Three Strategies for Heart Healthy Eating

This content originally appeared on diaTribe. Republished with permission.

By Constance Brown-Riggs

Constance Brown-Riggs, MSEd, RDN, CDCES, CDN, is a national speaker and author of several nutrition books for people with diabetes.

​Nutritionist and educator Constance Brown-Riggs, MSEd, RDN, CDCES, CDN, discusses the relationship between food and heart health, and how you can make eating choices to prevent heart disease.

If you have diabetes, you are at a much higher risk for heart disease. The good news is, there are steps you can take to lower your risk. What you eat is one of the most important steps to managing diabetes and reducing your chances of heart complications. What are the three main ways to do this? Choose heart-healthy fats, heart-healthy carbs, and reduce sodium in your diet.

Many people find that changing eating behavior is very hard. But it doesn’t have to be that way – not if you take the right approach. Some people use a food tracker to see how much of certain nutrients like carbohydrates, fat, salt, they are eating. And research shows that making small, gradual changes works best. Rather than drastically changing your eating habits in a day, start with setting just a few small, achievable goals that you can stick with. To help you get started, you will find tips and “small wins” throughout this article – these step-by-step changes can make your meals and recipes healthier for your heart.

Education is key to managing diabetes and heart health. Click here to learn about Diabetes Self-Management Education and Support (DSMES) services to help you live well and navigate your diabetes journey – and check out the Diabetes Food Hub for even more resources.

1: Choose Your Fat Wisely

Dietary fat often gets a bad rap. So, it might surprise you to know that fat plays a vital role in our health. We need fat to insulate our body, protect our vital organs, and transport and absorb vitamins A, D, E, and K.

Fat is also the most concentrated energy source for the body, providing nine calories per gram, more than double what is found in carbohydrates and protein. And when it comes to food, there is no denying fats’ ability to make food taste good.

Fats are made up of fatty acids that are linked together. There are three types of fatty acids: saturated, monounsaturated, and polyunsaturated. The predominant type of fat in a food determines which category the food falls into:

  • Saturated fat is usually solid at room temperature and is found mainly in foods that come from animals, such as meat, lard, bacon, poultry, dairy products, and eggs. Coconut oil, palm kernel oil, and palm oil are also saturated fats. This type of fat can cause your body to produce too much cholesterol (a natural substance that the body needs, but in limited quantities – read all about cholesterol here).
  • Monounsaturated fat is usually liquid at room temperature. Monounsaturated fat is mainly found in vegetable oils such as canola and olive oils, avocadoes, and peanuts. Monounsaturated fats are often called heart-healthy fats because they don’t cause higher cholesterol levels.
  • Polyunsaturated fats are usually liquid or soft at room temperature. Polyunsaturated fat is found mostly in vegetable oils such as safflower, sunflower, corn, and flaxseed. It’s also found in walnuts and fish like salmon, albacore tuna, herring, and mackerel. Polyunsaturated fats are also heart-healthy fats because they don’t increase cholesterol levels.
  • Trans fats are polyunsaturated fats that have been chemically changed to make them stay solid at room temperature. Hydrogenated vegetable oils such as vegetable shortening and margarine contain trans-fatty acids – as do the foods you make with these oils. Trans fats act like saturated fat in the body, raising your cholesterol levels. The American Diabetes Association recommends avoiding foods with trans fats as much as possible.

When it comes to the heart, monounsaturated and polyunsaturated fats are much better for you. Read “Dietary Fat: The Good, The Bad, and The In-Between” to learn more. Here are some tips for adding more heart-healthy fats to your diet:

Small Win:  Shift the fat you use from saturated to healthy oils, like olive and canola. Chef Wesley McWhorter, spokesperson for the Academy of Nutrition and Dietetics, says, “Don’t forget to add healthy fats in your recipes from things like avocado, beans, nuts, and seeds – which will also keep you full longer and prevent overeating.”

Small Win: Try a “protein flip.” Chef McWhorter suggests you keep the animal proteins and their fats that you love but shift the proportion of the ingredients. For example, instead of an all-beef burger, make a half vegetable burger by adding beans and veggies or mushrooms. “Blended burgers are great because the moisture from the mushrooms actually makes your burger taste better,” says McWhorter.

Tips for Choosing Heart-Healthy Fats

Healthy eating facts

Image source: diaTribe

Remember: Choose low-fat and reduced-calorie foods wisely because they can contain more added carbohydrate than the full-fat version.

2: Opt for Heart Healthy Carbohydrates

There are three main types of carbohydrates: sugar, starch, and fiber.

  • Sugar is called by many names – simple sugar, table sugar, cane sugar, brown sugar, turbinado, demerara, maple syrup, molasses, honey, and high-fructose corn syrup. Simple sugars are often referred to as fast-acting because they rapidly raise blood sugar levels. Sugars may be added to foods or occur naturally, like the fructose in fruit and lactose in milk.

Foods made with added sugars tend to have little or no nutritional value and are usually high in calories and fat. Simple sugars, especially high fructose corn syrup, raise triglyceride levels which is associated with heart disease. And when it comes to blood sugar levels, foods with added sugar like cookies, donuts, and cakes lead to blood sugar levels spiking which, when treated with insulin, can cause large, unpredictable blood sugar swings – also not good for the heart.

  • Starch is a complex carbohydrate. It’s made from lots of simple sugars that are linked together in long chains. Complex carbohydrate foods include whole-grain bread and cereal, starchy vegetables (green peas, corn, lima beans, potatoes), and dried beans (pinto beans, kidney beans, black-eyed peas, and split peas). Unlike fast-acting carbohydrates, starches are slowly broken down during digestion, resulting in a lower, steadier release of sugar into the bloodstream.
  • Fiber is also a complex carbohydrate. Fiber is the indigestible part of any plant food, including the leaves of vegetables, fruit skins, and seeds. Fiber helps to move food waste out of the body and may help lower cholesterol and keep your blood sugar in range. Dietary fiber is found in foods that come from plants, including fruits, vegetables, nuts, seeds, avocados, beans, peas, lentils, and whole grains.

Increase Fiber

Fiber is important for heart health and keeping your blood sugar in range. The American Diabetes Association recommends that people with diabetes eat at least 14 grams of fiber per 1,000 calories – or about 28 grams of fiber per day for women and 34 grams of fiber per day for men. However, increasing fiber too quickly can cause gas, bloating, and constipation. Before increasing your fiber intake, figure out approximately how much fiber you are currently eating.

Aim to increase your daily fiber intake slowly – on week one, increase your daily fiber intake by two or three grams, then the following week increase it by two to three more, until you’ve reached your goal. In addition, increase the amount of water you drink. This will help prevent constipation. If you begin to experience gas or bloating, slow down – instead of changing every  week, change your daily fiber by two to three grams every other week.

Small Win: McWhorter suggests swapping processed grains like pasta for whole grains like farro, millet, quinoa, or bulgur. Fiber is one of the best things for your heart, and whole grains are a great way to get more of it,” says McWhorter. “The good thing is there are so many delicious, whole grains out there.”

Tips for Choosing Heart-Healthy Carbs

Healthy eating facts

Image source: diaTribe

3: Slash the Sodium in Your Food

Your body needs sodium (or salt) for normal muscle and nerve functions and to keep your body fluids in balance. But, too much sodium in your diet can lead to high blood pressure, heart disease, and strokes, as well as bloating, puffiness, and weight gain. Most people eat about 3,400 mg of sodium a day – almost double what’s recommended by the American Heart Association. People with diabetes and prediabetes are encouraged to consume less than 2,300 mg of sodium per day – that’s about one teaspoon of table salt – to care for their hearts.

Despite what you may think, over 70% of dietary sodium comes from eating packaged and prepared foods – not from table salt added to food when cooking or eating. Reading the nutrition facts label on packaged and prepared foods is the best way to make informed decisions about how much sodium you eat.

Small Win: McWhorter suggests building flavor throughout the cooking process. “It’s important to focus on how to add flavor through herbs, spices, acid, and texture, which can help you reduce the sometimes, excessive saturated fat, sugar, and salt in your dishes. Don’t be afraid to experiment with new seasonings and get away from the typical ‘salt and pepper’ approach. Trust me – flavor matters,” McWhorter says.

