Thursday, December 30, 2010

Do You Really Want to Take the Ayurvedic Herb Coccinia cordifolia for Type 2 Diabetes?

A few months ago we repeated the glowing reports on the Ayurvedic herb Coccinia cordifolia, also known as koval or ivy gourd:

"At the beginning of the study, the average fasting blood sugar in the test group was 132 mg/dl (7.3 mmol/L), and the average post-prandial (after-eating) blood sugar was 183 mg/dl (10.2 mmol/L).

The effects of the herb gradually increased over 90 days. By the end of the third month of the clinical trial, the average fasting blood glucose among the diabetics who got the herb had fallen to 111 mg/dl (6.2 mmol/L), while the diabetics who did not get the herb actually had slightly higher morning blood glucose levels. Among the diabetics getting the herb, post-prandial (after-eating) blood sugars also improved, to an average slightly below 150 mg/dl (8.3 mmol/L). The improvement in blood sugar levels was confirmed by an average drop of 0.6 per cent in HbA1C.

The researchers noted that similar percentages of diabetics getting the herb (94 per cent) and diabetics getting the placebo (93 per cent) were able to stick to their diabetic diets. The difference in blood sugars was due to the herb."

And we stand by this report. However, it turns out there is another effect of the herb. It increases women's fertility by increasing estrogen, which leads to greater thickening of the lining of the uterus for the reception of the fertilized egg, if any,and by counteracting prolactin, which stimulates milk production in new mothers and which also stops ovulation. Reducing the response of a woman's body to prolactin may also (1) increase sexual arousal but (2) shorten orgasm, although these effects do not happen in every woman who takes the herb.

Whether all of this is a good thing or a bad thing, of course, is not for us to decide. But we do want our readers who are women of reproductive age to know that using this herb for diabetes may make pregnancy more likely, and may influence a woman's sex life. There are no corresponding effects in men or in women who have passed menopause.

Wednesday, December 29, 2010

Chinese Herbs that Actually Help Type 2 Diabetics: Coptis

Coptis is a Chinese herb that tastes terrible but that is highly likely to help you lower blood sugar levels, triglyceride levels, and keep your arteries healthy. This extraordinarily nasty tasting "detoxifying" herb is often brewed into a tea to be drunk three times a day, but when the herb is appropriate, the taste of the herbal medicine is greatly outweighed by the herbal benefits.

Coptis, also known by its botanical name, Coptidis chinensis, and as goldenthread or  huang lian, is familiar to herbalists as a source of berberine. While the herb has been used in both Chinese and Ayurvedic medicine for at least 2,500 years, most of what science knows about the way the herb works is from studies of berberine in the laboratory.

  • Stops some inflammatory processes,
  • Prevents damage to the lining of blood vessels caused by high blood sugars,
  • Blocks protein loss in muscle, and
  • Reduces insulin resistance caused by high-fat diet.
All of these benefits are strongly indicated in lab studies. Precisely how coptis works in the human body under clinical conditions is a different matter. Studies in China, where coptis is a common treatment for type 2 diabetes, have found that the berberine in coptis has some advantages over insulin. The most troubling issue for most type 2 diabetics who use drugs that increase insulin production or who take insulin is that insulin doesn't just help store sugar, it also helps store fat. The berberine in coptis moves sugar out of the bloodstream, but it does not also transport fat.

And unlike Actos and Avandia, berberine does not stimulate the creation of new fat cells. One clinical trial in China found coptis (which is the source of berberine) to as useful as Actos, Avandia, and metformin for lowering blood sugar levels.

Should you run out and buy coptis, or related herbs such as barberry, goldenseal, or Oregon grape root? Should look for an online source of the classic Chinese diabetes detox Huang Lian Jie Du Tang or "berberine capsules?'While these herbs will probably help lower your blood sugar levels, they can also cause a "colicky" reaction if you have colitis or irritable bowel syndrome. Women should not use them when pregnant or breastfeeding. The effects on blood sugar levels are not likely to be tremendous, but coptis usually can help type 2 diabetics keep blood sugar levels in control without gaining weight.

Selected Reference:

Affuso F, Mercurio V, Fazio V, Fazio S. Cardiovascular and metabolic effects of Berberine. World J Cardiol. 2010 Apr 26;2(4):71-7.

Tuesday, December 28, 2010

Chinese Herbs that Actually Help Type 2 Diabetics: Astragalus

Chinese herbal medicine is alternately praised and panned for treatment of all kinds of diseases. The problem with Chinese herbal medicine is usually one of two things. People either assume that "if it's an herb, it's good" and take the wrong herb or herbal formula, or they get a product that isn't what it's labeled to be. Fortunately, some Chinese herbs for diabetics not only are generally useful, they are also generally labeled truthfully.

One of these herbs is astragalus. Actually, astragalus is a genus name for about 200 plants in the bean family. These beans are low growing prairie or pasture plants with rows of leaves that come in pairs. The family contains milk vetch, which is a favorite of grazing milk cows, and a number of plants that are greatly favored by sheep and goats. The plant that is used in traditional Chinese medicine is Astragalus propinquus. It's the plant herbalists are actually referring to when they say "astragalus." In Chinese it's known as huáng qí or "yellow leader." The root is the part that is used in medicine, and it's off-yellow to bright yellow when dried.

The way astragalus helps diabetics is by increasing the production of a hormone known as adiponectin. Adiponectin is a hormone made in the adipose, or fat, cells. It's an extremely helpful hormone for type 2 diabetics. It slows down the rate at which the liver releases sugar. It stimulates muscle cells to take sugar out of the bloodstream, lowering blood sugar levels. It increases the burning of fat, and it lowers triglycerides.

Astragalus is not the only product available to type 2 diabetics that increases adiponectin levels. The drugs Actos and Avandia do this, too. The difference with astragalus is that it increases adiponectin levels through a different biochemical process, and the herb does not have the side effects that drugs do. And it's enormously less expensive.

We don't sell astragalus (or any other herbs). You can find good brands of astragalus in many herb shops. It's such an inexpensive herb that it's almost always sold unadulterated. Astragalus by itself is not a cure for diabetes, but it may be a great help in treating insulin resistance, and using it may help you get along with smaller doses of Actos or Avandia. Always consult your physician before changing your use of any prescription drug.

Selected Reference:

Xu A, Wang H, Hoo RL, Sweeney G, Vanhoutte PM, Wang Y, Wu D, Chu W, Qin G, Lam KS. Selective elevation of adiponectin production by the natural compounds derived from a medicinal herb alleviates insulin resistance and glucose intolerance in obese mice. Endocrinology. 2009 Feb;150(2):625-33. Epub 2008 Oct 16

Diabetes and Bone Problems

Two of the most common diseases in midlife and beyond are type 2 diabetes and osteoporosis, the weakening of once-healthy bones. It turns out that that the two conditions are related.

The common chemical in both type 2 diabetes and osteoporosis is an inflammation-causing molecule known as tumor necrosis factor alpha, abbreviated TNF-α. This inflammation factor is not inherently a bad thing. It acts as a beacon to white blood cells searching for sites of infection. It also causes fever, and helps the body clear away dead tissue. But that last function is the problem when people have diabetes.

When someone has poorly controlled type 2 diabetes, the body makes more TNF-α. This substance stimulates the bones to make osteoclasts, which are the clean up crew for aging bone. If you have just enough osteoclasts, then aging or dead cells in your bones are taken away so a different kind of cell, called an osteoblast, can make new bone. But in many people who have diabetes, the osteoclasts are stimulated a lot more than osteoblasts, so bone gets broken down faster than it can get built up.

What can diabetics do about this additional complication of high blood sugar levels? The very best treatment is to keep blood sugar levels normal. It also helps to avoid treatment with Actos and Avandia (pioglitazone and rosiglitazone). These drugs stimulate the production of baby fat cells inside bones, causing them to break. If you possibly can, it helps to lose excess body fat, since the problem hormone is made in your fat cells.

It also helps to make sure you get enough antioxidants (especially vitamin C, vitamin E, and selenium) from your food and you get enough vitamin D. These help your bones retain the calcium and other minerals that keep them strong. And if you get gentle exercise, strengthening your muscles helps your bones keep their proper shape. Some supplements may also help, but not as much as monitoring your diet and exercise so you keep your blood sugar levels right.

If you happen to be into herbal medicine, the herb cat's claw will help, but you have to take it in a certain way for it to be useful for stopping inflammation. You need to use a tincture, and you also need to add a few drops of lemon juice or vinegar into a 1/4 cup (60 ml) of water into which you add the cat's claw. This makes the tannins in the herb absorbable so they actually enter circulation. Don't add vinegar or lemon juice to the bottle of tincture itself.

Selected Reference:

Alblowi J, Kayal RA, Siqueira M, McKenzie E, Krothapalli N, McLean J, Conn J, Nikolajczyk B, Einhorn TA, Gerstenfeld L, Graves DT:. High Levels of TNF-%u03B1 Contribute to Accelerated Loss of Cartilage in Diabetic Fracture Healing. Am J Pathol, 2009 175: 1574-1585

Monday, December 27, 2010

Did What Your Father Ate Make You Diabetic?

