Category: Guest Post

Guest Post, Heart Health, Nutrition

Spotlight on the Mediterranean Diet

Posted on by mghdiabeteseducation

By Emma Louise Toolson
Dietetic Intern

Med Diet Pyramid 2

Earlier this year, the New England Journal of Medicine (NEJM) published a study linking the Mediterranean diet with a reduced risk of cardiovascular disease.  Quite simply, the Mediterranean diet is a way of eating that is based on the traditional foods and cooking styles of countries along the Mediterranean Sea. The general eating pattern while following a Mediterranean diet includes:

  • Several servings of fruits and vegetables daily
  • Focus on healthy fats like olive oil and canola oil
  • Consuming fish and poultry at least two times per week
  • Limiting dairy products, red meat, processed meats and sweets
  • Use of herbs and spices to flavor foods in place of salt
  • Red wine, in moderation (if appropriate)

While the Mediterranean diet is abundant in fruits, vegetables, whole grains and healthy fats, a typical Western diet, in contrast, contains more processed foods, refined carbohydrates and saturated fat. Another key feature of the Mediterranean diet is the inclusion of regular physical activity — the Western diet, meanwhile, tends to be more sedentary.

The NEJM study followed 7447 participants over 6 years. Two groups of participants were randomly assigned to a Mediterranean diet pattern, while a third followed a low-fat diet which acted as a control. The two groups following the Mediterranean eating plan were given either olive oil or mixed nuts to provide the monounsaturated (healthy) fats. Restricting calories was not advised for either group.  The study observed a Mediterranean diet, in which extra-virgin olive oil or nuts were the main source of fat, resulted in a significant reduction in the risk of major cardiovascular events in high-risk individuals. This led researchers to conclude that following a Mediterranean diet may prevent cardiovascular disease, particularly in those that are already at risk.

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Guest Post, Health

Healthy Vision Month: Cataracts

Posted on by mghdiabeteseducation

By Aparna Mani, MD, PhD
MGH Medical Walk-In Unit

Aparna Mani, MD, PhD

Much like with a camera, the lens of the human eye helps to bring the image  you’re looking at into focus.  The lens measures in length about half the diameter of a dime and is made of a gel-like protein called collagen. Through the work of thin muscle fibers, the lens changes its shape to bring objects into focus.  With age, pigment can collect and cloud the crystal clear lens resulting in vision loss. This clouding of the lens, called a cataract, is the leading cause of blindness worldwide.  Since the normal aging process is one of the main causes for cataracts, we are all at risk for developing cataracts.  However, people with diabetes, those who use corticosteroids for an extended period of time (for instance as treatment for asthma or arthritis), who smoke, or have a family history of cataracts are at increased risk.

Though painless, the presence of a cataract may cause symptoms such as increased glare from lights, difficulty with night driving, difficulty reading, and reduced ability to appreciate colors. The severity of these symptoms can increase over time and begin to impact one’s lifestyle. Though your health care provider may be able to pick up the presence of a cataract during a routine visit using an ophthalmoscope, you will need a comprehensive exam and detailed vision testing by an ophthalmologist to fully assess a cataract. Recommendations on management and treatment is based on this assessment.

Currently, the only treatment for cataracts is surgery, normally done in an outpatient setting.  Depending on the degree of the cataract and its impact on vision, the ophthalmologist may recommend observation and follow up vision testing for a period of time, or proceeding with surgery to treat the cataract.  With surgery, the clouded lens is removed and replaced with an artificial one made of plastic or silicone to restore vision. Results are usually apparent right away within hours to a few days of post-operative healing.

Though there is no proven therapy to reduce or slow the progression of cataracts, some studies have suggested that eating a healthy diet rich in fruits, vegetables and vitamins such as lutein is associated with a lower risk of developing a cataract. In addition, since smoking is a risk factor for cataract development, quitting tobacco use may help prevent cataract formation.

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Guest Post, Health

Healthy Vision Month: Glaucoma

Posted on by mghdiabeteseducation

By Aparna Mani, MD, PhD
MGH Medical Walk-In Unit

Aparna Mani, MD, PhD

Eyesight develops from the initial rudimentary flickers of a newborn to the full kaleidoscope of adult vision over the first three to five years of life. Our sense of vision has such a powerful impact on how we define ourselves, our loved ones, and the world in which we live.  Yet it’s one sense that can slowly slip away as we age.  Glaucoma and cataracts are two of the most common causes of vision loss and blindness in the aging adult population. But here’s some good news:  both conditions are treatable when caught and acted on early.  I will look at both in depth, starting today with glaucoma and continuing next week with a discussion on cataracts.

