So The Diabetic Warrior, Steve Cooksey, is going to court afterall. Is Advocating the Paleo Diet Against the Law? A New Institute for Justice Suit Stands Up For Free Speech Against Occupational Licensing Law - Hit & Run : Reason.com
The North Carolina Dietitians, now called the North Carolina Board of Dietetics/Nutrition, dropped their charges against Steve, but apparently Steve wasn't ready to let it go, or other parties were not ready to let it go. The Institute for Justice has decided to get involved and is sponsoring Steve in filing a lawsuit, Cooksey v. Futrell et al., in federal court against the state Board.
I like this decision as it may help clarify what can and cannot be said publicly by citizens and residents in many areas, not just nutrition.
This case is about a professional organization imposing its beliefs on people: nutrition is the same as medicine and people shouldn't be able to advise others about it in any way. I suppose the legislation was intended at professional practitioners, but the way it reads, anybody feeding or advising anybody else on what to eat breaks the law. *I'm not referencing the laws. I usually do, but today I'm not. If you are really interested, you can find them on your own. Hint: check Steve's blog.* Such cases might include a mother feeding a child: that child became obese so we're going to charge her for breaking this law. Many such relationships exist. One can argue that the lunch cart operator or the ice cream truck man are all breaking this law by offering foods not approved by this board. If the government cafeteria offers birthday cake for someone, say a retiring staffer who is diabetic, and that person ends up in diabetic ketoacidosis, then the givernment itself might be guilty of breaking its own law.
Regardless if you agree with these scenarios or not, many believe that this law -- these laws -- infringe on free speech. The question lingers of when can government restrict free speech. Can governments restrict the public's free speech by creating a professional organization to control all the relevant speech? Let's create an association of movie critics and license them. Let's make a law that only licensed movie critics can publish movie reviews and ratings. Let's do away with all the IMDBs and Rotten Tomatoes websites which only hurt movie sales. Let's make sure only qualified the professionals handle movie ratings properly. Who would go for that? Every one of us would brush it off and dare the government to challenge us; because we know we'd win. I have every right to say the Harry Potter movies were awful. Evelyn Beatrice Hall's words "I may not agree with what you say, but I will defend to the death your right to say it" loom large in American culture.
So why not nutrition advice?
The professional dietitians around the country believe it's medical advice. In some respects this statement is true. Many of us believe poor (wrong) nutrition causes many if not most modern diseases. We in the first world currently suffer from them on a large scale - pardon the pun. Changing your diet and losing weight is common advice given by health professionals. The benefits of becoming slimmer and fitter are apparently well known, though such studies cannot be easily layed on a table for display. [i'm not even going to address the failure of professional exercisers to band together and professionalize that industry. I don't want it becoming illegal to tell my wife to go out for a run so she can lose all that excess weight. By the way, she's down 18 pounds and feeling and looking like a new woman on my nutrition advice.]
I say nutrition is too fundamental to be considered medicine. It's so fundamental, we call it essential. There are three physical essentials: oxygen, water, and nutrition. Without one of them, we die. It's a simple fact. With no air we die in minutes. With no water we die in days. With no food we die in weeks or maybe months. But we die.
How to you legislate an essential component of life? How can you say the Standard American Diet is the only one that can be eaten and only a person educated and certified in SAD can advise you and anybody who feeds you otherwise is breaking a law? Who made you God?
I hope Steve takes them the distance. I hope he makes them look like communist whores. I hope in the end that all of us are free to write whatever we want about food.
I want us to also realize that such freedom comes with a cost. It comes with responsibility. We shouldn't feel free to feed our babies milkshake diets or advise our blog readers it's okay to eat nothing but coconut oil. We are free to say these things, but recipients are also free to challenge our advice. And when things go wrong, these challenges can become expensive, as they should.
Keep your head up Steve Cooksey!
Read the question mark as John not knowing what he's talking about [add because he's a man, if you so wish. I won't be offended.]
I stumbled upon a post linking a vegetarian food guide back to the Dietitians of Canada. It's a dead link. Yay, they've seen the error in their ways. I went to their real site and looked around. I wasn't looking for anything in particular. I just browsed out of curiosity. I quickly came across their "Career Stories" section, profiles of dietitians in various roles.
I skimmed through the profiles. I even opened a few. There's a lots of description about their roles. It's a nice site with only a couple of minor technical glitches. Here's a header image from the site. It's quite professional looking, and everybody wears happy, happy, joy, joy faces. It feels congruent with my own impression of dietitians. I run into them once in awhile at the local diabetic teaching clinic, at company dietary education presentations, at diabetic events, and we'd consullted a few in our now dead diabetes support group. They all look like the women in this picture: happy, happy, joy, joy women, often wearing lab coats. Congruency.
I decided to think. I think it's a good idea to think about what you see and ask why it makes you feel the way you do and whether those thoughts and feelings are valid, correct. Or if they are they artificially induced by marketing techniques.
Some of my thoughts bothered me. I thought about what happens to these happy faces when I tell them I don't eat grains and very low carb in general. The sunshine turns grey, the teeth get bared, and the hairs on their backs stand up. Suddenly my thoughts were no longer about congruency.
I realized these women had something against my style of eating. I didn't dig into the style of eating topic. I know it's a dead end. But I did realize I was viewing my happy, happy, joy, joy image of dietitians with a lychnathropic bent as all women. I was not able to relate any of my images and feelings to the man of the tribe. I looked through the career stories again. I counted 70 profiles in 11 career streams. I counted two men. 68 to 2, good odds if you're shopping around for a woman. Try the dietitian bar next time. Must be a hopping spot.
I said the word I usually say when something bothers me: why? Why are almost all dietitians women, and is this a problem? Is this a genetic abberation, a cultural difference, or maybe outright sexual descrimination? I have no doubt that if 97% of dietitians were male, that the female of the species would be at least a little bit upset.
Honestly, I have no desire to think this through. Give me your comments please. But I will say that the whole idea of Grok does seem very male oriented. Yes, an image of a naked woman hunting down a wild animal with a spear is sexy to me, very sexy to me, but is the opposite true? Women seem to prefer well dressed, well mannered, candy-a$$ed men. Men like I see profiled on their site.
Cultural differences. So we have this group of dietitians with regulatory power to decide what people should eat, who feed our sick, invalid, and government sponsered citizens, and they are dominated by a group of people who prefer to work in a garden and a nice warm kitchen than run around naked, hunting wild beasts with primitive weapons. If that's not an inherent food bias, I don't know what is. No wonder Canada is so obese and sick.
Put Grok in charge ... NOW, before it's too late.
I've posted in the forum about this case, but if you are not familiar with it, Steve Cooksey, owner of the blog-site Diabetes-Warrior.net, is being investigated by the North Carolina Board of Dieticians for giving nutritional advice on his website without a license. It has attracted the attention of most of the low-carb community. Even non-low carbers are paying attention. I stole the term 'Cooksey Affair' from a physician's blog: S. Andrei Ostric MD, a plastic surgeon.
At issue are some fundamental concepts. I'd like to say fundamental rights, but I think it's even more basic than rights. Rights are something we should have the freedom to do without restriction. I should be free to stand up and say what I think. I am free to write this blog, as long as I follow the blog owner's rules. Many people around the world have legislated rights. I think you understand them, at least inherently. If not, then shut up. [in the words of the estimable Foghorn Leghorn, 'That's a joke, son'] Nobody is challenging Steve's right to speak his mind. They are challenging his right to tell you what he thinks you should eat.
The basis for this argument is that nutrition, or simply food, is medicine. While I can't argue that nutrition isn't a valid treatment of disease, after all, I am a diabetic, I do challenge the logic of this argument. I see many references to the Hypocratic Oath. Wikipedia's "Classic" version contains the statement "I will apply dietic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice."
Let's tread carefully here. This logic is a slippery slope. Food is used to treat illness; therefore food is a medicine. Only licensed practitioners should give medical advice, and since food is a medicine, only licensed practitioners should be able to give such advice. And this is how North Carolina's legislation reads, and they are not the only state with such legislation. Let's apply this logic to other things in our lives. Dangerous weapons should be licensed, and they are in Canada and other countries. An automobile is a dangerous weapon. Hit and Runs happen daily in America. Cars are weapons. They are used as weapons. They should be licensed as deadly weapons. Really? Think about this. Food can be used as medicine, so therefore food is a medicine and should be controlled as a medicine. I can kill somebody pretty easily with a golf club. Anybody watch The Girl With The Dragon Tattoo? Should we license golf clubs as deadly weapons? The dietitians in the crowd will now be chanting foul because only advice given for disease should be considered medical advice. Sorry, that's not how the laws read.
