Diabetes 101: What you need to know

Diabetes is among the fastest-growing health conditions in the United States. Nearly 30 million adults have diabetes, with nearly 2 million new cases each year. If you include prediabetes, which tends to lead to diabetes if untreated, over 115 million Americans are affected. Fortunately, most cases of diabetes can be treated or prevented through healthy eating, weight control, and regular exercise.

Since November is American Diabetes Month, this seems like a good time to raise awareness about the prevention, treatment, and consequences of this serious medical condition.  If you want to learn more about diabetes, a great place to start is American Diabetes Association. This is also the topic of my Health & Fitness column in the Aiken Standard this week.


Diabetes mellitus is a metabolic disorder characterized by high blood glucose (sugar) caused by a lack of insulin production or impaired insulin action. The lack of insulin production can be caused by an autoimmune disorder that damages the pancreas. This typically occurs during childhood, as in type 1 or “juvenile” diabetes, but it can occur in adults, a condition called latent autoimmune diabetes of adulthood (LADA). For both types, injected insulin is required to control blood glucose.

More commonly, diabetes is caused by the body’s cells not responding to the insulin that is produced, a condition called insulin resistance. This is called type 2 diabetes and is thought to be caused by some combination of obesity, particularly excess abdominal fat, and physical inactivity.

Diabetes can be diagnosed based on a fasting blood glucose test, taken 8–12 hours after a meal, usually in the morning. Another test is an oral glucose tolerance test in which blood glucose is measured for two hours after drinking a special beverage containing glucose. This measures the body’s response to glucose. The hemoglobin A1C test is a long-term measure of blood glucose control. This is important because the higher the hemoglobin A1C level, the greater the risk of diabetes complications.

For most diabetics, the main treatment goal is to control blood glucose level to prevent serious complications including nerve damage, blindness, infection and amputation, heart attack, and stroke. This is typically accomplished through a combination of diet, exercise, and medications, with varying degrees of success. But “curing” diabetes is rare, so most patients require continued treatment.

Exercise is important for blood glucose control because exercise causes an increase in the uptake of glucose into cells and can improve glucose tolerance and insulin sensitivity. In addition, exercise has the added benefits of promoting weight loss and improving strength and fitness. Both aerobic and strength training are recommended, with a minimum goal of 30 minutes per day, every day.

Meal planning involves selecting healthy foods to help maintain consistent blood glucose levels while meeting energy needs for exercise and other activities. The dietary recommendations for preventing and treating diabetes are almost identical to the general recommendations for good health: Emphasize whole grains, fruits, vegetables, legumes, and low-fat meat and dairy and reduce unhealthy fats, added sugars, and salt. The diet should also promote weight loss and weight maintenance, especially for overweight patients. The glycemic index (GI), a measure of how much a food raises blood glucose, can be helpful in dietary planning, but it is not the only meal planning tool that should be used.

Proper diet, blood glucose testing, medication use, and regular exercise can improve blood glucose control, reduce the risk of other health problems, and improve quality of life in diabetics. In those with prediabetes these efforts can delay the progression to diabetes and may even result in a return to normal blood glucose. In fact, diet and exercise have been shown to be more effective than medications in preventing diabetes. Plus, these lifestyle changes lead to weight loss and improved fitness, benefits that no medication can match.

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The truth about restaurant salads

If you are looking for a healthy option for lunch or dinner at a restaurant, especially if you are trying to lose weight, chances are you will consider a salad. It turns out that at most fast-food and casual dining restaurants, salads may not be the low-calorie or low-fat choice you were expecting. However, ordering a salad can still be a healthy option, as I explain in my Health & Fitness column in the Aiken Standard this week.

Big salad

We think of salads as being a healthy choice because they contain lots of vegetables which are low in calories and high in vitamins, minerals, and fiber. But most restaurant salads are more than just vegetables. At a minimum, you would add salad dressing and many salads also include nuts, fruit, chicken, bacon, or cheese, all of which add fat and calories.

Salad dressing alone can add hundreds of calories. Creamy dressings like ranch and blue cheese tend to be higher in both calories and fat than vinaigrettes. In many cases the salad has more calories than the sandwich or entree you would have ordered instead.

