Mo Pro(biotics)!

Probiotics are all the rage. Between 2007 and 2012 the number of Americans taking probiotic supplements more than quadrupled. As of 2012 that is 4 million adults and 300,000 children. In 2016, the market for probiotics reached $4.3B and was projected to grow by 38% a year through 2021. Probiotics are forecast to outsell all other supplement products by 2020.

Considerable research supports the positive impact of a healthy microbiome - the trillions of bacteria that inhabit our gut, urinary tract, lungs, mouth and skin. Human studies confirm that certain strains of bacteria can alleviate irritable bowel syndrome, stave off the diarrhea sometimes associated with antibiotic use and certain illnesses and enhance our ability to digest the lactose in dairy products.

With that much money on the table and that much projected growth, you will probably be shocked to learn that food and supplement manufacturer's marketing departments are tripping over each other to capitalize on the boom. Equally surprising, many of their claims are bulls....err, questionable.

According to Prevention magazine, there is little evidence that probiotic supplements or additives have any impact at all on healthy people, and most of the benefits touted by the companies that manufacture them are, at best, hypothetical. "There is no compelling evidence that continued consumption of probiotics if you are healthy has any benefit," according to Jack Gilbert, head of the University of Chicago's Microbiome Center. But wait! There's more.

Probiotic manufacturers have a labeling problem. Shocking, I know. In one 2015 study analyzing the content of 16 probiotic supplements from a variety of manufacturers found that only 1 accurately identified their contents on the label.

Taking a page from their fiber playbook, many supplements contain only cheap, common and relatively ineffective bacteria when in fact a dazzlingly wide variety inhabit our innards.

And to ice the cake, many of the supplements sold today pass right on through your gut before the bacteria have any chance at all to replicate there. "You often read that probiotics are supposed to colonize and then reshape the microbiome," says University of Alberta microbiologist Jens Walter. "But there is virtually no evidence that that can actually happen."

This may all change soon. Scientists are developing "cocktails" of organisms that may be more potent and posses more staying power. In the meantime, if you are a basically healthy person and are spending money on probiotics, you are not spending it on something that might actually do you some good.

All this being said, there are things you can do to nurture and care for your microbiome, and you don't need a supplement to do it.

"One of the largest influences on our microbiomes and their activity in our gut is diet," advises Susan Lynch, a microbiome researcher at UCSF. Cultured milk like kefir and yogurt brim with healthy bacteria. And fiber encourages healthy bacteria to multiply, so - surprise! - fruits, vegetables and whole grains will do more than a supplement. Also, skip antibacterial products containing triclosan. Studies suggest that is can severely alter your microbiome, and it is in everything from soap to deodorant to toothpaste.

A Brief History of Diets

The idea of dieting - as opposed to having a diet - is fairly new to human history, not really gaining traction within a mass audience until after World War II. Since then the diet industry has surged (to a $64 billion business in 2014), with this fad and that promising better health and less weight. Recently though the growth trend has begun to reverse as more and more people realize that actual nutritionists have been right all along: a varied, balanced diet is best.

Here is a rundown of 60 years of diets.

1950: The Cabbage Soup Diet
           "Lose 10 - 20 pounds in one week!"
           Well ok, but you do it by basically eating water for 7 days.
           Besides being unhealthy, you can't remain on this "diet" for
           very long.

1965: Weight Watchers
           "Follow our point system to maintain balanced, healthy
            eating habits long term."
           Combined with AA-style support groups and a simple to
           follow system rather than a list of permitted and forbidden
           foods, this is one of the few really sensible diet programs to
           come along.

1990: Diet Shakes
          "Simply replace one meal a day with one of our tasty, easy
           to use shakes, and watch the pounds melt off."
           Slim Fast Foods built a following of 23 million people on this
           promise (and $100 million in advertising). There is little
           evidence that it works long term.

1995: Low Fat Diets
          "Cut out the fat to lose weight and protect your heart!"
          Manufacturers rolled out some 1,300 new fat free and low
          fat foods in response to the government's recommendation
          to adopt a low fat diet. They pretty much all crashed and
          burned because the products were packed with sugar.

2000: The Blood Type Diet
          "Customize your diet to your own unique blood type
           and metabolism!"
          This really was a thing. Sadly there is ample evidence
          showing no variation in nutritional requirement by
          blood type.

2003: The Atkins Diet
          "Ultra-low carbs not only solve blood sugar problems
           but improve your health and energy across the board!"
          It also gave people headaches and fatigue and proved
          too difficult for most people to stick with.

