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Type II Diabetes

Forty years ago, when I was a Physician Assistant Student with the Emory University program, the family practice group of students did our clinical year at the Medical Center in Columbus, Georgia with the family practice residents going through their training there. One of the teaching physicians was a specialist in endocrinology. I remember him telling us at that time, “if we can get type II Diabetics down to, or near, ideal body weight, they will not need any medication to control their diabetes, only diet and exercise control”.

I am now a retired Physician Assistant, but I still try to keep up with what is going on in the medical field. I recently read an article on written by Mitchel L. Zoler, PhD that says the same thing that we were told back then. The title of the article is “Primary Goal in Type II Diabetes Should Be Weight Loss”. His article states that if a Type II diabetic can lose 15% of their body weight, it would go a long way to maintaining control of their diabetes.

The basic problem with Type II diabetics is that with obesity comes insulin resistance. There is insulin available, but the resistance interferes with the insulin moving the sugar into the cells. Over time, the islet cells of the pancreas simply wear out, in layman’s terms. Then the patient has start insulin injections daily in order to control the blood sugar.

So, if you are a type II diabetic and don’t want to start taking insulin injections in the future, control your food intake, do your daily walk around the block, and lose the weight.

Metabolic Syndrome: As Deadly as Cancer

An Epidemic spreading across the United States is as deadly as cancer. Parkinson’s Disease, Lung Cancer, Colon Cancer, AIDS and other diseases make headlines, but Metabolic Syndrome receives little notice. Metabolic Syndrome increases the risk for stroke and heart attack, erectile dysfunction, type II diabetes, and some studies suggest that obesity, a prime factor in development of Metabolic Syndrome, increases the risk for colon and breast cancer.

“The Metabolic Syndrome is a newly recognized entity,” says Dr. A. O. Rifai, M.D., who specializes in hypertension, nephrology, and metabolic syndrome in Panama City, Florida, “and is as deadly as cancer for the following reasons. Cardiovascular disease is the number one killer in the United States, and hypertension is the number on cause of death worldwide, 12%. That means that for 12 out of 100 people who die in the world today hypertension is the number one risk factor, and the number on risk factor for hypertension is metabolic syndrome.”

Obesity, defined as a Body Mass Index (BMI) greater than 30, is calculated by using a BMI calculator that can be found on several web sites that can be found by a Google search. The higher the BMI above normal, the greater your risk for the metabolic syndrome. Lifestyle habits leading to obesity include unhealthy food choices combined with a general lack of fitness in adults and children.

“Metabolic Syndrome”, according to Dr. Rifai, “is a combination of interrelated conditions presenting as a disease process”. Those conditions are obesity, hypertension, high cholesterol and hign blood sugar, with obesity being the initiating factor.

Metabolic Syndrome ws less common in earlier generations because our grandparents and parents we more active. Today we drive everywhere, even short distances. We park near the door at the grocery store or mall rather than further out and walking. The foods we eat are much different such as fast foods, processed foods, high fructose corn syrup, trans-fats, and refined sugars. We now recognize their tendencies to cause illness and contribute to the metabolic syndrome.

“The luxuries of life have reduced our metabolic expenditures,” say Dr. Rifai, “causing metabolic syndrome to become a much more prevalent disease process. The luxuries of life combined with the newer foods have expressed themselves now. The body does not metabolize these food well.”

Treating the metabolic syndrome is complex and requires cooperative efforts between the health care provider and the patient.

“Treatment of the metabolic syndrome is an intense weight reduction lifestyle,” says Dr. Rifai. “If you tell me that I have high cholesterol, high blood pressure, and diabetes, and you are going to treat those, but I continue to eat anything I want, then we are not treating the metabolic syndrome, just the metabolic abnormalities. So, the treatment for metabolic syndrome is intense dietary and exercise intervention. The patient must do his or her part.”

A weight reduction lifestyle consists of two components, healthy eating to decrease calorie intake, combined with daily exercise to burn more calories. Taking in just 500 calories daily more than you burn will cause you to gain one pound per week.

