Gimzoo

Diabetes Prevention-The Right Fuel

Though there is not yet a cure for diabetes, type II diabetes is certainly preventable in most people. Yes, some inherit a genetic tendency towards diabetes but that is not a guarantee of getting the disease. As discussed in last week's post, the key to keeping diabetes at bay is to keep down the abdominal fat stores so that the pancreas does not become overworked. Quite simply, if you are overweight you must burn more than you take in. I realize that this is easier said than done. I've discussed diet and exercise before but will readdress these topics with a specific emphasis on how diabetes is impacted. I'll start with food intake and will discuss exercise next week.

First, let's talk about what is coming in. If the goal is to minimize the amount of glucose (sugar) that reaches the blood vessels, sweets must be avoided. Table sugar is sucrose which chemically is composed of two glucose molecules stuck to each other. It takes nearly no effort to split them in two. Compare that to fructose, the molecule that fruit contains. It is composed of one glucose molecule and another called galactose. For the same amount of food ingested, there will be half as much sugar in whole fruit than in sweets. In addition, fruit contains fiber, vitamins and other nutrients all of which are healthy. The fiber makes the body work harder to digest the food and thus delays how quickly the nutrients reach the blood stream. In addition to sweets, some foods have a much higher glycemic index than others. Think of the glycemic index as how much sugar a given food delivers to the blood vessels. Cereals are notoriously high, though the higher fiber cereals are much better than the others. Bread, pasta and potatoes are also high glycemic foods. Whole grains are always better than processed ones. The bran and fiber in whole grains makes it harder to digest and will therefore deliver less sugar to the blood stream. For more details about the glycemic index of specific foods, click here.

In addition to the types of food we eat, the amount eaten is just as important. Our body uses sugar to meet its metabolic demands. If too much glucose is delivered, it will get stored either in the liver as long chains called glycogen or be processed into fat stores. If small amounts of food are eaten frequently, total calorie consumption will not need to be decreased in order to keep the weight stable. In fact one of the worst things someone can do when trying to lose weight is to skip meals. When going too long between meals, the body does not receive the nutrients that it needs so it enters starvation mode. Signals are then sent throughout the body to turn down metabolism, lessening energy demand. In addition, cortisol is released from the adrenal gland. One of its effects is to decrease the sensitivity to insulin, thus raising blood sugar. It is best to have healthy food nearby during the day. Just a few grapes or a bite or two of carrots will keep down hunger and maintain the metabolism. Keep it small and keep it healthy.

Lastly, eating a large meal late in the evening prior to going to bed is a recipe for disaster. Very few of those calories will be metabolized. The exception is if you chose to exercise in the evening before eating. Exercise turns on a muscle enzyme called alcohol dehydrogenase. It is quite good at burning up glucose. It stays active in the muscles for 2-3 hours after exercising. If you are going to have foods with a higher glycemic index, the time to eat them is during this window of opportunity after exercise.

The Simvastatin Story

This week the FDA released new guidelines in regards to the use of the very common medication, simvastatin, which is used to lower cholesterol and thereby decreasing the risk of heart attack and stroke. The reason for the guidelines change was due to new information that has been received from their Adverse Event Reporting System. They found that there was an increased incidence of problems with muscles at the highest dose, 80 mg. The incidence for this was much higher during the first year that a patient took the drug and was much more so in combination with certain other medications. The most common are the calcium channel blockers used to control high blood pressure (diltiazem, verapamil). They recommend that no more than 20 mg of simvastatin be taken in combination with these drugs and 20 mg with a similar medication, amlodipine.

Simvastatin 80 mg pill

You may ask, if there are serious risks to taking this medication, why wasn't it just pulled off of the market? The reason is that for many people the risk of not taking the medication is higher than the risk of taking it. In the last twenty five years, the incidence of heart disease has decreased dramatically. Most researchers feel that it is due to the beneficial effects of the statin medications. Their effects on the liver and on muscle tissue is well known. When it is watched for and monitored, the medication is safe. Simvastatin in particular is useful because it is the only statin on the market that is both potent and available in a generic form. In my opnion, lovastatin and fluvastatin have more incidence of muscle pains. Pravastatin is quite safe, has fewer muscle problems but is not very potent. Basically, three options remain: Crestor, Lipitor and Vytorin. Crestor and Lipitor will both be quite a bit more expensive. The incidence of muscle problems is likely to be lower but the potential still exists. Vytorin is simvastatin, together with a medication called ezetimide (Zetia). It works by blocking the absorption of cholesterol in the intestines. It shows great reductions in cholesterol levels but there is some debate over whether that translates into fewer cardiovascular events (heart attacks).

