You Want To Know!
As a member of the LCDA, you should be proud knowing you are taking a proactive lead in healing the prediabetes or diabetes of yourself or a loved one or a patient. And, you have come to the right organization. By learning about The Eight Essentials, and how to bring positive changes to your diet, lifestyle, supplementation, you will learn information that may help you reverse prediabetes and can help you to reverse or control diabetes.
New Expert Interviews!
The low carb diet is the foundation diet for people who have prediabetes or diabetes. The LCDA promotes a nutritional, fun, tasty way to implement the diet.
The LCDA knows that change can be difficult! That is why we are here to help make sense of diabetes and help educate you about how simple life changes can have profound effects on your health and on reversing and controlling your diabetes. We know that you may start only dipping your toes into the water of healing. We are here to lend hope, support and offer answers and confidence in your success.
Quote of the Day:
“With the new day comes new strength and new thoughts.”
~ Eleanor Roosevelt
Board Member Updates
REGISTER NOW FOR THE DIABETES SUMMIT! Three LCDA board members are part of it: Dr. Brian Mowll, Dr. Mona Morstein and Dr. Jodi Stanislaw. This is THE diabetes webinar series to listen to each year with dozens of experts on all topics that totally resonate with all the LCDA is attempting to communicate. The webinars are FREE the day they air! Please sign up HERE to be educated, motivated and inspired!
Shift Work + Diabetes
Essential #3: Good Sleep
Chronobiology is the field of medicine that associates sleep and it’s affect on body systems, including on the endocrine systems and hormone regulation. Medicine has studied this for over 100 years.
Much of chronobiology is related to the circadian rhythms of the body. A circadian rhythm is a roughly 24 hour cycle in the physiological process of people (and other living beings including animals, plants, and microorganisms). Circadian rhythms are created by the body itself but can be affected by external factors, such as sunlight, temperatures, and when one sleeps. They are a kind of internal clock that runs in the background of our brain, especially in our hypothalamus, and sets regular intervals cycles between wakefulness and sleepiness. These clocks can run a little differently in people, such as some people known as “morning larks”, having more energy early in the morning, and others, the “night owls” having more energy later at night.
The part of the hypothalamus most active in regulating the body is called the suprachaismatic nucleus (SCN), and the pancreatic beta-cell is one of the organs in the body that responds to the output from the SCN. As a result the beta cell is directed by the SCN to insulin secretion.
Working shifts are generally termed:
- Day–working morning for 8 hours to early evening
- Swing–working some morning into some evening, outside normal day hours, for eg: 3 pm-11 pm
- Graveyard–working late evening to early morning.
Humans are set up to work day hours and then sleep during the night/graveyard hours. Even if one is a lark or owl, in general, you are still following the basic human set up for waking and sleep. Throwing off that basic human internal clock is not healthy, and can have detrimental effects on developing or controlling diabetes.
In animal studies of animals who had a tendency to develop diabetes, disruption in their circadian rhythms, it was found they had elevated levels of glucose, accelerated loss of beta cell function, decreased beta cells mass and increase insulin resistance. In rats who were not prone to diabetes, sleep disregulation did not produce the same results. Thus, shift work negative effects might be most pronounced on those with a susceptibility of already developing diabetes.
We already know the circadian rhythm of two diabetes related hormones: cortisol and human growth hormone have a normal raise in the early morning, part of cause of the “dawn phenomenon.”
For people with diabetes, regular patterns of everything help glucose control–regular times of eating, injecting insulin or taking oral medications, exercising, sleeping. When these aspects of health are irregularly performed, trouble can come in regulating glucose and insulin levels.
Sleep is a key factor in this regard. Variations in sleep patterns can cause big problems in this regard. A “circadian misalignment” occurs when your own body clock is not naturally allowed to follow its course, usually due to working shifts that are not tuned to your sleep rhythm. The worst type of shift work is working rotating day/afternoon/night shifts, vs. instead of just always working graveyard, for example.
