Artificial Sweeteners and Diabetes

Artificial sweeteners have been around since the discovery of saccharin in 1879. A scientist was working with coal tar, making benzoic sulfimide. One evening he noticed a white powder on his hand. He licked it and noticed a sweet taste.

He named the substance saccharin and applied for patents. After a bumpy history of being accused of causing bladder cancer and having no food value, saccharin was finally declared safe for humans. You can find it in tiny pink packets, and diabetic meals have included it for years.

Aspartame

Aspartame was developed as an artificial sweetener in 1965 and declared safe for use in 1974, but it has had a similarly bumpy ride because of perceived side effects. It does cause serious problems for people with a genetic disease called PKU (phenylketonuria). You can find it in tiny blue packets, and it’s used in many diet sodas. It is not used in cooking because it breaks down when heated, and it has a short shelf life.

Sucralose

Then along came sucralose (we see it in the store as Splenda). It is an artificial sweetener 600 times as sweet as sugar and twice as sweet as saccharin. It is made by a chlorinating process from regular sugar. In 1976 it was patented, and in 1998 it was approved by the FDA. You can find it in your restaurant in little yellow packets.

Sucralose, unlike aspartame, can be used in cooking. It is packaged with fillers that add a little bit of calories, but as long as the fillers add less than 5 calories they can call it “zero-calorie” on the label. The fillers make it easy to use sucralose in cooking because it can be measured out just like sugar.

But if you are cooking with this artificial sweetener, be aware that it does not dissolve into the cooked food like sugar does, so the texture won’t be right in some desserts. That’s why cooks often use half sucralose and half sugar. This halves the calories contributed by sugar and lets the dessert stay diet friendly.

Sugar Alcohols

The artificial sweeteners that end with -ol are sugar alcohols. All of them are made from messing around with sugar, either by chemicals or by fermentation. The product tastes sweet but has few or no calories, and it has no bitter aftertaste like the other chemical artificial sweeteners. The down side is that the sugar alcohols can cause GI upset (gas and diarrhea). They are used a lot in diabetic foods like candy.

The worst of these sugar alcohols is maltilol. It is not a calorie-free food at 2-3 calories per gram – sugar only has 4 calories per gram. It has a glycemic index of 52 and table sugar’s is 60. Not a huge difference. Let’s do some math.

It has three-fourths the sweetness of sugar, three-fourths the calories and three-fourths the glycemic index value. So if you use enough maltilol to match the sweetness of sugar what do you have? A high-priced sweetener that raises your blood sugar like table sugar and has the same number of calories.

You might want to read the labels of “sugar-free foods” and stay away from maltilol. It is not sugar-free and it is one of the worst sugar alcohols for causing bloating and diarrhea.

The best choice among all the sugar alcohols so far is erythritol. It has no bitter taste, is low glycemic and doesn’t cause GI problems in most people.

Stevia, the Naturally Sweet Herb

The newest artificial sweetener isn’t completely artificial. It comes from the stevia plant, and it was approved in Japan in the 1970s. It is used now in over 40% of their artificially sweetened drinks and foods. But it was just approved in the U.S. as a sweetener in 2008. One company sells it as Truvia, and another calls their product PureVia, but they’re both basically the same sweetener.

Why Don’t Artificial Sweeteners Make Us Thinner?

Studies of artificial sweeteners by researchers from the 1970s to today have been producing disturbing statistics. Instead of helping people lose weight, artificial sweeteners seem to be making people gain weight. This has researchers scratching their heads and wondering why.

Scientists who feed rats artificial sweeteners every day watch as the rats grow more and more obese. The additive seem to make them want to eat more. Outside the lab, scientists followed the histories of young people who drank diet sodas as opposed to those who did not, and the diet soda drinkers were consistently more obese with a higher incidence of type 2 diabetes.

These results have been duplicated, too. Everyone seems to know it’s happening, but they can’t figure out why. And the American Diabetic Association seems reluctant to come out against the use of artificial sweeteners, maybe because they hate to give up on them as a diabetic tool.

One problem with these sweeteners might be the sweetness – most of them have hundreds to thousands of times the sweetness of sugar. That may give us an exaggerated sensitivity to sweetness, making us crave it more. You have seen how we can change our taste for things. If you stop eating salt, you start disliking salty foods. You “lose your taste” for them. And it works the other way too. The more salt you use, the more you want.

Another theory is that the sweetness gives our bodies an expectation of calories that aren’t there, so our bodies go looking for them. It gives us an “empty” feeling, and that makes us hungry when we are not really in need of more food. That’s a bad thing to do to a diabetic, or anybody for that matter.

