Wisdom Wednesday: Gycohemoglobin A1c

This blood test measures the percentage of RBCs (red blood cells) saturated with glucose. RBCs live about 120 days. During that span they can slowly be glycosylated by high levels of serum glucose. Assuming the average age of an RBC to be 60 days, this test reveals what your glucose levels have averaged over the course of the past two months. By comparison, the fasting glucose only measures the glucose level after eight or more hours for fasting, with no stress on glucose metabolism.

For the past several years the A1c has been used to monitor diabetics to see how effective they are managing their disease. However, in July of 2015, the A1c was established as the medical standard for diagnosing diabetes. This big step forward that has met with either resistance or indifference from the medical community as less than half of primary care physicians currently order this test for their patients.

The new standard recommends physicians begin to test patients who are obese between the ages of 40 and 45. I have been using this test on my patient population for several years. I do not restrict the test by age or weight status. Clinically, I have found that this test often begins to elevate in patients by their late 20’s, even when they are at ideal weight.

The normal range for the A1c is 4.8 to 5.6%. However, the diagnosis of diabetes is restricted to levels at or above 6.5%. A “well controlled diabetic” will have an A1c of 7% or less. Levels between 5.6 and 6.5% are considered “pre-diabetic”. Currently, over 50% of all Americans are estimated to be either diabetic or pre-diabetic and that percentage is still increasing.

In my office, anyone exhibiting symptoms of metabolic syndrome – central obesity, hypertension, high serum lipids, hypothyroidism, or insulin resistance – is a candidate for A1c testing, regardless of age. Additionally, using the QA (Quintessential Applications) protocol, if a patient tests for sesame seed oil to block prostaglandin inflammation (PG2) I also recommend an A1c. Clinically, over 90% of patients demonstrating a need for sesame seed oil have an elevated A1c. The remaining 10% typically have altered serum lipids or hypothyroidism.

One-Third of Americans Have Dangerous Mix of Heart Risk Factors

More than one-third of U.S. adults have a combination of health problems collectively known as metabolic syndrome that increase the risk of heat disease and diabetes, according to new research.

What’s worse, the researchers found the rate of metabolic syndrome increases dramatically with age. Almost half of people 60 or older in the United States have metabolic syndrome, the study found.

“That’s concerning, because we know the population of the U.S. is aging,” said senior author Dr. Robert Wong, an assistant clinical professor at University of California, San Francisco. “I think it will potentially place a huge burden on our health care system.”

Metabolic syndrome is a “perfect storm” of conditions that include high blood pressure, abnormal cholesterol levels, increased levels of blood sugar, and a wider waist circumference, Wong said.

Medical experts are turning to metabolic syndrome as a key indicator of heart health risk. “Metabolic syndrome is a more comprehensive analysis, because it takes into account a lot of risk factors,” Wong said.

To assess the nation’s rate of metabolic syndrome, Wong and his colleagues used health data on Americans gathered by the U.S. Centers for Disease Control and Prevention between 2003 and 2013.

The researchers concluded that 35% of all U.S. adults had metabolic syndrome in 2011-2012. That number is up slightly from 33% in 2003-2004, the researchers said.

Nearly 3 in 10 Americans with Diabetes Don’t Know It

Almost 8 million Americans have diabetes but don’t know it, a new study shows.

That’s despite the fact that about two-thirds of those with undiagnosed diabetes have seen a doctor two or more times in the past year, according to the researchers.

The study also found that among those who were diagnosed with diabetes, only about one –quarter met three important goals for people with diabetes: managing blood sugar, blood pressure and cholesterol levels.


“Out of 28.4 million people with diabetes, more than a quarter don’t know [it],” said study author Dr. Mohammed Ali, an assistant professor of public health at Emory University School of Medicine in Atlanta.

“About 80% of those people are linked to a health care provider, and two-thirds are seeing them twice a year or more. So, through whatever means, they aren’t being identified with diabetes,” Ali explained.

Symptoms of type 2 diabetes, which may be subtle and come on slowly, include fatigue, blurred vision, slow-healing cuts and scrapes, and the need to urinate more often, according to Dr. Robert Ratner, chief scientific and medical officer for the ADA.

Despite greater awareness in recent years, diabetes remains a major cause of death and disability in the United States. It’s a leading cause of adult-onset blindness, kidney failure and limb amputations, according to the researchers.

MY TAKE:
This is a prime example of a failing heath care system – over 5 million undiagnosed diabetics are seen by a physician a least twice a year, but not properly diagnosed.

