Type 2 Diabetes and Insulin Treatment

New research suggests that treating type 2 diabetes with insulin therapy + metformin improves outcomes when compared to the traditional exercise, weight loss, and oral hypoglycemic agent drugs when needed. Three years into a 6-year study at the University of Texas’s Southwestern Medical Center, results showed that the insulin-treated group had fewer hypoglycemic episodes, gained less weight, and reported high treatment satisfaction [1].

While an abundance of my patients state that they will never take shots, I found this research interesting. As a clinician, I am deeply concerned about hypoglycemic episodes for patients on insulin regimens. Without the fundamental understanding of carbohydrates, carbohydrate counting, and insulin dosing, insulin therapy can open flood gates of displeasures and dangers. This research, however, recommends a sliding-scale of insulin dosing which is determined based on blood sugar readings [1].

Interestingly, the International Diabetes Foundation states that 3.8 million people will die from diabetes and related illnesses each year. With the number of diabetics growing from 20 million to 246 million in the past 20 years, diabetes is without a doubt a growing disease state among the US and other countries. The highest increases in diabetes cases are occurring in developing worlds, such as India (40.9 million) and China (39.8 million) [1]. I would’ve never guessed.

Yesterday's diabetic diet went like this...

Breakfast:

2 whole wheat waffles (2 carbs)

2 Tbsp apple butter (1 carb)

cappuccino with 2 Tbsp sugar-free International Delight (0 carbs)

     Total: 3 carbs

Lunch:

1 serving chili (1 carb)

6 wheat crackers (1 carb)

1 small apple (1 carb)

8 oz. V8 Fusion Light (1 carb)

     Total: 4 carbs

Dinner:

1 cup mini shredded wheats (2 1/2 carbs)

1 cup skim milk (1 carb)

     Total: 3 1/2 carbs

Snack:

1 small banana (1 carb)

1 cup skim milk (1 carb)

     Total: 2 carbs

 

[1]. Research Points to New Way to Treat Type 2 Diabetes: Insulin First. Diabetes in Control. October 21, 2009.

Nutrigenomics and Day #5

I have to admit, I know very little about nutrigenomics. What I do know is that certain races are seemingly more susceptible to various disease states when compared with Caucasian Americans.

The Nutritional Genomics Conference defines their mission as:

“The mission of the Center is to reduce and ultimately eliminate racial and ethnic health disparities resulting from environment x gene interactions, particularly those involving dietary, economic, and cultural factors. Our goal is to devise genome-based nutritional interventions to prevent, delay, and treat diseases such asthma, obesity, Type 2 diabetes, cardiovascular disease, and prostate cancer. To achieve this goal, the Center is taking a multidisciplinary approach to develop culturally competent methods and novel technologies to elucidate the complex interactions between environmental triggers, genes, and disease.”

Arguably, low socioeconomic status and chronic disease risk trend in congruence. There are those individuals, however, who “eat eggs and bacon every morning and have perfect cholesterol!” Similarly, reasons for such phenomenon, if you will, could be discovered.

But wouldn’t it be incredible for physicians and dietitians to hand patients a completely individualized set of nutritional guidelines based on their genetic makeup? Such information could help prevent diseases such as cancer, diabetes, and Alzheimer’s. Genetics are no longer the untouchable, unknown component to health and well-being…they’re emerging as a key player in the practice of medicine.

Nutrition scientist, Tim Carr, states, “We’re no longer dismissing it [genetics]. We’re trying to figure out how that works.” Nutrigenomics assesses genetic manipulation through the diet to improve chronic disease outcomes and prognoses [1].  

The University of Nebraska – Lincoln is leader in the nutrigenomic field. The team at UNL stated, “Since Nebraska is where America’s diet begins, it is appropriate that UNL would be a leader in the nutrigenomic field.” UNL team leader, Vicki Schlegel stated, “You’re making agriculture a pharmacy, basically.” Crops and livestock are being developed in order to implement findings produced by nutrigenomic research [1].

Any opinions on nutrigenomics or individualized nutrition guidelines based off genetic findings? I find this fascinating and look forward to hearing more on the latest research performed in the field of nutrigenomics.

