During a nutritional consult recently, my diabetic patient remarked how
pleased they were with results from working with Dr. Jill Rose in our
Physical Therapy department. Specifically, one of their symptoms due to
diabetes is poor sensation in their feet, and last year this had been a
factor in them losing their balance and sustaining a bad fall.  Fortunately
no bones were fractured but the recovery was a slow and arduous process,
something they hope to never have to go through again.  After the fall, the
patient's activity level had to dramatically decrease which led to weight
gain and lean muscle loss. Anything that can help prevent balance loss or
falls is a worthwhile investment in time and energy. Jill has been doing
Physical Therapy to improve balance and strengthen this patient's weak leg
muscles.  My patient noted that because they feel so much stronger they are
more motivated to resume their daily walks which they had really missed. It
is clear that the Physical Therapy work is significantly decreasing their
risk of a fall and injuries.

ABOUT OUR PHYSICAL THERAPIST

Dr.Jill Rose received her Master’s and Doctorate in Physical Therapy at Upstate Medical University, in Syracuse, NY. Her focus during her doctorate was osteoarthritis of the knee. She specializes in the McKenzie technique to treat spinal problems. She is also certified in kinesiotaping and specializes in treating orthopedic issues. She recently became certified in treating vestibular disorders such as BPPV (benign paroxysmal positional vertigo). Jill believes that educating clients on body awareness and proper technique is the best tool that she can give them, she believes in hands on treatment which is why she chose to work at a clinic that understands the importance of one on one therapy. In her spare time she enjoys boating with her husband, Chris; and running with her dog, Charlie.

Even though losing as little as 5% of your weight can be beneficial, losing 10%-15% was even better in reducing diabetes and heart disease. This is why, in my practice, I emphasize weight loss so much. Believe it or not, losing weight can actually be healthier for you in the long term then taking a lot of prescription medications!
 
 
Clinical Evidence Has Shown That Greater Weight Losses Were Associated With Greater Improvement in Cardiovascular Risk Factors Associated with Diabetes
For overweight and obese patients, the NIH recommends 10% weight loss over the course of 6 months as a goal for clinically meaningful differences in patients’ health. An observational analysis examined the association between the magnitude of weight loss and changes in cardiovascular (CVD) risk factors at 1 year and the odds of meeting predefined criteria for clinical significant improvements in risk factor in individuals with type 2 diabetes.
Significant Improvement in HbA1c (Diabetes)
Significant improvement in HbA1c (P<0.0001) was noted with a 10%-15% weight loss goal. The clinical endpoint evaluated was a 0.05% decrease in HbA1c (odds ratio, 5.44 [95% CI, 4.15-7.13]).

Significant Improvement in HbA1c (Diabetes)
Significant improvement in HbA1c (P<0.0001) was noted with a 10%-15% weight loss goal. The clinical endpoint evaluated was a 0.05% decrease in HbA1c (odds ratio, 5.44 [95% CI, 4.15-7.13]).

Significant Improvement in Fasting Glucose
Significant improvement in fasting glucose was noted in patients achieving ≥10% loss in total body weight (P<0.0001). The clinical endpoint evaluated was a 20-mg/dL decrease in glucose (odds ratio, 4.07 [95% CI, 3.09-5.36]).

Study Conclusions
The Look AHEAD study confirmed the benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes:
    •    The magnitude of weight loss at 1 year was highly related to the improvements with glycemic control
    •    Patient who lost 10%-15% had great odds of improvement than those who lost 5%-10%

Study Design
The Look AHEAD (Action for Health in Diabetes) study* is a multicenter, randomized clinical trial that examined the long-term effects of lifestyle interventions on cardiovascular morbidity and mortality in 5,145 overweight or obese participants with type 2 diabetes who were randomly assigned to intensive lifestyle intervention (ILI) or to usual care, referred to as diabetes support and education (DSE).

Pay-for-performance requirements for microalbuminuria are out of touch with the latest science.
Many want you to screen diabetes patients for proteinuria every year...and then TREAT microalbuminuria with an ACE inhibitor or ARB even if the patient doesn't have hypertension.
The idea is to slow the progression of kidney disease.
 But now we know that microalbuminuria is NOT a good marker for kidney disease...and adding an ACEI or ARB at this stage does NOT reduce risk.
  It's a different story for diabetes patients with MACROalbuminuria.
  In these cases, starting an ACEI or ARB does slow the progression of kidney disease.
 
