President Obama's comments about a visit to the doctor where the course of treatment is dictated by insurance reimbursement raises some serious issues and illustrates some misconceptions about health care delivery.
For my patients I hope it goes without saying that I do not decide a course of treatment by consulting insurance reimbursements. I suspect that most doctors do not do this either. But, having said this it is clear that health insurance does distort the health care market by distorting the relationships between price and cost as well as supply and demand.
One of the worst effects of health insurance is that it causes people to demand hundreds of dollars of service while only wanting to pay pennies on the dollar for this care. In virtually no other area of our economic life does this presumption exist. Think about it. If you take your car to get gas or an oil change you look upon this as routine service for your car and would not expect car insurance to cover the cost. Because car insurance doesn't cover the cost the market is able to operate here and the vast majority of people are able to purchase gas and oil changes at reasonable rates while the companies which provide these services are able to make a profit doing so. What most people demand of car insurance is catastrophic coverage. Because insurance is mainly used for this purpose it is reasonably affordable for most people. But, since this is not how health insurance works it is in most cases more expensive.
What would be so bad about altering health insurance to more closely resemble car insurance? At the very least we could have an option where health insurance is used to cover major medical problems while individuals pay for routine health care. You might respond that this would be too expensive since the cost of a doctor's visit is too expensive. But, in a free market doctors could only charge prices that the market would bear. This would be the case for all health care services not covered by insurance. Doctors or companies which tried to charge more would lose patients who would vote with their pocketbook by going elsewhere.
Another benefit of this approach would be to alter the culture of payment that now seems to exist now in health care. Think about it. Would you go to the grocery, load your cart up with groceries and expect to leave the store without paying? Would you take your car to have the oil changed and expect to drive away without paying? Of course not! But, some patients seem to expect to be able to go to the doctor's office, avail themselves of services and leave without paying their bill! I think much of this would change if doctors could state up front what their fees for services were (as do most other service providers in the economy) and be able to collect these fees when services are rendered. In other words, operate without the burden of insurance. What to do about patients who truly cannot pay? Most doctors are willing to work with people on a case by case basis. Solving this problem does not entail a wholesale overhaul of the health care system. And no, I won't try to take your tonsils out just to earn some extra fees!
Wednesday, July 29, 2009
Friday, July 24, 2009
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The Browne Academy Bookstore
The Family Medicine Bookstore
Radio Free Philosophy
Tranquility Retreat
Sunday, July 19, 2009
Lab Results
LDL—the bad cholesterol. This value should be no more than 130, if you don’t have any other cardiac risk factors, such as overweight, hypertension (high blood pressure), or diabetes. For two or more risk factors, it’s best if this level is less than 100. If you have diabetes or heart disease, the level should be 70 or lower. The LDL is the portion of a cholesterol panel that goes out to the arteries and deposits as plaque. LDL is made by the liver, so if you have a family history of high cholesterol, you are more likely to have high cholesterol yourself. However, the LDL is also caused partly by what you eat. Eating a diet rich in whole grains and low in animal fats will help. Ask for the healthy diet handout.
HDL—the good cholesterol. The higher the better, as this is the component that takes the cholesterol from the arteries and periphery back to the liver. For women, the HDL should be 45-50 or higher. Quitting smoking and exercising for at minimum twenty minutes per day (aerobic so your heart gets pumping) will help with this.
Triglycerides. These should be no more than 150. Factors in the diet that elevate triglycerides are sugars or white, processed carbohydrates, and animal fats. Other factors that can affect them are elevated blood sugars and hypothyroidism.
Insulin. If I have checked your insulin level, it is because I am concerned you may have insulin resistance, a condition that predisposes you to diabetes. This is a condition in which the body doesn’t use insulin properly. It is much more common if you are overweight or if you have a family history of diabetes. Adipose or fatty tissue doesn’t use insulin very well, so the pancreas has to pump out additional insulin when you consume something with carbohydrates. Over time, the pancreas gets burned out. Once the pancreas is no longer able to keep producing extra insulin to keep the blood sugars down, you will develop first pre-diabetes, then diabetes. Depending on the lab used, a fasting insulin level should be no more than 16-17. It is very important that you follow a diet without sugar or white, processed carbohydrates.
Fasting blood sugar. Normal fasting blood sugars are less than 100. The limits of normal have been changed over the past couple of years; it used to be that the cut-off was 111. If you have two fasting blood sugars above 100, you have impaired fasting glucose, or prediabetes. If you have two fasting blood sugars 126 or greater, you have diabetes. Sometimes I will order a glucose tolerance test. If the blood sugar goes over 200, this is diabetes. Occasionally people will have normal blood sugars in the morning, but their sugars go way up after meals. If your bloodwork shows elevated triglycerides, I may order a glucose tolerance test.
Vitamin D level. If your vitamin D level is less than 20, you are deficient in vitamin D. Between 20-30 is considered insufficient. Often times I will check this level if you have bone loss, whether osteopenia (mild-moderate bone loss) or osteoporosis. Symptoms of low vitamin D include fatigue and generalized achiness. It is a very common finding. Vitamin D is not actually a vitamin, but a hormone, and it can be obtained only by eating or drinking foods fortified with vitamin D (milk, for example) or by sunshine.
HDL—the good cholesterol. The higher the better, as this is the component that takes the cholesterol from the arteries and periphery back to the liver. For women, the HDL should be 45-50 or higher. Quitting smoking and exercising for at minimum twenty minutes per day (aerobic so your heart gets pumping) will help with this.
