Monthly Archives: March 2017

How To Increase Cholesterol Level That Is Good For You

Cholesterol gets a bad rap. But the truth is, you need it to live, let alone lead a long, healthy life. Without this waxy, fat-like substance, you couldn’t make sex hormones such as estrogen and testosterone, adrenal hormones that help regulate blood pressure and metabolism, or essential nutrients such as vitamin D.

Floating through your bloodstream, two different fat- and protein-containing carriers, called lipoproteins, carry cholesterol to and from your cells. At healthy levels – ideally less than 100 milligrams per deciliter – low-density lipoprotein, or LDL, delivers the cholesterol you need into your tissues for cell stability and healthy function. Meanwhile,high-density lipoprotein, or HDL, scavenges the excess cholesterol and carries it to your liver, which breaks down the cholesterol and removes it from the body, says Dr. Nauman Mushtaq, medical director of cardiology at Northwestern Medicine Central DuPage Hospital in Illinois. Hence the name “good cholesterol.”

However, when HDL levels are low – typically defined as less than 40 mg/DL – LDL can build up in the blood vessels, earning it the reputation of “bad cholesterol.” This buildup can cause plaque to form in the arteries, increasing your risk of heart attack or stroke.

Thankfully, research has shed new light on several lifestyle changes you can make to ensure your good cholesterol stays ahead of the bad. Here, experts share their top six methods for raising HDL levels and keeping your heart happy:

1. Be a cardio bunny. Cardiovascular exercise can help keep your weight down and HDL levels up. For instance, in one study published in the Journal of Sports Sciences, by walking or running 50 to 60 minutes per day, five days per week for 12 weeks, overweight men significantly decreased their body fat, insulin resistance, blood pressure and “bad cholesterol” levels while upping their “good cholesterol.” Meanwhile, an analysis in the Archives of Internal Medicine found that moderate-intensity aerobic exercise (e.g., walking, cycling or continuous swimming for at least 15 minutes) consistently increases HDL levels.

Increase your HDL levels: Perform at least 20 to 30 minutes of moderate-intensity aerobic exercise daily, Mushtaq says. Examples include brisk walking or light jogging, swimming or cycling. On a scale of 1 to 10, you should feel like you’re working at about 4 to 6.

2. Quit smoking. Smoking can do a number on more than your lungs, actually reducing the body’s concentration of HDL cholesterol. Fortunately, it’s never too late to quit: One review published in Biomarker Research concluded that HDL levels can rise by as much as 30 percent within three weeks of quitting.

Increase your HDL levels: Giving up cigarettes isn’t easy, but it can be done. According to Mushtaq, quitting cold turkey is the most effective method. Research in the Annals of Internal Medicine found that people who quit abruptly were more likely to be smoke-free at four weeks than those who gradually cut back (49 percent versus 39.2 percent). Try nicotine patches and gum to help tamp down cravings.

3. Go nuts. Eating a small serving of almonds (about eight kernels) daily is enough to raise HDL levels by as much as 16 percent after 12 weeks, according to research published in the Journal of NutritionResearchers believe the nutrients in almonds help limit the amount of LDL cholesterol that the body absorbs from foods while increasing the amount expelled by the body.

Increase your HDL levels: Pair a small handful of almonds with a piece of fruit for a snack, add slivered almonds and berries to yogurt or use sliced almonds as a topping for green beans or grain salad, recommends registered dietitian nutritionist Libby Mills, spokeswoman for the Academy of Nutrition & Dietetics.

4. Stick to moderate amounts of alcohol. Higher alcohol consumption can drastically increase your risk of heart disease (not to mention other conditions), but drinking moderate amounts of alcohol has been shown to raise HDL. A study in PLoS One suggests that low-to-moderate alcohol consumption – defined as one drink per day for women and two for men – may help increase the transfer of proteins involved in moving HDL through the bloodstream.

Increase your HDL levels: If you don’t drink, there’s no need to start. However, if you do drink, keep yourself in check by limiting yourself to one drink per day if you’re female and two drinks per day if you’re male. One drink equals 12 ounces of regular beer, 5 ounces of wine or 1.5 ounces of distilled spirits.

