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:
“Good health and good sense are two of life’s greatest blessings.”
~ Publilius Syrus
Dr. Morstein just recorded Dr. Joseph Pizzorno, a leading naturopathic physician, researcher, lecturer and author. Dr. PIzzorno was chosen by Presidents Clinton and Bush to serve on commissions discussing bringing integrative care into mainstream medicine. He is the author of the newly released book The Toxin Syndrome, and gives an amazing interview on environmental toxins, what they are, how they can cause diabetes, and how one can make choices to reduce both one’s exposure and help one’s detoxification.
You’ll find the interview up for members only under Essential #6 — Environmental Detoxification.
What Causes Cardiovascular Disease?
Cardiovascular disease is a huge crisis in the US today. About 610,000 people die of heart diseasse in the US each year; that is one of every four deaths. Around the world, around 17.7 million people died of heart disease in 2015, representing 31% of all global deaths. For diabetic patients, 68% of diabetic patients die of heart disease and another 16% die of strokes.
The paradigm view of cardiovascular disease has relied upon demonizing cholesterol for many decades. High cholesterol, High LDL cholesterol, these have been the guide-posts for treatment. Unfortunately, the American Heart Disease and the American Diabetes Association have both grabbed hold of those views and promote the use of statins. The ADA, as noted a couple of newsletters ago, recommends that every single Type 2 diabetic patient be put on a statin drug. Physicians who see diabetic patients and do not do so receive notifications from pharmacies, reminding them to prescribe it to their patients.
Since poorly controlled diabetic patients die mostly from cardiovascular disease, both heart attacks and strokes, this is very important for everyone who is either a diabetic patient, or who cares for one, or who is a medical practitioner treating diabetes, to really understand.
The fact is more and more science is being presented that is totally undermining the thin foundation that cholesterol is the key in cardiovascular disease.
In a recent article in The Pharmaceutical Journal, a British journal there was an article that stated facts that the LCDA hopes will truly turn heads in the US and around the world. The article is: The cholesterol and calories hypotheses are both dead–it is time to focus on the real culprit: insulin resistance. You can read it here.
In this article, written by a resounding cardiologist Dr. Aseem Malhotra, and professors Robert H Lustig and Maryanne Demasi, states that the value of statins drugs–now prescribed for so many people and conditions, including pediatric patients–is being questioned for effectiveness and need by many medical authorities. The authors state that the benefits for statins are over-exaggerated and the risks for taking them are consistently under-emphasized.
Quick review on cholesterol:
Cholesterol is a waxy substance produced in everyone’s liver and also eaten in animal foods. Cholesterol is the core of all hormones made in the body.
LDL-Cholesterol–LDL is a protein that takes cholesterol from the liver to the bloodstream, so too much of it is “bad,” associated with elevating the amount of cholesterol in the blood and risking the development of atherosclerotic plaques (clots in the blood vessels that can shut off blood flow).
HDL-Cholesterol–HDL is a protein that takes cholesterol from the bloodstream back to the liver for processing, thus lowering blood levels. That is why it is considered “good” cholesterol.
The authors use medical studies to support their view against the use of statin drugs: there are forty-four randomized controlled trials (RCTs–a good though not the best type of medical study), using drug or dietary interventions to lower LDL-C before or after people had a cardiovascular “event” (that is, heart attack or stroke). In none of those studies was there a benefit to people having less cardiovascular events or dying less from them. Another study called ACCELERATE, which was the very best and highly respected kind of study medicine can perform, did not show any reduction in cardac events or death even though LDL-cholesterol was reduced 130%. And, in general, even though in Western countries many people are put on statins, there does not seem to be any reduction overall in deaths from cardiac disease.
The authors also discuss the new drug that got a lot of media press: evolocumab (Repatha, a PCSK-9 inhibitor). PCSK-9 genes reduce the number of LDL receptors in the liver. These PCSK-9 inhibitor drugs help prevent that from happening so there are more LDL receptors in the liver, thus enhancing the liver’s breakdown of the LDL. Unfortunately, in studies, taking a PCSK-9 drug did not help anyone live longer.
In fact, a Mediterranean diet study, called the Lyon Diet Heart Study, showed that was a clear reduction in heart attacks and deaths eating a healthy diet, even though the LDL-cholesterol levels did not lower.