Triglycerides. These should be no more than 150. Factors in the diet that elevate triglycerides are sugars or white, processed carbohydrates, and animal fats. Other factors that can affect them are elevated blood sugars and hypothyroidism.
Insulin. If I have checked your insulin level, it is because I am concerned you may have insulin resistance, a condition that predisposes you to diabetes. This is a condition in which the body doesn’t use insulin properly. It is much more common if you are overweight or if you have a family history of diabetes. Adipose or fatty tissue doesn’t use insulin very well, so the pancreas has to pump out additional insulin when you consume something with carbohydrates. Over time, the pancreas gets burned out. Once the pancreas is no longer able to keep producing extra insulin to keep the blood sugars down, you will develop first pre-diabetes, then diabetes. Depending on the lab used, a fasting insulin level should be no more than 16-17. It is very important that you follow a diet without sugar or white, processed carbohydrates.
Fasting blood sugar. Normal fasting blood sugars are less than 100. The limits of normal have been changed over the past couple of years; it used to be that the cut-off was 111. If you have two fasting blood sugars above 100, you have impaired fasting glucose, or prediabetes. If you have two fasting blood sugars 126 or greater, you have diabetes. Sometimes I will order a glucose tolerance test. If the blood sugar goes over 200, this is diabetes. Occasionally people will have normal blood sugars in the morning, but their sugars go way up after meals. If your bloodwork shows elevated triglycerides, I may order a glucose tolerance test.
Vitamin D level. If your vitamin D level is less than 20, you are deficient in vitamin D. Between 20-30 is considered insufficient. Often times I will check this level if you have bone loss, whether osteopenia (mild-moderate bone loss) or osteoporosis. Symptoms of low vitamin D include fatigue and generalized achiness. It is a very common finding. Vitamin D is not actually a vitamin, but a hormone, and it can be obtained only by eating or drinking foods fortified with vitamin D (milk, for example) or by sunshine.
Diabetes Primer
If you have diabetes, there are several things you should know and do. Once you have the diagnosis of diabetes, your risk for having a heart attack is the same as someone who has already had a heart attack. For this reason, goals for cholesterol and blood pressure change significantly. Having diabetes also increases your risk of peripheral vascular disease, kidney disease, visual problems (retinopathy), infection, and even impotence. I strongly recommend that if you have diabetes, you go through diabetes education classes. I also strongly recommend that you adhere to what the nutritionist there says regarding diet. Exercise, too!
Recommended supplements for a diabetic
ASA 81mg
fish oil 1g twice a day
Things for you to do (aside from exercising and watching your diet):
Yearly flu shot
Pneumovax or pneumonia shot
Check your feet daily—both for cuts or peeling and for numbness.
Opthalmologic exams yearly to check for retinopathy
Goals
Blood pressure ideally should now be less than 130/80
LDL, the bad cholesterol, should be less than 100 and as close as possible to 70
Triglycerides should be less than 150
HDL, the good cholesterol, should be 45 or greater
Hgba1c—the “three month sugar level”, should be 6.5 or lower
I also periodically check a urine test for microalbumin. This is a test showing loss of proteins through the kidneys that is the earliest indicator of kidney problems. If you have a positive test, it can still be reversible.
I often screen for hypothyroidism as well, as a low thyroid is associated with diabetes.
Why does it seem that I am quick to give you more medicines? Because it is all about preventing complications. I would rather give you a medicine for your blood pressure now, than three medicines for heart disease later. Some of the medicines do more than one thing, for example a class of blood pressure medicines called ACE inhibitors (lisinopril, etc) not only lower the blood pressure, but they also protect the kidneys and help with the loss of protein from the kidneys, and they have been shown to lower the incidence of stroke. The cholesterol medicines not only lower the cholesterol, but also stabilize plaques in the arteries (so they don’t break off and head to your noggin), and lower inflammatory markers in the blood that are associated with heart disease. Incidentally, if you get achey with a cholesterol medicine, try some coenzyme Q10, an over the counter supplement. It is thought that the muscle aches due to the cholesterol medicines is caused by a decrease in CoQ10 in the body.
Recommended supplements for a diabetic
ASA 81mg
fish oil 1g twice a day
Things for you to do (aside from exercising and watching your diet):
Yearly flu shot
Pneumovax or pneumonia shot
Check your feet daily—both for cuts or peeling and for numbness.
Opthalmologic exams yearly to check for retinopathy
Goals
Blood pressure ideally should now be less than 130/80
LDL, the bad cholesterol, should be less than 100 and as close as possible to 70
Triglycerides should be less than 150
HDL, the good cholesterol, should be 45 or greater
Hgba1c—the “three month sugar level”, should be 6.5 or lower
I also periodically check a urine test for microalbumin. This is a test showing loss of proteins through the kidneys that is the earliest indicator of kidney problems. If you have a positive test, it can still be reversible.
I often screen for hypothyroidism as well, as a low thyroid is associated with diabetes.
Why does it seem that I am quick to give you more medicines? Because it is all about preventing complications. I would rather give you a medicine for your blood pressure now, than three medicines for heart disease later. Some of the medicines do more than one thing, for example a class of blood pressure medicines called ACE inhibitors (lisinopril, etc) not only lower the blood pressure, but they also protect the kidneys and help with the loss of protein from the kidneys, and they have been shown to lower the incidence of stroke. The cholesterol medicines not only lower the cholesterol, but also stabilize plaques in the arteries (so they don’t break off and head to your noggin), and lower inflammatory markers in the blood that are associated with heart disease. Incidentally, if you get achey with a cholesterol medicine, try some coenzyme Q10, an over the counter supplement. It is thought that the muscle aches due to the cholesterol medicines is caused by a decrease in CoQ10 in the body.
