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Protecting Your Longevity against Heart Disease and Cancer:

Emphasis on Diet and Exercise

 

Introduction

     There are no guarantees in life as we all know. But a good path to increase one’s longevity is to follow a prudent plan of healthy choices in the areas of diet (what to eat) and how best to exercise (what to do, activity wise).

Now most adults already are aware of these general statements, but often are not sure of exactly what healthy choices are, or how best to exercise. The purpose of this Blog is to more narrowly get specific as to answers needed, at least based on current research.

But there are three main obstacles to one’s desire to live a long life. Genetics is one, that is, what we inherit in our genes. The second biggest obstacle to a long life is disease. Many diseases can affect our lives but the two primary ones are Heart Disease and Cancer. A third obstacle to our success lies with the advertising industry. This later obstacle will be taken up in the final comments section of this Blog.

The following data sheds light on these diseases and comes from the Centers for Disease Control (CDC):

 

Heart Disease in the United States

  • About 610,000 people die of heart disease in the United States every year–that’s 1 in every 4 deaths.
  • Heart disease is the leading cause of death for both men and women. More than half of the deaths due to heart disease in 2009 were in men.
  • Coronary heart disease (CHD) is the most common type of heart disease, killing over 370,000 people annually.
  • Every year about 735,000 Americans have a heart attack. Of these, 525,000 are a first heart attack and 210,000 happen in people who have already had a heart attack.

These statistics relate to a barrage of specific ailments under the heading of heart disease. They include:

Americans at Risk for Heart Disease

High blood pressure, high cholesterol, and smoking are key risk factors for heart disease. About half of Americans (47%) have at least one of these three risk factors. As an aside, the risk factor of smoking is something people can absolutely control, if they want to. Here are some sobering statistics related to smoking:

Cigarette smoking causes about one of every five deaths in the United States each year. Cigarette smoking is estimated to cause the following.

 

  • More than 480,000 deaths annually (including deaths from secondhand smoke)
  • 278,544 deaths annually among men (including deaths from secondhand smoke) 201,773 deaths annually among women (including deaths from secondhand smoke)

Several other medical conditions and lifestyle choices can also put people at a higher risk for heart disease, including:

  • Diabetes
  • Overweight and obesity
  • Poor diet
  • Physical inactivity
  • Excessive alcohol use

 

Statistics at a Glance: The Burden of Cancer in the United States

  • In 2018, an estimated 1,735,350 new cases of cancer were diagnosed in the United States and 609,640 people will die from the disease.
  • The most common cancers (listed in descending order according to estimated new cases in 2018) are breast cancer, lung and bronchus cancer, prostate cancer, colon and rectum cancer, melanoma of the skin, bladder cancer, non-Hodgkin lymphoma, kidney and renal pelvis cancer, endometrial cancer, leukemia, pancreatic cancer, thyroid cancer, and liver cancer.
  • The number of new cases of cancer (cancer incidence) is 439.2 per 100,000 men and women per year (based on 2011–2015 cases).
  • The number of cancer deaths (cancer mortality) is 163.5 per 100,000 men and women per year (based on 2011–2015 deaths).
  • Cancer mortality is higher among men than women (196.8 per 100,000 men and 139.6 per 100,000 women). When comparing groups based on race/ethnicity and sex, cancer mortality is highest in African American men (239.9 per 100,000) and lowest in Asian/Pacific Islander women (88.3 per 100,000).
  • In 2016, there were an estimated 15.5 million cancer survivors in the United States. The number of cancer survivors is expected to increase to 20.3 million by 2026.
  • Approximately 38.4% of men and women will be diagnosed with cancer at some point during their lifetimes (based on 2013–2015 data).
  • In 2017, an estimated 15,270 children and adolescents ages 0 to 19 were diagnosed with cancer and 1,790 died of the disease.
  • Estimated national expenditures for cancer care in the United States in 2017 were $147.3 billion. In future years, costs are likely to increase as the population ages and cancer prevalence increases. Costs are also likely to increase as new, and often more expensive, treatments are adopted as standards of care.

Statistics at a Glance: The Burden of Cancer Worldwide

  • Cancer is among the leading causes of death worldwide. In 2012, there were 14.1 million new cases and 8.2 million cancer-related deaths worldwide.
  • 57% of new cancer cases in 2012 occurred in less developed regions of the world that include Central America and parts of Africa and Asia; 65% of cancer deaths also occurred in these regions.
  • The number of new cancer cases per year is expected to rise to 23.6 million by 2030.

 

Healthy Food Choices

I’m not here to describe different types of recipes that would make use of the kinds of foods I’m about to suggest for a healthy diet. Instead I’ve chosen to describe the best foods to do three things: (1) help to prevent heart disease, (2) cancer, and (3) promote healthy living in general.

I’d like to point out what I discovered while doing research for this blog. I learned early on that some of the recommended foods in one area were identical to other areas as well. Here are the results of my research:

 

To Prevent Heart Disease

 

Leafy Green Vegetables

Whole Grains

Berries

Avocados

Fatty Fish and Fish Oil

Walnuts

Beans

Dark Chocolate

Tomatoes

Almonds

Seeds

Garlic

Olive Oil

Edamame

Green Tea

 

To Prevent Cancer

 

Spinach

Turmeric

Tomatoes

Onions and Leeks

Garlic

Watercress

Green Tea

Salmon

Water or a once in a while beer

Brazil Nuts

Walnuts

Beans

Dark Chocolate

 

Foods for a Healthy Life

 

Brightly colored fruit and vegetables

Dark Chocolate

Oily Fish

Green Tea

Olive oil

Garlic

Cranberries

The Coffee Bean

 

Best Foods for Longevity

 

All of the Above

 

Exercise

The following article was published in the Business Insider by Erin Brodwin, September 8, 2018. It’s my opinion that this article will cover the best plan of exercise for most people. I’ve been employing both cardio and weight training for some time now. Detective Hunter (played by Fred Dyer) used to say on the TV show Hunter in the 1990s—“Works for me.”

“2 forms of exercise are the best way to stave off the effects of aging — here’s how to incorporate them into your life Sep 8, 2018, 8:19 PM

If you’re searching for an all-natural way to lift your mood, preserve muscle tone, and protect your brain against the decline that comes with aging, look no further than the closest mirror.

One of the most powerful means of reaping these benefits is exercise — and in many cases, you already have everything you need to get it: a body.

As we age, two forms of exercise are the most important to focus on: aerobic exercise, or cardio, which gets your heart pumping and sweat flowing, and strength training, which helps keep aging muscles from dwindling over time.

And most of the time, they don’t require any fancy equipment or expensive classes.

Read on to find out how to incorporate both forms of fitness into your life.

Aerobic exercises like jogging may help reverse some heart damage from normal aging.

Many of us become less active as we age. Over time, this can lead some muscles in the heart to stiffen.

One of those at-risk muscles is in the left chamber of the heart, a section that plays a key role in supplying the body with freshly oxygenated blood.

A recent study split 53 adults into two groups, one of which did two years of supervised exercise four to five days a week while the other did yoga and balance exercises.

At the end of the study, published in January in the journal Circulation, the higher-intensity exercisers had seen significant improvements in their heart’s performance, suggesting that some stiffening in the heart can be prevented or even reversed with regular cardio.

“Based on a series of studies performed by our team over the past 5 years, this ‘dose’ of exercise has become my prescription for life,” Benjamin Levine, a professor of internal medicine at the University of Texas Southwestern who wrote the study, said in a statement.

Walking, another form of cardio, could help reduce the risk of heart failure — a key contributor to heart disease.

Intense cardio activities like running or jogging aren’t the only types of movement that may have protective benefits for the heart as we age.

