Why Supplement?

 

 

Diabetes Superfoods

Ever see the top 10 lists for foods everyone should eat to superpower your diet? Ever wonder which will mesh with your diabetes meal plan? Wonder no more. Your list of the top 10 diabetes superfoods has arrived.

As with all foods, you need to work the diabetes superfoods into your individualized meal plan in appropriate portions.

All of the foods in our list have a low glycemic index or GI and provide key nutrients that are lacking in the typical western diet such as:

  • calcium
  • potassium
  • fiber
  • magnesium
  • vitamins A (as carotenoids), C, and E.

There isn’t research that clearly points to supplementation, so always think first about getting your nutrients from foods. Below is our list of superfoods to include in your diet.

Beans

Whether you prefer kidney, pinto, navy, or black beans, you can’t find better nutrition than that provided by beans. They are very high in fiber, giving you about 1/3 of your daily requirement in just a ½ cup, and are also good sources of magnesium and potassium.

They are considered starchy vegetables, but ½ cup provides as much protein as an ounce of meat without the saturated fat. To save time you can use canned beans, but be sure to drain and rinse them to get rid of as much sodium as possible.

Dark Green Leafy Vegetables

Spinach, collards, kale – these powerhouse foods are so low in calories and carbohydrate. You can’t eat too much.

Citrus Fruit

Grapefruit, oranges, lemons and limes. Pick your favorites and get part of your daily dose of soluble fiber and vitamin C.

Sweet Potatoes

A starchy vegetable packed full of vitamin A and fiber. Try in place of regular potatoes for a lower GI alternative.

Berries

Which are your favorites: blueberries, strawberries or another variety? Regardless, they are all packed with antioxidants, vitamins and fiber. Make a parfait alternating the fruit with light, non-fat yogurt for a new favorite dessert. 

Tomatoes

An old standby where everyone can find a favorite. The good news is that no matter how you like your tomatoes, pureed, raw, or in a sauce, you’re eating vital nutrients like vitamin C, iron, vitamin E.

Fish High in Omega-3 Fatty Acids

Salmon is a favorite in this category. Stay away from the breaded and deep fat fried variety... they don’t count in your goal of 6-9 ounces of fish per week.

Whole Grains

It’s the germ and bran of the whole grain you’re after.  It contains all the nutrients a grain product has to offer. When you purchase processed grains like bread made from enriched wheat flour, you don’t get these. A few more of the nutrients these foods offer are magnesium, chromium, omega 3 fatty acids and folate.

Pearled barley and oatmeal are a source of fiber and potassium.

Nuts

An ounce of nuts can go a long way in providing key healthy fats along with hunger management. Other benefits are a dose of magnesium and fiber.

Some nuts and seeds, such as walnuts and flax seeds, also contain omega-3 fatty acids.

Fat-free Milk and Yogurt

Everyone knows dairy can help build strong bones and teeth. In addition to calcium, many fortified dairy products are a good source of vitamin D. More research is emerging on the connection between vitamin D and good health.
Some of the above list can be tough on the budget depending on the season and where you live. Look for lower cost options such as fruit and vegetables in season or frozen or canned fish.

Foods that every budget can live with year round are beans and rolled oats or barley that you cook from scratch.

 

Omega-3 Fish Oil Supplements – Taking Stock and Awaiting Vital New Studies


Pub Date: Monday, March 13, 2017
Authors: Kenneth J. Mukamal, MD, MPH, MA
Affiliation: Division of General Medicine & Primary Care, Beth Israel Deaconess Medical Center, Boston, Mass.

Article Text

Controversy about the role of n-3 polyunsaturated fatty acids (PUFAs) in cardiovascular disease has a long and decorated history.  Beginning in 1971, Dyerberg and Bang published a series of highly-cited articles on Greenland Eskimos, suggesting that they have lower-than-expected rates of cardiovascular disease that the Danish investigators attributed to anti-atherosclerotic and antithrombotic effects of high n-3 PUFA intake.1, 2  However, the extraordinary Ancel Keys, Director of the Laboratory of Physiological Hygiene at the University of Minnesota School of Public Health, had already concluded in 1957 that “on no grounds is it possible to suggest that the case of the Eskimo contributes anything.”3  Unfortunately, Keys’ caution itself appears to be a misreading of an even earlier survey of clinical manifestations of atherosclerosis, which also suggested a lower rate among Greenland Eskimos than among poorly-matched Finns who had a much lower overall mortality rate.4

