Wednesday, December 06, 2006

Ralph Norris interview

I recently had the pleasure of interviewing Mr Ralph Norris (CEO of the Commonwealth Bank) for my book. Ralph was diagnosed with Diabetes a few years ago and has done an amazing job of controlling his condition. The reason I wanted to interview him is that the most common reason for not exercising or eating a healthy diet, is that people don’t have enough time. Well let me tell you Ralph is one of the busiest people in Australia (the guy runs a bank!!!!!!!) and travels for work extensively. With this busy schedule he would certainly have a lot of reasons why he couldn’t stick to a healthy lifestyle, yet Ralph’s diet and exercise would rate 5 stars with any health professional

Below are some of the keys I took from him on how a busy person manages their diabetes.

Outlook : His attitude was one of simplicity. So often we have internal conflict between our ears as to weather we should stick to our diet and exercise plan. Ralph looked at it so simply. I asked him how he keeps his motivation. He replied “Well I know that with Diabetes if I don’t eat right and exercise each day I run the risk of having heart disease, nerve damage, eye problems, and possible amputations. I don’t want those things to happen so I don’t even consider for a moment not sticking to my exercise and diet”. He went on to say “The whole thing is very simple, the problem is that most people over complicate it”.

Priority: For him his exercise takes priority in his day and is scheduled in before anything else. It is non negotiable.

Practical: Ralph stressed that any lifestyle change has to be practical. “I exercise first thing in the morning so that nothing will get in the way. If I leave it til the afternoon something will always take my attention away. Also when I am travelling I ensure that the place I stay in has a gym”.

No Excuses: Ralph went on to say “I eat out a lot and am on planes a lot, yet no matter where I go I can always find a Diabetes friendly meal to have. People often use these things as an excuse but at the end of the day there are always healthy choices. Its about making a firm decision to stick to a healthy diet”.

Not a Victim: Many people with glucose control problems complain that they are different to other people in the way that they have to eat and exercise. The bottom line is that a healthy diet and exercise routine for a person with diabetes is no different to the average person. Ralph’s comments backed this up, “My wife and I follow the same eating and exercise plan! Since I was diagnosed with Diabetes I have never been so fit and healthy and the quality of my life has never been better”.

Thanks Ralph for the words of wisdom.


The latest group to make it to the 3 month mark of the Glucose Club program that was sponsored by a very proactive corporate health fund, GU Health, have shown some amazing results. Over the 3 months the group lost 7kg in body weight and had a 0.8% reduction in their long term glucose levels (HbA1c). This is not bad for 3 months work considering that a 0.9% drop has been shown to reduce diabetic complications (eye problems, heart disease, amputations etc) by 20-50%.

Friday, August 25, 2006

Cut out the late night snacking

Are you a late-night eater? If you have diabetes, eating large amounts of food at night — more than one-quarter of your daily calories — you may be risking serious complications such as heart disease and kidney dysfunction. That is the finding of a new study that appears in the latest edition of "Diabetes Care."

Sunday, August 13, 2006

Kidney Disaster

The closer science looks, the more links it finds between lifestyle and long-term ailments, Julie Robotham writes in part two of a Herald series.

IN THE kidney dialysis unit at Royal Prince Alfred Hospital, patients get to watch TV free. Most public hospital patients pay a daily fee to activate the remote, but authorities have taken pity on those with kidney failure.

Hooked up to a machine that progressively filters their blood, five hours a day, three days a week, they get to see a lot of Oprah.

Magazines, knitting and a chat with those in the same predicament, and the entertainment options are just about exhausted. Only a quarter of patients remain in the paid workforce.

By any measure it is an unsatisfactory way to pass time, but dialysis is a reality for a growing number of Australians - for whom it is usually a late complication of a lifetime of imperfect health.

Ultimately, subsidising a few TV screens is a drop in the ocean. It costs between $50,000 and $100,000 to provide dialysis for a year, and most live three to four years after their illness has progressed this far.

"They have a lousy quality of life," says Associate Professor Steve Chadban, a transplant physician.

A healthy kidney filters water-soluble waste products. An unhealthy kidney leaves them in the bloodstream, dragging down the performance of just about every other organ.

Kidney disease, Chadban says, "affects mental functioning. People have inferior concentration. Physical stamina is reduced.

"We're hosing out the fires at this end. We need mass education at school to encourage people to have an active lifestyle and sensible eating habits."

About half of all cases of kidney disease occur in the wake of high blood pressure or diabetes, themselves often the direct consequences of excess weight and inactivity. Excessive weight can also damage the kidney directly, even in someone who is lucky enough to avoid diabetes, which is now the largest single cause of end-stage kidney disease. The kidneys are affected in about one-third of diabetics, but 90 per cent will die before their kidneys fail.

Even after this phenomenal rate of carnage, the ranks of Australians on dialysis are swelling by at least 6 per cent a year and swamping treatment services. Many are now so over-subscribed they no longer accept casual patients from elsewhere - adding the inability to travel to the indignities dialysis patients must endure.

Up to 2 million Australians have some kidney damage, of whom 40,000 have severe disease, including 12,000 - mostly in their 70s - who have reached "end stage", requiring dialysis or a transplant to stay alive. This is the sharp end of a mostly hidden epidemic.

But while few other diseases carry a comparable financial and personal cost for each victim, kidney failure is a microcosm of a rise in chronic illness attributable to poor diet, lack of exercise, excess weight and other features of a less than ideal lifestyle.