 
I frequently get letters from insurance companies claiming that they know the best way to treat patients. The above statements are excerpted from a letter that we sent to FREEDOM MEDICARE INSURANCE explaining why we do not do this test. It is hard enough practicing medicine in today’s political and economic climate and having an insurance company or the government dictating policy is not going to make it easier.

New clinical practice guidelines from the American Diabetes Association (ADA) include recommendations for a less stringent blood pressure target and greater individualization with regard to the frequency of blood glucose self-monitoring.
This year, the revisions reflect the increasing use of evidence-based recommendations in addition to the recognition that the population-based evidence derived from studies needs to be tailored to the individual patient The new ADA recommendation raises the target for systolic blood pressure from below 130 mm Hg to below 140 mm Hg on the basis of evidence that there is not a great deal of additional value, but there is an increase in risk in pushing systolic pressure much lower than 140 mm Hg.  

The truth of the matter, in my opinion, is that tight glucose control is not as important as previously thought and that the ADA is WRONG about blood pressure control!. The best prevention of diabetic complications is seen in those patients with systolic BP’s <130 and="" ldl="" cholesterol="" 100="" preferably="" less="" then="" 70="" hdl="" probably="" has="" no="" effect="" on="" outcomes="" i="" would="" also="" add="" that="" regular="" physical="" activity="" consisting="" of="" both="" aerobic="" exercise="" weight="" lifting="" is="" a="" major="" factor="" in="" preventing="" disease="" home="" monitoring="" blood="" glucose="" been="" shown="" to="" have="" non-insulin="" dependent="" diabetics="" these="" are="" personal="" observations="" reflecting="" my="" 31="" years="" private="" practice="" internal="" medicine="" p="">

This is also one of the reasons why we added nutritional and personal fitness services in my practice.

Fat Joe Before and After

Please read this story. It really summarizes why we spend a lot of time and energy planning wellness services for our patients. As I have stated in the past, it is a whole lot easier and cheaper to teach health than treat disease!

BY DAVID GREENWALD, L.A.
NOVEMBER 15, 2011 | 11:58PM
The rapper, who says he once tipped the scales at 460 pounds, told CNN that he's lost 100 pounds and counting.
"I think I weighed about 450, 460 at my heaviest," he said, explaining that his hip-hop success encouraged him to over-indulge. "[I thought,] I'm rich now, I can go to Mr. Chow's and eat me all the lobster and steak I want… And I always took pride in being fat, that's why my name was Fat Joe."
The impetus for the lifestyle change first came in 2000, when fellow MC Big Pun died from a heart attack. In the last year, he told CNN, six of his friends -- all around his weight -- died of heart attacks.
"I realized at a certain point, all my big people were dying," he said. "I couldn't see a clearer picture, what's the difference between me and him, of me being in a casket?"
He's since hit the gym and changed his eating habits, eating healthier foods and smaller portions more frequently. The weight loss has led to other health benefits, as well.
"I was diabetic for 16 years," he revealed. "Being that I lost weight, no more diabetes."
But don't expect a name change: at any size, the "Lean Back" rapper says he's still Fat Joe.”
 

Diagnosing Diabetes:
There are three parameters that qualify for a diagnosis of diabetes:
1.Hgb A1c (3 month average sugar)>6.5
2. Fasting Blood Glucose >125
3 Two hour post prandial glucose >200 (2 hours after a meal)
4. Metabolic syndrome (see earlier blogs) and a family history of diabetes does not mean YOU have diabetes; just an increased risk of getting it.
 
Once the diagnosis of diabetes has been established, you ARE at increased risk of getting (or maybe even already have!) eye disease, kidney dysfunction or neurological complications, even if your sugars are well controlled.
Heart disease seems to be more related to hypertension, cholesterol and lack of exercise than it does to tight glucose control!
 
This is why we try to tell our patients that is is better NOT to have diabetes as opposed to settling for well controlled diabetes.
 

How to cure diabetes?
 
