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

10 Ways I Know I Have Diabetes

No, I’m not going to give you the typical symptoms like thirst, peeing a lot, losing weight, blurry vision and fatigue. I’m going to give you my 10 ways I know I have diabetes. Those 10 things I find myself doing only because I have diabetes.

  1. I find myself screaming, “How many carbs are in that pancake? You don’t know?! Can I see the box?!?” My day is filled with stuff ordinary people never think about.
  2. Shit, shit, shit! (and really I don’t usually curse) I wasn’t going to walk this morning because they predicted rain and now the sun is out! Walk? Don’t walk? Will I risk going low? Will I then have to eat when the last thing I want to do is burn calories only to have to eat more? Damn! How many other people beat themselves up for wanting to take a walk?
  3. I am afflicted with a terrorist torture — sleep deprivation. “I’m so tired, can’t I just lie here and fall asleep?” No, gotta get up, go into the kitchen and stick a needle in my finger to check my blood sugar.” Sunday morning replay: “I’m so sleepy, can’t I just lie here just a little longer? It’s only 6:45 a.m. for goodness’ sake.” No, gotta get up and stick a needle in my finger, and then two more to take my insulin.
  4. “Hmmm… That’s a cute designer diabetes accessory. It would carry all my syringes, vials, test strips.” God, did I really say that? I want out of this club, never mind the cute accessories.
  5. Wiping blood off my counter, my cupboard, my shirt — yuck, my food — with absolutely no notice, hesitation or dismay.
  6. “When’s dinner? When? You sure? Really? You’re sure?”
  7. Glucerna has a cereal for diabetics — a product just for us. Hmmm, I notice there an “us.” I don’t really want to know there’s an “us.” Yet now people with diabetes are worthy of marketer’s attention. Right up there with Lexus drivers.
  8. How often do I really have to go to my endocrinologist? I just found a prescription to get lab work done from July 30, 2011. Oops.
  9. Sneaking lunch into a noon movie, no sweat. Taking my shot in the dark, not so easy. Last time, I think I stuck the guy next to me.
  10. I just checked my blood sugar and forgot the number! Alzheimer’s? Dementia? Is it really true that lows cause dementia? Who cares, now I have to do it again!!

If you don’t know if you have diabetes, find out. Risk factors for Type 2 diabetes include family history, being overweight, having a sedentary lifestyle, high blood pressure, high cholesterol and having given birth to a big baby. You can take the risk test on the American Diabetes Association website.

If you have any of the risk factors, have your health care provider give you a simple blood test. While there are times I’d rather forget I have diabetes, there is never a time I wouldn’t want to know that I have it.

If you find out that you do have diabetes — seven million Americans have it and don’t know — you can write your own list!

Originally published on Huffington Post.

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Sanofi Launches iBGStar: New Blood Glucose Meter for iPhone

iBGStar with iPhoneI was invited, along with several other diabetes patient online influencers, to Sanofi’s corporate office in Bridgewater, N.J. May 1. It was the eve of their launch of iBGStar.

iBGStar is the first FDA-approved blood glucose meter that plugs into an iPhone and iPod touch and is to be used with the iBGStar Diabetes Manager App.

I will get to the specs of the device shortly, but first I think it’s important to note what I am witnessing — and celebrating — more and more: the sure and steady rise of the patient. 

Sanofi, the third-leading global pharmaceutical company, is interested in what patients have to say. So is Roche, who invites me and 30-plus diabetes patient influencers to its annual social summit, and Medtronics, that just held its second annual event with patients.

While Marshall McLuhan’s famous line, “the medium is the message,” was oft-quoted during my college years, today patients are becoming deliverers of the message, especially in the online space. It’s smart business and, I should say, a healthy paradigm shift for all concerned as pharmaceutical Goliaths increasingly realize and respect the growing power of us little “Davids.”

Sanofi, maker of long-acting Lantus and rapid-acting Apidra insulins, is reaching beyond product into devices and services. Shawna Gvazdauskas, VP and Device Head U.S., told us the mission is to, “Meet patients where they live and improve their experience managing diabetes.” To be customer-centric through innovative and integrated solutions. The part I liked best was when she talked about “delighting customers.”

The iBGStar can be used as a stand-alone device. It has its own display where you’ll see your glucose reading. When you later attach it to your iPhone or iPod touch it will automatically download your data. When measuring your blood sugar while the iBGStar is attached to your iPhone or iPod touch, your number shows up on the small and large display.

SanofiUSDiabetes

Sanofi's Shawna Gvazdauskas, Brian Dolan of mobile health news, me, Emily Coles, Laura Kolodjeski, Sanofi Senior Manager, Patient solutions, Allison Blass of DiabetesMine, Kim Vlasnik of Texting My Pancreas.com, Kerri Sparling of SixUntilMe.com, Adam Brown and Kelly Close of Close Concerns, blogger Leighann Calentine and analyst David Kliff of Diabetic Investor attended the meeting but left before the photo was taken.

The hope is that patients will spend more time with their numbers during idle time during their day and consequently better manage their blood sugar. For doctors, their patients will have their logs with them when they arrive at their appointment or can email them ahead.

As you can see, the iBGStar is the width of an iPhone and less than 1 inch tall. It’s light as a feather, has a 6 second countdown, uses 0.5 microliter blood size — one of the smallest amounts — and meets accuracy requirements.

The iBGStar Diabetes Manager App captures blood glucose readings, records carbs and insulin doses, tags readings according to mealtimes and allows you to add customized notes regarding meals and exercise. You can analyze your data using a logbook, trend chart and statistics. Color-coded screens indicate if blood glucose is too high or too low.

