March 1, 2014

Registered Dietitians Increasing Whole Grains Promotion

Time after time in the last few months, I have read more blogs and articles from registered dietitians that are promoting whole grains as part of our food plans. Many of them are realizing that many people with type 2 diabetes are pushing back and are therefore taking different approaches to disguise their message of high carbohydrate, low fat food plans. We need to recognize this and realize that they have a true conflict of interest because their organization, the Academy of Nutrition and Dietetics (AND) is a puppet of Big Food that manages their strings.

The author of this blog states that as a dietitian, she believes that whole grains can be part of anyone's eating plan. She continues that despite the anti-grain sentiment, grains – whole grains – have many benefits to offer. She lists the following:
  1. Whole grains can reduce the risk of heart disease, cancer, and type 2 diabetes.
  2. People that eat whole grains tend to have lower BMIs, lower waist-to-hip ratios, and lower risk of obesity.
  3. Whole grains can improve the health of your digestive tract by promoting regularity and enhancing the growth of healthful bacteria.
The above three points are not as true as many would like to believe. There is little scientific evidence that whole grains contribute to less risk of heart disease, cancer, and type 2 diabetes. Whole grains actually increase the risk of type 2 diabetes and as a result heart disease. This is because when the whole grains are converted to glucose, our blood glucose levels increase to higher than normal levels. If there are problems within our pancreas, then risk for type 2 diabetes elevates.

Maintaining number 2 above becomes more difficult with whole grains and especially the modern day grains that have been genetically over modified. For those individuals that have the ability to consume whole grains because of their metabolism capable of processing the whole grains, then number 2 can be true. Many people do not have the ability. For number 3, fiber is the name that can be important and other foods can replace the fiber needed by our bodies.

It is true that whole grains have not been stripped of the bran and germ like refined white flour and white pasta. If we have problems with the whole grains, then the problems with the refined grains generate even more problems and really spike our blood glucose levels.

This is the reason many people and especially people with type 2 diabetes need to read about low carbohydrate food plans. Also, read about the paleo food plan, which eliminates all grains. Yes, eliminating whole grains can cause a shortage of some vitamins and minerals, but there are other foods that can be consumed that will replace what might be lost to the elimination of whole grains.

February 28, 2014

EHR's May Not Be As Private As Hoped

Over last few weeks, I have been reading more than I normally do unless it is a book. This time it is the website for Joe Flower, a healthcare speaker. He holds himself out as a healthcare futurist, but he knows his topic, what he is talking about, and writing about. He does not write for patients, but patients can learn from his writing.

I talked with a hospital CEO recently and mentioned his name. I was asked how I knew him and I said from his writing. At that point, I was tuned out and totally ignored.  I suspect he did not want conversation about computer security or how it would look when the hospital's computer system becomes compromised.

I did not need to ask the one question I had wanted to ask because I know that the patient electronic health records are not encrypted, but I did want to ask why they were not encrypted.

Joe Flower wrote a blog on the health care where he warns CEOs (chief executive officer) and COOs (chief operations officer) to start listening to the information technology (IT) people and have some serious meetings with them. He explains why and puts together a great argument as to why this is important.

In November, Target had their systems compromised and then other retailers discovered their systems had been compromised in similar ways. He tells CEOs and COOs not to say they had just passed a security audit as Target had just passed a security audit, just before they discovered the break-in to their servers, credit card machines, and cash registers. The security audit failed to find the malware installed through out the system.

How could this happen? The attackers have gotten more sophisticated, and they used new techniques of entry. The attackers in the biggest heist in the company's history entered through the thermostat. Yes, through the most unlikely of targets, a simple thermostat.

Most did not suspect that the heating, ventilation, and air conditioning (HVAC) systems would be vulnerable to this sort of attack. To understand what happened - most brick and mortar stores have complicated HVAC systems. Hospitals have even more complicated HVAC systems. The security leak happens because most stores and hospitals outsource the management of their HVAC systems to outside contractors. This contractor monitors and controls the HVAC over the internet. How? Because all sensors, thermostats, switches, control valves, and other controls are hooked to the store's and hospital's servers. The contractor is given password-controlled access to the store's central computer system.

