Sunday, October 15, 2017

Can type 2 diabetes be reversed? A researcher says yes.

Exercise and cutting calories can lead to curing type 2 diabetes within months.

From the Web site of Professor Roy Taylor at Newcastle University, UK 

Further information on the research on Reversing Type 2 Diabetes  

Thank you for contacting me about the studies on reversing type 2 diabetes. These have caused great interest amongst people with diabetes, and as of 2016, I have received over 3,000 enquiries and messages. Although I have replied to most of these personally, I am sorry to say that it is no longer feasible to do this. The research continues. I hope the following items will provide some useful information, but bear in mind that this is only factual information and only your doctor can provide personal medical advice.   

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What are the main research findings?   
1. The initial study was in people who had type 2 diabetes of up to 4 years. The CounterBalance study now shows that longer duration type 2 diabetes can be reversed. However, after more than 10 years of diabetes a return to normal glucose control, even with major weight loss, is much less likely.  
2. It is certainly possible to wake up the insulin producing cells of the pancreas by losing a substantial amount of weight.  
3. This happens at the same time as the fat content in the pancreas decreases. Previous studies have shown that fat stops insulin release, so it is reasonable to deduce that the removal of fat from the pancreas allowed insulin release to normalise.  

Could it work for me?   
 This research is in “type 2 diabetes”, the usual common form of diabetes. There are some rare forms of diabetes which may appear to be type 2 diabetes:  
a) Diabetes occurring after several attacks of pancreatitis is likely to be due to direct damage to the pancreas (known as “pancreatic diabetes”)  
b) Secondly, people who are slim and are diagnosed with diabetes in their teens and twenties, with a very strong family history of diabetes, may have a genetic form (known as “monogenic diabetes”)  
c) Thirdly, type 1 diabetes sometimes comes on slowly in adults, and these people usually require insulin therapy within a few years of diagnosis (“slow onset type 1”)  
None of these will respond in the same way as the common, true type 2 diabetes.  

 So, if you have the common form of type 2 diabetes, this could work for you. However, you should not underestimate just how much change in your day-to-day life will be necessary to bring this about. It requires motivation and persistence. 
   
Could it work for people with a normal BMI?   
 Yes, most certainly, provided that the diagnosis of type 2 diabetes is correct. Some people are unable to cope with even moderate amounts of fat in their liver and pancreas. Type 2 diabetes only happens when a Personal Fat Threshold is exceeded. Losing weight from a level, which is “normal” for the general population, is then essential for health. See the online article by Richard Doughty.  
Practical advice   
 The particular diet used in the 2011 study was designed to mimic the sudden reduction of calorie intake that occurs after gastric bypass surgery. By using such a vigorous approach, we were testing whether we could reverse diabetes in a similar short time period to that observed after surgery.   
 The essential point is that substantial weight loss must be achieved. The time course of weight loss is much less important.  
 It is a simple fact that the fat stored in the wrong parts of the body (inside the liver and pancreas) is used up first when the body has to rely upon its own stores of fat to burn. Any pattern of eating which brings about substantial weight loss over a period of time will be effective. Different approaches suit different individuals best.  
 It is also very important to emphasise that sustainability of weight loss is the most important thing to ensure that diabetes stays away after the initial weight loss. Ordinary steady weight loss, by cutting back on the amount eaten each day, may be preferable. However, if you are not able to lose around 2½ stone over, say, six months by this approach, then the very low calorie diet may be best for you. We now know that the very low calorie approach can be followed by very steady weight control.  

A. The standard approach would involve:  
a) Decreasing total food (and alcohol) intake by about one half b) Using smaller plates c) Eating more slowly d) Recognising that the sensation of hunger is sign of success, not a signal to eat e) Enjoy that hunger.  Celebrate with a glass of water; maybe fizzy water 
However, if a person finds this difficult, the liquid meal approach could be used. 
More details about steady, sustainable weight loss are available on the Diabetes UK website.  
B. The research diet   
To carry out the Newcastle research study, the following diet was used:   
 One sachet of a liquid formula diet (~ 200 calories) three times per day. The study used Optifast, but there are many other brands.  
     
