It’s unlikely that diabetes is on the forefront of your mind as we approach the end of the year and a busy holiday season, but November is Diabetes Awareness Month and now is really a better time than ever to think about your own personal risk factors for the development of this complex and chronic condition. Diabetes Mellitus is the name given to a group of metabolic diseases that are caused by the body’s decreased ability to utilize sugar appropriately. These diseases are ultimately caused by defects in the way that the body uses and/or makes insulin. Insulin is a very important hormone secreted by the pancreas that allows our tissues to absorb sugar in the bloodstream from the food that we eat, in addition to performing a number of other important functions. When the pancreas cannot make insulin or the tissues in our body become resistant to its effects, this results in high levels of sugar in the blood, otherwise known as hyperglycemia. Persistent hyperglycemia can cause many bothersome symptoms and both short and long-term complications, ranging anywhere from persistent nausea and fatigue to heart attack, strokes, chronic kidney disease, blindness, poor circulation, and nerve damage. Diabetes has the potential to affect literally every organ in our bodies. Somewhat surprisingly, perhaps, diabetes can can also be entirely asymptomatic. Regardless of the severity of symptoms, persistent hyperglycemia is an extremely serious condition that still puts one at risk for the complications noted above. Therefore, screening those at risk is a crucial first step in managing this condition.

It is estimated that about 30 million Americans live with a form of diabetes, most of whom have type 2 diabetes. Unlike type 1 diabetes, which is an autoimmune disease of the pancreas that is typically diagnosed in childhood and adolescence, type 2 diabetes typically develops during adulthood and has a slow and insidious onset. There are several factors that increase your likelihood of developing diabetes. If any of the following conditions or situations apply to you, you should talk to your healthcare provider about screening for diabetes:

• Sedentary lifestyle
• Overweight or obese
• First-degree relative with diabetes (such as your mother, father, or sibling)
• African American, Latino, Native American, Asian American, or Pacific Islander race/ethnicity
• Hypertension
• Dyslipidemia (specifically, low HDL levels and high triglyceride levels)
• PCOS
• History of cardiovascular disease
• History of gestational diabetes or delivering a baby > 9 lbs.

There are several types of tests available to screen for diabetes. The easiest tests that can be ordered during a routine office visit include a fasting glucose level or a hemoglobin A1c. A fasting glucose level of over 126 mg/dl or a hemoglobin A1c level over 6.5% is considered to be diagnostic for diabetes, though these tests should be repeated to confirm their accuracy. Any test that is borderline high is consistent with pre-diabetes, which is essentially a warning sign that you are likely to develop diabetes without an intervention. While several of the risk factors listed above are beyond one’s control, like family history or ethnicity, many of them are, of course, modifiable. The best way to prevent diabetes for those who are predisposed is to engage in a regular exercise routine, work on portion control, and reducing or eliminating consumption of foods that are high in sugar – such as sweets and sodas. These sorts of changes can be extremely challenging, so don’t ever hesitate to let your healthcare provider know if you need additional help or support. There is also a prescription medication called metformin that can be taken to help your body use sugar more appropriately, which can in turn help to prevent the progression from pre-diabetes to diabetes. This medication is most effective when it is used in combination with lifestyle changes.

While the holiday season may not seem like the best time to think about your health, it can provide a great opportunity to learn more about your risk factors for diabetes as you connect with family members and reflect on your own health histories and habits. This is really the first step in determining whether you are at risk for diabetes, and the next is to speak to your healthcare provider to learn more about screening and risk reduction. Our priority as healthcare providers is to offer you non-judgmental guidance and support as we work with you to optimize your health and minimize your risk factors for chronic diseases such as diabetes, and, most importantly, to remind you that big changes start in small ways.

If you are one of the 42 million Americans who still smoke cigarettes, or if you have family and friends that still do, we wanted to share a national initiative that is going on this month to help smokers quit. It is called “The Great American Smokeout” and takes place on November 17th this year. This special day was established by the American Cancer Society to help smokers pick a quit date and stick to it. It can be very difficult to quit smoking, but knowing that you are not alone in the struggle can be helpful, and hopefully motivating.

To help those who want to join in on “The Great American Smokeout” and choose November 17th as their quit date, we have gathered additional information and resources to help prepare you (or your family and friends) leading up to the big day.

The first thing to note is the innumerable benefits to quitting smoking. Diseases caused by smoking claim an estimated 443,000 American lives each year, including those that are not affected directly, for instance babies and children. According to the US Surgeon General, the choice to quit smoking is the “single most important step that smokers can take to enhance the length and quality of [their] life.” So, the choice to quit smoking- even for one day- is so important to your overall health that it can significantly reduce your risk of cancer and other diseases.

Now that you’ve made the decision to quit smoking, the next step is to pick a quit date, which we recommend to be within the month, so you don’t have the opportunity to change your mind. The quit date is important because it allows you time to prepare and plan. We encourage you to consider making an appointment with one of our providers to discuss options that are available to you, including Nicotine replacement therapy and prescription drugs. For many people, it may take the combination of medicine, changing personal habits, and emotional support in order to quit.

Which brings us to the next important step: building up your support system. Tell your family, friends, and co-workers that you are planning to quit, so that they can help motivate and encourage you. Also, consider stop-smoking programs, Nicotine Anonymous meetings, self-help materials, and telephone quit lines which all can be a great help as you lead up to your quit date.

Before you know it, it will be November 17th and you will be amongst thousands of other smokers who have decided to choose their health over their habit, and starting on a path to successfully quitting for good!! So, schedule an appointment to see one of our providers and check out the American Cancer Society’s webpage to learn more about resources that are available to you at www.cancer.org or calling 1-800-227-2345.

