A look at omega fatty acids

DEBATE ABOUT omega fatty acids has increased over the last decade. While separating fact from myth can be frustrating, let’s attempt to do just that.

What are omega fatty acids?

Contrary to popular belief, fat has important biological functions, from making up the basic structure of our cells to storing energy. But some fats are good for us, while others are not. Saturated fats often come from animal sources. An excess of saturated fats is bad for us, in part because they raise our bad LDL cholesterol, clog our arteries and cause heart attacks and strokes.

On the other hand, unsaturated fats, which include monounsaturated fatty acids and polyunsaturated fatty acids (PUFAs), are generally considered healthier. Omega fatty acids refer to a whole family of PUFAs: omega-3, omega-6 and omega-9 fatty acids. (It’s a little complicated, but the numbers refer to the fatty acid’s chemical makeup.)

Trans fats, incidentally, are unsaturated fats that have been partially hydrogenated. They’re found in deep-fried foods and other products, and are at least as artery-clogging as saturated fats.

Where do omega fatty acids come from?

Nature provides a bounty of sources of fatty acids. Here’s a short list:

  • Omega-3 fatty acids: flaxseed, fish oils
  • Omega-6 fatty acids: vegetable oils such as corn, sunflower, soybean, evening primrose, and borage and blackcurrant seed oils
  • Omega-9 fatty acids: olive oil

How can this food chemistry lesson help me improve my health?

In general, people who consume higher amounts of omega-3s are healthier because they have fewer problems with a variety of maladies, including plaque in their arteries, heart attacks, high blood pressure, macular degeneration, depression, menopausal symptoms, psoriasis, rheumatoid arthritis symptoms and some types of infections.

There is currently some controversy over the beneficial effects and even the safety of omega-6s, given that the typical North American diet is often too high in omega-6.

Typically, you can consume 10 to 30 times more omega-6 than beneficial omega-3, and while there is no consensus on what a healthy ratio of omega-6 to omega-3 is, consuming more omega-3 helps balance out the ratio. Increasing your intake of omega-3 by eating more fish can potentially expose you to
some of the toxins found in the fish, such as mercury, PCBs and dioxin, but quality supplements bearing a Natural Product Number have had those toxins removed or reduced to within Health Canada safety limits.

Monitoring blood pressure for diabetes

How often should I have my blood pressure checked?

Your blood pressure will be checked at least once a year at your annual review. If you have high blood pressure, you will probably have frequent checks, for example, every 1-4 weeks. Once stable, your blood pressure will be checked every 3-6 months.

How will my blood pressure be measured?

Your health professional will wrap a cuff around your upper arm and inflate it until it is tight enough to prevent blood from flowing to your lower arm. The cuff is then slowly deflated and your blood pressure is measured by the electronic device or by your health professional listening to the blood flow in your arm with a stethoscope. The two figures in your blood pressure measurement refer, firstly, to the pressure in your blood vessel as your heart contracts (systolic blood pressure) and, secondly, to when your heart is relaxed (diastolic blood pressure).

I am always anxious when I visit my clinic – will that raise my blood pressure?

Your blood pressure goes up and down depending on the time of the day and your stress levels. If you feel anxious about seeing your doctor, your blood pressure rises. This is why your blood pressure may be checked two or three times – or for 24 hours – before you are diagnosed with high blood pressure.

Can I measure my blood pressure at home?

Yes, but before buying your own monitor, talk to your doctor, who may give you useful information or be able to loan you a monitor if you need one just for a short time.

If I want to monitor my own blood pressure, how often should I do?

How often you check your blood pressure depends on what you want to know. For example, if you want to find out how a stressful situation affects your blood pressure, take “before and after” readings. If you simply want to know whether your blood pressure is in the recommended range, take readings several times a day for a few days to establish what is normal for you. After this, checking your blood pressure occasionally, for example, once or twice a week, will be enough.

How do I use my electronic monitor?

