There are currently 680,771 people in Massachusetts with diabetes, according to the American Diabetes Association. That’s 12 percent of Massachusetts’ adult population – and roughy 162,000 of them haven’t been diagnosed.
Additionally, 1.7 million people in Massachusetts have been diagnosed with prediabetes – 35 percent of the state’s adult population. The disease and its complications, including heart disease, stroke, non-traumatic lower-leg amputation, kidney disease and blindness, costs Massachusetts $8.1 billion every year according to the ADA.
The Diabetes Prevention Program is fighting to change these statistics. The class is a year-long, “lifestyle change”, according to Dara Midwood, YMCA Southcoast diabetes prevention coordinator. It was introduced to the Southcoast YMCA two years ago.
The goal of the classes, which are held at five of the six Southcoast locations (Swansea, New Bedford, Dartmouth, Wareham and Fall River) is to lower participants’ body weight by 5-7 percent in the first 16 weeks of the class, and to teach participants better lifestyle habits.
The first 16 weeks, the participants meet for one hour per week with a certified diabetes counselor, who will teach them how to read labels, make healthy choices, and increase their physical activity.
At the end, participants should be able to increase their physical activity to 150 minutes per week. “It’s not a diet program,” Midwood said. “We don’t say that you can’t have it. We explore your options to be able to eat in a healthy manner.”
The classes are held in small-group format, where participants can exchange ideas and share problems and successes with others in the same boat. “The success of the program is based on people being able to find out what works for them,” Midwood explained.
Current program member Christine Schryver showed the group MyFitnessPal, a phone application which breaks down what is in the food you eat, and tracks exercise. She enjoys the supportive small-group atmosphere. “I’ve done Weight Watchers, I’ve tried dieting on my own,” she said. “This works for me.”
The local classes have smashed their goals. The last Wareham class lost an average of 6 percent of their bodyweight in the first 16 weeks. Wareham’s program leader, certified lifestyle coach Lu Brito, said one participant in his class lost 46 pounds in that space of time.
“One hundred fifty minutes of walking every week, and developing a maintainable healthy lifestyle. She can still eat mostly what she wants, she just knows how to do it in a healthy manner. That’s all it took.”
New classes will begin in March – for more information, inquire with Diabetes Prevention Coordinator Dara Midwood, at 508-996-9622 ext. 141, or [email protected]
A typical breakfast for Alexander Cisneros is a two-egg omelette with spinach sauteed in coconut oil and full-fat cheese.
And for lunch or dinner his mother, Gladys Cisneros, prepares four ounces of fish, chicken or beef with a half a cup of bell peppers, asparagus or broccoli sauteed in real butter and smothered in cheddar cheese.
For dessert it’s jello made with heavy whipped cream or a fat bomb, whipped cream mixed with Stevia, a natural sweetener made from the Stevia leaf.
Not exactly what many people would consider a healthy diet.
But for Alexander, his mother and his sister Jacqueline, it works.
“There’s three of us on the diet for three different purposes,” Cisneros said. “He is on it because he has multiple disabilities, one of them being epilepsy so he is on it to address the epileptic seizures. My daughter is on it because she’s a competitive swimmer with WETT. I do it because it helps to balance my hormones. Being middle aged, it affects my body. Plus it helps my energy level.”
The Cisneros family is on the ketogenic diet, a very low-carb diet which turns the body into a fat-burning machine.
“Half the time, you can’t even finish your meal because it’s so rich and so good,” Cisneros said. “Alexander has three meals a day, plus I’ll send him a snack like pork rinds.”
Studies have found that this very low-carb, high-fat diet is effective for weight loss, diabetes and epilepsy. There’s also early evidence to show that it may be beneficial for certain cancers, Alzheimer’s disease and other diseases, too.
“It’s a high fat, low carbohydrate, adequate protein diet where we restrict the carbohydrates,” said Franco Lopez, a licensed dietitian with the Hospitals of Providence. “It’s called the modified ketogenic diet which is a little more liberal than the classic ketogenic diet. The classic ketogenic diet has to be measured with grams with a scale so it was very strict. This one is more liberal where you can eat more vegetables.”
