Sunday, 13 September 2009

An Apology to Individual Nutritionists

While I take pride in my wide variety of interests, from Morna and Coladera from Cabo Verde to the origins of Chinese Fishing nets in Cochin..I am certainly not a Nutritionist by profession. My Subspecialty of Endocrinology takes pride in understanding the Metabolism of the body. I have great interest in the galloping Obesity and Diabetes epidemic all around the world and of course Nutritionists are not the ones to blame.
The Quality of Food has dramatically decreased in the USA and Mexico and Australia and UK over the course of the past f ew years. What effect is a nutritional education when only artificial food is easily available for a fifty mile radius!
I have maintained that being Nutritionists is a very frustrating albeit a satisfying profession, I have counselled and work closely with Native Americans who are educating themselves in the field.
In a commentary to an article which provided information on the older ways of eating being beneficial to the American Indians,

Jamie Stang, PhD, MPH, RD, LN, Chair of the Public Health Nutrition Program at the University of Minnesota, School of Public Health, cites some of the dietary challenges faced by the American Indian population. “Limited access to grocery stores that offer low fat, low sugar or whole grain food products and a variety of fruits and vegetables is the most frequently cited barrier to healthy eating…The loss of hunting and fishing rights, unavailability of traditional foods such as wild game, loss of traditional agriculture due to water scarcity and poor soil condition and loss of traditional ways of procuring and preparing foods have also been identified as reasons for poor food choices. Many urban American Indians live in neighborhoods that lack large, well-stocked grocery stores which limits their availability of healthful foods…Even the most culturally competent, evidence-based programs cannot improve eating behaviors among individuals or populations who live and work in an environment that does not support or provide healthy food choice.

The best Nutritionists that I work with among the native people are those self taught Nutritionists who are living within the communities who face the same challenges faced by the patients.

but it is good to know about the incredibly strong tie The American Dietetic Association has with the Food Industry..

Funding Food Science and Nutrition Research: Financial Conflicts and Scientific Integrity. Lots of information is available on this topic on the Internet. Pro and Con. and it is good to have a discourse about it with your colleagues.

If a drug company is paying me $100,000 honorarium for some little work, I dont think I can be realistically be expected to be honest and not biased. In fact, my integrity is in question, when I accept that kind of money, which is not congruous with the expertise or time or actions i am willing to share!

The above link is a active discussion by patients and citizens and nutritionists and if you have time I recommend you to read it.

Once again, I dont mean to offend any professionals: whether they are Nutritionists or Physician's Assistants. If you are knowledgeable and doing an honest job, you have nothing to worry about! Self Confidence in our professions, whatever they may be, is very important..

I am also a Medical Anthropologist and i have heard more than my share of derogatory remarks from the Native people about Anthropologists but I have never been badly treated by them, and I have always kept their welfare supreme in my endeavours..

PS I read an article on FT Weekend about the lady whose caricature appears above. Believe it or not, she has a PhD in Business Management and she controls a large proportion of what we all eat or long for. Now she is aggressively trying to take over for 10 billion dollars, I think, the chocolate manufacturer, Cadburys.

You can find out who she is ...

Wednesday, 9 September 2009

Check in whose pocket the author is ? before you read them..

Would you buy an used car from this gentleman?

In an article published by Medscape CME by Louis Kuritzky MD of Gainesville, Florida, USA, he begins the premise by saying that:

All type 2 DM patients at diagnosis must be started on Metformin and titrated to bring the blood sugar down.

Because of disease progression and beta cell function loss over time, mot patients will require insulin therapy.

I didn’t wish to further read this article.

The article is titled

Overcoming Barriers to Insulin Treatment

Dated 27th august 2009

Hasn’t he read the recent article from Italy about putting people newly diagnosed with Type 2 diabetes on a Mediterranean diet and about 60 per cent were still doing well few years later on?

If most people will require Insulin therapy, what does it portend for the people from poor countries like Cambodia? Is he just talking about his population, obese and overweight people who live in a country with some of the worst food in terms of chemical content?

I decided to look up this guy, who is Louis Kuritzky MD

Clinical Assistant Professor, that usually means that he is not an academic but has an attachment to the university, and that he is in private practice of medicine.

His clinical (honorary) attachment is to the department of Community Health. Thus he is not an expert on Insulin therapy..

Here comes the icing on the cake.

This Dr Kuritzky is on the advisory boards for Eli Lilly and Novo Nordisk and Sanofi-Aventis; not just one company that makes Insulin but three..

Would you continue to read this article? You can if you wish, I rather not buy even an used car from him, let alone trust the future of my patients to his advice… Thank You..

