2018 Cholesterol Guidelines Updated

Stopping Heart Disease Before It Stops You

I was delighted to see that the new cholesterol management guidelines place a greater emphasis on listening to and understanding patients concerns and preferences for management. (1) While the guidelines still primarily focused on LDL (“bad”) cholesterol reduction there is less “mandate” to initiate therapy earlier in low and intermediate risk patients. Much of the clinical benefit of cholesterol lowering therapy has been in those individuals with established coronary artery disease and a previous heart attack. Doctors should now feel empowered to help their patients explore healthier lifestyle choices. Modifiable lifestyle factors include weight management, heart healthy eating, physical activity, adequate sleep, stress management, and avoidance of environmental toxins such as cigarette smoke, air pollution and toxic metals.  Coronary events such as heart attacks and revascularization procedures including coronary stents and coronary artery bypass surgery can effectively be prevented by implementing such modifiable risk factor alterations.

Below is a figure summarizing these new guidelines. Primary prevention refers to the prevention of cardiovascular risk factors and the subsequent development of atherosclerotic cardiovascular disease (ASCVD). Secondary prevention refers to the management of established ASCVD. Much like it is easier to shut the stable door before the horse escape, primary prevention requires less intensity than secondary prevention. The main limitation of the current medical treatments for hyperlipidemia, such as statin drugs, is not their effectiveness in lowering cholesterol but rather the lack of adherence to the medications. Nearly 60% of individuals prescribed statin drugs for secondary prevention either stop taking the drug or reduce the amount. (2) Thus, we need better options.

Many patients are now looking to alternatives to stain therapy to manage their cardiovascular risk and disease.  Fortunately, 90% of initial heart attacks can be avoided by switching to healthier behaviors. (3) Thanks to Dean Ornish, MD and Caldwell Esselstyn, MD, we know that programs focusing on lifestyle modification can prevent progression of ASCVD and reverse it as well. (4, 5)

To learn more about my integrative strategies for the prevention of atherosclerotic cardiovascular disease visit my web page at www.DaveJohnsonMD.com.

Figure 1. 2018 Guidelines for Cholesterol Management


ASCVD Risk Enhancers:
  • Family history of premature ASCVD
  • Persistently elevated LDL-C ≥ 160 mg/dL or ≥ 4.1 mmol/L
  • Chronic kidney disease
  • Metabolic syndrome
  • Conditions specific to women (e.g., preeclampsia, premature menopause)
  • Inflammatory disease (especially rheumatoid arthritis, psoriasis, HIV)
  • Ethnicity (e.g., South Asian ancestry)
  • Persistently elevated triglycerides ≥ 175 mg/dL, or ≥ 2.0 mmol/L
  • Persistently elevated hs-CRP ≥ 2.o mg/L
  • Elevated lipoprotein (a) [Lp(a)] > 50 mg/dL or > 125 nmol/L
  • apoB ≥ 130 mg/dL
  • Ankle-brachial index (ABI) < 0.9

In intermediate risk patients with an ASCVD risk estimate of 7.5% to 20% consider coronary artery calcification (CAC) imaging

  • CAC = zero (lowers estimated risk; consider no statin, unless diabetes, family history of premature coronary artery disease, or current smoking )
  • CAC = 1-99, favors statin therapy especially after 55
  • CAC = 100+ and/or ≥ 75th percentile, initiate stain therapy
  1. 2018 Colesterol Guidelines, https://www.ahajournals.org/guidelines/cholesterol.
  2. Colantonio LD, et al. Adherence to High_intensity Statins Following Myocardial Infarction Hospitalization Among Medicare Beneficiaries. JAMA Cardiol. 2017;2(8):890-895.
  3. Yusuf S, Hawken S, Ounpuu S, on behalf of the INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:937-952.
  4. Ornish D, Scherwitz LW, Billings JH, et al. Intensive Lifestyle Changes for Reversal of Coronary Heart Disease. JAMA. 1998;280(23):2001–2007. doi:10.1001/jama.280.23.2001
  5. Esselstyn C. A Way to Reverse CAD? The Journal of Family Practice. 2014; 63(7): 356-364.

An Anti-Inflammatory Diet Can Transform Your Health

Inflammation occurs when the body, mind and spirit are out of balance. Left unchecked this turns into chronic inflammation leading to a variety of disease states. Our diet and lifestyle choices are two powerful weapons that can be used to fight back against inflammation.

In focusing on dietary changes the primary drivers for inflammation are:

  • Added sugars and artificial sweeteners 
  • Saturated fat and trans fat
  • Excess omega 6 fatty acid intake related to consumption of processed foods made with inexpensive omega 6-rich cooking oils such as sunflower, corn, soybean and cottonseed oils.

Added to these three major contributing factors are high intakes of artificial food additives in processed foods and low intake of nutrient dense, fiber-rich plant-based foods. Much of what is triggering the rise in poor health statistics has really only occurred in the past 70+ years, since the beginning of food industrialization.

