Fall 2009 Vol. V

In This Issue:

185 Oser Avenue • Hauppauge, NY 11788 © 2009 Better Living Now, Inc.

October 2009 is the 25th anniversary of National Breast Cancer Awareness Month. I have been a supporter for many years of breast

cancer awareness, education and early screening. Better Living Now works closely with the American Cancer Society and is listed as a referral source. I am also a certified mastectomy fitter and can arrange a personalized appointment for you in our private boutique. We have what you need for essential care after breast surgery. I also provide services for hospitals and home calls. It would be my pleasure to speak with you. Please call me for a free consultation.- Christine Lilly Better Living Boutique Manager

We’re Here For You

Fact or Fiction 2

Whats New In Diabetes? 2-3 & (a multi-article feature) 5-6

Delicious & Nutritious 3

Lifestyle Works 4

News You Can Use 5

Upcoming Events 7

News You Can Use: Facts 7

Health Links 8

Letter From the President 8

Diabetes Centers in the NYC Metro and Long Island AreaLocation Contact Person Phone #Good Samaritan Hospital, West Islip Susan Proper 631-376-4064Long Beach Medical Center, Long Beach Rachel Ferdinand 516-897-4354Northshore-LIJ System At Glen Cove Meg Dilberto, RN, CDE 516-674-7936Jamaica Hospital, Queens Mimi Varughese, RN, FNP 718-206-8411Flushing Hospital Medical Center, Queens Nursing Department 718-670-5640Mount Sinai Diabetes Center –Program For Children, Teens and Parents, New York City

Loretta Iazzetti 212-241-6936

Metropolitan Hospital CenterNew York City

646-672-3203

St. Charles Hospital, Port Jefferson, NY Fran 631-474-6449Winthrop Diabetic Center Virginia Peragallo-Dittko 516-663-2350Lutheran Medical Center-Brooklyn Disease Management Program 718-630-6885Downstate Medical Center, Brooklyn Maria Yomtov 718-270-2020Montefiore Diabetes Teaching Clinic 718-920-5101Medical Center Diabetes Education 718-920-7247Albert Einstein, Bronx Sherly Merkin, RN 718-904-2883Bronx Lebanon Medical Center, Bronx 718-518-5581Northern Westchester Hospital Center, Mount Kisco

Rachel Lacks 914-666-1861

Staten Island University Hospital Mary Gunderson 718-226-1547Stony Brook University Hospital 631-444-0580

2 www.BetterLivingNow.com 1-877-BET-LIV-NOW (238-5486)

Low calorie sweeteners increase appetite and food intake.

Fiction. Several large studies comparing food intake between groups taking regular sugar and a low-calorie sweetener showed no affect on appetite. Also, these studies showed that the low-calorie sweeteners helped those in the study feel more satisfied with their meal plans that help them lose weight and keep it off. Low calorie sweeteners do not cause cancer.

Fact. Many studies have been completed over the last 20 years. A recent population study by the National Cancer Institute showed that aspartame (even at large intakes) was not associated with any increased risk of cancer. Although the amount of low-calorie sweetener consumed has increased in the last 20 years, no cause and effect relationship has been found between intake of the low-calorie sweeteners and cancer. Pregnant women and children can have low calorie sweeteners.

Fact. Pregnant women can consume low calorie sweeteners in moderation unless advised otherwise by their physician. To date all low calorie sweeteners have FDA approval for consumption by pregnant women and children. However, because both diet and calories are important in both groups, the advice of a registered dietitian to assess the overall meal plan is recommended.