As unlikely as it sounds, obesity and type 2 diabetes may not be caused by what you eat. They may be caused by what your father or grandfather didn't eat.

Scientists reporting research in the journal Cell have found that male mice who are starved activate certain genes in their livers that cause greater release of sugars from stored food. When they later mate and have offspring, the offspring also have these genes activated, even if they never have contact with their fathers, and even if they are not starved. When the offspring are given a normal diet, they become obese and diabetic. This effect is passed on at least to the third generation.

Studies of survivors of famine in World War II have also found greatly increased rates of diabetes in the children of people who had little to eat during their childhood, regardless of the diet eaten by the second generation. The effects are even greater in the grandchildren of World War II famine survivors. This does not mean that your diabetes may be your parents' or grandparents' fault, but it does mean that you may have to control it by very careful diet.

Selected Reference:

Benjamin R. Carone, Lucas Fauquier, Naomi Habib, Jeremy M. Shea, Caroline E. Hart, Ruowang Li, Christoph Bock, Chengjian Li, Hongcang Gu, Phillip D. Zamore, Alexander Meissner, Zhiping Weng, Hans A. Hofmann, Nir Friedman, Oliver J. Rando. Paternally Induced Transgenerational Environmental Reprogramming of Metabolic Gene Expression in Mammals. Cell, 2010; 143 (7): 1084-1096 DOI: 10.1016/j.cell.2010.12.008

What's Bugging Type 2 Diabetics?

It's well know that type 2 diabetes is on the rise around the world. Furthermore, as we tell our readers over and over again, the inflammatory changes that eventually cause type 2 diabetes are preceded by another set of inflammatory reactions that cause weight gain. Something other than simple overeating is making people gain weight and, in many cases, then become diabetic. But what is it that is bugging so many type 2 diabetics?

The answer may be "gut bugs," or the bacteria that live in the colon. When we eat, we don't just nourish ourselves. We also nourish the trillions of bacteria that live inside our digestive tract.

Some of these bacteria break down fibers that can't be digested by the human digestive tract into sugars that flow into the bloodstream. Overeating encourages the growth of Bacteriodetes and Firmicutes bacteria that in turn release enzymes that stop the flow of fatty acids out of fat cells--making sure there's more left for them. Eating modestly encourages the growth of Bifidobacterium and Lactobacillus bacteria, the healthy bacteria that replace the bad ones. When this happens, fat cells don't get the bacterial message to store fat, and weight loss is easier.

What this means is that some kinds of bacteria make overeating pack on even more pounds and other kinds of bacteria make dieting even more effective for weight loss. When you go on a diet, make sure to eat yogurt or to take a probiotic supplement several times a day to keep the fat-packing bacteria in check. Yogurts that contain a variety of healthy bacteria, not just Lactobacillus, are even more likely to help.

Thursday, December 16, 2010

Can Eating Apple Pie Really Lower Your Blood Sugar Levels?

In our inbox today we have a "doctor's" testimony that eating apple pie can lower blood sugar levels if that pie just contains one simple, secret ingredient, which is revealed to be cinnamon. While Robert is a red blooded American who loved his late mom and apple pie and Australian Bev likes apples, too, the idea that adding everyday cinnamon to apple makes it lower your blood sugar levels is a bald faced lie.

There are numerous fallacies in the article we received, but the major one is that the cinnamon used to make apple pies is the same cinnamon tested by researchers Drs. Karalee Jarvill-Taylor, Donald Graves, and Richard Anderson at the University of Iowa at Ames several years ago and continued by Dr. Anderson and his colleagues at the US Department of Agriculture several years ago.

The cinnamon used to make apple pie is a red, zesty, aromatic spice taken from the plant Cinnamomum verum. The cinnamon you get in over the counter capsules to lower your blood sugar is a gray, dull, not particularly aromatic spice taken from the plant Cinnamomum cassia. And Dr. Anderson did his experiments on yet another form of cinnamon Cinnamomum burmannii. There actually are apple pies made with this third kind of cinnamon, but it's the "cheap stuff," not the "good stuff."

Anderson and his colleagues found that when this third kind of cinnamon is heated in the presence of water to about the boiling point of water, it forms a chain of molecules to make a polymer called methylhydroxychalcone. This polymer in turn does some of the same things that insulin does at fat cells. To a limited extent, it can "park" sugar from your bloodstream in your fat cells. Of course, this makes fat cells fatter. And it isn't just any kind of fat cell that this particular kind of cinnamon works on. Methylhydroxychalcone is active on 3T3-L1 fat cells, the kind that concentrate in belly fat. And if you really want to feed your belly fat, all we can say is Nuts!

But the effect isn't so great that is makes apple pie a medicine, the more you eat, the lower your blood sugars will go!

Don't believe us. Put cinnamon in and on your apple pie. There's no point in adding so much cinnamon your pie doesn't taste good, especially since German scientists have discovered that using 10 to 100 times more cinnamon than you need can result in cinnamon poisoning.

Take your blood sugar levels. Eat the pie. Take your blood sugar levels again 60 minutes later. Do write in if they are lower. We have never heard of such a thing. And if you aren't taking your blood sugar levels, how would you really know? Do you really want to trust your health to some author who doesn't want you to test to find out if he's telling you the truth?

If we seem a little hot and bothered about this article, well, we are. It is hard enough to explain the real virtues of herbal medicine, and we have 17 articles on cinnamon on this site, without people busily making things up just to sell you products. But don't take our word for it. Be your own expert. The one way to know for sure if something really helps you manage or even reverse your diabetes is to test, test, and test again!

Tuesday, December 14, 2010

Vitamin D and Diabetes

noted author on natural health claims "Vitamin D is better than metformin (a common prescription drug) for diabetes!" Is she right?

Well, the answer to whether vitamin D is as good as metformin the lowering blood sugars and controlling diabetes is probably yes and no.

Almost 20 years ago Swedish scientists discovered that taking a vitamin D supplement helps control blood sugars in diabetic men if they are vitamin D deficient (and it slightly lowers blood pressure in others).

And if the diabetic is not vitamin D deficient? What are the symptoms of shortage of vitamin D?

In acute vitamin D deficiency, there's almost always bone fracture or bone pain. Otherwise, at deficiency levels that are a problem for diabetics and not for non-diabetics, it's hard to tell. The skin makes vitamin D when exposed to sunlight. People who get more sunlight, at least in North American culture, tend to exercise more. So whether it's the vitamin D or the exercise that's controlling high blood glucose levels in diabetes is hard to tell.

But are you vitamin D deficient?

In the winter months, if you live anywhere in Europe or Russia, north of Atlanta, Dallas, or San Diego in North America, north of Shanghai or Seoul or Tokyo in Asia, or south of Buenos Aires or Sydney or Auckland in the Southern Hemisphere, you probably are. A daily dose of up to 1000 IU (25 micrograms) a day may be helpful to your general health.

Recent reader questions:

Q. How long does it take to correct a vitamin D Deficiency?

A. Improved blood sugar control is usually measurable in two to three weeks. Recovery of bone health may take up to a year.

Q. What are the best sources of vitamin d in foods?

A. Cod liver oil, real butter, and cream. That's why a lot of people prefer the supplements.

Curcumin and Coenzyme Q10 for Congestive Heart Failure

Millions of type 2 diabetics who have used Actos (pioglitazone) or Avandia (rosiglitazone) suffer congestive heart failure. Since their condition came as a side effect of medication for diabetics, many diabetics understandably want to try natural therapies such as curcumin, the antioxidant component of the herb turmeric. While curcumin may be very helpful for congestive heart failure, an even better natural approach to supporting congestive heart failure is to add coenzyme Q10.

Curcumin acts outside the cells of the heart. It keeps fibrin "fibers" from sticking to platelets and slows down the production of blood clots, keeping blood flowing. Curcumin amplifies the effects of anticoagulant medications (and you shouldn't use curcumin if you're on an anti-coagulant without consulting your doctor). Anticoagulant medications like clopidogrel (Plavix), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, ticlopidine (Ticlid) and warfarin (Coumadin) act primatily by slowing the production of fibrin in the liver, while curcumin slows down the action of fibrin once it leaves the liver.

Coenzyme Q10, also known as CoQ10 or ubiquinone, acts inside the cells of the heart. To date, there are no known drug interations with this supplement.

CoQ10 is made by the same physiological processes that the body uses to make cholesterol, and statin drugs to lower cholesterol also lower CoQ10. What CoQ10 does in the heart is capture electrons released in the production of energy in the heart cell's mitochondria. Every cell in the heart works 24/7, so the heart needs more CoQ10 than almost any other organ in the body. When there's not enough CoQ10, the heart can't pump blood efficiently.

Several studies have found that supplementing with 100-200 mg of CoQ10 a day may:

  • Reduce angina and other heart pain
  • Increase walking distance
  • Reduce the thickness of the heart muscle and heart wall in "enlarged heart"
  • Decrease incidents of breathlessness (dyspnea), particularly breathlessness at rest
  • Lower stress on the kidneys associated with congestive heart failure, and
  • Reduce frequency of hospitalization

But does CoQ10 specifically relieve congestive heart failure?

