You might think that you’ve come to an age where you would know if you had a disease or not—perhaps you’re familiar with how your body works, keep in great shape, or visit the doctor on a regular basis. Just because you’re being careful doesn’t mean you should not get tested or read up on the warning signs.
For example, you could have prediabetes and not even know. And if you do, it means you are much more likely to develop full-blown diabetes. What about that strange rash on your skin? It might not be just a simple irritation, but rather a sign you should be looking closer at your blood sugar.
This section is not about fear but empowerment and the confidence as an older adult to ask the right questions of your doctor. We provide you with plenty of ideas for how to screen for diabetes and hopefully instill the confidence you need to recognize symptoms if they arise.
Do You Have Prediabetes? What You Must Know to Protect Yourself
As Americans continue to pack on the pounds, doctors are seeing a surge in weight-related health problems. An increasingly common condition that now affects about 40 percent of American adults is prediabetes, characterized by blood glucose (sugar) levels that are higher than normal but not yet at diabetic levels. People with prediabetes are five to fifteen times more likely to develop full-blown diabetes than people without this condition.
These are alarming statistics. Diabetes has serious potential consequences, including blindness, kidney failure, erectile dysfunction, heart failure, stroke, as well as nerve damage and circulation problems that can necessitate amputation.
Good news: Diabetes and its devastating consequences can often be prevented—by reversing prediabetes.
HOW THE DISEASE PROGRESSES
There are two main types of diabetes. With type 1 diabetes, the body’s immune system attacks the pancreas, impairing or destroying its ability to produce insulin, the hormone that helps cells absorb glucose and convert it to energy. Prediabetes and body weight are generally only minor contributors to type 1 diabetes.
In contrast, the development of type 2 diabetes—which accounts for about 90 percent of all diabetes cases—is greatly influenced by prediabetes and excess weight. An obese person is eighty times more likely to develop type 2 diabetes than a person of normal weight. With type 2 diabetes, the pancreas usually does produce insulin, but the body’s cells cannot use it properly. A person generally passes through several stages on the way to developing type 2 diabetes.
When we eat, the amount of glucose in our blood rises, alerting the pancreas that it needs to produce insulin. Excess fat, nutritional deficiencies, and the stress hormone cortisol interfere with cells’ ability to accept and use insulin, leaving excess glucose in the blood. When this happens, a person is said to have insulin resistance.
Sensing that the insulin is not doing its job, the pancreas churns out even more. But since the cells cannot accept the excess insulin, it remains in the blood, along with the excess glucose. When blood glucose levels reach a certain point (as measured with blood tests), the condition qualifies as prediabetes, and if levels climb higher still, it qualifies as diabetes.
High blood glucose levels cause many of the complications of diabetes, including damage to the kidneys, nerves, and eyes. However, in the years during which prediabetes and diabetes are developing, a bigger problem is high blood insulin.
Reason: Insulin helps produce muscle—but when insulin levels get too high, the hormone instead promotes formation of visceral fat, which in turn makes insulin resistance even worse. Insulin elevations also increase production of triglycerides and cholesterol, which clog arteries; C-reactive protein, which promotes damaging inflammation; and cortisol, which contributes to various diseases.
WHAT THE TESTS SHOULD TELL US
Too many doctors use antiquated guidelines for interpreting test results, then tell patients all is well when, in fact, the patients are at risk. I urge you to ask your doctor for the specific results of your tests and compare them with my guidelines below, which I have based on the most recent evidence. You may spot a warning sign that your doctor missed.
•Fasting glucose test. Routinely given at annual checkups, this test involves fasting for at least eight hours (optimally twelve hours), then having blood drawn to measure glucose levels.
Do You Have Prediabetes?
If you are age sixty-five or older, you are at increased risk for prediabetes regardless of the characteristics described below. For this reason, you should ask your doctor about receiving a fasting glucose test.
If you are under age sixty-five, answer the following questions. Speak to your doctor about receiving a fasting glucose test if you score 5 or higher.*
|
AGE |
POINTS |
|
20–27 |
0 |
|
28–35 |
1 |
|
36–44 |
2 |
|
45–64 |
4 |
|
SEX |
|
|
Male |
3 |
|
Female |
0 |
|
FAMILY HISTORY OF DIABETES |
|
|
No |
0 |
|
Yes |
1 |
|
HEART RATE |
POINTS |
|
Less than 60 |
0 |
|
60–69 |
0 |
|
70–79 |
1 |
|
80–89 |
2 |
|
90–99 |
2 |
|
Greater than 100 |
4 |
To determine your heart rate, place the tips of the first two fingers lightly over one of the blood vessels in your neck or the pulse spot inside your wrist just below the base of your thumb. Count your pulse for ten seconds and multiply that number by six.
|
HIGH BLOOD PRESSURE |
|
|
No |
0 |
|
Yes |
1 |
|
BODY MASS INDEX (BMI) |
|
|
Less than 25 |
0 |
|
25–29.9 |
2 |
|
30 or greater |
3 |
To determine your BMI, consult the National Heart, Lung, and Blood Institute website, www.nhlbi.nih.gov (search BMI).
Problem: The range generally accepted as “normal”—from 65 to 99 mg/dL—is much too broad.
