Newsmaker
Can I control my appetite and my hunger?
In general appetite is a learned response. It can be adaptive to stimuli and environmental factors and variable. Stress, emotional and psychological variables will result in behavioral changes, thus changes in appetite.
In contrast, hunger is an physiological response. It is an inborn behavior, common to all animals. It is a need based derive.
We can control our appetite, but not our hunger.
Ara Keshishian, MD, FACS

Completely Novel Action Of Insulin Unveiled
A Ph.D. student at Sydney’s Garvan Institute of Medical Research has uncovered an important piece in the puzzle of how insulin works, a problem that has plagued researchers for more than 50 years. The research brings scientists one step closer to explaining exactly how insulin prompts fat and muscle cells to absorb glucose.

“Since the 1920s, when Banting and Best discovered insulin, scientists have been battling to discover how it actually works,” said Professor David James, head of Garvan’s Diabetes Program. “Then along comes Freddy Yip, doing his PhD, who unveils a completely novel action of insulin, one which we believe plays a fundamental role in glucose uptake, a process that is defective in Type 2 diabetes.” There are two processes involved in Type 2 diabetes: insufficient production of insulin in the pancreas after a meal and faulty uptake and storage of glucose in fat and muscle cells, or ‘insulin resistance’.

Freddy’s finding focuses on the intersection between these two processes. “In the cell we have seriesof motor proteins that have the ability to move other molecules from one place to another along intracellular rail road tracks,” he explained. “I have discovered that insulin activates a specific kind of motor protein known as Myo1c, which in turn performs a critical role in glucose uptake.” Insulin controls glucose uptake into our fat cells by moving glucose transporter proteins from inside the cell to the surface membrane so that they can pump glucose into the cell. Myo1c aids in this process by helping the
transporters slide into the surface membrane.

In healthy people, around 80% of the glucose transporters migrate to the cell membrane after a meal, allowing plenty of glucose into the cell. In people with Type 2 diabetes, however, that figure drops to around 10%. Freddy Yip believes his study will create a strong foundation for future diabetes research. “We knew before that Myo1c was somehow involved in the regulation of glucose transport. My research indicates that Myo1c is a major target of insulin action and helps to accelerate the delivery of transporters to the membrane,” he said. “We think there may be blockages in the signal between insulin and myo1c in people who develop insulin resistance. If we’re correct, it should be possible to target that pathway for development of new therapies.”

Professor James sees the finding as a welcome milestone on a very long road of discovery. “While we’re certainly not saying we’ve found a way to cure diabetes, we are saying we’ve found a pretty significant clue.”

Treatment of diabetes and weight gain: A vicious cycle

There is a common concern that some oral agents or insulin can cause weight gain.

What insulin does to the body:

1. Regulates the liver from releasing too much glucose (I like to say that insulin leans up against the door of the liver and only lets a little glucose out at a time).
2. Acts as a “doorman, or key” to open the doors of the cells and allow glucose to enter the cells.
3. Acts as a storage promoter, to store extra glucose back into the liver, along with the muscles, while the excess is stored as fat.

The person without diabetes:
So as a person without diabetes, whenever I overeat, my pancreas automatically releases extra insulin to take care of my extra food intake; if I don’t exercise it off, that excess food gets stored as fat and I gain weight. Remember Rhoda on the Mary Tyler Moore Show? To paraphrase her comment, she said “don’t bother giving me that candy bar-just apply it directly to my hips, since that’s where it will eventually end up!”

The person with diabetes:
In contrast, with diabetes, if you don’t have enough insulin, then when you overeat, not all the food can enter the cells (to store in the liver and muscles, with the excess stored as fat); some of the glucose from your food just piles up in the blood, and gets urinated out-what I call a “false” weight loss/weight control.

What insulin does to the body:
If your diabetes were out of control for awhile, you were losing weight without trying; then as your blood glucose improved from taking diabetes medication, this would mean that instead of urinating out your food/calories, you were now able to retain your food and use it as energy (as well as store the excess in muscle and fat). The long-term studies proving that good diabetes control matters (i.e. the DCCT and UKPDS) also showed that people gained weight as their control improved. Despite the fact that losing weight and exercising are the keys to decreasing the risk of developing type 2 diabetes or to controlling diabetes and decreasing the risk of heart disease, experts have also agreed
that:

1. controlling glucose is important, even if it means gaining some desirable weight (the average weight gain in the DCCT was 10 pounds);
2. certain diabetes medications may not cause as much weight gain as others;
3. careful meal planning and exercise can help to limit the weight gain.

