June 8, 2012

Friday Tidbits 06-08-12

When I first read the title “Diabetic Home Care Management”, I thought this could be interesting and presented in a way I may not have read before. The second part of the last sentence in true, but the article was only a rehash of old information that I already was aware of and presented no new ideas. Are publishers so desperate for items to publish that they rehash former articles. No, they are trying to reach new readers, which is good. Read the article here that appeared on May 31, 2012, but is left undated. Read the last sentence as this false. There is not a diabetic diet that is standard although dietitians want us to believe there is.

The second and third articles are about Herpes Zoster or shingles and are not something to be taken lightly. In the first study, they are telling us that we could have eye problems from shingles as well. So make a practice of seeing an ophthalmologist on a regular basis if you have had shingles.

Two significant conclusions were found in the study. First, those that have had the shingles vaccination showed a 51 percent reduced incidence of all herpes zoster disease and a 67 percent reduction in the incidence of postherpetic neuralgia, a potentially devastating complication of shingles.

The study found that patients between the ages of 59 to 70 have the best results from being vaccinated. Those older than 70 had a lower rate of effectiveness. It is still encouraging patients older than 50 to be vaccinated against shingles.

A second study found that the risk of adverse events for a period of 42 days of vaccination of adults 50 and older which was comparable to a large managed care cohort study.  The article also states that the vaccine is well tolerated in adults.

The fourth article for today is not one I like, but one that people need to be aware of and know that this may be the thing for some people. Other than medical reasons, I see no excuse for not exercising as even if you are confined to a wheel chair, you often can exercise. For a small seven percent minority it may increase heart and diabetes risk factors. Yes, for a small percent exercise is a health problem that needs consideration. The adverse responses were not explained by the health status of the participants, or their age, amount of exercise they did, or lack of improvement in cardiorespiratory fitness

The study authors do say they still recommend 150 minutes per week of moderate physical activity, or 75 minutes a week of vigorous activity. They did state that people doing exercise should have regular exams and consultations with their doctor.

The last article speaks to a common problem many of us have with our doctors. This I am agreement with and wonder when the day will come when we don't feel rushed through our appointments. I understand when lab reports are all good or improving that the doctor will not have a lot to do. Nevertheless, when I have questions, I like to ask them. Most of my doctors are now aware of this and know I have a list that I will leave, if they will answer them. One will email me the answers and the rest like to call, but one doctor insists on typing the answers and mailing them. All are acceptable to me.

A doctor's impatience, though, is often driven more by economics than ego. When a doctor has that pressure to see three, four, maybe five patients an hour, they can't wait for the exposition of the patient's story. That is exactly what they should do, but they can't. This is an interesting story of one doctor's struggle.

June 7, 2012

Nutrition Challenges When You're Older or Sick

This was not written for those of us with diabetes; however, there are some aspects that must be considered and people with diabetes need to be extra careful in the manner which they view this. Now I realize that the persons that are quoted are registered dietitians in the Academy of Nutrition and Dietetics, and thus I must say that I at least need to be extra careful to avoid the traps that will be presented.

Having visited several nursing facilities locally, I realize that as we get older, we tend to eat less. Medications can affect our appetite and sometimes our taste. One of the largest problems I see is dental problems. Not only can this make it painful to chew food, but also dental problems may discourage intake of many foods. Ability to swallow some foods is also a problem unless water or other liquids are available to assist in swallowing.

Considering that there are reasons for appetite loss, consider when you are not feeling well or something is bothering you, how do we maintain adequate nutrition. Kathleen Niedert, RD, director of clinical nutrition and dining services for Western Home Communities in Cedar Falls, Iowa, who counsels many seniors on how to deal with loss of appetite says rightly that “no single strategy works for everyone.”

The article lists ten strategies that will fill some of the nutrition gaps. Please realize that this is written for people without diabetes. I will take each strategy and write my understanding as a person with diabetes. I may miss some items, but I will attempt to highlight the important parts.

Give Yourself Permission to Indulge in Favorite Foods
For people with type 2 diabetes, this is unhealthy advice. We need to worry about the nutritional aspect and attempt to eat properly. While we need calories, we need to find someone that can give us better guidance than the advice given as it is a total cop-out on even reasonable dietary advice.

Enjoy Meals With Friends
This advice can be excellent for some people with diabetes, especially if your friends have diabetes, or at least understand your needs. I agree with this because people generally do eat better with family and friends. The socializing can give a positive influence in what we eat and assist us in eating more slowly.

