Nov
09
2013

Successful Diabetes Treatment Requires Patient’s Discipline

90% of all diabetes cases are due to type 2 diabetes, which is associated with being overweight or obese. The other 10% are due to type 1 diabetes, which is caused by an autoimmune disease within the pancreas destroying the insulin producing beta cells. Diabetes, type 1 often occurs in childhood (hence the name “juvenile diabetes”), while type 2 diabetes is a condition of the middle aged and older population. There is however an alarming trend: overweight or obese youngsters are also being diagnosed with type 2 diabetes. Here I am discussing type 2 diabetes.

Causes that trigger diabetes

There is not just one way to get diabetes; it usually is a multifactorial disease. Sure, genetics play a minor role. But you need to have epigenetic factors to trigger the genes to develop diabetes: eating too much sugar, eating wheat and wheat products, drinking soda drinks that contain sugar or high fructose corn syrup. Alcohol binges can also cause diabetes as can accumulation of excessive weight (a body mass index above 25.0). Even when there is no genetic risk in your family (your family tree has nobody that came down with diabetes and all your ancestors lived into their 90’s), you can still develop diabetes, if you are exposed to one or more of the risk factors mentioned.

What is the reason why diabetes occurs?

At a Keystone Symposium from Jan. 27 to Feb.1, 2013 in Keystone, Colorado (Ref.1) leading scientific researchers gathered to discuss exactly this question. There seem to be several mechanisms, all of which lead to diabetes. It has been known for some time that in type 2 diabetes insulin resistance develops that renders the cells incapable of absorbing blood sugar (glucose) from the blood into the cells. It is because of this insulin resistance that doctors can diagnose diabetes when blood sugar levels are high.

Successful Diabetes Treatment Requires Patient’s Discipline

Successful Diabetes Treatment Requires Patient’s Discipline

There are at least 5 mechanisms that are presently known that can cause insulin resistance (and thus diabetes) by itself or in combination. For a deeper understanding of diabetes it is crucial to be aware of these. Without knowing the enemy, you cannot fight it.

1. When a person eats too much sugar or fructose the liver converts this into excessive fat that is accumulated in the body’s cells. As a result insulin receptors are becoming inefficient in absorbing sugar from the blood, and blood sugar levels stay high. The pancreas reacts to this by making even more insulin, which after a few years will cause the pancreas to fail in producing insulin. At this point the patient requires insulin or else gets into a diabetic coma.

2. Chronic inflammation is another mechanism that has been shown to cause insulin resistance. Obesity, the metabolic syndrome and diabetes have a common inflammatory denominator that results in insulin resistance. With the aging process there is also deterioration of mitochondrial function (mitochondria are the mini batteries inside of every cell that are responsible for you having energy). This causes fat accumulation and also insulin resistance. Exercise and weight loss are effective in combatting insulin resistance. Fasting has also been shown to improve insulin sensitivity.

3. The metabolism of visceral fat (the type of fat causing the apple appearance in obesity) is highly active and is associated with an increased risk for heart attacks and developing diabetes. The pear shaped woman runs less of a risk, as the fat around the hips is not metabolically active. On the other hand when these women enter into menopause, they also develop abdominal fat (apple-like fat distribution) with a high secretion of inflammatory substances causing insulin resistance, heart attacks and strokes.

4. Another mechanism of causing inflammation comes from invasion of organs with fat cells. The development of fat toxicity from these displaced fat cells can also cause insulin resistance. Heart cells have been shown to die from fat toxicity and in the pancreas the insulin-producing cells can be killed by fat toxicity as well causing diabetes or making existing diabetes worse.

5. Interestingly another line of research, namely researching binge drinking, has revealed that there is a short-term insulin resistance that lasts for several days until the alcohol has been properly metabolized. It is of concern that adolescents who are experimenting with binge drinking are very vulnerable to develop brain damage from this habit.