Glaucoma is a disease of increased pressure in the eye leading to damage of the optic nerve – the nerve that carries all the visual information our eyes pick up to the brain where it is interpreted. Think of the eye as a fluid filled, globe-like structure with the optic nerve exiting the back like the electrical cord on a toaster or TV. If the flow of fluid in the eye is not kept in balance, increased fluid pressure can develop inside the globe leading to compression and irreversible damage to the optic nerve.  There are two main types of glaucoma:  open angle, which accounts for approximately 90% of the glaucoma in the United States, and closed or narrow angle glaucoma.

Open angle glaucoma affects about 1 in 200 people over the age of 50.  A slow, chronic process, this type of glaucoma develops over a number of years. In fact, open angle glaucoma is often called the ‘silent thief of sight’ because of its painless presentation. However, once vision loss sets in, it is progressive and irreversible. People at increased risk for glaucoma include those with a family history of the disease; African Americans and Latinos; and people with heart disease or diabetes.   The risk of developing glaucoma also increases with age for everyone, regardless of whether they have any of the above risk factors.

So if glaucoma is “silent” how can you detect changes in time for treatment to be effective? Your health care provider can detect early changes with an eye exam before noticeable vision changes develop. In addition to examining the optic nerve, they will do a formal visual field test, measure intraocular pressure (fluid pressure in the eyes), and observe for any changes in eye size and shape. Although there is no cure for glaucoma at this time, early detection and initiation of treatment can help halt or slow down the progression of the disease. Treatment may entail prescription topical eye drops, laser therapy, or surgery. If you are prescribed eye drops for glaucoma, it’s crucial you take them as directed —not keeping up with treatment is a major reason for progression to vision loss. The American Diabetes Association also recommends seeing an eye care professional (either an ophthalmologist or optometrist) for a comprehensive eye exam at least once a year.  Don’t hesitate to ask if your provider is familiar with identifying and treating glaucoma and other diabetes eye conditions.

In contrast to the quiet and slow progression of open angle glaucoma, closed angle glaucoma is a medical emergency. Closed angle glaucoma presents with sudden vision loss and pain that often prompts one to seek medical care right away. In addition, a person may experience any of these symptoms:  seeing halos around lights, nausea and vomiting, developing a red eye and/or a fixed and dilated pupil. Again, this form of glaucoma is considered a medical emergency – if you experience any of these symptoms seek medical attention immediately.

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Fitness, Guest Post

Changing Seasons, Changing Habits

Posted on by mghdiabeteseducation

By Monica

Changing the way we do things, especially if it’s something we’ve done for a long time, is the hardest task anyone can ask.  We create a comfort zone of tranquility, serenity and calmness that our mind comes to prefer.  But it is not always the best.

As we get older, our appetite changes.  Our metabolism is different too, and we burn fewer calories.  We need to change the way we eat and learn to substitute in healthier foods.  And in order to continue to maintain a good healthy lifestyle, our daily routine needs to shift in a more active and productive way.  It’s not always easy, but it can be done with support from friends and family.

Regular activity is not just for little kids or young people – we all need to be active, and it’s never too late to start.  We had such a long winter; now that spring is finally here we have a chance to go outside and enjoy the warmer weather.  It’s also a perfect opportunity to change some of your habits.  Rather than just sitting in the sun, go for a little walk.  If you can, bring along a friend or co-worker.  You’ll be doing something good for yourself and getting a chance to be social at the same time.

Is there an activity you’ve always wanted to try?  Go for it!  Just about everyone has something they’ve said they’d like to try “someday.”  Well, why not now?  If you go to a gym, ask if they will let you try out a class to see if you like it.  There are also some programs in Boston that plan community fitness events or offer free classes like yoga and Zumba in spring and summer.  The Boston Natural Areas Network is another great group that organizes community activities like bike rides, canoeing and gardening – great opportunities for families to do something healthy and active together.

Let the change in seasons inspire you to get out there and get moving.

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Guest Post, Health

Notes about Pneumonia

Posted on by mghdiabeteseducation

By Aparna Mani, MD, PhD
MGH Medical Walk-In Unit

Aparna Mani, MD, PhD

Pneumonia is a disease that has been described since the time of Hippocrates.  Though the ancient Greeks accurately identified the symptoms that constitute pneumonia, it wasn’t until the mid-1800’s that a scientist named Edwin Klebs observed bacteria in the lungs of people who had died of pneumonia, pointing to infection as a major cause of this illness.  Simply put, pneumonia is an inflammation of the lungs most commonly caused by infection.  It affects more than five million people in the United States and an estimated 450 million people worldwide each year, thus the World Health Organization has designated November 12th as World Pneumonia Day.

