Perhaps you’ve only just been diagnosed with diabetes, or you’re a friend or family member who is hoping to better care for somebody else. There is so much information to contend with, even in simply understanding the concept of such a disease. The complications and details become even more varied when you’re past the age of fifty.
In these articles, we’ll provide a broad base of knowledge. This section explores the details of diagnosis—including risks like sugar, the APOE gene (which is also associated with Alzheimer’s disease), and weight gain—along with ways to help prevent and improve control of diabetes through healthy daily habits and awareness.
The first step to wellness is through education and understanding, and it’s never too late in your life to take the first step.
The Dangers of Diabetes
More Americans than ever before have diabetes mellitus, a disorder characterized by elevated levels of blood sugar (glucose). About twenty-nine million Americans (approximately 9.3 percent of the U.S. population) are afflicted with the disease, according to the Centers for Disease Control and Prevention. More than eight million of these people don’t even realize that they have it.
But that’s not all. A staggering eighty-six million Americans show early signs of diabetes (“prediabetes”) but don’t know that they are at risk of developing the full-blown disease. This alarming trend is due, in part, to the ever-increasing number of Americans who are overweight, which sharply increases diabetes risk.
If you have been gaining weight, eating a lot of high-fat and high-sugar foods, and/or not getting much exercise, I’m afraid that you’re already in danger of getting diabetes.
Even though this is a frightening scenario, there is some good news. If you identify the warning signs early enough, you can prevent diabetes from developing. If you already have diabetes, proper monitoring and healthful eating can help you control your glucose levels and avoid many of the disease’s serious complications, such as heart failure, stroke, kidney failure, eye disease, nerve damage, and/or amputation.
WHAT IS DIABETES?
Whenever we eat or drink, the food or liquid we ingest is broken down into nutrients that our bodies need to function. Glucose (a simple sugar that acts as the main energy source for our bodies) is one of the key nutrients. When glucose is absorbed into the bloodstream, it stimulates the pancreas to produce insulin. This hormone transports glucose into our body’s cells, where it is then converted to energy for immediate or later use.
There are two main types of diabetes.
Type 1 (formerly known as juvenile-onset) diabetes affects only about 10 percent of people with diabetes. Although the disorder usually develops in childhood or early adulthood (before age thirty), an increasing number of adults are now being affected.
Researchers theorize that the increasing incidence of obesity in adults may accelerate the autoimmune destruction that characterizes type 1 diabetes—specifically, the body’s immune system attacks and destroys the insulin-producing cells of the pancreas.
People with type 1 diabetes need frequent doses of insulin, which is typically delivered by injection with thin needles, a pen that contains an insulin-filled cartridge, or a small special “pump” that delivers a continuous dose of insulin.
Type 2 (once known as adult-onset) diabetes affects 90 percent of people who suffer from the disease. Most cases occur during adulthood, and risk increases with age. In recent years, many overweight children and teenagers have been diagnosed with type 2 diabetes.
In type 2 diabetes, the pancreas produces insulin (sometimes more than the usual amounts), but fat and tissue cells are resistant, preventing the hormone from doing what it’s supposed to do—which is to unlock cells so that blood glucose can enter.
Your risk of type 2 diabetes increases significantly if you eat a lot of foods that are high in simple carbohydrates (which are rapidly transformed into sugar) and foods that are low in dietary fiber (needed to slow the absorption of sugars from the food we eat and digest). Also, people who don’t get much exercise are more likely to develop type 2 diabetes because of the insulin resistance that results from weight gain and an imbalance of stress hormones.
In addition to obesity, risk factors for type 2 diabetes include a family history of the disease (especially in parents or siblings), apple-shaped body type, high blood pressure, high cholesterol, or, among women, a history of diabetes during pregnancy (gestational diabetes, which usually disappears after delivery). People with type 2 diabetes who have difficulty controlling their glucose levels may require oral medication, such as metformin and/or insulin injections.
HEADING OFF DIABETES
Prediabetes affects 35 percent of Americans between the ages of forty and seventy-four—well into your older years. In these people, blood glucose levels are elevated but not enough to be considered type 2 diabetes. Detecting the telltale signs of prediabetes—which show up in blood tests—helps you prevent the full-blown disease. Without these measures, there’s a good chance that a person diagnosed with prediabetes will develop type 2 diabetes within ten years.
I advise my patients (and readers) to get yearly blood tests to help identify many early-stage diseases, including diabetes. Diabetes-related tests should include fasting blood glucose to determine whether you are showing signs of prediabetes. Before you go to your doctor’s office for the test, you will need to fast for at least eight hours. Then blood is drawn and sent to a lab for a measurement of the glucose concentration, which is expressed in milligrams of glucose per deciliter (mg/dL). A fasting level of 100 to 125 mg/dL is considered prediabetes. (For more on the diagnostic criteria for diabetes, see “Test for Diabetes” on page 6.)
Too often, patients who have glucose levels of 100 to 115 mg/dL are told by their doctors that they don’t have a problem. In my view, a fasting blood glucose level in this range indicates prediabetes. I consider my patients to be free of any immediate risk only if their glucose levels are in the range of 70 to 86 mg/dL. If a patient’s glucose level is 87 to 100 mg/dL, I recommend some of the same strategies that I prescribe for people with prediabetes.
An oral glucose tolerance test can be used to check for prediabetes. After fasting for eight to twelve hours, a blood sample is taken to determine your fasting blood glucose level. Then your doctor will ask you to drink a solution with a high sugar content. After one, two, and three hours, your doctor draws a blood sample and checks your glucose reading. A level of 140 to 199 mg/dL for any of the readings indicates prediabetes. A reading of 200 mg/dL or above indicates diabetes.
I recommend that doctors also check insulin levels with the blood sample used for the glucose tolerance test. If insulin levels are abnormally high (15 to 20 microunits per milliliter or higher), it’s a sign that you are developing insulin resistance—which is often a step on the road to diabetes.
BETTER DIABETES MONITORING
If you have diabetes, proper monitoring of your condition can literally save your life. Blood sugar levels can change dramatically within a matter of minutes, causing confusion, dizziness, fatigue, and, in serious cases, a life-threatening coma. People with diabetes can easily measure their blood sugar levels with a small portable device that analyzes a drop of blood obtained by pricking a fingertip with a lancet. I recommend self-monitoring at least twice daily (upon awakening and thirty to sixty minutes after dinner). In addition, people with diabetes should make regular visits to their primary care doctors, have annual physicals, and get yearly eye exams from their ophthalmologists.
Other tests for people with diabetes include:
•Hemoglobin A1C. This test measures the amount of glucose sticking to the hemoglobin in red blood cells. It can be used as a marker of average blood glucose level over the past two to three months. Studies show that for every percentage point drop in A1C blood levels, risks for circulatory disorders as well as eye, kidney, and nerve diseases drop by 40 percent. Most doctors say that a hemoglobin A1C reading below 7 percent is acceptable. However, I believe that a reading below 6 percent is more desirable, because it shows better blood glucose control. People with an A1C reading of 7 percent or less should have this test twice a year. If your reading is above 8 percent, you should have it every three months.
•Oxidative stress analysis. This test measures the amount of tissue damage, or oxidative stress, caused by free radicals (harmful, negatively charged molecules). Few medical doctors know about oxidative stress testing, but I recommend it for patients with diabetes because they have high levels of oxidative stress, which accelerates the disease’s progression. The markers of free radical activity can be measured by blood or urine tests. Elevated levels mean that the antioxidants that are normally produced in the body and ingested via foods and supplements are not effectively neutralizing the overabundance of free radicals.
Your doctor can use Genova Diagnostics (800-522-4762, www.gdx.net) for the test. It costs about one hundred dollars, but most health insurers will cover it. People with diabetes should receive this test every six months until their values are normal.
•Cardiovascular markers. People with diabetes are more susceptible to heart disease. That’s because elevated glucose levels accelerate the buildup of plaque in the arteries. For this reason, I recommend blood tests for homocysteine, C-reactive protein, fibrinogen, lipoprotein A, apolipoprotein A and B, and iron. Abnormal levels of these markers are linked to the development of heart disease. I recommend a baseline test and yearly follow-up testing for people who have abnormal readings for any of these markers. Most health insurers will cover the costs of these tests.
THE SUGAR CONNECTION
Everyone knows that people who have diabetes or who are at risk for it should pay close attention to their diet. However, I’m convinced that few people realize just how damaging certain foods can be.
For example, about 20 percent of the average American’s energy intake comes from foods such as burgers, pizza, chips, pastries, and soft drinks. A study published in the American Journal of Clinical Nutrition found that between 1980 and 1997, the average American’s daily calorie consumption increased by five hundred calories. Eighty percent of this increase was due to increases in carbohydrates, which include almost all sweet and starchy foods. During the same period, the prevalence of type 2 diabetes increased by 47 percent, and the prevalence of obesity increased by 80 percent.
One of the worst culprits in the war on diabetes is the simple sugar fructose, which is naturally found in fruit and honey. Table sugar is half fructose (the other half is glucose, which is chemically the same as blood glucose). A type of fructose known as high-fructose corn syrup (HFCS) is especially harmful because it worsens insulin resistance. It has become the sweetener of choice for many soft drinks, ice creams, baked goods, candies/sweets, jams, yogurts, and other sweetened products. My recommendation is to put a strict limit on your consumption of foods that contain HFCS. This can be done by reducing your intake of packaged, processed foods, avoiding drinks that are high in fructose, and eating as many fresh foods as possible. (Natural sources of fructose, such as fruit and honey, can be safely consumed in moderation.)
There is one exception—some liquid nutritional supplements, such as liquid vitamin formulas, contain crystalline fructose, a natural sweetener that is far less processed than HFCS and is not believed to cause dramatic increases in insulin levels.
SYMPTOMS OF DIABETES
•Increased thirst
•Frequent urination (especially at night)
•Unexplained increase in appetite
•Fatigue
•Erection problems
•Blurred vision
•Tingling or numbness in the hands and/or feet
TEST FOR DIABETES
You have diabetes if any one of the following test results occurs on at least two different days:*
•A fasting blood glucose level of 126 mg/dL or higher.
•A two-hour oral glucose tolerance test result of 200 mg/dL or higher.
•Symptoms of diabetes (see previous list) combined with a random (nonfasting) blood glucose test of 200 mg/dL or higher.
›Mark A. Stengler, NMD, a naturopathic medical doctor and leading authority on the practice of alternative and integrated medicine. Dr. Stengler is author of the Health Revelations newsletter, The Natural Physician’s Healing Therapies, and Bottom Line’s Prescription for Natural Cures. He is also the founder and medical director of the Stengler Center for Integrative Medicine in Encinitas, California, and former adjunct associate clinical professor at the National College of Natural Medicine in Portland, Oregon. MarkStengler.com.
How America’s Top Diabetes Doctor Avoids Diabetes
You might think that a diabetes researcher would never develop the disease that he’s dedicated his life to studying. But I can’t count on it.
My family’s story: My father was diagnosed with diabetes at age seventy-two and was promptly placed on three medications to control his insulin levels.
What my father did next made all the difference: Even though he began taking diabetes medication, he simultaneously went into action—walking an hour a day and going on the diet described below. A year and a half later, he no longer needed the prescriptions. He still had diabetes, but diet and exercise kept it under control.
As a diabetes researcher and physician whose own diabetes risk is increased by his family history, I’ve got a lot at stake in finding the absolute best ways to avoid and fight this disease.
Here are the steps I take to prevent diabetes—all of which can benefit you whether you want to avoid this disease or have already been diagnosed with it and are trying to control or even reverse it:
Step 1: Follow a rural Asian diet. This diet includes the most healthful foods of a traditional Asian diet—it consists of 70 percent complex carbohydrates, 15 percent fat, 15 percent protein, and fifteen grams of fiber for every thousand calories. Don’t worry too much about all these numbers—the diet is actually pretty simple to follow once you get the hang of it.
You might be surprised by 70 percent complex carbohydrates, since most doctors recommend lower daily intakes of carbohydrates. The difference is, I’m recommending high amounts of complex, unrefined (not processed) carbohydrates. This type of carb is highly desirable because it’s found in foods—such as whole grains, legumes, vegetables, and fruits—that are chock-full of fiber. If your goal is to reduce diabetes risk, fiber is the holy grail.
Why I do it: The rural Asian diet has been proven in research to promote weight loss, improve insulin sensitivity (a key factor in the development and treatment of diabetes) and glucose control, and decrease total cholesterol and LDL “bad” cholesterol levels.
To keep it simple, I advise patients to follow a 2-1-1 formula when creating meals—two portions of nonstarchy veggies (such as spinach, carrots, or asparagus); one portion of whole grains (such as brown rice or quinoa), legumes (such as lentils or chickpeas), or starchy veggies (such as sweet potatoes or winter squash); and one portion of protein (such as salmon, lean beef, tofu, or eggs). Have a piece of fruit (such as an apple or a pear) on the side. Portion size is also important. Portions fill a nine-inch-diameter plate, which is smaller than a typical twelve-inch American dinner plate.
Helpful: I take my time when eating—I chew each bite at least ten times before swallowing. Eating too quickly can cause glucose levels to peak higher than usual after a meal.
Step 2: Fill up on dark green vegetables. I include dark, leafy greens in my diet every day. These leafy greens are one of the two portions of nonstarchy veggies in the 2-1-1 formula.
Why I do it: Dark green vegetables contain antioxidants and compounds that help your body fight insulin resistance (a main driver of diabetes).
