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Why is Medication Adherence Important? 


Natalie Stein, MPH Public Health, Michigan State University

April 12, 2018

Prescription drugs are ubiquitous in the United States. The Centers for Disease Control and Prevention, or CDC, reports that 48.9% of people said they used at least one prescription drug in the past 30 days. Nearly 1 in four people, or 23.1%, used 3 or more, and 11.9%, or nearly 1 in 8 people, used at least five prescription drugs in the past 30 days.

These drugs are addressing some of the most common health complaints and conditions in the U.S. Nearly 1 in 10 patients used a prescription analgesic (painkiller) recently. Many of the other most commonly used prescription drugs were used for chronic disease management.

·      Antihyperlipidemic agents for high cholesterol.

·      Beta-blockers and ACE inhibitors for heart disease and high blood pressure.

·      Diuretics for heart disease, kidney disease, and high blood pressure.

·      Antidiabetic medications.

·      Antidepressants.

Prescription medications can save lives and improve quality of life when used properly, but they are not always as effective as they could be. That is not because of poor medical care or problems with the drugs themselves. Rather, there is a major problem with medication non-adherence.

Improving medication adherence could save lives, improve health, and lower healthcare costs. To reduce medication non-adherence, it is important to understand why it happens and how harmful it is. Solutions can include educating patients, reducing prescription drug costs, and using technology such as smartphone apps designed to improve adherence.

The Lark health coach can assist with adherence to the medication regimen in a number of ways.

  • Connecting to claims data to monitor patients and segment them by risk;

  • Reminding patients to take their medications: when and how much.

  • Monitoring patients' at-home connected device readings and physical activity trends automatically to watch for outliers and correlations.

  • Connecting patients to healthcare providers when needed.

  • Educating patients on the importance of medication adherence.

  • Tracking patient adherence so patients can see how well they have been following doctor’s orders.

In addition, Lark provides coaching to encourage healthy behaviors, including weight management, nutritious eating, getting active, and getting enough sleep. These behaviors can all support general well-being as well as increase patient self-efficacy in taking charge of health and staying adherent to medications to stay as healthy as possible.


What Is Medication Adherence?

The definition of “medication adherence” can vary depending on the context, but the term refers to patients taking their prescription medications as prescribed. In research studies, researchers may measure medication adherence by seeing what percentage of the pills that patient has used over the study period. Proper dosage and timing are also part of medication adherence.

So what is medication non-adherence? These are some of the ways a patient can be non-adherent with prescription medications.

·      Taking the wrong dose.

·      Taking the prescription drug more or fewer times per day.

·      Not filling prescriptions on time or ever.

·      Taking the prescription on an empty stomach when it should be taken with food, or vice versa.

·      Taking the prescription at the same time as another medication or supplement that could interact.

Prescriptions are given by doctors to help patients get better, feel better, or prevent complications from their conditions, and medication non-adherence can lower the effectiveness of prescription medications. Why, then, do patients not always adhere? There are many possible reasons for non-adherence.

·      The patient does not understand the instructions for taking the medication, or it is too complicated to continue the regimen, especially when the patient has multiple prescriptions.

·      The medication is unaffordable due to high cost or limited drug coverage, or the patient prefers not to spend money on it.

·      The medication is inconvenient to purchase or use.

·      The medication has side effects or the risk of side effects, such as headaches, fatigue, muscle aches, gastrointestinal distress, and more. People who experience side effects are 3.5 times less likely to be adherent to their medication instructions.

·      The patient does not consider herself a “pill person,” or taking pills makes the patient remember that she has a health condition.

·      Patients can dislike the thought of medications as being “unnatural” chemicals.

·      The medication is for a disease that does not cause early symptoms, such as hypertension.

·      The patient was not home, ran out, or was too busy to take the medication.


Barriers to Adherence in the Elderly

Older adults are prescribed more medications than younger adults, and have a higher rate of chronic diseases such as high blood pressure, diabetes, and high cholesterol. Medication adherence is just as important in this population, and older adults who have high self-efficacy and have a high perception of health status.

Still, barriers remain. Older adults may be less likely to be adherent when they have:

·      Low health literacy.

·      High comorbidities.

·      Polypharmacy.

·      Poor cognition.

·      Logistical trouble obtaining prescriptions or refills.


Medication Adherence Stats and Trends 

Despite the importance of medication adherence, it is shockingly low in the U.S., with nearly 3 out 4 patients being non-adherent. Furthermore, adherence is lower among individuals with chronic diseases compared to acute conditions.

Consider these additional statistics, compiled in a survey conducted by the National Community Pharmacists Association (NCPA) and Pharmacists for the Protection of Patient Care (P3C).

·      49%, or nearly one out of two, patients forgot to take at least one of their prescription medications.

·      31%, or nearly one out of three, patients neglected to fill at least one of their prescribed medications.

·      24%, or nearly one out of four, patients took a dose lower than what they were supposed to take.

·      11%, or nearly one in nine, patients took an over-the-counter medication instead of their prescription medication.


Importance of Medication Adherence

The economic and health costs of medication non-adherence are high. An estimate from the Pharmaceutical Research and Manufacturers of America, or PhRMA, puts the annual cost of hospitalizations due to non-adherence at $100 to $300 billion. Each hospital visit costs, on average, an extra $3,575 for a non-adherent patient compared to a hospital visit for a patient who had been compliant.

These are some other statistics demonstrating the importance of medication adherence.

·      Non-adherent hypertensive patients had 17% higher hospitalization and 5.4 times the risk of poor clinical outcomes (e.g., hospitalization and premature death) than adherent patients.

·      Non-adherent hypertensive patients were 7, 13, and 42% more likely to get coronary disease, cerebrovascular disease, and heart failure, respectively, over 3 years than adherent patients.

·      In one study among individuals with diabetes, those who were non-adherent were 2.5 times more likely to be admitted to the hospital than patients who were at least 80% adherent.

·      The risk of hospitalization or death is 2.8 times higher among individuals with dyslipidemia (such as high cholesterol) who are non-adherent compared to those who take their prescription medications as prescribed.

Although one reason patients may not be adherent is because they do not have symptoms from their conditions. Or, they may not realize that the medication is working. However, hypertension is an example of a condition in which each step towards control helps, even if patients do not achieve a “normal” blood pressure. One study found that:

·      The relative risk of heart disease mortality with a systolic blood pressure of 140-149 mm Hg (Stage 1 hypertension) was 4.2 compared to a systolic blood pressure of 110.

·      The relative risk was 20 for a systolic blood pressure over 180 compared to under 110.

·      Each increment decrease of 10 mm Hg of systolic blood pressure was associated with a decreased risk, even when patients did not achieve complete control.

·      Patterns were similar for stroke risk.


 Medication Adherence in Various Patient Groups

While there are many common themes in medication adherence, there are some special considerations for different patient groups.

Medication Adherence in Diabetes

The goal of medication regimens in diabetes is to improve blood sugar control to prevent complications. Type 2 diabetes accounts for 9 out of 10 cases, and is the result of insulin resistance. Without proper management with lifestyle behaviors such as diet and exercise, the WHO asserts that most patients eventually need medications. Diet, exercise, monitoring, and medications are the cornerstones of management.


These are some facts related to diabetes self-management.

·      Only 1 in 4 patients follow a physical activity plan and only 1 or 2 in 3 are adherent to a diet plan.

