New study pegs sugar as main culprit in diabetes

For years, medicine has pegged obesity as the number one cause of diabetes. However, results of a recent large epidemiological study suggest it’s sugar that plays a pivotal role in diabetes. The study also illustrates that how many calories you eat isn't as important as what makes up those calories -- the study found calories from sugar is more damaging than calories from other foods.

Researchers looked at the correlation between sugar availability and diabetes in 175 countries during the last ten years and controlled for such factors as obesity, calories consumed, diet, economic development, activity level, urbanization, tobacco and alcohol use, and aging.

They found the more sugar a population ate the higher the incidence of diabetes, independent of obesity rates. According to Sanjay Basu, MD, PhD, the study’s lead author, “We’re not diminishing the importance of obesity at all, but these data suggest…additional factors contribute to diabetes risk besides obesity and total calorie intake, and that sugar appears to play a prominent role.” The study provides the first large-scale, population-based evidence for the idea that perhaps it’s not just calories, but the type of calories, that matter when looking at diabetes risk.

All calories are not created equal

One thing is clear from the study – although by definition all calories give off the same amount of energy when burned, sugar is uniquely damaging to the body.

The study showed an additional 150 calories from any food source caused a 0.1 percent increase in the population’s diabetes rate whereas an additional 150 calories of sugar caused it to raise a full 1 percent. That’s a ten-fold increase. To put it into perspective, a can of soda contains roughly 150 calories of sugar. Consider the average American consumes 22 teaspoons of added sugar a day, or about 350 calories’ worth, and it’s clear why diabetes is the fastest growing disease in history.

The study also showed the longer a population was exposed to excess sugar, the higher the diabetes rates were. The clincher: Diabetes rates dropped when sugar availability dropped, independent of changes in calorie intake, physical activity, or obesity rates.

Does sugar cause diabetes?

Does sugar cause diabetes? It’s too early to say definitively, but this study clearly shows a correlation and spotlights the need for more research. Dr. Basu suggested sugar affects the liver and pancreas in ways that need more exploration.

What can you do to prevent or manage diabetes?

While there are various forms of diabetes, Type II diabetes, which is caused by diet and lifestyle, accounts for 90 percent of all cases of diabetes.

What can you do to minimize your risk for diabetes? Reducing your sugar intake is a great place to start. In functional medicine we understand that every body is unique. We start with a careful evaluation of your health history, lifestyle, heredity, nutritional status, and environmental risk factors. We help you customize a program that includes diet, exercise, stress management, nutritional support, detoxification, gut health support, and dampening of inflammation -- all of which can dramatically affect your insulin and blood sugar levels and hence your risk of diabetes. This can reverse the path to diabetes and sometimes even the disease itself.

Ask my office for more information on support with blood sugar imbalances and diabetes.

How alkaline and acidic diets affect your health

You may have heard of the importance of an alkaline diet. It can help reduce acidity in the body and prevent bone demineralization, kidney stones, back pain, muscle wasting, hypertension, stroke, cancer, asthma and exercise-induced asthma. The foods you eat profoundly affect how acidic or alkaline you are, and thus your health.

Let’s begin with some chemistry… pH is a measure of how acidic or alkaline something is. On a scale of 0 to 14, a pH of 0 is totally acidic, 14 is totally alkaline, and 7 is neutral. Blood is slightly alkaline at between 7.35 and 7.45. The kidneys and respiratory system tightly control blood pH with little room for variation. Your stomach is very acidic at 3.5 or below. This acidity is necessary to break down food and protect you from harmful bacteria and other organisms. Your urine pH changes depending on what you eat.

The nutrients in food have either an acidic or alkaline effect on the blood. Fish, meat, cheese, eggs, legumes and grains are considered acid forming, while fruits, vegetables, and mineral soda waters are considered alkalinizing. All junk foods, sodas, and processed foods are considered acid forming, and should be avoided. Note that just because a food is acidic itself doesn't mean that it will be acid forming in the body and vice versa with more alkaline foods. For instance, although lemon and raw apple cider vinegar are acidic they are alkalinizing in the body.