FACTFICTION?

or

Transplants Help Individuals with Type 1 Diabetes Omit Insulin A study in the Journal of the American Medical Association published in April 2009 studied people with type 1 diabetes who received stem cell transplants. Study participants were followed for 4 years. These investigators were able to show these persons were able to go as long as four years without needing insulin treatments. Stem cells do not start as specialty cells (for example the bone marrow or the liver), but as they divide throughout life creating more cells, they can become specialized cells. The process involves injecting people with stem cells made from their bone marrow cells (also known as autologous non-myeloablative hematopoietic stem-cell transplantation). Researchers first used this as a short term therapy in 2007, and have since looked at how long its effects lasted. They reported that 20 of 23 patients “became insulin free -- 12 continuously and 8 temporarily for periods as long as four years.” The temporary group of eight restarted insulin at reduced levels. The patients ranged in age from 13 to 31. The research team measured C-peptide levels which show how well the body is producing insulin. They report that these levels increased “up to 24 months after transplantation and were maintained until at least 36 months.” The individuals who had to restart insulin also showed a significant increase in C-peptide levels that lasted at least two years, the researchers said. Further research is necessary to establish how this treatment can change the natural course of type 1 diabetes.

Pancreate Makes New Islet CellsPeople with type 1 diabetes loose the ability to produce islet cells that produce insulin. Most of those with type 2 diabetes will also experience a drop in mass of pancreatic islet cells. One company, CureDM, may have identified the protein that stimulates specialized cells to make insulin.The adult human pancreas contains large numbers of pancreatic progenitor cells. These work differently from stem cells in that they can only distinguish islet cells. Normally, these cells become specialized only during the fetal stage when the pancreas is forming. In adults more islet cells form in response to injury or stress to the pancreas. Armed with this information, CureDM investigated what causes these pancreatic progenitor cells to make new islet cells. This approach lead to the discovery of a small protein, Human proIslet Peptide (HIP) that is now called Pancreate. It is a segment of a larger protein called REG3a that is low after fetal development. CureDM believed that the lack of HIP prevented the formation of new islet cells in adults. The company was able to figure out the sequence of amino acids that make HIP and have been able to stabilize to improve its availability in the body. To date culture studies have resulted in a 4 fold increase in insulin secretion and in diabetic mice, insulin secretion was tripled. After 21 days of treatment these animals no longer needed extra insulin.It is anticipated that patients will take Pancreate once or twice daily for several months, during which their insulin

Cell Discoveries – It is a basic premise of science that the discovery for a cure for diseases must start at the cellular level. Often it is difficult for lay people to understand that these studies of the cell can lead to the discovery of a cure for their disease. The gap between cell study and practical daily life for those living with a chronic disease appear light years away. The 2 brief articles below show that the gap is not as wide as was once believed, and that scientists’ understanding of what goes wrong in diabetes (and finding treatments) has made great strides.

Continued on next page

What’s In Diabetes?

What’s In Diabetes?

3185 Oser Avenue • Hauppauge, NY 11788

&Delicious NutritiousEating healthy doesn’t mean you have to sacrifice great taste.

dose will be gradually decreased and eliminated. To protect the new islet cells from the body rejecting them would require concurrent treatment with anti-rejection drugs. Patients with type 2 would take Pancreate along with existing treatments to increase their islet cell numbers. CureDM has to file an application for an Investigational New Drug to the FDA before Pancreate can be tested in humans. The company expects to begin clinical trials in both type 1 and type diabetes in 2010.Blood Fat Lowering Drug Reduces Foot Amputation Risk in Type 2s Fenofibrate, a drug used to lower blood fat levels (cholesterol) also reduced the risk of foot amputation by 36% in individuals with type 2 diabetes. The study was completed in by an Australian research team at the National Health and Medical Research Council Clinical Trials Centre at the University of Sydney. This was a large study that tracked 9,795 persons with type 2 diabetes over a five-year period. Half took 200 mg of fenofibrate daily, while the other half took a placebo.The group taking the fenofibrate had a 36% lower risk of a first amputation than the placebo group. The risk was even less at 47% for amputations below the ankle for those who did not have large-vessel disease. (Large vessel disease is caused by the presence of plaque deposits in the large arteries, usually the result of heart disease, as opposed to the disease of the small

