Type 2 Diabetes: The Choice is Yours

The statistics for type 2 diabetes are staggering. There are about 20 million Americans with type 2 diabetes, a high sugar condition caused by poor nutrition, being obese, and a lack of exercise—factors that can all mostly be prevented.

About two-thirds of the people with type 2 diabetes have been diagnosed, which leaves about 6 million people walking around with undiagnosed diabetes. That’s a huge number of people who have a very serious disease and don’t know it. And that makes type 2 diabetes, like hypertension, another silent killer.

Unlike type 1 diabetes, type 2 diabetes is not a failure of the pancreas, but an inability to produce adequate amounts of insulin for a body that is out of control. On top of that, the insulin that is being produced is not acting the way it should, a situation called insulin resistance that occurs when the insulin can no longer stimulate the cells to process the sugar in the blood. This causes the sugar to build up in the blood, ultimately doing damage to the heart, eyes, and kidneys, and creating small-vessel disease.

Type 2 diabetes is now an epidemic, and if not corrected in this generation, it will probably be responsible for most of the strokes, hypertension, and cardiovascular disease that we will encounter in our sixties and seventies. Type 2 diabetes is especially common among African Americans, Latinos, Native Americans, and certain Asian populations.

Most people develop type 2 diabetes because they are overweight. Basically the human body does two things: it takes in calories, and it burns calories. When you consistently bring in more calories than you burn off, all those extra calories turn into fat. That fat first gets stored in the abdomen and the intestines, and then it begins to infiltrate the muscle mass of our body. And what you end up with looks very much like a marbleized piece of sirloin that you see at the butcher shop. That marbleization is one of the hallmarks of people with type 2 diabetes.

If you keep piling on the extra calories, the pancreas, whose function begins to slow down anyway with age, is no longer able to meet the demand for large quantities of insulin needed to metabolize all that sugar in the blood.

If you were to lose weight, a significant amount of weight, I mean, your type 2 diabetes could disappear almost overnight. Yes, it’s that simple. I, myself, was a diabetic. I had very elevated sugars. I was overweight, excessively stressed, and exercise-phobic. I had a very clear, black-and-white case of type 2 diabetes. So I lost 50 pounds; I now exercise three times a week, and I’ve maintained that weight loss.

Today, I am no longer diabetic. If, like me, you have not had type 2 diabetes for very long, and if you can overcome it by simple weight loss, you will end up with no permanent damage to your organs.

If you have any choice in the matter, diabetes is a road you don’t want to go down. Just to give you an idea, here are a few numbers:

–Heart disease from diabetes accounts for 65 percent of deaths in diabetics.

–The risk of stroke is two to four times higher in diabetic patients than in nondiabetics.

–Seventy-three percent of adults with diabetes have hypertension.

–Diabetic retinopathy, which is damage to the vessels of the retina, creates about 24,000 cases of blindness in America every year.

–Diabetes is the leading cause of kidney failure.

–One-third of people with diabetes have gum disease.

–About 10 percent of pregnant women who are diabetic may experience a spontaneous abortion or have children with major birth defects, including spina bifida.

–About 82,000 people lost a foot or a leg last year because of diabetes.

The list of damage diabetes does to the body is virtually endless. If you are a diabetic, you must learn to prevent complications and stay ahead of the game. Being a diabetic is a full-time job, and there are several measures you will have to take to ensure you keep your health on track.

You will constantly have to monitor your cardiovascular risks by monitoring your blood pressure and keeping it under control.

You will have to watch your cholesterol levels.

You will have to visit your ophthalmologist regularly to ensure you don’t development retinopathy.

You will need very comprehensive dental and foot care.

But, most important, you will have to monitor and control your sugar levels. Several times a day you must take a glucose reading either by using Accu-Chek or doing a finger prick. You will look at your morning sugar and at your sugar two hours after you eat. For the most part you want your morning sugar to be less than 100 milligrams per deciliter, and you want your postdinner values, usually two hours after you eat, to be 120 and 130 milligrams per deciliter.

If your sugar is high, you will need either to inject yourself with insulin or to take an oral hypoglycemic. This kind of supply-and-demand treatment model may soon give way to more convenient methods, made possible by new research into diabetes. Devices are now being developed in which a sensor that continuously monitors your sugar levels triggers a tiny pump when your blood sugar is elevated to release small doses of insulin.

