Tag Archives: diabetes

Diet, Pharmaceuticals and Diabetes

Kmareka is proud to cross-post with Elizabeth Carrollton, from Drugwatch.com. Ninjanurse spends her working days nagging people to take their meds, and needs to add the caveat that general advice and debate on the internet is no substitute for medical care for your own individual situation. So talk to your doctor and don’t even think about ignoring diabetes if you like doing stuff like seeing and walking and staying alive.

A Balanced Diet and Healthy Lifestyle for Type 2 Diabetes

The course of action a physician takes to manage diabetes is directly related to the severity of the patient’s diabetes. In some instances, diabetes health can be controlled through diet, exercise and other similar healthy lifestyle modifications. Although prescription drugs may be needed in addition to eating a balanced diet, only a physician can make this call.

Diabetes is a condition where blood glucose levels are much higher than the normal range, which on a glucometer is around 90. Once a diagnosis of prediabetes or diabetes has been established, it is imperative for a physician or registered dietician to create a course of action based on the patient’s weight and lifestyle.

Diabetes medications are also taken into consideration at this time. Patients need to be aware of the severe side effects of certain medications like Actos, which increases the risk of bladder cancer. Additionally, other diseases and health issues are part of the diagnosis and treatment process.

According to the National Institutes of Health’s MedlinePlus, the main factor in eating for diabetes health is to limit sugar intake. The National Institutes of Health also declares that eating smaller portions more frequently is essential in regulating glucose levels. In other words, rather than eating three larger meals per day, a person with diabetes should aim to eat smaller meals about five times a day.

Besides sugar being an issue, carbohydrates are also a variety of food that should be limited, due to their effect on glucose levels. This is because carbohydrates like white bread and crackers generally cause sugar levels in the body to increase.

Besides restricting sugar and carbs, a person with diabetes should incorporate foods into his or her diet that are part of a well-balanced diet. Fruits and vegetables, for example, are a vital component of a healthy diet, since they contain the necessary nutrients for cells and organs to function properly. Not to mention, the vitamins and minerals in veggies and fruits help support a healthy immune system.

Plus, the fiber within fruits and vegetables plays a positive role on cholesterol levels and on heart health. The American Heart Association (AHA) and the American Diabetes Association (ADA) note that fiber is important to heart health, which is oftentimes comprised by diabetes and certain diabetes medications, such as Actos.

Living a healthy lifestyle that includes exercise affects heart health, diabetes health and overall health. Being overweight, especially being in the category of obese, contributes to cardiovascular problems, such as congestive heart failure, which are made worse by taking certain diabetes drugs like Actos. Moreover, being overweight can lead to type II diabetes. It may worsen the severity of the diabetes if a person gains weight after he or she received a diagnosis of diabetes. When a person is considered to be in the stage of prediabetes, gaining weight can force that person into having full-blown diabetes.

Therefore, living an active lifestyle can help one maintain a healthy weight that can help manage diabetes, prevent complications of diabetes and prevent cardiovascular disease. It reduces stress and according to the National Institutes of Health, exercise contributes to a lower blood sugar and prevents future weight gain.

Elizabeth Carrollton writes about defective medical devices and dangerous drugs for Drugwatch.com.

Race, Obesity and Willpower

Alice Randall has an op-ed in the New York Times that touches the third rail of weight, race and body image, Black Women and Fat.

I’m not going to take the easy shot at her focus on behavior change and healthy eating. America as a whole needs to reject the junk diet that is killing us. Personal responsibility is crucial, but not the whole story. It’s not just willpower.

I’m returning to an earlier post here for a look at other factors that are steering us to ill health–

“Are we just losing our willpower year by year?

About a third of people in nine states were obese in 2009, a dramatic increase from 2007, when only three states had obesity rates that high, a new survey from the Centers for Disease Control and Prevention shows.

USA Today has a frightening map of obesity rates by state and year, and the CDC has the same map with more detail.

Were we all more virtuous thirty years ago, or has our environment changed? Certainly there are more temptations to be sedentary, and activity is being squeezed out of our daily routine. Cuts to public transit, to physical education in public schools, and lack of walkable communities all play a role. But what is happening to our food?

Between 1970 and 1990 the use of high-fructose corn syrup increased 1000%.

