Dietary Supplements and Your Doctor Visits

This is a topic that I cannot seem to stay away from as it is constantly in the news. I understand the concerns of the medical community in trying to warn patients about the harmful effects and potential deadly effects of some supplements and herbal medications. Having just written recently about the toxic effects of overdosing in Vitamin D, I am not immune to the need to bring this to the attention of the public as well.

The consumption of dietary supplements as increased from about 20 percent in 1970 to about 50 percent in 2006. This is a fact of life and people need to be aware of the dangers inherit in taking some supplements when certain prescriptions are taken. Most people ignore these warnings because they think because these supplements are found in nature, they can do no harm.

This article in Medscape should be read and serve as a reminder of some of the more common dangers people often overlook. This part of the article is very important and needs to be read as it could affect you. If you think this is a joke, I do not want to think about the complications you could suffer if you need to take some of the medications they react with in unfavorable ways.

The medical profession often strikes out at supplements, but in these proven circumstances, their concern is well justified and I have to support their concerns. If you are asked what supplements you are taking, please, please list all of them to prevent conflicts and even potentially deadly results. It is for your benefit they are asking.

If you are in excellent health, then there should be no concern, but if you blood pressure is elevated, some of the supplements are known to raise blood pressure and it might be that stopping these supplements could bring your blood pressure back within the desired range. This could save the need for blood pressure medications.

Many people also do not think, yes, I said think, that some supplements can cause some of the other problems mentioned in the table. I admit I was a believer is a couple of the supplements (Aloe and Goldenseal) and when I developed loose bowel movements, I wonder why. I was finally able to get to the information (a little more difficult 20 years ago) and stopped using them and problem solved, but not overnight.

This is why I encourage and urge everyone to fully disclose to your doctor(s) what supplements you are taking, the dosage taken, and even how long you have been taking them. I also strongly suggest that you learn everything about the supplement(s) you are taking to know what side effects are possible, what dangers may be present, and what limits you should be aware of to prevent dangerous toxic effects.

Even on today's internet, some information is very difficult to find. Yes, promoters of supplements and ardent herbalists will provide the health benefits with little or no scientific support, but they seldom provide any information about side effects with prescription medications or what levels may cause the supplement to be toxic. Many will deny that there can be problems.

Just because they are derived from nature, does not mean they are safe. This is a myth followed by most people and promoted by herbalists and health food stores. If you are a regular reader, you know this is a topic of many blogs and until people learn to be careful and know there are some dangers and potential problems, I will probably continue to blog about them. Recent blogs – No 1, No 2, No 3, No 4, No 5, No 6, and No 7.

Do I use supplements? Yes, and I am very careful in how I use them and generally I have researched the manufacturers to know their reputations and what, if any, problems they have had with business practices.

We Need a Unifying Symbol for Diabetes

I normally can live my life and let others live theirs. But this issue cries out for support and wide publicity.

The time has come to support the cause for diabetes and I admire Amy Tenderich for her stand on unifying behind one symbol and making this our symbol of choice. In reading the comments posted to her two blogs so far, I can see the division making its presence felt. I am not sure that those taking the opposing views have the well-being of the diabetes community in our best interest. I use the term community to include all types and variants of diabetes and say that we need a unifying symbol.

Amy says “the fact that AADE uses orange and gray as its branding colors, while JDRF uses its own acronym printed in blue. ADA uses that big red ‘A’ reminiscent of the Scarlet Letter, and more recently, that creepy hand with the blood drop — not exactly an image you want to ask friends and family to pin on their clothing. The fact is that NONE of their logos is universally recognized by people outside the D-community. Heck, most people within our community are confused about what color is supposed to represent us.”

If you agree with some of the comments posted and worry about money being spent for a unifying symbol, read some of the blogs about a JDRF ad in the NY Times. Talk about a waste of money and the use of fear. This is not what our young people need or their parents. While hypoglycemia is a fact of life and the Artificial Pancreas will be potentially a gigantic aid, the use of fear is something many people have blogged against when used by their physicians, and yet the JDRF chose to use the same tactic. This does not put a national organization in good standing.

One comment to Amy's blog really troubles me. It is one about not putting type 1 and type 2 under the same symbol. Except for those of us within the diabetes community, some family, and friends, very few actually understand the differences. And, we have the other forgotten types of MODY, LADA, and medically caused diabetes that this person does not even mention. If people are concerned about lumping all types of diabetes together, let me say that by leaving type 2 out would be one way of isolating us without an organization for support, but no more so than we already are.

