For four decades we've been led to believe that fat is the ultimate food enemy, but we've been fed a lie: sugar is the real danger !

So what do you know about eating and getting fat? If you’re the average British person then it’s probably something along these lines: eating too much fat will make me obese, clog up my arteries and lead to a heart attack, so I should follow a low-fat diet and eat lots of fruit and vegetables.

Wrong. While you were busy fretting over your saturated fats and dietary cholesterols, there was a far more potent food nasty lurking in your kitchen: sugar. The amount of sugar we eat is now being blamed not just for the obesity epidemic but for heart disease, type 2 diabetes and soaring cancer rates. It’s not just the excess calories we’re consuming; the problem lies in the way we metabolise sugar.

‘We have been sold an absolute lie about food and health,’ says Zoë Harcombe, nutritionist and author of The Obesity Epidemic. ‘It has been put about since the 1970s that fat was the bad guy, yet the only fats we know to be harmful are trans fats, and these are almost exclusively man-made. If the fat occurs naturally then it’s fine – no exceptions. Sugar, on the other hand, when added to food, is almost uniformly bad.’

So why was this information hidden from us? ‘Because,’ says Harcombe, ‘the commercial food producers, who rely on sugar, represent a huge and powerful lobby. It’s not just the obvious brands, such as fizzy drinks manufacturers, that would suffer if sugar were removed from our diets. Sugar is added to just about everything you buy ready-made: bread, sauces, ready meals, drinks, tinned foods… The list is endless.’ Even baked beans can contain two and a half teaspoons of sugar in just half a tin. Furthermore, say campaigners, the low-fat industry (now worth billions) is absolutely reliant on sugar because the only way to stop low-fat food tasting like cardboard is to replace fat with sugar.

We can only guess what John Yudkin, who died in 1995, would have made of the wide acceptance of his ideas. His book Pure, White and Deadly is back in print – this time with an introduction by Robert Lustig. ‘I think he would have been pleased,’ says his biochemist son, Professor Michael Yudkin. ‘Not to say, “I told you so”, but because my father’s great passion was public health and he saw the world being harmed by something he thought was preventable.’

Full story here.

Eddie

Government's own health campaign endorses junk food !

A healthy eating campaign funded by the taxpayer has come under fire for giving free advertising to junk food firms.

Shoppers are being offered money off fizzy drinks, tinned vegetables and ready meals with vouchers sent to more than 100,000 people who want to improve their diet.

Now the government has been accused of ‘endorsing’ companies like Pepsi and Uncle Ben’s while 'doing nothing' to tackle the nation’s obesity crisis.

The Smart Swaps campaign was launched by Change4Life, run by Public Health England, last month.

It encourages people to switch from unhealthy food and drink to low fat, low sugar alternatives.

People who sign up are sent money off vouchers, fridge magnets and a ‘Smart Swapper’ wheel containing advice on how to eat more healthily.

The packs also include 30p off a tub of Flora light, £1 off Cheeky Cow cheese and 30p off Green Giant tinned sweetcorn.

There is also a 30p discount on a £1.99 Uncle Ben’s RiceTime, an instant pot snack from the company owned by Mars.

The companies paid nothing to be included in the promotions and just had to offer some form of discount to encourage people to reduce the amount of fat, sugar and calories in their diets.  

The government-backed support for some of the world’s biggest food firms has been condemned by MPs and food experts.

Tam Fry, spokesman for the National Obesity Forum, said: ‘I regard it as being straightforward advertising which has been foisted on the Department of Health by an industry which wishes to put itself in a good light and has convinced DoH it is a brilliant idea.

More on the 'ya couldn't make it up story' here.

Eddie

Health chief slams statins: Millions face terrible side effects as prescription escalates

LEADING doctors are demanding an end to the widespread prescription of statins, warning that one in four Britons will soon be at risk of terrible side effects from the controversial heart drugs.

Those sounding the alarm include Dr Kailash Chand, deputy chairman of the British Medical Association, who suffered “awful” muscle pains while taking statins and claims that plans to prescribe them to millions more adults will “only benefit drug companies”.

The drugs are currently offered to patients with a 20 per cent risk of developing heart disease to help keep their cholesterol levels in check.

Around seven million adults take the drugs. Under guidance to be published later this month by Government drug watchdog the National Institute for Care and Health Excellence (NICE), the threshold will be cut to a 10 per cent risk.

This will see millions more adults routinely prescribed the drugs. Aseem Malhotra, a cardiology specialist registrar, and Dr Malcolm Kendrick, a GP and cholesterol expert, will write to Nice next week, urging it to reconsider the move.

They will ask the watchdog not to rely on evidence from drug company sponsored trials, which have been shown to play down the risk of side effects including diabetes, impotence, cataracts, muscle pains, mental impairment, fatigue and liver dysfunction.

Dr Chand last night warned that giving the drugs to low-risk patients was “a commercialisation device” and not in their interests. Many experts say it is unnecessary to “medicalise” a problem which could be controlled with simple dietary changes, pointing to a study showing that eating an apple a day cuts cholesterol levels as effectively as taking statins.

Dr Kendrick, who has written a book called The Great Cholesterol Con, said: “I can stop people dying from heart disease by pushing them off the edge of a cliff. They might not like the end result.