Buy Prepared or Convenience Foods
If you are a person with diabetes, this should be the last consideration for a diabetes friendly meal. I have no objections to the right foods purchased at the grocery store, but as much as possible, avoid convenience foods. Some grocery stores have a cafeteria-style area where some foods are prepared right, but you must be careful to avoid some of the foods with added sugars or I should say hidden sugars in their sauces and gravies.

I realize that many fresh and frozen foods can require a minimum of preparation and microwaves can really be a help. Do not forget that many fresh vegetables will lose nutrients when they sit around for longer than they should after being picked. Therefore, frozen vegetables can sometimes be a more nutritious choice.

Try New Flavors and Foods
This is a difficult one for people with diabetes as so many foods just do not belong on our menus. Occasionally a new food will come along that will fit our needs. At other times, we will need to use our meter to see how a new food reacts in our system.

The dietitians involved in writing this article in WebMD are very transparent and even use the term “comfort foods” to encourage their readers to eat. Those of us with diabetes should understand that we may eat some comfort foods, but in limited quantity and only what our meter allows.

Spice Up Your Meals
If you’re not hungry because food tastes bland, try adding extra spices and other flavors. This is common sense and does make some foods more palatable and some spices do add nutrient value to the meal. A sprinkling of some fruits with certain foods can also add flavor and desirability to some foods. Again, let your meter be your guide.

Add Calories to Foods Wherever You Can
If you are underweight, use creative ways to add calories to dishes, especially when you’re ill. Even if you have diabetes, these tips will work for you, just do not overdo. Switch from skim milk to 2% or even whole milk, for example. Add extra butter to help add flavor to vegetables. Try these tips as they are healthier than the dietitians are willing to admit. Just start using this tip slowly to give your body time to adjust and not all at once. Even being overweight, these tips can assist in losing some weight. Just limit the pastas and whole grains by what your meter says.

Consider Nutrition Drinks and Liquid Meal Replacements
By providing balanced nutrition in an easy-to-consume form, liquid meal replacements can help you make sure you’re getting the nutrients and calories you need. Your doctor or dietitian can discuss options that are appropriate for you. This may be in your best interest if the liquid meal in not loaded with carbohydrates, but contains a reasonable number.

Drink Plenty of Liquids
Dehydration can dampen appetite, so it is important to stay hydrated by drinking plenty of liquids, preferably water, low carbohydrate vegetable juices, and if allowed unsweetened iced tea or hot tea.

Graze on Snacks Throughout the Day
For people with diabetes, if you don’t feel like eating very much when you sit down to regularly scheduled meals, try eating smaller amounts more often throughout the day.
Eating small meals six times per day can actually assist in blood glucose management, but until you try this, you will not know. This technique can assist in keep blood glucose levels lower throughout the day and prevent spikes that often occur at three meals per day.

Get Meals Delivered to Your Home
Most communities have service organizations that provide meals to older people, either delivered at home or served in community senior centers. If you’re not well enough to prepare meals yourself, check with your local social services to find out what options are available. Senior community food programs are open to anyone 60 and older, regardless of income level. If your doctor indicates that you aren’t able to leave the house, you can qualify for meal deliveries. This is good advice and the only caution I would add is when signing up, do not check the diabetes menu.

The reasoning for this is because you will get more carbohydrates than you should or possibly can eat. Most meals are high in processed grains and starches, but the diabetic meals seem to be overloaded with carbohydrates. In my community, this is very true and a couple that receive them are able to spread the meals into five meals and occasionally more to maintain carbohydrate control. Not that they are trying to spread the meals, it is just more food that they normally eat and higher in carbohydrates than they are accustom to or have had for many years. For some reason, the diabetic menu gets you more food than you would otherwise receive – strange what dietitians think.

June 6, 2012

Doctor – Are You Obtaining Enough Sleep?

A conversation between a surgeon and his patient the day before his surgery.

