Bitter Melon: Sweet Reward for Diabetes?

Bitter melon is a plant that grows in regions of Asia, South America, East Africa, and the Caribbean. The fruit has been used, by natives, throughout time as food and in medicine to treat diabetes, cancer, viral infections, and immune disorders. The active ingredients in bitter melon have been extensively studied for the fruit’s blood glucose lowering properties.

Currently, there are 150 million people with diabetes worldwide, and this figure is expected to increase to over 300 million by 2025. For many people living with diabetes is a constant struggle. Checking their blood glucose levels, watching what they eat and taking medications doesn’t always mean that their diabetes is under control. A national survey conducted in 2007 found that 17.7 percent of American adults had used dietary supplements, other than vitamins and minerals, in the past 12 months for a health condition. With 18.8 million people in the United States diagnosed with type-2 diabetes some may look to the Internet for information and stumble upon bitter melon.

What is the Consumer Finding?
Patients are more proactive about their health in this new age. Unfortunately there is just as much inaccurate, or unsubstantiated, medical information on the Internet as there is accurate information. Homeopathic websites refer to bitter melon as “a natural remedy for type-2 diabetes” and “an alternative to insulin” yet provide little evidence supporting these bold statements. Top selling herbal supplement brands have websites that market bitter melon in a number of ways that could seem appealing for diabetics who are struggle with their blood glucose control. Some statements include:

• “Bitter Melon, also known as Bitter Gourd, has been traditionally used to regulate blood sugar levels within the normal limits. It contains Gurmarin, a polypeptide that has been shown in experimental studies to achieve its regulating effect by suppressing the neural response to sweet taste stimuli. Bitter Melon is also a natural source of Vitamin C.”
• “Bitter Melon, also known as Bitter Gourd, has been used to support already normal blood sugar levels and has been shown in experimental studies to achieve a regulating effect by suppressing the neural response to sweet taste stimuli. (These statements have not been evaluated by the FDA. This product is not intended to diagnose, treat, cure or prevent any disease)”

What Does the Research Show? 

Scientists in India began studying bitter melon’s effects on blood glucose in the 1950s, and their work has lead to other researcher’s interest in investigating the fruit’s potential for blood glucose management for those with diabetes. Throughout the past sixty years, studies reveal varying evidence to support the effectiveness of bitter melon for diabetes.

The largest study to evaluate the blood glucose-lowering effect of bitter melon was published in 1999 in the Bangladesh Medical Research Council Bulletin. The clinical trial examined the effect of the fruit on 100 patients with type-2 diabetes. The researchers recorded the patients’ blood glucose levels both without food intake for 12-24 hours and after taking 75g of glucose. They then administered a bitter melon pulp suspension to the diabetic patients and the results revealed a significant 14% reduction in fasting and post-meal serum glucose levels.

In another study researchers examined whether adding bitter melon capsules to the 40 participants existing medication could decrease their hemoglobin A1c levels by 1%. The results revealed only a 0.217% decline in the experimental group. The authors relied on the subjects to administer the supplements themselves and did not state the dosage used. The researchers stated that bitter melon’s effectiveness is undetermined.

A 2008 study, published in Chemistry and Biology, isolated four compounds in bitter melon that activate an enzyme that is responsible for regulating metabolism and transporting glucose from the blood into the cells. The researchers touted that isolating these compounds could lead to medications that someday could control obesity and type-2 diabetes.

Should You Recommend Bitter Melon to Patients? 

Personally, I would not recommend such a supplement to my patients. Not because there is limited scientific evidence on it, but because sometimes it has the potential to work too well. If taken incorrectly blood sugar can drop to unsafe levels. Often, in the case of supplements, dosage can be vague or worse—consumers can view it as safe at any dose because it is natural. The herbal supplement industry is loosely regulated and potency may differ between products.

One potential side effect is hypoglycemia, which can be fatal for diabetics. Hypoglycemia, a condition in which blood sugar drops too low, is the primary risk involved in taking bitter melon. If hypoglycemia is not treated quickly, the diabetic patient could fall into a coma that may result in death. 

With over 60 years of research bitter melon still lacks enough evidence for health care professionals to start recommending it for diabetes management. Many homeopathic websites justify the use of supplements by noting that several conventional medications used today came from natural substances. The difference is that conventional medications go through rigorous human testing before they hit the market. Make sure to always take in to consideration the cost, safety and effectiveness of supplements before recommending them to your patients.

Home-ish for the Holidays.

I realized, now that I am growing older, that controlling what you eat during the holidays gets harder and harder. Not because you have no self-control, although I am sure that is a part of the problem, but because someone else might be doing the cooking or you may be cooking for people that don't enjoy the same foods as you do.

