The Real Health Care Reform Program

It's starting to happen.

Slowly, a growing number of voices from establishment medicine are beginning to sound a different- and much overdue- theme in their writings on the health care crisis.

They're starting to talk about- wait for it- prevention.

What's gotten lost in all the shouting in Congress about the costs of universal health care and the costs of revamping the existing (and quite broken) system, is this simple message: untold millions could be saved by keeping people out of the damn system in the first place.

About which, let me just say two words: Diabetes and Obesity.

Writing in the June 23 edition of the Wall Street Journal, Mark Sklar, MD, writes: "We have unparalleled levels of obesity in our country. If we could prevent even a small percentage of people from becoming obese and developing these conditions, the costs of health care could go down far enough to cover everyone's insurance". Sklar recommends incentive programs to encourage healthy eating and exercise. First step: Ban vending machines and fast food from our schools. (Good luck with that one, but at least he's talking about it!)

"It's really stunning how the percentages for type 2 diabetes are going up in younger and younger Americans. Clearly, diabetes is following obesity, and both have huge ramifications on long-term health," says Siri Atma Greeley, a pediatric endocrinologist at the University of Chicago Medical Center.

"The health insurance system is just horrible for these kids as they age. They get kicked out of their cozy pediatric health care systems, knocked off their parents' health plans, then stop care and suffer the consequences," says Rebecca Lipton, associate professor in pediatric endocrinology at the University of Chicago. "We are already seeing some 20- and 25-year-old kids now on dialysis for kidney failure. It's chilling,"

Indeed. And this might just be the perfect teaching moment. We're all learning (painfully) about what happens when you overspend, overcharge, take an "interest only" mortgage and hope for the best later on. Now it's time to apply those economic lessons to the way we eat and the way we live.

No one said it would be easy, but it's doable. Both diabetes and obesity can be largely prevented and their staggering costs- physically and financially- can be substantially reduced.

How?

We need to do exactly what we're being forced to do with spending: Cut back.

It's really not that hard- and even if it is, so what? We've lived under the illusion that we can have whatever we want and eat whatever we want and folks, it was a big, fat, ugly lie. We spent on our credit cards and worried about the bills later, even though most of what we pay is interest on a principle that never seems to decrease and we've been doing the exact same thing with our health.

And forgive me for ranting, but I'm tired of hearing about "deprivation" as if having to turn down a Krispy Kreme is in the same class as poverty, hunger, or living on $2 a day (which is what half the world does).

Get over it.

It's time for some tough love. You're not deprived if you can't eat all the chocolate and cake and crappy cereals and Olive Garden sized portions of pasta and supersized fries you want.

I don't call that deprived-- I call it smart.

You can start your own health care reform program right now by following these four simple rules:

• Take your desired weight, multiply by 10 and eat that number of calories a day. (You can add a couple hundred if you exercise at least 1/2 an hour on that same day). And no, you won't starve.
  


• Do something that gets your heart rate pumping for at least 30 minutes a day
  


• Take omega 3 fatty acids.
  


• Don't smoke.
  

That may not keep everyone alive out of the health care system, but it'll sure make a profound difference in the amount of time you spend there.

Cinnamon Can Lower Blood Sugar

Cinnamon contains phytochemicals which can mimic insulin's ability to increase uptake of sugar by the cells. You can start seeing results by taking just 1g of cinnamon.

Diabetes Type 2 Rant

In the following guest article, my friend nutritionist Bernard Rosen, PhD, takes on the Diabetes Establishment! Visit Bernard at www.brwellness.com.

The current issue of Diabetes Forecast was so loaded that I need to vent.

It starts with page 9 and The Wake Up Call - What's Your Diagnosis Story? by the Editorial Director. And I quote, "If you're diagnosed relatively young, as I was, you've got a lot of years of disease management ahead of you, and a lot of years to worry about screwing up." How about, "If you're diagnosed young, you have a great opportunity to look at your life style, change it, and perhaps allow your body to heal itself." The attitude - I'm in disease management mold for the rest of my life. That's not going to get you better.

