Public Health Collaboration Conference 2018: a great success for Lifestyle Medicine

I was delighted to attend and speak at the third PHC conference in London this year.  We met at the Royal College of General Practitioners in London on the sweltering weekend of the Royal Wedding. Apart from superb international speakers we were treated to low carb, high protein food, such as one would typically eat on a ketogenic diet. Instead of picking at our dinners as we often have to do with mass catering  we could eat the whole lot. Great!

Dr Peter Brukner from Australia started off the weekend with a review of what was happening in the low carb world. There are more and more reports coming out describing the advantages of ketogenic and low carb diets to different groups of people but the establishment are fighting back viciously as can be seen by the attack on Professor Tim Noakes in South Africa.  Indeed if his defence lawyers and expert witnesses had not worked for free he would be bankrupt.  This is a terrible way to wage war on doctors who are acting in the best interests of their patients.

Dr Aseem Malhotra also described bullying tactics that had been used against him when he was a junior doctor and first becoming publicly engaged in the low carb debate. I have been subjected to this as well.  Professor Iain Broom showed that the proof that low carb diets are superior to low fat diets goes back 40 years.

Dr Zoe Harcombe gave us an explanation of how the calories in- calories out idea just doesn’t add up. The well known formulas about how many calories you need to avoid to lose weight don’t work in practice because of the complex compensatory mechanisms we have to avoid death from starvation.  How you put this over to patients and give them useful strategies for weight loss and blood sugar control was explored by Dr Trudi Deakin.

Food addiction is a real issue, at least it is for the majority of the audience in attendance, who answered the sort of questions usually posed by psychiatrists when they are evaluating drug addiction.  Unlike drugs, food can’t entirely be avoided but ketogenic diets are one tool that can be used to break  unhealthy food dependence. This worked for presenter Dr Jen Unwin who at one point had a really big thing for Caramac bars.  I haven’t seen these in years but they did have a unique taste.

Dr David Unwin showed clearly that fatty liver is easily treatable with a low carb diet.

Dr Joanne McCormick describes how her fortnightly patient group meetings are making change accessible for her patients and how many GPs in the audience could broach the subject in a ten minute consultation.

The website Diabetes.co.uk will shortly be starting up a type one educational programme online that all are welcome to join. I discussed the issue of what blood sugar targets are suitable for different people and how they can achieve this with dietary and insulin adjustment.

Dr David Cavan spoke about reversing diabetes in patients in Bermuda. Although Bermuda looks idyllic the reality is that good quality food is about five times as expensive in the UK as it is all shipped in. Many inhabitants work their socks off but barely cover their costs and cheap sugared drinks and buns are their staple diet. Despite these setbacks he managed to persuade a lot of diabetic patients to ditch the carbs and this had favourable results even after the educational programme had stopped.

A cardiologist Dr Scott Murray described the effects of metabolic syndrome on the heart and really why sticking stents in diseased arteries is too little, too late. He is convinced dietary change is needed to reverse and prevent heart disease. This is the first time I have been told that certain types of heart failure and atrial fibrillation are direct effects of metabolic syndrome on the heart.

The importance of exercise for physical and mental well being was not neglected and we had Dr Zoe Williams describing the great benefits that even the minimum recommended exercise can produce.

Dr Simon Tobin and Tom Williams spoke enthusiastically about Parkrun. This is a free event that runs every Saturday morning in parks all over the world. You can choose to walk, jog or run the course.

Claire McDonnell-Liu is the mother of two children who have greatly benefited from a ketogenic diet. The conditions are urticaria and epilepsy.  Although NHS dieticians do help families with childhood epilepsy who want to use a ketogenic diet, they can’t do it unless drugs have failed, as this is NICE guidance. I wonder how many children would benefit in fit reduction without side effects of drugs if this guidance was changed?

This was a fabulous conference with a positive enthusiastic vibrancy. Thanks to Sam Feltham for organising this event especially since he has become a new dad as well.

The Public Health Collaboration are putting all the talks on You Tube.

I was interviewed about diabetes and women’s health issues for Diabetes.co.uk and Diet Doctor and these interviews and many others will be available for you all to see to improve your lives with diabetes.

 

 

 

#TalkAboutDiabetes – Diabetes Awarness Week June 2018

What do you struggle with when you’re talking about diabetes? It’s Diabetes Week 2018 (June 11-18) and the theme of this year’s awareness-raising seven days is the stuff we find awkward, embarrassing, difficult or even funny to mention.

