Inflammatory Bowel Disease: More Than Just An Upset Stomach

May 20th, 2010
3D model of the Isotretinoin structure

3D model of the Isotretinoin structure

Do you suffer from frequent bouts of nausea, heartburn, indigestion, stomach bloating, or diarrhea? How often do you change your schedule due to an upset stomach? Do you find yourself planning your daily itinerary around the availability of restrooms?  Many people believe that rather than addressing a nutritional issue, temporary relief is available in the form of an anti-acid. Pop, pop, fizz fizz oh what a relief it is (catchy tune but really not addressing the issue)!  Stomach discomfort and diarrhea can be a sign of a more serious problem called Inflammatory Bowel Disease. Inflammatory Bowel Disease (IBD) refers to two chronic diseases: Ulcerative Colitis and Crohn’s Disease. According to the Centers for Disease Control, these diseases may affect as many as 1.4 million people in the United States. Symptoms include  diarrhea,  abdominal pain, fever, rectal bleeding, loss of appetite, weight loss, chronic fatigue, and inflammation of the skin, eyes, and joints. Serious complications can also occur, including intestinal blockage and ulcers, malnutrition from poor intestinal absorption of nutrients, and increased risk for colon cancer.

The exact cause of Inflammatory Bowel Disease remains unknown. According to the Mayo Clinic, there are a number of possible contributing factors in the development of IBD. Genetic predisposition, a compromised immune system from a virus or bacterial infection, cigarette smoking, being of Caucasian and particularly Ashkenazi Jewish descent, and eating a very high fat and low fiber diet can all lead to IBD. The Mayo Clinic also highlights a correlation between Isotretinoin (or Accutane), a powerful medication used to treat severe acne, and Inflammatory Bowel Disease. Isotretinoin  has a chemical structure and function which is similar to vitamin A.  The drug  was approved by the Food and Drug Administration in 1982. It  has been widely prescribed despite its well-known links with birth defects and it might also impair the immune system’s response to intestinal bacteria. Hypothetically, this can result in inflammation and the development of IBD.

Research studies indicate a strong association between Isotretinoin  and Inflammatory Bowel Disease. A study published  in the American Journal of Gastroenterology by Crockett et. al (March 2010),  reviewed a number of  cases of IBD which were linked with Isotretinoin exposure. Ulcerative colitis was strongly associated with Isotretinoin use, causing a 50% increased risk of developing Ulcerative Colitis in those who have used Isotretinoin previously compared to those who have not. The higher the dosage of Isotretinoin , the greater the likelihood of developing Ulcerative Colitis.

Due to strong scientifically backed evidence indicating a connection between Isotretinoin and IBD,  thousands of  lawsuits have been filed against Roche Pharmaceuticals, the maker of Accutane. Many plaintiffs state they developed severe gastrointestinal disorders after taking the medication and criticize Roche for not issuing sterner warnings about the dangers of the drug. The latest development in the series of Accutane lawsuits occurred on February 16, 2010, when a New Jersey court ruled that Roche Pharmaceuticals must pay $25.16 million in damages to a man who claimed he developed debilitating IBD after taking the medication. Roche Pharmaceuticals maintains they will appeal the latest results.

The bottom line is that if you have a family history of Inflammatory Bowel Disease, or have experienced stomach issues while on  Accutane , please discuss proper treatment options  with your doctor.  IBD management is possible through both medication management and nutrition counseling from a registered dietitian. Don’t wait! Talk to your doctor today if you are experiencing ongoing stomach discomfort. Remember you are your own best advocate!

Amy Santo
Dietetic Intern, New York Presbyterian Hospital
Master’s Candidate in Clinical Nutrition, New York University
amyjsanto@gmail.com

3D molecule custocy of Karl Harrison and 3dchem.com.

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Pre-Diabetes: The New Epidemic!

