August 27, 2011

Small Study – Do You Believe the Results?

When I started reading this blog, I was ready to do more research and thought this would also make a great blog – wrong, at least not the way I had hoped. With a small study – small being the key word; what can one infer from a study including only six people. And to not mention this in the blog means that either the author did not catch this or was passing off bad science as good science. Even the title can be misleading as chicken is seldom high fat unless cooked with the skin on and basted in fat drippings.

There is nothing particularly bad about small studies, but unless they are leading to larger studies, be careful what you read into them. The study used for this blog is just an example of poor science and very difficult to attach any validity to the findings. It is disappointing when a blogger does not mention the size of a study and leaves readers to discover this on their own.

The study was about a combination of spices used to negate the effects of high-fat meals. Great idea, but badly done.  Funds for large numbers of study participants are seldom available to studies of this type on spices.  The extract of the study may be read here.

Another issue not mentioned in the study is the fat content of the meal. Even when this article is read about the same study, nothing is defined about the fat content of the two meals. Also not mentioned is the food eaten by the participants on a normal basis which could potentially distort the results obtained for the triglyceride readings.

For me to have a tiny bit of faith in this small study would require many more facts which have been left out in reporting the study. This is a reader-beware type of blog.

August 26, 2011

Becoming Blood Glucose Trained (BGAT)

This is an interesting concept and does deserve more attention than it is getting. Most websites do not even mention it and none of the Associations give it much if any space. The only site I have found carrying anything is the American Diabetes Association. You may refer to it here for the full PDF file (7 pages).

I am talking about BGAT (blood glucose awareness training). This is a way for people to become more aware of what their body is telling them about their blood glucose. I have been following some of the steps they use, but was not aware of the training program and some of the essential steps to have success, even though I felt I was doing a decent job, but it turns out a less than fair job of it.

I think that because it is so very labor intensive (complex) and requires a lot of record keeping that many people chose not to even attempt this. For that, I wish more would give it a good trial and see if it would work for them. It is especially helpful in determining whether you are hypoglycemic or hyperglycemic and if you become very good, you can become very accurate in guessing your blood glucose level at anytime – if you learn what your body is telling you.

There are a lot of excellent materials available and several good blogs also and I will give you what I have found, but this only scratches the surface of the material available. Dr. William H. Polonsky directed me to his old book Diabetes Burnout and the chapter "The Hassles of Hypoglycemia".

The University of Virginia is the originator of much of the material and while you can register (link is no longer available) for the program, at present there are no materials available due to lack of funding. Registering for the program may increase those showing interest in it and give more interest in funding, but do not expect anything in the short term. This has been apparently available for about three years, with no results.

I agree with Scott Strumello in what he wrote on September 10, 2008 about this, especially the first five paragraphs. His discussion of the entire subject is worth the reading time. After you read his blog, read the blog by David Spero written on August 17, 2011. This is very interesting and informative as well.

Now that you are into reading about this read another article on the ADA website (6 pages). If needed go back to them (the one above in the first paragraph and this one) when you have the time. Next I refer you to two other articles – here and here.

I have referred to BGAT helping both those with hypoglycemia and hyperglycemia and I believe this is possible, but the primary reason this was developed was for those that were somewhat unaware or totally unaware of hypoglycemia episodes and needed to find unique ways for them to become alert to what was happening with their bodies to aid them in preventing hypoglycemia. For these people the program works very well and has been used to prevent serious to severe hypoglycemia.  I have been asked since I am type 2 and aware of the hypoglycemia symptoms, why am I learning it.  My answer is to find out how complex it is and for the education.

Why CDEs and endocrinologists are not using this to help their patients is still a mystery. Like Scott S., I don't understand why it is not a standard part of education for people experiencing hypoglycemia. Apparently the certified diabetes educators are afraid to tackle anything like this for fear of failure. Many do this anyhow, so why should they ignore this lifesaving tool.

