Prediabetes

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blood sugar, diabetes, integrative, Metformin, pre-diabetes

As high blood sugar becomes more of a national obsession–partly associated with our obesity epidemic, partly linked to our typical Western diet–the term pre-diabetes is being used more frequently. Prediabetes indicates fasting blood sugar over 100 but below 126 (or glycosylated hemoglobin above 5.7 but below 6.5), above which the diagnosis would indicate diabetes.  It is estimated that close to 80 million American adults fall into the pre-diabetic category.

One might wonder if “prediabetes” is comparable to being a little bit pregnant?  Happily, it is not, because while many people diagnosed with prediabetes go on to develop the full-blown disease, the condition is reversible with diet and physical activity. A landmark controlled trial proved that proper diet and regular exercise combined with intensive coaching beat out even the prescription drug Metformin in lowering blood sugar to normal levels.

Reversing the disease before it becomes full blown is important, because diabetes is a disease best treated before it starts or in its earliest, preliminary stage. Once blood sugar regularly rises above 126, it is much harder and often impossible to “cure” the disease  though progression can be largely halted and complications prevented with a lifetime regimen of one or more drugs.

High blood sugar is a much more complicated issue than it often appears in the media. Treating pre-diabetes immediately is important because capillary damage, which usually affects the retina in the eyes and the kidneys first, is silent and painless, and it occurs far earlier than was previously thought. So does neurological damage, which results in the tingling in the bottom of the feet, which many people with high blood sugar experience.

As an integrative practitioner, I counsel very effectively for diet and physical activity.   And I always prefer lifestyle changes over pharmaceuticals when possible. But recent studies have convinced me that this early damage to the microvascular system, which is irreversible, warrants medical treatment immediately.  Then as you work to lower your blood sugar through appropriate dietary practices and increased exercise, you can taper off and hopefully discontinue the drugs if you are successful. The two approaches work best in tandem.

Lest I sound too conservative, in my next post, I’ll discuss insulin sensitivity and a couple of natural non prescription supplements, which have proven helpful in dealing with pre-diabetes and diabetes.

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Call Me “Prof”

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Food, food science nutrition, Gillings School of Global Public Health, Susan Wyler, Triangle Nutritional Wellness, UNC at Chapel Hill, UNC-CH

What a thrill to announce I’ve been invited to join the faculty of the University of North Carolina at Chapel Hill as an Adjunct Instructor in Nutrition at the Gillings School of Global Public Health. Starting in January, I’ll be teaching a graduate course in Food Science. Being invited back to my alma mater means so much to me because of what the university gave to me. The academic scientific education and rigorous clinical training in nutrition and public health provided  a robust and multi-faceted toolbox to use in treating my patients. To have so much to draw upon has imparted both confidence and competence in my practice at Triangle Nutritional Wellness.

Whether it’s been the effectiveness of my weight-loss program or complicated medical nutrition therapy for complex chronic ills, the combination of evidence-based information, the holistic approach I learned from Dr.Thomas Rau, and my extensive professional culinary knowledge have served me–and my clients–well. It’s no accident that UNC at Chapel Hill is ranked as highly as it is.

If I can inspire even a few students the way the amazing Amanda Holliday, Clinical Assistant Professor and Director of the Dietetics Programs, who was my advisor and teacher, inspired me, it will be an achievement. I look forward to pairing academia with my clinical nutrition practice.

Talking Health, Wellness and Food with Chapelboro’s “SideDish”

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Chapelboro.com, Deborah Miller, health, SideDish, wellness

This weekend I had the great pleasure of being interviewed by Deborah Miller on her show, “SideDish” on WCHL radio in Chapel Hill, North Carolina.  Deborah is a fabulous full-of-life individual who gets up-close and personal with area chefs, cooking teachers and food and wine experts, and she has a gift for drawing out the best in everybody. I guess I qualified as a cross-over, having been a food and wine expert and now following my passion for nutrition. We talk about my clinical practice, which emphasizes delicious natural foods as the path to good health, and offer several great seasonal recipes for fresh corn and tomatoes.

To listen to my interview with Deborah on her show, SideDish” please visit http://chapelboro.com/pages/13454906.phpI would like to give Deborah and her team a very big, “Thank You,” for having me on “SideDish” this past weekend!

Healthy Eating Is Good Eating: Do-Ahead Dinner Party Lamb

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dinner party, entertaining, rack of lamb

It always puzzles me why we tend to do all or nothing.  Eat only vegetables or be meat and potato fanatics.  Food is so pleasurable, and every ingredient has something different to offer. Why not embrace them all? That’s why I think that while a preponderance of a variety of fresh vegetables should constitute the backbone of everyone’s diet, a little red meat now and again is not a bad idea. Choose lean and organic or hormone free, if possible. Red meat contributes high-quality protein; iron, an essential mineral in appropriate quantities; B12, which is hard to come by in completely vegetarian diets, as well as B1 and B6. Lamb contains one quarter to one third of an adult’s daily requirement for zinc.