vessels commonly found in people with type 2.) The beneficial aspects of fenofibrate consumption became apparent after 1.5 years of continuous use. A similar reduction in the risk for above-the-ankle amputations was not observed.Welchol and Metformin Lower Cholesterol and HbA1c levelsPeople with diabetes who took Welchol plus metformin had reduced their average hemoglobin A1c (HbA1c) levels (a measure of long-term blood glucose control) 0.47% compared to those who took a placebo plus metformin.When the HbA1c levels of people who took Welchol and a combination of drugs was compared to placebo, the Welchol group reduced HbA1c levels by 0.54%. The study participants who took Welchol, no matter what other medication they took, also ended up with significantly lower LDL cholesterol levels than the placebo group.Because one of the potential side effects of Welchol has been to raise triglyceride levels (especially when taken with a sulfonylurea or insulin) the manufacturer recommends caution in prescribing the drug in people whose triglyceride levels are over 300 mg/dl. Other potential drug interactions should be discussed with their doctor or pharmacist.

Drug Therapies

Continued on page 5

Bulgar & Pesto Wrap

1- 14 ounce can reduced sodium chicken or vegetable broth ¾ cup bulgur

⅓ cup basil pesto 1 medium red sweet pepper, chopped¼ cup thinly sliced green

onions2 Tbsp balsamic vinegar2 cups canned cannelli, pinto or other white beans*

Bulgar is a whole wheat grain that is high in fiber and contains many antioxidants. It also cooks faster than most grains. This recipe provides almost half the recommended daily intake of dietary fiber for most adults.

1. In large saucepan, combine broth and bulgar. Bring to boiling and reduce heat. Cover and simmer about 15 minutes until bulgur is tender.

2. Remove from heat and stir in sweet pepper, pesto, green onions and balsamic vinegar. Stir in beans. Season to taste with black pepper.

3. Transfer to an airtight storage container. Cover and chill for up to 3 days.

4. When ready to serve roll up in whole grain tortillas.

Per Serving: Calories 333, Total fat 11g, Saturated fat 2g, Sodium 426 mg, Carbohydrate 47g, Protein 15g, Dietary Fiber 11g

Makes 4 (1 cup servings)

*Use dry beans to lower sodium content.

4 www.BetterLivingNow.com 1-877-BET-LIV-NOW (238-5486)

Calorie Inflation There is no doubt that over the last 20 years, American society’s idea of reasonable portions have increased. The term coined for this is portion distortion. Below are comparisons of how society’s idea of ‘normal’ portions have grown. Take the fun quiz below and next time you order out, you’ll be more informed about what are reasonable portions. Answers to the quiz on page 7.

Lifestyle W rksThis section of emPOWER highlights small lifestyle changes that over time result in permanent weight loss and better health.

20 Years Ago TodayPizza 2 pepperoni pizza slices 2 large pepperoni pizza slices 500 calories a. 1000 calories

b. 900 calories c. 850 calories

Bagel 2 ounce bagel 5 ounce bagel 140 calories a. 600 calories

b. 350 calories c. 500 calories

Coffeewith whole milk and sugar with steamed whole milk and

caramel syrup 8 ounces 16 ounces 45 calories a. 350 calories

b. 200 calories c. 500 caloriesCheeseburger Cheeseburger (4 oz with bun) 320 calories a. 500 calories

b. 800 calories c. 600 calories

Spaghetti 1 cup and 2 small meatballs Spaghetti with meatballs 450 calories a. 1,000 calories

b. 800 calories c. 600 calories

1. Split an entrée and order a garden salad with low-fat salad dressing or a vinaigrette dressing.

2. Eat small meals throughout the day. For example if you feel a hunger pang in the afternoon, have a healthy snack like small piece of fruit or yogurt. This will help prevent over eating at the next meal.