Overeating:
True, if you are overeating and/or not exercising enough, and are thus requiring more oral agents or insulin, then you will gain weight because the diabetes medication is supporting your excess food intake. In the April, 2002 issue of Diabetes Forecast, Sheldon Gottlieb, MD addressed the issue of diabetes medication and weight gain, and commented that some people use insulin as a “carbohydrate credit card.” I hope you get my point that in this instance, the diabetes medication itself did not cause weight gain, but rather the excess calories did.
Insulin sensitizers (Thiazolidinediones) and weight gain:
These drugs (trade names Actos® and Avandia®), which are used in treating insulin resistance, also are associated with weight gain. They interact with a receptor in tissue that may convert it into fat cells, although how this occurs is not yet well understood. Despite the weight gain, this class of drugs is associated with improved cardiovascular function. To limit the weight gain, the drug Metformin (trade name Glucophage®) is often added.
Insulin and weight gain:
Generally, we tend to say that people might be prone to gain more weight on insulin, rather than on oral agents. But in addition to the issues discussed above, another common reason for weight gain is often related to the actual insulin regimen one is oni. e. if you take pre-mixed, intermediate, or long-acting insulin twice daily, you are forced to eat on time, to avoid skipping meals, and to anticipate exercise by taking an extra snack or decreasing your insulin, etc.-and this restricted regimen makes it harder to control weight. Often, using a rapid-acting insulin with each meal, with a bedtime dose of Lantus or NPH, or using an insulin pump, combined with careful diet and exercise, will allow you more flexibility in your lifestyle and an easier time controlling weight.

Newsmaker
In and ideal case we would like to have the blood work here in the office when a patient is here for their follow up. More often than not, some of the results may still be pending, weeks after they were drawn. This is because some of the highly specific vitamin and mineral levels that we request are only performed by only a handful of laboratories across the country. This means that your blood needs to be sent from the lab that you had it drawn at, to the specialty lab and the results need to be sent back thru the same channels to out office. This may explain why some patients may get update letters from out office, sometimes weeks later, recommending for changes in their supplements, even after they were seen in the office.
Ara Keshishian, MD, FACS

How Fatty Foods Curb Hunger
Fatty foods may not be the healthiest diet choice, but those rich in unsaturated fats – such as avocados, nuts and olive oil – have been found to play a pivotal role in sending this important message to your brain: stop eating, you’re full.

A new study by UC Irvine pharmacologists shows that these fats trigger production of a compound in the small intestine that curbs hunger pangs. This discovery, the researchers say, points toward new approaches to treating obesity and other eating disorders. Daniele Piomelli, the Louise Turner
Arnold Chair in Neurosciences, and his colleagues have studied how a fat-derived compound called oleoylethanolamide regulates hunger and body weight. In their current work, which appears in the Oct. 8 issue of Cell Metabolism, they found that an unsaturated fatty acid called oleic acid stimulates production of OEA, which in turn decreases appetite.

Oleic acid is transformed into OEA by cells in the upper region of the small intestine. OEA then finds itsway to nerve endings that carry the hunger-curbing message to the brain. There, it activates a brain circuit that increases feelings of fullness. In previous studies, Piomelli found that increasing OEA levels can reduce appetite, produce weight loss and lower blood cholesterol and triglyceride levels. Piomelli believes OEA could be used in a variety of drugs because it is a key to the way the body naturally handles fatty foods and regulates eating and body weight. “We are excited to find that OEA activates cell receptors that already have been the focus of successful drug development,” he said. “This gives us hope for a new class of anti-obesity drugs based on the savvy use of natural appetitecontrolling mechanisms.”

Nearly 30 percent of Americans are obese, according to the Centers for
Disease Control and Prevention, which has declared obesity an epidemic disease. The occurrence of obesity has risen by almost 60 percent since 1991, and it greatly increases the risk of premature death, diabetes, heart disease, stroke and some cancers.

