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What’s the Big Deal About a Fatty Liver?

I recently saw a patient in my clinic who had just gotten her liver ultrasound result and was found to have fatty liver. She wanted to know the implications of that, and whether she was going to get cirrhosis and liver cancer.

In my medical career, I have seen countless numbers of patients with “fatty liver” and they are always wondering what that means. I think it is time for the benefit of my patients and all of you reading this article to address this question of what does fatty liver really mean, and what are its health implications.

For those patients who have been diagnosed with non-alcoholic fatty liver disease, it is the leading cause of chronic liver disease in the United States and other Western countries. This non-specific title includes steatosis, non-alcoholic steatohepatitis, fibrosis and cirrhosis. Although chronic inflammation of the liver can lead to liver cancer and is frequently associated with cardiovascular disease risk factors, we’re not completely sure what its overall long term implications on health are, with or without elevated liver enzyme findings.

Fatty liver is frequently associated with high cholesterol, diabetes and obesity; therefore, it is difficult to say whether increased mortality and morbidity is associated with these diseases or the fatty liver itself.

In a recent prospective cohort study by Lazo, et al. published in Nov. 2011, in the British Medical Journalresearchers attempted to address this issue. They used the data from the U.S. Third National Health and Nutrition Examination Survey results from 1988-1994 with follow-up mortality data up until 2006 for this study. In the 11,371 adults aged 20-74 with fatty liver, the study looked for mortality of all causes including cardiovascular disease, cancer, and liver disease up to the 18 years of follow-up.

They found that people with non-alcoholic fatty liver were more likely to be older, men, Mexican-American, less educated, sedentary, obese, with a high waist circumference, diabetes, hypercholesterolemia, hypertension, history of cardiovascular disease, higher hemoglobin A1C levels, insulin resistance, hypertriglyceridemia, high density lipoprotein cholesterol ratio and elevated liver enzymes. They also seemed less likely to be current smokers and have low to moderate alcohol consumption.

This doesn’t mean that you should start smoking or drinking more alcohol. It just means that those with non-alcoholic fatty liver people don’t drink a lot or smoke a lot. That might mean that those with alcohol-associated liver disease tend to smoke more and drink more, so this does not by any means condone smoking or excessive alcohol intake.

The finding from this study showed that after accounting for the socio-demographic characteristics, lifestyle risk factors, and other medical conditions, the fact of having non-alcoholic fatty liver alone by itself was not associated with increased risk of death.

What’s interesting about this study is that there are significant and frequent findings on ultrasound of fatty liver and patients are always asking what that means. Now, we know that the fact that they have non-alcoholic fatty liver does not mean they have higher risk of death just based on that one factor. However, it does tell us that they likely have the fatty liver because they have one of the other confounding factors that could lead to increased death and disease.

As we can see from this study, non-alcoholic fatty liver is usually associated with other concerning health issues that do in fact place a person at higher risk for mortality and morbidity. So, despite the comforting information we now have that non-alcoholic fatty liver itself is unlikely to lead to increased mortality, the reason why you have the fatty liver, however, may still put you at risk for increased mortality and morbidity.

So, what are the take home points from this study?

When you see that “fatty liver” diagnosis on your ultrasound report, see it as an indication that you need to make sure your cholesterol and sugar levels are alright and that you keep your weight and lifestyle as healthy as possible. You should also try to avoid alcohol, smoking and any medications or herbs that may stress your liver in order to keep your liver function healthy.

You may want to see the “fatty liver” diagnosis as a wake-up call or a signal from your body to you that something negative is brewing in your body and that you should change your lifestyle towards more of an anti-inflammatory lifestyle that includes an anti-inflammatory diet, regular sleep and exercise, decreasing stress and avoiding toxins like cigarettes and excessive alcohol.

Take those steps toward healthy living with implementation of regular periods of rest and relaxation throughout your day to decrease the inflammatory effect of long term stress on the body and practice mindful eating and effective exercising.

Seek help from nutritionists, your doctor, therapists and personal trainers. This is not a time to be shy. See the diagnosis as a warning sign. When I see my patients take positive control of their health, I am always pleasantly surprised at how quickly their bodies display their tremendous ability to heal and improve upon themselves.