2004: The South Beach Diet
          "The realistic Atkins Diet: low carbs and reduced fat."
          This quickly became the best selling diet book of all time
          and is one of the better approaches and still popular today.

2015: Gluten Free
          "Eliminate this wheat protein from your diet an enjoy
           almost unlimited benefits."
           Perhaps 3% of the US population needs to be on a gluten
           free or reduced gluten diet. The rest apparently just likes
           to eat whatever is popular in Hollywood.

2016: The Paleo Diet
          "If it worked for cave people it will work for us!"
          Experts warn that the diet, which attempts to recreate the
          meat heavy, grain and dairy free diet of our paleolithic
          ancestors is dangerously misguided. The meats available
          to our ancestors is not available to us but were "biologically
          distinct". Also, the food groups eliminated have significant
          nutritional benefits.

2017: The Ketogenic Diet
         "Burn fat instead of carbs!"
         Originally developed as a treatment for pediatric epilepsy,
         this diet forces your body into a potentially dangerous state
         of ketosis. Ketosis occurs when people eat a low- or no-carb
         diet and molecules called ketones build up in their
         bloodstream. It can indeed help you shed a few pounds, but
         Ketosis is actually a mild form of ketoacidosis. Ketoacidosis
         mostly affects people with type 1 diabetes. In fact, it is the
         leading cause of death of people with diabetes who are
         under 24 years of age.

Since 2018, eating plans promoting balance and variety began making headway. The DASH, Mediterranean and Flexitarian diets were ranked #1, #2 and #3 on the US News and World Report diet plan listing. Atkins, Paleo and Ketogenic were the worst three diets evaluated.

Five Foods to Help You Not Feel Hungry

Despite what you might think from all of the miracle diet plans and no-lifestyle-change weight loss programs, the big secret to losing weight is to burn more calories than you take in. And there are two ways to do this: take in less or burn more. For most people a combination of both is the best approach.

One of the things that is probably going to doom your weight loss effort to eventual failure is to restrict your eating to the point where you are always hungry and can hardly think about anything else except for when you are allowed to have your next stick of celery. If you aren't feeling like you are getting enough to eat, your diet is not going to last. This is one reason why exercise is such an important part of successful weight loss, it lets you eat a bit more.

Here are five foods that will help you feel full longer and keep the hunger pangs at bay.

1. Avocados
    The oleic acid in an avocado is a fat contained in very few other
    foods. The body converts oleic acid into a compound that is
    believed to signal satiation (i.e., fullness) to the brain and a recent
    Italian study found that people who ate a breakfast high in oleic
    acid consumed about 250 fewer calories at lunch than those who
    did not. That adds up to about 1/2 pound lost per week, other
    things being equal.

2. Green Bananas
    Yes, green. Slightly unripened bananas contain a starch which is
    more resistant to digestion and acts to help stabilize blood sugar.
    If green is too hard for you, blend it into a smoothie and you won't
    be able to tell the difference.

3. Oatmeal
    No surprise here. Oatmeal's generous helping of both soluble and
    insoluble fiber slows digestion and will leave you feeling fuller for
    longer. I like to make it overnight in a slow cooker with eggnog
    and cranberries.

4. Soup
    The exact type doesn't matter all that much, just be careful of all
    of the sodium. A Penn State study found that people who start
    dinner with 150 calories of soup consumed fewer calories overall
    than those who went straight to the entree. Cream based soups
    are likely to surpass that 150 calorie threshold fast though.

5. Salmon
    Follow up that soup with with a serving of this healthy-fat rich
    fish. The combination of healthy Omega fats and high quality
    protein will make you feel fuller and more satisfied after your
    meal.

Don't starve yourself between meals either. Feel free to graze to keep the edge off any hunger pangs. Just be a little picky about what you snack on. Pretty much any fruits or vegetables are better than "snack food" (aka, crap) and there is plenty to choose from. Besides that celery stick, reach for cherry tomatoes, carrots, an apple or even a stick of mozzarella string cheese. Pick up some hummus as a dip. Vegetables are fiber rich and practically "free" from a calorie point of view.

Remember, if you are so hungry that all you can think about is food, your "diet" is doomed before you even get started.

Karing for Your Kidneys

You probably don't give your kidneys a lot of thought but they are crucial to your health and wellness. The kidneys filter waste out of the blood, help regulate blood pressure, control the production of red blood cells and regulate the concentration of electrolytes. Without them you die. And if they are compromised, you get ill, including high blood pressure, anemia and metabolic bone disease.  The final stage of kidney disease is kidney failure, dyalisis and/or a kidney transplant.