Corn is subsidized by the government, but people don’t eat that much fresh corn. The money is in the refined product. It’s cheap, it’s plentiful, and it’s not only a sweetener, it’s a preservative. The industry says there’s no difference between one sweetener and another, but recent research suggests otherwise…

In the 40 years since the introduction of high-fructose corn syrup as a cost-effective sweetener in the American diet, rates of obesity in the U.S. have skyrocketed, according to the Centers for Disease Control and Prevention. In 1970, around 15 percent of the U.S. population met the definition for obesity; today, roughly one-third of the American adults are considered obese, the CDC reported. High-fructose corn syrup is found in a wide range of foods and beverages, including fruit juice, soda, cereal, bread, yogurt, ketchup and mayonnaise. On average, Americans consume 60 pounds of the sweetener per person every year.

“Our findings lend support to the theory that the excessive consumption of high-fructose corn syrup found in many beverages may be an important factor in the obesity epidemic,” Avena said.

Correlation is not causation, but a grocery list of new, refined additions to our diet and an increase in obesity and diabetes is suspicious.

As bad as this is, it could get worse. A study shows a link between high fructose corn syrup and the growth of cancer cells. Business journalist Dana Blankenhorn asks if corn syrup will become the new tobacco.

High Fructose Corn Syrup (HFCS), a corn-based sweetener developed in 1957 and engineered into a wide range of food starting in 1975, looks headed to becoming a major health concern of this generation.
In the process Archer Daniels-Midland may become a one-company “big tobacco.”

And just as tax money intended to supply our soldiers with food in WWII was diverted into big tobacco– resulting in addiction and lung cancer for many veterans of that war, industry lobbyists succeeded in changing regulations so that food stamps could be used for soda. It’s a diversion of money that is supposed to be used to aid farmers and improve nutrition for low-income people.

What would ADM do with all that corn syrup? One answer is found on the ingredients list of almost any processed food– it’s in thousands of foods we don’t even think of as sweet. Read the label. And there’s another business plan. Send it to the second most obese nation–Mexico.

Mexico lost a trade dispute that had protected its domestic sugar production, and a flood of cheap corn syrup from the USA will displace sugar in their soft drinks. Meanwhile, some health-conscious Americans are buying Mexican soda sweetened with sugar to avoid the scary HFCS.

I have to say that this just plain sounds like evil product dumping. Nothing good will come in the long run if we export something that Americans have come to believe is unfit to eat. There is even evidence that people of Native American descent have a higher risk of health problems from a diet high in refined carbs. Ten percent of Mexicans are indigenous, and the majority of the population have mixed ancestry.

So we’re talking about dumping a cheap sweetener that Americans are getting leery of on to a poor nation whose people may be especially vulnerable to the health risks.

Why are our tax dollars subsidizing corn anyway? It’s not the most nutritious food crop. Why can’t Archer Daniels Midland GROW SOMETHING ELSE?

Obesity and being overweight are complex problems, with many causes. Willpower is one factor, certainly. But human nature can’t have changed so drastically in thirty years that we’ve all become gluttons. What has changed in thirty years is our environment, many small losses of activity and nutrition, many new chemical pollutants in our air and water. We’re all subjects in a global experiment in unnatural living and the results are starting to come in.

One great accomplishment of our time was getting the lead out of our gasoline and cleaning up our housing. Another was getting cigarette smoking out of the workplace and educating people about secondhand smoke.

Fixing our national obesity and diabetes epidemic will take more than slapping a ‘natural’ label on a box of donuts. But for the most part we know what we need to do. My neighborhood farmer’s market is open tomorrow. They take food stamps, and not everything there is expensive. They are part of the solution. It’s a start.

MORE: Here’s a link to this week’s news on HFCS and cancer. Kraft and Coca-Cola are fighting a tax on soda. There’s no hope that one person can get around corporate lobbyists, but you vote with your dollar every time you go to the store. Yacht Club sells a nice sparkling water and it’s local.

DRUNKARD AMERICA: Michael Pollard in ‘The Omnivores’s Dillemma’ recounts a fascinating historical episode of widespread alcohol abuse and cheap corn whiskey. The dynamic is the same– lots of corn and the advantage of creating a processed, indestructable product that people will crave and buy—

As it is today, the clever thing to do with all that cheap corn was to process it — specifically, to distill it into alcohol. The Appalachian range made it difficult and expensive to transport surplus corn from the lightly settled Ohio River Valley to the more populous markets of the East, so farmers turned their corn into whiskey — a more compact and portable, and less perishable, value-added commodity. Before long the price of whiskey plummeted to the point that people could afford to drink it by the pint. Which is precisely what they did.

