Thursday, November 27, 2008

Happy Thanksgiving!!

Hope everyone has a wonderful holiday full of family, friends, and good food! We're taking the rest of the week off, and will be back on Monday.

PS - Don't over-eat! Your Spleen will thank you for it.

Wednesday, November 26, 2008

Xiao Ke Continued

Xiao Ke is divided into three basic patterns: upper, middle and lower. Upper Xiao Ke has excessive thirst as the most prominent symptom, while middle Xiao Ke has excessive hunger, and lower Xiao Ke has excessive urination. In clinical practice these patterns are often mixed together. Today we'll cover upper Xiao Ke.

As we noted yesterday, a TCM disease diagnosis is accompanied by a TCM pattern diagnosis. For the disease Xiao Ke, the pattern diagnosis of Lung Heat with Injury to Fluids is given when excessive thirst predominates.

The clinical signs are excess thirst, high fluid intake and dry mouth, along with frequent urination and excess hunger. The pulse is rapid, the tongue has a dry red tip with a thin yellow coating. The treatment method is to clear heat, moisten the lung, generate fluid and relive thirst.

Prescription: Xiao Ke Fang (Wasting Thirst Formula)
Tian Hua Fen 15g (trichosanthes)
Huang Lian 6g (coptis)
Sheng Di Huang 15g (rehmannia)
Sheng Jiang 3g (fresh ginger)
Xian Ou Zhi 50cc (fresh lotus root juice, stirred in)
Feng Mi 20g (honey)
Ren Ru Zhi 50cc (human or cow's milk, stirred in)
Ge Gen 15g (pueraria)
Mai Men Dong 12g (ophiopogon)

These ingredients are cooked together (except the lotus root juice and the milk) in water for about 30 minutes. After they are done, the other ingredients are added and stirred in.

This prescription was taken from Practical Therapeutics of Traditional Chinese Medicine, by Yan Wu and Warren Fischer.

Tuesday, November 25, 2008

Xiao Ke: Wasting and Thirsting

Modern TCM (Traditional Chinese Medicine) has a useful system of integrating with Western germ-based biomedicine. In our textbooks, diseases are categorized in two ways: by Chinese disease name and Western disease name. Under the Western disease name, it breaks down all the different Chinese diseases it could be, and then further divides it into Chinese medicine pattern, which we'll come back to.

This is most revealing when looking at something like hypertension. "Hypertension" is a Western disease term defined by a relatively arbitrary number system. Systolic pressure under 140 used to be considered normal, but now the definition is under 125, meaning anyone with systolic pressure between 126 and 139 is all of a sudden considered to have high blood pressure.

Classical Chinese medicine (and most other systems of medicine up to a few hundred years ago, from Roman and Greek to Ayurveda and Umami) uses the doctor's powers of observation as the tools of diagnosis. Modern TCM takes full advantage of advances in equipment, while still taking as primary the doctor's observation, including subjective pulse-quality readings and observations of the patient's tongue color, shape and coating.

This means that "hypertension" can fall under a few different TCM disease names, including such terms translated from the Chinese as "dizziness" "headaches" and so on.

In the case of diabetes, there is a fairly direct correlation between the Chinese term xiao ke, which translates as "wasting and thirsting" and the modern disease name "diabetes." However, the test for diabetes is based on two fasting blood sugars of 126 or more on consecutive days. This means that people who do not test with those numbers aren't considered to have diabetes, even if they have all the other clinical signs of diabetes (although there is a newer category called "pre-diabetic" which may be useful, if not a little depressing). This addiction to numbers-based medicine ties the hands of many good Western doctors, or at the very least may make them hesitant to prescribe treatment for someone who doesn't actually "have diabetes."

TCM diagnosis has a big advantage in this area, because the blood sugar level becomes just another useful tool with which to assess a patient's condition, rather than the be-all end-all of treatment.

To summarize: most diabetics have some sort of xiao ke, but not everyone diagnosed with xiao ke has diabetes as defined by the blood sugar level test. Tomorrow we'll go over the different kinds of xiao ke.

Monday, November 24, 2008

A Plug For Mona Vie

To state it bluntly, I'm a skeptical cynic and don't believe most things I'm told unless I experience it myself. Although it can be a set-back in terms of time spent researching to find my own truth, all while indulging the OCD-side of me, it has led me to where I am today. With that disclosure statement, today's post is about a product called Mona Vie.

Maybe you've heard of it, maybe you haven't. It has been featured by Lara Spencer on The Dish with Rachel Ray, freestyle motocross pro Brian Deegan on MTV Cribs, and Dr. Oz on the Oprah Winfrey Show, to name a few. For a multi-level marketing product, it has gotten more exposure and endorsement than any other health-related MLM product in recent times - and trust me, being Vietnamese and all means that I know a thing or two or three about MLM's... (I don't know what the obsession is, but Vietnamese people love them!) It's also received a fair amount of skepticism and bad exposure as well.

