New diet to beat diabetes

A plant-based diet can dramatically improve the health of people with diabetes.

Diabetes diets typically call for portion control, carbohydrate limits and — for those who are overweight — calorie restrictions.

Fortunately, there is another way. Low-fat, plant-based diets are ideal for diabetes and the conditions associated with it, such as heart disease, weight gain, high cholesterol, and high blood pressure. And, they offer the advantage of not requiring any weighing or measuring of portions.

The old approach had us cutting down on carbohydrates. It's true that overly processed carbohydrates — those made with sugar or white flour, for example — are poor choices. However, delicious unprocessed or minimally-processed foods, such as potatoes, rice, oats, beans, pasta, fruit, and vegetables, were the main part of the diet in countries where people were traditionally fit and trim and where diabetes was rare. Unfortunately, highly processed carbohydrates and affordable meat and cheese dishes have moved in, and now we have a worldwide type 2 diabetes epidemic.

A low-fat vegetarian approach recognises that whole-food carbohydrates are fine; it's the fat in our diets that is the problem. New information suggests that fat in animal products and oils interferes with insulin's ability to move glucose into the cells.

Eating less fat reduces body fat. Less body fat allows insulin to do its job. However, choosing skinless chicken, skim milk and baked fish is not enough of a change for most people to beat diabetes. The new approach eliminates fatty foods and animal protein, such as meats, dairy products, and oils, and offers unlimited grains, legumes, fruits, and vegetables. One study found that 21 of 23 patients on oral medications and 13 of 17 patients on insulin were able to get off of their medication after 26 days on a near-vegetarian diet and exercise programme. During two- and three-year follow-ups, most people with diabetes treated with this regimen have retained their gains.

Type 1 diabetes and diet

While people with type 2 diabetes can often reduce, and sometimes eliminate, medication when they lose weight and food and exercise are better controlled, those with type 1 diabetes will always need insulin. Even so, a good diet can minimise the amount of insulin required. Type 1 diabetes, formerly called "childhood onset diabetes," occurs when the pancreas stops producing insulin. The cause of type 1 diabetes remains elusive. Several studies have implicated cow's milk consumption as a possible contributor. When milk consumption patterns were examined across various nations, there was a strong correlation with the incidence of type 1 diabetes. It may be that milk proteins cause an autoimmune reaction in which the body mistakenly attacks its own insulin-producing cells.

Remarkably simple new approach

A three-week trial is recommended for beginners.

1. Begin a vegan diet

A vegan diet has no animal products at all: No red meat, poultry, pork, fish, dairy products, and eggs. Why? Animal products contain saturated fat, which is linked to heart disease, insulin resistance, and certain forms of cancer. They also contain cholesterol and, of course, animal protein. It may surprise you to learn that diets high in animal protein can aggravate kidney problems and calcium losses. All the protein you need can be found in whole grains, legumes, and even vegetables: that's where strong horses, bulls, and elephants get their protein.

2. Avoid added vegetable oils and other high-fat foods.

Although vegetable oils are healthier than animal fats, you will still want to keep them to a minimum. All fats and oils are highly concentrated in calories. A gram of any fat or oil contains nine calories, compared with only four calories for a gram of carbohydrate. The amount of fat we really need each day is quite small and readily available by eating whole foods. Avoid oily toppings and foods fried in oil. Limit olives, avocados, nuts, and peanut butter. Read labels, and choose foods with no more than 2-3 grams of fat per serving.

3. Go high-fibre.

Aim for at least 40 gms of fibre each day. Choose beans, vegetables, fruits, and whole grains (eg, whole wheat pasta, barley, oats, quinoa). Aim for at least 3 gms/fibre per serving on labels and 10 to 15 gms per meal. Start slowly. Expect a change in bowel habits (usually for the better). Gassiness from beans can be minimised with small servings and thorough cooking.

4. Focus on the "new four food groups."

Enjoy unlimited whole grains, legumes (beans, lentils, peas), fruits and vegetables. Modest amounts of non-fat condiments, salad dressings, nuts, and seeds also fine.

A note on vitamin B12: Those following a diet free of animal products should take a B12 supplement of 5 mcg per day. Any common daily multiple vitamin will provide this amount.

