VITAMIN DEFICIENCIES 2

Vitamin B6 deficiency is seen occasionally in individuals who eat very few plant foods. Seizures occur in babies fed formulas deficient in B6. This has especially been a problem when a relatively high kidney excretion develops during pregnancy, while a mother was given high dose supplements. A number of drugs interfere with vitamin B6 utilization, such as isoniazid, used in the treatment of tuberculosis. Eating a natural varied diet, it is not difficult to get plenty of pyridoxine. It is the vegetable source of vitamin B6. Scurvy is another vitamin deficiency with worldwide prevalence as well as a colorful history. This condition is caused by a deficiency of ascorbic acid, also called vitamin C. It was a common cause of mortality in sailors during the fifteenth and sixteenth centuries. James Lind, a British naval surgeon, developed a simple cure in 1747 by giving the sailors two oranges and one lemon every day. Their swollen gums, weakness, and bleeding tendencies responded dramatically, giving rise to the nickname, “Limeys.” In more recent times scurvy appears more commonly in alcoholics, food faddists, and the impoverished elderly living on a grossly unbalanced diet.
The principal manifestations of scurvy are hemorrhages in the skin, swollen and bleeding gums, aching muscles, fatigue, and emotional changes. These symptoms appear after two months of depletion. Appearing occasionally in children, scurvy produces tenderness and swelling in the legs. Extreme pain may be present. Finally, after the teeth erupt, swollen gums and bleeding develops. Skeletal changes show signs of growth retardation. In some cases of a vitamin-D deficiency syndrome, rickets, may co-exist.
A carefully taken feeding history is helpful for the diagnosis of infantile scurvy. After 46 months of age any infant fed solely with the bottle, using only boiled cow’s milk or a milk substitute, may develop this disease. Fresh orange juice or another dietary source of vitamin C is rapidly curative. Extremely high supplements of ascorbic acid are seldom necessary. They may produce an abnormal dependency, based on the development of increased excretion originating in the kidneys to compensate for this superabundance.
Large doses of vitamin C can also inactivate vitamin B12. That, at times, unfavorably affects reproduction. Vitamin A is primarily manufactured by the conversion of dietary betacarotene into the active form, retinol. One of the first symptoms of vitamin A deficiency is inability to see in reduced light (night blindness). A later change in the eye is the presence of dryness, xerophthalmia. The conjunctiva becomes opaque, the secretion of tears decreases, then a sticky secretion appears over the cornea, called the Bitot spot. This mark has the appearance of a flake of meringue. Further destruction of the cornea may occur, leading eventually to blindness.
In treating the acute disease, a supplement of vitamin A is recommended. The prevention of deficiency using a balanced diet containing green and yellow vegetables, fresh fruit, and vitamin-supplemented milk is entirely adequate. Green and yellow foods such as carrots, cantaloupe, squash, and dark green leafy vegetables are considered excellent sources for this vitamin.
A high intake of carotene appears in adults using carrot juice or a similar food concentrate excessively. Carotenemia may color the skin, but should not be confused with jaundice. It is considered harmless and will subside when the carotene intake is reduced. Hypervitaminosis A, on the other hand, can produce an acute toxicity. In infants, it presents as drowsiness, vomiting,
and other signs of increased intracranial pressure. Adults commonly develop a headache within hours after any injection of a toxic dose. Blurred vision, nausea, vomiting, or drowsiness may also develop. The skin peels and hair loss occurs. With chronic ingestion of high doses, liver changes resembling cirrhosis are seen. Psychiatric side effects manifest themselves, but prognosis is good when vitamin A ingestion ceases.
Vitamin E is the common name of a group of related fat-soluble vitamin, called tocopherols. They vary in their potency, with the alpha form being thought most active. A number of animals develop a Vitamin E deficiency syndrome, with deterioration in the muscle fibers, impaired reproduction, or anemia. Clinically, these insufficiencies are rare in adults. When the diet contains enough polyunsaturated fatty acids, plenty of dietary vitamin B is usually available. Unfortunately, optimistic expectations of many researchers have been disappointed in spite of the literature proclaiming the miracleworking powers of this vitamin. We do not know for certain whether vitamin B supplementation can favorably affect physical endurance, cardiac status, sexual potency, or longevity in individuals with normal blood levels of Vitamin B (tocopherols).
A number of vitamins affect the production of blood or its proper coagulation. Vitamin K is present in most edible vegetables, particularly the green leafy ones. A similar vitamin is also produced by intestinal bacteria. The gradual accumulation of vitamin K levels in a newborn baby explains easily why ancient recommendation for an eight-day circumcision was made to the Jews. Hemorrhagic disease of the newborn as well as in adults is prevented by proper blood levels of this vitamin. Vitamin B12, folic acid, and iron are also closely related to blood production and have been discussed in Chapter 4, dealing with the circulatory system.

