Monthly Archives: July 2017

What Is Diabetic Retinopathy

There are plenty of complications that can arise from diabetes, but one you may not have considered is diabetic retinopathy. Without regular screening, diabetic retinopathycan lead to blindness.

“Diabetic retinopathy is an eye disease that affects the tissues in the back of the eye – called the retina – which process light and vision for the brain,” says Dr. Nancy Kunjukunju, a retina specialist at Krieger Eye Institute at LifeBridge Health in Baltimore. “High blood sugar levels can cause the retinal blood vessels to leak, swell, grow abnormally or be blocked. If that happens, the lack of normal blood and oxygen flow can cause a loss of tissue function that seriously affects vision.”

Among people who have had Type 1 diabetes for five years, 25 percent will develop diabetic retinopathy, Kunjukunju says. That number shoots up to 60 percent after 10 years. The numbers vary a bit more when you have Type 2 diabetes, but 53 percent of people who have had Type 2 diabetes for more than 10 years develop the disease. Many people with diabetic retinopathy are not aware that they have it, says Dr. Gregory Dodell, an assistant clinical professor of medicine, endocrinology, diabetes and bone disease at the Icahn School of Medicine at Mt. Sinai in New York.

The risk for diabetic retinopathy increases as you get older. You’re also at higher risk if you smoke. Of course, elevated blood sugar over an extended period leads to a higher risk for diabetic retinopathy as well.

“Other factors may also be high blood pressure, high cholesterol and kidney disease,” Kunjukunju says. “All of the different components of the body work together so when anything affects our blood vessels, including heart disease, our eyes can also be affected.”

A recently published study found a link between obstructive sleep apnea and diabetic retinopathy in patients who have Type 2 diabetes. However, when those patientsreceived continuous positive airway pressure treatment, or CPAP, they were less likely to develop retinopathy.

Having poor vision that makes you wear glasses or contacts has no connection to the development of diabetic retinopathy.

Many times, diabetic retinopathy has no symptoms until it’s too late – and that’s why regular eye exams are so important. “If diabetic retinopathy is not treated, symptoms can worsen, and eventually an individual may become blind,” Kunjukunju says.

Other times, symptoms like blurred vision, loss of color vision and floaters can occur. Other symptoms include spots, bleeding in the eye and an inability to see from the center of the eye. That’s the kind of vision you use when you are driving or reading, says Dr. Mark Goldfarb, an ophthalmologist with Advanced Eye Care in River Edge, New Jersey. If you haven’t already seen an eye doctor, make sure to do so when you have these kinds of symptoms.

The American Diabetes Association recommends that adults with Type 1 diabetes have an eye exam within five years of diabetes onset; people with Type 2 diabetes should have an exam at the time of diagnosis. Although someone with Type 2 diabetes may be newly diagnosed, that person could have been living with diabetes for as little as a month or as long as several years. That’s why an eye exam right after a diabetesdiagnosis is so important.

Even women who have diabetes and get pregnant or those who develop gestational diabetes while pregnant should be screened, Goldfarb recommends.

Although guidelines aren’t as clear on how often to return for an eye exam, Goldfarb generally advises returning once a year – although that will become more frequent if you’re diagnosed with diabetic retinopathy.

“I aim to ask patients during every office visit when their last ophthalmology evaluation was,” Dodell says. “Ideally, the ophthalmologist should be sending a note to the endocrinologist or primary care doctor regarding the office visit.”

During an exam for diabetic retinopathy, your eye doctor will dilate your eyes to see the back of the eye (the retina). He or she will look for abnormalities like swelling or the leaking or closing off of blood vessels. There are also newer imaging devices, like optical coherence tomography, that help eye doctors better view the back of your eye, Goldfarb says. These exams are also important to check for other eye problems that are more common when you have diabetes, such as glaucoma and cataracts.

When you see your eye doctor, be ready to share some of your recent blood sugar readings, Goldfarb says. This information can be helpful.

