Berries Are Good, But Watch Carbs – P1

I love most berries, but with type 2 diabetes, I know that I must limit the frequency and quantity that I can eat. I feel that this article by Franziska Spritzler, RD, CDE should be given more coverage.

She says, “"Berries are among the healthiest foods you can eat. They are delicious, nutritious and provide a number of impressive health benefits. Here are 11 good reasons to include berries in your diet.”

#1. Berries Are Loaded With Antioxidants: Berries contain antioxidants, which help keep free radicals under control. Free radicals are unstable molecules that occur as a normal byproduct of metabolism. It’s important to have a small amount of free radicals in your body to help defend against bacteria and viruses. However, free radicals can also damage your cells when present in excessive amounts. Antioxidants can help neutralize these compounds.

Berries are a great source of antioxidants, such as anthocyanins, ellagic acid and resveratrol. In addition to protecting your cells, these plant compounds may reduce the risk of disease. One study showed that blueberries, blackberries and raspberries have the highest antioxidant activity of commonly consumed fruits, next to pomegranates.

Important point - berries are high in antioxidants such as anthocyanins, which may protect cells from free radical damage.

#2. Berries May Help Improve Blood Sugar and Insulin Response: Berries may improve your blood sugar and insulin levels. Test-tube and human studies suggest they may protect cells from high blood sugar levels, help increase insulin sensitivity and reduce blood sugar and insulin response to high-carb meals.

Importantly, these effects appear to occur in both healthy people and those with insulin resistance. In one study of healthy women, consuming 5 ounces (150 grams) of puréed strawberries or mixed berries with bread led to a 24–26% reduction in insulin levels, compared to consuming the bread alone. Moreover, in a six-week study, obese, insulin-resistant people who consumed a blueberry smoothie twice per day experienced greater improvements in insulin sensitivity than the group who consumed smoothies without berries.

Important point - berries may improve blood sugar and insulin response when consumed with high-carb foods or when included in smoothies.

#3. Berries Are High in Fiber: Berries are a good source of fiber, including soluble fiber. Studies have shown that consuming soluble fiber slows down the movement of food through your digestive tract, leading to reduced hunger and increased feelings of fullness. This may decrease your calorie intake and make weight management easier.

What’s more, fiber helps reduce the number of calories you absorb from mixed meals. One study found that doubling your fiber intake could help your body absorb up to 130 fewer calories per day. In addition, the high fiber content of berries means that they're digestible or net carb content low. Net carbs are calculated by subtracting fiber from total carbs.

These are the carb and fiber counts per one-cup serving of berries:
Raspberries: 15 grams of carbs, 8 of which are fiber.
Blackberries: 15 grams of carbs, 8 of which are fiber.
Strawberries: 12 grams of carbs, 3 of which are fiber.
Blueberries: 21 grams of carbs, 4 of which are fiber.

Because of their low net carb content, berries are a low carb friendly food.

Important point - berries contain fiber, which may help decrease appetite, increase feelings of fullness and reduce the number of calories your body absorbs from mixed meals.

#4. Berries Provide Many Nutrients: Berries are low in calories and extremely nutritious. In addition to being high in antioxidants, they also contain several vitamins and minerals. Berries, especially strawberries, are high in vitamin C. In fact, one cup of strawberries provides a whopping 150% of the RDI for vitamin C.

With the exception of vitamin C, all berries are fairly similar in terms of their vitamin and mineral contents. Below is the nutrition content of a one-cup (144-gram) serving of blackberries:
Calories: 62.
Vitamin C: 50% of the RDI.
Manganese: 47% of the RDI.
Vitamin K: 36% of the RDI.
Copper: 12% of the RDI.
Folate: 9% of the RDI.

The calorie count for one cup of berries ranges from 49 for strawberries to 84 for blueberries, making berries some of the lowest-calorie fruits around.

Important point - berries are rich in several vitamins and minerals, especially vitamin C and manganese, yet low in calories.

