MORE: 5 Ways Type 1 Diabetes Is Different Than Type 2 Diabetes Approximately 29 million people in the United States have diabetes, a number that’s increased fourfold over the past 35 years—and may double or even triple again by 2050. And new evidence shows that at least 86 million Americans have prediabetes, a condition in which your blood sugar level is higher than normal, but not quite high enough to be classified as full-blown diabetes—not yet, that is. (Here’s 7 things you don’t know about prediabetes.) Diabetes, also known as diabetes mellitus, comes in two forms. Type 1, previously called juvenile diabetes or insulin-dependent diabetes mellitus, is believed to be an autoimmune condition in which the pancreas fails to manufacture insulin. Though onset can occur at any age, patients are usually diagnosed in childhood or as young adults and require daily insulin injections throughout their lives. People with the other form, type 2, usually develop the disease in adulthood, although more and more children and young adults also are developing type 2 diabetes now. In this case, the pancreas produces insulin, but the body does not use it properly, and the pancreas kicks into overdrive to make up for this “resistance.” In time, the pancreas can’t produce enough insulin to make up for the insensitivity, and diabetes follows. Inactivity, aging, obesity, or a diet high in saturated fat can contribute to insulin resistance. Type 2 diabetes, also known as adult-onset diabetes or noninsulin-dependent diabetes mellitus, accounts for 90 to 95% of all cases. With either form of diabetes, glucose builds up in the bloodstream. Left untreated, this can lead to serious complications, including kidney failure, limb amputation, heart disease, and blindness. But the good news is that type 2 diabetes often can be controlled through simple measures. Weight loss, proper nutrition, adequate exercise, and stress reduction all can improve blood glucose levels. Some experts believe that dietary supplements may help, too. Even people with diabetes who require medication will maintain better glucose control if they adhere to a healthy lifestyle. We’ve rounded up diabetes treatment advice from experts.
Lose Weight
The most effective thing that an overweight person with type 2 diabetes can do is to drop some pounds, says Christopher D. Saudek, MD. Shedding excess pounds is sometimes all it takes to bring blood sugar under control. How much weight to lose varies for each individual, but even small drops can yield big results. MORE: 15 Teeny, Tiny Changes To Lose Weight Faster “You don’t have to be skinny skinny, and you don’t have to reach that ideal body weight,” says Carla Miller, PhD, RD. Losing as few as 10 to 20 pounds, or just 5 to 10% of your body weight, may be enough to attain glucose control. Of course, you’ll have to maintain that weight loss, or your blood sugar will rise again. And that’s why how you trim down is especially important. Avoid fad diets, says Saudek. Most are difficult to sustain, and some are not healthy. Your best bet is to combine exercise with a low-calorie diet. Work with a health care professional or a registered dietitian to determine how many calories are right for you.
Count Carbs
The ADA emphasizes that carbohydrates are an important part of a healthful diet. This food group includes cereals, baked goods, legumes, fruits, vegetables, low-fat milk, and starches such as whole grains. Because carbohydrates have the biggest impact on blood sugar right after you’ve eaten, it’s important to get enough at each meal. An average portion size consists of 15 grams of carbohydrates. That’s equivalent to one slice of bread, 1/3 cup of rice, a small piece of fruit, two small cookies, or 1/2 cup of ice cream. Aim for three or four carbohydrate servings at each meal and one serving for snacks. (Try this diabetic diet.)
Read Labels
The best way to figure out how many carbohydrates are in a meal is to look at food labels. Also, be sure to check the serving size. A serving of pasta, for example, is just 1/2 cup, much less than most people typically eat at one time. (Here’s 8 things to look for on a food label.)
Measure Your Food
Don’t guesstimate, says Miller. Use a measuring cup for foods such as rice and vegetables. Meats are often gauged in ounces, so you’ll need a kitchen scale, available at most department stores, says Miller. When you’re without a scale, such as in restaurants, just remember that 3 ounces of meat is about the size of a deck of cards. MORE: 5 Diabetes Symptoms
Watch Your Sugars
Sugars aren’t as ominous as they would seem for people with diabetes. When eaten in equal amounts, starches and sugars have similar effects on blood sugar, Franz says. Still, foods containing sugars and sweets are often high in calories and low in nutritional value. If you do eat something high in sugar, it’s important to substitute that for other carbohydrate foods in your menu.
Eat Fewer Fats
Keeping fats to about 30% of your total calories can reduce your chance of developing high cholesterol and heart disease, both risk factors of diabetes.
