Monthly Archives: May 2017

How To Keep Us Happy During This Summer

Does the summer sun have you feeling extra thirsty? Me, too. When I’m thirsty, I want to choose something that’s refreshing and hydrating, but with so many different beverage options, it’s difficult to know what the healthiest selection is. Let’s navigate the sea of beverage choices that are available for you and your child.

Gold Medal Winner: Water

Water itself may sound like a boring and obvious choice, but its benefits are insurmountable. Water restores the fluids in your body that are lost through metabolism, excretion (sweating) and breathing. One of water’s most important jobs is to cool the body. During the summer months, your body requires more replacement fluids and cooling methods than at other times throughout the year. The cool thing is, your body could live off water alone (and food, of course), but no other beverages are really necessary to survive and thrive. Another benefit of water is that it’s virtually costless. Imagine how much you could save not buying that daily high-end coffee drink or not stopping by the vending machine for your afternoon sugar kick.

I always encourage parents to continue to provide and promote water even if their child doesn’t care for it. It’s so important to the body that you just can’t go without it. Try adding fruit and herbs, like lemon, berries and mint, to make infused water. Kids can choose which add-ins they want to use to flavor the water and make their own creations. While you’re working on getting your kids to enjoy drinking more water, here are some other acceptable hydration options:

Close Runners-Up

  1. Sparkling waters: Choose sparkling waters that are naturally flavored.
  2. Unsweetened iced tea: Tea has been shown to have numerous health benefits due to its antioxidant content, and it can be a great form of hydration. There are a variety of teas to choose from, but note that decaffeinated tea will be more hydrating that caffeinated.
  3. Milk or unsweetened milk alternatives: Although milk doesn’t seem like the most hydrating drink of choice in the summer, it’s a beneficial beverage full of protein, calcium and vitamin D. White milk has a natural sugar that’s OK to include daily.
  4. Sugar-free drinks (in moderation): Choose sugar-free drinks as an enhancement to your daily water intake, but not as a complete replacement. Choose drinks sweetened with more natural artificial sweeteners, like Stevia.

Leave These Out of the Running

  1. Sugar-sweetened beverages, including soda pop, lemonade, fruit punch drinks and sweet tea: These drinks provide zero nutritional benefit. They increase the risk of weight gain and associated diseases.
  2. Juice: Surprised to find juice in this category? There’s little room for it in your child’s (or anyone else’s) diet. Recent guidelines from the American Academy of Pediatricsrecommend no juice for any children under 1 year old, and suggest limiting juice to a maximum of 4 to 8 ounces per day for toddlers through adolescents. All the nutrients you receive from juice, you can get from eating a serving of fruit. Therefore, juice is an unnecessary addition to a hydration plan. The serving of actual fruit will also provide you with dietary fiber, which keeps you full and helps control blood sugar spikes. When juice is made, even 100 percent juice or juicing yourself at home, the fiber is stripped from the juice and all you’re left with is sugar.
  3. Energy drinks: Much like pop and lemonade, energy drinks are a giant blood sugar spike just waiting to happen. Additionally, the caffeine is a stimulant and not recommended for children, especially the excessive amounts in energy drinks.
  4. Coffee drinks: In addition to the caffeine concern for children, coffee drinks are typically loaded with sugary syrups and high-fat milks, and potentially whipped cream on top. You may think you’re getting an afternoon pick-me-up with that delicious frozen drink, but really, you’re getting a mega-dose of sugar that will leave you feeling sluggish shortly after. A healthier choice (for adults or adolescents only) would be a hot or iced coffee with milk or a milk alternative added.

Many people don’t realize how many calories are in the above beverages. Most of these drinks are classified as “empty calories” because they provide no nutrients for your body. In addition, 100 percent of the calories come from sugar; therefore, they’re not appropriate choices to hydrate your body or to promote a healthy body weight. Take a look at this sample day below to learn just how much those sugar-sweetened beverages can add up:

  • Breakfast: medium iced-coffee drink with cream and sugar – 150 calories
  • Lunch: 12 ounces soda – 140 calories
  • Mid-afternoon: 16 ounces lemonade – 220 calories
  • Dinner: water – 0 calories
  • After baseball practice: 20-ounce sports drink – 130 calories

Total calories from beverages: 640 calories. This intake from what one may think is just a simple day would equal nearly 40 percent of a 10-year-old child’s daily energy needs – from beverages alone.