The lungs are composed of airways that bring in oxygen and alveoli (microscopic air sacs) that help deliver it to the bloodstream. The lungs have several defenses to protect against invading bacteria, viruses and other types of microorganisms.  These include mucus producing goblet cells and tiny hair-like projections called cilia—not to mention the body’s own immune system.  Sometimes these defenses may be overwhelmed or breached, allowing a particular microorganism to take hold and fester in the alveoli. The result is a local pool of infection that fills and plugs up the alveolus, much like pus in a skin wound. The sheer volume of infection makes it hard for immune cells to get in and do their job of breaking it down and clearing it out.  A person suffering from pneumonia may experience fever, shaking chills, fatigue, productive cough, chest pain and shortness of breath.  Contact your healthcare provider if you are experiencing any of these symptoms.

To diagnose pneumonia, healthcare providers rely on history of symptoms and a lung exam which includes listening to breathing sounds through a stethoscope and percussing the lungs (a special technique of tapping the chest) with their hands.  A chest x-ray may also be done, though it is not always necessary. The main treatment for bacterial pneumonia is antibiotics.  Providers often base their treatment on the most commonly known microorganism given age, risk factors and living environment, though mucus or sputum samples may also be obtained to identify the specific bacteria causing the pneumonia. This allows providers to better pinpoint the appropriate drug to use in treatment. Depending on the severity of symptoms and other risk factors such as age and overall health, healthcare providers may choose to treat an individual as an outpatient or admit them to the hospital.  With treatment a patient may stabilize and begin to improve within a few days, but it may take a few weeks before symptoms resolve completely.

Risk factors such as smoking, excessive alcohol use, immunodeficiency, and chronic illnesses such as COPD, kidney disease and diabetes can increase an individual’s susceptibility for developing pneumonia. Seniors (people 65 and older) and young children are also at increased risk.  The pneumococcal vaccine developed against bacteria commonly known to cause pneumonia is recommended for seniors and anyone with the above risk factors. Talk to your healthcare provider about whether vaccination is indicated for you. In addition to vaccination, pneumonia can be prevented with everyday good hygiene practices such as hand washing, coughing or sneezing into an elbow or sleeve, and taking care of one’s overall health– including keeping blood sugar in good control.

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Guest Post, Health

The Flu: An Overview

Posted on by mghdiabeteseducation

By Aparna Mani, MD, PhD
MGH Medical Walk-In Unit

Aparna Mani, MD, PhD

It seems like every year come winter we’re inundated with health care providers’ recommendations and public service campaigns to get the flu vaccine. But what exactly is the flu and why is it such a big deal? ‘Flu’ is short for influenza, an infectious disease caused by a small group of viruses – namely influenza virus A, influenza virus B and influenza virus C. These viruses target and infect the respiratory tract (nose, throat and lungs) causing the illness we call the flu. People with the flu experience a combination of high fever, chills, sore throat, significant fatigue, muscle aches, headache, and cough. True, many of these same symptoms are associated with the common cold, but colds are caused by a different set of viruses and these symptoms are much less severe (and much shorter in duration) than with the flu.

One reason there is so much public attention given to the flu is its potential to cause large-scale outbreaks. In fact in 1918 a particularly lethal flu pandemic spread through many parts of the world, resulting in an estimated 500 million deaths. Though we have not seen as high a fatality rate from the flu in recent memory, and even though most healthy individuals will completely recover from the flu in about one to two weeks, it’s still a highly contagious illness that has the potential to turn particularly severe (and potentially deadly) in certain populations. The CDC estimates that approximately 3,000 to 49, 000 people have died from the flu each year over the past 30 years. This is the driving force behind the recommendation for the flu vaccine.

The Flu Vaccine

Each year the World Health Organization researches and identifies the strains of influenza viruses they predict will cause the bulk of the flu illness for the upcoming season.  Based on these predictions vaccine manufacturers develop the seasonal flu vaccine, which is made available to the public starting in the fall.  Why does a brand new vaccine need to be developed each year? The influenza viruses, influenza A in particular, have a high rate of mutation. This means that they’re able to change a component of themselves, one of their viral “body parts” as it were, to such a degree that the immune system is unable to remember prior versions of the virus. Put another way, someone who had the flu last year may build up immune defenses against the strain of virus that caused their illness, but those defenses may not recognize a new or different version of the virus this year. Thus, the flu vaccine given this season is no longer protective for the next.  This is also why some individuals may still get the flu despite having gotten a flu shot:  they may have gotten infected with a strain of the virus that was not included in the vaccine.  There are two forms of influenza vaccine available: an injectable version commonly known as the “flu shot” and a nasal vaccine which is sprayed into the nose.  You cannot get the flu illness from either of these vaccines themselves. The virus used to make the injectable vaccine is inactivated or killed while the virus used to make the nasal version is attenuated or weakened.

