May 12th, 2008 by Dr. Val Jones in Celebrity Interviews
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I had the chance to interview diabetes spokesperson and Hollywood A-lister, Maria Menounos, at a recent diabetes conference. Prior to the interview I was given her Entertainment Industry Foundation biography for my review. Most of the biographies that I see belong to physicians and health policy experts – so it was an interesting change to read an entertainer’s biography.
Of note, Maria is a featured reporter on The Today Show and Access Hollywood – she has directed and produced several films and was listed in People Magazine’s “50 Most Beautiful People.” She also landed in the top five of the askmen.com poll for “the girl men most want to marry” along with Angelina Jolie and Charlize Theron.
But don’t let her beauty fool you – Maria has struggled with poverty, a chronically ill father, and her own weight issues. I enjoyed getting to know her better, and to learn about why she is such a passionate advocate for diabetes awareness. Enjoy our chat!
Dr. Val: Tell me a little bit about your dad’s diabetes and how you’ve been helping him to manage it.
Maria: My dad has type 1 diabetes, and he’s quite unusual in that he is extremely compliant with medical advice and dietary restrictions. He NEVER cheats. Many years ago he was told to avoid carbohydrates and so even when he was having a low blood sugar attack he’d refuse to drink juice to bring up his levels. Unfortunately my dad’s English isn’t so good (his native language is Greek and he has quite a language barrier with doctors) and I think a lot was lost in translation when he was given advice about how to manage his disease.
As a result of growing up in a poor neighborhood and not having access to more advanced medical care (along with the language barrier), my dad’s doctors were not particularly effective at communicating what he should be doing. My mom did her very best to follow their instructions religiously – she became his personal chef and kept him from eating carbohydrates.
My dad was in and out of the hospital all the time for low blood sugar, and because of a lack of coordination of care my family never realized why this was happening or what we could do to prevent it. So we were trying harder and harder to be more strict with his diet, which was in fact making the problem worse. My dad did janitorial work and would nearly pass out on the job due to a low carbohydrate diet. But since the doctors told him not to eat sweets or bread or pasta, he believed that his sickness was due to his not being strict enough, so he’d just eat less and less until he ended up weighing 140 pounds at 6 feet tall. My family was living in constant fear of him passing out again and needing to go to the hospital. We knew every ambulance worker and every fireman in our neighborhood by name because they were always at our house.
Finally when I moved to Hollywood and had some career success I was able to get my dad to a world renowned endocrinologist, Dr. Anne Peters. Within three visits she straightened him out and explained how he did in fact need to eat some carbs. She got his blood sugars evened out and he never had to be hospitalized again.
What scares me the most is what’s happening to people who have diabetes and language barriers. They’re at incredible risk for misinformation, confusion, and poor care. Imagine how many people in this country are just like my dad – trying to follow advice they don’t fully understand? This is a real problem that we often overlook in diabetes education.
Dr. Val: As a Hollywood insider, how aware are your peers about diabetes and is there much talk amongst them about getting involved in campaigns to reduce type 2 diabetes?
Maria: I’m sure they are but I haven’t come across that many. It doesn’t come up that frequently. There haven’t been any breakthroughs in insulin therapy or any other huge scientific advances in diabetes care so the topic isn’t that newsworthy or “sexy.” It’s a real shame that it isn’t talked about more. Everyone seems to be aware that type 2 diabetes is preventable but no one seems to know how to do so. They don’t realize that you need to lose weight and exercise. But I learned about that when I had a weight problem.
Dr. Val: YOU had a weight problem?
Maria: As I said, I came from a diabetic home. We ate vegetables fresh from the garden every day and my mom was extremely careful about what we ate. We didn’t eat anything bad. My mom would buy ice cream and Doritos like, once a year when family was coming over. I didn’t even know what a bagel or a waffle was for most of my time growing up. Then I went to college and there was endless all-you-can-eat food. So over 3 or 4 years of eating pizza and I ended up gaining 40 pounds. One day I decided that I wanted to move to California and get into the business and I realized I needed to lose the weight.
I wrote down everything I ate in a week, and I realized that my problem was carbs. So I cut them back substantially and the weight just melted off. I lost about 20 pounds in several months, and then I added exercise to get the last 20 off. I’ve never looked back.
Dr. Val: How can we be more effective in getting Americans involved in their own health?
Maria: First of all, I think that we need to focus on educating children about healthy lifestyle choices. We have to get the message to them early. Kids enjoy knowing more than their parents and teaching them something new. So it’s really empowering for kids to learn about nutrition and then bring that knowledge home to their families and teach them a thing or two.
Obviously getting Americans to be more involved in their health is a very difficult challenge. Many people are struggling to get by and don’t have time to put their health first – they have to focus on work, paying their gas bill and putting food on the table. It will take a national, coordinated effort to really make a difference.
**Join Dr. Val’s Weight Loss Group**This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
February 8th, 2008 by Dr. Val Jones in Expert Interviews, News
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Much to the dismay of scientists, policy makers, and health care administrators, good medical decision making is not always black and white. I understand and sympathize with our desire to distill complex disease management issues into specific, easily measured variables. But unfortunately, the human body is exceedingly complex, and willfully resists reductionist thinking.
The recent ACCORD trial (which was designed to quantify the value of aggressive glucose management in a diabetic population) actually demonstrated a higher mortality rate in the intensive treatment group. What? That’s right, people were more likely to die if they had been randomized to the group that used all means necessary to keep blood sugars in a near normal range.