So, if lowering LDL-C is not helpful, then what can physicians do to help patients not have cardiovascular events, and even more so, not die from them? The authors write “It is an ethical and moral imperative that the true benefits and potential harms of these drugs are discussed to protect patients.”
The authors clearly state that insulin resistance is the key driver of risk of cardiovascular disease. Insulin resistance means that body cells do not listen to insulin and do not obey the signals it is supposed to produce–remove glucose from the bloodstream. Insulin resistance is a primary reason people develop high blood pressure, dyslipidemia, fatty liver disease, and Type 2 diabetes. They go on to show that in one study up to 69^ of paitents who were hospitalized for acute heart attacks had insulin resistance, and it was the insulin resistance that was shown to increase the risk of death and readmission over the next year. They believe that if insulin resistance was treated and reversed in young adults, there would be 42% less heart attacks.
The authors discuss best ways to reduce/reverse insulin resistance and it is in excellent alignment with the LCDA mindset. It is not based on medications but on changing dietary habits:
- Low carbohydrate diets (eating more fat as a result)
- More anti-inflammatory, anti-insulin resistant Omega-3 oils, and less pro-inflammatory Omega-6 vegetable oils.
- Any exercise, minimal or vigorous: even a brisk walk for 30 minutes more than 3x/week can reverse insulin resistance. One study showed that just 15 minutes of moderate-intensity exercise per can can increase life by three years.
This essay ends with a powerhouse statement: “Instead of funneling billions to drug research and development, perhaps more of that money could be spent encouraging the implementation of policy directives that encourage populations-wide behavioural change.”
This article best represents what the LCDA is all about! Using The Eight Essentials®, the LCDA is leading the way for societal diet and lifestyle changes. One hopes the age of statins soon ends and the age of The Eight Essentials® begins! Through those all T2DM can put insulin resistance into remission and as a result significantly reduce their risk of cardiovascular disease.
See Resources below for link to Dr. Malhotra’s new book:
Diet Drinks Increase Dementia
Essential #1: Low Carb Whole Foods Diet
Fresh, clean water is the premier beverage, and should be the focus of most liquid intake. People should on average drink about half their body weight per day in water; that is, if you weigh 150 lbs, you would drink 75 oz, or a little over two quarts. Of course, if you sweat a lot with work, or working out, you may need to drink more.
Nonetheless, it is typical that people wish for a little more variety and flavor in their drinks than solely sticking with water.
Yet a new study in Stroke, Diet Drinks Linked To Increased Stroke and Dementia Risk, published 4/20/17, showed a concern in choosing whatever a person might wish to drink. This article reviews an observational study that showed people drinking one or more cans of an artificially sweetened diet soda each day was associated with a three times increased risk for stroke, all cause and Alzheimer-related dementia over a 10-year follow-up period, compared to those who drink no diet soda pop. For those who only drank one to six cans a week, that intake was associated with an increase incidence of stroke, but not dementia.
In another study, Sugary beverage intake and preclinical Alzheimer’s disease in the community, however, the greater consumption of sugary drinks–that is drinking 1 or more drinks–either soda pop and/or fruit juices, were shown to lower brain volume, poorer episodic memory, early indicators of the possibility of developing Alzheimer’s Disease.
Although these studies are not clearly showing that drinking sugary sodas or artificially sweetened sodas are firmly increasing the risk of developing dementia and Alzheimer’s, experts do believe it should sound a warning bell. Dr. Keith Fargo, director of scientific programs and outreach at the Alzheimer’s Association, said, “Of the two papers, it is easier to grasp that high sugar intake is not doing good things to the brain, but there is growing evidence in the lieterature that diet drinks are not necessarily a panacea that some once might have believed them to be…It’s a better idea to skip both and just drink water.”
Dr. Heike Wersching, MD at the University of Munster, Germany, and two others, wrote an editorial on the study in Stroke. Although they stated that although such observational studies are not wholly clear to interpret, more studies seem indicated. He added, “Both sugar-sweetened and artifically sweetened soft drinks may be hard on the brain.”
Considering patients with uncontrolled diabetes have an increased risk of developing dementia and Alzheimer’s disease it seems that choosing one’s beverage is an easy way to at least not promote poor control (sugary drinks) and/or possibly increase the risk overall (diet drinks).
