Around the same time that the Diabetes Prevention Program in 1992 proved that losing a moderate amount of weight (7%--about 10 or 15 pounds for many people who are overweight) and getting 30 minutes of physical activity five times a week can possibly prevent diabetes, the Finns ran a similar study and came up with similar results.
But there the similarity ends. The Finns actually did something about it. For the past 15 years they’ve been building parks and bicycle paths, changing foods available in schools and restaurants: they've been making healthy choices easier to make. And people have been losing weight, getting fitter and lowering the incidence of type 2 diabetes in Finland.
As Dr. Pekka Puska, Director General of the National Public Health Institute says in Dr. Francine Kaufman’s documentary, Diabetes Global Epidemic, “You can give people all kinds of information but unless you make the healthy choice the easy choice, it’s not going to be the one people make." The key is connecting the dots from information to action, so in Finland city planning has changed direction so people can more easily be physically active. The central lesson from Finland’s success is it’s human nature to make the easy choice and when you make the easy choice the healthy choice, people will follow: fitness trails now fill Finland's cities and people who otherwise would not be, are on them.
I had the opportunity to reflect on this last week when out of my home town of New York City I was in the heartland, attending a conference in St. Louis. The first morning I was abruptly reminded and saddened to see how poor the choices are across much of America to make healthy choices when it comes to eating. Lodged at a very lovely, star-studded hotel, I was frankly appalled at the dismal breakfast buffet. It appeared the best way to make a healthy choice was to get on line for the fresh omelets. So I did. I got a spinach omelet dripping in butter and when I asked for lettuce and tomato instead of potatoes both grill chefs looked at me like I was speaking a foreign language.
Surveying the breakfast buffet, on tap were gummy scrambled eggs, fruits in canned syrup, bacon, sausage, biscuits with coagulated gravy, sweetened, flavored yogurt, frosted cold cereals and only instant oatmeal in only sweetened flavors like Apple and Cinnamon, Maple Syrup and Brown Sugar.
My whole four days were an enormous effort to work around the unhealthy selection of foods plentifully available and try to find a few nutritious choices. The one evening my colleagues and I went off premises we took a short ride into historic downtown St. Charles for dinner. Having asked our driver for a good restaurant that offered a variety of foods he recommended Lewis & Clark. It appeared to be a typical family restaurant chain like a Fridays or Houstons. Scanning the menu I immediately saw almost everything was fried. We settled on what I thought would be the healthiest choices: guacamole and a spinach-artichoke dip for appetizers. Both came creamed and with a mound of corn chips. Luckily there were two fish entrees which you could order grilled with steamed veggies which I did. If this is how America eats because this is what we're offered, how can we expect people will not be fat?
The straw that broke my back was breakfast at the St. Louis airport the day I left. In the new concourse there was only one place to sit and eat a meal, at the bar. I ordered scrambled eggs which came with sausage, only white sourdough bread, and when I asked if they could substitute lettuce and tomato for the hash browns, I got my second startled lettuce-and-tomato look. The eggs tasted like they came out of a plastic container not a chicken, the sausage was so salty I'm sure it spiked my blood pressure right then and there, the coffee incidentally was burnt. I felt almost sick after that meal, physically and spiritually.
Understand, I’m not picking on St. Louis and I’m not saying everyone in this country makes poor health choices; I am saying I experienced how difficult it was to make healthy choices in the course of a day in an ordinary American city, and that it's shameful to hawk at us on morning news programs and magazines that we have to change our eating habits and then make it almost impossible to do so.
America, shape up--and I'm not talking to those of you who have pounds to lose--but our agriculturalists, industrialists and politicians who let the food industry and big business get away with murder--because frankly they're killing us.