The answer is that it seems to be very helpful, but it's not necessarily a cure-all. That's because doctors can't "see" the effects of CoQ10 when they do ultrasounds of the heart--but that could be because it acts inside the cell, not outside it.

There are very few downsides to CoQ10 treatment. If you take Coumadin (warfarin), be sure to tell your doctor you're taking CoQ10; he or she can be on the outlook for any unusual changes in your PT times (clotting factors) that may start after you take the supplement.

And, like curcumin, CoQ10 is better absorbed when it is taken with bioperine. You can choose a slightly more expensive supplement that combines CoQ10 with bioperine, or just use a little more black pepper than usual on your food.

Curcumin and Hawthorn for Congestive Heart Failure in Type 2 Diabetics

Type 2 diabetics, especially those who have used Actos (pioglitazone) and Avandia (rosiglitazone), often suffer congestive heart failure. Standardized extracts of hawthorn berries, flowers, and leaves are a well-known and even doctor-recommended therapy for congestive heart failure. Hawthorn can be an excellent add-on to congestive heart failure support with curcumin, because the two natural products "open circulation" in different ways.

Curcumin prevents clots. Unlike anticoagulants that stop the production of fibrin "fibers" in the liver, curcumin slows down the rate at which fibrin can form clots along the lining of blood vessels.

Hawthorn helps the arteries relax. When the heart muscle is stressed, white blood cells known as neutrophils release a compound known as human neutrophil elastase (HNE). This elastase makes arteries more "elastic," lowering blood pressure and making it easier for the heart to do its job.

The process of relaxing the arteries, however, releases enormous volumes of free radicals that interfere with the action on L-carnitine. What hawthorn does it to "catch" the free radicals and preserve L-carnitine, which in turn allows the heart to make energy with a minimum of oxygen.

Regular use of hawthorn also stimulates the liver to use LDL cholesterol to make bile salts, which flow into the colon and are eliminated through bowel movement. And it contains a compound called a vitexin that relaxes blood vessels through a different biochemical pathway.

As a fruit and a "vegetable," hawthorn is non-toxic when consumed in normal doses (and probably is non-toxic if you took 100 times the amount that can benefit your heart). Some people experience mild queasy stomach the first day or two they take the herb. This usually goes away.

Of course, if you take any prescription medication for congestive heart failure or any other health condition, inform your physician so you can take the right doses of all your meds as you benefit from complementary therapy.

For Preventing Progression of Prediabetes to Type 2 Diabetes, Low-Carb Is Better than Low-Fat

The February 2008 edition of the American Journal of Clinical Nutrition told us that despite 50 years of doctors' advice that their patients might prevent diabetes by cutting out fat, it's really better--can this be a surprise--to try to prevent diabetes by cutting out sugar.

The diabetes treatment "establishment" has never particularly cared for Atkins-style diets. Three doctors at the Harvard Medical School and UCLA decided to go through the records of 85,059 participants in the Nurses' Health Study (all of them women) to see if Atkins-style diets might make diabetes more likely, or perhaps less.

This monumental study included 20 years of follow-up.

The researchers gave each woman in the study a score based on the percentages of carbohydrate, protein, and fat they ate. A low score meant the woman followed a low-fat diet. A high score meant the woman followed a low-carb (Atkins-style) diet.

When all 1.7 million woman-years of data were tallied up, the finding was that a high score, that is, a low-carb but higher-protein and higher-fat diet, was associated with a slightly lower risk of diabetes. Score one for the Atkins diet.

But when the researchers looked into the data further, they still found that low-carb was better than low-fat, but they also found that the kinds of fat make a difference, too.

To put it in very plain terms, if you eat a lot of meat and very few carbohydrates you can keep your sugars down if you already have diabetes (or at least lower than they would be if you ate a lot of carbohydrates). But if you don't have diabetes yet, it's better to eat high-protein but lean protein, and to get your fats from vegetable sources, like olive oil, nuts, and seeds.

Women who ate an "Atkins-style diet with a Mediterranean twist" fared best in preventing diabetes. This diet not only seems to protect health, it's also easy to add variety and to get vitamins and antioxidants, as it not only permits but encourages regular eating of small amounts of oil-dressed salads and well-cooked greens. (The diabetes establishment has not begun to look into raw foods diets for diabetes treatment, although they are rapidly becoming more popular.)
So how might you prevent diabetes if you are at risk?

Don't eat sugar.

Do eat the occasional piece of whole-grain bread or the occasional serving of whole-grain pasta. Eat the fresh vegetables and fruits that appeal to you. Eat low-fat meat but don't neglect getting some fat from healthy vegetable sources.

And if you are overweight, and already diabetic, rest assured that fat is not your fault.

When It is Better for Diabetics to Be Couch Potatoes

f you are a diabetic, there may be times that it’s better not to exercise, at least until you get your blood sugars down.

It’s a popular half-truth that exercise always lowers blood glucose levels. The reality is that exercise really does lower blood sugars through an increase in the number and activity of glucose transporters in muscle provided:

· There’s adequate insulin in the bloodstream.
· The period of exercise has to be long enough.
· Blood sugars can’t be too high before exercise, and
· For most diabetics, the exercise is not done within three hours of waking in the morning.

Any exercise that makes you even a little short of breath will release a surge of stress hormones such as cortisol. These stress hormones stimulate the liver to convert glycogen into glucose to make sure the muscles have enough sugar to burn.

If there isn’t enough insulin in circulation, however, glucose can’t be transported into the muscle cells that need it. It’s not unusual for swimming, climbing, weight lifting, or basketball to cause surges to the 300-400 mg/dl (16.5-21 mmmol/L) level in diabetics. If there is not enough injected insulin, or the body’s own insulin is insufficient, exercise, paradoxically, results in higher blood sugar levels, not lower.

Also due to the effects of cortisol and epinephrine, brief strenuous exercise raises blood sugar levels, while prolonged strenuous exercise lowers them. If you exercise for just a minute of two, say, doing one set of six repetitions in your weight lifting routine, the resulting release of cortisol will trigger the liver’s conversion of glycogen to glucose.

The first 1-2 minutes of heavy exercise release the glucose muscles need, but you need another 6-8 minutes for muscles to use the glucose and get blood sugars back down. Prolonged heavy exercise, that is, at least 20 minutes, will increase the rate at which muscles use glucose for their recovery for 1 to 3 hours.

You might consider just lying on the couch if your sugars are over 170 mg/dl (8.5 mmol/L). That’s because the sugar released during exercise has another effect on muscles, creating insulin resistance.

Glucose in the bloodstream can oxidize even before it is absorbed by a cell. This “burning in the bloodstream” releases toxic free radicals that can damage muscle cells.

The cells protect themselves by becoming less responsive to insulin so they do not import either the glucose or the free radicals. Over time, however, they become less and less responsive to insulin even at rest. That’s why exercise to lower unusually high blood sugars generally is not a good idea, unless it is extremely gentle (like walking slowly).

Finally, most diabetics should not be morning exercisers, especially if fasting sugars test as high as sugars throughout the day. The body recycles insulin during sleep, so less insulin is available early in the day. When there isn’t enough insulin, exercise cannot lower sugars.

None of this means that diabetics shouldn’t exercise. Quite the opposite, regular, prolonged, heavy exercise builds up muscles which in turn soak up glucose. To make healthy muscles, however, always start your workout knowing your blood sugars are under control and take steps to ensure they will stay in control throughout.

Prediabetes: Eat Your Veggies to Prevent the Progression of Prediabetes to Type 2 Diabetes

The antioxidants, magnesium, and fiber of vegetables may reduce the risk of developing type-2 diabetes by up to 30 per cent, according to a widely publicized study coming from China.

The study, published in the March 2008 edition of the Journal of Nutrition, tracked the eating habits of 64,191 women aged 40 to 70 in China. Food choices were tracked at the beginning of the study and four-and-a-half years later, and rates of diabetes compared.

Researchers measured intakes of cruciferous vegetables (bok choi, brussels sprouts, broccoli, cabbage, kale, mustard greens, turnip greens, and winter radish), other green leafy vegetables, yellow vegables, onions and garlic, tomatoes, and other vegetables. They also measured consumption of fruit.

The quintile of women eating the most vegetables--an average of 428 grams (nearly a pound) a day--was 28 less likely to become diabetic than the quntile of women eating the least--121.5 grams, or only about 1/4 pound a day. Eating more fruit did not reduce the risk of developing type-2 diabetes.

No particular vegetable stood out as diabetes-protective. The researchers believe that fiber, antioxidants, and magnesium in vegetables may all play an important role in preventing the disease. Generally speaking, vegetables are both relatively low-carb and low-fat, making them useful in almost any diet for weight loss or diabetes prevention. Some vegetables such as broccosprouts seem to have special protective properties, but these veggies are eaten in small amounts almost medicinally.

The authors of the study also pointed out that vitamin C and vitamin E are also known to influence blood glucose levels. Even antioxidant like DHEA may play a role in the ongoing health of people with type-2 diabetes.

And because the study, jointly conducted by the Shanghai Cancer Institute and the Diabetes Research and Training Center in Nashville, Tennessee, only looked at diets of women in China, it is possible the results are not exactly applicable to other populations.

