Thursday, January 24, 2008

Whole Grain Foods Might Reduce Diabetes Risk, But Evidence Weak

Many have touted whole grain foods as a way to prevent type 2 diabetes, and a new review finds a reduction in risk for people who consume a diet high in unrefined grains.

However, the authors caution that more research is necessary before scientists can confirm a causal relationship.

Refined cereal food products remove the nutrient- and fiber-rich bran and germ of the grain, leaving only the starchy inner parts.

A decrease in consumption of whole grain cereals over the last decade, occurring at the same time as an increase in type 2 diabetes, has lead to the theory that there is a connection between the two.

Read full article at Medical News Today

Diabetic Girls Skip Insulin to Lose Weight

Insulin-dependent girls know the dark secret that keeps off weight despite the deadly consequences

A dirty little secret is shared by many young women with Type 1 diabetes – when they skip their insulin, they lose weight.

This is dangerous and potentially life-threatening behaviour, experts in the field warn, but one that is hard to quash in a world obsessed with body image.

Psychiatrist Patricia Colton, who works in the eating disorders clinic at Toronto General Hospital, has had one diabetic patient in her twenties go blind, and another the same age suffer renal failure, as a result of avoiding their medication.

Doctors started guessing females were deliberately skipping their insulin as a weight control measure in the late '80s, Colton says, and notes that recent studies have revealed it is widespread, affecting approximately a third of diabetic young women.

Though Colton was concerned media coverage of the issue might spark copy-cat behaviour, it has become so widespread "it is too late to keep it a secret. They are wiping out 80 years of progress in diabetic medicine," says Colton, adding that the initial effects are nausea, depression and exhaustion but get more serious over time.

"It is extreme behaviour but it is tied into the mindset of our culture. They are under pressure to put a high premium on their weight, to believe that their success is based on looks."

Read Entire Article at The Star

Diabetes Study Favors Surgery to Treat Obese

Weight-loss surgery works much better than standard medical therapy as a treatment for Type 2 diabetes in obese people, the first study to compare the two approaches has found.

The study, of 60 patients, showed that 73 percent of those who had surgery had complete remissions of diabetes, meaning all signs of the disease went away. By contrast, the remission rate was only 13 percent in those given conventional treatment, which included intensive counseling on diet and exercise for weight loss, and, when needed, diabetes medicines like insulin, metformin and other drugs.

In the study, the surgery worked better because patients who had it lost much more weight than the medically treated group did — 20.7 percent versus 1.7 percent of their body weight, on average. Type 2 diabetes is usually brought on by obesity, and patients can often lessen the severity of the disease, or even get rid of it entirely, by losing about 10 percent of their body weight. Though many people can lose that much weight, few can keep it off without surgery. (Type 1 diabetes, a much less common form of the disease, involves the immune system and is not linked to obesity.)

But the new results probably do not apply to all patients with Type 2 diabetes, because the people in the study had fairly mild cases with a recent onset; all had received the diagnosis within the previous two years. In people who have more severe and longstanding diabetes, the disease may no longer be reversible, no matter how much weight is lost.

The operation used in the study, adjustable gastric banding, is performed through small slits and loops a band around the top of the stomach to cinch it into a small pouch so that people eat less and yet feel full. Other weight-loss operations are more extreme and involve cutting or stapling the stomach and rearranging the small intestine. Of the 205,000 weight-loss operations performed in the United States last year, 25 percent to 30 percent used the gastric banding.

Remission of Type 2 diabetes after weight-loss surgery is not a new finding; doctors have known about it for years. But the new research is the first effort to find out scientifically how it measures up against medical treatment in similar groups of patients with the disease.

The study reflects a growing interest among researchers in using surgery specifically to treat Type 2 diabetes, even in people who are not as obese as those who typically undergo operations to lose weight. The new thrust is in some sense a measure of desperation, as the United States and the world face increasing rates of the disease and its devastating complications, which can include heart attacks, blindness, kidney failure and amputation. To many doctors, the time is ripe for studying surgery as a potential cure for diabetes, and also as way to understand the disease better and develop better drugs to treat it.