Eat Even Fewer Saturated Fats
Saturated fats, from meats and cheeses, and polyunsaturated fats, in hydrogenated margarine, should account for only 10% of total daily calories. Switching to a diet higher in monounsaturated fats, found in olive oil and nuts, and lower in polyunsaturated fats may help reduce insulin resistance, according to Harry G. Preuss, MD, MACN, CNS. Choose low-fat dairy products and lean meats, and avoid margarine and baked goods containing trans fats, coconut oil, or palm oil.
Pass On High-Protein Diets
Because foods high in animal protein, such as meats and cheeses, also tend to be high in fat and cholesterol, limit proteins to between 10 and 20% of your diet. It’s true that you might lose weight following popular high-protein, low-carb diets, but keeping it off can be a problem. You’re better off adopting a balanced diet that you can live with for a long time, says Franz. MORE: 7 Reasons You’re Tired All The Time
Skimp On Sodium
Diabetes and high blood pressure sometimes go hand in hand, and people with diabetes can be more sensitive to the effects of excess sodium, says Franz. Limit sodium to less than 2,400 milligrams a day, which is the amount of sodium in 1 teaspoon of salt. The easiest way to do this is to eat less than 800 milligrams at each meal and no more than 400 milligrams in each food. Look for the amount of sodium on food labels.
Feast On Fiber
One small study of 13 people who ate 25 grams each of soluble and insoluble fiber—a total of 50 grams a day—found that they were able to achieve a 10% drop in blood sugar levels. While that’s encouraging news, Franz cautions that, from a practical standpoint, 50 grams a day may be a bit tough to stomach. “We really don’t know if, in the long term, people can eat enough fiber to influence blood glucose levels,” she says. Nevertheless, high-fiber diets have other health advantages. They slow the absorption of fats and carbohydrates into the system, reducing their adverse effects on the glucose-insulin system. Also, high-fiber foods tend to be very filling, so you eat less. Shoot for 25 to 35 grams a day by eating lots of whole grains, beans, lentils, and vegetables. (Here’s 6 tasty ways to get more fiber.)
Drink Sparingly
You needn’t become a teetotaler the moment you’re diagnosed with diabetes. Moderate drinking has been shown to lower the risk of heart disease and may actually improve insulin sensitivity, according to some studies. To realize such benefits, however, don’t drink too much. Women should cork the bottle after one drink a day (or fewer), and men after two or fewer. (One drink is 12 ounces of beer, 4 ounces of wine, or 1/2 ounces of hard liquor.) If you choose beer, light is best since it contains fewer carbohydrates and calories. MORE: 8 Things That Happen When You Stop Drinking Alcohol
Do It Drug-Free
“Beating type 2 diabetes by getting tough about your diet (and exercising) works better than drugs,” says researcher Christian Roberts, PhD. At the end of his small, controlled 3-week study at UCLA, Roberts found that 6 out of 13 overweight or obese men with type 2 diabetes were diabetes-free, with normal blood sugar levels. How? They ate meals low in fat (12 to 15% of calories), moderate in protein (15 to 25%), and high in carbs (65 to 70%). Participants also walked 45 to 60 minutes a day, and cut out refined carbs—absolutely no pastries or brownies. These changes were critical to their success, says Roberts, who predicts that sticking to the diet long-term may undo heart damage already started by earlier diabetes.
Enlist Your Spouse
Miller studied the eating patterns and food choices of 45 men and women with type 2 diabetes for 1 year. She found that those with the best blood sugar control were men whose wives prepared low-fat meals and walked with them. On the other hand, women without that level of support from another person didn’t have good blood sugar control. Worst off were those women who prepared low-fat meals for themselves but made separate meals for their families. The moral: Persuade your family to get healthy along with you. MORE: 13 Power Foods That Lower Blood Pressure Naturally
Plan Ahead
Diabetes requires a pretty intensive lifestyle overhaul, acknowledges Miller. You need to exercise, eat healthy, and monitor your blood sugar, which requires an enormous amount of organization and time. In her study, Miller discovered that the people most successful at controlling their blood sugar levels were those who did a lot of meal preplanning. Decide at the beginning of the week which healthy foods you want to prepare. Then shop for these foods. If you make bag lunches and have healthy food on hand, you’ll be less likely to rely on high-fat, fast-food meals or sugary snacks.
