If you have diabetes, proper monitoring of your condition can literally save your life. Blood sugar levels can change dramatically within a matter of minutes, causing confusion, dizziness, fatigue, and, in serious cases, a life-threatening coma. People with diabetes can easily measure their blood sugar levels with a small portable device that analyzes a drop of blood obtained by pricking a fingertip with a lancet. I recommend self-monitoring at least twice daily (upon awakening and thirty to sixty minutes after dinner). In addition, people with diabetes should make regular visits to their primary care doctors, have annual physicals, and get yearly eye exams from their ophthalmologists. Other tests for people with diabetes include:
- Hemoglobin A1C. This test measures the amount of glucose sticking to the hemoglobin in red blood cells. It can be used as a marker of average blood glucose level over the past two to three months. Studies show that for every percentage point drop in A1C blood levels, risks for circulatory disorders as well as eye, kidney, and nerve diseases drop by 40 percent. Most doctors say that a hemoglobin A1C reading below 7 percent is acceptable. However, I believe that a reading below 6 percent is more desirable, because it shows better blood glucose control. People with an A1C reading of 7 percent or less should have this test twice a year. If your reading is above 8 percent, you should have it every three months.
- Oxidative stress analysis. This test measures the amount of tissue damage, or oxidative stress, caused by free radicals (harmful, negatively charged molecules). Few medical doctors know about oxidative stress testing, but I recommend it for patients with diabetes because they have high levels of oxidative stress, which accelerates the disease’s progression. The markers of free radical activity can be measured by blood or urine tests. Elevated levels mean that the antioxidants that are normally produced in the body and ingested via foods and supplements are not effectively neutralizing the overabundance of free radicals. Your doctor can use Genova Diagnostics (800-522-4762, www.gdx.net) for the test. It costs about one hundred dollars, but most health insurers will cover it. People with diabetes should receive this test every six months until their values are normal.
- Cardiovascular markers. People with diabetes are more susceptible to heart disease. That’s because elevated glucose levels accelerate the buildup of plaque in the arteries. For this reason, I recommend blood tests for homocysteine, C-reactive protein, fibrinogen, lipoprotein A, apolipoprotein A and B, and iron. Abnormal levels of these markers are linked to the development of heart disease. I recommend a baseline test and yearly followup testing for people who have abnormal readings for any of these markers. Most health insurers will cover the costs of these tests.
THE SUGAR CONNECTION
Everyone knows that people who have diabetes or who are at risk for it should pay close attention to their diet. However, I’m convinced that few people realize just how damaging certain foods can be. For example, about 20 percent of the average American’s energy intake comes from foods such as burgers, pizza, chips, pastries, and soft drinks. A study published in the American Journal of Clinical Nutrition found that between 1980 and 1997, the average American’s daily calorie consumption increased by five hundred calories. Eighty percent of this increase was due to increases in carbohydrates, which include almost all sweet and starchy foods. During the same period, the prevalence of type 2 diabetes increased by 47 percent, and the prevalence of obesity increased by 80 percent. One of the worst culprits in the war on diabetes is the simple sugar fructose, which is naturally found in fruit and honey. Table sugar is half fructose (the other half is glucose, which is chemically the same as blood glucose).
A type of fructose known as high-fructose corn syrup (HFCS) is especially harmful because it worsens insulin resistance. It has become the sweetener of choice for many soft drinks, ice creams, baked goods, candies/sweets, jams, yogurts, and other sweetened products. My recommendation is to put a strict limit on your consumption of foods that contain HFCS. This can be done by reducing your intake of packaged, processed foods, avoiding drinks that are high in fructose, and eating as many fresh foods as possible. (Natural sources of fructose, such as fruit and honey, can be safely consumed in moderation.) There is one exception—some liquid nutritional supplements, such as liquid vitamin formulas, contain crystalline fructose, a natural sweetener that is far less processed than HFCS and is not believed to cause dramatic increases in insulin
SYMPTOMS OF DIABETES
- Increased thirst • Frequent urination (especially at night) • Unexplained increase in appetite • Fatigue • Erection problems • Blurred vision • Tingling or numbness in the hands and/or feet
TEST FOR DIABETES
You have diabetes if any one of the following test results occurs on at least two different days: * • A fasting blood glucose level of 126 mg/dL or higher. • A two-hour oral glucose tolerance test result of 200 mg/dL or higher. • Symptoms of diabetes.