Acid and alkaline imbalances

When the body’s pH gets out of balance, health issues can arise:

Acidosis (too acidic)

In acidosis, the enzyme systems of the body run on high speed, forcing the adrenal glands into overdrive. Symptoms include:

• Agitation
• Feeling fast and racy
• Being physically tired but mentally wired
• Cancer
• Candida

Alkalosis (too alkaline)

While acidosis is more talked about, one can become too alkaline. In alkalosis, the enzyme systems of the body run below par, reducing blood pressure and pulse, contributing to:

• Low thyroid activity
• Low stomach acid (digestive issues)
• Allergies
• Wheezing
• Diarrhea
• Fatigue
• Sluggishness and slowness
• Fertility issues

So, what’s for dinner when you want to reduce acidity?

There is little question that the mainstream western diet imposes a high acidic load on the body. You might think the fix would be to eliminate all acidic foods. Instead, increasing the ratio of alkaline foods to acidic foods is what makes the most sense. It's all about balance. An added benefit; this reduces the total number of calories consumed.

When you consider that many classically acid forming foods have important vitamins, fats, minerals, and other nutrients, it makes sense to find a reasonable place for them in the diet. Remember, the acidic foods you consume should be nutrient-dense, quality foods, not a binge in the chip aisle! Instead, focus on a plant-based diet that is made up primarily of vegetables, fruits in moderation, and enough protein and healthy fat to keep your blood sugar and energy levels stable.

Increased fruits and vegetables in an alkaline diet improve the sodium/potassium ratio, which can benefit bone health, reduce muscle wasting, as well as mitigate other chronic diseases such as hypertension, strokes and cancer. On the other hand, an overly acidic diet (such as too much meat and not enough veggies) can reduce bone density. In fact, in a recent study of 136 trials that examined the effects of dietary calcium (mainly from dairy) on fracture risk in osteoporosis, two-thirds of the trials showed that a high calcium intake does not reduce the number of fractures. Meanwhile, it was found that eating fruits and vegetables improved bone density in an amazing 85 percent of studies that looked at the effects of such foods.

A more alkaline diet can also increase growth hormone, which may improve cardiovascular health and memory and cognition.

Based on the alkaline/acidic nature of foods, scientists have created a way to rate foods called the Potential Renal Acid Load (PRAL) score. But take note: becoming too concerned with pH and doing constant measuring of urine pH (the most accessible form of testing) will likely cause more stress than good; it’s balancing the big picture that matters!

The acid-alkaline diet is about balance

Food isn't the only thing that affects pH in the body; stress also plays a big part. Stress causes us to breathe shallowly, creating a buildup of highly acidic carbon dioxide, which is acidifying. Therefore, it's important to utilize positive stress reduction methods to help manage your body’s acidic load.

Alkalinizing lifestyle tips

• Engage in regular, weight-bearing exercise.
• Eat a diet strong in alkalizing vegetables and fruits.
• Use positive stress management techniques such as yoga, meditation, laughter, qigong, and walking.
• Deep breathing reduces stress and increases the rate at which carbon dioxide is released from the body, reducing acidity.
• Go Organic: pesticides are acid-forming.
• Make the change gradually: If you think a quick switch will be stressful or set you up for failure bingeing, make the transition slowly over a matter of weeks.
• Adequate dietary Vitamin D levels may help with absorption of calcium, magnesium and phosphate, which can help with acid/alkaline balance. Most populations in northern climates are deficient in vitamin D, so getting tested may be a good idea for you.

Remember, the big picture is what matters; balancing diet, exercise, and lifestyle will provide you with the best tools for maintaining a healthy pH balance in your body.

Cholesterol often wrong target in heart disease risk

Everyone has heard that high cholesterol is bad for heart health. But as it turns out, the association between cholesterol and cardiovascular disease has been somewhat misrepresented. Doctors are starting to accept that cholesterol levels do not necessarily predict risk for heart disease as much as we thought. Consider the following:

• 75 percent of people who have heart attacks have normal cholesterol.
• Older patients with lower cholesterol have a higher risk of death than those with higher cholesterol.
• Countries with higher average cholesterol than Americans such as the Swiss or Spanish have less heart disease.
• Recent evidence shows that it is likely statins’ ability to lower inflammation that accounts for the benefits of statins, not their ability to lower cholesterol.

We need cholesterol!