As a clinician, you are responsible for the total health of your patient, regardless of their chief complaint on entry. If a patient seeks my help for acute low back pain and they also happen to be an undiagnosed diabetic, I am responsible to diagnose, properly treat, and/or refer that patient for their diabetes.

Diabetes is an easy diagnosis. Occult cancers like breast, lung, and prostate are much more challenging. This is why a good history is so important. I recently had a new patient who was being treated for anemia with iron supplementation by her MD. She had a microcytic anemia, so iron probably would be effective. However, her history included breast cancer. As a clinician, you must assume this patient has metastatic carcinoma until you prove otherwise. You can not just treat the anemia and ignore the potentially fatal diagnosis. My new patient was referred to her oncologist for further evaluation and treatment.

Every patient in my office is evaluated for signs of metabolic syndrome, the precursor to diabetes and heart disease. The signs are central obesity (weight gain around the belly), high blood pressure, high serum lipids, low thyroid function, and insulin resistance. I see these signs all day long. Look around you or maybe look at yourself and you will see them too.

THE BOTTOM LINE:
The fasting glucose only shows how well your body handles sugar without the stress of food for the past 8 hours. You are diabetic long before the fasting glucose is elevated on your lab test.

I recommend all my patients have laboratory testing each year as a preventative tool. Included in that panel of tests is a glycohemoglobin A1c. This test measures the percent of RBCs (red blood cells) that are saturated with glucose. That number should be below 5.7%. Please ask your physician to run an A1c. Don’t wait for your MD to diagnose you as a diabetic.

Source: National Institutes of Health -Tuesday, November 18, 2014

Diabetes Rise in the US is 'Alarming,' Says CDC

A new report from the US Centers for Disease Control and Prevention shows that the number of Americans with diabetes continues to rise, with over 12 percent of the adult population estimated to have the disease, and more than a third of those age 20 and over in the US now thought to have prediabetes.

In 2010, there were 26 million people in the US with diabetes – the new CDC report shows that this has gone up to 29.1 million. Moreover, 25% of people – 1 in 4 – do not realize they have the disease, which increases the risk of serious complications including heart disease, stroke, blindness, kidney failure, amputation of toes, feet or legs, and early death. (Junk Food Aricimboldo by Andy Council)

The CDC figures show that in 2012 alone, 1.7 million Americans age 20 and over were newly diagnosed with diabetes and 208,000 people under the age of 20 have either type 1 or type 2 diabetes.

The report says 86 million adult American have prediabetes, where blood sugar is higher than normal but not high enough to be classified as type 2 diabetes.

“Diabetes is costly in both human and economic terms,” says Dr. Ann Allbright, director of the federal agency’s Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion. She describes the new figures as “alarming”. The estimated total cost in medical bills and lost work and wages due to diabetes and related complications is $245 billion dollars for 2013, up from $174 billion in 2010.

If these numbers continue to rise, then 1 in 5 Americans will have diabetes by 2025, and 1 in 3 by 2050, she warns, adding that: “We simply can’t sustain this trajectory – the implications are far too great – for our families, our healthcare system, our workforce, our nation.”

She says we already know that the most effective way to prevent type 2 diabetes is to adopt a healthier lifestyle, and it also improves health in those already with the disease.

“The sooner people find out they have prediabetes and take action, the better their chances of preventing type 2 diabetes,” she adds, and suggests that CDC’s National Diabetes Prevention Program is a good example of how to help people change their lifestyle for the benefit of their health.

MY TAKE:
I have written about this issue frequently and will continue to harp on this message. I believe these figures are too conservative. I think we are already at 1 in 5 and will reach 1 in 2 by 2050.

We just eat too much. The only diet that has been proven to extend life is one that reduces caloric intake. We also eat the wrong stuff. The refined carbohydrates have to go. I don’t care whether you adopt the Paleo Diet, the Mediterranean Diet, the Paleo-Mediterranean Diet, or just cut out the junk.

The formula is really quite simple – eat 3 servings of protein, 5 vegetables and 2 fruits every day. If you eat a big salad, that’s 2 vegetable servings. So a salad at lunch, another at dinner, then just one more vegetable serving with dinner and you’ve met your goal for vegetables. Have a serving of protein for breakfast, lunch, and dinner. Eat a banana, an apple, or some other fruit as a snack in the mid-morning and mid-afternoon. Now you’ve met your macronutrient needs for the day and maintained a nice level blood glucose, avoiding any serious demands on the pancreas. (Photo by tmcpics)

THE BOTTOM LINE:
These is a preventable and even reversible disease. Begin today. Ask your doctor to order a glycohemoglobin A1c to measure your average blood glucose level for the past two months. The normal range is below 5.7%. If you are 5.7% or higher, you are in trouble. If you are above 6.0%, you are a diabetic.

