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.

How Often Should You Get A Diabetic Eye Exam?

Diabetic retinopathy is a complicated scenario when essentially blood vessels are over-growing on the retina of the eye. (Poorly controlled diabetic patients are also at increased risk to develop other eye conditions: macula edema, cataract and glaucoma). The retina is where light is changed into vision, and the overgrowth, swelling and leaking of retinal blood vessels can obscure vision, leading to blindness over time. Nearly 30% of diabetic patients over 40 years old have some phase of diabetic retinopathy. In fact, diabetic retinopathy is the leading cause of blindness in adults in the US.

Diabetic eye damage occurs due to hyperglycemia, hypertension and hypercholesterolemia. However, all of those can be fully controlled following The Eight Essentials. That can prevent diabetic retinopathy and also help stablize it, and possibly reverse it, depending on the stage.

There are several stages: mild non-proliferative retinopathy whereby little aneurysms occur in the retinal blood vessels; moderator non-proliferative retinopathy where the blood vessels can become blocked; severe non-proliferative retinopathy where more vessels are blocked to the body begins growing new blood vessels, even over the cells where we see; and proliferative retinopathy, whereby the new blood vessels are developed, stimulated by Vascular Endothelial Growth Factor, a substance that promotes new blood vessel formation. However, those new blood vessels are fragile and abnormal and can bleed, causing vision loss and eventual blindness.

A diabetic eye exam uses drops to dilate the pupil so that a closer look at what is happening on the retina is possible. It takes about 2-4 hours for the pupils to reduce in size to normal shape. The retina and blood vessels are examined and photographs can be snapped. Sometimes a dye is injected into the eye and pictures are taken as the dye passes through retinal blood vessels.

Diabetic organizations usually recommend a yearly diabetic eye exam (or more frequent if damage is already visible).

A research group just proposed that in low risk well controlled diabetic patients, they only need to get an eye exam checking for diabetic retinopathy every 3-4 years, instead of annual exams. The researchers followed 1400 people with T1DM for nearly 30 years. The patients had photographs of their eye retinas every 6 months during the first 10 years, then every 4 years thereafter. A total of 24,000 retinopathy examinations occurred.

In this long study, changes in patients’ exam results were analyzed throughout the years to estimate the odds of progression to proliferative diabetic retinopathy, the worst and most damaging form of diabetic eye complications, unfortunately requiring laser treatments, injections to prevent the development of blindness.

As a result of their findings, the researchers suggest the following screening schedule according to a patient’s retinopathy state:

  • State 1–No retinopathy: Do diabetic eye exam every four years
  • State 2–Mild non-proliferatirve retinopathy: Do diabetic eye eam every three years
  • State 3–Moderate non-proliferative retinopathy: Do diabetic eye exam every 6 months
  • State 4–Severe non-proliferative retinopathy: Do diabetic eye exam every 3 months

Patients who are having elevated hemoglobin A1C levels, indicating worsening of glucose control should warrant more frequent screenings.

The researchers believe lowering the screening rates could reduce finanical outlays by $1 billion dollars over 20 years. However, the article was printed by the NEJM and the editorialists did not agree with these screening recommendations. They worry that the above screening schedule could lower the exams too much, perhaps missing early disease and treatment.

When picking up a diabetic complication the LDCA prefers to be more proactive, and getting an exam every four years seems a little too far apart. Although this is a separate exam a patient has to set up, and may need to pay some money for, even with insurance, since most people have high deductibles today, ensuring one’s eyes are in good health everyone would agree is vitally important. The LCDA still prefers more frequent exams, even in well controlled T1DM patients, and others who have historically had exams showing no damage is occurring. Whether yearly or every other year or longer, the LCDA suggests you check with your comprehensive medical practitioner to ensure your follow-ups are responsible, safe and proactive for you.

