Herbal Health » Diabetes

DIAGNOSTIC CRITERIA OF GESTATIONAL DIABETES MELLITUS (GDM), HEMOGLOBIN A1C AS A DIAGNOSTIC TEST & PRE-DIABETES

admin — Wed, 08 Jun 2011 08:44:49 +0000

Gestational Diabetes Mellitus (GDM)

Screening test: 50 gm oral glucose load, with 1 hour value s 140mg/dl. The ADA recommends that the test be done between weeks 24 and 28 of pregnancy. The American College of Obstetrics and Gynecology (ACOG) recommends that all pregnant patients be screened and that the 1 -hour value of 130 (90% sensitivity) or 140 mg/dl (80% sensitivity) be used as the threshold for diagnostic testing. According to the ADA guidelines, testing is optional in low-risk groups: age < 25 years, normal body weight, no family history of diabetes, and not a member of an ethnic/racial group with a high prevalence of diabetes (Hispanic, African-American, Asian, Native American).

Diagnostic test: 100 gm glucose orally (if screeningiest is abnormal)

Time fasting Plasma glucose (mg/dl)

Diagnosis of GDM: Any 2 of the 4 plasma glucose values meet or exceed above values.

Hemoglobin A1c as a Diagnostic Test

Pro: (1) Has a frequency distribution like FPG or 2-hour PG.

(2) Studies have established a level above which the likelihood of developing retinopathy and nephropathy increases dramatically. This level is approximately 6.0%. Con: (1) Many different methods; limited standardization; limited world-wide availability. (2) Imperfectly correlated with FPG, 2-hr PG. Conclusion: HbA1 c is not recommended as a diagnostic test at present.

Pre-diabetes

A new condition; pre-diabetes, was defined by the ADA in 2002. A person with IGT or impaired fasting glucose (1FG: fasting glucose of 110-125 mg/dl) is now defined as having pre-diabetes. Such people are at high risk for developing diabetes in the next decade and have an increased risk for coronary heart disease. The ADA has estimated that about 12 million people in the U.S. have pre-diabetes.

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THE CARBOHYDRATE ADDICT’S PROFILE: DON’T PULL THE TRIGGER

admin — Mon, 11 Apr 2011 17:01:29 +0000

In the carbohydrate addict, individual triggers—sometimes situations or stressful events—can affect the body’s biochemistry. There may be an effect upon the neurotransmitter balance in the brain, which controls the experience of hunger and satisfaction and therefore the complex mechanisms involved in fat storage. This translates to a difficulty in losing weight or an increased or recurring hunger.

In general, weight-loss programs that do not treat the cause of carbohydrate addiction do not address such triggers. Most programs are unable to help the dieter to counteract them. The result is that carbohydrate addicts find themselves trying to cope with strong impulses to eat or snack with no alternative strategy available to help.

Some particularly strong-willed people are able to resist for a short time the urge to snack, eat, or binge. If the trigger situation or stress continues for a prolonged period, however, few carbohydrate addicts are able to withstand the resulting drive to eat. When several different trigger situations or stresses occur one after another or even simultaneously, they seem to have a multiplying effect, making it even more difficult to resist that powerful urge to eat. The Carbohydrate Addict’s Diet was designed to help the carbohydrate addict reduce the recurring desire to eat that is brought on by these triggers. The eating plan that makes up the diet was especially designed to reduce the hormonal backlash that the triggers can bring on.

Almost all of the carbohydrate addicts with whom we have worked over the years have found that they are better able to handle everyday stresses and strains with less anger, internal conflict, and aggravation when using the diet. When they put it to use, our dieters experience the benefit of a more balanced system. The system itself acts to enable carbohydrate addicts to deal with trigger situations or stresses and help them to stay firmly in control.

There are different triggers for different people, as the stories of Adrian, Mary, and the others that follow suggest.

Adrian’s Story

Adrian looked frazzled the first time she came to see us. Attractive and well groomed, Adrian was in her late forties, but her pent-up tension and anger made her look older.

“If I were an alcoholic, we would say that my boss was driving me to drink. Instead, he’s driving me to eat. I don’t mean this as an excuse, but I really feel that he’s making me eat.

“I am so angry at him, I tear into food. I literally bite into a roll like I’m biting into him. I don’t leave my anger at the office, either. I bring it home with me and overeat at home, too.”