Source - Medical News Today -Thursday, June 12, 2014

High Statin Doses Increase Risk of Diabetes

In a study covering more than 100,000 patient records in three nations, researchers with the Canadian Network for Observational Drug Effect Studies (CNODES) found that patients taking higher strength statins face an increased risk of developing diabetes.
Wednesday, June 4, 2014 (Health Data management)

The study published in the British Medical Journal, found a 15 percent relative increase in the risk of diabetes within two years of starting treatment with high potency statins, as compared with low potency statins. Patients included in the study had started statin therapy after experiencing a major cardiovascular event such as a heart attack or stroke. About two-thirds of these patients were prescribed a high-potency statin.

Statins considered to be high potency were rosuvastatin (e.g. Crestor) at doses of 10mg or higher; atorvastatin (e.g. Lipitor) as doses of 20mg or higher; and simvastatin (e.g. Zocor) at doses of 40mg or more. All other statins were considered lower potency.

To conduct the study, CNODES researchers from across Canada examined the health records of 136,966 patients who were 40 years of age or older in Canada, the United States, and the United Kingdom. As its mandate, CNODES has the ability to analyze a large amount of anonymous patient data to assess questions of drug safety more reliably that would otherwise be possible in smaller studies.

MY TAKE:
I keep saying it, but few are listening, statin drugs are dangerous. Statins do reduce the risk of CVA (cardiovascular accident) slightly. But they do so because they reduce vascular inflammation, not because they reduce cholesterol levels.

More than half the people who suffer their first heart attack have normal or even low cholesterol. The medical response to that statistic is “see everyone should be taken statin drugs”. Putting statins in our drinking water has been a topic of discussion at cardiac conferences across the country.

Statin drugs disrupt the chemistry of cholesterol metabolism. It also limits the production of CoQ10, another fat produced in the liver. CoQ10 is necessary to run the Krebs’ Citric Acid Cycle (CAC) that produces energy for every cell in the body. (Please refer to my blog on CAC posted on Wednesday, May 7, 2014.) CAC takes glucose (blood sugar) and coverts it to energy. Without adequate CoQ10, the CAC just doesn’t work.

I believe that all statin drug therapy impairs glucose metabolism. This extensive records review suggests that high doses of statin drugs impair glucose metabolism to the extent that Type II Diabetes more frequently develops.
In all fairness, Metabolic Syndrome is a precursor to both cardiovascular disease and diabetes. This is a vulnerable population that is likely to become diabetic anyway. The statins are just pushing them over the edge before their time.

Several recent research articles have been published questioning the emphasis on cholesterol lowering therapies. A few brave scientists in the field of cardiology have even come forward to question the validity of the original research in support of statin drug therapy. However, they have been quickly criticized and silenced by their peers.

Statin drug therapy is big pharmaceutical business. It is by far the most commonly prescribed drug in the world today. Until there is a financial penalty associated with statins, rather than a financial incentive, use of these drugs will continue to increase regardless of any research articles.

THE BOTTOM LINE:
If you are concerned about cardiac risk factors, have your glycohemoglobin A1c, CRP (high sensitivity C-reactive protein), homocysteine, and L(p)a checked in addition to the serum lipids. Those tests are much more indicative of your risks than the serum lipids.

If you choose to take statin drugs, at least supplement with CoQ10 to reduce some of the risk factors associated with this class of drugs.

Wisdom Wednesday: The Pancreas

The pancreas is the last organ in the endocrine system that we evaluate. We began with the endocrine system as a whole – adrenal, pineal/pituitary, thyroid, and reproduction. Then we looked at hidden adrenal issues. Last week we reviewed liver function; now finally, the pancreas.

The head of the pancreas secretes digestive enzymes. Digestion will be discussed next week. The tail of the pancreas secretes insulin and other hormones. Insulin binds to glucose in the blood stream and facilitates entry to most cells of the body.

Over the course of our lives, most of us become insulin resistant. Excess refined carbohydrates and just eating too much in general tax the system. Insulin receptors in the cells of the body become less responsive to insulin so the pancreas must produce ever increasing quantities of insulin to force sugar into the cells. This is early stage Type II Diabetes.