Prohibition was a disaster, but it was an attempt to solve a real social problem. One parellel here is that most people can handle alcohol in moderation, but most people can’t drink a pint of whiskey every day without becoming dependent or addicted. Most of us like sweets, but a highly refined sugar added to almost everything we eat is a diet that is addictive and unhealthy for anyone with a tendency to put on weight. When did you ever go to the store and buy a bottle of high-fructose corn syrup? The sixty pounds a year the average American consumes are added to other foods we buy. And some foods are so salted you don’t even know it’s sweetened unless you read the label.”

Alice Randall discloses that she struggles to keep her weight under 200 pounds. The photo of Josephine Baker as ‘fat’ is an example of the disconnect of image from the real lives of women. Josephine was a fit, athletic dancer with a beauty most of us can only aspire to, only in comparison to the anorexic fashion ideal is there anything wrong with her.

The combination of addictive eating and inactivity that is the norm of much of our population is a real threat to our national security and national health.

The answer is comprehensive change in our personal choices but also in our environment and culture. No easy road.

Documentary film-maker Byron Hurt shows us the challenges, the rewards and the urgency of addressing our health…

Hate to feel like I’m just a cut-and-paste blogger, so I want to mention that I enjoyed a local screening of ‘Soul Food Junkies’. Byron Hurt, the documentary maker, came to Rhode Island and showed his film at Miriam Hospital to health care workers, and later at an event open to the public at the Cathedral of Life Christian Assembly in Olneyville.

The film is an impressive balancing act– recognizing the centrality of food as culture, family and comfort– and the pleasure it brings. Also presenting the evidence that an un-balanced diet will take years off your life.

‘Soul Food Junkies’ was selected to show on PBS, date to be announced.

This short post is a taste, a larger portion will follow.

Amputations Bad–Public Health Good

If you spend a lot of your working time nagging people to keep their blood sugar under control and to take good care of their feet you will appreciate this. From the Centers for Disease Control…

CDC report finds large decline in lower-limb amputations among U.S. adults with diagnosed diabetes

The rate of leg and foot amputations among U.S. adults aged 40 and older with diagnosed diabetes declined by 65 percent between 1996 and 2008, according to a study by the Centers for Disease Control and Prevention and published today in the journal, Diabetes Care. The age–adjusted rate of nontraumatic lower–limb amputations was 3.9 per 1,000 people with diagnosed diabetes in 2008 compared to 11.2 per 1,000 in 1996. Non–traumatic lower–limb amputations refer to those caused by circulatory problems that are a common complication among people with diabetes rather than amputations caused by injuries.

The study, “Declining Rates of Hospitalization for Nontraumatic Lower–Extremity Amputation in the Diabetic Population Aged 40 years or Older: U.S., 1988–2008,” is published in the current online issue of Diabetes Care.

The study also found that among people with diagnosed diabetes in 2008, men had higher age–adjusted rates of leg and foot amputations than women (6 per 1,000 vs. 1.9), and blacks had higher rates than whites (4.9 per 1,000 vs. 2.9). Adults aged 75 years and older had the highest rate – 6.2 per 1,000 – compared to other age groups.

The study authors note that improvements in blood sugar control, foot care and diabetes management, along with declines in cardiovascular disease, are likely to have contributed to the decline in leg and foot amputations among people with diagnosed diabetes.

Awesome. This kind of progress comes from educating the public, engaging health care workers, and lots of government involvement. And everyone knows that it’s better to have legs than not. I see that up close all the time.

When I started out as an aide in a nursing home, back in the mid-80′s, bedsores were common and the general attitude was just beginning to shift from ‘nothing can be done’ to ‘we’d better do something or Medicare is going to whack us.’ It’s no longer routine or accepted that people get bedsores, and the people I see now who have them tend to be very immobile or paralyzed. It’s a terrible problem that is best prevented. But prevention required a big investment of labor and an attitude adjustment. The payoff comes later.

I gotta run to work, I have lots of people to nag. Have a nice day.

Like, Duh

Stop the presses! This just in from Yahoo News. Incredibly, lack of health insurance keeps people from getting care–Diabetes Care Thwarted by Unstable Health Insurance: Study

Among patients with continuous insurance, 48 percent received at least three lipid-screening tests during the three-year study, 25 percent received three or more flu shots, 72 percent received three or more blood glucose screenings, and 19 percent underwent three or more screenings for kidney damage.

