When Diet and Exercise are not enough

Mrs. Jones presented to my office approximately six months ago having been told that she had type 2 diabetes two years ago. Her HbA1c was 8.2. This is a measurement of how well glucose has been controlled for the previous three months. Normal is under 5.7 and anything over 7 is typically considered too high. Her number correlated with an average blood glucose of 186 and we know it needs to be under 120 to avoid serious diabetic complications. Since her previous primary care doctor had not been able to adequately help her,  I sent her to an endocrinologist. She returned to my office six months later and was proud to point out her HbA1C which was down to 6.2. Blood_Glucose_Testing_-_Kolkata_2011-07-25_3982She said to me, “I read my records from my previous doctor.  She told me to diet and exercise. That’s all she ever said. She never told me why it applied to my diabetes. Now I understand how increased weight and lack of exercise affects insulin. Why didn’t she tell me those things?” I thought about it. Why didn’t I tell her? I assumed that the physiology and treatment of her condition had been well explained to her and that she was just ignoring her doctor’s advice. Diet and exercise alone as words are not powerful enough for people to understand their importance. Education is more than advice. It includes understanding the significance of the recommendations.

How many times am I guilty of the same poor communication technique? Doctor comes from the latin docere, to teach. It is part of my job and I hope my patients feel comfortable enough to say, “Hey, I don’t understand that” when I am unclear.  Only by working together can we hope to improve the “outcomes of chronic disease”. And more importantly, my patients will feel better and live longer.

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The data is IN

Eating a diet high in fruits, vegetables, and whole grains will help you to live longer, healthier, happier lives.

  • Longer–it lowers the risk of heart disease.
  • Longer–it lowers the risk of diabetes and reduces the amount of medications necessary once you have diabetes.
  • Healthier–it appears to reduce risk of certain cancers.
  • Healthier–it may reduce incidence of Alzheimer‘s.
  • Happier–well the happier supposition is all mine. But it stands to reason that if you are losing weight and looking better, it should make you happier.  

Specifically, physicians and nutritionists are recommending the Mediterranean diet, unless you want to go “all out” and try being a vegan. That’s a LOT of work I am personally not yet prepared to tackle.

    From the Harvard Food Pyramid

    Couple this diet with the magic pill of exercise and people truly do feel better. It is amazing. It is also hard a hell to get people to change their lifestyles. My husband had his heart attack at 50 and we still eat red meat more than we should (which apparently is at all), I still cook with cheese and cream and pasta is an easy-out when I need a “go to” quick meal. Certainly there is plenty of data to support these lifestyle changes but the more impressive thing is the rare individual who makes the switch and comes in for a check up. They feel better, they look better, they move better, they have less pain, and most importantly, they never regret what they are doing. Their labwork improves and their blood pressure goes down. We get to stop some or all of their medications. Since it is a complete lifestyle change, they tend to stick with it, as opposed to trying to stick with Atkin’s or Sugar-busters, or whatever the latest fad diet is.

    Personally, the hardest thing for me to incorporate these dietary changes is the lack of a really good cookbook. So far, I’ve bought three and they are not “basic” enough. I want a Julia Child of Mediterranean cooking. Less recipe, more basics followed by recipes. THEN it would be easier  to “think Mediterranean” with future meals. In the meantime I did find a great website for that purpose (except the print is TOO small!). I’m such a visual thinker.

    With the beautiful weather outside right now and spring plants coming up from the ground, I can’t help but push the exercise button. I’m out there and hope to see you as well!


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