How the NHS failed me and mine.
What it did, to the most important person
in my life and how it could happen to you unless
we do something about it!

Wednesday, 14 July 2010

And There's More !

In my last post, I explored the wrongs that have been perpetrated on Type 2 diabetics by 'Big Pharma', and Doctors, on the very significant cohort in the population that they comprise. What I did not do, was to proffer suggestions as to what to do in the absence of the drugs one may be given, other than diet and exercise.

Well, those protocols are likely to yield extremely good results, even in isolation. Type 1's and 2's will improve their well being, reduce drug intake, or even be able to eliminate them, in the latter's case. It is very dependent upon the degree of beta cell loss and insulin resistance, so close monitoring of blood sugars is an important element of this method of diabetic control. This would be especially the case in the early days of attempts to reduce carbohydrate intake. It would also be useful to recruit your Doctor or Health Care Professional and get them on side, but it may be difficult. You are challenging some of the core values of the protocols that many have practised for most of their careers. Some will have no understanding of the mechanisms, as they have learned by 'rote', not by grasp of the science involved, (this is the depth of 'dumbing down', of the NHS).

Diets that eliminate carbohydrates will be alleged to be 'dangerous', as glucose is needed for brain function. Well that's untrue, as any Inuit can demonstrate, and I have not heard of Atkin's dieters losing their 'marbles' from eating fats and proteins. All changes should be gradual and controlled, with checks on blood sugar, postprandial, to ascertain degrees of success, or otherwise. Exercise between one and two hours after eating will help to burn off excess glucose by reducing insulin resistance. We only store enough in our blood generally, for about fifteen minutes, so there is no need for a marathon, and if fitness is poor, increase from a low level, very gradually until an hour or two half hours can be managed per day. Find what works for you.

There are in addition some supplements that help. Magnesium is generally deficient in most diabetics so 250mgs a day helps in glucose disposal. CoQ10, is useful, especially for the over 50's to help with muscle strength and general well being and is especially good if you are on Statin's or have been, 60 to 100mgs per day improves this greatly.  Alpha Lipoic Acid and Evening Primrose Oil are both 'insulin mimetics' and if taken at the rate of 300mgs of the ALA to 500mgs of the oil, glucose disposal is further enhanced. They are relatively long lasting so need to be taken three time a day.  But, none of these supplements has any profound effect and will not work without a low or carbohydrate free diet. But, these supplements are largely benign. They are often taken, for general well being by many who are not diabetic, so are unlikely to be challenged by Doctors as being dangerous or ineffectual.

One thing that has delayed my venturing down this road is the long delay my J' and I have experienced in obtaining test results from the GP practise. As indeed we have with all services, since the emergent Government of the 'LibCons' have abandoned targets. It seems the NHS have grasped the metal of this protocol, or rather the lack of it, with unparalleled efficiency (sic) and have consigned any idea of a timely delivery of services as something they no longer have to fulfill. However, I digress; the test for HbA1c has come back at 6.3%, which is an excellent figure for a type 2 diabetic, utilising the protocols outlined before as the sole means of control. That is mainly diet with exercise, not drugs.

 Barry Groves  has one of the best plans, and his advice, would be that which I would advocate to anyone contemplating this way of handling Type 2 diabetes. His views on weight loss are also embodied in this and are extremely effective, as are those of The Atkins Diet , although there are some detractors of this diet for diabetics. All, however are low carbohydrate in content, or rather lack of it (carb's that is). Information is the key, together with healthy scepticism about the current outmoded thinking about diabetic control, or even weight loss.

The science is there, and has proven to be sound. The studies are done and all it needs is for the NHS to 'catch up' and stop this is insane waste of precious resources for drug protocols that expose diabetics to risk for the enrichment of 'Big Pharma' and the Doctors that peddle drugs as the only means of treatment. I well remember the first GP appointment for J' after the diagnosis. The prescription for Metformin had already been written before we had said a word ! And even when we had, any thought of diet and exercise treatment was swiftly consigned as being too difficult, too arduous. So much for informed consent !

An HbA1c of 6.3%, down from 6.6%  a year before and from a start of 8.5% 20 months ago, is the proof that it works. It can be hard; there are carbs 'hidden' in many foods, especially 'low fat' products which is the food industry staple these days. There are setbacks when you get a cold or 'flu, and the 'dawn phenomena' can be a bugger to control. But it works and it's drug free and it costs the NHS sod all !

