In This Issue

• Diabetes In Epidemic Proportions
• Type II Diabetes in Children
• Weak Ankles?
• Got a Cough?
• No HRT, What's Next?
• Tropical Oils Update
• Safe Cigarettes?
• CoQ-10
• Exercise Corner-- Chair twists
• Questions And Answers

Diabetes refers to a group of diseases, but we will look at diabetes milletus [Note that when the word "diabetes" is used by itself, it commonly means diabetes milletus.], the most common form. And to further define our subject, it will be limited to type II diabetes (formerly called adult-onset diabetes, but no longer since it so often afflicts children in today's society) as opposed to the much less common type I (previously called juvenile or insulin-dependent diabetes).

This disease is a carbohydrate metabolic disorder that affects how blood sugar (glucose (see Note 2)) is used in your body. It is characterized by high blood glucose resulting from either low insulin (see Note 3) production or ineffective use of insulin, resulting in excess glucose in the blood, requiring that it be converted to, and stored as, fat.

Being overfat is both a risk factor for diabetes, and a result of it. About 90% of adult diabetics are overfat.

Diabetes is diagnosed by using a fasting blood test. After a normal overnight fast, your blood sugar level should be in the range 70-109 mg/dL (see Note 4). A level consistently tested at ( 126 mg/dL indicates diabetes.

Diabetes can be an insidious process -- it can develop slowly over a long period of time without displaying serious symptoms. For that reason, many more cases than are diagnosed are likely to exist.

Some of the risk factors for diabetes are:

• Fasting blood test as previously noted.
• Age -- risk for type II increases with age, especially after the age of 40.
• Weight -- being overfat is a primary risk factor. Typically eight of 10 people with type II diabetes are overfat. As it turns out, the more fat you have, the more resistant your cells are to insulin.
• Family history -- if you have a close relative with diabetes, your risk of getting it increases.
• Race -- Blacks, American Indians, and Hispanics have higher rates of diabetes.
• Inactivity -- couch potatoes are more prone to get it than more active people. Here again, that universal palliative must be mentioned -- EXERCISE (formal, or just being generally more active). The obvious reasons are that more active people use more glucose for energy, make cells more insulin-sensitive, have increased blood flow (better circulation), and have more muscle, which makes insulin use more effective.

So, what can you do if you have one or more of these risk factors? Obviously for some risk factors (family history, age, or race) nothing can be done; but, weight control is capable of dramatic results. As a last resort, there are drugs (aren't there always) -- statins, ACE inhibitors, and ??

Note 1 - Overfat is my preference over the more commonly used euphemism "over-weight." Overweight is a misnomer, a holdover from the 1950's use of charts developed by the insurance industry to help determine health risks based on bodyweight; a very oversimplified concept since two men, each 5'10" tall and weighing 225 lbs, were treated the same although one could be an athlete with 5% body fat, while the other was a slovenly 35% body fat. Overfat is a much more accurate descriptor.

Note 2 - Glucose is essential -- it is the primary source of energy for the brain, as well as an important energy source for all activity, especially as intensity of effort increases.

Note 3 - Insulin is a hormone secreted by the pancreas to control transport of glucose from the bloodstream into body cells.

Note 4 - Blood sugar is measured in terms of milligrams of glucose in a deciliter of blood (mg/dL). Blood sugar levels ordinarily fluctuate; they rise after meals, but only moderately during fasting.

Type II diabetes is rising dramatically in children; as is child obesity, along with increased general overfat. Preteens, actually children as young as age six, are acquiring these conditions -- too many sodas, fries, burgers, and other junk food, too many calories in general, and not enough physical activity. The same as for adults.

Diabetes can lead eventually to pleasantries like kidney failure, heart attacks, blindness, amputations, even death. Not a happy future to contemplate.

Type I diabetes is marked by one's immune system mistakenly attacking insulin-making cells in the pancreas, resulting in not enough insulin to convert sugar (carbohydrates) to energy. Type II differs in that insulin is made, but not enough; or is ineffectively used, and used to occur primarily in people over the age of 50, but one of the benefits of our modern world is that it has made is way to our children.

In girls, insulin resistance frequently triggers hormone abnormalities that cause facial hair, acne, and ovarian cysts.

Young blacks and Latinos seem to be especially prone to type II diabetes, maybe because of their weight, or maybe because of an as yet undiscovered genetic predisposition, possibly exacerbated by being over-fat.

