There exists today an unprecedented amount of medical information for people with diabetes
: the magazine you are holding, the Internet, television, radio-even billboard ads. We are inundated.
In addition to the uninterrupted wave of information, we also have far more treatment options at our disposal. Within my HMO, for instance, you will find practitioners of Chinese medicine, acupuncturists, hypnotists and doctors of osteopathy working side by side with MDs. Our health education center comprises not only the fundamental but the alternative as well. Meditation, yoga, herbal medicine and Chi Gong are but a few examples.
It is exciting to see patients viewed more holistically, and it is equally exciting to have so many choices.
But there is a downside.
Too much information and too many options can distract us from what's really important. It's easy to get caught up in the novelty of it all and take your eyes off the prize.
'What Ifs' Versus Facts?
I can't say for certain whether or not pesticide-treated foods or artificial sweeteners
will give you cancer. However, when I take into account the published research-as well as the large body of clinical experience involving the treatment of millions of individuals over a substantial period of time-I come to the conclusion that the benefits of including these foods easily outweigh any possible risks associated with their use.
That is to say, if eating more veggies and drinking diet sodas help you to lose body fat while gaining better control of your blood glucose, blood pressure and lipid levels, I'm all for it! Because we are certain that not controlling those risk factors will greatly increase your chances of developing micro- and macrovascular disease. And that will lead to end-stage complications such as heart attack, stroke, blindness, amputation
and kidney failure.
Don't get so caught up betting on the long shot that you ignore the odds-on favorite. You can take steps to reduce the aforementioned risks by utilizing farmers' markets or organic produce and washing your veggies well. Also, it is certainly okay to abstain from the use of artificial sweeteners if you so desire.
Gorilla Food and the Glycemic Index
If you find yourself arguing about whether green bananas have fewer calories than ripe bananas and worrying that carrots are full of sugar, you have again lost sight of what's important. The fact is, nobody eats green bananas. And overconsumption of carrots isn't to blame for obesity, nor is it a risk factor for vascular disease.
Smoking, inactivity, fatty animal foods, large portions, nutrient-sparse and calorie-dense "junk" foods-these are the things that matter! Focus on lifestyle changes that will give you the most "bang" for your buck. Don't get caught up in the minutiae.
On a different note, stress is a known risk factor for macrovascular disease. Stressing out about whether to eat carrots or green bananas while you remain sedentary, eat too many calories and smoke cigarettes will almost certainly kill you.
'Drugs Are Bad, Herbs Are Good'
I can understand a person's reluctance to take prescription medications. Prescribing errors, side effects and drug-related injuries are real. Because such events are heavily publicized when they do occur, people have a tendency to be fearful of drugs.
What I can't understand is how the same person who is so suspicious of prescription drugs can be so cavalier when it comes to herbal supplements
. Many people will happily ingest any over-the-counter (OTC) herbal remedy based solely on a claim they heard from a friend or read in their weekly alternative newspaper.
There are far more unknowns in the case of self-administered herbs and supplements than in prescription drugs. Not only are the risks involved in taking OTC products typically more uncertain, but the purported benefits of such products are equally dubious. How can the benefits outweigh the risks when no significant, measurable or reliable benefits have been documented?
Bad Drugs or Bad Monitoring?
Sure, prescription medications are potentially harmful. This is why they are prescribed by physicians, who then monitor and follow the patients taking the drugs. Ongoing lab tests, self-monitoring of blood glucose or blood pressure, and frequent follow-up visits are how it's typically done. This monitoring minimizes the risks associated with the use of prescription drugs. Therein lies a major advantage of pharmaceuticals: knowing the dangers ahead of time.
Still, the biggest advantage prescription drugs have over the OTC remedies is that the drugs have actually been shown to work-and not just in theory, in a test tube mode or in rodents. Studies have demonstrated that the drugs help prevent or postpone end-stage complications associ-ated with diabetes.
Drugs help to control blood glucose, blood pressure and lipids. Fur-ther, researchers have shown that the "statin" cholesterol
-lowering drugs and the ACE inhibitors have a salutary effect in the context of preventing heart and kidney disease. Even OTC aspirin has demonstrated efficacy in this regard. People simply have better outcomes when taking the medications, and people with diabetes appear to derive the most benefit from treatment.
Will every drug be right for you? Perhaps not, but neither is every herbal medicine or alternative therapy. In the case of the pharmaceuticals, however, your doctor may believe that the benefits of trying the medi-cations easily outweigh the risks incurred from not controlling those cardiovascular disease risk factors.
The Frustration of Hopes
The trace mineral chromium is involved in the "glucose tolerance factor" complex. Some have therefore theorized that it can improve insulin
receptor sensitivity when taken in supplement form. People also take chromium in the hope that it will help them lose weight and lower their cholesterol. The research on chromium supplementation has been mixed, but the consensus is that chromium is not a terribly efficacious glucose-lowering agent.
Some will still argue that chromium doesn't hurt, it may help, and it's inexpensive to boot-so why not try it? That logic may work in the case of chromium, a fairly well-studied nutrient that has a good safety record when taken in appropriate amounts. But if you take such an indiscriminate stance with some of the more esoteric supplements coming down the pike, you may find yourself in trouble. Exercise
-Free and Proven Effective
Of course, the real shame in all of this is that the time and energy spent researching, debating and purchasing chromium could have been spent exercising.
Exercise is a much more reliable and powerful insulin sensitizer than chromium could ever hope to be. Exercise has a favorable impact on nearly every other risk factor for vascular disease as well. The same cannot be said for chromium.
However uninspired and low-tech it may be, exercise works.
Many alternative therapies do work, and I encourage you to become informed and consider all your options. Just don't do so at the expense of ignoring the cornerstones of diabetes care.
Ask yourself whether you are spending adequate time and energy on the basics before pursuing the "cutting edge." These tried-and-true therapies really do improve outcomes.
Here are the real cornerstones of diabetes care:
• Monitoring (self-monitoring of blood glucose, blood and urine labs, foot exam, eye exam, blood pressure checks, and so on)
• Stress management/Behavioral health
Ron Zacker is currently attending graduate school at Marquette University. He would like to thank Karen Lovvorn, RN, CDE, and Jerry Minkoff, MD, endocrinology
and metabolism, for the years of mentoring they provided while he was employed as a diabetes care manager with Kaiser Permanente. n