Carbohydrates are controversial when it comes to diet these days. But what separates the good from the bad is a food's glycemic load, which has a big impact on blood sugar levels.
Every food you eat affects your body differently, and not just in terms of your long-range health, but also in the way it is processed and the effect it has on your energy level and blood sugar.
Glycemic Load and Diet: The Basics
The glycemic load is a classification of different carbohydrates that measures their impact on the body and blood sugar. The glycemic load details the amount of carbohydrates a food contains and its glycemic index, a measurement of its impact on blood sugar. “The glycemic index ranks foods based on how quickly they're digested and get into the bloodstream," says Sandra Meyerowitz, MPH, RD, a nutritionist and owner of Nutrition Works in Louisville, Ky. “Its glycemic load takes into consideration every component of the food as a whole, so it's a different number. It changes everything."
Because the glycemic load of a food looks at both components, the same food can have a high glycemic index, but an overall low glycemic load, making it better for you than it originally might have appeared.
Glycemic Load and Diet: The Effect on Your Health
Foods with a low glycemic load keep blood sugar levels consistent, meaning that you avoid experiencing the highs and lows that can be caused by blood sugar that jumps too high and quickly drops — the candy bar effect.
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Watching the glycemic load of the foods you eat can have a big impact on your health in many ways. A diet focused on foods with a low glycemic load can:
Make it easier to lose weight and avoid the dreaded diet plateau
Keep blood sugar levels more consistent
Burn more calories
Help prevent insulin resistance and diabetesLower heart disease risk
"It makes more sense to use the glycemic load because when you eat a food you don’t just eat one food by itself — you eat a whole bunch of foods together," says Meyerowitz. Looking at the total picture of foods you eat, rather than just the individual pieces, gives you a clearer and more accurate picture of the foods that make up your diet.
Glycemic Load and Diet: Glycemic Loads in Favorite Foods
It's tough to figure out on your own if a food has a high or a low glycemic load, but as a general guideline, the more fiber a food has the better. Here is a glycemic load reference list with many common foods to let you know which are low, medium, and high.
Foods with a low glycemic load of 10 or less:
Kidney, garbanzo, pinto, soy, and black beans
Fiber-rich fruits and vegetables, like carrots, green peas, apples, grapefruit, and watermelon
Cereals made with 100 percent bran
Lentils
Cashews and peanuts
Whole-grain breads like barley, pumpernickel, and whole wheat
Whole-wheat tortillas
Tomato juice
Milk
Foods with a medium glycemic load of 11 to 19:
Whole-wheat pasta and some breads
Oatmeal
Rice cakes
Barley and bulgur
Fruit juices without extra sugar
Brown rice
Sweet potato
Graham crackers
Foods with a high glycemic load of 20 or more:
High-sugar beverages
Candy
Sweetened fruit juices
Couscous
White rice
White pasta
French fries and baked potatoes
Low-fiber cereals (high in added sugar)
Macaroni and cheese
Pizza
Raisins and dates
Focusing on the glycemic load of foods is particularly important for people with diabetes to help maintain a steady blood sugar, but everyone can benefit from understanding and monitoring the glycemic load in their diet.
By Diana Rodriguez
Medically reviewed by Christine Wilmsen Craig, MD
Wednesday, March 30, 2011
Saturday, March 26, 2011
Why Don't People Take Their Insulin as Prescribed?
Risk factors differed between Type 1 and Type 2 diabetic patients, with diet nonadherence more prominent in Type 1 diabetes and….
The purpose of this study was to assess factors associated with patient frequency of intentionally skipping insulin injections, according to researcher Mark Peyrot, PhD.
Data were obtained through an internet survey of 502 U.S. adults self-identified as taking insulin by injection to treat Type 1 or Type 2 diabetes. Multiple regression analysis assessed independent associations of various demographic, disease, and injection-specific factors with insulin omission.
Intentional insulin omission was reported by more than half of respondents; regular omission was reported by 20%. Risk factors differed between Type 1 and Type 2 diabetic patients, with diet nonadherence more prominent in Type 1 diabetes and age, education, income, pain, and embarrassment more prominent in Type 2 diabetes. It is not surprising that non-compliance in Type 1 diabetes patients was associated with poor eating habits. The researchers found that younger age, lower income, and embarrassment were the most important factors for poor compliance in people with Type 2 diabetes.
Whereas most patients did not report regular intentional omission of insulin injections, a substantial number did. The findings suggest that it is important to identify patients who intentionally omit insulin and be aware of the potential risk factors identified here. For patients who report injection-related problems (interference with daily activities, injection pain, and embarrassment), providers should consider recommending strategies and tools for addressing these problems to increase adherence to prescribed insulin regimens. This could improve clinical outcomes. Although the results address the needed educational intervention, especially when it comes to embarrassment, pain, and interference with activities, it also points to the fact that healthcare teams need to talk with patients before this becomes a common practice, rather than a single occurrence.
Diabetes Care, Feb. 2011
The purpose of this study was to assess factors associated with patient frequency of intentionally skipping insulin injections, according to researcher Mark Peyrot, PhD.
Data were obtained through an internet survey of 502 U.S. adults self-identified as taking insulin by injection to treat Type 1 or Type 2 diabetes. Multiple regression analysis assessed independent associations of various demographic, disease, and injection-specific factors with insulin omission.
Intentional insulin omission was reported by more than half of respondents; regular omission was reported by 20%. Risk factors differed between Type 1 and Type 2 diabetic patients, with diet nonadherence more prominent in Type 1 diabetes and age, education, income, pain, and embarrassment more prominent in Type 2 diabetes. It is not surprising that non-compliance in Type 1 diabetes patients was associated with poor eating habits. The researchers found that younger age, lower income, and embarrassment were the most important factors for poor compliance in people with Type 2 diabetes.
Whereas most patients did not report regular intentional omission of insulin injections, a substantial number did. The findings suggest that it is important to identify patients who intentionally omit insulin and be aware of the potential risk factors identified here. For patients who report injection-related problems (interference with daily activities, injection pain, and embarrassment), providers should consider recommending strategies and tools for addressing these problems to increase adherence to prescribed insulin regimens. This could improve clinical outcomes. Although the results address the needed educational intervention, especially when it comes to embarrassment, pain, and interference with activities, it also points to the fact that healthcare teams need to talk with patients before this becomes a common practice, rather than a single occurrence.
Diabetes Care, Feb. 2011
Tuesday, March 22, 2011
Diabetes to double or triple in U.S. by 2050: government
WASHINGTON (Reuters Life!) – Up to a third of U.S. adults could have diabetes by 2050 if Americans continue to gain weight and avoid exercise, the Centers for Disease Control and Prevention projected on Friday.
The numbers are certain to go up as the population gets older, but they will accelerate even more unless Americans change their behavior, the CDC said.
"We project that, over the next 40 years, the prevalence of total diabetes (diagnosed and undiagnosed) in the United States will increase from its current level of about one in 10 adults to between one in five and one in three adults in 2050," the CDC's James Boyle and colleagues wrote in their report.
"These are alarming numbers that show how critical it is to change the course of type-2 diabetes," CDC diabetes expert Ann Albright said in a statement.
"Successful programs to improve lifestyle choices on healthy eating and physical activity must be made more widely available because the stakes are too high and the personal toll too devastating to fail."
The CDC says about 24 million U.S. adults have diabetes now, most of them type-2 diabetes linked strongly with poor diet and lack of exercise.
Boyle's team took census numbers and data on current diabetes cases to make models projecting a trend. No matter what, diabetes will become more common, they said.
"These projected increases are largely attributable to the aging of the U.S. population, increasing numbers of members of higher-risk minority groups in the population, and people with diabetes living longer," they wrote.
Diabetes was the seventh-leading cause of death in the United States in 2007, and is the leading cause of new cases of blindness among adults under age 75, as well as kidney failure, and leg and foot amputations not caused by injury.
"Diabetes, costing the United States more than $174 billion per year in 2007, is expected to take an increasingly large financial toll in subsequent years," Boyle's team wrote.
The numbers are certain to go up as the population gets older, but they will accelerate even more unless Americans change their behavior, the CDC said.
"We project that, over the next 40 years, the prevalence of total diabetes (diagnosed and undiagnosed) in the United States will increase from its current level of about one in 10 adults to between one in five and one in three adults in 2050," the CDC's James Boyle and colleagues wrote in their report.
"These are alarming numbers that show how critical it is to change the course of type-2 diabetes," CDC diabetes expert Ann Albright said in a statement.
"Successful programs to improve lifestyle choices on healthy eating and physical activity must be made more widely available because the stakes are too high and the personal toll too devastating to fail."
The CDC says about 24 million U.S. adults have diabetes now, most of them type-2 diabetes linked strongly with poor diet and lack of exercise.
Boyle's team took census numbers and data on current diabetes cases to make models projecting a trend. No matter what, diabetes will become more common, they said.
"These projected increases are largely attributable to the aging of the U.S. population, increasing numbers of members of higher-risk minority groups in the population, and people with diabetes living longer," they wrote.
Diabetes was the seventh-leading cause of death in the United States in 2007, and is the leading cause of new cases of blindness among adults under age 75, as well as kidney failure, and leg and foot amputations not caused by injury.
"Diabetes, costing the United States more than $174 billion per year in 2007, is expected to take an increasingly large financial toll in subsequent years," Boyle's team wrote.
Sunday, March 20, 2011
Insulin and Weight Gain?
Q: I take insulin and it's very hard for me to lose weight. I've read that this can happen — that insulin can contribute to weight gain. What can I do? I try to watch what I eat and have recently joined a fitness club, but I haven't had much success yet. Any advice?
— Susan
A:Insulin can, in fact, lead to weight gain. Here's how it works:
Insulin is a potent hormone that regulates glucose, fat, and protein metabolism. In many cases, people with type 2 diabetes start insulin therapy when oral medicines cannot or no longer control their glucose levels. This means that blood glucose levels in the body have been elevated for an extended period of time. In this state, the body does not metabolize glucose, fat, or protein in a well-regulated or efficient way. Cells that require glucose to function properly begin starving because of inadequate amounts of circulating insulin. Fat metabolism becomes abnormal, which can lead to high triglyceride levels. The body's metabolic rate then increases as it tries to convert this fat into a source of energy.
These abnormalities are usually corrected when you begin insulin therapy. The body begins using glucose better, and the metabolic rate declines by about five percent. Insulin also helps the body gain fat-free mass, but on the flip side, it also helps it store fat more efficiently. Therefore, efficient glucose and fat metabolism and the reduction in metabolic rate cause most people to gain four to six pounds during the first two to three years of insulin therapy. Individuals who had poor glucose control, or who lost significant amounts of weight before beginning insulin treatment, usually experience the most weight gain.
Losing weight in general requires persistent attention to energy balance — that is, the number of calories you take in versus the number you burn. During insulin therapy, the body does not need as much food to get the energy it requires, so reducing your caloric intake is quite important. This should be accompanied by an exercise regimen, as you have begun, to expend at least 200 to 300 calories a day.
In addition, you should consult with your doctor to consider other kinds of diabetes treatments that could mitigate the weight gain. These include metformin, an oral medication that prevents weight gain; an insulin analogue called detemir, which has been shown to cause less weight gain than NPH insulin; and exenatide, an antidiabetes injection that can lead to weight loss.
