Exciting News on the Cancer Front

Mark Davis of the California Institute of Technology runs a research group that designs and synthesizes new polymetric materials that allow assembly with therapeutic molecules. These systems are invented and investigated at the cellular and animal levels. Two systems developed in their labs have been translated into clinical materials and are currently used in human clinical trials.

Five days ago they announced their results from the siRNA Phase I clinical trial in cancer patients. The research team had designed nanobots to deliver a lethal blow to a cancerous cell, effectively killing it. The news? We may be staring at the end of cancer.

Looking at how it works ( see above image ), in the words of Mark Davis: "it sneaks in, evades the immune system, delivers the siRNA, and the disassembled components exit out."

According to a study to be published in Nature, Davis' team has discovered a clean, safe way to deliver RNAi sequences to cancerous cells. RNAi (Ribonucleic acid interference) is a technique that attacks specific genes in malign cells, disabling functions inside and killing them.

The 70-nanometer attack bots—made with two polymers and a protein that attaches to the cancerous cell's surface—carry a piece of RNA called small-interfering RNA (siRNA), which deactivates the production of a protein, starving the malign cell to death. Once it has delivered its lethal blow, the nano-particle breaks down into tiny pieces that get eliminated by the body in the urine.

The most amazing thing is that you can send as many of these soldiers as you want, and they will keep attaching to the bad guys, killing them left, right, and center, and stopping tumors. According to Davis, "the more [they] put in, the more ends up where they are supposed to be, in tumor cells." While they will have to finish the trials to make sure that there are no side-effects whatsoever, the team is very happy with the successful results and it's excited about what's coming:

"What's so exciting is that virtually any gene can be targeted now. Every protein now is druggable. My hope is to make tumors melt away while maintaining a high quality of life for the patients. We're moving another step closer to being able to do that now."

Get on top of your risk factors

Coronary Heart Disease is your new number one enemy. It is being fueled by the excess sugar that your liver is forced to deal with as a result of your Type 2 status.

A recent study in the New England Journal called Glycated Hemoglobin, Diabetes, and Cardiovascular Risk in Nondiabetic Adults has given my good friend Dr. Mintz reason to consider thinking about using cholesterol lowering agents in patients with elevated blood sugars, even if the cholesterol is normal. He has quite the blog post about it here.

Dr. Mintz notes that in the study, patients with an HbA1c of less than 5.0% had 4% relative decreased risk of cardiovascular disease compared to patients with and A1c of 5.0 to 5.5%. However, those with A1c's from 5.5 to 6.0% had a 23% increase, those with A1cs of 6.0 to 6.5% had a 78% increased risk, and those with 6.5% or greater had an almost double risk of cardiovascular disease. This suggest a strong correlation between elevated blood sugar (pre-diabetic patients) and cardiovascular risk.

For those of you paying close attention to what Dr. Lustig of UCSF has been tracking in his evaluation of sugar (as poison), you will not find any of this to be a great surprise.




As a diabetic, the role of sugar is especially insidious. So, get control of your HbA1C. Get in in the low 5's. Do it now. If you need help or motivation, send me an email.

Heart Health and Type II

It would appear that managing patients with hypertension and type 2 diabetes to a target systolic blood pressure (BP) of less than 120mmHg did not reduce cardiovascular events compared to a target of 140mmHg in a major randomized controlled trial. At least that's what a March 14th editorial in the New England Journal of Medicine have concluded.

People with type 2 diabetes are at increased cardiovascular risk compared to those without, and that management of all aspects of cardiovascular risk is important in such people, there is still debate over how best to do this. My problem with the study is that it starts off on a bad foot: participants were aged 40 or above, had type 2 diabetes with HbA1c 7.5 or above, and were at high risk for cardiovascular disease. Those with systolic BP between 130 and 180mmHg and taking three or fewer antihypertensive medications were eligible for the BP study.

The authors conclude that in this study, intensive BP management did not significantly reduce the rate of major cardiovascular events in high-risk individuals with type 2 diabetes, nor did it reduce the rate of death.