My secret “power veggie”: a Chinese vegetable called bitter melon. It is a good source of fiber and has been shown to lower blood sugar. True to its name, bitter melon tastes a little bitter but is delicious when used in soups and stir-fries. It is available at Asian groceries. Eat bitter melon as one of the two portions of nonstarchy veggies in the 2-1-1 formula.
Step 3: Adopt an every-other-day workout routine. I try to not be sedentary and to walk as much as I can (by using a pedometer, I can tell whether I’ve reached my daily goal of ten thousand steps).
While this daily practice helps, it’s not enough to significantly affect my diabetes risk. For that, I have an every-other-day workout routine that consists of thirty minutes of jogging on the treadmill (fast enough so that I’m breathing hard but can still carry on a conversation), followed by thirty minutes of strength training (using handheld weights, resistance bands, or weight machines).
Why I do it: Working out temporarily reduces your insulin resistance and activates enzymes and proteins that help your muscles use glucose instead of allowing the body to accumulate fat—a beneficial effect that lasts for forty-eight hours (the reason for my every-other-day routine). Strength training is crucial—your muscles are what really kick your body’s glucose burning into high gear. A weekly game of tennis helps shake up my routine.
Step 4: Keep the temperature chilly. At the courts where I play tennis, the temperature is naturally cool, but I wear a very thin T-shirt that leaves my neck exposed. This helps activate the “brown fat” in my body. Most people have this special type of body fat—mainly around the neck, collarbone, and shoulders.
Why I do it: Brown fat burns calories at high rates when triggered by the cold. To help burn brown fat, exercise in temperatures of 64°F or lower, set your home’s thermostat in the mid-60s, and dress as lightly as possible in cool weather. Walking for fifty to sixty minutes a day in cool weather also helps.
Step 5: Get the “sleep cure.” I make a point to sleep at least six hours a night during the week and seven hours nightly on weekends.
Why I do it: Lack of sleep has been proven to dramatically harm the body’s ability to properly metabolize glucose—a problem that sets the stage for diabetes. Research shows that seven to eight hours a night are ideal. However, because of my work schedule, I’m not always able to get that much sleep on weekdays. That’s why I sleep a bit longer on weekends.
Research now shows that the body has some capacity to catch up on lost sleep and reverse some—but not all—of the damage that occurs to one’s insulin sensitivity when one is sleep deprived.
›George L. King, MD, research director and chief scientific officer of Harvard’s Joslin Diabetes Center, where he heads the vascular cell biology research section, and professor of medicine at Harvard Medical School in Boston. Dr. King is coauthor, with Royce Flippin, of The Diabetes Reset: Avoid It, Control It, Even Reverse It—A Doctor’s Scientific Program.
The Best Way to Prevent Diabetes—No Drugs Needed
Approximately 9.3 percent of Americans have diabetes; the percentage of Americans age sixty-five and older remains high, at 25.9 percent, or 11.8 million people (diagnosed and undiagnosed). So if your doctor ever tells you (or has already told you) that you have prediabetes, you’d be wise to consider it a serious red flag. It means that your blood sugar level is higher than normal—though not yet quite high enough to be classified as diabetes—because your pancreas isn’t making enough insulin and/or your cells have become resistant to the action of insulin.
A whopping 35 percent of American adults now have prediabetes. Nearly one-third of them will go on to develop full-blown diabetes, with all its attendant risks for cardiovascular problems, kidney failure, nerve damage, blindness, amputation, and death.
That’s why researchers have been working hard to figure out the best way to keep prediabetes from progressing to diabetes. And according to an encouraging new study, one particular approach involving some fairly quick action has emerged as the winner—slashing prediabetic patients’ risk for diabetes by an impressive 85 percent, without relying on drugs.
NEW LOOK AT THE NUMBERS
The new study draws on data from the National Diabetes Prevention Program, the largest diabetes prevention study in the United States, which began back in 1996. The program included 3,041 adults who had prediabetes and were at least somewhat overweight.
Participants were randomly divided into three groups. One group was given a twice-daily oral placebo and general lifestyle modification recommendations about the importance of healthful eating, losing weight, and exercising. A second group was given twice-daily oral metformin (a drug that prevents the liver from producing too much glucose) and those same lifestyle recommendations. The third group was enrolled in an intensive lifestyle modification program, with the goal of losing at least 7 percent of their body weight and exercising at moderate intensity for at least 150 minutes each week.
The original analysis of the data, done after 3.2 years, showed that intensive lifestyle modification reduced diabetes risk by 58 percent, and metformin use reduced diabetes risk by 31 percent, as compared with the placebo group.
Updated analysis: Researchers wanted to know whether those odds could be improved even further, so they did a new analysis, this time looking specifically at what happened in the first six months after prediabetes patients began treatment and then following up for ten years. What they found:
•At the six-month mark, almost everyone (92 percent) in the intensive lifestyle-modification group had lost weight, while more than 25 percent in the metformin group (and nearly 50 percent in the placebo group) had gained weight. The average percentage of body weight lost in each group was 7.2 percent in the lifestyle group, 2.4 percent in the metformin group, and 0.4 percent in the placebo group. Ten years later, most of those in the lifestyle group had maintained their substantial weight loss—quite an accomplishment, given how common it is for lost pounds to be regained.
•In the intensive lifestyle-modification group, those who lost 10 percent or more of their body weight in the first six months reduced their diabetes risk by an impressive 85 percent. But even those who fell short of the 7 percent weight loss goal benefited. For instance, those who lost 5 percent to 6.9 percent of their body weight reduced their risk by 54 percent, and those who lost just 3 percent to 4.9 percent reduced their risk by 38 percent.
If you have prediabetes: Don’t assume that diabetes is an inevitable part of your future, and don’t assume that you necessarily have to take drugs. By taking action now, you can greatly reduce your risk of developing this deadly disease. So talk with your doctor about joining a program designed to help people with prediabetes adopt healthful dietary and exercise habits that will promote safe, speedy, and permanent weight loss. Ask your doctor or health insurer for a referral, or to find a YMCA Diabetes Prevention Program near you, go to www.ymca.net/diabetes-prevention.
›Nisa M. Maruthur, MD, assistant professor of medicine, The Johns Hopkins School of Medicine and the Welch Center for Prevention, Epidemiology, and Clinical Research, both in Baltimore. Her study was published in the Journal of General Internal Medicine.
The Shocking Diabetes Trigger That Can Strike Anyone
Everyone knows about high blood sugar and the devastating effects it can have on one’s health and longevity. But low blood sugar (hypoglycemia) can be just as dangerous—and it does not get nearly the attention that it should.
Simply put, hypoglycemia occurs when the body does not have enough glucose to use as fuel. It most commonly affects people with type 2 diabetes who take medication that sometimes works too well, resulting in low blood sugar.
Who gets overlooked: In other people, hypoglycemia can be a precursor to diabetes that is often downplayed by doctors and/or missed by tests. Having low blood sugar might even make you think that you are far from having diabetes when, in fact, the opposite is true.
Hypoglycemia can also be an underlying cause of anxiety that gets mistakenly treated with psychiatric drugs rather than the simple steps (see page 13) that can stabilize blood sugar levels. That’s why anyone who seems to be suffering from an anxiety disorder needs to be seen by a doctor who takes a complete medical history and orders blood tests. When a patient comes to me complaining of anxiety, hypoglycemia is one of the first things I test for.
What’s the link between hypoglycemia and anxiety? A sudden drop in blood sugar deprives the brain of oxygen. This, in turn, causes the adrenal glands to release adrenaline, the “emergency” hormone, which may lead to agitation, or anxiety, as the body’s fight-or-flight mechanism kicks in.
THE DANGERS OF HYPOGLYCEMIA
Hypoglycemia has sometimes been called carbohydrate intolerance, because the body’s insulin-releasing mechanism is impaired in a manner similar to what occurs in diabetics. In people without diabetes, hypoglycemia is usually the result of eating too many simple carbohydrates (such as sugar and white flour). The pancreas then overreacts and releases too much insulin, thereby excessively lowering blood sugar.
The good news is that hypoglycemia—if it’s identified—is not that difficult to control through diet and the use of specific supplements. Hypoglycemia should be considered a warning sign that you must adjust your carbohydrate intake or risk developing type 2 diabetes.
Caution: An episode of hypoglycemia in a person who already has diabetes can be life-threatening and requires prompt care, including the immediate intake of sugar—a glass of orange juice or even a sugar cube can be used.
Common symptoms of hypoglycemia include: Fatigue, dizziness, shakiness and faintness; irritability and depression; weakness or cramps in the feet and legs; numbness or tingling in the hands, feet, or face; ringing in the ears; swollen feet or legs; tightness in the chest; heart palpitations; nightmares and panic attacks; “drenching” night sweats (not menopausal or perimenopausal hot flashes); constant hunger; headaches and migraines; impaired memory and concentration; blurred vision; nasal congestion; abdominal cramps; loose stools; and diarrhea.
A TRICKY DIAGNOSIS
Under-the-radar hypoglycemia (known as subclinical hypoglycemia) is difficult to diagnose because symptoms may be subtle and irregular, and test results can be within normal ranges. Technically, if your blood sugar drops below 70 milligrams per deciliter (mg/dL), you are considered hypoglycemic. But people without diabetes do not check their blood sugar levels on their own, so it is important to be aware of hypoglycemia symptoms.
If you suspect that you may have hypoglycemia, talk to your physician. Ideally, you should arrange to have your blood glucose levels tested when you are experiencing symptoms. You will then be asked to eat food so that your blood glucose can be tested again. If this approach is impractical for you, however, talk to your doctor about other testing methods.
THE RIGHT TREATMENT
If you have been diagnosed with diabetes, hypoglycemia may indicate that your diabetes medication dose needs to be adjusted. The sugar treatment described earlier can work in an emergency but is not recommended as a long-term treatment for hypoglycemia. Left untreated, hypoglycemia in a person with diabetes can lead to loss of consciousness and even death.
In addition to getting their medication adjusted, people with diabetes—and those who are at risk for it due to hypoglycemia—can benefit from the following:
•A high-protein diet and healthful fats. To keep your blood sugar levels stabilized, consume slowly absorbed, unrefined carbohydrates, such as brown rice, quinoa, oatmeal, and sweet potatoes. Also, get moderate amounts of healthful fats, such as those found in avocado, olive oil, and fatty fish, including salmon, and protein, such as fish, meat, chicken, soy, and eggs.
Recommended protein intake: 10 to 35 percent of daily calories. If you have kidney disease, get your doctor’s advice on protein intake.
•Eat several small meals daily. Start with breakfast to give your body fuel for the day (if you don’t, stored blood sugar will be released into your bloodstream) and then have a small meal every three to four waking hours.
•Avoid tobacco, and limit your use of alcohol and caffeine. They cause an excessive release of neurotransmitters that, in turn, trigger the pancreas to deliver insulin inappropriately.
•Add supplements. The supplements below also help stabilize blood sugar levels (and can be used in addition to a daily multivitamin).*
›Chromium and vitamin B-6. Chromium helps release accumulated sugars in the liver, which can lead to a dangerous condition called fatty liver. Vitamin B-6 supports chromium’s function and helps stabilize glucose levels.
Typical daily dose: 200 micrograms (mcg) of chromium with 100 milligrams (mg) of vitamin B-6.
›Glutamine. As the most common amino acid found in muscle tissue, glutamine plays a vital role in controlling blood sugar. Glutamine is easily converted to glucose when blood sugar is low.
Typical daily dose: Up to four 500-mg capsules daily, or add glutamine powder to a protein drink or a smoothie that does not contain added sugar—these drinks are good options for your morning routine. Glutamine is best taken thirty minutes before a meal to cut your appetite by balancing your blood sugar.
›Hyla Cass, MD, a board-certified psychiatrist and nationally recognized expert on integrative medicine based in Los Angeles. She is author of numerous books, including 8 Weeks to Vibrant Health and The Addicted Brain and How to Break Free. CassMD.com.
The Secret Invasion That Causes Diabetes
It’s easy to get the impression that diabetes is all about blood sugar. Most people with diabetes check their glucose levels at least once a day. Even people without diabetes are advised to have glucose tests every few years—just to make sure that the disease isn’t creeping up on them.
But glucose is only part of the picture. Scientists now know that chronic inflammation increases the risk that you’ll develop diabetes. If you already have insulin resistance (a precursor to diabetes) or full-blown diabetes, inflammation will make your glucose levels harder to manage.
A common mistake: Unfortunately, many doctors still don’t test for inflammation even though it accompanies all of the main diabetes risk factors, including smoking, obesity, and high-fat/sugar diets.
SILENT DAMAGE
You hear a lot about inflammation, but what exactly is it—and when is it a problem? Normal inflammation is protective. It comes on suddenly and lasts for just a few days or weeks—usually in response to an injury or infection. Inflammation kills or encapsulates microbes, assists in the formation of protective scar tissue, and helps regenerate damaged tissues.
But chronic inflammation—caused, for example, by infection or injuries that lead to continuously elevated levels of toxins—does not turn itself off. It persists for years or even decades, particularly in those who are obese, eat poor diets, don’t get enough sleep, or have chronic diseases, including seemingly minor conditions such as gum disease.
The diabetes link: Persistently high levels of inflammatory molecules interfere with the ability of insulin to regulate glucose—one cause of high blood sugar. Inflammation also appears to damage beta cells, the insulin-producing cells in the pancreas.
Studies have shown that when inflammation is aggressively lowered—with salsalate (an anti-inflammatory drug), for example—glucose levels can drop significantly. Inflammation is typically identified with a blood test that measures a marker known as CRP, or C-reactive protein (see page 17).