About 10% of Americans have chronic kidney disease (CKD), the 9th leading cause of death in the USA. Many more are at risk and most of them have no idea there is even any issue. As a result, few people take any precautions to keep their kidneys healthy or get any treatment if they are not until the damage is far progressed.

If you have any of the main risk factors for CKD (high blood pressure, diabetes, are over age 60, are of non-Caucasian descent, are overweight or obese or have a family history of CKD) you should speak with your doctor about testing.  A bi-annual Kidney Profile will reveal any problems.

In the meantime, there are a lot of things you can do to reduce your risk of developing CKD, including:

1. Over the Counter Medicines.
    NSAIDs such as Advil, Motrin and Aleve can raise your risk by
    20% if you take 8 or more standard doses a month. Long term
    use of PPIs like Nexium, Prevacid and Prilosec raise your risk
    nearly 30%. The key here is "long term". Don't use these drugs
    to mask problems, address the problem with your doctor.

2. Herbal and Dietary Supplements
    I am a fan of supplements, but because the industry is so
    casually regulated there is often only a fanciful correlation
    between what is on the label and what is in the bottle. So
    make sure you are getting your supplements from a reliable
    manufacturer and not whatever you find at the Dollar Store.
    Chinese yew extract, St. John's wort and wormwood are all
    suspected of causing kidney injuries in any doses. Again,
    check with your doctor or pharmacist.

3. Lifestyle (You knew I'd get around to this, right?)
    Too much protein - common in low-carb diets - especially from
    red and any processed meats will raise your CKD risk. White
    meats, fish and dairy protein do not seem to have as high a
    risk. Vegetable proteins may even be protective. The inorganic
    phosphorus used in many processed foods as a preservative is
    much more easily absorbed by the body than organic
    phosphorus (90% vs 60%) and the kidneys are taxed to remove
    the excess. (Excess phosphorus causes a host of problems in
    its own right.)

4. Chronic Air Pollution
    The Journal of the American Society of Nephrology (the kidney
    guys) estimated that 45,000 new cases of CKD are caused each
    year by long term exposure to small particle air pollution (the
    kind in chimney smoke and car exhaust). Further study is
    needed to understand the link but for now its one more reason
    to limit your exposure as much as possible.

Wishing you and your kidneys a long and happy life together!

Three Popular Myths About Water

First of all, there is nothing wrong with drinking water. In fact, almost everything about it is good. Most of us are dehydrated. If, like me, you live in a high altitude and low humidity region, you are probably much more dehydrated than you realize. You get used to it, but its neither normal nor healthy.

I thought I was drinking plenty of water, about 50oz a day. Recently during my annual physical I mentioned to my doctor that every now and then I felt a little lightheaded when suddenly rising or after some exertion. I expected a discussion of blood pressure. My doctors suggestion? Try drinking more water.

But water is big business. Bottled water is the #1 beverage product in the USA. Bigger than soda, bigger than bottled juices, tea or coffee. There is vitamin water, mineral water, carbonated water, flavored water and yes, even water water.

Here a couple of things about water you may not know.

1. Bottled water is not "healthier" than tap water.

Despite the glaciers and pristine snowfields on the label, the source for many - if not most - bottled brands is tap water. It may be purified, filtered and enhanced with various additives but at its heart it is just tap water. And because tap water comes from municipal suppliers it is subject to EPA standards and regulations. Suppliers are subject to their own standards and testing. And then there are all those plastic bottles - an emerging health issue in its own right.

Save your money. Save the planet.

2. You need to drink 8 glasses of water a day to stay healthy.

Lets assume that a "glass" is 8oz. That's 64 ounces a day. Maybe I do need to drink that much. But that doesn't mean its right for you. The "8 glasses a day" comes from a government recommendation issued in 1945.

There is no doubt that every cell in our body needs water to survive. But how much water depends on a multitude of factors including our height, weight, gender, activity level and environment. Want a simple test to see if you are getting enough? Look at your pee. If it is a light straw color, your are doing fine. If its a dark yellow, bottoms up.

3. You can't drink too much water.

Yeah, you can. Its even got a name (hyponatremia) and it can be life threatening. It occurs when you drink so much water that the sodium in your blood becomes diluted to dangerously low levels. (Yes, too little sodium is dangerous too.) Your body can process about 1 liter of water an hour when you are very active. That's a lot of water. To stay safe, think about a maximum 12oz of water for every 30 minutes you are working out or being physically active.

Would You Like Plastic With That?