 Three portions of non-starchy vegetables per day. Lack of variety was a big problem of the diet, so we devised a few recipes to make the vegetables more interesting. The range of possibilities is infinite, but you can find the recipes we used on the website - http://www.ncl.ac.uk/magres/research/diabetes/reversal.htm.  
 No alcohol (merely because alcohol itself is so calorific – 7 calories in every gram).  
 You should consult your doctor before embarking upon any very low calorie diet. In particular, any medication you are taking may need to be adjusted.  Some general information about this is also on the website. None of this information is a substitute for proper, individual medical advice.   
 Our research subjects found the diet challenging to stick to especially in the first 36 hours. Motivated people were selected to take part in the research and support from the team was given frequently. Support from the families of the research volunteers was very important in helping them comply with the diet. Hunger was not a particular problem after the first few days, but the complete change in social activities (not going to the pub, not joining in the family meals etc.) was a challenge over the eight weeks. Careful planning in advance is essential.  

Optifast  
Although Optifast was used in the study, this is not readily available in the UK. An alternative liquid food supplement of similar calorific content is equally suitable. These are available from most local supermarkets; you should try several brands to find one most suited to your taste. One brand available on the internet is Exante. Do not be concerned by the high sugar content, as after the first day of very low calorie diet your body is able to handle this reasonably well. The product may need to be made up in water or skimmed milk. Always read the advice upon the particular product.  
After achieving your target weight - how do you keep your weight down in the long term?   
1. Once you are at your personal target weight, the critical thing now is to become accustomed to eating approximately 2/3 of the total amount you used to eat. Plan a gradual transition to normal eating over 2 -4 weeks. There need be no restriction upon any particular foodstuffs, although naturally foods that are very calorie-dense are best avoided. The goal is keeping the weight down [you may find your weight increases 1 – 2 kg over a few days on returning to a higher calorie intake; this is because your glycogen stores return to normal and glycogen is stored in the water inside your body].  
2. If you are increasing your exercise, do not eat more. It is so easy to over- compensate for exercise.  
3. Most people maintain a consistent healthy weight in the long term; most successfully by:  
a) Weigh weekly - write it down b) Watch portion size carefully and don’t eat between meals c) Walk, cycle, stairs.  Maintain a high level of everyday physical activity d) Party but payback. Enjoy life and especially occasions to celebrate, but there is a price. You must eat only about half your current intake for a few days  
  

How about exercise?   

 Do not increase your usual daily activity whilst losing weight. However, a sustainable increase during long term weight maintenance is wise, along with keeping food portion size under control.  
What research is going on?   
 Diabetes UK have funded a major 5 year study (DiRECT) to find out how many people can reverse or improve their diabetes by a low calorie liquid diet. This is being carried out entirely in Primary Care. Further details are available on the Diabetes UK website.  

 Further information will be posted on the website www.ncl.ac.uk/magres/research/diabetes.  
 Already available are the links to the full scientific paper describing the reversibility of diabetes study and also the scientific review of the existing knowledge in 2008, which described the “twin cycle hypothesis” which we have now tested. An up-to-date review of how weight loss works was added in 2013. In 2016, a review of what is happening to the insulin producing cells (beta cells) provides further explanation.  
 Also available is a paper, w hi ch describes what happened to diabetes when weight loss was achieved at home. This information was provided by many people around the world using email.  
 In the Information for Doctors, other research papers are available.  
 Also, all information will be added to the website, which is updated from time to time.  
 Please remember that this website and its links provide information and not personal medical advice. Do consult your Doctor for personal advice.  

Thank you for your interest in this work. 


Saturday, October 14, 2017

Harvey Weinstein and the Biology of Trauma

Hollywood movie executive Harvey Weinstein has been accused of and alleged to have committed sexual assault over a number of years on a number of actresses. Such a story strikes an all-too-common nerve in America, perhaps revealing the depth and widespread nature of such abuse. In this excerpt from Healing the Brain: Depression, we look at the biology of stress and trauma experienced by the victims and why it is a pernicious wound.


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Wounds that Time Alone Won’t Heal
The Biology of Stress


How do the brain and the body react to stress? Stress, such as the threat of attack, forces various changes in the body. First, adrenaline causes an increase in heart rate and blood pressure so that blood can be sent to muscles faster. Second, the brain’s hypothalamus signals the pituitary gland to stimulate the adrenal gland (specifically the adrenal cortex) to produce cortisol.

This stress hormone, a longer-acting steroid, helps the body to mobilize energy. However, prolonged exposure to cortisol can damage virtually every part of the body. Chronic high blood pressure can cause blood vessel damage and the long-term shutdown of digestion can lead to ulcers.



