How diabetic women's pregnancy chances can be boosted

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Watching what you eat, exercising properly and ensuring adequate nutrition with a vitamin supplement which has adequate amounts of folic acid may improve chances of conception in diabetic women.

Women with diabetes face a special challenge-getting and then staying pregnant. Poor glucose control may create an environment where the high sugars prevent both conceiving as well as maintaining the pregnancy, Diabetic Living India reported.

Women who develop diabetes can be prone to developing other disorders such as thyroid disease or autoimmune premature ovarian failure.

Miscarriage rates among women with poorly controlled diabetes can be as high as 30 to 60 percent during that crucial first trimester of pregnancy. The risk of birth defects is also high, and also stems from uncontrolled blood sugar levels around the time of conception.

A baby’s brain, heart, kidneys and lungs form during the first eight weeks of pregnancy, therefore high blood glucose levels are especially harmful during this early stage.

The main diabetes complication, including gestational diabetes, related to pregnancy is macrosomia – or a big baby (higher than the 90th percentile in birth weight).

Women with Type 1 diabetes will require insulin before, during and after their pregnancy.

However, if a woman has type 2 diabetes then she will require oral medications with or without insulin to achieve appropriate control of your diabetes.

In order to enhance chances of delivering a healthy baby, diabetic women should work with health care team to get their blood glucose under control before getting pregnant.

More Evidence Ties Obesity to Disability in Older Women – WebMD

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Evidence Ties Obesity to Disability in Older Women

By Dennis Thompson

HealthDay Reporter

MONDAY, Nov. 11 (HealthDay News) — Women who are obese as they near retirement age have a higher risk of early death and may find their remaining years blighted by disability, researchers say.

Obese women are three to six times more likely to suffer a disability late in life that will make it difficult for them to get around, with the risk rising with their level of obesity, according to a new study published online Nov. 11 in JAMA Internal Medicine.

A second study in the same journal issue found that being overweight or obese raises your risk of heart attack and heart disease even if you are otherwise healthy.

The number of women aged 85 years and older in the United States is increasing, according to study background information, with 11.6 million women expected to reach 85 by 2050.

Obesity rates also continue to increase, and nearly one-third of U.S. women 75 years and older are obese. This extra weight not only reduces life span, but also can severely harm an older woman’s quality of life.

“For dying and losing the ability to walk, the risks were alarmingly high — over threefold to upwards of over sixfold,” said study co-author Eileen Rillamas-Sun, a staff scientist at the Fred Hutchinson Cancer Research Center, in Seattle. “I believe that remaining mobile is very important to most older people, especially since it is useful for retaining one’s independence.”

The new findings aren’t that surprising, but they’re important, one expert noted.

Together, the two studies “verify something that we knew, but give us some more ammunition to craft more programs and pay more attention to women’s body weight and obesity overall,” said Dr. Georges Benjamin, executive director of the American Public Health Association (APHA).

“The obesity epidemic isn’t just our kids, and if you are thinking forward we are having this enormous growth as the baby boomers age through society,” he said. “We’re going to have to spend a lot of time encouraging women to achieve a sensible body weight.”

Rillamas-Sun’s study examined the health records of nearly 37,000 older women participating in the Women’s Health Initiative, a long-term study sponsored by the U.S. National Institutes of Health.

The researchers found that about 12 percent of healthy-weight women had become disabled by age 85, requiring a walker or some other assistance for getting around.

By comparison, between 25 percent and 34 percent of obese women were disabled, with incidence rising with the patient’s body mass index (BMI), a measurement of body fat that takes height and weight into account.

Overall, a waist circumference greater than 35 inches was associated with a higher risk of early death, along with new diseases developing during the study period and mobility disability, the researchers said.

New diet to halt diabetes: Eating less meat and dairy can slash risk by half

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They discovered that animal products such as meat, cheese and egg yolks trigger stomach acids linked to the killer disease.