In a study published in September in the Journal of the American College of Cardiology, researchers took a look at the physical activity levels of nearly 140,000 women aged 50 to 79 and found surprisingly salient links between walking and a reduced risk of heart failure, a condition when the heart stops pumping blood as it should. Heart failure is a key contributor to heart disease, the US’ leading cause of death.

For their work, the researchers looked at data from a 14-year women’s health study that documented heart failure and exercise levels.

When the researchers dove deeper, they found that the women who walked regularly were 25% less likely to experience heart failure than their peers who didn’t exercise. In fact, for every extra 30-45 minutes a woman walked, her risk of a failed heart dropped an average of 9%, the scientists concluded.

This is pretty important from a public health standpoint, given the poor prognosis this type of heart failure has once it’s present,” Michael La Monte, the lead author of the study and an associate professor of epidemiology at the University at Buffalo School of Public Health, said in a statement.”

 

Strength-training moves like tai chi are best for preserving muscles from age-related decline.

Strength or resistance training can take many forms, but it typically involves a series of movements geared toward building or preserving muscle.

Tai chi, the Chinese martial art that combines a series of flowing movements, is one form of strength training. The exercise is performed slowly and gently, with a high degree of focus and attention paid to breathing deeply.

Since practitioners go at their own pace, tai chi is accessible for a wide variety of people, regardless of age or fitness level.

Tai chi “is particularly good for older people because balance is an important component of fitness, and balance is something we lose as we get older,” I-Min Lee, a professor of medicine at Harvard Medical School, said in a recent health report called “Starting to Exercise.”

There may be a powerful link between regular cardio, like swimming and walking, and a lower risk of dementia.

A study published in March in the journal Neurology suggested that women who were physically fit in middle age were roughly 88% less likely to develop dementia — defined as a decline in memory severe enough to interfere with daily life — than their peers who were only moderately fit.

Starting in 1968, neuroscientists from the University of Gothenburg in Sweden studied 191 women whose average age was 50. First, they assessed their cardiovascular health using a cycling test and grouped them into three categories: fit, moderately fit, or unfit.

Over the next four decades, the researchers regularly screened the women for dementia. In that time, 32% of the unfit women and a quarter of the moderately fit women were diagnosed with the condition, while the rate was only 5% among the fit women.

However, the research showed only a link between fitness and decreased dementia risk — it did not prove that one caused the other. Still, it builds on several other studies that suggest a powerful tie between exercise and brain health.

Activities like cycling may also protect your immune system from some age-related decline.

For a small study published in March in the journal Aging Cell, researchers looked at 125 amateur cyclists aged 55 to 79, comparing them with 75 people of a similar age who rarely or never exercised.

The cyclists were found to have more muscle mass and strength and lower levels of body fat and cholesterol than the sedentary adults.

The athletic adults also appeared to have healthier and younger-looking immune systems, at least when it came to an organ called the thymus that’s responsible for generating key immune cells called T cells.

In healthy people, the thymus begins to shrink and T-cell production starts to drop off at around age 20.

The study found that the thymus glands of the older cyclists looked as if they belonged to younger people — their bodies were producing just as many T cells as would be expected for a young person.

“We now have strong evidence that encouraging people to commit to regular exercise throughout their lives is a viable solution to the problem that we are living longer but not healthier,” Janet Lord, the director of the Institute of Inflammation and Aging at the University of Birmingham in the UK, said in a statement.

Other types of strength training can include moves like planks and squats.

At its most basic, strength training involves using weight to create resistance against the pull of gravity. That weight can be your own body, elastic bands, free weights like barbells or dumbbells, or weighted ankle cuffs.

Research suggests you can use heavy weights for fewer reps or lighter weights for more reps to build stronger, more sturdy muscles.

Chris Jordan, the exercise physiologist who came up with the viral seven-minute workout — officially called the Johnson & Johnson Official 7-Minute Workout — told Business Insider that healthy adults should incorporate resistance training on two or three of the four or five days a week they work out.

Cardio workouts may also improve the look and feel of your skin.

A study from researchers at McMaster University found that people over 40 who regularly did cardio tended to have healthier skin than their sedentary peers. The overall composition of the regular exercisers’ skin was more comparable to that of 20- to 30-year-olds.

It’s not yet clear why our workouts appear to play a role in skin health, but the researchers found elevated levels of a substance critical to cell health called IL-15 in skin samples of participants after exercise — perhaps shedding light on why cardio can improve the look of our skin.

Aerobic workouts may guard against age-related decline because of reduced brain connectivity.

As we age, the brain — like any other organ — begins to work less efficiently, so signs of decline start to surface. Our memory might not be quite as sharp as it once was, for example.

But older people who develop Alzheimer’s disease often first enter a stage known as mild cognitive impairment, which involves more serious problems with memory, language, thinking, and judgment.

A study published in May looked at adults with MCI between the ages of 60 and 88 and had them walk for 30 minutes four days a week for 12 weeks.

The researchers found strengthened connectivity in a region of the brain where weakened connections have been linked with memory loss. That development, they said, “may possibly increase cognitive reserve” — but more studies are needed.

Cardio may also be tied to increases in the size of brain areas linked to memory, but more research is needed.

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A study of older women with MCI found a tie between aerobic exercise and an increase in the size of the hippocampus, a brain area involved in learning and memory.

For the study, 86 women between 70 and 80 years old with MCI were randomly assigned to do one of three types of training twice a week for six months: aerobic (like walking and swimming), resistance (like weight lifting), or balance.

Only the women in the aerobic group were found to have significant increases in hippocampal volume, but more studies are needed to determine what effect this has on cognitive performance.”

 

Final Comments

 

Most people know what is needed to promote the probability of living a long life. However, it takes a real commitment and motivation to make it happen. But even people who have the best of intentions fall off the health wagon from time to time. That’s normal human behavior. Most people blame themselves for failure to be perfect in diet and exercise. However, don’t beat yourself up too much over occasionally being less than perfect. I say this because you and everyone else trying to improve their health have an enemy out there. As I mentioned at the beginning of my Blog there are many obstacles to your success beyond your own occasional lapses in motivation.

One significant obstacle relates to the business and advertising industry. It appears that the constant onslaught of advertisers and commercial entities, whose motives are to sell products and make money, try to promote to consumers that their products are good for them no matter how fattening or injurious to our health they might actually be.

Commercials on TV have a choke hold over all of us. As a defense mechanism, I make regular use of my TV remote to pass over commercials. Try taping your programs in advance so you can later run through the commercials without listening to them. Granted, some commercials can be very entertaining but most don’t deserve any attention at all since most advertisers are just “bullshit” artists. Like a thief they just want to remove that wad of cash from your wallet or bank account. Your health and well-being at best would be lucky to be a tertiary concern to the advertising industry. In reality, it’s not even an afterthought!

Culture and society often works at cross purposes. That is the reality for now. This only makes it even harder for you to succeed in living a long life. I say best of luck to you in overcoming obstacles in your efforts to live a healthy life and, indeed, a long life.

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Best Foods for Specific Human Body Organs

 

The purpose of this Blog is to describe a better way to conduct your weekly or bi-weekly grocery shopping, and maximize the potential for bringing into your home only the most healthful full-body array of nutritionally healthy grocery items.

A lot of people already include or incorporate healthy foods (and some not so good healthy foods) into their diets. I eat a modified vegan diet by including fish (no beef or chicken) and a few eggs (technically I’m an ova-vegetarian). I still struggle with desserts every time I shop. I only include healthy sources of protein (primarily salmon and eggs) so I can maximize muscle growth for my particular exercise program of cardio and weight training.