Based on this patient population profile, I think the broad conclusion that BP management is not working is unwarranted. Doctors need to start addressing the hard facts: HbA1c of 7.5 is unacceptable. As a type 2 diabetic, you need to follow a plan of weight reduction, food control, and exercise to drive your HbA1c below 6.0. Aim for the low 5's.

At this point what we do know is that the greater the Body Mass Index, the higher systolic blood pressure, the higher ratio of cholesterol to high-density lipoprotein cholesterol, and presence of type 2 diabetes are all predictive of first coronary heart disease events. YOU are in control of how you handle these things. YOU need to change. If you change your lifestyle, you will live longer. If you don't, that's fine. You are just choosing a shorter lifetime. The choice is YOURS.

Hack #2: Start Exercising

In keeping with the goal of getting control over your blood glucose levels, starting a fitness program may be one of the best things you can do for your health.

Start by making sure your doctor thinks it is OK to start an exercise program. In all likelihood the answer will be yes because physical activity can reduce your risk of other chronic disease, improve your balance and coordination, help you lose weight — even improve your sleep habits and self-esteem. It gets better! You can make this a permanent change to your lifestyle in just five steps.

Step 1: Start with an initial assessment

We've already talked about the importance of metrics, so you'll understand why we want to start with some idea of how fit you are right now. By assessing and recording baseline fitness scores, you have benchmarks from which to measure your progress. Start by assessing your aerobic and muscular fitness, flexibility and body composition, get an old fashion notebook out and record the following:

1. Your pulse rate before and after a one-mile run/walk


2. How long it takes to run/walk one mile


3. How many push-ups you can do at a time ( or in 2 minutes )


4. How far you can reach forward while seated on the floor with your legs in front of you (hint use a board between your legs and mark it)


5. Your waist circumference at the level of your navel


6. Your body mass index

( You might consider going to a local CATZ facility and have them help you design a custom base line - tell them I sent you! )

Step 2: Design a program that works for you

As we discussed in Hack #1 It's easy to say that you'll do something every day. But you'll need goals. As you design your fitness program, keep these points in mind:

• Consider your fitness goals. You are starting this fitness program to help improve control of your blood glucose levels. In support of that goal, you will be trying to loose weight and/or increase muscle mass. You might use other motivations as well, such as preparing for a 5K (kilometer) race. Clearly defining goals can help you make and gauge your progress.


• Most type II diabetic adults should aim for at least 1 hour a day 5-6 days a week of moderate to vigorous intensity aerobic activity. You will also need two or more days of strength training a week.


• Start by planing a logical progression of activity. If you're just beginning to exercise, start slowly and progress at a speed that is just above your natural level of comfort. If you have an injury or a medical condition, you need to consult with your doctor and/or a physical therapist for help in designing a fitness program that gradually improves your range of motion, strength and endurance.

Think about how you'll build activity into your daily routine. Finding time to exercise is the biggest challenge by far. This is your life we're talking about, so you need to schedule time to exercise as you would any other appointment. To make it easier you might plan to watch your favorite show while running on the treadmill, or read while riding a stationary bike.

You should also plan to include different activities. Different activities (cross-training) can keep exercise boredom at bay. Cross-training also reduces your chances of injuring or overusing one specific muscle or joint. Plan to alternate among activities that emphasize different parts of your body, such as walking, swimming and strength training. CATZ ( and other gyms) will have some great programs in support of cross-training.

You need to allow time for recovery. Many people start exercising with frenzied enthusiasm — working out too long or too intensely — and give up when their muscles and joints become sore or injured. Plan time between sessions for your body to rest and recover. My rule of thumb is to actually take off every 9th week from running and do a body weight circuit in place of weights.

Whatever your plan is, write it down! A written plan will encourage you to stay on track. Enlist a friend to help keep you honest by making a monthly presentation to them of your progress against your goals.

Step 3: Gear up!

You'll probably start with athletic shoes. Be sure to pick shoes designed for the activity you have in mind.

If you're planning to invest in exercise machines, choose something that's practical, enjoyable and easy to use. You may want to try out certain types of equipment at a fitness center before investing in your own equipment. To stretch your exercise dollars, consider buying used equipment.

