Monday, March 20, 2017

Prediabetes – A lot of us Have it and Don’t Know it

Prediabetes is defined as a condition in which blood sugar levels are higher than normal but not high enough to be classified as full-blown diabetes.  According to studies from a number of universities and national surveys, 37% of U.S. adults have prediabetes and 12-14% have diabetes, indicating that about half of adults in this country are affected by high blood sugar.  Most cases of prediabetes are not diagnosed - people don’t know they have it. 

There are two types of diabetes, type 1 and type 2.  Type 1 diabetes, which often comes on in childhood, is an autoimmune disease and is not being discussed in this column. 

In type 2 diabetes, people have a fasting plasma glucose level of 126 mg/dl or higher on two occasions.  If you have a blood glucose level of 200 at random times, not after fasting for 8 hours, you may also have diabetes.  Another test commonly used is hemoglobin A1c, which indicates blood sugar levels in the recent past. Levels of 6.5 or higher are seen in diabetes; 5.7 to 6.4 may indicate prediabetes, and levels below 5.7 are normal. 

 Readers probably already know that diabetes is an unpleasant and dangerous disease, affecting vision, the brain, the heart, the nervous system, kidneys, and feet.  It can be reversed, by medication, exercise and a careful diet, but it is better to prevent it. 

Prevention programs are widespread, and generally consist of emphasizing weight loss (loosing even 5-7% of present body weight is very helpful), and exercise (walking or other activities that raise your heart rate), and a healthy diet.  Walk about 30 minutes almost every day.  There is widespread agreement that a diet to prevent diabetes would decrease or eliminate drinks with added sugar, replacement of red meat with beans, nuts, poultry, fish and yogurt.  Yogurt, rather than other sources of dairy foods, seems to reduce the risk of diabetes.  To facilitate weight loss, cheese should be used sparingly, as a condiment. Foods containing white flour, other refined starch, sugars and white potatoes should be avoided.   In a Harvard study by Walter Willett, coffee and decaf coffee decreased the risk of diabetes. Good news for coffee lovers – but avoid adding sugar!  Stevia seems to be a safe sweetener.   Magnesium containing foods, such as leafy greens, beans, nuts and whole grains also decreased the risk.  Following this diet carefully will naturally lead to weight loss in most people.

Walter Willett, an esteemed professor of nutrition at Harvard and the Harvard School of Public Health, has some encouraging words about lifestyle changes to prevent diabetes.  “If you make a change in your diet or lifestyle today, you’re taking your foot off the accelerator, and this happens almost overnight.  If you exercise today, your insulin resistance goes down within hours. And if you keep up the daily exercise, within a day or two your risk of diabetes drops.  Changing your diet might take longer to make a difference, but it’s a matter of weeks, not years.  Even if you are right at the brink of diabetes, you can still rapidly reduce your risk.”

Our local Coastal Health Alliance is a good place to go to get tested for prediabetes.  They have programs to help you if your blood sugar is too high.  We are lucky to have their services so close by. 

Sadja Greenwood, MD, MPH    back issues on this blog

Saturday, March 11, 2017

Two Amazing Tales: Obstetric Fistula Repair, and Women on Waves outside Guatemala

Obstetric Fistula: Women in some African countries may endure days of obstructed labor, due to an immature pelvis secondary to early marriage, or a contracted vaginal opening due to female genital mutilation.  (See my latest column on genital mutilation at  The baby is often stillborn, or the woman dies in labor because of a lack of hospitals performing Cesarean sections.  If she survives, the prolonged pressure on the vaginal walls often causes openings to appear between the vagina and the rectum or bladder.  She will leak urine and feces, becoming an outcast, often living alone and prone to suicide.  The story of one such woman is remarkable.  After three days of obstructed labor in Ethiopia, and a dead baby, she was taken to a hospital in Addis Ababa that specializes in fistula surgery. The hospital is run by two Australian doctors, who spend their lives in fistula reconstruction. The patient, Ms. Mamitu, was cured and decided to stay on at the hospital.  She was given a job making beds for other patients.  Then she began helping out during surgeries. After a couple of years of watching, the doctor asked her to cut some stitches.   Eventually, she was performing the entire fistula repair herself.  .  She gradually became an experienced fistula surgeon, teaching gynecologic surgeons from many countries.  Still illiterate, she decided to go to night school to learn to read and write.  When last heard of, she was in third grade. This is a wonderful story of enormous perseverance and a drive to help regardless of qualifications.

                Women on Waves (WoW) has sent a ship to international waters outside of Guatemala. Women on Waves is a Dutch prochoice, non-profit organization created in 1999 by Dutch physician Rebecca Gomperts, in order to bring reproductive health services, particularly non-surgical abortion services, to women in countries with restrictive abortion laws. Other services offered by WoW include contraception and reproductive counseling. Services are provided on a commissioned ship that contains a specially constructed mobile clinic. When WoW visits a country, women make appointments, and are taken on board the ship. The ship then sails out to international waters (where Dutch laws are in effect on board the ship) to perform the medical abortions (abortion performed in the first 10 weeks of pregnancy with pills).  Abortion is legal in Guatemala only if the woman’ life is in danger from the pregnancy, and if the procedure is endorsed by two doctors. As a result an estimated 65.000 illegal and unsafe abortions take place in Guatemala each year. Yearly, approximately 21.600 women are hospitalized with complications, and unsafe abortions are the third cause of maternal death in the country. Especially at the dawn of the Zika crisis, access to safe abortion is fundamentally an issue of social justice. WoW is asking the Guatemalan government to remove abortion from the penal code, to provide evidence based sexual education in schools and to ensure  access to contraceptives;
On 22 February 2017, the WoW ship docked in Puerto Quetzal on the Pacific coast for a planned five-day visit. On 23 February, a scheduled press conference was shut down shortly after it started and a blockade
was imposed by Army troops, preventing the activists from disembarking and visitors from boarding. 
WoW  is active in many countries throughout the world where abortion is illegal.  When contacted by phone or Internet, they will send abortion pills by mail, with careful instructions for use.  They have sent pills into Poland by drone!  You can donate to Women on Waves by check or credit card - by going to their

Sadja Greenwood, MD, MPH