Your monitor will contain specific instructions on how to use it – the exact position of the cuff or your arm varies from monitor to monitor. Once you start the monitor, the cuff will automatically inflate and deflate and then the monitor will give you a reading of your blood pressure. Sitting down for 5-10 minutes before you measure your blood pressure will increase the accuracy of the reading.

What do I do if I get readings that seem to be higher than my recommended range?

Occasional high readings can be due to stress or life events such as a busy day or pressure at work, but if you are regularly having high readings, you may need to have your treatment started, or reviewed and changed. With Type 2 diabetes, you may need three or more different types of pills to control your blood pressure. Other factors that can raise your blood pressure are eating a lot of salt and being very inactive. Tackling any of these factors can help lower your blood pressure – for example, you could regularly do relaxation exercises, you could increase your activity levels, or you could prepare more meals yourself instead of eating processed food.

A link between the brain and the heart

Have you noticed an older friend or relative feeling a little down lately? A link between the brain and the heart may shed some light on why the elderly suffer depression.

Eighty-five-year-old Margaret Hawkins always enjoyed life. After she lost her husband and two close friends, however, depression set in. “It’s something in your chest around your heart, and you think it’s anxiety,” says Margaret.

Duke psychiatrist Dr. Ranga Krishnan says Margaret is one of many older Americans who is suffering small, almost undetectable strokes inside her brain. “They were not identified as strokes clinically before because they did not affect motor movements,” says Dr. Krishnan. “In other words, they didn’t produce paralysis.”

These mini-strokes occur when blood vessels cut off blood flow to the areas of the brain which affect mood. The result is depression.

Dr. Krishnan is studying more than 200 patients like Margaret and has discovered none fit the profile for depression. Yet they all have classic signs of heart disease like a history of diabetes, high blood pressure and clogged arteries.

Dr. Krishnan says, “It just tells you, don’t treat depression just like a symptom. Don’t just give it a medicine and forget about the underlying medical problems that may be leading towards it.”

He also says medicines that help the heart may help the mind. So patients like Margaret take vitamin E and an aspirin a day.

Margaret Hawkins, “I’m not a depressed person. I’m a pretty happy person, and everybody I see now talks about how good I look.”

Researchers hope studying patients like Margaret will help them refine treatment for others. They believe vascular depression is so common, it could account for as much as 30 to 40 percent of all depression in people over the age of 65.

Healthy eating for diabetes

Myth “People with diabetes can’t eat sugar”
Truth It’s impossible to avoid sugar altogether but sugar and sugar foods are converted into glucose faster than other foods so they can cause a sudden rise in your blood glucose level. Eating less sugar reduces the strain on your pancreas (the organ that produces insulin). If you want to eat sweet foods, have them at the end of meal when your body is already digesting other food in order to slow down the rise in your blood glucose.

What should I eat now that I have diabetes?
Healthy eating is the key to managing your diabetes. The principles of healthy eating for you are the same as those for everyone else. No foods are banned but eating more of some foods and less of others can help keep you healthy and your blood glucose level within the recommended range. Sometime,s you may not have a choice about what food is available but, generally, you can adapt recipes and meals so that you can enjoy food while still eating healthy.

How do I know whether I’m eating a balanced diet?
Selecting a balance of foods from the main food groups is the first step. Aim for complex carbohydrates (starches) and fiber (such as bread, pasta, and whole grains) to make up about a third of what you eat, with fruit and vegetables forming another third. Making up the rest of your food intake form protein foods and dairy products (2-3 servings daily from each group) will give you a healthy balance. Choosing lower fat alternatives where you can will help reduce your risk of heart disease.

Does it really matter what I eat? My health professional told me I’ll eventually need to take pills – and probably insulin – anyway.
Eating healthily is not simply about avoiding medication to treat your diabetes – it reduces your risk of heart and circulatory diseases, helps your digestive system work more efectivley, and helps your pancreas be more efficient if it is struggling to produce enough insulin. Type 2 diabetes is progressive and you may need pills and insulin in time, but eating healthily can help slow down this progression and make it easier to manage your blood glucose level.