Reference:

Lazo, et al. Non-alcoholic fatty liver disease and mortality among US adults: prospective cohort study. British Medical Journal. 18 November 2011. 343. d6891.
Article posted in Huffington Post

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Five Ways to Detox Naturally

Are colonics the way to go when it comes to detoxing the body of toxins? The answer is plain and simple – no. The natural function of our intestinal tract is to cleanse itself. There is no physiological need to further clean above and beyond what it naturally does as its inherent function.
Some people may want the colonic because they are constipated, but it would be better to place someone who has constipation on a regular bowel regimen, rather than an occasional colonic. Other people may want the colonic because they lose some weight with it, but that will come back once they resume eating and regular bowel functioning.

The process of the colonics is concerning because it disrupts natural intestinal micro-flora and has the potential to cause either microscopic or clinically significant intestinal tears. So, based on this idea of unnecessary trauma and risk to our bowel, the usual recommendation for those seeking “cleanses” is to use food as a natural non-harmful cleanse. Here’s how…

Fiber acts as a natural cleansing tool for the body. By eating a stringent vegan/vegetarian diet for a few days, you can utilize the natural minerals, vitamins, fiber, phytonutrients, and water in the plant-based diet to “cleanse” your system without having to worry about potential mechanical trauma to your intestinal tract or physiological risk.

My usual recommendation for patients who are looking for a stringent cleanse to help calm and clean their system every few weeks or months is for the patients to eat vegan/vegetarian for 3 days before a vegetable-based juice fast for 2-3 days and again for 3 days after the juice fast.

This regimen can cause some fatigue when you first do the dietary cleanse and thus the juicing days should be on days where you do not need to be very active and can rest; weekends are likely the best time to be doing the juicing days. To make the juice, you would use a wide variety of vegetables and put them through a juicer machine and drink it fresh at each meal time.

I would recommend about 5 8-ounce glasses per day of the vegetable juice for those 2-3 days that you are consuming just the juice. Do not add sugars or processed foods or additives in the juice.

This juice cleanse should only be implemented once you have obtained approval and clearance by your physician first. It can be dangerous for those on certain medications (i.e., warfarin/Coumadin) and those with certain medical conditions such as diabetes, kidney problems, hormonal issues, liver diseases, and electrolyte/mineral disorders, just to name a few. This is because the types of food, fluid shifts/amounts, and minerals/vitamins, just to name a few factors, are altered from your natural diet and can cause issues in an otherwise stable medical condition.

So, for those of you interested in doing a “cleanse,” consider food as your friend and not your enemy. It’s just a matter of choosing the right foods. And this method of ‘cleansing’ is much less risky and significantly less medically concerning than colonics.

So, the five natural detox methods we can safely use at any time are:

  1.  High fiber diet
  2. Avoidance of processed foods or sugars
  3. Staying hydrated with water and antioxidant teas
  4. Eating the colors of the rainbow in plant-based foods on a daily basis at every meal
  5. Get plenty of sleep and relaxation

These general rules help to maximize your body’s natural tendency towards “detoxing” and “rebalancing.” By eating a wide variety of plant-based vegetables at every meal, you are naturally absorbing all the vitamins and minerals your body needs to maximize your body’s physiological functioning. When you rest and allow your body to relax, your body naturally turns toward cellular recovery and repair. So, instead of making drastic changes that may be too harsh on your body, why not just provide your body what it needs to naturally detox and repair.

Your money would be better off spent on purchasing healthy nutritious foods that act as a natural cleansing tool for our system; as Mother Nature had originally intended them to be, when she created the vast array of colorful fruits and vegetables grown in nature and made easily available to us at our neighborhood grocery stores.

Article posted in To Your Health

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Using Food as Medicine and Our Ally

Even as a child, I remember my family doctor telling my parents about how they should eat to make sure they don’t end up with heart disease, high blood pressure or strokes. My parents are significantly older now, in their 70s, but they still pay attention to their diet because they’ve heard all along that their diet significantly impacts their health. Over the last few years, their attention on their diet has increased tremendously. When they strayed from a “healthy diet,” their blood pressure, fasting sugar and cholesterol levels usually worsened, so now they have personal empiric evidence of the benefits of a “healthy diet.”

It’s no surprise that if I grew up listening to these teachings that I, myself, would be teaching these ideas to my patients as well. But, what’s great about modern research is that we now have study results that back up what we inherently knew all along about how our bodies really are reflections of what we eat.

