Diabetes management.
Untreated, this disease will likely cause you to die sooner, and miserably.  Untreated diabetes causes blindness, deafness, cardiovascular failure and is the leading cause of lower limb amputations.  Luckily, it can be effectively managed quite well, with dedication to lifestyle changes.

Key concepts:

Eat regular, smallish meals, 3 or 4 times daily.  Keep a steady schedule for feeding to help stabilize blood sugar levels.  Each meal should have more or less equal calories from fat, complex carbohydrates and protein.  Strictly avoid refined carbohydrates.  Eat less fat if weight is an issue.  However, diabetics NEED “good” fats, from vegetables and organically raised animals.  Avoid non-organic animal products because of the toxins in their fat.  Consider the following advice, which is especially true for diabetics and those with other, nutritionally-based chronic diseases: eat like your great-grandparents did.

Beans for breakfast (lentils, black, adzuke, etc) is an excellent choice.

Diabetics need minerals (take a multi-mineral) especially magnesium, potassium and, most importantly, chromium.  Chromium (ideally picolinate) is no longer in our soil in significant quantities, nor in processed grains.  Take up to 2000 mcg daily.  5000 mcg daily has been shown to cause reversible kidney damage, so use less.  The therapeutic dose is up to 10 times higher than the commonly prescribed 200 mcg daily.

Diabetics need B vitamins — take a B multi in the 50 mg dose range (with 1000-2000 mcg for B 12)

Good snacks:
apple slices coated with cinnamon
dried cherries (another low glycemic food) with almonds
dahl

help for peripheral neuropathy:
this is a CIRCULATORY, not nerve, problem.  600 mg ALA (alpha lipoic acid) daily may help. 

Brilliantly effective is a several week course of nearly nightly (5 out of 7 nights per week) of wet sock therapy.  You need a bowl of ice water, thin cotton socks and thick wool socks.  At bedtime, soak the thin socks in ice water then wring out thoroughly.  Slip onto feet while still very cold.  Cover immediately with thick socks and go to bed.  In the morning the socks will be completely dry and the feet warm.  Repeat faithfully until full sensation in the toes is restored.

help for sugar cravings:
eat protein at every meal
again, regular meals at regular times
a little bit of dark chocolate (low sugar, often made with good fats, full of antioxidants, and, most of all, really yummy)

help for diabetic ulcers:
over-the-counter Dessitin (zinc oxide paste), or
cholorophyll poultice — apply 1 tsp chlorophyll in a clean cloth or cotton wad to ulcer twice daily until healed.

 You need daily exercise.  Think of it as moving, for fun!  Why is this so important?  Will it help regulate/lower blood sugar levels?  Yes!  Will it improve your physical appearance?  Yes!  Will it promote strength and longevity?  Yes!  But the main reason I advocate 20 minutes of fairly vigorous daily exercise is because it has the capacity to create ecstasy — your own personal Nirvana farm!  Endorphins promote a state of bliss!

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Preventing Kidney Stones:

the main therapy is hydration — do NOT let yourself get dehydrated.  Be pro-active.

also, staying on B6 (250 mg in the morning) and Magnesium (500 mg at bedtime) is almost foolproof for prevention.

plus, avoid intensive eating of high oxalate foods such as spinach and rhubarb.
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the SOY question.  Good, or bad?
Well, according to Russell Marz (owner, Onmi Nutrition, and author of superlative nutrition textbook “Medical Nutrition from Marz”), it depends…

In general, soy does not (despite claims from Joseph Mercola, DC — who often gives excellent advice — and the Price-Pottenger Foundation) cause brain shrinkage, testicular atrophy or cancer.  Soy rarely causes thyroid problems.  Soy does have a high phytate content, which can bind minerals.  These effects, which lessen over time (with ongoing soy food consumption) are largely offset by the following: soy is HIGH in non-animal protein, fiber, isoflavones, magnesium, potassium, Vitamin K (which feed good gut flora, ameliorating digestion of soy, and all other foods) and also contains some Omega 3 (”good”) oils.  Soy beans have exceptional nutritional value with relatively low calories. 

When consumed with high iodine foods (sea vegetables, fish) soy does not contribute to goiters (growths on the thyroid gland generally associated with decreased thyroid functioning).  Fermented soy is the best form of soy (natto, miso) but other commercially available soy foods (soy milk, tofutti, soy pups) can not only provide good nutrition but also medicinal components to reduce cancer risk (especially breast, prostate and colon).

