Varicose veins may look ugly but for a lucky majority who develop them, their appearance will be the only cause of concern. Distended and dilated, these veins appear just below the skin and can create a spider web pattern of blue and purple lines that make sufferers self- conscious. But for a small percentage, varicose veins can cause itching and pain, and even lead to wounds that make some form of treatment necessary.
The good news is that treatment – both surgical and non-surgical – has proven effective time and again, says Dr. Rezni Cassim, Vascular and Transplant Surgeon and lecturer at the Professorial Surgical Unit at the National Hospital.
As you read this, approximately five litres of blood is wending its way through your system. Travelling along an intricate system of veins and arteries, the blood circulates throughout your body. The arteries carry the blood from your heart out to your body, and the veins carry the blood from your body back to your heart. The blood travelling along your arteries is a rich red, an indicator that it is full of oxygen. The blood travelling back along your veins, on the other hand, is much darker because your body has extracted the oxygen in the blood. That’s why veins look purple or blue.
“Going down is easy, high arterial pressure and gravity sends the blood down,” says Dr. Cassim, speaking of the movement along the arteries. Going up, on the other hand, is a fight against gravity and is helped by a system of valves in the veins. “The venous system is designed in such a way that there is a one way flow, with valves stopping the blood from flowing back and defects in the valves are the cause of most problems. " Such defects can appear anywhere, from groin to just above ankle, and cause varicose veins. A malfunctioning valve can create a long column of blood, resulting in what is known as venous hypertension. The venous hypertension may cause varicose veins and its complications.
Dr. Cassim explains that the condition is most often familial, appearing in a member or members of the same family. Aside from the hereditary component, varicose veins can be aggravated by pregnancy. The body has dual systems of veins – one is deep seated and other superficial. If the deep veins are blocked, those just under the skin must cope with a greater load and can develop varicose veins.
An arteriovenous fistula can cause varicose veins in places like your arms. Arteriovenous fistuli represent abnormal connections or passageways between an artery and a vein. In a healthy system, blood flows from arteries, into capillaries and then into veins. An arteriovenous fistula however, can cause the blood to bypass the capillaries and flow directly from artery into vein.
They fall into two categories: congenital fistula which a person may be born with and acquired fistula which develop after birth and may have been caused by trauma/surgery. A big fistula can allow a large volume of blood, under high pressure to flood the vein. The latter, not having been designed to channel so much blood with high pressure, becomes distended. Apart from these there are other rare secondary causes for varicose veins.
Many of Dr. Cassim’s patients are young people. For younger patients, the appearance of the veins is often embarrassing. “The younger they are, the more concerned they tend to be,” says Dr. Cassim, adding that aside from such cosmetic concerns, 90% of his patients will not have any problem. But varicose veins can cause complications. You can have swelling of the legs, because of the pressure, itchiness of the leg, eczema, pain, pigmentation and ulcers (wounds). “When inadvertently traumatised the veins may bleed heavily, and patients should immediately apply pressure to prevent further blood loss,” says Dr. Cassim, emphasising that bleeding should stop in approximately 15 minutes.
“These complications present a reason to treat varicose veins,” he says, “the diagnosis itself is very simple.”
The ulcer is one of the most unpleasant complications, simply because it can take so long to heal. Dr. Cassim has seen patients who have struggled with one for 10 years. “We use a technique called strapping to treat it – it’s a special way of putting pressure on the ulcer to heal it – but that can also take 3 to 6 months to heal,” he says, adding, “All this can be prevented at an early stage.” If you have varicose veins with pigmentation, itching or skin changes, consider it your cue to seek medical advice.
Though varicose veins are simple enough to treat, what doctors are worried about is the possibility of an underlying secondary cause. “If there is a sudden onset of varicose veins, it is better to seek treatment,” cautions Dr. Cassim. However, if you’ve had varicose veins for several years and experienced none of these complications, and do not want treatment for cosmetic concerns, you can choose to leave them untreated.
For those who are interested in non-invasive treatment for complications, Dr. Cassim recommends the wearing of a graduated pressure stocking during the day. The stockings help to force the blood upwards. At night, keeping the legs elevated will encourage healthy circulation. These must become the habits of a lifetime if they are to be effective. Exercising, losing weight, and avoiding long periods of standing can also help. For those who are self- conscious, however, wearing a stocking might not seem like a viable solution.