Tips to Reduce Sodium

Healthy eating facts

Image source: diaTribe

Remember, homemade food typically contains less sodium than prepared food (whether it’s canned, frozen, packaged, or from a restaurant). This is also true for sauces like pasta sauce, barbeque sauce, teriyaki sauce, ketchup, and salsa. As much as possible, aim to buy fresh, unprocessed ingredients and turn them into your favorite dishes. For heart-healthy recipes, click here.

Overall, the key to a heart-healthy meal plan is variety: fruits and vegetables, lean protein sources, nuts, legumes, whole grains, and healthy fats like avocados or olive oil. When revamping meals, chef McWhorter recommends starting with the whole plate in mind. “Our meals are most often focused on the main protein versus the whole plate. What is left leaves little room for creativity and deliciousness for the fiber-rich and nutrient-dense vegetables, whole grains, nuts, and seeds that we really want (and need) on our plate,” McWhorter says. And remember to start with small wins on your path to heart healthy eating.

Learn more about nutrition here.

This article is part of a series to help people with diabetes learn how to support heart health, made possible in part by the American Heart Association and American Diabetes Association’s Know Diabetes by Heart initiative.

About Constance

Constance Brown-Riggs, MSEd, RDN, CDCES, CDN, is a national speaker and author of Living Well with Diabetes 14 Day Devotional: A Faith Based Approach to Diabetes Self-ManagementDiabetes Guide to Enjoying Foods of the World, a convenient guide to help people with diabetes enjoy all the flavors of the world while still following a healthy meal plan, and The African American Guide to Living Well with Diabetes. Learn more about Constance and follow her on Instagram Twitter, and Facebook.

Source: diabetesdaily.com

Hitting a Nerve: Introduction to Neuropathy

This content originally appeared on diaTribe. Republished with permission.

By Cheryl Alkon

What is neuropathy? And more specifically, what is diabetic neuropathy? What are the symptoms and how can you prevent and treat neuropathy?

When someone hears about the long-term complications of diabetes, problems with the feet, foot ulcers, and even amputations are often brought up and can be some of the scariest outcomes. What leads to these issues is something called neuropathy, or damage to the nerves.

But neuropathy, and those subsequent complications, aren’t by any means a given – and prevention is possible. What is neuropathy and what can you do to avoid it entirely, or minimize it so that you can keep your feet, and the rest of your body, as healthy as possible?

What is the difference between neuropathy and diabetic neuropathy?

Neuropathy is the term used to describe any damage to nerves in the body (for example, an injury from a car accident can damage the nerves). Diabetic neuropathy, or diabetes-related neuropathy, is the term used to specifically describe the nerve damage from high glucose levels (hyperglycemia) over the long term.

Diabetes can cause three main types of neuropathies: peripheral neuropathy (medically referred to as distal symmetric sensorimotor polyneuropathy), autonomic neuropathy, and focal neuropathy.

Peripheral neuropathy affects the nerves outside of the brain and spinal cord, and often leads to symptoms involving the hands and feet. “This is what most people associate with diabetes-related neuropathy,” said Chris Memering, a nurse and inpatient diabetes care and education specialist at CarolinaEast Health System in New Bern, North Carolina.

Peripheral neuropathy involving the feet is the most common form of diabetic neuropathy. Loss of function in particular nerve fibers can change sensation and reduce strength in the foot. Loss of sensation can lead to injury from shoes that don’t fit, stepping on sharp objects you can’t feel, or not knowing the sidewalk is too hot. Neuropathy can also lead to pain, burning or other unpleasant sensations which may respond to medication.

But diabetes isn’t the only condition that can cause peripheral neuropathy. Other conditions that can lead to peripheral neuropathy include heavy alcohol consumption, trauma, nerve entrapment (such as that which occurs in carpal tunnel syndrome), vitamin B deficiency, chemotherapy, and an autoimmune process that attacks the nerves.

Neuropathy can also affect the functioning of the autonomic nervous system (which controls things like blood pressure, heart rate, digestion, and bowel and bladder function). This is called autonomic neuropathy. Autonomic neuropathy can lead to a variety of complications.

“In diabetes care, many people are familiar with hypoglycemia unawareness, erectile dysfunction or female sexual dysfunction, gastroparesis [when the stomach can’t empty properly and digestion slows], neurogenic bladder [when the nerves that tell your brain to tighten or release the bladder muscles don’t operate properly], or orthostatic blood pressure changes [dropping blood pressure when you stand up],” Memering said, adding that all these could be a result of neuropathy.

Finally, focal neuropathy results from issues with one or more nerve roots and usually happens suddenly. Focal neuropathies often involve both motor functioning – such as weakness – and sensory deficits, which can cause discomfort and pain.

What causes neuropathy?

Chronic hyperglycemia can damage both small and large nerve fibers. Over time, elevated glucose levels, often made worse by high triglycerides (a type of fat that can be found in the blood) and associated with inflammation (the body’s natural way of fighting infection) can cause damage to the nerves. That damage disrupts the way nerves interpret sensory information and how the messages about sensation are transmitted to the brain.

Usually, nerve damage from high blood sugar levels happens in the long nerves first (which run from your spine down to your toes), which is why the symptoms of peripheral neuropathy occur first in the feet. “The length of time someone has lived with diabetes increases their risk of developing neuropathies, as does that person’s level of blood glucose, in terms of A1C, Time in Range, and glucose variability,” Memering explained.

In essence, higher glucose levels over time increases your risk for developing neuropathy. This was confirmed by the famous Diabetes Control and Complications Trial (DCCT) and Epidemiology of Diabetes Interventions and Complications study (EDIC). The studies showed that the prevalence of confirmed peripheral neuropathy was 64% lower among participants in the intensive management group (those who managed their blood glucose carefully with treatment and kept their levels as close to normal as possible).

What does neuropathy feel like?

Symptoms of neuropathy usually start in the toes and progress upward. The sensations experienced with peripheral neuropathy differ from person to person. Some describe the feelings they have as numbness or tingling, while others say it feels like burning. Some say they are sensitive to being touched and cannot bear the feeling of a sheet or blanket covering their feet, while others describe it as feeling like they are always wearing a sock or a glove.

“Ultimately, you could end up losing protective sensation – which can be very dangerous and puts you at risk of not realizing when a part of your body is hurting or being injured,” Memering said. “While you may be able to still feel pressure – you know you are stepping on the ground with your foot – you may not be able to feel pain if you step on something sharp or hot.” This means you might not withdraw your foot from the unsafe environment, harming it further, and without realizing the extent of the damage.

The biggest concern about peripheral neuropathy involving the feet is that the loss of normal pain sensation can lead to greater skin and tissue damage. “Injury can result in the formation of a foot ulcer, which, if infected, can progress to ongoing tissue damage that can lead to amputation,” said Dr. Robert Gabbay, the chief scientific and medical officer for the American Diabetes Association. That’s why it’s so important to prevent, recognize, and treat any symptoms of neuropathy.

How is neuropathy diagnosed?

To assess for neuropathy, your healthcare team should do a thorough examination of your feet looking for sores or ulcers, changes in skin color, diminished pulses and any abnormality or injury to your foot. They can test for diminished strength, a change in your ability to know the position of your toes, and a change in sensation or sensory perception.

A foot exam will always involve taking off your socks and shoes, and your healthcare professional will inspect your feet to check for color changes, pulses, open areas, redness, rashes, and the overall condition of your feet, said Dr. Cecilia C. Low Wang, a professor of endocrinology, diabetes, and metabolism at the University of Colorado Anschultz School of Medicine.

A monofilament test uses a soft fiber to test for sensation in various parts of the feet and body, and a tuning fork can also help healthcare professionals understand how much sensation a person has lost. The monofilament test, as well as a pinprick test, can check to make sure you have good sensation, while other tests will evaluate vibration and position sense (whether you are aware of where your foot is). “The main question I would suggest asking your diabetes provider is whether they notice anything concerning about your foot exam, and whether they think you need to do anything different, or see an additional specialist, such as a podiatrist,” said Dr. Low Wang.