Diabetes-friendly recipe:

Pasta with Lentil Marinara Sauce

You need: 1 pound pasta of choice, 1 jar fat-free, low-sodium, tomato-based pasta sauce, 1 can lentils, rinsed and drained, 1/2 cup dry red wine (can be non-alcoholic) or low-sodium vegetarian broth, salt to taste, freshly ground black pepper.

Method: Cook the pasta according to package directions. Meanwhile, combine the pasta sauce, lentils, and wine or broth in a medium saucepan. Heat gently and season with the salt and pepper. Serve over the drained pasta. Makes 5 servings

Per serving: 470 calories, 19 gms protein, 91 gms carbohydrates, 9 gms sugar, 2 gms total fat, 3 per cent calories from fat, 0 mg cholesterol, 8 gms fibre, 173 mg sodium.


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Asthma in Children: Symptoms and Risk Factors

Asthma is the leading cause of chronic illness in children. It affects more than one out of every 10 children in the U.S., and, for unknown reasons, it is steadily increasing. It can begin at any age, but most children have their first symptoms by age 5.

What Makes a Child More Likely to Develop Asthma?

There are many risk factors for developing childhood asthma. These include:

• Presence of allergies
• Family history of asthma or allergies
• Frequent respiratory infections
• Low birth weight
• Exposure to tobacco smoke before or after birth
• Being male
• Being black
• Being raised in a low-income environment

Why Are More Children Getting Asthma?

No one really knows why more and more children are developing asthma. Some experts suggest that children are being exposed to more and more allergens such as dust, air pollution, and second-hand smoke. These are factors that can all trigger asthma. Others suspect that children are not exposed to enough childhood illnesses to build up their immune system. It appears that a disorder of the immune system in which the body fails to make enough protective antibodies may play a role in causing asthma.

Still others suggest that decreasing rates of breastfeeding have prevented important substances of the immune system from being passed on to babies.

How Can I Tell If My Child Has Asthma?

Signs and symptoms to look for include:

• Frequent coughing spells, which may occur during play, at night, or while laughing. It is important to know that cough may be the only symptom present.
• Less energy during play.
• Rapid breathing.
• Complaint of chest tightness or chest "hurting."
• Whistling sound (wheezing) when breathing in or out.
• See-saw motions (retractions) in the chest from labored breathing.
• Shortness of breath, loss of breath.
• Tightened neck and chest muscles.
• Feelings of weakness or tiredness.
• Dark circles under the eyes.
• Frequent headaches.
• Loss of appetite.

Keep in mind that not all children have the same asthma symptoms, and these symptoms can vary from asthma episode to the next episode in the same child. Also note that not all wheezing or coughing is caused by asthma.

In kids under 5 years of age, the most common cause of asthma-like symptoms is upper respiratory viral infections such as the common cold.

If your child has problem breathing, take him or her to the doctor immediately for an evaluation.

How Is Asthma Diagnosed In Children?

Asthma is often difficult to diagnose in infants. However, in older children the disease can often be diagnosed based on your child's medical history, symptoms, and physical exam.

• Medical history and symptom description. Your child's doctor will be interested in any history of breathing problems you or your child may have had, as well as a family history of asthma, allergies, a skin condition called eczema, or other lung disease. It is important that you describe your child's symptoms -- cough, wheezing, shortness of breath, chest pain or tightness -- in detail, including when and how often these symptoms have been occurring.
• Physical exam. During the physical examination, the doctor will listen to your child's heart and lungs.
• Tests. Many children will also have a chest X-ray and pulmonary function tests. Also called lung function tests, these tests measure the amount of air in the lungs and how fast it can be exhaled. The results help the doctor determine how severe the asthma is. Generally, children younger than 5 are unable to perform pulmonary function tests. Thus doctors rely heavily on history, symptoms, and examination in making the diagnosis.

Other tests may also be ordered to help identify particular asthma triggers. These tests may include allergy skin testing, blood tests and X-rays to determine if sinus infections, or gastroesophageal reflux disease (a gastrointestinal condition that causes reflux of acid stomach contents into the esophagus or even into the lungs) is complicating asthma.