Visit A Dietitian
A dietitian or nutritionist can design a customized nutrition plan just for you. This is especially important if you have other health issues, such as high cholesterol and high blood pressure, as well as diabetes, says Miller. Plan several sessions so that you can gradually incorporate changes. (Here’s 8 secrets every dietitian knows—and you should, too.)
Nurture Good Nutrition
No one nutrition prescription can apply to everyone with diabetes, says Marion Franz, MS, RD, LD, CDE. “Each person with diabetes deserves to have an individualized meal plan.” The American Diabetes Association (ADA) urges people to consider what ethnic and cultural foods they prefer, what other health concerns they may have (high cholesterol and high blood pressure, for example), and what changes they are realistically willing to make. Working within that framework, people should aim for the following goals.
Diabetes Treatments From The Kitchen
Many foods and spices have been found to lower or help control blood sugar. Give these a try. Avocado: This fruit is rich in a particular kind of monounsaturated fat called oleic acid, which has been found to improve fat levels in the body and help control diabetes. (Try these 10 tasty recipes that’ll help you eat more avocado.) Beans: Many studies have shown that eating foods high in soluble fiber, particularly beans, reduces the rise in blood sugar after meals and delays the drop in blood sugar later on, which helps maintain blood sugar at close-to-desired levels. Cinnamon: Some alternative practitioners think that cinnamon may be helpful in making insulin receptors work better. Stir 1 teaspoon daily into a food or beverage. Other spices found to help the body use insulin more efficiently include bay leaf, cloves, and turmeric. Coffee: Regular drinkers may be less likely to develop diabetes, reveals a study from the University of Minnesota. Diabetes experts suspect that compounds and minerals in coffee beans may improve the sensitivity of insulin receptors and help the body process blood sugar more efficiently. (This is your body on coffee.) Orange: Studies indicate the soluble fiber and pectin in oranges can help control changes in blood sugar as well as help lower cholesterol. Sweet Potato: Despite its name, and a flavor so divine it makes a good dessert, the sweet potato doesn’t raise your blood sugar as high, or as fast, as a white potato. Tea: Studies have shown that extracts of black tea may significantly reduce blood sugar levels. And enjoying a cup of chamomile tea may be more than a restful nighttime ritual—the herb may help reduce blood sugar fluctuations.
Best And Worst Foods For Your Blood Sugar
What you eat (and don’t) may play a major role in your risk of developing type 2 diabetes, according to a study from researchers at Tulane University and Harvard School of Public Health who tracked the eating habits of more than 71,000 women for 18 years. Here’s how to help prevent the disease, based on their research. Add: Leafy greens. For every additional serving of spinach, kale, or chard you eat, you may lessen your likelihood by as much as 9%. Add: Whole fruit. For every 3 servings, you may slash your risk by up to 18%. Avoid: Juice. Consuming one serving a day may raise your odds by nearly 18%. Some varieties are rich in antioxidants, but consider trading your daily glass of juice for whole fruit. MORE: Check Out These 10 Additional Foods That Can Lower Your Blood Sugar—Naturally
Get Your Heart Pumping With Regular Exercise
In addition to the obvious nutrition changes, experts recommend regular exercise for people with diabetes. “Exercise acts just like medicine,” explains diabetes educator Robert Hanisch, MA, CDE, CSCS. It lowers blood sugar as muscles turn glucose into energy. According to the American College of Sports Medicine (ACSM), obese people with type 2 diabetes who exercise regularly achieve better glucose control. What’s even better, studies find that increased physical activity, including walking, can reduce the risk of heart attack, stroke, and other complications in people with diabetes. Even people dependent on insulin or oral medicines can reap the benefits of exercise. “At the very least, they will take less medicine. And the results are immediate,” says Hanisch. You should check your blood glucose immediately before and after exercise. There will be individual variations, but on average there is a 1 to 2 point drop in blood sugar for every minute you exercise. This means 10 minutes of aerobic exercise will usually cut blood sugar 10 to 20 points. The glucose will remain lower until the next meal or snack. Check with your doctor before beginning any exercise program. Here are some tips to get you going.
