Welcome to my blog!

I'm an acupuncturist, teacher, fertility specialist, patient centered advocate, mom, activist and more! This blog is a place for me to write down the things on my mind, the things I discuss over and over, and the things I find helpful, interesting, and inspiring all in the hope that someone else out there, maybe YOU, will find some of these things to be helpful, interesting and inspiring too. I love learning, I love sharing, and I am passionate about helping others lead more balanced, fertile, and healthy lives - while trying to do the same myself. So here goes... The Blogging Life...
Showing posts with label Insulin Resistance. Show all posts
Showing posts with label Insulin Resistance. Show all posts

4.16.2014

Type 3 Diabetes - Alzheimers

One aspect of this "new" (to me!) approach to diet that is really powerfully resinating with folks I'm talking with is the idea of Alzheimer's disease being linked to insulin issues. If that aspect of this discussion is of interest to you here are a couple links you may like:

Here is a nice piece from the New York Times blog by foodie Mark Bittman about it (he has some further links in his piece too).

and, if you are interested in the more technical aspects...

Here is a link to the National Center for Biotechnology Information's review of the data on the hypothesis that insulin plays a role in Alzheimer's which concludes:


Conclusions

Altogether, the results from these studies provide strong evidence in support of the hypothesis that AD  [AD=Alzheimer's Disease] represents a form of diabetes mellitus that selectively afflicts the brain. Positive data stemmed from (1) direct analysis of postmortem human brains with documented AD; (2) an experimental animal model in which brain diabetes with cognitive impairment and molecular and pathological features that mimic AD was produced by intracerebral administration of a drug that is commonly used to produce T1DM or T2DM; and (3) a study showing that PPAR agonists, which are used to treat T2DM, prevent many of the AD-associated neurodegenerative effects of ic-STZ. The data are supported by abundant in vitroexperiments that demonstrated essentially the same or similar effects of STZ or oxidative stress treatments of neuronal cells. The human and experimental animal model studies also showed that CNS impairments in insulin/IGF signaling mechanisms can occur in the absence of T1DM or T2DM. Finally, we demonstrated that although obesity with T2DM causes brain insulin resistance with some features of AD-type neurodegeneration, the effects are relatively modest, not associated with significant histopathological lesions, and lack most of the critical abnormalities that typify AD. Therefore, T2DM was deemed not sufficient to cause AD, although it could possibly serve as a cofactor in its pathogenesis or progression. Altogether, the data provide strong evidence that AD is intrinsically a neuroendocrine disease caused by selective impairments in insulin and IGF signaling mechanisms, including deficiencies in local insulin and IGF production. 




4.04.2014

Carbs?!?

I'm on day 4 of changing my (and my family's) diet to a much lower carb diet than we were used to (not low carb in the grand scheme of things go) and I just had a brief discussion with a friend who is an insider to the natural foods industry. I was telling her about our new plan (she is just starting her own food experiment - the fasting diet) and her thoughts on the low carb idea were, "but we've been eating whole grain for way more than 50 years or whatever the statistics on obesity are saying. And there are lots of cultures who eat whole grains who aren't diabetic and obese."

Which got me thinking. One of the things that was covered at both lectures on insulin and diet was the scary statistic about how much more sugar we've been eating over the last 300 years. I wondered if there was the same data for carbs, and if so, why that wasn't included in the presentations.  Here's what I found...


basically this is from 1909-1997, the black dots are the total carbs consumed, the black bars are what percent of those total carbs were carbs from fiber 

You can see, that the scary statistic about our body being able to handle about 60-80g of net carbs per day and the average american eating 300-800g of carbs isn't quite so scary when you look at this chart. Or, maybe it is... depends on how you look at it. 

The part that makes this chart reassuring is it seems to say, it's not the total carb part of the equation that is the end all be all of the argument. People didn't have diabetes and obesity and infertility rates like we do now in 1909 and they still ate way more than 60-80g of carbs per day.

But, the part that makes this chart scary is how much whole grains and high fiber carbs they were getting vs. our dismally low levels now. If you look at 1909 the percent of carbs that were fiber was way higher.

