As vacation season arrives, here are travel tips for diabetics

It's vacation season. Traveling offers unique challenges for diabetics, but nothing that careful planning and a few precautions won't overcome, says the federal Centers for Disease Control and Prevention.

Image: diabeticlivingonline.com

The CDC offers these tips for diabetics to travel safely:

Before you leave

Discuss any concerns you may have about anticipated increased levels of activity, expected changes in diet and what to do if you have changes in your glucose readings with your physician. If you are traveling across time zones, let your doctor help you plan the timing of your injections. If you wear an insulin pump, make sure you know how to update the built in clock to reflect the change in time zone. The American Diabetes Association recommends making sure your blood sugars are well controlled before you leave.

Don't forget your supplies

Always keep your supplies close at hand and accessible, no matter how you travel. And don't forget to store them correctly; insulin stored in very hot or very cold temperatures may lose strength. Meters and supplies are also sensitive to extreme temperatures. There are cooling packs available made specifically for diabetes supplies.

To allow for any unexpected travel delays, it is recommended to pack twice the amount of diabetic supplies you expect to need. All supplies should be clearly labeled, with their original labels if possible, and don't forget to bring a copy your prescriptions with you.

It is also important to plan ahead for the possibility that your blood sugar might drop. Changes in what you eat, activity levels, and time zones can affect your blood glucose, so you need to monitor your blood glucose more often. If you use insulin, pack a glucagon emergency kit and all diabetics should pack glucose gel or glucose tablets, along with a few snacks.

Carry documentation and let others know

Carry a laminated 3-by-5 card in your wallet that says you have diabetes along with a list of any medications you use. Joslin Diabetes Center recommends that if you are traveling to a country where they speak a language other than your own, translate the note into this language. The ADA recommends that this card also say, "Sugar or orange juice please" in the language of the country you will be visiting.

In addition to wearing medical identification that says you have diabetes, tell the people you are traveling with that you have diabetes and tell them what to do in the case of an emergency. It is also a good idea to give them a copy of your medical card.

Keep your health insurance card and emergency phone numbers on hand at all times, including your doctor's name and phone number. First respondents are trained to look at cell phones for a contact labeled "emergency contact," so make sure you put one in there. All phone numbers should also include the country code if traveling abroad.

Once you arrive, find the closest medical care facility that could provide care if necessary. You can get a list of English-speaking foreign doctors from the International Association for Medical Assistance to Travelers at www.iamat.org or 716-754-4883, according to the ADA.

Nutrition

Do your homework before you go to determine the carbohydrate grams in the foods typically served where you are going. You might also want to pack a few bottles of water and some pre-measured dried fruit, nuts and seeds for snacks.

Air travel

If flying, put your diabetes supplies in a quart-size plastic bag separate from your toiletries. If you wear an insulin pump and don't want to walk through the metal detector with it on, tell the security officer about it and ask them to visually inspect the pump and do a security pat-down.

It is also important to call the airline ahead of time to assess whether your nutritional needs will be met while traveling. If a meal will be served, you can put in a request for a diabetic meal. If not, make sure to bring appropriate food with you.

Another thing to remember is that air on an airplane is probably pressurized, so when drawing up your dose of insulin, don't inject air into the bottle because the pressure differences can cause the plunger to "fight you," says the ADA. For more information about air travel and diabetes, click here.

To reduce your risk for blood clots, move around every hour or two.

Protect your feet

As always, diabetics need to protect their feet, being especially careful of hot pavement by pools and hot sand on beaches. Wear comfortable shoes and make sure to check your feet daily for blisters, cuts, redness, swelling and scratches.The general rule is to never go barefoot.

Health care professionals strongly endorse new federal dietary guidelines, which say to eat less red and processed meat

A group of 700 physicians and other health care professionals sent a letter of strong endorsement to the secretaries of the Department of Agriculture and the Department of Health and Human Services praising the recommended federal dietary guidelines that emphasize eating less red and processed meat, Whitney Forman-Cook reports for Agri-Pulse, a Washington newsletter.

The letter said the “shift toward a more plant-based diet” in the Dietary Guidelines Advisory Committee's recommendations is a potentially “powerful tool for health promotion” that would help reduce healthcare costs, Forman-Cook writes.

“Three of the four leading causes of preventable death, heart disease, cancer, and stroke -- are diet-related,” the letter reads. “Heavy meat consumption, especially red and processed meat, is associated with increased risks of heart disease, diabetes and some cancers, while plant-based diets are associated with decreased risks of all three.”

