April 20, 2012

A Few More Friday Tidbits

If you are a person that follows herbal and Chinese medicine, you may be interested in reading this article. I say great for the Australian researchers for uncovering some problems with “traditional” Chinese medicines. The new DNA sequencing technology developed by researchers at Murdoch University in Perth, Australia exposed some potentially toxic plant ingredients, allergens, and traces of endangered animals.

This was just the tip of the iceberg for these researchers as they also discovered animal impurities in some products and some cow DNA that in some countries may violate religious and cultural practices. Not only will this new procedure assist customs agents around the world, but should also help curb trafficking in endangered wildlife species.

The second tidbit comes from ADA and how they are patting themselves on the back for laws passed in Georgia and Alaska to protect school children with diabetes. I am not quite ready to give the American Diabetes Association full credit for these victories although this is what they want you to think. How much lobbying was done the ADA has not been reported by either state yet and the one small article I found in an Alaskan newspaper says the law was an effort by several individuals and no mention of ADA was given. I may have more in the future if I can find solid information.

The third tidbit also comes from the ADA and the European Association for the Study of Diabetes (EASD) because they have issued a joint position statement emphasizing patient-specific treatment of hyperglycemia in persons with type 2 diabetes. The new guidelines are reported concurrently in the April 19 online edition of Diabetes Care and in Diabetologia.

The last guidelines specific to management of hyperglycemia were published about 4 to 5 years ago, and developments that are more recent have now been incorporated into the new guidelines. Why the wait is a question I must ask, as it would seem with the developments that are coming at an ever increasing rate would demand new guidelines on a more frequent basis.

In the Medscape article, I do not understand why the ACCORD study has to be held up as a benchmark. Vivian Fonseca, MD, ADA president of medicine and science states, “On the basis of findings from ACCORD (Action to Control Cardiovascular Risk in Diabetes study) and other studies, the ADA has set the HbA1c goal at 7% in general, but with some individualization.” Hopefully, we are seeing a move away from the “one-size-fits-all” mantra, but while this statement is made, I am willing to say that the rank and file will continue in their old ways for several years.

"For patients with advanced cardiovascular disease, reduced life expectancy, and multiple medical problems, for example, the goal may be higher," Dr. Fonseca said. "For patients who are newly diagnosed and very motivated, the goal may be lower."

Another recent change underlying the new guidelines is the recognition that many people with diabetes will need multiple agents. Yes, that is the problem of the ACCORD study and why it was stopped early, too many problems developed with people dying from multiple agents and the aggressive nature of them being pushed on patients to manage blood glucose levels. When is the medical community going to understand that this will not always work and insulin may be the better route when multiple agents are required? This is more evidence that insulin should not be the medication of last resort.

I will be working on more about the new guidelines, but when I will have it ready is unknown. In the meantime, here is the full text PDF files for the ADA and for theEASD.

April 19, 2012

Metformin and B12 Deficiency

This is something my endocrinologist tests for and tells patients taking Metformin to take a Vitamin B12 supplement. Yet there are many doctors that do not tell their patients to add Vitamin B12 to their supplement regimen. One of the members of our group (Allen) is taking Metformin and was surprised when we told him to take Vitamin B12. After his last appointment, he said his doctor told him not to be taking supplements and said there was no reason to be on supplements if he was eating the right foods.

We decided to use this blog to discuss this with Allen. After reading this and following the links, he was still hesitant to go against his doctor. We did take time to explain that doctor or not, Metformin would cause the Vitamin B12 deficiency and that he should add this to his regimen. He did state that he had been on Metformin for almost eight years and we suggested strongly that he have the test to determine the level of B12. A call to his regular doctor confirmed that they would not do the test. We then suggested he go to the doctor that I see and he agreed

I was able to get him in the following day and went with him. After a quick talk with the doctor, he wanted to do several tests that his doctor was not doing. We waited for the lab to be available and he had a blood draw. Next, we sat for about 20 minutes and Allen asked if they will have the results that quickly. I said this was normal and depending on the tests ordered, he should receive most of them in another 10 to 15 minutes. He did ask me to accompany him when he saw the doctor and I agreed.

After updating and reviewing his medications, the nurse left and the doctor came in. He sat down, asked a couple of questions about allergies, and said he was going to get two shots. The first shot would be a Vitamin B12 injection. Then he surprised both of us by saying he would also have a large dose injection of Vitamin D. I stepped out for a few minutes and then was invited back in.