I didn't know anything about Mona Vie until my sister started selling it. Now I know way too much about it. For weeks she's asked me to post a little something on her behalf, and I have been reticent... until now.

Both my parents have chronic health problems, and the kind of lifestyles that produce and perpetuate those problems. I have tried for the last year - since moving closer to home - to convince them to change their habits. I've given them teas, came over on weekends for acupuncture, tried to influence their diet, only to fail at almost all attempts to help them long term. Every time I left their house, they just went back to their same old ways.

My sister has been selling Mona Vie for only a few months now, and with that she has managed to change my parents' ingrained habits more than anything I've done. Every day, she makes sure our dad drinks the recommended 2-4 ounces a day of Mona Vie, and with that he's stopped drinking his requisite coffee every morning, as well as the three cans of soda he used to drink throughout the day. She also got our mom to drink it too: my mom's a Type 2 diabetic who is extremely uncompliant with her meds and dietary recommendations, and she's got a raging sweet tooth. When she checks her fasting blood sugar, it's usually at 180 or higher, but after taking the Mona Vie regularly, she's leveled at 73. She's been checking her blood glucose levels every day just to make sure it's still at 73.

My sister, who just had a son this past year, started taking Mona Vie given to her by a friend. She noticed that the pain she had in her heel, which began during her third trimester of pregnancy and persisted after birth, had disappeared. She also was delighted to find that she had lost 6 pounds, and decided to find out more about the stuff. Now she won't stop talking about it.

Mona Vie is a blend of different fruits: acai, concord grape, pineapple, apple, prickly pear, pomegranate, elderberry, yumberry, bilberry, blackberry, blueberry, cherry, cranberry, raspberry, aronia, acerola, strawberry, cupuacu, and camu camu. It's basically a super-duper fruit juice. It tastes great, which is why it was so easy to get my parents to do it.

So that's my plug for Mona Vie. People argue that it's just a juice, and that it's network marketing at it's best, making for tons of hype and misinformation. Personally, the fact that it is just a juice proves to me that healthy living doesn't have to come from a pill. A larger percentage of Americans suffer from chronic health illnesses compared to populations of other developed countries. The food group we are missing the most of in terms of both quanitity and variety are fruits.

The argument that it's exobitantly priced leads me to ask people to compare what they are spending on coffee every day, or for drinks at the bar each week, to the cost of Mona Vie. Ideally, we should all be buying low-cost unprocessed foods, especially fresh seasonal fruits and veggies, but the fact of the matter is that most of us are lazy, and that there is limited access to affordable healthy food choices in many parts of the country.

I try to get my parents to eat more fresh fruits and veggies. They live in California where fresh foods are abundant year-round, and they even have a juicer, which unfortunately sits in their cupboard untouched. If Mona Vie, with it's easy-to-swallow taste and easy-to-pour refrigerator-ready bottle, is the only way they'll take in their daily servings of fruit, then that's good enough for me.

Here's my sister's contact info if you want to learn more about Mona Vie:
Nina, 714-860-3518 or email her at ninamai at myway dot com.

Friday, November 21, 2008

Meet The Herbs: Da Suan

Chinese: 大蒜
Pin Yin: Da Suan
Pharmaceutical: Allii sativi Bulbus
English: Garlic Bulb
Vietnamese: Củ Tỏi

In yesterday's post we learned that garlic can lower blood glucose levels. In Chinese medicine, garlic has been used for thousands of years to treat colds, skin rashes, fungal infections, and parasites. It warms the body and moves the qi, unblocking stagnations and accumulations. Garlic is especially effective in the treatment of intestinal parasites, killing hookworms and pinworms, and can be combined with other herbs to treat other kinds of parasites.

From the Commentary on the Divine Husbandman's Classic of Materia Medica:
Acrid and warm, it travels and pierces, reaching everywhere, including the five yin organs... In summary, its actions are best at unblocking and thrusting out the orifices, expelling cold-dampness, clearing away noxious pathogens, dispersing swollen sores, transforming gathered accumulations, warming the Spleen and Stomach, and promoting the flow of all qi.

Here's a little something from the great Li Shi-Zhen on the use of garlic with moxabustion:
To treat emerging large and deep sores, applying moxa is superior to using herbs, as the heat and toxicity are separated and the upper and lower [layers of the sore] are blocked [from communicating]. The toxic qi must be drained before it can be released and dispersed. Within the first day of its emergence, use a large clove sliced as thin as a coin, place it on the sore and moxa it, changing the garlic every three cones. Generally, one-hundred cones is the number needed. First, this will make the sore remain small; second, it will prevent putrefaction; and third, the perforation of the sore will readily close. In one application, three benefits. However, this definitely must not be used on the head or neck, for fear that it will lead the qi upward, causing even more problems.