Let's get back to rights, no, something more fundamental: necessities. Think about what is necessary for life. Is your right to speak your mind necessary to keep you alive? If you listen to the current political debates, you'd think so, but no. We can lock you away in solitary for decades, and you'd survive without being able to speak to anybody. You won't thrive, but you will survive. A necessity is something even more fundamental. You need them. You will die very quickly without air. You will die more slowly without water, but you will still die. You will die slower still without food, especially you, the modern day obese government legislated metabolically unfit diabetic. Clothes are not necessary. You can move to the tropics and survive just fine. Medicine is not necessary. Well it is for me, the type 1 diabetic, but generally we don't require medicine to live.
So we have these necessities. They are more fundamental than rights. Should they be legislated? Do we need 'Bills of Necessities?' My answer is no. If you deprive someone of their necessities, it is a criminal act. We have pollution legislation to ensure our necessities remain pure. *please don't laugh too hard* And we have lots of legislation surrounding food quality. A food producer who sells you cow dung as nutritious food will face some severe consequences. *Oops. I forgot we can buy cat-**** coffee* Really though, necessities are so fundamental, we do not have to legislate their freedom. Supplying people with bad necessities is a criminal offense against the person, assault & battery. Ask a restauranteur how they are treated when one of their patrons is poisoned from food.
The North Carolina legislation takes the high road: food is medicine and needs to be governed. Nobody should give nutritional advice to anybody else, and should not feed anybody else, especially not for the purpose of treating an illness but not limited to ill people. I've read this legislation carefully, and I'm not a lawyer. Please correct me if I'm wrong here, but there are cases that this law seems to govern that feel ... wrong.
Say I am a parent with children. According to this law, I cannot tell them what to eat. In fact, I cannot even feed them as that's running a food service. If I live in North Carolina, I put myself at risk by feeding my children. When my obese kids turn 18, should I expect a lawsuit? According to what I read here, it seems plausible. Do you have an elderly family member living with you? Are they ill, maybe even diabetic? You should not be accommodating and caring for them. You are breaking North Carolina laws. Send them to a nursing home where they have licensed dietitians to handle their medical needs.
"But Steve is treating diabetics!"
Am I treating diabetics? When someone asks me how they can eat like I do, and I tell them what they need to change, is that giving advice? Is that giving medical advice? It's not an easy question to answer. But there is one solution, and that solution already exists. If I give someone bad advice, they can sue me. If I represent myself as an expert in a field, and what I advise causes damage, they can take legal action against me. Shouldn't that be enough? Shouldn't that alone make Steve wary about handing out "you should do's?"
So, if someone represents themselves as the dietary experts and gives faulty dietary advice that results in damage to the recipients, shouldn't they be sued? And this leaves me with two questions I want you to think about. One: why hasn't Steve Cooksey been sued by any of his patients, and two: why isn't morbidly obese America suing dietitians and the USDA?
I will leave with a line from the modern version of the Hippocratic Oath intended for dietitians and food guideliners everywhere:
Above all, I must not play at God.
I began pumping on June 26, 2006, a fun year filled with eye hemorrhaging, a vitrectomy, beginning my life at Diabetes Forums, and learning how to use this new tool. One problem I experienced from the starting line is failed sets. I call them failed because either they don't work as intended. It might be complete failure or poor performance. It might fail when it's inserted or a day or two later. I almost always experience inflammation at the site - redness and swelling. When a set works well, my blood sugars are typically near perfect. When they don't work well, I will run high, sometimes at a tolerable number but too often at an extreme number. A painful set and high BGs are automatic signals I need to change sets.
During this autumn of 2011 I experienced many bad sets. It got to the point just before Christmas where I seriously considered taking a pump vacation. But I procrastinate. Since about the time I started my Christmas Vacation, the day before, every set I've inserted has worked. My current set is on day 5, and my fasting BG today was 5.3 mmol/l. I recall seeing double digits once in the last three weeks, and that came down right away when I corrected. We'll blame it on Christmas. I hesitate to say a change has occurred, but the difference in performance between pre-Christmas and post is quite dramatic.
I never before considered that bad sets might be caused by something other than physics - inserting in to a sensitive location, external interference such as clothing friction or door knob entanglements, or maybe staying in the shower too long. I like hot showers, especially on mornings like today's where I had to chip my coconut oil with a knife.
As far as I know, I have not changed any of my bad habits. Over the holidays I actually worked on increasing them. I drank a quart of Goslings Black Seal rum and probably four bottles of wine. That's rather excessive for me. I didn't experience any hypos, and of course I didn't drink and drive. We did buy a kinect, and I've been trying some of the games. I like the one where I throw balls at targets. I can't say I've played enough to make a difference, but maybe I have. I turned the photographing option off. Eww!
I have made one big change - I am now eating far fewer carbs each day. I wasn't eating many before, at least by my dietitian's standards, say 75-100g a day. Not what I preach, and I won't make excuses. In mid-December I decided I needed to track my food intake closely for at least awhile. I'd been gaining weight, and the pressures to consume carby foods grew within me. With Christmas approaching, I felt I'd collapse in a chocolate frenzy. I had to regain control. My first tests were eye opening. I began to discover the true content of my diet, and I wasn't happy. That 10% Tim Hortons morning cream I thought was good was a big contributor. I now bring whiping cream to work and keep it in a fridge. I also now keep coconut oil at work. When I buy my morning Tim's, I buy it black. With other changes, I think I am now at or below my 10% carb limit I've set for myself. Yay.
I track my "performance" through my total daily insulin dosage (TDD). When it's under 40u, I know I will lose weight. When it's over 50u, I gain weight. At least that's what I go buy. I don't have the desire to try to target the threshold more closely. I know from experience that weight measurements vary greatly from day to day. The result would be no more accurate than eye-balling, so I tell myself. Here's my daily totals since December 11, 2011.
57.25, 45.3, 58.125, 57.25, 33.30, 33.30, 37.30, 38.125, 32.175, 48.30, 43.55, 61.30, 53.30, 41.75, 70.20, 50.30, 48.30, 59.275, 48.70, 50.275, 52.75, 50.50, 42.35, 52.525, 37.55, 40.40, 36.30, 43.25, 42.30, 44.30, 38.30. *Chritsmas day and New Years day are bold.
Even on these 50+ days, my carb consumption has been pretty good. Inactivity had run rampant. I blame it on Skyrim. There is some Christmas chocolate mixed in, and Christmas dinner is easy to find. I'm not going to pass over second helpings of Christmas dinner. I'm down three pounds over this period and maintained a state of ketosis since about Dec 21st. Back to my original topic, I haven't had a bad set since Christmas.
It does intrigue me why my sets were failing before these last three weeks and none since. I have theory, and it goes something like this. Sugars not only cause inflammation but exacerbate other inflammatory pressures. We all know that diabetics are slow to heal, but are we also quick to inflame? If this is the case, could we treat pump-set health as a marker for our overall health? If my sets are going bad, then aren't my arteries? If my sets are not inflamming, then maybe my internals aren't either? Hypothesis, but right now I'm willing to try and prove it. Can some researcher please tackle this for me? Thanks.
This theory fits in to my model of how things work, and please consider that a prejudiced bias. All I know is these past three weeks have been pump-set heaven, and for me, a motivation to continue this low carb journey. I welcome any experiences or alternate theories.
This morning I had a whimsical idea. I thought I should ask somebody in my socialist health care system for help, you know, all this for the people ****. So I fired off an email. I didn't think much. I didn't spend time crafting. It's more a how's it goin' eh? than a what the F are you idjuts doing, eh? kind of letter. I'm sure it will be passed around a few times before being tossed away. *sigh*
For some weird reason I decided to read Durianrider's blog today. I'm sure you can find it. Not only is it unusual for me to read this whacko's scribes, but I was really busy today at work. I'm glad I did though.
He wrote about forms of of mental disorders, mainly three forms of dimentia, according to his definition, alzheimers, mad cow disease, and AIDS. I guess he couldn't include psychosis
He has a strange way of twisting logic to suit his needs. If you don't know him, he needs to mutilate things like logical thinking and scientific methods. Of course he blames all three of these diseases on meat consumption.
Perhaps his silliest case is AIDS: Scientists believe that the origins of AIDS also are related to the consumption of meat, and specifically bushmeat in Africa. Really? I checked it out. The first site I found was The Origin of AIDS and HIV May Not Be What You Have Learned , and it is a very good looking site, says this: Most people believe that the origin of HIV, the AIDS virus, derives from some natural evolutionary event. Key among these HIV origin theories is the so called "cut hunter theory" in which a human, allegedly African native, received a bloody wound or infected splash while preparing a chimpanzee carrying a similar virus (i.e., SIVcpz). Most recent research, along with the scientific consensus, holds that the origin of HIV and AIDS could never have happened this way. If you read carefully you'll note that it wasn't blamed on meat consumption. It was blamed on exchange of blood while cleaning a chimpanzee, arguably the closest relative to humans, Case closed? I'm not digging further. But if you can show me some real science linking AIDS to meat consumption, please bring it on!
