Nutritional management for people with diabetes has traditionally focused on blood glucose control. Key studies that evaluated reduction or alteration of dietary protein are summarized in Table 42. At the other end of the spectrum, high-protein diets are a particular concern in patients with diabetes because they increase albuminuria and may accelerate loss of kidney function. Evidence of biological activity of dietary fats and carbohydrates indicates that an exclusive focus on protein is too limiting with regard to broad effects on health in people with diabetes and CKD.
People with diabetes and CKD should receive intervention from a specialty-trained registered dietitian that includes individualized management of multiple nutritional aspects.
The Institute of Medicine established guidelines for intake of omega-3 fatty acids, which recognize significant variances in physiologicalpotency between different omega-3 fatty acids. Studies of dietary protein interventions in diabetes and CKD are relatively few, short term, completed in small numbers of participants, and have limited documentation of DKD. The Renal Dietitians Dietetic Practice Group of the American Dietetic Association recommends nutritional assessment and intervention at the diagnosis of CKD and quarterly thereafter.477Considering that diabetes further complicates CKD care, frequency of assessment may be adjusted based on the needs of individual patients. We’ve pulled together our most popular recipes, our latest additions and our editor’s picks, so there’s sure to be something tempting for you to try.
Subscribe to BBC Good Food magazine and get triple-tested recipes delivered to your door, every month. This light vegetarian version of your favourite Thai green curry is an unbelievable 5 of your 5-a-day! Back in the spring of 2007 I ordered what I thought were hibiscus seeds from a major seed house. This case of mistaken identity brings to mind another potential identity problem, much discussed with the recent legalization of hemp and marijuana in Colorado. In America hemp was a major fiber crop from Colonial times until 1937 when the Marijuana Tax Act regulated the industry in an effort to reduce marijuana production.
To this day, officially, the United States government recognizes no difference between marijuana and hemp.
What is bizarre about the many hemp products for sale in the United States, be it cigarette paper, writing paper, textiles and food products is that ita€™s perfectly legal to sell them here, but ita€™s not legal to grow hemp here. In the United States some states have already investigated the economic benefits of growing hemp.
Because of its status as an illegal drug, the selection and breeding process for the planta€™s intoxicating qualities has taken place underground and has emphasized increasing the levels of THC. Back in the spring of 2007 I ordered what I thought were hibiscus seeds from a major seed house.A  I started them early and transferred them to several patio containers. This case of mistaken identity brings to mind another potential identity problem, much discussed with the recent legalization of hemp and marijuana in Colorado.A  The proponents of hemp made a strong case that hemp is really a different plant. To this day, officially, the United States government recognizes no difference between marijuana and hemp.A  The Canadian government began issuing licenses for growing hemp for fiber and food in 1998. Because of its status as an illegal drug, the selection and breeding process for the planta€™s intoxicating qualities has taken place underground and has emphasized increasing the levels of THC.A  For a sense for how skillful these breeders were, you might be interested in reading the chapter on Cannabis in Michael Pollana€™s book, The Botany of Desire. Jan Bohuslav Sobota died on May 2nd of 2012 and this is my remembrance of this fine man who was a friend and mentor to me. Each autumn, salmon return to the rivers of their birth a€“ there to spawn and once again trigger a renewal of the eternal passion play.
Salmon that do eventually arrive at their destinations must once again compete a€“ this time for mates and to fight for access to the precious and very limited gravels. The profligate expenditure of life and extravagant wealth of biology is there everywhere to behold, as Death dances lightly among the gathering throngs of fish, picking and choosing from among them; who from their number shall successfully spawn and who shall just be food for the gathering predators and scavengers.
Spend a day in silence, walking among the spawning salmon, as they dig spawning redds, jockey for position and slash at competitors with those gaping, snaggletoothed, hooked jaws. Jan Bohuslav Sobota has died, while half a world away; I was preparing these etchings of Spawned Salmon and dedicating them to Jan, the lover of fish. The book you hold in your hands has evolved from my simply giving these etchings a second life in book form, to my using them as a vehicle for honoring a friendship of three decades. In 1985, Jan and I had been corresponding for some months without ever meeting a€“ all quite distant and correct.