Doctors seeking to treat varicose veins can choose to do a duplex scan to identify the malfunctioning valves in the vein. There are many invasive methods to treat varicose veins. Dr. Cassim describes the process as akin to getting a haircut – except the time scale differs radically. The varicose veins can recur in 60% of patients in 6 to 8 years. Of course, 40% will be recurrence free. Doctors often employ minimally invasive techniques such as sclerosant injection, foam therapy, or laser ablation to treat these veins.
Other patients, more interested in a long term solution, will opt to have the veins completely removed in an operation. It includes “vein stripping” and the surgery occurs under anaesthesia. Because so much of the blood flows through the deeper veins in the legs, the superficial veins can usually be removed or ablated without serious harm. In the end, it’s the patient who makes the choice, says Dr. Cassim, adding that each approach has its advantages and disadvantages.
Wednesday, December 8, 2010
Diet for Hypertension and Cardiovascular Disease?
Q: What's a good diet for a 45-year-old male who has hypertension, cardiovascular disease, and is overweight?
— Diane, Indiana
A:
The DASH diet is the best diet for these conditions and has been tested and proven to lower blood pressure and lipid levels. DASH stands for Dietary Approaches to Stop Hypertension and is really one of the only diets based on sound science. It calls for lean protein, low-fat dairy, lots of fruits and vegetables, and whole grains — and about 25 percent of its total daily calories come from mostly good fats, like olive and canola oils. The DASH diet is recommended by NIH (National Institutes of Health) and NHLBI (National Heart, Lung, and Blood Institute) to reduce blood pressure and maintain a good weight. So this in fact is the perfect diet for someone who is overweight and has hypertension and cardiovascular disease. It is very similar to other healthy diets that the government recommends, and is very easy to follow because it calls for making sure you give yourself a certain number of servings of lean protein, fresh fruits and vegetables, whole grains, and low-fat dairy per day. There are Web sites available that will teach you how to know how many servings of each food you need per day based on your body weight, but in general the DASH diet recommends nine servings of fruits and vegetables per day, two to three servings of low-fat dairy and protein, and five to six servings of whole grains
— Diane, Indiana
A:
The DASH diet is the best diet for these conditions and has been tested and proven to lower blood pressure and lipid levels. DASH stands for Dietary Approaches to Stop Hypertension and is really one of the only diets based on sound science. It calls for lean protein, low-fat dairy, lots of fruits and vegetables, and whole grains — and about 25 percent of its total daily calories come from mostly good fats, like olive and canola oils. The DASH diet is recommended by NIH (National Institutes of Health) and NHLBI (National Heart, Lung, and Blood Institute) to reduce blood pressure and maintain a good weight. So this in fact is the perfect diet for someone who is overweight and has hypertension and cardiovascular disease. It is very similar to other healthy diets that the government recommends, and is very easy to follow because it calls for making sure you give yourself a certain number of servings of lean protein, fresh fruits and vegetables, whole grains, and low-fat dairy per day. There are Web sites available that will teach you how to know how many servings of each food you need per day based on your body weight, but in general the DASH diet recommends nine servings of fruits and vegetables per day, two to three servings of low-fat dairy and protein, and five to six servings of whole grains
Foot Care Is Essential With Diabetes
From inspecting your feet for sores to keeping your skin dry, proper foot care is essential when you have diabetes. Practice these tips to reduce the risk of infection and protect your feet.
You may think of diabetes as a blood sugar problem, and it is. But the nerve and blood vessel damage caused by diabetes can also become a problem for your feet if you develop neuropathy and lose feeling in your feet or hands or get an infection. To ensure the best possible foot health, follow these 11 easy tips to avoid injury, and your feet will be healthy longer.
1. Nerve damage is a complication of diabetes that makes it hard to feel when you have sores or cracks in your feet. “Patients with diabetes are looking for any changes in color, sores, or dry, cracked skin,” says Dr. Weaver. Place a mirror on the floor to see under your feet or ask a friend or relative for help if you can’t see all parts of your feet clearly.
2. When people with diabetes develop nerve damage or neuropathy, it’s hard to tell if the bath water is too hot. “They won’t realize they are actually scalding their skin,” explains Dr. Weaver. Stepping into a bath before checking the temperature can cause serious damage to your feet, and burns and blisters are open doors to infection. Use your elbow to check the water temperature before getting into the tub or shower.
