Friday, January 27, 2017

Can you be “Just a little Diabetic*?”

*The title of the article is asking if one can be just a bit diabetic, not short of stature!

Most of the degenerative diseases we face in the modern world are not binary on/off propositions — they exist, and are diagnosed, on a spectrum. Here are some binary propositions: influenza virus (ya got it or ya don’t), compound fracture (bones are sticking out or they are not) pregnancy (knocked up or not). Here are some diseases which progress and are diagnosed on spectrums: cardiovascular disease, neurodegeneration, and diabetes (specifically type 2 diabetes — for the purpose of this article we are not considering type 1 diabetes even though that CAN exist on a bit of a spectrum during the “honeymoon phase, but that’s an article for a different day.)

I subscribe to a number of different news outlets on a wide variety of topics, but the largest block of information I look at daily comes from medical and health related sources. I subscribe to outlets from the mainstream to the outer fringes of credibility. I do not do this to get a “balanced perspective” as we are foolish to think looking at the two polar ends of a topic somehow provides deep insight or balance. Unfortunately this is how most of the media works (get two idiots from polar opposite positions, face them off and watch the ill-informed bloodbath). This lazy sensationalism (which in academic circles is called “journalism”) is a likely at root to a LOT of problems we face, but again, different topic for a different day.

I look at this spectrum of reporting for two reasons:

1-I hope that I might learn something I did not know and or look at things in a different way. I suspect this will be made illegal at some point and folks from both sides of the political divide will endorse the prohibition. No change for you!

2- (And this is the point germane to this piece) I like to see what information is being covered by what outlets. What is the “fringe” talking about that the mainstream is (or is not) talking about? One of my primary resources for the Orthodox, “Missionary Style”, medical perspective is MedPage Today. This is the low fat, vanilla ice cream with extra carrageenan of medical news outlets. It is bland, flavorless and generally uncontroversial. Part of its function is to provide CME’s (Continuing Medical Education) for doctors and other healthcare providers, so it influences a lot of people and is a bit of an insight into the mainstream thinking one will encounter within medicine. This recent piece, “Prediabetes by Any Other Name” caught my eye as it illustrates the challenge modern medicine faces in getting a handle on chronic degenerative disease that progresses over years or decades and is “diagnosed” along fairly arbitrary spectrums. There are several methods of establishing a diagnosis for prediabetes (and diabetes) ranging from oral glucose tolerance tests, to fasting insulin to A1c. All of them have strengths and weaknesses. What is interesting to me is there is a massive amount of time and energy spent trying to figure out which rubric is the best, what cut points are the most predictive of problems. Here is an interesting quote from the paper:

“These results suggest that impaired glucose tolerance is a stronger risk factor for all cause mortality, but not for cardiovascular disease, than other definitions of prediabetes, which might be caused by the significant association between impaired glucose tolerance and non-cardiovascular death, especially cancer mortality, they noted.”

 

Impaired glucose tolerance (insulin resistance and poor ability to deal with glucose) tends to be predictive of cardiovascular disease, but only up to a point…the reason why is at some point, impaired glucose disposal increases the likelihood of other problems, like cancer, faster than it increases CVD risk.

The frustrating thing for me in all this is NONE of the cut-points nor recommendations are approached from an evolutionary biology/ancestral health perspective. Using this methodology we would look at populations that have little to no diabetes for example, then establish cut points well in advance of seeing ANY disease process. This looney idea is simply starting the investigation from a health based perspective, then working towards disease process. Instead we generally work from an unhealthy population as our “normal” and then try to make lemonade from these metaphorical lemons. The short story in all this is we want all of these metabolic cut-points to be “better” than what is generally recommended if we want to remain disease free or at least kick that can as far down the road as possible. This is not complex stuff but outside of “fringe” circles there is little discussion, just lots of decimal point fiddling and paper shuffling. 

I dive deep on this topic in my forthcoming book, Wired To Eat, where I’ll help you determine where you are on this insulin resistant spectrum as well as suggest cut points to shoot for that are based on healthy populations, not the unhealthy “average.” 