Still, this study is strong evidence that getting a full nine servings of vegetables a day may protect against developing diabetes type-2.

Chromium for Diabetes

Chromium has been identified for a very long time as an essential component of the Glucose Tolerance Factor (GTF), enabling the body to transport glucose out of the bloodstream into cells where it's needed.

The problem with proving this scientifically has been, it's hard to prove anything (by modern standards) by studying just a few people, even if you do the study right. A meta-analytic review of 36 studies found that taking chromium (and I'll comment on how much in just a moment) on average lowered blood glucose levels by 0.8 mmol/L, or in the terms most non-scientists use, 15 mg/dl or so.

Moreover, while no scientist has found that taking chromium lowers your "bad" LDL cholesterol, two studies have found it can greatly increase the "good" HDL cholesterol.

The thing is, sometimes taking less chromium works better than taking more, but taking brewer's yeast (a natural food that contains chromium but delivers a lower amount of it) is even better.

This means if you come across a supplement that promises "New! Improved! More Chromium!" you shouldn't buy it.Further complicating the understanding is the fact that for chromium, as for so many aspects of diabetes, what works in one situation doesn't necessarily work in another.

There's some research that finds that the body wastes chromium, that is, flushes it out into the urine, when it's fed a high glycemic index diet (lots of sugar, flour, rice).

And along those lines, there's other research that suggests that chromium only works for people who really need it, that is, who have especially severe insulin resistance. If you have just a "touch of diabetes," it may not help you.

But if you don't have either diabetes or prediabetes, your fasting blood sugars go down slightly if you provide you body with as little as a 10 microgram daily dose.So does chromium help you or not?

The bottom line of over 400 research studies we've leafed through seems to be that a combination of chromium and the B-vitamin biotin may be helpful for overweight type 2 diabetics at an early stage of treatment. It probably will lower blood sugars 15 mg/dl (0.9 mmol/L) within the first month you take it, but it won't keep on lowering them once your body has all the chromium it needs.

As for helping you lose weight, well, sorry, that effect seems to be due to diarrhea when you take both chromium and metformin or diabetes drugs in the sulfonylurea class. At least the diarrhea is temporary. So's the weight loss.Taking chromium won't do for you what diet, drugs, and insulin can. Getting control over what you're eating and how much you weight is much more important. But chromium can help you get started.

Vitamin C for Diabetes?

What if instead of taking Actos (pioglitazone) or Avandia (rosiglitazone) or Glucophage (metformin), the medication you really needed for blood sugar control in diabetes were vitamin C? A study coming from Iran suggests that for some diabetics, vitamin C might be as useful as many common medications.

Researchers at the Shahid Sadoughi University of Medical Sciences & Health Services followed 84 diabetics given either 500 mg or 1,000 mg of supplemental vitamin C every day for six weeks.

Taking 500 mg of vitamin C every day did not result in any measurable benefits. Diabetics taking 1,000 mg of vitamin C a day, however, had lower fasting blood glucose, lower triglycerides, lower LDL cholesterol, and lower HbA1C in just 42 days.

How much lower?

Average fasting blood glucose levels fell from 169.33 mg/dl to 144.80 mg/dl (9.4 mmol/L to 8 mmol/L).
Average HbA1C fell from 8.82 per cent to 7.66 per cent. (This is better than most medications.)
Average LDL cholesterol fell from 130.95 mg/dl to 125.91 mg/dl.
And the drop in insulin levels was astonishing, from 16.91 microunits per ml to 8.77 microunits per ml.

When there is less insulin, there is less fat storage. Vitamin C should help diabetics keep from gaining weight.

These results suggest that many diabetics may benefit from vitamin C, but the results should be interpreted with some reservations. If you are already on one or several medications, the additional benefits of taking a 1,000 mg vitamin C tablet every day, at least in terms of your blood sugars, triglycerides, and HbA1c, may be limited. Also, vitamin in your blood interacts with the enzymes in blood glucose test strips so that the glucometer reading is low, while the actual blood sugar is higher.

It's also possible that using vitamin C for several months can, like using R-lipoic or alpha-lipoic acid, give you a reduction in HbA1C that doesn't really result from improved blood sugars. Doctors test HbA1C to get a rough estimate of how high or low blood sugars have run over several months. Strong antioxidants keep glucose from "sticking" to hemoglobin, so less HbA1C is formed at the same blood sugar level.

The effects of vitamin C on blood sugar measurements of various kinds may not be major, but they do tend to exaggerate the vitamin's benefits. Where vitamin C might really help you is to keep you from gaining weight.

Just get your C from an extended-release formula, and make sure you don't take more than 1,000 mg a day. And if you're really concerned about the question "How much vitamin C should I get daily," be assured you may get some benefits from just 250 mg a day (even though the study did not show this, some other studies suggest it). You don't need high-dose vitamin C crystals or capsules for this indication.

What fruit has the highest content of vitamin C? Acerola, but if you don't live in a tropical location where you can get acerola fresh, just about the only way you can get enough vitamin C to affect blood sugars is to take a supplement.

Vitamin C is also important for diabetics' cardiovascular health.

That's because the amount of vitamin C a diabetic gets may also measure risk of stroke. Among the 20,649 participants in the Norfolk Prospective Population Study in the UK, those whose bloodstream concentrations of vitamin C ranked in the top 25 per cent were 42 per cent less likely to have a stroke than those in the bottom 25 per cent.

This finding does not prove that diabetics can prevent strokes by taking vitamin C, or even confirm with certainty that diabetics can reduce their risk of stroke by taking vitamin C. It is possible that there's some other element of a healthy lifestyle that goes along with getting enough vitamin C that's really protective. This study does show, however, that getting adequate vitamin C certainly does not hurt diabetics' cardiovascular health.

Treating Diabetic Retinopathy Naturally

If you have been diagnosed with diabetic retinopathy, what can you do?

The standard medical recommendation for diabetic retinopathy is laser coagulation surgery. What most diabetics do not realize until after the procedure is, laser surgery tiny blind spots in the filed of vision of the affected eye. As its name suggests, laser coagulation coagulates the proteins in targeted blood vessels. Those areas of the retina no longer receive light, and there is also reduction in night vision and color perception.

But there is a reliable, non-surgical approach. The very best thing any diabetic can do to reduce the risk of and even reverse retinopathy is to keep blood sugars down. This means, preferably, keeping blood sugars low not just every morning, but after meals, too.

The United Kingdom Prospective Diabetes Study, running from 1977 to 1997, studied 5,200 people with type 2 diabetes. By the standards of the time, diabetics who kept their blood sugars down to an average of 165 mg/dl (corresponding to 9.2 mmol/L or an HbA1C of about 7) were considered to achieving “tight control.” Just keeping HbA1C, however diabetics managed to do it, reduced the risk of both diabetic changes to the retina and kidney disease by 25 per cent.

And if diabetics also managed to keep their blood pressure down to an average of 144/82, which by current standards is still “high,” the risk of diabetic changes to the retina dropped by 47 per cent. A much better approach to treating diabetic retinopathy is “tight control” of blood sugars. Nothing you can do does more for eye health that controlling both blood sugars and blood pressure.

And nothing in blood sugar control, at least from the standpoint of preserving vision, is more mportant than avoiding corn syrup and other high-fructose sweeteners. Especially during times of emotional stress, adrenalin-related hormones and high levels of fructose in the bloodstream can synergize to induce high blood pressure, high cholesterol, and high triglycerides, all of which are harmful to the eye. Fresh fruit has one advantage over fructose sweeteners: The fructose in fruit is absorbed more slowly because of the fibers and pectin in the fruit. Diabetics who cannot tolerate fructose sweeteners may be able to tolerate small amounts of fruit.

Some supplements also help. The most useful supplements are inexpensive and free of side effects.

The cells of the retina use magnesium to store energy in the form of ATP, and without magnesium, they cannot use glucose. Diabetics of European descent who have retina damage usually are magnesium-deficient, but diabetics of African descent who have retina damage usually are not. This means that not everybody will be helped by taking a magnesium supplement.

Magnesium citrate and magnesium tartrate are best absorbed. Don’t overdose. Magnesium supplements, like the namesake Milk of Magnesia, can cause diarrhea.
Magnesium supplements will not do you any good if you do not get your B vitamins. Vitamin B6 (pyridoxine) is essential for transporting magnesium into the cell.

Vitamin C supports the production of collagen that keeps the blood vessels in the retina in their normal courses. The retina uses vitamin C to make collagen and hang blood vessels in much the same manner as carpenters hang sheet rock on a wall. All diabetics are at risk for vitamin C deficiency even if they get a lot of vitamin C foods in their diets, but just 100 milligrams a day can be enough to slow down retina changes.

The jury is still out on vitamin E. Researchers at the Joslin Diabetes Center and Harvard found that really high doses of vitamin E in the form of alpha-tocopherol, up to 1,800 milligrams a day, could not just prevent retina changes, but even reverse them. The drawback is, taking that much vitamin E can interfere with various medications you take for your circulatory system. Ask your eye doctor before you start a high dose.

OPCs (oligomeric proanthocyanidins) like the ones found in grape seed extract protect collagen from injury from high blood pressure. They stop a collagen-destructive enzyme. Bilberry works in a simlar manner, and ginkgo may help color vision in milder cases.

