Want to get healthier? Eat better? Feel fitter? Have your “numbers” more in line with where they should be? Try this: look at what you eat as medicine, each morsel providing the nutrients that either increase your health or decrease it, because actually it does. I’m not advocating that you can’t eat a plate of French fries or a bowl of ice cream, but I am suggesting that if you approached what you eat differently, that everything you eat is either making you healthier or having the opposite effect, would you make healthier food choices? While vitamin and mineral supplements are useful, particularly for certain conditions, they are not quick fixes or substitutes for a healthy diet. In fact they've been shown to be less healthful than eating the real food that contains them because supplements contain only one trace element extracted from a whole host of nutrients that work together in the foods where they naturally exist.
Also, I have to say the notion of “fortifying” foods is somewhat misleading. It leads us to believe those foods become super healthy, but you can’t spray a nutrient on basically white bread (with a little caramel coloring or tablespoon of whole wheat flour and call it whole wheat bread) and then tell people it’s uber healthy. I firmly believe, in case you haven't gotten it yet, that what we eat, along with physical activity and our genetics forms the building blocks of our health.
I got to wondering whether it would inspire us to eat healthier if we considered food medicine the other day when I got my annual report from my endo: A1C, cholesterol, triglycerides, microalbumin, blood pressure. I sat across the desk from my doc shrouded in worry, I always find these things worrisome, and then found out that I’m fit as a fiddle. My A1c is in the 5’s, my HDL (good cholesterol) is as high as my LDL (bad cholesterol), my microalbumin which is supposed to be under 30 is 0.3 and on and on, one great result after another. My doctor, in fact, needing to fax my A1c report to the group I do the A1c Champion presentations for wrote on his report patient in “excellent control.” Seeing "excellent control" I had a flash of insight why I'm in excellent control--my numbers are by and large the direct result of what I put in my body, and what I don’t, and that I walk an hour a day. I translated "excellent control" not merely into blood sugar as he meant it, but something bigger: my overarching diet and exercise routine. Everyone with diabetes keeps hearing the mantra, "diet and exercise" and I really got it in that moment, yep, it makes all the difference. But diet doesn't mean low calories, or the debate between low carbs and low fats: it means healthful, nutrition-rich foods, which are basically vegetables, grains, fruits, beans, and a bit of the rest, largely unrefined foods and where fats are concerned the healthy ones.
I’m not discounting the role genetics plays, you may be more prone to one thing or another based on your genes. I’m on synthroid for my underperforming thyroid, my thyroid failed me at exactly the same age it happened to my mother. And, while my HDL is 105 and my LDL is 106, some would say my LDL should be lower, like 70 often quoted as the target for diabetics. I in fact think it should be lower as a result of my diet, but I know it’s 106 because of genetics, both my parents have high cholesterol. But genes are often triggered by our poor diets.
I’m also not saying in considering your diet as medicine that there's no room for fried calamari, bread sticks or a piece of incredibly delicious New York cheesecake, but consider that a day you skip your meds and know that the bulk of what you put in your body on a daily basis forms the health of your bones, your blood, your tissue, the foundation that you rest upon, and if you put in whole and wholesome foods, you know the ones that grow out of the ground and on trees, your house is going to stand on a stellar foundation. Whereas when we stuff ourselves with less healthy foods, lots of sugar and fat, refined carbs and animal protein, rather than plant protein, we cause inflammation of our body's tissues, the stimulus for disease and premature aging. Too many people are eating weak, not nutrient dense, foods and believing that “fortified” on a product label is the seal of approval. The real reason portion control has become so big is we're eating the wrong things and rather than pushing the right foods, some self invested organizations are trying to solve the problem by limiting the amount of bad things you eat. In the end, this is not the solution.