As an example, consider the Premium Bacon Ranch Salad with Crispy Chicken at McDonald’s. This popular salad contains 490 calories and 29 grams of fat. Compared to a Big Mac, which has 540 calories and 29 grams of fat, this salad doesn’t seem like such a healthy option. You could improve the salad by switching from fried chicken to grilled chicken and save 180 calories and 15 grams of fat.

The real problem is the ranch dressing—one packet contains 200 calories and 17 grams of fat. You could skip the dressing altogether, but a more reasonable approach is to switch to the Low-Fat Balsamic Vinaigrette, with only 35 calories and 1.5 grams of fat. Want to really cut calories? The salad with the vinaigrette dressing and no chicken has only 230 calories, almost 300 fewer than the version with crispy chicken with ranch dressing or the Big Mac!

Despite the fact that many restaurant salads have calorie and fat content similar to burgers and other entrees, it doesn’t make them a bad choice. The salad does contain several cups of vegetables, which means it is higher in vitamins, minerals, and fiber than a burger. The salads at McDonalds have about twice as much fiber as most sandwiches.

Think of it this way: the salad may be equivalent to a burger as far as fat and calories go, but it comes with a serving (or more) of vegetables. And the salad is even healthier when you consider that the sandwich would undoubtedly come with fries! One more point: I use McDonald’s as an example here, but the same holds true for salads at other fast food and casual dining chain restaurants.

What if you are at a restaurant and want to order a salad? What can you do to make it healthier? You could order a side salad. Given the huge portions at most restaurants, this smaller serving might be enough. You can also limit the toppings, especially meat and cheese, and choose a lower-calorie dressing. Another tried and true option is to ask for the dressing on the side so you can add just as much as you want. And don’t forget, you can always share one of the large salads with a friend or save half for another meal.

The bottom line is that salads at restaurants can be as high in calories and fat as other “unhealthy” menu items, but they do provide a serving of vegetables you might otherwise miss. And by making a few choices, you can create a salad that is a healthy, low-calorie option.

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Are the additives in your food safe?

Making healthier food choices is something that you should be thinking about every day. Since November 4 is National Eating Healthy Day, this seems like a good opportunity to revisit some advice to help you make smart decisions. Eating more fruits and vegetables, limiting added sugar, and focusing on “real food” instead of processed, prepackaged meals and snacks are always good ideas. One reason for this is to avoid food additives, some of which may be harmful.

food additives

If you have ever read the ingredients on a food package you no doubt realized that much of what we eat isn’t really food. Chemical additives are common in packaged foods as preservatives, coloring agents, flavor enhancers, and even vitamins and minerals. This isn’t necessarily a bad thing, since these chemicals allow food to last longer, look and taste more appealing, and provide essential nutrients. The assumption is that these additives have been tested and proven safe for us to consume. Unfortunately, that is not the case for many commonly used additives.

This may be surprising, but it isn’t new. In the late 1950s Congress required that new food additives must be proven safe before they could be used. That raised the question of what to do with additives that were already widely in use. Since people had been eating these additives with no apparent ill effects the decision was made to classify them as safe, and the “generally recognized as safe” (GRAS) list was created.

Now additives may be approved as GRAS by an expert panel without rigorous testing and FDA approval. One study found that in every case these reviewers worked directly for or had financial ties to the companies that manufactured the additives. This raises serious questions about the process and whether or not the chemicals added to our foods really are safe.

So, are the additives in our food safe? There is no good answer to that question, mostly because the safety studies haven’t been done. However, it is rare that a food additive is removed from the market for health reasons. Most research showing that a food additive may be unhealthy is conducted in animals. These studies often test amounts that are far higher than people would reasonably consume, so they may not predict the health effects in humans. And some additives, such as iron added to cereal or vitamin D added to milk, for example, are widely thought to be beneficial.

To be sure, there are some chemicals in our food that we should avoid, but it isn’t fair to say that all food additives are bad. Even so, eating foods that are free from additives is probably a good idea. Even though each individual additives may not be hazardous, it is possible that exposure to small amounts of several of these chemicals could be dangerous.

Much of our exposure to food additives comes in the form of processed, prepackaged foods, including many restaurant meals. Getting back to basics and cooking using “real” food— fresh fruits, vegetables, and meats—is one way to avoid processed foods. Reading food labels can help, too. Look for ingredients that you recognize as food and avoid additives that clearly aren’t.