What Causes Diabetic Retinopathy?

Five or ten years after the onset of diabetes, many diabetics begin to notice that their vision is just a little fuzzy. They may think they need new glasses, but the changing lens does not help. In far too many cases the visual impairment is diabetic retinopathy, a condition caused by uncontrolled high blood sugars and high blood pressure that can lead to blindness if left untreated.

Diabetic retinopathy can strike both type 1 (insulin-dependent) and type 2 (initially non-insulin dependent) diabetics. There are two types of the disease.

The more common, less serious form of the disease is known as background, nonproliferative, or simple retinopathy. This kind of retina damage is due to increased “leakiness” in the microscopic capillaries providing blood supply to the eye. There can be tiny sites of hemorrhage, swelling, or “oozing,” tiny aneurysms in the retina. Where the blood vessels leak, the visual field is impaired.

The second, less common, and more serious form of the disease is known as proliferative or malignant retinopathy. (The term “malignant” here refers to the severity of the condition, not to any danger of cancer.) Proliferative retinopathy, new blood vessels start growing forward from the retina into the fluid filling the eyeball. There can be scarring, and the fibers supporting the new blood vessels obscure the fall of light onto the retina where images are received and processed to be sent to the brain.

Both kinds of diabetic retinopathy result from a process called glycoslylation. Most diabetics are familiar with glycosylation from the measurement of glycosylated hemoglobin, of HbA1C. When blood sugars stay high, red blood cells eventually become “caramel coated.” They stick to the linings of blood vessels, and the injury slows the flow of blood, which in turn triggers the growth of misplaced, competing, microscopic blood vessels.

One of the risk factors for retinopathy diabetics are seldom warned about is high homocysteine. It’s a special risk factor for any diabetic who has kidney damage. And the damage done by too much homocysteine is compounded by high LDL or low HDL.

And if there’s any dietary additive that can bump up the risk of retinopathy even more than sugar, it’s the sweetener sorbitol. In diabetics and non-diabetics alike, sorbitol is a byproduct of the breakdown of blucose. In non-diabetics, sorbitol can be turned into fructose and flow into circulation. In diabetics, sorbitol, whether a byproduct of burning glucose or absorbed from the bloodstream, stays in the cell. The cell takes in water to dilute the sorbitol and swells, interfering with normal circulation. Sorbitol causes problems all over the body, but especially in the eye.

A reader question:

Q. What's effect of kidney transplants on diabetic retinopathy?

A. Generally, it's positive, but the longer the period of dialysis before transplant, the greater the risk of eye complications after transplant, and the older the kidney, the greater the risk of retinopathy. Drug treatment makes a difference, too. Diabetic retinopathy is accelerated by the administration of recombinant erythropoietin to patients waiting for transplant. Getting off the erythropoietin may halt the progression of retinopathy.

Is Gestational Diabetes Really Diabetes?

Sometimes when women are diagnosed with high blood sugars during pregnancy, that is, with gestational diabetes, their doctors are so casual that they could wonder whether gestational diabetes is really diabetes. After all, some doctors say, you will probably be fine after you deliver, just keep your sugars in control for the time being. The problems is that uncontrolled blood sugars during pregnancy can be the first sign of a kind of diabetes that is neither type 1 nor type 2 called LADA.

While obstetricians will insist that expectant mother's keep their blood sugars in check, after delivery the follow up care for women who have gestational diabetes is usually minimal. There might be one HbA1C reading to make sure it's below 7, and maybe a finger stick or two to make sure the fasting sugars aren't too high. One or two "clean" tests and the diabetes case is closed.

The problem is that women who get gestational diabetes tend to be "blood sugar impaired," but not fully diabetic. Some research published in late 2008 found that women who have diabetes during pregnancy have most but not all of the same genes found in type 2 diabetics of both sexes. They will have normal fasting blood sugars because their beta cells get around to churning out enough insulin to take care of the glucose released from food at night, but they do not make enough insulin to keep blood sugar levels low in the 2-3 hours after meals.

High post-prandial, or "after-meal," sugars can do just as much damage as high fasting sugars, but most doctors never test for them. Over time they can poison the remaining beta cells so that they stop making insulin, leading to diabetes that is only detected after it has done damage.

And, just as some women who have an Rh+ blood type have trouble bearing an Rh- baby, sometimes pregnancy triggers a series of autoimmune reactions that cause a kind of diabetes known as LADA (latent autoimmune diabetes in adults). It's something like juvenile diabetes in adults (and I have it, myself, obviously not because I got pregnant, which would no doubt get me an appearance on Oprah). Both men and women can get the condition, initiated most often by pregnancy in women or a viral infection in men.

Fasting blood sugars are fine because the pancreas retains its ability to produce some insulin, slowly. It just can't produce enough insulin quickly to keep blood sugars down after meals. The problem is, those high blood sugars after meals eventually "burn out" beta cells so blood sugars are high all the time.

If you are a new mother who had gestational diabetes, what should you do? To make sure you don't have LADA or type 2 diabetes that just happened to begin when you became pregnant, test your blood sugars about 2 hours after you eat, at least 3 or 4 times. If you get a reading of over 200 mg/dl (11 mM), first, make sure you didn't just happen to have sugar on your hands. But if you get two readings over 200 mg/dl, see your doctor about follow-up care.

Recent reader questions:

Q. What are acceptable levels for gestational diabetes?

A. I'm assuming you mean blood glucose levels. Blood sugars too high during pregnancy can harm both mother and child, producing unusually large babies and causing difficult delivery. Expectant mothers who have gestational diabetes or any other kind of diabetes should be under a doctor's care, but generally, mothers want to keep their sugars under 125 mg/dl (7 mM) at all times, not just fasting. This gets tricky as you eat for two, but the result is an easier birth and a healthier baby.

How to Avoid the Artery-Clogging Effects of a High-Fat Meal

There are many different ways to prevent heart disease. If you want to avoid the atherogenic (artery clogging) effects of a high-fat meal, Dutch scientists say, the main thing to do is not to eat a second one, at least not within four hours. That is, if you're not diabetic. If you are diabetic, the secret is not to eat carbs and fat at the same time.

Medical researchers at the VU University Medical Center in Amsterdam tested the effects of eating a meal containing 50 grams of fat (about 450 calories from fat), 55 grams of carbohydrate (about 220 calories from carbs), and 30 grams of protein. Their test subjects were healthy men.

The first high-fat meal didn't have a big effect on blood flow, oxidation of LDL cholesterol (which changes it into the form that can "clog"), or blood glucose levels. A second consecutive high-fat meal, however, stiffened the brachial artery, increased the oxidation of LDL into atherogenic forms, and elevated blood sugar levels, even though the clinical study participants were not diabetic.

A single high-fat meal, spaced at least six hours from any other high-fat meals, however, may have a paradoxical effect. A research team at the same university found that in diabetic women, a high-fat meal actually lowered stress on the cardiovascular system, provided it was not accompanied by carbs. For diabetic women and possibly diabetics of both sexes, there's at least some recent evidence that the way to escape the artery-clogging effects of dietary fat is to avoid the carbs.

Recent reader questions:

Q. Can red pepper cure heart diseases?

A. By itself, no, although an Australian research study found that regular consumption of chili peppers by men resulting in measurably slower resting heart rate and seemed to increase the perfusion (spread of oxygen) through the heart. Eating chili sauce won't compensate for eating a basket of tortilla chips followed by the enchilada special.

Q. How does this relate to the benefits of walking with heart disease?

A. Walking long distances will burn fat, and the fewer carbohydrates you have to burn, the more fat your body will use. Real benefits of walking with heart disease kick in after about 90 minutes of walking, however.

Q. What is the best cheap cure for arteriosclerosis?

A. Well, avoiding arterial stress after high-fat meals is free, and a good place to start. But it's not a substitute for a doctor's care.


Tushuizen ME, Nieuwland R, Scheffer PG, Sturk A, Heine RJ, Diamant M. Two consecutive high-fat meals affect endothelial-dependent vasodilation, oxidative stress and cellular microparticles in healthy men. J Thromb Haemost. 2006 May;4(5):1003-10.

Schindhelm RK, Alssema M, Diamant M, Teerlink T, Dekker JM, Kok A, Kostense PJ, Nijpels G, Heine RJ, Scheffer PG. Comparison of two consecutive fat-rich and carbohydrate-rich meals on postprandial myeloperoxidase response in women with and without type 2 diabetes mellitus. Metabolism. 2008 Feb;57(2):262-7.

Natural Therapies for Erectile Dysfunction in Diabetic Men

Erectile dysfunction (ED) is a common problem in men who have had diabetes for five years of longer. Constant high blood sugars eventually "sugar coats" the nerves controlling the blood vessels into the penis. This biochemical caramelizing of nerve fibers takes away their ability to release nitric oxide, the chemical that causes blood vessels to open and engorge the penis with blood to make it erect. Fortunately, there are things diabetic men can do about ED that don't require medication.

