"Adult" Onset Diabetes Prevention...in TEENS

A study was published last month called the "HEALTHY Study- Middle school-based intervention to reduce diabetes risk." Basically, the researchers took 42 schools, home to over 4000 students, and divided them into two groups: one group was the control, and the other group received changes in school food services, more intense PE classes, and classroom activities to promote healthy behaviors.

Happily, the treatment group did indeed shrink waistlines, BMIs (Body Mass Index), and insulin levels. Surprisingly, both groups had close to the same amount of weight loss (4% in the intervention group, and 4.5% in the controls.) Actually, I'm not that surprised, because kids are smart. The so-called "control group" knew that they were involved in a study about health, and were in fact, specifically tested with health screening, and if they had abnormal results, they were advised to seek care from their health provider.

Personally, I'm pleased that BOTH groups lost weight (as opposed to the nurses' study I discussed earlier this week, where it was a matter of which group GAINED less weight.)

What should our take home message be from this study? There is no age too early to emphasize healthy behaviors, and at the critical time of puberty, we need to give it a full court press! Kids can and WILL make changes if they are educated and offered opportunity to do so.

BOTTOM LINE: "Adult" onset diabetes is kicking in younger and younger as our population gains weight. Let's reverse this trend!

Best Haircut EVER!

Are you ready for a new "do"? Tired of taking a half hour to dry your locks before work? Please consider DONATING your hair to one of the companies that make wigs for people battling cancer. It typically takes about six hair donations to make one wig, so they are always looking for donations! How much hair do you have to cut off? Each company has different requirements, but the shortest that I am aware of is the Pantene Beautiful Lengths which asks for at least eight inches. Locks of Love and Wigs 4 Kids both ask for ten inches.
Both of our daughters donated their hair two years ago, and our younger one was back in the chair this week. What a wonderful gift!
Please read ALL the directions ahead of time, so your efforts are not wasted! Your hair must be washed and FULLY dried without any product left in (like gel or hairspray), then placed in a braid or ponytail before being cut. You are allowed to straighten it to maximize the length. Most companies do not accept highlighted hair (because part of it is bleached and then when the combined pieces of the wig are put together and dyed, the previously treated hair will not blend well) but many accept simply colored hair.
BOTTOM LINE: If you have long hair and are ready for a shorter style, DONATE your hair!

Swimmer's Ear- Prevention and Treatment

If you've made it this far into the summer without anyone in your family getting swimmer's ear, congratulations! You're probably either not swimming, or you've been consistently putting drops in your ears after swimming. What drops do we use? We make our own home brew of half and half, alcohol and vinegar. (Yes, rubbing alcohol and generic cooking white vinegar.) To be honest, I like the convenience of the over-the-counter little bottle, so I actually buy one and pour out the contents, replacing it with our home remedy. An extra tip is to set it outside (in the shade in Texas) where it will warm up a bit before you put drops in your ears, so it's not cold and irritating.

This mix will actually work both for prevention and for treatment, if you forgot to use it ahead of time. Nine times out of ten, this will be all you will need! The vinegar kills the fungus, and the alcohol dries up any moisture that remains.
If you are an ear-wax-builder-upper, you may need to flush your ears periodically (such as once per month) using an infant bulb syringe and luke warm tap water, to remove packed in ear wax prior to putting in the home brew drops.

BOTTOM LINE: As always, an ounce of prevention is worth a pound of cure, but remember vinegar/alcohol ear drops for swimmer's ear and you'll be set!

Shake Up Your Summer Habits!

Okay, we're nearing the end of summer- are your kids bored? Have they (or you) fallen into some poor habits? Time to take stock and be proactive! Let's start with activities.

What are you doing in your spare time? Hanging out and reading blogs? Turn off the computer (after you finish reading this, of course) and head out to your garage. In a minute or two, I'll bet you can find plenty of outdoor "toys" to get you moving. My garage had this: skates, volley balls, soccer balls, basketballs, croquet, bikes, jump rope, hula hoops, a scooter and golf clubs.

Now, what about food? Our kids realized they were falling way behind in the fruit and vegetable department, so we pulled out everything in the fridge (and a bunch from the pantry) to see what our choices were. Happily, we had the five ingredients for hummus, along with a fresh bag of baby carrots, so we whipped up that delicious snack first. The overripe bananas paired up with some frozen berries, peaches, and yogurt to provide smoothies, and we were back on track.