May 2nd, 2010

scaleAt least twice a week I receive phone calls from potential clients with “pre-diabetes”. The conversation usually goes one of two ways. Scenario #1: ”My doctor called and told me I have borderline diabetes. He told me to call you so that I could start on a diet to lose weight and get my blood sugars under control. I”m scared! What can I do?”. Scenario #2: “My doctor and wife made me call you because my blood sugar was a little high. I don’t have diabetes yet, so I’m not sure that I need to see you. They made me call. No rush.”  I’ve been a Certified Diabetes Educator for over 15 years and I still feel the deep angst when a person with pre-diabetes contacts me who is not yet willing to make appropriate diet and exercise modifications. Pre-diabetes is an easier condition to treat than Type 2 diabetes. So early detection and treatment is essential to prevent complications.

Pre-Diabetes should not be taken lightly! It’s now estimated that 57 million Americans have pre-diabetes. Pre-diabetes is actually “Pre-Type 2 Diabetes”. If  it is not properly treated, it has the potential to progress to Type 2 diabetes. If your fasting  blood sugar (after 8 hours of not eating, usually overnight)  is between 100 mg/dl and 125 mg/dl then you have pre-diabetes. A fasting blood sugar of 126 mg/dl puts you in the Type 2 diabetes category. Remember that pre-diabetes has nothing to do with Type 1 diabetes, which is an autoimmune disorder. (We must continue to support research to find a  cure for Type 1 diabetes).  Brett Michaels and Nick Jonas are examples of people who have Type 1 diabetes.

According to Dr. Gary Trager, the director of the Center for Diabetes and Endocrinology and Metabolism in Huntington New York, “The risk of heart attack and stroke triples to quadruples when you have the diagnosis of pre-diabetes”. Pre-diabetes can also increase the risk of retinopathy and neuropathy.  Many people are walking around undiagnosed with pre-diabetes (as there are often no overt symptoms). In a recent study in the American Journal of Preventative Medicine, about half of those diagnosed with pre-diabetes don’t even try to lose weight or alter their lifestyle habits. I suppose either people are scared and want to prevent Type 2 diabetes, or they are not motivated to change their diet and physical activity habits until they actually develop full blown diabetes! Anywhere from 33%-70% of people who have pre-diabetes will develop Type 2 diabetes. Since it is much easier to control than Type 2, I continue to reach out to those with pre-diabetes in order to help them properly manage their blood sugars.

A study called the Diabetes Prevention Program (DPP) found that losing 5-7 % of body weight (by reducing caloric intake and increasing physical exercise) can prevent (or substantially delay) Type 2 diabetes from developing. Carrying weight in your belly is very dangerous, and can significantly impact your blood sugar levels. People who are “apple shaped” are at high risk for being insulin resistant. A woman with a waist measurement of more than 35 inches is at high risk for developing blood sugar problems. And a  man with a waist circumference of more than 40 inches is in the  high risk category.

Don’t delay! Get started today! If your not sure how to manage your carbohydrate and calorie intake, contact a registered dietitian and certified diabetes educator to develop a meal plan that will fit into your lifestyle and control your blood sugars. Start moving! Exercise is a key component to blood sugar management. Talk to your doctor about possible blood glucose monitoring and medications changes. Do whatever you can to prevent pre-diabetes from developing into Type 2 diabetes.

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Depressed Appetite? Laugh, Laugh, Laugh!!!

April 28th, 2010

guitar_dogEveryone needs a good laugh.  Whether you are giggling or laughing out loud, laughter is terrific mood booster which can help set the tone for the day ahead. Now there is research available showing that laugher can promote appetite! Imagine having a compromised appetite because you’re sick or depressed, and being able to improve your food intake with a hardy laugh. What a fabulous concept!

We already know that exercise can improve appetite in people who are ill or suffering from depression. Over the years I’ve worked with many chronically ill people who are also experiencing depression, and simply can’t eat an adequate amount of food. Several of my elderly clients have many health ailments that limit their activity level and therefore don’t enjoy the benefits of improved appetite as a result of increased movement. So this new research is a very welcome adjunct therapy to good nutrition, increased exercise (as medically appropriate) and medications (such as anti-depression medication or appetite stimulants).