Adrian looked sad and hopeless as she told us, “I’m stuck. I can’t leave the job.” With a child in college and another in law school, she and her husband needed the money. Yet her physician had found her blood pressure had grown dangerously high, and she had put on twenty pounds since taking her high-pressure job. “I have more food in my drawers than the guy on the coffee cart. I’m getting to the point that I stuff my face without even knowing what I’m eating,” she said.

Adrian lost her weight and regained control of her eating— though it took a confrontation with her boss, as well as the Carbohydrate Addict’s Diet, to do it.

Mary’s Story

One of the most frequent addiction triggers for the women we work with are changes that occur immediately before the monthly onset of menstruation. Mary O.’s case is typical.

Mary made her appointment several weeks in advance. “I want to come and see you when I’m in the middle,” she told us on the phone. “I want you to see how bad it is.”

When she arrived, we were struck almost immediately by her anger. She was frustrated at her plight—and she had a deep sadness about her. It became apparent that she was very tired of fighting and feeling frustrated at her periodic loss of control.

“Four, five, maybe six days a month, I’m a mess. I’m miserable. And I can’t stop eating. I eat everything in sight. I’m like a crazy person. I’ve given up even trying to control myself. And I end up starving myself the rest of the month to try and limit the damage I’ve done during these few days.

“Nobody seems to be able to do anything to help me. They all agree that it’s probably hormonally related, but nothing they have done has helped. If you could just help me to stop eating, maybe I could get the other things under control.”

She unburdened herself of her fears. “I feel like my life is falling apart. It’s not getting better. If anything, it feels like it’s getting worse.”

The result of Mary’s Carbohydrate Addict’s Test placed her in the severe range during her premenstrual days, so we recommended she start on the Carbohydrate Addict’s Diet immediately.

She was reluctant at first because we advised her to remain on the diet all month long, not just on the days when she usually experienced her eating problems. She said when she decided to come to us that she had “hoped this diet was only going to be necessary during those four or five days.

We finally convinced her to try the diet full-time by explaining that a balanced eating program was necessary all month long. Only by its sustained use could the diet help her reduce or even eliminate the swings of mood and eating that she had experienced.

Mary called us within days; her own words speak most clearly for the results. “Why didn’t you tell me it would be like this?” she exclaimed. “I feel better than I have in years. Better than I ever felt. I can’t believe it. I wouldn’t go off this diet on a bet.

“The cravings are gone. I’m losing weight, and I never lose weight at this time of the month. I feel human again. It’s like I’m not expecting it at all.”

Chris’s Story

Chris L. presented us with a different kind of problem. She was a carbohydrate addict all right, her test scores revealed that. What wasn’t so apparent was the reason why.

“You have to understand that a couple of years ago my test results would have been entirely different,” she told us. “Something’s changed and, so help me, it’s making me a carbohydrate addict.”

Like detectives, we tried to trace the changes that had taken place in Chris’s life that might have set off an addictive response. At first, the only life event that seemed to correlate with her change in eating habits was that she had moved to a new apartment on her own, after having lived with roommates.

We asked her to keep a food diary to help us pinpoint the culprit. She was to note everything she ate, the times and places she ate, and the level of her hunger. Sure enough, a pattern emerged. When she ate with other people, whether it was at a restaurant, at her home or theirs, or at work, she didn’t experience the drive to eat. But when she ate alone, she often felt the compulsion to eat. But that still wasn’t the whole story, because it didn’t always happen when she ate alone.

Another week of keeping her food diary offered the answer. Her addictive response to food invariably occurred after eating at a restaurant in her neighborhood. She always ate alone there; it was kind of a second home for her. The people knew her, she liked the food, and she felt comfortable there.

We asked Chris to experiment. The test worked: when she stayed away from the restaurant for a week, her cravings stopped, confirming her and our suspicions. But we all wanted to know exactly what was the cause. A talk with the head cook provided the answer.

We had briefed her on food sensitivities, on the several foods and additives that we had found had brought about an addictive response in other people with whom we had worked. Chris called the next afternoon.

“Bingo.” She laughed with relief. “We got it. It’s MSG. Monosodium glutamate. They put it in the casseroles, they put it in corned beef hash, they put it in the vegetables.” Her trigger was the additive MSG, which is often used in preparing Chinese cuisine but may also be present in a variety of other foods, among them salad dressings.

Chris L. eliminated monosodium glutamate from her diet; with that gone, her cravings disppeared as if by magic.