In the 1967 film The Graduate, Walter Brook pulls Dustin Hoffman's character aside to give him some career advice. "I just want to say one word to you. Just one word." Hoffman listens attentively as he finishes, "Plastics".

In 1967 plastic was a booming chemical business with endless potential. Now, more than 50 years later, plastic is everywhere. It wraps our food - and just about everything else. It holds our drinks. It fills the stomachs of whales and kills them. It creates vast swirling garbage dumps in our oceans. And now it is, literally, becoming a part of us.

In a meta study by at the University of Victoria in British Columbia and published in the journal Environmental Science & Technology, researchers concluded that, on average, Americans consume (as in eat) 70,000 plastic microparticles every year. These arise from our food and water containers, our water supply and even the air we breath.

The authors note that the health effects of all this plastic (the particles are really, really tiny) are not known. Most of the microscopic bits of plastic "probably" pass through us harmlessly because the are "indigestible". But because of their small size, it is possible that "some" may be absorbed. If only 1% of them manage to find their way into your body, that is about 35,000 of them since The Graduate premiered.

There is nothing illegal about plastic nor is there a proven link between plastic and health problems (unless you happen to be a fish). But perhaps it is time to consider consuming less of it. Do you really need plastic bottles of water? Why not get yourself a reusable metal one? Glass for our drinks? It works for beer, and its recyclable. Cardboard food packaging? The health risks are in addition to the very real disposal problems. Plastic lasts a really, really, really long time.

How much are you willing to risk for convenience?

Unfamiliar Variety

Potatoes are white. Carrots are orange. Bananas are yellow. Asparagus are green. Tomatoes are red. Everybody knows this. And its not wrong. Its just woefully incomplete.

If you have never tasted purple, blue, yellow or red potatoes you are missing out on a tasty change of pace. (And this does not even consider yams and sweet potatoes.) You can cook and eat them the same way as the familiar white potatoes you are used to but the flavor and nutritional content can be noticeably different. Purple potatoes, for example, have about four times the antioxidants of white potatoes.

Red bananas are shorter, plumper and heartier than the average yellow banana. When ripe, it will have a thick, brick red peel and ivory-hued semi soft flesh. Its flavor is sweet and creamy with raspberry highlights. The Red banana has more beta carotene and Vitamin C than yellow banana varieties.

The orange carrot is a relative newcomer. Long before orange, yellow and purple carrots were cultivated. The purple variety contains twice the beta-carotene of the orange.

In Europe, especially Germany, white asparagus (called spargel) is very common. It is very similar nutritionally to the green asparagus we are familiar with but it has a milder flavor which many people prefer.

What is better than a fresh red tomato right off the vine? Maybe try a purple tomato. They have a similar taste with somewhat firmer flesh and higher levels of several antioxidants. And a bonus feature: a longer shelf life.

You can find many of these, and other, varieties of familiar fruits and vegetables in most supermarkets these days. Go ahead and give them a try. Worst case, your plate becomes a lot more colorful.

Health or Hype?

Judging from the packaging and advertising I see, pretty much all food is now healthy, good for you, and backed by "clinical research" that proves it. Even ice cream now boasts of its fiber, and foods with the tiniest trace of some trendy new "superingredient of the month" boast about it as though there were enough of it in their product to make any difference.

For decades, food industry organizations have supplied substantial amounts of cash to fund studies of the health and wellness impact of their products. Just last year Ocean Spray committed $10 million to study the antimicrobal properties of cranberries. Pom Wonderful has spent $35 million on pomegranate research, sparking endless reviews hailing the fruits' antioxidant benefits. It also sparked a warning from the FDA to stop making health claims that the research did not substantiate but somehow that did not generate the same media interest.

Here's the thing. Just because a study is funded by the industry does not invalidate the study. But you need to be wary and skeptical. Any study can be designed to produce the result desired. A New York University review of 168 food industry funded studies found that 156 of them (93%) drew conclusions favorable to their sponsors. "There may be a rare case when a company is motivated by a concern for public health or to advance nutrition science," says Bonnie Liebman, Director of Nutrition at the Center for Science in the Public Interest. "But overall, the purpose of this research is marketing, not science."

Whenever you see claims being made based on "studies", you need to do your part in weeding out the credible from the false. And your very first question should be "Who paid for this study?"

Obesity and Cancer Rates Rise in Lock Step

I like graphs. Pictures just seem to make things clearer to me than the numbers often do. I recently saw a graph that showed rates of obesity in the USA over the last 20 years. (Sorry about all the annoying popups. I don't really get how advertisers conclude that annoying people sells more stuff.) One particularly troubling aspect of this graph is the rise in obesity among our youth.