Often, conditions of the skin can have a psychological aspect that also needs to be addressed. Research has shown that mental illness, stress and other psychological factors can activate or worsen skin conditions.

Did you know that the skin is the body’s largest organ? It is a protective barrier that helps the body fight against injury and inflammation. The skin is involved in many complex biological processes, including the brain and nervous system. The brain and nervous system influence the skin’s immune cells through various receptors. When you are facing chronic negative stressors, research suggests it disrupts the function of the skin’s protective barrier, potentially leading to or exacerbating a skin condition.

Only in the past several decades have we seen the resurgence of the mind-body awareness in medicine; and only in the past decade have we seen an emphasis on understanding the interaction between the mind and the skin. Psychodermatology is a holistic view within the medical world looking into the cause and effect relationship of the mind and skin. Psychodermatologic disorders often fall into three different categories:

Psychological skin conditions are usually chronic conditions and can often be exacerbated by stress and other emotional factors.

• Acne
• Alopecia Areata
• Eczema
• Hyperhidrosis
• Pruritis

Secondary Psychiatric skin conditions, due to their visibility, can erode one’s self esteem, leading to social phobia’s and depression.

• Severe Acne
• Psoriasis
• Vitiligo

Primary Psychiatric skin conditions are symptoms of a psychiatric disorder and recognizing them is important in the treatment of a mental illness.

• Trichotillomania (chronic hair pulling)
• Delusional Parasitosis
• Body Dysmorphic Disorder
• Dermatitis Artefacta (self-inflicted picking, cutting)

When treating all skin conditions, it is important to know that not everyone responds emotionally through the skin, nor do all people react the same way to having a skin condition. But, evidence has suggested in patients with psychological issues that intersect with a skin condition, treating both the mind and skin offers the best chance for improvement. Like I tell all my patients, take ten minutes to relax and meditate, stick to a healthy diet, go for a walk in the park; your mind and skin will thank you for it.

With September being Hispanic Heritage Month, we would like to take this opportunity to review some facts about health trends among Hispanics by sharing both reassuring statistics as well as risks. These statistics are the result of factors including genetic, environmental, social, and economic, which encompass diet, risk for disease, and access to healthcare services and education. An individual’s personal characteristics and behaviors will also affect their risk.

Traditionally, Hispanic people are less likely to eat processed foods, oils, fats and sugars when compared to White Americans. This diet typically includes lots of grains, beans, fresh fruit and vegetables. They also take in a higher amount of fiber compared to White Americans. Hispanics are 14% less likely to be smokers and tend to have 35% less heart disease and 49% fewer occurrences of cancer.

However, it is also important to also focus on less healthy trends, in order to understand risk and work towards prevention. 24% of Hispanics-Americans, when compared to White Americans, have a harder time controlling their blood pressure and are more likely to be overweight. They are also 50% more likely to be diabetic. Tuberculosis is also prevalent in foreign-born Hispanics resulting in more chronic lung damage than caucasians. Evidence suggests that the poorer socio-economic positions of some ethnic groups is the main driver of ethnic health inequalities. One quarter of Hispanics in the U.S. live under the poverty line. This can result in families being unable to obtain foods used in their native diets, especially families living in regions known as ‘food deserts’ where fast and processed foods are more readily available than fruits, vegetables and lean meats.

Keeping in mind the already present favorable medical statistics, these socioeconomic disparities can be mitigated with a little more support and food education It should also be noted that the diverse cultures of Latin America also make it difficult to pinpoint specific problems and recommendations for Hispanic-Americans as a whole; not only is this due to cuisines specific to a particular country but also the genetic strengths associated with multiple generations of Latin-Americans eating the same locally available foods for hundreds of years. In fact, some studies have demonstrated that moving away from traditional cuisine towards ‘American food’ has negatively impacted the health of young Hispanic-Americans the most. The consumption of more high-sodium fast foods (big offenders are mozzarella sticks, and fried chicken and fish) and simple sugars (high fructose corn syrup, sodas, breakfast cereal) has been a major factor in worsening the health of hispanic-americans. For patients who already have diabetes, the cultural shift can tip a controlled diet into one that is uncontrolled and results in complications such is foot, eye and kidney disease. Likewise, a high-sodium diet in an already overweight patient can be the difference between normal and hypertension and the heart disease to go along with it.

Another cultural shift noticed in hispanic americans as opposed to their counterparts in Latin America is a shift to 3 meals a day – Mexicans in particular typically eat 4-5 meals a day so a shift to 3 meals a day may impact the total amount of calories being consumed leading to obesity. Another shift is breastfeeding which is less prevalent in the U.S. than most Latin American countries – immigrating families may move away from initiating breastfeeding which may have an impact on higher child obesity rates. The exclusion to this is Puerto Rico: the island actually has lower breastfeeding initiation rates than in the U.S.! Therefore families whose ancestors immigrated to the U.S. may start initiating breastfeeding more than their counterparts in Puerto Rico.

Overall, the health status of the Hispanic community shows good roots and a promising future. Hopefully with more focus on health education and weight-loss support, we should begin to see positive changes and a marked degree of improved health in the Hispanic-American population. To our Hispanic patients – please take this month as an opportunity to review your health – schedule a physical with one of our primary care providers. If your diet is not what you would like it to be, remember we have two lovely registered dietitians available to evaluate your food choices and make recommendations that can work for you. As mentioned previously, local Latin-American cultures have evolved to be healthy in their environment, so harness the knowledge of your ancestry to help you make healthy food choices in the future!