Which carbohydrate-containing foods are better for me?
Starchy carbohydrates, including bread, pasta, rice, potatoes, cereals, and legumes, are better because they take longer to digest and therefore cause your blood glucose to rise more slowly than sweet carbohydrates such as white sugar, chocolate, and sugary drinks.

I know that protein doesn’t really affect my blood glucose, so does it matter what type I eat?
Protein foods that are low in fat, such as low-fat milk, low-fat yogurt and cheese, and beans, peas, and lentils will reduce your risk of heart disease. Eating oily fish two to three times a week and having less red meat will also protect your heart.

I’m a vegetarian and have Type 2 diabetes. Does this make any difference to what I should eat?
Healthy eating principles for diabetes remain the same whether you are vegetarian or following any other eating pattern. One of the advantages of vegetarian eating is that it is usually lower in fat because it doesn’t include meat. You will know what sources of protein you prefer to meat, but there is no difference in the amount or type of carbohydrate you need to eat.

My local supermarket seems to label every food as healthy – how can I tell if they are?
Many supermarkets now sell ranges of food that are healthier tan their counterparts. It could mean the food is healthier is only one aspect or several – for example, less fat, less sugar, fewer calories, or more fiber, or it could include a range of more healthy aspect. Reading the label will help you figure out which foods might help you reach your healthy eating goals. In general, processed foods will still be less healthy than those you prepare using fresh ingredients.

Do I need to eat special diabetic foods?
No foods labeled “diabetic” are often expensive and do not give you any benefits. They usually contain the sweetener sorbitol, which has 2.6 calories/gram (compared with 4 calories/gram for glucose). Sorbitol causes a slower rise in your blood glucose but in large quantities it can give you diarrhea.

Should I use artificial sweeteners?
You can use artificial sweeteners as an alternative to sugar to sweeten food and drinks, such as tea and coffee. These products contain aspartame, saccharin, cyclamate, accsulfame K, or sucralose, none of which will affect your blood glucose. Those products are classed as food additives and, for his reason, have been tested for safety.

I have high blood pressure and need to cut down on salt, how can I do this?
Reducing the amount of salt you add to your meals, either while you are cooking or at the table, will reduce your overall salt intake. Most processed and convenience foods (including stock cubes and soy sauce) tend to be high in salt, so cutting down on these can also help reduce your salt intake.

How can I make sure that when I eat fruit my blood glucose doesn’t rise too high?
The fructose in fruit and fruit juice will make your blood glucose level rise. If you eat more than one piece of fruit at a time. Eating fruit after starchy meals and spacing out your fruit intake throughout the day will give you the nutritional benefits without raising your blood glucose too high.

Which drinks will make my blood glucose level go up?
Sugar drinks such as glucose drinks, cols, lemonade, and orange juice are digested very quickly and can cause a sharp rise in your blood glucose level (which is why it is recommended that you drink them when your blood glucose is too low). Sugar added to tea or coffee will have the same effect. Because your body is unable suddenly to increase its insulin production when you have Type 2 diabetes, your blood glucose may take some time to return to an acceptable level.

Which drinks won’t affect my blood glucose level?
For day-to-day drinks, water or sugar-free drinks such as diet cola won’t affect your blood glucose level. Tea, coffee, and other hot drinks without added sugar will not affect your diabetes. Drinking them with skim or low-fat milk will ensure that their fat content is not too high. Powered drinks can have a high sugar content, so check the label to determine what effect they are likely to have.

Connections between nutrition, genetics and disease

Do you think that nutrition needs to get more personalized?
It certainly needs to get more personalized for specific diseases like heart disease and like osteoporosis. Specific diseases that we know have a nutritional connection.

Would this be based on a person’s genetic code?
There are breakthroughs in the last several years in molecular biology which will allow determination of whether or not people are susceptible to particular diseases. Some appear to have a relatively simple genetic relationship such as osteoporosis, while others like heart disease have a very complex genetic relationship. There are markers being discovered that will help ascertain whether or not someone is susceptible.

