5 posts tagged “diabetes”

An Ounce of Prevention or a Pound of Government Intrusion?

Apr 13, 2009
44 comments

America is fat. All you have to do is walk around your local mall to see that. Obesity in America is growing (no pun intended) at an alarming rate which has a multitude of dreadful health consequences. The “why” is easy. People consume more calories than they expend and the problem is compounded by the fact that too many of the calories come from junk food.

So I read with some interest last week when the New England Journal of Medicine published a public policy perspective (yay alliteration!) on food taxes. Specifically, the idea that states should preferentially tax sugary soft drinks (sugared-sodas, sports drinks, and “energy” drinks) to the tune of 1-cent per ounce for the dual purposes of: a) raising revenue and b) discouraging consumption.

The authors argue (I believe correctly) that these drinks are one of the primary drivers of the obesity epidemic in the United States, particularly among children and adolescents (your 20 oz Pepsi packs a whopping 250 calories -- >10% of your daily caloric allotment). Market data suggests that a 10% increase in soda prices could raise billions in revenue and cause a 7-10% drop in consumption. Not bad.

You Think This Is A Coincidence?

But I don’t think the argument here is that people ought to be drinking sugary sodas – most people know they’re pretty bad for you – it’s a habit I kicked a couple decades ago. The question is whether the government should be in the business of telling you what you should and shouldn’t eat – you know, it being a free society and all that.

Now I tend to be a Jeffersonian “the best government governs least” sort of guy. One could suggest that people ought to drive the market by demanding more healthy choices (which IS happening at a certain level) and that those who choose poorly pay the price in poor health. And there’s no “Second Hand Mountain Dew Drinking” problem the way there is with smoking. Unfortunately, the reality is that we’re all paying for this epidemic in rising healthcare costs and insurance premiums. In a way, every Coke you drink is costing me– so cut it out.

Soft drinks Big calories

Behavioral modification of this type has worked before. I remember the hue and cry in the 70s when seat-belt laws were enacted. Many took that as government infringement on a personal choice. In the decades since, countless lives have been saved and a generation later, I don’t know really anyone that thinks twice about belting up. Score another one for intervention, I say.

I also know that cigarettes cost about a bazillion times more than they did when I was a kid – again big taxes as a revenue generator and deterrent – and the percentage of smokers in the US has been nearly cut in half during my lifetime. Wouldn’t that be a good thing to say about obesity in 25 years?

Now, beverage industry advocates (perhaps rightly so) cry “No fair!” – that they’re singling out one member of the junk food choir. But I wouldn’t really worry about that. If this idea catches on, it’s pretty easy to imagine the “fry tax”, the “big bowl of pasta tax”, the “donut tax”, the “afternoon Snickers tax”, the “cheeseburger tax” and so on…

Hmmm.. maybe this isn’t such a great idea after all. What do you guys think?

The Problem With The Clean Plate Club

Mar 13, 2009
39 comments

Nearly a century ago, President Woodrow Wilson started a “Clean Plate” campaign during World War I to help conserve food in America and focus citizens' attention not wasting valuable food. The mantra of “waste not, want not” was a rallying cry mothers and politicians through the Great Depression and World War II. President Harry Truman encouraged kids to pledge to join the “Clean Plate Club” to best utilize post-war resources.

Forward another generation or two and I can see myself as a child sitting at our family table being admonished to finish everything on my plate and then – and only then – could I <have dessert, play outside, watch TV, fill in reward here>. I think this was repeated across the land, often supplemented with the guilt-inducing “There are starving kids in Africa that don’t have anything.” – so not only was eating everything on my plate a reward-incentive, it was a moral imperative!

Forward to today and obesity in America is a rampant epidemic. 35% of Americans are considered obese (a staggering three-times as many as when I was being hounded by my mom) – and another third are overweight. Along with the psychological implications of “looking fat”, comes a whole host of fun add-ons: diabetes, heart disease, increased stroke incidence, hypertension, sleep disorders and arthritis. The main causes are – as you might guess – sedentary lifestyle and over-nutrition*.

