Is it the diabetes educator? Yes once more, for many and varied reasons. If you have received a referral, this person can get in the way. Sometimes it is not intentional, but they sometimes lack the ability to think for themselves and settle into poor habits of thinking they and only they are right and forgetting about the needs and maybe the goals of the patient. They should not openly disagree with the doctor, but many do.
If done properly, they can be of great help to the patient. The largest problem is the lack of diabetes educators so many areas of the country just do not have them available. Many others have not left the profession, but are not working with patients because they have related jobs and some are authors and will never be available to advise patients. Some have good books and some have books.
So if you get one that understands diabetes, personal goals, what the patient desires, and what the patient is capable of, treasure this person. Make use of what they have to offer and get questions answered. They will communicate with your doctor and see that you receive the best outcome. In some states, these educators are not licensed, but still have much knowledge and are able to communicate at all levels.
It is the dietitian? I must continue to answer yes. These people sometimes are so wrapped up in following the guidelines of their national association and other medical groups that they forget about the help patients need to battle diabetes. They are locked into dogma and mantra's that are losing favor among the rest of the population.
It is unfortunate that they are so locked to low fat and whole grains that they push these ideas to the exclusion of patients needs. One person who will never talk to a dietitian has celiac disease and cannot tolerate any wheat products. She was still advised to eat whole grains even after explaining that she could not eat whole grains and that she had celiac disease.
There are many good dietitians that are not fearful of their job and work for and with patients, doing what ever is necessary to serve the nutritional needs of people with diabetes. They work with people to make nutrition first and at the level that the patient desires to be able to achieve their goals.
The problem many people have is locating a good dietitian that knows diabetes and can work with you. People living in rural areas may not be able to locate a dietitian or have to travel hundreds of miles to see one.
Both the educators and dietitians can be assets to doctors and they can help patients when they can put their own importance and titles behind them on a shelf or wall and don't wear them on their lapels constantly remind people of their importance. These are the ones that are also assets to patients.
I will be covering more in part 3. (2 of 3)
February 22, 2011
February 20, 2011
Who Prevents Good Diabetes Management? - P1
Not an easy question to answer. Many think they have an answer. Bear with me for some questions and potential answers.
Is it you? Yes, and this is often the answer. We are often our own worst enemy. For what ever the reason, we can many times find ourselves to blame for non-management of diabetes. We should not blame ourselves for developing diabetes, but many cannot get past this and become the person at fault for not managing their diabetes. I will return to this at the end.
Is it the doctor? Yes again and for many reasons. First, lets define the potential range of doctors that may be potentially involved. Many people can have a general practitioner. Others will use a doctor of internal medicine. Some will have a doctor known only as a family practitioner. Still others will have a primary care physician. Very few of these will specialize in diabetes, but some will be very knowledgeable about diabetes because they have spent the time to stay current with the developments. Others will have little or limited knowledge and if they are good, they will adapt and learn. Some of the better doctors will refer patients to doctors that know about diabetes.
Then there are doctors that specialize in the endocrine system, but still may not be knowledgeable in diabetes. Then we have those that specialize in diabetes. And even then there are quality endocrinologists and those that are not. As with any doctor, it will take a good fit between patient and doctor to have great success. Others can have good success with a less that perfect partnership.
What needs to be recognized is many doctors just don't pass on information to assist you is managing diabetes. Or they refuse to get you to classes that would instill the reasons for management and how to manage diabetes effectively. Some will not work with you to battle the medical insurance monopoly to get you the testing supplies to help you get started. Many just don't want you testing your blood glucose as they want to be in charge and do not want you to become discouraged when the results are not good.
If you have one of these doctors, you should seriously consider finding another doctor if it is possible. I realize that many people live in rural areas where doctors are few and far between. In these situations, it may be necessary to stay with a doctor and attempt to get education if possible from the internet, but that can sometimes be difficult in some rural communities.
In these extreme situations, you may need to work more intelligently with your doctor and even beg for testing supplies and encourage the doctor to become more knowledgeable. An acquaintance of mine needs to drive 90 miles one way to the nearest doctor. He is very fortunate that the doctor is knowledgeable about diabetes and encourages use of the internet and also works with him to answer questions via emails. This is the exception, but it works for both of them. His appointments are also a rare thing as he is often there for a full half an hour, when needed.