Other new research is focusing on the possibility of transplanting the pancreatic cells, called isolet cells, into those who need them, in the hope of restimulating insulin production inside their body and minimizing the amount of insulin that needs to be injected. The hope is that this research will one day lead to a cure, whereby insulin will once again be naturally produced in the body. But as of right now, diabetes is not cured; it is treated.

Diabetes can be managed. Ultimately, if you’re talking about juvenile diabetes and you start very early in the game by getting diagnosed and getting effective treatment, you can probably expect a normal life expectancy, but it’s a very dedicated type of life.

If you are now in your forties and you develop type 2 diabetes, and you continue for a decade or more without any checks and balances, it’s very unlikely that you’ll make it into your late seventies or eighties. There’s just not enough time in the pot. In other words, if you are 40 years old, 50 or more pounds overweight, with high blood sugar levels and high cholesterol, and you don’t exercise and you don’t watch what you eat, you will without doubt see the effects 10 to 15 years from now.

By the time you’re in your sixties, you will most likely have hypertension, stroke, and cardiovascular disease. Don’t go there.

Sweet Questions

“I’m a fifty-five-year-old woman with two married daughters. We all have a sweet tooth in our family, and I’m worried that we might all become diabetic. Can people who eat a lot of sweets become diabetic?”

No. If you exercise and for the most part follow a balanced diet, you can like sweets and not become diabetic.

“Can people with diabetes eat sweets?”

If it’s part of a healthy lifestyle involving a good diet and exercise, a diabetic can eat sweets.

“Can you catch diabetes from someone else?”

No, though some people think they can. Diabetes is probably largely a matter of genetics for Type 1 and lifestyle factors for Type 2.

“Are people with diabetes more likely to get colds or other illnesses?”

No. Your immune system is not compromised when you have diabetes. However, people with diabetes should get regular flu shots because any infection can interfere with blood-sugar management.

The Big Ticker: Heart Disease

Clench your fist—that’s about the size of your heart. Located in the center of your chest, the heart beats about one hundred thousand times a day, pumping five to six quarts of blood per minute.

Once the blood receives oxygen from the lungs, the heart sends the blood from the aorta through the arteries and into the capillaries, which are smaller, thinner blood vessels. Then, once the capillaries have brought oxygen and nutrients to every cell in the body, the blood is redeposited into the veins, and from there it goes back to the heart for the cycle to begin again.

So what we have here is a plumbing system essentially, a smart pump with different connecting parts that circulates blood throughout the body. The heart itself is made up of four chambers—the two up top are called the atria, the two on the bottom are called the ventricles—connected by a set of valves. And the whole system is set in motion, or beats, thanks to the electrical impulses sent out by a small bundle of specialized cells in the right atrium that act as the heart’s natural pacemaker, causing the muscles of this organ to contract and relax.

Any malfunction of this blood pump is known as heart disease, of which one of the most common types is coronary artery disease. It is the number-one killer of both men and women in the United States. Half a million people die of it each year, and more than 12 million people have the disease.

Coronary artery disease, also known as coronary heart disease, is a narrowing and obstruction of the coronary arteries, which are responsible for bringing oxygen and nutrients to the heart itself. As early as your teen years, fat deposits begin to develop in some of these arteries, and as time goes by, the fat deposits build up, ultimately creating an obstruction that begins to decrease the amount of blood to the heart and cause an inflammation as the artery tries to heal itself.

Over time the fat deposits in the arteries begin to harden, and you begin to get deposits of small platelets that compound the obstruction. All of this can lead not only to a significant narrowing of the arteries, but to blood clots that may either obstruct the artery or get dislodged and create further obstructions elsewhere in the plumbing system.

One of the consequences of this narrowing or total obstruction of the coronary artery is ischemia, which occurs when there is an insufficient supply of oxygenated blood for the heart muscle. Any activity—eating, excitement, or changes in temperature—can make the problem worse.

One of the most common symptoms of ischemia is angina, which is a discomfort, heaviness, pressure, numbness, or squeezing feeling in the chest. Sometimes it is mistaken for indigestion or heartburn. It is usually felt in the chest, but it can also migrate to the arms, especially the left shoulder. Other symptoms include shortness of breath, irregular heartbeats or palpitation, a very fast heartbeat, nausea, and sweating. If this ischemia is not corrected, if it lasts more than 30 minutes and does not get better, a heart attack may result.

In a heart attack, the heart muscle begins to fail, either through a very erratic electrical stimulation called an arrhythmia or by stopping altogether. It is important to recognize these symptoms because early intervention could save your life.