In this age of telehealth visits, some podiatrists have been sending a monofilament (a small strand of nylon attached to a piece of plastic) to a person’s home and teaching them how to use it to determine if they have reduced sensation in different areas of the feet. Podiatrists might even examine a person’s foot onscreen during a video visit and ask questions about how the foot feels or looks. “If there’s something of concern, they will schedule an in-person visit,” added Memering.

If someone is experiencing symptoms of autonomic neuropathy, a healthcare professional may recommend a specific test depending on what the autonomic symptoms are. For example, if there are issues with blood pressure control, taking your blood pressure as you change positions from lying to sitting to standing or using a formal tilt-table test, may show loss of autonomic control of how your body regulates your blood pressure. If you have symptoms of delayed gastric-emptying (stomach-emptying), specialized radiology tests might be ordered that show the time it takes for food to exit the stomach. The Mayo Clinic has an informative list about many of these tests. If you have any symptoms of autonomic neuropathy, such as bladder or erectile dysfunction, feeling faint on standing up, or bloating and fullness, talk to your healthcare professional and explain what you are experiencing.

What are the best treatment options for neuropathy, especially in the hands and feet?

Although it is not always possible to prevent neuropathy completely, the best way to slow its progression (as shown in the DCCT) is to closely manage your blood sugar levels and try to stay in range as much of the time as possible. If neuropathy does develop, medications can decrease the burning and tingling sensations, said Dr. Gabbay.

“Diabetes is a leading cause of neuropathy, and the higher someone’s blood sugar levels are over time, the more likely they are to develop neuropathy,” Dr. Gabbay said. “The good news is by managing blood sugar levels, one can significantly reduce their risk of developing neuropathy.”

With painful neuropathy, “treatments are generally to try to manage symptoms,” Memering said. “Medications such as Neurontin [gabapentin, a drug used for pain and seizures], Lyrica [pregabalin, a drug used for pain and seizures], or Cymbalta [duloxetine, a drug used for chemical balance in the brain] may be used to help with pain associated with painful peripheral neuropathies. These medications can be very effective, but it may take a few weeks to adjust and find the right dose. However, people should know that the medications can also be somewhat sedating.” Other drugs that may be effective include drugs used for mood disorders such as venlafaxine, nortriptyline, or amitriptyline, said Dr. Low Wang, but they may have side effects at higher doses and with older age.

Dr. Gabbay added that neuropathy “is a very active area of research to identify new and effective treatments.”

There are also various treatments to help improve the symptoms of autonomic neuropathy:

  • For Postural Blood Pressure Changes:
    • If you have a significant decrease in your blood pressure on standing, your healthcare professional can teach you how to get up slowly to allow your body to regulate your blood pressure with positional change.
    • You can also wear an abdominal binder, which Memering described as “a big elastic girdle that puts more pressure on the big blood vessels in the body,” so that they have more support when changing positions.
    • Other treatments include adjusting salt intake, using compression stockings, doing physical activity to avoid deconditioning, and staying hydrated, said Dr. Low Wang.
  • For Neurogenic Bladder:
    • If you are experiencing a neurogenic bladder, urinating at regular intervals during the day and night can help the bladder empty even if you no longer feel the urge to urinate. You might also undergo a urinalysis or a bladder scan, said Dr. Low Wang. Medications can also help.
  • For Gastroparesis:
    • Eating low-fiber, low-fat foods in smaller and more frequent meals and getting a greater proportion of calories from liquids might help, said Dr. Low Wang.
    • Sometimes the drug metoclopramide (Reglan) may be prescribed and gastric electrical stimulation might be used in severe cases.
  • For Erectile Dysfunction:
    • You may be prescribed one of the medications – sildenafil, tadalafil, avanafil, or vandenafil – but you may also need to undergo a physical exam, or other tests.

If you are experiencing any of the symptoms of neuropathy, you should speak with your healthcare professional to determine what diagnostic tests need to be done and what treatment course might be best for you.

Can you reverse diabetic neuropathy?

Currently, neuropathy can’t be reversed, but its progression may be slowed. Keeping blood sugar levels in the recommended targets is the key to doing so, Memering said. “The use of diabetes technology may be very helpful – especially continuous glucose monitors – for keeping your blood sugar in range, along with eating a varied diet, including vegetables and fruits, and exercising regularly,” she said.

Tips for living with diabetes and neuropathy

The two best things someone with diabetic neuropathy can do are to:

  1. Manage their blood sugar levels to keep the neuropathy from getting worse.
  2. Check their feet regularly, both at home and during healthcare appointments.

Check your feet at home

Dr. Gabbay, Dr. Low Wang, and Memering each recommended that all people with diabetes, whether young or old, newly diagnosed or not, should regularly check their feet. Dr. Gabbay advised, “Use a mirror to see the bottoms of the feet and make sure there are no cuts or ulcerations” that would need immediate attention to ensure they don’t worsen. If need be, ask someone in your household to help you inspect your feet.
To help avoid foot injury, Dr. Low Wang recommended: “Always wear socks and well-fitting shoes, avoid going barefoot, and look at shoes before putting them on to be sure there is nothing in them.”

No matter where you are in your diabetes journey, daily foot checks “partly establish the habit before there are any problems, but are also a way to get to know your body so you can understand what is normal for you and what is not,” Memering said. “That way, when there is a change, you can all your healthcare office right away. Don’t wait until your next appointment ­ – call,” she said, adding that they should be able to tell you if you need to make an appointment right away.

Remember, as with many complications of diabetes, for neuropathy prevention is key! To learn more, view or download our infographic on preventing neuropathy.

About Cheryl

Cheryl Alkon is a seasoned writer and the author of the book Balancing Pregnancy With Pre-Existing Diabetes: Healthy Mom, Healthy Baby. The book has been called “Hands down, the best book on type 1 diabetes and pregnancy, covering all the major issues that women with type 1 face. It provides excellent tips and secrets for achieving the best management” by Gary Scheiner, the author of Think Like A Pancreas. Since 2010, the book has helped countless women around the world conceive, grow and deliver healthy babies while also dealing with diabetes.

Cheryl covers diabetes and other health and medical topics for various print and online clients. She lives in Massachusetts with her family and holds an undergraduate degree from Brandeis University and a graduate degree from the Columbia University Graduate School of Journalism.

She has lived with type 1 diabetes for more than four decades, since being diagnosed in 1977 at age seven.

Source: diabetesdaily.com

This Is Your Brain on Diabetes (ADA 2021)

The brain affects diabetes, and diabetes affects the brain, a complex relationship that goes in both directions.

For many patients, the brain-metabolism connection means challenges and health declines. Most people that have experienced hypo- and hyperglycemia are well aware of the way that blood sugar troubles can inflict brain fog and other minor short-term malfunctions. Unfortunately, that’s just the start of it. The cognitive dysfunctions associated with diabetes can become permanent.

The first days of the recent American Diabetes Association Scientific Sessions featured several sessions on the intersections between brain health and diabetes. Some presenters sketched out the scope of the problem; others suggested potential solutions. Patients with both type 1 and type 2 have a lot to think about.

The Vicious Cycle

At the heart of the brain-diabetes relationship is a negative feedback loop that pushes people towards bad decision-making and bad health outcomes. Hyperglycemia leads to both short- and long-term cognitive impairment, which leads to increasingly poor glucose management decisions, which leads to more cognitive impairment, a vicious cycle if there ever was one.

Australia’s Dr. Fergus Cameron sketched out this dynamic:

Source: ADA 2021 Presentation

This feedback loop helps define how and why brain issues tend to snowball as the years go by.

The Developing Brain

Diabetes can impact brain function at every age, but perhaps most important is its immense effect on the developing brain. Acute and chronic hyperglycemia during those early, critical years of development can easily cause lasting damage.