So, what do I take away from this PLUS the last 4 days of changing my family's diet?
I think we all eat WAAAAY more carbs then we every imagine. I considered my diet to be above average and in line with the healthy eaters of America, and yet once I started to focus on decreasing carbs I realized how much of the low fat, high carbs mentality I had (even though I eat all whole fat dairy and don't use low fat crap, cook with butter, etc. there was still a ton of room for change). We were eating fruit, whole grains, and enough random granola bars, crackers with cheese, and whole grain bread to really wrack up the grams, plus the mindless consumption of sugar... dried fruit, kefir, yogurt, a glass of juice a day, some sweet dessert... you get the idea. We really were eating a lot of healthy foods, PLUS a lot of sugar and mindless carbs.

I also realized how hungry we always were and how we just kept eating more and more... bigger portions, 2nd helpings, frequent snacks. And how our idea of a portion of carbs in particular got really out of control.

And the hungry thing I totally see as linked to the body pumping out insulin all day long because of the constant stream of sugar in the blood. And that I feel is worth a period of decreasing the carbs (not to a crazy low level like some diets suggest), but low enough and long enough to let my body get used to it and stop feeling like the other way is the norm.

The carbs I get from dairy, complex carbs, and fruit I'm limiting to 6og or less per day
I am not counting any carbs from any veggies (except the starchy ones like sweet potatoes)
I am not counting one glass of red wine per day
I am actually eating a fair amount of fruits and grains, but the serving size is WAY smaller to keep the carb total down.

I'm finally starting to feel full and not hungry all the time, and I'm guessing (because I had a pretty healthy diet in other ways) I'm getting off on the lucky side of things. My husband, who has more blood sugar issues is still feeling like he's starving with these changes. My kids do fine the first half of the day, then start begging for sugary foods like more fruit the second half of the day.

Here's what I ate today:

Breakfast: 1/4 cp full fat vanilla yogurt, 1 T peanut butter and a dozen rasperries in a parfait plus 1 soft boiled egg and some tea

Snack: walnuts, water

Lunch: Small piece  of ham, mashed cauliflower with cheese and butter, steamed broccoli with butter S&P, 1/2 cp whole milk

Snack: Kombucha, a 1 1/2 inch cube of gorgonzola cheese and some carrots and cauliflower

Dinner: a small piece of ham, a bunch of oil&vinegar coleslaw (with carrots, red onion), some honeydew melon, 1/2 cup of red wine, water

After dinner snack: walnuts, a blob of goat cheese and 1/4 cup strawberries 

bedtime: tea with half and half

I don't feel like I'm eating a boatload of fat, but I feel like I'm eating what I do eat with joy and feel good about having small portions of things like cheese and meat and butter. I'm by far eating more veggies and instead of just mindlessly grazing or throwing in something with a bunch of carbs, I'm still having fruit, but it's just smaller portions. 

8 different veggies (all fairly big servings)
3 fruits (just smaller portions)
yummy dairy (small portions)
some good nuts & meats

That doesn't seem like some crazy diet to me, it just seems like mindful, healthy, get my body on track with the cravings for sugar and simple carbs. 

In 6-8 weeks I'll start allowing myself a little more leeway with introducing some truly whole, naturally occurring grains back in the mix and of course, I'm not going to be a crazy person when I'm traveling or we are eating with others (outside our home). But I'm still excited about this and it feels like it makes sense!

One final thought, the thing I keep coming back to is that statistic on 50-70% of americans being OBESE by 2030. I know 50-70% of Americans are not eating what they would consider to be a terrible diet, so it's worth changing things up. 

The more I read, the more the carb/fat debate seems to be a hot button issue, but I feel like if I'm doing this with common sense, critical thinking and while listening to our bodies, this doesn't have to be a "which camp are you in" thing, but rather a shift towards good, real foods and mindful eating on a new level!



4.03.2014

Podcast - Salt, Sugar, Fat and a Breakfast Idea

Check out this podcast from the good folks at America's Test Kitchen with pulitzer prize winner and author Michael Moss about the industry of junk food in America (Starts at 15:50 marker).  So interesting, and as he states (in so many words)... knowledge is power!

A quick yummy breakfast idea if you are trying to decrease your carbs... I stumbled into this one today:

1/4 cup full fat vanilla yogurt
1 Tablespoon natural salted peanut butter
about 12 frozen raspberries

HOLY MOLY!  SO yummy... I could eat this as a treat... and it's about 12g carbs with the brands I used (check your own).

I ate this with a soft boiled egg with a little organic herby blend seasoning by frontier seasoning blends and a cup of tea.  Perfecto!