On page 11 we hear from "a dietician for more than 25 years" about feeling the pinch at the grocery store. So we get the great advice to "shop for canned or frozen foods to save money. Look for lower-sodium canned vegetables..Buy canned fruit that has no added sugar." Canned fruits and vegetables? Come on. Look for lower-sodium and no added sugar? Canned vegetables have very little nutritional value. How about look at the junk food you are buying and spend the money on the healthy food.

On page 20 we learn that "Gastric bypass surgery seems to be a powerful treatment for type 2 diabetes in some obese adults, and now a study suggests the procedure may work for teens, too." Great news. "Within a year, the blood glucose levels of all but one (of 11) teen who had surgery were normal without medication..." Well what about in two years or five years? What will that body be able to do without normal functioning of processing and absorbing nutrients? Perhaps there was/is a better answer than to "cure" type 2 diabetes with gastric bypass surgery?

On page 37 we learn then when you need to raise your blood glucose in a hurry, there are some sources suggested: glucose tablets, regular soda, orange juice, life savers, jelly beans (large), gum drops, sugar, honey, raisins, and SKIM MILK!!! Yes, skim milk. That food they tell you drink. Have low fat or non-fat products. Missing the connection? Skim milk causes a fast rise in blood glucose levels! So why drink it with your cereal in the morning??? UGH!!!

On page 44 begins the article titled "So, What Can I Eat?" It starts off great - "For most people who are new to diabetes, the one thing that seems clear is that sugar is off limits, right? Think again: It turns out that a diabetes diagnosis doesn't mean your sweet tooth has to go cold turkey. In fact, you can eat many of the foods you love - yes, even desserts..." Great advice. Don't change any habits. Permission to "cheat". A great way never to get better. There is the usual advice for "low-fat versions, such as skim milk". Isn't that the same skim milk that will raise your blood glucose levels in a hurry????? The ongoing lie that "both saturated fats and trans fat up your risk for heart disease and stroke...replace butter…"And" protein from lean meat, fish, or soy products like tofu." Guess they haven't read the latest about the dangers of soy either.

But the best is on page 48 where "free foods" are discussed. They contain fewer than 20 calories or 5 grams of carbs. Suppose they don't add up quickly - examples are "a quarter cup of salsa, a tablespoon of fat-free cream cheese...and as much as you'd like of sugar-free gelatin, sugar substitutes..." UGH, or did I already say that?

This advice is really sad and I feel bad for the honest people who want to live healthier and follow this advice. I guess that's why the magazine contains all the advertisements for medical equipment. Follow the advice and you will definitely need all the advertised products.

Want some good ideas about diabetes. Go to www.westonaprice.org and do a search on diabetes. Read the work of Dr. Thomas Cowan. He helps people to get blood sugar under control. He recommends that the diet contain 60 carbs per day. What is in this magazine - 60 carbs per meal. See the difference?

Well, I feel better. I hope you find this educational. Rant over.

- Bernard Rosen, PhD

Exercise Lowers Breast Cancer Risk

A new study by University of South Carolina researchers indicates aerobically fit women are three times less likely to die of breast cancer than those who seldom exercise.

The latest addition to the growing evidence on the benefits of aerobic exercise is reported in the April issue of the scientific journal Medicine & Science in Sports & Exercise.

Researchers from USC's Arnold School of Public Health studied 14,000 women who were given preventive medical exams and treadmill tests at the Cooper Clinic in Houston from 1970-2001. At the time of their exams, the women, ages 20 through 83, had no history of breast cancer.

Based on the treadmill tests, the women's fitness was classified as low, moderate or high. Researchers compared the fitness levels of the 68 women in the study group who had died of breast cancer through 2003.

"Women in the study's lowest fitness category were nearly three times more likely to die from breast cancer than women in the most fit group," said Dr. Steve Blair, a USC researcher and a past president of the American College of Sports Medicine.