Asians typically eat 15-30 grams of soy product daily.  This would be 1/2 block of tofu, or 2 glasses of soy milk, or 3 servings of miso soup, or a handfull of soy nuts.  They have relatively low rates of hormonally-induced cancers and thyroid problems.

Caution:  about 1/2 to 1 % of the US population is allergic to soy. 

 Also, one kind of soy to completely avoid (and this can be tricky) is GMO soy.  Much of the soybean crop grown in the US today (the world’s major soybean producer) is GMO, and grown with Roundup Ready seed. 

While direct evidence of GMO plants harming humans is not available, the harm is clear to both the environment and economic interests of farmers.  GMO crops create dependence on a few multinational food corporations for staple foods, as well as causing extinction of wild plants.  GMO foods are speculated to potentially harm humans by virtue of genetically modified material being taken up by our gut flora, permanently altering the DNA of the friendly bacteria that reside within our intestines.
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Vitamin D dosing
a recently published study (Gordon, CM, et al., “Treatment of Hypovitaminosis D in infants and Toddlers” J Clin Endocrin Metab. April 15, 2008: 10.1210/jc.2007-2790) summarized that giving three different therapeutic doses of Vitamin D resulted in equivalent improvements in serum Vit D (OH-25 cholecalciferol) levels.  These 3 treatment regimens were:

1) daily dose of 2,000 IU oral ergocalciferol (Vit D2, which needs to be converted to D3)
2) daily dose of 2,000 IU oral cholecalciferol (Vit D3, the “active” form)
3) weekly dose of 50,000 of oral ergocalciferol (the expensive drug, Calcitriol)

In my experience, it is best to give D3 because some folks don’t convert D2 to D3 efficiently.  Further, D3 is less expensive.  However, the 2,000 IU daily of D3 may not be enough to get serum levels up to above 50 ng/dL.  If your levels are below 32 ng/dL you may need to supplement more aggressively (10,000 IUs daily for at least a month).

Further, some clinicans and researchers are noticing that longer term (beyound 6 weeks) of high dose weekly D2 (the drug) therapy will start to reverse beneficial trends and create not only high calcium levels in the blood but ultimately a reversal in raising Vit D levels.

Another consideration for vegans maybe that D3 tends to come from fish oil whereas the D2 drug is synthetic, and not animal based.

For many years it has been standard practice for doctors to recommend bone density evaluation (with “DEXA” scans, or dual-energy X-ray absorptiometry, a special type of X-ray) around menopause because estrogen is a potent bone-builder, and estrogen begins to wane at menopause, or even before menopause. According to the National Osteoporosis Foundation, 30 million American women (and 14 million American men) have osteoporosis today. This is a preventable disease, and if not prevented can seriously compromise quality of life, and, ultimately, longevity also. The DEXA scans measure bone density at several sites and give a standardized “score” to the bone density (called the T-score). A T-score of zero (0) is perfect. Anything below zero represents bone loss. A T-score of minus 1.5 (-1.5) means osteopenia (bone loss) and a T-score of minus 2.5 (-2.5) means osteoporosis, literally “holes in the bone.” Typically doctors will offer various bone building drugs to patients with T-score approaching or below -2.5. Drugs are more controversial in the T-score range from zero to -1.5. My approach is based on good nutrition and regular weight-bearing exercise. The best time to begin to prevent bone loss is in the pre-teen years when girls are approaching their final growth spurt. At least 1000 mg of calcium daily is required to lay down enough bone to last a lifetime. This must be complexed with Magnesium (at least 500 mg) and Vitamin D (at least 400 IUs). Vitamin D has received a lot of press lately and many researchers feel that Americans living further north than 40 degrees latitude (

Q: I’m a 70-yr old female. What can I do naturally to improve my bone health and vertebrae deterioration? (H.G., Schooleys Mt., NJ)

A: Sounds like you already know that you have problems with your bones, because you have lost height (more than 2 inches from your maximum adult measurement) or have confirmed bone loss with a DEXA scan (this is a special x-ray of your low back, hip and thigh bone and sometimes arm bone or heel). The healthiest bones are flexible, not brittle, and it’s important NOT to depend on calcium alone for bone building. The highest rates of osteoporosis exist in countries where intake of dairy products is high (for example Sweden, Denmark and the US). Calcium alone will make bones brittle and MORE susceptible to breaking. This doesn’t mean calcium is bad: on the contrary, calcium is the most abundant mineral in the body and critical for strong bones. A good bone-healing multi will always contain about 600-1000 mg of Calcium, ideally in various forms (not just calcium carbonate, but also calcium citrate and malate), also a nearly equal dose of Magnesium, at least 400 IUs of Vitamin D to allow for mineral absorption, and the trace minerals boron (2-3 mg), silica (200 mcg), and strontium (300 mg). Strontium has received a lot of press lately for consideration as the single most important bone nutrient after calcium.