In fact, the rates of several cancers linked to obesity are on the rise among people ages 25 to 49 much faster than among older populations.

Between 1995 and 2014 the annual rates of gallbladder, pancreatic, uterine and colorectal cancers rose about 4% among 25 to 29 year olds. Kidney cancer risk was up about 6%. This is eerily in sync with the rise in obesity rates.

Now this doesn't prove that obesity causes higher cancer rates. But along with all the other problems caused by - lets be politically incorrect for a moment - being fat (high blood pressure, heart disease, diabetes, osteoarthritis, sleep apnea and more) here is one more reason to put an end to it.

At the end of the day, obesity is very much under our own control. The choices we make, the lives we live. Like Eric Cartman, we can blame it on being "big boned" and keep stuffing ourselves with crap food, or we can take control and eat ourselves healthy and slim.

The choice is yours.

Antioxidants and Diabetes

A new study suggests that among their many other benefits, antioxidants may play a role in preventing Type-2 Diabetes, perhaps by affecting the body's sensitivity to insulin.

The 15 year long study study of 64,000 women in France found that those who consumed the most antioxidants had a 27% lower risk of developing the disease than those who consumed the least. While this sort of study does not prove a causal relationship, it is one more reason to include antioxidants in your diet.

Good sources of antioxidants, which are also accused of helping to ward of cancer and heart disease, include beans, berries, grapes, nuts and dark green and orange vegetables.

Tricky Triclosan

Triclosan is an antibacterial agent that has been strongly linked to human hormone disruption, potentially leading to the development of non-descended testes in young males, breast cancer in women, prostate cancer in men, developmental effects on the nervous system in children, attention deficit /hyperactivity in children and thyroid cancer. 

In 2016 triclosan was banned by the US Federal Government from soaps and soap gels, hand gels and wipes. But you may still be exposed from an unexpected source - your toothpaste.

Toothpastes were not specifically named in the ban but, to their credit, most manufacturers have eliminated it from their products. But not all. 

Check the ingredients label on your toothpaste and if it contains this harmful ingredient toss it. Then toss your toothbrush too. Studies have shown that significant amounts of triclosan can accumulate on brushes over time and be released during brushing.

CBD - The New Wild West

"Ten years ago, when you talked about cannabis, you were talking about dried plant material that people smoked," says Ryan Vandry, associate professor of psychiatry at Johns Hopkins University. "Now cannabis is a blanket term that could mean hemp oil, topical creams, CBD products or high THC concentrates that can be smoked, vaped or orally ingested." As well as dried plant material that people smoke. Is it any wonder that confusion is rampant?

The first thing to be clear about is the difference between THC (tetrahydrocannabinol) and CBD (cannabidiol). THC is the substance that produces the euphoric "high" associated with marijuana. CBD is not intoxicating and produces most (not all) of the medically interesting benefits now claimed for marijuana and hemp.

The battle lines are drawn and people tend to either demonize cannabis or say it is the greatest medical discovery since penicillin. Unsurprisingly, the truth lies somewhere in  between.

A discussion of the scientific basis for the health claims made for cannabis products is for another day. What I want to call your attention to is the marketing wild west show surrounding the products. The 2018 Farm Bill legalized the interstate transport of and commerce in CBD-based products. Since then its hard to turn your head without being assaulted by another company offering you the incredible health benefits of CBD - relief from pain, anxiety, seizures, sleep problems and more.

The truth is that there are enormous medical possibilities for CBD but presently very few independent clinical studies have been done supporting its efficacy. But that doesn't slow down the marketing department, which is out promoting it for everything under the sun. Legal is not advisable. Harmless is not effective.

Whether CBD is a medication or a nutrient is still be be settled. But one thing the two have in common is scandalously misleading and unregulated labeling. In States where testing has been done the results are troubling. "You cannot rely on labels," Daniele Piomelli, professor of anatomy and neurology at UC Irvine, says flatly.

A 2018 California Bureau of Cannabis Control study tested over 25,000 products and found that 70% of them were mislabeled either for content or potency. Nearly 15% failed tests for purity, containing traces of pesticides or industrial solvents. "Some contained only barely detectable levels of CBD," said Piomelli, "and one in five contained detectable levels of THC."

If you want to try CBD by all means do so. But caveat emptor. You cannot rely on the marketing information provided to you by the vendor. The burden of doing the research to determine whether or not CBD is a candidate for your situation falls squarely on you. But you can't stop there. You need to research the company supplying the product just as carefully. Many of them are mislabeling their products and lying to you. Be especially suspicious of incredible offers you receive via an online add.