Step 4: Get started

Now you're ready for action. As you begin your fitness program, keep these tips in mind:

• Start slowly and build up. Give yourself plenty of time to warm up and cool down with easy walking or gentle stretching. Then speed up to a pace you can continue for five to 10 minutes without being able to carry on a conversation with someone but without being exhausted at the end. As your stamina improves, gradually increase the amount of time you exercise. Work your way up to 60 minutes of exercise most days(6) of the week.


• Treat the time that you exercise as the most important part of your day. You are doing this to extend your life and that goal allows you to do more of the other things you want or need to do over a longer lifespan.


• Think different! If you can't get into a good cross-training program, your workout routine should include various activities, such as running, bicycling or playing a sport. But don't stop there. Take a long walk after dinner each night or on your lunch hour. Take a hike with your family or spend an evening dancing.


• Listen to your body. If you feel pain, shortness of breath, dizziness or nausea, take a break. You may be pushing yourself too hard. Consult with your doctor and/or physical therapist and redesign your program accordingly.


• Be flexible. If you're not feeling good, give yourself permission to take a day or two off. As I mentioned before, I take every ninth week off of running, I think it helps my joints to recover.

Step 5: Measure your progress

Retake your personal fitness assessment four weeks after you start your program and then again every month. You may notice that you need to increase the amount of time you exercise in order to continue improving. The goal is to ensure you are exercising just the right amount to meet your fitness goals.

If you lose motivation, set new goals or try a new activity. Exercising with a friend or taking a class at a fitness center may help, too. I do that with one of my co-workers from Brookeside.

Starting an exercise program is an important first step on your path to glucose control. That being said, it doesn't have to be an overwhelming one. By planning carefully and pacing yourself correctly, you can establish a healthy habit that lasts for and extends your lifetime.

Hack #1: Set some goals for yourself

Almost every expert in the area of personal success and achievement outlines the fundamental importance of goal setting as a means of achieving success in any endeavor. It is acknowledgement of this simple fact: you cannot get anywhere if you do not know where you want to go.

You need to have a concrete purpose, a reason for doing what you are doing, indoor to succeed at something. When it comes to change, 98% of us cannot even define what our future goals are and this prevents us from achieving success. You must have a specific goal in mind. Once a goal is set you can take steps every day to achieve your outcome.

When we set goals, we are creating our future in advance. Goals literally allow us to create our own outcomes. We all have goals whether we know it or not. Some people’s goals are to pay their bills while others are just happy to make it through the day. Unfortunately. most people just have lousy goals. Lousy goals create a lousy life. Now that you, or someone you know, has Type II diabetes it is time to set some proper goals. Your life, and the quality of that life, depend on it. Realize that your goals now affect your live everyday you live it.

Our goals should inspire us to do better. Strong and compelling goals drive us to grow and expand and develop ourselves towards what we need to achieve. Compelling goals move us. Done properly and specifically goals transform our health and our lives. My current goal is to achieve and maintain an A1C level less than 5.0 for as long as possible. Every day I think about the steps I need to take in my life to achieve this goal.

You ought to think of goals in the same way you think of a map: if you know where you are and know where you want to go, even if you do get lost, you will find your ultimate destination. Set goals that are way beyond your present abilities and position in life. Focus on an ideal state of health without any inhibitions. As you do this, you will get excited about the possibilities and this excitement will start to drive you forward.

Let's face it, where you are today is based on your past activities and actions (along with some genes). If you choose to limit your future to your past you are not going to get anywhere. You need big hard to achieve goals to drive you forward to where you want to be instead of just settling for your current state of health and taking loads of medicine to counteract your continuing poor choices. Having gained back control over Type II diabetes, you need to set goals for how you are going to life your lives in every area. Emotionally, spiritually, physically, financially, your relationships and your attitudes; set goals for the kind of person you are committed to become.

Something happens the minute you set goals. You become a creator and something clicks. Immediately you change because immediately your expectations of yourself and your life changes. You acknowledge to both your conscious and subconscious minds that you are not satisfied with where you are and this is the driver to get you to do something about it.

