Do You Get Caught in the Food Label Trap?

Don't lie, I used to think I was not, but now that I know what Big Food is doing, I seldom get caught anymore. When I do, my meter lets me know that I need to go back and carefully reread the label. That is no longer fun and it is easy to get angry when this happens. Also, don't get caught in the measuring differences between a dry measure and a liquid measure. My daughter and I had a good demonstration early on in my diabetes and I was right more than wrong, but it was still embarrassing to get fooled by the measuring cup.

Even more exasperating was emptying a few containers and discovering that the 10 servings listed on the label of a box was really closer to 18 servings by dry measure. Then we opened a couple of cans of vegetables and found out that the two and a half servings were closer to two servings for both vegetables. It is bad enough that the food industry is allowed to have up to a 20% discrepancy from actual, but we never could figure out the box and why that was so far off. I won't go into the ridiculous letter from the manufacturer.

If the recently proposed changes to the food label actually are more helpful, they are supposed to reflect what people actually eat. But how are they supposed to know what I eat, when I often don't know until I am ready to eat and have counted the carbohydrates. I attempt to stay under 100 grams of carbohydrates per day and generally about 80. This allows me to vary what I eat but to stay in what I term medium carb range.

I have long ago learned that measuring serves best for carb counting. Having a digital food scale with the tare feature also helps. There are a few occasions when guessing becomes a necessity, but I don't like it. My wife insists on eating out on occasion. That is when I make sure that most of the carby foods don't reach my plate.

Most of my friends guess more often than I do, but many are not overweight. Even James is only about five pounds over ideal weight and is slowly losing that. Some of them use their meters to determine the amount of insulin to inject and they are getting away with this and not adding weight.

I don't advise guesstimating as a habit as this can make it easier to overeat and help diabetes gain the upper hand.

Activity Trackers Needed for Older Adults

Activity-monitoring apps, Web sites, and wearable devices are available, but for older adults are not well designed for usability. This is because product designers do not consider those over 65 to be a viable user group. The medical profession also is extremely slow to promote activity monitoring for any age group even though this may be helpful in finding out how patients are activity-motivated.

This technology could be helpful for older adults to improve their cognitive function through proper nutrition and exercise. New human factors/ergonomics research indicates that the current technology presents usability challenges for this population.

Using technology could allow for easy self-management of health and wellness. This would also allow many older adults who have chronic conditions such as diabetes and hypertension to self-manage their health more effectively. “Research has shown that they want to track their diet and exercise, but most don’t use activity-monitoring technologies to do so.”

“In research presented at the 2014 International Symposium on Human Factors and Ergonomics in Health Care in April, authors Preusse, Tracy Mitzner, Cara Fausset, and Wendy Rogers designed a study assessing the usability of two popular Web-based and wearable activity trackers.”

The study asked older adults to track their nutrition and exercise over two weeks (too short) and report on usability issues they experienced. They were also asked about their attitudes toward to technology. The authors did a separate analysis of both trackers to uncover any design issues that could be problematic for older adults.

Usability problems the researchers found included low color contrast between icons and the screen background, small fonts, and inconsistent navigation bars among the Web sites. Study participants saw the technology as inaccurate when tracking step counts and sleep patterns. Many also reported difficulty remembering to log their information and use the device. This problem could be mitigated by nagware or more prominent reminders.

Activity-monitoring technologies can make tracking nutrition and exercise easier because they gather some data automatically and display trends over time. More studies in this nature should be encouraged and promoted by geriatricians in colleges and universities across the country. This might get the attention of product designers and manufacturers and prove how the technology could be advantageous to older adults in managing their health.

Be Careful of Incorrect Online Health Information

This blog is about incorrect health information and the internet, but I will discuss both health and diabetes information. The author of the blog is correct; there is too much information on the internet for all phases of illness and chronic illnesses that is not or even close to being correct.

I even strike out at the American Diabetes Association (ADA) because they have a one-size-fits-all philosophy for people with diabetes. The last couple of years have improved slightly, but when an organization accepts funds from Big Pharma and other related sources, you know that the advice is questionable at best. In addition the ADA is for doctors and does very little to help patients. Until recently, even the nutrition therapy/advice was only one-size-fits-all.