Its the wild west out there folks. Be careful.

LOSE WEIGHT INSTANTLY WITHOUT DIETING OR EXERCISE!!!

No. Sorry. Can't be done. I just wanted to see what it felt like to tell people what they want to hear for once.

Better Burgers

Burgers are never going to make it onto a list of "healthy foods". Yet despite their negative health and environmental impacts (ranging from heart disease to antibiotic resistance to global warming) who doesn't love a burger?

And these days there are plenty of alternatives, from plant-based burger substitutes to laboratory grown meat cells. I've tried several of the plant-based options and I have to admit that some of them are pretty good - portabello mushroom and black bean seem especially tasty substitutes. But the fact is, there is no danger of mistaking them for the real thing.

So what do you do if you are trying to eat right and mind your health, but not ready to part ways with that 4th of July Fresh Off the Grill hamburger? Here are 5 things from Consumer Reports On Health newsletter that you can do to have your burger and make it healthier too.

1. Watch your portions.
    The "large" burgers served at fast food places are usually 1/4 pound of beef. In a restaurant your $12 burger may be two or even tree times that size. Try making your burgers about 1/3 of a pound and not more than 1/2 pound. Its plenty of meat.

2. Mix in some extras.
    Lean ground beef gives you less fat but it can also dry out when cooked on a grill. Mixing in some other ingredients can add flavor and keep your burger juicy without sacrificing anything. Try a puree of mushrooms and onion made in your blender. Or cracked bulgar, a grain with a meaty consistency that will soak up the flavor of the meat. Or find your own add-in. Go ahead, experiement when no one is looking. Replace from 1/4 to 1/3 of the meat with your add-ins and grill as usual.

3. Upgrade the bun.
    Most hamburger buns are made from "enriched white flour". Using a whole grain bun will add fiber and other nutrients to your burger. Also, watch the size of your bun. They can easily add 250 calories or more and you don't really need a giant bun since you've used a smaller burger (see #1).

4. Grill the safe way.
    High temperature cooking like on a grill can cause the formation of compounds in the meat that are known to increase cancer risk. Let the coals burn down a bit or turn down the propane. Avoid flameups. Flip the burgers frequently while cooking. It takes a little longer but they turn out just as well.

5. Make a salad on your burger.
    Pile on the produce. Red onion, sliced tomatoes and leafy green lettuce add flavor, texture and nutrition. Use your imagination. Grilled pineapple slices, sliced avocado, sauerkraut. mushrooms and red, green or even jalapeno peppers all make great toppings. You may find you can even forgo the cheese. Maybe. That's a tough one.

Eating healthy and well is not all about eating rabbit food. How much you eat, how you prepare it and what you have along with it makes a big difference. So go ahead, fire up that grill. Just be more intentional about what you throw on it.

Drugless Diabetes Remssion

The orthodoxy is that diabetes is an inevitably progressive disease. That is, once you are a Type-2 diabetic, you can manage the symptoms but the best you can hope for is that they do not get worse. This is good news if you are selling metformin or other drugs used in treating diabetes. It is also not true.

In March 2019, British researchers presented the results of the Diabetes Remission Clinical Trail (DIRECT), a study of 300 patients aged 20 to 65 who had been diagnosed with diabetes. It is important to note that none were taking insulin when the study began, but were using a variety of other drugs to manage their symptoms.

Study participants were divided into two groups. One group (the control group) followed the standard treatment guidelines (eat better, get some exercise, take your medication and monitor your blood sugar levels). The second group was put on a structured, three part weight loss program that included:

1. A low calorie diet of nutrition shakes and soups providing 850 calories a day for 12 to 20 weeks. Note that this is a very low calorie diet and ought not to be attempted without the supervision of a doctor.

2. Then a gradual, supervised return to eating a DASH-style diet built around fruits, vegetables, low fat dairy, healthy fats and lean meats, poultry and fish over an additional 6 to 8 weeks.

3. Finally, individual monthly monitoring and counseling to ensure that the lost weight was not regained, including an "intervention plan" option of going back on the 850 calorie diet if they regained more than a couple of pounds. (Talk about motivation!)

No drug therapy was used by the second group.

The results? After 2 years, 3% of those in the control group and 36% of those in the second group had blood sugar levels below the diabetic range. The more weight a person lost, the greater the improvement. Weight loss was the key. For those who lost 20+ pounds, 64% no longer showed symptoms of diabetes. For those who lost 10 - 20 pounds or less than 10 pounds, the corresponding numbers were 29% and 5%.

