Mark’s Daily Apple

Diabetes is Now a Disorder of the Small Intestine?24

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Just reroute the plumbing, doc!

I’m not a doctor… and I don’t play one on TV, but fer cryin’ out loud, when will they learn? I just want to SCREAM sometimes. Seems bariatric surgery as a possible cure for type 2 diabetes was not enough. Old technology. Now the rocket scientists have determined that surgically bypassing the upper part of the small intestine can cure type 2 diabetes even better than that silly old gastric bypass weight-loss “breakthrough” of just a few months ago. Read this Science Daily article and tell me I didn’t eat bad mushrooms in my salad today.

‘When we bypass the duodenum and jejunum, we are bypassing what may be the source of the problem,’ says Dr. Rubino, who is heading up NewYork-Presbyterian/Weill Cornell’s Diabetes Surgery Center.

In fact, it has become increasingly evident that the gastrointestinal tract plays an important role in energy regulation, and that many gut hormones are involved in the regulation of sugar metabolism. ‘It should not surprise anyone that surgically altering the bowel’s anatomy affects the mechanisms that regulate blood sugar levels, eventually influencing diabetes,’ Dr. Rubino says.

Surgically altering the bowel’s anatomy? People, the source of the problem is bad diet and lack of exercise. Full stop. I’ve said it a hundred times here. Give me 95% of type 2s and I can cure them of diabetes forever in 90 days if they simply eat and exercise right. It’s not easy, but it’s free and doesn’t leave you messed up for life. Life is all about gene expression. Send the wrong signals and your genes express themselves in the direction of diabetes. Send the right signals and you’ll decrease insulin, increase muscle cell insulin sensitivity and normalize blood glucose, burn fat and preserve muscle. And all the recent discussion here on MDA about “all the many genetic differences we are seeing in the human population” doesn’t change a thing. The fact that some of us are predisposed to respond to dietary changes slightly faster or slower than others doesn’t remove the fact that our basic biochemistry all works the same. Yes, that same way we were designed by evolution. Yet, Dr. Rubino is suggesting that this miracle surgery might be the only hope for millions of us.

In fact, bypass of the upper small intestine does not improve the ability of the body to regulate blood sugar levels.

[but didn't he just imply otherwise?]

‘When performed in subjects who are not diabetic, the bypass of the upper intestine may even impair the mechanisms that regulate blood levels of glucose,’ says Dr. Rubino. ‘In striking contrast, when nutrients’ passage is diverted from the upper intestine of diabetic patients, diabetes resolves.’

So what does that mean for a new surgically-corrected diabetic patient who finally decides to eat and exercise correctly? I guess he or she is just hosed for life? You gonna reconnect the bowel now? So much for homeostasis. And here’s the kicker:

There is, in fact, growing evidence that diabetes surgery can be effective even for patients who are only slightly obese or just overweight.

Leave it to a surgical specialist to come up with a plumbing cure for type 2 diabetes that applies to all 20 million in the US alone. Even at only $30,000 per procedure, let’s see, that’s six hundred billion dollars worth of business. Nice work if you can get it.

This, he explains, implies that the upper intestine of diabetic patients may be the site where an abnormal signal is produced, causing, or at least favoring, the development of the disease.

How exactly the upper intestine is dysfunctional remains to be seen. Dr. Rubino proposes an original explanation known in the scientific community as the ‘anti-incretin theory.’

By the way, I Googled “anti-incretin theory” and got four results, all as uttered by Rubino, so it’s unclear how the rest of the scientific community actually even feels about this theory.

I could dissect the rest of the article - everything said in it makes me want to puke. I know the good doctor is a well-respected specialist, but that just makes it even worse. I’m sure there’s a bunch of surgeons already drinking the Kool-aid and girding (maybe GERDing) their loins for a new rush in business. I can just feel my cortisol levels rising as I write this. Maybe the good doc can find a way to surgically bypass my adrenals. Just reroute the plumbing, doc. After all, stress is bad, and lord knows there’s no other possible way for me to avoid stress in my life. Am I just another hapless victim of bad genes?