Even the American Association of Clinical Endocrinologists (AACE) is for doctors and does little for patients. They are also a one-size-fits-all group and don't like to vary from this. They also advocate for Big Pharma and even go so far as to train the reps of Big Pharma that see the doctors around the country and promote all kinds of drugs and even promote larger doses and “off label” uses.

Yes, the quality of the information we find online depends on what we are searching for, as presented by a study published in January by Decision Support Systems. You can find high-quality information on the diagnosis and treatment of physical diseases or injuries online. However, search results related to nutrition, fitness, and preventive health varies tremendously in quality. What we do with the information we find can be hazardous to our health.

The Pew Research Internet Project gives much to think about and I will list some of the statistics used:

1. More than 60 percent of American adults look for health information online.
2. Of these people, 60 percent report that their most recent search influenced their health-related decisions.
3. 77 percent of people seeking health information start with a general search engine like Google, Bing, or Yahoo, as opposed to going the a health-specific website.
4. Searchers are most likely to view only the results listed on the first page.
5. 13% say they began at a site that specializes in health information, like WebMD.
   
6. The most commonly researched topics are specific diseases or conditions; treatments or procedures; and doctors or other health professionals.
7. Half of online health information research is on behalf of someone else – information access by proxy.
8. 26% of online health seekers say they have been asked to pay for access to something they wanted to see online (just 2% say they did so).

“Given the direction that mobile and online health information appears to be heading – in the more, not less, direction – people need guidance from unbiased sources. Rather than recommending patients avoid Internet searches for health information, [health care] providers may consider helping patients develop good strategies for recognizing high-quality information over questionable information."

While the last paragraph above is directed at health care professionals, doctors are not inclined to help patients unfortunately. They are more inclined to consider themselves as the only source their patients need. Therefore, they are falling further behind in creating an atmosphere conducive to good doctor-patient relationships.

Diabetes and Obstructive Sleep Apnea Relationship

As observational studies go, headlines are overstated and causation is not proved. Yet many headlines use the terms linked and tied instead of may increase the risk. The lead researcher, Dr. Tetyana Kendzerska, with the University of Toronto's Institute of Health Policy, Management, and Evaluation says, “Patients with severe sleep apnea had a 30 percent higher risk of developing diabetes than those without sleep apnea.”

The full study, a PDF file,  is garnering many headlines, from HealthDay, to Science Daily and several others. I developed severe obstructive sleep apnea which was finally diagnosed in 2001, approximately two years ahead of the diabetes diagnosis. I knew then that I had OSA for several years prior to that and my wife said that I had snored and had apneas for at least two years prior. The sad part was not getting a doctor to believe my wife until I almost wrecked our car when taking my wife to a doctor appointment.

“Kendzerska cautioned, however, that this was an observational study, and cannot prove that sleep apnea causes diabetes. "We are not able to investigate causality, just an association," she explained”

“Shelby Freedman Harris, director of the Behavioral Sleep Medicine Program and the Sleep-Wake Disorders Center at Montefiore Medical Center in New York City, said, "I definitely think that this is an important study highlighting the need for more sleep apnea awareness, screening and treatment. "Given the large sample size, it further places emphasis on sleep apnea as a predictor of diabetes, and hopefully with earlier intervention, it can greatly impact the health costs for diabetes management as well as improve the outcomes for many patients," she said.”

The most notable limitation of the study was there was no information about family history of diabetes.

Reducing Medical Errors in Diabetes Care Needed

The public believes that our medical system can and should be improved. Even I believe this, but the larger problem of diabetes care requires our attention. With the number of people diagnosed daily, even many of them are not finding out how to care for themselves adequately.

Errors in diabetes care become a common cause of complications that can result of disability and even death, according to this article in Diabetes in Control. Yet, the diabetes errors being reported are likely much lower than the actual number. At least the report from the Institute of Medicine (IOM) catapulted the issue onto the front pages of magazines and newspapers in the United States.

The challenge before us now in not documenting how bad the number of errors have been, but to focus on how best to help those who are in fact providing care to patients with diabetes. Not only is this task more difficult, but also more important. How this is done will be what we need to improve care. The following discussion may help us highlight some of the common misconceptions:

#1. It is the belief that there is always someone to be held accountable for the error and remove them from the system. However, most of the important medical errors are multifactorial and are the result of numerous small oversights, any one of which, if corrected, might have prevented or reversed the error.