Last night, I made a pretty amazing creation: Buffalo Chicken Salad. Mark and I just love buffalo wings, but I enjoy finding healthier ways to enjoy the bold, spicy flavor. I whipped this up last night:

Ingedients:

3-4 cups Romaine lettuce, chopped

2 ounces boneless, skinless chicken, cooked and cubed

2 Tbsp bleu cheese

1 1/2 Tbsp Hidden Valley Ranch, Light

1 1/2 Tbsp buffalo wing sauce (low-fat)

1 tomato, sliced

Place lettuce in a low bowl or plate. Top with chicken and tomatoes. Drizzle with wing sauce and ranch. Sprinkle on bleu cheese and enjoy!

Yesterday's diabetic diet looked like this:

Breakfast:

2 whole wheat waffles (2 carbs)

1 Tbsp peanut butter (0 carbs)

cappuccino with 2 Tbsp sugar-free International Delight (0 carbs)

1 medium banana (2 carbs)

     Total: 4 carbs

Lunch:

1 serving Baked Goat Cheese and Roasted Winter Squash over Garlicky Fettuccine (3 1/2 carbs)

1/2 cup Waldorf salad (0.5 carbs) 

     Total: 4 carbs

Snack:

1 pear (1 carb)

Dinner:

1 cup potato soup (1 carbs)

5 wheat crackers (1 carb)

3 cups Buffalo Chicken Salad (1 carbs)

     Total: 3 carbs

Snack:

3 graham cracker squares (1 carb)

2 Tbsp peanut butter (0 carbs)

     Total: 1 carb

[1]. ‘Personalized Nutrition’ is goal of Nutrigenomics initiative. High Plains/Midwest Ag Journal. October 5, 2009.

Day 2 and more

I dropped Lily off at "Camp Bow Wow" this morning for her "interview" (we're boarding her during our Thanksgiving trip to Chicago). Needless to say, she's having a blast right now at camp. How do I know this? I'm WATCHING her online! Yep, that's right! Camp Bow Wow has cameras installed in the facility so you can watch your dog play indoors, outdoors, sleep, eat, and more! Since she's going to be one POOPED little puppy tonight, I've asked my husband to take me out on a date tonight! So, here's my day so far...

Breakfast:

1 cappuccino with sugar-free International Delight (0 carbs)

1 slice wheat toast (1 carb)

1/2 Tbsp Smart Balance Light (0 carbs)

1 egg, large (0 carbs)

1 Fiber One bar (2 carbs)

     Total: 3 carbs

Lunch:

1/4th Spinach Calzone from last night (3 1/2 carbs)

1/2 c. roasted vegetables: potatoes, carrots, and squash (1/2 carbs)

     Total: 4 carbs

Snack:

1 large chocolate chip cookie (2 carbs)

Dinner and PM snack: TBD

While that afternoon cookie isn't the best choice, my co-worker always stops for cookies from an Amish Bakery before our RD meetings each month. So, I know cookies will be there (and she always gets chocolate chip), I will want one, and I need to limit myself to ONE to not go over my carbs.

Anyways, Chicago finds out today whether or not the 2016 Olympics will be held there! I'm really hoping they are, but that's easy to say as I don't live there anymore and will have my parent's home to crash at during the events if we decide to attend. Oh, and the taxes...I won't be paying Illinois taxes :) Either way, an exciting time for Chicago and the Olympics in Chicago supporters (there's a lot against it, and their reasoning is justified). We shall see!

The Chicago Tribune put out an article yesterday stating that life expectancy is still rising in "rich" countries and that many babies born after 2000 may live to be 100 years old. Even more shocking is that this upward trend in life expectancy is not showing a plateau in sight [1]. How old was Moses when he died? 120? Kidding, kidding.

The article states, "While illnesses affecting the elderly like heart disease, cancer and diabetes are rising, advances in medical treatment are also making it possible for them to remain active for longer. The obesity epidemic, however, may complicate matters. Extra weight makes people more susceptible to diseases and may increase their risk of dying. In the U.S., data from 1982 to 2000 showed a major drop in illness and disability among the elderly, though that has now begun to reverse, probably linked to the rise in obesity [1]."

Moving on....ginger. Ginger is by far a favorite ingredient of mine. While nothing tops garlic in my heart, ginger MAY take the silver. For hundreds of years, ginger has been used to ease nausea. A number of studies have been assessed to find that ginger does cure nausea caused from sea-sickness, morning-sickness, and chemotherapy. While the mechanism of action is yet to be determined, the proposed active ingredient in ginger is 6-gingerol, which helps relax intestinal muscles. How much ginger to ease nausea? Studies suggest 0.5 grams to be effective and it's available as powder in capsule form, as well as it's natural root state. Simply shave off several slices of ginger to chew and swallow, or enjoy it blended in water or a smoothie [2]. 