VITAMIN DEFICIENCIES 1

Although definite diseases can be associated with the excess intake of certain vitamins, these are seldom seen on a large scale. Much more common are the deficiencies described below. Pellagra is a disease caused by the deficiency of niacin, one of the B vitamins. The name is derived from the rough skin characteristically seen crusting around the hands and neck. Painful burning of the mouth, shaking of the body, and less commonly, mental disturbances can result. Pellagra was common in the United States in the early 1900’s. A healthful diet was discovered to be curative. One of the essential amino acids, tryptophan, is converted into nicotinic acid, a counterpart of niacin. Deficiency of other nutrients sometimes complicates the disease. Individuals subsisting on a diet primarily of corn are predisposed to pellagra, since corn protein is low in tryptophan and most of the milling removes the vitamin.
Classically pellagra is characterized by the “three D’s” — diarrhea, dermatitis, and dementia. Certain earlier symptoms may develop, however, including loss of appetite, indigestion, weakness, burning in the mouth, and insomnia. Pellagra most commonly appears in the spring or early summer, when the dietary deficiencies of winter combines with renewed exposure to the sun seems to precipitate the outbreak. The skin problems begin to look much like a sunburn. Burning may be intense. Sun-exposed areas, such as the neck, arms, and hands are affected most commonly. Later the skin becomes brownish in color, then rough and scaly. Soreness of the mouth is typical, with inflammation of the tongue. Diarrhea may or may not be present. Mental disturbances usually begin with episodes of nervousness and tremor. Later there occurs confusion, depression, or even delirium.
Early replacement of the B-complex vitamin with high doses of niacinamide is recommended. This related substance does not cause unpleasant vascular flushing like nicotinic acid does. Most people can take them orally. As symptoms subside, all vitamins should all be obtained from a wellbalanced, varied diet of natural foods.
Thiamine Deficiency, called Beriberi, has been known to western medical science since the seventeenth century. Recognized first in the Orient, beriberi has been associated with a deficiency of thiamine. It commonly appears when the diet exclusively consists of polished rice. Cases are occasionally encountered in the United States, particularly in infants and in alcoholics. Three main types of this disease are identified. A chronic form called “dry beriberi” causes tenderness in the calf muscles and weakness in the legs. The acute form, “wet beriberi”, is characterized by cardiovascular changes, with edema, congestion of the lungs, and heart failure. In alcoholics, the brain damage may be irreversible. Beriberi in infants continues to be a health problem in the Far East, where a child may lose his voice, develop heart failure, or gastrointestinal changes with vomiting and constipation.
Adequate nutrition for the breast-feeding mother is particularly important for its prevention. The therapeutic response to Thiamine in infants and adults with beriberi involving the heart is dramatic. A rapid transition, however, should be made from vitamin supplementation to a diet containing adequate wheat germ, rice polishings, or whole grain cereals. This disease is entirely preventable, and reflects one of many conditions following the wake of the industrial revolution.
Riboflavin deficiency is still common in many developing countries. In the Unites States there appears to be a correlation between low income and riboflavin intake. Milk and certain vegetables are good sources of riboflavin. However, when the milk is exposed to direct sunlight a considerable amount of this vitamin is destroyed. Riboflavin is reduced when the food is treated
with alkali, such as we find in certain preservatives and the use of soda. Lack of riboflavin usually results in sores, developing at the corners of the mouth, inflammation of the tongue, and sore throat. Late findings affect the nerves, as well as the blood, with the development of anemia. Replacement of the vitamin rapidly reduces these changes.