Carbonated soft drinks strip minerals from bones by creating a highly acidic environment in the stomach which draws alkalinizing minerals from the skeleton to neutralize the acidity. Avoid all soda pop. Bio-identical estrogen is helpful as a last resort unless you have a family history of blood clots or hormonal-type cancer.

Bones are complex, and when healthy they have an electrical charge which keeps the minerals flowing off and on the bone constantly. When a long bone is slightly bent, it creates a battery-like effect with the negatively charged minerals (sulfur, chloride) gathering on one side of the bone and positively charged minerals (calcium, magnesium) collecting on the opposite side. That’s why weight bearing exercise is important — it literally creates a healthy stress on the bones which CURVE them so they remain more lively. People on bed rest (in a hospital, for example) quickly lose bone because of lack of weight bearing exercise. So, walk every day if you can. Jump roping is even better (1000 jumps per week) if your knees and bladder can handle that!

And please don’t forget to practice your balance. You are much less likely to break a bone if you don’t fall! The one-legged yoga stances are wonderful for maintaining good balance. Try standing on one leg whenever you are standing in line, or at the kitchen stove or sink.

The group at highest risk for osteoporosis may be characterized by the post-menopausal, slender, small-boned, fair complexioned Caucasian woman. Men are also at risk, but tend to have congenitally denser bone, and sustain weight bearing exercise for longer periods. African American and Hispanic populations are much less prone than Caucasians to loss of bone density because they inherit, for the most part, a sturdier skeletal structure.

A woman’s risk of osteoporosis greatly increases after menopause because her production of the sex hormone estrogen dramatically drops off at her peak of maturity. After 50 a woman clearly has other concerns than caring for infants, and has no need to continue to maintain her endometrium for the possibility of pregnancy. It so happens that reduced estrogen results in diminished levels of active Vitamin D (crucial for calcium absorption) and in increased calcium excretion. For this reason, many physicians choose to routinely administer small doses of synthetic estrogen to mmenopausal women. Although this seems logical, it is also well known that estrogen ingestion bears many risks including increased incidence of breast, cervical and ovarian cancer. Weight bearing exercise, such as walking for 30
minutes daily or an hour 3 times weekly, plus adequate nutrition which will be discussed below, is far superior treatment, in this author’s opinion, to hormone therapy.

In addition, something that many physicians may have forgotten from biochemistry or physiology classes is that adequate stomach acid (HCl) is mandatory for calcium absorption. After the age of 40, when we no longer need to eat as much, stomach hydrochloric acid drops off naturally. If you do supplement with calcium, you may want to take a small glass of lukewarm or room-temperature water with the juice of a quarter lemon 20 minutes before each meal. And please make sure to use a bioavailable form of calcium. Calcium citrate is the state-of-the-art way to deliver calcium supplements. Calcium carbonate (such as in TUMS) is very inefficient. “About 45% of the calcium is absorbed from calcium citrate in patients with reduced stomach acid, compared to 4% absorption from calcium carbonate.” (Recker R., “Calcium absorpption and achlorhydria.” New England Journal of Medicine, 1985, 313, pp 70-73)

Coffee, more than 2 ounces of alcohol daily, and smoking all deplete serum calcium and are associated with an increased risk of developing osteoporosis. (Heaney, R., “Nutritional factors and estrogen in age-related bone loss.” Clin. Invest. Med., 1981, 5, pp 147-155) One of the worst offenders in osteoporsis is high-phosphate drinks such as soda pops. Serum phosphates compete with calcium in the blood for cellular absorption. Other dietary implications in osteoporosis are excessive protein (we rarely need more than 2 ounces daily) and trace mineral deficiencies. Complex carbohydrates turn out to be culprits, once again: After ingesting sugar, urine calcium increases. Vegetarian diets are associated with a lower risk of osteoposis because they eat less dense protein (and no mammalian protein) and probably consume less phosphorus and more bioavailable calcium from leafy green vegetables and colorful fruits, particularly berries. (Thom J., Morris J., Bishop A., Blacklock NJ, “The influence of refined carbohydrate on urinary calcium excretion,” British Journal of Urology, 1978, 50, pp 459-464.) The so-called “anthocyanadins” (a
class of dark blue and red, highly nutritious pigments found in berries) have a remarkable ability to stabilize collagen, including that found in bone matrix.