One of the major motivating factors in human action is a sense of dissatisfaction. In order to direct your life, you need to use both the positive and the negative consequences of goals. Ask yourself: "What will I gain by attaining my goals?" Ask yourself: "What will it cost me eventually if I do not achieve my goal?" In the case of Type II diabetes, if you set and meet appropriate goals you will enjoy a level of health and fitness that you might not have imagined possible. If you fail to do so, your risk of death by Heart Disease jumps to 30% from 3% and you will face the loss of fingers, toes, eyesight, and a whole host of other nasty outcomes. For me, the choice of what goals to set and meet was crystal clear from Day 1. Hopefully your path will be similar.

The power of goal setting is that it directs our focus. Every great success will testify to your power of focus. We get whatever we focus on - as I've said before, what gets measured get's achieved. In the fantastic book As a Man Thinketh by James Allen, he clearly outlines the power of focusing our thoughts on what we do want from life. Allen says that circumstances does not make the person, but reveals him to himself. We are who and what we are because of our thoughts. Therefore, it becomes critically important to have goals to direct our thoughts and minds and help us focus on what we desire most for ourselves and our lives. Thoughts are things. As you think, so you are and so you will become.

• Set your goals, regardless of previous "failures".


• Start afresh and do it properly.


• Come from a place of strength and believe and watch your life soar to greater heights of happiness and fulfillment.


• Above all, enjoy life for it is a gift and live it with passion. It is all out there.

The only thing that is required of you is to go and get it! Realize that step one is to have a strong enough goal to drive you in the right direction.

What gets measured gets achieved

In many respects, my early training as a statistician and my work in software engineering has benefitted me with a certain world view that has been tremendously useful in gaining control over my type 2 diabetes. I have often remarked to my endocrinologist that this diseases panders to the worst of my measurement proclivities. Yet, I think the soundest diabetes management advice I've can offer is the age old saw; "What gets measured gets done."

In my own life I apply this dictum rigorously. As a type 2 diabetic there are several aspects of your life that you are likely trying to gain control over at once. In my case, I needed to loose weight, increase my level of fitness, reduce the number of carbs in my diet and in so doing, gain control over my blood glucose levels.

In the diabetes management arena, I believe that the desire to regularly, and quantitatively measure of blood lipid and glucose levels provides a much better leading indicator of future health than does paying simple lip service to the need to get control. I suggest monthly measurement. Even though insurance companies might be reluctant to pay for monthly testing, this is penny wise but pound foolish. If you consider the willingness to test monthly as a proxy for the level of commitment to keeping control of the numbers, then it is clearly in a health insurance company's long term self interest to encourage such a testing regimen. Progress should be posted on charts and shared in a common space, a quantitative goal report should be the first item of business at every meeting with your medical team.

Next, I think that all physicians of Type II diabetics need to advocate a much more aggressive exercise program than the standard 30 minutes 3 times a week. I can tell you from personal experience that you need to change your lifestyle. Your goal should be to get your heart rate up to around 85% of your theoretical maximum 5-6 days a week for an hour each time. The table below shows estimated target heart rates for different ages. Look for the age category closest to yours, then read across to find your target heart rate.

Age	Target HR Zone 50–85 %	Avg. Max Heart Rate 100 %
20 years	100–170 beats per minute	200 beats per minute
25 years	98–166 beats per minute	195 beats per minute
30 years	95–162 beats per minute	190 beats per minute
35 years	93–157 beats per minute	185 beats per minute
40 years	90–153 beats per minute	180 beats per minute
45 years	88–149 beats per minute	175 beats per minute
50 years	85–145 beats per minute	170 beats per minute
55 years	83–140 beats per minute	165 beats per minute
60 years	80–136 beats per minute	160 beats per minute
65 years	78–132 beats per minute	155 beats per minute
70 years	75–128 beats per minute	150 beats per minute

Your maximum heart rate is about 220 minus your age. The figures above are averages, so use them as general guidelines. To combat type II diabetes, you need to exercise to supplement your body's diminished ability to help reduce your blood glucose levels. While you should start an aerobic exercise immediately, eventually you will need to combine both aerobic exercise as well as weight lifting.