Not A Value Meal At Any Level

Why do we eat so much? Well, at a basic level, because we can. Biologically, it seems we’ve got a lot more compensatory mechanisms to handle too-little-food rather than too-much. But today, this is less of a problem with our metabolism as it is with our brain. Our brains seek out pleasure and food is a pleasure. We are taught that “more is better” – so why pay $6 for a sandwich and chips, when I can get the super-giant sandwich and chips for $7.25. What a deal!

And that would be a deal if you saved half-the giant sandwich for later, but we don’t. Why? Because most of us operate not on signals of hunger from the gut, but on visual cues for satiety** -- that is, eat until it’s all gone. There was a great experiment that looked at how much soup was consumed by two groups. Group A had normal bowls of soup. Group B had bowls of soup that were plumbed to imperceptibly refill themselves***. The graph below shows that the people in Group B KEPT EATING THE SOUP.

Bottomless Bowls

They ingested nearly twice as much as Group A. They kept seeing a partially full bowl and kept eating -- and the best (or scariest) part was that when asked to estimate how many calories they’d consumed – they figured about as much as the first group, even though they’d eaten almost twice as much. Good job, brains!

So – what can you do?

1. Be aware of using your eyes (and not your stomach) to tell you whether you’re hungry or whether you’re “done”.

2. Eat slowly. It takes time for satiety signals to go from the gut to the brain. Pause between bites (and courses). Don’t wolf everything down. This is also easier on your pancreas.

3. Drink some water before eating. Water in your stomach will help you feel “full” and aid digestion.

4. Most importantly, PORTION CONTROL. Don’t put a lot on your plate or your bowl. Eat a smaller portion, wait and THEN decide if you need some more. The likely answer is no.

Now where did I leave that half-empty box of Girl Scout Cookies?

*These are the polite clinical terms for saying you're lazy and you eat too much

** This is the classic See-Food Diet – when I see food, I eat it.

*** What an awesome idea – especially when it’s the “Bottomless Fries” at Red Robin. Oh wait.

Get Your PHD Today!

Jan 14, 2009
15 comments

No – I’m not advocating carving out 4+ years to work like a dog for a sub-minimum wage salary in laboratory settings that would make an OSHA inspector blanch.*

I’m talking about getting your own Diabetes PHD (Personal Health Decisions) analysis using a new interactive tool developed by the American Diabetes Association (ADA). The PHD tool takes in an abbreviated health history with physical data, family history and relevant cardiovascular data (it helps to know your last blood pressure and cholesterol values) and charts your current and projected risk profile for type-2 diabetes, heart attack and other diabetes related co-morbidities over the next 30 years. The analysis only takes a few minutes. Here’s me:

Now

Okay – that looks not-so-bad. But one of the cool things about the tool is that you can adjust some of the values (that is, what if I lost weight or lowered my blood pressure) and recalculate the projection and compare it to the original. With a few clicks I got rid of those 20 pounds I know I ought to lose and lowered my bp into a safer niche:

Thinner and not-stressy

Pretty cool. So if I do those things my prognosis shifts from a 1-in-6 chance of developing diabetes to a 1-in-8. I like those odds better.

The information here is all stuff we ought to have heard, but I think the graphical representation and seeing the prognosis change with variables might do a better job of getting the point across than a physician wagging their finger at you. Or maybe it's because I'm a scientist and like to see data.

I just hope it won’t take as long for me to get to a more-fit, less-stressed Steve as it did to get my PhD.

*By no means am I hating on graduate school – despite the veracity of the characterizations, I loved grad school.

I Woke Up This Morning and My Diabetes Was Killing Me

Aug 30, 2007
25 comments

No one ever says that, and it’s too bad because it’s too often true. The other day, I heard from a good friend that his mom was diagnosed with Type-II diabetes. Older and not-as-active-as-she-used to be (aren’t we all??) she was a prime candidate.