If there’s room for you to do better with your “numbers” those target ranges for all your vitals, instead of thinking about another medication to add to your regimen, think about what you eat. I’m not giving any medical advice, or telling you not to take your medication, I’m just saying in addition try viewing the foods and beverages you put in your body, your engine, as either premium, super, leaded or leaded and to for the ones that will give you the most mileage so you're running like a fine tuned lamborghini. Leafy greens, broccoli, kale, salmon, walnuts, spinach, blueberries, ginger, tumeric, these are not "fortified" foods, these are whole, real foods, and among the most healthful, and I like to think medicinal foods you can feed yourself. Ask yourself: Would I make healthier food choices if I viewed everything I put in my mouth—well almost everything—as having a high or low rating of medicinal effect? I would, I do, and I can't go back, not when I've seen the results of an ironically fabulously tasty and satisfying "medicinal" diet.
Think you can't travel? Think again
A life in process, this stage is quite nice
I've been thinking recently about where I am in life and how I got here. How it's so different than where I expected to be, and, that diabetes is at the helm. So I thought I'd trace my trajectory and spend some time in reverie.
Early days - on the boardwalk in Brooklyn with the folks. Guess I was a little toughie from the start looking at that expression: Diabetes in store? Sure, I'll show you! Of course, not first without some trying decades of denial, distress and dullheadedness.
18 - Life takes a dramatic turn: surrounded by grey cubbyhole lockers and a woman who has numbers on her arm lying in the next bed. The hospital is so understaffed I run to get her meds from the nurse when she's in pain, she's already seen enough pain, it dwarfs my own, almost. What will happen to me? Boxes of vials and syringes go back to college with me, yet little understanding.
25 - First job in NYC, party with friends, diabetes not a subject for mixed company--me and anyone else. No meters yet or knowledge how important tight blood sugar control is. Only thing I remember from that first doctor in the hospital was all the awful things that diabetes will do to me--too much, can't think about it. Much more plagued by what I'm going to be when I grow up.
35 - Living and working in Japan. After years conflicted about being an advertising writer with all its b_llsh_t, I love that it takes me to Tokyo. Didn't love that first day in the company clinic when handed a giant bottle of alcohol (only big thing in Japan) and bag of cotton puff balls, "What, no alcohol swabs?" I asked. That's when I stopped using alcohol altogether. Other news: ate far too much rice, but who knew?
39 - Return from Japan. Early mid life crisis looking for my life partner, who'd guess I already knew him? Begin telling extended circle of friends that I have diabetes. Took a long time to get over that feeling of being "damaged goods." Living in Asia six years helps you get over most things, or is it that I'm approaching 40?
47 - Lose my job a week before I'm having diabetic frozen shoulder surgery. Go to a diabetes educator for the first time...hmmm...could this be my new career I wonder? Now in full-blown mid-life crisis. O.K., so a little late.
48 - Marry my partner in life - and in diabetes! Overwhelming for someone going it alone for so long. And, to my surprise, I turn embarrassingly shockingly anxious if a "bad" number comes up on the meter in front of him. Don't worry, I'm over it. For those in doubt that someone is waiting for you diabetes and all, read this.
49 - Daily walks around my local park for exercise and clarity, still pondering what do I want to be when I grow up? An unsuccessful, half-hearted job search causes me to really search what I want to do with the second half of my life. OK, I'm being generous here ...maybe
50 - The husband suggests I write a book about having diabetes. Puleeze, who would read it? Then suggests, "Interview other people with diabetes and tell their story." Brilliant idea and don't you know it begins to form my network of fellow diabeteers and diabetes professionals.
51 - First visit with an endo in I don't know how long. He says I'm doing great, finally (hmm...after 32 years?) A1Cs in the 5's, due to daily power walking, eating less and vacuuming carbs out of my diet. Yet, complications from first dozen years of uncontrolled sugars still knock me for a loop when they come: partial hearing loss which brings with it unnerving tinnitus, slow-growing cataract--first time eye doctor doesn't praise my incredibly disease-free eyes--on Synthroid for thyroid deficiency, but my neuropathy's hardly there anymore, my diabetes teaching has launched a new career and I'm pretty sure if I maintain this health regimen and purpose of heart I'm going to be one of those long-lifers. If a crazy person doesn't get me in the subway first.