The next step? I asked each kid to be in charge the menu for three days this week. The rules are that we need ten servings of fruits and vegetables per day (a serving is what you hold in your hand) and that only one of the nine meals could be from a restaurant. I'll let you know next week how it went, but today was terrific!

BOTTOM LINE: Take stock of your dietary and exercise habits, and make sure you haven't fallen into the summer doldrums!

MORE* Reasons to BIKE and WALK

I love it when new studies come out that reinforce what I already have been telling patients! Today, in the Archives of Internal Medicine, a study from the Harvard School of Public Health was published with the illustrious title: Bicycle riding, walking, and weight gain in premenopausal women. Basically, they found that YOUNG women-less than age 50, give or take- (yes, at 44, I still count as "young") who either walked briskly or bicycled had less weight gain than those who did not.

On the one hand, this seems like a no-brainer. Those who exercised more gained less weight. Where's the shock?
However, there is more to it, and I think this is is an interesting study. It derives from a large study (over 100,000 participants) of female nurses aged 25-42 in 1989, and follows them over 16 years. Sadly, despite their medical knowledge, they ALL gained weight in this timeframe, with an average gain of close to 20 pounds. Remember, that's barely over a pound per year, so it wasn't dramatic as it happened, but this is why we've got to look at the big picture!

The good news is that this study does document that small increases in activity- specifically adding even 5 minutes per day of bicycling (stationary or outdoor) or 30 minutes of brisk walking- will decrease weight gain. Obviously, if you are going for weight LOSS or weight maintenance, you've got to up the amount or intensity (and ultimately, calories OUT must be greater than calories IN.)

The best take home point of this study is that if you can make a lifestyle change such as BIKING TO WORK instead of driving (or biking with the kids to school instead of driving) then "bicycling could then be an unconscious form of exercise because the trip's destination, and not the exercise, could be the goal."

BOTTOM LINE: Find ways to get moving MORE in your daily life, and avoid that annual 1-2 pound weight gain!
(*See "MORE" strategies for weight loss in the January 2010 posts)

Mooove Cow's Milk Off the Menu!

Okay, pardon the pun, but today I'm talking about removing cow's milk from the diet of kids affected with chronic constipation. An interesting study was recently published that showed roughly 40% of kids (age range of 6 months to 14 years) in the study had resolution of their constipation by simply removing cow's milk from their diet.

Why did this happen? Researchers are really not sure, but believe it may be an allergic or otherwise immune-type response. This study was small- only 69 patients. However, the format of of the study is fairly convincing. They started with a baseline of one week, where they ran tests. Next, milk was removed and replaced with rice milk- and the researchers looked to see whether or not the constipation went away. This phase was followed with re-introducing the milk for three weeks, and then removing it for the final three weeks. Nearly 40% of the kids had normal bowel function in the two phases without milk, and returned to constipation in the weeks with milk.

What does this mean for your toddler or older child? Well, as long as you pay attention to calcium intake, it will do no harm to remove milk from your child's diet for a few weeks, and if that solves the constipation, terrific!
Will this work for adults? Hmm...maybe. Again, this is not a harmful fad diet, so why not give it a shot?

BOTTOM LINE: Consider a several week trial of removing milk from your child's diet if they suffer from chronic constipation.

Having "THE TALK" with your TEEN

Big thanks to Dr. Ira Breite on SiriusXM satellite radio, Sirius114/XM119, for having me as a guest on his show in NYC this Monday!
We spent some time chatting about how to have "the TALK" with your teen.Non-subscribers can sign up for a 30-day FREE online subscription at www.sirius.com/doctorradio, and catch the replay of our show throughout this week.
A few things to remember:
1. Of course this talk is awkward! You still don't want to think about your parents having sex, any more than your kid wants to realize that you and your spouse might be intimate. This topic will always be a bit embarrassing between generations, so accept that and move on!
2. KNOW THE FACTS YOURSELF before you initiate this talk.
3. Realize that if your teen asks you something you do not know, it's OKAY to tell them you aren't sure, but that you'll find out and let them know in a day or two. (NOTE: be sure to follow up on this, even if you used it as a stall tactic.)
4. Don't start interrogating them about their (or their friends') behavior! Your teen is already in a defensive mode, and this will shut down the lines of communication quickly.
5. Keep it short, pay attention, and...REPEAT. Take a minute or two each time you and your teen are together and the media hands you an opportunity to reinforce your message. Believe me, that will happen every time the tv is turned on!
Check out more hints on my primary website: JillGrimesMD.com

BOTTOM LINE: "THE TALK" is really an ongoing conversation with your teen, so make sure you're armed and ready with accurate knowledge and know you will NOT actually die of embarrassment!