When you think about hospitals, they have probably more hooked to the central computer system and they are also hooked to the internet. Most companies and hospitals are not aware that these outside contractors have very poor security and often use the same password across multiple customers.

Once these outside contractors have been hacked, they have access to many brick and mortar stores and hospitals. This in turn makes it easy for the hackers to gain access to any information they want.
Other writers are urging system encryption against people that might penetrate the firewall. I know that many say businesses and hospitals say they can't afford encryption, but the cost of being hacked, may open more than a few checkbooks.
With the Affordable Care Act and the ongoing interchange of data, especially between insurers and providers, enormous amounts of personal data, from address and credit card information, to medical health including embarrassing private health information may become available to hackers.

Consider this appearing on hacking forums: “We can get you the medical records of anyone — any celebrity, wealthy person, or blackmail target.” Yes, this will happen because they have hacked into the nets of information that flow between payers and hospitals, and hospitals and clinics. I can just imagine you seeing a headline in the local paper that says the local hospital or clinic has had a data breach. Will the hospital or clinic have an exodus of patients? I would not want to bet against this.

February 27, 2014

Older Type 2 Patients Feel Discriminated Against

Are you over the age of 65? Do you have type 2 diabetes? How many other health conditions (comorbid) do you have – hypertension, arthritis, retinopathy, hypercholesterolemia, coronary artery disease, and neuropathy? Now for the most important question – do you feel that the doctor(s) you are seeing is listening to you or even care to see that you are being treated properly?

More people are becoming very discouraged with their physician and feel that they are being treated poorly and herded through their appointments like cattle. It is understandable that the study I am now referring to is so small, but in many ways is typical of what is happening to the elderly needing health care today. It is my opinion that this is only going to become worse as the government intrudes further into health care decisions to cut cost and manage health care.

Considering that type 2 diabetes has increased in recent years, and is expected to increase even more in the coming years, where are the elderly going to find caring physicians that will help them manage their conditions. Most adults and especially the elderly have at least one comorbid condition and almost half have three or more. I admit I am becoming tired of the platitudes being handed out about developing effective management and individualized management to reduce each patient's diabetes risk of complications and lower the economic cost of this disease.

While this is true and what is sorely needed, many physicians are turning away from the elderly and not meeting their needs. The study involved 32 patients with type 2 diabetes and at least one other chronic health condition. All patients were 60 years of age or older and had diabetes for at least one previous year. The patients were divided into eight focus groups of 2 to 6 patients each. The interviews centered on the patient's experiences and opinions about their health care plans for their diabetes and other chronic conditions.  The following link is to a PDF file relating the findings of the study.

Older adults perceived a general unwillingness from their providers to treat their multiple health conditions and address their individual preferences for care. Older adults may require more in-depth communication with their providers in addition to individualized treatment plans that address their preferences for comorbidity management. Patients reported -
  1. A general unwillingness of their providers to treat their diabetes and other chronic conditions.
  2. Experiences of limited support and empathy from their providers.
  3. Some felt that their providers were insensitive to their remaining years of life because of their older age.
  4. Patients felt that their preferences for care were not considered by their provider.
  5. Patients felt their care was not tailored to their individual needs and medical history.
The patient population in this study was extremely homogenous, as all the patients were white, highly educated, and community dwelling. These patients also had good glycemic control, which may have affected some of their responses. The responses obtained from the patients in this study point to a "disconnect" between patients with these conditions and their providers.

The authors stated that future research should aim to incorporate data from physician-patient pairs to assess communication properly from both sides. Effective patient-provider communication and shared decision-making have been shown to not only improve patient satisfaction, but also increase adherence to treatment plans and improve health outcomes.

For those of us with diabetes, we need to be aware of the above to measure our own satisfaction and help us determine if we need to consider seriously changing doctors. I know that I have a decision to make in the near future about one of my doctors.