— Susan
A:Insulin can, in fact, lead to weight gain. Here's how it works:
Insulin is a potent hormone that regulates glucose, fat, and protein metabolism. In many cases, people with type 2 diabetes start insulin therapy when oral medicines cannot or no longer control their glucose levels. This means that blood glucose levels in the body have been elevated for an extended period of time. In this state, the body does not metabolize glucose, fat, or protein in a well-regulated or efficient way. Cells that require glucose to function properly begin starving because of inadequate amounts of circulating insulin. Fat metabolism becomes abnormal, which can lead to high triglyceride levels. The body's metabolic rate then increases as it tries to convert this fat into a source of energy.
These abnormalities are usually corrected when you begin insulin therapy. The body begins using glucose better, and the metabolic rate declines by about five percent. Insulin also helps the body gain fat-free mass, but on the flip side, it also helps it store fat more efficiently. Therefore, efficient glucose and fat metabolism and the reduction in metabolic rate cause most people to gain four to six pounds during the first two to three years of insulin therapy. Individuals who had poor glucose control, or who lost significant amounts of weight before beginning insulin treatment, usually experience the most weight gain.
Losing weight in general requires persistent attention to energy balance — that is, the number of calories you take in versus the number you burn. During insulin therapy, the body does not need as much food to get the energy it requires, so reducing your caloric intake is quite important. This should be accompanied by an exercise regimen, as you have begun, to expend at least 200 to 300 calories a day.
In addition, you should consult with your doctor to consider other kinds of diabetes treatments that could mitigate the weight gain. These include metformin, an oral medication that prevents weight gain; an insulin analogue called detemir, which has been shown to cause less weight gain than NPH insulin; and exenatide, an antidiabetes injection that can lead to weight loss.
Wednesday, March 16, 2011
Healthy Snacking With Type 2 Diabetes
You might not have to forgo that afternoon snack if you have type 2 diabetes, but you may have to change what you eat.
Having a quick bite to eat in the afternoon or before bed is a habit many people might not think twice about. However, after someone is diagnosed with type 2 diabetes, it seems like every eating habit gets scrutinized, including snacks. Since adjusting lifestyle factors like diet and exercise are among the first steps in managing type 2 diabetes, snacking in a healthy and controlled way can help manage the disease.
Living with Type 2 Diabetes: Should I Snack?
Not everyone with type 2 diabetes should snack regularly. Snacking patterns should be tailored to an individual’s preferences, schedule, and medication. For example, someone taking insulin can use a snack to help prevent a drop in blood sugar between meals. Someone else might have a snack while preparing dinner, to relieve hunger and keep from overeating before dinner is ready. Snacking in general can help spread out food intake over the course of a day, helping to lower blood lipids and glucose for people with type 2 diabetes.
Living with Type 2 Diabetes: Choosing the Right Snack
Choosing the right snack along with the right scheduling is equally important. Here are some tips for selecting that perfect snack:
Choose quality. Lorena Drago, MS, a registered dietitian and diabetes educator with the American Association of Diabetes Educators, has a catchy way to remember the important criteria for a good snack: “I tell my patients to mind their Ps and Qs — P stands for portion and Q for quality.” Keeping snack portion sizes small is important, but so is choosing quality, healthy snacks. For example, three crackers with one slice of cheese is a better-quality snack than a chocolate bar.Get educated. Educate yourself about basic nutrition components like carbohydrates, fat, and protein so that you are comfortable reading nutrition labels. Drago advises choosing snacks with “staying power,” those that will prevent you from eating too much later in the day. Drago recommends snacks with some fat and some protein, to slow food absorption and keep you feeling full longer. Stay away from foods heavy in carbohydrates, like sugary desserts.Plan ahead. Plan snacks in advance to make sure healthy choices are available and to prevent overeating. Living with Type 2 Diabetes: The Dark Side of Snacking
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Snacking can work against you if you take it too far. Thomas Wolever, MD, PhD, professor of nutritional sciences at the University of Toronto, says that research shows that when people with type 2 diabetes eat six meals a day, instead of three, they tend to overeat and, in turn, gain weight, which overcomes any potential benefit of managing blood glucose and lipids.
Since weight control is often a primary concern for people with type 2 diabetes, snacking carefully and strategically is very important. Some diabetics may have a hard time stopping after eating one handful of tasty cashews — a tightly restricted eating schedule might work better for these people.
People with type 2 diabetes should examine their own lifestyle, personality, and medication before deciding whether snacking is a healthy approach for tackling their diabetes. Diabetes educators can help you make these decisions and offer suggestions for how to fit different approaches into your lifestyle. The best snacking pattern for you is a custom plan that will fit comfortably into your lifestyle and help keep your type 2 diabetes under control.
Having a quick bite to eat in the afternoon or before bed is a habit many people might not think twice about. However, after someone is diagnosed with type 2 diabetes, it seems like every eating habit gets scrutinized, including snacks. Since adjusting lifestyle factors like diet and exercise are among the first steps in managing type 2 diabetes, snacking in a healthy and controlled way can help manage the disease.
Living with Type 2 Diabetes: Should I Snack?
Not everyone with type 2 diabetes should snack regularly. Snacking patterns should be tailored to an individual’s preferences, schedule, and medication. For example, someone taking insulin can use a snack to help prevent a drop in blood sugar between meals. Someone else might have a snack while preparing dinner, to relieve hunger and keep from overeating before dinner is ready. Snacking in general can help spread out food intake over the course of a day, helping to lower blood lipids and glucose for people with type 2 diabetes.
Living with Type 2 Diabetes: Choosing the Right Snack
Choosing the right snack along with the right scheduling is equally important. Here are some tips for selecting that perfect snack:
Choose quality. Lorena Drago, MS, a registered dietitian and diabetes educator with the American Association of Diabetes Educators, has a catchy way to remember the important criteria for a good snack: “I tell my patients to mind their Ps and Qs — P stands for portion and Q for quality.” Keeping snack portion sizes small is important, but so is choosing quality, healthy snacks. For example, three crackers with one slice of cheese is a better-quality snack than a chocolate bar.Get educated. Educate yourself about basic nutrition components like carbohydrates, fat, and protein so that you are comfortable reading nutrition labels. Drago advises choosing snacks with “staying power,” those that will prevent you from eating too much later in the day. Drago recommends snacks with some fat and some protein, to slow food absorption and keep you feeling full longer. Stay away from foods heavy in carbohydrates, like sugary desserts.Plan ahead. Plan snacks in advance to make sure healthy choices are available and to prevent overeating. Living with Type 2 Diabetes: The Dark Side of Snacking
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Snacking can work against you if you take it too far. Thomas Wolever, MD, PhD, professor of nutritional sciences at the University of Toronto, says that research shows that when people with type 2 diabetes eat six meals a day, instead of three, they tend to overeat and, in turn, gain weight, which overcomes any potential benefit of managing blood glucose and lipids.
Since weight control is often a primary concern for people with type 2 diabetes, snacking carefully and strategically is very important. Some diabetics may have a hard time stopping after eating one handful of tasty cashews — a tightly restricted eating schedule might work better for these people.
People with type 2 diabetes should examine their own lifestyle, personality, and medication before deciding whether snacking is a healthy approach for tackling their diabetes. Diabetes educators can help you make these decisions and offer suggestions for how to fit different approaches into your lifestyle. The best snacking pattern for you is a custom plan that will fit comfortably into your lifestyle and help keep your type 2 diabetes under control.
Tuesday, March 15, 2011
Is 'Borderline' Diabetes Really Diabetes?
Q: I just learned that I'm a "borderline" diabetic, even though my blood glucose reading was very close to normal. Now I'm not sure what to do. Should I be consistently checking my blood sugar level, eating differently, or taking medication as though I actually have diabetes? I don't want to develop diabetes, but I don't want to take unnecessary precautions either.
A: Great question! Now that you've been diagnosed with prediabetes, prevention is key. Prediabetes is characterized by either impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). Both of these terms refer to the level of sugar in the bloodstream, and they're both ways of saying that you have prediabetes.
If your fasting glucose level (a test in which blood is drawn after six hours without food) is between 100 and 125 mg/dl, you have IFG. If your blood sugar level two hours after a glucose challenge test is between 139 and 200 mg/dl, you have IGT.
Okay — now that we have the classification straight, why should you be worried about these numbers if yours are not in the diabetic range? Here's why: As your blood glucose rises above the normal level, your risk of developing damage in the body's small blood vessels, and ultimately your risk of a heart attack or stroke, also rises. In addition, having abnormal glucose levels is a risk factor for developing outright diabetes in the future.
By bringing you blood sugar levels back in the normal range, you can probably prevent the onset of diabetes and other complications, such as coronary artery disease. It is not absolutely essential to frequently check your glucose levels at home as long as you and your doctor monitor them periodically.
The precautions that you can and should take to prevent complications and the onset of diabetes consist of the same habits you'd cultivate to stay healthy in general. These include exercising, eating healthfully and not excessively, and maintaining your ideal body weight. One study showed that among a group of individuals who had prediabetes, those who lost as little as 7 percent of their body weight delayed the onset of diabetes or prevented it. There are also medicines that have been shown to prevent diabetes. While I do not recommend medicines to all people with prediabetes, it might be advisable in some cases. I wish you luck in this journey toward health.
A: Great question! Now that you've been diagnosed with prediabetes, prevention is key. Prediabetes is characterized by either impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). Both of these terms refer to the level of sugar in the bloodstream, and they're both ways of saying that you have prediabetes.
If your fasting glucose level (a test in which blood is drawn after six hours without food) is between 100 and 125 mg/dl, you have IFG. If your blood sugar level two hours after a glucose challenge test is between 139 and 200 mg/dl, you have IGT.
Okay — now that we have the classification straight, why should you be worried about these numbers if yours are not in the diabetic range? Here's why: As your blood glucose rises above the normal level, your risk of developing damage in the body's small blood vessels, and ultimately your risk of a heart attack or stroke, also rises. In addition, having abnormal glucose levels is a risk factor for developing outright diabetes in the future.
By bringing you blood sugar levels back in the normal range, you can probably prevent the onset of diabetes and other complications, such as coronary artery disease. It is not absolutely essential to frequently check your glucose levels at home as long as you and your doctor monitor them periodically.
The precautions that you can and should take to prevent complications and the onset of diabetes consist of the same habits you'd cultivate to stay healthy in general. These include exercising, eating healthfully and not excessively, and maintaining your ideal body weight. One study showed that among a group of individuals who had prediabetes, those who lost as little as 7 percent of their body weight delayed the onset of diabetes or prevented it. There are also medicines that have been shown to prevent diabetes. While I do not recommend medicines to all people with prediabetes, it might be advisable in some cases. I wish you luck in this journey toward health.
Sunday, March 13, 2011
Beating Family History
Q: There is a history of diabetes in my family, and I've been worried about getting it. Now my older sister just got diagnosed, and I feel it's hit my generation for the first time. I'm a little overweight but not too much, and I try to watch what I eat. Is there a specific diet I should try to follow so that I don't end up getting diabetes, too?