Allen was asking why the two shots. The doctor said that his Vitamin B12 was very low and required another test already ordered from the blood sample. The Vitamin D level was below minimum guidelines and he was given the shot just to prevent something that the doctor feared might happen. He did not say what it was, but for three days, Allen would need to return for the two shots. Or he said he could be admitted to the hospital. Allen said he could drive back and forth and the doctor said no driving until after two weeks or the tests were at or above minimum guidelines.

Then the doctor said he was also prescribing both B12 and D3 for him to start on the fifth day. He was to return in seven days for another round to tests and then in 14 days for repeat of tests to see if he could then drive. We asked why and he would only say that he was the first person they had seen with deficiencies that low and he and the head of the department did not want him to drive. He then asked for his license stating he could surrender it temporarily to them, or possibly a lot longer to the highway patrol. Allen looked at me and gave it up.

The doctor did say that the remainder of the tests would be available the next day and the head of the department was requesting two additional tests that would also be available. On the way home with me driving, Allen was somewhat surprised at the thoroughness and was wondering if he should consider changing doctors. I did suggest that he wait until the two weeks were done and see what he thought then. He agreed, but commented this had raised some serious issues in his mind and I had to agree.

Allen wanted to meet with Tim when we returned so he called him and Tim was there when we arrived. Tim was surprised at what had transpired, but agreed with the tests and asked if he was needed to drive. I said yes, to get me home, and for at least one or two trips. Allen asked about their taking his drivers license, and Tim said no, it was probably not legal, but that it was preferable to giving it up to the highway patrol where it would become part of his records, and that they could enforce it longer. Tim asked about which doctor he would keep and I said that Allen should not make a decision until at least this was done. Tim said that was probably best, but should be seriously considered. I agreed and said this should be discussed along with other possibilities.

Allen did want some reading and Tim said he would stop back after he took me home. We did discuss some reading and search words for him to leave Allen. Tim said he would take Allen the next day and we could alternate. I said that would work, but we should let Allen decide if he had preferences. Tim said he would, but that he could not go every time.

The next day, Allen asked me to come by when he returned home. So with Tim and me present, Allen asked what was he to do. He had all the test results now and he was really frightened. All the tests had been out of range on the low to extreme low side and the doctor had suggested he see another doctor for more tests. I agreed with Tim when he said that he should see the second doctor and get his health checked out. Tim did state that it was time to decide on making a change in doctors. He said he felt from what had been discussed today, that Allen was being given a second chance and he should take full advantage of it by switching doctors now and having his records transferred.

I could see some fear in Allen, so I asked him when his VA appointment would be. He said in about five months and I said that would be good. Therefore, if he ended up with some expensive medications and the VA had them or ones in the same drug family, the doctors would synchronize with the VA and he would be ready. I could see Allen relax visibly and he asked if the doctors would work with the VA? I said not the way he was thinking, but that he would give the doctors the name of his VA doctor and they would send a fax or call them with what they were suggesting for medications and see if the VA could get them started coming to him. The doctors would also forward copies of the tests and the reasons for the drug request.

Tim did say that the doctor had suggested that with his A1c and creatinine level that Allen should consider changing oral medications or start on insulin. He also said he would make a referral to the endocrinologist. Allen did say he would like to stay on oral medications if possible, but he was going to pay more attention to our discussions about insulins and not leave it as a medication of last resort. We said that was okay. I suggested that he should ask for the test for determining how much insulin he was still producing before he made that decision. Tim said that was another test they had done and his own insulin production was still okay, but on the low side. He said to Allen that just the fact he wanted to learn about insulin was a good sign and would make him ready when the change was right.

The following two days I drove Allen and we had some interesting discussions about the different oral medications and insulin. He did say that since the doctor had given him some time to read about the different oral medications and their side effects, he was thinking seriously about insulin. I did suggest that he ask which oral medications they would be recommending and Allen said that would give him a better idea instead of learning about all the oral medications.

One the fourth day, Allen said doctor (after conferring with the endocrinologist) would have a recommendation for him when he came in for the blood draw the following Tuesday, and that he should seriously consider insulin. So we asked several others to meet with us on Saturday and we would research and discuss oral medications in more detail and insulin. Even Brenda asked to be included so we would be only short one person as Sue had another commitment.