For more on “blood glucose awareness training”, use your search engine for the words in quotes or just use “BGAT”.

August 25, 2011

CMS Threatening More Euthanasia?

This is being opposed by the medical profession with vigor and by the rest of us as well. Although this is only a proposal at this time, what it could do is create an environment that means if you are, for example, involved in an severe auto accident, your chances of being treated properly will go away. This will force hospital emergency departments to make an evaluation as to whether they can treat you or not.

In other words, if the injuries are too severe, they will be forced to make you comfortable and let you die instead of using technology to find the source of injuries and treat all injuries. The current proposal will be for computed tomography (CT scans), magnetic resonance imaging (MRIs), and ultrasound scans and will mean cost cutting measures so that CMS will only reimburse in full for a head scan, but only at 50 percent for any other needed tests on the rest of your body that requires scanning resulting from the same accident.

Sound like Obama's death panels? If this proposal gets put into effect, that is essentially what this will be. This will force hospitals to say that it will cost too much and that treatment is denied. So if the accident is that serious, better hope that you die at the scene, so all insurances can be collected for your family.

Sound harsh? This is what we are facing if CMS (Centers for Medicare and Medicaid Services) has its way. At least 61 members of Congress have seen the folly and intent of CMS and has called for this to end. But this is still not a majority of both houses to stop this action. At stake also is the 29.5 percent across-the-board reduction in physician pay that Medicare's sustainable growth rate formula will trigger on January 1, 2012. Organized medicine is counting on Congress to postpone this cut before year's end, as it has with other cuts going back to 2003.

Many of the medical professionals call this proposed cut in CMS reimbursements “Blind Cost-Cutting” and arbitrary. Please read this article thoroughly and follow the links to see what you can do.

Now having said all this, I am not giving hospitals and doctors a clean pass, as many times to avoid even the chance of a lawsuit, too many medical tests are ordered for no justifiable reason and only because they can be reimbursed by Medicare or Medicaid. This is a practice that needs to be stopped, but the wording of the proposed CMS rules will hurt more people than actually prevent unwarranted tests. Somewhere there needs to be some common sense applied which is sadly lacking on both sides of this issue.

August 24, 2011

'Women's' Diseases That Men Get, Also

Yeah, go ahead and laugh! I consider myself lucky not to have any of these problems, but 10 years ago when I found a large lump in my breast, I too was embarrassed. It turned out to be benign, but put a scare in me, and when I hear about a man having breast cancer, I don't laugh. This article in WebMD accurately points out that many health problems thought to be for women only, may happen to men as well.

Granted, we cannot have ovarian or uterine cancer or other problems affecting women's reproductive organs. Men do get osteoporosis, depression, irritable bowel syndrome, lupus, and other autoimmune diseases, even though these happen in women more frequently. Men often face special challenges when these happen as they may not recognize the symptoms, and because these are regarded by society as “women's problems” men will sometime ignore it or become very frustrated because they don't know how to handle them.

Looking at the statistics, breast cancer – one man will have breast cancer for every 108 women. Not exactly something to ignore is it. Men do not get regular mammograms and it is not recommended. The National Cancer Institute says there is no information on the benefits or risks of breast cancer screening in men.

Men – do take heart, if caught early, your chances are excellent to survive and even though many men do not catch it early, their treatments are the same as for women and the results are as good as for women.

Lupus affects one man for every nine women having lupus. Men tend to have more serious cases of the disease than women. It's often especially severe in young men. However, men typically respond as well to treatments - which are mostly the same for men and women -- and the risk of death from the disease is similar.

Osteoporosis is even worse at one man for every four women. Even doctors don't always have the disease on their radar screens with male patients. Men can develop this as they age and their natural supply of bone-building testosterone decreases. Often the use of steroid drugs like cortisone and prednisone which are used for treating some chronic diseases as well as testosterone reducing drugs used to treat prostate cancer lead to osteoporosis in men. Smoking and alcohol use can also bring on osteoporosis. Men can take many of the bone-building drugs that are FDA-approved for men and women.

