Pre-diabetes? Me? Risks, Tests, and Lifestyle Change

By Kat Kleman

I’ve been very successful at ignoring the fact that I’m getting older. Hair dye and the good fortune of looking –or at least acting– a little younger than I am are a big part of this feat. And a steady diet of fast food, Chinese food, and pizza, with Denny’s and IHOP occasionally thrown in, hasn’t killed me, which has only enabled me in my denial.

Except,  as much as I don’t want to admit it, I am getting older. On my honest days, I can see 50 coming (ok, hurtling toward me at breakneck speed,) and I’m pretty sure I’m closing in on my lifetime threshold of fast food consumption, after which I will most likely spontaneously combust. As for exercise, well, I think about exercising a lot. That counts for something, right? All of these bad habits make me a likely candidate for being one of the 1 in 3 Americans with pre-diabetes.

Pre-diabetes is exactly what it sounds like. You have elevated blood sugar levels, but not full-on diabetes. Because the symptoms are not always obvious, 90% of people with pre-diabetes don’t even know it(or, like me, are avoiding knowing it!) With so many people unaware of pre-diabetes, it’s important to know some of the warning signs. People who are over 45 who don’t exercise regularly, are overweight, and/or have a family history or prevalence of diabetes are at a higher risk of having pre-diabetes, as are African Americans, Hispanic/Latino Americans, American Indians, Pacific Islanders, and some Asian Americans. If any of these factors apply to you, talk to your doctor, who will give you a test to determine your blood sugar levels.

There are three different diagnostic tests you can take to confirm a diagnosis of pre-diabetes. The A1C test measures your average blood sugar levels over the course of the past 2-3 months. You can also take a test after fasting for 8 hours or two hours after a meal. Table 1 shows the results for each type of test.[2]

Test Normal Pre-diabetes Diabetes
A1C < 5.7% 5.7% – 6.4% 6.5% or greater
Fasting (mg/dl) < 100 100 – 125 126 or greater
2 hours after eating (mg/dl) < 140 140 – 199 200 or greater

Table 1: Comparison of the results of blood sugar tests.[3]

Not everyone with pre-diabetes  develops full-on-type 2 diabetes. However, 70% of cases do progress to type 2, and pre-diabetes comes with its own set of complications.  For example, pre-diabetes increases your risk of heart disease. Scientists at Wake Forest University discovered  that the risk of developing cardiovascular disease increased in. people with diabetes:  “. . . the risk for CVD [cardiovascular disease] ranged from 15 percent (non-diabetic) to 38 percent (diabetic) among women and from 21 percent (non-diabetic) to 47 percent (diabetic) among men.”[4] While there wasn’t an increased absolute risk for developing cardiovascular disease, because so many people with pre-diabetes end up with type 2 diabetes, the connection is there. Additionally, when you reach mid-life the risk of having diabetes and developing CVD increases even more.[5] The risk for stroke also increases in people with pre-diabetes. One study found the risk to be 21% higher, but that number varies depending on the definition of pre-diabetes. Regardless, the correlation is there.[6]

The good news in all of this is that pre-diabetes can be reversed or at least slowed down through diet and lifestyle change. If you’re overweight, losing even a small amount of weight can help (5-7% of starting rate, which would be 10-14 pounds for a 200 lb. person). Increasing your exercise to 150 minutes per week of brisk walking (or an equivalent activity) can change your risk for developing pre-diabetes[7]. Changes in diet such as eating more fruit, vegetables, beans, and whole grains can also lower the risk. Finally, avoiding sweets, fatty or fried food and refined carbohydrates like those found in white bread or pasta can actually slow down the progression of pre-diabetes[8]. The CDC’s National Diabetes Prevention Program has a lifestyle program to help make these changes; joining this program can reduce your risk of developing type 2 diabetes by 58%, or 71% if you’re over 60.[9]

Are you at risk for Pre-diabetes?