So if you have a doctor that you can work with, consider it a blessing and cultivate the good relations and ask questions.
I will be covering more in part 2. (1 of 3)
Is it you? Yes, and this is often the answer. We are often our own worst enemy. For what ever the reason, we can many times find ourselves to blame for non-management of diabetes. We should not blame ourselves for developing diabetes, but many cannot get past this and become the person at fault for not managing their diabetes. I will return to this at the end.
Is it the doctor? Yes again and for many reasons. First, lets define the potential range of doctors that may be potentially involved. Many people can have a general practitioner. Others will use a doctor of internal medicine. Some will have a doctor known only as a family practitioner. Still others will have a primary care physician. Very few of these will specialize in diabetes, but some will be very knowledgeable about diabetes because they have spent the time to stay current with the developments. Others will have little or limited knowledge and if they are good, they will adapt and learn. Some of the better doctors will refer patients to doctors that know about diabetes.
Then there are doctors that specialize in the endocrine system, but still may not be knowledgeable in diabetes. Then we have those that specialize in diabetes. And even then there are quality endocrinologists and those that are not. As with any doctor, it will take a good fit between patient and doctor to have great success. Others can have good success with a less that perfect partnership.
What needs to be recognized is many doctors just don't pass on information to assist you is managing diabetes. Or they refuse to get you to classes that would instill the reasons for management and how to manage diabetes effectively. Some will not work with you to battle the medical insurance monopoly to get you the testing supplies to help you get started. Many just don't want you testing your blood glucose as they want to be in charge and do not want you to become discouraged when the results are not good.
If you have one of these doctors, you should seriously consider finding another doctor if it is possible. I realize that many people live in rural areas where doctors are few and far between. In these situations, it may be necessary to stay with a doctor and attempt to get education if possible from the internet, but that can sometimes be difficult in some rural communities.
In these extreme situations, you may need to work more intelligently with your doctor and even beg for testing supplies and encourage the doctor to become more knowledgeable. An acquaintance of mine needs to drive 90 miles one way to the nearest doctor. He is very fortunate that the doctor is knowledgeable about diabetes and encourages use of the internet and also works with him to answer questions via emails. This is the exception, but it works for both of them. His appointments are also a rare thing as he is often there for a full half an hour, when needed.
So if you have a doctor that you can work with, consider it a blessing and cultivate the good relations and ask questions.
I will be covering more in part 2. (1 of 3)
February 18, 2011
Cook to Resolve Your Food Issues
I guess that I was very lucky when my first wife died of cancer. The last several months of her life, she worked on getting me to cook, yes, simple dishes and when I complained about them being tasteless, she told me to get a certain cookbook and do some reading that she selected. I used a post-it to mark the section on using herb and spices and still refer to it.
No, I don't do as much cooking as I am remarried and my wife loves to cook. But I still love being in the kitchen. I am learning other things now, like doing the dishes without a dishwasher. No this I learned on my own after I sold the house. I do help with chores and some food prep, like chopping vegetables in various sizes.
This article in WebMd is very good and should be read by anyone that does need to cook and has not learned to cook. If you have started, this is still good. It has a list of kitchen tools. I have that and a few more, but the best tools are an excellent set of knives for the many uses. I seldom use the food processor and it sits. I do have a very small processor for onions and a few other foods. Yes, I will not do more than cut the onions to fit in the processor and then let it do its magic – mostly on the pulse mode.
Doing your own cooking is very important as it allows you control over the foods and lets you do what is necessary to limit sodium (salt) and the amount of cholesterol that you eat, to say nothing of sugars, especially high fructose corn syrup (now renamed corn sugar) that you can keep out of your foods.
While many people detest cooking from scratch, it is the most healthy and rewarding. I have not made bread for several years, but I am rereading about this and may do this again. I will not be using wheat, rye, or oat flours. This is why I need to do more reading.
Another good source of information is a blog by Amy Campbell. Select the year to read many excellent blogs on cooking. They may not be specific enough for those of us with diabetes, but there is much information that can be adapted quite easily. She runs many series for four to six or more blogs about the same topic and then starts another topic with a sprinkling of other excellent ideas mixed in for good measure.
