Just you wait! Your turn is coming! (updated)

Things are still pretty hectic and my writing time is still sporadic, but I wanted to get this down before too much time passed and I forgot too many details.  So here is a continuation of our new doctor medical practitioner saga. 

Dh had his triple appointment last week.  I made a mistake in my last post; I thought we would get to see the actual doctor, but nope, not at all.  That appointment turned out to be with someone to help with chronic pain, but still another nurse.

When we came in for his appointment, he went to the receptionist.  She looked him up and noted that he was due to see the dietician first, then the diabetes nurse, then the NP.  Dh asked, "what about the chronic pain specialist?"  The receptionist checked again and corrected herself.  The second person was the chronic conditions specialist, who usually sees patients about diabetes, so she had assumed he was there to talk to her about his diabetes.  She apologized for the assumption.

Shortly after, we got called in to see the dietician.

It did not go well.

First off, after the introductions, she asked us why Dh was there to see her.  It turns out that, while she had been able to look at his file, there was nothing specific about why an appointment was made with her.  We just sort of hemmed and hawed a bit, then said we guessed it was because of Dh's diabetes.  He's been having difficulties controlling his sugars, especially when the pain gets really bad (as it has been recently).  He can't get enough exercise because of the pain, the meds don't seem to be doing very much, so we figured he was there to talk about dietary possibilities.

The rest of the meeting was very disjointed, uncomfortable and... weird.  One of the things we found weird was a mannerism; she talked as if we were 5 yr olds.  I wasn't sure what to make of it, but I'll assume she is used to talking to patients who don't research their own conditions very much - or anything else, for that matter.  Who knows?

We were booked for a 1 hour meeting with her and went over time by about 10 minutes.  In all that time, we basically came away with:

- eat more vegetables.
- and lentils.  (looking things up since then, lentils are on the off list, along with several other foods she mentioned, though plenty of sites promote lentils as some sort of miracle blood sugar controller)
- Dh doesn't have to avoid fruit (even though we told her fruit makes his sugars spike badly)
- margerine is better then butter
- butter and margerine both have 45 calories per teaspoon, and that has something to do with why there's no difference in bioavailability between butter and margerine.
- he should eat yogurt and cheese (yes, we did mention he's lactose intolerant, which is why milk isn't on the list, but he should just take lactase and eat them anyways)
- she thinks Dh, who is 6'1", should only eat 1800 calories a day (that was the level of starvation for men in the Ancel Keyes starvation study during WWII)
 
Now, Dh's diet sucks.  We know that, and it's a point of contention between us.  He'll go on about how he needs to eat healthier, but when it comes time to actually sit down for a meal, he eats little or none of the foods he's said he should be eating.  When it comes right down to it, though, we already know that the diet that best meets his needs for controlling blood sugar is basically an Atkins or paleo type diet - high protien,  plenty of fats, very little carbs.  The problem with this is it's friggin' expensive.  The price of groceries has been increasing quite a bit over the past couple of years and, though we've increased our grocery budget, (it's looking like I'm going to have to find some way to increase it again soon),  it's still not affordable for us to be buying that much meat (and no, vegetable substitutes are not adequate to the job.  They may be for others, but not for him).  When it comes to stretching the food budget, there's little that can beat the cheapness of high carb foods.  They are also a lot easier to work with and work out better as lunches for him at work.  For someone who's struggling just to bring his numbers into the single digits (in the Canadian system), that isn't going to work for him.  Even whole wheat pasta (which he finds disgusting) causes his sugars to spike, so all pastas would have to be out, along with all breads, potatoes and rice, along with fruit. 

Anyhow.

So that meeting wasn't particularly useful, and I found myseld dreading the idea of seeing her myself.  Especially since I have even less reason to see her then Dh did, and his appointment seemed to confuse her enough as it was.

Our next appointment was with the chronic care nurse, and I will say right now, she was AWESOME!  To begin with, she had a great attitude, which always makes things easier.  However, she asked us a lot of questions about his injury (the pain of which was the reason we needed to get a new doctor so urgently in the first place) and his history with it.  We also talked about his blood sugars, but it was in relation to everything else.  We learned a few new things from her.  For example, no one had ever mentioned the need to wash your hands with plain soap and water before using a glucometer to us before.  It turns out that just basic sweat on your hands can lead to false high readings.  Scented and fancy soaps can also cause false high readings, as can those anti-bacterial hand sanitizers and wipes.  "Milking" your pricked finger to get a drop of blood out can also lead to false readings, so it's a good idea to vigorously rub the hands together before using the lancet.

You know what else can lead to elevated blood sugar readings?

Pain.

Of course, Dh has noticed his readings getting wildly higher when he's in a lot of pain, but this is the first time anyone actually said outright that the pain itself has anything to do with it.  With every other person, his diabetes was viewed in isolation from his back injury, and since he's started seeing the NP at this new clinic, the focus has been entirely on his diabetes, with almost no discussion about the injury.  As I mentioned in my last post, stress is something else that can cause high readings, and he's got plenty of that completely aside from his pain, too.

While we saw her, she took his blood pressure.  His BP was normal, though one reading was ever so slightly on the high side of normal compared to the other.  His heart rate was really high, so she checked it again.  It was still high.  No surprise, really.  Aside from "white coat syndrome" (his BP readings are always higher in the doctor's office then when taken elsewhere, though they don't usually cross over into the high range), he was in massive amounts of pain at the time - he needed a cane to walk, and was breaking into a sweat from the pain, just sitting there.  Or should I say squirming, not sitting, as he constantly had to adjust his position to try and alleviate the pain.

Oh, there was something else that stood out.  During the meeting with the dietician, she had asked if we knew what Dh's A1C was.  She didn't see one on his file.  The last one Dh could remember, it was 9.  The chronic care nurse, on the other hand, had no problem finding it in his file.  It was 7.   That is still higher then recommended, but it is a HUGE improvement from where it had been some time ago.  He's cut his A1C to about 1/3rd what it was at one point.  She was pleased by that progress.

In the end, there wasn't much she could do for him.  He's got his MRI in about 2 weeks.  She did say that a major part of controlling his blood sugars is going to be controlling his pain - we're not going to get much progress with his sugars as long as he's having so much trouble with his back.  Until she gets the results from the MRI, though, she wasn't going to suggest anything beyond what we're already doing.


Even so, we came out of that meeting pretty happy.  She was really refreshing, and we felt confident that she was interested in all of his issues, not just his diabetes.  We look forward to seeing her again.

Then there was the appointment with the NP.

*sigh*

Now, the last time he saw her, she'd added 2 more prescriptions to his collection - baby asperin and a low dose blood pressure medication.  Note that he does not have high blood pressure, but the combination is to help protect his kidneys from all the other meds he's taking.  At least that's what we were told back then.

That's right.  Because he's on so many meds, they may be over taxing his kidneys, and the solution is to prescribe more meds.

No, there's no actual evidence that his kidneys are having a problem.

This time, she went over his numbers and latched onto his BP reading.  You know, the one that was normal, but had one number on the slightly high side of normal.  Both of which were slightly lower then the last time he saw her, so even though the low dose blood pressure medication was prescribed to him as being part of protecting his kidneys, she attributed the slightly lower reading this time to the prescription (because apparently any fluction can only be because of meds).  She wanted that second reading to be more in line with the first reading - or at least that was her reasoning - so she doubled the dosage on the BP prescription for him.  She also added two new prescriptions.  One is a cholesterol medication.  Does he have high cholesterol?  Of course not.  However, his HDL reading was lower then she wanted it to be, so more pills!  The other was a low dose anti-depressant.  This was the first one that was actually about his pain; it seems that low dose anti-depressants have been found to help with chronic pain.  At least that's what she said then; at this rate, I wouldn't be surprised if she says something else the next time he sees her.  The first brand of anti-depressant she named was one he'd been put on many years ago and reacted badly to, so she wrote him up for another one we've never heard of before.

As she was writing him up for all these prescriptions, I made a comment about "more pills" for him to take.  That's when she looked at me and said,

"Just you wait!  Your turn is coming!"

Then, before I had a chance to react, she started talking about when my appointment with her was.  It had originally been booked for the afternoon of the same day as Dh's triple appointment, but I hadn't had a chance to take the blood test, so I had rescheduled it to the end of this week.  I'm not sure what to make of her reaction, but her promise - threat? - was clear.  She already intended to put me on prescriptions, even though she had yet to see any new test results.

I was not impressed.

We finished up the appointment with getting Dh written up for medical leave for a week, on top of the days he'd already missed from the week before because of the pain.  By then, he was pretty wasted, so I took him home so he could lay down for a while.

That evening, I took the new prescriptions to the pharmacy.  There's one pharmacist I've been dealing with regularly, and he's quite familiar with Dh's file by now.  He's also given us a lot of advice and information, and we're quite comfortable asking him questions.  I had plenty of them when I gave him the new prescriptions.

