Pay Walls and Other Road Blocks to Learning

This blog is written for people with diabetes, but applies to most diseases, illnesses and other maladies.

Develop a chronic disease and learning on the internet can become expensive. Unless you are a medical professional, access to many studies is nearly impossible for the average person. Even paid subscriptions are expensive; often the charge is by the study or a month of studies. For example, most studies behind the pay wall at the American Diabetes Association cost $25 per study. That would mean that for 16 studies, the cost would be $400.

That is not cheap and the average person could not afford this with the costs of medications and treatments increasing and the current insurance costs with large copays and medication copays. Then consider the junk science that is passed off as studies and it becomes a hellacious nightmare to know if you are receiving anything of value for your money.

There are many things to consider and often these are even kept out of the press and are not among standards or ethics of research. Some of these include the following:

• financial conflicts of interest
• inadequately rigorous selection criteria, outcome measures and criteria of statistical significance
• the practice of testing products against placebo or no treatment and inclusion of control groups
• recruiting subjects using financial incentives that introduce outcome bias
• marketing campaigns masquerading as research
• research agendas driven by corporate or individual interests rather than patient needs
• extreme small studies using few participants
• studies masquerading as human studies that are rodent studies
• studies that are fabricated by excluding participants that would bias the study
• studies that use healthy adults rather than people with the disease
• using deceptive low doses of a medication
• overly brief study periods to avoid averse results

The list could go on, but this gives you an idea of what makes it difficult to know about many studies. Are they really reliable and valuable for what you are searching for information? Often you can’t even trust press releases that just parrot what the researcher wants you to know in order to entice you in.

Until researchers are bound by a code of ethics and research standards with severe penalties, purchasing copies of studies hidden behind a pay wall is a farce at best and a ripoff most of the time. A research code of ethics and research standards are topics for other blogs.

Even most research extracts are misleading and missing important information from the above list. Research or study extracts provide just enough information to entice people to purchase a study. Even research extracts should have information inclusion standards to prevent misleading people.

Be Careful of Your Food If In the Hospital

One of the members of our support group and another friend are both in the hospital this week. Our member, A.J. is recovering from an auto accident in which he had both arms broken and other injuries. The other friend was working in his yard and being near the street, had a motorcycle hit him when the operator lost control. Most of his injuries were internal, but the operator of the motorcycle was less fortunate and lost his life.

What is surprising is both were visited by the hospital dietitian and put on high carb/low fat meal plans. Both have complained that this is not good for them, as the internal injuries have created a need for a liquid diet for my friend as he was being fed through a tube for the first three days and his doctor wants him to remain on a liquid diet for several more days. He got his diet changed by the doctor, but the doctor had a battle with the dietitian.

A.J. had the problem that he is used to a low carb/high fat diet meal plan and had to refuse food until he was able to have a nurse call Tim and Barry and tell them that he was in the hospital. When more of us were notified once Tim arrived at the hospital, we arrived and there were eight of us in his room. Since it was Saturday, we were surprised to have the dietitian walk in and start ordering that he eat the food from the hospital.

Tim stepped out of the room and called Dr. Tom. We were fortunate that he was in the hospital and came quickly. The dietitian started informing Dr. Tom that she was in charge of nutrition and the patients would eat what she prepared. Tim and Allen were entering the information for the food on the tray and both could only guess at the weight, but both arrived at over 130 grams of carbohydrates. Dr. Tom said A.J. is a person with type 2 diabetes and that his food plan should be allowed.

At that point, the dietitian informed us that a new rule issued by the Centers for Medicare and Medicaid Services gave registered dietitian nutritionists the ability to now work more independently in hospitals, providing patients with more effective and efficient nutrition care thanks to the final rule on therapeutic diet orders. She said she would be filing a complaint that her nutritional expertise was being ignored by patients and doctors.

No one had noticed Allen and Barry leaving and when they returned about 40 minutes later, they had prepared a meal for A.J.  A.J. had asked Dr. Tom for a prescription of metformin while he would be in the hospital, as he would not be able to exercise and wanted to keep his blood glucose managed. A.J. took one 500 mg of metformin and asked to be fed. Allen said that the meal had 30 grams of carbohydrates and A.J. said he had guessed about 35 grams.