Evidence: A study published in the New England Journal of Medicine found that men with a fasting blood glucose level of 87 mg/dL had almost twice the risk of developing diabetes as did men whose level was 81 mg/dL or less. My guidelines:
›Optimal—76 to 81 mg/dL
›Normal—82 to 85 mg/dL
›At risk—86 to 99 mg/dL
›Prediabetic—100 to 125 mg/dL
›Diabetic—126 mg/dL and above
Though most doctors do not order it routinely, you can ask your doctor to have your insulin levels checked as part of your fasting glucose test. These results are not used to officially diagnose diabetes, but they do provide additional information about your risk. Although the generally accepted guidelines put the normal range for blood insulin levels at 6 micro-international units per milliliter (mcU/ml) to 35 mcU/ml, I think this range is far too wide to be meaningful. My guidelines:
›Optimal—7 mcU/ml or less
›At risk—8 to 10 mcU/ml
›Prediabetic—11 to 25 mcU/ml
›Dangerous—above 25 mcU/ml
•Oral glucose tolerance test with glucose and insulin levels. A more accurate way to measure blood insulin levels, this test requires fasting for twelve hours and having blood drawn, then drinking a glucose solution and having blood drawn again after one, two, and up to three hours. Many medical doctors fail to order this test because they are unaware that it dramatically improves the ability to identify prediabetic patients. I often order this test for patients who are overweight, have a strong family history of diabetes, or have a history of elevated fasting glucose levels—even if their most recent fasting glucose test results appeared normal. In this way, I have diagnosed type 2 diabetes in several patients whose fasting glucose results did not suggest any problems. My guidelines for blood drawn at the two-hour point:
›Normal—blood glucose below 140 mg/dL, or insulin levels at or below 55 mcU/ml.
›Prediabetic—blood glucose of 140 to 159 mg/dL, or an increase in glucose of 50 mg/dL or more within one hour, or insulin levels at 56 to 90 mcU/ml.
•Dangerous—blood glucose of 160 mg/dL or higher, or insulin levels above 90 mcU/ml.
•Hemoglobin A1C (HbA1C). This blood test indicates damage to blood proteins caused when glucose binds to the oxygen-carrying hemoglobin in red blood cells, creating free radicals (harmful negatively charged molecules). Results are expressed as a percentage. A British study involving 10,232 adults indicated that HbA1C results accurately predict health problems, including heart attacks (for which prediabetes and diabetes are risk factors). For each 1 percent rise in HbA1C, study participants’ heart attack risk increased by 20 percent. My guidelines:
›Normal—4.5 to 4.9 percent
›At risk—5.0 to 5.6 percent
›Prediabetic—5.7 to 6.9 percent
›Diabetic—7.0 percent or higher
STEPS TO TAKE TO PREEMPT PREDIABETES
Fortunately, there is a lot you can do to prevent prediabetes—or even to reverse it if you have it.
•Lose excess weight. This is without question the most important step. To determine if you are at a healthful weight, calculate your body mass index (BMI), a ratio of your weight to the square of your height (for a free online BMI calculator, go to www.nhlbi.nih.gov and search “BMI calculator”). BMI of 30 or higher indicates obesity and a strong likelihood of developing prediabetes or diabetes; BMI between 25 and 29.9 puts you at risk for prediabetes. If necessary, a holistic doctor or nutritionist can help you devise a personal weight-loss plan.
•Reduce body fat percentage. Apart from its effect on weight, excess body fat increases prediabetes risk. I measure a patient’s body fat percentage with bioelectrical impedance, a painless test that involves placing electrodes on your hand and foot. For women, an ideal range is 21 to 24 percent; anything above 31 percent is risky. For men, ideal is 14 to 17 percent; above 25 percent is risky.
Self-defense: Build muscle and banish excess fat by doing thirty minutes of aerobic exercise, such as brisk walking, five days a week, plus thirty minutes of strength training twice weekly.
•Eat right. Good dietary habits help to control weight; prevent spikes and drops in blood glucose levels; slow digestion, giving the pancreas time to produce insulin; boost energy, making it easier to exercise; and provide nutrients that optimize health.
›Eat three meals a day at regular times, keeping portions moderate. Never skip breakfast.
›Keep snacks small.
Options: Nuts, seeds, low-sugar protein drinks, vegetables, or fruit.
›Include a small portion of protein at every meal.
Good choices: One or two eggs, 1.5 ounces of nuts, or three ounces of fish, chicken, turkey, or lean meat.
›Eat at least one or two servings of whole grains daily. For variety, try quinoa, couscous, and bread made with spelt or kamut flour.
›Avoid sugary foods, processed foods, trans fats (found in some margarines, baked goods, and crackers), and saturated fats (in meats, dairy foods, and many vegetable oils).
›Have at least two servings of fruits and three or more servings of vegetables daily.
•Take appropriate supplements. Many manufacturers offer a “blood sugar control formula” that provides a combination of nutrients to help stabilize blood glucose and promote proper insulin function. Alternatively, you can follow the following guidelines.
If you are at risk for prediabetes, take:
›Chromium, a mineral, at 500 micrograms (mcg) daily.
›Pycnogenol (maritime pine extract) at 200 mg daily.
If you have been diagnosed with prediabetes, also take:
›Biotin (vitamin B-7) at 500 mcg daily.
›Alpha-lipoic acid, an antioxidant, at 300 mg daily.
›Magnesium at 400 mg daily.
›Vitamin D at 1,000 international units (IU) daily.
