Over 65 – Building a Meal Plan for Health

I had to read this several times, but to my surprise, even though this is from the USDA, they are not pushing whole grains. They are doing more for a great food plan than pushing unhealthy whole grains.

It could be that they are truly concerned about the over 65 citizens. Making healthy food choices is a smart thing to do—no matter how old you are! Your body changes through your 60s, 70s, 80s, and beyond. Food provides nutrients you need as you age. Use these tips to choose foods for better health at each stage of life. This is written of all over 65; however, I will write for over 65 with type 2 diabetes.

#1 Drink plenty of liquids. Water is best for those of us with type 2 diabetes. If the water supply is not safe, buy bottled water. Avoid most juice and all sweetened beverages.

#2 Make eating a social event. Meals are more enjoyable when you eat with friends. Invite a friend to join you or take part in a potluck at least twice a week. A senior center or place of worship may offer meals that are shared with others.

There are many ways to make mealtimes pleasing. Please use caution to avoid high carbohydrate foods.

#3 Plan healthy meals. Find trusted nutrition information from a source you trust. Be sure that what you eat is good for type 2 diabetes, be careful of how much you eat, and if necessary limit the quantity you eat. Find sensible, flexible ways to choose and prepare tasty meals so you can eat foods you need.

#4 Know how much to eat. Learn to recognize how much to eat so you can control portion size. MyPlate’s SuperTracker shows amounts of food you need, but does not have a guide for people with diabetes. When eating out, pack part of your meal to eat later. One restaurant dish might be enough for two meals or more.

#5 Vary your vegetables. Include a variety of different colored vegetables to brighten your plate. Most vegetables are a low-calorie source of nutrients. Vegetables are also a good source of fiber. Not all vegetables are low carb. Watch carrots and corn as they are generally high in carbohydrates.

#6 Eat for your teeth and gums. Many people find that their teeth and gums change as they age. People with dental problems sometimes find it hard to chew fruits, vegetables, or meats. Don’t miss out on needed nutrients! Eating softer foods can help. Try cooked or canned foods like unsweetened fruit, low-sodium soups, or canned tuna. Also if you have a food grinder or even a blender, make use of it to make softer food that does not need to be chewed. Just hold the food in your mouth and gum the food to add saliva to help your stomach and intestines digest it easier.

#7 Use herbs and spices. Foods may seem to lose their flavor as you age. If favorite dishes taste different, it may not be the cook! Maybe your sense of smell, sense of taste, or both have changed. Medicines may also change how foods taste. Add flavor to your meals with herbs and spices.

#8 Keep food safe. Don’t take a chance with your health. A food-related illness can be life threatening for an older person. Throw out food that might not be safe. Avoid certain foods that are always risky for an older person, such as unpasteurized dairy foods. Other foods can be harmful to you when they are raw or undercooked, such as eggs, sprouts, fish, shellfish, meat, or poultry. This is an important point.

#9 Read the Nutrition Facts label. Make the right choices when buying food. Pay attention to important nutrients to know as well as calories, fats, sodium, and the rest of the Nutrition Facts label. Ask your doctor if there are ingredients and nutrients you might need to limit or to increase. For those of us with diabetes, carbohydrates need to be limited while fats (except trans fats) need to be increased/

#10 Ask your doctor about vitamins or supplements. Food is generally the best way to get nutrients you need. Should you take vitamins or other pills or powders with herbs and minerals? These are called dietary supplements. Your doctor may know if you need them. More is not always better. Some can create conflicts with your medicines or affect your medical conditions.

Eating healthy and being active is important at any age. That’s why MyPlate and the National Institute on Aging, National Institutes of Health, are delighted to offer a new resource on healthy eating designed specifically for people ages 65 and older. Follow the links on the site.

Authors with Conflicts Lead Most Diabetes Studies

Why am I not surprised? On October 25, 2011, the British Medical Journal (BMJ) had an article that showed just over one in five (21 percent) of articles published in six leading medical journals in 2008 have evidence of honorary and ghost authorship. This was done to hide what the latest article discloses.