Medical societies in the United States and abroad that once called their specialty bariatric surgery, a term that refers to weight loss, have started adding the word “metabolic” to their titles to emphasize the new focus on diabetes.

“I think diabetes surgery will become common within the next few years,” said Dr. John Dixon, the lead author of the study and an obesity researcher at Monash University in Melbourne, Australia, where the research was conducted.

The study and an editorial about it are being published Wednesday in The Journal of the American Medical Association.

The editorial, by doctors not involved in the study, said, “The insights already beginning to be gained by studying surgical interventions for diabetes may be the most profound since the discovery of insulin.”

A researcher who is not a surgeon and was not part of the research, Dr. Rudolph L. Leibel, co-director of the Naomi Berrie Diabetes Center at Columbia University Medical Center, said the study was important because it showed that a minimally invasive type of surgery could reverse diabetes.

“At this point,” Dr. Leibel said, “maybe we should be more accepting or responsive to the idea of surgical intervention for reducing or prevention of diabetes and its complications.”

But at the same time, he said, caution was in order, because the study lasted only two years and it would be essential to find out how these patients fared over time.

About 19 million people in the United States have Type 2 diabetes, and another 54 million are “prediabetic,” meaning they have abnormalities in their blood sugar that increase their risk for the disease, according to the American Diabetes Association. Diabetes is the fifth-leading cause of death by disease in this country, killing about 73,000 people a year. The number of cases in the United States is growing by about 8 percent a year, according to the association. Though treatable, the disease is not curable, and it is often poorly controlled.

The 60 people in the study had an average age of 47 and were assigned at random to have either surgery or medical care. All were obese, with a body mass index, or B.M.I., of 30 to 40. A B.M.I. over 25 is considered overweight, and over 30 is obese. (A person who is 5 feet 6 inches tall with a B.M.I. of 25 would weigh 155 pounds; with a B.M.I. of 30, 186 pounds; a B.M.I. of 35, 216 pounds; and a B.M.I. of 40, 247 pounds.)

Based on guidelines created by the National Institutes of Health in 1991, weight-loss surgery is generally only recommended for people whose B.M.I. is 40 or more, unless they also have Type 2 diabetes, in which case a B.M.I. of 35 is the cutoff. In this study, 13 people, or 22 percent, had a B.M.I. under 35.

Medicare covers weight-loss surgery according to the institutes’ rules, but many private insurers refuse to cover the surgery at all, said Dr. Philip Schauer, director of the bariatric and metabolic institute at the Cleveland Clinic. He said his center had to turn away three or four patients for every one accepted because insurers would not pay.

On average in the United States, banding costs $17,000 and the other bariatric operations $25,000.

Dr. Schauer said that the B.M.I. cutoffs did not make sense medically and that the study “blows away this arbitrary barrier.” He said that the cutoffs should be lowered, so that a patient with diabetes and a B.M.I. of 34.9 would not be considered ineligible, as is now the case.

Dr. Francesco Rubino, director of the metabolic surgery program at NewYork-Presbyterian/Weill Cornell Medical Center, also said that the criteria for the surgery should be changed so that it could be offered to diabetes patients early enough to reverse the disease.

Dr. Rubino and other researchers said that weight-loss operations that rearranged the small intestine had faster and more powerful effects on diabetes than did the banding, because the other operations changed the levels of certain gut hormones that greatly improve the body’s ability to control blood sugar, weight and lipid levels in the bloodstream. These operations, and the hormones responsible, have become the focus of intense research.

Dr. Dixon has received research grants and speakers’ fees from the company that makes the gastric bands, Allergan Health, and the company paid for the study through a grant to the university. But his report said the company had no influence on the design of the study, the data or their report.

The editorial writers said they had accepted travel grants from Allergan and other companies to attend a conference on diabetes surgery in Rome.