Piomelli’s study colleagues include Jin Fu and Giuseppe Astarita of UCI; Gary Schwartz and Xiaosong Li of Yeshiva University; and Silvana Gaetani, Patrizia Campolongo and Vincenzo Cuomo of the University of Rome. The National Institutes of Health, New York Obesity Research Center, the Skirball Institute of Biomolecular Medicine and the Italian Ministry of Research supported the study.

Antioxidant Effects From Eating Almonds
Eating almonds significantly decreased levels of two biomarkers for oxidative stress in a group of 27 male and female volunteers with elevated cholesterol. The study was conducted by scientists funded by the Agricultural Research Service, the Almond Board of California, and the Canada Research Chair Endowment.

Coauthor Jeffrey Blumberg is director of the Antioxidants Research Laboratory at the Jean Mayer USDA Human Nutrition Research Center on Aging (HNRCA) at Tufts University in Boston, Mass. He and colleagues reported the findings from this study in the Journal of Nutrition. HNRCA scientists analyzed blood and urine samples from the subjects who had consumed three different dietary treatments, consisting of the same amount of calories each, for one month. The study was a cross-over, randomized clinical trial, so eachsubject received each treatment in random order.

Treatments consisted of a “full dose” of almonds, defined as 73 grams daily (about 2.5 ounces), a “halfdose” of almonds plus a half-dose of muffins, and a full-dose of muffins as a control. The subjects consumed a low-fat background diet and were counseled on strategies to maintain weight and to consistently follow their usual exercise routines throughout each test phase.

The researchers wanted to investigate possible antioxidant effects from eating almonds. The team found that when the volunteers ate the full dose of almonds, their concentration of two biomarkers of oxidative stress– plasma malondialdehyde (MDA) and urinary isoprostanes–were significantly lowered. MDA decreased by nearly 19 percent compared to the start of the study in the full-dose almond group. Isoprostane decreased by 27 percent in both the almond groups when compared to the control period, suggesting a possible threshold effect for that biomarker. While this study helps to show the antioxidant benefit of eating almonds, further research is needed to shed light on the individual contributions of vitamin E and polyphenolic constituents, such as flavonoids, found in almonds and other tree nuts. The study did not demonstrate a minimum amount of dietary almonds that would result in a biological effect.

Newsmaker
What is the source of your healthcare?
Newsletters, emails, group meetings, websites or neighbors?
It is very important to put the source of the information into
perspective. The information you may get from any of the above
sources will lack any perspective. A generalized statement made in a group meeting is not in any way form or fashion to be taken as a specific recommendation of your particular case.
Ara Keshishian, MD, FACS

Naturally Produced ‘Rotten Egg’ Gas Helps Control Blood Pressure In Body, Researchers Find
Anyone with a nose knows the rotten-egg odor of hydrogen sulfide, a gas generated by bacteria living in the human colon. Now an international team of scientists has discovered that cells inside the blood vessels of mice — as well as in people, no doubt — naturally make the gassy stuff, and that it controls blood pressure.

Having discovered that hydrogen sulfide, or H2S, is produced in the thin, endothelial lining of blood vessels, the researchers, including scientists from Johns Hopkins, now report in Science that H2S regulates blood pressure by relaxing blood vessels. As the newest member of a family of so-called gasotransmitters, this messenger molecule is akin in function, if not form, to chemical signals like nitric oxide, dopamine and acetylcholine that relay signals between nerve cells and excite or put the brakes on mind-brain activities.

“Now that we know hydrogen sulfide’s role in regulating blood pressure, it may be possible to design drug therapies that enhance its formation as an lternative to the current methods of treatment for hypertension,” says Johns Hopkins
neuroscientist Solomon H. Snyder, M.D., a co-author of the paper. Conducting their investigations using mice missing a gene for an enzyme known as CSE, long suspected as responsible for making H2S, the researchers first measured
hydrogen sulfide levels in a variety of tissues in the CSE-deficient mice and compared them to normal mice. They found that the gas was largely depleted in the cardiovascular systems of the altered mice, engineered by Rui Wang, M.D., Ph.D., of Lakehead University in Ontario, and Lingyun Wu, M.D., Ph.D., of the University of Saskatchewan, Canada. By contrast, normal mice had higher levels — clear evidence that hydrogen sulfide is normally made by mammalian tissues using CSE. Next, the scientists applied tiny cuffs to the tails of the mice and measured their blood pressure, noting spikes of about 20 percent, comparable to serious hypertension in humans.