If you want more information on this guy, just google it and you will find that:

He is a Family Practitioner/General Practitioner. Dr. Kuritzky is a consultant for GlaxoSmithKline and is on the speaker's bureau of GlaxoSmithKline, 3M, Wyeth-Ayerst, Pfizer, Novartis, Bristol-Myers Squibb, AstraZeneca, Jones Pharma, and Boehringer Ingelheim.

Ah Well!

Tuesday, 8 September 2009

Eat Food, Not what is passed off as Food

I am more than ever convinced that eating FOOD is the essential element of Health, rather than watching Carbohydrates and Calories, Fats and portions.. I decided to do a 24 hour check on blood sugar on myself while eating liberally in Paris without ocnsideration of Carbohydrates, Fats or calories. the only condition, the one I always have imposed upon myself, please make the food as FOOD as possible: not ingredients and macro and micro nutrients that I cant even pronounce.
in a matter of about 24 hours I have had: Breton crepes made of wheat with tuna fish and salad, and another one with sugar. another meal was grilled salmon at a korean restaurant with korean side dishes; lebanese food with various dishes, all vegetarian. The breakfast was two eggs with bell pepper, onions and tomato.. coffee with sugar, many cups of mint tea with sugar and two glasses of a nice sauvignon blanc from Chile.. at least six cups of coffee (Nespresso, what else?) with two teaspoons of sugar...
The blood sugar has been in the range of 83 mg/dl to a high of 114 post prandially. I have noticed that when i go to the USA, my postprandial blood sugar does increase. I know that most of the food I had very little preservatives. One hour after eating: salmon with Gravlox and two pieces of Conte cheese on a piece of Baguette, 7 pieces of shrimp pastries, two glasses of wine, two glasses of fruit juice.. my blood sugar was 103 mg/dl.

We have to become our own nutritionists, if we depend upon others, they will take us up the wrong path! I am hoping that we can have peer educators in Nutrition among the Indians in North America so that we no longer help from university educated nutritionists, whose help has not reduced Obesity or the incidence of Diabetes, nor has it helped any one diabetic have better control of his blood sugar..

To Each his or her own!

Monday, 7 September 2009

Blood Sugar Control in a determined Patient

I am enclosing a chart of blood sugar readings, 90 of them over a period of 30 days, done by a patient of mine at an american indian reservation.
As you can see, apart from a couple of readings over 150 mg/dl, he had kept it within range. He has had Type 2 Diabetes for many years.
What combination of medications is he on?
Precisely Nothing. He had been prescribed three oral medications and two types of Insulins, but over the period of years, he has been able to come off all his medications for Type 2 Diabetes. So his pancreas are still responsive ( after many many years of having Type 2 Diabetes)..He is one determined man, he has proven every one wrong... and he can laugh as he looks at this graph...

Friday, 4 September 2009

How to avoid Treatment if you are diagnosed with Type 2 Diabetes?

Carrying on our conversation about what to do when a person is newly diagnosed as Type 2 DM and is overweight ( and is Italian!)

Diet alone can be the Treatment. Remember Italian diet is much closer to Mediterranean Diet than say Cambodian, but there must be a way to prove that Cambodian/East Indian/Malaysian food can be used as a treatment.

At least we know the part Food can play in the treatment. If after diagnosis you keep on eating the same kind of food you have been eating, the chances are that you will need Drug Therapy. If you make changes ( soon we will know what changes are necessary… when I read the full article) whether Mediterranean Diet or a Low Fat diet.. Chances are that 6/10 in the former group and 3/10 in the latter group did not need therapy after being followed up to 4 or more years! That is quite impressive, because most of the Doctors think that most people can’t stick to a Diet.. If Italians can, anyone can!

Effects of a Mediterranean-Style Diet on the Need for Antihyperglycemic Drug Therapy in Patients With Newly Diagnosed Type 2 Diabetes

Conclusion: Compared with a low-fat diet, a low-carbohydrate, Mediterranean-style diet led to more favorable changes in glycemic control and coronary risk factors and delayed the need for antihyperglycemic drug therapy in overweight patients with newly diagnosed type 2 diabetes.

Background: Low-carbohydrate and low-fat calorie-restricted diets are recommended for weight loss in overweight and obese people with type 2 diabetes.

Objective: To compare the effects of a low-carbohydrate Mediterranean-style or a low-fat diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes.

Design: Single-center, randomized trial. Randomization was computer-generated and unstratified. Allocation was concealed in sealed study folders held in a central, secure location until participants gave informed consent. Participants and investigators were aware of treatment assignment, and assessors of the primary outcome were blinded.

Setting: Teaching hospital in Naples , Italy