HOW TO FIGHT INFLAMMATION
Even though salsalate reduces inflammation, when taken in high doses, it causes too many side effects, such as stomach bleeding and ringing in the ears, to be used long term. Here are some safer ways to reduce inflammation and keep it down:
•Breathe clean air. Smoke and smog threaten more than just your lungs. Recent research has shown that areas with the highest levels of airborne particulates that are small enough to penetrate deeply into the lungs have more than 20 percent higher rates of type 2 diabetes than areas with the lowest levels of these particulates.
Air pollution (including cigarette smoke) increases inflammation in fatty tissues and in the vascular system. In animal studies, exposure to air pollution increases both insulin resistance and the risk for full-fledged diabetes.
My advice: Most people—and especially those who live in polluted areas—could benefit from using an indoor HEPA filter or an electrostatic air filter. They will trap nearly 100 percent of harmful airborne particulates from indoor air.
If you live in a large metropolitan area, avoid outdoor exercise during high-traffic times of day.
•Take care of your gums. Even people who take good care of their teeth often neglect their gums. It’s estimated that almost half of American adults have some degree of periodontal (gum) disease.
Why it matters: The immune system can’t always eliminate infections that occur in gum pockets, the areas between the teeth and gums. A persistent gum infection causes equally persistent inflammation that contributes to other illnesses. For example, research shows that people with gum disease were twice as likely to develop diabetes as those without it.
My advice: After every meal (or at least twice a day), floss and brush, in that order. And clean your gums—gently use a soft brush. Twice a day, also use an antiseptic mouthwash (such as Listerine).
It’s particularly important to follow these steps before you go to bed to remove bacteria that otherwise will remain undisturbed until morning.
•Get more exercise. It’s among the best ways to control chronic inflammation because it burns fat. When you have less fat, you’ll also produce fewer inflammation-promoting cytokines.
Data from the Nurses’ Health Study and the Health Professionals Follow-Up Study found that walking briskly for a half hour daily reduced the risk of developing diabetes by nearly one-third.
My advice: Take ten thousand steps per day. To do this, walk whenever possible for daily activities, such as shopping, and even walk inside your home if you don’t want to go out. Wear a pedometer to make sure you reach your daily goal.
•Enjoy cocoa. Cocoa contains a type of antioxidant known as flavanols, which have anti-inflammatory properties. Known primarily for their cardiovascular benefits, flavanols are now being found to help regulate insulin levels.
My advice: For inflammation-fighting effects, have one square of dark chocolate (with at least 70 percent cocoa) daily.
•Try rose hip tea. Rose hips are among the richest sources of vitamin C, with five times as much per cup as what is found in one orange. A type of rose hip known as Rosa canina is particularly potent, because it may contain an additional anti-inflammatory compound known as glycoside of mono and diglycerol (GOPO). It inhibits the production of a number of inflammatory molecules, including chemokines and interleukins.
My advice: Drink several cups of tangy rose hip tea a day. It’s available both in bags and as a loose-leaf tea. If you’re not a tea drinker, you can take rose hip supplements. Follow the directions on the label.
•Season with turmeric. This spice contains curcumin, one of the most potent anti-inflammatory agents. It inhibits the action of eicosanoids, signaling molecules that are involved in the inflammatory response.
My advice: Eat more turmeric—it’s a standard spice in curries and yellow (not Dijon) mustard. You will want something more potent if you already have diabetes and/or elevated CRP. I often recommend Curamin, a potent form of curcumin that’s combined with boswellia, another anti-inflammatory herb.
Important: Be sure to talk to your doctor before trying rose hip or turmeric supplements if you take medication or have a chronic health condition.
CHECK YOUR CRP LEVEL
An inexpensive and accurate blood test that is often used to estimate heart attack risk is also recommended for people who have diabetes or are at increased risk for it. The blood test measures C-reactive protein (CRP), a marker for inflammation, which can lead to heart disease and impair the body’s ability to regulate glucose.
A high-sensitivity CRP (hs-CRP) test typically costs about twenty dollars and is usually covered by insurance. A reading of less than 1 mg/L is ideal. Levels above 3 mg/L indicate a high risk for insulin resistance and diabetes as well as for heart attack.
If the first test shows that your CRP level is elevated, you’ll want to do everything you can to lower it—for example, through exercise, a healthful diet, and weight loss. Repeat the test every four to six months to see how well your lifestyle improvements are working.
›George L. King, MD, research director and chief scientific officer of Harvard’s Joslin Diabetes Center, where he heads the vascular cell biology research section, and professor of medicine at Harvard Medical School in Boston. Dr. King is coauthor, with Royce Flippin, of The Diabetes Reset: Avoid It, Control It, Even Reverse It—A Doctor’s Scientific Program.
How Your APOE Genes Lead to Diabetes or Heart Disease
If you have a family history of diabetes or heart disease, you no doubt have been told to watch your diet—to consume whole grains, olive oil, lean protein, tons of produce, and maybe some red wine. But could some of those supposedly heart-healthy foods actually be increasing your risk? Yes, depending on a particular gene that you may have, a gene that even many doctors don’t know about.
Your family’s ailments may be linked to a gene known as apolipoprotein E (APOE), which determines how your body metabolizes certain foods. According to cardiologist Suzanne Steinbaum, DO, author of Dr. Suzanne Steinbaum’s Heart Book, if your diet suits your APOE type, you should be able to avoid following in your family’s unfortunate medical footsteps. “The APOE genotype is like a light switch—it is going to activate only if you turn it on by eating foods that are wrong for your type,” she says.
There are three genotypes (gene subtypes) associated with the gene—APOE-2, APOE-3, and APOE-4. A person inherits one of these from each parent.
About two-thirds of people have a “3/3” pairing, meaning they inherited APOE-3 from their mother and APOE-3 from their father. These lucky folks don’t need to adhere too closely to any particular type of diet in order to avoid heart disease and diabetes, provided they follow a reasonably healthful diet, control their weight, exercise regularly, and don’t smoke.
However, people who inherited the APOE-2 gene from one or both parents (a bit more than 10 percent of the population) have trouble metabolizing carbohydrates. This makes them prone to diabetes.
People who inherited the APOE-4 gene from one or both parents (just over 20 percent of the population) can’t handle fat. This increases their risk for coronary artery disease.
An unlucky minority (less than 2 percent of the population) have a “2/4” pairing—meaning they inherited APOE-2 from one parent and APOE-4 from the other parent—and thus are prone to both diabetes and coronary artery disease.
TELLING YOUR TYPE
A blood test can determine which genotype you have inherited. Dr. Steinbaum often recommends the test because she has found that patients generally comply better with dietary advice when there’s a scientific indication that a particular diet will be especially protective for them. Some insurance policies cover the test (which costs about $150 or more, depending on the lab), so ask your insurance company.
If you choose not to get the blood test, you can get some idea—though not with certainty—of whether you carry the APOE-2 and/or APOE-4 genes.
People who inherited the APOE-2 gene from one or both parents tend to have:
•High triglycerides and blood sugar
•A family history of diabetes and obesity
Diet recommendations: People with APOE-2 often crave foods like cookies, jelly beans, bread, and soda—but their bodies cannot metabolize sugars and simple carbohydrates, and they often wind up overweight or obese, Dr. Steinbaum says. Lean proteins and moderate amounts of complex carbohydrates (such as whole grains and legumes) are the keys to good health for these people.
Note: Even though a glass of red wine with dinner is often said to be heart-healthy, Dr. Steinbaum advises APOE-2 carriers against drinking wine because it is loaded with sugars.
People who inherited the APOE-4 gene from one or both parents tend to have:
•High LDL “bad” cholesterol
•A family history of coronary artery disease
Recommended: If this is your profile, you’re likely to gravitate toward Buffalo wings, cheeseburgers, rich ice cream, and other fatty foods—yet your body has a hard time breaking down and absorbing fats, and the receptors that are supposed to sweep up LDL “bad” cholesterol are suppressed. Dr. Steinbaum says, “For these people, I usually advise following an extremely low-fat diet, preferably a vegetarian or vegan diet, with less than 7 percent of calories coming from saturated fats.” Even plant-based fats such as olive oil and nuts, which are considered heart-healthy for other people, should be consumed only in moderate amounts by people with the APOE-4 gene. You should also be aware that cholesterol-lowering statin drugs are less effective in APOE-4 individuals than in other people, so even if you take a statin, a low-fat diet is still very important for you.
People who inherited the APOE-2 gene from one parent and the APOE-4 gene from the other parent tend to have:
•High triglycerides, high blood sugar, and high LDL cholesterol
•A family history of both diabetes and coronary artery disease
Recommended: If you have a “2/4” pairing, you’re in the unfortunate minority of people who have trouble metabolizing not only sugars and simple carbohydrates but also fats. Your best choice is to be a vegetarian, Dr. Steinbaum says. Focus primarily on vegetables, legumes, whole grains, and other complex carbohydrates, and avoid sweets, wine, white bread, white pasta, and other simple carbs. You also need to keep your fat intake quite low, consuming only modest amounts of plant-based fats and little or no animal fat. Your healthiest food options are vegetables, legumes, whole grains, and other complex carbohydrates.
Knowing your APOE gene can be very empowering. “When you think of heart disease as being genetic, you might assume, ‘Well, my dad got it, my aunts got it, and my grandfather got it, so I’m going to get it too.’ But if your dad’s whole family had eggs for breakfast, chicken for lunch, and beef for dinner most days, the real problem lies in the fact that everyone was eating the wrong way for their gene type,” Dr. Steinbaum says. The same goes for a family legacy of diabetes when the family diet tended toward high-carb foods.
So remember—whether your genetic legacy leaves you vulnerable to heart disease, diabetes, or both, committing to the right type of diet for you might well be enough to break that chain.
›Suzanne Steinbaum, DO, attending cardiologist and director of Women’s Heart Health, Lenox Hill Hospital, New York City. SRSHeart.com.
Could Antibiotics Give You Diabetes?
Antibiotics can cure. They kill infectious bacteria and save lives. Type 2 diabetes is a chronic disease. It shortens lives. But older men and women generally have to be extra careful when it comes to antibiotics, and now there is disturbing evidence that the cure may be contributing to the disease—in other words, certain antibiotics may increase the risk of developing diabetes.
The connection is the ecosystem of bacteria in our gut that scientists call the microbiome. It affects digestion and immunity, and an unhealthy microbiome has been linked to diseases as diverse as obesity, certain cancers, inflammatory bowel disease, rheumatoid arthritis, and diabetes. Several studies have shown that type 2 diabetes, the kind that affects most people, is more common in people who have microbiomes with altered or low bacteria diversity. What we eat and drink changes the composition of the bacteria, and so can the medication we take, especially antibiotics.
Penicillin, the original wonder drug, saved soldiers from battlefield infections in World War II and later revolutionized medicine by curing once-fatal infections. But antibiotics by their very nature disturb the microbiome by killing bacteria, including beneficial bacteria in the gut.
Now, the newest research finds an association between the repeated use of certain antibiotics and the diabetes epidemic that affects thirty million Americans…and counting.
A STRONG ASSOCIATION IN A MILLION PEOPLE
In the latest study, researchers had access to nearly complete medical records of almost ten million people living in the United Kingdom. The records included medical diagnoses, tests and procedures, prescription medications, and lifestyle factors, including smoking and drinking history.
The research team identified 208,002 people who were diagnosed with diabetes (either type 1 or 2). Each case was matched with four controls, people of the same age and sex who did not have diabetes. In all, the study included more than one million men and women, with an average age of sixty.
Looking deeper into the medical records of the participants, the researchers searched for prescriptions for several different antibiotics, including, yes, penicillin, still the most popular choice. They excluded antibiotics prescribed in the year before a diabetes diagnosis, since many of these patients may have had undiagnosed diabetes already. They adjusted statistically for many variables, including smoking, high cholesterol, obesity, heart disease, skin and respiratory infections, and previous blood sugar measurement. The results:
•In most cases, a single course of antibiotics was not associated with any increased risk for diabetes, compared with taking no antibiotics at all.
•The exception was a class of antibiotics called cephalosporins, broad-spectrum antibiotics often prescribed for strep throat and urinary tract infections (UTIs). Even taking a single course of these antibiotics was associated with a 9 percent increase in type 2 diabetes risk.
•For the antibiotics linked with type 2 diabetes, the more courses people took in any one year, the greater the risk. Taking two to five courses of penicillin in a single year was linked to an 8 percent increase in diabetes risk, for example, while taking more than five courses was linked to a raised risk of 23 percent. Similarly, taking two to five courses of quinolones, prescribed for skin and respiratory infections as well as UTIs, was linked to a 15 percent increase in diabetes risk, while taking more than five courses raised risk 37 percent.
•Tetracyclines were associated with a raised type 2 diabetes risk only in people who took them for five or more courses in a year.
•Nitroimidazoles, prescribed for vaginal infections as well as skin infections such as rosacea, were not associated with increased diabetes risk when taken at any frequency.
•Neither antiviral nor antifungal medications were linked with diabetes risk.
•While there appeared to be an association between some antibiotics and type 1 diabetes, an autoimmune condition, for some antibiotics, the results were inconclusive.
WITH ANTIBIOTICS, DO THE RIGHT THING
This study, while big and statistically powerful, doesn’t tell us whether using antibiotics actually cause diabetes. That’s because it’s observational. It looks back and draws connections. A prospective study would assign one group of people to take antibiotics whether they need them or not, deny them to another group, and follow them for years to see who gets diabetes. For practical and ethical reasons, of course, that’s impossible.
