Necrosing Narcotic 'Krokodil' Makes Its Way to US Streets: MEDSCAPE Deborah Brauser

"Krokodil" in Russia has been used extensively by addicts since 2003 It may have made its way to the United States, according to a report from an Arizona poison control center.

This version of the opioid desomorphine was nicknamed Krokodil and pronounced crocodile because it causes a users' skin to turn scaly and green, eventually leading the skin to rot and even drop off.

Although the New York State Office of Alcoholism and Substance Abuse Services (NYS OASAS) estimates that as many as 1 million people in Russia have used this drug, what is thought to be the first 2 cases of use in the United States were reported during the past week in Arizona.

Frank LoVecchio, DO, a medical toxicologist and co–medical director at the Banner Good Samaritan Poison and Drug Information Center in Phoenix, Arizona, told Medscape Medical News that this is a "very frightening drug" that clinicians need to be aware of.

"Based on what we know from Russia, it is just so devastating," said Dr. LoVecchio.

"It might be a little sensational to say it's killing you from the inside out. But if you inject this toxin into your skin, or muscle, or veins, you actually can say that. It can cause a lot of damage."

Paint Thinner, Lighter Fluid, Gasoline

Desomorphine was invented in 1932 in the United States as a faster and more potent form of morphine and was used under the name "Permonid" in Switzerland, reports the NYS OASAS.

However, the recent bootleg version of this injectable drug contains crushed codeine tablets (which can be purchased in Russia without a prescription), as well as red phosphorus and often iodine, hydrochloric acid (HCA), paint thinner, lighter fluid, and even gasoline. It is also approximately 3 times cheaper to buy in Russia than is heroin.

Use has been reported in other European countries, such as Germany.

As reported recently by Medscape Medical News, Krokodil is known as "the drug that eats junkies," and for many users leads to having exposed bones and rotting sores all over their bodies. It can also cause a rupture of blood vessels, and complications can include thrombophlebitis and gangrene.

The survival rate after first use of this designer drug is usually only 2 to 3 years.

"The reason the skin effects from this are so tragic is because of the way this stuff is made. Addicts know that injecting gives a quicker and better high. But they want to get 'the medication' out of the codeine pill by crushing it and then adding in different chemicals and then passing it through filters, such as coffee filters," said Dr. LoVecchio.

"However, some impurities remain. We know from our poison center experience that just having HCA on your skin can cause illnesses and significant scarring. And some of the other chemicals can lead to fat cells and muscles dying, leading to big holes in the skin or tissue."

Be on the Lookout, Call for Help

Although there have been few studies of this drug, an article published last year in Substance Use and Misuse notes that treatment should be similar to that of heroin, including the use of naloxone. The serious tissue damage at injection sites should help clinicians to distinguish between users of the 2 substances.

"It is not unusual for users to present to the emergency department with exposed skeletal anatomy, ligaments, and tendons," writes Ashley Grigsby, from the Arizona College of Osteopathic Medicine.

She adds that identification and treatment of infections in these patients are also hugely important.

In 2011, Time magazine published a story about a woman who survived her addiction to Krokodil but had a subsequent speech impediment and decreased motor skills ― and only stopped using the substance after gangrene began to develop around her groin, which was her injection site. Still, she considered herself lucky because most of her friends who were users had already died or "simply rotted."

Dr. LoVecchio noted that if clinicians suspect that a patient is presenting with complications from Krokodil use, they should contact their local poison center through the nationwide number 1- 800-222-1222 to discuss management options.

"I don't want to oversensationalize it, but I am worried. And I hope the use of this drug just stops and doesn't go any further. So my goal is to tell physicians to just be on the lookout and to be aware from a public health standpoint," he said.

Treatment Resistant Depression.

Many people have depression that seems to never end. One tries medication after medication but after the first flush of excitement one sinks back into tiredness and anxious boredom.  Partially we are all subject to the prevailing atmosphere - the heat, the cold, the grayness, never-ending saga of dreadful news items and, history. Watching the CNN movie on NIXON I was struck with how nothing much has changed and how government appears to be making the same mistakes now as then - 30+ yrs ago!
The following will be a series of articles that may be helpful - if only to reassure that one is not alone, and that one is not being recalcitrant!