And did anyone else hear that Coke is putting calories on all their products? Read more here. I have to say, however, it would be MOST useful to do one of two things with say, 20 ounce bottles of soda - 1) list the TOTAL calories and carbohydrates in the whole bottle (people won't look at servings per container!) or 2) do away with anything other than 1-serving containers for individual sale (which won't happen). Unfortunately, even consumers who are trying to follow labels and make better decisions are unclear on how to read nutrition labels. So many of my patients fail to realize that while there are 26 grams of carbohydrate in an 8-ounce serving of soda....there are 65 grams of carbohydrate in the 20-ounce bottles they drink!!! Without knowing how to read the labels, however, most go on thinking they're consuming 26 grams, or "2 carbs". As soon as I point out the math (i.e. "You're drinking more carbohydrates than you're supposed to eat in a MEAL"), that soda loses a lot of appeal. So, I do wish labeling were a bit more straight forward for consumers to utilize appropriately. Off soap box.

In reading a fellow RD's blog this week, I found this YouTube view -- a snipet from The View on an episode hosting Paula Dean and her new cook book for children and specifically, children's lunches. Listen for Barbara Walters calling out Paula, it's great!

I hope it's as beautiful where ever you are as it is here today! TGIF and have a WONDERFUL weekend!

[1]. Cheng, Maria. Happy 100th Birthday! Most babies born since 2000 will hit 100, life expectancy still rising. Chicago Tribune. October 1, 2009.

[2]. O'Connor, Anahad. The Alternative Medicine Cabinet: Ginger. The New York Times. October 1, 2009.

Omega-3 Show-Down!

Know that omega-3’s are good for you…but that’s about it? Bruce Watkins, Purdue University professor of nutrition and director of the International Omega-3 Learning and Education Consortium for Health and Medicine helped in developing a website devoted to teaching consumers about types of omega-3’s, benefits of omega-3’s, and where to find them in the diet. They created this site in the process. The site answers basic questions about omega-3 fatty acids. Also included for doctors, medical providers, and veterinarians is a fact sheet and patient handout [1] – check it out!

Additionally, the site includes a database of foods containing omega-3’s as well as the amounts. I know Gina and I have a discussion back about the feasibility of consuming adequate omega-3’s for cardio-protective benefits through the diet alone. There is also a chart showing how much and what types of omega-3’s men and women of varying ages and with differing health histories should consume [1]. Sign-up to receive their monthly newsletter, too! Jackpot!

Omega-3’s for asthma? Heart disease? Cancer? Maternal Health? Cognitive function? Transplantation? Mental health? Eye health? Diabetes? Go here!

The run-down (per 100 grams/~3.5 ounces):

Highest overall omega-3 content (fresh fish) = salmon, Atlantic, farm-raised (2507 mg omega-3’s)

Highest ALA content (fresh fish) = salmon, wild (295 mg ALA)

Highest EPA content (fresh fish) = salmon, Atlantic, farm-raised (862 mg EPA)

Highest DHA content (fresh fish) = salmon, wild (1115 mg DHA)

Okay…salmon takes the cake for the fresh fish. Other great options include: swordfish, trout, tuna (bluefin), whitefish, halibut, catfish, and anchovies.

Highest overall omega-3 content (shellfish) = shrimp (540-601 mg omega-3’s)

Highest ALA content (shellfish) = crayfish, wild (32 mg ALA)

Highest EPA content (shellfish) = shrimp (293 mg EPA)

Highest DHA content (shellfish) = squid (342 mg DHA)

So, shrimp are a GREAT option for omega-3's. Other shellfish sources of omega-3’s include: blue crab, Dungeness crab, queen crab, spiny lobster, mussels (yum!), and scallops!

And FYI: canola oil and flaxseed oil contain omega-3’s! Per 100 grams there are 9137 mg omega-3’s in canola oil and 53,300 mg omega-3’s in FLAXSEED OIL! I must ask, who knew that canola and flaxseed oils had so many omega-3’s!? You can boast your intelligence, it’s alright!

What do YOU need?

- If you have no documented coronary heart disease, eat a variety of fish at least twice a week. Try to focus on fattier fish such as salmon. Use other products such as flaxseed and canola oil, as well as flaxseeds and walnuts.

- If you HAVE documented coronary heart disease, consume about 1 gram of EPA + DHA per day, preferably from fatty fish. Supplementation may be recommended by a physician.