This new data on the connection between laughter and improved appetite in the elderly or chronically ill can be extremely helpful for care givers and family members. The study was conducted by Dr. Lee S. Berk,  a preventative care specialist and psycho-neuro-immunology researcher at Loma Linda University’s Schools of Allied Health and Medicine in California. Dr. Berk released the following statement:  “the value of the research is that it may provide those who are health-care providers with new insights and understandings and thus further potential options for patients who cannot use physical activity to normalize or enhance their appetite”. The news was directly released from the Federation of American Societies for Experimental Biology (April 26, 2010).

Although it was a small study (14 volunteers in total), I believe the findings are significant. The participants all watched different types of videos over a three week period of time. The hormone levels of those who watched the “funny”videos, mimicked positive changes similar to people who exercised moderately. These findings are particularly interesting to me, as I strongly believe in a “mind-body” connection. My clients and I always focus on the relationship between the mind and the body.  Your head is actually attached to your body. What you feel emotionally effects your physical being,  just as your body effects your thoughts. This research provides another possible way to stimulate appetite in those who are struggling to eat due to depression.

If you are a health care provider or caregiver to someone whose appetite has been negatively effected because they are ill or depressed, please continue to provide them with appetitzing food and encourage them to stay as physically active as possible. They must also remain complaint with their medical regime. But now think of ways to make them laugh! Pop in a funny movie, tell some silly jokes or share a hilarious story. You can also share  funny pictures (like the one I posted above of the dog playing the guitar)!  What makes you laugh? Everyone could use a little laughter. So laugh and eat together and enjoy the road to improved health!

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Susan Weiner Nutrition: A Small Biz Story!

April 11th, 2010

Small Biz Stories

My fascination with food, dietary habits and health led me to a career in nutrition over 2 decades ago. Since I started my own nutrition consulting practice, I never thought of myself as a business owner or entrepreneur. In my mind a  business was a place that had a bunch of employees, a lunch room and several policy and procedure manuals.  But raising a family and trying to balance my work and personal goals brought me to the realization that I wanted to (and needed to) work for myself. I enjoy working with others, but I also want to work on projects that I find meaningful and enjoyable.

Recently I was featured in an article published by Small Biz Stories. Please check it out!  Susan’s Story: Susan Weiner Nutrition

As I read the other blogs on this incredibly informative site, I realized that I really am a successful small business owner! I’m learning so much from reading them, that I decided to join a group of network bloggers and share my blog with them on Facebook!

It’s a great way to share my ideas about good nutrition. For my clients who don’t know me out of the one-on-one nutrition counseling realm, please read about my other projects. For those of you who have a dream of expanding your own business, I suggest reading the blogs on smallbizstories.org. It’s given me a great deal of inspiration!

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Ending Childhood Obesity! But How?

March 17th, 2010

Packaged food lies in a vending machine.

At the beginning of the school year in elementary school, parents are instructed to send in only “healthy snacks”. Cut up veggies, fresh fruit snacks and low fat string cheese for example. The list forbids candy and excessive amounts of cookies and baked goods. I always marvel at how the rule doesn’t apply to the bi-weekly birthday parties (when kids bring in cupcakes decorated with candies or donut holes).  When my boys reached middle school, the cafeteria oozed with chips,  vending machines (pictured here), and ice cream treats. In high school, fund raising included candy sales and bake offs. The teenagers were given the freedom to eat lunch off campus. This often meant drinking a soda with a bagel or a slice of pizza (everyday for a month) or skipping lunch and pocketing the money. So I am very interested in following Michelle Obama’s campaign to end childhood obesity. Where will this process lead?

At a meeting this past week of the Grocery Manufacturers Association (which includes Coca Cola Co., Kraft, Del Monte Foods Co. and General Mills), Mrs. Obama strongly recommended  that food manufactures “step it up” and put less fat, salt and sugar in their products. She was quite direct in her statements: ” We need you not to just tweak around the edges but entirely rethink the products you are offering, the information that you provide about these products, and how you market those products to our children”. Let’s not forget that in 2005 President Bill Clinton along with the American Heart Association tried to campaign against childhood obesity. His efforts did not seem to be met with the same enthusiasm as Mrs. Obama’s.