Consequences of insulin resistance

We know that insulin resistance is the cause for adult onset, type 2 diabetes. It is entirely preventable. But there are powerful influences on people’s lives that will allow one or more of these factors mentioned to cause diabetes. The most common cause is putting on excessive weight. The reason for this is that people like to eat fast foods, drink sugar-containing sodas, and feast on processed foods, bagels and cookies. The end result is a change of the metabolism with an increase in triglycerides from the liver, an increase in LDL cholesterol, particularly the very low-density lipoprotein sub fractions of cholesterol. It has been known for some time that this is the connection to the high, premature death rates from heart attacks in diabetics, in people with obesity and in people with the metabolic syndrome. Hardening of the arteries is accelerated by the deposition of foam cells in the walls of arteries. These are scavenger cells (macrophages) that have engulfed noxious fats. This leads to narrowed coronary arteries and also a general narrowing of arteries all over the body including the brain vessels. In diabetics hardening of the arteries is accelerated and leads to premature strokes, heart attacks and heart failure, kidney failure, blindness and amputations of limbs.

Important tests for borderline diabetics

I you have a fasting blood sugar that is above 100 mg/dL (5.5 mmol), but less than 126 mg/dL (7 mmol) you are considered to be prediabetic or “borderline diabetic”. In this case rather than waiting for disasters in terms of cardiovascular disease, take action and ask your doctor to do the following three tests.

a) Arrange for a glucose tolerance test where you are given 75 grams of glucose; then blood tests are taken at one, two and three hours after this challenge dose. These blood tests are checked for blood glucose levels and insulin levels and tell the doctor exactly what is going on in terms of your sugar metabolism. It shows the glucose clearance and also the insulin response from your pancreas.

b) Have a hemoglobin A1c test done: it shows how your blood sugars have been controlled over the last 2 to 3 months.

c) You also need a VAP (vertical auto profile) test, which tests your lipid profile. Both prediabetics and overtly diabetics have been shown to have lipid profile disorders. Apart from low values in sub fractions of HDL cholesterol this test will also measure the very-low density lipoproteins (VLDL), which has been shown to be responsible for heart attacks and strokes.

With these three tests your doctor can  tell you more accurately what treatment protocol you require to succeed in controlling or curing your pre diabetes or diabetes.

Conventional treatment of diabetes

The conventional treatment of diabetes is to send the patient to a dietician, to ask the patient to do regular exercises and to either start them on hypoglycemic drugs or on insulin injections. Unfortunately the dietician often will encourage the patient to eat “healthy multigrain bread”, which will stimulate your taste buds to eat more sugar, high fructose corn syrup and starchy foods making weight loss impossible. Often the treating physician is satisfied that a hemoglobin A1c of 7% or less is good enough for the diabetic. But non-diabetic people have a hemoglobin A1c of 4% and 5.6%. This should be your goal or you will suffer the consequences of uncontrolled diabetes.

This is what I would call the conventional, symptomatic treatment approach. This may be the approach for patients who are not willing to seriously change their lifestyles, but it is more powerful on the long-term to treat diabetes by treating the underlying causes.

Alternative treatment approach for diabetes

Based on the above discussion regarding the various causes of insulin resistance, it is important to analyze what would be the main contributory factors in your particular case of diabetes.

Here are some suggestions:

1. If you are on the typical North American diet, also known as Western diet, it would be important to face the fact that wheat, wheat products in processed foods and sugar including high fructose corn syrup are the main culprits in stimulating your appetite and making you a sugar and wheat addict. Ref. 2 describes this in detail and offers 150 recipes to overcome this addiction. For more information just follow this reference text. Essentially it is a wheat-free Mediterranean type diet without rice, pasta and bread. You will shed significant amounts of pounds within a short period of time and feel a lot more energetic (due to revitalization of your mitochondria). At the same time insulin resistance is disappearing, because the insulin receptors are fully functional again. The insulin production of the pancreas will go down to normal levels and fat from the visceral fat storage gets melted away resulting in less inflammatory substances circulating in your blood.