I talked to him about the BP medication that got doubled, even though Dh's BP was normal.  He was rather taken aback by that.  He was also taken aback when I mentioned that Dh had just gotten 2 new prescriptions so recently, and now there was 2 more.  On looking at the list, he asked if Dh was having sleep problems.  One of the new meds - the anti-depressant - is often prescribed to people as a sleep aid.  This rather alarmed me because of Dh's severe obstructive sleep apnea.  When I mentioned that, the pharmacist was yet again taken aback that she would prescribe something like this to someone with sleep apnea.  That one was to be taken just before going to bed, but the other new one was to be taken in the morning, about half an hour before eating.  Dh is already taking something at that time, which I mentioned.  The pharmacist did yet another double take and checked the file.  It turns out the two meds are contra-indicated!  So he changed the instructions so that the old one is still taken half an hour before eating, while the new one can be taken with food.

Then the pharmacist noted the NP's name on the prescriptions and realization seemed to dawn on him.  It turns out he's had problems with this NP before - and he's never met or talked to her.  He knows her by her prescriptions.  Which is pretty interesting, considering this clinic is so new, and she's been there only a couple of months.

Dh is still going to take the new medications, though we have serious reservations about it.  He now has 11 different meds that he's on, including an injection, with two of them needing to be taken 3 times a day.  Of all those, only the 2 meds related to his back injury are taken as needed, rather then at set times.

There's something very wrong with this.

I've been really unhappy with all this.  We called this place looking for a new doctor, and we have yet to see one.  The doctor at this clinic we'd originally asked to see comes highly recommended by our pharmacist, I've heard positive comments about her elsewhere, and even Eldest has heard good things about her from someplace else.  Instead, we're seeing an NP seems to be a pill pusher and seems to make her decisions not based on actual readings, but her own idea of what things should be - and she's already got me labelled and is eager to put me on prescriptions, too!

So what do we do?

Today, I called and cancelled my appointments with the dietician and the NP and asked for an appointment with this doctor.  It turns out I still need to book a meet-and-greet appointment, and the earliest that can be done is in September.  That works for me, but Dh can't wait that long.  He's stuck seeing the NP for at least a few more times, as we have another follow up appointment before his MRI, then a follow up for the MRI results.

I still have to book an ultrasound for myself - my reason for seeing a doctor is still about the discomfort in my side - but I'm not going to take the fasting glucose test again.  When I see the doctor in September, I want to ask for an oral glucose tolerance test instead.  Meanwhile, I'm still using Dh's glucometer to test myself, and my non-fasting blood sugar levels are well within the expected ranges for non-diabetics, even based on the printout the dietician gave Dh.

I don't know if I dare hope too much that when I finally see the doctor, it will work out.  For all I know, she might be much like the NP.  Or she could be more like the chronic care nurse.  I don't know.  As I've been looking more into the implications of the change in diagnosis for diabetes, the more disturbed I am about it.  Will the doctor be just as eager to hang a Sword of Damocles over her patients as the NP?

Before the diagnosis change, 4.0 - 6.9 was considered the "normal" range for blood sugars.  7.0 and up was considered high.  Readings below 4 can be dangerous and, for someone with diabetes, readings of 4.5 or lower can be equally dangerous, as their blood sugars can drop so quickly, leading to coma and possibly death.  Still, there was a decent range of "normal."

Then the "pre-diabetes" notion showed up, and readings in the 6 range were considered something to worry about, but was still in the normal range. Readings of 4.9 or lower just don't seem to be discussed much anywhere.  Now, with a diagnosis of diabetes being made with only a single reading of 6.0 or greater, the range of "normal" is so small, it's almost impossible to not be diagnosed diabetic!  It also means that anything under 6 is now "pre-diabetic."  So basically, we're all either low blood sugar, "pre-diabetic" or diabetic.  How does that even make sense??

So if you're reading this and think you don't have to worry about being diagnosed as a diabetic, just you wait!  Your turn is probably coming, too.

update: June 28

Since writing this, I've had a chance dig around some more, and I'm even more pissed with the NP then before.  First off, I'm not finding anything, anywhere, that the threshold to diagnose diabetes has changed from => 7.0 to => 6.0  Going through the Canadian Diabetes Association website, not only does it still say 7.0 and higher for a fasting blood glucose, but it also says that no matter what type of test was used, a second test should ALWAYS done before diagnosis. 

I noticed something else.  For the fasting blood test, everywhere I looked said to fast at least 8 hours.  I was told to fast at least 12 hours.  As we go without food, our livers begin to release glucose to prevent our cells from starving, so even without eating, our blood sugar levels can go up the longer we go without food.  The sites I read also all said that only water is to be ingested during the fasting period.  I was told I could only drink a small amount of water in the morning.  Lo and behold, there is some sort of relationship between water and blood sugar levels, though the why and how of it is not completely understood.  Lack of water can lead to a high blood sugar reading.  More importantly for me, lack of water in general also leads to high blood sugar levels.  I don't drink much water, as I don't enjoy the taste.  Yes, I know, water isn't supposed to have a taste, but ours does.  I don't like bottled water, either, as I find they have an unpleasant taste, too (I find Dasani quite salty, for example).  Though I do drink things like tea, Coke Zero or iced tea, depending on what we happen to have in the house, I don't drink much of anything overall.  I have been recording my food and drink along with my blood sugar readings for the past while.  I also been recording all fluids *except* water in my records, though it's still on my mind as I document it all.  In the process, I've come to realize that not only am I not eating much, but I'm drinking even less, to the point that dehydration is probably a concern. So here I have yet another possible cause for my one anomalously high fasting blood sugar test. 

Not only is my increased level of stress lately a contributing factor; not only is my borderline dehydration another possible contributing factor, but the parameters I was given for my fast were practically a recipe for a higher reading.

And this woman's specialty is diabetes.  I find myself thinking of the old saying, that when your only tool is a hammer, everything starts to look like nails.

Really?

It's been a while since I've posted - life has been hectic, and there's no sign of things slowing down.  We're actually heading into the busiest time of our year, so I don't expect to be posting regularly for a while.

It's probably silly of me to be starting a post now, when it's past 1:30am, but I feel the need for a rant.

First, a bit of background.

We lost our family doctor.

We're not sure what happened to him, other then he went on medical leave and hasn't come back.  I had been expecting to hear back about the ultrasound I had done to try and figure out why I'm having pains in my lower left side, near where I had a large cyst removed over a year ago.  Though the discomfort is usually mild - it feels like I pulled a muscle or something, except it doesn't go away - it sometimes becomes uncomfortable to the point that I can't sit up straight.  Every now and then, there are sharp, shooting pains as well.  I figured it would be a good idea to get it checked out, rather then just put up with it, like I normally do with such things.

When I didn't hear from our doctor's office, I figured it was one of those "no news is good news," things; they had no reason to have me come in.  Then Dh needed to see the doctor and called to make an appointment.  There was an automated message saying the doctor was on leave for medical reasons (which has happened before) and giving the name of a doctor at another clinic that was willing to take our doctor's patients, if needed.  We were willing to wait for our own doctor, so never called the other one.  Eventually, though, Dh needed to get updated prescriptions and called again.

The number was no longer working.  Not even our pharmacist had a working number to get an updated prescription.  We ended up having to pay an extra fee for the pharmacy to able to get a 1 month prescription renewal for him.

Dh ended up calling the College of Physicians and Surgeons and, while they didn't know what happened with our doctor, they were able to see that all his files were sent to a holding company in Ottawa!

Long story short, we found ourselves in need of a new family doctor for the 4 of us and, based on a recommendation from our pharmacist, we found one almost immediately at a new health centre just up the block from our pharmacy.

Sort of.

 Dh ended up needing to see a doctor quickly, and they were able to get him in on the same day.  I made appointments for me and the girls for a meet and greet at the same time.

Except we never actually saw a doctor.  Nurse Practitioners (NP) do the majority of the visits with patients now, including being able to prescribe most medications.  We all ended up with the same NP.  Dh had his visit, got written up for a new and very thorough set of blood tests.  The girls and I came back a few days later for our meet and greet appointments, which we were able to do together, saving a whole lot of time.

Before my appointment, they were able to look up the results of the ultrasound for me.  The only thing that was found was a 6mm benign cyst on my left kidney - not something that could be causing the discomfort I'm feeling, nor anything of any concern.  Also, my liver is slightly larger then expected - a "fatty liver" - but I knew that already from an MRI I had done a few years back.  It's also not a health concern.  Everything showed healthy.  I got written up for a very thorough series of blood tests as well, and that was that.

At this point, I was feeling cautiously optimistic about the situation.  Sure, we weren't actually seeing a doctor, but if an NP can do the job, I'm good with that. 

Then I came back for a follow up visit.

The results of my blood tests were pretty much as expected.  My thyroid is working fine, my cholesterol is fine, my liver had one slightly elevated reading, but that was expected and is not a health concern, etc.  There was one reading however, that was off.