A doctor can tell you if you have coronary artery disease by discussing your symptoms, especially shortness of breath, taking your medical history, and looking at your risk factors, in particular, smoking, cholesterol, blood pressure, and sugar control. There are a host of diagnostic tests your doctor can do, such as an electrocardiogram (ECG or EKG); an exercise stress test; an ultrafast CAT scan, which looks for calcium deposits in your coronary artery; and cardiocatheterization, which can help determine the degree of obstruction of the artery.

If you are diagnosed with coronary artery disease, treatment is threefold. The first has to do with lifestyle changes, like quitting smoking, starting to exercise, and keeping to a low-fat, low-sodium, low-cholesterol diet.

The second aspect of treatment is medication, which may be needed to get your heart working more effectively. Other medication will be prescribed to reduce the cholesterol.

The third aspect of treatment has to do with procedures to help improve the blood flow through the coronaries. One possibility is a balloon angioplasty, in which a small balloon-tipped catheter is inserted into the coronary arteries and then inflated to open up the clogged artery. Another possibility is placing a small, metal stent inside the artery to keep it open and improve blood flow.

A heart bypass operation takes place when total replacement of the piece of the coronary that is obstructed becomes necessary.

Plumbing Vs. Electrical Problems

Other types of cardiac disease have nothing to do with obstruction of the coronaries but with the way the electrical system of the heart works. Sometimes the specialized cells that electrically stimulate the heart become dysfunctional, and you can develop an arrhythmia, where the heart beats either too slowly, too quickly, or out of sync. These conditions can be diagnosed with an electrocardiogram, and sometimes medications alone can help to regulate the rhythm.

Another common problem is heart failure. This occurs when the heart can no longer effectively pump all the blood that it receives. Heart failure affects about five million Americans, and it’s the leading cause of hospitalization of people older than 65. Many times, heart failure is due to prior damage caused by coronary artery disease, or by arrhythmias that have weakened the function of the heart. Ultimately, heart failure creates a backlog of pressure into the lungs, and people with heart failure tend to have difficulty breathing. Depending on the cause of the heart failure, different medications are available for treating it.

The valves of the heart are another source of heart problems. The valves can be damaged at birth or through infection. Abnormal or infected valves can interfere with normal blood flow and heart function and can lead to major cardiac disease. Surgery may be needed to replace the valves.

Sometimes the lining of the heart may be infected, a condition called pericarditis. If this membrane is inflamed, the heart may not beat properly. Valve abnormalities, arrhythmias, and heart failure all have a common symptom—shortness of breath or difficulty catching your breath. If you have this problem, see a cardiologist to get the correct diagnosis and treatment.

The heart is a remarkable organ. It is the core of life, and its beat is central to your survival. Keeping it in prime working order is of paramount concern.

All for One and One for All

When we talk about heart attacks, we tend to describe them in a way that suggests there are different kinds of heart attacks. But those are just words to describe our experience of the same underlying disease.

Number one is the silent heart attack. Here you don’t have major chest pain, you don’t have shoulder pains, you may have a little palpitation, but you’re not tired, you’re not fatigued, and you’re not dizzy. However, when you go in for a physical, the doctor finds that you have had a silent heart attack.

Number two is typical angina. This is the chest pressure that doesn’t go away, and you have thirty minutes to get yourself to an emergency room.

Number three is the sudden heart attack. This occurs when you have a major, catastrophic obstruction in a main branch of the coronary artery, and a very large area of your heart is instantly void of any blood.

Even though the three heart attacks described here evolve differently, the underlying theme is the same—they all involve chronic coronary artery disease. In other words, you don’t go around with a normal coronary artery one day and the next day develop a major clot. That’s just not the way it works. The heart attack may present itself differently in different people, but the cause is the same no matter how we experience the critical moment.

A Heart Test for Venusians

What works for men, doesn’t always work for women. We all know that, but medicine is just catching up to the fact.

The standard test for heart disease is known as an angiogram. In this test a dye is injected into the coronary arteries, which are then X-rayed to look for blockages. The test is very effective in detecting heart disease in men, but a new study has discovered that this test often misses the symptoms of heart disease in women. When the tests turn up nothing, women are given a clean bill of health, even though as many as 3 million women could be at risk with a buildup of fatty deposits that could ultimately interfere with blood flow to the heart and cause a heart attack.