Avoiding all food additives is almost impossible. Even foods that don’t come in packages, such as fruits and vegetables, may contain coatings that prevent damage or preserve freshness. Even canned fruits and vegetables will likely have added salt or sugar, so even apparently healthy foods can contain additives. The best way to limit them is to select as many fresh foods as possible and make an effort to check labels for additives.

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Forget about the ghosts and zombies at your door. Watch out for candy dressed up as healthy food on your breakfast table!

Boo! Since Halloween is this weekend, it’s a good time to think about what makes this holiday so scary. It’s not the ghosts or zombies that come to your door in the evening that you should be scared of, though. In fact, you don’t even need to wait until dark to get spooked. You are likely to see the scariest costumes on your breakfast table on Halloween morning—candy and soda dressed up as healthy food!

candy corn

Here are three of the most common frightening “costumes”:

Frozen yogurt dressed up as healthy yogurt

Most people would consider yogurt to be a healthy breakfast. And it is, provided you aren’t getting tricked! Low-fat and fat-free flavored yogurt is almost always sweetened with sugar. This is true for the yogurt tubes that kids love and much of the Greek yogurt that is so popular. Sure, it contains protein and beneficial bacteria, but the added sugar makes it equivalent to frozen yogurt or ice cream in terms of calories and sugar . Some of these yogurts even come with toppings, like bits of chocolate, just like fro-yo! A healthier alternative is plain yogurt with real fruit. Sure, it’s not as sweet, but you will be getting the benefits of eating yogurt without all the added sugar.

Soda dressed up as fruit juice

Many “fruit” drinks contain less than 5% juice but plenty of added sugar, so they are essentially soda without bubbles. For example, the orange drinks like Hi-C or Sunny D are a popular substitute for orange juice, but they are far from a nutritional equivalent. The same is true for other drinks, including juice boxes and pouches, which are commonly part of breakfast, lunch, or snacks. Even scarier is the fact that these drinks are much sweeter than real fruit. Children may develop an expectation that oranges or orange juice should taste as sweet as soda and prefer the sugar-sweetened version over the real fruit. A better choice is to make real fruit and fruit juice, not soda disguised as juice, a part of meals and snacks

Candy bars and cookies dressed up as cereal and breakfast bars

Many popular breakfast foods targeted at children include sugar-sweetened cereals, pastries, and bars. Some breakfast bars and cereals that seem healthy are really candy bars in disguise. Some even skip the disguise and actually look like candy or dessert. Pop Tarts and some granola bars are covered in chocolate or frosting, and favorite cereals often contain marshmallows or are shaped like cookies. No surprise that these foods are as high in calories and sugar as cookies or some candy bars. Worse, a child who is used to breakfast or snack foods that taste like candy or cookies may resist real food when it is offered. Now that’s scary!

While the focus here is on food for kids, it really isn’t much different for adults. Breakfast foods like donuts and pastries are almost always topped with icing and it would be difficult to distinguish many muffins from cupcakes. For many people, coffee isn’t just coffee anymore, but a drink that contains as much sugar and as many calories as a milkshake, sometimes with whipped cream on top. What’s really scary is that this is how many people eat every day.

The good news is that you can make your breakfast healthier without too much effort. While there is much debate about what constitutes a healthy breakfast, there is agreement about what it doesn’t include—lots of added sugar! Look for cereals that are low in added sugars and high in fiber. Include real fruit, fruit juice, and milk (or soy milk) whenever possible. If you have time, eggs are an excellent source of protein and healthy fats. Yogurt is good, too, but watch out for added sugars in flavored yogurt. Whole grain toast or a bagel with peanut butter makes a good alternative to Pop Tarts or breakfast bars.

As a general rule, steer clear of foods that look like dessert. Frosting, marshmallows, chocolate chips, and sprinkles simply aren’t part of a healthy meal!

If you are worried about the big bags of candy that get brought home on Halloween night, keep this in mind.  While eating a lot of candy is never healthy, a typical Halloween candy binge lasts a few days, after which time the candy is gone or the kids are literally sick of eating it.  The long-term effects on your kid’s health (and teeth) can be offset by a good diet, regular activity, and diligent brushing and flossing. The same applies to you, too, if you find yourself digging into the big bowl of candy that is inevitably left over.


