Diabetes Defeated by Diet: How New Fresh-Food Prescriptions are Beating Pricey Drugs

I have been teaching my clients how to heal from diabetes through nutrition for 20+ years.  It is not that hard.

  • Spending on diabetes drugs in the U.S. reached $53.7 billion last year, more than double what it was in 2013.
  • Roughly 100 million Americans have diabetes or prediabetes.
  • The Fresh Food Farmacy program, being tested by Geisinger Health System in Pennsylvania, which includes education and free nutritious meals, can lower diabetes treatment costs by 80 percent.
  • The high-fat, low-carbohydrate ketogenic diet is being used by new health-care start-up Virta Health, which aims to treat 100 million patients by 2025.

At first glance Sami Inkinen, an elite triathlete and co-founder of the real estate company Trulia, and Rita Perkins, a grandmother of eight in central Pennsylvania, have little in common.

But they do share one thing: Both have grappled with diabetes.

“I thought, This is absolutely nuts,” Inkinen recalled of his diagnosis with prediabetes. “It was really a personal experience and a shocking experience that a world-class triathlete can become type 2 diabetic or prediabetic.”

For Perkins it was less of a surprise. Diabetes ran in her family, she said, and her weight had reached 300 pounds before she lost about 100 just through increased walking. But her diet was still bad, and she struggled to control her blood sugar.

Now things have turned around for both Perkins and Inkinen. And their paths were both through food.

In Shamokin, Pennsylvania, about 75 miles northwest of Allentown, Geisinger Health System is trying something new for some of its diabetes patients.

Instead of relying solely on drugs to manage the disease, doctors are writing prescriptions for certain patients to enter its Fresh Food Farmacy program: 15 hours of education about diabetes and healthier living, followed by 10 free nutritious meals a week for participants and their families.

Dietitian Anna Ziegler selects fresh produce for a Fresh Food Farmacy patient.

Geisinger

Dietitian Anna Ziegler selects fresh produce for a Fresh Food Farmacy patient.

“In health care we spend an awful lot on drugs and devices because it’s business,” said Dr. Andrea Feinberg, Geisinger’s medical director of health and wellness. “But we spend a very small amount on preventive medicine. … It’s sort of like we’re upside down and backward.”

The program targets people with diabetes and food insecurity, those for whom it’s not always clear where the next meal will come from.

“We understand the relationship of food insecurity and the impact that poverty has on developing certain lifestyle conditions, like type 2 diabetes,” Feinberg said. She added that the goal is “to diminish complications of diabetes and also close the meal gap to end hunger.”

The program, started 18 months ago, is a partnership with the Pennsylvania Food Bank. So far, it’s enrolled 150 patients, feeding a total of about 450 people a week.

Rita Perkins, her husband and three grandchildren who live with them are among those families. For Perkins the program has been transformative.

Each week, she visits the Farmacy and picks out food with guidance from a nutritionist. Perkins said the food, along with what she learned in the course about managing diabetes, has changed not just her approach to eating but also her family’s.

“Before, I’d never buy this stuff; I would never buy fresh fruit,” Perkins recalled. “Money was tight. And now since I get this stuff for free, I can put it on the table for the kids.”

Since she started the program, Perkins said her weight has dropped to 134 from 179. She walks all over town and said her doctors are evaluating the doses of her diabetes medications. Her blood sugar, measured by an A1C test, has been a steady 5.8 percent for the last six months (normal A1C, according to the National Institutes of Health, is below 5.7 percent).

“If a new diabetes drug became available that could double the effectiveness of glucose control, it would likely be priced considerably higher than $6 per week (and if it wasn’t, the pharmaceutical firm’s stockholders would be in revolt).”-Andrea Feinberg , Geisinger’s medical director of health and wellness

Those results aren’t atypical. On average, patients in the program have seen their A1C levels drop from a pre-enrollment level of 9.6 percent to 7.5 percent, Feinberg and colleagues wrote in an April article in NEJM Catalyst that they called “Prescribing Food as a Specialty Drug.”

“Clinically, we see great outcomes,” Feinberg told CNBC. “The impact is that we really know long-term that we’ll see a decrease in incidence of heart disease, the No. 1 killer here in the United States, because if you improve the diabetes, improve your cardiac risk factors, you have less heart disease as well.”