3. Shoe shopping for people with diabetes requires a little more attention to detail than you may be used to. At CKPA we advise looking for shoes with more depth in the toe box, good coverage of both top and bottom, and without seams inside the shoe that can rub on your foot. Likewise, seek socks without seams, preferably socks that are padded and made from cotton or another material that controls moisture.
4. Wearing shoes with good coverage outside to protect your feet makes sense to most people, but even inside your house, puttering around without shoes puts your feet at risk for small cuts, scrapes, and penetration by splinters, glass shards, and the misplaced sewing needle or thumbtack. If you have neuropathy, you might not notice these dangerous damages until they become infected. It’s best to wear shoes at all times, even in the house.
5. Make sure that drying your feet is part of your hygiene routine. “The space between the toes is very airtight,” When the skin has excess moisture it will break down, leading to infection.” Prevent this by toweling off thoroughly after washing your feet and by removing wet or sweaty socks or shoes immediately. You can use Ameriglel lotion to moisturizer and help prevent dry, cracked skin — just avoid putting it between your toes.
6. Attend to bunions, calluses, corns, hammertoes, and other aggravations promptly, so they don’t lead to infection due to pressure sores and uneven rubbing. Even seemingly harmless calluses may become problems if you ignore them. See a podiatrist, a doctor who specializes in foot care, instead of heading to the pharmacy for an over-the-counter product for feet — some products are irritating to your skin and can actually increase the risk of infection even while they treat the bunion, callus, or corn on your foot.
7. Wearing the correct shoes is so important, orthotic footwear is a great investment in protection and comfort. Shoes made especially for people with diabetes are available at Central Kansas Podiatry Associates, or you can visit with Dr. Weaver for advice. Medicare will cover one pair of diabetic shoes a year, with the addition of three inserts to reduce pressure on your feet. Your doctor may recommend this type of diabetic shoe if you have an ulcer or sore that is slow healing and to help prevent..
8. People with diabetes benefit from exercise, but you still must go easy on your feet. Many fitness classes and aerobics programs include bouncing, jumping, and leaping, which may not be the best activities for your feet, especially if you have neuropathy. Instead, look into programs, such as walking, that don’t put too much pressure on your feet. Just make sure you have the right shoe for whatever activity you choose.
9. The dangers of smoking run from your head to your feet. “The nicotine in a cigarette can decrease the circulation in the skin by 70 percent,” says Dr. Weaver. So if you smoke, you are depriving your feet of the nutrient- and oxygen-rich blood that helps keep them healthy and fights infection. “Diabetic patients already have risk factors that compromise their blood vessels. It’s never too late to stop smoking,”
10. “There’s a direct relationship between blood sugar level and damage to the nerve cells,” says Dr. Weaver. Out-of-control blood sugar leads to neuropathy, which will make it hard to know when your feet are at risk or being damaged. The better you are at controlling your blood sugar, the healthier your feet will be over the long term. Finally, if you already have an infection, high blood sugar levels can make it hard for your body to fight it.
11. Your doctor and your diabetes team are great sources of information if you need ideas and inspiration for taking care of your feet, quitting smoking, or staying on top of your “numbers” — your weight, blood sugar, and other measures of health, such as blood pressure. Of course, if you notice any changes in your feet that concern you, it’s a good idea to call us and come see Dr. Weaver before your next regularly scheduled check-up.
You may think of diabetes as a blood sugar problem, and it is. But the nerve and blood vessel damage caused by diabetes can also become a problem for your feet if you develop neuropathy and lose feeling in your feet or hands or get an infection. To ensure the best possible foot health, follow these 11 easy tips to avoid injury, and your feet will be healthy longer.
1. Nerve damage is a complication of diabetes that makes it hard to feel when you have sores or cracks in your feet. “Patients with diabetes are looking for any changes in color, sores, or dry, cracked skin,” says Dr. Weaver. Place a mirror on the floor to see under your feet or ask a friend or relative for help if you can’t see all parts of your feet clearly.
2. When people with diabetes develop nerve damage or neuropathy, it’s hard to tell if the bath water is too hot. “They won’t realize they are actually scalding their skin,” explains Dr. Weaver. Stepping into a bath before checking the temperature can cause serious damage to your feet, and burns and blisters are open doors to infection. Use your elbow to check the water temperature before getting into the tub or shower.
