Video Post – 5 Tools Everyone Should Own

In today’s video post, I talk about 5 tools everyone should own to assist in daily maintenance and recovery of their bodies – specifically their muscles, which can get very tight from non-deal lifestyle factors, sports, or training. Be sure to go to Science for Fitness’ YouTube channel and subscribe if you haven’t already.



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Tooth-Organ Relationships

Several months ago my mother started feeling out of it and began to develop lower back pain around her sacroiliac (SI) joint. She’s always fairly active, tap dancing and going to the gym, but she had no choice other than to take it easy. After a month or so I visited her and examined her movement patterns. The pain was particularly bad when she got up from sitting down. I noticed she was bending her torso very far over to get up. This was her body’s way of mechanically compensating for weak hip flexors. I had been working with her on getting her legs stronger, but with the onset of the lower back pain, things were coming undone. I speculated that the excessive forward torso lean was now overworking her erector spinae muscles (the muscles that stabilize your lumbar spine). I had her rise from sitting by keeping a more vertical back, driving through her heels, and pressing with her hands on the arm rests as an assist. It worked very well and she was now able to rise from sitting without serious pain. I told her to keep using this approach to let her lower back muscles rest.

Time continued to pass, the lack of energy worsened and the pain was still there during movements of her lower back. I decided too much time had passed for a muscle strain injury and was about to call my parents to suggest seeing a specialist. Before I could call them up, my father called me and said that one of my mother’s molars was dying. The nerve was shot and giving her excruciating pain. They both new she needed a root canal, but it was late in the night. After discussing interaction effects (or lack thereof) of over-the-counter pain killers, I suggested she call her dentist at his home and set up a visit for the next morning – an emergency root canal seemed required. It turned out to be exactly what was required. The tooth had 3 nerves and all of them were dying. One of the three was particularly buried and in the dentist’s search for it he found a serious infection. The infection was so buried, he didn’t notice it in previous encounters even though he said it must have been there a while since it was so far along. He told my mother that the infection had likely leaked into her entire body by now, which would explain why she felt so terrible. He said it also likely explained her excruciating back pain. After removing the tooth and nerves, he put my mother on antibiotics. The very next day she felt substantially better. Her energy levels were not to be believed.
 


Click to zoom

What are we to make of all this? The dentist had a chart on his office wall similar to the one to the left. The chart indicates a relationship between the teeth of the body and the health of other organs. But my literature review of how tooth health may affect the health of other organs was largely unsuccessful. Indeed, the chart has origins from Acupuncture suggesting that the connection may have its roots from observations within the Traditional Chinese Medicine (TCM) paradigm. Still, web searching reveals many individuals who experienced pain in various parts of their body, only to have it disappear after a root canal. Given that root canals are almost always paired with antibiotic treatment, it’s unclear whether the mere removal of the dead nerve or the antibiotics are relieving the pain. Personal observation seems to suggest both are possible and at least one study gives support for the role of antibiotics in improving back pain. Although a terrible experience for my mother, this turned out to be quite eye-opening for all of us. It was a great reminder. Even though science can explain a great deal, there are still major gaps in our understanding. In addition, for those that treat, train, or coach others, we must remember that the body is an exquisitely interconnected structure; just because a problem presents itself in one region of the body does not mean that region is also the root cause of the problem.

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Science For Fitness Newsletter

A number of my readers requested that I create an email mailing list so they can more easily keep tabs on when new content is posted. Everyone is busy these days and checking websites constantly doesn’t help things much. In addition, there is no guarantee you will see an Science for Fitness post on your Facebook pages feed. Therefore, I have launched an email newsletter for Science For Fitness! It won’t be a weekly mailing (so you won’t be inundated with emails), but it will be regular enough for you to keep up to date with things. The newsletter format will also enable me to offer some more varied content. I will be able to update everyone on what I’m working on, comment briefly on certain news items, share some fun things like quotes and of course, I will end with a listing of the most recent website and YouTube posts so you won’t miss any of those. You can opt-in or out of the newsletter at any time and I will NEVER share the email list with third parties.

To sign up for the newsletter, just fill out your information in the form that appears to the right of the website, or if you’re on the Science for Fitness Facebook page, click the “Newsletter Signup” tab.

~Hayden

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Fructose Content in Popular Beverages


From Wikipedia

Last year I posted a review of a conference abstract looking at the sugar (carbohydrate) content of soft drinks. You can view the original post here. The abstract was a summary of work in progress with only preliminary findings. As such, there was no way to know how the full study would turn out. Recently, the authors completed and published the full study so now we can see how they compare.