They also noted that 75 percent of U.S. health-care costs and diminished labor supply and worker productivity is caused by chronic and preventable diseases, costing the country "$1 trillion in lost economic output and billions more in rising healthcare cost," Forman-Cook writes.

For the first time, the guidelines include environmental standards and sustainability language. Agriculture Secretary Tom Vilsack "has not said he is opposed to including sustainability concerns in the final guidelines," Forman-Cook writes. He told her that "he would be personally involved" in writing the new guidelines, keeping them "narrowly focused on nutrition."

U.S. meat producers and many farm organizations have pushed back against the recommendations and the sustainability language.

The health-care professionals also endorsed the DGAC's recommendations on sustainability and calls for the DGAC to "explicitly" list the "common names" of foods in the guidelines and identify appropriate "non-animal protein sources" to help consumers modify their eating habits.

The guidelines, which are revised every five years to reflect advancements in scientific knowledge, are used to guide federal nutrition programs, including school meal standards, and to inform consumers. They are expected to be published later this year.

How do diet and exercise influence risk of diabetes? Diet seems more important

Many people think exercising and eating properly are interchangeable, but a paper by Edwards Weiss, associate professor of nutrition and dietetics at Saint Louis University, asserts that exercising and restricting diet results in specific and cumulative benefits in reducing the risk of Type 2 diabetes. According to the 2013 Kentucky Diabetes Report, 6.9 percent of Kentucky adults have diabetes.

Participants in the study were sedentary, overweight middle-aged men and women who reduced their weight 6 to 8 percent through calorie restriction, exercise or both. Researchers measured their insulin sensitivity levels, which determines risk of diabetes. "Your blood sugar may be perfectly normal, but if your insulin sensitivity is low, you are on the way to blood sugar issues and, potentially, Type 2 diabetes," Weiss said.

The researchers measured twice the improvement of insulin sensitivity in the group of participants who both exercised and restricted their diets than in the other two groups. Weiss notes that exercise helps regulate glucose, even if a person isn't losing weight as a result. The researchers also found that exercised-induced weight loss didn't regulate glucoregulation more effectively than calorie restriction. "What we found is that calorie restriction, like exercise, may be providing benefits beyond those associated with weight loss alone," Weiss said.

Weiss said that though it might seem obvious that a combination of diet and exercise would engender the best results, "there are a lot of people who believe that if they maintain a healthy weight, it doesn't matter what they eat. And others have an appropriate food intake but don't exercise."

Two weeks of high-fiber, low-fat diet brings changes that protect against colon cancer; high-fat diet brings changes with more risk

Two weeks is all it took for a change in diet to increase production of a substance in the gut that may reduce the risk of colon cancer, according to a recent study, published in Nature Communications.

The study asked 20 African Americans in Pittsburgh and 20 rural South Africans to switch diets for two weeks. The Americans were fed a high-fiber, low-fat diet, with plenty of fruits, vegetables, beans, cornmeal and very little meat, while the Africans were given a diet high in fat with lots of meat and cheese, Sindya N. Bhanoo reports for The New York Times.

“We made them fried chicken, burgers and fries,” Stephen J. D. O’Keefe, a gastroenterologist at the University of Pittsburgh and one of the study’s authors, told Bhanoo. “They loved it.”

After two weeks, colonoscopies on the volunteers found that the African Americans who ate the traditional African diet had "reduced inflammation in the colon and increased production of butyrate, a fatty acid that may protect against colon cancer," Bhanoo writes. Africans who ate the Western diet had changes in their gut bacteria "consistent with an increased cancer risk."

African Americans are disproportionately affected by colon cancer, while the disease affects few people in rural Africa, Bhanno notes.

Colorectal cancer is the second most common cancer in both men and women in the U.S. and is expected to cause about 49,700 deaths during 2015, according to the American Cancer Society. Kentucky leads the nation in both incidences and deaths from colorectal cancer, with 51.4 cases per 100,000 people and 18.7 deaths per 100,000, according to the Kentucky Cancer Registry.

Researchers discuss physical activity as a way of maintaining or improving health; daily walking is still the best exercise

By Melissa Patrick
Kentucky Health News

Obesity worsens the damage that arthritis does to joints, but simply telling patients to go home and diet and exercise is not working, and health care providers must proactively monitor their patients and help them find affordable solutions to succeed. And daily walking is still the best exercise.

