Grip Strength Measures Undiagnosed Diabetes

Whether you grasp it right away or not, your grip strength may indicate whether or not you have undetected diabetes and high blood pressure, University of Florida (UF) researchers say. I can say this is interesting for several reasons. I thought my age had something to do with my losing strength in my hands. Apparently, even those of us with diabetes loose some grip strength.

Grip strength is something many people don’t think about. Does it really matter whether or not you have a firm handshake? While that may be up for debate, researchers have found a link between how strong your grip is and your chances of developing diabetes.

Grip strength measures could be useful for identifying diabetes and high blood pressure in adults who have healthy weight obesity, also known as normal weight obesity or "skinny fat." The condition is characterized as having a body mass index within the normal range, but a high proportion of fat to lean muscle, typically more than 25 percent body fat in males and 35 percent in females. These individuals may be less likely to get regular screenings for diabetes and hypertension because they aren't considered overweight or obese by BMI measures alone, said Arch G. Mainous III, Ph.D., the study's lead investigator and chairman of the department of health services research, management and policy in the University of Florida (UF) College of Public Health and Health Professions, part of UF Health.

"We've had a significant amount of interest and focus on obesity, and rightfully so," said Mainous, the Florida Blue endowed chair of health administration. "But there is a concern that health problems in people who have decreased muscle mass, but don't fit the criteria of being overweight, are being missed because these people aren't targeted by screening programs."

People with healthy weight obesity are four times more likely than people with lower body fat to develop metabolic syndrome, which includes increased blood pressure, high blood glucose and abnormal cholesterol levels, according to a study by Mayo Clinic researchers. As many as 30 million Americans have healthy weight obesity and many don't know it.

For the UF study, researchers analyzed data from the 2011-2012 National Health and Nutrition Examination Survey, a nationally representative study that uses a combination of interviews and physical examinations. The team assessed grip strength measurements, blood pressure readings and blood glucose levels for nearly 1,500 adults age 20 and older that had a BMI within the healthy weight range—18.5 to 24.9. People with undiagnosed and diagnosed high blood pressure and diabetes had weaker grip strength than other healthy weight individuals who did not have those conditions.

"In our study, grip strength was able to identify people with undiagnosed hypertension and diabetes relatively easily, even after we adjusted the analyses for age, sex and whether or not they had a family history of disease," Mainous said.

The reason for decreased muscle strength in healthy weight individuals with high blood pressure and diabetes isn't well understood, but it could be caused by lower muscle quality or a condition called "diabetic hand syndrome," which limits finger movement.

“Because most patients visiting the doctor have their blood pressure tested, grip strength may be most valuable as a non-invasive, low-cost tool for identifying people who could possibly have diabetes. But more research is needed before it can be put into practice as a screening tool, including investigating how variables such as gender, age and height might affect grip strength levels,” Mainous said.

"We still have a ways to go before we can actually implement grip strength testing and make it clinically useful to a primary care physician, but I think this a good first step toward determining who might need further testing, particularly among this group of people who would otherwise not be recommended for screening," he said.

In Dealing with CDEs and RDs, Are You Confused?

You very easily could be. With so many having dual titles, they often switch from one profession to another without saying anything. If you have an appointment for diabetes education, it will start out as education, but somewhere in the education, they switch to telling you what to eat and you are in areas that a dietitian should be covering.

I haven't had this happen to me, but several of our new members have been asking questions about how to handle this when it happens. I thanked Jake for how he handled the situation. When diabetes education became about food and the number of carbohydrates, Jake told the instructor that he was there for diabetes education and not what a dietitian was to be teaching in a class he would be attending the following week.

Jake told me that he hadn't raised his voice and thought he was polite, but the CDE/RD turned on him and told him that she was qualified to teach both and would teach both. Jake said that this was only about 15 minutes into the session, but he decided it was time to leave. Once he was out of sight of the building, he called the insurance company and informed them about what had happened and said it was more about information than diabetes education.

His health insurance company was very thorough in their questions and when they had the information, they thanked him and said she would be paid for education only since that was what the class was supposed to be about. He was told that she would only be paid for 15 minutes. He was asked if he would be attending any more classes with her and Jake said no, after what happened.

Allen also thanked him and said that he could believe she would bill for the full time and for both education and diet advice. Another new member, Elmer, said something similar had happened to him, only it was in reverse. Both Allen and Jake advised him to contact his health insurance and let them know what happened. Allen said we don't believe they should be able to cover both topics during a session and be paid for both especially when they were referred for one topic only.