Clearly there is a paradox. We are living longer than ever. Children are rarely carried off by pneumonia or measles. Men no longer commonly drop dead from heart attacks in their 50s. By many measures we are healthier.

But there has been a trade-off. More of us are sustained through middle age and beyond on medications that keep us alive but sap our energy levels, blunt our libidos and mess with our heads. The exquisite boredom of the out-patient waiting room is a regular reality for an increasing number of people as medicine turns more to monitoring vital signs to head off the stroke or asthma attack before they happen.

Heart disease, arthritis, dementia, many cancers … the closer researchers look, the more links they find between daily lifestyle choices and the development of long-term health conditions, which threaten to ambush the health budget as the population ages.

Knee replacements last year outstripped hip replacements for the first time in Australia, as knee joints are more susceptible to overloading with extra weight. That is just one phenomenon in the changing demographics of arthritis, which is on the rise and affecting younger people, especially women.

Depending on the joint, the risk of arthritis may be doubled, trebled or even quadrupled in an obese person compared to one of normal weight, Access Economics found last year in a report commissioned by Arthritis Australia. "Twenty-four per cent of knee arthritis could be attributed to obesity," the report says. It also estimates that in 2004, 16 per cent of people were affected; their medical treatment cost $3 billion - 5 per cent of the health budget.

Factor in the indirect costs - carers, home modifications, special transport, lost taxes from those who can no longer work - and the bill climbs to $11 billion.

The cost of treating uncomplicated diabetes is $4000 per person per year, Professor Stephen Colagiuri from Prince of Wales Hospital told a state diabetes summit this year, rising to $10,000 for those whose disease has affected the eyes, heart or circulation. And conservatively, 1 million people have the disease, in which excess sugar in the blood combines with proteins in body tissues, attacking the heart, kidneys, eyes and blood vessel walls, leading to poor circulation and amputations - though only about half of the sufferers know they have it.

Being overweight, inactive or both can also increase the chance of developing a range of cancers.

John Hopper and Graham Giles from Cancer Council Victoria have tracked the effect of body weight on the occurrence of cancer and how patients fare after a diagnosis.

Their study of Victorian women found those who were obese were 50 per cent more likely to have a relapse of their disease and to die of any cause during five years of follow-up after a breast cancer diagnosis. There was no evidence doctors were under-dosing the obese women, and no evidence that their higher oestrogen levels contributed to their poorer prognosis.

The probability, the researchers concluded, was that the women's weight was linked to some other, as-yet unidentified, biological difference.

The same team found that the chance of developing myeloid leukaemia increased fivefold in overweight and obese people - or by one-third for every additional 10 centimetres they measured around the waist. And they confirmed a link between weight and bowel cancer.

The cancer council cautions people to try to limit weight gain to five kilograms or less throughout their adult life.

Fat chance! A wide-ranging national health study of Australian women published last year found the average young woman puts on five kilograms over seven years while she is in her 20s, typically before she has even started having babies. AusDiab 2, a large study of patterns of diabetes in the community, found women and men put on an average 14 kilograms between age 25 and 50.

As Australia's weight crisis worsens - pushed along by the ageing of the population - health authorities have a monster problem on their hands.

The system, with its grand old hospitals, its centres of excellence and its god-like specialists, was designed for a different era - in which otherwise healthy people would fall suddenly ill with a heart attack or infection, and either get better or swiftly die.

Administrators now need to realign that huge edifice to cater to a generation of people who may become moderately ill in midlife, and survive for decades.

At a conference on chronic disease last month, NSW Health officials outlined their strategy, adding arthritis, diabetes and dementia to a target list of illnesses for which an increasing proportion of care will be provided out in the community, and increasing from $15 million to $20 million annually the seed funding available to local areas to pilot new ways of working.

The good news, NSW Health's health system performance chief, Katherine McGrath, told the audience, was that 65,000 days of hospital care had been avoided for people with lung disease and heart disease. Extra heart monitoring machines and lung function measuring equipment had allowed better supervision of people with long-term illnesses in smaller clinics - preventing catastrophic relapses that would otherwise land them in emergency wards or in-patient beds.

Closer ties with occupational therapists, dietitians and psychologists and GPs meant more co-ordinated care and closer monitoring of symptoms.

But it was a speaker from the US, a few years ahead of Australia on the chronic illness curve, who captured the scale of the problem. "Thirty per cent of total health-care expenditure is attributable to 1 per cent of people," said Professor Paul Wallace, a medical director at health insurer Kaiser Permanente. "Over half the people in the [most expensive] 1 per cent have diabetes."

We are killing ourselves

For the first time in generations children may again die younger than their parents. They eat too much, walk less and worry more, write Julie Robotham and Sherrill Nixon. Sydney Morning Herald

THINK of it as a vast experiment in human biology. Put millions of people in a limited space, then crank a few levers: increase the hours they work, and increase the distance they have to travel; tempt them with material goods but undermine their sense of security about the future; allow them almost unlimited access to food, but subtly direct their choice by making grease and sugar most accessible. See what happens.

The results are nearly in. Half a century of postwar growth - driven by escalating production, and flavoured by hard-core consumption and mass migration to cities - is yielding a consistent global pattern.

The population's physical health is starting to degrade. The body, overfed and under-exercised, stacks on weight; those extra kilograms turn on their owners, unlocking diabetes, kidney disease and cancers from a genome that evolved with little experience of carrying fat. Psychiatric illness increases as unbarred competition between individuals excludes and denigrates the more vulnerable.