Can Your Toiletries and Cosmetics Give You Diabetes?
We’ve known for years that chemicals called phthalates—types of plasticizers contained in many products, including furniture, toys, plastic bags, and detergents, as well as in some cosmetics, including lotions, hair sprays, and perfumes—can knock our endocrine systems out of whack, potentially raising our risk for obesity and hardening of the arteries. What’s worse, a recent study suggests that we can now add type 2 diabetes to the list of phthalate dangers. The cosmetics part is especially creepy, since we do more than simply touch that stuff—we often massage lotions or makeup into our skin and spray perfume onto our necks, where we breathe it right in. And if you should kiss someone wearing phthalate-containing cosmetics or perfume, what’s getting into your mouth? The chemical and cosmetics industries dispute the latest research and tell us that we should be perfectly happy to smear and spray their phthalates onto our bodies. It might be that they turn out to be right and the products are safe. But that’s a long-term result that’s not worth the risk to find out. We spoke with the researchers who found the diabetes link and then learned how to find phthalatefree cosmetics and perfumes.
WHAT LURKS IN OUR COSMETICS?
The phthalates are put into many types of cosmetics because they do have some benefits. In perfume, for example, they help the scent linger longer; in nail polish, the chemicals reduce cracking by making polishes less brittle; and in hair spray, phthalates allow the spray to form a flexible film on hair, avoiding stiffness. But phthalates in these products can be either absorbed through the skin or inhaled, which causes them to enter the bloodstream…and then, watch out! In the study, the researchers from Uppsala University in Sweden drew fasting blood samples from more than one thousand adults, looking for several toxins, including four substances specifically formed when the body breaks down phthalates. Even after adjusting for typical type 2 diabetes risk factors such as obesity, cholesterol levels, smoking, and exercise habits, researchers found that participants whose phthalate levels were among the highest 20 percent of the group were twice as likely to have type 2 diabetes when compared with those whose phthalate levels fell into the lowest 20 percent of the group. Study author Monica Lind, PhD, an associate professor of occupational and environmental medicine at the university, says that since she and her colleagues are among the first scientists to measure phthalate levels in blood, “high” and “low” are relative to this study—in other words, it’s difficult to discern whether the levels of phthalates in this study were high on any kind of absolute scale. And researchers didn’t track the amount of phthalate-containing products that participants used. But the study does suggest that the higher the levels of phthalates in the blood, the higher the risk of getting type 2 diabetes, and that might reflect a greater use of products that contain them.
CHECK THE LABELS
Phthalates may increase the risk for type 2 diabetes by disrupting insulin production and/or inducing insulin resistance, Dr. Lind says. But those ideas are disputed by the FDA, which states that “it’s not clear what effect, if any, phthalates have on health.” In the United States, the FDA does not require cosmetics or perfumes to be phthalate-free. It does require nonfragrance ingredients to be listed on cosmetic products, but the loophole is that any ingredients that are parts of a fragrance don’t have to be listed—a manufacturer can simply put “fragrance” on the label. As a result, according to the nonprofit Campaign for Safe Cosmetics, most cosmetics and perfumes that contain phthalates don’t list them on the label. In other words, if the word “fragrance” is listed, then you won’t know for sure what’s in the product, unfortunately.
If this is a concern for you, go through your makeup, perfumes, and lotions. Search online for cosmetics that are fragrance-free using the nonprofit Environmental Working Group’s Skin Deep cosmetics database at www.ewg.org/skindeep, and then choose among the products that are also phthalate-free. For perfumes, specifically, search online using the phrase “phthalate-free perfumes,” which should lead to many brands, such as Zorica of Malibu, Kai, Pacifica, Agape & Zoe Naturals, Rich Hippie, Honoré des Prés, Blissoma Blends, Red Flower Organic Perfumes, Tsi-La Organic Perfume, and Ayala Moriel Parfums.