No, I don't do as much cooking as I am remarried and my wife loves to cook. But I still love being in the kitchen. I am learning other things now, like doing the dishes without a dishwasher. No this I learned on my own after I sold the house. I do help with chores and some food prep, like chopping vegetables in various sizes.
This article in WebMd is very good and should be read by anyone that does need to cook and has not learned to cook. If you have started, this is still good. It has a list of kitchen tools. I have that and a few more, but the best tools are an excellent set of knives for the many uses. I seldom use the food processor and it sits. I do have a very small processor for onions and a few other foods. Yes, I will not do more than cut the onions to fit in the processor and then let it do its magic – mostly on the pulse mode.
Doing your own cooking is very important as it allows you control over the foods and lets you do what is necessary to limit sodium (salt) and the amount of cholesterol that you eat, to say nothing of sugars, especially high fructose corn syrup (now renamed corn sugar) that you can keep out of your foods.
While many people detest cooking from scratch, it is the most healthy and rewarding. I have not made bread for several years, but I am rereading about this and may do this again. I will not be using wheat, rye, or oat flours. This is why I need to do more reading.
Another good source of information is a blog by Amy Campbell. Select the year to read many excellent blogs on cooking. They may not be specific enough for those of us with diabetes, but there is much information that can be adapted quite easily. She runs many series for four to six or more blogs about the same topic and then starts another topic with a sprinkling of other excellent ideas mixed in for good measure.
February 15, 2011
Lessons Diabetes Teaches Us – Part 2
Hopefully you have read David Spero's blog from my last blog. If not, go back and read the previous blog here. Now for some more lessons from the college of hard knocks about diabetes.
These are some of the problems associated with diabetes and some are considered short-term complications. A brief list includes hypoglycemia, hyperglycemia, diabetic ketoacidosis (DKA), and hyperglycemic hyperosmolar nonketotic coma (HHNKC). The last two need immediate medical intervention. Hypoglycemia may require immediate medical intervention of the blood glucose levels gets too low. Read about the short-term complications here.
Certain oral medications can cause hypoglycemia and is is very common for those on insulin. People that become hypoglycemically unaware need to be especially cautious about letting their blood glucose levels get low. DKA is normally associated with Type 1 diabetes, but a few Type 2's can have this problem. HHNKC is generally for those with Type 2 diabetes who let their blood glucose levels get above 600 mg/dl for extended periods.
A word of caution to all people with diabetes, if you live alone, make sure that you have family or friends available for assistance if needed. If you live in an area and know other people that have diabetes, get to know each other for support and to check on each other.
Other effects that are associated with diabetes are loss of sexual drive – erectile dysfunction in men, urinary track infections (UTIs) in women. Also relevant are heart disease and diabetes, stroke and diabetes, and high blood pressure and diabetes. Most doctors will automatically screen for these and prescribe medications to alleviate the problems, but a few do not. So be prepared to ask for these screenings.
If you are able to manage your blood glucose levels, then there are some sneaky problems that still can make themselves present. Depression can assert itself. Most people with diabetes, about 67 percent, are likely to develop mild depression and then there is about 19 percent that may develop severe depression. Mild depression can be helped with antidepressants and the more severe should be treated under the care of a doctor. Read my blog on depression here. Even excellent management of diabetes is not a guarantee that you will not have depression.
Over 50 percent of people with diabetes, are likely to develop sleep apnea. Most because they are overweight and have apneas up to several hundred times a night which interrupts your sleep and you feel over tired during the day. There are several treatments available depending the the severity of the sleep apnea and the type. See my blogs here for further details: blog 1, blog 2, blog 3, blog 4, and blog 5. There are other blogs, but I have provided those relevant for this discussion.
Another link to diabetes is dementia, in particular, Alzheimer's disease. There is a proven link between the two now so that it cannot be ignored. So for those of us in our golden years, you do need to be concerned. Read David Mendosa's blog here and my blog here.
There are other problems such as skin problems caused by diabetes. Some skin problems need immediate attention, but others can be treated with various medications and skin conditioners. There are other other minor complications that few people have problems with. The big four were covered by name in the first part.