Pull the Plug!

On the tv set, mind you! A recent study from the Centers for Disease Control and Prevention (CDC) notes that despite the recommendations of the American Academy of Pediatrics to limit children's television viewing to one or two quality shows per day and to remove tv's from kid's bedrooms, almost one in five TODDLERS have tv's in their bedrooms! There is no question that the kids with tv's in their bedrooms watch more than two hours per day. Of course they do- it's available all the time!
We know that excessive television exposure is linked with impaired childhood development and childhood obesity. Parents complain that their kids need to be entertained. Well, if they grow up BEING constantly "entertained" by the moving screen, is this a surprise?

Parents, I promise you that if you remove the tv and leave books and A FEW non-electronic toys in your child's room (legos, dolls, blocks) - your child's imagination will be STIMULATED and they WILL be happy and play! TRY IT!

BOTTOM LINE: REMOVE the tv's from kid's rooms and let their imaginations EXERCISE!

New Weight Loss Drug in the New England Journal!

PLEASE do not ask me for this drug! I cringe every time that there is media attention to a new weight loss drug. This is not rocket science! If you read the study in the New England Journal of Medicine, ultimately this is what you will see:

1. All the participants received nutrition counseling and behavior modification in addition to the drug.
2. Yes, the folks on the test drug (Lorcaserin) lost more weight than placebo.
3. The people on the drug lost an average of roughly 12 pounds in ONE YEAR (note-one pound per month), and the placebo group lost an average of almost 5 pounds.
4. Everyone was relieved that there were no serious heart valve issues.
5. Side effects include: headache, dizziness and nausea.

Good weight loss from improving the quality of your diet (more fruits and veggies) and starting to exercise regularly is one half to one pound per week- so 2-4 pounds per month, or 50 pounds or more in a year. Side effects? Let's see- you feel better, have more energy, and bonus- don't mind looking in the mirror.

Please stop looking for a magic pill! All medications have side effects, and this new weight loss pill is no exception.
BOTTOM LINE: Old fashioned fruits, vegetables and exercise yield better weight loss with fewer side effects! Spend your money on MIchelle May, MD's book: Eat What You Love, Love What You Eat and break out of your "eat-repent-repeat" eating cycles!

More Drug Warnings- This Time, Rosiglitazone

We seem to be constantly bombarded with drug warnings these days. Today, an FDA panel is debating about a diabetes medication that has been on the market since 1991, rosiglitazone (Avandia). Studies have shown that patients taking this medication have a higher rate of "cardiovascular events", though it is not clear whether or not these events lead to a greater death rate.

Why is there any debate? Shouldn't we simply remove it from the market, since there are other diabetes drugs? Well, of course, it's not that simple. Diabetes itself causes an increased risk of cardiovascular events. There are many diabetics who have uncontrolled blood sugars despite being on several other medications. This class of drugs actually has produced significant lowering of high blood sugars for many patients. It's all a balance.

Ultimately, this puts me back on my soap box. Though I have a few (literally less than five) patients with adult-onset diabetes who eat perfectly (tons of fruits and veggies, high fiber, and few sweets), and have normal weight, yet still require medications to control their blood sugars (yes you, "FP"!), the VAST MAJORITY of my adult onset diabetic patients would have completely normal blood sugars if they ate well, exercised, and lost weight.

BOTTOM LINE: NO medication is without risk, so MAXIMIZE your health with proper diet and exercise and MINIMIZE the number of medications you need to take!

Leg Cramps Killing You?

Okay, on a more serious note today, there is a way leg cramps could kill you. Unfortunately, the prescription drug, quinine sulfate, that has been used off-label for decades as an effective cure for nighttime leg cramps is once again having continued reports of serious side effects- from bleeding to kidney damage to death.

If you are taking this medication and you notice bleeding gums, easy bruising,or blood in your urine- go immediately to your doctor and she will need to check your blood count, with special attention to your platelets (the team members that cause your blood to clot.)

So, what are you to do if you swear by this drug? First of all, please discuss it with your doctor. Make sure you have been recently checked for low iron stores (a ferritin level) to be sure that isn't the real cause of your leg pain. Your physician will examine you and possibly check a few blood tests.