This push towards combating childhood obesity is coming at a time when the Food and Drug Administration is also considering stricter guidelines on food labels. The Nutrition Facts Labels (on food products) can be very confusing, and often misleading.  Portions sizes are not uniform (look at the cereal boxes in your pantry). In New York State, there is also a proposed tax on “soda” and “sugary drinks”.  Whatever your point of view on the soda tax, it will discourage children (on a tight budget) from purchasing these non-nutritious beverages due to price.

Michael Lynton, the chairman and chief executive officer for Sony Pictures recently suggested that movie theaters offer healthier snacks “to help fight obesity”. He backed up his suggestion when he told theater owners that a survey by the studio at 26 U.S. theaters found that 2/3 of moviegoers say they would purchase healthier snacks if they were available. Maybe there will be a time where we don’t have to carry large bags full of sliced apples, air popped popcorn, low fat granola bars unsalted nuts and peanut butter on celery sticks into movie theaters! And guess who offered to help advise the movie theater concession efforts? You guessed it… former President Clinton and the American Heart Association. (Maybe they should have a nutritionist on that panel this time around). The point is that from food manufacturers to company executives, the need to address childhood obesity is evident.

I can only hope that the battle against childhood obesity becomes a true group effort. As a Registered Dietitian and  Certified Diabetes Educator I have given many talks, and participated in many educational programs in school districts, Scout Troops, and foster care programs to offer suggestions on how to improve a child’s nutritional health. But our children’s nutritional health needs to be a joint effort, and it is very difficult to battle food companies and junk food promotion  in the media. The campaign to fight childhood obesity is also promoting increased physical activity for our children.  If food and snack choices in schools are actually appealing to kids, I believe given the choice (and with adequate education for children and parents or caregivers), we can begin to successfully fight childhood obesity and help prevent many cases of Type 2 diabetes. Let’s feed our children well. After all, they are our future!

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Weight Gain At Work? No Way!

March 14th, 2010

paperbagMy 21 year old son is one of those unusual people who was born wanting to eat healthy foods and run, bike, jump and scale walls. He doesn’t seem to desire cookies or chocolate and would choose salad and salmon over a Philly Cheesesteak sandwich any day of the week. This kid would rather exercise than watch a movie or play a video game. His job is physically demanding, and he prepares his breakfast and lunch everyday. He is amazed that the guys he works with buy pastries and sugary coffee drinks for breakfast, fast food and soda for lunch and munch on chips and cookies all afternoon. “Why would anyone spend all that money for junk food?” he asks. He realizes that if you eat well and move at work  you’ll have more stamina and be in a much better mood when you get home.

After Halloween and Easter, many people bring tubs of leftover candy to work (attempting to get it out of the house).  If it’s in front of you all day long while you’re sitting behind a desk (or passing the reception area where the candy dishes are conveniently positioned), chances are you might eventually eat some. Birthday celebrations at work revolve around bagel and donut breakfasts. These early morning eating parties are fine every once in a while, but when they occur twice a week the calories really start to add up. Make sure if you do participate in a special occasion breakfast or lunch, you limit it to once a week.  Bring your own food with you to work (don’t forget to add up all the money you’ll be saving). Take control over your food! For lunch, put together a big salad (enough for a couple of days at a time) and top it off with some chicken, tuna, turkey, salmon, or shrimp. How about a veggie or chicken burger as a tasty lunch protein! Throw in some beans and sliced almonds. Bring along some unsalted nuts to munch on. Every other day prepare a sandwich on whole grain high fiber bread with some lean protein (mentioned above). Top it off with some lettuce, tomato and bean sprouts. Bring along some low fat Greek yogurt and walnuts for an afternoon snack. Thinking of making a pot of soup? Make a BIG pot and freeze it in containers. If there’s no place to heat it up at work, bring the soup in a Thermos!  No refrigerator? No problem. Pick up an insulated lunch bag and an ice pack.