1.Don’t let your body progress from Prediabetes (sugars >99 but <125) to="" diabetes="" eat="" right="" exercise="" increase="" muscle="" mass="" and="" burn="" belly="" fat="" br="">2.Alcohol is very fattening not only because it is mostly wasted carbs but it usually stimulates your appetite. I have a patient who is 50 pounds overweight and drinks 6-10 beers/day. His diabetes is well controlled on medications, but I cannot convince him that he is better off being an ex-diabetic rather than a well controlled one. I’m afraid he will learn his lesson the hard way 5-10 years from now!
3. Some medications may be cheap but have many side effects are are not healthy in the long run. Others, such as metformin, Actos (yes, Actos, not Avandia!) Januvia, Onglyza, Byetta or Victoza are the drugs of choice. Most patients do not want to take insulin and I try to reserve that as the final option. Notice how I did not mention glimiperide or similar drugs. They are cheap, but that’s it!
4. Healthy eating is not as hard as it sounds. That’s why we offer nutritional services to ALL of our patients. Unfortunately, we can’t accept insurance, since the insurance companies are NOT in the business of wellness - but rather treating sickness!
5. Exercise is also easier than you think. Just walking 15 minutes/day (again, see earlier blog) can add 3 years to your life! We are also one of the few Internal Medicine practices, I believe, in the USA to employ personal fitness trainers in our office. Try us out. The first session is free.
 

During a nutritional consult recently, my diabetic patient remarked how
pleased they were with results from working with Dr. Jill Rose in our
Physical Therapy department. Specifically, one of their symptoms due to
diabetes is poor sensation in their feet, and last year this had been a
factor in them losing their balance and sustaining a bad fall.  Fortunately
no bones were fractured but the recovery was a slow and arduous process,
something they hope to never have to go through again.  After the fall, the
patient's activity level had to dramatically decrease which led to weight
gain and lean muscle loss. Anything that can help prevent balance loss or
falls is a worthwhile investment in time and energy. Jill has been doing
Physical Therapy to improve balance and strengthen this patient's weak leg
muscles.  My patient noted that because they feel so much stronger they are
more motivated to resume their daily walks which they had really missed. It
is clear that the Physical Therapy work is significantly decreasing their
risk of a fall and injuries.

Dr. Jill Rose
Physical Therapist
Kaizen Total Wellness Center
941-556-7788

What It Is:
The ripe seeds of the milk thistle plant (Silybum marianum) are used medicinally. One of the most important constituents of milk thistle is silymarin, which itself has of several chemical constituents, the most prominent of which is silybinin (silybin).
What It Does:
Diabetes
The silymarin component of milk thistle may decrease blood sugar, hemoglobin A1c, and LDL cholesterol levels when used with conventional therapy in people with type 2 diabetes. It has also been shown to reduce insulin resistance in people with coexisting diabetes and alcoholic cirrhosis.

Diseases of the Liver
Silymarin is thought to act as a liver-protectant. However, evidence of benefit in liver disease has been mixed.
One preliminary study of a specific silybinin preparation improved liver function in people with chronic active hepatitis. However, most studies in patients with hepatitis B or C have generally not shown an improvement in mortality or liver function using milk thistle or preparations of milk thistle. Similarly, in alcoholic liver disease, some preliminary clinical studies suggested that milk thistle might improve liver function and mortality. However, an analysis of several studies did not show a significant effect.

Liver protection from chemotherapy and other drugs
Preliminary evidence suggests that milk thistle extract standardized to 70% - 80% silymarin may protect the liver against damage from certain toxins, including drugs such as acetaminophen and phenytoin (Dilantin).

A recently published study (Ladas, Cancer 2010) suggests that milk thistle extract may reduce  liver toxicity due associated with chemotherapy.  Liver toxicity is often a complication of chemotherapy and limits therapy.  The study was conducted on children with acute lymphoblastic leukemia (ALL) receiving maintenance chemotherapy.  Milk thistle extract standardized to 33% silibinin was given at a daily dose of 80 mg to 320 mg of silybinin.  Milk thistle was associated with reductions in levels of liver enzymes that indicate toxicity.  Interestingly, a benefit was not seen during the short course of therapy (28 days) but one month later.
Administered intravenously (IV), silybinin may lessen liver damage due to poisoning by Amanita phalloides mushroom (death cap) — although this IV preparation is not readily available in the U.S.

Other:
Silybinin is under investigation for use in preventing or treating various forms of cancer, especially prostate cancer

www.kaizentotalwellness.com   (941)556-7788
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The following should be helpful for those patients who either have diabetes or are at risk of getting diabetes who are using steroid medications.
Please make an appointment if you are taking steroids and have any questions about your blood sugar.