Helps delay or defray a low blood sugar incident
Glucose Rapid Spray was one of my finds at the American Association of Diabetes Educators' (AADE) Conference a few weeks ago as I ambled through the Exhibition Hall. I think it's a most innovative product that offers three distinct advantages--it provides what it says "rapid glucose delivery" with quick absorption through the surface of your inner cheeks. It offers great portability as its tiny size fits in the palm of your hand, and, it can delay and possibly deflect a low. My only word of caution, however, since we all react to things diabetes differently, is if you give it a try, since it's uncertain just how many sprays will lift your blood sugar how far, test your blood sugar response over an hour after using, to see how your body reacts. The directions call for 5-10 sprays but you may require more, or less. Also, it's not marketed as an emergency remedy but a way to keep your blood sugar from dropping like a stone before you can treat it.
My unexpected test of Glucose Rapid Spray occurred the other day when I took my usual one hour walk around my local park and returned at 11 AM with a blood sugar of 50. Great, I said, now I can try out Glucose Rapid Spray! The label directs you to spray 5 to 10 sprays into your mouth directed to your cheek and repeat as desired. So I sprayed 5 sprays into each cheek. While I have the orange flavored version, it also comes in raspberry, the taste is strong, and almost simultaneously sweet and slightly bitter.
I checked my blood sugar fifteen minutes later and it had lifted me to 60. Not bad I thought, but wanting to see what would happen over a bit more time I tested my blood sugar again in another fifteen minutes, now 30 minutes from my initial blood sugar of 50. I was 53. I had risen to 60 and then dropped to 53. Obviously I needed more than 10 sprays to lift me higher. As the directions instruct, I could have sprayed several more mists, but I opted since I was already home to chomp on some glucose tabs.
The takeaway: this may indeed be a valuable product to have with you when you're on the go to delay a major low, but I'd suggest testing it to determine how many sprays you require to lift your blood sugar sufficiently before you can get your hands on some fast-acting carb or your next meal.
Your blood pressure buddy
While I'm not going to get into the argument whether pharma companies want to keep people sick to sell drugs, there was an interesting item at the AADE conference to help patients lower their blood pressure--without drugs.
It's called Resperate and claims to be the only non-drug solution to high blood pressure available as an over the counter treatment to lower blood pressure.
Resp@rate as you can see from the photo is a device that trains you to do therapeutic breathing exercises to slow your breathing so that you your breath intake from 14 to 19 breaths per minute--down to what they call a "therapeutic zone"--just under 10 breaths/minute. The physiological result is muscles surrounding the small blood vessels in your body relax and dilate; blood flows more freely and pressure lowers.
The company says practicing 15 minutes, 3 to 4 times/week can create a significant all-day reduction in blood pressure. I don't endorse products, especially when I haven't tried them, as I don't have high blood pressure, but it seems worth investigating if you do.
Of course doing any relaxation technique like meditation or yoga, or right now just slowing down your breathing and taking deeper breaths likely creates a similar effect (including getting the anger out of your life). The trouble with slowing your breath sans device is it's easy to get distracted, but I have done meditation for decades and can attest to the benefits at slowing breathing and clearing the head and taking a break to recharge--and look mom, "no drugs."
Now, to conclude my last post, remarking on the annual American Association of Diabetes Educators Conference in Washington D.C. Let’s be honest, the most fun at one of these events is
looking at all the stuff in the exhibition hall, and of course eating your way
through it. I managed to do both: nibbling almost every few feet on low-fat blueberry yogurt,
Activia, walnuts, cereal bars, Lean Cuisine, soft serve ice cream and lots of tidbits that resembled food but I’m not really sure they were.
Gadget-wise, in truth I’ve been to a lot of exhibition halls and I didn’t find
all that much new, but these things are worth mentioning:
- Eat smart. A small, great looking scale that measures everything and tells you how much it weighs, its calories, carb content and 7 or so vitamins and minerals. To be honest, my husband was immediately attracted to the gadgetry while I thought oh another thing to be bothered by. But, having it in our kitchen now and knowing that the plum in my fruit bowl I’m about to eat has 27.6 carbs is an incredibly useful addition to my management.