A “share” function allows specific data to be sent via email to your doctor. 

The iBGStar is available for purchase at Apple retail stores and Walgreens stores nationwide and online at Apple.com, Walgreens.com and through Diabetic Care Services. It’s priced at about $100 through Apple and comes with 50 test strips. It’s about $75 at Walgreens and comes with 10 test strips. The iBGStar Diabetes Manager App is available for free from the App Store on iPhone and iPod touch or at www.itunes.com/appstore.

Sanofi offers a copay savings cardso strips will not cost more than $20 per order. Plus, plans are afoot to integrate Sanofi’s GoMeals App with the iBGStar Diabetes Manager App.

So, is this just moving chairs around on the Titanic, or a real advancement for helping patients better manage their blood sugar? I imagine only time and slated studies to analyze patient use will tell. People on average currently check their blood sugar .83 times (less than once) a day. 

Given that only 1.6 million people are today potential users for Sanofi — those who have diabetes and iPhones or an iPod touch — it’s a small pool, and a large commitment. Then again, we have to start somewhere.

Disclosure: I was given a free iBGStar to leave with, my transportation to the meeting was paid for by Sanofi and lunch was provided. I was not asked to write this post.

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How Society Influences Diabetes Management

2012-04-23-Screenshot20120423at2.44.12PM.pngThis is part two of my conversation with Dr. Ann Albright, director of the Division of Diabetes Translation at the Centers for Disease Control and Prevention (CDC).

In part one Albright talks about meeting the challenges and opportunities to improve diabetes care through public health programs.

Q: What stands in most people’s way regarding preventing and managing diabetes?

Ann Albright: I can best answer that question with a model many of us in the public health sector use. Imagine concentric rings, and in the middle ring is the individual.

For those of us who have diabetes or are at risk, there are things we personally need to do: pay attention to the foods we eat, get physical activity, look at how we manage stress.

All the things we do have some impact and influence on us, but we’re not an island. We all live influenced by the things around us. So the next ring in this model is your family and those in your close network. They also impact how an individual lives with this disease.

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The next ring out is your life systems, where you work, go to school, your place of worship, where people spend a lot of time interacting with others. Those entities also have a big impact on us.

For instance, what are the policies in your workplace? What support do you get for health care coverage from your job? What types of health care are available to you? All these things have an impact.

The final ring in the model is policy and the bigger community. These are things where you might change people’s access to things. For instance, are there food deserts in the community? How far do people have to travel to get fresh fruits and vegetables? Can they afford them? All these things affect our ability to make healthy choices.

So while we have to think about what the individual does and individual responsibility, the individual does not live in isolation. We all are influenced, and supported or undermined, by those other circles. You have to intervene in those areas so that as we say in public health, “The healthy choice is the easy choice.”

Q: Are there other obstacles for people in managing their diabetes?

Ann Albright: I think three intersecting areas affect people’s ability to take care of themselves. That’s medical management, self-management and ongoing support.

In medical management, while a person has to take their medication as prescribed, the health system they go to also has to have health care professionals who really know how to manage diabetes. People who understand what it’s like to live with a chronic disease. You know like I know that it’s 24/7. You don’t get any breaks.

In self-management the individual has to know how to live with their disease and take responsibility for their daily choices. For instance, they need to understand what their numbers mean and what to do about them. Too many people never get this information.

Regarding support, we know when you live 24/7 with something people get burned out. They get tired and frustrated. Ongoing support is critical, whether it’s from close people in our lives or having a supportive environment.

When you look at the whole picture it’s these kinds of things that broaden your view as to why people wrestle with managing their diabetes.

I’m about to hit 44 years with Type 1 diabetes so I’ve had it way longer than I haven’t. But that doesn’t mean you don’t have days when you’re thinking, oh, my god! Particularly when you’ve done everything you’re supposed to be doing and it’s not behaving or cooperating the way it’s supposed to. Those are the very frustrating days. 

Q: Is there more that stands in people’s way of good self-management?

Ann Albright: I think it’s similar to prevention. In part, people don’t feel any different when they get diabetes. They don’t feel symptoms if their blood pressure or cholesterol isn’t where it should be so they don’t do much.

Diabetes complications may not happen for quite some time, so you’re asking people to act now to prevent something from happening in the future. For many people that’s a difficult thing to do. Also, some people have issues around consistently taking their medication, or they may not be able to afford their medication.

We also do a poor job putting managing diabetes into context for the patient. By that I mean talking about it in terms of what matters to him or her. When I was seeing patients I had a gentleman who was just not interested in checking his blood sugar. He said, “I just don’t know what this is all about. I’m busy traveling and there are lots of things I want to do, not spend my time doing this.”

I wasn’t a magical educator, but I listened to him and discovered he wasn’t afraid of poking himself, he wanted time to do what he liked doing. So I asked about his hobbies and I tied testing his blood sugar to giving him more freedom to do those things he liked to do. That way it became real for him and there was a reason to do it.

Q: What do you do to keep yourself healthy and your diabetes managed?

Ann Albright: I check my blood sugar six to eight times a day. I work to make sure my food choices are healthy. I enjoy yummy things like the next guy but I am particular about how much of those foods I’ll eat. I keep physically active by riding my recumbent bike and dancing.

I also volunteer for groups that support diabetes. It helps you to cope and adjust when you give to others. And I think you have to develop a philosophy about living with a chronic disease. A positive, constructive philosophy. You have to think how can I live successfully with this? 