52 - Decide career as a cde is not for me, my interest is more emotional than medical. Go back to school for six years to be a diabetes shrink, hmmm...I don't think so. Instead I get trained to deliver A1C Champion presentations inspiring other patients to take better care of themselves, and hit the road.
54 - On a roll living the life of an overworked executive without the office, salary, secretary or bonus. Instead fitting doing the laundry, food shopping, cooking and housecleaning into my overly-busy, lovely life: My self-published book, The ABCs of Loving Yourself with Diabetes is out there. I'm currently writing a book debunking diabetes myths to be published fall 09, I'm thick as thieves with an extremely generous network of diabetes specialists--well, c'mon, they return my phone calls--and in my spare moments I'm wondering how I got here: from that boardwalk in Brooklyn through the years of ignoring my diabetes, feeling like "damaged goods," letting it into my life to making it my life, oh yes, with jobs come and gone, boyfriends come and gone, self-worth high and low, tearful chats with friends when diabetes scared me, the last one outside the train station in Paris, and extended work stays in Tokyo, Hong Kong and Sydney. How did I get to here, to the bench I sit on now also in Brooklyn with my husband drawing up mind maps and future plans amid my coaching others, chatting with my book agent and speaking at health fairs around the country. How have the puzzle pieces fallen together to answer the constant questioning, "Why am I here?" "What am I supposed to be doing?" "How can I help others?" My husband keeps reminding me it wasn't pure luck that has brought me here as I have a tendency to say but work, determination and tenacity. I suppose it's a bit of both.
By time you're this age you learn life is a process. The husband also says you can't connect the dots until you're in front of them. Like the fact that in my twenties I left advertising to pursue my heart's desire and wrote and illustrated inspirational greeting cards. Twenty-five years later the progression of those writings and drawings became my The ABCs Of Loving Yourself With Diabetes book. Like the fact that I spent three years participating in personal development seminars including working for the company and now I draw on much of what I learned and teach it to others. As the expression goes, "luck is when opportunity meets preparedness."
Diabetes, like life, is a process too. You pull the strings that speed and slow the process. Keep seeking, keep reaching, keep looking, keep learning, keep doing and chances are one day your life will surprise you. Life can be good with diabetes, don't stop searching for how. Signing off now, another myth to draft, another expert to call, another day to marvel at the fact that my blog just got picked up by a web site that's all diabetes news, all the time, and woo hoo, there's little ol' meway down at the bottom.
Who's watching out for our humanity?
Many of us would agree it doesn't feel like there's a lot of "care" in Health Care anymore. HMOs, Health Maintenance Organizations, that most of us probably participate in, were set up as cost-saving vehicles not care-giving vehicles; they work more or less until you really need some kind of care--I can't get the orthotics my podiatrist says I need, there's no coverage for anything that might help the tinnitus that drives me mad on certain days and until recently my test strips were so minutely parsed that I could never feel the assurance of testing as I needed.
But I digress. I want to talk about the visit to my ophthamologist yesterday for my annual dilated eye exam. What I observed prompted me to wonder if we need to not just change how Health Care works in this country, but the name itself. Given the power of words, if we renamed "Health Care" to "Humanity Care" for instance would it help remind over burdened doctors who have been mandated to see a ridiculous number of patients within a scant ten to fifteen minutes each day that there are actually human beings inside these objects that get moved like on an assembly line from outer waiting office, to inner waiting office to their sanctuary?
I like my ophthalmologist: she's bright, wholly competent, invites questions, has a personal and reassuring manner and I am extremely happy I have her in my life since I was made to believe 36 years ago when I got diabetes that I would end up going blind. So, I always feel celebratory leaving her office but I used to also feel comfortable going in, which changed yesterday; I felt a difference in the air, and then on the ground. It was obvious how many more patients needed to be seen, so that everything that was done exhibited that the priority had been given to time management and not to patient care. I observed patients were being treated like objects to be processed; to be moved from point A to point B and then out the door.