Far and away the one most effective treatment for diabetic ED is keeping blood sugars down. Men who manage to keep their blood sugars below 100 mg/dl (5.5 mM) all the time may notice improvement in as little as six weeks without any drug treatment at all. But for diabetic men who cannot control blood glucose readings quite that tightly, there's alpha-lipoic acid, also known as ALA.

ALA is the best-researched and most reliable over-the-counter aid to recovery from any kind of diabetic nerve damage, including ED. Doctors recommend up to 3,000 milligrams a day, although much more than 1,800 milligrams a day is likely to be more than the body can use. ALA depletes the B vitamin biotin, so it's important to take supplemental biotin or to use a brand of ALA that includes biotin in the formula.

Diabetic men who use ALA report that it restores sensation before it restores erection. ALA will enhance the ability of either the conventional prescription drugs Viagra, Cialis, and Levitra or the herbs that contain yohimbine, namely yohimbe and quebracho, to enable damaged nerves to release nitric oxide (NO). The antioxidant NO opens the blood vessels that fill the penis with blood to enable intercourse. ALA may also restore sensation in feet, hands, and other parts of the body.

Many nutritional experts and some holistically oriented doctors recommend supplementing with the amino acid L-arginine for erectile dysfunction. It's a complement to either the "little blue pill" or alpha-lipoic acid. L-arginine provides the raw materials from which nitric oxide, NO, is made. ALA and/or Viagra, Cialis, and Levitra stimulate nerve endings to release it.

Men get L-arginine from food, especially soy and meat, but it's simply not possible (unless you can wolf down a 72-ounce steak every day) to get all the L-arginine that your body can use from food. Take up to 5 grams (that's 5,000 milligrams) of L-arginine daily. L-arginine is not likely to be the complete remedy for erectile dysfunction all by itself, but it will greatly enhance the effects of either prescription medications (that is, those taken by mouth, not the papaverine injection) or ALA.

L-arginine is frequently recommended for ED, and may increase the effectiveness of Viagra, since it provides the chemicals from which NO is made. Clinical studies of L-arginine have used relatively small doses, no more than 3,000 milligrams per day,7,8 and using more than 5,000 milligrams of L-arginine may make ED worse. The herbs damiana, ginseng, and muira puama are also frequently recommended for ED, but their effects are unpredictable and they do not help the majority of men who take them.

Read about maca for side effecs causing sexual dysfunction induced by antidepressant medications.

Are Hot Flashes Always a Sign of Menopause?

Sometimes they are a sign of diabetes.

We all know that hot flashes are one of the most common symptoms of menopause, but are they always due to menopause? Here's the information you need to know to choose whether to ask your doctor to test for something else.

Hot flushes are most common in women in the period of life called perimenopause, the two to seven years before full-blown menopause when the menstrual period becomes irregular. For instance, there could be a period lasting three weeks in perimenopause, or a period lasting five. They also occur in women of any age who have had their ovaries surgically removed.

Most women sense a flash coming on before it actually happens. There can be a feeling of veins popping in the face and neck as they actually do open up to admit greater blood flow to the head. Waves of heat strike the head and then radiate out to the torso and arms. The heat is wavelike and can last for a few minutes up to an hour. There can be dizziness, nausea, headache, or mood disturbance during the flash. The difference between hot flashes and flushing is that hot flashes include any, many, or all of the aforementioned symptoms, but flushing only involves redness spreading up the face.

Hot flashes strike women of all races, but for reasons scientists do not entirely understand, they tend to be more problematic for women of African descent. A study in the Journal of the American Medical Association found that they affect 53 per cent of African-American women but only 29 per cent of white women.

Flashes also strike women of all ages, but they are most common between the ages of 40 and 56. And men can get them too, but for entirely different reasons.

If there is any doubt as to whether a hot flash is a symptom of menopause, the doctor can run a test for a hormone called follicle stimulating hormone (FSH). There are non-hormonal causes of night sweats and hot flashes. Other kinds of hot flashes are also distinguished by the timing.

The flushing that men and women can get due to diabetes occurs usually during eating or up to 30 minutes after, especially when the food is high in carbohydrate. Tidal fevers of malaria occur approximately the same time every day, while periodic flashes due to hormones occur at random intervals. And hot flashes can be triggered by eating spicy foods. The corresponding symptom of diabetes and malaria is not.

Recent reader questions:

Q. Is there a way to make your period start naturally? Will this relieve hot flashes?

A. Herbalists have used feverfew, ginger, parsley, rosemary, sage, thuja, and wild carrot seed as mild emmenagogues to induce menstruation. They aren't strong enough to interfere with pregnancy, but they are enough, in some cases to restore menstruation. There are stronger herbs, but they have potentially dangerous side effects.

And these herbs won't relieve hot flashes. For that, black cohosh is best.

Q. What about young people with hot flashes?

A. Although menopause may be surgically induced in young men, hot flashes in the young usually are an early warning sign of diabetes, especially if they occur during or within 30 minutes of eating.

Q. Can hot flashes just be chills?

A. Do you mean, can you have a hot flash without getting hot? Yes, but it would have the other characteristics of hot flashes listed above: irregular occurrence, feeling of spreading from the neck up and out, and other symptoms, like dizziness.

How to Make No-Sugar Ice Cream

hanks to an Australian reader for requesting this republication of my entry on how to make a no-sugar ice cream.

If you’re new to making low- or no-carb desserts, this recipe for making lemon ice cream is absolute easiest way to start (and there’s a recipe for strawberry ice cream here, too). Even if you don’t have an ice cream maker, you can make this diabetic dessert in minutes for less than it costs at the store.

This recipe for making lemon ice cream has an advantage of all store-bought brands in that you can make with the best of all the sugar substitutes for diabetes, an all-natural, stevia-sweetened version. Ice cream made with “sugar alcohols” such as mannitol, sorbitol, xylitol, lactitol, isomalt, maltitol, or hydrogenated starch hydrolysates (HSH) is usually labeled as “sugar free” or “no sugar added.”

Don’t believe it. Sugar alcohols have a negligible effect on blood sugars in the short term, but they are eventually converted to glucose, too. A day after eating your big bowl of “sugar free” ice cream you can be wondering why your blood sugars are so high. Stevia, which the FDA recently decided was safe, after all, will not raise blood sugars and may even lower them ever so slightly, 1 to 3 mg/dl (0.05 to 0.15 mM).

Here’s all you need to make lemon ice cream:

Lemon extract

These are the ingredients for the absolutely zero-carb, almost-no-trace-of-artificial ingredients version. It’s sweet, it’s creamy, it will have no effect on your blood sugars other than slowing down the absorption of any carbs from other foods you eat at the same meal, and it’s scrumptious. It’s also a high-calorie food. Don’t worry, this isn’t the only version of the recipe! Two lower-calorie versions (one of them with just 20 calories a serving and no Nutra-Sweet.

½ teaspoon (2-3 ml) liquid stevia extract or 2 teaspoons (4 grams) green stevia powder
2 cups (480 ml) whipping cream
½ teaspoon (2 ml) lemon extract

If you really must use NutraSweet, it takes 5 packets to equal 2 teaspoons of stevia powder.

If you are using an ice cream maker, just pour the ingredients into the chilled mixer bowl (if your ice cream maker requires you to freeze the mixer bowl first) and turn on the machine. Be sure not to add too much stevia or lemon extract. Both flavorings rely on “tricking” your palate with the slightest hint of bitterness to activate sweetness receptors. Too much stevia or lemon extract and the end product tastes bitter. I know this from experience.

If you don’t have an ice cream maker, use a mixing bowl that’s just large enough to hold the 2 cups of cream. Pour in the cream and stir in the stevia. Cover the stevia-sweetened cream with plastic wrap and put the bowl in the freezer for 1 hour or until the mixture is just beginning to freeze around the edges.

After the mixture begins to freeze, take it out of the freezer and the lemon extract. Give the ice cream a thorough stirring, replace the plastic wrap and return to the freezer for another hour. At the 2-hour mark, take the ice cream out and beat again. Replace the plastic wrap and allow the ice cream to freeze until it’s firm enough to stay in the bowl but soft enough to dip. This usually takes about six hours. Two cups of cream makes 6 servings of ice cream.

The all-cream ice cream has no carbohydrate but 225 calories per half-cup serving.

If you can tolerate about 6 grams of carbohydrate a serving and you want to cut the calories in half, then try this no-eggs, no-gluten half-and-half lemon ice cream recipe:

½ teaspoon (2-3 ml) liquid stevia extract or 2 teaspoons (4 grams) green stevia powder
1 cup (240 ml) whipping cream
1 cup (240 ml) skim milk, whole milk, or almond milk
¼ cup (60 ml) fresh lemon juice
1/8 teaspoon (0.5 ml) lemon extract

Same procedure as above, adding lemon juice and lemon extract after the milk and cream mixture has begun to firm up in the freezer, if you don’t have an ice cream maker.

How about a strawberry sugar-free ice cream? To make strawberry ice cream, use just 2 tablespoons (30 ml) of lemon juice but add 2 cups (300 g) of sliced fresh strawberries at the same time you’d add lemon.

I’ve tried these variations with soy milk, and it works, but you have to be very careful not to use too much stevia or lemon extract. Soy milk can have a slight, bitter aftertaste that really comes out if you use too much stevia.