Of course I would say I didn’t want diabetes and I wouldn’t wish it on anyone, but if it comes to you take it by the horns and make the best of it and use it in a way that can help you be healthy and productive.

I’m incredibly blessed and fortunate to have the opportunity to do something that helps others, to have an impact on improving the public’s health. For me it doesn’t get much better than that.

Personally, I will not forget the openness, energy and passion Albright radiated when I met her. It’s comforting to know she’s advocating for all of us at the CDC.

Originally published on Huffington Post.

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Dr. Ann Albright Is Translating Diabetes Research Into Health

Last year Dr. Ann Albright was the closing speaker at Diabetes Sister’s “Weekend for Women.” Albright is the director of the Division of Diabetes Translation at the Centers for Disease Control and Prevention (CDC). 

Dr. Ann Albright

Albright formerly served as the chief of the California Diabetes Program for the California Department of Health Services, president of the American Diabetes Association’s Health Care and Education and senior health policy advisor to the U.S. Surgeon General.

Impressive? Yes, but the reason I wanted to interview Dr. Albright is because she lives with diabetes, and I saw her dance. While on the conference stage talking about strength, music and diabetes, she shimmied with the music and inspired 100 women with diabetes to shimmy along with her.

This is part one of a two-part conversation with Dr. Albright and the 16th in my series on diabetes change leaders.

Q: You lead a team of more than 100 people working to eliminate diabetes through “translation.” What does that mean? 

Ann Albright: Our mission is to create a world free of the devastation of diabetes. Our efforts are to turn the research we gather into public programs and policies to do that. My division has three goals: to prevent Type 2 diabetes, to reduce the burden of diabetes on those who live with it and to help eliminate ethnic, racial and economic barriers. 

The research we do is both surveillance and translation. That means all the statistics you read about diabetes come from the CDC. Then we take the research, and with funding from agencies like National Institutes of Health (NIH) and partnerships with state diabetes prevention and control groups and public health programs across the U.S. create practical programs that work in the real world, particularly for the populations hardest hit by this disease. Our policy work is about scaling and making a program sustainable.

Q: Can you give me an example of creating such a program?

 

Ann Albright: The recent national diabetes prevention program. From end to end we worked to assure quality, reimbursement, sustainability and also, frankly, that people show up and continue to show up. We trained people to deliver the program, looked at ways to expand and scale the program and brought the third-party reimbursement payer to the table. That’s an example of translating the science into a fully functional program.

Q: That must be very satisfying.

 

Ann Albright: This work is at my core. I was trained as a basic researcher doing work at the molecular, cellular level, then moved into clinical work and got credentials as both an exercise physiologist and nutritionist. Now I’ve been in public health and public policy for more than 15 years, and it’s an absolute joy.

Public health is all about finding big solutions to big problems to have the biggest impact on the most people. And, knowing it’s not going to happen overnight. 

In public health you see how people’s health is challenged by everything – from what individuals do to what goes on in the community, to people’s physical environments, to what policies exist that help or undermine their health.

Q: What makes you want to get up every day and take on such enormous challenges?

 

Ann Albright: Working on very tangible things that people with diabetes will experience and benefit from is incredibly rewarding because I know personally what the challenges of living with diabetes are.

I find it exciting to be working in such a high-needs area. We get to implement what we know works and get it into people’s hands. We get the chance to try and prevent people from ever getting Type 2 diabetes. I think if you don’t it’s beyond unethical.

I was diagnosed with Type 1 diabetes when I was 9 and I tried not to go into diabetes. I thought I live this, I volunteer, do I really want to work in this area? But pretty early on in my career it was clear to me that you’re either part of the solution or part of the problem.

When I got diabetes there weren’t meters or insulin pumps. We had no notion how to prevent Type 2 diabetes. Now we’re working to help people get access to those meters and supplies and we’re delivering self-management training so people can learn how to live with this disease.

Q: Does it get to you having diabetes and working in diabetes?

Ann Albright: Yes, it gets to me. But what really gets to me is when something else rears up and disrupts your life and you still have to be attentive to your diabetes. That can be really hard.

I was widowed at the age of 42 — my husband died 11 years ago. The last thing I wanted to do while I was caring for him dealing with cancer was have to worry about my diabetes. Here’s a man who’d just undergone massive surgery to remove a large tumor that ultimately took his life and the first thing he did when he came out from under anesthetic was ask the nurse if I was OK.

That’s one of the hardest things for me, to make my family worry. Of course you wish you didn’t have this burden for yourself, but it’s also a burden for your loved ones. Those people in your life who are there to support you are also living with this disease, and they worry that this can take your limbs prematurely and your heart and your kidney.

I can deal with paying attention to what I’m eating and poking my finger multiple times a day. My challenge is to not have other people worry.

Q: That reminds me of the comedian Rodney Dangerfield. He would say, “Diabetes gets no respect!”

 

Ann Albright: We definitely are the Rodney Dangerfield of diseases! That’s one of the biggest downsides and challenges that diabetes faces. People at large don’t understand diabetes. That if things don’t go well this is a very nasty disease. It chips away at people, particularly if people don’t have access to tools.

Many patients are scared and frustrated by the demands of this disease, and so don’t want to look at it. They don’t see the amputees in hospitals or people in a dialysis unit and they don’t get that it was diabetes that put them there.

It’s easy for the general public to think we’re not doing what we’re supposed to to take care of ourselves, and for some of us that’s true. But many of us are working very hard.

I remember having to go to the hospital for something un-diabetes related and telling my husband, “If anybody makes a negative statement about my diabetes you have my permission to knock them down.” 