The LCDA recommends many beverages for patients with diabetes: WATER, herbal teas, green tea, black tea, carbonated water, unsweetened alternative milks, smoothies, unsweetened chocolate milk drinks, coffee, coffee substitutes (Pero, Cafix, Teecino), green veggie drinks, alternative soda pops sweetened with stevia and erythritol, wine and hard liquor (of course, only for adults!).
By following the guidelines of the LCDA and having excellent control of diabetes, losing weight and becoming less inflammatory, and avoiding diet soda pops and patient may indeed significantly reduce their risk of developing dementia
Yoga and Diabetes
Essentials #2 and 4: Exercise and Stress Management
Yoga is a very old practice from India, originally formulated, it is believed, by the Indian sage Patanjali, around 2,000 years ago. Originally consisting of eight “limbs”–restraints, observances, postures, breathing, weithdrawal of senses, cocentration, meditation and absorption, today in the US, yoga mostly focuses on the third limb, postures. These varifying postures are designed to purify the body and develop its physical strength and stamina to allow the person to engage in long periods of meditation. However, all yoga guides the practitioner to coordinate breath, mind and body to promote deep breathing, relaxation, and the feeling of inner peace.
Another yoga term “Hatha” means forceful/willful, and is designed to help your body align the skin, muscles and bones. It is especially helpful to align the spine so the body’s energy can flow easily through it. In another interpretation of the word meaning both sun and moon, male and female, hatha yoga can help people create balance and unite opposites. For example, it can help develop both strength and flexibility, effort of striving to attain the pose and one’s surrender into it.
Yoga can be practiced generally an hour or hour an a half one or more times a week. There are many yoga studios and gyms where yoga is taught and there are also courses on-line or on DVDs for home self study.
How does yoga relate to diabetes?
Medically, yoga can be advantageous for people with diabetes in two clear ways. One, it is considered a type of exercise and will help burn glucose and calories. In that way it can help attain and maintain good glucose control. Yoga is also a good way to reduce stress. The emotion of “stress” has physical effects in the body; in particular, an adrenal hormone called cortisol is secreted (and if one is very stressed, epinephrine can also be secreted, as well). These hormones are designed to elevate blood sugar to allow one to “fight or flight,” such going back a million years or so, that is what stress oftentimes meant–evading death at the hands of animals or other humans. Today, we can have the same reaction driving on a crowded freeway, or being in a long, slow moving line, or getting a letter from the IRS, or having an unpleasant work place, or having a teen-ager act out regularly, and so forth. Whenever one feels “stressed” one is producing stress hormones and raising one’s glucose levels.
Yoga has been studied showing it can help reduce stress, prevent one from feeling stressed as easily as one did before, can lower blood pressure, blood sugars and improve overall wellbeing. Thus, less cortisol and epinephrine are secreted. While not wholly as cardiovascularly beneficial as a long hike, or as strength intense as lifting weights, yoga improves flexibility, agility and balance, all key components to a complete picture of good health. In older patients, that can also mean less chance of falling and suffering a bone fracture.
There is a good review of studies of yoga in patients with diabetes, “Yoga–a potential solution for diabetes and metabolic syndrom,” published in 2015. (click in article link below). Yoga has been shown to reduce anxiety and depression, enhance sleep, improve concentration and focus, increase energy, and improve the functioning of many different body systems and organs. In studies, yoga has been shown to reduce fasting glucose and A1C values. It has reduced BMIs, improved nerve functioning, fasting insulin, and led to weight loss.
Considering how easy it is for any person at any age to do yoga, and the many places and ways it can be studied, adding yoga into one’s week seems sensible, practical and therapeutic. The LCDA recommends diabetic patients investigate adding yoga therapy into their lives, to help reduce their weight, their glucose and A1C numbers, and to help feel less stressed in what can be considered a very stressful world.
Best Two Drugs For T2DM Patients
Although the LCDA strives to have T2DM patients control their glucose numbers with the first seven Essentials®, many patients for some time may indeed need to be on medication for treatment support. If that is the case, what are the best medications for a T2DM to be prescribed?