Some will say I did not cover amputations, but I am. They can result from two of the big four. Neuropathy and atherosclerosis are the cause of poor healing and lead to amputations when not properly and immediately cared for. So make sure that you take excellent care of your feet and legs, inspect them daily and see a doctor if a problem develops.
Many people insist that every little health problem is caused by their diabetes and this is just not so. There are other diseases that people with diabetes can get, but as of yet, there is no firm or related link to diabetes resulting in posing a risk to have the disease.
Most people that manage diabetes and are able to maintain blood glucose levels near normal very seldom develop complications. It is when people do not manage their blood glucose levels that they will develop the complications. Retinopathy seems to happen first, but they may all develop to some level at the same time.
I have had three friends or acquaintances that had diabetes that they did not manage their diabetes and they went on dialysis. All three have passed in the last 18 months because they could not or would not continue the dialysis. Another friend had both her legs amputated above the knees because she did not manage her diabetes. She is now approaching the end of her sight because she has continued to not manage her diabetes.
So life's lessons can be hard for some and others do very well. How are you managing diabetes. Has the college of hard knocks helped? Or have you ignored the lessons of life handed to you?
These are some of the problems associated with diabetes and some are considered short-term complications. A brief list includes hypoglycemia, hyperglycemia, diabetic ketoacidosis (DKA), and hyperglycemic hyperosmolar nonketotic coma (HHNKC). The last two need immediate medical intervention. Hypoglycemia may require immediate medical intervention of the blood glucose levels gets too low. Read about the short-term complications here.
Certain oral medications can cause hypoglycemia and is is very common for those on insulin. People that become hypoglycemically unaware need to be especially cautious about letting their blood glucose levels get low. DKA is normally associated with Type 1 diabetes, but a few Type 2's can have this problem. HHNKC is generally for those with Type 2 diabetes who let their blood glucose levels get above 600 mg/dl for extended periods.
A word of caution to all people with diabetes, if you live alone, make sure that you have family or friends available for assistance if needed. If you live in an area and know other people that have diabetes, get to know each other for support and to check on each other.
Other effects that are associated with diabetes are loss of sexual drive – erectile dysfunction in men, urinary track infections (UTIs) in women. Also relevant are heart disease and diabetes, stroke and diabetes, and high blood pressure and diabetes. Most doctors will automatically screen for these and prescribe medications to alleviate the problems, but a few do not. So be prepared to ask for these screenings.
If you are able to manage your blood glucose levels, then there are some sneaky problems that still can make themselves present. Depression can assert itself. Most people with diabetes, about 67 percent, are likely to develop mild depression and then there is about 19 percent that may develop severe depression. Mild depression can be helped with antidepressants and the more severe should be treated under the care of a doctor. Read my blog on depression here. Even excellent management of diabetes is not a guarantee that you will not have depression.
Over 50 percent of people with diabetes, are likely to develop sleep apnea. Most because they are overweight and have apneas up to several hundred times a night which interrupts your sleep and you feel over tired during the day. There are several treatments available depending the the severity of the sleep apnea and the type. See my blogs here for further details: blog 1, blog 2, blog 3, blog 4, and blog 5. There are other blogs, but I have provided those relevant for this discussion.
Another link to diabetes is dementia, in particular, Alzheimer's disease. There is a proven link between the two now so that it cannot be ignored. So for those of us in our golden years, you do need to be concerned. Read David Mendosa's blog here and my blog here.
There are other problems such as skin problems caused by diabetes. Some skin problems need immediate attention, but others can be treated with various medications and skin conditioners. There are other other minor complications that few people have problems with. The big four were covered by name in the first part.
Some will say I did not cover amputations, but I am. They can result from two of the big four. Neuropathy and atherosclerosis are the cause of poor healing and lead to amputations when not properly and immediately cared for. So make sure that you take excellent care of your feet and legs, inspect them daily and see a doctor if a problem develops.
Many people insist that every little health problem is caused by their diabetes and this is just not so. There are other diseases that people with diabetes can get, but as of yet, there is no firm or related link to diabetes resulting in posing a risk to have the disease.
Most people that manage diabetes and are able to maintain blood glucose levels near normal very seldom develop complications. It is when people do not manage their blood glucose levels that they will develop the complications. Retinopathy seems to happen first, but they may all develop to some level at the same time.
