Diabetes from Hamburgers?

Last week, the media was abuzz with a recent study: Changes in Red Meat Consumption and Subsequent Risk of Type 2 Diabetes Mellitus, published in JAMA. Since my last post was addressing knowing your diabetes risk, this is a nice follow up, so I will jump on the bandwagon.

The study involved several separate groups: over 26,000 men in the Health Professionals Follow Up Study, nearly 50,000 women in the Nurses Health Study and around 74,000 women in the Nurses' Health Study II. Dietary choices were tracked with validated food records updated every four years.

What did they find? People who increased their red meat intake during a four year interval had a significantly higher risk of developing diabetes in the next four years. In fact, adding only a half serving of meat per day was associated with a 48% elevated risk, and on the flip side- DECREASING your red meat intake by more than a half serving per day was associated with a 14% DECREASE risk of developing diabetes over the next four years.

Did eating those extra steaks and burgers (and maybe the baked potato and fries on the side) just make people gain weight, and because of the weight gain, then develop diabetes? Researches agree that this theory played a role, but only partly explained the significant changes.

BOTTOM LINE: Significantly lowering your average daily red meat consumption appears to decrease your risk of developing diabetes. Take it a step further, and REPLACE that red meat with some colorful vegetables, and you will really give yourself a healthy push!

Are YOU at Risk for Diabetes?

Although the internet is packed with misleading and erroneous medical advice, there certainly are a great number of medically accurate and helpful sites as well. Today I stumbled across an excellent tool to help people quickly assess their risk for DIABETES on the American Diabetes Association website:
The Type 2 Diabetes Risk Test. Their catch phrase is "It's Fast. It's Free. It's Easy."- and it IS all that!

The numbers of people being diagnosed with type 2 (adult onset) diabetes in this country are staggering. There are nearly 2 MILLION new cases of diabetes being diagnosed each year in the United States, and nearly 80 MILLION people thought to have Pre-Diabetes. To clarify, Type 1 Diabetes, previously known as Juvenile diabetes, is a condition typically diagnosed in childhood or young adulthood, when the person's pancreas is not able to produce insulin.

This type accounts for only around 5% of all diabetics. Type 2 Diabetes is the more common type, and in this disease the body makes insulin, but either it cannot make enough insulin or the cells in the body are resistant to the insulin. Either way, blood sugars rise and cause problems in the rest of the body (such as the kidneys, eyes, blood vessels and nerves) and that sugar is not being converted into energy.

Bottom Line: If you are overweight and/or have a family history of diabetes, or simply are wondering about your risk, please take a minute and jump to the ADA website and see where you stand. Then take that number with you and head to your family doctor to see how you can optimize your health and minimize your risk for developing diabetes!

It's NOT the Carrots!

I've been practicing medicine for nearly two decades now, and I find it fascinating to see some of the persistent myths in medicine- most of which pertain to food/calories/weight loss. I find that people get very caught up in looking at specifics, and miss the big picture entirely. The classic example of this is CARROTS.

Many of my diabetic patients tell me that they are careful to avoid CARROTS, because they have such a high glycemic index. The same is true for fruits ("don't worry, Dr. Grimes, I KNOW not to eat bananas or apples!") Seriously? I believe with all my heart that everyone SHOULD know deep down that carrots and fruits are HEALTHY choices. Diabetic or not, these foods should be part of your healthy diet. Okay, yes, if eaten alone, carrots can transiently raise your blood sugar, but if you have adult onset diabetes, it is WEIGHT LOSS that will ultimately improve your blood sugars. I have yet to meet a SINGLE person who is overweight from eating too many fruits and vegetables. It simply does not happen.

If you are overweight, please take an honest look at what you are eating. In fact, write it down- all of it- for a few days. Perhaps the daily Starbucks muffin & latte have a little something to do with your extra calories...And while lettuce, carrots, tomatoes and cucumbers are all healthy, low calorie choices, adding tons of croutons, sunflower seeds, cheese and a generous amount of ranch dressing take a healthy salad and push the calories too high to help with a weight loss plan.

Carrots are a wonderful source of nutrition. They are packed with provitamin A, vitamin E and vitamin K. Carrots satisfy the need to crunch and work beautifully to scoop up hummus as an afternoon snack.

BOTTOM LINE: Recognize that no one is UNHEALTHY from eating too many fruits and vegetables. Ramp up these foods, limit processed "junk", and talk to a registered dietitian if you want to get serious about improving your diet!

How are the Poor Obese?

When did it become the norm that poor people are obese? Right now, 1 in 3 Americans are obese, and nearly 2 in 3 are overweight or obese. Throughout history, the poor have been HUNGRY...and thin. Meat has become cheaper than grains and vegetables, while we super-size and sugar everything. Check out the CDC's latest info on obesity in America for some shocking statistics...

Remember when going to the ice cream store meant picking out a single scoop of your favorite one of 31 flavors? Now the ice cream is simply the base, and we put multiple toppings of fudge and CANDY on top of our multiple scoops. In simply the past decade, fast food sales climbed from $107,147 BILLION to $164,836 BILLION dollars per year. Hmm...what if we spent some of those BILLIONS on health promotion, instead?