Eventually, the pancreas just wears out, insulin production falls and the body becomes dependent on insulin injections to maintain some semblance of glucose control.

There are four tissues that do not require insulin to absorb glucose – the small capillaries, the kidneys, the nervous system and the eyes. These tissues are saturated with excess glucose for years prior to the diagnosis of diabetes. The result is progressive degeneration of these tissues resulting in neuropathy, blindness, amputation of the lower extremities, kidney failure, and ultimately death.

It is estimated that by the year 2050, 50% of the US population will be diabetic. Diabetes is an epidemic that is preventable and often reversible just by making good choices in diet and exercise.

When evaluating the pancreas, we correlate function with the remainder of the endocrine system. Sometimes pancreas dysfunction is secondary to an adrenal issue or a thyroid problem. However, most commonly, the problem begins with general inflammation.

When the body is inflamed, from just about any cause, it produces arachidonic acid. This most frequently results in the production of prostaglandins (PG2), primarily from the liver. (Please review my first Wednesday Wisdom blog on QA evaluation, “Inflammation – part 1”, posted on March 19, 2014) Adequate intake of omega 3 and omega 6 fatty acids should produce PG3 and PG1 respectively, which counterbalance the inflammation from PG2. However, early on in insulin resistance, the conversion of healthy omega 6 fatty acids from the diet is shunted into the arachidonic acid pathway creating more inflammation rather than less.

Supplementation with sesame seed oil prevents this shunting and restores the omega 6 to PG1 pathway. This simple change in body chemistry often dramatically improves glucose metabolism, even in drug dependent diabetics.

In resistant cases, the herb Gymnema can be most effective. Gymnema actually helps restore the beta cells of the pancreas that secrete insulin. In Ayurvedic medicine, Gymnema means “sugar destroyer”. For thousands of years, it has been used to eliminate the sickly sweet smell of urine produced when diabetics spill glucose into the urine in an attempt to reduce blood levels.

THE BOTTOM LINE:
If you are not yet diabetic, the odds are quite good that you will become one. Have your glycohemoglobin A1c checked yearly. It will detect problems in glucose metabolism years before the fasting glucose is out of control and the diagnosis of diabetes is given. Maintain a regime of regular exercise and reduce the refined carbohydrates in your diet.

If you have a blood sugar issue, no matter how advanced, consult with a qualified nutritionist. The damage begins long before you are aware you have a problem. However, it can be reversed with proper guidance.

Many Kids May Have High Cholesterol

About one of three Texas kids screened for cholesterol between the ages of 9 and 11 had borderline or high cholesterol, potentially placing them at greater risk for future cardiovascular disease a new study has found.
Friday, March 28, 2014 (WebMD News from HealthDay)

Obese kids were more likely to have abnormal cholesterol levels, but a large percentage of normal-weight children also had borderline or high cholesterol, said lead investigator Dr. Thomas Seery, a pediatric cardiologist at Texas Children’s Hospital and an assistant professor of pediatrics at Baylor College of Medicine, in Houston.

“The reality is that 35 percent of kids who were not obese had abnormal cholesterol as well,” Seery said. Physicians and parents need to teach kids healthy habits, such as eating right and exercising regularly, or as adults they will me more likely to suffer heart disease and stroke, he said. “Cardiovascular disease in children is rare, but we know that atherosclerosis has its beginnings in childhood,” Seery said. “The better a job we do now, the better they will do later in life.”

Previous studies have indicated that as many as 70 percent of children who have elevated cholesterol levels maintained those high levels as they entered young adulthood, said Dr. Patricia Vuguin, a pediatric endocrinologist at Cohen Children’s medical Center in New Hyde Park, N.Y. “Your cholesterol at 9 is a reflection of where your cholesterol is going to be in your 40s and 50s,” Vuguin said.

Seery and his colleagues undertook their research after new guidelines for juvenile cholesterol screening were issued by the U.S. National Hear, Lung, and blood Institute in 2011 and endorsed by the American Academy of Pediatrics.

These screenings present “the perfect opportunity for clinicians and parents to discuss the importance of healthy lifestyle choices on cardiovascular health.” he said. “Our findings give a compelling reason to screen all kids’ blood cholesterol.”

MY TAKE:
I like the concept of discussing “healthy lifestyle choices” with parents and children. However, the standard American diet (SAD) has condemned fat for the past 30 years promoting refined carbohydrates and processed foods. This is why cardiovascular disease is on the rise. It has little or nothing to do with cholesterol levels.