While fruits, vegetables, whole grains, and legumes are staples in healthy diets, I posed to myself the following question? What would happen if I looked at only the best foods for specific major body organs: Heart, Brain, Liver, Kidneys, Lungs and Pancreas? Would I be creating a better shopping list that actually maximizes eating foods that will better protect every major organ in the body? Since no one can predict when a major body organ is going to give us trouble or fail, wouldn’t it be good to give ourselves a little better insurance policy of prevention?

Consequently, here is what I found out on the internet. Mind you such lists are a matter of opinion and sometimes subject to change by those reporting on the foods they list. Also, remember everyone’s physical state is very individualistic; there may be reasons your doctor doesn’t want you to eat certain foods. MY RECOMMENDATION IS ONCE YOUR MASTER GROCERY LIST is CREATED GET a BY-OFF FROM YOUR PRIMARY CARE PHYSICIAN.  

As you peruse the following foods by body organ, remember that there will be duplication in places. This is good because you can generate a more efficient smaller list to manage at the grocery store.

Good Foods for Specific Body Organs

Heart

 

Oatmeal

Salmon

Avocados

Olive Oil

Nuts (walnuts, almonds, macadamia)

Berries

Legumes

Spinach

Flaxseed

Soy

 

Brain

 

Whole Grains

Avocados

Nuts and Seeds

Wild Salmon

Blueberries

Coffee (3-5 cups a day)

Apples

Chocolate

Cinnamon

Spinach

Extra Virgin Olive Oil

Curry

Concord grape Juice

 

Liver

 

Garlic

Grapefruit Juice

Beets

Leafy Greens (spinach and lettuce)

Green Tea

Avocados

Broccoli and Brussels sprouts

Lemons

Turmeric

Walnuts

 

 Kidneys

 

Turmeric

Salmon

Red Grapes

Flaxseed Oil

Garlic

Green Tea

Quinoa

Berries

Nuts

Broccoli

Red bell peppers

Cabbage

Cauliflower

Onions

Apples

Cranberries

Blue berries

Raspberries

Strawberries

Cherries

Red grapes

Egg whites

Fish

Olive oil

 

Lungs

 

Water

Fatty fish

Apple Juice

Apples

Apricots

Broccoli

Poultry

Walnuts

Beans (kidney, black, pinto)

Berries

 

Pancreas

 

Jalapeno Peppers

Raspberries

Green Tea

Turmeric

Carrots

Salmon

Kale

Cabbage

Broccoli

Water Cress

Fish Roe

Horseradish

Arugula

Cherries

Chicory Greens

Sweet Potatoes

 

     As one can see there are best foods that appear as a kind of theme that is needed for every body organ. While some people will like certain healthy foods, personal preference might dictate what foods you actually purchase. For example I might not buy Fish Roe from the Pancreas list. I also might only use Chicory Greens very sparingly. But I definitely would buy and eat all the other items on the pancreas list individually. Some items lend themselves better in a recipe. 

     To save you time, I’ve constructed a master list for my weekly grocery list. Slight modifications of my master grocery list may be needed as preferences do differ from one person to another. Being an ova-vegetarian I probably won’t include poultry on my list. However, in general I think my general master list will give you all the healthy foods your body needs. Stay healthy my friend! Life is good so stay around to enjoy it!

 

Here is my Master Grocery List (in no special order). Drum roll please!

 

Salmon

Blueberries

Cherries

Raspberries

Strawberries

Blackberries

Avocados

Carrots

Whole Grains

Legumes

Onions

Arugula

Water (tap water okay or bottled)

Sweet Potatoes

Apples

Apple Juice

Horseradish

Water Cress

Broccoli

Cabbage

Kale

Cauliflower

Spinach

Turmeric

Green Peas

Green Tea

Apricots

Beans (kidney, black, pinto)

Nuts (walnut, almonds, macadamia)

Seeds

Red grapes

Egg whites

Fish in general (cod, halibut, haddock, sardines, shrimp, crab, tuna, trout, etc.)

Cranberries

Red bell peppers

Quinoa

Jalapeno peppers

Flaxseed oil

Garlic

Grapefruit Juice

Beets

Leafy Greens (spinach and lettuce)

Brussels sprouts

Lemons

Extra Virgin Olive Oil

Curry

Concord grape Juice

Chocolate

Cinnamon

Coffee (3-5 cups a day, caffeinated or decaf)

Flaxseed (sprinkle on soups or salads)

Soy

Oatmeal

 

Health Tip:

     We all lead busy lives. But just as that is no excuse for not exercising, it is also no excuse for not getting back to cooking meals at home. Use your kitchen most of the time. Soon it will become a good habit and will seem second nature to you.

Post Script

Here are 21 healthy lifestyle quotes I found on the internet to help inspire you to kick-start your healthy lifestyle or make you appreciate your good health:

  • “The greatest wealth is health.”  –Virgil

 

  • “The power of love to change bodies is legendary, built into folklore, common sense, and everyday experience. Love moves the flesh, it pushes matter around. Throughout history, ‘tender loving care’ has uniformly been recognized as a valuable element in healing.” – Larry Dossey

 

  • “He who takes medicine and neglects to diet wastes the skill of his doctors.” – Chinese Proverb

 

  • “If you have health, you probably will be happy, and if you have health and happiness, you have the wealth you need, even if it is not all you want.” – Elbert Hubbard

 

  • “A good laugh and a long sleep are the best cures in the doctor’s book.” – Irish Proverb

 

  • “Health is a state of complete harmony of the body, mind and spirit. When one is free from physical disabilities and mental distractions, the gates of the soul open.” – B.K.S. lyerngar

 

  • “Happiness lies, first of all, in health.” – George William Curtis, author of Lotus-Eating

 

  • “To keep the body in good health is a duty, otherwise we shall not be able to keep our mind strong and clear.” – Buddha

 

  • “A vigorous five-mile walk will do more good for an unhappy but otherwise healthy adult than all the medicine and psychology in the world.” – Paul Dudley White

 

  • “Health and intellect are the two blessings of life.” – Menander (ca 342-291 BC)

 

  • “Lack of activity destroys the good condition of every human being, while movement and methodical physical exercise save it and preserve it.” –Plato

 

  • “To insure good health: eat lightly, breathe deeply, live moderately, cultivate cheerfulness, and maintain an interest in life.” – William Londen

 

  • “There are lots of people in this world who spend so much time watching their health that they haven’t the time to enjoy it.” – Josh Billings

 

  • “The human body has been designed to resist an infinite number of changes and attacks brought about by its environment. The secret of good health lies in successful adjustment to changing stresses on the body.” – Harry J. Johnson

 

  • “The secret of health for both mind and body is not to mourn for the past, not to worry about the future, or not to anticipate troubles, but to live the present moment wisely and earnestly.” – Siddartha Buddha

 

  • “Men worry over the great number of diseases, while doctors worry over the scarcity of effective remedies.” – Pien Ch’iao

 

  • “Prevention is better than cure.” – Desiderius Erasmus

 

  • “Take care of your body. It’s the only place you have to live.” – Jim Rohn

 

  • “People who laugh actually live longer than those who don’t laugh. Few persons realize that health actually varies according to the amount of laughter.” – James J. Walsh

 

  • “The reason I exercise is for the quality of life I enjoy.” – Kenneth H. Cooper

 

  • “The groundwork for all happiness is good health.” – Leigh Hunt

 

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Kidney Disease: The Importance of Diet and Exercise

Part II

 

     In Part II of this series I will explore what is known regarding the benefits of diet and exercise as it pertains to kidney disease. Why is this topic important? If you have kidney disease you will need to work very closely with your doctor as he/she develops a treatment plan for you. And your relationship is important at all stages of kidney disease from Stage I to Stage V. Another reason this topic is important is that there is an accumulating body of research that strongly suggests that both diet and exercise will be critically important to the success of your treatment plan.