5. Limit processed foods. The average American diet is rife with processed foods, which contain high amounts of trans and saturated fats. When consumed in excess, trans and saturated fats have a negative effect on cholesterol levels, according to Mills. Trans fatsin particular have been shown to lower HDL levels.

Increase your HDL levels: Check food labels for hydrogenated and partially hydrogenated ingredients, which contain trans fats, Mills says. Cut back on prepared desserts, packaged snacks, fried foods and powdered creamers.

6. Get your fiber. Fiber does more than regulate bowel movements. According to a report published by the National Heart, Lung, and Blood Institute, once ingested, soluble fiber (which, unlike insoluble fiber, absorbs water during digestion) helps to block the absorption of cholesterol in the bloodstream. Unfortunately, the average American gets only about half the daily recommended intake of 25 to 30 grams.

Increase your HDL levels: According to Mills, some of the best cholesterol-lowering sources of fiber include beans, lentils, apples, blueberries, flax seeds and oatmeal. However, adding too much fiber too quickly can cause gastric distress (think: constipation or diarrhea). Mills recommends increasing your fiber intake slowly and drinking plenty of water to help keep your gut happy.

Easy Tips to Test Your Blood Sugar at Home

When you have diabetes, it’s important to keep a constant check on your blood sugar numbers. Your numbers help determine what causes your blood sugar to spike. Testing your blood sugar – also called blood glucose – once or a few times a day can help show if your diabetes medications and insulin are working the way they should.

The way you keep track of your blood sugar is with at-home testing kits – also called point-of-care glucose monitoring devices. You can find the devices at pharmacies and larger supermarkets. You’ll want to share your blood sugar readings with your doctor to look for trends. Yet ultimately, blood sugar testing has another purpose. “The testing is really for you,” says Susan M. De Abate, a nurse and certified diabetes educator and team coordinator of the diabetes education program at Sentara Virginia Beach General Hospital in Virginia Beach, Virginia. By tracking blood sugar trends, you get a better handle on how to manage your numbers.

Here are some tips and tricks to maximize blood sugar tests for better health when you live with diabetes.

Use a branded meter instead of a generic one. “The branded meters have gone through quality testing and are appropriately scrutinized,” says Dr. Michael Bergman, a clinical professor of endocrinology at NYU Langone Medical Center in New York. Although all blood glucose meters need to have a certain level of accuracy, the branded ones are more likely to have reliable results, he believes. If you have health insurance, the insurance company likely will want you to purchase a specific type of meter, and it often will be a brand-name one.

Learn the ins and outs of your meters – and ask for help. Some meters come with extra bells and whistles that appeal to tech-minded folks (for instance, they can track your physical activity), while others are more straightforward. If you have dexterity or vision issues, find a meter that’s easy to grip or easy to see. Don’t be afraid to ask for help if the monitor seems overwhelming at first. “Over 90 percent of inaccuracy with the meters is operator-dependent,” Bergman says, reflecting on experience with his own patients. The result: Meters used incorrectly could result in risky medication errors based on faulty readings. Consult with a certified diabetes educator to learn how to use your meter properly, Bergman recommends.

Buy test strips made for your specific meter. The test strips add to the cost of blood sugar monitoring, especially if you have to check your numbers several times a day, says Erin Kelly, a nurse educator and certified diabetes educator at Joslin Diabetes Center, which is part of Harvard Medical School in Boston. Buy the test strips made for your meter to ensure accurate results.

Make sure there’s enough blood to fill the landing section of each strip. Otherwise, your meter may not be able provide a correct reading. Some devices require slightly more blood on the test strip than others.

There’s more to managing your health than eliminating white foods or gluten.

Wash your hands before using the meter. If you have any food on your hands – say, you just peeled an orange and the juice is still present on your fingers – it can affect your reading.

Use the device on the sides of your fingers, not on the fingertips. “If you stick the fingertip, that’s where you have more nerve endings,” says Lucille Hughes, a certified diabetes educator and director of diabetes education at South Nassau Communities Hospital in Oceanside, New York. That can cause a slight pinch. If you use the sides of your fingers, it’s painless. Kelly also advises people to regularly change the fingers they use with their monitor. “Don’t play favorites,” she says.