Obesity has numerous health consequences: Type 2 Diabetes, heart disease, high blood pressure, stroke, cancers (such as colon, breast and uterine), liver disease, sleep apnea and joint problems (especially knee and hip.) Our estimated obesity-related medical costs as a nation are $147 Billion annually. The obese INDIVIDUAL spends at least $1400 more on their medical care than a normal weight person.

BOTTOM LINE: Stop looking for the perfect diet, diet pill, or most amazing gym, and start making common sense small changes, like focusing on eating MORE vegetables and fruits and getting MORE active!

Raise a Glass for the Mediterranean Diet!

Cheers! We have MORE good news about the Mediterranean Diet. A recent study (Reduction in the Incidence of Type 2-Diabetes with the Mediterranean Diet: Results of the PREDIMED-Reus Nutrition Intervention Randomized Trial) showed a "52% reduction in the incidence of diabetes" whether or NOT the participants lost weight! We have known for years that weight loss will reduce your chance of developing diabetes if you are overweight, but this is the first significant study to show that simply a change in the types of foods you eat-regardless of the total calories- can make a difference.

The study took place in Spain, and consisted of around 400 non-diabetic adult patients aged 55-80. They were randomly placed on either a low fat diet or a mediterranean diet. Those in the control group (the low-fat dieters) had a 17.9% incidence of diabetes at four years, whereas those on the mediterranean diet had 10-11%.

So, what does the Mediterranean diet consist of? LOTS of olive oil, fruits, vegetables, legumes, nuts & fish, moderate red wine, and less meat (using white meats more than red.) Also, they recommend avoidance of butter, cream, fast-food and sweets. Hmm. Sounds like MORE, doesn't it?
Once again, we find that eating more whole foods like fruits, veggies, and nuts, while reducing processed stuff like fast food and instant boxed meals (think mac & cheese) is good for you.

BOTTOM LINE: Pump up the olive oil, fish, nuts, fruits and vegetables to help decrease your risk of becoming diabetic!

Avandia Latest News

Last week, the FDA issued more restrictions regarding the diabetes medication Avandia (rosiglitazone). You can read the full notice at FDA.gov, but I will try and hit the highlights for you.

Avandia is a "TZD" which is a class of medications that helps to increase the body's sensitivity to insulin in diabetics. We have seen that it is very effective at lowering blood sugars. Unfortunately, it was discovered that this class should NOT be used in diabetics who also have congestive heart failure. Now, additional studies have shown that there is also an increased risk of heart attack and stroke in patients who took Avandia. At this time, the other drug in the same TZD class, Actos (pioglitazone) is not proven to have the same risks, though many experts are concerned this will be a class effect. Europe has completely withdrawn Avandia from the market, but in the United States, patients doing well on Avandia may discuss the risks with their physicians before making a decision whether or not to continue this drug.

What should YOU do if you take Avandia? There is no need to panic, but schedule an appointment with your doctor to discuss what is best for you. My advice is to take this news as a wakeup call that it is time to STOP LOOKING TO PILLS for an answer for your diabetes, and get serious about the behavior modifications in your diet and exercise that are necessary to reverse your disease! Yes, there are patients with adult onset diabetes who are thin and fit (I have three such patients in my practice) but the vast majority are significantly overweight. The GREAT news is that I have seen time and time again that when patients really embrace healthy eating and daily exercise ("MORE") the high blood sugars, high blood pressures, and high lipids (cholesterol) not only improve, but often disappear!

In Western medicine, we are conditioned to find the quick fix for disease states by prescribing the "right" pill. We have invented wonderful medications that improve the quality and quantity of life. However, the longer people take them, the more long term side effects we identify. What is safe and the "best" practice today is often the next great lawsuit tomorrow. I am NOT anti-medication, but I am most definitely PRO-behavior modification when that choice exists to treat the same problem.

BOTTOM LINE: If you take AVANDIA, please schedule an appointment with your physician and ask for concrete suggestions for a healthier lifestyle!
PS. For a jump start towards "MORE" health, check out my January 2010 blogs: More, More Exercise Buddies, More Fun, When is a pound really gone, etc.

"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!

Too Tired to see the Doctor?

Should you bother going to the doctor when your only complaint is "I'm tired"? Well, truthfully, it depends. If there is an obvious explanation- having a newborn and getting no sleep, starting back to school while working two jobs (and getting no sleep), having a teenager learning to drive (and getting no sleep)- see the trend? However, if you have not changed your diet or sleep patterns significantly and you find yourself sleepy or fatigued all the time, then YES, DEFINITELY go see your doctor!
What could it be? Anemia (low red blood cell count), thyroid disease, diabetes, infections (especially chronic viral ones such as mono or hepatitis), fibromyalgia (and other rheumatic diseases) and vitamin deficiencies are the most common causes that I see. Certainly there are other more serious causes such as cancers, kidney or heart failure, or neurologic disease, to name a few, but my point here is that there are many causes of fatigue that can be improved or cured IF you are looking for them!
BOTTOM LINE: Don't be "TOO TIRED" to go to the doctor and find out what might be causing your fatigue!