Nutrition, exercise, and health information can be confusing. 
But it doesn't have to be that way.
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Breaking the chain: What you can do to prevent a relapse in your diet or exercise program.

Making changes to diet and exercise habits for weight loss or to improve health and fitness are among the most difficult behavior modifications to make. Being able to change these behaviors now and in the future is a key to success. Since what we eat and our activity become habitual, many people have spent years developing bad habits, so it will take time and effort to change them.

Making lasting changes—think years, not weeks or months—means that these behaviors must be maintained, and success depends on much more than simply following a diet or exercise program. Perhaps the most important tool for promoting long-term behavior change is relapse prevention.

A lapse is a one-time or short-term “slip up” in making a behavior change. For example, a bad day or even a bad week following a diet is considered a lapse. A relapse is a lapse that is continued for so long that you have essentially gone back to your previous behaviors, what some might call “falling off the wagon.” Since getting back on is so difficult, your goal should be to stay on the wagon by preventing a lapse from becoming a relapse. This is the topic of my Health & Fitness column in the Aiken Standard this week.

breaking the chain

No one is perfect, so lapses will naturally occur. While we often think that lapses occur without warning, the reality is that these events are often the last link in a chain of behaviors. This is illustrated by Barbara, a participant in one of my weight loss programs.

After several weeks of success on her diet Barbara faced her first real challenge, attending a catered event after work. She was rushed in the morning getting her kids ready for school and she didn’t have time for her usual breakfast. She settled for a banana and coffee, but she was hungry by midmorning. She spent her lunch break running errands. Instead of grabbing something unhealthy to eat while she was out, she didn’t eat anything. After a busy afternoon, she was tired and hungry when it was time to go to the event. She made her way to the food table and filled a small plate with the healthiest options she could find. But she wound up standing near the food talking to friends, and she ended up filling her plate a few more times with the very things she meant to avoid at first, including desserts.

Barbara’s story is a perfect example of a lapse, both because it is so common and because it demonstrates the chain of events leading up to it. The lapse—overeating at the party—actually started much earlier in the day. Not having her normal, filling breakfast and skipping lunch meant that Barbara was unusually hungry when she arrived at the party. And standing near the food table made it easy for her to go back for seconds (and thirds). Barbara was able to identify the links in the chain that led to the lapse in her diet, allowing her to get back on track the next day and make efforts to break those links in the future.

Like Barbara, recognizing the steps that lead up to a lapse in your diet or exercise program can help you avoid a slip-up in the first place and prevent a lapse from becoming a relapse. In many ways, long-term success is as much about building confidence in your ability to handle difficult situations as it is the number on the scale or the time you spend in the gym.

Nutrition, exercise, and health information can be confusing. 
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New reasons why it is so easy to gain weight. And what you can do to stop it.

If you have been gaining weight or find it more and more difficult to maintain your weight, you are not alone. According to current statistics, one-third of U.S. adults are obese and two-thirds are considered overweight. Being overweight is now the norm in America, since only about 3 in 10 people are at a healthy body weight.

This is consistent with other reports that show that the waistlines of Americans are expanding. One recent study looked at the percentage of adults who had a high waist circumference (over 35 inches for women and over 40 inches for men). Overall, the average American added over one inch to their waist circumference over the past decade. As of 2012, over half of U.S. adults meet the criteria for abdominal obesity. This is bad news, since excess fat, especially around the waist, increases the risk of type 2 diabetes, hypertension, and heart disease.

It wasn’t always this way. As recently as the 1980s the prevalence of obesity was much lower, around 15%. There has been much interest in figuring out why this widespread weight gain has occurred. While there is no single cause, there are a host of factors that contribute to the obesity epidemic. This is the topic of my Health & Fitness column in the Aiken Standard this week.


Among the forces that seem to be working against you are your genetics and our environment, specifically as it relates to eating and activity behaviors.  Over the past several decades our “food environment” has changed so that now low-quality, high-calorie food is readily accessible and more nutritious food is harder to find and more expensive. Our “activity environment” has changed, too. For most of us, the physical activity that was common at work and home years ago has been replaced by lots of sitting. While there are genes that influence our eating and activity behaviors, these genes have not changed enough over time to explain the obesity epidemic.