— Susan,
A:Congratulations! First, you recognize the predisposition you carry to the disease. Second, you are motivated to beat the odds. The good news is that there is something you can do to prevent diabetes. Two recent large studies have found that healthy habits can stave off diabetes among those who are at risk. These habits include eating a balanced diet, getting regular exercise, and maintaining a healthy weight. Of course, I understand if your eyes are glazing over, since this is the same mantra for everything from improving skin health to reducing the risk of heart disease and certain types of cancer. But seriously, a healthful diet should accomplish several things:
1.Provide an adequate amount of vitamins, minerals, proteins, and essential fatty acids
2.Help you lose weight
3.Be pleasing to your palate
4.Be a plan that you can maintain for the rest of your life.
There are many registered dietitians who can help design a plan for you. The specific composition of a diet that meets your body's needs depends on your age, current health condition, and health risks, including diabetes. But simply put, if you make sure that every meal contains a variety of sources of vitamins and minerals, two of your meals contain one source of protein, and you use olive or canola oil (in lieu of animal fat), you should be able to meet most of your needs.
A quick way to ensure that you are consuming all that your body needs is to make your plate as colorful as you can. The colors of vegetables and fruits are an indication of the different vitamins they contain. You should also think outside the box when it comes to protein sources, which should include not only animal products such as meat, chicken, fish, cheese, milk, and eggs but also plant-based products such as soybeans/tofu, nuts, and legumes. Generally, the more plant-based protein sources you ingest, the fewer calories you consume.
While you concentrate on including vitamins, minerals, and proteins in your diet, you mustn't forget that carbohydrates matter. We need carbohydrates as energy sources, and whole grains as a source of various vitamins and fiber. There are two categories of carbohydrates: simple and complex. If you remember anything, remember this: Avoid simple carbohydrates such as white bread, white-flour pasta, cakes, candy, and table sugar. Instead, focus on fruits, vegetables, and whole-grain products that contain complex carbohydrates and are a great source of energy.
More words to the wise: Don't forget to pay attention to portion sizes and cooking methods, as both are very important in limiting caloric intake. Again, you must determine the amount of energy you need to reach your ideal body weight and adjust your caloric intake accordingly. A registered dietitian can help, but the rule of thumb is that regular exercise is key to maintaining weight loss and reducing sugar levels.
I know I have given you a general guide instead of a specific diet, in the hope that you can craft a plan that meets your particular needs, and one that you can maintain over the course of your life. Diabetes risk is a lifelong risk, and the changes you make in your diet and exercise plan should be long-term behavioral adaptations. Remember — an overall healthy diet, good weight maintenance, and regular exercise are key in reducing the odds of developing diabetes.
— Susan,
A:Congratulations! First, you recognize the predisposition you carry to the disease. Second, you are motivated to beat the odds. The good news is that there is something you can do to prevent diabetes. Two recent large studies have found that healthy habits can stave off diabetes among those who are at risk. These habits include eating a balanced diet, getting regular exercise, and maintaining a healthy weight. Of course, I understand if your eyes are glazing over, since this is the same mantra for everything from improving skin health to reducing the risk of heart disease and certain types of cancer. But seriously, a healthful diet should accomplish several things:
1.Provide an adequate amount of vitamins, minerals, proteins, and essential fatty acids
2.Help you lose weight
3.Be pleasing to your palate
4.Be a plan that you can maintain for the rest of your life.
There are many registered dietitians who can help design a plan for you. The specific composition of a diet that meets your body's needs depends on your age, current health condition, and health risks, including diabetes. But simply put, if you make sure that every meal contains a variety of sources of vitamins and minerals, two of your meals contain one source of protein, and you use olive or canola oil (in lieu of animal fat), you should be able to meet most of your needs.
A quick way to ensure that you are consuming all that your body needs is to make your plate as colorful as you can. The colors of vegetables and fruits are an indication of the different vitamins they contain. You should also think outside the box when it comes to protein sources, which should include not only animal products such as meat, chicken, fish, cheese, milk, and eggs but also plant-based products such as soybeans/tofu, nuts, and legumes. Generally, the more plant-based protein sources you ingest, the fewer calories you consume.
While you concentrate on including vitamins, minerals, and proteins in your diet, you mustn't forget that carbohydrates matter. We need carbohydrates as energy sources, and whole grains as a source of various vitamins and fiber. There are two categories of carbohydrates: simple and complex. If you remember anything, remember this: Avoid simple carbohydrates such as white bread, white-flour pasta, cakes, candy, and table sugar. Instead, focus on fruits, vegetables, and whole-grain products that contain complex carbohydrates and are a great source of energy.
More words to the wise: Don't forget to pay attention to portion sizes and cooking methods, as both are very important in limiting caloric intake. Again, you must determine the amount of energy you need to reach your ideal body weight and adjust your caloric intake accordingly. A registered dietitian can help, but the rule of thumb is that regular exercise is key to maintaining weight loss and reducing sugar levels.
I know I have given you a general guide instead of a specific diet, in the hope that you can craft a plan that meets your particular needs, and one that you can maintain over the course of your life. Diabetes risk is a lifelong risk, and the changes you make in your diet and exercise plan should be long-term behavioral adaptations. Remember — an overall healthy diet, good weight maintenance, and regular exercise are key in reducing the odds of developing diabetes.
Saturday, March 12, 2011
Are Pedicures Safe for A Diabetic
Q: I have diabetes. Is it safe to get a pedicure?
— Mica,
A:The short answer is no, you shouldn't get a pedicure. You have to be careful not to expose yourself to potential infection, skin breaks, and other foot damage.
Before you go to a nail salon, it's best to see your doctor first. He or she will examine your feet for any signs of poor circulation, reduced sensation, skin damage, foot or nail infection, or bone and joint changes. Based on this exam, your doctor will advise you on whether or not you should have a pedicure. If there is any immediate concern, you may also be told to see a podiatrist — a foot doctor. Podiatrists can trim nails, remove calluses, and treat warts safely. They can also correct any deformity that might lead to further damage and advise about daily foot care.
If there is no significant abnormality in your feet, then you can safely get a pedicure. You will, however, need to ask for some special treatment because of your diabetes. In general, unless you are visiting a specialized salon that is familiar with diabetic foot care, avoid getting your nails trimmed or your cuticles removed. Also, do not allow any sharp objects to be used on your feet. If you are getting a pedicure for the first time, talk with the salon personnel regarding their disinfection procedures. Examine the place, and observe how they sterilize and care for their tools. Alternatively, you can bring your own tub and supplies (a soft pumice stone, nail polish) to the salon.
In general, to keep your feet healthy and prevent complications, it's important that you stay well hydrated and prevent your skin from becoming dry. Avoid products that might cause your skin to peel or products that contain steroids. Examine your feet daily for any skin breaks and seek care from your doctor or podiatrist promptly if you observe any problems.
— Mica,
A:The short answer is no, you shouldn't get a pedicure. You have to be careful not to expose yourself to potential infection, skin breaks, and other foot damage.
Before you go to a nail salon, it's best to see your doctor first. He or she will examine your feet for any signs of poor circulation, reduced sensation, skin damage, foot or nail infection, or bone and joint changes. Based on this exam, your doctor will advise you on whether or not you should have a pedicure. If there is any immediate concern, you may also be told to see a podiatrist — a foot doctor. Podiatrists can trim nails, remove calluses, and treat warts safely. They can also correct any deformity that might lead to further damage and advise about daily foot care.
If there is no significant abnormality in your feet, then you can safely get a pedicure. You will, however, need to ask for some special treatment because of your diabetes. In general, unless you are visiting a specialized salon that is familiar with diabetic foot care, avoid getting your nails trimmed or your cuticles removed. Also, do not allow any sharp objects to be used on your feet. If you are getting a pedicure for the first time, talk with the salon personnel regarding their disinfection procedures. Examine the place, and observe how they sterilize and care for their tools. Alternatively, you can bring your own tub and supplies (a soft pumice stone, nail polish) to the salon.
In general, to keep your feet healthy and prevent complications, it's important that you stay well hydrated and prevent your skin from becoming dry. Avoid products that might cause your skin to peel or products that contain steroids. Examine your feet daily for any skin breaks and seek care from your doctor or podiatrist promptly if you observe any problems.
Thursday, March 10, 2011
Whole-Fat Milk and Cheese Can Lower Diabetes Risk
The incidence of Type 2 diabetes declined significantly as levels of a fatty acid found in whole-fat dairy products increased....
Adults with the highest levels of trans-palmitoleic acid had a 60% lower diabetes incidence compared with individuals who had the lowest levels. Higher levels of the fatty acid also were associated with a more favorable metabolic profile.
Multivariate analyses of demographic, clinical, and lifestyle factors showed that whole-fat dairy consumption had the strongest association with levels of trans-palmitoleate. However, the authors remained circumspect about the association.
Dariush Mozaffarian, MD, DrPH, of the Harvard School of Public Health, and coauthors wrote in conclusion that, "Our results demonstrate an inverse relationship between levels of trans-palmitoleate and metabolic risk factors and diabetes incidence."
"The small differences in trans-palmitoleate levels raise questions about whether this is the active compound or a marker for some other, unknown protective constituent of dairy or other ruminant foods."
The findings support previous evidence of favorable associations between whole-fat dairy consumption and metabolic factors. The authors speculated that trans-palmitoleate could exert effects on pathways related to insulin resistance, dyslipidemia, and hepatic fat synthesis.
A product of endogenous fat synthesis, circulating palmitoleic acid has been associated with protection against insulin resistance and metabolic dysregulation in experimental models. Studies in humans, however, have yielded mixed results, the authors wrote in the introduction to their findings.
Efforts to study circulating palmitoleic acid have been confounded by the effects of endogenous synthesis and metabolism. The trans isomer of palmitoleate represents an endogenous source of the fatty acid and avoids confounding endogenous effects. Derived primarily from naturally occurring dairy and other ruminant trans fats, trans-palmitoleate is not associated with increased cardiovascular risk, in contrast to trans fats derived from partially hydrogenated oils.
"In fact, several studies have demonstrated inverse associations between dairy consumption and risk for insulin resistance, the metabolic syndrome, or diabetes," the authors continued. "To our knowledge, no previous studies have evaluated a potential role of trans-palmitoleate in metabolic risk."
The patient cohort of the Cardiovascular Health Study provided an opportunity to examine associations between trans-palmitoleate, metabolic risk factors, and risk of Type 2 diabetes. Mozaffarian and coauthors analyzed data on 3,736 study participants, all of whom were 65 or older and were identified from Medicare eligibility lists.
Baseline assessments included physical examination, diagnostic testing, questionnaires about health status, and laboratory evaluation that included measurement of 45 different fatty acids. Study participants were followed for 10 years, including annual clinic visits and interim telephone calls.
Laboratory results showed that trans-palmitoleate accounted for an average of 0.18% of total fatty acid. Levels had a strong correlation with known biomarkers of dairy-fat consumption but a weak correlation with biomarkers of partially hydrogenated oils.
Whole-fat dairy consumption had the strongest association with trans-palmitoleate levels. Separate analyses of different types of dairy foods further refined the association by showing that levels of the fatty acid were most closely associated with whole-milk consumption. Levels of trans-palmitoleate were not significantly related to consumption of carbohydrates, protein, red meat, or low-fat dairy foods.
