non-fatal heart attacks during the three years of the study? If you were in the study and you weren't taking Crestor, your risk of a heart attack was about 1 in 300. If you were taking Crestor, risk of heart of attack was about 1 in 600.

So the drug company can honestly claim that their product seems to reduce the risk of having a non-fatal heart attack by 50% (even though it raises the risk of having a fatal heart attack by the same 50%). What isn't told is that the reduction in risk was from 1 in 300 to 1 in 600.

And to be fair, there were 31 fewer strokes in the Crestor group and 3 fewer deaths from stroke. But 54 more people in the Crestor group developed diabetes.

So what's the bottom line?

Any difference Crestor makes in heart health, good or bad, is small. The absolute improvement in risk of heart attack was 1 in 300, or 0.3%.

The study seems to confirm the idea that inflammation, not cholesterol levels, are what count.

Crestor reduces risk of stroke and heart attack, but raises rate of deaths from heart attack. It's important to note that only 1 in 1000 participants died of heart attack, with or without the drug.

Crestor seems to increase the risk of progressing from prediabetes to diabetes.

The study did not look at memory loss, dementia, or kidney and liver damage in people already known to be susceptible to those conditions. Nor did the study look at the impact of cheaper generic statin drugs such as Zocor (simvastatin).

You have to look at the find print to find essentially all the authors receive money from AstraZeneca, Novartis, Merck, Abbott, Roche, Sanofi-Aventis, Vascular Biogenics, Genentech, Relians, Aegerion, Reaverlogis, Pfizer, or Schering-Plough.

So what should you do?

If inflammation is more than cholesterol as the study suggests, make sure you have an inflammation problem before your doctor gives you a statin drug. That means a test for CRP rather than just a cholesterol reading.

Make sure your doctor runs a liver panel before giving you Crestor and repeats blood tests for liver disease regularly.

Don't take Crestor if you have a family history of age-related memory loss or dementia, and stop taking Crestor if you experience muscle pain (and call your doctor).

But before taking any drug for inflammation, consider taking supplement fish oil and lowering the amount of carbohydrate in your diet, following up with your doctor after you've tried them for at least 3 months. The natural approach just might save you both side effects and $100 a month.

If You Are Diabetic, Fat Is Not Your Fault

2008-12-29T07:48:00.001-08:00

Most newly diagnosed type 2 diabetics (and even some newly diagnosed type 1 diabetics) have a few extra pounds around the waist.

It's common for diabetics, their families, their friends, their coworkers, and even their doctors to blame diabetes on fat.

The fact is, diabetes makes diabetics fat, not the other way around. The reason is a phenomenon called insulin resistance. The way insulin resistance packs on the pounds is something like this:

You eat a food containing fat, and your body converts the fat into fatty acids that begin to circulate in the bloodstream. Some of these fatty acids arrive at fat cells, where insulin helps move the fat inside the fat cell for storage.

Insulin that's "busy" transporting fat isn't available to remove sugar from the bloodstream and into the cells where it's needed. Fortunately, for non-diabetics there's enough insulin to go around.

The problem in people with a genetic predisposition to diabetes is, fat cells aren't very good at using insulin to store sugars, but they're great (300 times better) at using insulin to store fat. In people who have the genes for diabetes, fat cells are particularly unskilled at storing sugars but just fine at storing fat.

It's as if fat cells gulp down fatty acids and try to suck up glucose through a tiny straw. As fat cells grow larger and larger, it's harder and harder for glucose to find that "straw," its receptor sites. It's no problem for fat to get in, however. Eventually, the fat cells are leaving so much glucose in the bloodstream that the pancreas acts to remedy the problem by pumping out extra insulin.

This extra insulin, of course, also transports fat. Fat cells get fatter and fatter and blood sugar levels go higher and higher.

The problem is even worse in the liver and the muscles. Liver and muscle store (and use) glucose, too, but they have protective mechanisms to keep them from being overwhelming with toxic free radicals of oxygen.

The free radicals of oxygen become a problem when there's so much glucose in the bloodstream it begins to "burn," that is, to oxidize, before it even reaches a cell.

To protect themselves against free radicals, liver and muscle cells turn off their receptors for insulin. They become "insulin resistant." This protects their RNA and DNA from free radical attack, but it makes it even more difficult for fat cells to remove glucose from the bloodstream.

Insulin, of course, is not the only hormone involved in fat storage and fat burning. But insulin is the key hormone in blood sugar regulation.

If you have type 2 diabetes, that is, your pancreas makes a lot of insulin that cells can't use, you'll store fat really well. If you have type 1 diabetes, that is, your pancreas makes little or not fat, your body will burn fat because that's the only fuel it can use well.

That's why type 2 diabetics are usually overweight. There are, however, genetic conditions (especially among people whose ancestors come from India, Pakistan, Sri Lanka, or Bangla Desh) that create super-storing fat cells even in type 1 diabetes.

Insulin resistance is the reason fat is not your fault. It's also the reason that dieting to lose fat when you have diabetes is especially difficult. Fortunately, weight loss, as you'll read in later posts, is not your primary goal in a diabetes diet.

Lowering Cholesterol by Lowering Salt

2008-12-29T07:42:00.000-08:00

Some years ago I was fortunate to have spent a week interviewing Demetrio Sodi-Pallares, an internationally renowned cardiologist who had a very different approach to lowering cholesterol.

A woman whose heart had been damaged by rheumatic fever was referred to "Dr. Sodi," as we called him, for ongoing heart treatment. When the doctor first took a look at her lab results, he could hardly believe his eyes.

Total cholesterol came back at 800 mg/dl. As you probably know, 200 mg/dl is about the upper limit of healthy cholesterol.

Total cholesterol came back at 4500 mg/dl. A healthy level is generally 150 mg/dl or lower. And Dr. Sodi's patient also had extremely low levels of T4, the thyroid hormone.

At first, the doctor simply did not believe the lab. He sent blood samples to two other laboratories for verification, and the numbers came back nearly the same. One laboratory reported triglycerides were 4339 mg/dl, and the other, 4442. Since triglycerides at this concentration are almost visible in the blood, Dr. Sodi decided lipid lowering was urgent, but he was at a loss as to what to prescribe.

Then, acting on a hunch, the doctor gave his patient some very unusual instructions:
Eliminate salt from your diet. No canned soups, no pickles, no food made from mixes, no barbecue, only half a teaspoon of salt to be added to food in any one day. The doctor showed his patient a thimble. "This," he said, "is half a teaspoon of salt."

If this patient improved, it would be due to cutting out the salt, not cutting out the fat. Dr. Sodi wanted to save his patient, who was extremely poor and had no insurance, the expense of cholesterol- and triglyceride-lowering drugs, as well as their side effects. But he gave the diet only two weeks to work.

Two weeks later the patient returned to the doctor to have her blood drawn, and cholesterol and triglycerides were measured yet again.

The results were not perfect, but they were enormously improved. Triglycerides were now 800 mg/dl and total cholesterol was 240 mg/dl. That was interesting, but the doctor was concerned that results might have been a fluke. He told her, therefore, go back to your original low-fat, low-cholesterol diet, but eat all the salty foods you want.

The patient returned for a third visit in a month. Triglycerides were back up to 2224 mg/dl, and cholesterol had skyrocketed along with it. She was so fatigued she asked if she could not have a prescription for Synthroid.

But the doctor had a different idea. He asked her to go back to the very low sodium diet, but to eat all the eggs and unsalted butter she wanted. This brought triglycerides down to 600, which is still too high but an enormous improvement, and cholesterol to 240.

Dr. Sodi was working with impoverished patients who had no insurance, but results have also come from well-to-do Americans. When I mentioned this method in a radio interview, an 82-year-old man who had had two heart attacks and two angioplasties and who was taking Lasix, Norvasc, Tenormin, and Lescol called in and said he'd ask his doctor about trying the plan for a month (and you should make any dietary change working with you doctors, not against them).

Six weeks later he emailed, that he was no longer on Tenormin for high blood pressure or Lescol for high cholesterol, and "Had my routine check-up yesterday by my cardiologist and she was surprised and pleased with my progress. We have dropped two of my medications. Triglycerides are 80 down from 150, HDL 48 up from 40, and LDL 117 down from 147. How about that!"

When drugs don't work, and you can't find any more fats to eliminate, work with your doctor to follow a very low sodium diet. You may be equally happy with the results. a>

The Seven Habits of Highly Successful Diabetics

2008-12-29T07:39:00.000-08:00

With a note of appreciation to Dr.Stephen Covey to coining the phrase, here is my take on the seven habits of highly successful diabetics. These are not new ideas, and they certainly do not require diabetics to buy new products. They are simply commonsensical, time-tested principles that can help every diabetic design a truly healthy blood sugar control diet.

1. Drink only no-calorie beverages, preferably water and green tea.

When the question is "Got milk?" diabetics should not say yes. Liquid milk is loaded with lactose sugar, and as little as 1/4 cup (60 ml) will cause a rapid rise in blood glucose levels in most diabetics. Fruit juices and sugar-sweetened beverages are obvious no-no's, and most artificially sweetened beverages just make it harder to kick the sugar habit.

2. Get your carbohydrates from vegetables and a very small amount of fruit.

Any diabetic can easily eat too much noodles, potatoes, bread, cereal, or rice, but it's very difficult indeed to get a blood sugar high from too much spinach. The carbohydrates in vegetables are slowly released and slowly absorbed. This gives the body's long-term, "second phase" production of insulin or a type 1 diabetic's injected insulin a chance to transport sugars that cannot be "covered" when diabetics eat fast-acting carbs.

"Slow" foods for diabetics include artichoke hearts, asparagus, avocado, bitter melon, bamboo shoots, green and red but not yellow bell peppers, bok choy, bottle gourd, broccoli, brussels sprouts, cabbage, celery, celeriac, Chinese leek, choy sum, collard greens, daikon, dandelion greens, eggplant, endive, escarole, green beans, hearts of palm, kohlrabi, komatsuna, lo kui, luffa (the edible kind, not the scrubbing kind), mushrooms, mustard greens, okra, pak choi, pei tsai, pumpkin, radicchio, rhubarb, sauerkraut, scallions, snow peas, spaghetti squash, spinach, string beans, summer squash, turnips and turnip greens, water chestnuts, watercress, yin tsai (amaranth leaves), zucchini and zucchini blossoms. Beets, carrots, onions, tomatoes, and fresh fruit should be eaten in small amounts only. All diabetics get better control if they avoid bread, potatoes, and grains altogether.

3. Eat complete protein with every meal.

A "complete" protein contains all the amino acids the human body needs for nutrition. Sources of complete protein that are low in carbohydrates include meat, fish, eggs, soy, cheese, and quinoa, although quinoa should be eaten in moderation.

Why eat complete protein?

The body can convert amino acids into glucose. Even eating meat can slowly raise blood sugars. If you consume complete protein, your body will not have to strip some amino acids out of tissue, while having too much of other amino acids it turns into sugar.

4. Eat small meals more frequently.

The best-disciplined diabetics often tend to starve themselves to get lower blood sugars. Particularly if you are active, it is important to have a steady stream of both carbohydrate and protein so tissues can keep themselves in good repair. It's especially important to keep carbohydrates and proteins available if you are trying to build muscle.

Insulin-dependent diabetics who eat small meals regularly are able to manage their blood sugars with "slow" rather than "fast" insulin. The use of slow insulins like Lantus greatly reduces the risk of hypoglycemia or insulin shock.

5. Eat vegetables with every meal.

Even diabetics need carbohydrate, they just do not need very much. The vegetables listed for the second rule above are advisable for breakfast, lunch, dinner, and every meal in between.

6. Make sure that you get some fat every day.

Although monounsaturated fats like olive oil and omega-3 fatty acids like fish oil are widely considered "healthy," the fact is, the body needs omega-6 and omega-9 fatty acids from a variety of plant and even animal sources to power the immune system and to enable at least the level of inflammation that removes diseased or damaged tissue. Up to 35 per cent of calories can come from fat. It may help to know the human body makes most of its own cholesterol.

7. Finally, eat mostly whole foods.

Minimally processed foods have tremendous advantages for diabetics. They release sugars slowly. They contain more antioxidants, vitamins, and minerals. And they contain more water, so they are more filling.

Diabetics who can follow these seven rules 90 per cent of the time are a long way down the road to good blood sugar control. And if you are in the early stages of type 2 diabetes, monitoring blood glucose levels and following these seven rules assiduously may even help you reverse diabetes entirely.

How Teens with Type 2 Can Shed the Pounds

2008-12-29T07:36:00.000-08:00

Managing diabetes is challenging at any age, but it’s especially difficult for teens with type 2 diabetes, who have to gain muscle while they lose fat. Fortunately, the science of nutrient timing is beginning to give us some insight in just how this seemingly impossible feat is accomplished.

