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Archive for the ‘diabetes’ Category

On Paula Deen and Diabetes

UPDATE (1/17): Paula Deen has announced she has been living with Type 2 diabetes for 3 years. Oh, and she’s endorsing Novo Nordisk.

UPDATE 2 (1/17): Dear members of the media: dietary fat has nothing to do with diabetes. Please stop trying to connect it with butter, lard, and deep-frying.

Rumors have circulated since last Spring, but according to multiple reports, Paula Deen is apparently days away from announcing that she has been diagnosed with Type 2 diabetes (and living with it for a while?).

Allegedly, the decision to publicize her condition is financially motivated, as several sources report that she has signed a multimillion-dollar deal with the makers of a diabetes medication (Novartis, according to reports not Novartis, which has denied bringing Ms. Deen on as a spokesperson).

I know — and in other news, water is wet (take a look at Ms. Deen’s “ultimate fantasy deep fried cheesecake” and Krispy Kreme burger). The ‘big news’ to me isn’t Ms. Deen’s medical condition, but rather that her “coming out party” will essentially be a drug company’s latest press release. It’s a worrisome message.

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Cultured Meat Is An Alternative, Not A Solution

The idea of cultured meat (also known as ‘in vitro’ meat) has been played with for several years, as scientists have attempted to produce meat from cell cultures. Over the past week, this topic created headlines once again thanks to reports that ‘cultured’ sausage and hamburgers are on the way within the next six to twelve months. That is not to say they will be commercially available, but rather that they will serve as tangible proof of this technology’s capabilities.

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You Ask, I Answer: Omega-3s Increase Type 2 Diabetes Risk?

080708193249-largeWhat are your thoughts on the reported link between omega-3 intake and type 2 diabetes recently published in an article featured in the American Journal of Clinical Nutrition?

– xo2hearts
(via Twitter)

The AJCN is a well-respected, top-of-the-line journal, so it is no surprise that many of its studies resonate all over the Internet.

This one, titled “Dietary omega-3 fatty acids and fish consumption and risk of type 2 diabetes” is particularly controversial, since its main conclusion is that there appears to be “an increased risk of type-2 diabetes with the intake of long-chain omega-3 fatty acids, especially with higher intakes (more than 0.20 g omega-3, or more than 2 servings of fish a day.)”

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You Ask, I Answer: How Much Coffee?

cappuccinoYou recently tweeted that 16 to 24 ounces of coffee a day are linked to a lot of health benefits.

Does that figure refer to drip coffee?

If so, how many espresso shots is that amount of black coffee equal to?

Also, is going above the 24 oz figure bad?

– Travis (last name withheld)
La Jolla, CA

The vast amount of research on coffee concludes that 200 to 300 milligrams of caffeine a day provide plenty of health benefits for adults — from lowered diabetes, Alzheimer’s, and Parkinson’s disease risk to cardiovascular protection.

If you’re more of a latte drinker, consider that your average espresso shot contains 100 milligrams of caffeine.

This means, then, that a single Starbucks venti latte fully provides health-promoting levels.

Does surpassing the 300 milligram mark pose health risks?  No.  In fact, large-scale studies (some almost two decades long) saw even higher percentages of decreased disease risk in subjects who drank 500 – 600 milligrams of coffee each day.

However, many individuals find that much coffee difficult to tolerate (they may develop gastrointestinal symptoms, heightened anxiety, or sleep disturbances).  This is also a good time to point out that pregnant women are strongly encouraged to keep their daily caffeine intake below the 200 milligram mark.

If you find that you are able to tolerate that much caffeine on a daily basis, though, there is no reason to worry or cut back.

Keep in mind that a lot of these benefits assume you are having unsweetened — or very lightly sweetened — coffee.  If your lattes are a vehicle for 3 tablespoons of added sugar, you aren’t doing yourself many favors.  This is precisely why coffee is much preferred to energy drinks high in caffeine.  Some of those drinks provide as much sugar as a can of soda.

Similarly, coffee-based desserts (i.e.: Frappuccinos) are certainly not the desired way to consume caffeine.

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You Ask, I Answer: Food Exchange Lists

3607-1I know that 1/8th of an avocado is considered one serving of fat but considering it’s also a vegetable, does it have a vegetable exchange as well?

If I were to add a serving of avocado to my sandwich, is that a serving of vegetables in addition to a serving of fat?

I’m confused about exchange lists.

– Cate (last name unknown)
(Location Unknown)

Here’s some good news — unless you have diabetes (or provide nutrition counseling to diabetes patients), you don’t need to be familiar with exchange lists.