MALNUTRITION

Although over-nutrition so characteristic of obesity could be considered a type of malnutrition, such diagnosis is usually reserved for the deficiency syndromes. In all parts of the world various deficiencies of vitamins, minerals, protein, or calories can be seen. Deficiencies are naturally more prevalent in countries where food supply is limited and poverty abounds. Careful analysis
of food intake and any form of intemperance—such as manifested in alcohol consumption, bizarre food practices, food faddism, or the abuse of drugs— are productive to evaluate these conditions. Repeated closely spaced pregnancies and psychological disturbances manifested by a change in food intake should be assessed. Chronic infection, anorexia, or diarrhea likewise may profoundly affect the nutrient balance.
Measurement of height and weight should never be omitted. These are the most commonly used measurements of growth in children and adolescents. Other body measurements include skin fold thickness, head circumference, and biochemical tests measuring blood levels of various nutrients, such as proteins, vitamins and minerals. At times, therapeutic trials of replacement nutrients play a role in the diagnosis of deficiencies. In general, however, nutrient stores must be depleted before low blood levels of any nutrients are found. Changes in the body chemistry and functional neurologic defects occur late in the course of a deficiency. Take a careful history for invaluable help in the initial phase of treatment. Then combine this with a high index of suspicion for various nutrient-related disorders. In spite of modern technology and transportation, there are still large areas in our world where famine is epidemic. In fact, the risk of mass starvation in many countries is all too real, and often associated with other diseases. Body changes during the starvation reflect physiologic attempts to adapt to undernutrition. Fat stores are utilized first in order to spare structural protein. Thus, body fat diminishes more rapidly than does muscle. Extensive losses occur later in other organs, especially the liver and intestines. Fortunately, the central nervous system and circulation maintain themselves, whatever the cost to less essential parts of the organism. The person during starvation also conserves calories by reducing his output of energy. Voluntary physical activity decreases, as does the metabolic rate. A semi-starved patient complains of feeling tired, irritable, and depressed. He may also show lack of ambition, and narrowing of interests, then develops muscle soreness and cramps. The hair begins to fall out, andcuts and wounds heal slowly. Cold temperatures are poorly tolerated.
Ultimately, the individual looks haggard, pale, and emaciated. At times swelling (edema), particularly of the eyelids and cheeks appear, masking the degree of weight loss. The pulse weakens and the eyes become dull, looking like unglazed porcelain. Without relief and too often alone, the hapless victim of starvation then dies on the street of some large city.
The rehabilitation diet for patients recovering from starvation must begin with small quantities of the simplest food, taken at frequent intervals. A natural diet is preferable to the use of “predigested” end products. Vitamin and protein supplementation are ordinarily unnecessary. General dietary allowances should be approximately 100% of those recommended on the basis of the patient’s “desirable” weight. Recovery from starvation, however, advances at a very slow pace. Weakness, fatigability and muscle aches, as well as depression, may persist for weeks to months. Recovery of strength and working capacity is slow. Eventually, recovery is sure, and a life has been saved.
Protein Calorie Malnutrition is another type of disorder seen in early childhood. One such syndrome, called kwashiorkor, appears most commonly between the ages of one and three years. This tragic disorder occurs frequently in Africa in children displaced from their mother’s breast by subsequent pregnancies. Conditioning factors, such as diarrhea, parasites, and skin rash may be seen. Edema is the principal sign. It is associated with low serum proteins. The child’s face may appear round and moon-like. The hair changes with lightening of color, straightening of curly hair, and stripes of lightened color that attest to oscillating levels of good and poor nutrition in the past.
The other major type of malnutrition is called nutritional marasmus. This compares with severe semi-starvation in adults. It most commonly affects infants during the first year of life. The most conspicuous features in marasmus are wasting of muscle and fat, with growth retardation. Affected infants appear prematurely old, and often suffer from vitamin deficiency. Both types of malnutrition respond to a careful feeding regimen of simple foods, given first at frequent intervals, containing both adequate protein and calories.