Extensive medical literature shows that shift work, especially the rotational type, increases insulin resistance, the risk of developing T2DM, and related metabolic syndrome conditions. It is also much harder to control glucose levels in those who already have diabetes. A large Dutch study showed that those with a median age <61 years old, and who had a circadian misalignment of more than two hours had a nearly twofold greater risk of metabolic syndrome, prediabetes and T2DM. This can affect men and women. In in very large Nurses Health Study of 177,000 women, those who worked rotating night shifts for 1-2 years increased their ris of developing diabetes by 5% over a 20-year follow-up period. Women who kept up night work for 10-19 years increased their risk by 40%. Working on and off at night for more than 20 years boosted the risk of diabetes by 60%.
With shift work also tends to come loss of sleep, as well. Loss of sleep can start producing a tendency to insulin resistance within days, and certainly by a few weeks of continual loss.
There are some ways to help people with diabetes on shift work:
- Try to not work rotating shift work, but have some sort of regular shift, either day, swing or night.
- Try to still eat three meals a day, without snacking. Higher fat and protein foods can last longer and make it easier to avoid snacking.
- Figure out a way to get good sleep–loss of sleep increases the appetite, especially for carbohydrates, and in and of itself harms glucose regulation. Don’t add lack of sleep to shift work.
- Continue your exercise regimen, even if it has to happen at odd times of day or night.
- Monitor your glucose levels regularly.
- Take your oral medicines on a regular schedule, to keep the effect steady in your system.
- If using insulin, work with your integrative physician to ensure you are dosing your basal correctly and covering meals so that glucose levels are on target. If on a pump, having two settings, waking and sleeping his helpful for basal dosing and switching from one to the other given your schedule may be helpful. With good direction from a physician who is an expert in diabetes and insulin, even rotating shift can be dealt with as best as possible.
Yes, You Must Floss
General Diabetes Information
T2DM is driven by inflammation. Inflammatory substances in the body directly increase insulin resistance at the cellular level. Abdominal fat, for example, is very active tissue and produces many different chemicals and hormones, such as TNF-alpha. TNF-a, also produced by inflammatory cells in the intestinal tract–that can be absorbed by the body and also lower insulin sensitivity–is an inflammatory molecule. Anywhere in the body where their is inflammation, glucose regulation will suffer.
The oral cavity counts, as well! If there is chronic inflammation in the mouth, it can also negatively affect glucose control. It is important for a physician to ask a diabetic patient, and for you to discuss with your medical practitioner, what your oral hygiene is like and if you have or ever had any diagnosed gum disease. Factors that may contribute to periodonal disease include poor oral hygiene, diabetes, smoking, aging, genetic disposition, systemic diseases, stress, poor nutrition, hormonal fluctuations, substance absuse and certain medications.
Here are the different stages of gum disease:
- Gingivitis: this is the mildest form of periodontal disease, when the gums become red, swollen and easily bleed. However, it’s generally not painful or causing much discomfort.
- Periodontitis: As gingivitis worsens, plague can spread below the gum line. The bacteria in the plaque can produces toxins that irritate the gums, causing an inflammatory response. As a result, the tissues and bone are broken down, and the inflammation can spread throughout the body. Gums can separate from the teeth forming pockets, than can easily become infected.
A study in Diabetologia reported that having periodonal disease was increased with uncontrolled diabetes, but when periodontal disease was eradicated, glucose control and the A1C significantly decreased. The study worked were two groups of T2DM patients who had periodontal disease; one group was treated for six months and the other was not. At the end of six months, those in the treatment group had significant improvement in all periodontal parameters that had been measured at the beginning. Even better, the treated T2DM patients lowered their A1C by 0.5% (control group has no lowering) and lowered their fasting blood sugar by 18.71 mg/dl, which is very substantial.
It is vitally necessary for a medical practitioner to ask any diabetic patient:
- How often do you brush your teeth each day? (At least twice is best)
- Do you use a regular or electric type brush? (Electric is better)
- How often do you floss? (1-2 times a day is best; using toothpicks/StimuDents at work when not brushing or using a Water Pik is also good)
- How often do you see your dentist (at least 2x/day is best).