Where does this leave you? It depends on your individual situation. Step one is to estimate your cardiovascular risk. If you have known vascular disease (atherosclerosis-partial blockage in any of your arteries), it is imperative that your LDL, bad cholesterol, be less than 100 mg/dl. This is unlikely to be achieved by diet alone. A statin drug has the best data in regards to lowering your future risk. If you have diabetes you fall into that same risk category. If neither of the two are present, go to the Framingham Risk Calculator (click here) and if your risk is above 10%, you should be on a statin. If it is lower you need to ask yourself if you are truly doing everything you can in regards to diet and exercise to ensure that you remain healthy. Healthy living is preferable to medications any day of the week as long as the proper levels are attained.

If you need to take a statin medication, the good news is that if you have been taking simvastatin at 40 mg or less and are doing well on it, there is no concern about staying on that dose. If you take 80 mg of simvastatin or you are also taking any of the medications that interact with it, you should discuss this with your physician. For a detailed summary from the FDA and a list of all medications that can interact with simvastatin (click here). If you have any questions, feel free to ask in the comments. I'll be happy to respond. Remember, these medications are there only to assist your own efforts in eating right and getting plenty of exercise. They do not take their place. Let's just simply be healthy!

A Salty Study

I received an email recently from a patient wanting to know what to do in regards to salt intake in light of a study which was released this month from the Journal of the American Medical Association. There has been long standing consensus that too much salt in the diet raises blood pressure. High blood pressure (hypertension) indisputably increases the risk of both heart attacks and strokes. The study looked at a group of people for eight years and followed them till they were 49 years old. The Centers for Disease Control made a public statement expressing concern over the study's findings and reiterated their support of the stand of the World Health Organization and the American Heart Association that sodium be limited to 1500-2300 mg a day. Interestingly, the Salt Institute, was the lone organization that hailed the study.

One of my big concerns about the study is how young the patients were. The chance of dying of heart disease before the age of fifty is quite low. The fact that they could measure a statistically significant difference surprises me. It makes me wonder if those who died had preexisting heart disease. They would be much more likely to be on low salt diets because that is what their doctors would have told them to do in order to minimize their risk. If that were the case, it would not be salt restriction which caused them to have more adverse events, but rather their underlying heart disease.

Tropical fruit high in potassium with no salt!

Some of the best information we have in regards to sodium restriction come from studies done in relation to the DASH (dietary approaches to stop hypertension) diet. It is sponsored by the National Institutes of Health (NIH). Recent studies are summarized on their website at www.dashdiet.org. Some years back I came across a study from a remote pacific island. The population that lived there did not have access to processed foods. The amount of sodium in their diet was exceedingly low and the amount of potassium was quite high due to a high intake of the native tropical fruits and vegetables. The astonishing finding to me was that they did not find one single person with high blood pressure. Not one! I would have thought that someone would have had a genetic aberration that would have caused their blood pressure to be high. To me, this study stands as a testimony of what eating the right foods will do for us. Remember, if it sounds too good to be true, it usually is. Leave the salt in the cupboard.

"Lung Painters"

Sick in the ICU, my patient's heart was beating so fast that her heart, stiff from years of untreated high blood pressure, couldn't keep up. Her kidneys were starting to fail because the heart couldn't get enough blood to them. Her lungs were struggling mightily both from emphysema and the fluid building up from her heart. Wanting to comfort her as well as she could, the nurse, entering the room, asked, "Can I get you anything?" Without a moments hesitation, my patient responded, "Yeah, get me my cigarette."

My patient did not lack for knowledge in regards to the dangers of smoking. She knew full well that it was the cause of her emphysema and was the main contributer to her high blood pressure. The addiction is so powerful, it did not matter to her. I have spent my career educating my patients to the dangers of smoking and encouraging them to quit. I am the eternal optimist and will never quite trying. I am pleased to say that a 95 year old patient of mine decided to quit with my prodding. I understand, though, that the knowledge of the dangers of smoking will only take people so far. They need a cheerleader. They need support at home. Children are some of my best co-conspirators. If one of my smoking patients comes in with a child, I will look the child in the eye and commit them to be my partner. I ask them to hide the cigarettes and watch out for Mom or Dad. My daughter drew the "Lung Painters" picture as a nine year old. I have it framed and hung in an exam room. Many patients have looked at its simple message and given the decision to quit another look. Who wants to have a "gurntee" to have your lungs turned black?