What if you do have some diabetic retinopathy? Read the next article to find out a comprehensive way to protect your eyes!

http://www.nejm.org/doi/full/10.1056/NEJMoa1612836?query=pfw&jwd=000012407954&jspc=GP

Treating Diabetic Retinopathy: Using The Eight Essentials

The best way to prevent diabetic retinopathy is to have excellent glucose control, with an A1C at or under 5.5% . This is significantly lower than the goals of the ADA or AACE (endocrinologists), and that is because in conventional care, lower A1Cs are usually occurring due to a lot of hypoglycemia, from overmedication of oral medicines or insulin. In comprehensive integrative care, low A1Cs are from following The Eight Essentials and reflect overall lower glucose levels as a general rule, not due to over-aggressive medication trying to lower higher carbohydrate diets.

Still, an A1C of 5.5% is something a diabetic patient has to work hard to achieve. But, lower glucose levels in the serum, means lower glucose levels in the eyes, and less diabetic damage occurring there as a result.

HOWEVER, it is vitally important for a patient with diabetes who is committing to a program based on The Eight Essentials to first get a diabetic eye exam before engaging in a comprehensive glucose lowering program. If the patient has no diabetic eye damage, then everything is fine and a full protocol can be immediately started. If a patient does have some diabetic damage, however, suddenly lowering glucose numbers can worsen the damage! This is called “Re-Entry Phenomenon”. When glucose numbers are suddenly normalized, insulin levels decrease and as a result Insulin Like Growth Factor-1 is increased. Insulin helps the fat and liver cells store glucose, but IGF-1 allows muscle cells to utilize more glucose. IGF-1 also produces angiogenesis, that is, the building of new blood vessels. If diabetic retinopathy is already occurring and new, abnormal, fragile vessels are growing in the retina, that process can be accelerated and lead to a bleed, causing a patient to develop blindness in one eye due to blood being mixed in with the vitreous humor, the normal gel like substance of our eyeballs.

Essential #1 — Eating a low carb whole foods diet–is the first place to start. Whether you wish your low carb diet to be omnivore low carb, plant-based low carb, vegetarian low carb, or ketogenic low carb can be decided in discussions with your comprehensive integrative medical practitioner. But, to lower glucose in the body and eyes, less carbohydrates need to be eaten and drunk.

Essential #2 Exercise — is a key way to help lower glucose, too! Engaging in a regular exercise regimen is a fantastic way to prevent diabetic eye disease.

Another key Essential to focus on is #7 — Supplements.

There are some key supplements to consider taking, with the approval and guidance of your physician:

  1. A good multiple and fish oil product to give all the nutrients, including antioxidants like Vitamins E/A/C, a body needs to function well.
  2. Benfotiamine: this fat soluble vitamin B1 has been shown to be protective against the development of diabetic retinopathy. Dosing from 150-450 mg/day is best.
  3. R-Alpha Lipoic Acid (not just regular ALA): This fat and water soluble antioxidant is a wonderful supplement for all diabetic patients to take at all times. Also has studies showing protective against diabetic retinopathy. 600-1200 mg/day is good.
  4. Bilberry or Blueberry–these berries, high in anthrocyanidins, also specifically act on the eyes and vision. Around 200 mg/day is good.

If a new patient already has some diabetic retinopathy an extra supplement regimen should be begun adding in:

  1. Taurine–an amino acid found in high levels in the eyes. 1000-3000 mg/day
  2. N-Acetyl-Cysteine–an antioxidant that can protect the eyes 600-24000 mg/day
  3. Lutein–another bioflavionoid specific to eye tissue (can also add zeaxanthin). 10-40 mg/day

It can all come together well for a patient with diabetes. Lowering glucose can be done safely and responsibly and can help prevent, stabilize, and help reverse diabetic retinopathy. Following a specific protocol under medical guidance is what the LCDA strongly recommends.

Periodic Exams For Diabetic Patients

There are other regular exams and assessments to consider doing regularly in diabetes. Keep an eye open to see if your medical practitioner is being careful to do these evaluations.

