Health Topics 

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Diabetes

Type 2 Diabetes Every year 1.4 million Americans are diagnosed with diabetes, a condition that results from too much sugar in the blood. It's usually related to being overweight, so getting to a healthy weight is the critical first step to fighting or even reversing the disease.

The most common form of diabetes is type 2, which causes your body not to use insulin properly. This is called insulin resistance. Your pancreas makes extra insulin, but eventually it isn't able to make enough to keep your blood sugar at normal levels. But there are things you can do to decrease your risk.

Fight Back with Healthful Foods.
Foods like white bread, rice and sugary snacks digest quickly and raise your blood sugar in a short period of time. Choosing foods low in simple sugars and high in other nutrients - like fruits, vegetables, dairy products, whole grain breads and lean proteins - help insulin do its job and remove sugar out of the blood vessels.

Make Moving a Must Do.
The American Diabetes Association recommends 30 minutes of moderate-to vigorous exercise at least five days a week or a total of 150 minutes. Moderate intensity means you can talk, but not sing, through your workout or activity. If you're just getting started, begin with 10 minutes a day and increase a few minutes each week.

Don't Be Afraid to Ask for Help.
If you're concerned about your weight or your risk for developing diabetes, your doctor probably is too. Your doctor, a registered dietician or diabetes educator can answer your questions. They can also help you set realistic weight loss goals (if needed), and show you ways to get to your healthy weight - and stay there.

Everyone needs to be aware of their blood sugar levels, and the simple blood test for diabetes is usually covered by insurance. The sooner you know about a pre-diabetes or diabetes diagnosis, the sooner you can make lifestyle changes that can reverse the condition in its early stages and improve your health overall.

Could you have diabetes and not know it?
The initial symptoms of diabetes or pre-diabetes can be subtle - so subtle that you might not even notice them. If you're experiencing one or more of these symptoms, talk to your doctor.

  • Excessive thirst
  • Using the bathroom more frequently, especially at night
  • Increased irritability
  • Blurry vision
  • Feeling exhausted, even after sleeping all night
  • Slow or non-healing wounds
  • Recurring yeast infections

- David Castrilli, M.D.

Healthy Diet Principles

Many of us our familiar with counting calories, but we miss thinking about macronutrients which are the three main categories of food.

It’s important to get a balance of protein, carbohydrates, and fats. Our bodies need each of these to function.  In the typical American diet, we gravitate towards eating fast food and snacks which contain high amounts of fats and carbs - and not always good fats and carbs. We need to consider proportions of food rather than what seems healthy based on a nutrition label.

Serving sizes are based on weight and how active you are.  It’s helpful to talk with your physician or a nutritionist to find out serving sizes that fit your lifestyle.  I like to use some of the Zone diet principles for guidance which is geared toward an active lifestyle.

Balanced diet

About one-third of your meal should be protein. I like eating more plant protein than animal because of cardiovascular benefits. Legumes are a great source. These are a good source of fiber, protein, zinc, iron, and b vitamins. Examples include chickpeas, lentils, and beans.

The next third of your meal should consist of healthy fats. Fats are important for energy and brain health. They cushion our organs and have other important roles. Fats from plants are the healthiest. Avocado, olive oil, nuts, seeds, fish are good sources.

Carbs should make up 30-40% of our meal. While carbohydrates fuel our body, some help maintain our energy more than others. I won’t get into the nitty gritty of different forms of carbs, but the short version is most carbohydrates should come from colorful vegetables and fruits. Vegetables are the ideal because they generally contain less sugar than fruit.

Eating healthy doesn’t have to be expensive. A good guideline to follow is shopping on the perimeter - though skipping the bakery, of course - helps keep you on track.

