Tuesday, 20 October 2009

Stress and Diabetes: The case of the Native Indians

Can Stress Cause Diabetes among the American Native Indians? If you had asked this question about ten years ago, to a group of medical/nursing practitioners, the answer would have been a profound NO. Whereas at the same time, a predominantly Native Indians would have said a resounding YES.

That had gotten me to think anthropologically into the high rate of obesity and why Indians become obese so quickly. Looking at laboratory studies, it was evident that it was the stressed rats that became fatter than the lean rats who could eat at will and at leisure. Many years later, there were studies to show that the stressed rats had put on the fat around the midriff and cortisol may have played a role.

Indians are generally happy people, they are the least of the miserable people of the Americas, but suffering has been their lot ever since that Genovese arrived on these shores. Neglected, subjected to rules and regulations and oppressed with different religious values, this “fatal contact” gave them a generational legacy of suffering: unresolved grief.

You can put it all together and come to your own conclusion. For those of you who would like scientific proof, here is an abstract to follow:

Journal of Clinical Endocrinology & Metabolism , doi:10.1210/jc.2009-0370

The Journal of Clinical Endocrinology & Metabolism Vol. 94, No. 8 2692-2701
Copyright © 2009 by The Endocrine Society


The Pathogenetic Role of Cortisol in the Metabolic Syndrome: A Hypothesis

Evidence Synthesis: Emerging data suggest that patients with MetS show hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis, which leads to a state of "functional hypercortisolism."The cause for this activation of the HPA axis remains uncertain but may be partly associated with chronic stress and/or low birth weight, which are both associated with increased circulatingcortisol levels and greater responsiveness of the HPA axis. Increased exposure to cortisol contributes to increased fat accumulation in visceral depots. However, cortisol metabolism is not only centrally regulated. The action of 11β-hydroxysteroid dehydrogenase-1 at the tissue level also modulates cortisol metabolism. Increased 11β-hydroxysteroid dehydrogenase-1 activity in adipose tissue and liver might contribute to the development of several features of the MetS.

Conclusions: MetS shares many characteristics of CS, and cortisol might play a role in the development of MetS at both a central and a peripheral level.

MetS Metabolic Syndrome CS Cushings Syndrome/Hypercorticolism

Add to that Native Indians like most indigenous people around the world ( e.g: Australian Aboriginal People; San of Kalahari ) are hyperinsulinemic in that they have an exaggerated insulin response to meals, especially meals which have a different composition from their traditional foods.

Grieving Indians, deprived of their food culture and thus their hunting and gathering culture which made a dramatic impact on their nutrition, going from a highly balanced nutrition to one of contrived nutrition which continues to this day, were sitting ducks for the obesity epidemic to arrive.. even without much trying! Soon Type 2 Diabetes and its consequences followed.

I wish I could lament with a voice stronger than Porfirio Diaz: Pobre Mexico.. tan circa de Estados Unidos y tan lejos de Dios!

Pobre, Pobre Indios !

Tuesday, 6 October 2009

Better Together, a new Innovation for Diabetes Care and Prevention among UmonHon Indians of Nebraska

Better Together, the UmonHon Tribe Diabetes Programme’s Version of MoPoTsyo in Phnom Penh, Cambodia.

Of all my visits to Cambodia, the most fruitful one was the visit in October 08, exactly one year to the day, when I met Maurits van Pelt of MoPoTsyo Peer to Peer Health Education Centre in Phnom Penh, Cambodia. When I listened to him explain the model, I could intuitively recognize a man who was innovative and knew what works in the Cambodian Context. I realized that it will work in an International context as well.

It has taken me one year to implement a model loosely modeled on Maurits’s working model in Cambodia. Before I begin, thank you, Maurits.

Natives of America, from now on referred to as Indians, have other advantages over Cambodians and also the general population of USA.