- If you have elevated triglycerides, take 2-4 grams of EPA+DHA per day through a supplement provided under a physician’s care.

As always, purchase and use supplements with caution. Supplements are not FDA-regulated and are not tested for purity or potency.

All the nutrition facts are provided by the US Department of Agriculture’s National Nutrient Database for Standard Reference, Release 21.

[1]. New Web Site Aims To Deepen Public Knowledge of Omega-3s. Purdue University. August 21, 2009.

Exercise won't make you thin.

I can recall sitting in an undergrad nutrition class (who I believe was taught by the yummiest of professors) and having it explained how much more effective controlling diet for weight loss was than increasing exercise alone. Because really, weight loss is just simple math. To lose one pound, you need to create a deficit of 3,500 calories which can be done through the diet, exercise, or ideally, a combination of the two. With exercise alone, an average-sized adult owes the gym 35 hours of moderate-to-intense exercise, or approximately 35 miles of walking/running. Now that's not exact science, but it gets the point across: exercise alone will probably lead to osteoarthritis before it gets you to your weight loss goal (half jokingly). Needless to say, that yummy professor solidified my thoughts on proper nutrition -- it's important stuff, especially in regards to weight loss.

So TIME put out this article on August 9th explaining why exercise won't make you thin. In addition to the information above, the article explains that some believe exercise to increase their appetite, causing them to eat more and negate the work of their exercise. Some exercisers just make poor decisions because they exercise, likely overestimating the calories they expend during exercise [1].

The article states that there are more than 45 million Americans who belong to a gym, up from 23 million in 1993. Of course, that doesn't mean that people actually GO to the gym (unfortunately a membership alone does not qualify you as physically active). A study performed by the Minnesota Heart Survey found that more people say they exercise than the number who actually do. The 20-year survey found that the number of individuals saying they exercise rose from 47% in 1980 to 57% in 2000 [1].

Until recently, exercise was deemed an integral part of weight loss, when in fact, its role is largely over-stated. Exercise does, however, play an essential role in fighting chronic disease and in particular, heart disease...as well as cancer and diabetes [1]. So it's not to say exercise isn't hugely important...just maybe not so for weight-loss endeavors.

A recent study lead by Dr. Timothy Church randomized 464 overweight, sedentary women into 4 groups. The groups were asked to workout with a trainer for 72 minutes, 136 minutes, and 194 minutes per week for six months, with the last group being a control group. The women were asked to change nothing diet-related and to fill out monthly medical-symptom questionnaires. The results? On average, all the women lost weight. The three groups meeting with the trainer for varying lengths of time did not lose significantly more weight than the control group, however. Some women in each of the four groups actually gained weight -- some more than 10 lbs! What happened? Some of the exercising women ate more because the worked out. Some "rewarded" hard work at the gym with an extra treat. Some moved less when they got home because they worked out [1].

Current 2007 recommendations for exercise put out by the American College of Sports Medicine and the American Heart Association include 60 to 90 minutes most days of the week for weight loss. That's quite a lot for the average Joe [1].

A quote from the article:
"According to calculations published in the journal Obesity Research by a Columbia University team in 2001, a pound of muscle burns approximately six calories a day in a resting body, compared with the two calories that a pound of fat burns. Which means that after you work out hard enough to convert, say, 10 lb. of fat to muscle — a major achievement — you would be able to eat only an extra 40 calories per day, about the amount in a teaspoon of butter, before beginning to gain weight. Good luck with that."

So today during my TWO hockey games (makes me tired just thinking about it!), I will opt for water in place of my G2 (Gatorade's low-sugar option). While even I was thinking, "It's just 100 calories...I'm burning WAY more than that"...I am reminded of otherwise. Thanks, TIME.

[1]. Cloud, John. Why Exercise Won't Make You Thin. TIME. August 9, 2009.

Nutrition Hodgepodge

It's been a busy week. I attended a Conversation MAPS training by Merck for diabetes education on Tuesday night. I got my own set of 5 maps and I'm going to start facilitating sessions next month with my patients. These maps are AWESOME! Check out HealthyI for training sessions near you. If you work with a diabetic population, or just want an awesome set of educational tools free of cost, attend one of these sessions -- it was so rewarding!

Because there's so much I want to blog about today, consider this a hodgepodge of nutrition-related news. Here we go!