Once we can determine if this person is susceptible then what would happen with their diet, how can we use that information?
One of the things that it will allow us to do is to test whether diet is really going to have an effect on a particular disease, in people who have a susceptibility. One of the things we do right now is use large populations of people for study. The problem with that is we don’t know who is susceptible and who isn’t so we just take a chance that we’re getting a significant number of susceptible people and then determine whether diet has an effect or not. If you happen to get susceptible people then it looks like diet might have an effect and if you happen not to you don’t see a dietary effect, that’s why there is so much confusion in the reports that come out in the literature. This dietary treatment helps in one report and it doesn’t help in the next report, so by working with those who are susceptible then we have a much better shot at determining specifically whether or not a dietary or drug treatment is effective.

What effect might this have on diseases in the future?
One of the things that we tell people for example is to increase the amount of fiber in their diet with the hope that this might reduce the possibility of colon cancer. If we know who is susceptible for colon cancer, and there are particular markers for particular types of colon cancer, then we can determine whether a high fiber diet helps them or doesn’t help them. If it does we can target them for a high fiber diet and not try to get the entire population to eat more fiber.

Do you think this might actually be able to prevent diseases, if people eat the right kind of foods based on their genetic code earlier in life?
This kind of information will help us to be able to determine whether or not eating a particular kind of food is going to be helpful. Right now recommendations are based on statistical probability, not genetics. If we can base them on genetics and work with a susceptible group of people specifically, then we have a much better shot at determining whether any dietary choices are helpful or not.

Explain how this kind of diet might work. Let’s take osteoporosis for example, researchers have suspected a genetic link to the disease right?
There has been a suspicion for many years of a genetic link. One of the genetic links has been discovered in the last few years that a defective gene affects Vitamin D absorption from our diet. In order for Vitamin D to get into the body like anything else it has to cross from the gastrointestinal tract into the blood stream. There is a particular protein required for Vitamin D to get across into the blood stream. People who do not have that protein or not enough of it get more osteoporosis. If you know who those people are you can give them higher levels of Vitamin D and therefore increase calcium absorption and increase calcium utilization. The problem is that you can’t give everybody that level of Vitamin D because Vitamin D is toxic.

If someone has osteoporosis and if you’re able to increase their absorption of calcium through Vitamin D, if they did this early in life could that possibly prevent them from getting the disease later in life?
That’s what one would expect, yes. That if you could get enough calcium absorbed and deposited in the bones early in life then you could prevent osteoporosis later in life.

That would be a really big breakthrough.
Yes, there are potentially several of those kinds of breakthroughs that are coming down the road. Maybe in the next few years, maybe in the next decade but they are certainly coming.

What other kinds of diseases, aside from osteoporosis?
Heart disease, or stroke caused by high blood pressure. There’s been some interesting information coming out on high blood pressure. Muscular dystrophy and cystic fibrosis have been studied extensively and so have numerous other diseases that affect humans.

When do you think we could be looking at diet based on genetic codes, how many years down the road?
It will vary depending on which particular disease we’re talking about. We expect that the osteoporosis breakthrough will happen in the next few years because it seems to be a relatively simple genetic relationship. On the other hand cancer, that might take a long time because you can either inherit a defective gene that causes cancer or the defective gene can be made through mutation during your life. So that’s going to take much longer.

When researchers get a handle on this what effect do you think it will have on the diseases that the population gets? Do you think you will get a sharp reduction?
Hopefully, it really depends on whether or not you can make dietary or drug changes that affects the progress of that disease. Some cases I think we can, and some cases it may simply not be possible. It may be just part of human existence.

