Health for life

Hi,

Day 3 -- and I am not holding my mis-steps against me, I am simply moving on. I have had no sugar today -- which means I did on both days 1 and 2. It only stalls my own progress to do such things, but Ive gotten that out of my house, now. I think where I made the mistake was in not setting my start date a little farther in the future by a day or two and doing the prep steps a little more thoroughly.

I got almost everything out of the house that I should not eat, and I got good raw veggies and protein in the house to provide what I need. It is that "almost everything" that is the problem. I did not even follow my own advice during the preparatory steps -- but the Christmas candy is now gone. Im actually wondering if I should simply call this Day 1.... No, Ill just accept the responsibility and move on. Today was a mostly clean program day. I hope yours was too. Today my only faulty meal was three breaded chicken strips with honey mustard dip. Everything else was on target.

Ive been thinking about the overall positive and negative "side affects" that can be expected when following a narrow program like this one (see previous days post). I dont actually think that eating fresh raw veggies and animal protein is narrow, but I can see where other people might. It is rather a large jump to go from eating the Standard American Diet (SAD) directly to the blood sugar reducing program I am advocating here. I truly believe it is the best program an over weight, hypertensive, post-menopausal woman with pre-diabetes and gout can do. It is the only one that actually allows me to lose any weight at all so Im glad to be back on it.

If you are coming directly off of SAD it will be easier on you if you start with the 50/50 portions. Do that for a week and then begin adding more veggies and removing a little protein until you gradually work your way up to 80/20. Do not remove the protein entirely because you need it to help stabilize your blood sugars. Remember: eat when you are hungry -- and always have both raw veggies and animal protein.

Side affects: The first side affect Ive been thinking about is the way we react emotionally to this kind of a food program. There is a reason that high carb dishes are called "comfort food." They actually do affect our moods so when you first go off of them you may at some point run into a feeling of either anxiety or depression -- the opposite of "comfort." The high carb meal on day seven should alleviate most of that. In fact that is part of the purpose of the weekly cheat meal: to restore the brain carbs that we need. Carbs seem to have what I call a "cumulative" effect which is why the withdrawals take three days and the reduction in pain takes six days, so restocking the carb stores every seven days should side-step the mood swings.

If you happen to run into it sooner there are also two supplements that my doctor advised me to take that really seem to keep bad feelings completely out of my picture. One is called L-Theanine and the other is Taurine. These are both amino acids that can be purchased at any health food store or on the internet. I take one of each in the morning to prevent anxiety and black moods and am rarely troubled by them. If before I go to bed I feel the need of more peaceful feelings I am likely to take one more of each before going to bed. I only do that on rare occasions. You will have to try it out to see if it helps you. That emotional response is part of the addictive behavior that Ive been mentioning and I am all for anything that helps me to conquer the addiction.

The other thing I want to address is not really a "side effect" but a symptom of our own "SAD food syndrome." We seem to be a nation of people that mentally files particular foods into certain meal slots and heaven forbid that they might be eaten at a different time or in a different way. Like eggs are relegated to breakfast only. Steak or salad is only for dinner. Who decided that and why do we feel the need to force ourselves to follow it? What purpose does it serve? None that I can see.

Try having a new thought about when and where you can eat different food items. It really is not far fetched to eat salad for breakfast. Ive been enjoying salad for breakfast for quite some time and find it really pleasureable. I like eggs for breakfast (and also eat them any time during the day) so I fry up a couple of over-easy eggs and place them on my salad. The liquid yellow actually makes a very tasty salad dressing. If you have ever had a Cobb Salad or a Chef Salad you have had hard boiled eggs on your salad before. Why not some over-easy or scrambled eggs? Try it. You might like it.

I also put salt and pepper and spices on my salad before I put either the eggs or the salad dressing on them. Try sprinkling a few Italian herbs on your salad with a little salt and pepper to really move a salad into the "actually tasty" realm. Experiment with your own favorite seasonings and create some new combinations for yourself. Salad does not have to be a boring bowl of ice berg lettuce and grape tomatoes that needs to be drowned in salad dressing to be appetizing.

