In the first two parts of this series we learned about how to identify glucose intolerance and some techniques for using exercise to manage blood sugar.  In this last section we will look at food choices and supplements that are most helpful for blood sugar control.

Sugary Snacks

Let’s face it sometimes we just want a little something sweet.  If you are going to indulge your sweet tooth why not make it as healthy as possible?  Dried figs and dates make a great choice for a sweet indulgence that also provides a powerful dose of nutrition.  Try to limit intake to 2 or 3 at a time.

With baked goods make sure that your choice is free of trans fats such as margarine and hydrogenated oils.  You may sacrifice some calories but the natural fats found in butter and egg yolk provide nutrients that will help the body burn off the sugar.

Include Some Fiber

Fiber slows down the introduction of sugar from sweet and starchy foods into the bloodstream.  Especially when consuming starchy foods like bread, rice, pasta, or potato, make sure to include a fresh salad, steamed vegetables, or beans to balance the meal. Whole grain breads and pastas, and brown rice still have the naturally occurring fiber within them so it is not as critical to add an extra source of fiber.

Get More Protein

Protein has a balancing effect on blood sugar. Eating protein stimulates the body to secrete hormones that act to lower blood sugar and turn down hunger signals.  Do your best to include a protein source at every meal and snack in the form of meats or fish, eggs, dairy, nuts or seeds, and beans.

Consider Supplementation

There are a number of herbs and supplements that have been shown to help normalize blood sugar metabolism.  Here are a few with the most promising research behind them:

ECGC found in green tea has been found in some studies to lower blood glucose levels, though the effects seem to be more pronounced at higher concentrations, such as can be found in a pill, rather than brewed tea.

Zinc is a trace mineral that plays an important role in blood sugar metabolism and low zinc levels have been correlated to glucose intolerance in humans.  Shellfish as well as sunflower and sesame seeds are excellent dietary sources of zinc.

Korean red ginseng (Panax ginseng) has been shown to benefit glucose in metabolism, although studies of American ginseng (Panax quinquefolius) have not shown the same benefit.

Make sure to consult with a professional trained in the use of dietary supplements before starting any supplement program.  Not all brands contain the same quality of ingredients and certain substances used in many weight loss formulas contain ingredients which could cause damage to the body or interact with certain medications.

References

Maruyama K, Iso H, Sasaki S, Fukino Y. The Association between Concentrations of Green Tea and Blood Glucose Levels.  J Clin Biochem Nutr. 2009 Jan;44(1):41-5. Epub 2008 Dec 27.

Nagao T, Meguro S, Hase T, Otsuka K, Komikado M, Tokimitsu I, Yamamoto T, Yamamoto K. A catechin-rich beverage improves obesity and blood glucose control in patients with type 2 diabetes. Obesity (Silver Spring). 2009 Feb;17(2):310-7. Epub 2008 Nov 13.

Masood N, Baloch GH, Ghori RA, Memon IA, Memon MA, Memon MS. Serum zinc and magnesium in type-2 diabetic patients. J Coll Physicians Surg Pak. 2009 Aug;19(8):483-6.

Jansen J, Karges W, Rink L.  Zinc and diabetes--clinical links and molecular mechanisms.  J Nutr Biochem. 2009 Jun;20(6):399-417.

Ma SW, Benzie IF, Chu TT, Fok BS, Tomlinson B, Critchley LA.  Effect of Panax ginseng supplementation on biomarkers of glucose tolerance, antioxidant status and oxidative stress in type 2 diabetic subjects: results of a placebo-controlled human intervention trial. Diabetes Obes Metab. 2008 Nov;10(11):1125-7. Epub 2008 Mar 18.

Vuksan V, Sung MK, Sievenpiper JL, Stavro PM, Jenkins AL, Di Buono M, Lee KS, Leiter LA, Nam KY, Arnason JT, Choi M, Naeem A.  Korean red ginseng (Panax ginseng) improves glucose and insulin regulation in well-controlled, type 2 diabetes: results of a randomized, double-blind, placebo-controlled study of efficacy and safety.  Nutr Metab Cardiovasc Dis. 2008 Jan;18(1):46-56. Epub 2006 Jul 24.

Sometimes weight loss isn't as simple as watching your calorie intake. While the conventional model of weight loss states that simple energy balance (calories in, calories out) is all that matters, newer research indicates that how those calories are metabolized can have a large impact on the level of success that can be achieved with a basic calorie reduction approach to weight loss.