“Statins might alter what is written on your death certificate but they are extremely unlikely to change the date.”

Dr Malhotra said while patients with established heart disease can benefit from statins, the “mass medicalisation” of a healthier group is likely to do more harm than good.

He added: “Widespread prescription of these drugs to low-risk groups will contribute to immeasurable extra health care costs.”

Dr Malhotra pointed to the “huge discrepancy” between reports of side effects from drug company-sponsored trials and from independent research.

Company-funded studies show side effects in less than one per cent of patients. Independent studies show them in at least 20 per cent.

Inquiries have suggested adverse effects can be minimised in drug company trials by excluding patients if they fail to tolerate statins during “run-in” periods or if they have certain pre-existing health problems.

Opponents of statins also claim some side effects such as muscle pain or confusion are not included in drug company reports. Claims of widespread side effects are borne out by the fact that up to half of patients voluntarily stop taking statins within a year of prescription.

In some parts of the country, hospital clinics have been set up to ensure patients continue to take the drugs despite the problems. Dr Malhotra said: “It is time to practise medicine according to what is best for patients, not to feed drug company profits.”

Dr Chand, speaking to the Sunday Express in a personal capacity rather than in his official BMA role, told how he suffered debilitating side effects after he was prescribed statins five years ago.

The 60-year-old GP from Tameside, Greater Manchester, said: “After a few weeks I started getting awful muscle aches which were almost everywhere and which would wake me up at night.

“Initially I didn’t know what was wrong and put the symptoms down to stress. The drug companies were saying this drug was the best thing since sliced bread and should be given to everyone. I didn’t blame them.”

However, Dr Chand, a father-of-one, carried out his own research and discovered concerns about side effects including muscle pain. After a year he took himself off the drugs.

“The only way to find out was to stop taking the pills, irrespective of any medical advice,” he said. “Things started to improve within two to three weeks. Now I have no symptoms at all.

“I am hugely concerned about the new advice on statins. The only people who will benefit are drug companies.

“I do not undermine the role of statins in those people who have heart disease but for healthy people this is nothing but a commercialisation device.”

Fiona Godlee, editor in chief of the British Medical Journal, said: “The decision to increase use of statins is based on trial data only a few chosen people have seen. We need to demand greater transparency about the research on these drugs. Why aren’t we looking at changes in lifestyle that reduce heart disease risk instead of medicalising vast numbers of people?”

A spokesman for Nice said: “Drug therapy plays a key role in the management of people with high cholesterol levels and this is properly reflected in the draft guideline which provides clear advice on the most cost-effective drugs, based on the best available research evidence.

“However, and just as importantly, the guideline also recommends that standard models of care should include advice and support in lifestyle changes for both primary and secondary prevention of heart 

disease.”

He said Nice had no concerns that industry-sponsored research “need necessarily be of lower quality or relevance than independent research”.

The Association of the British Pharmaceutical Industry said it could not comment.

http://www.express.co.uk/

Graham

DCUK: And verily Troll shall speak unto Troll

Lets not speak ill of Kman, laying there on his(sorry) her  hospital bed. Try to imagine the difficulty of a newly diagnosed diabetic reading the crap (discussion) between Karen  and Ken (who'd have thought it!) and lets say Ash Diamond and Douglas Isle of Man (Low Carb and Low Fat: who after several years of 800 -1200 calories per day is still a fat ex-copper.

John  

The Wonder Diet Mysteries Are Revealed !

"A more likely scenario is that, under the conditions stated, that those who claim a sustained low carb, low fat, lifestyle are charlatans or naive fools."

Nice one John, something I wrote a few years ago, when low carb, adequate protein and low fat was being promoted on the flog. As you and I, and straight thinking people know, it is unsustainable when weight loss has been achieved and is not viable as a long term strategy for the control of diabetes.

I have often wondered, how a diabetic can low carb, and reduce fat, down to what many people would regard as a low fat diet, and stay fit and active. With only three main food groups, proteins, fats and carbs, how do you reduce carbs to a low carb level, for me, that’s between 30 and 50 carbs per day i.e. around a tenth of what is considered normal, for a non diabetic, and reduce fats down to, let’s say half of the daily recommended 90 grams. Other than supplementing with a huge amounts of protein. The answer appears to be starvation and minimal physical activity!

Reading various posts on the forum of fun, calorie levels reported in some cases are very low. Some people are claiming low calorie, low fat, and low carb diet. According to Dietitian, Julie Kellow BSc RD, the daily recommended calorie intake for 4-6 year old boy is 1715 and for a 7-10 year old boy 1970. So, how does an adult get by, and live an active life, on a low calorie, low carb, low fat diet.

Let’s take a look at energy expenditure.

About 70% of a human's total energy expenditure is due to the basal life processes within the organs of the body. About 20% of one's energy expenditure comes from physical activity and another 10% from thermo genesis or digestion of food. So, with 70% of energy being used just to stay alive and only 20% of ones energy available for physical activity, one has to ask the question. What levels of physical activities do low carb, low fat and low calorie diabetics participate in ?

Judging by the times, frequency and duration of some individuals on the forum of fun, and the minimal calorie intake, I deduce the total physical activity appears to be, the moving of a plastic mouse.
 

Source of information wiki here.

