Riva is finally doing what she set out to do in high school – writing her observations of life and human behavior - little did she know then that diabetes would be her muse. Riva has had type 1 since 18 and is the author of “50 Diabetes Myths That Can Ruin Your Life: and the 50 Diabetes Truths That Can Save It” and “The ABCs Of Loving Yourself With Diabetes.” Read full bio

Health Ills That Can Come With Years of Diabetes

November is Diabetes Month. This month you’ll hear more about diabetes symptoms and risk factors than you will all year.

But there’s something you won’t hear about. The health challenges those of us who’ve lived with diabetes for decades may face. There’s little research on it; not so long ago people died before they could live that long with diabetes.

But for those of us who will have lived much of our lives with diabetes — those who got, and will yet get, Type 1 diabetes as a child, teen or young adult, and younger adults and children now getting Type 2 diabetes — there are many health ills (comorbidities) that can come with long-duration diabetes. These comorbidities are in addition to the complications we often hear associated with diabetes: heart disease, kidney disease, amputation, blindness, neuropathy and retinopathy.

Comorbidities with long-term diabetes

Certified Diabetes Educator Claire Blum says the following comorbidities — muscle and joint pain, carpal tunnel, trigger fingers, high blood pressure, a deformity of your foot called Charcot’s foot, nerve and thyroid problems, hearing loss, frozen shoulder, loss of flexibility and increase of rigidity and celiac disease — occur with greater frequency in people who’ve had diabetes 25 to 35+ years.

What happens is, living with diabetes, your body experiences greater and more frequent inflammation. This is largely due to impaired immunity, impaired metabolism of carbohydrates and fats, hormonal imbalances and the metabolic stress associated with these disorders. These are in part caused by elevated blood sugar levels and the rate and speed at which blood sugar rises and falls.

As a result, the comorbidities above are more typically seen in people with diabetes, and at an earlier age.

Blum says traditional diabetes therapies, like checking your blood sugar, taking your medicine and counting carbohydrate and fat grams, should be considered only part of a treatment plan for staying healthy. “We need to see our body,” says Blum, “as a whole system and do what supports it as a system.”

What to do now to stay healthier over time

    • Manage your blood sugar — Keep your blood sugar in the best control you can to reduce the stress to, and inflammation within, your body.
    • Eat nutritiously — Our bodies pay metabolically with inflammation for nutrient-deficient food. Foods rich with anti-oxidants — colorful fruits and vegetables like berries, raisins, apples and apricots, broccoli, Brussels sprouts, carrots, sweet potatoes, peppers and artichokes, beans like kidney, navy, garbanzo and pinto, help curb inflammation and increase flexibility.
    • Practice stress reduction — be aware of, and minimize, stress through mindful practices such as meditation or breathing exercises. Stress can cause adrenalin rush and increased inflammation.
    • Stay flexible and build muscle mass — Do activities where you’re moving and building bone and muscle strength like brisk walking, swimming, yoga, pilates, using resistance bands or lifting weights. It can help you prevent getting frozen shoulder, rigidity and joint inflammation.

Blum, who has type 1 diabetes herself, said if she’d known that being more flexible might have helped her avoid the frozen shoulder she developed a few years ago, she would have started the yoga she does today earlier. “Taking care of yourself now,” says Blum, “is going to help you delay comorbidities and diabetes complications if you get them at all.”

When I was diagnosed at 18, I was told my lifespan would be 15 years shorter than if I hadn’t gotten diabetes. Yet today many say that people with Type 1 diabetes may outlive others because we have to take care of ourselves.

The message is take care of your whole self — body, mind and spirit — and start now. It pays off.

As Claire and I both will tell you, she having lived with Type 1 diabetes 35 years, and me, 41 years, taking good care of ourselves we are, in many ways, healthier than we’ve ever been.

Originally published in The Huffington Post.

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12 Healthy Ways to Lose Weight for Good

You’re 10, 20, 30 or more pounds overweight and you’ve dieted, on and off, for years. You’ve lost weight and then put it back on and more.

Why? Diets don’t work. Today we know diets don’t work. Even Weight Watchers says so. Restricting calories again and again alters your metabolism. That’s why so many people put back the weight they lost while dieting, plus more.

Yet, desperate to lose weight, Americans keep going on diets. While there’s no magic bullet for weight loss, there are steps you can take to lose weight, safely and for good, while increasing your health.

The common sense advice to “eat less, move more,” isn’t entirely correct. It matters what you eat.

And here’s a dirty little secret: Consuming refined carbohydrates — simple sugars and starches — is one of the biggest reasons Americans are now battling obesity. Carbohydrates you don’t burn get stored in your body as fat.


Since food manufacturers began lining supermarket shelves with “no-fat” and “low-fat” foods — most of which have added sugars — we have become fatter than ever.

This list of healthy eating habits is by no means complete. But here are 12 of the many recommendations in my new book to help you lose weight and gain the benefits — more energy and a fitter, healthier you. 

1. Eat a healthy breakfast every morning. Eating breakfast revs up your metabolism. If you skip breakfast you’re likely to eat more calories by binging later in the day. In a study of people who lost weight and kept it off for more than five years, one major thing they all did was eat breakfast. But Pop-tarts, donuts and Hot Pockets don’t cut it. Cooked oatmeal, whole grain cereals, whole grain breads, eggs and tofu with a salad are all healthy choices.

2. Stop counting calories and eat foods that nourish your body. A meal of fat-free, sugar-free, refined processed foods is also nutrient-free. Plus, it won’t satisfy you for long compared to a meal of nutrient-dense whole foods like vegetables, lean meats, whole grains, and healthy fat. As you begin eating more nutritious foods and get a little more physical activity (if you aren’t physically active now), your body will come to its natural healthy weight.

3. Always have some veggies and fruit washed and cut in your fridge. This way they’re easy to grab when you’re hungry (instead of reaching for that giant-size bag of potato chips) and you can throw them in your bag when you’re on the go.


4. Replace diet soda with unsweetened beverages. Diet drinks keep your sweet tooth craving sweets. Plus, they make you feel virtuous. Many people who drink diet drinks actually reward themselves with extra calories through the day. Instead, drink iced teas or plain or carbonated water with a slice of lemon or lime.

5. Use the “Plate Method” to make a healthy meal. Fill half your plate with low or non-starchy veggies like broccoli, asparagus, cauliflower, Brussels sprouts, string beans, mushrooms, peppers, or leafy greens and some fruit. Fill one quarter, with a whole grain like brown rice, barley, bulgur, or quinoa, or a starchy vegetable like corn or potatoes, or beans. Fill the last quarter with protein like broiled, sauteed, roasted, or baked (not fried) fish, chicken or turkey without the skin, lean cuts of meat, tofu or eggs.

6. Cut down on carbs. Refined carbohydrates (cake, candy, cookies, muffins, scones, cupcakes, soda, fruit juice, syrups, chips, and most supermarket breads) you don’t burn turn into fat. Even foods like fruit yogurt and many breakfast cereals have lots of added sugar. Replace fruity yogurts with Greek plain yogurt, choose high-fiber, lower carb cereal and add small amounts of healthy fat to your meals with avocado slices, unsalted nuts, seeds and olive oil.