·      As few as 1 in 3 patients regularly monitor blood glucose at home.

·      Adherence ranges from 15 to 80%, with non-adherence including taking extra doses and skipping doses.

·      A greater self-efficacy, better stress management, and better support are all linked to improved adherence.


Medication Adherence in Schizophrenia

Schizophrenia is a condition in which the patient has an altered perception of the world that can include untrue beliefs or hearing voices that are not there. Treatment usually includes psychotherapy and medications such as antidepressants, antipsychotics, and anti-anxiety drugs. As in other long-term conditions, such as diabetes and hypertension, patients are less adherent as their diagnosis is further in the past, and only about 1 in 4 continue to take medications properly.

·      There are no immediate consequences for skipping doses, so patients may not understand the significance.

·      Patients often skip up to half of doses due to forgetfulness.

·      Side effects can cause patients to stop taking their medications.

·      Family and social support can improve adherence.

HIV Medication Adherence

Medication adherence in patients with HIV/AIDS is particularly challenging. Adherence of at least 95% is required for best results, but the WHO reports that only 1 out of 3 patients take their medications properly, even when they understand the importance of highly active anti-retroviral therapy, or HAART, in preventing progression of HIV/AIDS. Even slight non-adherence can allow viral cell loads to increase, and infectiousness can also increase with non-adherence.


These are some challenges:

·      The drug regimen is complex, with multiple doses per day and possible food restrictions.

·      Side effects can be unpleasant and include nausea, diarrhea, and neuropathy.

·      Substance abuse is a predictor of non-adherence.

·      Social support and patient-provider trust can help in adherence.


Medication Adherence in Hypertension

Estimates vary from 20 to 80%, but what is clear is that many hypertensive patients are non-compliant. Consequences include a higher risk of stroke, coronary heart failure, dementia, reduced renal function, and blindness.

·      Hypertension is largely asymptomatic, so motivation to adhere can be lower because medications do not make patients feel better.

·      The biggest cause of uncontrolled hypertension is non-adherence.

·      Low understanding of hypertension and its risks may contribute to non-adherence.

·      Hypertension drugs can be complicated to take.


Medication Adherence in COPD

Chronic obstructive pulmonary disease, or COPD, is a progressive chronic disease that makes breathing difficult and is the fourth most common cause of death in the U.S. Medication adherence issues in patients treated for COPD include periods of symptom remission and the long-term nature of the disease. In addition, side effects can be severe. Only about half of COPD patients are adherent to their prescribed regimen.


How to Improve Medication Adherence

Improving medication adherence could potentially save lives, reduce healthcare costs, and improve healthcare outcomes. There are several strategies for improving medication adherence, and patients, healthcare providers, and manufacturers can all be involved.

Reducing Forgetfulness

Forgetting to take medications can be a barrier to adherence for patients who intend to take their medication as prescribed. These are some CDC medication adherence strategies that could be effective at improving medication adherence among patients who fill their prescriptions, but do not always remember to take the proper dose at the right time.

·      Pillboxes allow patients to set out their pills for the day or week ahead so they can see which ones they have taken and still need to take.

·      Blister packs make it easier for patients to see whether they have already taken their medication.

·      Electronic pill monitors can not only remind patients when to take their medication, but can also notify healthcare providers if the patient misses a dose.


Increasing Access to Medications

Cost is a significant barrier to medication adherence. Reducing or eliminating co-pays for prescription drugs, especially common ones with big payoffs such as statins, could potentially increase patient adherence. The move could pay for itself because of cost savings from fewer hospitalizations and adverse events. Offering generics is another way to limit costs.

Another way to increase access to medications is to implement delivery methods that are easier for patients. Free delivery of medications from the healthcare provider or pharmacy is one example. Pharmacists can also automatically prepare refills and notify patients via phone calls or text messages that they can pick up their prescriptions at any time. This eliminates barriers such as remembering to call in the refill order, and waiting for a long time at the pharmacy for the order to be filled.


Improving Motivation

Patients who can see the effects of their medications, such as when they have less pain as the result of taking prescription analgesics, may be more adherent than patients who do not feel immediate benefits. This can happen when managing chronic conditions, such as high blood pressure or cholesterol.

Frequent self-monitoring is one way to try to improve motivation. In conditions such as diabetes or hypertension, patients who regularly measure their blood sugar or blood pressure may not feel any symptoms of their condition. However, they may notice that their numbers are lower when they follow their drug regimen properly, and therefore be more motivated to be adherent.


Patient Education and Support

An article in the “Annals of Internal Medicine” explores potential solutions for medication non-adherence. Case management is an approach to patient support can increase medication adherence. It can include:

·      Identifying patients who at risk for non-adherence for reasons such as polypharmacy or lack of reaching treatment goals.

·      Assessing each medication for necessity and safety.

·      Working with the patient to identify and address each barrier to adherence.

There are more ways to support patients. Explanations from pharmacists and clear labels can make it easier for patients to understand how to take their medications properly once they get them. Prescribing fixed-dose medications, or two-in-one pills, when possible reduces the number of pills the patient needs to take. It can actually reduce patient non-compliance by almost one-quarter.


Medication Adherence Program

Medication adherence interventions can address many of the barriers to non-adherence. They can include care coordination between doctors and pharmacists to target and assist patients who have trouble following their regimens. They can assist patients in obtaining the lowest-possible cost medications. And all of this can be coordinated by Lark.

There are some limitations to traditional medication adherence programs.

·      They can be costly due to the live human interaction and cost of paying pharmacists and doctors or nurses for extra time.

·      Not all members of the patient support team can be available 24/7. What happens if the patient needs a nudge on the weekend or evenings?

·      The patient may feel some embarrassment at asking for help or admitting that a dose has been missed.

Apps & Tools for Medication Adherence

There are abundant medication adherence tools that can improve adherence rates among patients, but Lark stands out for it's effectiveness and "whole person" approach to care. Some other innovative strategies are:

·      Automatically sending pre-sorted pills to patients every week or two.

·      Automatically detecting a patient’s pill ingestion via an ingestible sensor.

·      Learning patients’ habits through digital interactions.

·      Using wearables that easily allow for patients to record when they take their medications.


Medication adherence apps show promise as low-cost, effective solutions that are easy for patients to use. Features can include:

·      Reminders to take medications and order refills.

·      Tracking dose history.

·      Notifications for caregivers or providers if users do not login to the app.





5 Life-Altering Changes You Can Make in Under 5 Minutes a Day

December 6th, 2017

By Natalie Stein, BS Food Science, BS Nutritional Sciences, MS Human Nutrition, MPH Public Health

Finding out that you have pre-diabetes can make you wonder what you can do to prevent diabetes. The good news is that there is plenty that you can do, since making healthy lifestyle changes can cut your risk for diabetes by over 50%! Even better, these changes can be easy and quick, so they fit into your busy life. Here are a few places to start.

  1. Choose whole grains. Research shows that swapping whole grains for refined grains can lower your risk for type 2 diabetes. It also helps you control your weight and prevent cardiovascular disease. The magic may come from the fiber, antioxidants, vitamins, and minerals that are naturally present in whole grains, but are lost during processing when producing refined grains. A good goal is to get at least half your servings of grains from whole grains, not refined. Try:

  • Whole-grain bread instead of white bread

  • Brown rice instead of white rice

  • Whole-wheat pasta instead of white pasta

  • Oatmeal or whole-grain cereal, such as shredded wheat, instead of refined cereal

  • Farro, quinoa, whole-wheat couscous, and bulgur.