#5. The Antioxidants in Them Help Fight Inflammation: Berries have strong anti-inflammatory properties. Inflammation is your body’s way of mounting a defense against infection or injury. However, modern lifestyles often lead to excessive, sustained inflammation due to increased stress, inadequate physical activity and unhealthy food choices. This type of chronic inflammation is believed to contribute to the development of diabetes, heart disease and obesity, among other diseases.

Important point - berries may help reduce inflammation and decrease the risk of heart disease and other health problems.

Christmas Gifts for People with Diabetes

Gifts for people with diabetes can be troublesome for many people. This is why I have reviewed my previous blogs and will list them for your reading. This blog from December 2012 is one of the better ones.

At this time of year and before birthdays, people are always looking for gifts that people with diabetes will appreciate. Joslin Diabetes has a list and some suggestions that could be appropriate. I will say that the books listed in the blog should be considered with care as the American Diabetes Association is not known for low carbohydrate cookbooks, but some may appreciate them.

One suggestion from the Joslin blog is the possible purchase of an electronic food scale that calculates the carb counts of food. This may be on the expensive side for many people, but could be of value if you have the funds. On the less expensive side are items like a pedometer or resistance bands. Read the entire Joslin blog as ideas are presented to the end of the blog.

Another suggestion is a scale that allows you to zero out the container and give the weight only of different contents in the container or containers. This is what I own and I enjoyed it for several years before I remarried and my wife took over doing most of the cooking.

The second blog is about poor gift ideas for people with diabetes. Food is often the choice of many people to give as gifts and why they assume that sugar free is all they need to be concerned about is puzzling to most of us with type 2 and type 1 diabetes.

The third blog is about various gifts that are suitable for all ages, from young children to senior citizens. And many gifts are for different occasions, which can be valuable for people looking for gifts.

I will be pulling together different ideas for gifts during the next year and hopefully will have more suggestions another year.

Oils – Which to Use When

As a person with diabetes, I found this article in the United Kingdom Telegraph newspaper very informative. I was aware of some of the points, but others I had not encountered, as my mother never used them.

You may want to copy this or print it to have it as a ready reference.

Extra virgin olive oil

• What is it made from: the extracted juice of crushed olives. It is one of the only cooking oils made without the use of chemicals and industrial refining. There are very specific standards oil has to meet to receive the label "extra-virgin." Because of the way extra-virgin olive oil is made, it retains more true olive taste, and has a lower level of oleic acid than other olive oil varieties. It also contains more of the natural vitamins and minerals found in olives.

• Best for: dressing salads, drizzling over pasta, baking

• Worst for: frying at high temperatures, because of its low smoke point

Olive Oil

• What is it made from: the oil extracted from pressed whole olives. This oil is typically a blend of virgin olive oil and refined olive oil (which refers to oil where heat and/or chemicals are used in the process of extracting oil and removing flaws from the fruit).

An olive branch Credit: Alamy

Pure olive oil is a lower-quality oil than extra-virgin or virgin olive oil, with a lighter color, more neutral flavor, and oleic acid measuring between 3-4%. This type of olive oil is an all-purpose cooking oil

• Best for: light frying and salad dressing, baking, dressings

• Worst for: high temperature frying

Rapeseed oil

• What is it made from: oil extracted from rapeseed. In the last few years there's been a surge in artisanal, British, "cold-pressed" rapeseed oils, which are marketed much like single-estate olive oils. Unlike olive oil, rapeseed doesn't go toxic at high heat, while a smoke point higher than that of olive oil makes it marginally more suitable for frying

• Best for: roasting potatoes, frying

• Worst for: it has a very subtle flavor, so is not to everyone's taste for drizzling

Lard

• What is it made from: fatty deposits from pigs

• Best for: baking, high-temperature frying

• Worst for: anything that doesn't involve high temperatures

Ghee

• What is it made from: boiled butter, churned with cream with the liquid residue removed

• Best for: high-temperature frying

• Worst for: anything that doesn't involve high temperatures

Goose/duck fat

• What is it made from: the fat drained from cooked goose or duck

• Best for: high-temperature frying, roasting potatoes

• Worst for: anything that doesn't involve high temperatures

Sunflower oil

• What is it made from: oil extracted from sunflower seeds

• Best for: the latest advice says we should avoid altogether

Worst for: cooking or frying at high temperatures

Vegetable oil

• What is it made from: the oils extracted from seeds like soybean, corn, sunflower, and safflower

