House Calls

House Calls Started This Year

House calls are meant for patients who are temporarily or permanently home bound, or for other good reasons can't make it into the office.

To schedule a house call: Tel (203) 853-1919; email

Thursday, September 24, 2009

The Better Sweeteners

There’s no question that refined sugars, widely used in the US and hidden in many foods, are a major health hazard and their use should be minimized. But if you like your food to be sweetened, what can you use safely?

Here are some of my favorites:

1. Agave syrup. Agave syrup (also known as agave nectar) is a natural plant product extracted from the agave plant in several states of Mexico. It’s a liquid resembling honey, but less viscous. It is a little less sweet than sugar, and is available in light and darker varieties, depending on the degree of filtering. The darker varieties have more of the plant product in them, and have the additional caramel-like flavor.

Agave syrup is not calorie free. It has the same number of calories as sugar, but it contains much more fructose than sugar, and therefore raises blood sugar levels to a much lower extent than does sugar (table sugar, or sucrose, is made of 50% glucose, 50% fructose; it’s the glucose that causes most of the damage). As a sweetener, agave syrup is considered much safer than sugar, but because it does contain the same amount of calories as sugar, it should be used in moderation.

Agave syrup can be used in cooking. It’s a good substitute for other liquid sweeteners. When used instead of solid sweeteners, the consistency of the baked product will change.

2. Erythritol. Erythritol is a natural sugar-alcohol (not to be confused with regular table sugar or with the ethanol present in alcoholic beverages). Erythitol is produced from glucose, usually derived from corn, by yeast fermentation. It’s available as a powder, is about 2/3 as sweet as table sugar, and can be used in cooking and baking. It is present in many commercial foods, and in chewing gum. Unlike table sugar, erythritol does not cause tooth decay.

Erythritol’s main advantage is that it’s almost calorie free, and does not significantly raise blood sugar or insulin levels. Erythritol is considered very safe, but using it in very large amounts may cause abdominal bloating and discomfort.

3. Xylitol. Xylitol is a natural sugar-alcohol, a powder with some similarities to erythritol. It is present in plants, fruits and vegetables, and also in the human body as part of glucose metabolism. Most xylitol used and sold commercially is extracted and processed for human consumption from birch and corn. Xylitol contains approximately half the calories of table sugar, and causes a significantly smaller increase in blood sugar and insulin levels than does table sugar. It is considered “tooth friendly,” not causing tooth decay. Xylitol is much more likely to cause abdominal bloating than erythritol, which may limit the amount one can use.

Are you a dog lover? Make sure your dog doesn’t get a hold of your xylitol. In dogs, xylitol can cause severe hypoglycemia which can be fatal.

4. Truvia. Truvia is a natural product made from rebiana, a sweetener derived from the sweet leaves of the Stevia plant. It is approximately 200 times sweeter than table sugar, and has essentially zero calories. Stevia is native to South and Central America; its leaves are harvested and dried, and are steeped in fresh water in a process similar to that of tea making. Unlike agave syrup, Truvia is available as a powder. It contains erythritol as its first item on the list, but most of its sweet taste comes from the rebiana. According to the Truvia website, you can cook and even do some baking with Truvia. But I’m not so sure about “traditional” cake baking.

When shopping, read those labels and pay special attention to sugar or sugar-like ingredients like corn syrup and high fructose corn syrup. Frequently, you’ll find more than one sweetener in the ingredient list. In my opinion, this is done mainly to confuse us by shifting these sweeteners to a lower position on the ingredient list, and to make us think we’re consuming less of the bad stuff.

My vote (as table sweetener)? Erythritol, agave, xylitol, Truvia, in that order of preference.

Sunday, September 20, 2009

About Vitamin D…

Vitamin D deficiency in the US is now widespread, and appears in headlines and news media with increasing frequency. But what’s the fuss all about?

Vitamin D, also referred to as “the sunshine vitamin,” is not even a true vitamin, because the body can actually synthesize it under appropriate conditions. Vitamin D is synthesized in the deeper sections of the outer layer of the skin. It does so from cholesterol derivatives present in the skin in the presence of sufficient sunlight (UBV radiation).

It's a true epidemic. Depending on the study, vitamin D deficiency in the US is said to be present in 26-58% of the population. It is more prevalent in the elderly, in dark-skinned people, and in those with some chronic diseases. The further north you are from the equator, the more likely you are to be vitamin D deficient.

The major contributors to the recent increase in vitamin D deficiency are the general decrease in exposure to sunlight (skin cancer awareness), the use of sun screens, and the use of cholesterol lowering medications which reduce the availability of cholesterol compounds in the epidermis.

Vitamin D deficiency is believed to be associated with a wide variety of disorders, with its full role in some conditions under intense investigation and not fully understood yet. This includes vitamin D’s well established role in bone metabolism, and less well established roles in the prevention of diabetes, heart disease, prostate cancer, muscle fatigue, postmenopausal weight gain and hypertension, and the list goes on. It is believed that people with adequate vitamin D levels have an overall increase in longevity compared with those with D deficiency.

Vitamin D deficiency can sometimes be treated with diet modification, and almost always with over the counter supplements (prescription drugs are required in some cases).

Foods that contain significant amounts of vitamin D include fatty fish such as herring, catfish, salmon, mackerel, sardines, tuna and eel (also cod liver and beef liver, but who really wants that…), and whole eggs.

So pay attention, and make sure your doctor pays attention, to vitamin D, the frequently unmentioned vitamin.

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