Try to bring a refilable water bottle with you to work (and fill it up throughout the day). It is truly silly to spend money on water all day long. Take sips throughout the day. Quench your thirst with water (and avoid too much caffeine and sugary sodas). Don’t eat when you are bored at work… drink water instead.

If you can prepare food in advance and freeze it in portions (defrost food in the refrigerator as you need it for meals), you will be able to save a ton of time. Of course make sure the ingredients you need to prepare your work meals and snacks are available at home. Chop and dice veggies once every few days to save time.

If you work in an office enviornment, walk around (whenever you can) during the day. Wear a pedometer so that you can monitor your progress. Take the stairs whenever possible. If you have time, eat outside on a nice day then talk a walk. Keep your sneakers at work so that you can walk whenever you have a free moment. Moving during the day will help you focus (no more afternoon naps at your desk).

Not everyone is like my son who enjoys preparing his own food and eating well almost all the time. But he is trying to inspire the people he works with by showing them that even after a long day’s work, he has the energy to do just about anything. So start cooking and freezing, chopping and dicing, washing and peeling when you can. You’ll feel better when you have some healthy foods at your finger tips, and you’ll have a little extra money to spend when you’re finished with work. Maybe you can even spend the money you saved on a gym membership! Okay I won’t push my luck.

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All Champions Eat A Nutritious Breakfast. So What’s A Nutritious Breakfast?

March 7th, 2010

cereal_and_fruitWe are constantly bombarded with conflicting nutrition and diet information.  In the 1990′s researchers were sure the answer to all our health concerns was to eat “low fat” foods. In the decade that followed “low carb” was the way to go. While these points can be argued, there is one nutrition tip that has stays constant. EAT BREAKFAST!

Mom told us to eat breakfast because (say it together) “it’s the most important meal of the day”. Starting off the morning with a nutrient rich breakfast will help set you up for a great day of healthy eating. If you are not hungry in the morning, I’ll bet you ate too much the night before.

Breakfast Tips:

1. Drink a tall glass of water in the morning (avoid the juice). Just dropping the juice can take off 100- 200 calories from your morning menu! Some people enjoy warm water with lemon. Or try a nice glass of ice water. Can’t live without juice? Just add a splash of juice to your water. Better yet squeeze a little lemon or lime into your water. Great way to get your system up and running!

2. Include protein in your morning meal. Egg whites and veggies with a little low fat cheese and some blueberries or sliced melon on the side is fantastic! If you can’t stand just egg whites, have one whole egg with a couple of whites. You should always enjoy what you are eating!

3. Have you tried steel-cut oatmeal? High in fiber (keeps you fuller longer) and it can also help to lower your cholesterol. Add a few unsalted crushed walnuts or almonds with a sliced apple. Top it off with some cinnamon and you have a delicious (and yes nutritious) breakfast.

4. Try whole grain bread with some natural peanut butter or almond butter. Have some sliced strawberries or a banana on the side for a scrumptious, on the go meal.

5. Cottage cheese or Greek yogurt with fresh pineapple and sliced almonds is simple and nutritious. The taste combination is satisfying, yet calorie controlled.

6. In the mood for some crunch? Try some whole grain rye crackers with low fat cheese! Have an orange on the side (which will give you some vitamin C).

7. Sometimes we need a little comfort food to get going in the morning. Enjoy a whole wheat English muffin with melted low fat cheese, topped off with tomato. Try eating each half separately to make it last just a bit longer. Still hungry? Enjoy a half of a grapefruit with your breakfast.

8. I really enjoy brown rice cakes and hummus. Have some Greek yogurt or a glass of low fat milk with it to give you a calcium boost.

9. Try a bowl of high fiber cereal with unsalted almonds, berries, low fat milk and a dash of cinnamon. Simple and tasty!

10. How about trying something really different. Tuna or salmon on rye crackers or brown rice cakes for breakfast! It’s a fun protein packed meal. Top it off with some lettuce and tomato. This breakfast combination will get you through the morning.