Next he digs into mad cow disease and alzheimers. First he states Mad cow disease is specifically related to the consumption of meat. Related is a rather nebulous word. Does he mean cows ate meat? Cows have been fed meat at one time. Should cow eat cow? It was banned because it supposedly caused this condition. Or does he mean we get it from eating cows? I don't know if that's been proven, but I'll give it to him. But I wonder if he asked why cows get mad cow disease. Wikipedia, the Olde Faithful of blogging argument support says this. Bovine spongiform encephalopathy - Wikipedia, the free encyclopedia It is notable that there are no cases reported in Argentina, Australia, Brazil, New Zealand, Uruguay, and Vanuatu where cattle are mainly fed outside on grass pasture and, mostly in Australia, non-grass feeding is done only as a final finishing. Interesting! What John giveth, Wikipedia taketh away.
The limited evidence I've discovered on the next points seems to confirm my preference for the cause: grains!
He then discusses alzheimers and how his favorite veggie doctor thinks it's caused by eating meat based on some nebulous -- I hate this word, but this is the way buddy writes -- associations. He writes that amyloid proteins are associated with alzheimers. Yup, I think it is. He says it's also associated with type 2 diabetes. Yup again. But so what? Any decent logician knows that associations do not indicate cause. Enough of that. You've heard it before. He goes on to say several wonky things:
He goes on about causes and even slips in that healthy people not only don't eat meat, but they also don't eat clarified sugars, bleached grains, and artificial chemicals. So which is it, the meat or these other nasties? Logic. He has none.
But the Amyloid thing is what turned my crank. I'd never really paid any attention to them, you know, this nasty association business. I tend to simply shrug those finding off. I was now curious about them, so I did some reading. I couldn't find any causes of amyloid buildup anywhere, but this site was very interesting. It describes how these things might cause type 2 diabetes:
AMYLOID PROTEIN–A CAUSE OF DIABETES / Diabetes / Dr. Pinna
It found that a type of immune cell called a macrophage, whose normal role is to get rid of debris in the cell, reacted abnormally when it ingested amyloid. It triggered activity in other cells nicknamed angry macrophages, which in turn released proteins that cause inflammation. The inflammation then destroys the vital beta cells, and the ability to produce insulin is reduced.
If you're on the same page as I am, you recognize macrophages from atherosclerosis development. Could these amyloids also be at the root of atherosclerosis? I don't know, but I'll be watching.
As I leave I'm overcome with temptation. I need to leave you with a Durianriderism logic argument:
Dr. Pinna says:Take lots of Vitamin B complex. It seems to reduce amyloid.
B Complex reduces amyloid? Where does B complex come from. Can you say MEAT?
P.S. Here are a couple more articles I read today suggesting meat and fat are not to blame for mental disorders.
Evolutionary Psychiatry: Do Carbs Make You Crazy?
There is tension in the world of cholesterol. Those of us eating high saturated fat,low carbohydrate diets are claiming that this is much better for heart disease prevention because we increase the size of our LDL particles. The problem seems to be though, that the medical establisment can't take their sights off of the LDL value in our standard lipid measurements. I think we can all agree that the LDL value alone is a lousy predictor of heart diease. Even teh staunchest cardiologists admit this. However, it's the best we have. *gawd*
The problem is these policy setting scientists that have listened to their cheque-writers (For you Americans, a cheque is a check. If you can't handle such a change, you shouldn't be reading my blog!). They have listened so hard, they forgot to follow teh real science. Now that science is catching up to them. In my opinion, the stage is almost set for some class action lawsuits against the NHLBI and USDA for setting policy according to paycheques and not science. The key point I want to make clearis they are very likely looking for a way out, a compromise if you will.
I'm hearing some rumblings about a new measurement. It's not that new, but it hasn't been used much. It's not been set in policy or even discussed by teh ATP in their timely seven year reports. Good God, the number one killer in America only gets discussed every seven years. Another slant against them if a law suit gets launched. Anyway, this new measurement amazing keeps the old LDL value in play and also seems to accomodate the new breed of lipidologists like myself. It's called non-HDL cholesterol.
NHC? Is that it? Yup, that's it. I do not know if the VLDL value nees to be added into the total value. It's the sum of all cholesterol or APO-B particles. The theory says that APO-B is actually what's dangerous, so we should measure it all. Correct me if I'm wrong, but I always thought HDL used the same APO-B as LDL, the APO-B 100 protein. Basically what they are saying is both LDL and VLDL are atherogenic, VLDL being the lipoprotein not currently measured. Amazingly it seems that those persons with LDL that experience heart atacks do in fact have high VLDL numbers, so this new capture may in fact be much more relevant. It also opens up the door for doctors to accept those up us on HFLC diets whose LDL value increases. Maybe. Doctors, just like my fellow Americans, do not like to change. [sorry, but politics is getting to me lately]. I hope this accomodates the new LDL size way of thinking. I really do.
It should fit my way of thinking, that LDL size is the cause of modern heart disease, and that LDL size is based on triglyceride levels. Triglyerides are caried by VLDL aprticles. Therefore, high trigs means high VLDL which means high NHC. Win, win, win!
So scientists now have a compromise which lets them off the hook for hundreds of millions of early deaths, rampant obesity, and the entire host of western diseases. Wow. We new self-proclaimed [really, we know squat] lipidologists are acknowledged, and most importantly it opens teh door to change our food guidelines and systems. It's not a wholesale admittal of wrong advice but a step towards better advice.
I still hope somebody sues their butts!
In the last few days there has been a backlash against diabetic educators (DE's), particularly one named Hope Warsaw, or affectionately called "High Carb Hope" by some of us more vocal anti-DE writers. I won't go into the details of what she wrote to raise the ire of the Paleo community, but here's some recent blogs.
Livin' La Vida Low-Carb
Healthy Low Carb Living
and a more generic The Poor Diabetic
I read her article, got angry, posted a reply, and moved on. I am upset, but I know there's nothing I can say or write to change her mind. It doesn't matter to her that I've dropped thirty pounds, that my HDL is as high as my LDL, which has gone up, or my triglycerides are as low as triglycerides can get at 42. It doesn't matter that my proliferative retinopathy has fully stabilized, that my sexual functioning has improved, my aerobic performance has improved, or that there's absolutely no signs of atherosclerisis in my eyes. She believes I'm killing myself with a fad diet, but why does she believe this?
One reason she believes is because she sees her recommendations working, and studies show it does. Her Mediterranean diet does work better than the standard American diet or SAD. People who follow her advice do better. If you are one of the 90% of diabetics who fail to achieve good control, and your diet, well, if your diet sucks, then follow her advice. It will be an improvement. It's not the best plan. A primal diet is best. Eat 60% fat -- mostly saturated -- 30% protein, and 10% carbs. Make sure all this food is as natural as possible.
The main reason she believes though is because she trusts her own guidance. She was educated to believe what she believes, and the official nutrition and health comminities all push the same message as she spouts. She's less than the tip of a mammoth iceberg.
I want to target the base of this mess, the root of all this diet nonsense we've been fed the last 34 years. I want to target the National Heart Lung and Blood Institute's Adult Treatment Panel. This panel of scientists sets cholesterol treatment policy for the world, and since heart disease is such a big killer, everybody follows what they say. The USDA food guide, endocrinologists, the American Diabetes Association, the American Heart Association, and every country's equivalents around the globe base their guidance on the ATP's recommendations. They will not change their cholesterol treatment guidelines until the ATP changes their tune.
ATP IV is scheduled to meet later this summer: Background, CVD Risk Reduction, Cholesterol, Hypertension, and Obesity Guidelines, NHLBI I took a look at the panel and searched for the web for anything about them. Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel IV), Expert Panel Memberhip, Health Professionals - NHLBI, NIH I won't post my findings now; because they are on my laptop at work, I think. My cursory assessment goes like this
Low Carb: Daniel Rader, M.D. University of Pennsylvania
Undecided: Ronald M. Krauss, M.D. Children's Hospital Oakland Research Institute and Frank M. Sacks, M.D. Harvard University School of Public Health
High Carb: 13 pawns
Dr. Krauss authored the infamous meta analysis that showed no associations between saturated fat and heart disease. I initially held out some hope for him, but an interview I heard with him on one of the blog-casts told me he is not yet converted. Dr. Sacks has been a hard core anti-fatologist, but he seems to have softened after working with Dr. Krauss. Dr. Rader's comments showed promise, but the rest are all staunch industry backers. Why did I call them this? Take a look at the ATP III conflict of interest. Review this page: ATP III Update 2004--Financial Disclosure, NHLBI, NCEP It is my firm belief that this so-called scientists tow the line. Admitting current guidelines are wrong is the same as cutting off their own money supply. Say cholesterol is not the enemy means Big Pharma won't sell many drugs. If they collapse, their funding collapses.