First up: cholesterol-lowering supplements [1]
Of course there's a TON of supplements on the market touting to be the ultimate cholesterol-lowering aid. Please note, supplements are meant to be used in addition to healthy diet and regular exercise regimens! Additionally, what works for one individual may not work for the next. Please consider the role an unconscious change in diet and/or a placebo affect can alter results of supplement-taking persons [1].

1. Artichoke leaf extract (also known as Cynara scolymus).

• The good: In 2000, a randomized, double-blind, placebo-controlled trial including 150 "high risk" adults (cholesterol > 280) was performed. The trial lasted 6 weeks and LDL-cholesterol (the bad) dropped 23% compared to the placebo group.
• The bad: The results are yet to be replicated. Similar studies show a decrease in cholesterol (-4%), but no major impacts on LDL or HDL have been found.
• The bottom line: Few studies conducted, mixed results, don't expect miracles.

2. Fenugreek.

• The good: Studies from the 1990's show a drop in total cholesterol and LDL, and in some cases, significant drops (as much as -38% in LDL). Fenugreek contains20-50% fiber and thus cholesterol-lowering effects may be attributable to this fact, if nothing else.
  
• The bad: The studies were small and poor quality questioning the validity of results noted above.
  
• The bottom line: Not enough evidence to support the cholesterol-lowering effects of this supplement.

3. Fiber (soluble - found in oats, barley, bran, peas, citrus fruits, and dietary supplements).

• The good: A 1999 meta-analysis performed by Harvard Medical School researchers contained nearly 70 clinical trials assessing the effectiveness of soluble fiber in cholesterol reduction. High soluble fiber intake was associated with reducing in both total and LDL cholesterol in 60-70% of the studies examined. For each gram of soluble fiber added to participant diets, and overall reduction in LDL was estimated at 2 points (in an average of 7 weeks).
• The bad: That's a lot of fiber. The current recommended guidelines state 25 grams of dietary fiber and the typical intake is comprised of a mere 20% soluble fiber. For example, 3 bowls of oatmeal will provide a measly 3 grams of soluble fiber. Supplements? Fine, but many experience GI upset and some prescription interferences.
• The bottom line: A diet high in soluble fiber can lower LDL-cholesterol, however, the drop in LDL will be relatively modest.

4. Fish oil (this is the one I was most interested in reading about!) - also known as omega-3's or EPA and DHA.

• The good: In clinical trials assessing dosing of 3 or more grams, fish oils have been shown to lower triglyceride levels by 10-30%.
  
• The bad: While fish oils do not lower LDL, they have been shown to sometimes cause the opposite: a small rise in LDL-cholesterol.
• The bottom line: Fish oils do lower triglycerides, especially in individuals with high triglycerides. The American Heart Association recommends those with high triglycerides consume 2-4 grams of fish oil a day. Those with heart disease should consume approximately 1 grams a day of EPA and DHA (combined), preferably through the diet and the consumption of fatty fish, such as salmon.

5. Garlic (oil, extract, pill, or natural state).

• The good: A 2000 report on garlic's impact on cardiovascular risk factors showed a small (but measurable) drop in LDL and total cholesterol.
• The bad: Studies to follow showed less encouraging results. A well-executed study performed in 2007 compared raw garlic and commercial garlic supplements over a 6 month period and found no measurable effects in total cholesterol, LDL, HDL, or triglycerides versus the placebo.
• The bottom line: Garlic may lower LDL temporarily but its meaningful effect on cholesterol long-term is questionable.

6. Red yeast rice - a fungus that grows on rice and contains a small amount of lovastatin (a type of statin found in prescription meds).

• The good: Compared to most supplements, evidence in support of red yeast rice is strong. Several high-quality trials have shown red yeast rice to lower LDL-cholesterol by 20-30%, comparable to a statin drug. A 2009 trial performed on patients discontinuing the use of statin drugs, red yeast rice showed a 15% and 21% decrease in total cholesterol and LDL, respectively. Cool.
• The bad: The amount of lovastatin in the supplements vary widely across brands.
• The bottom line: Red yeast rice is a potentially effective way to lower cholesterol, but its potency varies dramatically. Due to safety concerns with statin use, experts discourage the use of off-the-shelf red yeast rice.

The cliff notes version of the rest...

7. Ginseng

• The bottom line: There is not enough evidence to support the use of ginseng for lowering cholesterol.

8. Guggul

• The bottom line: More research is needed; there is not enough evidence to justify the cholesterol-lowering effects of guggul.