My blood sugar was at 8.2  This, apparently, is now considered very high.

Now, I've been pretty aware of my blood sugar levels.  When Dh was first (mis)diagnosed as diabetic (the high reading was before he got his CPAP, and it normalized after his sleep apnea was treated) we charted both his and my blood sugars several times a day for a week for comparison.  Both were well within normal ranges, though mine were on the low side of normal.  Years later, he was re-diagnosed, and this time his blood sugars really were consistently and extremely high.  We still tested my blood sugars every now and then, just to compare.  'cause we're like that.  Mine continued to test normal.

In all these years, my blood sugars have been well within the normal range, and no sign even of "pre-diabetes."  The most recent series of blood tests were about a year ago, and there was nothing odd about them.  My blood work has consistently tested right where it was supposed to be.

But with this one reading, she was ready to pronounce me a diabetic.

Now, if this had been my old doctor, I would not have been suspicious or concerned.  With the NP, however, there were a few things she said that made me increasingly bothered.

First, there were the comments in regards to diabetes itself.  She had some pages printed out from a medical website she referred to as her "Bible." (It turns out diabetes is a specialty of hers.)  I can only half remember the name, and in searching for medical websites, I can't find anything even close to what I'm half remembering.

Anyhow, she started reading off about diabetes to me from this printout, including the part that mentioned that the percentage of people with diabetes is 75%.  I did a double take, but didn't say anything, as she kept on talking, but this sounded really off.  I've looked it up since then, and the Canadian Diabetes Association says that there are 9 million diabetics and pre-diabetics in Canada.  Hardly 75%.  Did she actually believe that 3 out of 4 people were diabetic, whether they knew it or not?  Did I missunderstand what she was saying?  Unfortunately, I can't find anything that could clear that up.

The other thing she mentioned was the change in diagnosis.  It used to be that a blood sugar reading from 4-6.9 was considered normal, while 7 and up was considered high.  Now, anything 6 and up is considered high.  Way to make sure lots more people get diagnosed diabetic.  (It reminds me of how the range of "normal" weight on the BMI was dropped, rendering millions of people "overweight" in an instant.)  It also used to be that it took more then one test to determine if a high reading was not an anomaly, but it hasn't been done that way in a long time.  Now, all it takes is a single high fasting blood sugar reading, and that's it.  No matter how normal your blood sugars might be after that, you're still considered a diabetic, since diabetes is a chronic condition with no cure.

When I mentioned that this reading was a surprise and an anomaly, she said she was willing to give me "the benefit of the doubt."  She wouldn't diagnose me as a diabetic just yet (NPs can now render diagnosis without a doctor, apparently), and wrote me up for another blood test, this one for just fasting blood sugars.

As we were talking, we went back and forth with the other test results as well.  When she went back to my liver test, with it's one slightly elevated but not a concern reading, she mentioned treating it with weight loss.  ??  If something is not a health concern, why does it need to be treated?

The kicker was when she mentioned the normal thyroid results again, saying that we'd tested my thyroid to rule it out as the cause of my weight.

What?  When she wrote me up for blood tests, my weight was never mentioned at any point.  She certainly never mentioned anything in particular about testing my thyroid, since she was checking me off for a whole bunch of things that tend not to get tested for very often.  She had said she wanted to get a thorough blood work, and that's what I got.  The only thing that was mentioned in any other context was when she saw that I had some testing done on my liver in the past - some 5 or 6 years ago - because I'd been put on a prescription that had liver damage as one of the possible side effects.  I wasn't on that prescription long, so it was never an issue again.  That was partly why testing my liver was thrown on the list, too.

One of the things that she said was that, based on the 8.2 reading, she would put me on metformin.  She wasn't going to because of my saying this was an anomalous reading, so she'd wait for a second test to confirm that I'm diabetic.  She clearly already thought of me as such.

Because Dh has a series of follow up appointments coming up, she had me book a follow up appointment with her to go over the new test results, plus a dietitian, on the same day as Dh.  Hopefully, even at the same times, in that he'd be seeing the dietitian while I was seeing her, then he'd be seeing her while I saw the dietitian.  He also has an appointment with the actual doctor, whom we've yet to meet.  In the end, they were only able to book me in the afternoon.

Well, I didn't get a chance to take the test, so I've rescheduled my appointments.  I have to admit, though, I'm not happy with this.

Now, don't get me wrong.  It's entirely possible that I have suddenly become diabetic.  That's not how diabetes works, but it's possible.  I'm over 40 and fat, so my risk factor is a bit higher, however T2 diabetes has a strong hereditary factor, and both my parents are fat, and there is no diabetes in my family.

What gets me is that, if she really believes that 3 out of 4 patients she sees are diabetic, then she'd have decided I was diabetic right from the start, and before I was tested, simply because... I'm a fat, middle aged woman?  Granted, so is she, if not as large as I am, but still...

She also made no attempt to learn more about me.  No attempt to figure out why I went from normal health to diabetic within a year.  She did ask if I'd gained any weight, and I have - it was something I'd intended to bring up, because it's so unusual.  I've gained between 15 and 20 pounds in the space of a few months.  Curiously, I have not changed clothing sizes at the same time.

Oh, and we did also discuss the reason I wanted to see a doctor in the first place - the pain in my side.  I've been written up for another ultrasound.  The previous one was abdominal.  This one will be pelvic.  Beyond that, she really didn't know what to make of it.  It might be because of scarring from my surgery, but that's about all she could think of.  Hopefully, the new ultrasound with tell us more.

So I go to see a doctor (or not see one, as the case may be) about a pain in my side, and end up being told I'm fat and most likely diabetic.

From an NP reading off of online printouts with information I can't find anywhere else.

Since the appointment, I've found myself becoming increasingly angry about this.  Not because of her diagnosis - if I'm diabetic, then I'm diabetic - but because of the circumstances surrounding it.

Oh, and there was one more thing she said that has perplexed me from the start.  Near the end of the appointment, printouts for tests in hand, talking about the follow up appointment with her at the same time as the dietitian (because... I'm fat?  She is convinced I'm diabetic?), she gave me this sort of slyly humorous look and said, "you don't have to be diabetic if you don't want to be."

Really?

What does that even mean??  Is she saying that I can just ignore it and pretend I'm not a diabetic?  Or is she saying that I can physically choose to not be diabetic?  And if that's what she meant, how would I go about doing that?  Was it like with the liver test, in that I could "treat" it with weight loss?

I recall when Dh got re-diagnosed diabetic, and he picked up a new glucometer and other stuff the doctor prescribed for him, among the things he got was a booklet about the facts and myths of diabetes.  I'd skimmed through it.  Among the things the booklet said was, to paraphrase, "it's not your fault that you are diabetic; you did not do anything to cause it," and "if you are overweight, your weight did not cause your diabetes.  If you change your diet and exercise to control your blood sugar, you may lose some weight, but you might not, either.  Losing weight is not the goal; controlling your blood sugars is."  It also stated things like, "no, eating sugar does not cause diabetes, either."

Though I haven't had time to get the blood test done yet, or even make an appointment for an ultrasound, there are a few things I've managed to do.  I've borrowed Dh's glucometer, and I've been testing my blood sugars while keeping track of what I eat or drink.

I've also looked up information on diabetes.  Here's a list of symptoms for T2 diabetes, and my comments about whether or not I've got them.

Unusual thirst - no


Frequent urination - no


Weight change (gain or loss) - most sites just mention weight LOSS, not weight gain.  During the appointment, the NP said that my weight gain was probably a symptom, then mentioned weight loss as something that happens after many years. 


Extreme fatigue or lack of energy - no.   The only time I feel extreme fatigue is when I haven't slept.


Blurred vision - no, except when I haven't slept


Frequent or recurring infections - no


Cuts and bruises that are slow to heal - no


Tingling or numbness in the hands or feet - no


Trouble getting or maintaining an erection - n/a


Granted, diabetes can also be asymptomatic, so not having symptoms does not mean no diabetes.  What about risk factors?  Here's another list, with my comments added.


Being:
A member of a high-risk group (Aboriginal, Hispanic, Asian, South Asian or African descent) - no
Overweight (especially if you carry most of your weight around your middle) - yes

Having:
A parent, brother or sister with diabetes - no
Health complications that are associated with diabetes - no
Given birth to a baby that weighed more than 4 kg (9 lb) - one was 9 lbs 6 ozs, and there was nothing the least bit unusual suggested because of it; quite the opposite.  She's about to turn 16, so I think if that was a contributing factor, it would have shown up a lot earlier.
Had gestational diabetes (diabetes during pregnancy) - no
Impaired glucose tolerance or impaired fasting glucose - no
High blood pressure - no
High cholesterol or other fats in the blood - no
Been diagnosed with polycystic ovary syndrome, acanthosis nigricans (darkened patches of skin), or schizophrenia - no


The thing that made me most curious is why I would suddenly have a high blood sugar reading after all these years of testing normal.  It turns out that there are a few things that cause blood sugars to right in non-diabetics.  One is simply eating lots of carbs.  Not usually an issue with me.  Another is liver function.  Since our bodies always need glucose, our livers store it for later release when we're sleeping, which is why our blood sugars can be elevated in the morning, before we've eaten anything.  Other possibilities are illness and medication related, which doesn't apply to me, unless I count the discomfort in my side as an illness.