The best approach to preventing, and treating, osteoporosis is a comprehensive plan that incolves regular weight-bearing exercise, a good source of calcium and Vitamin D (as well as magnesium, B6, folic acid, B12, Vitamin K and trace minerals boron and strontium), botanical medicines for women with estrogen deficiency or in menopause, and a vegetarian diet.

Great juicing sources of

Calcium:
alfalfa, comfrey leaves, dandelion leaves, nettle leaves, parsley, mustard greens, red clover flowers, collard greens, kale, broccoli (best is lightly steamed first), cooked garbanzo and soy beans.

Vitamin D:
Sunshine (not necessary to put through the hopper), alfalfa, watercress, nettles.

Flavonoids (to stabilise collagen structures):
Blackberries, blueberries, cherries, raspberries, salmonberries.

If you suspect you may have, or be heading towards, osteoporosis, or know someone who is concerned about the disease, please consult a medical professional. The naturopathic physician or nutritionist will be the most skilled at dietary counselling. To find the closest naturopathic physician or nutrionist trained in biochemistry and physiology please call the American Association of Naturopathic Physicians at (206) 326-1612.

References (other than those speicifically indicated)

• Wm McGarey, “Osteoporosis: The silent disease,” Patient Care, 1988, 5, pp 191-194
• M Murray, J Pizzorno, “Encyclopedia of Natural Medicine,” Prima Publishing, Rocklin CA 95677

Q: I’m 50 and starting the “change of life.” I’m very upset that I can’t make a decision about whether or not to take hormones. If I don’t take hormones maybe my bones will all shatter. But if I do take hormones maybe I’ll get uterine cancer. So maybe I should get a hysterectomy. But I could still get breast cancer. Help!

A: These days, the post-menopausal phase may well be the longest of women’s increasingly longer lives. They may well live another 50 years without menstruating. Which is, of course, why estrogen replacement therapy, breast and uterine cancer, osteoporosis and the spectre of fractured hips are all enormously important topics about which every woman must make decisions.

There are 3 types of estrogen:

E1/Estrone is the most carcinogenic form of estrogen; it increases at menopause. It is formed mainly in the adrenals and ovaries. It is difficult for the liver to break it down.

E2/Estradiol is the most active form of estrogen; it’s what the patches and Premarin are made from. Oral Estradiol (i.e. Premarin) turns into Estrone in the small intestine. Estradiol is secreted by the ovaries. The body recognizes and metabolizes it easily.

E3/Estriol is the least active form of estrogen; current research suggests it may be ANTI-carcinogenic. This is the form of estrogen used in Europe and China for menopausal hormone replacement. Two to 4 mg of estriol is equivalent to the minimal dose of estrone – 0.6 to 1.25 – the dose taken by most women on ERT. (Currently most women deciding about hormone replacement therapy are making choices that include progesterone; the therapy is now known as HRT.) Estriol is formed in the liver.

The task of the wild and lively crone is to prevent degenerative
disease, reduce the risk of cancer as much as is known how, continue to take care of skin, exercise and sleep regularly, maintain good functional bowel habits, plus two additional and critically important categories. These are cardio vascular protection (heart disease is the number one killer of both men and women) and maintenance of bone density. These issues will be briefly discussed here one by one.

First, some MYTHS about Estrogen Replacement Therapy (ERT) and Hormone Replacement Therapy (HRT):

• prevents aging of the skin
• prevents bladder or urinary problems
• relieves depression or other psychological symptoms
• increases sexual desire
• prevents heart disease

Some doctors recommend estrogen for all women (except those with a history of breast or cervical cancer, or heart attack, stroke, liver disease, or unexplained vaginal bleeding) at menopause, to continue for the rest of their lives. Routine use of these powerful and potentially dangerous hormones on healthy women is often unwarranted.

In general, ERT should only be used by women who have had their uterus removed. Estrogen does play a role in preventing osteoporosis — a thinning of the bones that can lead to fractures of the vertebrae and hips in later life. Estrogen may also be effective in preventing heart disease, which is more prevalent in women who have early menopause. Its usefulness for healthy women who have gone through a normal menopause is unclear. Young women take note: Prolonged use of the “pill” (low dose estrogen/progesterone for birth control) will likely increase a physiologic need for estrogen later in life. This is because the organs which naturally produce female homones (primarily the ovaries, but also the adrenal glands, and the liver which synthesizes and breaks them down) will atrophy and become less functional when an outside source of hormones is taken. Explore other ways to control fertility or menstrual irregularity, please.