Most experts in sports nutrition, Dr. John Berardi, for instance, tell their elite athletes they should eat a complete meal, protein, carbs, and fat, about every three waking hours. The same principle applies to teens performing the elite feat of losing fat while gaining muscle.

There are very good reasons for recommending snacking and small meals to teens with type 2 diabetes.

Stop-and-go activities like a dash between classes require quick energy in the muscles. Endurance activities, that can be as simple as tapping your feet, require long-lasting energy in the bloodstream.

The body’s answer to both needs is glycogen. It stores glucose away in the muscles and liver in the form of glycogen so it doesn’t have to drain this vital sugar out of the bloodstream. Glycogen is right where the muscles need it when they have sudden heavy energy demands, and the liver can turn glycogen into a steady stream of glucose for longer activities.

Another of the very good reasons type 2 teens should eat balanced meals frequently is recovery. After any kind of exertion, and throughout the growth process, muscles need to replenish their glycogen energy supplies and to repair their proteins.

Their first priority seems to be the protein. Muscles take in glucose to make glycogen, but they can’t do this efficiently unless they’re taking in amino acids, too. Ergo, athletes drink their protein-fortified energy drinks during and after workouts to protect muscle. Teens with type 2 diabetes may not need the carbs of an energy drink, but they do need protein.

The principles are the same for diabetics doing either milder exercise or a heavy workout, except for the carbohydrate replenishment part. Diabetics don’t have to do “carb loading.” They’re pretty much already carb loaded.

And if teens with type 2 diabetes are going to eat extra carbs, right after the workout is a good time to eat them. Exercised muscles store 51 per cent more glucose as glycogen than muscles that haven’t been exercised. That’s a really big difference is how much exercise lowers blood sugars. To get this benefit, diabetic teens need protein, and they especially need it after exercise.

When It's Better for Diabetics to Be Couch Potatoes

2008-12-29T07:34:00.000-08:00

If you are a diabetic, there may be times that it’s better not to exercise, at least until you get your blood sugars down.

It’s a popular half-truth that exercise always lowers blood glucose levels. The reality is that exercise really does lower blood sugars through an increase in the number and activity of glucose transporters in muscle provided:

· There’s adequate insulin in the bloodstream.
· The period of exercise has to be long enough.
· Blood sugars can’t be too high before exercise, and
· For most diabetics, the exercise is not done within three hours of waking in the morning.

Any exercise that makes you even a little short of breath will release a surge of stress hormones such as cortisol. These stress hormones stimulate the liver to convert glycogen into glucose to make sure the muscles have enough sugar to burn.

If there isn’t enough insulin in circulation, however, glucose can’t be transported into the muscle cells that need it. It’s not unusual for swimming, climbing, weight lifting, or basketball to cause surges to the 300-400 mg/dl (16.5-21 mM) level in diabetics. If there is not enough injected insulin, or the body’s own insulin is insufficient, exercise, paradoxically, results in higher blood sugar levels, not lower.

Also due to the effects of cortisol and epinephrine, brief strenuous exercise raises blood sugar levels, while prolonged strenuous exercise lowers them. If you exercise for just a minute of two, say, doing one set of six repetitions in your weight lifting routine, the resulting release of cortisol will trigger the liver’s conversion of glycogen to glucose.

The first 1-2 minutes of heavy exercise release the glucose muscles need, but you need another 6-8 minutes for muscles to use the glucose and get blood sugars back down. Prolonged heavy exercise, that is, at least 20 minutes, will increase the rate at which muscles use glucose for their recovery for 1 to 3 hours.

You might consider just lying on the couch if your sugars are over 170 mg/dl (8.5 mM). That’s because the sugar released during exercise has another effect on muscles, creating insulin resistance.

Glucose in the bloodstream can oxidize even before it is absorbed by a cell. This “burning in the bloodstream” releases toxic free radicals that can damage muscle cells.

The cells protect themselves by becoming less responsive to insulin so they do not import either the glucose or the free radicals. Over time, however, they become less and less responsive to insulin even at rest. That’s why exercise to lower unusually high blood sugars generally is not a good idea, unless it is extremely gentle (like walking slowly).

Finally, most diabetics should not be morning exercisers, especially if fasting sugars test as high as sugars throughout the day. The body recycles insulin during sleep, so less insulin is available early in the day. When there isn’t enough insulin, exercise cannot lower sugars.

None of this means that diabetics shouldn’t exercise. Quite the opposite, regular, prolonged, heavy exercise builds up muscles which in turn soak up glucose. To make healthy muscles, however, always start your workout knowing your blood sugars are under control and take steps to ensure they will stay in control throughout.

The Effects of Uncontrolled Blood Sugars on the Immune System

2008-12-29T07:29:00.000-08:00

Whether you are a newly diagnosed diabetic or you have had diabetes for many years, one of the most critical aspects of blood sugar control is the deleterious effects of high blood glucose levels on the immune system. Infections, especially gum, bladder, and kidney infections, can wreak havoc on diabetes control.

Diabetes guru Dr. Robert Bernstein notes that a kidney infection can triple insulin requirements overnight. My personal experience from taking care of family members has been that older diabetics especially tend to get "loopy" when they have bladder infections. The combination of the stress of the infection and the stress of high blood sugar levels creates a kind of dementia that, fortunately, usually abates when the infection is brought under control. Scientists at Finland's Päijät-Häme Central Hospital note that the problem is especially severe when steroids are administered to treat or prevent shock by a "shot" (bolus injection) rather than by a "drip" (intravenous infusion).

Pneumonia can pose an even greater stress on diabetics. A study at Wake Forest University found that the average insulin (Humalog) requirement in diabetics suffering pneumonia after injury went up from 7 to 26 units a day, a nearly four-fold increase.

But what if you are diabetic but you are not an older person with a bladder infection or a crash victim suffering pneumonia?

There are two kinds of infections diabetics of all ages need to be careful about.

One is the common cold. The effect of a cold on insulin requirements is less dramatic than the effect of pneumonia, but it is not unusual for blood sugars to soar the day before cold symptoms are noticeable. That's why keeping kids infection-free benefits every diabetic in the household and diabetics should be especially careful not to feed a cold.

An even more serious problem is any kind of gum disease. Gum disease and diabetes make a vicious circle. Gum disease can cause high blood sugars, and high blood sugars feed the bacteria that cause gum disease. Whenever your diabetes medications or insulin aren't "working," the first place to look is your mouth.

See if there is any sign of infection, tenderness to pressure, swelling, or redness of the gums. Then put some water with crushed ice in your mouth for a minute. If a tooth hurts, there may be a gum infection.

Whenever you have even the hint of gum infection, make an appointment with your dentist as quickly as possible, even on an emergency basis. Gum infections are very common in diabetics and it is essential to bring them into control to keep blood sugars and insulin requirements down.

References:

Martin RS, Smith JS, Hoth JJ, Miller PR, Meredith JW, Chang MC. Increased insulin requirements are associated with pneumonia after severe injury. J Trauma. 2007 Aug;63(2):358-64.

Loisa P, Parviainen I, Tenhunen J, Hovilehto S, Ruokonen E. Effect of mode of hydrocortisone administration on glycemic control in patients with septic shock: a prospective randomized trial. Crit Care. 2007;11(1):R21.

Is "Sugar-Free" Really Sugar-Free?

2008-12-29T07:28:00.001-08:00

If you are a diabetic who cannot explain an unexpected spike in blood sugars, the problem just could be "sugar-free" candies and desserts.

Table sugar (sucrose, which is a chemical combination of fructose and glucose) produces a well-known effect on blood sugars that diabetics know to avoid. The problem is, almost any sugar substitute with a name that ends in -ol or -ose will also raise blood sugars, just a little more slowly.

A "sugar-free" mint sweetened with sorbitol, for example, can raise blood sugar levels between 12 and 13 mg/dl. If you eat ten of them, chances are you will raise your blood sugars about 125 mg/dl.

There is a dizzying variety of chemicals that are intensely sweet and truly sugar free:

Acesulfame-K (The Sweet One, Sunett),
Aspartame (Equal, NutraSweet),
Cyclamate tablets (not yet available in the USA),
Neotame tablets (not yet available in the USA),
Saccharine (Sweet 'n Low), and
Sucralose (Splenda)

The problem with the powdered versions of all of these sweeteners (aside from their other health effects) is that all of them are mixed with sugar to provide bulk. The amount of NutraSweet you really need to sweeten your coffee, for example, is so small you could not see if come out of the package. The makers of NutraSweet, Sweet 'n Low, Equal, and similar products add glucose (dextrose) or maltodextrin to every packet, providing 1/3 as much sugar as a similarly sized package of pure cane sugar.

Stevia powder, however, contains no added sugar, and liquid forms of all the sweeteners listed above are genuinely sugar-free.

"Sugar-free" candies and ice creams are even more problematic. Many diabetics's blood glucose levels are just fine 2, 4, or even 12 hours after eating them, but there can be a huge spike in blood sugars the next day.

That's because the body eventually converts the "sugar-free" sweeteners into blood glucose. Products made with any of the sweeteners on this list will raise blood sugars just as much as any regular-sugar dessert, only over the course of 24 hours, not 4-6:

Carob
Corn syrup
Dextrin
Dextrose
Dulcitol
Fructose
Honey
Lactose
Levulose
Maltose
Mannitol
Mannose
Saccharose
Sorbitol
Turbinado
Xylitol
Xylose

Because the effects of these sugar-substitutes are unpredictable, diabetics may actually be better off consuming small amounts of known sugars in special situations, such as just before exercise. Stevia is also essentially carbohydrate-free (although it does contain minute traces of some carbs, not enough to raise blood sugars even 1 mg/dl).

Even though diabetics cannot have sugar, they can have flavor. Flavor extracts added to cooking can make food more exciting. Stevia and flavor extracts can be combined to make homemade ice creams and puddings and to flavor yogurt. Here's an example:

Recipe for Making Lemon Ice Cream the Low- or No-Carb All-Natural Way

If you’re new to making low- or no-carb desserts, this recipe for making lemon ice cream is absolute easiest way to start (and there’s a recipe for strawberry ice cream here, too). Even if you don’t have an ice cream maker, you can make this diabetic dessert in minutes for less than it costs at the store.

This recipe for making lemon ice cream has an advantage of all store-bought brands in that you can make an all-natural, stevia-sweetened version. Ice cream made with “sugar alcohols” such as mannitol, sorbitol, xylitol, lactitol, isomalt, maltitol, or hydrogenated starch hydrolysates (HSH) is usually labeled as “sugar free” or “no sugar added.”

Don’t believe it. Sugar alcohols have a negligible effect on blood sugars in the short term, but they are eventually converted to glucose, too. A day after eating your big bowl of “sugar free” ice cream you can be wondering why your blood sugars are so high. Stevia, which the FDA recently decided was safe, after all, will not raise blood sugars and may even lower them ever so slightly, 1 to 3 mg/dl (0.05 to 0.15 mM).

Here’s all you need to make lemon ice cream:

Cream
Lemon extract
Stevia

These are the ingredients for the absolutely zero-carb, almost-no-trace-of-artificial ingredients version. It’s sweet, it’s creamy, it will have no effect on your blood sugars other than slowing down the absorption of any carbs from other foods you eat at the same meal, and it’s scrumptious. It’s also a high-calorie food. Don’t worry, this isn’t the only version of the recipe! Two lower-calorie versions (one of them with just 20 calories a serving and no Nutra-Sweet.

½ teaspoon (2-3 ml) liquid stevia extract or 2 teaspoons (4 grams) green stevia powder
2 cups (480 ml) whipping cream
½ teaspoon (2 ml) lemon extract

If you really must use NutraSweet, it takes 5 packets to equal 2 teaspoons of stevia powder.

If you are using an ice cream maker, just pour the ingredients into the chilled mixer bowl (if your ice cream maker requires you to freeze the mixer bowl first) and turn on the machine. Be sure not to add too much stevia or lemon extract. Both flavorings rely on “tricking” your palate with the slightest hint of bitterness to activate sweetness receptors. Too much stevia or lemon extract and the end product tastes bitter. I know this from experience.

If you don’t have an ice cream maker, use a mixing bowl that’s just large enough to hold the 2 cups of cream. Pour in the cream and stir in the stevia. Cover the stevia-sweetened cream with plastic wrap and put the bowl in the freezer for 1 hour or until the mixture is just beginning to freeze around the edges.