A short bit of background on Jan Sobota to begin, but fear not; Ia€™ll soon be spinning anecdotes and thoughts on books as art a€“ celebrating Jana€™s life of course, telling a few stories out of school, but also straying into the personal and speculative in search of the meaning to be derived from the life and death of a friend. Jana€™s father was a serious bibliophile and collector of fine books, who nurtured that same love of books in his son a€“ an appreciation that steadily grew, until he was apprenticed to master bookbinder Karel A ilinger in PlzeA?.
The pivotal event in Jana€™s early life as a book artist was the posthumous retrospective exhibition of fellow Pilsener, Josef VA?chal in 1969. Jan supported a family, sponsored workshops, exhibited widely, did conservation work on rare historic books, ran a gallery a€“ and on it went. What Jan did for contemporary bookbinding, was to act as a bridge between the traditionally trained masters of the past and innovators of the present. America was a great place to be a book artist in the early 1980a€™s precisely because it was an active zone of hybridization and hotbed of creativity.
An instructive contrast to the anything-goes US scene was the icy reception I got when I showed a wooden box containing loose sheets of poetry and etchings to a Prague publisher. Neither Jan nor I had much interest in the book-like objects that often sneak into the museums as book arts a€“ the carved and glued together things that sorta, kinda have a bookish aspect to them a€“ rough-looking a€“ perhaps chain-sawed Oaken boards or granite slabs, slathered in tar and lashed together with jute; but lacking text.
When Jana€™s books went beyond function, conservation or decoration, they were subtle statements about binding and the place of books, knowledge and art, as well as statements about the dignity inhering in the handcrafted - with a good dose humor. There are others who know their conservation and those, whose scientific contributions are far greater, but few of them are also artists at heart. It can sound so pedestrian, these eternal compromises between art and craft, yet what Jan represented was not at all common. There is an inflection point at which exceptional craft begins to make the transition to art and it is closely associated with surmounting the limitations inhering to the discipline. Visiting with Jan in his workshop you quickly realized, that he did what a professional must, but ultimately, he just loved messing about with books. A curiously protean hybrid of artist and craftsman, ancient and modern, one cannot think of Jan without seeing an unabashed Czech patriot in a foreign land. Early on in their stay in Cleveland, the Sobotas experienced the quintessential American disaster. Even after their medical debts were retired, money was still an issue for a family of immigrants with three kids a€“ two with special needs. Later on, when they were living in Texas, the massacre at Waco opened Jana€™s eyes to yet another difficult side of his adopted home.
In 1979, I apprenticed with Jindra Schmidt, an engraver of stamps and currency, living in Prague. Schmidt had engraved stamps for Bulgaria, Iraq, Ethiopia, Albania, Guinea, Vietnam and Libya. In 1992, Jindra Schmidt was honored for his contributions and depicted on the last stamp of a united Czechoslovakia, before it split into Czech and Slovak republics a€“ a fitting tribute. Unlike most children of immigrants, my destiny remained connected to that of my parentsa€™ homeland.
My vocation as artist clarified itself in Prague while learning the increasingly obsolete skills of steel engraving. My first book was indeed, modeled after VA?chal, even to the extent of its diabolical subject matter.
Jan showed me a great deal in the following years about the tradition of books as the meeting place of art, craft and ideas a€“ where printmaking intergrades seamlessly with the worlds of language, typography and illustration.
One can like these things just fine and admire them from an uncomprehending distance, or you can become engaged. The book you hold was to have been a simple reprint of the Spawned Salmon a€“ something fun for Jan to work his magic upon. Nice sentimental reminiscences, but there is still the matter of getting the work accomplished and out before the public, organizing exhibitions, printing catalogs and paying for transatlantic flights. The Prague show was reconfigured and curated by Jana€?s longtime friend, Ilja A edo, for exhibition at the West Bohemian Museum in PlzeA?.