As with any chronic health problem, learning how to cope is often the key to successful treatment. Finding a support group is important but is generally harder for men to find than it is for women. Many men find they need to build a new identity or build a new persona to feel more relaxed and learn how to live a less restricted life. And finally develop a plan for situations which may lead to embarrassing discussions. Think about how you can remain in control of these moments and remember your health is your business. Who you tell, and when, is strictly your call.

August 23, 2011

High Fructose Corn Syrup Is Not The Same As Sugar

According to the National Corn Growers and their web site, sugar is sugar. They have petitioned the USDA for a name change from high fructose corn syrup (HFCS) to corn sugar which to date has not been granted. The sugar industry is considering a law suit to prevent the change and you may read about this here.

Sucrose (aka, table sugar) contains one molecule of fructose and one molecule of glucose, which are bound chemically. HFCS also contains one molecule of each, but they are not bound together chemically. HFCS is also used in more foods than sugar would ever be used. This is the primary reason many of us with type 2 diabetes try to avoid it at all costs. This means that we avoid most highly processed foods because it has been added, whereas sugar itself, often would not have been added. True, some processed foods do add sugar, but not as often or in the quantity of HFCS.

I still detest the ads the corn industry uses promoting HFCS when they say sugar is sugar. Although the corn industry claims this they are wrong as pointed out above. Sucrose must go through several intermediary steps to be broken into separate molecules of fructose and glucose. The fructose in HFCS does not need these steps and heads directly for the liver where is starts being used in the liver as a building block of triglycerides.

Because the liver is flooded by an excess of fatty acids, the liver releases them into the bloodstream. Now the muscles find themselves facing an overdose of these fats and the cells develop insulin resistance. With the increase insulin resistance comes an increase in visceral adiposity in overweight/obese adults. Not a pretty picture about what HFCS does to us.

Read what the corn industry does not want you to know here. More information on HFCS can be read here, and about fructose from fruit here.

August 22, 2011

Physicians Delaying Retirement

According to information released the first week of August 2011 by a physician recruiting agency, many physicians are delaying their plans for retirement. The number one reason is the current recession which greatly reduced their investment portfolios and net worth. Some are claiming they will not be able to retire and many are saying that they may work for many more years.

Of 522 physicians who completed an online survey, 52 percent said their retirement plans had changed since the onset of the recession. This group, which included physicians of all ages, 70 percent said they planned to work longer so they could make up for the recession’s effects on their investments. The story is much the same for a subset of physicians who, just before the recession, had planned to hang up their stethoscope within 6 years, according to the survey. Fifty-five percent of them are postponing retirement on account of decreased nest eggs. Another four percent who are working longer cite family or personal reasons, and two percent blame healthcare reform.

A California physician recruiting agency says the report is correct and many physicians that had retired are reentering the job market and are very angry. Their investment losses and stagnant income is compounded by a depressed housing market which has left most underwater in the housing market making a problem in two mortgages and unable to sell their primary residence to save their retirement residences.

Another problem is by postponing their retirement, they are putting pressure on some physician groups with mandatory retirement ages. This leads to internal strife and conflicts. Most recruiting firms say this should not be a problem as physicians are short supply and many physicians that had planned to retire are looking to part-time positions.

Not mentioned by this article is concierge practice in which several physicians could share offices and practice part-time in this setting. The article did say that under the new law, positions are being created for older physicians who want to keep practicing medicine as a more leisurely pace. The accountable care organizations (ACOs) are generally formed by hospitals and these groups offer older physicians more flexibility than they would have had in solo practices.

Work plans may change for a generation of senior physicians; however, if the economy rebounds and investment portfolios fatten up. A recovery may set off an enormous wave of physician retirements. This is a worrisome prospect from a public health point of view as it will create a dramatic shortage of physicians.

You may read the article for yourself here.