Saturday, July 11, 2009
Insulin and aging
Centenarians, people who have lived over 100 years, don't have much in common. Many are smokers, for example. They come from all over the world without a favoring any geographic location in particular.
However, there are 3 consistent blood metabolic indicators of all centenarians which are relatively consistent: low sugar, low triglycerides, and low insulin. All 3 are relatively low for age. Among these 3 variables, insulin is the common denominator. The level of insulin sensitivity of the cell is one of the most important markers of lifespan.
Controlling your insulin levels is one of the most powerful anti-aging strategies you can possibly implement. Sugar and grains cause your body to produce insulin and high insulin levels are the single largest physical cause of accelerated aging. If you want to slow down aging and be healthy then you need to change your grains for greens.
Insulin resistance is the basis of all of the chronic diseases of aging, cardiovascular disease, osteoporosis, obesity, diabetes, cancer, all the so-called chronic diseases of aging.
Fortunately insulin is the variable most easily influenced by a healthy diet and exercise.
Traditional doctors will prescribe drugs to lower blood sugar in type 2 diabetics and give verbal acknowledgment to exercise.
A low grain, no sugar diet is one of the most effective ways to lower one's insulin levels. This is especially effective when combined with an aerobic exercise program which increases the heart rate to about 75% of its maximum and maintains it there for 45 minutes, 5 times a week.
In addition to the steps we discussed related to diet and exercise, you may want to consider chromium supplementation. Chromium helps insulin to work efficiently. Many well-controlled clinical studies through the years show blood glucose improvements in the patients tested.
Important studies include one from the Human Nutrition Research Center of the United States Department of Agriculture conducted in 1996. Researchers in the study randomized 180 adult-onset diabetics into 3 groups of 60 each: one group received placebo twice a day, the second received 100 mcg twice a say of chromium as chromium picolinate and the third received 500 mcg of chromium as chromium picolinate twice per day. Their blood work was examined at baseline, at 2 months and at 4 months. The patients were told to remain on their anti-diabetic medications and to continue with their diets and activity levels as before. The results were impressive: blood glucose, insulin levels, and cholesterol all decreased, with the higher dose generally (but not always) more effective than the 200 mcg.
I spend a lot of time researching the internet for the best prices for high quality supplements, and in my opinion the lowest price for high quality chromium picolinate is here .
Your goals should be: Reduce insulin levels as much as possible, through diet and exercise, and control your weight. 90% of those with insulin resistance are obese.
(source: http://www.healingdaily.com/detoxification-diet/insulin.htm)
However, there are 3 consistent blood metabolic indicators of all centenarians which are relatively consistent: low sugar, low triglycerides, and low insulin. All 3 are relatively low for age. Among these 3 variables, insulin is the common denominator. The level of insulin sensitivity of the cell is one of the most important markers of lifespan.
Controlling your insulin levels is one of the most powerful anti-aging strategies you can possibly implement. Sugar and grains cause your body to produce insulin and high insulin levels are the single largest physical cause of accelerated aging. If you want to slow down aging and be healthy then you need to change your grains for greens.
Insulin resistance is the basis of all of the chronic diseases of aging, cardiovascular disease, osteoporosis, obesity, diabetes, cancer, all the so-called chronic diseases of aging.
Fortunately insulin is the variable most easily influenced by a healthy diet and exercise.
Traditional doctors will prescribe drugs to lower blood sugar in type 2 diabetics and give verbal acknowledgment to exercise.
A low grain, no sugar diet is one of the most effective ways to lower one's insulin levels. This is especially effective when combined with an aerobic exercise program which increases the heart rate to about 75% of its maximum and maintains it there for 45 minutes, 5 times a week.
In addition to the steps we discussed related to diet and exercise, you may want to consider chromium supplementation. Chromium helps insulin to work efficiently. Many well-controlled clinical studies through the years show blood glucose improvements in the patients tested.
Important studies include one from the Human Nutrition Research Center of the United States Department of Agriculture conducted in 1996. Researchers in the study randomized 180 adult-onset diabetics into 3 groups of 60 each: one group received placebo twice a day, the second received 100 mcg twice a say of chromium as chromium picolinate and the third received 500 mcg of chromium as chromium picolinate twice per day. Their blood work was examined at baseline, at 2 months and at 4 months. The patients were told to remain on their anti-diabetic medications and to continue with their diets and activity levels as before. The results were impressive: blood glucose, insulin levels, and cholesterol all decreased, with the higher dose generally (but not always) more effective than the 200 mcg.
I spend a lot of time researching the internet for the best prices for high quality supplements, and in my opinion the lowest price for high quality chromium picolinate is here .
Your goals should be: Reduce insulin levels as much as possible, through diet and exercise, and control your weight. 90% of those with insulin resistance are obese.
(source: http://www.healingdaily.com/detoxification-diet/insulin.htm)
Symptoms of insulin resistance
1. Fatigue. The most common feature of Insulin Resistance is that it wears people out. Some are tired just in the morning or afternoon, others are exhausted all day.
2. Brain fogginess. Sometimes the fatigue of Insulin Resistance is physical, but often it's mental. The inability to focus is the most evident symptom. Poor memory, loss of creativity, poor grades in school often accompany Insulin Resistance, as do various forms of "learning disabilities."