7. Shrink your lunch and dinner plates. If you and your family eat off a plate larger than ten inches, replace them with plates that are nine or ten inches in diameter. We tend to eat what’s in front of us. Using smaller plates there’s less food in front of you to eat.

8. Enjoy less healthy foods now and then, in small portions, unless there’s a medical reason not to do so. Not letting yourself eat something you love may make you feel deprived and frustrated and subvert your efforts to eat well.

9. When eating out ask your server to double the green veggies in place of the potato or rice. I always do this and benefit from more nutrition and less carbs. Also, share food at the table. My husband and I always share an appetizer and when with a group, if someone orders dessert, it comes with a spoon for everyone.

10. Keep tempting foods out of the house. Stock your fridge and pantry with healthy foods and you’re creating an environment that will help make you successful. Enjoy treats occasionally when you’re out.

11. Enlist family members and friends to eat healthier with you. It’s easier
when it’s a team effort, and, your family will also reap the health benefits along with you.

12. Talk positively to yourself and quiet your inner critic. Notice during the day your positive efforts and compliment yourself. “I chose a healthy vegetable plate instead of a slice of pizza. Great job!” The more you pat yourself on the back for what you’re doing well, the more energy you’ll have to keep doing it. If you notice you’re telling yourself you’ll never succeed, or beating yourself up for having two bowls of ice cream, stop! To quiet your inner critic head out for a brief walk, turn on some music and sway, and above all, tell yourself tomorrow is a new day and a new start.

My new book, Diabetes Dos & How-Tos, contains 65 “Dos” for people to manage their diabetes. But the 20 “Food Dos” in the book will benefit anyone.

If you don’t have diabetes they will show you how to lose or maintain your weight and eat more nutritiously. If you are at risk for diabetes, or have pre-diabetes, (Stage 1 Type 2 diabetes), the book’s “Food Do’s” can help you prevent full-blown (Stage 2) Type 2 diabetes.

Originally published in The Huffington Post.


What Happens When Doctors Go Too Slow

I just returned from the American Association of Diabetes Educator’s national conference. About 2,500 educators attended out of approximately 17,000 in the country. (The 17,000 educators for now more than 26 million people with diabetes is another story!)

I attended as a presenter (“Dancing Together: The Power of a Relationship-Centered Approach”), to hear the latest news and to connect with my fellow educators — perhaps the most impassioned group of health care providers I know.

But that’s not what I want to talk about. I want to share the opposite — the phenomena that too many health care providers fall victim to — clinical inertia.

Clinical inertia is when a health care provider gets sluggish with your care. When he or she doesn’t initiate or change your treatment when clinically indicated.

The Danger of Clinical Inertia
Clinical inertia is a major contributor to inadequate treatment in chronic illnesses like diabetes, heart disease and depression. It may even account for up to 80 percent of cardiovascular events.

Like medical errors, clinical inertia can put a patient in danger. For instance, your depression goes untreated or your blood sugars are always high because you’re not on the right medicine.

Yet unlike medical errors, clinical inertia goes mostly unreported and under the radar. That’s why it’s up to you to be mindful whether your provider is providing treatment and recommendations in your best interest.

I hear about clinical inertia often in diabetes. Not from physicians, but from patients. While they don’t use the term, they describe its effect. 

A patient will tell me their blood sugar has been consistently in the 300s mg/dl (above 16.6 mmol/l). When I ask, “For how long?” they say for years. After I recover, they go on to tell me their doctor doesn’t seem concerned. 

When I first heard this from patients I was surprised. I hear it so often now, I’m not. What does surprise me, however, is many patients’ inertia to discuss their continued poor health with their doctor.

Is it the white coat syndrome? The authority we bestow on doctors? It could be because when I suggest switching providers, whomever I say this to typically hesitates. Then a moment later I see the lightbulb go on. Of course I should do that!

I’m not damning doctors. I have some amazing doctors. Nor can I know when a patient tells me they’re struggling, whether they’re on a poor treatment plan, or it’s brilliant and they’re not following it.

But I do know clinical inertia is real and it occurs frequently among general practitioners in diabetes. And it’s understandable why.

Treating diabetes is complex and time-consuming. Many patients need to be taught how to manage their blood sugar, blood pressure, cholesterol and weight. How to organize taking a plethora of medicines by time and amount and keep their prescriptions constantly filled.

Most patients will need to change lifelong behaviors around eating and exercise — actions that have been ingrained for decades. They may also need to learn how to use blood sugar monitoring and tracking devices, or learn how to adjust their insulin doses daily on a sliding scale. And much more.

Causes of Clinical Inertia
There are three main reasons cited for clinical inertia: 1) Providers believe they’re already giving sufficient care, 2) Providers lack sufficient training and 3) In chronic illnesses that require patients to change behavior, many providers don’t believe patients are capable of, or willing, to do so.

The fear of losing patients and the income they provide can also be a cause of clinical inertia. A pharmaceutical rep, who works with doctors in New York City’s Chinatown, told me a doctor he knows who has Type 2 diabetes finally put himself on insulin and said it was the best thing he’d ever done.

When the rep asked if he now recommends insulin for more patients, he said, “Absolutely not. They’ll only leave me and go around the corner to a doctor who’ll happily give them pills.”

I hope this is uncommon. I also hope if you are a medical professional and fear patients will leave you because you recommend an injectible as their best treatment, that you help them understand why this is in their best interest and explore with them what they’re willing to consider and do to address their own fear of taking shots.

Speak Up For Yourself
If you have a chronic condition and a voice in your head is saying, “I should be doing better, something’s not right,” you owe it to yourself to say that to your doctor. If you don’t get the answer you want, find a doctor who agrees with you.

Dr. David Agus, professor of medicine at the University of Southern California, Keck School of Medicine, says in his book The End of Illness that the knowledge you carry about yourself is as essential to your wellness as your doctor’s knowledge. Agus also recommends if you feel you can’t talk to your doctor, find another doctor.

We’re all prone to inertia from time to time. But when it comes to living with a chronic illness, if you’re doing nothing when things are going poorly, you are actually doing something — getting worse. Trust me, I know. My friend’s cousin did just that and he’s no longer here to tell you about it.

Originally published in The Huffington Post.

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The Diabetes Test Strips Crisis: How Cutting Costs Is Robbing Your Health

Medicare and the FDA (Food and Drug Administration) are choosing to lower costs at the expense of your health. They are allowing cheap and faulty diabetes test strips into the marketplace. Test strips that have been proven — the FDA admits — to give inaccurate glucose readings.

This is dangerous for anyone who has diabetes, no matter what your age. We cannot allow this to continue and, together, we can stop it — and we must.

I want you to write a letter to the FDA to keep bad strips out of the market. That’s it, that’s all, that simple. Go, as soon as you read this, and use one of the sample letters that has already been created for you at StripSafely.com.