High cholesterol as a cause of heart disease has never been supported by research. High fat intake as a cause of heart disease is also not supported by the literature. Over 50 percent of people suffering their first heart attack have normal or even low cholesterol.

The elevated cholesterol in our youth is mostly because the medical norms have gradually been lowered over the course of the past 30 years. Beyond that true elevated cholesterol is most commonly associated with a diet high in trans-fats. The second most common cause is an underactive thyroid, not heart disease. The third is the presence of harmful bacteria in the gut.

“Low fat” or “reduced fat” foods have been developed over the past 30 years in response to the myth that fat is bad. The result is food that has been processed to remove the healthy fat and replace it with trans-fats. Butter is a very healthy fat – Margarine is a very unhealthy fat. However, the total fat content of margarine is lower than butter, so it is touted as being healthy. By trying to reduce our fat intake we have dramatically increased the rate of heart disease.

THE BOTTOM LINE:
Encourage your children to eat fresh fruits and vegetables. Lead by example and avoid the processed foods as much as possible. Don’t buy into the cholesterol myth. That is just an elaborate ploy to sell statin drugs. If you decide to screen your child for cholesterol, run a glycohemoglobin A1c as well to see if they are insulin resistant. That’s where the heart issues begin.

Wisdom Wednesday: Inflammation – Part 4

Insulin, the hormone produced by the pancreas to escort glucose into the cells of the body, can stimulate inflammation. It is the most insidious inflammatory pathway and very difficult to reverse.

Most cells in the body require adequate insulin in the blood stream to facilitate glucose absorption. However, a majority of Americans are now insulin resistant. They eat too much and too much of the wrong foods – refined carbohydrates. As the pancreas increases the output of insulin to control glucose levels, the body slowly becomes insulin resistant. This occurs long before the eventual diagnosis of Type II diabetes. It is estimated that by the year 2050, over half of all Americans will be diabetic.

Today, many of these young Americans are already insulin resistant and pre-diabetic. The systemic inflammation caused by excess insulin production is evidenced by our inability to process omega 6 fatty acids, like olive oil.

Most nutritionists recommend against supplementing omega 6 fatty acids. They claim that the omegas 6’s are abundant in our diet and that they can be pro-inflammatory. Although both of those claims are true, I disagree with their recommendations. First, the omega 6 fatty acids in our diet need to be converted to GLA (gamma linolenic acid) and many people can not make that conversion. Secondly, it’s only the people who are insulin resistant that take healthy omega 6 fatty acids and convert them to inflammatory compounds. I recommend fixing the chemistry rather than denying the body an essential fatty acid. Essential means just that, your body can not make it, it is essential to the diet.

The key, of course, is cleaning up the diet, reversing all the factors associated with metabolic syndrome – central obesity, high blood pressure, low thyroid function, high serum lipids, and insulin resistance. In the meantime, the addition of sesame seed oil, and possibly GLA, to the diet will support healthy utilization of omega 6 fatty acids and effectively block the conversion to inflammatory compounds.

I have seen uncontrolled type II diabetics, on multiple medications, cut their medication by 75% with the simple addition of sesame seed oil and GLA, while reducing their blood sugar levels from over 250mg/dL to 85mg/dL in less than 3 weeks. Simultaneously, their inflammatory complaints – IBS, musculoskeletal pain, headaches, etc. also improve markedly.

In my office, as soon as I see impaired chemistry on the omega 6 fatty acids, I suspect insulin resistance as the cause. Fortunately, the glycohemoglobin A1c is a simple blood test that tells us what your blood sugar has been averaging for the past 60 days. I mention this test often in my blogs and I advise you to have this test run annually.

THE BOTTOM LINE:
Diabetes is epidemic in our county and is not only preventable, but often time’s reversible. The vast majority of pre-diabetics are undiagnosed. The odds are at least half of you reading this blog are pre-diabetic. Get an A1c performed. If you have any of the characteristics of metabolic syndrome and you suffer from inflammation, chances are your pain is being driven by insulin.

Glucosamine Fails to Prevent Deterioration of Knee Cartilage or Decrease Pain

A short-term study found that oral glucosamine supplementation is not associated with a lessening of knee cartilage deterioration among individuals with chronic knee pain.
Tuesday, March 11, 2014

Findings published in Arthritis & Rheumatology, a journal of the American College of Rheumatology (ACR) journal, indicate that glucosamine does not decrease pain or improve knee bone marrow lesions – more commonly known as bone bruises and thought to be a source of pain in those with osteoarthritis (QA).