In multivariate analyses, higher trans-palmitoleate levels were significantly associated with:
Lower body mass index (-1.8%, P=0.058)
Smaller waist circumference (-1.8%, P=0.009)
Higher levels of HDL cholesterol (1.9%, P=0.043)
Lower triglyceride levels (-19.0%, P<0.001)
Lower total cholesterol:HDL ratio (-4.7%, P<0.001)
Lower levels of C-reactive protein (-13.8%, P=0.050)
Lower fasting insulin levels (-13.3%, P=0.001)
Less insulin resistance by homeostasis model (-16.7%, P<0.001)
During follow-up, 304 study participants developed new-onset diabetes. In adjusted analyses, comparison of trans-palmitoleate quintiles showed that participants in quintiles 4 and 5 had diabetes hazard ratios of 0.44 and 0.36, respectively, compared with quintile 1 (P<0.001 for trend).
"Each higher standard deviation of trans-palmitoleate was associated with a 28% lower risk of diabetes," the authors wrote.
Acknowledging limitations of the study, Mozaffarian and colleagues noted that trans-palmitoleate levels were measured at a single point in time and that food intake was based on self-reports. They also pointed out that causality cannot be determined due to the possibility of residual confounding and that "the small differences in trans palmitoleate levels raise questions about whether this is the active compound or a marker for some other, unknown protective constituent of dairy or other ruminant foods."
Adults with the highest levels of trans-palmitoleic acid had a 60% lower diabetes incidence compared with individuals who had the lowest levels. Higher levels of the fatty acid also were associated with a more favorable metabolic profile.
Multivariate analyses of demographic, clinical, and lifestyle factors showed that whole-fat dairy consumption had the strongest association with levels of trans-palmitoleate. However, the authors remained circumspect about the association.
Dariush Mozaffarian, MD, DrPH, of the Harvard School of Public Health, and coauthors wrote in conclusion that, "Our results demonstrate an inverse relationship between levels of trans-palmitoleate and metabolic risk factors and diabetes incidence."
"The small differences in trans-palmitoleate levels raise questions about whether this is the active compound or a marker for some other, unknown protective constituent of dairy or other ruminant foods."
The findings support previous evidence of favorable associations between whole-fat dairy consumption and metabolic factors. The authors speculated that trans-palmitoleate could exert effects on pathways related to insulin resistance, dyslipidemia, and hepatic fat synthesis.
A product of endogenous fat synthesis, circulating palmitoleic acid has been associated with protection against insulin resistance and metabolic dysregulation in experimental models. Studies in humans, however, have yielded mixed results, the authors wrote in the introduction to their findings.
Efforts to study circulating palmitoleic acid have been confounded by the effects of endogenous synthesis and metabolism. The trans isomer of palmitoleate represents an endogenous source of the fatty acid and avoids confounding endogenous effects. Derived primarily from naturally occurring dairy and other ruminant trans fats, trans-palmitoleate is not associated with increased cardiovascular risk, in contrast to trans fats derived from partially hydrogenated oils.
"In fact, several studies have demonstrated inverse associations between dairy consumption and risk for insulin resistance, the metabolic syndrome, or diabetes," the authors continued. "To our knowledge, no previous studies have evaluated a potential role of trans-palmitoleate in metabolic risk."
The patient cohort of the Cardiovascular Health Study provided an opportunity to examine associations between trans-palmitoleate, metabolic risk factors, and risk of Type 2 diabetes. Mozaffarian and coauthors analyzed data on 3,736 study participants, all of whom were 65 or older and were identified from Medicare eligibility lists.
Baseline assessments included physical examination, diagnostic testing, questionnaires about health status, and laboratory evaluation that included measurement of 45 different fatty acids. Study participants were followed for 10 years, including annual clinic visits and interim telephone calls.
Laboratory results showed that trans-palmitoleate accounted for an average of 0.18% of total fatty acid. Levels had a strong correlation with known biomarkers of dairy-fat consumption but a weak correlation with biomarkers of partially hydrogenated oils.
Whole-fat dairy consumption had the strongest association with trans-palmitoleate levels. Separate analyses of different types of dairy foods further refined the association by showing that levels of the fatty acid were most closely associated with whole-milk consumption. Levels of trans-palmitoleate were not significantly related to consumption of carbohydrates, protein, red meat, or low-fat dairy foods.
In multivariate analyses, higher trans-palmitoleate levels were significantly associated with:
Lower body mass index (-1.8%, P=0.058)
Smaller waist circumference (-1.8%, P=0.009)
Higher levels of HDL cholesterol (1.9%, P=0.043)
Lower triglyceride levels (-19.0%, P<0.001)
Lower total cholesterol:HDL ratio (-4.7%, P<0.001)
Lower levels of C-reactive protein (-13.8%, P=0.050)
Lower fasting insulin levels (-13.3%, P=0.001)
Less insulin resistance by homeostasis model (-16.7%, P<0.001)
During follow-up, 304 study participants developed new-onset diabetes. In adjusted analyses, comparison of trans-palmitoleate quintiles showed that participants in quintiles 4 and 5 had diabetes hazard ratios of 0.44 and 0.36, respectively, compared with quintile 1 (P<0.001 for trend).
"Each higher standard deviation of trans-palmitoleate was associated with a 28% lower risk of diabetes," the authors wrote.
Acknowledging limitations of the study, Mozaffarian and colleagues noted that trans-palmitoleate levels were measured at a single point in time and that food intake was based on self-reports. They also pointed out that causality cannot be determined due to the possibility of residual confounding and that "the small differences in trans palmitoleate levels raise questions about whether this is the active compound or a marker for some other, unknown protective constituent of dairy or other ruminant foods."
Tuesday, March 8, 2011
Diabetic socks: More than meets the toe
With so much emphasis placed on proper diabetic footwear, especially for those who suffer from peripheral neuropathy, patients with diabetes may not realize how crucial the size, fit, fiber, and construction of socks also are. Since socks are an integral part of treatment, the following do’s and don’ts may help practitioners educate patients about proper sock selection and wear.
Do’s
Do prescribe specially constructed, seamless socks that have a soft, flexible, and stretchy toe area where the material is joined.
Do advise patients of the dangers of wearing socks with any irregularities, including darned socks or socks with holes. A seam, wrinkling, or a tiny fold can generate friction, creating microtrauma that can lead to ulceration and worse.
Do prescribe socks made of high quality fibers. They will last longer and wear evenly, instead of leaving thin spots where friction can occur.
Do look for socks made of stretchy synthetics with moisture-wicking properties to minimize the risk of infection and blisters. Any natural fibers should be blended with synthetics and make up a small portion of the total fiber content.
Do choose socks with antibacterial properties. Socks made with silver and copper fibers have been shown to decrease bacteria and combat foot odor.
Do pay attention to fit. Good diabetic socks conform to the foot and resist wrinkling inside the shoe. The best therapeutic socks fit no more than two shoe sizes and offer a range of four or five sizes to choose from.
Do prescribe therapeutic socks with silicone padding to reduce plantar pressure in patients with neuropathy. The padded socks are also a good choice for diabetic patients with rheumatoid arthritis. Double padding can be achieved by wearing two pairs of the socks, one inside the other. To accommodate the extra thickness, the shoe size needs to increase by at least 1/2 size, or suggest the patient wear the socks with extra-depth shoes.
Do make sure patients buy an adequate number of pairs to avoid the temptation to wear the same socks twice or revert to nondiabetic socks.
Do ensure that socks are not causing callus buildup or corns. The presence of a callus or corn on the surface of the foot should be a warning sign that abnormal skin shear is occurring.
Do tell patients how socks fit into their preventive care plan. Patients who find themselves in the high-risk category for ulcers and amputations should know that wearing properly sized prescription shoes and socks as well as visually inspecting and washing feet every day are all necessary to avoid infection.
Do tell patients who develop an infection not to wear socks until they’ve laundered them with bleach or another disinfectant.
Do stress the importance of regulating blood glucose, exercising, and quitting smoking to minimize the risk of foot ulceration and improve healing.
Don’ts
Don’t prescribe socks that are too tight for patients with poor circulation. If the patient has vascular disease as well as neuropathy, the socks need to have the capability of expanding as the foot and ankle swell.
Don’t prescribe socks that are too loose. They may bunch up, causing friction.
Don’t use socks with metallic fibers to treat infections or ulcers. Just because the sock itself resists bacterial growth does not mean it has been demonstrated to reduce infections on the surface of the foot.
Do’s
Do prescribe specially constructed, seamless socks that have a soft, flexible, and stretchy toe area where the material is joined.
Do advise patients of the dangers of wearing socks with any irregularities, including darned socks or socks with holes. A seam, wrinkling, or a tiny fold can generate friction, creating microtrauma that can lead to ulceration and worse.
Do prescribe socks made of high quality fibers. They will last longer and wear evenly, instead of leaving thin spots where friction can occur.
Do look for socks made of stretchy synthetics with moisture-wicking properties to minimize the risk of infection and blisters. Any natural fibers should be blended with synthetics and make up a small portion of the total fiber content.
Do choose socks with antibacterial properties. Socks made with silver and copper fibers have been shown to decrease bacteria and combat foot odor.
Do pay attention to fit. Good diabetic socks conform to the foot and resist wrinkling inside the shoe. The best therapeutic socks fit no more than two shoe sizes and offer a range of four or five sizes to choose from.
Do prescribe therapeutic socks with silicone padding to reduce plantar pressure in patients with neuropathy. The padded socks are also a good choice for diabetic patients with rheumatoid arthritis. Double padding can be achieved by wearing two pairs of the socks, one inside the other. To accommodate the extra thickness, the shoe size needs to increase by at least 1/2 size, or suggest the patient wear the socks with extra-depth shoes.
Do make sure patients buy an adequate number of pairs to avoid the temptation to wear the same socks twice or revert to nondiabetic socks.
Do ensure that socks are not causing callus buildup or corns. The presence of a callus or corn on the surface of the foot should be a warning sign that abnormal skin shear is occurring.
Do tell patients how socks fit into their preventive care plan. Patients who find themselves in the high-risk category for ulcers and amputations should know that wearing properly sized prescription shoes and socks as well as visually inspecting and washing feet every day are all necessary to avoid infection.
Do tell patients who develop an infection not to wear socks until they’ve laundered them with bleach or another disinfectant.
Do stress the importance of regulating blood glucose, exercising, and quitting smoking to minimize the risk of foot ulceration and improve healing.
Don’ts
Don’t prescribe socks that are too tight for patients with poor circulation. If the patient has vascular disease as well as neuropathy, the socks need to have the capability of expanding as the foot and ankle swell.
Don’t prescribe socks that are too loose. They may bunch up, causing friction.
Don’t use socks with metallic fibers to treat infections or ulcers. Just because the sock itself resists bacterial growth does not mean it has been demonstrated to reduce infections on the surface of the foot.
Saturday, March 5, 2011
Can Diabetes Be Cured?
Q: I'm 47 years old and was recently diagnosed with diabetes. I'm about 25 pounds overweight and lead a sedentary lifestyle, but I'm starting a diet and an exercise program. Will my diabetes go away if I lose weight, watch my diet, and exercise regularly?