3. Low blood sugar. Mild, brief periods of low blood sugar are normal during the day, especially if meals are not eaten on a regular schedule. But prolonged periods of this "hypoglycemia," accompanied by many of the symptoms listed here, especially physical and mental fatigue, are not normal.
Feeling agitated, jittery and moody is common in Insulin Resistance, with almost immediate relief once food is eaten.
4. Intestinal bloating. Most intestinal gas is produced from carbohydrates in the diet. Insulin Resistance sufferers who eat carbohydrates suffer from gas, lots of it.
5. Sleepiness. Many people with Insulin Resistance get sleepy immediately after eating a meal containing more than 20% or 30% carbohydrates. This means typically a pasta meal, or even a meat meal which includes potatoes or bread and a sweet dessert.
6. Increased weight and fat storage. For most people, too much weight is too much fat. In males, a large abdomen is the more obvious and earliest sign of Insulin Resistance. In females, it's prominent buttocks.
7. Increased triglycerides. High triglycerides in the blood are often found in overweight persons. But even those who are not overweight may have stores of fat in their arteries as a result of Insulin Resistance.
These triglycerides are the direct result of carbohydrates in the diet being converted by insulin.
8. Increased blood pressure. It is a fact that most people with hypertension have too much insulin and are Insulin Resistant. It is often possible to show a direct relationship between the level of insulin and blood pressure: as insulin levels elevate, so does blood pressure.
9. Depression. Because carbohydrates are a natural "downer," depressing the brain, it is not uncommon to see many depressed persons who also have Insulin Resistance.
(source: http://www.healingdaily.com/detoxification-diet/insulin.htm)
Insulin and insulin resistance
Each time we eat, insulin is released into the bloodstream. This vital hormone, secreted by special cells in the pancreas, encourages our tissues - our muscles in particular - to gobble up the glucose surging through the bloodstream after we eat a meal.
That's good news, because glucose hanging around in the blood is dangerous stuff. It can stick to proteins and destroy their ability to do their job. Kidney damage, blindness, and amputations may result.
But insulin has many other vital roles. After a meal, insulin stops the liver from releasing any fat, a potential metabolic fuel, into the blood. Why after a meal? It turns out that just like glucose, these fats, released as triglycerides, are dangerous if they hang about in the blood too long.
In some organisms, insulin plays the role of controlling their lifespan. What is the purpose of insulin in humans? If you ask your physician, they will say that the role of insulin is to lower blood sugar and you must learn right now, that is one of insulin's many roles.
Insulin, sugar, and glycogen
When your body notices that the sugar level is elevated, it is a sign that you have more sugar than you need right now, your body is not burning it and therefore it is accumulating in your blood. So insulin is released to take that sugar and store it. How does it store it? Glycogen? Your body stores very little glycogen at any one time. All the glycogen stored in your liver and muscles would not last you through 1 active day. Once you have filled up your glycogen stores, that sugar is stored as saturated fat.
So the idea of medical professionals recommending a high complex-carbohydrate, low-saturated-fat diet is absolutely a mistake. A high complex-carbohydrate diet is nothing more than a high-glucose diet, or a high-sugar diet. Your body is just going to store it as saturated fat, and the body makes it into saturated fat quite readily.
Your body's principal way of getting rid of sugar, because it is toxic, is to burn it. The sugar which your body can't burn will be rid of by storing it as glycogen, and when those glycogen reserves are full, sugar gets stored as fat. If you eat sugar your body will burn it and you stop burning fat. Another major effect of insulin on fat is it prevents you from burning it. What happens when you are insulin resistant and you have all this insulin floating around all the time? You wake up in the morning with an insulin level of 90.
High levels of insulin cause health problems
High levels of insulin cause several problems: one of them is high blood pressure. One of the roles of insulin is to assist the storing of excess nutrients. Insulin plays a role in storing magnesium. But if your cells become resistant to insulin, you can't store magnesium so you lose it through urination. Intra-cellular magnesium relaxes muscles. What happens when you can't store magnesium because the cell is resistant? You lose magnesium and your blood vessels constrict. This causes an increase in blood pressure.
Insulin also causes the retention of sodium, which causes fluid retention, which causes high blood pressure and congestive heart failure.
A recent study(1) showed that overweight children with high levels of insulin in their blood are also likely to have high levels of homocysteine, a substance which appears to raise the risk of heart disease, stroke, and birth defects.
Osteoporosis is another potential problem resulting from insulin resistance. Insulin is a master hormone which controls many anabolic hormones such as growth hormone, testosterone, and progesterone. In insulin resistance, the anabolic process is reduced. Bone is built upon the command of such hormones. When these hormones are reduced, the amount of bone building is reduced, and the amount of calcium excreted is increased.
Insulin increases cellular proliferation. How does this affect cancer? It helps it grow. And there are some pretty strong studies(2,3) which show that one of the strongest correlations to breast and colon cancers are levels of insulin.
Insulin resistance
When your cells are exposed to insulin at all, they get a little bit more resistant to it. So the pancreas just puts out more insulin. Cells become insulin resistant because they are trying to protect themselves from the toxic effects of high insulin. They down-regulate their receptor activity and number of receptors so that they don't have to be subjected to all that stimuli all the time.