Wired to Eat by Robb Wolf

 

 

Photo credit: PracticalCures.com

 



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From Kicking and Screaming to Loving Life

It’s Friday, everyone! And that means another Primal Blueprint Real Life Story from a Mark’s Daily Apple reader. If you have your own success story and would like to share it with me and the Mark’s Daily Apple community please contact me here. In fact, I have a contest going right now. So if you have a story to share, no matter how big or how small, you’ll be in the running to win a big prize. Read more here.

realifestories in line My husband was happy. Happier than I’ve ever seen. He was also getting healthier. Already healthier and at a better weight than at any time in our relationship. I saw what he was doing. He was following the Primal Blueprint. But during the first 6 months of his journey, I was still skeptical.

Then one month of his journey became two, two became three and so on. At 7 months I realized that he had never complained. Not only did he never complain, but he mentioned how great the food was (which I knew firsthand as he was cooking most of our meals) and his particular emphasis: he was never hungry. At least one time a day he’d tell me “I want you to experience this, I want you to feel what it is like to never be hungry.”

I myself had a particular habit of eating right before bed no matter how much I’d eaten that evening. Looking back, it was my body’s inability to process carbs and my blood glucose swings. I know now I was probably well on my way to being type 2 diabetic. But while I’d enjoy his meals at home, I would still eat as before at work and out with my friends. I hadn’t committed. I was still afraid of ‘missing out.’

The sustainability question never quite went away for me those first seven months. My husband had tried to get healthier before by exercising more and cutting out ‘junk.’ But it was never sustainable. (Our extra room looked like an exercise machine junk yard.) Why change everything, even if in stages, only to go back?

But right around New Year 2014, his 7 month mark I realized this was different, very different. He truly was loving his food (and especially how he felt) and as time went on he kept discovering new life upgrades. It was dawning on me not only was this sustainable, it was actually getting easier for him as time went on, not harder. He kept discovering more foods and more recipes he could enjoy. He was also happier and had more energy to devote to my daughter and me.

Piper_fire_hat_croppedSo I made the decision to extend this way of eating to my work and social life. I took small steps to start. Cutting out bread and pasta was the first step. Then instead of takeout for lunch or any of those bland frozen meals, I took leftovers from dinner. I saved time and money. When I went out with friends, same thing, no bread or pasta.

The first couple of weeks were the hardest. I knew from my husband’s experience and reading that I would feel a little wonky, flu-like symptoms to be exact. I powered through the tough part and am so glad I did. I started to feel better right around the 2-week mark.

Allow me to paint a ‘before picture’ of myself at the beginning of my journey. I was around 200 lbs. I had battled anxiety and depression since my early thirties. My skin was red and blotchy. (I wouldn’t leave the house without powder). I was starting to feel the aches and pains that I thought were associated with my approaching middle age. I would wake up in the morning with my joints aching, (especially my hips) fingertips and limbs numb and tingly. I could rarely get a full night’s sleep because I was tossing and turning to get comfortable. Sleep apnea compounded the situation. The cumbersome mask was a nightly annoyance that I had to endure.

4-6 weeks after my initial changes I started noticing that I was waking up less achy. Also, pound by pound the weight started to come off. I had the energy to start walking on the treadmill when I got home. Nothing strenuous, 20-30 minutes a few times a week. A few months into my journey I had lost about 15 pounds and was feeling better than I had in years. It was at that time I found out I needed surgery.

Creek_2I had suffered from endometriosis for years, and it had got to the point I needed to do something about it. After my first procedure and sketchy test results, my doctor recommended a hysterectomy. Which meant I was laid up and recuperating for several months. I wasn’t able to exercise anymore. Part of me felt defeated. What if my weight loss stalled? What if I started to gain it back? Although frustrated, I stuck with my new way of eating and concentrated on healing. An amazing thing happened. I didn’t gain any weight back. In fact, I continued to lose weight. By the time autumn rolled around, 8 months into this new way of life, I had lost 35 pounds.