I'll have to say that my biggest ally in helping people quit smoking has been the government. I can talk till I'm blue in the face or get on my knees and beg (which I'll happily do if it would work!) but I've noticed that the willingness to quit has increased in direct proportion to how much it costs to buy them. The cigarette tax works. I can now tell patients, "It is too expensive to smoke anymore, you need to save your money for gas." Restricting smoking in public places has also helped. "I might as well quit," I've heard, "I can't smoke anywhere, anyways."

What is the best way to quit smoking? The best way is whatever works for you. There are medications that now directly attack nicotine receptors and work well. I have seen people do well with hypnosis, with electrical current placed on an ear lobe. Support groups are good. The nicotine patches and gum work well. The word is not yet out on the "electronic cigarette" but I say if you want to try it-do it. Almost anything is better than smoking. Some can just out and out quit on their own. My own grandfather had a hard time quitting. He tried over and over again. He probably felt as did one of my patients who said, "quitting smoking is easy, I do it every week!" One of those weeks, he was out plowing his potato field on the tractor. He took his cigarettes, crumpled them up and threw them in the dirt. By the time he reached the end of the row he started wanting a cigarette. Turning around he started scanning for his discarded pack. When he returned to the area where he had thrown down his cigarettes, he jumped down off the tractor and started digging through the dirt. Something about a grown man on his hands and knees, digging through the dirt was so ridiculous that he started to laugh at himself. "How pathetic", he said. From that moment on he let them lie in the dirt, where they belong.

Medication Mayhem

As a physician who spends much of his day prescribing, renewing or monitoring medications you may find it unusual for me to advocate using less of them. As with the air we breath, the food we eat, the beverages that we drink and the supplements we consume, we should be mindful of everything that goes into our bodies. This applies particularly to prescription medications. There have been wonderful scientific advances in the development of medications. The incidence of rheumatic heart disease (basically strep throat of the heart valves) is almost nonexistent now. The incidence of death due to heart disease has dropped dramatically to the point that this number one cause of death is now being rivaled by cancer. There now exists for cancer, many treatments that can cure or at least greatly prolong life. Medications have been developed that have transformed the AIDS epidemic from a universally deadly infection to one of managing chronic HIV infection.

As great of an effect that medications can have, there are possible down sides as well. Some medications which were thought to provide benefit have been taking off of the market when they were later found to increase disease or death in unforeseen matters. A commonly prescribed group of anti-inflammatory drugs were found to increase the risk of heart attacks. A diabetic medication was found to cause liver failure. Devastating birth defects occurred due to an anti-nausea medication used by pregnant mothers. Certainly, if medications are used they should be used for well established needs in a setting where one is watched and monitored so that the desired effects are achieved and regular reappraisals are made to ascertain if untoward effects are being experienced. As time goes on, there may be better options available or new information while come to light that would indicate a better coarse of action.

Of particular concern in my mind are medications that are not used to prolong or save life but rather to improve symptoms. Pharmaceutical companies are particularly interested in developing these medications because they can be marketed to a large number of people. Immense profits have been made from these drugs. The marketing of these drugs has advanced the thought that there is "a pill for everything." The peril comes when a patient takes one medication to assist in maintaining attention and focus only to be stimulated to the point of not being able to sleep well at night. A sleeping pill may be prescribed only to find that the system as a whole has been slowed down causing daytime sluggishness and constipation. Similarly, the need for pain medications needs to be monitored closely. I have seen patients come to the hospital due to life threatening bleeding from stomach ulcers. Upon further questioning it was found that the patient had ingested a large amount of common, over the counter anti-inflammatory medications to treat chronic headaches. The medication not only caused the ulcer but in and of themselves were perpetuating the headaches. In other situations, if narcotic based medications are used for more than a few weeks, the dose invariably will be escalated as the body will build up tolerance to them and they will lose their effectiveness. In addition to the constipation that almost all who use these medications experience, we are now finding syndromes of inappropriate nerve activations, that can also be debilitating. If a medication is to be used, it should be given for a clear reason and for a predetermined length of time.