If you use diabetes medication, check with your doctor before taking these supplements—your medication dosage may need to be adjusted. These supplements are sold in health-food stores, are generally safe, rarely cause side effects, and can be taken indefinitely. Ideally, however, your improved diet and more healthful lifestyle will decrease your risk for prediabetes or reverse the condition, so the supplements will eventually no longer be necessary.
For a complete guide on prediabetes, I recommend Stop Prediabetes Now, by Jack Challem and Ron Hunninghake, MD, from which the following checklist has been adapted. Check off all the risk factors that apply to you. If you have five or more checks, see your doctor—you may be at high risk for prediabetes.
I have:
›A brother, sister, or parent with diabetes
›A personal history of gestational diabetes (diabetes during pregnancy)
›A waist measurement of more than thirty-five inches (women) or forty inches (men)
I have been diagnosed with:
›High blood sugar or insulin levels
›High blood pressure
›High cholesterol or high triglycerides (a type of fat in blood)
›Hypothyroidism (low thyroid hormone)
›Polycystic ovary syndrome
›Carpal tunnel syndrome, Bell’s palsy, or gout (which may be linked to diabetes)
I often:
›Skip breakfast
›Breakfast only on coffee and/or something starchy (bagel, muffin)
›Feel tired after meals, especially lunch
›Nap during the day or early evening
›Have trouble falling asleep at night
›Have trouble getting up in the morning
›Crave sweets
›Crave starchy foods (pasta, pizza, bread)
›Snack late at night
›Drink nondiet soft drinks daily
›Have one or more sweet foods daily
›Lack energy
›Skip exercise
›Feel thirsty
›Urinate frequently
›Have trouble maintaining an erection
›Feel less interested in sex than I used to
›Feel stressed, irritable, or depressed
›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.
Hidden Diabetes—You Can Get a Clean Bill of Health and Still Be at Risk
With all the devastating complications of type 2 diabetes, such as heart disease, stroke, dementia, and blindness, you might assume that most doctors are doing everything possible to catch this disease in its earliest stages. Not so.
Problem: There are currently no national guidelines for screening and treating type 2 diabetes before it reaches a full-blown stage.
Research clearly shows that the damage caused by type 2 diabetes begins years—and sometimes decades—earlier, but standard medical practice has not yet caught up with the newest findings on this disease.
Fortunately, there are scientifically proven ways to identify and correct the root causes of diabetes so that you never develop the disease itself.
WHEN THE PROBLEM STARTS
Diabetes is diagnosed when fasting blood sugar (glucose) levels reach 126 mg/dL and above. Prediabetes is defined as blood sugar levels that are higher than normal but not high enough to indicate diabetes. Normal levels are less than 100 mg/dL.
What most people don’t know: Although most doctors routinely test blood sugar to detect diabetes, it’s quite common to have a normal level and still have “diabesity,” a condition typically marked by obesity and other changes in the body that can lead to the same complications (such as heart disease, stroke, and cancer) as full-fledged diabetes.
Important: Even if you’re not diabetic, having belly fat—for example, a waist circumference of more than thirty-five inches in women and more than forty inches in men—often has many of the same dangerous effects on the body as diabetes.
Important finding: In a landmark study in Europe, researchers looked at twenty-two thousand people and found that those with fasting blood sugar levels of just 95 mg/dL—a level that’s generally considered healthy—already had significant risks for heart disease and other complications.
AN EARLIER CLUE
Even though we’ve all been told that high blood sugar is the telltale sign of diabetes, insulin levels are, in fact, a more important hallmark that a person is in the early stages of the diabetes continuum.
High blood sugar is typically blamed on a lack of insulin—or insulin that doesn’t work efficiently. However, too much insulin is actually the best marker of the stages leading up to prediabetes and diabetes.
Why is high insulin so important? In most cases, it means that you have insulin resistance, a condition in which your body’s cells aren’t responding to insulin’s effects. As a result, your body churns out more insulin than it normally would.
Once you have insulin resistance, you’ve set the stage to develop abdominal obesity, artery-damaging inflammation, and other conditions that increasingly raise your risk for prediabetes and diabetes.
A BETTER APPROACH
Because doctors focus on prediabetes and diabetes—conditions detected with a blood sugar test—they tend to miss the earlier signs of diabesity. A better approach:
•Test insulin as well. The standard diabetes test is to measure blood sugar after fasting for eight or more hours. The problem with this method is that blood sugar is the last thing to rise. Insulin rises first when you have diabesity.
My advice: Ask your doctor for a two-hour glucose tolerance test. With this test, your glucose levels are measured before and after consuming a sugary drink—but ask your doctor to also measure your insulin levels before and after consuming the drink.
What to look for: Your fasting blood sugar should be less than 80 mg/dL; two hours later, it shouldn’t be higher than 120 mg/dL. Your fasting insulin should be 2 to 5 IU/dL—anything higher indicates that you might have diabesity. Two hours later, your insulin should be less than 30 IU/dL.
Cost: fifty to one hundred dollars (usually covered by insurance). I advise all patients to have this test every three to five years and annually for a person who is trying to reverse diabetes.
STEPS TO BEAT OBESITY
With the correct lifestyle changes, most people can naturally reduce insulin as well as risk for diabesity-related complications, such as heart disease.