Many of the most important negative cognitive effects of type 1 diabetes seem to occur in the first days and weeks leading up to diagnosis. Just days after diagnosis, children already perform more poorly than expected on intelligence tests. “We’re seeing impacts right from the get-go,” said Dr. Ferguson.

The severity of hyperglycemia at diagnosis is also significant: children that are diagnosed during diabetic ketoacidosis (DKA) see much more cognitive impairment than children that never experience that critical state. That difference alone might mean as much as 6 points of IQ, on average.

We don’t like to dwell on immutable factors—today, you cannot change the circumstances around your diagnosis or that of a loved one. It is more important to people with diabetes to learn what they can do now to help improve their health and quality of life. The answer to that is clear: avoid chronic hyperglycemia.

Mental Issues Accumulate

The effect of chronic hyperglycemia is cumulative and comprehensive. As people with type 1 diabetes age, they perform worse on tests of executive functioning, IQ, information processing speed, and memory. The differences are bigger in high school than in elementary school, and the gap just continues to widen throughout adulthood. A 2019 study found that an incredible (and terrifying) 48% of older adults with longstanding diabetes displayed “clinically significant cognitive impairment.”

Dementia and Diabetes

Dr. Anna Marseglia, a neuropsychologist with Sweden’s Karolinska Institutet, took the baton to discuss cognitive impairment and dementia in old age. Most of her talk referred to patients with type 2 diabetes, although it’s possible that patients with other forms of diabetes could still benefit from her conclusions.

Diabetes is a major risk factor for dementia—in fact, the link between metabolic dysfunction and late age mental decline is so clear that Alzheimer’s disease has sometimes been called type 3 diabetes.

But diabetes is not destiny—the risk of dementia is significantly amplified by lifestyle.

The Power of Activity

Dr. Marseglia presented the results from her own study, a look at thousands of older Swedish adults with diabetes, to see if an active lifestyle might prevent progression to dementia. Researchers tried to track both the number of leisure activities that participants enjoyed and the strength and extent of their social connections. Would an active social life reduce the risk of dementia?

The answer was yes, and the correlation was enormous, as you can see in the graph below. “Inactive” adults with diabetes were vastly more likely to develop dementia than “active” adults, whose risk was barely higher than that of people without diabetes. Dr. Marseglia suggested that if all of the adults in the study had led “active” lives, as many as 48% of dementia cases could have been avoided.

Source: ADA 2021 Presentation

The study suggests that while both diabetes and social inactivity are hazards in and of themselves, the real danger is when those two conditions coexist.

Accordingly, Dr. Marseglia highlighted two broad strategies to improve one’s risk of late age cognitive decline. The first is to employ strategies that reduce physical cardio-metabolic burden: improved glucose control, healthier diet, exercise, weight loss, quitting smoking, and so on. The second is to create a kind of resilience within the brain through education, challenging work, and vibrant social activities.

The protective effect of an active life is physically verifiable. Adults labeled “inactive” actually have significantly smaller brains than active adults. Activity, by preserving brain volume, somehow overrides the vascular damage associated with diabetes.

An active life to fight dementia doesn’t just start in old age—good health, mental stimulation, and social activity early in life will also protect the brain from decline decades later.

Executive Functioning in Teens

Teens have a particularly tough go of it; typically, they are the age bracket with the highest A1c.

Anxiety, depression, and diabetes burnout are distressingly common in the teenage years. Such mental health issues can easily throw diabetes decision-making out of whack. As Oregon’s Dr. Danny Duke stated, “When we’re emotionally dysregulated, it affects all of our other executive functions.”

Executive functioning, explained Oregon’s Dr. Danny Duke, is the part of the brain that’s “in charge of making sure things happen when and how they’re supposed to happen.” It’s like “the conductor of the orchestra of our thinking.”

Good executive functioning is of paramount importance to all humans, but especially to those with diabetes, who must almost continually balance short- and long-term costs and benefits. And because executive functioning usually does not fully mature until age 25, it’s no surprise that teens can have so much difficulty managing their conditions.

Some teens have better executive functioning than others, and those that struggle to make good diabetes management decisions need as much help as they can get. Otherwise, the vicious cycle will rear its ugly head once again: poor executive functioning leads to reduced glycemic control, and reduced glycemic control leads to poor executive functioning.

While Dr. Duke focused mostly on the ways that executive functioning failures could lead to dangerous blood sugar swings, he had little doubt that the converse was equally true:

I’ve worked with a lot of these kids that are hanging up there in the mid-300s [mg/dL], doing the bare minimum necessary to stay out of DKA. When we get them back down into range, they’ll often say ‘Wow, I had no idea how bad I felt and how foggy I was thinking.’

A Family Affair

For kids and teens, good diabetes decision-making is a family affair. Dr. Maartje de Wit, of Amsterdam University Medical Center, pointed to several studies assessing the role that parental executive functioning plays in diabetes management success.

Naturally, in younger children, parents will make all significant treatment decisions, but even as children age, parents continue to play a surprisingly big role in treatment success (or lack thereof). Studies show that, for example, maternal executive functioning skills have a significant influence on a child’s A1c levels, and that both the father’s and mother’s involvement played a big role in delivering better glucose control, especially when the children had executive functioning issues themselves. This did not change as children aged, even as they presumably took on more of their own management decisions.

This sounds obvious—less disciplined kids need more help—but it’s not necessarily so easy to determine who needs help, and how to help them.

Identifying and Improving Executive Function Issues

Children and teens with subpar executive function, when asked why they can’t adhere to their diabetes treatment regimen, may say things like “I forget” or “I’m lazy,” or “I don’t know why.”

Whether by nature or nurture, executive function problems are often shared between parents and children. In a presentation aimed at medical professionals, Dr. Rachel Wasserman encouraged practitioners to consider disorganized or scatterbrained parents a real warning sign of potential executive function issues in children.

If you recognize these sorts of behaviors in your child (or in yourself!), it might be worth trying to work with your child to improve his or her executive functioning skills.

Dr. Wasserman recommended activities that require repeated practice and offer progressive challenges. That could describe schoolwork and related academic pursuits; it could also describe athletics like martial arts and yoga.

Today there are also a dizzying number of scheduling apps that people with diabetes can use to help enforce good habits. More old-fashioned techniques, like alarm clocks and post-it notes, can be equally effective. Dr. Wasserman cautioned that advanced diabetes technology, such as insulin pumps and continuous glucose monitors, as helpful as they can otherwise be, do not necessarily lessen the cognitive load on the executive functioning system.

Takeaways

Diabetes has a significant negative effect on cognitive abilities. In type 1 diabetes, this effect can begin very early in life, with the first bouts of acute hyperglycemia leading up to diagnosis. In both type 1 and type 2 diabetes, the damage wrought by high blood sugars is cumulative, and symptoms are likely to get worse over the years.

Hyperglycemia can also set a vicious cycle in motion, whereby high blood sugars cause bad decisions, which just cause more high blood sugars.

The best way for a person with diabetes to avoid cognitive decline, probably, is to avoid chronic and acute hyperglycemia—the more time you spend with your blood sugar in a healthy range, the more likely that you will avoid accumulated damage to your brain.

It also may be possible to strengthen executive functioning skills and make the brain more resilient to age-related decline by enjoying a robust social and intellectual life. Hobbies, education, challenging work, and community involvement—in short, an active and stimulating mental life, at every age—may protect against eventual decline.

Source: diabetesdaily.com

Diabetes & Smoking: What You Need to Know

Most of us know that smoking is horrible for one’s health. According to the Centers for Disease Control and Prevention (CDC), tobacco use is the leading cause of preventable death in the United States, yet over 34 million Americans still smoke tobacco cigarettes nearly every day.

Unsurprisingly, smoking is even worse for your health if you live with diabetes. This article will outline the reasons why smoking is so bad for people with diabetes and what you can do to stop smoking.

Smoking Is Bad for Everyone

Smoking is the leading cause of lung diseases, including COPD, emphysema, and chronic bronchitis. Smoking also contributes to the growth and development of many types of cancer, including cancers of the mouth and throat, voice box, esophagus, stomach, kidney, pancreas, liver, bladder, cervix, colon and rectum, and acute myeloid leukemia. On average, life expectancy for smokers is at least 10 years shorter than for nonsmokers.