I am spending my first holiday in Charlotte with my mother's side of the family. Not to bad mouth the area, but when I see macaroni and cheese listed as a vegetable side-dish on numerous restaurant menus I begin to doubt the food sanity of those around me. Since I will be helping to plan and cook the Christmas day menu I thought I should share with you how I intend to get in as many winter vegetables and whole grains so that even the kids will eat healthy.

The first challenge I faced wasn't even the people, it was where to find the healthy food. The local Walmart is where the majority of my family buys groceries, but their produce is often limited. So after traveling to three different supermarkets I was finally able to get all of the produce I needed for dinner.

The second challenge was to cut the sugar, salt and fat. Essentially, most recipes that I found I simply cut the sugar in half, eliminated adding salt by using pepper or spices instead, and used low-fat milk and half of the butter or oil. Cutting things out of recipes won't always work (especially with certain baked goods), but most of the time you can cut back on salt, sugar and fat without overly altering the taste. 

The third was to get everyone to try the food. (I avoided telling them that I had modified the recipes. Some may see this as unethical, but I think serving them the original recipes would be unethical).

My Christmas Day Menu

Hot Chocolate with Skim Milk
Baked Apples with Cinnamon
Roasted Butternut Squash with Beets and Parsnips
Winter Greens Salad with Balsamic and Dijon Dressing (Chicory, Radicchio, Escarole and Cabbage)
Pineapple Ham (Lean, Smoked, Shank Cut)
Smashed Potatoes (Reds with Skim Milk and a Little Butter)
Whole Wheat rolls

What was on your holiday menu?

StrongWomen Across America

For the past four months I have been working with StrongWomen Across America as part of a directed study at Tufts University. The StrongWomen Across America program is an evidence-based community exercise and nutrition program for midlife and older women. During the fall of 2011 the founder and director, Miriam Nelson, PhD, and the StrongWomen strength training program manager, Eleanor Heidkamp-Young, ACSM HFS, traveled from Kenai, Alaska to Brodheadsville, Pennsylvania visiting eight small towns to empower groups of women to make healthy changes for themselves and their communities.

I had the pleasure of helping out with the media, technology and communication aspects of the tour with the program coordinator, Allison Knott, RD. Allison and I spent many hours locked in an office editing photos, video and blog posts.

Check out our hard work and videos on the StrongWomen Across America blog and see what the StrongWomen Team and groups of women have to say.

Also, check out our podcast, an interview with Miriam and Eleanor about their 6,800 mile road trip, on Tufts University Friedman School of Nutrition Science and Policy Nutrition Talk Radio.

Enjoy!

Work, work, work.

Sorry about the four month delay on posts. I have gotten a bit distracted with some of my school projects, volunteer stuff and work. I promise that this week I will put something up relating to the holidays and then never leave you alone for such a long time again.

Massachusetts' Schools Are Giving Chocolate Milk the Boot.

Chocolate milk has been like a controversial celebrity in the news over the past several months.  The superstar of the cafeteria has been demonized and praised in the media. School nutrition experts can’t even agree on whether removing this sweet treat from schools is a necessity.  Questions have emerged on both sides of the debate. Will the children drink white milk? Does the added sugar and excess fat lead to childhood obesity? Will children be getting enough calcium, a nutrient that many school-aged youths are deficient in?

According to CDC data, 31.7% of children in the United States ages 2-19 years old are overweight. Overweight and obesity in children can have harmful short and long-term health effects and an endless list of contributing causes. The typical 8-ounce chocolate milk contains 160 calories, 15 grams of added sugar (about 3½ teaspoons) and 1½ grams of fat. If a child drinks chocolate milk instead of 1% low-fat milk with lunch they could be consuming an extra 50 calories per day, 250 calories per week and an extra 1,000 calories per month. Based on a 180-day school year a child could consume an extra 9,000 calories per year, which in theory translates to a possible weight gain of 2 ½ pounds.

Time Measurement	Add’l kcals from Chocolate Milk with Breakfast vs 1% White	Add’l kcals from Chocolate Milk with Lunch vs 1% White	Breakfast and Lunch Add’l kcals from Chocolate Milk vs 1% White
Day	50	50	100
Week	250	250	500
Month	1,000	1,000	2000
Year (based on 180 school days)	9,000 (or 2.5 lbs)	9,000 (or 2.5 lbs)	18,000 (or 5.14 lbs)

           

The United States Department of Agriculture (USDA) 2010 Dietary Guidelines and the Institute of Medicine emphasize limiting the amount of added sugar because it can contribute to excess calories. “Saying we need to add sugar and flavoring milk is like saying we need to feed kids apple pie if they don’t like apples” said Ann Cooper, Chef and school nutrition pioneer. The USDA Healthy Hunger-Free Kids Act, which regulates the school lunch programs, requires that flavored milk be fat-free. In addition to the USDA Healthy Hunger-Free Kids Act, the newly passed Massachusetts School Nutrition Bill requires that 8-ounce flavored milk have less than 22g of total sugar. Unless products are developed that meet these standards, full implementation of non-flavored milk will occur in the state by 2013.