In a Nov. 2011, article published in the Journal of Human Hypertension by Q. Chen, et al., researchers found that a diet rich in fruits, vegetables, low-fat dairy products and low saturated fat/total fat/cholesterol significantly lowered blood pressure by blunting the counter-regulatory response of the renin-angiotensin system. What this means is that a healthy diet like this could help our body regain a more healthy normal blood pressure range by helping our own body’s signals do what it needs to do to achieve that.

The renin-angiotensin system is a regulatory system in our body such that when our blood pressure drops, the plasma renin-angiotensin (PRA) level rises to try to counteract that drop and increase blood pressure to support blood flow to our organs. This is also a system that is utilized in therapies for hypertension to help patients with hypertension to obtain more normal blood pressure levels. In prior studies where they used diet to decrease hypertension using the DASH diet (Dietary Approaches to Stop Hypertension diet), this diet seemed to affect the PRA level.

In this November study, researchers used data from the DASH trial to further evaluate the impact of various diets on hypertension and the PRA system. In this study, 459 people consuming a fruits and vegetables diet, DASH (Dietary Approaches to Stop Hypertension) diet or typical American diet were evaluated for associations between those diets and the plasma renin-angiotensin response. The fruits and vegetable diet along with the DASH diet were both rich in minerals and fiber, and low in saturated and total fat and cholesterol. Whereas the “typical American Diet,” which was used as the control diet, is low in nutrients and high in saturated and total fat and cholesterol. Sodium in the diets was similar across all diets for this study.

The study participants were aged 22 and older and were not on medications for hypertension. They were followed for three weeks on the control diet and then were randomly assigned to one of the three diets for another eight weeks. The plasma renin-angiotensin levels were available for 83 percent of the patients.

For patients in the fruits and vegetable group and DASH diet group, when blood pressure was reduced, the plasma renin-angiotensin levels did not rise as much as the control group’s, thus allowing for correction of hypertension without a rebound effect of the PRA system. In other words, the patients in the fruits and vegetables diet group and the DASH diet group were able to retain the blood pressure reduction without a rebounding PRA system that auto-corrected that. The body’s PRA system in the patients of the healthy diet groups allowed for the appropriate drop to remain in the blood pressure in order to correct the hypertension.
In this study, it seems that foods rich in nutrients and minerals and low in pro-inflammatory components seem to act as medicine in our body to positively affect our own PRA system in our favor when we have hypertension, such that when hypertensive people have lowering of their blood pressure, the body knows not to increase PRA so as to allow blood pressure to normalize.

My interest in this article is that I have always been a firm believer of using food as medicine. It is the least-likely option to cause side effects as compared to synthetic medications, and it is likely to benefit multiple aspects of our health at once instead of addressing one medical issue at a time like most medications. While I am a fan of medications when they are needed because our bodies sometimes just need some additional support, I am a bigger fan of using mother nature to help our bodies right itself when there is disarray.

The minerals, vitamins and phytonutrients in the fruits/vegetable diet and the DASH diet allow our body to act intelligently to find its equilibrium instead of doing its automatic gut reaction of increasing PRA just because blood pressure reduction occurred.

I have always said to my patients that our bodies are miraculous machines and if given what they need to function optimally, they know what to do to heal and strike the perfect balance. This study shows us that a diet rich in the fundamental building blocks needed by our bodies for optimal functioning will allow our bodies to know what to do with their signals to achieve optimal health outcome.

So, the next time you hear your doctor tell you to eat your vegetables and to avoid fatty processed pro-inflammatory foods, just remember that it’s not just your doctor who’s telling you that… your body is screaming to you for the same thing as well. It just needs your help to give it the fundamental nutrients it needs to do its job; and once you do that, your body knows exactly what to do to achieve its main purpose of repairing and healing itself so that you can function at your ultimate best.

Reference:
Chen, et al. Journal of Human Hypertension. The Effects of Dietary Patterns on Plasma Renin Activity: Results from the Dieatary Appraoches to Stop Hypertension Trial. November 3, 2011.

Article posted in Huffington Post

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Ask Dr. Julie Chen,MD: Knowing When to Say No to Alcohol

The Secret to a Lifetime of Love and Health!

One of my patients recently asked me about alcohol intake and how much is safe for women.