The only natural way to lose weight has always been to burn more calories than you eat, and you do that by eating less and being more active. And tricking your body with empty artificial sweeteners seems to be a bad idea in the long run.

You don’t have to do without sweets, though. If you want them, keep them a small part, like the cherry on top of your diabetic diet, and keep an eye on that calorie counting. The glycemic index can keep you on track. It helps me decide where the bulk of the food I eat comes from. Give your body the good stuff, and cravings won’t trip you up.

Diabetes And Feet: Why A Podiatrist Is A Vital Part Of A Diabetic’s Care

Diabetes is a serious disease that affects millions of Americans, and that number is going to astronomically grow as the baby boomer generation ages further. Complications associated with diabetes can be devastating, and can lead to organ failure and even death. Foot-related complications in particular are very common in diabetes, and unfortunately cause the majority of leg amputations performed by surgeons. Comprehensive care by a podiatrist can identify foot problems early before they lead to leg loss, and in many cases can prevent those problems in the first place. This article will discuss the ways a podiatrist can protect diabetic feet, and ultimately save a diabetic’s limb and life.

Diabetes is a disease in which glucose, the body’s main source of ‘fuel’, is not properly absorbed into the body’s tissues and remains stuck in the bloodstream. Glucose is a type of ‘sugar’ derived from the body’s digestion of carbohydrates (grains, breads, pastas, sugary food, fruits, starches, and dairy) The body needs a hormone called insulin, which is produced in the pancreas, to coax the glucose into body tissue to fuel it. Some diabetics are born with or develop at a young age an inability to produce insulin, resulting in type 1 diabetes. The majority of diabetics develop their disease as they become much older, and the ability of insulin to coax glucose into tissue wanes due to a sort of resistance to or an ineffectiveness of the action of insulin. This is called type 2 diabetes. Diabetes can also develop from high dose steroid use, during pregnancy (where it is temporary), or after pancreas disease or certain infections. The high concentration of glucose in the blood that remains out of the body tissue in diabetes can cause damage to parts all over the body. Organs and tissue that slowly are damaged by high concentrations of glucose stuck in the blood include the heart, the kidneys, blood vessels, the brain, the nerve tissue, skin, and the immune and injury repair cells. The higher the concentration of glucose in the blood, and the longer this glucose is present in the blood in an elevated state, the more damage will occur. Death can occur with severe levels of glucose in the blood stream, although this is not the case in most diabetics. Most diabetics who do not control their blood glucose well develop tissue damage over a long period of time, and serious disease, organ failure, and the potential for leg loss does eventually arrive, although not right away.

Foot disease in diabetes is common, and one of the more devastating and taxing complications associated directly and indirectly with high blood sugar. Foot disease takes the form of decreased sensation, poor circulation, a higher likelihood of developing skin wounds and infections, and a decreased ability to heal those skin wounds and infections. Key to this entire spectrum of foot complications is the presence of poor sensation. Most diabetics have less feeling in their feet than non-diabetics, due to the indirect action increased glucose has on nerve tissue. This decreased sensation can be a significant numbness, or it can be a mere subtle numbness that makes sharp objects seem smooth, or erases the irritation of a tight shoe. Advanced cases can actually have phantom pains of burning or tingling in addition to the numbness. With decreased sensation comes a much greater risk for skin wounds, mostly due to the inability to feel pain from thick calluses, sharp objects on the ground, and poorly fitting shoes. When a wound has formed as a result of skin dying under the strain of a thick corn or callus, from a needle or splinter driven into the foot, or from a tight shoe rubbing a friction burn on the skin, the diabetic foot has great difficulty starting and completing the healing process. Untreated skin wounds will break down further, and the wound can extend to deeper tissue, including muscle and bone. Bacteria will enter the body through these wounds, and can potentially cause an infection that can spread beyond the foot itself. A diabetic’s body has a particularly difficult time defending itself from bacteria due to the way high glucose affects the very cells that eat bacteria, and diabetics tend to get infected by multiple species of bacteria as well. Combine all this with decreased circulation (and therefore decreased distribution of nutrients and chemicals to preserve foot tissue and help it thrive), and one has all the components in place for a potential amputation. Amputations are performed when bacteria spreads along the body and threatens death, when wounds and foot tissue will not heal as a result of gangrene from advancing tissue death and infection, and when poor circulation will not allow the tissue to thrive ever again. The statistics following a leg amputation are grim: about half of diabetics who undergo one amputation will require an amputation of the other foot or leg, and about that same number in five years will be dead from the heart strain endured when one’s body has to expend energy to use a prosthetic limb.