The American people have known for a long time that smoking causes cancer. Nearly 60 years ago, in 1964, the then U.S. Surgeon General Luther Terry issued a definitive report linking smoking cigarettes with lung cancer for the first time. Smoking is even worse for people living with chronic diseases, especially diabetes.

Why Is Smoking Especially Bad for People With Diabetes?

People with diabetes who smoke are more likely to have serious health problems and complications, including heart and kidney disease, poor blood flow to the extremities, increased risk of infections, higher incidence of foot ulcers, increased rates of lower limb amputation, and retinopathy, which increases the likelihood of blindness than people with diabetes who do not smoke.

Why is this so?

People with diabetes are constantly working to manage their blood sugars and prevent complications brought on by the disease that include damage to the nerves, eyes, kidneys, and heart. The tobacco in cigarettes exacerbates these issues and accelerates the rate of decline in a person already suffering from a chronic disease.

There are over 7,000 chemicals in cigarettes, 70 of which are directly linked to the development of cancer, aging, and oxidative stress. For example, some of the chemicals found in cigarettes include toilet cleaner, candle wax, insecticide, arsenic, nicotine, lighter fluid, and carbon monoxide, just to name a few. These addicting, dangerous chemicals cause harm to your body’s cells, interfering with their normal function.

In a person with diabetes, the harm caused by a cigarette’s chemicals and nicotine causes chronic inflammation, resulting in insulin resistance and higher blood sugars, and thus makes it harder to manage one’s diabetes.

All of these issues compound to make diabetes management harder, and complications more likely. For people with diabetes, the health risks of smoking a cigarette is four times greater than for someone without diabetes.

Even more striking, a 2014 study revealed that smokers are 30-40% also more likely to develop type 2 diabetes, making the relationship between cigarette smoking and diabetes a vicious cycle.

quit smoking

Photo credit: Adobe Stock

Reduce Your Risk and Improve Your Health by Quitting Smoking

The best thing to do if you have diabetes and smoke is to quit immediately, and it’s never too late to quit! Quitting smoking before age 40 results in lifespans as long as people who have never smoked, and one’s lungs start to immediately heal the day they stop smoking.

Quitting smoking before the age of 40 reduces the risk of death (associated with continued smoking) by 90%, and quitting before age 30 avoids more than 97% of the risk of death associated with continued smoking into adulthood. The sooner, the better, but there never is a bad time to quit smoking.

Studies have shown that people who have diabetes start to respond to insulin better and their insulin resistance drops within 8 weeks of quitting smoking. 

Quitting smoking may be one of the hardest tasks you ever undertake, but the benefits are worth it: a longer, healthier life, better blood sugars, lower HbA1c levels, and fewer diabetes complications.

How to Stop Smoking

There are many resources available to people who want to quit smoking, including:

If you have diabetes and you’re a smoker, take heart: there is never a bad time to quit smoking, and quitting smoking won’t only improve your overall health, your diabetes management will likely become easier as well.

Quit smoking not only for yourself but for the health of your family as well. Lean on your loved ones for support, and work with your doctor to find a treatment plan that will work for you, minimize withdrawal symptoms, and make the transition to a smoke-free life easier.

Whatever it takes, give yourself grace: a new study reveals that smokers try to quit 30 times before they succeed, and living with the stress of diabetes can make those attempts even more challenging, but definitely more worthwhile for you and your health.

Have you quit smoking or tried to quit smoking in the past? What has worked best for you? Share your story in the comments below.

Source: diabetesdaily.com

Managing My Anxiety of Possible Retinopathy

I remember feeling anxious. Sitting in the waiting room of the eye doctor in March of 2019, I knew this sensation all too well. It came from my experience of receiving “bad news” one too many times. I was nervous but quietly tried to connect with the inner knowing that I was not the only person who has to go through these types of feelings. With a deep breath in and a long breath out, I thought of my friends within the diabetes community who constantly remind me that I’m never alone.

When you live with diabetes, it often feels like you’re just waiting for that next thing to go wrong. We try to be positive but at the end of the day we’re still human and being scared of the unknown is normal. Even people without diabetes typically know the risks associated with trying to manage blood sugars without a properly functioning pancreas and/or metabolism. Heart disease, nerve damage, kidney failure, and blindness are issues people with diabetes may live in fear of since day one of their diagnosis.

Deep down, I knew something was off. My vision had changed enough that I had a sneaky suspicion this time would bring that moment where I would be told that there were now signs of diabetes in my eyes. And I was right.

The doctor informed me that I had retinal bleeds in both my eyes but that “I didn’t need to worry” and they wouldn’t need to treat it just yet. She even kindly offered to check them again in 6 months time if that might make me feel better. It did… and at the same time, it didn’t. I suddenly felt sick to my stomach. Thoughts of friends who have gone through so much with their eyes raced through my mind. Would I have to experience all of that, too?

Photo credit: Sarah Macleod

I started to cry and felt the same sadness wash over me that I had felt in 2012 after being diagnosed with gastroparesis. The guilt and shame I had been working through for years knocked on the door to my heart but I knew that the only way through this moment was to face this new information with acceptance and an attitude that I wasn’t powerless.

I had been taking a pump break while in yoga teacher training and had decided to continue on injections after I had graduated from the program. However, upon being diagnosed with retinopathy, I made the decision to switch back to my insulin pump once again. Everyone is different, but for me, having an insulin pump is a privilege and asset I couldn’t ignore. I knew that utilizing the technology available to me would be in my best interest.

When it came time for my next appointment, the world had already been impacted by COVID-19 and I wasn’t able to get my eyes checked when I had anticipated. I did my best not to let the fear creep in, but working from home and being on screens more than ever before didn’t do much to quell my anxious mind. Yet I knew I had to keep going.

For months, I tried to find a balance between discipline and letting go of what I simply could not control. I stayed connected with the diabetes community and my peers who understood what it was like to be managing diabetes daily while also navigating additional complications, illnesses, and issues. Utilizing tools like emotional freedom technique, guided meditation, and yoga continued to be a way I could serve myself while remaining focused on the balance I wanted to achieve.

I can’t tell you how many tears I cried. The worry would consume me most when I thought of a potential future pregnancy, breastfeeding, and motherhood. I wanted to see the children of my dreams and soak in every freckle on their face, their tiny fingers, and little toes. I wanted to see my children grow and watch them become who they were meant to be. If I lost my vision, how could any of these dreams come true? I found acceptance in knowing that I was willing to do whatever it took to preserve my vision even if that meant facing treatment options that terrified me.

It took me so long to make that next eye doctor’s appointment. Yet I knew in 2021 I wanted to address any of the issues I had been avoiding because of the fears that still existed within. The night before my appointment, I joined a meditation session with my diabetes friends and appreciated the energy, loving-kindness, and support that our “diabetesangha” was offering to me. It allowed me to relax, be present with how I was feeling, and honor any emotion that was coming to the surface to be acknowledged and released.

Sitting in that chair again, eyes dilated and heart open, I felt hopeful that I may be given the news that nothing had changed and to just keep working towards optimal glycemic control. However, the news I received was even better than I had anticipated. The doctor told me she could no longer see any signs of diabetes in my eyes. The retinal bleeds were gone and I was doing just fine. I was overjoyed and elated at the knowledge that I had reversed my diabetic retinopathy.

Each one of us living with diabetes is different. Despite ardent efforts and steadfast diligence, we don’t always receive positive news or the outcomes we are most hopeful for. Yet it is important to recognize that we must not give up even when we’re given bad news. There are avenues of support as well as resources and recommendations from peers and professionals that can offer us a sense of empowerment. If you are struggling with diabetes complications, remember that you are never alone and that there are people who understand what you’re going through. Don’t lose hope and keep in mind that there are many paths to healing ourselves body, mind, and spirit.