But most fruits, including lemons and oranges which are widely perceived as acidic, effectively knock out these acids before they can have a harmful effect on the body’s metabolism.

Study leader Dr Francoise Clavel-Chapelon said: “A diet rich in animal protein may favour net acid intake, while most fruits and ­vegetables form alkaline precursors that ­neutralise the acidity.

“Contrary to what is generally believed, most fruits such as peaches, apples, pears, bananas and even lemons and oranges actually reduce dietary acid load once the body has processed them.”

Acid load, or excess acid, can spark serious complications with the metabolic system. This in turn reduces the body’s ability to regulate its insulin levels, leading to diabetes.

Dr Clavel-Chapelon’s team at the Centre for Research in Epidemiology and Population Health in Paris studied tens of thousands of women volunteers over 14 years.

They found those with the most acidic diets were more likely to develop type 2 diabetes.

And, alarmingly, women whose potential renal acid load (Pral) scores were in the top 25 per cent had a 56 per cent greater risk of getting diabetes than those in the bottom 25 per cent.

Pral refers to the potential impact of certain foods on kidney and urine acid levels. Meats can have a Pral value as high as 13.2, cheeses 26.8 and fish 10.8.

Obesity Weekend Roundup, November 8, 2013 | Dr. Sharma's …

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As not everyone may have a chance during the week to read every post, here’s a roundup of last week’s posts:

Have a great Sunday! (or what is left of it)

@DrSharma
Edmonton, AB

Obesity Weekend Roundup, November 8, 2013, 10.0 out of 10 based on 1 rating

Posted by Arya M. Sharma, MD, at 7:00 AM   0 comments

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One-day diabetes awareness festival attracts hundreds

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AURANGABAD: Hundreds of people visited the ‘Madhumeha Anandnagari’ at the St Francis School ground here on Sunday. The event was aimed at creating awareness about diabetes and its complications and also to commemorate the World Diabetes Day on November 14.

Customized diet plans, diabetes management, sugar-free and oil-free cooking and a focus on effective detection of the disease in the early stages remained the crowd pullers at the fair, hosted by Udaan, a voluntary organisation working for the well-being of diabetic children.

The Anandnagari was inaugurated by television actor Anup Soni, along with deputy commissioner of police (zone-II) Arvind Chawria. The duo appealed to the people to take preventive measures before the lifestyle disease starts taking a toll on the health.

Noted chef Archana Atre from Mumbai gave a demo of over 10 oil-free and sugar-free nutritional dishes that could be easily cooked. The recipe books of the same were distributed by Udaan.

Chawria said, “I am a diabetic for about eight years. Initially I was reluctant in accepting it but gradually I brought the required discipline in my lifestyle and diet. Now, having a disciplined schedule makes me feel fitter than any of my non-diabetic colleagues.”

“The aim of the festival is to erase the fear of diabetes from the minds of people and create awareness in a joyful way to lead a healthy life. The focus of the fair is on detection of diabetes as early as possible and proper management for patients. There are stalls providing guidance on every aspect associated with it like a heart kiosk, exercise kiosk, etc,” said diabetologist Archana Sarda.

Sarda added that it was an attempt to spread awareness about the disease, which is fast spreading among the younger population and appealed to both the diabetics as well as non-diabetics to maintain a healthy lifestyle as cases of diabetes has been reported even in six-month-old babies.

Services such as measurement of blood glucose, blood pressure and body fat percentage, estimation of heart attack and stroke risk for diabetics, ECG, eye examination to detect diabetic retinopathy, were kept open at the fair. Street plays, games, tattoo making, bioscope watching, etc, were also arranged for visitors.

To bring awareness about the lifestyle disease, Udaan has conducted essay writing competitions on ‘Role of children and youth to control diabetes’ and ‘My dream – Diabetes-free India’ in about 140 schools, and around 300 students participated in the contest. Actor Soni judged the street plays for college students and awarded the best five winners.