The study centers around the sugar Fructose which is somewhat controversial. I discussed Fructose in detail previously, but the essence of the controversy is that Fructose is metabolized preferentially by the liver and as part of this process there is the potential, if conditions are right, for the sugar to more readily build fat. Fructose has been linked to obesity, fatty liver disease, and other health problems. It’s because of all this that many people are scrutinizing foods and drinks with high levels of fructose. And of course when foods with high fructose corn syrup (HFCS) are brought up, well, the name alone suggests a potential problem. Of course, what many people don’t realize is that most HFCS doesn’t have notably more fructose than glucose. Or does it? Since companies are not forced to list the final ratio of fructose to glucose on product labels, there is no way for the consumer to know. And so, the authors of Walker et al., 2014 wanted to find out for themselves.

The Takehome: The results of this full study supported the authors’ original conference abstract findings. Even using two additional independent methods, higher than expected levels of fructose in sweetened beverages were found. Specifically, the 5 most popular HFCS-sweetened beverages (Coca-Cola, Pepsi, Dr. Pepper, Mountain Dew, and Sprite, which comprise ~90% of the annual beverage market share) had fructose to glucose ratios of ~60:40 which means they contained 50% more fructose than glucose. Remember, sucrose (table sugar) has a ratio of 50:50 and HFCS-55 is 55:42. In addition, beverages had ingredient errors such as Mexican Coca-Cola having a high fructose content despite no source of free fructose being listed and Pepsi listed sucrose as an ingredient but none was found after analysis by the authors. There are many possible causes for all these discrepancies including production methods that allow for hydrolyzed syrups (loss of sucrose content), use of juice concentrates (which may have high fructose contents), and bleeding of HFCS-55 with higher syrups like HFCS-90. All of these methods are allowed in beverage production and do not have to be indicated on labels. Regardless of the sources of discrepancy, and regardless of whether or not manufacturers are intentionally creating products with sugar levels higher than claimed, the data suggest that sweetened beverage ingredients are not what they seem. Thus, according to the result of this study, estimates of society’s fructose intake are likely being underestimated.
 
STUDY DETAILS

The Experiment:

  • In addition to the original measurement data using liquid chromatography (LC), two different approaches were used to measure sugar content: 1) a metabolomics-type (MET) approach based on mass spectrometry combined with liquid and gas chromatography and 2) gas chromatography (GC) by itself.
  • The different analyses were performed by separate companies and both companies were blinded as to the identity of the samples they were testing in order to prevent bias.
  • 14 popular sodas/teas were analyzed (e.g., Dr. Pepper, Pepsi, Sprite, Mountain Dew, Coca-Cola) along with 19 juices/juice-like drinks (e.g., Minute Maid Apple Juice, Kool-Aid Jammers, V8 Splash Berry Blend).
  • Product sugar measurements were compared against standards with known concentrations of glucose, fructose, sucrose, and maltose (and also galactose and lactose for the GC analysis).
  • The amount of each sugar present in the tested sodas and juices was obtained from the NCC Food and Nutrient Database, USDA Nutrient Data Laboratory, data in the scientific literature, and food manufacturer’s information.

The Results:

  • Results were consistent across all three methodologies for % fructose, glucose, sucrose, and maltose. In addition, free fructose content was consistent across all the three methodologies.
  • Mexican Coca-Cola consistently contained 49% of total sugar as free fructose even though neither HFCS nor fructose was listed on the label.
  • Pepsi Throwback, Gatorade and Sierra Mist (none of which list HFCS or fructose as ingredients) contained fructose as 59, 40, and 8 percent of their total sugar, respectively.
  • Beverages listing HFCS as an ingredient had a mean fructose to glucose ratio of 59 while those not listing HFCS had a mean ratio of about 50.
  • Sprite, Dr. Pepper and Pepsi had free fructose accounting for 60% or more of total sugar.
  • Pepsi listed sucrose as an ingredient, but no sucrose was detected as an ingredient using gas chromatography.
  • Minute Maid and Juicy Juice 100% Apple Juices had the highest ratios of fructose to glucose of all the juices measured (67.1 and 67.3, respectively).