Since Tim had his laptop, I asked him to go to this article and after he found it, he started reading it aloud. When he read this, “Allowing registered dietitian nutritionists to independently order therapeutic diets and monitor and manage dietary plans for their hospital patients will save the country hundreds of millions of dollars and also help hospitals provide better multidisciplinary care,” we all laughed.

Jason said this could cost more and do more health damage than what the patients needed, especially those with diabetes. When Tim finished reading the article, Dr. Tom commented that her filing a complaint could create problems. At that point, Barry had finished feeding A.J. and he said this does not sound good for patients that do not eat high carb/low fat.

I commented that when a dietitian orders solid food for a patient on a liquid diet, this is very troubling. Dr. Tom said you know about this happening. I told Dr. Tom to talk to and gave him the name of the doctor, and he could get what happened. Dr. Tom said that he had heard this, but was not sure about the details. I said the person is a friend of mine and was visiting him before receiving Tim’s call about A.J.

Barry said he would bring A.J. meals with Allen’s help. The rest of us offered money to defray the costs and A.J. said if we could do this, he would repay people when he was out of the hospital. Barry said that was not necessary, as by spreading the cost over several people should not cause a burden. Dr. Tom told us to call him if any problems arose because of our actions, as he needed to leave to see the rest of his patients.

We all looked at the time and A.J. thanked us for coming and said he needed to sleep if he could with the nurses and others coming and going all evening and night. We wished him well and Barry asked what time he wanted breakfast. We all left A.J. then. I headed for my friend’s room, said good night to him, and told him I would be back the next day.

Steps to Prevent Prediabetes Becoming Diabetes

Not everyone gets the advantage of a wake-up call and being told he/she has pre-diabetes. Too many doctors are not into pre-diabetes and would prefer you advance to diabetes so they have something to treat. To avoid legal problems, they tell you things such as your sugar level is a little high, watch what you eat. They also say that your blood sugar is near diabetes, be careful what you eat. They know that most people will not pick up on these clues and will progress to diabetes, giving them an income.

If you get any of these signals, consider them real and take action now. Just because your doctor was being obtuse and not telling you that you now have pre-diabetes, this is what the doctor does to prevent you from taking action to delay or prevent the progression to full diabetes.

There are actions that you can do that will stop the progression to diabetes if you act on them.

#1. Exercise. I don't care what you do for exercise, but if you are medically able, you need to begin slowly and build up gradually to ideally a 30-minute regimen at least five days per week. Hopefully you can have several types of exercise that you enjoy and will follow through and use. Hopefully your doctor will let you know if there are limits you need to be aware of and not exceed. 

#2. Lose weight. This may be difficult for some, but yo-yo dieting will not succeed. Most suggestions advise losing 10% of your weight if you are overweight. I suggest looking up your ideal weight and then setting reasonable goals to get to that weight. It may take some time, but that is okay.

#3. Develop a good food plan. Since there is not a diabetes diet or a recommended food plan, you will need to find what works for you. I would suggest a low carb – high fat, medium protein type of food plan. Use your meter to tell you if this works and expect some hunger pangs the first month as you start the plan. Over time, you will lose the hunger as your body adjusts.

#4. Get the right amount of sleep. Most studies recommend at least eight hours of sleep and some suggest eight and one-half hours is best for people with diabetes. I know many people try to get by with less than I know seven, but this is not good as your body needs more to deal with pre-diabetes and diabetes.

#5. Take any medication on schedule. For best use, oral medications seem to work best when taken at the same times daily. With metformin being generic and relatively inexpensive, consider using this to help manage pre-diabetes and the early states of diabetes. Insurance generally will not reimburse for medications for pre-diabetes.

#6. Take care of your heart. Heart healthy foods which means eliminating processed foods and eating more vegetables and certain fruits can really help your heart and improve your blood glucose levels.

