Pajaro Street Health and Wellness
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Preventing Degenerative Disease
- Identifying Diabetes
- Syndrome X
- Obesity -Treating Diabetes
- Diet and Diabetes
- Diabetes and Supplements
- Low-Glycemic Meals
All physicians agree that we should first give our patients a chance to improve their diabetes by encouraging them to make effective lifestyle changes. But as I've noted, many physicians simply give lip service to such changes while relying heavily on medications to control the disease.
If we are going to make any significant headway in decreasing the number of diabetics, as well as help current diabetics improve control of their disease, two things have to happen. First, we need to pay more attention to insulin resistance, the underlying problem in the overwhelming majority of cases of type 2 diabetes mellitus, and not simply focus on treating blood sugar levels (see box). Second, we need to aggressively encourage lifestyle changes that well improve insulin sensitivity. I strongly believe that in type 2 diabetes mellitus, physicians should rely on medication as a last resort.
Doctors Are Treating the Wrong Thing
In a review article for the Mayo Clinic. Dr. James O'Keefe stated: "Therapeutic efforts in patients with diabetes have focused predominantly on normalizing increased blood sugar levels while often ignoring many of these other modifiable risks, which are caused by the underlying insulin resistance"'
This accounts, in part, for the fact that 80 percent of diabetics still die of cardiovascular disease.: I maintain that treatment of the underlying cause of most diabetes, insulin resistance, is a much better way to confront and control diabetes.
Lifestyle Changes Spelled Out
What many people don't realize is how simple the lifestyle changes are for treating the primary underlying problem in both diabetes mellitus and insulin resistance. We are talking about modest exercise, eating in such a manner as not to spike the blood sugar, and taking some basic nutritional supplements to improve the patient's sensitivity to his or her own insulin. When you combine all three of these changes, as you saw in doe's case, the results are phenomenal.
Let's look at each of these ingredients in a healthy response to insulin resistance.
In my opinion too many doctors make major mistakes in the diet they recommend to their diabetic patients. Since the greatest risk for these patients is cardiovascular disease, the American Diabetic Association has remained prirmarily concerned about the amount of fat in people's diets. Therefore, the diet the ADA and many dieticians support is a high-carbohydrate, low-fat diet.
Diabetics have religiously followed the ADA's recommendations for the past thirty-five years. In the mid-seventies, 80 percent of diabetics were dying from cardiovascular disease. And as we enter the new millennium, 80 percent of diabetics are still dying from cardiovascular disease.4 Shouldn't this warrant some reconsideration of our approach?
Once we understand that we need to treat the underlying resistance to insulin, we recognize that carbohydrates are the main concern. This is contrary to dietitians who believe that "a carbohydrate is a carbohydrate" and that the source does not matter. This thinking completely ignores the glycemic index (the rate at which the body absorbs various carbohydrates and turns them into simple sugar).
Numerous studies demonstrate that some carbohydrates release their sugars more rapidly than others.10 The more complex carbohydrates (ones with a dot of fiber) like beans, cauliflower, brussel sprouts, and apples release their sugars slowly When these low-glycemic carbohydrates are combined with good proteins and good fats in a balanced meal, the blood sugar does not spike. This is critical in controlling diabetes. If the blood sugar doesn't rise significantly after a meal- -a major factor in diabetic control-there is no problem of having to bring it back down with drugs.
Dr. Walter C. Willett, chief of' nutrition and preventive medicine at Harvard Medical School, proposed in his book Eat, Drink, and Be Healthy that we must rethink the food pyramid the USDA recommends. The bottom rung should be low-glycemic carbohydrates, while high-glycemic foods (white bread, white flour, pasta, rice. and potatoes) belong at the top of the food pyramid with all the sweets. 11
Everyone realizes how bad sweets are for diabetics. But few realize that high-glycemic foods raise blood sugar much faster than eating candy does. When I finally convince my diabetic patients to eat low-glycemic carbohydrates combined with food protein and good fat, their diabetic control improves dramatically, and their bodies become more sensitive to their own insulin.
Basic Diet Instruction
The following are good fats. proteins. and carbohydrates. When you combine these in each meal or snack you eat your blood sugar will not jump to dangerous levels that need controlling.
The best protein and fats come from vegetables and vegetable oils Avocados. olive oil. nuts. beans. soy and so on are great sources of protein and contain fats that will actually lower your cholesterol.