SimplyPsychology.org
Stress, such as the threat of attack, forces changes in the body carried out by the hypothalamus-pituitary-adrenal axis (HPA).

Why do some people experience more stress than others? Individuals who feel they have control over their lives appear to experience less stress. It also depends on personality and temperament. Aggressive, competitive types are more likely to define a situation as stressful than a passive, accommodating personality. A universal stress producer seems to be social isolation.

PTSD: A Breakthrough in Diagnosis
In 1980 the mental health community established the diagnosis of Post Traumatic Stress Disorder, PTSD, and revolutionized the way the field views the effects of stress. This change acknowledged that many of the symptoms people experience after exposure to trauma can be long-lasting, if not permanent. Before that shift, the field tended to view stress-related symptoms as a transient, normal response to an adverse life event, not requiring intensive treatment.

Furthermore, before 1980, people who did develop long-term symptoms following trauma were viewed as implicitly vulnerable; the role of the actual event in precipitating their symptoms was minimized. For a while, in a reversal of previous thinking, experts expected most trauma survivors to develop PTSD. More recent research has confirmed that only about 25 per cent of individuals who are exposed to trauma develop PTSD.

So who is likely to develop PTSD following a traumatic experience, and why? The answer is not yet clear, but it now appears that PTSD represents a failure of the body to extinguish or contain the normal nervous system response to stress. This failure is associated with many factors:

  • the nature and severity of the traumatic event
  • preexisting risk factors related to previous exposure to stress or trauma, particularly in childhood
  • the individual’s history of psychological and behavioral problems, if any
  • the person’s level of education, and other cognitive factors
  • family history—whether parents or other relatives had anxiety, depression, or PTSD


People who develop PTSD are also more likely to develop other psychiatric disorders involving mood (depression, anxiety and panic, bipolar disorder), personality, eating, and substance dependence.


People also seek medical help for problems that may develop after the trauma that can mask or intensify PTSD symptoms. These symptoms include chronic pain, fatigue, headaches, muscle cramps, and self-destructive behavior, including alcohol or drug abuse and suicidal gestures. Often, survivors are not aware that their physical symptoms are related to their traumatic experiences. They may even fail to mention those disturbing events to their physicians, which can make PTSD difficult to diagnose accurately.



Some PTSD symptoms in teens may begin to look like those of adults. One difference is that teens are more likely than younger children or adults to show impulsive and aggressive behaviors.


School-aged children (ages 5-12)
These children may not have flashbacks or problems remembering parts of the trauma, the way adults with PTSD often do. Children, though, might put the events of the trauma in the wrong order. They might also think there were signs that the trauma was going to happen. As a result, they think that they will see these signs again before another trauma happens. They think that if they pay attention, they can avoid future traumas.


Children of this age might also show signs of PTSD in their play. They might keep repeating a part of the trauma. These games do not make their worry and distress go away. For example, a child might always want to play shooting games after he sees a school shooting. Children may also fit parts of the trauma into their daily lives. For example, a child might carry a gun to school after seeing a school shooting.


Teens (ages 12-18)
Some PTSD symptoms in teens may begin to look like those of adults. One difference is that teens are more likely than younger children or adults to show impulsive and aggressive behaviors.

Wikimedia Commons
Teen experience of PTSD can mimic those of adults and include re-experiencing a traumatic event, flashbacks, and nightmares.


Adult symptoms may include:
  • Re-experiencing the traumatic event
  • Increased anxiety and emotional arousal
  • Intrusive, upsetting memories of the event
  • Flashbacks (acting or feeling like the event is happening again)
  • Nightmares (either of the event or of other frightening things)
  • Feelings of intense distress when reminded of the trauma
  • Loss of interest in activities and life in general
  • Sense of a limited future (not expecting to live a normal lifespan, get married, have a career)

Below the surface, some children from deprived surroundings, have vastly different hormone levels than their parent-raised peers even beyond the baby years. Studies have shown that children who experienced early deprivation also had different levels of oxytocin and vasopressin (hormones that have been linked to emotion and social bonding), despite having had an average of three years in a family home.