The Skinny on Sports Drinks

Sports drinks or electrolyte-containing beverages can be incorporated into a healthy hydration plan if your child is exercising for more than 60 minutes. When kids are highly active and burning calories, these fluid replacement drinks are beneficial due to the added carbohydrates and electrolytes. However, if physical activity is less than that time period, water is enough to hydrate and replace all fluid losses. Sports drinks add to daily calorie and sugar intake in a large amount, just as any other sugar-sweetened beverage does. One bottle of a typical, 20-ounce sports drink contains approximately 34 grams of sugar – which is more than the sugar content of a full-size candy bar (around 27 grams).

Satisfying Smoothies

Smoothies are a highly consumed beverage, particularly in the summer, and they are a great way to get in some fruit and veggie servings. However, commercial smoothies, either pre-bottled or from your local smoothie shop, often contain added sugars from juices, frozen yogurts, honey or other additives. One medium smoothie contains about 60 grams of sugar, much of which is added sugar. To create a healthier smoothie, try making one at home and use water or milk as your liquid in place of juice. You can always ask at the smoothie shop to swap out the juice and frozen yogurt for low-fat milk or unsweetened milk alternatives.

What Is Diabetic Retinopathy

There are plenty of complications that can arise from diabetes, but one you may not have considered is diabetic retinopathy. Without regular screening, diabetic retinopathycan lead to blindness.

“Diabetic retinopathy is an eye disease that affects the tissues in the back of the eye – called the retina – which process light and vision for the brain,” says Dr. Nancy Kunjukunju, a retina specialist at Krieger Eye Institute at LifeBridge Health in Baltimore. “High blood sugar levels can cause the retinal blood vessels to leak, swell, grow abnormally or be blocked. If that happens, the lack of normal blood and oxygen flow can cause a loss of tissue function that seriously affects vision.”

Among people who have had Type 1 diabetes for five years, 25 percent will develop diabetic retinopathy, Kunjukunju says. That number shoots up to 60 percent after 10 years. The numbers vary a bit more when you have Type 2 diabetes, but 53 percent of people who have had Type 2 diabetes for more than 10 years develop the disease. Many people with diabetic retinopathy are not aware that they have it, says Dr. Gregory Dodell, an assistant clinical professor of medicine, endocrinology, diabetes and bone disease at the Icahn School of Medicine at Mt. Sinai in New York.

The risk for diabetic retinopathy increases as you get older. You’re also at higher risk if you smoke. Of course, elevated blood sugar over an extended period leads to a higher risk for diabetic retinopathy as well.

“Other factors may also be high blood pressure, high cholesterol and kidney disease,” Kunjukunju says. “All of the different components of the body work together so when anything affects our blood vessels, including heart disease, our eyes can also be affected.”

A recently published study found a link between obstructive sleep apnea and diabetic retinopathy in patients who have Type 2 diabetes. However, when those patientsreceived continuous positive airway pressure treatment, or CPAP, they were less likely to develop retinopathy.

Having poor vision that makes you wear glasses or contacts has no connection to the development of diabetic retinopathy.

Many times, diabetic retinopathy has no symptoms until it’s too late – and that’s why regular eye exams are so important. “If diabetic retinopathy is not treated, symptoms can worsen, and eventually an individual may become blind,” Kunjukunju says.

Other times, symptoms like blurred vision, loss of color vision and floaters can occur. Other symptoms include spots, bleeding in the eye and an inability to see from the center of the eye. That’s the kind of vision you use when you are driving or reading, says Dr. Mark Goldfarb, an ophthalmologist with Advanced Eye Care in River Edge, New Jersey. If you haven’t already seen an eye doctor, make sure to do so when you have these kinds of symptoms.