If you’re diagnosed with diabetic retinopathy, your eye doctor may tell you that you have nonproliferative diabetic retinopathy – which is an earlier stage of the disease – or proliferative diabetic retinopathy. With the latter, blood vessels become so damaged they close off, according to the American Diabetes Association. Then, newer but weaker blood vessels grow and leak blood, which can block your vision and potentially lead to the growth of scar tissue. Proliferative diabetic retinopathy can also lead to something called retinal detachment, and that can cause permanent vision loss, Goldfarb says.

Diabetic macular edema is a condition that can also develop when you have diabetic retinopathy. It involves swelling in the macula of the eye, according to the American Academy of Ophthalmology.

Treatment for diabetic retinopathy is most effective when it’s started early. Your eye doctor may perform laser treatments on the retinal blood vessels to help stop them from bleeding and leaking and to reduce swelling. There are also injections that can be made in the eye to slow or stop tissue damage.

Because many patients do not see an eye doctor regularly, there are efforts underway to increase the use of telemedicine to screen more patients for diabetic retinopathy. “This is fantastic, and I suspect will lead to better outcomes for patients,” Dodell says. However, telemedicine screenings can’t replace a full eye exam, Goldfarb believes.

The best way to reduce your risk for diabetic retinopathy is to keep your blood sugar under control and follow other healthy habits, like eating a balanced diet, exercising, not smoking and using your medications as prescribed. “If blood sugar levels are close to normal, an individual is less likely to be at risk,” Kunjukunju says.

Providing Social Support To Overcome Depression

Humans are social animals by nature. But modern life has disrupted many of the traditional social norms that people have relied on for millennia, to the detriment of our overall health. The American Psychological Association reports that loneliness has been linked to health problems including “high blood pressure, diminished immunity, cardiovascular disease and cognitive decline” and that “low levels of social support have even been linked to increased risk of death from cardiovascular disease, infectious diseases and cancer.” Social support plays a big role in depression, as well.

Individuals with poor social support have a higher probability of developing depression, according to a study in the Journal of Clinical Nursing. And many Americans today don’t feel like they have a social network they can count on. The APA reports that 55 percent of survey respondents said they could use “at least a little more emotional support” when talking about problems or making difficult decisions. Strong social support can help people cope with problems and improve self-esteem and a sense of autonomy, the APA says. But not everyone has the skills to be socially connected, while many others find that maintaining those connections are harder these days.

“At its worst, depression is a disease of isolation,” says Dr. Drew Ramsey, assistant clinical professor of psychiatry at Columbia University and chair of the American Psychiatric Association’s Council on Communications. “People generally tend to be social creatures. We feel best when we are connected to others and to our community. That is a huge part of the human identity.” It also provides us with important psychological benefits. “It’s like the keel on the ship,” Ramsey says. “You can have an awful day, but if you can lean on social support, be that your regular Tuesday basketball game, your church choir or whatever you use, the bumps in life are digested much better.”

Breaking Out of the Cycle

While social support is one of the most powerful protections against depression, it’s also one of its most challenging treatments. “In the depths of depression, someone’s self-esteem is awful,” Ramsey says. “They know they are not their best selves, and so they don’t want other people to see them that way. They are alone in the darkness, which perpetuates the depression and is also dangerous. Our biggest fear is that they end up isolated and disconnected, which leads to the worst outcome, which is suicide.”

Carl Tishler, a psychologist and adjunct associate professor of psychiatry and psychology at The Ohio State University, adds that trying to help depressed people back into the world when they don’t want to go can be difficult for those trying to help them. “The ‘alone’ feeling is something they don’t know what to do about. The friend or relative or significant other who is trying to help the person gets frustrated and throws her hands up and walks away,” he says. “That causes frustration for support-givers, who can feel overburdened, and then the depressed person feels increased guilt and becomes more withdrawn. It’s a viscous circle.”