It has been thought that these changes in hormones and neurotransmitters impair development of vulnerable brain regions. If we observe an association between a history of abuse and the presence of a physical abnormality, the abuse may have caused that abnormality. But it is also possible that the abnormality occurred first and elevated the likelihood of abuse, or that the abnormality ran in the family and led to more frequent abusive behavior by family members or other relatives.

People with PTSD actively avoid situations that might bring back memories of the trauma.

Monday, October 9, 2017

Just What Is Diabetes, Anyway?

What is Diabetes?

Diabetes is a disease that occurs when your blood glucose, also called blood sugar, is too high. Blood glucose is your main source of energy and comes from the food you eat. Insulin, ahormone made by the pancreas, helps glucose from food get into your cells to be used for energy. Sometimes your body doesn’t make enough—or any—insulin or doesn’t use insulin well. Glucose then stays in your blood and doesn’t reach your cells.

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Over time, having too much glucose in your blood can cause health problems. Although diabetes has no cure, you can take steps to manage your diabetes and stay healthy.
Sometimes people call diabetes “a touch of sugar” or “borderline diabetes.” These terms suggest that someone doesn’t really have diabetes or has a less serious case, but every case of diabetes is serious.

What are the different types of diabetes?

The most common types of diabetes are type 1, type 2, and gestational diabetes.

Type 1 diabetes

If you have type 1 diabetes, your body does not make insulin. Your immune system attacks and destroys the cells in your pancreas that make insulin. Type 1 diabetes is usually diagnosed in children and young adults, although it can appear at any age. People with type 1 diabetes need to take insulin every day to stay alive.

Type 2 diabetes

If you have type 2 diabetes, your body does not make or use insulin well. You can develop type 2 diabetes at any age, even during childhood. However, this type of diabetes occurs most often in middle-aged and older people. Type 2 is the most common type of diabetes.

Gestational diabetes

Gestational diabetes develops in some women when they are pregnant. Most of the time, this type of diabetes goes away after the baby is born. However, if you’ve had gestational diabetes, you have a greater chance of developing type 2 diabetes later in life. Sometimes diabetes diagnosed during pregnancy is actually type 2 diabetes.

Other types of diabetes

Less common types include monogenic diabetes, which is an inherited form of diabetes, andcystic fibrosis-related diabetes .

How common is diabetes?

As of 2015, 30.3 million people in the United States, or 9.4 percent of the population, had diabetes. More than 1 in 4 of them didn’t know they had the disease. Diabetes affects 1 in 4 people over the age of 65. About 90-95 percent of cases in adults are type 2 diabetes.1

Who is more likely to develop type 2 diabetes?

You are more likely to develop type 2 diabetes if you are age 45 or older, have a family history of diabetes, or are overweight. Physical inactivity, race, and certain health problems such as high blood pressure also affect your chance of developing type 2 diabetes. You are also more likely to develop type 2 diabetes if you have prediabetes or had gestational diabetes when you were pregnant. Learn more about risk factors for type 2 diabetes.

What health problems can people with diabetes develop?

Over time, high blood glucose leads to problems such as
  • heart disease
  • stroke
  • kidney disease
  • eye problems
  • dental disease
  • nerve damage
  • foot problems
You can take steps to lower your chances of developing these diabetes-related health problems.

References


Saturday, October 7, 2017

The Emotional Toll of Diabetes

Diabetes has become a worldwide epidemic.

It is is a self-managed condition. This means that it is the person with diabetes, not their doctor, who is responsible for taking care of him or herself on a daily basis. Diabetes involves making frequent, sometimes life or death decisions under sometimes stressful and physically uncomfortable circumstances.

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In addition, diabetes management is constant and can feel overwhelming. If you or someone close to you has diabetes, take a minute and think about all of the steps you take in your diabetes management everyday. What to eat, how much insulin to take, when (or whether) to exercise, how to interpret a glucose reading, how many carbs to take to treat a low, the list goes on. Decisions, and resulting behaviors (and their consequences) are critical aspects of diabetes management. However doing everything necessary to manage diabetes can become overwhelming – and feeling overwhelmed is usually no fun.