9. Niacin

• The bottom line: Niacin boosts HDL (the good), but you should NOT take it without consulting a doctor. Niacin should not be used in lieu of a prescription due to potentially serious side effects.

10. Soy protein

• The bottom line: Soy protein lowers LDL slightly.

Next up, mercury found in ALL fish caught in US streams (!) The government tested fish caught from 300 streams in the US. All the streams contained fish contaminated with mercury and thus the U.S. Geological Survey's research launches a comprehensive examination of mercury contamination [2]. Should this worry us? Maybe so. It was shown that 27% of the fish contaminated contained levels of mercury deemed unsafe by the Environmental Protection Agency for the average fish eater, consuming fish twice weekly. Mercury is a neurotoxin which is especially dangerous to neurological development in infants and fetuses [2]. The waters in urban areas, surprisingly, were less contaminated than those in costal plain streams fed by wetlands and forests, especially in North and South Carolina, Georgia, Florida, and Louisiana. The fish most highly contaminated included bass while the lowest levels of mercury were found in brown, rainbow-cutthroat trout and channel catfish [2]. To check for fish consumption advisories in your area, go here [2].

And up last, some reading material to leave you with. Is saturated fat being falsely accused? Read more!

I had planned to talk about myths surrounding egg consumption, but I'm out of time... it's off to the dog park. Hope Lily get some energy on the ride over! Have a wonderful weekend!

[1]. Hainer, Ryan. Cholesterol-Lowering Supplements: What Works, What Doesn't. CNN Health. August 20, 2009.
[2]. Weise, Elizabeth. Mercury Found In All Fish Caught in U.S.-Tested Streams. USA Today. August 22, 2009.

100+: the fastest growing age segment!

That's right! The US and Japan lead the world in populations of centenarians as a population growing 20x the rate of the total population by 2050. In 1950, there were only a few thousand over the age of 100 while today there are an estimated 340,000 worldwide [1].

Why is this?

Demographers declare medical advancements and improved diets are to thank. How'bout it, nutrition!? Genetics, lifestyle factors, and doctors willing to treat chronic diseases aggressively are also key contributors to the climb in age [1]. There's so such thing as "too late" in today's medical field to reverse the progression of disease. Nope, nope, nope!

While Japan leads the projected number of centenarians at 627,000 by the year 2050, the US is not far behind. We come in second with an estimated 600,000 come 2050, which is up from the current 75,000 in the 100+ age segment [1].

What does this mean for Medicare and Social Security? Well, it means something better if we each do our part in preserving our health. The cost of chronic disease management is perverse...obscene, even. The reality is, the younger generations may be SOL when it comes to government assistance come post-retirement age. 401k anyone?

Though the average American lives to be 78, most Americans would like to live to 89. Twenty percent of Americans would like to live to 90 with 8% wishing to live to see 100 [1]. With those goals and aspirations, we'd better aim to better our health or else it could certainly feel like a really long life.

Well, I'll have you know, I take my health very seriously and I intend to preserve it to the best of my abilities. It's a personal aspiration of mine to live to be 100+. When I was growing up, every Sunday at church there was the cutest little old lady who used to handout candy to kids as they exited the sanctuary. Every week she was there. While I appreciated the candy, I had come to appreciate her over the years. It wasn't until after her passing that I learned she was nearly 103 years of age. She was mentally sharp as a tack, and physically well enough to never require mobile assistance. She even posed in a Harley Davidson photo shoot on her 100th birthday I later found out. Seriously though, what a woman!

I see much of the same in my own 86-year-old Grannie. I'm sure you recall my boasting of her dance moves at my recent wedding reception...but here's a new story for you. On my way home from work last Friday I gave her a ring. I figured she would be heading downstairs to have dinner shortly (she lives in an independent living facility), but I tried her anyways. Turns out, she invited her "friend" Bill over (I use the term "friend" loosely. Grannie likes gentlemen, and has forever required several leading "friends" in her life. Bill just happens to be geographically desirable, however). They ordered in a pizza and were listening to music together. Maybe she was planning on showing off her dance moves, I'm just not quite sure. She did mention he was handsome. But, my point is...besides some short-term memory loss, the use of a walker (by choice), and some controlled hypertension, the woman is kickin' strong. You go, Grannie!

Aging can be a beautiful process, and I look forward to it...because I plan to do what it takes to do so gracefully. Kudos to those over 100 or well on your way...you're my inspiration!

[1]. Yen, Hope. Starting to Get Crowded in 10o-Year-Olds' Club. The Washington Post. July 20, 2009.