Example: The well-respected Diabetes Prevention Program sponsored by the National Institutes of Health found that overweight people who improved their diets and walked just twenty to thirty minutes a day lost modest amounts of weight and were 58 percent less likely to develop diabetes. You can reduce your risk even more by following these steps:
•Manage your glycemic load. The glycemic index measures how quickly different foods elevate blood sugar and insulin. A high-glycemic slice of white bread, for example, triggers a very rapid insulin response, which in turn promotes abdominal weight gain and the risk for diabesity.
My advice: Look at your overall diet and try to balance higher-glycemic foods with lower-glycemic foods. In general, foods that are minimally processed—fresh vegetables, legumes, fish, etc.—are lower on the glycemic index. These foods are ideal because they cause only gradual rises in blood sugar and insulin.
•Eat nonwheat grains. Many people try to improve their diets by eating whole-wheat rather than processed white bread or pasta. It doesn’t help.
Fact: Two slices of whole wheat bread will raise blood sugar more than two tablespoons of white sugar. If you already have diabetes, two slices of white or whole wheat bread will raise your blood sugar by 70 to 120 mg/dL. Wheat also causes inflammation, stimulates the storage of abdominal fat, and increases the risk for liver damage.
These ill effects occur because the wheat that’s produced today is different from the natural grain. With selective breeding and hybridization, today’s wheat is high in amylopectin A, which is naturally fattening. It also contains an inflammatory form of gluten along with short forms of protein, known as exorphins, which are literally addictive.
Best: Instead of white or whole-wheat bread and pasta, switch to nonwheat grains such as brown or black rice, quinoa, buckwheat, or amaranth. They’re easy to cook, taste good, and they don’t have any of the negative effects. Small red russet potatoes are also acceptable.
•Give up liquid calories. The average American gets 175 calories a day from sugar-sweetened beverages. Because these calories are in addition to calories from solid food, they can potentially cause weight gain of eighteen pounds a year. The Harvard Nurses’ Health Study found that women who drank one sugar-sweetened soft drink a day had an 82 percent increased risk of developing diabetes within four years.
Moderation rarely works with soft drinks because sugar is addictive. It activates the same brain receptors that are stimulated by heroin.
My advice: Switch completely to water. A cup of unsweetened coffee or tea daily is acceptable, but water should be your main source of fluids.
Bonus: People who are trying to lose weight can lose 44 percent more in twelve weeks just by drinking a glass of water before meals.
Important: Diet soda isn’t a good substitute for water—the artificial sweeteners that are used increase sugar cravings and slow metabolism. Studies have found a 67 percent increase in diabetes risk in people who use artificial sweeteners.
›Mark Hyman, MD, founder and medical director of the UltraWellness Center in Lenox, Massachusetts. A leading expert in whole-systems medicine that addresses the root causes of chronic illness, he is chairman of the Institute for Functional Medicine in Gig Harbor, Washington. Dr. Hyman is also the author of several books, including The Blood Sugar Solution: The UltraHealthy Program for Losing Weight, Preventing Disease, and Feeling Great Now!DrHyman.com.
What Is Type 1.5 Diabetes?
How does type 1.5 diabetes differ from other types of diabetes?
Type 1 diabetes is an autoimmune disorder in which the body’s own immune system destroys the insulin-producing cells of the pancreas. As a result, the body does not produce enough of the hormone insulin to control blood sugar levels.
Type 2 diabetes is characterized by insulin resistance—the body responds to insulin inefficiently and fails to keep blood sugar at a normal level. The vast majority of people with diabetes have type 2.
A person who shows attributes of both type 1 and type 2 is said to have type 1.5 diabetes. What initially appeared to be type 2 diabetes is actually slowly evolving into type 1 diabetes. Type 1.5 diabetes is also called slow-onset type 1 or latent autoimmune diabetes in adults (LADA). It is diagnosed through a blood test for antibodies. Diet, exercise, and some oral medications may help keep the condition under control, but many type 1.5 patients require insulin within ten years of diagnosis.
›Anne Peters, MD, professor of clinical medicine, Keck School of Medicine, University of Southern California, Los Angeles, and director of the USC Westside Center for Diabetes. She is author of Conquering Diabetes: A Complete Program for Prevention and Treatment.
Is It a Rash…or Diabetes?
We all know that we should keep an eye on moles and any other skin changes that might be a sign of skin cancer.
But there’s another reason to look closely at your skin: it can point to—or sometimes even predict—internal diseases that you might not be aware of.
Many internal diseases are accompanied by skin symptoms. The yellowish skin tint (jaundice) caused by hepatitis is a common one—but there are other serious health problems that most people don’t associate with skin changes.
Skin symptoms: Rash or pimple-like eruptions (sometimes containing pus) under the breasts, between the buttocks, or in other skinfolds.
Possible underlying cause: Candidiasis, a fungal infection that commonly affects people with diabetes. This infection can also lead to whitish spots on the tongue or inner cheeks.
Candidiasis of the skin or mucous membranes that is chronic or difficult to control can be a red flag for poor blood sugar control—and it can occur in patients who haven’t yet been diagnosed with diabetes. People with poor blood sugar control often have impaired immunity, increasing their risk for infections such as candidiasis.
Next step: Most candidiasis infections are easily treated with topical antifungal preparations. People with persistent/severe cases may need an oral medication, such as over-the-counter clotrimazole or prescription fluconazole.
Also: Dark patches of skin that feel velvety and thicker than normal (especially on the neck and under the arms) could be due to acanthosis nigricans, a sign of insulin resistance, a condition that often precedes diabetes. The skin may also smell bad or itch.