According to the ACR, 27 million Americans over 25 years of age are diagnosed with OA – the most common form of arthritis and the primary cause of disability in the elderly. Patients may seek alternative therapies to treat joint pain and arthritis, with prior research showing glucosamine as the second most commonly used natural product. In fact, a 2007 Gallup poll reports that 10% of individuals in the US over the age of 18 use glucosamine, with more than $2 billion in global sales of the supplement.

For this double-blind, placebo-controlled trial, Dr. C. Kent Kwoh from the University of Arizona in Tucson, enrolled 201 participants with mild to moderate pain in one or both knees. Participants were randomized and treat daily with 1500mg of glucosamine hydrochloride in a 16-ounce bottle of diet lemonade or placebo for 24 weeks. Magnetic resonance imaging (MRI) was used to assess cartilage damage.

Trial results show no decrease in cartilage damage in participants in the glucosamine group compared to the placebo group. Researchers report no change in bone marrow lesions in 70% of knees, 18% of knees worsened and 10% improved. The control group had greater improvement in bone marrow lesions compared to treated participants, with neither group displaying a worsening of the bone marrow lesions. Dr. Kwoh concludes, “Our study found no evidence that drinking a glucosamine supplement reduced knee cartilage damage, relieved pain, or improved function in individuals with chronic knee pain.”

MY TAKE:
Glucosamine Sulfate was the first supplement I recommended to patients 38 years ago. Clinically, 80% of my patients with chronic low back pain experienced reduction in symptoms within 30 days. I quickly realized that about half of the patients that did not respond favorably were diabetic.

Today, we have uncovered the chemistry behind glucosamine sulfate. Basically, it requires good glucose metabolism and good sulfur metabolism to function. That explains why my diabetic patients failed to respond. Sulfur metabolism depends on the ability of the body to strip sulfur from sulfur bearing amino acids.

Please read my recent Wisdom Wednesday: Vitamin B6 blog post for information on this process.

The first flaw in this study is the use of glucosamine hydrochloride, not glucosamine sulfate. Without adequate sulfur, the chemistry just doesn’t work. They also failed to identify participants that may have impaired glucose metabolism. As I have frequently written, insulin resistance is epidemic in this country. Finally, glucosamine sulfate, MSM, and chondrotin sulfate all help form ground substance which is necessary to repair connective tissue. None of these chemical are inherently anti-inflammatory in nature. If you do not reduce inflammation first, healing can not occur.

I still use glucosamine sulfate in my practice today. However, I first address inflammation, sulfur amino acid metabolism, and glucose metabolism prior to supplementation. Most of the time, correcting these three chemical pathways solves the problem and direct supplementation of sulfur and glucose in not necessary or desired.

THE BOTTOM LINE:
If you want to take one of these supplements, at least take one that contains both glucose and sulfur. Better yet, have your glucose and sulfur metabolism evaluated. A simple blood test, the glycohemoglobin A1c will assess your metabolism of sugar for the past two months. If eating cruciferous vegetables, like broccoli, cauliflower, or cabbage, gives you gas, then your sulfur amino acid metabolism is suspect.

Food Price Hikes May Affect Those with Type 2 Diabetes

Health Day News – Food prices are linked to blood sugar levels in people with type 2 diabetes, a new study suggests.
Friday, February 14, 2014

To reach this conclusion, researchers from the U.S. Department of Agriculture (USDA) merged information from two giant studies. The first study, by the National Health and Nutrition Examination Survey (NHANES), gathered blood sugar measures of about 2,400 adults who met the definition of type 2 diabetes. Then they compared those levels to average grocery prices over the previous three months in 35 markets around the United States. Those prices came from the Quarterly Food-at-Home Price Database.

The result – As the costs of healthy foods like fruits, vegetables and low-fat dairy products climbed, so did blood sugar levels. The reverse was true for unhealthy foods. Falling prices for sugar, saturated fat and total calories were tied to higher blood sugar levels in people with diabetes. Those relationships were strongest for low-income consumers.

“Most likely, it’s because people eat less produce and switch to products that are less healthy,” said study author Ilya Rahkovsky, an economist with the USDA’s Economic research Service in Washington, D.C. The study was published in the February 13 issue of the American Journal of Public Health.