Strip Safely

StripSafely was created by the diabetes online community with a single mission. To have the FDA create a plan to best ensure test strips’ accuracy. A plan that holds test strip manufacturers accountable to meet minimum accuracy standards — and reviews test strips’ accuracy after they enter the marketplace, when new lots are often found to be unreliable.

Gary Scheiner, certified diabetes educator and author, says, “The 4 million plus people in the U.S. who take insulin typically base doses on meter readings. Inaccurate readings can lead to inappropriate dosing. This greatly increases the likelihood of severe hypoglycemia (low blood sugar) and long-term hyperglycemia (high blood sugar).”

Meaning, each blood sugar reading I get throughout the day tells me my starting point for every decision I make about eating, activity and how much insulin to take. Each of my daily diabetes decisions is based on that reading. If my reading is falsely high or low I will take an action that can cause me to fall into a coma or die or suffer diabetes complications.

Another problem, says Scheiner, is if patients lose faith in their meter and strips due to inaccuracies, they are likely to stop testing altogether.

Why is this a problem now?

Because this month Medicare rolled out its price-slashing program on blood sugar test strips. After requesting competitive bids, Medicare now limits the test strips a beneficiary can receive to 18 selected manufacturers, mostly from overseas.

Several of these manufacturers’ strips failed accuracy tests or their accuracy was deemed uncertain. In one study of 34 blood glucose systems, more than one-fifth did not meet the minimal accuracy requirements of the ISO standard.

The FDA acknowledges there are strips in Medicare’s new program that give inaccurate results and they have no way of removing them. Further problematic is the FDA reviews manufacturers’ test strips before the strips are marketed, but not after. Strips can, and do, vary after they’re in the marketplace.

And while this is currently being imposed on Medicare members, this may hurt us all. David Edelman reports in “Can You Trust Your Test Strip’s Accuracy?” that the winners of our government’s bidding war may price U.S. manufacturers out of the market as they are held to the FDA accuracy standard.

Or U.S. manufacturers may have to drop their prices so low, they will abandon the other essential things their test strips fund — new product development, innovation, customer service support, educational programs, and oh yes, accuracy.

Mike Hoskins, at DiabetesMine.com says all “PWDs (people with diabetes) will have less choice (of meters and strips) and an even harder time getting coverage for the best brands.”

Medicare’s cost-cutting strategy is clearly save now, pay later. You, or someone you love, may pay with heart disease, kidney disease, an amputation, neuropathy or retinopathy, all diabetes complications. Or the payment may be the co-morbidities of diabetes: cancer, obesity, hypertension, fatty liver disease, sleep apnea and fractures. You may pay in health care costs for surgeries, drugs, medications and not being able to work. Inaccurate blood sugar readings will contribute to all of these. 

Write a Letter, It’s Easy-Peasy

Take just a few minutes, use one of the sample letters on the site and add your voice to urge the FDA to protect you or someone you love by ensuring test strips meet regulatory requirements — both before and after they’re in the marketplace.

My letter is on the site as well and here’s the beginning:

Jeffrey Shuren, MD JD Director, Center for Devices and Radiological Health Food and Drug Administration 10903 New Hampshire Avenue, WO66-5442 Silver Spring, MD 20993

July 2, 2013

Dear Dr. Shuren:

I’ve had type 1 diabetes for 41 years and I’m turning 60 next month. Two weeks ago my A1C was 5.5 percent, yes, normal. How is that possible? I adhere to a healthy diet, exercise every day, and check my blood sugar diligently using a meter and strips recognized among those with the tightest accuracy.

I am writing to you because while I might have said as a teenager, “I’d die if I don’t get that!” I actually could die if I don’t have accurate test strips…


Hold the FDA to their job

Many would argue the most basic job of government is to protect its citizens. Yet, the federal government is causing seniors to lose out and set the ball in motion for U.S. strip manufacturers to get priced out of the market. If this happened it would deny nearly a third of American citizens, the population with diabetes and pre-diabetes, accurate glucose meters and test strips — the most essential tool to manage our diabetes and our health.

FDA accuracy standards are already low, and I have been among the many fighting to increase accuracy of meters and strips. But now all of us may face strips that don’t even meet those standards.

Can massive organizations like Medicare rob us of our health? Not if we don’t let them.

Write your letter please. Help urge the FDA to pursue a plan to keep us healthy. This is too important. And pass this on to anyone you know with diabetes.

They’ll thank you for it — as does my aunt, my downstairs neighbor, hundreds of my friends and acquaintances, and my husband — who doesn’t have diabetes, but if we don’t fix this, one day soon may not have me.

Originally published in The Huffington Post.

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The Dirty Secret About Medical Errors

In my last post, “What Doctors Feel…” I interviewed Dr. Danielle Ofri, an attending physician at Bellevue Hospital and author of four books.

What Doctors Feel

Her latest book, What Doctors Feel is an insightful look at what medical professionals experience emotionally — how under-recognized and unaddressed these feelings are, and how they affect health care providers’ sense of self-worth, performance, and patient care.

In this, part two of my talk with Dr. Ofri, we delve into medical errors and shame.

Riva Greenberg: Why did you want to write about the emotions health professionals experience?

Danielle Ofri: As physicians we see medicine as a science. We think of ourselves, and present ourselves to the public, as rational, evidence-based practitioners. But in truth, most of what we do is based on experience, what we’ve learned from mentors, what we’ve seen, what we feel in our gut, what seems to work.

I think we are far less rational than we tell our patients and ourselves that we are. My experience, and others I’ve witnessed, has taught me that emotions play a large role in how we practice medicine and work with our patients.

RG: Can you give me an example?

DO: Medical errors, unfortunately. There’ve been pushes on many fronts to attack medical error, which of course we must. But how we’ve been going about it addresses only the tip of the iceberg — creating new systems approaches, relabeling medications and enacting legislation changes.

Yet medical errors will keep happening until we bring them out in the open and talk about them. But because making an error is so shameful for a doctor all we want to do is hide it.

In What Doctors Feel I write about one of my most egregious errors. An error that so shamed me it took me 20 years to write about. I was a second-year resident and I didn’t give a patient who was coming out of Diabetic ketoacidosis (DKA) a shot of long-acting insulin. That’s the very thing you’re supposed to do in this situation. Otherwise the patient goes right back into DKA, which is exactly what the patient did.

I called a medical consult in a panic. The senior resident asked me, “Didn’t you give the patient long-acting insulin before you turned off the drip?” I realized I had made a horrible mistake. I couldn’t get a word out of my mouth. “What were you thinking?” she yelled, right there in the middle of the emergency room. My intern was by my side, gunshot wounds were rushing past us, and I was so humiliated and ashamed that all I wanted to do was dive into a hole and die.

The person I thought I was no longer there. Until that moment I thought I was a pretty good doctor. I was studying hard, doing the right thing, but in one moment that whole persona was shot to bits.