The program also should save money. With operational costs of $2,400 per patient each year, early findings show costs for patients in Geisinger Health Plan dropped by 80 percent: from an average of $240,000 per member per year, to $48,000 per member per year.

“If a new diabetes drug became available that could double the effectiveness of glucose control, it would likely be priced considerably higher than $6 per week (and if it wasn’t, the pharmaceutical firm’s stockholders would be in revolt),” Feinberg and her colleagues wrote.

Indeed, spending on diabetes drugs in the United States reached $53.7 billion last year, more than double what it was in 2013. The number of prescriptions in that time rose 18 percent, to 227 million, according to data from industry researcher IQVIA.

Ketogenic diet led to drop in blood glucose, weight and drug usage

Almost 3,000 miles away, in San Francisco, Inkinen got his startling diagnosis: He was pre-diabetic even as he set records in endurance sports (in 2014 he and his wife rowed across the Pacific Ocean, from California to Hawaii, he said on his blog: 2,750 miles in 45 days and 3 hours, setting a speed world record for two people.)

His solution? The ketogenic diet, a high-fat, low-carbohydrate way of eating that’s enraptured many in Silicon Valley.

“There is a way to reduce insulin resistance without exercise, without dieting or without bariatric surgery, using the traditional ketosis,” Inkinen told CNBC. “But to deliver this type of treatment, you would need technology and the ability to continuously monitor and deliver care.”

Inkinen’s online real estate information company, Trulia, was sold in 2014 to Zillow for $3.5 billion. So naturally, the next step for Inkinen was to start a new company. He teamed with a doctor and a scientist, Stephen Phinney and Jeff Volek, and founded Virta Health.

Virta connects patients virtually with doctors and coaches who help tailor the ketogenic diet to their lifestyles and monitor certain biomarkers daily.

In a trial of about 260 patients, published last year in JMIR Diabetes, Virta’s treatment led to reductions in blood glucose, weight and use of diabetes medication after 10 weeks. After a year A1C levels were down an average of 1.3 percent, diabetes medication usage was down 48 percent, and body weight was down 12 percent.

To cardiologist Ethan Weiss, who sits on Virta’s scientific advisory board, the outcomes are strong enough to recommend the program to his patients.

“For people with type 2 diabetes headed toward bariatric surgery, to have this result, that they’re coming off almost all insulin, coming down on almost all other diabetes medicines, losing weight, feeling like they control their diet, I think it’s an awesome thing to recommend,” said Weiss, an associate professor of medicine at the University of California San Francisco.

While most of the metrics move dramatically in the right direction — Inkinen says 60 percent of patients see their diabetes reversed in a span of between two and nine months — Weiss notes one data point that may not. Levels of LDL, or so-called bad cholesterol, appear to rise on the ketogenic diet. But he notes a distinction in the type of LDL that goes up, saying it may not be the type that leads to clogged arteries. And he says LDL levels can be controlled with drugs called statins, like Lipitor, if that’s a concern (though he said to him it’s not).

Virta’s program, which costs $370 a month after a $500 initiation fee if patients pay out of pocket, also saves money, according to Inkinen, who estimates an average savings of $9,600 per patient in the first 24 months in drug and medical costs. After the first year the cost drops to $199 a month.

The company is working to expand to more coverage from insurers and employers, with the goal of reversing diabetes in 100 million people by 2025.

That’s about the number of Americans with diabetes or prediabetes, according to the Centers for Disease Control and Prevention.

As usage — and costs — of diabetes medicines rise, both Geisinger and Virta are showing that food, along with a healthy dose of education and support, can go a long way in changing the course of this disease.


THAI MANGO AVOCADO SALAD

THAI MANGO AVOCADO SALAD - an easy, light, gluten free salad perfect for the summer! Filled with fresh mango, red pepper, avocado, and a light sesame vinaigrette to bring everything together!

Dressing;

1/2 cup seasoned rice vinegar
1 tablespoon black sesame seeds
1 small clove garlic, minced
1 tablespoon Dijon mustard
1 tablespoons soy sauce
1/4 cup olive  oil
2 tablespoons sesame oil
pinch of salt
1/4 teaspoon fresh cracked black pepper

Salad;

1 large mango, julienned

1 red pepper, julienned

1 avocado, diced

1/4 cup diced cashews, roasted and unsalted

1/4 cup diced fresh cilantro

 

1. In a small bowl, add lime juice, sesame oil, maple syrup, tamari, and sriracha. Using a whisk, stir until combined and oil no longer separates. Set aside.