WATER RETENTION

Adults who suddenly increase their body weight may have an increase in fatty (adipose) tissue, accumulation of fluid (edema) or both disorders. Weight gain in excess of two pounds per day usually implies excess fluid retention. It is easy to confirm this by comparing the body weight in the morning and then again in the evening. Weight gains of less than two pounds during one day usually will subside by the following morning. Fluid retention may disclose increased salt and water intake or decreased sodium and water secretion.
Checking weight changes from morning to evening often provides early evidence of disease. Dietary indiscretion, the use of diuretics, excessive intake of licorice root, or a cortisol-type drug preparation may also be responsible. A special type of fluid retention called cyclic edema occurs predominantly in women. This is characterized by periodic episodes of fluid retention, frequently accompanied by distention of the abdomen, Patients may weigh several pounds more in the evening than in the morning. Although there is some relation to the menstrual cycle, evidence suggests also that psychological and hormonal factors may be related. The treatment of cyclic edema includes restriction in salt intake, rest in the feet elevated (supine) position for several hours during the day, and the use of elastic stockings.

Careful medical work-up is sometimes indicated to evaluate underlying causes.

DIABETES MELLITUS 2

This is associated first of all by the achieving and maintaining of an ideal body weight. Our third goal is the prevention or delay of the specific complications associated with diseases of the eye, kidney, and nerves. Finally, we try to stem the accelerating atherosclerosis to which the diabetic is particularly liable. Success in these therapies depends on how well the patient has been instructed and his conscientiousness in following directions. The avoidance of cigarette smoking, with regular daily exercise, the monitoring of the urine and blood sugar, cholesterol and triglycerides, blood pressure and body weight are all imperative. Basically, however, the treatment of diabetes revolves around an appropriate diet.
The dietary treatment must meet the basic nutritional requirements. These are usually the same as those of a nondiabetic patient and, of course, to be acceptable, taste, variety, economy, and other nutritional factors should be considered. The prevention of high blood sugar occurring after a meal is important to avoid aggravating the symptoms. On the other hand, if a person is taking insulin it is important to provide enough calories of the right type to prevent hypoglycemic reactions. Ideal body weight should be achieved as soon as possible. In order to delay the atherosclerotic complications, the diet should be low enough in fat and animal products to normalize the serum cholesterol and triglyceride levels.
The basic caloric requirement is dictated by age, ideal weight, physical activity, climate, and the patient’ s occupation. An approximate calculation can be obtained by multiplying the ideal weight in pounds by ten. Individuals who are less active or past middle age should reduce their calories somewhat. Meals should be regular, usually spaced 5-6 hours apart. They are ideally limited to two or three meals a day, the latter especially for those taking insulin. I recommend taking the greater number of calories at breakfast, in order to provide energy during the active part of the day. Suppers should be light, eaten several hours before going to bed.
Careful regulation of the insulin level can usually avoid the necessity of a bedtime snack. The fat content of the diet should definitely be reduced from the 40% eaten by the average American. Protein should also be reduced slightly. The remaining calories should be obtained from complex
carbohydrates. This can lower the insulin requirement dramatically, and in many maturity onset diabetics, make a need for the needle entirely unnecessary. Some dietary suggestions for diabetics, as used in my institution, are presented in the accompanying tables. Insulin therapy is usually necessary for diabetes of juvenile onset. Several types are available, having fast, intermediate, and long duration of action.
Most of the insulin used in the United States today contains 100 units per milliliter. This has helped considerably to standardize the syringes and simplify the self-administration of this hormone. Regular or crystalline insulin is the shortest acting and is usually used for emergencies. Its duration of action is 6 to 8 hours. Intermediate acting insulins, such as NPH or Lente have a peak effect in 8-12 hours and usually last for 24. The longer-acting insulins are seldom used. At times, a second small dose of intermediate insulin before bedtime is preferable to increasing the daily dose.
It is preferable to have a small amount of sugar spill in the urine during the day than achieve such rigid glucose control as to render the patient hungry all the time or prone to hypoglycemic reactions. Be sure to rotate the sites of injections and use sterile techniques in the administration of all insulin hormones. Although many diabetic patients develop antibodies to the insulin used, only a few, about 0.1% will develop insulin resistance. A regular exercise program helps, in combination with the low fat diet, to lower daily insulin requirement. Using the more convenient but less physiologic oral diabetic pills should be discouraged, because of numerous side effects, particularly an increased acceleration of vascular complications. Hope is definitely on the way for patients with diabetes, who will eat properly, exercise regularly, and keep their weight under control.