Signs and symptoms of breast cancer

Widespread use of screening mammograms has increased the number of breast cancers found before they cause any symptoms. Still some breast cancers are not found by mammograms, either because the test was not done or because even under ideal conditions mammograms do not find every breast cancer.

The most common symptom of breast cancer is a new lump or mass. A mass that is painless, hard, and has irregular edges is more likely to be cancerous, but breast cancers can be tender, soft, or rounded. They can even be painful. For this reason, it is important to have any new mass, lump, or breast change checked by a health care professional with experience in diagnosing breast diseases.

Other possible signs of breast cancer include:

• Swelling of all or part of a breast (even if no distinct lump is felt)
• Skin irritation or dimpling
• Breast or nipple pain
• Nipple retraction (turning inward)
• Redness, scaliness, or thickening of the nipple or breast skin
• A nipple discharge other than breast milk

Sometimes a breast cancer can spread to lymph nodes under the arm or around the collar bone and cause a lump or swelling there, even before the original tumor in the breast tissue is large enough to be felt. Swollen lymph nodes should also be reported to your doctor.

Factors of unproven effect on breast cancer risk

Diet and vitamin intake

Many studies have looked for a link between certain diets and breast cancer risk, but so far the results have been conflicting. Some studies have indicated that diet may play a role, while others found no evidence that diet influences breast cancer risk. Studies have looked at the amount of fat in the diet, intake of fruits and vegetables, and intake of meat. No clear link to breast cancer risk was found.

Studies have also looked at vitamin levels, again with inconsistent results. Some studies actually found an increased risk of breast cancer in women with higher levels of certain nutrients. So far, no study has shown that taking vitamins reduces breast cancer risk. This is not to say that there is no point in eating a healthy diet. A diet low in fat, low in red meat and processed meat, and high in fruits and vegetables may have other health benefits.

Most studies have found that breast cancer is less common in countries where the typical diet is low in total fat, low in polyunsaturated fat, and low in saturated fat. But many studies of women in the United States have not linked breast cancer risk to dietary fat intake. Researchers are still not sure how to explain this apparent disagreement. It may be at least partly due to the effect of diet on body weight (see below). Also, studies comparing diet and breast cancer risk in different countries are complicated by other differences (such as activity level, intake of other nutrients, and genetic factors) that might also alter breast cancer risk.

More research is needed to better understand the effect of the types of fat eaten on breast cancer risk. But it is clear that calories do count, and fat is a major source of calories. High-fat diets can lead to being overweight or obese, which is a breast cancer risk factor. A diet high in fat has also been shown to influence the risk of developing several other types of cancer, and intake of certain types of fat is clearly related to heart disease risk.

Antiperspirants

Internet e-mail rumors have suggested that chemicals in underarm antiperspirants are absorbed through the skin, interfere with lymph circulation, and cause toxins to build up in the breast, eventually leading to breast cancer.

There is very little laboratory or population-based evidence to support this rumor. One small study has found trace levels of parabens (used as preservatives in antiperspirants and other products), which have weak estrogen-like properties, in a small sample of breast cancer tumors. However, the study did not look at whether parabens caused the tumors. This was a preliminary finding, and more research is needed to determine what effect, if any, parabens may have on breast cancer risk. On the other hand, a large population-based study found no increase in breast cancer in women who used underarm antiperspirants and/or shaved their underarms.

Bras

Internet e-mail rumors and at least one book have suggested that bras cause breast cancer by obstructing lymph flow. There is no good scientific or clinical basis for this claim. Women who do not wear bras regularly are more likely to be thinner or have less dense breasts, which would probably contribute to any perceived difference in risk.

Induced abortion

Several studies have provided very strong data that neither induced abortions nor spontaneous abortions (miscarriages) have an overall effect on the risk of breast cancer. For more detailed information, see the separate American Cancer Society.

Breast implants

Several studies have found that breast implants do not increase the risk of breast cancer, although silicone breast implants can cause scar tissue to form in the breast. Implants make it harder to see breast tissue on standard mammograms, but additional x-ray pictures called implant displacement views can be used to examine the breast tissue more completely.

Breast implants may be linked to a rare type of lymphoma called anaplastic large cell lymphoma. This lymphoma has rarely been found in the breast tissue around the implants. So far, though, there are too few cases to know if the risk of this lymphoma is really higher in women with implants.

