Here is a copy of a letter — with the author’s name and other identifying information redacted out — about anecdotal evidence that medical marijuana might help some complications of diabetes.

The person who wrote me has a better memory than I do. I don’t remember corresponding with him before, but he remembers that when I used marijuana I was addicted to it. It got to where I had to be high all my waking hours. My correspondent is also quite correct in writing that I would not be a good candidate for medical marijuana, except as a last resort.

The jist of what he wrote follows:

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Stanley Kim is a practicing physician in Southern California who recently invented the smallest and painless lancets for testing our blood glucose. I wrote about this invention here this August.

At that time Dr. Kim and I hadn’t met. I interviewed him on the phone from my home office in Colorado.

We had to travel all the way to South Korea to meet in person. We are in Busan, Korea’s second largest city with about 3.6 million residents. Specifically, we are both attending the International Diabetes Federation’s Western Pacific Region Congress along with about 3,000 other people who work with diabetes. This congress is taking place in Busan Exhibition and Convention Center (BEXCO) in the most modern part of the city near Haeundae, the most famous and frequented beach in all of South Korea.

As modern as Korea is — particularly in this part of the country — it is naturally quite different from what I normally experience in Colorado. But for Dr. Kim, Busan is quite familiar. He grew up in Busan and has a condo here.

Until I mentioned the meeting during the course of the interview for the article I wrote here in August, Dr. Kim didn’t know that it was happening in his hometown this year. He then arranged to attend the meeting. And at the last minute the conference organizers approved his poster presentation for the tiniBoy lancets. [Read more →]

Greetings from the bottom of my heart and the top of Seoul. I am writing you from South Korea where I am for two weeks at the invitation of one of the largest blood glucose meter and test strip manufacturers in the world.

People from i-SENS Inc., a company headquartered in Seoul that designs and manufacturers blood glucose monitoring systems, asked me to visit them this fall. In fact, they originally invited me to come last October. But I had to postpone my visit because I had an emergency operation for twisted small intestines at the beginning of that month, and my surgeon said I couldn’t travel.
For the first few days of my trip I am staying on the top floor of a hotel in the Seongbuk district of Seoul, near the company’s headquarters. With 24.5 million inhabitants Seoul is the world’s second largest metropolitan areas in population (after Tokyo and ahead of Mexico City, New York City, and Mumbai, in that order). Seoul has been Korea’s capital for more than 600 years.
On Friday I left Seoul for the day to visit the new factory that i-SENS built in Wonju city four years ago to make test strips for its blood glucose meters. I went with my friend and hostess, Margaret Leesong. The i-SENS director of international business relations, Margaret visited me in Boulder a couple of years ago, when we had a great hike together in the foothills of the Rockies.

Margaret lived in the States from 1973 to 1978 and then again from 1988 to 1996, when she moved to Australia, remaining there until 2005. After her college years at Seoul National University, she earned a Ph.D. in biophysics from Purdue University in Indiana and then an LLB (law degree) from the University of Sydney. She speaks flawless English.
When Margaret met me at the hotel on Friday morning, we took a taxi to the bus station, where we took a two-hour ride to Wonju, a much smaller city of about 300,000 people in northeastern Korea. From there a staff member who helped us as driver and tour guide from the company picked us up and took us to the factory.

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“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.

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 →]

If you never heard about Atul Gawande, M.D., you don’t know the best medical writer in the world. As a medical writer myself, I consider my naming him that to be about the highest praise I can offer.

When the people at the American Association of Clinical Endocrinologists told me that Dr. Gawande would be the keynote speaker at this year’s meeting in Boston, I didn’t think twice about accepting their invitation. Listening to his address this morning, I was as impressed by his talk as I was earlier by reading his three books and his many articles in the New Yorker magazine.