She has a history of breast cancer and an autoimmune disease. She has chronic pain as well because of her autoimmune disease.

Based on her history, we had a lengthy discussion about how much alcohol is too much… especially in women.

For years now, studies have shown some cardiovascular benefit to one glass of wine per night for men. However, many women are still unaware that this level of alcohol intake may not be beneficial for them, unlike their male counterparts.

In prior studies, it has been suggested that more than two glasses of wine per night for women may put them at higher risk for breast cancer. Now, more recent studies suggest that even three glasses of wine per week may lead to higher risks of breast cancer.

So, what does that mean for women and alcohol? Does this mean women should stay away from alcohol altogether?

My answer to questions such as this is to make sure you live, eat, and drink in moderation.

In my clinical experience, most autoimmune patients and those with chronic pain do not respond well to daily alcohol intake; as far as how it impacts their overall inflammatory status. However, an occasional glass of wine here and there may not necessarily mean definitive negative impact to overall health.

However, in regards to breast cancer, my recommendation for all of the women who have a family history of breast cancer or have a personal history of breast cancer, I would recommend that they err on not imbibing alcohol except for special rare occasions.

For these women, alcohol intake should be kept to a minimum if possible. If you keep alcohol consumption to rare special events, the likelihood of that leading to significant negative impacts on overall health in the long run would be very unlikely.

So, as we dive into the holiday season, a rare glass of wine should not lead to panic about your health outcome…however, I would caution all of my female readers to imbibe in moderation and definitely try to keep alcohol intake to less than three glasses per week, if at all possible.

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Stress Reduction: Key to Our Overall Wellbeing

Stress is something we all deal with on a daily basis to some varying degree. Some of us deal with a significantly higher level from hour to hour than most. What’s unfortunate about that is that the source of the stress may be out of our control but its negative impact on our body, we have to deal with on a daily basis as well.
So, how can we take back control our own physiology when we’re not even the ones potentially causing the stress on ourselves?

The key is to intentionally implement relaxation into your day and to use factors in your life that you can control to help you combat the negative effects of long term stress. The sheer act of empowering yourself to take back control of your own life and body has a positive effect all on its own. So, let’s get started!

Just Breathe

Breath work is something you can do patients for stress management rather discreetly even on public transit or in your work cubicle. There are many versions of breath work but one of the simplest is to just double your exhalation time compared to your inhalation time.

So, you can inhale slowly for a count of 4 or 5 and exhale slowly over a count of 8 or 10. By doing this for a few cycles, you can notice that your mind calms and your heart rate slows down. If you are able to do this at least a couple times a day, you’ll be able to keep your overall daily stress level to a more manageable state. You may want to incorporate calming scents or music or imagery to this exercise to further augment the effectiveness of your relaxation time by utilizing multiple senses at once.

Keep Active

yoga Other possibilities for relaxation activities would include, but are not limited to, journaling, self-hypnosis or imagery, meditation, walking in nature, tai chi, qi gong, yoga, relaxing baths or play time with your pet. Studies show that by implementing these types of activities, overall wellness and health can be improved along with your mood and quality of sleep or management of some medical conditions such as chronic pain.

Now that you’ve got a few starting ideas to help you regain control over your stress level, let’s talk about some things you can do to try to combat the effects of long-term stress. Our foods have a huge impact on our overall health and inflammatory state. By opting to limit processed foods, drinking adequate water daily, and eating anti-inflammatory, you will be able to try to optimize your body’s physiology so that it is more resistant to the negative effects of stress.

Sleep and exercise are also two very important factors that, if approached consistently in a healthy manner, can help our body be more resilient against health hazards such as chronic stress in our life. One thing that we do know in medicine is that chronic stress over time has an overall negative impact on our mood, inflammatory state, metabolism, body weight, and propensity towards chronic diseases.

So, let’s take the steps now to combat the impact of stress and not wait until we start to see these negative effects come to fruition in our body. Here are five steps to help you try to reduce stress and its impacts on your health:

  1. Implement breath work at least three times a day on a regular basis.
  2. Consider journaling or any of the above mentioned activities as a way to establish a regular stress reduction routine and do them a few days a week, if not daily.
  3. Focus on eating an anti-inflammatory diet to help your body be more efficient in fighting off the negative effects of chronic stress.
  4. Aim for at least 7-8 hours of sleep every night if possible.
  5. Get in regular exercise to help with stress management and to optimize your body’s overall health.