I have had three friends or acquaintances that had diabetes that they did not manage their diabetes and they went on dialysis. All three have passed in the last 18 months because they could not or would not continue the dialysis. Another friend had both her legs amputated above the knees because she did not manage her diabetes. She is now approaching the end of her sight because she has continued to not manage her diabetes.
So life's lessons can be hard for some and others do very well. How are you managing diabetes. Has the college of hard knocks helped? Or have you ignored the lessons of life handed to you?
February 12, 2011
Lessons Diabetes Teaches Us – Part 1
We all learn from diabetes. Necessity is the teacher and not a patient teacher at that. If we don't follow instructions, we pay dearly for those lessons. If we think we can outsmart diabetes, are we in for a rude awakening. Diabetes does extract a toll whether we are willing to accept the charge or not.
Many of us have experienced college, but the college of hard knocks teaches us the lessons we need for life and living. The grades handed out are how we live and manage our daily living. Diabetes is its own college and can knock us around unmercifully unless we learn how to manage it. Otherwise it loves to manage us.
David Spero at diabetes self management approaches this a different way and has it as a class. To me it is a degree by itself and has many courses to cover the complications and idiosyncrasies of the disease. Some classes are easy to pass and others take some study and much patience to pass the course. Some classes are for the short term and others are lifelong.
One of the hardest lessons that many just never seem to learn is diabetes is not your fault. Whether you have Type 1 or Type 2 diabetes, LADA, or one of the MODY types, they may be caused by genetics, environment, or even some unknown genetic abnormality. This even applies if you have medically induced diabetes, see my blog here.
The second lesson is you must learn that the past is past and you must learn to live in the present and manage your diabetes. This is hard for many people also as they want to continue to heap blame on themselves and then go into denial. Diabetes loves this phase as it gets to do what it wants with your body and you are being managed by diabetes and not the other way around.
Acceptance if the final lesson and is when you have removed your fist from the panic panel and are mastering the lessons of diabetes and how to best manage this chronic disease. These lessons do not not manifest themselves in the same order for everyone and anger is another lesson that some people have a difficult time getting past. For me anger was short lived and denial can later even after I had accepted diabetes. So be careful in how you analyze your situation.
Gretchen Becker in her book The First Year, Type 2 Diabetes, discusses three of the common complications of diabetes as the three O'pathy sisters. I like her humor to get you to remember how serious these complications are. Neuropathy is damage to the nerves and for some can be very disabling. Nephropathy is damage to the kidneys, and retinopathy is damage to the retina of the eye.
Then she adds Arthur O. Sclerosis for atherosclerosis which can lead to heart attacks, strokes and open wounds on the feet and legs. Yes, indeed these can be very serious and debilitating for those that don't manage diabetes. These require you to manage diabetes by maintaining control as near to normal levels of blood glucose as possible. This management may delay or even prevent their development. These are considered the big four and most common complications.
Please read David Spero's blog here. He makes some excellent points that I chose not to cover and they are to the point. My next blog will be about some of the other complications and related problems.
Many of us have experienced college, but the college of hard knocks teaches us the lessons we need for life and living. The grades handed out are how we live and manage our daily living. Diabetes is its own college and can knock us around unmercifully unless we learn how to manage it. Otherwise it loves to manage us.
David Spero at diabetes self management approaches this a different way and has it as a class. To me it is a degree by itself and has many courses to cover the complications and idiosyncrasies of the disease. Some classes are easy to pass and others take some study and much patience to pass the course. Some classes are for the short term and others are lifelong.
One of the hardest lessons that many just never seem to learn is diabetes is not your fault. Whether you have Type 1 or Type 2 diabetes, LADA, or one of the MODY types, they may be caused by genetics, environment, or even some unknown genetic abnormality. This even applies if you have medically induced diabetes, see my blog here.
The second lesson is you must learn that the past is past and you must learn to live in the present and manage your diabetes. This is hard for many people also as they want to continue to heap blame on themselves and then go into denial. Diabetes loves this phase as it gets to do what it wants with your body and you are being managed by diabetes and not the other way around.
Acceptance if the final lesson and is when you have removed your fist from the panic panel and are mastering the lessons of diabetes and how to best manage this chronic disease. These lessons do not not manifest themselves in the same order for everyone and anger is another lesson that some people have a difficult time getting past. For me anger was short lived and denial can later even after I had accepted diabetes. So be careful in how you analyze your situation.