CORTICOSTEROIDS
Hyperglycemia can occur with non-oral corticosteroids...topical, inhaled, or local injections. Hyperglycemia is less likely when corticosteroids are given by these routes instead of systemically...but can still occur in susceptible patients.  Topical steroids can cause hyperglycemia when used in chronic or high doses...especially for diffuse conditions such as psoriasis. We monitor blood glucose in patients using high-potency steroids...large steroid doses...or when treatment exceeds 6 months. We are  especially vigilant if patients are at risk for diabetes.  Inhaled steroids can increase the risk of hyperglycemia when used in high doses, such as fluticasone 1000 mcg/day or more. If hyperglycemia occurs, we try to lower the steroid dose and add a bronchodilator or other agent if needed. Steroid injections into joints can cause hyperglycemia for about 2 to 5 days in patients with diabetes...and longer for long-acting steroid formulations. Epidural injections can increase blood glucose up to 2 weeks.

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www.drmishner.com   (941)747-2090
 

Are you Short of Breath?
There are several reasons why obese people get short of breath. When you are heavy, your diaphragm can not expand enough to allow you to take a deep breath. Also, heavy people generally do not exercise, leaving them in a deconditioned status. The last reason is that fat cells in the abdomen lead to inflammation in the lungs, further decreasing lung capacity.
Here is an article showing how shortness of breath may in itself be a precursor to diabetes or metabolic syndrome (obesity, hypertension, abnormal lipids, gout and diabetes)
There is a reason why we consider obesity to be a major disease and why we have many programs in our office to help you make lifestyle changes to try to prevent these diseases.
Our practice is one of the few in the United States to employ dietitians, fitness trainers, physical therapists and massage therapists. We are aligned with the nationally known Venice Nutrition System and even have our own gym with our exclusive Power Plate and bioDensity machines.
To learn more, please call 941-747-2090.
 
 

Obesity in Adults Is Associated With Reduced Lung Function in Metabolic Syndrome and Diabetes

The Strong Heart study
Abstract
OBJECTIVE The purposes of this study were to investigate whether reduced lung function is associated with metabolic syndrome (MS) and diabetes (DM) in American Indians (AIs) and to determine whether lower pulmonary function presents before the development of DM or MS.
RESEARCH DESIGN AND METHODS The Strong Heart study (SHS) is a multicenter, prospective study of cardiovascular disease (CVD) and its risk factors among AI adults. The present analysis used lung function assessment by standard spirometry at the SHS second examination (1993 to 1995) in 2,396 adults free of overt lung disease or CVD, with or without DM or MS. Among MS-free/DM-free participants, the development of MS/DM at the SHS third examination (1996 to 1999) was investigated.
RESULTS Significantly lower pulmonary function was observed for AIs with MS or DM. Impaired pulmonary function was associated with MS and DM after adjustment for age, sex, abdominal obesity, current smoking status, physical activity index, hypertension, and SHS field center. Both forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were negatively associated with insulin resistance or DM severity and with serum markers of inflammation (P < 0.05). FVC and FEV1-to-FVC ratio both predicted DM in unadjusted analyses but not when adjusted for covariates, including waist circumference. In the adjusted model, abdominal obesity predicted both MS and DM.
CONCLUSIONS Reduced lung function is independently associated with MS and with DM, and impaired lung function presents before the development of MS or DM; these associations may result from the effects of obesity and inflammation.

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We all know that DIABETES increases risks of heart disease, strokes, kidney failure and blindness......but have you heard of this one?
 
 
“Type 2 diabetes mellitus and colorectal cancer: Meta-analysis on sex-specific differences ?European Journal of Cancer, 09/25/2011  Evidence Based Medicine
Kramer HU et al. – In both men and women, risk estimates from case–control studies were slightly higher than those from cohort studies. Overall, type 2 diabetes mellitus (T2DM) is associated with a moderate increase in colorectal cancer (CRC) risk in both men and women“
 
At our office, we are more than just a place to get medicine when you are sick. We like to teach and practice wellness. The word “doctor” literally means teacher. We firmly believe in preventive medicine. That is why we employ nutritionists, life coaches, fitness trainers, physical therapist and massage therapists.

www.kaizentotalwellness.com  (941)556-7788
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This is one of the reasons we have developed a total wellness program for our patients and friends. Everyday, we read about the connection between “fat” and heart disease. There is a reason why we measure waist lines (not belt or pants sizes): Any man with a waist greater than 40” or woman greater than 35” has elevated visceral (belly) body fat. This is the fat that literally surrounds and infiltrates important organs in the body. Notice its link to inflammation. Most chronic diseases are also linked to obesity. Arthritis. Cancer. Diabetes.
With diet and exercise, we believe that most illnesses can be either prevented or diminished. Of course, once the horse has left the barn........
For more information, or to schedule a free demo, including a measurement of your abdominal body fat, call 941-556-7788.