Hidden heart disease may be a significant problem in women. It appears that one cause may be due to a phenomenon called arterial remodeling. This means that the artery dilates as plaque is deposited in the blood vessel so that, in the early stages of atherosclerosis or coronary artery disease, very little overall narrowing is seen on an angiogram. But late in the disease, the deposits may overwhelm the body’s ability to compensate by remodeling, and severe narrowing or complete blockage can occur. If this happens, a sudden heart attack can result.

To diagnose heart disease in women, physicians will now have to use the new generation of CT scanners and magnetic resonance scanners, which can visualize the heart’s blood vessels with ever-greater detail. In many cases, these tests can detect problems before a stress test or a conventional angiogram. Physicians should test for the presence of coronary artery disease in women who have risk factors for heart disease such as diabetes, hypertension, high cholesterol, a family history of heart disease or stroke, or nicotine use.

The moral of this story is: paying closer attention to the vast differences between men and women could save lives—in this case, women’s lives.

Which Fruit Are You?

Researchers have long noted the importance of body shape in determining a person’s risk factors for heart disease. They talk about the apples versus the pears. The apples tend to store their access fat in their stomach and chest. The pears store it below the hips, in their thighs and buttocks. A recent study found that a person’s waist-to-hip ratio is an even better predictor of cardiovascular risk than their body mass index, or BMI, the commonly used ratio of weight to height. It appears that a large waist size, which generally indicates large amounts of abdominal fat, is more harmful than a larger hip size.

Determine your body shape and risk for cardiovascular disease by calculating your waist-to-hip ratio. First, measure your waist at its smallest circumference; then, measure your hips at their widest. Next, divide your waist measurement by your hip measurement. For example, a person with a thirty-six-inch waist and forty-inch hips would have a waist-to-hip ratio of 0.9. Waist-to-hip ratios over 0.85 in women and over 0.9 in men are strongly associated with an increased risk for heart disease.

Dr. Manny’s Freedom Diet

One recent survey of Americans on body image found that more than half of all men and women would rather lose their job than gain an extra seventy-five pounds. And nearly 20 percent of the population would give up, or consider giving up, 20 IQ points to have the perfect body.

Obviously, weight and the way we are perceived is an important factor in our daily lives. It’s not surprising then that dieting is on the minds of so many people these days, particularly as people get on in their forties, when the metabolism begins to slow and the pounds begin to add up. So which diet is best? I’ll tell you.

First, let’s look at some of the big blockbuster diets that have appeared over the past decade or so—the South Beach Diet, the Atkins Diet, the Mediterranean Diet, and so on. Each one of these diets has simply incorporated a different method of teaching you about nutrition in order to get you to lose weight. Each one gives you something to focus on, a behavior to motivate you, which is great because, after all, to lose weight you have to change your thinking.

But if you look at the fundamentals, the underlying theme of each diet is calories. Whether you do Atkins, South Beach, or Dr. Phil, it’s really all about calories.

When reviewed carefully, most diets are really nothing more than low-calorie nutrition plans disguised by clever marketing gimmicks. Scientific-sounding “facts” and hocus-pocus “research” are just ornaments on the diet tree. Diet-plan marketers go to great lengths to explain how their diet can work for everyone, or claim that it is carbohydrate intake or fat intake—or whatever the bad intake of the day is—that’s the culprit.

However, the bottom line is that the only way to lose weight is to have a caloric deficit, which occurs only when you burn more calories than you consume.

The average American today consumes 300 more calories per day today than did the average American of 30 years ago. Today’s average American also burns 260 fewer calories each day due to increased automation, technology, and sedentary occupations. Put those numbers together, and it becomes rather obvious why America’s waistline is growing at an alarming rate.

Check Your BMI

The BMI can tell you if you are underweight, normal, overweight, or obese. Adults 20 years old and older can calculate their BMI with this formula:

BMI = your weight/pds divided by height/in x height/in x 703

You are UNDERWEIGHT, if your BMI is below 18.5.

You are of NORMAL WEIGHT, if your BMI is between 18.5 and 24.9.

You are OVERWEIGHT, if your BMI is between 25.0 and 29.9.

You are OBESE, if your BMI is 30.0 or more.

So here is Dr. Manny’s Freedom Diet. If you really want to lose weight, you have to do two things: eat fewer calories and burn more calories. This is not an optional “either/or” plan but an “and” plan. Of course, the calories you eat should be healthy calories. That’s all. Eat less. Exercise more. It really is that simple.

Fight obesity. Spread the word.

Exercise

People spend an enormous amount of time trying to find the perfect exercise, and while they’re doing that, their clock is ticking. Any physical activity is great, though the best kinds of exercise for you are those like walking, swimming, running, hiking, and skiing—all of which have a “global” impact on your body and mind.