A podiatrist can ensure that all the above complications are significantly limited, and in some cases prevented all together. Podiatrists are physicians who specialize solely in the care of foot and ankle disease, through medicine and surgery. The attend a four year podiatric medical school following college, and enter into a two or three year of hospital-based residency program after that to hone their advanced reconstructive surgical skills, and to study advanced medical. Podiatrists are generally considered the experts on all things involving the foot and ankle, and their unique understanding amongst other medical specialties of how the foot functions in relationship to the leg and ground (biomechanics) allows them to target therapy towards controlling or changing that function in addition to treating tissue disease. A great majority of the problems that lead to diabetic amputations start off as problems related to the structure of the foot and how it relates to the ground and to the shoe worn above. Controlling or repairing these structural problems will often result in prevention of wounds, which in turn will prevent infection, gangrene, and amputation.

To start with, a podiatrist will provide a diabetic patient with a complete foot exam that takes into account circulation, sensation, bone deformities, and skin issues, and pressures generated by walking and standing. From this initial assessment, a protection and treatment course can be created specific to the individual needs of the diabetic for maintenance, protection, and active treatment of problems that do develop. Commonly performed maintenance services include regular examinations several times a year to identify developing problems, care of toe nails to prevent a diabetic with poor sensation from accidentally cutting themselves when attempting to trim their nails, regular thinning of calluses to prevent wounds from developing, and repetitive education on diabetic foot problems to ensure proper habits are followed. Preventative services include using special deep shoes with protective inserts in diabetics at-risk for developing wounds from regular shoes, assessment of potential circulation problems with prompt referral to vascular specialists if needed, and possible surgery to reduce the potential of wounds to develop over areas of bony prominences. Active treatment of foot problems performed by a podiatrist involves the care and healing of wounds, the treatment of diabetic infections, and surgery to address serious foot injury, deep infections, gangrene, and other urgent problems. Because of a podiatrist’s unique understanding of the way the foot structure affects disease and injury, all treatment will be centered around the principles of how the foot realistically functions in conjunction with the leg and the ground. This becomes invaluable in the struggle to prevent diabetic wounds and infections, while allowing one to remain mobile and active at the same time.

The essential goal of a podiatrist in caring for a diabetic patient is to prevent wounds, infections, and the amputations that result. This philosophy is called limb salvage, and it is accomplished through the above listed methods. Because of the severity of foot disease as a complication of diabetes, a podiatrist is an integral part of a diabetic’s care, and sometimes can even be the physician that diagnoses diabetes in the first place if foot disease appears as an early symptom of undiagnosed diabetes. For these reasons, all diabetics should be assessed by a podiatrist for potential problems, and those at-risk for foot wounds and infections should have regular foot examinations and preventative treatment. As a final note, online resources by podiatrists discussing diabetic foot issues abound, including a regular blog by this author ( thediabeticfoot.blogspot.com ). While these resources do not replace a diabetic foot exam, they do help educate diabetics on how best to care for their feet, and what to do if problems develop. This can lead to better knowledge and understanding of foot issues when diabetics begin to see a podiatrist regularly, and can help prevent early foot complications from developing.

Type 2 Diabetes: Causes and Treatments

As most of us know, diabetes is linked with high blood sugar levels while type 2 diabetes is associated with insulin resistance. When a person is affected with type 2 diabetes, his body loses the ability to respond to insulin levels. This article focuses on the causes and tips to overcome type 2 diabetes.

What are the causes?

  • Heredities: People with a family history of diabetes are at higher risk.
  • Birth weight: There is a very strong relationship between birth weight and diabetes. The lower the birth weight, the higher the risk.
  • Metabolic fluctuations: People suffering from metabolic syndrome and metabolic fluctuations are more likely to get diabetes type 2.
  • Obesity: Statistics show obesity causes the most health issues. Since it increases our body’s resistance to insulin, obese people are more likely to develop the condition.
  • Gestational Diabetes: Some mothers will have gestational diabetes at some point during pregnancy. Usually there are no noticeable signs but have it in mind!

Ways to treat and prevent:

Genetics play the most important role in the development of diabetes and this is something that cannot be controlled. Nevertheless, there are other things in your surroundings and personal routines that will definitely help you lower the risk. Some are listed here:

Exercise: Jogging and fitness play a vital role in maintaining top health. Physical exercise three to four times per week will make you will feel awesome! Most people think that exercise is only for those who want to lose weight. Combine those two concepts and you will see the difference right away!