Adipose tissue pro-inflammatory gene expression is associated with cardiovascular disease
Authors: Weiss, T. W.; Seljeflot, I.; Hjerkinn, E. M.; Arnesen, H.
Source: International Journal of Clinical Practice, Volume 65, Number 9, 1 September 2011 , pp. 939-944(6)
 

Background:  Obese patients are at high risk of developing cardiovascular disease. Several studies suggest obesity as an independent risk factor. Adipose tissue is now accepted as an endocrine organ that produces and secretes a variety of cytokines, hormones and other metabolic players involved in the pathogenesis of atherosclerosis. Among this versatile group of mediators and effectors of inflammation and atherothrombosis, we have studied the expression of matrix metalloproteinase-9 (MMP-9), tissue inhibitor of metalloproteinase-1 (TIMP-1), plasminogen activator inhibitor-1 (PAI-1), interleukin-18 (IL-18) and interleukin-6 (IL-6). All these markers, in their circulatory form, have been associated with cardiovascular disease. However, there is no much data available on their expression in adipose tissue in human subjects with and without cardiovascular disease.

Material and methods:  We successfully isolated RNA from subcutaneous fat biopsies of 61 patients with or without cardiovascular disease. We then measured the RNA expression of MMP-9, TIMP-1, PAI-1, IL-18 and IL-6 with Real-Time PCR, using relative quantification.

Results:  Albeit not statistically significant, all inflammatory mediators - except IL-18 - were highly expressed in patients with cardiovascular disease (n = 16) compared with those without (n = 45). Pooling the gene expression data, trying to capture the overall inflammatory activity in adipose tissue in a score system, we observed a highly significant association with CVD.

Conclusions:  Trying to capture the overall inflammatory activity, in addition to the mass of adipose tissue, could provide useful hints towards a pathogenetic link between obesity and presence of cardiovascular disease.

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For years now, we have been touting the benefits of eating nuts. At first, we noticed it’s benefits for hypertension. (low salt please!) This is because nuts are naturally high in magnesium and potassium which are known to help lower blood pressure. Now, let’s see what they can do for diabetes!
Sure, nuts are high in fat, but the GOOD FAT!
Just be careful of portion sizes. Too much of anything isn’t a good thing!
Please call Barbara or Annette for more information: 941-556-7788
Annette Schuchert is a Venice Nutrition Certified Nutritionist

Eating Nuts Daily Could Help Control Type 2 Diabetes and Prevent Complications, Study Suggests

ScienceDaily (July 12, 2011) — Eating nuts every day could help control Type 2 diabetes and prevent its complications, according to new research from St. Michael's Hospital and the University of Toronto.

In the research, published online by the journal Diabetes Care, a team of researchers led by Dr. David Jenkins (University of Toronto Department of Nutritional Sciences; St. Michael's Hospital Risk Factor Modification Centre) reports that consuming two ounces of nuts daily as a replacement for carbohydrates proved effective at glycemic and serum lipid control for people with Type 2 diabetes.
"Mixed, unsalted, raw, or dry-roasted nuts have benefits for both blood glucose control and blood lipids and may be used as part of a strategy to improve diabetes control without weight gain," said Dr. Jenkins, who also has appointments with St. Michael's Division of Endocrinology and Metabolism and the U of T's Department of Medicine. He also serves as Canada Research Chair in Nutrition and Metabolism.
Jenkins and his colleagues provided three different diet supplements to subjects with Type 2 diabetes. One group was given muffins, one was provided with a mixture of nuts including raw almonds, pistachios, walnuts, pecans, hazelnuts, peanuts, cashews, and macadamias, and one group was given a mixture of muffins and nuts.
Subjects receiving the nut-only supplement reported the greatest improvement in blood glucose control using the glycosylated hemoglobin (HbA1c) test. The nut diet subjects also experienced a reduction in low-density lipoprotein cholesterol (known as LDL, or "bad cholesterol"). The subjects provided the muffin supplement or mixed muffin-and-nut supplement experienced no significant improvement in gylcemic control but those receiving the muffin-nut mixture also significantly lowered their serum LDL levels.
"Those receiving the full dose of nuts reduced their HbA1c [the
long-term marker of glycemic control] by two-thirds of what the U.S. Food and Drug Administration recognizes as being clinically meaningful for therapeutic agents. Furthermore, neither in the current study nor in previous reports has nut consumption been associated with weight gain. If anything, nuts appear to be well suited as part of weight-reducing diets," Dr. Jenkins said.
"The study indicates that nuts can provide a specific food option for people with Type 2 diabetes wishing to reduce their carbohydrate intake."

