Prediabetes in Depth

While not as serious as frank diabetes, prediabetes is, nevertheless, dangerous and common: 1 in 3 adults in the US has prediabetes and most of these people are not aware of it (unless their blood sugar or A1c has been checked by their doctor). They also have no symptoms. The risk for developing frank type 2 diabetes, heart disease, and stroke is significantly increased in people with prediabetes, so we need to take prediabetes very seriously. Go and get tested for prediabetes if you fall into any one of the following categories:

·     have belly fat

·     are over 45 years old

·     have a family history (parent or sibling) of type 2 diabetes

·     have high blood pressure (higher than 130/80 mm Hg)

·     are a woman with previously diagnosed gestational diabetes, polycystic ovaries or have given birth to a child weighing over 9 pounds

Make an appointment to see your primary care provider and make a point to exclusively focus on prevention of diabetes, heart disease, and stroke. Your provider may order blood tests beyond merely your blood sugar and A1c (cholesterol, LDL, HDL and triglycerides and your TSH to evaluate thyroid function).

Be a true partner to your provider: know your weight, waist circumference (ideally no more than 37 inches in men and 32 in women; for Asians the numbers are about 5 inches lower). Know your family history and what your average blood pressure (home measurements) is. Mention any prior history of heart or artery disease or procedures (stress tests, echos, ultrasounds of your carotid arteries, angiograms). If you have an old ECG, bring it to your appointment.

A blood pressure log with at least 10-15 measurements is especially helpful. You need to have a good blood pressure monitor and follow your provider’s instructions on how to accurately measure your blood pressure at home.  

If you smoke, you need to give up smoking. The combination of smoking and either diabetes or prediabetes is too dangerous for your arteries. It can lead to heart attacks and stroke even if your doctor prescribes adequate medications to control blood sugar, blood pressure, and cholesterol.

You have to increase the level of your physical activities, achieving at least 15,000 steps a day, grabbing any opportunity you have (at home, work or school) to move, lift light or medium weights on a daily or every other day basis and perform balance and stretching exercises like tai chi or yoga.

You also need to understand what a healthy diet is: what a portion of fruits and vegetables is and what are the healthful fats. You have to severely restrict added sugars (sugary beverages, cookies, desserts, candies, cakes, donuts), refined grains (white bread, white past, white rice, white potatoes) and fried foods. Depending on other factors, you may be more liberal with good sources of protein like fish, nuts, eggs, dairy (avoid full fat) and lean meat.

Investing in a personal trainer and/or a dietician/nutritionist is a great idea.

Getting your metabolism back on course requires motivation, willingness to invest about two hours of your personal time, and working closely with your primary care provider. Insulin resistance, prediabetes and type 2 diabetes are all serious conditions. Treat them as such.

Fitness Trackers … Are they worth it?

The newest rage in fitness is the fitness tracker. They range in price from  around $30.00 to several hundred dollars. Do they work? Are they worth the money? And what exactly are they “tracking”?

The fitness tracker is a wearable device that will track everything from your steps, your sleep, your heart rate, blood pressure or oxygen level and even your sweat.  It may reveal that you need to “step it up” (pun intended) or that you are on track to your fitness goals.  It is available in app form as well and/or will work in conjunction with an app or your smart device. For most people, it is a reminder that you need to do more, and to some a surprise, that they have not been doing enough!

The fitness trackers are usually in the form of a band (usually worn on your wrist, ankle or neck) and they track your progress. One brand will light up to show your progress, another will display a red move bar after one hour of inactivity acting like a personal coach.  A sweat tracking wearable is attached to the skin of your leg.

Shape magazine reported a recent survey by the NPD Group showed 58 percent of women who were asked intend to buy one of these devices. The most sought after features: counting calories and tracking the number of steps taken in a day.