#7. Be careful of all illnesses. Many people are not careful about other illnesses especially the common cold. Washing your hands more often after being out in public will help. Avoiding crowded stores and people that are sneezing will also help. Colds are not helped by antibiotics and normally need to run their course. Being careful also means taking care of yourself and getting enough sleep.

#8. Know your hormone levels. This applies to men as well as women. There are many ads for testosterone for men and estrogen for women. Before buying in to these, have a discussion with your doctor and follow his/her instructions. Tests may be necessary to determine if there is a need and your doctor will know your health history to make a determination.

#9. Manage your stress levels. Stress and pre-diabetes or diabetes is not helpful in managing blood glucose levels. Read my blog here about diabetes and stress for some tips and possible activities to reduce stress.

#10. Stop or lower alcohol consumption. Many people think that they can continue to drink as usual. Alcohol consumption messes with your blood glucose levels and often gives false readings. This is because alcohol suppresses blood glucose levels initially and then causes them to rise to higher levels later.

#11. Stop smoking. Smoking causes people with pre-diabetes and diabetes to have problems with neuropathy and other health conditions including heart problems.

#12. Keep you doctor appointments. To stop pre-diabetes from becoming diabetes, see your doctor as often as he wants. Research in the meantime and have questions for your doctor. The good doctors will generally work with you to help. If they don’t or won’t consider finding another doctor.

#13. Find the right support structure. This may be the most difficult part, but is worth the effort. Family may be supportive, or not. Check with the doctor to see if there is a support group. Also, check out some of the diabetes forums to ask questions. Do not go seeking specific answers, but be open to a variety of different answers.

#14. Commit to your plan. We are human and can make mistakes. As such, realize that returning to old habits can bring on the onset of diabetes. A one-day mistake should not become a pattern. To commit to your plan, your need to commit to it 24/7/365.

The above tips are will hopefully provide some direction and guidance in your battle with pre-diabetes to prevent the onset of full diabetes. Even those in the early stages of diabetes can have some hope to reverse diabetes, but this is not a cure. Do not return to old habits.

Recording Your Doctor Visits

Since writing this blog on April 1, I am seeing more discussion about the topic. I did receive 2 emails shortly after the blog was posted and they were anything but kind and one doctor was asking me why I would write about a topic that the medical profession would oppose. I did answer that one and suggested that if he felt that way, he did not belong in medicine.

I took great effort to say that often, elderly people can have memory problems and need a recording to clarify what was said by the doctor. I also suggested that if he was feeling that way, maybe he should be worried about the poor care he was giving patients.

Now there is another blog by a doctor from a very positive point of view. This doctor had it happen to him and was not even told.  He was informed later by someone that had heard it. The rest of his office and staff were angry and disgusted. Dr. Ramachandran said, “(This) is typical of what most physicians would feel in the same situation. Why would a physician be upset about a patient secretly recording a conversation with them?”

His next statement is what most doctors fear. “Well, simple, really. Most physicians are in chronic fear that the next person to hear or view that recording will be a malpractice lawyer, dissecting it, consonant by consonant, probing for potentially actionable material.”

Then he makes some very good points.

#1. A patient of his could not remember what he, (the doctor) had said and his wife confirmed this.

#2. Another patient could not remember which medication to stop and which medication to start.

#3. How about the concerned adult children who were unable to attend the parent’s appointment and want to talk to me about how their parent is doing?

Dr. Ramachandran feels those people could benefit from the ability to record a discussion with the physician. 

Cullman Regional Medical Center has one of the finest medical facilities in north Alabama and Cullman is impacting thousands of lives by providing care to people who are sick and hurting. More than 150 doctors practice medicine here with a team of nearly 1,000 nurses, technicians and other support staff.

Cullman has instituted a plan that creates audio recordings of the instructions that patients received at the time of discharge from the hospital. This audio is a verbatim recording of what the patient was told as part of their discharge. This is done by a nurse or case manager and is uploaded to the cloud, where they can be accessed by calling in, or via the Web. The program is a great success and reduced 30-day readmissions by 15 percent.