Monday, 12 July 2010

The Diseases of Prosperity.

Diabetes and Cardiovascular disease are the major causes of our modern day demise, usually before our time. They are wreaking havoc with our health, and eating up vast resources within all Health care and the NHS. They are largely preventable, but successive Governments have had neither the will, nor desire to do anything about it, having become pawns in the games played by the industrial conglomerates that constitute drugs manufacturing and food production, to maximise their 'bottom line'. Diabetes Mellitus type 2 is reaching epidemic proportions and is costing huge sums, within the NHS, for both treatment and so called prevention, but the protocols for both are founded in a mire of obfuscation, junk science and vested interests.

Non-insulin dependent diabetes mellitus is an endocrine disorder which involves the pancreas, or more importantly the 'islets of langerhans'; the beta cells that secrete the hormone insulin. In addition a common factor especially in the early stages is Insulin resistance. This is caused by the muscles and other cells, inability to take up the glucose circulating in the bloodstream, leaving it at high levels; this is hyperglycemia. Interventions by drugs and insulin is the way medicine then acts, to reduce this dangerous excess. But this is often counterproductive, as it exacerbates the problem of the insulin resistance, and pushes an already exhausted pancreas to secrete more and more insulin until it dies completely under the load imposed upon it. At that stage, insulin injections become mandatory and these are potentially life threatening and almost always cause obesity to increase, or appear, if it has not already begun.

To enable a more proactive approach to the prevention, detection and treatment of diabetes, a number of 'sacred cows' need to be taken out of the equation, preferably round the back of the surgery, and administered a fatal shot to the brain. Perhaps along with some of the physicians that promote these drugs and protocols. These are;-
 
  • Low fat, high carbohydrate diets.


  • Exercise, but with little direction as to what or when.


  • Various hypoglycemic agents that have some serious side effects.


  • A culture that offers a chemical fix instead of a lifestyle changes


With this initial nutritional advice, to consume low fat, high carbohydrate diets we come up against the pig headed views, about the fat-diet-heart hypothesis that have dominated dietary advice for the last thirty years. It takes no account, of numerous studies that have thrown this into the long grass, where it belongs, and I cannot see why it still prevails, as even some mainstream medics are beginning to cast doubt on it's veracity. When even simple biochemistry dictates, that any starch intake is going to be converted to glucose almost instantly in some foods, it is obvious that blood levels are going to rise with it's consumption, which will then require that level to lowered. The only conventional way for a diabetic to achieve normoglycemia from this position is to take something to lower the level and/or burn it off by exercise. Why in the name of Hippocrates would you suggest that you take a 'poison', merely so you can take the antidote ? Far better, I say not to take the damn stuff in the first place, surely ?


Exercise, is always advocated by all in Health care for, well, virtually everything. But it does little at all to reduce obesity of itself. OK it will help a little to keep you healthy, but obesity tends to make exercise an effort, so tends to go on the back burner for most. It can and does burn off excess glucose in diabetics, but has to be carefully targeted to do this at times, postprandial, that will have the maximum effect, but it will do little to reduce weight in any meaningful way. In the last few days it has been widely reported in the media that childhood obesity is not caused by lack of exercise, as reported by this study, from the Peninsular Medical School in Plymouth. Read it here , it explodes a few myths.


Hypoglycemic agents are oral drugs, generally that lower glucose absorption, increase it's disposal by the liver, help to lower insulin resistance or pressurise the pancreas to produce more insulin. They have significant and often unpleasant side effects, and whilst I would not entirely rule them out, I would always advise extreme caution in their use. With the possible exception of Metformin, they often invoke hypoglycemia, which can be more dangerous than too much blood glucose, and they almost always promote weight gain. Once you are prescribed these drugs the condition almost always worsens, and more and more are prescribed until insulin injections are needed because you will no longer have any functional beta cells. 