Different cells respond to insulin differently. Some cells are more resistant than others, as some cells are incapable of becoming very resistant. The liver becomes resistant first, followed by the muscle tissue and lastly the fats. As all these major tissues, become insulin resistant your pancreas is putting out more insulin to compensate. Any time your cell is exposed to insulin it is going to become more insulin resistant. That is inevitable, we cannot stop this process, but the rate we can control.
But the pancreas can't always keep up that high level of insulin production forever. Once the production of insulin starts slowing down, or the resistance goes up, then blood sugar goes up and the person becomes a diabetic.
"Insulin resistance syndrome" refers to a combination of risk factors for type 2 diabetes, including chronically elevated insulin levels, low HDL ("good") cholesterol, abdominal obesity and high blood pressure.
Excessive intake of all carbohydrates, especially the high-glycemic type, is the primary culprit in the development of insulin resistance.
Type 2 diabetes occurs when the body no longer responds to insulin. As a result, levels of insulin in the blood become elevated and over time, can raise the risk for kidney failure and blindness, as well as heart disease.
A recent study(4) has found that insulin resistance syndrome, or "syndrome X," is found in families with a history of early heart disease - a heart attack or blood vessel blockage before age 55 in men and before age 65 in women.
(source: http://www.healingdaily.com/detoxification-diet/insulin.htm)
That's good news, because glucose hanging around in the blood is dangerous stuff. It can stick to proteins and destroy their ability to do their job. Kidney damage, blindness, and amputations may result.
But insulin has many other vital roles. After a meal, insulin stops the liver from releasing any fat, a potential metabolic fuel, into the blood. Why after a meal? It turns out that just like glucose, these fats, released as triglycerides, are dangerous if they hang about in the blood too long.
In some organisms, insulin plays the role of controlling their lifespan. What is the purpose of insulin in humans? If you ask your physician, they will say that the role of insulin is to lower blood sugar and you must learn right now, that is one of insulin's many roles.
Insulin, sugar, and glycogen
When your body notices that the sugar level is elevated, it is a sign that you have more sugar than you need right now, your body is not burning it and therefore it is accumulating in your blood. So insulin is released to take that sugar and store it. How does it store it? Glycogen? Your body stores very little glycogen at any one time. All the glycogen stored in your liver and muscles would not last you through 1 active day. Once you have filled up your glycogen stores, that sugar is stored as saturated fat.
So the idea of medical professionals recommending a high complex-carbohydrate, low-saturated-fat diet is absolutely a mistake. A high complex-carbohydrate diet is nothing more than a high-glucose diet, or a high-sugar diet. Your body is just going to store it as saturated fat, and the body makes it into saturated fat quite readily.
Your body's principal way of getting rid of sugar, because it is toxic, is to burn it. The sugar which your body can't burn will be rid of by storing it as glycogen, and when those glycogen reserves are full, sugar gets stored as fat. If you eat sugar your body will burn it and you stop burning fat. Another major effect of insulin on fat is it prevents you from burning it. What happens when you are insulin resistant and you have all this insulin floating around all the time? You wake up in the morning with an insulin level of 90.
High levels of insulin cause health problems
High levels of insulin cause several problems: one of them is high blood pressure. One of the roles of insulin is to assist the storing of excess nutrients. Insulin plays a role in storing magnesium. But if your cells become resistant to insulin, you can't store magnesium so you lose it through urination. Intra-cellular magnesium relaxes muscles. What happens when you can't store magnesium because the cell is resistant? You lose magnesium and your blood vessels constrict. This causes an increase in blood pressure.
Insulin also causes the retention of sodium, which causes fluid retention, which causes high blood pressure and congestive heart failure.
A recent study(1) showed that overweight children with high levels of insulin in their blood are also likely to have high levels of homocysteine, a substance which appears to raise the risk of heart disease, stroke, and birth defects.
Osteoporosis is another potential problem resulting from insulin resistance. Insulin is a master hormone which controls many anabolic hormones such as growth hormone, testosterone, and progesterone. In insulin resistance, the anabolic process is reduced. Bone is built upon the command of such hormones. When these hormones are reduced, the amount of bone building is reduced, and the amount of calcium excreted is increased.
Insulin increases cellular proliferation. How does this affect cancer? It helps it grow. And there are some pretty strong studies(2,3) which show that one of the strongest correlations to breast and colon cancers are levels of insulin.
Insulin resistance
When your cells are exposed to insulin at all, they get a little bit more resistant to it. So the pancreas just puts out more insulin. Cells become insulin resistant because they are trying to protect themselves from the toxic effects of high insulin. They down-regulate their receptor activity and number of receptors so that they don't have to be subjected to all that stimuli all the time.
Different cells respond to insulin differently. Some cells are more resistant than others, as some cells are incapable of becoming very resistant. The liver becomes resistant first, followed by the muscle tissue and lastly the fats. As all these major tissues, become insulin resistant your pancreas is putting out more insulin to compensate. Any time your cell is exposed to insulin it is going to become more insulin resistant. That is inevitable, we cannot stop this process, but the rate we can control.
But the pancreas can't always keep up that high level of insulin production forever. Once the production of insulin starts slowing down, or the resistance goes up, then blood sugar goes up and the person becomes a diabetic.
"Insulin resistance syndrome" refers to a combination of risk factors for type 2 diabetes, including chronically elevated insulin levels, low HDL ("good") cholesterol, abdominal obesity and high blood pressure.
Excessive intake of all carbohydrates, especially the high-glycemic type, is the primary culprit in the development of insulin resistance.
Type 2 diabetes occurs when the body no longer responds to insulin. As a result, levels of insulin in the blood become elevated and over time, can raise the risk for kidney failure and blindness, as well as heart disease.