Patients with interrupted or no coverage received far fewer of these preventive health services, the investigators found.

“Our study shows that patients need continuous health insurance coverage in order to ensure adequate preventive care, even when that care is provided at a reduced cost,” study author Rachel Gold, an investigator with the Kaiser Permanente Center for Health Research in Portland, Ore., said in a Kaiser Permanente news release.

Even if consigning our fellow citizens to blindness, amputation and early death is the right thing to do in Aynrandia, it’s very bad for the USA. Diabetes, for unclear reasons, is now an epidemic. If the disease were not so ubiquitous and gradual people would be more afraid of it. If mercy is not a word we are allowed to use in political arguments, consider enlightened self-interest. Preventive care today can keep people healthy and working. Neglecting public health leads to suffering and depletes our national strength.

Conditional Freedom

Gladys Scott wanted to donate a kidney to her sister Jamie who has been on dialysis and not doing well. The two sisters have been in prison for 16 years for their part in a robbery.

Having worked with patients whose kidneys failed due to inadequate treatment for their diabetes, I wonder if Jamie’s life-threatening illness could have been prevented with low-tech, basic care. Scratch that– I’m certain that she would not be on dialysis if her diabetes had been treated properly.

Barbour said in a statement. “The Mississippi Department of Corrections believes the sisters no longer pose a threat to society. Their incarceration is no longer necessary for public safety or rehabilitation, and Jamie Scott’s medical condition creates a substantial cost to the State of Mississippi.”

What will Jamie Scott do for medical care? Sixteen years of her life gone and no safety net.

Having read some details of the legal case, I wonder why they were given such a long sentence.

Here’s a link to a site called Free the Scott Sisters.

Here’s Bob Herbert– on the ethics of requiring an organ donation as a condition of release.

As Bob Herbert notes– Gladys had long wanted to donate a kidney to her sister, but was ignored. Making a ‘condition’ of what she was going to do out of family love throws a moral dilemma into the situation unnecessarily.

I hope this story won’t disappear after the sisters are released. I want to know what happens to them, and wish them better health in 2011.

I have to go to work now, but I want to re-run a story from 2007, about commodification of the body—

Desperately Selling a Kidney

It was a strange experience reading Sally Satel’s essay, Desperately Seeking a Kidney in last Sunday’s New York Times. The writer, a resident scholar at the conservative think tank, American Enterprise Institute, needed a kidney transplant. She offers her personal narrative, and then some proposals for inducing the poor to sell their bodies in a free market.

Ms. Satel begins with her experience as a woman suddenly faced with a life-threatening illness…

Three days a week, for four debilitating hours at a time, I would be tethered to a blood-cleansing machine. Even simple things like traveling to see friends or to give talks would be limited. This would very likely continue for at least five years until my name crawled to the top of the national list of people waiting for kidneys from the newly deceased. On average, 12 names, the death toll from the ever-growing organ shortage, would be scratched off the list each day.

She is a psychiatrist, working in a methadone clinic, and she knew from her medical training what dialysis involves. She dreaded it so much that she chose not to wait on the transplant list, opting instead to search for a live donor. She writes honestly and unsparingly of her failed negotiations with two friends, then with a man she met online. Finally she received an offer from an acquaintance, Virginia Postrel, a fellow conservative writer, and the transplant was successful.

While Ms. Satel calls the gift she received, ‘altruism’ she has a different definition when applied to people outside her circle.

We must be bold and experiment with offering prospective donors other incentives for giving, not necessarily payment but material reward of some kind– perhaps something as simple as offering donors lifelong Medicare coverage. Or maybe Congress should grant waivers so that states can implement their own creative ways of giving something to donors: tax credits, tuition vouchers or a contribution to a giver’s retirement account.

This is the kinder, gentler version. She is not ignorant of how desperate things can get for the poor in this world…

I flirted with the idea of becoming a ‘transplant tourist’ in Turkey or the Philippines, where I could buy a kidney. Or going to China, where I would have to face the frightful knowledge that my kidney would probably come from an executed prisoner. Grim choices, but I was afraid I could die on dialysis if I didn’t do something to save myself.