“Often, people don’t realise the severity of diabetes and leave treatment after two or three months of the diagnosis, exposing themselves to various life threatening diseases. Diabetes is a lifestyle disorder, and stressful life together with unhealthy living is a major factor behind the huge diabetic population we have in our country,” Sarda said.

Obesity May Increase Risk for Clostridium difficile Infection — AAFP …

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Inflammatory bowel disease (IBD) previously has been identified as an independent risk factor for C. difficile colonization and disease, as has use of antibacterial drugs — a relationship that appears to be modulated by a dysbiosis of intestinal microbiota. Recently, studies have shown that obesity also may be associated with decreased diversity and changes in composition of the intestinal microbiome, which could translate into a similar risk profile.

The current retrospective analysis looked at 132 cases gleaned from infection control database records, microbiology results and medical records of adult patients at a medical center who had laboratory-confirmed CDI from November 2011 to April 2012. By comparing a relatively low-risk group of patients with CDI to those with more traditional risk factors for the disease, such as exposure to health care facilities, antibacterial drug use and IBD, the researchers were able to identify an association between obesity and CDI.

Prevalence and Epidemiology

According to the CDC, CDIs cause about 14,000 deaths each year, and the annual number of hospital discharge diagnoses of CDI has doubled during the past decade, rising from about 139,000 to 336,600.

In addition, the epidemiology of CDI has shifted during that time, with an increasing number of cases that originate in the community being seen in traditionally low-risk populations. This shift has sparked concerns that unidentified risk factors may be increasing the likelihood of contracting CDI in this population subset.

The study’s authors note that before 2010, guidelines developed by the Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America (SHEA-IDSA) defined CDIs as “having community onset (CO) or inpatient health care facility onset (HO).” In recognition of the changing epidemiology of CDI, that definition was expanded in a 2010 guideline update to include an additional category of disease: community-onset health care facility-associated (CO-HCFA). This category refers to CDI cases that occur among patients in the community who had exposure to health care facilities during the previous four weeks.

For the purposes of this study, hemodialysis centers, day surgery centers, chemotherapy suites and long-term care facilities, in addition to traditional inpatient facilities, were grouped under the “health care facility” designation.

Study Specifics

The chief goal of the study, according to researchers, was to pinpoint potential demographic and risk factor differences between patients who develop CO CDIs and those with HO or CO-HCFA infections. “In particular,” they said, “we examine whether obesity is overrepresented in patients with community-onset infections who did not have exposure to health care facilities, antibacterial drugs or the diagnosis of IBD.”

In addition, the researchers noted, identifying the specific health care delivery sites represented among patients with CO-HCFA infections could facilitate targeted staff training and education, as well as improved allocation of infection control resources.

Using the former SHEA-IDSA classification, the 132 patients shown to have lab-confirmed CDI were categorized as having either community or nosocomial onset disease. Patients then were reclassified according to the new SHEA-IDSA guidelines as having CO, CO-HCFA or HO disease.

Initially, 91 cases were counted as CO disease, and 41 were determined to be HO disease. By using the definitions described in 2010, 35.2 percent of the CO cases were found to be HCFA-CO. Of these, 62.5 percent had a prior hospital admission as a risk factor, and 28.1 percent were from a long-term care facility. Other risk factors (accounting for those with more than one risk factor) included recent surgery (12.5 percent), hemodialysis (9.4 percent) and outpatient chemotherapy (3.4 percent).

Additional Study Findings

Univariate analysis testing for differences across the three groups revealed lower percentages of patients with IBD in the HO and CO-HCFA categories compared with the CO group. A higher percentage of patients in the CO category were noted to be obese; in fact, the percentage of patients in the CO group who were obese (34 percent) was statistically higher than the state average (23 percent). HO cases were more likely to have had previous exposure to antibacterial drugs compared with the CO and CO-HCFA groups.