Eddie

Carnivorous Body Builders, Alcoholics or Skeletal Rakes? Low Fat Low Carb Diabetics

Nutritional Problem

To determine if a low carb, low fat lifestyle is sustainable and consider the characteristics of diabetics claiming such a lifestyle.

As a means of structuring the post a diabetic male aged 51 or older and leading a sedentary lifestyle is considered.  The diabetic is not attempting to lose weight. According to:

http://www.webmd.com/diet/features/estimated-calorie-requirement

such a diabetic requires a nutritional intake sufficient to provide 2000 calories per day. A younger male or one having a more physically active lifestyle will require more calories per day.

Nutritional Data

1 gm of carbohydrate ≡ 4 calories,

1 gm of fat ≡ 9 calories

1 gm of protein ≡ 4 calorie

1 25 ml unit of Scotch whisky ≡ 70 calories

Nutritional Equation

calories per day =

4 x carbohydrate (gm per day) +

9 x fat (gm per day) +

4 x protein (gm per day) +

70 x whisky (unit per day)                                                                                                                       (1)

Low Carb

Low carb is defined to be 50 gm per day. It should be readily apparent how to complete the analysis with other definitions of low carb but 50 gm per day seems to be the amount used by a number of diabetics.

Low Fat

Low fat regimes of 0, 25 and 50 gm per day are analysed.

Protein (gm per day) required for sedentary diabetic

Using a simple manipulation of Equation (1), the definitions of low carb and low fat and the nutritional data, the following table shows the amount of protein (gm per day) required for the sedentary diabetic following a low carb, low fat regime and having a maximum of 3 units of whisky per day .

Low Fat	Units of Whisky
gm per day	0	1	2	3
0	450.00	432.50	415.00	397.50
25	393.75	376.25	358.75	341.25
50	337.50	320.00	302.50	285.00

There are many sources of protein. However, it seems reasonable to label a diabetic requiring such large (and dangerous) amounts of protein as “Carnivorous Body Builder”.

Whisky (units per day required for sedentary diabetic

Using a simple manipulation of Equation (1), the definitions of low carb and low fat, the nutritional data and RDA for protein of 55 gm per day, the following table shows the amount of whisky (units per day) required for the sedentary diabetic following a low carb, low fat regime.

Low Fat gm per day	Units of Whisky
0	22.57
25	19.36
50	16.14

It seems reasonable to label a diabetic requiring such large (and dangerous) amounts of whisky as “Alcoholic”.

Number of calories per day for sedentary diabetic

Using Equation (1), the definitions of low carb and low fat, the nutritional data, the RDA for protein of 55 gm per day and a maximum of 3 units of whisky per day, the following table shows the number of calories per day for the sedentary diabetic.

Low Fat	Units of Whisky
gm per day	0	1	2	3
0	420	490	560	630
25	645	715	785	855
50	870	940	1010	1080

It seems reasonable to label a diabetic having such small (and in some cases, dangerous) intake of calories as “Skeletal Rake”.

Conclusions

This post has examined the nutritional requirements for a male sedentary diabetic aged 51 or older to achieve a sustained 2000 calories per day under a low carb low fat regime. The analysis showed that there were only three outcomes.

1. With a maximum of 3 units of whisky per day, carnivorous body building amounts of protein would be required; or

2. With a RDA of protein, an alcoholic inducing number of units of whisky would be required; or

3. With a maximum of 3 units of whisky per day and a RDA of protein, the calorific input would result in a skeletal rake.

A more likely scenario is that, under the conditions stated, that those who claim a sustained low carb, low fat, lifestyle are charlatans or naive fools.

John

Hallelujah Kman lives !

Wondrous news my friends, Kman lives ! Thought by many to have disappeared up the local crematorium chimney, Kman returns from the dead. Despite every grim medical condition known to man, and on Morphine levels that would croak an elephant, the great man returns. Rejoice with me my Brothers and Sisters, if we only have half of Kman’s luck we will all live to a hundred years of age.

Graham do me a favour, get me a 12” deep pan pizza, 2lb of french fries and a pint of full fat coke. I've got it all wrong, why have I ballsed around with a low carb lifestyle for nearly six years. Jeez what am I missing?

Eddie

Why low GI diets don't work for most diabetics ! Part 2

If you watched the video in the thread 'Why low GI diets don't work for most diabetics' it is clear the whole idea is a minefield. When you look at low GI there are a huge amount of variables, you have to start looking into glycemic loading, more variables, the variables go on and on. Also as stated, 100 grams of carb is a hundred grams of carb full stop. There may be some variance in the curves of timing and blood glucose spikes, but there will be spikes for most. In the early days of my diabetes I tried for a long time to fool the betus, it can't be done. Once you accept that fact you can move on and consider beta cell destruction (in type two diabetes) how much beta cell function do you have left ?

There are tests that can determine this,( a plasma insulin level test among others) but are rarely done on the NHS on the grounds of costs. Besides most medics believe type two diabetes is always a downward spiral to palookaville and the knackers yard, so why bother saving what beta cells a type two has left. If we accept as often reported upto and beyond 50% of beta cells are destroyed at diagnosis and it is a fact after the age of around 30 they do not replace themselves, It seems logical to me to do everything you can to protect the beta cells you have left. Are you going to do that meddling around with a low GI/GL diet ? I don't think so. It makes sense to me to give the beta cells the least amount of work as possible, let's face it, overworking them brought about the destruction in the first place, why flog the remaining beta cells to death producing high amounts of insulin brought about by unnecessary carbs in the diet.