So it’s possible that people who would go on to develop diabetes even years later are more prone to infections and so would need more antibiotics. On the other side, prospective animal studies have shown that antibiotics promote the growth of bacteria that promote diabetes. Because diabetes is so common and such a damaging disease, researchers are looking for other ways to tease out whether and how antibiotics contribute to diabetes.
You don’t have to wait to do the right thing though. These wonder drugs have been overused, both for human medicine and animal livestock, and many are losing their effectiveness due to rising antibiotic resistance, a scary prospect. Using antibiotics only when they are really needed not only protects your own health but helps keep these drugs effective when they are really needed.
By all means, take an antibiotic if it’s the right treatment. But there are already many good reasons to avoid antibiotics if possible, and the truth is, they are often prescribed for health conditions for which they can’t possibly work. Antibiotics kill bacteria, so they won’t help with, say, the common cold, which is caused by a virus. Most sinus infections, even those caused by bacterial infections, don’t require antibiotics either.
In many cases, doctors prescribe antibiotics when they’re not needed because a patient insists on it for almost any sort of infection or even suspected infection.
Don’t be that patient!
›Yu-Xiao Yang, MD, associate professor of medicine, division of gastroenterology, department of medicine, department of epidemiology and biostatistics, Perelman School of Medicine at University of Pennsylvania, Philadelphia. His study was published in the European Journal of Endocrinology.
These Drugs Can Raise Diabetes Risk
When your doctor pulls out his/her prescription pad, you probably assume that your health problem will soon be improving. Sure, there may be a side effect or two—perhaps an occasional upset stomach or a mild headache. But overall, you will be better off, right?
Not necessarily. While it’s true that many drugs can help relieve symptoms and sometimes even cure certain medical conditions, a number of popular medications actually cause disease—not simply side effects—while treating the original problem.
Here’s what happens: Your kidney and liver are the main organs that break down drugs and eliminate them from your body. But these organs weaken as you age. Starting as early as your twenties and thirties, you lose 1 percent of liver and kidney function every year. As a result, drugs can build up in your body (particularly if you take more than one), become toxic, damage crucial organs, such as the heart and brain—and trigger disease, such as diabetes.
Older adults are at greatest risk for this problem because the body becomes increasingly less efficient at metabolizing drugs with age. But no one is exempt from the risk.
Many commonly prescribed drugs increase risk for type 2 diabetes. These medications include statins, beta blockers, antidepressants, antipsychotics, steroids, and alpha blockers prescribed for prostate problems and high blood pressure.
There are a number of safer alternatives to discuss with your doctor, consultant pharmacist, or other health-care professional.
If you’re prescribed a beta blocker: Ask about using a calcium-channel blocker instead. Diltiazem has the fewest side effects. The twenty-four-hour sustained-release dose provides the best control.
If you’re prescribed an antidepressant: Ask about venlafaxine, a selective serotonin and norepinephrine reuptake inhibitor (SSNRI) antidepressant that treats depression and anxiety and has been shown to cause fewer problems for diabetic patients than any of the older selective serotonin reuptake inhibitor (SSRI) drugs.
If you’re prescribed an alpha blocker: For prostate problems, rather than taking the alpha blocker tamsulosin, ask about using dutasteride or finasteride. For high blood pressure, ask about a calcium-channel blocker drug.
THE VERY BEST DRUG SELF-DEFENSE
If you’re over age sixty—especially if you take more than one medication or suffer drug side effects—it’s a good idea to ask your physician to work with a consulting pharmacist who is skilled in medication management. A consulting pharmacist has been trained in drug therapy management and will work with your physician to develop a drug management plan that will avoid harmful drugs. These services are relatively new and may not be covered by insurance, so be sure to check with your provider.
To find a consulting pharmacist in your area, go to the website of the American Society of Consultant Pharmacists, www.ascp.com, and click on “Find a Senior Care Pharmacist.”
Also helpful: Make sure that a drug you’ve been prescribed does not appear on the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Originally developed by the late Mark Beers, editor of the Merck Manual of Medical Information, the list has been recently updated by the American Geriatrics Society. To download the list for free, go to www.geriatricscareonline.org and click on Clinical Guidelines & Recommendations.
›Armon B. Neel Jr., PharmD, a certified geriatric pharmacist, adjunct instructor in clinical pharmacy at Mercer University College of Pharmacy and Health Sciences in Atlanta. Dr. Neel is also coauthor of Are Your Prescriptions Killing You? How to Prevent Dangerous Interactions, Avoid Deadly Side Effects, and Be Healthier with Fewer Drugs. MedicationXpert.com.
Get More of This Mineral to Shield Against Diabetes
Diabetes—the disease of chronically high levels of blood sugar—is an epidemic.
Ten percent of American adults have it, including 40 percent of people sixty-five and older. In fact, the rate of diabetes is rising so fast, the Centers for Disease Control predict the number of Americans with the disease will triple by 2050.
Key fact not widely reported: One reason so many of us get diabetes may be that so few of us get enough of the mineral magnesium in our diets.
In a recently completed twenty-year study of nearly forty-five hundred Americans, researchers from the University of North Carolina at Chapel Hill found that those with the biggest intake of magnesium (200 mg per every one thousand calories consumed) had a 47 percent lower risk of diabetes than those with the smallest intake (100 mg per every one thousand calories consumed). The study also linked lower magnesium intake to higher levels of a biomarker of insulin resistance and three biomarkers of chronic inflammation (C-reactive protein, interleukin-6, fibrinogen).
What happens: Insulin is the hormone that ushers blood sugar (glucose) out of the bloodstream and into cells. In insulin resistance, cells don’t respond to the hormone, and blood glucose levels stay high—often leading to diabetes. And inflammatory biochemicals trigger the manufacture of proteins that increase insulin resistance.
“Magnesium has an anti-inflammatory effect, and inflammation is one of the risk factors for diabetes,” says Ka He, MD, the study leader. “Magnesium is also a cofactor in the production of many enzymes that are a must for balanced blood sugar levels.”
COMPELLING SCIENTIFIC EVIDENCE
Other recent studies also link magnesium intake and diabetes:
•Ten times more magnesium deficiency in people with diabetes. Compared with healthy people, people with newly diagnosed diabetes were ten times more likely to have low blood levels of magnesium, and people with “known diabetes” were eight times more likely to have low levels, reported researchers from Cambridge University in the journal Diabetes Research and Clinical Practice.
•Low magnesium, high blood sugar. People with diabetes and low intake of magnesium had poorer blood sugar control than people with a higher intake of magnesium, reported Brazilian scientists. “Magnesium plays an important role in blood glucose control,” they concluded in the journal Clinical Nutrition.
•More nerve damage. Nerve damage—diabetic neuropathy, with pain and burning in the feet and hands—is a common complication of diabetes. Indian researchers found that people with diabetic neuropathy had magnesium levels 23 percent lower than people without the problem.
•Magnesium protects diabetic hearts. High blood sugar damages the circulatory system, with diabetes doubling the risk of heart attack or stroke. In a study from Italian researchers, taking a magnesium supplement strengthened the arteries and veins of older people with diabetes. The results were in the journal Magnesium Research.
A magnesium supplement balances blood sugar—even if you’re not diabetic. In a study of fifty-two overweight people with insulin resistance (but not diabetes), those who took a daily magnesium supplement of 365 mg had a greater drop in blood sugar levels and insulin resistance than those who took a placebo, reported German researchers in Diabetes, Obesity and Metabolism.
Bottom line: “Based on evidence from the study I led and other studies, increasing the intake of magnesium may be beneficial in diabetes,” says Dr. He.
MORE MAGNESIUM
The recommended dietary allowance (RDA) for magnesium is 420 mg a day for men and 320 mg a day for women.
However: In a study conducted by the Centers for Disease Control, no group of U.S. citizens tested—including Caucasian, African American, Hispanic American, men, or women—consumed the RDA for magnesium. “Substantial numbers of U.S. adults fail to consume adequate magnesium in their diets,” concluded researchers in the journal Nutrition.
They also found that magnesium intake decreased as age increased—a troublesome finding, since diabetes is usually diagnosed in middle-aged and older people.
Healthful strategy: “I recommend increasing the intake of foods rich in magnesium, such as whole grains, nuts, legumes, vegetables, and fruits,” says Dr. He.
Best food sources of magnesium include:
•Nuts and seeds (almonds, cashews, pumpkin seeds, sunflower seeds, sesame seeds)
•Leafy green and other vegetables (spinach, Swiss chard, kale, collard greens, mustard greens, turnip greens, cabbage, broccoli, cauliflower, Brussels sprouts, green beans, asparagus, cucumber, celery, avocado, beets)
•Whole grains (whole-grain breakfast cereals, wheat bran, wheat germ, oats, brown rice, buckwheat)
•Beans and legumes (soybeans and soy products, lentils, black-eyed peas, kidney beans, black beans, navy beans)
•Fruit (bananas, kiwi fruit, watermelon, raspberries)
•Fish (salmon, halibut)
CONSIDER A MAGNESIUM SUPPLEMENT
But magnesium-rich food may not be sufficient to protect you from diabetes, says Michael Wald, MD, director of nutritional services at the Integrated Medicine and Nutrition clinic in Mt. Kisco, New York. That’s because many factors can deplete the body of magnesium or block its absorption. They include:
•Overcooking greens and other magnesium-rich foods
•Eating too much sugar
•Emotional and mental stress
•Taking magnesium-draining medications, such as diuretics for high blood pressure
•Exposure to environmental toxins such as pesticides
•Bowel diseases and bowel surgery
“Low blood levels of magnesium are very common,” says Dr. Wald. And conventional doctors rarely test magnesium levels.
Recommended: To help guarantee an adequate blood level of magnesium, Dr. Wald recommends taking PERQUE Magnesium Plus Guard. For maximum absorption and effectiveness, this doctor-developed supplement contains four different forms of the mineral (magnesium glycinate, magnesium ascorbate, magnesium citrate, magnesium stearate). It also contains nutritional cofactors that help the mineral work in the body.
The supplement is available at www.perque.com and through many other retail outlets, both online and in stores where supplements are sold. Follow the dosage recommendations on the label.
›Ka He, MD, chair and professor, epidemiology and biostatistics, Indiana University, Bloomington. Environmental Nutrition. EnvironmentalNutrition.com.
›Michael Wald, MD, physician and director of nutritional services at the Integrated Medicine and Nutrition clinic in Mt. Kisco, New York. IntMedNy.com.
Supplement Safely with Magnesium
If you feel that you are one of the majority of Americans who don’t get enough magnesium from their diets, it may make sense to take a daily supplement, but always check with your doctor before taking any supplements.
If you decide to get your magnesium level checked, ask your doctor for a magnesium red blood cell (RBC-Mg) test. It measures the magnesium that is inside cells. It’s a more accurate measure of magnesium than the standard serum magnesium test. An optimal RBC-Mg level is more than 5.5 mg/dL.
The test isn’t essential. If you are generally healthy, you can’t go wrong with extra magnesium. The Institute of Medicine advises women thirty-one years old and older to get 320 mg of magnesium daily. For men, the recommended amount is 420 mg. These are conservative estimates based on your minimal needs. I recommend that you multiply your weight in pounds by 3 mg to determine the optimal dose.
Example: A 140-pound woman would take 420 mg of magnesium. During times of stress, when your need for magnesium is higher, multiply your weight by five instead of three. Keep taking the higher dose until things calm down again. You will start to feel the benefits within a few days.
When you’re shopping for supplements, look for products that end with “ate”—magnesium glycinate, taurate, malate, etc. These forms are readily absorbed into the bloodstream and less likely to cause diarrhea.
›Dennis Goodman, MD, board-certified cardiologist, clinical associate professor of medicine at New York University School of Medicine. He is author of Magnificent Magnesium: Your Essential Key to a Healthy Heart and More. DennisGoodmanMD.com.
Don’t Let Artificial Sweeteners Sabotage Your Health
In recent news, it was reported that sucralose—the artificial sweetener marketed as Splenda—interferes with insulin secretion and glucose metabolism. That report knocked sucralose out of the water as a sweet alternative for people who need to keep their blood sugar in check. Now, a more recent study has found that the problem is much broader—it goes well beyond Splenda—and the study also got to the bottom of what exactly you’re doing to your body when you opt for artificial sweeteners.
THE SUGAR-FREE TRUTH
After decades of thinking that artificial sweeteners were the answer to weight and sugar control, nutritionists and scientists are now realizing that it’s not so. Sucralose isn’t the only culprit—and glucose intolerance (a reduced ability to remove sugar from the blood) is not the only damage caused by artificial sweeteners. No-calorie artificial sweeteners in general have been linked to weight gain, as illogical as that sounds. And if you are thinking that folks who drink diet soda gain weight because they otherwise load up on other sugary foods, that’s not so, says the research.
So how do you get fat on sugar-free edibles? That part of the research equation wasn’t clear until Israeli scientists discovered what artificial sweeteners do to the gut microbiome—the galaxy of bacteria that live in the gut, aid digestion, and play a big role in whether someone is healthy.
The researchers conducted a series of experiments that began with mice. Some mice were fed water spiked with one of three different artificial sweeteners—saccharin, sucralose, or aspartame. Then these mice were compared with mice fed either plain water or sugar water.
Result: Glucose intolerance developed within eleven weeks in the mice given each of the artificial sweeteners. Meanwhile, the mice given plain water—and even those given sugar water—were just fine.
Why that’s bad: Glucose intolerance can lead to prediabetes.