3. If you have a snack, avoid eating out of the package; instead, place a small portion in a small plate.

4. Exercise mindful eating. Eat when you can focus on eating... not while you’re walking around and especially not while watching television.

5. Store tempting foods in containers that are not easily visible and not easily accessible.

6. Have a high fiber food such as vegetable soup or a salad before your entrée.

7. Serve food from the stove. Don’t keep food at the table. The temptation to go back for seconds is irresistible.

8. Drink water or a calorie-free drink between bites of food.

Keep your portions on track with these easy tips. Remember that small changes add up to big losses.

UseNewsYou Can

5185 Oser Avenue • Hauppauge, NY 11788

If you’re taking medications called angiotensin receptor blockers (ARB) or angiotensin converting enzyme (ACE) inhibitors, your doctor may be trying to not only control your blood pressure, but reducing your risk of having a stroke or heart attack. In addition, ACE inhibitors may help reduce events that cause damage to the kidneys and to the eyes.ACE inhibitors work to widen blood vessels and increase the amount of blood supplied by the heart to the body. This increased blood flow also helps the heart work easier. To the right is a list of ACE inhibitors.

ARBs block a hormone that causes blood vessels to narrow. When vessels are relaxed blood flows more efficiently. This class of medications also help the body rid of sodium and water through the urine. This lowers the volume of blood in the body which then lowers blood pressure. There are currently no generics available for ARBs.

BrandAtacand DiovanAvapro MicardisBenicar TevetenCozaar

Brand GenericsLotensin BenazeprilCapoten Captopril Vasotec EnalaprilMonopril FosinoprilPrinivil, Zestril LisinoprilAccupril QuinaprilAltace RamipirilAceon [none]

Scientists at the University of California, Santa Barbara and Sansum Diabetes Research Institute have demonstrated for the first time that an automated artificial pancreas system (APS) can safely and effectively maintain desired blood glucose levels in patients with type 1 diabetes. The automated insulin delivery system consists of the OmniPod(R) System and the DexCom STS7(R) continuous glucose monitor, and are linked and controlled through the university’s artificial pancreas software. The software contains insulin delivery calculations based on the patient’s blood sugar readings and other clinical data designed to prevent insulin-induced low blood glucose levels (hypoglycemia). Without

any outside intervention, the system restored normal blood sugar readings after both induced high blood sugar readings and unexpected meals; hypoglycemia was avoided. The insulin delivery calculations achieved this through the automatic delivery of insulin to correct high blood levels, and tapering the insulin rate to ensure a return to normal blood glucose levels. This completelt automated technology frees the patients from controlling their pumps manually and would help with adherence to the treatment. Study is ongoing as this trial consisted of only 4 participants who were followed for an average of 5 hours.

Automated ‘Artificial Pancreas’ Controls Blood Glucose Levels in Persons with Type 1 Diabetes

Concluded on next page

What’s In Diabetes? (continued)

We still do not know one-thousandth of one percent of what nature has revealed to us. -Albert Einstein

What’s In Diabetes?

6 www.BetterLivingNow.com 1-877-BET-LIV-NOW (238-5486)

(continued)

Estimated average glucose (or eAG) = hemoglobin A1c (HbA1c)If you’ve ever wondered what that 3 month glucose level in percent has anything to do with your blood sugar, now your health professional can give you an actual blood sugar level that represents that percentage; this number is also called the estimated average glucose (or eAG). To the right is the table that gives the hemoglobin A1c in

percent and the corresponding eAG in mg/dl which is a similar number that you see everyday when you check your blood sugar. That number represents your blood sugar reading at that moment; whereas the eAG gives you an average of your blood sugar over the last 3 months.