Let's consider a young type two diabetic, say thirty or forty years of age, holding good BG numbers and non diabetic HbA1c. Let's say he can hold those numbers on a moderate protein and hundred carbs per day diet. It seems logical to me he can protect his beta cells and help them live longer by reducing the load he places on them. It maybe half the carbs means they will live twice as long, and that could be very important in the future. At 64 years of age I have used around 50 carbs per day for almost 5.5 years, and have held non diabetic HbA1c numbers (highest 6.1 in old money) the whole time of my known type two diabetes, other than at diagnosis, (HbA1c almost 12) reduced with a 30 carb per day diet to non diabetic within three months. The 50 carbs per day was a decision based on my comfort levels taking into consideration my age. If I had been in my 20's 30's 40's as so many people are joining the betus club these days, I would have stayed on a keto diet (30 carbs or less for most) or semi keto for life. Anything to stay independent for as long as possible and free of medication.

By the way, the oaf known as douglas99 made a comment on the forum of flog the other day re my use of Metformin and not practising what I preach, when I was diagnosed I soon realised Metformin made very little difference to my BG numbers, but being on Metformin gave me free prescriptions and an adequate supply of test strips and other benefits. It was also reported at the time Met offered benefits regarding CVD. As I have learnt, to get what you want as an NHS patient, is not always as straightforward as it should be, games sometimes have to be played. Those who fight for good treatment and test strips usually get them, of course, games should not have to be played.

Some fascinating information on Beta cells and how above ground nuclear bomb testing played a part in diabetes knowledge. 

"Beta cells, which make insulin in the human body, do not replicate after the age of 30, indicating that clinicians may be closer to better treating diabetes. Type 1 diabetes is caused by a loss of beta cells by auto-immunity while type 2 is due to a relative insufficiency of beta cells. Whether beta cells replicate after birth has remained an open issue, and is critically important for designing therapies for diabetes.

By using radioactive carbon-14 produced by above-ground nuclear testing in the 1950s and '60s, researchers have determined that the number of beta cells remains static after age 30.

Lawrence Livermore National Laboratory scientist Bruce Buchholz, with collaborators from the National Institutes of Health, used two methods to examine adult human beta cell turnover and longevity. 

Using LLNL's Center for Accelerator Mass Spectrometry, Buchholz measured the amount of carbon 14 in DNA in beta cells and discovered that after age 30, the body does not create any new beta cells, thus decreasing the capacity to produce insulin as a person ages. Carbon 14 atmospheric concentration levels remained relatively stable until the Cold War, when above-ground nuclear bomb tests caused a sharp increase, or peak, which decreased slowly after the end of above-ground testing in 1963. This spike in carbon 14 in the atmosphere serves as a chronometer of the past 57 years.

Type 2 diabetes (often called adult onset diabetes) is common in older people whose ability to secrete sufficient insulin to regulate blood sugar deteriorates as they age and is often due to increased demand in obese people.

"It could be due to loss of beta cells with age," Buchholz said. "The body doesn't make new ones in adulthood and there might not be enough cells to control blood sugar."

Source of information here.

Eddie

Why has it gone so wrong?

Why has it gone so wrong? Everywhere we go a camera is watching us, our emails read by strangers, our phone calls, someone listening in. Our private information, including medical records, someone reading to be used against us in the future. The sea and land and air polluted, our food tainted, everywhere lies and corruption and greed. War in every corner of the globe. Innocent Children and Women and old Men being killed, in far off places by drone weapons, and Men imprisoned without access to independent lawyers and a fair trial. This is called progress.

I long for the simplicity of my youth, but it is gone, and will never return. I feel for the youth of today. I am glad I am becoming old, I am so grateful to have lived in my time. But my time is almost over. Young people going down with chronic diseases, unheard of when I was young, and big pharma waiting on the sidelines, like carrion vultures. This is called progress.

Everyone knows the price of everything, but the value of nothing. The latest plastic junk, paid for with a plastic card, just a click of a plastic mouse away. This is the modern world. Everyone hears the clock ticking, but so few know the time. Corrupt Banks and Politicians are richly rewarded, while the hard working Man and Woman is robbed. Robbed of their pensions, robbed of their savings, robbed of their birthright and robbed of their culture. Unborn Children saddled with debt brought about by greed and stupidity and avarice. This is called progress.

The NHS being destroyed day by day, piece by piece, brick by brick, by politicians who have never done an honest days work, or held down a real job in their lives. While Labour politicians like Tony Blair add to their multi-million pound property portfolios. When are the people going to stand up and be counted. When will they say, enough is enough, when it is too late? Is this progress?

Eddie

The Doors - Riders On the Storm

Sensible video tonight but next week a completely mad one ! watch this space.
Graham

Kill Bill Soundtrack - Santa Esmeralda - Don't Let Me Be Misunderstood !

This will do for me, this is where I stand. Eddie.