As doctors, if we fail, it’s not something outside of us; it is us. We are the error. The shame is so powerful that most doctors will never come forward about an error.

So we can make all the laws we want and change the color of syringes, but until we address the shame, we’ll never get past this problem. We won’t know about the enormous number of hidden medical errors until someone dies from them.

RG: Why is the shame so intense that doctors would risk more errors occurring?

DO: I think the socialization of doctors makes it extremely hard for us to admit a mistake. We tend to pick perfectionists as medical students, knowing that the medical system is not for the faint of heart. Then they’re trained to be perfectionist doctors. There’s no place for a “good enough” doctor. You’re either excellent or terrible.

When I was a medical student, the review of medical errors (the “M&M,” which stands for morbidity and mortality) was combative. At one review, the chief of surgery standing at the lectern yelled out, “Who put that IV in?” Then he made the resident who’d done it stand up in front of 150 people. He made her the “error maker” who kills her patients. After witnessing this humiliation, who would then come forward about a mistake that no one has noticed?

RG: Are reviews still conducted this way?

DO: Now they are more about what lessons we can learn. Also I’ve seen responsibility shift from the individual who made a mistake to the leader of the team so that the whole team bears the error together.

But there’s still room for improvement. I’d like to see the chairman say at a review, “Here’s the error that I made, here’s how I dealt with it, here’s how I handle the shame. It was difficult, but it didn’t destroy me. I’m still here. I am not the error, but I can learn from the error to be a better doctor.” What a difference that would make.

When we are patients, we may feel our doctors don’t see us, yet do we see them? As What Doctors Feel captures so well, the stresses of medical life — from hours of paperwork to fear of lawsuits, shame about mistakes and grieving the death of a patient — the health care system is in need of repair, not just in caring for patients but also caring for providers.

As Ofri said in “What Doctors Feel…” when medical professionals and their patients are supported to go on a journey together, we will all be more successful.

And as I read the final page of What Doctors Feel, a last thought from Ofri resonated. Beyond curing, doctors must also be taught, and supported, to help patients heal. As more and more Americans are, and will be, living with chronic illnesses, medical technologies can only take us so far. It is in truly “caring for” patients — with compassion, empathy and connection — that patients begin to heal.

Danielle Ofri is editor-in-chief of The Bellevue Literary Review (BLR). The BLR accepts submissions and twice a year Bellevue Hospital holds readings for the public.

Originally published in The Huffington Post.

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What Doctors Feel, An Interview with Danielle Ofri

“When I was pregnant with my first child, I had to get an ultrasound and an amnio but I couldn’t find the office. I walked up and down the hallway of my own hospital and I couldn’t find where I needed to go! I was so lost and no one was there to help me. It was so unnerving. Now I think about my own patient who has six tests to do and doesn’t speak English, or is frightened — and then we say, “They’re not compliant.” There’s so much involved in being a patient we don’t think about.” — Dr. Danielle Ofri

Danielle Ofri

(Dr. Danielle Ofri, Photographer Joon Park)


In internist’s Danielle Ofri’s latest book, What Doctors Feel, she explores the emotions doctors shoulder — from feeling an exaggerated sense of responsibility for their patients wellbeing to the shame of medical errors, to how empathy is being trained out of medical students.

Ofri is by accomplishment extraordinary and in her writing humble. She is a 20-year internist at Bellevue Hospital, associate professor of medicine at NYU School of Medicine and editor-in-chief of the Bellevue Literary Review. She traveled extensively in Central and South America to learn Spanish because that’s the native language of most of her immigrant patients, takes cello lessons, is a wife and mother of three, a regular contributor to the New York Times health section and the author of four books.

Ofri’s books explore the “other world” of medicine — emotions. Writing, Ofri told me, “began as a way to walk through some intense experiences and process my feelings.” Her books are also “thank yous” to her patients who have taught her how to, and made her a better, doctor.

Ofri provides a window into her own, and many fellow doctors’, emotional experience caring for patients. Daily we are learning that the quality of connection between patient and physician impacts health more than we realize, as well as patient outcomes. Now we can begin to understand how emotions impact medical professionals’ health, and performance.

Ofri’s unchanging sentiment about empathy can also be found in her second book, Incidental Findings: Lessons From My Patients in the Art of Medicine.

I’ve often wondered, what makes it so difficult for doctors to envision patients beyond their role as sick people? When we gaze at our patients in those awful blue gowns, camped on that ultimate symbol of infirmity, the hospital bed, it seems impossible that they ever had other lives. We can’t imagine them running for the subway, balancing a checkbook, shouting down an underling, changing light bulbs, having sex.

Is our vision clouded because we are so immersed in the world of sickness? Is it because this helps reinforce the power dynamic that has kept patients “in their place” for centuries? Or might it be because, like Mr. Karlin [patient featured in the book] we doctors are scared down to our bones? If we were to see our patients living the lives that we live, then there would be nothing to separate them from us. And then we could easily become them. (Page 93)


I had the pleasure of sitting in Dr. Ofri’s apartment discussing the doctor-patient relationship while sipping a cup of cappuccino she made for me. This is part one of a two-part interview.

What Doctors Feel

Riva Greenberg: As you wrote about in What Doctor’s Feel, why do medical students lose empathy during their training?

Danielle Ofri: I think it’s not about who we select to become doctors. Medical students come in with all the right traits. They’re eager, caring, desperate to help, but then too often come out of medical school jaded. Oddly, their empathy seems to erode just as they’re starting to work with patients in their third year. Empathy doesn’t solve medical problems, but you can’t solve them without it.

RG: Why do they lose empathy?

DO: The first two years of medical school are classroom years and the third and fourth are clinical. When you first get to work with patients, there’s lots of pressure. You’re constantly being tested, disrupted, you’re disoriented and no one’s paying much attention to how you feel.

During your training you typically don’t stay in one place so you have to keep getting used to new patients, nurses, the system, the set-up, the computer. Then, just as you start getting used to things, you’re moved again.

Some schools are changing this by having students stay with patients for a longer period of time both in and outside the hospital. But, clearly, we need to pay closer attention to this crucial time and change the prototypical training. Most of all, perhaps, we have to let students experience forming relationships with their patients and being on a shared journey.

RG: You’ve written about how giving birth to your daughter gave you an appreciation of what it’s like to be a patient. It seems doctors often forget what patients feel, especially in a hospital setting.

DO: Having my baby was a real education, and I was in my very own hospital! First they starve you before you give birth, so when I finally got back to my bed I was famished and thirsty beyond belief. They put this tantalizing frosty pitcher of water on my bedside table — just out of reach! My whole universe became about this pitcher of ice water I couldn’t reach. I even tried to lasso it with my pillow, but that didn’t work.

I didn’t want to page the nurses because I know they’re busy and people are sick, but after several minutes I finally asked someone if someone could come and give me some water. No one came so I broke down and called the nurses station. Five calls later I did what I promised myself I wouldn’t: I pulled rank. “I’m Doctor Ofri,” I barked. “I’m a faculty member here and I need someone to give me a glass of water!”