After the mixture begins to freeze, take it out of the freezer and the lemon extract. Give the ice cream a thorough stirring, replace the plastic wrap and return to the freezer for another hour. At the 2-hour mark, take the ice cream out and beat again. Replace the plastic wrap and allow the ice cream to freeze until it’s firm enough to stay in the bowl but soft enough to dip. This usually takes about six hours. Two cups of cream makes 6 servings of ice cream.

The all-cream ice cream has no carbohydrate but 225 calories per half-cup serving.

If you can tolerate about 6 grams of carbohydrate a serving and you want to cut the calories in half, then try this no-eggs, no-gluten half-and-half lemon ice cream recipe:

½ teaspoon (2-3 ml) liquid stevia extract or 2 teaspoons (4 grams) green stevia powder
1 cup (240 ml) whipping cream
1 cup (240 ml) skim milk, whole milk, or almond milk
¼ cup (60 ml) fresh lemon juice
1/8 teaspoon (0.5 ml) lemon extract

Same procedure as above, adding lemon juice and lemon extract after the milk and cream mixture has begun to firm up in the freezer, if you don’t have an ice cream maker.

How about a strawberry sugar-free ice cream? To make strawberry ice cream, use just 2 tablespoons (30 ml) of lemon juice but add 2 cups (300 g) of sliced fresh strawberries at the same time you’d add lemon.

I’ve tried these variations with soy milk, and it works, but you have to be very careful not to use too much stevia or lemon extract. Soy milk can have a slight, bitter aftertaste that really comes out if you use too much stevia.

Now if you are really just wanting a recipe for lemon ice, not a recipe for lemon ice cream (zero fat, 3 grams of carbohydrate and just 20 calories per 1 cup serving), you’ll need:

¾ cup (180 ml) of fresh lemon juice (3 or 4 lemons)
½ teaspoon (2-3 ml) liquid stevia extract or 2 tsp (4 grams) stevia powder
6 cups (1500 ml) water

Again, if you must use NutraSweet, it takes 5 packets to equal 2 teaspoons of stevia powder.

Put the lemon juice and stevia in a pitcher or jar and stir thoroughly to dissolve add the stevia. Pour in water and stir to mix thoroughly. Place lemon juice and water mixture in a bowl as above, then cover with plastic wrap and place in freezer 1 hour. Take the mixture out of the freezer, stir with a fork, and replace the plastic wrap. Repeat the procedure at the two-hour mark and once again before serving.

For a tart and colorful variation, replace 2 cups (500 ml) of the water with Red Zinger or hibiscus tea to make beautiful lemon-hibiscus granita. Incidentally, I tried making lemonade ice cubes and then pulsing them in the food processor. The result was closer to a snow cone than to an ice.

Ice creams, ices, and granitas are the easiest diabetic desserts. Just be sure your ice cream freezer bowl is thoroughly frozen and, if you are making ice cream in the freezer, don’t forget to stir!

What Your Doctor Doesn't Tell You About Fats and Carbs

2008-12-29T07:25:00.000-08:00

If you recently have been diagnosed with type 2 diabetes, chances are your nutritional advice has fallen into one of two mutually exclusive categories:

Eat fewer carbs. Your body turns almost all carbohydrates into glucose either quickly or slowly, so to get your blood sugar levels down, eat less carbohydrate.
Eat more carbs. You have diabetes because you are overfat, so replace the fat in your diet with carbohydrate.

It's enough to make you wonder if doctors and nutritionists really know how to treat diabetes, but there is, despite what you may hear from true believers in one kind of diabetes diet or another, value in both approaches.

The idea that diabetics should eat less carbohydrate makes inherent sense. Diabetes is a condition in which either the body is not making enough insulin or insulin does not work effectively. If you are not going to inject insulin or take drugs that sensitize cells to insulin or use medications that force the pancreas to produce more insulin, it makes sense to give your insulin less to do.

In type 2 diabetes, at least in the earlier stages, the body can produce insulin slowly, but not fast enough to take care of a "dump" of carbohydrate from a high-carb meal. For these diabetics, it makes sense to eat a different kind of carbohydrate, the more slowly digested carbohydrates associated with low-glycemic index foods like whole grains and vegetables. Even whole grains and vegetables, however, add up, and there are no "freebies." Too many turnips can raise blood sugars as much as too much cake, only much more slowly.

But what if you ate almost no carbohydrate at all? Wouldn't this be even better for getting blood sugars down?

There is a growing number of doctors and diabetics finding success with diets that allow 1/10 to 1/5 as much carbohydrate as suggested by the American Diabetes Association. The body still needs insulin to move glucose into cells, because about 23 per cent of the amino acids in high-protein foods are eventually transformed into sugar. The body does not need as much glucose, and blood sugars do not swing up and down as they do on high-carb diets, even "good carb" diets. And fats do not turn into blood sugar.

The problem comes when diabetics try to mix the two approaches, eating both high-fat and high-carb, or alternating high-fat and high-carb. If you eat a meal that's mostly carbohydrate, the liver will sense raising blood sugar levels and stop converting its stores of glycogen into even more glucose. If you eat a meal that is high in both fat and carbohydrate, the liver will not sense the load of glucose and stop releasing sugar. This is because the liver is "blinded" to glucose levels by the fatty acids released in the digestion of fatty foods.

A high-fat meal can cause excess production of glucose by the liver for as long as seventy-two hours. And in those seventy-two hours, elevated levels of sugar in the bloodstream can "turn off" muscle cells in ways that make them less sensitive to insulin the next time the diabetic eats any kind of meal, either high-carb or high-fat.

This principle is why both vegan raw foods diets and Atkins-style diets work for getting blood sugars down, provided any food that is consumed is consumed in moderation. The good news is, diabetics who manage to keep both blood sugar and blood fatty acids low for 72 hours begin to repair insulin sensitivity, sometimes to the level of people who do not have diabetes, whichever approach they use.

References:

Hawkins M, Gabriely I, Wozniak R, Mevorach M, Rossetti L, Shamoon H: The effect of glycemic control on hepatic and peripheral glucose effectiveness in type 2 diabetes mellitus. Diabetes 51:2179–2189, 2002.

What Your Doctor Doesn't Tell You About LDL Measurements

2008-12-29T07:22:00.003-08:00

American standards of medical practice dictate that almost every diabetic will eventually be placed on a cholesterol-lowering statin drug, as soon as blood tests come back with an LDL number over 100 mg/dl two times in a row. But most diabetics, and many doctors, don't realize that standard blood tests don't even measure LDL, they estimate it.

While the numbers diabetics get with the lab reports tell them total cholesterol, HDL, and triglycerides, the LDL number is a guestimate. That's because low-density lipoprotein (LDL) is lighter, bulkier, and harder to measure directly, so labs make a quick and dirty approximation as follows:

Total cholesterol - HDL - 1/5 of triglycerides = Estimated LDL.

We tend to think of cholesterol as either HDL ("good") or LDL ("bad"), but there is also another form of cholesterol, VLDL, or very low density lipoprotein. Cholesterol is actually an essential substance, not a poison. Every cell in the body is lined, in part, with polymers made with cholesterol. Brain tissue requires enormous amounts of cholesterol. Cholesterol protects the "insides" of cells from oxidating chemicals "outside."

Most of the body's cholesterol is made in the liver. Only about 15 per cent, typically comes from food. Larger, lighter particles of cholesterol are progressively stripped down and used, VLDL to LDL to HDL, but only the LDL can become oxidized and trapped in the linings of blood vessels. And not all the LDL poses an atherosclerosis risk. The form known as apo-B can form plaques. Apo-A does not.

But how does this explain why diabetics are so often prescribed statins for cholesterol?

Let's say you take your diagnosis of diabetes seriously, and you work hard to get your sugars down. You diet, you exercise, you take medication. You lower your blood sugars and your body has less excess glucose to turn into triglycerides.

Now let's take another look at that equation:

Total cholesterol - HDL - 1/5 of triglycerides = Estimated LDL.

If you lower your triglycerides, you raise your estimated LDL.

That would be fine if VLDL always equalled 1/5 of triglycerides, but it doesn't. As you get better and better control over your diabetes, your LDL estimates are going to appear to go up, whether there's more LDL in your bloodstream or not. Many diabetics are prescribed statin drugs they don't need because it's easier to write a prescription than to run another blood test.

Be forewarned that direct measurement of your LDL can cost more than all the other blood tests for your diabetes exam put together. If the test comes back that you do not really need a statin, however, the blood test pays for itself in about four months--and you will not be needlessly exposed to any side-effects of statin drugs. Even better, a doctor who takes the trouble to measure your actual LDL is far more likely to respect all the effort it takes for you to control your blood sugars.

Niacin for Lowering Cholesterol

2008-12-29T07:22:00.001-08:00

A typical, successful amount of niacin to reduce cholesterol is 3,000 mg a day, but there are certain precautions you should take.

Taking more than 1,000 mg of niacin a day can raise homocysteine levels, especially if niacin is not balanced by folic acid (400-1,000 mg a day), vitamin B6 (10-50 mg a day), and vitamin B12 (50-300 micrograms a day). If you take more than 1,000 mg of niacin daily, you need additional B vitamins.

There have been no trials of niacin for lowering cholesterol in persons who have not had a heart attack, but the Coronary Drug Project followed 8,000 men who had had a heart attack for eight years. Taking 3,000 mg of nicotinic acid every day resulted in:

10 per cent reduction in total cholesterol,
26 per cent reduction in triglycerides,
27 per cent reduction in the rates of second heart attacks, and
27 per cent reduction in the rates of stroke.

Follow-up over 15 years found that men who took nicotinic acid were 11 per cent more likely to still be alive at the end of the study.

Other studies of both men and women have found that taking niacin raises HDL levels and transforms LDL cholesterol from the sticky apo-A form to the lighter, less harmful apo-B form. Taking beta-carotene, vitamin C, vitamin E, and selenium, however, reduced the benefits of niacin.

If you do choose to use niacin/nicotinic acid to lower cholesterol, you should consult your doctor. That's because a number of things can go wrong when you take nicotinic acid in doses potent enough to have an effect on heart health:

Like statin drugs, niacin sometimes damages the liver. Hepatitis has been observed from taking dosages as low as 500 mg a day for a period as short as two months, although most cases of liver damage occurred when the dosage was 3,000 to 9,000 mg for several years.
Diabetics should not take high-dose niacin. The vitamin can reduce insulin sensitivity and raise blood sugars.
Occasional side effects have included blurred vision, migraine, peptic ulcers, disturbances of heart rhythm, and gout.

And facial flushing with an outbreak around the nose resembling acne is very problem. A slower-release form of niacin, nicotinamide, does not cause flushing, but can aggravate diabetes and cause liver damage. Niacin may lower cholesterol levels for people who cannot or choose not to use statins, but niacin should always be used under professional supervision.

Vitamins for Healthy Gums

2008-12-29T07:20:00.000-08:00

Next to regular brushing, flossing, and dental care, vitamins have the closest relationship to healthy gums.

Vitamin A stimulates the gums to make keratin, the same protein that makes the skin just "tough enough" to resist wounds and infection. Vitamin A is especially important for protecting the gums against those irritated sores caused by bacterial infection. Various metabolites of this vitamin are necessary for the cells lining the gums to differentiate into new, growing cells to maintain and repair the protective outer membrane.

Vitamin A also stimulates the differentiation of cells in bone into white blood cells that fight infection. And it stimulates the production of growth hormone.

Not very many foods contain vitamin A. Cod liver oil, egg yolks, whole milk, and butter head the list. Your body, however, can make vitamin A from beta-carotene, found in abundance in orange and yellow vegetables, such as carrots, squash, and pumpkin, and also in kale, collards, mango, broccoli, and sweet potato. The process of making vitamin A from beta-carotene is most efficient in people who have the least body fat, but anyone can avoid vitamin A deficiency by eating just one serving of a yellow or orange vegetable every day.

Gum disease is a classic symptom of scurvy, the vitamin C deficiency disease. Scurvy even occurs today, in people who consume very high dosages of the vitamin and then stop.

For instance, a Swedish man drank 8 to 10 glasses of fresh-squeezed orange juice on his vacation in Florida, but stopped drinking orange juice when he returned to Sweden. A month later, he had lesions on the gums characteristic of scurvy. And in my own experience, a woman who had been taking 3,000 mg of vitamin C every day to complement her cancer treatment had both gum and skin sores when she stopped.

Many natural therapists also recommend vitamin E for healthy gums. There is some laboratory evidence that vitamin E counteracts the effects of mercury amalgams, although there is no proven relationship between old-style silver-mercury fillings and increased risk of gum disease.