Many people with pre-diabetes are unaware of their condition. Here are some risk factors:

  • 45 years old or older
  • Overweight
  • Physically active less than 3 times a week
  • Close family members (mother, brother, sister) with type 2 diabetes
  • Having gestational diabetes or giving birth to a baby who weighed more than 9 pounds
  • Having polycystic ovary syndrome

If you have one or more of these risk factors, talk to your doctor about being tested for pre-diabetes.

Ok. I can check 2 of those boxes, and I know I’ve had some high blood pressure in the past. Combined with my not-so-stellar diet, I’m thinking it’s time to check in with my doctor. I’m not ready to give up pancakes for dinner just yet, but it’s definitely worth digging out the last decade’s worth of New Year’s resolutions and start making some changes.



[3] ibid


[5] Ibid.





How Sweet it is! Splenda, Stevia, and Surviving the Season of Sugar

pexels-photo-227432.jpegWith the last of the holiday sweets eaten and Valentines Day on the horizon, now is the perfect time to think about sugar. We all know that too much sugar is bad. It is addictive, causes weight gain, and lurks in almost every food we eat. Natural sugars, like the sugars in fruit, are usually not the problem; it’s the added sugar that adds up. With the current obesity crisis and soaring rates of Type II Diabetes, controlling simple sugar intake has become even more critical. It seems like the obvious solution is to eat less sugar. But that’s the hard way, and we Americans are always searching for an easier way to do things. So, rather than trying to curb our intake of sweets by reducing sugar consumption, the food industry has invested billions of dollars over the past decades to find sugar substitutes. Nearly every sugar substitute has its cheerleaders and detractors, and the research as to the benefits and side effects of each sweetener is divided at best and contradictory at worst.

Take Splenda, for example. Splenda was marketed at its introduction in 1998 as a more “natural” artificial sweetener because it is “made like sugar.” Early research showed that sucralose passed through the stomach and intestines undigested, so it had no effect on the body, which meant no negative side effects. Sounds too good to be true? It is.

In 2008, a Duke University study found that Sucralose contributes to obesity, destroys helpful bacteria in the gut, alters the pH of the body, and can reduce the absorption of some medications.1 More recently, a 2013 study by the Italian Ramazzini Institute showed that, when lab rats consumed Splenda on a daily basis, they developed Leukemia and other blood cancers. While the amount of Splenda consumed by the mice was the equivalent of drinking ten diet sodas per day, the study, published in the International Journal of Toxicology and Environmental Health Part B: Critical Reviews serves to remind us that simply substituting an artificial sweetener for sugar is not the answer2.

If you’re not quite ready to embrace black coffee, however, there’s hope. A better option than Splenda is Stevia. Stevia comes from an extract of the Stevia plant, which makes it actually natural. It has been used as a sweetener in teas and traditional medicine for centuries in Paraguay, Brazil, and Bolivia.3 Compared to Splenda, which is 600 times sweeter than sugar, Stevia is only 300 times sweeter.4 Stevia has no calories and is non-nutritive, although there is no evidence that it is more effective than Splenda or other sugar substitutes when it comes to weight loss. While some people have reported nausea and a feeling of fullness when using stevia, it has not been credibly linked to significant side effects.

In addition, reaserchers at the University of New Haven in Connecticut have discovered that Stevia can act as an anti-microbial that is more effective than antibiotics in treating drug-resistant forms of the pathogen that causes Lyme disease.5 With the CDC estimating that 300,000 people are diagnosed with Lyme disease each year, Stevia is an excellent alternative to toxic and increasingly ineffective conventional antibiotics.6 It is important to note, however, that the Stevia used in the study is extracted from the whole Stevia Rebaudiana plant and, while it is available in this form, it is not necessarily the same extract found in commercial products like such as soda. Even so, for now, Stevia seems like the better sweet choice, at least compared to Splenda.

