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!

http://www.grist.org/article/bad-dietary-habits/

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 ...

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 27^th 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!

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!

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...

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

Take the Sugar Warning of American Heart Association with a Pinch of Salt

SUGAR IS BAD FOR YOU SAYS AMERICAN HEART ASSOCIATION, BUT TAKE THIS ADVICE WITH A PINCH OF SALT

New AHA statement adds upper limit to added sugar intake, cites links with CV risk factor

The scientific statement incorporated new evidence on the relationship between sugar intake and cardiovascular health gathered since the publication of the 2002 AHA Statement on Sugar Intake and CV Disease. In 2006, the AHA published an update to its recommendations for the intake of beverages and foods with added sugars. Citing results from several studies, the authors of the 2009 statement said that intake of excess sugars has been associated with risk factors for CVD such as elevated blood pressure and higher triglyceride levels.

“Although the mechanisms are unclear, relative to other carbohydrate sources, sugar intake appears to be associated with increased triglyceride levels, a known risk factor for coronary heart disease,” the researchers wrote in the statement. “However, relative to other sources of carbohydrate, the effects of sugar intake on HDL and LDL levels remain unclear.”

Hold on, it is not time yet to throw out your sugar containers and switch on mass to no calorie substitute, don’t feel happy that you can now drink Diet Coke instead of the Regular Coke!

Why?

Do you think Sugar is the Culprit?

When I say sugar, what comes to your mind?

Above, white sugar and brown sugar in the photo

(reminds me what Louis LaRose, a HoCank Indian, once asked me, are you a white sugar doctor or a brown sugar doctor? There is more irony in it than meets the eye, since I am brown skinned and I am a “sugar doctor”, someone specializing in treatment of Diabetes)

And whenever I ask an audience, do Americans Consume more Sugar now than ever before? The answer is always a resounding YES. Then I show them the above graph..

Most Americans are astounded to hear that we eat 45 pounds less sugar now than thirty years ago. What they mean by Sugar is Sugar Additives and Sugar substitutes. As you can see from the above graph, the consumption of their ever increasing High Fructose Corn Syrup now occupies the lions share of Sugar Consumption. It is produced from Corn chemically.

The other chemical products in this category which has entered into the imagination of American Public include: Maltodextrin, Corn syrup Solids, Dextrose, Crystalline Fructose etc.

Knowing that in 1970 High Fructose Corn Syrup did not exist and Obesity and Diabetes were not in the minds of Americans and in 2000 High Fructose Corn Syrup is in everything, with Americans consuming at least 65 pounds of that stuff each year for each and every adult American…now look at the statement of the American Heart Association..

So whatever reason, American Heart Association does not want to come out and say it is High Fructose Corn Syrup and other artificial additives that is raising Triglycerides (a fact known to the biochemical scientific fraternity for a long time, but not the medical community), they can lump everything together and say Sugar is the culprit.. and thus the innocent American Public can go on reducing the meager white sugar consumption (instead put the deadly Splenda in their coffees) and happily go on consuming High Fructose Corn Syrup, with the outcome that nothing beneficial happens to their triglycerides and Insulin Resistance and Diabetes..

Dr Sudah Yehuda Kovesh Shaheb, an Endocrinologist and an Anthropologist, works with UmonHon and HoCank Indians, among other things. His social blog is at www.medicoanthropologist.blogspot.com

Native Americans, Diabetes and Happiness in their Clinic

Indian Faces one day at the Clinic. 26 August 2009

A colleague who lives in a nearby town, said, At the party last Friday, I met so and so, they would love to see you, they cant understand why you just stopped seeing them, ten years ago..

A party of petite bourgeoisie in this isolated part of the world, where they tell each other who wonderful their lives are, sequestered into their own insecurities, show and tell kind of existence.. what do I do with them?

I am sorry, when I come to the Indians, I have only just enough emotions to share with the Indians, and they give me a lot so I really don’t have anything left over to share..When I am with the Indians in the USA, I am very reluctant to mix with the Non Indians of this country, however nice they are, I don’t want to be dragged into their world of worries and concerns, so different from the people I have come to serve.

Look one day at the Clinic of the Indians: I have learned so much personal history of so many people.. let me try and recollect..

77 year old Lakota, met and married the Omaha tribal member, lived in LA where she had her three daughters, now all three daughters are nearby. She is on Dialysis, going on eight years, she was telling me about optimism and acceptance of life. When I told her my sister was undergoing chemotherapy for cancer, she said, tell her to be strong and be positive.

When I said good bye to her, she said, I have one request, could you please send me a post card from Paris?

I remembered, when I first started working with this tribe, I was living in Jamaica and when I returned home from my work here, I used to spend hours writing post cards to the people I had met on that trip. What a pity in this world of Face Book and emails.. No, I wont fall for that excuse, I will send her a post card of tour Eiffel to her..

Her two daughters came to see during different hours. So quickly they filled me up with their individual lives, because they knew that I had already placed myself in their world . I am the doctor who is a friend of their mother.. this trust can be utilized to achieve the results of treatments. Only a naïve person would believe that in most of the chronic diseases, just the pharmaceuticals will achieve the desired outcomes.