For vitamin E, "natural" is better. Vitamin E is not one but eight related chemical compounds, and a mixture of all eight, even at a lower dose is more effective. Take one capsule of "mixed tocopherols" a day, or if you can only find alpha-tocopherol, eat vitamin E-rich foods, especially those richest in gamma-tocopherol (using a tablespoon of soybean, corn, or canola oil, all rich in gamma-tocopherol, in cooking every day, or eating an ounce of peanuts or three ounces of almonds every day).

Do Diabetics Really Need Lipitor?

2008-12-29T07:18:00.001-08:00

If you're diabetic and you've been taking fish oil to lower your triglycerides, you may have noticed a nasty (but misleading) relationship between fish oil and LDL cholesterol: When your triglycerides go down, your LDL goes up.

Or at least it appears to. This is what is really happening:

It's relatively expensive to measure LDL cholesterol directly. The cost of a true LDL test could run more than all the other tests your doctor orders at your diabetic checkup, well into the hundreds of dollars.

Labs typically estimate LDL levels by:

1. Measuring total cholesterol.
2. Measuring the denser, easy to separate, HDL or "good" cholesterol, and
3. Then assuming any cholesterol you happen to have in your blood that isn't HDL or LDL is 1/5 as much as your triglycerides.

Most people don't know that there is yet another major class of cholesterol, VLDL or very low-density lipoprotein. The typical rule of thumb is that you'd have 1/5 as much VLDL as triglycerides (from which it is formed).

So the equation is:

1. Take total cholesterol.
2. Subtract HDL.
3. Subtract triglycerides x 1/5.
4. And the answer is supposedly your LDL.

But what happens if you have been taking fish oil to lower your triglycerides? And it's been working?

Your triglycerides go down, so your LDL appears to go up.

Suppose before you started taking fish oil, you had:

Triglycerides: 400 mg/dl
Total cholesterol: 180 mg/dl
HDL: 45 mg/dl

Then your estimated LDL would be 180 - 45 - (1/5 of 400) or 55.

But then you work really hard at getting your triglycerides down. You take fish oil. You're really careful with your carbohydrate. You keep your blood sugars down. And you get your triglycerides all the way down to 100 mg/dl. Your total cholesterol stays at 180 and your HDL stays at 45.

And let's suppose your LDL didn't really go up--but the estimate will be off:

180 - 45 - (1/5 of 100)= 115.

So you're reward for getting your triglycerides down will be your doctor will want to put you on a statin for high LDL, even if your actual LDL stayed same, even if your actual LDL went down.

If your insurance does not cover your lab work, it probably won't pay for Lipitor, either. If you don't want to pay $500 for an Apo-B test ("bad LDL" is apo-B, LDL can also be apo-A, which doesn't require a statin) to keep you from paying $100 a month for a cholesterol-lowering drug, consider this:

1. Ask your doctor is there isn't a little room for interpretation of the lab results. Your doctor should know how LDL is estimated, and if they don't, well, consider finding another doctor.
2. You can lower both triglycerides and LDL safely and inexpensively by using both fish oil and red yeast rice. If LDL goes up, try red yeast rice for 3 months before submitting to either an expensive lab test or an expensive medication.

Do Diabetics Really Need Lipitor?

2008-12-29T07:18:00.000-08:00

Fish Oil and Cholesterol: What to Do When Lowering Triglycerides Appears to Raise LDL

2008-12-29T07:16:00.000-08:00

Red Yeast Rice for High Cholesterol

2008-12-29T07:14:00.001-08:00

What is the safest medicine to lower cholesterol? For a while it seemed it might be red yeast rice.

One of the best-known over-the-counter nutritional supplements for naturally controlling your cholesterol is a product called Cholestin, which nowadays contains a sugar cane derivative called policosanol. Before the makers of Cholestin began making their product with policosanol, however, they used a natural product that contains exactly the same chemical that is in the cholesterol drug Mevachor. That natural product was red yeast rice, once one of the most popular alternatives to statins for lowering cholesterol.

Red yeast rice does not contain a chemical that just works the same way as the statin drug Mevachor (lovastatin). The yeast actually makes Mevachor. When the makers of the older formulation of Cholestin learned that Chinese researchers had confirmed that the fungus can be used to lower both choelsterol and triglycerides, nobody was paying a whole lot of attention to Chinese research.

The natural products maker Pharmanex ran its own clinical trials at the University of California at Los Angeles and confirmed that people with high cholesterol who take red yeast rice can lower their LDL levels by an average of 22 per cent.

These findings meant that the supplement not only was as effective as a prescription statin drug, it worked better than most. And since anybody with the technical expertise can grow red yeast rice without paying royalties on a patent, the product was much, much less expensive than the comparable prescription drugs.

You might have guessed by now that the FDA was not going to allow a natural product that really does lower the "bad" LDL cholesterol to stay on the market.

That's in spite of the fact that the older version of Cholestin was purified, standardized, and clinically tested. That's in spite of the absence of reports of rhabdomylosis (muscle tissue breakdown) as an occasional side-effective of prescription Mevachor. (It's possible other compounds in the yeast prevent side effects.)

The FDA forbade the manufacturer of any clinically tested, standardized, and proven effective red yeast rice supplement.

But it allows red yeast rice that isn't standardized for known purity, effectiveness, and safety. Isn't that just bizarre? Banning the standardized supplement protected a pharmaceutical company's bottom line.

You may read from time to time that red yeast rice supplements are more effective than statin drugs at lowering cholesterol, and, except for the FDA's intervention, that would be true. In other countries where red yeast rice is treated like any other drug, however, new clinical studies come in nearly every year showing that it can in fact lower cholesterol in healthy people and in people at risk for heart disease.

Citations:

Cicero AF, Brancaleoni M, Laghi L, Donati F, Mino M. Antihyperlipidaemic effect of a Monascus purpureus brand dietary supplement on a large sample of subjects at low risk for cardiovascular disease: a pilot study. Complement Ther Med. 2005 Dec;13(4):273-8. Epub 2005 Sep 9.
Huang CF, Li TC, Lin CC, Liu CS, Shih HC, Lai MM. Efficacy of Monascus purpureus Went rice on lowering lipid ratios in hypercholesterolemic patients. 1: Eur J Cardiovasc Prev Rehabil. 2007 Jun;14(3):438-40.

Could Drinking Decaf Prevent Diabetes?

2008-12-29T07:09:00.000-08:00

As I noted in an earlier post, caffeine in general can raise blood sugars in people who already have diabetes, and black coffee and diabetes is generally not a good combination. A light-roast decaf speciality coffee, on the other hand, may actually help.

Caffeine does not cause an immediate spike in blood glucose levels. Instead, it encourages a "dump" of insulin right after you drink the caffeinated beverage (typically at the same time as you eat a high-carbohydrate food), so that your body does not continue to clear sugar out of the blood stream 3, 4, and 5 hours after you eat. Caffeine interferes with what is called Phase 2 secretion of insulin, the longer-term action of insulin as your meal is more completely digested.

Light-roast coffee, on the other hand, may protect against developing diabetes. The research study is in Japanese, and although I do read some Japanese, I just skimmed the article to the part where the scientist notes that the protective compounds found in light-roast coffee that aren't found in dark-roast coffee are chlorogenic lactones and 5-HMF.

You'd get even more of the chlorogenic acid that's believed to be diabetes-protective if you drank coffee from raw beans, but this is not necessary. Light-roast coffee doesn't contain the sugars that raw beans do, but it does have the trigonelline that dark-roast doesn't. Dr. Oka, author of the Japanese study, believes that these compounds may protect against diabetes.

There is one possible exception to the general rule that caffeinated coffee is bad for diabetics, and this comes from a study of coffee drinkers in Greece.

Among Greeks aged 65 to 100 who:

Did not drink tea but
Did drink boiled coffee (that is, coffee with the grounds in the bottom of the cup)

Rates of diabetes in old age were 53 per cent lower.

This could mean, however, that people drank boiled coffee just didn't tend to live to be 65, but it's also possible that there is something in boiled coffee that protects against diabetes, too. The protective effect of coffee was not found in people who also drank tea.

Citations:

Panagiotakos DB, Lionis C, Zeimbekis A, Makri K, Bountziouka V, Economou M, Vlachou I, Micheli M, Tsakountakis N, Metallinos G, Polychronopoulos E. Long-term, moderate coffee consumption is associated with lower prevalence of diabetes mellitus among elderly non-tea drinkers from the Mediterranean Islands (MEDIS Study). Rev Diabet Stud. 2007 Summer;4(2):105-11. Epub 2007 Aug 10.

Oka K. [Pharmacological bases of coffee nutrients for diabetes prevention] Article in Japanese. 1: Yakugaku Zasshi. 2007 Nov;127(11):1825-36.

Does Caffeine Raise Blood Glucose Levels?

2008-12-29T07:07:00.000-08:00

Can caffeine raise blood sugar levels? If you are a diabetic, is it safe to drink caffeinated coffee, tea, and soft drinks?

A clinical trial at Dartmouth Medical School in New Hampshire found that caffeine may indirectly raise blood sugar levels.

Testing young adults aged 18 to 22, the doctors found that higher levels of insulin after intake of caffeine. The higher level of insulin suggests that their bodies needed more insulin to move the same amount of glucose out of the bloodstream and into cells.

In healthy young adults who don't have diabetes, blood glucose levels stayed the same. In type II diabetics, however, whose blood glucose elevations are caused by insulin resistance, caffeine raises blood glucose levels.

Instant black tea with caffeine, in particular, raises blood glucose levels, but it does not raise them immediately. Instant black tea drinks seem to cause a spike in insulin production right after you drink them, clearing out blood sugar, but they interfere with the release of insulin a couple hours later, allowing you to get a sugar high.

This does not mean, however, all coffee and all tea are bad for diabetics, in fact they can sometimes help prevent diabetes, as you can read here.

Citations:

Bryans JA, Judd PA, Ellis PR. The effect of consuming instant black tea on postprandial plasma glucose and insulin concentrations in healthy humans. J Am Coll Nutr. 2007 Oct;26(5):471-7

MacKenzie T, Comi R, Sluss P, Keisari R, Manwar S, Kim J, Larson R, Baron JA. Metabolic and hormonal effects of caffeine: randomized, double-blind, placebo-controlled crossover trial. 1: Metabolism. 2007 Dec;56(12):1694-8.

Could Curcumin Lower Cholesterol?

2008-12-29T07:03:00.000-08:00

Curcumin, the bright orange-yellow pigment found in the curry spice turmeric, might prove to be an inexpensive and side effects-free way to lower cholesterol. (There is also a corresponding health benefit of turmeric supplements, but curcumin is much easier to take on a regular basis because the dosage of turmeric would need to be more than an ounce a day.)

A study designed to determine whether curcumin could be safely administered to people who are sick, two Indian researchers gave 500 mg of curcumin a day to 10 healthy volunteers every day for seven days. The test subject volunteers did not get sick, but they also showed an astonishing lowering of cholesterol.

In just seven days, there was a 29 per cent increase in the "good" HDL cholesterol, a 12 per cent decrease in total cholesterol (which means there was roughly a 34 per cent decrease in LDL cholesterol, which is not measured directly), and a 33 per cent decrease in lipid peroxides.

What are lipid peroxides?

These are compounds in your blood that are actually more worrisome than LDL. A lipid peroxide can get "stuck" in the lining of a blood vessel, and the a kind of white blood cell called a macrophage can come along to dislodge but get stuck, too. Lipid peroxides from the core around with a plaque calcifies.

So can curcumin lower cholesterol if you aren't healthy?

A follow-up study suggests that it can. Just 10 mg of curcumin twice a day for 28 days lowered LDL and raised HDL in patients who already had atherosclerosis. men and women who suffer cardiomyopathy and high cholesterol or congestive heart failure and high cholesterol may benefit from the addition of curcumin to their health care routines.

Source:

Soni KB, Kuttan R. Effect of oral curcumin administration on serum peroxides and cholesterol levels in human volunteers. 1: Indian J Physiol Pharmacol. 1992 Oct;36(4):273-5.

Vitamin E for Diabetes

2008-12-29T07:02:00.001-08:00

Vitamin E is a term used to describe eight different chemicals performing the same function.

Many physicians and nutritionists typically refer to alpha-tocopherol as if it were the only component of vitamin E, but, the fact is, it's just the easiest form of vitamin E to measure. Vitamin E consists of not just alpha-tocopherol but a total of four "tocopherols" and four "tocotrienols."

Can supplementing with vitamin E help if you have diabetes?

The answer seems to be "it depends."

A study conducted in Israel and published in late 2007 found that taking 400 IU of vitamin E a day (and by "vitamin E," these researchers meant just alpha-tocopherol) could cut your risk of having a heart attack or stroke almost in half if:

You have type 2 diabetes,
You're over 55 years old, and
You have a special set of genes known as the Hp 2-2 genotype.