Those were examples of research findings discussed at the 10th annual Center for Clinical and Translational Science conference sponsored by the University of Kentucky on March 25. More than 700 researchers, students, policymakers and guests discussed research with a focus on physical activity across the lifespan.

Stephen Messier, professor and director of a biomechanics laboratory at Wake Forest University, said obesity has a significant effect on joint health, particularly osteoarthritis, which he said is quite painful. He called for closer attention to obese patients with arthritis.

He said a study found that a combination of diet and exercise over an extended period of time offers the best results for less pain and less disability. He said that a separate study found those who lost 10 percent of their body weight had the most "significant outcomes" related to function, which included walking speed.

The conference featured 31 oral presentations and 270 poster presentations, addressing a vast array of topics including physical inactivity in children, physical inactivity in chronic disease and biomedical informatics.

"The conference was designed to raise awareness of the science behind the benefits of exercise and the dangers of physical inactivity," Charlotte Petterson, professor and associate dean of research in the College of Health Sciences, who chaired this year's conference, said in a UK press release.

The keynote speaker, Duke University medicine professor William E. Kraus, encouraged walking as a proven and simple activity that can improve health and actually extend life. "Fitness always trumps fatness," he said, noting that a "culture of convenience" and conditions of built environments, such as absence of sidewalks, deter people from physical activity.

Research on fourth and fifth graders in two Clay County schools, while in the early stages of analysis, found that obesity and inactivity begins early.

Karyn Esser, professor of physiology at the UK College of Medicine, said her research was examining the circadian rhythms and physical activities of students because changes in natural circadian rhythms "can create pre-cursors to disease" in just seven days, even in healthy young people. She said her study is intended to help schools improve students' health by adjusting meal times and offering physical activities to best coincide with circadian rhythms.

The data for Esser's study was gathered through electronic devices that the 136 students wore for seven days to measure activity, heart rate and skin temperature. The students also kept a daily journal to record their activities. So far, Esser said, the data show 33 percent of the students are considered obese, their initial blood pressure measurements are on the high end of normal, and the students are less active on weekends and nights than during the school week.

Another UK study found that students who are more active during the school day do better in mathematics.

Alicia Fedewa and Heather Erwin of the College of Education said they found that increased physical activity levels "significantly improved" math scores and slightly improved reading scores of the students who got an extra 20 minutes of movement on each school day. They recommended two short 15-minute recesses per day, rather than one long one. They also said that classroom "energizers" and stability balls also help students with these behaviors.

The researchers said many studies show that students who participate in recess and physical education during the school day are more focused and less fidgety, show less listlessness, and have better overall classroom behavior. They said more controlled studies need to be conducted, but said most studies to date have found that fit kids have less anxiety and better overall well-being. Also, a regimen of consistent physical activity is best for kids with attention deficit hyperactivity disorder (ADHD).

Research suggests eating only during a nine- to 12-hour time period can help maintain healthy weight

For a long time, scientists supposed that eating after midnight was unhealthy, but now a study has provided support for the notion. When scientists prevented mice from eating whenever they wanted, the animals avoided obesity and metabolic issues—even when the diet was unhealthy, Ben Wiseman reports for The New York Times.

In a previous study, researchers at Salk Institute for Biological Studies in San Diego began studying mice eating patterns. The mice in the study that were permitted to eat whenever they wished gained weight and became unwell, while the mice who were only permitted to eat during an eight-hour window didn't gain much weight or develop metabolic problems.

The new study, which was published in the journal Cell Metabolism in December, Salk scientists provided groups of mice with one of four diets: high-fat, high-fructose, high-fat and high-sucrose and regular mouse food. "Some of the mice in each dietary group were allowed eat whenever they wanted throughout their waking hours; others were restricted to feeding periods of nine, 12 or 15 hours," Wiseman writes. The caloric intake for all the mice was the same.

Some of the mice in the time-restricted groups were allowed to eat whenever they wanted on weekends, and some of the eat-anytime mice were moved to the restricted groups halfway through the study. At the end of the study, the mice that ate whenever they pleased became obese and metabolically ill, but the time-restricted mice stayed healthy. The mice switched from the former group to the latter lost some of the weight they'd gained, Wiseman writes.