- Meters, meters, meters everywhere. Glucose meters have become a parody product, but I did see one that caught my eye by Intuity. You put your finger over a hole at the bottom, it pricks it and in seconds gives you your blood sugar reading. Notice, no test strip. Due out next January, now let‘s just hope they make it a little less masculine looking.
- On site A1c testing. I only learned recently many doctor’s offices offer A1c testing right in their office, while I’m always trekking off to the lab. Well, here at the show I could avail myself of five booths that would give me my A1c result within minutes, so of course I had to test this. I tried three different booths and came up with a 5.0, 5.4 and 5.5. Given that I’d just had my A1c done at the lab two weeks ago and it was 5.8, I’m inclined to say two of my three tests at the exhibition hall were in the ball park. Reli-On makes a kit where you smear some blood on a pad, mail it in and get your A1C results in a week.
- My lancing device ratings. Since we all know lancing devices cause more pain than injections I have a personal investment in keeping up with improvements in this area.
- First place winner- Pelikan Sun. It’s battery operated and has a feather touch. Downside: expensive, about $200 for the instrument and a little larger than a pack of cards. I’m told lancets should be covered by insurance Upside: you won’t mind testing 10x a day.
- Accucheck Multi-clix. The best, least painful cheap lancing device. It runs on a track so the lancet doesn’t shred your skin when piercing. My favorite run of the mill device.
- Renew from Can-Am Care. Operates on the same track technology as Multi-clix. Cool packaging and the only other stand-out in the pack. You can request a free trial sample online.
- Pumps are getting smaller and more are getting tubeless. Omnipod, the only tubeless pump right now promises a pump half the size within two to three years, I'm staying tuned, and Medtronics is working toward the same. I’ve always said when the pump is the size of a credit card, count me in.
- Omron, a company that makes blood pressure machines and pedometers is coming out with a new pedometer next year that’s slim, you can slip it in your pocket rather than clip it on your belt and it will work at any angle. I like the ease of putting it in a pocket. The husband loves the techie gadgetry.
- Glucose Rapid Spray. A tiny atomizer mist spray. 5 to 10 sprays onto your cheek will help bring your blood sugar up a bit when you're going low. Handy to carry when away from home or exercising, but I'm told not a resue item. I'm waiting for my first potential low blood sugar to give it a try.
- Dreamfields. A dream of a pasta. I gave up pasta for a dozen years due to how high and how quickly it raised my blood sugar. Now Dreamfields has created a pasta that nets only 5 grams of carbs per serving and I know it works. They’ve reconfigured the pasta’s molecular structure and much of it is highly non-digestible when traveling through your stomach. It still tastes delicious but doesn’t break down into carb. I swear give it a shot. I find it at my local supermarket chain, Key Food, but they’re distributing many places.
Helping Third World Children with Diabetes
The conference was closed by Dr. Francine Kaufman, pediatric endocrinologist at the Center for Diabetes, Endocrinology and Metabolism at Childrens Hospital Los Angeles. Kaufman is a tireless advocate against childhood diabetes. She shared clips from a documentary she made for the Discovery Health channel, Diabetes: A Global Epidemic, where she traveled through Africa and India bringing medicine, training and treatment to poor children, families and caretakers. Countless children are dying of diabetes because there is no medicine, no meters, no test strips, no doctors. In places where insulin is obtained on an irregular basis children are given whatever is available. Can you imagine using only Humalog one month, then only Lantus another, then NPH yet another? How would you ever figure out your protocol? I get chills just thinking about it.
If you would like to donate unused, unexpired medical supplies they are taking them at www.Lifeforachild.org. You can also contribute $1/day and a child will receive medicine and testing supplies.
Having this podium I leave you with my own closing remark which is an observation: I found it profound that here in America we are literally dying of abundance: too much food and too many luxuries that make us lazy, while around the planet people are dying of scarcity: too little food, too little medicine and too few health care professionals.
It’s something to ponder, I think.
As promised, here’s my brief report of the 35th
annual conference of the American Association of Diabetes Educators (AADE).