April 18, 2012

No Cure Means Just That – No Cure

I had previously written this for publishing when I had need of something to post. In the last two weeks I have received five emails criticizing some of my blogs for being so critical of people seeking out cures. I did email them back telling them that I would be publishing one they may not appreciate as well. I also told them they should be more concerned about the blog I published Monday which would shut out some of the people they follow on the holistic side. It may definitely stop these people from giving out nutrition advice (the naturopaths and homeopaths).

There is not a cure yet or for the near term for diabetes. When people ask for the cure, they are told there is no cure. Disappointed when they hear this, many people still believe there is a cure in this day and age of advanced medical knowledge and think their doctor has missed something.

These people will do one of several things to satisfy themselves that there is a cure. They will head for the nearest health food store or store selling supplements, proteins, and body building products, and engage the sales people asking for something to help their diabetes. Alternatively, they will head for internet to find a cure.  They may talk to a friend or relative that has had success with herbal medicines and seek out that supplier. They may try two or all three of the above. In addition, there may be other sources they may seek out. They are desperate for the “cure” which they think their doctor is withholding from them.

These people will listen to almost anyone saying there is a cure. They become prime candidates for the shills to take their money for the “snake oil” these people are promoting. Now if the person is in the early stages of diabetes or has prediabetes, they may (emphasis on may) receive some minor assistance from the “snake oil”. If they take up exercise and change their eating habits to healthier foods, they just might succeed for a while. By healthier foods, I am not talking about whole grain foods although this is what the American Diabetes Association talks about and the American Association of Diabetes Educators promote as well as the Academy for Nutrition and Dietetics.

Sooner or even later, diabetes will gain a strong foothold and they will be back to the snake oil salespeople who will gladly take their money. This time the snake oil will have not benefits and they will continue to develop complications because they are unable to manage their diabetes.

Some will continue to search for a cure and go from one snake oil sales person to another. Others will finally realize that their doctor was right about there not being a cure, go back to traditional medicine, and get the medications that will help them manage their diabetes. Now they have more to manage as some complications will be there and other problems may be on the list as well.

In the last three months, I have deleted three promotions for snake oils and two emails asking me to promote the cure they had discovered. Since I know better, I just press the delete button and do not put up with these “snake oil” salespeople. And no, I will not list the URLs, as I do not want to give people looking for these sites a source.

I generally avoid most health-food stores and stores promoting strength and health products. Recently I thought it might be time to review pricing and see if the price I pay for Vitamin D3 was reasonable. As I entered the store, I could see several people looking in various areas and three salespeople. After looking for a comparable product, I knew price comparison was not possible. I found what I was looking for and that they only carried Vitamin D2 and in capsules of 5000 IU and 10,000 IU. The quantity was the same as my 2000 IU D3 but the price for the 5000 IU was well in excess of five times what I was paying. None of the containers displayed a seal of quality or good manufacturing practices seal.

As I turned to leave a salesperson attached to me asking what I was looking for or if I was looking for something for a specific health problem. I avoided answering, but the salesperson was persistent. So I stated I had found the answer I was looking for and would be leaving the store. The salesperson blocked my way temporarily asking what health problem I was treating. I carefully said I am trying to avoid having an anger moment about an overly aggressive salespersons, and left. I will give this store a wide berth when in the mall again.

Next, I went to strip mall and stopped by a family health-food store. I found the section for vitamins and other supplements. They had both Vitamin D3 and D2, but the quantity size of the container was less than I usually purchase, but the price was about five cents a capsule higher than I have been paying. This completed my research on prices and let me know I was purchasing from the right place. Since this store and my usual place both carry brands displaying the right seals of manufacture and quality, this also confirms my time spent for price comparison.

April 17, 2012

Medicare Already Has a Death Panel in Place

Okay, I am being over dramatic, but this is scary. People that are on Medicare and receive a kidney transplant only have about three years of life remaining, per the direction of Medicare. Yes, Medicare will pay for the transplant, but after three years on immunosuppressants, Medicare pulls the plug and will no longer pay for the immunosuppressants. If the patient can pay for these, they are in the minority.

Between 1993 and 1995, Medicare did raise the length of time for immunosuppressants support from one year to the present three years. The one exception to this is for those over the age of 65 and that have work-related disabilities. They are eligible for lifetime immunosuppressants.

While this is technically not a death panel, it is completely arbitrary and governed by those in charge of Medicare. This policy is the only one of its kind among industrialized countries where state-funded life-time coverage of immunosuppressant drugs is provided to all kidney transplant recipients. It is therefore not surprising that long-term survival rates are substantially higher than in the United States.