Though scientists don't know exactly why eating during a designated timeframe helps prevent weight gain, Dr. Satchidananda Panda, who oversaw the studies, and his colleagues think it has to do with the body's internal clock. "Meal times have more effect on circadian rhythm than dark and light cycles," Panda said. Circadian rhythm influences the function of many genes in the body that have to do with metabolism.

These studies have only been performed using mice, but Panda believes the results could apply to humans. He suggests that people only eat within a 12 hour—or shorter—window each day. The clock begins with the first thing a person eats in the morning. (Read more)

Study finds students with heavy fast-food diets have test scores about 20% lower than those who don't east fast food

Eating fast food may cause lower test scores in school, says a recent study of U.S. school children.

The study, published online in the journal Clinical Pediatrics, found that "The more frequently children reported eating fast food in fifth grade, the lower their growth in reading, math and science test scores by the time they reached eighth grade," says an Ohio State University news release.

Specifically, the study found that children who ate fast food four to six times per week, or every day, had test-score gains in all three achievement areas that were about 20 percent less than those of children who did not eat any fast food in the week before the survey.

“There’s a lot of evidence that fast-food consumption is linked to childhood obesity, but the problems don’t end there,” said Kelly Purtell, lead author of the study and assistant professor of human sciences at Ohio State. “Relying too much on fast food could hurt how well children do in the classroom.”

The study included 11,740 students who were tested in reading/literacy, mathematics and science in both fifth and eighth grades. They were also given a food consumption questionnaire in fifth grade.

The researchers tried to accounted for many other reasons that might have influenced the results, including how much children exercised, how much television they watched, what other foods they ate, their family’s socioeconomic status, and characteristics of their neighborhood and school, according to the release.

While this study establishes a correlation between fast-food consumption and lower grades, it does not establish the cause of lower grades. However, Purtell said she and the other authors are "confident fast food explains some of the difference in achievement gains over time."

Other studies have suggested that it may be related to a lack of nutrients found in fast food, such as iron, and another study suggests that diets high in fat and sugar, found in most fast food, hurt immediate memory and learning processes, the news release says.

“We’re not saying that parents should never feed their children fast food, but these results suggest fast-food consumption should be limited as much as possible,” Purtell said.

Americans' sweet tooth blamed for increases in obesity and diabetes; new website explains the dangers of too much sugar

A new website called SugarScience is now available to help consumers understand the health dangers of sugar in our lives, Lisa Aliferis reports for NPR.

This University of California, San Francisco project examined 8,000 studies and research papers and "found strong evidence that over-consumption of added sugar contributes to three major chronic illnesses: heart disease, Type 2 diabetes and liver disease," Aliferis writes.

"Right now, the reality is that our consumption of sugar is out of whack, and until we bring things back into balance, we need to focus on helping people understand what the consequences are to having the average American ... consume too much added sugar," Laura Schmidt, a professor of health policy at UCSF and leader of this project, told Aliferis.

SugarScience is a user-friendly website that partners with health departments across the country to educate the public. Two departments have already agreed to participate in the outreach, Aliferis writes.

Schmidt told Aliferis that the food environment is the driver of the increased obesity of Americans in the last generation: "Sugar isn't just making us fat, it's making us sick."

"It's not like Americans suddenly lost their will power," she said. "The only major change in the diet that explains the obesity epidemic is this steep rise in added sugar consumption that started in the 1980s."

What our average daily diet of added sugar looks like

Schmidt said that while not all sugar is bad, we need to determine how much sugar is too much, pointing out that Americans consume the "equivalent of 19.5 teaspoons a day in added sugar, " Aliferis reports. She also suggest there is a need for federal guidelines to recommend a limit.

"SugarScience suggests the same limits advocated by the American Heart Association and the World Health Organization: no more than 9 teaspoons a day for men and no more than 6 teaspoons a day for women," Aliferis writes.

A taste of what the SugarScience website tells us is: Added sugar hides in 74 percent of packaged foods; fructose, a common type of sugar, can damage your liver more than other kinds of sugar; and one 12-ounce can of soda a day can increase your risk of dying of heart disease by one-third, Aliferis reports.

It also suggest the best way to cut down on sugar is to stop drinking sugar-sweetened drinks, saying this is where we get more than one-third of added sugar in our diets. Another suggestion is for us to read nutrition labels, suggesting that if a chemical on the label ends in "ose," it is probably sugar.