Lastly, if one has multiple chronic medical conditions, I feel that it is imperative that the patient regularly sees a primary care Internal Medicine physician to coordinate care between specialties. An extreme example is a patient I saw once who was taking over twenty different medications. The patient was seeing about five sub specialists, each of whom prescribed three or four medications. There have not been any studies performed with patients in a similar situation. We have no idea what kind of interactions may occur. This is especially true in the elderly where medications are not metabolized as efficiently as they are in younger people. If you are concerned that you may be on too many medications, it is perfectly reasonable to ask your physician if any of them can be cut back or discontinued. This is especially true if changes in life style can result in reducing the need for many of these medications. Make sure your medications make a difference, not mayhem!

Drink Up!

One of our staff members one day asked, "I heard that there is a great new drink out for diabetics. It has no calories and is supposed to be real good for you, did you hear about it?" Passing by, my partner turned to her and said, "Yeah, it's called water." Yes, water...the forgotten beverage. Most of the earth is covered by it. Wars have been fought over it. More than sixty percent of our own bodies are composed of it and yet the amount of money that is spent and the amount of calories that are consumed in other beverages is staggering.

We are so fortunate to live in a society where we can turn on a tap and receive good, clean water. There are still many places across the world where that is not the case. A clean water supply has done more for the health of our society than any other single intervention. At the level of our own body, water affects every single physiologic process. The easiest to consider is our blood volume. The contents of the blood, such as the oxygen carrying red blood cells must travel to every part of the body. Without water, it is impossible. The water in our blood stream allows other organs such as the kidney and liver to filter out waste products and toxins that we are exposed to. The more that can be filtered out, the healthier we are going to be. A low flow of urine in some people can lead to the formation of tiny crystals. Over time these can grow big enough to lodge in the tubes that drain the kidneys causing incredible amounts of pain in the form of kidney stones. Muscles contract according to differing concentrations of calcium and other molecules that flow across cell membranes. That flow is dependent upon water. The number one way to decrease painful muscle cramps that some people at night is to drink more water. In a similar fashion, nerve activation is dependent upon flow of small molecules across cell junctions. Without adequate hydration, the responsiveness becomes sluggish. The intestinal tract is dependent upon enough ingested water to safely carry that which cannot be absorbed out of body for elimination. Can you guess what the number one reason why constipation occurs? You guessed it, not enough water. Think about your skin. How much money is spent on skin moisturizers? They work by holding moisture in but if we are not drinking enough water to begin with, it won't do any good.

I have been accused, rightly so I may add, that the answer to almost all problems is to drink more water and exercise. When thought about in regards to how our body works it makes sense. Water allows all those processes discussed above work better. Exercise increases the flow of blood throughout the entire body. It makes sure that the water we ingest gets to all the cells that need it. I cannot tell you how many times I have seen patients who complain of feeling sluggish, fatigued, achey, etc who come back feeling so much better, and often 15-20 pounds lighter, after having switched from drinking alcohol, soda and tea to simply drinking more water. I call it "God's Soda," it comes straight from heaven. Try to get eight, 8 oz glasses of water in a day. Have a source of it near you at all times. Here's to your health. Drink up!

How Much is Too Much?

Nothing is quite so controversial as alcohol ingestion. A small amount of red wine has been shown to improve the HDL (good cholesterol) and is felt to be good for the heart. I define a "small amount" as four glasses a week for women and six for men. Given the very real risks of drinking too much alcohol, I feel there is absolutely nothing wrong with complete abstinence. I have noticed in my practice an interesting phenomenon as I see new patients. We have them fill out a personal health inventory which includes a family history. I have yet to see a patient come in and report that they have a problem with alcohol. Some will report that they had a problem in the past. It is, however, very common for patients to report that family members have an issue with drinking too much alcohol. It is easy to deny that there is a problem. Here is a list of four simple questions. If you answer yes to any of these, you should speak to your doctor about your alcohol intake.

1. Have you ever felt like you should cut down on your drinking?
2. Have people annoyed you by criticizing your drinking?
3. Have you ever felt bad or guilty because of your drinking?
4. Have you ever taken a drink first thing in the morning to steady your nerves or get rid of a hangover?

It surprises many to learn that the definition of a "heavy" drinker is someone who has three drinks per day. I remember questioning an older man who when asked if he drank alcohol, he responded "only occasionally." After further questioning he reported having 4-5 beers a day. Surprised, I reminded him of his previous response. He declared, "I'm from South County (home of Anheiser Busch), that is what we drink. I don't drink alcohol." He was not pleased to hear that yes, beer counts as alcohol too. Water remains our best source of hydration.