So do we have hope of breaking these high carb shackles? I don't have much at the moment, not if we all keep attacking the middleman, the diabetic educators. I want to turn our guns on the ATP. I want them to stand up and acknowledge the real science, behave with some scientific integrity, some hypocraticness and make the logical decision to target sugar, not fat and cholesterol.
It's the sugar stupid!
We get fat is because we eat too much, right? That's what our doctors tell us. That's what our dietitians tell us. That's what diet gurus tell us. Weight Watchers and other diets work because we reduce calories. Exercise works because it burns calories.
So why is there an obesity epidemic? Why do 97% of dieters fail?
There is one simple fact that refutes the whole concept of calories in vs. calories out. It's called type 1 diabetes.
We need to review what happens to type 1 diabetics. What, not why.
Our bodies stop making insulin, our tissue -- not all tissue -- cannot ustilize glucose. Our brain, heart, and other organs can, but not much if anything else can. Our food stores, our fat, glycogen, and muscle will be used up and we will die. Correct me if I'm wrong, but we don't actually starve to death. We die from glucose toxicity as the blood glucose levels skyrocket and stay at toxic levels. We can still utilize fats and proteins. The important point for this argument is we will not store fat or glycogen.
Let me repeat this. Without insulin, we will not store fat or glycogen. It doesn't matter how much we eat, it doesn't matter what we eat, eat 100,000 calories a day if you can, we will not store fat or glycogen. Do you understand this point? Storing fat and glycogen is not possible without insulin. If it's merely a case of calories in vs. calories out, how come type 1 diabetes even exists?
Don't brush this off. It's fundamental metabolism. Insulin controls adipose tissue. It's in medical textbooks. If you want to control your weight, the ONLY way to do it is by controlling your insulin levels. Don't make me starve myself to prove this, which I can easily do. Almost all diets are lower carb and therefore lower insulin. If you are losing weight, you are lowering your insulin levels.
Let me repeat this once again for the thick-headed readers: it doesn't matter how much we eat, it doesn't matter what we eat, we will not store fat or glycogen without insulin.
The next time some medical person says you only need to eat less to lose weight, ask them "if that's true, why does type 1 diabetes exists?" It cannot be rationalized. Watch them squirm!
Some time ago I listened to a podcast with Dr. Rosedale. It was probably one of Jimmy Moore's. He said some interesting things about fat metabolism. His premise was that a healthy person is somebody who burns fat. If your not burning it, you're storing it, including in arteries. It has stuck with me and forms a basis of my eating -- a ketogenic diet.
Recently I found myself thinking about protein metabolism, particularly gluconeogenesis (GNG). We type 1's have runaway GNG due to our absence of the hormone amylin. What got me thinking about this further was a post here (maybe elsewhere) about weight distribution of type 1s. Many say we tend to be skinny and I say otherwise, so I tried to find some evidence online that we are normal. I found a study that said we were nearly normal with the exception that many of us are skinny. Great. Thanks for clarifying.
So there are many skinny type 1's. Why? We generally take more insulin than the normal person; we should all be fatter. What could be going on? My thoughts turned to protein. I don't know any muscular type 1's. I'm not. I can gain muscle; I have. I gain fairly easily in my legs, but my upper body tends to be weak. If I train for six months I can work up to 3x10 120lb bench presses. My 19yr old son can do that much without training. I also lose muscle mass easily. I just started weight training again this week, and I'm starting off at very low weights. 120lb squats should be something I can do on one leg all day long, but it's a struggle at the moment to get 15 reps in.
So I'm guessing that we skinny and muscle-challenged type 1's are fighting GNG as a protein drain. It consumes protein, including our muscles. It seems reasonable to me. But here's a question: what impact does resistance training have on GNG? If I lift heavy weights, will muscle repair override GNG demands? Will I reduce the protein draw? Will my sugar production come down? Will my insulin levels fall? Will I lose fat because of this?
This is my current experiment. Let's see if I leave everything else the same what some intense resistance training will do for me. Starting weight: 225lbs.
Our doctors treat blood pressure (BP) very simply: "take these meds and don't eat salt."
Do doctors really understand the cause of high BP? Do they really know how to treat it? Or are they simply going through the motions, covering their asses just in case we die from it? And by doctors I mean the whole medical community from the Surgeon General down to your lowly ditetitian. The fact that our dietitians are on the bottom of the chain might be a topic for another discussion. Our health depends on nutrition.
So what is high BP and what should we do about it? Let's first discuss conventional wisdom.
High BP is simply high blood pressure. One cause is supposedly that the arteries become stiff and become less flexible. If they can't expand as widely, more pressure builds up. It seems plausible, but does science prove it? This study didn't http://www.ncbi.nlm.nih.gov/pubmed/2632754 This Mayo article suggests stifness results in low diastolic and high systolic pressures: http://articles.sun-sentinel.com/2010-06-22/health/fl-jjps-pressure-0623-20100622_1_blood-pressure-blood-loss-diastolic/2 I suppose if they can't expand, tehy can't contract. This statement from the last site is interesting. Atherosclerosis — a condition in which fat (plaque) builds up in and on artery walls — can stiffen blood vessels and have the same effect on blood pressure. A little logic tells us that if the first study is true, that stiffness doesn't really affect BP, then this last sentence is wrong. I suspect it is very wrong.
Most practitioners promote the idea that sodium in our diets is responsible for high BP. High sodium causes us to retain water which raises our BP, another plausible idea that's pushed on us hard. It makes sense except for a couple of things. First, there's very little evidence it works. Find it for me please! Second, it shoudn't work. Huh, you ask.
Our sodium levels are tightly controlled. If they weren't, we'd be dead. Too little or too much sodium will kill you. Exactly how much is not clear, but that's not the main point. The main point is that if you eat too much, you pee out the excess, and if you don't eat enough, you will retain it. Homeostasis.
Another idea is excess weight can cause it. "Lose ten percent of your body weight, and your BP will come down." I was recently told this in a diabetes education class.
My friend Dan weighs over 400 pounds. He can't be wighed at the doctors' office. They have to weigh him at truck stops. He has high blood pressure. We discussed his history: he gained about 40 pounds the previous year and his blood pressure was high before and was high then. I got him to try eating like me. His sinsulin dropped dramatically, he lost 40 pounds, and his BP was almost normal. Unfortunately he hasn`t stuck with it. He thinks boxes of Oreos are okay to eat. But it was interesting to see his BP results. At 360 pounds on the way up, he has high BP, but on the way down, he has more normal BP. It`s not the weight. In my case, I`m still overweight by some 40lbs. Yesterday I tested at 105é59 after a day in the garden. I`m pretty sure it`s not the weight causing high BP.
I highly suspect -- of course I don't really know these things -- that atheroclerosis, excess weight, diabetes, and high BP are symptoms of the same cause. We discuss this cause all the time. I think it causes most of our diabetes troubles and probably most of our western diseases. I think our medical community is guilty of making false assumptions about cause and effect. Of course I'm talking about high sugar consumption. Sugar (all carbs and half of protein) consumption causes higher insulin levels. Gary Taubes asserts that high insulin causes the kidneys to retain salt. When you retain more salt, you retain more water and your BP rises. You will see a criticism of the Atkins Diet: "It`s all water loss. It`s not really fat loss, and it`s not healthy!" But your BP dropped. Hello? Your BP dropped!
Cut the sugar, elimate atherogenic LDLs, lose the weight, lower your BP, become more active as you stop feeding your fat, and basically get healthy.
I don't know if this concept has a name, but I need to call it something. We've all heard about LDL being the bad cholesterol and HDL being the good cholesterol. These lipoproteins are not cholesterol at all but merely carriers. LDL takes cholesterol to cells from the liver and HDL returns cholesterol from cells to the liver. It's a flowing system.
Why does it need a blog entry? Because we haven't got it right. We say simple things like "too much LDL is bad." The problem is, that doesn't cover all the bases, sorry non baseball fans.
What got me thinking about this angle are the fruitarians. Personally I can't stand their cult-like behavior, at least the ones I've read. I'm sure there's a few good apples in the bunch. I have a hard time believing their "interpretation" of science. I see it as "it works for me, so it must be true." We all know that science has to cover all the bases.
But what if the Fruitarians and Atkinsers are both right about heart disease? Can they be? Can we explain it? Obviously if we are both right, it has to be explainable. We just have to figure it out. I think this flow theory might just do that.