Acanthosis nigricans often will improve without treatment when you get your blood sugar under control, so get tested for insulin resistance and glucose tolerance.
›Cindy Owen, MD, an assistant professor of dermatology and associate program director at the University of Louisville School of Medicine, where she practices medical and inpatient dermatology with a focus on the skin signs of internal disease and drug reactions. She has published many articles in medical journals such as the Archives of Dermatology and Journal of Cutaneous Pathology.
This DIY Test for Diabetes Could Save Your Life
If you’re conscientious about your health, you probably see your doctor for an annual physical or perhaps even more often if you have a chronic condition or get sick.
But if you’d like to keep tabs on your health between your doctor visits, there’s an easy, do-it-yourself test that can give you valuable information about your body.
Here’s a self-test for diabetes—repeat it once every few months, and keep track of the results. See your doctor if you don’t “pass” this “Pencil Test.” *
Why this test? It checks the nerve function in your feet—if abnormal, this could indicate diabetes, certain types of infections, or autoimmune disease.
The prop you’ll need: A pencil that is freshly sharpened at one end with a flat eraser on the other end, and a friend to help.
What to do: Sit down so that all sides of your bare feet are accessible. Close your eyes, and keep them closed throughout the test.
Have your friend lightly touch your foot with either the sharp end or the eraser end of the pencil. With each touch, say which end of the pencil you think was used.
Ask your friend to repeat the test in at least three different locations on the tops and bottoms of both feet (twelve locations total). Have your friend keep track of your right and wrong answers.
Watch out: Most people can easily tell the difference between sharp and dull sensations on their sensitive feet. If you give the wrong answer for more than two or three locations on your feet, have your doctor repeat the test to determine whether you have nerve damage (neuropathy).
Beware: Neuropathy is a common sign of diabetes, certain autoimmune disorders, including lupus and Sjögren’s syndrome, infection, such as Lyme disease, shingles, or hepatitis C, or excessive exposure to toxins, such as pesticides or heavy metals (mercury or lead).
›David L. Katz, MD, MPH, an internist and preventive medicine specialist. He is cofounder and director of the Yale-Griffin Prevention Research Center in Derby, Connecticut, and clinical instructor at the Yale School of Medicine in New Haven, Connecticut. Dr. Katz is also president of the American College of Lifestyle Medicine and author of Disease-Proof: Slash Your Risk of Heart Disease, Cancer, Diabetes, and More—by 80 Percent.
What Your Urine Says About Your Health
You would be surprised by how much information can be gleaned from the urine that you produce each day (one to two quarts, on average). For example, the simple “dipstick” urine test that doctors often use to check for a urinary tract infection can also help them diagnose kidney disease, diabetes, cancer, and other conditions. But there is more.
What you may not realize: If you know what to look for, you can tell a lot about your health just by being aware of the physical characteristics of your urine—such as color, smell, and frequency.
COLOR
When you’re healthy and drinking enough water, your urine should be mainly clear or straw-colored with just a hint of yellow. The yellow color comes from urochrome, a pigment produced by the breakdown of a protein in red blood cells.
Urine is naturally darker in the morning because you don’t drink water while you sleep. If a color change persists, however, it could be a problem. For example:
•Brown or dark brown. Pay attention if your urine is dark for more than a week.
What this usually means: Liver disease. The liver normally breaks down and excretes bilirubin, a pigment that’s produced by the turnover of red blood cells. Patients with liver disease accumulate bilirubin. This will initially cause jaundice, a yellowing of the skin or the whites of the eyes. As more bilirubin accumulates, it can cause the urine to become brown. A combination of dark-colored urine and jaundice means that liver disease might be getting worse. See your doctor right away.
Dark-colored urine can also be a side effect of some antibiotics, laxatives, and muscle relaxants. Eating large amounts of fava beans, rhubarb, or aloe can cause brown urine as well. In some cases, dark-colored urine can signal kidney failure.
•Red or pink. Urine that’s tinged with red or pink could simply mean that you have been eating beets. (The medical term for beet-induced urine changes is beeturia). Or it could mean that you’re urinating blood.
The amount of blood will affect the color. If the urine resembles cabernet wine, you’re bleeding a lot; urine that’s pinkish or just slightly red contains only traces of blood. A microscopic amount of blood won’t be visible—it can be detected only with a laboratory test.
What this usually means: Blood in the urine is always a problem. Make an appointment to see your doctor. If you see blood and it also hurts when you urinate, you could have an infection in the urethra, bladder, or kidney or even a malignancy in the bladder. Bleeding without pain can also indicate these conditions.
•Green. Though rare, a person’s urine can turn a greenish color.
What this usually means: Green urine can appear when you’ve consumed a chemical dye—from food coloring, for example, or from taking medications such as amitriptyline, an antidepressant, or indomethacin, a nonsteroidal anti-inflammatory drug. In some cases, urine with a greenish tint can signal a urinary tract infection with certain bacteria (such as Pseudomonas) that affect the color.
If your urine is greenish, increase fluid intake to see if it clears. If it doesn’t in two days, see your doctor or a urologist.
ODOR
If you’re healthy, your urine should be highly diluted, consisting of about 95 percent water, with only small amounts of dissolved chemical compounds and metabolic byproducts. It typically has no—or only a faint—odor.