It is not a question of "Just turn that smile upside down!"

More will appear as the bloggers find articles and items that are more accessible.

A work in progress

Seven Practical and Proven Ways to Maintain Estrogen Balance

1. Go organic ­Assures minimum exposure to toxic chemicals like pesticides and bovine growth hormones that mimic estrogen in a woman’s body.
2. Maintain normal weight ­Fat cells actually produce and store estrogen.
3. Eat broccoli ­Broccoli contains an estrogen-balancing chemical called indole-3-carbinol. Try to get 4 or more servings per week. If raw broccoli is too crisp for your taste, lightly steam a pot of it so that it has just a slight crunch to it; then refrigerate it and include in a daily salad. Steaming actually opens up the cell wall to release nutrients. Just don’t oversteam or microwave the broccoli, which will destroy most of its nutrients. You can also try an indole-3-carbinol supplement like BioDIM.
4. Exercise ­A significant factor that places the odds in your favor of maintaining female health. Exercise reduces stress, improves sleep and helps excrete surplus hormones.
5. Get to sleep by 10 pm­ The sleep hormone melatonin decreases the amount of estrogen the body produces. If you go to bed late, your melatonin levels don’t rise as high because you’re exposed to darkness for a shorter period of time.
6. Eat foods that have a low Glycemic Index (GI)­High insulin levels trigger an increase in estrogen. Check the GI of your favorite foods at www.glycemicindex.com and aim for foods with a GI of 50 or less. To lower the GI of your entire meal, try a supplement like FenuLife.
7. Drink water and limit consumption of alcohol­ Water keeps the liver cleansed of toxins so that it can excrete hormones efficiently. Drink an ounce for every 2 pounds of body weight. Conversely, alcohol significantly compromises the liver’s ability to metabolize estrogen.

Important Supplements for Estrogen Balance

• Turmeric­ Regulates estrogen receptors and also enhances soy’s estrogen blocking properties.
• Green Tea ­Important antioxidant that helps keep the immune system strong, with emphasis on benefits for women’s health issues.
• BioDim ­Helps the body effectively metabolize estrogen with the same chemical compound found in broccoli.

".......  But I feel that as a woman of a certain age, the deck is stacked against me. A woman's metabolism typically slows down as she ages (a 2 to 8 percent decrease per decade beginning in her 30s), so that even if I ate the same amount I'd gain weight. Then the hormonal imbalances that come with menopause do their dirty work, the main culprit being the thyroid, that fickle gland that regulates how quickly cells burn calories.

During menopause the thyroid is already functioning less effectively," says Keith Berkowitz, M.D., founder of The Center for Balanced Health in New York City. "If you cut fat and carbs to extremely low levels, as dieters may be inclined to do, you can further inhibit the thyroid from functioning appropriately, in addition to inhibiting the production of sex hormones." So, though I need to eat less to lose weight, I can't each too much less or my thyroid will mess with my metabolism. No wonder I am getting fatter by the minute.

I also recently learned why my fat is in my belly. During menopause, which I am experiencing, a woman's predisposition for tummy fat becomes even more dangerous. Abdominal fat is visceral fat, the kind that's more active metabolically and can wreak more havoc by contributing to higher cholesterol, higher blood fats, and higher blood pressure. In the ongoing Iowa Women's Health Study, women with the greater amounts of tummy fat had higher rates of diabetes, heart disease, and high blood pressure. Even with a low BMI, a woman with belly fat is more likely to die early. That's bad news for somebody like me who has a belly and a high BMI. "  (comment on AARP newsletter)
http://www.msnbc.msn.com/id/12919730/site/newsweek/

Fight back the bulge

Since visceral fat is buried deep in your abdomen, it may seem like a difficult target for spot reduction. As it turns out, visceral fat responds well to a regular exercise routine and a healthy diet. Targeted tummy exercises can help to firm the abdominal muscles and flatten the belly.