Energy balance can be easily thrown off due to difficulties with sugar metabolism that cause swings in blood sugar which result in inappropriate hunger signals and increased fat storage. Inability of the body to properly maintain blood sugar is known as impaired glucose tolerance. Left unchecked, impaired glucose tolerance can lead to weight gain, insulin resistance, metabolic syndrome, diabetes, hypertension, polycystic ovarian syndrome (PCOS), and premature aging.

In this article we will look at some of the signs and symptoms of impaired glucose tolerance, as well as how to use laboratory testing to help identify the presence of impaired glucose tolerance.

Although it is possible to have impaired glucose tolerance with no symptoms, there are a few indicators which can provide some helpful clues. One of the most obvious is uncontrollable sugar cravings, especially following activity or exercise. People with impaired glucose tolerance can also experience tiredness or fatigue after eating.

Impaired glucose tolerance can also present itself as mood swings, irritability, brain fog, or a feeling of heaviness in the limbs. Most of these symptoms are experienced during the low swings of blood sugar, therefore they are most commonly experienced during the time in-between meals, and are exacerbated after meals high in carbohydrate.

There are also a few basic biometric indicators that can be a sign of impaired glucose tolerance.  While not conclusive evidence, these numbers can be a signal that something is not going right with the metabolism, especially if they are going up even though there has been no change in food intake or activity level.

Biometric Indicators of Impaired Glucose Tolerance

·        Body Mass Index (BMI) > 25

·        Waist / hip ratio > 0.9 for men, > 0.7 for women

·        Body Fat Percentage > 20% for men > 35% for women (exact ranges are age-specific)

Body fat percentage can be measured using skinfold calipers, with circumference measurements, or via electrical bioimpedance such as with certain body fat scales. Each method has its own advantages and limitations, and it is important to know that results from one method are not easily compared with another. The most accurate way to measure body fat percentage is by being weighed under water, however it is also the least convenient.

One of the elements of a complimentary FitPoint assessment is to get a body fat measurement. Along with a few other parameters, this is one of the best ways to monitor yourself during a weight loss program. It is important to ensure that the weight being lost is fat, not muscle, otherwise it could result in a further impairment of glucose metabolism.

If you suspect that you may have impaired glucose tolerance, the next step is to have some lab work done. There are a number of test which, taken together, can provide evidence to support the notion of impaired glucose tolerance. It is important to understand that there is no single lab test that can alone determine if there is an issue with sugar control, and that impaired glucose tolerance is not a diagnosable disease but merely a syndrome.

Often times a routine blood screening includes a fasting blood sugar test to check for diabetes. While a normal result rules out the presence of diabetes, it does not rule out impaired glucose tolerance. Many times I consult with clients who have assured me that their doctor has checked everything out however when we actually look at the lab report we find that only a spot glucose was performed. If blood sugar control is a concern, it is important that a comprehensive workup be performed, and that the results are interpreted by somebody who knows what to look for.

A comprehensive lab workup for glucose intolerance should include:

·        Comprehensive Metabolic Panel (CMP) + Ferritin

·        Fasting blood glucose

·        2 hour Glucose Tolerance Test + Insulin

·        Serum lipids

·        Glycosylated hemoglobin (Hb A1c)

·        High-sensitivity C-reactive protein (hsCRP)

·        RBC magnesium

It is important to remember that impaired glucose tolerance is a functional diagnosis, therefore there is no one result that can pinpoint a blood sugar problem. Rather, each result must be taken in the context of all the other parameters measured. Nevertheless, there are some key elements that are generally found with impaired glucose tolerance.

Lab Indicators of Impaired Glucose Tolerance

·        Fasting blood sugar >90 mg/dl

·        Post-prandial blood sugar >120 mg/dl

·        Fasting insulin >8 mIU / ml

·        Post-prandial insulin >30 mIU / ml

·        Hb A1c > 6%

·        HDL <50 mg/dl for men, <60 mg/dl for women)

·        Triglycerides > 150 mg/dl

·        Triglyceride / HDL ratio > 4:1

·        hsCRP > 1.0 mg / L

There is also a relatively new form of testing available that measures advanced glycation end products (AGEs) in the body's tissues. AGEs form as a result of exposure of the tissues to unhealthy levels of sugars over time. AGEs can be measured noninvasively by a method known as tissue fluorescence.

If present, impaired glucose tolerance can be managed through a combination of exercise and nutrition. In the next part of this series, we will take a closer look at how to use exercise to help balance blood sugar, and in the final part we will discuss how to use nutrition and supplements to further optimize blood sugar.