In your partnership with your doctor and health care team, you will be the primary one who actually carries out the treatment plan. And, where diet and exercise are specifically concerned, you have control over your own diet and exercise choices. And, as it turns out, like many other diseases (e.g., heart disease, diabetes, liver disease, etc.) both diet and exercise are critically important.

Current Research Findings

 Diet, Exercise May Slow Kidney Disease Progression

     Back in 2011 it was reported in Health Day News that, in a scientific study, that shedding pounds may be good for most people, especially for those with kidney disease. The study was published in the Clinical Journal of the American Society of Nephrology. Their review of previously published studies on weight loss through diet, exercise or surgical intervention found that the weight loss had a positive effect on kidney function in obese kidney disease patients.

Traditional weight loss from dieting and exercising cut down on proteinuria — the increased output of protein in the urine — while also preventing kidney function from worsening. The researchers noted these findings in a news release from the American Society of Nephrology. In addition, surgical procedures to induce weight loss helped bring down high filtration rates, a condition that increases disease risk in kidney patients, the studies showed.

The authors of the new
report, led by Dr. Sankar Navaneethan of the Cleveland Clinic, pointed out that their findings were based on their review of only 13 studies, and that a larger, more long-term look at weight loss and kidney function in obese kidney disease patients should be completed before definitive conclusions are drawn.

The following is an abstract from the Department of Epidemiology of the University of Pittsburgh. The authors looked at the association between physical activity and kidney function as part of the National Health and Nutrition Examination Survey.

Abstract

INTRODUCTION:

Chronic kidney disease is a condition characterized by the deterioration of the kidney’s ability to remove waste products from the body. Although treatments to slow the progression of the disease are available, chronic kidney disease may eventually lead to a complete loss of kidney function. Previous studies have shown that physical activities of moderate intensity may have renal benefits. Few studies have examined the effects of total movement on kidney function. The purpose of this study was to determine the association between time spent at all levels of physical activity intensity and sedentary behavior and kidney function.

METHODS:

Data were obtained from the 2003-2004 and 2005-2006 National Health and Nutrition Examination Survey, a cross-sectional study of a complex, multistage probability sample of the US population. Physical activity was assessed using an accelerometer and questionnaire. Glomerular filtration rate (eGFR) was estimated using the Modification of Diet in Renal Disease study formula. To assess linear associations between levels of physical activity and sedentary behavior with log-transformed estimated GFR (eGFR), linear regression was used.

RESULTS:

In general, physical activity (light and total) was related to log eGFR in females and males. For females, the association between light and total physical activity with log eGFR was consistent regardless of diabetes status. For males, the association between light and total physical activity and log eGFR was only significant in males without diabetes.

CONCLUSIONS:

When examining the association between physical activity, measured objectively with an accelerometer, and kidney function, total and light physical activities were found to be positively associated with kidney function.

Kidney Disease Patients Can Benefit From Exercise

     It was recently reported in Health Day News that researchers have found that exercise can be safe and effective in people with kidney disease, even if they have other related health problems, such as high blood pressure or diabetes.

According to the new study, a structured exercise and lifestyle program can improve kidney patients’ fitness, body composition and heart health, and this type of regimen can be offered to kidney disease patients with other co-existing medical conditions.

The program included 150 minutes a week of moderate intensity exercise and group counseling about behavior and lifestyle changes. A health care team including a kidney specialist, a nurse practitioner, an exercise physiologist, a dietitian, a diabetes nurse and a psychologist were involved in helping the patients keep on track, the researchers explained in a news release from the American Society of Nephrology.

A total of 83 patients with chronic kidney disease were randomly assigned to either take part in the program or receive usual care.

When the study began, only 45 percent of the participants were able to meet the exercise capacity expected for their age group. Patients who took part in the exercise program for one year showed an 11 percent increase in their maximal aerobic capacity, while those in the usual care group had a 1 percent decrease.

Patients in the program also had small but significant amounts of weight loss, according to the study published online in the Clinical Journal of the American Society of Nephrology.

“We demonstrated that this could be done safely in spite of patients having a number of other health problems. This was in part because of the expertise of the multidisciplinary team who frequently adjusted diabetic and blood pressure medications,” study author Dr. Nicole Isabel of Princess Alexandra Hospital and University of Queensland in Australia said in the news release.

Importantly, patients in the exercise group also showed improved heart function. People with chronic kidney disease have a high risk of premature death from heart disease, the study authors noted.

Erin Howden, also of Princess Alexandra Hospital and University of Queensland, stated that the, “findings suggest that with the inclusion of structured exercise training and the right team support, improvements in fitness are achievable even in people with multiple health issues.”  And Howden added in the news release: “Improvements in fitness translate not only to improved health outcomes, but result in gains that are transferable to tasks of everyday life.”

However, before it can be determined that this type of program can help reduce kidney disease patients risk of dying prematurely from heart disease, larger studies with longer follow-up are needed, Howden said.

About 60 million people worldwide have chronic kidney disease.

Exercise and Chronic Disease: Get the facts

 [What you can do]

     What follows was put together by Mayo Clinic staff: “If you have a chronic disease — such as heart disease, diabetes, asthma, or back or joint pain — exercise can have important health benefits. However, it’s important to talk to your doctor before starting an exercise routine. He or she might have advice on what exercises are safe and any precautions you might need to take while exercising.

Find out what you need to know about exercise and chronic disease.

How can exercise improve a chronic condition?

If you have a chronic condition, regular exercise can help you manage symptoms and improve your health.

For example:

  • Heart disease. Strength training can improve muscle strength and endurance, make it easier to do daily activities, and slow disease-related declines in muscle strength.
  • Diabetes. Regular exercise can help insulin more effectively lower your blood sugar level. Physical activity can also help you control your weight and boost your energy.
  • Asthma. Often, exercise can help control the frequency and severity of asthma attacks.
  • Back pain. Regular low-impact aerobic activities can increase strength and endurance in your back and improve muscle function. Abdominal and back muscle exercises (core-strengthening exercises) help reduce symptoms by strengthening the muscles around your spine.
  • Arthritis. Exercise can reduce pain, help maintain muscle strength in affected joints and reduce joint stiffness.

What exercises are safe?

Your doctor might recommend specific exercises to reduce pain or build strength. Depending on your condition, you might also need to avoid certain exercises altogether or during flare-ups. In some cases, you might need to consult a physical or occupational therapist before starting to exercise.

If you have low back pain, for example, you might choose low-impact aerobic activities, such as walking and swimming. These types of activities won’t strain or jolt your back.

If you have exercise-induced asthma, you might choose activities that involve short bursts of activity — such as tennis or baseball. If you use an inhaler, be sure to keep it handy while you exercise.

If you have arthritis, the exercises that are best for you will depend on the type of arthritis and which joints are involved. Work with your doctor or a physical therapist to create an exercise plan that will give you the most benefit with the least aggravation on your joints.

How often, how much and at what intensity can I safely exercise?

Before starting an exercise routine, it’s important to talk to your doctor about how long your exercise sessions can be and what level of intensity is safe for you.

If you haven’t been active for a while, start slowly and build up gradually. Ask your doctor what kind of exercise goals you can safely set for yourself as you progress.

 

Do I need to take special steps before getting started?

Depending on your condition, your doctor might recommend certain precautions before exercising.

If you have diabetes, for example, keep in mind that physical activity lowers blood sugar. Check your blood sugar level before any activity. If you take insulin or diabetes medications that lower blood sugar, you might need to eat a snack before exercising to help prevent low blood sugar.

If you have arthritis, consider taking a warm shower before you exercise. Heat can relax your joints and muscles and relieve any pain you might have before you begin. Also, be sure to choose shoes that provide shock absorption and stability during exercise.