In all of this long essay Ms. Satel never wonders what would have happened if she were poor and uninsured. She seems to live in a bubble where the only problem is a lack of donated organs. And she downplays, almost callously, the risk to the donor.

The operation is done by laparoscope, leaving only a modest three-inch scar. She would have been out of the hospital after two or three nights. Most important, the chance of death is tiny–2 in every 10,000 transplants– and the long-term health risks are generally negligible.

This kind of reasoning explains a lot about why conservatives can be persuaded that whatever works for them is just peachy. There is a reason nature gave us two kidneys, a woman with chronic renal failure should be able to figure that out. If you lose one, as did my aunt, to a tumor, or my friend, to a motorcycle accident, you have a spare. And I’m not so casual about the long-term health risks — we haven’t been doing these transplants for all that long. Not to mention the risk of post-surgical infection as antibiotic resistant germs increase. Myself, I would gladly take this risk for love, but god grant I never have to for money.

But back to the kinder, gentler. The mother who sells a kidney so her son can go to college ( no pressure, Sonny), or the eighteen year old who needs cash and feels invincible. Or the man who needs insurance and can’t get accepted on an affordable plan. David Holcberg, of the Ayn Rand Institute puts it a little more frankly. This was printed on the Journal’s editorial page –

A person may reasonably decide, after considering all the relevant facts (including the pain, risk and inconvenience of surgery), that selling an organ is actually in his own best interest. A father, for example, may decide that one of his kidneys is worth selling to pay for the best medical treatment available for his child…

Opponents of a free market in organs argue as well that it would benefit only those who could afford to pay–not necessarily those in most desperate need. This objection should also be rejected. Need does not give anyone the right to damage the lives of other people, by prohibiting a seller from getting the best price for his organ, or a buyer from purchasing an organ to further his life. Those who can afford to buy organs would benefit at no one’s expense but their own. Those unable to pay would still be able to rely on charity, as they do today. And a free market would enhance the ability of charitable organizations to procure organs for them.

Just think, all those deadbeats sitting in the waiting room at Hasbro with their sick kids, they could be persuaded to put out if they want ‘the best medical treatment for their sick child’.

But don’t consider giving free medical care to needy children, or scholarships to hardworking poor students. That would be immoral.

We are really on the edge of a class disparity that is not only about money but blood. We already pay lip service to ‘serving our country’ while dangling cash and scholarships in front of the kids at Central and Hope High. The recruiters know where to go.

No matter how well written, and no matter how much natural sympathy one feels for anyone who goes through a dangerous illness, Sally Satel’s essay is horrible. In countries where desperate people sell their kidneys, you can be sure there will be many who die prematurely when their remaining kidney gives out, and there will be no help for them. I wonder where in the Libertarian scheme of things you put the person who sold a kidney, and now needs one. Do you chalk it up to ‘bad choices’ ? We will be going down a very dark road if we give up the principle of taking care of our own, rich or poor, and instead let the rich use the poor for spare parts.

For another, less temperate, take on this, check out Daily Kos. And yes, I’ve signed a donor card, but they’re not getting them until I’m dead.

Willpower

Are we just losing our willpower year by year?

About a third of people in nine states were obese in 2009, a dramatic increase from 2007, when only three states had obesity rates that high, a new survey from the Centers for Disease Control and Prevention shows.

USA Today has a frightening map of obesity rates by state and year, and the CDC has the same map with more detail.

Were we all more virtuous thirty years ago, or has our environment changed? Certainly there are more temptations to be sedentary, and activity is being squeezed out of our daily routine. Cuts to public transit, to physical education in public schools, and lack of walkable communities all play a role. But what is happening to our food?

Between 1970 and 1990 the use of high-fructose corn syrup increased 1000%.

Corn is subsidized by the government, but people don’t eat that much fresh corn. The money is in the refined product. It’s cheap, it’s plentiful, and it’s not only a sweetener, it’s a preservative. The industry says there’s no difference between one sweetener and another, but recent research suggests otherwise…

In the 40 years since the introduction of high-fructose corn syrup as a cost-effective sweetener in the American diet, rates of obesity in the U.S. have skyrocketed, according to the Centers for Disease Control and Prevention. In 1970, around 15 percent of the U.S. population met the definition for obesity; today, roughly one-third of the American adults are considered obese, the CDC reported. High-fructose corn syrup is found in a wide range of foods and beverages, including fruit juice, soda, cereal, bread, yogurt, ketchup and mayonnaise. On average, Americans consume 60 pounds of the sweetener per person every year.