The American Diabetes Association recommends that adults with Type 1 diabetes have an eye exam within five years of diabetes onset; people with Type 2 diabetes should have an exam at the time of diagnosis. Although someone with Type 2 diabetes may be newly diagnosed, that person could have been living with diabetes for as little as a month or as long as several years. That’s why an eye exam right after a diabetesdiagnosis is so important.

Even women who have diabetes and get pregnant or those who develop gestational diabetes while pregnant should be screened, Goldfarb recommends.

Although guidelines aren’t as clear on how often to return for an eye exam, Goldfarb generally advises returning once a year – although that will become more frequent if you’re diagnosed with diabetic retinopathy.

“I aim to ask patients during every office visit when their last ophthalmology evaluation was,” Dodell says. “Ideally, the ophthalmologist should be sending a note to the endocrinologist or primary care doctor regarding the office visit.”

During an exam for diabetic retinopathy, your eye doctor will dilate your eyes to see the back of the eye (the retina). He or she will look for abnormalities like swelling or the leaking or closing off of blood vessels. There are also newer imaging devices, like optical coherence tomography, that help eye doctors better view the back of your eye, Goldfarb says. These exams are also important to check for other eye problems that are more common when you have diabetes, such as glaucoma and cataracts.

When you see your eye doctor, be ready to share some of your recent blood sugar readings, Goldfarb says. This information can be helpful.

If you’re diagnosed with diabetic retinopathy, your eye doctor may tell you that you have nonproliferative diabetic retinopathy – which is an earlier stage of the disease – or proliferative diabetic retinopathy. With the latter, blood vessels become so damaged they close off, according to the American Diabetes Association. Then, newer but weaker blood vessels grow and leak blood, which can block your vision and potentially lead to the growth of scar tissue. Proliferative diabetic retinopathy can also lead to something called retinal detachment, and that can cause permanent vision loss, Goldfarb says.

Diabetic macular edema is a condition that can also develop when you have diabetic retinopathy. It involves swelling in the macula of the eye, according to the American Academy of Ophthalmology.

Treatment for diabetic retinopathy is most effective when it’s started early. Your eye doctor may perform laser treatments on the retinal blood vessels to help stop them from bleeding and leaking and to reduce swelling. There are also injections that can be made in the eye to slow or stop tissue damage.

Because many patients do not see an eye doctor regularly, there are efforts underway to increase the use of telemedicine to screen more patients for diabetic retinopathy. “This is fantastic, and I suspect will lead to better outcomes for patients,” Dodell says. However, telemedicine screenings can’t replace a full eye exam, Goldfarb believes.

The best way to reduce your risk for diabetic retinopathy is to keep your blood sugar under control and follow other healthy habits, like eating a balanced diet, exercising, not smoking and using your medications as prescribed. “If blood sugar levels are close to normal, an individual is less likely to be at risk,” Kunjukunju says.

Will You Die Because Of Broken Heart

Elderly married couples have been known to die within hours or days of each other. Doctors sometimes treat patients with heart attack-like symptoms who have come directly from a funeral. In other words, a figurative broken heart can actually lead to a literal broken heart.

It’s called stress-induced cardiomyopathy, and it’s one of the more perplexing disorders for cardiologists. “It’s a fascinating condition,” says Dr. Chintan Desai, a cardiovascular disease specialist at Northwestern Medicine Regional Medical Group in Illinois. “We see it in people who have suffered severe emotional distress – a widow at her husband’s funeral, hearing a child is in a bad accident.”

Doctors have not completely unraveled the causes of the condition, also called broken heart syndrome. The symptoms are similar to a heart attack but are caused by a distinct process. “Our understanding is it is caused from adrenaline and other hormones related to adrenaline,” Desai says. “Whether that’s the whole story or not is not completely understood.”

An article in the June 2017 issue of the journal Circulation notes that positive and surprising news in a person’s life can also trigger the syndrome. Think winning the lottery, or a son or daughter who comes home from war to surprise a parent. According to the article: “Recently it has been shown that [stress-related cardiomyopathy] can occur after a positive life event, hence the recently proposed term happy heart syndrome.”

