Article #10

Artificial Sweetners

 

Sweetening agents used in the United States include sugar, fructose, sugar alcohols, and artificial sweeteners. Sugar and fructose provide 4 calories/gram. Sugar alcohols provide about 2 calories/gram. Aspartame provides 4 calories/gram, while other artifi- cial sweeteners provide almost no calories.

  Sugar alcohols have names such as isomalt, lactitol, maltitol, mannitol, sorbitol, and xylitol. These sweeteners are known to produce side effects such as gas, abdomin- al discomfort, and diarrhea when consumed in large quantities. If a food is likely to be consumed in amounts that provide more than 50 grams of sugar alcohols/day, its label must state "Excess consumption may have a laxative effect".

  The major artificial sweeteners on the market today are saccharin, aspartame, acesulfame-potassium, and sucralose. These have all been approved for use by the Food and Drug Administration. Each has an acceptable daily intake (ADI) which is the amount of a food additive that can be safely consumed on a daily basis over a person's lifetime without any adverse effects. They do not usually cause diarrhea.

  Saccharin is also known as Sweet & Low or Sweet Twin. It has been used longer than any other artificial sweetener. For many years, products containing saccharin were required to carry a warning about saccharin being a possible cancer hazard. In the year 2000, the FDA determined that saccharin does not cause cancer.

  Aspartame is also known as Equal or Nutrasweet. Aspartame is made from amino acids which are components of protein. It cannot be used by people who have a condi- tion known as PKU (phenylketonuria).

  Sucralose is made from sugar, but the structure of the sugar molecule has been changed so it passes through the digestive tract unchanged. Very little is absorbed into the blood stream. Sucralose is also known as Splenda.

  Acesulfame-potassium is also known as Sunette or SweetOne. During 15 years of testing and use, it has been used without reported health problems.

  Based on current evidence, moderate intake of artificial sweeteners have not been proven to cause health problems. When used, they should be used in moderation. People consuming sugar alcohols need to remember that they can cause a laxative effect.

Article #9

 

“5 a Day” May Reduce Risk of Cancer

Why does one person develop cancer and another does not? One theory involves diet. Evidence suggests phytochemicals (fight-o-chemicals) may play a role in decreasing the risk of developing cancer. According to the American Institute of Cancer Research, evidence is mounting that vitamins, minerals, and phytochemicals from a plant-based diet can interact to provide extra cancer protection.

Over 4000 phytochemicals or “plant chemicals” have been identified. Some phytochemicals are antioxidants; they protect cells from damage caused by free radicals. Plant antioxidants protect plants from the damaging effects of oxygen, sunlight, and other factors. Our bodies can use many of these antioxidants in the same way.

Some phytochemicals also help prevent the formation of cancer-causing chemicals and/or suppress cancer development. Phytochemicals are found in fruits, vegetables, beans, and whole grains. The action of phytochemicals varies by color and type of food in which they occur. Phytochemicals have unusual names such as allicin, anthocyanins, bioflavonoids, capsaicin, carotenoids, flavonoids, indoles, isoflvaones, genistein, ligins, lutein, lycopene, and resveratol.

Currently there are no recommended daily allowances for phytochemicals. Researchers be- lieve that a daily intake of five to nine servings of fruits and vegetables will provide adequate phytochemicals.
There is no specific fruit or vegetable responsible for reducing cancer risk. Research shows that a regular consumption of a variety of these plant foods helps reduce cancer risk. Fruits and vegetables can be divided into five color groups – blue/purple, green, white, red, and yellow/orange. One serving from each color group should be eaten daily to obtain a variety of phytochemicals.
Blue/purple foods include blueberries, blackberries, purple grapes, grape juice, and purple cabbage. Red foods include red apples, cranberries, cherries, strawberries, watermelon, beets, radishes, red onions, red potatoes, and tomatoes.

Yellow/orange foods include apricots, cantaloupe, grapefruit, lemons, oranges, peaches, carrots, pumpkin, sweet corn, sweet potatoes, and yellow squash. Green foods include green apples, green grapes, kiwi, limes, asparagus, broccoli, green beans, green cabbage, celery, cucumbers, lettuce, spinach, and zucchini. White vegetables include bananas, cauliflower, mushrooms, onions, potatoes, and turnips. (See www.5aday.com for additional foods in each group.)

One serving is defined as ½ cup raw or cooked fruit, vegetable or cooked dried beans, 1 cup salad greens, 1 medium piece of fruit or ¼ cup dried fruit, or 6 oz juice. A daily trip to a well-stocked salad bar could provide foods from all color groups. Instead of filling your salad bowl with iceberg lettuce, choose raw cauliflower, carrots, tomatoes, green peppers, and red cabbage. Drink orange juice, grape juice, or tomato juice for breakfast. Have a banana or baby carrots for a snack. Try a low fat 6 inch Subway sandwich loaded with fresh spinach, tomatoes, jalapeno peppers, red onion, and cucumbers for lunch. Enjoy steamed broccoli or asparagus with your evening meal.