Source: diabetesdaily.com

Diabetes Complications: How They Affected My Body

I have a list of excuses as to why my diabetes was never really properly controlled. At 24 years old, I was diagnosed, but I was treated as a type 2. My doctor based it on my age. For 2 years that I was treated as a type 2, my sugars were never coming down, and my doctor kept upping my dosages until I was taking over 20 pills a day. I had tried a couple of different doctors through my insurance, but with no result. Finally, I went to see a highly rated endocrinologist, whom I had to pay out of pocket. At 26, I didn’t exactly have the funds to do so. I was properly diagnosed by this doctor, but unfortunately, couldn’t keep seeing him at such a high cost.

Recently, through type 1 (T1) meetup groups and social media, I see many young women, men too, who’ve been diagnosed in their twenties. There really isn’t any time in someone’s life that’s a great time to be diagnosed, but for me, and I’m assuming many others, your twenties can be difficult for so many reasons. You’re suddenly on your own health insurance. Your parents are no longer in control of it, and I’m sure, like me, you don’t want them to be! In your twenties, you’re invincible! Your life is yours, your decisions are yours, you feel like everything is yours.

Suddenly the doctors are telling you, “You can’t do this, you can’t have that,” and that diabetes will affect other aspects of your life, your health. But I wasn’t told specifically, all the things. For me, it started to feel like the doctors were in some conspiracy to take all (and more) of the money I made. I couldn’t afford diabetes.

Go to the dentist for a cleaning, I’m told I should be going every 3 months. I didn’t have dental insurance, and I always had great teeth. Never had a cavity, why do I need to worry now?

Quickly I became frustrated. Another endo, who had come highly recommended, did accept my insurance, so I vowed to take better care of myself. And then he started selling me bars and shakes, thought I needed to lose weight (I weighed 138 lbs., I’m 5’7” – not exactly overweight). I tried for a while but realized it was a lifestyle I could never keep up with, and he obviously had ulterior motives.

I felt that if the people who were “supposed” to be helping and supporting me didn’t care, why should I? Well now I wish I did, I wish I had understood all of the “little” complications, some of which are discussed, and some that aren’t as much.

I see young women on social media, who have changed their ways (and I applaud them), but I know there are many who suffer from diabulimia. You’re young, you’ve lost all this weight, you suddenly can wear anything you want, it seems like there’s at least one benefit of this illness. And there are those who have fallen into a depression, have lost hope, and just don’t care for themselves properly.

My sugars were always a little high, but I never (knowingly) missed a shot. My A1c typically ran in the 9% range. Definitely not near where it should be, but I see people who’ve run 13-14%, just to remain slim.

Gums and Teeth

First, it started with my gums. While I was still in my twenties,  I sliced them, just on a potato chip. Crazy! Usually, if that happened, it would heal, almost immediately. Not this time. This time, I got an infection. Gum disease isn’t pretty, especially when your mouth is constantly infected. Infections can raise glucose levels, and raised glucose levels can exacerbate infections. Round and round it goes. And this doesn’t happen overnight.

Nothing really ever went wrong until I hit 40. Even though through my thirties, I had surgeries and saw a periodontist every three months; eventually my gums just weren’t strong enough to keep my teeth in place. But at 20-something, who thinks they’re going to lose their teeth? I was someone who was always known for smiling. I have one of the biggest, cheesiest grins. But suddenly, I lost it, five teeth, and a lot of bone to go with it. Dental implants? Well, aside from being expensive, I need sinus lifts just to ensure the implants take hold.

Frozen Shoulder

What almost seemed out of the blue, I suddenly could not move my shoulder. It didn’t happen overnight, so at first, I thought maybe I was just sleeping funny. But then, I couldn’t raise my arm, even a little. Of course, it was my left shoulder, as I’m left hand dominant (Murphy’s law, right?). I hadn’t heard of this, but it was debilitating. When you can’t move your shoulder, raise your arm – showering, getting dressed, every basic thing becomes nearly impossible to do. I went for an MRI, physical therapy…and this went on for months. It finally subsided, but for months, I couldn’t get dressed, or undressed, without help. For someone who has always been active, lifted weights, this was frustrating, depressing, completely debilitating.

Diabetic Gastroparesis

My sugars definitely got a little out of control when I took a second job. I was working constantly, my part-time job was at a catering hall, so getting fed properly, and at proper times, became nearly impossible. Checking my sugar? Well, that was out the window too. That’s on me for taking that job, but when you need money, you do what you have to. Until you can’t. I’d be feeling fine, I’d finally eat, and almost immediately, I was nauseous, vomiting, feeling like I was going to die. At first, I just assumed I had a stomach flu. Nothing can really be done, you just have to let those run their course. But then, it was happening every week, two times, then three, until I was driving home from work, less than a 15-minute commute, and I couldn’t even pull my car over, I was just opening my car door and vomiting right out the door, several times.

I couldn’t get an appointment with the doctor, so I was told I could see a nurse. As soon as she took my vitals, she told me I needed to see the doctor, and she immediately set me up for an EKG. Fortunately, my heart is fine. But I do suffer from diabetic gastroparesis. Now that I’m aware, I can properly handle, and though every now and again I have a bout with it, overall, it’s basically under control.

Diabetic Mastopathy

I’m 43 years old, and I finally went for my first mammogram. Yes, I’ve been putting it off, because I’ve been in fear of finding something else wrong with me. I loved my teeth, I’ve lost them. I loved my hair, lost a lot around the time I was diagnosed, and though it did get better, it never was the same. I’ve dealt. But I’ve always felt that whatever else could happen to me, I would never let anyone cut into my breast(s), so the less I knew… I know, irresponsible, and ignorant.

Well, I finally went, and just to my luck, they found a lump. I had to be scheduled for a biopsy right away. To say this was nerve-wracking (even though I know women go through this every day, I’m sure they’re not calm about it either), was an understatement. (The stress also seemed to elevate my blood sugars like I’ve never known) I went for my biopsy, and metal markers were inserted, should I need surgery. I waited, very impatiently, for my results. Fortunately, my doctor called me immediately following the weekend (I went on a Thursday).

Now funny, you would think the doctor would know my medical history, but he didn’t! Thankfully, first, he did say it was benign. I can’t tell you what relief I felt, but then he followed with, “Are you an insulin-dependent diabetic?” What? What does that have to do with anything? Well, apparently, diabetic mastopathy happens to more of than not type 1s, but even types 2s, who are insulin-dependent, and whose glucose levels run higher.

Fortunately, this is not life-threatening. None of what I’ve gone through has been. But I promise you, I would’ve preferred to not have had to endure any of it. Managing diabetes alone can be difficult. There’s no need to add anxiety, fear, cost, insecurity, to an already consuming illness. What I wouldn’t give to have my teeth, the hours spent clinging to the toilet or garbage can, thinking I might die, or the lost months of movement in my shoulder/arm back. I would’ve preferred to never have dealt with the anxiety of knowing metal clips were being inserted. Granted, anything in life can happen to us, whether or not we’re diabetic. People lose teeth, suffer from gastroparesis, lose mobility, or get biopsies, who aren’t diabetic. But if we can help to not exacerbate or trigger the situation by managing our blood sugar levels properly, why wouldn’t we? No matter how skinny you might feel you need to be, if you have no teeth to show your smile, no mobility in your shoulder, how good can you really feel about yourself? At 43, my will to be healthy, to live healthy, is stronger than it ever was.

Source: diabetesdaily.com

Marijuana as a Treatment for Neuropathy: Emerging Evidence

Marijuana, or cannabis, has a long history of human use. Although it remains federally illegal, many states have opened the door to medical, and even recreational use legislation. Notably, more and more research studies are being conducted on the medicinal properties of cannabis, and a growing body of evidence now supports the relevance and efficacy of this plant and its compounds in the treatment of various health conditions.

Here, I focus on a common diabetes complication, peripheral neuropathy, and the emerging scientific evidence for the use of marijuana to reduce pain associated with this condition. If you want to learn more about marijuana and diabetes in general, please check out our recently updated and comprehensive resource:

Marijuana and Diabetes: What You Need to Know

What is Neuropathy?

