Healthy lifestyle can prevent diabetes (and even reverse it)

Originally Posted Here: https://www.health.harvard.edu/blog/healthy-lifestyle-can-prevent-diabetes-and-even-reverse-it-2018090514698

The rate of type 2 diabetes is increasing around the world. Type 2 diabetes is a major cause of vision loss and blindness, kidney failure requiring dialysis, heart attacks, strokes, amputations, infections and even early death. Over 80% of people with prediabetes (that is, high blood sugars with the high risk for developing full-blown diabetes) don’t know it. Heck, one in four people who have full-blown diabetes don’t know they have it! Research suggests that a healthy lifestyle can prevent diabetes from occurring in the first place and even reverse its progress.

Can a healthy diet and lifestyle prevent diabetes?

The Diabetes Prevention Program (DPP), a large, long-term study, asked the question: we know an unhealthy diet and lifestyle can cause type 2 diabetes, but can adopting a healthy diet and lifestyle prevent it? This answer is yes: the vast majority of prediabetes and type 2 diabetes can be prevented through diet and lifestyle changes, and this has been proven by 20 years of medical research.

Researchers from the DPP took people at risk for type 2 diabetes and gave them a 24-week diet and lifestyle intervention, a medication (metformin), or placebo (a fake pill), to see if anything could lower their risk for developing diabetes. The very comprehensive diet and lifestyle intervention had the goal of changing participants’ daily habits, and included: 16 classes teaching basic nutrition and behavioral strategies for weight loss and physical activity; lifestyle coaches with frequent contact with participants; supervised physical activity sessions; and good clinical support for reinforcing an individualized plan.

Perhaps not surprisingly, the diet and lifestyle intervention was incredibly effective. After three years, the diet and lifestyle group had a 58% lower risk of developing diabetes than the placebo group. Participants aged 60 and older had an even better response, with a whopping 71% lower risk of developing diabetes. The diet and lifestyle effect lasted: even after 10 years, those folks had a 34% lower risk of developing diabetes compared to placebo. Men, women, and all racial and ethnic groups had similar results (and almost half of participants represented racial and ethnic minorities). These results are not surprising to me or to other doctors, because we have all seen patients with prediabetes or diabetes get their sugars down with diet, exercise, and weight loss alone.

Meanwhile, the medication group had a 31% lower risk of diabetes after three years, and an 18% lower risk after 10 years, which is also significant. It’s perfectly all right to use medications along with diet and lifestyle changes, because each boosts the effect of the other. Studies looking at the combination of medication (metformin) with diet and lifestyle changes have shown an even stronger result.

Dietary recommendations to prevent diabetes (and even reverse it) Decrease intake of added sugars and processed foods, including refined grains like white flour and white rice. This especially includes sugary drinks, not only sodas but also juices. The best drinks are water, seltzer, and tea or coffee without sugar. Swap out refined grains for whole grains. Whole grains are actually real grains that haven’t been stripped of nutrients in processing. Foods made from 100% whole grain (like whole wheat) are okay, but intact whole grains (like farro, quinoa, corn, oatmeal, and brown rice) are even better. Swapping out grains for starchy veggies (like potatoes) is also okay, as long as these veggies aren’t in the form of french fries! Increase fiber intake. High-fiber foods include most vegetables and fruits. Legumes are also high in fiber and healthy plant protein. Legumes include lentils, beans, chickpeas, peas, edamame, and soy. People who eat a lot of high-fiber foods tend to eat fewer calories, weigh less, and have a lower risk of diabetes. Increase fruits and vegetables intake. At least half of our food intake every day should be non-starchy fruits and vegetables, the more colorful the better. Cruciferous vegetables like broccoli, cauliflower, and Brussels sprouts, and high-fiber fruits like berries of all kinds, are especially healthy. All fruits and vegetables are associated with living a significantly longer and healthier life! Eat less meat, and avoid processed red meat. Many studies have shown us that certain meats are incredibly risky for us. People who eat processed red meat are far more likely to develop diabetes: one serving a day (which is two slices of bacon, two slices of deli meat, or one hot dog) is associated with over a 50% higher risk of developing type 2 diabetes. Eating even a small portion of red meat daily (red meat includes beef, lamb, and pork), like a palm-sized piece of steak, is associated with a 20% increased risk of type 2 diabetes. This may be because of the iron in red meats, and the chemicals in processed meats. As a matter of fact, the less meat you eat, the lower your risk of diabetes. People who don’t eat red meat at all, but do eat chicken, eggs, dairy, and fish, can significantly lower their risk of developing type 2 diabetes, by about 30%; those who eat only fish, 50%; those who eat only eggs and dairy, 60%; those who are vegan, 80%. Eat healthier fats. Fat is not necessarily bad for you. What kind of fat you’re eating really does matter. Saturated fats, particularly from meats, are associated with an increased risk of diabetes and heart disease. Plant oils, such as extra-virgin olive oil and canola oil, carry less risk. Omega-3 fats, like in walnuts, flax seeds, and some fish, are actually quite good for you. Diet and lifestyle changes that can help prevent diabetes