Rack of Lamb with Herbed Garlic Crust is one of my favorite dinner party dishes, because it can be completely assembled in advance. While the chops on the plate you see look hefty, they constitute at most 4 ounces of meat, albeit so flavorful and well seasoned, the satisfaction level is high. And notice, as recommended by the powers that be, three quarters of the plate are filled with vegetables.

I like this recipe primarily because it is so delicious, but also because its do-ahead aspect removes as much fat as possible from the lamb and the smell from the initial browning will disappear by the time your guests arrive. For my plate, I’ve included Yukon gold potatoes roasted with onions, roasted beets, and steamed baby broccoli and asparagus. You can choose your favorite accompaniments.  And look for dessert in an upcoming blog.

Rack of Lamb with Herbed Garlic Crust

Baby racks of lamb from New Zealand are available in most parts of this country.  Because they are from young animals, the flavor is mild, and if you allow one rack for 2 to 3 people, portion size is appropriate.  Those prepackaged at Trader Joe’s are already heavily trimmed. Whole Foods also carries them, but be sure to ask the butcher to trim off any excess fat.You can brown the meat, layer on the crust, and finish the dish in the oven within an hour and a half of serving; or brown ahead and refrigerate until one to one and half hours before dinner.       Serves 2 to 3

• 1 rack of baby lamb (12 to 16 ounces)
• Sea salt and freshly ground pepper
• 3 tablespoons extra virgin olive oil
• 1/2 cup panko bread crumbs
• 1/2 cup flat-leaf parsley sprigs, tough stems removed
• 3/4 teaspoon minced fresh rosemary
• 2 garlic cloves, minced
• 1 small shallot, chopped
• 2 to 3 teaspoons Dijon mustard

1. Trim any visible solid fat from the lamb. Season  all over with salt and pepper. Heat 1 tablespoon of the olive oil in a cast-iron or other heavy ovenproof skillet just large enough to hold the rack. Add the rack meaty side down and brown over moderately hot heat for about 3 minutes. Turn over and brown the other side for 2 to 3 minutes. Remove the lamb to a plate. Pour off all the fat from the skillet, and carefully wipe it clean with paper towels. If you’ve done this preparation well in advance, cover the meat and refrigerate.  If you are within an hour and a half of serving, set aside to cool slightly.
2. Preheat the oven to 400 degrees F.  In a mini-food processor, combine the panko crumbs. parsley, rosemary, garlic, and shallot. Pulse, then process, until the parsley is chopped and the breading evenly mixed.
3. Paint the meaty side of the rack and the ends with the mustard.  Spread the seasoned crumbs over the rack and onto the sides, pressing it firmly but gently with your hands to help it adhere.
4. Return the rack to the skillet and roast until the center of the meat registers 139 degrees F for medium rare, about 15 minutes, or slightly higher if you prefer it better done. (The flavor is best if the meat is pink.)  Remove from the oven and let stand for 3 to 5 minutes to finish cooking.  Divide into double chops to serve.

Move It or You Won’t Lose It

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exercise, lowering blood sugar, physical activity, weight loss

There’s nothing like personal experience to drive home a lesson. I always tell my clients physical activity is a major component of good nutrition. I even pass out free pedometers, explaining how moving skeletal muscles not only speeds up metabolism, but perhaps more importantly, facilitates transport of glucose from the bloodstream into the cells, where it’s used for energy, without any action of insulin. But do I practice what I preach?

Zipper

I walk my dog Zipper for up to an hour every day, but he zips only occasionally and stops and sniffs a lot. There’s no room for my treadmill where I live now, and I dropped membership in my health club when they moved farther away. My yoga mat, well used most of my adult life, remains rolled up and tucked away. I use the same excuses as all the people I’m trying to help.  Too busy: the computer and stove, work and responsibilities take up all my time, as does life.

So no surprise my own recent efforts to drop a few pounds hit a wall. First I gave up bread and booze, an easy first-line strategy. Dispensable calories, at least in the short run. Bingo: 3 pounds in 3 weeks—an optimal weight loss rate: slow, steady and often permanent.  But then, the numbers just wouldn’t budge. Granted, it was a casual diet, and after a few weeks, I wanted a glass of wine. I made further changes, eating lighter, including even more vegetables than usual, creating more salads, some of which you’ll find elsewhere on this blog. The food was delightful and I felt great, but still, no more pounds came off.

Then recently, with the weather absolutely perfect and a little more time on my hands, I took a long hike with my good friend graphic designer Suzin Purney. We let the dogs off their leashes and kept a brisk pace up and down hills for about an hour and a half. The next day, I picked up my tennis racket for the first time in at least a decade. Another dear friend, Mary Ann Kendall, who is a pro at the local tennis club, gave me a lesson. Miraculously, the muscle memory was there, and it started to come back. It felt great to hit the ball and run around the court. I kept up the pace for another few days.

Well, at the end of the week when I stepped on the scale, there were two more pounds gone. I’d reached my goal.  But it was only achievable when I added some rigorous physical activity to my dietary plan. It’s not trivial that in the biochemistry of nutrition, we study exercise physiology along with calories, carbohydrates, protein, and fats. Proper diet and physical activity go hand in hand. You cannot achieve optimal health with one without the other.