DIABETES MELLITUS 1

We now turn to the common problems of metabolism that can often be treated, controlled, or prevented in a home setting. Knowledge of sugar diabetes is important, because of its high prevalence. This disease has been recognized from antiquity. Both Greek and Chinese writings have mentioned it; and in the sixteenth century Paracelsus initiated the study of the chemistry of diabetic urine. The word mellitus, introduced by Thomas Willis one hundred years later, describes the sweetness of the diabetic urine, “as if imbued with honey.” This rapidly led to a dietary approach to this disease, until finally Langerhans, a medical student, in 1869 described the islets in the pancreas where the basic production of insulin occurs. Two Canadians, Banting and Best, finally prepared the extract from dog pancreas that was capable of reducing the elevated blood glucose level. A fascinating long history of discoveries marks the approaches to understanding and treating this common disorder.
It is estimated that there are about 200 million diabetics in the world and approximately 4.2 million in the United States. This disease is more frequent in older people. Hence, as the population grows and becomes older, diabetes will continue to increase. With treatment, the life expectancy of the diabetic is increasing, and since inheritance is an important factor, the more diabetics that have children, the greater will be the prevalence of this disease, Obesity is also on the rise and appears to precipitate diabetes among those predisposed to it.
Next to obesity and thyroid disorders, diabetes is the third most common problem in metabolism. Interrelated are the metabolic or hormone, and vascular or long-termed components of this disease. The latter consist of an accelerated arteriosclerosis that leads to premature aging and particularly affects the eyes and the kidneys. Gangrene of the foot, arteriosclerotic heart disease, blindness, and kidney failure (uremia) are the most frequent manifestations of the vascular syndrome. Statistically, the diabetic is faced, not only with a decreased life expectancy, but also with the eventual possibility of disabling complications.
The early detection of diabetes first involves a high index of suspicion. This disease is two and half times more frequent in relatives of known diabetics. Furthermore, 85% of diabetic patients were or are overweight. Four out of five diabetics are over 45 years of age. Mothers who deliver large babies have a high potential for the development of diabetes.The simplest screening test for this disorder is a urinalysis for sugar.
Measurement of the blood sugar (glucose) level in the fasting patient should also be encouraged as a screening tool. The five-hour Glucose Tolerance Test is less commonly performed for diabetes, but is usually used to diagnose and evaluate hypoglycemia. Pathologic changes occur with the passage of time in diabetes, and seem accelerated by failure to control this disease. The
islets of Langerhans in the pancreas typically deteriorate, resulting in the lack of insulin production. Atherosclerosis occurs earlier in a diabetic patient, often leading to coronary artery disease and stroke as the most frequent cause of death. These also occur from the lack of insulin production. The eyes show changes after 10 to 1 5 years of diabetes. Small retinal hemorrhages, dilated sacs in the weakened blood vessel (aneurysms), and waxy patches (exudates) develop.
Later a dangerous type of new blood vessel forms, then further hemorrhages and gradual or sudden loss of vision. Although marvelous advances in the diagnosis and treatment of these visual complications have been made, diabetic eye disease remains the second most frequent cause of blindness in the United States. Increased tendencies toward cataract formation also occur. In the kidney, characteristic damage to the filtering unit (glomerulus) progresses to destroy renal function. Infections of the kidney and urinary tract are common, and many patients go on to develop high blood pressure, serious loss of protein, and later kidney failure.
The symptoms of diabetes, as mentioned above, are multiple. Increased fatigability and weakness is common. The diagnosis is frequently suggested by history of increased thirst (polydipsia), increased urination (polyuria), and excessive hunger (polyphagia) in association with weight loss. Long standing disease is reflected in the pathologic changes mentioned above.
Two typical types of diabetes mellitus are seen. The juvenile onset type is characterized by a rapid onset, with instable diabetes, associated with loss of weight and strength, irritability, and the three “polys” mentioned above.
Insulin therapy is mandatory in this type of patient and long-term medical counseling is needed. The second type of diabetes is termed maturity onset. Frequently symptoms are minimal or absent at first. Weight loss or weight gain may be present. These may be increased tendency to urinary infections or Vaginitis. Blurred or decreased vision, anemia, loss of sensation, or other neurologic problems may send the patient to the physician. Since many patients are obese, the reduction of weight associated with a careful diet can bring a return of health to most people who will cooperate with simple health principles.
The treatment of diabetes involves several basic principles. Doctors aim to correct the underlying metabolic abnormalities and thereby reduce diabetic symptoms.