Now if you are really just wanting a recipe for lemon ice, not a recipe for lemon ice cream (zero fat, 3 grams of carbohydrate and just 20 calories per 1 cup serving), you’ll need:

¾ cup (180 ml) of fresh lemon juice (3 or 4 lemons)
½ teaspoon (2-3 ml) liquid stevia extract or 2 tsp (4 grams) stevia powder
6 cups (1500 ml) water

Again, if you must use NutraSweet, it takes 5 packets to equal 2 teaspoons of stevia powder.

Put the lemon juice and stevia in a pitcher or jar and stir thoroughly to dissolve add the stevia. Pour in water and stir to mix thoroughly. Place lemon juice and water mixture in a bowl as above, then cover with plastic wrap and place in freezer 1 hour. Take the mixture out of the freezer, stir with a fork, and replace the plastic wrap. Repeat the procedure at the two-hour mark and once again before serving.

For a tart and colorful variation, replace 2 cups (500 ml) of the water with Red Zinger or hibiscus tea to make beautiful lemon-hibiscus granita. Incidentally, I tried making lemonade ice cubes and then pulsing them in the food processor. The result was closer to a snow cone than to an ice.

Ice creams, ices, and granitas are the easiest diabetic desserts. Just be sure your ice cream freezer bowl is thoroughly frozen and, if you are making ice cream in the freezer, don’t forget to stir!

Tips for Preventing Diabetic Foot Ulcers

Are you at risk for diabetic foot ulcers? If you have the tingling, burning, or numb sensation in your feet caused by diabetic neuropathy, chances are, you are. But there is a great deal you can do to avoid diabetic neuropathy progressing to diabetic foot ulcers. Here are some easy but important tips.

To prevent diabetic ulcers, diabetics who have neuropathy in the feet, and diabetics in general, should:

Inspect feet and toes every day for any bruises, bumps, cuts, contusions, scrapes, or infections, including fungus infections like athlete’s foot. If you can’t look at your feet yourself, it is very important to find someone who can look at your feet for you.

Only use warm water, not hot, and mild soap (no Lava), to wash your feet. Test the temperature of the water by using your wrist before you immerse your heat. This will help prevent burns.

Dr. Robert Bernstein cautions against soaking your feet if you have diabetes. Too much exposure to water may loosen protective calluses. Dry feet carefully with a soft towel, and don’t forget to dry between your toes. It’s a good idea to wash your feet every day.

Before you put on your socks, make sure your feet are dry, but then moisturize with a foot cream, cold cream, lanolin, or petroleum jelly. Moisturize will keep the skin on the foot from cracking and letting infection in.

And you don't want tight-fitting socks. Specially designed "diabetic socks," that don't leave grooves on your calves and ankles when you take them off, are both better for circulation and a lot more comfortable. Diabetic socks are pricey, you can find a wholesale diabetic sock section at most WalMarts throughout North America. Medipeds Diabetic Socks are also available at K-Mart and Sears and occasionally for as little as US $1.50 a pair on eBay.

Be picky about your shoes. Make sure you get shoes with firm heels that support and stabilize. There should be plenty of room for your toes. Break news shoe in gradually, only an hour or two at a time. 

There are open-toed sandals designed especially for diabetics, such Ambulator Conform Sandals. These sandals accommodate bunions, hammer toes, claw toes, and mallet toes, problems that are not unusual in diabetics’ feet. It's OK to buy cheap diabetic shoes as long as they have inserts to minimize skin damage in daily use.

Every time you see your primary health care provider, make sure he or she examines your feet. Do not hesitate to call if a sore on your feet is not healing well.

Try not to sit with your legs crossed. Crossing legs reduces blood flow to the feet.

Examine your shoes regularly to make sure they have not picked up any stones, tacks, nails, or street debris.

If your feet get cold at night, wear socks, but do not use heating pads, because diabetic neuropathy make prevent your feeling burns.

It’s OK to remove dead skin, but do not remove calluses covering a wound.

What Causes Diabetic Foot Ulcers?

It’s the sign of advanced diabetes that diabetics dread, ulcers of the feet and lower legs. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDKD) has published estimated that one in six diabetics oeventually develop a foot ulcer, and 6 out of every 1,000 diabetics will undergo an amputation. Foot ulcers are most common in diabetics who have neuropathy, and neuropathy is most common in diabetics who have high blood sugars after meals, but normal or “OK” blood sugars in the morning. Letting blood sugars get too high during the day is a leading contributor to diabetic foot disease.

Before diabetics develop foot ulcers, they usually have diabetic neuropathy of the feet. This condition can manifest itself as a simple feeling like the foot is “asleep,” or maybe a tingling or burning sensation, usually worse at night. The condition can progress so that the feet feel the same way your mouth does after you get a shot of anesthetic at the doctor’s office, only the feeling never goes away.

Loss of sensation in itself is something diabetics can deal with, as long as they can see their feet. The problem comes when a diabetic does not feel a broken bone or notice an infection after a cut or a scrape. Clogged capillaries cannot carry immune cells to clear out infection, and gangrene can set in. Treating gangrene without surgery is not impossible, but it is very difficult.

Doctors at the Hospital General in Durango, Mexico have published a study that almost 95 per cent of their diabetic patients presenting foot ulcers suffer low magnesium levels. Another study found that low magnesium levels are associated with a 300 per cent greater risk of foot ulcers in type 2 diabetics. When diabetics take supplemental magnesium (something to be done carefully and in moderation, since, like Milk of Magnesia, magnesium supplements can cause diarrhea), modest improvement usually comes about in 3 or 4 days. It lasts as long as you take the supplement, or eat magnesium-rich foods like greens or spinach every day.

Recent reader questions:

Q. What's the significance of bites or bumps just on toes of a diabetic?

A. I can't diagnose you, but my question would be whether there weren't really bites further up the foot and leg and only the toes were not healing quickly? Toes are the first part of the foot, usually, to show diabetic changes.

You may also be interested in

An Unexpected Cause of High HbA1C's: Hypothyroidism

The measurement of glycosylated hemoglobin, also known as HbA1C, is often described as a "diabetic truth detector." A measurement of the percentage of red blood cells that are coated with sugar, HbA1C goes up when blood sugar levels generally run high and goes down when blood sugar levels generally run low. Every high HbA1C reading, however, is not caused by high blood sugar levels.

When people have slow thyroid function, or hypothyroidism, the body doesn't recycle old red blood cells o make new red blood cells as quickly. The longer red blood cells stay in circulation, the more sugar they attract. In the worst cases of hypothyroidism, some people have been misdiagnosed as prediabetic because their HbA1C's levels were unexpectedly high.

More often than not  a high HbA1C level really does mean that blood sugar levels have been going too high. At least once every five years, however, every diabetic should have tests for TSH, T4, and T3 to make sure that thyroid function is normal.

Saturday, December 11, 2010

Cholesterol Do's and Don'ts for Diabetics (and Non-Diabetics, Too)

All too often doctors use total cholesterol as a measure of statin deficiency. In much of the world, as soon as your total cholesterol reaches 200 to 220 mg/dl, boom, it's a prescription for some statin drug, such as Crestor (rosuvastatin) Lescol (fluvastatin), Lipitor or Torvast (atorvastatin), Lipostat or Pravachol (pravastatin), Litava or Pitava (pitavastatin), or Zocor or Lipex (simvastatin).

Anywhere statin warnings are much more in the news, the test is usually your LDL or so-called "bad" cholesterol. The threshold for treatment recently has been lowered.

  • For high-risk patients (those with a 10-year risk of a cardiac event of 20%): The LDL cholesterol should be lowered to below 100 mg/dL, and consideration should be given to lowering it to below 70 mg/dL.
  • For moderately high-risk patients (those with a 10-year risk of a cardiac event between 10 and 20%): LDL cholesterol should be lowered to below 130 mg/dL, and consideration should be given to lowering it to below 100 mg/dL. 
  • For intermediate-risk patients (those with a 10-year risk of a cardiac event less than 10%): LDL cholesterol should be lowered to below 130 mg/dL.
  • For low-risk patients (those with a 10-year risk of a cardiac event less than 1%): LDL cholesterol should be below 160 mg/dL.
Your official risk factors include smoking, a personal history of a heart attack, a family history of a heart attack, high blood pressure, and type 2 diabetes. If you check "yes" in any of the boxes for these factors in your intake chart, it's highly likely your doctor will feel compelled to offer you a statin drug.

There are two big problems with prescribing statin medication on the basis of your cholesterol levels. One is that if you are a type 2 diabetic, how high your LDL numbers go doesn't really predict whether you will have a heart attack. And also, if you are not a type 2 diabetic, your  LDL numbers and total cholesterol numbers don't really predict heart attack risk, either.

Even worse, if you aren't a type 2 diabetic yet, taking statins to lower your cholesterol may slowly and insidiously raise your blood sugar levels so that you become a type 2 diabetic. And since doctors almost never run the very simple test (it costs less than US $0.20 for a test strip) at the right time to tell you whether this is happening, you'll just get fatter and fatter, your doctor probably blaming you for not staying on your diet, until one day you discover you also have diabetes. This is not even to mention other statin side effects, that frequently include memory loss, and sometimes include muscle tissue damage caused rhabdomyolysis, which in turn puts tremendous stress on the kidneys as they attempt to clear out damaged proteins.