Most important, you should stick to the exercise of your choice and do it regularly. If you adhere to those two principles, you’re going to burn calories, feel better, improve your metabolism, and benefit your health.

Any activity you do during the day—from climbing stairs, to housecleaning, to watching TV—will, of course, burn calories. But those activities don’t provide the necessary continuity, and I think the essence of getting into shape and having a good metabolism has to do with a continuity of exercise.

In other words, it’s better to burn 120 calories a day, seven days a week, doing your favorite exercise, for example, than to burn 800 calories doing the housework once a week. It’s the exercise regimen that has an impact on your health, not necessarily the intensity.

Burn, Baby, Burn

Estimated number of calories burned per minute based on an individual weighing about 150 pounds:

Sitting: 1

Talking on phone: 1

Sleeping: 1

Driving: 2

Housework: 3

Cooking: 3

Washing dishes: 3

Stretching: 4

Sex (active): 5

Walking (3 mph): 5

Calisthenics (moderate): 5

Ballroom dancing (fast): 6

Gardening: 6

Swimming (moderate): 7

Aerobics (low impact): 7

Hiking: 7

Jogging: 8

Stair step machine: 8

Bicycling (12 to 14 mph): 10

Basketball (full court): 12

Running (10 mph): 20

To easily calculate how many calories you burn in a day, go to www.healthstatus.com and click on “Calculators” then “Calories Burned.”

It is also very important to drink adequate amounts of fluid when you exercise. You need to drink about a half cup of water for every fifteen minutes of vigorous exercise. People think that muscle cramps during exercise are caused by a shortage of electrolytes, but that’s not true. You get muscle cramps because of water loss and dehydration. Drink that water!

Hypertension: The Silent Killer

Hypertension is known as the silent killer for good reason. Some 50 million Americans have high blood pressure and one-third of those don’t even know it, despite the fact that it’s very easy to diagnose.

Hypertension kills some 40,000 Americans each year, and another 200,000 die annually of a high-blood-pressure-related illness. People with hypertension are seven times more likely to have a stroke, six times more likely to have congestive heart failure, and three times more likely to develop a heart attack.

In all, hypertension claims more lives per year in the United States than cancer. Those numbers are doubly sad: first, because they are so high, and second, because they could easily be so much lower. More than half of the people with hypertension are not receiving treatment at all, and one-quarter of them are being inadequately treated. Only about one-fifth are receiving the proper treatment to control their blood pressure.

There are two types of hypertension. More than 90 percent of all cases of hypertension involve what is known as essential hypertension, which is high blood pressure without a definite cause. The rest, fewer than 10 percent of the cases, have a known cause; this is known as organic hypertension, or secondary hypertension. Organic hypertension occurs when a specific disease, such as a tumor of the kidneys, vascular disease, or hormonal disease, causes your blood pressure to be elevated.

When we talk about blood pressure, we are referring to a comparison of the blood pressure when the heart is beating versus the pressure when the heart is resting. A blood pressure reading is represented as the systolic (or beating pressure) over the diastolic (or resting) pressure. A normal blood pressure is anything lower than 120 over 80. But if you are 140 over 90 or above, you have high blood pressure. Anything in between the two sets of numbers is considered prehypertensive.

How can you tell you have high blood pressure? Certainly not by your symptoms; most people with hypertension don’t have any. But any qualified health professional can measure your blood pressure in a very non-evasive way using a blood pressure machine. Of course, if your blood pressure is very high, you will have symptoms like nose bleeds, irregular heartbeats, headaches, and dizziness.

Hypertension affects more males than females and more blacks and Latinos than whites. The lifestyle characteristics that can put you at risk of developing hypertension include obesity, lack of exercise, a diet rich in sodium, and excessive alcohol consumption. Smoking raises blood pressure as well. Genetic factors may be involved, too, as some individuals have a family history of hypertension.

In younger women, hypertension is sometimes associated with birth control pills. Other medications that can give you high blood pressure include some nonsteroid anti-inflammatories, cold remedies, decongestants, and appetite-suppressant pills.

Your diet plays a very significant role in blood pressure. Foods high in cholesterol thicken the blood with fat, and that forces the heart to work harder, thereby raising your blood pressure. As the heart works harder to push that blood through, the heart becomes larger because it has to expand more to grab enough volume in order to squeeze the blood out of its chambers. If the heart has to work harder, the heart and the arteries come under tremendous pressure and stress, and this, of course, weakens the heart. It also means that organs like the kidneys and eyes and liver don’t get enough oxygenated blood, which causes cell damage to those organs that ultimately damages them.

