U.S. Cities Weigh in on Bad Diets and Obesity

Earlier this month Onlyourhealth.com spotlighted The New York Times coverage of how NYC is facing increased diabetes, but New York isn't the only city concerned with expanding waistlines. Consider these other recent reports from around the nation:

Study: Certain Diabetes Drugs Tied to Mortality

Jeff Minerd of MedPageToday writes about a study from the Jan. 17 issue of the Canadian Medical Association Journal that examined diabetic drugs Daibinese (chlorpropamine) and Orinase (tulbutomide).

Patients were placed into three groups. There were 120 who received a first-generation sulfonylurea, either Daibinese (chlorpropamine) or Orinase. A second group included 4,138 who received Diabeta (glyburide), and the third group included 1,537 who received the non-sulfonylurea drug metformin, which improves insulin sensitivity.

Each of these groups was further divided into a high-dose or low-dose group, with the median daily dose serving as the dividing line.

Participants were followed until death or termination of Saskatchewan Health coverage. Average follow up was about five years. The main outcomes were all-cause mortality and death from an acute ischemic event.

There were 1,503 deaths during the study period, of which 372 (about 25%) were attributable to an acute ischemic event. First-generation sulfonylurea users had the highest mortality (67.6 deaths per 1,000 person-years), compared with Diabeta users (61.4 deaths per 1,000 person-years) and metformin users (39.6 deaths per 1,000 person-years).

Compared with the low-dose patients, a greater risk of death was found in the high-dose patients receiving first-generation sulfonylureas (adjusted hazard ratio=2.1; 95% confidence interval=1.0-4.7) and Diabeta (HR=1.3; 95% CI= 1.2-1.4), but not metformin (HR=0.8; 95% CI=0.7-1.1).

The study also found an increased risk of death from ischemic event in the high-dose patients receiving first-generation sulfonylureas, though it was not statistically significant (HR=1.21; 95% CI=0.10-3.75). A significant association was found for Diabeta (HR=1.37; 95% CI=1.25-1.50). A slight and non-significant association was found for metformin (HR=1.10; 95% CI=0.75-1.30).

Asian-American Diabetes Trends Point to Diet

According to New York Times reporter Marc Santora the current diabetes epidemic is hitting the city's Asian population like a tsunami. The article warns that immigrants abandoning their traditional diets for typical American foods are at extremely high risk of developing diabetes. Santora explains:

Asians, especially those from Far Eastern nations like China, Korea and Japan, are acutely susceptible to Type 2 diabetes, the most common form of the disease and the subject of this series. They develop it at far lower weights than people of other races, studies show; at any weight, they are 60 percent more likely to get the disease than whites.

And that peril is compounded by recent immigrants' sudden collision with American culture. Many of them left places where factory and fieldwork was strenuous, televisions were rare and advertising was limited. They may speak little English and have poor access to medical care.

Many have never even heard of diabetes, much less the recent scientific studies showing that a Western diet, high in fat and sugar, puts them in danger of getting Type 2 diabetes, which has been linked to obesity and inactivity, as well as to heredity. (Type 1, which comprises only 5 percent to 10 percent of cases, is not associated with behavior, and is believed to stem almost entirely from genetic factors.)

Many recent Chinese immigrants have come from places where food was scarce, and experts say some view fat as a trophy of wealth and status. Their children try to fit into their new country by embracing its foods and its sedentary pastimes.

In Asia diabetes is so rare that many people have never heard of it, yet as the Times reports, we now know that many Asians have the genes to be highly susceptible to the disease. Of course, genes don't change much when people move to a new country, but diets certainly do.

In his book Eat to Live Dr. Fuhrman offers some insight in to why some Asians are facing severe shocks to their health when switching to the typical American diet:

The Chinese [living in China], who on the average consume more calories, are thinner than Americans.1 In China the calorie intake per kilogram of body weight is 30 percent higher than in the United States. The Chinese eat about 270 more calories per day than Americans, yet they are invariably thin. Exercise cannot fully explain this difference, as researchers discovered the same thing with Chinese office workers as well.

This may be because calories from carbohydrates are not as likely to increase body fat as the same number of calories from high-fat foods such as oils and meats, which make up such a high proportion of the American diet. The data suggests that when a very low fat diet is consumed (15 percent average dietary fat in rural China), as compared to the typical Western diet (30-45 percent of calories from fat), more calories are burned to convert carbohydrate in fat, so the body cannot store fat easily.

The modern American diet receives about 37 percent of its calories from fat, with lots of sugar and refined carbohydrates. The combination of high fat and high sugar is a metabolic disaster that causes weight gain, independent of the number of calories.