No, do not even think that the American Diabetes Association represents us. It is an organization of and for doctors and does not represent the patients, of any type. Even the American Association of Clinical Endocrinologists does not represent any type as it encompasses the entire endocrine system. It does come the closest to having our best interests in mind by providing vetted sources for reliable diabetes information. There are some notable absences currently missing from the list, but at least they are starting a service for type 2 diabetes. Many of the vetted sites also work well for all types of diabetes.

Another comment on the first of Amy's blogs about the blue circle had been well covered by Amy in her second blog when she says, “To be clear, this not a call for those organizations to spend countless dollars remaking or “rebranding” themselves; all we’re asking is that they officially recognize the Blue Circle as “our lapel pin,” and do their part to ensure that consumers across America begin to recognize it.”

She then describes five ways to accomplish this without a large outlay of funds. I agree with her blogs and support her efforts. When I look at the money spent by the ADA for lobbying, I have to think the efforts are mainly for protecting the income of the physicians from Medicare cuts and not for research for cures. See my blog here for the actions of ADA.

In an effort to unify the diabetes outcry for education and the needs of the diabetes community at large, we need a common symbol to unify behind and give a united front for the well-being of all types of diabetes. Then we can start true education of the type differences and work harder for all types of diabetes. I agree that we need the blue circle as our symbol for all types of diabetes.

Physicians Worry about Misinformed Patients

Again, I must say sorry, but the AACE site has pulled the page referred to in the first link.

The battle between physicians and patients about information on the Internet just will not go away. Physicians continue to say that the Internet is not a reliable source for information and do not want their patients getting their information from the internet. Patients are complaining that their doctors are not providing them with information and the internet is the only place they can see and get information. Now who is right in this battle? Well, both are right, and both are in error.

The physicians are correct about the poor information available on the internet and I agree. There is much misinformation and false information on the Internet – way too much. What are the physicians doing about this other than complaining – very little. Except for one organization, the American Association of Clinical Endocrinologists that now has a website here with approved sites listed. There are some glaring absences from the AACE list.

While not the same type of site, the American Academy of Neurology has the following web site and provides free subscriptions to their magazine to whom ever desires them.  Yes, for it to be free, you will have a lot of Big Pharma advertising.

Both organizations are still learning how to communicate with the patients, but I will give them credit for reaching out to the patients. Many neurologists and endocrinologists are still not promoting the sites, but this may change. During my next appointments with either, if I am not told about the sites, there will be some teaching done by this patient. Even some endocrinologists are not promoting their site on their own web sites.

Some doctors do use the Internet for themselves, but will discourage their patients from using the Internet for information. I say we need to challenge them to give us a list of URLs for information that is reliable and hold their feet in the fire until they do. This needs to be on a sheet of paper that can be handed to each and every patient and updated on an annual basis or more frequently.

Many patients actually do misuse the internet looking for “cures” and “herbal medications” that will supposedly cure their problem. These patients can often be a lost cause for physicians as they will likely not fill any prescriptions and head for the nearest health store looking for a quick cure. Others will simply use the internet to see what they can order there and believe the misinformation.

Another problem is the advertising done on the Internet and television by the pharmaceutical companies promoting their latest drug for whatever disease and this can create very difficult discussions for physicians when they tell their patients that they do not have the problem or do not need the medication. I blame the patients for not doing their research properly and believing what they hear and see. Often these advertisements do not spell out the severe side effects correctly or gloss over them giving just enough information to keep them within FDA guidelines.

Another real problem is patients trying to diagnose everything instead of really reading and doing proper research. Then they give the doctor what they think are symptoms for their self-diagnosis instead of telling the physician what symptoms they actually have and letting the doctor perform the tests and make a proper diagnosis.

The last paragraph in this article is well stated and is what physicians and their professional organizations need to be doing. Another article on the neurology now web site is very interesting. It tells a doctors story of why he changed his view of using the internet, even with the misinformation that is on the Internet. 

Read the press release about the survey results here.

The Type 2 Diabetes Sourcebook

The Type 2 Diabetes Sourcebook by David Drum and Terry Zierenberg, R.N., CDE copyright 2006 is a book I purchased recently. I have just finished reading it and may donate it to my local library if I decide I want to give a very poor book to them. I think not.