Chemicals in the environment

A great deal of research has been reported and more is being done to understand possible environmental influences on breast cancer risk.

Compounds in the environment that studies in lab animals have found to have estrogen-like properties are of special interest. These could in theory affect breast cancer risk. For example, substances found in some plastics, certain cosmetics and personal care products, pesticides, and PCBs (polychlorinated biphenyls) seem to have such properties.

Although this issue understandably invokes a great deal of public concern, at this time research does not show a clear link between breast cancer risk and exposure to these substances. Unfortunately, studying such effects in humans is difficult. More research is needed to better define the possible health effects of these and similar substances.

Tobacco smoke

For a long time, studies found no link between cigarette smoking and breast cancer. In recent years though, some studies have found that smoking might increase the risk of breast cancer. The increased risk seems to affect certain groups, such as women who started smoking when they were young. In 2009, the International Agency for Research on Cancer concluded that there is limited evidence that tobacco smoking causes breast cancer.

An active focus of research is whether secondhand smoke increases the risk of breast cancer. Both mainstream and secondhand smoke contain chemicals that, in high concentrations, cause breast cancer in rodents. Chemicals in tobacco smoke reach breast tissue and are found in breast milk.

The evidence on secondhand smoke and breast cancer risk in human studies is controversial, at least in part because the link between smoking and breast cancer is also not clear. One possible explanation for this is that tobacco smoke may have different effects on breast cancer risk in smokers compared to those who are just exposed to secondhand smoke.

A report from the California Environmental Protection Agency in 2005 concluded that the evidence about secondhand smoke and breast cancer is "consistent with a causal association" in younger, mainly pre-menopausal women. The 2006 US Surgeon General's report, The Health Consequences of Involuntary Exposure to Tobacco Smoke, concluded that there is "suggestive but not sufficient" evidence of a link at this point. In any case, this possible link to breast cancer is yet another reason to avoid secondhand smoke.

Night work

Several studies have suggested that women who work at night, such as nurses on a night shift, may have an increased risk of developing breast cancer. This is a fairly recent finding, and more studies are looking at this issue. Some researchers think the effect may be due to changes in levels of melatonin, a hormone whose production is affected by the body's exposure to light, but other hormones are also being studied.

Lifestyle-related risk factors for breast cancer

Recent oral contraceptive use: Studies have found that women using oral contraceptives (birth control pills) have a slightly greater risk of breast cancer than women who have never used them. Over time, this risk seems to go back to normal once the pills are stopped. Women who stopped using oral contraceptives more than 10 years ago do not appear to have any increased breast cancer risk. When thinking about using oral contraceptives, women should discuss their other risk factors for breast cancer with their health care team.

Having children

Women who have not had children or who had their first child after age 30 have a slightly higher breast cancer risk. Having many pregnancies and becoming pregnant at an early age reduces breast cancer risk. Pregnancy reduces a woman's total number of lifetime menstrual cycles, which may be the reason for this effect.

Birth control

Depot-medroxyprogesterone acetate (DMPA; Depo-Provera) is an injectable form of progesterone that is given once every 3 months as birth control. A few studies have looked at the effect of DMPA on breast cancer risk. Women currently using DMPA seem to have an increase in risk, but the risk doesn’t seem to be increased if this drug was used more than 5 years ago.

Hormone therapy after menopause

Hormone therapy using estrogen (often combined with progesterone) has been used for many years to help relieve symptoms of menopause and to help prevent osteoporosis (thinning of the bones). Earlier studies suggested it might have other health benefits as well, but those benefits have not been found in more recent, better designed studies. This treatment goes by many names, such as post-menopausal hormone therapy (PHT), hormone replacement therapy (HRT), and menopausal hormone therapy (MHT).

There are 2 main types of hormone therapy. For women who still have a uterus (womb), doctors generally prescribe estrogen and progesterone (known as combined hormone therapy or HT). Progesterone is needed because estrogen alone can increase the risk of cancer of the uterus. For women who've had a hysterectomy (those who no longer have a uterus), estrogen alone can be prescribed. This is commonly known as estrogen replacement therapy (ERT) or justestrogen therapy (ET).

