“Often when we feel depleted, we reach for a cup of coffee,” says Dr. Richard Ryan, a professor of psychology at the University of Rochester, “but research suggests a better way to get energized is to connect with nature.”

He is the lead author of a series of studies that the Journal of Environmental Psychology just published in this June 2010 issue. I asked him to send me a PDF of the full-text of his research report, “Vitalizing effects of being outdoors and in nature,” and he did. You can find the abstract online.

Instead of coffee, I restore my energy by going out for a hike. In fact, one of the most popular parts of my website is my blog of photo essays, “Fitness and Photography for Fun.”

Certainly, physical activity makes us feel better. Staying fit is indeed one of the four legs that those of us with diabetes have to keep our blood glucose levels down in the normal range (the other three legs are diet, reducing stress and inflammation, and usually taking oral medication or insulin).

Over the years I have written many articles extolling the benefits of exercise. Some of those articles say how much better I feel after going out for a hike.

Nature This Morning

That’s all true. But these new studies for the first time have teased out the effects of being out in nature alone from the feel-good effects that we get from physical activity and from the socializing that we often get at the same time.

Dr. Ryan and his co-authors were able to separate out the effects of nature alone. To do so they conducted five separate experiments with 537 of the usual suspects — college students.

What they found was so clear, Dr. Ryan says, that “being outside in nature for just 20 minutes in a day was enough to significantly boost vitality levels.” The Journal of Environmental Psychology article defines vitality as having physical and mental energy giving us a sense of enthusiasm, aliveness, and energy.

When we have a greater sense of vitality we not only have more energy to do the things that we want to do but were are also more resilient to physical illnesses. “One of the pathways to health may be to spend more time in natural settings,” he says.

I’m not knocking physical activity. Most of us who have diabetes need to get up and out a lot more. If you aren’t getting out yet, this beautiful late spring weather is a great time to start. I’m saying that getting our physical activity outdoors in nature gives us two for the price of one.

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.

Does it make you angry by my asking if you are a noncompliant diabetic? I didn’t mean to do that by asking you that in the title of this essay. I just wanted to grab your attention.

Getting angry is as unproductive as called us noncompliant or a diabetic. In fact, a new study in Hormones and Behavior shows that when we get angry, our heart rate and arterial tension increase along with other psychobiological changes. So please relax and read on.

No doctor ever dared call me noncompliant, but plenty have labeled me a diabetic. Those terms don’t make me angry — any more. But I don’t like them at all and am doing my best to stomp them out.

As a writer, words are important to me. As a positive person I try my best to avoid these “negative cues.”

This morning a friend mentioned another negative cue that health professionals sometimes use to describe the way we lead our lives. I hadn’t thought of this before, and that conversation is what prompted this essay.

“How are you managing your diabetes?” is the common clinical phrase that they throw at us. While to speak of managing doesn’t appear negative on its face, it really is. It focuses on our burden.

Likewise, I talk all the time about controlling diabetes. I’m now going to try to stop doing that.

The positive way to ask the question is whether we are living our lives boldly and fully. That’s a lot more than a dry, narrow emphasis on management or control.

Six years ago I first wrote about these and other “incorrect diabetes terms” at www.mendosa.com/incorrect_terms.htm in an article with that title. I wrote there that many people who have diabetes actively resist being labeled as a diabetic, as if we were an illness. A correspondent writes, “What I give as an example to doctors and other technical people is: If a person has hemorrhoids, does that make that person one?”

If you have diabetes but aren’t a diabetic or a hemorrhoid, I think that you might enjoy exploring my earlier article about the other words and phrases that our language would be better off without.

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.

The National Weight Control Registry is the best guide we have showing us how people actually lose weight and keep it off. These are the people who have succeeded in a major weight loss program and in keeping off the pounds.

Diabetes doctors typically tell us to loose 10 percent of our body weight. I know from my own experience that this helps to control our blood glucose level. And I know too that getting down to a normal body mass index, or BMI, is even better for maintaining a low A1C level.

The National Weight Control Registry started in 1994 and now tracks more than 5,000 people. And because I am one of them, the people at the registry sent me a copy of a publication that summarizes their findings as thanks for returning a one-year questionnaire. The article, “Long-term weight loss maintenance,” appeared in the American Journal of Clinical Nutrition.

To be included in the registry, people have to be at least 18 and have kept off at least 30 pounds for a year or more. I reached that milestone four years ago. And a couple of years ago my friend Gretchen Becker encouraged me to share my results with the registry.