• Best for: the latest advice says we should avoid altogether

• Worst for: high temperature frying

Coconut oil

• What is it made from: most coconut oils are made from smoke drying, sun drying, or kiln drying the dried meat of the coconut called 'copra'

• Best for: high-temperature frying, baking

• Worst for: drizzling over food, although it can be combined with other ingredients to make a dressing

Scientists have discovered that heating up vegetable oils leads to the release of high concentrations of chemicals called aldehydes, which have been linked to illnesses including cancer, heart disease and dementia.

Until recently, many experts recommended that we avoid olive oil when cooking and instead choose either vegetable or sunflower oil.

However, the new research found that sunflower oil and corn oil produced aldehydes at levels 20 times higher than recommended by the World Health Organization. Olive oil, rapeseed oil, butter and goose fat produced far fewer harmful chemicals.

"More and more, we are realizing that the food scientists who scared us away from cooking with certain fats got it wrong. It was our grandmothers – who cooked with goose fat or butter, ghee or coconut oil, depending on where they came from – who had the right idea."

Have a great time cooking and please do it right!

Is Aspirin Part of Your Diabetes Regimen?

Diabetes increases your risk of heart attack and clot-related stroke (cardiovascular events). Peripheral artery disease — a condition in which your arteries narrow, reducing blood flow to your arms and legs — also increases your risk of cardiovascular events.

Aspirin interferes with your blood's ability to clot. Because diabetes increases your risk of cardiovascular events, daily aspirin therapy typically has been recommended as part of a diabetes management plan. Research has shown that aspirin therapy is effective at reducing the risk of heart attack and clot-related strokes if you've had a previous cardiovascular event.

Aspirin therapy also appears to reduce these risks if you're experiencing symptoms of peripheral artery disease — such as leg cramping, numbness or weakness.

What's not clear is whether aspirin lowers the risk of a cardiovascular event if you haven't experienced one before and you aren't experiencing symptoms of peripheral artery disease. More study is needed on the potential benefits and risks of aspirin therapy in these people. Aspirin therapy does have potential side effects, such as bleeding ulcers and stroke caused by a leaking or burst blood vessel (hemorrhagic stroke).

If you have diabetes, peripheral artery disease or both, ask your doctor about daily aspirin therapy, including which strength of aspirin would be best for you.

The doctors on my team are happy with the 81 mg aspirin and the time I ran out and used 325 mg, two of the doctors very clearly told me to get back on the 81 mg aspirin and stay there. They were also concerned about aspirin causing tumors or ulcers in my stomach. Then when I was diagnosed with GERD (Gastroesophageal reflux disease), two doctors were concerned about even the 81 mg aspirin I was taking. When the GERD improved, they relaxed and told me not to take any aspirin more than 81 mg.

There are times when doctors recommend stopping the aspirin, especially before an operation and at certain other times. They want the non-clotting aspect of aspirin to be out of the system before the operation. The period of time before an operation varies among doctors between seven to ten days.

Anemia as We Age – Part 3

The following information on anemia is excerpted from “Anemia in the Older Adult: 10 Common Causes & What to Ask,” originally written and published by Leslie Kernisan, MD, on Better Health While Aging.net. I am reposting this with her permission and am sharing it to educate readers about anemia.

How doctors evaluate anemia

Once anemia is detected, it’s important for health professionals to do some additional evaluation and follow-up, to figure out what might be causing the anemia.

Understanding the timeline of the anemia — did it come on quickly or slowly? Is the red blood count stable or still trending down with time? — helps doctors figure out what’s going on, and how urgent the situation is.