Try wandering the produce aisle at your favorite grocery store and imagining how you might choose to use the different ingredients in your own creative salad! See if they have some items that you have never noticed before and try some out. I like to print out a copy of the "Craving Reducing Shopping List" (see yesterdays post) and highlight the things Im planning on purchasing. That keeps me in the "safe" zone and also reminds me of what I need. Try some endive in your salad. Try some broccoli sprouts!! What about some red leaf lettuce? It is very tender and tasty. I like to use Romain as my basis but I add various other lettuces and rotate the greens to get all the goodness from the variety that is available.

Once you have been eating this way for a while your stomach will likely no longer be bothered by cucumbers or radishes, too. Begin to experiment and add new vegetables to your basket and your salads as you go along.



I find that the best way to store lettuces is to stand them up in about a half inch of water which I accomplish by putting them diagonally into a 1-gallon size plastic zipper bag and standing it up against the wall of the rigerator. Sometimes I place them in a colander for support in staying upright. The water (which should be changed every other day) will keep your lettuces fresh and lively longer. Think about it: they are still alive when you purchase them -- they need a drink. You do that to cut flowers and it keeps them attractive longer -- the same is true for lettuces -- they need a drink to stay fresh, crisp, and lively.

Here is the last piece of advice for today: Eat when you are hungry. You do not have to deprive yourself. It will be a new experience (it was for me) to actually trust the messages you are getting from your body.  Listen to you body and eat when you are hungry and stop eating when you are full.

OK one more: Dont forget to decide not to eat the things you should not eat. I need that one the most!!

Be back soon,

Marcia

Well talk diabetes in a sec Mrs Smith, but first, hows those darling kids?

Just being back from a whirlwind tour, the Disease Management Care Blog is happy to report that it became newly acquanted with some colleagues who are furiously at work building care management programs for newly minted integrated health systems and ACO wannabes.

They provided two big insights for the DMCB:

1) While the DMCB guesstimated that the typical ratio of care management nurses to enrollees amongthe mainstream care management service companies was in the range of 1:1500, at least two new programs are using a 1:750 ratio.  By the way, 1:800 is what was quoted in this peer reviewed article.  Thats a lot of nurses for an "accountable" population and a lot of budget for a CFO to approve. 

2) There is less of an emphasis on care manager "productivity,"  thanks to a recognition that nurse-client conversations outside hard nosed chronic illness management "engagement," "barrier identification" and "shared decision making" contribute to relationship building.  The DMCB thinks of this as "magic nursing dust" that adds to the likelihood of patient behavior change.  There are no hard data on the topic, but its important in other parts of the health care universe, so why not here?

Statins -- the popular class of cholesterol-lowering drugs used widely to prevent recurrent heart disease or stroke as well as risk for having a first cardiac or stroke event -- appear to cause few side effects, according to new research reported in Circulation: Cardiovascular Quality and Outcomes.

Researchers conducted the largest meta-analysis on statin side effects to date, reviewing data from 135 previous drug studies to evaluate the safety of the seven statins on the market. They concluded "as a class, adverse events associated with statin therapy are not common."

Researchers noted that simvastatin and pravastatin, the generic names of the brands Zocor and Pravachol, were found to have the best safety profile in the class. This is particularly true when patients were prescribed low to moderate doses of those statins, said Huseyin Naci, M.H.S., the studys lead author and a doctoral candidate at the London School of Economics and Political Science and research fellow at Harvard Medical Schools Department of Population Medicine.

Researchers also noted a 9 percent increased risk of diabetes among statin users. But according to a previous landmark study, 250 patients need to be treated with a statin for one case of diabetes to be diagnosed.

"I am concerned that patients may misunderstand this small increase in risk and stop adhering to their medications," Naci said. The proven ability of statins to significantly cut the rate of death and hospitalization in patients who have heart disease outweighs the "small increase in diabetes risk," he said.