It would seem that the solution is obvious : make better food choices, cut calories, and increase physical activity. The motivational aspect is harder. We pretty much know what to do , but . . .?

If you have weak ankles, here are some potentially helpful exercises:

• Inverted/everted walking -- walk on the insides of your feet, then roll your feet outward and walk on the outsides. This can be done at home, in a park, or on a nearby track.
• Ankle alphabet -- sit on a chair with one foot flat on the floor, and hold the other one in the air. Now, using your "big toe" as a pointer and your ankle to control it, "draw" the alphabet.
• Ankle/heel raises -- on a raised surface (stairs, a board (2"x 4"), etc. place the balls of your feet on the raised surface -- your heels are unsupported. Now raise up on your toes as high as you can, hold, then slowly lower your heels until they are below the balls of your feet. Conversely, stand on your heels -- pull your toes toward your shins, hold, then return to a flat-footed stance.
• Stair climbing on your heels -- walk both up and down stairs on your heels. A handrail is obviously a requirement for his exercise.
• Push-outs -- stand or sit with your shoulder next to a wall, and push against the wall with the side of your foot. Turn around and do the other foot.

• One-foot stand -- this one is pretty obvious, stand like a stork, and do it on both legs.
• Heel-toe walking -- walk in-line so the toe of one foot touches the heel of the other foot.
• Body leans -- start in a standing position with your feet together. Lean forward slightly from the ankles, so your weight shifts to your toes. Now rock back slightly onto your heels. Do the same thing to each side. Now, the pièce de résistance, move your body in the shape of a cone (360 degrees, and remember that your legs and trunk remain in a straight line. Only your ankles move to initiate the leaning and rotating.

If you have a cough you should know there is a good one and a bad one, so proceed accordingly. If your cough brings up phlegm, leave it alone, that's what it is supposed to do. A "bad" cough is a nonproductive, dry, hacking one. It can tire you out (coughing requires muscular exertion), and give you a sore throat.

If you decide to medicate, start with O-T-C remedies. They come in the form of 1) expectorants, 2) suppressants, and 3) combination drugs (cough, sore throat, runny nose, etc.). Note that your chances for success are better with drugs that target a specific symptom (unless you have them all), and if your cough lasts more than seven days, you should see a physician. You probably need a prescription for a more aggressive approach than O-T-Cs can provide.

Now that HRT (Hormone Replacement Therapy) has been more-or-less blown to smithereens, what options are left? Following is a list of some symptoms HRT was designed to improve, and some alternatives other than HRT.

"Hot Flashes"

• "Natural" estrogens can be effective, but long-term safety is untested.
• Estrogen patches -- effective
• Progestin is effective in 70% of women, but long-term safety is untested.
• O-T-C progesterone creams -- there is no scientific evidence supporting their effectiveness, but some personal supportive testimony exists.
• Antidepressants -- effective (used in smaller doses than for depression).
• Hypertension drugs may be effective when used in smaller doses.
• Black cohosh may be effective in small doses.
• Evening primrose oil, dong quai root, vitamin E, and flax seed oil have all been found to be ineffective; dong quai may actually be toxic.
• Soy products -- reports on its effectiveness show conflicting results, and long-term safety is unknown.

• Prescription estrogen creams, tablets, and rings are ineffective, and long-term safety is untested.
• O-T-C vaginal lubricants are effective, and with no known side-effects.

Calcium -- women over 50 should take 1200-1500 mg per day.
• Vitamin D increases effectiveness of calcium, and between ages 50-70, 400 IU daily is recommended, and 600 IU for the over-70 group.
• Raloxifene is not effective against menopausal symptoms, but is used to treat diagnosed osteoporosis.
• Biphosphonates can delay bone loss, and are used to treat osteoporosis.
• Calcitonin, a hormonal nasal spray, can prevent or delay bone loss. Long-term safety is unknown. Used to treat osteoporosis.
• Do: eat a healthy diet, do weight-bearing exercise (e.g., walking, weight training), don't smoke.

• Low dose aspirin -- use only per physician's advice. If asymptomatic, take a baby aspirin (81 mg) daily, and a full-strength (325 mg) aspirin every 15 days as a "booster," or take physician's advice. He/she will probably recommend a higher dose for those with previous heart problems.
• Cholesterol-lowering medications, such as niacin or statins are common if diet modifications and exercise are ineffective.
• Alcohol -- a drink a day may work, but this is not a license to start if you don't already drink.
• Do: practice weight control, eat a diet rich in fruits, vegetables, whole grains, and non- or low-fat dairy products; limit saturated and trans fats; and do regular aerobic exercise.