Quite predictably, I like seeing the kind of work I do honored a€“ the wood engravings and etchings made to shine in the context of crisply printed type and an excellent binding. Ia€™ve heard printmakers lament that the surest way to devalue prints is to add excellent poetry, sensitive typography and a bang-up binding a€“ and then live to see the whole thing sell for half the price of just the unbound prints.
Therea€™s nothing quite like seventeenth century Bohemia, the dead center of Europe, for particularly thorough violence a€“ with the Bubonic Plague stepping in afterwards as mop-up crew.


The chapel at Sedlec was rebuilt after the major blood-letting of the thirty-years war as a memento mori a€“ reminder of death. What can you say about the mounds of dead, the ruined lives, destroyed nations and misery multiplied by millions that isna€™t trite or self-evident? But then I pan over to other fields a€“ not the kind where the grass is composting my fellow man, but to fields of endeavor where the ferment is of ideas recombining into ever more refined ways of thinking. I once lived at the Golem house in Prague a€“ at Meislova ulice, number 8, in the old Jewish ghetto. Horoscopes might seem a curious basis on which to select ministers and diplomats, but it is also more common than youa€™d think. Picture the scene before you: Ita€™s a late night in Prague, before the Marlboro man dominated every street corner, even before the neon of casinos and the vulgarity of Golden Arches assaulted the nightwalkersa€™ eyes at all hours a€“ back when darkness, oh yes, that beautiful comforting velvety, all-enveloping and blessed dark, broken only by the moon, stars and late night taxis, still ruled the streets after the sun went down. The Golem was a mythic being of Jewish folklore, created from clay and quickened by the Shem, a magical stone engraved with an ancient Hebraic inscription, inserted into Golema€™s forehead. The maternal tongues of these small nations have miraculously survived all the invasions, floods, plagues and foreign occupiers to this day a€“ a gift preserved and delivered to them across the generations. Minority languages, on the other hand, carry an emotional load that can scarcely be exaggerated. Ishi and his sister were the last of the Yahi tribe to survive the genocidal colonization of California. Those whose language and culture are not threatened can never know the burden under which the carriers of small minority languages labor a€“ nor how those in exile bring up their children to preserve that which is beyond their capacities to save. Jan was all about preserving traditions and the kind of ancestral knowledge that today is mostly enshrined in books.
Today, the stories of our tribes are less and less passed on as oral tradition and most often read to us from the childrena€™s books wea€™ve learned to treasure a€“ illustrated by fine artists and produced with care for the highly discriminating purchasers of childrena€™s books a€“ for grandparents.
A?epelA?k employed binders and typesetters to present complete suites of his work and in this too, he introduced me to a new world. Later in Prague I missed my flight back, due to the World Trade Center bombing and was delayed by a week. The difficult thing to bear in acknowledging my teachers, models, heroes, suppliers and inspirations, is that these masters of the crafts and industries surrounding and supporting the book arts are mostly deceased. The fruit we seek is not fast food, but laden with full-bodied flavors, attained by slow natural processes.
All of us come from grandfathers who once were wheelwrights, cobblers or instrument makers; men with a profound love of wood and leather, who knew the working qualities of every kind of obscure tree growing in their countryside a€“ men who knew when to reach for elm or hickory a€“ as well as for goat, dog or even fish-skins. Jan spoke fondly of his grandmother, who baked bread every week of the year to feed an entire estate a€“ farm hands, livery people, gentry, trainers and hod-carriers alike. Working consciously is the ultimate goal a€“ and that is the legacy youa€™ll find evidently contained within and upon the boards of every book bound by Jan Bohuslav Sobota. The etchings you see here first came to life as illustrations for the wedding anniversary announcements of MA­la and Jaroslav KynA?l. Jan Bohuslav Sobota died on May 2nd of 2012 and this is my remembrance of this fine man who was a friend and mentor to me.A  He was an exceptional bookbinder, teacher and promoter of the book arts, but also an exile who successfully returned home after years abroad.
However, dietary protein intake at all stages of CKD appears to have an important impact in this population.
Reduction in albuminuria and stabilization of kidney function have been reported with dietary protein intake at the RDA level.