The best carbohydrates come from fresh whole fruits and vegetables Avoid all processed foods An apple is bettor than apple juice Whole grains are essential and avoiding processed grains is critical in developing a healthy diet for everyone. especially the diabetic.
The next best protein and fats come from fish. Cold-water fish such as mackerel. tuna, salmon, and sardines contain these fats: omega 3 fatty acids These fats not only lower cholesterol levels but also decrease the overall inflammation in our bodies.
The next best protein comes from fowl because the fat of the bird is on the outside and not marbled into the meat. Even though this is saturated fat by removing the skin from the meat you still can have a very lean protein meal.
Obviously the worst fats and protein come from our red meats and dairy products. If you are going to eat red meat, at least eat the leanest cut you can. You should avoid dairy products except for low fat cottage cheese. milk. and egg whites. If you are going to eat eggs, try to get range fed chicken eggs, which contain omega 3 fatty acids.
Some of the worst fats that you can eat are the trans fatty acids These are called rancid fats because they are so harmful to our bodies. Get used to looking at labels and any time you see ''partially hydrogenated" anything - don't buy it.
These are the basic diet instructions I share with my diabetics and my patients who have developed Syndrome X, like Joe. The focus of this book does not allow me to get into the fine details of the diet I recommend to my patients. For those curious about diets and Syndrome X, I recommend a couple of books: 40-30-30 Fat Burning Nutrition by Gene and Joyce Daoust, and A Week in the Zone by Barry Sears. These straightforward books recommend the 40 30 30 balance: 40% carbohydrates, 30% protein, and 30% fat-this is the balance of these macronutrients recommended during a meal. I tend to use more of a 50 25 25 ratio in my office, but the principles are the same.
This is not a high-protein meal program like the Adkin's diet. This is a healthy diet you can continue the rest of your life. If everyone would eat this way, exercise, and take some basic micronutrients, the diabetic epidemic would be nonexistent.
When you eat this way, instead of stimulating the release of insulin, you stimulate the release of the opposite hormone called glucagons. Glucagon utilizes fat, lowers blood pressure. decreases triglycerides and LDL cholesterol, and raises HDL cholesterol. This is eating for hormonal control rather than calorie control. I tell my patients that they are eating a healthy diet that has the side effect of fat loss.
Modest exercise has tremendous health benefits. And exercise is especially critical for the patient with Syndrome X or diabetes mellitus. Why? Studies show that exercise makes patients significantly more sensitive to their own insulin and is, therefore, a critical part of the lifestyle change needed for diabetics and those who have insulin resistance.
The exercise program should include a balance of aerobic and weight resistance exercise done at least three, and not more than five or six, times per week. It is important that people get involved in an exercise program that they enjoy. No one has to become a marathon runner. Even a thirty- to forty-minute brisk walk three times weekly makes a tremendous difference.
Several clinical trials have found that individuals with preclinical diabetes or impaired glucose tolerance have significantly increased levels of oxidative stress. Often these same people have depleted antioxidant defense systems. Other studies have revealed that oxidative stress was more significant in those with secondary complications of diabetes, such as retinopathy (damage caused by diabetes to the blood vessels in the back of the eye that can lead to blindness) or cardiovascular disease. The researchers conducting these studies concluded that antioxidant supplements should be added to the traditional diabetic treatments as a way to help reduce these complications.12
Several studies have shown that all antioxidants may improve insulin resistance. It is important that a diabetic take a good mixture of several antioxidants in supplementation at optimal-not RDA levels Table 1
. In my research and medical practice, I have learned that several micronutrients are normally deficient in patients with preclinical and full-blown diabetes:
is critical in the metabolism of glucose and the action of insulin, but studies show that 90 percent of the American population has a chromium deficiency. Chromium has been shown to greatly improve insulin sensitivity, especially in those who are deficient in this mineral." Diabetic patients and patients with Syndrome X need 300 mcg of chromium in supplementation.
not only improves antioxidant defenses but also seems to help the body in the problem of insulin resistance. Research reveals that a low Vitamin E level is an independent and strong predictor for the development of adult-onset diabetes. Individuals who have low levels of vitamin E have a fivefold higher risk of developing diabetes than those with a normal amount of vitamin E.
deficit has been associated with both type 1 and type 2 diabetes, as well as an increased risk of retinopathy in diabetic patients. Studies show that when this deficiency is corrected in the elderly, insulin function improves significantly. 14
Unfortunately, diagnosing magnesium deficiency is very difficult. Typically, serum magnesium levels are tested where only a trace amount of the body's total magnesium is located. Cellular levels of magnesium are much more sensitive and accurate; however, these can be tested only in research labs, not in hospitals. This is why magnesium deficiency is so under diagnosed.