Cholesterol is a fat-like substance found in every cell in the human body. The liver makes 75 percent of cholesterol. Cholesterol helps produce cell membranes, vitamin D, and vital hormones, and is needed for neurological function. Put bluntly, we would die without it.

The cholesterol players

When we measure cholesterol levels, we are actually measuring the lipoproteins LDL and HDL. We refer to them as cholesterol, but they are actually small packages of fat and protein that help move cholesterol throughout the body.

High-density lipoprotein -- HDL

This is considered “good” cholesterol. It helps keep cholesterol away from your arteries and removes excess arterial plaque.

Low-density lipoprotein -- LDL

This is considered “bad” cholesterol. It can build up in the arteries, forming plaque that narrows the arteries and makes them less flexible (atherosclerosis).

Also important are:

Triglycerides

Elevated levels of this dangerous fat have been linked to heart disease and diabetes. Levels rise from eating too many sugars and grains, smoking, being physically inactive, excessive drinking and being overweight.

Lipoprotein (a) or Lp(a)

Lp(a) is made up of an LDL part plus a protein (apoprotein a). Elevated Lp(a) levels are a very strong risk for heart disease.

When testing cholesterol, total cholesterol is not as important as:

• Levels of HDL “good” cholesterol versus LDL “bad” cholesterol
• Triglyceride levels
• The ratio of triglycerides to HDL
• The ratio of total cholesterol to HDL

In order for cholesterol to cause disease, it has to damage the arterial walls. There are small and large particles of LDL, HDL, and triglycerides. Large particles are practically harmless, while small, dense particles are the dangerous ones, lodging in the arterial walls, causing damage and inflammation. The resulting “scar” is called plaque. Repeated trauma causes a buildup of plaque and chronic inflammation while your risk of high blood pressure and heart attack increases.

The biggest culprits in high cholesterol? Sugar and bad fats!

Although we’ve been taught that a high-fat diet causes problems with cholesterol, the type of fat you eat is more important than the quantity. Trans fats, or hydrogenated and saturated fats, promote abnormal cholesterol, while omega-3 fats and monounsaturated fats actually improve the type of cholesterol in our bodies. Eat your good fats, your body needs them!

The surprise: the biggest source of abnormal cholesterol isn’t dietary fat, but sugar. Sugar (and refined carbs, including processed white foods), drives good cholesterol down and triglycerides up. It causes those small particles, encouraging dangerous plaque buildup, and can lead to heart disease and metabolic syndrome or “pre-diabetes.” Doctors are starting to admit that sugar, not dietary fat, is the bigger cause of most heart attacks.

So, the real concern isn't really the amount of total cholesterol you have, but the type of fats, sugar, and refined carbohydrates in your diet that lead to abnormal cholesterol production.

Inflammation promotes heart disease

Systemic inflammation plays a key role in heart disease and, in fact, most all chronic illnesses. Systemic inflammation can arise from poor diet, a sedentary lifestyle, stress, allergies, and more. Research at Harvard has shown that people with high levels of systemic inflammation (measured by a test called C-reactive protein, or CRP) had higher risk for heart disease than those with high cholesterol, while normal cholesterol was not protective to those with high CRP.

Clearly, multiple factors come together to determine your risk for heart disease, including diet, lifestyle, and environment. If you are concerned about your heart health, contact my office for a comprehensive evaluation to help reveal the factors that may increase your risk for heart disease.

ME/CFS: A new name for Chronic Fatigue Syndrome

Chronic Fatigue Syndrome (CFS), a condition of severe, chronic tiredness, is a well-known term in the medical world and affects between one and four million people in the United States. However, since it was coined in 1988, considerable controversy has arisen over the term CFS. Many patients, advocacy groups, and experts believe the name trivializes the condition and leads to a lack of respect for patients within the medical community; some doctors view the illness skeptically and as a psychosomatic condition, and patients find they receive improper –- or no –- treatment for the illness.

Globally, a number of accepted names for this illness of uncertain cause are used, including Myalgic Encephalopathy (myalgic means muscle aches or pains, encephalomyelitis means inflammation of the brain and spinal cord), Post-Viral Fatigue Syndrome, and Chronic Fatigue Immune Dysfunction Syndrome. In the United States, organizations and doctors recently started calling the illness ME/CFS, for Myalgic Encephalopathy/Chronic Fatigue Syndrome. This combined name reflects the standpoint that the illness is indeed physical as opposed to psychological.