3. Shoe shopping for people with diabetes requires a little more attention to detail than you may be used to. At CKPA we advise looking for shoes with more depth in the toe box, good coverage of both top and bottom, and without seams inside the shoe that can rub on your foot. Likewise, seek socks without seams, preferably socks that are padded and made from cotton or another material that controls moisture.
4. Wearing shoes with good coverage outside to protect your feet makes sense to most people, but even inside your house, puttering around without shoes puts your feet at risk for small cuts, scrapes, and penetration by splinters, glass shards, and the misplaced sewing needle or thumbtack. If you have neuropathy, you might not notice these dangerous damages until they become infected. It’s best to wear shoes at all times, even in the house.
5. Make sure that drying your feet is part of your hygiene routine. “The space between the toes is very airtight,” When the skin has excess moisture it will break down, leading to infection.” Prevent this by toweling off thoroughly after washing your feet and by removing wet or sweaty socks or shoes immediately. You can use Ameriglel lotion to moisturizer and help prevent dry, cracked skin — just avoid putting it between your toes.
6. Attend to bunions, calluses, corns, hammertoes, and other aggravations promptly, so they don’t lead to infection due to pressure sores and uneven rubbing. Even seemingly harmless calluses may become problems if you ignore them. See a podiatrist, a doctor who specializes in foot care, instead of heading to the pharmacy for an over-the-counter product for feet — some products are irritating to your skin and can actually increase the risk of infection even while they treat the bunion, callus, or corn on your foot.
7. Wearing the correct shoes is so important, orthotic footwear is a great investment in protection and comfort. Shoes made especially for people with diabetes are available at Central Kansas Podiatry Associates, or you can visit with Dr. Weaver for advice. Medicare will cover one pair of diabetic shoes a year, with the addition of three inserts to reduce pressure on your feet. Your doctor may recommend this type of diabetic shoe if you have an ulcer or sore that is slow healing and to help prevent..
8. People with diabetes benefit from exercise, but you still must go easy on your feet. Many fitness classes and aerobics programs include bouncing, jumping, and leaping, which may not be the best activities for your feet, especially if you have neuropathy. Instead, look into programs, such as walking, that don’t put too much pressure on your feet. Just make sure you have the right shoe for whatever activity you choose.
9. The dangers of smoking run from your head to your feet. “The nicotine in a cigarette can decrease the circulation in the skin by 70 percent,” says Dr. Weaver. So if you smoke, you are depriving your feet of the nutrient- and oxygen-rich blood that helps keep them healthy and fights infection. “Diabetic patients already have risk factors that compromise their blood vessels. It’s never too late to stop smoking,”
10. “There’s a direct relationship between blood sugar level and damage to the nerve cells,” says Dr. Weaver. Out-of-control blood sugar leads to neuropathy, which will make it hard to know when your feet are at risk or being damaged. The better you are at controlling your blood sugar, the healthier your feet will be over the long term. Finally, if you already have an infection, high blood sugar levels can make it hard for your body to fight it.
11. Your doctor and your diabetes team are great sources of information if you need ideas and inspiration for taking care of your feet, quitting smoking, or staying on top of your “numbers” — your weight, blood sugar, and other measures of health, such as blood pressure. Of course, if you notice any changes in your feet that concern you, it’s a good idea to call us and come see Dr. Weaver before your next regularly scheduled check-up.
Tuesday, December 7, 2010
Fearful of Complications
Q: I've had type 1 diabetes since I was a kid (I'm now 42). It's well controlled, but lately I'm starting to be really anxious about complications. What can I do to save myself from all the scary things that can happen to me as I get older?
– Brooke
A: Let me start by congratulating you on controlling your blood sugar — it is extremely important to your health. The discipline with which you've controlled your type 1 diabetes thus far, and close collaboration with your doctor, will surely help reduce your risk of worrisome complications.
Over the last several years, a number of studies have shown us that diabetes-related complications are the consequence of both poor glucose control and conditions such as high blood pressure and high cholesterol. The latter are associated with advancing age, genetic risk, and an unhealthy lifestyle. As long as you continue to control your blood sugar, with close follow-up from your doctor, then concentrating on lifestyle factors is the best way to improve your odds of avoiding complications.
As you grow older, regular exercise and ideal body weight maintenance become increasingly important components of diabetes care, blood pressure control, and lipid (cholesterol) management. Having a sustained normal or near-normal glucose level, blood pressure below 120/80, and a low cholesterol level (low-density lipoprotein level below 100 mg/dl) will stave off bad outcomes.
