Apr
01
2005

One Shot For Better Blood Sugar Control

People with permanent health conditions face the need for lifelong medications, and patients with type 2 diabetes see insulin shots as part of an everyday routine. There are different types of insulin, which helps in tailoring the medication to the needs of the patient.
It is old news that a new type of insulin under the name insulin glargin can be used for the treatment of type 1 diabetes. The news of a study just published in February is, that also patients with type 2 diabetes benefit from insulin glargin. Often the standard treatment with diabetes drugs does not provide optimal control of blood sugar levels.
371 type 2 diabetes patients with inadequate diabetes control who were not supplemented with insulin were part of a 24-week clinical trial in Bremen, Germany, headed by Dr. Hans U. Janka.

The patients received an antidiabetic combo consisting of sulfonylurea and metformin. These patients were randomly picked, and they received a morning dose of glargine insulin injection along with the antidiabetic medication. Others did not receive the oral medication, but were administered twice-daily injections of NPH insulin. Patients were monitored for the level of glycosylated hemoglobin (= HbA1c), which is the best indicator for diabetes control. The improvements in laboratory tests were more pronounced in the group that received the combination between an oral antidiabetic and glargine injection. In addition 46% reached HbA1c levels of 7% or less, which is excellent long-term blood sugar control, as compared to only 29% of the NPH insulin group. Fasting blood sugar levels also showed improvement. There is a risk of patients becoming hypoglycemic. Again, the risk was significantly lower in those who were on the glargin combination, than those who were on the NPH insulin.

One Shot For Better Blood Sugar Control

One Shot For Better Blood Sugar Control

These results show that one single injection, which is added to the oral medication, can help type 2 diabetes patients, whose condition has been poorly controlled. Glargine insulin has been approved in Canada already in 2002, but due to supply problems it is only now expected to be on the pharmacy shelves soon.

More information on treatment of diabetes with insulin: http://nethealthbook.com/hormones/diabetes/treatment-diabetes-insulin/

Reference: National Review Of Medicine, March 15,2005,page22

Last edited October 28, 2014

Jan
01
2005

Doctor Recommended Diet Against Obesity

After overindulging over the holidays, new years resolutions often have diets and life style choices high on the list.
These concerns are not something new. Doctors have had concerns about heart disease, diabetes, bulging waistlines and elevated cholesterol. For over three decades there have been concerns that elevated insulin levels may be associated with heart disease, and the constellation of symptoms was called “syndrome X” and later the “insulin resistance syndrome”.

Most recently the evils that are associated with body fat have been called the “metabolic syndrome”.The problem has assumed epidemic proportions: by 2001, 30% of US adults were considered obese with a body mass index of over 30, and 50% were overweight with a body mass index over 25. The form of type 2 diabetes (the adult onset of the disease) is predicted to double in the next 20 years. Physicians are reporting that they are seeing increasing numbers of children who are obese and suffer of type 2 diabetes. The major concern with an accumulation of body fat is the area of the abdomen (think of the “apple shape” with fat around the abdomen). This visceral fat tissue is not just innocently sitting there stopping you from closing buttons and zippers. It is very metabolically active and the substances it releases are a threat to your health. These fat cells secret pro-inflammatory substances called “cytokines.”

They also form substances that influence blood-clotting, factors that increase insulin resistance, substances like angiotensin, which are signing responsible for high blood pressure as well. Among the host of damaging substances is also the C-reactive protein, which is recognized as a risk factor for heart disease.

Doctor Recommended Diet Against Obesity

Doctor Recommended Diet Against Obesity

There is only one solution: to reduce the risk, excessive weight has to be shed. A sensible diet to achieve that goal has to contain less saturated fat, more fiber, and low glycemic index carbohydrates. Proper dietary habits are only one part. The other as important measure is life style intervention, which includes 2.5 to 3 hours of moderate exercise per week.
Many of the current diets promise weight loss without compromising health. All of them promote weight loss, provided they are strictly adhered to.
The high protein diets (Atkins, Protein Power Plan) are useful for rapid initial weight loss, however due to the overload of protein long term use is highly questionable. Kidney dysfunction as a consequence is a threat to health and no benefit at all!
Moderate carbohydrate diets, moderate fat, as well as moderate protein will remain the answer for long-term life style changes. It is also of significance that the glycemic index of carbohydrates plays a major role. Food intake, which favors carbohydrates with a low glycemic index, is associated with less heart disease. It has also been documented that insulin levels are more stable. Low glycemic carbohydrates include most vegetables, beans, lentils, as well as fruit like apples, pears and oranges. In contrast, high glycemic carbohydrates result in a fast insulin release, which ultimately leads to insulin resistance. Among these items are potatoes, crackers and other flour products, rice, puffed or flaked breakfast cereals, and tropical fruit (papayas, pineapple, melons).