2. A regular exercise program in a gym with an aerobic component (30 minutes of treadmill for instance and 20 to 30 minutes of isometric machine exercises) will help you to lower the triglycerides, and increase the healthy HDL cholesterol. It will also improve insulin sensitivity and control inflammation in your body. The best is to exercise 7 days per week. Remember your body works for you 7/7 every week, but for those of you who need a little rest in between 5 days per week is still very good. You may have to adjust your medication and insulin dose downwards, ask your physician about that.

3. Cut out alcohol. This may sound radical to you, but studies show this to be true. I have not mentioned cutting out smoking (it is causing inflammation and insulin resistance), because this is an absolute must that is given. When it comes to alcohol, the famous 1 drink per day for cardio protective purposes may not show up statistically as a bad effect, but your body will nevertheless get the message and let you age somewhat faster than a person who stays sober all the time. Staying sober will allow your brain to think clearly and adhere to your overall lifestyle approach in treating diabetes. Cutting out alcohol protects your brain (including the hypothalamus), liver and pancreas and prevents the prolonged periods of insulin resistance mentioned above that last for days. By keeping your hypothalamus in good working order, your hormone balance will stay stable for as long as possible until you reach menopause (for women) or andropause (for men). When you reached this milestone, I suggest you engage in bioidentical hormone replacement, which I have reviewed here. Hormones are essential to keep you younger for longer.

4. It is useful to monitor your blood sugar with a home glucometer, as this will show you when your blood sugar normalizes. Stay in touch with your doctor at all times, as this will help you in your overall management of your diabetes. Also, you will want to discuss with your doctor that you should have a blood tests called “hemoglobin A1c” measured every three months to see how well your diabetes is controlled. It should be below 7% for sure, but better below 6%. Non-diabetic people have levels of 4% and 5.6%. You may not know that hemoglobin A1c is actually measuring the amount of advanced glycation end products (“AGE”) of red blood cells. These AGE substances essentially are firmly bound sugar/protein compounds that shut down the cell metabolism wherever they are formed. In my opinion it is best to aim at a hemoglobin A1c level of non-diabetic people (4% and 5.6%) to avoid the consequences of tissue damage of all vital organs, which is the reason why long-term diabetics have a life expectancy of 15 to 20 years shorter than non-diabetic persons. Some diabetic patients may benefit from the oral hypoglycemic drug, metformin (brand name: Glucophage), which has anti-inflammatory properties and is used in patients with type 2 diabetes and a high fasting insulin level, but this is a decision requiring your physician’s input.

5. Supplements: There are some supplements that are useful to take as an adjunct, like chromium, which helps insulin to transport glucose into the cell; alpha-lipoic acid, an antioxidant, which is useful to prevent glycation (formation of a complex between sugar and protein, which prevents normal cell functioning); and coenzyme-Q10, which supports your heart (A4M recommends 400 mg per day, higher than Dr. Weil’s link). Other supplements of merit are curcumin, cinnamon, genistein and silymarin (standardized extract of milk thistle), which suppresses a pro inflammatory molecule, which in turn helps to fight insulin resistance (Ref. 1). Omega-3 fatty acid supplements are anti-inflammatory and will improve insulin resistance as well (dosage 1000mg or more per day). According to Ref. 3 vitamin D3 is useful as a supplement for diabetics, because it activates DNA, is involved in cellular repair and deficiency of it is known to lead to higher mortality rates in diabetics. Ref. 3 recommends between 1000 and 4000 IU of vitamin D3 daily and suggests doing blood tests to measure effective vitamin D3 levels (keep 25-OHD in the blood between 30 and 80 ng/mL).

6.Patients whose pancreas no longer produces insulin will need insulin injections, but instead of using long-acting insulin once per day the best results in getting blood sugar control is by injecting insulin three or more times per day using short acting insulin. It is important to always monitor the blood sugar lowering effect by glucometer readings; the injections are best given just before meals (recombinant human insulin is the preferred insulin to be used). Ask your physician or diabetic coach for more details.