I haven’t seen any statistics about how many of the people included in the registry have diabetes. But I know that my weight loss strategies have been different from most. Using Byetta got me started with my weight loss program, and a very low-carb diet intensified it.

Most people, however, say that they have lost weight by following a low-calorie, low-fat diet. Without question, weight loss means a low-calorie diet. Almost certainly, following a diet of any sort is also a key to success. In fact, participants who maintained a consistent diet during the week and year after year were much more likely to maintain their weight than those who varied their approach.

Other keys include:

Eating breakfast every day, followed by 78 percent of registry members.

High levels of physical activity. Fully 94 percent report that they get more exercise now than they did before they lost weight, and 90 percent report that on the average they exercise an hour a day. Walking is the most common activity, reported by 78 percent of the participants.

Regular weighing. More than 44 percent report that they weigh themselves at least once a day.

I know from my own experience that when my scales broke in February just before I went on a long trip that not weighing myself regularly was disastrous for my weight. In a three-month period I gained 12 pounds and am now fighting to take them off.

The really good news is that it gets easier. People who successfully maintained their weight loss for two to five years had a much greater chance of long-term success.

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.

If you didn’t think that testing your blood glucose could be fun, you probably haven’t tried Bayer Diabetes Care’s new Didget blood glucose meter.

I hope that you aren’t as poor a speller as I am. If so, you might have thought that Bayer named its new meter for the word that we use to denote a finger or a number. Both meanings make sense when we use fingersticks to test the level of our blood. But most people spell that word “digit.”

The Didget is the first blood glucose meter that connects directly to the Nintendo DS and DS Lite gaming systems. Lots of American kids have an Nintendo, but unfortunately I’m not a kid, so I don’t.

Bayer just sent me at no charge their newest meter, which the U.S. Food and Drug Administration cleared for sale on March 12. Unaccountably, however, the company forgot to include an Nintendo, so I’m still not having any fun testing my blood.

Bayer’s New Didget Meter

But if you have an Nintendo in your home as well as a child with diabetes, this could be the way to go. It awards points that kids can use to unlock new game levels and customize their gaming experience.

Kids ages 4 to 14 are the target audience. The Didget comes with a full-length Nintendo adventure game, “Knock ‘Em Downs World’s Fair.” You can even use the Didget meter separately without using an Nintendo, if you don’t have one yet. My guess, however, is that this wouldn’t be as much fun. Soon it will also connect to Bayer’s Didget World, a password-protected Web community where kids can create their own page and spend points that they earn when they consistently monitor their levels.

The Didget meter uses Bayer’s Contour test strips and takes just 5-seconds and 0.6 microliters of blood. It is now available for purchase in the United States through CVS.com, Drugstore.com, and Walgreens.com. The suggested retail price is $74.99. If it gets your child to test his or her blood glucose more often, this is cheap fun.

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.

With all the ways that we have now to treat fatty liver disease I don’t understand why any of us still have it. Yet most people with diabetes suffer from this potentially dangerous condition.

Now we have yet another tool in our arsenal against fatty liver disease. It’s a strange one. Not strange as in being unfamiliar, but rather strange as being surprising.

The new tool that may reverse fatty liver disease is vitamin E.

Years ago I had fatty liver disease myself. My late wife had it too. I was able to reverse it, but for her it eventually progressed to cirrhosis of the liver, which killed her three years ago.

Sadly, we didn’t know then how serious fatty liver disease could be and about all the ways to avoid it. I’ve written here how milk thistle and metformin can help. So too can eating a diet high in omega-3 fats. Exercise certainly works, as I know from my own experience. Even a little exercise helps.

The latest word on potential treatments for fatty liver disease saw the light of day a week ago in the advance online edition of The New England Journal of Medicine. Many people consider this the world’s leading medical journal. As of today only the abstract is free online, although I was able to download the full-text yesterday. The NEJM plans to publish the study in the printed journal tomorrow.

Researchers found that vitamin E improved the livers of people who had nonalcoholic steatohepatitis (NASH), which lay people like us know as fatty liver disease. In the study 247 adults with advanced fatty liver disease were randomly assigned to take vitamin E or a placebo (dummy pills) for nearly two years. They found that 43 percent of those treated with vitamin E showed significant improvement in their liver, while only 19 percent of those who received a placebo got better.