Know your goal numbers. This will be a decision you’ll make with your doctor, and it will depend on the time of day when you check your blood sugar, what you’ve eaten and whether you’ve exercised recently. However, generally speaking, a safe reading is between 80 and 180, Kelly says. “We don’t like to see numbers above 250,” she adds, as this indicates uncontrolled blood sugar.

Track your blood sugar readings. This can be challenging for many people with diabetes. After all, who has time to make a note of all that information? However, without the numbers, your health care team will have a hard time determining if your blood sugar levels are within a reasonable range or if you need any changes in medication, Hughes says. Poor blood sugar control could lead to serious health complications. “Diabetes is about self-management,” Hughes says.

Another advantage of tracking numbers: You learn if there are certain foods that spike your blood sugar. Hughes got a blood sugar meter when she found out she has prediabetes. She learned that white flour tends to raise her blood sugar, but when she eats Greek yogurt, her blood sugar “reacts beautifully,” she says.

Some meters nowadays will capture numbers from readings and download them to an electronic device of your choice. When you have readings that are higher or normal than usual, you should also make note of what you ate before those readings.

Check your blood sugar at different times of the day. Doctors often ask patients to check fasting blood sugar in the morning. However, sticking to only that could steer patientsaway from spotting other times of the day when readings can spike higher, De Abate says. If you always test your blood sugar at the same time, the numbers may not accurately reflect what’s happening throughout the day. “We try to encourage doctors to go beyond fasting blood sugar as everyone’s different,” she says.

Check your blood sugar before your drive or before you operate heavy machinery. You don’t want to take the chance of having a high number, experiencing side effects and causing an accident.

Keep your meter out of the freezing cold or extreme heat. “The meter should never be in direct sunlight,” Kelly says.

One last point: The U.S. Food and Drug Administration, which approves and monitors blood sugar devices, allows for a little variation in numbers when you test your blood sugar. So, if you take your reading twice within a few minutes and see some variability, don’t panic. “That’s always a teaching point for us,” Kelly says.

A1C Hemoglobin Test at Home can help you monitor Blood Sugar

If you have diabetes, you probably already use a glucometer, which allows you to check your blood sugar at home. Just like there are at-home blood sugar testing devices, there are also at-home devices to check your hemoglobin A1C. Your hemoglobin A1C gives you and your health provider a better idea of your average blood sugar level over a two- to three- month period.

Usually, you go to a lab to check your hemoglobin A1C. So why would you want to check it at home?

There are two kinds of patients who tend to use the hemoglobin A1C at-home testing kits, says Grace Derocha, a certified diabetes educator and registered dietitian with Blue Cross Blue Shield of Michigan. “It’s usually patients who are really compliant and want to know every 90 days, ‘Am I still there?’” she says. These same patients may have such good diabetes numbers that they are only required to get their A1C checked every six months, so they use the monitors at the three-month mark.

On the other end of the spectrum, Derocha has recommended that some patients use the A1C test if they having trouble with blood sugar control. “I want it to be a motivator or a reminder for them,” she says.

Although certified diabetes educator Anna Simos, a diabetes education and prevention program manager at Stanford Health Care in California, supports seeing a health provider regularly for lab work and diabetes care, she has seen patients use the hemoglobin A1C tests at home when they can’t get lab work done every three months, be it for scheduling or financial reasons.

Simos also has seen patients who are not diagnosed with prediabetes or diabetes but who have a family history of the disease, so they use the at-home testing kits to self-monitor. Yet one other kind of patient using these devices is someone nervous about seeing lab numbers in front of the health provider. This person would rather know their A1C number ahead of time. “The A1C is like your report card, and there’s anxiety about having to check that,” Simos explains.

Imprecise A1C Readings May Hamper Diabetes Diagnosis or Management

Experts recommend additional testing, in some cases to ensure timely detection and proper care.