It doesn't have to be this way. But you will need to understand some things about cholesterol, heart attacks, insulin, and blood sugar that most doctors don't to get good care.

Cholesterol does not clog your pipes. For over 50 years, misinformed "experts" have explained the dangers of cholesterol in terms that are more appropriate for plumbing. Your arteries and veins are not pipes. They are living tissue capable of expanding and contracting to regulate blood flow. Most heart attacks occur when blood vessels cannot flex themselves to accommodate changes in flow, not just because they are "clogged."

Cholesterol can form obstructions in arteries, but it's not just any kind of cholesterol that does this. Even "bad" LDL cholesterol is, for the most part, harmless. But the lab test you are likely to get, even in the United States, that tells you your cholesterol numbers doesn't actually measure LDL cholesterol at all. Worse for type 2 diabetics, the better care you take with your blood sugar levels, the more likely this test is to be wrong.

Why doctors get bad LDL numbers for type 2 diabetics and everybody else. The way to measure true LDL cholesterol levels is to count the number of carrier molecules that make their fatty parts soluble in the bloodstream. Fats are not soluble in water, so the only way cholesterol can get around in your bloodstream is if it is attached to a water-soluble protein. Every molecule of LDL cholesterol is attached to a carrier protein called apolipoprotein B (abbreviated APO B).

It is quite expensive to measure APO B in order to get a truly accurate LDL number. The cost of a true LDL test could run more than all the other tests your doctor orders at your checkup, well into the hundreds of dollars. The US $500 for an APO B test is often not covered by American health insurance plans, and if you live in a country with a national health scheme, even if your doctor orders it, the receptionist or the clerk handling your forms may cross it off the list.

Labs typically estimate LDL levels by:

1. Measuring total cholesterol.
2. Measuring the denser, easy to separate, HDL or "good" cholesterol, and
3. Then assuming any cholesterol you happen to have in your blood that isn't HDL or LDL is 1/5 as much as your triglycerides.

Most people don't know that there is yet another major class of cholesterol, VLDL or very low-density lipoprotein. The typical rule of thumb is that you'd have 1/5 as much VLDL as triglycerides (from which it is formed).

So the equation is:

1. Take total cholesterol.
2. Subtract HDL.
3. Subtract triglycerides x 1/5.
4. And the answer is supposedly your LDL.

But suppose you are non-diabetic who has been taking fish oil, eating nuts, using microalgae capsules, or generally consuming the healthy fats that protect the heart. Or you are a diabetic who has been diligently taking care of blood sugar levels.

Your triglycerides go down, so your LDL appears to go up.

Suppose before you started taking better care of yourselfl, you had:

Triglycerides: 400 mg/dl
Total cholesterol: 180 mg/dl
HDL: 45 mg/dl

Then your estimated LDL would be 180 - 45 - (1/5 of 400) or 55.

But then you work really hard at getting your triglycerides down. You take fish oil. You're really careful with your carbohydrates. Or if you are diabetic, you carefully keep your blood sugar levels down. And you get your triglycerides all the way down to 100 mg/dl (5.5 mmol/L). Your total cholesterol stays at 180 and your HDL stays at 45. (We'll use the American measuring system here because the math is easier to follow.)

And let's suppose your LDL didn't really go up--but the estimate will be off:

180 - 45 - (1/5 of 100)= 115.

So you're reward for getting your triglycerides down will be your doctor will want to put you on a statin for high LDL, even if your actual LDL stayed same, and even if your actual LDL went down.

Statins used to be quite expensive. They are now relatively affordable, even if you have to buy them yourself. But in addition to the usual statin side effects, there is a problem most doctors have never heard of. Using statins induces the insulin resistance that first causes weight gain, and then all too often causes type 2 diabetes.

How using statin drugs may make or keep you diabetic. About 10 years ago, Dr. David Jenkins and his colleagues at the University of Toronto in Canada conducted a study of dietary change versus statin medications for lowering cholesterol levels. The Canadian research team found that it was actually more productive to use dietary fiber, plant stanols (products like Cholest-off), and small amounts of soy protein, preferably from edamame and tofu rather than from industrially processed soy protein meat substitutes. 

The Canadian doctors did not question whether lowering cholesterol was a valid objective. But buried deep in the paper was a note that taking statin drugs raised insulin levels. And that explains more recent findings that vast numbers of people given statins for cholesterol develop type 2 diabetes.

The reason high insulin levels lead to weight gain and then type 2 diabetes has to do with the phenomenon of insulin resistance. Insulin, as you probably know, transports sugar out of the bloodstream and into cells.  Too much sugar, however, would cause the energy-making machinery of the cell to "burn too hot" and produce free radicals of oxygen that damage DNA. To keep from absorbing too much sugar, most kinds of cells in the body have the capacity to "shut down" receptor sites for insulin when either blood sugar levels or blood insulin levels are high.

Transporting sugar, however, is not the only thing insulin does. This vital hormone also transports fat. When insulin levels go up high enough to induce insulin resistance, cells fail to absorb sugar, but are primed to receive fat. This is one of the reasons people who take statin drugs often gain weight. 

To be sure, eating too much is also required! However, the process of storing fat becomes much more efficient. Type 2 diabetes probably requires additional genetic and environmental triggers, but in many cases the scenario runs something like this.

The person who is on statin medications gets an infection, has to have surgery, becomes extremely fatigued, or just has to follow a quirky diet for a few days or weeks. As we explain in our book Staying On Your Diabetes Diet, there are at least six genes that can be activated by life events that also contribute to insulin resistance.

The pancreas deals with the problem of too much insulin by making even more insulin. Eventually, there is no amount of insulin that keeps blood sugar levels normal, and type 2 diabetes results.

Doctors usually run the right test for type 2 diabetes at the wrong time. The reason type 2 diabetes "sneaks up" on so many users of cholesterol medication is that doctors using take fasting blood tests. Your pancreas has the ability to work all night to get blood sugars down to normal much longer than it has the ability to lower them in the hour or two after a meal. If doctors just took non-fasting blood sugar levels, then type 2 diabetes could be detected much earlier, while it is relatively easy to reverse. If you have been gaining weight, or if you have a family history of diabetes, you should ask your doctor to take a post-prandial, or after-meal, reading of your blood sugar levels just to make sure you are not on your way to becoming a diabetic. And if you are already a diabetic, you should be taking your post-prandial blood sugar readings to make sure your diet, exercise, and medication are really working for you.

What is the best cholesterol-lowering supplement? Are there foods to eat to lower cholesterol? Is there any one single food that lowers your cholesterol best?  First of all, you need to find out whether lowering your cholesterol levels really should be your highest priority. The people who most urgently need to lower cholesterol levels are those who have markers of inflammation called CR-P, or C-reactive protein. This is a sign that any excess cholesterol in your bloodstream is being transformed into the calcified crystals that actually clog arteries and veins. If you have had a blood test that shows you have high CR-P and high cholesterol, then you almost certainly will benefit from taking a statin. (If you take statins then you need to be aware of the impact of caffeine on statin efficacy. Caffeine from coffee and tea makes it harder for your heart to recover from oxygen deprivation after a heart atttack, if the statins don't actually work for you. And they often don't.)

Then, if you are someone who needs cholesterol control, try plant stanols and more fiber in your diet before you take statin drugs, if you possibly can. Stanols don't cause statin side effects, especially causing your to become diabetic or making your diabetes harder to control! Many, many diabetics find that taking a daily dose of a product like Cholest-Off is all they need to have great LDL numbers.

But if you really want to prevent a heart attack, it's probably more important to keep your blood sugar levels in control. Too much sugar in your bloodstream interferes with the action of nitric oxide, a healthy free radical that enables arteries to relax. That's why so many people have heart attacks after a big holiday meal, and it's also why about half the people who actually have heart attacks have normal or even low cholesterol!

It's also important to have normal blood pressure, to avoid supersizing any meal, and to minimize your consumption of fat at any one meal. The problem that causes heart attacks is not so much "clogs" as "sludge." The risk factors that really make a difference may be temporary, just lasting an hour or two after you eat. But if you keep you blood sugar levels in control, either naturally, because you are non-diabetic, or by good diabetes control, you are far, far less likely to suffer the sludge that cause dangerous cardiovascular events.

Selected references:

White SS et al. Apolipoprotein B but not LDL Cholesterol Is Associated With Coronary Artery Calcification in Type 2 Diabetic  Diabetes August 2009 vol. 58 no. 8 1887-1892 doi: 10.2337/db08-1794

Jenkins D.J., Kendall, C.W., Marchie, A., et. al. 2003. Effects of a dietary portfolio of cholesterol-lowering foods vs Lovastatin on serum lipids and C-reactive protein. JAMA. 290(4): 502-10.

Sattar, N., Preiss, D., Murray, H., et. al. 2010. Statins and risk of incident diabetes: A collaborative meta-analysis of randomised statin trials. Lancet. 375(9716): 735-42..

Read more about a list of foods to avoid for high cholesterol.