Exchange lists group foods by nutritional composition rather than by the nutrients they offer (which is how the food pyramid classifies foods).  They were especially formulated to ease meal planning for people living with diabetes, who have to carefully monitor — and distribute — their intake of carbohydrates, fat, and protein.

Exchange lists classify foods as:

  • Starches
  • Fruits
  • Vegetables
  • Very lean/lean/medium fat proteins
  • Non-fat/low-fat dairy
  • Fats

Nutrition students often times get tripped up when they first learn about the food pyramid and exchange lists, since they can be easy to confuse.

In the food pyramid, for instance, an avocado counts as a fruit serving (it is not a vegetable).  In the exchange lists, avocado is considered a “fat”.

Similarly, while a slice of Swiss cheese falls under the “dairy” category in the food pyramid, the exchange lists classify it as a “medium-fat protein”.

Why?  Cheese, ounce by ounce, has a similar protein and carbohydrate content to meat.

In the exchange list, a “very lean” protein is one that, per serving, offers 35 calories and no more than 1 gram of fat.  Lentils, egg whites, and turkey breast all fall into this category.

When figuring out what category the foods you eat fall into, go by food groups, not exchange lists.

In your case, half a cup of avocado is considered a fruit serving.  Avocados are not considered part of the food pyramid’s “added oils and sugars” tip since an avocado contains a whole lot more than fat — it is also a wonderful source of vitamins, minerals, and phytonutrients.

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You Ask, I Anwer: Excess Protein & Kidney Damage

minimallyinvasivediagramDoes excessive protein consumption damage the kidneys?

– Corey Clark
(Location unknown)

Yes and no.  Let me explain.

Individuals with healthy kidney function can safely consume up to 250 percent of their protein needs.

To figure out your protein needs, convert your weight to kilograms (divide your weight in pounds by 2.2) and then multiply that by 0.8.

The value you get from that equation is the amount of protein (in grams) your body needs on a daily basis.

If you multiply that by 2.5, you can determine how many grams of protein you can safely consume each day with no adverse effects on kidney function.

What makes the “protein is bad for the kidneys” issue confusing is that, at any given time, approximately ten to fifteen percent of U.S. adults are unknowingly living with beginning stages of reduced kidney function (the early stages of this condition do not manifest symptoms).

Individuals with compromised kidney function can make the situation significantly worse if they do not curb their intake of protein.

One of the best things you can do for kidney health is stay properly hydrated throughout the day.  Your urine should be colorless or, at most, a very pale yellow.  Darker shades are an indication you need to increase fluid intake (unless, of course, you are on any medications that may alter urine color).

Keep in mind, too, that hypertension and diabetes greatly increase the risk of developing reduced kidney function.

The best way to decrease your risk of developing hypertension and (type-2) diabetes?  Maintain a healthy weight and stay physically active.

It can’t be stressed enough — once those two pieces fall, the domino effect on your health can get very, very ugly.

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In The News: Explain Something To Me, Bro…

CChearingNJ_303Lost amidst the sea of shocking celebrity obituaries last week week was Nick Jonas’ diabetes-related visit to the White House.

In case you just awoke from a two-year slumber,  Nick Jonas is the youngest member of the Jonas Brothers, a tween-friendly Disney band composed of — you guessed it — three brothers.

The most-repeated trivia facts about Nick are:

  1. He is the youngest brother
  2. He is involved in a Melrose Place-worthy on-again off-again relationship with Miley Cyrus
  3. He has Type 1 diabetes

In the wake of his White House visit (where he attended a meeting hosted by the Juvenile Diabetes Research Foundation’s Children’s Congress), the “JoBro” PR machine celebrity press has applauded Nick for his commitment to diabetes.

While Nick’s visit to the White House is positive in terms of visibility for type-1 diabetes, I just can’t ignore that his group’s 2009 tour is co-sponsored by Burger King.

Heart disease is a significant concern for anyone living with Type-1 (or Type-2) diabetes.  Two key nutrients that must be watched in a heart-healthy diet — saturated fat and sodium — are found by the bucketload in most Burger King food.

And while obesity may not be a factor for the development of Type-1 diabetes (as it is with Type-2), obesity among Type-1 diabetics has been found to increase their risk of kidney disease.

Research has shown that frequent consumption of fast food — at least twice a week — is directly related to an increased risk of obesity.

The Coronary Artery Risk Development In Young Adults (CARDIA) study concluded that, among white children, eating fast food more than twice a week was with an 86 percent increased risk of becoming obese (compared to their peers who consume fast food less than once a week).

