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What’s New! – A Healthy Living Newsletter

December, 2002
My patients frequently ask my opinion about new health books on the market. And there's certainly no shortage of experts peddling their advice! While many of these books are excellent, others are written by people who don't have a clinical background in the subject. Simply put - they're inaccurate.

The people writing the books either don't regularly use the medicines they write about or they're presenting theories as if they are facts. Others can be valuable tools for improving the quality of your life.

If you find this newsletter useful, please forward it to a friend!

Type 2 Diabetes in Teens

Jean Betschart-Roemer, M.S.N., C.P.N.P., and C.D.E.
(masters in nutrition, nurse practitioner, and diabetes educator)

Many years ago, when I was a student doctor, a teenage girl with diabetes came into the clinic where I was working. Despite her family history of diabetic complications including blindness and limb amputation, she refused to take insulin or monitor her disease in any way. I remember earnestly spouting a sermon of the consequences in ignoring her disease. She, fairly bored with yet another repetition of this sermon, looked me in the face and said "I don't care, it's too hard and I'm a teen - and that's what hospitals are for."

So, I was pretty excited when I read the title of this book. Did Type 2 Diabetes in Teens contain the magic words to help this teen and the millions like her? The answer is yes and no. Author Betschart-Roemer starts off with a clear and simple description of diabetes. It is probably the most layperson-friendly description I have ever read. A diabetic herself, she states "the goal is to fit diabetes into your life, not to have your life revolve around diabetes". Wonderful sentiment. It is quickly undermined by the goal of the book: teaching teens how to maintain a good diet, a weight loss program, an exercise program, daily blood glucose monitoring, drug taking, possible daily insulin injections and understanding lab tests. Yet, it's a really good book - in theory.

She writes about changing taste buds as the teen starts eating a healthier diet. She recommends massing a team of family, friends, and teachers to support the teenager in maintaining control of the condition - and more importantly, what to do, if the blood sugar goes too low. She gives advice on how to tell friends and potential dates about diabetes without sounding an alarm. And she offers decent suggestions on how to deal with well-meaning friends and relatives who offer desserts as they murmur soothingly, "just a little piece won't hurt".

But she doesn't mention that daily glucose monitoring can be painful and inconvenient. And she doesn't write about how hard it is to conform to any sort of diet in public. For example, when discussing eating out, the author suggests asking the waitress to help identify ingredients in the food and to make cooking changes such as broiling the fish in butter and having the sauce served on the side. In the real world, teenage kids eat at fast food places in which the food is uniform and there are few options. It might have been more helpful if they were advised to eat burritos, hold the rice, at the Mexican taco-type restaurants.

Similarly, in the examples in her book of teenagers with diabetes, the whole family changes the way they eat to accommodate the diabetic member. It might be better to give examples of what to eat when the rest of your family is sitting down to macaroni and cheese - and you can't eat it. I also thought the book strayed a bit from the topic of diabetes when it launched into safe sex. Or when it compared the various popular diets. There is no fad about eating and diabetes. The diabetic diet is a fairly controlled low-carb, low-fat diet. It was almost as if Betschart-Roemer wanted to fill pages in her book. It would have been better if she left the page count to 150 - a more suitable reflection of the average teenager's attention span on a less-than exciting subject.

As a naturopath, my biggest criticism is her paltry explanation of the value of food - in particular beans and fiber. Beans are given 1 word in the book even though there are multiple studies demonstrating the measurable effect of beans on reducing blood glucose counts.

Type 2 diabetes is epidemic in the United States. The American Diabetic Association posted a 17.4 million figure which many in the medical field feel is very conservative. Many people, of all ages, can be diabetics for years before diagnosis. There is no pain with the symptoms and they just don't realize that they have a disease. Take teenagers - what teenager is going to report frequent urination, extreme thirst, unexpected bouts of hunger and possibly a sore that heals slowly? So this book is really needed. And for the most part, Betschart-Roemer does a great job. However, I doubt that many newly diagnosed teenagers will find the book on their own. If you know of any children in this category, give the book to them and to their parents.


The Soy Solution for Menopause

The Estrogen Alternative
Machelle Siebel, M.D.