- Do you oil pull? (A valid way to remove bacteria associated with gum disease–see previous LCDA newsletter–March 2017)
- Have you ever had any gingivitis or periodontitis?
Of course, any intake should ask about smoking and any good physician should investigate your diet and supplementation to check for nutrient deficiencies or inadequacies that are easily corrected.
There are supplements to help with gum health. Here are a few regularly used by integrative physicians that are based in good medical science, and check with your own practitioner to learn which ones you should take and at what dosage:
- BioAvailable folic acid (methyltetrahydrofolate): 1-5 mg a day Can help repair and maintain healthy periodontal tissue.
- CoQ10 (crystal free form): 100-200 mg/day CoQ10 has been studied as a valuable antioxidant to help heal damaged periodontal tissues.
- Xylitol: 6-10 grams a day Xylitol has been shown to be useful in reducing the strep mutans bacteria that causes cavities and gum disease in the mouth. You can chew gum (Pur Gum, eg), sucking on tasty sucking xylitol candies (Dr. John’s kosher sun-kissed candies, eg), or use xylitol in your cooking/baking, or add it to your food and beverages. It can also be helpful for dry mouth.
- Streptococcus Salivarius chewable probiotic: one chewable a day of 30 billion bacteria. This probiotic has been specifically shown to be a beneficial bacteria for the oral cavity, improving health of the teeth and gums, and reducing inflammation.
- Myrrh botanical: Among many herbs known to help with oral health, myrrh and a commonly prescribed herb. Using it as a swish in one’s mouth and then swallowing can be helpful for healing gums and oral tissues.
Abdominal Fat Physiology
General Diabetes Information
In reality, T2DM comes usually from abdominal fat, that is, extra weight around one’s middle. There are T2DM people who are lean or normal body weight, and usually they develop T2DM from eating a lot of sugar and fast food having a significant history of T2DM in the family, turning on their diabetes genes without excess weight gain.
However, for the vast majority of people with T2DM, that “apple” or “beer belly” figure is essentially where the diabetes oftentimes comes from. This type of fat is called abdominal fat, or visceral fat, as it is fat that surrounds organs in the body cavity.
Why is that? What is it about excess abdominal fat, causing a person to be overweight, obese or morbidly obese that causes insulin resistance and elevated glucose levels?
Historically, body fat was thought to be an inert substance, simply unused calories stored away for potential usage later if calorie needs were unmet based on activity. Insulin, known as the “fat building hormone” is designed to lead the body to store fat and glucose as fat in cells, and prevent their metabolic burning. For a long time we thought fat cells were just that–potential energy to burn.
Today, however, we know that fat is very active in our bodies, and that some of its actions lead decisively to an increased risk of developing diabetes.
First off, excess abdominal fat creates many chemicals, including inflammatory cytokines, and these are secreted into the bloodstream for movement throughout the body. Some of these inflammatory chemicals are TNF-a. Interleukin-6 (IL-6), resistin (, and macrophage chemoattractant protein-1 (MCP-1). Inflammatory chemicals are medically associated with preventing muscle and other cells in your body from recognizing insulin and thus absorping glucose from your bloodstream. As a result, you become insulin resistant and either pre-diabetic or diabetic.
These inflammatory factors are also associated with damaging blood vessels, increasing the risk of developing cardiovascular disease, which is the main reason of death in patients with T2DM diabetes.
Abdominal fat also produces leptin and adiponectin. Leptin was named from the Greek word Leptos, which means thin, because it is a hormone that inhibits hunger, and thus, a person would naturally eat less with its secretion. People who are overweight and obese lose the sensitivity to leptin, and thus can easily have bigger appetites causing over-eating to occur, with the resultant weight gain, which creates a cycle of further lack of response to leptin.