Attending Senate hearings and advocating for more funding for diabetes research is important and makes for a great photo op, but the most powerful statement the Jonas Brothers’ PR team can make is to refuse advertisement and sponsorship-related associations with companies that sell junk food.

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In The News: "Second Hand" Obesity

Today’s New York Times reports on a new pooled analysis study published in the Journal of the American Medical Association which concluded that “obese women are more likely to have babies with rare but serious birth defects, including spina bifida and other neural tube defects.”

Although spina bifida is generally associated with insufficient maternal intake of folic acid, lead study author Dr. Judith Rankin theorizes that in the case of obese women, “insulin resistance and undiagnosed diabetes may be playing a causative role in birth defects… though the precise mechanism is not known.”

This new study gives further credence to weight-loss recommendations given to obese women planning to start a family.

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In The News: An Odd Solution

The San Francisco Chronicle reports that skyrocketing obesity and diabetes rates in India are leaving citizens looking for healthier alternatives to mithai — “sweet, fudgy goodies rich with cardamom, pistachio and saffron… eagerly eaten, given as gifts, [or] offered to the gods]” during annual Diwali celebrations.

Partially due to an improved economy, many Hindus are opting to replace the sugary treats with clothes, electronics, and jewelry.

Two interesting points stand out here.

Number one: sales of sugar-free mithai are improving.

Number two: the government has taken action by releasing “millions of tons of sugar into the markets… in a bid to drive down prices.”

As you may imagine, both of these developments leave me shaking my head.

First of all, sugar-free varieties of candies are not necessarily lower in calories.

The overwhelming majority of sugar-free candies contain higher amounts of fat than their standard counterparts, often times resulting in mere 10 or 20 calorie differences.

Remember, whereas sugar adds 4 calories per gram, fat contribues 9 calories per gram.

Of course, the average consumer is not aware of this, and often finds themselves thinking they can eat more simply because sugar is absent. Not quite.

And lastly, why on Earth is the government’s solution providing more sugar at lower prices?

If a large percentage of the country is concerned about obesity and diabetes, cheapening sugary food is not the optimal solution!

Why not look into long-term policy that can begin to address some of the population’s needs (for instance, calorie labeling)?

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In The News: Is Fat Acceptance Acceptable?

Yesterday’s New York Times Magazine ran a short piece on the “growing” fat-acceptance movement (although it’s been around for approximately three decades and has yet to catch on, but I digress.)

“Fat-acceptance activists insist you can’t assume someone is unhealthy just because he’s fat, any more than you can assume someone is healthy just because he’s slim. “

In fact, this movement firmly believes that “it is possible to be healthy no matter how fat you are.”

No matter how fat? Really?

So how do they explain, then, the countless research studies that have observed reductions in LDL (“bad”) cholesterol, type 2 diabetes risk, and blood pressure in overweight and obese individuals who lose weight, even just five pounds?

Well, they point to a report published in The Archives of Internal Medicine this past August, which “reported that fully half of overweight adults and one-third of the obese had normal blood pressure, cholesterol, triglycerides and blood sugar — indicating a normal risk for heart disease and diabetes, conditions supposedly caused by being fat.”

Too bad that study didn’t examine levels of C-reactive protein, a marker of inflammation.

Remember, most diseases — especially cardiovascular ones — have cellular inflammation as a precursor.

And guess one of the factors that increases C-reactive protein levels? Overweight and obesity!

Additionally, one of those study’s co-authors was quoted as saying that “among people of healthy weight in the study, elevated blood pressure, cholesterol and other factors were more common for people with larger waists or potbellies” and that “among overweight and obese adults, those in the “healthy” category tended to have smaller waists than those with at least two risk factors.

Need I say more?

The problem with this entire “movement” is that it attempts to kill two very different birds (social acceptance of overweight/obese physiques and the health consequences of being overweight/obese) with one stone.

It is one thing to denounce the media’s obsession on borderline unhealthy bodies, but how anyone can believe weight has nothing to do with health status is beyond me.

All you have to do is speak to formerly obese people.

Ask them how they feel walking up a flight of stairs now as opposed to when they were carrying an additional 60 or 70 pounds on them.

Ask them how their lipid profiles have changed.

Ask them, very simply, if they miss carrying that excess weight.

Similarly, people who are extremely underweight (purposefully or not) are also at increased risk of mortality.

I point that out to show that nutrition and weight management are not inherently “anti fat,” it’s just that with the obesity rate doubling in the past 30 years in this country, it is not surprising that most public health nutrition efforts are concentrated on that particular problem.