“Our findings lend support to the theory that the excessive consumption of high-fructose corn syrup found in many beverages may be an important factor in the obesity epidemic,” Avena said.

Correlation is not causation, but a grocery list of new, refined additions to our diet and an increase in obesity and diabetes is suspicious.

As bad as this is, it could get worse. A study shows a link between high fructose corn syrup and the growth of cancer cells. Business journalist Dana Blankenhorn asks if corn syrup will become the new tobacco.

High Fructose Corn Syrup (HFCS), a corn-based sweetener developed in 1957 and engineered into a wide range of food starting in 1975, looks headed to becoming a major health concern of this generation.
In the process Archer Daniels-Midland may become a one-company “big tobacco.”

And just as tax money intended to supply our soldiers with food in WWII was diverted into big tobacco– resulting in addiction and lung cancer for many veterans of that war, industry lobbyists succeeded in changing regulations so that food stamps could be used for soda. It’s a diversion of money that is supposed to be used to aid farmers and improve nutrition for low-income people.

What would ADM do with all that corn syrup? One answer is found on the ingredients list of almost any processed food– it’s in thousands of foods we don’t even think of as sweet. Read the label. And there’s another business plan. Send it to the second most obese nation–Mexico.

Mexico lost a trade dispute that had protected its domestic sugar production, and a flood of cheap corn syrup from the USA will displace sugar in their soft drinks. Meanwhile, some health-conscious Americans are buying Mexican soda sweetened with sugar to avoid the scary HFCS.

I have to say that this just plain sounds like evil product dumping. Nothing good will come in the long run if we export something that Americans have come to believe is unfit to eat. There is even evidence that people of Native American descent have a higher risk of health problems from a diet high in refined carbs. Ten percent of Mexicans are indigenous, and the majority of the population have mixed ancestry.

So we’re talking about dumping a cheap sweetener that Americans are getting leery of on to a poor nation whose people may be especially vulnerable to the health risks.

Why are our tax dollars subsidizing corn anyway? It’s not the most nutritious food crop. Why can’t Archer Daniels Midland GROW SOMETHING ELSE?

Obesity and being overweight are complex problems, with many causes. Willpower is one factor, certainly. But human nature can’t have changed so drastically in thirty years that we’ve all become gluttons. What has changed in thirty years is our environment, many small losses of activity and nutrition, many new chemical pollutants in our air and water. We’re all subjects in a global experiment in unnatural living and the results are starting to come in.

One great accomplishment of our time was getting the lead out of our gasoline and cleaning up our housing. Another was getting cigarette smoking out of the workplace and educating people about secondhand smoke.

Fixing our national obesity and diabetes epidemic will take more than slapping a ‘natural’ label on a box of donuts. But for the most part we know what we need to do. My neighborhood farmer’s market is open tomorrow. They take food stamps, and not everything there is expensive. They are part of the solution. It’s a start.

MORE: Here’s a link to this week’s news on HFCS and cancer. Kraft and Coca-Cola are fighting a tax on soda. There’s no hope that one person can get around corporate lobbyists, but you vote with your dollar every time you go to the store. Yacht Club sells a nice sparkling water and it’s local.

DRUNKARD AMERICA: Michael Pollard in ‘The Omnivores’s Dillemma’ recounts a fascinating historical episode of widespread alcohol abuse and cheap corn whiskey. The dynamic is the same– lots of corn and the advantage of creating a processed, indestructable product that people will crave and buy—

As it is today, the clever thing to do with all that cheap corn was to process it — specifically, to distill it into alcohol. The Appalachian range made it difficult and expensive to transport surplus corn from the lightly settled Ohio River Valley to the more populous markets of the East, so farmers turned their corn into whiskey — a more compact and portable, and less perishable, value-added commodity. Before long the price of whiskey plummeted to the point that people could afford to drink it by the pint. Which is precisely what they did.

Prohibition was a disaster, but it was an attempt to solve a real social problem. One parellel here is that most people can handle alcohol in moderation, but most people can’t drink a pint of whiskey every day without becoming dependent or addicted. Most of us like sweets, but a highly refined sugar added to almost everything we eat is a diet that is addictive and unhealthy for anyone with a tendency to put on weight. When did you ever go to the store and buy a bottle of high-fructose corn syrup? The sixty pounds a year the average American consumes are added to other foods we buy. And some foods are so salted you don’t even know it’s sweetened unless you read the label.