Article #8

WHAT IS A HEMOGLOBIN A1C TEST?

If you check your blood sugar before you eat breakfast and have a reading close to normal, does that mean your blood sugar is going to be normal at 3pm? No, it does not. Your blood sugar fluctuates during the day. Since you cannot constantly monitor your blood sugar, the hemoglobin A1C test helps you know if your blood sugar is higher than it should be at times when you are not checking.

The hemoglobin A1C test determines the average amount of sugar in your blood during the past three months. All people with diabetes should have a hemoglobin A1C test twice a year. If your treatment changes or your blood sugar stays too high, you should get a hemoglobin A1C test every three months until your blood sugar level improves.

The hemoglobin A1C goal for people with diabetes is less than 7 percent. Studies have shown that people with diabetes who keep their hemoglobin A1C levels close to 7 percent have a much better chance of delaying diabetes complications that affect the eyes, kidneys, and nerves. If your hemoglobin A1C number is too high, work with your health care provider to reach the 7% goal.

For more information, visit www.a1cnow.com

Article #7

VERY LOW CARB DIETS

What’s Wrong With a Very Low Carbohydrate Diet?

Five years ago, I heard a physician speak about obesity at a professional conference. The speaker made the prediction that “100% of the US population will be overweight by the year 2020”. That seemed absurd! That means everyone! How could this be?
According to the CDC, more than 60% of American adults are already overweight or obese. Most do not understand why they continue to gain weight. Some blame it on “white” foods such as potatoes and bread, while they continue to drink a six-pack of Coke every day.
It is estimated Americans will spend $25-30 billion this year on weight loss books, products, and programs. Due to the demand for fewer carbs, more and more food products are sporting labels describing them as “no carb”, “carb friendly” and “carb aware”, even though there are no standards for these terms. Most of these products cost more than similar items with more carbs, and many have just as many calories. A study of 1,017 adults done by the Opinion Research Corporation found that 19% of people trying to lose weight are trying to cut carbs. Forty-seven percent of them believe low carbohydrate diets can help them lose weight without cutting calories.
People want a “quick fix”, and it needs to be easy, which is probably why very low carbohydrate diets have been so popular. Ten years ago, Americans tried to make drastic reductions in the fat content of their diets and continued to gain weight, because in the process of eliminating fat, they increased their consumption of refined grains and sugar without regard for calories.
Likewise, making drastic reductions in carbohydrate intake, while increasing fat and protein, will not lead to long term weight loss, unless calories are also taken into consideration. According to the National Weight Control Registry, very few people consuming less than 24 % of their calories as carbohydrate have been able to maintain a weight loss of 30# or more for over one year. This has led researchers to conclude that very low carbohydrate diets do not offer a long-term weight loss advantage. Due to lack of food variety, most people will not stay on a very low carbohydrate diet indefin- itely. When a person reintroduces carbohydrates into a very low carb diet, the rapid weight gain they experience is being called weight “snap back”.
Because carbohydrate foods are our primary sources of antioxidants, phytochemi- cals, and B vitamins, eliminating them from our diets is believed to increase our risk for heart disease and cancer. The risk for gout and kidney stone formation is also believed to increase.
According to the National Academy of Sciences Institute of Medicine, diets high in acid-generating foods, such as animal proteins, lower the body’s supply of potassium. The results of chronic potassium deficiency include high blood pressure, heart attack, stroke, kidney stones, and loss of bone minerals.
In our bodies, carbohydrates are converted to glucose, which is the preferred source of energy for our muscles and brains. In 2002, the National Academy of Science recommended adults and children should get a minimum of 130 grams of carbohy- drate/day for maximum brain function. They also recommended that no more than 25% of our calories come from sugar, which means most of our carbohydrates should be provided by starchy foods, unsweetened fruits, and low fat dairy products.

In response to the question “are low carb diets safe?”, a website sponsored by Colo- rado State University says: “We actually do not know, because no one has carried out a long-term study of people on low carb diets, but we can make an educated guess from the studies of people who eat high-protein diets. Perhaps one of the most consistent relationships observed is the positive relationship between the consumption of animal protein and the development of chronic diseases. It is not clear, however, whether the effects are due to the large amount of protein, large amounts of fat associated with eating high-protein diets, or due to the lack of consuming enough protective phyto- chemicals in plant based foods. Nevertheless, we know that it is healthier to eat plant- based foods than animal-based foods.”
Finally, people attempting weight loss need to think in terms of lifestyle changes, rather than “diets”. The primary goal of weight loss should be improved health, rather than achieving a particular number on the bathroom scale. Eliminating simple sugars, while continuing to consume a limited amount of complex carbohydrates, is a healthier way to lose weight without taking health risks associated with very low carb, high protein intake. Increasing activity in our daily routines will help maintain muscle mass and also help expend some additional calories.
A balanced diet with fewer calories than needed to maintain weight will lead to weight loss. There are many different ways to achieve weight loss without creating additional health risks. Registered dietitians are the experts that can help you determine the best way for you to cut calories. If you would like to speak with a registered dietitian, ask you physician to refer you to one in your area.