A ketogenic diet is similar to other strict low-carb diets, such as the Atkins diet or LCHF (low carb, high fat). A ketogenic diet typically limits carbs to 20–50 grams per day.
According to the Epilepsy Foundation, the ketogenic diet is one of the oldest treatments for epilepsy. It is intended to maintain the starvation or fasting metabolism over a long time. When the body is in a fasting state, it creates ketones, a by-product of fat-burning metabolism. It has been established that seizures often lessen or disappear during periods of fasting in some individuals with epilepsy.
“A lot of people are afraid of the amount of fat consumed in this diet,” Lopez acknowledged. “But there’s a big misconception that fat is harmful when in reality it’s the carbohydrates that are causing the harm. Unfortunately what is being promoted is low fat, high carbohydrates so my role is to do seminars and educate people and have kids not only with epilepsy but who have elevated cholesterol in their diet, kids with diabetes, people with a brain tumors; I have a patient with a brain tumor which has been shrinking.”
Lopez sees patients Monday through Friday at the Specialty Clinic at The Hospital of Providence Children’s Hospital.
“I have about 40 to 50 patients on the ketogenic diet,” he said. “The diet works on 50 to 70 percent of my patients. Any very good medication, at the most, will have a 30 percent effectiveness. This diet surpasses that.”
Lopez, who is on the diet, said his triglycerides, a type of fat in the blood the body uses for energy, has improved and he has lost weight.
“The diet requires preparation, it requires committeemen, dedication and creativity,” he said. “I encourage the entire family to adopt the diet that way everybody can eat the same food at the dinner table. Everyone benefits from the diet.”
He has a patient who is a football player who experiences seizures.
“He is 6-4 and weights about 240 pounds,” Lopez said. “His caloric intake is about 5,000 calories so his mom prepares a half dozen eggs and half a package of bacon. She cooks the eggs in the fat of the bacon juice so he can get enough fat into his diet.”
Alexander’s intake is about 1,620 calories.
“We haven’t seen a complete elimination of seizures but they’ve gone from one to two a day to maybe two a week so there has been a drastic drop in the frequency, the duration and the intensity of the seizures,” Alexander’s mother said. “Once upon a time when he would have a seizure, he would sleep for three hours. Now when he has a seizure, nine times out of 10 he doesn’t fall sleep at all. He’s a little droggy but he doesn’t sleep so his recovery rate is a lot better.”
Cisneros and her daughter have also seen the benefits.
“For my daughter, her endurance is so much better,” she said. “When she would compete, she was so exhausted. Now she feels like she can swim longer. She told me that that she is studying less but retaining more. Her energy level and her endurance are both up. Also her muscle tone has gotten more defined.
“For me, my energy levels were dropping and my menstrual cycle was off because I was very hormonal,” she said. “I had to take a 2 o’clock nap almost every day. All of that changed. I no longer have to take a nap, my energy levels are high now, everything is different.”
Victor R. Martinez may be reached at 546-6128; [email protected]; @vrmart on Twitter.
The Fat Plan
What: The ketogenic diet, a high fat, low carbohydrate diet which turns the body into a fat-burning machine. Studies have found that the diet is effective for weight loss, diabetes and epilepsy.
Who: Franco Lopez, a licensed dietitian with the Hospitals of Providence, sees patients Monday through Friday at the Specialty Clinic at The Hospital of Providence Children’s Hospital.
One of my earliest memories is being dragged along with my mother and father to a funeral service held at a church somewhere deep in the countryside of North Florida.
The poor fellow who’d died, let’s call him Luther, once worked with my grandfather at my grand-pappy’s mule barn and livery stable in downtown Marianna. Luther was a member of a Pentecostal church that did not believe in air conditioning but did believe in pulling out all of the stops when it came to funerals. A small combo — drums, organ, electric guitar — set up in one corner of the sanctuary. The band kept the beat and soundtrack humming as the service roller-coastered its way along with shouted scriptures from the pulpit, foot-stomping songs, hand claps, wild wails and whoops from the congregation.