What had happened? I had done almost no exercise and the weight was falling off. As I had said before, my first step was cutting out bread and pasta. While I enjoyed those things, I quickly realized the tradeoff was worth it. My next step was not as easy. I titled my story From Kicking and Screaming to Loving Life for a reason. Here is where the kicking and screaming come in. The hardest part of my first seven months was… Tortilla chips.

My husband had continued to read research, listen to podcasts and discuss key points of LCHF and Paleo with his new found community. He read all of Mark Sisson’s views on grains. His lifelong love of learning saved our lives. He felt so great, and I was beginning to, we both wanted it to continue. But at this point I wasn’t so happy about what he had learned. I still remember where I was when he said “I think we have to give up corn.” My exact reaction “you’ve got to be kidding me!!” A little more background on me. I was born and raised in the Southwestern United States. Corn tortillas, corn chips, cornbread… They are not just foods, they are sacred morsels to be shared with loved ones at the holidays, enticing appetizers to be enjoyed with friends at parties. They are vehicles for delicious things like salsa, queso, and every combination of meat dish you can think of. I could not imagine a life without corn. Let’s suffice it to say, it took me a bit to give this up.

Kay puppyWe weren’t eating it at home anymore, but I still had it when I went out with friends. If there was a corn chip in the staff lounge, I ate it. Little by little though, the time in between eating corn grew. I started to notice that when I did eat it, I felt sluggish and my achy joints returned. While I still loved these items, it became very apparent that my body did not. I also found I could still enjoy all the things I used to pile on the corn chips. I just enjoyed them with raw veggies or “gasp” by themselves! What I now know is that my body got inflamed when I ate corn. That is why I ached. I also know now that most chronic diseases are caused by inflammation. I wanted to share this part of my story to illustrate one key fact. Yes, I had to give up things that I liked, even loved. But I then created new habits and through these habits I found new foods I liked and loved that allowed me to be the best wife, mom, and teacher I could be.

Fast forward 2 and a half years. I have lost a total of 70 pounds. My anxiety has never been better. My skin has improved to the point that I don’t fear leaving the house without makeup. For myself, my husband and my daughter, the Low Carb, High Fat/Primal lifestyle has changed our lives. I used to fear growing older. My fear was that my daughter would be saddled with taking care of aging parents in her early twenties. I no longer have that fear. With LCHF, I can be strong and healthy for many years to come.

As for my daughter, she was 3-years-old when we started to make this change. She had always eaten what we ate. I never made separate meals for her as she began to eat solid foods. We included her in our new way of eating, and I am forever grateful we did.

At her 3-year old checkup, she was in the 3rd percentile for height. After a year of being gluten free, she was in the 25th percentile for height. She is now at around the 35th percentile. She continues to thrive and grow with our lifestyle. I will admit that the way we eat can cause her to feel excluded. We take our own cupcakes and snacks to birthday parties. She sees other kids eating things we have told her are unhealthy. She wonders why they get to and not her. We explain other families make the decisions that are right for their family, we make the decisions that are right for our family. And, importantly, that people react differently to the same food. Her 23andMe results do show a greater likelihood of celiac disease for instance.

DiamondFamily1She longs to order cafeteria lunch at school. Unfortunately, because of the dietary guidelines public schools must follow it is not food we are willing to let her eat. For instance no full-fat dairy is allowed, but fruit juice and chocolate milk are. I should add that we are not as strict with her food as ours. She does have some rice here and there and definitely more fruit and higher carbs than we do. As she has grown older, we try and bring her into the food decisions as much as possible. We try and give her as much choice as possible. Primal Kitchen products have been invaluable. She can devour an entire cucumber in one sitting with Primal Ranch. And at times, we have let her have some of those items she wants, orange techno colored snacks, a piece of Halloween candy here and there. When we do, she feels sick, and she goes bonkers. She has started to realize that food affects her. Just this weekend she had a stomach bug. I had made a Paleo friendly cake with almond flour and honey. She said, “I would like some, but I don’t want the sweetness to make my tummy hurt more.” She is beginning to connect food choices with how she feels and her energy levels.