  1. Take the stairs. Too much sedentary time is linked to poorer blood sugar control and higher diabetes risk, while getting moving for even a minute can slash your risk. Taking the stairs instead of the elevator gives you benefits, and takes no extra time. You can also break up hours sitting at a desk by taking 1-minute breaks every hour to stand up and stretch, march in place, or do squats, calf raises, or arm swings

  2. Breathe. Too much stress can send your hormone levels out of whack and raise your blood sugar. Deep breathing exercises can help you relax and reduce stress. Try taking a deep breath, then slowly letting out as much air as you can. You can start by doing this for five breaths, and work up to more if you want. Other ways to relax include exercising, replacing negative thoughts with positive ones, and sitting out in the sun.

  3. Turn off electronics. The light from electronic devices, such as smartphones, iPads, and laptops, can stimulate your brain and make you more alert. Turning off your devices at least an hour before bed can help you fall asleep faster. Since sleep deprivation interferes with your body’s ability to control blood sugar levels, getting better sleep can only lower your diabetes risk. You can also enjoy the added bonus of extra energy during the day.

  4. Add intervals. Interval training can boost your calorie burn, which can increase weight loss and lower diabetes risk. It takes no extra time to sneak intervals into your workouts. Here is how you can do it.

  • Warm up for 5 to 10 minutes, starting at an easy effort and ending with a little bit more effort.

  • Add intervals: Add a harder-intensity “interval” that lasts about 15 to 60 seconds. Your intervals can consist of faster walking or jogging, walking at a higher incline on the treadmill, increasing the resistance or speed on an exercise bike or elliptical trainer, or doing jumping jacks, plyometrics, or push-ups in the middle of a weight-training session.

  • Work up to doing about 10 intervals throughout your total workout.

  • At the end, cool down for 5 to 10 minutes to let your heart rate drop.

  1. Add olive oil. Adding healthy fats to high-carbohydrate foods, such as fruit, starchy vegetables, and grains, can lower their glycemic index so your blood sugar does not spike as much. You can mix peanut butter with oatmeal, mix nuts into a fruit salad, and spread avocado on your toast. Olive oil in particular has been linked to lower rates of diabetes, so consider using it on roasted vegetables, with vinegar and herbs on salads, and in pasta sauce. You can even use it as a substitute for butter when baking.


With simple changes like these, you can lower your diabetes risk and improve your health in other ways. These changes take no extra time, and they are easy to implement. Your Lark health coach can give you reminders on lifestyle changes like these, plus suggest other ways to stay at your healthiest. You can get started as soon as you are ready!

5 Fats that Can Boost Your Weight Loss Journey and Help Prevent Diabetes

What does it mean when Lark tells you to eat healthy fats? Aren’t they…well…fatty? It turns out that you need fat not only for nutrient absorption and optimal health, but also for easiest weight loss, since fat helps keep you full and satisfied for hours. Of course, it’s not quite as simple as “eat fat, lose weight.”

Tricks to fatty foods: 

Right type of fats – high in healthy unsaturated fats, low in unhealthy saturated and trans fats.

Right serving size – fat calories can add up fast, and serving sizes might be smaller than you think.

Right nutrient package – healthy fat foods usually come with other healthy nutrients.

Right add-ons – eat your fats with lower- calorie, nutritious foods to get a filling meal for weight loss.

ground flaxseed

Ground flaxseed has alpha-linolenic acid (ALA), an essential omega-3 fatty acid. It may help lower risk of heart disease and reduce levels of chronic inflammation in your body.

Choose ground over whole flaxseed for better nutrient absorption.

Per 2-tablespoon serving, but they provide fiber and cholesterol-lowering components called lignans. Sprinkle flaxseed on cereal, yogurt, salads, and sandwiches, and add it to soups and casseroles.

Use it in salads:

Right type of fats – 3.2 grams of ALA  Right serving size – 2 tablespoons have 75 calories.

Right nutrient package – Fiber and cholesterol-lowering components called lignans

Right add-ons – sprinkle on hot or cold cereal, yogurt, salads, and soups.

Flaxseed oil is higher in ALA, with 7.3 grams per tablespoon, but it does not provide the amounts of fiber and lignans you get in flaxseed.


Avocados are rich in monounusaturated fats (MUFA), which can lower cholesterol levels and improve blood sugar control.

Right type of fats – 2/3 of its fat is MUFA. Right serving size – 2 ounces, or about ½ of a small avocado, have 90 calories.

Right nutrient package – folate, potassium, and fiber.

Right add-ons – salads and lean proteins to balance the heaviness of the avocado.

Avocado is a nice addition to soups to make them creamier. Try this: add 1 diced onion, 1 clove of crushed garlic, 2 lbs of peeled cubes of butternut squash or acorn squash, 3 cups fresh spinach leaves, 1 peeled, mashed avocado, cups of low-sodium chicken or vegetable broth, and black pepper  and cumin to taste to a pot. Bring it to a boil, then let it simmer, stirring occasionally, until the squash is soft enough to stir into the mixture. Serve it with fresh parsley or cilantro.


Salmon itself is not a fat, but it is one of the best sources of one of the best types of fat: long-chain omega-3 fatty acids known as DHA and EPA.

Right type of fats – rich in long-chain omega-3 fatty acids DHA and EPA. Right serving size –3 ounces of cooked salmon have 127 calories.

Right nutrient package – protein, B vitamins, potassium, and selenium.

Right add-ons – veggies and high-fiber carbs to complement the protein and fat in salmon.

Try this weight loss meal: Mix ½ cup low-sodium cannellini or white beans (drained), 1 teaspoon diced capers, 1 tablespoon lemon juice, and red pepper flakes. Sear 3 ounces of salmon in a pan with cooking spray. Add the salmon and bean mixture to 2 cups of baby arugula mixed with ½ cup halved cherry tomatoes. 370 calories, 27 grams protein, 8 grams fiber.

Other types of fatty fish have DHA and EPA, too – think herring, mackerel, tuna, and sardines. Just avoid high- mercury species such as king mackerel, swordfish, and shark.

olive oil

Olive oil is used liberally in a Mediterranean diet pattern, and it probably contributes to many of the diet’s benefits. Like avocados, olive oil is rich in monounsaturated fats (MUFA).

Right type of fats - MUFA

Right serving size – 2 teaspoons of olive oil have 80 calories

Right nutrient package – improves nutrient absorption from other foods.

Right add-ons – salads and other vegetables and lean proteins.

You can make a basic salad dressing by mixing olive oil with an equal amount of rice, white wine, or balsamic vinegar, or lemon juice, and adding herbs to flavor it if you want.

Try this easy salad dressing for four people: Mix 3 tablespoons olive oil with ¼ cup balsamic vinaigrette, 1 tablespoon lemon juice, and 1 clove crushed garlic. Use it as is, or vary it by adding dried Italian herbs or any combination of fresh basil, oregano, thyme, or rosemary. Serve it on greens or make a 1-bowl meal with ½ cup cooked whole grain pasta or barley, 1/3 cup each of halved cherry tomatoes, 1/3 cup sliced mushrooms, and 1/3 cups chopped bell pepper, and 3 ounces cooked diced chicken breast or tofu.

macadamia nuts

Macadamias have more MUFA than any other kind of nut, but the fat in other nuts is mostly healthy, too. Each ounce of macadamias has 21.5 grams of total fat, including 16.7 grams of MUFA.