A high salt intake also makes you retain more water in your vascular system, and that, too, increases your blood pressure. To reduce your risk of high blood pressure, the American Heart Association (AHA) suggests that you ingest no more than 2,400 milligrams of sodium a day. That’s just one and a quarter teaspoons of salt per day, and it mounts up faster than you think; many foods, especially prepared foods, contain large amounts of sodium. And then there is all the salt we actually add to our food.

Being overweight is also a fundamental factor in developing high blood pressure. Conversely, losing weight is one of the essential ways of improving your blood pressure. Lack of exercise and physical inactivity is another risk factor for heart disease. This means that exercising will improve your cardiac performance, making your heart work better, thus lowering your blood pressure.

Stress has also been linked to hypertension: it narrows the blood vessels, thereby causing high blood pressure, so it is vital for people who have high blood pressure to learn how to manage their stress.

The treatment of high blood pressure involves making dietary changes, losing weight, lowering cholesterol, practicing relaxation and meditation techniques, and getting some exercise. If these don’t work, there are medications that can specifically target the kind of hypertension you have.

So how do we prevent high blood pressure?
Number one, watch your weight. If you are 30 percent above your ideal body weight, you’ve got a problem and are more likely to develop high blood pressure.

Second, if you’re drinking excessively—more than three hard drinks a day—this also is a problem.

Third, watch your salt intake; eat fewer processed foods. If you go out to eat, ask your wait person if the kitchen can reduce the amount of salt in your order. Eat a balanced diet. Consume foods that can help lower your cholesterol, like vegetables and grains.

Don’t smoke; nicotine is a major vasoconstrictor.

Exercise regularly; try to do 30 minutes’ worth of aerobic activities three to four times a week.

The bottom line on hypertension is to do your best to prevent it. If you can’t, identify it, and then treat it. Whatever you do, don’t become a statistic like so many other Americans.

You Are What You Eat

I think Americans generally pay more attention to the gasoline they put in their cars than to the food they put in their mouths. We are a society of excess, and one of our more impressive excesses is the way in which we eat and what we choose to put in our mouths.

We are the leading country in the world in almost everything, yet our mortality rates, our cancer rates, and our neonatal death rates don’t rank among the best in the world. We lead in research, we lead in academic training, we lead in freedom of information, yet we don’t lead in taking care of our health.

We have all the knowledge in the world about everything in life, but that has made no impact on our health. Why? I think nutrition is part of the reason, and I think I know why.

No one is ever taught about nutrition. We certainly don’t teach the subject in grammar school, and it’s rarely taught in high school. Some colleges may offer it as an elective. But our parents certainly don’t talk to us about carbohydrates and proteins the way they do about the birds and the bees. If you combine this lack of knowledge with our appetite for diversity, taste, and presentation, what you have is a lot of people who know nothing about the food on their plate.

It’s never too late to learn about nutrition. The fundamental issue with nutrition is learning how to balance your caloric intake with the number of calories you burn. Everything we eat has a caloric value. If you take in more nutrients that contain a lot of calories and you don’t burn them up, the excess caloric energy is going to be stored as fat, and you’re going to gain weight. That weight and that fat will then interfere with all the normal functions of your body.

On the other hand, if you consume too few calories, say fewer than 1,200 calories a day, then your body doesn’t have sufficient energy to maintain adequate functioning. The caloric intake for a normal adult should range between 1,500 and 2,000 calories a day.

The body requires certain nutrients in order to work properly. Nutrients are the chemicals our body gets from food. These nutrients are used to build muscles, improve cell-to-cell transmission, and manufacture hormones. In describing nutrients, the word “essential” means that the body must consume them; it cannot produce them on its own. The nutrients we need include:

Essential amino acids.
The body requires amino acids to produce new body proteins and replace damaged proteins to build and maintain the body.

Vitamins and minerals.
These are recognized as essential nutrients that are specifically linked to the functionality of cells. If we’re deficient in vitamins and minerals, we develop a weak immune system, cell metabolism disorders, premature aging, scurvy, goiters, and bone loss.

Fatty acids.
Also essential, fatty acids are crucial for maintaining the body’s normal health. They are responsible for the normal formation of hormones and creation of some of the biological pathways responsible for dealing with inflammation and cell repair.