Weight gain, says Dr Michael Booth, is a physical portrait of consumerism, an externalisation of our value system. "We do need to do something about 'I will give myself pleasure whenever and however I please and not think about the consequences,"' he says. "It's a problem that comes with greater and greater wealth. We see the world as the range of things available to us. Virtually anything is there for the taking. We've lost the notion that we should be denied anything."

Australia's various chronic health epidemics - obesity in particular - have been widely noted. Less frequently remarked is the degree to which they are just the logical conclusion of the lifestyle we have collectively adopted. Work, food, suburbs - the fundamentals of our lives - are no longer calibrated to be in harmony with the human body and soul, but have been relegated to afterthoughts in rampant economies as they lap one high-water mark after another.

And for now at least, there seems little chance of a radical rethink. "The intensity in terms of policy we need won't happen until we all know a teenager with type-2 diabetes who has just taken 20 years off their life," says Booth, who is the director of the NSW Centre for Overweight and Obesity.

He is as aware as anyone how real that prospect is. The centre's study this year of more than 5000 children for the NSW Government found 20 per cent of year 10 students had raised insulin levels, putting them at increased risk of the chronic and incurable disease. Among the heaviest boys, that figure was 68 per cent.

It has been said frequently that this generation of children may die younger than their parents as a result of their weight gain. But the phenomenon of children having the physiology of unhealthy adults is so new that no one can really predict the consequences.

The fat boom is not reflected in official life-expectancy projections - slated to increase for at least another half century.

The Australian Bureau of Statistics considers a man who reaches 50 in 2051 will live to an average 87 years, and a woman to 89. Those are improvements of six and 4.5 years respectively on the present crop of 50-year-olds.

What seems guaranteed - because it is happening already - is that more people will live with debilitating illnesses that will reduce their capacity to work and leach the enjoyment from those extra years.

Booth thinks it will take two generations to fix the sabotaging of our health. Australia is now making serious progress with reducing smoking rates, he points out, but that has taken 20 years. "I think this is a much harder problem than smoking. Everyone's affected. Everyone sits, everyone eats."

CITIES are hymns to hyper-consumption, and from this year, for the first time, more than half the world's population will live in one. But Australia is well ahead of that trend. Three-quarters of us live in cities, says the Australian Bureau of Statistics, and the urban population is gaining four times as many people annually as regional Australia. Sydney alone gains 30,000 residents a year.

The London of Charles Dickens, with its orphans and its garbage-sifters and debtors prisons, added citizens at a similar speed, trebling from 1 million to more than 3 million during the 1800s. More than a century later and in developed countries there is less explicit urban poverty, but by other measures the modern city may be at least as hostile to the striving human, and possibly more so.

"Cities are only there because they're supposed to be useful to people. When they start to have more negatives to people than positives you have to stop and think," says Pieta Laut, the executive director of the Public Health Association of Australia. "We can sustain human life in some of the cruddiest environments, and always have. We need to get beyond what we can survive in, but what's good for a community … cities will not become untenable but they'll get nastier and nastier."

People will need more resources just to survive, and more people will be marginalised if they cannot run fast enough to keep up, says Laut, who was a town planner before finding its solutions too simplistic. "Life is complex and highly integrated. That's why I find public health so interesting."

In some remote Aboriginal communities infection-related deafness is so commonplace that people affected do not believe themselves sick.

Affluent city dwellers may have to drive two hours every day just to maintain their standard of living, but they do not consider that an imposition on their wellbeing.

It is the dark side of the celebrated adaptability of the human species. "There is a slow deterioration in human health - and people learn to accept that," Laut says.

She is not talking about the few people who are too fat to walk. She means the rest of us who buy a takeaway and collapse in front of the TV because life is too exhausting to contemplate doing otherwise.

"Our health system will do better by everyone losing two to five kilos," she says, than more dramatic weight loss among the heaviest.

Twenty-five years ago, long before it was either fashionable or profitable, David Crawford spotted the first signs of the weight-gain trend. Though it was then much less extreme, Crawford - now the associate head of Deakin University's School of Exercise Nutrition and Sciences - saw the association between weight and heart disease in statistics compiled by the National Heart Foundation, and took a punt on its importance. He has been delving into the connection ever since, and has watched the epidemic unfold.

"There's something basically wrong with our lifestyles," Crawford says. Diabetes and obesity are woven into the fabric of dysfunction, but so are, "depression, social isolation, people dying alone in an apartment".

He is frustrated with the standard political response to the latest dire new health statistic: "TV campaigns with jingles. That's lovely but most [researchers] would say on its own it's not going to make a difference."

He would prefer serious, focused study into the uncharted territory of how individuals navigate the plethora of options in their lives, and how these choices play into the balancing act of keeping them healthy.

"One of the areas I think we need to look much more closely at is those groups in the community who are disadvantaged. The gap between them and the rest of the community is widening all the time," he says.

"Just because healthy foods are readily available and well priced, is that enough to persuade people to eat them? You can't stop to fill your car without someone offering you a chocolate bar. There's all this informal eating that happens anywhere and everywhere nearly all the time."

On the other side of the energy-balance equation, Crawford says: "We are engineering exercise out of our lives, and opportunities to sit still are becoming even more common: ride-on lawn-mowers, kettles that switch themselves off. You can sit still and live huge chunks of your life."