When the researchers delved into whether the gut microbiome had something to do with these findings, they discovered that it sure did. Mice treated with antibiotics to wipe out their gut microbiomes didn’t become glucose intolerant when fed artificial sweeteners, because the artificial sweetener had nothing to react with once it hit the gut. But water-fed mice that lost their microbiomes became glucose intolerant when gut bacteria from mice fed artificial sweeteners was transplanted into them to repopulate their microbiomes.
Translation: The artificial sweeteners transformed the gut microbiomes to include a very unhealthful mixture of organisms.
Mice are mice, but what about people? Experiments in humans delivered the same results. The researchers already knew, from an earlier study they had done, that nondiabetic people who consumed artificial sweeteners were more likely than people who didn’t use artificial sweeteners to gain weight and show signs of impaired glucose tolerance. They reconnected with a portion of those study participants to examine their microbiomes. Sure enough, just as in the mice, the microbiomes of people who consumed artificial sweeteners were altered compared with the microbiomes of people who didn’t touch fake sugar.
SUGAR-FREE CHALLENGE
Going sugar-free but then consuming edibles that mimic or try to taste exactly like the food and drink you give up is the kind of trickery where the joke is on you. Not only are you not losing weight from substituting sugar with artificial sweeteners, you’re training your body to be diabetic! There is a much better way. You can retrain your taste buds to simply stop craving or expecting sugary flavors.
›Jotham Suez et al., “Artificial Sweeteners Induce Glucose Intolerance by Altering the Gut Microbiota,” Nature 514, no. 7521 (October 9, 2014): 181–186.
Thin People Get Diabetes Too
It’s widely known that type 2 diabetes tends to strike people who are overweight. In fact, about 85 percent of people with diabetes are carrying extra pounds, and one out of four Americans who are sixty-five or older have type 2 diabetes. But what about those who aren’t overweight?
A popular misconception: It’s commonly believed—even by many doctors—that lean and normal-weight people don’t have to worry about diabetes. The truth is, you can develop diabetes regardless of your weight.
An unexpected risk: For those who have this “hidden” form of diabetes, recent research is now showing that they are at even greater risk of dying than those who are overweight and have the disease.
THE EXTRA DANGER NO ONE EXPECTED
No one knows exactly why some people who are not overweight develop diabetes. There’s some speculation that certain people are genetically primed for their insulin to not function properly, leading to diabetes despite their weight.
Still, because diabetes is so closely linked to being overweight, even researchers were surprised by the results of a recent analysis of twenty-six hundred people with type 2 diabetes who were tracked for up to fifteen years.
Startling new finding: Among these people with diabetes, those who were of normal weight at the time of diagnosis were twice as likely to die of non-heart-related causes, primarily cancer, during the study period as those who were overweight or obese.* The normal-weight people were also more likely to die of cardiovascular disease, but there weren’t enough heart-related events to make that finding statistically significant.
Possible reasons for the higher death rates among normal-weight people with diabetes include:
•The so-called obesity paradox. Even though overweight and obese people have a higher risk of developing diabetes, kidney disease, and heart disease, they tend to weather these illnesses somewhat better, for unknown reasons, than lean or normal-weight people.
•Visceral fat, a type of fat that accumulates around the internal organs, isn’t always apparent. Unlike the fat you can grab, which is largely inert, visceral fat causes metabolic disturbances that increase the risk for diabetes, heart disease, and other conditions. You can have high levels of visceral fat even if you’re otherwise lean. Visceral fat can truly be measured only by imaging techniques such as a CT scan (but the test is not commonly done for this reason). However, a simple waist measurement can help indicate whether you have visceral fat (see below).
•Lack of good medical advice. In normal-weight people who are screened and diagnosed with diabetes, their doctors might be less aggressive about pursuing treatments or giving lifestyle advice than they would be if treating someone who is visibly overweight.
HOW TO PROTECT YOURSELF
It’s estimated that about 25 percent of the roughly twenty-nine million Americans with diabetes haven’t been diagnosed. Whether you’re heavy or lean:
•Get tested at least once every three years—regardless of your weight. That’s the advice of the American Diabetes Association (ADA).
Remember: If your weight is normal, your doctor may have a lower clinical suspicion of diabetes—a fancy way of saying he/she wouldn’t even wonder if you have the condition. As a result, the doctor might think it’s OK to skip the test or simply forget to recommend it. Ask for diabetes testing—even if your doctor doesn’t mention it.
A fasting glucose test, which measures blood sugar after you have gone without food for at least eight hours, is typically offered.
Alternative: The HbA1C blood test. It’s recommended by the ADA because it shows your average blood glucose levels over the previous two to three months. Many people prefer the A1C test because it doesn’t require fasting. Both types of tests are usually covered by insurance.
•Pull out the tape measure. Even if you aren’t particularly heavy, a large waist circumference could indicate high levels of visceral fat. Abdominal obesity is defined as a waist circumference of more than thirty-five inches in women and more than forty inches in men. Even if you are under these limits, any increase in your waist size could be a warning sign. Take steps such as diet and exercise to keep it from increasing.
To get an accurate measurement: Wrap a tape measure around your waist at the level of your navel. Make sure that the tape is straight and you’re not pulling it too tight. And don’t hold in your stomach!
•Watch the sugar and calories. The Harvard Nurses’ Health Study found that women who drank just one daily soft drink (or fruit punch) had more than an 80 percent increased risk of developing diabetes.
Research has consistently linked sweetened beverages with diabetes. But it’s not clear whether the culprits are the sweeteners (such as high-fructose corn syrup) or just the extra calories, which lead to weight gain. Either way, it’s smart no matter what you weigh to eliminate soda and other supersweet beverages from your diet—or if you don’t want to give them up, have no more than one soft drink a week, the amount that wasn’t associated with weight gain in the study.
Remember: A single soft drink often contains hundreds of calories.
•Get the right type of exercise. People who want to lose weight often take up aerobic workouts, such as swimming or biking, which burn a lot of calories. But if you don’t need to lose weight, strength training might be a better choice. When you add muscle, you significantly improve insulin sensitivity and enhance the body’s ability to remove glucose from the blood.
Walking may not sound very sexy, but it’s one of the best exercises going because it has both aerobic and muscle-building effects. In fact, walking briskly (at a pace that causes sweating and mild shortness of breath) for half an hour daily reduces the risk for diabetes by nearly one-third. That’s pretty impressive!
›Mercedes Carnethon, PhD, associate professor of preventive medicine and epidemiology at Northwestern University Feinberg School of Medicine in Chicago, where she specializes in population studies of diabetes, obesity, cardiovascular disease, and fitness.
Skipping Breakfast Raises Risk for Type 2 Diabetes by 21 Percent
Skipping breakfast is associated with a 21 percent increase in type 2 diabetes risk. And the best breakfast is a combination of low-saturated-fat protein and low-glycemic-index carbohydrates.
Example: A western omelet with peppers, low-fat cheese, and ham. Eating fruit is common at breakfast but not ideal—it contains too much sugar and may leave you hungry again within as little as an hour.
Other ways to avoid type 2 diabetes: Increase physical activity and intake of omega-3s and vitamin D.
›The late Frederic J. Vagnini, MD, a cardiovascular surgeon at the Heart, Diabetes and Weight Loss Centers of New York, New Hyde Park.
High Triglycerides: This Heart Disease Threat Can Increase Your Diabetes Risk
The medical mantra for people age fifty or over is to “know your numbers,” which is to say, your cholesterol, blood pressure, and blood sugar levels as they relate to cardiac risk, so that you can take action to address potential problems. While many people pay attention to this advice, and because there is enduring truth to this medical sound bite, it is important to mention that there is one number that eludes even the savviest health consumers. It is tested right along with cholesterol and blood sugar and is becoming increasingly respected as a marker for cardiac risk—triglycerides.
Like cholesterol, triglycerides are a type of fat in the blood, but they are quite different from their more famous cousin. Triglycerides are produced by the body and ingested from food, as is cholesterol, but they serve a different purpose. If the body’s energy needs are exceeded by food intake, the body converts the excess calories into triglycerides and stores them to provide extra energy when called for.
However, for a variety of reasons, triglyceride levels can rise to unhealthy levels in the blood, sometimes along with a rise in cholesterol, sometimes independently of that. Normal fasting levels of triglycerides are less than 150 mg/dL, and when triglycerides rise to a fasting level of 200 mg/dL or over, the level is considered high. Occasionally, levels go to even 500 mg/dL or higher, though this is usually because of genetic disorders or an underlying disease.
A good deal of controversy exists about the exact role of high triglycerides and atherosclerosis, but there is definitely an association between high levels of them and heart disease. People who have triglycerides over 150 mg/dL and HDL “good” cholesterol under 40 mg/dL have a higher risk for heart disease. And high triglycerides are associated with a number of other diseases as well, all of which make it important to pay attention.
According to cardiologist Helene Glassberg, MD, physician at the University of Pennsylvania Health System, high triglycerides are especially associated with insulin resistance—a prediabetic state—and diabetes, in particular when it is poorly controlled. In fact, high levels of triglycerides signal the need to check for the presence of diabetes. Other problems that are sometimes associated with high levels are hypothyroidism or kidney disease. Pancreatitis is also associated with high triglycerides, which Dr. Glassberg says can exacerbate or even cause this disease.
LOWERING YOUR TRIGLYCERIDES
The good news is that this is one problem that lifestyle can often turn around. Dr. Glassberg recommends the following:
•Normalize your weight. Obesity is a risk factor for elevated levels, especially if you carry excess pounds in your abdomen.
•Reduce or eliminate alcohol. Excessive drinking has been directly associated with elevated triglycerides. In some people, even modest amounts of alcohol can affect the level.
•Eat a nutritious diet. Pay special attention to getting plenty of omega-3s and eliminate excess carbohydrates, saturated fat, and all trans fat.
•Exercise at least thirty minutes each day. Push away from the table before dessert and go for a walk instead.
•Avoid smoking.
When lifestyle changes are not enough to lower levels sufficiently, Dr. Glassberg says that there are excellent medications patients can take that address the problem in addition to lifestyle changes. Of course, pharmaceutical treatments often come with associated risks as well.
THE NATURAL APPROACH
For more natural ways to manage triglycerides, Mark Stengler, NMD, advises all individuals with high triglycerides to talk with a trained professional before trying any supplements. His favorites include aged garlic extract (AGE)—the most commonly available brand is Kyolic—with the caveat that people on blood-thinning medications clear it with their doctor first. And those on the muscle-relaxant drug chlorzoxazone or the antiplatelet drug ticlopidine must not take garlic supplements. Pantethine has also been shown to lower triglycerides.
Dr. Stengler adds his advice to Dr. Glassberg’s in emphasizing how important it is to treat insulin resistance and diabetes, since triglycerides tend to be high in these people. In addition to a careful diet and regular exercise, Dr. Stengler suggests taking chromium picolinate, which research has shown may lower levels significantly. And to end on a tasty note, a recent study in Norway showed that eating two or three kiwi fruits each day lowered triglyceride levels by as much as 15 percent.
›Helene Glassberg, MD, physician, University of Pennsylvania Health System.
›Mark A. Stengler, NMD, a naturopathic medical doctor and author of the Health Revelations newsletter, The Natural Physician’s Healing Therapies, and Bottom Line’s Prescription for Natural Cures. He is also the founder and medical director of the Stengler Center for Integrative Medicine in Encinitas, California, and former adjunct associate clinical professor at the National College of Natural Medicine in Portland, Oregon. MarkStengler.com.
Certain Statins Are Linked to Diabetes…Is Yours?
Has your doctor put you on cholesterol-lowering statin medication or suggested that it’s time to start? If so, you probably know that statins can have some very serious side effects, such as muscle aches, liver problems, and perhaps impaired memory. But you may not have heard that the medication can increase your risk for developing a very common and potentially deadly disease—diabetes.
Now, thanks to a major recent study, we’ve learned that all statins are not created equal when it comes to diabetes risk. As it turns out, some are significantly riskier than others.
Which type are you taking?
STUDYING STATINS UP NORTH
Statin drugs reduce blood cholesterol levels by interfering with an enzyme that helps the liver make cholesterol. However, different types of statins work in slightly different ways, and their effects on the body vary somewhat. Earlier studies suggested that statins in general made people more likely to get diabetes, but that one type, pravastatin, made people less likely to get diabetes.
So for the recent study, researchers set out to determine more specifically how the most commonly used types of statins affected the risk for diabetes relative to each other. With access to health and pharmacy records of 1.5 million older Canadians, researchers identified 471,250 people age sixty-six and up who did not have diabetes when they first started taking statins. Then they followed each statin user for up to five years to see which ones got diabetes. (Though this study took place in Canada, the same statin drugs are prescribed in the United States.)
An earlier study suggested that patients taking pravastatin had a lower risk for diabetes compared with people taking a placebo. For that reason, in the new study, the researchers used pravastatin as the basis of comparison in gauging the diabetes risk associated with five other types of statins. After adjustments were made for various other diabetes risk factors (age, sex, health status, other medication use), here’s how each drug fared relative to pravastatin:
•Atorvastatin, which accounted for more than half of all new statin prescriptions, was associated with a 22 percent increase in diabetes risk.
•Rosuvastatin was associated with an 18 percent increase in diabetes risk. However, the researchers noted that this risk may be dose-dependent, meaning present at higher dosages but not at lower dosages.
•Simvastatin was associated with a 10 percent increase in diabetes risk.
•Both lovastatin and fluvastatin were comparable to pravastatin.