The Metabolic Syndrome

A person with metabolic syndrome has three or more of the following:
• A large waist (forty inches or more for men and thirty-four inches or more for women; to measure your waist size, don’t go by your belt measurement—instead, wrap a tape measure around the largest part of your midsection and make sure you keep the tape measure parallel to the floor)
• Borderline or high blood pressure (anything above 130/85 mm Hg)
• A high level of triglycerides (above 150 mg/dL)
• Low HDL (under 40 mg/dL for men or 50 mg/dL for women)
• High fasting blood sugar (above 100 mg/dL)
What does metabolic syndrome do to the body? Doctors and researchers think that metabolic syndrome’s impact on health is more than the sum of its parts. Basically, in people with this disorder, blood sugar levels stay high after a meal or snack instead of dropping to a base level as they do in most people. The pancreas, sensing still-elevated glucose levels, continues to pump out insulin. Constant high levels of insulin and blood sugar have been linked with many harmful changes, including damage to the lining of coronary and other arteries, increased triglyceride levels in the blood, changes in how the kidneys handle salt, and blood that clots more easily. Chronic overstimulation of the pancreas may exhaust it so that it stops supplying enough insulin.
This cascade of changes isn’t healthy. Damage to artery walls, high triglycerides, and increased chance of blood clots can lead to heart attacks and some strokes. Changes in the kidneys’ ability to remove salt contribute to high blood pressure, another path to heart disease and stroke. And dwindling insulin production by the pancreas signals the start of type 2 diabetes, which greatly increases the chances of having a heart attack or stroke, as well as nerve, eye, and kidney damage.
Even after heart disease appears, the metabolic syndrome continues to complicate things. Among almost sixty-five hundred men and women who had bypass surgery, for example, those with metabolic syndrome were four times more likely to have died within eight years of their surgery than those without it. This syndrome was especially hazardous for women, who were thirteen times more likely to have died.
Researchers from the Centers for Disease Control and Prevention applied the given definition of metabolic syndrome to almost nine thousand people who took part in the Third National Health and Nutrition Examination Survey. In this sample, about 23 percent had the metabolic syndrome. Applied to the entire United States, this would mean about forty-seven million Americans have this problem. The treatments outlined in the next chapters can decrease the chance that you’ll have the symptoms that characterize metabolic syndrom.