While there is a lot of conflicting information about artificial sweeteners out there, a few things do hold true:

  1. All artificial sweeteners are, well, artificial. As in—fake. As in—someone in a lab somewehere made it.
  2. All artificial sweeteners are not created equal. The more processed a sweetener is, the farther away from natural. Not to mention all bodies react differently to different substances, which means side effects will vary unpredictably from person to person.
  3. If you have to feed your sugar demons, avoid refined sugar and substitutes. Treat them to natural products like Stevia, honey or maple syrup instead.
  4. Above all, the best way to reduce the effects of sugar is to consume less sugar, no matter what the form. Pay attention to labels. Be wary of hidden sugars in food that really does not need sugar, or much sugar anyway, like bread, commercial sauces and dressings, and crackers—even products marketed as “healthy” or “organic” can contain added sweetener.

American culture is a culture of consumption and convenience and our taste for sugar is no exception. We demand instant access to everything and avoid inconvenience like an overly chatty neighbor. It only makes sense that our food is high in sugar content. The temporary energy rush sugar provides fuels the Faster! Easier! More! mindset, which requires more and more sugar to sustain.

Realistically, cutting sugar out completely is a Herculean task. But cutting back on sugar is fairly simple. Look for products without high fructose corn syrup. Use measured quantities of sugar (and less of it!) in your morning coffee rather than pouring sugar from a jar. And remember, a sugar substitute is just a substitute, not a solution.


Take a Stand for Health

Women jumping

Take a Stand for Health

By now you may have heard the phrase “sitting is the new smoking.” Beyond being clever, the catchphrase, coined by Mayo Clinic-Arizona State University Obesity Solutions Initiative director Dr. James Levine, underscores a disturbing fact. According to Levine, we lose two hours of our lives for every hour we spend sitting. In fact, in an interview with the LA Times, Levine makes a further comparison: “Sitting is more dangerous than smoking, kills more people than HIV and is more treacherous than parachuting. We are sitting ourselves to death.”1 With the CDC’s National Health and Nutrition Examination Surveys showing that 50-70 percent of Americans sit for six or more hours each day, sitting has truly become an epidemic2.

The sitting epidemic is fueled by contemporary culture and lifestyle, particularly in the U.S. Our bodies and brains developed in response to particular environmental pressures and an active lifestyle. These days, most of us are not exposed to life-threatening scenarios on a regular basis. We exert little energy in our daily efforts to survive. Even our schools and workplaces promote the sedentary lifestyle: children are expected to sit still for hours upon end, and our workplaces have us sitting at desks, often typing away at keyboards for most of the day. Even our recreational habits have become less active: video games, instant access to movies and television shows, and virtual social environments tempt us to sit more and stand less.

The physical effects of this cultural shift are daunting. Excessive sitting has been linked to hormonal changes, increased inflammation, cardiovascular disease, diabetes, obesity, and cancer.3 From a chiropractic standpoint, sitting can distort the natural curvature of the spine, cause undue stress on nerves and ligaments, overstress muscle tissue, and compress the vertebral discs and spinal joints. As we age, too much sitting leads to disability. According to an NPR report, research out of Northwestern University found that, “For people 60 and older, each additional hour a day spent sitting increases the risk of becoming physically disabled by about 50 percent — no matter how much exercise they get.” With U.S. Census data revealing that nearly half of the population over age 65 have a disability, the impact on our aging population, their families, and their communities is significant.4

The science behind the sitting epidemic revolves around a neat acronym: NEAT. NEAT stands for non-exercise activity thermogenesis. Along with exercise activity thermogenesis, NEAT is the third component of human energy expenditure—calories burned during daily activity (basal metabolic rate, which is the energy required for basic body functions, and the energy needed to process food are the other two.) Some people have a “NEAT switch” that gets them up and moving after over-eating, while other people do not, which can lead to obesity. Surprisingly, the simple act of standing burns more calories than sitting, as noted in the table below.