Of course, everyone is familiar with the effect that asparagus and some other foods, such as onions or fish, have on the smell of one’s urine. This strong “rotten” smell is due to the chemical compounds in certain foods, particularly molecules that are not completely broken down by the body. The smell usually disappears within a day or so.
Some other less common urine smells include:
•Ammonia-like. If your urine is concentrated, with a larger-than-normal amount of urea (a chemical compound in urine), you might smell an aroma that resembles ammonia. Or you might just notice that it has a stronger smell than usual.
What this usually means: Dehydration. The less water you drink, the higher the concentration of urea and other substances—and the stronger the smell. You can diagnose this yourself by drinking, say, one extra glass of water an hour for several hours to add water to your urine. The strong urine smell will probably disappear within a few hours. If it does not, see your doctor.
•Foul-smelling. If your urine smells foul or unusual in any way for more than a few days, pay attention to the odor.
What this usually means: If it’s not caused by a food that you’ve eaten, it could signal an infection in the bladder or kidneys. Less often, it’s due to a metabolic disorder that reduces the body’s ability to fully break down foods during digestion.
Uncontrolled diabetes can cause an abnormally sweet odor, and penicillin can cause a distinctive medicinal odor.
Even if you have no other symptoms, such as pain while urinating, if your urine continues to have an unusually strong smell for more than a couple of days, talk to your doctor.
FOAMY OR BUBBLY
It’s natural to see foam in the toilet when you really have to go and have a heavy stream. But urine that’s consistently foamy or bubbly could mean that you’re losing protein.
What this usually means: Kidney disease. Large amounts of protein in the urine is one of the main signs of chronic kidney disease. See your doctor right away.
MUCUS OR CLOUDY
Mucus in urine could indicate inflammation in the urinary tract.
What this usually means: Urinary tract infection. See your doctor.
Cloudy urine can also be related to infection but is often just an indication that your urine is alkaline, which is harmless at low levels.
VOLUME AND FREQUENCY
The average adult typically urinates four to eight times in twenty-four hours. A change in the frequency of your urinary habits, including getting up more than twice a night to urinate or an increase or decrease in the amount that you urinate, warrants attention.
What this usually means: An increase in the frequency of urination, along with an increase in volume, is one of the telltale signs of diabetes.
If the amount of urine seems the same but you’re urinating more often, you could have a urinary tract infection. If this is the case, you’ll probably have very strong urges to urinate even when just a small amount comes out.
Frequency of urination and/or urinary urgency in the absence of a urinary tract infection can indicate an overactive bladder.
In men, enlargement of the prostate gland can trigger urinary urgency. Patients with neurological conditions, such as multiple sclerosis, can also have this symptom.
Don’t worry if there’s been a decrease in the amount or frequency of urination. You probably just need to drink more water. If this doesn’t help, see your doctor.
›Jonathan M. Vapnek, MD, a urologist and clinical associate professor of urology at Mount Sinai School of Medicine in New York City. A member of the American Urological Association, he was named by New York Magazine as one of New York City’s best urologists. Dr. Vapnek has authored or coauthored more than thirty-five papers on urological topics.
Get That Eye Exam
You may know that a good eye exam can reveal more than just your eye health. But did you know that it can detect signs of multiple sclerosis, diabetes, high blood pressure, rheumatoid arthritis, high cholesterol, and Crohn’s disease? In a study of insurance claims, 6 percent of these conditions were first detected by eye doctors.
Why: The eyes contain blood vessels, nerves, and other structures that can be affected by chronic illness. If you’re over age forty, get an eye exam at least every two years.
›Linda Chous, OD, chief eye-care officer, UnitedHealthcare Vision, Minneapolis.
The Body/Brain Connection
Put yourself on a weight-loss diet, and you can measure your success with a bathroom scale. If fitness is your goal, you can track your improvement by charting how fast you can run or walk a mile.
But how can you tell if your brain is as fit as the rest of you?
If you’re having memory problems, that’s an obvious red flag. But even if you’re basically healthy (or are being treated for a chronic condition such as high blood pressure), a routine medical exam can tell a lot about your brain health—if you know what the seemingly basic tests may mean, according to former U.S. Surgeon General Richard Carmona, MD. A physical checkup reveals information about your brain—and the additional tests you may need.
LAY IT ALL OUT
Doctors aren’t mind readers—they don’t know what you’re worried about unless you tell them. At your physical, tell your doctor about any changes in your health (even if you think they sound trivial).
Where most people get tripped up: There’s always that routine question about medications you’re taking. Don’t assume that your doctor knows everything he/she has prescribed—include every medication and supplement you’re taking.
Many common prescription or over-the-counter drugs—alone or in combination—can affect your brain. The following types of drugs are among the most commonly associated with dizziness, fuzzy thinking, and/or memory problems. All drugs within each class can addle a person’s brain, not only the specific drug examples given.
•Allergy medications (e.g., antihistamines)
•Antianxiety medications
•Antibiotics
•Antidepressants
•Blood pressure medications
•Sleep aids
If you are taking one of these types of medications and are experiencing cognitive problems, ask your physician about switching to a different drug.
Fortunately, the fuzzy thinking and/or problems with memory usually go away when the drug is discontinued. And because everyone responds differently to individual medications, you may be able to safely take a different drug that’s within the same class.