Emotions

Many people with diabetes know that having diabetes can result in some unpleasant and uncomfortable emotions. One question that I get asked a lot is why living with diabetes is so tough and what causes these negative emotions. Unfortunately, this is not an easy question to answer. Being diagnosed and living with a chronic condition like diabetes can be really hard, and as we talked about before, managing the balancing of everything that’s necessary to live well with diabetes can be overwhelming. Even if you do everything that you are “supposed” to do, diabetes can be unpredictable and frustrating.
And if you aren’t able to do everything you are “supposed” to do, it can cause feelings of anxiety, guilt and even hopelessness. And we haven’t even talked about the emotional impact of not feeling well. As you can see, there is no easy answer to this question because well, diabetes is complicated.

Relationships

Diabetes can have a big impact the way that people with diabetes live their daily lives and interact with the world, and this can be especially challenging when it comes to relationships with family and friends. Stress and other negative emotions can affect the ability to be present in relationships, and sometimes the ability to have relationships at all. And that is without even throwing diabetes in the mix. Relationships are an important part of the human condition and in many people’s emotional well-being, and when diabetes affects relationships – and it does – this can cause a significant level of distress.

Behavior

I am a big believer that everything we have talked about up to this point leads back to behavior. People often seek mental health treatment because of how their situation, emotion or relationship is causing them to behave. Having diabetes and the stress it involves (the situation), the way it makes you feel (the emotions), and the impact it has on your relationship with others intersect, and can sometimes make it difficult to behave in the way that you want to. For some people, this means adhering to their diabetes treatment plan and taking care of themselves. For others this means feeling so depressed, anxious or helpless that they have trouble going to work or school, or doing things they enjoy. Still for others diabetes causes strain or conflict in a relationship, making it hard to be a loving supportive friend. And for others, it is a combination of all of these issues and others we haven’t talked about here.
Even though the intersection of diabetes and mental health is complex, I want to re-assure that there’s hope. There are many people living with diabetes who live fulfilling lives and who have fulfilling relationships. If you are struggling with diabetes-related stress issues, know that it can get better. But before we can solve a problem, it’s important to think critically and define it. I hope that this gives you a good place to start.

Source: Mark Heyman (PhD, CDE) www.beyondtype1.org

Friday, October 6, 2017

Diabetics (and everyone): America runs on sugar...and poorly


Image by Catherine MacBride via Getty Images
We know that too much sugar is bad for our waistlines and our heart health, but now there’s mounting evidence that high levels of sugar consumption can also have a negative effect on brain health — from cognitive function to psychological wellbeing.

While sugar is nothing to be too concerned about in small quantities, most of us are simply eating too much of it. The sweet stuff — which also goes by names like glucose, fructose, honey and corn syrup — is found in 74 percent of packaged foods in our supermarkets. And while the Word Health Organization recommends that only 5 percent of daily caloric intake come from sugar, the typical American diet is comprised of 13 percent calories from sugar.


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“Many Americans eat about five times the amount of sugar they should consume,” Natasa Janicic-Kahric, an associate professor of medicine at Georgetown University Hospital, told The Washington Post.

It’s easy to see how we can get hooked on sugar. However, we should be aware of the risks that a high-sugar diet poses for brain function and mental well-being.

Here’s what you need to know about how overconsumption of sugar could wreak havoc on your brain.

It creates a vicious cycle of intense cravings.
When a person consumes sugar, just like any food, it activates the tongue’s taste receptors. Then, signals are sent to the brain, lighting up reward pathways and causing a surge of feel-good hormones, like dopamine, to be released. Sugar “hijacks the brain’s reward pathway,” neuroscientist Jordan Gaines Lewis explained. And while stimulating the brain’s reward system with a piece of chocolate now and then is pleasurable and probably harmless, when the reward system is activated too much and too frequently, we start to run into problems.

“Over-activating this reward system kickstarts a series of unfortunate events — loss of control, craving, and increased tolerance to sugar,” neuroscientist Nicole Avena explained in a TED-Ed video.

In fact, research has shown that the brains of obese children actually light up differently when they taste sugar, reflecting an elevated “food reward” response. This suggests that their brain circuitry may predispose these children to a lifetime of intense sugar cravings.

It impairs memory and learning skills.
A 2012 study on rats, conducted by researchers at UCLA, found that a diet high in fructose (that’s just another word for sugar) hinders learning and memory by literally slowing down the brain. The researchers found that rats who over-consumed fructose had damaged synaptic activity in the brain, meaning that communication among brain cells was impaired.