Combined hormone therapy (HT): Use of combined post-menopausal hormone therapy increases the risk of getting breast cancer. It may also increase the chances of dying from breast cancer. This increase in risk can be seen with as little as 2 years of use. Large studies have found that there is an increased risk of breast cancer related to the use of combined HT. Combined HT also increases the likelihood that the cancer may be found at a more advanced stage.

The increased risk from combined HT appears to apply only to current and recent users. A woman's breast cancer risk seems to return to that of the general population within 5 years of stopping treatment.

The word bioidentical is sometimes used to describe versions of estrogen and progesterone with the same chemical structure as those found naturally in people. The use of these hormones has been marketed as a safe way to treat the symptoms of menopause. It is important to realize that although there are few studies comparing “bioidentical” or “natural” hormones to synthetic versions of hormones, there is no evidence that they are safer or more effective. The use of these bioidentical hormones should be assumed to have the same health risks as any other type of hormone therapy.

Estrogen therapy (ET): The use of estrogen alone after menopause does not appear to increase the risk of developing breast cancer significantly, if at all. But when used long term (for more than 10 years), ET has been found to increase the risk of ovarian and breast cancer in some studies.

At this time there appear to be few strong reasons to use post-menopausal hormone therapy (either combined HT or ET), other than possibly for the short-term relief of menopausal symptoms. Along with the increased risk of breast cancer, combined HT also appears to increase the risk of heart disease, blood clots, and strokes. It does lower the risk of colorectal cancer and osteoporosis, but this must be weighed against the possible harms, especially since there are other effective ways to prevent and treat osteoporosis. Although ET does not seem to increase breast cancer risk, it does increase the risk of stroke.

The decision to use HT should be made by a woman and her doctor after weighing the possible risks and benefits (including the severity of her menopausal symptoms), and considering her other risk factors for heart disease, breast cancer, and osteoporosis. If a woman and her doctor decide to try HT for symptoms of menopause, it is usually best to use it at the lowest dose that works for her and for as short a time as possible.

Breastfeeding

Some studies suggest that breastfeeding may slightly lower breast cancer risk, especially if it is continued for 1½ to 2 years. But this has been a difficult area to study, especially in countries such as the United States, where breastfeeding for this long is uncommon.

The explanation for this possible effect may be that breastfeeding reduces a woman's total number of lifetime menstrual cycles (the same as starting menstrual periods at a later age or going through early menopause).

Alcohol

Consumption of alcohol is clearly linked to an increased risk of developing breast cancer. The risk increases with the amount of alcohol consumed. Compared with non-drinkers, women who consume 1 alcoholic drink a day have a very small increase in risk. Those who have 2 to 5 drinks daily have about 1½ times the risk of women who don’t drink alcohol. Excessive alcohol use is also known to increase the risk of developing cancers of the mouth, throat, esophagus, and liver. The American Cancer Society recommends that women have no more than 1 alcoholic drink a day.

Being overweight or obese

Being overweight or obese after menopause has been found to increase breast cancer risk. Before menopause your ovaries produce most of your estrogen, and fat tissue produces a small amount of estrogen. After menopause (when the ovaries stop making estrogen), most of a woman's estrogen comes from fat tissue. Having more fat tissue after menopause can increase your chance of getting breast cancer by raising estrogen levels. Also, women who are overweight tend to have higher blood insulin levels. Higher insulin levels have also been linked to some cancers, including breast cancer.

The connection between weight and breast cancer risk is complex, however. For example, risk appears to be increased for women who gained weight as an adult but may not be increased among those who have been overweight since childhood. Also, excess fat in the waist area may affect risk more than the same amount of fat in the hips and thighs. Researchers believe that fat cells in various parts of the body have subtle differences that may explain this.

The American Cancer Society recommends you maintain a healthy weight throughout your life by balancing your food intake with physical activity and avoiding excessive weight gain.

Physical activity

Evidence is growing that physical activity in the form of exercise reduces breast cancer risk. The main question is how much exercise is needed. In one study from the Women's Health Initiative, as little as 1¼ to 2½ hours per week of brisk walking reduced a woman's risk by 18%. Walking 10 hours a week reduced the risk a little more.

To reduce your risk of breast cancer, the American Cancer Society recommends 45 to 60 minutes of intentional physical activity 5 or more days a week.