A recent study(4) has found that insulin resistance syndrome, or "syndrome X," is found in families with a history of early heart disease - a heart attack or blood vessel blockage before age 55 in men and before age 65 in women.
(source: http://www.healingdaily.com/detoxification-diet/insulin.htm)
Therapeutic Diet for Insulin Resistance
This low-carbohydrate, moderate-protein and moderate-fat diet is focused on real foods as the solution to Insulin Resistance Syndrome (IR), sometimes called Metabolic Syndrome or Syndrome X. It is mainly refined foods, especially sweets, combined with deficient exercise that gets people into trouble so a program based on whole foods, not more refined food products, is the best long-term solution in IR, and a host of other health problems as well. It is also recommended to take a good multiple vitamin/mineral.
Based on human evolutionary history and physiology this should be your most natural and optimal diet. It reflects what our Paleolithic ancestors (i.e., before agriculture) evolved eating over a million years and, as such, has the highest potential of supporting healing and preventing disease. In addition, this diet is naturally alkalizing, which is considered by some people to be healthier than the typical American acidifying diet.
If you need more dietary support than this webpage provides, the popular diet that is closest to this IR diet is The South Beach Diet by Arthur Agatston, M.D. We also recommended reading The Paleo Diet by Loren Cordain, Ph.D. It gives a good background on the problems of the modern diet and the advantages of the Paleolithic diet. However, use this webpage as your main reference and refer to these books only for recipes, background and support.
It will take at least 2 to 3 months to reestablish normal insulin sensitivity. If there is severe IR or obesity it could take much longer to stabilize. However, most people will experience some improvements early on in the program. After stabilization has been shown through lab values, blood pressures, improved energy, loss of weight (especially abdominal), loss of carbohydrate cravings and loss of hypoglycemic symptoms, then switching to the Maintenance Diet for Insulin Resistance is possible. However, it will be essential to continue to monitor the lab values, signs, symptoms and weight.
With this diet you should not be hungry until its time for the next meal. If this is happening try increasing the non-starchy vegetables, nuts, fats and/or protein intake in the meals. Do not avoid naturally fatty foods, but limit saturated fats. Avoid hydrogenated oils and fried foods. For hypoglycemia symptoms eat smaller more frequent meals. Try to eat for hunger and not emotional reasons. If you must eat for emotional reasons, eat non-starchy vegetables or lean protein. Snacks should be non-starchy vegetables, nuts, seeds or protein foods.
PROBLEM CARBOHYDRATES (refined and starchy) – The cause of the problem!
· No potatoes or simple sugars/carbohydrates (common table sugar, fructose, sweets, cookies, candy, ice cream, pastries, honey, fruit juice, soda pop, alcoholic beverages, etc.). Anything that tastes sweet (including artificial sweeteners and Stevia) may raise insulin levels, thus aggravating IR and perpetuating the cravings for sweets. As IR improves, sweet cravings usually decrease.
· Almost no grain products (breads, pasta, cornbread, corn tortillas, crackers, popcorn, etc.) and no refined grains/carbohydrates (white flour products, white pasta, white rice, etc.).
· Whole grains (whole brown rice, wheat, rye, barley and buckwheat) only in very small amounts.
GOOD CARBOHYDRATES (non-refined and non-starchy)
· Small amounts of fruit are OK but eat it with protein meals and not alone. Berries are best. No dried fruit.
· Eat lots and lots of non-starchy vegetables. Raw or lightly cooked is best. These should be the main source of carbohydrates in the diet. Fresh vegetables are best, frozen is OK but canned is to be avoided except for canned tomatoes and tomato sauce.
· Legumes (beans, peas, peanuts, soybeans, soy products, etc.) have a low glycemic index so are OK.
PROTEINS
· Consume moderate amounts of leaner meats, seafood and fish. The best are wild fish, wild game, free-range chicken & turkey, range-fed beef, lamb, buffalo and naturally grown pork. Grain-fed means more saturated fats and omega-6 oils. Wild and range-fed means less of these and more omega-3s. The more omega-3s the better. Feeding grain to animals, like cows, that were meant to eat grass is not healthy for the animal nor the person eating the animal.
· If you do not have a dairy allergy, some dairy is OK. Interestingly, the lower the fat in milk the more it raises the blood sugar, so low fat milk is worse than whole milk. But the best is no milk, it raises the blood sugar too much, plus cow's milk is for calves, not people. Other dairy products are okay. Use only unsweetened yogurt. Limit butter and no hydrogenated margarine.
· Eggs are fine unless you have allergies to them, but the best are eggs from free-range chickens and eggs grown to be high in omega-3 oils. Best is no more than 7 per week due to the high fat content.
· For most people: moderate amounts of nuts (walnuts, macadamia nuts, almonds, cashews, pecans, etc.) and seeds (sesame, sunflower, pumpkin, etc.). Raw are best. Walnuts are high in omega-3s. Nut and seed butters are good (almond, cashew, sesame). Peanut butter and peanuts are legumes.
FATS
· Consume moderate amounts of healthy oils. A low-fat diet is not healthy, nor is it compatible with this diet.
· Healthy oils are: Monounsaturated oils (olive, canola, nuts). Polyunsaturated oils that are high in omega-3 oils (canola, flax, fish oils, walnuts). Saturated fats from vegetable sources (coconut, palm, avocado).
· Limit animal sources of saturated fats as found in dairy products (cheese, butter, etc.) and most commercial red meats.