Basic physical exams for people with diabetes that should be done regularly include: weight, thyroid exam, injection/infusion site assessment, and a visual and monofilament foot exam.

Other things to evaluate in an office visit your medical practitioner asking about hypoglycemia occurrences, screening for depression, checking in about alcohol/tobacco/drug use, enquiring gently about sexual issues/contraception, digestive questions screening for Celiac Disease, food allergies and leaky gut, and diabetes self management skills.

Doing a diet diary recording food eaten for several days, glucose levels throughout the day (before and after meals and at bedtime), and insulin dosages taken (if used) helps the medical practitioner understand the interaction between food, glucose, and medication, which set the foundation of diabetes control.

Blood tests should be done regularly (though individualized for each patient):

  1. Every three months: Fasting glucose, A1C, Glycomark, and Lipids. Once lipids, glucose and A1c are in good range, they can be measured every 6-12 months.
  2. Annually: Complete blood panel, Comprehensive Metabolic Panel checking liver, kidney, white and red blood cells, electrolytes, and ferritin (a way to see if a T2DM has fatty liver).
  3. As needed—at least once per year, and more often if problematic: Vitamin D3, thyroid panel (TSH, free T3, free T4, reverse T3, and antithyroid antibodies); celiac antibody panel (done once in type 1 diabetes, and then as-needed dependent on symptom presentation).

Since poorly controlled patients with diabetes have a high risk of developing cardiovascular disease, it’s important to analyze cardiovascular risks. That includes checking blood pressure; total, HDL (good) & LDL (bad) cholesterol, and triglycerides. However, medicine is realizing that cholesterol tests are less useful given their poor accuracy of predicting cardiovascular risk, and realizing the fact that the majority of people experiencing heart attacks have normal cholesterol levels.

Thus seek out a medical practitioner who can and will investigate other blood tests to assess your cardiovascular risk in much depth. There are specialty labs that do very comprehensive panels which really delve into multiple cardiovascular risk factors. These factors include genetic risks, such as APOE gene; more pertinent cholesterol analyses using lipoprotein(a), LDL-P (particle number), apolipoprotein B; inflammation markers, such as hsCRP and Myeloperoxidase; clotting risk measuring fibrinogen; measurement of essential fatty acids in body cells; and many more etc. Insurances cover these panels unless you have Medicare, which unfortunately does not.

The determination if further, non-blood related tests are applicable to you must be determined via a discussion with your doctor, or a cardiologist, given your individual characteristics and risk factors. These tests include: a treadmill stress test, a coronary artery calcium score, calcium density study, and/or a CT angiography of the coronary arteries (to check for blockage).

There are also four cardiovascular risk calculators that can be used to gauge cardiovascular disease risk over the next ten years:

  1. Framingham Risk Assessment Tool: https://www.framinghamheartstudy.org/risk-functions/coronary-heart-disease/hard-10-year-risk.php
  2. Multi-Ethnic Study of Atherosclerosis 10-year tool: https://www.mesa-nhlbi.org/MESACHDRisk/MesaRiskScore/RiskScore.Aspx
  3. Reynold’s Risk Score: http://www.reynoldsriskscore.org
  4. United Kingdom Prospective Diabetes Score (for patients with Type 2 Diabetes): https://www.dtu.ox.ac.uk/riskengine/

Urine tests need to be done at least yearly to exam kidney function, checking to see if any diabetic nephropathy, or damage to the kidney is occurring. These tests include: random microalbumin, creatinine clearance, urine albumin-to-creatinine ratio, and estimated glomerular filtration rate (GFR).

Last, once someone has one auto-immune condition, such as Type 1 diabetes (Type 2 is not auto-immune), there is a higher chance for having another auto-immune condition. The most common ones associated with Type 1 are auto-immune thyroiditis, called Hashimoto’s; celiac disease, which is an auto-immune reaction against gluten thus gluten must be eliminated from the diet; Addison’s disease, a destruction of the cells that produce cortisol in the adrenals; and inflammatory bowel disease. Thus periodic assessment of other auto-immune conditions may be warranted in type 1 patients.