Tropical oils (e.g., coconut oil, palm kernal oil, and others) were once considered to be nearly toxic, but the latest thinking is that maybe they are not that bad. They are high in saturated fat; the reason for their poor reputation, but their declining use has a downside; trans fat, which often has been used to replace tropical oils, and is actually worse than saturated fat, although saturated fat remains the principle villain in the nutrition story by virtue of being more abundant.

It has been discovered that in the body, tropical oils act like unsaturated fat, and may actually reduce heart disease. The bottom line is that resumption of use of topical oils is not being recommended, but you needn't feel like you will drop dead immediately upon eating a coconut-containing food.

Safe Cigarettes? "Bidis" are flavored cigarettes from India that have "caught on" with teenagers. They are thin, unfiltered, contain tobacco, are cheaper, and the flavors (e.g., strawberry, licorice, and grape) make them appealing to teens, who seem to perceive them as being safer than more traditional cigarettes, but they aren't. They may look "cool," but they release more nicotine and toxic chemicals than the traditional stuff.

Clove cigarettes are another product advertised as safer than regular cigarettes, but aren't. They come mostly from Indonesia, where they are called kreteks, and are 60% tobacco and 40% ground cloves; but clove smoke brings along its own junk to add to normal cigarette smoke; and they deliver more tar than traditional cigarettes. If your kids are using these, give them the facts.

CoQ-10 is a coenzyme in the body that has been touted by the dietary supplement industry as one of those "cure alls" that we frequently hear about -- it can be used to treat or cure heart disease, hypertension, AIDS, asthma, Parkinson's, Huntington's, lung disease, some cancers, and ??? Research hasn't verified any of these claims, but it is approved for use in Japan for cardiovascular disease; although U.S. research is in early stages, with uncertain results. If you are taking it on your own, talk to your doctor. Also, it is expensive; may interact with other medications; there is no identified effective dose for any disease; and if you are taking it as a preventative medication, there is no evidence that it can keep you healthy or reduce the effects of aging, as claimed.

Exercise Corner features seated chair twists. It works and stretches the "core " muscles in the waist, abdomen, chest, and back: rectus abdominus, obliques, anterior serratus, quadratus lumborum, and intercostals.

You will need a chair with a back, but no arms, and this exercise can be done at home or at the office.

Begin by sitting sideways on the chair, knees pointing to the right, and your chest toward the back of the chair. Grasp the upper left side of the chair back with your left hand, and grasp the upper right corner with your right hand. Your back should be very upright -- no slouching. Now pull with your left hand, and push with your right. Keep it slow and controlled, this is not an aerobic exercise. As you inhale, lengthen your spine (raise up tall); and as you exhale, twist more until you reach your maximum, but train don't strain..

(Q) I spend a lot of time at a local Starbucks. Is coffee fattening?
A. H., Eugene, OR

(A) Coffee itself has very little fat and few calories, but if you indulge in something like a caffe mocha "grande," you are consuming about 400 calories and 23 grams of fat -- mostly saturated.

(Q) I know that prunes, now euphemistically called dried plums, are high in calories, and that I probably shouldn't eat them. Is that true?
R.L., Scappoose, OR

(A) Not necessarily, the drying process increases calories, but otherwise they are a healthy food containing fiber, magnesium, calcium, potassium, vitamin C, boron, copper, and carotene. And, they are loaded with antioxidants.

Eaten in moderation, they are a good snack, but as with all dried fruit they are sticky and can cause tooth decay, so brush or rinse your teeth after eating them.

(Q) My daughter has started to smoke, much to my displeasure. She knows about lung cancer, and other health risks, but seems to feel invulnerable. Is there anything else I can tell her that might discourage the habit?
J.P., San Jose, CA

(A) Probably not, but if she isn't totally retractable, you could tell her that essentially every tissue in the body is negatively affected by smoking; especially bones muscles, and joints. It can, for instance, damage spinal disks and increase the risk of bone fractures.

(Q) I seem to be gradually losing my hearing. Is there anything I can do short of seeing a doctor?
D.Z., Cedar Rapids, IA

(A) The cause may be an accumulation of earwax, in which case you can try putting a drop or two of warm mineral or vegetable oil in your ear using an eye-dropper. After 10-15 minutes use a bulb syringe, with warm water, to flush your ears. Hold your head upright to flush, then turn it sideways to drain. This may work as well as using more expensive commercially prepared products.

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