We all need at least 400-500 mg of magnesium in supplementation.
is not a well-known mineral, but it is very important for the diabetic. It has been show to significantly increase insulin sensitivity when taken in supplementation. A diabetic needs to take 50-100 mcg of vanadium in supplementation each day.
Several experimental and clinical studies have shown that alpha lipoic
acid has potential therapeutic uses in diabetes, atherosclerosis, cataracts, heavy metal poisoning, neuro-degenerative diseases, and HIV infection.
I have been amazed at what can be achieved with patients who are willing to change their diet, start exercising, and take nutritional supplements with key minerals and antioxidants that improve the body's sensitivity to insulin. Along those lines, here's one case history I love to tell.
Matt, whose longtime dream had been to join the Peace Corps, came to me for the organization's required physical. During the exam, Matt complained that he had been really thirsty and urinating quite often. Since he was only twenty-three, he did not understand why he needed to go to the bathroom several times each night.
I drew a blood sugar blood test for Matt, and it came back at 590, a level so dangerously high I admitted him to the hospital and started immediate infusion of intravenous insulin. When his blood sugar did not respond well to this treatment, I consulted an endocrinologist. This physician also had problems controlling Matt's diabetes and ended up giving him higher doses of insulin than he had ever given a patient before. At one point Matt was taking ninety units of insulin twice a day (a normal dose is approximately ten).
After Matt finally stabilized and left the hospital, I suggested that he make lifestyle changes while still taking insulin. He agreed and began working out, eating food that would not spike his blood sugars, and taking mineral and antioxidant tablets. Matt was dedicated and did well staying with his program. His weight started to fall and gradually he was able to decrease the amounts of prescribed insulin. Month after month he improved.
Four months after his visit for the physical, Matt came into my office and informed me that his blood sugars were normal and that he wasn't taking any insulin. Knowing his history, I really didn't believe him. So I checked his fasting blood sugar. The result was 84. I then challenged him with a sugar load and checked his blood sugar two hours later. It was within normal limits. His hemoglobin A1C was 5.4, which also was normal. Matt was no longer diabetic.
I then had the difficult task of writing a letter to the Peace Corps, explaining that Matt was at one time an insulin-dependent diabetic but now was no longer even diabetic. I feared that the unusual report might disqualify Matt and end his dream of service. But the Peace Corps repeated his blood work and concluded too that he was no longer diabetic.
Matt joined the Peace Corps and spent two years in Africa. The organization actually flew him out of the bush to a hospital every six months for tests to be sure his blood sugars remained normal. He said staying with the balanced diet I had recommended was a challenge, but by eating the unprocessed grains that were available, he did very well.
I had the privilege of seeing Matt again last month in my office. He is now finished with his tour in the Peace Corps and still maintains normal blood sugars. He also informed me that he stayed with the program I initially laid out for him, and he has dropped his weight from 315 pounds down to 205 pounds. He said the weight just came off without his even trying, once his blood sugars returned to normal and he had corrected the insulin resistance.
I believe that many other persons who are borderline or fully diabetic can experience a similar change in their physical health. If you struggle with diabetes, are you willing to invest in necessary lifestyle changes to free yourself from a decreased dependency on medication and live a healthier life? Remember, you want to control your diabetes and at least maintain a hemoglobin A1C of less than 6.s. This is very difficult to do with medication alone. Applying these principles to your own life will significantly improve your diabetic control. You should watch your blood sugars closely when you begin these lifestyle adjustments; if the blood sugars drop too much, you need to consult your doctor so he can adjust your medication.
As I said earlier, diabetes mellitus is increasing at epidemic proportions. In spite of the billions of dollars spent on this disease, we are losing the battle. Physicians and laypeople alike must refocus their attitudes and attack insulin resistance rather than elevated blood sugars. When we see elevated triglyceride levels along with lower HDI. cholesterol levels, hypertension, or unusual weight gain, we need to recognize the possible development of Syndrome X and accelerated cardiovascular damage that may have already begun.
Rather than simply treating the diseases that insulin resistance causes, we need to aggressively treat the insulin resistance itself. Isn't it amazing that such simple lifestyle changes can effect a near-miracle: the disappearance of diabetes?
"What Your Doctor Doesn't Know About Nutritional Medicine May Be Killing You."
Dr. Ray Strand http://www.raystrand.com/bookstore.asp