Most of all, we need to get people with diabetes to understand that it takes effort to manage it but the alternative can be devastating. We need to get people with diabetes, and the public, to understand that diabetes is a day-to-day adventure and that you have to be able to manage that newness each day.

Stay tuned for part two of my talk with Dr. Albright, where she talks about the challenges we as patients face and the influence of society.

Originally published on Huffington Post.

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7 Diabetes Tips to Make You Tops

It’s hard to condense 300 pages into one, but since I believe in the value of small steps, here are seven small but mighty “Tips to Make You Tops” from my book, 50 Diabetes Myths That Can Ruin Your Life and the 50 Diabetes Truths That Can Save It.

You’ll find more than 100 tips in my book covering all aspects of diabetes care, but each of these below will help you do a little better managing your diabetes.

7 Diabetes Tips to Make You Tops

  1. Know Your Numbers Before and After Meals — If you have diabetes, the American Diabetes Association recommends your blood sugar be between 70 and 130 mg/dl (3.9 and 7.2 mmol/l) before meals, less than 180 mg/dl (10 mmol/l) two hours after starting a meal, and that you have an A1C (a blood value that reflects your average blood sugar for the past two to three months) under 7 percent — or as close to normal as possible (between 4 and 6 percent) without incurring hypoglycemia (low blood sugar). The Association of Clinical Endocrinologists recommends tighter control: that your blood sugar isunder 110 mg/dl (6.1 mmol/l) before starting a meal, lower than 140 mg/dl (7.8 mmol/l) two hours after beginning a meal, and that your A1C is 6.5 percent or less. Dr. Richard Bernstein, who advocates maintaining near normal blood sugars if at all possible, recommends a blood sugar of 83 mg/dl (4.6 mmol/l) for patients without severe gastroparesis before, during and after meals. If you don’t know your target range for your blood sugar, or your blood sugar numbers are often outside your range, discuss this with your health care provider. Managing blood sugar is key to help prevent and/or delay diabetes complications.
  2. Symptoms Of, And Ages For, Type 1 Diabetes — While people think of type 1 diabetes as a disease that only affects children, you can get it at any age. Typical symptoms include: high blood sugar, excessive urination, hunger, thirst, weight loss and fatigue. Just know many adults with type 1 are misdiagnosed with type 2 because they’re past puberty (I was). However, people with type 1 are not typically overweight or insulin resistant — the hallmark characteristics of type 2 diabetes.
  3. Protect Your Feet — People with diabetes are at increased risk of foot ailments due to nerve-related diabetes complications. Keeping the muscles in your feet and legs strong can help ward off foot problems. One of the easiest and most effective ways to do this is regular, simple walking — 30 minutes five days a week
  4. Treating a Stress High — For most people stress raises blood sugar. To treat high blood sugar caused by stress, if you use insulin take half the amount you would normally to bring down your blood sugar. If you use oral medications, don’t do anything. Orals do not act quickly enough to compensate for the short-term effects of stress.
  5. 2012-02-06-Screenshot20120206at2.23.55PM.pngMaking a Healthy Meal — The “Plate Method,” recently adopted by the USDA, makes putting together a healthy meal — a moderate amount of carbohydrates, little fat and cholesterol, a good amount of fiber — easy. Fill half your plate with any variety of colorful veggies low in carbohydrates, such as asparagus, broccoli, Brussels sprouts, eggplant, carrots, or cauliflower. This can include fruits also low in carbohydrate like berries and melon. Fill one-quarter of your plate with carbohydrate-dense foods such as potatoes, rice, beans, corn, or legumes, and fill the remaining quarter with lean protein such as chicken, fish, lamb, pork, or beef.
  6. Fruit Choices — Different fruits contain different amounts of carbohydrate and some raise blood sugar more than others. Berries and melons, because they contain a lot of water, raise blood sugar less than more starchy fruits like bananas and mangoes. Dried fruits such as figs, apricots, and raisins contain approximately the same amount of carbohydrate as they do in their fresh state, but because of their smaller size, you may be tempted to eat more of them and consume more carbohydrates and calories.
  7. Attitude Adjustment — See your blood sugar numbers as information not a judgment of your self-worth. Monitoring your blood sugar is the best tool to help you evaluate the effectiveness of your diabetes treatment plan. If your numbers are often out of your target range, discuss your treatment plan with your health care provider. You may need to adjust your meal plan, activity level, and/or your medication to meet your blood glucose goals. Know also that no matter how hard you work at managing your blood sugar sometimes your glucose levels, for some inexplicable reason, just won’t be in your target range.

Originally published on Huffington Post.

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PepsiCo’s Imperative to Increase Wellness: Derek Yach

Derek Yach is a physician, epidemiologist and Senior Vice President of Global Health and Agriculture Policy at PepsiCo.

The first part of my interview with Yach talked about global health and how we need to change our agricultural policies and work more closely with farmers.

Here, Yach shares what PepsiCo is doing through their product lines, to be a major player on the world stage helping to reduce hunger and obesity.

Q: What initiatives is PepsiCo involved in to help produce more nutritious foods?

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 (Yach in yellow shirt in Ethiopia for chick pea program)

 

Derek Yach: We’re investing in small farmers around the world and we’re involved all along the chain, from the seed and development of farming practices to the final product and its consumption. We’ve partnered with the World Food Program and the United States Agency for International Development to fund better seeds and drip irrigation systems in Ethiopia so farmers can improve their yield of chickpeas. We believe this project can potentially reduce famine in Africa over the long term. Excess chick peas PepsiCo doesn’t use, the World Food Program is using in a ready-to-eat food product to address famine in Pakistan.