What kind of discomfort can I expect?

Talk to your doctor about what kind of discomfort you might expect during or after exercise, as well as any tips for minimizing your pain. Find out what type or degree of pain might be normal and what might be a sign of something more serious.

If you have heart disease, for example, signs or symptoms that you should stop exercising include dizziness, unusual shortness of breath, chest pain or an irregular heartbeat.

What else do I need to know?

Starting a regular exercise routine can be tough.

To help you stick with your routine, consider exercising with a friend. You might also ask your doctor to recommend an exercise program for people who have your condition, perhaps through a local hospital, clinic or health club.

To stay motivated, choose activities that are fun, set realistic goals and celebrate your progress.

Share any concerns you might have about your exercise program — from getting started to keeping it up — with your doctor.”

Dealing with Kidney Disease—An Overview

     I’d like to make it clear in describing this next section that developing guidelines for how to treat any stage of kidney disease is highly individualistic. That is, one size does NOT fit all. This is why what is prescribed for your stage of kidney disease will vary from patient to patient. In addition, even patients with the same stage of kidney impairment will nevertheless receive a highly individualistic treatment plan. What you read next is a set of general guidelines that may not apply to all patients.

General Guidelines

     When you have kidney disease, your kidneys are no longer able to filter waste products and fluids from your blood. You can help control a buildup of these substances by avoiding foods that tend to make the problem worse.

It is also important to make sure you get enough calories. Healthy eating can help control your blood pressure, weight, and cholesterol and blood sugar levels to help slow the progression of kidney disease. Your doctor may recommend calcium supplements or vitamin D for bone health.

Each person has different needs, based on body weight, size, and remaining kidney function. Most people need to limit sodium, fluids, and protein. Some also have to limit potassium, phosphorus, and calcium. A registered dietitian or nutritionist can help make an eating plan that is right for you.

To limit sodium:

  • Make a habit of reading food labels. Avoid foods that list salt (sodium) or monosodium glutamate (MSG) near the beginning of the list.
  • Do not use processed cheeses or canned, pickled, or smoked meats, which may be high in sodium.
  • Do not add salt to your food. Use lemon, herbs, and other spices to improve the flavor of your meals.

To limit protein:

  • Work with a dietitian to develop an eating plan that balances your need for less protein with enough protein to stay healthy.
  • Your dietitian may tell you to limit high-protein foods to 5 to 7 ounces (142g to 198g) a day. A 3-ounce (85g) serving of protein is about the size of a deck of cards.
  • Learn about the sources of protein. Most people know that meats, fish, and dairy products contain protein. They may not know that foods such as breads, cereals, and vegetables also contain protein.
  • Choose high-quality protein, such as lean meat, chicken, fish, cheese, or eggs, in your diet. If you eat tuna, choose water-packed, and rinse it well before eating.

To limit fluid:

  • Do not have more than 48fl oz. of fluids a day. Food that is liquid at room temperature, such as soup, Jell-O, and ice cream, count as fluids.
  • Be aware that some fruits and vegetables contain a lot of water and will count in your fluid intake. Examples include grapes, oranges, apples, lettuce, and celery.

To limit phosphorus:

  • Limit your phosphorus intake to 800 to 1000 mg a day.
  • Limit your intake of dairy products, such as milk, yogurt, or ice cream.
  • Avoid nuts, peanut butter, seeds, lentils, peas, and beans.
  • Avoid drinks such as beer, cola drinks, and cocoa.

To limit potassium:

  • Ask your doctor if it is all right to use a salt substitute. Some people with kidney disease need to limit their potassium intake.
  • Use lemon, herbs, and other spices to flavor your meals. Most commercially available salt substitutes are very high in potassium.

If you are having trouble keeping your weight up, keep the following in mind:

  • You may eat bread, tortillas, and cereals, but avoid bran breads or cereals. Do not eat pretzels, chips, or other salted snack foods.
  • You may use margarine, oil, and mayonnaise to add calories to your diet. Vegetable oils like olive oil, canola oil, or safflower oil are the healthiest choices.
  • Unless you have diabetes, you may use honey and sugar to increase energy and add calories.
  • It is important to continue to eat meals and snacks at regular times.

If you are overweight:

  • Limit the amount of calories you take in daily.
  • Increase your overall physical activity.

How can I stop kidney disease from progressing?

Stopping the progression of chronic kidney disease (CKD) can be as simple as changing daily habits. The most common way kidney disease accelerates is high blood pressure. Exercise and a healthy diet can greatly improve blood pressure, as well as prescription medicines called ACE inhibitors and angiotensin-II receptor blockers. The ideal blood pressure for kidney disease patients is 130/80 or lower. Being under a doctor’s care can help determine if medication is necessary.

Smoking also advances kidney disease and interferes with high blood pressure medicine. According to the American Lung Association, as few as 1 to 4 cigarettes per day nearly triple the risk of death from heart disease. Cigarette smoke contains about 4,000 chemicals, 60 of which are known to cause cancer. The detrimental effects of smoking can multiply the complications for CKD patients.

It’s crucial to take all medication as prescribed by your doctor and keep scheduled doctor’s appointments. Skipping appointments or not taking medication (or taking too much) can reduce the effects of the drug or can be toxic. Half of the people who have chronic kidney disease don’t have symptoms. Unlike other conditions, feeling healthy doesn’t mean kidney disease is cured. CKD needs to be monitored regularly. It’s also very important to tell a doctor about over-the-counter medications and vitamins. Anti-inflammatory drugs including ibuprofen can be harmful to kidneys and multivitamins can cause spiked potassium levels.

How kidneys age

Kidneys are similar to skin. They both show signs of age. Even the healthiest person will most likely lose a bit of kidney function due to the natural process of growing old. How fast a person ages can be up to them. If the skin is exposed to too much sun, cigarettes, alcohol, abusive behavior or an unhealthy diet, it wrinkles quicker. Similarly, kidneys can be treated well to help maintain function. Unfortunately, chronic kidney disease can never get better, but you can help maintain and even prolong kidney function.

Exercise and diet are important tools to maintain health

Exercise is an excellent way to maintain a healthy body weight. Being overweight can lead to high blood pressure. By lowering blood pressure, it helps reduce the progression of kidney disease. Other benefits to exercise are building body strength and according to USA Today, can improve memory. Exercise increases the supply of oxygen to the brain, which helps expand memory. Walking 30 minutes a day can help provide better physical and mental health.

A proper diet is crucial to help lower blood pressure and aid kidney function. Here are some dietary considerations that should be discussed with your doctor:

  • Protein – A protein heavy diet can strain kidney function. Protein includes: meat, fish, cheese, eggs, milk and nuts. Ask your doctor or a dietitian how much protein you should have each day to help prolong kidney function and maintain good health.
  • Alcohol – Too much alcohol can increase blood pressure, interfere with medicines, prevent kidneys from maintaining proper fluid and mineral balance, and lead to dehydration. While alcohol in moderation can be okay, ask your doctor if it is okay for you to drink alcohol.
  • Fluids – Fluid can build-up in CKD patients when kidney function declines. People on dialysis are generally given a fluid restriction, which includes foods such as: jelly, ice cream, milk on cereal, porridge, pudding, soup, gravy and sauces. Your doctor or dietitian will let you know if you need to restrict your fluid intake.
  • Sodium – A salty diet can increase blood pressure and lead to thirstiness. A high-sodium diet can make a fluid restriction difficult. Talk to your doctor about how much sodium you can have each day and ask your dietitian for tips on eating a low-sodium diet.
  • Potassium – When kidneys aren’t functioning properly, they cannot get rid of potassium in the blood. High levels of potassium can be dangerous to the heart. You may be instructed to limit high-potassium foods. Some foods high in potassium are: bananas, potatoes, tomatoes, kidney beans and milk products.
  • Phosphorus (phosphate) – It’s a mineral found in the bones. Kidneys normally get rid of excess phosphorus, which can cause thinning of the bones, joint pain and can damage blood vessels. As kidney function declines, you may be instructed to limit phosphorus intake. Some foods containing high levels of phosphate are: colas, chocolate, citrus candy, processed meats,      mayonnaise and hot dogs. People on dialysis are usually prescribed phosphorus binders, or phosphate binders, to absorb the phosphorus in the gastrointestinal system so it doesn’t get into the bloodstream.
  • Cholesterol – Foods high in cholesterol, including red meat and dairy, may need to be reduced to protect your heart.
  • Triglycerides –Triglycerides are a type of fat. People who have kidney disease often have higher triglyceride levels. Foods that contain high triglyceride are alcohol, fried foods, fast foods, prepackaged snack foods, sugary foods,fruit juices and energy bars.