Conclusion

Diabetes used to be a dreadful disease that caused premature heart attacks, strokes, blindness, kidney failure, and limb amputations. With aggressive management of diabetes as well as strict lifestyle intervention this has changed. A diabetic who treats the causes of the illness can have a normal life expectancy. In many cases the initial diagnosis of type 2 diabetes can disappear, when treatment was started early enough and insulin resistance could be stopped in its tracks. Without the patient’s full co-operation disciplining him/herself to follow through on all of these recommendations the caregiver will fail in controlling the patient’s diabetes. It is the patient who owns the problem; it is the patient who needs to make every possible effort and follow through on all of the details of dieting, exercising, blood sugar monitoring using a glucometer and taking the required supplements.

More information on diabetes: http://nethealthbook.com/hormones/diabetes/type-2-diabetes/

Reference

1. http://www.lef.org/magazine/mag2013/oct2013_2013-Keystone-Diabetes-Symposium_01.htm

2. William Davis, MD: “Wheat Belly Cookbook. 150 Recipes to Help You Lose the Wheat, Lose the Weight, and Find Your Path Back to Health”. HarperCollins Publishers LTD., Toronto, Canada, 2012.

3. Rakel: Integrative Medicine, 3rd ed. © 2012 Saunders. Integrative Therapy; Supplements.

Last edited Dec. 17, 2014

Jul
06
2013

The Inconvenient Truth About Convenience Foods

When your grandmother grew up there was very little convenience food, maybe ketchup and yes, there was processed cheese and coke. There were also bread and butter.

Now we go through a large grocery store and the center of the whole store is occupied by convenience food, row after row.

What is convenience food? It is pre-cooked or processed food that sits on a shelf waiting to be bought and consumed. You may be able to just eat it the way it is (power bars, fruit yoghurt snacks, ice cream, breakfast cereals etc.) or you just have to microwave it for a minute or two (ready made meals, pizzas). Even, if you make a fresh salad, you top it with a salad dressing that has been processed and may contain chemicals that are not necessarily healthy for you.

This blog is meant to make you think and get educated as a consumer. As a physician I am guided by what is healthy for you, but at the same time food needs to be interesting and taste good and be affordable.

As fat, carbohydrates and protein are the main food groups that we eat, I will deal with each of these categories first followed by vitamins and minerals, which we also need.

Fats and oils

Many convenience foods are full of saturated fatty acids, which contribute to the overall calorie count of the package and are one of the main reasons why we gain weight and deposit fat into our arteries in preparation for a heart attack or stroke down the road. As you may know the worst form of fat is hydrogenated fat, also known as “trans fat”.

It contains free radicals from the hydrogenation process, which damage your cells and interfere with normal body metabolism. Read labels and avoid any foods that have a long shelf life as this is due to hydrogenated fats and chemicals known as food preservatives.

This food group also contains sausages and other processed meat; I wrote a separate blog about this recently.

If you eat cheese, reduce your saturated fat intake by buying cheese with only 18% fat (such as Cantenaar cheese, Jarlsberg light, skim milk mozzarella and goat cheese). Avoid the rich 45% type cheeses. The best oil in your kitchen would be an organic cold pressed olive oil. It figures prominently in Mediterranean cooking.

The Inconvenient Truth About Convenience Foods

The Inconvenient Truth About Convenience Foods

Sugar, starch and other carbohydrates

A large portion of snacks from the mid section of the grocery store contains all forms of sugar: high fructose corn syrup, sugar, honey, agave syrup, maple syrup etc.  You may think that a harmless fruit juice would be healthy until you see from the ingredient list on the label that it contains 5 to 6 teaspoons of sugar per cup (250 ml) of juice.

Unfortunately our body is not equipped to process all the sugar that the food industry wants us to consume and we develop insulin resistance; the liver converts the excess sugars into fat and deposits it into our arteries and as fat deposits between our guts (visceral fat) and as subcutaneous fat in the thighs, around the hips and the waist. It is no secret that a lot of obesity is related to overconsumption of sugar containing convenience foods (snacks and sugar-laden drinks).