“Patients with community onset infections had higher body mass indices than the general population, and those with community onset after exposure to a health care facility had higher rates of IBD and lower prior antibacterial drug exposure than patients who had CDI onset in a health care facility,” the researchers wrote. “Obesity may be associated with CDI, independent of antibacterial drug or health care exposures.”

Let's link hands against diabetes

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A 68-year old Mrs. S. developed high fever and had to be hospitalised since her blood sugars were very high. With no personal income or medical insurance, she had to depend on her son for paying hospital expenses for which he was not too willing.

Mr. S, 58, a watchman in a company, developed fever and infection in the foot. He had very high blood sugars and was hospitalised. Despite all efforts, his left leg had to be amputated and he had to use his entire savings which he had kept aside for his daughter’s wedding. This was a sad story of a man who lost his leg and his personal savings because he had diabetes, of which he was unaware. Innumerable are such pathetic cases.

Diabetes is one of the major health and development challenges of the 21st century. In India, it is estimated that around 62 million people have diabetes. One in two people with diabetes doesn’t know he/she has it. But diabetes and its complications are largely preventable, and proven, affordable interventions available. Everyone is concerned and everyone has a role to play in helping to turn the tide of diabetes to protect our future.

What can be done?

There are two major components of the burden of diabetes in India — genetic and environmental factors. Environmental factors such as physical inactivity and unhealthy diet pattern play an important role. There is an immediate need to seek the involvement of several stakeholders in prevention and control of diabetes.

To start with, the media plays a major role in not only creating awareness of the risk factors but also making policymakers and others focus on various avenues leading to a better living environment. The existing knowledge of prevention of diabetes can be disseminated to all with the help of the Ministry of Information and Broadcasting, NGOs and healthcare centres in both the private and public sectors.

Next, to put the knowledge into practice, it is necessary to create a conducive environment for the public to increase their physical activity. This needs earmarked funding for construction of parks, safe footpaths and cycle pathways.

In order to ensure healthy eating habits, retail shops, fast food outlets and chain restaurants should be encouraged to provide alternative healthy food choices. An additional tax could be levied on junk food. Regulation of pricing policy for fruits and vegetables is necessary.

The government should encourage small entrepreneurs to manufacture nutritious and palatable snacks for people belonging to different economic strata at an affordable cost. Agricultural research is also required for producing low glycemic cereals and grain. More operational research is necessary to develop strategies to reduce the burden of diabetes and its risk factors. Allocation of funds for such projects has to be given high priority by the funding agencies.

In order to help people with pre-existing diabetes, insurance companies should introduce policies which will cover both outpatient and hospitalisation costs.

This will help a large number of people in India with diabetes to have good control of their blood sugar levels and thus prevent dreadful complications.

Although various stakeholders are required to build the web of partnership for diabetes prevention, the most essential is individual commitment to a better living.

(The writer is Head and Chief Diabetologist, MV Hospital for Diabetes, and Prof. M Viswanathan Diabetes Research Centre, Chennai. Email: drvijay@mvdiabetes.com)

Beyond Obesity: Reframing Food Justice with Body Love by TC Duong

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Oakland has been at the forefront of what many would call the food justice movement – a movement to ensure that disenfranchised communities have power over they foods they produce, sell and eat.  Organizations like People’s Grocery have led the way in identifying the intersections between race, income and health.  Phat Beets Produce and City Slicker Farms have been innovators in community-led urban gardening.

Being in one of the centers of food justice work has been exciting but as someone who has also been involved in body acceptance movement, I find myself increasingly uncomfortable with the frame of obesity prevention as a justification some use to enter this great work.  Many groups doing this work have to apply for funding (such as Michelle Obama’s Let’s Move) that frames food access as obesity prevention.  Researcher Linda Bacon coined the term “Health at Every Size” to challenge ideas that weight loss is desirable for everyone and I wanted to think further about the impact of the framework of obesity prevention of food justice and communities of color.  That’s when I read Sonya Renee’s post  Weight Stigma in Diverse Populations.