Follow your doctor’s advice and take prescribed medicines

Several conditions may accompany kidney disease and can be helped with prescription medication. The following conditions can be treated by your doctor:

  • Fluid overload – It can cause swelling throughout the body and shortness of breath.
  • High blood pressure – Causes blood vessel, kidney and heart damage, which can lead to stroke, heart disease and circulation problems.
  • Anemia – A deficiency of a hormone produced by the kidneys to stimulate red blood cell production from the bone marrow.
  • Bone disease – A serious problem for CKD patients that causes joint pain and bone fractures.
  • Acidaemia – An excess of acid waste in the blood.
  • High cholesterol – It can lead to increased risk of heart disease.
  • High triglycerides – May lead to high blood pressure and increase risk of heart disease.

Post Script

Learning about chronic kidney disease, being aware of resources available for people with CKD and making healthy lifestyle choices can help you get the support you need to help slow the progression of chronic kidney disease.

In the meantime while scientists are pursuing finding a cure for many of the diseases that are out there (heart disease, kidney disease, liver disease, diabetes, etc.) it is perhaps more important for everyone to adopt a few positive steps they can take ownership of: There are no guarantees in life, but you can do something very important if you are ever diagnosed with a disease: (1) maintain a very positive attitude, (2) be tenacious and a good steward of your own life (take personal responsibility for your health with a proactive take-charge attitude), and (3) adopt a healthy lifestyle, eat right, and become very physically active. Do it for your family and friends, but above all do it for you.

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Introduction

This is Part I of a two-part series on diabetes in America. Part I is intended to provide a portrait of this disease in terms of types of diabetes, the epidemiology of diabetes, its prevalence and who is at risk for the disease. I will also describe my personal experience with diabetes, and provide a better understanding of the roots causes of diabetes, based on our current state of knowledge.

 In Part II of this series I will describe the Vegan Diet, what it is, how it differs from other forms of a vegetarian diet and the many benefits of a Vegan diet, including reversing diabetes and related medical problems.

 As a society we’re closing in on the root causes of this disease and improving its management all the time. There is absolutely new hope for those who suffer from this disease, and there are great steps being launched to prevent it. Like any other thing we do in life—unlocking the mystery of diabetes requires two things: (1) research is the key and (2) human determination and intelligence are the underlying forces for turning that research key in the right direction.

For purposes of this Blog there are two components to understanding the disease of diabetes: (1) Understanding the epidemiological facts surrounding this disease, and (2) Understanding what may be the root causes of diabetes and how one in the 21st century might better treat and deal with this, at times, dreadful disease. Before launching into the epidemiological facts of the disease and its root causes, I would like to share with you my own experience with this disease. I will then launch into describing the types of diabetes, epidemiological facts, followed by its root causes.

Connections

I have a family history of diabetes.  My father had diabetes (he died at 57 in 1963) and my older brother (age 73) has diabetes. In terms of pre-diabetes, I was 37 years old when a test for glucose tolerance first revealed there was something wrong with my body’s ability to control blood glucose, i.e., blood sugar. This news gave me ample warning that one day I might develop diabetes. Nevertheless, I was slow to react to the news. I didn’t do anything in response to it like suddenly engage in daily exercise, or convert immediately to a more healthy diet. Instead, I continued on my “Fat-food Buffet of Life” with my own special, “See Food diet” i.e., whenever I saw food— I ate it. Eleven years later in 1991 at the age of 48, I paid the ultimate price—I was officially diagnosed with Type II diabetes.

I cleaned up my act for six weeks then fell back upon old habits. In the early to mid-1990s I struggled with seriously coming to grips with my own “up and down” approach to diet and exercise. I had all the excuses, and was lying to myself regarding my efforts to fight this disease. I was constantly struggling with inconsistency in both proper diet and exercise. And such inconsistency led to improvement one month, only to be followed by less successful control the next. As a result, in 1999, I finally had to go on medication (oral hypoglycemics) to get my blood sugar under better control. And, indeed, the medications actually did a very good job in helping me to maintain better blood sugar control.

 By this time I was actively engaged in utilizing the American Diabetes Association’s standard diet which emphasized a low-fat, more complex carbohydrate diet. That was a step in the right direction as it brought my HA1c down from a range of 8.5 to 9 to a better level, 7.5. However, animal protein was still part of the menu (generally, lean cuts of meat, as well as fish and chicken). And, in many recipes it still called for dairy products like eggs, cheese, yogurt and milk (my preference 1%).

In 2006, I started a low carbohydrate diet and would eat in restaurants a lot less often. I started to lose weight 8-12 lbs and was feeling I was really on the right track. My HA1c was bouncing up and down between 7.0 and 7.3. Nevertheless, up until August of 2009, I was still a couch-potato. I started a program of walking 30 minutes a day 5-6 times a week. Where I live there is a beautiful park so it was very pleasant to use the park as my walking course. In January 2010, I began to expand my exercise horizons. That is, I became a member of USA Track & Field and became actively involved in the Master’s Senior Olympics. I still continued, despite the low-carb diet, to use recipes that called for animal protein and fat along with additional fat consumption via the dairy products that I loved so much.

 I now want to tell you about a new way of eating that I think is an improvement for diabetics to follow. It is a Vegan Diet. At the beginning of 2011—I became a Vegan. It’s new to me, but it is a very ancient approach where plant protein sources are the mainstay of eating, not animal sources of protein. Instead of using the old food pyramid the Vegan diet utilizes just four food groups: grains, legumes, vegetables, and fruits.

 A Vegan diet is a stricter form of Vegetarianism, as the latter is a matter of degree to which certain foods are included or excluded regarding animal protein and various dairy products. Typical might be the ovo-vegetarian where dairy products, meat, fish, and fowl are excluded, however, they will still eat eggs. Instead of going into great detail on a Vegan Diet in Part I, I’d rather refer you to an excellent book on the subject that I acquired in December, 2010. The name of the book is, “Dr. Neal Barnard’s Program for Reversing Diabetes.”  This book will provide you with all the detail you need (including the research on which the book’s recommendations are based) in order to get started with a Vegan diet. And, as always, see your physician before embarking on any serious changes to your diet or activity level.

What I’d prefer to do with the rest of the Blog is, as they say, cut to the chase. The question running through your mind is, or should be—why should you do this? What’s so important about making a drastic change in the way one eats and going vegan?  To answer that question I’ll share with you research and the benefits of the vegan diet. For now, I just want to share with you my own personal experience with the vegan diet. For me, I’ve lost 1+1/2 lbs a week since the start of the new year; and my Lipid Profile is outstanding (Total Cholesterol is now 139, HDL is 45, LDL is 67, and Triglycerides are 135).