Even beyond the home and garden, opportunities for incremental exercise are eroding, for some people at least. How suburbs are designed strongly influences how people travel around them, and that in turn is an important determinant of residents' health.

The mass production of cars early last century allowed suburbs to sprawl in areas not served by public transport. That was rapidly followed by the rise of the shopping mall, usually built on a busy, main road; who needed corner shops, when you could jump in your car and drive to retail heaven?

That assumption perpetuated itself. For decades, town planners creating new suburbs did not bother with local shops or public transport because they figured everybody had a car. Suburb design started to take on the look of a rabbit warren, full of dead-end streets and winding roads, because people no longer needed to walk. Only now are planners returning to the more grid-like pattern of older suburbs that makes it easier for people to leave the car behind.

Professor Anthony Capon, a visiting fellow with the Australian National University's National Centre for Epidemiology and Population Health, says Australia's suburb design is not quite as bad as that of the United States, but it goes close.

"The motor vehicle is positive in some respects," says the former medical officer with Sydney West Area Health Service. "I drive a motor vehicle, it can be quite liberating. But it's like penicillin. There's a place for it, it isn't a magic bullet. There's a need for a balance between the motor vehicle, walking, cycling and mass transit."

But for the people Professor Christina Lee studies - women - the developing science of the suburbs may continue to miss the point.

Even the terminology of the debate is a poor fit with the reality of women's lives, says Lee, the head of the School of Psychology at the University of Queensland and an architect of the long-running Australian Longitudinal Study on Women's Health.

Transport researchers talk about "journeys" and whether they are on foot, by train or by car. But time-use studies show women make more generalised forays into the outside world. A trip to work probably also involves ferrying children to sport or music, picking up dry-cleaning and dropping off a library book. That means for many women there is no realistic way to travel without a car - removing another opportunity for the small bouts of activity that add up to sufficient exercise.

n last year's update from the study, the average woman in her late 20s had gained five kilograms in seven years - despite the fact that two-thirds had not yet had children. It is a rate that far outstrips the average for adults.

Young women also had the highest depression rates. Money worries are having a real, measurable effect on women's health, says Lee, as casual work, shift work and a culture of working longer than standard hours to prepare for a conference or to get an order to a client have all taken the predictability out of the working week.

"The time pressure associated with money pressure means people are more likely to be working long hours," she says. "They're working unpaid overtime because they're frightened of losing their jobs, and paid overtime because they need the money."

The result is less time for all people - but women in particular with their extra family commitments - to use at their discretion. And that translates directly into poorer health.

"Particularly with exercise it's very easy to get out of a pattern and very hard to get back into it," she says. When unencumbered time evaporates, wellbeing goes with it. "It becomes kind of normal that you feel a bit tired and like you're going to come down with flu."

For Lee, the solution to Australia's chronic health crisis has to go well beyond public transport, well beyond a redesign of what we eat, when and how, and engage head-on with critical questions of social policy: child care, gender roles, disadvantage, industrial relations.

"An individual woman's decision that she's going to lead a healthy life can only take you so far," she says. "Individuals make choices, but only in a social context. Urban design, workplace relations … the interaction between personal preferences and social structure has fallen through the cracks."

Friday, August 11, 2006

Diabetes related to reduced Cognitive Function

SAN FRANCISCO, Aug. 10 -- Chronically elevated blood glucose saps cognitive function in older women, according to researchers here.


Postmenopausal women with glycosylated hemoglobin (HbA1c) levels of 7% or higher had a fourfold risk of mild cognitive impairment or dementia over four years compared with women with HbA1c lower than 7%, reported Kristine Yaffe, M.D., of the University of California San Francisco and colleagues, in the current issue of the Journal of Nutrition, Health and Aging.


"We already know there's a connection between diabetes and cognitive problems," said Dr. Yaffe. "We were interested in what this measurement [HbA1c] would tell us about a group of women with and without diabetes who were followed for four years. Nobody has really looked at that before."


The American Diabetes Association recommends maintaining HbA1c levels below 7%. The American Association of Clinical Endocrinologists recommends HbA1c levels at 6.5% or below.


The investigators conducted a four-year prospective study of 1,983 postmenopausal women with osteoporosis who had HbA1c levels measured at baseline.


The women, 53 of whom were known to be diabetic at baseline, had a mean age of 67.2 years. The investigators followed these women for signs of mild cognitive impairment or dementia over the study period as part of a dementia ancillary study. The analysis included risk for dementia or mild cognitive impairment potentially associated with every 1% increase in HbA1c, and risk associated with HbA1C of 7% or greater.


The mean level of HbA1c was 5.8% at baseline, ranging from 3.0% to 12.1%. Over the course of the study, 86 women (4.3%) developed mild cognitive impairment or dementia.


The authors found that for every 1% increase in HbA1c, women had a greater age-adjusted likelihood of developing mild cognitive impairment (odds ratio 1.50, 95% confidence interval, 1.14-1.97) and of developing MCI or dementia (odds ratio 1.40, 95% CI 1.08- 1.83).


For the 49 women with HbA1c levels of 7% or higher at baseline, the age-adjusted risk for developing mild cognitive impairment was increased nearly fourfold (odds ratio 3.70, 95% CI 1.51-9.09) and nearly threefold for developing either mild cognitive impairment or dementia (odds ratio 2.86; 95% CI 1.17-6.98).