So what is this flow theory? I can't give you all the gory details, but guys like Chris Masterjohn can: High Cholesterol and Heart Disease — Myth or Truth? I think what he's saying is that the load of evidence points to oxidyzing LDL as the number one suspect. But things like too much saturated fat, high LDL alone, and physcal experiments do not support the concept that LDL by themselves are in any way dangerous. These are not simple proteins with cholesterol particles stuck to it but complex compounds. One of the things they contain are antioxidants, things that prevent oxydyzation. Further complicating matters are factors such as particle sizes and fat composition -- he says PUFAs are much more prone to oxydization that SFs. His premise is basically this: the longer an LDL is out there floating around, the more it decays. I think we can also add a few others: the less antioxidants packaged in the LDL, the faster it will decay, the more prone the fats contained in it are to oxydization, the faster it will decay, and the smalle they are, the more likely they will get stuck and decay. So lets take a look at these things under three different diets; let's try to measure each diet's atherominity according to this idea of flow or time: the Standard American Diet (SAD), the Atkins (HFLC), and the Fruitarian (F). We'll simply mark them as 0 for good, 1 for indifferent, and 2 for bad. The higher the score, they worse they are.
- - - - - - - - 1 HDL qty - - - - - 2 LDL qty - - - - 3 LDL Size - - - 4 PUFA - - - 5 Anti - - - - - - Total
SAD - - - - - - 2 - - - - - - - - - - - 2 - - - - - - - - - 2 - - - - - - - - - 2 - - - - - - - 2 - - - - - - - - 10
HFLC - - - - - - 0 - - - - - - - - - - - 2 - - - - - - - - - 0 - - - - - - - - - 0 - - - - - - - 1 - - - - - - - - - 3
F - - - - - - - - 2 - - - - - - - - - - - 0 - - - - - - - - - 2 - - - - - - - - - 1 - - - - - - - 0 - - - - - - - - - 5
1. Fructose and excess carb consumption cause high triglycerides which borrow APO B-100s from HDLs thus lowering HDL. Less HDL means LDL stay longer.
2. HFLC will add dietary cholesterol. More LDL means more to clear out so they stay longer.
3. Sugar consumption lowers LDL size. The smaller things are, the stickier they get. The more they stick, the longer they stay stuck.
4. HFLCers eat very little PUFAs while F's avoid SFs but also lower fat intake (affects #2 as well).
5. HFLC lowers need for anti-oxidants (because they work better?) and get many thru high veggie consumption; while F consume more. Add 1 to HFLC if u disagree.
* My weightings are even because I don't kow how to weight them sensically. I debate keeping the size factor.
* This analysis addresses only heart disease forces. I still believe obese people suffer from too much carb consumption for their level of insulin resistance.
It seems according to this flow theory, both low carbers and fruitarians might be right about diet and heart disease. The sure way to fail seems to be SAD. But I'm not a scientist. Don't believe anything I write about this stuff.
As many of you know, I have taken up creative writing as a hobby. I've been drawn to the power of words.
There's a concept writers use to describe effective fiction writing: show, don't tell. There are many examples of this idea. Instead of writing Jill walked down the street, I might write Jill's reflection bounced off store front windows in the early morning light. I'm not saying she's walking, but you might get the sense that she is. I will sometimes try to show instead of tell in my forum posts too, but often it's not that simple. Usually we want to be succinct and get to the point.
This morning I stumbled across a little video which illustrates the power of this concept. Enjoy!
We would like to invite you to take part in an opportunity to help you manage your diabetes. By getting involved you will:
participate with others who also have diabetes.
learn new ways to increase your confidence and motivation.
take part in a "new" approach designed to meet the needs of your group.
learn how to become more involved in your care.
Most times when you come for appointments at St. Joseph's Community Helath Centre, you may have been ill or have a specific problem to be addressed. It's difficult, during these visits to have the time to talk with you about ways to better manage your diabetes. The purpose of these group appointments is to involve you more in your own care and to help maintain or improve your health.
Starting in April we are planning 3 group appointments, in which [Mr. B the pharmacist] and [Miss M. the diabetes edumacator], two of our team members will be facilitating. We invite you and others that have diabetes to work with members of our health care team at St. Joseph's Community Helath Centre. By working together, we are hoping that you will learn new ways to better manage your diabetes. We encourage you to bring a family member/friend to these 3 appointments ... [blah blah blah]
Sounds kind of cool. Afterall, the absence of this type of program is what I have complained about. I probably wouldn't be half blind today if this was available 30 years ago. It sounds a lot like a forum moderated by health care workers. Maybe they finally said "How come John's doing so well? Maybe we should do what he's doing? Yea, but let's supervise it. If we don't, he'll have them all drinking bacon grease."
My initial thought -- I wonder how fast I can get kicked out? I know this may help someone. It may even help me. In all likelihood it will be more of the same old CDA bullfeathers. Tow the line and you'll be fine. Right. 90% failure is not where I want to be. It's not because I don't do what you say; it's because it's what you tell me to do is insufficient or wrong. My NP and PCP, who I've been in contact with in the last week -- John's new A1C is back down to 5.9%! -- know I'll be there. I finished another friendly battle with NP today. I'm sure they'll warn Mr. B and Miss M.
Don't worry. I'll be good .
God's Heavy Hand
For Captain Roger Finley and all EMT people everywhere; thanks for the help.
My yellow car, my friends and theirs
Lined in front of the fence
We're going for a ride
God's heavy hand
I know this place
My yellow car, my friends in theirs
Lined in front of the fence
Waiting for a ride
Surface for air
Gods heavy hand, pulling
Lined in front of the fence
Thrashing, screaming, sinking
God's heavy hand
drags me down
Where's my car?
Where's my friends?
Where's my fence?
I know this place
God's heavy hand
I'm not going
Not down there
Where's my car?
God's heavy hand
They're on their way
God's heavy hand
lifting me up
not yet, not this time!
I'm shaky and cold
My bed is wet
Today I read yet another blog about the horrors of hypoglycemic reactions -- of going hypo for you noobs. It was at SixUntilMe and written by a young guest.
I kind of laughed when I read it. On one hand a 23 yr old writing about Larry Bird -- #33 -- seems wrong. Was she watching basketball at age 4? Could she actually remember him? Anyway, that's neither here nor there. I also laughed at her story. Nothing bad happened yet she was scared enough to blog about it. I kept wondering what she might write if she had a "Big One"? Larry Birds are not that bad. I've had Gordie Howes and lived to tell about them, barely. Yes, I remember watching Gordie play hockey. Howes are much worse than Birds. There's contact involved with Howes. If you've ever stumbled around your house in a manic blur throwing body checks into everything and everybody, then you know exactly what I mean. I once took out a painting, a lamp, and put my wife and daughter in danger. Gordie Howe, #9. One of my visits to ER was not for being hypo but to get my foot x-rayed after I did mutiple Beckhams on my bed post. Beckams are #23's
In all seriousness, hypos are all nasty, personified or not. The blogger was out of control and scared. Put this person at the top of stairs or behind the wheel of a car, and you have a truly bad situation. If you are on insulin, it's not so much a matter of if this will happen but when it will happen. It's an inherent danger of being an insulin dependant diabetic. We need to be prepared to handle them, and we need to take extra steps to prevent them. As we so often say in this game -- knowledge is power!
Handling hypos is problematic. Of course we all take those super-sealants off the bottles of glucose tablets before we need them. We also keep our sugar tabs in the exact same place by our bed, a juice is on the top shelf of the fridge, and our family members are taught what to look for and how to treat it. Our coworkers, teammates, and friends as well.
This is all standard stuff, but is it enough? Can we do more? Do we need to do more? Perhaps you are like I was a number of years ago. I had a friend who nodded off all the time. One time she was walking to work in the morning and did a faceplant. She hypo'd as she was walking and never clued in. I considered myself very lucky that I always knew when hypos come on, especially when sleeping. I was glad I wasn't one of those diabetics.
Nine 911's and dozens of Larry Birds and Gordie Howes later, I think I finally caught on that I'm no different from any other insulin dependant diabetic; and neither are you! I can tell you my stories. I can proobably write a book about them. Violence, drama, humor, nudity!
So let's get to the boring stuff -- prevention. How do we make sure we never meet Larry or Gordie? The first step is to understand the situations that cause these events. Unfortuneately I can't tell you all of them. We're all so different in our treatmetns and our lifestyles. I will give you my big three.
Corrections -- I now assume that whenever I need to correct that my control has gone South. It's not on track, and I need to be wary. I don't care the cause of the variance. It really doesn't matter. I know that nearly all of my major hypos were preceded by corrections. There are probably reasons for this, but I'll assume we are simply all bad at math.
Exercise -- Activity comes in several flavors. I might spend an intense hour playing hockey, I might do a high aerobic night at the gym, or I might spend a hot afternoon in the garden. I've had nasty hypos while golfing, and one of my worst ever happened after planting four large trees. Exercise is great, but it's a trigger for hypos.
