Healing and Hope

A Newsletter of the Diabetes Institutes Foundation

August 2006

FOUNDATION NEWS

Tai Chi for Diabetes

On July 19th SDI's Education Institute presented "Tai Chi for Diabetes", as part of a continuing series of informational lectures at the Virginia Beach Central Library. Tai Chi for Diabetes, created by Dr. Paul Lamm, is an exercise program based on Tai Chi principles and movements which addresses many of the major problems associated with diabetes. It focuses on building strength, balance and flexibility through slow fluid movements, combined with mental imagery and deep breathing.

What has Tai Chi got to do with diabetes? Studies have shown Tai Chi to have beneficial effects on cardio-respiratory fitness; muscular strength, balance and peripheral circulation, as well as reducing tension and anxiety, all of which help minimize the complications of diabetes.

Phillip Szpiech, a Medical Assistant certified to teach Tai Chi for arthritis, diabetes and back pain, introduced this interactive session and ably demonstrated some of the techniques. He was accompanied by Judith Forsyth, exercise physiologist and founder of Bending Tree Tai Chi Kung. The mission of Bending Tree is to provide guidance on the journey to wellness, harmony and balance, by combining the ancient culture of Tai Chi with today's modern knowledge of medicine.

Philip and Judith explained that Tai Chi is not the only form of exercise for people with diabetes, nor is it a treatment by itself. A healthy eating plan, adhering to medication, stress control, as well as a safe exercise routine recommended by qualified health professionals are the cornerstones of diabetes self management.

Exercise has many benefits. It helps release the body's natural "happy hormones" (endorphins) that make you feel good. It also assists the tissue cells in recognizing and utilizing the body's own insulin to lower blood sugar levels. Walking with a buddy is a great social activity on the move. Instead of catching up on the gossip, discussing problems or airing grievances sitting on the couch, put on your comfortable well-fitting sneakers and padded socks and get rid of stress on the move. Exercise classes can be an excellent way of meeting others with the same problem, so why not try some gentle Tai Chi?

Remember that before starting any exercise program you need to be checked out by your physician.

Lee Mazilli Tournament 2006

This year's Lee Mazzilli Celebrity Golf Tournament at the Seawane Club on Hewlitt Harbor, Long Island, was a fun day in the sun for all involved. Ron Guidry of the New York Yankees was honored at the event as were Clyde and Estelle Duneier for their leadership of the event over the past fifteen years. Every year the success of this popular New York chapter event contributes valuable funds to SDI. Thank you, New York chapter!

---

MEDICAL NEWS

PATIENT PROFILE: CLAUDETTE DAVIS

Twenty three years ago, Claudette Davis, a retired English teacher and writing specialist, was in a Boston law office, when she noticed something strange going on in her hands. Later came troubles with her feet. "I remember I was wallpapering and my feet felt frozen, like Barbie feet" she remembers.

"My doctor said it might be arthritis. Then I noticed that the feeling of tightness and numbness was spreading, first up to my ankle, like a golf sock. Then a bobby sock. Then a knee sock, a very tight one. I'd wake up in the middle of the night and try to take it off."

At the same time Claudette noticed that breeze from the ceiling fan felt like burning on her legs and feet. No one could help her. The neuropathy got worse. She now felt like she was wearing gloves as well as socks. Her doctor prescribed antibiotics. Then a different course of them, but none of it worked. Then in 1997, when she was finally diagnosed with diabetes, Claudette discovered the Institutes and things began to change.

She says, "I first came in walking with a cane, very poorly, and absolutely sure my next step would be a wheelchair." Claudette signed up for a clinical trial and was immediately impressed with the treatment she received. Eventually, she began seeing Dr. Vinik and he has been addressing her neuropathy ever since.

Claudette, who now volunteers at the Bruton Parish Gift Shop in colonial Williamsburg, has a husband and two grown children. The difference in her quality of life before SDI and after is like night and day. Since her diagnosis, she's become a master gardener, works out at the gym and can once again look forward to traveling, one of her favorite pastimes.