It made me realize just how vulnerable and dependent patients are. There are so many simple things all of a sudden you can’t do. I remember an incident where a patient had asked me for a Ginger Ale. I thought at the time, I’m juggling 20,000 important things andthis is what you’re asking me for?

Now I know if my patient gets that Ginger Ale it makes all the difference in the world. And not just because they can drink something, but they know they’re going to be taken care of. On rounds now, I’m constantly fussing with the bedside table, moving the phone and the tissue box to where patients can reach them. These are small things, but they can feel so important when you’re sick.

RG: In your first book, Singular Intimacies, you wrote that you asked a patient if she would share with you how you could be a better doctor. Have your patients helped you become a better doctor?

DO: Absolutely. One patient — I called him Mr. Moreno in Medicine in Translation — is an older gentleman I’ve seen since I was an intern. He has diabetes, hypertension and heart disease, and his cardiologist wanted him to get an implantable defibrillator to prevent further problems.

He asked me what to do. I told him to do it since it was a very low-risk procedure. After the operation, however, he got every complication possible. The defibrillator went off at the wrong times, they had to put him on more meds that had side effects, he had impotence and incontinence and his diabetes worsened. It took him a year to recover.

What I learned is even with the limited time we have, you have to find out what patients regard as important to have a good life. I had considered his heart, but not him.

My other patient, Julia — whose story I began in Medicine in Translation, and follow more fully in What Doctors Feel — gave me the gift of sharing a wide-angle lens on her life and taught me to be on a journey with a patient. Now whether I see a patient for years or only a few visits, I’m committed to being on a ride with them.

As our health care system struggles to improve patient care, lifting the veil on what health care providers experience emotionally, should be required study. What Doctors Feel gives us a valuable insider’s view how emotions help and hinder health professionals’ ability to deliver the care they’re charged with.

In part two, Dr. Ofri talks about medical errors and the shame that keeps them ongoing.

Originally published in The Huffington Post.

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Forgotten Dimension of Diabetes Revealed in DAWN2 Study

Would you be surprised to know family members of people with diabetes share similar emotional difficulties as their loved ones? Many health care providers don’t acknowledge the self-blame and anxieties that keep diabetes patients away for years? Enough people report positive experiences with diabetes that it’s leading to a new field of research?

Below are highlights from my talk with Søren Skovlund, global director of patient research and engagement at Novo Nordisk and research director of the company’s DAWN2 (Diabetes Attitudes, Wishes and Needs) study. Above were some of the study’s surprising findings.

Novo Nordisk, the Danish pharmaceutical giant, is one of the world’s largest health care companies and manufacturers of insulin. Its 90-year history has been built on improving the everyday experience and care of people living with diabetes through its services as well as products.

The purpose of the DAWN studies (the first was conducted in 2001) is to help people with diabetes improve their self-management by looking at, and increasing understanding and awareness of, the unmet psycho-social needs of people with diabetes and caregivers. And subsequently, fostering initiatives, policy changes and education to help meet those needs.


Over the weekend at the 73rd Scientific Conference of the American Diabetes Association (ADA), the company released results from their two-year long DAWN2 study.

As an advocate myself of emotional strength and support to self-manage diabetes, oddly, I see an increasing appetite for everything but — for quick and slick fixes.

We salivate over new technology and devices — meters with increasing bells, whistles and download capability, cool iPhone-like looking insulin pumps, greater functionality in mobile health devices, apps and games.

Yet just as in the Hans Christian Andersen tale “The Emperor’s New Clothes,” where no one in the kingdom told the emperor he wasn’t wearing any clothes but for one small child, few acknowledge the emotional component of managing diabetes. Why? It’s murky, messy, ill-defined and hard.

But study after study shows nearly half of the U.S. adult population with diabetes do not achieve the ADA’s recommendation of an A1C less than 7 percent and two-thirds of young people are not meeting their A1C target goal.

Study after study also shows that people do significantly better managing diabetes, and their quality of life improves, with support.

Do we need the best medicines and tools we can get to help us manage diabetes? Absolutely. My point is that you can have access to better medicines and tools and yet do little because you haven’t got the emotional strength, resilience and support to get up every day and manage this chronic condition; you may lack internal resources and/or family, friend, caregiver or peer-support.

Successful diabetes management in my book requires a “MUSE”: Meaningful reason to stay well, Understanding what diabetes is, Skills for lifestyle changes and Emotional strength/support, in addition to medicine and devices.

Dr. Skovlund

Here follow highlights from my talk with Dr. Skovlund (pictured at left).

Key and surprising findings of DAWN2

RG: What are the key findings from both the original DAWN study in 2001 and the DAWN2 study?

Søren Skovlund: Both studies confirm the increased psychological burden that people with diabetes face and how significant that burden is in managing diabetes. Simply, you cannot deal with diabetes without also addressing how it affects your life.

We also learned the differences in perception health professionals and people with diabetes hold about what diabetes is and what the challenges are. And, I’m sure you won’t be surprised to know, there’s a communication gap between doctor and patient.

While health professionals report that they ask their patients regularly about how diabetes affects their life, few people with diabetes report that their care team asks them this question or involves them in any other ways, including planning their own treatment.

The good news, however, is we saw that the more people with diabetes feel that those helping them listen to them, the better they do with their diabetes.

One key finding in the first DAWN study that resonated particularly with clinical professionals was what keeps people with Type 2 diabetes from seeking and accepting treatment. Across all countries, fear and denial often keep people from seeking treatment for years. Then when offered treatment they often change doctors or delay.

RG: What other surprises were revealed in the new study?

SS: The fact that there’s a profound emotional burden on family members of a loved one with diabetes, yet so very little is known about it or done about it. We saw this for the first time in DAWN2 because we were evaluating spouses’ and other cohabitating adults’ experience on a larger scale.

DAWN2 shows us that this is an important aspect to address, particularly since this burden can be reduced.

Positive stories yield a new research field 
On the positive side, we were surprised by the pocketful of positive, meaningful experiences a quarter to a third of people related about life with diabetes. We have thousands of hopeful, encouraging stories of meaning and inspiration.

DAWN2 researchers are now analyzing and coding thousands of personal stories we collected from four continents to see where people find positive images and turning points in living with diabetes, and we’re very excited about this as a new area of research.

If we can understand how people climb up their mountain of challenges, then maybe we can use these stories therapeutically. So DAWN2 may help us not just look at the burden of diabetes but also how we meet its challenges. And now we have a rich database to offer the global community from which to establish a research field. One we hope may also contribute to other chronic diseases.

RG: How open are health care professionals to changing their behavior?

SS: From our first study to DAWN2, we see greater openness and readiness on the part of healthcare professionals to partner with their patients. There’s a marked positive shift toward valuing patient empowerment and recognizing that the person with diabetes is the expert on his condition just as the professional is an expert in providing support, coaching and knowledge.