And other notable topical uses of garlic from the Grand Materia Medica:
Ground into paste and applied to the umbilicus, it reaches the lower burner to eliminate edema and facilitate the movement of stool and urine. Bandaged to the middle of the sole, it guides heat downward to treat diarrhea, sudden dysenteric disorder, and both dry and damp-type sudden turmoil disorders; it also stops nosebleeds. Held in the rectum, it unblocks the pylorus and treats plugged and rejecting disorder.

Thursday, November 20, 2008

Garlic Lowers Blood Glucose

Garlic is one of those super foods that you know intuitively must be potent due to its distinguishable pungency and pentrating taste. Turns out scientific studies have proven that it has strong antibacterial properties, making it an effective treatment for colds and skin infections. It is also an anti-oxidant that has been used for managing high cholesterol levels.

A recent study published in Metallomics shows that garlic has the potential to be used in the treatment of diabetes. Researchers found that ingesting substituents found in garlic lowers blood sugar for both Type 1 and Type 2 diabetics. If proven to be effective, this would be a breakthrough for Type 1 diabetic patients, reliant on injectable insulin, who can potentially take a garlic pill instead of a shot.

Read the article here.

Wednesday, November 19, 2008

Health Insurance for Everyone

Health insurance companies seemed to have had a change of heart, announcing today that they would accept all applicants for insurance regardless of their previous health history. This would include any and all pre-existing medical conditions, such as cancer, chronic illnesses like diabetes, autoimmune diseases, and disabling injuries.

Is there a catch? Of course there is!

Insurers are pushing for mandatory coverage for everyone. In order for them to be able to handle the costs of accepting all applicants, those who are healthy should also be required to buy insurance to cover the costs of those who are not.

Universal health care is the direction we seem to be heading in, and it's about time in my opinion. The problem I see with this proposal is that mandatory purchases of insurance policies does not guarantee that the services and care I want would be covered. It also does not guarantee that individuals who need more care will necessarily get adequate coverage even if they are accepted under an insurer's plan. Also, as the cost goes up for insurance companies that accept high-cost patients, the cost of insurance coverage will go up all around. Even if the companies wouldn't incur a loss because of the increased number of individuals buying in through a mandatory insurance policy, I wouldn't put it past them to use that high-risk cost factor as an excuse to have to raise policy prices anyway.

It just seems impossible for the government to enforce mandatory purchasing of health insurance.

Regulation of prices and the enforcement of regulations are subjects that have not been mentioned much during the last two years of dueling health care plans. Politicians have given a lot of lip service to changing the state of the system, and it's a mystery how it's all going to go down in the next few years. Most insurance companies do not cover acupuncture as part of their policies, even in California where acupuncturists are considered primary care providers. As an aspiring acupuncturist, I'm concerned with what the revised health care system will include, and whether or not our role as primary care, pain management and preventative care specialists will be upheld.

Tuesday, November 18, 2008

The Cost of Diabetes

  • $218 billion spent in the last year by government and the public - this includes direct medical costs, from insulin and pills for controlling patients' blood sugar to amputations and hospitalizations, plus indirect costs such as lost productivity, disability, and early retirement
  • $218 billion is about 10 percent of all health care spending
  • estimated cost of people not yet diagnosed: $18 billion
  • estimated cost of gestational diabetes: $636 million
  • estimated cost of those who are considered pre-diabetic: $25 billion
  • average number of diabetes medications prescribed per patient rose from 1.14 in 1994 to 1.63 in 2007
  • yearly patient visits for diabetes increased from 25 million to 36 million between 1994 and 2007
  • 17.9 million Americans are diagnosed with diabetes
  • cost for those with Type 1 diabetes total $14.9 billion
  • Type 1 diabetes, which generally begins in youth and is genetically linked, accounts for only 6 percent of those diagnosed
  • cost for those with Type 2 diabetes total $159.5 billion

The information above was taken from an article published by the Associated Press today. Some notable quotes from that article:
Diabetes has not seen a decline or even a plateauing, and the death rate from diabetes continues to rise

The numbers just keep going higher and higher, and what we want to say is, 'It's time for government and businesses to focus on it'

Drugmakers such as Novo Nordisk also see diabetes as an important — and lucrative — disease.

Monday, November 17, 2008

Dilled Mushroom Blintzes with Sour Cream

Below is a recipe I found on I took out some things, like the butter-flavored cooking spray and canola oil, and added the almond milk dairy alternative, but all-in-all the recipe sounds tasty and I can't wait to try it. The best thing about this site is that it lists the nutritional content of each serving sized portion of the recipes, for those who are keeping track of what they're eating.