Then there was stress.  At first thought, I dismissed it, as I don't really think of my life as being stressful.  Then I thought about it and realized that, yeah, life has been VERY stressful lately!  In fact, once I started thinking about things, the list of stressers in my life right now is pretty friggin' long!  Some of them have been going on for quite a while now, with no respite.  So, yeah, stress could very well have something to do with that high fasting reading.

And what about the non-fasting readings I've been taking?

When talking to the NP about the diagnosis change in what's considered a high reading while fasting (from 7 to 6), I mentioned testing my blood to compare with Dh's, and that my numbers tended to the low side, not the high side.  She casually mentioned that 11 was normal for non-fasting numbers.

After keeping track for a few days (none of my numbers hit the 11 mark she mentioned, though I did get one that eeked above 10 after a restaurant meal), I went digging around for a chart of what normal, non-fasting readings throughout the day should be.  It was hard to find anything to say what's normal for non-diabetics (or any with the scale used in Canada), but from what I have found, my readings fall into the good to excellent range - and that's a very small range according to the charts and sites I looked at!  That 11 she mentioned, by the way, was considered high in all the charts I found, so again, I don't know what she was talking about.

As you can imagine, my confidence in the NP has faded dramatically.  I don't want to go back to her.  I plan to get that second test done, but I don't want to go back to her to go over the results. I sure as heck don't want to talk to a dietitian.  Somehow, I don't think that is going to go ever well.  You see, I discovered something else I was not aware of while keeping these records.  Or should I say, not aware of how bad it was.

I'm not eating anywhere near enough!

I don't obsess with eating or calorie counting, but I do have a problem when I start feeling hungry.  The hungrier I am, the less appetite I have, and the longer I tend to delay eating.  Even so, with my blood sugars normally tending to be low, I have long known I need to eat regularly to prevent them from dropping too much.  I try to, but things tend to get in the way and, before I know it, it's 2 or 3 in the afternoon, and I haven't had breakfast yet.  Some days, I've barely managed to eat a single meal.  I've been doing that far too often.  I hadn't realized how bad I had gotten. 

Somehow, I don't think a dietitian is going see me and my big round belly and bodacious butt and believe that I hardly eat.  I could be wrong and I don't want to prejudge someone I haven't met yet, but I'm already discouraged by what's going on with the NP.
 
I miss my doctor.

Twisted words

Okay, I haven't been posting much lately, as I've got a lot of things on my plate, but I was having a debate with someone over an article that was getting too long for the format.  That and I'm seeing the article being passed around by others as if it were God's Own Truth, so I figured I'd finally hunker down and write about it here.

This is the article.

15 Food Companies that Serve You 'Wood.'

This is typically followed by comments about how Teh Big Bad Food Companeez are Out to Killz Us (yes, I mock). 

The problem?

The article is horribly misleading.  In fact, in light of something my debating partner pointed out about an assumption I had made, it's even more misleading than I originally thought.

The basic premise of the article is this.

Companies are using cellulose as filler in food.
Cellulose is wood pulp.
Companies are feeding us wood pulp (insert nefarious motives here).
These are fifteen companies and their products that use cellulose, therefore they are feeding us wood pulp, therefore you should refuse to buy these products or support these companies, or anything else where you see cellulose in the ingredients list.

Well, let's start from the top.  The article opens with this.

The recent class-action lawsuit brought against Taco Bell raised questions about the quality of food many Americans eat each day.

Chief among those concerns is the use of cellulose (wood pulp), an extender whose use in a roster of food products, from crackers and ice creams to puddings and baked goods, is now being exposed. What you’re actually paying for – and consuming – may be surprising.

Now, I will admit the mistaken assumption I made that was pointed out to me right here.  I hadn't followed the link at the top.  Since the writer went straight from the class action lawsuit against Taco Bell to writing about using wood pulp as an extender, I assumed that the use of wood pulp as an extender was actually part of the lawsuit.  Turns out it isn't.  At least not that you can tell from the brief piece linked to, with no link to a source.  It's talking about the use of filler and the accusation that there's more filler than beef in their seasoned Taco filling.  There is nothing to tell the reader that "Chief among those concerns is the use of cellulose (wood pulp)..."

So right off the hop, by going from the lawsuit to the use of wood pulp, the reader is lead to believe that Taco Bell is being used for using wood pulp as filler in their products.  This is false.  The accusation is that they were using a lot of filler in their seasoned beef.  Filler can be any number of things, and for all we know, that includes the seasonings in their seasoned beef.

Now, just as aside, I do most of my cooking from scratch.  When I cook ground beef, you know what I do?  I use fillers.  And seasoning.  Back in the old days, this was called "stretching" and was a way of stretching a small amount of meat to feed everyone in the family.  In the depression era, it wasn't unusual for the family meatloaf to have more filler than meat.  I have cookbooks from that era that share tips on how to stretch meat as far as possible.  Bread and bread crumbs were most commonly used.  Myself, I tended to use a combination of bread crumbs, milk, egg and whatever herbs and spices I had handy.  Unfortunately, I have family members who are lactose intolerant and one that's gluten intolerant.  So I don't use as much filler.  The result is a less flavourful meatloaf that tends to fall apart.  Those breadcrumbs act as a binding agent that also hold moisture and flavour.

Which brings me to the next point.  Do you know why breadcrumbs hold moisture?  Because they have cellulose in them.

Now, if you read this article, you are lead to believe that cellulose is wood pulp.  In fact, they are very specific about that.

Chief among those concerns is the use of cellulose (wood pulp)

Cellulose is virgin wood pulp  

It even goes so far as to differentiate cellulose from dietary fibre.

Cellulose adds fiber to the food, which is good for people who do not get the recommended daily intake of fiber in their diets, Inman said lied. 

I find the unexplained strikeout particularly revealing.  Right there, you are told that anyone who suggests cellulose adds fiber as a good thing is revealed to be a liar.

The writer goes on to further separate cellulose from fibre or anything other than wood pulp.

...powdered cellulose has a bad reputation but that more of his customers are converting from things like oat or sugar cane fibers to cellulose

So his customers are moving away from good, safe food based fillers, like oat or sugar cane fibers, to cellulose, which has already been defined for us as wood pulp and has a bad reputation.  What is that reputation and why is it bad?  We aren't told.

The article also tells us how the use of cellulose is a bad thing.  Most of this is through the use of leading language.  The use of cellulose in a wide variety of products "is now being exposed." It "is deemed safe for human consumption" by the FDA which "sets no limit on the amount of cellulose that can be used in food products meant for human consumption."  Oh, and I just love this guilt by association paragraph.

... a company that supplies “organic” cellulose fibers for use in a variety of processed foods and meats meant for human and pet consumption, as well as for plastics, cleaning detergents, welding electrodes, pet litter, automotive brake pads, glue and reinforcing compounds, construction materials, roof coating, asphalt and even emulsion paints, among many other products.

 You see?  If you're eating cellulose, even "organic" cellulose (note the scare quotes), you may as well be eating pet food.  Or plastic.  Or asphalt.  Or pet litter.  Isn't that just disgusting?

Booga Booga.

And, of course, we MUST bring up that other evil of food, fat.  Companies are feeding us wood pulp to pander to the weight loss crowd.

...allowing consumers to reduce their fat intake.

...able to remove as much as 50% of the fat...

He said cellulose is common in processed foods, often labeled as reduced-fat or high-fiber...

So companies are basically accused of misleading/cheating/whatever their customers who want to avoid fat by feeding them wood pulp, instead.

And why are companies doing this?

Money, of course.

Perhaps most important to food processors is that cellulose is cheaper...

...the fiber and water combination is less expensive than most other ingredients...

...food producers save as much as 30% in ingredient costs by opting for cellulose...

Of all the egregious statements made in this article, I find this note from the editor most fascinating.

[Note: Humans are unable to digest cellulose since we lack the appropriate enzymes to break it down. This is a food adulterant and another example of the wholly corrupt nature of the federal agency responsible for food safety but continues to prove itself more concerned with corporate profit. ~Ed]

Take the time to follow that link.  I'll wait.

Notice something?

Yeah.

Cellulose is a carbohydrate.  All plants have it.  Of course humans can't digest it.  We are not ruminants, with their specialized stomachs, bacteria and enzymes.  That's why cows eat grass and we eat cows. 