But if Dr. Gawande were just a writer, this organization of practicing endocrinologists wouldn’t have made him their keynote speaker today. This incredibly talented young man, born in 1965, also happens to be associate professor of surgery at Harvard Medical School and a general and endocrine surgeon at Brigham and Woman’s Hospital in Boston — two list just two of his many positions.

At least he didn’t have to travel far in order to speak to speak to about 1,000 of us today. I made sure to get to the auditorium early so I could sit in the front row to photograph him.

Dr. Atul Gawande Speaking This Morning to Endocrinologists

I also wanted to take a close look at Dr. Gawande to see if he looked frazzled from all his work. As you can see from my photo, somehow he looks quite relaxed.

Earlier in one of my articles here I named Dr. Gawande as as inspiration for my writing style. He even takes time to answer my emails when I write him. No wonder that the John D. and Catherine T. MacArthur Foundation a few years ago named him a MacArthur Fellow, which well deserves its nickname, “the genius award.”

President Obama cited Dr. Gawande’s article last year in the New Yorker, “The Cost Conundrum,” which used as an example the town of McAllen, Texas, to argue that unnecessary medical tests and procedures were a primary factor in driving up the cost of health care in this country. That article affected the President’s thinking dramatically, according to Senator Ron Wyden, and soon after its publication, he showed the article to a group of senators including Wyden and said, “This is what we’ve got to fix.”

Today, Dr. Gawande spoke on “Beyond Reform: Facing the Complexity of Health Care.” The key word is complexity.

He mentioned diabetes a couple of times in his talk. But for now please think of diabetes as subsumed within our country’s much broader health care problems. Here are some of the passages of Dr. Gawande’s talk that immediately caught my attention as I recorded them.

“The deepest struggle of health care is its complexity,” he said. “This is the reason why health care often doesn’t work. Just half a century ago medicine wasn’t either expensive nor effective.

“We have identified now more than 13,600 diagnoses. And for each of them we have identified steps in their care that can reduce people’s suffering, if not actually cure their disease. But that arsenal has now accumulated to become more than 6,000 drugs currently that you and I can prescribe and more than 4,000 medical and surgical procedures that we can provide.

“It’s incredibly hard. There is no industry in the world that has to provide 13,600 different service lines to every community in the country, let alone the world, and customize it to every customer. It is man’s most ambitious endeavor.

“The value it’s producing, though, is already excellent. Life expectancy has increased five years since 1960 and nearly all of it has accumulated after the age of 65. It’s brought longer lives and later disability, and that has produced its own problems, because during that same time period we have reduced the average retirement age from 67 to 61. Somewhere this is not going to add up (he smiles).

“We are at the point where the volume and complexity of the discoveries we have had in the last century has now exceeded our ability as individuals to delivery optimal care reliably and safely. I think we were fooled by penicillin. It was miraculous for a couple of reasons: number one was the idea that you could treat this incredible range of infectious disease that could never be reliably treated before, and the second thing was that this took only an injection.

“It was that simply. And it led us to imagine that the future of medicine would look like that. There would be an injection for cancer. There would be an injection for heart disease. But it hasn’t turned out to be anything like that at all.

“We were fooled into imagining that discovery was the only hard part and that execution would be easy. And that couldn’t be further from the truth.

“What’s missing is innovations for great care. It’s innovations not as we are used to thinking, where we think of drugs and devices as the sole carrier of innovation; it’s about systems innovation in health care.

“Making food of higher quality at lower cost was the fundamental question of the 20th century. Now, we are coming to a basic understanding of how we will make better care at lower cost. This is the fundamental issue of the 21th century.”

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.

Gastric bypass surgery is getting more and more attention as a potential cure for type 2 diabetes. For example, Dan Hurley’s outstanding recent book Diabetes Rising, which I reviewed here, included it in the author’s section on cures for diabetes.

Usually people define a cure based on fasting blood glucose and A1C tests. Anna L. Marina, M.D., a primary author of the case study, and her associate, Dace Trence, M.D., described a case that met those criteria, “but did not support remission of diabetes on further evaluation.”