For the crepes:
3cups (708 ml) skim milk or unsweetened almond milk
4large eggs
1/2teaspoon ( 2.5ml) salt (optional)
2cups (250 g) unbleached flour

For the mushroom filling

2teaspoons (10 ml) olive oil
2cups, about 10 ounces (315 g), finely chopped onions
1 1/2pounds (750 g) mixed fresh mushrooms, chopped coarsely
2teaspoon minced garlic
5tablespoons (15 g) chopped fresh dill
3-4tablespoons (45-60 g) unbleached flour

freshly ground pepper, to taste
1/4cup( 60 ml) Madeira or sherry
1/2 to 2/3cup (120-160 ml) 98% fat free, no-salt-added canned chicken broth

fat-free sour cream

extra dill, garlic powder, chives, or horseradish for garnish
  1. To make the crepes batter: Place the milk, eggs, and salt (if using) in a blender or food processor fitted with the metal blade. Add the flour, and process for 30 seconds. Scrape down the sides and process for another 10 seconds. Allow the batter to sit for 30 minutes.
  2. Lightly coat a 6 or 7 inch non-stick crepe pan or non-stick skillet with cooking spray and place over high heat. When hot, add about 2 tablespoons (will depend on size of pan) batter and tilt so batter covers the bottom of the pan. Allow the crepe to cook until set. Loosen with a spatula and turn onto a towel. Repeat using all of the batter, stacking the cooked crepes. These can be made ahead of time and frozen with waxed paper in between each crepe.
  3. For the filling: Coat a non-stick skillet with cooking spray and add 1 teaspoon of the oil. Cook the onions until tender, about 10 minutes over moderate heat. Set onions aside.
  4. Re-coat the skillet with cooking spray and add the remaining oil. Cook the mushrooms over high heat, so they do not give off too much liquid, for about 5 minutes. Add the garlic and cook for 1 minute. Mix in the dill and flour and cook for 3 minutes. Season with pepper. Stir in Madeira and chicken broth. Blend until smooth and thick.
  5. To assemble the blintzes, place 2 tablespoons of filling in the center of a crepe on the cooked side. Tuck in the sides and fold the top over the bottom edge to make a neat rectangular envelope. Repeat until all blintzes are made.
  6. When ready to serve, coat a non-stick skillet with cooking spray. Sauté a skillet-full of the blintzes until browned on each side. Keep warm covered with foil while you continue to sauté the remainder of the blintzes.
  7. Serve with fat-free sour cream to which you can add chopped dill, garlic powder, chives, or horseradish, or leave plain depending on your whim.
Per 2-blintz serving:58 calories (16% calories from fat), 3 g protein, 1 g total fat (90.2 g saturated fat), 9 g carbohydrates, 0 dietary fiber, 24 mg cholesterol, 19 mg sodium
Diabetic exchanges:1/2 carbohydrate (bread/starch)

Thursday, November 13, 2008

Statin Drugs And Increased Risk Of Diabetes

The Morning Edition of NPR this morning reported on a study published in the New England Journal of Medicine that supported the use of statin drugs to lower the risk of heart attack, even for those with normal cholesterol levels. Use of statins, however, lead to an increased risk in the development of diabetes.

It is argued by the reporter that the study illuminates why those with what is considered a normal cholesterol range can still end up having heart attacks. It is argued that really low cholesterol levels is the key to heart health. What I don't understand is why he jumped to that conclusion instead of considering a different possibility: that cholesterol levels have nothing to do with the likelihood that an individual would have a heart attack. I'm not suggesting that high LDL's don't play any part in the formation of plaque in arteries, but there are other factors, including lifestyle factors, that don't necessarily get put into print when these studies are conducted. Just as there are reports of people with normal to low cholesterol levels having heart attacks, there are those with high cholesterol levels not having heart attacks.

The article brings up the point of view of Dr. Lori Mosca of Columbia University. She says that putting patients on a lifetime regimen of statin drugs is not the best answer to the problem. She notes that she can tell who is at risk for a heart attack by the size of their waistline, and recommends putting patients on diet and exercise programs before prescribing them any drugs.

The thing about pharmaceutical drugs is that they are very good at what they do. Statin drugs in particular prevent the liver from producing cholesterol. Cholesterol is used throughout the whole body; it forms the backbone of a lot of different hormones, and the different kinds of cholesterol keep the body in a constant flux of homeostasis. Really low levels of cholesterol in the body result in depression of mental acuity, anemia, acidosis, frequent fevers and cataracts. Taking a statin drug in high doses and/or over a long period of time can have deleterious effects not yet "proven" by studies.