Family History of Obesity and/or Diabetes

It has long been known that obesity runs in families, although the determinants of that heritability are not likely to be all genetic, with parental influence on dietary and physical activity patterns also playing a role. Whitaker et al. examined the influence of parental obesity on the development of childhood obesity and its persistence into adulthood. They found that having at least one obese parent greatly increased one’s risk of becoming obese as an adult. However, the risks of adult obesity were magnified in subjects who had an obese parent and who were also obese as children. In younger children this effect was small or nonexistent (OR = 1.3 for children aged 1–2 years) but was very pronounced in older children (OR=17.5 in 15- to 17-year olds). Thus it would appear that identifying children with obese parents and intervening early to prevent unhealthy weight gain may allow the progression to adult obesity to be prevented.
It has also been well recognized for some time that the children of parents with type 2 diabetes are particularly susceptible themselves to type 2 diabetes should they gain weight. Recent studies have found that this susceptibility is much stronger in children whose mother, rather than father, had type 2 diabetes and have attributed this problem to the diabetic intrauterine environment. Therefore, preventive measures should properly be focused on the children of obese adults with or without a family history of diabetes and pregnant women with a history of type 2 diabetes.

Early Lifestyle Triggers Obesity

Lifestyle triggers obesity in kids. Many young people are not physically active on a regular basis and physical activity declines dramatically during adolescence. Regular physical activity in childhood and adolescence improves strength and endurance, helps build healthy bones and muscles, helps control weight, reduces anxiety and stress and increases self-esteem. It also helps normalize blood pressure and cholesterol levels.
There are numerous reasons for concern for these overweight children. Studies show that overweight children are at risk for many serious diseases such as high levels of blood pressure, insulin and cholesterol, making them excellent candidates for conditions like heart disease, diabetes and cancer. In addition, there is the emotional stress and depression associated with peer pressure and the stigmatism of being fat.
It’s important to be supportive, accepting and loving of all children, overweight or not. A positive self-image is important for weight control. There are many ways to help an overweight child regain control of their weight. By cutting out 100 calories a day, he’ll lose 15 pounds a year! Turn off the TV and video games and encourage physical activity; sports, handball, tae kwon do, rollerblading, swimming, trampolining, tennis, etc. Teach nutrition and healthy eating practices, not only by making healthy meals, but by example – eat the right foods and avoid fast foods, high sugar snacks, sodas and desserts altogether. Substitute healthy fresh fruit snacks and raw veggie stick snacks. Eat slowly and chew each mouthful thoroughly. Don’t overeat. Exercising, eating healthy foods and an occasional fast day helps teach children early to normalize their weight.

Negative Effects of On-the-Job Stress

For many of us, most of our stress is encountered in the workplace because we spend so much time there. A lot depends on our ability to financially support ourselves and our families and to achieve success in the eyes of the world. Therefore it is important to develop tools for managing on-the-job stress.