What is clear is that estrogen causes cancer of the uterus – 5 to 14 times as often in women who take it as in women who don’t. It is also strongly associated with an increased risk of breast cancer. When taken with progestins, the increased risk of uterine cancer is canceled out. However, the addition of progestins to estrogen for HRT may raise the breast cancer risk even further. It may also cancel out estrogen’s protection against heart disease — or it may even increase that risk. Current research suggests that progestins alone, especially non-synthetic creams based on the Mexican wild yam, Dioscorea, may be more effective than estrogen in reducing the risk of osteoporosis, without the increased risk of uterine or breast cancer. More research is needed here.

Women who are plagued by hot flashes can benefit from short term use (maximum of two years) of HRT, tapered off very slowly. Suddenly stopping therapy will cause a return of the hot flashes. Women who suffer from vaginal dryness, who do not respond to increased Vitamin E and essential fatty acids (such as Flax oil), can use estrogen, applied directly in cream form. It should be used only as often as necessary to correct the condition.

Bottom line based on what we know today: Women who are not at high risk for osteoporosis need not expose themselves to the unknown risks of long term HRT.

RISK FACTORS FOR OSTEOPOROSIS:

• family history of osteoporosis or hip fractures
• ovaries removed especially before age 40
• no full-term preganancies
• small-boned, thin Caucasian or Asian women
• fair-skinned women
• sedentary lifestyle
• smoking
• drinking more than moderately
• diet high in salt, animal protein, caffeine, soft drinks
• diet low in calcium and vitamin D
• hyperthyroidism, kidney disease, gastrectomy, long-term use of steroids, glucocorticoids, anticonvulsants or antacids

The best way to maintain healthy bones may include some form of
progesterone, and possibly estrogen replacement, either by synthetic hormones or plant medicines to potentiate the adrenals and maintain ovarian function. Other than progesterone and estrogen, healthy bones need weight-bearing exercise regularly. The very best kind is brisk walking, 1-4 miles daily depending on stamina. The reason weight-bearing exercise is so important in maintaining bone density is because the molecular components of the bone float on and off continuously creating an electrical current which renders the bone not only a structural support, but an electro-magnetic sensing system for the body. Appropriate physical stress increases bone formation.

There are, in addition, a number of nutrients which comprise the ingredients for healthy bones, which should be taken as supplements. These include, of course, Calcium — about 500 mg daily, preferably in the gluconate or carbonate form, and Magnesium (oxide) in an equal amount. Calcium absorption requires sufficient gastric HCl. Calcium and Magnesium are best taken at night, as they are smooth muscle relaxants. Vitamin D is also important for keeping bones hard (not brittle) especially for people who don’t live in sunny climes. Boron is a critical trace mineral as is hydroxy appatite (responsible for the crystalline formation in long bones). Make sure to ingestsufficient protein and avoid phosphates (soda pop – use fresh juices instead). Barbitruates and steroids (such as Prednisone) inhibit calcium and Vitamin D absorbtion. Herbal bone protectors include Red Clover flowers, Marshmallow root, and Horsetail reeds.

Heart disease is another complex topic, inlcuding congestive heart
disease, angina, coronary artery disease, and myocardial infarction. There can be different problems with the valves of the heart, or the electrical conduction system, or the blood supply to and from the heart, or the pumping action of the four muscular chambers. In general it is crucial to avoid substances and conditions which are toxic to the heart. These include hard alcohol (any amount), excess weight, tobacco, uncontrolled infections and unrelenting stress. Nutrients which support optimal cardiac function include the amino acids Carnitine and Taurine (2 g daily), the enzyme CoQ10, vitamins C, E, B1, B3 and B6, elemental Magnesium (1 gm daily) and the botanicals Hawthorn berry (Crataegus oxycantha), Gingko biloba leaf, Cactus (whole plant) and Lily of the Valley (Convallaria majalis).

Please note that each person is completely individual and the best approach to optimal health by route of a clean diet and wisely chosen supplements is to start a relationship with a trusted licensed primary health care provider. Many medical doctors are under-educated in the field of nutrition and nutritional supplements. Finding and maintaining optimal health is a life-long commitment. Stay flexible and keep up with the news.

I urge you to join the National Women’s Health Network to help monitor research and bring accurate information to all women. “Taking Hormones and Women’s Health: Choices, Risks and Benefits” is a readable, detailed 35 page booklet summarizing all the latest studies on ERT and HRT. To receive a copy of this booklet, send $7.50 to NWHN, 1325 G Street NW, Washington, DC 20005.