The dose was 800 IU of the natural form of vitamin E. The specific form was “RRR-α-tocopherol (formerly known as d-α-tocopherol) vitamin E,” according to the full-text of the research report. [Read more →]

The odds are that you haven’t yet fully empowered your search for good health. I know this about you because a couple of months ago HealthCentral surveyed 2,888 of its registered members who have one of eight chronic conditions, including diabetes, and who completed the study. And in this respect at least people with diabetes are just like the people with the other seven chronic conditions.

HealthCentral CEO Christopher M. Schroeder and James E. Burroughs, associate professor of commerce at the University of Virginia, presented their findings at the DTC National Conference in Washington, D.C. earlier this month and shared them with me. After asking the people in the survey all sorts of standard psychological assessments, they found that about 30 percent of us take an active role in our health care plan. If you are in this group, one of your characteristics is that you are energized and engaged when you need to learn new tasks or master new subjects — you are what the survey calls a person with a need for cognition. If you are an empowered health seeker, the other characteristic you have is self-confidence — you have, in the formal terminology of the survey, high self-efficacy.

You can click to view the study, “Understanding What Motivates the Empowered Patient,” here. Mr. Schroeder and Professor Burroughs prepared it in association with Ted Smith, Ph.D., HealthCentral’s executive vice president for research.

My posts here at HealthCentral and your many comments are just one small corner of this huge health resource. HealthCentral is a collection of condition and wellness websites providing clinical information, tools, and mobile applications. Its sites provide a platform for more than 3,000 bloggers, 200 expert patients, and more than 12 million monthly visitors sharing real-life experiences about specific conditions. [Read more →]

One little problem with disasters is that when they strike it’s too late to start preparing for them. You never know when or where they will hit.

Those of us who have diabetes are particularly vulnerable, because we have so many things that we have to consider. That’s why the American Association of Clinical Endocrinologists working with Eli Lilly and Company created the “Power of Prevention: Diabetes Disaster Plan.”

Todd Frieze, M.D., who practices diabetes, endocrinology, and metabolism in Biloxi, Mississippi, spoke on the organization’s disaster plan for those of us with diabetes this morning at a media briefing during the last full day of the AACE’s annual meeting in Boston. He said that they developed this checklist of items that we need to plan for after thousands of people were caught unprepared as a result of Hurricane Katrina in 2005.

Dr. Frieze Plans

In such an emergency we may well be totally on our own. “When something does happen, access to medical care may be curtailed or absent completely,” Dr. Frieze said. He noted that in 2005 his patients were out of touch with him for seven weeks.

Here is the checklist. As the Boy Scouts say, “Be Prepared:”

Prepare a portable diabetes disaster kit that is both insulated and waterproof containing the following items:

• List of all medical conditions and prior surgeries.
• Information about your diabetes, including past and present medications, any adverse reactions to medications, and past and present complications.
• List of all your health care professionals with their contact information.
• Letter from your diabetes health care professionals detailing most recent diabetes medication regimen (especially for insulin) and containing most recent laboratory results.
• List of all medications, which should also include pharmacies and active prescription information and eligible refills.
• A 30-day supply of medications for diabetes and all other medical conditions. This should include insulin, oral anti-diabetic agents and severe hypoglycemia emergency kit (if prescribed by your physician).
• Blood glucose testing supplies including lancets, test strips and preferably at least two glucose meters with extra batteries.
• A cooler and at least four refreezable gel packs for storing insulin (do not use dry ice when storing your medication).
• Empty plastic bottles and/or sharps container for syringes, needles, and/or lancets.
• Source of carbohydrate to treat hypoglycemic reactions (e.g. glucose tablets). Ideally should also have one or two day’s supply of food that does not require refrigeration (e.g. non-perishable).
• At least a three-day supply of bottled water.
• Pen and/or pencil and notepad to record blood glucoses and any other test results and any new signs/symptoms suggesting medical problems.
• Additional medical/first aid supplies like bandages, cotton swabs, dressings, and topical medications (antibiotic ointments or creams) to treat cuts or abrasions.

Other recommendations:

• Wear shoes at all times and examine your feet often for infection.
• Make sure that all immunizations including tetanus are updated.
• Pack extra comfortable clothing including undergarments.
• Take a cellular phone with extra batteries for you and family members.
• Consider choosing a designated meeting place in case you are separated from your family and unable to reach them by phone.

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.