Gretchen Becker in her book The First Year, Type 2 Diabetes, discusses three of the common complications of diabetes as the three O'pathy sisters. I like her humor to get you to remember how serious these complications are. Neuropathy is damage to the nerves and for some can be very disabling. Nephropathy is damage to the kidneys, and retinopathy is damage to the retina of the eye.
Then she adds Arthur O. Sclerosis for atherosclerosis which can lead to heart attacks, strokes and open wounds on the feet and legs. Yes, indeed these can be very serious and debilitating for those that don't manage diabetes. These require you to manage diabetes by maintaining control as near to normal levels of blood glucose as possible. This management may delay or even prevent their development. These are considered the big four and most common complications.
Please read David Spero's blog here. He makes some excellent points that I chose not to cover and they are to the point. My next blog will be about some of the other complications and related problems.
February 9, 2011
Obstructive Sleep Apnea Surgery
I don't know what it is lately, but apparently surgeons are trying to build their retirement fund before the Affordable Care Act gets before the Supreme Court. I am reading more and more about surgery being the solution for more and more health problems. That in itself sets off alarms about what is happening in healthcare that has surgeons operating everywhere they can.
Some surgeries are for the best and are unavoidable, but for obstructive sleep apnea, I have a real problem with this as even the American Sleep Apnea Association (ASAA) is very cautious about recommending surgery. Most surgeries cannot be reversed and can leave worse problems than using other options.
Apparently the surgeons at Henry Ford Hospital in Detroit have determined that it is acceptable and are trying to convince other surgeons that surgery is best. Since I don't have access to the full study, I can only assume that they did not compare results of the Epworth Sleepiness Score (ESS) questionnaire for those that have success with CPAP Equipment. I know that after being on the CPAP machine for three months that my score would have been 0.5 compared to the maximum score before the sleep study and use of the CPAP machine.
I can understand why the study only selected obstructive sleep apnea patients that were not successful with the CPAP equipment as this group would show an advantage for the surgery. They also don't state the sex of the participants to determine whether there were problems other than just the equipment that may have caused these patients to have problems with CPAP.
Before you let this study influence you, I would suggest reading what the ASAA has to say about surgery and then read my blog about surgery here. Please read what patients on site 5 have to say about surgery. I know that I would not want surgery that is often less than successful and cannot be reversed. I have and use a CPAP (actually VPAP) and use nasal mask liners to keep air from escaping around the mask. Yes, I do get marks from the straps holding the mask, but within a short time after taking the mask off, they are unnoticeable.
I would encourage anyone to give the CPAP equipment a chance to work or if needed an oral appliance, before you even consider surgery.
Some surgeries are for the best and are unavoidable, but for obstructive sleep apnea, I have a real problem with this as even the American Sleep Apnea Association (ASAA) is very cautious about recommending surgery. Most surgeries cannot be reversed and can leave worse problems than using other options.
Apparently the surgeons at Henry Ford Hospital in Detroit have determined that it is acceptable and are trying to convince other surgeons that surgery is best. Since I don't have access to the full study, I can only assume that they did not compare results of the Epworth Sleepiness Score (ESS) questionnaire for those that have success with CPAP Equipment. I know that after being on the CPAP machine for three months that my score would have been 0.5 compared to the maximum score before the sleep study and use of the CPAP machine.
I can understand why the study only selected obstructive sleep apnea patients that were not successful with the CPAP equipment as this group would show an advantage for the surgery. They also don't state the sex of the participants to determine whether there were problems other than just the equipment that may have caused these patients to have problems with CPAP.
Before you let this study influence you, I would suggest reading what the ASAA has to say about surgery and then read my blog about surgery here. Please read what patients on site 5 have to say about surgery. I know that I would not want surgery that is often less than successful and cannot be reversed. I have and use a CPAP (actually VPAP) and use nasal mask liners to keep air from escaping around the mask. Yes, I do get marks from the straps holding the mask, but within a short time after taking the mask off, they are unnoticeable.
I would encourage anyone to give the CPAP equipment a chance to work or if needed an oral appliance, before you even consider surgery.