Occupational Non-exercise Activity Thermogenesis (NEAT)*
Occupation type NEAT, cal/d
Chair-bound 300
Seated work (no option of moving) 700
Seated work (discretion and requirement to move) 1000
Standing work (eg, homemaker, cashier) 1400
Strenuous work (eg, farming) 2300
*Data based on a basal metabolic rate of 1,600 cal/d. Adapted from Black AE, Coward WA, Cole TJ, Prentice AM. Human energy expenditure in affluent societies: an analysis of 574 doubly-labelled water measurements. Eur J Clin Nutr. 1996;50:72-925

So what can we do about this national health crisis? Unlike with anti-smoking campaigns, we can’t tax chairs and benches, people can’t be banned from sitting in public spaces, and we can’t enact a legal sitting age. We can, however, actively participate in our own health. As shown above, just standing makes a difference. Some workplaces and even schools are using sit-to-stand desks, which allow the user to set their workspace at a different height in order to stand. If your boss is not quite there yet, or if you’re retired, here are some simple things to do to reduce the effects of sitting.

  • Stand. It seems obvious, but, as shown above, standing burns more calories. Instead of just sitting during a lunch break, try standing for a bit, or even doing some simple stretches like bending forward and reaching for your toes to get the blood flowing. Standing a little more each day not only increases your metabolism, it also helps tone muscles, burns calories, and increases blood flow.6
  • Walk. Directly related to standing, of course, is walking. You should get up and walk around every 20-30 minutes.
  • Stretch at your desk. Shrug your shoulders up to your ears and hold that position for several seconds before releasing. Gently stretch your fingers, hands, wrists and arms by bending at the joints. Straighten your legs and point and flex your toes. These simple stretches are great for multitasking: the person on the other end of the phone will never know!
  • Do eye yoga or eye palming to stretch and moisten your eyes. Try moving your eyes in circles of varying sizes, or doing a figure eight with them. Or you can stare at the tip of your nose—and no, your face won’t freeze like that. Eye palming is simply cupping your hands over your eyes and breathing. As well as giving your eyes a break, this can make your vision clearer and reduce headaches.7
  • Use good posture. Your mother was never more correct. Good posture goes a long way to preserving the overall health of your spine and reducing stress on the nervous tissue of the spinal cord (which provides nerve input to all your muscles and internal organs.) Maintaining and supporting the natural curves of the spine is paramount to spinal health. While sitting at your desk/computer, use a lumbar and/or a thoracolumbar support cushion height along with proper workstation ergonomics (correct workstation, chair, and monitor height, proper keyboard placement, etc.).
  • Exercise, exercise, exercise. With summer coming, it’s easier to jog, swim, or hike, and there’s always the treadmill or elliptical machines at the gym. While, by definition, exercising doesn’t affect your NEAT, it does help your overall metabolism and health.

Moving around during the workday not only benefits individuals, but companies and schools as well. Research shows that productivity and focus improve if employees and students have the ability to stand or move during the day.8 According to Dr. Levine, “This is about hard-core productivity. You will make money if your workforce gets up and gets moving. Your kids will get better grades if they get up and get moving.”9 Like ergonomic keyboards, standing desks are becoming a workplace necessity.

With summer coming, we’re likely to be more active outside of work. Warm weather tends to get us out-of-doors on the weekends and inspires us to exercise more overall. But after spending the weekend on the trail, don’t forget your body during the weekday grind. Take a stand for your health by taking a stand at work.

1MacVean, Mary. “‘Get Up!’ or Lose Hours of Your Life Every Day, Scientist Says.” Los Angeles Times, July 31, 2014.

2“Questionnaires, Datasets, and Related Documentation.” Accessed May 11, 2017.

3“Sitting Disease: The New Health Epidemic.” The Chopra Center, August 14, 2014.

4“Sit More, And You’re More Likely To Be Disabled After Age 60.” Accessed May 4, 2017.


6Just Stand “Burn Calories at Work.” Accessed May 11, 2017.

7 “Sitting Disease: The New Health Epidemic.” The Chopra Center, August 14, 2014.

Why do I have fallen arches?