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Please read the following article. It examines the benefits of certain spices added to foods. Please note it studied the actual spices and not antioxidant pills. At Kaizen Total Wellness, we recommend healthy eating, not taking unproven pill supplements! Enjoying real spices and fruits and veggies are not only cheaper then pills but taste better.

Barbara Bingham, Director
Kaizen Total Wellness Center
Nutritionist,  Wellness Coach

Eating a diet rich in spices, like turmeric and cinnamon, reduces the body's negative responses to eating high-fat meals, according to Penn State researchers.
"Normally, when you eat a high-fat meal, you end up with high levels of triglycerides, a type of fat, in your blood," said Sheila West, associate professor of biobehavioral health, Penn State, who led the study. "If this happens too frequently, or if triglyceride levels are raised too much, your risk of heart disease is increased. We found that adding spices to a high-fat meal reduced triglyceride response by about 30 percent, compared to a similar meal with no spices added."
West and her colleagues prepared meals on two separate days for six men between the ages of 30 and 65 who were overweight, but otherwise healthy. The researchers added two tablespoons of culinary spices to each serving of the test meal, which consisted of chicken curry, Italian herb bread, and a cinnamon biscuit. The control meal was identical, except that spices were not included. The team drew blood from the participants every 30 minutes for three hours. They reported their findings in the current issue of the Journal of Nutrition.
"In the spiced meal, we used rosemary, oregano, cinnamon, turmeric, black pepper, cloves, garlic powder and paprika," said Ann Skulas-Ray, postdoctoral fellow. "We selected these spices because they had potent antioxidant activity previously under controlled conditions in the lab."
When the meal contained a blend of antioxidant spices, antioxidant activity in the blood was increased by 13 percent and insulin response decreased by about 20 percent.
According to West, many scientists think that oxidative stress contributes to heart disease, arthritis and diabetes. "Antioxidants, like spices, may be important in reducing oxidative stress and thus reducing the risk of chronic disease," she said, adding that the spice dose they used provided the equivalent amount of antioxidants contained in 5 ounces of red wine or 1.4 ounces of dark chocolate.
Skulas-Ray noted that adding two tablespoons of spices to meals did not cause stomach upset in the participants. "They enjoyed the food and had no gastrointestinal problems," she said. But, she added, "The participants were notified ahead of time that they would be eating highly spiced foods and they were willing to do so."
In the future, West plans to investigate whether she can get the same results by adding smaller doses of spices to meals.


Other Penn State researchers on the paper include Ann Skulas-Ray, graduate student; Penny Kris-Etherton, Distinguished Professor of Nutrition; Danette Teeter, former research assistant; and John Vanden Heuvel, professor of veterinary science. Chung-Yen (Oliver) Chen, scientist, Tufts University, also was involved in the study.
The McCormick Science Institute and National Institutes of Health supported this work.

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Diabetes Diagnosis Reversed!

Congratulations to JC who, after just one meeting with our dietitian lowered his Fasting Blood Glucose from 130 to 88 and his HgA1c from 6.9 to 6.2. Not only is he now NOT considered to be diabetic, he does not require any medications.