They sure didn’t have anything like it down at the polite and tight-lipped First United Methodist Church. Luther, stretched out in his open casket with his funeral parlor tan, was missing one helluva show.
At one point, as the electrically charged vibe ebbed and flowed, Luther’s ample-sized widow in the front row was suddenly overwhelmed with emotions. She jumped from her pew and charged the casket. After grabbing Luther by his shoulders, she shook him and yelled at the top of her voice: “Who’s going to cook your dinner tonight, Luther? Who’s going to cook your dinner tonight?”
The pallbearers had to pry her out of the coffin.
I was initially frightened by such a display of raw, hysterical grief. After a few minutes, though, I began pondering the dining situation in the afterlife. Naturally, everything in hell was burnt to a crisp, but did heaven have some sort of meal plan? A lunch room? A Morrison’s Cafeteria? If heaven didn’t serve Morrison’s macaroni and cheese, then I didn’t want to go.
After a somber and quiet graveside service in the July heat, we dropped by Luther’s house to offer our condolences to his family. Luther’s modest home was stacked to the rafters with pecan pies, bowls of banana pudding, baskets of fried chicken, biscuits, pound cakes and hams. The food was dropped off and delivered by Luther’s friends and neighbors. According to the rules of Southern grief, the only cure is carbs, sugar, starches and fat grams.
It’s called comfort food for a reason. I proceeded to eat my weight in pound cake. No wonder Luther’s wife was worried about supper plans in heaven.
Did you eat yet?
Within hours of my mother’s death last month in Marianna, the Southern Grief Relief Diet Plan began full throttle at my oldest brother’s house.
On the first night, close friends of the family from the Methodist Church brought batches of homemade fried and smoked chicken. They were toted in cardboard boxes large enough to transport microwave ovens. The perfectly cooked chicken was served up with heaping side dishes of field peas, creamed corn, mashed potatoes, gravy, dinner rolls and butter. I should have worn sweat pants with an elastic waist band.
That was just a warm-up. Pass the beef tips with rice, please. Someone get the suitcase of Brunswick stew out the fridge and heat that sucker up. Dim the lights and chill the ham. Which one of you dirty rotten scoundrels ate the last barbecue rib?
It was nearly impossible to keep up with the number of cakes (Italian cream, layered chocolate, lemon, you name it), pies and desserts as they stacked up around my brother’s kitchen and dining room. His two grandsons — who are ages 4 and 6 — went on a sugar binge just like I did after Luther’s burial. The family dachshund, Molly, was so worn out from barking at the long stream of kindly visitors that my brother finally boarded the pooped-out pooch in a kennel. The casserole and cake convoy continued uninterrupted.
There must be a law in the Deep South stating there cannot be a funeral or wake without a congealed salad somewhere on the premises. As I studied the orange, gelatinous blob in front of me, I wondered why it was classified as a salad at all. There’s no butter lettuce or romaine hiding in there. Why isn’t it called a concealed salad instead?
No Southern Grief Relief Diet Plan would be complete without the mystery casserole. It usually has a thick layer of cheese and Ritz Crackers crumbles on top but you dare not ask what lies beneath.
My best friend and lawyer, Matt, had the smartest approach to the Grief Relief effort after my mother died. He dropped by with a mixed six-pack of pinot noir and sauvignon blanc from California and New Zealand. There’s a reason why my mother referred to Matt as her fifth son and called him Number Five. Way to go, El Cinco.
A little blasphemy, please
My mother, Ann, had a sweet tooth for candy. I can’t walk by a bag of chocolate Hershey’s Kisses in the grocery aisle these days without feeling a sudden pang of sadness and loss. That said, she never baked cakes, cookies or desserts. Her culinary skills were hit and miss, which is a blasphemous thing to say about your mama in the South.
Ann was a master when it came to broiling fish or cooking any type of seafood but her meatloaf tasted like it had particle board as its prime ingredient. She made beef soups that were spiked with whole peppercorns lurking just beneath the surface, like little floating mines waiting to destroy taste buds by the thousands when bitten in half. My three older brothers and I did not share her dietary fascination with liver and onions. Her adventures with rutabaga recipes left the house with the lingering aroma of burnt toenails.