A December study from the Harvard School of Public Health estimated that healthy eating costs the average person about $1.50 per day more than unhealthy eating. That may not be such a stretch for a middle-class family. However, experts say that kind of price hike may be prohibitive for the poor, forcing them to swap fruits, vegetables and lean proteins for more processed and junk foods.

The new study found that for every increase of roughly 10 cents per pound in the cost of produce, fasting blood sugar climbed 20 milligrams per deciliter (mg/dL), or about 13% of the average fasting glucose level in the study, which was 162 mg/dL.

MY TAKE:
Type 2 diabetes is an epidemic in the United States. Additionally, there are millions of undiagnosed cases. If you meet any of the criteria for metabolic syndrome – overweight, high blood pressure, insulin resistant, low thyroid function, or high serum lipids – you are well on your way to becoming diabetic or you’re already there and just don’t know it.

For centuries, we have fed our poor with cheap grains – wheat, corn, and rice. Refined carbohydrates provide inexpensive calories for fuel but little in the way of micronutrients. Today, the small amount of vitamins, minerals, and phytonutrients in these foods are processed out and then replaced with synthetic chemicals.

The ancient Egyptians were the first to cultivate wheat. Atherosclerosis, heart disease, arthritis, and diabetes quickly followed according to archaeological findings. This pattern has continued to accelerate to the present day. It is estimated that by the year 2050, a third of our population will have type 2 diabetes.

THE BOTTOM LINE:
Follow this simple formula – eat 3 servings of protein, 5 servings of vegetables, and 2 fruit servings every day. That leaves little room for the grains, starches, and refined carbohydrates. Have your hemoglobin A1c checked through a simple blood test. If you are 5.7 or higher, seek professional support with a qualified nutritionist.

Metabolic Syndrome Linked to Poor Breakfast Habits in Childhood

Researchers in Sweden report a link between the incidence of metabolic syndrome in adults and the kind of breakfasts those adults ate as children.
Friday, January 31, 2014

Studies reported in Medical News Today during 2013 suggested that eating a large breakfast could boost fertility for women with PCOS and lower the risk of heart disease, diabetes and high blood pressure.

In addition, skipping breakfast has been said to increase the appeal of high-calorie foods later in the day. Some studies have even suggested that eating breakfast every day can help to lower body mass index (BMI), though other researchers have disputed this.

Researchers at Umea University in Sweden studied a group of Swedish schoolchildren, asking questions about what they ate for breakfast. Twenty-seven years later, the follow-up checked these same subjects for signs of any metabolic risk factors.

The study found that the people who did not eat breakfast (or who ate an insubstantial breakfast) as children were 68% more likely to have adulthood metabolic syndrome that their peers who ate substantial breakfasts.

MY TAKE:
It is estimated that 34 percent of the U.S. adult population meets the criteria for a diagnosis of metabolic syndrome. The high prevalence and spectrum of diseases associated with metabolic syndrome make it the number one public health issue in the this country.

You qualify for the diagnosis of metabolic syndrome if you have three or more of the following:

• Waist circumference > 39 inches in males, > 33 inches in females.
• Blood pressure 130/85 or higher.
• Fasting blood sugar of 100 or higher.
• Triglycerides of 150 or higher.
• HDL less than 40 in males, 50 in females

People with metabolic syndrome are three times more likely to have a stroke or heart attack, and twice as likely to die from these events. The risk of developing type 2 diabetes is five times higher in people with metabolic syndrome.

The good news is that this syndrome is preventable and even reversible. Dietary changes, including eating a good breakfast, are a good start. Regular exercise habits and proper nutritional support are also vital.

THE BOTTOM LINE:
Assess your current health status. Have fasting blood tests annually. In addition to the tests noted above, check your glycohemoglobin A1c. It will predict the rise in fasting blood sugar years before it gets out of control. Also check thyroid function. The TSH (thyroid stimulating hormone) normally ranges from 0.4 to 4.5, but levels above 2.0 are also associated with metabolic syndrome, especially in women. Consult with a qualified nutritionist to reverse the diseases associated with this epidemic in our nation. Finally, make sure your children do not leave home in the morning without a good meal to start their day.

Idea of Healthy Obesity Is Tested

The idea that there are obese people who are nonetheless healthy may be a myth.
December 13, 2013

Although some overweight or obese people have normal cholesterol, glucose levels and blood pressure – elements of so-called metabolic health – a new study suggests that obesity itself increases the risk for heart disease, stroke, diabetes and death.