Finally, the team tested how blood vessels of CSE-deficient mice responded to the chemical neurotransmitter methacholine, known to relax normal blood vessels. The blood vessels of the altered mice relaxed hardly at all, indicating that hydrogen sulfide was largely responsible for relaxation. Because gasotransmitters are highly conserved in mammals, the findings of the research are believed to have broad applications to human physiology and disease.

“In terms of relaxing blood vessels, it looks like hydrogen sulfide might be as important as nitric oxide,” Snyder says, referring to the first gasotransmitter that two decades ago was discovered to regulate blood pressure.

Just because these two gas molecules perform similar functions, doesn’t mean they’re redundant, says Wang, the paper’s principal author. “Nature has added on layer upon layer of complexity to provide a better and tighter control of body function — in this case, of blood pressure.”

Studying gaseous messengers can be tricky, explains Snyder, an authority on nitric oxide (NO) whose lab in 1990 discovered that the enzyme triggering NO production is activated by a protein mechanism known as calcium-calmodulin. “When a nerve fires, it releases a bit of neurotransmitter. Then it fires again, very quickly, and releases more of the neurotransmitter, which is always in reserve and at the ready in large storage pools called vesicles. However, gasses can’t be stored; they diffuse. So every time there’s a nerve impulse, an enzyme must be activated to make it,” he says.”

Although CSE, the enzyme that activates hydrogen sulfide, was characterized more than half a century ago, the new work is the first to reveal that it is activated in the same way as the nitric oxide-forming enzyme, thus establishing how hydrogen sulfide regulates blood pressure by relaxing blood vessels. “It’s difficult to overestimate the biological importance of hydrogen sulfide or its implications in hypertension as well as diabetes and neurodegenerative diseases,” Wang says. “In fact, most human diseases probably have something to do with gasotransmitters.”

The research was supported by grants from the U.S. Public Health Service and the Canadian Institutes of Health Research as well as a Research Scientist Award.

Authors on the paper are Guangdong Yang, Lingyun Wu, Bo Jiang, Wei Yang, Jiansong Qi, Kun Cao, Qinghe Meng, all of the University of Saskatchewan, Canada; Wang of the University of Saskatchewan and Lakehead University, Canada; Shengming Zhang of Lakehead University, Canada; and Asif K. Mustafa, Weitong Mu and Snyder, all of Hopkins.

Newsmaker
Look on the label of a sugar-free candy, and you’re likely to see words like maltitol, xylitol, and sorbitol. These are sugar alcohols. However, they aren’t actually sugar or alcohol. So what are these substances and how will they affect your body? This sounds like “Enron accounting” where things are not what they are advertised as. More on this later. The most important thing to remember is that as a consumer we all need to read the labels and clearly understand what it all means. An example is “…sugar free, contains sugar alcohol….” what does all this mean. It should also be noted that sugar alcohols can cause profound diarrhea and gas post Duodenal Switch and should be avoided.
Ara Keshishian, MD, FACS

 

What are sugar alcohols?
Sugar alcohols are carbohydrates which are also called “polyols.” Part of their chemical structure resembles sugar, and part of it resembles alcohol — hence the confusing name. Examples of common sugar alcohols are maltitol, sorbitol, isomalt, and xylitol.

Where do sugar alcohols come from?
Sugar alcohols occur naturally in plants. Some of them are extracted from plants (sorbitol from corn syrup and mannitol from seaweed), but they are mostly manufactured from sugars and starches.

Why use sugar alcohols?
Sugar alcohols are like sugar in some ways, but they are not completely absorbed by the body. Because of this, the blood sugar impact of sugar alcohols is less and they provide fewer calories per gram. Additionally, sugar alcohols don’t promote tooth decay as sugars do, so are often used to sweeten chewing gum. One, xylitol, actually inhibits bacterial growth in the mouth.

It’s important to note, however, that the different types of sugar alcohols act very differently in the body (see chart below).

How are sugar alcohols labeled?
The names of the individual sugar alcohols will be on the ingredient list of any product that contains them. They will be included in the amount of carbohydrate on the label, either in the total or on a separate line for sugar alcohols. If the product is labeled “sugar-free” or “no added sugar,” the manufacturer must show the sugar alcohol count separately. As I indicated above, sugar-free does not mean sugar alcohol free.