We’ve had people who, because of changes in their daily habits, found themselves snacking and gaining weight. One recently widowed woman had begun spending time with a group of women in her building. They played cards, went to the movies, lunched, and dined together. This also meant a significant change from her previous eating history. She had kept her husband company at meals, she told us, but “food was never very important to him, and not to me either.” When she suddenly found herself around food all the time, she started eating a lot more than she ever had.

Another woman who came to us drank quantities of a certain diet soda that triggered her carbohydrate addiction. Caffeine seemed to be the culprit in her case. Other people, too, have found that changing seasons seem to provoke an addictive response—the cravings and the pounds accumulate in the fall and winter and they struggle (but fail) to take them off in the spring.

These varied problems suggest how everyday foods, activities, and other factors can trigger a carbohydrate addiction. Be alert for such life-events. If your carbohydrate addiction occurred suddenly, or if your addiction intensifies rapidly, there may be a simple explanation. Finding it may help you resolve or more easily gain control over your addiction.

But now it’s time to learn about the diet itself in detail.

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KEY POINTS: SCOPE AND IMPACT OF DIABETES IN THE U.S.

admin — Fri, 25 Mar 2011 11:39:31 +0000

Prevalence of diagnosed diabetes has risen from 4.9% in 1990 to 7.3% in 2000.
There are approximately 12-14 million adults with known diabetes. Prevalence rises with increasing age.
An additional 6-7 million adults have diabetes but do not know it. When people with IGT are included, over 25% of the adult population in the U.S. has abnormal glucose metabolism.
Type 1 diabetes is present in less than 1 million people in the U.S. In 1997, expenditures attributable to diabetes were $98 billion.
Total medical expenditures by people with diabetes in 1997 were in excess of $10,000/year, about 4 times the expenditures for people without diabetes.
People with diabetes lose about 8.3 days from work each year, 5 times the days lost by those without diabetes.
A shift from hospital to outpatient-based care resulted in a decrease in direct costs for diabetes between 1992 and 1997, despite increased prevalence of the disease.
Major cardiovascular risk factors are usually present in excess before the diagnosis of type 2 diabetes as well as during the course of the disease.
Major advances in preventive measures directed at the complications of micro and macrovascular disease will lead to reduced costs of diabetes in the future, if translated into usual diabetes care.
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THE G.I. FACTOR: A HIGH CARBOHYDRATE DIET IS ESSENTIAL FOR PEAK SPORTING PERFORMANCE

admin — Fri, 08 May 2009 13:53:34 +0000

A high carbohydrate diet is a must for optimum sports performance because it produces the biggest stores of muscle glycogen. As we have previously described, the carbohydrate we eat is stored in the body in the form of glycogen in the muscles and liver. A small amount of carbohydrate (about 1 teaspoon) circulates as glucose in the blood. When you are exercising at a high intensity, your muscles rely on glycogen and glucose for fuel. Although the body can use fat when exercising at lower intensities, fat cannot provide the fuel fast enough when you are working very hard. The bigger your stores of glycogen and glucose, the longer you can go before fatigue sets in.

Unlike the fat stores in the body which can release almost unlimited amounts of fatty acids, the carbohydrate stores are small. They are fully depleted after two or three hours of strenuous exercise. This drying up of carbohydrate stores is often called ‘hitting the wall’. The blood glucose concentration begins to decline at this point. If exercise continues at the same rate, blood glucose may drop to levels which interfere with brain function and cause disorientation and unconsciousness. Some athletes refer to this as a ‘hypo’ and in cycling it is known as ‘bonking’.

All else being equal, the eventual winner is the person with the largest stores of muscle glycogen. Any good book on nutrition for sport will tell you how to maximise your muscle glycogen stores by ingesting a high carbohydrate training diet and by ‘carbohydrate loading’ in the days prior to the competition. In this chapter we provide instructions for increasing muscle glycogen as well as using the G.I. to your advantage in sport.

It was not until a highly respected British endocrinologist, professor David Jenkins, published the first list of G.I. Values that people began to listen. Now working in Canada, he and his colleagues showed that many foods containing starch gave blood sugar responses almost as high as an equivalent load of glucose. Further research showed that many sugary foods had lower blood sugar rises than starchy foods. In other words, scientists and medical practitioners all over the world had it the wrong way round. Unfortunately, many still do.

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