In 2014, the US Department of Health and Human Services contracted the Institute of Medicine to review the evidence and create a clinical definition for ME/CFS, one that might also result in a newer name for the disease(s). Using both terms together in the new name is somewhat controversial since ME has an identifiable viral trigger, while CFS may not, and continues to be diagnosed solely by symptoms. Over time the research will reveal more; for now, patients are thankful that the new combined name reflects a medical basis for the illness.

What is ME/CFS?

ME/CFS affects four times as many women as men, occurs most often in people in their 40s and 50s, and does not draw lines around race. It is a debilitating chronic illness characterized by the following symptoms:

• Extreme Fatigue -- brought on by low levels of, or no exertion. “Post-Exertional Malaise” is a hallmark.
• Unrefreshing Sleep -- disrupted and unrefreshing sleep that increases symptoms of fatigue and pain.
• Cognitive Problems -- characterized by brain fog; difficulties with concentration, attention and memory.
• Pain -- muscle, joint, and all-body pain; headaches are common.

Many patients also experience visual disturbances, gastrointestinal issues, food and chemical allergies and sensitivities, irritability, chills and night sweats, depression and weight changes. A diagnosis is made after ruling out other illnesses that can cause similar symptoms, such as: fibromyalgia, thyroid problems, anemia, Lyme disease, lupus, MS, hepatitis, sleep disorders, and depression.

The Functional Medicine Approach To ME/CFS

Functional medicine uses an individualized, multi-dimensional approach toward working with the symptoms and possible causes of this debilitating illness. While no known cure for ME/CFS exists, addressing underlying health imbalances through diet and lifestyle changes and customized supplementation and other therapies can relieve symptoms, increase function, and allow the person to engage more fully in daily activities.

The functional medicine practitioner will look at possible underlying roots of an individual’s symptoms, such as:

• chronic inflammation
• immune system activation (is a food, infection, or environmental chemical or metal triggering the immune system?)
• impaired functioning in the hormone system
• neurological system dysfunction
• gut inflammation, leaky gut, bacterial infection or other gut dysfunction
• problems with detoxification and methylation
• mitochondrial dysfunction
• poor glutathione activity
• and more

By paying close attention to and working with these possible roots of ME/CFS, the practitioner can help the patient achieve a greater level of relief from debilitating symptoms, and create a lifestyle that supports ongoing health and well-being.

Transition successfully to a special diet

Are you considering going on a special diet, such as the autoimmune Paleo diet, the leaky gut diet, the SCD diet, or the GAPS diet? The thought of a major diet change can bring feelings of uncertainty and questions such as, “Can I handle this? What do I eat for breakfast?” Food powerfully impacts our emotions, and dietary changes can really “rock the boat” in daily life. However, by thinking ahead and employing some simple strategies you can ensure a successful transition and hence better health.

In this article I suggest some surefire ways to help set yourself up for success on your new diet.

Plan ahead and do your research

The most important step is to plan ahead. Why are you changing your diet? Do you understand the potential health benefits? Knowing this will help you move forward with commitment and confidence. Find reputable, current resources through your health care practitioner, at the library, or online. Even an hour of self-education will help you feel more empowered.

Menu planning

Menu planning is key to succeeding at a major diet change. Sit down with your resources, look at recipes, and write out a menu plan for at least a full week. Pick foods you know you will eat so you don’t find yourself falling into old habits. This way you will have backup when you get home late from work or fall behind helping your child with homework. Over time, your menu options will grow. Check out online menu planning services for special diets.

Make a grocery list

Make a comprehensive grocery list that fits the menu plan. Some items may need to be bought later for freshness; know what they are in advance.

Clean out the pantry

Before going to the store, empty your house of all prohibited foods. If there are foods you may test later for tolerance, put them in a location that’s not front-and-center. Grab those grocery bags, and go to the store!

Go shopping

Leave some extra time for this trip; you may be navigating new sections of the store, or finding unfamiliar foods. Ongoing, remember to stock up during sales and ask about discounts on case orders.