This means there are some people whose arteries vitamin E can help a lot, and others maybe little or not at all.

In Western societies, only about 36 per cent of the population has the Hp 2-2 genotype. (Scientists haven't measured the genotype in African and Asian populations yet.) The other 64 per cent won't benefit from taking alpha-tocopherol for their hearts.

Vitamin E, however, can have a much more direct effect on diabetes when it's used in "pharmacologic" doses.

An Italian study found that taking 900 mg (that's about 1200 IU) of alpha-tocopherol a day increased the ability of insulin to move glucose into muscle by about 30 per cent in type 2 diabetics. In this study, vitamin E performs better than any oral prescription medication for type 2 diabetes on the market, but....

The problem with taking a vitamin E supplement that's pure alpha-tocopherol at that dosage is that it can interfere with your body's absorption of the other forms of vitamin E (gamma-tocopherol in particular) and actually raise your risk of having a "sudden cardiovascular event."

You can avoid this problem by taking a supplement that contains at least gamma-tocopherol in addition to alpha-tocopherol, and preferably all eight of the chemical forms of vitamin E.

And if you have "just a touch of diabetes," that is, if you've been told you're "borderline diabetic" or if you have metabolic syndrome, consumption of all of the eight chemicals that make up "vitamin E" may be very useful to you.

A Finnish study found that high-level consumption of the four "tocopherols" and four "tocotrienols" that together function as vitamin E might reduce the risk of developing type 2 diabetes by about 30 per cent.

The Finnish scientists also found that high rates of consumption of a related antioxidant, beta-cryptoxanthin, might reduce the risk of developing diabetes by about 40 per cent.

What's beta-cryptoxanthin?

Well, it's not vitamin E, but it has some of the same functions as vitamin E. Beta-cryptoxanthin is chemically similar to beta-carotene.

Beta-cryptoxanthin, like beta-carotene, is a provitamin that the human body can use to make vitamin A. This hard-to-pronounce antioxidant seems to keep LDL cholesterol from changing into plaques and possibly to prevent the progression of arthritis.

And, for reasons scientists can't explain yet, it is associated with lower rates of diabetes. There's not known to be any downside to taking it. It tends to disappear from circulation in people who use large amounts of margarines with plant sterols to lower cholesterol, like Benecol and Take Control.

So what's my recommendation?

Mixed tocopherols and tocotrienols ("natural" vitamin E) is probably more beneficial for most diabetics. 400 IU a day is enough. 1200 IU a day is better. Do not take more than 400 IU a day of any supplement that's solely composed of alpha-tocopherol.

If you use Benecol or Take Control, be sure you get your beta-cryptoxanthan, either from a supplement or from regular servings of avocado, cilantro, serrano peppers, or (in moderation) grapefruit, oranges, or watermelon.

Chromium for Diabetes

2008-12-29T05:42:00.000-08:00

Chromium has been identified for a very long time as an essential component of the Glucose Tolerance Factor (GTF), enabling the body to transport glucose out of the bloodstream into cells where it's needed.

The problem with proving this scientifically has been, it's hard to prove anything (by modern standards) by studying just a few people, even if you do the study right. A meta-analytic review of 36 studies found that taking chromium (and I'll comment on how much in just a moment) on average lowered blood glucose levels by 0.8 mM, or in the terms most non-scientists use, 15 mg/dl or so.

Moreover, while no scientist has found that taking chromium lowers your "bad" LDL cholesterol, two studies have found it can greatly increase the "good" HDL cholesterol.

The thing is, sometimes taking less chromium works better than taking more, but taking brewer's yeast (a natural food that contains chromium but delivers a lower amount of it) is even better.

This means if you come across a supplement that promises "New! Improved! More Chromium!" you shouldn't buy it.Further complicating the understanding is the fact that for chromium, as for so many aspects of diabetes, what works in one situation doesn't necessarily work in another.

There's some research that finds that the body wastes chromium, that is, flushes it out into the urine, when it's fed a high glycemic index diet (lots of sugar, flour, rice).

And along those lines, there's other research that suggests that chromium only works for people who really need it, that is, who have especially severe insulin resistance. If you have just a "touch of diabetes," it may not help you.

But if you don't have either diabetes or prediabetes, your fasting blood sugars go down slightly if you provide you body with as little as a 10 microgram daily dose.So does chromium help you or not?

The bottom line of over 400 research studies I've leafed through seems to be that a combination of chromium and the B-vitamin biotin may be helpful for overweight type 2 diabetics at an early stage of treatment. It probably will lower blood sugars 15 mg/dl within the first month you take it, but it won't keep on lowering them once your body has all the chromium it needs.

As for helping you lose weight, well, sorry, that effect seems to be due to diarrhea when you take both chromium and metformin or diabetes drugs in the sulfonylurea class. At least the diarrhea is temporary. So's the weight loss.Taking chromium won't do for you what diet, drugs, and insulin can. Getting control over what you're eating and how much you weight is much more important. But chromium can help you get started.

Vitamin D for Diabetes

2008-12-29T05:41:00.001-08:00

A noted author on natural health claims "Vitamin D is better than metformin (a common prescription drug) for diabetes!" Is she right?

Well, the answer to whether vitamin D is as good as metformin the lowering blood sugars and controlling diabetes is probably yes and no.

Almost 20 years ago Swedish scientists discovered that taking a vitamin D supplement helps control blood sugars in diabetic men if they are vitamin D deficient (and it slightly lowers blood pressure in others).

And if the diabetic is not vitamin D deficient?

It's hard to tell. The skin makes vitamin D when exposed to sunlight. People who get more sunlight, at least in North American culture, tend to exercise more. So whether it's the vitamin D or the exercise that's controlling high blood glucose levels in diabetes is hard to tell.

But are you vitamin D deficient?

In the winter months, if you live anywhere in Europe or Russia, north of Atlanta, Dallas, or San Diego in North America, north of Shanghai or Seoul or Tokyo in Asia, or south of Buenos Aires or Sydney or Auckland in the Southern Hemisphere, you probably are. A daily dose of up to 1000 IU (25 micrograms) a day may be helpful to your general health.

Citation:

Lind L, Pollare T, Hvarfner A, Lithell H, Sørensen OH, Ljunghall S. Long-term treatment with active vitamin D (alphacalcidol) in middle-aged men with impaired glucose tolerance. Effects on insulin secretion and sensitivity, glucose tolerance and blood pressure. Diabetes Res. 1989 Jul;11(3):141-7.

A "New" Ayurvedic Herb for Diabetes?

2008-12-29T05:39:00.000-08:00

In the February 2008 edition of the medical journal Diabetes Care there is a report of a clinical trial of a "new" Ayurvedic herb for type-2 diabetes, Coccinia cordifolia.

Better known as koval or ivy gourd (and in various local languages, as tindora', dondakaya, tendli, or gentlemen's fingers), this herb is in the same plant family as the better known bitter melon. Like bitter melon, it both grows wild and is cultivated for its shoots and fruits. Koval is a common plant of India and Bangladesh that grows over the Indian sub-continent like kudzu grows over the southern USA.

Koval grows enormous tubers that anchor it into the ground and then it spreads vines in all directions. Unlike kudzu, it bears trumpet-like white blossoms that produce a zucchini-shaped but purplish-red fruit. Ayurvedic medicine has used the fruit and the leaves for centuries as a treatment for diabetes, but this study is the first detailed clinical trial.

Since Ayurvedic practitioners typically recommend "a handful" of the dried leaves and chopped gourd brewed into a tea, the researchers at the St. John's National Academy of Health Sciences in Bangalore prepared a standardized extract from 15 grams of the dried herb. They gave the extract or a placebo to 60 newly diagnosed type-2 diabetics for 60 days.

If you're familiar with how most prescription medications for diabetes work (many of them encourage weight gain), you'll be impressed that the finding that people who took the herb not only did not gain weight, there was a slight trend to weight loss (less than 0.1 kilo, or one-quarter pound, per month). There was also a very slight trend to slimmer waists and tighter hips (again, a few millimeters, or tenths or an inch), all without any changes in food eaten or total calories. Body fat percentages, however, very slightly rose.

And as you may have read in other natural health headlines, the Ayurvedic herb definitely lowered blood sugars.

At the beginning of the study, the average fasting blood sugar in the test group was 132 mg/dl, and the average post-prandial (after-eating) blood sugar was 183 mg/dl.

The effects of the herb gradually increased over 90 days. By the end of the third month of the clinical trial, the average fasting blood glucose among the diabetics who got the herb had fallen to 111 mg/dl, while the diabetics who did not get the herb actually had slightly higher morning blood glucose levels. Among the diabetics getting the herb, post-prandial (after-eating) blood sugars also improved, to an average slightly below 150 mg/dl. The improvement in blood sugar levels was confirmed by an average drop of 0.6 per cent in HbA1C.

The researchers noted that similar percentages of diabetics getting the herb (94 per cent) and diabetics getting the placebo (93 per cent) were able to stick to their diabetic diets. The difference in blood sugars was due to the herb. It's also important to note that the diabetics taking the herb did not take any of the medications for diabetes commonly prescribed in North America, Australia, New Zealand, or the UK, and that they did not have blood sugar levels requiring immediate use of insulin.

So how does Coccinia cordifolia work?

The researchers don't know for sure, but it seems that some chemical in the herb is insulin-mimetic. That is, this as-yet-unidentified compound works the same way as insulin in clearing glucose out of the bloodstream, but does not work the same way as insulin in moving triglycerides into hungry fat cells.

Will a koval extract for type-2 diabetes be coming soon to a natural health products retailer near you? Just ask at any retailer specializing in Ayurvedic herbs or anywhere the proprietary extract Gencinia is sold. It's already available. If you take the herb, use 15 g (about half an ounce) a day to make a tea, drunk warm after brewing in a closed tea pot for 15 minutes. If you use a 15:1 dried extract, use 1,000 mg (1 g) per day.

If you have relatively mild type-2 diabetes and you are taking your blood sugars every day and avoiding carbohydrates, this herb is certainly worth a try.

Citation:

Kuriyan R, Rajendran R, Bantwal G, Kurpad AV. Effect of supplementation of Coccinia cordifolia extract on newly detected diabetic patients. Diabetes Care. 2008 Feb;31(2):216-20. Epub 2007 Nov 13.

Reduce Your Risk of Type 2 Diabetes by Eating Your Vegetables

2008-12-29T05:35:00.000-08:00

The antioxidants, magnesium, and fiber of vegetables may reduce the risk of developing type-2 diabetes by up to 30 per cent, according to a new study coming from China.

The study, published in the March 2008 edition of the Journal of Nutrition, tracked the eating habits of 64,191 women aged 40 to 70 in China. Food choices were tracked at the beginning of the study and four-and-a-half years later, and rates of diabetes compared.

Researchers measured intakes of cruciferous vegetables (bok choi, brussels sprouts, broccoli, cabbage, kale, mustard greens, turnip greens, and winter radish), other green leafy vegetables, yellow vegables, onions and garlic, tomatoes, and other vegetables. They also measured consumption of fruit.

The quintile of women eating the most vegetables--an average of 428 grams (nearly a pound) a day--was 28 less likely to become diabetic than the quntile of women eating the least--121.5 grams, or only about 1/4 pound a day. Eating more fruit did not reduce the risk of developing type-2 diabetes.

No particular vegetable stood out as diabetes-protective. The researchers believe that fiber, antioxidants, and magnesium in vegetables may all play an important role in preventing the disease. Generally speaking, vegetables are both relatively low-carb and low-fat, making them useful in almost any diet for weight loss or diabetes prevention.

The authors of the study also pointed out that vitamin C and vitamin E are also known to influence blood glucose levels. Even antioxidant like DHEA may play a role in the ongoing health of people with type-2 diabetes.

And because the study, jointly conducted by the Shanghai Cancer Institute and the Diabetes Research and Training Center in Nashville, Tennessee, only looked at diets of women in China, it is possible the results are not exactly applicable to other populations.

Still, this study is strong evidence that getting a full nine servings of vegetables a day may protect against developing diabetes type-2.

Citation: Villegas R, Shu XO, Gao YT, Yang G, Elasy T, Li H, Zheng W. Vegetable but not fruit consumption reduces the risk of type 2 diabetes in Chinese women. J Nutr. 2008 Mar;138(3):574-80.

Vitamin E for Diabetes: How Much Is Too Much?