Exercise. Daily, moderate-intensity exercise is the best way to lose belly fat ­ when you lose weight and tone your muscles, your belly fat begins shrinking, too. In fact, you may notice that your tummy bulge is the first area to shrink when you start exercising. The amount and type of exercise you should get varies depending on your current activity level and your health goals. Talk to your doctor about the right exercise program to promote good health and specifically combat abdominal fat.

Strength training. Some research has shown that exercising with weights is effective in trimming tummy fat. Talk to your doctor about how to incorporate strength training in your exercise routine.

Healthy diet. Changing unhealthy eating habits can help fight belly fat. Read nutrition labels, and replace saturated fats with polyunsaturated fats. Increase portions of complex carbohydrates like fruits and vegetables, and reduce simple carbohydrates like white bread and refined pasta. If you need to lose weight, reduce your portion sizes and daily calorie intake.

Tone your tummy. While you can't "spot-burn" belly fat, you can firm up your abdominal muscles and get a flatter belly. Traditional sit-ups aren't the most effective way to firm your tummy, however. Instead, use these exercises to target both deeper and lower abdominal muscles:

• Deeper abdominal muscles. Target deeper abdominal muscles by doing "abdominal hollowing" or "drawing in the belly button." First, get down on all fours. Let your tummy hang down as you take a deep breath. Let your breath out, and at the end of your exhalation, gently draw your belly button inward and upward toward your spine. You should feel a slight tightening around your waist ­ think of it as trying to squeeze through a partially closed door. Hold for 10 seconds, then rest for 10 seconds. Work up to 10 repetitions. During each effort, your spine position shouldn't change and you should breathe freely. Eventually, you'll be able to do this exercise standing up. It's so subtle, no one should be able to tell you're doing it.
• Lower abdominal muscles. Tone your lower abdomen by doing pelvic tilts and pelvic lifts. To do a pelvic tilt, lie on your back on the floor with your knees bent. Flatten your back against the floor by tightening your abdominal muscles and bending your pelvis up slightly. Hold for 5 to 10 seconds. Repeat five times and work up to 10 to 20 repetitions. For pelvic lifts, lie on your back with your knees bent up toward your chest and your arms relaxed by your sides. Tighten your lower abdomen and lift your buttocks up off the floor, with your knees aimed toward the ceiling. Hold for 5 to 10 seconds. Repeat five times and work up to 10 to 20 repetitions.

Everything Old becomes New again?

April 23, 2013

Does Psychiatry Need Science?

Posted by Gary Greenberg

In 1886, Pliny Earle, then the superintendent of the state hospital for the insane in Northampton, Massachusetts, complained to his fellow psychiatrists that “in the present state of our knowledge, no classification of insanity can be erected upon a pathological basis.” Doctors in other specialties were using microscopes and chemical assays to discern the material causes of illness and to classify diseases accordingly. But psychiatrists, confronted with the impenetrable complexities of the brain, were “forced to fall back upon the symptomatology of the disease—the apparent mental condition, as judged from the outward manifestations.” The rest of medicine may have been galloping into modernity on the back of science, but Earle and his colleagues were being left in the dust.
Thirty years later, they had not caught up. In 1917, Thomas Salmon, another leading psychiatrist, echoed Earle’s worry in an address to his colleagues, drawing their attention to the way that their reliance on appearances had resulted in a “chaotic” diagnostic system, which, he said, “discredits the science of psychiatry and reflects unfavorably upon our association.” Psychiatry, Salmon continued, needed a nosology that would “meet the scientific demands of the day” if it was to command public trust.