Over time, high blood glucose levels can damage blood vessels and affect nerve function. A common complication of long-standing diabetes, especially for those who have chronically high blood glucose levels, is neuropathy. Neuropathy occurs due to nerve damage from high blood glucose levels and patients often experience numbness, tingling, and pain (most often occurring in the legs and feet).

Common treatment strategies include optimizing glycemic management to help prevent disease progression, as well as pain management with medications like Lyrica (pregabalin), Neurontin (gabapentin), and sometimes with certain antidepressants.

Research Shows Cannabis Is a Promising Treatment

Recent research points to the potential benefits of cannabis for the treatment of peripheral neuropathy pain. According to Way of Leaf, nine states – Arkansas, Connecticut, Missouri, Montana, New Mexico, New York, North Dakota, Pennsylvania, and West Virginia – already list neuropathies as a “qualifying condition” for medical marijuana use.

Experts say that there is now “substantial evidence” that cannabis is effective in treating chronic pain. So far, at least three studies have evaluated the efficacy in the treatment of diabetic peripheral neuropathy.

For example, one preliminary randomized clinical trial conducted in 2015 identified a “dose-dependent reduction in diabetic peripheral neuropathy pain” in patients whose pain was not alleviated by other treatment strategies. This study focused on the effects of inhaled cannabis. Interestingly, another clinical trial that evaluated the efficacy of Sativex, an oral spay containing cannabis-derived ingredients (THC and CBD), did not find a significant improvement in pain reduction as compared to the placebo arm in their analysis.

It is possible that there are additional compounds that contribute or synergize with the known active compounds to deliver the therapeutic effects. Experts explain:

“Currently, there is a debate about the so-called “entourage effect” which refers to the idea that compounds other than cannabinoids in marijuana (i.e. terpenes and flavonoids) are important in its therapeutic effects. This idea has wide lay-popularity, but little scientific evidence to support it.”

Overall, while more research is needed, there is increasing evidence that cannabis can be useful for treating neuropathic pain:

“The scientific literature demonstrates some efficacy of medical marijuana/cannabis in the treatment of chronic neuropathic pain. Clinical trials of different routes of administration (sublingual, oral, smoked, and vaporized) have demonstrated analgesic benefit in the treatment of this costly and disabling condition and some treatment guidelines for neuropathic pain recommend consideration of cannabinoids as a second or third line agent.”

They also note the potential financial challenges that may come with using cannabis to treat neuropathy:

“As expenses for medical marijuana are not covered by health plans and are out-of-pocket, knowing the cost-effectiveness of medical marijuana may impact patients’ decisions regarding its use. Based on a recent published article, inhaled cannabis appears to be cost-effective when used as second or third-line treatment in chronic neuropathic pain.”

Summary

The medicinal properties of cannabis have been described for thousands of years, and now more and more modern research study outcomes suggest that cannabis and cannabis-based treatments are effective and well-tolerated for a variety of ailments. So far, several studies have shown that cannabis-based treatment approaches for neuropathy are effective, although additional investigation is warranted.

What do you think? Please share your thoughts on your experiences with neuropathy in the comments below. Have you tried or considered using this type of alternative treatment?

References

Heimerl K; “Medical Marijuana and Cannabidiol (CBD): Perception vs Facts” (2019) American Academy of Osteopathy (OMED 2019) http://files.academyofosteopathy.org/CME/OMED2019/Heimerl_MedicalMarijuana.pdf

Mechtler L, Ralyea C, Hart P, Bargnes V; “Medical Cannabis in the Treatment of Neuropathy” (2020) Neurology, 94(15S). https://n.neurology.org/content/94/15_Supplement/5020

Nemergut G; Marijuana (2019) Pain, pp. 315-319. https://link.springer.com/chapter/10.1007/978-3-319-99124-5_69#enumeration

Robinson-Papp J. and Dehbashi S; “Medical Marijuana for Peripheral Neuropathy” (2019) Neuropathy Hope Newsletter, Western Neuropathy Association. P.1 https://pnhelp.org/application/files/1415/6081/5051/WNAENews0719L.pdf

Wallace MS, Marcotte TD, Umlauf A; “Efficacy of Inhaled Cannabis on Painful Diabetic Neuropathy” (2015) Journal of Pain 16(7): 616-627. https://pubmed.ncbi.nlm.nih.gov/25843054/

Source: diabetesdaily.com

What to Eat for Better Heart Health

As the famous saying goes, “You are what you eat,” and it is in fact true that our diet is intimately connected to health outcomes. When it comes to something that we have a lot of control over – our diet – why not take the next steps to make it healthier!

This article focuses on research-backed tips for achieving a more “heart-healthy” diet, which is especially important for people with diabetes, since the condition can increase the risk for heart disease.

Choose Unprocessed Foods

Many researchers will agree that population-based nutritional studies can be prone to many limitations. It can be very difficult to draw accurate and consistent conclusions about the specific effects of a single food or food group; instead, it is generally accepted that the overall dietary patterns and combination of specific foods consumed paint a more complete picture. However, most studies do agree on the importance of choosing whole foods over highly processed items.

For instance, ample evidence points to the harmful effects of highly-refined, high-glycemic load carbohydrates (e.g., corn syrup, white bread, most pre-packaged desserts), when it comes to cardiovascular health. The Cleveland Clinic recommends eschewing such carbohydrate sources and instead choosing less processed sources, like whole-grain bread and quinoa, for example.

Similarly, there has been some evidence to suggest that eating processed meats may increase heart disease risk. When possible, choosing unprocessed or minimally processed protein sources is the better choice.

Eating “clean” in this regard can also help you minimize your intake of trans fat, which has been consistently shown to increase heart disease risk.

Incorporate More Plants

Numerous studies point to the heart health benefits of a plant-based diet. Did you know that the vast majority of our pharmaceuticals are derived from plants? It’s no wonder that eating more plants can mitigate disease risk – they are packed with antioxidants, vitamins, fiber, and numerous other beneficial substances.

Have you ever heard of “eat the rainbow”? Choosing a variety of fiber-rich and colorful vegetables and fruits will help you incorporate a diverse array of heart-healthy nutrients.

Of course, for people with diabetes, the carbohydrate (sugar) content matters, so be mindful and opt for lower-glycemic-impact choices, like leafy green vegetables, zucchini, brussels sprouts, broccoli, and peppers. Consider choosing berries, and high-in-fiber, lower-in-sugar fruits to get the nutrients you need while also keeping the blood sugar level steady.

Photo credit: Foundry (Pixabay)

Don’t Shy Away from Fats

For many decades, it had seemed that dietary fat was public enemy #1 when it came to heart health. In particular, saturated fats and cholesterol (and thus many nutritious foods, like eggs and meat) earned a bad rep.

However, the picture turned out to be much more complicated. Experts explain that there has been a lack of consistency in the available data regarding the effects of saturated fat and cholesterol intake on cardiovascular disease (CVD) risk. Importantly, while some studies showed an association between red meat consumption and CVD, most of these studies were focused on processed meat products (see above).

Photo credit: GerDukes (Pixabay)

What is well-established is that incorporating “healthy-fats” (in particular, omega-3 fatty acids) from sources like fish, avocados, and nuts, appears to have favorable effects on CVD risk. This is a large component of the famous Mediterranean diet, which has been consistently associated with improved cardiovascular health. In contrast, keep trans fat intake at bay (which should be easy enough when mainly eating whole, unprocessed foods).

Choose Water

Besides choosing whole foods (read: no sugar added!), it is equally important to stay smart about beverages. We live in a society that makes it easy and normal to choose sugar-laden drinks (from the orange juice or Macchiato in the morning to the soda at lunch, to the sweetened iced tea with dinner). Choosing to forgo sugar-sweetened beverages is highly recommended for better heart health.

Summary

While many nutrition studies can be inherently messy in their design and interpretations, a few well-accepted notions regarding a heart-healthy diet have consistently emerged. Overall, whole-foods-based, unprocessed meals that are low in sugar and high in omega-3 fatty acids, incorporating a variety of plants, and drinking water or unsweetened beverages, can help reduce CVD risk.