Glomerular hyperfiltration and increased intraglomerular pressure are well-recognized mechanisms of kidney damage induced by excess dietary protein. When protein intake is limited, caloric distribution of the other macronutrients must be addressed. Recommendations for fatty acids usually combine polyunsaturated fatty acids together without differentiating between categories. The management of diabetes and CKD involves multiple nutrients (macronutrients and micronutrients), including protein, carbohydrate, fat, sodium, potassium, and phosphate, among many others.
Meta-Analysis Demonstrating Reduced Risk of Progression of DKD (Loss of Kidney Function or Increased Albuminuria) by Treatment with Low-Protein Diets. Recommendations for phosphorus and potassium are the same for CKD with and without diabetes. Effect of Reduced Dietary Protein Intake on CKD Stage 5 and Death in Type 1 Diabetes and CKD Stage 2 (inferred) at baseline. In addition, both the qualitative (eg, beef, chicken, or soy sources) and quantitative definition of a low-protein diet differ tremendously among studies. A registered dietitian who is knowledgeable of both conditions should perform nutritional assessments and interventions.
The flower color varies from cream, light pink or apricot to burgundy, with blossoms appearing as the days get shorter. The flower color varies from cream, light pink or apricot to burgundy, with blossoms appearing as the days get shorter.A  The leaves range from heart shaped to palmate, if you will, marijuana-like. Researchers tell us that the practical uses of this plant came first and the intoxicating qualities were discovered much later in human history.
I have been looking for new recipes using mangoes,away from the monotony and I found one dessert recipe,Aam Ki Kheer,which is new to me that I had tasted at my frienda€™s place recently. There they encounter resident trout and bass a€“ even sunfish, chubs and dace, all keyed into the increasingly plentiful and highly nutritious bounty of salmon eggs. Situated 90A km south-west of Prague at the confluence of four rivers, PlzeA? is first recorded in writings from the tenth century. That vision was about innovation and creativity within the context of an historical tradition. This is what youa€™ll see in a Sobota binding a€“ exceptional attention paid to context and relationships, using materials and technical means that do indeed function and last. He knew his work was valuable and documented it fastidiously a€“ confident that it would be last. There was, however, nothing about his nationalism that demeaned anybody elsea€™s traditions or origins. That smallish incident within the parade of American fringe politics elicited an insanely violent level of suppression. Masaryk a€“ and the cute little girl with a bouquet of flowers, is my mother Eva, at the age of three. Schmidta€™s income from the federal mint far exceeded anybody elsea€™s in the extended family and supported a network of cars, cottages and rent-controlled flats. Schmidt, as he preferred to be called, was a man of conservative demeanor who preferred polite and reserved forms of speech and address. While visiting their unassuming engraver and extending my tourist visa 30 days at a time, I was quietly becoming qualified for life as a counterfeiter a€“ a vocation within which, one is set for life, however it may eventually turn out.
Jan allowed several binders to have their way with it a€“ amo boxes for slipcases with shell casings for hinges and so forth. This next incarnation of our exhibit in PlzeA? was all just a bit more prosaic and provincial. Is it the binding we consider and exhibit a€“ or is the binding there to conserve a text, which is ultimately the point? There are also binders to whom everything else is merely the text block, who care little if it is an offset trade edition or a book made by hand. The tales therein recorded reflected the accreted wisdom and wit of a people as they retold them across the highlands in modest log cottages after the harvest was in. The way of working belongs to the Sobota vision I addressed earlier a€“ the honor and soul to be found in conscientiously made handcrafts.
I dona€™t feel that accomplished or ready to assume their mantle and yet with every generation that is what must happen.
Gravels, with just the right flow of fresh water running up through stones of the right size are but a tiny portion of the riverbed.A  The salmon must struggle past cities and sewer pipes, farms and irrigation systems, dams and turbines, fishermen and waterfalls a€“ just to reach the streams of their birth. In recent studies of people with prehypertension or untreated stage 1 hypertension, higher protein intake from either soy or predominantly vegetable sources reduced blood pressure in short-term (6 to 12 weeks) feeding studies.200, 201 Along with the DASH trials, these data suggest that predominantly nonmeat protein may have a beneficial effect on blood pressure. Few studies have examined the effects of fatty acid intake or supplements on markers of kidney disease and risk factors in patients with diabetes (Table 41).468-472 Moreover, these studies were short term and performed in small numbers of people, precluding firm conclusions.