To restore and maintain health requires individuals, and communities, to reclaim ownership of their health and well-being. The first step is becoming more informed about how lifestyle choices impact health and then making conscious choices that influence the health of the body and environment. A recent study by Harvard University demonstrated how adhering to 5 lifestyle factors can extend longevity by over a decade.

  1. Never smoke
  2. Maintain a healthy weight (Body mass index of 18.5 -24.6 kg/m²)
  3. Daily exercise
  4. Healthy plant-rich diet
  5. Light to moderate alcohol intake

So, it is obvious that the rising tide of chronic inflammatory conditions such as heart disease, cancer, and diabetes, can be prevented by choosing an anti-inflammatory lifestyle.

One of the most powerful tools one has in combating chronic inflammation in the body is to chose foods that not only nourish the body and mind but fight against unnecessary inflammatory response. Currently, the typical American consumes 60-70% of their daily calories from processed foods made up of high concentrations of sugar, salt, and unhealthy fats. Below you will find where many of these unneccesary and pro-inflammatory foods hide.

Here is a basic checklist of what can be done to fight inflammation:

Foods to Avoid (very inflammatory) 

  • Processed sugars and artificial sweeteners (sugar, brown sugar, cane sugar, cane juice, corn syrup, high fructose corn syrup, dextrose, sucrose, sucralose, aspartame, maltodextrin)
  • Highly processed foods which often contain added sweeteners and omega-6 rich cooking oils which are often very inexpensive for food manufactures to use (cereals, chips, crackers, snacks)
  • Refined grains, especially in processed foods
  • Salty processed foods
  • Processed soy, especially products with isolated soy protein
  • Dairy
  • Meat
  • Fish
  • Eggs
  • Fried foods
  • Fast food
  • Sodas
  • Energy drinks
  • Coffee
  • Alcohol
  • Nicotine

Foods to Limit (Eat no more than a few time weekly)

  • Vinegars are very acidic except apple cider vinegar which is alkaline
  • Processed chocolate
  • Wheat products
  • Roasted nuts and seeds
  • Roasted nut butters
  • Soy-based processed foods (tofu or tempeh meat substitutes)
  • Natural sweeteners such as coconut, maple, or stevia
  • Dried fruits, especially with added sugars and sulfites
  • Salad dressings
  • Salt, limit added salt.

Foods to Eat Liberally (Anti-inflammatory)

  • Leafy green vegetables
  • Vegetables, maintain a variety of colors
  • Fruits, especially berries, limes, lemons and oranges
  • Legumes, soak beans, lentils and peas in water and consider sprouted sources
  • Whole grains, agains soak prior to cooking and/or consider using sprouted grains
  • Raw nuts, seeds and nut butter
  • Fermented foods such as sauerkraut and kimchi
  • Herbs and spices, create ethnic diversity to your palate
  • Apple cider vinegar
  • Herbal teas
  • Seaweed such as spirulina, nori, kelp, dulse
  • Water
  • Green juices and smoothies, consider adding plant-based protein powder, especially as you age

Anti-inflammatory Activities

  • Sleep, aim for 7-9 hours daily
  • Relax, enjoy walks in nature, unplug from screen time, try meditation
  • Exercise, find activities that cause you to move your body and have fun. Try yoga, pilates or T’ai chi.
  • Connect, find a tribe and celebrate life with those you love.
  • Consider intermittent fasting

Take the plunge! Test out an anti-inflammatory diet this week and begin to see how much better your body and mind feel. In the first few days you might notice some headaches, fatigue, or changes in digestion. These symptoms are only a result of the increased efficacy your body has at detoxification and removing unwanted products that may have been stored in fats cells. This will all pass within a week and you can then begin to experience the benefits of an anti-inflammatory, nutrient-rich, whole food, plant-based lifestyle.

Need help with recipes then download the Food Monster App today. Also check out the blog from UC Davis Integrative Medicine and become updated on evidence in support of plant-based living.

An excerpt from The China Study was recently posted by T. Colin Campbell, PhD and his son Thomas M. Campbell, MD  entitled Eating Right: 8 Principles of Food and Health. This is a well written post with essential information to support you on your plant-based lifestyle.

Or, contact me for a consultation and learn more about integrative health and healing.


Am I really as healthy as I look (and think)?

Cardiovascular disease remains the leading cause of premature death in the United States despite the escalating expenditures used to develop pharmaceuticals and medical procedures. Yes, these latter two investments do prolong survival after you’ve been diagnosed with cardiovascular disease but do nothing to help prevent the disease from developing.

Did you know the over 90% of heart attacks can be avoided? More recently, research from Harvard University reported that 5 simple lifestyle behaviors could extend survival by over a decade.

Healthy Behaviors
  • Never smoking
  • Maintain a body mass index of 18.5 to 24.9 kg/m2
  • Getting more than 30 minutes per day of moderate to vigorous physical activity
  • Minimizing alcohol intake
  • Eating a plant-rich diet

The researchers at Harvard University have defined a high quality diet as having high intakes of vegetables, fruit, nuts, whole grains, polyunsaturated fatty acids, and long-chain omega-3 fatty acids and low intakes of red and processed meats, sugar sweetened beverages, trans fat, and sodium.