2. To a medium bowl, add mango, red pepper, avocado, cashews, and fresh cilantro. Pour the sauce over the mango salad and gently toss using two spoons.

Serve immediately.


Crab Tabouli with Quinoa

crab Tabouli

I demonstrated this dish in cooking class one night and my students took one look at the recipe and said they would never make it; too many ingredients!. But after tasting it they agreed that this dish was REALLY worth the effort!!

Serves 4

1 cup quinoa
3 cup boiling water
1 tart apple2 Roma tomatoes-  diced small
1 medium cucumber-  diced small
3 whole scallions-  sliced thin on diagonal
1 yellow tomato- small diced
2 Tablespoons chopped spearmint
2 Tablespoons chopped basil
1/3 cup sliced black olives
1/2 cup fresh mayonnaise
2 Tablespoons lemon juice
1 pound lump crabmeat
salt and pepper

1)  Toast quinoa on stovetop, in heavy skillet, shaking pan, until lightly browned. transfer to a bowl, pour in boiling water, cover tightly and let sit for about and hour. Or you can simmer on low until liquid is completely absorbed.  Drain and cool.

2)  Combine all ingredients except crab. fold in crab and season to taste. Cover and refrigerate for 2-4 hours.


Salmon Soba Noodle Bowl with Asparagus, Shiitakes, and Egg

On the menu, for delivery tomorrow!

Soba Noodle Bowl with Asparagus, Shiitakes, Egg and Kimchi

Serves 4

For the soba noodles:

4- 6 ounce salmon filets

1 1/2 cups tahini

6 Tbs. fresh lime juice

4 Tbs. Coconut Aminos- (soy-free soy sauce)

4 Tbs. honey

2 Tbs. toasted sesame oil

2 garlic cloves, minced

Kosher salt and freshly ground pepper

10 oz. dried soba noodles

For the vegetables:

6 Tbs. Sesame oil

1 bunch asparagus, trimmed and cut into 3-inch pieces

2 Tbs. Coconut Aminos- (soy-free soy sauce)

2 heads Bok choy, leaves separated, cut into 3-inch pieces

1 1/2 lb. shiitake mushrooms, brushed clean, stemmed and sliced

Kosher salt

For serving:

4 hard- or soft-cooked eggs

1 cup (4 oz./125 g) kimchi

1/2 cup (1 1/2 oz./45 g) sliced green onions

3 Tbs. sesame seeds (I used Gamasio)

1. To make the soba noodles, in a bowl, whisk together the tahini, lime juice, soy sauce, honey, oil, garlic and 3 Tbs. water. Season with salt and pepper. Set aside. Cook the soba noodles according to the package instructions. Drain, transfer to a large bowl and set aside.

2. To make the vegetables, in a large fry pan over medium-high heat, warm 2 Tbs. of the oil. Add the asparagus and cook, stirring occasionally, until browned, about 7 minutes. Add 1 Tbs. of the soy sauce and cook for 1 minute longer. Transfer to a plate and cover loosely with aluminum foil.

3. In the same pan over medium-high heat, warm another 2 Tbs. of the oil. Add the Bok Choy and cook, stirring occasionally, until browned, about 5 minutes. Add the remaining 1 Tbs. soy sauce and cook for 1 minute longer. Transfer to a plate and cover loosely with foil.

4. In the same pan over medium-high heat, warm the remaining 2 Tbs. oil. Add the mushrooms and cook, stirring occasionally, until browned and tender, about 6 to 8 minutes. Season with salt. Set aside.

5.   In the same pan, sear salmon (salt and pepper on on both sides) in butter and sesame oil about 4 minutes on each side.

5. Peel and halve the eggs lengthwise.

6. Add the tahini dressing to the noodles, thinning the dressing with 1 to 2 Tbs. of water if needed. Toss the noodles to coat, and divide among 4 bowls. Top with the vegetables, salmon, eggs, and kimchi. Garnish with the green onions and sesame seeds and serve immediately. Serves 4.


Berries Stimulate Cancer-Fighting Enzyme

Bowl of Blueberries

Raspberries, blueberries, and other berries contain natural pigments known as anthocyanins which give them their deep color. Numerous studies show that anthocyanins fight the inflammation that leads to aging.  A new study from the University of Eastern Finland shows that anthocyanins increase the function of an enzyme in cancer cells that fights cancer called sirtuin 6 enzyme (SIRT6).