The good news is that a well controlled diabetic patient following The Eight Essentials has less chance of having cardiovascular disease or complications develop.

RESOURCE GUIDE

Books:

  1. The Stress Relaxation and Stress Reduction Workbook by Martha Davis and Elizabeth Robbins Eshelman.
  2. Less Toxic Living: How to Reduce Your Everyday Exposure to Toxic Chemicals–An Introduction for Families by Kirsten McCulloch and Joanna Cozens
  3. America’s Great Hiking Trails by Karen Berger and Bart Smith

Sulfonyureas and Cardiovascular Disease Risk

For decades now Sulfonylurea oral hypoglycemic medications have been a standard drug used to help lower glucose in T2DM patients. Typically given after Metformin, if Metformin alone was not effective, Sulfonylureas force the pancreas to secrete more insulin. Considering that the main condition of T2DM is elevated insulin due to insulin resistance, adding even more insulin into the body does lower glucose levels, but also causes weight gain and water retention. Since losing weight can totally reverse T2DM, gaining weight, and not being able to lose it easily, from your medication is a significantly negative side effect. Sulfonylureas are also a drug that has a high risk of causing hypoglycemia reactions.

Sulfonylureas go under these names: Glyburide (Diabeta, Micronase, and Glynase), Glimeperide (Amaryl), and Glipizide (Glucotrol and Glucotrol XL). The medications are inexpensive, as they are all available in generic forms. They are taken once or twice a day.

In the ADOPT study done years ago, Glyburide was one of three drugs used in monotherapy treatment of T2DM against two other agents in different drug categories. At the end of the multi-year study, the conclusion showed that Glyburide had the least effect at lowering A1C, the most treatment failure (when fasting glucose went above 180 mg/dL), and stopped being effective sooner than the other medications. After 4 years, the least amount of patients in the Glyburide group had an A1C less than 7%. In a more recent analysis of six studies that did not show any major bias clearly five out of six indicated that being on a sulfonylurea increased the risk of developing cardiovascular disease and mortality. Considering that poorly controlled diabetes already increases the risk of cardiovascular disease, having one’s medication also lead to that devastating consequence is hardly encouraging.

For patients paying for medications out of pocket, Sulphonylureas can be very helpful, as they can be on $5 pharmacy lists, and at least temporarily they can lower glucose levels. However, overall, these are problematic medications with a growing knowledge of long-term serious risk of complications. Instead, committing to a protocol based on The Eight Essentials, it’s likely that being able to stop taking them, or avoid ever having to go on them, is highly likely and even probable. If you are on a sulphonylurea, consider going full speed onto a comprehensive integrative program for even a month, to see how amazingly your glucose can lower. Board members on the LCDA have seen many patients be able to stop using their Sulphonylureas as a result of a commitment to good integrative medicine.

http://www.nejm.org/doi/full/10.1056/NEJMoa066224#t=article
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(98)07019-6/fulltext

LOW CARB RECIPES:

Recipe #1 | The Best Keto Bread

Avoiding grains doesn’t mean avoiding bread or rolls! Here are a couple of great recipes for these made from nut flour, coconut and psyllium seed.

Bread: 20 slices per loaf

Ingredients:

* 1.5 cups of almond flour
* 6 large eggs, separated
* 4 TBSP butter, melted
* 3 tsp baking powder
*1/4 tsp cream of tartar (though will work without this)
* 1 pinch of salt

Directions:

1. Preheat oven to 375F

2. Separate the egg whites from the yolks. Add Cream of Tartar to the whites and beat until soft peaks are achieved.

3. In a food processor combine the eggs yolks, butter, almond flour, baking powder and salt. Mix until combined. This will be a lumpy thick dough until the whites are added. Combine in two parts to ensure thorough mixing.