Now go to the bottom of that page.  Notice something else?  Where it talks about dietary fibre?  Right.  Dietary fibre - which is part of cellulose - is good for us.  Which also, according to the strikeout in the article, is a lie.

Ah, but wait!  Not only is this a lie, but according to the editor's note, it is a "food adulterant and another example of the wholly corrupt nature" of the FDA.  Why?  Because they are "more concerned with corporate profit" of course.  Implication: the FDA is controlled by the corporations.  Do they have proof?  Who needs proof?  The FDA did something the writer disagrees with, and that's supposed to be proof enough. 

The article then finishes with...

To that end, TheStreet rounded up a list of popular foods that use cellulose. It’s by no means an exhaustive list, and we suggest consumers read food labels carefully.

So what do you come away with from reading this?

Taco Bell is being sued for using filler.
Cellulose is used as a filler.
Cellulose is wood (implication: Taco Bell is feeding you more wood than beef)
The products listed at the end of the article contain cellulose.
Since cellulose = wood pulp, that means these companies are feeding you wood.

Or, to simplify it even further, this is the premise of the article.

1) Cellulose = wood pulp
2) Product X contains cellulose
Therefore
3) Product X contains wood pulp.

So what's the problem?

The problem is right with item one.  Throughout the article, the writer maintains that cellulose is wood pulp, and even goes so far as to differentiate cellulose/wood pulp from fibre sources such as oats and sugar cane.  Cellulose is then painted as something horrible that shouldn't be in our food, even if we aren't getting enough fibre, because saying cellulose adds fibre is a lie.

Even if you followed the link in the editor's note, you are *still* told that using cellulose is bad and lead to believe the cellulose is wood pulp and wood pulp only.

This is the core of what's false and misleading about this article.

The other problem is the implication that cellulose is bad for us.  Yet we need cellulose, even though we can't digest it.

Although cellulose is indigestible by humans, it does form a part of the human diet in the form of plant foods. Small amounts of cellulose found in vegetables and fruits pass through the human digestive system intact. Cellulose is part of the material called "fiber" that dieticians and nutritionists have identified as useful in moving food through the digestive tract quickly and efficiently. Diets high in fiber are thought to lower the risk of colon cancer because fiber reduces the time that waste products stay in contact with the walls of the colon (the terminal part of the digestive tract). Read more

----

Because cellulose passes through your digestive tract virtually untouched, it helps maintain the health of your intestines. One way cellulose helps the intestines is that it clears materials from the intestinal walls, keeping them clear, which may help to prevent colon cancer. Cellulose is the fiber (or roughage) of which your cereal box says you need more.  Read more.

 ----

Cellulose is the substance that makes up most of a plant's cell walls. Since it is made by all plants, it is probably the most abundant organic compound on Earth. Aside from being the primary building material for plants, cellulose has many others uses. According to how it is treated, cellulose can be used to make paper, film, explosives, and plastics, in addition to having many other industrial uses. The paper in this book contains cellulose, as do some of the clothes you are wearing. For humans, cellulose is also a major source of needed fiber in our diet. Read more.

So if you sit down with a lovely salad, fresh from your own garden, you are eating cellulose.

If you crunch down on some fresh, organically grown vegetables or fruits picked up at the local farmer's market, you are eating cellulose.

If you eat some delightfully flavourful whole grain bread, with crunchy seeds and flax and other tasty bits like that in there, you are eating more cellulose than if you chowed down on a slice of white bread.

Rice?

Cellulose.

Wheat?

Cellulose.

Barley?  Lentils?  Chick peas?  Kamut?  Spelt?

Cellulose.

Oh, and yes, M, I was clumsy in my phrasing about making cellulose from rice.  That, by the way, is here if you want to see it.  I guess I'll have to remember to stop telling my family that I'm making rice, when in fact I am actually cooking it.  I had caught the clumsy phrasing but never got around to fixing it.

Now, in direct response to my debating partner (other points have been responded to above)....

I don't think this article misleads. I only agreed that it isn't as informative on all the aspects of naturally-occurring cellulose as you'd like it to be.

 Uhm.  No.  The article is pretty clear that cellulose = wood pulp.  That's not less informative.  That's misleading.  Of course wood pulp contains cellulose, and cellulose from wood may indeed be used as filler in food.  My argument was that the article maintains that cellulose *is* wood pulp, and that is what is the core of what is misleading.

I assume the writer has knowledge that the "cellulose" they are talking about is from wood.

 Why?  The writer bends over backwards to associate cellulose with wood pulp and differentiating it from anything else.  At that level of dishonestly, why assume the writer is being honest about anything else?  Or that the writer is doing anything other than assuming the cellulose in question is sourced from wood pulp?  The writer simply states that cellulose is wood pulp, then goes from there.  The writes gives nothing to tell us she knows that the cellulose used in the products list is actually from wood.  We are simply to assume it is.

I am baffled by your statement that you're not claiming there is no wood. 

 I have no idea if there's wood or not.  There is cellulose.  That cellulose could have come from wood.  Or it could have come from something else.  We don't actually know.  The writer simply tells us that cellulose is wood.  My claim is that this is misleading.  It is.  I don't know how much clearer I can get then that.

If your point is not that they're lying about the wood, why make all this fuss? I don't understand your motive.

 My point is that the article is misleading.  That in itself is not a big deal, I suppose.  The problem is that in the process, this article also attempts to speak with the voice of authority, makes a claim that it does not back up, then provides a list of companies and products and tells consumers to avoid those companies based on the writer's misleading claims about cellulose.  Then people who have bought into the highly charged lede and emotional claims start passing it around as if it were some great and wise truth.  It is maligning companies and products without evidence.


My motive?


I am no longer willing to let bullshit pass without comment.  When something as egregiously misleading as this article starts getting passed around, I'm going to say something.  Because not saying something is a sort of tacit approval. 

 Having gone over what the article does do, here's a bit about what the article doesn't do.

The article tells us the cellulose is bad but, other than talking about its use as filler and extenders, it doesn't tell us *why* it's bad.

The article tells us the cellulose is wood pulp.  There's even a picture of someone holding wood pulp.  Another thing about it that's misleading, since it implies that wood pulp is actually being used as filler, bringing to mind the image of that grey stuff in someone's hands is being mixed in with Taco Bell's seasoned beef, or mixed in with your yogurt and ice cream.  The cellulose is extracted and isolated into crystals or powder forms.  Wherever the cellulose came from, it is no longer that thing.  It is simply cellulose.  Does the source matter?  Well, it might from an ethical perspective (for example, the cell line used to make chemicals to enhance flavour and reduce calories used in some soft drinks originated from aborted babies.  It's generations away from the original cells.  Does that make it any less from aborted babies?  I don't know, but I don't think I can ever drink Pepsi again).  In this case, the source is supposedly from trees, and that's a bad thing.


Why?  We're not told.


I was told that it's because trees aren't food.  Except that people do eat trees.  We eat bamboo shoots and heart of palm.  We eat cinnamon and other barks as food or medicine.  First Nations have been eating the fresh shoots and inner bark of tamarack trees for centuries, and the starchy pith of the sago tree has long been an important food source. 


So why is cellulose from trees a bad thing?


It just is, apparently.

Even the use of fillers at all is assumed to be a bad thing, but again, why?  The use of fillers is common and can enhance a food.  Don't just tell me using fillers is bad.  Tell me why.  Make the case.  This article fails to do that.

Now, I can agree with the use of fillers can be a bad thing.  If I buy a pound of ground beef, I want it to be ground beef, not meat plus filler.  If, on the other hand, I buy seasoned beef, I expect there to be fillers of some kind.  Then it becomes an issue of how much is too much?  I don't want companies to be dishonest about what they put in food, but it doesn't help if the people railing against the companies are just as dishonest.


As to the types of fillers that are a problem, I have very little concern with the use of cellulose, even if it *is* from trees.  I am more concerned about fillers that are soy based (two out of four in our household cannot tolerate soy), dairy based (three lactose intollerant members in my household) or grain based (one household member who cannot do gluten). 


It's not cellulose that should be the concern here, and by being so misleading, the writer misses the boat completely and does her own cause a disservice.

Another one?

So here's a rarity.  Two posts in one day - and on the same subject; pithy sayings that reveal more about the people making them, then the people they are targeting.

This time, after being away from my computer for a few hours, I came back to find another graphic making the rounds.  This one is a combination of text an image.  On one side, there is a bicycle.  On the other, a car.

I'll bet you already suspect which one is demonized.

Over the bike, the text reads: This one runs on fat and saves you money.
Over the car, the text reads: This one runs on money and makes you fat.

*sigh*

I've said it before, and I'll say it again, because so far, nothing has shown me otherwise.  Logic is what people use to justify their emotional responses.  I now add to this, the stronger the emotional attachment, the more willing people are to suspend logic completely.

Let's look at the first part.  The bike, we are told, runs on fat.