The adverse affects from alcohol are numerous. It is well known to be toxic to the developing fetus. Our brain is affected short and long term. Chronic balance issues are seen as well as cognitive (thinking/memory) functions. It can even cause a peripheral neuropathy in our arms and legs (numbing nerve damage). The majority of all fatal car accidents involve alcohol. In our digestive tract it is more than just the liver that can be damaged. Alcohol is tied to acid reflux and esophageal cancer as well. The pancreas is certainly involved. The heart can be weakened and it is well known to trigger rhythm problems such as atrial fibrillation. This is just a short list. Do you want to be healthy? Keep the alcohol to a minimum.

Take Your Vitamins

Most of us from an early age remember our mother imploring us to "take our vitamins." I often get asked by patients what I think about taking vitamins and which ones they should take. The array of choices is enormous and confusing. Again, let me try to simplify.

I take vitamins every day. I take no pills or capsules. I don't like to take medication if I don't have to. Now you may say, "Doc, these aren't medication, they are vitamins." I frankly don't understand the logic of making a distinction between synthesizing vitamins and making them into pills and capsules and synthesizing other materials to be used to treat medical conditions. Many medications are "natural." We grind up the foxglove leaf and make something called digoxin. If used improperly it is a very dangerous medication. There are chemotherapy agents that come directly from the bark of the Yew tree. Again, natural but potentially dangerous. Just because something is purported as natural does not make it safe. In fact, the vitamin/herbal remedy industry concerns me a great deal. It is an unregulated industry. Studies have been done analyzing the exact ingredients in some of these products. One, claiming to aid in sexual function, found traces of Viagra in the tablets. Others have found traces of Arsenic and Lead. In my mind, the best way to take vitamins is in their natural form. The more colorful your food is, the more vitamins we will get. Make your goal to eat four to five servings of fruits and vegetables a day.

God's Vitamins

How much is a serving? The size is relatively small, so this is not as hard as one might think. It is basically a cup. That is only six small baby carrots. Most apples would be a cup and a half. The CDC has a great website called, fruitsandveggiesmatter.gov. We can and should receive almost all of the vitamins that we need through our diet. It is always healthier to ingest the whole food, which includes fiber and other nutrients, than pills and capsules which don't.

Man's Vitamins

Let me discuss a few specifics. First, what about Calcium? Recent studies have shown the benefit of getting our calcium through dairy sources rather than supplements. Most people need about 800-1200 mg of calcium a day. Each serving of dairy has about 300 mg of calcium. If extra calcium is taken, make sure it has at least 400 units of vitamin D with it. Taking supplemental calcium without the vitamin D has been linked to higher rates of heart disease. Take the calcium with a meal, which will help its absorption. It does not matter if it is calcium carbonate or calcium citrate as our stomach acid will allow either to be absorbed equally as well. If you are taking medicine that decreases stomach acid (like Prilosec, Prevacid, etc) then calcium citrate will be a better choice.

Vitamin D helps our body absorb calcium and we are learning of the many other benefits that it has as well. It comes initially through plant products and most dairy (having been added or enriched). We should get between 800-1000 units a day. The active form of vitamin D requires sunlight. We live in a society where we are getting less and less sun. We know the dangers of skin cancer are real. But as little as 15 minutes of sun exposure a day, 3 days a week is sufficient to activate our vitamin D. The next time you see your doctor, ask if it is appropriate to check your level, especially if you have naturally darker skin. It is harder for the sun to penetrate in these individuals and they will need more exposure to the sun or may need to take a supplement.

There are many vitamins sold to enhance "prostate health." This varies from vitamin E to selenium and lycopene. A very large study recently has shown that selenium is not beneficial. Lycopene did help but not in the supplement form, only as a dietary source. Your red fruits and vegetables are the ones that have lycopene. Again, the more color in your food, the better.

If you have specific vitamin questions, leave a comment. Remember always to take your vitamins!

Making Diet a Way of Life

The desire for weight loss has spawned innumerable diets. Most gain popularity for one or two years only to be discarded as they are abandoned. You may have heard of "The Zone Diet," "The Cabbage Diet," and even the "Atkin's Diet." The "yo-yo" effect of going on a diet only to revert to old ways and regain all the weight, is well documented and is dangerous to one's health. If a dietary change for weight loss is not permanent it will always fail. The newest fad is the "HCG Diet." I feel this is one that is particularly dangerous. It calls on taking the pregnancy hormone HCG (human chorionic gonadotropin) and limiting daily calories to 500 a day. Of course this is not sustainable and it will fail. I have repeatedly seen people regain weight after stopping this diet. Let me discuss several programs or ideas that can be sustained life long and thus have merit. There are links to their respective websites by clicking on the highlighted titles.