Heavy sugar intake caused the rats to develop a resistance to insulin — a hormone that controls blood sugar levels and also regulates the function of brain cells. Insulin strengthens the synaptic connections between brain cells, helping them to communicate better and thereby form stronger memories. So when insulin levels in the brain are lowered as the result of excess sugar consumption, cognition can be impaired.

“Insulin is important in the body for controlling blood sugar, but it may play a different role in the brain,” Dr. Fernando Gomez-Pinilla, the study’s lead author, said in a statement. “Our study shows that a high-fructose diet harms the brain as well as the body. This is something new.”

It may cause or contribute to depression and anxiety.
If you’ve ever experienced a sugar crash, then you know that sudden peaks and drops in blood sugar levels can cause you to experience symptoms like irritability, mood swings, brain fog and fatigue. That’s because eating a sugar-laden donut or drinking a soda causes blood sugar levels to spike upon consumption and then plummet. When your blood sugar inevitably dips back down (hence the “crash”), you may find yourself feeling anxious, moody or depressed.

...

Chronically high blood sugar levels have also been linked to inflammation in the brain. And as some research has suggested, neuroinflammation may be one possible cause of depression.
Teenagers may be particularly vulnerable to the effects of sugar on mood. A recent study on adolescent mice, conducted by researchers at Emory University School of Medicine, found a diet high in sugar to contribute to depression and anxiety-like behavior.

Research has also found that people who eat a standard American diet that’s high in processed foods — which typically contain high amounts of saturated fat, sugar and salt — are at an increased risk for developing depression, compared to those who eat a whole foods diet that’s lower in sugar.

It’s a risk factor for age-related cognitive decline and dementia.
A growing body of research suggests that a sugar-heavy diet could increase risk for developing Alzheimer’s disease. A 2013 study found that insulin resistance and blood glucose levels — which are hallmarks of diabetes — are linked with a greater risk for developing neurodegenerative disorders like Alzheimer’s. The research “offers more evidence that the brain is a target organ for damage by high blood sugar,” endocrinologist Dr. Medha Munshi told the New York Times.
Some researchers, in fact, have even referred to Alzheimer’s as “Type 3 Diabetes” — which suggests that diet may have some role in an individual’s risk for developing the disease.

  • Arizona Raspberry Iced Tea
    Amazon.com
    These recognizable-anywhere cans are bad news: They contain 23.5 ounces, nearly three times the suggested serving size for the tea inside. With 90 calories per 8 ounces, finishing an entire can adds up to almost 270.

    Photo from Amazon.com

  • Starbucks Bottled Mocha Frappuccino
    Amazon.com
    The 9.5-ounce Starbucks to go contains 180 calories.

    Photo from Amazon.com

  • Jamba Juice Smoothies
    Granted, Jamba Juice All Fruit smoothies are made with much better-for-you ingredients than a can of cola. However, it’s still easy to mindlessly sip your calories when a 16-ounce size clocks in at least 210 calories.

    Flickr photo by libookperson

  • Minute Maid Lemonade
    Amazon.com
    A 12-ounce can of the summer favorite clocks in at 150 calories, more than a can of Coke and the same as a can of Pepsi.

    Photo from Amazon.com

  • Snapple Apple Fruit Drink
    Amazon.com
    There are 100 calories in every 8 ounces of this fruity pick, but the bottle is deceiving, since it packs 16 ounces.

    Photo from Amazon.com

  • Sunkist Orange Soda
    Amazon.com
    There are 170 calories per 12-ounce can of this sweet drink.

    Photo from Amazon.com

  • Dr. Pepper
    Amazon.com
    A 12-ounce can clocks in at 150 calories, more than a can of Coke and the same as a can of Pepsi.

    Photo from Amazon.com

  • Dunkin’ Donuts Strawberry Coolatta
    Even the small size of this frozen concoction from the coffee chain is a diet danger, with 230 calories in 16 ounces.

    Flickr photo by ReneS

  • Monster Energy Drink
    Amazon.com
    There are only 100 calories in 8 ounces of this pick-me-up, but who only drinks half a can? The whole thing will set you back 200 calories.

    Photo from Amazon.com

  • Nesquik Lowfat Chocolate Milk
    Amazon.com
    An 8-ounce bottle of this sweet sip adds up to 170 calories. Beware of larger sizes that encourage bigger portions.

    Photo from Amazon.com

  • Barq’s Root Beer
    Amazon.com
    Each 12-ounce can contains 160 calories.

    Courtesy, Huffington Post