Renal Threshold

The classic presentation of uncontrolled diabetes is the “polys” – polyphagia (eating too much), polydipsia (drinking too much) and polyuria (urinating too much) accompanied by weight loss. The underlying cause is that the blood sugar level is too high for the kidneys and sugar leaks out into the urine.

The body tries hard to hold onto sugar since in earlier days it was hard to get enough food for survival and the kidneys would reclaim glucose as they filtered blood so as not to waste calories. However, once the blood sugar level is greater than about 180 the system gets overwhelmed and sugar leaks out. The sugar molecules attract water leading to increased urine volume. The body needs to replace the water lost via urination leading to increased thirst. Weight loss can be dramatic and the thirst relentless.

The whole idea of losing weight by peeing it out is enticing but creates metabolic havoc. The high blood sugar is toxic to small blood vessels, especially in the eyes and the kidneys. The liver attempts to compensate by storing excess blood damage; this creates another set of problems.

A new class of diabetes medications “tricks” the kidneys into allowing glucose into the urine without setting off a bad cascade of events. While useful these medications can have significant side effects.

The National Diabetes Education Initiative has many excellent PDF downloads that discuss many of the newer medications as well as advice on diabetes management. 

Am I being lazy?

One of my mentors once said, “If you are thinking about doing something, you should be doing it.” The context then was about checking a blood count, looking up drug interactions or getting a second opinion on a chest X-ray. In other words: don’t be lazy.

Making a point not to be lazy improves life in general. Go take that walk. Put the dishes in the dishwasher – and then empty it after the cycle. Write the thank-you note right away. Peel the orange instead of grabbing chips.

After a while, these conscious decisions will become habit. If it’s a habit to pack lunch then you won’t spend time and money scrounging for something to eat. That makes it easier to spend a few minutes exercising (even if it means climbing stairs or circling the parking lot). A less cluttered environment is associated with improved health outcomes. If you don’t want to purge, at least put things away.

At least once a day I’ll ask myself if I am being lazy – if the answer is yes I will go ahead with the task. I don’t bother with a to-do list since at the end of the day I would rather just have things done.

Hand Washing

The best way to avoid becoming sick is to wash your hands with soap and water. Disease causing bacteria and viruses are everywhere and we can’t go through life without touching contaminated surfaces. Dirty hands don’t cause disease, but touching your nose, eyes or mouth will deposit the germs directly to a surface that will allow infection. Don’t think you touch your nose, hands or mouth? Just watch someone else for a few minutes and see how often his hand comes to the face.

A word about hand sanitizers: These waterless cleansers can be convenient, but are designed to kill surface bacteria -- not to remove dust and dirt, which may contain body secretions (full of bacteria and viruses). Washing with soap and water, on the other hand, kills bacteria and more thoroughly removes grime from hands to reducer any toxic exposures.

The best product for home use is conventional soap and water. The main reason to avoid anti-bacterial soaps is its active ingredient: triclosan (and the related triclocarbon). Triclosan is an anti-bacterial chemical found in many consumer products, and it's nearly ubiquitous in liquid hand soap.

In other words, we are continually exposed to triclosan. The problem is that triclosan may not be safe. In animal studies it has been shown to interfere with the regulation of thyroid hormones (affecting metabolism and brain development), testosterone synthesis (decreasing sperm counts) and estrogen action (causing early onset of puberty). Exposure to triclosan has been shown to weaken heart muscle, impairing contractions and reducing heart function, and to weaken skeletal muscle, reducing grip strength. In aquatic environments fish exposed to triclosan were unable to swim properly.

A tip: wash your hands like you mean it. The water doesn’t have to be hot but you should wash for thirty seconds, about the time it takes to sing “Happy Birthday.” Sing and wash away – “Happy Birthday” is no longer under copyright.

An opinion from the Smithsonian. 

MRI

Conventional x-rays are very helpful in determining if a bone is broken or if there is fluid accumulation in the lungs. Radiography has been used since the 1890’s and revolutionized the practice of medicine. However, it can be difficult to take a look at soft tissue inside the body. The MRI was born in 1977 and hospitals quickly competed for the limited numbers of machines. Rather than using radiation, the MRI machine uses a very strong magnet to temporarily realign the hydrogen atoms. As the atoms ‘push back’ a little the machine captures the signal and uses the information to create a three dimensional image of the body part.

MRI is the most frequently used imaging test of the brain and spinal cord. MRI may be used in addition to mammography to detect breast cancer, particularly in women who have dense breast tissue or who may be at high risk of the disease.

Because the MRI machine uses a very strong magnet, any metal or electronic devices in the body could be a safety hazard. The special dye used for a MRI can be a problem if one has liver or kidney disease. Like all medical procedures, both the doctor and the patient need to discuss the risks versus the benefits.

The actual scan is painless but very noisy. The scan can take as long as an hour and a patient may feel claustrophobic.  Some patients tolerate the procedure more comfortably with a mild sedative.

The key to obtaining a good set of images is full cooperation with the MRI technician as well as a lot of patience.

NAFLD

Non-alcoholic fatty liver disease (NAFLD) is a very common disorder and refers to a group of conditions where there is accumulation of excess fat in the liver of people who drink little or no alcohol. The majority of individuals with NAFLD have no symptoms and a normal examination. NAFLD is part of the metabolic syndrome characterized by diabetes, or pre-diabetes (insulin resistance), being overweight or obese, elevated blood lipids such as cholesterol and triglycerides, as well as high blood pressure.

NAFLD may affect as many as one in three to one in five adults in the United States. The diagnosis of NAFLD is usually first suspected in an overweight or obese person who is found to have mild elevations in their liver tests during a routine blood testing or incidentally detected on radiologic investigations such as abdominal ultrasound or CT scan.

A few studies have suggested that weight loss may be associated with regression of fat within the liver. Therefore, the most important recommendations for people with fatty liver are to lose weight if they are overweight or obese, increase their physical activity, follow a balanced diet and avoid alcohol and unnecessary medications.

These are liver-loving foods:

·      Fruits that are red, purple and blue are high in anthocyanin have been found to be an effective therapy against a fat-laden liver.

·      Coffee and green tea (both caffeinated and decaffeinated) can lower the level of abnormal liver enzymes.

·      Olive oil can protect the liver from oxidative stress.

·      Salmon is loaded with omega-3 fat and vitamin D.

NAFLD can progress to more severe liver disease that could ultimately require liver transplant. An ounce of prevention!

A very basic introduction from the American Liver Foundation.

More information (including a podcast) from the American College of Gastroenterology.