Common follow-up tests include:

• Checking the stool for signs of microscopic blood loss
• Checking a ferritin level (which reflects iron stores in the body)
• Checking vitamin B12 and folate levels
• Checking kidney function, which is initially done by reviewing the estimated glomerular filtration rate (included in most basic blood work results)
• Checking the reticulocyte count, which reflects whether the bone marrow trying to produce extra red blood cells to compensate for anemia
• Checking levels of an “inflammation marker” in the blood, such as the erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP)
• Evaluation of the peripheral smear, which means the cells in the blood are examined via microscope
• Urine tests, to check for proteins associated with certain blood cell disorders

If the anemia is bad enough, or if the person is suffering significant symptoms, doctors might also consider a blood transfusion. However, although even mild anemia has been associated with worse health outcomes, research suggests that transfusing mild to moderate anemia generally isn’t beneficial. (This issue especially comes up when people are hospitalized or acutely ill.)

What to ask the doctor about anemia

If you are told that you or your older relative has anemia, be sure you understand how severe it seems to be, and what the doctors think might be causing it. This will help you understand the plan for follow-up and treatment.

Some specific questions that can be handy include:

• How bad is this anemia? Does it seem to be mild, moderate, or severe?
• What do you think is causing it? Could there be multiple causes or factors involved?
• How long do you think I’ve had this anemia? Does it seem to be stable or is it getting worse?
• Is this the cause of my symptoms or do you think something else is causing my symptoms?
• Could any of my medications be involved?
• What is our plan for further evaluation?
• What is our plan for treating this anemia?
• When do you recommend we check the CBC again? What is our plan for monitoring the anemia?

Be sure to request and keep copies of your lab results. It will help you and your doctors in the future to be able to review your past labs related to anemia and any related testing.

Avoiding common pitfalls related to anemia and iron

A very common diagnosis in older adults is iron-deficiency anemia. If you are diagnosed with this type of anemia, be sure the doctors have checked a ferritin level or otherwise confirmed you are low on iron.

I have actually reviewed medical charts in which a patient was prescribed iron for anemia, but no actual low iron level was documented. This suggests that the clinician may have presumed the anemia was due to low iron.

However, although iron deficiency is common, it’s important that clinicians and patients confirm this is the cause, before moving on to treatment with iron supplements. Doctors should also assess for other causes of anemia, since it’s very common for older adults to simultaneously experience multiple causes of anemia (e.g. iron deficiency and vitamin B12 deficiency).

If an iron deficiency is confirmed, be sure the doctors have tried to check for any causes of slow blood loss.

It is common for older adults to develop microscopic bleeds in their stomach or colon, especially if they take a daily aspirin or a non-steroidal anti-inflammatory drug (NSAIDs) such as ibuprofen. (For this reason — and others — NSAIDs are on the list of medications that older adults should use with caution.)

Bear in mind that iron supplements are often quite constipating for older adults. So you only want to take them if an iron-deficiency anemia has been confirmed, and you want to make sure any causes of ongoing blood loss (which causes iron loss) have been addressed.

The most important take home points on anemia in older adults

Here’s what I hope you’ll take away from this article:

#1. Anemia is a very common condition for older adults, and often has multiple underlying causes.

#2. Anemia is often mild-to-moderate and chronic; don’t let the follow-up fall through the cracks.

#3. If you are diagnosed with anemia or if you notice a lower than normal hemoglobin on your lab report, be sure to ask questions to understand your anemia. You’ll want to know:

• Is the anemia chronic or new?
• Is it mild, moderate, or severe?
• What is thought to be the cause? Have you been checked for common problems such as low iron or low vitamin B12?

#4. If you are diagnosed with low iron levels: could it be from a small internal bleed and could that be associated with aspirin, a non-steroidal, or another medication?

#5. Keep copies of your lab reports.

#6. Make sure you know what the plan is, for following your blood count and for evaluating the cause of your anemia.

Anemia as We Age – Part 2

The following information on anemia is excerpted from “Anemia in the Older Adult: 10 Common Causes & What to Ask,” originally written and published by Leslie Kernisan, MD, on Better Health While Aging.net. I am reposting this with her permission and am sharing it to educate readers about anemia.

The most common causes of anemia

Whenever anemia is detected, it’s essential to figure out what is causing the low red blood cell count.