February 4, 2011
The New USDA Dietary Guidelines
USDA and HHS have unveiled the seventh edition of the US Department of Agriculture Dietary Guidelines. There were a few changes, but lacked the changes needed to be in line with many of the Medical Associations' current positions. Only two associations have welcomed the new edition and the American Heart Association has said the improvement is still lacking for bringing sodium in line for everyone.
I do not understand why some of the other medical associations have not issued statements. But if they were to issue acceptance or rejection, they might have to agree with something they wish to avoid. The American Caner Society says the new guidelines could reduce the cancer risk.
To read the full copy of the latest dietary guidelines go here. I used Adobe
Reader to save a copy to my files. The seventh edition has six chapters and 16 appendices.
The first chapter labeled Introduction explains how the dietary guidelines were developed. This may be of interest for many.
Chapter two is Balancing Calories to Manage Weight.
Chapter three is Foods and Food Components to Reduce.
Chapter four is Foods and Nutrients to Increase.
Chapter five is Building Healthy Eating Patterns.
Chapter six is Helping Americans Make Healthy Choices.
There is over 90 pages of reading, but I will say it is well organized, but short of some reasonable specifics. There are many specifics and some welcomed discussions for ethnic specifics which should make this more useable than previous editions.
Linda Van Horn, PhD, RD, LD, from Northwestern University in Chicago, Illinois, chaired the 13-member Dietary Guideline Advisory Committee. For 18 months, the committee reviewed the scientific and medical literature regarding the role of diet and nutrition in health promotion and disease prevention.
One of the features in this edition is the emphasis on managing body weight from age two to elder ages. This includes eating patterns for balanced nutrition and also for vegetarian adaptions. The report includes recommendations for all ages as well as for those at risk for chronic diseases, a real plus
The recommendation presently generating the most discussion is about salt. The American Heart Association recently lowered the maximum from 2300 milligrams to 1500 milligrams. The USDA only lowered the maximum for those age 51 and older. If we are serious in reducing obesity and hypertension then the limit for all ages should be 1500 milligrams.
There are many areas that this report should have covered, but it is the most comprehensive report issued yet by the USDA and does have something for almost everyone. There will be disagreements and groups that will find fault; however, this report should be read and understood by everyone. It is the first time national action has been addressed for obesity.
Read some of the takes on the press release and report here by Medscape and here by Medicine Net. You may also have seen parts of this on the nightly news. There is much information about the report and represents views not in the actual report.
I do not understand why some of the other medical associations have not issued statements. But if they were to issue acceptance or rejection, they might have to agree with something they wish to avoid. The American Caner Society says the new guidelines could reduce the cancer risk.
To read the full copy of the latest dietary guidelines go here. I used Adobe
Reader to save a copy to my files. The seventh edition has six chapters and 16 appendices.
The first chapter labeled Introduction explains how the dietary guidelines were developed. This may be of interest for many.
Chapter two is Balancing Calories to Manage Weight.
Chapter three is Foods and Food Components to Reduce.
Chapter four is Foods and Nutrients to Increase.
Chapter five is Building Healthy Eating Patterns.
Chapter six is Helping Americans Make Healthy Choices.
There is over 90 pages of reading, but I will say it is well organized, but short of some reasonable specifics. There are many specifics and some welcomed discussions for ethnic specifics which should make this more useable than previous editions.
Linda Van Horn, PhD, RD, LD, from Northwestern University in Chicago, Illinois, chaired the 13-member Dietary Guideline Advisory Committee. For 18 months, the committee reviewed the scientific and medical literature regarding the role of diet and nutrition in health promotion and disease prevention.
One of the features in this edition is the emphasis on managing body weight from age two to elder ages. This includes eating patterns for balanced nutrition and also for vegetarian adaptions. The report includes recommendations for all ages as well as for those at risk for chronic diseases, a real plus
The recommendation presently generating the most discussion is about salt. The American Heart Association recently lowered the maximum from 2300 milligrams to 1500 milligrams. The USDA only lowered the maximum for those age 51 and older. If we are serious in reducing obesity and hypertension then the limit for all ages should be 1500 milligrams.