To reach the moderate fitness category, women need to exercise about 150 minutes per week. High fitness translates to 300 minutes per week.

"With more than 40,000 women dying each year from this disease, finding a strong association between fitness, which can be improved by the relatively inexpensive lifestyle intervention of regular physical activity, such as walking, is exciting," Blair said.

Exercise should be a standard part of preventive treatment for a number of health problems, according to the American College of Sports Medicine.

The new study also backed up previous findings that exercise helps control cholesterol levels, lowers blood pressure and lessens the likelihood for diabetes and heart disease.

Senior Moment? Maybe it's Your Blood Sugar!

Is the phrase "I'm having one of those senior moments" becoming an increasingly common utterance?

New research suggests it might be related to your sugar levels.

The new research, published in the December 2008 Annals of Neurology focused on a particular section of the hippocampus- an area of the brain associated with memory and learning. This section- the dentate gyrus- is typically affected by changes seen with aging.

"In this study, we were able to show the specific area of the brain that is impacted by rising blood sugar", said Scott Small, MD, the lead researcher on the study which was partly funded by the National Institute on Aging. Using special high-resolution brain imaging, Small and his team found that rising blood sugar was directly associated with decreased activity in the dentate gyrus.

The result: you forget where you put your keys!

The important point here is that the research strongly suggests that keeping blood sugar under control could be the key to preventing "senior moments" and lapses in memory, even in healthy individuals with no hint of diabetes!

"Our findings suggest that maintaining blood sugar levels, even in the absence of diabetes, could help maintain aspects of cognitive health", said Small.

Two of the most effective measures to manage blood sugar are and a controlled-carb diet!

Yet another reason to not eat high-carb, high-sugar foods.

Make Your Genes Behave

Insulin resistance is a condition in which the body doesn't process sugar well, and it often leads to diabetes or heart disease. But with all the talk of finding "genes" for diabetes, what often gets overlooked is the fact that genes interact with the environment. According to a new study, lifestyle choices have a lot more to do with insulin resistance than heredity does. What you do- or don't do- can actually "turn on" these genes (or render them inactive).

A new study from the University of Helsinki found that a sedentary lifestyle actually impairs the functions of certain genes that are related to insulin resistance in obese people. The study looked at pairs of identical twins in which only one twin was obese. In every single case, the obese twin had greater insulin resistance-- and was less fit. The twin who was more fit- even though he or she had identical genes- had far better insulin sensitivity, and wasn't obese.

Remember: genes loads the gun, but environment pulls the trigger. Lifestyle and diet choices actually impact what your genes do. In many cases- if not most- you have the choice to "turn them on" or "turn them off".

Overeating Triggers Overeating

Want a terrific example of the proverbial "vicious circle" when it comes to diet?

Check this out:

Overeating can actually stimulate a metabolic response in the brain that induces cravings to eat more. The result? A vicious cycle of elevated calorie consumption that can lead to obesity, diabetes and insulin resistance.

We've long known that inflammation is a huge part of every degenerative disease from Alzheimer's to heart disease, and it's a big part of obesity as well.

Researchers at the University of Wisconsin-Madison and University of California-San Diego found that overeating can induce inflammatory responses that underlie Type ll Diabetes and obesity.

Here's how it works. There's a structure in your brain called the hypothalamus which is like the command center for regulating appetite, feeding behavior, energy and body-weight balance. And there's a hormone in the body called leptin which has a lot to do with regulating appetite. Leptin talks to the hypothalamus, but when communication lines are down and the hypothalamus doesn't get the message that "we don't need any more food", the hypothalamus can promote or induce either obesity or type ll Diabetes (or both).

Overeating turns on a (normally inactive) protein in the hypothalamus that screws up the communication that would normally keep obesity and associated metabolic problems at bay. When you eat "normally", this protein keeps its mouth shut. When you overeat, the protein acts like a drunk at a Karaoke bar.

So what's the big news? We've known that eating too much makes you fat since forever.