References

Miyazaki Y, Akasaka H, Ohnishi H, Saitoh S, DeFronzo RA, Shimamoto K. Differences in insulin action and secretion, plasma lipids and blood pressure levels between impaired fasting glucose and impaired glucose tolerance in Japanese subjects. Hypertens Res. 2008 Jul;31(7):1357-63.

Reed JA, Benoit SC, Pfluger PT, Tschp MH, D'Alessio DA, Seeley RJ. Mice with chronically increased circulating ghrelin develop age-related glucose intolerance. Am J Physiol Endocrinol Metab. 2008 Apr;294(4):E752-60. Epub 2008 Feb 12.

Bewick GA, Kent A, Campbell D, Patterson M, Ghatei MA, Bloom SR, Gardiner JV. Mice with hyperghrelinemia are hyperphagic and glucose intolerant and have reduced leptin sensitivity. Diabetes. 2009 Apr;58(4):840-6. Epub 2009 Jan 16.

Mori Y, Hoshino K, Yokota K, Yokose T, Tajima N. Increased visceral fat and impaired glucose tolerance predict the increased risk of metabolic syndrome in Japanese middle-aged men. Exp Clin Endocrinol Diabetes. 2005 Jun;113(6):334-9.

Soyama A, Nishikawa T, Ishizuka T, Ito H, Saito J, Yagi K, Saito Y. Clinical usefulness of the thickness of preperitoneal and subcutaneous fat layer in the abdomen estimated by ultrasonography for diagnosing abdominal obesity in each type of impaired glucose tolerance in man. Endocr J. 2005 Apr;52(2):229-36.

Petersen JL, McGuire DK. Impaired glucose tolerance and impaired fasting glucose--a review of diagnosis, clinical implications and management. Diab Vasc Dis Res. 2005 Feb;2(1):9-15.

Unwin N, Shaw J, Zimmet P, Alberti KG. Impaired glucose tolerance and impaired fasting glycaemia: the current status on definition and intervention. Diabet Med. 2002 Sep;19(9):708-23.

For somebody who is struggling to make ends meet, choosing healthier foods may not be at the top of the priority list.  Yet perhaps it should be.  In this two-part article we will investigate how the way one thinks about money impacts food choices, and in turn how food choice can impact the way one thinks.

The correlation between economic status and nutritional status may not come as a surprise to most.  What might be surprising is that the explanation is not as simple as the commonly held belief that eating healthy costs more.  Two recent studies investigated the links between economic status and food choices.

One recent study published in BMC Public Health demonstrated a link between higher levels of indebtedness and obesity.  While the authors partially attributed the findings to the “high cost” of a healthy diet, they also noted a lack of awareness in the subject group that there are foods that are both healthy and budget friendly. 

Another link between income and obesity was identified by means of a survey among participants in the U.S. Food Stamp Program.  The study, conducted though a partnership of Ohio State University and the University of Michigan, found the Body Mass Index (BMI) of food stamp users was an average of 1.15 points higher than non-users, and growing at a faster rate.  Somewhat curiously, this observation was only noted in female users of the program.  This study appears in the current issue of Economics and Human Biology.

While it is commonly thought that healthy, nutritious foods are more expensive, this is only partly true and mostly myth. Take for example the price of potatoes.   A bag of potatoes at the grocery will cost about $1 per pound.  By contrast, potato chips run about $6 a pound and French fries from a fast food restaurant a whopping $8 per pound!  When you consider how many hours a low-income worker would need to work to be able to afford these more convenient, but less nutritious, options it makes a lot more financial sense to slice up some fresh potatoes and throw them in the oven.

Another part of the confusion stems from food education programs which focus too highly on what not to eat and choosing low-calorie foods rather than those that are nutrient-dense.  One group seeking to raise the bar on nutrition education is called the Nutrient Rich Foods Coalition.  The NRFC is currently working to develop scientifically validated tools that can help educate people on how to get more nutrition for their calories. Using their newly developed Nutrient-Rich Foods Index, the coalition hopes to change the way people think about food as it relates to their pocketbook.

This simple change in the thinking process- from “how many calories can I get for my dollar” to “how much nutrition can I get per calorie” – could completely revolutionize how people shop for groceries.  When thinking in these terms, $8 a pound for raw almonds seems like a much better deal than paying $2 for a ¼ pound of fries.

In general, the foods which present the best value for their relative nutritional benefits include seeds, nuts, eggs, beans, dairy and whole grain products. 

While better education about nutrition will certainly result in better food choices, this might be only part of the solution.    Other research which investigates the link between food and brain chemistry provides a compelling link between nutritional status, and the ability to make better choices.