CLUES FROM YOUR PHYSICAL
Even if you’re not having cognitive problems, your physical can give you a measure of key markers of brain health. For example, most people know that high blood pressure is linked to increased risk for certain types of dementia (normal blood pressure is 120/80 or below). But low blood pressure (lower than 90/60) may make you dizzy, fatigued, and unable to think clearly. Other important brain-health markers include:
•Eyes. When your doctor shines that bright light in your eyes, he is looking at the retina, the light-sensitive tissue at the back of the eye that is connected directly to the optic nerve leading to the brain. Blood vessels in the retina reflect vascular health in the whole body—including the brain.
•Hearing, balance, and coordination. While many diseases can cause problems with hearing, balance, or coordination, one possibility is dysfunction of the eighth cranial nerve, which connects directly to the brain. Ears have fluid-filled canals that relay information to the brain via the eighth cranial nerve and act as a kind of gyroscope, giving us our sense of orientation in space. When we change position, the fluid moves, and the brain adjusts our balance and coordination. With some inner-ear disorders, such as Ménière’s disease or labyrinthitis, people are dizzy, lose hearing, or fall frequently due to loss of balance and coordination.
•Reflexes. A tap on your knee with a tiny hammer sends an electrical impulse to the spinal cord, which then sends a signal back to the foot, triggering a kick. A weak or delayed response could indicate a problem with the nervous system or brain.
•Sensation. All of the senses are housed in the brain, including the sense of touch. Any change in sensation—tingling hands or feet, weak hands, and/or numbness anywhere in the body—could signal a problem in the brain.
DIGGING DEEPER
If your memory is failing or you’re having other cognitive problems, such as difficulty making decisions or planning activities, your doctor may want to run tests for:
•Inflammation. A blood test for C-reactive protein (CRP) measures general levels of inflammation in the body. High levels of CRP (above 3.0 mg/L) could be due to a simple infection, cardiovascular disease that may also be putting your brain at risk, or an autoimmune disease, such as lupus or multiple sclerosis, which can cause problems with memory and thinking as well as physical symptoms.
•Vitamin deficiencies. A vitamin B-12 deficiency can lead to memory loss, fatigue, and light-headedness. Other common nutrient deficiencies that can affect thinking include vitamin D and omega-3 fatty acids—there are tests for both.
•Diabetes and glucose tolerance. Left untreated, diabetes can dramatically increase one’s risk for dementia. If your doctor suspects you have diabetes (or it runs in your family), get your blood glucose level tested (following an overnight fast).
Useful: An HbA1C test, which gives a broader picture of your glucose level over the previous six to twelve weeks. While most people, especially after age forty-five, should get glucose testing at least every three years, it’s particularly important for those having cognitive symptoms.
•Tick-borne illness. Lyme disease and Rocky Mountain spotted fever can cause mental fuzziness.
Also helpful: Liver function tests, including new genomic tests, may also be ordered to assess your liver’s ability to remove toxins. If the body doesn’t clear toxins, this can alter brain metabolism, possibly leading to cognitive decline.
›Richard Carmona, MD, FACS, MPH, president of the Tucson, Arizona–based Canyon Ranch Institute and vice chairman of Canyon Ranch, a health resort, spa, and wellness retreat. He served as U.S. Surgeon General from 2002 to 2006 and is author of Canyon Ranch’s 30 Days to a Better Brain.
Are You Getting the Most from Your Blood Tests? Even Doctors May Miss Signs of Health Problems
Unless your doctor tells you there’s a problem, you may not give much thought to the blood tests that you receive periodically.
But standard blood tests and certain other blood tests that you may request from your doctor can offer valuable—even lifesaving—clues about your health, including explanations for such vexing conditions as short-term memory loss and fatigue.
What you may not realize: If your doctor says that your test results are “normal,” this is not the same as “optimal” or even “good.”
For example, a total cholesterol reading of 200 mg/dL is considered normal, even though the risk of developing heart disease is sometimes higher at this level than it would be if your numbers were lower. Always ask your doctor what your target should be.
Blood test results that you should definitely make note of—and certain tests you may want to request:*
•Low potassium. Low potassium (hypokalemia) is worrisome because it can cause fatigue, constipation, and general weakness, along with heart palpitations.
Causes: An imbalance of the hormone insulin often causes low potassium. It can also be due to problems with the adrenal glands or a loss of fluids from vomiting and/or diarrhea. A magnesium deficiency or a high-sodium diet can lead to low potassium too. It is also a common side effect of certain medications, including diuretics, such as hydrochlorothiazide; laxatives; and some asthma drugs, such as albuterol.
•Normal potassium: 3.6 to 5.2 mEq/L.
•Optimal potassium: 4.5 to 5.2 mEq/L.
What to do: If your potassium is not optimal, your doctor will probably recommend that you eat more potassium-rich foods, such as fruits (bananas, oranges, cantaloupe), vegetables (tomatoes, sweet potatoes), and whole grains (quinoa, buckwheat). You’ll also be advised to reduce your sodium intake to less than 2,300 mg daily—high sodium depletes potassium from the body. Additionally, you may be advised to take a magnesium and potassium supplement.
Also: Keep your stress level low. Chronic stress can lead to a high level of the hormone cortisol—this can overwhelm the adrenal glands and lead to low potassium.
•“Normal” glucose. Most people know that high fasting blood glucose (126 mg/dL or above) is a warning sign of diabetes. But you may not be aware that slight increases in blood sugar—even when it is still within the so-called normal range—also put you at greater risk.