Another way the handheld A1C devices are used is in some primary care clinics, says Edwin Torres, a nurse practitioner with the endocrinology department at Montefiore Health System in Bronx, New York. The device can provide an immediate picture of average blood sugar control, and that helps the health care provider give instant feedback and guidance to the patient.

The devices are easy to use; in fact, they work similar to a glucometer. “I tell people they just need a bigger drop of blood,” Derocha says.

The devices are regulated by the U.S. Food and Drug Administration to ensure accuracy. They could give slightly off results, but so can standard lab tests, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

This is where diabetes care experts share a major caution about at-home hemoglobin A1C devices: Don’t use them to make major decisions about your care on your own. Instead, use any readings you obtain to share with your health provider so he or she can advise you accordingly. Your health care provider will want to consider your A1C results along with a variety of other lab and physical findings.

“It’s a good place to start a conversation. You may say, ‘I took my A1C at home. How does my result from home compare with my lab work?’” Torres recommends.

Derocha has seen patients who get favorable A1C results and think that means they can treat themselves to extra ice cream or not take a certain medication dose. Don’t make those decisions alone. Always talk with your health care provider first.

Another caution is that hemoglobin A1C findings can be deceptive at times. In other words, you may have a great hemoglobin A1C reading, but your blood sugar has fluctuated from low to high on a day-to-day basis. So, your overall blood sugar control may not be great even if the A1C reading is favorable. “The number needs to be taken in perspective,” Torres says.

How Hemoglobin A1C and eAG Indicate Your Diabetes Control

Get a better understanding of these important diabetes numbers.

Here are some tips to maximize your use of at-home hemoglobin A1C testing kits:

Buy one from a reputable brand. The larger companies have done their homework to make their devices reliable, Simos says.

Make sure the packaging for the device is sealed before you use it. Also check that the device has not expired.

Wash and warm your hands before use. If your hands are not clean, you may get a false reading. Also, warmer hands will help your blood flow, making it easier to take a small blood sample.

Keep the device away from extreme hot or cold. Simos gives the example of buying an A1C testing kit in a place like Arizona and then keeping it in your hot car while you do other shopping. “You could fry part of the device. It’s sensitive,” Simos says. The same idea applies in extreme cold.

Read the instructions. If your instinct is to tear something open and use it right away, you’re not alone – but that’s not the best approach, Simos cautions. Take the time to read the instructions or watch any related instructional videos.

Don’t pull away when you poke yourself. You need to stay still to capture a blood sample, Derocha advises.

Share the results with your doctor or other health provider. He or she will want to consider your A1C along with high blood pressure, cholesterol and other key numbers to make important care decisions.

Use the device only every two to three months. Any more than that, and the results will not vary much, Derocha says. However, you still need to do your regular at-home glucometer checks, she adds.

Talk with your health care provider about factors that may affect your A1C readings. This could include if you have anemia or if you have just had surgery.

The Truth about Vitamins and Herbal Supplements

Alice arrived in Wonderland and promptly downed a vial that said “drink me,” and we can probably all agree she was being a bit of an idiot. Magical land or not, she’s a child, she has no idea where that conveniently placed tube came from, and come on—“drink me”? That’s in the textbook definition of “gullible.”

But if we’re being honest, is taking a supplement you bought at the drug store any smarter?

The bottles don’t say “swallow me,” but they might as well. Instead they’re emblazoned with promises. The yellow ones will make you stronger. Red will increase your energy levels. Purple will heal your scars. It’s a veritable rainbow of cures. They offer quick and easy solutions in a way that medicine can’t—because medicine is bound by evidence. Supplements aren’t.

Which is why every 24 minutes the U.S. Poison Control Centers get a call about bad reactions to supplements. That’s 274,998 exposures from 2000-2012. Those numbers come from a recent study in the Journal of Medical Toxicology, but the idea isn’t new: Supplements aren’t likely to kill you, but they’ve never been particularly safe either. And the companies producing them have shockingly little oversight.