Speak to me.

harrymoon Flickr Photo (CC)

Further Reading:

Lap Bands and Type 2 Diabetes

The Definitive Guide to Insulin, Blood Sugar and Type 2 Diabetes (and you’ll understand it)

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Technorati Tags: diabetes, bypass surgery, bariatric, Dr. Rubino, anti-incretin theory, insulin, overweight, obesity, blood sugar

Posted: Big Pharma, Health, Sisson Said What?

A Pain in the Neck - and Back!7

Stand up straight!

With the rise of obesity and the prevalence of sedentary lifestyles in the U.S., it’s little surprise that back problems are common in this country. And, sure enough, health expenditures for these problems are going through the roof. According to a newly published research analysis, expenditures for neck and back treatments have risen a whopping 65% since 1997! But here’s the kicker: with all the extra money insurance companies and individuals are paying for back related treatments (surgeries, pain meds, etc.) patients are actually getting less relief. The research comes out of the University of Washington at Seattle and is published in the Journal of the American Medical Association.

Martin and colleagues analyzed data from 1997 to 2005 from a nationally representative survey of patient health expenditures and health status. They found that in 1997 people with spine problems on average spent $4,695 a year, adjusted for inflation, compared with the average $2,731 spent for people without back problems. The average health cost for spine patients in 2005 rose to $6,096, compared with $3,516 for people without those problems. …”What we’re seeing is that although costs have gone up, outcomes have not changed, which is really discouraging,” said Dr. Orly Avitzur, a neurologist from Tarrytown, N.Y., and an advisor to Consumer Reports, which recently named back surgery on its top-10 list of “Medical Gotchas.”

via LA Times

We can’t resist saying that, while a 65% increase in overall expenditures seems more than excessive, the 171% increase in pharmaceutical expenditures for neck and back treatments struck us as outright extreme. (All right, that wasn’t the word, but we’re trying to be polite.) But again, it’s not much of a surprise, is it?

The study found that the annual bill for spinal treatments in this country totals $85.9 billion a year. The cost for cancer treatment: $89 billion.

This is the kind of news we shake our fists at. Of course, there are numerous legitimate, non-lifestyle reasons people require spinal care (car accidents, injuries, pregnancy and childbirth related strains). For those with lifestyle related back issues, spinal treatment can allow them enhanced opportunity to pursue fitness goals, etc. Though we’re not Rodney Yee, we recognize that spinal health is essential for overall wellness. But we would also argue the reverse: overall physical condition is important for spinal health.

When treatments support a person’s ability to lead a healthy life, they can make a truly positive difference. As this analysis shows, our current treatment situation in this country isn’t doing the job. Treatments, pharmaceutical or not, shouldn’t be stand-ins for healthy choices. Ideally, treatment should complement our own efforts and act as a temporary “support” to get us back on track. We don’t gain much from being weakened, or worse yet, infirm. We don’t gain much from being poorer after the bills come due. And we certainly don’t gain anything from, at the end of the day, still being in pain. The question is, then, who does gain?

Comments? Stories? Do share.

Further Reading:

Natural Alternatives to OTC Painkillers

The Single Best Stretch

FitSugar: Fetal Position Back Stretch

Technorati Tags: back pain, JAMA

Posted: Big Pharma, Fitness, Health, Worker Bees' Weekly Bites

Pharma Confidential4

If you have ever experienced difficulty in finding the motivation needed to complete the most common daily tasks you may be part of the estimated 20% of the population that is burdened by a newly discovered debilitating disorder - Motivation Deficiency Disorder, or MDD. Luckily, there is a simple answer: Strivor.

No. We aren’t serious. But you can easily imagine hearing this sort of thing in the next Big Pharma television ad campaign.

This is at the heart of this parody video that provides biting commentary on the tactics used by Big Pharma and the state of the healthcare industry. It is put together by Consumer International, which, as they say, is “the world federation of consumer groups that, working together with its members, serves as the only independent and authoritative global voice for consumers.”

Get ready to both laugh and cry…

Follow this link to CI’s website to view additional videos.