Careful with Calcium

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evidence-based nutrition

For years, many of my friends were popping calcium supplements like candy. How else to prevent slow bone erosion and eventual osteoporosis, especially after menopause? (Well, proper diet– including dairy products, leafy greens, and fish–and weight training are two good ways, but that’s not what we’re talking about here.)  Anyone with heartburn added calcium from antacids to the mix, thinking they were doing themselves even more good. Wrong on both counts.  Most doctors recommended 1200 mg, the government’s number for women over 50. But keep in mind, if you take 1200 mg calcium citrate or calcium carbonate in supplements and drink milk or fortified orange juice or eat yogurt, salmon, fortified cereal, or leafy greens, you’re taking in anywhere from 30%-50% more.

I first became skeptical when I learned that a pregnant young woman needs no more calcium than a woman her age who is not pregnant.  How can that be?  Well, the body, it turns out, takes what it needs and ignores the rest. Not long ago, a couple of very large studies published in the British Journal of Medicine noted an alarming increase in sudden heart attacks associated with too much calcium intake. They recommended taking no more than 800 mg in supplements. The USDA, which regulates both the dairy industry and our nutrition recommendations, stuck to their guns and continued to insist on an adult DRI of 1200 mg calcium at least, insisting it was safe as long as you were getting enough vitamin D–which almost no one is unless they take a supplement.  Now, a study of over 35,000 individuals has shown a direct relationship between too much calcium and mortality from heart attacks.  It may be that all that extra mineral  circulating in the blood  may lead to calcification of the inner lining of the blood vessels.Don’t get me wrong. Calcium is an extremely important nutrient and the most abundant mineral in the body. We need minute amounts of it for vascular health, muscle contractions, to speed nerve impulses, allow proper cell signaling and hormone secretion. The majority of calcium serves to replenish our bones, which are constantly turning over, balancing in the blood with potassium, to preserve critical acid acid/base balance necessary for life.  If you know your diet is deficient, a 600 mg supplement should be plenty. But strive to obtain what you need form a healthy diet. Here is a list of excellent natural sources of calcium:

• yogurt
• cheese
• sardines (bones in)
• canned salmon (bones in)
• leafy greens: kale, Swiss chard, spinach, turnip greens, collards, turnip greens, bok choy… (Tip: Always add a splash of fresh lemon juice to your greens to help absorb the calcium.)
• soy:  tofu, soy milk
• figs
• molasses
• fortified cereal

The Acid Reflux Solution: GREAT NEWS!

My new book, The Acid Reflux Solution: A Cookbook and Lifestyle Guide for Healing Heartburn Naturally,  is chock full of easy lifestyle tips and over 100 recipes for preventing heartburn and losing weight at the same time. The exciting news is we popped at #14 on Amazon.com a few weeks ago, after Dr. Jorge appeared with Whoopi Goldberg and Barbara Walters on “The View.”

Should You Take a Daily Multivitamin?

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health

Some months ago, results of a Swedish study published in one of the premier scientific journals in the field, The American Journal of Clinical Nutrition, revealed a startling association. After following over 35,000 women for 9 1/2 years, they noted that those who reported taking a multivitamin everyday had a 19% greater likelihood of developing breast cancer.  This was an unexpected finding, contrary to the protective association seen with increased intake of fruits, vegetables and whole grains and lower rates of many cancers. In trying to explain the results, they postulated it might be the folic acid in the pills that was accountable.

You see, folate is an extremely important B-vitamin, crucial for proper DNA replication. Lack of folate has been shown to result in increased birth defects, especially neural tube defects like spina bifida, which occur during the first few weeks of the embryo’s life. That’s one main reason the government started fortifying grains with folic acid. It’s easy to get enough folate from your food if you eat enough vegetables regularly, but many young women of childbearing age do not have healthy enough diets. At the same time, while over one-third of the adult population of America is clinically obese, ironically many of these individuals are actually under-nourished. They get more than enough calories, but not enough vitamins, minerals and antioxidants.

The problem with multivitamins is that the artificial form of folate that is added to most pills, folic acid, enters the cell and interacts with another vital nutrient, vitamin B12, slightly differently. It’s actually much more bioavailable than the natural form, so that you get a big hit from the pill. But that may not be completely beneficial.

A subsequent meta-analysis, which is a grouping of lots of smaller studies so the results can be considered as if it were a really, really large study, did not find the same association between multivitamins and breast cancer. They found no statistical significance one way or another. However, given the gravity of the subject, they recommended further research be done on the subject.

My approach to nutrition is to encourage eating more delicious and colorful vegetables and fruits everyday, as well as a balance of other food groups, so that you maximize your nutrition in the most natural as well as most pleasurable way possible. Almost everyone thinks she or he is eating healthy. A registered dietitian or licensed nutritionist can measure your actual nutrient intake scientifically with enough accuracy to determine your individual needs and how well you are meeting them, which can be surprising.  For my clients who do require supplements, especially those over 40, I recommend locating a brand of multivitamin that contains a natural form of folate and taking the pill 3 or 4 times a week. With nutrition, as with many other things in life, too much of a good thing is not always helpful.