Start Easy
Not accustomed to exercise? Don’t sweat it. Begin with a low-impact, low-intensity workout, such as walking. “Walk at a comfortable pace,” says Hanisch. If you push yourself too hard, you won’t find it enjoyable, and you’ll be less likely to continue. “Blood sugar can go down even when you are walking very slowly,” he says. MORE: The Best Workout To Fight Prediabetes
Join The 1,000 Club
The ACSM recommends that people with type 2 diabetes perform at least 150 minutes of moderate to vigorous exercise per week, spread out over at least 3 days of the week, and there should be no more than two consecutive days go between exercise bouts.. Hanisch suggests a goal of gradually building up to a 30-minute workout on most days of the week. Even brisk walking counts as a moderate-intensity exercise. Experts recommend also adding strength training 2-3 times per week.
Strive For Five
“Consistency is the key,” notes Hanisch. Whether you hike, bicycle, swim, or jog, a routine you can manage 5 times a week will produce optimum results, creating a long-term change in your body. After 2 to 3 months of consistent exercise, you likely will become more sensitive to insulin, and you’ll need less medicine, Hanisch says.
Be A Morning Person
An early workout will hold blood sugar down all day long. You will still see fluctuations in glucose levels after meals, but a 30-minute morning walk will keep levels 30 points lower than what they might otherwise be, says Hanisch.
Drink Up
Dehydration can affect blood glucose levels, so staying well hydrated during exercise is especially important for people with diabetes. Drink 16 ounces of fluid—two glasses of water—2 hours before exercising, and sip throughout your workout. (Here’s the exact amount of water you need to drink after a workout.)
Lift Lightly
Weight training can help build strength. But people with long-standing diabetes, and especially those with diabetes-related eye disease, need to limit themselves to multiple repetitions with very light resistance in the range of 1- to 5-pound weights. Heavy weights can injure weakened eye muscles, says Hanisch. To know that the weight is light enough, you should be able to perform the correct strengthening techniques with minimal effort. If in doubt, use a lighter weight.
Take Care Of Your Toes
People who have diabetes-related foot problems such as peripheral neuropathy should take special care before they go walking or jogging. “They may need to work with a podiatrist to get shoes that distribute the force differently when they land,” says Hanisch. MORE: 10 Things Podiatrists Wish Everyone Knew About Their Feet
Stress Less
When something gets you stressed out, sending your emotions on a roller coaster, your blood sugar goes along for the ride. That’s because stress hormones, such as adrenaline, increase blood glucose. “Stress hormones mobilize glycogen that has been stored in the liver and metabolize it into glucose,” says Angele McGrady, PhD. The adrenaline and extra sugar released into the bloodstream give you a boost of energy. If you were undergoing physical stress—say, being chased by a pack of wild dogs—you’d respond by running away, and the extra blood sugar would be used up, McGrady points out. Today, however, most of our stressors are psychological. We sit and stew and don’t use up all that blood sugar. Since their bodies don’t metabolize glucose effectively, it’s especially important for people with diabetes to try to decrease their stress levels. In a small study that McGrady conducted, 18 people with diabetes reduced their blood sugar levels 9 to 12% by practicing simple relaxation exercises. Those who also had depression, however, did not benefit without additional treatment. Here are some stress busters worth trying.
Breathe Deeply
“Deep breathing is a good way to start,” says McGrady. Sit with your legs and arms uncrossed. Inhale deeply from your abdomen. Then breathe out as much air as you possibly can, relaxing your muscles as you do. Continue this relaxed breathing for about 15 minutes. MORE: 10 Silent Signals That You’re Way Too Stressed
Purchase A Relaxation CD
Can’t settle down? A relaxation CD can help. “Most of us aren’t used to sitting quietly with no thoughts in our heads,” says McGrady. “It’s very helpful to have sound in the background.” Recordings of gentle noises from nature, such as ocean waves, enable you to pace your breathing and set a tone for you to relax. Or choose a guided imagery CD, in which a soothing voice mentally shepherds you through a pleasant scene, such as a walk in a forest.
Focus On Something Pleasant
Guided imagery works because it guides your senses of recall and concentration to help you relax. You can achieve the same effect by examining an art book or an illustration that you find pleasant. “Look at the picture for several minutes, then close your eyes and recall as much as you can,” explains McGrady. “If you do it enough, you can eventually do it without even having the book in front of you.” You could put a peaceful scene on your computer screensaver, too, she suggests.