When I purchased this book, I was in a rush and while I did look at the table of contents and especially a couple of chapters, I missed something because when reading it, I realized how little valuable information was presented. Many areas are completely lacking in detailed information and explanation of aids for improvements for patients to have tools to guide them. If you are looking for information about ADA norms or AACE norms, this book has them. If you are looking for tools to assist you in managing diabetes to prevent complications, you will need to look elsewhere.

Also lacking was definitive information about why the guidelines are established where they are. Many of the guidelines are presented as fact and no further information of value is given. Since I do not follow the American Diabetes Association guidelines or the American Association of Clinical Endocrinologists guidelines, this book was a real disappointment. There were no suggestions of how to accomplish goals for diabetes health to improve on the guidelines.

Very disappointing was the discussion on the tests needed by people with diabetes. Why should people with a diagnosis of diabetes need another oral glucose tolerance test (OGTT)? Even this was presented for what normal people achieve and not about making a diagnosis. A discussion of OGTT for diagnosis would have been good.

Then when discussing hyperglycemia and hypoglycemia, the authors stated something I find reckless and almost criminal. This statement is “The two immediate problems associated with blood sugar are unusually high and unusually low blood sugar. Although neither is fatal, both are serious.” We know better, as both can be fatal if the patient is not hypoglycemically or hyperglycemically aware of what is happening.

As books about diabetes go, this is one I will not keep in my library, nor is it one I can recommend to anyone. In a real pinch, it might make expensive TP.

COI for Clinical Practice Guidelines Rampant

Yes, conflicts of interest (COI) are influencing our clinical practice guidelines. It is not surprising that the American Diabetes Association is one of the offenders as is the American Heart Association. Now they may have the actual numbers by organization, but we are only given a total – 52 percent or a majority had either open conflict of interest or hidden conflict of interest.

Blogger Tom Ross thinks one thing and expresses his opinion very vividly. I can agree in part with him especially for the committee heads that denied any conflict of interest while in fact having conflicts. These people are committing fraud and deserve to be thrown to the wolves. But let us look to the bigger picture. The American Diabetes Association and the American Heart Association made their selections without due diligence, therefore some people within the associations on the selecting committee must already be associated with Big Pharma.

Does not say much for the integrity of the associations when Big Pharma already has their minions in place to give them an advantage. Another black eye, yes, but with all the other bruises from misdeeds, what is one more. It is no wonder that people mistrust the ADA so vehemently. Besides being so behind the times, now we need to be concerned about the additional harm that may be foisted on patients. It is no wonder that the American Heart Association is pushing statins so earnestly.

“The study also found that panelists on government-sponsored guidelines committees--such as those organized by the Veterans Administration or the US Preventive Services Task Force--were less likely to have conflicts of interest than panelists on non-government guidelines panels (15/92 [16%] vs 135/196 [69%]; p<0.001). However, the researchers point out that the government-sponsored guidelines committees were less likely to have rigorous COI transparency policies.”

In an accompanying editorial, Dr Edwin Gale from the United Kingdom tries to make humor of the situation. He states “guideline committees should include only experts with no conflicts of interest has "a charming sense of unreality,".” Then he gets testy when he says "Money from drug companies is the oxygen on which the academic medical world depends.” He then makes other statements basically stating how the professional organizations are beholden to the companies in various ways and won't be changed until we have a change in the culture.

I am happy to see this exposure and putting the professional organizations' feet to the fire.

Read some of the various press releases: No. 1, No. 2, No. 3, and No. 4.

Parents Now Have Web Site to Test Amblyopia

This is not about diabetes, but I felt that parents of young children should know about this free test to assess their children for amblyopia. What is amblyopia you ask? The definition in Merriam-Webster's Medical Dictionary says “Function: n: dimness of sight especially in one eye without apparent change in the eye structures called also lazy eye, lazy-eye blindness.”

The test was designed by David P. Taylor while he was a graduate student in the Department of Medical Informatics at the University of Utah, Salt Lake City. Researchers, led by Shaival Shah, MD, from the Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City presented the test at the American Academy of Ophthalmology 2011 Annual Meeting.