In the century that has passed since Salmon’s lament, doctors in most medical specialties have only gotten better at sorting our suffering according to its biochemical causes. They have learned how to turn symptom into clues, and, like Sherlock Holmes stalking a criminal, to follow the evidence to the culprit. With a blood test or tissue culture, they can determine whether a skin rash is poison ivy or syphilis, or whether a cough is a symptom of a cold or of lung cancer. Sure-footed diagnosis is what we have come to expect from our physicians. It gives us some comfort, and the confidence to submit to their treatments.
But psychiatrists still cannot meet this demand. A detailed understanding of the brain, with its hundred billion neurons and trillions of synapses, remains elusive, leaving psychiatry dependent on outward manifestations for its taxonomy of mental illnesses. Indeed, it has been doubling down on appearances since 1980, which is when the American Psychiatric Association created a Diagnostic and Statistical Manual of Mental Disorders (D.S.M.) that intentionally did not strive to go beyond the symptom. In place of biochemistry, the D.S.M. offers expert consensus about which clusters of symptoms constitute particular mental illnesses, and about which mental illnesses are real, or at least real enough to warrant a name and a place in the medical lexicon. But this approach hasn’t really worked to establish the profession’s credibility. In the four revisions of the D.S.M. since 1980, diagnoses have appeared and disappeared, and symptom lists have been tweaked and rejiggered with troubling regularity, generally after debate that seems more suited to the floors of Congress than the halls of science. The inevitable and public chaos—diagnostic epidemics, prescription-drug fads, patients labelled and relabelled—has only deepened psychiatry’s inferiority complex.
But it’s not entirely clear that psychiatrists want a solution to the problem, at least not to judge from what happened when the experts conducting the most recent revision of the manual, the D.S.M.-5, were offered one. A group of seventeen prominent doctors—biological psychiatrists, experts in diagnostics, subspecialists in the field of depression, and even a historian—petitioned the D.S.M.-5’s mood-disorders committee to add a diagnosis they named melancholia.
The proposal was not so much an innovation as a retrieval of an old idea. Melancholia is one of the most venerable of psychiatric disorders, noted by doctors at least as far back as Hippocrates, who attributed its characteristic dejection and unresponsiveness to external events to an excess of black bile. But melancholia lost its place in psychiatric nosology in 1980, when all forms of depression were consolidated under a single diagnostic label—“major depressive disorder”—of which melancholia was only a variant. It was the D.S.M. equivalent of calling Pluto just another ice dwarf in the Kuiper Belt.
The group argued that this was a grievous scientific error and cited evidence that melancholia was qualitatively different from other forms of depression. Some of the evidence was derived from the same kind of clinical observation that is the backbone of the D.S.M. For instance, people who showed the characteristic clinical symptoms—an unshakeable despondency and sense of guilt that arises from nowhere, responds to nothing, and dissipates for no apparent reason—also displayed some distinctive physical signs: hand-wringing, for instance, and psychomotor retardation, an easily perceived slowing down of movement, thought, and speech. But some of the group’s proof was of precisely the kind that psychiatrists had been looking for since the nineteenth century. Thirty years of replicated studies had shown that patients with those signs and symptoms had a sleep architecture and cortisone metabolism that was distinct from that of other people, both normal and depressed. A night in a sleep lab could detect the reduced deep sleep and increased REM time characteristic of melancholics, and a dexamethasone suppression test (D.S.T.) could determine whether or not a patient’s stress hormones were in overdrive, as is generally the case among melancholic patients. And melancholia responded better than other kinds of depression to two treatments: tricyclic antidepressants (the first generation of the drugs) and electroconvulsive therapy (E.C.T., better known as shock therapy). Treatment success rates with this population reached as high as seventy per cent, much more robust than the anemic results found in trials that mixed melancholic and non-melancholic depression, and melancholics were less likely to respond to placebos.
Distinctive signs, symptoms, lab studies, course, and outcome—if melancholia wasn’t the Holy Grail, it was at least a sip from the chalice of science, one disorder that could go beyond appearances. You would think that the committee would at least have been eager to consider it as a partial remedy for ongoing concerns about the profession’s lack of scientific rigor. But the panel barely gave melancholia the time of day, let alone a full-on floor debate, relegating it to the same slush pile as the proposed Parental Alienation Syndrome and Male-to-Eunuch Gender Identity Disorder. And the main obstacle was exactly what you would think was melancholia’s main strength: the biological tests, especially the D.S.T. “I believe you and your colleagues are fundamentally correct,” committee member William Coryell wrote to the melancholia advocates, by way of explaining his panel’s inaction. But “the inclusion of a biological measure would be very hard to sell to the mood group.” Coryell explained that the problem wasn’t the test’s reliability, which he thought was better than anything else in psychiatry. Rather, it was that the D.S.T. would be “the only biological test for any diagnosis being considered.” A single disorder that met the scientific demands of the day, in other words, would only make the failure to meet them in the rest of the D.S.M. that much more glaring.
Coryell also noted that the melancholia proposal represented a departure from the notion, central to the D.S.M.’s descriptive method, that that the criteria for depression constitute a single disorder that every patient who matches the description has. “Depression is depression is depression,” another mood-disorders specialist has said, and so, Coryell counselled, evidence for such a “sweeping change” in paradigm would have to be “extensive and compelling.” (Coryell declined to comment for this article.)
This notion—that the apparent mental condition is all that can matter—underlies not only the depression diagnosis but all of the D.S.M.’s categories. It may have been conceived as a stopgap, a way to bide time until the brain’s role in psychological suffering has been elucidated, but in the meantime, expert consensus about appearances has become the cornerstone of the profession, one that psychiatrists are reluctant to yank out, lest the entire edifice collapse.
Gary Greenberg’s new book, “The Book of Woe: The DSM and the Unmaking of Psychiatry,”from which some of this essay is adapted, will be published in May.