Researchers reviewed trials published between 1985 and early 2013, which included almost 250,000 patients. On average, the trials lasted a bit longer than a year. Some compared one statin to another, while others compared a statin to an inactive placebo, which is often called a sugar pill or dummy pill.

The study also found that statins were not linked to an increase in cancer risk. However, the drugs were associated with a typically reversible increase in liver enzymes, which Naci said still resulted in a very low rate of actual liver toxicity in statin patients.

"Although the benefits of statins clearly outweigh risks at the population level, individualizing such benefits and risks is more difficult," he said. "This brings into sharp focus the importance of identifying the individuals who stand to benefit the most from statin therapy.

Although the risk of developing diabetes is low, what this risk would amount to over time is simply not known based on the existing evidence," Naci said.

Perhaps I should have elaborated more on the vitamin D and cancer connection.  I doubt anyone will actually watch that one-hour vitamin D lecture I posted a link to, and I know everyones been told for years to stay out of the sun because itll give you skin cancer.  So simply telling you that sun exposure reduces cancer rates probably isnt convincing.  Allow me to explain myself.

First off, how serious is the skin cancer problem?.  One look at the cancer statistics from 2010 shows that non-melanoma skin cancer is surprisingly benign.  In 2010, less than 1,000 people in the United States died from skin cancer.  Thats about 0.0003% of the population, and less than 0.2% of total cancer deaths, according to the National Cancer Institutes statistics.  There are at least 12 other types of cancer that are more deadly.  Perhaps the problem has been a bit overstated.

But on to the task at hand.  Let me begin with these two maps... the one on the left shows the amount of UVB radiation received across the nation, and on the right is a map of breast cancer prevalence.  There are maps like this for all types of cancer, and they all show similar patterns.



Theyre strikingly similar.  Areas with more UVB exposure, the type of sunlight that your skin uses to make vitamin D, tend to have lower cancer rates.  Heres another chart, this ones pretty old, but still very relevant...


Cities that see more solar radiation from the sun have lower rates of breast cancer.  But like I explained in my last post, correlations like these dont indicate causality.  Thats where the new research on vitamin D comes into play.  High blood levels of vitamin D, 25(OH)D, are clearly associated with a lower risk of cancer.  According to this study, supplemental vitamin D combined with sun exposure is enough to raise blood levels of vitamin D to 52 ng/ml, a level that is associated with a 50% reduction in the incidence of breast cancer.  Another study, this time a controlled, clinical trial, tested the impact of vitamin D and calcium supplementation on cancer rates in postmenopausal women.  The study showed that the group receiving both vitamin D and calcium, as opposed to just calcium, or a placebo, showed a "60% or greater reduction in all forms of cancer."  Very significant.

Lets put this all together.  Climates receiving more UVB exposure from the sun, the type that forms vitamin D in our bodies, are associated with lower cancer rates.  High vitamin D blood levels are associated with lower cancer rates.  Vitamin D supplementation significantly lowers the risk of developing cancer.  Add to this the fact that it makes evolutionary sense that the sun would be beneficial for us:  When humans migrated further and further from the equator, their skin became lighter and lighter, becoming more efficient at making vitamin D through limited sun exposure.  And while were at it, throw in some common sense too:  Why would the very thing that gives us life on earth, the sun, kill us at the same time?  Connect the dots, and it looks like sun exposure probably prevents cancer more than promotes it.  At least thats my interpretation of the evidence.

Now Im not saying you should go out in the sun and tan all day long to the point where you burn.  Thats not good for anybody.  However, it is completely unnatural to avoid the sun altogether.  Theres nothing wrong with moderate sun exposure.  And take it easy on the sunscreen.  Sunscreen prevents UVB absorption, meaning you wont get burned but you also wont make vitamin D.  If youll be in the sun all day, at least hold off on the sunscreen until youve had a chance to get the benefits of sun exposure. 

Could it be that the conventional medical advice to stay out of the sun has actually caused more cancer than it has prevented??  Let that marinate for a while.