Notice none of these tips include fast food menus, bagel shops or donut stops. If you make your own breakfast, you will start off your day with a calorie controlled healthy meal that will set the tone for your day! So here’s to better concentration, more energy and a metabolism that is rearing to go.

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It’s More Than Spring, March Is National Nutrition Month!

February 28th, 2010

bed of flowers

Spring is a time of beauty and renewal. The sight of flowers blooming, the smell of grass growing  and the sound of birds chirping make us feel that anything is possible. Living in the Northeast, I’ve learned to appreciate and welcome the change of seasons. The arrival of Spring allows for endless possibilities.

March is not only the arrival of Spring, it is also National Nutrition Month! If you made nutrition related New Year’s resolutions which never materialized, think of March as your “spring- board” into good health! What can you do to improve your nutritional health?

Make National Nutrition Month work for YOU. Here are some suggestions to get you going:

-Maintain a daily food journal!

If you do one thing to improve your nutritional health this Spring, please keep a food journal. Very often we don’t realize all the little extras that we eat and drink. 100 calories here and 50 calories there can really add up.  Keep a record of everything you put into your mouth to figure out where all of those extra calories are coming from. Keeping a food record can also point out what you are missing (healthy unsalted nuts, fruits and vegetables).

- Eat 4-6 servings of vegetables a day

Veggies are very low in calories and very high in fiber! Fiber can help keep you fuller longer and stabilize your blood sugar levels. One serving of vegetables is about 1/2 cup. Try eating different color veggies (such as an orange pepper, green broccoli and red tomato).

- Go For The Omega 3′s

Include unsalted walnuts, ground flaxseed, salmon and albacore tuna into your menu. At least 3 servings of these foods each week will help protect against heart disease (and can even help with brain function).

-Go For The Winning Whole Grains

Throw out the white bread. Toss the white rice. Get rid of the white pasta. Instead try whole grains, brown rice, quinoa and cous cous. These are nutritionally dense choices which also pack a good fiber punch!

-Eat Breakfast

Get yourself started in the morning with some wholesome eggs with veggies, whole grain cereal with unsalted nuts and fat free milk or natural almond butter on whole wheat bread and blueberries. If you are not hungry in the morning, you probably ate too much the night before.

- Cut Back On your Salt

Reduce your sodium intake to less than 2,300 mg per day (that’s about 1 tsp of salt per day). Find out more about salt and your diet.

- Bring Your Lunch With You To Work Or School

Be prepared. It’s not only the boy scout’s creed, it’s the only way to assure that you have the right foods with you to get through the day. What a great way to save money! Bring your food and water with you, everyday.

I could go on and on with more tips and suggestions on how to make National Nutrition Month personal for you. Perhaps the best way to improve your well being is to help better the life of someone less fortunate. During March (and hopefully for months and years to come) please donate money or needed supplies to your local food pantry. Contact your local religious community leaders or town office to find a food pantry near your home. I guarantee that they will welcome donations of money, supplies (such as canned goods), and time (serving meals to the less fortunate). The best way to celebrate National Nutrition Month this March is to be achieve your personal best. Start by sharing the nutrition tips mentioned above and by helping those who perhaps don’t have the same resources available. Let’s make National Nutrition Month the beginning of a Spring to remember.

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High Blood Pressure? Stop The Salt Before It Stops You!

February 21st, 2010

P6260308saltshaker

As a nutritionist and Certified Diabetes Educator I am constantly looking at ways to help people battle obesity, heart disease, hypertension and diabetes. As we continue to deal with our expanding waistlines, we need to add sodium to our list of dietary concerns.

Even the politicians are jumping on the salt cutting band wagon. New York City Mayor Michael Bloomberg asked restaurants to voluntarily reduce the sodium content of foods by 25 % over the next five years. Not to be outdone by the east coast,  San Francisco Mayor Gavin Newsom (who already suggested his city reduce sugar consumption) is looking into ways to apply Mayor Bloomberg’s suggestion on salt reduction. I believe it’s time we start paying close attention to salt and its effects on health.