Did you know that atherosclerosis, or arterial plaque, takes decades to develop? Conventional medical practices focus on severe disease and the consequences as they develop yet it is well known that this disease process can be completely prevented.

Where are you on this spectrum?

Atherosclerosis formation. Healthy artery and unhealthy arteries showing step by step how plaque is developing.

The conventional medical approach focuses on Steps 4 and 5 (above image) when symptoms begin to develop, yet it takes decades to progress through the stages. The process always begins with Step 2 (above image). Endothelial dysfunction is triggered by unhealthy lifestyle patterns. This is why maintaining the 5 healthy lifestyle choices can add over a decade to your life span. Plant-based foods, physical activity, avoiding tobacco and managing stress are the most effective ways to maintain a healthy endothelium. Protecting your endothelium can avoid and potentially reverse vascular disease as it arises from endothelial dysfunction.  Vascular disease is the precursor to high blood pressure, heart attacks, heart failure, stroke, dementia and many other chronic conditions.

Click here to learn more about how to assess the health of your blood vessels.

Click here to schedule a consultation with an integrative cardiologist to learn how to restore and protect your health and well-being.

Integrative Health Coaching

Now offering Integrative Health Coaching

The longer that I practice the more I realize how much our lifestyle choices influence our health and wellbeing. Eating well, being physically active, enjoying restful sleep, finding work-life balance and simply being kind to others can go a long way in protecting health and well-being but I know it is not easy. That is where I want to help you; to help you find the solutions you need to optimize your health and well-being and, when necessary, I can put on my medical hat and help you overcome any physical symptoms that may be getting in your way.

Health coaching is becoming much more readily available yet remains largely unregulated. Anyone can claim to be a health and wellness coach with as little as a weekend certification course to doctorate level training. The International Consortium of Health & Wellness Coaching (ICHWC) is a nonprofit looking to create national standards for health coaching. I will soon complete my integrative health coaching certification from the University of Arizona, Center for Integrative Medicine (AZCIM), an ICHWC-approved program, and will be the first in Michigan to offer such services.

Whether it is treating a disease process or helping you overcome lifestyle choices that adversely effect health and wellbeing, I will work with you to help you achieve your health goals.

Bridging the knowledge of medicine with the art of coaching, I am now offering integrative health coaching.

What is Integrative Health Coaching?

Integrative Health Coaching is a client-centered, relational approach to working with individuals collaboratively in order to address the health and wellbeing of the whole person. It acknowledges the interdependent roles of mind, body and spirit on health and wellbeing as well as the innate healing capacity within each person. In integrative health coaching there is an emphasis on self-care. An integrative health coach forms a partnership with individuals or groups of individuals to empower and support them in achieving their personal goals related to optimal health and wellness.

Who is a candidate for Integrative Health Coaching?

Anyone who is seeking to regain control over their own health and wellbeing, regardless of whether you have chronic disease or simply want to better maintain health and wellbeing.

What do we focus on in Integrative Health Coaching sessions?

During the coaching session, we will work together to articulate…

  • What is most important to you in your life and explore the reasons that you want for health and wellbeing.
  • The cores areas that affect your health and wellbeing – how would you rate them currently and which areas need more attention than others.
  • Your goal to improve your health and wellbeing.
  • Action steps to achieve this goal.

Additionally, we will discuss what may support you in completing your action steps, establish timelines, accountability strategies, and anticipate possible challenges.

Why is Integrative Health Coaching effective?

  • This style of coaching works with you as a whole person – addressing all core areas of health that influence your health and wellbeing.
  • You are in charge of your health and wellbeing – coaches ask powerful questions and facilitate the process to maximize your potential for success.
  • You and your coach partner to identify and articulate your goals and the actions to achieve them.
  • Integrative health coaches have extensive knowledge in lifestyle and integrative approaches for optimal health and wellbeing.

Why choose an Arizona Center for Integrative Medicine (AZCIM) Certified health Coach?

An AZCIM-certified integrative health coach is the most thoroughly trained and evaluated.

  • Previous background and experience in a health-related field (including medicine, nursing, psychology, nutrition, acupuncture, therapy/counseling).
  • Have completed either AZCIM 2-year (1000-hour) Integrative Medicine Fellowship or 6-month (250-hour) Integrative Health and Lifestyle Program (IHeLp).
  • Completed and passed all requirements of the AZCIM Integrative Health Coaching Program.
    • Over 200 hours of training, including 35 hours of face-to-face, faculty-led training in Tucson, AZ and 28 total mentor-supervised practice hours.
    • Rigorous evaluations of live coaching sessions by coaching faculty, motivational interviewing skills using proven MITI scoring by outside evaluator, and documentation of 100 hours of practice coaching sessions.

What does an Integrative Health Coach provide?

  • Partners with you in helping you achieve your personal goals to improve your health and wellness.
  • Is fully present with each encounter.
  • Recognizes the innate wisdom and healing potential within you.
  • Meets you where you are on your journey and without judgment.
  • Enters each session or encounter as a facilitator, not an expert.
  • Emphasizes self-care and self-empowerment within you.