I believe that the most important benefit of a fitness tracker is that it signals your determination to be directly involved in your own health and to start monitoring it. This is a much bigger step than most people would think. A great example is the number of steps you take in a day; taking at least 10,00 steps a day means that you meet or exceed the minimum exercise requirements of 150 minutes per week, an important milestone in healthy living.  The 10,000 steps a day is also part of the “Step Diet”, a relatively straightford combination of physical activity and diet to help you lose weight. Exercise can also help you reduce your  blood pressure (which can also be monitored by some wearables) and, thus, reduce the chances of heart attack, stroke and kidney disease.

Tracking your fitness is valuable; it can bring you back to reality. Maybe walking down the hall for that cup of coffee at work is not walking enough even though you pat yourself on the back for getting up and moving. Fitness trackers or apps can be the extra kick in the pants to help get you on the right path, but only YOU can make the changes you need.

There are a few issues that come along with the benefits of the fitness trackers. One is that they are not always very accurate. They can miss the number of steps you took and can tell you that you did not get enough sleep even if you did. Their data may also be too much to handle and can cause some confusion. There are technical improvements on the way that can improve the accuracy of these devices.  And you don’t have to get caught up in the entire amount of information the tracker is telling you. You body, body weight and waist circumference, are good indicators of your health report card and complements the information from your wearable.

In Abdobesity, I write that “diagnosis is extremely important in medical care because it reveals the seriousness of the illness and suggests those treatments that are most likely to help the sick person.” While a tracker or app or device cannot diagnose a problem, they may be able to indicate if there is an issue with something such as blood pressure, blood oxygen levels, etc. If this is the case, discuss it with your physician.  Your doctor can delve deeper to uncover what the issue is and what can be done to help with the problem at hand.

As always, be your own health advocate. Choose wisely. A fitness tracker is definitely an important step forward, but you may not need to pay too much for all the bells and whistles. Use your wearable to keep you in check, get moving or “coach” you to a healthy lifestyle. Just don’t rely on it as the end-all-be-all to good health.

To your health!

Dr. Anthony

Should you integrate Eastern Medicine into your lifestyle?

Traditional Chinese Medicine (TCM), part of Eastern as distinguished from Western Medicine, has been practiced for thousands of years and focuses on HEALTH and WELL BEING through the cultivation of harmony within our lives, according to a University of Minnesota article. Concepts like ying and yang and balance as a condition of healthy living are of central importance to TCM.

While the holistic approach to wellness, health and disease is intuitively appealing, the specific methods of diagnosis and treatment that TCM uses are highly debatable. TCM methods are not subject to as rigorous a data analysis as the ones used in Western Medicine.  Biology is very complex and no statistical method can do perfect justice, whether it is Western or Eastern Medicine.

TCM includes herbs, acupuncture, massage and focusing on the whole body. Listening to one’s body is also regarded highly important. TCM leans toward prevention and wellness, not just diagnosing a problem.  According to Psychology Today, Western Medicine lies in “the newest is the best” camp. Eastern Medicine (like TCM) followers look to their doctor for experience and guidance and consider wellness a lifelong practice.

In the western world, especially in the United States, many doctors are quick to prescribe medicine. More often than not the diagnosis is not 100% determined, but doctors are trying to find a “fix”, something their patients have learned to expect or even demand. Western Medicine emphasizes the use of medications or procedures to stop the pain and suffering. Eastern Medicine practitioners claim that they want to get to the bottom of the issue- and diagnose the problem first - THEN provide a treatment. They believe that sometimes the best treatment is not a man made drug; this attitude is shared by increasingly more practitioners of Western Medicine. Additionally, more and more western physicians are embracing certain eastern practices. Acupuncture has been offered to help stop nausea and vomiting associated with surgery or chemotherapy and for chronic low back pain or even as an adjunct in attempts to quit smoking.  One US hospital has offered a chair massage before imaging examinations at their department of radiology as a way to help calm patients.  