Meal Variations -- Like most IDDs, I follow fairly standard eating patterns. My days look very much alike. But the exceptions can be special! My evening bolus is typically now 6-8 units. For Christmas dinner I bolused 18 units, three times my normal. I didn't have a hypo, but I needed to correct afterwards. I was not in full control. Large meals have caused hypos before, and they will again. We call this the law of small numbers. The more food you eat, the more insulin you take, the more variance you can expect. The potential for error rises.
This list is not complete for me. If I control all of these, hypos will still happen. I am not a perfectly controlled diabetic, but I am getting close. My last Larry Bird was the second weekend in January, 2010. Not bad for a sub-sixer. But I still drift low now and then, and my mind sometimes forgets to remember that I bolused early and still need to eat. My worst ever hypo happened when I fell asleep in front of the TV after I bolused.
Acknowledging such events, such causes, is not enough. The blogger at SixUntilMe knew she was in danger before she went to bed, but she assumed she'd corrected properly. Assumption is the mother of all screw-ups! Never assume you're in control when you are not. We need to validate it. As an IDD you should know what validation means. If not, tell me what your blood sugar is right now. Validate it. Test, don't guess!
"But It's midnight and I need to get up in six hours. I have a mid-term in the morning!" Too bad, so sad. Would you rather wake up dead? When I am presented with a hypo triggering event, I go into Red Alert status. Nothing takes precedence over monitoring my blood sugars. However, like all diabetics, I try not to sacrifice my life for the disease. If I'm tired, I'll sleep. If I'm due to play hockey, I will. If it's time for Easter Supper, I'm there! But I'm still on red alert. If I go to sleep, I set multiple alarms. I won't go beyond two hours, and I tell my wife to treat me as hypo if I don't wake up. I've set two alarms for each of 2am and 4am before. Yes my wife complained, until I told her how much fun it is to treat me for a hypo. I've also stayed up half the night monitoring. If I'm going to play hockey, a Pepsi and a Snickers defers the problem until after the game, but I have taken my meter on the bench with my Gatorade.
So yes, all of us IDDs can expect Larry Birds and Gordie Howes, those hypoglycemic events where we are out of control and are wandering around like a bull in a china shop. We can take some steps to make sure we can treat them, but we really need to learn what activities or states cause them and go into a state of high alert to make sure they don't take us out of the game. Trust me please, they will happen to you! It's only a matter of time.
I read a number of diabetes blogs, articles, and forums. I try to stay in touch with what's what. So far learning as much as I can, debating and sharing with other diabetics, and really thinking about what's what has worked for me. This morning I saw 224 lbs for the first time since 1992; my last randon BP was 102/68; my A1C is up to 6.0 but has been very good the last four years; and my retinopathy has taken a vacation -- zero signs of damage for the last almost three years.
I did not get here by listening to my doctors, diabetic educators, dieticians, or pharmacists. I did not get here with any help whatsoever by the Canadian Diabetes Association. I got here because I listened to you, all you crazy, rebellious diabetics out there. And I am not alone. Every day I see stories of people gaining control over their conditions. I see weight falling off, I see meds being thrown away, and I see people becoming vibrant once again -- I see people getting healthy.
I read many rants against this team that is supposed to be there for us. Doctors are out of touch, my DE has no time for me, and my food advisor wants me to eat more carbs. I'm getting fat and taking more meds, and all they can say is it's normal. Pfft! I hear these stories a lot. I also read more targeted rants about the ADA (CDA or your-DA). Yesterday a blog slammed them for taking $19 million from Big Pharma. How can they work for me if they have this big funding source they need to protect? Valid complaints all.
My personal history with the CDA goes back to 1975. They supplied me with lots of diabetes literature. My health care team all used CDA literature. I started getting monthly newsletters -- "Diabetes Dialogue." It had stories from other diabetics and of course recipes we never made. They now have an extensive website with numerous portals for patients, volunteers, and professionals. They continue to push information. I suppose if a kindergertener examined what they've done over their lifespan, they'd have to conclude that they are a publishing house.
I made some interesting contact with them a few years ago. It was after I joined DF. I was helping organize a diabetes support group at a local downtown church. We has about a dozen interested patients, a church nurse, and a CDA rep. Everything was going great until the CDA rep told us what we couldn't talk about. Couldn't talk about? No, we couldn't discuss anything that could be deemed medication or treatment. That had to be discussed with doctors and only doctors. Diet then? No, that is treatment. It can only be discussed with dieticians. And we can't talk adjustments for exercise or stress? No, only a diabetes educator can talk about that. Apparantly doctors, dieticians, and DEs are interchangeable.
I had no idea what we were going to talk about. The church lady hung around for almost two years, so we couldn't swing freely. We did bring in a number of speakers though. That was fun and interesting. Mostly useless for day-to-day control though. Finally she buggered off and we could talk freely. And we did. It didn't help much though. A very obese and sick type 2 diabetic can't be making any changes in their regimens without consulting all the specialists first. You just can't do that.
I saw a post recently on a forum where a user was looking for a Canadian Diabetes Forum. That got me thinking whether there were any. I checked the extensive publishing empire of the CDA and wasn't dissapointed. They don't have one. Then the little devil inside me took over. I decided to ask them why not.
Here's what they said. "Unfortunately we do not run a forum due to the complexities of tracking correspondences between individuals." Wow. It is too complex to track correspondence between individuals. Of course it is. Nobody but the CIA does it, not even Linda and Tony *ka-bam* But the real question is why? Why would they even want to track correspondence. Oh yea, I forgot, they don't want us talking about medications or treatment. We aren't qualified for that. Nevermind I live with this disease 24/7/365. Nevermind I make life and death decisions about every four hours of my existence. Nevermind 80% of us will die of heart disease. Nevermind I'm at high risk of blindness, amputation, kidney failure, nerve damage, cancer, alzheimers, and probably every other ****ing western disease out there. I can't be discussing medications or treatment!
They went on to say "Thereby we recommend Diabetes Education Centers, which are staffed by health care professionals such as Certified Diabetes Educators and Dieticians and may also employ other professionals such as social workers, Podiatrists, pharmacist and physiotherapists." Then they gave me a list of choices. Hello? I wasn't asking for help. I was asking a simple question" why don't you have a ****ing forum?
Do I need to say I was a little upset? Do I really need to say what I think of them? I wrote back with a three paragraph letter. I suggested they visit diabetesforums.com to see how real diabetics get better. I said some more too, but I was nice. At least I tried to sound nice. He double-hockey sticks, I don't really care if I pissed them off.
So where does this lead us. What's the real problem here? When faced with such an issue, I typically put on my consulting hat. A consultant wants to know two things: what's happening and what should be happening.
What should be happening. This is always tough. It's often based on opinion. But lets start with some facts. We diabetics are sick people. We really are. And our lives are not easy. I've already identified challenges, and we already know I make life critical decisions every day of my life. Am I not the most important person in the hierarchy? Ask who should be put on the pedestal. Who is the person or group who's needs override all others? What are those person's needs?
I need information. Knowledge is power. I need to know all the possible techniques, treatments, and options. And I need to know why they work or do not work. WHEN I make my life decision of the morning, I realy do NEED to be in charge. I need to be free to act, and I need the entire medical, nutritional, and adminsitrative communities of my health care teams and industries behind me. I need the ****ing odds in my favor!
Will I make mistakes? Of course. Could I die? Yes. Could I take out a village? Possibly. But that decision is going to be made with or without your help. Don't you think it might be wise to get me as much information as possible?
So what's happening. There seems to be an overriding concern that I might screw up if I get too many ideas in my head; afterall, I'm not a trained physician. I can't reliably spew out all 78 pages of the diabetes treatment guidelines with footnotes and references. It's too dangerous to trust me. Therefore, give John a confined set of options. Make him eat these foods. Make him take these medications at these times. Make him do this, that, and those other things. It may not be great treatment, but if he does what he's told, he'll be better than most.
And of course the CDA, the dietician, the DE, and the doctor will have warm arses because theirs are covered with the thickest layer of bull****.
What I see them doing is putting a standard set of treatments on the pedestal all held up by the health care professionals. This is what counts. This is the end all and be all. This is what diabetics across the country NEED to strive for. Nothing else will do.
And what happens of course is that most follow this light in the dark. They walk blindly along the road trusting that no car will come along and take them out. This light will guide them. Then there's those like me that have found the light insufficient. I've stepped in too many potholes and stumbled into too many ditches. Finally I hit my head enough in the darkness that I sought a better light. Then there's those of you who see the problem from the start. I'm very envious of those who saw right away the folly of this light and sought another.