Sugars.
They are essential because they provide the fuel our cells need to function adequately, which allows the other nutrients to be utilized properly. If cells don’t have the sugar molecule necessary to generate the energy required for repairing, functioning, transmitting, and utilizing nutrients, then cellular damage and disease will result.

Each nutrient carries out one or more unique tasks your body needs to function. And because you need many nutrients to stay healthy—protein, fat, carbohydrates, vitamins, minerals—you have to eat a wide variety of foods to get them all.

It’s when we don’t recognize the necessity of all those elements that we begin getting into trouble. It’s like filling your gas tank with gasoline and forgetting to change the oil every 3,500 miles, or forgetting to put water in the radiator. The car needs the gasoline, the oil and the water, all in the proper proportions, in order to function properly. The same is true of the human body.

The problem, as I’ve mentioned before, is that about one-third of all American meals are prepared foods. And the problem with prepared foods is that their contents are not nutritionally balanced.

Our lack of knowledge of nutrition, combined with our obsession with processed foods, is really damaging our health. So we have to get back to fundamentals, a good example of which is the diet of people who live in the Mediterranean. Their diet is well balanced with vegetables and fruit, fish and lean meat, and the good unsaturated fats like olive oil.

Today, many people think that if they stick to low-fat or nonfat foods, they won’t gain weight. That’s a myth, because gaining weight has to do with calorie intake. If you take a salad and you add cheese and eggs and everything else in the book, even if you select low-fat ingredients, you’re still consuming a tremendous load of calories. And size matters, too; the size of your portions does make a difference in terms of the total amount of calories consumed. It’s just a plain mathematical calculation.

There are no magical foods that are going to help you burn calories or increase your cell metabolism either. There is no such a thing as a food that is more active in the body than others. People think that eating a grapefruit each day or having cabbage soup for lunch is going to burn off their fat. But that’s a myth. There is only one way to burn off those extra calories: exercise, any exercise at all.

How to Eat
It’s not just what or how much we are eating that’s the problem these days, it’s the way most of us eat. Many people skip breakfast, gulp down a quick lunch at noon, and then consume a large meal at seven o’clock at night.

Trouble is, they don’t need all that fuel at night. They need a little bit throughout the day when they are active—either moving, thinking, or both.

So what happens in the middle of the day if this is the way we eat? Without a supply of energy, our metabolism gets altered. Our blood sugar level is erratic. Our hormones go haywire trying to figure out where to obtain the fuel we need. People are always telling me, “I don’t eat, so how come I’m not losing weight?”

That’s the answer. Their metabolism is out of whack, and they need to get it back in order.

Supplements
If you eat a balanced diet with fruits, vegetables, grains, fish, and all the rest, you don’t need to take supplements. But how many of us really eat such a balanced diet?

And even if we do, because we are all predisposed for certain diseases and the aging processes, being proactive and adding certain supplements to our diet may be a good idea. But before popping supplements like candies from a bag of M&M’s, check with your doctor about what’s best for you. Some supplements can be toxic. Others may cause allergies or cross reactions with medications you may be taking. But there is no doubt that certain supplements can have specific health benefits and can lower the cost of health care at the same time.

An Important Word About Supplements
Many supplements contain active ingredients that can have strong effects on your body, and some supplements can interfere with prescription medicines. Always consult with your doctor or pharmacist before taking supplements.

I am particularly bullish on five supplements that have been well studied and are proven to support optimal health.

Omega-3 Fatty Acids
I love the omega-3 fatty acids. They are an important contributor to the improvement of human health. Some studies have shown that omega 3s are good for the prevention of heart disease, as well as for depression, rheumatoid arthritis, and asthma. You can get omega 3s by eating leafy greens and fish or by taking a fish oil tablet. Omega 3s assist with fat metabolism and help maintain a balance of good and bad cholesterol.

Calcium
Calcium is another very good supplement, specifically calcium with vitamin D. Calcium intake is an important factor in bone health and may play a role in the prevention of colon cancer, though it doesn’t appear to be the silver bullet that everyone hoped it would be. Research has shown that calcium supplements can significantly lower the occurrence of hip fractures among those aged 65 and older.

Folic Acid
Folic acid and folate are forms of a water-soluble vitamin B that occur naturally in leafy vegetables such as spinach and turnip greens, dry beans and peas, fortified cereal products, and some other fruits and vegetables. Folic acid supplements have been a lifesaver in the prevention of neural tube defects in children. They are also very beneficial for cell function and the prevention of heart disease.