My added advantage: AZCIM-certified integrative medicine physician (my other hat)

The Fellowship in Integrative Medicine is a 1,000-hour, two-year distance learning program founded by Andrew Weil, MD at the University of Arizona, Center for Integrative Medicine. Integrative medicine is a patient-centered whole health approach. Topics studied in depth include:

  • Nutritional health. The latest nutritional approaches and dietary recommendations for general health, as well as specific conditions such as cancer and diabetes
  • Botanicals and dietary supplements. Research-based uses, how to identify a quality product, supplement-drug interactions, and use in specific patient populations
  • Mind-body medicine. Ways in which emotional, mental, social and behavioral factors affect health and how to teach patients meditation and other mind-body techniques
  • Complementary and alternative practices. Uses, benefits and recommendations for Traditional Chinese Medicine, Ayurveda, manual medicine and homeopathy.
  • Integrative approaches. To women’s health, pediatrics, mental health, gastrointestinal, respiratory, cardiovascular disease, cancer and much more. 

Unlike traditional health coaches, my extensive training can effectively guide you on your health journey and continually be  able to diagnose and initiate treatments, when necessary.

Call Today to schedule a free 15 minute consultation to find a service that meets your needs.
Integrative health and medicine consultation
Cardiovascular wellness consultation
Integrative health coaching

Now at two Locations:

Grand Rapids Natural Health   638 Fulton St. W., Ste B, Grand Rapids, MI 49504, (616) 264-6556

 Sleeping Bear Natural   Health   3180 Racquet Club Dr., Ste. B, Traverse City, MI   49686,  (231) 252-9000

November – Diabetes Awareness Month

The goal of my posts this month were to increase awareness of type 2 diabetes (T2DM) and how T2DM is:

  • preventable
  • manageable
  • reversible.

T2DM is a complex interaction between genetics, the environment and lifestyle choices. Pharmaceuticals can be lifesaving when blood sugars are out of control.  However, pharmaceutical do not adequately prevent or even reverse the disease process, rather they help your body maintain better blood sugar control.

Prevention and reversal of T2DM is a multifaceted approach. Essential self-care strategies can lead to weight loss and include exercise and a nutrient-rich plant-based diet.  Read my seven steps to preventing and reversing diabetes. Regardless of treatment strategies it is always important to monitor your blood sugar. 

If you or someone you know is struggling with T2DM and eager to learn how they can be in better control of the disease process, please do not hesitate to contact my office and schedule an appointment.

November Is Diabetes Awareness Month – Burning Away Diabetes

Burning Away Diabetes

As we have discussed on the previous post, diabetes occurs when blood sugar become too elevated. Well, we discussed reducing the intake of sugar on previous posts but now lets explore how to more effective burn sugar so that blood doesn’t become too sweet.

Physical activity is both low-cost and side-effect free. The benefits of exercise are numerous and include such things as:

  • lower blood pressure
  • lower hear rates
  • better circulation
  • lower cholesterol
  • lower blood sugar
  • less unhealthy weight gain and body fat
  • sleep better
  • have more energy
  • notice less stress
  • feel happier
  • enjoy more vitality.

Can exercise prevent and reverse diabetes?

Absolutely, especially when combined with a healthy diet and high quality sleep. In a recent clinical trial, people who exercised regularly, in addition to a healthy diet enjoyed:

  • 3 times greater weight loss
  • 3 times more likelihood to decrease their medications
  • 50% more likely to be able to stop their diabetes medication.

What exercise was involved?

  • Aerobic training such as walking, swimming, and bicycling for 30 minutes 5-6 times a week. Maybe consider activities that you enjoy such as dancing, gardening or walks in the park.
  • Strength training  with weights or resistance bands for 30 minutes 2-3 times per week.
  • Monitoring of overall movement ensuring that participants were also walking at least 10,000 steps daily.

Getting Started

  • Get a medical clearance if you have not exercised in over a year, especially if you are a man over 45 years old or a women over 55 years old.
  • Buy a pedometer. Monitor your normal activity for a few days. Aim to build an extra 3000 steps daily for a week. Perhaps your baseline in 2000 steps; then increase to 5000 steps for one week. The next week increase by another 3000 step until you are over 10,000 step daily. If you need to lose weight you might consider slowly building this to over 20,000 steps daily.
  • Start slow and build slow. Fitness should be fun and without pain. Listen to your body and work with a trainer if you need encouragement or further advise.
  • Find a partner. Get a family member, friend or pet involved.
  • Have fun. Finding a variety of activities you enjoy will help you stick with it.

Our bodies are intended to move. The conveniences of modern lifestyle has generated a more sedentary life contributing to weight gain, diabetes and many other chronic health conditions. Physical activity is the single greatest stimulus to optimize body flow in the body enhancing nutrient delivery to the cells and waste removal away from the cells. Hence, physical activity is a healthy prescription for diabetics as well as those who simply want to remain healthy.