I said this is what more dual titled people are doing and we don't think this is right as even doctors are being limited in what they can charge for when you go in to see a doctor. I continued that is why we are asking my cousin to speak at our next meeting to give everyone a better understanding of nutrition and what balancing a meal plan means. Carbohydrates will not be pushed and she will work with you at the level of carbohydrates you desire to consume.

Jake said that then I would be wiser to not attend the meeting with a dietitian. Allen said that is up to you, but you will learn more with Bob's cousin. Most of us use her and she helped me when I needed help because I was vitamin B12 and vitamin D deficient and receiving shots to help. I had not been cleared for supplements, but she went with me to a special appointment and talked with the doctor after hours and had a meal plan I approved of and was able to use and with the supplements that were necessary.

She helped Jerry and others when they needed help. I said Brenda is the only one she has not worked with because her daughter helps her. Allen continued that even Brenda respects Suzanne and asked her questions from time to time, but does not use her, as she prefers to keep it in the family. I said Suzanne knows this and respects this.

Allen told the two new members that he would contact Tim and explain what had happened and ask Tim to send out an email to all members about this and suggest that the rest of the members hold up in any appointments with CDEs or RDs. I said that most of the older members could help with education and that my cousin Beverly already was helping members on education. Jake and Elmer said this sounds like what we should do.

Jake and Elmer thanked us for our time and Jake said he felt better after talking with someone.

Our October Group Meeting

We normally have our meeting on Saturday, but because many would be attending a funeral for a non-diabetic friend, we held the meeting Friday evening. Because of this, we were without a program, as Beverly was to speak to us. We were just happy to have the extra time to answer questions from our members.

Jennifer started the questions by asking why so many of us used a low carb/high fat meal plan. Allen answered that by saying this helped us keep our blood glucose levels at levels we were happy with and for those of us on insulin, it meant that the lower levels of insulin were needed with less chance of hypoglycemia.

Barry added that while this was good, eating whatever we wanted and covering it with insulin, generally meant weight gain and no chance of reducing the gain. Sue said this why she had suggested asking the members as she knew they could explain it in ways she had not thought about and even tried since she was not on any medications.

Sue continued that those on oral medications could also benefit because it would mean that the level of medication could be held to lower levels and not needing to add other medications as the CDE had told them to do. At this, her brother Ben said that dietitians would give the same advice of eating more carbohydrates and then talking to the doctor about adding medications if the blood glucose levels became elevated.

Jennifer said she had tried low carb/high fat for a couple of weeks and was always hungry. Barry said that some people could try a low carb/high fat meal plan for a month before the carving for food subsided.  He asked Jennifer how many carbs she was eating per day. Jennifer said about 100 grams per day with most carbs eaten at the evening meal. Barry said that might be part of the problem. He said that either eating the same number at each meal or doing like Doctor Bernstein suggests using a ratio of 6-12-12 is more conducive to reducing hunger.

This brought more questions and some of the new members asking questions of why most of us consumed less than 80 grams of carbs. When they discovered that most of us were at 50 grams or less, many were surprised and wondered what we did when our weight reached our goal and we were still eating so few carbs. Allen said that normally when we reach our ideal weight, up to a pound or two under, we normally stop losing weight and maintain the ideal weight. He said that is what happened to him and he asked Barry and Ben and they confirmed this. Even Sue said that she and her husband had no more weight loss.

Tim said that even he had no additional weight loss after reaching his ideal weight. Now more were asking questions and saying that the dietitians they had seen were promoting a minimum of 45 grams of carbohydrates per meal up to 70 grams per meal. Tim quietly stated that is one reason we will have Suzanne in to talk to you for our next meeting as this is what we have discovered does not work for us and caused our A1c to rise. Jerry said he could confirm this and briefly told them why he is now divorced from his former wife, a dietitian.

Jerry said that Suzanne is a nutritionist and would work with the level of carbohydrates they wanted and would try to balance the meal plan for the day. Tim explained that both Beverly and Suzanne were relatives of mine and were well received by the group. Rose and Brenda confirmed this and Brenda said one of her daughters was also a nutritionist, but did not have her doctorate as my relative had. Brenda also stated that many of the dietitians do not even have a masters degree.

At the end of an hour, Tim said the meeting was over, but everyone wanted to talk longer and about an hour later cleanup was done and everyone left.