— Mary, Kansas City
A: It is wonderful that you are changing your lifestyle to become healthier! This will benefit you greatly, not only in controlling your blood sugar but also in improving your cholesterol levels, strengthening your bones, and improving your heart function. These changes come with a long list of health benefits, but whether they will allow you to stop taking medicines completely depends on several factors:
The primary cause of your diabetes
The length of time that you had undiscovered, or "hidden," diabetes
The length of time you've had diagnosed diabetes
How well your pancreas is functioning, including how much insulin it is producing, and the extent of insulin resistance associated with excess weight
As you probably know, the cause of diabetes among most adults is twofold. It's caused by insulin resistance resulting from excess weight, and inadequate insulin production in the pancreas. These two causes are also interrelated. Many people whose diabetes is primarily the result of excess weight and insulin resistance can potentially reduce their glucose levels by losing a significant amount of weight and controlling their sugar levels through diet and exercise alone. This assumes that their pancreas is still producing an adequate amount of insulin.
A good number of diabetics, however, have the illness but don't know it for at least five years before diagnosis. This is crucial because over time, the insulin-producing cells in the pancreas decline in function. Often, by the time a patient is diagnosed, a critical number of cells have stopped producing insulin entirely. There is no way to reverse this. If your diabetes is diagnosed early in the disease process, however, aggressive management may help you prevent further loss of function in those cells. This means maintaining your fasting glucose levels below 100mg/dl and your after-meal (two hours after) levels below 140 mg/dl. This is the same for morning and evening glucose levels.
It is also entirely possible for some people to control their blood glucose with diet alone. I have a few patients who have been able to do so. All are producing adequate insulin, have lost weight or are within their ideal body-weight range, and watch their diets.
— Mary, Kansas City
A: It is wonderful that you are changing your lifestyle to become healthier! This will benefit you greatly, not only in controlling your blood sugar but also in improving your cholesterol levels, strengthening your bones, and improving your heart function. These changes come with a long list of health benefits, but whether they will allow you to stop taking medicines completely depends on several factors:
The primary cause of your diabetes
The length of time that you had undiscovered, or "hidden," diabetes
The length of time you've had diagnosed diabetes
How well your pancreas is functioning, including how much insulin it is producing, and the extent of insulin resistance associated with excess weight
As you probably know, the cause of diabetes among most adults is twofold. It's caused by insulin resistance resulting from excess weight, and inadequate insulin production in the pancreas. These two causes are also interrelated. Many people whose diabetes is primarily the result of excess weight and insulin resistance can potentially reduce their glucose levels by losing a significant amount of weight and controlling their sugar levels through diet and exercise alone. This assumes that their pancreas is still producing an adequate amount of insulin.
A good number of diabetics, however, have the illness but don't know it for at least five years before diagnosis. This is crucial because over time, the insulin-producing cells in the pancreas decline in function. Often, by the time a patient is diagnosed, a critical number of cells have stopped producing insulin entirely. There is no way to reverse this. If your diabetes is diagnosed early in the disease process, however, aggressive management may help you prevent further loss of function in those cells. This means maintaining your fasting glucose levels below 100mg/dl and your after-meal (two hours after) levels below 140 mg/dl. This is the same for morning and evening glucose levels.
It is also entirely possible for some people to control their blood glucose with diet alone. I have a few patients who have been able to do so. All are producing adequate insulin, have lost weight or are within their ideal body-weight range, and watch their diets.
Friday, March 4, 2011
Meal Replacements Don't Help Obese Teens
Dietetic shakes and prepackaged entrees help obese teenagers lose weight loss at first. But "meal replacements" were no better than a standard low-calorie diet for helping young people continue losing weight over the course of a year....
Dr. Robert L. Berkowitz, Children's Hospital of Philadelphia, and his team note in their report that swapping regular meals for shakes, bars or prepackaged entrees can be a useful weight loss strategy for adults.
One reason that these meal replacements may work is that they take the guesswork out of dieting; people often sharply underestimate their calorie intake when they eat regular foods. Given that adolescents also underestimate how many calories they consume, the researchers sought to investigate whether meal replacements might be helpful for them, too.
The researchers randomly assigned 113 obese teens and their families to one of three regimens for a year: (1) a standard 1,300- to 1,500-calorie-a-day diet; (2) four months of meal replacements (three SlimFast shakes, one prepackaged entrée, and five servings of fruits and vegetables per day) followed by eight months on the conventional diet; or (3) an entire year of meal replacements.
At four months, patients in the meal replacement groups had reduced their body mass index (BMI) by a mean of 6.3%, compared to 3.8% for teens in the low-calorie diet group.
But by the end of the year, there was no significant difference in mean BMI reduction between the three groups: 2.8% for the low-calorie diet group, 3.9% with four months of meal replacements, and 3.4% with a year of meal replacements.
One-third of the patients dropped out of the study. Among those who stuck with it, adherence waned as time wore on. By the end of 12 months, the researchers note, the meal-replacement group reported using SlimFast only 1.6 days a week, compared with 5.6 days a week in month two.
"The potential benefit of (meal replacement) in maintaining weight loss was not supported," the researchers conclude, and further study is needed to find ways of getting obese teens to start diets and stay on them.
Dr. Robert L. Berkowitz, Children's Hospital of Philadelphia, and his team note in their report that swapping regular meals for shakes, bars or prepackaged entrees can be a useful weight loss strategy for adults.
One reason that these meal replacements may work is that they take the guesswork out of dieting; people often sharply underestimate their calorie intake when they eat regular foods. Given that adolescents also underestimate how many calories they consume, the researchers sought to investigate whether meal replacements might be helpful for them, too.
The researchers randomly assigned 113 obese teens and their families to one of three regimens for a year: (1) a standard 1,300- to 1,500-calorie-a-day diet; (2) four months of meal replacements (three SlimFast shakes, one prepackaged entrée, and five servings of fruits and vegetables per day) followed by eight months on the conventional diet; or (3) an entire year of meal replacements.
At four months, patients in the meal replacement groups had reduced their body mass index (BMI) by a mean of 6.3%, compared to 3.8% for teens in the low-calorie diet group.
But by the end of the year, there was no significant difference in mean BMI reduction between the three groups: 2.8% for the low-calorie diet group, 3.9% with four months of meal replacements, and 3.4% with a year of meal replacements.
One-third of the patients dropped out of the study. Among those who stuck with it, adherence waned as time wore on. By the end of 12 months, the researchers note, the meal-replacement group reported using SlimFast only 1.6 days a week, compared with 5.6 days a week in month two.
"The potential benefit of (meal replacement) in maintaining weight loss was not supported," the researchers conclude, and further study is needed to find ways of getting obese teens to start diets and stay on them.
Thursday, March 3, 2011
A Closer Look At New Developments In Diabetes
The prevalence of diabetes is increasing rapidly and is expected to reach epidemic proportion over the next decade. Recent research estimates that the number of people diagnosed with diabetes will rise from 23.7 million to 44.1 million between 2009 and 2034.1 The Centers for Disease Control and Prevention (CDC) further predict that up to one-third of U.S. adults could have diabetes by 2050 if Americans continue to gain weight and avoid exercise.2
Diabetes is associated with a myriad of complications with foot ulcerations being the most common. An estimated 15 percent of all patients with diabetes will develop foot ulcers.3 About half of these ulcers become infected and 20 percent of those patients will end up with some form of lower extremity amputation.3 With the prevalence of diabetes dramatically increasing, billions of dollars are spent in the field of diabetes research for the early diagnosis, prevention and management of this disease.
With that said, here is a closer look at current research in the field of diabetes and emerging methods of disease management.
What You Should Know About Biomarkers For Diabetes
Researchers are constantly studying biomarkers to help predict the possibility of developing certain diseases. Biomarkers can indicate a change in the expression or state of a protein that correlates with the risk or progression of a disease, or with the susceptibility of the disease to a given treatment.
Recently, researchers from the United Kingdom have reported that microRNA (MiR) can help identify people who are likely to develop type 2 diabetes even before the onset of symptoms.4 MicroRNAs are classes of approximately 22 non-coding nucleotide regulatory ribonucleic acid (RNA) molecules that play important roles in controlling the developmental and physiological processes.5 Specifically, microRNAs regulate gene expression including differentiation and development by either inhibiting translation or inducing target degradation. MicroRNAs can also help serve as diagnostic markers to identify those who are at high risk of developing coronary and peripheral arterial disease.
In a study of 822 people, researchers identified five specific microRNA molecules with an abnormally low concentration in blood in people with diabetes and in those who subsequently went on to develop the disorder.6 One molecule in particular, microRNA 126 (MiR-126), was among the most reliable predictors of current and future diabetes. MiR-126 is known to help with angiogenesis and regulate the maintenance of vasculature. Healthy blood vessel cells are able to release substantial quantities of MiR-126 into the bloodstream.
However, when endothelial damage occurs, the cells retain MiR-126 and subsequently release less MiR-126 into the bloodstream. A decrease in plasma MiR-126 can therefore be an indicator of blood vessel damage and cardiovascular disease. Researchers also found that levels of MiR were lower when they gave large amounts of sugar to mice with a genetic propensity to develop diabetes.6 The MiR test can directly assess vascular endothelial damage secondary to diabetes and has a fairly low cost at around $3 per test. Clinicians may possibly be able to use this in conjunction with conventional tests in the near future.
Plasma thrombin activatable fibrinolysis inhibitor (TAFI) antigen is another biomarker that may participate in arterial thrombosis in cardiovascular diseases and may be involved in the mechanism of vascular endothelial damage in patients with diabetes.
Erdogan and colleagues investigated the association of plasma TAFI antigen level in the development of diabetic foot ulcers in people with type 2 diabetes.7 Specifically, researchers determined TAFI antigen levels in plasma samples in 50 patients with diabetic foot ulcers, 34 patients with diabetes but without diabetic foot ulcers, and 25 healthy individuals. The diabetic foot ulcer group and the diabetic non-ulcer group were similar in terms of mean age and sex distribution.
The researchers found TAFI levels to be significantly elevated in patients with diabetes with or without foot ulcers in comparison to the healthy controls. However, there was no difference in TAFI levels between the diabetic foot ulcer group and diabetic non-ulcer group, or between diabetic foot ulcer stages.
As research in this arena continues, a new class of blood markers may give additional insight to screen people who are at a higher risk of developing diabetes and intervene before the symptoms and the broad spectrum of associated complications occur.
Can An Artificial Pancreas System Enhance Glucose Control?
The artificial pancreas is a technology that is best described as a closed loop glucose management system that is intended to afford patients with diabetes better glucose control while averting the hypoglycemic state.8 With the advancement of technologies, newer artificial pancreas systems consist of a real-time continuous glucose monitoring (CGM) system. This system transmits information every one to five minutes from an under the skin sensor to a handheld receiver that can be integrated into a pump. The device also has an insulin pump with a pre-programmed algorithm that calculates appropriate insulin dosages based on the glucose ratings.
A potential imperfection to this CGM system is that the system reads glucose levels from the patient’s interstitial fluid as opposed to the actual blood glucose levels. The interstitial compartment has a lag time of eight to ten minutes and can affect the glucose readings, especially postprandial readings.