Dr. Ramachandran concludes by instructing his patients that feel the need to record the conversation to feel free to ask the question, “May I record this conversation?” You’ll find the answer is often “Yes, please do!”

Trisha Torrey then writes about this and says it is legal. What she forgets to say is that it is legal in some states and not others, unless both parties consent. If you record after being told no – you could be the one on the wrong end of the lawsuit.

Thin and Type 2, Other Risk Factors for Diabetes

Are you aware that about 15 percent of people diagnosed with type 2 diabetes are thin and normal; meaning their body mass index (BMI) is between 18.5 and 24.9? Even though there are some variances and possible inaccuracies in BMI, this is what the American Heart Association uses.

What are the factors that affect thin people to develop type 2 diabetes?

1. Genetics – plays a prominent role in determining diabetes onset. This includes family history which sometimes isn't known because of secrecy.
2. Sedentary lifestyle – can help trigger diabetes.
3. Poor eating habits – can also help trigger diabetes.
4. Previous diagnosis of gestational diabetes or having a baby with birth weight greater than nine pounds.
5. Many have metabolic profile similar to overweight individuals.
6. Many are insulin resistant in places where their fat cells are stored because of lack of exercise.

It is unfortunate that many normal weight people with type 2 diabetes have excess visceral fat. Visceral fat is the type of fat surrounding the abdominal organs. Visceral fat is very metabolically active. It produces a variety of hormones that influence glucose and fat metabolism.

Fatty acids are released from the fat cells and enter the blood stream. These fatty acids can damage the muscle cell's ability to attach properly to insulin causing insulin resistance. This also affects the glucose output of the liver. One method to convince yourself of this is to measure your waist and then your hips. Now divide your waist measurement by your hips measurement and record the result. Warning – do not do this if you are a woman and pregnant. If the results are greater that eight tenths, you likely have more visceral fat and may be at risk for developing type 2 diabetes even if you have no history of weight problems.

Although most doctors will laugh at you and make statements that it is all in your head, consider the above six points, and ask your doctor to screen you for blood glucose levels (plasma blood glucose) and A1c every year.

Weight loss is obviously not the treatment in this case, but exercise and healthful eating certainly is. Aerobic exercise and especially strength training are two important lifestyle measurements that can keep blood glucose managed and help avoid complications down the line. The more muscle you have the greater your uptake of glucose into the cells, where it belongs.

Now, choose low-glycemic index carbohydrates such as legumes, fruits, and vegetables and limit added sugars to help. Carefully choose a heart-healthy food plan of eating. This is important in people who are thin with type 2 diabetes because some studies have shown that those who develop type 2 diabetes despite being of normal weight have an increased risk of heart disease in excess of those obese people with type 2 diabetes. The diagnosis may not seem fair, but there are things you can do to manage your diabetes and live a long life.

Is Denial Preventing Diabetes Management?

After having the intervention with James who was definitely in denial, I have been reading more about denial. The reactions of being diagnosed with diabetes can cause anger, a feeling of being overwhelmed, and being scared – all at the same time. Other reactions include fear, grief, depression, and denial and finally acceptance. It is important to remember that each person may react differently. Do not attempt to apply a one-size-fits-all conclusion to this, as you will be wrong more often than right.

I have seen some people bypass all of the above and start managing diabetes immediately. Some of the above then happen later and can be very dramatic. A person I knew did this and had none of the above, but two years later blew up at his diagnosing doctor, really asked him why he had not done any education, and was so angry that nothing his doctor said was getting through to him. Three days later he was back to near normal and would not talk about it. I don't think he has accepted his diabetes and may have been in a form of denial all along, but I have only suspicions.

That is one reason I was happy to see this blog on the Mayo Clinic page. The list some items about denial that I have not seen before, and for that I am thankful.

#1. Denial takes many forms and if often difficult to understand as denial. The following are just some of things that many give you a clue (#'s 2 to 5).

#2. "I have a mild case of diabetes; I only have to take one pill." Even your health care provider may have told you that you have a "mild case" of diabetes, giving you the mistaken impression that the disease isn't serious.