Diabetes research is dominated by a small group of prolific authors, raising questions about the imbalance of power and conflict of interests in this field, argue experts in The BMJ this week. I will let you read the details as they are rather revealing and point out how much conflict of interest exist in the studies published about diabetes.

With the elderly discrimination in studies and the degree of restricted participant selection, the pharmaceutical industry is working to make sure that all trials are favorable to their products. Example: the trial with rodents that were normal rodents that ended up having Avandia pulled from the market. Then the multitude of rodent trials using extremely healthy rodents were used to get Avandia returned to the market.

In most trials, anyone over the age of 65 is normally excluded and anyone under the age of 65 with more than one medical condition is generally excluded. This way for the human studies, they have the healthiest individuals with diabetes to obtain the most positive results. An extreme example would be the glycemic index, which was, arrived at by using only healthy individuals. Yet again, those of us with multiple chronic conditions and over the age of 65 often do not receive the same results. Granted we cannot do the tests necessary to determine how the glycemic index affects us, but this is what they depend on and this is true for the pharmaceutical industry as well.

I am surprised at the doctors that just assume that because the clinical trials say a drug may be safe, they prescribe it to the elderly without the concern they should have.

Now think about the latest class of drugs, SGLT2 and the side effect of DKA (diabetic ketoacidosis). When the different drugs in this class arrived on the market, did we hear about this side effect? No, because they did not want us to know that now many people with type 2 diabetes could now develop DKA. Before this, it was a rare occurrence among people with type 2 diabetes. Yes, it did happen, but now it is more common.

The real problem now is doctors don't know how to treat it as almost every indication is that there is nothing wrong, blood glucose levels are in the normal range and there is no arrow saying that DKA is present. Yet, it is as deadly as DKA in type 1 diabetes.

This is the result of conflicts of interest not revealing this problem before the drug became available on the market.

This is the reason a few writers (including me) keep pointing out the conflicts of interest as we can see what can happen with the doctors and patients that blindly follow evidence based medicine and think they have all the answers when the trial is based on random controlled trials. What many people forget is the principal of the bell curve in which the majority can be covered, but there is always some that fall at the extremes and present problems that often are ignored during the trial phase. Those with conflicts of interest wish these outliers would disappear.

Too Much Sleep May Be Linked to Type 2 Diabetes

I almost passed this by when I read the title - Longer Sleep Duration Linked to Type 2 Diabetes. I thought this must be a joke or a very poor study. When I read the article, I admit that it is worse than most studies and has some obvious weaknesses. Italics are my thoughts.

1. An increased risk for developing type 2 diabetes was observed in participants slept for an average of less than 5.5 per night or more than 9 hours per night. I thought this was about too much sleep and they talk about five and one half hours per night.

2. BMI and weight changes may serve as confounding factors affecting the results of the study. They did not keep track of this during the trial to the extent they should have.

3. Sleep and diabetes are often affecting each other. Normally we hear about this after a person has type 2 diabetes when lack of sleep makes type 2 diabetes more difficult to manage.

People who sleep 9 or more hours per night are associated with higher risk of incident diabetes according the study. Evidence suggests that diabetes and sleep problems are linked to each other. Diabetes can cause insomnia in some people and sleep deprivation may increase for developing diabetes. Yes, “may” is the operative word. Someone blew this, if you have diabetes, how do you develop diabetes?

This was a 20-year study that consisted of four periods of five years each. I would have thought they could have done a more thorough job of research instead of saying, “Further studies are recommended before the association between sleep and diabetes can be established.”

The researchers recorded and calculated the changes in sleep duration for a total of 17,841 participants without diabetes. At the end of each period, incident diabetes was defined using 1) fasting glucose, 2) 75-g oral glucose tolerance test, and 3) glycated hemoglobin, in conjunction with diabetes medication and self-reported doctor diagnosis.