When the 53 women with diabetes were excluded from the analysis, the association between HbA1c and mild cognitive impairment was a little less robust, but still elevated, the authors reported. The unadjusted odds ratio for mild cognitive impairment among the women without diabetes was 1.59 (95% CI, 1.01-2.50). The age-adjusted odds ratio in this group was 1.42 (95% CI, 0.89-2.28).


In addition, in multivariate analyses adjusted for age, education level, race, depression, alcohol use, and treatment with raloxifene, the association between HbA1c and cognitive impairment was similar, the investigators reported.


"Type 2 diabetes is a very common and growing problem," Dr. Yaffe said. "The point is that now you can identify people who are at risk for mild cognitive impairment or dementia and monitor them closely with glycosylated hemoglobin. I think we need to take these people who are at risk and see whether we can target them for trials or interventions for better blood glucose control."

Myths about Diabetes

Here from the American Diabetes Association are just the facts on eight myths about diabetes:

Myth No. 1: You can catch diabetes from someone who has it. Fact: Diabetes isn't contagious like the flu. Major causes include lifestyle, aging and heredity.

Myth No. 2: Diabetics can't eat sweets. Fact: People with diabetes can eat sweets and desserts as part of a healthy diet and exercise plan.

Myth No. 3: Eating sugar causes diabetes. Fact: Weight gain from too little exercise and too many calories is strongly linked with type 2 diabetes. The calories can come from sugar, protein or fat.

Myth No. 4: Avoid insulin since it puts weight on. Fact: For most diabetics, the benefit of better blood sugar control with insulin far outweighs the possible risk of gaining weight.

Myth No. 5: People with diabetes need special food. Fact: Special foods aren't necessary. A diet that is low in fat, moderate in salt and sugar, and high in produce and whole grains brings the greatest health benefits.

Myth No. 6: Diabetics must strictly avoid starchy foods. Fact: Reasonable amounts of starchy foods such as whole grain breads, cereals, pasta, rice, potatoes, yams, peas and corn are part of a healthy meal plan for diabetics. People with diabetes can typically eat about three or four servings a day.

Myth No. 7: People with diabetes are prone to colds and flu. Fact: The risk of contracting contagious illnesses is no greater when you have diabetes. It's a good idea to get an annual influenza shot, however, since an infection can send blood sugar levels skyrocketing.

Myth No. 8: Insulin causes cardiovascular disease. Fact: Insulin does not cause heart disease, the No. 1 killer of people with diabetes. The real culprit is elevated blood sugar levels in untreated or inadequately controlled diabetes.

Chromium helps people with Diabetes

Results from a new study in patients with type 2 diabetes demonstrate that daily supplementation with 1000 mcg of chromium as chromium picolinate, in combination with a common oral anti-diabetic medication, improves insulin sensitivity and glucose control better than the oral anti-diabetic agent alone.

The study found that chromium picolinate significantly reduced the weight gain typically associated with the use of a commonly prescribed antidiabetic medication.

These findings are significant as more than two-thirds of people with type 2 diabetes are not at the suggested goal for their blood sugar.

Additionally, more than 80 percent of people with type 2 diabetes are overweight, which can significantly increase their risk of disease-related complications, including cardiovascular disease, which is the leading cause of death amongst patients with diabetes.

Wednesday, August 09, 2006

vegan diet

A low-fat vegan diet treats type 2 diabetes more effectively than a standard diabetes diet and may be more effective than single-agent therapy with oral diabetes drugs, according to a study in the August issue of Diabetes Care, a journal published by the American Diabetes Association.

Study participants on the low-fat vegan diet showed dramatic improvement in four disease markers: blood sugar control, cholesterol reduction, weight control, and kidney function. The randomized controlled trial was conducted by doctors and dieticians with the Physicians Committee for Responsible Medicine (PCRM), the George Washington University, and the University of Toronto with funding from the National Institutes of Health and the Diabetes Action Research and Education Foundation.

The vegan diet represents a major departure from current diabetes diets, in that it placed no limits on calories, carbohydrates, or portions. "The diet appears remarkably effective, and all the side effects are good ones - especially weight loss and lower cholesterol," says lead researcher Neal D. Barnard, M.D., PCRM president and adjunct associate professor of medicine at the George Washington University. "I hope this study will rekindle interest in using diet changes first, rather than prescription drugs."

Diabetes rates have climbed rapidly in recent years, and more than 20 million Americans now have the disease, which is linked to kidney failure, blindness, and cardiovascular disease.

camp for kids with diabetes

Juvenile diabetes has become a growing concern in this country, but a local medical center is doing something to help. Ashli Kimenker went to Diabetes Summer Camp at the FMC Park today.
Portneuf Medical Center hosted their Juvenile Diabetes Summer Camp today, and the kids gained more than just a education.

Learning about diabetes isn't fun, but it is something kids who have it need to know.

Nancy Bickley, camp organizer: "One of the important things about managing their diabetes is that they have a knowledge, they know how to do good management, and that's what we do. We try to make them learn about it in a fun way and gain some education about it."

But education wasn't the only goal of this camp.

Nancy Bickley, camp organizer: "I think probably the most important thing is that they develop really good friendships. They learn about diabetes and they kind of become motivated to do better."

Building friendships between the children shows they have support, and that is what keeps one mother and daughter coming each year.

Joann Cook, happy mother: "Becky loves it. She loves seeing the little kids take care of their blood sugars and it's a good educational thing and it makes the kids feel all on the same level like nobody is different."

Showing them they aren't alone is a successful way to build awareness and build a support group of kids their own age.