Here are mine:

  • I don’t like telling people in general. I’m not ashamed or embarrassed; I just don’t like drawing attention to myself.
  • Jelly baby etiquette. When you eat sweeties in front of someone, politeness dictates you offer them around. But they’re the medicine that corrects low blood sugars*, so stinginess is understandable.
  • Explaining a hypo when you’re in the middle of one. Most of my low blood sugar episodes are manageable. But I can be in the middle of a conversation and my mind goes blank. “Bear with me! My mind’s distracted. It’s screaming ‘SUGAR, SUGAR, SUGAR’ at me. My word power will return in a few minutes,” is what I should say.
  • Or don’t talk to me. When I’m high, conversation is too much effort. Please don’t take it personally.
  • I don’t talk much either when I’m high because I’m conscious of the nasty taste in my mouth and am reluctant to impose halitosis on anyone.
  • And don’t take the grumpiness low blood sugars produce personally either. First aiders once told me about diabetics who punched people when they were low, so grumpiness seems moderate in comparison.
  • Please know that managing diabetes is like having a part-time job that you do on top of everything else.
  • If you manage to work out I’m hypo long before I do, be aware I’ll deny it in an exasperated fashion. “Flip’s sakes, no I’m not. Look I’ll even do the blood test to show you and here it…oh. Alright then.”
  • Sometimes when I say I can’t do something because of the diabetes, I might be using it as a fab, ready-made excuse. It’s not me, it’s you. OH NO! I’ve just given away diabetes’ best-kept secret!

*I told a little girl my jelly babies were medicine once. She gave me one of those, ‘why do adults lie to me?’ looks.

Celebrate the NHS 70th birthday with tea and cakes?

On the 5th of July the NHS celebrates its 70th Birthday.  There is a concerted effort to celebrate this with tea parties and people are meant to contribute the proceeds to an NHS charity of their choice. Diabetes UK perhaps?

The trouble could be the cakes, sandwiches, scones and stuff that is likely to be scoffed along with the tea and coffee.

My practice has been gifted a hamper to celebrate the event.

This is what it contains:

plain and fruit scones

Clotted cream

strawberry jam

tea

Fudge oat crunch cookies

strawberries and cream shortbread biscuits

If you are having one of these events at your workplace, there are many low carb alternatives you can bring instead.

It is a pity the event didn’t feature something that emphasised good health promotion instead of bad health promotion. Going for a 30 minute walk for instance.

https://nhsbig7tea.co.uk/

More Thrush Ladies?!

a picture of canesten cream on The Diabetes DietCould I live with more thrush? Ladies who live with diabetes, you’ll join me at wincing at this one. No thanks, eh? Who wants to spend their days wishing they were sitting in a bath of calamine lotion?

I ask because I filled in a survey last week which asked me if I’d take a tablet to help with my blood sugar control despite initial findings where the control group suffered thrush as a side effect. That wasn’t the only reported side effect—weight loss is another one—but the benefits reported are exciting.

The drug is sotagliflozin (marketed as Zynquista), made by Sanofi and Lexicon, and it’s a dual SGLT1 and SGLT2 inhibitor. At present, it’s about to be reviewed by the US Food and Drug Administration, as diabetes.co.uk reported.

The SGLT1 bit works to delay glucose absorption in the intestines which helps with blood sugar spikes after eating. The SGLT2 inhibitor makes the kidneys better at getting rid of excess sugar in the blood.

Zynquista had undergone clinical trials. People who took the drug achieved better HbA1c levels without increasing the risk of severe hypos. But one group of trial participants taking sotagliflozin developed diabetic ketoacidosis, compared to just 0.6 percent taking a placebo.

Participants on the trial lost 2.98kg compared to those not taking the drug.

Would I take it? Heck, yes, even if it means stockpiling the clotrimazole creams beforehand. All addition help in the blood sugar battle is always welcome.

 

 

Office Etiquette with Diabetes

person holding jelly babies at The Diabetes Diet
Mine, all mine!!

I waved goodbye gaily to office life in 2013, glad to embark on new adventures in freelance world.

There’s a lot to be said for freelancing, not least the ‘free’ bit. I love being in charge of my own scheduling. But the pay… ah, the moolah just isn’t to be found, folks. You’re undercut all the time by global competitors who can afford to write for tiny sums or people in your own country who do it for free as a hobby. Argh.