Despite this challenging history, the importance of dietary n-3 PUFA intake has gained a substantial measure of consensus.  The American Heart Association (AHA) itself includes fatty fish intake as part of a healthy diet, one of Life’s Simple Seven, and specifically recommends that adults consuming a 2000-kilocalorie diet aim for at least 8 ounces of fatty fish per week,5 at least in part to ensure adequate intake of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).  This recommendation owes much to the pioneering work of David Siscovick, whose case-control study in Seattle and suburban King County, Washington demonstrated that, compared with no n-3 PUFA intake, consumption of one fatty fish meal per week was associated with 50% lower risk of primary cardiac arrest.6

Siscovick and colleagues, in their new Science Advisory, now tackle the challenge of n-3 PUFA supplementation, a topic previously addressed by many of the same authors in an AHA Scientific Statement in 2002.7  At that time, the evidence supporting a benefit of n-3 PUFA supplementation seemed clear, at least among individuals who had survived a myocardial infarction.  The GISSI-Prevenzione trial confirmed 73 fewer deaths among participants randomized to 1 gram of n-3 PUFA supplementation daily than to control, 42 of which were sudden deaths (relative risk for sudden death 0.74; 95% confidence interval 0.58–0.93).8  The DART trial, in a similar population, found a significant reduction in risk of coronary death (despite a numerical increase in cases of myocardial infarction) with advice to consume at least two fatty fish meals per week.9  Thus, these two large and complementary trials both suggested that n-3 PUFA intake has a specific benefit on reducing risk of cardiac death (but not necessarily incident events) among survivors of previous myocardial infarction.  Unfortunately, evidence in the ensuing years has not necessarily been entirely consistent, and the new Advisory therefore serves a highly welcome function in collecting and synthesizing this evidence.

The Advisory specifically targets n-3 PUFA supplementation and thus addresses the clinically relevant question of whether physicians should recommend supplements (which can be costly and have unpleasant sensory side effects) to their patients.  The authors correctly caution that their results do not bear directly on n-3 PUFA intake by diet.  Of course, several reasons exist to justify fish consumption well beyond its n-3 PUFA content, including its rich protein and low saturated fat contents, and hence this Advisory does not alter the AHA recommendation to consume fatty fish regularly.  Nonetheless, even answering the more limited clinical question of n-3 PUFA supplementation poses substantial hurdles, such as the host of cardiovascular conditions for which it has been tested in randomized trials, the varied and overlapping trial populations, and the sometimes contradictory results that trials have yielded.

The authors focus their work on long-term trials of clinically meaningful endpoints, which are obviously of most relevance for patients and physicians.  Necessarily, this restricts most of their analyses to EPA+DHA doses generally in the range of 1 gram per day, well within the range attainable with over-the-counter or prescription n-3 PUFA supplements but substantially below the 4 gm per day dosing approved for hypertriglyceridemia; the one exception is trials of incident atrial fibrillation, where doses have occasionally been higher.  Because trials on endpoints have not yet attempted to determine dose-response relationships, the Advisory provides expert guidance on commonly-used doses of these supplements (as might be used in clinical care) but not on the long-term health effects of these fatty acids at pharmacological doses, nor on whether an ideal dose of supplementation might exist.

What did the Advisory find, and what did the authors conclude?  As the authors did, it may be easiest to summarize their results by clinical indication:

  1. Primary prevention
    this is potentially the largest pool of patients for whom n-3 PUFA supplements could be recommended.  However, the authors make no recommendation about the use of supplements for primary prevention of coronary heart disease, heart failure, or atrial fibrillation, because the only trial to test any of these indications – the The VITamin D and OmegA-3 TriaL (VITAL) – is still underway.10 VITAL began in 2010 and will enroll over 25,000 adults in factorial-design, randomized trial of 2000 IU vitamin D and 1 gram of fish oil daily for an average of 5 years of follow-up.  Clearly, based both on its size and the more broadly representative nature of its study population, VITAL has the potential to alter recommendations about n-3 PUFA supplementation substantially; even for higher-risk subgroups, such as those with diabetes, who have been the subject of previous n-3 PUFA trials, VITAL may well enroll enough individuals in those strata to modify the conclusions of this Advisory.  VITAL investigators have also identified a broad range of cardiovascular outcomes of interest with which to evaluate primary prevention, although power to detect benefits of supplementation will inevitably differ between them.  Until the results of VITAL are available, the Advisory concludes, reasonably, that no recommendation for primary prevention can be made in either direction.  Although n-3 PUFA supplementation may have other effects in a primary prevention context for which its use might be justified even by randomized trials, these benefits extend well beyond the scope of the Advisory and none are of sufficient in themselves to justify a recommendation for routine supplementation.
     