The dietary protein recommendation should be based on idealized body weight because obesity, which is highly prevalent in the diabetes and CKD population, otherwise would lead to overestimating the dietary protein recommendation. Phosphorus binders may be needed in patients with advanced CKD because of the emphasis on whole grains and dairy products.
The Work Group is not aware of studies indicating disadvantages from this amount of EPA or DHA.


Substantial differences in amounts and types of fat and carbohydrate also have not been acknowledged adequately. In addition, diets recommended by health care professionals often are viewed as unpalatable and unattractive.
Obtaining accurate dietary histories often is challenging because of the subjective nature of reporting and difficulty with recall. This widely beloved stamp was re-issued in 2000 and mother continues to receive philatelic fan mail to this day. He died the day I was composing a colophon for the Spawned Salmon with words of praise for his lifea€™s work. These patients (85% to 89% during the course of the study) also received ACE inhibitors and had similar control of blood pressure and other risk factors irrespective of diet group assignment, indicating that reducing dietary protein provided benefits beyond established medical therapies.181 Benefits of limiting dietary protein intake are more evident in type 1 than type 2 diabetes, but fewer studies have been done in the latter population.
Nevertheless, the available evidence suggests that increased intake of omega-3 and monounsaturated fatty acids may be considered because of potentially favorable effects on progression of CKD (Table 41).
However, some concerns exist related to the potential for unacceptable levels of mercury or other contaminants.
This type of variability is a potential explanation for the inconsistent results observed between studies evaluating the effect of protein intake on kidney outcomes. Culinary approaches to enhance appeal of nutrient-appropriate foods should be encouraged, along with methods to make food preparation easy and inexpensive.
For some key nutrients in the regimen recommended for diabetes and CKD, such as sodium and protein (estimated by urinary urea nitrogen excretion), 24-hour urine studies are useful to assess intake and guide counseling. I have been wanting to try it ever since I tasted it and today I finally got down to preparing and also present it for JFI a€“ Mango Event (Jihva For Ingredients) started and hosted by the lovely Indira of Mahanandi.I followed my friendsa€™s recipe except for making some changes to make it a low fat mango dessert , by reducing the sugar quantity and substituting the whole milk and condensed milk with low fat milk.
The engraving was masterfully done by Schmidta€™s long-dead colleague, Bohumil Heinz (1894-1940). The state security apparatus was surely aware of my presence, but if they kept tabs on me, I never knew.
To address dietary recommendations for people with diabetes and CKD stages 1 to 4, studies evaluating interventions that reduced or altered sources of dietary protein and other nutrients were reviewed (Table 37 to Table 41). Based on the available evidence (Table 37 and Table 38), the Work Group concluded that limiting dietary protein will slow the decrease in kidney function and progression of albuminuria, and it may prevent CKD stage 5. Therefore, a DASH-type diet that emphasizes sources of protein other than red meat may be a reasonable alternative to a lower total protein intake in people with hypertension, diabetes, and CKD stages 1 to 2.
Fatty acid intake can be modified easily by substituting canola oil, a blend that includes both omega-3 and monounsaturated fats, for vegetable oils.
Nevertheless, in the opinion of the Work Group, these recommendations may be considered for the diabetes and CKD population. An example of a meal plan that meets the nutritional goals of this guideline is provided in Appendix 1.
Close monitoring of patients who follow a dietary protein restriction is important to ensure adequate, but not excessive, protein intake. I also added a few pieces of ripe mangoes to the payasam for variety, for the feel of that natural fruity sweetness and to intensify the mango flavor.Its simple heavenly, the feel of biting into the mango pieces in between the creamy smoothness of the payasam. Everything is just so wonderful and everybody so creative, but suspending judgment long enough to actually look at some artwork and then giving it a chance isna€™t so bankrupt, is it?