Batch Cooking

One of the best tools for a special diet is batch cooking. Batch cooking is preparing meals in bulk ahead of time, and refrigerating or freezing for later. Many who follow a special diet prep meals two days a week. On Sunday, you might take half a day to make a crock-pot of stew, prep a bunch of vegetables, and roast two chickens to put in the fridge or freezer. On Wednesday, you might bake fish for two meals, prepare a sweet potato dish for two meals, etc. It may seem like a lot of time to commit in one day, but soon you will come up with an efficient system where most of your food is prepped ahead of time and you save energy doing it.

Batch cooking reduces the stress of cooking every day, and when that moment comes when you might normally say, “Heck, I’m ordering a pizza!” you can reach for that tasty stew in the freezer. Success.

Sourcing local products

Some special diets require hard-to-find food items. You may have some luck at local food co-ops or farmers markets for these products, or even from the farmer directly. Buy bulk where you can.

What about the family?

One of the biggest challenges of being on a special diet is cooking for a family. Ideally, the whole family is on the same diet but anyone with kids knows this is wishful thinking. Depending on the age of your children, explaining why you are eating this way may help encourage acceptance. Some people cook one way for themselves, and one way for the family, but this is a lot of work. Others find they can cook most of the food to meet everyone’s needs, then throw in some extras for the kids (such as grains or potatoes).

Bring your lunch and keep snacks handy

Since you have prepped meals ahead of time, lunch can go in a container with you to work. Also, keep diet-friendly snacks handy in case you are delayed getting home or are hungry between meals. Preventing hunger is one of the best ways to be successful on your diet.

What about restaurants?

Eating at restaurants can be a challenge on a special diet, though more restaurants are becoming aware of special dietary needs. Ask questions, be firm, and don’t order if you are uncertain.

What to do when you fall off the wagon

Just about everyone “falls off the wagon” at some point. Try not to kick yourself for it. Dust yourself off, climb back on, and remember the longer you’re on the diet, the more successfully you will stick to it. Also, when you start to enjoy the health benefits of your diet you’ll find compliance becomes easier. Many foods lose their appeal when they trigger uncomfortable or even unbearable symptoms every time you eat them.

How to go gluten-free the right way

Anyone concerned with health and wellness has heard about the gluten-free diet. Eliminating gluten is critical for those who have celiac disease or non-celiac gluten sensitivity. What many gluten-free newcomers don’t realize is that many common gluten-free foods contain ingredients that just promote a different set of health problems. In this article we’ll discuss how to avoid this common pitfall so you can transition more easily to a healthy gluten-free diet.

The hidden risk in going gluten-free

Many people rely on packaged and prepared foods for the bulk of their diet, such as breads, pastas, crackers, sauces, and mixes. The tendency when going gluten-free is to replace those items with gluten-free versions of the same products. When you look at the label for packaged gluten-free products, however, you will see ingredients such as rice flour, tapioca starch, corn starch, and potato starch, plus a load of unhealthy fats.

Though free of gluten, these highly-processed, high-sugar, high-carb, low-fiber ingredients can contribute to blood sugar imbalances that affect weight gain, mood, brain function, and other aspects of health. Many of these processed foods also lack vital minerals and nutrients, which over time can contribute to micronutrient deficiencies. Overall, the general lack of nutritional density of packaged gluten-free products outweighs their convenience.

Variety, nutrient density, and whole foods key in healthy gluten-free diet When choosing to go gluten-free, keep in mind the basis for any truly health-supporting diet: simple, fresh, whole foods that are as close to their original state as possible. The more processed a food is, the less it has to offer your body in the way of nutrition and health.

Variety and high nutrient-density foods are key for long-term health; a diet of only cheese and rice pasta won’t make you much healthier than your former gluten-laden diet did. When you’re craving the comfort of carbs, go for a baked sweet potato instead of bread. Curb cravings by eating a diet heavy in fresh vegetables and modest amounts of fruit (so as not to imbalance blood sugar). You may need to retool your eating habits but you will be amply rewarded with significant improvements in how you feel and function.