References

Anand SS, Hawkes C, de Souza RJ, et al. (2015) “Food Consumption and its impact on Cardiovascular  Disease: Importance of Solutions focused on the globalized food system.” Journal of the American College of Cardiology. 66(14): 1590-1614. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4597475/

Cleveland Clinic (2018) “Heart Healthy Diet.” https://my.clevelandclinic.org/health/articles/17079-heart-healthy-diet

Harvard T.H. Chan School of Public Health (2020) “Preventing Heart Disease.” https://www.hsph.harvard.edu/nutritionsource/disease-prevention/cardiovascular-disease/preventing-cvd/

Kim H, Caulfield LE, Garcia-Larsen V, et al. (2019) “Plant-Based Diets Are Associated With a Lower Risk of Incident Cardiovascular Disease, Cardiovascular Disease Mortality, and All-Cause Mortality in a General Population of Middle-Aged Adults.” Journal of the American Heart Association 8(16). https://www.ahajournals.org/doi/full/10.1161/JAHA.119.012865

Source: diabetesdaily.com

Study Sheds Light on How High Blood Sugar Can Cause Complications Years Later

People with all types of diabetes are at a higher risk for numerous health complications, in particular for various vascular problems. While it is known that consistently tight glycemic management can greatly minimize these health risks, there are numerous factors which will determine long-term health outcomes.

One interesting concept is that of “metabolic memory,” a phenomenon that suggests high blood glucose levels experienced early on (for instance, before and some time after diagnosis) may still play a role in the development of complications years later, even if blood glucose has been generally well-managed. Several theories have been proposed as to why this may be, and most recently, researchers at the City of Hope conducted a study that may help explain why. The results of the study were recently published in Nature Metabolism.

Researchers selected patients from the DCCT/EDIC trials and compared their DNA to identify differences as they relate to glycemic management histories. The scientists were looking at something called DNA methylation, a process that involves the attachment of chemical groups (methyl groups) to specific regions of DNA.

The addition of certain chemical groups to DNA can change its function. This is one example of epigenetic regulation, a way that gene expression can be altered without a change in the actual DNA sequence (i.e., a mutation). These chemical groups that bind to the DNA can change the way that gene behaves, may affect the function of other genes and alter various physiological events downstream.

In this study, the authors report that they uncovered a connection between the HbA1c levels of patients at the end of the DCCT, their DNA methylation patterns, and the development of complications later in life. They believe that these differences in DNA methylation may promote the development of diabetes-related retinopathy and neuropathy (and likely other complications as well). In fact, many of these changes were occurring in genes that are directly relevant to the development of complications.

Rama Natarajan, PhD, one of the authors of the study, had this to say in a recent press release:

“This comprehensive study has systematically compared the epigenetic states of a large number of type 1 diabetic subjects with their glycemic history and their future development of key diabetic complications over 18 years. While the link between epigenetics and diabetes and related complications has been reported before, this is the first large scale study in type 1 diabetes showing that a prior history of high glucose levels can cause persistent changes in DNA methylation to facilitate metabolic memory and trigger future diabetic complications. This study provides the first evidence in humans supporting the link between DNA methylation in inflammatory and stem cells, a patient’s blood sugar history and development of future complications.”

Having a better understanding of detectable “markers” for complications before they even develop may mean earlier detection (i.e., via blood test) and more timely treatment of diabetes complications in the future. This research group is currently continuing to explore these findings, in collaboration with other research groups. They are planning to evaluate the relationship of DNA methylation and other diabetes-related complications, as well as investigate whether these changes may be a reliable biomarker for early detection. They are also investigating what other epigenetic changes may be relevant in metabolic memory.

Source: diabetesdaily.com

Unusual Type 2 Diabetes Symptoms Not to Ignore

Approximately 463 million people globally are living with type 2 diabetes and by 2045, this is supposed to rise to 700 million. Type 2 diabetes is largely caused by insulin resistance (IR) while the cause of IR can range from any number of genetic deficiencies to environmental causes. It’s important to look at both of these factors when considering a type 2 diagnosis.

Symptoms may be similar to those of type 1 diabetes but are often less pronounced since the condition progresses gradually over time. A startling statistic is that 1 out of 2 people will be misdiagnosed, leaving them susceptible to years of elevated blood sugars and the risk of complications that come along with the disease before being properly diagnosed and treated.

It is more important than ever to know the signs of type 2 diabetes so that a person can properly educate themselves in order to make better choices to improve their blood sugars and overall health. Routine blood tests at your yearly physical should help determine if you are experiencing issues that need medical attention.

Many of us are aware of the common symptoms associated with type 2 diabetes. But since it may take years before a correct diagnosis, many say they were unable to detect the slow changes to their health. It is important to pay attention to these signs especially if you are at an increased risk for type 2 diabetes.

Common Symptoms of Type 2 Diabetes

Some common symptoms to look out for are:

  • Increased thirst and frequent urination. As sugar build-ups up in your blood, it forces your body to try to flush it out through increased urination.
  • Increased hunger. Because your body is not absorbing sugar properly, it thinks it needs more creating you to become hungrier than normal.
  • Weight loss. As your body can’t utilize sugar, it turns to muscle and fat for fuel, which can result in significant weight loss.
  • Fatigue. Your body loses access to sugar which has been your main source of energy, therefore, leaving you feeling exhausted.
  • Blurred vision. High blood sugars can cause swelling of your lens and damage blood vessels which can create vision issues.
  • Slow to heal sores. High blood sugar can make your immune system not function as well as normally, causes wounds to heal more slowly.
blurred vision diabetes sign

Blurred vision is a classic symptom of type 2 diabetes. Photo credit: Adobe Stock

Unusual Symptoms of Type 2 Diabetes

While many will have classic symptoms leading up to a type 2 diagnosis, some people have rare and unusual symptoms that occur. Here are some of the less common symptoms to look out for, as being vigilant can help add years to your life.

  • Dark patches of skin. This condition is known as acanthosis nigricans (AN) and seems to occur mostly around the neck area or other areas where there are creases of skin such as the armpit or groin area. It is more common for people with darker skin and is a result of skin cells reproducing too quickly because of the excess of insulin in the blood.
  • Yeast infections and jock itch. High levels of sugar in your blood can cause an overgrowth of yeast in the genital area, resulting in a fungal infection. Other fungal infections such as bladder infections and skin infections can also be indicators of diabetes.
  • Itchy, bumpy, discolored skin. Eruptive xanthomatosis is a condition that can occur in people with poorly-managed blood sugars who have very high triglycerides and high cholesterol. It creates itchy, yellowish-colored bumps on the backs of the appendages and buttocks when blood sugars are elevated for a long period of time.
  • Sexual dysfunction. This is seen mostly among men with type 2 diabetes who frequently have high blood sugars. Elevated blood sugar levels can lead to nerve and blood vessel damage making it harder to achieve an erection. Women can also experience sexual issues related to high blood sugars, including arousal problems and less lubrication.
  • Lightheadedness. We often assume that when we feel this way it must be because we are hungry or fatigued but this can also be a result of diabetes. Dizziness will often be a sign of low blood sugar, but long bouts of high blood sugar will lead to dehydration, affecting sodium and electrolyte levels, resulting in cognitive changes.
  • Lack of sleep. There are quite a  few reasons a looming type 2 diagnosis could cause you issues when it comes to getting sleep. If you have undetected high blood sugars, you are likely to get up a few times to urinate disrupting your rest. Additionally, being obese isn’t only a risk factor for diabetes, it increases your risk of sleep apnea as well. If you notice your sleep patterns are changing, it is important to talk to your doctor.

It isn’t always easy or possible to be attuned to all the changes in your health but being aware of the symptoms, both common and uncommon, can help you to detect any issues if they arise. The good news is that once a proper diagnosis is given, you can take control of your health and normalize your blood sugars which will make many of these symptoms disappear. Acting fast is key to ensuring no long term complications.

If you were diagnosed with type 2 diabetes, what symptoms did you have? And if you haven’t been diagnosed, but have reason to think you may, what symptoms are you experiencing? Share and comment below!

Source: diabetesdaily.com

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