Quit Smoking: 16 to 20 cigarettes per day (as the usual statistics) put a person at high risk for developing diabetes (among other things). Since smoking decreases the body’s ability to develop insulin resistance, blood sugar levels increase immediately after your next cigarette.

Eating Nuts: About an ounce or 28 grams of nuts a day will keep your doctor away! It’s time to say goodbye to your favorite yummy calorie-stuffed chips!

Create Awareness: Spread the word about diabetes and make everyone learn how serious it actually is. Discuss with community members, local doctors and organize the best awareness event! Marathons, walkathons, game shows… or make a documentary and publish it online. Social media is always there to help you advertise your cause, so it can reach as many people as possible! Don’t forget that trendy giveaways like personalized silicone bracelets with a special message will make your event more successful!

If you feel that you are at risk, consult your doctor. The earlier you do this, the better the chances are for you to stay safe and healthy. Remember that self-treatment is not always perceived as unproblematic!

Health Insurance Coverage for Cancer Survivors or Cardiac and Diabetes Patients in India

Introduction:

The basic health indices in India have widely improved since we became independent in 1947, the average life expectancy has gone up, the infant mortality rates and maternal mortality rates have improved a lot but we still have a long way to go before we achieve developed or European standards.

These improvements happened because of improvement in education, sanitation, health care facilities and increase in disposable income resulting in general improvements in living standards across the board.

Today we are producing more cereals, pulses, fruits, poultry, fish and also consuming more as a result the availability of protein in our diet has improved very much resulting in taller and healthier Indians.

But along with increase in disposable income and increasing living standards there is increase in consumption of alcohol, tobacco, red meat and fatty foods.

The increase in affluence and affordability of new technological gizmos has made us more sedentary and dependent even for smallest and easiest of the job; today we tend to use mobile phone from the comforts of our home to contact grocer, pharmacist, maid, electrician, mechanic, etc.

And instead of walking to nearest convenience store, we tend to use vehicle and instead of walking or cycling for moving-around in our neighbourhood we take motorised vehicle.

Many of us will have trouble remembering last time we walked a distance to catch an auto rickshaw or taxi today we tend to book taxi and it picks us up from our door step.

Which along with unresponsive or indifferent civic management has resulted in unplanned development across most of the urban centres where availability of potable water, sanitation services are under stress along with increased and unmanaged vehicular, industrial, ground, noise pollution.

In 2012 GOI with Indian council of medical research released an updated definition of overweight and revised the figures to:

If BMI (Body Mass Index) is between 18-22.9kg/m2 person is of normal weight

If BMI is 23-24.9kg/m2 the person is overweight.

If BMI is more than 25 kg/m2 the person is OBESE.

In 21st century obesity has taken epidemic proportion in India and more than 5% of population comes under definition of OBESE.

While studying of 22 SNP ( single nucleotide polymorphism) near to MC4-R-gene, scientist have identified a SNP 12970134 to be mostly associated with waist circumference. In this study nearly 2000 people of Indian origin participated and this SNP was found to be most prevalent in this group.

Hence genetically we are predisposed towards abdominal obesity and this is one of the biggest morbidity factor behind diabetes type 2 and cardio vascular disease.

Globally 3-5 million deaths are because of obesity, 3.9% years of life lost and 3.9% of years lost to disability adjusted life years.

All the above has increased the number of Indians suffering from non-communicable lifestyle induced diseases like Cancers,Cardiac Vascular diseases, Diabetes, Hypertension, Mental Illness, breathing disorders like Asthma etc.

What is the disease burden for non-communicable prevalent disease like cancer, diabetes and cardiovascular diseases in India? (Reference: Background papers on Burden of disease in India published by National commission on macroeconomics and health)

The figures for Diabetes, CVD (Cardio vascular disease) and cancers are alarming and the biggest percentage of new cases are being reported from Urban areas and the younger men and women are as vulnerable as middle aged men.

Diabetes:

India is projected to become diabetes capital of the globe, it is estimated that in 2015 approximately 4.6 crore Indians were diabetic.

The prevalence is estimated as:

In 30-39 years age group around 6% of population is estimated to be diabetic.

In 40-49 years age group around 13% of population is estimated to be diabetic.

In 70+ years age group around 20% of population is estimated to be diabetic.

Diabetes has been recognised as one of the major contributing factor towards increase in numbers of Cardio Vascular Disease (CVD) patients in India.

Cardiovascular Disease (CVD):

It is estimated that around 6.4 crore Indians had one or the other condition which can be classified as CVD.