These chemical 'fixes' are there because you will never be told to eliminate as much as possible the source of all that glucose, carbohydrates, that is largely causing the condition. It is not politically correct to consume fats, especially saturated animal fats, and proteins should only be consumed in relatively small volumes, so the bulk of the diet advised is carbohydrates, of up to 66% of intake, if you include the insane notion, of fruit and vegetables not being carbohydrates, which they largely are. So, with the connivance of the medical profession you are told to eat carbs in abundance, even some sugars (!) because the drugs you are being given will take care of the problem. You will also be told that eating fats will make you fat, except of course the awful man made vegetable types; monounsaturated and polyunsaturates, (and I do advocate some intake of the latter, in the form of  Omega 3's), margarine with plant sterols, are in fact in that group. These are alleged to assist in cholesterol lowering, which you will also be told is an essential of diabetic protocols (see last post). The simple truth is that saturated fat has no insulin reaction whatsoever in it's metabolism in the human so it cannot make you fat. It will in fact help to make you thin as well as providing a food stuff you will satiate your craving for sustenance, which is a side effect of insulin resistance.


So even if you are a diabetic, even on insulin, you will benefit from the 'primitive' or 'paleolithic' diet we were eating only some ten thousand years ago. 'A blink of the eye' in evolutionary terms. Man, especially those hunter gatherer types, northern in origin, which people the USA and Europe are poorly adapted to the absorption of nutrients from grains and other carbohydrates, and as a consequence, much of that which we eat in this food group, increases our likelihood of becoming diabetic and largely is stored as fat. Abdominal fat increases our chance further of becoming diabetic and obese. Worse, the huge consumption of sugars both sucrose, which has risen from 3kgs per person in 1900, to 75kgs per person today, and more importantly, in the past few years, fructose, is complicit in this phenomena of increase in both risk and consequence.


By failing to take account of these factors, in the dietary advice given to all diabetics, by current mainstream dietitian's, nutritionists and most doctors, a considerable disservice has been perpetrated upon diabetics. By, adding to the burden of drug protocols, the need to lower all lipoproteins, and blood pressure often when these are in the normal or low risk levels; the health and well being of the diabetic is often further compromised. Often, this is founded in dogma and poorly researched science, typical of preventative measures advocacy that much of health care interventions is steeped in today. These are '5-a day'; statins lower CVD risk ( in otherwise healthy people); a (so called) cholesterol level of 4.0 mmol/L is dangerous; eating saturated fat increases CVD risk, etc,etc. These are all hypotheses that are unproven or worst proven as being untrue. The vast sums we have literally 'thrown' into these protocols and the 'bribes' given to Doctors to both advocate and invoke them is a scandal of enormous proportions. It is patently not working and we are are on the brink of an epidemic of diabetes and obesity in society, that is going to eat up more and more of our precious resources, with prospect of 4.2 million diabetics by 2025, as opposed to approximately 2.5 million today (Diabetes UK figures). 


We are now faced with the prospect of GP Commissioning of all Primary care in the UK, which will include diabetes care. If this comes to pass, for which there is some inevitability, GP's will be given the budget for this area, with perhaps even more of the same outmoded beliefs and treatments inevitable. As most, if not all GP's are contractors, it will place them in the difficult position, for the patient that is, of being both the purchaser and provider of services. The situation not of 'poacher turned gamekeeper', but of them being one and the same simultaneously. That is not a scenario that bodes well for patients, and is likely to make for even more corruption of care than is currently the case. There is already vested interests at play both in the National bodies that oversee diabetic care and in those that treat us for it. To allow even more to be invoked is likely to make it worse, not better. The diabetic will once more be a pawn of those interests, with the  prospect of large private 'for profit' entities bidding for their care, with their outcomes likely to suffer as a result. And society's spiral towards diabetic overload likely to result.

Friday, 9 July 2010

Ken Coates RIP

In a pause from normal business, I was shocked and saddened by the news of Ken Coates death. Never quite a friend, but a close acquaintance from the days when he worked on Prof Daniels roses, way back in my teens. To the days when he was head of the Bertrand Russel Peace Foundation in the 70's and I was in concert with both his views and protests. I used to help out there in a few ways then and always viewed him as a slightly distant mentor.

Prolific and accomplished author, he remained an unashamed rebel probably to the end of his days. I will remember him at the height of his powers, although he was always hampered by his partial deafness, which may have been the result of his mining days. Principled as he was he refused, to join the army and spent some years at the coalface instead. He was diabetic, which I did not know at the time, only years later.

Like many I have known, I lost touch with him and the Foundation some years ago as I was reincarnated once more into a different world that survival dictated, but I always remembered him with admiration and respect. It breaks one more of the bonds to that time in the 70's when we had it all, almost, and it trickled through our fingers, like sand. We should have listened to Ken, we might not have had to put up with the Blair years if we had, well maybe.