Will children drink white milk? Many studies funded by the Dairy Council report that children will not drink white milk, while many independent studies suggest otherwise. A preliminary report by the Harvard School of Public Health, The Healthy Lunch Study, evaluated 3,188 school lunch trays and reveals “when only 1% white milk was served instead of chocolate milk, students still drank the same amount of milk.” Lauren Smith, Medical Director of the Massachusetts Department of Public Health, commented on the issue saying  “Studies have shown that when flavored milk is banned, milk consumption drops slightly but then rebounds.”

Many parents are condoning the removal of chocolate milk complaining that schools are acting as food police. According to the CDC’s Children’s Food Environment State Indicator Report, 2011 “The environments to which children are exposed in their daily lives—schools, child care facilities, and their communities—can influence the healthfulness of their diets. With the high prevalence of childhood obesity in the U.S., supporting healthy food environments is a key strategy to reach the public health goals of reducing childhood obesity and improving nutrition.” Children typically eat 2 out of 3 meals per day at school, therefore schools need to provide children with a healthful food environment and model healthful habits that children can become accustom to and continue into adulthood.

Sorry chocolate milk, although you are just one of the many, many culprits in this epidemic, you may have to take the fall on this one. 

Strawberry Rhubarb Crisp, Oh My!

A dinner party invitation is a great opportunity to bake seasonal favorites and have your friends help you eat it all! Obviously, I chose to contribute dessert because I have a sweet tooth. Since strawberries and rhubarb are in season and at their peak of flavor I thought this sweet and sour crisp would make a great addition to our meal. I love this crisp served hot or cold; as dessert or breakfast and sometimes I take seconds and thirds.

Strawberry Rhubarb Crisp


Ingredients:
2 cups rhubarb (cut off the ends and slice into nickel sized pieces)
2 cups strawberries (cut off the stems and slice into a similar size as the rhubarb)
1/4 cup brown sugar
1/4 water
1/2 cup all purpose flour
1/3 cup whole wheat flour
1/4 cup old fashioned rolled oats
2/3 cup sugar
1/2 cup butter (keep cold until use)
Cinnamon- as needed

Directions:
1. Preheat your oven to 350 degrees.
2. Combine your strawberries, rhubarb, brown sugar and water in a 9 x 9 inch baking pan.
3. In a mixing bowl combine the flours, oats, and sugar and mix well.
4. Add the butter to the sugar and flour, mix with your hands until everything is well combined and resembles pea-sized pieces. *Do not over mix*
5. Add the sugar and flour mixture to cover the top of the strawberries and rhubarb.
6. Sprinkle cinnamon onto the crisp topping and place in the oven.
7. Bake for 45-50 minutes or until the crisp is golden brown.
8. Let it cool for 30 minutes and then DIG IN!

A Taste of Food and Culture.

          "Tell me what you eat, and I’ll tell you who you are”-Jean Anthelme Brillat-Savarin
                      

Foods are often a central aspect in every culture. They are an important part of various traditions, religious practices, and social gatherings. Every cultural group has its own unique food and nutrition concepts. The evolution of cultural cuisines has been greatly influenced by geographic factors and history. Regions not only vary in the staple grains, fruits, and vegetables that they use but also in the cooking methods, spices, and ways in which they eat the food.

Asian Food
In many parts of Asia the traditional cuisines among different regions focus on fresh vegetables, flavorful ingredients, and rice as a staple. In Northern Asia rice, noodles, dumplings and steamed buns are most popular. Healthy cooking methods that are most often used are steaming, roasting, braising, and stir-frying. Northern Asian cuisine is known for its use of garlic, leeks, scallions, chili peppers, and hot sauces.

Southeast Asia has its own distinct food and culture with rice also being its staple food. This region utilizes root vegetables, soybeans, and fresh herbs and spices. Flavors such as soy sauce, green onion, garlic, ginger, and lemon/lime juice are incorporated in many dishes. Lard is a popular fat used in frying but in very small amounts. To prepare many of the regional dishes broiling, grilling, steaming, or stir-frying are healthy options.

An island nation surrounded by ocean, Japan has various fish dishes. Fresh, raw fish cuisines are very popular in Japan and well known as Sushi and Sashimi. Japan’s traditional food focuses on seasonal vegetables, beans, grains, and seafood with little to no meat. Tofu is a versatile lean protein source that is popular.