A 17 year old who had been prescribed medications, brought it in. Indians are brutally honest and tend not to lie. If you ask someone, are you taking the medications prescribed for you, they tend to answer: no, doctor, I have not been taking any of the medications you gave me two months ago. Perhaps that could explain the blood pressure of 180/120 mm Hg and a blood sugar close to 300 mg/dl.. and all of 17 years old.

I saw his 15 year old sister later on, and she is following the same road. Forget about family history, the physiology of diseases, this definitely a social phenomenon. In this tribe like many other tribes, the behavior is so influenced by the unspoken rules of the tribal ethics.

Their mother was with them, a lady not even 45 years of age but already in a wheel chair because of the right sided stroke she sufferd a few years ago. A very cute young child was with them and they were all laughing and making the consultation room ring with joy..

At 11 am went to the school in the nearby village where most of the students are Indian. The principal is a very pleasant woman and they had just hired a new school nurse. We talked to them about our projects of prevention of diseases among the school children especially Obesity. And made plans to come on my next visit to check all the students for their growth, height and weight and any unnatural body habitus!

Lunch had been prepared by the Filipina who met this Indian sailor in Subic Bay in 1988 I think, married him and here she is , almost an Indian herself. No one thinks of her other wise. She mentions that she would like to take her daughter aptly named after the Mexican national saint and her husband to a newly opened Chinese buffet in the nearby town. I made arrangements for that. She always takes care of me and once in a while visitors to the house where I stay here, the Blue House, are treated to Filipino delicacies.. chicken adobo, pancit etc..

Working in the clinic, there are so many interactions with various people working there. It is almost as if you are on a holiday in an exotique location. The helper at the kitchen, who wanted to know whether I have children at every port. The resident of the nursing home attached to the clinic wanting to know why I am covering my face with a mask, are we that smelly? She laughs..

Then there are my colleagues, the same two women I have worked all these years I have been with the indians. Incredible coincidence indeed.. and we have become good friends and when they have questions about medical care in the family or the news about their children or grandchildren to share, I am informed. Also when their family members meet me, in or outside the clinic, it is always a little intrigue about this foreign friend who speaks a little differently, who dresses a little differently and who is always travelling and sending post cards!

Those of us who work with poor people and try to provide medical care at the best of our ability. As Pablo Neruda had written: it is only the rich think that poverty breeds character. It is not as if the medical care you can get in these isolated parts of America, whether it is Bismarck North Dakota or Sioux city, iowa are anywhere comparable to decent clinics in the developed world, they are expensive and they are not compassionate and downright damaging to your health.. such are the examples we see, the dodgy health care given to our patients, the Indians, who once owned the entire land and now disposed and poor and unable to afford the system that has been hoisted upon them.

The afternoon is marching on, the hours are full of conversations and chatting, with various peoples, some of whom happen to be patients as well.

The video of the day was taken of a man, coming to be 70 years of age, who just a short five years ago, was a walking advertisement for American Health. He had embodied every single disease of the civilization. I got to know him around that time, and to use an American term, he was truly a medical basket case: diabetes, hypertension, heart disease, vascular disease, obesity and an array of over 16 different medications prescribed by a slew of practitioners who looked at his organs with their scotomatous medical gaze.

He sought to lead a spiritual life and read voraciously about various philosophies and his wife was a mental health counselor and they lived in a nearby village. I asked him, while I filmed him with the camera which had been lent to me by my best friend in Asia, how did you manage to control your blood sugar so well?

He began; about five years ago I was tired of being a poster boy for Obesity. I was 260 pounds and had been given three oral medications and two types of insulin for high blood sugar and four medications for blood pressure.

I was dieting and then not dieting, loosing a few pounds and gaining some back and putting some more on, the typical Yo Yo diet ! then I decided that if I ate Protein for breakfast: eggs; a salad for lunch and then some fish/chicken salad for dinner, may be I will loose weight. Since he was reading many self help books, Cinnamon and its effects on diabetes caught his eye. Soon his blood sugar began falling down, he began loosing weight and one by one he was able to abandon his medications for diabetes, in fact currently he is on no medications at all. He dutifully checks his blood sugar and they are incredibly within a narrow normal range and he continues with cinnamon and also a variety of herbs. His blood pressure is under good control and the number of the medications there also has decreased. He is going to celebrate his 70^th birthday with a happiness he thought was not possible. We had given him as a gift a pair of trekking sticks that Robert Sweetgall used on his walks across America. When you use those sticks for walking an extra 20 per cent of effort is transferred to the upper body and a greater expenditure of energy. Our patient loves those sticks and goes for a walk, one mile or so a day to the swings of the trekking sticks.

He is on no medications for his diabetes (remember he was on three oral agents and two types of insulin, what was going through the minds of the doctors or nurses when they loaded him up with all these?). he feels good and enjoys his newly found freedom in health.

I suggested to him that he get together people he knows in his village, for weekly sessions on health where he would be the peer teacher. There has been much interest in my recovery he told me.. good luck, and thanks for the inspiration and when you have the group together, I will come over one evening when you are meeting, and talk to you about whatever you want to hear.. my philosophy of heath and disease and the immediate actions to take back control over your own bodies.. don’t surrender it doctors, nurses, pharamacists and worse still, the nutritionists!

Oh I didn’t mention about the Indian adolescent with Type 1 Diabetes ( somewhat rare), I visited him at the school. Time to rest a little bit…..