Farewell then Ken, I will break a glass for you. May you live in the hearts of those you leave behind.
His Guardian Obituary is here, http://www.guardian.co.uk/politics/2010/jun/29/ken-coates-obituary

                                        

Wednesday, 7 July 2010

It's Those Statins Again !

Seem to write a lot about these, but there are a lot of them ! This study shows that their use is, well, pants !

A new meta analysis, published in the Archives of Internal Medicine today and given some prominence in both Pulse and SearchMedica, highlights the fact that there is no evidence that statin therapy has any effect on all cause mortality, even in high risk categories of patients, without a history of CVD. Makes you feel like saying 'told you so'. Some even advocate we give them to children! I kid you not !

With more than 65,000 participants and spanning some 39 years, I find this pretty conclusive evidence, to stop spending our money on pointless, expensive, and potentially harmful treatment protocols, for relatively healthy people, who fall the wrong side of a line drawn, by the very architects of the drug used to treat those who do. And of course, the line moves, in concert, with the never ending greed of 'Big Pharma'.

The jury is still out, on the use of statin's in patients presenting with existing CHD/CVD, although, even that has pretty flimsy evidence in it's favour, to say the least. But, it is without doubt a useless protocol, for those who do not have heart disease already, but are classed as 'at risk'. Probably by gist of one of the several 'risk engines' available in health care that predict that likelihood, but again, are notoriously poor at doing so, with any degree of accuracy ( The Framingham Index  being one). The elderly, hypertensives, and diabetics are generally those targeted, to their detriment and that of their future health. I personally have talked to women, put on statin's, because their overall cholesterol level was above 4.0 mmol/L ! Is there a conspiracy in the GP cohort to enrich 'Big Pharma' ? Because  that sort of prescribing is profligate, and is bordering on dangerous !

But, so long as NICE keep churning out the guidelines, that allow it, and provide financial incentives for those that prescribe, then Doctors will keep writing the the scrips, doing the lipids profiles, and telling us all we need to get our cholesterol down to an insanely dangerous low level. Of course it isn't even cholesterol it's simply it's transport molecule level, i.e. the total lipoprotein level in the blood, about which they generally know bugger all !

In these austere times, when money for health care is under pressure, it seems stupid to continue this pointless exercise, for the enrichment of the pharmaceutical giants, and give incentive awards to Doctors to medicate patients, that do not need to be treated, except in the la, la land of Quality Outcome Frameworks. These are set, in the misguided belief, that interventions of this type, will make us all more healthy and save the NHS money in the future. In fact this group, despite the (often) cocktail of drugs they are taking, present to hard pressed A&E, just as frequently with CHD/CVD, as those who do not. Of course it isn't just the Doctors time, and the drugs cost, it's the test protocols that also become necessary, at regular cycles to ensure that these so called 'benign' drugs are not destroying liver, kidneys or other organs of the recipient, or worse, precipitating the very thing they are alleged to prevent; heart failure. It seems ironic that the drug used to prevent Coronary Heart Disease, can of, and in itself, bring about muscle wastage to the extent that heart failure ensues.

In diabetics, there are 17 Quality Outcome Frameworks to structure their lifestyle, and lipid modification even if their (so called) cholesterol is near normal will likely be invoked, condemning them to a lifetime of statin therapy. This will be in addition to other protocols, involving blood pressure lowering medication, again even if their BP is normal and various interventions to keep their blood sugar within guideline levels. DM23 for instance, which has now been proven as being too stringent and putting Type 2's at risk, being just one, is being reviewed in the light of evidence that it is dangerous. All because, I believe mainstream medicine will not review it's strategy of low fat diets instead of low carbohydrate diets for diabetics. Doh !

The cost of the tests, drugs and Doctor time for the 5 million people the NHS suggest needs these drugs (statin's that is). Well, we do not quite know, but the drugs alone come to a £billion, the tests probably another at least, and that does not include Doctor time, the bonus paid for achieving the QOF, or the huge cost to the patients who have suffered from the many adverse outcomes, even death, from the use of statin's. I think that £3 billion would be a fairly accurate estimate. You could re-open a few wards with that sort of money, or even train a few Doctors (perhaps even properly, so they know what they are doing).

'Primum non nocere', is perhaps something those who advocate these drugs, should remember.

 Next up, diabetics (type 2 that is).