health updates

september 2006

Welcome, to what those of us who went to school forever, to the beginning of the New Year. Learning is great, isn’t it? This month I want to tell you about a book that a reader sent us to review titled How I Lost 80 Pounds with Smart Carb Eating by Richard Price. Mr. Price’s book is published by Infinity Publishing from West Conshohocken, PA. You can contact them at 877-Buy Book or on the web at www.buybooksontheweb.com. This is a book that touts low glycemic foods, nutritional balance, eating foods with lower energy density (for carbs this means foods which have fewer carbohydrates per serving), and exercise. First, let us say that we found the basis of the book easy to understand. Although the ADA does not back using the glycemic index, there are many other books that use high fiber carbs, low fat, less saturated fats, and exercise presented in an easy to understand way. None of this is new. What I find tiresome in this book is the layers of comparisons to other diets and of note to us, missing glycemic ratings for some foods. We know that these may not have been done but if one is writing a book and including the foods, why not pay someone to figure this nutritional information so that the reader will have the information needed to make intelligent decisions? Again, there is nothing wrong with a balanced diet and exercise. We publish healthy cookbooks for diabetics and these web sites and tout exercise for all. In fact, if you look at the exercise articles on the site you’ll even find seated exercises for those who can’t stand. The author does have an excellent bibliography which you may want to keep just in case. Losing weight is not easy. We all know that. You can certainly try this method or talk to your physician for some easy guidelines. What works for one of us may not work for others. I use a vegetable diet to loose weight. We all know that it’s easy to start a diet, but staying on that diet is difficult so please read about various diets and talk over your goals and medical needs with your physician. Select a style of eating that matches your lifestyle, medical needs, and background, and start an exercise program that fits you, and stay with it. As we end this, please raise your coffee cup to Mr. Price who has taken on a major problem in his life and figured out his way to control it.