Really?  Not too familiar with biology, are we?  Fat, of course, is basically stored energy.  Key word being "stored."  It's not going to do anything on its own.  What we use when riding a bike are our muscles.  Yes, I do realize that this statement implies that, if only we all just cycled more, we'd lose fat.

Which is bullshit.

Yes, some people do lose body fat when they increase their exercise levels.  Lots of people don't.  There are skinny cyclists and there are fat cyclists, and a fat person suddenly starting to cycle isn't going to miraculously become a skinny person.  Because bikes don't run on fat.  They run on muscle.  Now, I'm not going to go on yet another rant on how you can't judge a person's health by looking at them right now.  Suffice to say, there is a whole lot of ignorance and misinformation surrounding body fat. 

The second part of the statement tells us biking saves money.

Well, that depends.  If you're just tootling along a few blocks every now and then, you can get away with a cheap or second hand bike and minimal equipment.  Of course, there are helmets (if local laws require them).  And backpacks.  Water bottles.  Repair kits.  Lights and reflectors (cyclists, pleasepleasePLEASE don't skimp on lights and reflectors!).  Proper clothing and shoes.

For a dedicated cyclist, a good bike can easily set you back a thousand dollars or more, not counting equipment.  Others, just a few hundred dollars.  Still a lot cheaper than a car, but certainly not pocket change, either.

That's just for one person.  What about families?  For my own family, if we were to switch to cycling instead of our van, we'd need to multiply all the expenses by 4.  Still cheaper than a van, sure, but the cost is climbing fast.  For people with small children, there is the additional cost of child seats or trailers.  If cycling is one's primary mode of transportation, add in saddle bags or a trailer to haul the groceries or other such things.  One could, of course, just dangle the grocery bags off the handle bars, but that gets rather dangerous.  I speak from experience, there.

You can forget hauling anything big.  For that, you'd have to either borrow/rent a vehicle, pay someone else to deliver, or find some other way of hauling larger items.  Forget about hauling anything fragile, either.

You can also forget about helping other people out by giving them rides and whatnot. 

None of which covers another problem of cycling I know only too well - it can be surprisingly dangerous.  As someone who used to cycle as my primary mode of transportation, I try to be understanding and considerate of cyclists on the road.  They don't make it easy.  I know it's not a bike-friendly city that we live in, but when cyclists don't even try to follow the rules of the road, it frustrates the heck out of me.  Or scares the heck out of me as I find myself having to avoid killing someone who thinks it's a good idea to swerve in and out of traffic, run red lights, go from road to sidewalk and back again, and my personal "favourite," cycle and text at the same time.  Using both hands to text. 

But I digress.

Simple rebuttal; no, bikes don't run on fat.  They run on muscle.  And no, they do not make you skinny, either.  Do bikes save you money?  That all depends on your family needs and what use they'll be put into.  I'd say yes, with exceptions.

What about the next statement?  Do cars run on money?

Well, obviously they don't.  It's the price of fuel that's being referred to.  And yeah, fuel costs are getting ridiculously expensive.  That fact that these price increases are completely artificial and contrary to a free market economy doesn't help.  What about the cost of the vehicle?  Well, for us, the monthly cost of car payments plus insurance, plus fuel, plus maintenance does add up.  However, buying 4 adult bus passes per month is pretty much a car payment right there.  Buying four bikes, helmets and equipment?  Still a financial hit, but yes, cheaper than our van.  Not being able to buy in bulk makes food purchases more expensive.  Having to pay to deliver larger items, uncommon as that might be, also adds to the expense. 

As to the second part, does driving a car make you fat?

Just as the magical thinking involved in saying bikes run on fat, saying cars make us fat is false and misleading.  Cars can't make anyone fat.  The implication, of course, is that people who drive don't exercise, and if they don't exercise, they will become fat.

Ah, if only the world were so simple and magical.

Judging some one's body size by the fact that they drive a car is as ludicrous as judging a person's health by the size of their body. 

Of course, judging a person for driving is just plain stupid in the first place.  Unless you actually know a person's circumstance, you have no idea why they are driving.  We had some neighbours who would drive the two blocks to the store.  They were both thin, too.  So why did they drive?  Because being heavy smokers, they both found walking two blocks left them short of breath.  If you want to talk wasting money, there's a much better example! 

There are also other possibilities.  A person may be driving because they have health problems or injuries you know nothing about.  Their job might require them to go places and do things that cannot be done on a bike.  Who knows?

What I know, however, is that it's pretty rich for people to make such smug, judgemental statements about people based on what mode of transportation they use, and just plain stupid to make assumptions that those choices affect our body sizes.

How not to do (and publish) science; metabolic syndrome

I've got another post I've been working on in draft that is taking me forever to finish, but I just had to post about what I encountered in today's health news.

This was the first article I encountered.  One in 5 Canadian adults has 'metabolic syndrome": study

A very brief article, short on details, but at least clear that "Metabolic syndrome isn't a disease in and of itself."  Rather, it's a group of symptoms that increase the risks of increasing the risks of getting "real" diseases.

Seriously.  That's what it comes down to.

No link to the study.

Then I found this one.  Metabolic syndrome now affects 1 in 5 Canadians.  So what is it?


This one, at least, links to the study.  More on that later.  First to the article, which starts with...

If I were to ask you what my most important tool as a doctor was, I bet you would say it is my stethoscope! Wrong. It is a tape measure.

Seriously??  This doctor considers a tape measure her most important tool?  Over a stethoscope?  Over her blood pressure cuff?  Over any number of tools available to her, she chooses a tape measure?

I'm glad she's not my doctor!!

So what is metabolic syndrome?  Well, you have to have at least 3 of these 5 symptoms.

Abdominal obesity
high triglycerides
low HDL cholesterol ( the good cholesterol)
high blood pressure
impaired glucose tolerance

For full disclosure, I have only one of these symptoms - abdominal obesity (more on what that turns out to be later).    My husband has two.

So of these 5 symptoms, abdominal obesity is the most common at... wait for it... 35%.  In other words, while it was the most common of the five, 65% of people don't have it.   They have three of the other 4 symptoms.  Meanwhile, the most common combination of factors was abdominal obesity, high triglycerides and low HDL (note that high cholesterol, the long time scare, isn't even mentioned - they are specifically sticking with low "good" cholesterol).  The article doesn't say how many that group represents.

Now, what are the predictors of having metabolic syndrome?  Is it the usual stuff I hear of lazy fatties stuffing their faces with junk food and too stupid to know better?

Nope.

These predictors that increased the risk were: education and income level. Higher levels of education and income predicted a lower likelihood of metabolic syndrome.

In other words, the more you know and the more money you have, the less likely you are to have metabolic syndrome.  Which could be considered good news, since 80% of Canadians do NOT have metabolic syndrome.  So solving this "problem" should just be a matter of helping people become more educated, and improving income.  Right?







Nope.

The implications of these findings are truly important. Among younger adults particularly, it is critical to address poor lifestyle habits.

Wait.  What?  Where did that come from?  Didn't she just write that education and income were...


*facepalm*

And in conclusion...

Cardiovascular disease increases with age and if we don't address abdominal obesity, and the other symptoms of metabolic syndrome the burden of chronic disease will continue to soar. What is more critical is that each if the components of metabolic syndrome can be addressed by lifestyle changes.

 So we have a study that, according to this article, shows that low income and education levels are the most common predictors of metabolic syndrome, and that 65% of the people with metabolic syndrome in this study did NOT have abdominal obesity as their  minimum 3 of 5 symptoms (note that some people in the study would have had 4 or 5 of 5 of these symptoms, too), and the cure for this is lifestyle changes.

Well, I suppose if lifestyle changes includes improving our education and increasing income, I could go with that. 

So what does the original report say?  The abstract is here. 

Notice something?

Yup.  This report is based on a survey.  In the pdf, you learn this survey was done in 2007-2009.

The abstract doesn't even end with a conclusion, but an interpretation (good to see that, for a change, but that doesn't seem to stop the media from reporting is as fact).

Interpretation: About one in five Canadian adults had metabolic syndrome. People at increased risk were those in households with lower education and income levels. The burden of abdominal obesity, low HDL (high-density lipoprotein) cholesterol and hypertriglyceridemia among young people was especially of concern, because the risk of cardiovascular disease increases with age.

 Which tells us... what?  Poor people with a lack of education are at higher risk for poor health than everyone else?  This is news?  Cardiovascular disease increases with age, also not news, but how does this address the problem of young people with metabolic syndrome?  Young people tend to have less education than older people, and less money than older people, anyhow.  It takes time to increase income and continue education.  What is the news here?

Also not addressed; the headlines reads that metabolic syndrome "now effects" 1 in 5 Canadians.  So what was the rate of metabolic syndrome before?  No idea.  As far as I can tell, this is the first time anyone has actually tried to measure it before.  We have data for 2007-2009.  That's it. 

Now then.  What does the report tell us?