  • Right type of fats – Great source of MUFA. Right serving size – 1 ounce has 201 calories.

  • Right nutrient package – thiamin, magnesium, and manganese.

  • Right add-ons – Low-calorie veggies, fruits, and lean proteins to complement the heaviness of the nuts.

Macadamias have more MUFA than any other kind of nut, but the fat in other nuts is mostly healthy, too. Each ounce of macadamias has 21.5 grams of total fat, including 16.7 grams of MUFA.Try this recipe for nut-topped tilapia and serve 1/4 recipe with cooked veggies such as broccoli or green beans and a whole grain or (low-carb or paleo) 1 ounce of parmesan cheese. Mix ¼ cup chopped  macadamias (or other nuts) with 2 tablespoons chopped cilantro or parsley, the juice from 1 lime, 2 tablespoons of pineapple or orange juice, and 1 crushed clove of garlic.

Spread the mixture over 4 4-ounce fillets of tilapia, and bake 12 minutes at 375 degrees. Each serving has 180 calories.


6 Myths about Gluten-Free Foods That Could Harm Your Health

By Natalie Stein, BS Food Science, BS Nutritional Sciences, MS Human Nutrition, MPH Public Health

December 15th, 2017

Gluten-free foods are everywhere these days, and you may already be enjoying the gluten-free breads, cookies, pastas, and even take-out pizzas if you are on a gluten-free diet. If not, you may be wondering whether you should be. Gluten-free veteran or gluten-free skeptic, you should know the facts so you can make the best choices about your diet for weight loss and health. To get started, here are some common misconceptions about gluten-free foods, and the truth.

  1. “Gluten-free” means “low-carb.” No way! “Gluten-free” means there is no wheat, rye, or any other gluten-containing grain, but the food can still have grain, and grains have carbohydrates. Foods such as gluten-free bread or pasta may be made with gluten-free, high-carb flour, such as rice flour, potato flour, or cornmeal. Gluten-free cereals can be based on rice, corn, or oats - all grains, and all high-carb foods.

Take a look at the carbohydrate comparisons between certain gluten-containing and gluten-free foods. As you can see, the carb counts are similar, and so are the effects on your blood sugar.

Food with Gluten (Carbohydrates per Serving)

Gluten-Free Version (Carbohydrates per Serving)

1 slice whole-wheat bread (13 grams)

1 slice gluten-free, whole-grain bread (11 grams)

1 1-oz packet cream of wheat (20 grams)

1 1-oz packet cream of rice (22 grams)

1 ounce whole-wheat pasta (21 grams)

1 ounce whole-grain, gluten-free pasta (23 grams)

1 small whole-wheat tortilla (21 grams)

1 small gluten-free corn tortilla (18 grams)

1. “Gluten-free” foods are always healthy. Nope! Just like foods with wheat, gluten-free foods can be healthy, or they can be unhealthy. Whole-grain brown rice, oatmeal, quinoa, and black bean pasta are gluten-free foods that tend to be on the healthier side. They are sources of fiber, vitamins, and minerals, and are low in sugar.

Sweetened rice cereal, gluten-free brownies and cookies, and gluten-free pizza are at the other end of the spectrum. They are likely to have highly processed refined grains instead of whole grains, and can be high in sugar, salt, and/or fat. Have too many foods in this category, and you are likely to have a little more trouble hitting your weight loss and blood sugar goals.

2. “Gluten-free” is better than whole-grain. Whole grains are where you will find the superfood grains. Whole grains are less processed versions of refined grains. They are natural sources of fiber, antioxidants, iron, and B vitamins.

Gluten-free products are only whole grain if they say so on their packages. Check the label for a claim that they are “whole-grain,” and read the list of ingredients to be sure that a whole grain is listed before a refined grain.

3. Gluten is a toxin. Gluten is dangerous if you have celiac disease, gluten sensitivity or intolerance, or gluten ataxia, or a wheat allergy. Otherwise, there is not much evidence that gluten is not harmful. You are best off asking your doctor if you suspect that you are sensitive to gluten, since going gluten-free when there is no need could even make you miss out on a more nutritious diet. For example, if you choose gluten-free potato bread instead of whole-wheat bread, you will be missing out on a whole grain opportunity.

4. All foods with gluten are obvious. Regular bread, cereal, pasta, and baked goods are easy to spot as sources of wheat, so you probably already knew to choose gluten-free versions. Less obvious sources of gluten are some processed foods, such as the following.

  • Soy sauce, gravies, and salad dressings.

  • Beer.

  • Soups and bouillons.

  • Luncheon meat and imitation crab.

  • Flavored potato and tortilla chips.

When you are following, or considering following, a gluten-free diet, it is important not to make some of the same mistakes that many people do. When you know the truth behind some of the common misperceptions, you can put yourself on a faster track to better health and weight loss. Gluten-free or not, you can get tips for a healthier diet every day with your Lark Health Coach!

These 10 Foods Have a Shocking Amount of Added Sugar


By Natalie Stein, BS Food Science, BS Nutritional Sciences, MS Human Nutrition, MPH Public Health

If you could point to one culprit in your diet, it might be added sugars. They bring calories without essential nutrients, drive up your blood sugar levels, and contribute to diabetes and other chronic diseases. The World Health Organization recommends limiting your sugar intake to no more than 5% of your total calories. For someone on a 2,000-calorie diet, that works out to 24 grams of sugar, or 6 teaspoons.

Some foods with added sugars are obvious; they include candy, soft drinks, and desserts. Other sources of sugar, though, sneak into your diet, usually by way of processed foods. Check the labels of the following foods before you buy them, because they can be surprisingly high in sugar.

  1. Yogurt. Fruit-flavored yogurt sounds like a nutritional bargain, with a mixture of protein and probiotics from the yogurt, and fiber and antioxidants from fruit. The trouble is that the “fruit” is often a mixture of sugar and flavoring, not real fruit. The result is that a container of fruit-flavored yogurt can have 24 grams of sugar. That is your entire daily limit from a food you thought was healthy! Do yourself a favor by choosing plain yogurt and adding fresh or frozen peaches, blueberries, or other fruit.

  2. Spaghetti Sauce. Think again if you thought that store-bought spaghetti sauce was a wholesome mixture of tomatoes and herbs. It can actually be a source of added sugars, often in the form of high-fructose corn syrup. A half-cup of marinara sauce can half 7 grams of sugar, or nearly 2 teaspoons. Are you sure you want to put two spoonfuls of sugar on your pasta? Instead, make your own easy marinara sauce with fresh or stewed canned tomatoes, olive oil, onions, garlic, and herbs. Make it chunky with mushrooms, zucchini, or bell peppers, or make it meaty with lean ground turkey.

  3. Instant Oatmeal. Nothing feels as virtuous as oatmeal for breakfast, but are you really being as good as you think? A packet of flavored oatmeal, such as apple cinnamon, peaches and cream, or maple brown sugar, can have 12 grams of sugar. That means you will have half your daily sugar limit before you have barely woken up. Avoid added sugars by making plain oatmeal and adding healthy options such as apples or pumpkin with cinnamon; peaches; berries; or sliced banana and walnuts.