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Diabetes Funding Doesn't Focus on Long-Term Success

The New York Times coverage of the diabetic crisis in New York City continues with an alarming investigation into modern health insurance's coverage and treatment options for people living with diabetes. As the Times reports, most insurance companies do not focus on long-term treatment with intent to cure. Instead, the funding is directed to expensive procedures that address acute symptoms. Ultimately the patient remains sick and continues that way indefinitely.

Ian Urbina of The New York Times reports that in the treatment of diabetes, success often does not pay:

With much optimism, Beth Israel Medical Center in Manhattan opened its new diabetes center in March 1999. Miss America, Nicole Johnson Baker, herself a diabetic, showed up for promotional pictures, wearing her insulin pump.

In one photo, she posed with a man dressed as a giant foot - a comical if dark reminder of the roughly 2,000 largely avoidable diabetes-related amputations in New York City each year. Doctors, alarmed by the cost and rapid growth of the disease, were getting serious.

At four hospitals across the city, they set up centers that featured a new model of treatment. They would be boot camps for diabetics, who struggle daily to reduce the sugar levels in their blood. The centers would teach them to check those levels, count calories and exercise with discipline, while undergoing prolonged monitoring by teams of specialists.

But seven years later, even as the number of New Yorkers with Type 2 diabetes has nearly doubled, three of the four centers, including Beth Israel's, have closed.

They did not shut down because they had failed their patients. They closed because they had failed to make money. They were victims of the Byzantine world of American health care, in which the real profit is made not by controlling chronic diseases like diabetes but by treating their many complications.

Insurers, for example, will often refuse to pay $150 for a diabetic to see a podiatrist, who can help prevent foot ailments associated with the disease. Nearly all of them, though, cover amputations, which typically cost more than $30,000.

Patients have trouble securing a reimbursement for a $75 visit to the nutritionist who counsels them on controlling their diabetes. Insurers do not balk, however, at paying $315 for a single session of dialysis, which treats one of the disease's serious complications.

Dr. Fuhrman continually stresses that the best way to prevent, control, and eventually cure diseases like diabetes is through nutritional excellence (as described in his books) and exercise. Many of his diabetic patients are able to maintain excellent health without any medications--some of their stories are in Followhealthlife's Success Stories.

In the member center of Dr. Fuhrman.com, he recently talked to members about the importance of exercise for diabetics:

The most effective prescription for diabetes is exercise. An essential component of my prescription for diabetes is daily exercise; it is more important than daily medication. Two hundred calories a day of formal exercise on an incline treadmill and an elliptical machine are a great goal to shoot for. It is not an official recommendation of anyone except me.

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Reversing Diabetes: Harnessing the Power Within Ourselves

Janice S. Lehet discusses how Eat to Live changed her life (This story originally appeared on Dr.Fuhrman.com):

"There is no failure, except in no longer trying; no defeat, except from within; no insurmountable barrier, except our own inherent weakness of purpose." Anonymous

Four months ago, I was grossly overweight, had triglyceride and cholesterol levels of nearly 400, and received reports that my liver function tests exceeded the normal range by 25%. Experiencing numbness in my face and foot, I checked into the emergency room at a local hospital fearing that I might have been experiencing a stroke. I don't think I had a stroke since I was released after an overnight stay, but my admittance to Hunterdon Medical Center in 19126, New Jersey changed my life.

After ten years of knowing that I had diabetes, I had regressed to a position of taking three daily potent time release pills to manage my glucose levels in spite of my sincere efforts to manage the disease as carefully as possible. I found that as my pill intake increased so did my glucose levels. Still, my doctors continued to increase the medicine's dosage in spite of my discussions with them about articles in the New York Times and other publications revealing that the drug could potentially cause heart failure and kidney disease. One doctor dismissed the articles and touted the benefits of taking the drugs, again weighing such "benefits" against the deleterious effects of the disease.

The pills prescribed to lower my triglycerides and cholesterol levels ravaged my body with pain since I was among the small percentage of patients who cannot safely tolerate statin drugs. Still, the doctor who prescribed the drugs kept changing the prescriptions to other statins, which caused the same symptoms.

As I noted the drugs' potential side effects that I had read about on the Internet, my doctor at the time advised me, "Stay off the Internet. You need to take these or suffer the consequences." Then, he gave me several packets of Baycol. Of course, Baycol was removed from the market because of its serious side effects! Luckily, I had graciously taken the packets but never ingested them.

I don't believe that traditional doctors mean to overmedicate their patients. I believe that they do the best they can based on their training and current medical practices. Most doctors follow a specific path according to having always treated illnesses by medicating their patients. I must add in their favor that some modern medicines have prolonged the human life span even though medicines are not the "magic bullet" for all patients or all diseases.

I need to mention that I did try a nutritional approach to management throughout my bout with diabetes, and I committed myself fully to following the advice of those nutrition professionals. I now believe that I did not receive suitable or even accurate advice in both of the programs. My previous nutritionist kept telling me how "great" my diet was although my glucose average kept rising.