Since the July 2002 Journal of American Medical Association (JAMA) article about HRT (hormonal replacement therapy) and menopause, there has been a media blitz in the U.S. capitalizing on the significant health risks of long-term HRT for women during menopause. Many authors have come forward offering alternatives for the treatment of menopausal symptoms. Some of them conjure up unviable solutions, while others suggest a new look at decades of research on natural medicine. Happily, The Soy Solution for Menopause is in the latter category. And even better, it discusses the benefits of soy for more than just menopause.

Author Siebel explains the conventional approach for the treatment of perimenopause (the symptomatic period prior to the menses actually stopping) with a telling remark. "Unfortunately, probably half of the women seeking medical help for the early symptoms of perimenopause are given a sedative for their anxiety…" Of course, after a few years when the symptoms are more definitive of menopause, the woman is offered HRT. And those were the choices in the conventional medical model: sedatives, HRT, or doing nothing and suffering. Women, spurred by hot flashes, mood swings, and the desire to feel a bit more like themselves again, explored the natural medicine options on their own. Therefore, The Soy Solution is not treading on virgin territory here. Instead it offers an extensive explanation of why soy is good for you including 40+ pages of references as proof.

For example, 85% of American and 70-80% of European women get hot flashes. This is much more than the 14% of soy-eating Japanese women. Similarly, Siebel explains the benefits of soy's protective nature from heart disease, osteoporosis, diabetes II, thyroid dysfunction, vaginal dryness, and many types of cancers.

One of the things I really liked about this book was a listing of the warning signs of osteoporosis. There is a U.S. pharmaceutical company that frequently airs a commercial on a drug for osteoporosis in which they uncategorically state that there are no warning signs for the condition. I guess Siebel didn't agree with the commercial as he lists the warning signs in his book: chronic low back pain, loss of height, breaking a hip with minimal trauma or any other bone with no trauma, leg cramps at night, joint pain, tooth loss, and periodontal (gum) disease. This is incredibly important as women get both genetic clues from the posture of their mothers, grandmothers and aunts as well as these physical signs to indicate the early, and possibly reversible stages of osteoporosis. "A 50-year-old white postmenopausal woman has the identical risk of one day dying from a fracture related to osteoporosis as she does dying from breast cancer."

The Soy Solution delves into the specific components of soy: genistein, and daidzein, the two phytoestrogens that have been studied the most. Genistein slows down bone loss and builds new bones as well as decreases blood clot formation. In fact, genistein is so beneficial, that those nice folks in the vitamin and pharmaceutical industries developed a pill that will accomplish the same thing as eating the food. And that is where I get less than enthusiastic.

By isolating a component of soy, you do two things: first, you make a drug-like product with the potential of side-effects and second, you ignore the synergy of the whole food. Genistein and daidzein aren't the only important constituents of soy; we just haven't isolated and/or studied the others to the same degree. We are in danger of repeating the same mistake that we made close to 100 years ago. The fledgling pharmaceutical companies of the early 1900s explored herbs and healthy food, isolated components and voila - created the pharmaceutical industry that exists today. I'm not arguing that some drugs haven't been enormously beneficial to modern man. I'm arguing that modern man has forgotten the need for a healthy diet and lifestyle based on the misplaced confidence that drugs will fix everything. Scientific studies have demonstrated that soy in its whole food form has significant benefits for the menopausal woman. Why create the potential for adverse side-effects with isolated components? The vitamin and pharmaceutical companies promoting genistein reply with a single word - taste. Evidently, some people find soy hard to eat.

Despite the author's affirmation that soy in its whole food form is preferable to a pill form, The Soy Solution makes a tiny unconvincing stab at showing the reader how to incorporate soy into their diet. However as someone who has eaten a steady diet of soy for close to 30 years, I find that it's amazingly versatile and can be easily adapted to any food taste from Cajun, to Indian, to Thai, to Italian to American barbecue. How can you argue with the multitude of countries in which soy has been a staple for hundreds of years?