The insulin pump is a beeper-sized device that is flexibly attached via a tube in the tissue just under the skin and will release as per patient requirement. Some partial “half-loop” solutions are available in Europe and the FDA has recently approved three of the closed loop systems. Meticulous testing is still needed before the system can go on the market.9
Emerging Insights On Stem Cell Advances
With islet cell transplantation research quickly on the rise to help regenerate the disordered islet cells of the pancreas, we have seen much promise in stem cell research. Ideally, the in vitro generation of insulin-producing cells from stem or progenitor cells presents a promising approach to overcome the scarcity of donor pancreases for cell replacement therapy in people with diabetes.10
In an ongoing study, researchers at the Diabetes Research Institute are assessing the effects of biohybrid devices, also known as “scaffolds,” to house and protect the transplanted insulin producing cells.11 These “scaffolds” are designed to mimic the pancreatic environment and are being tested in different areas of the body that include the abdominal pouch, muscle tissue or subcutaneously. Furthermore, the “scaffolds” are also being tested to deliver favorable agents that may help promote the growth and viability of the transplanted islet cells.
Current studies are very optimistic in showing that these “scaffolds” co-transplanted with mesenchymal stem cell regenerative islet cells can help accelerate angiogenesis, which prolongs the longevity and functionality of islet cell regeneration.12
Encouraging Patient Adherence: What Recent Studies Reveal
Patient adherence is one of the many challenges in the treatment and management of diabetes. For years, physicians have been researching new methods in tracking patient adherence to glucose monitoring and management, and to pressure mitigation devices.
In an article published in the Annals of Family Medicine, researchers looked at the participation levels of patients with type 2 diabetes in their primary care check-up visits.13 Several offices sent questionnaires to these patients regarding their treatment goals and plans at the initial visit as well as follow-up visits. Researchers found that the more patients participated in their treatment decisions and management, the better they adhered to the prescribed medications and treatment. This resulted in better control of their diabetes.
Another study compared the efficacy of a reciprocal peer support program with that of nurse care management in 244 men with diabetes in two Veterans Affairs healthcare facilities.14 Researchers matched patients in the reciprocal peer support group with another age-matched peer patient and were encouraged to talk via telephone and participate in optional group sessions. Patients in the nurse care management group attended a 1.5-hour educational session and were assigned to a nurse care manager.
After six months, the mean hemoglobin A1C level for patients in the peer support program decreased from 8.02% to 7.73% while it increased from 7.93% to 8.22% in the nurse care management group.14 This was statistically significant.
Both studies support the notion that some patient empowerment in their treatment decisions and management may translate into better long-term outcomes.
In Conclusion
Diabetes is estimated to impose more than $174 billion dollars per year on United States healthcare. This astounding financial toll is expected to continue to rise as more and more people are diagnosed with this debilitating disease.2 In addition to being aware of the plethora of current research, patient education and preventative care are important strategies to emphasize. It is through innovative research, teamwork and preventative strategies that we continue to gain successful outcomes and improvement in the prevention and management of diabetes and its complications.
VOLUME: 24 PUBLICATION DATE: Jan 01 2011
Author(s):David A. Farnen, BS, and Stephanie C. Wu, DPM, MSc
Diabetes is associated with a myriad of complications with foot ulcerations being the most common. An estimated 15 percent of all patients with diabetes will develop foot ulcers.3 About half of these ulcers become infected and 20 percent of those patients will end up with some form of lower extremity amputation.3 With the prevalence of diabetes dramatically increasing, billions of dollars are spent in the field of diabetes research for the early diagnosis, prevention and management of this disease.
With that said, here is a closer look at current research in the field of diabetes and emerging methods of disease management.
What You Should Know About Biomarkers For Diabetes
Researchers are constantly studying biomarkers to help predict the possibility of developing certain diseases. Biomarkers can indicate a change in the expression or state of a protein that correlates with the risk or progression of a disease, or with the susceptibility of the disease to a given treatment.
Recently, researchers from the United Kingdom have reported that microRNA (MiR) can help identify people who are likely to develop type 2 diabetes even before the onset of symptoms.4 MicroRNAs are classes of approximately 22 non-coding nucleotide regulatory ribonucleic acid (RNA) molecules that play important roles in controlling the developmental and physiological processes.5 Specifically, microRNAs regulate gene expression including differentiation and development by either inhibiting translation or inducing target degradation. MicroRNAs can also help serve as diagnostic markers to identify those who are at high risk of developing coronary and peripheral arterial disease.
In a study of 822 people, researchers identified five specific microRNA molecules with an abnormally low concentration in blood in people with diabetes and in those who subsequently went on to develop the disorder.6 One molecule in particular, microRNA 126 (MiR-126), was among the most reliable predictors of current and future diabetes. MiR-126 is known to help with angiogenesis and regulate the maintenance of vasculature. Healthy blood vessel cells are able to release substantial quantities of MiR-126 into the bloodstream.
However, when endothelial damage occurs, the cells retain MiR-126 and subsequently release less MiR-126 into the bloodstream. A decrease in plasma MiR-126 can therefore be an indicator of blood vessel damage and cardiovascular disease. Researchers also found that levels of MiR were lower when they gave large amounts of sugar to mice with a genetic propensity to develop diabetes.6 The MiR test can directly assess vascular endothelial damage secondary to diabetes and has a fairly low cost at around $3 per test. Clinicians may possibly be able to use this in conjunction with conventional tests in the near future.
Plasma thrombin activatable fibrinolysis inhibitor (TAFI) antigen is another biomarker that may participate in arterial thrombosis in cardiovascular diseases and may be involved in the mechanism of vascular endothelial damage in patients with diabetes.
Erdogan and colleagues investigated the association of plasma TAFI antigen level in the development of diabetic foot ulcers in people with type 2 diabetes.7 Specifically, researchers determined TAFI antigen levels in plasma samples in 50 patients with diabetic foot ulcers, 34 patients with diabetes but without diabetic foot ulcers, and 25 healthy individuals. The diabetic foot ulcer group and the diabetic non-ulcer group were similar in terms of mean age and sex distribution.
The researchers found TAFI levels to be significantly elevated in patients with diabetes with or without foot ulcers in comparison to the healthy controls. However, there was no difference in TAFI levels between the diabetic foot ulcer group and diabetic non-ulcer group, or between diabetic foot ulcer stages.
As research in this arena continues, a new class of blood markers may give additional insight to screen people who are at a higher risk of developing diabetes and intervene before the symptoms and the broad spectrum of associated complications occur.
Can An Artificial Pancreas System Enhance Glucose Control?
The artificial pancreas is a technology that is best described as a closed loop glucose management system that is intended to afford patients with diabetes better glucose control while averting the hypoglycemic state.8 With the advancement of technologies, newer artificial pancreas systems consist of a real-time continuous glucose monitoring (CGM) system. This system transmits information every one to five minutes from an under the skin sensor to a handheld receiver that can be integrated into a pump. The device also has an insulin pump with a pre-programmed algorithm that calculates appropriate insulin dosages based on the glucose ratings.
A potential imperfection to this CGM system is that the system reads glucose levels from the patient’s interstitial fluid as opposed to the actual blood glucose levels. The interstitial compartment has a lag time of eight to ten minutes and can affect the glucose readings, especially postprandial readings.
The insulin pump is a beeper-sized device that is flexibly attached via a tube in the tissue just under the skin and will release as per patient requirement. Some partial “half-loop” solutions are available in Europe and the FDA has recently approved three of the closed loop systems. Meticulous testing is still needed before the system can go on the market.9
Emerging Insights On Stem Cell Advances
With islet cell transplantation research quickly on the rise to help regenerate the disordered islet cells of the pancreas, we have seen much promise in stem cell research. Ideally, the in vitro generation of insulin-producing cells from stem or progenitor cells presents a promising approach to overcome the scarcity of donor pancreases for cell replacement therapy in people with diabetes.10
In an ongoing study, researchers at the Diabetes Research Institute are assessing the effects of biohybrid devices, also known as “scaffolds,” to house and protect the transplanted insulin producing cells.11 These “scaffolds” are designed to mimic the pancreatic environment and are being tested in different areas of the body that include the abdominal pouch, muscle tissue or subcutaneously. Furthermore, the “scaffolds” are also being tested to deliver favorable agents that may help promote the growth and viability of the transplanted islet cells.
Current studies are very optimistic in showing that these “scaffolds” co-transplanted with mesenchymal stem cell regenerative islet cells can help accelerate angiogenesis, which prolongs the longevity and functionality of islet cell regeneration.12
Encouraging Patient Adherence: What Recent Studies Reveal
Patient adherence is one of the many challenges in the treatment and management of diabetes. For years, physicians have been researching new methods in tracking patient adherence to glucose monitoring and management, and to pressure mitigation devices.
In an article published in the Annals of Family Medicine, researchers looked at the participation levels of patients with type 2 diabetes in their primary care check-up visits.13 Several offices sent questionnaires to these patients regarding their treatment goals and plans at the initial visit as well as follow-up visits. Researchers found that the more patients participated in their treatment decisions and management, the better they adhered to the prescribed medications and treatment. This resulted in better control of their diabetes.
Another study compared the efficacy of a reciprocal peer support program with that of nurse care management in 244 men with diabetes in two Veterans Affairs healthcare facilities.14 Researchers matched patients in the reciprocal peer support group with another age-matched peer patient and were encouraged to talk via telephone and participate in optional group sessions. Patients in the nurse care management group attended a 1.5-hour educational session and were assigned to a nurse care manager.
After six months, the mean hemoglobin A1C level for patients in the peer support program decreased from 8.02% to 7.73% while it increased from 7.93% to 8.22% in the nurse care management group.14 This was statistically significant.
Both studies support the notion that some patient empowerment in their treatment decisions and management may translate into better long-term outcomes.
In Conclusion
Diabetes is estimated to impose more than $174 billion dollars per year on United States healthcare. This astounding financial toll is expected to continue to rise as more and more people are diagnosed with this debilitating disease.2 In addition to being aware of the plethora of current research, patient education and preventative care are important strategies to emphasize. It is through innovative research, teamwork and preventative strategies that we continue to gain successful outcomes and improvement in the prevention and management of diabetes and its complications.
VOLUME: 24 PUBLICATION DATE: Jan 01 2011
Author(s):David A. Farnen, BS, and Stephanie C. Wu, DPM, MSc
Tuesday, March 1, 2011
The 15 Worst Health & Diet Myths
15 Worst Health and Diet Myths not to follow my friend told me over lunch recently. We were sitting in a great new Italian restaurant near my office.
“I know,” I replied, scanning the menu. “Everything looks terrific!”
“Yeah, but everything is bad for you!” she exclaimed, practically in tears. “I’m passing on the veal—red meat causes cancer. And the eggplant parmesan—cheese has fat, which gives you high cholesterol. And the bread plate—carbs give you diabetes. I can’t eat anything! And I’m really hungry!”
With those kinds of fears, it’s a wonder my “health-conscious” friend didn’t die of starvation: no protein, and no fat, and no carbs? What’s left? Fortunately, as author of Eat This, Not That!, I was able to calm her lunch plate panic, and explain that most of what we consider “bad for you” foods aren’t bad for you at all—they’re just innocent victims of well-intentioned misinformation. A well-balanced diet, combined with some smart choices, is all you need to lose pounds and keep most of our greatest health worries at bay. But many food and nutrition “myths” persist, confusing our food choices and making weight-loss harder and eating less enjoyable. So relax, and start enjoying food again: Here are 15 food fallacies you can forget for good.