Celebrate small successes! You should be tracking your workouts against your blood glucose levels and weight and each time you improve by 10% reward yourself!

To get started, modify your workout calendar to get in at least 4 x 1 hour long workouts a week in the next two weeks. To lock the change into place, conduct a detailed, quantitative weekly review (perhaps with your peers) of your progress, as measured by the precise amount of time spent exercising and your heart rate maximum, minimum, and average for those workouts. When you have accomplished that, increase your workouts to 5 x 1 hour long workouts over the next two weeks. In 6 weeks you should be doing 6 x 1 hour long workouts and loving life.

Why don't you plan to make the change today? I can tell you from experience, you'll be glad you did!

The First Day: Change, Change, Change...

My son Zachary's Lacrosse team was having a end of year celebration party the night that I found out. I remember quite clearly my thinking: tonight I'll have my last slices of pizza and tomorrow is the first day of the rest of my life. I needed to do things very differently from now on.

I was 223 lbs. I didn't exercise very much. I had a 40 inch waist. By average blood glucose according to my A1C was 229. My triglycerides were 660. My total cholesterol was 223. None of these numbers were good.

I need to change. Change is a process.

The Stages of Change:

• Precontemplation (Not yet acknowledging that you are headed to type 2 diabetes and you need to change)


• Reality: The unavoidable truth (Acknowledging that there is a problem but not yet ready or sure of wanting to make a change)


• Preparation/Determination (Getting ready to change)


• Commitment (Changing your diet and exercise routines)


• Maintenance (Maintaining your new diet and exercise routines)


• Relapse (Returning to older diet and exercise routines)

Stage One: Precontemplation

In the precontemplation stage, you are not thinking seriously about changing and you are not interested in any kind of help. Likely, you to defend your current bad habit(s) and you do not feel it is a problem. You've probably noticed the changes in your body and there is probably some documentation in you medical record that tells you this was where you were headed, but you didn't think it could happen to you. After all, they called it pre-diabtetes didn't they?

You simply just do not yet see yourself as having a problem.

Are you in the precontemplation stage? Probably not, because the fact that you are reading this likely means you have recently gotten a diagnosis of type 2 diabetes.

(Of course, you may be reading this because you have a loved one who is still in the pre-diabetic stage. If this is the case, keep reading for suggestions about how you can help others progress through their stages of change to take control over their diabetic body)

Reality: The unavoidable truth

In the reality stage you are now aware that clinically you are classified as a diabetic. Although you are able to consider the possibility of changing, you might be ambivalent about it. Certainly there must be some drugs you can take, do you really need to change your lifestyle?

In this stage, you are on a teeter-totter. You weigh the pros and cons of modifying your lifestyle. Although you think about the negative aspects of your diabetes and unhealthy lifestyle and the positives associated with changing your levels of fitness and what you eat, you may doubt that the long-term benefits associated with change will outweigh the short-term pain.

It might take you as little as a day or as long as a lifetime to get through the reality stage. (In fact, some people think and think and think about changing their lifestyle and eating habits and may die never having gotten beyond this stage...)

On the plus side, you are more open to receiving information about your disease, and more likely to actually use educational interventions and reflect on your own feelings and thoughts concerning the impact you can have in controlling your own diabetes through diet and exercise.

Stage Three: Preparation/Determination

In the preparation/determination stage, you have made a commitment to make a change. Your motivation for changing is reflected by statements such as: “I’ve got to do something about this — this is serious. Something has to change. What can I do?”

This is sort of a research phase: you are now taking small steps toward a positive change in your behavior. You are trying to gather information (sometimes by reading things like this) about what you will need to do to control your diabetes.

You may find yourself calling a lot of people, trying to find out what strategies and resources are available to help you in your goals of managing your diabetes. Too often, people skip this stage: they try to move directly from contemplation into action and fall flat on their faces because they haven’t adequately researched or accepted what it is going to take to make this major lifestyle change.