THE STATIN/INSULIN CONNECTION
There are several possible explanations for why patients taking certain statins are more prone to develop diabetes. Some statins may cause damage to beta cells, which are responsible for storing and secreting insulin, and/or these statins may interfere with the process that transports glucose from the blood through the cell membrane and into the body’s cells.
As for why pravastatin might reduce diabetes risk, animal studies have suggested that it improves cells’ sensitivity to insulin. Lovastatin and fluvastatin may have similar beneficial effects on insulin sensitivity.
Bottom line: If you are taking or have been advised to take one of the statins associated with increased risk for diabetes (atorvastatin, rosuvastatin, simvastatin), talk with your doctor about the diet and lifestyle changes that could lower your cholesterol and perhaps reduce your need for the medication. Also, discuss whether it’s appropriate to consider switching to pravastatin (or perhaps lovastatin or fluvastatin), particularly if you have other risk factors for type 2 diabetes, such as excess weight, high blood pressure, high triglycerides, a history of gestational diabetes or polycystic ovary syndrome, or a family history of diabetes.
›Muhammad M. Mamdani, PharmD, MPH, professor, University of Toronto, director, Applied Heath Research Centre, St. Michael’s Hospital, and adjunct scientist, Institute for Clinical Evaluative Sciences, all in Toronto, Canada. His study was published in BMJ.
Don’t Let Stress Raise Your Blood Sugar…and More
It’s widely known that acute stress can damage the heart. For example, the risk for sudden cardiac death is, on average, twice as high on Mondays as on other days of the week, presumably because of the stress many people feel about going back to work after the weekend. People also experience more heart attacks in the morning because of increased levels of cortisol and other stress hormones.
Important recent research: In a study of almost one thousand adult men, those who had three or more major stressful life events in a single year, such as the death of a spouse, had a 50 percent higher risk of dying over a thirty-year period.
But even low-level, ongoing stress, such as that from a demanding job, marriage or other family conflicts, financial worries, or chronic health problems, can increase inflammation in the arteries. This damages the inner lining of the blood vessels, promotes the accumulation of cholesterol, and increases risk for clots, the cause of most heart attacks.
Among the recently discovered physical effects of stress:
•Increased blood sugar. The body releases blood sugar (glucose) during physical and emotional stress. It’s a survival mechanism that, in the past, gave people a jolt of energy when they faced a life-threatening emergency.
However, the same response is dangerous when stress occurs daily. It subjects the body to constantly elevated glucose, which damages blood vessels and increases the risk for insulin resistance (a condition that precedes diabetes) as well as heart disease.
What helps: Get regular exercise, which decreases levels of stress hormones.
•More pain. Studies have shown that people who are stressed tend to be more sensitive to pain, regardless of its cause. In fact, imaging studies show what’s known as stress-induced hyperalgesia, an increase in activity in areas of the brain associated with pain. Similarly, patients with depression seem to experience more pain—and pain that’s more intense—than those who are mentally healthy.
What helps: To help curb physical pain, find a distraction. One study found that postsurgical patients who had rooms with views of trees needed less pain medication than those who had no views. On a practical level, you can listen to music. Read a lighthearted book. Paint. Knit. These steps will also help relieve any stress that may be exacerbating your pain.
Also helpful: If you have a lot of pain that isn’t well-controlled with medication, ask your doctor if you might be suffering from anxiety or depression. If so, you may benefit from taking an antidepressant, such as duloxetine or venlafaxine, which can help reduce pain along with depression.
•Impaired memory. After just a few weeks of stress, nerves in the part of the brain associated with memory shrink and lose connections with other nerve cells, according to laboratory studies.
Result: You might find that you’re forgetting names or where you put things. These lapses are often due to distraction—people who are stressed and always busy find it difficult to store new information in the brain. This type of memory loss is rarely a sign of dementia unless it’s getting progressively worse.
What helps: Use memory tools to make your life easier. When you meet someone, say that person’s name out loud to embed it in your memory. Put your keys in the same place every day.
Also helpful: Make a conscious effort to pay attention. It’s the only way to ensure that new information is stored. Sometimes, the guidance of a counselor is necessary to help you learn how to manage stress. Self-help materials, such as tapes and books, may also be good tools.
•Weight gain. The fast-paced American lifestyle may be part of the reason why two-thirds of adults in this country are overweight or obese. People who are stressed tend to eat more—and the “comfort” foods they choose often promote weight gain. Some people eat less during stressful times, but they’re in the minority.
What helps: If you tend to snack or eat larger servings when you’re anxious, stressed, or depressed, talk to a therapist. People who binge on “stress calories” usually have done so for decades—it’s difficult to stop without professional help.
Also helpful: Pay attention when you find yourself reaching for a high-calorie snack even though you’re not really hungry.
Healthy zero-calorie snack: Ice chips.
Low-calorie options: Grapes, carrots, and celery sticks. Once you start noticing the pattern, you can make a conscious effort to replace eating with nonfood activities—working on a hobby, taking a quick walk, etc.
STRESS-FIGHTING PLAN
There are a number of ways to determine whether you are chronically stressed—you may feel short-tempered, anxious most of the time, have heart palpitations, or suffer from insomnia.
However, I’ve found that many of my patients don’t even realize how much stress they have in their lives until a friend, family member, coworker, or doctor points it out to them. Once they understand the degree to which stress is affecting their health, they can explore ways to unwind and relax.
In general, it helps to:
•Get organized. Much of the stress that we experience comes from feeling overwhelmed. You can overcome this by organizing your life.
Examples: Use a day calendar to keep your activities and responsibilities on track, and put reminder notes on the refrigerator.
•Ask for help. You don’t have to become overwhelmed. If you’re struggling at work, ask a mentor for advice. Tell your partner/spouse that you need help with the shopping or housework. Taking charge of your life is among the best ways to reduce stress—and asking for help is one of the smartest ways to do this.
•Write about your worries. The anxieties and stresses floating around in our heads often dissipate, or at least seem more manageable, once we write them down.
•Sleep for eight hours. No one who is sleep-deprived can cope with stress effectively.
›Irene Louise Dejak, MD, an internal medicine specialist who focuses on preventive health, including counseling patients on the dangers of chronic stress. She is a clinical assistant professor at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University in Cleveland and an associate staff member at the Cleveland Clinic Family Health Center in Strongsville, Ohio.
Another Reason to Quit
Smoking increases risk for type 2 diabetes. Smoking can lead to insulin resistance, a precursor to type 2 diabetes.
Recent finding: Smokers have a 44 percent higher risk for developing diabetes than nonsmokers.
Self-defense: If you smoke, get help quitting from a health professional. Also, maintain a healthy diet and exercise regularly.
›Carole Willi, MD, chief resident, department of community medicine and public health, University of Lausanne, Switzerland, and leader of a meta-analysis of twenty-five studies, published in the Journal of the American Medical Association.
Can Your Toiletries and Cosmetics Give You Diabetes?
We’ve known for years that chemicals called phthalates—types of plasticizers contained in many products, including furniture, toys, plastic bags, and detergents, as well as in some cosmetics, including lotions, hair sprays, and perfumes—can knock our endocrine systems out of whack, potentially raising our risk for obesity and hardening of the arteries.
What’s worse, a recent study suggests that we can now add type 2 diabetes to the list of phthalate dangers.
The cosmetics part is especially creepy, since we do more than simply touch that stuff—we often massage lotions or makeup into our skin and spray perfume onto our necks, where we breathe it right in. And if you should kiss someone wearing phthalate-containing cosmetics or perfume, what’s getting into your mouth?
The chemical and cosmetics industries dispute the latest research and tell us that we should be perfectly happy to smear and spray their phthalates onto our bodies. It might be that they turn out to be right and the products are safe. But that’s a long-term result that’s not worth the risk to find out. We spoke with the researchers who found the diabetes link and then learned how to find phthalate-free cosmetics and perfumes.
WHAT LURKS IN OUR COSMETICS?
The phthalates are put into many types of cosmetics because they do have some benefits. In perfume, for example, they help the scent linger longer; in nail polish, the chemicals reduce cracking by making polishes less brittle; and in hair spray, phthalates allow the spray to form a flexible film on hair, avoiding stiffness. But phthalates in these products can be either absorbed through the skin or inhaled, which causes them to enter the bloodstream…and then, watch out!
In the study, the researchers from Uppsala University in Sweden drew fasting blood samples from more than one thousand adults, looking for several toxins, including four substances specifically formed when the body breaks down phthalates. Even after adjusting for typical type 2 diabetes risk factors such as obesity, cholesterol levels, smoking, and exercise habits, researchers found that participants whose phthalate levels were among the highest 20 percent of the group were twice as likely to have type 2 diabetes when compared with those whose phthalate levels fell into the lowest 20 percent of the group.
Study author Monica Lind, PhD, an associate professor of occupational and environmental medicine at the university, says that since she and her colleagues are among the first scientists to measure phthalate levels in blood, “high” and “low” are relative to this study—in other words, it’s difficult to discern whether the levels of phthalates in this study were high on any kind of absolute scale. And researchers didn’t track the amount of phthalate-containing products that participants used. But the study does suggest that the higher the levels of phthalates in the blood, the higher the risk of getting type 2 diabetes, and that might reflect a greater use of products that contain them.
CHECK THE LABELS
Phthalates may increase the risk for type 2 diabetes by disrupting insulin production and/or inducing insulin resistance, Dr. Lind says. But those ideas are disputed by the FDA, which states that “it’s not clear what effect, if any, phthalates have on health.”
In the United States, the FDA does not require cosmetics or perfumes to be phthalate-free. It does require nonfragrance ingredients to be listed on cosmetic products, but the loophole is that any ingredients that are parts of a fragrance don’t have to be listed—a manufacturer can simply put “fragrance” on the label. As a result, according to the nonprofit Campaign for Safe Cosmetics, most cosmetics and perfumes that contain phthalates don’t list them on the label. In other words, if the word “fragrance” is listed, then you won’t know for sure what’s in the product, unfortunately.
If this is a concern for you, go through your makeup, perfumes, and lotions. Search online for cosmetics that are fragrance-free using the nonprofit Environmental Working Group’s Skin Deep cosmetics database at www.ewg.org/skindeep, and then choose among the products that are also phthalate-free. For perfumes, specifically, search online using the phrase “phthalate-free perfumes,” which should lead to many brands, such as Zorica of Malibu, Kai, Pacifica, Agape & Zoe Naturals, Rich Hippie, Honoré des Prés, Blissoma Blends, Red Flower Organic Perfumes, Tsi-La Organic Perfume, and Ayala Moriel Parfums.
›Monica Lind, PhD, associate professor of occupational and environmental medicine, Uppsala University, Uppsala, Sweden. Her research was published in Diabetes Care.
How to Keep the Toxic Chemical BPA Out of Your Food
BPA (bisphenol A) is used in many plastic food and beverage containers, particularly those made of hard, clear polycarbonate plastic. BPA is also an additive in polyvinyl chloride (PVC) plastic, which is used in some plastic food wraps.
Surprising news: BPA is in the epoxy resins found in the lining of almost all cans used by the food industry (including baby formula cans!). In fact, canned food is the primary food source of BPA for adults.
The problem: BPA molecules that escape their chemical bonds can migrate into the foods and beverages they contact, especially if the container is heated or the food inside is acidic. We then ingest the BPA, thereby increasing our risk for numerous health problems. There’s even BPA on the coated paper from cash registers—the toxin gets into our bodies when we touch the paper and then handle the food we’re about to eat. BPA can also be absorbed through the skin.
Frederick S. vom Saal, PhD, curators’ professor of biological sciences at the University of Missouri and a leading BPA researcher, explains that this chemical has estrogen-like effects on the body. It acts as an endocrine disruptor, interrupting our hormonal patterns and actually reprogramming our genes. Roughly one thousand published, peer-reviewed studies have linked BPA to negative health consequences. These include:
•Breast cancer, ovarian cysts, and uterine fibroids in females (and prostate cancer, sexual dysfunction, and altered sperm in males)
•Type 2 diabetes and its precursor, insulin resistance
•Heart disease and heart rhythm abnormalities
•Liver disease
•Thyroid dysfunction
•Obesity and greater accumulation of fat in cells
Unborn babies, infants, and children are especially susceptible to BPA’s harmful effects because they are still growing. Exposure before birth and/or during childhood has been linked to:
•Birth defects
•Cognitive problems, including learning deficits
•Behavioral problems (e.g., hyperactivity)
•Early puberty in females
•Increased risk for cancer in adulthood
How much is too much? The EPA estimates that exposure of up to 50 micrograms (mcg) of BPA per kilogram (kg) of body weight per day is safe. However, recent studies suggest that even a tiny fraction of this amount—as little as 0.025 mcg/kg per day—may be dangerous.
Dr. vom Saal says, “No matter what you might hear from the plastics industry, which is trying to convince consumers that BPA is safe, hundreds of published papers show that BPA is a toxin with no safe levels.”
Scary: When the CDC studied urine samples of more than twenty-five hundred Americans age six and older, 93 percent of those tested had BPA in their urine.
BPA SELF-DEFENSE
Here are Dr. vom Saal’s suggestions for minimizing your exposure to BPA:
•Avoid canned foods as much as possible.
Note: It does not help to store cans in the refrigerator or to use canned goods soon after you buy them. The harm is already done even before the cans reach the market, because high heat must be used to sterilize the food during canning.
Exceptions: Several manufacturers—including Eco Fish, Eden Organic, Edward & Sons, Muir Glen, Oregon’s Choice, and Wild Planet—have begun using BPA-free cans for some of their products. (See a manufacturer’s website for information on its BPA-free canned products, or contact the company directly.)