We also see the need for people with Type 2 diabetes, particularly, to speak up and get more actively engaged. Many people with Type 2 can be symptom free for years, and since few are cared for by diabetes specialists, they tend not to see their condition as serious or ask questions. Yet while diabetes is clearly serious, with information, hope, reassurance from their doctors, and a team effort, people can live a good and full life with diabetes.

So we need to find effective ways to get people with diabetes engaged, sooner, and sensitize and equip health professionals to respond.

Next steps
RG: How will the results of DAWN2 be used?

SS: Our next steps are for the national DAWN2 committees to begin to define concrete initiatives relative to emotional support, education and patient involvement that will help improve glycemic control and treatment outcomes in all our participating countries.

Over this year and next, we’ll also be ensuring that the study results are available to scientific publications and then publicly so anyone can apply to the committee to research the data and learn more.

For my 41 years living with diabetes, the last 10 working in the field, I see all too often the emotional toll diabetes extracts. My first book, The ABCs Of Loving Yourself With Diabetes, was expressly written to help readers develop greater emotional strength and resilience to better manage their care.

If you are having difficulty managing your diabetes look for sources of support — family, friends, social media sites, a coach or counselor, and tell your health care team.

Note: In full disclosure, Novo Nordisk has not asked me to write this blog. Personally, I applaud their investment in bringing greater awareness to the psycho-social dimension of living with, and managing, diabetes.

Originally published in The Huffington Post.

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The Lie That’s Killing Us: Pre-Diabetes

Pre-diabetes is a lie. Pre-diabetes is Stage 1 diabetes. And I’m taking a stand now advocating that we call it what it is.

Pre-diabetes doesn’t exist. And the lie we tell that it does does incredible harm. It stops the nearly 80 million Americans we say have it from making the lifestyle changes necessary to prevent advanced Type 2 diabetes. Pre-diabetes is in truth the first stage of diabetes.

My proposition is that recognizing pre-diabetes as “Stage 1” Type 2 diabetes will get millions more people to take action to stop their diabetes from progressing.

About 80 million people is roughly the populations of California, Texas and New York combined. The International Diabetes Federation reports that in 2011, 280 million people worldwide were glucose intolerant (pre-diabetic). In only 17 years, 398 million people will be.

We clearly need a new strategy. The 25-year campaign the American Diabetes Association has waged to raise awareness of diabetes and pre-diabetes and urge preventive and healthful behaviors has been sadly, and enormously, unsuccessful. 


Pre-Diabetes Is Stage 1 Diabetes

Pre-diabetes literally says you don’t have diabetes — but you do. Your blood sugars are higher than normal, a defining characteristic of diabetes.

study performed at Crittenton Hospital Medical Center in Detroit showed 36 percent of people with pre-diabetes already had coronary artery disease, similar to the 42 percent with Type 2 diabetes and strikingly higher than the 21 percent with normal blood sugars. Higher than normal glucose levels impact hypertension (high blood pressure) and lipids like cholesterol and triglycerides. Plus, most people with pre-diabetes show signs of retinopathy (eye damage), nephropathy (kidney damage) and neuropathy (nerve damage), all diabetes complications.

Lynda Sardeson, a certified diabetes educator and registered nurse, wrote to me in an email, “We began diagnosing pre-diabetes and put it in practice guidelines around 2004 to try and ‘catch’ those with diabetes earlier to prevent more complications.”

Exactly: “To catch those with diabetes earlier…” So let’s call pre-diabetes what it is: Stage 1 diabetes. Why? Because it is. Because health care providers need to take it seriously and not soft pedal it. Because policy makers must decrease the health care costs of diabetes now poised to bankrupt us. Costs have risen $70 billion in the past five years with no end in sight. Last year the U.S. spent $245 billion health care dollars on diabetes — the total GDP of Israel.

And, because for patients, hearing you have Stage 1 diabetes, like hearing you have Stage 1 cancer, has power and hope in it. The power of alarm to motivate behavior change — and the hope of remission if you do.


Four Stages of Type 2 Diabetes

Since Type 2 diabetes is progressive for most people, it can be characterized like cancer, chronic kidney disease and Parkinson’s as having stages.

Stage 1 — The body’s ability to regulate blood sugar is impaired and blood sugar is higher than normal. One may already have signs of diabetes complications. Treatment includes maintaining healthy body weight, eating healthfully, being physically active and possibly adding medication. With proper treatment one may go into remission, or be able to prevent or delay moving to Stage 2. 

Stage 2 — The body’s ability to produce and use insulin is further impaired than in Stage 1.Complications are often present, particularly those that affect the circulatory and nervous systems. Metabolic syndrome is common. Poor management leads to increased severity of complications and reduced life expectancy.

Stage 3 — Patients exhibit several and/or severe diabetic complications including neuropathy, vision loss, foot ulcers, amputation, blindness, kidney disease and heart disease. Quality of life is reduced and lifespan is shortened. Hospitalizations may be frequent.

Stage 4 — Death due to diabetes-related cause. Diabetes is the seventh leading cause of death in the U.S. Two-thirds of people die from heart disease or stroke.


Current Diagnosis Criteria

Clinically, you are diagnosed with “pre-diabetes” when your fasting blood sugar is between 100 (5.5 mmol/l) and 125 mg/dl (6.9 mmol/l). You are diagnosed with Type 2 diabetes when your blood sugar is 126 mg/dl (7 mmol/l) and higher. Who are we kidding when one point stands between pre-diabetes and diabetes on tests that often need to be taken more than once? 

I’m not being coy about a name change. While Shakespeare’s Juliet said, “What’s in a name, that which we call a rose by any other name would smell as sweet.” There’s enormous leverage in a name to either motivate action or not.

Currently more than one-fourth of our nation’s population are standing idly, waiting to board the train to Stage 2 Type 2 diabetes. There, many will suffer the life-crippling complications of diabetes and die prematurely, as people with Type 2 diabetes do every day. Diabetes kills more Americans than breast cancer and AIDS combined.


Low Awareness of Pre-Diabetes

Approximately 1 in 3 U.S. adults age 20 and older have pre-diabetes. Yet 89 percent are unaware of it, according to Doctor YanFeng Li, Division of Diabetes Translation, Centers for Disease Control and Prevention. 

Dr. Li and her colleagues concluded in their study that the critical first step to encourage people with pre-diabetes to make healthy lifestyle changes to prevent Type 2 diabetes is improving awareness of pre-diabetes.

I disagree. I believe the first critical step is a name change and a change in our national conversation.

If you are a health care provider, tell your next patient with pre-diabetes that he has Stage 1 diabetes. See what happens. I’m thinking he’ll look up and listen hard. Let him know he’s at the fork in the road. “Good day, Mr. Gottlieb, I have some bad news and some good news. The bad news is you have Stage 1 Type 2 diabetes. If you do nothing now you are working your way toward Stage 2. However, the good news is together we can work at reversing it, so you may never go on to Stage 2. In the worst case scenario we may be able to delay it for years.” 