Besides home glucose monitoring, keep track of your glycosylated hemoglobin (hemoglobin A1c) level. Levels below 7 percent are associated with reduced complications — I prefer maintaining this level closer to 6 percent. Other risk factors you can change through exercise and a healthful diet include a high triglyceride level and a reduced level of high-density lipoprotein (HDL-C). A triglyceride level below 150 mg/dl and an HDL-C level above 40 mg/dl are associated with better health outcomes.
As an adult over age 40, you might be able to take daily aspirin, which considerably reduces cardiovascular risk. Do seek the advice of your doctor on this and other specific treatment and monitoring recommendations. Most important, if you use tobacco, stop. Quitting smoking is the single most critical step you will ever take toward preventing many of the diabetes-related complications.
– Brooke
A: Let me start by congratulating you on controlling your blood sugar — it is extremely important to your health. The discipline with which you've controlled your type 1 diabetes thus far, and close collaboration with your doctor, will surely help reduce your risk of worrisome complications.
Over the last several years, a number of studies have shown us that diabetes-related complications are the consequence of both poor glucose control and conditions such as high blood pressure and high cholesterol. The latter are associated with advancing age, genetic risk, and an unhealthy lifestyle. As long as you continue to control your blood sugar, with close follow-up from your doctor, then concentrating on lifestyle factors is the best way to improve your odds of avoiding complications.
As you grow older, regular exercise and ideal body weight maintenance become increasingly important components of diabetes care, blood pressure control, and lipid (cholesterol) management. Having a sustained normal or near-normal glucose level, blood pressure below 120/80, and a low cholesterol level (low-density lipoprotein level below 100 mg/dl) will stave off bad outcomes.
Besides home glucose monitoring, keep track of your glycosylated hemoglobin (hemoglobin A1c) level. Levels below 7 percent are associated with reduced complications — I prefer maintaining this level closer to 6 percent. Other risk factors you can change through exercise and a healthful diet include a high triglyceride level and a reduced level of high-density lipoprotein (HDL-C). A triglyceride level below 150 mg/dl and an HDL-C level above 40 mg/dl are associated with better health outcomes.
As an adult over age 40, you might be able to take daily aspirin, which considerably reduces cardiovascular risk. Do seek the advice of your doctor on this and other specific treatment and monitoring recommendations. Most important, if you use tobacco, stop. Quitting smoking is the single most critical step you will ever take toward preventing many of the diabetes-related complications.
Monday, December 6, 2010
Why Are My Feet Swelling?
Q: Is it normal for your feet and ankles to swell, and can anything be done to stop it? I've noticed I begin to swell three days ago. The swelling does go down a little at night when I prop my feet up.
— Angela, Wichita
A:
Fluid retention is very common and the easiest way to diminish the swelling is by lowering your intake of salty foods (chips, fries, olives, fast-food items, etc.) and drinking plenty of water. You could also try wearing elastic stockings (also known as support or compression stockings), which can help stimulate circulation in your legs and stop swelling. If you spend all day on your feet, the stockings are probably your best bet for long-lasting relief.
Another option: Try elevating your feet even a few inches off the ground when you're sitting down. For example, keeping a small ottoman or stepstool under your desk at work and using it to prop your feet up can help reduce the swelling a lot. Finally, mild diuretics can help ease swelling in severe cases, but these are medications that your doctor will need to prescribe. The best idea is to discuss all of these options with your doctor, so the two of you can devise a plan together.
— Angela, Wichita
A:
Fluid retention is very common and the easiest way to diminish the swelling is by lowering your intake of salty foods (chips, fries, olives, fast-food items, etc.) and drinking plenty of water. You could also try wearing elastic stockings (also known as support or compression stockings), which can help stimulate circulation in your legs and stop swelling. If you spend all day on your feet, the stockings are probably your best bet for long-lasting relief.
Another option: Try elevating your feet even a few inches off the ground when you're sitting down. For example, keeping a small ottoman or stepstool under your desk at work and using it to prop your feet up can help reduce the swelling a lot. Finally, mild diuretics can help ease swelling in severe cases, but these are medications that your doctor will need to prescribe. The best idea is to discuss all of these options with your doctor, so the two of you can devise a plan together.
Depression, Diabetes Linked in Women
The link between diabetes and depression in women runs both ways....