For short-term dieters, it is an option to embark on any of the current diets without deleterious effects, no matter whether they are high-carb or low-carb. But at this point only the diets with moderate carbohydrates have shown to have some benefits on heart health.
Ultimately the wiser choice is to consume foods with a low to moderate glycemic index, by increasing the intake of vegetable proteins and oils and by choosing increased servings of vegetables and fruit instead of highly processed items. So, when you next walk through your supermarket, remember that most of the good stuff is in the periphery, namely the area where all the fresh, unprocessed or minimally processed foods are found.

More info about Mediterranean diet: http://nethealthbook.com/news/mediterranean-diet-benefits-us-workers/

Reference: Metabolic Syndrome Rounds, Oct. 2004, Vol. 2, Issues 8, St. Michael’s Hospital, University of Toronto/On/Canada

Last edited October 27, 2014

Nov
01
2004

Flax Seed A Source Of Omega 3

Prevention has been gaining more momentum for public health as well as for the health conscious individual. Instead of looking at salvation from a slew of diseases like arteriosclerosis, high blood pressure, osteoporosis, Alzheimer’s, and the complications from diabetes in the form of super pills, prevention looks a lot more promising.
Flax seed has been around for several thousand years, but it has been making a name for itself as part of healthy eating.

Its most important components are its fiber content, the alpha-linoleic acid, and the lignans. Eating flax seed helps to mop up cholesterol in the bowel, and studies have shown a drop in the “bad” LDL cholesterol levels. Duke University is publishing results that show flax seed to be helpful in blocking prostate cancer. A publication going back to August 2001 in the Archives of Ophthalmology point out the fact, that the omega-3 fatty acids, which are contained in flax seed, reduce the risk of macular degeneration. The same omega-3 fatty acids also have a favorable influence in the glucose response after a meal, a fact that is important for the prevention of diabetes.

It has to be mentioned at this point, that flax seed oil does not have all the benefits, as the fiber has been removed, and some of the benefits get lost as a result of the temperature used with processing. Also, just eating a spoon full of flax seeds will not be the answer, as flax seed is not fully used during digestion (the seeds are simply excreted in a bowel movement). To unlock the benefits it is best, to grind the seed.

Flax Seed A Source Of Omega 3

Flax Seed A Source Of Omega 3

A coffee mill does the job well enough, and freshly ground seeds are better than the pre-ground variety that has been sitting around in the bin of a store for some time. Two teaspoons of ground flax seed mixed with some yogurt and fruit makes for a good starter in the morning or an easy evening snack. A slice of flax seed bread does not give you the benefits; remember that heat during cooking or baking destroys the key components.
The nice part about flax seed is the fact, that it is inexpensive, plentiful, has no adverse side effects*, and it is the ounce of prevention which is readily available to you.

More info on Omega-3: http://nethealthbook.com/news/inflammation-extinguished-omega-3/

Reference: The Medical Post, October 12, 2004, page 13

* Comments (added Aug.28, 2005): Despite the Duke University study cited above there are disturbing news from a 14 year follow-up prospective study that has been confirmed by other studies showing that there are side-effects. This study showed that in males there is a 2-fold risk of developing invasive prostate cancer when flax seed was the supplement used. As flax seed contains alpha-linolenic acid (=ALA) and fish oil contains eicosapentaenoic acid (=EPA), there are striking differences of action that have not yet been defined in more detail. The same study showed that over 14 years EPA (when mixed with DHA) lowered the risk of getting invasive prostate cancer by 26%. Until it is known more how flax seed works, it likely is wiser to to take a molecularly distilled EPA/DHA supplement daily as this also reduces the cardiovascular risk, but at the same time prevents cancer.