Abdominal fat also releases free fatty acids into the portal venous system, which are the blood vessels from the entire gastrointestinal tract that first go to the liver before entering the systemic body. This occurs overnight during sleep. When the liver is washed in the increased free fatty acids, it can develop fatty liver, the most common chronic liver disease in America today. The liver will also become insulin resistant, so that it is not signalled to stop producing glucose from glycogen and amino acids; it can thus over-produce glucose for hours during the night. This is one reason that the “dawn phenomenon” happens, that is, elevated glucose levels in the early morning hours.
Subcutaneous fat, which is directly located under your skin, can be another type of problematic fat. Subcutaneous fat can noticeably regenerate cortisol from cortisone using the 11 beta-hydroxysteroid dehydrogenase enzyme. Cortisol, usually made by the adrenals, signals the liver to product glucose and also also associated with being a risk factor for developing abdominal obesity. Having your own fat produce more cortisol is not helpful!
Last, excess fat in one’s body is also where you store the vast majority of environmental toxins. Fat is a storage for Persistent Organic Pollutants, the types of environmental chemicals scientifically associated with leading to insulin resistance, further weight gain, and diabetes (as well as neurological, allergic and auto-immune conditions).
All of these reasons are why you should work with your integrative physician to help lose your excess body fat in a slow, steady, safe and effective method. By doing that, you will be much less inflammed, reduce your risk of cardiovascular disease, reverse your T2DM, heal your fatty liver, and remove dangerous toxins from your body. Win-Win all around!
- The Diabetes Summit: Register here!
- Folic acid and Periodontal disease
- CoQ10 and Periodontal Disease
- Xylitol and Gum Disease
- Oral Probiotics for Dental Health
- S. Salivarius and Gum Disease
- Fat cells and inflammation
- Fat cells and environmental toxins
LOW CARB RECIPES
Recipe #1 | Keto Low Carb Gummy Bears
Low carb candy for those moments you just want to sneak one (or 25 of them!)!
* 0.3 oz packet of sugar free jello–any flavor you like
* 0.25 oz packet of powdered unflavored gelatin–Knox or similar
* 1/4-1/3 cup of water (see main text for quantities)
* Gummy bear plastic mold tray
* A little pipette dropper
If you order Gummy Bear mold on Amazon, it comes with the dropper.
1. Add the jello and water to a small saucepan. Place over a low heat and cook until all teh crystals have dissolved.
2. Remove from the heat and use the dropper to fill the plastic mold cavities
3. When all the cavities are complete, transfer the tray to the fridge for around 30 minutes until the bears are set.
4. Pop them out of the mold and enjoy!
Amount Per Serving: 25 gummy bears
* Calories: 20
* Protein: 3 gm
* Total Carbohydrates: 0.01 gm
* Dietary Fiber: 0.01 gm
* Net Carbs: 0 gm
Recipe #2 | Spaghetti Squash all’Arrabbiata
Ah, Italian food! You can have a nice, spicy dish of pasta, the low carb way!
Cook Time: 15 minutes
* 1 TBSP olive oil
* 4 oz chopped pancetta
* 1 tsp garlic paste or minced garlic
* 2 small fresh tomatoes, chopped
* 1/2 tsp onion powder
* 1/2 tsp red pepper flakes
* salt and pepper
* 1.5 lb cooked spaghetti squash shredded into strands (cook it anyway you wish)
* 1/2 cup shredded Parmesan cheese
1. Heat the olive oil in a large skillet and add the pancetta and garlic paste.
2. Cook until the fat on the pancetta has rendered, then add chopped fresh tomatoes, onion powder, red pepper flakes, salt and pepper. Cook for 5 minutes until the juice from the tomatoes has reduced.
3. Add the cooked spaghetti squash to the skillet, then turn to coat it in the tomato sauce. Add some shredded parmesan cheese, then serve.
4. Garnish with extra red pepper flakes.
Nutrition Information (large serving):
* Calories: 464
* Calories from Fat: 333
* Total Fat: 37 gm
* Protein: 17 gm
* Total Carbohydrates: 14 gm
* Dietary Fiber: 3.0 gm
* Net Carbs: 11 gm