In Part Two, we will examine how making better food choices can actually help to make improvements in one’s economic status, as well as in other areas of life.

This just in. . .  a flurry of articles truimphantly reporting the results of a review study which found that there is very little difference in the nutritional content of organic food as compared to conventionally produced food.  The only problem is that more nutrition isn't the main reason people choose to go organic.  Most people choose organic foods because they are produced ethically, sustainably, and free from potentially harmful chemicals.

The last time this debate heated up was in late 2007 when the E.U. funded Quality Low Input Food (QLIF) Project released results of a study indicating that organic fruits and vegetables have up to 40 per cent more antioxidants than conventially-grown produce, and that organic milk contains up to 60 per cent more antioxidants than its conventionally-produced counterpart, as well as higher levels of healthy fat.  This latter finding was published in the Journal of the Science of Food and Agriculture, and readers may find a copy of the study here.

The latest review, published in the July issue of the American Journal of Clinical Nutrition, looked a number of studies and concluded that the preponderance of evidence does not support the notion that organically grown produce is more nutritious. The authors did not conduct their own investigation into this issue, but simply reported on the studies which have already been done.

This whole debate, however, misses the point.

Organically produced food is made according to certain production standards, the primary one being the restriction of use of organophosphate pesticides.  Pesticide exposure is associated with a number of health problems including cancer, depression, neurotoxicity, and birth defects.  While the amount of pesticides that an average person consumes is generally considered to be safe, there is a concern over the levels to which farm workers are exposed. 

According to Barbara Haumann of the Organic Trade Association, the report fails to look at the big picture and does not address the primary reasons people choose organic food.  Says Ms. Haumann, "What we've said all along is that when a consumer buys an organic product he or she is supporting a system of agriculture that is healthier for the land and farmers producing that food because they're not exposed to pesticides."

She also noted that the study did not look at the issues of antibiotic use in livestock or genetically-modified foods.

When making the choice to go organic, it is important to be clear on the reasoning behind the decision.  If all one cares about is getting more nutrition, it makes much better financial sense to simply take a multivitamin than to shell out for organic products.   However if one is concerned about the ethics of the business practices involved in farming, the sustainability of the planet, and the consumption of antibiotics and pesticides, organic may still be a good buy after all.

If you are like most Americans trying to get an edge on healthy eating, you have probably been diligently working to get your 6 to 11 servings of whole grains in every day as recommended by the USDA Food Pyramid.  Whole wheat breads, crackers, cereals, and pastas have now become common fare at mealtime.  Yet while it's true that whole wheat is a better choice than refined, for many Americans it is looking like wheat is not a great choice in any form.

The problem lay in a protein component of certain grains called gluten.  While harmless to most, gluten causes an adverse immune reaction in a minority of people.  But new research shows that the minority is growing.  Known as celiac disease, or simply gluten intolerance, the manifestations of this condition range from no noticeable symptoms, to nutrient malabsorption and chronic inflammation involving multiple organ systems.  While celiac disease is not new to science, what is surprising to researchers is a seeming increase in the number of undiagnosed cases.

A recent study led by researchers at the Mayo Clinic in Rochester, Minnesota, analyzed blood samples taken from 9133 otherwise healthy adults between 1948 and 1954, and compared them to 12,768 more recent samples.  The blood was tested for certain markers of celiac disease called transglutaminase and endomysial antibodies.  This study, published in the July issue of Gastroenterology, represents one of the largest and longest-running investigations into gluten intolerance.

The researchers concluded that the rate of undiagnosed celiac disease was about 4 to 4.5 times greater now than it was 50 years ago.  More disturbing was the finding that undiagnosed celiac disease was also associated with a nearly 4-fold increased risk of death.  While celiac disease has been previously thought to be a relatively rare condition, affecting 1 in 133 people, these new estimates now place the prevalence at 1 in 33.

In addition to wheat, gluten is also found in rye and barley, and in certain products made with these ingredients, such as soy and Worcestershire sauces.  Gluten intolerance may initially manifest as a sensitive or irritable bowel, and in some cases rashes and allergic symptoms, but can progress into any number of conditions associated with nutritional deficiencies.  In its more extreme forms gluten intolerance may precipitate autoimmune diseases such as rheumatoid arthritis, Hashimoto's thyroiditis, Chron's disease, psoriasis, and others.  For many people, a first clue to a gluten intolerance can be a seeming difficulty with weight loss despite proper caloric restriction.

Gluten intolerance is traditionally tested via a blood sample that is ordered by a physician, however newer technologies as employed by companies such as Dallas-based Enterolab offer stool testing that is available without a physican's order.