Further Reading:

Big Pharma: Bad Science and Bad Business

Best of Mark’s Daily Apple January 2008

Technorati Tags: big pharma, Consumer International, health industry, motivation deficiency disorder, Strivor

Posted: Big Pharma, Hype, Videos

Friday Link Love0

Conditioning Research reports a score for low-carb and paleo diets.

Eating Fabulous considers a few benefits of the oft-vilified cholesterol.

zenhabits offers 17 Fitness Truths to Get You in Shape.

The Consumerist keeps an always critical eye on those sneaky fast food marketers.

Interactive Health posts video tips on how to increase the mobility of tense shoulders.

lifehack provides 10 Tips for a Good Night’s Sleep Without Pills.

Diethack makes it clear as to how we can all die faster.

and last, but not least…

Pharma Marketing Blog tells us about Big Pharma’s big switch from the marketing of lowering cholesterol to the lowering plaque buildup.

Posted: Big Pharma, Diet, Fitness, Health, Nutrition, Personal Improvement, Stress

High Blood Pressure and Follow-up Care4

Low Follow-up Pressure

High blood pressure is a major public health threat and one of the leading causes of death in the U.S. An analysis of hospitalization and follow-up care for individuals with severe hypertension, however, shows gaping holes in the maintenance of care.

Granger and colleagues at nearly two dozen institutions around the country created a special registry to find out what happens to patients with acute, severe hypertension - those with blood pressure readings above 160/110 - when they come to an emergency department or critical care setting for treatment. They found that although 90 percent of them already had a diagnosis of high blood pressure, about a quarter of them were not taking the medicines they were supposed to. The researchers also found that extremely high blood pressure was related to high complication and death rates. Many of the patients already had major organ damage and over six percent of them died in the hospital. Upon discharge, most of the patients were given prescriptions for at least two medicines, but 41 percent had to be readmitted within three months.

via Medical News Today

Clearly, this is a sad scenario for these patients, but this part of the research summary really made our jaws drop:

“What may be most unsettling, however, is the fact that the investigators could not find any evidence in the discharge records of about 60 percent of the patients that there had been any attempt to schedule a follow-up appointment for them.”

No attempt to schedule a follow-up visit? Anyone who’s been to the emergency room before knows it’s not the place to go for detailed explanations of care strategies. It’s largely triage, by necessity. Clearly, there are many unfortunate reasons (no insurance and little money, etc.) someone may refuse to schedule a follow-up visit, but isn’t it the place of medical personnel to at least try?

Not only is a follow-up visit necessary (at some point) to get a refill on a prescription, more importantly a personal conversation with a medical professional should offer a discussion of lifestyle changes that can support the natural lowering of blood pressure as well as general health.

Every day your blood vessels have to work that much harder, you put yourself at increased risk for heart disease, stroke and kidney disease. High blood pressure is largely a disease initiated by unhealthy living choices and circumstances, and reversing unhealthy patterns should be a natural part of treatment. What kinds of simple advice did these patients miss out on that would have provided useful and free tips for managing their blood pressure? How about cutting sodium, caffeine and alcohol? How about stress management therapies? What about weight loss and smoking cessation counseling? What about increasing fruits and vegetables in the diet and incorporating garlic and fish oil? What about other tips like research out this week showing a daily glass of beet juice appears to be very effective in reducing blood pressure?

Reading tips is one thing, and we think it’s important, by the way! But for someone in medical crisis, individual follow-up can provide a level of support and personal planning that articles cannot. These patients deserved better.

Lifestyle changes should be a serious part of every medical plan. It’s true, you can lead a horse to water, but you can’t make it drink. Nonetheless, this report shows too many medical professionals don’t even make it that far.

cursedthing Flickr Photo (CC)

Further Reading:

Big Pharma: Bad Science and Bad Business

PharmaLot: Bob Jarvik Doesn’t Prescribe, And He Can’t Row

Technorati Tags: high blood pressure, prescription, follow up visit

Posted: Big Pharma, Health, Men's Health, Prevention, Women's Health, Worker Bees' Weekly Bites