Meet the Herbs: Sang Shen

Chinese: 桑甚
Pin Yin: Sang Shen
Pharmaceutical: Fructus Mori Albae
English: White Mulberry

Strongly tonifies Blood and enriches Yin, goes to the Heart, Liver, and Kidney, and treats constipation due to Blood deficiency in the elderly. What more could you ask for?

It does a handful of other things too, but more importantly, it tastes great! It's like having the satisfying mouth-feel of eating soft granola with the sweetness of dried berries and the texture of fibrous buds popping in my mouth. Did I make that sound appealing? Probably not. But really though, it's that good.

Sang Shen is known to contain high amounts of iron, calcium, potassium, magnesium, sodium, phosphorus, sulphur, and anthocyanins. It also contains resveratrol, a polyphenolic phytoalexin also found in grapes that has been shown to be an antioxidant, antimutagen, and anti-inflammatory. According to Wikipedia, the "unripe fruit and green parts of the plant have a white sap that is intoxicating and mildly hallucinogenic."

I bought a bag of them in NYC last weekend and have been munching on them everyday since.

Small Changes Lead to Big Changes in Preventing Diabetes

Tim and Paul Daly, identical twins. One has diabetes, one does not.

Here's an inspirational story about beating diabetes. Tim and Paul Daly are identical twins who were inseparable up through young adulthood - they even joined the Army together. Later they took different paths, and while Tim kept playing basketball every week with friends on Tuesday night, his brother didn't do any exercise at all.

In 1996 Paul was diagnosed with Type 2 diabetes. His identical twin Tim was pre-diabetic. Then...

Tim volunteered to take part in a huge national research study aimed at determining exactly what it takes to prevent or delay the onset of Type 2 diabetes.

Like him, all of the 3,234 volunteers in the study were at high risk of developing the disease. The volunteers were broken down into three groups.

Tim was randomly assigned to the "lifestyle intervention" group. He received intensive counseling from a dietitian and motivational coach who helped him develop a plan to eat less and exercise more.

A second group of participants took a diabetes medicine called Metformin twice a day. These volunteers received information about diet and exercise, but they didn't get motivational counseling. A third group received placebo pills instead of Metformin.

Researchers wanted to know which intervention would work best to prevent diabetes and all of the complications that can develop as a result: loss of vision, kidney failure, amputations and a substantial increase in risk of heart disease and stroke.

As it turns out, the study found lifestyle changes to be twice as affective as the medicine.

Twice as effective!! Keep that in mind when you read the possible side effects of Metformin:

Metformin may cause side effects. Tell your doctor if any of these symptoms are severe, do not go away, go away and come back, or do not begin for some time after you begin taking metformin:

• diarrhea
  
• bloating
  
• stomach pain
  
• gas
  
• constipation
  
• unpleasant metallic taste in mouth
  
• heartburn
  
• headache
  
• sneezing
  
• cough
  
• runny nose
  
• flushing of the skin
  
• nail changes
  
• muscle pain

Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them or those listed in the IMPORTANT WARNING section, call your doctor immediately:

• chest pain
  
• rash

Some female laboratory animals given high doses of metformin developed non-cancerous polyps (abnormal growths of tissue) in the uterus (womb). It is not known if metformin increases the risk of polyps in humans. Talk to your doctor about the risks of taking this medication.

Metformin may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

Just more evidence that exercise is good for nearly everything. The audio version of this story, available for free on the NPR website, has more detail than the printed version.

Preventing Diabetes: Small Changes Have Big Payoff by Allison Aubrey
Diabetes Prevention Program Study Repository
Medline Plus: Metformin

Disease Smells

This short National Geographic video here shows how dogs can smell certain diseases and can be trained to help those in need. One researcher in the video talks about how one day we humans might even be able to use the dogs' sniffing skills to diagnose disease.

Chapter Four of the Huang Di Nei Jing had stated thousands of years ago that a medical diagnosis could be made or confirmed by the presence of certain smells, ones that humans can detect. According to the five phases theory:

In the five odours, the odour of liver is stink. (urine)

In the five odours, the odour of heart is scorching.

In the five odours, the odour of spleen is fragrance.

In the five odours, the odour of lung is stinking. (fishy)

In the five odours, the odour of kidney is rancid. (rotten)

The above was quoted from: Yellow Emperor's Canon of Internal Medicine by Wang Bing (Tang Dynasty), translated by Wu Liansheng and Wu Qi.

I've found that after I leave a patient in the room with the door closed, their distinctive smell is always much more noticeable when I come back. I've definitely smelled the scent of burnt or scorched, but I haven't yet encountered a person smelling like stink and urine during treatment. That's probably a good thing.

More About Sugar

That's a model of the Mormom temple in Salt Lake City, made with sugar cubes.

Most Americans eat too much sugar. We drink too much soda, eat too much ice cream, and ingest a huge amount of sugars from sources we might not suspect, like bread. Many commercially available pre-sliced breads (great for sandwiches!) have high-fructose corn syrup added as a softener and preservative.

The New York Times has a pretty good discussion of some of America's problems with sugar, corn syrup, obesity, soda and so on.

Here are some of the good parts:

Neither ordinary sugar — sucrose — nor high-fructose corn syrup contains any nutrients other than sweet calories, and both are added in prodigious amounts to beverages and many foods that offer few if any nutrients to compensate for their caloric input.

“What consumers need to do is cut down on both,” Dr. Jacobson said. “Sugary foods either add calories or replace other, more nutritious foods.”