Anyway, I started a new part-time job in April, working in a communications role on a project at Glasgow University—a worthwhile project and the chance to add a regular income. The equal opportunities form asked if I had a disability. I ticked the ‘no’ box. It also asked if I had a chronic health condition. Er…no?

Okay, I get that I do, but until my thirties, I thought all I had was diabetes. When someone pointed out it is a chronic health condition, I was stunned. No, really. I know that sounds like a “duh” moment, but diabetes hadn’t caused me much hassle. Calling it a chronic life condition felt a bit like I was straying into hypochondriac territory.

Back to my new office job. I decided to be a grown-up and tell my colleagues about my condition, instead of sneakily eating jelly babies at my desk and hoping they didn’t notice. It’s not that I don’t want to tell folks; I just I hate drawing attention to it.

I introduced the subject at a team meeting in a round-about way. Did my new colleagues know of anywhere on the campus where I could offload spare medical gear , I asked. (And benefit others at the same time by recycling my stuff. See what I did there?)

They suggested places. I’d told them I was a diabetic by default.

Job done.

Next up—the hypo talk, where I explain what a hypo looks like and why I’m a stingy jelly baby hogger, instead of offering them around.

A news story this week reported that scientists have improved the naturally occurring enzyme that can ‘eat’ plastic.

Good news, eh? Few people fail to be moved by the sight of the oceans brimming with waste. We all want to cut down on plastic and our use of it.

When you have diabetes, particularly type one, you use more plastic than most people. It wraps itself around individual pump components, it shields needles and it’s what lancets are made from. I hope the plastic-eating enzyme hurries up in its development so I’ll be able to chuck all that junk into a machine in my house.

The only figures I can find relate to general medical waste in the US. The market is expected to increase from $10.3 billion in 2015 to $13.3 billion in 2020. As rates of diabetes increase, that figure will only get higher.

I can’t find many specific tips to help us reduce the plastic we use for we diabetics, but here are some ideas I came up with…

  • Can you choose reusable pens, instead of disposable ones? This will depend on your insulin and what the manufacturers offer. Perhaps we should ask them to provide permanent devices if they don’t?
  • Recycle what you can—in my case, I throw the clean needle covers and empty test tube tubs into the recycling bins.
  • Nearby animal sanctuaries might be able to use old syringes to feed baby animals or give them meds. (Not sure about this one—check it out with your shelter.)
  • Small local businesses that do mail orders might take the polystyrene packing you get with any ordered supplies.
  • Finally, donate your old insulin and medical gear. If you have sealed, unopened packets of insulin, needles, lancets, infusion sets for pumps, unopened test strips and more, please give them a charity if you can. Insulin for Life works to distribute insulin and supplies to disadvantaged people. It operates in nine countries, including Germany, Australia, the UK and the US and distributes to 74 places.

Do you have imaginative ideas for what to do with diabetes-related medical waste? I’d love to know. Please feel free to comment.

 

 

ADA Reveals Diabetes Now the Costliest Health Condition

At the end of March, the American Diabetes Association released a report on diabetes’ fiscal impact. Guess what? It’s scarily high.

Diabetes is now the costliest chronic condition in the country. Diagnosed diabetes expenses in the US totalled $327 billion in 2017. The data indicates that one of every four healthcare dollars in spent by someone diagnosed with diabetes. And one of every seven is spent directly treating the condition and its complications.

The Economics of Diabetes in the US in 2017 kicked off the ADA’s annual call to congress event. More than 150 diabetes advocates meet with members of congress and staff, urging them to make diabetes a national priority.

The report showed that the economic costs of diabetes increased 26 percent from 2012 to 2017, thanks to its increased prevalence and the rise in cost per person living with the condition. The costs include $237 billion in direct medical bills and $90 billion in reduced productivity. The largest contributors to the costs of diabetes are higher use of prescribed medications, hospital in-patient services, medications and supplies.

These costs are passed on to all Americans thanks to higher medical costs, higher insurance premiums and taxes, reduced earnings, lost productivity, premature mortality, and intangible costs in the form of reduced quality of life.

ADA’s chief scientific, medical and mission officer, William Cefalu said: “From our new economics report, it is very clear that diabetes bears a significant impact on our nation, both in its toll on the lives of the millions affected by it, and the economic costs for all.

“The most important solution we have is continued and increased investment in critical diabetes research, care and prevention to improve diagnosis and treatment, and to help us turn the tide through diabetes prevention. These efforts can help us to improve health outcomes for people with diabetes – and hopefully decrease the cost of diabetes.”