Yet, Ann always came though when I needed her most. When I entered the sixth grade at Marianna Middle School, where the cafeteria fare was one notch below chain-gang chow, she got up early every morning to pack my lunch box. Her over-stuffed ham sandwiches on rye bread would look right at home at the Carnegie Deli in Manhattan and made me the envy of the school. How many other moms get up at the crack of dawn to fry fresh chicken thighs and legs for their youngest kids’ midday meal? No one made better tuna fish salad than Ann. So what if she wasn’t Julia Child? She put her heart into it when it really counted.
When Ann got older, her appetite diminished and she ate very light meals. It helped that she no longer had to cook for her hellion sons and a husband who was a devout carnivore.
As I sat in my brother’s house surveying all the rich and delicious treats, I chuckled because, if my mother were there, she would have asked for a spinach salad and some fresh fruit. Those items are not included in the Southern Grief Relief Diet Plan.
Buncombe County, like much of the nation, has a diabetes problem. The disease was ranked as the 10th-leading cause of death in the county in the 2015 Community Health Assessment, an annual gathering of data from residents to determine local wellness in relation to state and national averages. While there are numerous reasons why this has become an epidemic, the assessment found that 23.5 percent of Buncombe adults are obese, and that just over 30 percent of students in K-5 public schools are overweight or obese, factors that increase the incidence of diabetes.
The good news: Asheville-area health professionals say there are affordable and accessible ways to address this growing risk for generations young and old. A wealth of information, diet trends and practices has emerged to address weight loss and the prevention of diabetes.
Christin Banman, a registered dietitian with Mountain Kidney and Hypertension Associates, is accustomed to dealing with the factors that lead to diabetes, Type 2 in particular. “You immediately have to get into the home life situation with these issues,” she says. “Who does the cooking? Who’s in the house?” The majority of her patients have fought weight gain, high blood pressure and long-standing medical issues their entire lives. Their multiple problems create the onset of Type 2 diabetes, she says, which in turn causes kidney malfunction due to higher levels of blood sugar.
Banman’s advice for someone who has contracted the disease and is seeking reversal of the diagnosis is similar to that she’d offer anyone who is prediabetic. She recommends affordable and simple dietary solutions that include buying frozen vegetables for cost and longevity, avoiding most beverages in favor of purchasing foods, buying grains in bulk, and shopping at Aldi and other affordable markets in their area.
Watching your weight is key to help preventing Type 2 diabetes, Banman says. “I really feel like if someone can jump start or hit the restart button with the sugar busters or Atkins diet just to get an initial amount of weight off, I’m a supporter of that. I think the long-term benefits of just getting a little bit of weight off exceed the consequences of that diet.
“I think what we’re dealing with is what’s referred to as a toxic food environment, where we have heavily marketed, very inexpensive, unhealthy foods on every corner — in hospitals, airports and even in our school systems,” she continues. “This food environment surrounds us. So it’s hard for me to argue with someone who says, ‘The croissant sandwiches were two-for-one on the way in.’ With someone that has limited food money, that speaks. So that’s part of the food environment we’re dealing with.”
Diabetes and lifestyle
Type 2 diabetes affects 29.1 million people in the U.S., according to the Centers for Disease Control and Prevention. The most common causes for the onset of this illness are obesity, smoking, physical inactivity, age, family history, high blood pressure and a high alcohol intake, according to WebMD.
Diabetes causes blood glucose levels to rise above normal. When people eat, their bodies turn food into glucose, or sugars, for their body to use as energy. The pancreas creates the hormone insulin, which allows those sugars to get into the cells of the body. But with Type 2 diabetes, the body is no longer able to use its own insulin as well as it should, causing sugar to build up in the blood.
In 2014, the North Carolina State Report named diabetes as the seventh-leading cause of death in the state, the fourth-leading cause for African-Americans and the third-leading cause for American Indians. In WNC, the rate of white people living with the disease is highest, at 11.6 percent, while the rate of African Americans in the eastern part of the state is 15.3 percent.