Last edited October 27, 2014

Oct
01
2004

Studies Show Ginseng Works

As early as 25 A.D. a medical journal praised ginseng “the imperial herb” because of its nontoxic and rejuvenating properties. In the meantime 16-31% of Americans have consumed ginseng in the hope to increase their health and wellness. It is mostly the root of ginseng, which is used for medical purposes, and it is sold either whole, as a powder, or as a water- or alcohol based extract.
Among the many medically active ingredients, the ginsenosides are the most intensely studied substances.
There are well designed clinical studies which have tested ginseng’s ability to modulate diabetes, heart disease, mental function and physical performance. In the meantime there is enough evidence, which shows that Panax quinquefolius (its botanical name) can reduce blood glucose in individuals with and without type 2 diabetes.
Another study examined ginseng and its influence on blood pressure readings. Patients with type 2 diabetes (adult onset diabetes) who received a dosage of 3 grams daily over a period of 8 weeks achieved a reduction in their blood pressure readings, making it safe to take and also as an adjunct in the management of blood pressure.

Cognitive performance may be influenced positively by ginseng, however it is dependent on the dose, which is used. A lower dose of 200 mg reduced the mental performance, whereas a dose of 400 mg significantly improved accuracy in a demanding test.
Ginseng has not found to be effective to improve physical performance or be a weapon against fatigue.
In a 12- week trial patients received ginseng as a general supplement together with multivitamins or multivitamins alone. Ginseng significantly improved the quality of life, which could not be achieved with multivitamins alone.

Studies Show Ginseng Works

Studies Show Ginseng Works

Taking all the findings together, it is evident, that ginseng has beneficial properties for patients with diabetes, and it is also useful to improve cognitive function. Ginseng may reduce blood pressure readings, but more studies are needed. The blood pressure reducing effect seems marginal and ginseng, if taken for this purpose, should be used only as an adjunctive treatment along with the regular medication. As far as physical performance is concerned, it seems to be of little use. It does not show any interaction with prescription drugs, and for this reason it can be considered safe for general use.

More info on:

Diabetes: http://nethealthbook.com/hormones/diabetes/type-2-diabetes/

Heart disease: http://nethealthbook.com/cardiovascular-disease/heart-disease/

Alzheimer’s disease: http://nethealthbook.com/neurology-neurological-disease/alzheimers-dementia-and-delirium/

Reference: The Whitehall-Robins Report, September 2004, Vol.13,No.3

Last edited Oct. 27, 2014

Sep
01
2004

Stop That Heart Attack

There is a window of opportunity for the patient who is rushed to hospital with a heart attack.

To be precise: if the patient is brought to hospital without delay, and there are changes in the ECG, which traces the heartbeat, and there are changes that point to the possibility of a heart attack, there is a chance to administer medication that prevents blood clots. If these “clot busters” are administered within one hour, as many as 25 % of heart attacks in the making can be aborted. This procedure is called “fibrinolysis”.

Dr. Paul Armstrong, professor of medicine at the University of Alberta, explains, that the aborted heart attack (or “aborted MI”) is a new term in cardiology. If treatment is received early, the patient will avoid heart muscle damage. Even if the treatment with the anti-clotting medication is given after only two hours, the patients still have a more favorable outcome. Patients with aborted heart attacks also have smaller infarcts than those who go on to have a full-blown MI (or heart attack). Dr. Armstrong points out that it is important to not only watch out for known high-risk factors (previous coronary artery bypass surgery, hypertension and diabetes), but also to pay close attention to treating the patient early.

Stop That Heart Attack

Stop That Heart Attack

More info on heart attacks: http://nethealthbook.com/cardiovascular-disease/heart-disease/heart-attack-myocardial-infarction-or-mi/

Reference: The Medical Post, July 27,2004, Vol.40, No. 29,pg.8

Last edited October 26, 2014

Jul
01
2004

Flu Shots For Young Children And Pregnant Moms

It may be summer, but next winter will be there and along with it the threat of flus.
Flu shots are offered in fall, and especially people with health problems (like asthma or diabetes, just to name a few) and seniors have been the primary target groups for public vaccination programs. U.S. health authorities now have also added young children under 2 to the program.