Stage Four: Commitment

This is the stage where you commit to change your behavior. You are actively involved in taking steps to change your eating habits and fitness level.

Believe it or not, this can be the shortest of all the stages. The amount of time you spend in commitment varies. It generally lasts about 6 months, but it can literally be as short as one hour! This is a stage when you most depend on your own willpower. You are making overt efforts to change the behaviors and eating habits and are at greatest risk for relapse.

Mentally, you review your commitment to yourself and develop plans to deal with both personal and external pressures that may lead to slips. You may use short-term rewards to sustain your motivation, and analyze your behavior change efforts in a way that enhances your self-confidence. People in this stage also tend to be open to receiving help and are also likely to seek support from others (a very important element).

Hopefully, you will then move to:

Stage Five: Maintenance

Maintenance involves being able to successfully at changing your level of fitness and eating habits. The goal of the maintenance stage is to maintain the new status quo. People in this stage tend to remind themselves of how much progress they have made.

People in maintenance constantly reformulate the rules of their lives and are acquiring new skills to deal with life and avoid relapse. You are able to anticipate the situations in which a relapse could occur and prepare coping strategies in advance.

You will remain aware that what you are striving for is personally worthwhile and meaningful. You are patient with yourself and recognize that it often takes a while to let go of old behavior patterns and practice new ones until they are second nature. Even though you may have thoughts of returning to your old bad eating habits and low level of fitness, you resist the temptation and stay on track.

As you progress through your own stages of change, it can be helpful to re-evaluate your progress in moving up and down through these stages.

(Even in the course of one day, you may go through several different stages of change).

And remember: it is normal and natural to regress, to attain one stage only to fall back to a previous stage. This is just a normal part of making changes in your behavior.

Additionally, there will be some foods that are not healthy for you as a diabetic but that you simply must eat from time to time. To this end, you should plan some sort of semiannual day where you will eat anything you want for a day and not worry about your blood glucose levels.

Relapse

Along the way to permanent change, most people experience relapse. In fact, it is much more common to have at least one relapse than not. Relapse is often accompanied by feelings of discouragement and seeing yourself as a failure.

While relapse can be discouraging, the majority of people who successfully change any ingrained behavioral pattern do not follow a straight path to a life time free of self-destructive bad habits. Rather, they cycle through the five stages several times before achieving a stable life style change. Consequently, the Stages of Change Model considers relapse to be normal.

There is a real risk that people who relapse will experience an immediate sense of failure that can seriously undermine their self-confidence. The important thing is that if they do slip and say, not exercise as they had planned for a week, they shouldn’t see themselves as having failed.

Rather, they should analyze how the slip happened and use it as an opportunity to learn how to cope differently. In fact, relapses can be important opportunities for learning and becoming stronger.

Relapsing is like falling off a horse — the best thing you can do is get right back on again. However, if you do “fall off the horse” and relapse, it is important that you do not fall back to the precontemplation or contemplation stages. Rather, restart the process again at preparation, determination or even the maintenance stages.

You need to learn how to handle unexpected episodes of stress without letting it impact your diet or exercise routines. This gives you a stronger sense of self control and the ability to get back on track and stay there. Controlling your diabetes through lifestyle changes will help stave off the day when medication is the only mechanism to control your blood glucose levels.


Transcendence

Eventually, if you “maintain maintenance” long enough, you will reach a point where you will be able to work with your emotions and understand your own diabetes and view it in a new light. This is the stage of “transcendence,” a transcendence to a new life. In this stage, not only is your old lifestyle no longer an integral part of your life but to return to it would seem atypical, abnormal, even weird to you.

When you reach this point in your process of change, you will know that you have transcended the your old lifestyle and that you are truly becoming a new “you", a person who is in control of their type 2 diabetes through the use of diet and exercise.

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I was lucky that I went from reality to total commitment in 24 hours. I've been working towards trancendence for a little over a year now, and I'm making some progress. If you look at my success charts, you can see my journey for the last year. In my next post, I'll explain what it took to drop the weight, and change my blood glucose and lipid profile in such a dramatic fashion.