"The best thing is that they talk together and they find out what to do about their diabetes. They can talk about their different problems and what they do."

Organizers said they have these camps because the best way to learn how to take care of yourself the rest of your life is to start early.

New proof that Diabetes is an epidemic

NEW research has provided compelling evidence of the rapid increase of diabetes in Australia.

The study investigated medicine used to control diabetes and found a twofold increase in the use of insulin and a threefold increase in the use of oral blood glucose-lowering medicines between 1990 and 2004.

According to the report, Use of Medicines by Australians with Diabetes, released by the Australian Institute of Health and Welfare (AIHW), the trend is continuing.

Kathleen O'Brien, from the AIHW's Cardiovascular Disease and Diabetes Unit, said the growing use of antidiabetic medicines was consistent with the increasing number of Australians being diagnosed with type two diabetes.

About seven per cent of Australian adults have type two diabetes, which has been called the "lifestyle disease" and is often blamed on obesity and poor diet.

According to the AIHW, 89 per cent of men and 64 per cent of women with type two diabetes are overweight.

Ms O'Brien said some people with type two diabetes could control their blood glucose through lifestyle measures alone, but some required medication, and all sufferers of type one diabetes required insulin.

An estimated 75 per cent of Australians with either type one or type two diabetes used insulin or other medications to manage their condition.

"Diabetes is a chronic condition that can have a major impact on life expectancy and quality of life, especially if undetected or improperly controlled," Ms O'Brien said.

"A healthy diet and regular exercise are important in managing blood glucose levels.

"Along with avoiding smoking and maintaining good control of blood pressure and cholesterol levels, these lifestyle approaches also help reduce the risk of complications such as heart attack and stroke."

The report also investigated medication used to control diabetes complications such as high blood pressure and high cholesterol and found use of those medications had also increased.

Other complications of diabetes include coronary heart disease, diabetic eye disease, kidney disease and circulatory problems that can lead to foot ulcers and lower limb amputations.

A report published in the latest edition of the Medical Journal of Australia found half of all diabetics also have chronic kidney disease.

vegetables prevent diabetes

Chomping on a few vegetables may help ward off diabetes. That is according to a new study at the Minnesota School of Public Health. Inside these and other orange, red, and green foods like carrots, tomatoes, kale, and spinach are caroteniods. Those carotenoids have previously been shown to protect against cancer. These have been shown to lower your odds of a lifetime of getting diabetes, but there is a catch. This is only true if you don't smoke. When researchers looked at the combined effect of smoking and eating these foods, they were trying to find out if a smoker with high carotenoid levels might still be protected against diabetes. They concluded that smoking somehow blocks the protective benefit of these nutrients

Researchers analyzed data of nearly 5,000 people between the ages of 18 and 30 and then followed them for 16 years. Non-smokers with high carotenoid levels were less likely to develop diabetes, but smokers saw no similar benefit. Carotenoids may counteract oxidative stress in the body and that is how it is thought that they reduce the risk of diabetes. However, this antioxidant metabolism and oxidative defense system appears to behave differently in smokers than non-smokers. With that said, we talked to addictive psychiatrists at the University of Cincinnati and asked their advice if you are a person who needs to quit smoking. "Get help," was the advice offered by Dr. Robert Anthenelli. "It's nearly impossible to do things by oneself and there's a lot of good help available in the Greater Cincinnati Area." Some of that help is available through the Tri-State Tobacco and Alcohol Research Center.

Go Low GI

ISLAMABAD: People with diabetes are advised to watch the amount of carbohydrates in their diet, but that may not be enough. The so-called glycemic index of food can also have a big impact on blood sugar levels.
Past research has shown that the effect on blood glucose levels of different foods with the same carbohydrate content can vary by as much as five-fold. This has led to foods being assigned a glycemic index. The glycemic index multiplied by the amount of carbs indicates the glycemic load of a particular food.

"The use of diets with low glycemic index in the management of diabetes is controversial, with contrasting recommendations around the world," Dr. Jennie Brand-Miller, of the University of Sydney, Australia, and associates note in the medical journal Diabetes Care.

To investigate further, they pooled the results of 14 clinical studies comparing the effects of diets with low versus high glycemic indexes on overall glycemic control in diabetic patients. Assessment of glycosylated hemoglobin (HbA1c) levels indicated the degree of control over a period of time.

The researchers report that "low-glycemic index diets reduced HbA1c by 0.43 percentage points over and above that produced by high-glycemic index diets."

They conclude that their analysis "provides objective evidence that targeting postprandial hyperglycemia via choice of low-glycemic index foods has a small but clinically useful effect on medium-term glycemic control in diabetics."

Nutrition and lifestyle approaches to diabetes prevention and treatment, they recommend, "should be given as much attention as drug therapies."

Soy may help kidneys

ISLAMABAD: The kidney function of people with type 2 diabetes seems to be improved by dietary soy protein, with the added benefit that their levels of "good" cholesterol also go up a bit, preliminary research suggests.
Kidney function often becomes impaired with long-standing diabetes. The study of 14 older men with diabetes-related kidney disease found that adding a soy product to their diets reduced the amount of protein in their urine -- an indicator of improved kidney function.

The study is too small to draw conclusions, but the results provide "initial evidence" that isolated soy protein may help reduce diabetics’ risk of kidney and heart disease, the researchers say.

Dr. John W. Erdman Jr., one of the study’s authors, told Reuters Health he hopes the work will spur larger studies.