When compared to the controlled group of persistent 7 hours sleepers, results of the study showed "an increase of greater than or equal to 2 hours of sleep per night was associated with a higher risk of incident diabetes in analyses adjusted for age, sex, employment grade, and ethnic group. This association was partially weakened by adjustment for BMI and change in weight. An increased risk of incident diabetes was also seen in persistent short sleepers (average of less than or equal to 5.5 hours of sleep per night).

According to the study, the significance of the results was weakened when researchers factored in adjustment for BMI and changes in the weight. The authors suggest that, "greater weight and weight gain in this group partly explain the association."

The findings of this study provides some understanding about the role of sleep and its effect on the development of diabetes. I am still disappointed by the study.

Algae, Quinoa, Legumes - Alternative Protein Choices

The vegans are pushing hard to eliminate meat from our diets. The latest is from a July 12th presentation at IFT15: Where Science Feeds Innovation hosted by the Institute of Food Technologists (IFT) in Chicago.

But knowing the food industry, I will not be surprised if they mess this up by putting too many chemicals in the food that will erase any good that the new foods can garner.

Algae, quinoa and pulses (legumes) are considered by some food technologists to be the best protein sources and strong alternatives to slow meat consumption, reduce food waste, and help feed the world’s growing population.

Algae: This is a new vegan source of protein. It contains 63 percent protein, 15 percent fiber, 11 percent lipids, 4 percent carbohydrates, 4 percent micronutrients and 3 percent moisture. It is said to be easily digested and considered heart healthy. It’s found in the ingredient lists of some protein shakes, crackers or bars, cereals, sauces, dressings and breads.

There are thousands of algae strains, which can be melded in a variety of produces and consumers seem anxious to learn about algae.

Quinoa (keen-OH-wa): This is a centuries-old “poor man’s” crop grown in the High Andes Mountains of Bolivia and Peru, which continues to grow in popularity. There are more than 1,400 quinoa products currently on the market. It is a nutritious, sustainable food and protein source.

Pulses: Pulses, also known as legumes, beans, chickpeas and lentils, are also high in protein, vegetarian, gluten-free, non-allergenic, non-GMO and sustainable.

The important thing about all three is the lack of GMO at present and this appeals to many people that don't trust our USDA when the department claims there is no health risk posed by GMOs.

My concern is the mess Big Food will make of the products and add too many chemicals and sugar to the products before they read the store shelves.

Founded in 1939, the Institute of Food Technologists is committed to advancing the science of food. Our non-profit scientific society—more than 17,000 members from more than 95 countries—brings together food scientists, technologists and related professionals from academia, government, and industry. For more information, please visit ift.org.

Statins Are Not Good Drugs

The medical professions have a dismal record for being wrong more than right. Now they can add statins to their losing record. Like the issue of fat in our diet, there will be holdouts and others that will double down to defend their right to be wrong. They won't admit to this and will defend their mistakes and claim they were right because they want to continue receiving the lucrative fees from Big Pharma.

Here is a listing of some of these findings that show the error of their ways:

• Statins interfere with the production of coenzyme Q10, which supports the body’s immune and nervous systems, boosts heart and other muscle health, maintains normal blood pressure, and much more.
• Statins weaken the immune system, make it difficult to fight off bacterial infections, and increase the production of cytokines, which trigger and sustain inflammation.
• They make some patients unable to concentrate or remember words, and are linked to muscle and neurological problems, including Lou Gehrig’s Disease.
• Statins inhibit the beneficial effects of omega-3 fatty acids by promoting the metabolism of omega-6 fatty acids, which increases insulin resistance and the risk of developing diabetes.
• There is evidence that statin use blocks the benefits of exercise. Exercise increases the activity and numbers of mitochondria, cells’ “power plants” that process sugars and fat. The study found that with statin use, mitochondrial activity actually decreases with exercise.
• Statins work by reducing the body’s ability to produce cholesterol, which is essential to brain health—the brain is 2% of the body’s weight, but contains 25% of the entire body’s cholesterol.
• Statin users have a higher incidence of nerve degeneration and pain, memory loss, confusion, depression, and a higher risk of ALS and Parkinson’s, according to Dr. David Williams in his July 2014 Alternatives newsletter. Statins also decrease carotenoid levels. Carotenoids, which are found in fresh fruits and vegetables and act as antioxidants, have a number of benefits, including protecting against cell damage, aging, and chronic diseases.
• Statin drugs may also be driving Americans to overeat: a twelve-year study published in JAMA Internal Medicine found that statin users increased their calorie intake by 9%, and fat consumption by 14.4%, over the study period, whereas those who didn’t take statins didn’t significantly change in either measure.
• An animal study linked statin use to muscle damage. Animals that exercised on statins had 226% more muscle damage than those not given statins.
• They affect the quality of sleep.
• Statins increase the risk of prostate and breast cancer.
• Statins are known to cause liver damage by increasing the liver’s production of digestive enzymes.
• Statins also speed aging and lower sex drive.
• Statins have been linked to aggressive and violent behavior in women.

Despite these widely documented risks, the media’s coverage of any adverse side effects is typically followed by the reassurance that the benefits of statins outweigh the risks.

There is much more that should be convincing, but many doctors are not convinced to change their thinking. Read the full article here.

Are You Getting “Best Care” From Your Doctor?

This is a question that needs an answer! When a doctor resorts to using engaged and other words to mask communication, this is when you, as the patient, need to find another doctor. Even this doctor, that in general I respect, has to muddy the communication waters by using words other than communication.

The truth is that as patients, we have to learn in the health care atmosphere of today. Thirty to sixty years ago, we often could depend on the doctors to be more careful and spend the time necessary to give us the care we needed. Little by little, the insurance industry has taken time away from the doctors and forced them to become less caring, more time conscious, and often less proficient in treating patients.

Medical care today needs to meet the following criteria:

1. It should be grounded in the most recent medical knowledge, which is generally reflected in the relevant expert guidelines, as well as in peer-reviewed clinical resources. This doesn’t mean that doctors should follow guidelines blindly, practice “cookbook medicine,” and go on autopilot. It does, however, mean that for you to get better health care, your doctor should be aware of recent recommendations for how a given condition should be evaluated and managed. When doctors decide that your circumstances merit a different approach, they should be prepared to explain their reasoning.

2. These recommendations should be adapted to your preferences and values when it comes to medical care. In most cases, especially when it comes to people who are middle-aged or older, “one size fits all” medicine is not optimal. That’s because often there are a number of reasonable ways to manage a certain health problem.

3. An optimal medical recommendation should be made after informing a patient of the options for treatment and involving the patient in the medical decision-making process. The doctor should also tell you about these two approaches, and then you’d decide together which to start with. This is called shared decision-making. Unfortunately most doctors will never consider this and their egos insist that they are all the patients needs.

Many medical recommendations don't even come close to measuring up to these criteria. The reason is that many doctors have not been trained to practice this way. Then you need to remember that the insurance cartel influences how doctors practice. Under the Affordable Care Act, many doctors know that they are the only doctor in the area that your insurance authorizes and they act accordingly and you can be forced to follow their directions and their way as you will pay higher by going out of the network. The drug companies continue to spend a lot of time and money to influence doctors to prescribe their products. Finally, doctors tend to develop habits and do whatever takes less mental and emotional energy.

The fact is that medicine is usually practiced according to the doctor’s preferences, rather than according to what the best evidence and best practices recommend. Now that you know the truth, here are some ideas of what you can and should do (providing your insurance does not limit you in your choices):

#1. If you can, look for doctors who seem open to discussing options with you. A doctor who gets defensive when you ask about guidelines or alternatives is probably not a good choice.