This step has been taken, as babies and young children are at a substantially increased risk for influenza-related hospitalizations.
The U.S. Centers for Disease Control has just release a new recommendation, that all women who are pregnant during the influenza season should get flu shots. Pregnant women who contract influenza frequently have an increased rate of complications, including pneumonia, tachycardia (rapid heart beat), and contractions.
Even though most pregnant women are young and healthy, their hospital admission rate during the flu season is similar to what you see in the elderly.
Statistics show that generally only 12% of women with uncomplicated pregnancies get vaccinated. With the threat of a severe strain of influenza A, which showed its aggressive and widespread activity last winter, it can be expected that there will be an increased demand for flu shots this year.

Flu Shots For Young Children And Pregnant Moms

Flu Shots For Young Children And Pregnant Moms

References: The Medical Post, May 18, 2004, pg. 8 and 9

Last edited December 8, 2012

Jun
01
2004

Take A Deep Breath For Insulin

Patients with diabetes sometimes find it difficult to face the daily insulin injections.
Studies by Dr. Robert A. Gerber from Pfizer Global Research and Development in Groton, Mass. are showing that improvements in the lab tests for the diabetes marker hemoglobin A1C were similar for patients who received insulin inhalations to those patients who received the conventional injections.

The ease of use, comfort, as well as the overall satisfaction of inhalation as opposed to injection rated high. Long-term improvement in the control of blood sugar is maintained up to the 1 year follow-up.
In the future the patients may very well have the choice between inhalation and injection of insulin. Even though the 1 year follow-up results are in, longer follow-up studies are needed, before insulin shots become a thing of the past.

More info on diabetes: http://nethealthbook.com/hormones/diabetes/type-2-diabetes/

Based on Diabetes Care 2004; 27:1318-1323

Take A Deep Breath For Insulin

Take A Deep Breath For Insulin

Comment on Nov. 5, 2012: Pfizer marketed the inhalable insulin under the brand name “Exubera”. It was available in the US from Sept. 2006 onward after FDA approval. The inhalable insulin was proven to be as effective as the injectable insulin, but the cost of Exubera was prohibitive and Pfizer had to discontinue the production after October of 2007 as it was unlikely to be cost-effective, just 1 year and 1month after its initial release.

Last edited October 26, 2014

May
01
2004

Age-Related Macular Degeneration Can Be Postponed

In a well-controlled study that was published earlier in 2004 Dr. Johanna M. Seddon

has shown that age-related blindness (AMD) is caused from an inflammation in the blood vessels, which is associated with an elevated blood marker, called C-reactive protein (CRP). The authors of this study also showed that the dry form of AMD would tend to deteriorate with age and/or from smoking cigarettes into the more serious wet form, a common cause of blindness.

The inflammatory component of cardiovascular disease is known to be controlled by the use of aspirin (ASA) or the statins, medication that is known to lower the bad LDL cholesterol. It is with this background that the author of the study that I am reviewing here, Dr. Jacque L. Duncan from the University of California at San Francisco, has examined the effects of ASA and of statins on AMD. 326 patients with AMD (204 with dry AMD, 104 with wet AMD from blood vessels forming underneath the retina and 18 with geographic atrophy) were followed between January 1990 and March 2003. Patients were at least 60 years old or older and followed at the San Francisco VA Hospital Eye Clinic.
Dr. Duncan found that patients with blindness due to wet AMD used ASA or statins significantly less than patients with stable AMD. Moreover, he found that patients who had AMD and took statins were 49% less likely to develop wet AMD and if they took ASA the were 37% less likely to develop wet AMD.

Age-Related Macular Degeneration Can Be Postponed

Age-Related Macular Degeneration Can Be Postponed

The study also suggests that there is a link between the inflammatory process that leads to heart attacks and strokes on the one hand and the further deterioration to blindness when dry AMD is not treated on the other hand. The notion that inflammation is the missing link in both of these processes is a relatively new finding.

More information about Macular Degeneration here.

Based on article by Dr. Jacque L. Duncan in the American Journal of Ophthalmology 2004;137: 615-624.

Last edited October 26, 2014

Mar
01
2004

Ankle Blood Pressure Reveals Diabetic Problems

One of the complications of diabetes is that ity leads to clogged arteries from peripheral artery disease and this can lead to heart attacks, strokes and circulation problems in the legs.

Recommendations were recently given to physicians in the December edition of the medical journal Diabetes Care that circulation problems in diabetics need to be monitored more stringently to avoid needless amputations.