Steps for Safe Exercise with Diabetes – Part 2

This is continued from the previous blog.

Remember, you don't need a gym membership to exercise. Any exercise that gets your heart pumping and makes you break a sweat will do. You don’t need a health club membership or a personal trainer. And here is a little secret: You don’t have to do 30 minutes all at once. Ten minutes in the morning, 10 minutes in the afternoon, and 10 minutes after dinner is just fine.

Here are some easy daily activities that count toward your daily goal.

• Walk the dog. If you don’t have a pet, walk with a friend or neighbor. Or get some work buddies to join you in a lunchtime stroll.
• Rake leaves, mow the lawn, or dig in the dirt to clean up your garden.
• Play tag with your children or grandchildren.
• Ballroom dance. You can also take dance lessons, modern, ballet, or hip-hop. It doesn’t matter what type of dance you choose, as long as you get moving.
• Roller skate. It burns about 225 calories per hour and uses muscles that may be rusty. Make sure the area you do this is safe.
• Play tennis or any team sport. You’ll make some new friends and stay active.
• Swim. It's a great total body workout and helps you relax. It’s also a low-impact workout that is easy on your joints.
• Take an evening after-dinner walk. Walking at the end of day can help you unwind and feel less stressed after a busy day. Challenge yourself with plenty of hills and new routes. Just make sure that the area for walking is safe.
• If it is difficult to find an area safe for walking, consider a mall for walking as they are air conditioned and you can do your walking during the day instead of early morning or late evening when it is cooler out. Also, malls are great during the winter.
• Wash your car or clean the house. Even if you get your closets in order instead of doing a deep cleaning, you’re still moving.

Try to sneak activity into your day when and where you can:

1. When doing work around the house, pump up some fun music and make all your movements bigger. Squat while you work. Bend from the hips and knees like you're sitting down in a chair. Make sure your knees don't go farther forward than your toes.
2. Take the stairs instead of the elevator, if possible. If you’re going to a high floor, get off a couple of floors below and climb the rest of the way.
3. Don't call or email your colleagues at work. Walk over to a co-worker’s desk for a face-to-face.
4. Walk or pace when you're on the phone, at home, or at work.
5. Park your car at the far end of the parking lot when shopping unless there will be a lot of packages. At the grocery store, they will normally let you walk to the car and drive up to have the groceries put in your car.

The list does not include all the possibilities, so don't think because your favorite dancing or a form of exercise that you can do is not listed, you get a pass. Far from this, if you can do it, get moving.

Steps for Safe Exercise with Diabetes – Part 1

Authors on WebMD seem to always leave out important points when they write. The topic is safe exercising, yet they do not mention the blood glucose levels for safe exercising. This author did advise patients with diabetes to talk to their doctor and receive an okay before starting an exercise program. Make sure your doctor reviews your diabetes drugs also.

You may have heard exercise helps you burn extra glucose in your body and that it can make your body more sensitive to insulin, which is a good thing. It’s true! Exercise can also bust stress and boost your mood and overall health. Here’s how to get moving, ideally 30 minutes a day. Many people do not start out gradually and overdo exercise at the beginning. Unless you have been a person that has exercised on a regular basis, always start out slowly to not injure yourself.

Exercise Safely:

• Generally, the blood glucose guidelines for exercising for all types of diabetes are 100 to 250 mg/dl (5.6 to 13.9 mmol/L). For most people, this is a safe pre-exercise blood glucose range. See my blog here.
• Carry at least 15 grams (or more) of a fast-acting carbohydrate in case of low blood glucose. It might be a half-cup of fruit juice, five hard candies, or glucose tablets, or gels that equal 15 grams.
• Wear well-fitting shoes that are for the activity you’re doing, and choose athletic polyester socks. They dry quicker and cause less friction than all-cotton socks. This is good advice unless you are swimming.
• Inspect your feet before and after exercise. Check for blisters or sores.
• Drink plenty of fluid before, during, and after exercise.
• Wear a medical ID bracelet or a medical ID on a necklace, or carry a medical ID in your pocket.
• Check your blood glucose level before and after exercise to make sure it’s in your target range. Your doctor can tell you what it should be before you start exercising or use the guideline above. This is very important if you take insulin. After an intense workout or exercising for a long time, you may want to eat something with at least 5 grams of carbohydrates within 2 hours. This will help you avoid low blood glucose.
• If you become shaky, anxious, or more sweaty than usual, or feel a change in your heartbeat, stop exercising right away and check your blood glucose. If it is low, follow your doctor’s advice about how to treat it.
• Always warm up for 5 to 10 minutes at the start of your workout. For instance, walk or bike slowly. Do 5 to 10 minutes of cool-down and gentle stretching at the end.