February 26, 2014

Joslin Bloggers Hide Behind Anonymity

Very seldom does a blogger on Joslin Communications identify him/her self as the author of a blog. This raises all types of questions about the integrity of the message of the blog and of Joslin itself. This allows authors to take pot shots at various people in complete anonymity. Since doctor William Davis published the book in 2011, I did not write a review about it until December of 2012. I have to question why Joslin decided to try to discredit the book in February 2014.

Did Joslin succeed, not to my way of thinking? They only succeeded in discrediting Joslin. The author has to be a registered dietitian or certified diabetes educator. One common thread promoted by registered dietitians is, “... some of the restricted foods, such as fruit and oats, eliminate sources of vitamins, minerals and phytoestrogens.”  I have never understood why this line of defense is so often used when other foods will provide the vitamins and minerals. Anyone working with a nutritionist or knowing nutrition can always find many foods rich in the vitamins and mineral dietitians claim we are missing by not consuming whole grains.

Then we also need to remember that dietitians that are members of the Academy of Nutrition and Dietetics are strongly influenced by the grain and food industry. I would think that the employees of Joslin would rise above the conflict of interest. I guess this is wishful thinking on my part considering that other Joslin employees are operating with conflicts of interest from the pharmaceutical industry and medical device industry.

The Joslin blog reads very much like reading the information put out by the Grain Foods Foundation. It contains much misleading information and focuses on half-truths and citing information to mislead the reader. If you want to understand the issue, read this blog by David Mendosa who questions why Dr. Davis did not go farther and eliminate all grains. Then read this by Peter Bronski, who objectively points out the shortcomings of Dr. Davis's book.

The Joslin blog, in my opinion, rehashes old information and adds little to the discussion that has not been said before by the 'experts' of the Grain Foods Foundation.

February 25, 2014

Tips That May Help You in Blogging

I know that I don't always follow my own advice, but if you find these useful, have at. First, I write about one topic – diabetes, specifically type 2 diabetes. Second, there are topics that relate to diabetes and sometimes the relationship is obtuse or difficult to recognize. However, I still try to stay on the topic of diabetes.

Second, I have researched blogging and there are many tips and discussions on what to do. Rather than list a large number of links, I suggest using the following search string in your search engine – 'tips for bloggers'. Please understand that many of the tips apply to many types of blogs and some are not for bloggers writing about diabetes or other chronic diseases. Some will still apply, but not all. I would suggest reading this discussion first Tips Beginner Bloggers.

One blog author does say that some rules and tips are meant to be broken from time to time. Two blog authors suggest limiting blogs to under 700 words and one author says if you can't say it in 600 words, it does not need saying. Now admittedly I have over 900 words more often than I should and I have too many two and three part blogs. Now I say that I detest overly long blogs, but there are times when I would rather read a long blog when the subject matter is interesting.

One tip I find useful is providing a email sign up for new posts. This is one way to make sure your readers are alerted when you post a new blog. Another way to inform your readers of a new blog is to have a RSS or other blanket feed for those that subscribe.

Third, I would like to cover a few minor issues that drive readers away. Some are not minor to some people and they will quite reading your blog.
  1. People with color blindness – read about it and look at the color charts on . Avoid using a lot of colored fonts in your blog.
  2. Do not use acronyms without an explanation the first time. You may know the meaning of the acronym, but will your readers. Consider the acronym ADA. Yes, often it is easy to figure out in context, but I would not say this all the time. I recently had a blog here in which I could have used ADA for two of its many meanings – American Diabetes Association and Americans with Disabilities Act. I did only use it for the first one.
  3. Always admit when you make a mistake – I do more often than I like.
  4. Never apologize for expressing your opinion. Not everyone may agree with you, but that is expected. However, it is better to avoid controversial opinions.
  5. One frustration I have is when reading a blog is not having a date for the blog to know whether it is the most recent or if there are more recent blogs.
When it comes to diabetes, some words do make readers angry. David Mendosa does explain them and I agree with him. I would urge my readers to take time and read his blog Incorrect Diabetes Terms. The only term that David describes that I have some disagreement with is the term “brittle diabetes.” It is often used incorrectly, but now has official recognition from the National Institutes of Health, which recently listed brittle type 1 diabetes as a rare disease, a distinct and separate form of type 1.