Medically these circulation problems that affect mainly lower legs and feet are known as “peripheral vascular disease” (or PVD for short). PVD can be detected by the physician checking for ankle pulses. Another valuable and very simple test is to measure the blood pressure in the arm and at each ankle (using the stethoscope just under the inside (medial) ankle bone. If there is a major discrepancy between the arm and ankle blood pressure or if the ankle pulse is missing, this would be a sign of possible PVD. With a diabetic patient it would still be important to get the hemoglobin A1C under control through exercise, a low glycemic diet and possibly anti-diabetic medication. But the patient likely would have to be referred to a cardiovascular surgeon for further testing in order to find out whether there would be hardening of the arteries with circulation problems in the lower leg, the ankle or foot.

Ankle Blood Pressure Reveals Diabetic Problems

Ankle Blood Pressure Reveals Diabetic Problems

Dr. Peter Sheehan, the director of the Diabetes Foot & Ankle Center at the New York University school of medicine, stated that many patients and doctors overlook how frequent this condition is. About 33% of diabetic patients who are older than 50 years have PVD, but only a fraction know about it until it is too late. Once a patient has PVD in one of the legs there is a 4-fold risk of getting a heart attack or a stroke, because the hardening of the arteries is happening simultaneously in all of the body’s arteries. If the blood pressure is normal at the ankle, Dr. Sheehan recommends to check it again in 5 years.

Who should have the blood pressure check at the ankle? Here is a table that summarizes Dr. Sheehan’s recommendations.

Which diabetic needs the ankle blood pressure check?
High risk group: Remarks or more detail:
Anyone with leg PVD* symptoms legs tired or hurting when walking
Young diabetics
with other risks
smoking, high blood pressure, high cholesterol, diabetes present for more than 10 years are such risk factors
diabetics 50 years of age and over particularly when the hemoblobin A1C is high and other risk factors are present
*PVD peripheral vascular disease

Why is it so important to screen for circulation problems in the lower legs? Because this is the area where diabetics tend to get problems that often result in amputations of a foot or lower leg below the knee. With early detection of these problems and intervention by a cardiovascular surgeon often disastrous outcomes can be avoided.

More info is available at:

Diabetes: http://nethealthbook.com/hormones/diabetes/type-2-diabetes/

High blood pressure: http://nethealthbook.com/cardiovascular-disease/high-blood-pressure-hypertension/

Last edited October 26, 2014

Mar
01
2004

Less Diabetes With Coffee

A Dutch Study has shown previously that coffee consumption was reducing the risk for developing diabetes. Now Dr. Salazar-Martinez and co-workers have confirmed this in a study involving even larger numbers of both men and women. This was published in the Annals of Internal Medicine and the research team is from the Harvard School of Public Health, Channing Laboratory, Harvard Medical School, and the Brigham and Women’s Hospital, Boston, Massachusetts. A total of 41,000 men and 84,000 women from the Nurses’ Health Study and the Health Professionals’ Followup Study were followed between 12 and 18 years. 1,333 men and 4,085 women developed diabetes during the time of observation. All of the data was analyzed carefully by controlling for other factors such as obesity, smoking, high blood pressure etc. to be certain that the only difference in the observed groups was the amount of coffee consumed.

According to the authors the gender differences are probably unimportant and may have to do with the different sample sizes. However, as the graph shows clearly, with the consumption of around 4-5 cups of coffee per day there is a significant 30 % drop in risk to develop diabetes.

The Dutch Study showed a 50% drop in risk with 7 cups or more per day and the study here suggests a similar drop with 6 cups or more.

Less Diabetes With Coffee

Less Diabetes With Coffee

Dr. Frank Hu, associate professor of nutrition and epidemiology at Harvard School of Public Health, who co-authored this study stated that physicians should still recommend to patients first to exercise and to loose weight to control diabetes. It would be premature to recommend heavy coffee consumption to patients for diabetes control.

Diabetes risk decreases with coffee consumption (%reduction)
 Less Diabetes With Coffee1

This beneficial effect was also observed to a lesser extent with decaffeinated coffee, but not with tea. According to Dr. Hu caffeine, chlorogenic acid and magnesium likely play a role in the protective effect with regard to diabetes prevention. Further studies will be done to see whether diabetes patients who drink coffee have a better outcome when they develop a heart attack.

Reference: Ann Intern Med – 6-JAN-2004; 140(1): 1-8

Last edited December 8, 2012