Jeannine Hutchcraft, MS RD LD CDE

Article #6

MEDICATIONS FOR TYPE 2 DIABETES

Do you take pills to help control your Type 2 diabetes?

If so, what do they do to help keep your blood sugar in control? Some stimulate the pancreas to make more insulin. Others slow the production of glucose by the liver, while others increase the sensitivity of muscle cells to insulin. Some slow the digestion of carbohydrates.

These medications stimulate the pancreas to make more insulin. They stay in the body longer than some of the newer medications used to stimulate insulin production:

MICRONASE, GLYNASE, DIABETA, AMARYL & GLUCOTROL.

Two newer medications stimulate the pancreas to make more insulin, but work more quickly and for a shorter time. They must be taken immediately before each meal: PRANDIN & STARLIX.

If your liver tends to produce too much glucose, you may be taking this medication, which should be used only by persons with normal kidney function. It must be temp-porarily discontinued when having tests that use IV iodine dye: GLUCOPHAGE.

These two medications that slow the digestion of carbo-hydrate are not recommended for persons with serious stomach disease. If you experience hypoglycemia while taking these medications, it must be treated with milk, glucose tablets, or glucose gel, since the absorption of other carbohydrates will be delayed: PRECOSE & GLYSET.

These two medications increase the sensitivity of muscle cells to insulin. It may take 4-6 weeks to see the full effect of these pills. They are not for persons with congestive heart failure or abnormal liver function: ACTOS & AVANDIA.

Another relatively new medication is a combination of Glucophage and Glucotrol: GLUCOVANCE.

Some Type 2 diabetics may need to use insulin or insulin in addition to some of the above named medications

Article #5

Frozen Shoulder

Frozen shoulder is a very painful condition that often persists for as long as 8 to 24 months. Statis- tics indicate that about 20% of people with diabetes develop frozen shoulder, while only 5% of non-diabetic people experience the condition. It can be- gin after a shoulder injury or as a result of bursitis or tendonitis. In addition, people with diabetes are less likely than non- diabetics to have a complete recovery from frozen shoulder.
It is not known why diabetes increases the risk of frozen shoulder. One theory is that glucose molecules attaching to collagen cause abnormal de- posits of the collagen in the cartilage and tendons of the shoulder. This buildup could cause the shoul- der to stiffen.
Once the shoulder joint begins to stiffen, it becomes painful to move. Therefore, it is used less and becomes even more difficult to use. Without movement, adhesions can begin to form.
Physical therapy should be the first treatment tried. A physical therapist can stretch and move the shoulder to help prevent adhesions from forming. This can be very painful.
If physical therapy is too painful, doctors cn try saline shots or cortisone shots to help get the shoul- der moving again. Surgery is used as a last resort, since the condition usually improves over time with- out surgery.
It is important to seek medical attention within one to two weeks after noticing loss of shoulder mobility and/or pain.

Source: "Frozen Shoulder & Diabetes" by Terri Kordella, Diabetes Forecast, August, 2002.

Elizabeth Hutchcraft

Article #4

The following is a review of the article "Watch This" that appeared in the June, 2002, edition of Diabetes Interview.

Glucose meters that are worn like watches became available for purchase in the United States on April 15, 2002. This product is noninvasive and does not require blood to measure glucose. It is called the GlucoWatch Biographer. The GlucoWatch Biographer measures glucose in the fluid just beneath the surface of the skin. Readings are recorded up to three times per hour. A disposable sensor on the back of the watch makes contact with the skin. The sensor must be changed every 12 hours, but the watch can store up to 4,000 readings.

According to the manufacturer, the GlucoWatch is intended for use in addition to conventional glucometer readings. It will help track trends in blood glucose readings that would otherwise not be seen.

The GlucoWatch Biographer has an alarm that can be set to alert the user when readings are too high, too low, or dropping rapidly. According to this article, the GlucoWatch is more effective at detecting high blood sugars than low blood sugars.