Continued in the next blog.

The Supplement - Biotin

Biotin is a water-soluble vitamin that is generally classified as a B-complex vitamin. After the initial discovery of biotin, nearly 40 years of research were required to establish it as a vitamin. Biotin is required by all organisms but can be synthesized only by bacteria, yeasts, molds, algae, and some plant species.

Biotin is likely effective for treating and preventing biotin deficiency. Symptoms of deficiency include thinning of the hair (often with loss of hair color), and red scaly rash around the eyes, nose, and mouth. Other symptoms include depression, listlessness, hallucinations, and tingling in the arms and legs. There is some evidence that cigarette smoking may cause mild biotin deficiency.

There is insufficient evidence for:

1. Hair loss. There is some preliminary evidence that hair loss can be reduced when biotin is taken by mouth in combination with zinc while a cream containing the chemical compound clobetasol propionate (Olux, Temovate) is applied to the skin.

2. Diabetes. Biotin alone doesn’t seem to affect blood sugar levels in people with type 2 diabetes. However, there is some evidence that a combination of biotin and chromium (Diachrome, Nutrition 21) might lower blood sugar in people with diabetes, whose diabetes is poorly controlled by prescription medicines. Other early evidence shows that the same combination reduces ratios of total cholesterol levels to “good” high-density lipoprotein (HDL) cholesterol, “bad” low-density lipoprotein (LDL) cholesterol to HDL cholesterol, and non-HDL to HDL cholesterol in people with type 2 diabetes.
3. Diabetic nerve pain. There is some evidence that biotin can reduce nerve pain in people with diabetes.

4. Brittle fingernails and toenails. Biotin might increase the thickness of fingernails and toenails in people with brittle nails.

5. Other conditions.

More evidence is needed to rate biotin for these uses.

Although overt biotin deficiency is very rare, the human requirement for dietary biotin has been demonstrated in two different situations: prolonged intravenous feeding (parenteral) without biotin supplementation and consumption of raw egg white for a prolonged period (many weeks to years). Avidin is an antimicrobial protein found in egg white that binds biotin and prevents its absorption. Cooking egg white denatures avidin, rendering it susceptible to digestion and therefore unable to prevent the absorption of dietary biotin.

Table 1. Adequate Intake (AI) for Biotin

Life Stage	Age	Males (mcg/day)	Females (mcg/day)
Infants	0-6 months	5	5
Infants	7-12 months	6	6
Children	1-3 years	8	8
Children	4-8 years	12	12
Children	9-13 years	20	20
Adolescents	14-18 years	25	25
Adults	19 years and older	30	30
Pregnancy	all ages	-	30
Breast-feeding	all ages	-	35

Table 2. Some Food Sources of Biotin

Food	Serving	Biotin (mcg) (32, 33)
Yeast	1 packet (7 grams)	1.4-14
Bread, whole-wheat	1 slice	0.02-6
Egg, cooked	1 large	13-25
Cheese, cheddar	1 ounce	0.4-2
Liver, cooked	3 ounces*	27-35
Pork, cooked	3 ounces*	2-4
Salmon, cooked	3 ounces*	4-5
Avocado	1 whole	2-6
Raspberries	1 cup	0.2-2
Cauliflower, raw	1 cup	0.2-4
*A 3-ounce serving of meat is about the size of a deck of cards.

Please take time to read these sources for more information on biotin:

http://www.webmd.com/vitamins-and-supplements/lifestyle-guide-11/supplement-guide-biotin

http://lpi.oregonstate.edu/mic/vitamins/biotin

More on AADE Activities

This not an easy topic, but I feel very confident that the article written by ANH-USA is on target. Where the problem in the proposed bill starts and needs change is - (a) IN GENERAL. —Section 1861(qq) of the Social Security Act (42 U.S.C. 1395x(qq)) is amended — (1) in paragraph (1), by striking ‘‘by a certified provider (as described in paragraph (2)(A)) in an outpatient setting’’ and inserting ‘‘in an outpatient setting by a certified diabetes educator (as defined in paragraph (3)) or by a certified provider (as described in paragraph (2)(A)).’’