Where do we go from here? In my opinion, the CDA needs to put me on top of their pedestal. They need to try and hold me up there. Stop worrying about whether I'll fall. We all need to be able to fail, and we need to be able to fail on our own. Open up the doors to discussion and debate. Open the doors to an exchange of ideas. Encourage us to try new things. Whatever that ends up being, it's better than getting fat, having your legs lopped off, and dying in a corner from a failed heart at too young an age.
I now march with my own light.
I've not been exercising regularly. I've not been doing nothing, but shovelling snow and lugging firewood aren't enough. I did walk a lot during September and October, but then the dark season hit and I got busy with that novel writing business. DW and I decided to do something about it.
We didn't join a standard mass-market gym. We joined the gym run by a local sports rehab guru. Stewart went to the same university as DW and me, and he's helped our son on several occaisions deal with injuries. We've seen how thorough his knowledge and understanding of the human body are. We trust him. The gym is also full of old, sick people trying to get healthy. The only young, vibrant ones either work there or are treating injury. Stewart also does rehab work for our QMJHL hockey team and used to work for our AHL franchise when we had one.
He starts people off on his "Wellness Program." It begins with a health and mobility assessment followed by a half hour of cardio and ending with stretching. Session #2 will add lower body resistance exercises, if I'm up to it, and session #3 will add upper body.
We started off with the interview. It went fine. He pulled me away immediately to show me all the sugar caches. Next came the blood pressure test. I was kind of concerned that it might be high and he wouldn't let me work out. I really don't feel like visiting doctors right now. He took a long time to read it, and when he was done he asked me to raise my arm and squeeze my fist ten times. I didn't think it sounded like high BP. It sounded more like low. He then squeezed it up again for a second read. I watched him this time. I could see the meter. I really don't kknow how to read them. The verdict was 126/60 twice. Sweet!
One treadmill ride with my heart rate between 120 and 130 for 25 minutes and a few tortuous stretches later it was "we'll step it up a bit next time' and on I went. A mostly painless session, and I felt pretty good. Legs didn't like it, but the lungs felt great.
Will it help with the weight loss? I'll check back in in a month.
I define a serious hypo as one where I can't control myself. My last one was 53 weeks ago. For me this beats my best span between events by about 41 weeks, at least over the alst 15 years. A1C's have been between 5.6 and 6.0.
I think my wife is finally starting to believe in me again
My project in Newfoundland is done, I fly home tonight.
Project is a success. The work was pretty easy though. It wasn't very stressful at all. The most stressfull part was looking for work on several days.
I don't feel like writing much, so I'll point form things:
- took bus for first 8 weeks; then the bus strike Nov 4 forced me to rent a car. Bosses won't be happy, but pfft.
- Hurricane Igor was fun, really. I'm now impressed with hurricanes.
- Wrote a novel. It's not done, not even close, but I won NaNoWriMo by writing 52265 words in November. I met some fine young writers in the process.
- I also met some fine old writers including Mirriam Toews who was here for a reading at The Ship Pub.
- I fell in love with the city of St. John's Newfoundland. It's a happening place.
- I hate hotel beds. I'm going to sleep all day tomorrow.
- Met a fine endocrinologist, Dr. Carol Joyce who does some cool research with pumpers. All her pumpers basal test and have at least eight different rates. We partially agree on diet. She'll change
- Diabetes is rampant here, highest T1 rates in Canada.
- Never saw a moose, but heard warnings about them on the TCH nearly every morning.
- One heck of a city to drive in. It is not built on a grid!
- Snowed three times. While Toronto got three feet in one day, we got a bit of rain. It rains every day here at some point. I never saw any frost. Weather was gorgeous. Bring on global warming!
- Sugars were mostly great. Current 14 day avg = 6.1. I'm sure there was at least one bad day in there with a bad set. NO BAD HYPOS! I did go through half a bottle of dex 4's. I seem to remember a 3.3 mmol/l (59). I was 3.5 (63) last night 2hrs after dinner. No sleeping hypos!
- Got a modest travel bonus and free food and gas for 90 days. My wallet is a little happier.
- Daughter moved home and wife had the bathroom and master bedroom re-done.
- My new computer parts are waiting for me! Athlon 1090T 6 core, modest yet great for BOINCing.
- Being one of the first in North America to see the sun each day is kind of weird feeling.
- Did a little sight seeing. Pics below.
Cape Spear. Can't walk any furrther east than this. Hi Dave, Azz, and everyone else out there!
View of St. John's. Mile One is the arena. The big building on top is The Rooms
Yesterdy I travelled to St. John's Newfoundland. I'm on a project here, and I'll be living mostly alone for about three months. My wife will be joining me for a couple of weeks.
It's a real cool city, literally and figuratively. st. john's newfoundland - Google Search The people here are awesome. If you don't know where it is, I'm as far east as you can go in North America.
I'm not scared at all, or worried. If you don't already know, I've had my share of hypo-episodes: nine 911's and many more severe events. Much of this past seems to be just that, the past. I now rarely have hypos, and when I do have them, they are minor. Except for yeterday.
They weren't intense, but I was chronically low. My first flight was at 9:30am and my final landing was 1pm. DW made a nice breakfast of eggs and bacon. I took what I thought would be an appropriate 4u of insulin. My fasting sugah was 6ish. I tested just before boarding at 9:15am.I was 3.1 mmol/l! I popped a couple of Dex-4's and ate two dates. I had six dates packed for extra security. I realized it was too much, so I dosed a unit to cover. No biggie.
The first leg was only 40 minutes. landing was very cool. It was a Dash 8, I was in seat 2, and I could see right out the front. Sitting in Halifax International Airport was kind of strange. Nine years earlier it was packed with stranded American jets. Being on an airplane wasn't scary, but it did make me think about those 9/11 events.
The strangeness continued when I tested at 3.4. Two more dates and another unit.
11:23 we took off into a totally cloudy sky. Boring! I read some of the way, but I nodded off for most of it. It was rainy and foggy in Newfoundland, normal. Caught my ride to the hotel which I booked from home earlier, and checked in. I felt fine, but the first thing I did was test. 4.1! There's no food there and little nearby. I ate my last two dates. I have an 'Efficiency Unit', a room with a kitchen, so I caught a bus and headed to the mall. I bought a monthly bus pass and groceries. It was about 4:45 when I got back.
I unpacked, made some grub, and settled in for some football. My Packers won! Sugar after dinner was another low 4.8. ****.
I decided to be safe and use a 25% reduced basal rate for the night.
I woke this morning at 9.0, slightly high. I corrected with 2u and set my basals back to regular. I was 6.1 before lunch, and my 2hr pp was 4.1 again. I just re-adjusted my basals to my low pattern again. I feel good, but as I've said many times: "Test, Don't Guess!"
Going for a walk after work to pick up a few more groceries, get some exercise, and watch more football
Wish me good fortune please!
I had an opthamologist appointment this morning. I rescheduled it a month early because I'll be away for the next three months.
If you are new to seeing an eye butcher ... errr, eye doctor, I'll walk you through the process. understand that I've been fighting diabetic proliferative retinopathy since March 1994. I've experienced photocoagulative laser, some 4,000 zaps, minor bleeding, major hemhorraging, and major surgery, a vitrectomy. I know what it's like to have an eye full of blood, so full that my vision measured 0/20. It's the legally blind kind of vision.
I see my optho more frequently than most diabetics do, every four months. For awhile, pre-2006, I was visiting every two months or better. I get full examinations. Newly diagnosed patients may or may not get as intense treatment as me. Likely you won't.
I think optho's offices must be the plainest in the whole health care office caste system. At the high end are dentists. My dentist's office is pristine. The waiting room has expensive carpeting, nice cushioned chairs, a play area for the kids, extra newspapers for us dads, and a big screen tv. The dental area, where they do their torturing, is a shiny, plasticized , and high tech equipment chamber of pain. Dentist offices are nothing but profssional.
My family doctor's office isn't nearly as nice. PCPs have no need for fancy gear. Their lounges are much more plain than dentists' lounges, but they still cater to kids and readers. Have you ever noticed that the quantity of reading material in any doctor's office is proportional the the wait time you experience there? PCPs have the most reading material.
My optho's office is about as plain Jane as you can get. It has a coat hanger, a ring of aluminum legged chairs, and a small table with large print Readers Digests, Sports Illustrated, and Golf magazines. Small kids are rare visitors to Optho offices. If you bring one, bring your own toys and books.
I didn't need to register today. I rode up the elevator to the 6th floor with the receptionist. She asked, "How are you today John?" Usually when I register, I walk up to the window, say "Hey, I'm here." and sit down. The receptionist doesn't even look up. I am an important patient. I'm surprised he hasn't named his yacht after me.