The key factor here is weight loss, not the diet that achieved it. If you suffer from Type-2 diabetes, find a way to drop some weight. The more, the better. But any weight loss will help. If you need the structure or support of a program or other people then get it. It is not true that you inevitably face a lifetime of drug use.

Et tu Coffee?

Coffee lovers have had it good recently. Study after study continue to show that drinking moderate amounts of coffee ( 2  - 3 cups a day) is not only not bad for us, but may actually offer some significant health benefits. So its disappointing to find coffee shops misleading (or is it lying to?) us about the trendy "coffee drinks" that they offer.

Take, for example, Dunkin Doughnuts, long synonymous with coffee. When you order your Dunkin' Frozen Coffee you might expect to get a cold cup of coffee with perhaps some sort of flavorinig and creamer. A reasonable expectation. But Dunkin Doughnuts has a surprise for you!

What you are actually getting is 840 calories, 27 teaspoons of added sugar and 22 grams of fat (a two and a one day supply respectively), in a 32oz cup. That's right. You can now get sugary beverages by the quart. How do they manage to pack so much goodness into the frozen treat? Simple. A blend of water, cane sugar, phosphoric acid, natural coffee flavor (why not just use coffee??), salt (yes, salt), sodium benzoate, potassium sorbate and, of course, everyone's favorite coffee add-in, xantham gum.

Dunkin Doughnuts is far from the only company to be pulling this kind of crap on their customers. Pizza Hut recently unveiled its 1,150 calorie Meaty P'Zone, a calzone-like pocket of cheap white flour stuffed with salt, cheese and processed meats.

The point is, eating out is a mine field for anyone who aspires to spending the rest of their lives not requiring a seat belt extender when they get on an airplane. Restaurants are now required to put calories on their menus, and that's a great start. But the burnden is on each of us to be aware of what we are stuffing ourselves with, and how that might affect our waistlines and our health.

"There is a whole generation of people who have never had the P'Zone," Pizza Hut's Chief Brand Officer told Forbes magazine. That's about to change.

Veggies Get No Respect

Vegetables are nutritional superstars. Pretty much every credible diet - Mediterranean, DASH, Paleo, Weight Watchers - are built around them. In many countries, vegetables are the centerpiece of the meal. Not here in the USA though. Nine out of 10 Americans fall short of recommended guidelines (at least 3 cups per day), despite the fact that this is not a very large volume.

Here are some facts about the neglected vegetable that may surprise you.

1. All vegetables are good vegetables. Sure some are richer in nutrients than others, but who cares? They are all packed with minerals, vitamins and phytonutrients. And the available variety is enormous, so you surely can find some that you enjoy.

2. Vegetables are your dieting ally. They can help you seriously slash calories without feeling empty and hungry. As a snack they will add about 20 - 50 calories to your total, and they are mostly water. So unless you slather them with butter or oil, they add almost no fat.

3. Veggies protect your heart and brain. Although we often read about vegetables as cancer fighters, the strongest evidence is for how they support your heart and blood vessels (and thus your brain). A recent study in the International Journal of Epidemiology found that those eating at least 3 cups per day of vegetables had a 30% lower risk of heart disease and stroke, compared with those who ate little or none. The original DASH diet study concluded that a diet emphasizing vegetable and limiting meats resulted in a drop of 8 - 14 points in systolic blood pressure (the upper number) - a comparable drop to what you would get using the most common blood pressure drugs.

4. Frozen vegetables are just as nutritious as fresh, and sometimes more so. Freezing and thawing can can sometimes result is a "mushy" vegetable, so they are often best used in cooking. As always, don't overcook.

5. Vegetables can be steamed, boiled, sauteed, fried, roasted, baked and grilled.  Growing up, I was traumatized by Brussels sprouts. Then I was served them at a Thanksgiving dinner. They were delicious. The difference? They were roasted with garlic and oil instead of boiled. The way you prepare them can produce very different tasting results so experiment.

6. Everything counts toward your total. Lettuce and tomato on your sandwich, carrots dipped in hummus as a snack, salad, peas and corn with dinner. You'll be surprised how easy it is to reach 3 cups a day.

7. A typical serving of vegetables is 1/2 cup, so you are looking for 6 servings a day. This is not a lot, so its pretty easy to run up the score.

Working some vegetables into your daily diet is easy to do and pays health dividends. Be creative and you'll surprise yourself to find you even enjoy them.