Talk to your chiropractor for more tips on combating stress in your daily life.

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Revving Up Our Metabolism This Winter

With all the “dashing through the snow” this winter season, why is it that we are all still concerned about gaining weight? With all of the sweets around every corner of our work environment, it’s no wonder that we are all concerned about at least maintaining our weight and not gaining weight.
So, how can we best keep our metabolism revved up this winter season to win the battle of the bulge?

Of the utmost importance is that we make sure that we keep our body moving as much as it can on any given day or time. The more we move, the more we burn and the more efficient our metabolism is. Some easy ways to incorporate activity into our day include, but are not limited to:

  1. Taking the stairs
  2. Walking to your neighbor’s house or work colleagues cubicle instead of calling on the phone
  3. Parking farther or even walk to the store
  4. Sitting on a stability ball at your desk to work your core
  5. Doing exercises during commercial breaks on TV
  6.  aking family time an active time with dancing to music or going for a walk
  7. Making time to go to the gym before or after work several times a week

When you build more muscle tone and then use those muscles in daily activities and exercise, your metabolism benefits from that and you prevent it from getting sluggish.

Another factor in keeping our metabolism humming smoothly this winter season is to make sure you are eating enough so that your body doesn’t think it’s in starvation mode, but not so much that it can’t burn off the excess calories you are consuming.

So, make sure that what you are putting into your mouth is high in nutritional value, fiber, vitamins, minerals, and phytonutrients to help your body run efficiently; but not so much that your body has a hard time getting rid of the extra calories. Avoid processed foods and sugars if you can…instead, snack on mostly vegetables or one serving size of nuts or fruits when you are hungry. By eating this way, your body isn’t starving and has adequate nutrients to function at its optimal metabolic state.

When we talk about foods, we frequently forget about our water intake. I am a big fan of green teas and water. Your body needs water to function optimally. So, in trying to keep your metabolism running at its best, you cannot forget about water consumption. If you can’t stand the way plain water tastes, try dropping a small amount of fruits or cucumber or vegetables into your water to give it some natural flavoring. This way, your water doesn’t taste as bland and you’ll get the nutrients of the fruits and vegetables in the water.

Lastly, don’t forget that your body needs rest and relaxation to be able to repair, regenerate, and recuperate from your daily activities and functioning. So, make sure you are getting plenty of sleep and try to go to sleep and wake up around the same time every day to help your body maintain its usual rhythms and cycles. Decreasing long term stress with relaxation and sleep also can be beneficial to your metabolic functioning.

So, if you can remember just five tips towards revving up your metabolism this winter season, remember that you need to:

  1. Keep active and incorporate daily exercise or movement into your daily routine.
  2. Stay hydrated to optimize physiological functioning.
  3. Get plenty or rest and relaxation to decrease stress and fatigue.
  4. Eat a mostly plant-based anti-inflammatory diet.
  5. Avoid processed foods and sugars.

Talk to your chiropractor about other ways you can boost your metabolism.

 

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All My Articles and More…

Hi Everyone, Thank you all for following my blog. I have had a lot more articles and interviews posted recently on my website…check them out at www.makinghealthyez.com !

Keep tuning in for more articles every month on new health topics that you’ll definitely want to learn more about!

Just remember…living healthy doesn’t have to be hard, so let’s take those steps towards making living healthy EZ! Dr. Julie

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Star Supplements in the Nutraceuticals Aisle

My patient population sees me because they believe in natural options for disease prevention and treatment. However, not everyone believes in supplements and with the confusing study reports out these days about how some supplements are harmful, not everyone is comfortable taking them.

I would like to take this opportunity to clarify some issues with these studies. When you are reading summarized reports about various studies, you should know that in order to truly understand what these studies show, you have to go look at the primary study article and not a summary article. Frequently, the poor results apply only to a specific population of people or that they did the study in a way that does not apply to clinical practice. Allow me to explain…

For example, the studies that look at vitamin D at high dosages leading to more fractures were done with dosages that are not used in clinical practice so would not apply to the general public. Even in prior studies with dosages closer to that used in clinical practice, those studies showed benefit, not harm, in regards to fractures.