Health Central sent me to the meeting, where I interviewed Dr. Sachmechi this morning. He is clinical associate professor of medicine at Mount Sinai School of Medicine in New York City and Queens Hospital Center in Jamaica, New York.
Dr. Sachmechi presented his poster and abstract, “Impact of Diabetes Education on HbA1C and Weight Reduction at the meeting.” He told me that he designed the study and involved the chief resident and one of his colleagues. Certified Diabetes Educators and nutritionists provided the diabetes education.

Dr. Sachmechi Supports Diabetes Education

Don’t people with diabetes generally get diabetes education? “No,” Dr. Sachmechi replied. “In many areas of the country people with diabetes don’t get nutritional advice or see CDEs. The CDEs show them how to do home glucose monitoring, how to prevent hypoglycemia, the importance of exercise, and other things that are needed for the care of diabetes.”

But doesn’t it cost a lot of money? “I don’t think so,” Dr. Sachmechi replied. “Certainly, a session with a CDE costs less than a session with a physician!”

The study group of 150 people included people with type 2 diabetes who their primary care physician referred to two CDEs and a dietitian. A control group of 150 people with type 2 diabetes didn’t get to see either a CDE or a dietitian.

The researchers compared the A1C and weight of the study participants before and then six months after the study. A1c went down 1.02 percent in the study group but only 0.59 percent in the control group. The average weight went down 2 pounds in the study group but only 0.71 pounds in the control group.

“This is one of the few studies demonstrating a measurable improvement in diabetes control and weight loss solely due to diabetes education and diet counseling in a municipal hospital with limited resources,” Dr.Sachmechi concluded. Dr. Sachmechi’s study worked with people with diabetes who are largely uninsured and generally have poor health literacy. My conclusion is if diabetes education works there, it can work for you too.

Dr. Sachmechi tells me that he is now working on the impact of support groups on the impact of A1c and other measures of diabetes control. Do support groups help us? That’s what he hopes to find out, and I will let you know here the results of that study.

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.

When I had elective surgery a year and one-half ago and then when I had an emergency operation about six months ago, I told the hospital that I wanted them to provide me with a diabetes diet. Big mistake. They have no idea what a proper diabetes diet is.

At that time I had read the book by Richard K. Bernstein, M.D., Dr. Bernstein’s Diabetes Solution. But I hadn’t focused on his guide to hospitalization. You can be sure that if I have a chance, the next time a hospital tries to run my diabetes life, I will guide it with a letter to them like the one here.

This week he told me that I was free to reproduce that guide here. What happened was this.

One of the regular readers of my articles here sent me a copy of a letter that she had written protesting the awful treatment that she had received in a hospital in Wyoming and in another hospital in Colorado. She wanted to get the letter to Dr. Bernstein, who she and I both look to for guidance on controlling our diabetes.

When I passed on her letter to him, Dr. Bernstein was sympathetic. But he added that he gets even worse horror stories from other people who run into our American health care system.

“They all relate to the ignorance and lack of compassion of physicians and hospital personnel,” he said. “I asked my literary agent if we should transcribe them for a book. I was told that people don’t want to read depressing stories, and no publisher would be interested. If you think this kind of thing would serve a purpose on your blog, just post a request for stories about interactions with medical personnel and you’ll be overwhelmed.” [Read more →]

My most recent post here reviewed a new study indicating that resting after meals is hard on the pancreas, could lead to diabetes, and could make existing diabetes worse. This is an interesting hypothesis and one that you can check out yourself.

But one of my correspondents suggests that the results might be related to the fact that overweight people who overeat at a meal are more likely to lie down. “Edgy thin people probably jog instead,” she says.

That’s a good suggestion, and I’m not sure that the authors of the new study controlled for weight. But now comes a closely related study that indirectly offers support for the hypothesis that lying down after we eat isn’t a good idea.

People in China in the 50s and over who regularly take naps after a meal increase their risk of diabetes by 28 to 36 percent, according to a study just published in Sleep, the official publication of the Associated Professional Sleep Societies, a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society. The authors of the study are associated with universities and hospitals in China and the U.K.

Correlation, of course, doesn’t prove causality. It is suggestive and may be a good suggestion to follow, because the only downside is probably being a bit tired, which in fact could lead to a better night’s sleep. Anyway, a little jog after a meal will do a lot more to reduce blood glucose than lying down ever will.

The authors of the study that I review last week are in Kazakhstan and Ukraine, while the new study is China-based. Some of the most interesting research on diabetes now seems to be coming from countries that hadn’t been at the forefront of diabetes research. This Internet age seems to be leveling the playing field.

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.