Of course, when it comes to YOUR HEALTH - remember YOU are your own best advocate. You are free to choose a physician who keeps an open mind and is willing to embrace or try eastern medicines, if good evidence supports it. Prevention IS the best medicine, and a holistic approach is the most appropriate one; perhaps these are the principles in Chinese philosophy and TCM that merit further investigation and consideration. As long as professional organizations certify practitioners of eastern medicine using acceptable standards, why not find  a doctor willing to use TCM techniques?

One needs to consider that both Western Medicine drugs and Eastern Medicine herbals can have significant side effects and cause harm. Further scientific research is necessary to help incorporate practices of Eastern and TC Medicine into mainstream Western Medicine.

It is YOUR BODY - YOUR WELLNESS should be priority #1!

To Your health!

Dr. Anthony

New Year’s Health ‘Re-Solutions’

Aiming at an almost daily practice of a healthy lifestyle is my suggestion for 2016  health resolution.  

Here I need to explain two things: first, what healthy lifestyle really means in practical terms and, second, why I believe that embracing and practicing a daily healthy lifestyle makes a better new year’s resolution than losing weight.

A healthy lifestyle means not smoking, following a healthy diet (six or more portions of fresh fruits and vegetables, taking in the good fats and lean protein, avoiding the bad fats, significantly limiting the intake of salt and sugar and controlling our calories) in at least 90% of our meals, near-daily exercise (combination of aerobic, low-weight resistance, and stretching), not drinking more than moderate amounts of alcohol (no more than one alcoholic beverage daily for women or two for men) and avoiding prolonged or unnecessary use of non-steroidal anti-inflammatory medications (‘NSAIDs’). The practice of a healthy lifestyle should be coupled with monitoring, with the help of our doctor, our blood pressure and LDL cholesterol and with keeping our wellness visit appointments.

Losing weight as a new year’s resolution is a cliché. A goal of weight loss at any cost or by any means does not improve our health or prolongs our longevity as much as the consistent practice of a healthy lifestyle (and keeping our blood pressure and LDL cholesterol low). Additionally, for so many people, weight loss can be difficult-if not impossible- to achieve and the struggle to lose weight may deteriorate into a frustrating uphill battle, a daily nightmare that can make people feel worthless and give up on their health altogether. Finally, a near-daily practice of a healthy lifestyle very often results, over time, in a healthy and sustainable weight loss.

Here is a personalized list of healthy daily practices, with emphasis on individual health profiles:

If you smoke, quit. Daily exercise and a perfect diet won’t come even close to offering you the health benefits of quitting smoking. Smoking, even as your only vice, is plenty capable of destroying your arteries (giving you heart attacks and strokes) and your lungs (causing emphysema) and contributing to an assortment of cancers, provided you continue to smoke long enough (it may take a couple of decades for smoking to destroy a young human body, considerably less for a middle-aged one)

If you have high blood pressure, eliminate salt from your diet, take your medications, and monitor your blood pressure at home, aiming at the blood pressure goals that your physician recommends for you (less than 140/90 mm Hg, or even lower, depending on your medical history)

If you are diabetic, do whatever it takes to keep your A1c at the level your physician recommends (around 7% or even lower, again depending on your unique health circumstances), monitor your blood sugar and blood pressure at home and discuss with your doctor whether a statin is appropriate for you.

If you have high cholesterol, eat at least six portions of fresh fruits and vegetables a day, take in the good fats (in the forms of fish, olive oil, unsalted nuts, or dark chocolate) and discuss with your doctor whether medications are necessary

If you are overweight or obese, eat a healthy diet, exercise at least five times a week (including not only aerobic but also resistance and stretching exercises), don’t smoke, do not drink more than moderate amounts of alcohol, make your home as sugar-free as possible, and keep your blood pressure and LDL cholesterol low, with the help of your physician. If your obesity has already caused significant health problems, discuss with your doctor about bariatric surgery and obesity-treating medications.

Remember: it is what we do on most of our days that counts. Good health is built or destroyed, one day at a time.

Have a most healthy 2016!

Your Mom Was Right ...

when she was advising you to eat your fruits & veggies to grow big & strong.

