Michelle Wien, DrPH, RD, CDE, assistant professor, UMDNJ-School of Health Related Professions
Can Almonds
Tame Blood Sugar?
by Jill Spotz
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Staying healthy in the boomer years may seem like a full-time job for those struggling with weight gain and a diagnosis of type 2 diabetes. The daily regimen for a person with type 2 diabetes can be exhausting: self-testing of blood glucose levels multiple times daily, learning how to recognize and self-treat signs of high and low blood sugar, determining what to eat and when, and juggling medications.
nfortunately, obesity and type 2 diabetes frequently go hand in hand. In fact, the term “diabesity” now appears on health websites and this dual diagnosis contributes to a host of chronic conditions like cardiovascular and renal diseases. Data collected by the National Center for Health Statistics last year showed that 40 percent of baby boomers are obese. Coincidently, the Centers for Disease Control and Prevention reported that from 1997 to 2004, the incidence of diabetes increased 45 percent among persons age 18 to 44 years, and by 34 percent among persons age 45 to 64 years. But there are new pharmaceuticals on the horizon, as well as a diabetes prevention push that is moving faster than a freight train to stop the onset of this deadly and costly disease. A 2002 nationwide clinical study, The Diabetes Prevention Program, demonstrated that type 2 diabetes can be prevented or delayed by keeping weight in control and by increasing physical activity. Participants from more than 20 clinical centers across the country were randomly split into different treatment groups: one group received counseling on effective diet and exercise, the second received Metformin (an oral medication to treat type 2 diabetes) and the third received a placebo. The diet and exercise group reduced their risk of developing diabetes by 58 percent, while Metformin cut chances of developing diabetes by 31 percent. In essence, exercise and weight management was superior to medications as the trial confirmed that millions of high-risk people can diet and exercise to avoid developing type 2 diabetes.
Due to the low fat, low cholesterol diet craze of the 1980s and ’90s, boomers have fared well with a decrease in the overall number of heart attacks and strokes. “At that time we did not realize the need for a more balanced approach with healthy fats and carbohydrates explains Michelle Wien, DrPH, RD, CDE, assistant professor at the UMDNJ-School of Health Related Professions.
Wien is a registered dietitian and principal investigator of a study that is testing a tree nut that may help control this epidemic. Working in conjunction with endocrinologists at UMDNJ-New Jersey Medical School and colleagues in the UMDNJ-New Jersey Dental School and UMDNJ-School of Health Related Professions Institute for Nutrition Interventions, Wien is studying the metabolic effect of almond consumption in adults with prediabetes. Their intention is to reduce the crossover from pre-diabetes to full-blown type 2 diabetes. Prediabetes, or impaired glucose tolerance, is a relatively new diagnosis characterized by higher than normal blood glucose levels and insulin resistance. The American Diabetes Association (ADA) estimates that 41 million Americans between the ages of 40 and 74 are living with prediabetes, and most are unaware of their condition. Failure to treat prediabetes results in a high risk of developing type 2 diabetes.
In the UMDNJ almond study, half of the participants are consuming almonds daily while on a calorie-controlled diet, the other half on a similar calorie-controlled diet without nuts. Participants in the almond group are consuming 20 percent of their daily energy needs from almonds, which is 1.5 to 2 ounces per day (35-46 almonds) for females and 2 to 3 ounces per day (46-69 almonds) for males. “Almonds have a favorable composition,” Wien explains. Not only are almonds rich in healthful monounsaturated fat, they are a good source of vitamin E, fiber, magnesium and antioxidants. “We want to focus on the quality of the calories that persons with prediabetes are consuming in addition to the quantity.” Preliminary results of the UMDNJ almond study will be released in Spring 2007.
Clinicians and scientists agree that the future of diabetes management is prevention. One way to circumvent the onset of type 2 diabetes is to recognize risk factors. This ticking time bomb, sometimes called the metabolic syndrome, is the deadly combination of obesity, elevated blood sugar levels, high blood pressure, high triglyceride levels and low levels of HDL - the good cholesterol. “When a person meets even three of the criteria, it’s a potentially serious situation,” says co-investigator David Bleich, MD, chief of endocrinology at UMDNJ-New Jersey Medical School. “It greatly increases a person’s likelihood of having a heart attack, stroke or developing type 2 diabetes.”
As both a member of the boomer generation and a certified diabetes educator, Wien understands the importance of keeping one’s body in working order by eating healthful whole foods and exercising. Wien sees how Western society’s sedentary lifestyle and toxic diet contribute to type 2 diabetes and obesity. But, for the person with type 2 diabetes, a healthy meal pattern and exercise may help prevent complications such as high blood pressure, uncontrolled blood glucose and cardiovascular disease.
Stephen Schneider, MD, professor of medicine, Robert Wood Johnson Medical School
Smart Drugs
Stephen Schneider, MD, professor of medicine, UMDNJ-Robert Wood Johnson Medical School, is a boomer. As one of the researchers who tested the new inhaled insulin Exubera, Schneider agrees that the future of diabetes management is extremely exciting. An expert in this debilitating disease, he also recognizes the importance of maintaining a healthy diet, staying physically fit and is a self-proclaimed exercise fanatic.