ZZ Top - Gimme All Your Lovin' (OFFICIAL MUSIC VIDEO)

This is a great heavy rock track, and Stella video. This was Graham's first taste of stardom. He is the grizzled old git, Paul is the good looking bloke that get's the girls. Did you know the guy in ZZ Top (the drummer) without a beard, real name is  err... Frank Beard. Eddie

AC/DC - Whole Lotta Rosie (Live At River Plate 2009)

I have never forgotten my first girlfriend Fay, but my second girlfriend was Rosie, what a Woman, I was strong and fit in those days, but Rosie very near wasted me, happy days. Eddie

A girl called Fay.

A girl called Fay. I know what you mean John. My first love was a girl called Fay. She was 15 and I was 16. We both lived in very rough areas. She was beautiful and as pure as the driven snow. We grew apart and we went our separate ways, but I often think of her, I hope she is happy and healthy and living a good life. I have been very lucky and have known some fantastic Women. Fay loved the Beach Boys with a passion and introduced me to their great music. Eddie

Saturday night is music night on this blog. The Girl From The North Country.

Over 50 years (almost to the day) I met my first love. She lived in the same rough neighbourhood. She had just started work for the Inland Revenue and I was in the first year of my A-levels. I was completely smitten. She was tall, willowy with very long dark hair. However, after a very passionate year, it became clear to her that it was going to be a very long time before I had any income or status other than student (8 years). She was very ambitious and desperate to leave the neighbourhood and I was dumped. In my first year at Uni the following song was always on the record player. I can’t find a YouTube for the original track from the Freewheeling album. This version is not too bad.

Years later I was told she had married a solicitor.

John

DCUK Phoenix displays a rare moment of honesty !

"It can be as complicated as you want to make it. There are breads in the GI data base with GIs from as high as 104 down to as low as 24."

Phoenix at DCUK on the District Nurse recommends Low GI diet for Diabetes thread. She knows the low GI diet is a complete crock for diabetics, and pretty much useless for anyone else.

Eddie

Edit:

From that thread at DCUK linky here, phoenix surprisingly gives a link to a lecture by Prof J Mann at the European diabetes association conference, check it out Prof Mann's comments on Low GI diets (about 20 mins into the lecture) he's not exactly endorsing them the opposite is true. 

http://www.easdvirtualmeeting.org/

Graham

The Eyes Have It - final part

Dear Reader, this is the final part of my 'Eyes 'series wherein I have tried to give my personal experiences and tips for those having to undergo investigations and treatment of diabetic retinopathy, maculopathy, etc.

Those who have read the previous posts in the series may remember that my eye problems were induced by medications, bringing my bg levels down too quickly and by my being advised to eat more starchy carbs in order to tolerate the medication better!

After attending the hospital's eye clinic every month for a year with nothing but background retinopathy to be seen ,(my doctor had thought he could see something on the macula - before the days of retinal screening) I was told at an appointment that I would be discharged if I returned to have a final scan and to see a consultant 3 days later. I duly returned but the consultant only glanced at the scan before he ran out of the room calling for a nurse. and demanding immediate laser treatment for me. During this 3 day period I had stopped taking one drug - just as it was about to kick in -and had started on another. I always have an immediate and extreme reaction to medication and my blood sugar had dropped immediately, by several points, obviously resulting in the massive bleed.. The consultant - a visitor- did not get his way - Christmas and New year intervened. This was a very good thing as I discovered later.

When there is a great deal of fluid present laser will not work and I have met several patients who have waited six months and more before any treatment was attempted because of major leakages of fluid. Sometimes patients even have to contend with temporary blindness. I think I had to wait about eight weeks for my laser treatment - and these were filled with trepidation. I had heard several patients telling doctors that they did not want more laser treatment as they had found it so painful.

In these circumstances I did what many others do and researched it on the internet. In every other situation I have found this to be useful and would encourage everyone to do so in order to understand treatment.

Eye clinics are busy places and often Drs do not know the answers at a particular stage. Research helps to explain why. In the case of laser - I mean before the first laser treatment - I do not think that this is advisable for several reasons. In the first place the language used to describe laser - numbers of 'burns' etc- is very emotive and often distressing to patients. I remember very well how so many members on DCUK hesitated about treatment purely for this reason. When people talk of having had thousands of burns to each eye - what are the uninitiated to think? Then there are concerns about the effect on peripheral vision in some cases and the possibility of driving licences being withdrawn etc. While these things sometimes can and do happen they are unlikely to happen at an early stage and there is no point in worrying unnecessarily. The important thing is to prevent the disease progressing.

Laser treatment to the eye is not comparable to anything else. The eye and the brain work together and intense laser can be very disorientating. Add to that the fact that every case and every treatment is different and individual sensitivity varies so much and you will see why it is probably better to await the first treatment before undertaking further research.

I have heard and read, of people having had one brief experience of laser treatment, telling others that they didn't understand why some had problems with laser . Nothing to it! I was told that it was not painful per se and this has proved quite true in my case. On the other hand I have had to go to bed -totally- but temporarily-blinded - for 24 hours after intensive laser treatment. This blindness did not come in the form of darkness but of blocks of different coloured light totally filling the field of vision which only faded gradually.