Power Plate Exercise & Diabetes
 
A patient at Kaizen Total Wellness® shared with me the other day how much working out in our gym was helping her with a variety of issues.  One fantastic result is that the circulation improvement she attributes to using the Power Plate has made her Type II Diabetes less of a problem and her doctor is very pleased.
Physical activity is a vital component of a diabetes treatment plan.  Reported health benefits of being active for people with diabetes include a reduced cardiovascular disease risk, more normal weight management, reduced body fat, and an improved sense of well-being. In addition, exercise significantly improves blood glucose control by increasing peripheral insulin sensitivity, reducing insulin needs, and improving glucose tolerance.   People with diabetes who are in good metabolic control and do not have serious diabetic complications may participate freely in competitive or recreational activities, with their doctor's okay. Working with our medically supervised personal trainers is an ideal fitness solution for diabetics.

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Maybe the strict Lakewood Ranch, FL zoning laws aren't so bad after all! Please take a look at this article associating the number of fast food places in a neighborhood with obesity:

As Unhealthy Food Outlets Multiply, Teens Eat More Junk
ScienceDaily (July 27, 2011) — Got lots of fast food restaurants and other outlets that sell junk food in your neighborhood? Then your teen is more likely to nosh regularly on burgers and fries and wash them down with a soda.

That is the unpalatable finding of a new study from the UCLA Center for Health Policy Research that examined the effect of higher concentrations of less healthy food outlets on adolescent junk food consumption.
The upshot? Nearly three-quarters of California teenagers live or go to school in neighborhoods that are crowded with fast food restaurants and other outlets that sell unhealthy food -- convenience stores, liquor stores, dollar stores and pharmacies -- relative to the number of healthier food outlets, such as grocery stores, produce vendors and farmers markets. And unsurprisingly, teens who live or go to school in such neighborhoods are more likely to drink soda and eat fast food.
Research has shown that the consumption of fast food and soda has been linked to taking in excess calories and can contribute to diabetes and obesity.
"You are what you eat. You are, also, where you live," said Susan Babey, a study co-author and a senior research scientist at the center. "And if you live in a place where there's a fast food restaurant or convenience store on every block, with few healthier alternatives, you are likely to eat more junk."
Many more unhealthy outlets
Using both the 2007 California Health Interview Survey and InfoUSA, a 2007 database of U.S. businesses, the study's authors calculated a Home and School Retail Food Environment Index, which measured the number of less healthy food outlets relative to the number of healthier outlets surrounding the homes and schools of California teens, and compared that measurement to teen junk food consumption.
They found that the average California teen has more than seven times as many junk food outlets near home and school as healthier food outlets.
And teens in more unhealthy neighborhoods were 17 percent more likely to drink soda every day and 18 percent more likely to eat fast food at least twice a week than their peers in healthier neighborhoods.
"It is a travesty that our kids have better access to liquor stores and other unhealthy food outlets than a grocery store," said Robert K. Ross, M.D., president and CEO of the California Endowment, which funded the study. "We have put our children and youth in harm's way, and they are paying the price for our carelessness. If nothing is done, this will be the first generation to live shorter lives than their parents."
Few counties immune
The research showed that few counties, whether rural or urban, were immune from the unhealthy effects of junk-food outlet density. In San Benito, Sutter, Merced and Fresno counties, more than 70 percent of teens consume at least one soda per day. In Tulare, Riverside, Ventura and Kern counties, more than 55 percent of teens eat fast food at least twice a week. In total, 13 counties across California had Home and School Retail Food Environment Index scores of more than 8 points -- an indication of a relatively unhealthy food environment.
The authors recommended a number of policy options to improve the food environments where teens live and go to school, including better zoning, especially around schools, and farm-to-school programs that bring fresh produce into school cafeterias. They also noted that better incentives were needed to bring healthy food outlets, such as farmers markets and grocery stores, into underserved neighborhoods.
"The research shows that how we plan and zone our communities has a real impact on our health and quality of life," Babey said. "Policymakers need to take this into account when deciding whether to zone a new grocery store or a fast food restaurant. Hopefully, they will make the healthy choice."

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During an extended period of time focused on weight loss, there will be weeks when there are more pounds lost than expected, sometimes less than expected and sometimes there are 'plateaus' where the scale just seems stuck for a while.

In Monday's Kaizen Healthy Lifestyle class we discussed how to deal with plateaus so they aren't too discouraging nor lengthy.  Again, keeping a food log is one of the best tools anyone has used which helps us not only be more mindful during the day but can provide important clues when weight loss plateaus and we aren't sure why. Class members shared that looking at the food log helped them break a plateau period by making them more conscious of portion sizes, how much water they were drinking, how frequently they were eating out at restaurants, and how much fiber they ate each day.