Healthy eating means changing the types of food you eat. Eat more high volume, low calorie foods such as fresh fruits and vegetables, whole grains, protein and fiber rather than low volume high calorie foods such as fast food and desserts. At mealtime, control your portion size. A portion of meat, whether beef, pork, chicken, or fish, is three ounces, about the size of a deck of cards; a portion of vegetables is one cup, about the size of a tennis ball, and a portion of starchy vegetables like rice, potatoes and pasta is one-half cup, or about half the size of a tennis ball. Use a salad plate for your meal to help limit the portion size, and no second helpings. Use an APP like “My Fitness Pal” to track your food and exercise.

Read food labels. The label tells you the portion size, the number of calories in the portion, the number of calories from fat, protein, and carbohydrate, all information that is important if you are going to keep track of what you are taking in.

Taking in calories is much easier than getting rid of calories. An average piece of pie contains about 400 calories, and it takes only a few minutes to eat, maybe a little longer if we are visiting at the same time. Burning those same 400 calories takes about one hour of BRISK walking. Think about all the little things that you munch during your day, and the calories you are taking in. Compare that to the exercise you do to burn off the excess. Do they balance? Or, are the calories in more than the calories out?

Exercise is very important in the treatment of metabolic syndrome. Studies by the American Heart Association show that regular exercise, thirty minutes of moderate paced walking, three to five days a week improve the cardiovascular tone and decreases the risks of metabolic syndrome. Start slowly and gradually increase the length of time and intensity of the exercise. You’re not sixteen anymore, and it will take time to build up to the level of exercise that you need to do daily. Many people stop exercising because they start too vigorously and think they can’t do the exercise and quit. Take it easy in the beginning and gradually build up to the level you need to accomplish your goal. Marathon runners don’t start by running marathons. They start by running around the block, gradually increasing their duration and intensity until they can go the distance.

According to Dr. Rifai, any increase in activity can help. “Park far away from the mall entrance and walk in, walk a flight of stairs instead of taking the elevator, just walk around the neighborhood,” he says. “Be more active, walk a little faster, and eventually you will have the energy to do more.”

Metabolic syndrome is a serious disease for both adults and children, and obesity is the greatest risk for metabolic syndrome. It is a deadly epidemic, and the patient must be as involved in the treatment as the health care provider. Without a combined effort, the treatment will not work.

No One Should Die of Colon Cancer Today

My grandfather died of colon cancer in 1960 when I was fourteen. He got sick, went to the hospital, and died within six weeks, leaving a big hole in my life. That was normal then because there was no way to diagnose colon cancer early.

Today things are much different. Colon cancer can be diagnosed almost as easily as skin cancer because colon polyps of the type that can become cancer can be seen with a colonoscope, removed, and treatment begun as needed.

According to Dr. Chris Wells of the Digestive Disease Center in Panama City, Florida, colon cancer can be found and treated with a cure rate of at least 85% today. Why not 100%? Because some people, even with symptoms put off examination until it’s too late. Others may develop the cancer at an age much younger than what is considered the normal risk age and have advanced disease before they are examined.

The key to finding and treating colon cancer is early detection. Patients with symptoms should be evaluated as soon as possible. The Mayo Clinic patient information site list the following symptoms that should be evaluated: a change in bowel habits, rectal bleeding or blood in your stool, persistent abdominal discomfort, a feeling that your bowel doesn’t empty completely, weakness or fatigue, or unexplained weight loss.

Everyone is at risk for colon cancer, but some are at greater risk than others such as people over age 50, a family history of colon cancer in parents or siblings, African-Americans, people with chronic inflammatory bowel disease such as ulcerative colitis or Chron’s Disease, low fiber high fat diet, obesity, smoking and alcohol consumption all have an increased risk of colon cancer.

Early detection of colon cancer is the key to successful treatment. Routine screening should begin at age 50, age 40 for those with risk factors. Any of the listed symptoms should prompt you to visit your doctor for evaluation or to make an appointment with a gastrointestinal specialist for evaluation. As part of a healthy lifestyle, get regular check-ups to look for any hidden disease before it lets you know it is there. Only with early detection and treatment can we truly say that no one should die of colon cancer today. © 2019 Guy A. Crawford, PA, retired