The food ORDER matters

Have you noticed that 2-3 hours after eating a high carb meal you feel hungry again? Or even worse, after meals you might actually feel weak, sleepy, or dizzy, shaky and with headaches: this reaction is called reactive hypoglycemia. It occurs due to a rapid absorption of carbohydrates followed by an insulin spike. Insulin will bring the glucose down and that’s when you feel hungry again, or if the response is exaggerated you’ll feel more than just hungry and you might experience the symptoms described above.

hypoglycemia 2

Can we do something about it? Sure we can: Avoid REFINED CARBOHYDRATES (simple starches and refined sugars). But since that can be difficult sometimes, there is a simple trick that can reduce the negative impact of the refined carbs in our bodies. A recent study showed that eating vegetables and proteins before carbohydrates, reduces the glucose spike and attenuates the insulin response. This can contribute to preventing prediabetes and the progression of insulin resistance. It looks something like this:


To put it in simple words: eat your veggies (roasted, grilled, boiled, raw, in salads or soup, guacamole…) and your proteins (chicken, fish, meat, eggs, nuts, seeds, legumes, dairy…) BEFORE your carbs (grains, potatoes, corn, fruits…).

And here is a BONUS: you might not even be so hungry afterwards and that can help to lower your carb intake overall! 🙂

Try it in your next meal! and the next one and the next one… and it will soon become a new healthy habit!



NOVEMBER 14TH, World Diabetes Day


It is estimated that about 30 million Americans have type 2 diabetes, and as much as 80 million (1 in 4 adult Americans!) have prediabetes (high risk for developing the condition). Most patients with prediabetes are not aware of their risk and might go for years without being treated. Type 2 diabetes is the leading cause of blindness and kidney failure in the US, and it is associated with increased risk of heart disease, strokes, limb amputations, and several other complications.

Are you at risk of developing Type 2 diabetes? These are some of the risk factors:

  • Being overweight: calculate your BMI here
  • Being older than 45 years – the risk increases with age
  • High Blood Pressure: over 130/80 mmHg
  • High “bad” cholesterol (LDL): over 130 mg/dl
  • Low “good” cholesterol (HDL): less than 40 mg/dl
  • High fat in the blood: triglycerides over 200 mg/dl
  • Having history of gestational diabetes
  • Having family history of type 2 diabetes
  • Being of certain ethnic groups: Latino, African American, Native American, Asian American, Pacific Islander…
  • Take a simple risk test developed by the American Diabetes Association here

If you have any of these risk factors, you should be screened with just a simple blood test.

I like to share good news with my patients and readers, and this one is a GREAT ONE: Eighty to ninety percent of type 2 diabetes is preventable! That means that if you work on the modifiable risk factor, you can PREVENT or even REVERSE the disease. The key actions to modify your risk are: lose weight, eat healthy, stay active.

  • Avoid refined carbohydrates: white starches, sugary drinks, candies…
  • Eat more fiber: leafy greens, berries, beans, avocados…
  • Eat healthy fats: nuts, seeds, fish…
  • Reduce your portion size
  • Avoid eating at night
  • Fill your plate with at least 50% of non-starchy vegetables
  • Drink at least 1/2 gallon of water every day
  • Increase your activity level: aim for 10,000 steps per day, or 150 minutes of physical activity per week
  • Cut off your snacks, and if you really want some: go for fruits, nuts or non-starchy vegetables.
  • Sleep at least 8 hours every night

Since changing behavior is so hard, you might find these tips helpful:


  1. Set Clear, realistic and defined Goals: “I’ll eat at least 3 fruits per day for the next 10 days”, “I want to walk 90 minutes this week and I’ll do it in 3 sessions of 30 minutes”, “I will eat 3 meals per day for the next 3 days without eating anything in between meals”, “I’ll go to bed at 9 pm every night from Monday through Friday”…
  2. Self-monitor: keep a calendar, log your progress, monitor your weight, keep a food and exercise diary. Be honest with yourself but don’t blame yourself if you couldn’t make it, just identify the weaknesses to overcome them in your next challenge
  3. Feedback: let people around you know about your goals, find a good friend or a health care provider to be accountable to. Support groups can be very helpful here.
  4. Boost your confidence: “Every victory gained prepares the way for a fresh victory” (Ellen White). You can’t fail if you keep trying! Communicate your victories to your friends, family and providers.
  5. Get Incentives: reward yourself after you’ve achieve each little goal (or not so little!). Get your nails done, go for a massage, buy a new book or new sport clothes :), adopt a puppy

More info on Word Diabetes Day:

Time to get started!

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Dr. Maria B. Menucci

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Menopause is one of the most important transitions for women. Many things change during this period, and it is a golden opportunity to intervene before negative health outcomes present. Studies have shown that after menopause the risk of cardiovascular disease increases significantly. But today I have GREAT NEWS to share with you!

A few weeks ago, The Journal of Clinical Endocrinology and Metabolism published a study conducted on more than 3300 women ages 42-52 years. These ladies were transitioning into menopause and they were followed for about 5 years. The researchers evaluated the presence of Metabolic Syndrome during those years.