Good News from the War on Cancer

Between 1990 and 2015, cancer death rates in the US have declined by about 25%. That's a big number and certainly very welcome news. The decline was seen across the board but most notable for lung, breast, prostate and colon cancers.

According to CA: A Cancer Journal for Clinicians, the reasons for this decline in death rates are advances in early detection and diagnosis, improved treatment options and changes in lifestyle and lower smoking rates.

While the specific impact varies with the type of cancer, "lifestyle factors including smoking, the typical high-fat, refined-sugar diet and physical inactivity account for the majority of cancer", according to the National Institutes for Health. The majority of cancers. Last I checked, most of us have 100% control over what we eat and whether or not we smoke. Maybe we should exercise it.

5 Painless Ways to Cut Back on Sodium

Most of us struggle to keep our daily consumption of sodium within the recommended 2,300mg. According to the CDC, the average American is getting 3,136mg daily and a large part of the problem is that most of that - 71% - does not come from our salt shakers. It is mostly hidden away in the prepared foods and restaurant meals that we eat.

Even if you take pains to choose healthy foods, this hidden sodium can add up pretty quickly. Bread and baked goods, canned foods, salad dressings and many other regularly consumed foods contain far more sodium than we imagine.

Here are 5 steps that you can take to cut back without resigning yourself to bland, tasteless meals.

1. Cut back gradually, not all at once.
    Start switching to lower sodium versions of the products you
    already use, and adding just a but less salt to your meals. You
    may not even notice and, if you do, your taste will adjust
    surprisingly quickly. Example: I am a big V-8 fan. When I made
    the switch to the "low sodium" version, it tasted a little flat and
    watery. But within 2 weeks it tasted fine. Now if I try the regular
    version, it tastes like sea water it is so salty. Start slow and as
    your taste adjusts, cut back a little more.

2. Learn the language.
    Food labeling is designed to confuse and mislead you. Learn the
    language so that you know what you are getting. Read the
    nutrition facts label, and remember that everything is listed "per
    serving" so check the serving size. Here is how to decode the
    marketing babble.

    "Low Sodium" means  a serving contains 140mg or less of
     sodium.

    "Salt/Sodium Free" means less than 5mg per serving.

    "No Salt Added" means just that. None was added during
     processing. It does not mean the product contains no sodium.

    "Reduced Sodium" means there is 25% - 50% less sodium than
     is found in the regular product. So a canned soup that may
     have 800mg of sodium will still be providing 400mg to 600mg
     in its "reduced" version.

3. Compare options.
    It pays to compare sodium content across - and even within -
    brands. It can vary by as much as 100%.

4. Rinse canned foods.
    Yes, rinse them. Canned beans and vegetables can be very
    high in sodium. By rinsing them in a colander under water
    you can reduce the sodium constant by as much as 40%.
    Obviously this is a poor strategy for soups and sauces.

5. Don't use any salt in cooking.
    Instead of adding salt for flavor, try different herbs and
    spices. Garlic, oregano, basil, dried peppers, curries,
    turmeric and cumin all add a lot of flavor with no sodium.

If you sometimes think that markets and food companies deliberately try to mislead you, that is because they do. But with a little knowledge and a little effort, you outsmart them. Remember, its your health, not theirs.

3 Foods You Already Love that Promote Eye Health

For most of us, our eyes do not get much attention unless and until we have a problem with them. Perhaps you visit the optometrist every few years for new glasses or to update your contacts. Maybe you have gone the Lasik route and rarely see an eye professional at all. Yet our vision is our primary way of experiencing and interacting with the world around us. Maybe you should think about seeing a real ophthalmologist every 2 or 3 years (more often as you get older).

In the meantime, here are three foods that you probably already consume that are known to provide health benefits for your eyes.

Sweet Potatoes
Sweet potatoes are a rich source of beta carotene (your body converts it to vitamin A), which helps prevent "dry eye" and night blindness. It may also help to slow the progress of macular degeneration - the #1 cause of new blindness. Other foods with high concentrations of beta carotene include carrots, butternut squash and spinach. Milk and eggs are also a good source of vitamin A.

Strawberries
Strawberries are vitamin C powerhouses. Vitamin C is a strong antioxidant that can help reduce your risk of cataracts. Bell peppers, broccoli, cantaloupe and citrus fruits also contain lots of vitamin C.

Salmon
The Omega-3 fatty acids in this oily fish offer protection against "dry eye", while the vitamin D helps avoid or slow macular degeneration. Other good sources of Omega-3s include walnuts and flax seeds, while milk and orange juice can help ramp up your vitamin D.

"See" you again soon!