One word that does upset me is the word control. I sincerely wish we could control diabetes, but this is impossible under any circumstance. We are capable of managing diabetes to the best of our abilities and many people are able to manage diabetes with nutrition and exercise without medications. Others of us must use a medication, whether oral medication or insulin, to assist us in managing our diabetes. Some people chose not to manage their diabetes and they wonder why they must put up with the complications. If those of us with type 2 diabetes could actually control diabetes, we would not have diabetes.

The other word that offends those with any type of diabetes is the word “cure.” As of today, there is no cure for diabetes. There is some great research offering hope, but no cure, yet. Repeat, no cure! That is why we know that when someone advertises they have been cured and can provide that cure to us, we know that we are being conned and all they want is to separate us from our money. Those that use the word cure and the word remission, may not have had diabetes in the first place. We know they also wish to sell us something that will not cure us.

People with diabetes do like other words, but have a strong mistrust for today's media and their sensationalism of many topics. We know they want listeners and to sell papers, but they seldom report diabetes accurately. Most do not even understand diabetes.

February 24, 2014

Our Diabetes Support Group and Stress

Our February meeting was somewhat different. Tim had taken the topic and assigned different people parts of it to present. Since I was blogging about stress, Tim chose to leave me out since I had provided him with several links and a variety of stress topics. When the meeting started, he stated why some topics had been left out. He had purposely left out the positive stress topics I covered in my blog here. He said no one had asked to have them or felt the need for inclusion. He even stated that several of the other stress topics saying we don't have traffic jams and even when the river overflows, we still have routes to get to the stores for food and other supplies.

No one disagreed with him when he said that the extremely cold weather and frequent snow days were enough of a stress. He asked how many experienced bad batteries because of the cold. Six hands went up, and then he asked how many that worked were unable to get to work. Only one hand remained up. A.J. stated that all of his neighbors had left for work before he needed to leave and as such, he had no way to get to an auto supply to purchase a new battery. He said, he then called his work site and was told that they would be closed for the day.

With that pressure off, he raised the hood and recorded the information on the battery. Next, he called the auto supply store he did business with and asked if they would be making deliveries. They were and he ordered the battery. He paid for it when it arrived and then installed the new battery. The car started and he took the old battery to the auto supply store for credit since it was still under warranty.

Next, Tim put the topic of diabetes stress into discussion. No one disagreed that the daily management of diabetes was without some stress. Allen stated that he is happy with the success he is having with his diabetes management, but that he is worried about burnout. Allen turned to me and asked me how to overcome burnout. I said that a positive attitude is a key to help a person get through. Often people can have depression to go along with burnout. I brought up the book by Dr. William H. Polonsky and that it was a good resource - “Diabetes Burnout: What to Do When You Can't Take It Anymore”. Jason said that he had a copy that he referred to often, but he would loan it to Allen. Max said he had a Kindle version and reread it several times and he said it had helped him avoid burnout.

Brenda said she would be ordering it, now that her granddaughter had been diagnosed with type 1 diabetes. If she found that it would help her family, she would possibly order another copy. Sue then asked what burnout was. She could understand stress and depression, but could not make the link to burnout. Ben said he and Barry had been talking about burnout and was not sure he had the right answer, but they had agreed that burnout was when the repetition becomes frustrating, and the effort of the daily chores becomes overpowering. Stress may help cause burnout or be a contributing factor.