Nicole

3.31.2014

Food & Diet Part 2

So this is the slide that Marlene Merritt LAc. DOM (NM), ACN of Merritt Wellness Center started her lecture with. And the info below is my summarizing and expounding on the concepts she covered. What I especially liked about her talk is that it appealed to both my logical brain and the sense of honoring and trusting what history and experience can reveal (something that is a BIG part of Traditional Chinese medicine). 

To understand the basic lifestyle and dietary changes Marlene's lecture was ultimately advocating please see my first post, which contains links to her youtube videos where she explains the concepts herself. This post is about more support and follow-up info: historical evidence and modern scientific support.

I'd like to start by acknowledging that this is a departure from my previous recommendations, because it is NOT entirely based on chinese medicine food therapy. And while I still do advocate for many of the concepts in TCM food theory (namely focusing on increasing your food's ability to be cooked down by your digestive kettle by doing things like eating more cooked foods, chewing well, slowing down, eating smaller meals more frequently, enjoying food mindfully, being moderate, eating seasonally and locally). This post definitely represents a shift from a purely TCM recommendation to more of a hybrid. 

Why, you ask?  Because one of the very interesting things Marlene pointed out is that different populations have evolved to eat different foods (in our digestive tracts). Yes, in Asia there is a lot of rice and soy and no dairy and yes, eating this way is what TCM food therapy recommends, but most of my patients are not of Asian descent and so our guts have evolved to eat what was traditional in the places we came from. In European countries for example, dairy was much more common (especially Scandinavian ones), in Africa it was not.  So this really puts some perspective on everyone eating the same foods... it just doesn't make sense from an evolutionary perspective. We have different guts and different abilities. This does still go with the TCM concept of listening to your own body above any one rule.

The History
There was a man named Weston Price who has been called the Isaac Newton of Nutrition. He was a dentist and a vegetarian and in the 1930s he went and searched the world to find a healthy vegetarian culture. He went to cultures all over the world and used the powers of observation to come up with basic assertions. Although he did not find any healthy vegetarian cultures, he did find indigenous cultures that had much higher levels of health (when you took away illnesses and accidents that would be readily preventable and treatable in the west), fertility and ultimately nutrition. 

These traditional diets were much more like our own ancestors and included:

Foods grown in nutrient rich/fertile soil 
ALL the parts of animals including organ meats, marrow)
Animal fats
Animals on pasture
dairy products that were raw and/or fermented
grains and legumes that were soaked or fermented 
and bone broth
only real foods found in nature

Our modern diets includes:

Foods grown in depleted soil
muscle meats (which are the least nutritious parts of animals) 
vegetable oils
Low Fat
Animals raised in confinement
pasteurized dairy
refined and or extruded grains 
WAY more grains than would have traditionally been available
lots of artificial and synthetic foods

So basically, as time went on and we had the luxury of not having to worry about starving and had more science, agriculture and politics enter into our food arena. Much of the traditional diet went out the window.

In the 1800s people averaged 18 lbs of sugar per year
In the 1900s it went to 90 lbs per year
In 2010 the average american consumed 120-150 lbs of sugar per year and 50% of americans consume a half a pound of sugar per day.
see USDA Agricultural fact book, profiling food consumption in america, pg. 20. www.usda.gov/factbook/chapter2.pdf

Yet, the FDA has NO recommendations on sugar intake, it has it for fat (especially saturated fat).

Since the 1950s the US food pyramid has advocated for less fat and more carbs (but, carbs are ultimately sugars: so simple and complex grains, fruits, legumes and actual sugar all are increasing our blood sugar)

And the typical american eats between 300-600 grams of carbohydrates per day... The American diabetic association recommends the reduction down to 45-60g PER MEAL. But the human body can only actually possibly use and process about 60-100 grams of carbs per day.

So the body is resilient and amazing and can make it look like it is coping for a long time even though it is in stressed out, coping mode day in and day out... really, the human body is AMAZING!  The things we can do to it and that it will tolerate for YEARS!  (that's not to say they won't catch up with us, individually and culturally)... 