Now, this does NOT mean that it’s a bad thing for diabetics to keep tight control of their blood sugars, but it MAY mean that if they have to take high doses of multiple drugs to get them to that aggressive goal, the negative drug side effects may collectively outweigh their benefits.
I spoke with Dr. Zachary Bloomgarden, a renowned diabetes expert, to discuss his interpretation of the trial results. Here is a snippet from our interview:
My feeling is that this study shows that there is an art to medicine, and that patients can’t be managed via cookbook methods to treat their disease. If a person can control their blood sugar to an A1c of 6.0 without using too many medications, then that might be a good goal for him or her, but if you have to take high doses of several pills to get to that same goal (and therefore experience all the unfavorable additional side effects from taking them like weight gain, fluid retention, and potential arrhythmias) then it might not be appropriate in that case.
Ultimately, it takes a personalized approach by an experienced physician to determine the best treatment plan for an individual patient. One size doesn’t fit all – that’s part of my
take away from this study. We still
certainly want all people with diabetes to do as well as they can with blood
sugar as well as blood pressure, cholesterol, and the myriad other markers of
control of the disease.
And so my plea is that in our race to ensure “quality care for all” in this country, we take a moment to consider that real quality may not be about getting every patient to the same blood test target, but to get every patient to a primary care physician who can apply evidence based recommendations in a personally relevant way. Cookbook medicine is no substitute for good clinical judgment. Let’s invest in our primary care base, and make it financially viable for them to spend the time necessary to ensure that their patients are on individually appropriate therapeutic plans. I hope our next President will appreciate the critical role of primary care in a healthy medical system.
Addendum: a like-minded fellow blogger weighs in on the study
.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
November 27th, 2007 by Dr. Val Jones in Expert Interviews
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I was speaking with Revolution Health expert Dr. Zach Bloomgarden about advances in diabetes care, and I suddenly realized that enhancing compliance with lifestyle measures is more important than researching treatments. In other words, we have the power to cure many cases of type 2 diabetes already – without any new research/treatments. The challenge is sticking with diet and exercise programs. Perhaps the same could be said of many diseases.
I thought I’d share this audio clip of Zach explaining that we already have the tools to radically improve diabetes outcomes and virtually eliminate this disease.
Listen Here
I hope that the new community groups at Revolution Health will help us all work together to get to a healthier place. I’m still struggling along with my diet team. I’m proud of those who have had great success already!This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 27th, 2007 by Dr. Val Jones in Health Tips, News
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Heart disease is the number one killer of Americans, and high cholesterol levels are a primary contributor to heart disease. But the cholesterol story is a bit complicated – some of it is damaging to blood vessels (Low Density Lipoproteins or LDL is considered “bad” cholesterol) and some of it is restorative (High Density Lipoproteins or HDL is “good” cholesterol). Most medications are aimed at lowering the “bad” cholesterol, and this strategy has been very helpful in reducing heart disease and atherosclerosis. But what about raising the good cholesterol as part of a heart healthy strategy?
A new study in the New England Journal of Medicine suggests that having low levels of HDL can put people at risk for heart disease and heart attacks, even if the LDL is well controlled. This is the first study to show that low LDL does not erase heart disease risk if the individual’s HDL is also low. In fact, each increase of 1 mg in HDL cholesterol is associated with a decrease of 2 to 3% in the risk of future coronary heart disease. So lowering LDL with statins (if lifestyle measures fail) is only half the battle for those who also have low HDL.So how do you increase your HDL levels?The most effective medicine for raising HDL is a type of Vitamin B called niacin. Taken in the quantities required to have an effect on HDL, though, there are usually unpleasant side effects: flushing (redness or warmth of the face), itching, stomach upset, mild dizziness, and headache.
Perhaps the best way to increase HDL is to lose weight and exercise regularly.? In fact, the list of HDL-raising “to do’s” reads like a healthy living manual:
1. Avoid trans fats
2. Drink alcohol in moderation
3. Add fiber to your diet
4. Use monounsaturated fats like olive oil where possible
5. Stop smoking
6. Lose weight
7. Engage in regular aerobic exercise
So next time you see your doctor, make sure you review your cholesterol levels, and discuss some strategies to get your levels of HDL and LDL in the optimal zones for a healthy heart.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 10th, 2007 by Dr. Val Jones in News
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I rarely get too excited about mouse studies, but this one is pretty amazing. Researchers at my alma mater have discovered that osteoblasts (cells that create bone) secrete a certain protein that affects the health of the pancreas. The protein (osteocalcin) stimulates the pancreas to create more insulin-secreting beta cells. When people don’t secrete enough insulin, the result is often type 2 diabetes. So a healthy pancreas with a good insulin secreting capacity is critical to regulating blood sugar.
The researchers also discovered that mice who were bred to have no osteocalcin gene had abnormal amounts of fat in their bodies. So this means that bones may have something to do with energy metabolism and weight gain.
Of course it’s too early to speculate on the implications of all this (what’s true for mice is not necessarily true for humans – but I’m going to anyway). Since bone cells (osteoblasts) are sensitive to gravity, and increase their activity with weight bearing, this could explain why exercise (especially weight lifting) is important in weight loss. The new ACSM guidelines recommend weight training as part of a healthy exercise regimen, and the underlying mechanism for this may be that bone cells rev up metabolism and insulin secreting capacity in response to weight lifting.
So, if you want to lose weight – make sure you stimulate those bone cells with some good weight bearing exercises. They may just help to reduce your risk of type 2 diabetes as well!This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