Myth #1: Too much protein hurts your kidneys
Reality: Protein helps burn fat, build muscle, and won’t harm your kidneys at all
Way back in 1983, researchers discovered that eating more protein increases the amount of blood your kidneys filter per minute. Many scientists immediately made the leap that a high-protein diet places your kidneys under greater stress. They were proven wrong. Over the past two decades, several studies have found that while protein-rich meals do increase blood flow to the kidneys, this doesn't have an adverse effect on overall kidney function.
Put the Truth to Work for You: Eat your target body weight in grams of protein daily. For example, if you're a chubby 180-pound woman and want to be a lean 160, have 160 grams of protein a day. If you're a 160-pound guy hoping to pack on 20 pounds of muscle, aim for 180 grams each day.
Bonus Tip: Lose weight fast. Build muscle. Get out of debt. Whatever your resolution for 2011, here's your plan.
Myth #2: Sweet potatoes are healthier than white potatoes
Reality: They’re both healthy!
Sweet potatoes have more fiber and vitamin A, but white potatoes are higher in essential minerals such as iron, magnesium, and potassium. As for the glycemic index, sweet potatoes are lower on the scale, but baked white potatoes typically aren't eaten without cheese, sour cream, or butter—all toppings that contain fat, which lowers the glycemic index of a meal.
Put the Truth to Work for You: The form in which you consume a potato—for instance, a whole baked potato versus a processed potato that's used to make chips—is more important than the type of spud.
Myth #3: Red meat causes cancer
Reality: Research says enjoy the steak!
In a 1986 study, Japanese researchers discovered cancer developing in rats that were fed "heterocyclic amines," compounds that are generated from overcooking meat under high heat. Since then, some studies of large populations have suggested a potential link between meat and cancer. Yet no study has ever found a direct cause-and-effect relationship between red-meat consumption and cancer. The population studies are far from conclusive. They relied on broad surveys of people's eating habits and health afflictions—numbers that illuminate trends, not causes.
Put the Truth to Work for You: Don't stop grilling. Meat lovers who are worried about the supposed risks of grilled meat don't need to avoid burgers and steak—just trim off the burned or overcooked sections of the meat before eating.
Myth #4: High-fructose corn syrup (HFCS) is more fattening than regular sugar
Reality: They’re equally fattening. Beware!
Recent research has show that fructose may cause an increase in weight by interfering with leptin, the hormone that tells us when we’re full. But both HFCS and sucrose—better known as table sugar—contain similar amounts of fructose. There's no evidence to show any differences in these two types of sugar. Both will cause weight gain when consumed in excess. The only particular evil regarding HFCS is that it’s cheaper, and commonly shows up everywhere from bread to ketchup to soda.
Put the Truth to Work for You: HFCS and regular sugar are empty-calorie carbohydrates that should be consumed in limited amounts. How? By keeping soft drinks, sweetened fruit juices, and prepackaged desserts to a minimum.
Myth #5: Too much salt causes high blood pressure
Reality: Perhaps, but too little potassium causes high blood pressure too
Large-scale scientific reviews have determined there's no reason for people with normal blood pressure to restrict their sodium intake. Now, if you already have high blood pressure, you may be "salt sensitive." As a result, reducing the amount of salt you eat could be helpful. However, people with high blood pressure who don't want to lower their salt intake can simply consume more potassium-containing foods—it's really the balance of the two minerals that matters. In fact, Dutch researchers determined that a low potassium intake has the same impact on your blood pressure as high salt consumption does. And it turns out, the average person consumes 3,100 milligrams (mg) of potassium a day—1,600 mg less than recommended.
Put the Truth to Work for You: Strive for a potassium-rich diet—which you can achieve by eating a wide variety of fruits, vegetables, and legumes—and your salt intake won't matter as much. For instance, spinach, broccoli, bananas, white potatoes, and most types of beans each contain more than 400 mg potassium per serving.
Myth #6: Chocolate bars are empty calories
Reality: Dark chocolate is a health food
Cocoa is rich in flavonoids—the same heart-healthy compounds found in red wine and green tea. Its most potent form is dark chocolate. In a recent study, Greek researchers found that consuming dark chocolate containing 100 milligrams (mg) of flavonoids relaxes your blood vessels, improving bloodflow to your heart. And remember: Milk chocolate isn't as rich in flavonoids as dark, so develop a taste for the latter.
Put the Truth to Work for You: Now that you know which "bad" foods aren't actually so awful, you need to know which deceptively dangerous diet-destroying foods to avoid. Check out our must-see slideshow of 25 "Healthy" Foods that Aren’t.
Myth #7: Gas station snacks are nutritional nightmares
Reality: Even at filling stations, you’ll find food that isn’t filling
Beef jerky is high in protein and doesn't raise your level of insulin—a hormone that signals your body to store fat. That makes it an ideal between-meals snack, especially when you're trying to lose weight. And while some beef-jerky brands are packed with high-sodium ingredients such as MSG and sodium nitrate, chemical-free products are available.
Put the Truth to Work for You: Sometimes, the service station is a healthier rest stop than a fast food joint. Heck, even pork rinds are better than you’d think: A 1-ounce serving contains zero carbohydrates, 17 grams (g) of protein, and 9 g fat. That's nine times the protein and less fat than you'll find in a serving of carb-packed potato chips.
Myth #8: Restaurants comply with nutrition disclosure regulations
Reality: Most restaurants would rather load you up with additional cheap calories
Even though many restaurants offer healthy alternatives, you could still be at the whim of the kitchen's cook. A recent E.W. Scripps lab investigation found that "responsible" menu items at chains ranging from Chili's to Taco Bell may have up to twice the calories and eight times the fat published in the restaurants' nutritional information.
Put the Truth to Work for You: Restaurants run from us, but they can't hide. Discover their secrets every day by signing up for our free Eat This, Not That! newsletter or by following me right here on Twitter, and you'll make 2011 the year of your flatter, toner belly!
Myth #9: Sports drinks are ideal after-workout refreshment
Reality: You need more than that to keep your muscles growing
Carb-loaded drinks like Vitaminwater and Gatorade are a great way to rehydrate and reenergize; they help replenish glycogen, your body's stored energy. But they don't always supply the amino acids needed for muscle repair. To maximize post-workout recovery, a protein-carb combination—which those drinks may not offer—can help.
Put the Truth to Work for You: After you suck down that sports drink, eat a bowl of 100 percent whole-grain cereal with nonfat milk, suggests a 2009 study in the Journal of the International Society of Sports Nutrition. A glass of low-fat chocolate milk is a good choice as well.
Myth #10: You need 38 grams of fiber a day
Reality: More fiber is better, but 38 is nearly impossible
That's the recommendation from the Institute of Medicine. And it's a lot, equaling nine apples or more than a half dozen bowls of instant oatmeal. (Most people eat about 15 grams of fiber daily.) The studies found a correlation between high fiber intake and lower incidence of heart disease. But none of the high-fiber-eating groups in those studies averaged as high as 38 grams, and, in fact, people saw maximum benefits with a daily gram intake averaging from the high 20s to the low 30s.
Put the Truth to Work for You: Just eat sensibilty. Favor whole, unprocessed foods. Make sure the carbs you eat are fiber-rich—that means produce, legumes, and whole grains—because they'll help slow the aborption of sugar into your bloodstream.
Myth #11: Saturated fat will clog your heart
Reality: Fat has gotten a bum rap
Most people consider turkey, chicken, and fish healthy, yet think they should avoid red meat—or only choose very lean cuts—since they've always been told that it's high in saturated fat. But a closer look at beef reveals the truth: Almost half of its fat is a monounsaturated fat called oleic acid—the same heart-healthy fat that's found in olive oil. Second, most of the saturated fat in beef actually decreases your heart-disease risk—either by lowering LDL (bad) cholesterol, or by reducing your ratio of total cholesterol to HDL (good) cholesterol.
Put the Truth to Work for You: We're not giving you permission to gorge on butter, bacon, and cheese. No, our point is this: Don't freak out about saturated fat. There's no scientific reason that natural foods containing saturated fat can't, or shouldn't, be part of a healthy diet.
Myth #12: Reduced-fat foods are healthier alternatives
Reality: Less fat often means more sugar
Peanut butter is a representative example for busting this myth. A tub of reduced-fat peanut butter indeed comes with a fraction less fat than the full-fat variety—they’re not lying about that. But what the food companies don’t tell you is that they’ve replaced that healthy fat with maltodextrin, a carbohydrate used as a filler in many processed foods. This means you’re trading the healthy fat from peanuts for empty carbs, double the sugar, and a savings of a meager 10 calories.
Put the Truth to Work for You: When you're shopping, don't just read the nutritional data. Look at the ingredients list as well. Here's a guideline that never fails: The fewer ingredients, the healthier the food.
Myth #13: Diet soda is better for you
Reality: It may lead to even greater weight gain
Just because diet soda is low in calories doesn’t mean it can’t lead to weight gain. It may have only 5 or fewer calories per serving, but emerging research suggests that consuming sugary-tasting beverages—even if they’re artificially sweetened—may lead to a high preference for sweetness overall. That means sweeter (and more caloric) cereal, bread, dessert—everything. In fact, new research found that people who drink diet soda on a daily basis have an increased risk of developing type 2 diabetes and metabolic syndrome.
Put the Truth to Work for You: These days, the world of food is full of nasty surprises like this one, and knowledge is power. Check out Eat This, Not That! 2011 and Cook This, Not That! for the best food, nutrition and health secrets, and avoid shocking waistline expanders with our slideshow of 20 Salads Worse Than a Whopper.
Myth #14: Skipping meals helps you lose weight
Reality: Skipping meals, especially breakfast, can make you fat
Not eating can mess with your body's ability to control your appetite. And it also destroys willpower, which is just as damaging. If you skip breakfast or a healthy snack, your brain doesn't have the energy to say no to the inevitable chowfest. The consequences can be heavy: In a 2005 study, breakfast eaters were 30 percent less likely to be overweight or obese.
Put the Truth to Work for You: The perfect breakfast? Eggs, bacon, and toast. It's a nice balance of all the nutritional building blocks—protein, fiber, carbs—that will jumpstart your day. The worst? Waffles or pancakes with syrup. All those carbs and sugars are likely to put you into a food coma by 10 a.m.
Myth #15: You should eat three times a day
Reality: Three meals and two or three snacks is ideal
Most diet plans portray snacking as a failure. But by snacking on the right foods at strategic times, you'll keep your energy levels stoked all day. Spreading six smaller meals across your day operates on the simple principle of satisfaction: Frequent meals tame the slavering beast of hunger.
“I know,” I replied, scanning the menu. “Everything looks terrific!”
“Yeah, but everything is bad for you!” she exclaimed, practically in tears. “I’m passing on the veal—red meat causes cancer. And the eggplant parmesan—cheese has fat, which gives you high cholesterol. And the bread plate—carbs give you diabetes. I can’t eat anything! And I’m really hungry!”