The Grinding Slowness of Change

The results of the Diabetes Prevention Program (DPP) , heralded as a landmark study, were published in 2002 yet little has changed. The DPP proved that with a modest weight loss, about 7 percent of body weight (for most people about 15 pounds) and 30 minutes of moderate activity five days a week, people with pre-diabetes reduced their chances of developing Type 2 diabetes by 58 percent. Participants over age 60 reduced their risk by 71 percent. 

Newer research shows that by treating people with “pre-diabetes” more aggressively, with lifestyle changes and medication, they can further minimize their chances of, or further delay, getting Type 2 diabetes. 

It’s clear: We are failing miserably at awareness-raising, behavioral change efforts and containment of health costs, says diabetes advocate David Edelman, founder of DiabetesDaily.com. In his post, “Diabetes Alert Day, Why Do Cancer & AIDS Get More Support Than Diabetes?” he writes, “Why is diabetes tucked into the closet, door closed, and safely ignored? How many millions of lives will we sacrifice and how many billions of dollars will we waste before we act? “

We’re not setting any precedent changing the diagnosis of pre-diabetes to Stage 1. We renamed “juvenile diabetes” Type 1 diabetes because adults get Type 1 diabetes. We renamed “adult-onset diabetes” Type 2 diabetes because now children get Type 2 diabetes.

So I’m calling on health care professionals and the American Diabetes Association, the World Health Organization, the Centers for Disease Control and Prevention, the International Diabetes Federation and our legislators to do what they want people with “pre-diabetes” to do — take action.

Almost 10 years ago we called out “pre-diabetes.” Now call out what it is — “Stage 1” Type 2 diabetes — and halt the killing.

What do you think?

Are we disempowering people telling them they have pre-diabetes?

Would you do something different hearing you have Stage 1 diabetes than pre-diabetes? 

Originally published in The Huffington Post.


Turning Diabetes Over to the Bionic Pancreas

I considered titling this “Anna Floreen Was Diabetes-Free for 5 Days,” because she was and now she’s not. And I’m curious what that transition has been like — picking up your chronic illness again after you dropped it from your shoulders and walked off into the sunshine, so to speak.

April 4, 5, 6, 7 and 8, days I’m sure Anna Floreen will never forget, she was effectively “cured” of her Type 1 diabetes (T1D). Anna participated in the Massachusetts General Hospital Beacon-Hill study.

She was among approximately 30 T1D patients testing the performance of the “bionic pancreas” outside the hospital. She was, however, hooked up to an IV monitor overnight, restricted to a three-mile radius and had a nurse by her side at all times.

Anna Floreen wearing the bionic pancreas

Anna’s had type 1 diabetes for 24 years, since she was 6 years old. Yet that early week in April, she didn’t. She didn’t have to figure out how many carbohydrates were in every morsel of food she ate and how much insulin she needed to take to cover it.

She didn’t have to guess if her workout at the gym or her walk to work would cause her blood sugar to go too low, and then wonder whether or not to go or prepare for possible low blood sugar.

She didn’t have to poke her finger 10 times a day to see her blood sugar number. That’s 50 pricks she didn’t have to feel. Or worry as she fell asleep that she might get a severe low blood sugar during the night and not wake up.

That is what makes T1D so relentless and dangerous. Throughout the day, every day, one has to think and act like a normal functioning pancreas, the organ that controls blood sugar. That is also what makes this study exciting and hopeful.

The Bionic Pancreas

The bionic pancreas consists of three pieces of hardware. There’s an iPhone with an app that contains the system’s control software and algorithm and a continuous glucose monitor (CGM).

The CGM’s sensor/transmitter, worn under the skin, streams glucose (blood sugar) data to two connected infusion pumps. One delivers insulin to lower blood sugar and one delivers glucagon to raise it. Based on glucose levels transmitted every five minutes from the CGM, the app determines and dispatches how much insulin or glucagon should be delivered to maintain ideal blood sugar levels.

If Anna’s blood sugar began to veer toward hypoglycemia (blood sugar below 70 mg/dl (3.8 mmol/l) — the dreaded side effect of insulin that can cause coma and even death — the pump containing glucagon released some to raise Anna’s blood sugar. If Anna’s blood sugar began rising too high, the insulin pump sent a precise amount of insulin into Anna’s blood stream to curb the rise and bring it back down into the normal range between 80 mg/dl (4.4 mmol/l) and 120 mg/dl (6.6 mmol/l).

The bionic pancreas and its algorithm are the genius of biomedical engineer Edward Damiano. Damiano is also the father of David, who got Type 1 diabetes at 11 months. That’s when he began working on an automated “closed loop” system that would regulate blood sugar and relieve patients of the daily decisions and actions they must now perform.


Anna’s Experience

Anna blogged each of the five days she wore the bionic pancreas sharing her experience with the thousands of visitors to the Type 1 diabetes online community, Glu. Anna works as Glu’s Community Outreach Manager, and I recommend you read her posts. You will see how far technology has taken us.

I interviewed Anna five days after her trial participation wanting to know a bit more about the emotions she’d expressed, and also what it is like to suddenly be disease-free and then ill again.

Anna wrote in her first post, “The best part so far has been the lack of worry, emotional guilt, and shame that accompany all of us too often when it comes to decision-making between me and my ‘external organ’ pump that I’ve had a solid relationship with for over a decade.”

Anna told me over the phone, “The 24/7 of diabetes eats away at your mental aptitude and spirit. I would wear 10 sites on my body if it meant I didn’t have to deal with the constant thinking, and the embarrassment, shame and guilt that accompanies diabetes each day. I stare at my CGM and base my self-worth on a trending number graph! How crappy is that, and people don’t get it.”

“During the trial I felt so free. My brain was free of decision-making and dreading the consequences of my decisions. No more thinking should I have taken the subway instead of walking to prevent that low? Should I not have had that extra chocolate kiss at the holiday party? The lack of worry was amazing.”

What most people don’t know about T1D is the emotional stress of all day trying to keep your blood sugar within a narrow, prescribed, acceptable band. Anna tells people it’s like stepping on a scale 24 hours a day. The moment before you do, you feel the shame and guilt of maybe discovering you gained weight. She said many people with Type 1 diabetes feel that 24 hours a day.

As for what it’s like to lay down your disease and pick it up again ,Anna indeed went through bionic pancreas withdrawal.

“For days I was angry at diabetes again,” Anna said. “I thought I would be much more motivated to take care of my diabetes, knowing the potential for it to be in phenomenal control. But it was like I was diagnosed all over again. I didn’t want to do anything.”

“During the trial everything was done for me,” said Anna. “So much so even the nurse asked me, ‘Do you want to prick your finger or do you want me to do it for you?’ You do it, I said. Imagine having someone prick your finger being a treat!”

The outpouring of support from the online diabetes community, having so many families and friends thank Anna for what she did and knowing she’s provided important data from the trial motivated Anna to take care of her diabetes again.

She’s also inspired by having experienced something she never thought she would, the day she didn’t have to worry about her diabetes. She hopes the trial inspires others to trust that research and technology arebringing us closer to a cure.