Schneider explains that Exubera is a powder that is inhaled through the mouth 10 minutes before eating a meal. The lungs absorb the medicine into the blood where it starts keeping blood sugar levels under control right away. “The lung represents a large, vascular surface capable of absorbing insulin efficiently into the circulation,” he explains. “We have shown that inhaled insulin is absorbed slightly more rapidly than the currently available rapid acting insulin. This actually makes inhaled insulin a better option with meals than injectable insulin.” Exubera is prescribed for adults who have healthy lungs, no additional medical conditions and either type 1 or type 2 diabetes.
For boomers with type 2 diabets, the saying “weight gain increases with age” is a double-edged sword since diabetes and obesity are interrelated. Thanks to a new medication that will soon be available in the U.S. - a cannaboid receptor blocker - diabetes and weight gain can be treated simultaneously. “This drug works by blocking reinforcement from pleasurable activities,” Schneider explains. Results of an earlier ADA- sponsored study showed that a daily dose improved HbA1C (a measure of blood sugar control) in those with type 2 diabetes. Study participants also experienced significant weight loss, an average of 11.7 lbs versus 3 lbs for those on a placebo. “Since some current diabetes medications cause weight gain, the weight loss reported for this class of drugs in patients with diabetes is a very important finding,” he concludes.
The Diabetes Check
If you are over 45, have your blood sugar levels checked every year. Most often this is done during a regular physical. In addition to that annual checkup, watch for:
- Sudden, unexplained loss of weight
- Excessive thirst
- Frequent infections
- Healing slowly from wounds
- Excessive urination
- Tingling or numbness in hands or feet
Remember, some patients encounter some, none, or all of these diabetes symptoms. Consult your physician if you experience any of the above.
Maya Raghuwanshi, MD, associate professor of medicine, New Jersey Medical School
Diabetes Do's and Don'ts
I‘m very passionate about endocrinology,” says Maya Raghuwanshi, MD, MPH, a New Jersey Medical School (NJMS) associate professor of medicine. Director of the Diabetes Clinic at NJMS and a fellow in the American College of Clinical Endocrinology, she has donated numerous hours for testing blood glucose, cholesterol and blood pressure in the community. She also runs workshops on glucose monitoring for her patients and can be found preparing nurses for their certified diabetes educator (CDE) examinations.
But this disorder is more than just her professional passion. For Raghuwanshi, diabetes is very personal. She comes from a large Indian family where diabetes has been prevalent. She has spent her life researching and treating it along with obesity, lipids and hypertension, especially in the South Asian population where Type 2 diabetes is four to five more times widespread than in Caucasians. “We do like our sweets,” she admits.
“The media is just so powerful presenting us with contradictions. On one hand, we see coverage of good nutritional things but on the other, we’ve got fast food restaurants on every corner and a rush-rush, sedentary lifestyle which really promotes weight gain. Even in third world countries where McDonalds and now Dunkin Donuts and Starbucks are fighting for a market share, we see an increase in obesity and diabetes. I don’t mean to criticize but you start with the free coupons and get hooked into bad eating habits, loading up with lattes, double burgers and shakes which are really bad for you. If you can learn good habits, you won’t crave bad food.”
Weight gain and diabetes don’t have to become unmovable facts of life in middle age, according to Raghuwanshi. And simple changes in routines can make a difference. Twice a day, for 15 minutes in the morning and 15 minutes in the evening, you can find this baby boomer on her stationery bike. This regular exercise is keeping her metabolism up and has helped her drop 17 pounds recently, along with a few minor changes to her diet.
Cut down on portion sizes. Instead of two slices of toast at breakfast, eat one. Instead of eight ounces of meat, go for four. One study showed that in the years between 1971 and 2000, women increased their calorie intake by 22 percent and men by 7 percent.
Curtail the fat. For fuel, your body will use the complex carbohydrates first, which digest and empty out slowly, long before the fat, which gets stored. Eliminate saturated and trans-fatty products and limit cholesterol, sugars, salts and alcohol.
Eat more vegetables. More than half your plate should be filled with a variety of vegetables and salads. Concentrate on lean meats, fish, beans, peas, nuts and whole grains for the other half.
Don’t eat white at night. No white potatoes, white rice, white pastas, baked goods, ice creams or starches.
Focus on fruits. Go with fresh, frozen, canned or dried rather than fruit juice and make it two cups a day.
Don’t forget calcium-rich foods. Get three cups of low or fat-free milk products in the form of milk, yogurt or cheese.
Don’t drink sweetened sodas or even sugary juices. Choose water or dilute juice with water to quench your thirst.
When Raghuwanshi eats out — “and our Indian dinners can be very heavy” — she asks the waiter to package up portions on her plate to take home for later…even before she starts eating. “When you eat less, you leave room for breathing, for air,” she says.
Above all, move your body. Walk. Bike. Climb steps. Swim. Get out of your chair and stretch. Even 10 to 15 minutes of exercise regularly have proven to be the best way to achieve and then maintain weight loss.