Our feet are charged with supporting our entire bodies, maintaining our balance, and acting as shock absorbers. They are under constant strain: even a gentle stroll causes stress to the feet, particularly the arches. And because our arches can wear down overtime, this stress can lead to pain in other regions of the body as well as in the feet.


Fallen arches can affect your entire body. (image courtesy of

What we call the arch of the foot is actually three arches made up of the bones of the feet. Ligaments and tendons made of semi-flexible fibers connect these bones. The fibers bend and stretch as we walk, but, unlike other more flexible fibers in the body, they are less elastic and more plastic (rigid). Consider the difference between a rubber band and a piece of taffy. If you stretch out a rubber band, it will snap back to its original shape. But if you pull on a piece of hard taffy, the taffy will just stretch. It will regain some of its original shape, but as you continue pulling it, the taffy will begin to lengthen until it wears thin and loses its shape: once you stretch a piece of taffy, it will never be the same again.

The arches of your feet are like taffy. Normal use slowly breaks down the fibers in the arches until they can no longer support the rest of the foot. The arches collapse, causing overpronation of the foot which pulls on the fascia of the bottoms of the feet and can lead to plantar fasciitis as well as pain in the ankles, Achilles tendon, and the inside of the knee. Fallen arches can also cause or contribute to lower back pain and lateral hip pain.

Fallen arches occur more often over the age of forty and in women. While they can occur through normal wear and tear, a fall or regular participation in high-impact sports can increase the likelihood of damage to the arches. In addition, obesity, diabetes, high blood pressure, and steroid injections may contribute to the degradation of the arch. Your genes can play a role in the development of fallen arches or flat feet as well. For example, if your mother or father had dropped arches or flat feet, you may as well.

The good news is that you can do something about it. Orthotics can provide support when your arch collapses, preventing plantar fasciitis, heel spurs, Achilles tendonitis, and ankle pain from developing. If you are already suffering from arch-related issues, orthotics can lessen the pain and correct the strain on your feet and bring that spring back into your step.


Our office recommends non-custom Superfeet (priced at $36-$46) and custom orthotics made from your own imprint by Footlevelers.


Understanding High Blood Pressure

blood pressure tracker

For most people one of the most stress inducing things that happens in any doctor’s office is the taking of blood pressure. You can tell yourself to relax, breathe easy and envision yourself on a beach, but the truth of the matter is you are at a doctor’s appointment for one reason or another having your health evaluated. What is the most concerning is that a lot of people aren’t exactly sure what the numbers mean or where they come from. In this article we will be going over how to understand blood pressure readings, why it matters, understanding your risks, and new research on how to lower that high blood pressure and improve quality of life.

Understanding High Blood Pressure

Blood Pressure– is a ratio of systolic over diastolic and is measured in millimeters of mercury, mmHg.

Systolic– is the top number of the ratio and is the higher of the two. It measures the pressure of the body’s arteries when the heart muscle contracts.

Diastolic– is the bottom number of the ratio and is the lower of the two. It measures the pressure of the body’s arteries between heartbeats, aka contractions, so this is when the heart muscle is relaxed.

The systolic, or top number is the more important of the two and usually slowly increases with age after 50, due to stiffness of arteries, plaque buildup etc.

Blood Pressure Chart


(taken from American Heart Association website

Blood pressure should be taken at least once every two years, even if it is around normal, and more frequently if it is higher. The numbers change in a person minute to minute due to the time of day, exercise, stress, lack of sleep, posture, and the food one has eaten! If your blood pressure is higher than desired, your doctor might monitor it on a consistent basis and/or have you keep track of it frequently at home. Even if your blood pressure is normal, it is always a good idea to develop healthy lifestyle habits to help prevent high blood pressure (HBP).