A smart transition to a healthy gluten-free diet

Although any major dietary change is challenging, a healthy switch to a gluten-free diet can be easy and rewarding with some mindful lifestyle habits. Below are some tips to help with the transition:

1. Learn to read and understand nutrition fact labels

You will quickly develop an eye for those low-nutrient, highly processed ingredients, and learn what products contain them. These should never, or rarely, be in your grocery cart. Also, learn which common ingredients have hidden gluten in them, and eliminate them from your kitchen.

2. Make whole, unprocessed foods the bulk of your diet

Whole, unprocessed foods are the foundation for any diet that supports long-term health and wellness. Avoid the packaged food aisles, make friends with the bulk and produce departments, shop your local farmer’s market, and if you don’t already cook at home…

3. Learn to cook from scratch

- Cooking from scratch can be satisfying, easy and very rewarding

- Cooking at home means you know what’s in your food, and you can more successfully avoid gluten cross-contamination

- Batch cooking meals that you can refrigerate or freeze and re-heat makes it much easier

- A crock pot, blender, and food processor are very useful for making big-batch meals ahead of time

- Many fabulous blogs are devoted to healthy gluten-free home cooking

4. Mindfulness at the grocery store

When you pick up a package of processed gluten-free food, ask yourself if you’d normally eat it, or if you’re picking it up just because it says “gluten-free.” You may find yourself putting a lot of things back… especially if you look at the nutrition label!

5. Commitment

Remember every day why you have chosen to go gluten-free; you are honoring your own body and long-term health by making a positive choice. Stick with it!

The functional medicine approach to high blood pressure

The most commonly diagnosed medical condition in the United States is high blood pressure, or hypertension, and blood pressure medications are among the top 10 most commonly prescribed drugs. However, these medications can cause undesirable side effects. It’s better to address the underlying causes of high blood pressure—research shows diet and lifestyle changes are just as effective or even better than medications in lowering high blood pressure.

Why should you be concerned about high blood pressure? High blood pressure increases the risk of heart attack, heart failure, kidney failure, diabetes and peripheral vascular disease. Thirty percent of the population has high blood pressure, and another 30 percent has pre-hypertension, or somewhat elevated high blood pressure. Men are more likely than women to have high blood pressure before the age of 45, but after 65 the ratio reverses. African Americans and Mexican-Americans are at an increased risk.

Diet and lifestyle changes most effective approach

Instead of treating symptoms, address the actual causes of high blood pressure for lasting better health. Studies have shown that lifestyle changes alone can reduce risk of heart disease by a dramatic 90 percent. Lifestyle interventions influence the fundamental biological mechanisms leading to all chronic disease. For instance, regular exercise is one of the best ways known to control high blood pressure. Other important factors include a whole foods diet rich in plant fiber and low in sugar and sodium, maintaining a healthy weight (a BMI less than 25 is ideal), not smoking, and managing stress, such as through yoga, meditation, walking, and laughter.

Adding the functional medicine approach

In functional medicine, we look for why the person has high blood pressure rather than simply at what can be done to lower it; it’s a person-centered approach, versus a disease-centered one. Factors to consider include genetic predispositions, nutritional deficiencies, environmental triggers, and lifestyle habits, such as:

• Deficiencies in nutrients such as biotin, vitamin D, vitamin C, B1, choline, magnesium and CoQ10.
• Toxic levels of mercury.
• Hypothyroidism: Appropriate management of a thyroid condition such as autoimmune Hashimoto’s hypothyroidism can normalize blood pressure.
• A lack of dietary potassium and too much sodium. Balancing these nutrients can help balance blood pressure.
• Magnesium deficiency. Many people are deficient in magnesium, which can help relax the blood vessels.
• Chronic systemic inflammation.
• Elevated blood sugar and metabolic syndrome (pre-diabetes), which are related to hypertension.
• Hormonal imbalances, such as an estrogen deficiency, can lead to high blood pressure.

By addressing these and other factors, a functional medicine approach addresses the root cause of high blood pressure. Research has shown that up to 62 percent of high blood pressure patients were able to go off their anti-hypertension medications and maintain normal blood pressure by making diet and lifestyle changes. Eating a whole foods, vegetable-based diet and avoiding processed foods will help keep you sufficient and balanced in the right minerals to support healthy blood pressure.

Ask my office for more information on how you can address the root cause of your high blood pressure.