Another example is a study done on calcium and vitamin D causing more heart attacks in women. This study looked at a subgroup of a larger study and drew that conclusion but various other subgroup studies done on that larger study did not show the same result. The hypothesis is that the calcium and vitamin D, when taking abruptly higher dosages in a woman who has never taken calcium or D supplementation, might be concerning but is still not definitive. The recommendation is to take calcium and D if osteoporosis is a concern and to adjust dosing slowly upwards toward the health goal dosage.

So, as you can see, the studies are complex and if you are concerned, you should print out the primary article and bring it to your doctor so that he or she can explain it to you. In regards to those who are very much a believer of supplements, there are a few that you should make sure you have in your supplement cabinet.

Turmeric or Curcumin with black pepper to improve systemic absorption

  1. Fish oil and Omega-3
  2. Resveratrol
  3. Free form amino acids
  4. Vitamin D3

Turmeric is seen to have some anti-cancer properties as well as being anti-inflammatory. There are numerous other health benefits but for the purposes of this article, I will stick to these two and you can read more about it and ask your physician about it.

Fish oil or omega-3 and resveratrol also has many health benefits but it can be helpful as an adjunctive therapy for anti-inflammation, sugar metabolism, and high cholesterol or triglycerides, just to name a few benefits. You should of course clear all supplements by your physician before taking them and make sure that there are not any contraindications for you to use them.

Finally, vitamin D3 and free form amino acids are helpful for many body functions. Vitamin D is a hormone in the body and is important for bone health, mood, and even has effects on cancer if that is a concern in your family history. Free form amino acids are more easily absorbed and usable than long-chain amino acids and they are used in many organ functions. So these two supplements are meant as gap fillers since many people are not getting enough in their diet.

While there are many other supplements that should also belong in your supplement cabinet, the most important thing to keep in mind is to clear your supplements by your doctor first before using them and to always update all your physicians of your supplement list so that they can help you avoid complications and drug-supplement interactions.

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Winning the Battle Against Diabetes!

Making Healthy EZDiabetes is a scary disease and most of us want to avoid it…but for those with a strong family history of this disease, the desire to avoid this debilitating disease is much stronger. What is hopefully a beacon of light at the end of this scary tunnel is that diabetes can be avoided or at least the severity can be significantly diminished by some lifestyle modifications that we can all incorporate into our life.

The most important thing is to monitor your diet. You need to eat foods that are low in glycemic load which takes into consideration the glycemic index of a food and the quantity of it that you eat so that it measures the sugar load you consume at any given food intake point. When you learn to eat a low glycemic load diet, your body will be healthier because there won’t be a rapid rise in blood sugar such that your body is unable to process it.

If you are concerned about diabetes, you should learn more about these key words such as glycemic load and glycemic index. You can also ask your physician for a fasting blood glucose level and a hemoglobin A1C level to see how efficient your body is at processing sugar at this point. If it is already impaired, it is extremely important to start implementing dietary changes as soon as possible.

Diabetes is a disease where if you catch it early and you take the steps to improve your health, it will definitely make an impact on the outcome. So, make sure you start learning about eating low glycemic index foods and keep in mind to keep all foods in moderation and smaller portions.

While making dietary changes is a very potent way of impacting your diabetes risk factor, exercise is also extremely important in your battle against diabetes. Start by increasing your daily activity level and incorporating even small amount of exercise daily and build up to at least about 30 minutes of exercise on a daily basis with variations of activity types throughout the days of the week. If you are a beginner, you should enlist a personal trainer or ask your work out fiend of a friend for help! This is so that you start exercising safely. You should also gain the approval of your doctor before you start this regimen to make sure you are safe to start.

Finally, there are a few things you can take to help with your sugar metabolism and I would start with the safest options. When you start to incorporate bitter vegetables into your diet and vinegars into your dressings and cooking, you’ll naturally help your body’s insulin sensitivity. Insulin is the main hormone that helps to take sugar from your blood stream and allows it to be processed into your metabolic demands of your body. The supplements you can take to help with this as well are cinnamon, alpha lipoic acid, nopal cactus, resveratrol, and bitter melon, just to name a few.

So, make sure that you attack your sugar concerns from all directions with your food, activities, and your supplements…this way you’ll make sure you are victorious in your battle against diabetes!

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