If you could give me in a nutshell why do we need to change the way we tell people what’s good for them to eat, why do we need to get more specific and base it on this genetic code?
Right now we make general population wide recommendations. For example, we’ve recommended that there be about twelve hundred milligrams per day of calcium intake. This is particularly important during the teenage years up through the age of thirty years old. The compliance with that recommendation has been depressingly little. If we knew which particular people were susceptible and which particular people needed the dietary treatment, then I think if we could get those people to comply and leave the rest of the world alone in terms of how much calcium they consume, or at least in terms of needing to consume large amounts of calcium.

We’re doing a one size fits all diet plan and that’s not really working?
We are making general recommendations for the whole population and in a lot of cases it’s not working. People are not doing what those recommendations would suggest that they do. One of the problems in the last eight or ten years has been a wide spread body weight increase. Well one of the recommendations is that you limit caloric intake. People are not doing it and they’re gaining weight. If we knew who was susceptible to particular diseases then I think we have a better shot at getting them to change their particular diet or drug treatment in order to prevent or at least ameliorate the consequence of that disease.

You’ve done informal research in your classes where you ask people if they comply with different guidelines, dietary, what’s the response when you ask the students that?
One of the things I ask students is to give me a list of their top five favorite foods. Usually pizza tops the list but nowhere on the top five do you find fruits and vegetables for college age students. If you ask them, how many of you drink three glasses of milk a day. Only a very small percentage drink that much milk each day. They are probably not getting sufficient calcium, or at least the calcium amount that’s recommended.

Long-term Complications of Diabetes

I’ve just been diagnosed with Type 2 diabetes. What sort of health problems might I develop in the long term?

You are at increased risk of two main sets of complications: those affecting your heart and circulation (macrovascular problems) and those affecting your eyes, feet, kidneys, and nerves (microvascular problems). Although serious, these problems are not inevitable. You can do a lot to reduce the risk of developing them by leading a healthy lifestyle and working with your health professionals to make sure that you have routine medical checks when you need them.

How long after diagnosis do the complications of Type 2 diabetes usually occur?

Complications take at least 5-10 years to develop but this can be misleading because you can have signs of them when you are first diagnosed. This is because you may have been developing Type 2 diabetes for years before your diagnosis. Once you know you have diabetes, you can show the rate at which complications progress, or increase the time before they develop.

What heart problems might I experience?

Type 2 diabetes is strongly linked to high blood pressure and high blood cholesterol. These two factors increase your risk of cardiovascular disease (CVD) and heart attack.

Why is diabetes linked with kidney problems?

High blood glucose levels over a period of years can damage the delicate filtering system in your kidneys. If left untreated, this damage can eventually progress so that your kidneys no longer function efficiently. Urine tests will be done once or twice a year to look for any early signs of damage.

Is it true that diabetes can affect my eyesight?

When you are first diagnosed with diabetes, you may have blurred vision. This is linked to high blood glucose levels and is usually temporary. Once your blood glucose levels reduce, your eyesight will return to normal. In the longer term, one of the complications of diabetes is retinopathy – damage to the small blood vessels at the back of your eye. Retinopathy can be successfully treated if diagnosed at an early stage, but if it is left untreated, your eyesight will be affected. Having your eyes checked at least once a year will reveal whether you have retinopathy.

Why are people with diabetes prone to foot problems?

Over a long period of time, high blood glucose levels can cause poor circulation and nerve damage, resulting in reduced sensation in your feet. This makes you more prone to problems such as ulcers on your feet or legs, or damage to the bones of your feet.

How will having diabetes affect my sex life?

If you are a man, over time you may find it more difficult to get an erection because of damage to your nerves or circulation. There are a variety of treatments for erectile dysfunction.

What can I do to prevent myself from getting the long-term complications of diabetes?

Controlling your blood glucose level and blood pressure as well as possible reduces your risk of complications. Eating healthily, being physically active, losing weight if you need to, stopping smoking, and taking prescribed pills or insulin all help. Other important measures include an annual checkup and keeping your knowledge of diabetes up to date. To minimize foot problems, check your feet daily, and seek help if you notice any injuries or abnormalities.