It is not an exaggeration to say that the Primal lifestyle first saved our lives, but then also gave us new lives: as the healthy fat-burning beasts we were meant to be. Our biggest adventure has now become experiencing who we always had the potential to be—not hampered and encumbered by the constant physical, mental, and energy tolls of fake food and fake fats in particular. My husband often says the reality of Primal Living exceeded all his wildest expectations. I’ve now lived and experienced that. Even at just six years of age, we feel our daughter would be living an entirely different life, be almost an entirely different version of herself had we not adopted Primal Living.

Primal Blueprint Story

We try and help family, friends, and community (both local and online) as much as we can. My husband has gotten particularly involved with social media and the wonderful Paleo(fx) Austin-based crew. He also completed the Primal Health Coach course and loved it. We were even pleasantly surprised to be one of the success stories in the new edition of the Primal Blueprint.

My post-college career has been entirely in elementary school teaching. Going into teaching was a way to help children grow to their full potential. Primal Living, what we’ve learned, the skills we’ve developed, the nutritional knowledge, effective exercising with the whole family, Primal Kid tips and tricks, the cooking and shopping techniques, are all ways I can give back to others, of all ages. Primal Living made us whole and healed, all three of us. It gives us great joy when we can pass the Primal gift on to others.

BA

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What You Should Know About Hydroponic Vegetables

Soil seems so essential to our concept of vegetables that those grown hydroponically – that is, in water rather than soil – may seem confusing. Even futuristic. But hydroponic crop farming is in fact here now. In the last five years, the hydroponic crop farming industry has shown an annual growth of 4.5 percent, according to the U.S. market research firm IBISWorld, and new companies are projected to continue to expand over the next five years.

Hydroponic farms produce high yields in a small area. Often grown indoors – in warehouses or greenhouses and in artificial light instead of sunlight – they are protected from extreme weather. Hydroponically grown vegetables, which are fed by nutrient solutions in the water, may be just as nutritious as field-grown vegetables and, depending on the solutions they’re fertilized with, can help meet the rising demand for organic produce.

Curious to learn more about hydroponic vegetables, we asked Rebecca Elbaum, MPH, RD, CDN, a clinical dietician in New York City who has worked with hydroponic farms, particularly small, rooftop gardens, to fill us in on some of the basics:

 

What, exactly, are hydroponic vegetables?

Hydroponic literally means “water-grow or survive,” so basically hydroponic vegetables are those that survive, and likely thrive, in water. Hydroponic vegetables are grown in a closed system in which their roots are submerged in water. This water is fortified or “spiked” with nutrients, such as potassium, magnesium and phosphorus. In conventional farming, natural soil contains vitamins, minerals and trace elements that water does not, so hydroponic farmers need to add those nutrients into the water. Conventional farming also uses the natural light of the sun, which helps vegetables develop their nutrients.  Hydroponic farming mimics sunlight through greenhouses. 

 

How do they compare to field-grown vegetables from a nutritional standpoint?

It is not yet fully known whether hydroponically grown vegetables are nutritionally superior to conventionally grown ones. There are studies that show the nutrient content to be the same, while there are others that show hydroponic vegetables to be richer in nutrients than conventional. While we can artificially add nutrients to water, we might not know certain components in soil that are important for the growth of nutritious vegetables. We also don’t know the impact of natural sunlight versus greenhouse light on the nutritional quality of the vegetables.

 

What are some of the nutritional advantages of hydroponic vegetables, and what are the disadvantages?

In hydroponic cultivation, nutrient quality can be very carefully controlled. While nutrients are also added to soil in conventional farming, it is more difficult to control and more likely to have fluctuations in its nutrient content. The downside of hydroponic vegetables is that how trace elements in soil affect the nutrition of vegetables is unknown. We might not be able to replicate the nutrient quality as well in hydroponic farming.

