The Salt Debate – Not Going Away

Salt, one of the essential elements of life is generating a great debate. While the salt industry still claims it is all hot air and a turf war, other agencies including the Centers for Disease Control and doctors the world over say that too much salt is eaten by everyone and salt intake needs to be reduced. And, in another press release by another group, they say reducing salt only reduces blood pressure a little, but may also increase levels of some hormones and unhealthy fats. The study also states that reducing sodium may not have a health benefit. Both the CDC and the second study are published in WebMD.

A third article is an interview of Jiguang Wang, MD, PhD, about the sodium and hypertension problems in China. Dr. Wang points out that in countries where potassium is in balance, that the reduction in sodium may have smaller benefits. In China where potassium is generally low in the population, reduction in sodium intake has significant health benefits for the population.

All of this raises some interesting discussion and points for concern about who is correct and if the studies are indeed not focusing on the true issues. When will we have a correct answer I think will depend on the scientists reevaluating the entire underpinnings of the studies and possibly redoing some studies to make sure that all factors are evaluated for different ethnic and cultural backgrounds.

Both the CDC study and the second study are important and need to be carefully read to help in the individual decisions that need to be made. I think there is some truth in both studies and possibly some incorrect information because of poorly designed studies. I also think Dr. Wang may have exposed some of the weaknesses in his interview.

Does Prediabetes Mean Eventually Diabetes?

At least this one subject I can understand and partially agree with the answer given to a prediabetes question. Granted there are some terms that need better definition. This doctor missed a golden opportunity to give a great answer instead of the partial answer.

The question is does prediabetes mean that diabetes will follow. First, the answer that many people do not want to hear. If you do nothing and do not manage prediabetes, it will progress rapidly to type 2 diabetes. That you can count on.

If you take the doctor's answer, you may be able to delay type 2 diabetes for a few years if you do not let denial take over. The doctor talks about making lifestyle changes that can significantly delay or even prevent type 2 diabetes. The answer then goes on to suggest a five to ten percent weight loss. He does explain that this means about 30 minutes of exercise daily and eating healthy meals.

In describing healthy meals, he says nothing about doing any blood glucose testing to see what the food you are consuming does to your blood glucose levels. Then the answer becomes lopsided and the meals he is suggesting becomes very agenda oriented. The agenda excludes any red meat and foods containing any cholesterol. The mantra of egg whites, soy, and whole grains sounds like the American Diabetes Association mantra.

The suggestion of vegetables and fish for foods is acceptable, but do be careful of the quantity of fruit and soy or soy products and especially whole grains. The soy and whole grains can be an overdose of carbohydrates which will undue the benefits of exercise and may well cause weight gain. He says nothing about avoiding highly processed foods and educating yourself to avoid or severely limit potatoes, rice, and bread.

Final suggestions include quitting smoking, drinking alcohol in moderation if you drink and reducing stress to assist in managing your blood glucose levels. The doctor again partially covered the at risks from prediabetes. He mentions heart disease and stokes, but fails to mention any of the other complications that can or may occur in prediabetes. These include kidney damage and eye and hearing problems. Since these vary greatly from one individual to another, it is still wise to know the symptoms and solutions.

Read the short WebMd question and answer here.

Under Age 60, Have Diabetes, Get Hepatitis B Shot

The Advisory Committee on Immunization Practices (ACIP) stopped short of recommending hepatitis B vaccination for those over 60 because there is data showing that the vaccine is less likely to be effective in those who are frail and elderly.

They did have concern for many in nursing homes where proper procedures are not followed, and hepatitis B was accidentally spread by shared glucose monitors. I have some questions about whether they were talking about continuous glucose monitors or if they were talking about glucose meters. I suspect the later and more likely the lancer tool. I wonder why a nursing home would share something that is very likely to spread medical problems.

The ACIP did by a 12 to 2 vote strongly recommend that diabetes patients under the age of 60 that have not been fully vaccinated for hepatitis B have their vaccination completed. While not saying which elderly diabetes patients, they feel that many still need the vaccination over 60.

The hepatitis B vaccine is generally more effective in young adults. The ACIP advises that when people learn of their diabetes diagnosis, they should get the 3 or 4 dose series, which lasts a lifetime.

The hepatitis B virus infects the liver and for those that are not able to fight off the infection results in about 1.25 million Americans having a chronic hepatitis B infection. Hepatitis B kills 3 to 5 thousand people a year in the USA.

“The ACIP is made up of independent experts who advise the CDC and FDA on vaccination policy. The committee's recommendations form the basis of the U.S. immunization schedules.”

If you have not had the series of hepatitis B shots and have diabetes, please get the shots as recommended by the ACIP. Read the press release here.