These are the medicinal categories of drugs used in T2DM patients:
- Biguanides–Metformin is the only drug used: reduces liver glucose support and slightly lowers insulin resistance. Can upset the stomach in many patients, but no other side-effect.
- Sulfonylureas–Glyburide, Glipizide, Glimiperide: These force the pancreas to secrete more insulin. Can cause hypoglycemia, weight gain and pancreatic burnout.
- DPP-IV inhibitors–Sitagliptin, Saxagliptin, Linagliptin, Alogliptin: Prevent the breakdown of GLP-1 hormone which lowers glucagon, increases insulin, slows gastric emptying, and reduces the appetite. These medications barely lower the A1C, so very ineffective.
- Thiazolidinediones (TZD)–Pioglitazone, Rosiglitazone: These did lower insulin resistance, but are so rarely used due to dangers associated with them, they are basically off the market.
- Meglitinides–Netaglinide, Repaglinide: Short acting pancreatic insulin secretors. Same side-effects as the longer acting Sulfonylureas.
- Alpha glucosidase inhibitors–Acarbose and Miglitol: Never used by anyone. They prevent absorption of carbohydrates, causing intense and chronic gut symptoms and liver disease.
- Sodium-Glucose Transporter 2 Inhibitors–Canagliflozin, Dapagliflozin, Empagliflozin: These prevent the kidneys from absorbing glucose back into the bloodstream. Can cause many serious side-effects, including diabetic ketoacidosis (yes, in T2DM patients), genital fungal infections, dehydration and low blood pressure episodes. It is unknown if they cause long-term damage to the kidneys.
- Glucagon Like Peptide-1 injection–Exenatide, Liraglutide, Albiglutide, Dulaglitide: Actions listed in DPP-IV category. Side effects include nausea and a good patient intake/history and family history can help decide if this category is safe for an individual.
- Basal insulin–Lantus, Levermir, Toujeo, Degludec, U-500, NPH
- Rapid insulin–Humalog, Novolog, Apidra
Please notice that out of all the medications listed above, only Metformin (a little) and the TZDs (off the market) deal with the actual cause of T2DM: insulin resistance. None of the other medications are designed to reduce the etiological reason people have the condition they are being treated for!
In general, Metformin is the first medication used in all T2DM patients because it is extremely inexpensive; it is on the $5 list for many pharmacies. It does not cause weight gain or hypoglycemia, and has a gentle action in helping to lower glucose numbers. But, what if Metformin is not enough medication on its own to really lower glucose and the A1C? If another medication is required, which is the best one to next use? The ADA no longer specifically recommends a treatment pathway, and leaves succeeding medication after Metformin up to the individual prescriber.
Historically, a Sulfonylurea drug was used next, as it is also very inexpensive. However, these drugs are very problematic. T2DM is due to insulin resistance, because although the pancreas is secreting plenty of insulin the body is no longer listening to it; although, in conventional care, the idea is the pancreas is failing because it cannot continue to produce enough extra insulin to overcome the cellular resistance. (And, over time, if diabetic control is poor enough for long enough, the T2DM pancreas really can suffer such significant oxidative damage, it does lose the capacity to produce enough insulin and the patient requires insulin therapy.)
So, what happens when Sulfonylureas force the pancreas to produce even more insulin? Patients have a high risk of low glucose episodes, they gain weight from the additional insulin in their system, and their pancreas can burnout–that is, it can squeeze out insulin to such an extent is just stops producing any more. Since weight loss can put a T2DM patient into remission, adding more weight from the diabetic drug they are taking is really a bad idea!
DPP-IV inhibitors really don’t do much for diabetic patients and patients would rather at least take a one a day Sulfonylurea than a Metiglinide before each meal. No one wants to use the Alpha glucosidase inhibitors and have terrible flatulence all day long instead of higher glucose numbers! The TZDS wound up being associated with life-threatening side effects to the extent no physician feels comfortable prescribing them.
So, out of all those drug categories, what is left?
In an article in Practical Diabetology journal, a supplement magazine to Diabetes Self-Management, Sept/Oct 2017 edition, Dr. David Bell (Professor of Medicine) and Dr. Edison Goncalves (MD) discussed this topic. Their assessment is that GLP-1 injections and SGLT-2 Inhibitors are the best drugs for T2DM patients, with or without Metformin.