Compared to most cells in the body, normal red blood cells have a short lifespan: about 100-120 days. So a healthy body must always be producing red blood cells. This is done in the bone marrow and takes about seven days, then the new red blood cells work in the blood for 3-4 months. Once the red blood cell dies, the body recovers the iron and reuses it to create new red blood cells.

Anemia happens when something goes wrong with these normal processes. In kids and younger adults, there is usually one cause for anemia. But in older adults, it’s quite common for there to be several co-existing causes of anemia.

A useful way to think about anemia is by considering two categories of causes:

• A problem producing the red blood cells, and/or
• A problem losing red blood cells

Here are the most common causes of anemia for each category:

Problems producing red blood cells. These include problems related to the bone marrow (where red blood cells are made) and deficiencies in vitamins and other substances used to make red blood cells. Common specific causes include:

• Chemotherapy or other medications affecting the bone marrow cells responsible for making red blood cells.
• Iron deficiency. This occasionally happens to vegetarians and others who don’t eat much meat. But it’s more commonly due to chronic blood loss, such as heavy periods in younger women, or a slowly bleeding ulcer in the stomach or small intestine, or even a chronic bleeding spot in the colon.
• Lack of vitamins needed for red blood cells. Vitamin B12 and folate are both essential to red blood cell formation.
• Low levels of erythropoietin. Erythropoietin is usually produced by the kidneys, and helps stimulate the bone marrow to make red blood cells. (This is the “epo” substance used in “blood doping” by unethical athletes.) People with kidney disease often have low levels of erythropoietin, which can cause a related anemia.
• Chronic inflammation. Many chronic illnesses are associated with a low or moderate level of chronic inflammation. Cancers and chronic infections can also cause inflammation. Inflammation seems to interfere with making red blood cells, a phenomenon known as “anemia of chronic disease.”
• Bone marrow disorders. Any disorder affecting the bone marrow or blood cells can interfere with red blood cell production and hence cause anemia.

Problems losing red blood cells. Blood loss causes anemia because red blood cells are leaving the blood stream. This can happen quickly and obviously, but also can happen slowly and subtly. Slow bleeds can worsen anemia by causing an iron-deficiency, as noted above. Some examples of how people lose blood include:

• Injury and trauma. This can cause visibly obvious bleeding, but also sometimes causes people to bleed into a space inside the body, which can be harder to detect.
• Chronic bleeding in the stomach, small intestine, or large bowel. This can be due to many reasons, some common ones include:
  • taking a daily aspirin or non-steroidal anti-inflammatory drug
  • peptic ulcer disease
  • cancer in the stomach or bowel
• Frequent blood draws. This is mainly a problem for people who are hospitalized and getting daily blood draws.
• Menstrual bleeding. This is usually an issue for younger women but occasionally affects older women.

There is also a third category of anemias, related to red blood cells being abnormally destroyed in the body before they live their usual lifespan. These are called hemolytic anemias and they are much less common.

Problems losing red blood cells. Blood loss causes anemia because red blood cells are leaving the blood stream. This can happen quickly and obviously, but also can happen slowly and subtly. Slow bleeds can worsen anemia by causing an iron-deficiency, as noted above. Some examples of how people lose blood include:

• Injury and trauma. This can cause visibly obvious bleeding, but also sometimes causes people to bleed into a space inside the body, which can be harder to detect.
• Chronic bleeding in the stomach, small intestine, or large bowel. This can be due to many reasons, some common ones include:
  • taking a daily aspirin or non-steroidal anti-inflammatory drug
  • peptic ulcer disease
  • cancer in the stomach or bowel
• Frequent blood draws. This is mainly a problem for people who are hospitalized and getting daily blood draws.
• Menstrual bleeding. This is usually an issue for younger women but occasionally affects older women.

There is also a third category of anemias, related to red blood cells being abnormally destroyed in the body before they live their usual lifespan. These are called hemolytic anemias and they are much less common.

A major study of causes of anemia in non-institutionalized older Americans found the following:

• One-third of the anemias were due to deficiency of iron, vitamin B12, and/or folate.
• One-third were due to chronic kidney disease or anemia of chronic disease.
• One-third of the anemias were “unexplained.”