The inhibition of cholesterol production with a statin drug also stops the production of two other necessary substances in the body: Co-Q10 and dolichols. The heart muscles require high levels of Co-q10 in order to function. Dolichols are used by the body to ensure that things coded for in the DNA reached their programmed target. Without dolichols, there is an increased likelihood for unknown things to occur on the cellular level.

High cholesterol is a disease that shows no outward signs or symptoms. One can be perfectly happy and healthy and have what is considered to be high cholesterol. Diabetes, on the other hand, is a disease that is usually diagnosed after the symptoms have already begun to show. Things like thirst, fatigue, blurring of vision, tingling of extremities, sweating, feelings of nausea or dizziness, etc. Both diseases can be prevented or controlled by proper diet and exercise. Taking a statin drug for an asymptomatic disease just to increase your risk for diabetes, which itself increases the risk of heart disease, sounds like running around in circles. Which, ironically enough, is probably the best thing to do.

Wednesday, November 12, 2008

My Foot

I know we promised you all diabetes, all the time for the month of November, but I have to take this rare opportunity to present you with a fresh case study.

My foot.

So, I was sparring in Kenpo class last Wednesday night when the most unfortunate thing happened. My right foot was forward, my left foot behind, and I was gearing up to punch this guy. As I was lunging forward, but before making any contact with my opponent, I heard a loud "SNAP" and I fell to the floor.

This is what happened:

It's amazing all the different colors the body can make!

I believe it's a severe ligament tear, though I haven't gotten the MRI to prove it. It's definitely not a broken bone, and nothing is completely severed as far as I can tell. The night it happened, I was fortunate enough to be near the clinic while it was still open, and Keven Uchida - a wonderful supervisor and orthopedic specialist - took a look at it. I also showed it to three different MD's who agreed that it's probably not broken. So don't worry. I know those of you out there who know me well and are concerned that I'm not taking the proper precautionary measures can rest assured that I'm not self-diagnosing... not entirely, anyway.

But I am self-treating, and it's been great!

Day One:
  • 30 minutes on ice immediately after injury
  • E-stim acupuncture at SI-3 and SI-4 on contralateral for 15 minutes
  • Dr. Brady Chin's dit da jow all over top and bottom of foot
  • San Huang San plaster made of huang qi, huang lian, da huang, pu gong ying, hong hua, and zhi zi powdered, mixed with just enough green tea to make a thick paste. Wrapped my foot loosely in gauze roll and medical tape overnight
  • Five Photos Brand hit pill (these always make my heart a little thumpity, but work like a miracle every time)
Day Two:
  • Woke up with no swelling and no bruising, but my skin around my foot was red. Removed plaster, and within five minutes my foot started to balloon. Reapplied dit da jow til dry, then another coat of plaster and gauze. The swelling went down immediately
  • Needled contralateral hand sensitive points near SI-3, SI-4, LU-10, Luo Zhen, Yao Tong Xue, and SJ-4. Manually stimulated for 20 mins.
  • Change of plaster and gauze overnight
  • Jin Gu Die Da Pian patent pills for the pain
Day Three:
  • Definite bruising! All blurple in color
  • Acupuncture treatment at the clinic with Kumiko Yamamoto (wonderful intern, by the way). E-stim acupuncture with same points on contralateral hand. Additional points without e-stim: ST-36, SP-9, SP-10, LV-8, GB-34, and Yin Tang
  • Epsom salt soak
  • Plaster and gauze
  • Jin Gu Die Da Pian
Day Four:
  • More purple and green in color
  • Epsom salt soak
  • Moxabustion all around foot for 30 minutes
  • Dit da jow
  • Jin Gu Die Da Pian
Day Five, Day Six, and Day Seven
  • I stopped using the plaster because my foot wasn't swollen; it had effectively kept the swelling to a minimal, and then no swelling at all. The bruising seemed to reach its climax around day six (the pics are from day five), and is now lightening around the edges
  • Moxabustion 2 times a day over affected area on foot, and on reflective areas on the opposite foot. Also ST-36, SP-10, GB-34, UB-60, KD-1 on affected foot/leg.
  • Acupressure on contralateral hand
  • Jin Gu Die Da Pian
And here I am on day eight! I can move my foot fairly freely in all directions, and wiggle all my toes, but am still unable to put any weight on it. Throughout the week, I've been doing strengthening exercises with all my new-found spare time, flexing and extending through the ball of my foot and ankle. I can stand on it just long enough to pick my other foot off the floor, as long as I'm holding on to something for balance.