4,000 educators from around the U.S. and a sprinkling from outside the U.S.
convened at the Convention Center in Washington D.C. for four days of lectures to earn credits and learn the latest news regarding drugs, devices and behavioral
practices to better help their patients. They are an impassioned group truly
wanting to make a difference. Having a concern of my
own, why I’m getting red dots every time I inject, each educator I asked went
right to work examining the problem and investigating my behavior truly wanting
to help, and yes, I did take advantage of my circumstances. Unfortunately, diabetes educators are dwindling in number each year while
patients are increasing, making their work ever-more demanding.
My husband and I descended upon Washington together both eager to hear what educators are learning, teaching, what’s new in the field and how patients are being served and responding. I also wanted to thank, in person, the many experts who were speaking there and have been helping me with the book I’m currently writing, debunking diabetes myths. Arriving the night before the conference began our first self-assigned task was to find fruit for the husband’s next morning breakfast. Within a 20 block radius of downtown D.C. there is not a banana, orange or apple to be had. Trust me, I know; I asked shopkeepers, restauranteurs, passers-by and the hotel concierge. The closest we came was Tang, a powdered orange juice like drink at a CVS drugstore, but alas, not a single piece of fruit. I found it remarkable that blocks away 4,000 people had convened to learn how to help patients improve their diet and eating habits, and yet in our nation’s capital I could not find a piece of fruit. Proving once again diabetes is not just a medical issue, not just a behavioral issue, but also a systemic issue: our society's infrastructure does not support practicing the healthy behaviors we hear about daily on the morning news.
But, forgive me, I digress. The conference was opened by Amparo Gonzalez, current president of the AADE. Her lilting accent welcomed everyone in the huge basement hall where I sat amid a sea of largely Caucasian, middle-aged women, with perhaps one man to every 50 women. Elizabeth Edwards, the key-note speaker, gave an hour long, impassioned address sharing her own experience of living with cancer and built a bridge between all of us who live with a chronic illness. She was real, warm, bright, funny, engaging, shared her darker days with cancer and spent the last 15 minutes comparing Senators McCain and Obama’s health plans. While she promised to be impartial, which I believe she was, she gave both plans low grades letting us know neither is as workable as either politician would have us believe. I left concerned that our already broken health care system is not getting fixed anytime soon. Unfortunately, two days later her broken marriage was being aired on the Convention Center’s TV monitors every few feet.
Here’s what educators are learning:
- New medicines, largely that deal with type 2 diabetes, and more meds on the horizon indicate diabetes is not merely an insulin problem, gastric hormones are getting more and more attention.
- The artificial pancreas is inching ever forward in trials largely due to the efforts of the Juvenile Diabetes Research Foundation.
- Diabetes educators’ largest hurdle is getting patients to change behaviors: adopt healthier eating habits and exercise.
- Educators’ second biggest hurdle is once they’ve gotten patients to adopt healthier behaviors, getting them to sustain them. The drop off seems to occur 4-6 weeks later.
- Educators are being encouraged to shift from being “teachers” instructing patients to being “coaches” partnering with patients.
- "Peers for Progress" is a new AADE initiative getting underway to utilize patient mentors. We knew it was coming, too many patients for too few educators.
- Personal note: My book, The ABCs Of Loving Yourself With Diabetes, initially declined by the AADE bookstore because it wasn’t deemed something educators would find useful, sold out in the first few days.
Maybe he's just another hawker wanting to sell books or sit next to Oprah, or maybe he's got it right. Joel Furhman is a doctor and up and coming weight loss healthy eating guru. I'm now reading one of his earlier books, Eat to Live, from 2003 and here's his proposition in a nutshell: Make the overwhelming bulk of your diet nutrient-dense foods and you'll avoid disease, particularly heart disease and cancer, your diabetes' symptoms may go away if you're type 2, your blood pressure and cholesterol will lower and you'll lose weight and maintain a "normal" body weight. Furhman says most of our weight, ills and diseases come from our (profit-making-big-business) unhealthy American diet which is high in fat, refined carbohydrates and calories and low in nutrient-dense foods, leaving us hungry, unsatisfied, fat and unhealthy.