The news is that it's not just that excess calories go right to your butt and thighs. That would be bad enough. But those excess calories actually upset and inflame metabolic processes that underlie disease.

There's a Confucian-inspired adage used by the long-lived healthy people in Okinawa: Hara hachi bu.

It means- eat till you're 80% full.

In other words, push away from the table before you're stuffed. You won't get fat, you might just live longer, and you'll probably protect yourself from some really nasty metabolic consequences.

Atkins Induction Diet improves Glycemic Control in Diabetics

Diabetes is a disease of uncontrolled sugar. In a nutshell, uncontrolled sugar is also a huge contributing factor to obesity and heart disease. When your blood sugar goes too high, insulin comes in to escort that extra blood sugar into the cells where it can be burned for energy. But if insulin doesn't work effectively, you wind up with too much blood sugar and high levels of insulin, and you're on your way to big health problems down the road.

The technical name for this ability of the body to regulate sugar effectively and efficiently is glycemic control.

So what's the number one thing that raises blood sugar anyway? Clearly it's carbohydrates. And study after study has shown that low-carb diets improve the ability of the body to effectively deal with sugar.

Previous research has shown that a low-glycemic diet (i.e. one high in beans, lentils and breads made with flaxseeds) does much better at managing glycemic control for Type ll diabetes than the "traditional" high fiber diet based on whole grain breads and breakfast cereals (which are often loaded with extra sugar).

Now a new study shows that when it comes to controlling blood sugar, the Atkins Induction phase program does even better.

Eric Westman, MD and his research team put 84 community volunteers with with obesity and type 2 diabetes on one of two diets- the very-low carb Atkins Induction Phase Diet or a low-glycemic, reduced calorie diet. After 6 months, there was improvement in both groups in glycemic control. But the Atkins Induction group improved more.

The main measure of improvement was a blood test called hemoglobin A1c, which is a kind of "Rolls Royce" of blood sugar measurement. While blood sugar levels at any given time fluctuate, Hemoglobin A1c gives us a much more realistic reading of the overall effectiveness of blood sugar control over an extended period of time. Since red blood cells basically live for about 3 months before dying, when sugar sticks to these cells it's possible to tell just how much sugar has been around for the past three months.

Both diets- Atkins Induction and low-glycemic- improved Hemoglobin A1c as well as fasting glucose, fasting insulin and even weight loss. But the Atkins Induction diet did slightly better on all four counts.

Both groups were also able to reduce their diabetic medication. But in patients taking insulin, the effects of the Atkins Induction diet were really quite powerful. Participants taking from 40-90 units of insulin before the study were able to eliminate their insulin use after starting the Atkins Induction Diet, sometimes so quickly that the study researchers had to issue the warning that subjects with type 2 diabetes who are unable to adjust their own medication shouldn't make these dietary changes without close medical supervision!

Does this study mean that an Induction diet is preferable to a low-glycemic diet, which in other studies has been shown to be very useful for glycemic control. No. "A low-carbohydrate, (Atkins Induction) diet combines two approaches that, on their own, improve blood glucose control: weight loss and a reduced glycemic index diet", wrote the researchers. Because low-glycemic diets typically contain from 40-60% of calories from carbohydrate, it's possible that the beneficial effect of low-glycemic diets could be augmented even further by the reduction of the absolute amount of carbs- or by a reduction in calories", said Dr. Westman.

Low-Glycemic Diet and Diabetes

Low-glycemic foods - beans, peas, lentils, pasta, rice boiled briefly and breads like pumpernickel and flaxseed - do a better job of managing glycemic control for Type-2 diabetes and risk factors for coronary heart disease than diets based around the "traditional" high-fiber foods such as whole grain breads, crackers and breakfast cereals.

That's the finding of a new study published in the Journal of the American Medical Association. And it doesn't surprise me one bit.