Oh, dear.

First, they describe the methods.  Not only is this survey data by Statistics Canada (granted, data taken only from those that had actual blood test information available), but there is a whole bunch of number crunching for weight by

multiplying the weight for the collection site by the selection weights for household, and adjusted for non response. The weights for collection site and households were based on the 2006 census. The household weights were then converted to individual weights and further adjusted for nonresponse.

In other words, it's a data dredge.  They never actually studied anyone, weighed anyone, measured anyone, or took blood tests from anyone.  They used Statistics Canada information.

So let's look at the criteria.  First, let's look at what it means to be "abdominally obese."

waist circumference ≥ 102 cm for men and ≥ 88 cm for women

To translate into Imperial, that means men with waists equal to or greater than 40 inches, and women with waists equal to or greater than 34 1/2 inches, are "abdominal obese."

In other words, unless you are quite thin at the waist, regardless of anything else about your body, you are "abdominal obese." 

No wonder that most people in the survey were "abdominal obese."  It would be almost impossible not to be!

And on it goes.

You can go ahead and read the rest of the report yourself.

It's a whole bunch of data, but what does it actually say?  And what does it recommend?

Well, it takes a bunch of symptoms and, if people have enough of them, they are labelled as having "metabolic syndrome."  It doesn't mean anything more than having a combination of medical readings.

Having that combination of medical readings increases your risks of increasing your risk of actual diseases.  Nothing about causes, of course.  Just correlation.

It shows that there is an increased risk of having metabolic syndrome (the increased risk of increasing your risks) if you lack education an income.

Then we're told in various articles that we can reduce our risk of metabolic syndrome by reducing our abdominal obesity through lifestyle changes, even though 65% of the people described as having metabolic syndrome do not have abdominal obesity.

What questions aren't answered? 

Well, I would wonder what role lack of education and income plays.  Education (and I do not mean "schooling" necessarily, though I imagine formal schooling is how Stats Can defines it) and income are tightly connected.  There are plenty of studies this connection.  No surprise that people's health would be compromised if they don't have enough money to buy nutritionally adequate food.  No surprise, also, that young people are the hardest hit when it comes to low income and less education. 

Instead, writers leap to the idea that, if we just loose our abdominal fat, we'd solve all our problems.

Critical thinking?  What's that?

Fascinating

It perplexes, yet fascinates, me when I see how people will take information and turn it around to be something else entirely.

I've got the "share on facebook" button on my browser bar, which makes it easy for me to share various things I find online on my facebook.  Most of the time, there's little or no comments made on them, though I see quite a few people going on to share the links themselves.  The topics range from the trivial to the deep; from entertaining to data heavy.  If I think others might be interested, I share it.

In the last while, I shared three links that not only got a lot of comments, but the comments themselves were absolutely bizarre to me.  They put me straight into observation mode, wanting to figure out just how and why they went in the directions they did.

This was the first of the three.  More young children are alarming thin.  Here are a couple of key points in the article, but please follow the link and read the whole thing.

From 1999 to 2006, eating-disorder hospitalizations for children younger than 12 increased by 119 percent, according to the federal Agency for Healthcare Research and Quality.

 ...

...doctors have seen more of their young patients misinterpreting messages intended to fight childhood obesity. A child's desire to eat healthier food, initially applauded by parents, can lead to dangerous and addictive behaviors.

 The article covers a lot about how very young children are seeing what their parents are doing (dieting, either for health or weight loss), absorbing the anti-obesity messages in their schools, and being affected by the "healthy eating" obsessions of our culture, and how this seems to be playing a large role in why so many very young children are developing anorexia nervosa.

So what was the response this story got?

Gee, that's terrible, but ZOMG TEH FATZ, kids these days are FAT and LAZY and STOOPID, and FAT PEOPLE are DISGUSTING and OUT OF CONTROL and oh, yeah, super skinny people are disgusting, too.

Yeah, I'm paraphrasing a bit.  Still, the gist it is that the point of the story - that we are seeing a massive increase in very young children being hospitalized because they're starving themselves, and that our dieting culture plays a significant role in that - was completely ignored as people ranted about how terrible it is to be fat, and there are just sooooo many more fat people, and if only parents modelled better behaviour for their kids, we wouldn't have an obesity epidemic, with a token mention that skinny people are gross, too.

Basically, everything that the article said was the problem was being repeated as a solution.

It blew my mind that sharing an article about the alarming rise of children being hospitalized for anorexia would bring out such incredible anti-fat ranting.

Some time later, I shared another link - this to a pdf paper called Morality and Health: News Media Constructions of Overweight and Eating Disorders.  Again, I recommend following the link and giving it a good read.  It's 20 pages, though, so you might want to save it for a thorough reading later.

I found this a fascinating examination on the differences of how the media portrays eating disorders that lead to extreme thinness vs eating disorders that lead to extreme fatness.  It also touches on the differences on how family, friends and our culture treat people with different eating disorders.  In the process, it touches on race, gender and economic status.  In a nutshell, people who are very thin and with anorexia and bulimia tend to be wealthier, female and white.  People with these eating disorders are viewed and portrayed as victims, and their treatment reflects this.  Fat people, however, tend to be poor, non-white and while eating disorders are still predominantly found in women, there tend to be more males involved.  For those with Binge Eating Disorder, there is a tendency to blame the victim for their condition, and to deny that their eating disorder really is a disorder, rather than a sign of how weak willed they are.  Their treatment, either medically or socially, is completely different.  In both cases, projections on the morality of the victim are also being made.

There is much more, of course, and once again, I encourage you to read the whole thing.

Now, this piece is a pretty straightforward examination of how the two extremes of eating disorders are portrayed by our media.  It makes no judgement on people who have eating disorders.  It makes no commentary on people's weights or diets or lifestyles.

Our news sample typically attributes anorexia and bulimia to a host of complex and interrelated factors, thus mitigating individual blame while representing anorexics and bulimics as victims. In contrast, it predominantly blames overweight exclusively on bad individual choices and emphasizes individual-level weight loss solutions. News reports emphasize medical intervention when it comes to anorexia and bulimia but not when discussing binge eating disorder, which they tend to deny the status of a real eating disorder and frame instead as ordinary overeating caused by lack of self-control and requiring greater personal discipline. After reviewing the quantitative patterns, we examine each case qualitatively.

So what happened in the comments?

I got a huge rant about how this was just the "intellectual elite" finding excuses for being fat and abdicating responsibility for being fat and TEHFATZ!!!OMG!!!!OBESITYFATZFATZFATFATZ!!!!!!

Yes, I mock.  Mockery is all it was worth.  In fact, I seriously wondered if the person even bothered to read the paper at all.  It was a nonsensical rant against fat that actually repeated many of the negative portrayals of fat people by the media.  Fat people are lazy.  Fat people are irresponsible.  Fat people are gluttons.  On top of that, the emotional derangement attached to the phrasing was rather extreme and included bizarre projections onto me and the body issues I must have, and my looking for reasons to excuse them.  This person was ANGRY.  Why an examination of how eating disorders are portrayed in the media would get this reaction escapes me.  Why the anger should be directed at me personally was also very curious.

Finally, we come to our third piece.  Living to see 100 is just luck, not lifestyle. 

Academics studied almost 500 people between 95 and 109 and compared them with over 3,000 others born during the same period.

They found those who lived extremely long lives ate just as badly, drank and smoked just as much, took just as little exercise and were just as likely to be overweight as their long-gone friends. 

 Basically, these old timers lived lifestyles no different than their peers who died earlier.  Yet they still concluded:

"Although this study demonstrates that centenarians can be obese, smoke and avoid exercise, those lifestyle habits are not good choices for most of us who do not have a family history of longevity.

"We should watch our weight, avoid smoking and be sure to exercise, since these activities have been shown to have great health benefits for the general population, including a longer lifespan." 

 In other words, even though there was absolutely no physical evidence for it, they still recommended people should go on diets, etc. if they wanted to live longer.

I actually found this bit even more interesting.

When it came to the centenarians' views about why they had lived so long, the group identified good genes as the main reason, followed by diet and physical exercise. 

 So even though these long lived people recognized that genetics played the main part of why they've lived so long, and even though they themselves have had lifetimes of smoking and drinking, eating "bad" foods and a lack of exercise, they still believed that having a "healthy" lifestyle is a big part of why they've lived so long.

 And what responses did I get to this one?

Several people talking about how they felt so much better after going on diets and exercising more.  Sure, it might not mean they'd live any longer, but gosh darn it, it's quality of life that matters! 

Now, I don't know about you, but I have a hard time seeing a life of self-inflicted deprivation as improving quality of life.  I realize ascetics is rather popular right now, especially when it comes to food, but what good is gaining a few more years, if the simple pleasures of life are denied?  Of course, they seemed to completely miss the fact that, for a lot of these long-lives folks, eating, drinking and smoking is part of their quality of life.  If some 90 yr old wants to enjoy a shot of whiskey and a good cigar, who am I (or anyone else) to lecture them? 