How do sugar alcohols compare to other carbohydrates?
Though sugar alcohols have fewer calories than sugar, most of them aren’t as sweet, so more must be used to get the same sweetening effect. Still, there is a range of sweetness and impact on blood sugar among the sugar alcohols.

The presence of Sugar Alcohol is sugar free food is the dietary version of the Enron Accounting. The label may suggest there is no calories from Sugar, thus Sugar Free label, yet is contains calories from Sugar Alcohol. This is usually listed separately and usually in fine print. By Paying close attention to the ingredients of food purchased, patients can avoid some of the common problems that we see in the office. Inadequate weight loss, weight regain, gas , bloating etc.

Newsmaker
There is an continuous stream of information that highlight the importance of certain supplement. As post up patient you may not be able to tolerate the source food of those minerals and vitamins. Green vegetables may be a good source of Folate, yet they may cause increase bowel movements. In Contrast nuts may be much better tolerated..
Ara Keshishian, MD, FACS

New Evidence On Folic Acid In Diet And Colon Cancer
Researchers in the United Kingdom and Texas are reporting a new, more detailed explanation for the link between low folate intake and an increased risk for colon cancer, the second leading cause of cancer
death in the United States.

Their study reinforces the importance of folate in a healthy diet. Susan Duthie and colleagues note that researchers have known for years that a deficiency
of folate, one of the B vitamins commonly called folic acid, increases the risk of birth defects. As a result, manufacturers enrich some foods with folate.

Scientists also have found that low folate in the diet increases the risk of developing colon cancer in adults. However, scientists lack an adequate explanation of how folate depletion affects the genes, proteins, and cells
involved in cancer. In this new research, scientists grew human colon cells in folatedepleted and folateenriched tissue culture. They found that folate depletion caused increased DNA damage and a cascade of other biological changes linked to an increased cancer risk.

About Folic Acid

What is folic acid?

• Folic acid, also called folate or folacin, is a B vitamin often lacking in the diet.
• When consumed in adequate amounts by women before and during pregnancy, folic acid reduces the risk of serious birth defects of the
  brain and spine, called neural tube defects.
• Folates also are needed for cell growth and blood production. As a fetus grows, it takes folates from the mother’s blood, which in turn
  creates a shortage in the mother.
• Because of their control over homocysteine, an amino acid
  produced by the body, folates are thought to give some protection against heart disease. High levels of homocysteine in the blood may be a risk factor for heart attacks.
• Additional health benefits associated with folic acid consumption include reduction in depression, colon, cervical, and breast cancers. It also may help prevent memory loss and susceptibility to Parkinson’s disease.

Where do I get it?

• Foods rich in folic acid include fortified breakfast cereals, enriched breads, pastas and grains, dried beans and peas, orange juice,
  oranges, cantaloupe, avocados, green leafy vegetables, broccoli, lima
  beans, nuts, and peanut butter.
• Some cereals are fortified with 100 percent of the recommended daily amount of folic acid.
• Effective Jan. 1, 1998, enriched grain products, such as white bread and flour, pasta and rice, were required to be fortified with folic acid.

How much do I need?

• Females of childbearing age need 400 micrograms from fortified foods
  and/or supplements daily in addition to what they get from food. Because spina bifida and similar birth defects occur in the first two weeks of pregnancy, women need to build up their folate stores long before they become pregnant. Once they realize they are pregnant, it is too late.
• Because 50 percent of pregnancies in the United States are unplanned, it is even more crucial for all women of childbearing age to continually
  consume large intakes of folic acid.
• Centers for Disease Control and Prevention (CDC) reported a 26 percent decrease in the incidence of neural tube defects following folic acid fortification.
• Adult men and older women need 400 micrograms (μg) of folate.
• To obtain 400 micrograms per day through diet, eat according to the Dietary Guidelines for Americans and include a highly fortified breakfast cereal. For individuals unable to get enough folic acid from the diet, a vitamin supplement is strongly recommended.
• Grain foods and breakfast cereals contribute over 62 percent of dietary folic acid, according to a study conducted by the Bell Institute of Nutrition.