Harvard University’s PATHS (Providing Access to Healthy Solutions) report for North Carolina in 2014 outlined how legislation could mitigate the disease, including a mandate for insurers to cover diabetes-related services as well as the creation of a unified public health system to provide “whole-person care.” The PATHS report is funded through Together on Diabetes, a philanthropic program of the Bristol-Myers Squibb Foundation, and was launched in 2010 to improve the health outcomes of people living with Type 2 diabetes by strengthening patient self-management education, community-based supportive services and broad-based community mobilization.
Short of legislative measures, how can the millions of Americans seeking to control their weight and improve their health avoid Type 2 diabetes?
Dr. Daniel Stickler of the Apeiron Center for Human Potential in Asheville relates the illness to lifestyle. “Type 2 diabetes is not truly a disease,” he says. “Type 2 diabetes is a lifestyle aspect. You can progress to the point where you actually poison your beta cells in the pancreas after years of being Type 2 diabetic, but it really is a lifestyle. We’ve seen plenty of reversals on people that were diabetic or prediabetic that changed their lifestyle and completely reversed the disease without medication.”
Stickler says that a whole-person approach is needed. Apeiron uses that approach, looking closely at a person’s genetics and at about 75 different genomic variations that help predict appetite, hunger and nutrient selection — from fats to carbs and proteins. Apeiron tailors diets specifically around a person’s genomics, goals and experiences to create a program that is individualized, rather than using a diet from a book.
“The problem that you run into is that when you diagnose someone with a disease, they become the disease,” Stickler says. “The title becomes them, and until they can get to the point where they understand they are not Type 2 diabetes, you’re not going to make any progress with them. We’re treating it with these medications that aren’t treating the core cause, which is lifestyle. It’s OK to bridge that to get things under control, but the whole focus needs to be on treating the core cause, which is a lifestyle component that has created an insulin resistance in the body. And it is easily reversible.
“We have epigenetic coaches that work with clients and read their genetic data, looking at 500 genetic variations and working with sleep, stress, nutrition, exercise and human movement … environment, thoughts, etc. So we’re venturing into all realms in how we address health.”
Ways to approach diet, exercise
Banman notes that Medicare initially covers only three hours a year of dietary intervention and just two hours annually thereafter. “This is where support becomes very limited,” she says, adding that a majority of her patients are diagnosed in their mid-60s, which makes it difficult for them to get up and get moving. In addition, stress from finances, work and family are debilitating factors, pushing diet and exercise to the bottom of their priorities. “I’m struck with the layers in their lives that are making things so complicated, and I’m very sympathetic to it and help however I can,” she says.
Stickler and Banman both recommend the Mediterranean diet, “which is in concert with the diabetic diet,” according to Banman, and which research has consistently shown to be an effective way to also reduce the risk of heart disease, lower low-density lipoproteins (or bad cholesterol) and lower risks associated with cancer, Parkinson’s and Alzheimer’s diseases.
The American Diabetes Association outlines a Mediterranean meal plan on its website. Key components of the diet, according to the Mayo Clinic, are limiting red meat; eating fish at least twice a week and otherwise primarily plant-based food, whole grains and nuts; replacing butter with olive oil; and using herbs and spices instead of salt.
In Buncombe County, residents can address stress, exercise and diet through the Diabetes Wellness and Prevention Program offered by the YWCA, a program designed specifically for adults with or at risk for Type 2 diabetes. Preventive health coordinator Leah Berger-Singer saysthat participants are given a gym membership, bimonthly personal training, a weekly support group (which discusses health-related topics such as living healthy on a budget) and tips on stress management. “We’re aiming to provide access to people that may not otherwise have access to a gym, cooking classes, swim lessons and other options,” she says. “We also provide monthly dinner lectures or ‘lunch and learns,’ hands-on cooking demos, field trips and other extracurricular activities.”