The Limitations:

  • Some values for sugar amount claimed/known to be in beverages were missing and a probable value had to be created using statistical procedures.
  • A variety of sources were used to obtain the claimed/known amount of sugar in beverages and we do not know how the authors handled different values being reported in different sources (if any).
  • This study would have been enhanced with a variety of control beverages such as those that are artificially sweetened and those with minimal ingredients and low sugar amounts (such as Honest Teas and Inkos Teas).
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Video Post – How to Make Almond Milk

In today’s video post, I team up with Nieves, owner of Sexy Batch Baking Company to show you how to make your own Almond Milk. It’s quick, simple and healthy. Be sure to go to Science for Fitness’ YouTube channel and subscribe if you haven’t already.



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Individual Variation: A Revisit of Lactose Intolerance


Bacillus by Jennifer Hulsey

I have always had certain dietary restrictions growing up. Apple juice and grape juice gave me a great deal of gas so I shied away from them. I also developed moderate lactose intolerance when I was in college. But since then I have been able to manage my issues fairly easily. Then, sometime last year, I started having significant food issues. I ate a banana that was all yellow (ripe) and got severe gas. I would be up all night trying to relieve the pain (gas relief pills were no use). I switched to super ripe bananas (very brown) and those were ok. But things went downhill fast. In roughly chronological order, over the course of several months, I no longer was able to eat raisins, peanuts, avocado, almonds, pickles, banana (no matter how ripe), cold cheeses, goat cheese, soy milk, lactaid milk, any yogurt, apples, baked goods that had any kind of milk in them. They all gave me severe gas pain and often diarrhea. I was a mess and running out of healthy foods I could comfortably eat.

Utterly desperate I went to a gastrointestinal (GI) specialist on the upper east side. I gave him a detailed written explanation of my dietary history and how things took a turn for the worse of late. After reviewing my history he said I have symptoms indicating irritable bowel syndrome (IBS). This is a disorder of the large intestine and many cases can be managed long-term by modifying one’s diet. But I was fast running out of things I could eat. The doctor said there are a number of cases of IBS that are a result of too many gut bacteria and this can sometimes be completely cured by taking an antibiotic called Xifaxan. Xifaxan is an antibiotic with poor oral bioavailability which means it does not easily get absorbed into the bloodstream. Instead, it tends to collect in the gut, which enables it to target gut bacteria. My prescription was for 1 week of antibiotics and after just one day I felt notably better. I was stunned.

By the end of the week I was completely back to normal and over the next few weeks I began to slowly introduce foods back in. It was a complete success. I could eat all my usual foods again. Curious, I sat down and tried to trace the origins of this disorder. For someone who eats as healthy as I do (and has done so for so long), it just seemed like something must have happened. The recollection was a little difficult, but ultimately it hit me. I had changed one key thing about my diet right before all of this began. If you have been reading this blog, you’ll remember that in 2012 I posted an article on personal insight, which used my lactose intolerance as the example. A reader had commented saying he too had issues with lactose intolerance which were not fixed by just lactase enzyme supplements and that a particular lactase enzyme+probiotic pill had worked wonders and basically cleared up his lactose intolerance completely. Probiotics are supplements that contain beneficial gut bacteria – the kinds you would normally have in your gut. They are often used to repopulate your gut bacteria after being lost because of treatments such as antibiotics given for bacterial infections. So, in the case of this supplement, the reader of my article found the probiotic component to help. Thus, repopulating his gut bacteria seemed to be part of the fix. Since the fix worked for him I decided to give it a try myself and see if I could “cure” my lactose intolerance. I believe I tried the pills on three separate occasions, but they didn’t seem to make a difference. In fact, they seemed to give me a bit more gas while digesting the food they were paired with. This should have been my first warning. It was now easy to piece together what happened.

By taking the lactase+probiotic pill I was adding more beneficial bacteria to my gut. But it turned out my gut bacteria were already in great shape – I had plenty. By adding more, I overpopulated my gut. There were then too many bacteria present and they were breaking down nearly every piece of food that I ate for energy to survive in an attempt to not be out-competed by each other. The Xifaxan reduced the population back to normal and my ceasing to take the lactase enzyme+probiotic pill prevented it from getting worse again. This tale is a good example of individual variation. Most of know we are all different and have to be careful, particularly with prescription drugs that often have side effects. But we also have to be careful with other things we consume (e.g., foods, supplements, etc.). The lactase+probiotic pill was basically a cure for my reader, but the opposite for me. Individual variation can be powerful. We must remember this and always seek to find what is best for us knowing that it may not be so for another.