Often low calorie alternatives contain aspartame or sucralose (Splenda). Aspartame is an excitotoxin damaging your brain cells and sucralose was developed in the 1950’s as an insecticide. We do not want to replace disease-promoting sugar with toxins as sweeteners. Safe alternatives for sugar are xylitol, mannitol, and stevia.

What is sometimes overlooked is the fact that your body digests bread, starchy foods such as potatoes, and pasta, rice and flour products like pizza or cookies within 30 minutes into sugar that is as harmful to your pancreas as plain sugar or high fructose corn syrup. The body reacts with the same overproduction of insulin converting the excess sugar into fat and depositing it in your body as described above. Much of the obesity wave we see in the past 3 decades is due to baked goods like bagels, bread, pasta and pizza. It is much better to enjoy your stevia-sweetened coffee without any bakery pieces to go along with it.

Protein in meats, dairy products and sausages

You would think that a healthy cut of meat from the grocery store would be a good source of protein for you. You probably did not think that it could be contaminated with a superbug when you bought it. This is especially true for ground meats like hamburger meat. If you bought a portion of organic meat you can be more certain that you are buying a qualitatively superior product. I discussed this whole issue of superbugs in meat and meat products in this blog recently.

We need to be aware of the agroindustry, the feedlots and what they fed the animals. I only buy organic meat and organic dairy products as my source of protein. I avoid sausages altogether because of the food additives that they contain, which are cancer causing.

The problem with prepared meats like chicken nuggets and others is that they contain breading and food preservatives and they have been deep fried, which makes these items an unhealthy choice.

What are some of the problems with dairy products? Despite the allegations that bovine growth hormone would be harmless to your health, your body thinks otherwise. Your body has hormone receptors that are very specific and bovine growth hormone can block them so your own human growth hormone from the pituitary gland cannot function properly. This is why I would recommend only organic milk products. You may have heard that in many European countries bovine growth hormone is banned for that reason.

Next the fat content of dairy products needs to be monitored: go for low-fat milk, cheese and yoghurt. While we are talking about yoghurt, stay away from fruit yoghurts that have all kinds of sugar and food additives mixed in. Add fruit of your choice and stevia, if you need a sweet taste.

Vitamins and minerals

The more foods are processed, the less natural vitamins and minerals stay behind. Particularly vitamin C and the B complex group are affected, but also magnesium, which is an important co-factor to enzymatic reactions within our cells. Often processed foods contain too much salt with sodium displacing potassium from the cells resulting in a lack of energy and high blood pressure.

Your best prevention is to stick to as little processed food as possible and to eat organic. If you eat enough organic greens and vegetables, there is an ample supply of vitamins and minerals. Prepare your own soups as canned products are high in sodium; another unwanted additive is often sodium glutamate (MSG), which comes under many disguised names. It belongs to the group of excitotoxins like aspartame and is not welcomed by your brain cells.

Public Awareness

Lately there has been more of public interest and awareness to the detrimental effects of convenience foods. Alarming reports about the increase in the obesity rates, the rise in diabetes type 2 even in children have been in the media for some time. The publications are not only North American, but also European, as can bee seen in this link.

New legislation is being introduced in many states of the US regarding school snacks and vending machines in schools.

Not all food news is bad. Recently it was reported that fish oil could protect against the effects of junk food. Omega-3-fatty acids contained in fish oil are helping to rebalance the ratio between omega 3 and omega 6-fatty acids in food, which often is disbalanced towards an overabundance of omega-6 fatty aids in processed foods. Rebalancing the omega3/omega6 ratio in food helps to normalize the metabolism of the brain and prevents hardening of arteries.

What you can do to get healthy food

It starts when you buy food. Read labels and look for calories, sugar, fat and sodium content. You may be surprised how many stores carry organic foods now. The price may not be that much more. There is a useful app for your cell phone, Buycott, that you may want to download. This way you can scan items in the store and find out what ingredients are contained in a particular food item and which company produces it.