A1C eAG% mg/dl mmol/l6.0 126 7.06.5 140 7.87.0 154 8.67.5 169 9.48.0 183 10.18.5 197 10.99.0 212 11.89.5 226 12.6

10.0 240 13.4How Sweet It Is -- Natural Sweetener Products Stevia

After many years of regulatory hurdles and setbacks, stevia (Stevia rebaudiana) has finally entered the mainstream sweetener market. This natural sweetener comes from the leaves of the South American plant. It is 200 to 300 times sweeter than sucrose (table sugar). Adding to its appeal is that these sweeteners contain zero calories. The various brands contain either stevia leaf extract or rebiana, which is a high purity extract of the stevia plant. Because so little stevia is needed, several brands contain bulking agents, such as erythritol or dextrose. Erythritol is a natural sugar alcohol that is found in fruits. It is well tolerated in the stomach and very little is absorbed by the body so it does not affect blood sugars.

Stevia can be used not only as a sweetener, but for baking.The manufacturer of the brand name sweetener SweetLeaf hired 2 groups of independent scientists to review the available worldwide data on stevia. These groups contained former FDA officials familiar with the generally recognized as safe (GRAS) process (This is the procedure by which food products consumed in the United States are tested for consumer safety). Both groups determined that stevia meets safety and production requirements necessary for GRAS status, and this status was officially given to the manufacturer on March 5, 2008.The list on the right contains the names of other companies’ brand of the sweetener stevia.

Erythritol

As briefly mentioned above erythritol is a 100% natural sugar alcohol that is found in fruits, vegetables and several fermented foods. It is made from sugar cane juice that is naturally fermented and crystallized to create organic erythritol. Unlike other sugar alcohols, erythritol is well tolerated in the stomach, and because very little is absorbed by the

body it does not raise blood sugars and contains zero calories. It is 70% as sweet as sugar. It can be used not only as a sweetener, but also for baking.

Diabetes Self-Care

Diabetes ProductsFormula: 28.7 X A1C – 46.7 = eAG

Brand Sweetener Calories per gramOrganic Zero Organic erythritol 0Zsweet Erythritol 0.2

Brand SweetenersOnlySweet Stevia leaf extract

Purevia RebianaStevia Extract in the Raw

Rebiana

SweetLeaf Stevia leaf extractTruvia Rebiana,

erythritol

Diabetes Centers in the NYC Metro and Long Island AreaLocation Contact Person Phone #Good Samaritan Hospital, West Islip Susan Proper 631-376-4064Long Beach Medical Center, Long Beach Rachel Ferdinand 516-897-4354Northshore-LIJ System At Glen Cove Meg Dilberto, RN, CDE 516-674-7936Jamaica Hospital, Queens Mimi Varughese, RN, FNP 718-206-8411Flushing Hospital Medical Center, Queens Nursing Department 718-670-5640Mount Sinai Diabetes Center –Program For Children, Teens and Parents, New York City

Loretta Iazzetti 212-241-6936

Metropolitan Hospital CenterNew York City

646-672-3203

St. Charles Hospital, Port Jefferson, NY Fran 631-474-6449Winthrop Diabetic Center Virginia Peragallo-Dittko 516-663-2350Lutheran Medical Center-Brooklyn Disease Management Program 718-630-6885Downstate Medical Center, Brooklyn Maria Yomtov 718-270-2020Montefiore Diabetes Teaching Clinic 718-920-5101Medical Center Diabetes Education 718-920-7247Albert Einstein, Bronx Sherly Merkin, RN 718-904-2883Bronx Lebanon Medical Center, Bronx 718-518-5581Northern Westchester Hospital Center, Mount Kisco

Rachel Lacks 914-666-1861

Staten Island University Hospital Mary Gunderson 718-226-1547Stony Brook University Hospital 631-444-0580

7185 Oser Avenue • Hauppauge, NY 11788

UseNewsYou Can

Self-Monitoring Blood Glucose Targets

Hemoglobin A1c <7%

Glucose: Pre-Meal 90-130 mg/dl Post-Meal* 140-180 mg/dl *(2 hours after finishing the meal)Source: Diabetes Care 27(1):s19, 2004