Practice Progressive Relaxation
Tensing and relaxing your muscles allows you to consciously control their tension. First, lie on your back in a comfortable position. Begin deliberately tensing and releasing one muscle—the fist is a good place to start. Move upward along your arms, to the neck and face, and then down the back and legs. Don’t tense any muscle enough to make it hurt, McGrady cautions. CDs are available to talk you through this process. MORE: Try Yoga For Stress Relief
Try Biofeedback
Researchers at the Medical University of Ohio followed 30 diabetes patients, half of whom practiced daily tension-taming exercises such as muscle relaxation, and had their techniques monitored with weekly 45-minute biofeedback sessions. The others took diabetes education classes. After 10 weeks, those who relaxed saw about a 10% drop in fasting blood sugar and in their average blood glucose level—a sign that their glucose had stayed lower around the clock for the previous couple of months. Meanwhile, the education group’s same levels rose slightly. But if that’s not motivation enough, the stress management group also experienced a drop in depression and anxiety. To find a biofeedback therapist in your area, visit the Biofeedback Certification Institute of America and click on Find a Practitioner.
Take Care Of Your Feet
Peripheral neuropathy is a complication of diabetes in which high blood sugar damages nerve cells over time, leading to a lack of sensation. Because the nerves in the feet are the longest in the body, the feet are usually most affected by this condition, making them prone to injury and damage. Sores on the feet that don’t heal properly can become ulcerated and infected and, in serious cases, may lead to amputation. An estimated 4 out of every 1,000 people with diabetes have a limb amputated—and it often can be avoided. Here are some recommendations for protecting your feet. See a podiatrist. Once you’ve been diagnosed with diabetes, have your feet checked frequently, recommends Marc A. Brenner, DPM. A podiatrist will determine if you have neuropathy and will help care for your feet if you do. Trimming toenails or self-treating calluses and corns, for example, can pose hazards for people with neuropathy and should be done by a podiatric physician. Some other tips: Keep them covered. Wear a good pair of socks. The best are made of a combination of cotton and synthetic material. On very cold days, wear two pairs—a thin one next to your skin and a thick pair. “The more insulation you have between your foot and the ground, the better,” says Brenner. Make sure the shoe fits. Your shoe size should be determined by a certified pedorthist, a person specially trained to measure feet, says Dr. Brenner. Ask your podiatrist to recommend a shoe store that offers such services. Have your feet measured in the afternoon, when your feet are more likely to be swollen. Step out in sneaks. You probably won’t need custom shoes. A high-quality cross-trainer or running shoe will serve you well. Look for a type with a roomy toebox, a removable inlay to exchange for a custom orthotic, a padded tongue, and a cushioned heel and ball. Wear an orthotic. A diabetic orthotic is a custom-made device that fits into your shoe. It’s important to wear one since it keeps pressure off certain spots on the foot or spreads pressure across the entire foot. Your podiatrist can advise you and measure you for an appropriate orthotic. Inspect daily. Check for swelling or sores, using a large mirror to see all angles of the foot. Better yet, ask a family member to look for discoloration and feel for warm spots—signs of possible infection. Take them swimming. If you have neuropathy, exercise is still important. “Swimming is safest,” says Brenner, because you don’t have to put pressure on your feet. Carefully dry your feet afterward and sprinkle them with foot powder to avoid fungus or yeast. MORE: 10 Things Podiatrist Wish Everyone Knew About Their Feet
Supplement Savvy
Some practitioners believe that dietary supplements can be helpful for people with diabetes. Consult your physician before trying them out. Here are a few that the experts recommend.
Consier Chromium
Some people with diabetes can benefit from chromium supplements, especially if they have a deficiency of this mineral. Preuss suggests 400 to 600 micrograms of chromium a day for 1 to 2 months under the direction of a physician.
Get Some American Ginseng
One small Canadian study found that patients with type 2 diabetes who took 3 grams of American ginseng 2 hours before eating 25 grams of sugar reduced their after-meal blood sugar levels by 20%. Talk with your doctor about the right dose for you.
Seek Sight-Saving Herbs
According to herbal experts, the herbs bilberry and ginkgo biloba may improve circulation, thereby lowering the risk of eye damage for people with diabetes. Both are available freeze-dried or as a tincture. Follow the manufacturer’s directions.
Baby Your Arteries With Aspirin
Aspirin reduces heart attack risk by discouraging blood cells called platelets from sticking together in the arteries. Amazingly, it’s even more effective for those with diabetes than for those without diabetes. That’s good news, because the incidence of heart attack among women with diabetes has been rising in recent years. Ask your doctor before taking aspirin on your own to avoid potential side effects such as bleeding, says Aaron I. Vinik, MD, PhD.