Regardless of whether it’s triggered by good news or bad, stress-induced cardiomyopathy occurs when acute stress leads to heart muscle distress. The left ventrical, the heart’s main pumping chamber, becomes weak and balloons out, leaving the heart unable to pump enough blood. The condition, first named in Japan in 1990, was described as takotsubo cardiomyopathy because the enlarged left ventrical resembles a Japanese octopus trap called takotsubo.

Doctors say the condition, now often called takotsubo cardiomyopathy, is not uncommon. “We’ve all seen a bunch of them,” says Dr. Pamela S. Douglas, Ursula Geller Professor of Research in Cardiovascular Diseases in the Department of Medicine at Duke University and director of the Multimodality Imaging Program at Duke Clinical Research Institute. “It’s not as rare as you might think it is.”

More than 90 percent of cases occur in women ages 58 to 75, according to Harvard Women’s Health Watch, a publication of Harvard Medical School. Up to 5 percent of women evaluated for a possible heart attack actually have stress-related cardiomyopathy. Researchers believe older women are more vulnerable because of a drop in estrogen after menopause.

Symptoms of stress-related cardiomyopathy are almost identical to a heart attack – sudden chest pain and shortness of breath – but the process that causes the event is quite different.

In a typical heart attack, the heart can’t get enough oxygen and blood because one or more arteries that lead to the heart are blocked by plaque and cholesterol. This prevents the heart from pumping effectively. During stress-induced cardiomyopathy, the heart is also pumping incorrectly, but the arteries are open and healthy, with mild or negligible signs of coronary artery disease. Doctors believe that stress hormones, not clogged arteries, cause the heart to pump inadequately. “A surge in stress hormones stuns the heart and creates changes in blood flow,” Douglas says. “It makes the heart stop squeezing effectively.”

Broken heart syndrome is usually diagnosed in an emergency room because the patient needs urgent care.

An electrocardiogram, or EKG, which measures the heart’s electrical activity, will often show the same abnormalities for patients who are having a heart attack as it does for those suffering from broken heart syndrome. In order to rule out a heart attack, doctors take images of the heart using a test such as a diagnostic cardiac ultrasound. About 20 percent of patients who experience broken heart syndrome have heart failure, according to Harvard Women’s Health Watch.

Another significant difference between a heart attack and broken heart syndrome is that a person experiencing a stress-related heart event will not have the same risk factors as a heart-attack victim, such as high blood pressure and narrowed arteries, and will also present as healthy prior to the heart muscles weakening. Because of that, people who suffer from stress-related cardiomyopathy recover quickly as long as they survive the event. The heart generally returns to normal within several weeks. “By definition, it gets better and normalizes over time,” Desai says.

Stress-induced cardiomyopathy is treated with standard medications that treat heart failure and improve the heart’s contraction function. Examples are ACE inhibitors, which correct blood flow and decrease the heart’s workload; beta blockers, which slow heart rate and reduce blood pressure; and diuretics, which prevent fluids from collecting in the body.

Treatment is evolving as doctors learn more about the condition. And unlike a heart attack, if someone has had stress-induced cardiomyopathy, it’s unlikely to occur twice. “It’s possible that you may have broken heart syndrome again if you have another stressful event,” according to the Mayo Clinic’s website. “However, the odds of this happening are low.”

Ways to Avoid Diabetes Product Scams

You have diabetes, and it can be challenging to manage. You’re watching TV one night and there’s a commercial for a product that says it can cure all of your diabetes woes, magically lowering your blood sugar. You wonder: Should I order that?

The lure of products that may not do all that they claim is understandable when you have diabetes. But that doesn’t mean everything that’s said to help you will actually do so.

“The unfortunate fact is that living with diabetes is difficult,” says Brian Dunning, a Laguna Niguel, California-based science writer and director of the film “Principles of Curiosity,” which focuses on how to evaluate dubious claims. “People who have diabetesare always going to be on the lookout for ways to improve their situation. In some cases, they get desperate. And when there is desperation, unfortunately, there are always charlatans waiting to take advantage.”