As reported in the recent State of the Plate report, after a brief rise thru 2009, per capita fruit and vegetable consumption has declined 7% over the past 5 years. The Dietary Guidelines for Americans advise that we eat a diet with plenty of fruits and vegetables. According to USDA's dietary guidance system MyPlate, more than half of our plate should be made up of fruits and vegetables. So for a 2,000-calorie diet, eating at least five portions of fresh fruits and veggies (one portion is about the size of a tennis ball) each day is advised.

Benefits of Eating Fruits and Vegetables

Fresh fruits and vegetables have minimal salt content, helping you keep  your blood pressure low.

As they contain large amounts of fiber and water, fruits and vegetables contain few calories and they  keep you fuller longer, helping you maintain a healthy  weight.

While fruits and vegetables are carbohydrates, they are the good kind (low-glycemic index carbs). These carbs do not stress your pancreas and  reduce your chance of becoming diabetic later in life. Eating these healthy bits helps your body avoid the insulin peaks that  simple sugars (candies, sweets, white bread) cause. Insulin peaks lead to a mild hypoglycemia and hunger pangs an hour and a half after simple carbs are consumed and  that makes you eat again.

Eating veggies and fruits helps your body  fight inflammation and prevent cancer and the buildup of cholesterol plaques in your arteries.

Remember that frozen fruits and vegetables offer similar amounts of vitamins, fiber, antioxidants and minerals as their fresh versions.

Explore the rainbow of fruits and vegetable options out there!  Eating from a colorful assortment of vegetables is best, because every color offers its own benefits. The orange color of carrots, pumpkins and sweet potatoes is due to the antioxidant beta-carotene; the deep red pigment in tomatoes is reflects the antioxidant lycopene, which is linked to prostate health.

While all fruits and vegetables are healthy, here is a short list of some nutrition powerhouses:

Vegetables

Broccoli is rich in phytochemicals with antioxidant properties. It is chock full of fiber, vitamins A and C, and calcium and contains sulforaphane, a compound that can fight cancer.

Carrots are a good source of fiber, which helps to maintain bowel health, lower blood cholesterol, and keep a healthy weight. The orange pigment found in carrots is due to the antioxidant beta-carotene, also found in other deep orange foods such as sweet potatoes, pumpkin, butternut squash, papaya, and cantaloupe. Beta-carotene is converted in the body to vitamin A, essential for healthy eyesight. Vitamin A also supports  your immune system, keeps your skin healthy, and protects against certain cancers.

Spinach is a year-round staple in grocery stores, rich in vitamins and minerals. This super veggie contains iron and potassium, the B-complex vitamin folate as well as vitamins A, K, C. Spinach also contains flavonoids, antioxidants that help against certain cancers and a variety of phytochemicals that boost your immune system.

Sweet Potatoes are full of fiber, vitamin B6, folate, vitamin C, as well as the antioxidant beta-carotene and potassium. Be sure to eat them with the skin on, as they are especially nutritious. Contrary to a popular diet myth, sweet potatoes aren’t fattening!

Fruits

Cantaloupe. This melon family member is rich in the antioxidant beta-carotene. It is also rich in potassium, which, by lowering blood pressure, reduces  the risk for stroke.

Citrus fruits are a robust source of vitamin C, potassium, and folate, as well as fiber. Pink grapefruits are especially rich in the antioxidant lycopene. You benefit even more by eating these fruits whole because they yield more nutrients than drinking them as juice.

Avocados are rich in heart-healthy MUFAs (monounsaturated fats), which help lower LDL (bad cholesterol) while raising levels of HDL (good cholesterol). These little powerhouses are also high in vitamin E, a very important  antioxidant.

Grapes. Nibbling on grapes may lower LDL cholesterol (the bad kind), reduce the risk of blood clots, and prevent damage to your heart's blood vessels. Grapes contain  resveratrol that has  may help prevent cancer.

Healthy Tip

It is best to eat your fruits and vegetables from whole foods. Shop local, choose produce that's in season and don’t forget to go organic whenever you can!