Source: New York Times - Diabetes Study Favors Surgery to Treat Obese

Tuesday, January 15, 2008

Happy Birthday MLK

Happy Birthday MLK

King directed the peaceful march on Washington, D.C., of 250,000 people, and delivered his famous "l Have a Dream" speech. He was awarded five honorary degrees; was named Man of the Year by Time magazine in 1963; and became a world figure for peace.

Martin Luther King, Jr., was the youngest man to have received the Nobel Peace Prize. When notified of his selection, he announced that he would turn over the prize money of $54,123 to the furtherance of the civil rights movement.

Thursday, January 10, 2008

The Poor Get Diabetes; The Rich Get Local and Organic

Well the holidays are over, and I'm back from vacation. Hope everyone had a great holiday, and looking forward to positive things and change in 2008.

This is a long article, but I know that as a retiree, I have been put off from buying a lot of the organic products due to the cost. I suspect that many of you are in the same boat. Charles

The Poor Get Diabetes; The Rich Get Local and Organic

From the War on Poverty to new farmers' markets, a food expert tackles America's dangerous dietary split.

By Mark Winne, Beacon Press

The following is an excerpt from Mark Winne's new book, Closing the Food Gap: Resetting the Table in the Land of Plenty.

As a class, lower income people have been well represented in some of the best-covered food stories of our day, particularly hunger, obesity, and diabetes. As these issues have faded in and out of the public's eye over the last 25 years, another food trend was rapidly becoming a national obsession -- namely, local and organic.

At about the same time that Berkeley diva Alice Waters was first showing us how to bestow style and grace on something as ordinary as a local tomato, the Reagan administration's anti-poor policies were driving an unprecedented number of people into soup kitchens and food banks. And as organic food advocates were putting the finishing touches on what was to become the first national standard for organic food, supermarket chains were nailing plywood across their city store windows bidding farewell to lower income America.

Organic food and agriculture had barely climbed out of the bassinet in 1989 when 60 Minutes ran its now famous Alar story. The exposure it received before 40 million television viewers ignited a firestorm of consumer reaction that eventually made organic food the fastest growing segment of the U.S. food industry.

Yuppie families reacted first. Like every parent since time immemorial, these parents wanted what was best for their children, and the emerging evidence that our food supply was tainted accelerated their desire for the healthiest and safest food possible. Though the research surrounding the health and safety attributes of various foods remained foggy, competing claims opened up a never ending number of consumer options. One's food choices may be vegetarian, vegan, organic, grass-fed, free-range, humanely raised, or some combination of these. As to the source of this food, it could range from "generally local when it's easy to get" to "obsessively local and will eat nothing else."

In low-income circles, however, such food anxieties got little traction. Between getting to a food store where the bananas weren't black and having enough money to buy any food at all, low-income shoppers had little inclination to parse the differences between grass-fed and grass-finished. But this didn't imply that their awareness of organic food was non-existent, nor did it mean that low-income consumers were less likely to buy organic if they had the chance.

Low-Income Shoppers Speak

To better understand a variety of issues, the Hartford Food System, a Connecticut-based non-profit organization that I directed for 24 years, would often meet with low-income families to get their point of view. On one such occasion, we asked eight members of Hartford's Clay/Arsenal neighborhood to discuss local and organic food. Like other impoverished urban neighborhoods, Clay/Arsenal was entirely devoid of good quality food stores, and their residents experienced hunger, obesity, and diabetes at rates that were two to three times the national average. This group was comprised exclusively of Hispanic and African American residents.

First off, the group expressed an immediate consensus that fresh, inexpensive food -- the food they generally preferred -- was unavailable in their neighborhood. Everyone agreed that traveling to a full-line supermarket was a hassle because it required one or two long bus rides or an expensive taxi fare. As a result, they did their major shopping once or twice a month, and when they shopped, price was their most important consideration.