They have clinics right where they live, usually in rural and isolated parts of the country. And they have access to doctors and educators and specialists. They also receive medications free of charge. Yet their health status remains one of the poorest in that rich country, the reasons are much more anthropological than medical, I shall dwell on it another time.

I had chosen Mr. PM, close to 70 years of age, as my Peer No 1, in this phase of educating Families with and without Diabetes who live in the Omaha Indian Reservation in the village of Macy in Nebraska, USA. He has had Diabetes type 2 for fifteen years and has been overweight for most of his life.

I had first met him about five years ago, just before he had aortic valve replacement. At that time he was on a long list of medications. In March of this year, he had decided to make dramatic changes in his way of living, for, as he said: I was sick of being tired and sick. I was short of breath and couldn’t walk up a light incline.

He weighed 264 lbs (120kg). He also knew that any diet he choose would make him loose a few pounds the first few days of trying so he decided to keep tab on his intake and be careful to create this lifestyle for him as of 1 April 2009. He was on a long list of medications. For Diabetes, he was on Metformin 500 mg twice a day ( his GP had wanted him to take 1000 mg three times a day but he was afraid of hypoglycemia and refused to follow the advice). He was also on Lantus Long Acting Insulin 50 units twice a day and Gabapentin for his diabetes related Neuropathy. He was on medications for Hypercholesterolemia, Gastro Esophageal Reflux, multiple medications for Hypertension. He had discussed with his natural therapy advisor about diet and was told that he like many others in this country was addicted to carbohydrates and that he should slowly wean himself off Carbohydrates. By chance he ran into a book at a second hand bookstore, it was titled: Carbohydrate Addict’s diet and found the advice to be much to his liking.

Tired of being sick, with his blood sugars running in the high 200s with an A1C of 11.4%, he would slump on his sofa two hours after eating, without energy for anything substantial. It was the blood sugar increase on his regular diet, then the medications kicking in and soon after wards a rebound rise of blood sugar and a flat feeling.

He began watching what he ate. He educated himself about HFCS, and the many other very dangerous chemicals in the food. One day he was told that he may be a Carbaholic when his dietary habits were analyzed. He got hold of a book called The Carbohydrate Addict’s Diet and began changing his dietary habits.

Rob Sweetgall is a prevention expert who lives in Idaho. He has the distinction of having walked across the USA several times and he has fashioned walking sticks which aid people with their walking. We had given PM a gift of these a year and half ago, and now he began using it, realizing that his upper body is also being used while walking around his village with the two walking sticks.

Soon he noticed that the sagging muscles of his upper arms were becoming tight and the scale on his bathroom revealed that he was beginning to lose weight. He became an avid reader of natural medicine and complementary medicine and began supplementing his nutrition with Cinnamon and Fish oil, among others.

He began keeping a log from 1 April 2009. His goal was to lose about one pound per week but do it on a consistent basis. By 15th April 2009, his weight was down to 241 lbs and he was able to drop Metformin. In the weeks following, his weight chart shows: in lbs, 238, 234, 229, 227, 224. He realized that when you begin a diet or nutritional change you can expect a rapid weight loss and then it becomes a steady loss. By the ninth week of his new Life Style Therapy, his weight was down to 224 lbs and he was able to stop his Insulin. 12th week, 216; 16th week, 209; 20th week, 204; 24th week, 202 and now on the 27th week of his Life Style Modification Therapy his weight was done to 200 lbs, a full 64 pounds from when he contemplated these changes and a full 50 pounds since he began keeping detailed records.

And on 5th October 2009, when he presented his efforts to two groups of families of Indians, he showed his medications. From the long list of medications he was taking, right now he is not taking any medications for his Diabetes (remember this is after 15 years of various intense pharmacological manipulations including once Metformin 1000 mg three times a day!). He is coming off his Metoprolol, which he was taking 50 mg, two tablets twice a day and now he is down to ½ a tablet twice a day. He was prescribed Hydrochlorthiazide25 mg which he plans to stop as well.