#2. Do your homework when it comes to your health conditions and treatment options. There is really no substitute. Even if your doctor is progressive and used to shared decision-making, you’ll participate better in the process if you’ve done a little preparation beforehand. Prepared patients and families generally get better health care.

To learn more about your health conditions and your options for evaluation and management, go to reputable websites. I find that the Mayo Clinic website is generally quite good. You can also get useful information and support by accessing online communities of people with the same health problem. SmartPatients.com (for cancer) and PatientsLikeMe.com (general medical problems) are two well-established sites. Remember, your goal is not to be a doctor yourself, but to arrive at your doctor's office with good questions and to have a good discussion.

#3. Be prepared to ask about alternatives. When the doctor makes a medical recommendation, be sure to ask what other alternatives are available. You may want to specifically ask about non-drug options for treating a problem. These often exist and are even often now recommended as first-line treatment. But busy doctors may not think to suggest them unless you ask them.

#4. Consider a second opinion. Especially if you’re considering a treatment of significance, such as a major surgery, it can be good to get a second opinion (if your insurance will allow this). Maintaining your own copies of your medical information in a personal health record can facilitate this.

Taking care of your health, or helping your parents with their health, is like investing energy in maintaining or even renovating your home. You don’t have to be super involved in monitoring the people involved in the process and things very well might turn out okay. But then again, they might not. The people working on your home, after all, have less at stake than you do. For them, it’s one of many jobs. For you, it’s your home and your money.

The body is like your home, except you have much more at stake. For better health care, plan to do your homework, prepare to ask questions and remember that the medical care should be based on your preferences, not the doctor’s preferences when appropriate.

Being Screened for Prediabetes and Diabetes

One-third of adults with diabetes don't know they have it, according to the National Institutes of Health.

This is scary! The blog at the Mayo Clinic about is taking a pro-active point of view and calling for people meeting the following criteria to be tested for diabetes or prediabetes.

The NIH says that you are at greater risk of developing prediabetes and type 2 diabetes if you:

• Are age 45 or older
• Have a family history of diabetes
• Are overweight
• Have an inactive lifestyle
• Are members of a high-risk ethnic population (e.g., African American, Hispanic/Latino American, American Indian and Alaska native, Asian American, Pacific Islander)
• Have high blood pressure: 140/90 mm/Hg or higher
• Have HDL cholesterol less than 35 mg/dl or a triglyceride level 250 mg/dl or higher
• Have had diabetes that developed during pregnancy (gestational diabetes) or have given birth to a baby weighing more than 9 pounds
• Have polycystic ovary syndrome, a metabolic disorder that affects the female reproductive system
• Have dark, thickened skin around neck or armpits
• Have a history of disease of the blood vessels to the heart, brain, or legs

If you're age 45 or older, ask your healthcare provider about testing for diabetes or prediabetes. If you are younger than 45 and overweight, and have another risk factor, you should also ask about testing.

If you have prediabetes you can often prevent or delay diabetes if you lose a modest amount of weight by cutting calories or increasing physical activity. If you're overweight and lose just 5-7 percent of your body weight, you can lower diabetes onset by 58 percent. That is why early detection is so important.

Why doctors will not test more people is a puzzle, but many doctors are trying to keep costs down and therefore do little diabetes testing until forced into it. They seem to care less about the health of their patients until there is an actual problem and then many will dismiss diabetes by saying, “Watch what you eat as your blood sugar is a little high.”

If your doctor says this, then it is time to ask for a copy of the test results and really take a look at the tests. If your blood glucose level is above 125 mg/dl, then chances are good that you have diabetes or prediabetes and should be having a serious talk with your doctor. If the doctor just repeats the above statement, then it is time to look for another doctor – seriously.

A.J and I are having a discussion with an acquaintance of ours that is overweight and the last time he went to the doctor A.J did ask him to obtain a copy of his tests. When he showed us the sheet, A.J told him he was probably a person with diabetes and then A.J asked if I agreed. When I saw the results, I said he is even higher than you (A.J) were when you were diagnosed – 209 mg/dl.

