Those with prediabetes have blood glucose (blood sugar) levels that are higher than normal but not yet high enough to be diagnosed as diabetes. Doctors will sometimes refer to prediabetes as impaired glucose tolerance (IGT) or impaired fasting glucose (IFG), depending on what test was used when detected. Many americans that have prediabetes will convert to diabetes within 10 years. There are an estimated 37,000,000 Americans that have prediabetes of which the majority have no idea that they do.
Prediabetes is often without clear symptoms. Some people who have pre-diabetes may experience some of the symptoms of diabetes. These include frequent urination, fatigue, increased thirst and blurred vision. People who are overweight (BMI of 25 or above) or have a family history of diabetes are definitely in a higher risk category as well as those of African American and Native American descent. People with these risk factors or symptoms should definitely ask their doctor to have a blood test called hemoglobin A1c (HbA1C),glycosylated hemoglobin or glycated hemoglobin test.
The HbA1C test shows how well your diabetes is being controlled. It provides an average of your blood sugar control over a 2-3 month period. The HbA1C test measures what percentage of your hemoglobin or protein in red blood cells that carries oxygen, is coated with sugar (glycated). The higher your A1C level, the more uncontrolled your blood sugar is and the higher your risk of diabetes and complications from diabetes. If your HbA1c is between 5.7%-6.4% you are pre diabetic. If it is 6.5% or above you are considered diabetic. Ideally you want yours to be below 5.4%. Also, you should take into account fasting blood glucose which should be less than 100mg/dl. Those with pre-diabetes are 100mg/dl-125mg/dl and diabetes 126mg/dl or higher on two separate tests.
So, you were diagnosed as pre diabetic, now what? Well, there are several ways in which you can reverse this condition before it progresses. But, before making any health or lifestyle changes definitely check with your physician first. A good idea would be to see a doctor that practices functional or integrative medicine. These physicians can be found all throughout the country. Integrative or functional medicine is a healing-oriented medicine that takes into account the whole person including all aspects of lifestyle i.e. diet, exercise, family history, stress levels and environment. It emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and complementary.
You can find local integrative doctors near you here: ACAM.org.
Losing about 7% of your body weight or 15 pounds if you weigh 200 pounds, is an easy place to start for those overweight. However, things are not always so easy. A recent study from Korea concluded that visceral fat mass, or fat around the organs, acquired using dual-energy X-ray absorptiometry (DXA), has stronger associations with diabetes and pre-diabetes than other measurements. Therefore, fat around the organs or visceral fat, is a better predictor of pre diabetes than adipose fat or fat under the skin which is the fat we can see when looking at a person (or ourselves in the mirror).
Visceral fat is basically excess intra-abdominal tissue accumulation. It is fat that is actually covering the organs including the liver, pancreas and kidneys. A sign of excess visceral fat storage is if you have a belly that sicks out and a large waist. This is most noticeable in overweight and obese people but anyone can have visceral fat and not know it. Visceral fat cells do more than just make your pants tight, they also cause changes in the way your body functions by producing hormones and inflammatory factors leading to heart disease, inflammation, cancer, dementia, strokes, depression and diabetes.
Carrying a high amount of visceral fat is known to be associated with insulin resistance, which can lead to glucose intolerance and type 2 diabetes. Researchers have found that visceral secretes a protein called retinol-binding protein 4 (RBP4) which has been shown to increase resistance to insulin. Storing excess fat around the organs increases production of pro-inflammatory chemicals called cytokines, which leads to inflammation. It also interferes with hormones that help regulate appetite, weight, mood and brain function.
A relatively good indicator of visceral fat is to take a measurement of your waist. Harvard University notes around 10% of our total fat is likely to be stored as visceral fat, therefore if you are carrying higher amounts of body fat than is recommended, it is therefore more likely that you are also storing more visceral fat than is healthy. The most certain way to tell if you are carrying excess visceral fat is with an MRI. MRI's are expensive and do not tell you if you have diabetes so this should be discussed with your physician.
In order to reverse pre diabetes, you must focus on decreasing body fat and improving your insulin sensitivity. In part II, I will discuss ways to do this using four categories for lifestyle change; diet, exercise, vitamins and supplements and stress reduction. Keep an eye out for this life changing blog post coming soon!
Vitamin C (Ascorbic Acid) is a water-soluble vitamin, this means that your body doesn't store it. You have to get what you need from food, including citrus fruits, broccoli, and tomatoes.
In my practice, I will recommend my surgical, trauma and wound care patients to increase their daily dose of Vitamin C on a per case basis. You need vitamin C for the growth and repair of tissues in all parts of your body. It helps the body make collagen, an important protein used to make skin, cartilage, tendons, ligaments, and blood vessels. Vitamin C is needed for healing wounds, and for repairing and maintaining bones and teeth. It also helps the body absorb iron.
Vitamin C is an antioxidant, along with beta-carotene, Vitamin E and many other plant-based nutrients. Antioxidants block some of the damage caused by free radicals, substances that damage DNA. The build up of free radicals over time may contribute to the aging process and the development of health conditions such as cancer, heart disease, and arthritis.