· Freely add healthy oils to salads, sauces for vegetables and when cooking lean meats. Natural palm and coconut oil are excellent for cooking and frying. Flax oil is high in omega-3 oils but goes rancid very easily so refrigerate and do not heat and add only after cooking.
· No hydrogenated oils and limit fried foods. Some low-heat frying with natural palm and coconut oil is okay.
MISC.
· Drink lots of pure water.
· Organic is always best when available.
· Cut down on salt but feel free to use other spices liberally.
· Except for non-starchy vegetables, the other carbohydrates should be limited to protein meals.
· It is usually safe to assume that most processed foods will interfere with this diet, even if low-carb.
· Finally, it must be emphasized that exercise is a very important component of success.
(Source: http://www.heartlandnaturopathic.com/irdiet.htm)
Based on human evolutionary history and physiology this should be your most natural and optimal diet. It reflects what our Paleolithic ancestors (i.e., before agriculture) evolved eating over a million years and, as such, has the highest potential of supporting healing and preventing disease. In addition, this diet is naturally alkalizing, which is considered by some people to be healthier than the typical American acidifying diet.
If you need more dietary support than this webpage provides, the popular diet that is closest to this IR diet is The South Beach Diet by Arthur Agatston, M.D. We also recommended reading The Paleo Diet by Loren Cordain, Ph.D. It gives a good background on the problems of the modern diet and the advantages of the Paleolithic diet. However, use this webpage as your main reference and refer to these books only for recipes, background and support.
It will take at least 2 to 3 months to reestablish normal insulin sensitivity. If there is severe IR or obesity it could take much longer to stabilize. However, most people will experience some improvements early on in the program. After stabilization has been shown through lab values, blood pressures, improved energy, loss of weight (especially abdominal), loss of carbohydrate cravings and loss of hypoglycemic symptoms, then switching to the Maintenance Diet for Insulin Resistance is possible. However, it will be essential to continue to monitor the lab values, signs, symptoms and weight.
With this diet you should not be hungry until its time for the next meal. If this is happening try increasing the non-starchy vegetables, nuts, fats and/or protein intake in the meals. Do not avoid naturally fatty foods, but limit saturated fats. Avoid hydrogenated oils and fried foods. For hypoglycemia symptoms eat smaller more frequent meals. Try to eat for hunger and not emotional reasons. If you must eat for emotional reasons, eat non-starchy vegetables or lean protein. Snacks should be non-starchy vegetables, nuts, seeds or protein foods.
PROBLEM CARBOHYDRATES (refined and starchy) – The cause of the problem!
· No potatoes or simple sugars/carbohydrates (common table sugar, fructose, sweets, cookies, candy, ice cream, pastries, honey, fruit juice, soda pop, alcoholic beverages, etc.). Anything that tastes sweet (including artificial sweeteners and Stevia) may raise insulin levels, thus aggravating IR and perpetuating the cravings for sweets. As IR improves, sweet cravings usually decrease.
· Almost no grain products (breads, pasta, cornbread, corn tortillas, crackers, popcorn, etc.) and no refined grains/carbohydrates (white flour products, white pasta, white rice, etc.).
· Whole grains (whole brown rice, wheat, rye, barley and buckwheat) only in very small amounts.
GOOD CARBOHYDRATES (non-refined and non-starchy)
· Small amounts of fruit are OK but eat it with protein meals and not alone. Berries are best. No dried fruit.
· Eat lots and lots of non-starchy vegetables. Raw or lightly cooked is best. These should be the main source of carbohydrates in the diet. Fresh vegetables are best, frozen is OK but canned is to be avoided except for canned tomatoes and tomato sauce.
· Legumes (beans, peas, peanuts, soybeans, soy products, etc.) have a low glycemic index so are OK.
PROTEINS
· Consume moderate amounts of leaner meats, seafood and fish. The best are wild fish, wild game, free-range chicken & turkey, range-fed beef, lamb, buffalo and naturally grown pork. Grain-fed means more saturated fats and omega-6 oils. Wild and range-fed means less of these and more omega-3s. The more omega-3s the better. Feeding grain to animals, like cows, that were meant to eat grass is not healthy for the animal nor the person eating the animal.
· If you do not have a dairy allergy, some dairy is OK. Interestingly, the lower the fat in milk the more it raises the blood sugar, so low fat milk is worse than whole milk. But the best is no milk, it raises the blood sugar too much, plus cow's milk is for calves, not people. Other dairy products are okay. Use only unsweetened yogurt. Limit butter and no hydrogenated margarine.
· Eggs are fine unless you have allergies to them, but the best are eggs from free-range chickens and eggs grown to be high in omega-3 oils. Best is no more than 7 per week due to the high fat content.
· For most people: moderate amounts of nuts (walnuts, macadamia nuts, almonds, cashews, pecans, etc.) and seeds (sesame, sunflower, pumpkin, etc.). Raw are best. Walnuts are high in omega-3s. Nut and seed butters are good (almond, cashew, sesame). Peanut butter and peanuts are legumes.
FATS
· Consume moderate amounts of healthy oils. A low-fat diet is not healthy, nor is it compatible with this diet.
· Healthy oils are: Monounsaturated oils (olive, canola, nuts). Polyunsaturated oils that are high in omega-3 oils (canola, flax, fish oils, walnuts). Saturated fats from vegetable sources (coconut, palm, avocado).
· Limit animal sources of saturated fats as found in dairy products (cheese, butter, etc.) and most commercial red meats.