First, I noticed extra chairs had been placed in the hallway of the interior office so that every time someone passed, which happened almost every 30 seconds, you had to scrunch your body out of the way or get out of your chair to create more room that wasn't there, difficult for elderly patients. Then the rush was present everywhere: twice I saw technicians call a patient as they passed by to follow them into an examining room. The first time the technician was gone in a blinding flash around the corner before the patient, well into her seventies, could inch along with her cane. By time she was half way down the hall she shuddered in a slight panic right before me because she'd lost sight of him. The second time it happened, a doctor issued a greeting to a patient, and then when he got to the end of the hallway where his office was turned around to usher her into his room only to see that she hadn't moved from her seat. He called her again, and she replied in a chirpy, female-wanting-to-please voice, "Oh, I didn't realize you wanted me to follow you!" laughter. Well why would she, he hadn't asked her to, he'd just whizzed by.
My own treatment is what made me start notice all this. I was ushered into the first examining room by a technician after I'd sat in the waiting room for over an hour. When the technician closed the door she quickly apologized for the delay, but she didn't apologize to me, she apologized to her computer since she was facing it and checking the screen for my details as she spoke. In fact, everything she said that was meant for me she said to her computer, her notebook or her equipment. Was I meant to feel sincerity in this communication?
Just the night before I'd seen a segment on the news show, 60 minutes, where a British adverturer in his 70s, who began a business to fly doctors, equipment and medicine to third world countries is now doing it almost exclusively in impoverished areas of America. His flying doctors, dentists, eye doctors, nurses take over a hall for a weekend in West Virginia, Kentucky, Washington and see about 800 patients over the weekend, sadly having to turn away hundreds for lack of time, personnel and equipment. A man was there who'd had an abcess tooth for more than two years which pained him every day. Young women were there who got a cancer diagnosis that day and the name of a nearby clinic. Yet the story that made me cry was of a petite, slim woman in her seventies, frail and cheerful who'd been one of the ones turned away and still she was cheerful until by a small tender act the journalist interviewing her ushered her to an eye doctor who made an extra few minutes to attend to her. She's been wearing the same glasses for the last 16 years out of which she has not been able to see properly for years, yet she can't afford to go to an eye doctor. She has no insurance because she can't afford it after a lifetime of working. When she thought she'd be turned away she expressed that it was alright, she'd manage somehow, she had some friends and support in her church group, yet her face told another story of disappointment and our working poor. When asked if she asks her friends or church group to help her, she responded she didn't want to be a burden, and the journalist reassured her there was no shame in asking for help, and she burst into tears. Watching this I began to cry for this frail, poor woman who's worked her whole life and now can't even afford an eye exam and a pair of glasses--here, in one of the wealthiest nations in the world.
If we started hearing on every news station what an awful state "Humanity Care" is in these days and reading about how poorly run our "Humanity Care"is instead of "Health Care," maybe we'd at least be reminded that we're actually talking about people, not cattle, not objects, not numbers. Can two words change how we think? Hmmm...."Humanity Care," it's beginning to grow on me.
Well, here’s one for the diabetes professionals, educators and nurse practitioners--although as a patient you may learn something too. July 26th at the Marriott East Side Hotel in mid-town Manhattan I attended Dr. William Polonsky’s seminar, “Understanding Behavioral Change to Help Improve Diabetes Outcomes,” which he delivered to more than 120 diabetes professionals. You can look here for future programs.