So how much should you eat? If you ate ¼ cup of beans or soynuts, 1 cup of soy milk, or ¼ lb of tofu or tempeh daily, you are pretty much covered. But before you head off to the store, remember that there is one major problem with soy that the author didn't mention. Soy is in the top ten foods in the U.S. to which people are or can become allergic. And where does that leave us? Back on my soap box with Seibel, preaching the need for a varied diet of whole foods and exercise. Genistein can be found in many other beans such as garbanzo beans (the wonderful bean that Middle Eastern hummus is made from). So, eat your soy, but eat your cabbage, broccoli, garbanzos, lentils, mung beans and navy beans as well.

Herb & Health Tip: Recently one of my patients forwarded an email on to me that has been circulating on the Internet and creating some confusion as to the safety of herbs. The email is lengthy, so I decided to address one component of it at a time.

First, an excerpt from the email:
"Although natural, and therefore popularly considered harmless, herbal supplements contain active ingredients that may not safely mix with prescription or over-the-counter (OTC) drugs. Tell your doctor about any herbal supplements you take.

In addition, some medical problems may increase your risk of adverse effects if you take herbal products. Talk to your doctor before taking any herbal products if you're pregnant or nursing or have any of the following medical conditions: high blood pressure, thyroid problems, depression or other psychiatric problems, Parkinson's disease, enlarged prostate gland, blood-clotting problem, diabetes, heart disease, epilepsy, glaucoma, history of stroke or history of transplant.

Here are 10 herbs and the prescription and OTC drugs you shouldn't mix them with:

Feverfew, garlic, ginger, ginkgo

Avoid mixing with: Aspirin, Ticlopidine (Ticlid), Clopidogrel (Plavix), Dipyridamole (Persantine) and Warfarin (Coumadin).

These herbs may augment the anticoagulant effect of these drugs and may cause spontaneous and excessive bleeding."

My reply:

This statement is entirely correct. These particular herbs have blood-thinning properties that if mixed with these drugs could lead to spontaneous and excessive bleeding.

Having said that, I will also state that these herbs are also incredibly beneficial. Take garlic. Garlic has antibacterial, anti-fungal, anti-viral and anti-cancerous properties. Why would anyone want to avoid a beneficial herb like this? Instead, I would tell my physician that garlic is part of my diet and what would s/he recommend in terms of reducing my prescription medicine a little to accommodate that dietary choice.

Similarly, ginger has substantial scientific research supporting its anti-inflammatory properties. Some of this research includes positive double-blinded studies against prescription anti-inflammatory drugs. Feverfew is another anti-inflammatory herb that has a history of nontoxic prophylactic use for some cases of migraine headaches. If someone is controlling their migraines with feverfew, but also takes a blood thinner such as the ones mentioned above, talk to your physician about reducing the dosage of the prescription medication.

Aspirin, Ticlopidine (Ticlid), Clopidogrel (Plavix), Dipyridamole (Persantine) and Warfarin (Coumadin) are anti-coagulant (blood thinning) drugs most commonly used in serious cardiovascular conditions such as strokes, intermittent claudication, and a history of heart attacks. The most common side-effects range from headaches, dizziness, skin rashes (clopidogrel) to headache, dizziness, gastrointestinal distress, fatal and nonfatal heart attacks, and respiratory spasms (dipyridamole) to diarrhea, nausea, vomiting, abdominal pain, blood disorders and phlebitis (ticlopidine) to nausea, hair loss in patches, hives, and hemorrhage (warfarin). Often, if you are on these drugs, you need a major overhaul of your diet and lifestyle. And with side effects such as these, the person should be even more motivated to that end.

When you read a warning about mixing prescription drugs and herbs, take a step backward and look at the whole picture. If you are on one of these drugs, work on improving your health through diet and exercise, so that you, with the help of your physician, can wean yourself off of potentially harmful substances and onto a safer herbal alternative.

Greens Plus

Last month, I incorrectly stated the name of the company selling the greens
plus product as Orange Blossum. I received a few emails and calls pointing
out this mistake. I apologize for any wasted time on the internet. Here is
the correct name. Orange Peel Enterprises, INC.

To all the local readers, our office is located at 11825 SW Greenburg Rd., Ste A2, Tigard, Or. 97223.

Copyright 2002 Dr. Suzanne C. Lawton, LLC


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Snail Mail: Dr. Suzanne C. Lawton
11825 SW Greenburg Road, Suite A2
Tigard, Oregon 97223