My veggie super stars 

  • Beets – They do come with a warning because they contain a higher sugar content, but they are nitrate rich which improves blood flow and naturally lowers blood pressure.
  • Bell peppers – These are easy to add in to several kinds of dishes or eat raw. They are valuable source of nutrients and antioxidants.
  • Zucchini - Zoodles are all the rage!  Zucchini is low in sugar, high in fiber and electrolytes.
  • Cabbage – It’s an unsung hero, and great for the immune system which helps with acute and chronic illness.
  • Exercise
As far as exercise goes, we often think that getting healthy means getting back on that treadmill. While cardio is good for us, research shows that strength training is also important.

Lifting weights is amazing for bone health and weight loss or just maintaining a healthy weight.  It also improves blood sugar levels and may improve cognitive function.  You can use weight resistance bands, dumb bells, or your own body weight.  Weight training twice a week helps mix up your workout routine, and helps you see results faster.  Weights don’t make you bulky, and you don’t have to be a power lifter. To learn how to lift weights, it’s helpful to find someone who knows proper technique like a personal trainer.     

- Sarah Baker, M.D. 

Preventing High Blood Pressure with Diet 

Hypertension, commonly known as high blood pressure, is a major risk factor for heart disease. The American Heart Association recommends your blood pressure be less than 130/80. Why does your blood pressure matter? High blood pressure gradually increases the pressure of blood flowing through all the arteries in your body, damaging or narrowing your arteries and ultimately limiting blood flow. Uncontrolled hypertension weakens your brain’s blood vessels, causing them to rupture or leak. This commonly known as a stroke. Hypertension can also cause damage to your kidneys and the delicate blood vessels in your eyes that lead to bleeding, blurred vision or even a loss of vision! 

Although some people are genetically inclined to have high blood pressure even when they are eating well, most will benefit greatly from following a diet that’s low in sodium. DASH (Dietary Approaches to Stop Hypertension) is an eating plan that emphasizes eating more fruits, vegetables and low-fat dairy products while limiting foods high in cholesterol, saturated fat and trans fats. Instead of fatty red meat or process foods, choose whole grain breads, poultry, fish and nuts to keep you satisfied.   

The standard DASH Diet recommends consuming up to 2,300 mg of salt per day. The lower sodium DASH diet allows for 1,500mg of salt per day. 

Consistent, Manageable Changes
It’s difficult for anyone to make a drastic overhaul to their way of eating. I recommend picking one new thing to change in your diet at a time. Once you get that down, pick another small change from the DASH plan. It’s better to make lifestyle changes slowly than start a crash diet that you quit because it’s too hard. A good place to start is by cutting down your salt intake (not just how much salt you are put on your food but counting the salt in the food you are already eating). Other options include eating more fruits and veggies (four to five servings a day) or substituting whole wheat for white flour breads. 

Diet and Exercise Make a Difference 
Following DASH can lower your systolic blood pressure (the top number of your blood pressure) by 8 to 14 points. Heavy drinkers who cut back to moderate drinking can also lower systolic blood pressure (the top number of your blood pressure) by two to four points and diastolic blood pressure (the bottom number of your blood pressure) by one to two points. Moderate drinking is one drink a day for women and two drinks a day for men. A drink is five ounces of wine, 1.5 ounces of 80-proof distilled spirits, or 12 ounces of beer.  

Changing your diet and limiting alcohol consumption can also lead to weight loss, which in turn can help lower your blood pressure. If you’re overweight or obese, every 20 pounds you lose you could drop your systolic pressure by five to 20 points. Lastly, exercise can lower your blood pressure, dropping your systolic blood pressure by four to nine points if you exercise for at least 30 minutes each day. 

It’s worth mentioning again that properly controlled blood pressure contributes to a healthy life by reducing your risk of strokes, heart attacks, kidney failure and other conditions. Following a healthful diet that’s low in sodium is a great place to start. But if these changes aren’t making a difference in keeping your blood pressure under control, your next move is to talk with your doctor about blood pressure medication. 

- Sarah Baker, M.D. 