•Choose cardboard over metal. Cardboard cartons (such as those used for juice or milk) and cardboard cylindrical “cans” (such as those used for raisins) generally are better options than metal cans—but they are not ideal, because they may contain some recycled paper (which is loaded with BPA), or they may be lined with a resin that contains BPA.
Best: Opt for foods that are fresh or frozen or that come in glass bottles or jars or in foil pouches.
•Never give canned liquid formula to an infant. Powdered is much safer.
•When microwaving, never let plastic wrap come in contact with your food. If a product has a plastic film covering that is supposed to be left in place during microwave cooking, remove the film and replace it with a glass or ceramic cover instead.
•Transfer prepackaged food to a glass or ceramic container before cooking, even if the instructions say to microwave the product in the plastic pouch it comes in.
•Check the triangle-enclosed recycling numeral on plastic items that come in contact with foods or beverages—storage containers, water pitchers, baby bottles, sippy cups, utensils, and tableware. The numeral 7 indicates a plastic that may or may not contain BPA. To be safe, Dr. vom Saal says, “If you see a numeral 7 and it doesn’t say BPA-free, assume there is BPA.” The letters “PC” stamped near the recycling number are another indication that the plastic contains BPA.
•Recheck what’s in your cupboards. Those new travel mugs? They might be made from number-seven plastic. Plastics labeled number two or five, which are also often used for food containers, do not have BPA. But they may contain other potentially harmful chemicals that can leach out, especially when heat breaks down the molecular bonds of plastic. To be safe, wash all plastic kitchenware in cold to room-temperature water with a mild cleanser, not in the dishwasher. Never microwave plastic containers, not even those labeled microwave-safe, such as frozen entrée trays. Instead, use a glass or ceramic container. Before putting hot soup or gravy into plastic containers to freeze, first allow it to cool. Throw out any plastic kitchenware that is scratched, chipped, or discolored—damaged plastic is most likely to leach chemicals.
•Do not assume that plastics with no triangle-enclosed numeral are safe. Dr. vom Saal cautions, “Manufacturers know that consumers are looking for BPA, so they’re taking identifying numbers off their products and packaging.” Don’t fall prey to such tricks.
›Frederick S. vom Saal, PhD, curators’ professor of biological sciences at the University of Missouri, Columbia. He is a leading researcher on the effects of BPA and has conducted dozens of studies on this topic.
Toxic Tea Bags
Perhaps you wouldn’t dream of microwaving plastic food containers, because you know that heating plastic can allow toxins to leach into your food. But you probably don’t think twice before dunking your fancy mesh tea bag into boiling-hot water. Well, you may want to give that some thought right now.
Yes, those pyramid-shaped mesh sachets filled with pretty multihued leaves lend sophistication to your daily tea-drinking ritual.
But: Even though they’re often called “silky,” those bags aren’t made from silk. Most are actually made from plastic, either polyethylene terephthalate (PET), polylactic acid (PLA, or corn plastic), or food-grade nylon (indeed, nylon is a plastic).
PET, PLA, and nylon are widely used for food packaging, and their safety as packaging materials has been tested. “However, when you subject plastics to stressors such as heat, the molecules begin to break down and they can leach—no matter whether it’s a microwave oven or a cup of hot water that is warming the contents,” says Sonya Lunder, MPH, a senior analyst at the Environmental Working Group, an environmental health research and advocacy organization. “So, is stuff leaching out of the plastic in the tea bag and getting into your beverage? The answer is yes.”
Problems with plastics: No studies have looked specifically at leaching from plastic tea bags, so we don’t yet know how much of any particular toxin might be getting into our tea. But past experience should teach us to be wary. After all, people used to think it was perfectly OK to microwave food in plastic containers—until we learned that certain plastics contain bisphenol A (BPA), an endocrine disruptor that has estrogen-like effects on the body and that has been linked to breast cancer, prostate cancer, diabetes, obesity, heart fertility, early puberty, and cognitive and behavioral problems in children!
The plastics used for tea bags don’t contain BPA. But PET plastics can contain phthalates (not because these chemicals are used as ingredients in the plastic, but rather because they may originate from recycled content), and phthalates are another type of endocrine disruptor that has been linked to birth defects. There is also some concern that PET may leach antimony trioxide, a heavy metal. “We just don’t know whether the amount of various substances in PET, PLA, and/or food-grade nylon might someday prove to have negative health effects,” Lunder says. “As yet, there is no scientific consensus about what is too much, who is at risk, or what other health effects we may be seeing from plastic food packaging. But given the worrisome potential effects on our hormones, I advise that people avoid heating plastics at every opportunity.”
It boils down to this: If you enjoy an occasional cup of tea made from a fancy “silky” tea bag, you probably don’t need to worry too much—that once-in-a-while treat isn’t likely to hurt your health. However, it’s possible that your body may reach potentially harmful levels of various chemicals if you are drinking tea made from plastic tea bags multiple times each day—particularly if you try to be frugal by making a second cup from a single tea bag, given that repeated stress in the form of heat can make plastics leach even more.
What about good old paper tea bags? They might not be any better than plastic, because many are treated with epichlorohydrin, a compound that has been linked to cancer, infertility, and suppressed immune function.
Your best bet: Buy yourself a nice metal tea ball. They typically cost only a few dollars. When you want a cup of tea, fill the ball with your favorite organic loose-leaf tea, and let it steep in the mug. When the drink is as strong as you like, remove the strainer and enjoy your tea—worry-free.
›Sonya Lunder, MPH, senior analyst, Environmental Working Group, Washington, DC. Lunder’s research focuses on toxic chemicals in food, water, air, and consumer products. EWG.org.
Want Diabetes? Drink Soda
To prevent diabetes, we’re often told by health experts what not to eat, such as too many refined carbohydrates from breads, pasta, and ice cream.
What not to drink may be just as important.
Latest finding: Researchers at the Harvard School of Public Health analyzed health data from 310,000 people who participated in eleven studies that explored the connection between sugar-sweetened beverages (SSBs) and diabetes.
Fact: SSBs include soda, fruit drinks (not 100 percent fruit juice), sweetened iced teas, energy drinks, and vitamin water drinks. And in the last few decades, the average daily intake of calories from SSBs in the United States has more than doubled, from 64 to 141. The beverages are now “the primary source of added sugars in the U.S. diet,” wrote the Harvard researchers in Diabetes Care.
The researchers found:
•Drinking one to two twelve-ounce servings of SSBs per day was linked to a 26 percent increased risk of type 2 diabetes, compared with people who drink one or fewer SSBs per month.
The increased risk for diabetes among those drinking SSBs was true even for people who weren’t overweight, a common risk factor for diabetes. The researchers concluded that while SSBs are a risk factor for overweight, they’re also a risk factor for diabetes whether you gain weight or not.
“The association that we observed between sodas and risk of diabetes is likely a cause-and-effect relationship,” says Frank Hu, PhD, professor of nutrition and epidemiology at the Harvard School of Public Health.
Theory: A typical twelve-ounce serving of soda delivers ten teaspoons of sugar. That big dose of quickly absorbed sugar drives up blood sugar (glucose) levels, in turn driving up blood levels of insulin, the hormone that moves glucose out of the bloodstream and into cells, leading to insulin resistance, with cells no longer responding to the hormone and blood sugar levels staying high, eventually leading to diabetes.
SSBs also increase C-reactive protein, a biomarker of chronic, low-grade inflammation, which is also linked to a higher risk for diabetes.
•Cola-type beverages also contain high levels of advanced glycation end products, a type of compound linked to diabetes, say the researchers.
And many SSBs are loaded with fructose, a type of sugar that can cause extra abdominal fat, another risk factor for diabetes.
Bottom line: “People should limit how much sugar-sweetened beverages they drink and replace them with healthy alternatives, such as water, to reduce the risk of diabetes, as well as obesity, gout, tooth decay, and cardiovascular disease,” says Vasanti Malik, PhD, a study researcher.
GOOD-FOR-YOU BEVERAGES
“I help many of my clients break the habit of regularly drinking soda, sweetened iced tea, and other sugary beverages,” says Lora Krulak, a healthy foods chef and self-described “nutritional muse” in Miami, Florida. “I show them how to make other beverages that have natural sugar or are naturally sweetened, so they don’t miss the sugary drinks.”
One of her favorite thirst-quenching combinations:
•2 to 3 liters of water (sparkling or still)
•Juice of 2 lemons
•Juice of 2 limes
•Small bunch of mint
•Pinch of salt
•1 tablespoon of maple syrup, honey, or coconut sugar or stevia to taste (stevia is a natural, low-calorie sweetener)
1.Let the mixture steep for 30 minutes before drinking.
“It’s good to make a lot of this drink, so it’s in your refrigerator and you can grab it any time,” says Krulak. When leaving home, put some in a water bottle and carry it with you.
CUT SUGAR CRAVINGS
“If one of my patients is craving sugary drinks, it means his or her blood sugar levels aren’t under control,” says Ann Lee, ND, LAc, a naturopathic doctor and licensed acupuncturist in Lancaster, Pennsylvania.
To balance blood sugar levels and control sugar cravings, she recommends eating every three to four hours, emphasizing high-protein foods (lean meats, chicken, fish, eggs, nuts, and seeds), good fats (such as the monounsaturated fats found in avocados and olive oil), and high-fiber foods (such as beans, whole grains, and vegetables).
She also advises her clients to take nutritional supplements that strengthen the adrenal glands, which play a key role in regulating blood sugar levels.
Recommended: Daily B-complex supplement (B-50 or B-100) and vitamin C (2,000 to 5,000 mg daily, in three divided doses, with meals).
For healthy drinks, she recommends green tea sweetened with honey or stevia or a combination of three parts seltzer and one part fruit juice.
›Frank B. Hu, MD, PhD, an epidemiologist, nutritional specialist, and professor of medicine at Harvard Medical School and the Harvard School of Public Health, both in Boston. He is codirector of Harvard’s Program in Obesity Epidemiology and Prevention.
›Vasanti Malik, research fellow in the Harvard School of Public Health.
›Lora Krulak, healthy foods chef and “nutritional muse” in Miami, Florida. LoraKrulak.com.
›Ann Lee, ND, LAc, naturopathic doctor and licensed acupuncturist in Lancaster, Pennsylvania. DoctorNaturalMedicine.com.
Vitamin D May Lower Risk for Diabetes
Researchers in Germany have found that people with adequate blood levels of vitamin D had a lower risk for type 2 diabetes than those with low levels of vitamin D. Protection against diabetes, which is a chronic inflammatory condition, is believed to come from vitamin D’s anti-inflammatory effect. People should have their vitamin D levels checked annually and ensure that they have blood levels of between 50 and 80 ng/ml. Older adults are at increased risk of developing vitamin D insufficiency in part because, as they age, skin cannot synthesize vitamin D as efficiently, they are likely to spend more time indoors, and they may have inadequate intakes of the vitamin, according to the Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium.
›C. Herder et al., “Effect of Serum 25-Hydroxy-vitamin D on Risk for Type 2 Diabetes May Be Partially Mediated by Subclinical Inflammation: Results from the MONICA/KORA Augsburg Study,” Diabetes Care (2011).
Hidden GI Problems Can Cause Diabetes and More
If you have a stomachache, nausea, or some other digestive problem, you know that it stems from your gastrointestinal (GI) tract. But very few people think of the GI system when they have a health problem such as arthritis, depression, diabetes, asthma, or recurring infections.
Surprising: Tens of millions of Americans are believed to have digestive problems that may not even be recognizable but can cause or complicate many other medical conditions.
Latest development: There’s now significant evidence showing just how crucial the digestive system is in maintaining your overall health. How could hidden GI problems be responsible for such a wide range of seemingly unrelated ills?
Here’s how: If you can’t digest and absorb food properly, your cells can’t get the nourishment they need to function properly, and you can fall prey to a wide variety of ailments.
Good news: A holistically trained clinician can advise you on natural remedies (available at health-food stores unless otherwise noted) and lifestyle changes that can often correct hidden digestive problems.*
LOW LEVELS OF STOMACH ACID
Stomach acid, which contains powerful, naturally occurring hydrochloric acid (HCl), can decrease due to age, stress, and/or food sensitivities.
Adequate stomach acid is a must for killing bacteria, fungi, and parasites and for the digestion of protein and minerals. Low levels can weaken immunity and, in turn, lead to problems that can cause or complicate many ailments, including diabetes, gallbladder disease, osteoporosis, rosacea, thyroid problems, and autoimmune disorders.
If you suspect that you have low stomach acid: You can be tested by a physician—or simply try the following natural remedies (adding one at a time each week until symptoms improve):
•Use apple cider vinegar. After meals, take one teaspoon in eight teaspoons of water.
•Try bitters. This traditional digestive remedy usually contains gentian and other herbs. Bitters, which also are used in mixed drinks, are believed to work by increasing saliva, HCl, pepsin, bile, and digestive enzymes. Use as directed on the label in capsule or liquid form.
•Eat umeboshi plums. These salted, pickled plums relieve indigestion. Eat them whole as an appetizer or dessert or use umeboshi vinegar to replace vinegar in salad dressings.
•Take betaine HCl with pepsin with meals that contain protein. The typical dosage is 350 mg. You must be supervised by a healthcare professional when using this supplement—it can damage the stomach if used inappropriately. If you still have symptoms, ask your doctor about adding digestive enzymes such as bromelain and/or papain.
