| Litvin Centers for Diabetes Newsletter |
Volume 31
July, 2008 |
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With the summer season upon us again, here are some of my tips for keeping diabetic patients healthy and safe:
*During these hot and humid months it is imperative to stay well hydrated. Trust your thirst! The drive to drink is very basic and is "hard-wired" into our brains from the time we as a species emerged from the oceans. Don't listen to commercials regarding drinking habits, humans were here long before bottled water! Quench your thirst, but don't over-drink.
*Take advantage of the extended daylight and spend more time outdoors to "stetch your muscles."
*Test your glucose levels more often, you may need to decrease your insulin dosage to prevent hypoglycemia. Maintain your caloric intake and don't gain any weight.
*Get ample sleep - no less than 6 hours.
Have a happy and healthy summer!
Dr. Litvin |
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Recent Diabetes News
The ACCORD Study
This study involved 10,251 diabetic patients that were divided into two treatment groups: one intensive, in which HbA1c levels were aimed to come down to 6.4% after 3.5 years, and one standard, in which level was set at 7.5%. A third of the patients had a previous cardiovascular event (heart attack or stroke). Interestingly, and almost paradoxically, the intensive group had a higher (22%) relative increase in all-cause mortality, compared with the standard group. It's as if normalizing their A1c levels, caused more trouble for the patient than predicted. Consequently, the American Diabetes Association has revised their guidelines to reflect these findings, and is promoting more focus on hypertension and lipids correction, and a more moderate approach to the control of diabetes. Personally, I think that in this diabetic population, we "missed the boat" or the window of opportunity, to change the course of their diabetic condition. Ideally, we should intervene much earlier, but when complications have already set in, we should act with moderation.
Metabolic Surgery
The American Society for Bariatric (weight reduction) Surgery has changed its name to the American Society of Metabolic and Bariatric Surgery. This is significant, since it implies that these procedures (gastric bypass or banding) will have their role to play even in patients who are not necessarily obese, but may just be metabolically malfunctioning. The reasons for the change are the dramatic results achieved by these procedures, even before weight loss is documented. Apparently, reshuffling the gastro-intestinal tract has a huge impact on correcting the metabolic pathology of diabetes. Don't line-up just yet to have these procedures, but expect more of them approved for non-obese individuals.
Metabolic Surgery for Sexual Dysfunction
As is well known to endocrinologists, obese males have lower testosterone levels. In a recent study coming out of Philadelphia, these males were found to have significantly higher rates of erectile dysfunction(ED). Undergoing gastric bypass, these individuals were followed and assessed one year later for their ED complaints. On average, they lost 117 lbs. Using the 11-question Brief Sexual Inventory, researchers found a dramatic improvement in all domains of their ED. What is missing in this study are some "hard" data (measurements of hormones, etc.), but this may represent a new trend for correcting ED - only time will tell.
Parkinson's, Alzheimer's and Diabetes
A history of type 2 diabetes was associated with a 34% higher risk of new-onset Parkinson's disease in older men, but diabetes did not appear to cause Parkinson's. These two conditions appear to "cluster" near each other, but without causality, however more research is needed. Similarly, another study looking at diabetes and Alzheimer's could not come up with causality, but rather with an association at baseline. Obviously, the topics are complex, and further study is necessary, but it's interesting to note that despite the fact that diabetes is a vascular condition, and despite the fact that our heads are fully packed with blood vessels, diabetes is denied entry into the real inner recesses.
Screening for Diabetes at Wal-Mart Stores
Between 09/07 and 03/08, 999 people underwent free diabetes screening at Wal-Mart stores in the Delta Regional Authority. 78% of participants were found to have hypertension, 56% had high cholesterol, 47% had elevated blood glucose, and 71 %(!) of participants were obese. This project was finance by a gift of $500,000 provided by the Wal-Mart Foundation, and should show the way for similar future endeavors intended to expose the extent of the metabolic pathology in America. I have long thought of the idea of providing a yellow school bus with all the necessary equipment for screening the public for diabetes etc., and parking it at inner city locations for free screening. What I'm lacking are funds for such a project. |
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Cuisine Corner
For Chocolate Lovers
After an intensive sampling campaign, the team from the magazine "Whole Living/Body+Soul", have come up with the following options:
1. Best dark chocolate: 365 Organic Swiss Dark Chocolate - found at wholefoods.com for $1.69.
2. Best Milk Chocolate: Lake Champlain Organic Milk Chocolate found at lakechamplainchocolate.com, for $2.50.
3. Best "Wild" Chocolate: Seeds of Change playa del Coco found at seedsofchangefoods.com for $2.45.
Summer Layered Chicken Salad Recipe
Prep time: 15 minutes; Start to Finish: 15 minutes; Serving: 6
SALAD
7 cups torn romaine lettuce (from 1 head)
1 package (9 oz) fully frozen cooked chicken breast strips (not
breaded), thawed (2 cups)
1/2 cup crumbled Gorgonzola cheese (about 2 oz)
1/2 cup pecan halves (1 oz)
1 quart fresh strawberries, quartered (3 cups)
DRESSING
2 tablespoons sugar (may try splenda, (my suggestion))
3 tablespoons red wine vinegar
2 tablespoons olive or vegetable oil
1 teaspoon Dijon mustard
1/2 teaspoon salt
1 clove garlic, finely chopped
1. In deep 3-quart salad bowl, place half of the lettuce. Layer with
chicken, cheese, pecan halves, remaining lettuce and strawberries.
2. In small bowl or glass measuring cup, mix dressing ingredients
with wire whisk until well blended. Just before serving, pour
dressing over salad.
Nutrition Info: Calories 230 (calories from fat 120); Total fat 13g;
cholesterol 35 mg; sodium 610mg; total carbs 14g; protein 14g.
Exchanges: 1/2 fruit, 1/2 other carbs, 2 lean meat, 11/2 fat.
Recipe taken from Betty Crocker Diabetes Easy Family Recipes |
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Medication & Lifestyle Info
Teens with Bedroom TVs
A Minnesota School of Public Health study reports less physical activity, poorer dietary habits, and worst school performance among teens with bedroom TVs than in those without. Very intuitive and predictable, but how many parents can actually stand up and demand expulsion of the TV set from the bedroom? With recent technology making shows available on phones, TV sets may become obsolete to these teens. The real challenge is to keep these teens engaged in their reality, rather than fall for the trap of the "virtual" reality. Make them appreciate LIFE, not the screen.
Cinnamon and Diabetes
Based on a clinical study coming out of Pakistan, researchers there reported in 2003 a significant improvement in diabetes in patients treated with cinnamon. A second study coming out of the States, reported no such improvement, and the most recent Meta-analysis which includes five prospective randomized controlled trials with a total of 282 participants, fails to show any significant improvement of diabetes caused by cinnamon. Sadly, we all have to grieve over the loss of another exotic natural product in the fight against diabetes.
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