11/24/17

Friday, November 24, 2017

#DearDiabetes: Michael Eisenstein

Dear Diabetes,

Is that what they call you? My intimate stranger who invades every bit of me. They should call you out, put you on the FBI’s Most Wanted list and turn you into D Dust …

No one really knows you. Is that why you’ve attacked so many? Invaded enough of us so we’ll give you a name? You’re famous now. There have been thousands of studies, trials, journal article after journal article and investigators everywhere. You’re even on TV! But where is Detective Columbo asking the subtle questions to take you down? Where is Holmes, as your White-Walker Baskerville Hounds bay in the pancreatic moors?

The hundreds of millions you’ve taken hostage, as you took my family and I. The hundreds millions more you’re lurking within, that you haven’t taken yet, waiting for you to scrutinize their lives. How dare you?

I’ve called you “The Riddler,” because you are. At 17, my smarty pants internist told me I was hypo – as in glycemic. “Glucose too low,” he said after a gross glucose tolerance test – “It’s telling me you’ll have diabetes when you grow older.”

You were already inside my dad, hurting him. He took these little white pills to keep you at bay, along with other pills for the angina you caused. But that was my dad, not me, and I didn’t connect you to his heart – not yet. Didn’t connect it to me, the way I thought about most things at that live-forever age. I was too smart to get diabetes.

However, Mr. Smarty Pants was right. I got the call about you at work, decades later. My doctor calls and says, “Your fasting sugar this morning was 400. Eat something.” My blood test wasn’t supposed to show that; I thought maybe 85 or 90, or in the 70s like when I was 17. Thunderbolt. It felt like I’d been shot, unprotected by my fancy desk, in my cushy office with my big stupid job and my expensive Brooks Brothers tie. Frozen. I called my wife, who said, “Don’t worry. We’ll figure this out.”

Quickly, I turned to Google. What can I eat? “Low carbs,” the Internet said, and “just meat” and “go vegan.” Some chirped, “Cinnamon!” I began to Google more. Heart disease. What? Amputations! Phantasmagoric. I still played tennis, I was athletic, but suddenly you, a stranger, lurked inside me. Someone please pull your puppet strings and waft away like a frayed kite to the dark galaxy you came from.

I felt fine, but knew I wasn’t. At the follow-up, the doctor said I had high cholesterol and HBP. Three new things to worry about. Stay tuned, more to come. And more did come.

My wife’s obstetrician told her she had you, gestational diabetes, a new name for you. He warned her that the real you, type 2 diabetes, could follow. And you did a few years later, moving quietly into her body, as you did in mine. Both of us now on Metformin, both of us wondering more about the future. Both of us thinking about you every day.

Then you took a liking to our firstborn. You struck early with type 2 when she was 19. Now all of us were popping Metformin, fighting you, hating you, dragging you around all day—an invisible ball and chain. I never imagined my firstborn being hauled into an ambulance with KTA, languishing in the ICU with sacks of IV fluids drip, drip, dripping into her veins.

But I‘m where I belong now, my intimate stranger. Fighting you with my colleagues at the American Diabetes Association, where I was meant to be. There’s science everywhere—journals piling up on my desk, each one brilliantly attacking a piece of you, no matter where you hide. We are determined to strike at you, to find out who you really are, to discover why you’re here, and to put arrows into your heart to finish you off. One scientist told me you were evolutionary, and that nothing can eliminate or remove you from our bodies. Another says with a smile, “That’s so wrong; you’re not really part of us.” We’ll find you, turn off your switches, pull the plug on you, eject you from our bodies, forever.

DONE.

Michael Eisenstein
SVP, Products, American Diabetes Association

From: American Diabetes Association http://diabetesstopshere.org/2017/11/24/deardiabetes-michael-eisenstein/

Fish oil capsules: Net benefits for the heart are limited

Every day, millions of people swallow fish oil capsules, many of them lured by the promise that the pills will help them cast off heart disease. In fact, the label of one popular brand includes the line, “May reduce coronary heart disease risk.”

Don’t take the bait: these bold marketing claims haven’t caught up with the latest science. Earlier this year, the American Heart Association (AHA) issued an updated advisory about fish oil supplements and their cardiovascular benefits. Their verdict: fish oil supplements may slightly lower the risk of dying of heart failure or after a recent heart attack. But they do not prevent heart disease.

Angling for advice?

“It’s probably not wise for any middle-aged person to start taking fish oil supplements without the advice of a physician,” says Dr. Eric Rimm, professor of epidemiology and nutrition at the Harvard T.H. Chan School of Public Health. Even for people who do have heart disease, the potential benefits are quite modest, he notes. If you’ve had a heart attack, taking about a gram (1,000 mg) of fish oil per day may lower your risk of sudden cardiac death by about 10%. In people with heart failure, fish oil supplements may reduce death and hospitalizations by about 9%.

The AHA’s earlier recommendation, published in 2002, advised people with known heart disease to consume about a gram per day of the omega-3 fatty acids DHA and EPA, ideally from eating fatty fish. But people could also consider omega-3 fatty acid supplements in consultation with a physician.

The early evidence for fish oil supplements looked promising. But over the past 15 years, many trials have compared them with placebos. There is no evidence that taking fish oil supplements offers any benefit for people prone to cardiovascular disease, including those with diabetes, atrial fibrillation, or stroke.

Not necessarily risk-free

Even so, some people — including those who aren’t in that small group who might benefit from the supplement — may be tempted to keep taking fish oil. They figure that it can’t hurt and just might help. But that’s not necessarily true, says Dr. Rimm. Although “there’s still good evidence that eating fish twice a week may help lower heart disease risk,” he says, the concentrated oil found in supplements is not entirely without risk.

As is true for all dietary supplements, there is no oversight or regulation regarding the source, quality, or amount of active ingredient in these over-the-counter products. Some studies have detected trace amounts of polychlorinated biphenyls (PCBs) in some brands of fish oil supplements. Although these industrial chemicals were banned in 1979 after they were linked to cancer, they’re still found in fish exposed to water contaminated from soil runoff. Other research has revealed that some supplement brands don’t provide the amounts of DHA and EPA advertised on their labels.

It’s also worth noting that fish oil may reduce formation of blood clots. That’s potentially beneficial, but only up to a point. Too much fish oil may increase bleeding risk, particularly in people who also take anticlotting medications, including warfarin (Coumadin) and low-dose aspirin.

Many people take low-dose aspirin for heart attack prevention, Dr. Rimm points out. “Taking fish oil on top of that may not only have no benefit, it may even have some risks that we don’t realize because we haven’t studied them.”

The post Fish oil capsules: Net benefits for the heart are limited appeared first on Harvard Health Blog.

From: Julie Corliss https://www.health.harvard.edu/blog/fish-oil-capsules-heart-benefits-limited-2017112412763