Potential Complications, Treatment and Prevention

So how does a virus that causes sore throat, muscle ache, fever, chills, headache and cough become deadly? Well, some individuals can develop an infection of the lung or pneumonia caused by the influenza virus itself, or by bacteria that began growing in the lungs while the immune system was busy dealing with the flu virus.  Babies under the age of 2, pregnant women, and people over 65 are most susceptible to this complication.  People who are immunocompromised (have a weakened or no immune system) from another illness, who smoke, or have a chronic illness such as asthma, diabetes, lung or heart disease are also at risk for severe complications.

What happens when someone gets the flu?  Depending on the severity of symptoms and any complicating medical conditions, healthcare providers may prescribe an oral antiviral medication. Though these medications do not cure the flu, they may decrease the severity and duration of symptoms as well as the chance of developing complications.  The CDC recommends such treatment for specific populations, including hospitalized patients and people at high risk for complications including children under 2; adults over 65; pregnant or postpartum women; residents of nursing homes; immunosuppressed individuals; and those with chronic illnesses.  For anyone not included in the above populations, flu symptoms can be effectively treated with some over the counter medications. Acetaminophen or ibuprofen can help to reduce fever, headache and muscle aches.  Aspirin or other salicylates should be avoided, especially in children under 18, as it has been associated with Reye syndrome. In addition, people with the flu should drink plenty of fluids and get a good amount of rest. Flu symptoms may last for one week or more.

As with anything, prevention is the best course of action.  Flu viruses are highly contagious through contact with contaminated surfaces and through the air, so habits such as hand washing with soap and water, covering one’s mouth when coughing or sneezing, and avoiding touching the eyes, nose and mouth limit its spread and transmission.  Good hygiene and annual vaccination are the best defenses against the flu.

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Guest Post, Health, Heart Health

A Cholesterol Q & A

Posted on by mghdiabeteseducation

By Aparna Mani, MD, PhD
MGH Medical Walk-In Unit

Aparna Mani, MD, PhD

We hear about cholesterol almost as often as we hear about the weather on the news these days – but what is it really and why is it such a hot topic?  Cholesterol is actually a type of fat particle that travels around in the bloodstream. It’s true that we get cholesterol from food, but our body also makes its own cholesterol in the liver. In fact, the liver can produce all the cholesterol our body needs even if we do not take in any cholesterol from our diet.  Foods that are high in cholesterol include mostly animal sources like meats, eggs, fish, poultry, and dairy products like whole milk and butter. Plant-based foods like fruits, vegetables, tofu and grains contain little to no cholesterol.

So what do we need cholesterol for?  Well, cholesterol is used for a couple of different things.  It’s a component of the outer layer of all of the cells in our body, it helps to make vitamin D and hormones like estrogen and testosterone, and it helps in the digestion of fats in the intestine. 

What’s the story about the good versus bad cholesterol?  To understand this a bit better, we need to take a closer look at how cholesterol gets around the body.  Because cholesterol does not mix easily with blood, it’s carried around in the bloodstream by a particle that acts as a kind of vehicle called a lipoprotein. There are several types of lipoproteins, but the ones you have probably heard of are HDL and LDL.  The LDL particles carry cholesterol around and deliver it wherever it’s needed in our body.  However, if we have too much LDL, the excess cholesterol can be deposited on the walls of our blood vessels.

Why is this a bad thing?  The deposits of cholesterol in the coronary arteries, the blood vessels that supply our heart, can form plaque. It’s exactly this plaque that can eventually rupture and cause a blockage in a coronary artery, leading to a heart attack. This is why LDL is often referred to as ’bad’ cholesterol.  But let’s look at another particle:  HDL cholesterol. What makes HDL different is that instead of depositing cholesterol in various parts of our body (including blood vessels), it picks up any extra cholesterol that is lying around and brings it back to the liver. The liver can take this extra cholesterol and either make it into something useful or recycle it.  This is why HDL is referred to as ‘good’ cholesterol.

The balance between LDL and HDL in our body is important.  We want to keep the levels of LDL low and the levels of HDL high so  our body can function well without creating too much cholesterol or plaque build-up in our blood vessels. Some of us might have a genetic predisposition that determines our LDL and HDL levels, but we also have a role in striking this balance through diet and lifestyle.  By eating a diet rich in fruits, vegetables and grains we can keep our LDL low.  Healthy activities such as exercise and refraining from smoking also help to strike the right balance between HDL and LDL cholesterol. Some of us may need medications to modify our cholesterol levels in addition to following healthy habits.  According to the American Heart Association, adults should get their cholesterol levels checked periodically so  their health care provider can make recommendations for keeping their cholesterol levels in good balance.