These findings represent just one of a constellation of research studies demonstrating that genetic and environmental differences among human beings preclude a one-size-fits-all approach to nutritional recommendations.  While the Food Pyramid may be a reasonable teaching tool, for at least 1 in 33 Americans, following it may be a giant step in the wrong direction.

This afternoon, Vice President Joe Biden, Health Secretary Kathleen Sebelius, and Agriculture Secretary Tom Vilsack announced the findings of President Barack Obama's Food Safety Working Group that was created in March after the salmonella outbreak.  For those of you who missed it, the peanut recall was the largest food recall in U.S. history and sickened more than 700 people in 46 states.  The administration also created a new post of deputy food commissioner whose charge it will be to coordinate safety during future outbreaks.

According to a statement released by the White House, "The Working Group is recommending a new public health-focused approach to food safety based on three core principles: prioritizing prevention, strengthening surveillance and enforcement, and improving response and recovery."

As with all things, prevention is the best cure.  While many efforts are being made to identify and remove contaminated products, some research indicates that we can altogether avoid the E. coli problem by altering what is fed to cattle.

A study by Cornell University researcher James B. Russel found that grass-fed animals have 80% less E. coli than those fed grains.  What is more, it turns out that the strains of E. coli which grow inside of corn-fed cattle are extremely acid resistant and make it through human stomachs intact.  These findings were later confirmed by the University of Nebraska and can be found in the 2000 Nebraska Beef Cattle Reports.

Well here we are halfway to 2010 with several more outbreaks under our belts and still the media is presenting the issue as a big mystery.  If you are like me, you probably aren't feeling too comforted by the proposal of yet another federal agency "looking into the matter."  So here's what you can do right now to protect yourself and your family from E. coli and other nasty critters in your food.

1.  Use caution when purchasing ground beef.  Choose your cuts at the grocer and have them grind it for you on the spot.  Also, don't be fooled by stickers that say "fresh ground."  What that means is that the grocer has purchased frozen ground beef and then grinded it again "fresh" before they put it out on the shelf.

2.  Look for beef that comes from grass-fed cattle.  If you just can't find the space in your pocketbook, you can buy beef from "grass-finished" cattle.  Turns out that putting them back out to pasture for the last two weeks greatly reduces the levels of E. coli in the meat.  If it is still looking like you can't afford it, you may wish to reconsider your portion sizes.  Most Americans eat 2 - 3 times the amount of meat than is appropriate for a meal, so if you cut your 8 - 12 ounce portion down to 4 - 6 ounces, you will find higher quality products to be much more affordable.

3.  Support local farmers.  Sometimes consumers feel that a smaller, less well-known name means that that a product isn't as safe.  This is not necessarily the case.  In many instances, smaller operations have an easier time meeting food safety standards because there aren't as many points in the production process where things can go wrong.

In tough times it is very tempting to try to scrimp and save on your food, but try to keep in mind that without your health nothing else really matters.  With food, just as with everything else in life, when you purchase the cheapest thing you can find on the market, you can rest assured that you get what you paid for.

For those of you that are interested in learning more about the inner workings of the food industry, I would highly recommend you go see Food, Inc., which is out now in theaters.  Here is a link to the trailer.

With evidence of its use in Egypt around 3000 B.C., vinegar might just be the oldest condiment known to man, but it also has an extensive history of use in medicine.  The famous Greek physician Hippocrates prescribed vinegar for wounds and it has long been a staple of folk remedies for just about every ailment we can think of.  But does it stand the test of science?

Recent evidence suggests that it may.

In 2004, vinegar was shown to improve insulin sensitivity in type 2 diabetics fed high carbohydrate meals. In 2006, a couple of studies investigated the ability of vinegar to lower blood sugar and cholesterol, and in 2007 it was shown that ingestion of vinegar at bedtime helps to control morning blood sugar levels.

Now researchers in Japan have reported that vinegar can help prevent accumulation of body fat and weight gain.  The study will be published in the 08 July issue of the Journal of Agricultural and Food Chemistry.  This study demonstrated that mice fed a high-fat diet along with vinegar had a significantly lower body fat than those without and posits that the mechanism is trough activation of genes that control the body’s ability to burn fat for energy.

Between improved insulin response, lower cholesterol, improved blood sugar, and increased fat burn it would seem that good old-fashioned vinegar is in the running for the best weight loss supplement yet. . . and it’s cheap!  Perhaps Americans could take a lesson from the Brits and start dousing their fries in malt vinegar rather than corn syrup poorly disguised as tomatoes.