Back to the Times article, I can’t help but roll my eyes at the mention of “a new book out this fall, Health at Every Size, by Linda Bacon, a nutritionist and physiologist at the University of California at Davis, which is less about dieting than a lifestyle change that emphasizes “intuitive eating”: listening to hunger signals, eating when you’re hungry, choosing nutritious food over junk.”

What exactly is so revolutionary? The guidelines mentioned above are precisely the same ones advocated for permanent weight loss and increased health awareness by many Registered Dietitians.

In fact, if any of you have ever been to a Registered Dietitian, you know the focus is on establishing healthy dietary patterns. It’s not about six packs, fitting into size 0 clothes, or looking like the cast of the new Beverly Hills 90210.

To place the nutrition field on the same level as a celebrity diets segment on The Insider is preposterous and extremely reductive.

I don’t see the damage in advocating for a healthy medium, where the end goal is to not be underweight or overweight.

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You Ask, I Answer: Hydrogenated/Interesterified Fats

Thanks for explaining all about trans fats.

I have a question, though.

I have recently seen hydrogenated oils on Crisco food labels (not “partially hydrogenated”, but “hydrogenated”.)

Are these also trans fats?

– Patrick Altug
Boulder, CO

No, they are not.

Whereas the partial hydrogenation of a liquid oil transforms its chemical structure in such a way that yields a solid, yet pliable texture (i.e.: easy to spread on toast,) full hydrogenation results in a solid mass that you can’t do much with.

So, in an attempt to remove trans fat from their formulations, many products will interesterify fats.

In this process, solid oils and liquid oils are combined in vats, hydrogenated, broken down to their most basic form (triglycerides) and later manipulated/reconstructed in order to achieve a desired consistency.

Unfortunately, these fats come at a price.

Recent research studies in the United Kingdom and Malaysia have found that interesterified fats decrease HDL (“good” cholesterol), raise blood sugar, and, perhaps more worrying, suppress the secretion of insulin.

Why the worry?

Raising blood sugar while lowering levels of insulin (the hormone that moves glucose out of the bloodstream and into cells) is certainly a rather powerful risk factor for the development of Type 2 diabetes.

Although many people roll their eyes at this bit of news and often make statements like, “Are these dietitians EVER satisfied with anything? If it’s not trans fats, it’s something else,” there is an important lesson in all of this — stick with unadulterated fats!

Whether partially or fully hydrogenated, those fat molecules have been chemically altered.

A diet rich in minimally processed foods (whole grains, vegetables, fruits, lean protein, and heart-healthy fats) won’t include either type of hydrogenated oils.

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You Ask, I Answer: Low Blood Sugar (Hypoglycemia)

What happens when your blood sugar is usually low?

– Anonymous
Via the blog

This is known as hypoglycemia, which many people with diabetes can experience if their blood glucose levels are not appropriately managed.

Whereas a fasting (remember, that’s at least 8 hours of no food or drink, other than water) glucose of 125 mg/dL points to diabetes, anything below 50 mg/dL is a sign of hypoglycemia.

Symptoms can include dizziness, paleness of the skin, general confusion, and shakiness.

If the symptoms are detected early enough into a hypoglycemic episode, the situation can usually be remedied by consuming a predetermined amount of carbohydrate.

If, however, one of these episodes goes untreated, fainting will occur.

In this case, the only viable step is to inject glucagon (an enzyme that, like insulin, is also secreted by the pancreas but, unlike insulin, RAISES blood glucose levels.)

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You Ask, I Answer: Blood Sugar Levels

One of my family members is a Registered Nurse.

She was over at the house today and took my blood sugar — my number came out to 128.

Is this high?

– Greg (last name withheld)
Los Angeles, CA

It depends.

Upon asking Greg for clarification, he mentioned that approximately half an hour prior to this “exam” he had eaten a Fruit Roll Up.

Bingo!

When determining blood sugar levels, it is important to make a distinction if this is a fasting or post-prandial (“after a meal”) value.

If someone’s fasting (for testing purposes, this is considered at least 8 hours of no food or drink other than water) blood glucose is 128, there is certainly cause for concern.

However, if that is the value 30 minutes after essentially eating pure sugar, it isn’t worth worrying about.

If anything, the fact that your blood sugar was 128 so soon after eating that Fruit Roll Up is a good sign. If you had diabetes, that figure would probably be above 200!

For future reference:

Your fasting blood glucose should be lower than 100. Values between 100 and 125 tend to indicate “pre diabetes.”

If your blood glucose is taken randomly, you are in good shape if you are below 140. Anything above 200 is problematic, and values between 140 and 200 in this case also point to “pre diabetes.”