In addition to a high-fiber diet reducing your risk of diabetes, digestive disorders, hemorrhoids, certain cancers and heart disease, getting plenty of fiber assists with weight loss and weight maintenance.  The USFDA recommends including 20-30 grams of fiber each day.  Eating fiber adds no calories yet helps to keep you feeling full and satisfied.  When class members paid attention to getting enough fiber they found they were eating more desirable foods like fruits, vegetables and whole grains, and feeling satisfied. They decreased overeating and junk food snacking.

Keeping your eye on fiber has many benefits, and if you want to give your weight loss efforts a boost, read your food labels and choose higher fiber products. For example, for cold cereals, look for more than 5 g of fiber and less than 5 g of sugar per serving.  Adding sliced almonds or walnuts boosts any cereal's fiber without sugar, so try that also.

Healthy Substitutions was the nutrition topic discussed in Monday's Healthy Lifestyle class. The Kaizen approach is not about deprivation, it is about making choices that will help you get your optimum nutritional value out of each calorie.

Smart substitutions are ones that provide more 'good stuff' like fiber and vitamins and less 'bad stuff' like saturated fats and sugar. The smartest substitutions do this without making you feel you are missing out on anything, like flavor, texture, or sense of fullness.

Here are some of my favorite substitutions. Please share yours with me!   

• For vegetable oil called for in a baking recipe, substitute the same amount of unsweetened apple sauce.
• Instead of mayo, use guacamole (healthy, home-made) on a sandwich. 
• Instead of grits with poached eggs, have half a piece of whole grain toast and ¼ cup black beans.
• Rather than M & M’s, have a few Emerald's cocoa roasted or cinnamon almonds.
• Instead of sugar for iced tea, use stevia and fresh mint leaves.
• Rather than lettuce for sandwiches or salads, use raw spinach and/or arugula.
• Use no-sodium chicken stock to make soup and spice it with pepper or cilantro.
• For a change from broth soups, use unsweetened almond milk to make it ‘creamy’.
• Instead of granola crumbles, add sliced almonds to yogurt or cereal.
• Use cinnamon instead of brown sugar to top oatmeal.
• Dip apple slices into natural peanut butter or almond butter, not caramel.
• For 2/3 of the usual amount of lean ground beef when making meatballs or hamburgers, substitute ground turkey breast and rolled oats.
• For the bread crumbs needed to make crab cakes or salmon cakes, substitute half the amount with whole grain bread crumbs or crushed original Fiber One cereal,  and half shredded raw zucchini.
• Make a gallon of orange Crystal Lite to keep in the fridge instead of orange juice.
• Instead of the usual cocktail, make a mixed drink with club soda, diet cranberry juice and lime wedge.
• Cut an apple into small chunks, sprinkle with pumpkin pie spice and stevia then microwave 2 min. and ‘dessert’ is ready.
• Marinate chicken in buttermilk instead of high-sodium marinades - very tenderizing! 
• Instead of a butter or cream sauce for fish, make a mango salsa, Kaizen's recipe for Georgia Relish, or other interesting fat-free topping.
• Use plain yogurt and a variety of seasonings instead of sour cream and salt to make dips.
• Wrap your hors d'oeuvres like cantaloupe bites with smoked salmon instead of prosciutto.
• Peel and core an apple, then cut across into ½ rings to use as a ‘bagel’ for lox and fat-free cream cheese.
• Blend a smoothie with skim milk, vanilla whey protein powder, diet root beer and ice and you’ve got a ‘Root Beer Float’.

A lack of sex hormone-binding globulin (SHBG), which regulates testosterone and estrogen, plays a role in developing diabetes. It's interesting that drinking coffee actually increases levels of SHBG. So does drinking coffee prevent diabetes?

Maybe. But don't get on the bandwagon just yet. In the world of medicine, what was once good is now bad, and vice versa. It wasn't too long ago that we warned patients of the dangers of getting pancreatic cancer from coffee consumption. As it turns out, it wasn't the coffee, but rather the cigarette that was so often in the other hand.

An almond-enriched diet improves LDL-Cholesterol and Insulin Sensitivity which are major risk factors for heart disease and type-2 diabetes.

Also olive oil and leafy vegetables have been shown to decrease heart disease in women by 40% according to a recent study that lasted 8 years.