Last week the Annals of Internal Medicine published a report that followed more than 61,000 adults, most for at least 10 years. About 9 percent of the subjects were obese and metabolically healthy – that is, they had normal LDL, HDL and total cholesterol, along with healthy blood pressure and blood sugar levels.

Compared with metabolically healthy people of normal weight, the obese group had a 24 percent increase in risk for total and nonfatal cardiovascular events like heart attack and stroke, and death by any cause.

Increased weight, waist circumference, blood pressure, and insulin resistance all rose together. However, increases in triglycerides, glucose, or LDL cholesterol were not associated.

“The message here is pretty clear,” said the lead author, Dr. Caroline K. Kramer, a researcher at the University of Toronto. “The results are very consistent. It’s not O.K. to be obese. There is no such thing as healthy obesity.”

MY TAKE:
The study appears to be pretty obvious – if you are overweight, your health suffers. However, if you look more closely, it says something more profound – They found no correlation between high triglycerides, high glucose, or high LDL cholesterol and increased cardiovascular events. Waist circumference was a better indicator of health risk! Please note they did see a correlation between insulin resistance and cardiovascular events.

More than 50 percent of Americans having their first heart attack have normal or even low cholesterol. We don’t need to put statin drugs in the drinking water; we need to focus on the real risk factors of metabolic syndrome – central obesity (weight around the middle), insulin resistance, and low thyroid function.

What is the difference between insulin resistance and fasting blood glucose? The fasting glucose tells you how well your body controls blood sugar levels without the stress of eating (adding more sugar) for at least 8 hours. That’s like an open book test, setting the bar too low. By the time the fasting glucose is high, insulin resistance is out of control and you are a full blown diabetic.

The glycohemoglobin A1c is a simple test that measures insulin resistance. It actually measures the percentage of red blood cells (RBCs) that are saturated with glucose. Normal is below 5.7 percent. Because RBCs live about 120 days, this test measures your average blood glucose over the course of the past two months.

BOTTOM LINE:
Watch your weight, especially your waist line. Have yearly laboratory tests, but insist on a glycohemoglobin A1c and don’t be too concerned with the serum lipids. If you want to see if your cholesterol is really a risk factor, have an L(p)a run. It is the only lipid test that really correlates with increased risk of cardiovascular events.

Tom Hanks Could Reverse His Diabetes

Type II diabetes is simply caused by a poor diet. In Tom’s defense, his dramatic weight fluctuations to meet the various roles he has played required terrible dietary practices. In gaining, or losing 30 pounds or more over relatively short spans of time, he has highlighted an exaggerated form of SAD (the Standard American Diet).

Americans just eat too much, too much of everything – protein, carbohydrate, and fat. Obesity rates, currently at 37 % nationally, are skyrocketing. Type II diabetes is also at epidemic levels and scientists predict about half the adult population of the United States will be diabetic by 2050, unless our eating habits change. Only one diet has been shown to increase longevity – reduced caloric intake. So Tom, you and the rest of the country have to start eating less.

Now let’s talk about food quality. It is estimated that early man, the hunter-gatherer, ate a bushel basket of fruits and vegetables per day. That seems like a lot of food, but it was not a lot of calories. These foods were high in fiber and much of the material passed through as undigested bulk. Today, the bulk of our diet is refined carbohydrates, devoid of insoluble fiber, and loaded with calories. These simple sugars rush into our blood stream and tax our pancreas and liver, dismantling our ability to manage blood glucose levels.

The solution is quite simple – I recommend 5 servings of vegetables each day, 2 fruit servings, and 3 servings of protein. If Tom (and the rest of the nation) would just meet these simple goals daily, there is little room for the refined foods and they drop away from the diet. Unfortunately, when I review food journals in my practice, I often find diets that average less than one serving of fruits or vegetables per day. The protein intake is usually adequate, unless the patient is trying to lose weight, then they typically will restrict the protein intake as well, piling on more refined carbohydrates. Then they wonder why they can’t lose weight.

Early detection of diabetes is where you need to start. It is not enough to test your fasting glucose. That just shows how well your body manages glucose without the stress of adding any calories from eating. Everyone should have a glycohemoglobin A1c performed yearly. This test measures what percentage of your RBCs (red blood cells) are saturated with sugar. The A1c tells us what your blood sugar has averaged over the course of the past two months. Tom Hanks A1c has been elevated for years prior to his diagnosis of Type II Diabetes. Yours may be elevated as well. Every week I see young adults with early signs of diabetes, all undetected, all unaware of the devastating disease they are creating by eating SAD.