This may now explain why I have had friends that were on dialysis that stopped their treatment, chose the time of their death than get their transplant, and take the regimen of immunosuppressants. They would have been limited to three years. This does not seem appropriate for this to happen in the USA.

Another argument against this practice is that transplant kidneys are lifesaving gifts made possible by living donors or by families of deceased persons and are of immense value to society. The current policy undermines the value of this gift and does jeopardize the organ-donor system. Providing lifelong immunosuppressant drug coverage would restore value to the system.

The current legislation before Congress seeks to correct this problem, but faces many foes and may end up like a similar attempt that was defeated in the Democratic Congress of 2009. The current bill (H.R. 2969) would correct this harmful policy and bring the U.S. Inline with the rest of the industrialized countries.

This is probably the reason that this article that I included in this blog is so important and the medical profession is determined to succeed in making this happen. Having kidney transplants without immunosuppressants is one way of taking Medicare out of the equation on immunosuppressants.

April 16, 2012

What Is the American Dietetic Association Attempting?

This is definitely a two-edged sword and I have to wonder at the basis for the name change. The American Dietetic Association (ADA) changed its name to the Academy of Nutrition and Dietetics (AND) in January 2012. Does this mean that they now have an organization for teaching nutrition and dietetics? Or, is this now an organization through which they will enforce their mafia-style tactics on their members to keep them in line and preaching their mantras. I suspect all of this and more after reading this article in forbes dot com.

The article is several pages and points out a frightening array of changes ahead as they attempt to gain control of the field of nutrition. They are doing this through credentialing and state licensure. In the process, people that have degrees in nutrition and are practicing their profession will no longer be allowed to under efforts being supported and lobbied for by the AND. Until they become credentialed under the Commission on Dietetic Registration, they will be forced to stop what they are teaching. Under the laws supported in some states, if they do not stop, they may face jail time and severe financial penalties.

I even have to wonder if they will go after instructors teaching nutrition in our colleges and universities. This remains to be determined, but under the laws of a few states, this may be possible. We do not need nonsense like this crowding our over worked court system.

What the AND has done in effect is to prevent the nutritionists from forming their own group and credentialing organization. They are in effect legally taking over by bringing this group of people under their control, and credentialing. If you doubt this, why else would this organization apply to the US Patent and Trademark Office for a series of certification marks, a type of trademark related to credentialing, for a comprehensive array of nutrition-related professional titles, including:
  • Certified Nutrition Associate
  • Certified Nutrition Coach
  • Certified Nutrition Educator
  • Certified Nutrition Manager
  • Certified Nutrition Professional
  • Registered Nutrition Associate
  • Registered Nutrition Coach
  • Registered Nutrition Educator
  • Registered Nutrition Manager
  • Registered Nutrition Professional
The certification mark applications, in conjunction with the name change, suggest that the AND is attempting to expand its scope and influence, from its decades-old role as the industry group for Registered Dietitians, to now encompass the entire field and professional practice of nutrition.

To quote from the article “The document specifically bemoans that the word “dietitian” (the trade group’s decades-old area of coverage and specialty) is regulated far more heavily than the word “nutritionist”:
Simply put, governments more strictly regulate the work of and qualifications for dietitians than it does for nutritionists, and competitors are explicit about their intention to exploit this dietetics/nutrition distinction. An array of competitors is already providing would-be clients with personalized health education and nutritional counseling in growth areas such as prevention and wellness and in private practice careers. The required and necessary skill set of RDs competing with these other nutrition professionals may not necessarily be the same that clinical dietitians [sic], but RDs cannot cede this expanding market to others who clearly intend to provide nutrition services. [Emphasis added]”
The document does list in detail the competitive threat posed by many different types of non-RD practitioners who give nutrition advice and includes the threats from nurses, pharmacists, personal trainers, chiropractors, and naturopaths and homeopaths.

As the author of the article was so careful to document, “the devil is in the details.” In several states the then ADA was able to force several qualified nutritionists out of business because the law was not specific enough for their profession in allowing for them to dispense nutritional advice as part of their practice and thus ADA succeeded in forcing them out.

It will be a sad day for nutrition if this is allowed to run its course and obesity will become even more of a problem. Plus we will be forced to live closer to USDA guidelines. If the AND makes further intrusions into the healthcare system, we may be forced to pay fines for not eating by their guidelines.

Carefully read what the full article says and especially take time to read this PDF from the files of the then ADA, now AND.