Newsmaker “…But my surgery was 2 years ago…” This was the response that I got after I questioned a patient as to why were we not contacted when the patient was having abdominal pain. Granted, not all of the aches and pains following a weight loss surgery, are related to it. However it is important for post weight loss surgical patients to remember that as your surgeon, we would like be kept informed, especially if new changes occur. Ara Keshishian, MD, FACS

What Is Stevia?

Stevia is one of the most health restoring plants on earth. What whole leaf Stevia does both inside the body and on the skin is incredible. Native to Paraguay, it is a small green plant bearing leaves which have a delicious and refreshing taste that can be 30 times sweeter than sugar. Besides the intensely sweet glycosides (Steviosides, Rebaudiosides and a Dulcoside), various studies have found the leaf to contain proteins, fiber, carbohydrates, iron, phosphorus, calcium, potassium, sodium, magnesium, zinc, rutin (a flavonoid), true vitamin A, Vitamin C and an oil which contains 53 other constituents. Quality Stevia leaves and whole leaf concentrate are nutritious, natural dietary supplements offering numerous health benefits.

Stevia as a Sweetener
Stevia is the sweetener of the future. Because the human body does not metabolize the sweet glycosides (they pass right through the normal elimination channels) from the leaf or any of its processed forms, the body obtains no calories from Stevia. Processed forms of pure Stevia can be 70-400 times sweeter than sugar. Whether these products are called Stevia, Stevioside, Rebaudioside, Stevia Extract, or Stevia Concentrate, if they are in their pure unadulterated form they do not adversely affect blood glucose levels and may be used freely by both diabetics and hypoglycemics. For people with blood sugar, blood pressure or weight problems Stevia is the most desirable sweetener.

In all of its current forms Stevia has a taste unique to itself. Along with its sweetness there is also a bitter component. The poorer the quality of the leaf the more bitterness is evident in the taste. In good consumer products, however, this bitter flavor disappears as does the slight licorice taste of whole-leaf products when appropriately diluted for consumption. Unlike artificial sweeteners, the sweet glycosides do not break down in heat which makes Stevia an excellent sweetener for cooking and baking.

Stevia as a Dietary Supplement
The vast majority of reported health benefits, both from the research laboratory and consumer experience, comes from daily use of a water based whole leaf Stevia concentrate. Scientific research has indicated that Stevia effectively regulates blood sugar and brings it toward a normal balance. It is sold in some South American countries as an aid to people with diabetes and hypoglycemia. Since its introduction into the US, numerous people have reported that taking 20-30 drops with each meal brought their blood glucose levels to normal or near normal within a short time period. Obviously each individual’s condition is different and such experimentation should be done under the supervision of a qualified physician. An important benefit for hypo-glycemics is Stevia’s tonic action which enhances increased energy levels and mental acuity. Studies have also indicated that Stevia tends to lower elevated blood pressure but does not seem to affect normal blood pressure. It also inhibits the growth and reproduction of some bacteria and other infectious organisms, including the bacteria that cause tooth decay and gum disease.

This may help explain why users of Stevia enhanced products report a lower incidence of colds and flu and why it has such exceptional qualities when used as a mouthwash or added to toothpaste. Many people report significant improvement in oral health after adding Stevia concentrate to their toothpaste and using it, diluted in water, as a daily mouthwash. Stevia is an exceptional aid in weight loss and weight management because it contains no calories and reduces one’s craving for sweets and fatty foods. Hunger sensations are lessened when 10 or 15 drops are taken 20 minutes before meals. Preliminary research data indicates that Stevia may actually reset the hunger mechanism in people where the pathway between the hypothalamus and the stomach has become obstructed. If so, Stevia would help people to feel satiated sooner, helping them to eat less. Other benefits of adding Stevia to the daily diet include improved digestion and gastrointestinal function, soothed upset stomachs and quicker recovery’ from minor illness. Users have also reported that drinking Stevia tea or Stevia enhanced teas helped to reduce their desire for tobacco and alcoholic beverages. Stevia concentrate tablets are available for those who want the medicinal benefits of Stevia concentrate in an easy to swallow tablet form.