The fellow said it was not fasting and his wife had fixed his favorite breakfast of pancakes before he went to the doctor. I asked how long from breakfast until they drew blood and he answered about three hours. I answered that if he did not have diabetes, his reading would have been at or below 100 mg/dl at two hours. Because his reading was still that high at three hours, he could count on having diabetes. A.J said he agreed with me and asked him which doctor he wanted to see and gave him three names.

The fellow said not at this time and he would need more proof than one test. A.J started to encourage him and I shook my head. When the fellow moved off, A,J asked why I had discouraged him. I said you did not see the recording device he had on record and he will probably replay it several times and then call one of the three doctors you gave him. I said I had watched his body language change drastically when I said if he did not have diabetes, his blood glucose level would be at or below 100 at two hours. He was alarmed and it showed. A.J said he would not push and see what happened. With that we went out separate ways.

Questions for Your Doctor

If you were recently diagnosed with type 2 diabetes, ask your doctor these questions at your next visit. In the meantime, I will give you my answers and possible things for you to think about when you ask your doctor.

#1. Does having diabetes mean that I am at higher risk for other medical problems? My answer is yes. Think of heart disease, neuropathy, and the diabetes complications. There are other possibilities and your doctor may be aware of your family history, which could affect the answer.

#2. Should I start seeing other doctors regularly, such as an eye doctor? My answer again is yes. I had several doctors that I saw on a regular basis – some were quarterly and others were 2 times a year. There should be no doubt about this and the doctors you may need to see will depend on your medical history and how well your doctor knows diabetes. I often see the dentist as a doctor to see on a regular basis and especially if you have type 2 diabetes.

3. How often should I test my blood sugar, and what should I do if it is too high or too low? This will depend on the medication you are taking. I test about six times per day as I only eat twice a day and use insulin. The two “experts”, Dr. Ratner of the ADA and Dr. Garber of the AACE don't believe we need to test if on oral medications and that we should rely on the A1c. Even some professional organizations do not believe we should be testing. To this I say BS and I know better to operate completely in the dark to manage diabetes effectively. Read my blog here about testing.

4. Are there any new medications that I could use to help manage my diabetes? I will only use metformin or insulin. Every oral diabetes medication has side effects to be concerned about. Your doctor should discuss the side effects with you. If the doctor does not do this or side steps the question, refuse the new medication.

5. Does diabetes mean I have to stop eating the foods I like best? My answer is – maybe.  There are some foods you will probably eliminate such a potatoes and rice.  By using your blood glucose meter before (preprandial) and after (postprandial) your meal is the best way to discover what to restrict or eliminate from your meal plan.  

6. How can exercise make a difference in my diabetes? It can help make blood glucose easier to manage, is my answer. Do realize that for some people, other medical conditions may prevent most types of exercise.

7. If I'm overweight, how many pounds do I have to lose to make a difference in my health? This will depend on how much you are overweight. I say if you are greater than 10 percent overweight, then the full amount needs to be lost. The “experts” all agree that 5 to 7 percent of the weight will help reduce the problems and help in diabetes management.  The best thing to do is lose the weight.

8. Are my children at increased risk for the disease? This will depend on whether you pass the genetic properties for diabetes, but in general your children will have the opportunity to avoid diabetes if they learn how to eat properly and exercise at a young age.

9. What is the importance of diet in diabetes? Diets are worthless because they fail. It is the food plan that you develop using your blood glucose meter that work. Generally, a low carb food plan may be the best for many.

10. Do I need to take my medications even on days that I feel fine? This will depend on the medication you are taking, how often you are taking it, and what your blood glucose level is at the time you are to take the medication. Generally, unless your blood glucose level is above 150 mg/dl when you are to take your medication, you should not. The best answer is to have this conversation with your doctor.