There is no swelling, but there's a significant amount of bruising all along the top of my foot, as though I've spilled a bucket of ink on it or something. It's kind of purple, kind of blue, kind of green all in one. It still hurts, but at least I'm sleeping through the night now and can get around on my crutches without it hurting due to movement.

All in all, a steady and fairly speedy recovery. I'm planning on using a tendon soak from here on out, coupled with the moxa, acupuncture and exercises. I'm not taking the pills anymore, since they're really dispersing and moving, and hope to be back on my feet in another week.

If you have any questions about the herbs I used or where to find such wonderful remedies, feel free to contact us!

Monday, November 10, 2008

Jamaica, Diabetes, and Its Youth

Jamaica's National Diabetes Week is this week, and its focus is on children and adolescents.

...the Ministry is taking a proactive approach to educating all children and their families about healthy food options and the importance of daily exercise, through various healthy lifestyle initiatives in schools and communities.

It is reported that 2 percent of those between 15 and 19 have been diagnosed with diabetes, but that the number could be as high as 17 percent. The story of Ryan Dwyer describes how being diagnosed with diabetes affected aspects of his social life and education:

"I woke up with two IVs in my arm and when I came to my senses the doctor told me I had diabetes," he said. "I started crying. I said diabetes is for old people like my grandmother and I am no where near being a grandfather."

For him, back then having diabetes was like a death sentence as he was discriminated against by his schoolmates.

"Nobody wanted to be my friend. I couldn't play the games that I wanted to play anymore," said Dwyer who is now a mixologist. "I got a separate chair in class and I had to write on the ground because I didn't have a desk."

This story made me think about how illness and disease is perceived so differently across cultures and communities. Diabetes is known to be a non-communicable disease. It seems strange that even at school a kid diagnosed with diabetes can be openly discriminated against. With a public stigma against the diagnosis, it's no wonder there is difficulty in finding out what the prevalence of diabetes is amongst teens there.

I did a Google search to try to find Chinese medical physicians in Jamaica, and only found two business listings: Daling Chinese Acupuncture & Moxibustion, and Shortwood Dental & Acupuncture Center, both in Kingston. According to the website for Anhui College of TCM in China, there is a TCM school in Jamaica called the Jamaican Cultural Center of Chinese Medicine, but I couldn't find a website for it.

Friday, November 7, 2008

Lowering Blood Sugar, Increasing Risk of Death?

Below is an article published in the New York Times earlier this year about a study conducted on diabetes and cardiovascular health. The results raised a lot of questions about how the current medical understanding of the disease views blood glucose levels as a primary factor when determining the patient's prognosis. Clearly, meeting some numerical requirement alone isn't the answer when it comes to health care. I've highlighted some of the interesting parts for your reading pleasure.

Diabetes Study Partially Halted After Deaths
By: Gina Kolata
Published: February 7, 2008

For decades, researchers believed that if people with diabetes lowered their blood sugar to normal levels, they would no longer be at high risk of dying from heart disease. But a major federal study of more than 10,000 middle-aged and older people with Type 2 diabetes has found that lowering blood sugar actually increased their risk of death, researchers reported Wednesday.

The researchers announced that they were abruptly halting that part of the study, whose surprising results call into question how the disease, which affects 21 million Americans, should be managed.

The study’s investigators emphasized that patients should still consult with their doctors before considering changing their medications.

Among the study participants who were randomly assigned to get their blood sugar levels to nearly normal, there were 54 more deaths than in the group whose levels were less rigidly controlled. The patients were in the study for an average of four years when investigators called a halt to the intensive blood sugar lowering and put all of them on the less intense regimen.

The results do not mean blood sugar is meaningless. Lowered blood sugar can protect against kidney disease, blindness and amputations, but the findings inject an element of uncertainty into what has been dogma — that the lower the blood sugar the better and that lowering blood sugar levels to normal saves lives.

Medical experts were stunned.

“It’s confusing and disturbing that this happened,” said Dr. James Dove, president of the American College of Cardiology. “For 50 years, we’ve talked about getting blood sugar very low. Everything in the literature would suggest this is the right thing to do,” he added.

Dr. Irl Hirsch, a diabetes researcher at the University of Washington , said the study’s results would be hard to explain to some patients who have spent years and made an enormous effort, through medication and diet, getting and keeping their blood sugar down. They will not want to relax their vigilance, he said.

“It will be similar to what many women felt when they heard the news about estrogen,” Dr. Hirsch said. “Telling these patients to get their blood sugar up will be very difficult.”

Dr. Hirsch added that organizations like the American Diabetes Association would be in a quandary. Its guidelines call for blood sugar targets as close to normal as possible.

And some insurance companies pay doctors extra if their diabetic patients get their levels very low.