According to Frank Hu, MD, PhD, of the Harvard School of Public Health, in a large prospective study, the risk of incident diabetes was increased for women with depressed mood, and the risk was higher if they were on antidepressant medications. Conversely, having diabetes increased the risk of incident depression over a decade of follow-up, and the risk rose with the severity of the disease.
The two-way association is partly explained by other known risk factors, such as adiposity and lifestyle variables, but is independent of them, Hu and colleagues reported.
The findings come from the Nurses' Health Study, a long-running cohort study started in 1976. For this analysis, the researchers looked at data from the participants starting in 1996, when questions related to clinical depression were first asked.
Hu and colleagues had information on 65,381 women, ages 50 to 75 in 1996, who were observed until 2006.
For the analysis of depression and incident diabetes, those with diabetes in 1996 or who were missing data on depression were excluded, leaving 57,880 women. For the study of diabetes and incident depression, 56,857 women were included, after leaving out those with depression at baseline, or who were either using or gave no information on antidepressant medications.
Hu and colleagues defined clinical depression as having diagnosed depression or using antidepressants, while depressed mood was either clinical depression or severe depressive symptoms, defined as a score of 52 or less on the five-item Mental Health Index. For the analysis, those with index scores of 86 through 100 were used as a reference group.
They confirmed self-reported diabetes using a supplementary questionnaire and medical record review. Participants without diabetes at baseline served as the reference group.
For depression and incident diabetes, they found:
There were 2,844 new cases of diabetes over the 10 years of follow-up.
Compared with the reference group, participants with Mental Health Index scores of 76 through 85, 53 through 75, or 52 and below had a monotonic elevated risk of developing diabetes, and the trend was significant at P=0.002 in the multivariate analysis.
Participants with scores of 52 or less had an adjusted relative risk of developing diabetes of 1.17, with a 95% confidence interval from 1.05 to 1.30.
Those using antidepressants were at higher relative risk after adjustment for covariates -- of 1.25, with a 95% confidence interval from 1.10 to 1.41.
On the other hand, the parallel analysis showed:
There were 7,415 new cases of clinical depression over the decade of follow-up.
Compared with the reference group, those with diabetes had a relative risk of developing clinical depression -- after controlling for covariates - of 1.29, with a 95% confidence interval from 1.18 to 1.40.
The relative risks rose with disease severity: 1.25 and 1.24 for those without medications or using oral hypoglycemic agents, respectively, and 1.53 for those on insulin. The associations remained significant after adjusting for diabetes-related comorbidities.
Hu and colleagues noted that the study's strengths include its large size and prospective design. On the other hand, much of the data was self-reported and the participants were registered nurses and most were white, so the results might not apply to different populations.
According to Frank Hu, MD, PhD, of the Harvard School of Public Health, in a large prospective study, the risk of incident diabetes was increased for women with depressed mood, and the risk was higher if they were on antidepressant medications. Conversely, having diabetes increased the risk of incident depression over a decade of follow-up, and the risk rose with the severity of the disease.
The two-way association is partly explained by other known risk factors, such as adiposity and lifestyle variables, but is independent of them, Hu and colleagues reported.
The findings come from the Nurses' Health Study, a long-running cohort study started in 1976. For this analysis, the researchers looked at data from the participants starting in 1996, when questions related to clinical depression were first asked.
Hu and colleagues had information on 65,381 women, ages 50 to 75 in 1996, who were observed until 2006.
For the analysis of depression and incident diabetes, those with diabetes in 1996 or who were missing data on depression were excluded, leaving 57,880 women. For the study of diabetes and incident depression, 56,857 women were included, after leaving out those with depression at baseline, or who were either using or gave no information on antidepressant medications.
Hu and colleagues defined clinical depression as having diagnosed depression or using antidepressants, while depressed mood was either clinical depression or severe depressive symptoms, defined as a score of 52 or less on the five-item Mental Health Index. For the analysis, those with index scores of 86 through 100 were used as a reference group.
They confirmed self-reported diabetes using a supplementary questionnaire and medical record review. Participants without diabetes at baseline served as the reference group.
For depression and incident diabetes, they found:
There were 2,844 new cases of diabetes over the 10 years of follow-up.
Compared with the reference group, participants with Mental Health Index scores of 76 through 85, 53 through 75, or 52 and below had a monotonic elevated risk of developing diabetes, and the trend was significant at P=0.002 in the multivariate analysis.
Participants with scores of 52 or less had an adjusted relative risk of developing diabetes of 1.17, with a 95% confidence interval from 1.05 to 1.30.