India is a very diverse country with many races, religions, and cultures. Typical Indian meals are a combination of meat or vegetarian dishes with rice, bread, dal, chutneys, and desserts. Many spices are blended to enhance the flavors of various dishes. Pepper, cardamom, nutmeg, mace, ginger, vanilla, tumeric and cumin are used to season a variety of foods.

Mediterranean Food
The Mediterranean can be divided into three cultural regions: North African (especially Morocco), eastern Mediterranean (Egypt, Greece, Israel, Lebanon, Syria, and Turkey), and southern European (Italy, France, Spain). Wine and herbs are central to Southern European cuisine, while spices intricately and boldly flavor North African foods.

Vegetables play a primary role in dishes throughout the region. Onions, garlic, and tomatoes, surrounded by olive oil, begin many dishes. Eggplants, squash, peppers, mushrooms, cucumbers, artichokes, okra, and various greens and lettuces are popular. Legumes are eaten often: lentils, chickpeas, fava beans in Egypt, green beans in France, white kidney beans in Tuscany. Fresh herbs that are utilized in different regions include rosemary, basil, cilantro, parsley, mint, dill, fennel, and oregano.

Latin American Food
The Latin American diet is high in complex carbohydrates and abundant in fresh fruits and vegetables. Corn and rice are staple foods of many Latin American countries. Depending on the country pork, chicken, sausage, veal, and seafood may be eaten. Condiments made from fresh ingredients are used in many dishes such as salsa and guacamole.

Chili peppers, onions, tomatoes, and beans are native to many areas and are therefore used most often. Tropical fruits are abundant and eaten when in season. Latin America’s food guide pyramid differs from other countries in that its places equal importance on grains, fruits, and vegetables.

African Food
Africa is the second largest continent in the world and offers a variety of different regional cuisines. 

Central- The basic ingredients used are plantains, chile pepper, peanuts, spinach, tomato, onions, okra, ginger, beef and chicken. Meals are generally in the form of a stew.

 
East- The main food and spices used include maize (corn), green bananas, rice, saffron, cloves, cinnamon, pomegranates, lentils, lemon, lime, chilies, tomato, pineapple and domestic pigs. The most utilized method of cooking is roasting.

Horn- In the highlands, injera bread is the staple diet and is eaten daily. Injera is made from teff, wheat, barley, sorghum and corn and is formed into a pancake. In the lowlands, the main dish is akelet, a porridge made from wheat flour dough. Somali cuisine varies from region to region and all food is served halal. Basmati rice is usually served as the main dish and spices like cumin, cardamom, cloves, cinnamon and sage are used.

West- A typical West African meal is heavy with starchy items, meat, spices and flavors. Common foods and spices include yams, cocoyams, cassava; cereal grains like millet, sorghum or plantains; seeds of Guinea pepper (also called grains of paradise), chillies, tomatoes, native rice, rice, groundnuts, black-eyed beans, brown beans, and root vegetables Cooking is done in multiple ways: roasting, baking, boiling, frying, mashing, and spicing. In some areas, beef and mutton are preferred, and goat meat is the dominant red meat Guinea fowl eggs, eggs and chicken are also preferred.

North- Over several centuries traders, travelers, invaders, migrants and immigrants all have influenced the cuisine of North Africa. There are noticeable differences between the cooking styles of different nations. The foods and spices of North Africa include sausages, wheat, couscous, olives, olive oil, saffron, nutmeg, cinnamon, ginger, cloves, potatoes, tomatoes, zucchini and chilies.

South- This region’s influences include its many indigenous African tribal societies, Asian and European. Different foods and spices consumed throughout South Africa include seafood, meat products (including wild game), poultry, as well as grains, fresh fruits and vegetables. Fruits include apples, grapes, mangoes, bananas and papayas, avocado, oranges, peaches and apricots. Desserts may simply be fruit, but there are some more western style puddings. Meat products include lamb, and game like venison, ostrich, and impala. The seafood includes a wide variety such as crayfish, prawns, tuna, mussels, oysters, calamari, mackerel, and lobster. Milk products are consumed in many different forms such as buttermilk, yogurt and sour cream.

American Food Culture
America is a melting pot of many different cultures. Take a look at your diet today and see if you can use your knowledge of cultural cuisines and foods locally grown to incorporate healthier foods and cooking methods into your life.

• Try using a combination of fresh herbs and spices while cooking an Indian inspired dish. 
• Research how to use tofu in smoothies, stir-frys, and in place of ground meat. 
• Add lemon, ginger, garlic, and olive oil to broiled fish for an Asian inspired entrée. 
• Snack on some hummus and pita for a healthy Mediterranean inspired bite. 
• Make taco night healthier and more traditional with whole grain corn tortillas, beans, and fresh tomato, lettuce, onion, and jalapeno.