Studies Prove

Back at the dawn of time, when you could smoke in the lunch room, I worked in a factory that–I’m not joking–retouched high school yearbook photos.

It was 10:30am in the year 1973 and time for first break. (Our job provided deadly monotony and exposure to chemicals for eight hours minus two fifteen-minute breaks and a half hour for lunch unpaid. Oh, you worked there too? Eight to Four-thirty? Eh, Paisan!)

Anyway, we were enjoying our brief respite and eating plastic-wrapped muffins. There was nothing to look at but yesterday’s Evening Bulletin. In the ‘Women’s Section’ was the latest health scare. Saccharin causes cancer.

For the younger generation, let me clarify that Saccharin was the great white powdery hope for women who wanted to be slim while still eating food. But now it was proved deadly.

Andrea was having none of it. She waved her coffee cup.

“Everything causes cancer!” she cried. This cup causes cancer!” She’s shaking the paper cup with the Greek key pattern around the rim.

Well yeah, Bunky, no one gets out of here alive. And you can’t go nuts about the latest headlines. The news reporters have no more memory than a gerbil. This week’s panic leads.

It helps to take the long view. Reporters, bless their little Journalism Degree hearts, don’t know squat about Science. They would probably like to actually report some news, but real life is 8:00-4:30 with lunch not included.

Well, I could go on. My topic today is a recent medical study that is both disappointing and counter-intuitive..

A decade ago, the federal government launched the three-part study to see whether intensely lowering blood sugar, blood pressure, or fats in the blood would reduce heart attacks and strokes in diabetics. The first piece of the study — about blood sugar — was stopped two years ago, when researchers saw more instead of less risk with that approach. Now, the other two parts of the study are in.

The later news don’t look good.

The drugs used in the study to manage hypertension and cholesterol did not improve health or longevity in the people enrolled in the study.

This is disappointing because Diabetes is punching the time card on the shift that Tuberculosis used to work. He’s got a different M.O. He reaps the fatter and the older instead of the younger and the thinner. But he’s got greedy and is taking out so many that society might have to recognize a non-contagious epidemic.

What can we conclude from early study results that indicate that drug treatment for hypoglycemia, and high cholesterol does not improve health for people with type II diabetes?

We could conclude that having good blood sugar control doesn’t improve your health, but that doesn’t make sense. If your pancreas is doing its job you can eat cotton candy for breakfast and feel just fine. And it’s better to have clear coronary arteries than not, I think we would agree.

I would examine this study and question whether the drugs that were used on the volunteers were effective in promoting health. That’s not the same as promoting optimal lab test results.

Your individual concern is to find what works. A drug that totally sucked for the woman sitting beside you in the waiting room might work miracles for you.

Taking the long and cynical view of this recent study, I first would like to know how much influence the drug companies had in the design of the research. Context is everything. Ask an artist if you don’t believe that.

And the conclusion I draw from this study is not that controlling your blood sugar and cholesterol is useless. Rather, I question whether the drugs tested were the best ones. And whether drug therapy is the best approach. Maybe diet and exercise would work better. But there’s no lobby for that.

And these studies, comprising a few thousand people for a few years can’t answer the most important question–What should I do to stay healthy?

Taking the long view, I would say to use the old wisdom of eating right and exercising. If that doesn’t fix things, ask a doctor you trust to prescribe the drugs that seem like the best choice. Ask your doctor to track the effectiveness and explain the lab test results to you. Some people really need to take prescription drugs, and they are healthier when they do. I really mean that. Be reality-based. If a pharmaceutical helps you then for goodness sake, take the pill.

We unfortunately don’t have a science press to educate the public. We have a cage of gerbils chasing headlines.

Science seems wimpy sometimes. Studies don’t ‘prove’ anything. They support a hypothesis. How dry and dull.

The latest studies may show that drug treatment is not effective, or maybe that other drugs would work better, or we need better drugs, or maybe that diet and exercise is the only effective treatment.

Like Gilda Radner said, ‘It’s always something.’

We can’t panic on cue every time studies ‘prove’ something. It’s good to be skeptical, and take the long view, and ask who’s signing the checks. That’s something that reporters don’t usually dig deep enough to investigate. When they do, it gets buried on the back pages.

