ACCUPUNCTURE - USEFUL OR PLACEBO??

Acupuncture is the procedure of inserting and manipulating needles into various points on the body to relieve pain or for therapeutic purposes. The earliest written record of acupuncture is the Chinese text Shiji with elaboration of its history in the second century BCE medical text Huangdi Neijing. Different variations of acupuncture are practiced and taught throughout the world.
Acupuncture has been the subject of active scientific research both in regard to its basis and therapeutic effectiveness since the late 20th century, but it remains controversial among medical researchers and clinicians. Research on acupuncture points and meridians is preliminary and has not conclusively demonstrated their existence or properties. Clinical assessment of acupuncture treatments, due to its invasive and easily detected nature, makes it difficult to use proper scientific controls for placebo effects.
 Evidence supports the use of acupuncture to control some types of nausea and pain but evidence for the treatment of other conditions is equivocal and several review articles discussing the effectiveness of acupuncture have concluded it is possible to explain through the placebo effect.
 The World Health Organization and the United States' National Institutes of Health (NIH) have stated that acupuncture can be effective in the treatment of neurological conditions and pain, though these statements have been criticized for bias and a reliance on studies that used poor methodology. Reports from the USA's National Center for Complementary and Alternative Medicine (NCCAM), the American Medical Association (AMA) and various USA government reports have studied and commented on the efficacy (or lack thereof) of acupuncture. There is general agreement that acupuncture is safe when administered by well-trained practitioners using sterile needles, and that further research is needed.

Making Healthy Food Choices!!

Knowing what to eat can be confusing.

Everywhere you turn, there is news about what is or isn't good for you. Some basic principles have weathered the fad diets, and have stood the test of time.

Here are a few tips on making healthful food choices for you and your entire family.

1. Eat lots of vegetables and fruits. Try picking from the rainbow of colors available to maximize variety.
2. Eat non-starchy vegetables such as spinach, carrots, broccoli or green beans with meals.
3. Choose whole grain foods over processed grain products. Try brown rice with your stir fry or whole wheat spaghetti with your favorite pasta sauce.
4. Include dried beans (like kidney or pinto beans) and lentils into your meals.
5. Include fish in your meals 2-3 times a week.
6. Choose lean meats like cuts of beef and pork that end in "loin" such as pork loin and sirloin. Remove the skin from chicken and turkey.
7. Choose non-fat dairy such as skim milk, non-fat yogurt and non-fat cheese.
8. Choose water and calorie-free "diet" drinks instead of regular soda, fruit punch, sweet tea and other sugar-sweetened drinks.
9. Choose liquid oils for cooking instead of solid fats that can be high in saturated and trans fats. Remember that fats are high in calories. If you're trying to lose weight, watch your portion sizes of added fats.
10. Cut back on high calorie snack foods and desserts like chips, cookies, cakes, and full-fat ice cream.

Eating too much of even healthful foods can lead to weight gain. Watch your portion sizes.

CRITICISMS TO CONCEPT OF GLYCEMIC INDEX!!

If a person consumes 50% of his or her calories from carbohydrates, the glycemic index can enable him or her to consume the same number of calories and have lower, more stable glucose and insulin levels. The use of the glycemic index, however, is limited by several factors:

The glycemic index does not take into account other factors besides glycemic response, such as insulin response, which is measured by the insulin index and can be more appropriate in representing the effects from some food contents other than carbohydrates.

The glycemic index is significantly altered by the type of food, its ripeness, processing, the length of storage, cooking methods, and its variety (white potatoes are a notable example, ranging from moderate to very high GI even within the same variety


The glycemic response is different from one person to another, and even in the same person from day to day, depending on blood glucose levels, insulin resistance, and other factors.

The number of grams of carbohydrate impacts blood sugar levels more than the glycemic index. Lowering glycemic index leads to small improvements in the blood sugar level, but consuming fewer calories, losing weight, and carbohydrate counting would benefit the blood sugar level more.Carbohydrate impacts glucose levels most profoundly, and two foods with the same carbohydrate content are, in general, comparable in their effects on blood sugar. A food with a low glycemic index may have a high carbohydrate content or vice versa; this can be accounted for with the glycemic load. Consuming carbohydrates with a low glycemic index and calculating carbohydrate intake would produce the most stable blood sugar levels.

Most of the values on the glycemic index do not show the impact on glucose levels after two hours. Some diabetics may still have elevated levels after four hours.

The GI of foods is determined under experimental conditions after an overnight fast, and might not apply to foods consumed later during the day because glycemic response is strongly influenced by the composition of the previous meal, particularly when meals are consumed within an interval of few hours. Indeed, it has been shown that a high-GI breakfast cereal (GI = 124) elicited a lower increase in blood glucose concentrations at lunch than at breakfast. Also, the difference in glycemic responses induced by the low- and the high-GI breakfast cereals at lunch were lower than that predicted by the large difference in their GI, which was determined at breakfast.

GLYCEMIC INDEX

The glycemic index, glycaemic index, or GI is a measure of the effects of carbohydrates on blood sugar levels. Carbohydrates that break down quickly during digestion and release glucose rapidly into the bloodstream have a high GI; carbohydrates that break down more slowly, releasing glucose more gradually into the bloodstream, have a low GI. The concept was developed by Dr. David J. Jenkins and colleagues in 1980–1981 at the University of Toronto in their research to find out which foods were best for people with diabetes.

A lower glycemic index suggests slower rates of digestion and absorption of the foods' carbohydrates and may also indicate greater extraction from the liver and periphery of the products of carbohydrate digestion. A lower glycemic response usually equates to a lower insulin demand but not always, and may improve long-term blood glucose control and blood lipids. The insulin index is also useful, as it provides a direct measure of the insulin response to a food.

The glycemic index of a food is defined as the area under the two hour blood glucose response curve (AUC) following the ingestion of a fixed portion of carbohydrate (usually 50 g). The AUC of the test food is divided by the AUC of the standard (either glucose or white bread, giving two different definitions) and multiplied by 100. The average GI value is calculated from data collected in 10 human subjects. Both the standard and test food must contain an equal amount of available carbohydrate. The result gives a relative ranking for each tested food.

The current validated methods use glucose as the reference food, giving it a glycemic index value of 100 by definition. This has the advantages of being universal and producing maximum GI values of approximately 100. White bread can also be used as a reference food, giving a different set of GI values (if white bread = 100, then glucose ≈ 140). For people whose staple carbohydrate source is white bread, this has the advantage of conveying directly whether replacement of the dietary staple with a different food would result in faster or slower blood glucose response. The disadvantages with this system are that the reference food is not well-defined and the GI scale is culture dependent.

FLATBUSH DIABETES - TYPE 1 or TYPE2??

Flatbush diabetes is named after an area in New york where it was described some years ago.

Etiology

Exact etiology is not clear as of now. it has been suggested that some patients may develop Flatbush diabetes as they are extremely sensitive to transient damage to Beta cells by Glucotoxicity & Lipotoxicity. when this condition is reversed with diet , oral hypoglycemic agents or Insulin the beta cells are able to recover.

Why is the knowledge about Flatbush Diabetes important??

There is a lot we do not know about flatbush diabetes but the more we are aware that such a form of diabetes exists ,the more our physicians will be apt to spot patients who have it, and the more patients are correctly Diagnosed, the better their treatment will be!!

Characteristics of Flatbush Diabetes

Patients present with very high blood sugars (>700mg/dl)

No antibodies as seen in type 1 Diabetes

Ketosis might be present

Obesity

family history of type2 diabetes

patients have signs of insulin resistance

Patients respond well to OHA ( oral hypoglycemic agents)