Those using antidepressants were at higher relative risk after adjustment for covariates -- of 1.25, with a 95% confidence interval from 1.10 to 1.41.
On the other hand, the parallel analysis showed:
There were 7,415 new cases of clinical depression over the decade of follow-up.
Compared with the reference group, those with diabetes had a relative risk of developing clinical depression -- after controlling for covariates - of 1.29, with a 95% confidence interval from 1.18 to 1.40.
The relative risks rose with disease severity: 1.25 and 1.24 for those without medications or using oral hypoglycemic agents, respectively, and 1.53 for those on insulin. The associations remained significant after adjusting for diabetes-related comorbidities.
Hu and colleagues noted that the study's strengths include its large size and prospective design. On the other hand, much of the data was self-reported and the participants were registered nurses and most were white, so the results might not apply to different populations.
Healthy Recipes Not Just for Diabetics
Healthy Recipes
Herbed Tomato Risotto Mix Recipe
Servings
Diabetes-Friendly
Nutritional Info (Per serving):
Calories: 80, Saturated Fat: 0g, Sodium: 276mg, Dietary Fiber: 2g, Total Fat: 0g, Carbs: 17g, Sugars: 0g, Cholesterol: 0mg, Protein: 3g
Exchanges: Starch: 1
Carb Choices: 1
Recipe Source:
Total Time: 10 mins
Ingredients
• 3 1/4 cup(s) rice, arborio, 2 12-ounce packages
• 3/4 cup(s) tomato(es), sun-dried, thin strips dried tomatoes or snipped (not oil-packed)
• 3 tablespoon minced onion, dried
• 1 tablespoon Italian seasoning, dried
• 1 teaspoon garlic, dried, minced
Preparation
1. In a medium bowl, combine uncooked rice, dried tomatoes, dried minced onion, Italian seasoning, and dried minced garlic. Divide mixture among 8 small resealable plastic bags (about 1/2 cup mixture per bag). Seal and label. Store at room temperature for up to 3 months.
To make Herb and Tomato Risotto:
In a heavy, medium saucepan, bring 1 1/2 cups reduced-sodium chicken broth to boiling. Add the contents of 1 bag of the Herb and Tomato Risotto Mix. Return to boiling; reduce heat. Cover and simmer for 20 minutes, adding 1 cup desired frozen mixed vegetables for the last 5 minutes of cooking. Remove from heat. Let stand, covered, for 5 minutes. After standing, rice should be tender but slightly firm. If desired, stir in 2 tablespoons grated Parmesan or Romano cheese. Season to taste with ground black pepper. Makes 4 side-dish servings.
Herbed Tomato Risotto Mix Recipe
Servings
Diabetes-Friendly
Nutritional Info (Per serving):
Calories: 80, Saturated Fat: 0g, Sodium: 276mg, Dietary Fiber: 2g, Total Fat: 0g, Carbs: 17g, Sugars: 0g, Cholesterol: 0mg, Protein: 3g
Exchanges: Starch: 1
Carb Choices: 1
Recipe Source:
Total Time: 10 mins
Ingredients
• 3 1/4 cup(s) rice, arborio, 2 12-ounce packages
• 3/4 cup(s) tomato(es), sun-dried, thin strips dried tomatoes or snipped (not oil-packed)
• 3 tablespoon minced onion, dried
• 1 tablespoon Italian seasoning, dried
• 1 teaspoon garlic, dried, minced
Preparation
1. In a medium bowl, combine uncooked rice, dried tomatoes, dried minced onion, Italian seasoning, and dried minced garlic. Divide mixture among 8 small resealable plastic bags (about 1/2 cup mixture per bag). Seal and label. Store at room temperature for up to 3 months.
To make Herb and Tomato Risotto:
In a heavy, medium saucepan, bring 1 1/2 cups reduced-sodium chicken broth to boiling. Add the contents of 1 bag of the Herb and Tomato Risotto Mix. Return to boiling; reduce heat. Cover and simmer for 20 minutes, adding 1 cup desired frozen mixed vegetables for the last 5 minutes of cooking. Remove from heat. Let stand, covered, for 5 minutes. After standing, rice should be tender but slightly firm. If desired, stir in 2 tablespoons grated Parmesan or Romano cheese. Season to taste with ground black pepper. Makes 4 side-dish servings.
Subscribe to:
Posts (Atom)