November Is Diabetes Awareness Month – Foods That Fight Diabetes

Foods that Fight Diabetes

Nothing seems more controversial today than nutrition. What diet is right for me? What is known is that four main food groups can protect against the silent war diabetes rages within the body eventually leading to heart disease, stroke, kidney failure, blindness and many other chronic conditions. Prevention is key to winning this battle. Limiting the fuel used by diabetes including sugar, highly digestible carbohydrates and saturated fats while bolstering the defenses that support a healthy body can not only prevent type 2 diabetes but even reverse it. So, what is this special formula? If one looks historically at what forces best equipped human evolution with longevity and vitality then some simple solutions prevail. Added bonus, there is no real need to monitor calories or even macronutrients.

The Fabulous Four

In my office, we make it simple and focus on four main food groups that are used to both bolster our defenses and limit the fuel that drives diabetes. By limiting the intake of saturated fat and highly digestible carbohydrates like sugar and flour, the fuel source for diabetes is cut off. Then adding nutrient-rich foods with abundance of vitamins, minerals and antioxidants the body’s defenses are bolstered.

  • Vegetables. Perhaps no other food source can provide us with the diversity of nutrients than vegetables. Loaded with fiber, vitamins, minerals, and antioxidants they both nourish the body’s energy needs and protect it from harm. Eat a variety of vegetables and include with each meal. Aim for 4 or more servings daily.

A serving is 1 cup of raw vegetables or 1/2 cup cooked vegetables.

  • Fruits: Loaded with fiber and antioxidants, fruits support the body by fighting oxidative stress and help get rid of toxins by providing healthy amounts of fiber. Eat a vareity of colors, berries are especially nutrient packed. Aim for 3 or more servings a day.

A serving is 1 medium piece of fruit, 1/2 cup cooked fruit or 4 ounces of freshly made juice.

  • Legumes. Beans, peas, and lentils are packed with fiber, protein iron, calcium, zinc and B vitamins. Legumes make a meat substitute. Eat 2 or more servings a day.

A serving size is 1/2 cup cooked beans, 4 ounces of tofu or tempeh, or 8 ounces of soy milk. Try sprouted legumes as well.

  • Whole grains. Let me make it clear, whole grains do not cause diabetes or lead to an unhealthy gut, unless you have Celiac disease, where you should eliminate wheat, barley and rye. Whole grains actually protect against diabetes, heart disease, cancer, obesity and protect gastrointestinal health. There are a variety of types of whole grains including whole wheat, whole oats/oatmeal, whole grain cornmeal, popcorn, brown rice, whole rye, whole-grain barley, wild rice, buckwheat, triticale, bulgur (cracked wheat), millet, quinoa, and sorghum. Other less common whole grains include amaranth, emmer, farro, grano (lightly pearled wheat), spelt, and wheat berries. Include these in your meals to make them more hearty. Eat 5 or more servings daily.

A serving size is 1/2 cup of rice or other grain, 1 ounce dry cereal or 1 slice of bread.

In all, these four foundational food groups should occupy over 80% the lunch or dinner plate and can readily be used for healthy snacks.


There are at least 3 nutrients found in everyday food that foster the battle against diabetes.

  • Fiber. A whole food, plant-based diet is the primary source of dietary fiber. Fiber helps maintain gut health, protects against cancer and heart disease and limits the absorption of highly digestible carbohydrates from the gastrointestinal tract.
  • Chromium. This feisty mineral helps insulin do its work thus promoting lower blood sugar levels, otherwise known as improved insulin sensitivity. Additionally, chromium may help prevent carb cravings. Chromium-rich foods include whole grains, whole grain bread, brown rice, broccoli, mushrooms, green beans, brewer’s yeast, corn, potatoes, and fresh vegetables. Herbs such as wild yam, nettle, catnip, oat straw, licorice, horsetail, yarrow, red clover and sarsaparilla are also rich in chromium and can be added to the diet.
  • Magnesium. This elemental metal is an essential participant in over 300 biochemical reactions that occur within the body. Elevated blood sugar, especially when detectible in the urine causes magnesium to be depleted from the body. Additionally, it is well known that magnesium helps to lower blood sugar by enhancing insulin sensitivity. Magnesium-rich foods include beans and nuts, whole grains, green leafy vegetables, organic raw cacao beans, chlorella, spirulina, seaweed. Some herbs and spices to consider include basil, Chinese parsley, cilantro, caraway seed, cardamom, celery seeds, rosemary, saffron, oregano, thyme, red clover, burdock root, yellow dock and chaparral.

While there are many other potential nutrients that may help prevent diabetes and limit the damage diabetes causes, this information is something that begins with the dinner plate and requires no special prescription.

Next Up

Next week I will review simple measures that can be taken to burn away diabetes.