Sonya-Renee-Taylor-2

By stating “Our society tells us fatness is not beautiful.  Blackness is historically, not beautiful.  So even while battling weight stigma and reclaiming size diversity as beautiful, the presence of Blackness complicates the narrative,” Sonya Renee names the very real intersection between marginalization of women of size and black women.  Performance Poet, Activist and transformational leader, Sonya Renee is a National and International poetry slam champion, published author, and change maker.  As the founder and CEO of the The Body is Not An Apology, she is working to promote an international movement focused on radical self love and body empowerment. I asked Sonya more about the impact of the obesity prevention frame on food justice work.  Her responses are eye opening.

There are a lot of well-meaning people trying to do right by their communities by working on “food justice.”  Does that have relevance to size acceptance and body love?  Where do you see the intersections?  

I think food justice absolutely has relevance to size acceptance and body love or what The Body is Not An Apology calls Radical Self Love.  Radical Self Love is about being an advocate for your own well-being, your body and then allowing that advocacy to demand those things that aid well-being.  Asking for healthy food and access to nutrition is without question an element of radical self-love.  Also, when we think about who has access to good grocery stores, nutritious choices in their communities; we must look at the ways body impacts that.  There is a racial aspect that must be named which is about what bodies are valued and cared for systemically and which we do not. Those observations lead us directly to the way we further disenfranchise bodies of color, fat bodies, poor bodies.  Food justice is about ensuring all bodies have access and autonomy over their bodies.

How do community activists combat the obesity frame in public health, especially related to black communities?  There’s some real dollars attached to doing food justice as “combating obesity.”

I think it is essential to talk about the intersections of discrimination.  Asking how is a framework that makes someone’s body “wrong” an act of public health? We must ask who benefits from a war against people’s bodies.  Does it benefit communities to be at war with their bodies?  Does it benefit large people to view their bodies as a thing they must fight?  If the benefit is not to the communities we serve then what makes the model a justice movement?  Given that there are actual health indicators that can be assessed without size and size actually is not valid indicator of health unto itself, it is completely possible to talk about health without pathologizing bodies.  I also challenge public health professionals to be honest about the mental health aspects of having society be at war with your body or teaching people to be at war with themselves which is the translation of “combating obesity.”  Anything that reinforces inequity, bigotry, prejudice or shame IS NOT a justice movement.  Food justice work that does not include dismantling weight stigma in my opinion is not a justice movement.

There’s a lot of momentum around promoting health in marginalized communities (i.e. Michelle Obama’s work) but with the frame of ending obesity.  What frame would you recommend using to address what are real problems of accessibility for food and recreation?

I often just sit with the idea that the “ending obesity” paradigm is actually saying “we want to end Fat People.”  There simply is no health promotion in that framework.  The Body is Not An Apology operates from the framework that says injustice starts in many ways from the inability to make peace with the body, our own and others.  From that premise, the issue of promoting health is not about the failure of the body but the failure of our society to protect and care for EVERY BODY equally and the ways in which we as individuals and communities have internalized that lack of care.  If we cared for each person in our society we would have those things that are required for basic human sustainability in all communities.  We would have grocery stores with affordable healthy options; we would have playgrounds and recreation in all communities.  If we did not have recreation due to community violence we would be addressing and healing community violence.  We would be ensuring our media replicated images of all members of society in nuanced, dynamic, psychological healthy ways.  If we were using an intersectional community care model we would be addressing the myriad ways we could better care for each other and for ourselves.

How do we incorporate the historical analysis of the commodification of black bodies into our work as food justice advocates?