I believe I am an example that Type 2 diabetics can reverse their disease, but only the most courageous and innovative thinkers in the medical profession can help us free ourselves of medicine and direct us to healing our own bodies by eliminating the causes of the disease. I found such a doctor in Joel Fuhrman, M.D.!

Dr. Fuhrman, a board-certified family physician in private practice in New Jersey who specializes in preventing and reversing disease through nutritional and natural methods, had recently opened an office at the hospital's professional center, and I read about his work in reversing patients' diseases while I was waiting to leave the hospital.

In mid-June, I had my first appointment with Dr. Fuhrman who put me on a nutritional plan phasing in specific kinds of healthy foods, supplements and exercise as part of a program that worked wonders for me within a four month period. By July, I had lost 11 pounds. By August, I had lost 21 pounds and reduced my serum cholesterol to 180 and my glucose level to a thirty-day average of 110. Now, in October, my thirty-day average is 103. To date, I have lost 40 pounds and still plan to lose an additional ten since the plan is so easy to follow.

Under the guidance of this knowledgeable physician, I found that I had the power within myself to be healthy and diabetes free once again. The journey to restored good health took only four months under Dr. Fuhrman's direction.

I sincerely hope that my personal renaissance-my delivery to excellent health-will be an inspiration of hope to many other senior citizens and others who suffer from Type 11 diabetes, high triglycerides, high cholesterol, and/or potential liver or kidney failure or worse. At age 66, I am now in better health than I was twenty years ago since I no longer have diabetes, high serum cholesterol levels or high triglycerides, and I am medicine free.

At this writing, I find myself in excellent health once again. I feel great and look six dress sizes better-since I literally plummeted from a size 12 to a size 6 within the first three months under Dr. Fuhrman's care. Most important, is that I have enormous energy and can complete five miles of rigorous exercise on my tread mill within an hour with little effort each day. I feel better now than I did at age 50!

Dr. Fuhrman is one of our country's leading experts on nutrition and natural healing. I feel lucky to have discovered him. He has appeared on hundreds of radio and television shows including Good Morning America, CNN, Good Day NY, TV Food Network and many more. He has been interviewed for Esquire, Woman's World Magazine, Food and Wine, Ebony, Health Confidential, Mothering Magazine, Health Science, Bottom Line, and many others.

Dr. Fuhrman is committed to sharing his formula for successful diabetes reversal through this book, for diabetics, this is a "must own" publication. I can testify to that-by my "new" body, my flood of energy, my good health, and the knowledge I have gained that will help me control my own future health. I am a living example that Dr. Fuhrman's writings and practices are most effective!

A footnote: To those senior citizens who feel that it is too late to improve their health, I point them to Alexander Graham Bell who said,

"Sometimes we stare at a door that is closing that we see too late the one that is open."

A Tale of Two Cities: New York's Diabetic Dilemma

Continuing from yesterday's story, New York Times reporter N.R. Kleinfeld probes deeper into New York City's diabetic epicenter. In East Harlem diabetes is extremely common. The next neighborhood to the South, on the other hand, has one of the lowest rates in the city. As the article explains, culture and income drive important dietary differences:

A few things to notice. On Third Avenue, around the corner from the art shop, a banner outside McDonald's proclaimed, "$1 Menu." Down the way, plastered on Burger King, "New Enormous Omelet Sandwich. It's Huge." At KFC, a sign boasted, "Feed Your Family for Under $4 Each."
The art-shop gatherers sometimes talked about 96th Street, the tangible southern divide of a neighborhood and of a disease. Go north of 96th Street and you enter a constricted world laden with poverty. Go south and you find promise and riches, thin not fat, the difference between East Harlem and the Upper East Side, the difference between illness and health.
Go north and the chances of bumping into a diabetic are maybe 20 times greater than if you go south. For the Upper East Side, according to the health department, has the lowest prevalence in the city, about 1 percent.
In East Harlem, people sometimes have to choose between getting their diabetes medication and eating. They sometimes share their pills, cut them in half and take half-dosages. They improvise. Everywhere blare the signals that the best meal is the biggest meal.
Nutritious food exists, but it isn't easy to find. Dr. Carol R. Horowitz, an assistant professor at Mount Sinai School of Medicine, heads an East Harlem coalition trying to improve diabetes care. She oversaw a study several years ago that tracked the availability of diet soda, low-fat or fat-free milk, high-fiber bread, fresh fruit and fresh vegetables in food stores in East Harlem and the Upper East Side.
Stores on the Upper East Side were more than three times more likely than those in East Harlem to stock all five items. It did not seem to matter that East Harlem has more than twice as many food stores per capita as its wealthier neighbor to the south.