High blood pressure is known as “the silent killer” because there can be no signs or symptoms of it. If untreated, consequences of HBP (but not symptoms) may include:

  • damage to the heart and coronary arteries
  • stroke
  • kidney damage
  • vision loss and damage
  • memory loss
  • fluid in the lungs
  • angina
  • peripheral artery disease

Risk factors that can contribute to hypertension, also known as high blood pressure, include:

  • family history
  • advanced age
  • lack of physical activity
  • poor diet, especially one that includes too much salt
  • being overweight or obese
  • drinking too much alcohol (binge drinking, ie 3-5 alcoholic drinks in one sitting)

Contributing factors to high blood pressure include:

  • stress
  • smoking and secondhand smoke
  • sleep apnea

Recent research from the National Institutes of Health has shown that being more aggressive in the treatment of high blood pressure, can significantly lower a person’s rate of cardiovascular disease. Until recently, it was recommended by the American Heart Association that the systolic pressure should be less than 140 mmHg for most adults to be out of the high blood pressure or hypertension category. This new research found that decreasing the systolic number to 120 mmHg and below reduces the risk of death of cardiovascular disease by 43%.

In 2013, 360,000 deaths were associated with or directly related to high blood pressure. About 80 million, or one in three American adults have HBP which puts them at a much higher risk of heart attack, stroke, kidney failure and other serious health problems.New research from Tulane University School of Public Health and Tropical Medicine, found that patients age 75 and older benefited even more from this lowering of the systolic blood pressure than the younger age group. However, one unfortunate side effect in some patients in the aggressively treated group with medication, is acute kidney failure. Even with the immediate push for a lowering of the systolic BP, experts all agree that the best way to go about it is a thorough lifestyle change and not rely on drugs alone.

Here are a few lifestyle interventions to aid in the process of lowering HBP and keeping it within the goal range of systolic 120 mmHg or below:

  • HBP Medication
  • Weight Reduction
  • Exercise (2.5 hours per week of moderate exercise: jogging, swimming, walking etc.)
  • Reduce salt intake (only 3 or 4 grams per day)
  • Eat more fruits and vegetables (4-6 servings per day)
  • Snack on dark chocolate (antioxidants in cocoa, called flavanols, can help dilate arteries)
  • Reduce alcohol intake (maximum drinks per day:one for women and two for men)
  • Meditate

The US National Institutes of Health has created what is known as the DASH diet plan ( in order to lower blood pressure without medication, and also subsequently aid in weight loss. Through copious amounts of research, DASH is a strict eating plan that is rich in vegetables and fruit, low-fat and nonfat dairy products, along with beans, nuts, and seeds. The snacks and meals are balanced with both fiber filled foods (fruits and vegetables) along with food that is protein-rich and/or contain heart healthy fats (nuts, seeds, avocado, fatty fish) that aid in offsetting hunger. A decrease in high blood pressure was achieved by decreasing the amount of “empty carbs” (pasta, bread, rice, sweets, ice cream, candy etc.) consumed and replacing them with heart healthy fats and/or protein. By doing so, the diet provides more key nutrients which includes: potassium, calcium, and magnesium, which all contribute naturally to lowering blood pressure.


Resources: “No-Smoking Confidence Assessment and Tips.” Understanding Blood Pressure Readings. American HEart Association. N.p., 18 Dec. 2015. Web. 24 Feb. 2016.

“Why Blood Pressure Matters.” Why Blood Pressure Matters. American Heart Association. N.p., 13 Aug. 2014. Web. 24 Feb. 2016.

“Understand Your Risk for High Blood Pressure.” Understand Your Risk for High Blood Pressure. American Heart Association, 18 Dec. 2015. Web. 02 Mar. 2016.

“More Aggressive Treatment of High Blood Pressure Saves Lives in Study – News on” News on Heartorg. American Heart Association, 09 Nov. 2015. Web. 02 Mar. 2016.

Goldschmidt, Debra, and Carina Storrs. “High Blood Pressure Control Improving; What Else to Do.” CNN. Cable News Network, 12 Nov. 2015. Web. 24 Feb. 2016.

Heller, Marla. “What Is the DASH Diet?” What Is the DASH Diet? N.p., n.d. Web. 02 Mar. 2016.