Further, our most recent mania to control portions is like putting a band-aid on a levy that's bursting; limiting our portions of non-nutritive food may cut some calories but it still leaves us nutritionally deficient with over stimulated appetites. He says if you have type 2 diabetes you can eradicate insulin resistance using his eating plan, if you have type 1 you can dramatically lower your insulin requirement. And I believe him. It seems common sense to me that the over-processed, packaged, chemically-formulated and steroid-pumped, refined junk we eat causes weight gain and disease.
Furhman just hates the food pyramid the U.S. Department of Agriculture rolls out each year and proposes one of his own. Drum roll please: our personal food pyramid's bottom, the foundation of our diet, should be built on vegetables and leafy greens, then fruit, beans and legumes, whole grains, with the top of the house giving us a trickle of non-fat diary, animal protein and healthy fats derived from foods like nuts and avocado. If you think you've heard this a million times, his USP (unique selling proposition) is he rates foods according to their nutrient density. Something by the way is going to soon make an appearance in supermarkets. But what I found compelling was Furhman's forceful argument, continue to eat unhealthy foods and your sickening yourself every day, want to truly "fortify" yourself against disease? Do it with food, not drugs. Highlights from his book:
1. Olive oil is not the miracle drug we all thought, 97% of its fat will go straight to your hips so use it limitedly.
2. Leafy greens like salad greens and green vegetables are 1/2 protein, 1/4 carbs and 1/4 fat. Who knew? You don't need to eat a side of beef to get enough protein if you're eating lots of veggies.
3. If you're eating a diet rich in fresh fruits and veggies you're getting enough water. 8 glasses a day, fugedabout it, 3 is plenty!
4. Furhman agrees, don't be fooled be foods that say "fortefied." A spray of folic acid won't do it.
5. Animal protein whether white, as in chicken or red, as in beef is equally disease causing. Fish is better but even fish should only be eaten 2xweek and mercury-free.
6. Don't worry about getting the right mix of veggies and beans etc. on your plate to get your protein covered, eat this healthy way and you will.
Mind you, always, any significant change in your eating plan may create a change in your blood sugars, which means a change in your medication--and I guarantee you if you follow this plan you will definitely need less medicine, whether you're on orals or insulin. So, be alert and discuss this with your health care provider. If you have a condition like kidney disease you may not be able to eat enough veggies, fruits, nuts and legumes for this to work for you, so please don't undertake this without consulting with a professional. Also if you have vitamin or mineral deficiencies talk with a professional before making any dietary changes.
You might call this a super-charged slightly left of center vegetarian eating plan, but many vegetarians rely on refined carbs and saturated fats like pasta, crackers, pretzels and cheese, which are not nutrient-dense, whereas this plan is mostly vegetables, fruits and beans. Whole grains, healthy fats and animal protein are parceled out according to your weight loss goals.
Of course, restaurants and social outings are harder to maneuver than home cooking, so he proposes using outings as a time when you indulge a little. If you're living in this century, time is the other nasty. Who has much time to shop and prepare vegetarian meals? Furhman offers recipes, but darn, somebody's got to make them. I mostly do the simplest thing: steam an assortment of fresh veggies every night for dinner, lunch is a spinach salad with beans, left over veggies from the night before and a little feta cheese. Breakfast is steel cut oats.
If you want to really get healthier and drop some pounds read the book, try the diet and see what you think. Wouldn't it be remarkable to shed those 20 pounds forever, really feel full and satisfied, and watch your health transform, including your energy and outlook?
End note: I will be away this week at the American Association of Diabetes Educators annual conference in Washington D.C. I am not an educator or any other type of medical professional, merely a lay person interested in knowing what educators are learning, talking about, being taught, where their struggles are with patients, what they see for the future and will let you know.