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Video Post – Wrist Pain in the Overhead Position

In today’s video post, I address an issue that many new weightlifters and CrossFitters have – wrist pain in the overhead position. Ultimately wrist strength and flexibility need to be improved to properly address this issue, but there are a few things to consider while these are being developed. Be sure to go to Science for Fitness’ YouTube channel and subscribe if you haven’t already.



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Performance on a Plant-Based Diet

I am very pleased to present the very first guest article on Science for Fitness. I have received lot of questions from vegan and vegetarian readers (and from those looking to start this route) on how to make sure they are eating right for an active and healthy lifestyle. As such, I turned to my friend Billy Prusinowski who is a vegan CrossFit athlete and trainer for some personal insight on a successful plant-based diet. Billy has been amazingly successful on a plant-based diet and he has many great tips to share. Enjoy!
 


 
 
Even in 2014, when people hear the word ‘vegetarian’ or ‘vegan,’ images of a pale, unhealthy, skeleton-like person are evoked. I’m not sure if that was ever the reality of how the majority of vegans looked to the public, but my mission as an entirely plant-based (vegan) CrossFit athlete in the 21st century is to prove that misconception wrong.

In 2001, I became vegan for ethical reasons while in high school. It wasn’t until several years later that I began to take weight-training seriously. I began to understand the importance of high-protein diets towards the end of college when I saw positive results from using my first tub of protein powder (GNC Soy Protein). The question that I’d end up repeatedly asking myself was, “Would my vegan diet allow me to get the necessary amounts of protein that I’d need to build serious muscle in the years to come?”

I set out to answer this question through both personal trials and with help from an extensive community that was beginning to populate around 2007 through a website called VeganBodybuilding.com. Some of the most important information that I obtained was about protein-dense vegetables and legumes that I could eat to achieve my desired 100+ grams of protein per day. Members from this online community who did some cooking, and then did their math, taught me that a meal of lentils, cooked with quinoa, served over spinach, and topped with a handful of hemp seeds, will get me that 30 grams of protein that I need per meal. If both meals contain the same amount of protein, how is my plant-based meal different from the chicken or fish meal that my lifting buddy is having? It’s not.

I have repeated the question above many times and have had people respond back with their own “facts” about complete proteins and protein pairings. I don’t pretend to be a chemist or biologist (my degrees are in social work and education), but I have had my muscles grow, bulge, and perform, over my 13 years as a vegan, and have not once ever considered a “protein pairing” when choosing what to eat. When I was gaining my certificate as a personal trainer, the nutrition section of my program described a protein pairing for a vegetarian as a combination of pasta and black beans. I remember this protein pairing five years later, mostly because I’ve still yet to try it! When I see 20 grams of protein on a nutrition label, I know I am getting that 20 grams whether I pair it with soybeans, salmon, or sand.

If you are eating a variety of foods everyday and keeping your calories well over 2,000 (as any athlete would), then your proteins will find their own pairings in your digestive system. Whether you are vegan or not, there would be no need to do a mix and match at every meal.

Protein-Packed Plants

As a vegan, people usually want to ask, “Hey vegan, how do you get your protein?” It’s certainly not an unimportant question, but it’s not the only part of vegan fitness. Before I digress to other aspects of plant-based performance, I will offer a quick list of high-protein foods that I eat to obtain adequate amounts of protein per day:

**Depending on the brand/style you find available at your local grocery, the exact number of grams of protein may vary, so I will list these from highest to lowest (although none are actually “low”) without listing the exact grams. I encourage you to put a few of these on your shopping list and check out the nutritional labels yourself!

  • Seitan (wheat meat)
  • Tempeh (fermented soybeans)
  • Split Peas
  • Mung Beans
  • Wheat Berries
  • Edamame
  • Pumpkin Seeds
  • Black-eyed Peas
  • Steel-Cut Oats
  • Green Peas
  • Tofu
  • Almond Butter
  • Quinoa
  • Cashews

I believe that a shopping bag full of these groceries will already make someone slightly more amicable toward the idea of plant-based eating, even the most devout meat-eaters. The way to any person’s heart is through their mouth, and this food list is absolutely delicious! So, pick up a handful of cashews and start munching as you continue to read!