When asked what the word organic meant to them, the residents answered "real food," "natural," "healthy," and "you know what's in it." While they believed that organic food was preferable to food they described as "processed," "full of chemicals," or "toxic," they said that buying organic food wasn't even an option, because it was simply not available to them. One young woman made a point of saying that she didn't trust the environment where she lived or the food she ingested. "Everything gives you cancer these days," she said. Conversely, there was an underlying tone of confidence in the safety and healthfulness of food that they could identify as local and organic.

Their awareness of the benefits of local and organic food was very high. For the elderly, there was the nostalgic association with tastes, places, and times gone by. For those with young children, there was an apprehension that nearly everything associated with their external environment, including food, was a threat. Like parents of all races, education levels, and occupations, these moms wanted what was best for their children as well, even when they knew that what was best was not available to them.

Local and Organic Go Mainstream

"In a burst of new interest in food," spouted Newsweek's 2006 food issue, "Americans are demanding -- and paying for -- the freshest and least chemically treated products available." Whole Foods' John Mackey told the Wall Street Journal, "The organic-food lifestyle is not a fad ... It's a value system, a belief system. It's penetrating into the mainstream."

As we cast our eye over the sheer effulgence of American food, there appears to be no limit to the type and number of food products for those who are motivated by taste, environmental concern, animal welfare, political correctness, or simple virtue. Niman Ranch produces a pork to die for, and costs significantly more than the factory-farmed alternative. Don't want to spend the "best four years of your life" eating swill from the college cafeteria trough? Select from any of hundreds of colleges and universities that are now featuring "sustainable dining" (some inspired by master chef Alice Waters). And when you just can't find anything that satisfies your organic lifestyle where you live, you can always pack up and leave. The New York Times style page featured a number of families who had the financial wherewithal to escape from New York City to the Hudson River valley. Once there, the families "began eating strictly organic foods." One couple said they had moved because the wife was pregnant with their second child and "we decided that the children needed to be in nature."

Sounds pretty good. In fact, it just may be the latest incarnation of the American dream. But what about those who can't escape or afford to eat "strictly organic" or for whom "buying local" means the past-code date, packaged baloney at the neighborhood bodega? How do we fulfill the desire for healthy and sustainably produced food that is increasingly shared by all?

There are two general directions that have shown promise in closing this food gap: one is through private, largely non-profit projects and the other is through public policy. At the Hartford Food System we founded the Holcomb Farm Community Supported Agriculture (CSA) Farm that made an explicit commitment to distribute about 40 percent of its local and organic produce to the city's low-income community. Using a hybrid method of funding, CSAs like the Holcomb Farm (Just Food in New York City and the Western Massachusetts Food Bank in Hadley are other examples) have been organized around the country to ensure that CSAs are not solely the province of a white, bright elite. Other models like the People's Grocery in Oakland are using mobile markets to bring high quality, healthy food into communities that are underserved by supermarkets.

Public policy advocacy has leveraged federal and state funding to provide special farmers' market vouchers to low-income women, children, and elders (Farmers Market Nutrition Program). These small denomination coupons have opened an increasing share of the nation's 4,500 farmers' markets to a wider demographic of shoppers. Along the same lines, a small but steady stream of farmers' markets are installing swipe card machines to enable food stamp recipients to use their electronic benefit transfer (EBT) cards to buy local food. And in what might be the biggest breakthrough yet, the national Women, Infant, and Children Program (WIC) will be implementing a new fruit and vegetable program that is potentially worth hundreds of million dollars to lower income consumers and local farmers.

While it may be some time before we see a Whole Foods open in East Harlem, non-profit organizations like the Philadelphia-based Food Trust have secured millions of dollars in state financing to develop food stores in underserved urban and rural Pennsylvania communities. As part of an overall economic development strategy, these stores are not only providing new sources of healthy and affordable food to low-income families, they are also expanding employment opportunities and the local property tax base.

These projects and policies have inched us closer to bridging the divide between the haves and have-nots, but unless every segment of society rejects the notion that there is one food system for the poor, and one for everyone else, these gains will remain marginal.