It’s unclear why soy protein might aid in diabetic kidney disease, but estrogen-like plant compounds called isoflavones could be involved, said Erdman, a professor of food science at the University of Illinois at Urbana-Champaign.

He and his colleagues there and with the Veterans Affairs Illiana Health Care System in Danville, Illinois, report the findings in the Journal of Nutrition.

For eight weeks, men in the study used an isolated soy protein powder that could be added to a drink or food. For another eight weeks, they used a milk-based protein powder.

The goal, Erdman explained, was to have the men replace part of their usual protein intake with the soy or milk protein; however, the patients failed to follow the diet instructions and instead added the protein powders to their normal routine.

Yet even with the extra protein intake, the men’s excretion of protein in urine fell an average of nearly 10 percent when they consumed the soy product, the researchers found. In contrast, protein levels in the urine increased with the milk-based powder. < In addition, eight weeks on the soy powder boosted the men’s levels of heart-healthy HDL cholesterol by about four percent, while it tended to dip while the men were on the milk protein.

It’s possible, Erdman and his colleagues note, that the estrogen-like activity of soy isoflavones explain the kidney effects they found, because kidney disease seems to progress more slowly in women than men, and estrogen may be a factor. In this study, blood tests showed that as the men’s isoflavone levels increased, their protein excretion declined.

Another possibility, Erdman said, is related to the fact that soy protein and animal protein have different compositions. While using the soy powder, the men’s blood levels of amino acid called arginine increased; arginine is a precursor to nitric oxide, a compound that helps dilate blood vessels.

The study received partial funding from Protein Technologies International, maker of the soy- and milk-based protein powders used in the research.

Chromium helps Diabetes

ISLAMABAD: Chromium supplementation may be good for the heart in people with type 2 diabetes, according to study findings. It appears to lead to a shortening of a harmful heart rhythm, which may lower cardiovascular risk in type 2 diabetics.
The heart rhythm disturbance known as a prolonged QT interval has been linked to fatal heart arrhythmias. Therefore, the changes in QT interval observed with chromium supplementation in patients with type 2 diabetes may also translate into a survival benefit, study investigator Dr. Bojan Vrtovec from Ljubljana University Medical Center in Slovenia told Reuters Health.

In the study, researchers had 30 diabetic patients take 1000 micrograms of chromium daily for 3 months followed by an inactive placebo for 3 months. Another 30 diabetic patients started with 3 months of placebo and then crossed over to chromium for 3 months.

At the start of the trial, the QT interval viewed on a standard electrocardiogram or ECG was similar in both groups -- 422 milliseconds in the first group and 425 in the second group.

However, at 3 months, the QT interval was significantly shorter in the supplementation group (406 milliseconds) than in the placebo group.

In the next 3 months, QT shortening was observed in the second group but not in the first group. At the end of the study, the OT interval duration was similar in both groups and was markedly lower overall than at the start of the trial before chromium supplementation.

This study shows that increased intake of chromium may lower cardiovascular risk in type 2 diabetic patients, the researchers say.

They also note in the American Heart Journal that blood insulin levels decreased significantly after 3 months of chromium supplementation and this may be partly responsible for the QT interval shortening.

A prolonged QT interval has been associated with high blood sugar levels, high insulin levels and reduced sensitivity to insulin in type 2 diabetics, they explain. Chromium supplementation improves sensitivity to insulin, lowers blood insulin levels and improves glucose homeostasis.

Thursday, August 03, 2006

Wal-Mart fights diabetes

For six weeks this August, September and October, dLife will be part of
the Wal-Mart and SAM'S CLUB Diabetes Aware & Care program occurring at over
2200 store locations.
dLife will assist Wal-Mart by providing in-store diabetes education, a
valuable membership offer for Wal-Mart customers, dLifeTV video airings and
much more. dLife CEO Howard Steinberg believes this is a prime example of
responsible entities coming together for a common goal. "Wal-Mart has a
long history of providing a major service to America's diabetes population,
including screening millions for diabetes over the past few years. It is
critical to reach people in their daily habit stream to make them more
aware about diabetes and help educate and motivate those with diabetes to
better care for themselves. We feel it is an honor to be Wal-Mart's partner
in this important effort."
About dLife and dLifeTV
dLife is the first and only multimedia platform for information,
inspiration, and connection to help people with diabetes manage their
challenging condition and live long and healthy lives. dLifeTV, the first
weekly lifestyle talk show about diabetes, is produced by dLife and airs
Sunday evenings on CNBC at 7:00PM ET, 6:00PM CT, and 4:00PM PT. dLifeRadio
is heard around the country and on XM satellite radio. dLife.com is the
largest independent website devoted to the diabetes lifestyle.

coffee is great for women

A study recently analysed the coffee-drinking habits of 28,812 post-menopausal women who averaged 61 years old and did not have diabetes or heart disease. During an 11-year period, 1,418 women reported a diagnosis of diabetes. Overall, those who drank the most coffee were 22% less likely to have diabetes, with decaf drinkers reaping even greater benefits, at a 33% less risk (versus 21%).

Sunday, July 30, 2006

How common is it?

From

mydr.com.au

An alarming number of Australians and Europeans have diabetes, with many new cases expected to be diagnosed in the coming years, according to Australian and European research.

The Australian Diabetes, Obesity and Lifestyle Study (AusDiab), presented to Federal Health Minister Michael Wooldridge in April this year, revealed that diabetes and its associated complications are set to become Australia’s most costly and significant public health issue within a decade.