Although the god-awful American Dietetic Association continues to mindlessly parrot the "conventional" wisdom about whole grain breads and cereals, truth is that most of these whole grain products are fiber lightweights. (Read the label- typically 1-2 grams of fiber at best compared to say, 11-17 in a cup of beans.) And if you check the glycemic index/ glycemic load tables, you find that the difference between a processed grain like white rice and its whole grain counterpart (brown rice) is- from a blood sugar point of view- almost negligible.

Obviously whole grains are better than white junk, but only because they contain slightly more vitamins and other nutrients. From a blood sugar point of view- and from a food sensitivity or allergy point of view- they're not that much of an improvement. If you've got gluten sensitivity- which is way more common than you might think- whole grains are just as much a problem for you as the processed kind.

In the JAMA study, researchers found that hemoglobin A1C- a very important marker for diabetes- decreased significantly more in subjects on the low-glycemic diet than it did for people eating the "traditional high-fiber" choices with cereal fiber. The low-glycemic group also saw a significant increase in HDL (the so-called "good" cholesterol) as well as a significant reduction in LDL (the so-called "bad" cholesterol).

The low-glycemic diet group did eat some breads- like pumpernickel, rye pita and quinoa bread with flaxseed- and some cereals- like real oatmeal- but they were all low-glycemic.

Bottom line: just because a cereal or bread product says "made with whole grains" doesn't mean it's the best food for you. Many of these products raise your blood sugar way too high, and manufacturers are notorious at trading on the "whole grain" buzz to create ridiculous products like "whole grain Cocoa Captain Sugar Krispies" (I made that one up, but you know what I'm talking about).

Glycemic impact is very important and should be paid attention to by anyone interested in his or her health. And you don't have to walk around with a bunch of scientific formulas to figure out whether a food has high or low glycemic impact. Just look for foods that have minimum processing, maximum color (exception is oatmeal and cauliflower) and as much fiber as possible.

Vitamin C and the Risk for Diabetes

In a recent issue of the Archives of Internal Medicine, researchers at the University of Cambridge reported an association between higher levels of vitamin C in the bloodstream and a lower risk of developing Type ll Diabetes.

The researchers looked at over 21,000 participants from 1993-1997 who did not have diabetes when the study started. Their vitamin C levels were tested, and the participants were given dietary questionnaires to fill out when they enrolled in the study. Then the researchers followed the participants till 2005.

Over the twelve years of follow-up, 423 men and 312 women developed diabetes. But those men and women who were in the top 20% of vitamin C levels had a whopping 62% lower risk of developing the disease compared with those in the bottom 20%.

There are a couple of things that are interesting here. One, vitamin C is often a "marker" for fruit and vegetable intake in the diet- people who eat more fruits and vegetables have more vitamin C in their blood stream, and in the Western diet, 90% of our vitamin C comes from fruits and vegetables. So the protection against diabetes may have come from the vitamin C, but it also may have come from fruits and vegetables and all their assorted protective vitamins, minerals and phytochemicals.

So the authors did an interesting statistical analysis. They also evaluated fruit and vegetable intake independently of vitamin C in the blood. Not surprisingly, fruit and vegetable intake was also associated with a lower risk of diabetes (22% lower) but- perhaps surprisingly- fruit and vegetable consumption was associated with a lower reduction of risk against diabetes than high vitamin C levels in the blood.

"Higher plasma vitamin C level and, to a lesser degree, fruit and vegetable intake were associated with a substantially decreased risk of diabetes," the study authors wrote.

Never in the world would I recommend taking a vitamin supplement instead of eating vegetables and fruits. There are hundreds, perhaps thousands, of plant compounds found in the plant kingdom that probably have synergistic effects on our health, and many have specific health benefits besides the ones looked at in this study.

But the fact is that vitamin C is an incredibly important vitamin and most of us don’t get the optimal amount, even when we do eat a lot of fruits and vegetables. (Much vitamin C is lost between the time the fruit is picked and transported to your grocers shelf- more is lost once it’s cut.) My personal recommendation: Eat all the vegetables and fruits you possibly can- and also take a high quality vitamin C supplement such as Stellar C or Bio Fizz for added protection!