If all is normal, here is one alternative medicine thing to try. Don't laugh (although I did chuckle when my dear patient first told me about this!). Try sleeping with a bar of soap. Yes. What brand? Whichever one you prefer. There are actually a few scientific studies that have shown promise with this, though I'll be the first to say I wont expect this to help everyone. On the plus side, though, there are no serious negative side effects from sleeping with a bar of soap under your pillow or covers!

BOTTOM LINE: If you take quinine for leg cramps, it's time for another discussion with your doctor!

Everybody Loves Parfait

"Donkey, what are you doin' here?" Okay, if you're a Shrek fan, you'll get the link. Otherwise, work with me. It's summer, and our family is recovering from a long car trip. We ate too much fast food, and so it's time to pay more attention to our nutrition.

What did we do this morning? Well, our younger daughter thought it would be fun to make parfaits for breakfast. She grabbed yogurt, bananas, blueberries and strawberries. I found a fun glass to make it look "official". Doesn't it look yummy? She had fun making it, and her body is thanking her for this delicious treat. I'll think we'll have them for dessert tonight, too!

BOTTOM LINE: Too many pop-tarts and cereal? Try making a parfait with yogurt and your favorite fruits!

There's an APP for that, too!

From previous blogs, you may know that I'm a big fan of pedometers. They are generally the least expensive piece of exercise equipment that you can purchase. I love that they give instant positive feedback, and that people of all fitness levels can use them. If you are very overweight and the thought of an exercise plan overwhelms you, get a pedometer and start with "a single step". Simply put it on, and measure your baseline steps today. Tomorrow, add on 100 steps and make that your new goal. Continue this each day until you reach a final goal of 10,000 steps per day!

Pedometers come in all shapes, sizes and prices. I prefer ones that clip on to my waistband, but obviously, that necessitates wearing clothing with a waistband! If you prefer dresses, you'll need to find a different style. They now make pedometers that look like a credit card, and you slip them into your pocket- how cool is that?

When I realized I had forgotten to bring a pedometer on my vacation, but wanted to be able to measure the distance of our hikes, my friend pulled out her iPhone and simply downloaded an APP! (Go Pedometer) Before you knew it, we were happily hiking and able to track our distance. Is it accurate? Honestly, not at first. There was some user-error, where we entered in her height incorrectly. (Okay, I'm OCD enough that I measured it against my bike odometer and even against the car odometer to be sure- but I wanted to confirm it before I recommended it!) Ultimately, it worked perfectly on me but did not accurately count her steps, though we could not figure out why.

However, the main point is not so much that you need to know exactly how far you've gone (get a GPS-based one for better accuracy on hikes), but that you need to have accurate step counts so you can appreciate how your activity is IMPROVING each day. And wear it ALL DAY, not just when you are exercising, if you are simply trying to increase your overall fitness!
BOTTOM LINE: Check out all different kinds of pedometers, including the apps for your i-everythings!

Great Family Game!

Okay, after dealing with more serious issues all week, how about a fun one? Summer is a wonderful time to focus on your family, without the constant stress of homework and packed schedules. Breaking out a deck of cards or a traditional board game can be a terrific break from the electronic world we all live in. Our family is, well, a touch competitive- yes, including the adults ;0) So, we were thrilled to find a game a that allows us all to compete equally, yet on our own level: BANANAGRAMS.

The game comes in a cute little bag shaped like a banana. It consists of alphabet tiles like those in a Scrabble game. How it works is that each person creates their own crossword-type puzzle (again, a la Scrabble). Points do not matter, however- it's all about being the first person to finish your own puzzle, using up all of the tiles. The cool thing is that one player may use simple words (DOG, GO, MAD) while another is using SAT-prep words; it makes no difference!

Our family discovered this game a few years ago, and we actually have one we keep in the car for any restaurant trips. We typically play the condensed version which means that play starts once we've ordered our drinks and stops when the waiter arrives with the food. By the way, we purchased our first game in a local bookstore, and have since seen Bananagrams in numerous retail stores and on line. I have no financial ties to this product, though from the number of games we purchased for ourselves and friends, perhaps I should!

BOTTOM LINE: Find games to play with your friends and family that engage players of all levels, and sit back and ENJOY!

I would LOVE to hear from you about your family's favorite games!