The DASH diet

Each one of us at some time will experience ourselves as being out of synch with our health.  This diet is recommended for people with metabolic syndrome and diabetes or pre-diabetes. Another good food regimen is the so-called Mediterranean diet.

High Blood Pressure and the DASH Diet

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One step to lower high blood pressure: Incorporate the DASH diet into your lifestyle. Doctors recommend:

• Eating more fruits, vegetables, and low-fat dairy foods
• Cutting back on foods that are high in saturated fat, cholesterol, and trans fats
• Eating more whole grain products, fish, poultry, and nuts
• Eating less red meat (especially processed meats) and sweets
• Eating foods that are rich in magnesium, potassium, and calcium

The DASH diet, which stands for Dietary Approaches to Stop Hypertension, is an example of such an eating plan. In studies, patients who were on the DASH diet reduced their blood pressure within two weeks. Another diet -- DASH-Sodium -- calls for reducing sodium (salt) to 1,500 mg a day (about 2/3 teaspoon). Studies of patients on the DASH-Sodium plan significantly lowered their blood pressure as well.

Is Your Blood Pressure in Check?

Is Your Blood Pressure in Check?

Starting the DASH Diet

The DASH diet calls for a certain number of servings daily from various food groups. The number of servings you require may vary, depending on your caloric need. When beginning the diet, start slowly and make gradual changes. Consider adopting a diet plan that allows 2,400 mg of salt per day (about 1 teaspoon). Then, once your body has adjusted to the diet, further lower your salt intake to 1,500 mg per day (about 2/3 teaspoon). These amounts include all salt eaten, including salt in food products as well as in what you cook with or add at the table.

Here are some tips to get you started on the DASH diet:

• Add a serving of vegetables at lunch and at dinner.
• Add a serving of fruit to your meals or as a snack. Canned and dried fruits are easy to use.
• Use only half your typical serving of butter, margarine, or salad dressing, and use low-fat or fat-free condiments.
• Drink low-fat or skim dairy products any time you would normally use full fat or cream.
• Limit meat to 6 ounces a day. Try eating some vegetarian meals.
• Add more vegetables and dry beans to your diet.
• Instead of typical snacks (chips, etc.), eat unsalted pretzels or nuts, raisins, low-fat and fat-free yogurt, frozen yogurt, unsalted plain popcorn with no butter, and raw vegetables.
• Read food labels carefully to choose products that are lower in sodium.

Staying on the DASH Diet

The following is a list of food groups and suggested serving amounts for the DASH diet:

• Grains: 7-8 daily servings
• Vegetables: 4-5 daily servings
• Fruits: 4-5 daily servings
• Low-fat or fat-free dairy products: 2-3 daily servings
• Meat, poultry, and fish: 2 or less daily servings
• Nuts, seeds, and dry beans: 4-5 servings per week
• Fats and oils: 2-3 daily servings
• Sweets: try to limit to less than 5 servings per week

How Much Is a Serving?