· Freely add healthy oils to salads, sauces for vegetables and when cooking lean meats. Natural palm and coconut oil are excellent for cooking and frying. Flax oil is high in omega-3 oils but goes rancid very easily so refrigerate and do not heat and add only after cooking.
· No hydrogenated oils and limit fried foods. Some low-heat frying with natural palm and coconut oil is okay.
MISC.
· Drink lots of pure water.
· Organic is always best when available.
· Cut down on salt but feel free to use other spices liberally.
· Except for non-starchy vegetables, the other carbohydrates should be limited to protein meals.
· It is usually safe to assume that most processed foods will interfere with this diet, even if low-carb.
· Finally, it must be emphasized that exercise is a very important component of success.
(Source: http://www.heartlandnaturopathic.com/irdiet.htm)
Friday, July 3, 2009
Nutrition: How to Make Healthier Food Choices
Why is healthy eating important?
When combined with exercise, a healthy diet can help you lose weight, lower your cholesterol level and improve the way your body functions on a daily basis.The U.S. Department of Agriculture’s (USDA) Food Guide Pyramid divides food into 6 basic food groups, consisting of
1) grains, 2) fruits, 3) vegetables, 4) meats and beans, 5) dairy and 6) fats.
The USDA recommends that an adult daily diet include the following:
3 ounces of whole grains, and 6 ounces of grains total
2 cups of fruit
2 1/2 cups of vegetables
3 cups fat-free or low-fat dairy
The following are some ways to make healthier food choices and to get the recommended amounts of whole grains, fruits and vegetables and dairy.
Grains
Whole-grain breads are low in fat; they're also high in fiber and complex carbohydrates, which helps you feel fuller longer and prevents overeating. Choose these breads for sandwiches and as additions to meals.Avoid rich bakery foods such as donuts, sweet rolls and muffins. These foods can contain more than 50% fat calories. Snacks such as angel food cake and gingersnap cookies can satisfy your sweet tooth without adding fat to your diet.Hot and cold cereals are usually low in fat. But instant cereals with cream may contain high-fat oils or butterfat. Granola cereals may also contain high-fat oils and extra sugars. Look for low-sugar options for both instant and granola cereals.Avoid fried snacks such as potato chips and tortilla chips. Try the low-fat or baked versions instead.
Fruits and Vegetables
Fruits and vegetables are naturally low in fat. They add flavor and variety to your diet. They also contain fiber, vitamins and minerals.Margarine, butter, mayonnaise and sour cream add fat to vegetables and fruits. Try using nonfat or low-fat versions of these foods. You can also use nonfat or low-fat yogurt or herbs as seasonings instead.
Meat, Poultry and Fish
Beef, Pork, Veal and Lamb
Baking, broiling and roasting are the healthiest ways to prepare meat. Lean cuts can be pan-broiled or stir-fried. Use either a nonstick pan or nonstick spray coating instead of butter or margarine.Trim outside fat before cooking. Trim any inside, separable fat before eating. Select low-fat, lean cuts of meat. Lean beef and veal cuts have the word "loin" or "round" in their names. Lean pork cuts have the word "loin" or "leg" in their names.Use herbs, spices, fresh vegetables and nonfat marinades to season meat. Avoid high-fat sauces and gravies.
Poultry
Baking, broiling and roasting are the healthiest ways to prepare poultry. Skinless poultry can be pan-broiled or stir-fried. Use either a nonstick pan or nonstick spray coating instead of butter or margarine.Remove skin and visible fat before cooking. Chicken breasts are a good choice because they are low in fat and high in protein. Use domestic goose and duck only once in a while because both are high in fat.
Fish
Poaching, steaming, baking and broiling are the healthiest ways to prepare fish. Fresh fish should have a clear color, a moist look, a clean smell and firm, springy flesh. If good-quality fresh fish isn't available, buy frozen fish.Most seafood is low in saturated fat. Omega-3 fatty acids are found in some fatty fish, such as salmon and cold water trout. They may help lower the risk of heart disease in some people.Cross-over FoodsDry beans, peas and lentils offer protein and fiber without the cholesterol and fat that meats have. Once in a while, try substituting beans for meat in a favorite recipe, such as lasagna or chili.TVP, or textured vegetable protein, is widely available in many foods. Vegetarian "hot dogs," "hamburger" and "chicken nuggets" are low-fat, cholesterol-free alternatives to meat.
Dairy
Choose skim milk or low-fat buttermilk. Substitute evaporated skim milk for cream in recipes for soups and sauces.Try low-fat cheeses. Skim ricotta can replace cream cheese on a bagel or in a vegetable dip. Use part-skim cheeses in recipes. Use 1% cottage cheese for salads and cooking. String cheese is a low-fat, high-calcium snack option.Plain nonfat yogurt can replace sour cream in many recipes. (To maintain texture, stir 1 tablespoon of cornstarch into each cup of yogurt that you use in cooking.) Try mixing frozen nonfat or low-fat yogurt with fruit for dessert.Skim sherbet is an alternative to ice cream. Soft-serve and regular ice creams are also lower in fat than premium styles.
Fats, Oils and Sweets
Eating too many high-fat foods not only adds excess calories (which can lead to obesity and weight gain), but can increase your risk factor for several diseases. Heart disease, diabetes, certain types of cancer and osteoarthritis have all been linked to diets too high in fat. If you consume too much saturated and trans fats, you are more likely to develop high cholesterol and coronary artery disease.
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