  4. Ready-to-Eat Breakfast Cereals. Some cereals, such as kid-focused fruit-flavored loops, cinnamon sugar squares, and chocolate cookie cereals are obviously sugar bombs, but some cereals are surprisingly high in sugar. A serving of raisin bran has 20 grams of sugar, for example. To avoid an overly sugary breakfast or snack, read the label and choose an unsweetened, whole-grain cereal with no more than 3 grams of sugar per serving. Plain Cheerios, shredded wheat, Corn, Rice, or Wheat Chex, and Fiber One are all good choices.

  5. Dairy-Free Milk Substitutes. Almond, coconut, and soy milk let you avoid dairy products and the sugar called lactose that is in milk, but you may be getting a hefty dose of added sugar instead. Original, vanilla, and chocolate-flavored non-dairy milk can have 9 grams of sugar. You are better off cutting calories and sugar, and getting your calcium from unsweetened varieties instead.

  6. Dried Fruit. Dried fruit can have 12 grams of added sugars, and nearly 30 grams of total sugars, and that is in a single ¼-cup serving. Grab a handful of dried fruit, and you can easily get 60 grams of sugar from something you thought was healthy. Dried pineapples, mangoes, and cranberries are among the types of dried fruit that are most likely to have added sugar. To avoid it, read the list of ingredients and select types without sugar. Better yet, opt for fresh fruit, which has a much larger serving size. You can have an entire cup of grapes or a large apple instead of a quarter-cup of raisins or apple rings, and you will not have to worry about preservatives, such as sulfites, that are in dried fruit.

  7. Granola Bars. Granola bars seem like the ultimate health food, with whole-grain oats, heart-healthy nuts and seeds, and fibrous fruit. Unfortunately, the package often comes with unhealthy hydrogenated fats, as well as honey, sugar, or cane juice - all added sugars. You can get a more satisfying snack, with no added sugars, with any combination of whole grains, nuts or peanuts, and fresh fruit. Try apple slices with peanut butter, whole-grain toast with almond butter, or half a whole-grain English muffin with mashed banana and walnuts.

  8. Canned Soup. What do a serving of tomato soup and a serving of vanilla ice cream have in common? They each have about half your daily limit for sugar. A cup of canned tomato soup has 12 grams of sugar, and it is not your only sugar soup option. When choosing canned soup, opt for low-sodium versions with no more than 2 grams of sugar per cup.

  9. Chocolate. We all know that milk chocolate is sugar-laden, but did you know that dark chocolate is not always as innocent as it sounds? An ounce of dark chocolate can have 10 grams of sugar. That certainly puts a damper on the health benefits from the antioxidants in chocolate. You can limit the sugar by choosing higher-percent dark chocolate and sticking to a 1-ounce serving size, and skip the sugar entirely by choosing 100% chocolate or unsweetened chocolate.

  10. Ketchup. Ketchup may be your go-to condiment, but each ounce has as much sugar as a fun-size Snickers bar. Ketchup is not the only condiment culprit, though. Barbecue sauce, teriyaki sauce, and many low-fat salad dressings and vinaigrettes have more sugar than you might think. Stick with sugarless alternatives, such as mustard for burgers or olive oil and vinegar for salads, or find condiments with no more than 4 grams of sugar per serving, and stick to a single serving size.

It is hard enough to stay under a daily goal of 24 grams of sugars without getting extra sugars from hidden sources. All of the above foods can sneak in a big dose of sugar without you even realizing it, but you can protect yourself from a sugar overload by staying aware and reading labels. By avoiding some of these hidden sugars, you can lower diabetes risk and control your weight better. Your Lark health coach can give you more tips for health and weight loss as you use the app, so make Lark part of your regular health routine!

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Getting Diabetes Costs You - Are You Prepared to Pay?

By Natalie Stein, BS Food Science, BS Nutritional Sciences, MS Human Nutrition, MPH Public Health

December 14th, 2017

Having pre-diabetes means that you are at higher risk for type 2 diabetes, and that serves as a wake-up call. It is a good time to work on some healthy lifestyle changes, because doing so can cut your risk of getting diabetes by over 50%.

Healthy food can have the reputation of being expensive, but if you are concerned that you cannot afford to pay for nutritious food and other costs of healthy living, consider this: the costs of diabetes go beyond health problems. Diabetes can hit your wallet just as hard. In fact, this is why you may not be able to afford not taking on a healthy lifestyle.

A National Burden

Diabetes costs the country around $250 billion each year. Medical costs come from hospitalizations, the cost of prescription drugs to manage diabetes and treat complications, and doctors’ visits. Non-medical, or indirect, costs come from missed days from work, reduced productivity while at work, and patient disability.

The Average Costs per Person

Each diabetes patient spends on average nearly $10,000 per year, including an average of $1,600 out of pocket, or $133 per month. Medications alone can cost $200 per month if you are on one medication, or $500 for  multi-drug regimen. Can you think of any other ways to spend $10,000? A couple family vacations or a down payment on a new car comes to mind!

Your Own Outlook

As you might expect, the younger you are when you are diagnosed, the more you can expect to pay for diabetes over your lifetime. A 45-year-old can expect to pay, on average, $124,600 on diabetes care and complications over her lifetime, while a patient diagnosed at age 65 will spend about $35,900 in total. The numbers increase for people who develop diabetes complications.

Needless to say, your personal outlook is a lot rosier than those averages if you can prevent diabetes in the first place! Seeing these numbers may motivate you even more to take charge of your health and do what you can to prevent diabetes.

Are You Ready to Invest in Your Health?

Sometimes the healthy choices seem expensive, but they are minimal compared to the cost of diabetes and complications.

  • $5 more per week could get you an extra 5 servings of vegetables per day.

  • $2 more per week can let you upgrade from fatty to lean meat every single meal.

  • $200 per year can get you the shoes and clothes you need to work out.

  • $3 per month can let you use olive oil instead of butter.

In addition, those examples do not include the examples of healthy choices that are absolutely free, such as standing up once an hour to stretch, buying plain instead of sugary flavored oatmeal, cooking your own dried beans instead of using salty canned ones, and turning off your smartphone a full half-hour before bedtime.

The costs of these and many other healthy choices are so small compared to the costs of diabetes that they may convince you that you can afford to work to adopt healthy behaviors on a daily basis. If you are ready to get healthier and lose weight, your personal Lark coach is ready, too! Chat with your health coach whenever you want, and get tips and encouragement. Together, you can work towards getting those health numbers where you want them to be.

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Different kinds of protein, like meat, beans and quinoa, displayed on a cutting board.

5 Ways to Capture the Power of Protein

By Natalie Stein, BS Food Science, BS Nutritional Sciences, MS Human Nutrition, MPH Public Health

December 16th, 2017

It seems as though protein is all the rage these days for weight loss and health. The trend follows from the knowledge that protein can decrease hunger, improve your blood sugar levels, and support lean muscle mass.