How can depressed individuals escape this circle? Psychotherapy can help patients reframe their view of the world, making it less scary for them to re-enter. “Depression is a distortion in the mirror we evaluate ourselves in,” Ramsey says. “When we see or more importantly feel our role in others’ lives, that is very protective from the worst of depression.” Mental health professionals screen suicide risk by asking patients what keeps them alive. “We are reassured when people look you in the eye and say, ‘I know I need to be here for my children’ or ‘I need to show up to work because my employees depend on me,’” Ramsey says.

He also reminds patients that, even in the depths of depression, “their light can still shine and people can enjoy them. I spend a lot of time with people who are depressed, and I often find them making me laugh. I remind them that, in the midst of feeling horrible, they are still themselves.”

Start Small

Someone who is depressed isn’t likely to go to a big party. But he may be convinced to make baby steps back into society. That may be a small community function without much social interaction, or going to a movie instead of dinner with a friend to limit conversation, or simply taking a walk in a park, Ramsey says. “I want to chip away at their isolation,” he says. “One of the tips I learned from patients is that it is easier to socialize if there is something other than yourself to focus on.”

He also tries to add structure to their lives by creating commitments they need to meet. “It’s hard to go work out when you’re depressed, but it’s easier if you have a commitment of a class to go to.” He might also suggest less stressful ways to revisit activities patients usually enjoy. “If they used to like dinner parties, they might take a cooking class or go to a tasting menu, or simply go to a farmers’ market,” he says. “The goal is to get them out of the home and with other individuals. What makes you feel good is being with other people mutually enjoying an activity. Getting out of your head and into your life is one of the things I try to engage people in.”

Tishler adds that taking care of another living thing is also helpful. “[Caring] for plants or animals makes them feel they have some responsibility for another life, not just their own,” he says. “I have had a number of patients who, were it not for their dog, wouldn’t get out of the house. The dog forces them to meet the neighbors, say hello, go to the vet or to buy dog food. It forces interaction.”

Ramsey provides one more caution. “The word ‘social’ has changed because of social media,” he says. “Socializing online doesn’t count.” Indeed, data suggest that social media networks lead to more depression, he says. “Social media provides the potential for connecting us, but is real human connection really happening? When we spend hours online comparing ourselves to others, counting ‘likes,’ that is horrible for the human psyche. Make sure social media is actually social in that it is making you feel good and connecting you with friend outside the house. That is what feels best as humans, and I don’t need any research to support that.”

Sleep Better With Ways Diabetes

Sad but true: If you have diabetes, quality sleep may be hard to get.

However, you should work with your doctor to try and pinpoint just what’s causing your sleep problems.

“While a good night’s sleep and maintenance of a healthy weight are good for everyone, those good habits promise special health benefits for people with diabetes,” says Dr. Paris Roach, an endocrinologist with Indiana University Health in Indianapolis.

There are a few reasons why you may not get the restful sleep you need when you have diabetes.

First, major swings in your blood sugar at night can disrupt your sleep. “Very high blood glucose levels can lead to excessive urination, and sleep may be interrupted by frequent visits to the bathroom if blood sugar is poorly controlled,” Roach says. If your blood sugar gets too low at night, symptoms like restless sleep, excessive sweating and a pounding heart can occur.

A common condition called sleep apnea is more common when you have diabetes. “Apnea literally means ‘not breathing,’ and sleep apnea refers to brief periods of a minute or two when breathing is extremely shallow or absent during sleep,” Roach says. Usually, it’s a partner who spots this problem because you’re snoring or breathing shallowly at night. However, you also may feel fatigue or sleepiness during the day or have trouble concentrating.

Sleep apnea increases your chance of a heart attack and stroke, and the more severe the sleep apnea, the more severe the risk for diabetes, says Dr. Christopher Winter, medical director of Sentara Martha Jefferson Hospital Sleep Medicine Center in Charlottesville, Virginia, and author of “The Sleep Solution: Why Your Sleep Is Broken and How to Fix It.”