The low-blood-sugar hypothesis was so entrenched that when the National Heart, Lung and Blood Institute and the National Institute of Diabetes and Digestive and Kidney Diseases proposed the study in the 1990s, they explained that it would be ethical. Even though most people assumed that lower blood sugar was better, no one had rigorously tested the idea. So the study would ask if very low blood sugar levels in people with Type 2 diabetes — the form that affects 95 percent of people with the disease — would protect against heart disease and save lives.

Some said that the study, even if ethical, would be impossible. They doubted that participants — whose average age was 62, who had had diabetes for about 10 years, who had higher than average blood sugar levels, and who also had heart disease or had other conditions, like high blood pressure and high cholesterol, that placed them at additional risk of heart disease — would ever achieve such low blood sugar levels.

Study patients were randomly assigned to one of three types of treatments: one comparing intensity of blood sugar control; another comparing intensity of cholesterol control; and the third comparing intensity of blood pressure control. The cholesterol and blood pressure parts of the study are continuing.

Dr. John Buse, the vice-chairman of the study’s steering committee and the president of medicine and science at the American Diabetes Association, described what was required to get blood sugar levels low, as measured by a protein, hemoglobin A1C, which was supposed to be at 6 percent or less.

“Many were taking four or five shots of insulin a day,” he said. “Some were using insulin pumps. Some were monitoring their blood sugar seven or eight times a day.”

They also took pills to lower their blood sugar, in addition to the pills they took for other medical conditions and to lower their blood pressure and cholesterol. They also came to a medical clinic every two months and had frequent telephone conversations with clinic staff.

Those assigned to the less stringent blood sugar control, an A1C level of 7.0 to 7.9 percent, had an easier time of it. They measured their blood sugar once or twice a day, went to the clinic every four months and took fewer drugs or lower doses.

So it was quite a surprise when the patients who had worked so hard to get their blood sugar low had a significantly higher death rate, the study investigators said.

The researchers asked whether there were any drugs or drug combinations that might have been to blame. They found none, said Dr. Denise G. Simons-Morton, a project officer for the study at the National Heart, Lung and Blood Institute. Even the drug Avandia, suspected of increasing the risk of heart attacks in diabetes, did not appear to contribute to the increased death rate.

Nor was there an unusual cause of death in the intensively treated group, Dr. Simons-Morton said. Most of the deaths in both groups were from heart attacks, she added.

For now, the reasons for the higher death rate are up for speculation. Clearly, people without diabetes are different from people who have diabetes and get their blood sugar low.

It might be that patients suffered unintended consequences from taking so many drugs, which might interact in unexpected ways, said Dr. Steven E. Nissen, chairman of the department of cardiovascular medicine at the Cleveland Clinic.

Or it may be that participants reduced their blood sugar too fast, Dr. Hirsch said. Years ago, researchers discovered that lowering blood sugar very quickly in diabetes could actually worsen blood vessel disease in the eyes, he said. But reducing levels more slowly protected those blood vessels.

And there are troubling questions about what the study means for people who are younger and who do not have cardiovascular disease. Should they forgo the low blood sugar targets?

No one knows.

Other medical experts say that they will be discussing and debating the results for some time.

“It is a great study and very well run,” Dr. Dove said. “And it certainly had the right principles behind it.”

But maybe, he said, “there may be some scientific principles that don’t hold water in a diabetic population.”

Thursday, November 6, 2008

Meet The Herbs: Xi Yang Shen

Chinese: 西洋參
Pin Yin: Xi Yang Shen
Pharmaceutical: Panacis quinquefolii Radix
English: American ginseng root
Vietnamese: Hoa Kỳ Sâm

Categorized by Bensky et al as a yin tonifying herb, Xi Yang Shen is like Ren Shen's heat clearing cousin. It's cold and bitter, slightly sweet, and enters the Heart, Kidney, and Lung channels. Some modern studies conducted in China comparing the constituents of Xi Yang Shen and Ren Shen have concluded that they are equivalent in effectiveness. This makes the herb useful when you want to tonify qi without the warmth of Ren Shen.

Because of this, Xi Yang Shen is an excellent herb to use in the treatment of diabetes. The symptoms of excessive thirst and hunger are indicative of heat in the Lungs and Stomach. The cold nature of the herb can cool the fire, while it generates fluids to replenish the yin burned up by heat and lost through excessive urination. Individuals with diabetes require tonification, due to the nature of chronic illness burning up qi and yin.

There have been several studies conducted to test the efficacy of Xi Yang Shen in the treatment of diabetes. One recent study showed that this herb increases production of insulin and reduces the death of pancreatic beta cells (which make and release insulin). It was also shown to benefit immunity, mitochondrial function (cellular energy production), and improve blood sugar levels taken after eating.