Doctor: Make sure you get a good nights sleep!
Patient: Speak more clearly doc – your mumbling.
Doctor: How long will you sleep tonight?
Patient: It is not me you should worry about doc. You are already having trouble speaking and it’s only nine-thirty in the morning. I think the issue is how much sleep will you get tonight?
Doctor: That is not your concern.
Patient: I think it is doc, I am the person you will be opening up tomorrow and you are already half asleep. I think it is time to ask for another surgeon, one that will be rested for the surgery.
Doctor: You need this surgery now. You cannot let this go for another doctor.
Patient: Doctor, unless you bring in another surgeon, you will be in trouble. I hope your liability insurance is paid up to date.
Doctor: I will see you at 10:00 AM tomorrow.
Patient: Not unless you have another surgeon doing the operation. I will not let a doctor that is this sleep deprived operate on me. So what is it going to be? Another surgeon or do I find another surgeon on my own?
Doctor: Have it your way – but don't expect me to give you a referral.

This is not what you want to have happen under any circumstance, but it did and to an individual I know. He was indeed lucky as the next day; the surgeon lost a patient because he was sleep deprived. Whether it would have happened to him, he does not care as he did locate another surgeon and had the surgery a week later. This time it was at the Mayo Clinic in Rochester. The surgery was successful and he is recovering quite well. There was a minor adjustment the surgeon had to take during the operation, but he said he had encountered this before and it was not life threatening.

This is a good lesson for anyone. Yes, the patient can always be very anxious before surgery and get very little sleep. This is not good for the patient, but is understandable. It is not understandable for a surgeon to be that way, yet this happens all too frequently. If this was a teaching hospital, we could expect interns to be overtired, but for a surgeon in a non-teaching hospital, this is unconscionable.

The study that got me started can be read here. It describes some of the effects of sleep deprivation, but cannot be relied on, as there were many parts of the study that caused no problems. I do understand the inability to actually follow practicing surgeons, as a study does not want to be responsible for actual harm. So all the study was done on simulators.

June 5, 2012

The Challenges in Self-Management of Diabetes

Even though this is a small UK study, it could apply to any developed country and fit the conditions found in this study. This study highlights many of the problems people with diabetes face on a daily basis. These problems include prejudice, ignorance, and stereotyping not only by medical professionals, but also by the society in general.

It is no wonder that even with a trend toward having individuals manage their own health; individuals are ready and able to do this, but need more support. Even in the USA, many doctors are not supporting having individuals manage their diabetes. They often feel that education is wasted on uncaring individuals and many doctors use fear to force people to use oral medications when insulin may make the individuals task of managing their diabetes easier. Plus many in the medical profession feel that for type 2 diabetes, insulin should be the medication of last resort.

If you are a person with type 2 diabetes, you invest time and effort in managing your diabetes. This includes self-monitoring of your blood glucose levels, managing your medications, and carefully following a restricted diet. On top of this, there are the challenges of not offending relatives who think they have your interests at heart. Then we all have the food police that can be rude and offensive in their instructions about what you may consume. Lastly, we have the diabetes police that want to tell you when to test and want to know what the reading is so they can advise you. If you thought life was difficult, then consider the doctors that use fear to motivate you or doctors that belittle you for not having followed orders that were never that specific in the first place.

Since the doctor cannot be with you but only 15 to 30 minutes per appointment approximately four times per year, we must learn to manage our diabetes on a daily basis. This means that for over 99 percent of the time, you are on your own in managing your diabetes.

What is interesting about this study compared to many studies, is that the researchers shadowed the participants for several periods of two to five hours while they were living their lives. They took notes of how they managed their diabetes and the challenges they faced. Trisha Greenhalgh, Professor of Primary Health Care at Queen Mary, University of London, led the study. She said, “Until now there has been very little research on what people with diabetes do and how they cope when health professionals aren’t around. We have shown that self-management of diabetes is hard work both practically and emotionally, and that many but not all people with diabetes are skilful at undertaking and co-ordinating all the different tasks involved."

It is interesting that this part was examined and the participants praised for the efforts they put into managing diabetes. They did say that for those not managing their diabetes well, it was understandable since many were cycled in family responsibilities, some had other illnesses, and some were struggling financially, or even had a combination of these factors. The researchers correctly state that these factors can limit opportunities to manage diabetes and that those who could benefit the most from self-management were the ones least able to achieve it.

The researchers did acknowledge that more needs to be known about how patients manage diabetes outside the clinic. In reality, doctors should be more aware of the efforts patients expend to self-manage their diabetes and understand the many factors that will influence how successful patients are. Until doctors are better able to assess patients and their ability to manage their diabetes, little will be acknowledged in the value of education patients receive. Doctors will continue to resist educating patients.