Diet and lifestyle changes are so effective for diabetes prevention that as of April 2018, insurance companies are now covering these programs for people at risk. The CDC’s Diabetes Prevention Program, used in many clinics, is a free tool to help you learn and stick with the healthy diet, physical activity, and stress management techniques that reduce your risk of diabetes.

One helpful tool is the Harvard School of Public Health Nutrition Source Healthy Eating Plate, which shows you what your daily food intake should look like: half fruits and vegetables, about a quarter whole grains, and a quarter healthy proteins (plant protein is ideal here), with some healthy fats and no-sugar-added beverages. The Harvard Health Blog also offers many articles with recipes and cooking videos to help you create a healthier, diabetes-free lifestyle.

Resources

New CDC report: More than 100 million Americans have type 2 diabetes or prediabetes. CDC Newsroom, July 18, 2017.

Reduction in the incidence of Type 2 diabetes with lifestyle intervention or with metformin. New England Journal of Medicine, February 7, 2002.

10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. The Lancet, November 14, 2009.

Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality—a systematic review and dose-response meta-analysis of prospective studies. International Journal of Epidemiology, June 1, 2017.

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Heat related illness: How to keep your cool

Originally Posted Here: https://www.health.harvard.edu/blog/heat-related-illness-how-to-keep-your-cool-2018081714590

The summer season is waning but we’re not done with the heat. Hot and humid weather can bring a host of heat-related problems: heat cramps, heat rash, heat exhaustion, heat stroke…. It’s helpful to be aware of these issues, especially as we experience changes in the climate with humidity or rising temperatures. There have been several studies which have documented an uptick in emergency department visits and hospital admissions for conditions like dehydration, electrolyte imbalances, and other types of heat related illness during times of high heat. Persons who are particularly at risk are the very young and old, those who do prolonged exertional work outdoors, and intense athletes.

Getting overheated: The cause of heat related illness

Our bodies are not well-equipped to withstand large increases in our core body temperature, which is usually around 98.6 ˚ F (37˚ C). With heat stroke, core body temperatures may rise dangerously to around 103˚ to 104˚ F (39.4˚ to 40˚ C). If you have a concern about overheating, be sure to check a rectal temperature, as other methods like oral, axillary, or tympanic measurements can be inaccurate in these situations.

Our bodies have a number of mechanisms to help us cool down. One of the most important is evaporation through sweat, but this mechanism becomes less efficient in high humidity. Also, when we are dehydrated or when we are not accustomed to exertion in the heat, cooling off through evaporation becomes more challenging.

Furthermore, there are a number of medications that impair our bodies’ mechanisms for cooling off, like antihistamines, anticholinergics, decongestants, diuretics, stimulants, and some blood pressure pills, to name a few.

Signs and symptoms of heat-related illness vary. Dehydration may cause feelings of thirst, dizziness, and fatigue. Heat stroke, which needs urgent medical attention, may include hot or flushed skin, a fast heart rate, headache, nausea, dizziness, confusion, or loss of consciousness.

3 key questions about hydration

1.   How much should you hydrate? If you know you are going to be exerting yourself in the heat, start your hydration beforehand, so you start with a “full tank.”

2.  Is it possible to “overhydrate”? Yes. Best to speak with your doctor if you have a medical condition that requires you to be on diuretics or a fluid restriction. Also, though not common, drinking too much water can cause hyponatremia, or a low sodium concentration in the blood. This can be quite serious when it does happen, leading to symptoms like nausea, vomiting, headache, muscle cramps, confusion, and seizures. Hyponatremia is more likely to happen with athletes who sweat a lot, losing salt and water, but then replace the sweat by drinking only water, causing a diluting effect. Sport electrolyte drinks (which can be high in sugar and calories) are an option, but usually not necessary if you hydrate with water while having regular meals or salt-containing snacks.

3.  How do you know if you are getting enough fluids? Well, if you feel thirsty, you may already be dehydrated. Another telltale sign of dehydration is making less and darker urine, as opposed to normal amounts of light yellow urine.