Exposures are increasing, especially for certain herbal supplements and homeopathic remedies

From 2005 to 2012, the rate of reported dietary supplement exposures increased 49.3 percent. Homeopathic cures and ma huang-containing pills were responsible for most of that uptick. Homeopathy is the line of thinking that says if you take a solution of water and an active ingredient, then dilute it many times over until the active ingredient is no longer detectable, the water somehow retains the memory of the active ingredient and will have some medicinal effect on your body. There is absolutely no evidence to support it. Ma huang is a plant extract that contains ephedrine and pseudoephedrine, which stimulate your nervous system and can be deadly.

Between the two of them, homeopathy and ma huang account for a large chunk of the total adverse outcomes related to dietary supplements. The problem is that we’re only finding this out years after they’ve happened.

The Food and Drug Administration can’t review supplements for safety OR efficacy before they hit the market

The FDA is literally not authorized to evaluate a supplement’s efficacy or safety. It’s up to the manufacturer to make sure their product is safe and as effective as they claim. They’re also tasked with policing themselves to ensure the supplements aren’t contaminanted. This near total lack of oversight means that a huge fraction of botanical supplements either contain an entirely different active ingredient from what they claim or contain a filler like rice powder.

One study of the supplements sold at GNC, Target, Walgreens, and Walmart found that four out of every five products didn’t contain the ingredient they claimed. In cases where you just get filler, all you’ve done is waste your money. But what if those pills contain allergens that aren’t listed on the package? Or if the secret active ingredient interacts with another medication you’re taking? If you don’t know what’s in your supplement, you could get sick and have no idea why.

That’s why there are reporting tools to tell the FDA—or poison control—when you have an adverse outcome. The trouble is that lots of people don’t. The FDA estimates that some 90 percent of adverse reactions go unreported. Some people report the problem straight to the company, who are supposed to self-report to the FDA. But it’s basically an honor system. One shampoo company got tens of thousands of complaints and never passed a single one on to the FDA. It wasn’t until people whose hair started falling out complained directly to the FDA that they realized the problem (though it’s worth noting that shampoo hasn’t been definitively proven to cause hair loss).

Between under-reporting and self-policing, there’s plenty of room for supplement companies to shirk best practices.

Companies can get away with all of this because people don’t speak up

When you stand in the supplement aisle in the drug store, you’re faced with decisions. How do you choose between the generic store version and that all natural herbal option? Every supplement company out there has invested time and money into making their packaging look appealing. They want you to trust them. They want that lovely green label to say “this is natural and harmless.”

It can be hard to ignore that psychological effect. And regardless of which brand you pick, if you have a weird reaction you’re probably not likely to tell anyone. Even if you mention it to a friend, you’ll probably chalk it up to a personal issue—maybe your gut is just finicky, or the pills contained an ingredient you’re slightly allergic to.

This is why it’s hard for deceptive companies to get caught. You’re not likely to tell your doctor if that echinacea tablet you had last month seemed to give you a stomach ache, and you almost certainly won’t report it to the FDA. Because it’s easy to think of supplements as safe by definition. They seem like a medication, and medications have to be approved before they’re sold. And in addition to that veneer of medical approval, supplements are also gilded with supposed wholesomeness. After all, when is the last time you thought twice about taking some Vitamin C? It’s all natural.

But it’s important to remember, as you stand in that drug store aisle, that almost none of the products before you were tested by any kind of regulatory agency. The only way the FDA will test them is if people start having problems—and start complaining.

What you can do to stay safe

You often can’t be 100 percent sure that a supplement is safe. Even if you have a way to test for the claimed active ingredient—which you probably don’t—you’d be hard-pressed to test for other potential contaminants.

But there is one good option. The United States Pharmacopeial Convention runs a voluntary testing program for supplements, testing vitamins and supplements to ensure they actually contain what they claim to in the amounts listed. Plus they test to make sure the products are contaminant-free and made with clean, safe manufacturing practices. They maintain a list of all the supplements that are certifiedon their website, and it contains shockingly few brands. It’s basically just NatureMade and Costco’s Kirkland Signature brand. You can also look for their USP certified label on the supplement itself.

Apart from that list, you’re in the wild west. Melatonin pills might as well be sugar tablets and echinacea drops could easily be herb-flavored water. Drink me.