Tuesday, February 9, 2016

Dynamics of Diabetes: Diabetes and Cognitive Decline

Dynamics of Diabetes: Diabetes and Cognitive Decline
            The issue of the aging population and type 2 diabetes are major public health concerns in the 21st century. By the year 2050 it is estimated that the number of individuals aged 65 and older will exceed 83 million. In addition, the prevalence of type 2 diabetes is expected to dramatically increase, affecting one of three elderly individuals over the age of 65 years old. Furthermore, as the aging process continues cognitive decline is common, ranging from mild cognitive impairment which includes difficulties with memory, verbal communication, and thinking and judgement abilities to dementia, which can be detrimental enough to impede an individual’s ability to function and be self-sustaining on a daily basis.
            Previous research has provided a link between cognitive decline and blood glucose control, but clinical trials have not been able to support this theory due to short lengths of time the study was implemented in the elderly participants. However, a study that was published in the Annuals of Internal Medicine journal in 2014 found that participants with diabetes with poor blood glucose control in middle age had an average of a 19% increase in the decline of their cognitive abilities later in life as compared to individuals in the study without diabetes. In addition, this study also found that individuals who were diagnosed with diabetes appeared to have increased aging effects of their minds, aging five years faster than expected with the normal advanced aging effects.
            Due to the complex and intensive treatment and care of type 2 diabetes, patients with type 2 diabetes require a higher level of cognitive function to appropriately provide self-care and diabetes self-management for themselves. Therefore, it is crucial that dietitians provide middle aged adults with education about diabetes and how blood glucose control can protect against cognitive diseases later in life. According to Ruth Frechman, MA, RDN, CPT dietitians should occasionally check blood levels of folate, vitamin B6, and B12, especially if a patient is taking Metformin, a common drug prescribed to diabetes patients, which can cause vitamin B12 and folate deficiencies. In addition, this dietitian suggests that patients should be encouraged to increase their fatty fish, and use of anti-inflammatories such as turmeric in their cooking process, control their blood glucose, blood cholesterol, blood pressure, and weight within the healthy normal limits, and stop smoking.
            With the great and unique position that dietitians play in the clinical management and treatment of diabetes they are in the perfect position to help patients preserve their cognitive abilities. By practicing quality care and effective counseling skills dietitians can make a substantial difference in this field of clinical dietetics. 

Brown-Riggs, C. (2015). Dynamics of diabetes: Diabetes and cognitive decline. Today’s Dietitian, 17(8), 18. Retrieved from http://www.todaysdietitian.com/


Saturday, January 23, 2016

Use of Medical Nutrition Therapy for Chronic Kidney Disease

Medical Nutrition Therapy for Chronic Kidney Disease Improves Biomarkers and Slows Time to Dialysis

Source: Science Direct

A recent study published by the National Kidney Foundation found that medical nutrition therapy from a Registered Dietitian slowed the development of chronic kidney disease. It was additionally found that nutrition related biomarkers also improved as a result of the intervention.

The study included 265 participants, divided into therapy and non-therapy groups. Dialysis time and changes in glomerular filtration rate (GFR), blood urea nitrogen, albumin, phosphorous, calcium, and intact parathyroid hormone levels were measured.

It was found that the group which received medical nutrition therapy has less of a decline in GFR and was less likely to start dialysis than the group receiving no therapy at all. The therapy group was also more likely to have albumin, phosphorous, calcium, and intact parathyroid hormone levels within normal limits.

This study's results suggest that medical nutrition therapy by Registered Dietitians with an expertise in treating chronic kidney disease improves outcomes in patients. The study indicates that intervention beginning in Stage 3 or Stage 4 of the disease results in better outcomes than if intervention is initiated at Stage 5. By educating patients about nutrition and kidney disease, progression can be slowed, biomarkers improved, and quality of life is maintained or  improved.


Desirée de Waal, Emily Heaslip, Peter Callas, Medical Nutrition Therapy for Chronic Kidney
Disease Improves Biomarkers and Slows Time to Dialysis, Journal of Renal Nutrition, Volume 26, Issue 1, January 2016, Pages 1-9, ISSN 1051-2276,   http://dx.doi.org/10.1053/j.jrn.2015.08.002.

Monday, December 14, 2015


     Low income people are at higher risk for nutrition related illnesses such as diabetes, cardio vascular disease, obesity and hypertension. Many aspects of these diseases are preventable with the right nutrition and the proper health care. Community food pantries are a regular source of nutritious foods for many living with low income, but getting proper medical care can be more difficult.

     The barriers to seeking medical care for those with low income include financial issues, finding time off of work and trust issues. Therefore, many health issues are neglected until it’s too late. One solution being developed is linking food pantries to local clinic healthcare. The local community food pantry is considered a safe, friendly place to get help. The next logical step is bring the clinic to the food pantry on distribution days.

     Of course there are a number of logistical issues that need to be worked out, but the concept works. One pilot program, called LINKS, was started in the Los Angeles area. At a number of different pantry sites, the local clinic would “set up shop”. The basic system involved pantry clients getting blood tests, blood pressure and basic anthropometrics while getting their food. Referrals back to the local clinic and health pamphlets were handed out. This provided quick easy healthcare in a trusting environment.

Biel, M., Evans, S. H., & Clarke, P. (2009). Forging Links Between Nutrition and Healthcare Using CommunityBased Partnerships. Family & community health, 32(3), 196-205.


Quick! Help for Meals: personalized recipes from the food pantry


One question asked when providing free or low cost food to the communities in low socio-economic areas is what are they actually doing with the food?  More than 30 million low-income people in the United States rely on 26,000 community pantries each year for obtaining part of their household’s food, and the availability of fresh produce been increasing steadily (http://www. feedingamerica.org). Unfortunately, much of this is distributed in a haphazard way, and many don’t know what they are getting or what to do with it.
     One current solution to this problem is a software program called Quick! Help for Meals.  As community members get their bag of pantry food, they are asked a few simple food questions. These questions are entered into the program and out pops a small colored recipe booklet tailored to them and the food they are getting.
     What is important here is that the food being distributed is being used to its full nutritional value by the pantry client. The software is inexpensive for the pantry to use and allows for what is called ““indigenous” tailoring where the information is friendly and personal to the individual. This style differs from the “paternalistic” where the information is just a straight, one size fits all directions. Those who developed the program discovered that more fresh produce was used and in more ways by those who received Quick Help recipes than with those who did not.

     The more fun, personal help we can provide those in low SES with their food choices, the more they appear to be eating healthy.

Clarke, P., Evans, S. H., & Hovy, E. H. (2011). Indigenous message tailoring increases consumption of fresh vegetables by clients of community pantries. Health communication, 26(6), 571-582.