Another common problem in some people with diabetes is diabetic neuropathy. That can cause painful sensations in the feet like burning or stinging that can disrupt sleep. Another sleep disorder called restless legs syndrome can cause an urge to move your legs when you fall asleep. “Diabetic neuropathy and restless legs syndrome can be present in the same person, making the two sometimes difficult to separate diagnostically,” Roach says.

Because of these problems, insomnia is often more common in people with diabetes, says Dr. Rajkumar Dasgupta, an assistant professor of clinical medicine at Keck Medicine of USC in Los Angeles. Insomnia also can occur as a side effect of certain medications such as antidepressants – and depression can be more common in people with chronic diseases such as diabetes.

That lack of sleep can cause an increase in stress hormones, which then make it harder to control your weight. It can start a tricky cycle that connects to diabetes, obesity and sleep deprivation, Dasgupta explains.

To find out what’s causing your sleep issues, your doctor will likely recommend a sleepstudy. During a sleep study, your heart rate, body movements and brain activity are monitored to see how well you sleep and to determine what may cause your sleepproblems. Although these tests are often done in a lab, they can also now be done at home, Dasgupta says. This makes these tests more common and less of a hassle.

It’s important that you get treatment for any sleep disorders so you can have deeper rest at night and better function during the day. For example, if your doctor says you have sleep apnea, one common treatment is a CPAP mask, short for continuous positive airway pressure. You wear the mask over your mouth and/or nose, and it helps provide pressure to the upper airway so it stays open during sleep. “Most people can be fitted with a mask they can sleep with comfortably and are often surprised how much better they feel during waking hours when their sleep apnea is effectively treated,” Roach says.

Sleep apnea treatment may help with blood sugar control, insulin resistance and other signs associated with heart disease, Winters says. Also, losing weight can help improve and possibly eliminate sleep apnea.

For less-severe sleep apnea, doctors may recommend a dental device that moves your jawbone slightly forward while you sleep.

For blood sugar swings, some people will use a continuous glucose monitoring device, Roach says. Another solution is waking up once or twice at the night for a week to check your blood sugar and track trends. Usually, adjustments in medication or diet can help address this problem.

For RLS, your doctor may prescribe medications. You may also have to get your iron level checked, as that can contribute to the problem, especially in premenopausal females, Dasgupta says. If you smoke and you have RLS, there’s yet one more reason to quit: Smoking cessation can help alleviate the problem, Roach says.

There are some things you can do on your own to help improve your sleep:

Make sleep a priority. Sleep at consistent times and in adequate amounts, advises says Susan M. De Abate, a nurse and certified diabetes educator and team coordinator of the diabetes education program at Sentara Virginia Beach General Hospital. Many Americans are not getting the recommended seven to eight hours. Make a commitment to better sleep.

Sleep in a dark, quiet cool room, De Abate recommends. And put the technology away, as it can work against going to sleep.

Avoid sleep medications. They can make sleep apnea worse and have other side effects.

Use your bed for sleep only. If you have trouble going to sleep after 15 to 20 minutes, leave the bed and go read a book (preferably not on a tablet or electronic device, Dasgupta cautions). Do something that’s not stimulating for your brain.

Make exercise a habit. It will help you sleep better at night.

Talk about sleep problems with your doctor. Dasgupta sees a lot of focus on what’s happening in patients’ lives during the day and how that relates to health problems, but he’d like more talk about sleep issues. By diagnosing and treating sleep issues, you can improve your quality of life and your health, he says.