By the time we are 65, 77% of people are diabetic or pre-diabetic 
us centeres for disease control and prevention 2011 
US dept. of health and human services, national diabetes information clearinghouse, fast facts about diabetes, 
http://diabetes.niddk.nih.gov/dm/pubs/statistics/#fast, 2011

American's are getting fatter and fatter... for years the statistic was 1 in 7 americans was obese and this statistic was stable for decades and decades... but with modern diets the rates are quickly jumping up... so that in 2012 most of the US was one out of 3 or 4 and the projected rates for 2030 are that most of the states in the US will have at least 1 out of every 2 people categorized as obese (NOT overweight, but obese!)



Clearly, cutting out fat isn't the answer. Weston Price showed lots of healthy indigenous cultures who ate lots of foods that we look at as unhealthy but they were actually healthy. AND the actual statistics show that despite eating less and less fat, we are getting fatter and more unhealthy.

If you want more big picture evidence, look at the lower rates of heart disease associated with higher levels of saturated fat in the diet in the modern french, swiss, dutch, icelandic, belgium, finnish and austrian cultures!
european cardiovascular disease statistics

And for those of you who like the research based approach check out these: 

The Framingham Study (Archives of internal medicine, jul 1992, 152(7), 1371-1372)
showed that the more saturated fat and cholesterol one ate, the more calories one ate, the lower people's serum cholesterol was.

And the follow up 30 years later which concluded that lower cholesterol equaled a greater risk of death. "For each 1% ml/dl drop of cholesterol there was an 11% increase in coronary and total mortality." Anderson, leaven M., William P. Castelli, and Daniel Levy. "Cholesterol and mortality: 30 years of follow-up from the Framingham Study." Jama 257.16(1987):2176-2180 l

And it doesn't get much more clear and damning than this: "Those individuals with a low serum cholesterol maintained over a 20 year period will have the worst outlook for all-cause mortality."
Schatz, Irwin J., et.al. "Cholesterol and all cause mortality in elderly people from the honolulu heart program: a cohort study." the lancet 358.9279 (2001): 351-355

But those are just on cholesterol, how about this:

"In studies conducted over 20 years, the Harvard School of Public Health showed that total fat intake bore no significant relation to coronary Artery Disease risk... epidemiological studies have shown no evidence that men who eat less fat live longer or have fewer myocardial infarctions"
Hooper, L., et. al. "Reduced or modified dietary fat for prevention of cardiovascular disease." Cochrane Database Syst. Rev 2 (2000)
Mozaffarian, Dariush, Renata Micha, and Sarah Wallase. "Effects on coronary heart disease of increasing polyunsaturated fat in place of saturated fat: a systematic review and mata-analysis of randomized controlled trials." PLos medicine 7.3 (2010): e1000253

or for Women:

"In women and in the elderly, no appreciable difference in coronary heart disease rate for any level of cholesterol. In fact, for women of all ages and the elderly, higher cholesterol is associated with longer lifespan.
Circulation medical journal 86, 1026-1029, 1992

And this one has been in the news, because it was just released 2 weeks ago: in over 500,000 subjects the conclusion was that decreasing saturated fats should not be encouraged!
Chowdhury R. et al. Annals of Int. Med. 2014, March 160(6) 398-406

So why is cholesterol actually not so bad?
In addition to being a basic building block for many of our cells (it is part of cell membranes), It acts as a bandaid to fix up cellular damage and if we don't have enough our cells can't repair. Leaving our bodies more prone to damaged cells turning into problems. 

Cholesterol is also a precursor to many hormones and Vitamin D, so when you decrease it, you mess with those. 

It helps fight infection and it protects against depression and helps your nervous system deal with stress. So much so, that one study showed people who relaxed prior to blood draws had lower cholesterol than they did on days when they were stressed prior to blood draws.

So, there is SOOOO much more I got from these talks and more I will definitely be discussing with patients, friends and family, but for now, I'll give a few closing tidbits:

If you want more information on the diet changes Marlene Merritt suggests it is basically the Weston Price approach Which you can read about at length here PLUS specifically limiting your carbs to under 100g/day ideally more around 60 is the goal... Remember, doing what you can and making some changes is better than doing none and sticking with the low fat, high carb approach. 

A thought provoking article from the Atlantic about medical research and the fads/bad info they can result in.



and if you've made it this far... way to stick with it!  Thank You...

on McDonalds French Fries, Saturated Fat and Flavor!