2008-12-29T05:33:00.000-08:00

Scientists have long known that vitamins C and E can be antioxidants in low concentrations but tissue- and DNA-destructive pro-oxidants in high concentrations. A recent clinical trial conducted at the Bertram Diabetes Research Unit and the Institute for Food Research in Norwich in England finds that there really is such a thing as getting to much alpha-tocopherol.

Scientists gave diabetics a daily dose of either a placebo or 1200 IU (800 mg) of alpha-tocopherol, one of the eight chemicals known as "vitamin E," every day for 29 days. At first there were no differences between the diabetic volunteers who got the placebo and those who got vitamin E.

By day 29, however, evidence of pro-oxidant effects began showing up in the diabetics who got the high-dose vitamin E. By day 29, from 6 to 20 per cent of the white blood cells (particularly the kind that get "stuck" in oxidized cholesterol) in the vitamin E treatment group had DNA damage.

This finding suggests that if you are a diabetic who takes just alpha-tocopherol, that is, no other form of vitamin E, and no other antioxidants, you are taking a damaging amount of vitamin E.

It's easy to correct the problem, of course. Take less alpha-tocopherol, and if you have a medically determined indication for high-dose vitamin E, take a supplement that contains at least gamma-tocopherol and preferably the other six tocopherols and tocotrienols, as well. Balanced antioxidant supplementation is always preferable to a high dose of a single antioxidant.

Citation:

Winterbone MS, Sampson MJ, Saha S, Hughes JC, Hughes DA. Pro-oxidant effect of alpha-tocopherol in patients with type 2 diabetes after an oral glucose tolerance test--a randomised controlled trial. Cardiovasc Diabetol. 2007 Feb 22;6:8.

DHEA and Diabetes

2008-12-29T05:31:00.000-08:00

From Italy comes a study suggesting that DHEA supplements might reduce some of the complications of type 2 diabetes.

Many of the chronic complications of non-insulin dependent diabetes are vascular. In diabetes, there can be so much glucose in the bloodstream that it begins to "burn," that is, it begins to oxidize, even before it reaches the cells that need it.

This auto-oxidation process generates huge quantities of the superoxide free radical, which in turn can change normally harmless LDL cholesterol into a form of LDL that clogs blood vessels. The smallest, microscopic capillaries are the first affected. Only when the effects of diabetes are greatly progressed does atherosclerosis show in major arteries.

Research physicians at the university and hospitals in Turin found that giving elderly diabetics DHEA did not lower blood sugars or cholesterol, but did lower oxidative stress in the bloodstream. The concentration of free radicals of oxygen in the blood lowered on average 53 per cent.

Interestingly, taking DHEA also elevated bloodstream concentrations of vitamin E. This is because DHEA protected vitamin E from destruction by free radicals.

Diabetics are given statin drugs to lower cholesterol, ACE-inhibitors and ACE-receptor blockers for high blood pressure, calcium channel blockers, and/or thiazolidinediones (Actos/Avandia or pioglitazone/rosiglitazone), all of which have side-effects. The doctors conducting this story express a hope that DHEA, which occurs naturally in the body and which can be given in a dosage of 50 mg a day without side effects, might eventually replace these drugs.

Citation:

Brignardello E, Runzo C, Aragno M, Catalano MG, Cassader M, Perin PC, Boccuzzi G. Dehydroepiandrosterone administration counteracts oxidative imbalance and advanced glycation end product formation in type 2 diabetic patients. 1: Diabetes Care. 2007 Nov;30(11):2922-7. Epub 2007 Aug 17.

Vitamin C for Diabetes

2008-12-29T05:30:00.001-08:00

What if instead of taking Actos (pioglitazone) or Avandia (rosiglitazone) or Glucophage (metformin), the medication you really needed for blood sugar control in diabetes were vitamin C? A study coming from Iran suggests that for some diabetics, vitamin C might be as useful as many common medications.

Researchers at the Shahid Sadoughi University of Medical Sciences & Health Services followed 84 diabetics given either 500 mg or 1,000 mg of supplemental vitamin C every day for six weeks.

Taking 500 mg of vitamin C every day did not result in any measurable benefits. Diabetics taking 1,000 mg of vitamin C a day, however, had lower fasting blood glucose, lower triglycerides, lower LDL cholesterol, and lower HbA1C in just 42 days.

How much lower?

Average fasting blood glucose levels fell from 169.33 mg/dl to 144.80 mg/dl.
Average HbA1C fell from 8.82 per cent to 7.66 per cent. (This is better than most medications.)
Average LDL cholesterol fell from 130.95 mg/dl to 125.91 mg/dl.
And the drop in insulin levels was astonishing, from 16.91 microunits per ml to 8.77 microunits per ml.

When there is less insulin, there is less fat storage. Vitamin C should help diabetics keep from gaining weight.

These results suggest that many diabetics may benefit from vitamin C, but the results should be interpreted with some reservations. If you are already on one or several medications, the additional benefits of taking a 1,000 mg vitamin C tablet every day, at least in terms of your blood sugars, triglycerides, and HbA1c, may be limited. Also, vitamin in your blood interacts with the enzymes in blood glucose test strips so that the glucometer reading is low, while the actual blood sugar is higher.

It's also possible that using vitamin C for several months can, like using R-lipoic or alpha-lipoic acid, give you a reduction in HbA1C that doesn't really result from improved blood sugars. Doctors test HbA1C to get a rough estimate of how high or low blood sugars have run over several months. Strong antioxidants keep glucose from "sticking" to hemoglobin, so less HbA1C is formed at the same blood sugar level.

The effects of vitamin C on blood sugar measurements of various kinds may not be major, but they do tend to exaggerate the vitamin's benefits. Where vitamin C might really help you is to keep you from gaining weight.

Just get your C from an extended-release formula, and make sure you don't take more than 1,000 mg a day. And if you're really concerned about the question "How much vitamin C should I get daily," be assured you may get some benefits from just 250 mg a day (even though the study did not show this, some other studies suggest it). You don't need high-dose vitamin C crystals or capsules for this indication.

What fruit has the highest content of vitamin C? Acerola, but if you don't live in a tropical location where you can get acerola fresh, just about the only way you can get enough vitamin C to affect blood sugars is to take a supplement.

Vitamin C is also important for diabetics' cardiovascular health.

That's because the amount of vitamin C a diabetic gets may also measure risk of stroke. Among the 20,649 participants in the Norfolk Prospective Population Study in the UK, those whose bloodstream concentrations of vitamin C ranked in the top 25 per cent were 42 per cent less likely to have a stroke than those in the bottom 25 per cent.

This finding does not prove that diabetics can prevent strokes by taking vitamin C, or even confirm with certainty that diabetics can reduce their risk of stroke by taking vitamin C. It is possible that there's some other element of a healthy lifestyle that goes along with getting enough vitamin C that's really protective. This study does show, however, that getting adequate vitamin C certainly does not hurt diabetics' cardiovascular health.

Citations:

Afkhami-Ardekani M, Shojaoddiny-Ardekani A. Effect of vitamin C on blood glucose, serum lipids & serum insulin in type 2 diabetes patients. Indian J Med Res. 2007 Nov;126(5):471-4.

Myint PK, Luben RN, Welch AA, Bingham SA, Wareham NJ, Khaw KT. Plasma vitamin C concentrations predict risk of incident stroke over 10 y in 20 649 participants of the European Prospective Investigation into Cancer Norfolk prospective population study. Am J Clin Nutr. 2008 Jan;87(1):64-9.

Fight Gum Disease with Yogurt

2008-12-29T05:26:00.000-08:00

From Japan's Kyushu University comes a report of a new study published in this month's Journal of Periodontology that finds that eating yogurt may prevent gum disease.

Dr. Yoshihiro Shimazaki and colleagues have been trying to find out for several years whether any personal habits besides brushing and flossing might prevent, or accelerate, the development of gingivitis. In their latest study, the scientists assessed the severity of periodontal disease in over 940 men and women between the ages of 40 and 80 against their consumption of lactic acid foods such as yogurt and buttermilk. They also looked at consumption of whole and skim milk, and cheese.

The scientists learned that eating at least two ounces (56 g) of foods cultured with the friendly bacterium Lactobacillus significantly reduced the risk of severe gingivitis, that is, with pockets more than 2 mm (about 1/10 of an inch) deep in the gums. The benefits of Lactobacillus held even when the researchers accounted for differences in age, gender, frequency of tooth brushing, blood sugar levels, cholesterol levels, smoking, and alcohol consumption.

What the scientists did not find was a protective role for consumption of milk and cheese. These foods seem to feed the bacteria that attack the gums. Only yogurt and similar foods were helpful. It's well known that acidity produced by Lactobacilli kills E. coli, Campylobacter, and Salmonella.

Which other foods contain lactic acid? Here is a partial list:

Cottage cheese, especially the mass-produced kind which is preserved with the acid,
Koumiss,
Kefir,
Sourdough breads, especially sourdough rye, and
Wheat beers (especially lambic).

The protective chemical also occurs in sauerkraut and salami, and wiener makers use it to give hot dogs (frankfurters) a firmer texture than the meats from which they are made. The researchers did not, however, find that eating these foods protected gums or teeth.

Yogurt is your best bet. As little as one-quarter cup (about 60 g) of yogurt a day may help protect teeth and gums from chronic bacterial infection.

Diet, Diabetes, and Gum Disease

2008-12-29T05:23:00.000-08:00

Brushing and flossing are generally thought to be the only way to prevent gum disease, and a home remedy always seemed out of the question. From Kyushu Unviersity in Japan, however, comes a series of studies showing the importance of making the right choices in food and drink to avoid periodontal infections.

In the most recent study, the research team of Dr. Yoshihiro Shimazaki and his colleagues found that people with advanced periodontal disease tended to consume fewer lactic-acid rich foods than people with healthy gums.

Lactic acid foods include yogurt, yogurt drinks, buttermilk, leban, koumiss, cottage cheese, sauerkraut, wheat beers, rye bread, and sourdough bread, especially sourdough rye. When the Japanese researchers made allowances for age, gender, frequency of brushing teeth, use of floss, smoking, alcohol intake, high cholesterol, and diabetes, they found that exposing the gums to probiotic bacteria such as Lactobacillus seemed to discourage the growth of tissue-damaging germs in the gums.

The gums were protected by eating the equivalent of a quarter-cup (about 60 g) of yogurt a day. Consuming milk and cheese did not protect against gum disease.

Earlier releases of this ongoing study also found that people who drink more than 1 oz of alcohol a day (the amount of alcohol in a jigger of whiskey or a tall beer) run about a 3-fold greater risk of developing advanced periodontal disease. Moreover, people with pockets of gum infection deeper than 2 mm (a little less than one-tenth of an inch) were 60 per cent more likely to develop irregularities of heart rhythm on EKG suggesting heart disease.

And a study at the University of Michigan also found that gum disease can aggravate diabetes, although the link is easy to break. People who experience pain with eating tend to eat soft foods, such as potatoes, puddings, ice cream, and white bread, and to get their calories from fruit juices, milk, and cola. The added glycemic burden makes it harder to control blood sugars.

Similarly bad results have been found from eating dark chocolate. Although there are many conditions that may benefit from the antioxidants abundant in dark chocolate, gingivitis isn't one of them. Studies of chocolate factory workers who eat on the job have found that 75 per cent have gum disease.

Citation:

Shimazaki Y, Shirota T, Uchida K, Yonemoto K, Kiyohara Y, Iida M, Saito T, Yamashita Y. Intake of dairy products and periodontal disease: the Hisayama Study. J Periodontol. 2008 Jan;79(1).

For Preventing Diabetes, Low-Carb Is Better than Low-Fat

2008-12-29T05:20:00.000-08:00

The February 2008 edition of the American Journal of Clinical Nutrition tells us that despite 50 years of doctors' advice that their patients might prevent diabetes by cutting out fat, it's really better--can this be a surprise--to try to prevent diabetes by cutting out sugar.

The diabetes treatment "establishment" has never particularly cared for Atkins-style diets. Three doctors at the Harvard Medical School and UCLA decided to go through the records of 85,059 participants in the Nurses' Health Study (all of them women) to see if Atkins-style diets might make diabetes more likely, or perhaps less.

This monumental study included 20 years of follow-up.

The researchers gave each woman in the study a score based on the percentages of carbohydrate, protein, and fat they ate. A low score meant the woman followed a low-fat diet. A high score meant the woman followed a low-carb (Atkins-style) diet.

When all 1.7 million woman-years of data were tallied up, the finding was that a high score, that is, a low-carb but higher-protein and higher-fat diet, was associated with a slightly lower risk of diabetes. Score one for the Atkins diet.

But when the researchers looked into the data further, they still found that low-carb was better than low-fat, but they also found that the kinds of fat make a difference, too.

