This morning, I listened to music while I was cleaning the house, after months of neglect. It was Ludwig van Beethoven’s string quartet op. 131. I can’t help myself but I always think about Beethoven as writing street music: A piper comes around the corner, creating excitement. A military band is heard from afar, then is coming nearer – the brass glittering in the sun, and the tune tickling the ear of little Ludwig. Coarse pub music lures with a rhythm that makes your feet stamp. A hurdy-gurdy man takes your penny and plays an ear worm that won’t leave your head for weeks to come – or never (Beethoven wrote this late in life). None of Beethoven’s music seems to show the street influence better than this quartet, if you ask me – and I am not an expert, just a listener. And then, in some passages, the street music stops, and you hear all the longing for a better life in young Ludwig’s soul. For all these reasons, I think LvB still speaks to us. At least to me.
But that was not even what I wanted to talk about. Yesterday, it seems to be official now, my diabetes book (as my part as the writer is concerned) was finished, as per today I am not allowed to make any more changes. The book is supposed to come out in August – initially as a “direct mail” product from Rodale’s, my publisher. It will take a full year before they will release it as a paperback and will show up in stores. Of course, it is available at Rodale's before.
I am exhausted, clearly. And elated. I have an idea for (and the first pages of) a new book, but I am not sure I still have the strength to go through with it. Give me a few days to recover – and to clean up the house!
Another thing that happened today: With a friend, I spend the morning in the garden, trying to kill a bamboo that had sprung – and burst – the pot we had planted it in about two years ago. Or, I have to say, my friend worked and I talked – that’s probably the more truthful description of our endeavor. My family were in love with the bamboo at one time – until I noticed new strong shoots coming out beyond the circumference of the pot. My worst fears have come true: We followed one of the roots three yards into the lawn! Remember, I already have a beautiful wisteria that is crisscrossing my perennial bed with shoots thirty yards long (no lie!), and pachysandra that’s my bane, and wormwood that creeps deeper and deeper into my flowers. – That’s why the bamboo has to go – and don’t tell me, after you fall in love with a bamboo that I didn’t warn you! And, of course, I will plant one root in a pot on the terrace because I don't want to live without the beauty of bamboo. Read More
Blog: On Health. On Writing. On Life. On Everything.
龙年快乐Happy Dragon Year 2012!
January 23, 2012
The Chinese New Year begins today – time for miscellaneous thoughts and new resolutions! 龙年快乐 read character by character, means “dragon year happy happy” – pronounced long nian kuai le. What I find fascinating is that both “happy” terms are spoken with a down tone. In my ear that double happy-happy sounds less than a Western easygoing, lucky-feeling happy but grimly determined: You better be happy – or else! I might be over-stating it, but to me the Chinese kuai! le! shows perfectly the difference in the Chinese approach to ours: We expect happiness, well, to “happen”, for instance in a relationship. The Chinese know it is hard work … Just finished the Scripps Conference on Natural Supplements here in San Diego – taking advantage to me being right here in California (for only another week now!). Here are some thoughts I am carrying home from that wonderful conference: • Listening to the results of modern science (the conference was for physicians and health practitioners and the talks were evidence-based – using modern science; no touchy-feely mumbo-jumbo). It seems, my thoughts on health have well held up during those many years I am thinking about what our bodies and souls need. The only point where I am more radical is in fat consumption: Most health practitioners are still fat-phobic. I am not talking bacon dripping fat, ice cream and cream puffs here – I am talking olive oil, coconut oil, fish oil, and never say no! if somebody puts foie gras on your plate – it doesn’t happen that often! - George Bernard Shaw (1856 to 1950) had this to say: “No diet will remove all the fat from your body because the brain is entirely fat. Without a brain, you might look good, but all you could do is run for public office“. • Let’s correct that touchy-feely part: Turns out, we alternative practitioners know that body and soul belong together, and at the conference there was a healthy amount of hugging, laughter and tears going on. Because if one thing has become clear – through our old failings and brand-new science: One can’t go it alone. As a physician, I need like-minded colleagues; as a fat person, you need friends, family, community around you to make a dent in your weight – or whatever health problem you are tackling in the moment. • Obesity is a good guess of mine because, firstly, now more than a quarter of Americans are grossly overweight – half are only overweight - and all conditions that physicians usually label as single diseases are coming together: heart disease, diabetes, depression, arthritis, obesity (Mark Hyman called it aptly “diabesity”), cancer – they are ALL ONE, namely a wrong