Driving Safely While Aging Gracefully

This week, I've been talking about seniors, driving and maintaining independence. This topic is incredibly difficult to bring up with family members and friends. What role should the primary care physician play in this situation? Well, frankly, I'm sure we need to be playing a far more active role than most of do. In fairness, often it is difficult to squeeze in all the pure medical issues that an elderly patient has into a routine office visit. Many seniors have multiple chronic issues (such as high blood pressure, high cholesterol, diabetes or thyroid disease) and simply addressing the ongoing concerns with these problems more than fills the appointment time.

However, I do think that at least addressing driving issues should be a routine part of annual physicals for our aging patients. There is a wonderful booklet, developed by the USAA Educational Foundation, AARP, and the National Highway Traffic Safety Administration, that outlines the physical effects of aging, as well as tips on coping with them so that people remain a safe driver as long as they can. The booklet is called "Driving Safely While Aging Gracefully" Take a look at this booklet, and print it out (in large print) for the senior you are concerned about. Additionally, if you have concerns about a family member's driving, let their physician know. A simple note with specific concerns ("Mom has had several fender-benders in the last year" or "I'm scared for my kids to ride with my father because he darts out into traffic, or drives 40 mph in a 65 mph fast lane") will help direct your parent's physician.

BOTTOM LINE: Don't wait for a serious accident to address issues with seniors driving, and PHYSICIANS- remember to ASK about driving and recommend the booklet Driving Safely While Aging Gracefully.

More on Senior Driving

How else can you talk with a parent or loved one about whether or not it is time to stop driving? Well, for many seniors, they have realized that they are not as comfortable driving as they used to be. Perhaps they have already self-limited their driving: no driving at night, or in the rain, or maybe no driving on busy highways any more. Often, they have narrowed it down to a weekly grocery trip, often doubling up with their same weekly trip to church. At this point, they are most likely spending more money on car insurance, car maintenance and gas then they would spend on a car service!

If they feel uncomfortable with "a stranger" and using public transportation, perhaps you could consider paying a responsible family member or friend to set aside a couple hours per week to run errands. Frankly, in this economy, there are many people happy to make an extra $100 per month for a couple hours work per week! Relying on friends and family members for favors is fine for the occasional event, but making a real business arrangement- even at a minimum wage plus gas type fee-helps all parties be more consistent and helps the senior feel more empowered (as opposed to feeling like a "charity case" or that they are imposing on someone to ask for a ride.)

BOTTOM LINE: Consider the financial bottom line as a legitimate talking point when deciding whether or not to stop driving.

Senior Independence

One of the most challenging issues with an aging family member is whether or not they should drive. As we age, most of have significant decreases in hearing and vision, as well as delayed reflexes. As I argued with my own father, if you complain that you can't see and you can't hear, why are you still driving? Of course, his answer was that if we took away the car, we were taking away his independence.

So, what can you do? First of all, I encourage people to start using public transportation BEFORE they "have to". Now, in many parts of the country, this is no big deal, but in others (such as Texas) we tend to rely on our own cars. Public transportation can be buses or trains, but don't forget about the cabs! Using a debit card (or a gift card- hint, hint) for a taxi service gives many people the independence they want to preserve without be limited by a set schedule or need to get to a specific bus stop or station. Often, regular clients form a working friendship with a specific driver, which creates the feeling of having a personal driver more than "having to take a cab".

BOTTOM LINE: Giving up driving does NOT have to mean giving up your independence!

Happy Independence Day!

July 4th is a wonderful day in America, filled with family celebrations, picnics and fireworks. We are so fortunate to live in a country that allows us so many freedoms! In our family, this day has additional significance, as today marks the 6th anniversary of my mother's independence from Alzheimer's Disease. As we visited her grave today, surrounded by the incredible beauty of the wildflowers and the snow-capped mountains, I looked around the cemetery and wondered how many other lives represented there were affected by this disease.

Did you know we have over 5.3 million Americans living with Alzheimer's? Chances are good that you either have a family member or friend affected. We have medications that can slow down the progression of dementia, but none yet that can stop or cure it. With our aging population, it is clear that this disease alone will consume a progressively larger chunk of our healthcare dollars.
Check out the Alzheimer Association website, and consider participating in a local Memory Walk or other fundraiser.

BOTTOM LINE: Let's celebrate our country's independence today by thinking about the future of our aging population, and pro-actively working towards a cure for Alzheimer's.