To put it in very plain terms, if you eat a lot of meat and very few carbohydrates you can keep your sugars down if you already have diabetes (or at least lower than they would be if you ate a lot of carbohydrates). But if you don't have diabetes yet, it's better to eat high-protein but lean protein, and to get your fats from vegetable sources, like olive oil, nuts, and seeds.

Women who ate an "Atkins-style diet with a Mediterranean twist" fared best in preventing diabetes. This diet not only seems to protect health, it's also easy to add variety and to get vitamins and antioxidants, as it not only permits but encourages regular eating of small amounts of oil-dressed salads and well-cooked greens. (The diabetes establishment has not begun to look into raw foods diets for diabetes treatment, although they are rapidly becoming more popular.)
So how might you prevent diabetes if you are at risk?

Don't eat sugar.

Do eat the occasional piece of whole-grain bread or the occasional serving of whole-grain pasta. Eat the fresh vegetables and fruits that appeal to you. Eat low-fat meat but don't neglect getting some fat from healthy vegetable sources.

Cinnamon for Blood Glucose Control, Lowering Triglycerides, and Raising HDL

2008-12-29T05:16:00.001-08:00

Cinnamon for diabetes is one of the hottest topics in natural products today. The problem is, there are a lot of people who are otherwise experts on diabetes but who don't know much about herbs putting out a lot of misinformation about it.

My own claim to expertise on the subject is, other than having been involved in designing a clinical trial to test the efficacy of cinnamon for diabetes and having written a few books on herbal medicine, I'm also a former formulator of some of the kinds of products you find on store shelves.

The good news about cinnamon for diabetes is, it sometimes actually works. The bad news about cinnamon for diabetes is, it doesn't always work for diabetes, and there's more than one kind of cinnamon.

The cinnamon that has been documented in published clinical research is Cinnamomum cassia. Despite what some "experts" say, this isn't the kind of cinnamon you sprinkle on your oatmeal or you get with cinnamon rolls, at least if you're getting the good stuff. That other kind of cinnamon is Cinnamomum cassia. is dark brown, whereas the milder Cinnamomum zeylanicum is more of a tan.

Cinnamomum cassia is a slightly bitter, not quite as aromatic variety of cinnamon used in South Asian cuisine. It's not the kind used in quality baked goods. It's the kind used in curry.
Cinnamomum cassia is a centuries-old Ayurvedic and Udani (Pakistani) remedy. And it's the herb that was used in the now-famous study conducted in Pakistan and monitored in the US.
This study of the use of 1, 3, or 6 grams (1 gram = 1,000 mg) of cinnamon every day for 40 days found that on average in a group of diabetics who did not have any other treatment:

Fasting glucose was lowered 18 to 29 per cent. For most diabetics, this would be something in the range of 30-50 mg/dl, or 1-2.5 mM.

LDL, or "bad," cholesterol was lowered 7 to 27 per cent.

Total cholesterol was lowered 12 to 26 per cent without any loss of the protective HDL cholesterol.

Fasting triglycerides were lowerd 23 to 30 per cent.

What's even better was, the benefits continued even after the clinical trial participants quit taking cinnamon. And more was not necessarily better. The optimum dose was 3,000 mg a day, not 6,000 mg.

So what's the catch?

The people who benefited most from taking cinnamon in this study (and in several others) were people who had type 2 diabetes and who didn't have access to any other medication. They weren't in severe distress from high blood sugars, but they probably did have sugars running 220 mg/dl (10+ mM). Cinnamon got sugars down to 140 mg/dl (7 mM) or so.

Cinnamon--and remember, it has to be the right kind of cinnamon--helps a whole lot of if you're just diagnosed and struggling to find some way to get your sugars down. No doctor is going to tell you it's enough, but the fact is, it can help.

If your goal is to get your morning blood sugar from 90 mg/dl to 85, cinnamon won't help you all that much.

What about the other kind of cinnamon? Well, basically, it's tasty. And there's nothing wrong with that. Just be sure the product you take for diabetes is labeled Cinnamomum cassia. It doesn't have to be an expensive extract. The cheaper capsules of pure cinnamon work just as well.

Frequently Asked Questions (Updated April 3, 2008):

Q. Wasn't there a Dutch study that found that cinnamon does not lower blood sugars?

A. There’s always a researcher out there trying to prove an herb doesn’t work, so a few years after the study I mention above, Dutch researchers tried using a low dose (1,500 mg a day) to treat type 2 diabetes in women.

The findings in the Dutch study?

Cinnamon lowered blood sugars.
Cinnamon lowered triglycerides.
Cinnamon lowered total cholesterol.
Cinnamon lowered LDL cholesterol.
Cinnamon raised HDL cholesterol.

But the Dutch researchers concluded cinnamon didn’t work because there were no significant differences between the control and treatment groups. They studied half as many patients, so the statistics were less likely to show significance.

Q. Wasn't there a study that found that cinnamon does help teens with diabetes?

A. Yes, but that's teens with type I diabetes. No one has studied the use of cinnamon in teens with type II.

Lipoic Acid and L-Carnitine as Diabetic Fat Burners

2008-12-29T05:14:00.001-08:00

If there's anything diabetics all over the world can agree on, it's that it's nearly impossible to lose weight while keeping blood sugars in check.

The problem for diabetics has become even worse since the late 1990's and the introduction of thiazolidinediones (TZDs), a class of drugs that includes commonly prescribed drugs like Actos (pioglitazone) and Avandia (rosiglitazone).

TZDs are terrific for lowering blood sugars. The problem is, they do this by stimulating molecule called PPAR-gamma. PPAR-gamma makes insulin far more efficient at taking glucose out of the blood stream so it can be stored in fat. Unfortunately, it also makes the same fat cells more efficient at storing fatty acids, and it even encourages the transformation of bone and heart cells into fat cells, contributing to, as you might imagine, osteoporosis and congestive heart failure.

What diabetics need is something that takes glucose out of the bloodstream without increasing the size or number of fat cells. And a research team working out of the University of California at Irvine and Shanghai's Institutes of Biological Sciences may have found it in lipoic acid and L-carnitine.

As most diabetics know, lipoic acid, usually taken in the form alpha-lipoic acid, reduces the rate at which hemoglobin combines with glucose in the bloodstream to form glycated hemoglobin, or HbA1C.

Alpha-lipoic acid isn't actually the best form of lipoic acid for diabetes. Alpha-lipoic acid is a mixture of two isomers, only one of which, R-lipoic acid, is readily available to the body. The body can sort the R-lipoic acid out of alpha-lipoic acid, however, so about 50 per cent of the relatively inexpensive alpha-lipoic acid does a diabetic good.

L-carnitine is better known by body builders. There's a growing body of evidence, however, that up to 2,000 mg of L-carnitine a day might protect diabetic brain tissue.

And it was brain researchers who discovered the application of the combination of these two supplements in burning fat.

Since this was a relatively preliminary study, the researchers took fat cells from lab rats and cultivated them under "test tube" conditions to see how they would react to lipoic acid and L-carnitine used singly and together.

Fat cells didn't respond very much to either lipoic acid or L-carnitine used without the other. When the fat cells were exposed to a combination of R-lipoic acid and L-carnitine, however, some astonishing things happened:

The mitochondria, or energy makers of the cell, began to activate their DNA so they could grow.
Larger mitochondria took up more oxygen so they could in turn
Burn more glucose and fatty acids.

And the combination of antioxidants had another interesting effect. Like the well-known TZDs, they increased the activity of PPAR-gamma. They stimulated the fat cells' ability to clear glucose and fatty acids out of the bloodstream (or, in this case, the cell culture medium).

What was different from Actos and Avandia, however, is the fact that these fat cells not only could take up more glucose and fatty acids, they burned them instead of stored them. This experiment seems to suggest that possibly diabetics, in particular, could benefit from lower blood sugars (as they already do with high levels of lipoic acid supplementation) as well as increased metabolism and lower weight, if lipoic acid and L-carnitine are taken together.

If you decide to give this supplement combination a try, remember that lipoic acid depletes biotin. Be sure to take 125 micrograms of biotin for every 200 mg of lipoic acid. Also, be sure to tell your doctor you're taking the supplements. While lipoic acid protects you against some of the effects of high blood sugars, notably in the nerves and heart, it also masks long-term high blood sugars as measured by HbA1C.

No one knows how many pounds this combination might help you lose--but please note your results in the comments section here.

Source:
Authors: W. Shen, K. Liu, C. Tian, L. Yang, X. Li, J. Ren, L. Packer, C.W. Cotman, J. Liu. R-alpha-Lipoic acid and acetyl-L-carnitine complementarily promote mitochondrial biogenesis in murine 3T3-L1 adipocytes.Diabetologia
2008, Volume 51, Pages 165-174, doi: 10.1007/s00125-007-0852-4.

Starve a Fever, Feed a Cold?

2008-12-29T05:12:00.001-08:00

If you have trouble remembering whether the old adage was to starve a fever and feed a cold or maybe it was to feed a fever and starve a cold, well, forget it. The old adage (starve a fever, feed a cold) was wrong, at least with regard to carbohydrates.

When you eat sugary or starchy foods, your body has to burn glucose. Metabolizing glucose creates carbon dioxide. Carbon dioxide has to be exhaled, and the more you eat, the deeper you breathe.

The deeper your breathe, the more your lungs suck colds and flu viruses down into the throat and lungs to spread the infection.

There's another reason not to hit the refrigerator when you are just starting to notice the symptoms of a cold.

Your body can use vitamin C to slow down infection, but vitamin C operates best in an alkaline environment. Eating lots of sugar slightly acidifies both the bloodstream and nasal secretions and makes it less likely that vitamin C will work for you.

So when you first notice colds or flu symptoms, don't feed your virus. Give your body a chance to focus on fighting the infection and save that midnight snack for when you're feeling better.

Vinegar and Diabetes

2008-12-29T05:09:00.000-08:00

Vinegar in the daily diabetic menu does help diabetics keep blood sugars lower by effectively lowering the glycemic index of foods (slowing the rate at which carbohydrates are converted to glucose), and here's how it works:

Most diabetics are aware of the glycemic index as an explanation of high blood sugar spikes. The higher the glycemic index, the faster the glucose released by digestion is absorbed.

Vinegar essentially overrides the glycemic index. Vinegar, or a vinegar and oil salad dressing, "soaks up" bicarbonate in the lower digestive tract. Without this bicarbonate, the sugars released by digestion are absorbed much more slowly.

When sugars are absorbed slower, blood glucose levels go up less. In type II diabetic patients, sometimes the pancreas can't make enough insulin for a sudden "dump" of glucose into the bloodstream, but it can keep up with slowly released sugars.

Vinegar, in effect, lowers the glycemic index of food. Vinegar won't affect your blood sugars if you aren't eating carbs, but if you aren't eating carbs, your blood sugars are going more slowly, anyway. Moreover, eating starchy foods and vinegar at the same time reduces the release of insulin, and indirectly slows the storage of fat. (The less insulin there is in circulation, the less insulin there is to move fatty acids into fat cells.)

Sourdough breads have a similar benefit, as does yogurt. They reduce both blood sugar levels and insulin release.If you're interested in the primary scientific reference for this, please click
here. There's also a review article here.

There's another potential benefit from vinegar for type II diabetic patients. As the glycemic index of food goes up, appetite and drive to eat go down. Consuming vinegar at every meal, whatever other effects it may have, reduces appetite and makes it easier to eat less.

Frequently Asked Questions (updated April 3, 2008):

Q. Can vinegar prevent diabetes?

A. It's really unlikely that you could guarantee yourself to be diabetes-free just by taking a tablespoon or two of vinegar before every meal every day--although for most people, it would not hurt. Like many other natural therapies for diabetes, and pre-diabetes, vinegar is helpful but it won't do all the work of healing or prevention. If you are on the borderline of diabetes, however, it may help you keep your sugars low enough to avoid the insulin resistance that leads to full-blown diabetes.

Q. Are there any potentially detrimental effects of vinegar?

A. One is relatively common. If you have weak tooth enamel, vinegar can erode it further. Vinegar does not make the body more "acidic" once it's in the digestive tract, only while it's in the mouth.

Accupressure and Weight Control

2008-12-29T05:02:00.001-08:00

(Thanks to Jasmine White for her corrections to an earlier version of this article.)

Wouldn't be wonderful you could just massage your weight away?

As unlikely as it sounds, the upcoming March 2008 edition of the Journal of Alternative and Complementary Medicine reports a clinical trial in which the Tapas Acupressure Technique applied to the right acupressure pressure points for weight loss really does seem to melt away the pounds.