High blood pressure (aka hypertension) is very common among people with diabetes. Blood pressure (which is the force of blood against the artery walls) is measured in millimeters of mercury. Systolic pressure (heart beats) over diastolic pressure (the heart relaxing between beats), defines blood pressure.  If your blood pressure reading is above 140/80mm Hg, you are considered to have hypertension. Actually if you have diabetes the recommendation is to reduce your blood pressure below 130/80mmHg. Elevated blood pressure can increase your chance of developing a stroke, heart attack, coronary artery disease and nephropathy.

Sodium is a mineral (just like potassium and calcium). Although we do need a little bit of sodium in our diets (it can help maintain fluid balance in the body), we get way too much sodium (usually in the form of salt) and not enough of other very important minerals. 1 teaspoon of salt contains 2,400 milligrams of sodium. Foods that have 140 mg of sodium or less per serving are considered to be  ”low sodium” foods. The average American consumes about 4,000 mg of sodium per day while the American Heart Association recommends that healthy adults limit sodium to 2,300 mg per day, the National High Blood Pressure Education Program suggests less than 2,400 mg per day and the World Health Organization recommends less than 2,000 mg daily. That means there is no room for using your salt shaker. Toss it out!!

The DASH program (Dietary Approaches to Stop Hypertension) was developed based on findings by the National Heart, Lung, and Blood Institute (NHLBI) and emphasizes an eating plan rich in  fruits, vegetables, lean protein, unsalted nuts and whole grains. The DASH program limits simple sugars and is rich in potassium, magnesium, calcium, lean protein, low fat dairy products and fiber. By increasing fruits, veggies and unsalted nuts the overall nutritional density of the diet is improved, promoting better health while encouraging weight control (which is key in controlling blood pressure). In my opinion people with diabetes should closely consider their carbohydrate intake on the DASH diet (or any other program) to help properly manage blood sugar levels. As always, it’s a balancing act.

In order to control your blood pressure, please consider making some important lifestyle changes:

1. Achieve and maintain a healthy weight. Contact a registered dietitian  to begin a safe weight reduction program.

2. Increase your physical activity level! Start moving. Find something you enjoy doing physically (find a buddy and start walking today). Swim, try an cardio workout DVD, ride your bike… but start moving! Remember, if you have not been physically active in a while, you must consult your doctor before starting an exercise program.

3. Reduce the amount of sodium in your diet. Eat out less. Cook more! Buy less processed foods.

4. Reduce your consumption of alcoholic beverages.

5. If your doctor prescribed medication for your blood pressure, please take it as recommended.

6. Read food labels. Many foods contain hidden forms of sodium such as;  MSG (monosodium glutamate), baking soda, seasoned salts, salty marinades and of course canned and many frozen processed foods. Remember that sea salt and kosher salt still contain salt.  The list goes on and on!

7.  Drink water. Yes plain water. Reducing the salt, increase the water and the fiber and watch the pounds melt off!

8. Try to choose lower sodium foods when possible. Remember fresher is usually better (less sodium and more nutrition). If you do buy canned foods (such as canned tuna or beans), please rinse off the product with cold water.

9. Uses spices instead of salt. Since I already convinced you to throw out the salt shaker, buy all new spices and herbs. Squeeze fresh lemon on your fish and chicken to seal in the natural flavor. Enjoy the full flavor of your food!

10. Limited foods which are cured (such as bacon) or packed in a brine (such as pickles or olives) or smoked. Canned soups are also packed with salt.  These are super salty foods! Use them only for special occasions.

11. Choose fruits and vegetables instead of salty snack foods. Natures snacks provide you with  much needed potassium, which will help keep your blood pressure in check.

Please don’t be overwhelmed when trying to reduce the amount of sodium in your meal plan. Try to incorporate one or two good habits at a time. In a few weeks you will see a significant reduction in your weight and sodium intake. It is also important to increase your potassium intake while improving your  physical activity level to help achieve a normal blood pressure. Habits that were developed over many years can’t be changed in an instant. So talk a walk today, throw out the salt shaker and snack on a few raw veggies. Let me know how you are doing in a few weeks. Remember, good health happens one habit at a time.