Weight Watchers:

The evolution of Weight Watchers through the years has been interesting to follow. In its current form, I feel that it is a great way to learn how to eat. It is a "points" system. An individual is given so many points per day. One can choose any food that they want but the least healthy foods are awarded more points. Most fruits and vegetables are "free." You can get more points through exercise. The program works because it is sensible, but it must be followed and all the "points" must be counted. There are new smart phone aps which make keeping track of everything so much easier. I highly recommend it. It is a great way to learn how to eat healthy for the rest of your life.

South Beach Diet:

The low carb craze heralded in by the Atkin's diet (see below) got smarter with the South Beach Diet. I especially think that the maintenance phase of the diet is quite healthy and is a great way to make good food choices. It is especially beneficial for people who have elevated triglyceride levels, have diabetes or are borderline for such. First, a few facts about carbohydrates (carbs). This is prevalent in much of the processed food discussed previously. It is converted into blood sugar quite readily by our digestive tract and will raise blood sugar if we are prone to such. It is also what is the common denominator for "comfort food." If we are feeling lonely, angry, down or blue carbs will give us momentary pleasure. Our bodies acquire a physical dependence to them. Cutting back on them is hard since there will be actual withdrawal symptoms when one cuts back. They can also be eaten in large quantities before our hunger center tells us that we are full. This makes it much easier to over eat. Foods high in fiber are filling. Greasy foods, though not healthy, are harder to indulge on in large quantities. Most people need to get control of their carbs and the South Beach Diet helps do just that.

Lastly, the South Beach Diet allows for the ingestion of "healthy carbs." These are the ones found naturally in fruits and vegetables. There are three reasons why they are healthy. First, natural sugar comes in a compound that is just half of the glucose of table sugar. Secondly, fruits and vegetables have that filling fiber making them harder to be over eaten. Thirdly, fruits and veggies contain the essential vitamins necessary for basic bodily functions.

Mediterranean Diet:

This has been studied fairly extensively and has been found to significantly lower one's risk for heart disease. It is not as popular here as it is in Europe, though there are many more people learning of its benefit. . Similar to what has been stated above, it is a diet high in fruits and vegetables. Meat is limited and most all fats are converted to olive oil.

DASH Diet:

This is an acronym which stands for "Dietary Advise to Stop Hypertension." This is a specific diet for high blood pressure but it is quite healthy for anyone. Again, focusing on fruits and vegetables is essential. There is also a strong focus on limiting salt intake, which is very important for lowering blood pressure. There will be more about that later.

Atkins Diet:

I include this diet as it has remained popular for many years. It has shown to be effective in modest weight loss, however, recent research has shown that the risk of heart disease is unchanged and may be slightly higher. In the immortal words spoken at Curley's funeral in the movie, City Slickers: "He ate bacon for breakfast every day....You just can't do that!"

Watching What We Eat

Of all the things we can do to stay healthy, putting in the right nutrients will always be front and center. I remember well working at the football stadium concession stand in college, taking an order for bratwurst, nacho's and "a diet soda." It is almost as oxymoronic as the label on marshmallows that reads, "a non fat food." Who is kidding who here? I think we all have a good understanding of how to eat healthy but many of us lack the will power to do it. It is not necessary to go to extreme's. Beware of the latest fad diet. By definition it will not last. What we need is a way of life that includes healthy food. I often refer to this as "God's food." I like to tell my patients, "If it grows on a tree, a bush or is dug out of the ground, it is better than if it is in a wrapper, can or a box." The less "Man's food," or processed food, we eat, the better we will be. Fruits and vegetables are the perfect fast food. They come with their own wrapper and can be eaten anywhere. They are full of nutrients, vitamins and fiber. They are more filling than processed carbohydrates and will make it less likely that we will over eat. We should eat four to five servings a day.

God's Food

Man's Food

Meats should be eaten sparingly remembering that fish is the best followed by chicken and turkey. Some pork is not bad but bacon and sausage are very fatty and should be avoided. Red meat should be saved for a special occasion.