November is Diabetes Awareness Month – Know Your Numbers

Know Your Numbers – Blood Sugar

“Blood alone moves the wheels of history.”  -Martin Luther


A single drop of blood can provide the information you need to better understand your risk of diabetes and heart disease. Pre-diabetes can linger for decades before transitioning to the diagnosis of diabetes and yet during this time, history is being made, but not with the outcome you might desire. The leading cause of death in diabetics is cardiovascular disease. Even in the early stages of pre-diabetes changes are beginning to happen in the lining of the blood vessels that cause them to become inflamed and accumulate plaque through a process called atherosclerosis. Fortunately, it is during these early stages when history can be altered and the adverse health outcomes from both diabetes and cardiovascular disease can be averted.

Diabetes is a major risk factor for heart disease.

According to the American Heart Association:

  • At least 68 percent of people age 65 or older with diabetes die from some form of heart disease; and 16% die of stroke.
  • Adults with diabetes are two to four times more likely to die from heart disease than adults without diabetes.
  • The American Heart Association considers diabetes to be one of the seven major controllable risk factors for cardiovascular disease.

Diabetes is both preventable and reversible.

Diabetes is both treatable and reversible but even when blood sugar is controlled with medications there remains a persistent elevation of the risk for heart disease and stroke. Diagnosing the disease at earlier stages, especially during pre-diabetes, can often allow one to reverse the condition of insulin resistance and minimize the cardiovascular risk associated with diabetes.

The American Diabetes Association have set blood sugar targets to help reduce the burden of heart disease. Many feel these targets are too high so a new category has been created and referred to as “ideal level,”  which has been added to the chart below for your reference.

Understanding the Meaning of Blood Sugar Levels

MarkerIdeal LevelNormal LevelPre-diabetesDiabetes
Fasting blood sugar (mg/dL)< 86< 99100 - 125> 125
Oral glucose tolerance test (OGTT)< 120< 140140 - 199> 200
Hemoglobiun A1c (%)< 5.3< 6.06.0 - 6.4> 6.4

It can be costly and time consuming to have your blood sugar checked through your physician and general labs. Fortunately, there is an inexpensive option that helps put you in control of your own health. Wouldn’t it be nice to know what foods raise your blood sugar too much, so that, you can personalize your carbohydrate intake? Well, take charge and buy a glucometer. These devices are widely available and inexpensive. You can now safely and conveniently follow your blood sugars and see how you are responding to the dietary choices you make. The more “ideal” your blood sugars remain the less likelihood of developing diabetes and heart disease.

Four Step Action Plan

Step one: Buy a glucometer, lancets and test strips

A glucometer is a device used to measure blood sugar. These devices and the test strips are widely available at most pharmacies. You will also need some sterilized lancets which are often sold with the glucometer or as an additional purchase. After pricking your finger with a lancet then a small drop of blood is placed onto a “test strip” according to the directions provided by the manufacturer of the glucometer that you purchased.

There are many options available but companies such as Contour, One Touch, ReliOn and Accu-Chek. Some have the capacity to interact with your smartphone to help you store data. ReliOn Prime is found at Walmart.com for $9.00 and you can get an additional 50 test strips for $9.00 and 100 lancets for $1.48, for a total investment of less than $20.00.

A word of caution, these devices may not be as accurate as a laboratory determined blood sugar but can help you monitor trends in blood sugar. If you have elevated blood sugars then have you doctor confirm it with a fasting blood sugar and hemoglobin A1c done in a standard clinical laboratory.

Step two: Testing your blood sugar at home
  1. Fasting blood sugar: Test your blood sugar first thing in the morning after fasting at least 12 hours. You may drink some water just after arising, as you should always do. However, don’t eat anything or exercise before the test. Keep a dated record of these values. Optimal levels are less than 86 mg/dL and anything over 100 mg/dL needs attention.
  2. Glucose tolerance test at home.
  • Pre-lunch blood sugar: This is a pre-test to determine your baseline prior to eating your lunch meal.
  • Eat your lunch. Do not eat anything for the next three hours.
  • Post-lunch blood sugar: Test your blood sugar one-hour, two hours and 3 hours after lunch.

Create a chart such as this one:

Date/MealPre-Meal Blood Sugar1-hour Post Meal Blood Sugar2-hour Post Meal Blood Sugar3-hour Post Meal Blood Sugar
Day 1
(Regular lunch)
Day 2
(Regular lunch)
Day 3: Carb Load
(Eat 60-80 grams of starch with low-to-no fat)
Goals (mg/dL)< 86< 140< 120Back to Baseline

On days 1 and 2 you will eat a normal lunch and record what you ate for that meal. This will help you see how the foods you usually eat impact your blood sugars.

On day 3 you will add a carbohydrate challenge. Instead of eating a normal lunch this will be a low-fat meal with a highly digestible carbohydrate or sugar. You will want the equivalent to 50-100 grams of a rapidly digestible carbohydrate or sugar. Examples include:

  • 6 oz. Grape juice = 30 grams
  • 9 oz. apple juice = 40 grams
  • Slice of bread = 15 grams
  • cup of cereal = 30 grams
  • banana = 20 grams
  • cup of milk = 12 grams
  • two slices of bread = 30 grams
  • 16 oz. orange juice = 40 grams

Combine any of the above items to achieve 50-100 grams. This might be a combo such as 6 oz grape juice, a banana and two slices of bread or a cup of cereal and a 16 oz orange juice.