The best way to cook this herb is by double boiling it for several hours - here's a good explanation of the process on this retail website (just to let you know, you can buy a ginseng cooker for less at your local Asian market). The longer it cooks, the more potent the tea will be.

Another way to extract the goodness of the herb is by making a tincture. Simply put the herb in a glass container and cover it with vodka. Keep the container out of direct light, and shake it up once a day. If the herbs expand above the level of the alcohol, just add more to keep the herbs covered. The longer the herb is extracted, the more potent the tincture will be, but definitely do it for at least two weeks.

Wednesday, November 5, 2008

Yes We Can!

There was a comparison of the two candidate's health care plans, written by the organization Doctors for Obama, highlighting the differences between them in terms of diabetes care. To tell you honestly, I didn't read the McCain part because it's written by a partisan group and probably not entirely accurate. I did read the Obama side because this is the plan that would ideally be put in place some time in the next four years. I feel like the most significant differences, and the most valuable if Barack Obama and his team can really make this happen, are payment for preventative health services and the inability for insurance companies to penalize patients with chronic illnesses - such as diabetes - with higher costs for coverage.

Tuesday, November 4, 2008

Diabetes: What Is It?

According to the Western allopathic model of medicine, diabetes is a disease that develops due to a diminished production of insulin (Type I) or a resistance to its effects (Type II and gestational diabetes), both of which result in excessive urination, increased thirst, increased appetite, and lethargy. The disease diabetes insipidus, which means "without taste", is a rarer form of diabetes that is caused by kidney or pituitary gland damage. For the next month on our blog, we'll be mostly discussing diabetes mellitus, meaning "to pass through [urine] honey/sweetness", a term for a group of diseases characterized by the increased concentration of sugar in the blood.

Diabetes mellitus Type I is also referred to as juvenile diabetes or insulin-dependent diabetes. Type I patients require exogenous insulin in order to survive. Diabetes mellitus Type II is also called adult-onset diabetes, obesity-related diabetes, and non-insulin dependant diabetes. These patients do not need exogenous insulin, and can be treated effectively through change of diet, weight loss, and/or management of stress factors in their lives.

In Vietnamese, diabetes is called đái đường, or "pee sugar". An old diagnostic method for the disease, once the other tell-tale symptoms were observed, was to see if ants were attracted to the patient's urine. Another way was to simply taste it yourself for sweetness. As a health care practitioner, I'm glad we have such modern technologies as blood tests, urine tests, glucose test strips and glucometers. These advances keep me from having to taste pee, and also help individuals with diabetes manage their own health.

So what exactly determines if one has diabetes? According to allopathic medicine, a fasting blood sugar level equal to or above 126 mg/dL, or a casual blood sugar level (two hours after eating) at or above 200 mg/dL. In some cases, the patient may be asymptomatic, but still show an elevated concentration of blood sugar which requires treatment and management.

In Chinese medicine, diabetes is often equated to the disease xiao ke, or "wasting and thirsting". The three common symptoms are also characterized as excessive urination, excessive thirst, and excessive appetite. There are several different patterns that stem from this diagnosis, dependent on the symptomatic presentation of the patient. In a patient that presents with mostly excessive thirst, they would be treated for heat accumulation or fluid damage. A patient who has excessive hunger may be be treated for intense heat in the Stomach, whereas the treatment for a patient with excessive urination may focus on the lack of warmth or Yang of the Kidneys. The Chinese differential diagnosis of patterns depends not only on the presence of the primary symptoms, but also on the patient's overall constitution coupled with other factors like sleep patterns, bowel movements, and temperature sensitivities, to name a few. Because each person can present with a variety of symptoms, and to varying degrees of each symptom, this model of breaking a disease state into more and more refined patterns allows a physician to better address each individual's needs.

Although there is no modern pharmaceutical or surgical cure for diabetes, patients with the disease have been able to manage their diabetes through diet, exercise, lifestyle changes, and careful monitoring. It is recognized that the primary treatment for diabetes is patient education, and that learning as much as one can about the disease process and the signs and symptoms can help to prevent future complications.

If you or someone you know has been diagnosed with diabetes mellitis, a consultation with a Chinese medicine physician can help them manage their disease. Acupuncture has been proven by the NIH and WHO to have metabolic effects on the body that can modulate systemic regulatory functions. There are various nutritional therapies, herbs, herbal formulas, and exercises such as Tai Chi and Qi Gong that a patient can benefit greatly from. Chinese medicine provides another metaphor with which to understand the disease process in the body, arming the patient with more information to help them better manage their care.

Monday, November 3, 2008

November is American Diabetes Month

American Diabetes Month is an event designed to raise awareness about diabetes. To do our part, every single post this month will be related to diabetes! We'll be covering diabetes from the perspective of both biomedicine and TCM.