I also saw an article today that contained data that the prevalence of diabetes’ not-so-sweet sister obesity continues to increase in the US. At an alarming rate. (Hey, congratulations Mississippi, >30% of your adult population is obese…) One problem is: you can be diabetic without being obese and vice versa.

US Diabetes

While your clothes not-fitting will tell you that you’re putting on weight, diabetes (and we’re talking T2D here, not Type-I) is silent and well on its disease progression before a patient or physician even notices. High blood sugar levels are the classic tell-tale sign, but before that happens your body’s cells become less responsive to insulin. So how does your body respond to poor insulin action – it just makes more insulin until it covers the problem (its like the governmental equivalent of throwing money at an issue).

Getting younger all the time

The real problem is that your pancreas (which makes insulin) is kinda like a battery. It only has a certain capacity to produce and secrete insulin over your lifetime. And once the battery goes dead, you’re in a world of hurt. And recent data reinforces what we already know: that people are using up their batteries faster than ever.

Q: So what’s a society to do?

A: Don’t make your pancreas work so hard!

Stop eating crap. Fast food, highly refined breads and pastas, white potatoes– especially the French fry version, ice cream and most desserts, sugar-based sodas etc get sugar into the bloodstream really quickly causing a big spike in glucose which your body responds to by a big spike in insulin. Complex carbohydrates, vegetables, lean meats and other proteins are broken down more slowly, allowing easier absorption by the body. Unfortunately, crap foods are often the cheapest and most convenient things to get your hands on. Be judicious with their ingestion.

Your pancreas -- its a battery

Stop eating so much. Huge portions don’t do your body any good. You can only absorb so much in a given amount of time. The leftovers your muscles can’t use get deposited as fat. So eat reasonable portions. Eat bigger breakfasts and lunches (that you have more time to burn off) and eat smaller dinners (an idea that is anathema to most Americans).

Exercise regularly. You can get your body to utilize insulin more effectively by increasing lean muscle mass. Muscles are the main consumer of glucose by the body – keep them in shape. And unlike your pancreas-battery, getting in shape will reverse poor insulin use by your body.

Okay – that’s enough… I’ll get off my soap-box its just that this is important to me, and you folks are important to me. We’ve all heard it before – diet and exercise. It really is that simple.

Who Hearts Avandia?

Jul 30, 2007
14 comments

Well, I guess the FDA advisory panel does. Well, not exactly. They just don’t dislike it enough to pull it off the market.

Avandia

In a remarkable 22-1 decision, the advisory panel voted to allow Avandia (the multi-billion dollar drug from Glaxo for Type-II diabetes). I find this remarkable because I wasn’t sure the Agency had the cajones to stem a rapidly swelling tide against the drug.

Much hay was made in May when a NEJM article described a meta-analysis of thousands of patients and found an increase in myocardial ischemia (a loss of bloodflow usually caused by a blockage) which can offer be a pre-cursor to a heart-attack.

A meta-analysis is performed by combining results from several studies to form a database with a large number of patients. And that's the problem -- because the combined trials were all run differently, its really hard to extract statistically meaningful data – and so such analyses are used to guide specifically designed clinical trials that WILL yield statistically significant data – if there’s anything to find.

And here’s the kicker – Glaxo’s been DOING THAT TRIAL. They know they need this answer. The damn thing is Avandia has always had a “heart disease” issue, and is contra-indicated in people likely to have congestive heart failure. They think their compound is safe (enough) and that the trial will show it. But suddenly, there were ascending cries to remove the compound from the marketplace right now.

And I’m glad it wasn’t. The FDA can not let media feeding frenzies dictate the nation’s health policy.

That said – if I was diagnosed as a Type II diabetic, would I want to take Avandia? No. Not because of the heart risk (if its there), but because Avandia is hell on your liver, causes edema AND there are new medicines that take advantage of a different mechanism that has a good chance of being way better than Avandia. I would choose to take Amylin’s Byetta or Merck’s Januvia.

But that’s just me – if you’ve got questions, go talk to your doctor – better yet get your PCP to recommend an endocrinologist and get the real deal from someone that knows.

(end of rant -- back to travel and music and books and movies...)