November 11, 2011

Byetta Has Powerful Anti-inflammatory Effect

Byetta is a diabetes medication that I have wrestled with for several years about using. My endocrinologist and several friends have encouraged me to use it, but I have resisted because of the unpleasant side effects. Then along comes a press release that has me thinking about it again.

Exenatide (Byetta) is a drug prescribed to diabetes patients to improve blood glucose management. Now according to a University of Buffalo study, it has a powerful and rapid anti-inflammatory effect.

"Our most important finding was this rapid, anti-inflammatory effect, which may lead to the inhibition of atherosclerosis, the major cause of heart attacks, strokes and gangrene in diabetics," says Paresh Dandona, MD, UB Distinguished Professor in the Department of Medicine, UB School of Medicine and Biomedical Sciences, and senior author.” This is a gigantic plus and will factor into my decision.

It is interesting that the study reports that this anti-inflammatory effect happens completely independent of weight loss over the 12-week study period. This is important as obesity is an inflammatory problem and adipose tissue contributes to inflammation. Weight loss on its own can lead to an anti-inflammatory effect.

The authors of the study state that corticosteroids and insulin which are anti-inflammatory, but neither drug demonstrates such a powerful and rapid anti-inflammatory effect. Plans are under way to use exenatide in acute inflammatory cases in intensive care units or following heart attacks and strokes, where rapid anti-inflammatory effect is required and such drugs may be of potential use and helpful.

November 10, 2011

Food Labels May Get Overhaul

This press release in HealthDay News is somewhat confusing and makes me wonder whom the writer works for, HealthDay News or the food industry.

First off, food labels are rarely on the front of food and beverage packages. Most are on the back, side, and occasionally even the bottom. Do they need to be simpler? Maybe not simpler, but a lot more informative and accurate is my point. Presently there are gaping holes in the current food label requirements that the food industry are taking full advantage of and abusing to the maximum.

"There are a lot of different [rating] systems out there," said Ellen Wartella, chair of the IOM committee that wrote the report, and director of the Center on Media and Human Development at Northwestern University. "But no one system has all the features we think are most helpful. Our goal is to say no one has to be a nutrition scientist to discern whether a packaged food is healthy or not healthy."

"We want something that's readily identifiable, easily understood and that cues the consumer that this is a healthy product," Wartella added.

This is about the sum of the report issued by the Institute of Medicine (IOM). I do have to agree with the author that some standardization is due and the package fronts could very well be the place to put this so that consumers would know where to look instead of having to flip the box around to look on the back or sides.

The IOM report suggests a rating system based on the serving size that tells the consumer whether the package contains ingredients that are more or less healthy than recommended for fats, sodium, and sugar. The report also suggests the label be located in the same spot on all products.

Now I may have to disagree on using the USDA healthy dietary recommendations and even many of the Medical Groups recommendations. I do agree with the report that the food and beverage industry be motivated to reformulate products to be healthier. I also agree that foods that do meet these requirements be prominently displayed in food stores.

The report also urges that a single system would let consumers quickly compare choices within a variety of food categories just by looking at the front of the packages.  “Determining whether or not a product can carry a healthy food package label would be done on a point system based on how much sugar, salt and fat it contained. These were picked because they are linked to obesity, diabetes and high blood pressure, among other illnesses.  To be eligible for a "healthy" label, the product would have to have limited amounts of sugar, salt and trans fats, the IOM committee said.”

The Grocery Manufacturers Association has already come up with its own labeling system. "In January, the Grocery Manufacturers Association and the Food Marketing Institute launched Facts Up Front, a fact-based, front-of-pack nutrition labeling system to help busy consumers -- especially parents -- make informed decisions when they shop," said association spokesman Brian Kennedy.”

No matter how this is accomplished, there are bound to be discussions about who gets favored status and whether the labels meet any standards that are easier to read and assess whether the food and beverage industry have more loopholes to be able to sidestep the requirements. It is clear that current labels are not meeting the needs of consumers and the loopholes are being abused.

One example is the term “contains whole wheat” and this can mean maybe if we are lucky ten percent whole wheat and the remainder is not whole wheat. In addition, whole wheat in its current form may not be the healthiest for us. Moreover, those of us with diabetes know that high fructose corn syrup raises our blood glucose levels faster and higher than we should have them increased, and the same goes wheat.

November 9, 2011

What Your Meter Tells You About Your Eating

We have all read this, but have you really tested this? Eating to your meter can be very beneficial in helping you manage your blood glucose. For those with type 2 diabetes and on oral medications, this is a philosophy you almost must adopt to manage diabetes effectively. Counting carbohydrates is even more important so that you learn how to manage the food intake to get the greatest efficiency from your diabetes medications.

The medications you are taking will only manage so many carbohydrates effectively and then you start to lose control. This then becomes more important to know what your blood glucose meter is telling you about the quantity of food you consumed. Using your meter also can indicate which foods you need to severely limit and which you can consume or may need to eliminate altogether from your menu.

This is your reason for supporting my previous blog here for having extra test strips available after diagnosis and for other times when you are having diabetes management problems and need to figure out what may be wrong with your menu selections.

On limited test strips, eating to you meter may be very discouraging because you do not have a lot of information to guide you. That is one reason, I suggest that if you can afford it for a few months, buy extra test strips. The extra testing supplies will give you confidence in your carb counting and portion of food intake. It will also make it easier to determine what foods are best left off the menu.

There are various plans discussed for those on limited test strips so you will need to work with what works best for you. A food log after diagnosis is also an aid that many people just do not understand the need to keep. I can attest to how many times this has told me why my postprandial blood glucose levels were higher than they should have been and what I did not do. The important part is not lying to yourself, but keeping accurate logs.

Knowledge is power, and therefore knowing what each test is telling you, watch for trends in fasting blood glucose levels and use your meter to learn more from pre-meal testing to tell you about your prior meal. If you can afford extra test strips for a month or two, learn that you do not want your preprandial and postprandial readings to increase more than 40 mg/dl if possible. You should also develop an exercise regimen with your doctor's approval to help get your blood glucose numbers to become the best for you.

If you do have trouble with managing your blood glucose levels, give insulin a consideration and study about it before the need arises.

Read a couple of other articles about eating to you meter here and here.

November 8, 2011

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.

November 7, 2011

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.