PS. For those who are vegetarian or vegan and may site the China Study (Book, not actual study). There were shown to be over 8000 correlations in that study and one of the authors of the actual study went on to publish several other papers stating animal protein is not harmful. Here is the Weston A Price foundation's page on info for you



Dietary Recommendations - Going Off the TCM Grid

Those of you who know me know I am NOT a fan of anything that is extreme, immoderate, unsustainable or crazy-making. I've seen plenty of studies on XYorZ and fertility or general health and advocated against doing them (often for more than just the crazy-making piece- see cartoon below!)




This weekend I went to a symposium with 400 other acupuncturists and herbalists. I had the pleasure of seeing one of the TCM rock stars of today and delving into the philosophy, history and even spiritual aspects of the medicine, another practitioner presented on the newly "discovered" aspects of chinese herbal medicine's biochemistry. There were also TWO sessions (one taught by an RE and one by and acupuncturist/functional medicine doc) on insulin resistance and the American diet. The RE's focus was on PCOS and fertility and the acupuncturist/functional medicine doc was on navigating traditional chinese food therapy, history, modern lifestyle and HEALTH.  Although they both ended up suggesting dietary changes that do have the possibility of being a bit crazy-making, I feel like the benefits and proof (both scientific and historically - more to come on both of these)  REALLY made me want to give this a try with my own family.

I of course, realize there is no one size fits all approach, but I think this really has some chops and hope you'll consider it too. We ALL are living in a culture where obesity, type 2 diabetes, and health related problems are on the rise (did you know by 2030 the projected obesity rate for most of the country is 50-70%?). And especially if you are dealing with PCOS, blood sugar concerns, weight issues or worried about inflammatory illnesses (from digestive problems to cancer) this is something worth looking at and thinking about.

Because I am a newbie at all this, I'll let the acupuncturist/functional medicine doc lay it all out for you!
And I'll be following up this post with the studies and citations for you to look at if you want the science.

Each one is under 10 minutes long and she can explain SO much and so well... instead of watching one primetime show, check it out and see what you think!

Start with this video
To understand what happens when you eat

Watch this one 2nd
To understand why eating certain diets and the modern lifestyle fuel inflammation, heart attacks, PCOS, Cancer, Alzheimer's (not to mention diabetes)

And how to reverse these issues and feel better!
Yaaaaay!  It might seem challenging, but it is TOTALLY empowering AND makes sense when you look at history and just getting back to old school eating. (Sad that it actually seems so very different than what we do today).

And if you want to see the difference between different common diets you can watch this one as a bonus :)

See my next post if you want some of the citations as well as the historical perspective!

9.20.2012

PCOS Mother load Part TWO Obesity and Insulin Resistance

If you missed part one of this article you can find it here.  In part one I cover the causes and mechanisms of PCOS.

In the most typical presentation of PCOS a woman has additional weight (especially around the midsection - i.e. an apple shape) the very very best treatment is both incredibly simple AND difficult... weight loss...

In the Journal of Human Reproducation in 1998 a study was published that showed the difference between women who were overweight (with any diagnosis, not just PCOS) who lost weight for six months prior to trying to conceive using ART and those who did not lose weight and used ART.  The pregnancy and birth rates were HUGELY improved in the weight loss group (with the average weight loss just over 22 lbs.):

Without Weight-loss
Pregnancy rates 12%

With Weight-loss
Pregnancy rates 77%

Without Weight-loss
Miscarriage rates: 75%
Live Birth rates: 3%

With Weight-loss
Miscarriage rates: 18%
Life Birth rates: 67%

When the amount of money spent on fertility treatments compared to the rate of live birth was compared, the data was staggering...

The average cost per baby for the weight-loss group was $4,600
The average cost per baby for the group who did not lose weight was $275,000!

These are some powerful statistics, but when there is insulin resistance weight gain becomes even more problematic.

Why does Insulin resistance make people gain weight (especially around the middle)?
Insulin's job is to bind together with glucose (blood sugar) in the blood stream (where the glucose is floating around and waiting to be used for energy by the cells). Once insulin binds to the glucose, it acts as a sort of key... and the glucose can bind to and pass through these little receptors on the surface of the cells all over the body.  Once the glucose is inside the cell it is used to fuel the cellular function. This is how it should work.