PepsiCo is also fortifying many of its products to get micro-nutrients into millions of people’s diets. For example, we’re addressing iron deficiency in India with an iron-fortified cookie. In Mexico, we’re fortifying some of our more nutritious cookies with Vitamin A.

Internationally we’re at some of the largest global conferences, like the World Economic Forum, as part of a consortium looking at what the agricultural industry feels needs to be grown to address world hunger.

And across Africa and parts of Pakistan and when there’s a crisis in the U.S., like Katrina, the company mobilizes a range of food, water, related relief and cash.

Q: Why don’t more companies feel a moral obligation to move in this direction?

DY: I can’t answer for other companies but I think a great business is one that is doing things that are both right for the business and right for society.

We are seeing that over the medium and long terms, the companies that started investing in healthier foods and in agricultural supply chains that are less vulnerable to climate change are the ones that will win.

It’s less the moral case but the business case that needs to be made inside companies for doing this.

My hope is that increasingly we’ll be competing against each other to see who can become the healthiest company.

Q: Was there any resistance within or without PepsiCo to move in this direction?

DY: Yes, but being a South African growing up in a period of profound national change, I have seen there will always be resistance to change. When you have a senior team all speaking the same message, a CEO, Indra Nooyi, who sees the business growth opportunities that come with developing healthier products and investment in research and development, suddenly the change that seems so tough, happens. And suddenly, the investment in innovation you made is no longer visionary, but business as usual.

Today, the annual revenues from our health and wellness portfolio — brands like Tropicana, Quaker and Naked — are about $13 billion. We believe that will grow to $30 billion by 2020.

This is a company that has been focused on health and wellness for quite some time. This journey accelerated about a decade ago when the company acquired Tropicana, Quaker and Gatorade — three businesses which became the new engine of growth for the company and the foundation of our health and wellness portfolio.

Q: How do you reconcile doing this work in a company that’s also the largest producer of what we think of as less than healthy snack foods?

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DY: I can answer that by saying there are two big strategies underway. One is to take many of our products and make sure that the salt, sugar and fat levels are at the lowest possible level and that they meet nutrition criteria, without sacrificing the great taste consumers expect from PepsiCo products.

We’re pretty close to that in many of our products. If you take our Sun Chips, for example, they would do very well on almost every nutrition criteria. Yet because Sun Chips are a classic snack food, and people equate snacks with junk food, many still don’t see how healthy they are.

Our beverage selection offers a full range of zero calorie and small calorie options that are inherently healthy like water, tea and Gatorade products for athletes. Also, the full calorie ones are starting to come down.

This year we’re launching a new soft drink, “Pepsi Next.” I think it’s going to be a revolutionary product that gives consumers real cola taste with 60 percent less sugar.

While we invest in our core brands, we’re also growing other parts of the company in order to build that $30 billion health and wellness portfolio that I mentioned earlier.

For example, we’re expanding our Quaker line and many of our smaller brands. We have a range of healthier pita bread related products, like our hummus brand, Sabra and some of the healthiest low fat and skim milk yogurt-related products in Russia and the Middle East. Over the next few years you’ll see more of these products.

Q: You sound enormously hopeful.

DY: Absolutely. If you look at the trends for demanding healthier foods the trend lines are upward in every market in the world. Even in the current economic environment with people turning, in part, to comfort foods, the overall trend toward improving health and nutrition seems to universally be going in the right direction. And the trend lines are echoed by steadily improving life expectancy and steadily declining diseases we thought we would never be able to conquer.

I was in South Africa at the start of the upswing of the AIDS epidemic. The evidence is now that it’s starting to go down. I was very involved in tobacco control and now we’ve seen dramatic decline in tobacco-related mortality like lung cancer. That was unthinkable 15 or 20 years ago. I’ve seen the almost complete collapse of measles and almost complete eradication of polio.

Over the course of my career I’ve seen changes that people thought would be impossible.

I’ve also seen that individual and community action can make a big difference to global health. And as an epidemiologist I’m stimulated by changing the shape of the trend line to make sure as bad things are going up we can slow them down and bring them back down sooner. 

We’re starting to see the peak of obesity in a number of European countries and a slowdown or first indication of reduction in parts of the U.S. I think a decade from now we’ll be looking at a reversal of the diabetes epidemic in many parts of the world and a continued upward trend of people living longer, healthier lives.

For Part 1 of this interview click here.

I find how Yach is looking at health and wellness — from the ground up — almost revolutionary amid the status quo, and his working within this snack foods giant to improve quality of life around the world a mighty stand. While some will say, “How healthy can it be to fortify cookies?” — and while I can hope PepsiCo will spend more of their wellness effort creating more product lines that rely on fresh foods — it would be great to see more companies joining in, as Yach said to me, “to do things that are right for the business and right for society.”

Originally published on Huffington Post.

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Taking On Agriculture to Reduce Obesity And Hunger: Derek Yach

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I heard Derek Yach speak at Albert Einstein’s Global Diabetes Summit last September. He presented a case to curb obesity, hunger and diabetes that we don’t often hear: turn our agricultural policies around and work more closely with farmers.

Mr. Yach — a physician and epidemiologist — is a noble fish trying to change the sea around him and around us. Formerly an Executive Director at the World Health Organization (WHO), Yach is Senior Vice President of Global Health and Agriculture Policy at PepsiCo.

Yach’s mission is to help address global challenges such as hunger and obesity, and the ills they cause, by finding ways for PepsiCo — the world’s second largest food and beverage business — to be a part of the solution.