#3. "I hate diet drinks; I won't give up my soda." Often times, this doesn't refer to the occasional soda drink. It refers to 80 ounces or more of regular soda — or sometimes milk — a day. When you continue to consume large quantities of carbohydrates, you may be in denial, thinking complications can't happen to you.

#4. "I've had diabetes since I was young and can do what I want now that I'm going off to college." Be careful with this, as an attitude of rebellion can be denial.

#5. "I don't need to test my blood sugar." You may neglect to test your blood glucose levels as suggested by your health care provider, thinking that you can tell what your blood glucose level is by how you feel.

For your health, it is important that you reach the point of accepting diabetes as a fact of your life. Fight for your health. Set realistic goals, make a plan, and ask for help from health care professionals. Regardless of how you start your journey, it is important to move forward and accept the challenge of managing your diabetes. Your emotions will get in the way, if you let them, and prevent you from accepting your diabetes.

I hate to say this, but once the diagnosis is made, it will not go away. Yes, it is possible with changes in lifestyle and food plans that type 2 diabetes can be managed with nutrition (diet) and exercise, but if you don't stick to a regimen, diabetes will return. Even though doctors declare that diabetes is progressive, it is only people that do not manage diabetes that causes diabetes to be progressive. Type 2 diabetes is a lifelong, chronic disease that can lead to complications of left untreated and unmanaged.

Instead of being secretive about your diabetes, tell your friends and family how they may assist you. Things in your life have changed and you need support if a support group exists near you.

More Studies from 35 to 50 years Ago Proven False

It seems that in light of today's fabricated studies, that in years gone by, studies were also fabricated by researchers to gain a reputation and a little fame. These people may be the cause of the research fabrications by many companies and government today as they learn how easily researchers can be coerced. Researchers in general seem to have no ethics and even less interest in research that could be of clinical value. It is all about the money

Like researchers of three or more decades ago, it was about agendas and the amount of research money that fabrication of research could bring into their pockets. Researchers today have the Big Four plus Big Government to provide money and direction for research – Big Pharma, Big Food, Big Chemical, Big Agriculture, and Big Government. And the direction is of even less clinical value. My blog on junk science is big business helps explain this.

Now like the fat fiasco by 1956 of the “Seven Countries Study” led by Ancel Keys, another study has been disproved. A supposedly landmark study from 1970 by two Danish researchers, Bang and Dyerberg has been finally shown to be false and exactly the opposite is the case. Their research has been the basis for heart healthy guidelines for years and recommended oily fish to be heart healthy.

Guess what? A new review of information has determined that Bang and Dyerberg failed actually to investigate the cardiovascular health of the Eskimo population, meaning that the cardioprotective effects of their diet are unsubstantiated. Their research focused on the dietary habits of Eskimos and offered only speculation that the high intake of marine fats exerted a protective effect on coronary arteries.

Now, researchers have found that Eskimos actually suffered from CAD (coronary artery disease) at the same rate as their Caucasian counterparts. Bang and Dyerberg relied mainly on annual reports produced by the Chief Medical Officer of Greenland to ascertain CAD deaths in the region.

“In fact, researchers have now found that concerns about the validity of Greenland’s death certificates have been raised by a number of different reports and that at the time, more than 30% of the population lived in remote outposts where no medical officer was stationed. This meant that 20% of the death certificates were completed without a doctor having examined the body.”

“The 2014 study has identified a number of reasons that those records were likely insufficient, mainly that the rural and inaccessible nature of Greenland made it difficult for accurate records to be kept and that many people had inadequate access to medical personnel to report cardiovascular problems or heart attacks.”

“Overall, their life expectancy is approximately 10 years less than the typical Danish population and their overall mortality is twice as high as that of non-Eskimo populations.”

Yet, this study is still widely cited today when recommending the dietary addition of fish oil supplements (like omega-3 fatty acids) or oily fish to help avoid cardiovascular problems. Even with this evidence, our doctors continue to believe these old studies and still trot them out as fact when patients are resistant to their advice.