The plot thickens. Kleinfeld points out that a person's image also has a lot to do with their food selection. A resident of East Harlem comments:

"We've got cultural differences. Here, for a guy to eat a salad, he's a wimp. He'll eat a big portion of rice and beans and chicken. The women can't be chumps, either. A woman can eat a salad but has to eat it on the low. She has to do it quiet. They make fun of you: What are you, a rabbit?"

Diabetes Mine also has news that New York City recently announced plans to track people with diabetes.

For more of Dr. Fuhrman's thoughts about the diabetes epidemic, refer to New York City's Diabetes Epidemic from yesterday.

New York City's Diabetes Epidemic

One in twenty people has diabetes in this country, more than 16 million Americans. New York City in particular is quietly approaching a diabetes crisis. N.R. Kleinfield of the New York Times reports:

An estimated 800,000 adult New Yorkers - more than one in every eight - now have diabetes, and city health officials describe the problem as a bona fide epidemic. Diabetes is the only major disease in the city that is growing, both in the number of new cases and the number of people it kills. And it is growing quickly, even as other scourges like heart disease and cancers are stable or in decline.

The dangers of diabetes are twofold. Not only is the disease itself dangerous, but more than 70 percent of adults with Type II diabetes die of heart attacks and stroke. Kleinfield points out additional complications resulting from diabetes:

Diabetics are two to four times more likely than others to develop heart disease or have a stroke, and three times more likely to die of complications from flu or pneumonia, according to the Centers for Disease Control. Most diabetics suffer nervous-system damage and poor circulation, which can lead to amputations of toes, feet and entire legs; even a tiny cut on the foot can lead to gangrene because it will not be seen or felt.
Women with diabetes are at higher risk for complications in pregnancy, including miscarriages and birth defects. Men run a higher risk of impotence. Young adults have twice the chance of getting gum disease and losing teeth.

There is a simple explanation for instances of diabetes in New York City and the entire country. As our country's weight has risen, diabetes has increased accordingly. The worldwide explosion in diabetes parallels the increase in body weight. Kleinfield presents the factors attributed to climbing rates of diabetes in our sedentary nation:

  • An aging population
  • A food supply spiked with sugars and fats
  • A culture that promotes overeating and discourages exercise
  • In Dr. Fuhrman's book Eat to Live he outlines a vegetable-based, high-nutrient diet that is instrumental in preventing and reversing disease. For those already stricken with the disease he offers some dietary suggestions to help control its effects:

  • Refined starches such as white bread and pasta are particularly harmful; avoid them completely
  • Do not consume any fruit juice or dried fruits. Avoid all sweets, except fresh fruit in reasonable quantities. Two or three fruits for breakfast is fine, and one fruit after lunch and dinner is ideal. The best fruits are those with less sugar � grapefruit, oranges, kiwis, strawberries and other berries, melons, green apples
  • Avoid all oil. Raw nuts are permitted, but only one ounce or less
  • The name of your diet is the "greens and beans diet"; green vegetables and beans should make up most of your diet
  • Limit animal food intake to no more than two servings of fish weekly
  • Try to exercise regularly and consistently, like dispensing your medication. Do it on a regimented schedule, preferably twice daily. Walking upstairs is one of greatest exercises for weight loss
  • Check out this previous post for success stories about how how the Eat to Live diet can help defeat diabetes.

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    Pharmaceutical Rep Urges Healthy Diet Over Drugs

    Here's a great e-mail that recently came into Dr. Fuhrman's office:

    I just wanted to tell you that I've been eating primarily a vegan diet for the last seven months, with a lot of it being raw fruits and veggies.

    I have personally dropped ten pounds, and feel great. I really didn't need to lose this weight, but I am loving it! I am 5'2" and now weigh 112lbs. That being said, I workout almost everday so I am also a lot of muscle.

    Recently my HDL increased substatially as well, which is truly amazing. My fiance has lost over thirty pounds, and I am so proud of him!

    I also find your way of practicing medicine ideal. I am personally a pharmaceutical rep and promote a diabetic medicine. It is interesting to me the corelation between diabetes and eating. You would also be amazed at the offices I call on. When I order healthy, vegetarian lunches for offices, they complain that it's not some deep fried chicken choice! And these are the same people who are telling their patients to eat well.

    It's astonishing. I am constantly being picked on in these same offices for my dietary choices too! It's weird. This is the problem with our society today. It's easier for physicians to just throw medications at patients, rather then really consult with them about diet and exercise.

    That being said, those that do consult with these patients--a lot of the patients are not compliant. It's like asking an alcoholic to quit drinking. These behavioral patterns are embedded early into these patients.

    I want to tell you thank you for all the good work you do. If more people followed your advice, we would find Americans would be living much healthier, productive lives. Let's face it: diabetes and cancer are expensive! Seeing the typical diabetic will be on about six medicines, if not more!

    Thank you.