GLP-1 hormones can lower appetite and body weight, and, lowering body weight means more chance of reversing T2DM. These shots are given either twice a day, once a day or once a week. They are expensive if your insurance doesn’t cover them, around $230/month. The LCDA doesn’t mind these medications at all, if a diabetic patient needs to be prescribed a drug. Dr. Bell reports on several studies where patients used a combination of the GLP-1 Liraglutide with the SGLT-2 Inhibitor Canagliflozin: these patients had significant weight loss, A1C drop from 9.1 to 7.0, and they were able to discontinue their insulin injections. In another study, the same results occurred as well as a reduction in systolic blood pressure.
While the LCDA believes everyone can be empowered to make positive changes and follow The Eight Essentials®, that takes finding an integrative physician and slowly working a comprehensive program to achieve the desired results of getting one’s diabetes under superb control. In the meantime, medications may be needed for T2DM patients. Discussing the best medications to take, and the best combinations to be prescribed is vitally important for all T2DM patients. Starting with Metformin will always make sense, and if other medications seem necessary, considering adding in a GLP-1 injection is a good next start, especially if weight loss needs to occur.
The LCDA is much more wary about SGLT-2 inhibitors, given some real concerns of the possible side-effects listed above, although reports are showing that combination may be very helpful. In the end, each patient should seek guidance from their comprehensive integrative medical practitioner on which medications to use if they are deemed necessary.
- The Toxic Syndrome by Dr. Joseph Pizzorno
- The Encyclopedia of Natural Medicine by Dr. Joseph Pizzorno
- Google “Yoga Online” for a list of on-line yoga classes one can do at home; and, “Yoga Studios (with your zip code) to find out local studios you can practice in.
- Rachel Zinman, a Type 1 diabetic who teaches yoga, (Interviewed on the LCDA website) has a great website: https://yogafordiabetesblog.com/author/rachelzinmanyoga/
LOW CARB RECIPES
* 6 skinless boneless chicken thighs, excess fat removed
* 6 oz jar marinated artichoke hearts
* 1 clove garlic, crushed
* 1 tsp oregano
* salt and fresh pepper
* 1/4 cup feta cheese
* 2 tbsp fresh chopped parsley
* lemon juice, optional
1. Combine artichoke hearts along with liquid and chicken and let it marinade about 20 minutes.
2. After it’s marinated, drain all liquid.
3. Add garlic, oregano, salt and pepper.
4. Broil on low about 6 inches from the flame for about 10 minutes or until golden brown, turn chicken and cook an additional
8-10 minutes and chicken is fully cooked.
5. Top chicken with feta and broil an additional minute.
6. Remove from oven and top with fresh parsley. Squeeze with lemon juice, if desired!
Yield: 3 servings
Serving Size: 2 medium thigh with artichokes
Amount Per Serving:
* Calories: 215
* Total Fat: 6 g
* Protein: 31 g
* Carbohydrates: 8 g
* Fiber: 3 g
* Total Carbs: 5 g
Recipe #2 | Zucchini Tots
Getting your family to eat their veggies can often be difficult. Well these kid-friendly zucchini tots are the perfect solution! They make a great side for breakfast or dinner!
* cooking spray
* 1 packed cup grated zucchini
* 1 large egg
* 1/4 medium onion, minced
* 1/4 cup grated reduced fat sharp cheddar cheese
* 1/3 cup almond meal (instead of bread crumbs)
* 1/4 tsp kosher salt and black pepper to taste
1. Preheat oven to 400°F. Spray a baking sheet with cooking spray.
2. Grate the zucchini into a clean dish towel until you have 1 packed cup. Wring all of the excess water out of the zucchini, there will be a lot of water. In a medium bowl, combine all of the ingredients and season with salt and pepper to taste.
3. Spoon 1 tablespoon of mixture in your hands and roll into small ovals. Place on the cookie sheet and bake for 16 to 18 minutes, turning halfway though cooking until golden. Makes 16.
Yield: 3 servings
Serving Size: 5 tots
Amount Per Serving:
* Calories: 178
* Protein: 10 g
* Carbohydrates: 3.5 g
* Fiber: 1.5 g
* Total Carbs: 2 g