Step three: Interpreting the results

The goal is to have a fasting blood sugar less than 86 mg/dL while making sure that blood sugar doesn’t consistently rise higher than 140 mg/dL 1-hour after a meal and stays below 120 mg/dL two hours after the meal. Finally, you want to be sure that your blood sugar returns to baseline 3-hours after your meal.

A couple of caveats to note with this testing. Most reliable glucometers have a ~10% margin of error so this is not an exact science. This error is acceptable since we are only tracking patterns of blood sugar responses. Secondly, look for rapid drops in blood sugar suggesting reactive hypoglycemia in which the blood sugar drops below 70 mg/dL within 3 hours of eating and associated with symptoms such as sweatiness, shakiness, fatigue, lightheadedness, blurred vision, headache and confusion. This condition is associated with pre-diabetes.

Step four: Taking action

So, where are your numbers? If they are higher than the guidelines then you have impaired glucose tolerance otherwise known as insulin resistance. If your your blood sugar is rising higher than 180 mg/dL after 1 hour then I would recommend getting some help, especially if you are already eating a low carbohydrate diet. Dietary changes and exercise are always the first therapy in managing insulin resistance and pre-diabetes. However, in some cases these changes will be insufficient when there are other contributing factors such as beta cell destruction in the pancreas and autoimmunity. These latter two possibilities require evaluation by a health care provider.

If you blood sugar is > 180 mg/dL,  find a health care provider who will help you get your blood sugar under control

If your post-prandial blood sugar is between 120 mg/dL and 180 mg/dL then you are in position to make some simple dietary changes and monitor the results. Refer to my last post to learn Seven Steps to Preventing (or Reversing) Pre-diabetes and Diabetes. Eating a high fiber plant-rich diet is the most effective way of preventing and reversing diabetes. This may simply mean monitoring your added daily sugar intake and keeping it below 36 grams (9 teaspoons) in males and 24 grams (6 teaspoons) in women. Please read your food labels and note serving sizes.  The easiest way to think of this is minimizing or eliminating processed foods in favor of organic, whole plant-based foods including a wide variety of vegetables, legumes, whole grains, fruits, nuts and seeds.

Keep sugar intake less than 9 teaspoons (36 grams) a day in males and 6 teaspoons (24 grams) in females.

Focus less on the macronutrients such as carbohydrates, fats and protein and more on consuming a variety of nutrient dense whole foods. Increasing fiber is essential in achieving better blood sugar control.

I would suggest reassessing your blood sugar in this way in order to see how you are progressing. I hope you can see now how a single fasting blood sugar may be insufficient in determining your risk. An alternative route would be to work with a health care provider that is knowledgeable of insulin resistance and how to properly diagnose this condition. Often fasting insulin levels and other blood tests can be obtained, since, after all, insulin elevation is the first signal that the body is developing insulin resistance and can occur decades before the diagnosis of diabetes is ever made.

Next week I will discuss how foods can be used to fight diabetes.

To learn more about the prevention and reversal of pre-diabetes, or insulin resistance, and diabetes then make an appointment today. Contact my office to schedule consult to begin your journey towards optimal health and wellbeing. 

November Diabetes Awareness Month

November is Diabetes Awareness Month and there are some simple steps that you can take to avoid diabetes and its complications.


Taking small steps can have huge impacts!

Diabetes is one of the leading causes of disability and death in the United States. It can cause blindness, nerve damage, kidney disease, and other health problems if it’s not controlled.

One in 10 Americans have diabetes — that’s more than 30 million people and another 84 million adults in the United States are at high risk of developing type 2 diabetes. This means about half the adult population have prediabetes or diabetes.

The good news! People who are at high risk for type 2 diabetes can lower their risk by more than half if they make healthy changes. These changes include: eating healthy, getting more physical activity, and losing weight.

How sweet is your blood?

Over the last decade the incidence of new onset diagnosed diabetes in U.S. adults has increased by 90% (1). Although there has been a steady rise in type 2 diabetes, the rate of increase markedly changed around 1990 (2). Interestingly, this rate of rise parallels the rate of increase in chemical production and consumption of increasingly calorically dense processed foods.

According to the Centers for Disease Control and Prevention (CDC), more than 84 million Americans are living with prediabetes, yet almost 90 percent don’t know they have it. This means they may be unaware of the long-term health risks associated with progressing to type 2 diabetes and the increased risks of heart attack and stroke (3).

Diabetes is a condition when your blood becomes too sweet, that is too say, that your body is no longer able to maintain healthy blood sugar levels. Although there are many factors involved in the development of diabetes the simplest explanation is that insulin, a hormone produced by the pancreas, can no longer adequately keep blood sugar at healthy levels as a result of insulin resistance. The muscle and liver are the primary storage sights for sugar in the body. Insulin resistance, which can progress to diabetes, occurs when the channels the sugar uses to get into the cells become gummed up and requires increasing insulin to force sugar into the cells. Eventually, insulin can’t keep up despite production of very high levels and blood sugars rise uncontrollably causing diabetes. The rising blood sugar is like shrapnel circulating in your blood damaging tissue as it passes through leading to a wide range of complications such as heart attack, stoke, blindness, kidney damage and nerve damage. Multiple mechanisms play role in insulin resistance leading to diabetes, including consumption of a highly processed standard American diet and sedentary lifestyle along with increasing exposure to toxic chemicals that contaminate our air, water, food, clothing, furniture, household products, and even our personal hygiene and beauty products.

