Prediabetes: Why is it important?

What is prediabetes and why is it important?

You may have been told that you have prediabetes, if that is the case there is a 10 to 20% chance of you developing diabetes in 10 years and 50-60% chance of you developing diabetes in your lifetime. With some conditions like PCOS the risk of developing diabetes may be as high as 40% within 10 years.

Once you understand the importance of this condition, you will realize that you need to be more closely monitored than someone who doesn’t have prediabetes.

95% of diabetes in this country is Type 2 also known as adult onset. It is thought that 50% of Americans will be diabetic by 2030.

Diet is critical with preventing prediabetes from progressing.

Some people refer to the dietary changes that need to be made in prediabetes as  “Precision Nutrition”.

It includes moving more towards a Mediterranean type of diet and an increase in fiber, vegetables and magnesium and less sugary liquids.

By changing your diet you can change your gut microbiome. Did you know that a 20 ounce soda contains the equivalent of 17 packets of sugar? Not what you want to give your children surely.

Salmon twice a week may be more helpful than fish oil capsules. Activity is also critical, any kind of activity even a 20 minute walk every day.

Just a small amount of weight loss can have a huge impact on whether you develop diabetes or not.

Fat cells around the stomach area (central adipose tissue) create inflammation in the pancreatic cells as well as fatty liver.

Natural supplements that may help: Fenugreek, Chromium and Bitter Melon.

If you are not sure of you blood sugar status ask about it at your next physical and let’s get on it if it’s a problem.

I didn’t want to write a long email about diabetes and medications because obviously that is separate and huge problem.

As always prevention is better than cure.

Don’t hesitate to come in and discuss further especially if you have diabetes in the family.

 

Do not be afraid of the Johnson and Johnson/Janssen vaccine!

Oh dear! What is wrong with this picture? A facility in Baltimore got the contract to make components of the J and J vaccine because of political ties to the previous administration despite prior FDA sanctions. We are told that 15 million doses of the vaccine had to be discarded last month because of the wrong components and contamination. Now it has been decided to halt production in that facility altogether and the vaccines will be made elsewhere. On the bright side it is reassuring to know that quality control inspections really work. Be that as it may, despite all the hiccups, do not be afraid of the J and J vaccine. As expected the CDC recommended on Friday that states should resume giving the vaccine with a “written warning” about the rare potential for causing severe blood clots. I did not believe there was enough evidence to stop the vaccine distribution to most people and I am glad the ‘pause’ was only a week long. Remember, it only took the FDA less than 2 weeks to approve the EUA’s for Moderna and Pfizer. The CDC, the FDA and the State of Maryland Health Department have all issued statements allowing reintroduction of the J and J vaccine. Here is the joint statement from the FDA and the CDC: “Following a thorough safety review, including two meetings of the CDC’s Advisory Committee on Immunization Practices, the U.S. Food and Drug Administration and the U.S Centers for disease Control and Prevention have determined that the pause regarding the use of the Johnson and Johnson (Janssen) Covid-19 Vaccine in the U.S should be lifted and the use of the vaccine should resume.” I can tell you from personal experience that the vaccine is fine, my husband and I both got it. I drew blood on him the other day (the joys of being a doctor’s spouse) and his antibody levels far exceeded those needed for immunity. None of the vaccines are side effect free and none is better than any other unless you have certain medical conditions. Hopefully we can now get our vaccination surge back on track and stop this pandemic once and for all. Stay safe and be heartened.

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Don't panic and throw the baby out with the bath water! The J and J vaccine

 This email is about the Covid vaccines. I am not going to go into the mechanism of the different vaccines again, but I hope to make a video soon to explain the two main groups of vaccines and how they differ.

Let’s start with the facts as we know them.

Immunization against Covid has left the realms of strictly medicine and become more political. That cat clearly is out of the bag.

I think everyone is agreed that the benefits of the Covid vaccines outweigh the risks, whichever vaccine you use. For the most part the scarcity of the vaccines does not allow for choice, however some people will still have to be picky or closely supervised.

Pfizer has been used since mid December, Moderna since January and Janssen since February.

So far 23.4% of the US population has been fully vaccinated with a total of 195 million doses having been given. Yeah, America is back leading the way with positive news about Covid for a change!

This week after 6.8 million doses the Janssen (Johnson and Johnson) vaccine was ‘paused’ because of 6 cases of a clotting disorder. This has caused quite a stir (understandably) and a similar situation happened with the Astra Zeneca/Oxford vaccine in Europe.

To put it in context, in the US annually 300,000 to 600,000 people per year develop blood clots according to the CDC. Women who use birth control pills have a 0.3 to 1% chance of developing blood clots, that is 2 to 6 times the rate of women who are not on birth control. You can compare that to one in a million chance of getting clots with the vaccine.

I must admit I am always skeptical now, when I hear that people are announcing things in an effort to be ‘transparent’ but they have not yet done the work to really deliver facts. Often people are vying for market share rather than serving the interests of public health.

We now know that the 6 cases were all women between the ages of 18 and 48. We are still waiting to hear if any of these people had underlying conditions, platelet disorders, on birth control pills or other things that increase clotting etc.

We will have to be patient and wait for the data on the 6 women.

I think pausing the vaccine was a bad idea for 2 reasons:

One, it could have been paused for women under 60 (to err on the side of caution) only, and then men could have at least continued to get the vaccine, which means we would reach herd immunity faster. People on the Indian reservations for example who have difficulty with transportation could at least get a one time vaccine and many other benefits. Some people should not take an mRNA vaccine, now once again they must wait.

Number two, what does a ‘pause’ mean? Basically bad publicity and damage to health education and the vaccine program that will be hard to undo. I, myself, would be very leery of something that had to be paused and then restarted.

The clots were seen within 3 weeks of vaccination so if you got a Janssen vaccine more than 3 weeks ago you do not need to be alarmed.

Women that got it less than 3 weeks ago need to be vigilant of any unusual symptoms and bring them to the attention of their primary care provider.

While I am on the subject of severe side effects: 2.5 million people who got Moderna and 4.7 million who got Pfizer have had severe allergic reactions so if you have a history of anaphylaxis be very careful. I worry about people with chronic autoimmune conditions getting a flare up from the vaccine activating their immune system.

Pfizer announced this week that people will probably have to get (another) booster in 9 to 12 month. Lastly, I will not be surprised if eventually people get a hybrid of different vaccines to prolong immunity …..stay tuned. But don't panic!