PlantBuilt

There is a team of competitive vegan bodybuilders and CrossFitters in the United States called Team PlantBuilt. PlantBuilt’s mission is to spread the idea that muscle can not only be built, but built well on a strictly plant-based diet. I mention PlantBuilt because they are sheer believers that a plant-based diet is, in fact, optimal for muscle-building because of the anti-inflammatory benefits. Animal products cause inflammation while being metabolized and where there is inflammation, there is delayed muscle-repair and no bodybuilder or CrossFitter wants that! In their latest fundraising video, PlantBuilt mentions their stance on inflammation and muscle recovery. You can also take a look at what actual vegan bodybuilders look like! Watch the PlantBuilt crew here.

Thrive

In addition to the Team PlantBuilt ideology, there is an all vegan supplement company called Vega, which is entirely formulated by the vegan Ironman Triathlete, Brendan Brazier. Brazier has a book called Thrive, which endurance athletes and strength athletes alike both champion as an excellent resource for performance optimization through nutrition.

Brazier speaks about foods that are acidic versus foods that are alkaline-forming in our digestive system. In the human body, all animal products (including other substances, such as alcohol) are acid-forming, where plant foods are alkaline-forming.

Why does one want alkaline-forming foods in his/her body rather than acid-forming ones? There are numerous reasons that you can read about in Thrive, but my personal favorite is that alkaline-forming plant foods protect bone density. It is a fact that the pH of our blood is tightly controlled, and when the blood becomes acidic, the kidneys pull minerals from the bones to balance out that acidic-state (to alkalinize it). This balancing act leads to the kidneys stealing important nutrients from bones and possibly leading to osteoporosis. Being someone that has experienced a broken bone in my hand and been a witness to others obtaining fractures through sport and bodybuilding, this sounds terrible. I need my bones at their full strength at all times.

Brazier’s book, Thrive, and the science behind the alkalinization of foods are worth a closer look. Whether you’re someone who needs to know the exact science behind the metabolism of the foods that he suggests, or just want some tips on stress-busting while you are chasing your fitness goals, this information is gold. You will come away from his book with a wealth of new information that you can share with your friends, who will soon after look at you like you are some kind of insightful alkalinity wizard!

Going Vegan

My advice to anybody considering eating more of a plant-based diet (which, for the record, I do strongly encourage if you want to optimize fitness performance) is to do plenty of research. Make Google your best friend! With so many resources available to you at your finger tips, if you don’t like something you hear, an excellent counter-argument is just a click away.

Please understand that veganism isn’t a big taboo thing anymore. There are professional football and baseball players that adhere to the diet you don’t hear that much about it, because it’s really not that big of a deal. What is a big deal is your appetite and knowing how to satisfy hunger with what you have available to you. I believe that more people would be vegan if they didn’t have that one Friday night where hours after they have had lunch, head to Chipotle with all of their friends just had to grab a carne asada burrito!

People, please read the internet. Be aware of this ever-accommodating world that you live in! Chipotle has vegan “Sofritas” and can veganize everything. Taco Bell has lard-free refried beans and can also veganize everything. Even Burger King has a veggie burger! Let me make it clear that I do not advocate eating at any one of these places, and only mention them to bring home the point that this world can be very vegan-friendly for the well-informed.

Where to Start?

Where I would start is at Trader Joe’s or Whole Foods to get your staple proteins (seitan, tempeh, tofu, Tofurky sausage, Morningstar Farms vegan burgers, etc.) and then round out your cart with the vegetables you like. Every shopping trip, I purchase broccoli, kale, spinach, sweet potatoes, avocados, and all of the raw nuts that I can afford that week! My meal plan would look very “paleo” to the untrained eye; just proteins cooked over a huge bed of green vegetables. You can still maintain your paleo-nutrient balance while not harming any animals… and that’s really the best part. :)

Supplements

I do take supplements and there is nothing “unvegan” about using them. Most stores will offer a variety of plant-based protein powders and many companies are getting away from using soy altogether. I haven’t fallen prey to the anti-soy rhetoric, nor have I developed gynecomastia (i.e. soy tits) after my 13 years of eating it, but I do like to source my protein from different plants, including brown rice, yellow pea, hemp, sacha inchi, and green blends. Your absolute best resource for finding a vegan protein would be the aptly named VeganProteins.com.