Dean Schillinger, a professor of medicine at UCSF and a primary care doctor at San Francisco General Hospital, is also part of the SugarScience team. He told Aliferis that beds in his hospital that used to be filled with AIDS patients are now filled with diabetes patients.

"The ward is overwhelmed with diabetes — they're getting their limbs amputated; they're on dialysis. And these are young people. They are suffering the ravages of diabetes in the prime of their life,"Schillinger told Aliferis.

"We're at the point where we need a public-health response to it, " he said.

Five things you can start doing today to decrease your risk of getting diabetes, which affects one of every 10 Kentuckians

By Melissa Patrick
Kentucky Health News

Diabetes is a real problem in Kentucky and one that is not projected to get any better. You may be at risk of getting it, but there are things you can do to decrease your risk of becoming diabetic.

"Type 2 diabetes is still entirely preventable with certain lifestyle changes," Dr. Manny Alvarez writes for Fox News. "I always preach to my patients the importance of exercise and diet."

Kentucky ranks 17th in diabetes. One in 10 adult Kentuckians have been diagnosed with it and 40 percent of Kentuckians age 40-74 have pre-diabetes, according to the state Department for Public Health.

Even more worrying is the 2014 "States of Obesity" report that projects a 51 percent increase of Kentuckians with diabetes by 2030, going from an estimated 400,000 in 2010 to almost 600,000 in 2030.

Alvarez cites a study that identifies five simple habits to cut your risk of developing diabetes by as much as 80 percent:

1. Have a healthy diet, including lots of fruits and vegetables
2. Exercise three times a week for at least 20 minutes.
3. Maintain a normal body weight, which means a BMI between 18.5 and 24.9
4. Don't smoke.
5. Consume alcohol in moderate amounts.

Maintaining a normal body weight is the single most effective factor to prevent getting diabetes, according to the study, Alvarez reports. "Men of normal weight were 70 percent less likely to develop diabetes than overweight or obese men, while normal weight women were 78 percent less likely to develop diabetes."

But that doesn't mean overweight people don't benefit from incorporating these healthy lifestyle changes. "Overweight people who adopted just one of the other healthy lifestyle factors, such as exercising three times a week, could still reduce their risk of diabetes," Alvarez writes.

These suggestions should offer some hope to Kentuckians as lifestyle changes are things we have some control of and often come at little to no cost.

Choose a diet specific to your health needs, and recognize that even small changes will create a healthier you

Dieting doesn't just mean cutting back on calories anymore. Now you can choose a diet based on specific outcomes such as weight loss, heart health or diabetes control, writes Travis Thomas, assistant professor in the Division of Clinical Nutrition at the University of Kentucky College of Health Sciences.

Nutrition professionals embrace having more than one choice in dieting, recognizing that a single diet plan doesn't suit all people, Thomas writes. The goal is to "tailor a diet strategy to the goals and personalities of each patient," with the understanding that a structured diet plan makes dieting easier.

But just because there are plenty of diets to choose from doesn't mean they are equally recommended.

U.S. News and World Report recently posted the Best Diets Rankings for 2014, evaluating 32 of the most popular diets. They were evaluated on ease to follow, nutrition, safety and effectiveness for weight loss and whether they were against diabetes and heart disease.

Many of the trendy diets like Atkins, which ranked No. 29; Zone, No. 22; and Paleo, No. 31, are near the bottom of the U.S. News rankings. The DASH diet, developed to fight blood pressure, and the TLC diet, or Therapeutic Lifestyle Changes diet, ranked Nos. 1 and 2.

Thomas says it is important to recognize that no one diet is right for everyone, and to remember that our dietary needs change throughout life. For example, certain medical conditions such as pregnancy have specific dietary recommendations that many popular diets don't support. He also notes that sometimes the list of restrictions in some diets is not sustainable.

And for those who find following a rigid diet plan overwhelming, Thomas recommends starting small.

Making small lifestyle changes that include the attributes found in the top-rated diets is also effective in improving overall health, Thomas writes. Incorporating a balanced diet high in fruits and vegetables, paying attention to what you eat and including structured exercise will "improve overall health without the perceived rigidity of a traditional diet plan."

"Recognize that significant diet overhauls may be difficult to maintain long-term and are not always indicated or scientifically validated," Thomas writes. "Consider starting with small, manageable changes to help you on your way to a healthier life."

For more information on diet and lifestyle go to www.choosemyplate.gov.