Dr. Marina is a senior clinical research fellow in the division of metabolism, endocrinology, and nutrition of the University of Washington. Dr. Trence is associate professor of medicine there.

Dr. Anna Marina

Dr. Marina presented her findings at a press briefing during the annual meeting and clinical congress of the American Association of Clinical Endocrinologists in Boston today. I am attending this meeting to represent Health Central.

The subject of Dr. Marina’s presentation was a 55-year-old man who was morbidly obese with a BMI of 45.2 and who had had type 2 diabetes for seven years. He had undergone Roux-en-Y gastric bypass surgery, by far the most commonly performed bariatric procedure in the United States.

The surgery obviously helped him a lot. Right after his operation he was able to cut his insulin injections from 100 to 30 units a day. After four months he had lost more than 100 pounds and his A1C went from 9 to 6.1 percent. At that point he and his doctor decided that he didn’t need insulin any more.

But after seven months he started having post-meal blood glucose levels in the 180 mg/dl range. Then, as tested with a continuous blood glucose monitor, they could see that his post-meal levels were often in the 200 mg/dl range — all the way up to 294 mg/dl. Those levels are consistent with a diagnosis of diabetes.

This is also consistent with another recent study, Dr. Marina said. Dr. Mitchell Roslin and two associates reported at last year’s annual meeting of the American Society for Metabolic and Bariatric Surgery. They performed glucose tolerance tests on 38 people more than six months after they had Roux-en-Y gastric bypass surgery.

“They found that six out of these 38 people still had diabetes,” Dr. Marina said. She concluded that “fasting blood glucose and normal A1C are insufficient to establish that gastric bypass surgery is a cure for type 2 diabetes.”

Gastric bypass surgery is a last resort. It can work for some people with diabetes who are morbidly obese. But unfortunately not for all.

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.

Today, after 15 years of work, a Boston-based company focused on obesity and diabetes came out of stealth mode. Gelesis Inc. unveiled something that promises to make losing weight a lot easier.

Nothing on the immediate horizon could be more important for most of us who have diabetes. More than 85 percent of us are overweight or obese, according to a survey by the U.S. Centers for Disease Control and Prevention.

While I lost a lot of weight by using the first GLP-1 mimetic, Byetta, and then more by following a very low-carb diet, it wasn’t easy. That personal experience is in part what makes me so excited about the product that Gelesis presented to the public for the first time today.

The company made its presentation at a media briefing that I was privileged to attend. Health Central sent me to Boston this week to attend the 19th annual meeting and clinical congress of the American Association of Clinical Endocrinologists. About 1,700 doctors from all over the world are here for the association’s largest meeting ever.

I arrived in Boston yesterday evening, and for me the meeting started with the media briefing this morning. It started with a bang as two doctors presented the results of their efforts to date. After the briefing, I cornered four other experts involved with the development of their product.

Dr. Hassan Heshmati, the chief medical officer for Gelesis, kicked off the presentation. He announced that they have developed the first superabsorbent hydrogel composed entirely of food components. They call it Attiva.

It swells up after people swallow it, making people feel full. This feeling of satiety lasts even after it goes through the stomach into the intestines. Then it safely degrades in the colon and releases the liquids that it absorbs, one of Attiva’s important safety features.

They designed Attiva to have the same physical properties as masticated food. The most common side effect was nausea. But only about 7 percent of the people in their clinical trial experienced it, Dr. Heshmati said.

After Dr. Heshmati’s introduction of Attiva, Eric Elenko, Ph.D., showed us what Attiva can do. Dr. Elenko is a partner in Puretech Ventures, which co-founded Gelesis.

Eric Elenko Shows How Absorbent Attiva Really Is

To measure Attiva’s effect on satiety, doctors at the Gemelli Hospital in Rome, Italy, gave it to 95 people. While some of them had a normal weight, others were overweight or obese, and they had an average body mass index of 31. [Read more →]

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 →]