The article gives first place to those who claim there's nothing really wrong with high fructose corn syrup, but ends with links to three studies showing the exact opposite:

“It is not surprising that several studies have found changes in circulating lipids when subjects eat high-fructose diets,” he wrote in an editorial in The American Journal of Clinical Nutrition in 2007. A study by Elizabeth J. Parks and colleagues at the University of Minnesota, for example, found that triglyceride levels rose when people consumed mixtures containing more fructose than glucose.

Another study, by nephrologists at the University of Florida, found that fructose consumption raised blood levels of uric acid, which can foster “metabolic syndrome,” a condition of insulin resistance and abdominal obesity associated with heart disease and diabetes.

And a study by Chi-Tang Ho, professor of food science at Rutgers University, found “astonishingly high” levels of substances called reactive carbonyls in 11 carbonated soft drinks. These molecules, which form when fructose and glucose are unbound, are believed to cause tissue damage. They are elevated in the blood of people with diabetes and linked to complications of the disease. Dr. Ho estimated that a can of soda has five times the concentration of reactive carbonyls found in the blood of an adult with diabetes.

Detroit Native Loses Over 250 Pounds at Chinese Weight-Loss Clinic with the Help of Acupuncture

Here is an interesting article from USA Today about obesity in China. The focal point of the article is Alonzo Bland, who won a year-long stay at the Aimin Fat Reduction Hospital, courtesy of China Connection, a firm that promotes medical tourism to China.

Side note: mixed in with the straight-ahead reporting is a curiously out-of-place bit of chest-beating propagandizing. Apparently China was "kept thin by poverty and communist policies in the 20th century" rather than rice farming and vegetable eating. It's even funnier when you consider the whole quote:

The once-slim Chinese nation, kept thin by poverty and communist policies in the 20th century, is now on the fast track to a U.S.-style obesity crisis.

Gee, who should we cheer for? The Chinese government, which has finally seen the light and unleashed capitalism, prosperity, and therefore obesity on the people? Or America? (still the world leader in something! Obesity, in this case)

To Learn More About Diabetes and Xiao Ke

Thank you all for following along with American Diabetes Month. As we've seen, diabetes is a huge public health problem with staggering economic repercussions. Fortunately, many of the more serious symptoms can be controlled with proper diet and exercise. One of the most important parts of managing any chronic disease is a positive outlook. If you live with diabetes, reach out to others in the same situation. Start a running club, share recipes, and do your best to be happy.

Here is a short list of some of the many resources out there for diabetic patients and health care practitioners:

Websites:

• American Diabetes Association
  
• Diabetes Mine
  
• Diabetic Recipes
  
• Tips on exercise for diabetics
  
  Books for patients:
  
• How Can Chinese Medicine Help My Diabetes?
  
• Controlling Diabetes Naturally with Chinese Medicine
  
  Books for health care practitioners:
  
• Practical Therapeutics of Traditional Chinese Medicine
  
• Treatment of Diabetes With Traditional Chinese Medicine
  
• Treatment of Diabetes Mellitus with Chinese Medicine
  
• Typical TCM Therapy for Diabetes

Xiao Ke - Lower

Lower Xiao Ke falls under the pattern Kidney Yin Depletion. Typical symptoms include frequent urination, copious turbid milky urine, dry mouth and lips, thirst, high fluid intake, weak aching lower back and knees, dizziness and vertigo, blurred vision and red cheeks. The tongue is small and red with little coating, the pulse is deep, rapid and thready. The treatment method is to nourish kidney yin.

The prescription for this pattern is the famous Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill).
Shu Di Huang 24g (prepared rehmannia)
Shan Zhu Yu 12g (cornus fruit)
Shan Yao 12g (dioscorea root)
Ze Xie 9g (alisma)
Mu Dan Pi 9g (moutan)
Fu Ling 9g (poria)

This prescription is easily modified for many different presentations. For deficiency heat, Huang Bai (phellodendron) and Zhi Mu (anemarrhenae) are added. For eye irritation, add Gou Qi Zi (goji) and Ju Hua (chrysanthemum).

Xiao Ke - Middle

The second basic pattern for Xiao Ke is Stomach Fire. People with this pattern diagnosis often have ravenous hunger with high food intake, dry stools or constipation and thirst. You might often get the feeling "if I don't eat soon I'll die!" The tongue has a yellow coating and the pulse is slippery and forceful. The treatment method is to clear the stomach, drain fire, nourish yin and generate liquid.

Prescription: Yu Nu Jian (Jade Lady Brew)
Shi Gao 30g (gypsum)
Shu Di Huang 15g (prepared rehmannia)
Mai Men Dong 12g (ophiopogon)
Zhi Mu 9g (anemarrhena)
Niu Xi 9g (achyranthis)
Huang Lian 6g (coptis)
Zhi Zi 9g (gardenia)

As we noted last week, this is only a basic pattern. Often patterns are combined and there are many different ways of treating Xiao Ke. Only a qualified TCM practitioner is eligible to diagnose and treat with Chinese herbs.

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.

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.

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.

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.

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.

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.

Dilled Mushroom Blintzes with Sour Cream

Below is a recipe I found on diabetic-recipes.com. 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:

3	cups (708 ml) skim milk or unsweetened almond milk

4	large eggs

1/2	teaspoon ( 2.5ml) salt (optional)

2	cups (250 g) unbleached flour

For the mushroom filling

2	teaspoons (10 ml) olive oil

2	cups, about 10 ounces (315 g), finely chopped onions

1 1/2

pounds (750 g) mixed fresh mushrooms, chopped coarsely

2	teaspoon minced garlic

5	tablespoons (15 g) chopped fresh dill

3-4	tablespoons (45-60 g) unbleached flour

freshly ground pepper, to taste

1/4	cup( 60 ml) Madeira or sherry

1/2 to 2/3

cup (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)

Wilford Brimley - Diabetes Dance Remix

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.

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.”

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.

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.