This free and widely available Web-based test will allow parents to test their own children for amblyopia. “LazyeyeTest.org assesses visual acuity, which has proven to be more reliable than other sensory tests. The online test comprises a series of 6 graphically rich, jargon-free, plain-language screens describing the test and how to interpret the findings. Typically, the test takes less than 15 minutes to complete.”

One warning to parents – follow directions carefully. The most common error was the parent putting the patch over the incorrect eye. The next most common error was measuring the distance from the screen.

“Refinements of the screen instructions might lead to fewer misinterpretations of the instructions and decrease the error rate,” according to Richard Olson, MD, also from the University of Iowa, who was head of the research team.

Please read the press release here.

Diabetes Self-Education – An Important Tool

Self-education is one of the best tools for managing diabetes. The doctors do not have the time necessary and some do not have certified diabetes educators (CDEs) available even for referral. Often the doctors do not even have a registered dietitian available that specializes in diabetes. Many, but not all of us, have had less than favorable experiences with CDEs and others, so do be careful.

Self-education is key for people to manage diabetes effectively and studies are showing that this works. My blog here with its link shows that education does work in reducing A1c's. This is just one of several studies that is receiving little attention or publication because writers cannot make it sexy enough to draw attention to it.

My second blog here is about foot care and why it is so important. However, without education, many people continue to ignore the consequences of unmanaged diabetes. Amputation is becoming a thriving money maker for many surgeons and the patients have only themselves to blame in many cases.

Another tool in the education arsenal is peer-to-peer groups. It has been shown that there is a need for these groups. The results they accomplish in reducing A1c's are positive. David Mendosa has an excellent blog about this as part of his reports from the Medicine 2.0 conference at Stanford University in Palo Alto, CA.

There are several of us with type 2 diabetes that occasional get together and exchange ideas and discuss what we have been reading. No, not a support group, but a few of us that do research and study about diabetes. We exchange emails and compare notes about different articles, press releases, and technologies to aid in our management of diabetes. An informal peer-to-peer group at best, but it has helped us in managing our diabetes more effectively.

That is also the reason for discussing the types of patients in previous blogs, here and here. This makes people more aware of what education can do to make us. Education make us more knowledgeable and assists us in making good decisions to manage our diabetes. With this now being diabetes awareness month, keep focused on education. The more education, the easier advocacy becomes and for some even activism.

Prediabetes and Its Dangers

So you think there is no danger associated with prediabetes? An acquaintance of mine in this small town told me he was not going to worry about the prediabetes diagnosis as there were no dangers associated with it and either you had diabetes or you did not. So sure was he that he constantly reminded the group of us that had type 2 diabetes that he was going to be okay.

Why we continued to accept him and his taunts still bothers me, but we did. I guess we knew that eventually he would change his tune and start asking questions, serious questions. Well that day finally arrived, but not the way we had expected. When he was not present for our get together (now over a month ago), one of the others called his wife and got a shock. He was in the hospital and was in a high blood glucose coma. We do not know how high it was, but we guessed he now had full-blown type 2 diabetes.

We asked if he could have visitors and his wife said the doctor had asked not for that day or the next for other than family. Well, we never did get to see him. Whether we will every know the full story is doubtful, but that night he passed. His wife said that their two children had arrived after work so she was on her way home to clean up and return. On her way home, their son called and said Dad was gone.

We know a little more, his heart had failed and they had been told that his kidneys were in poor condition. I have been researching and yes, cardiovascular disease does dramatically increase with prediabetes, retinopathy can develop, and kidney health can be impaired. Many with prediabetes can develop diabetic neuropathy or peripheral neuropathy. Not quite what I had expected for prediabetes. Again, this is a reminder that everyone can be affected differently when it comes to prediabetes and type 2 diabetes.

Which leads me to the question – why not treat it as diabetes. I'm sure the American Diabetes Association will not have an answer.

We have also learned that our friend had high blood pressure and had stopped taking his medications. Could we have done more for him? We have talked about this and have decided that for him we had done all we could have under the circumstances, as he would not have listened to us. How will we treat future people that come to the fringes of our group? We will invited them in if they have a diagnosis and work to get them past denial if they are in denial. Will we be successful – remains to be seen. We just know that we will make every attempt.

We have checked the books on diabetes at our local library and they will be acquiring two more books at our request to supplement the ones they have. We are investigating other activities like making our informal group a little more known and possibly working with doctors in nearby towns if they are open to this.

This WebMD article is available as a reference on prediabetes.