Try A Good Multi
Look for a good multivitamin and mineral supplement that provides at least 25% of the Daily Values of magnesium, zinc, vitamin E, and vitamin C. Magnesium deficiency is thought to increase insulin resistance, high blood pressure, and cardiovascular disease in people with diabetes. Zinc deficiency also can negatively impact glucose levels. Vitamin E helps sensitize insulin receptors. Vitamin C assists the immune system and enables tissue repair, says Preuss. MORE: 4 Vitamins You’re Probably Not Getting Enough Of
Testing Blood Sugar
Once diagnosed with diabetes, testing your blood sugar at home becomes an integral part of your life. Here are some techniques that experts advise.
Look For Patterns
Monitor your glucose levels by recording your levels 5 times a day for several weeks, suggests Miller. That helps you discern patterns, she says. Check first thing in the morning, 1 to 2 hours after meals, and right before bed.
Check Out Changes
When making changes in your diet, test immediately before a meal, then 2 hours after. Before a meal, levels should range between 90 to 130 milligrams per deciliter (mg/dl). After a meal, levels should be no higher than 160 mg/dl.
Test When You Exercise
If you start a new exercise routine, test immediately before and immediately after your workout, says Hanisch. If your blood sugar is low before starting—100 to 120 mg/dl—eat a piece of fruit or drink half a cup (4 ounces) of juice. Both have about 15 grams of carbohydrates to elevate blood sugar about 25 points. Do the same if your levels drop after exercise.
Do Spot Checks
Most people with diabetes habitually monitor first thing in the morning. That’s not enough, says Miller. Do an occasional test after lunch or in the evening to achieve a better picture of what influences your blood glucose. Blood sugar values should be 110 to 150 mg/dl on average at bedtime.
Write It Down
Use a notebook or your phone to keep a written record of your levels, and note what and when you ate as well as when you exercised and for how long. Share the information with your doctor. The log can help you and your doctor better manage your care.
When To Call A Doctor About Diabetes
Diabetes is a serious illness that requires a doctor’s care, even when it is well controlled. In addition, three complications of diabetes require prompt medical attention:
Severe hyperglycemia (high blood sugar), characterized by frequent urination, fatigue, unexplainable weight loss, and increased thirst.Hypoglycemia, which causes shakiness, dizziness, headache, confusion, sudden mood changes, and a tingling sensation around the mouth. Many people with diabetes experience hypoglycemia, but frequent or severe episodes require a doctor’s care.Ketoacidosis, the warning signs of which include increased thirst, nausea, frequent urination, fatigue, and vomiting. This is a serious, potentially life-threatening condition that occurs when ketones—acids that build up in the blood—become dangerously high.
Panel Of Advisors
Marc A. Brenner, DPM, is founder and director of the Institute of Diabetic Foot Research in Glendale, New York. He is past president of the American Society of Podiatric Dermatology and author and editor of various books. Marion Franz, MS, RD, LD, CDE, is former director of nutrition and health professional education at the International Diabetes Center in Minneapolis and past cochair of the American Diabetes Association’s Task Force to Revise Nutrition Principle Recommendations. She is editor of the American Association of Diabetes Educators Core Curriculum for Diabetes Education. Robert Hanisch, MA, CDE, CSCS, is an exercise physiologist and graduate program instructor in the diabetes department of the health and sciences division at Mount Mary College in Milwaukee. Angele McGrady, PhD, is a professor and director of medical education in the department of psychiatry at the University of Toledo College of Medicine in Ohio. Carla Miller, PhD, RD, is associate director of the Diabetes Center at Pennsylvania State University Milton S. Hershey Medical Center and an assistant professor of nutrition at Pennsylvania State University, both in Hershey. Harry G. Preuss, MD, MACN, CNS, is a professor at Georgetown Medical Center in Washington, DC, and a certified nutritional specialist. He is former president and a master of the American College of Nutrition and former president of the Certification Board for Nutrition Specialists. Dr. Preuss is coauthor of The Natural Fat-Loss Pharmacy. Christian Roberts, PhD, is an assistant adjunct professor in the department of physiological science at the University of California in Los Angeles. Christopher D. Saudek, MD, is former president of the American Diabetes Association and director of Johns Hopkins Diabetes Center in Baltimore. Aaron I. Vinik, MD, PhD, is a professor of medicine and scientific director of the department of internal medicine at the Strelitz Diabetes Research Institute at Eastern Virginia Medical School in Norfolk.