June 4, 2012

Article about Academy of Nutrition and Dietetics

Are we headed for problems in the field of nutrition? If the Academy for Nutrition and Dietetics (AND) has their way, many people with chronic diseases will be worse off than they are presently. Those of us with diabetes will need to educate ourselves completely about nutrition to avoid the poor information that will be dispensed by those licensed by the AND. AND's former name was ADA (American Dietetic Association),

Currently in several states where AND licensure has been passed by state legislatures, nutritionists of all types are being force out of business. This includes, but is not limited to nutritionists having a PhD in nutrition, but other highly trained nutritionists specializing in other fields, but give out nutritional information. Am I endorsing all types of people giving out nutritional advice? No, but those that have a degree in nutrition should not be forced out of business just because they do not want to belong to AND.

However, this is what is transpiring in many states where the AND has gotten their licensure bills passed. They consider people not part of their organization as competition and are going after them with a vengeance unlike many of us have seen before. Yes, history shows that this has happened before in the medical community between different professions, but the bitterness this time is very bad for the registered dietitians (RD) and style in which the AND is attempting to end competition.

At least now several groups are fighting the efforts of the AND and their campaign to criminalize non-RD nutrition providers. These groups include the Alliance for Natural Health, USA, the American Nutrition Association, and the Weston A. Price Foundation. These groups plus other organizations are mobilizing their memberships and constituents to oppose the AND monopoly. Even consumers will lose the choice of nutrition professionals to choose from and where they wish to receive nutrition information.

If you do not wish to have policies from the American Diabetes Association, the USDA, and other government agencies that the AND follows and advocates, then you need to pay attention and oppose the actions of AND in your state. If you did not read my previous blog on the same topic, read it here and the links in the blog. Read the link for starting this blog here.

I know from correspondence with several people I consider friends in the current AND and outside, that some of them are joining other organizations where they will be able to practice nutrition outside the AND and one is retiring to avoid the squabble. A couple of current RDs will retain their membership in AND until such time as they are able to leave.

It is a shame that so much of the then ADA (American Dietetic Association) and now Academy of Nutrition and Dietetics licensure requirements was pushed through many state legislatures so quietly. Now the battle will be to have the laws repealed or changed to prevent the monopolization of nutrition. Check the licensure requirements for you state here,

June 3, 2012

HFCS Denied Name Change to 'Corn Sugar'

Score one for those that opposed the name change by 'big corn'!  The Food and Drug Administration on May30, 2012, officially announced the denial of the request of the Corn Refiners Association for the name change from high-fructose corn syrup to corn sugar.  For those desiring to read the technical reasoning the link is here.

I am happy the decision went against the corn industry and kept the current name in place.  Many of us with diabetes know what this does to our blood glucose levels and that we need to avoid products containing this. There are many that believe that HFCS is a large factor in our obesity epidemic. There are studies for and against, and I firmly believe many are agenda driven.

The above being said, apparently the corn industry is thinking about continuing the advertising and doing other questionable activities. I have noticed several products on grocery shelves in the last week that do not list high fructose corn syrup, but definitely list corn syrup. Since I was looking, I checked many of the canned items, and refrigerated foods. Since this was before the FDA ruling, I was surprised to see corn sugar listed on a couple of products. Also seen were corn products, corn byproducts, and cornstarch. I would expect these and admit I was even more surprised to see corn byproducts on an ingredient label with high fructose corn syrup.

Now on to some serious information. This article has put some reality into our problems with high fructose. Even though is is from the animal model, the researchers have declared the findings have relevance for humans. The finding is that diets high in fructose impair cognitive function. Then in the next sentence, they state that if the diet is supplemented with the correct intake of omega-3 fatty acids, the fructose impairment is reversed.

Coauthor Fernando Gomez-Pinilla, PhD, from the UCLA Brain Injury Research Centre, Los Angeles, California, states, "High fructose consumption can induce some signs of metabolic syndrome in the brain and can disrupt the signalling of the insulin receptors and reduce the action of insulin in the brain."

Then he adds, "On the other hand, consumption of omega-3 fatty acids, particularly decosahexanoic acid [DHA], seems to protect against the effect of this high fructose consumption. That was the most interesting thing for us, to find that these changes in the brain that the fructose was triggering, the poor learning and the other molecular changes, could be buffered by omega-3 fatty acids."

The study is published in the May 1 issue of the Journal of Physiology.

I am sure we will see more studies on HFCS and more agenda driven studies as the corn industry wants to preserve their stranglehold on the cheap product added to many foods.