The responses, however, were fascinating to me.  Here we have an article that basically said diet and exercise makes no difference to longevity.  It's in your genes. Yet other than one response where someone talked about how her grandmother, who'd lived to 105, had still been an avid gardener at 99, and another that was rather preachy about that whole "quality of life" thing (because apparently the only good quality of life involves eating "healthy" and exercise), they were very "look at me!  I feel so GREAT because I diet/exercise!  I LOST WEIGHT!! It's so WONDERFUL!!!"

It was like listening to preachy ex-smoker, or someone who's just started a new diet program (It's not a diet!  It's a LIFESTYLE change!!!).  It was also curiously "Me, me, me!! Aren't I wonderful!"  I don't think they intended to come across as smug and superior, but they did anyhow.

In each of these pieces I shared, the thing that struck me the most about the responses is that they had almost nothing to do with the stories themselves.  Rather, the stories seemed to be mere stepping stones for people to run off on something they, themselves, have as a personal issue. 

It was truly fascinating.

Heaven in a spoon

Imagine this with me.

You are sitting in a comfortable restaurant - one of your favourites.  Coming here is an anticipated treat.  The waitress brings a bowl to your table, and you are immediately greeted with a warm and delicate scent that hints at a rich, savoury flavour.  Earthy mushroom.  Rich truffle oil.  Buttery garlic bread.  You see the smooth textured soup, with its speckles of mushroom pieces, artful swirl of glistening oil and a cheerful green splash of parsley at the top.  Beside the bowl is golden brown, pan toasted garlic bread.  Already, your mouth is watering in anticipation.

First, you stir the oil gently into the soup.  A new burst of glorious, delicious scent rises up with the steam as you stir.  Taking up a piece of garlic bread, you raise a spoonful of soup, rest the bottom of the spoon on the garlic bread for a moment to catch any drips, then raise the spoon to your mouth.

That first taste is a rich explosion of intense, almost meaty, yet delicate, creamy mushroom flavour.  You may not even normally like mushroom but, somehow, here it tastes heavenly.  You hold the soup in your mouth a moment, savouring the taste and the texture of mushroom bits just barely big enough to chew.  You swallow the mouthful of soup, then wait a moment for it to hit.  There!  There at the back of your mouth, a new flavour comes out - a flavour you can feel as much as you taste - as the truffle oil works its deep, rich magic.  At this point, you utterly and completely understand what the word umami means!

After a few moments of enjoyment, you take a bite of the garlic bread, where the few drops of soup from the bottom of your spoon are.  The bread is crusty and crisp; a perfectly toasted contrast to the smoothness of the soup.  The taste of real butter, enhanced with just enough garlic, melds with the flavour of the soup.  A light crunchiness on the outside, yet still soft and delicate under the crispy shell.  You chew slowly, enjoying every moment, while anticipating the next spoonful of soup.  You resist the temptation to eat quickly.  You are in no hurry.  You can allow yourself to take the time to appreciate every whiff, every spoonful, every bite of garlic bread.  Even so, the bowl is soon empty.  The garlic bread is already gone, yet you still scrape the sides of the bowl with your spoon, unwilling to let any go to waste.

When you're done, the flavours still linger.  That little bit of truffle oil is still working its magic.  There is no desire to spoil the flavours by having a sweet dessert or even a sip of water. You are completely satisfied.

Pure heaven in a spoon.

What I've just described is a wonderful treat I had today.  A couple of years back, Eldest took me out for Mother's Day to a restaurant walking distance from our home, yet we'd never gone to before.  It was a higher end place and not one we could typically afford to go to - at least not all four of us!  I'd tried an entree on special with a trio of items.  A small amount of fettuccine Alfredo, a small piece of Kobe beef lasagna and a tiny bowl of mushroom soup with a piece of garlic bread.  The fettuccine was marvelous.  It was the first time I'd had Kobe beef in anything, and I was not disappointed.  Delicious.

Yet, much to my surprise, the soup was my favourite of the three.  We finished with dessert, and I was actually regretful for that choice.  Not because there was anything wrong with the dessert - it was delicious, too - but because I regretted replacing the flavour of that soup with sweet.  For days afterwords, I would suddenly remember the taste of that soup and find myself craving it.  Some time later, Eldest and I went back.  We found the mushroom soup was available as a regular menu item in a larger bowl.  I had the soup as a starter.  I don't remember what I ordered with it.  I know I liked it - there isn't a single thing we've ordered in that restaurant that was a disappointment.  They're just really good.  Yet I wished I hadn't ordered it.  Or that I'd eaten the soup after the entree instead of before!

In the two + years since our first visit, we have gone back a few times.  Hearing Eldest and I waxing poetic about this soup, even Youngest - who doesn't like mushrooms at all - found herself wanting to try it.  She's now hooked on it, too!  Now when we go there, we rarely order anything else, and if we do, we ask to have the soup served after the entree.  On its own, the soup is very inexpensive, so this has allowed us to go more often to enjoy it.

And we do enjoy it!  Every moment of it.  It's become a treat, not only for the luxurious flavour of the soup, but as an outing together, enjoying each other's company.  As we linger over the flavours of the soup, slowly savouring every spoonful, it gives us time to chat and share our thoughts about ... oh, pretty much anything under the sun! *L*  It's not something we can do regularly or often, but when we do, it's always something special.

So why am I telling you this?  Why have I taken so much effort to describe something as mundane as eating soup? (even if it IS a fabulous soup)

Well, I discovered something rather shocking, at least to me.  Some time ago, after stumbling on the "fatosphere" and discovering blogs and websites about body acceptance and learning just how wildly uninformed I was about some health beliefs I had never even though to question, I discovered something else.  Perhaps it's because I had been thin (though not by today's standards) for most of my life and missed it, I discovered that a lot of fat people struggle with self acceptance and body dismorphia so strong, they literally don't know how to enjoy food.  In fact, some people, both fat and thin, don't even know how to eat in public.  They have been so thoroughly indoctrinated in diet culture and beaten down by the belief that they and their bodies are a source of disgust and mockery that eating in front of other people is sheer torture.  I've read heart breaking posts from people describing how painful eating in public is, with the stares, the mockery, and the judgemental comments. I simply never thought to care what the people around me might be thinking as I ate.  It didn't even occur to me that complete strangers might be judging me about my food choices based on my body size, never mind my friends or family.

Over the last while, however, I've encountered that judgemental attitude as well.  It's something that has been on the increase, and I'm seeing it from some pretty surprising sources; people I really expected to know better, and who would never have said such things in the past.  I suppose it's because I'm fat now, so I actually see it now that it's being directed at me.

I guess I'm fortunate in having somehow escaped dieting culture.  I have no guilt about eating in public.  I have no guilt about enjoying my food.  Food is meant to be enjoyed!  Food is more than just nourishing our bodies.  Food is often a sharing of precious time with our loved ones.  Food can refresh a flagging spirit.  Food can give us a well deserved break from the stress and rush of our daily lives.  Food, beautifully and skillfully prepared, can be an art form.  Food can connect us with our past.  Food can excite us about the future.

Eldest mentioned something, as we were enjoying our bowls of soup and discussing the notion that there are people who find eating in public humiliating and painful (such is the nature of our casual conversations! *L*).  She said that food is a universal language.  Like music, the sharing of food allows us to reach out and connect with others in a way beyond words or culture.

I have no doubt that there are people out there who judge me when they see me eating in public, simply because I'm fat.  People assume that if a fat person is eating something "bad," like a dessert, they are fat because they eat too much dessert.  If they see a fat person eating a salad or some other "good" food, they assume that person is being "good" by being on a diet and eating "healthy" to lose weight.  Complete strangers have no problem believing that they know what a person's health, diet and habits are, just by the size of their bodies and the fact that, the one time they've seen them, that fat person happened to be eating a "bad" food.  Or just plain eating at all.

Yes, I know there are people out there who will judge me based on my body size.  You know what?  I don't care.  They can think whatever they want.  I am still going to enjoy every savoury drop of my favourite mushroom soup in my favourite restaurant.  I'm going to enjoy the Fat Frank's cheddar smokie that I have once or twice a year.  I'm going to enjoy the delectable chicken and brie sandwich with fig jam that I've never tried before and haven't had since.  I'm even going to enjoy that spinach salad, or that fresh, perfectly ripe and fragrant necterine.  If they're disgusted by the sight of my fat body while I enjoy my food, making judgements about my dietary and lifestyle habits, they are the ones with the problem, not me.

Enjoy your food.  Enjoy eating.  Whatever your favourite food it, please give yourself permission to take pleasure in it.  Enjoy your bit of bliss on a bowl; your heaven on a spoon.

And if someone out there tries to make you feel guilty about it, they can just go stuff their judgemental attitudes where the sun don't shine.