A practical explanation for weight gain, both for individuals and the population as a whole, is that we are eating more and expending less energy through activity. Indeed, even small changes in energy balance can add up to increased weight over time . A new study, however, suggests that there may be other factors that may have contributed to the rise in obesity beyond eating and activity.

Among these factors are exposure to certain chemicals in the environment, the use of prescription drugs that cause weight gain, and how our current diet has changed the bacteria in our intestines, that we now know regulate our physiology in surprising ways. For example, bisphenol A (BPA), still found in some plastics, food containers, and receipts, alters normal hormone activity in a way that may increase fat storage.

There is some good news, though. Eating a healthy diet and being active everyday can help you lose weight and maintain a healthy weight. This is true whether your concern is changes in your own eating and activity habits or these other potential causes of weight gain. Indeed, regular exercise may help treat many conditions, like depression, for which prescription medications that may cause weight gain are often used. And a diet rich in fruits, vegetables, and whole grains and low in added sugar may help restore more normal gut bacteria which might help with weight control.

Until we know otherwise, eating smart and moving more is still your best approach to weight control and good health.

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Take steps to reduce breast cancer risk. Literally.

Many local and national organizations are busy promoting breast cancer awareness, sharing information about the disease, raising money to support research, and celebrating survivors as a part of Breast Cancer Awareness month. This represents the most visible part of a year-round effort to educate about, screen for, and hopefully cure this devastating disease. Of course, these are all worthy goals that deserve our attention and support. What is often missing are the steps women—especially young women—can take to reduce their risk for, or even prevent, breast cancer. This is the topic of my Health & Fitness column in the Aiken Standard this week.

cancer exercise group

Approximately 1 in 8 women will develop breast cancer. The American Cancer Society estimates that around 300,000 new cases of breast cancer are diagnosed and nearly 40,000 women die from this disease each year. Breast cancer can occur in men, but these cases are rare, so the focus is rightfully on women.

Much attention is given to genetic factors that increase the risk of breast cancer. These include certain gene mutations, including BRCA1 and BRCA2, as well as family history. A woman who has a first-degree relative (mother, sister, or daughter) who has had breast cancer has nearly twice the risk of being diagnosed herself.

Considering that most women diagnosed with breast cancer have no family history, it is also important to try to reduce other modifiable risk factors. This involves making health behavior changes that are probably familiar to most people. Among these is regular exercise.

Regular activity and exercise can lower breast cancer risk by as much as 30%, according to a study of over 3,000 women. The intensity of the activity didn’t seem to matter, so participation in light activity such as housework and gardening was as effective as walking. What did matter was the amount of time spent being active. Women who reported even low amounts of activity showed a 6% reduction in breast cancer risk, but the greatest benefits were seen in women who were active for over 10 hours per week.

Women who exercise regularly also have a lower chance of recurrence of breast cancer. As many as 1 in 5 of breast cancer survivors experience a recurrence within 10 years. Even relatively low levels of exercise may reduce this risk, and women who do exercise have greater rates of survival. The amount of exercise needed to realize these benefits is equivalent to 45–60 minutes of brisk walking five days per week.

Exercise is effective for reducing breast cancer risk because it lowers levels of the hormone estrogen. This is important because estrogen is linked with the majority of breast cancers and is especially relevant for women with estrogen receptor-positive cancers.

Exercise can also reduce the risk of breast cancer by helping with weight control. Excess body fat increases levels of estrogen, resulting in a higher risk of breast cancer diagnosis and recurrence. Regular physical activity is essential for losing weight and keeping it off. Exercise can also help reduce the increased risk of breast cancer that comes with weight gain, something that is common as women get older.

Women who have been active their whole lives have the lowest risk of breast cancer, but it is never too late to start. Women who exercise also tend to handle breast cancer treatment better than women who aren’t active. In fact, post-cancer exercise programs are becoming more common as a way to help women recover from cancer treatment and prevent recurrence.

Other lifestyle changes that can reduce the risk of breast cancer include maintaining a healthy body weight, consuming alcohol in moderation, not smoking, and eating a diet rich in fruits and vegetables. The good news is that these changes will also help you reduce your risk of other cancers, cardiovascular disease, and most other chronic diseases, too.

Nutrition, exercise, and health information can be confusing. 
But it doesn't have to be that way.
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