With those kinds of fears, it’s a wonder my “health-conscious” friend didn’t die of starvation: no protein, and no fat, and no carbs? What’s left? Fortunately, as author of Eat This, Not That!, I was able to calm her lunch plate panic, and explain that most of what we consider “bad for you” foods aren’t bad for you at all—they’re just innocent victims of well-intentioned misinformation. A well-balanced diet, combined with some smart choices, is all you need to lose pounds and keep most of our greatest health worries at bay. But many food and nutrition “myths” persist, confusing our food choices and making weight-loss harder and eating less enjoyable. So relax, and start enjoying food again: Here are 15 food fallacies you can forget for good.
Myth #1: Too much protein hurts your kidneys
Reality: Protein helps burn fat, build muscle, and won’t harm your kidneys at all
Way back in 1983, researchers discovered that eating more protein increases the amount of blood your kidneys filter per minute. Many scientists immediately made the leap that a high-protein diet places your kidneys under greater stress. They were proven wrong. Over the past two decades, several studies have found that while protein-rich meals do increase blood flow to the kidneys, this doesn't have an adverse effect on overall kidney function.
Put the Truth to Work for You: Eat your target body weight in grams of protein daily. For example, if you're a chubby 180-pound woman and want to be a lean 160, have 160 grams of protein a day. If you're a 160-pound guy hoping to pack on 20 pounds of muscle, aim for 180 grams each day.
Bonus Tip: Lose weight fast. Build muscle. Get out of debt. Whatever your resolution for 2011, here's your plan.
Myth #2: Sweet potatoes are healthier than white potatoes
Reality: They’re both healthy!
Sweet potatoes have more fiber and vitamin A, but white potatoes are higher in essential minerals such as iron, magnesium, and potassium. As for the glycemic index, sweet potatoes are lower on the scale, but baked white potatoes typically aren't eaten without cheese, sour cream, or butter—all toppings that contain fat, which lowers the glycemic index of a meal.
Put the Truth to Work for You: The form in which you consume a potato—for instance, a whole baked potato versus a processed potato that's used to make chips—is more important than the type of spud.
Myth #3: Red meat causes cancer
Reality: Research says enjoy the steak!
In a 1986 study, Japanese researchers discovered cancer developing in rats that were fed "heterocyclic amines," compounds that are generated from overcooking meat under high heat. Since then, some studies of large populations have suggested a potential link between meat and cancer. Yet no study has ever found a direct cause-and-effect relationship between red-meat consumption and cancer. The population studies are far from conclusive. They relied on broad surveys of people's eating habits and health afflictions—numbers that illuminate trends, not causes.
Put the Truth to Work for You: Don't stop grilling. Meat lovers who are worried about the supposed risks of grilled meat don't need to avoid burgers and steak—just trim off the burned or overcooked sections of the meat before eating.
Myth #4: High-fructose corn syrup (HFCS) is more fattening than regular sugar
Reality: They’re equally fattening. Beware!
Recent research has show that fructose may cause an increase in weight by interfering with leptin, the hormone that tells us when we’re full. But both HFCS and sucrose—better known as table sugar—contain similar amounts of fructose. There's no evidence to show any differences in these two types of sugar. Both will cause weight gain when consumed in excess. The only particular evil regarding HFCS is that it’s cheaper, and commonly shows up everywhere from bread to ketchup to soda.
Put the Truth to Work for You: HFCS and regular sugar are empty-calorie carbohydrates that should be consumed in limited amounts. How? By keeping soft drinks, sweetened fruit juices, and prepackaged desserts to a minimum.
Myth #5: Too much salt causes high blood pressure
Reality: Perhaps, but too little potassium causes high blood pressure too
Large-scale scientific reviews have determined there's no reason for people with normal blood pressure to restrict their sodium intake. Now, if you already have high blood pressure, you may be "salt sensitive." As a result, reducing the amount of salt you eat could be helpful. However, people with high blood pressure who don't want to lower their salt intake can simply consume more potassium-containing foods—it's really the balance of the two minerals that matters. In fact, Dutch researchers determined that a low potassium intake has the same impact on your blood pressure as high salt consumption does. And it turns out, the average person consumes 3,100 milligrams (mg) of potassium a day—1,600 mg less than recommended.
Put the Truth to Work for You: Strive for a potassium-rich diet—which you can achieve by eating a wide variety of fruits, vegetables, and legumes—and your salt intake won't matter as much. For instance, spinach, broccoli, bananas, white potatoes, and most types of beans each contain more than 400 mg potassium per serving.
Myth #6: Chocolate bars are empty calories
Reality: Dark chocolate is a health food
Cocoa is rich in flavonoids—the same heart-healthy compounds found in red wine and green tea. Its most potent form is dark chocolate. In a recent study, Greek researchers found that consuming dark chocolate containing 100 milligrams (mg) of flavonoids relaxes your blood vessels, improving bloodflow to your heart. And remember: Milk chocolate isn't as rich in flavonoids as dark, so develop a taste for the latter.
Put the Truth to Work for You: Now that you know which "bad" foods aren't actually so awful, you need to know which deceptively dangerous diet-destroying foods to avoid. Check out our must-see slideshow of 25 "Healthy" Foods that Aren’t.
Myth #7: Gas station snacks are nutritional nightmares
Reality: Even at filling stations, you’ll find food that isn’t filling
Beef jerky is high in protein and doesn't raise your level of insulin—a hormone that signals your body to store fat. That makes it an ideal between-meals snack, especially when you're trying to lose weight. And while some beef-jerky brands are packed with high-sodium ingredients such as MSG and sodium nitrate, chemical-free products are available.
Put the Truth to Work for You: Sometimes, the service station is a healthier rest stop than a fast food joint. Heck, even pork rinds are better than you’d think: A 1-ounce serving contains zero carbohydrates, 17 grams (g) of protein, and 9 g fat. That's nine times the protein and less fat than you'll find in a serving of carb-packed potato chips.
Myth #8: Restaurants comply with nutrition disclosure regulations
Reality: Most restaurants would rather load you up with additional cheap calories
Even though many restaurants offer healthy alternatives, you could still be at the whim of the kitchen's cook. A recent E.W. Scripps lab investigation found that "responsible" menu items at chains ranging from Chili's to Taco Bell may have up to twice the calories and eight times the fat published in the restaurants' nutritional information.
Put the Truth to Work for You: Restaurants run from us, but they can't hide. Discover their secrets every day by signing up for our free Eat This, Not That! newsletter or by following me right here on Twitter, and you'll make 2011 the year of your flatter, toner belly!
Myth #9: Sports drinks are ideal after-workout refreshment
Reality: You need more than that to keep your muscles growing
Carb-loaded drinks like Vitaminwater and Gatorade are a great way to rehydrate and reenergize; they help replenish glycogen, your body's stored energy. But they don't always supply the amino acids needed for muscle repair. To maximize post-workout recovery, a protein-carb combination—which those drinks may not offer—can help.
Put the Truth to Work for You: After you suck down that sports drink, eat a bowl of 100 percent whole-grain cereal with nonfat milk, suggests a 2009 study in the Journal of the International Society of Sports Nutrition. A glass of low-fat chocolate milk is a good choice as well.
Myth #10: You need 38 grams of fiber a day
Reality: More fiber is better, but 38 is nearly impossible
That's the recommendation from the Institute of Medicine. And it's a lot, equaling nine apples or more than a half dozen bowls of instant oatmeal. (Most people eat about 15 grams of fiber daily.) The studies found a correlation between high fiber intake and lower incidence of heart disease. But none of the high-fiber-eating groups in those studies averaged as high as 38 grams, and, in fact, people saw maximum benefits with a daily gram intake averaging from the high 20s to the low 30s.
Put the Truth to Work for You: Just eat sensibilty. Favor whole, unprocessed foods. Make sure the carbs you eat are fiber-rich—that means produce, legumes, and whole grains—because they'll help slow the aborption of sugar into your bloodstream.
Myth #11: Saturated fat will clog your heart
Reality: Fat has gotten a bum rap
Most people consider turkey, chicken, and fish healthy, yet think they should avoid red meat—or only choose very lean cuts—since they've always been told that it's high in saturated fat. But a closer look at beef reveals the truth: Almost half of its fat is a monounsaturated fat called oleic acid—the same heart-healthy fat that's found in olive oil. Second, most of the saturated fat in beef actually decreases your heart-disease risk—either by lowering LDL (bad) cholesterol, or by reducing your ratio of total cholesterol to HDL (good) cholesterol.
Put the Truth to Work for You: We're not giving you permission to gorge on butter, bacon, and cheese. No, our point is this: Don't freak out about saturated fat. There's no scientific reason that natural foods containing saturated fat can't, or shouldn't, be part of a healthy diet.
Myth #12: Reduced-fat foods are healthier alternatives
Reality: Less fat often means more sugar
Peanut butter is a representative example for busting this myth. A tub of reduced-fat peanut butter indeed comes with a fraction less fat than the full-fat variety—they’re not lying about that. But what the food companies don’t tell you is that they’ve replaced that healthy fat with maltodextrin, a carbohydrate used as a filler in many processed foods. This means you’re trading the healthy fat from peanuts for empty carbs, double the sugar, and a savings of a meager 10 calories.
Put the Truth to Work for You: When you're shopping, don't just read the nutritional data. Look at the ingredients list as well. Here's a guideline that never fails: The fewer ingredients, the healthier the food.
Myth #13: Diet soda is better for you
Reality: It may lead to even greater weight gain
Just because diet soda is low in calories doesn’t mean it can’t lead to weight gain. It may have only 5 or fewer calories per serving, but emerging research suggests that consuming sugary-tasting beverages—even if they’re artificially sweetened—may lead to a high preference for sweetness overall. That means sweeter (and more caloric) cereal, bread, dessert—everything. In fact, new research found that people who drink diet soda on a daily basis have an increased risk of developing type 2 diabetes and metabolic syndrome.
Put the Truth to Work for You: These days, the world of food is full of nasty surprises like this one, and knowledge is power. Check out Eat This, Not That! 2011 and Cook This, Not That! for the best food, nutrition and health secrets, and avoid shocking waistline expanders with our slideshow of 20 Salads Worse Than a Whopper.
Myth #14: Skipping meals helps you lose weight
Reality: Skipping meals, especially breakfast, can make you fat
Not eating can mess with your body's ability to control your appetite. And it also destroys willpower, which is just as damaging. If you skip breakfast or a healthy snack, your brain doesn't have the energy to say no to the inevitable chowfest. The consequences can be heavy: In a 2005 study, breakfast eaters were 30 percent less likely to be overweight or obese.
Put the Truth to Work for You: The perfect breakfast? Eggs, bacon, and toast. It's a nice balance of all the nutritional building blocks—protein, fiber, carbs—that will jumpstart your day. The worst? Waffles or pancakes with syrup. All those carbs and sugars are likely to put you into a food coma by 10 a.m.
Myth #15: You should eat three times a day
Reality: Three meals and two or three snacks is ideal
Most diet plans portray snacking as a failure. But by snacking on the right foods at strategic times, you'll keep your energy levels stoked all day. Spreading six smaller meals across your day operates on the simple principle of satisfaction: Frequent meals tame the slavering beast of hunger.
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