I think that taking care of yourself is a good idea. If you have a chronic disease like diabetes you should watch the research for new developments while doing the old-fashioned stuff to take care of yourself. A cure may be a long ways off, meanwhile we have to live in the world we’re in and make the best of it.

That Stuff Will Make You Sick

For about twenty years I’ve noticed that some of my diabetic patients have a bad craving for sugary drinks, especially soda.

I’ve noticed that a whole double aisle of the supermarket is full of soda, and there’s another pair of aisles of sweet fruit juice and sports drinks. This low-nutrition, high-sugar item is a best-seller even in a recession when staple foods are getting harder to afford.

A study shows that soda is linked to diabetes.
Stop the presses!

It’s a tough habit to break, too. A shot of glucose that kicks in fast. Once in a while won’t hurt you, but if you drink it all the time it will make you sick.

A Little Bit’a Sugar

Due to the fact that last time I checked you don’t need to update your credentials to be a Certified HIV Counselor, I think the test I passed in the early 90′s at the Rhode Island Department of Health still covers me.

I haven’t done HIV counseling in years, and I would absolutely get an update if I expected to counsel anyone now. A lot has changed.

In the 90′s, they were just finding the meds that are keeping a lot of people alive today. I did counseling with patients prior to the HIV test, and counseling when giving results. After all, this might be dire news, and you didn’t want your patient to lose all hope. You also wanted to educate them for prevention.

Today, we can light a candle, and the AIDS quilt with its acres of squares dedicated to all the people we lost has not come to Rhode Island for a long time. Sorrow fades, we survive.

When I was actively counseling, I had a guy come in for his results–negative. Good news, absolutely. However, I read his chart for primary medical care, and there was bad news of another health threat in it. He had uncontrolled diabetes.

So the conversation went something like this–

“Good news, your HIV test was negative.”
“Oh, thank God!”
“Yes, but I have to tell you that your chart shows that your blood sugar was 356 last time you came in to see the doctor. You really need to schedule an appointment to talk about your diabetes.”
“Yeah, I know I have a little bit’a sugar, but I don’t have AIDS.”
“As far as the test can tell, you are HIV negative [explanation of the limits of testing, plus safe sex advice], but I’m concerned about your blood sugar.”
“Whatever. I’m just relieved I don’t have AIDS.”
“But diabetes could kill you!”
“Yeah, but I don’t have AIDS.”

What counsel can we give the American public today? We are being destroyed from within by a commonplace malady– one that kills our relatives, neighbors, and nameless people who show up in the statistics. But we’re used to it. A terror like AIDS will mobilize us. A terrorist who killed tens of thousands of Americans yearly would generate outrage.

But death by incompetence, greed, blind stupidity and cowardice? We’re used to it.

I wish we were able to reach a consensus that every American should be able to get health care. Other countries have done it. It’s not easy, and it is expensive, but the alternative is paying more for less, as we are doing today.

In the older population, which is my patient base, diabetes affects over 10%. The consequences are horrific. I think that if we could step back, and see how the number of Americans suffering and dying from lack of health care outnumbers the Americans dying of HIV we would have more sense of crisis.

Part of the fear of HIV was the possibility that we might be next. But if you are average, you certainly know someone who is afraid of losing their health insurance. Who is on COBRA. Who is running up their credit card with medical expenses. Can you catch unemployment? It does seem to be spreading.

Universal Health Care, like peace, has to come eventually. Let’s skip the rest of the war and just do it now.

Life and Limb

I tried to explain to a pro-lifer at the Town Hall that the high infant mortality in the US means that for every baby who dies, there are many others who suffer unnecessary disabilities. What a price to pay, over a lifetime.

Thousands dead from lack of access to health care means that many more suffer from diseases that could be prevented or treated. Here’s one we see all the time. From AP…

Limb-salvage experts say many of the 80,000-plus amputations of toes, feet and lower legs that diabetics undergo each year are preventable if only patients got the right care for their feet. Yet they’re frustrated that so few do until they’re already on what’s called the stairway to amputation, suffering escalating foot problems because of a combination of ignorance — among patients and doctors — and payment hassles. [read the rest if you want a very informative article about the cost of diabetes]

That it’s labor-intensive to provide wound care is not a total loss. Money spent employs workers who pay taxes. Kind of stimulating. And if the Canadians ever attack, Americans are going to need two good legs to defend the border.

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