For patients with certain conditions, for example, epilepsy, migraine, asperger's syndrome, laser can be especially traumatic. Patients should ensure that any concerns are made known to the medical staff before the treatment day, as sedation can be given and the person delivering the treatment be made aware of potential problems. Here again, the laser machines themselves and the operators, vary. Should a patient experience discomfort they should always mention it to the Dr. at the time. The machine setting might need to be changed to suit the individual, or a pause in the proceedings might be indicated. Patients should never be afraid to ask for the procedure to be halted if they are uncomfortable. Laser treatment requires concentration. and co-operation from patient and operator, but it is the patient who risks damage and for whom the treatment is vitally important.

Some doctors may become a little testy with patients, as in other procedures. I try never to take this personally, as it often takes the form of chiding the patient to keep still etc but may reflect anxiety on the part of the Dr. In this case a break may be in the interests of all.

When the laser gets closer to the macula it is very important that the patient is able to concentrate and keep as still as possible for a few, vital, seconds. That is why it is so important that the whole procedure is as relaxed as possible before this stage is reached.

But what actually happens at a session of laser surgery?

The patient will already have had dilating and iodine drops instilled. An anaesthetic drop will also be given before a contact lens is placed on the eye or eyes. The patient will sit facing the operator at the table with the laser machine - very much in the same way as for eye examinations - and place chin on chin rest and head against head rest The patient will see large blocks of light filling the screen, again as in eye examinations. He/she will be asked to confirm that they can see a red dot and to follow it with the eye, then told not to follow it but to look straight ahead. This is quite difficult sometimes as nothing of the room beyond or the operator can be seen and the red dot is the only point on which the eye can focus.

When the treatment begins little bleeps will be heard and small black or grey dots or holes will appear in the vision. This is not painful - the discomfort - if any, generally comes from the lights. When a crucial point is reached the patient should be warned not to move for a short time. When the procedure is finished the lens will be removed and the patient told to sit back. After-effects will depend on the individual and the amount and intensity of treatment given. This is another reason to be extremely careful about reading well intended literature - even sometimes that issued by hospitals.

My first session of laser was very intense. I was not given any particular advice or told what to expect - merely to call if I had any concerns. I had already downloaded a leaflet from a hospital in another region on this subject. That night and for each night until my next appointment two months later I experienced a 'firework display' in both eyes when I went to bed. This lasted for several minutes and was quite unlike anything I had ever experienced before. I was not worried - the leaflet from the other hospital informed me that this was perfectly normal and to be expected.

The point I missed ,however, was that the leaflet did not tell me for how long this phenomenon should continue. At my next appointment I mentioned the matter and was told that side effects of that kind should only last for a few days, and that they could, in fact, have been a sign of a detached or detaching retina.

It was some years before I discovered what the firework displays actually were a sign of, and in the meantime I was given another session of laser - but not so intense, which I also understood better later.

As neither of the laser treatments made the slightest difference to my retinopathy, maculopathy, or macular oedema I was told I would be referred to a consultant for consideration of eye injections as, apart from laser, this is the only treatment available at present.

When I finally saw the consultant, he explained that the laser had not worked because there had been too much fluid present. He said the injections would dry up the fluid by sealing blood vessels and that he thought he would then be able to perform effective laser treatment. He told me of the worst case scenario risks -blindness and retinal detachment. He then asked if I were willing to go ahead with the injections.

He was new to the hospital and before his arrival patients had needed to go elsewhere for this treatment. As there seemed to be no alternative, I agreed. It was explained that I would be admitted as a day case and the pre-op was carried out immediately.

The procedure - injection of the steroid triamcolone into the vitreous part of the eye took place under full operating theatre conditions. The steroid is intended to reduce inflammation and swelling in macular oedema and other retinal conditions. Other side effects include glaucoma and progression of cataracts - I suffered all these side effects eventually - but for a long period it was effective -with laser-ing preventing the progression of the disease.

On the first occasion there were students with laptops literally lining the walls of the operating theatre. I had had a long wait because the previous operation had been difficult. Every passing doctor or nurse had renewed my anaesthetic drops - which I found very reassuring.! Of course, the thought of an eye injection is frightening and disturbing. It is almost against nature to allow a sharp pointed instrument near the eye, I wish someone had told me that I would not be aware of a sharp pain but only a deep pressure. Not pleasant but certainly not agonising. Before the procedure the eye is cleansed thoroughly and either painted with iodine, or an iodine eye wash is used. I must say that this eyewash is the most painful part of the procedure, but again this will vary according to individual sensitivity.

A hood made of some substance reminiscent of bubble wrap with an adhesive inner surface is placed over the patient's head and pressed down to adhere closely to the skin. to seal off the treatment area. The surgeon then uses a scalpel to cut holes for the eye to be treated, or nowadays, sometimes pushes through, perforated eye sections. The aim is to expose as little of the facial area as possible in order to avoid infection. The eyelashes are clipped upwards. Some surgeons mark the place where the needle is to enter the vitreous part of the eye. They also have a choice of needle sizes, but that does not affect the patient experience. If both eyes are to be injected the hood is removed and the procedure repeated on the other side. This hood removal sometimes requires two people to remove it and is probably the most effective exfoliation any of us will ever experience!