I agreed with Ben and added that even minor depression may be a factor to burnout. Jason agreed and said he believed burnout was all of these and people sometimes are at wit's end or mental resources to deal with diabetes. Rob said he would like to add that burnout can happen even when blood glucose management is going well and people just become tired of doing the same thing day after day. Tim asked Sue if she had a better understanding of burnout. Sue agreed that what we had said helped and her husband said he felt he had a handle on it and would talk about it at home.

Tim then brought up the article from Washington University in St. Louis and we covered what stress can do to the organs listed.

When we discussed what effect stress can have on the pancreas, John said that stress may have been part of the reason he developed diabetes because he was in an extremely stressful job at the time and dealing with his father nearing the end of his life. He admitted that he was not aware of anyone in his family having type 2 diabetes and had wondered why he had developed it. He stated that by leaving his job and having two sisters available to be caregivers to their father had been a big help, but he still did what he could to give the sisters some relief. The job he obtained after leaving the stressful job was actually fun to be at and not stressful.

We had some more discussion about the effects of stress and quickly covered the points in my blog here. When we discussed the use of counseling or psychotherapy, Jason said we could all think that it might not be for us, but stop and think about it. He continued that counseling had saved his marriage shortly after he was diagnosed with type 2 diabetes and now his wife and he are enjoying a stronger and closer marriage. He felt that his diabetes almost cost him his marriage because of the stress of diabetes.

Tim asked to end the meeting and interested people could continue discussions if desired. Discussion did continue for another half hour and then several decided to take the discussion to other places. All I can say is this was not the most intense meeting we have had, but it was not far from it.

February 23, 2014

Who Should Be in Charge of Medical Care?

This could be the $64 billion dollar question. I have been reading several blogs lately and each one seems to want to go in a different direction. Insurers are beginning to feel that they should have management control over health care. Doctors are beginning to push back demanding that they be in control. More patients are saying, “Now wait a minute, we would appreciate some voice in our treatment.” All of this may be out the window with government voicing more from the Centers for Medicare and Medicaid Services (CMS). They may drown out the other voices as they dictate more in what will be allowed and not allowed.

For many, having CMS wag the reimbursement tail and the insurance industry following lock-step will mean that neither doctors nor patients may have much hope of managing health care decisions. This may not be a good situation when insurers refuse to allow life saving procedures.

It was with some amusement that I read this by Dr. Pelzman in MedPage Today. Dr. Pelzman says, “A couple of years ago one of the major insurers got in touch with our practice and told us that they would like to come over to our office for a sit down, to talk about our patients and how we take care of them. When they arrived, the executive and his retinue of employees presented us with data that suggested that "we" were costing "them" a lot of money to take care of "their" patients. We went over the data they had, which showed it was costing them several million dollars more per year to take care of the panel of patients we shared than they collected in premiums from those patients.

Despite the fact that it appeared that much of the cost was due to several patients with acute leukemia who had massive unavoidable costs, they firmly came down with the recommendation that we find ways to take care of their patients with less cost.”

What follows is not a surprise as insurers want to make a profit and will take measures to ensure a profit. It is obvious that the practice Dr. Pelzman is part of felt they had to allow the insurer to install a care coordinator in their practice, even if this meant doing some practices that would literally exclude people based on their insurance status.

As patients, even we know the insurers have a purely financial interest in delivering care more efficiently and cheaply to patients. Then Dr. Pelzman goes where many doctors fear to go and says, “We should welcome the insurers to the table, as we continue building the patient-centered medical home, but it's time we as practitioners and providers of care seize the reins, take control, and start making some rules of our own. We are here to provide care for "their" patients, and ultimately we (hopefully) know best. We understand that they're worried about fraud, over-spending, over-testing, over-referring, but hopefully we can work together to build a more patient-centered way of taking care of these patients as our healthcare model changes in the 21st-century.”

Now if he had urged bringing the patients into the discussion and making them part of the decision process, then the doctors and patients would have had more bargaining clout for dealing with the insurers. Yet most doctors refuse to consider patients as having any advantage other than providing them income in the practice of medicine.  Too often, we are thought of as non-adherent and incapable of following their ill thought-out instructions.