Food That You Should Not Eat

Imagine the following scenario. You’re engaged in conversation at a dinner party with friends that you feel comfortable enough to discuss “hot button” topics with. Politics, religion, and parenting techniques probably come up and most likely, the views vary by person. When I attend dinner parties, however, the issue of food is often the hot topic of the night, and even hotter, the opinions surrounding the right and wrong way to eat. It’s not enough these days that we are eating more kale (thank you trendy farmers markets and Hollywood celebrities!), we have to now dissect the right and wrong way to eat it as well. It was discussions like these that motivated me to write this blog. After all, my career surrounds helping people to simply eat better — to get, what I call, the most bang for their nutritional buck. There are many factors that impact the amount of nutrients that you will derive from a food. Things such as cooking and ripening method, food pairing and even your own gut flora may impact how much benefit you get from plant-based foods. Different varieties of foods affect this as well. Not all nuts, apples or as you’ll read in my first example, potatoes are created equal. If you’re interested in knowing how science views the best way to eat, then read on. Spoiler alert: Raw is not always the right way to go!

Potatoes 
Think you’re getting the benefits of the potato vegetable when you consume French fries, mashed or baked potatoes from white potatoes? Think again! One study found that it was purple potatoes that gave the best benefits, like lowering blood pressure and reducing the risk for cancer. Further, a 2014 study found that purple potatoes surpassed their white counterparts when it came to high amounts of polyphenols and decreased effect on overall blood sugar response.

Carrots 
As fall gears up, our love of soup increases as well. Next time you’re making a batch of chicken noodle soup, resist the urge to cut up your carrots. One study found that cutting carrots increased surface size and allowed more nutrients to leach out. That means after washing and peeling, your carrots should hit the water in their whole form. Keep cooking (vs. raw) though. One study found that cooking carrots increased the bioavailability of carotenoids.

Tea 
If you want high nutrient absorption with your high tea, then forget about doing as the Brits do it! Several studies have shown that adding milk to your tea may actually take away some of the cardiovascular benefits that tea provide. Going with green tea? Add a little juice instead to sweeten. The vitamin C in juice may help to increase the bioavailability of green tea’s nutrients.

Garlic 
Don’t rush your garlic, CRUSH your garlic! Research indicates that crushing your garlic and allowing to sit for at least ten minutes released an enzyme called allicin that has been shown to help reduce the risk of cardiovascular disease by making platelets less sticky or more likely to flow freely through the cardiovascular system.

Salad dressing 
Fat free dressing may seem like a good idea in theory, but when you look at what you give up; it’s no match for the full fat counterpart. Several studies have shown the benefits that fat has when dressing your greens, from keeping you fuller and more satisfied after consumption to getting more nutrient absolution from your salad (specifically from lutein, lycopene, beta-carotene and zeaxanthin).

Apples & Pears 
Let your fruit ripen up a bit! One study found that the ripening process allowed the breakdown of chlorophyll in ripening apples and pears which, in turn, produced more “highly active” antioxidants in the fruit.

Broccoli
Broccoli is, without doubt one of the best foods you can feed your body! Broccoli is part of the brassica family of foods, a family that has shown to be quite effective in terms of prevention of certain cancers from breast cancer to skin cancer , but how you prepare your broccoli makes all the difference in the world. A 2008 study found that steaming was the only cooking method that completely preserved, and even increased, the cancer fighting components of broccoli. Boiling and frying were found to be the worst cooking methods. Still don’t want to ditch the boiled broccoli? Pairing with a spicy food may help! A 2012 study found that adding spicy foods to broccoli increased its cancer fighting power and the spicier the better according to the study authors!

Mustard
Mustard in any form is a fabulous condiment to add to sauces, salads and sandwiches, but if you’re interested in decreasing overall inflammation as well as reducing your risk for certain cancers then you better keep your mustard choices simple. That’s right! It’s the cheap yellow mustard options that have the best benefits. Why? Because they contain a compound called curcumin (that’s the active ingredient in turmeric) that not only gives cheap yellow mustard its yellow color, but all of its potential health benefits as well!

While the factors discussed in this blog have an impact on the best ways to consume your foods, the truth is, simply adding these foods to your diet is a huge step in the right direction. Once you have mastered a liking for these healthier food options, the next logical step is to prepare in the best way for maximum nutrient density!