According to Dean Sunseri, individuals who do not manage their work-related stress have a higher level of absenteeism, decreased work performance, and emotional instability at their jobs. In their personal lives, this inability to manage stress leads to relationship problems, emotional isolation, substance abuse, verbal/physical violence, and increased high-risk behaviors such as alcoholism.
A recent study by Drs. Nicole A. Roberts and Robert W. Levenson of U.C. Berkeley, published in the Journal of Marriage and Family, shows that high levels of on-the-job stress seem to play a significant role in marital problems and could potentially lead to divorce if the stress isn’t acknowledged and managed. “These influences of job stress were found regardless of couples’ marital satisfaction, husbands’ work shift, and couples’ parenthood status,” the authors wrote. They went on to suggest that when job stress levels become highest, couples should make an extra effort to be attuned to themselves so that they could find ways to handle their stress in a constructive manner. “This may include employing stress management techniques, making an effort to infuse positive emotions into marital conversations, and finding ways to talk about job stress rather than avoiding it.”
This is often easier said than done. According to a recent article in the New Orleans Times-Picayune, job stress can sneak up on you so gradually that you don’t even realize it. Many employees entering the workforce are young and single with ample time for leisure activities, exercise, rest, and sports. As they grow older, marry, have children, and acquire a mortgage and other major responsibilities, their stress load will build and their productivity levels drop. Add to this the fact that many companies lay off employees during times of economic recession, burdening those who remain with an increased workload and even greater stress.
Recently I saw a dramatic example of this when a shipping company called me to inquire about my corporate program. Their top salesperson, a middle-aged man named Arnold, had serious physical problems. Arnold was 400 pounds, had a fifty-two-inch waist, and had a blood sugar level of 126, which made him diabetic. Arnold hadn’t been this heavy or this sick when he first went to work for them. But the stresses of his workload and the amount of constant traveling he had to do had brought him to this point. Arnold was a prime candidate to drop dead of a heart attack. And if he had, his company would have been in serious trouble. Fortunately, Arnold is thrilled with the program and has already lost twenty-five pounds.
Dee Edington, director of Michigan’s Health Management Research Center, has spent twenty-five years researching how major corporations have saved literally millions of dollars in health care costs by offering services to their employees such as wellness programs, onsite gyms and fitness programs, and health newsletters. What Edington stresses, however, is that companies should not focus on just those employees whose stress loads and health needs are the greatest. There are tremendous long-term benefits in retaining relatively healthy employees who eat right, exercise regularly, and manage their stress healthfully. “It is much easier to help a low-risk person remain low-risk than to try to change a high-risk person to low-risk,” Edington says.
Unfortunately, most corporations do not take responsibility for their employees’ health. Even if you are fairly healthy, you cannot count on your workplace to take responsibility to help you maintain your health and emotional well-being. Ultimately, that responsibility falls squarely on your shoulders.
In this fast-paced, stress-filled world, the only answer is to develop your own stress management skills. I have found the following stress management techniques to be tremendously effective. I suggest that you experiment with one or a combination of these until you find what works best for you.

7 Ways to Keep Blood Sugar Levels Low

Australian researcher Dr. Jennie Brand-Miller cites in her new book The Glucose Revolution, that when you eat a carbohydrate – any sugary or starchy food – your blood sugar goes up. If it rises slowly, that’s ideal; however, if it soars quickly, this could lead to serious health threats. Researchers at Harvard Medical School have also cited that a spike in blood sugar can double or triple your risk of developing Type 2 (adult onset) diabetes.
Dr. Brand-Miller has created a Glycemic Index that ranks foods based on how quickly they raise blood sugar. High-glycemic-index foods make blood sugar jump; lowglycemic- index foods cause a slower rise.

• Eat health giving legumes with abandon, such as lentils, soybeans, lima and kidney beans, etc., for they promotea gradual blood sugar rise and have a low-glycemic index.
• Don’t worry about carrots spiking blood sugar. Wide reports that carrots are bad for blood sugar are wrong.
• Add Bragg Apple Cider Vinegar or fresh lemon juice to foods. Studies show only a few tsps in a salad dressing, over veggies, etc. helps lower blood sugar because the acid slows stomach emptying and promotes better digestion.
• Eating organic brown rice, lentils and whole grain pastas are best. They help normalize blood sugar and reduce appetite as well as help in the weight loss because they are filling.
• If you snack, choose fresh organic fruits, even popcorn, never eat jelly beans – they spike your blood sugar.
• Eat fresh, organic vegetables. Think of salad vegetables as “free” foods, with no significant impact on blood sugar or weight. It’s best to avoid fatty foods, sugars, meat, etc.
• Avoid all processed, refined foods: refined breads, cereals, cookies, crackers, desserts etc. These refined starches zip through your digestive tract, raising your blood sugar