California acupuncturist Tapas Fleming and Associates (TAPAS) originally developed Tapas Acupressure Technique to treat the fears, phobias, and post-traumatic stress that she believes underlies allergies. Since the deposit of belly fat is also related to stress hormones, a team of seven research scientists at Kaiser-Permanente Health Research Center in Portland tested the idea that this kind of acupressure might enhance weight loss.

It does.

Not a whole lot in the clinical trial, although at least one reader of this blog reports losing four dress sizes using TAT.

The Kaiser-Permanente doctors found that the average additional weight loss with the help of Tapas Acupressure Technique was only about 1.2 kg, or about 3 pounds. (That's the additional weight loss, not the entire weight loss.)

The more important finding was that Tapas Acupressure Technique helped people who usually regained weight after dieting keep the weight off. That's enough reason to use Tapas if you're a repeat dieter. And four dress sizes from acupressure, well, that's even better.

This study, of course, was not the first study of acupressure pressure points for weight loss. The earlier investigations focused on the use of auricular acupressure (studs in or on the ear). While the people who used auricular acupressure did lose more weight--about a pound--this wasn't a sufficiently dramatic effect to achieve statistical significance, at least in the small trials that researchers were able to get funded.

Acupuncture, the Chinese hit-it-hard approach where you'll have pain and bleeding, is usually more effective, but the pain and bleeding part keep most Westerners away. Tapas Acupressure Technique, in contrast, is pain-free, and the clinical trial found no adverse effects.

Where do you go if you want to learn more about Tapas Acupressure Technique?You can read the books You Can Heal Now: The TAPAS Acupressure Technique or visit the Tatlife site, http://www.tatlife.com/ to find a therapist, or if you want to try the technique right now, here are some basic instructions on where to find the basic acupressure pressure points for weight loss:

Gently place your thumb just inside the corner of your eye next to the bridge of your nose. You should just barely be touching the bottom side of your eyebrow.

Next place your fourth finger (your ring finger) also rest gently on the corner of your eye, while your middle finger rests between your eyebrows.

Hold your fingers in place. Relax.

What if you have sensitive skin? A broken nose? How would you use this technique on a baby?

The technique works equally well if you just hold your fingers above the corners of your eyes and middle of your eyebrows (I know it sounds strange, but it works). If you want to be extra careful applying pressure, as you do when you are working with an infant, a person with sinusitis or allergies, or a person with a facial injury, just hold your hand right above these points for several minutes.

Now if you've gone this far, this pose is a good time to consider the stresses in your life and just, for the moment at least, let them go. They'll still be there when you've finished the session. This is a time just to relax and let all your other responsibilities wait a few minutes.

If this sounds like it's on the fringe of health practice, well, maybe it is. It's not exactly the sort of technique I personally am really quick to try. But as odd as may be to the conventionally minded, there's growing evidence it works. Five minutes twice a day actually does help people lose weight and keep it off.

One caveat: Licensed acupuncturist and certified TAT trainer Jasmine White notes that TAT doesn't work for everyone, in her words, "because you have to start with a basic awareness of what is causing you to reach for food when you are not physically hungry." But if you gain that awareness in the space of your TAT sessions, all the better.

About Me

2008-12-29T04:50:00.000-08:00

Hello, and welcome to The Savvy Diabetic!

My name is Robert Rister, and I'm the author or co-author of nine books about the rational use of scientifically based natural remedies, including Healing without Medication, 753 pages of documented complementary healing techniques that covers many complex topics in far greater depth than I can provide here. Now that I have a regular readership of this blog, I realize I should have called it Diabetics, because every page distills not just my experience but the experience of many other healers from all over the world and especially comments from readers like you.

I'm generally considered a "conservative" commentator on natural health. That means I take care to give you the facts, and to tell you what level of proof is behind them.

Although my books are often shelved under the heading "alternative medicine," the fact is, there is no alternative to medicine. Sometimes you absolutely have to have the help of a doctor to get well (and, as you'll read on almost any site of this type, you can't use the information here to make a medical diagnosis or as a substitute for doctor-directed care' always see a physician for emergency treatment).

I consider what I'm providing you here to be "complementary healing." That is all the techniques you can use to take charge of your health while your doctor is taking care of your illness. I try to give you some information your doctor won't have time to give you, and also to give you some considerations for lowering the risk of occurence or recurrence of disease.

Thank you for visiting my site. Please come back often, and please share your questions, comments, and insights in the comments sections for each page.

A Sampling of Recent Posts at My Mirror Site, Savvy Natural Healer

2008-03-17T09:48:00.001-07:00

When Green Tea Diets Don't Work
For over a decade, trainers, coaches, and natural health experts have touted the benefits of green tea and green tea diet pills and capsules for losing weight and lowering blood sugars. Not everyone who uses these and similar products, however, benefits equally. Here's what the research literature is telling us now.

What Are the Benefits of Green Tea Diets?
For over a decade, trainers, coaches, and natural health experts have touted the benefits of green tea and green tea diet pills and capsules for losing weight and lowering blood sugars. Not everyone who uses green tea diet pills and similar products, however, benefits equally. Here's what the research literature is telling us now.

Is There An Appetite-Suppression Oolong Tea Supplement?
Is there an "appetite-suppress" oolong tea supplement? How about weight reducing oolong tea caps or an oolong metabolism product or an oolong appetite tablet?

Writing as a formulator who would have loved to have given you the product if there were, I have to say, as far as I know, the answer is....

Can Drinking Decaf Speciality Coffee Prevent Diabetes?
As I noted in an earlier post entitled "What's This About Caffeine Raising Blood Sugar Levels," caffeine in general can raise blood sugars in people who already have diabetes, and black coffee and diabetes is generally not a good combination. A light-roast decaf speciality coffee, on the other hand, may actually help.

What's This About Caffeine Raising Blood Sugar Levels?
Can caffeine raise blood sugar levels? If you are a diabetic, is it safe to drink caffeinated coffee, tea, and soft drinks?

A clinical trial at Dartmouth Medical School in New Hampshire found that caffeine....

Vinegar for Type II Diabetes
Vinegar in the daily diabetic menu does help diabetics keep blood sugars lower, and here's how it works.

Reduce Risk of Diabetes by Eating Veggies
The antioxidants, magnesium, and fiber of vegetables may reduce the risk of developing type-2 diabetes by up to 30 per cent, according to a new study coming from China.

Chromium for Diabetes
Chromium is perhaps the best-known supplement in diets for type II diabetes, but it does not work for every diabetic. Here's how to know whether chromium will work for your type II diabetes symptoms.

Vitamin C for Diabetes
Recent research suggests that vitamin C could be as useful in controlling diabetes as many of the most commonly prescribed diabetes medications, with the added advantage of lowering blood sugars without encouraging weight gain. And you don't need megadoses to get results.

Vitamin D for Diabetes
A noted author on natural health claims that using extra "Vitamin D is better than metformin (a common prescription drug also labeled Glucophage) for type II diabetes!" Is she right? Well, the answer to whether taking this supplement is as good as metformin the lowering blood sugars and controlling type II diabetes is probably yes and no.

Vitamin E for Diabetes
Type II diabetics used to be told that they should take vitamin E to prevent heart disease, and then research announced that vitamin E might be harmful. Does vitamin E prevent cardiovascular disease in diabetics or not? The real answer seems to be "it depends."

Vitamin E for Diabetes: How Much Is Too Much?

A recent clinical trial conducted at the Bertram Diabetes Research Unit and the Institute for Food Research in Norwich in England finds that there really is such a thing as getting to much alpha-tocopherol when it comes to heart problems and vitamin E, although alpha-tocopherol is just one form of vitamin E. This post discusses why in diabetes you need high-gamma vitamin E.

DHEA and Diabetes
From Italy comes a study suggesting that DHEA supplements might reduce some of the complications of type 2 diabetes. Many of the chronic complications of non-insulin dependent diabetes are vascular. In diabetes, there can be so much glucose in the bloodstream that it begins to "burn," that is, it begins to oxidize, even before it reaches the cells that need it. DHEA....

Diet, Diabetes, and Gum Disease

Brushing and flossing are generally thought to be the only way to prevent gum disease, and a home remedy beyond good personal hygeine always seemed out of the question. From Kyushu Unviersity in Japan, however, comes a series of studies showing the importance of making the right choices in food and drink to avoid periodontal infections if you have diabetes.

To Prevent Diabetes, Low-Carb Is Better than Low-Fat
For decades doctors have been telling us that the best way to prevent type II diabetes is to cut out the fat from your diet and take off the pounds. Now the research is saying, oops, we meant you should cut out the carbs. And maybe Atkins and South Beach are really OK.

Acupressure for Weight Control

Wouldn't be wonderful you could just massage your weight away?

As unlikely as it sounds, the upcoming March 2008 edition of the Journal of Alternative and Complementary Medicine reports a clinical trial in which the Tapas Acupressure Technique applied to the right acupressure pressure points for weight loss really does seem to melt away the pounds.

Coffee and Heart Attacks

If you have been following natural health news over the past few months, you may have noticed two headlines:
1. A study in the Journal of the American Medical Association found that drinking coffee with caffeine (not decaf) may raise the risk of heart attacks.
2. A study in the Journal of the American Medical Association found that drinking coffee with caffeine (not decaf) may lower the risk of heart attacks.
And both findings are correct. Whether coffee is heart-healthy or heart-harmful seems to depend on...

Smokers: Folic Acid Reduces Risk of Stroke If You Can't Quit

From the Finnish National Public Health Institute and the Karolinska Institutet in Sweden comes recent research into the use of folic acid in hyperlipidemia finding that smokers who get more folic acid have lower risk of stroke, but not every smoker benefits the same amount or the same way.
A New Antioxidant Fat-Burner for Overweight Diabetics?

If there's anything diabetics all over the world can agree on, it's that it's nearly impossible to lose weight while keeping blood sugars in check. R-Lipoic Acid and L-Carnitine, however, may be the miracle fat-burners that make losing weight while controlling blood sugars possible.

A New Ayurvedic Herb for Diabetes?

In the February 2008 edition of the medical journal Diabetes Care there is a report of a clinical trial of a "new" Ayurvedic herb for type-2 diabetes, Coccinia cordifolia. Better known as koval or ivy gourd (and in various local languages, as tindora', dondakaya, tendli, or gentlemen's fingers), this herb is in the same plant family as the better known bitter melon, only much more more effective.

Acupressure for Sinus Pain, Colds, and Flu

For stuffy nose and sinus pain caused by colds and flu, here's a quick but useful tip. It doesn't rank among the viral flu cures, but it will bring quick relief.

Asking About the Loo

Sometimes the best way to stay healthy on trip overseas is simply to know how to ask for directions to the toilet.

Botox for Anal Fissures? How About a Simpler Approach?

Anal fissures and fistulas plague millions of people who don't ask their doctors the questions they really need answered--the treatment isn't what you'd expect. Here's what you need to know to keep the treatment from being worse than the problem.

Bran and Irritable Bowel Syndrome

Despite what you may read in some medical forums for irritable bowel syndrome, bran is usually low on the list of the best natural remedies for IBS.

Artichoke Leaf for IBS

Once used primarily as a remedy for stomach growling in IBS, artichoke leaf is now one of the most widely promoted remedies for this condition. But does it really work?

Peppermint Oil for IBS

If you are looking for an answer to the question of how to get rid of IBS naturally, this might be your answer.

Cheese and Indigestion

If you're seeking to stop flatulence, especially flatulence in the workplace, consider deleting cheese from your diet. It turns out cheese combined with other foods can cause flatulence, too.

Don't Let Traveler's Constipation Ruin Your Next Trip

While health publications devote more coverage to traveler's diarrhea (ciguatera, E. coli, giardiasis, and Salmonella), the fact is, more travelers have a problem with constipation--especially if they take Lomotil or Pepto-Bismol prophylactically to prevent diarrhea. Constipation can literally ruin a trip, so here's what you can do.

Is There a Flatulence-Free Bean?

Many people avoid one of the least expensive and most versatile sources of protein and fiber, the bean, because of it produces odorific flatulence. From the UK, however, comes the promise of a "gas-less" bean popularized by Dr. Colin Leakey.

Managing Flatulence During Menopause

Gassiness and gastric distress are among the more common and less talked about symptoms of menopause. Here are some menopause and perimenopause remedies to relieve the problem that doctors often overlook.

Teas for Tummy Trouble

Equally appropriate when you have to deal with children with upset stomach and nerves and when you don't know what to eat when you have gas and upset stomach,teas are inexpensive, they are easy to make, they are safe and effective. Teas of various kinds make the perfect home remedy for all kinds of digestive distress. Just match the right tea to the symptoms. You may also be interested in valerian root tea for anxiety and nerves.