#2. The "system" is providing obstacles that result in blame falling on the individual at the point of care. However, these problems often have more to do with the system of care itself. This system or “culture of safety” is defective and needs to be improved or at the minimum corrected from the top-down. A culture of safety should be defined as any situation requiring providers to work together as a cohesive unit on behalf of patients; safety.

#3. It is the belief that correcting all errors in the main objective. Wrong! Many errors do not harm anyone and often are spotted by the people who make them. These often are the result of taking shortcuts. These errors are usually corrected when the work is reviewed. It is sound strategy to set up procedures for providers to routinely check both their work and others. In this way, the vast majority of errors can be caught and corrected without harming patients.

#4. It is often believed that the nurses are the cause of many errors. Not correct! It is the hospitals that have reduced the nurse-patient ratio and added stress to the nursing staff. By employing non-nurse technicians, the error rate is increasing and the nurses and doctors cannot keep the stress at even a manageable level. Many errors are repeated again and again because they are not reported or shared with others. The Institute for Safe Medication Practices is one place to report errors anonymously. This will share the errors with hundreds of thousands of medical professionals and help them prevent these errors.

For patients with diabetes, frequent glucose monitoring, wound care, and the clinical needs of those with orthostatic hypotension, renal disease, and retinopathy can lead to increased nursing requirements. We can do a great deal to champion the need for more nurses at the bedsides of patients.

Electronic Medical Records (EMRs) can prevent errors from poor handwriting, but they also open the door for new types of errors. These errors are checking off the wrong dose, directions, or even the wrong drug. Some errors can be stopped if providers would routinely run a drug-interaction check on prescriptions before giving them to the patients. With EMRs, this can be done almost instantly.

If hospitals and doctors are to improve safety for diabetic patients, here are a few starters:

#1. Offer more education that is patient-centered, requiring the patients to demonstrate what they know.

#2. Increase awareness of the need for adequate resources, particularly sufficient time for doctors to thoroughly evaluate clinical problems.

#3. Form ad-hoc teams of doctors and nurses to work together more cohesively in the care of diabetic patients.

#4. Change the paradigm so that providers think less about who is to blame and more about how to prevent catastrophes caused by the system in which they work.

#5. Change the tort system so that hospitals and providers can focus on making the system better and not on avoiding frivolous and illogical lawsuits. And

#6. Make the system of care as focused on quality as it is on cost containment.

Each of these issues can play an important role in the improvement of the system of care and in the protection of the diabetic patients from the consequences of medical errors. To this, add patient education to help them prevent errors at home that may well prevent the need for hospitalization.

Food Industry Profits Come First

What will the food industry think up next to fool the public? The abstract for the study by a George Washington University associate professor, Ivy Ken, makes some accurate observations about the priorities of the food industry. The full study is in this PDF file.

Learn about these two organizations - the Partnership for a Healthier America (PHA) and the Alliance for a Healthier Generation (AHG). Ivy Ken says, “The analysis I present here reveals that the organizations’ positive message of “getting everybody together” to solve the problem of childhood obesity is meant to deliberately obscure corporate culpability.”

Food corporations and the related industries rarely prioritize healthy communities over healthy profit margins, but their profits depend on community acceptance. Corporations co-opt the rhetorical tactics typically associated with social movement organizations to frame their profit-maximizing practices as the solution to the problem of childhood obesity. The “work together” theme is a cover to obtain the acceptance of the public.

The extent of the companies' commitments is to create new marketing campaigns for lower-calorie products, making healthier options more prominent in stores, but still on the same shelves as their full-sugar, full fat options products. An example of the marketing campaign can be found here. Phil Ruggiero covers two different marketing campaigns and both show what can happen if people with diabetes believe the advertisements.

Food companies or Big Food work hard to divert our attention away from the problems of obesity and diabetes so that they can continue to have a healthy profit. It is fortunate that we have as much information on packaging as we do, although Big Food is attempting to corrupt the latest labeling change.

Please consider reading the full study by downloading the PDF file at the link in the first paragraph.