My first steroid injection was almost a psychedelic experience. I saw flashing lights, amazing colours and when the surgeon asked me if I could see a light and then tell him how many fingers he was holding up, I was amazed to hear a round of applause from the students watching the procedure around the table and via computers around the walls. Later treatments were far less spectacular, so I assume much was due to the state of my retina at that time. I later discovered that the original laser treatment, before the injection, had been so intense - albeit ineffective, that it had caused extensive scarring to the retina. It was fortunate that I had mentioned my side effects to the Dr or I would have had a second round of over-intensive laser, while still believing [as per the hospital leaflet] that this was normal.

Over six years later I was shown the area of scarring on a photo and have to say that this was the most shocking thing I have seen in the course of my treatment. The biometrist had told me that there was a large area of scarring but until I saw the blackened area for myself I did not understand the extent of it. This makes other procedures more difficult and gives me an increased risk of irreparable retinal detachment. Being shown that photo was when I first understood the term 'burn' in connection with laser. A reminder that although there is no outward sign - this is what it is doing, in fact, although the patient is unaware of it. Once these things have happened there is no reversing them so I would advise people to speak up even though most of us are reluctant to make a fuss.

The HCP’s can't know if the patient doesn't tell them. I completely understand now, why not every hospital will produce its own guide to laser treatment. There is always the problem of false reassurance but in this particular area it is almost impossible to avoid pitfalls and much better to deal with these matters on an ad hoc basis.

The steroid injections can cause side effects for a few weeks after treatment. Floaters may have been mentioned but I was not prepared for the outsize spider webs in my eye for four weeks on one occasion. The chemical, or its carrier is black, it became very irritating when strands began to break off from the web and behaved as pendulums swinging back and forth across the eye. I once drew what I could see each week until the after-effects faded for the surgeon, he had had no idea previously of the extent of the problem and changed his injecting technique as a result. I find that it is always worthwhile mentioning these matters.

The other injection used in the treatment of retinal eye disease is Avastin also known as bevacizumab. This is an anti-cancer drug used off-licence to prevent the growth of new blood vessels, which in retinopathy will often be fragile and weak as well as in the wrong place. In the hospital I attend, Avastin injections are given in a mini-operating theatre, as these are often used in age-related wet macular degeneration too. The procedure is the same for both injections but with Avastin the fluid is clear and there should be no floaters after the injection. With both types of injection it is necessary to use antibiotic eye drops 3 or 4 times daily for a week afterwards.

Avastin is what I always think of as Poor Man's Lucentis. Lucentis was developed for use in eyes, Avastin was not. I have heard it described as the same chemical with a few cosmetic changes - it is even made by the same company. There is however, an enormous difference in price, so using Avantis allows for treatment of many more patients.

How effective are these treatments?
From a personal perspective steroid injections always worked for me and I hoped to have a steroid implant so that the number of injections and hospital visits could be reduced. Unfortunately I developed glaucoma and as this is a major risk with implants this option seems to have been ruled out. I have had several Avastin injections over the years but none have worked for me. At present I am awaiting the results of an intensive course of 3 injections to each eye given at monthly intervals. This does not appear to have been successful to date but has worked for others. Avastin has been very successful in treating wet macular oedema in some patients and diabetic eye disease in some patients too.

Steroids are also effective for a limited time. All of these procedures carry risks - and very real risks .but some patients need only the minimum of treatment to successfully treat the condition. I think the jury is still out overall but current treatments work for many even if the condition recurs and thus buys time. It should never be forgotten that it is tied to diabetes but there is disagreement about exactly how this works.

Too strict control of bgs has been found in some studies to be counter productive and certainly I have found that low bgs affect it as much as high.

HCP’s in my hospital are discovering ,all the time that Type 1 ophthalmology patients fare better than Type 2, and some think that is the case with most diabetic complications. Although it is true that some may reverse retinopathy with treatment and lifestyle changes often the damage has been done and it is much more difficult to diagnose than most people believe. In my case there were only the smallest signs of background retinopathy and, at times, the treatment appeared to be working. Unfortunately angiograms have shown that although they no longer leak fluid the blood vessels are spongy. From wear and tear over the years and fluid gradually accumulates causing maculopathy .As the only available treatments are no longer effective then the outlook appears bleak at present, but I feel that I have been fortunate, in many ways, in my consultant and hospital and will continue hoping for as long as possible.

Whereas most diabetic complications may be reversed or minimised by the appropriate diet and bg control this is not necessarily the case with diabetic eye disease. That is why I explained some time ago that it can be equally important to keep levels stable. A sudden drop or spike can cause a bleed. Sometimes the effects can be temporary and reversible - but not always. I stress that I mean in those already diagnosed with retinopathy, I try to keep my levels low and stable to avoid further complications.

It is now recognised that bg control alone is not sufficient to keep retinopathy at bay and it is suggested that as well as blood pressure levels - which are always important, cholesterol levels also have a part to play. As ever this is not properly understood, but is another reason why patients will have lipid levels looked at, - and, no doubt, statins prescribed.

I feel strongly that insufficient evidence is available at present to evaluate treatments, but that there is hope on the horizon, in that the Americans are now investigating the efficacy of treatments, after shunning injections for a long time because insurers would not consider them. Many still refuse to do so but will help with some aspects and patients can choose to pay for injections. This means that they are more widely available and that the data is also becoming available, and many trials are in progress. Some advances has already been made in assessing the best way of using Avastin and there are alternatives, including drugs, in the pipeline.