TOO MUCH BACTERIA
When HCl levels are low, it makes us vulnerable to small intestinal bacterial overgrowth (SIBO). This condition occurs when microbes are introduced into our bodies via our food and cause a low-grade infection or when bacteria from the large intestine migrate into the small intestine, where they don’t belong. Left untreated, this bacterial overgrowth can lead to symptoms, such as bloating, gas, and changes in bowel movements, characteristic of irritable bowel syndrome (IBS). In fact, some research shows that 78 percent of people with IBS may actually have SIBO.
SIBO is also a frequent (and usually overlooked) cause of many other health problems, including Crohn’s disease, scleroderma (an autoimmune disease of the connective tissue), and fibromyalgia.
SIBO can have a variety of causes, including low stomach acid, overuse of heartburn drugs called proton pump inhibitors (PPIs), and low levels of pancreatic enzymes. Adults over age sixty-five, who often produce less stomach acid, are at greatest risk for SIBO.
Important scientific finding: A study recently conducted by researchers at Washington University School of Medicine found that, for unknown reasons, people with restless legs syndrome are six times more likely to have SIBO than healthy people.
To diagnose: The best test for SIBO is a hydrogen breath test—you drink a sugary fluid, and breath samples are then collected. If hydrogen is overproduced, you may have SIBO. The test, often covered by insurance, is offered by gastroenterologists and labs that specialize in digestive tests. A home test is available at www.breathtests.com.
How to treat: The probiotic VSL 3, available at www.vsl3.com, can be tried. However, antibiotics are usually needed. Rifaximin is the antibiotic of choice because it works locally in the small intestine.
LEAKY GUT SYNDROME
The acids and churning action of the stomach blend food into a soupy liquid (chyme) that flows into the small intestine. There, the intestinal lining performs two crucial functions—absorbing nutrients and blocking unwanted substances from entering the bloodstream.
But many factors, such as chronic stress, poor diet, too much alcohol, lack of sleep, and use of antibiotics, prednisone, and certain other medications, can inflame and weaken the lining of the small intestine. This allows organisms, such as bacteria, fungi, and parasites, and toxic chemicals we encounter in our day-to-day activities to enter the blood. The problem, called increased intestinal permeability, or leaky gut syndrome, is bad news for the rest of your body.
What happens: The immune system reacts to the organisms and substances as foreign, triggering inflammation that contributes to or causes a wide range of problems, such as allergies, skin problems, muscle and joint pain, poor memory and concentration, and chronic fatigue syndrome.
To diagnose: A stool test that indicates the presence of parasites, yeast infections, or bacterial infection is a sign of leaky gut. So are clinical signs, such as food intolerances and allergies. However, the best test for leaky gut checks for urinary levels of the water-soluble sugars lactulose and mannitol—large amounts indicate a leaky gut.
How to treat: If you and your doctor believe that you have leaky gut, consider taking as many of the following steps as possible:
•Chew your food slowly and completely to enhance digestion.
•Emphasize foods and beverages that can help heal the small intestine, including foods in the cabbage family, such as kale, vegetable broths, fresh vegetable juices (such as cabbage juice), aloe vera juice, and slippery elm tea.
•Take glutamine. This amino acid is the main fuel for the small intestine—and a glutamine supplement is one of the best ways to repair a leaky gut. Start with 1 to 3 g daily, and gradually increase the dosage by a gram or two per week to up to 14 g daily. Becoming constipated is a sign that you’re using too much.
•Try the probiotic L. plantarum. A supplement of this gut-friendly bacteria, such as Transformation Enzyme’s Plantadophilus, can help heal the small intestine.
•Add quercetin. This antioxidant helps repair a leaky gut. In my practice, I’ve found that the products PERQUE Pain Guard and PERQUE Repair Guard work better than other quercetin products.
Typical dosage: 1,000 mg daily.
•Use digestive enzymes with meals to help ensure your food is completely digested. Good brands include Enzymedica, Thorne, and Now.
›Liz Lipski, PhD, CCN, a Duluth, Georgia–based nutritionist who is board-certified in clinical nutrition and holistic nutrition. She is author of several books, including Digestive Wellness: Strengthen the Immune System and Prevent Disease Through Healthy Digestion. InnovativeHealing.com.
Weight Loss: The Key to Diabetes Prevention
Losing weight is the single most effective way to prevent diabetes.
Reason: Putting on even as little as ten pounds—especially around your middle—automatically increases insulin resistance. Losing just fifteen pounds reduces your risk of developing diabetes by more than half.
A simple, proven way to lose weight: Eat smaller portions. Use small (ten-inch) plates at home—and therefore serve smaller portions—since studies show that people tend to finish whatever is on their plates. Also, avoid fruit juices and soft drinks as well as white foods (white bread, baked potatoes and french fries, pasta, white rice), all of which cause sharp rises in blood sugar. Finally, make sure that every meal contains a mix of high-fiber fruits and vegetables and high-quality protein (fish or lean meat).
Another key: Do an hour of exercise at least five times a week. A good program for most people is forty-five minutes of aerobic exercise—such as walking, biking, or swimming—and fifteen minutes of light weight lifting.
Reason: Regular exercise encourages weight loss and increases your body’s sensitivity to insulin. This effect only lasts a short time, however, which is why it’s important to exercise often.
For many, these steps will be enough to prevent diabetes. If your body’s ability to respond to insulin is 75 percent of normal and you can lower your insulin resistance by 25 percent through diet and exercise—a typical response—then your blood-sugar regulation will be brought back in balance.
›Anne Peters, MD, professor of clinical medicine, Keck School of Medicine of the University of Southern California in Los Angeles, and director of the USC Westside Center for Diabetes. She is author of Conquering Diabetes—A Cutting Edge, Comprehensive Program for Prevention and Treatment.
Stand Up and Move
Exercise is not enough to take off the pounds if you spend a lot of time sitting. When people sit for long periods—doing desk jobs, using computers, playing video games, watching television, or for other reasons—the enzymes that are responsible for burning fat shut down.
Result: People who sit too much have significantly greater risk for premature heart attack, diabetes, and death.
Self-defense: In addition to exercising, it is important to stand up and move around as much as possible throughout the day—walk around the office, go up and down stairs, take a break from the computer and go outdoors, or do something else to get out of a seated position.
›Marc Hamilton, PhD, associate professor of biomedical sciences, University of Missouri-Columbia, and leader of a study of the physiological effects of sitting, published in Diabetes.
Too Much Sugar in Your Diet Carries More Risk Than Weight Gain
We all know that it’s not good for our health to consume too much sugar. Excessive amounts of sugar in the diet are widely known to cause weight gain. But that’s only part of the story.
Both table sugar and high-fructose corn syrup (HFCS) contain fructose, which recent research has shown can increase the risk for diabetes, fatty liver disease, high blood pressure, and chronic kidney disease when consumed in excessive amounts. Currently, most Americans consume way too much added sugar in their daily diets, putting them at risk for all these diseases.
WHAT’S THE TROUBLE WITH FRUCTOSE?
Fructose is a simple sugar. It is found naturally in honey, fruits, and some vegetables. But a typical fruit contains only about 8 g of fructose, compared to about 20 g in a sugary soda. Unlike soda, fruits and vegetables contain nutrients and antioxidants that are beneficial to health.
The two main sources of fructose in the American diet are table sugar (which is squeezed from beet and cane plants) and HFCS (which is processed using enzymes that turn corn starch into glucose and fructose). Table sugar and HFCS are almost identical in their chemical composition—and both, consumed in excess, can contribute to health problems.
But few Americans are aware of just how much added sugar they are getting in their diets. That’s because many added sugars are often listed as ingredients that are not recognizable as sugar and are found in unexpected food sources (see page 55 for a list of these terms). For example, added sugar is found in not only obvious places like soft drinks and other sweet beverages, but also in great abundance in many salad dressings, condiments (such as ketchup), cereals, crackers, and even bread.
EMERGING RESEARCH ON FRUCTOSE
While there are many studies being conducted on different types of added sugars, there is important research that now focuses on various forms of fructose. For example, recent research suggests that fructose is harmful because it increases levels of uric acid, a naturally occurring acid found in the urine. In crystalline form, uric acid can deposit in the joints and lead to gout.
Eating foods rich in a compound called purines (found in foods such as anchovies, beer, brewer’s yeast supplements, clams, goose, gravy, herring, lobster, mackerel, meat extract, mincemeat, mussels, organ meats, oysters, sardines, scallops, and shrimp) can also produce high levels of uric acid.
SMART WAYS TO LIMIT SUGAR
It’s important to remove added sugar from your diet—with a special focus on fructose due to its unique potential risks that are now being discovered in new research.
To minimize the health risks associated with added sugars, try these steps:
•Beware of “hidden” sugar. When buying processed foods, remember that added sugars can appear on food labels in various ways. (See various names for sugar on page 55.)
•Avoid any prepared or processed product that does not provide an ingredient list.
•Don’t eat more than four fruits daily. Even the naturally occurring fructose found in fruit counts toward your total daily intake of fructose. It’s also important to limit your intake of fruit juice, which has been stripped of the nutritious fiber present in whole fruit and often contains added sugar.
•Limit fructose intake to 25 to 35 g per day. Consuming more than that amount could trigger the physiological changes that may lead to disease.
To learn the fructose content of specific foods, go to the USDA Food Database.
•Take nutritional supplements. Limiting fruit in your diet may lower your levels of important nutrients. To replace them, take a multivitamin plus an additional 250 mg of vitamin C daily.
•Be cautious when eating in restaurants. Limit restaurant meals and takeout food to menu items for which you know the ingredients.
•Be prepared for sugar withdrawal. In rare cases, you may develop withdrawal symptoms from sugar and fructose, such as headache, fatigue, and an intense craving for sweets. To help ease these symptoms, be sure to drink plenty of water (five to eight cups daily).
SUGAR ALIASES
Take this list to the supermarket with you to help you identify the various terms for added sugars:
•Beet sugar
•Brown sugar
•Cane sugar
•Corn sweetener
•Corn syrup
•Demerara sugar
•Fruit juice concentrate
•Granulated sugar
•High-fructose corn syrup
•Honey
•Invert sugar
•Maple syrup
•Molasses
•Muscovado sugar
•Raw sugar
•Sucrose
•Syrup
•Table sugar
•Tagatose
•Turbinado sugar
›Richard J. Johnson, MD, professor and chief of the division of renal diseases and hypertension at the University of Colorado, Denver. He is author of The Sugar Fix: The High-Fructose Fallout That Is Making You Sick.
How a Quick Massage Can Help You Beat Diabetes
No one wants to be overweight, have diabetes, or grow old prematurely. Well, a new study shows that there’s a simple strategy that may help prevent all three that is actually quite fun and relaxing.
A massage might do the trick!
We’re not talking about an expensive, hour-long massage either—recent research shows that an inexpensive massage lasting just ten minutes can be beneficial.
STOP THE DAMAGE!
Mark Tarnopolsky, MD, PhD, a professor of medicine and head of neuromuscular and neurometabolic disease at McMaster University in Canada, explains that the researchers in this specific massage study found two very interesting differences in muscles that had been massaged after exercise.
A gene pathway that causes muscle inflammation was “dialed down” in these muscles both immediately after the massage and two and a half hours after the massage. (Specific genes can be present in our tissues but not always active.) Dr. Tarnopolsky says that this is helpful knowledge because muscle inflammation is a contributor to delayed-onset muscle soreness, so it confirms biologically what we’ve always believed through anecdotal observation—a postexercise massage can help relieve muscle soreness.
Conversely, another sort of gene was “turned on” by the massage—this is a gene that increases the activity of mitochondria in muscle cells. Mitochondria are considered the power packs of our muscles for their role in creating usable energy. Better mitochondrial functioning has been shown by other studies to help decrease insulin resistance (a key risk factor for type 2 diabetes) and obesity and even to slow aging. When Dr. Tarnopolsky was asked about whether it’s a stretch to link postexercise massage to these benefits, he said that it’s not unreasonable—there is a potential connection, and future research will need to be done to confirm it.
TREAT YOURSELF TO A MASSAGE
The massage type that Dr. Tarnopolsky and his colleagues used was a standard combination of three techniques that are commonly used for postexercise massage—effleurage (light stroking), petrissage (firm compression and release), and stripping (repeated longitudinal strokes). It’s easy to find massage therapists in spas, salons, fitness centers, and private practices who use these techniques. Or you could ask your spouse or a friend to try some of these moves on you (even if his or her technique isn’t perfect), because there’s a chance that it could provide the benefits, says Dr. Tarnopolsky—he just can’t say for sure, since that wasn’t studied.
Dr. Tarnopolsky studied massage only after exercise, so that’s when he would recommend getting one, but it’s possible that massaging any muscles at any time may have similar benefits—more research will need to be done to find out.
Remember, you don’t have to break the bank on a prolonged sixty-minute massage—a simple ten- or twenty-minute rubdown can do the trick.
›Mark Tarnopolsky, MD, PhD, division of neurology, department of pediatrics and medicine, McMaster University, Ontario, Canada.
*American Diabetes Association, “Diagnosing Diabetes and Learning about Prediabetes,” last modified November 21, 2016, http://www.diabetes.org/diabetes-basics/diagnosis/.
*Consult your doctor before trying any supplements, especially if you take prescription medication and/or have a chronic medical condition, including diabetes.
*Normal weight is defined as a body mass index (BMI) of 18.5 to 24.9, overweight is 25 to 29.9, and obese is 30 or above. To calculate your BMI, go to http://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm.
*Consult your doctor before trying these remedies—especially if you have a chronic medical condition or take any medication.