Another advantage is we can grow almost any produce locally, all year round.  Lettuce and tomatoes grow beautifully hydroponically. A local tomato contains more nutrients than one that has been imported and has sat on a truck for a few days before making it to your plate.

 

Do you see hydroponic vegetables as assuming a greater role in American diets?

Since hydroponic vegetables can be grown just about anywhere with the right space, I do think they will become more prevalent in American diets. Hydroponic gardens are playing a bigger role in cities, with people growing fruits and vegetables on their rooftops. With a growing population and climate change, alternative methods of growing fruits and vegetables are coming into play. We may already be buying hydroponic vegetables in grocery stores without knowing it. Growing hydroponically allows us to grow a variety of fruits and vegetables locally, rather than importing them from other countries, which causes a loss of nutrition in transit. This not only improves the nutritional quality of the vegetables that make it our plates or kitchens, but it is almost more environmentally friendly.  We unfortunately won’t know the nutritional impacts of hydroponic vegetables for a number of years, as more studies need to be done, but I think we will see them become more prevalent in grocery stores and on menus.

 

What do you see as the key takeaway for consumers here?

Bottom line: Eat vegetables. These alternative methods are growing and are here to stay with the boom in agricultural technology and climate change. Since we don’t have conclusive evidence at the current time about which method produces nutritionally superior vegetables, I would tell my patients to buy any vegetables they can get their hands on. Since very few people actually consume the three servings of vegetables and two servings of fruits recommended daily, I would not want to restrict consumers further on what produce they should buy. As the research continues to grow however, it will be interesting to see if indeed hydroponic vegetables can be nutritionally superior to conventional.

Also, though it would be great to have delicious local lettuce and tomatoes all year round, there is something very special about savoring the fresh tomatoes of summer while they are in season.

 

Amy Reiter is a writer and editor based in New York. A regular contributor to The Los Angeles Times, she has also written for The New York Times, The Washington Post, Glamour, Marie Claire, The Daily Beast and Wine Spectator, among others, as well as for Salon, where she was a longtime editor and senior writer. In addition to contributing to Healthy Eats, she blogs for Food Network’s FN Dish.



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Restaurant Week At Heirloom

Restaurant Week is always a good time in Charlottesville, and you locals still have time to make a reservation this weekend! There are three levels of pricing: $19, $29 and $39, depending on the restaurant, and all proceeds benefit the Blue Ridge Area Food Bank.

I was invited by Heirloom, the swanky restaurant and bar at the top of the new Graduate Hotel by the University of Virginia, to enjoy their restaurant week menu and share my experience on KERF.

I’ve been meaning to go to Heirloom since it opened earlier this year, and my friends have been buzzing about how awesome the view from the terrace is. We don’t have many skyscrapers in our little town, so it’s not everyday you can see Main Street like this:

On a mild winter day the heaters were on, and with a coat we could have had a drink outside, but that was pushing it a bit with temps dropping : ) I cannot wait to go back on a warm spring day and sip wine looking at that view!

Back inside, I ordered a glass of the Prince Michel Merlot and we picked our dishes for the evening.

In respect for the other diners, I didn’t take any interior photos, but this is what the space looks like in the daylight as shown on the website. Very pretty with a vintage-rustic feel!

To start we shared the Roast Shrimp stuffed with horseradish, wrapped in bacon, and served with a whiskey apple BBQ sauce.

And the Arugula and Pear Salad served with McLaurin Cheddar, roasted pears and a honey lemon vinaigrette. The pears totally made the salad great!

I ordered the salmon for my entree, which came with saffron butter, pearl couscous, and roasted cauliflower and carrots.

And T had the duck with a clover honey glaze and apple chutney.

My favorite course was dessert, naturally, and we tried one of each of the offerings:

An Heirloom Apple Pie served in its own little cast-iron skillet and topped with whipped cream.

And Bourbon Bread Pudding : )

On a regular night, Heirloom has a ton of tapas-style plates to share, so I think it would make a great spot for happy hour or al fresco dinner with friends!

Thanks for having me in, friends!

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