Most striking to Claudette is feeling that she is not simply in a doctor-patient relationship, but part of a collaborative effort. Dr. Vinik doesnt' just prescribe drugs. Hes' connected Claudette to a network of other specialists who can help and always encouraged and suggested rather than dictated. When something doesn't work, he is at the ready with a new idea for treatment.

"Now I have an umbrella of care," Claudette says, a"nd I've never left here without hope and a renewed spirit and I never feel like I'm by myself."

---

NUTRITION TOPICS

Wondering About Reduced Calorie Sweeteners?

Phyllis Woodson, MS, RD, CDE, Clinical Dietitian

Any intake of sugar by individuals with diabetes should replace other carbohydrates in their diet so as not to exceed recommended calorie intake - or elevate blood glucose levels. Read food labels. Sugar intake may need to be covered by diabetes medication, for example, insulin. Many foods with sugar also have fat, and this needs to also be considered.

It is recommended to use moderate amounts of reduced calorie sweeteners and non-nutritive sweeteners (see below). Reduced calorie sweeteners have half the calories of real sugar and non-nutritive sweeteners essentially have no calories. These products allow individuals who are avoiding sugar because of the excess calories or because they have diabetes, to have "sweetened" foods. The American Diabetes Association approves moderate use of these products even during pregnancy.

The US Food and Drug Administration (FDA) has approved reduced calorie sweeteners which include sugar alcohols (sorbitol, xylitol, mannitol, maltitol, lactitol, erythritol, isomalt, hydrogenated starch hydrolysates) and tagatose. These products result in a lower blood glucose response after eating than sugar, and contain half the calories (2 calories per gram vs. 4 calories per gram). Moderate amounts of these sweeteners are approved for consumption during pregnancy. You can subtract half the sugar alcohol grams from the total carbohydrate grams on the food labels. However, keep in mind that excess intake of sugar alcohols may cause abdominal discomfort, elevated blood glucose, and weight gain since sugar alcohols do have calories.

Five non-nutritive sweeteners approved by the FDA include: aspartame (Equal or NutraSweet), saccharin (Sweet 'n Low), acesulfame-K (Sunett), sucralose (Splenda) and neotame (no calories).

Zsweet, a blend of erythritol and natural flavors from fruits vegetables, has no calories and tastes, looks, and measures (1 c per 1 c) like sugar without the aftertaste. It can be used in hot or cold cereal, liquids, and browns like sugar. It is suggested to reduce by half the sugar in recipes when using this product. It has no artificial components. Zsweet is generally recognized as safe (GRAS) by the FDA.

Stevia is native to South America and has been used medicinally for centuries in Paraguay. Stevia is 200- 300 times sweeter than sugar and has no calories. You can use it as you would sugar. Some studies have shown it may help control your blood glucose, blood pressure, and reduce your risk for tooth decay. Stevia is composed of stevioside and rebaudioside. Stevia is not approved by the FDA, due to concerns of safety if used in large amounts. It is not approved as a food additive and has not been determined to be GRAS by the FDA, because there is no acceptable daily intake. Since it is a free-growing plant, it will be difficult to patent.

Stevia is sold as a white or green powder, in liquid form, and as a powdered leaf. None of these forms are standardized. It can also be purchased from a garden center as a small plant. Liquid stevia can be easily added to beverages (hot or cold) or to sauces as a sweetener. It does not deteriorate when cooked. A few leaves from the plant form may be added to hot, brewing tea.

When using stevia for baking, remember that it doesn't have all the qualities of sugar (browning or adding texture and bulk). You will need to add bulk to the food, such as applesauce, yogurt, low fat/fat free sour cream, or ground seeds (flaxseeds).

For more information, please go to your local library or bookstore or click here for the Center for Science in the Public Interest web site.

References

American Diabetes Association. (January 2006). Clinical Practice Recommendations, Diabetes Care, 29, Supplement 1.

Smith, J. (August 2006). Stevia-A New Player in the Artificial Sweetener Game, Diabetes Health.

Zsweet