 In Part II of this series I will provide you with details on what a Vegan diet is all about, including all of its benefits that are known at this time. I want to add that it is also important for the general public as well (not just diabetics) to consider making dietary changes to the Western diet and way of eating. The health of the nation may well depend heavily upon making changes to the way we approach eating food.

Lobbyists in Washington are working very hard, on behalf of certain industries (dairy, cattle, fast foods, etc.) to keep things as they are and maintain a policy of praying at the altar of the all-mighty dollar. Your health and well-being isn’t even a tertiary consideration.

In ending Part I want to describe the root causes of diabetes. For hundreds of years diabetes was thought to be a very mysterious disease whose causes were unknown. Doctors, other health professionals, and those affected by the disease (including close family members) saw the havoc diabetes had on the lives of millions of people; but understanding how this disease comes about and how the human body works was quite another matter. However, in the last 10-15 years our knowledge on the causes of diabetes is beginning to form a picture. As said before, research is the major key to unlocking the mystery of diabetes. I don’t mean to oversimplify what I’m about to present—but I think it provides a clearer picture on the causes of diabetes. While not all pieces of the puzzle are known at the biochemical, cellular, and genetic levels, the following is what we do know.  

 Types of Diabetes

 There are basically three types of diabetes. They are Type 1, Type 2, and Gestational Diabetes. They are defined as:

 

Type 1This type of diabetes usually manifests itself in childhood or young adulthood. It used to be called childhood-onset or insulin-dependent diabetes. In Type 1 diabetes, something has damaged the pancreas’s ability to produce insulin; therefore there is a need to take insulin, usually by injection. As Dr. Neal Bernard explains in his book, Dr. Neal Bernard’s Program for Reversing Diabetes, it is an autoimmune disease because the damages done to the insulin producing cells of the pancreas are attacked by the body’s own white-blood cells, those substances that are supposed to fight bacteria and viruses. More will be reported later on what triggers that process.

Type 2—This type of diabetes affects 9 out of every10 individuals who are diagnosed with the disease. This used to be called adult-onset diabetes, or sometimes non-insulin-dependent diabetes. Most people with this form of the disease still produce insulin; the problem is that their cells resist it. Insulin tries to bring glucose into the cells, but the cells respond like a door with a malfunctioning lock. In response to these sluggish cells, your body produces more and more insulin, trying to overcome the resistance. If the body’s insulin supply cannot overcome the resistance, glucose simply builds up in your blood. More will be reported later on how to overcome insulin resistance.

Gestational Diabetes —This type of diabetes is similar to Type 2 except that it occurs in women during pregnancy. While it typically disappears after childbirth, it is a sign of insulin resistance, and that means that type 2 diabetes may be around the corner. Steps taken to prevent Type 2 diabetes may be useful also for those women who have gestational diabetes. Two things women should do post-pregnancy is continue monitoring their blood sugar, and give strong consideration to implementing a more healthy lifestyle, and especially—a more healthy diet.  As always, see your primary-care physician first.

The Epidemiology of Diabetes

Epidemiological Facts

 The data presented here are from the 2007 National Diabetes Fact Sheet (the most recent year for which data is available).

Total: 23.6 million children and adults in the United States—7.8% of the population—have diabetes.

Diagnosed: 17.9 million people

Undiagnosed: 5.7 million people

Pre-diabetes: 57 million people

New Cases: 1.6 million new cases of diabetes are diagnosed in people aged 20 years and older each year.

Total Prevalence of Diabetes

Under 20 years of age

  • 186,300, or 0.22% of all people in this age group have diabetes
  • About 1 in every 400 to 600 children and adolescents has type 1 diabetes
  • About 2 million adolescents aged 12-19 have pre-diabetes

Age 20 years or older

  • 23.5 million, or 10.7% of all people in this age group have diabetes

Age 60 years or older

  • 12.2 million, or 23.1% of all people in this age group have diabetes

Men

  • 12.0 million, or 11.2% of all men aged 20 years or older have diabetes

Women

  • 11.5 million, or 10.2% of all women aged 20 years or older have diabetes

 

Race and Ethnic Differences in Prevalence of Diagnosed Diabetes

After adjusting for population age differences, 2004-2006 national survey data for people diagnosed with diabetes, aged 20 years or older include the following prevalence by race/ethnicity:

  • 6.6% of non-Hispanic whites
  • 7.5% of Asian Americans
  • 11.8% of non-Hispanic blacks
  • 10.4% of Hispanics

Among Hispanics rates were:

  • 8.2% for Cubans
  • 11.9% for Mexican Americans
  • 12.6% for Puerto Ricans.

 

Morbidity and Mortality

Deaths

Diabetes was the seventh leading cause of death listed on U.S. death certificates in 2006. This ranking is based on the 72,507 death certificates in 2006 in which diabetes was listed as the underlying cause of death. According to death certificate reports, diabetes contributed to a total of 233,619 deaths in 2005, the latest year for which data on contributing causes of death are available.

 Complications

Heart Disease and Stroke

• In 2004, heart disease was noted on 68% of diabetes-related death certificates among people aged 65 years or older.

• In 2004, stroke was noted on 16% of diabetes-related death certificates among people aged 65 years or older.

• Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes.

• The risk for stroke is 2 to 4 times higher among people with diabetes.

 

High Blood Pressure

• In 2003–2004, 75% of adults with self-reported diabetes had blood pressure greater than or equal to 130/80 mmHg, or used prescription medications for hypertension.

Blindness

• Diabetes is the leading cause of new cases of blindness among adults aged 20–74 years.

• Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year.

 Kidney Disease

• Diabetes is the leading cause of kidney failure, accounting for 44% of new cases in 2005.

• In 2005, 46,739 people with diabetes began treatment for end-stage kidney disease in the United States and Puerto Rico.

• In 2005, a total of 178,689 people with end-stage kidney disease due to diabetes were living on chronic dialysis or with a kidney transplant in the United States and Puerto Rico.

 Nervous System Disease (Neuropathy)

• About 60% to 70% of people with diabetes have mild to severe forms of nervous system damage.

Amputation

• More than 60% of non-traumatic lower-limb amputations occur in people with diabetes.

• In 2004, about 71,000 non-traumatic lower-limb amputations were performed in people with diabetes.

Cost of Diabetes

$174 billion: Total costs of diagnosed diabetes in the United States in 2007

  • $116 billion for direct medical costs
  • $58 billion for indirect costs (disability, work loss, premature mortality)

After adjusting for population age and sex differences, average medical expenditures among people with diagnosed diabetes were 2.3 times higher than what expenditures would be in the absence of diabetes.

The American Diabetes Association has created a Diabetes Cost Estimator that takes the national cost of diabetes data and provides estimates at the state and congressional district level.

Factoring in the additional costs of undiagnosed diabetes, pre-diabetes, and gestational diabetes brings the total cost of diabetes in the United States in 2007 to $218 billion.

• $18 billion for the 6.3 million people with undiagnosed diabetes
• $25 billion for the 57 million American adults with pre-diabetes
• $623 million for the 180,000 pregnancies where gestational diabetes is diagnosed

For Additional Information

These statistics and additional information can be found in the National Diabetes Fact Sheet, 2007, the most recent comprehensive assessment of the impact of diabetes in the United States, jointly produced by the CDC, NIH, ADA, and other organizations.

 The Root Causes of Diabetes

 Many people believe that genetics plays the most important role in determining who gets diabetes and who doesn’t. We now know that this isn’t necessarily the case. Why? It’s because environmental factors and human behavior also play a significant role in diabetes. For example, there have been many studies conducted on Twins particularly in psychology so that greater knowledge could be found that better explained heredity versus the environment.  And many Twin studies have been conducted in the field of medicine as well.