Yach is the 15th leader featured in my series on diabetes change agents. This is Part 1 of a two-part interview. Yach talks here about the world situation and our agricultural policies. Part 2 covers what role PepsiCo is playing.

Q: When you were at the World Health Organization you were instrumental in reducing smoking. Why is it so much harder to get food companies and consumers on the path of producing and eating healthy food?

Derek Yach: Reducing tobacco use was much simpler. You demonize the industry, then tax it to the sky, ban marketing and reduce smoking in public places. Those are all very crude, easy things to do. They don’t have the nuance of a diet, the complexity of the thousands of things available for people to eat or the numerous invested parties.

What makes food complex to regulate according to Yach:

 

1. You can consume too much of a healthy food, and then it is no longer healthy.

2. Everyone thinks they’re an expert — the consumer, the policy makers, agricultural people, politicians, dietitians, nutritionists — yet no one has come up with clear and coherent strategies.

3. Everything you ask people to eat less of has enormous interests behind it. If you want people to eat less meat, there’s a red meat lobby and a Cattleman’s lobby.

4. The groups that are asking people to eat more healthy foods, like fruits vegetables, whole grains and beans, don’t advocate their causes very effectively.

I think we’re going to need incentives rather than regulations. And we’ll need to apply them all the way along the agricultural supply chain and human behavior. There isn’t one single instrument, as we had in tobacco, that’s going to change food consumption for the better. It will take years of different interventions to reverse the trends we see today in obesity.

Q: What has to happen regarding agricultural policies in order to help stem the tide of obesity and diabetes?

DY: Simply, we need a far more nutrition-focused perspective embedded in agricultural policy. In terms of health, our food policies have failed miserably. The escalation of diabetes around the world is an indicator of how off course we’ve gone.

As an epidemiologist I look at trends and see problems before they begin and things getting better before it’s noticed.

 

The public hasn’t yet seen our agricultural policies translate into a direct impact on diabetes-related death, but it has. And, they are having significant consequences regarding increased diabetes, ill health and health care costs.

Q: What else needs to happen at a national and global level?

DY: In the public sector, agricultural and health departments need to be brought closer together to align their priorities, specifically for diabetes. Our current support structure and subsidies are for meat, not fruits and vegetables, and we need just the opposite.

We need to more closely link farm subsidies with the prevention of chronic disease, and that means we need to play a more active role with our agricultural partners. Farming and agriculture play a root role in the quality of calories we furnish, and right now we have an energy imbalance.

We are caught between hunger in the world and obesity and both come from the same cause: cheap calories. We must play more actively with our partners in agriculture.

Fruit and vegetable consumption will also be helped if the relative price of fruits and vegetables become more competitive with corn, corn syrup and sugar-related products. Then companies will want to innovate and use those products across their product lines and this will benefit both companies and consumers.

Q: How can governments and businesses work more closely with agriculture to stem the tide of obesity and produce more healthful foods?

DY: That’s the critical question. When I was at the WHO, one of the things we failed to do when working on diet and physical activity policy was persuade agricultural organizations to look at what agricultural supply would be if it was meeting the health and nutrient needs of the world. I think that’s the intimate bridge between what gets grown and what is needed from a health point of view.

In the U.S. the structure for agriculture did not start by asking the question, “How can we make sure that the healthiest foods are those we grow the most of and are most available in terms of pricing, availability and accessibility?”

Q: What question underlies the food industry in the U.S.?

DY: I think it’s one of agricultural output, “How do we increase yield and maximize yield output for the return of farmers?” That’s an important question but what we need to ask is, “How do we maximize the use of agriculture to meet nutrition needs?”

The good news is the World Economic Forum is now asking the question. Many domestic discussions are on how we can meet the gap in fruit and vegetable consumption. And, it’s part of the bigger, complicated issues around subsidy structures and research and development for fruit and vegetables as opposed to soy, corn and palm oil. And the food industry’s toughest critics, like Michael Pollan and Marion Nestle, as she reviews farm bill issues, are asking the question. But this shift will not happen overnight since we’ve built our current system up over many decades.

In Part 2 of my interview Yach talks about PepsiCo’s commitment to health and wellness.

Originally published on Huffington Post.

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Changing Whole Towns to Reduce Type 2 Diabetes: Itamar Raz

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This is the second part of my interview with leading diabetologist, Professor Itamar Raz. Raz is the director of the Hadassah University Hospital’s diabetes unit and one of the world’s leading researchers and clinicians in diabetes.

In addition to being close to preventing Type 1 diabetes, Raz is working to protect the heart and kidney from diabetic complications, educating doctors how to treat patients with diabetes and changing towns across Israel to improve lifestyle behaviors.

Q: Tell me about the research you’re doing in Type 2 diabetes 

Itamar Raz: I’m working on a number of things. We’re developing a drug to decrease the muscles’ resistance to metabolizing glucose. You know of course Type 2 is a situation of insulin resistance. We’re developing small proteins that may overcome this insulin resistance.

Mostly I’m doing clinical research to protect the kidney and the heart from complications. Now I’m running studies that show certain drugs can protect the kidney from deterioration. 

For the heart it’s more complicated. We have to show the FDA that while a drug can reduce blood sugar we need to assure that it doesn’t cause heart damage. Most Type 2 patients die and suffer from cardiovascular events. For one of the recently-developed oral hyperglycemic drugs (saxagliptin) we are running a very large study, 16,500 people at 800 centers, with a leading cardiology group in Boston.

Q: What else are you working on that you’re excited about? 