If everyone knows that protein is good, why isn’t everyone losing weight already? One reason may be that they do not know how to use protein to their advantage. Here are 5 ways you can capture the power of protein to improve weight loss and health:

1. Go lean. Some protein foods are high in calories because of their excess fat, so it is easy to overeat and gain weight from them. Also, the saturated fat in fatty meats such as bacon, ground beef, ribs, bologna, and fatty steaks, can interfere with your blood sugar control. Instead, choose lean proteins when you can. Most lean proteins are low in fat. Exceptions include nuts and peanuts, which are considered “lean” because their fat is healthy and research shows that people who eat them tend to have lower body weights. These are examples of lean proteins.

  • Fish, including fatty fish such as salmon, and shellfish.

  • Skinless chicken and turkey, and lean ground chicken and turkey.

  • Eggs and egg whites.

  • Beans, peas, lentils, and soy products, including tofu.

  • Peanuts, nuts, seeds, and peanut and nut butter.

  • Low-fat cheese and yogurt.

2. Remember moderation. If protein is good, more protein must be better, right? Not so fast. While your body can absorb all the protein you eat, your body can only use about 30 grams of protein at once for protein-specific purposes, such as building muscles. Any protein above that amount goes to energy production. Protein has 4 calories per gram, which is the same as carbohydrates. As with carbohydrates, getting too many calories from protein eventually leads to fat storage and weight gain. You can get 30 grams of protein in a small chicken sandwich. For reference, here are the protein contents of common foods.

  • Fish, poultry, and lean meat: 20-25 grams per 3-ounce serving.

  • Eggs: 7 grams per large egg.

  • Low-fat cheese: 5-7 grams per ounce.

  • Beans: 14 grams per cup.

  • Peanut butter: 7 grams per 2-tablespoon serving.

3. Eat plants. All plants are cholesterol-free, and most are low in unhealthy saturated fats. In addition, many plant-based protein sources are high in important nutrients such as fiber, which helps keep you full, and potassium, which helps lower blood pressure. Swapping plant-based proteins for meat a few times a week can help improve blood sugar levels, too. It is possible to hit the daily value of 50 grams of protein from an all-plant diet. Here is a sample menu that will get you there.

Breakfast (13 grams protein)

  • 1 cup of oatmeal made with soy milk (10 grams)

  • 2 tablespoons of chopped walnuts (2 grams)

  • 1 sliced banana (1 gram)

Lunch (22 grams protein)

  • 1 cup of vegetable lentil soup (8 grams)

  • PB sandwich with 2 slices of whole-grain bread, 2 tablespoons of peanut butter, and ½ cup of berries (13 grams)

  • 1 cup baby carrots (1 gram)

Dinner (18 grams protein)

  • 1 medium whole-grain tortilla  wrapped around 1/2 cup fat-free refried beans, ½ cup brown rice, and ¼ cup avocado slices (14 grams)

  • Side salad with lettuce, tomatoes, sprouts, and vinaigrette (4 grams)

4. Demand double duty. Why settle for just protein when you could also get one or more additional nutrients? Some protein sources are practically superfoods because of the other nutrients they provide. It makes sense to consider the entire nutrient package when choosing your protein. Here are some protein foods that can do double or triple duty for you.

  • Cheese and yogurt have bone-building calcium.

  • Salmon, tuna, and other fatty fish have heart-healthy omega-3 fatty acids.

  • Beans, lentils, and split peas have filling fiber, which also helps stabilize blood sugar.

  • Nuts and peanuts have heart-healthy monounsaturated fats and blood pressure-lowering potassium.

  1. Put protein in its place.

Which protein sources you choose are important, but they will do you even more good if the sources of carbohydrates and fats that you choose are healthy, too. For example, an egg with bacon on a biscuit is laden with refined carbohydrates and unhealthy fat compared to an egg with low-fat cheese on a whole-grain mini-bagel. The same is true of a chicken burger with fries compared to chicken with a baked sweet potato and broccoli.

Protein has the power to improve health and increase weight loss, but it can take a while before you get into the habit of harnessing protein’s full potential. Your Lark personal health coach can give you the reminders and tricks that you need for using protein as best you can as you log meals and chat with Lark.

Here are some tips on how to not lose all of your hard earned weight loss progress this Thanksgiving and Holiday Season.

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What Does It Mean to Have Pre-Diabetes?


Prediabetes definition and facts

  • Prediabetes means your blood sugar is higher than normal, but not high enough to diagnose type 2 diabetes.

  • Prediabetes typically has no symptoms or signs; however, it has been associated with being overweight.

  • Usually, blood sugar is high because of insulin resistance, meaning glucose can't get into the cells to be used for energy.

  • Prediabetes is diagnosed with blood tests.

  • Prediabetes levels of blood sugar fall in the range of 100-125 when blood glucose is measured fasting.

  • Prediabetes is reversible by getting healthier.

  • Treatment for prediabetes begins with getting more physically active. All exercise helps reverse prediabetes, especially exercise that helps build muscle.

  • Following a low glycemic index, low carb diet, and following a healthier lifestyle helps reverse prediabetes.

  • Medications and dietary supplements also can be used in reverse prediabetes management.

  • Without making lifestyle changes (or taking medication), the "side effect" of prediabetes is that it is likely to progress to type 2 diabetes.

What is prediabetes?

Prediabetes is the term used to describe elevated blood sugar (glucose) that has not yet reached the threshold of a type 2 diabetes diagnosis. Consider pre-diabetes a warning sign that it is time to take your health more seriously.

What is the difference between prediabetes and type 2 diabetes?

  • Prediabetes occurs when there is too much sugar (glucose) in the blood. It is an early warning sign that the body has more sugar in the blood then it can use.

  • Type 2 diabetes is a condition that occurs slowly over time. The pancreas cannot produce enough insulin to keep up with the increased need to move sugar into the cells for energy. Medication and lifestyle changes are necessary to manage blood sugar levels and avoid diabetes complications.

  • Type 1 diabetes is different, and results from auto-immune attacks on the pancreas.

What are the signs and symptoms of type 2 diabetes?

Without reversing prediabetes, blood sugar continues to rise and signs and symptoms of diabetes may develop. The most common symptoms and early signs are thirst and excess urination. Sometimes people will notice unexplained weight loss. Later signs of type 2 diabetes are

  • Fatigue

  • Blurry vision

  • Slow healing wounds or bruises

  • Thirst

  • Excess urination

  • Unusual smell to the urine

What causes prediabetes, and what are the risk factors for prediabetes?

Pre-diabetes is a warning sign that metabolism is getting out of balance. Humans are designed to be physically active hunters and gatherers who move a lot and eat only occasionally. This isn't what most of us do. Essentially, the underlying cause of prediabetes is that there is more fuel (glucose) available than can be used up. This can be because of excess intake of dietary carbs and sugars, because of insulin resistance, or because the liver is making too much glucose. The easiest causes of prediabetes to manage are insulin resistance and excess dietary intake. For many people with prediabetes, it can be reversed with exercise in combination with a eating a low-carb diet (low-glycemic index diet).

Some of the risk factors for prediabetes include


Quick GuideDiabetes Diet: Healthy Meal Plans for Diabetes-Friendly Eating

Symptoms of Type 2 Diabetes

Type 2 diabetes is an epidemic in the US; symptoms include

  • Frequent urination

  • Blurry or cloudy vision

  • Fatigue

  • Erectile dysfunction (ED, impotence)

  • Excessive thirst...

Could you have type 2 diabetes? Read the rest of the symptoms »

What are the signs and symptoms of prediabetes?