For pre-workouts and vitamins, I make sure nothing that I consume come in a gelatin capsule, because gelatin is derived from animal parts. If there are any questions about whether a product is vegan friendly, I typically call the company. Most companies are very helpful with information about their formulations because they must know that us fitness freaks are super-concerned with every little thing that we put into our bodies. My interactions with companies like B.S.N., Max Muscle, and Gaspari Nutrition have put me in touch with very knowledgeable staff. Personally, I couldn’t tell you where they all source their citrulline malate or L-arginine from, but a quick phone call will usually do the trick.

Good Luck

Good luck with your training and wherever it takes you. Follow Team PlantBuilt on their fitness journey and see the impact that they are beginning to make on our world. I think you will find most of us vegan athletes to be very open-minded and similar to everyone else who is gym-minded, so you should stay in touch (especially if you think this may be something for you).

-Billy

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Video Post – Watermelon Juice for Sore Muscle Relief

In today’s video post, because summer has now officially arrived, I revisit one of last year’s written posts on watermelon juice for sore muscle relief. Be sure to go to Science for Fitness’ YouTube channel and subscribe if you haven’t already.



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National Diabetes Report 2014

Diabetes is a serious medical condition in which blood sugar (glucose) levels are abnormally high due to improper production or functioning of insulin, the major hormone regulating blood sugar levels.
 
In Type 1 diabetes, insulin is not produced in high enough quantities by the pancreas because the cells that produce it (beta cells) have been destroyed by the individual’s own immune system. In Type 2 diabetes, insulin is produced, but cells of the body (e.g., muscle, liver, and fat) do not respond to its action – they are said to be resistant. While there is little individuals with Type 1 diabetes can do to reverse the condition outside of insulin injections or a pump, Type 2 diabetes can in many cases, be prevented and/or improved by physical activity and diet.
 
This month the Center for Disease Control and Prevention (CDC) released a 2014 Statistical Report on Diabetes in the United States.

The Takehome: The statistical analysis compiled by the CDC emphasizes that many Americans suffer from diabetes (about 10% of the population), that it is a leading cause of death, and that its economic burden is quite high (over $200 billion). These findings were largely expected based on prior studies. What was less clear from prior studies was the number of individuals with prediabetes and this study indicates that the numbers are very high (37% of U.S. adults aged 20 years or older and 51% of those aged 65 years or older). This may be indicative of a trend towards more individuals developing Type 2 diabetes with each passing year. However, those with Type 1 and Type 2 were combined in this statistic and any change over time, which is arguably the most interesting analysis that could be done, was not examined in this study for any parameter. So, we can’t read to much into this CDC report beyond 1) diabetes is a very common and costly disease, 2) more individuals may have diabetes than we thought and 3) even more may be on the verge of developing diabetes due to higher than normal blood sugar levels (they have prediabetes). Future studies are needed to see whether these trends are getting worse over time.
 
STUDY DETAILS

The Experiment

  • This study was a statistical analysis from a variety of national data sets. As such it presents data in the context of correlations and associations; experiments to support causation were not performed.
  • The total number of people with diabetes and prediabetes were derived from a variety of surveys and resident population estimates from 2009-2012.
  • Estimates for those with diabetes undiagnosed and those with prediabetes (high blood sugar levels, but not yet high enough to be Type 2 diabetes levels) were calculated based on fasting glucose and hemoglobin A1C (A1C) levels of participant data.

The Results:

  • About 9.3% of the US population has diabetes (about 29.1 million people).
  • 28.7% of people with diabetes don’t know they have it (about 8.1 million people).
  • 37% of U.S. adults aged 20 years or older and 51% of those aged 65 years or older had prediabetes.
  • Diabetes was the seventh leading cause of death in the United States in 2010 based on the 69,071 death certificates reporting it as cause of death (but diabetes as a cause of death is likely being underreported here).
  • The estimated total costs of Diabetes in 2012 was $245 billion.

Conclusions: The study presents a variety of data which hits home the burden of diabetes on the American population. Specifically, a large portion of the population is afflicted with diabetes (about 10%), it is a leading cause of death, and its economic burden is quite high (over $200 billion). The number of individuals with prediabetes is particularly troublesome as the numbers are very high and may be indicative of a trend towards more and more individuals developing Type 2 diabetes. However, this report is limited in many ways. Several of the statistics do not separate Type 1 from Type 2 diabetes. Further, the most interesting data would be how all these statistics are changing over time. It would have been more insightful to see if we were significantly worse off in 20012 than in 2009. The narrative of the report suggests we are, but there is no way to know given the way this study was done. Future data will be needed to determine if diabetes and prediabetes numbers are worsening over time.

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