As always, we begin with our headlines and then go on to our abstracts which will deal with type 1 diabetic children, exercise, glycemic control, cognitive control and its effect on cognitive functioning in older diabetics, and finally an update on flu shots and diabetes. Pull up your cup of coffee or tea and let’s go. We have all read about the escalating cost of diabetes care in the US but we are not alone. I saw an article in The Diabetes Research and Clinical Practice which is medical journal from the Western Pacific Region. The article written by Andrew M. Tomlin et al is titled Hospital Admissions in Diabetic and Non-diabetic Patients: A Case-Control Study. Bottom line, diabetes patients in this study were more likely to be admitted to the hospital for any reason than people without diabetes. 46% of hospitalizations for type 1 diabetics are for complications of diabetes with 35% for type 2 diabetics. If you are reading these articles, you are in the know about all of the long and short term complications of diabetes. If you aren’t please go to our What’s Hot articles. The authors concluded that with the growing prevalence of diabetes will come an increasing demand for hospital beds. I saw an article from Diabetes Care written by Dr. Neal Bernard et al. Dr. Bernard is the president of the Physician’s Committee for Responsible Medicine and works at George Washington University. It caught my attention, because years ago I found that when I want to lose a few pounds I found that this method works well for me. He and others from the University of North Carolina tested 99 people with type 2 diabetes. They compared weight loss by randomly assigning groups using the ADA recommended foods or a low-sugar, low-fat vegan diet. After 22 weeks, 43% of those on the vegan diet and 26% on the standard diet were either able to stop taking some of their insulin or glucose-control medications or lowered their doses. A1c levels fell 1.23 points in the vegan group and 0.38 points in the standard diet. In those who continued to take whatever cholesterol lowering medications during the trial, LDL fell 21% in the vegan group and 10% in the standard group diet. On a personal note, we just finished writing a new book and tasting and cooking helped me gain 8 pounds. Not good for a small type 1 diabetic or for anyone. This is the diet I followed and off came the weight. It took a few months, but there it was. I have always eaten a vegetarian diet 3-4 nights a week but my cholesterol on a vegan diet fell to its lowest level (135), my LDL fell, and HDH rose. Not bad. It worked for me. Ask your health care provider before you begin a diet. If you can, exercise, and lose that weight. An article in the July, 2006, Journal of Clinical Endocrinology and Metabolism may be of interest to that half of us that may worry about prostrate disease. BPH, or benign prostrate hyperplasia, is more prevalent in older men, but the risk seems to be increased by obesity and blood sugar levels. Dr. J. Kellogg Parsons, and his team from the University of California, San Diego, is the author of the study. BPH can lead to troublesome difficulty with urination–urgency, discomfort, and incomplete voiding. The condition can be relieved by surgery or by taking medication. Very obese men in the study were especially likely to have an enlarged prostrate, with 3.5 times rate compared with their normal weight counterparts. Blood glucose concentration was also associated with the risk of prostate enlargement their results indicated. Those with elevated glucose had 3-times the risk of having an enlarged prostate. The researchers concluded that diabetics were more than twice as likely to have prostrate enlargement compared to non-diabetics. They are currently designing studies to determine why obese and diabetic men have enlarged prostrates. Want more reasons to live a healthier lifestyle and try to get your family to do the same? The NIH News presented an article from the July 20, 2006 issue of the New England Journal of Medicine, by Jose Florez, M.D., PhD. of Massachusetts General Hospital. These researchers confirmed that a gene variant confers susceptibility to type 2 diabetes in participants of the Diabetes Prevention Program (DPP), a large clinical trial of adults at increased risk for developing type 2 diabetes. The researchers were delighted to observe than even the participants at highest genetic risk benefited from healthy lifestyle changes as much or perhaps more than those who did not inherit the variant. In fact lifestyle intervention reduced risk even in those who carried both copies of the variant. Dr Florez stated, “This finding emphasizes that people at risk of diabetes, whether they’re overweight, have elevated blood glucose levels, or have this particular genetic variant, can benefit greatly by implementing a healthy life style." Let’s jump into the abstracts. As always we ask you to e-mail with any suggestions fro topics. We’ll try to keep an eye out for your topics of interest. The Archives of Pediatrics and Adolescent Medicine 2006;160:573-577 has an article of interest titled Effects of Regular Physical Activity on Control of Glycemia in Pediatric Patients with Type 1 Diabetes Mellitus by Antje Herbst, M.D. et al. The researchers’ objective was to evaluate the effect of regular physical activity (RPA) on the control of glycemia (glycosylated hemoglobin A1c) and the frequency of severe hypoglycemia in a large cohort of patients with type 1 diabetes. The used a cross-sectional analysis of data for 19,143 patients, comparing glycemia and the rate of hypoglycemia by the frequency of exercise in German and Austrian diabetic patients aged 3 to 10. Patients were grouped by frequency of RPA per week as follows:RPA0,none; RPA1or2 times per week; and RPA2, 3or more times per week. Glycosylated hemoglobin A1c level, body mass index z score, and frequency of severe hypoglycemia. The results indicate RPA was one of the important factors influencing the glycosylated hemoglobin level. No association was noted between frequency of RPA and frequency of severe hypoglycemia or hypoglycemia with loss of consciousness or seizure. The researchers concluded that since there was no association between these factors that regular physical activity should be recommended in pediatric [patients with type 1 diabetes. In my history with diabetics I have found that some type 2 diabetics do not routinely take blood glucose levels during the day. We are hoping that reading this article will motivate those who tend to “forget" this important part of treating this disease, will modify their thinking about the effects of diabetes. Diabetes Care has an article titled Cognitive Dysfunction Is Associated with Poor Diabetes Control in Older Adults by Medha Munshi, M.D. et al from Boston. Dr. Munshi of the Joslin Diabetes Center and colleagues from Beth Israel, Harvard Medical School and the Geriatric Neuropsycology Laboratory of the VA examined the association between cognitive dysfunction and blood sugar control in 60 diabetics older than 70 years of age. These subjects had diabetes for an average of about 14 years and elevated hemoglobin A1c. The groups’ average A1c was 7.9 percent which is over the ADA’s suggested 7 percent. Patients were screened for cognitive dysfunction with the Mini Mental State Examination (MMSE) and a clock-drawing test (CDT). Depression was evaluated with the Geriatric Depression Scale. Interview questionnaires surveyed activities of daily living (ADLs) and instrumental ADLs (IADLs), as well as other functional disabilities. These patients reported a high incidence of functional disabilities including hearing impairment (48%), vision impairment (53%), history of recent falls (33%), fear of falls (44%), and difficulty performing IADLs (39%). Thirty-four percent had low clock in the box scores and 38% had low clock-drawing test scores. Both of these test results were inversely correlated with HbA1c suggesting that cognitive dysfunction is associated with poor glycemic control. 33% of patients had depressive symptoms with greater difficulty completing the tasks of the Instrumental Activities of Daily Living survey. The researchers concluded that older adults with diabetes have a high risk of undiagnosed cognitive dysfunction, depression, and functional disabilities. Cognitive dysfunction in this population is associated with poor diabetes control. The ADA reports that Dutch researchers have found that like other high-risk groups, adults with diabetes benefit from having a flu vaccination every year. Their findings were reported in August Diabetes Care. The good news was that “Influenza vaccine was associated with a 56% reduction in any complication (from the flu), a 54% reduction in hospitalizations, and 58% reduction in deaths". Dr. Ingrid Looijmans den Akker at al support the value of annual flu shots in adults with diabetes. They call for renewed efforts to increase vaccination rates in this high –risk group. Please speak to your health care providers and make sure that you are called when the flu vaccine is available. BSP