Chiropractor and yoga instructor J. Anya Harris of Crystalign Chiropractic in Asheville says that stress-reduction techniques coupled with group exercise can be keys to combating many diseases, including diabetes. “Getting out of your routine and your house and away from your cellphone is really important,” she advises. Her approach with patients is to address both spinal health and overall physical health, as well as stress and energy levels. Chiropractic care helps to create a range of motion and mobility, freeing up the body to get patients to the point where they feel good enough to exercise again or continue exercising, she explains. It also opens up the neural pathways that keep the organs, muscles and spine balanced, she adds. “With the energy work, I’m shifting relationships and trauma to give them the spark to get them moving. It’s all about setting up the mind, body and soul to help them feel at ease in their own skin and really define their ‘why.’ If you don’t know your why, then none of it matters, because you won’t stay consistent. The why will give them reframing in their consciousness that will keep them moving toward their goal.”
For more information:
Mountain Kidney Hypertension, 10 McDowell St., Asheville, offers a variety of services, including diet and meal planning for diabetics and services for those suffering from hypertension and kidney disease. 258-8545
The Apeiron Center for Human Potential, 190 Broadway, focuses on preventive wellness, including genomic assessments, epigenetic coaching and human potential assessments and coaching. (888) 547-1444
Crystalign Chiropractic, 36 Clayton St., off Charlotte Street in Asheville, offers head-to-toe chiropractic adjustments, trigger-point muscle therapy, energy work, nutrition analysis and wellness coaching. 335-2208
Along with the New Year come the resolutions to get healthy and lose weight. If you’re like me, you have tried every diet imaginable. You probably think you have heard it all. Well, there may be something you might not have heard of. Did you know that fat can be good for you? The Ketogenic Diet is a low carb, low sugar, moderate protein, and high fat diet that turns your body into a fat burning machine. Most of us consume a lot of sugar and carbs which our keeps our bodies in a constant state of glycosis which basically means our bodies are burning off sugar, not fat. When you drastically cut your intake of carbohydrates and sugars, your body eventually enters a state of ketosis, in which it is getting its energy from the ketones causing fat to burn quickly. This is beneficial not only for weight loss, but other aspects of your health as well.
Some research suggests that a ketogenic diet can help lower your risk of heart disease. Studies have also shown that it may alleviate some symptoms associated with type 2 diabetes, Alzheimer’s, Parkinson’s, and ALS. This is thought to be because abnormal glucose levels can cause damage to neurons and ketones are believed to protect them. The Mount Sinai School of Medicine in New York was the first to demonstrate that ketosis actually slowed down the progression of ALS in mice.
So how can you achieve ketosis?
The diet has a strict guide for the 3 main categories of food: 75% fats, 20% protein, and 5% carbohydrates. Good sources of fat are from avocadoes, nuts (especially almonds, cashews, and macadamia nuts), coconut and olive oils, butter, pumpkin seeds, whole eggs, full fat cheese, chicken thighs and legs, beef (make sure it’s not lean), pork rinds, sour cream, cream cheese, bacon, and fatty fish. Vegetables that are typical of a ketogenic diet include spinach, broccoli, asparagus and mushrooms. There’s actually a wide variety of foods that you can have, this is by no means an all-inclusive list. The internet is thriving with delicious recipes waiting for you to try. You can test your body’s ketone level with test strips available at most pharmacies to make sure you are in the optimal range.
One warning: Don’t get discouraged by “The Keto flu.” As your body is detoxing and switching gears to get healthy, you may feel sluggish and moody, almost flu-like. Like an addict kicking a bad habit, your body is craving the carbs and sugars it’s used to. Many people give up at this point, but if you persevere through it, you will see amazing results!
Remember to get your physician’s advice before beginning a new diet.
On today’s edition of “The Dr. Oz Show”, Dr. Oz discusses a great new dietary plan that just may help you shed those extra pounds that you have been meaning to get rid of. This new eating and diet plan just may have what other diet regiments may be lacking. This new diet plan is […]
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The Yavapai Regional Medical Center’s Pendelton Center offers the Reversing Heart Disease Support Group the second Monday of every month to help participants learn about diet and lifestyle strategies that are key to long-term heart health. The group revolves around the lifestyle habits and plant-based diet proposed by cardiologist Dr. Dean Ornish, who over the […]