Surprising: Among forty-six thousand people who were tracked for ten years, for every one-point rise in fasting blood glucose over 84 mg/dL, the risk of developing diabetes increased by about 6 percent. Vascular and kidney damage may begin when glucose reaches 90 mg/dL—a level that’s within the normal range.
Causes: High blood glucose usually occurs when the body’s cells become resistant to the hormone insulin and/or when the pancreas doesn’t produce enough insulin. Obesity and genetic factors are among the main causes.
•Normal glucose: 65 to 99 mg/dL.
•Optimal glucose: 70 to 84 mg/dL.
What to do: If your fasting glucose isn’t optimal or if tests show that it’s rising, try to get the numbers down with regular exercise, weight loss, and a healthier diet.
Powerful spice: Add one-quarter teaspoon of cinnamon to your food each day. People who take this small dose can lower their blood glucose by 18 to 29 percent.
Alternative: A standardized cinnamon extract in capsule form (125 to 250 mg, two to three times daily).
•High homocysteine. Most doctors recommend a homocysteine test only for patients with existing heart problems. Everyone should get it. High homocysteine may damage arteries and increase the risk for heart disease and stroke.
Causes: Homocysteine rises if you don’t get enough B-complex vitamins or if you’re unable to properly metabolize methionine, an amino acid that’s mainly found in meat, fish, and dairy. Vegetarians tend to have higher homocysteine levels. Other causes include a lack of exercise, chronic stress, smoking, and too much caffeine.
•Normal homocysteine: Less than 15 umol/L.
•Optimal homocysteine: 8 umol/L or below.
What to do: If your homocysteine level isn’t optimal, take a daily B-complex vitamin supplement that has at least 50 mg of vitamin B-6.
Also helpful: A fish oil supplement to reduce inflammation and protect the arteries. Take 1,000 mg, two to three times daily.*
•Low DHEA. This is a hormone that’s used by the body to manufacture both testosterone and estrogen. It’s also an antioxidant that supports the immune system and increases insulin sensitivity and the body’s ability to metabolize fats. DHEA is not usually measured in standard blood tests, but all adults should request that their levels be tested.
Low DHEA is a common cause of fatigue, weight gain, depression, and decreased libido in men and women of all ages. Over time, it can damage the hippocampus, the memory center of the brain.
Causes: It’s normal for DHEA to slightly decrease with age. Larger deficiencies can indicate an autoimmune disease (such as rheumatoid arthritis) or chronic stress.
•Normal DHEA: Levels of this hormone peak in one’s late twenties. Normal levels vary widely with age and sex.
•Optimal DHEA: The high end of the normal range is optimal—it reflects a reserve of DHEA.
Examples: 200 to 270 mcg/dL for men, and 120 to 180 mcg/dL for women.
What to do: If your DHEA level isn’t optimal, managing emotional stress is critical. Get at least eight hours of sleep every night, exercise aerobically for about thirty minutes, three to four times a week, and practice relaxation techniques, such as yoga and meditation.
Also helpful: A daily supplement (25 to 50 mg) of DHEA. If you take this supplement, do so only under a doctor’s supervision—you’ll need regular blood tests to ensure that your DHEA level doesn’t get too high.
•High LDL-P (LDL particle number). Traditional cholesterol tests look only at triglycerides and total LDL and HDL cholesterol. I advise patients to get a fractionated cholesterol test for a more detailed picture.
Important: Patients with a large number of small LDL particles have an elevated risk for a heart attack even if their overall LDL level is normal. The greater the number of these cholesterol particles, the more likely they are to lodge in the lining of blood vessels and eventually trigger a heart attack.
Causes: Genetics is partly responsible for high LDL and LDL-P. A poor reading can be due to metabolic syndrome, a group of factors that includes abdominal obesity, elevated triglycerides, and high blood pressure. A diet high in animal fats and processed foods can also cause an increase in LDL-P.
•Normal LDL-P: Less than 1,300 nmol/L.
•Optimal LDL-P: Below 1,000 nmol/L on an NMR lipoprofile (this test is the most accurate).
What to do: If your LDL-P level is not optimal (and you have not had a heart attack or other coronary event), I recommend exercise, weight loss, blood pressure and blood sugar management, more antioxidant-rich foods such as vegetables, berries, and legumes, and three to five cups of green tea daily—it’s a potent antioxidant that minimizes the oxidation of cholesterol molecules, which is important for reducing heart attacks.
Also: Daily supplements of bergamot extract, which has been shown to change the size of cholesterol particles (Earl Grey tea, which is flavored with oil of bergamot, provides a less potent dose), and aged garlic extract, which has a beneficial effect on multiple cardiovascular risk factors. If these steps do not sufficiently improve your LDL-P level, talk to your doctor about taking a statin and/or niacin.
›James B. LaValle, RPh, CCN, a clinical pharmacist, nutritionist, and founder of Progressive Medical Center, Orange County, California. He is the author of Your Blood Never Lies: How to Read a Blood Test for a Longer, Healthier Life. JimLaValle.com.
*Source: Richelle J. Koopman et al., “Tool to Assess Likelihood of Fasting Glucose Impairment,” Annals of Family Medicine 6, no. 6 (November 2008): 555–561.
*This self-test is not a substitute for a thorough physical exam from your doctor. Use it only as a way to identify potential problem areas to discuss with your physician.
*These blood tests are typically covered by health insurance.
*Check with your doctor before using fish oil, especially if you take a blood thinner—fish oil can interact with it and certain other medications.