Sirtuins are enzymes that regulate the expression of genes that control the function of cells through key cellular signaling pathways. Aging causes changes in the function of sirtuin, and these changes contribute to the development of various diseases.

“The most interesting results of our study relate to cyanidin, which is an anthocyanin found abundantly in wild bilberry, blackcurrant and lingonberry,” says the study’s lead author Minna Rahnasto-Rilla.

Cyanidin increased SIRT6 enzyme levels in human colorectal cancer cells. The researchers also found it decreased the expression of two cancer genes — Twist1 and GLUT1. At the same time, cyanidin increased the expression of the tumor-suppressing FoXO3 gene in cells.

The findings that anthocyanins increase the activation of SIRT6 lays the foundation for the development of new cancer drugs.

The study’s findings were published in Scientific Reports.

A 2017 study published in the Journal of Nutritional Biochemistry found that pigs fed a high-calorie diet supplemented with purple potatoes, which are high in anthocyanins, lowered their risk of developing colon cancer. Pigs fed purple potatoes had levels of an inflammatory protein called interleukin-6 that were six times lower than that of pigs on a regular high-fat diet. Interleukin-6 is associated with the development of cancer.

The study authors suggested that a daily cup of fresh or frozen berries fights the inflammation that leads to aging.

A study from the U.K.’s University of East Anglia found that people who ate the most blueberries and strawberries — three or more servings a week — reduced their risk of a heart attack by a third when compared to women who ate berries once a month or less. Experts believe berries’ heart-healthy effects are due to anthocyanins, which help prevent the buildup of plaque in arteries.

© 2018 NewsmaxHealth.


Need a Reason to Lift Weights? Pumping Iron Might Cut Early-Death Risk by Nearly Half

image

The list of reasons you should start lifting weights just keeps on growing: Not only does strength training help you create a body that’s toned and defined, but it also assists in preventing osteoporosis, combatting depression, and reducing pain. But one study outlined another important benefit: The activity can help you live longer.

Researchers found that those who pumped iron cut their early-death risk by a whopping 46 percent.

For the study published in the journal Preventative Medicine, researchers tracked 30,162 adults aged 65 and older for 15 years, and 9.6 percent of them (about 2,900) strength-trained regularly. Researchers found that those who pumped iron cut their early-death risk by a whopping 46 percent, and the results remained true even after taking in account participants’ past medical history and health behaviors.

Strength training obviously keeps your muscles strong, which gives you better stamina and balance, and also increases bone density—all things that can reduce your risk of falls and fractures, according to study co-author Dr. Jennifer Kraschnewski.

Study co-author Jennifer Kraschnewski, MD, told Men’s Health that there’s a simple explanation: Strength training obviously keeps your muscles strong, which gives you better stamina and balance, and also increases bone density—all things that can reduce your risk of falls and fractures. And that’s important to note since 2.8 million people aged 65 and older are treated in emergency departments for fall injuries every year.

Even better, you don’t need to turn into a professional bodybuilder to live a longer life: The study participants strength-trained twice a week, and doing so gave them a 41 percent decreased risk of cardiac death and a 19 percent decreased risk of dying from cancer, according to the press release.

Well, strength-training certainly carries a lot of…weight, but this celebrity trainer’s advice can help you get into a routine if you’re new to lifting.


Roasted Bananas with Poached Red Grapefruit

 image          

This simple dish is very elegant and is one of my all time favorite desserts.  Great for breakfast also!         

Serving Size : 4

2 large red grapefruit — sectioned

1 large red grapefruit — juice only

2 tablespoons lemon juice

2 lemons — zested

4 large bananas — ripe

1 tablespoon honey

 

1) Peel grapefruit over bowl to retain juice. Carefully section grapefruit so as not to break the sections.

2) Pour all the juice into a saucepan with the lemon juice, honey and lemon zest. simmer until it is reduced in half.

3) Turn off heat, allow to cool for 5 minutes. place grapefruit sections in pan with warm juice and toss.

4) Preheat oven to 500°. Peel bananas and slice once lengthwise. Place in glass baking dish. roast approximately 3-4 minutes, until bananas are fairly soft.

5) to serve, place bananas with some of the juice that cooked out of them into a shallow bowl and spoon grapefruit sections with juice over the bananas.