With meats it is particularly important to buy organic (because of superbugs and also because of the aspect that feed lot animals often receive antibiotics and hormones). Stick to organics also with vegetables and greens (xenoestrogens in non-organic greens that block hormone receptors). Milk products also need to be organic because of the bovine growth hormone facts mentioned above.

When you eat out, things become more difficult unless you find an organic food restaurant. You can always prepare your own salad for lunch with organic greens and a lean protein food, which you keep refrigerated until you are ready to consume it. On weekends a portable picnic in a park can be a great way to relax and socialize, especially in summer.

More information about nutrition: http://nethealthbook.com/health-nutrition-and-fitness/nutrition/

Last edited Nov. 6, 2014

Nov
01
2004

The Mediterranean Diet Definitely Not A Fad

Giacomo Castelvetro has first described healthy eating Mediterranean style in 1614. As an exiled Italian living in England, he tried to convince the English to eat a wider variety of fruit and vegetables and to prepare them in the same way he had eaten them in Italy. His attempt was a failure, however the same book has since been translated into English and published in 1989. In the meantime The Seven Countries Study by Ancel Keys in the 1950’s showed that the population of Crete in Greece had very low rates of heart disease, of certain cancers and a very long life expectancy, despite generous consumption of fat in the form of olive oil.

Despite a wide variation between all the 15 countries bordering the Mediterranean Sea, there are common characteristics: an abundance of vegetables and fruit are consumed, along with nuts and legumes. Cereal products are largely whole grain. Olive oil is the principal fat source, and fish, seafoods and poultry are eaten in moderation. Red meat is consumed rarely. Cheese and yogurt may be eaten, depending on the region.

The first clinical evidence supporting the health benefits of the Mediterranean diet came from the Lyon Heart Study. Patients who had suffered a heart attack were either assigned the diet designed by the American Heart Association or a Mediterranean style diet. After a follow-up of 27 months, the group eating the Mediterranean diet had a reduction of heart attacks by 73 % and a decreased mortality by 70% compared to the other group.

The Mediterranean Diet Definitely Not A Fad

The Mediterranean Diet Definitely Not A Fad

When the various foods of the Mediterranean diet are analyzed, the reasons for the health benefits become very clear. The fats, which are consumed, are heart-healthy monounsaturated fats like olive oil or fats that contain omega-3 fatty acids, which are found in fish (tuna, salmon, trout, sardines) or from plant sources (walnuts and other tree nuts and flax seed).

As there is an emphasis on natural foods, the diet is extremely low in trans fatty acids (hydrogenated fats), which are known to increase the risk for cardiovascular disease. As more than 300g of vegetables per capita are consumed daily, the contents of antioxidants and other beneficial plant chemicals is much higher when compared to Western diets. There are many individual components of the Mediterranean diet that contribute to the reduction of disease and in particular of heart disease. It also is apparent, that it is not one single food or nutrient, but all the interactive effects of all the nutrients that are responsible for the health benefits.

The practical application does not mean deprivation and starvation, but a move away from processed fats (margarine), baked goods (donuts, muffins, pastries), and high saturated fat snacks and trans fats (chips, crackers, cookies, pies). Food choices move towards those of fresh fruits and vegetables, nuts, fish, and olive oil. Portions or servings have to be adequate to maintain a healthy weight.

Mediterranean food is not the heaping plate of pasta with an afterthought of vegetables nor the super-size fast food pizza with pepperoni and cheese, but foods that incorporate the fresh food rather than the fast food. It entails a shift from large portions of red meat to smaller portions of fish, a transition from highly processed foods to ample helpings of dark green vegetables with a dose of olive oil. Low amounts of alcohol, especially red wine can make a meal enjoyable, which means one drink per day for women, and two drinks per day for men. And after dinner go for a walk! What Castelvetro tried to teach us in his writings back in 1614 is still true today.

More info on Mediterranean diet: http://nethealthbook.com/news/mediterranean-diet-benefits-us-workers/

Reference: Patient Care Canada, September 2004, Vol.15, No.9

Last edited October 27, 2014