So don’t let the sweetness in your blood ruin your sweetness in life.

Seven steps to preventing (or reversing) prediabetes and diabetes

  1. Eat delicious whole plant-based foods. Filled with essential vitamins, minerals and nutrients, plant-based foods optimize cellular health while providing abundant fiber to help your remove unwanted waste products from your body while helping support healthy blood sugar levels.
  2. Move your body. The human body is hardwired for physical activity. Exercise plays a major role in the prevention and control of insulin resistance, prediabetes, gestational diabetes, type 2 diabetes, and diabetes-related health complications (4).
  3. Sleep well. Too much or too little sleep can impair blood sugar control. Aim for consistent high quality sleep of 6-8 hours duration (5).
  4. Live cleanly. Toxic chemicals have managed to find there way into our food, air, water and even our health and beauty aid products. The Environmental Working Group (ewg.org) can provide you with useful information to make healthier choices whether it is organic foods, filtered water, skin care products and household cleaning products.
  5. Live leanly. Perhaps one of the most important contributing factors to diabetes risk is excessive weight gain from accumulation of body fat, especially the type that occurs around the waist. Following steps 1 through 4 will help you lose excess weight and maintain a healthier body.
  6. Supportive supplements. If your blood sugar is elevated some dietary supplements, such as chromium picolinate, cinnamon, omega-3 fatty acids and bitter melon extract have been shown to aid insulin sensitivity helping you to better control your blood sugar.
  7. Know Your Numbers. In the upcoming post I will show you how you can assess yourself and monitor your blood sugars for as little as a $20 investment.

In the next blog you will learn how as little $20 could provide you with the tools and knowledge you need to prevent the wrath of diabetes on your body. To learn more about diabetes prevention and reversal contact a knowledgeable health care provider willing to support you on your health journey.

If you would like to learn more about preventing or reversing type 2 diabetes, then schedule an appointment with me at Grand Rapids Natural Health where we will work in partnership to achieve your health goals.


  1. MMWR Morb Mortal Wkly Rep. 2008 Oct 31;57(43):1169-73.
  2. Diabetes 2011 Jul; 60(7): 1838-1848.
  3. https://www.cdc.gov/media/releases/2017/p0718-diabetes-report.html.
  4. Diabetes Care. 2010 Dec; 33(12): e147–e167.
  5. Diabetes Care 2013 Mar; 36(3): 611-617.
  6. Diabetes Technol Ther. 2006 Dec;8(6):677-87.
  7. Ann Fam Med. 2013 Sep-Oct;11(5):452-9.
  8. J Res Med Sci. 2011 Jul; 16(7): 862–871.
  9. Asian Pac J Trop Dis. 2013 Apr; 3(2): 93–102


Nutrigenomics: Choosing Foods According to Your Genes

Left out of the conversation within the never ending dietary hype and promotion is the fact that there is individual genetic variations that can effect how people respond to the foods, beverages, and supplements they consume. An emerging field of nutrigenomics is beginning to reveal these variable responses and how specific dietary habits can be altered to overcome or even embrace these genetic variances.

Nutrigenomics is an emerging field that looks at single nucleotide polymorphisms (SNP’s – pronounced snips) that impact how a specific protein or enzyme, our major metabolic machinery, functions. These SNP’s can advantageous or possibly disadvantageous impact on how food is absorbed, digested, distributed and eliminated. Knowing this information allows you and your health care provider the opportunity to make informed decisions of food and supplement choices aimed to optimize your health and wellbeing. Unlike other genetic tests that look at major gene mutations as in Down’s syndrome and cystic fibrosis, genomic testing looks at slight alterations in genes (SNP’s) that can change how a specific protein functions. Genomic testing does not diagnoses disease or even if nutrient deficiency exists but rather, whether there is at risk for nutrient deficiency based upon the known SNP’s impact on nutrient metabolism which can then impact the risk for future disease.

Nutrigenomix Inc, is a University of Toronto affiliated company that is founded by global researchers in nutrigenomics research. The Nutrigenomix test is a panel of 45 genetic markers that influence weight management, nutrient metabolism, heart health, food intolerances, eating habits and physical activity. This simple saliva test can provide you and your health care provider the personalized information you need to modify your diet, eating patterns and exercise in an effort to maximize your health and wellbeing.

At Grand Rapids Natural Health we are the first clinic in West Michigan to offer such testing. The cost of the test is $648, which covers the cost of the test and subsequent appointment to review the results.

Learn to eat according to your genes!

Call Grand Rapids Natural Health today, (616) 264-6556, to schedule your initial appointment to learn about the test and have your test collected.