When you're trying to follow a healthy eating plan, it may help to know how much of a certain kind of food is considered a "serving." The following table offers some examples.

SERVING SIZES

Food/amount

1/2 cup cooked rice or pasta

1 slice bread

1 cup raw vegetables or fruit

1/2 cup cooked vegetables or fruit

8 ounces of milk

1 teaspoon olive oil

3 ounces cooked meat

3 ounces tofu

taken from http://www.webmd.com/hypertension-high-blood-pressure/guide/dash-diet

Alzheimer's or Dementia

Alzheimer’s or Dementia Therapy:

Deep Brain Stimulation

Researchers have seen considerable success in slowing down the progress of the disease.

Reality orientation is a technique in which people caring for others with this type of disorder take every opportunity to orientate the person.  This might be to remind the person where they are and what time and day it is.  It is important to validate accurate perceptions and disagree when the person says something incorrect.

Reality orientation does help people make changes and to respond realistically to their environment.  But, this should be sensitive to the person’s emotional state and to any care plan that is in place.

Reminiscence therapy involves stimulating the recollection of events and memories from the past.  This is achieved by using music, DVD, pictures, movies (that the person may have seen in their past) or food and clothing from past times.

People often enjoy this process and it does tend to make them feel empowered.  Older people love telling stories and younger people love hearing them.  Grandchildren will want to know stories about their parents as children.  Effective as this can be, it is still not going to prevent the memory getting worse in the long run.  Creative application of long term reminiscences can be comforting by being about situations that are familiar.

Validation therapy emphasizes the emotional world of the person and offers useful techniques for communication.  One may play a game of “tuning in” to a particular person or situation and guess strategies for handling or recognizing what is familiar. 

It is important to listen to the person but not get into protracted negotiation or arguments about dates, facts or realities.  Validate what is useful and concrete knowledge and perception but try to minimize the effects of failure. 

This may bring sense out of less clearly articulated communication.  The idea is not to impose our reality but to let them express a more real version of theirs. 

Memory training by using external aids, mnenemonies, photographs, and a written list of routine functions can be effective.

Going over self care tasks helps the person to feel empowered and less needy. Short daily training classes with a lot of stimulating interaction may prove useful.  Emphasis can be place on how the tasks feel rather than relying on verbal or written instruction.  This appeals to the person’s felt-sense experience.

Stimulate the individual by conversation, books, dance, art and movement.  Going shopping or for a drive while noticing the environment and sounds.  Use of exercise programs, and calming by stretching or relaxation all bring a sense of awareness which brings comfort and confidence.

Behavioral approaches promote a sense of achievement:

• Increase the person’s level of independence including relearning of lost skills and maintaining existing skills.  The use of caring verbal prompts helps as a reminder when short term memory is lacking.
• Reduce the level of behavioral disturbance and difficulty.  This would include independence in mobility and such basic issues as continence.  The person might be encouraged to void often and at regular intervals.

• COMMON DIETARY SUPPLEMENTS
• Ginkgo Biloba
• Vitamins B6, B9 & B12
• Vitamin E
• ω-3 Fatty Acids
• Vitamins A & C
• Vitamin D
• Phospholipids: Phosphatidylserine & Phosphatidylcholine
• Ginseng  

Cognitive-behavioral therapy with a trained professional has been found useful.  Weekly sessions may include caregivers as well as the person in need.  Thus, everyone learns to be more observant of change and more able to support.  This can assist with depression and burn out.  Therapy can include progressive relaxation techniques and strategies for anger and stress management.  Successive tensing and relaxation of muscle groups relies on procedural memory which is relatively spared in dementia.

Even after all of this it may be necessary to place the person in long term residential care. But the early adoption of interactive strategies can slow down the frustrations of impairments and support more active involvement in the community or family, and thus enhance quality of life.

Complementary Alternative Medicine should be explored as well as psychopharmacology of a more traditional ‘Western’ kind.  There have been many advances in geriatric care and prescription drugs.  As with everything, information brings power and safety.  Seek professional trained consultation at all times. 