Understanding the commodification of black bodies helps understand why there is little investment in our community’s well-being and health.  I think it would also help black people understand how their demand to be treated humanely via Food Justice is as vital as the Civil Rights movement, abolition movement etc.  The value of black bodies was directly tied to unpaid labor.  When that unpaid labor was no longer a resource, we saw a complete divestment in the lives of black people.  Now that the commodification of black bodies comes via the criminal justice system there is an absolute necessity to foster the disrepair of black communities. The commodification depends on us growing up in such a way that increases our likelihood of engaging in criminal activity.  That is shown time and again to be directly tied to poverty and not having one’s basic needs met.  Food justice is about ensuring that all communities have their basic needs met so that they might thrive. The treatment of people in such communities is an illustration of the difference between commodifying bodies and valuing bodies. Food Justice is about demanding our bodies be valued!

Finally, how do we make the shift from shame and blame to love?

The question I ask that gets me to the answer of that question is always about who does blame and shame serve?  How does blame and shame make a world that creates positivity and possibility?  I reject the notion that there is some way that my body can be wrong.  And if there is nothing wrong with my body then there is no place for blame or shame.  From this space I can focus on how I can better LOVE my body and how I can better advocate that the world support me, my family, and my community in growing that love.

Written and Posted with permission from TC Duong

Thanks to TC for allowing us to share this wonderful article!  —First Read and Found on Oakland Local —

Nutrition and obesity studies may overstate results, warn researchers

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Many studies focusing on obesity and nutrition may overstate conclusions of their findings, which may lead to policy makers and other researchers basing decisions on inaccurate assumptions, according to new research.

The study, published in the American Journal of Preventive Medicine,  suggests that around one in 11 publications on nutrition and obesity in leading journals may overstate the results of their research findings – such as inappropriately describing a correlation as a cause-and-effect relationship and generalising a study’s claims to large groups of people even when the study population was quite different.

“This is troubling because such statements likely influence policymakers, clinicians, other researchers, and the public into making decisions without an accurate understanding of the supporting science, which may have unjustified costs,” said the research team – led by Professor Nir Menachemi from the University of Alabama at Birmingham in the US.

“They also have the potential to be amplified and disseminated to a larger audience when they are reported by journalists, who are a key source for public information about scientific discoveries,” said the team. “Given that, by and large, journalists dutifully convey the claims made in scientific papers, overstatement of results poses a concern.”

According to the results of the study, public health journals had a ‘significantly higher’ prevalence of publishing overreaching statements when compared to medical, nutrition, and obesity journals, “especially with respect to reporting associative relationships as causal or making policy recommendations based on observational data.”

Study details

Menachemi and colleagues tracked how often authors overreached in the summary of their findings by searching research articles published in eight leading journals in either 2001 or 2011, in order to examine changes in reporting over time. The team found 937 papers—377 from 2001 and 560 from 2011.

In 8.9% (around one in 11) of the studies, the team reported that findings had been overstated in the abstract – with studies from 2011 more likely to overreach than 2001 papers. 

Overreaching statements were also found to be more common in unfunded studies compared to funded studies, regardless of what type of group paid for the study; while a higher number of co-authors was also associated with a reduced likelihood of presenting overreaching statements.

“This trend may be because funded researchers are selected for superior knowledge or skills; have greater resources (as a result of their funding); or are subject to oversight from the funding agency, all of which may translate into a more straightforward presentation of their scientific work,” wrote Menachemi and colleagues.

Although those overstatements may be unintentional, they can distort what doctors, policymakers, and the general public know about nutrition, the researchers said.

The team noted that their work is an extension of a project originally funded by The Coca Cola Company, but noted that the Company had no role in the design, execution, or reporting of the current study.

Source: American Journal of Preventive Medicine
Volume 45, Issue 5, November 2013, Pages 615–621, doi: 10.1016/j.amepre.2013.06.019

” Overstatement of Results in the Nutrition and Obesity Peer-Reviewed Literature”
Authors: Nir Menachemi, Gabriel Tajeu, Bisakha Sen, et al