GlucoWatch readings may lag behind readings from a standard meter by 20 minutes. The GlucoWatch may skip readings when subjected to rapid temperature changes, excessive sweat, electrical noise, high background circuits, as well as open and short circuits. The GlucoWatch Biographer with two rechargeable batteries and battery charger costs $595. Sixteen sensors cost $69.75. The software needed to analyze data from the GlucoWatch costs $35. These costs are not covered by insurance at this time. A prescription is required to obtain a GlucoWatch and they are not approved for patients 18 years and under. They are only available by mail order. Additional information may be obtained on the web at www.glucowatch.com or by calling (866) 459-2824.

Elizabeth Hutchcraft

Article #3

The following is a review of an article written by Shirley Gutkowski, a dental hygenist from southern Wisconsin. The article entitled "Power Cleaning Your Teeth" appeared in the March- April, 2002, edition of Diabetes Self-Management magazine.

Having diabetes increases the risk of developing periodontal disease. (Peridodontal disease is the bacterial gum infection caused by a buildup of plaque.) Good oral hygiene is especially important for people who have diabetes. Having diabetes reduces the blood flow to the gums, making the tissue less resistant to infection. Also, the saliva of people with high blood glucose contains more glucose which provides food for the bacteria that causes periodontal disease. Dry mouth, caused by high glucose and some drugs, make acids produced by the bacteria more concentrated, which increases tooth decay and possibly causes sores in the mouth.

Untreated periodontal disease leads to tooth loss. Periodontal disease can also cause high blood sugar, making diabetes and the infection harder to control. Good blood glucose control and good oral hygiene lower the risk of gum infections.

Research has shown that periodontal disease can lead to an increased risk of heart disease. It is believed that when gums are infected, bacteria living in the mouth can enter the bloodstream. People who have diabetes are at higher risk of heart disease and periodontal disease increases this risk.

To help prevent periodontal disease, it is recommended you should brush your teeth morning and evening for two minutes, floss daily, replace your toothbrush every three months, and have your teeth cleaned every six months.

Flossing can be done any time of day. Since it takes approximately 24 hours for the bacteria in plaque to organize on the tooth and gum surface, flossing every 24 hours is sufficient to disrupt the bacterial organization.

People with limited manual dexterity might benefit from power flossers. People with deep gum pockets might benefit from oral irrigators. (Irrigators must be used correctly to avoid pushing the bacteria deeper into the pockets.) Power toothbrushes encourage people to spend more time on their teeth and may remove more plaque than manual toothbrushes.

If you choose to use a power device, be sure to use it properly. Brushing too long or with too much pressure can also damage your gums.

Elizabeth Hutchcraft

 

Article #2

This is a review of the article "Dr. Quick's Aspirin Fix" by Dr. Sheldon H. Gottlieb, which was printed in the October, 2001, issue of Diabetes Forcast:

People with diabetes are at risk of forming dangerous blood clots that can cause heart attacks and strokes. Aspirin can prevent these dangerous clots from forming. Therefore, in 1977, the American Diabetes Association recommended that all people with diabetes who are older than 30 take aspirin unless there are specific reasons not to.

High blood sugar levels increase the concentration of the substance in our blood that causes platelets to clump leading to blood clots, heart attacks, and strokes. People with Type 2 diabetes may have the same risk of heart attack as someone without diabetes who has already had a heart attack. This risk is greater for women than men. It is even higher for women with diabetes who smoke.

Some diabetics may not be able to take aspirin if they are allergic to aspirin or have a gastro-intestinal intolerance to aspirin. People allergic to aspirin may take a new medicine called clopi-dogrel which also blocks the clotting action of platelets.

The effect of aspirin on bleeding time was first discovered by Dr. Armand J. Quick in 1966.

Elizabeth Hutchcraft

Article #1

In the August 2001 publication of Diabetes Forecast, the "Practical Living" column featured a response to a patients questions about autonomic neuropathy. The patient felt he was experiencing symptoms of gastroparesis. (Gastoparesis is a form of autonomic neuropathy that affects the nerves of the stomach when they have been damaged by high blood sugar levels.) Due to gastroparesis causing a delay in the emptying of the stomach, diabetic patients affected by gastroparesis often experience uncomfortable fullness, nausea, and/or vomiting after meals.

The delayed emptying of the stomach leads to low blood sugar one to three hours after eating. This is followed by high blood sugar levels four to six hours after eating.

Information of particular interest in this article is the following statement by Dr. Robert J. Tanenberg: "It is also a well-known fact that the rate of stomach emptying correlates with plasma glucose levels, even in patients without gastroparesis." As blood sugar rises above normal range, stomach contractions begin to diminish. At a blood sugar level of 250, gastric contractions may be completely absent.

Therefore, diabetic patients who do not have gastroparesis may still experience gastric upset due to delayed gastric emptying when blood sugar levels are not properly controlled.

If you suspect you may have gastroparesis, it can be diagnosed by having a gastric emptying test. These tests are done in the nuclear medicine department of a hospital or radiology center.

Elizabeth Hutchcraft

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