There is more in the bill than the AADE website shows, but at this point I am not allowed to use it. One of my Senators has told me this and he is stating that at this time, the bill is not scheduled for committee and several attempts to bypass committee approval have met with defeat. Both my Senator and the attorney have stated that it is doubtful there will be action this year on H.R. 1726 and S. 1345.

On September 25, I met with an attorney who specializes in Social Security law. He feels that the landscape has changed. I had a printout of the two bills and he read and reread both and asked if I had any other versions available. After his arrival in Washington DC, and a meeting with several Senators and Representatives he called me on Saturday and stated that I could blog about what I knew, but that he could not say more at this time other than what is in the paragraph above.

The attorney did state that the bills currently on file confirm the article published by ANH-USA. If the wording is not changed, what the AADE told Diabetes Mine indicates they are deflecting the truth.

On Monday Oct 5, the attorney called again and stated he does agree that some wording needs to be added to fairly reimburse CDEs for their time on education. He thanked me for sending a copy of my blogs for Oct 3 and 5 and he is upset by the law in Kentucky and the charge of a misdemeanor for violating the law.

I will continue to correspond with both my senators and my representative to urge them to not approve the version currently on file. It is also no surprise that the members of #DiabetesMiseducation Coalition oppose these bills.

Founding members of #DiabetesMiseducation Coalition include:

• International Association for Health Coaches
• National Association of Nutrition Professionals
• Nutrition Therapy Association
• National Health Freedom Coalition
• University of Natural Health
• Maryland University of Integrative Health
• Alliance for Natural Health USA
• American School of Natural Health
• Institute for Transformational Nutrition

These are all organizations that would be excluded under the changes, plus a few more.

This is speculation on my part, but I think that with all the AADE members and officers that have both the CDE and RD (registered dietitian)(dual) titles may be behind this and the Academy of Nutrition and Dietetics is making its presence felt in the actions of the AADE.

I will make my feelings known about the dual titles and that something needs action to specify that if they are acting as CDEs then they need to clearly state this at the beginning of any education and not stray into nutrition as many are doing. I have spoken about this with one of my Senators and she agrees that it should be one and not both and they should only bill Medicare for one topic and not two as some have been accused of doing.

Information on Monopolistic Health Organizations

When dealing with registered dietitians (RDs) and certified diabetes educators (CDEs) you will often be given bad advice. Not only is this true in the United States, but is full blown in Australia. At least others are blogging about this and letting everyone know about dietitians and how bad they are.

The dietitians in Australia, DAA (Dietitians Association of Australia) are really punishing one that advised a patient to eat low carb. Read this blog and then this blog. Apparently, it is against the law as stated by dietitians in Australia to promote low carb. Her dietitian organization, the Southern New South Wales Local Health District (SNSW Health), has removed her license and banned her from all dietetic activities.

As if this was not bad enough, we have Dr Darren Curnoe writing in The Conversation “that there is plenty of evidence that humans have evolved to eat carbohydrates especially starches. Take the amylase genes which evolved to aid the digestion of starch either in our saliva or pancreas through secretion into the small intestine.” Associate Prof Darren Curnoe is based at the University of New South Wales. See the relationship? It is small wonder that the SNSW dietitian group heavily promotes carbohydrates.

I think those of us in the USA have an advantage as several court cases have stopped medical groups and others from running monopolistic and restrictive organizations. Read this - On February 25, the US Supreme Court ruled that North Carolina’s dental board violated antitrust laws by shutting down hair salons and day spas that offered teeth whitening services. According to the Wall Street Journal, “The decision preserves the power of antitrust enforcers to scrutinize professional licensing organizations, even if they are designated as state-government entities.”

Then with the Academy of Nutrition and Dietetics, Steve Cooksey was able to take the state of North Carolina and the Board of Dietetics and Nutrition to court on freedom of speech grounds, and with the assistance of the Institute of Justice have the court rule in his favor. With the Supreme Court case and this court decision anything put forth by the American Association of Diabetes Educators at the state level should be lost by the state CDE boards.

Therefore, I think if those of us that blog about diabetes and try to educate people about diabetes are put under the strain of criminalization by any CDE state board of diabetes education, we will have the law on our side. This means that the different meal plans (low carb or paleo food plans) are challenged by the AADE or AND, they will be dismissed.

This is good news and hopefully I will have more later.