10 tips for avoiding heat related illness Plan to take it easy, especially if you are not used to exerting yourself in the heat and humidity. Seek shade or cool areas and avoid prolonged exposure to the heat. Protect yourself from sunburns. Wear light, loose, reflective clothing. Stay hydrated and avoid alcohol and caffeinated drinks. Cool down with a cold bath or shower. Dampen your clothes or apply wet towels while cooling off with an electric fan. Use ice packs, especially on the neck, underarms, or groin near the main blood vessels. If you feel ill and your symptoms are severe, seek prompt medical attention. And remember, check in on anyone you think is at risk and might be more vulnerable!

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Small study suggests benefits of computer-guided CBT for substance abuse

Originally Posted Here: https://www.health.harvard.edu/blog/small-study-suggests-benefits-of-computer-based-cbt-for-substance-abuse-2018082014434

There is no way to meet the need for substance abuse treatment through the current healthcare system. The number of people who need treatment for drug and alcohol abuse is far greater than the number of clinicians available to treat them. In more rural areas, patients might have to spend a lot of time traveling great distances to appointments, which can be difficult to do while working or taking care of a family. And, the cost and stigma of treatment can get in the way of getting help. Moreover, even if people do get to substance abuse treatment, they often do not receive the most effective ones. As illicit drug use increases in the United States, new ways to deliver treatment are urgently needed.

Computer-guided treatments are one way to overcome the hurdles of access to evidence-based treatments, including travel and scheduling, cost, and stigma. Additionally, using computers to treat one’s own substance abuse can be empowering, giving a sense of “I did it on my own.”

How well do computer-guided treatments work compared to live counseling?

Researchers from Yale University recently developed and studied the “Computer-based Training for Cognitive-behavioral Therapy” (or “CBT4CBT”) web-based substance abuse treatment as a fully standalone intervention. CBT4CBT provides cognitive behavioral therapy (CBT) — an evidence-based treatment for substance abuse. The treatment is completely computer-guided, and does not involve interacting with a counselor or other healthcare professional. It combines online games and video vignettes with actors to teach how to manage one’s own substance use. Specifically, CBT4CBT covers: how to understand and change patterns of substance use; dealing with cravings; refusing offers of alcohol and drugs; problem-solving; noticing thoughts about drugs and alcohol and how to change them; and strengthening decision-making abilities.

Earlier research has shown that CBT4CBT can be an excellent complement to make live treatment with a counselor more effective and efficient. Recently, the research team conducted the first comparison of any standalone web-based treatment for substance abuse to “treatment as usual” — and data suggest that it may be better.

The study on CBT4CBT

The Yale team recruited 137 people seeking substance use treatment from the Connecticut Mental Health Center in New Haven; 49% African American, 34% Caucasian, and 8% Latino or Latina. Substances used were marijuana, cocaine, alcohol, opioids, and PCP. It was a real-world sample in that most participants used more than one illicit drug and most also used alcohol.

One-third of the participants were randomized to use CBT4CBT, with 10-minute in-person weekly checkups to evaluate their overall functioning, their safety, and their use of the online program. One-third of participants were enrolled in “treatment as usual,” which was either group or individual therapy, and covered topics including motivational interviewing, life skills, relapse prevention, harm reduction, mindfulness, and others. The other third were assigned to in-person CBT with a therapist who delivered the same type of content as the CBT4CBT online program.

The researchers found that drug use (measured by urine tests — which corresponded closely with self-reported use) in the CBT4CBT group was significantly less than treatment as usual, and remained lower over six months of follow-up. Persons who received live CBT had the same level of drug use as the treatment as usual group after six months. They also found that participants in the online treatment learned the CBT concepts the best, and had the highest level of satisfaction and lowest dropout rate of any of the three study conditions. Overall, after treatment the percentage of days abstinent from any drug use was 75% for the CBT4CBT group, vs. 67% of days abstinent for the treatment as usual group and 61% for the live CBT group. The study did not enroll a large enough number of participants to conduct a head-to-head comparison of CBT4CBT and live CBT. That may come later, and the results could inform how to conduct live CBT more effectively.

Getting access to computer-guided CBT

Computer-guided CBT for substance abuse should be studied further should be studied further, with different populations and in different settings, the next real challenge is to disseminate it widely across the US and beyond. According to its website, the CBT4CBT program is not yet available to the public, outside of clinical trials.

Building computer-guided treatment programs is often easier than building companies to deliver them. Barriers include acceptance by institutions, payment by insurance companies, liability, FDA approval, and resistance from healthcare providers — as well as coming up with viable business models. But if these obstacles can be overcome, the world could benefit from a highly effective and accessible treatment for drug and alcohol abuse.

References

Randomized Clinical Trial of Computerized and Clinician-Delivered CBT in Comparison With Standard Outpatient Treatment for Substance Use Disorders: Primary Within-Treatment and Follow-Up Outcomes. American Journal of Psychiatry, May 2018.

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