Coronary Heart Disease is a mix of conditions that include Acute Myocardial Infraction, Angina Pectoris, Congestive Heart Failure (CHF) and inflammatory heart disease.

It is increasing in rural areas it is estimated to effect 13.5% of rural population in age group 60-69 years.

More and more cases of CVD are being diagnosed among young adult in age group 40 and above.

Cancers:

It is estimated that nearly 10 Lakh new cancers wold have been diagnosed in 2016 and 670,000 deaths were expected because of cancer in 2016.

Across the globe Cancers account for 5.1% of disease burden and 9% of all death, in India cancers account for 3.3% of disease burden and 9% of all deaths.

Response of health insurance companies towards the increased disease burden:

Looking at the large number of people being diagnosed and being affected by increased disease burden, it is a fact that all these diseases or conditions are rejected as preexisting conditions and risks are not accepted by any insurance company.

The best response has been benefit policy from Life insurance companies which offer fix term plans for cancer or cardiac disease but for paying the benefit the diagnosis has to be during policy period.

The survivor benefit plans popularly known as critical illness benefit policy pays only when the disease becomes critical particularly in cancer today many cancer cases are diagnosed and treated completely during the early stage and do not become critical hence most claims under the Critical Illness can only be made once disease reached 3rd or 4th stage of manifestation.

Presently schemes for people diagnosed by or surviving these diseases are bare minimum some insurance companies have tried to launch products catering to people with some preexisting condition or survivors but the effort seems halfhearted.

New India assurance have launched Cancer care policies with Indian cancer society and CPAA but both these policies exclude existing cancer patients or Cancer Survivors and only enrol people who have no sign of cancer.

Health Insurance Policies for Cardiovascular Disease Patients:

Start Health and Allied insurance company has launched Star Cardiac care policy for people who have undergone PTCA, CABG within 7 year period prior to the commencement of the coverage under this policy.

Few features of Cardiac Care insurance policy:

There are 2 sections of the policy section 1 is normal health insurance with PED covered after 48 months, 2% limitation on room, doctor fee and nursing charges subject to max of Rs.5000 per day and liability in case of package rates is limited to 80%of package rates.

But section 2 covering giving coverage to known cardiac cases there is no limitation other than SI.

There is a waiting period of 91 days before a person can claim for any complication because of preexisting cardiac condition under this policy

Health Insurance plans for people with diabetes:

In Diabetes space there are two products Diabetes safe from Star Health and Allied insurance company and Energy Health insurance plan from Apollo Munich Health insurance company:

A comparison between the two products is as:

Insurance Company: Star Health Insurance

Product: Diabetes Safe Insurance Plan

Who is covered?

Patients suffering from Type 1 and type 2 diabetes

Number of plan:

2 plans in plan A pre-acceptance medical test must, in plan B no pre-acceptance medical tests

Waiting period: In plan A no waiting period, in plan B 15 months waiting period for coverage of disease related to CV system, Renal System disease of eyes and diabetic peripheral vascular disease, foot ulcers

Family floater option: available,both plans have 2 section one section covers

benefits under family floater and section 2 is specific to diabetes care.

Sum Insured Rs. 300,000, to Rs. 10,00,000

Income Tax Benefit: Under 80(D)

Limitation:

For Cataract the limitations are defined as :

For SI 3-500,000 liability to Rs.20,000 per eye person and Rs. 30,000 per policy period

For SI Rs. 10,00000 liability limited to Rs. 30,000 per eye person and Rs.40,000 for policy period

For diseases of cardio vascular system the limitation are defined as:

For SI 300,000 liability limited to Rs.200,000

For SI 400,000 Liability limited to Rs.250,000

For SI 500,000 liability limited to Rs. 300,000

For SI 10,000,00 liability limited to Rs.400,000

Cost of artificial limbs limited to 10% of SI if amputation is related to diabetes.

Insurance Company: Apollo Munich health insurance co. Ltd

Product : Energy Health Insurance Plan

Who is covered?

Patients suffering from Type 2 diabetes, impaired fasting glucose, impaired glucose tolerance and or Hypertension are covered.

Number of plan: Single plan

Waiting period : No waiting period, day 1 hospitalisation arising out of diabetes and hypertension

Family floater option: No, policy available on individual basis

Sum Insured : Rs. 200,000 to Rs. 10,000,000

Income Tax Benefit : Under 80(D)

Limitation: No limits

VAS (Value added services): Health coach, telephonic consultation, health line, discounts, access to wellness portal that conducts HRA, stores medical record

Optional VAS services: diagnostic monitoring program to monitor and manage health).

Rewards: Discounts on premium and addition benefits on good health management