Although it is rare to be significantly deficient in vitamin C, there are some people that tend to have lower levels, such as smokers. A severe form of vitamin C deficiency is known as scurvy. Some signs of vitamin C deficiency include dry and splitting hair; gingivitis and bleeding gums; dry, scaly skin; decreased wound-healing rate, easy bruising; nosebleeds; and a decreased ability to ward off infection.
Authors of one small study have concluded that "vitamin C supplementation represents an effective lifestyle strategy" for reducing the blood vessel constriction that is increased in overweight and obese adults. Vitamin C was shown to be just as effective as exercise. A study of 35 obese or overweight adults compared the effects of Vitamin C and exercise on the protein known as endothelin-1, which has a constricting action on small blood vessels. The protein's activity is raised in overweight and obese people and because of this high endothelin-1 activity, small vessels are more prone to constricting, becoming less responsive to blood flow demand and increasing the risk of vascular disease. The researchers explain that exercise has been shown to reduce endothelin-1 activity, but including it in a daily routine can be challenging.
Caitlin Dow, PhD, postdoctoral research fellow at the University of Colorado, Boulder, led the study to examine whether vitamin C supplements, which have been reported to improve vessel function, can also lower endothelin-1 activity. The researchers found that daily supplementation of Vitamin C at a time-release dose of 500mg daily, reduced endothelin-1 mediated vessel constriction as much as walking did.
The 35 sedentary, overweight/obese adults completed 3 months of either the supplementation or aerobic exercise training. Measures included forearm blood flow and responses to intra-arterial infusion of endothelin-1 before and after each intervention. Vasoconstriction to endothelin-1 increased similarly - about two-fold - in response to both interventions.
Many people already know that eating fresh vegetables and fruits may benefit heart health. Recently researchers pinpointed one specific benefit. A Danish study published in the American Journal of Clinical Nutrition in May 2015, demonstrated that high plasma Vitamin C, intake of fruit and vegetables, decreased the risk of ischemic heart disease. This study helps explain that a primary reason why people who eat lots of fruits and vegetables have a lower risk of heart disease and early death is because of their high vitamin C levels.
This study followed more than 100,000 people and found those with the highest intake of fruits and vegetables had a 15 percent lower risk of developing heart disease and a 20 percent lower risk of early death compared with those with the lowest intakes.
What about Vitamin C and the common cold? This is a much studied and talked about topic. The human studies published to date are conflicting. Additional controlled clinical trials are necessary to conclusively demonstrate that supplemental vitamin C enhances the function of the immune system in adequately nourished individuals.
Linus Pauling's work with large doses of vitamin C (greater than 1gm/day) was largely the reason why the public has assumed that vitamin C prevents the common cold. His original results were from a study performed on school children in a skiing camp which he then extrapolated to the general population. Over the last 40 years, several studies have examined the effect of vitamin C supplementation on the prevention and treatment of colds.
A recent review from the Department of Public Health, University of Helsinki, Helsinki, Finland found 53 placebo-controlled trials that evaluated the effect of vitamin C supplementation on the incidence, duration, or severity of the common cold when taken as a continuous daily supplement or as therapy upon onset of cold symptoms.
Regarding the incidence of colds, a distinction was observed between two groups of participants: regular supplementation with vitamin C (0.25 to 2 grams/day) did not reduce the incidence of colds in the general population; however, in participants undergoing heavy physical stress (e.g., marathon runners, skiers, or soldiers in subarctic conditions), vitamin C supplementation halved the incidence of colds. A benefit of regular vitamin C supplementation was also seen in the duration of colds, with a greater benefit in children than in adults: the pooled effect of vitamin C supplementation was a 14% reduction in cold duration in children and an 8% reduction in adults. Finally, no significant effect of vitamin C supplementation (1-8 grams/day) was observed in therapeutic trials in which vitamin C was administered after cold symptoms occurred.
This post only scratches the surface in terms of the benefits of Vitamin C. For more in-depth information please click on the links included within this post.
To conclude, there are currently several integrative physicians who are administering high dosages of IV Vitamin C to their patients. Other than the known complications of IV vitamin C in those with renal impairment or glucose 6 phosphate dehydrogenase deficiency, high dose intravenous vitamin C appears to be remarkably safe. High dosages of Vitamin C are used by alternative and complementary physicians to help treat diseases and conditions such as cancer, infections and fatigue.
Check out the recipes below to help add Vitamin C to your diet!
Foods High in Vitamin C:
Triple C Smoothie (via www.aloha.com)
This recipe is packed with vitamins from oranges and Daily Good Greens, hydration and essential minerals from coconut, and antioxidants.
6 to 8 oranges, juiced
2 pinches cayenne (optional)
1 pinch sea salt
1/2 cup goji berries (can substitute with another high antioxidant berry such as Acai or Mulberries)
2 1/2 cups frozen mango
1/2 cup young coconut meat
1 packet ALOHA Daily Good Berry
1 teaspoon ALOHA Coconut or sweetener of choice
Blend all ingredients on high for 30 to 40 seconds.
Sauteed Brussel Sprouts (via Foodnetwork.com)
This recipe has 160% of the recommended daily value (60mg) of Vitamin C.