Anemia as We Age – Part 1

As we age, anemia can become a fact of life. Many people fail to realize that some types of food plans can promote anemia at any age.

Anemia is often more serious than even many doctors are willing to admit. Three friends of mine had anemia and when taken to the emergency room were treated as having something contagious and were admitted under quarantine while several of us repeatedly asked for them to be checked for anemia.

We were politely ushered out of the hospital after being thoroughly checked and rechecked for the same symptoms the other three had. Yet no one would believe us about anemia until three days later when none of the other symptoms of the disease they were expecting developed. Then they were tested and retested for anemia and severe anemia was determined.

My final thoughts: If you have diabetes, be extra cautious and make sure your doctor does all the tests to determine the correct cause of any anemia diagnosed. Also read my blog about anemia. Another of my blogs on vitamin deficiency anemia can be read here.

The following information on anemia is excerpted from “Anemia in the Older Adult: 10 Common Causes & What to Ask,” originally written and published by Leslie Kernisan, MD, on Better Health While Aging.net. I am reposting this with her permission and am sharing it to educate readers about anemia.

Defining and detecting anemia

Anemia means having a lower-than-normal count of red blood cells circulating in the blood.

Red blood cells are always counted as part of a “Complete Blood Count” (CBC) test, which is a very commonly ordered blood test. To determine your general health status; to screen for, diagnose, or monitor any one of a variety of diseases and conditions that affect blood cells, such as anemia, infection, inflammation, bleeding disorder, or cancer

A CBC test usually includes the following results:

• White blood cell count (WBCs): the number of white blood cells per microliter of blood
• Red blood cell count (RBCs): the number of red blood cells per microliter of blood
• Hemoglobin (Hgb): how many grams of this oxygen-carrying protein per deciliter of blood
• Hematocrit (Hct): the fraction of blood that is made up of red blood cells
• Mean corpuscular volume (MCV): the average size of red blood cells
• Platelet count (Plts): how many platelets (a smaller cell involved in clotting blood) per microliter of blood

(For more information on the CBC test, see this Medline page.)

By convention, to detect anemia clinicians rely on the hemoglobin level and the hematocrit, rather than on the red blood cell count.

A “normal” level of hemoglobin is usually in the range of 14-17gm/dl for men, and 12-15gm/dl for women. However, different laboratories may define the normal range slightly differently.

A hemoglobin level below normal can be used to detect anemia. Clinicians often confirm the lower hemoglobin level by repeating the CBC test.

If clinicians detect anemia, they usually will review the mean corpuscular volume measurement (included in the CBC) to see if the red cells are smaller or bigger than normal. This is because the size of the red blood cells can help point doctors towards the underlying cause of anemia.

Hence anemia is often described as:

• Microcytic: red cells smaller than normal
• Normocytic: red cells of a normal size
• Macrocytic: red cells larger than normal

Symptoms of anemia

The red blood cells in your blood use hemoglobin to carry oxygen from your lungs to every cell in your body. So when a person doesn’t have enough properly functioning red blood cells, the body begins to experience symptoms related to not having enough oxygen.

Common symptoms of anemia are:

• fatigue
• weakness
• shortness of breath
• high heart rate
• headaches
• becoming paler, which is often first seen by checking inside the lower eye lids
• lower blood pressure (especially if the anemia is caused by bleeding)

However, it’s very common for people to have mild anemia — meaning a hemoglobin level that’s not way below normal — and in this case, symptoms may be barely noticeable or non-existent.

That’s because how bad the symptoms depends on two crucial factors:

• How far below normal is the hemoglobin level?
• How quickly did the hemoglobin drop to this level?

This second factor is very important to keep in mind. The human body does somewhat adapt to lower hemoglobin levels, but only if it’s given enough time to do so.

So this means that if someone’s hemoglobin drops from 12.5gm/dL to 10gm/dL (which we’d generally consider a moderate level of anemia), they are likely to feel pretty crummy if this drop happened over a two days, but much less so if it developed slowly over two months.