Twins have the same genes. Yet, if one twin is diagnosed with diabetes, the other twin should develop the disease if genes are so determinative of disease causation. This however is not the case. The other twin only has a 40% chance of developing diabetes.

Other factors are involved. And, whether someone lives a long life obviously depends on both individual behavior and environmental factors.

Individual behavior, of course, really matters. Recently, the exercise and fitness icon/guru Jack Lalaine died at the age of 96. Jim Fixx, the famous runner of the 1980s, should have died earlier in life if genetics determined everything (His father died of a heart attack at 43). By my standards Jim Fixx also died young; he was only 52 years old. But he still outlived his father by 9 years because of his personal fitness as a marathon runner.

What implication then does environment and behavior, as causal factors, have on the prevalence of diabetes?  As most of you probably know epidemiology is the study of the prevalence and incidence of disease. It is a kind of sociology of medicine where large population studies take place. And, like the research field of psychology or sociology, the research conducted in epidemiology is extraordinarily important.

What I’m presenting in this Blog is only a short summary overview of the causation of diabetes.  

 Epidemiological Clues to Diabetes Begin to Form 

The most common treatment approach for decades has been the diabetic diet and exercise. Lots of exercise is always good and the exercise revolution went into high gear four decades ago. Besides exercise (30 minutes a day most days of the week) the basic recommendation of the medical community was to follow the ADA’s diabetic diet that included very little sugar and limited starchy foods such as bread, potatoes, rice, and pasta. This was logical since starch breaks down into sugar in your digestive track. Diabetic diets generally cut calories so one could simultaneously lose weight and limit certain fats. This would help to reduce heart disease and other complications. Over time however weight loss was generally modest and the diet itself was not enough to bring blood sugar down under excellent control.

 The first clue that something was amiss came from the field of epidemiology based on studies from other cultures. Large population studies revealed that diabetes was rare in Japan, China, Thailand, and other Asian countries. It was also found to be quite rare in parts of Africa. Such studies were showing something else. That is, people in countries where diabetes was rare or uncommon were not following anything like the diabetes diet. The typical Asian diet (and in Africa) did not avoid carbohydrates and included rice and other grains, starchy vegetables, bean dishes, and noodles.

 Despite eating lots of carbohydrates (much more than among North Americans or Europeans) diabetes was relatively rare. Among the Japanese eating their traditional Japanese diet the prevalence of diabetes is 1 percent. Among Americans the prevalence is 30 percent. However, when Japanese move to North America their risk of acquiring diabetes dramatically increases as does their risk of heart disease, obesity, and other medical problems.

 Unfortunately for Japanese living in their homeland, the American way of eating has finally come to them; they now have Burger King, McDonalds, and KFC. Meat, cheese, and other greasy foods, and other Western eating habits, are replacing rice and vegetables.  It turns out that the genes that allow diabetes to occur are surprisingly common among the Japanese, but as long as they stuck to their traditional diet, the disease was held mostly in check.

 The inescapable fact is that the problem is not a diet of lots of carbohydrates (sugar and starch). The causal problem is actually how the body processes them. Type 1 diabetes has an additional problem that I explain below.      

Cause of Type 1 Diabetes

It turns out Type 1 diabetes occurs because of what might be called “friendly fire.” This is the current explanation:

For many years researchers have known that type 1 diabetes occurs when the immune system attacks and destroys the insulin-producing cells in the pancreas. Your immune system, of course, is your defense against viruses, bacteria, and cancer cells. It is not supposed to attack your own healthy tissues, but that is exactly what occurs in type 1 diabetes.

As you probably know your immune system is made up of specialized white blood cells. Evidently, some of the cells engulf invading germs and digest them. Others make antibodies—molecules that attach to invading organisms like harpoons and identify them for other immune cells to attack. If you have Type 1 diabetes, your immune system has made a major error. It has attacked and destroyed your insulin-producing cells, making it what scientists call an autoimmune disease.

Everyone’s question has been—why does this occur? In 1992 a team of Canadian and Finnish researchers reported on an important discovery in the New England Journal of Medicine. They examined the blood samples of 142 children newly diagnosed with Type 1 diabetes. They found that each of the children had antibodies that were primed to attack cow’s milk proteins.

These antibodies had apparently arisen in response to cow’s protein in their infant’s formula, but the antibodies were also capable of attacking the body’s insulin producing cells in the pancreas. A portion of the cow’s milk protein turned out to be an exact match for a portion of human insulin-producing cells. The antibodies thus ended up attacking the children’s insulin-producing cells. This biochemical reaction led to the children being diagnosed with Type 1 diabetes.

Cause of Type 2 Diabetes

 

All humans need energy to live. Consequently, every cell in the body needs energy, including cells in our large muscle groups. How do our cells get this energy? Normally, the foods we eat provide that energy. The food is then converted to blood glucose (blood sugar) and leads to circulation in our blood stream. The pancreas produces a hormone called insulin, and sends it into your bloodstream to travel to the various cells of the body. Insulin then attaches to a receptor on the cell’s surface and causes the cell membrane to permit blood glucose to enter. In Type 2 diabetes this system doesn’t work very well. The insulin gets to each cell; however, when it arrives, it has trouble unlocking the door to each cell and then the cell fails to permit the glucose to enter. Since glucose cannot get into the cells, it then builds up in the bloodstream. This condition is called Insulin Resistance.

The mystery of Type 2 diabetes has always been to find out why Insulin Resistance occurs. We now have a pretty good idea of the cause. So, what is the cause of Type 2 diabetes? Insulin’s ability to work is blocked in the human cell (like gum jamming up a lock as the metaphor suggests) by actual FAT. The cell’s receptors are blocked or jammed by fat. Normally small amounts of fat are stored for energy in an emergency in each cell. However, in a diet (like the Western diet high in fat and cholesterol) excessive fat builds up in each cell creating the jamming process that prevents glucose from entering. If fat, called intramyocellular lipid, accumulates inside the cell, it interferes with insulin’s intracellular signaling process. Tiny organelles, called mitochondria, are supposed to burn fat. But their failure to keep up with the accumulating fat may be the origin of Type 2 diabetes. Fortunately, evidence shows that diet can reduce the amount of fat inside the cell. And, once excess fat is removed, insulin resistance greatly improves by once again allowing blood sugar to enter the cell.

My initial reaction to all this new information was to ask myself why not, rather than diet, find a way to simply increase the important mitochondria in the body first? Bright ideas aren’t quite so bright sometimes, especially when talking about bio-chemistry of the human body. What happens is that, through diet, one can easily add excessive fat (as we do in the American diet).  Traces of fat begin accumulating many years before diabetes manifests itself. Our genes in the body at the cellular level are a blueprint for mitochondria.

It turns out fatty foods actually do more than add excessive fat to each cell—they also interfere by turning off the genes that would help them create mitochondria and thus burn fat. The genes become disabled and do not allow the cells to produce the needed mitochondria. Your ability to eliminate fat inside your cells seems to slow down when you eat fatty foods. Continue this faulty intracellular activity long enough, and guess what—you end up being diagnosed with Type 2 diabetes.  

At the Imperial College of Medicine in London, researchers studied a group of individuals following a vegan diet. They compared the participants to others who were similar in age and body weight but were not following a vegan diet. When the researchers measured the intramyocellular lipid in each participant’s calf muscles, they found it was 31 percent lower in the vegans than in the omnivores. These findings strongly suggest that a vegan diet may significantly alter the problem of insulin resistance.

In Part II of my series on Diabetes in America, I will present details on what a vegan diet is. If you combine exercise with the vegan diet, you will possess two tools to create a permanent one-two punch that will knock diabetes to the canvas while the referee for a healthy life counts it out.

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