AusDiab showed that one in 4 Australians now has diabetes or are at high risk of developing it in the next 5–10 years, while the number of Australians with diabetes has increased by more than 300 per cent in the past 20 years, from 250,000 to one million.

Co-Chief Investigator of AusDiab, Professor Paul Zimmet, warned public health officials to take heed of the figures.

‘This is now an epidemic rivalling infectious diseases such as smallpox, typhoid and cholera. The scenario is identical for obesity, a major cause of diabetes,’ Professor Zimmet said.

Meanwhile, similarly alarming European results were announced at the International Diabetes Federation’s Summit in Switzerland in May.

It was revealed that Type 2 diabetes (previously referred to as non insulin-dependent diabetes) currently affects one in 20 European adults (about 22.5 million in all), with a further 6 million expected to be affected by 2025.

An even more worrying fact is that half of these people are undiagnosed and a further one in 7 adults (65 million) has a condition that places them at very high risk of developing diabetes and its associated complications.

Despite advancements in its treatment, Type 2 diabetes remains a major risk factor for blindness, amputations, kidney failure and cardiovascular disease (heart disease and stroke). Eight out of every 10 people with Type 2 diabetes will die from cardiovascular disease.

International Diabetes Federation President Professor Sir George Alberti urged governments to take action to fight the growing worldwide epidemic of diabetes.

‘Prevention and early detection of Type 2 diabetes must now be the priorities. It is time to consider screening high-risk individuals for diabetes,’ Professor Alberti said.

The major risk factors for diabetes are a family history of the disease, obesity, being aged over 50 and being from certain ethnic backgrounds, such as Pacific Island or Asian Indian.

Exercise for type 2 diabetes mellitus.

Exercise for type 2 diabetes mellitus.

Thomas D, Elliott E, Naughton G.

BACKGROUND: Exercise is generally recommended for people with type 2 diabetes mellitus. However, some studies evaluate an exercise intervention including diet or behaviour modification or both, and the effects of diet and exercise are not differentiated. Some exercise studies involve low participant numbers, lacking power to show significant differences which may appear in larger trials.

OBJECTIVES: To assess the effects of exercise in type 2 diabetes mellitus. SEARCH STRATEGY: Trials were identified through the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and manual searches of bibliographies. Date of last search was March 3, 2005. SELECTION CRITERIA: All randomised controlled trials comparing any type of well-documented aerobic, fitness or progressive resistance training exercise with no exercise in people with type 2 diabetes mellitus.

DATA COLLECTION AND ANALYSIS: Two authors independently selected trials, assessed trial quality and extracted data. Study authors were contacted for additional information. Any information on adverse effects was collected from the trials.

MAIN RESULTS: Fourteen randomised controlled trials comparing exercise against no exercise in type 2 diabetes were identified involving 377 participants. Trials ranged from eight weeks to twelve months duration. Compared with the control, the exercise intervention significantly improved glycaemic control as indicated by a decrease in glycated haemoglobin levels of 0.6% (-0.6 % HbA(1c), 95% confidence interval (CI) -0.9 to -0.3; P < 0.05). This result is both statistically and clinically significant. There was no significant difference between groups in whole body mass, probably due to an increase in fat free mass (muscle) with exercise, as reported in one trial (6.3 kg, 95% CI 0.0 to 12.6). There was a reduction in visceral adipose tissue with exercise (-45.5 cm(2), 95% CI -63.8 to -27.3), and subcutaneous adipose tissue also decreased. No study reported adverse effects in the exercise group or diabetic complications. The exercise intervention significantly increased insulin response (131 AUC, 95% CI 20 to 242) (one trial), and decreased plasma triglycerides (-0.25 mmol/L, 95% CI -0.48 to -0.02). No significant difference was found between groups in quality of life (one trial), plasma cholesterol or blood pressure.

AUTHORS' CONCLUSIONS: The meta-analysis shows that exercise significantly improves glycaemic control and reduces visceral adipose tissue and plasma triglycerides, but not plasma cholesterol, in people with type 2 diabetes, even without weight loss.

A new Canadian study indicates that diabetics have the same risk of cardiovascular disease as someone who is 15 years older. The Eye on Health Team spoke with a local heart surgeon who is not surprised by the findings.

Researchers found, on average, a 40-year-old diabetic has the same risk for heart disease as a non-diabetic at age 55.

Las Vegas cardiovascular surgeon, Matthew Cooper, says evidence of diabetes shows up in pre-operative angiograms. "Because diabetics tend to have very diffuse and very severe disease. And we often say that their arteries looked pruned. That is, they're very small like the small branches of a tree branch," Dr. Cooper said.

The narrowing effect which diabetes has on blood vessels can sometimes cause an enlarged heart. If the diabetic patient winds up needing a procedure such as a bypass, their outcome and recovery is less certain.

"Dr. Cooper continued, "Diabetes is a significant risk factor in patients we operate on. And when there's poor left-ventricle function, the left ventricle being the main pumping chamber of the heart, that really is the main determinant of long-term survival."

Dr. Cooper says that even close monitoring of blood glucose levels is not a guaranteed protection against heart disease. Proper diabetes management, including exercise, improves your odds.

"Individuals who tightly control their sugars, in general usually take better care of themselves overall. The better shape you're in, the better you're able to handle any additional insult, whether that be progression of your heart disease or anything else that comes along," he explained.

Dr. Cooper says diabetics who smoke are taking an even bigger risk. That combo can be lethal on the heart.