Unfortunately, there really are no symptoms or signs of prediabetes. It almost always is diagnosed by chance during a medical screening or routine bloodwork. This is why it is important to get screened, especially if you are overweight or have family members with diabetes or pre-diabetes. However, the most common sign associated with prediabetes is being overweight.

It is common for a person with prediabetes to only have slightly elevated blood sugar levels, but the body continues to require increased insulin to maintain it. Hyperinsulinemia or high insulin, has signs and symptoms of:

  • Sleepiness (after a meal)

  • Lethargy

  • Weight gain around the abdomen

Occasionally, people may notice they are thirstier than normal or are urinating more frequently.


Is there a test to diagnose prediabetes (HbA1c and prediabetes chart)?

There are three blood tests that can diagnose prediabetes and type 2 diabetes.

Hemoglobin A1c (HbA1c)

  • Hemoglobin A1c (HbA1c) measures the average blood sugar (glucose) over the last 3 months. It is a measure of how much sugar is attached to your red blood cells.

  • A pre-diabetes level is 5.7% and 6.4%.

  • An HbA1c > 6.5% is considered a diabetes glucose level.

Fasting blood sugar levels (serum glucose)

  • Fasting blood sugar or serum glucose is a measure of your blood sugar first thing in the morning before you have eaten anything.

  • Prediabetes also can be identified with serum glucose, or blood sugar level. A fasting blood sugar test of 100-125 mg/dl indicates prediabetes.

Oral glucose tolerance test

  • Prediabetes and diabetes also can be diagnosed with an oral glucose tolerance test. This test measures how high blood sugar levels get at fixed time intervals after consuming a high sugar content beverage. This test is most commonly used to diagnose diabetes related to pregnancy(gestational diabetes).

Prediabetes glucose levels are shown here in a chart of normal, prediabetes, and diabetes lab test numbers so you can make comparisons.

Prediabetes Chart


HbA1c5.6% or less5.7%-6.4%6.5% or more

Fasting blood glucose99mg/dl or less100-125mg/dl126mg/dl or more

Oral glucose tolerance140mg/dl or less140-199mg/dl200mg/dl or more



Can prediabetes be reversed?


Prediabetes can be reversed with lifestyle changes. This includes being more physically active and following a healthy diet plan such as a low glycemic index diet, rich in quality, real foods. Quitting smokingstress management, and keeping alcohol intake moderate all help too. If lifestyle is not changed, prediabetes usually progresses to diabetes.

How do I monitor my efforts to reverse prediabetes?

When you are working to reverse prediabetes, your health-care professional will advise you on how often you should have your blood tests checked – usually every 3 months.

Having your own personal home glucose monitor (finger stick test) gets you involved in managing your prediabetes, and also can help you track your progress. Write down the numbers and what was consumed to learn how you respond to different meals. This is a great way to test different prediabetes meal plans to find out what foods cause your blood sugar levels to go up the least, and the most!

Do the following to track your meals and foods.

  • Check your blood sugar and write it down.

  • Enjoy your meal and write down what you ate and the portion sizes.

  • In two hours, check your blood sugar and write it down. Did that meal treat your body well? How much did your blood sugar go up? How did you feel?

  • Keep a log of these readings to discuss them with your health-care professional or nutritionist to problem-solve ways to make better diet choices. This will help you find foods to eat and foods to avoid for your personal situation.


What is the treatment for prediabetes?

Prediabetes is best treated with a proactive, renewed commitment to getting healthier, and making healthier choices every day. It can, and usually is, treated with diet and exercise alone. However, some people with prediabetes are treated with a medication called metformin (Glucophage, Glucophage XR, GlumetzaFortametRiomet). Research published in the New England Journal of Medicine showed that lifestyle changes reduced diabetes incidence by 58% compared to metformin, which reduced the incidence by only 31%.1

If you have been diagnosed with prediabetes, discuss a treatment plan with your health-care professional.


Is there prediabetes diet?

The best foods for prediabetes are

  • healthy proteins and fats,

  • lots of vegetables,

  • some fruits, and

  • some low glycemic index carbohydrates like quinoa, oatmeal, and brown rice.

The foods to eat for prediabetes are real foods in their natural or whole form. There needs to be a balance of fat, protein, and carbohydrate. Drinking lots of water or unsweetened tea also is important.

Food to avoid for prediabetes management

And easy way to identify the most important foods to avoid is to avoid any food that is white. This includes

  • Sugar (and anything made with sugar)

  • White flour (and anything made with flour)

  • White bread

  • White rice

  • White pasta

  • White potato, etc.

Cauliflower is white, but it is a good food for prediabetes because it is a whole, real vegetable.

It also is best to avoid highly processed foods (like foods that come in boxes or packages already prepared). These foods are high in calories, carbs, chemicals, and low in nutrients and vitamins. Other foods to avoid include:

  • Fried foods

  • Fatty meat such as prime rib, burgers, bacon, and fatty cuts of pork, sausages, greasy burgers, hydrogenated fats.

  • Blackened or burned foods (these cause inflammation)

  • Snack foods like pretzels, chips, or cookies

  • Many “energy bars” (compare nutrition labels - a bar that is friendly for prediabetes will have less than 5 grams of sugars and at least 2 grams of fiber)

  • Meals without any vegetables

  • Sodas, sweetened tea, fruit juice, juice-like sweetened beverages

The take home message is to pay close attention to the quality of all foods - fats, proteins, and carbohydrates – and choose less processed ones.


What about a low carb diet for prediabetes?


A low-carb diet is a great option for prediabetes because it will improve blood sugar, help you lose weight, and help you feel more energetic. Carbohydrates are digested into glucose very easily. A person with prediabetes already has too much sugar in the blood so you don’t want to add any more.

To feel satisfied on a low carb diet you have to eat healthy amounts of protein and fat. Many people continue to try to follow a low-fat or fat-free diet while also trying to make low carb choices, and understandably, feel hungry and frustrated because there is nothing tasty to eat. Recent research published in the British Medical Journal debunked the low fat hypothesis (that people on a low fat diet have a lower risk of developing prediabetes).2 People actually are not at a lower risk of prediabetes.

What is the glycemic index?

The easiest way to choose quality carbohydrates by following a low glycemic index diet. With a low glycemic index diet you balance the carbohydrate/sugar content of a meal with enough fiber, fat, and protein so that the meal is digested and absorbed slowly. This gradually releases glucose into the bloodstream, and thus the body does not require a large amount of insulin. It also provides the body with good, steady energy over many hours.


What are examples of good food choices for a prediabetes diet?

Choosing quality fats and proteins means choosing real food rather than processed versions. Believe it or not, a serving of organic full-fat Greek yogurt with real raspberries will be much more satisfying, and better for your blood sugar and weight, than the fat-free fruity version.

Good protein choices include:

  • Organic poultry (chicken or turkey)

  • Grass-fed red meat (beef or buffalo)

  • Organic lean pork

  • Wild fish and seafood

  • Whole eggs

  • Plant-based proteins such as

    • beans

    • lentils

    • nuts

    • seeds

    • tofu

    • peas

    • protein powders for smoothies

Organic and grass fed choices are important because what an animal eats changes the nutrition of the meat. Non-organic and factory-fed animal meats increase inflammation. In prediabetes, this means increased risk for heart disease and complications.