lifestyle. Wrong food, heavily subsidized and advertised by your own government, with your own tax dollars. Time to take matters into your hands and “own your health”! “Own Your Health”, of course, is the title of Roanne Weisman’s book about alternative medicine. She wrote it after overcoming a stroke with the help of many different alternatives, after mainstream medicine had told her she would stay disabled and had to adjust to it. Boy, were they wrong! • The old excuse that it is “all in the genes” cannot be used anymore. Yes, a lot of your weight might be determined by your genes – but only if you allow it to be so. The new science of epigenetics teaches us that genes can be switched on and be switched on – and guess, who does the switching? Your food does it, and you moving your butt around, that does it. Isn’t it marvelous? • It takes a village to raise a child – you have heard it. It also takes a village, or a tribe, or your church group to change your health habits. Line up with a friend to start walking during lunch hour – five minutes in one direction, five minutes back. And be part of the solution, not the problem: Whenever you bring cookies or brownies or a potluck – don’t go to the old recipes! Explore new options without sugar, dairy, white starches. I always see that deviled eggs are the favorite of everybody – and they is nothing wrong with eggs, especially if the are organic, from free-walking hens. Bring cooked greens with olive oil and garlic, pepper and salt – they are delicious cold or hot! Educate your friends – don’t give in to their sugar-icing cravings! They will thank you. • If we would not eat alone and always at a table (not in the car, not in front of TV, not in bed), we likely would be slimmer. In olden times, if you grabbed the biggest piece of meat, your mom would slap you and say: “Don’t be greedy!” If you asked for your fifth pancake, your grandma would say sharply: “Now is enough, dear!” And since nobody catered to their little hurt feelings, children found home less congenial than the outside and their friends. We always asked if we could go “outside” – whatever it was, it was not inside with the parents (your parents made you uncomfortable because they always wanted to prepared you for life), and it was not in front of TV, computer or game boy. When I was a child, our first TV came with a key – whatever happened to THAT technology?? - and we children could not even turn it on when the grown-ups were out working. Of course, we children soon figured out that the key was kept in the bar, behind the bottles. But it was a high-risk gamble – and TV was never half as exciting as our friends outside. We had one fat girl in class, in all of my thirteen years of school. And that poor girl, we all pitied her – but we wouldn’t play with her. • “This body is not a home but an inn, and that only briefly.” Seneca (4 BC to 65 AD) said that. I think we have to start talking about what is needed: That people take their own health in their hands. Your doctors can only assist you – not do the work for you. So let’s start by calling fat “fat” – no more pussyfooting around it; physicians have long enough colluded with patients and avoided the “F” word: “I won’t call you fat, if you stay my patient”. The health care system is falling apart under the burden of health care costs brought about by overweight people (don’t forget – I still am for a national health care system!), the Earth is brought down under the burden of too many people who consume too much, and all our wealth so far has brought us very little real happiness it seems – if we judge by how many people are on anti-depressants. • Bad news: Before you die of being overweight, the Earth might have died of pollution. Definitely, future generations – they are your kids, my kids, our kids and grandkids! – are in danger. Newborn babies have been found to have more than 200 industrial chemicals in their umbilical cord blood, right when they are born. The womb has not protected them. We are finding out the hard way that you can’t dump dirt there, and assume you are safe here. We all have only this one Earth – and do you want to be responsible for babies born with birth defects? Global warming is real – so is overpopulation and increasing environmental diseases. • And what do they mean by “natural supplements”? I am glad to report that they do not mean artificially manufactured vitamins or new-fangled molecules, but they promote (mostly – no industry is perfect!) clean, whole, fresh herbs preserved in a bottle of tincture or capsule as well as possible. And if you are waiting for that miracle pill that might do the work for you – dream on! Real health is work. And didn’t you know it: Being sick sucks much worse. Real health takes very little: A bit clean water, a few simple, fresh foods, a good night’s sleep – every night, a few herbs to treat little things early, abundance and walking and dancing and laughter with friends. Music, art, books. Ask more of this life just than a heavily mortgaged house, a car and a career! A happy, hard-working New Year to you! Read More
How to Measure Diabetes
July 21, 2010
In ancient times, diabetes was diagnosed by licking the urine of the patient. If it tasted sweet, a diagnosis of diabetes mellitus (“honeysweet flow”) was made. As a physician, I am glad we have advanced to better tests...