FACTSFACTS

Individuals who have diabetes and smoke are more likely to develop peripheral vascular disease (PVD) than those who do not smoke. PVD is a condition in which plaque builds up in the arteries and blocks blood flow. As a result symptoms such as cramping or aching in the calves, thighs or buttocks occur with walking that is relieved with rest. These are symptoms of a condition called intermittent claudication. Due to the prevalence of this condition as a person with diabetes ages, a screening test called an ankle-brachial index test is recommended for people with diabetes who are over 50 years of age and repeated every 5 years. Individuals younger than 50 years of age who smoke, have high blood pressure, high cholesterol or diabetes for more than 10 years are candidates for this screening test.

Diabetes Expo 2009Sept. 26 New York, NYOct. 24 Tampa, FLOct. 24 Minneapolis, MN

Tour de Cure 20102010 Dates for the region have been announced. Sign up today!

Walk to Cure DiabetesOct. 4 Belmont Lake State ParkOct. 18 SUNY College at Old

WestburyOct. 25 Suffolk County Community

College at RiverheadRide to Cure DiabetesOct. 15 Death Valley, CANov. 19 Tucson, AZ

American Diabetes AssociationCure • Care • Commitment

Be sure to visit www.diabetes.org and www.jdrf.org to find out more about these and other events in your area. Participating in these events not only raises awareness, but needed funds for research and an eventual cure!

Get Involved!

Answers to Lifestyle Works Quiz:Pizza: c. 850 caloriesBagel: b. 350 caloriesCoffee: a. 350 calories

Cheeseburger: c. 600 caloriesSpaghetti a. 1,000 calories

Better Living Now: 1- 877-BET-LIV-NOW www.betterlivingnow.com

For all diabetic supply needs:

For educational information about diabetes:

American Diabetes Association: 1-800-Diabetes www.diabetes.orgAmerican Dietetic Association: www.eatright.orgJuvenile Diabetes Foundation: www.jdrf.orgJoslin Diabetes Centers: www.Joslin.orgWeb MD: www.WebMD.comBayer Care Diabetes www.bayercarediabetes.comAbbott Diabetes www.abbottdiabetescare.com

All Recipes www.allrecipes.comADA Virtual Grocery Store vgs.diabetes.orgHealthy Meals Resource healthymeals.nal.usda.govMyRecipes myrecipes.com

Nutri-Facts www.nutri-facts.comFastFoodNutrition.org www.fastfoodnutrition.orgNutrition.gov www.nutrition.govNutritionData www.nutritiondata.comCalorieKing www.calorieking.com

For nutrition food facts:

For recipe ideas:

A Letter From The President

Better Living Now

Dear Valued Friends and Customers,

As the fall season leads us into the closing act for 2009, our lives will get busier. School is back in session and various holidays will be approaching. This also means we might become strapped for time or get a bit forgetful. I tend to take a moment to prepare myself by taking a few simple and helpful steps.

By sorting your medications into daily pill holders and keeping them on your night table, you will remember to take your medications. By keeping your testing supplies close by, you will also remember to test yourself. If that does not work, try making a sign for your refrigerator door. If you have children, make it a fun task. I am sure your kids will get a kick out of making you a reminder sign. Fall season also means proper skin care. You need to continue to take a few minutes each day to care for your body by applying, ever so important, skin creams and lotions to your feet and hands.

Make sure your medicine cabinet is stocked with the essential OTC products. Sugar free cough syrups, sugar free throat lozenges and sugar free mouthwash to name a few. To check out all the products and categories I spoke about, please visit our website at www.betterlivingnow.com. As a Better Living Now member, you will receive a discount on all these daily products and much more.

In closing, I urge you to read through our newsletter. 2009 has been a year for new research and important findings. Please feel free to contact our staff of pharmacists and certified diabetic educators with any questions you may have.

Daniel Pope, CEO

Warm Regards,

Daniel S. Pope and Family