  2. High cardiovascular risk
    Across a range of conditions marking cardiovascular risk, including diabetes, hypercholesterolemia, and macular degeneration, the authors found no consistent benefit of n-3 PUFA supplementation, although one large trial from Japan found a significant benefit on non-fatal coronary events.11 A sizable fraction of participants in this subgroup had existing prevalent cardiovascular disease, but the trials typically excluded individuals with a recent myocardial infarction. The Advisory recommends against supplementation in this group of individuals.
     

Prevalent atherosclerotic cardiovascular disease
As noted above, n-3 PUFA supplementation had specifically been found to improve prognosis among survivors of acute myocardial infarction when the AHA last reviewed this topic.7  In the updated Advisory, three new trials have been included, none of which showed statistical evidence of benefit from n-3 PUFA supplementation, although, as the authors note, pooling of results

 

 

Vitamin D Holds Skin Cancer Drug Potential

May 8, 2014

Early research suggests that vitamin D, a compound the human body makes naturally when exposed to the sun and essential to healthy bones, has the potential to be used as a starting point in the creation of new drugs to treat skin cancer.

Scientists in recent years have shown that vitamin D3, one form of vitamin D, appears to have the ability to stop a broken network of proteins linked to the development of the most common type of skin cancer – basal cell carcinoma. Basal cell is also the most prevalent of all cancer types in the United States, with more than 2 million diagnoses each year.

The protein network, called the Hedgehog signaling pathway, is vital during embryonic development, but usually remains shut off in adults. Sometimes though, the Hedgehog pathway gets reactivated. When this happens it can cause out-of-control cell growth that leads to some types of basal cell cancers.

The discovery of the linkage between vitamin D3 and the Hedgehog pathway is what spurred University of Connecticut chemist and researcher Kyle Hadden, Ph.D., to start trying to create chemical compounds based on vitamin D that could help treat basal cell cancer. With the help of a 4-year, $716,000 grant from the American Cancer Society, Hadden, is trying to engineer a version of vitamin D3 that possesses only its anti-cancer abilities, but leaves out the potentially harmful effects it could have at the high does necessary to treat cancer.

Vitamin D essentially increases the amount of calcium in the body; and too much calcium can cause problems like nausea and vomiting and can impact a person’s mental state and heart rhythms. “You can’t give a patient vitamin D3 itself over an extended period of time because it would have detrimental side effects,” says Hadden. “We want to create a drug to do one thing specifically – we want it to selectively target the Hedgehog pathway.”

Hadden notes that there is currently one Hedgehog inhibitor drug on the market, but it stops working over time. “We are hopeful that our compound would continue to work over time … we want to be better than the current therapy.”

Every 4 to 5 months, Hadden’s lab creates about 20 new vitamin D3 analogs – chemical compounds similar to the vitamin, but with certain components changed. Then, they spend about 1 month testing the batch on mouse cells grown in the lab. Over the past 3 years, Hadden has made several hundred different vitamin D3 compounds. “We have learned a lot and we have moved closer [to a viable compound].”

Clinical Trials and Beyond

The next step is to work with a collaborator to test the compounds in live mice, which he hopes to start doing in the next 6 months. Hadden says that if in the next few months his lab creates a compound that “really blew us out of the water,” a drug might potentially make it to clinical trials (studies in people) in 3 to 5 years.

Those with basal cell carcinoma aren’t the only ones who stand to benefit. Hadden notes that a type of brain cancer seen primarily in children – called medulloblastoma – is also linked to the Hedgehog pathway. “Right now there are treatments that can extend life, but there is not a good drug or treatment that gets anywhere close to a cure,” says Hadden. He is looking at how the vitamin D3 analogs he is creating could also be used to treat this type of cancer.

In addition to working on the vitamin D3 compounds, Hadden is also trying to determine whether the ways the body moderates vitamin D3 is part of the reason the Hedgehog pathway malfunctions in the first place to cause cancer.