Glucosamine
I also like glucosamine. It has good anti-inflammatory effects, especially for individuals with arthritis. It doesn’t prevent arthritis, and it doesn’t repair or rejuvenate cartilage, but I think it’s a very good supplement because it helps promote joint function and relieves the symptoms of inflammation and pain.

Other supplements that are thought to make a positive contribution to health include saw palmetto, the fruit of the fan palm, for men. Native Americans consumed it as food and used it to treat urinary and genital problems. Some research has shown that it could be effective for the treatment of an enlarged prostate in men. It increases urinary flow and has no known safety hazards.

Eating Ethnic When You’re Expecting

For busy expectant mothers who juggle family, school and work, healthy eating is a constant struggle. And, sometimes the healthy options seem dull. The challenge increases when your body starts craving exotic and bizarre foods—especially those that are deep-fried or dipped in chocolate. With these obstacles, and no time to prepare even the simplest ‘30–minute meal,’ what’s a woman to do?

Order out and eat ethnic!

Ethnic restaurants can provide a wide variety of tasty meat and vegetables dishes rich in nutrients such as folic acid, calcium, potassium and iron essential to a healthy pregnancy.

Many of the worlds’ healthiest foods can be found in abundance in the staples of many ethnic cuisines, according to nutritionists at the George Mateljan Foundation, a non profit organization that offers scientific information about the benefits and nutritional value of food. The exotic dishes from other regions or parts of the world can even satisfy–in healthy ways—your sweet, sour, salty or spicy cravings.

The key to eating out at ethnic restaurants is to be informed and make healthy choices, says Whittney Hoyler, a reproductive educator with the American Pregnancy Association. She cautions pregnant women to avoid soft cheeses found in some ethnic dishes. For example, Hoyler says that brie, feta, gorgonzola and Mexican-style cheeses such as ceso blanco or ceso fresco may have been made from un-pasteurized milk and put woman at risk of contracting listeria, a kind of food poisoning that can be fatal to the fetus.

Eating ethnic foods can be a healthy culinary adventure. Choose foods with high nutritional value. Ask questions about food preparation and select low-fat variations. In general, nutritionists recommend that pregnant women avoid deep fried or over-cooked foods, raw meat, heavy creams and foods cooked with fatty meats or lard. With this information, explore ethnic restaurants and satisfy your cravings the right way.

Soul Food
Among the staples on a soul food menu are at least six of the foods that the Mateljan Foundation has identified as the world’s healthiest foods. These super foods are collard greens, sweet potatoes, Lima beans, green beans, mustard greens and watermelon.

These foods are packed with calcium, dietary fiber, iron and folate (folic acid), one of the most important nutrients for a pregnant woman and her baby, says Angelika Bekman, a nutritionist at Beth Israel Women’s Health Center in New York. According to Bekman, folic acid is crucial in the early stages of pregnancy to prevent neural-tube birth defects such as spina bifida.

Rickey Hill, a chef at Bob Law’s Seafood Café in Brooklyn, New York says that people should find soul food restaurants that do not cook vegetables with pork fat or lard. He adds that important vitamins are lost when the food is over cooked in the traditional southern manner. Ask health conscious friends to recommend their favorite restaurants.

Indian
The myriad spicy, sweet and aromatic menu choices are topped only by the nutritional value of the core ingredients. “The magic of Indian cuisine is that one dish can bring every food group together,” says Survir Saran, executive chef at Devi Restaurant in New York City.

Lentils, always present on restaurant menus, are also named on the Mateljan list. One cup of cooked lentils has about 90 percent of the daily recommended value of folate. They are also high in fiber, iron, potassium and protein.

Another nutrition-packed staple in Indian food is the chickpea. It’s used in curries, ground into flour and uses independently. Chickpeas contain high levels of folate, fiber, protein and iron.

Not only are the core ingredients chock-full of good things, but the herbs and spices used to flavor them are also healthy.

Avoid the fried breads and opt for naan instead. Also, be aware that most menu items will be cooked in ghee (clarified butter), unless you request otherwise.

Chinese
Chinese food is known for a variety of crisp stir-fried and steamed vegetable dishes that do not lose much of their vitamin content. With the addition of steamed rice, lo mein or rice noodles, these dishes can be good sources of iron, carbohydrates and other vitamins.

Avoid restaurants that use msg (monosodium glutamate) to flavor and preserve foods. Ask before you order. Also, stay clear of the deep-fried wontons, pot stickers and egg rolls.

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