Make at least some of your meals vegetarian because plant-based fats are associated with lower oxidized LDL and less inflammation. Good fat choices include

  • Avocado

  • Olive oil

  • Coconut oil and coconut milk

  • Organic full-fat dairy products

  • Wild, cold water fish

  • Grass-fed red meat

  • Dark meat from pastured poultry

Check labels because hydrogenated fats are often are used in packaged bakery products.


What about exercise and prediabetes?

All exercise helps reverse prediabetes by using up sugar in the bloodstream and improving insulin sensitivity. An exercise plan should focus on two things:

  1. Be physically active every day. This could be a walk after dinner, doing yard work or gardening, playing with the kids, swimming, biking, dancing, etc. Tracking the number of steps you take each day with a smartphone or fitness tracker can be very helpful.

  2. Focus on building more muscle a few times a week.

Increasing muscle strength makes the cells of the muscle "hungrier (more insulin sensitive), and that equals a healthier metabolism. You can build muscle by using weights, your own body weight, or resistance bands. If you choose weight training start slowly, and ask for help using the equipment safely and properly. Begin with low weights, and gradually work up to heavier weights. Lifting one round of heavy weights for only 6-8 repetitions has more benefit than one round of light weights for 10 or more repetitions. If you can do more than 10 repetitions, add more weight.

This plan also is great if you are in a hurry. You can complete a full workout in just 20 minutes twice a week. Work up to this gradually to avoid injury.

If you like cardiovascular exercise, focus on short bursts of high intensity activity. Research studies show that few people lose weight by spending an hour on a treadmill or elliptical machine. Lifting heavy weights, and short sprints that make you breathless helps you lose weight best. For most people, this is less than 90 seconds, after which, you should walk until you catch your breath and do it again! You'll be done in 20 minutes.

And, as always check with your health-care professional before starting any exercise program and get help using equipment properly to avoid injury.


What medications or supplements treat prediabetes?

Metformin is the only medication approved by the FDA to treat prediabetes. It works by stopping the liver from producing excess glucose. For some people, metformin also helps them lose weight. It can be an option for people who aren't ready or able to make lifestyle changes right away. Metformin also is a medication that can be discontinued as soon as blood sugar levels are at goal, and healthy lifestyle habits have become routine.

Some dietary supplements have good evidence of helping reverse prediabetes. For example, most people with prediabetes are deficient in vitamin D and magnesium. Both of these are necessary to keep cells properly sensitive to insulin. A health-care professional can order a blood test to check and see if your deficient in these and other nutrients, for example, chromium, biotin, and N-acetyl cysteine. These also are nutrients that have research supporting their role in improving insulin sensitivity.3 Check with a health-care professional before taking supplements. You may need to find one with this specialized knowledge such as a naturopathic doctor, nutritionist, or integrative medicine doctor.


What kind of doctor treats prediabetes?

Prediabetes is typically diagnosed and managed by your primary care practitioner, including internists and family medicine specialists, or pediatricians in the case of children or adolescents. Other specialists who may be consulted include physicians who specialize in endocrine glands and hormones including diabetes management (Endocrinologists). A nutritionist can be consulted to help you review your diet and suggest dietary and lifestyle changes. A personal trainer can be helpful if you are having a hard time putting together an exercise plan for yourself. There are a lot of self-care resources too. Eating healthier, exercising, and losing weight are ways to improve your health, and are key to prediabetes treatment.


Can prediabetes be prevented?

Absolutely! The best way to prevent prediabetes are to

  • stay active,

  • eat a healthy low glycemic index diet, and

  • handle stress in healthy ways.

If you had gestational diabetes, you may want to pay special attention to adopting the habits discussed in this article.

Most importantly, for people with prediabetes, diabetes can be prevented by taking action now.


What is the prognosis for a person with prediabetes?

Unfortunately, most Americans with prediabetes don't make healthy changes or aren't empowered to take control of their health. Because of this, most people with prediabetes do progress to diabetes. But the good news is, and what research proves, is that with physical activity and healthier foods 58% of new cases of diabetes can be prevented.


1. Diabetes Prevention Program Research Group. "Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin." N Engl J Med 2002; 346:393-403.

2. Ramsden, C. E. et al., "Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968-73)." BMJ 2016;353:i1246.

3. Mwiti, K. C., et al. "The Biochemical Role of Macro and Micro-Minerals in the Management of Diabetes Mellitus and its Associated Complications: A Review." Int J Vitam Nutr Res. 2015;85(1-2):88-103.

If you're not already a member of the Lark app, we recommend taking advantage of the Coach like so:

  • Use the link below to get the "Lark Coach" app;

  • The app will open and you'll be prompted to indicate your basic eligibility information, which determines whether the $600 program is covered by your insurance!

  • If you qualify, you'll find out and we'll activate the free health Coach + send you the FitBit, scale, and more.

The Lark Coach is the most innovative thing to happen to health in years, especially when it comes to losing weight and preventing diabetes. Lark was named the most Innovative Company in the World; Apple and Google named it “Top App” and “Best of 2016” as well. See how she can help you.


Diabetes | NOT Just For Your Parents

By Natalie Stein, BS Food Science, BS Nutritional Sciences, MS Human Nutrition, MPH Public Health

December 23rd, 2017

Diabetes may have seemed like something that your parents or grandparents had to worry about, until now. It can be a shock to learn that you have pre-diabetes or another risk factor for diabetes, but you can use it as a wake-up call. A healthier lifestyle can help you can lower your risk of diabetes by over half. That is where you do have the advantage over your parents - healthier foods, an encouraging culture, and even helpful technology are available today!

Who’s at Risk? may be! Diabetes is not just a condition for other people. It is something that can affect you, too. That National Institutes of Health (NIH) report that over 9% of Americans, or 30 million Americans, have it. Another 84 million Americans - or about 1 in 3 - have pre-diabetes and are likely to develop diabetes within 10 years without lifestyle changes: think healthier diet, more physical activity, and weight loss.

Beat Your Parents

You may have their risk factors, but you have way more tools at your disposal than your parents might have. You have the upper hand on your parents’ generation, from knowledge to choices to a supportive culture. We now know:

  • The value of healthy eating, from the benefits of whole grains and healthy fats, to the harms of added sugars and trans fats.

  • How physical activity can lower insulin resistance and blood sugar levels.

  • The role of getting enough sleep in managing blood sugar.

  • That losing just a few extra pounds can significantly lower diabetes risk.

A Culture of Health

Healthy opportunities are all around, and healthy behaviors are increasingly the norm. Are you doubtful that health is “in?” A look around the supermarket may convince you otherwise. Foods that were specialty items or even unavailable a few years ago are now mainstream - think about:

  • Whole-grain wraps and whole-grain versions of almost all grains.

  • Fresh vegetables of all kinds available year-round.

  • All-natural peanut butter without added sugars or trans fats.

  • Nitrate-free, low-sodium sandwich meat.

As for exercise, there have never been more gyms, fitness opportunities, or casual walkers to keep company.

The Final Piece of the Puzzle

You may have a reason to want to develop healthier habits; you may know what you need to do to lose weight and get healthier; and you may have the nutritious foods and walking paths available to you. Now what? There may be another piece of the puzzle: a health coach.

Your parents may not have had a personal health coach, but you can. Your Lark coach is available 24/7 to give encouragement, ideas, and reminders to put you on the right track and keep you there. She may be the tool you need to get your diabetes risk down.