Since pre-diabetes poses negative health consequences to cardiac health — and is clearly a precursor for Type 2 diabetes — many doctors now start aggressively treating it.

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You Ask, I Answer: Michael Phelps

I was a little surprised when I visited your site tonight and couldn’t find anything on Michael Phelps, or more specifically his much talked about 8,000-10,000 calorie a day diet.

Yes, he is an athlete who trains 5 hours a day and probably burns calories just getting dressed in the morning (due to his muscle mass).

But this “olympic phenomenon” could choose better/healthier choices than his daily consumption of 2 fried egg sandwiches, 2 pizzas, 2 ham sandwiches on white bread (the list goes on).

Yes, he is a mean lean calorie burning machine, but can’t these poor diet choices still lead to potential health risks such as high cholesterol.

Or what about his sugar levels with all those large portions in one meal?

And doesn’t his eating habits give substance to the public notion out there that you can eat whatever you want as long as you’re exercising?

Just curious what your thoughts on the subject are.

– Becky (last name unknown)
Via the blog

You raise some very good points, Becky.

By the way, for those of you not familiar with Phelps’ “diet,” The New York Post breaks it down:

“[Breakfast is] three fried-egg sandwiches loaded with cheese, lettuce, tomatoes, fried onions and mayonnaise.

He follows that up with two cups of coffee, a five-egg omelet, a bowl of grits, three slices of French toast topped with powdered sugar and three chocolate-chip pancakes.

At lunch, Phelps gobbles up a pound of enriched pasta and two large ham and cheese sandwiches slathered with mayo on white bread – capping off the meal by chugging about 1,000 calories worth of energy drinks.

For dinner, Phelps really loads up on the carbs – what he needs to give him plenty of energy for his five-hours-a-day, six-days-a-week regimen – with a pound of pasta and an entire pizza.”

Let’s keep a few things in mind.

We are not just talking about “an athlete.” Mr. Phelps is an Olympic athlete, which means heavy-duty, constant, hardcore training.

This is not someone swimming for 45 minutes three days a week at the local YMCA.

Mr. Phelps trains by swimming approximately five HOURS a day. Then there’s the additional weight lifting he needs to do to keep his muscles in top shape!

Add to that youth (he is, after all, 23 years old,) a super fast metabolism that is the product of genetics, and plenty of muscle mass (and very little body fat,) and you have a body that needs pretty extraordinary amounts of fuel (food) to operate the way it does.

I suspect that part of the reason why Mr. Phelps’ diet is low in fiber is to prevent him from getting full too quickly and not eating as many calories as he should.

I also suspect there are appetite stimulants involved here.

What also makes Mr. Phelps a special case is that although his diet isn’t necessarily “heart healthy,” his lifestyle certainly is.

Remember, physical activity — which Mr. Phelps is getting PLENTY of — increases HDL cholesterol, lowers LDL cholesterol, and reduces the risk of developing diabetes, heart disease, and high blood pressure.

I certainly hope no one is taking away that you can eat as much as you want as long as you’re exercising. Mr. Phelps is not “exercising,” he is devoting every second of his life to an athletic career.

He is the very definition of a “special case.”

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Watch Your Mouth

Brushing, flossing, and visiting your dentist every six months can do remove tartar, whiten teeth, freshen breath – and help your heart!

Confused? Allow me to clarify.

Gum disease (known in dentistry circles as “periodontal disease”) is responsible for much more than tooth loss.

Researchers theorize that the different bacteria in your gums – the same ones that, if not treated, inflame them and make them bleed when you brush – can enter the bloodstream and cause plaque buildup — and inflammation — in your arteries.

Remember, a buildup of plaque in coronary arteries blocks bloodflow to the heart. Bad news indeed.

While brushing and flossing are the best way to keep gums healthy, nutrition also plays an important role.

Recent studies strongly support the notion that vitamin C and zinc deficiencies make gum tissue more penetrable to bacteria and, consequently, more vulnerable to infection.

Calcium is another central character in this oral drama.

Since it is needed for bone structure – including the bone that supports teeth – it is believed that insufficient intakes make dental bone more vulnerable to infection by bacteria, thereby increasing the risk of developing gum disease.

Another risk factor? Diabetes!

Tuns out bacteria absolutely thrive in saliva high in blood glucose levels. And by “thrive” I mean “wreak havoc on gum tissue.”

And so we go back to the idea that, in the field of health, everything is related.

Consider the following summary: excess calories can lead to weight gain, increasing your risk of developing Type 2 diabetes, thereby increasing periodontal disease risk, which can negatively affect cardiovascular health.

It’s kind of like a less fun “six degrees of separation” game.

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