Food, sugar, insulin, weight and glucose.

And our old friend CANDIDA! 

When we eat, our body converts digestible carbohydrates into blood sugar (glucose), our main source of energy. Our blood sugar level can affect how hungry and how energetic we feel, both important factors when we are watching how we eat and exercise. It also determines whether we burn fat or store it.

Our pancreas creates a hormone called insulin that transports blood sugar into our body's cells where it is used for energy. When we eat refined grains that have had most of their fiber stripped away, sugar, or other carbohydrate-rich foods that are quickly processed into blood sugar, the pancreas goes into overtime to produce the insulin necessary for all this blood sugar to be used for energy. This insulin surge tells our body that plenty of energy is readily available and that it should stop burning fat and start storing it.

However, the greater concern with the insulin surge is not that it tells our body to start storing fat. Whatever we eat and don't burn up eventually gets turned into fat anyway.

The greater concern is that the insulin surge causes too much blood sugar to be transported out of our blood and this results in our blood sugar and insulin levels dropping below normal. This leaves us feeling tired and hungry and wanting to eat more. The unfortunate result of this scenario is that it makes us want to eat something else with a high sugar content. When we do, we start the cycle all over again.

What to Watch For

• Simple Carbohydrates: Because of their small molecular size, simple carbohydrates can be metabolized quickly and are therefore most likely to cause an insulin surge.
Simple carbohydrates include the various forms of sugar, such as sucrose (table sugar), fructose (fruit sugar), lactose (dairy sugar), and glucose (blood sugar). Watch for the "-ose" ending.

• Hidden Sugar in Processed Foods: Watch for "hidden" sugar in processed foods like bread, ketchup, salad dressing, canned fruit, applesauce, peanut butter, and soups.
• Sugar in Beverages: Be aware of the amount of sugar in beverages, especially coffee and soda pop. It can add up quickly, and most such drinks aren't filling.
• Fat-Free Products: Sugar is often used to replace the flavor that is lost when the fat is removed. And as if that's not bad enough, without any fat to slow it down the sugar is absorbed into your blood faster.
• Cereal Box Claims of Less Sugar: Many newer cereals do contain less sugar, but the calories, carbohydrates, fat, fiber and other nutrients are almost identical to the full-sugar cereals. The manufacturers have simply replaced sugar with other refined, simple carbohydrates.
• No Sugar Added: It doesn't mean that the product doesn't naturally contain a lot of sugar. 100% fruit products often contain concentrated fruit juice, still another form of fructose or sugar.
Table sugar (sucrose) is often said to provide "empty calories" because it has no nutritional value other than providing fuel for energy. Honey and other more natural sugars, on the other hand, are often considered to be healthier because of the trace vitamins and minerals they provide. Still, for weight loss purposes, all of these sweeteners can simply be treated as sugar.

What You Can Do

It is also important to understand what happens when you skip a meal or go on a crash diet. When you skip a meal your metabolism slows to conserve your energy. And when you lose weight too quickly for a few days, your body thinks it is threatened with starvation and goes into survival mode. It fights to conserve your fat stores, and any weight loss comes mostly from water and muscle.

Regulating your blood sugar level is the most effective way to maintain your fat-burning capacity. Never skip a meal, especially breakfast, and eat healthy snacks between meals. Eating frequently prevents hunger pangs and the binges that follow, provides consistent energy, and may be the single most effective way to maintain metabolism efficiency.

When you will be away from home or work, plan your snacks and take them along so that you will be able to eat regularly and won't be tempted by junk food. This may be good advice for people who stay at home, too.

But remember that it was probably snacking between meals that caused you to become overweight in the first place. It will be very important that any snacks are healthy; that they are pre-portioned so you won't be tempted to overeat; and that meal sizes are reduced to compensate for the additional calories the snacks provide.

High fiber snacks and meals also help to regulate your blood sugar level. The fiber slows down glucose absorption and your rate of digestion, keeping your blood sugar level more consistent and warding off feelings of hunger. This makes eating apples and oranges a better choice than drinking (pulp free) apple and orange juice.