4. Add 1/3 of the beaten egg whites to the almond flour mixtures and process until mixed.

5. Add the remaining 2/3 of the egg whites and gently process until fully incorporated. Be careful not to overmix as this is what gives the bread its volume.

6. Pour the mixture into a buttered 8 x 4 loaf pan. Bake for 30 minutes. Check with a toothpick to ensure the bread is cooked through. Enjoy!

Calories: 90 kcal
Fat: 8 g.
Carbs: 2.25 g
Fiber: 0.9 g
Protein: 4 g
Net carbs: 1.35 g

Recipe #2 | Low Carb Keto Dinner Rolls

Roll: 10 rolls per recipe

Ingredients:

* 1/2 cup Coconut flour
* 2 TBSP Psyllium husk powder
* 1/2 tsp Baking powder
* 1/4 tsp Salt
* 3/4 cup Water
* 4 large eggs
* 4 TSBP Butter

Directions:

1. Start by combining all of the dry ingredients (coconut flour, psyllium husk powder, baking powder, salt) and mixing thoroughly.

2. In a sparate bowl start beating the eggs iwth a hand mixer. Add in melted butter and water and continue to mix until combined.

3. Pour the dry ingredients into the wet and continue mixing until the dough becomes thick and well mixed. For the desired consistency see the video at the URL listed above.

4. Form into 10 dinner rolls and place on a greased baking sheet or silicon baking mat. Larger rolls can be made if desired, just add on a few more minutes to the baking time.

5. Bake for 30-35 minutes at 350F. Enjoy!

Calories: 102
Fat: 7 g
Carbs: 5.8 g
Fiber: 4.5 g
Protein: 3 g
Net carbs: 1.3 g

Recipe #3 | Low Carb Pancakes

Serves one “Big Man”–probably two servings for the rest of us!

Ingredients For Pancakes:
* 3 TBSP coconut flour
* 1-2 TBSP healthy sweetener: Stevia, Monk Fruit, Xylitol, Chicory, Combination Product
* Pinch of baking powder
* Pinch of sea salt
* 2 large egg whites
* 1 TBSP mashed pumpkin
* 1/4-1/2 cup unsweetened dairy free milk (you may need more)
* 1/2 tsp of vanilla extract

Ingredients for Coconut butter vanilla glaze:
* 1 TBSP coconut butter
* 2 TBSP unsweetened dairy free milk
* 1 TBSP healthy sweetener
* 1/2 tsp vanilla extract

Directions:

1. In a large mixing bowl, sift the coconut flour, sweetener, sea salt and baking powder to avoid clumps. Mix well to combine.

2. In a small bowl, whisk the egg whites very well (can be until stiff peaks form–This makes them even more fluffier that pictured!) or flax egg with the vanilla extract. Add to the dry mixture, along with the mashed pumpkin. Using a tablespoon at a time, add dairy free milk until a thick batter is formed (you may need more than 1/4-1/2 cup). Mix lightly, but do not over mix.

3. Spray a pan with cooking spray and heat on low/medium. Once pan is hot, pour batter using a 1/4 cup at a time. Cook pancakes for 2-3 minutes or until the edges brown, before flipping very gently and cooking for an extra minute or two, until cooked through. Repeat until all the pancakes are cooked. For best results cover pancakes while they cook.

4. To make the coconut butter glaze, whisk all the ingredients in a small bowl and top pancakes.

(The LCDA apologizes for not having found net carbs per pancake for this recipe)

 

Company Donation

A BIG THANK YOU TO AEGIS INSURANCE COMPANY FOR A VERY NICE DONATION TO THE LCDA! AEGIS is a malpratice insurane company that serves naturopathic physicians, MDs, DOs, chiropractors with excellent coverage, excellent service and lower prices. Please contact Lyle Cheeney if you would like a malpractice review at http://aegisnd.com/about-aegis/lyle-cheeney. And, please contact Dr. Morstein at [email protected] if you wish to give a tax deductiable donation to the LCDA!