IR: Here in Israel I was nominated by the Ministry of Health to head the National Council of Diabetes. That makes me responsible for all the policy and treatment of diabetes care. In this capacity I am expanding the knowledge of the general doctor on diabetes treatment.

Ninety percent of diabetes patients in Israel and worldwide see a general practitioner (GP), but there’s so much diabetes knowledge and experience the GP doesn’t have. Especially with the vast array of new drugs available for treatment. So we’re teaching them when to start insulin, how to start insulin, which drug to use first, how to combine drugs and many more things like this. 

We run large scientific meetings in Europe, Asia and Latin America where we sit everybody together, diabetologists, nurses, doctors, dietitians, social workers, psychologists, representatives from organizations like the JDRF, and we talk with them about how to improve treatment and care. We’re also publishing that knowledge in medical journals like Diabetes Care to make it accessible to more doctors and nurses.

Members of the OECD, that’s an organization that works at improving the economy — and they’re looking closely at medicine — they just came here to Israel to learn one thing from us. How we deal with diabetes. We are very good at it.

Q: Are you also teaching doctors that Type 2 diabetes is not just about medicine but also behavior change?

IR: Yes, and I completely agree with you. If you want to cure Type 2 diabetes, you must change your lifestyle. We see it in evidence-based studies. Do more exercise, eat properly and you have a 60 percent chance you’ll be cured of diabetes. Take a drug and it’s only a 30 percent chance and over a few years most people deteriorate. But no one has taught doctors how to help patients embrace a healthy lifestyle. Many doctors themselves are fat so doctors don’t put enough emphasis on lifestyle.

In Israel we’re changing people’s lifestyle by changing whole towns. We learned from the U.S. and Britain that government cannot change people’s lifestyle. You have to change the environment.

People need places to exercise. If a person works they should have an hour to stop and do exercise. You can’t just tell somebody, “You have to run five miles a day!” You have to give him that ability.

So we are in the process of instituting what we hope will become a nationwide program in Israel called “Healthy Living.” We went into 10 towns and began making changes. We are using one town, Ashdod, which has about 250,000 people as a model.

Last year we began creating opportunities for people to exercise. We went to the factory where many people work and now they serve healthy food and give an hour off for exercise. We are changing drinks in school to only water. We are going into people’s homes and explaining the best foods to have in their refrigerator. We are making a green line in the supermarkets to show where the healthy food is. And we’re trying to make healthy food cheaper than unhealthy food. Next year we will have another three towns and each year more.

I’m a diabetologist, why am I doing this? I think we have to do this. And I am trying to do this without too much money and in a way that two or three years from now the government won’t have a choice but to continue.

Q: What are you most proud of in all that you’ve done?

IR: That I can sit with each one of my patients and after five or 10 minutes I can change them from people who are terribly worried to being less worried and more relaxed.

I see about 50 new patients a week. At the end of the day, after all these things I do, I’m just a simple doctor who wants to help people and wants to do good.

I came away from my entire interview with Professor Raz awed that we may actually be so close to preventing Type 1 diabetes and deeply curious what we may yet see emerge in the next few years.

Originally published on Huffington Post.

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Itamar Raz: A Few Years Away From Preventing Type 1 Diabetes

Forty years ago I was diagnosed with type 1 diabetes. I was told — as we all were — that the cure was five to 10 years away. There still is no cure, but I just interviewed the man who may be a breath away from preventing type 1 diabetes.

“Right now we can diagnose who will develop type 1 diabetes within five years.” — Diabetologist Itamar Raz.

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Last month after I was in Dubai to cover the International Diabetes Federation Congress, I went to Israel where Professor Raz’s secretary, working extremely hard, found 30 minutes for me to meet with Raz.

Professor Raz is Director of the Hadassah University Hospital’s Diabetes Unit and one of the world’s leading researchers and clinicians in diabetes. Raz’s work is changing the future of type 1 and type 2 diabetes.

But what I remember from the almost 50 minutes we spent together is the warmth that radiated over his desk toward me. His bright blue eyes that never left mine and how intensely present he was, wanting me to understand both his work and the fact that he is still a simple doctor who wants to ease patient’s pain. 

This is Part I of a two-part interview and the 14th in my series of profiles on diabetes change leaders.

Q: Tell me about the work you’re doing to prevent type 1 diabetes.

Itamar Raz: Before you develop type 1 diabetes, for most people and mainly in children, you develop antibodies against your pancreas. Most of the time it is two or three antibodies. When these antibodies are seen in a child you know that he/she will most likely develop diabetes within three to four years. If you follow such children you can track how fast they respond to glucose with their own insulin secretion. The moment they are not responding as quickly as before you know it’s only another year before they will develop diabetes.

We have an assumption about how type 1 diabetes occurs. When the beta cell is under stress, current theories suggest from a possible viral disease or early exposure to cow’s milk (rather than breast milk) we don’t really know yet, a part of the cell and a protein inside the cell get exposed in a way that the white blood cell sees the beta cell as an invader and attacks it.

Now we’re trying to stop this attack. Simply, we’re injecting an antigen (a foreign molecule that triggers the body’s production of an antibody) that the cell expresses when it’s under stress. Then we’re stimulating the part of the protein inside the beta cell that goes into action to prevent the attack. When we inject this antigen into animals we can prevent diabetes.

Different studies have been done with other antigens but they have all failed. But three weeks ago we were the first in the world to show in our study that what we are doing works in newly-diagnosed diabetic patients. We are in trials now and soon hope to try it in young children before they develop diabetes to see if we can stop the disease from occurring.