Blame is Bad; Positive Attitude is Good for Diabetes

When we are first diagnosed with diabetes, we all tend to go through a grieving process. First, we have anger, then denial, sometimes depression, and then acceptance. We do not all experience them at the same level, order, or even all of these. Denial for me was about three years after diagnosis and I had already developed good treatment habits, which did save me from many problems because the period of denial was shortened by the good habits. Depression set in about the same time and it was good that I was courting my second wife as this helped end the depression and I think denial as well.

Now a study has looked at some of the happenings after diagnosis and how this affects us. I was a little shocked by some of the results, but still I realize that this can happen. Many “people with diabetes who see themselves as responsible for their disease onset blame themselves for making poor lifestyle choices and are significantly less likely to monitor their glucose levels, properly inject themselves and make lifestyle choices that would benefit their condition.” I know blame had something to do with this, but I was not aware that these people are significantly less likely to monitor their blood glucose levels and take proper care of themselves.

Getting rid of the blame game quickly may have been my saving force and caused me to start monitoring my blood glucose levels quickly and often. I was trying to decide what foods I could and could not tolerate, and which ones to eat less of or eliminate from my menu. This became my driving force the first several months and then when I was put on insulin; my habits became even more ingrained.

"As perceptions of responsibility for disease onset increased, so did trait anger," said Mary Turner DePalma, professor of psychology at Ithaca College, "Increases in trait anger were associated with increases in self-blame and negative social support, which were associated with the self-report of poorer disease management." This is why many people with type 2 diabetes also become angry when not so well meaning people make very impolite remarks when at public and private events when food is being served.

"That perceptions of responsibility for diseases onset are associated with health behavior illustrates their importance in the specific context of diabetes," DePalma said. "Our study shows that interventions designed to improve anger management and increase disease acceptance may offer additional mechanisms to improve diet, exercise and perform appropriate blood glucose testing in individuals with diabetes."
This last statement is very important and is one of the factors that need to be considered more. Positive interventions can go a long way to improve diabetes care and patient support by the medical community should be part of this. The medical community seems not to care about attitudes that they display to patients with diabetes and many physicians use the blame and fear tactics to get patients to follow their directions. Positive attitudes by physicians and nursing staff could go a long way to provide good examples for patients with diabetes and other chronic diseases.

Drugs for Depression Can Cause Hypoglycemia

Damn if you do, and damn if you do not, seems to be the current dilemma if you have diabetes and suffer from depression. This is the warning that needs to be on every box of certain depression medications. If you suffer from depression, take time to read the instructions for the drug you are prescribed and do ask the doctor what side effects it will cause for people with diabetes. Be sure that you understand the instructions.

A term you should be knowledgeable about is antidepressant medications called SSRIs (selective serotonin reuptake inhibitors). There are several drugs that fit this class and not all have warnings. Either they are different, or are so new that no cases have been reported. Since first introduced in the 1980's, Prozac has been very effective for treating depression. Another drug Zoloft introduced later is also effective. Viibryd, a late comer to the depression treatment has no warnings.

The warning for this class of depression drugs is they can cause hypoglycemia while taking the drugs and can cause hyperglycemia when you stop taking the drug. This means for all medications, insulin and oral, a reduction in dosage may be needed when starting any of the SSRIs. Then this reduction may need to be reversed when you are taken off any of the SSRIs.

Be sure to talk this over with your doctor. Who knows, you may educate the doctor and you will be safer for knowing how to look out for and treat the side effects. Read the blog by Dr. Quick here. Make sure also that your pharmacist gives you complete instructions.

What is up at Health Central?

There are some excellent diabetes bloggers writing for Health Central, but I do not know whether I am missing something, but with two diseases receiving national attention in the month, Alzheimer's and Diabetes, I would have thought Diabetes Month would have also rated some space. It is just for the number of times I have visited the site recently, I thought I would have seen something on the site about this being Diabetes month or that tomorrow November 14 is World Diabetes Day.

Granted, I have not visited the entire site, but the home page features National Alzheimer's Awareness Month, as does the page for Alzheimer's. When you go to the page for diabetes, nothing is mentioned about Diabetes Month or World Diabetes Day. This seems a little odd considering the bloggers for diabetes. Not only am I disappointed, but I am also wondering about the position of Diabetes Health. I have been skimming the site regularly since the beginning of November, but nothing appears on the pages for Diabetes, and Diabetes and Teens, about Diabetes Month or World Diabetes Day.

The official organizations representing diabetes in the USA may not agree on a symbol to represent diabetes, but they do recognize Diabetes Month and World Diabetes Day.  There are people trying to get the diabetes organizations to accept one symbol and I applaud their efforts. We need unity to give us recognition like breast cancer.

This unity needs to come from the American Diabetes Association, the American Association of Clinical Endocrinologists, the American Association of Diabetes Educators and the JDRF. Presently all are going their separate ways and seem to have little interest in accepting something that the World Diabetes Federation is promoting for the world. Many in the diabetes online community are working to bring this about, but Health Central is not one of them.