Another reason that someone with diabetes may turn to products that are not medications is because they want to try something more natural, says endocrinologist Dr. Deena Adimoolam, an assistant professor of diabetes, endocrinology and bone disease at the Icahn School of Medicine at Mount Sinai in New York.

Products advertised for diabetes outside of medications can include – but aren’t limited to – supplements, herbs, juices, shakes, “miracle” pills or products said to quickly help diabetes complications like diabetic neuropathy. These products may claim to lower blood sugar, reduce weight, cure complications or stifle your appetite. There are also books that heavily promote specific plans for weight loss to cure diabetes but don’t have the evidence to back up what they say, Dunning says.

Generally speaking, the nutritional products mentioned above are not regulated by the U.S. Food and Drug Administration. The FDA is the federal government agency that requires rigorous clinical studies before it will approve medications and medical devices. The studies required by the FDA help to ensure a product is as safe as possible. Still, products not approved by the FDA may appeal to people with diabetes if they’re easy to obtain and at a lower cost, says nurse practitioner Stephen Ferrara, an associate dean of clinical affairs and assistant professor at the Columbia University School of Nursing in New York City.

Health products and supplements not backed by the FDA do not undergo the same rigorous studies, and because they are sold as supplements, their manufacturers can make claims not supported by scientific evidence, Ferrara says. Additionally, the ingredients in supplements or similar nutritional products may vary widely from brand to brand.

The FDA approval process tends to run very slow, so it’s not perfect, Ferrara says. However, he notes that it does help to prevent scam treatments in diabetes.

Although not all diabetes products that you see advertised will harm you – except maybe your wallet – they won’t necessarily help you, Dunning says. “Where they become a risk is when they replace actual medical treatment,” he says.

Here are four ways to help avoid diabetes product scams:

Talk to your health professional about any treatments you are considering. He or she can help separate science from marketing hype. “Diabetes is a medical condition. When your car breaks down, you don’t take it to an accountant. When you have a medical problem, you need to seek medical care,” Dunning says.

Sometimes, certain products that aren’t medications may have some benefit, says physician assistant Daryl Wein, author of “Type 2 Diabetes: The Owner’s Manual.” Wein practices in Oakdale, California, and also has Type 2 diabetes. For example, cinnamon may have a slight positive effect on lowering blood sugar. However, that doesn’t mean it’s enough to make any major investment. “If you want to eat more cinnamon, go for it, but don’t expect much benefit from it,” Wein says. Again, check with your health provider first.

Some herbs that are helpful for diabetes can be added in small quantities, Adimoolam says. “I recommend using them in addition to medication and lifestyle to help control diabetes,” she says.

Be wary of certain buzzwords. If a product says that it’s “breakthrough,” “revolutionary” or “clinically proven” (with no studies to back it up), think twice before you buy. “FDA authorized” or “FDA cleared” are other phrases you might read or hear, when there’s really no such thing, Wein says. “FDA approved” is what is used for a product approved by the FDA.

If a product says it has dozens or hundreds of uses, that’s another reason to be cautious, Wein says.

And just because a product says it’s natural doesn’t mean it’s beneficial for your health.

Dunning also adds what he says is the “king of all red flags”: the word “miracle.” “If you see it, you are being scammed, guaranteed,” he says.

Be skeptical of recommendations from friends and family. Just because a friend or family member touts a product, that doesn’t mean it’s scientifically effective or will work for your diabetes, Wein cautions.

Let your health professional know about anything you are using for your diabetes. “Providers need to be aware of all medications, supplements and alternative treatments so that we can properly adjust prescription medication accordingly, since it’s possible that blood sugar levels can improve with some supplements,” Ferrara says.

You can use the Dietary Supplement Label Database from the federal government’s National Institutes of Health to help obtain additional information about specific supplement brands. You can share and discuss information from that database with your health providers about products that you are using.

Additionally, you can check the FDA’s website to see if a particular product is approved for diabetes, Adimoolam suggests.