Vital Vaccines

When you hear the word vaccine, it’s easy to think of children first. Vaccines are a way to build up your body’s natural immunity – and to protect against serious illnesses and complications from diseases. But vaccines aren’t just for children. Adults also gain vital protection for their health when they follow the recommendations for vaccinations. 

Tetanus

What it is: Tetanus, also known as lockjaw, can cause painful muscle spasms and can lead to death. It’s caused by bacteria that is commonly found in soil, saliva, dust and manure. It generally enters through a break in the skin – such as a cut or wound – by a contaminated object.

Why you need it: There are few different types of tetanus vaccines for adults that provide protection against several diseases. Td is a combo vaccine that protects against diphtheria and tetanus. The Tdap shot protects against diphtheria, tetanus and whooping cough. 

Recommended vaccination schedule: You should get Tetanus shot every 10 years. Adults who have never received Tdap should get it in place of a Td dose, one time. Pregnant women should get Tdap during the 3rd trimester of every pregnancy to protect her baby from whooping cough in the first few months of life. 

Shingles

What it is: Shingles is a viral infection that causes a painful rash.

Why you need it: One out of three people in the United States will develop shingles in their lifetime. In addition to the itchy and uncomfortable rash, shingles can also lead to postherpetic neuralgia, which is a chronic pain syndrome on the skin.

Shingrix is a new shingles vaccine that became available in January 2018, which is a replacement for the older vaccine named Zostavax. It’s more than 90% effective in preventing shingles and postherpetatic neuralgia. As far as we know, its protection stays above 85% for at least the first four years after you get vaccinated. We are waiting for further studies to see how long the vaccine can last before a booster is needed.

Recommended vaccination schedule: Shingrix is recommend for healthy adults 50 years and older. For full protection, you need two doses separated by 2 to 6 months.   

Pneumonia

What it is: Pneumonia is a lung infection that occurs in one or both lungs, causing the air sacs to fill up with pus or fluid. Because the condition makes it hard for you to breathe, it often leads to hospitalization.

Why you need it: A variety of organisms, including bacteria, viruses and fungi, can cause pneumonia. The pneumonia vaccine helps to prevent the most common bacterial pneumonia, streptococcus Pneumoniae. Each year in the United States, pneumococcal disease causes thousands of infections that are not just pneumonia but meningitis, bloodstream infection, and ear infection. The pneumonia vaccines can help prevent severe diseases which often require treatment in the hospital and reduce your risk of premature death. 

Recommended vaccination schedule: There are two pneumonia vaccines: Prevnar 13 and Pneumovax 23. Anyone age 65 years or older should get both vaccines. The typical vaccination schedule is to get Prevnar13 first, followed by Pneumovax23 a year later. These vaccines are also recommended for certain adults younger than age 65 who have chronic illness – like heart disease, kidney disease, liver disease, lung disease, diabetes or alcoholism. Those with other conditions that weaken the immune system (like HIV/AIDS, cancer or who have damaged/absent spleens) and individuals with a cochlear implant, cerebrospinal fluid leaks or who smoke, should also be vaccinated early. It’s important to talk with your doctor about your personal risk factors.

Insurance Coverage

Shingrix for shingles is covered by commercial insurance. If you are 65 years or older, it’s is covered under Medicare Part D. This means patients must get the vaccine at their pharmacy because it’s under the prescription portion of their healthcare plan. Pneumonia and Tetanus vaccines are routinely covered in full, but it’s important for you to check the specific details of your plan.   

When it comes to taking care of your health, vaccines are a simple and relatively painless way to protect yourself against certain infectious that could lead to hospitalization and death. Take the next step and talk with your physician about which vaccines are right for you. 

- Sarah Baker, M.D. 



Video Library

Dr. David Castrilli discusses cholesterol, exercise and healthy eating.

Dr. David Castrilli discusses tips for managing type 2 diabetes.

Dr. Baker discusses the flu vaccine.

Dr. David Castrilli shares tips managing type 2 diabetes in the summer months.