There are many areas that this report should have covered, but it is the most comprehensive report issued yet by the USDA and does have something for almost everyone. There will be disagreements and groups that will find fault; however, this report should be read and understood by everyone. It is the first time national action has been addressed for obesity.
Read some of the takes on the press release and report here by Medscape and here by Medicine Net. You may also have seen parts of this on the nightly news. There is much information about the report and represents views not in the actual report.
February 2, 2011
Suggestions for Doctors
Sometimes doctors are open to suggestions from patients and other doctors will never take suggestions from patients. But I will still make suggestions as most of my doctors have not turned them away completely. Some have even admitted that they like a few of them, but don't have the time or office staff time to put them into effect. That I do understand. Now I will need to ask some questions to find out if there is something I am able to do that would be accepted.
My main suggestion has been to have a list of acceptable web sites to get patients started in their research. Also a list of books about the disease, to be in the local library or ordered on line. These would vary by disease or illness. For this discussion I am talking about diabetes and the related complications, but this will involve more then just diabetes when I get started. I have worked on lists for one doctor recently and am encouraged again after reading a blog by Dr. Fran Cogen.
Her statement in the blog of “Families often walk into their appointments with reams of Internet papers and articles strongly suggesting a certain form of treatment.” When this is what doctors see and get, it is easy to understand why they are less than happy about the internet.
Dr. Cogen has an excellent discussion about information overload and why this is sometimes not a good thing. People on information overload often become incapable of making a simple decision. They have too many ideas to digest and this causes them to not make a decision.
Dr. Cogen also does not like “the paternalistic approach in which the physician and team reverts to the 'father knows best' mantra.” Many doctors do use this and even this is not always the best or most appropriate. Often the best decisions are made from a few well thought out possibilities that are discussed with the patient and/or their advocate.
I am taking this and trying to pare down the internet resources to a few good sources to help people find information and then ask the doctors to review the list and add or subtract from this list. This is going to take some time, but I am looking forward to see what reaction I will receive from some of the different doctors with the different specialties.
Of course, the diabetes, type 2, is complete, but I have a lot to do for the rest. I do believe that people are more internet conscious and savvy than ten or more years ago and people need good information. The doctors deserve consideration and not being buried in unrelated papers that have no bearing on the subject of the visit. I may even suggest that the doctors have a book list for patients to order through them.
There will always be changes to the sources as some sites shut down and other good sites appear. New books appear all the time and while many may be good, some are far better. Some of the current books will continue to be relevant as they are updated with revisions to stay current. Each type of diabetes is different and needs its own resources.
My main suggestion has been to have a list of acceptable web sites to get patients started in their research. Also a list of books about the disease, to be in the local library or ordered on line. These would vary by disease or illness. For this discussion I am talking about diabetes and the related complications, but this will involve more then just diabetes when I get started. I have worked on lists for one doctor recently and am encouraged again after reading a blog by Dr. Fran Cogen.
Her statement in the blog of “Families often walk into their appointments with reams of Internet papers and articles strongly suggesting a certain form of treatment.” When this is what doctors see and get, it is easy to understand why they are less than happy about the internet.
Dr. Cogen has an excellent discussion about information overload and why this is sometimes not a good thing. People on information overload often become incapable of making a simple decision. They have too many ideas to digest and this causes them to not make a decision.
Dr. Cogen also does not like “the paternalistic approach in which the physician and team reverts to the 'father knows best' mantra.” Many doctors do use this and even this is not always the best or most appropriate. Often the best decisions are made from a few well thought out possibilities that are discussed with the patient and/or their advocate.
I am taking this and trying to pare down the internet resources to a few good sources to help people find information and then ask the doctors to review the list and add or subtract from this list. This is going to take some time, but I am looking forward to see what reaction I will receive from some of the different doctors with the different specialties.
Of course, the diabetes, type 2, is complete, but I have a lot to do for the rest. I do believe that people are more internet conscious and savvy than ten or more years ago and people need good information. The doctors deserve consideration and not being buried in unrelated papers that have no bearing on the subject of the visit. I may even suggest that the doctors have a book list for patients to order through them.
There will always be changes to the sources as some sites shut down and other good sites appear. New books appear all the time and while many may be good, some are far better. Some of the current books will continue to be relevant as they are updated with revisions to stay current. Each type of diabetes is different and needs its own resources.
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