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What Are The Differences Between Type 1 and Type 2 Diabetes?

February 10th, 2010

cohdradiabetes100_1819

You finally agreed to go for your annual all inclusive physical. A few days later your doctor calls  with those bone chilling words “your blood sugar is elevated, you have diabetes”. And there is always this dreaded scenario…your child has lost a lot of weight, is experiencing extreme thirst and is always tired. One morning she is unable to wake up for school and you rush her to the emergency room. After a blood test the doctor emerges and announces ”your child has diabetes”. Diabetes is a scary word. So I thought I’d go back to basics and discuss the difference between Type 1, Type 2 and Pre-Diabetes.

Diabetes is a serious problem which will require medical attention and lifestyle adjustment. As a Certified Diabetes Educator, I want to increase awareness about the different types of diabetes. Type 1 diabetes (also known as juvenille diabetes, insulin-dependent diabetes mellitus or sometimes childhood diabetes) accounts for about 5- 10% of the diabetes in the United States. Although it is usually diagnosed in childhood, it can develop in adults as well.  At this point in time there is no cure for Type 1 diabetes and it   CAN NOT be prevented. It is an autoimmune disorder that occurs because the beta cells in the pancreas do not produce ANY insulin. Insulin is a hormone (chemical messenger) that helps the body’s cells use glucose for energy. Without insulin, glucose builds up in the blood and over time can cause excessive high blood sugar levels. If diabetes is uncontrolled it will cause major problems in every organ of the body. Serious complications of diabetes can include blindness, heart disease, kidney disease and stroke. All people with Type 1 diabetes must take insulin. Some people use injectable insulin and others use insulin pumps.

Type 2 diabetes also known sometimes as adult onset diabetes is more common than Type 1. Since many obese children have developed Type 2 diabetes, it should no longer be referred to as adult onset diabetes!  Having a sedentary lifestyle, being overweight and having a family history of Type 2 diabetes are all factors that will increase the risk of developing Type 2 diabetes.  Certain ethnic groups such as African Americans and American Indians also have a higher incidence of Type 2 diabetes. Most people with Type 2 diabetes can still produce some insulin. Unfortunately there is a problem with the  insulin receptors and therefore glucose continues to build up in the blood. The pancreas will continue to produce insulin in order  to keep up with the high blood sugar levels, but due to the problem with insulin receptors, blood glucose remains high and continues to cause problems. So although people with Type 2 may start out with insulin resistance, eventually they will develop insulin deficiency. In order to control Type 2 diabetes, it is important to modify carbohydrate and calorie intake while increasing physical activity in order to promote weight loss. Weight reduction can help reduce the excess “belly fat”  which increases the risk of insulin resistance. You must eat right, reduce your carbohydrate consumption and for goodness sake start moving! In addition to proper diet and exercise, many people with Type 2 also take oral medications. It is also important to realize that many people with Type 2 diabetes also eventually require insulin. Insulin may therefore be a necessary part of your treatment plan if you have Type 2 diabetes.

1 in 4 Americans over the age of 20 (about 57 million people) have Pre-Diabetes. Pre-Diabetes is a condition in which your blood sugar levels are elevated, but you are not yet diagnosed with diabetes. The important point to remember is that Pre-Diabetes is Pre-Type 2 diabetes. If you lose weight, control your belly fat and increase your physical activity you can control your blood sugars and prevent Pre-Diabetes from turning into Type 2 diabetes!

Diabetes is a serious and complex metabolic disorder. As a Registered Dietitian and Certified Diabetes Educator, I truly want to educate as many people as possible on the ways to treat the disease. If you have a child with Type 1 diabetes (or suffer from the disease yourself), please know that I support research in finding a cure. If you have Pre-Diabetes or Type 2 diabetes start to modify your lifestyle today! Many of my future articles/blogs will be about ways to improve living with diabetes!

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