Human body parts are again flying and the Baron is at his best defeating Turks and evading friendly fire from buffoonish generals.
Farmers would occasionally find their possessions and take them as souvenirs, unaware that the last Indians still lived in their midst.
Damn the cost; ita€™s who we are and the last material vestiges of soulful encounters with our elders a€“ onea€™s whose stories are slipping inexorably away, thinned by each passing year and generation. Their kids were grown and they were by then slipping into that last, reflective phase of life a€“ done competing.
Several brands of salad dressings and butter replacement products made from canola oil are available in most grocery stores.
A professional chef designed the menu and accompanying recipes in collaboration with registered dietitians experienced with diabetes and CKD.
These scraps turned out to be a deck of medieval playing cards - the second oldest such cards known. A book is so much more than the sum of its parts a€“ and yet each of us tends to have our own bailiwick in which we shine and to which we look first. Regardless of the level of protein intake, 50% to 75% of the protein should be of high biological value, derived predominantly from lean poultry, fish, and soy- and vegetable-based proteins.
To reduce intake of saturated fat, consumption of red meats should be reduced, and low-fat or nonfat dairy products should be used. In the view of the Work Group, these types of creative approaches facilitate interest and feasibility for lifestyle modification in diabetes and CKD. These plates have been inked and wiped by hand, employing methods that woulda€™ve been familiar to Rembrandt. They crashed with my wife Jana and me in Kalamazoo, while taking the a€?orientation coursea€?nearby. I can confidently report back to my English reader, that Jan would only grow in stature for you, if you could have fully understood the subtlety of his thoughts in his own maternal tongue.
Perhaps right for those who shouldna€™t have sharp objects, for fear of hurting themselves.
That show was purchased whole by Special Collections at Western Michigan University and constitutes the largest collection of Sobota bindings and the most complete archive of my work. I enjoy cooking for my family using fresh produce from my vegetable garden and farmer's market. Few people would have cast a second glance at that glued-up mess of moldering old papers before pitching it, nor would they have recognized what they had in hand or known how to restore or sell it. These folks were a profound blessing to a family facing some truly rough sailing a€“ a Godsend. Schmidt had worked was signed with warm dedications to him and thus worth real money to collectors.
He wanted to see the printmaker in me come to full fruition and I wanted to be worthy of his attentions. The family has dwelled within sight of the seats of power, pushing copper plates through a press and outlived the Hapsburg Monarchy, First Republic, Nazis and Communists.
The intact packages were still there on their shelves, all duly graded, labeled and priced, awaiting an owner who was never to return. I believe that hard work, self-discipline, and a positive attitude cannot help but reap a harvest of fantastic results. Back home, their Czech neighbors would have envied them and accused them of theft or worse, but people here seemed to be pleased as punch to see them prosper a€“ genuinely happy for them.
Those items too, kept trickling out the door, until there came a sad, sad day, when the golden eggs were all gone.
They bashfully admitted their foolishness and went back to making beautiful books a€“ and their American friends were so relieved to see them regain their sanity.
You take time to grieve and then pick yourself up by your bootstraps (by God a€“ get a grip) and get on with it (Rome wasna€™t built in a day you know). StrejA?ek was still working, but it was all coming to an inevitable end, as he grew shaky of hand and hard of seeing.
Enriched by my days of being nurtured by Prague, Matkou MA›st (Mother of Cities), I moved on to meet my destiny with art. Great move sailu and wishing you all the best for your venture Lots of love NThank you,NanditaA  Ammulu Hi Sailugaru, nenu intaku mundu oka sari comment raasaanu, mee website ki professional look isthe chala andamga untundani. Andhra bommalu pettadamu tho chala kala vachindi.Chala rojulu nunchi emi post cheyaledemita anukunnanu. I was going back and forth in your blog to find this piece of information abt kondapalli dolls. If you dont mind can you add ur snap in the home page?luv Satya Meghna Perfect summer dessert and very quick to make.



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