The Stevia Leaf
Stevia leaves vary widely in quality due to many environmental factors including soil, irrigation methods, sunlight, air purity, cleanliness, farming practices, processing and storage. There are also numerous species of Stevia with differing Stevioside/Rebaudioside content. Bacterial and fungal contamination is a serious problem and one must be careful about the original source of Stevia. Chinese Stevia leaves are a poor quality, containing only 5-6% of the sweet Steviosides/ Rebaudiosides, while Paraguayan leaves contain 9-13%. Stevia should be compared according to aroma, taste, appearance and sweetness. Leaves are available in tea bags (only from Wisdom of the Ancients at the time of writing) and make a delicious tea. Tea bags may be placed in any beverage desired and make a delightful lemonade. The sweet glycosides are released more rapidly in hot liquid than in cool liquid. You may want to place a tea bag in a small amount of hot water for a few minutes and then add the sweetened water to the beverage. A mild Stevia tea offers excellent relief for an upset stomach. After use, a Stevia tea bag placed over the eyes (similar to using a cucumber) for a few minutes effectively tightens the skin and smoothes out wrinkles. Ground Stevia is excellent when sprinkled lightly over cooking vegetables and meats, cereals and salads. Besides adding its own sweet taste it significantly enhances the flavor and nutritional value of the food. Ground Stevia can be used in many cooking and baking applications.

Stevioside
Refined Steviosides & Rebaudiosides are the sweetest form of Stevia and may be purchased in a semi-white powder form (usually referred to as an extract) or in a clear liquid made by adding the powder to water and a preservative. The powder may be added directly to food and beverage but in very tiny amounts. The liquid is used drop by drop.

Stevioside has over 50% of the commercial sweetening market in Japan, which consumes 90% of the world’s supply of Stevia leaves. The refined Chinese Stevioside product is only 80-91% pure and some samples have been found to be high in pathogens.

Although Stevioside is a desirable sweetener it does not have the extraordinary health benefits of the Stevia leaf or products made from whole leaf Stevia concentrate.

Stevia for Exceptional Skin Care
Water based whole leaf Stevia concentrate offers several exceptional benefits when used regularly in skin care. When applied as a facial mask it effectively softens and tightens the skin, smoothes out wrinkles and helps to heal various skin blemishes including acne. One simply smoothes the dark liquid over the entire face, allowing it to dry for at least 30-60 minutes. As it dries you will feel the skin tightening. A drop of the concentrate may be applied directly on any blemish, acne outbreak, lip or mouth sore. People report success from applying Stevia to a variety of problem skin conditions. Stevia concentrate is also effective when used on seborrhea, dermatitis and eczema. Reports indicate that when a few drops of the concentrate are placed in cuts and scratches there is a more rapid healing of the wound without scarring. This will sting for 30-40 seconds followed by a significant lowering of pain. The concentrate is easily washed away with soap and warm water. In Paraguayan experiments the Stevia concentrate was added to a unique native herbal soap made from edible oils extracted from the seeds and leaves of trees native to the Paraguayan rain forest. Marketed in the U.S. under the name Cream of Coco Hair & Body Shampoo, the soap blends well with the concentrate. Used together these two natural products help retard the graying process and retain natural hair color, eliminate dandruff and various scalp problems, and improve the health and luster of the hair. Many Americans today add the concentrate to this native soap or to their regular shampoo and report excellent results. Most people wash the hair first and then add Stevia concentrate to the second shampoo, allowing it to remain on the hair for a few minutes before rinsing.

Safety of Stevia
There has never been a complaint that Stevia, in any of its consumable forms, has caused any harmful side effects in the 1500 years of use in Paraguay and about 20 years in Japan. Scientists who have studied Stevia state that it is safe for human consumption.

Following extensive research Dr. Daniel Mowrey reported: “More elaborate safety tests were performed by the Japanese during their evaluation of stevia as a possible sweetening agent. Few substances have ever yielded such consistently negative results in toxicity trials as have stevia. Almost every toxicity test imaginable has been performed on stevia extract [concentrate] or stevioside at one time or another. The results are always negative. No abnormalities in weight change, food intake, cell or membrane characteristics, enzyme and substrate utilization, or chromosome characteristics. No cancer, no birth defects, no acute and no chronic untoward effects. Nothing.”

This brief review of the Stevia plant and its worldwide uses in no way constitutes an endorsement of such uses. At this time the FDA permits Stevia to be imported, labeled and sold only for its approved use as a dietary supplement and in skin Care. The information contained is provided for educational purposes only. Medical advice is neither implied nor intended. Please consult your health care professional for medical advice.

Additional reading and information on Stevia here.