There are basically four different tests to diagnose diabetes (I am talking here mostly of type II):
• Spot blood sugar. Since sugars rise and fall depending what and when you ate, this is a very unreliable test.
• Fasting blood sugar. Does only take a bit of blood, is cheap and fast – but still can vary with what one ate the day before. However, if your fasting numbers are up consistently, you should pay attention!
• Oral Glucose Tolerance Test: a complicated procedure where one drinks an awfully sweet fluid before blood will be drawn in half-hour intervals to ascertain how fast the sugar load is cleared out. It’s complicated, and very time-consuming for the patient. I object of giving a patient a drink 75 to 100 gm of unpalatably sweet glucose solution – which can’t be healthy if there is a disease caused by sugar. My suspicion is that this test is still be used because doctors can bill the most for this.
• Glycosylated hemoglobin, also called A1c: An easy blood test that gives a rough average of your sugars through the last month. I like this one the best because the usual ups and downs of sugar are not interfering with the test, but going into the overall measuring. With frequent episodes of hypoglycemia (too low blood sugars), the test might come back falsely low or normal. In iron-deficiency, A1c are higher than they really are, suggesting diabetes where there might be none. Every time one eats sugar, it “glycosylates” (adding a sugar to the molecule) a protein on the surface of an erythrocytes (red blood cells), and the chemical process is never reversed as long as the blood cell lives. Red blood cells live about three months; blood we draw is always a mixture of very young cells, newly released into the bloodstream from the bone marrow, and older cells, soon to be discarded. Measuring blood glycosylation therefore represents a fair mirroring of recent sugar intake and over time, those numbers can be compared: A lower A1c means you have done something right lately.
In conventional medicine, A1c is called normal if it is below 6.0. A1c is measured in percent of how much of the blood is “sugared”. Starting at 6.1, you have diabetes. That in it itself is rather absurd: A little step upward from 5.9 to 6.0 does not give you diabetes – you had it coming all along. In Natural Medicine, we think that between 5.0 and 6.0, one has “latent” (developing) diabetes. Why that number of 6.0? Because if one would chose 5.0 as the cut-off point, most Americans would have to be diagnosed with the disease.
The Oral Glucose Tolerance Test is more sensitive to detect cases of diabetes – but only if the cut-off point for diabetes is set at 6.0 A1c.
Arbitrarily putting the number to 6.0 does not make a person healthier. In fact, at the date of diabetes diagnosis, I good proportion of patients have already end-organ failure, namely eye problems, kidney failure, neuropathy – to name a few.
Just looking around tells us that many people are overweight and have some of the telltale signs of diabetes: belly fat, scant hairs on arms and legs, rosy cheeks. One sign alone does not make the diagnosis – but several together gives me an idea. But one can be very overweight and never develop diabetes, because in order to get the disease, you have to have the genes AND an unfortunate lifestyle.
Don’t think that genes are an excuse. Because diabetes type II does not strike, if one lives frugally. For instance, after World War II in Europe, basically nobody had it (but people died in droves of tuberculosis then…). Ten years later, with ballooning economies and waistlines, diabetes was back.
But you don’t have to starve yourself, to heal diabetes. You need a mixture of moderate movement (walking, swimming, biking – or dancing; whatever you like) and a diet without sugars, white starches and bad fats.
In diabetes drug studies, diabetes often is called “controlled” if the blood sugar stays within the limits if 7.0 to 10.0 A1c. We can be sure that at those numbers the damage done by high sugars is continuing in the body. I personally favor an approach that does not “manage” the patient’s diabetes, but gets rid of it. And in many cases it can be done, with exercise, better nutrition – and determination on the patient’s side. Read More