Dr. Polonsky is a noted figure in diabetes, in fact I started this blog talking about him. He's a psychologist, diabetes educator, Associate Clinical Professor of Psychiatry at the University of California, President and Founder of the Behavioral Diabetes Institute (BDI) in San Diego, the only institute looking at the emotional side of managing diabetes. He's also the author of several coping with diabetes books. The program he's created helps practitioners identify and address their patients' psychological hindrances to self-management. He identifies 7 “Tipping Points” -- tipping points being those hindrances that get in patients' way--and helps educators coach patient's through them tipping them toward better self-care. Invariably, if you work with patients you will recognize these among your patient population. If you're a patient, you may just notice one of these emotional blocks applies to you:
1. Depression, which can be tipped toward a positive, engaged outlook on life
2. It's no big deal, which can be tipped toward recognition of personal risk
3. Inevitability of complications which can be tipped toward hope
4. Treatment skepticim which can be tipped toward a realization that treatment can work
5. Unrealistic action plans which can be tipped toward clarity of action
6. Poor social support which can be tipped toward optimal social support
7. Environmental pressures which can be tipped toward new, effective ways of coping with stresses
The "tipping" is done by helping patients address their underlying emotional or psychological block or wrong-thinking and through inquiry and coaching getting to the root of the block and helping patients see a more positive outcome, this helps them get more invested in managing their diabetes.
Polonsky went for a laugh first by asking his audience, “How many of you have run into a patient in the last month that wasn’t taking perfect care of himself?” He to the expected response as laughter spread across the room. He then told us that no patient is unmotivated to live a long and healthy life although sometimes it appears that way; the problem is that taking care of diabetes often doesn't seem very rewarding. Imagine an educator saying to a patient, "You know Mrs. Smith if you take this medication I’m prescribing, see a battery of doctors regularly, get an A1C test every three months, watch what you eat and exercise every day, check your blood sugar all the time and do this 24 hours a day the rest of your life, here’s what’s in it for you -- Nothing! If you're lucky nothing is likely to happen." It takes a lot of motivation for the average patient to perform the over 150 (they were counted by diabetes educators) self-care tasks day after day after day just to maybe not have something bad happen, maybe.
Polonsky’s course, sponsored by Roche, gives healthcare providers resources, training and support to help them identify and evaluate their patient's tipping points and address them to create partnered, meaningful treatment plans. If you’re an interested healthcare provider, you’ll find more information here and on the BDI web site. If you're a patient take a look at his brochure on the BDI site: The emotional side of diabetes: 10 Things You Need to Know. It's a reassuring read, especially if you notice you may have a tipping point of your own.
Change your view about diabetes for 3 minutes
Is it a poem? Is it a video? Yes, and it may be just the thing to have you see your diabetes -- upside down.
You may have seen this video but if not you must. Granted when I said that to a diabetes educator she almost scolded me saying it may well depend on where patients are in their diagnosis and their care, but if you've had diabetes long enough to take a cold, hard look at it, watch this. And you must watch the entire video or you won't get it. A month or so ago this video, "It Turned Everything Upside Down" was posted on YouTube by two young medical students as a project assignment for their FCE requirement. What is FCE you ask? It's a course requirement (Family Centered Experience) of first and second year medical students at the University of Michigan Medical School. FCE engages students in understanding the personal side of medicine by having them make several visits to patients' homes and meet with them and their families over a two-year period.
The value of this course work is, of course, medical students realize illness is not just a breakdown of the body but it can also be a breakdown of our spirit, our families, our dreams and our values: our lives in their greatest sense.
The clever creators of this video, Nicholas Dewyer and Jane Lee, both have type 1 diabetes and visited with two patients who have diabetes during their FCE experience.
Dewyer and Lee also wrote this about their video, “Given the same illness (diabetes) … different patients view their illnesses through their individual lenses from diagnosis forward. These views may change constantly with time. Using a single poem to convey both devastation and hope, we hoped to reflect the spectrum of attitudes that our patients shared with us from fear of amputation and death to gratitude for the changes made due to their illness.”
How we view our diabetes and whether we think there is anything to be gained from it is central to how we live with it and how we manage it. Personally, I've "chosen," and I say that very deliberately to try and find what diabetes has given me and I have found: strength, diligence, confidence, pride, great friends and now this work.
I won't tell you why this video is so very clever, but I will tell you to take three minutes and find out for yourself. It will make you think about the condition you live with every day, and maybe change something about how you think about it.