When there is a lot of insulin in the blood stream the glucose gets let into the cells too quickly.  The cells get flooded with glucose (sugar) at a rate that is not healthy or necessary.  Because the body is smart, it knows this is not good.  So because it cannot always control how much glucose the body has in it (that's up to the person and how they choose to eat) or how much insulin is being produced (when there is a glitch or the body is pumping it out because the diet is requiring it) the body does the only thing it has left to do to keep the cells from getting flooded with too much glucose. It cuts down the number of receptors on the cells so that the glucose cannot get in.

In an average, healthy person, each of their cells has about 20,000 receptors on its surface.
In a person with insulin resistance the average cell has about 5,000 receptors on its surface - 1/4!

So then the glucose can't get in as fast.

What happens next makes sense.  The glucose is still there, but it can't get into the cells.  It is floating around in the blood stream with nowhere to go and it creates congestion in the blood vessels.  The tiniest capillaries in the fingers and toes get the worst, in fact, they are so small, the damage from the congestion causes inflammation and them to be blocked (microcirculation issues... which is a big deal, because the circulation to a newly implanted embryo depends on this type of blood flow). As this microcirculation gets blocked the glucose (sugar) begins to concentrate more and more in the center of the body where the bigger blood vessels are and where there is room.

The cells that are closer to the center of the body, where the glucose builds up the most have a constant and steady stream of sugar entering them.  Even though they have reduced their receptors down to 1/4 of what they normally would have they get fed a non-stop supply of glucose... And the liver that is located right in the thick of where the glucose is building, converts extra glucose into fat, which get deposited nearby around the middle of the body... and this is why the apple shape type of obesity is common with insulin resistance.

In general 25% of women who are overweight are also poly-cystic (not all have fertility troubles, but many do)
In general only 5% of women who have a healthy body weight are also poly-cystic.

What is the best way to lose weight if I have insulin resistant type obesity patterns?
Exercise is key, and every little bit helps.  Do not feel discouraged or like you have to go all out, just do something every day possible!  Remember, the women in the study above did not lose a TON of weight, they lost an average of 22 lbs!

As for diet, one of the best way to disrupt this vicious cycle is by slowing down the sources of glucose (sugar) to the body.  Certain foods are easily turned into big bursts of glucose (simple carbs and sugars do this), while other foods break down more slowly and supply a more slow and steady form of glucose to the body (proteins do this).  Lots of foods fall in between (complex carbs).  If you follow a high protein/low glycemic index diet you will be eating in the best way to decrease this build up of glucose in the bloodstream.

A certain type of protein has another benefit. Whey protein has an amino acid that helps regulate insulin production, so adding whey protein is a good option (in moderation).

And there are some lovely herbal formulas and acupuncture treatments to help decrease dampness (which weight is considered) and improve metabolic function, so you can always throw those into the mix!

So that's the scoop on why losing weight is important and why the weight gain happens in the first place.

In my next installment I'll be going over common treatments used for PCOS infertility... what the studies say and why Traditional Chinese medicine may very well be the best possible treatment for women with PCOS...


4.13.2012

Specific Nutrition for Fertility & Pregnancy Concerns- Chromium

Chromium (PCOS, metabolic syndrome, diabetes, gestational diabetes)

Chromium is a mineral that helps the body break down and store fats, carbohydrates, and protein. It also works with the hormone insulin to maintain normal levels of glucose (sugar) in the body – an important consideration, for fertility concerns where blood sugar or metabolic syndrome play a roll (PCOS) especially if you're diabetic or become diabetic during pregnancy. Chromium has also been studied for its ability to increase sperm count.
How much chromium you need
TTC/Pregnant women: About 25-30 micrograms (mcg) a day (29 mcg if you're 18 or younger).
Breastfeeding moms: 45 mcg a day (44 if you're 18 or younger)
Men: About 35mcg
Brewer's yeast is a concentrated source of chromium, containing as much as 60 mcg per tablespoon. Other good sources include:
  • 1 tablespoon peanut butter: 41 mcg
  • 1 cup boiled spinach: 36 mcg
  • 3 ounces broiled skinless chicken: 22 mcg
  • 1 cup button mushrooms: 20 mcg
  • 1 medium apple: 15 mcg
  • 1/2 cup broccoli: 11 mcg
  • 3 ounces turkey ham (processed): 10.4 mcg
  • 1 cup grape juice: 8 mcg
  • 1 cup romaine lettuce: 7.34 mcg
  • 1 waffle (about 2.5 ounces): 6.7 mcg
  • 1 whole wheat English muffin: 4 mcg