Among our patients with Diabetes, we use Lisinopril or other ACE Inhibitors for renal protection, since Indians like other indigenous peoples have very delicate kidney metabolisms.

He talked in detail about his diet, since him like our patients lives in a small village with very limited access to good food. The small audience sat there with rapt attention. It was so good to hear that something like this is possible, the negative thoughts that affect you is relieved a little bit when you live in such a “diabetogenic Toxic Environment”.

From the two families, I identified, two other possible Peer Educators, a 29 year old who was diagnosed as having Type 2 Diabetes just on 17th August 2009 and another 32 year old mother of three who is very serious about her health and of those of her children and is determined to control the hyperglycemia and hypercholesterolemia with natural and social methods of combating this ever increasing illness among the Indians.

So, it was a good beginning. We had Mila, the Filipina chief cook at this rural Indian clinic, prepare some healthy food: pancit, adobe, homemade banana bread among others. So our participants realized that good food choices don’t have to be boring! We also gave each one of them a book: Eat this and Not that, it is about making better choices at the supermarket.

Apart from my colleagues at the Tribe who helped me organize this, which now becomes a monthly event when I visit them, I would very much like to thank Maurits in Phnom Penh for his inspiration and my two moral helpers: MM in Paris and MC in Kuala Lumpur...

A heartfelt Thank You. Today you have helped me assist these ancient people of the Americas!

Sunday, 4 October 2009

When to drink this poison?

it has been a while since I had drank coca-cola ( I must have been healthy?) btu this morning at Charles de Gaulle Airport- I had, not one, but three cans of Coca Cola.
Why? Because I was sick!
Doctor and Traveller, I am naturally immune to a whole host of voluntary , non voluntary immunizations: Influenza, Pnuemococcus and Hepatitis of various varieties etc..It has been a while since I have had symptoms of Flu, which used to be an accompaniment, an occupational hazard on long distance flying to Japan.
There is no vaccine against food poisoning, since a a variety of bugs cause the symptoms, depending upon the country. Yesterday, at a boulangerie, in a Paris suburb, I ate a 2 tier pita sandwich filled with avacado, cream and what tasted as crab (artificial?)
The result was almost immediate. I have the appropriate medications to stop the symptoms, but I was worried about the nine hour flight to New York.
At CDG, I drank three cans of coca-cola( regular ) within an hour and half.. so reluctantly at first to overcome the psychological hatred for this drink..Soon after the first one, the rumblings of the stomach had ceased.
This is the only time I wished, the Airlines wouldnt upgrade me, since it would be a crime to waste the good food and wine. I preferred the Economy Class where suffering is made much easier-not too much food or service, which is beneficial in a case like mine. Today.
Moral of the story is this: coca-cola is more poisonous than the poisons that give you food poisoning and coca cola can be used as an urgent/emergency measure like a snake anti-venom.
No healthy person should drink Coca-Cola Regular or Light or Diet or whatever or any other soft drink for that matter manufactured in any country.. even though not all coca cola are the same, the ones in Venezuela are still made with sugar I think, Mexico shifted from Sugar to High Fructose Corn syrup after USA took them to International Court and won over Trade practices.. Also the phosphorus added to create the bubbly feeling in your mouth sucks out the calcium in an already depressed calcium millieu of the western diet and leeches the necessary calcium from the bones, I have seen young women with osteoporosis caused by drinking litres of soft drink, Needless to say these things also cause Diabetes when drunk in large amounts regularly..
I wrote this as I was about to arrive in the land that concocts Coca Cola, hoping that i wont have any need to drink that poison!!
It is paradoxical that I got food poisoning in Europe, just few days before I was in Malaysia and indulged in delicious food (food and not fabricated rubbish) to my hearts content without any untoward health problems ..
In Cuba, for most people, a soft drink is usually a Treat since it is not available readily for most of the population and children consider a sip of Tropicola, which used to be made with cane sugar but now with artificial sweeteners, a rare treat..