ADA Advocating for Poorer Food in Schools

The American Diabetes Association (ADA) is putting words in my mouth and they are very sour. In an email I received today, June 10, 2014, from Tekisha D. Everette, PhD, Managing Director, Federal Government Affairs, American Diabetes Association, I was told, “As a Diabetes Advocate, you led the fight to ensure America’s children have access to healthy school food. Because of you, Congress passed legislation in 2010 making school breakfasts and lunches healthier. Next year, snacks and drinks served in school will be as well.”

Apparently, they don't know me at all. I would never advocate for the food the USDA says must be served in school lunch menus. High carbohydrate - low fat is not my idea and for many students they are protesting as well. Limiting the total calorie count to 850 calories is not good for growing adolescents. In addition, the USDA is pushing low sodium (not salt) which a growing body needs. And the USDA is promoting whole grains to be served with every lunch.

Then the email continues - “But now, the House of Representatives is poised to roll back these important new nutrition standards. We cannot allow this to happen!”

Well, ADA, I have written my representative advising him that I will vote against him if the bill does not get passed and USDA taken out of the equation. The school lunch program has been ruined for many children and they are complaining about being hungry.

Is it any wonder that the fast food establishments are the first stop for many children when they leave school? The more meat they can get the better they feel. Most are left completely unsatisfied by the manufactured meats they receive in sandwiches they are served as part of the school lunch program.

The USDA high carb/low fat will not reduce the obesity epidemic threatening our children and this will add to the diabetes numbers ADA says we must prevent by supporting the USDA nutrition guidelines for our schools.

For those that agree with me or need more reading, three blogs by Tom Naughton should help. Blog 1, blog2, and blog 3 are just a few of his against the current USDA policy of the poor food supplied out children.

Interventions, Understanding Depression

I don't know what happened for the month of May, but with several of the members helping others and others visiting friends and members in the hospital and then the nursing home, we had no reason for a meeting, as we were busy enough. Then Dr. Tom advised us that the speaker for the June session on interventions asked to be excused until September or October.

For now, we have no plans for meetings until at least September. Allen and Tim have been working with James and report that he is finally doing much better and that his last A1c was 7.9% which is a great improvement and even Dr. Tom is pleased as he hopes to have it under 6.5% when it will be checked again in August.

A.J. asked me to do this blog and thanked me for the previous depression blog. He knew about this and admitted that he had intended to ask me earlier, but when he read the blog, he felt that he should wait so it would be later. Thank you A.J. as I had intended on having it for our May meeting, which did not happen.

The blog referred to is about depression and when you should get help. The Centers on Disease Control and Prevention reports that depression many affect as many as 1 in 10 adults. They list the following as possible symptoms:

1. Have little interest or pleasure in doing things
2. Can't work or have trouble with doing routine activities
3. Feel down, very sad, or hopeless
4. Have trouble falling asleep, staying asleep, or find you are sleeping too much
5. Feel tired or have little energy
6. Can't eat or are overeating
7. Feel bad about yourself, feel that you are a failure, or that you have let yourself or your family down
8. Have trouble concentrating on things, such as reading the newspaper or watching television
9. Find that you are moving or speaking so slowly that other people have noticed, or the opposite, you are so fidgety or restless that you can't be still

Many people fear seeking mental health care. Seeking professional help is often the best way to get well. Mental health is just like physical health, sometimes we need to get treatment and care to get better.

Depression is often associated with other chronic diseases, like arthritis, heart disease, or diabetes, and can make managing those conditions more difficult. For many people, physical conditions can contribute to problems with their mental health, problems that are often ignored and not treated.

Even though the author recommends that you start with your primary care physician, I have found that most try to laugh it off and say you are not depressed if you have enough fortitude to bring it up. At least my endocrinologist knew what I was saying and after looking at my A1c and a few other tests, asked a couple of questions and then advised me to stay in touch. My depression was minor and he felt that I could handle it, but I was to call if I could not.

Medication and talk therapies are about equally effective. Sometimes it is best to use both together and for some people it does not work. I know from experience that if you have a major depression, you need to see a therapist sooner rather than later. If you have depression multiple times, a combination of therapy and medication is the usual treatment. Talk therapy for the first few times of minor depression can often be the best, especially if the doctor helps train you in how to overcome minor depression.