Metabolic Syndrome is defined as the presence of at least 3 of these 5 conditions: high blood pressure, high blood glucose, low “good” cholesterol (HDL), high fat in the blood (Triglycerides), abdominal obesity (waist circumference greater than 34 inches). This Syndrome carries a high risk for heart disease and many other serious conditions.

The study showed that women who entered the transitioning years of menopause already having Metabolic Syndrome were able to REVERSE it by being more active and eating less calories; and women who did not have Metabolic Syndrome before menopause were able to PREVENT it by doing the same.

So, if you are a midlife woman, this is a call for you:

  • Increase your activity level: walk, run, dance, jump, play…
  • Decrease your caloric intake: eat smaller portions, cut off the snacks, avoid eating late…

Time to enjoy life to its maximum capacity!

Best wishes,

Dr. Maria Menucci

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In case you missed previous posts, you might find these ones relevant:


Do you take OTC Dietary Supplements? You need to know this!

Earlier this month, the Journal of the American Medical Association (JAMA) published an article that adds to a strong body of evidences showing that Over the Counter supplements are not always as harmless as most people think.

I’ll never forget a night when I was on-call during residency and a young lady came to the ER. Her husband brought her in, she was very anxious, to the point that she couldn’t talk. Her heart rate was very high, blood pressure up, she was trembling, sweaty and cold. Her labs showed all sorts of electrolytes imbalances. We were puzzled, what’s going on with this previously healthy young lady? Once we stabilized her, she started talking: “I’m taking a natural supplement to help me lose weight”. Her husband brought the pill bottle and we sent it to the lab to be analysed. We were shocked when the results came back. This “natural supplement” contained not one but three unapproved ingredients: a strong diuretic, an amphetamine and thyroid hormones!

On this Original Investigation article published by JAMA, the researchers found that from 2011 to 2016, a total of 776 adulterated dietary supplements were identified by the FDA, and 146 different companies were implicated. We need to keep in mind, that the FDA does not require premarket safety and effectiveness testing for dietary supplements, only postmarket adverse effects are investigated. Most patients don’t associate adverse reactions to supplements therefore most times they go unreported. Given these facts, we can assume, that there are more adulterated supplements out there that have not been identified yet.

The study showed that most of the supplements with unapproved ingredients were marketed for sexual enhancement, weight loss or muscle building. For sexual enhancement, the most common adulterant was sildenafil (Viagra); for weight loss, sibutramine; and for muscle building, anabolic steroids. There were other adulterants in the supplements as well, all of which were not included in the labels and they were not supposed to be there!

This is a multi-billion dollar industry, more than 50% of Americans report taking at least one OTC dietary supplement. We can only imagine how competitive this business is and how much it’s invested on marketing to convince the public and create the need to buy their products.

So, with this in mind:

  • Always check with your health care provider before taking any OTC supplement.
  • Don’t assume that because it’s “natural”, it’s risk-free.
  • Think what are you trying to solve with that supplement and ask for professional medical advise first. For example, if you are trying to boost your energy level, don’t you think you might need a fatigue evaluation first?
  • Most times, you can get what you need from a well-balanced diet.
  • Don’t believe all you see on adds. Remember: they are selling something, they are not trying to treat you.
  • Be particularly cautious with “blends” or combinations for specific symptoms or conditions. In general, it’s better to buy the ingredients separately: for example, for “bone health”, it’s better to take the amount of Vitamin D3 recommended by your provider based on your case, than to take combinations that might contain too much Calcium for your body.
  • If you choose to try a supplement to achieve certain benefit, try it for some time and if it doesn’t help you, stop it! I’ve seen many patients taking supplements for symptoms that they continue to have, so what’s the purpose to keep taking it?
  • To continue to take supplements just because “it’s not going to hurt me”, is not a good reason to keep buying it. One of the most common side effects of supplements, it’s actually in your wallet! $$$ Save that money to buy more fruits and vegetables 🙂



Great benefits in just few minutes!

It is well know that exercise is good for us. We hear about this since we are little kids and throughout our lives. Despite that, very few individuals take this seriously and include exercise as part of their daily routines. According to a statement from the American Diabetes Association the average American sits more than 7 hours a day!

Some common reasons (or excuses) that are given for not exercising: “I’m too busy”, “I can’t find the time”, “I have knee/ankle/back pain that gets worse with exercise”, “I’ll start next week”, “I’m too tired”, “I’ve never been active”, “It’s too hot/cold”…

I have great news! Recent studies have shown that even a few minutes can make a difference! Regular brief light-intensity activity bouts before or after meals improve the way the body manages glucose and fat metabolism. When associating exercise with a meal, your muscles will burn those carbs more effectively preventing the glucose to go up that high, which reflects on smaller insulin spikes released from your pancreas. Keep in mind that insulin is a strong fat-growing hormone. We don’t want high insulin levels in our blood so we don’t grow fat. Does it make sense?

exercise insulin

So, no more excuses! If you want to continue on your journey to a healthier you, shed some extra pounds, improve your cholesterol & glucose, increase your muscle mass & tone as you also help your cardiovascular system: Move for just a few minutes before or after your meals: dance, jump the rope, walk around the couch/desk, go up a flight of stairs, walk around the block, do squads… you name it! No more waiting, start with your next meal 🙂