That was 8:40. Frank came in at 8:50. You know you are not in great shape when you call your optho by his first name. BTW on this forum I often refer to him as 'The Grunter.' He doesn't like to talk much, and when he does, it's often a gutteral version of yes or no. At 8:55 he called me into my favorite examination room. This was a bit different. Usually, during my typical late afternoon visit, he or his assistant will call me into the prep-examination room. It's like all three of his exam rooms, but the prep room is usually only used for dilations and glaucoma testing. After prep, you usually sit in a little hall next to it to wait for the drops to work.
His favorite office is also pretty low key. There's a big chair, some big equipment used to exmine eyes, a few smaller pieces, and a small fridge in the back corner. The focal point though is the desk. This desk holds all his tools. A big case of eye pieces to test vision, 19 bottles of eye-drops (I counted them!), examination lenses in old, worn leatherish cases, and a couple of hand-held lights. The desk itself looks homemade. The varnished pine finish makes it look like it was pulled out of a wall-mart bargain bin. It's screwd to the wall with about a dozen screws. I can only assume the installer either lost his stud finder or didn't know what one was. Maybe he was Frank's first patient? The hilight though is the light switch panel. It's a piece of knotty pine screwed onto the front later and finished to match. It's covered in little metal toggles. Each of these switches controls a light or piece of equipment.
First he asked me if I had any problems. I responded with "No, just the usual lousy vision."
This sent his warning system into high gear. "Lousy vision?"
We had a big discussion about my history of laser, my affected pepheral vision, and of course what I was really expiencing. We settled on "annoying." My vision is not crappy, my eyes just annoy me. And it's true; they do. It's a combination of getting old and needing reading glasses, slightly reduced field of view in the right and more in the left, and the mega-laser I've had. It's not easy to describe. Annoying comes as close as anything.
Frank sits down, flicks one switch to turn on the eye chart projector and another to turn off the main light. I read all the letters just fine with each eye! I should visit in the morning more often. Usually I struggle with the bottom row with my left eye. There are occaisions in my afternoon visits where I can barely read any of them.
Then come the freezing drops. He doesn't even bother to lean me back or have me look up. Freaks me out when he does that. I have no idea how he can get em in, but he always does first try. He also dries my eyes with a Kleenex. He never offers one to me. I usually grab one anyway, but I couldn't see the box today.
The glaucoma test didn't go smoothly today. They usually do; though for years I struggled hard through them. Frank uses the physical device that touches your eyes. Some opthos use air pressure. I much prefer air. Sometimes, like today, my eyes are too sensitive for the physical device. It's basically a contact lense with a machine attached to it. I never get good looks at the machine, obviously. It took three tries to get my right measured and one for the left.
Now for the dilating drops. He does lean me back for these. I wonder if he knows how incongruent this is. He wipes again, and walks out simply saying, "stay there."
He sees two other patients, a man then a woman. I hear some talk, but I can't follow it.
On his return he sits down and pulls a contraption towards me. It's attached to a bigger contraption to my left, connected with a flexile arm. I put my chin on a rest, he lines it up, and turn on its light. The light he shines into my right eye is a narrow vertical strip. He doesn't look long, less than 10 seconds, and moves on to my left eye. I don't know what the name of this thing is, but it's used to look at the front of the eye for outer problems like cataracts.
The light gets swung away, he flips the main light off, and pulls up close with his hand held "stinger" light. With this light he gets a high resolution view of my maculas. I'm not sure he uses a lens or not. He might. Again, I'm not exactly seeing everything that's going on. Nor am I paying much attention. To tell the truth, I get pretty stressed during these visits, and I'm trying to maintain control. Continual negative thoughts keep hitting me such as "what if he finds something?" This light sometimes stings, hence the name I give it. Of course it's not a laser; it's just very bright and uncomfortable.
This is probably as far as most pateints go. Not me.
Now comes the "torture" light. This sucker is so bright, you'd think you were witnessing a nuclear event. And it's not quick. He leans the chair back, moves in close with the light and lens, lines them up and "wham!"
"Look down ... look down and right ... look right ... look up and right ... look up ... look up and left ... look left ... look down and left ... look down ..."
Why does he always need to repeat down?
Now for the pain. "Look right at the light."
Ow, ow, ow, ow, ow, intense ow, ow, ow, more intense ow, it's burning through the back of my head ow, hurry the **** up ow!
Well I survived it. He called this a dispersing lense that lets him see into the far reaches of the periphery, but it doesn't give him as fine detail as his stinger. sounds like a wide angle camera lens.
Now comes the discussion. "You have some micro-anuerisms in your right eye. They might have been there all along."
"Will they bleed?"
"No. They will not bleed. They may leak and build up in the retinal tissue. This is called edema."
Happy happy joy joy!
"They are not in the macula, so they are not a problem. Keep your sugars in control, that's the best medicine. But really, your eyes look great."
So now I have something else to worry about.
I forgot to eat lunch today.
I wasn't hungry, and I was busy. I never even thought about eating.
When I realized what I had done or what I had not done, at 2:10pm, my heart started racing. I went into panic mode. Anybody on rapid insulin knows what panic mode is: you've screwed up, you don't really know what you did wrong, but you know your in deep trouble! All the events of the morning went racing through my head: the coffee, the meeting, the work, the quick visits to DF and FB. I realized I did in fact still have my lunch in my bag. I also realized I had no reason to panic.
I'm getting near the end of 35 years of doing this. I think I've forgotten to eat lunch a few times, but I really can't remember. I was started on Lente insulin in 1975. I took one shot a day for probably the first x years. Then I moved to two a day. Progress! In the late 80's, around 1987, I remember discussing how silly this routine was with my doctor, and he agreed. I don't know the exact routine I was put on though. It involved Lente and Toronto (Regular). It's all a blur. I do know it wasn't until 1995 that I went on Intensive Insulin Therapy or MDI with Novalog and UltraLente. During these first 20 years skipping meals just wasn't done. Skipping meals would send me into a severe hypo. I needed to eat just as much to keep from going low as for energy or sunstainance. Even on MDI I didn't skip. I remember Mr. Endo saying I could, but I also remember somebody saying I shouldn't skip meals. I know I never had the confidence too. For some reason I always had raging hunger at meal times. The carbs? It has been ingrained in my head that missing meals is BAD!
I do know that I can now skip meals. In fact I do it all the time. I omitted breakfast three times last week. I just wasn't hungry in the mornings. But I don't forget. These were conscious decisions. I was prepared for the consequences.
There were no consequences with the planned or unplanned omissions. That's a good thing. It's a sign of control, of normalcy. We all strive for a level of normalcy in our lives.
Next time I won't panic. At least that's what I'm telling myself.
I am not going to discuss economics or money. I'm going to talk about management.
Effective managers have authority to make decisions, they are responsible for achieving objectives, and they are held accountable for their decisions. Too often in business these three get out of alignment. We might tell our managers to run their unit, but we might also tell them that any expenditure over $1,000 has to be approved by a director. We might not give our employees bonuses because they didn't achieve their goals, but when we dig into it, we discover that those goals were forced on them and we gave them no authority to make necessary and timely decisions. There are countless examples of this sort of mis-alignment in the business world, and it will keep management consultants employed in perpetuity.
One of the turning points in my own self management was to determine who had authority, responsibility, and accountability. Obviously I was being held accountable. It was my fault my A1C was in the 7's or higher. It was my fault my eyes were deteriorating. Nobody was suffering but me. Well my family was too. Dealing with my hypos was not fun.
Not only was I not taking responsibility for my disease, but my doctors weren't delegating it. Doctors don't do that. Well they do some, but they don't act like a senior business mentor that discusses your actions with you and encourages you to take the reigns. No, our doctors generally want to make decisions for us. They only delegate what they feel i necessary.
Authority is not an easy concept to get your head around. It's very similar to responsibility, but they are different. I can be responsible for dosing my insulins, but I will never have the authority to prescribe it to myself. My doctors and my insurance company, Medavie Blue Cross, held most of the authority. But I can certainly make the decison on which meter to use, where to buy my supplies, and how many strips to buy.
The disconnect was in responsibility, and it likely is in your world too.
Understand that you are being held accountable for your actions. Your doctor might say to you "take 5 to 10 Novarapid" before lunch, but it's you that suffers when that doesn't work. Is your doctor going to work hard at finding a unique dosing system that works for you? Not bloody likely. They'll maybe modify it slightly at each three month visit, charge you a few bucks for their services, and wait for you to fail again. And you will fail again. This disease needs rapid decision making. We can't send every decision to head office. We need to act now. If we ever want good decisons made, we need to take responsibility for making those decisons.
My health team members are now consultants. I ask them questions, and I listen to their advice, but I make my own decisions. I do not bring my test results to my doctors. There is no place in this relationship for them to hold me accountable for my actions or make decisions on my behalf. They provide me with advice, and I choose to give them information as needed.
For good or bad, I am in charge. I am the boss. Are you?