Defining the Cure

One of the last things Anna shared both surprised and didn’t surprise me. “I feel like I’ll always have diabetes even if there is a cure,” Anna said. “Just like during the first meal of the trial when I reached down to grab my pump and then realized it wasn’t there. Diabetes has been my life. My mindset, that diabetes perspective whatever it is, will never go away. Even if there is a cure, I don’t think I will ever feel mentally cured.”

Having lived with T1D for 41 years I feel the same. I also feel the same as Anna that I’ll be happy to give up the rest. The constant carbohydrate and insulin calculations, the running tape of what’s my blood sugar now, and questioning is it safe to simply go take a walk? 

It’s a brave thing Anna did. That everyone who participates in a clinical trial does. Not just risking that the device you’re testing may fail, but that it will succeed. That you will know freedom and then have to give it back.

Would you give up your diabetes, cancer, AIDS, Parkinson’s, rheumatoid arthritis only to have it back again after being free?

Damiano’s hope is that the bionic pancreas will be perfected and available by 2017, the year his son will be entering college. I’m sure there are about 3 million people who are now hoping right along with him.


Next Steps

Extensive testing of the bionic pancreas’ software-controlled system has already been done on diabetic pigs and in three successful in-hospital studies of adults and adolescents over the past 4.5 years.

The Food and Drug Administration has given Damiano and his research associates the green light to carry out the first of three longer-duration outpatient studies over the next 18 months. Participants will have less nursing supervision and greater freedom of movement.

Originally published in The Huffington Post.


5 Healthiest and 5 Unhealthiest Packaged Foods (According to FoodFacts.com)

Cream powder, partially hydrogenated soybean oil (trans fat), “flavors,” saturated fats, sodium, controversial ingredients and added sugar. That was dinner for thousands, maybe millions, of babies and toddlers last night who ate Gerber Graduates Lil’ Meals Pasta Shells and Cheese.

Most of us know the healthiest foods are natural and unprocessed like fruits, vegetables, nuts, seeds and whole grains. Yet we spend a great deal of our nutrition equity chowing down on chemicals disguised as food. And unaware, feeding them to our children. 

So I was excited to find this user-friendly food rating website FoodFacts.com. FoodFacts can help you and your family eat more healthfully by knowing if a food has excessive sugar, fat, salt or harmful chemicals. 


FoodFacts.com reviews more than 100,000 popular packaged, non-packaged and fast foods and 20,000 ingredients. Each product or food is graded from a head-of-the-class “A” to a failing “F” based on the quality of ingredients andwhether a food offers any nutritional value.

There’s also a full list of ingredients, nutrition facts panel and bulleted good news/bad news report card for each product. Taste is not considered.

Stanley Rak, FoodFacts’ founder and sole funder, started the site after he was feeding his 3-year-old grandson and noticed the food was sticking to his fingers. “I thought what’s in this?” Rak told me. “So I looked at the label on the jar and couldn’t pronounce most of the ingredients!” Rak then went home and looked at the ingredients in everything in his cupboard. That was the beginning of FoodFacts.com.


I marvel at and support the initiative of one individual doing what he can to protect all of our health. Rak’s aim is to help people eat more nutritiously, eat safely if they have food allergies or dietary restrictions, and create a community where members (it’s free) can share their food findings and experiences.

Rak also hopes FoodFacts.com will influence manufacturers to produce healthier products. For instance, manufacturers can still hide ingredients. “They don’t have to list trans fat on the package if it’s under half a percent,” Rak told me, “but you’ll see it on FoodFacts.” Paid for only by Rak, FoodFacts is entirely transparent and not supported by any advertising.

“Sometimes my neighbors are afraid to invite me to dinner,” said Rak chuckling, but he’s always adding to the site. A recent addition goes back to its roots — a “Baby Nutrition, Allergen and Score Guide” to help new mothers provide their babies nutritious products. “Because,” Rak says, “the abundance of sugar, including hidden sugars, in baby foods is where our lifelong struggle with obesity and nutrition begins.”


5 Healthier Foods and Their Scores, as Rated by FoodFacts.com


  1. Dreamfields Pasta Linguine Low Carb – (A)Low in calories, fat and sodium, Dreamfields Pasta packs a nutritional punch, providing 40 percent of our folic acid and thiamin requirements, as well as riboflavin, niacin and iron.
  2. Little Duck Organics Blueberry Apple Tiny Fruits (A) – Organic freeze-dried apples and blueberries, this product is low in calories, saturated fat, cholesterol, sodium, contains no controversial ingredients and is an excellent source of vitamins A and C.
  3. Beech Nut Good Morning Oatmeal & Mixed Fruit Cereal (A) – A baby food product with only good news! Low in calories, saturated fat, cholesterol, sodium and contains no controversial ingredients. It is also an excellent source of twelve vitamins and minerals.
  4. Bumble Bee Chunk White in Water Tuna Albacore (A-) – Low in calories, saturated fat, cholesterol, contains no controversial ingredients and contains naturally-occurring vitamins and minerals, and is an excellent source of niacin.
  5. Triscuit Original Low Sodium Whole Wheat Crackers (B+) – Low sodium, low in calories and no controversial ingredients, makes Triscuit a great snack. It doesn’t score an “A” because it’s also low in vitamins and minerals.


5 Unhealthy Foods and Their Scores, as rated by FoodFacts.com


  1. Hot Pockets Beef and Cheddar Sandwiches (F) – The entire line of Hot Pockets products gets an “F.” This product has multiple controversial ingredients, there is little “good” in this product and it displays a hidden form of MSG. Hot Pockets products have one of the longest lists of ingredients, up to 160!
  2. MorningStar Farms Veggie Chik’n Nuggets (F) – These vegetarian imitation chicken nuggets are high in sodium and contain the controversial ingredients hydrolyzed corn gluten and yeast extract (both are nicknames for MSG). The product also provides little vitamin content. 
  3. Arby’s All American Classic Roastburger (F) – Equal parts good and bad — low in calories, cholesterol and contains Fiber, Vitamin C and Iron. Yet highin saturated fat, sodium, contains a moderate amount of added sugar and several controversial ingredients.
  4. Propel Zero Berry Flavored Fitness Water (D+) – This product has no calories, fat or sugars, but gets a poor grade due to its very controversial ingredients, like acesulfame potassium, potassium sorbate and other preservatives. A great example of a product that looks healthy based on the nutrition label, until you read the ingredients. Plus, researchers are linking 1 in 10 deaths in the U.S. to overconsumption of salt, and this flavored water has over 160 mg of sodium!
  5. Apple and Eve Grover’s No Sugar Added White Grape Juice (D) – While most believe 100 percent fruit juice is healthy, it’s mostly sugar. A single eight-ounce serving of this grape juice contains 38 grams of sugar and 130 calories. Comparatively, Coca-Cola contains 27 grams of sugar. This product also contains “natural flavors,” a label food manufacturers are permitted to use for any number of chemicals that they don’t have to disclose. This usually indicates that the real thing (often fruit) has been left out.


Originally published in The Huffington Post


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