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Guest Post, Health, Heart Health

About Stroke

Posted on by mghdiabeteseducation

By Aparna Mani, MD, PhD
MGH Medical Walk-In Unit

Aparna Mani, MD, PhD

It’s thought that the medical term stroke comes from ancient Greek for ‘struck down’. This meaning makes sense when you think of what happens when someone suffers the symptoms of a stroke. They may experience sudden weakness, numbness or paralysis of the face, arms or legs, a sudden loss of vision, difficulty speaking or an inability to understand speech.  Our brains are responsible for all of these specialized, unique functions. Blood vessels carry oxygen-rich blood and glucose to the brain cells, powering them to do this work. With a stroke, there is a sudden block in the flow of blood through the arteries that supply blood to the brain. 

This sudden ‘block’ in flow most commonly happens due to a clot getting stuck in an artery, or bleeding of the artery itself. When this happens, the blood flow is interrupted, and the cells in the affected area of the brain don’t get the oxygen and glucose that they need to function. If the blockage clears and blood flow resumes within a very short period of time, the patient may have had a transient ischemic attack (TIA) or ‘mini-stroke. If, however, blood flow does not resume for a longer period of time, the brain cells will start to die. A person suffering a stroke will show symptoms based on the specific portion of the brain that has bad blood flow.  Emergency care is required for both strokes and TIAs.  Doctors may use a CT scan or MRI to get an image of the brain to assess someone who has symptoms of a stroke. Depending on the time that has elapsed since symptoms began, doctors may be able to intervene and restore good blood flow to the brain. 

Risk factors for stroke include high blood pressure, smoking, high cholesterol, family history of stroke, age, obesity and diabetes.  Stroke prevention begins with a discussion of your personal risk factors with your doctor. By recognizing these personal risk factors you and your doctor can come up with strategies for lifestyle changes and medications to reduce your risk for stroke. 

Strokes can have serious consequences and can lead to permanent brain damage, long-term disability and death. In fact, Strokes are one of the leading causes of death in the United States today.  Know the signs:  watch out for sudden weakness, numbness, paralysis, and difficulty with speech or vision.   If you or someone you know has any symptoms of a stroke, Call 9-1-1 immediately.  With fast treatment, it may be possible to avoid the long-term consequences of a stroke.  Remember, time is of the essence and every minute counts.

Aparna recently finished an internal medicine residency at Mass General and sees patients at the hospital’s Medical Walk-In Unit.
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Guest Post

A Home Gardening Experiment: Harvest

Posted on by mghdiabeteseducation

By Chrisanne Sikora
Social Media Coordinator

Let me get this out of the way first:  I have tomatoes!!!

Tomato plants (give or take an oak tree)Okay, now I’ll back up a bit.  Last time I checked in, I’d just transplanted my seedlings from the kitchen greenhouse to the backyard.  That was back in early June, and almost immediately afterward we had a little cold spell.  My tomato seedlings went into shock and of the ten that were planted only about three looked like they were going to make it.  Though that was a little disappointing, there wasn’t much I could do about it – can’t control the weather after all.  What I did do was spread some mulch over the garden bed to protect the roots, and watered.  Every day.  If I’ve learned one thing it’s that tomatoes are thirsty little things.

Delicate yellow flowers

As it turns out, most of the seedlings recovered from the cold snap and I soon had about a half dozen thriving tomato plants (and one oak tree trying to pass itself off as one.  If you look closely at the picture above, you can see it hiding in the middle of the pack).  Right before I went on vacation in July, I noticed a few little yellow flowers popping up on some of the vines – a good sign that tomatoes were not far behind.

Young green tomatoesSure enough when I got back home there were still a few yellow flowers here and there, and a number of little green tomatoes.  The vines had also grown another several inches while I was away and they’re now peeking up over the bottom of the deck.  Amazing how they went from scrawny not-sure-they’re-going-to-make-it seedlings to a mini jungle in about a month and a half.

So after a few false starts, I’d say my home gardening experiment was ultimately a success.  A few tomatoes have already started turning orange, and there’s enough young fruit that I expect to have home grown tomatoes in my salad for the rest of summer and into the fall.  Hmm, what should I try growing next year?

Tomato harvestGot any good tips for a newbie gardener, or a suggestion for my next gardening  adventure?  Leave me a comment below.

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