1 pound Brussels sprouts
4 thinly sliced shallots
4 tablespoons butter (Recommend Grass-Fed Butter)
Salt and pepper for Seasoning
2 tablespoons cider vinegar
1 tablespoon cane sugar
Shred 1 pound Brussels sprouts in a food processor.
Saute 4 thinly sliced shallots in 2 tablespoons butter over medium heat, 3 minutes. Season with salt and pepper.
Add 2 tablespoons cider vinegar and 1 tablespoon sugar and cook, stirring, 2 minutes. Transfer to a plate and wipe out the skillet.
Add 1 tablespoon butter to the skillet and increase the heat to medium high. Add the Brussels sprouts, and salt and pepper to taste; cook 5 minutes. Add 1/2 cup water and 1 tablespoon of butter; cook 5 more minutes. Stir in the shallots.
Spiced Eggplant-Lentil Salad with Mango (Adapted via EatingWell.com)
Indian Inspired Vegetarian Salad. This recipe contains over 100% DV of Vitamin C as well as Vitamin A, Potassium, Magnesium, Folate and Iron.
4 tablespoons virgin organic coconut oil, divided (you may use peanut or olive oil if you do not have coconut)
2 1/2 teaspoons chili powder, divided
2 1/2 teaspoons curry powder, divided
2 medium eggplants (3/4 pound each), trimmed and cut into 1-inch cubes
1/3 cup lemon or lime juice, plus more if desired
1/4 cup prepared salsa
1/4 cup honey
1/4 teaspoon salt
1/4 teaspoon freshly ground pepper, plus more to taste
1 1/2 cups cooked lentils or one 15-ounce can, rinsed
2 bunches scallions, coarsely chopped (reserve 2 tablespoons for garnish)
4 cups torn Kale
2 large ripe organic mangoes, peeled and diced
1/4 cup coarsely chopped roasted peanuts or cashews
1/4 cup chopped fresh cilantro
Preheat oven to 500°F.
Combine 1 tablespoon oil with 2 teaspoons each chili powder and curry powder in a large bowl. Add eggplant and toss well. Spread the eggplant on a large, rimmed baking sheet. Roast, stirring once halfway through, until tender, about 15 minutes.
Thoroughly combine the remaining 3 tablespoons oil, remaining 1/2 teaspoon each chili powder and curry powder, 1/3 cup lemon (or lime) juice, salsa, honey, salt and pepper in a large bowl. Add the roasted eggplant, lentils and scallions; gently toss to combine. Taste and season with more pepper and/or lemon (or lime) juice, if desired.
Serve the salad on a bed of kale, topped with mango, nuts, cilantro and the reserved 2 tablespoons scallions.
Tip: To cook lentils, combine 1/2 cup red or brown lentils in a medium saucepan with 1 1/2 cups water. Bring to a boil over medium-high heat; reduce heat so the lentils boil gently, cover and cook, stirring occasionally, until just tender, 12 to 18 minutes (red lentils cook more quickly than brown). Makes 1 1/2 cups.
Exploring Nutrition, Fitness and Environmental Impact on Our Overall Health Using Evidence Based Medicine
Most of us know that healthy eating and exercising helps us maintain a healthy weight and can prevent many diseases. We watch the news and read articles on the internet about the health benefits of kale or the importance of drinking 8 glasses of water a day. Dr. OZ and The Doctors are two television programs that day after day shell out several tips on how to lose weight, cleanse the colon and even delay aging!
Some of this information might be helpful or even true, however, most of these topics sound sexy and sell copies of magazines, papers or gain ratings. My goal with this blog is to find the latest evidence based nutrition,fitness and environmental information to help answer my questions and yours on how to benefit our overall health and longevity. One year its ok to drink a glass of red wine a day, the next, it causes cancer. How many hours of sleep do we really need? Does it depend on the individual? Do blueberries and other foods with antioxidants really help prevent cancer. Does diet help with healing after surgery? Do pesticides and hormones in the food your children eat cause long term health effects? Are you confused yet? I know I am.
Recently, the NIH has cut funding to nutrition research due to budgetary cuts. This should not stop or prevent us from finding answers. I plan on helping to distinguish between the good, the bad and the BS by exploring articles, lectures, interviews and other sources that innovative and intelligent scientists and health professionals are currently discussing and researching nationally and internationally. The information on this blog will be evidence based and not on beliefs and societal myths.
I definitely would appreciate any and all comments, feedback, links and resources you are willing to share with us all on this blog.
Disclaimer: Information on these blog posts are my interpretation of articles, interviews, discussions, conversations etc. This information is not meant to be a treatment for any disease or condition. You should seek personal evaluation from a medical professional if you are ill or injured.
Click Each Category for Information
Dr. Suzanne Fuchs has a passion for nutrition, health and fitness. She aims to connect the dots between our overall health and the substances that go into our bodies on a daily basis by using only evidence based medicine, science and expert advice.
Dr. Suzanne Fuchs currently practices concierge foot and ankle medicine and surgery in Palm Beach and Palm Beach Gardens, Florida at LuxePodiatry™
If you have health concerns you should contact your physician for professional advice.
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