 

Q: Do you think we will see a cure for type 1 diabetes in your lifetime?

IR: I think it’s a hard question. Hoping that my life will extend for another 20 or 25 years, I’m sure we will see many treatments emerge to stop the attack on the beta cell without causing damage to the patient. Whether we will have a full cure I don’t think so, but I don’t know.

A cure may come in three ways. Either we’ll turn stem cells into beta (insulin-producing) cells, or infuse beta cells, or it will be some kind of artificial pancreas. Stem cell therapy is still very far away from being a solution. Islet cell transplantation is a big disappointment. We learned that within three years most patients are insulin dependent again.

I think we’re going to have an artificial pancreas within five or 10 years that will make the life of someone with type 1 diabetes much easier. You won’t have to check your blood sugar and you’ll be able to live more or less a normal life. You won’t have to deal with diabetes all day long and you’ll have an A1C that will probably protect you most of the time from complications.

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Photos ©Riva Greenberg

Q: Why did you go into this work?

IR: I went into medicine because I love to help people. This is me, I love people and I love to give.

When you are a doctor you are like a god, and you can be a good or a bad god. You are a bad god if a patient comes to you and you say, “Why don’t you do this! Why don’t you do that! What you are doing now, you are killing yourself!” You can be a good god if you show your patient that most of the time things are not so bad and you take whatever he worries about and help him worry less. You have a lot of strength in your hand to do good for people.

I went into diabetes for two reasons. I found it very interesting and I thought that this was going to be the main disease the world would face. I saw how our lifestyle was changing. I was right, but 30 years ago no one thought this way.

The other reason was I thought I’d like to have a little time for myself. If I was a cardiologist I’d be running to my patients all hours of the day and night. I didn’t go into cancer because at the time I thought what can I do about cancer? But, diabetes, I thought I’ll have a little time for myself. Of course do I have any time for myself? No, but I love it. 

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Paula Deen’s Diabetes: Are We Getting the Right Message?

The blogosphere was thrumming about whether the Food Network’s down-home Southern queen, Paula Deen, has Type 2 diabetes. Yes, by now you know she does.

It doesn’t bother me that she kept it “close to my chest” as she announced on the Today Show to Al Roker. She said she didn’t want to talk about it until she had something to offer her public.

So I’m left to wonder, did the three years it took Deen to come clean mean she waited until she could help others by being spokesperson for a new Novo Nordisk campaign, “Diabetes in a New Light”? (Deen takes Victoza, a Novo Nordisk injectable, to manage her diabetes.) Or should we finally recognize and admit, just as Deen now has, that diabetes is a lot for a person to take in and learn how to responsibly manage?

No matter what Deen’s real reason was for keeping her diagnosis mum, I applaud that she’s now using her popularity to help inspire the millions of Americans who eat as she ate: an unhealthy high-fat, high-carb, excessive-calorie diet.

What I fear, however, is that too many Americans will still dismiss weight and healthy eating as inconsequential to managing diabetes. Already Deen appears to be dragging her feet on just saying that being overweight or obese, along with a lack of physical activity, is one of the most common causes of Type 2 diabetes. Together, these factors are responsible for nearly 95 percent of diabetes cases in the U.S.

When asked by Roker what the main causes of diabetes are, Deen seemed to fumble and then said genetics, age and lifestyle (an easy cover for unhealthy eating and excess weight), and put emphasis on stress. 

In the USA Today article, “Paula Deen Spreads Word About Diabetes in Down-Home Manner,” Deen answered who gets diabetes by saying, “It’s about heredity. It’s about age, lifestyle, race.” Funny that weight has once again gone missing in this string of risk factors.

Let’s also be clear: Age is becoming less and less relevant to who gets Type 2 diabetes, with increasing obesity in children. According to the U.S. Surgeon General, the number of overweight children in the U.S. has doubled and the number of overweight adolescents has tripled since 1980. The CDC reports 151,000 youths under the age of 20 have diabetes, and cases of Type 2 diabetes among youth and adolescents has been reported with increasing frequency. Understand there’s a reason why Type 2 diabetes, once called “adult-onset” diabetes, is no longer.

I applaud Deen for coming out. I give her a lot of credit for putting her credibility and career at risk and for all she’s overcome in her life, including crippling years of agoraphobia and poverty.

I also love the positive take of Novo’s campaign, a new light — diabetes is not a death sentence. We can live with diabetes and have a full life.

I only hope as Deen leads a nation of almost 26 million with diabetes and 79 million with pre-diabetes that she doesn’t sidestep the importance of healthy eating, maintaining a normal weight and activity. Let’s not soft-peddle the “lifestyle” bit and merely replace it with medicine. 

As those of us in diabetes do know, the Diabetes Prevention Program in 1992 with 3,000 participants showed that 58 percent of participants — across all ethnic groups, for both men and women — reduced their risk of developing Type 2 diabetes with moderate weight loss and exercise. In those over age 60, the risk reduction was a whopping 71 percent! Those participants who were taking metformin, an oral diabetes drug, only reduced their risk by 31 percent.

So Paula, keep it going, keep it clean and keep it real. Let’s not create more diabetes myths, and let us do recognize that managing diabetes takes a personal commitment to healthy eating, proper weight, activity, being well informed, yes, managing stress and yes, taking your meds if prescribed.

And let’s particularly stress that healthy eating, weight and activity are the best tools the nearly 80 million Americans with pre-diabetes have to prevent or delay their diabetes diagnosis.

What do you think? Are we spreading the right message by having Paula Deen as a spokesperson for diabetes?

Originally published on Huffington Post.

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