It is of course, a personal choice whether to accept treatment by laser and /or injection I know of many who hesitate for months. I feel that I must say, from my own experience, that they are deluding themselves. Many, including me, will at some stage, think, when one eye is being treated and the treatment is not particularly successful that they will settle for sight in the other eye. I hear this all the time and once believed it possible myself. Believe me you do not have this choice. Overnight things may deteriorate in the other as many of us have discovered. Those who hesitate because of fear of loss of peripheral vision cannot have considered how their driving licence will be affected should they lose their vision completely.

The fact is, that when you are told that treatment is required then it is important, although often unpalatable, to accept and come to terms with it. As with all other treatment it is the patient's own responsibility to stay abreast of the treatment, to ask appropriate questions, to report side effects, to indicate when treatment is uncomfortable or painful. Be proactive - but also be patient. Laser and injections do not work instantly. HCP's are not issued with a crystal ball. If you do not always receive a satisfactory answer it may be that it is not possible at a particular stage.. Many of us are very busy these days. Please be a patient, patient. If a particular Dr is busy and in great demand there may be very good reasons for that. Worth waiting for, perhaps, I have often observed staff being bullied into pushing a patient through the system because that person's priority is obviously just to be seen by anyone and to leave as soon as. possible Obviously, this will only lead to further appointments having to be made and more time being wasted. It is the same with preliminary checks at each visit. They are essential and no progress will be possible without them. In other words - be patient, co operate but always remember it is your vision at stake and you have a perfect right to choose and to question. The best HCP's know this. Above all never expect to pay a short visit to an eye clinic.

I recently found this video on You tube which avoids some of the pitfalls of information sheets, but which may be of interest, to anyone who is concerned about treatments for diabetic eye disease.

I have not attempted technical descriptions of eye disease or treatment as they are readily available for anyone to Google but merely  speak from my own experience. I have undergone other procedures as side effects of my treatment and may undergo more. In this series I have concentrated on the common treatments and diagnostic tests which most patients will undergo.

You Tube - Understanding Proliferative Diabetic Retinopathy



I hope none of this is ever necessary for any of you but please remember many people are successfully treated.

I am a "difficult and unusual case" That is official.

Best wishes Kath 


Post edit

Thank you Kath for a fantastic series of highly educational articles. To find all of Kath's eye posts in one place, please go to our wordpress blog here.

Eddie  

Why low GI diets don't work for most diabetics !

This is a must watch for diabetics and illustrates why a low GI diet does not work for most diabetics. I believe Low GI is a minefield of confusion. After watching the video I think you will agree. What a coincidence I post this video up again just as the Carboholics at the flog are waxing lyrical about low GI LOL. Eddie

Is Spring Here ?

Well it’s the 1st March and the weather presenter was heard to say “it’s Spring”. Apparently weather presenters take the 1st March as being the first day of Spring! Well I wont argue and if we are now in for some sunny Spring like weather that would be a bonus. However, in all probability it’s going to be more rain.

Never mind - it’s the weekend, so that can’t be bad. Saturday breakfast and it was ham, mushrooms and a lovely fried egg …with the obligatory cup of tea. If ever I call on you please have the kettle ready .. It’s a standing joke in our family. After we say hello the kettle goes on and the tea is brewing.

Saturday should be a quiet day, shuffling around getting a few things done which didn’t get done in the week. Why is it that sometimes 24 hours in a day just isn’t enough? It would be nice to think we can enjoy a Spring walk but we’ll have to see what the weather decides to do.

So in the meantime the next best thing is some pictures of Spring flowers.

 

 

Snowdrops, crocus and daffodils. Around the gardens and local park there has been a good display, and the earlier golden type daffodils are doing very well. Now that‘s a good link into the first verse of William Wordsworth‘s poem. I can certainly remember this from school days ……

Words of William Wordsworth 1770 - 1850

I wandered lonely as a cloud
That floats on high o'er vales and hills,
When all at once I saw a crowd,
A host, of golden daffodils;
Beside the lake, beneath the trees,
Fluttering and dancing in the breeze.

……… and if you don’t know the next verses and wish to read go to here

Whatever you do this weekend, hope you have a good one, and thanks to all for reading and commenting on the many and varied articles on the blog.

All the best Jan

Liver and bacon casserole

Liver and bacon, mushroom, onion, carrot and courgette casserole served with white cabbage and mashed swede.

A very tasty low carb, healthy meal. Total cost was less than £2.00 per person. With enough gravy and vegetables left over for a very tasty soup for two tomorrow. Very easy to prepare and cook. Whole fresh low carb good food does not have to be expensive.

Cut up lambs liver into small chunks and place in casserole dish. Slice and chop a small red onion, put in casserole dish. Slice some courgette, carrot and mushrooms and put in casserole dish with the liver and onion. Scatter some mixed herbs over the ingredients and add seasoning. Make up approx pint gravy stock and pour over ingredients. Cover with lid and cook in the oven for about 90 mins at 190 degrees / Regulo 5. Every 30 minutes or so gently mix and turn the ingredients. Check food is thoroughly cooked and serve with some white cabbage and mashed buttery swede. A really tasty meal which was even better because Eddie prepared it ..... what a treat .....lovely.

All the best Jan