WASHINGTON – Food hijacked Dr. David Kessler's brain. Not apples or carrots. The scientist who once led the government's attack on addictive cigarettes can't wander through part of San Francisco without craving a local shop's chocolate-covered pretzels. Stop at one cookie? Rarely.
It's not an addiction but it's similar, and he's far from alone. Kessler's research suggests millions share what he calls "conditioned hypereating" — a willpower-sapping drive to eat high-fat, high-sugar foods even when they're not hungry.
In a book being published next week, the former Food and Drug Administration chief brings to consumers the disturbing conclusion of numerous brain studies: Some people really do have a harder time resisting bad foods. It's a new way of looking at the obesity epidemic that could help spur fledgling movements to reveal calories on restaurant menus or rein in portion sizes.
"The food industry has figured out what works. They know what drives people to keep on eating," Kessler tells The Associated Press. "It's the next great public health campaign, of changing how we view food, and the food industry has to be part of it."
He calls the culprits foods "layered and loaded" with combinations of fat, sugar and salt — and often so processed that you don't even have to chew much.
Overeaters must take responsibility, too, and basically retrain their brains to resist the lure, he cautions.
"I have suits in every size," Kessler writes in "The End of Overeating." But, "once you know what's driving your behavior, you can put steps into place" to change it.
At issue is how the brain becomes primed by different stimuli. Neuroscientists increasingly report that fat-and-sugar combinations in particular light up the brain's dopamine pathway — its pleasure-sensing spot — the same pathway that conditions people to alcohol or drugs.
Where did you experience the yum factor? That's the cue, sparking the brain to say, "I want that again!" as you drive by a restaurant or plop before the TV.
"You're not even aware you've learned this," says Dr. Nora Volkow, chief of the National Institute on Drug Abuse and a dopamine authority who has long studied similarities between drug addiction and obesity.
Volkow is a confessed chocoholic who salivates just walking past her laboratory's vending machine. "You have to fight it and fight it," she said.
Conditioning isn't always to blame. Numerous factors, including physical activity, metabolism and hormones, play a role in obesity.
And the food industry points out that increasingly stores and restaurants are giving consumers healthier choices, from allowing substitutions of fruit for french fries to selling packaged foods with less fat and salt.
But Kessler, now at the University of California, San Francisco, gathered colleagues to help build on that science and learn why some people have such a hard time choosing healthier:
_First, the team found that even well-fed rats will work increasingly hard for sips of a vanilla milkshake with the right fat-sugar combo but that adding sugar steadily increases consumption. Many low-fat foods substitute sugar for the removed fat, doing nothing to help dieters eat less, Kessler and University of Washington researchers concluded.
_Then Kessler culled data from a major study on food habits and health. Conditioned hypereaters reported feeling loss of control over food, a lack of satiety, and were preoccupied by food. Some 42 percent of them were obese compared to 18 percent without those behaviors, says Kessler, who estimates that up to 70 million people have some degree of conditioned hypereating.
_Finally, Yale University neuroscientist Dana Small had hypereaters smell chocolate and taste a chocolate milkshake inside a brain-scanning MRI machine. Rather than getting used to the aroma, as is normal, hypereaters found the smell more tantalizing with time. And drinking the milkshake didn't satisfy. The reward-anticipating region of their brains stayed switched on, so that another brain area couldn't say, "Enough!"
People who aren't overweight can be conditioned hypereaters, too, Kessler found — so it's possible to control.
Take Volkow, the chocolate-loving neuroscientist. She's lean, and a self-described compulsive exerciser. Physical activity targets the dopamine pathway, too, a healthy distraction.
Smoking didn't start to drop until society's view of it as glamorous and sexy started changing, to view the habit as deadly, Kessler notes.
Unhealthy food has changed in the other direction. Foods high in fat, sugar and salt tend to be cheap; they're widely sold; and advertising links them to good friends and good times, even as social norms changed to make snacking anytime, anywhere acceptable.
Retrain the brain to think, "I'll hate myself if I eat that," Kessler advises. Lay down new neural reward circuits by substituting something else you enjoy, like a bike ride or a healthier food.
Make rules to resist temptation: "I'm going to the mall but bypassing the food court."
And avoid cues for bad eating whenever possible. Always go for the nachos at your friends' weekend gathering spot? Start fresh at another restaurant.
"I've learned to eat things I like but things I can control," Kessler says. But he knows the old circuitry dies hard: "You stress me enough and I'll go pick up that bagel."
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EDITOR's NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
Senin, 20 April 2009
When unhealthy foods hijack overeaters' brains
Study paints picture of collegiate mental health
STATE COLLEGE, Pa. – Ever since campus counseling centers were established in the 1940s, college officials have known that the prevalence and severity of students' mental health problems were rising. They just didn't know by how much.
A pilot study released Monday by the Center for the Study of Collegiate Mental Health, at Penn State University, hopes to fill that void. Organizers call it a first-of-its kind effort by college counseling centers designed to get an up-to-date picture of mental health trends affecting higher education.
Most schools collect data of counseling center clients on their own. Until now, though, there have been no national data to help study perceived trends, organizers said.
"Mental health affects every aspect of a college student's functioning," said Ben Locke, executive director of the center. "The earlier you intervene in mental health issues, the more likely you are to be successful in treating it."
The numbers will further help colleges and universities equip themselves to support students, Locke said.
The Association for University and College Counseling Center Directors does a separate annual survey of its members. That survey estimated that about 1 in 10 college students seek treatment from campus counseling centers.
But the Penn State study is the first to get data from the counseling center clients themselves, Locke said.
"This is actual data from the counseling centers: the clients who are coming in, what they're saying," said Robert Rando, the director of counseling and wellness services at Wright State University in Dayton, Ohio. "It's accurate in that way, and no one has done that."
There is concern about the increased severity of mental health problems counseling centers are seeing among student clients, in part because of the increased use of medications such as Prozac by high school students, Rando said.
The collaboration began four years ago, but data collection began only in fall 2008.
The effort had been in the works before the high-profile campus shootings at Virginia Tech in 2007 and Northern Illinois University last year.
The killing of 33 people, including the gunman, at Virginia Tech and five people at Northern Illinois put a spotlight on campus counseling services and risk reduction, said Dennis Heitzmann, director of counseling and psychological services at Penn State.
"What this effort will do will keep our work in the forefront, identify the importance of our function before the administration, parents and students themselves," Heitzmann said.
More than 130 schools nationwide are registered with the center. Of them, 66 participated in the initial study, with responses from more than 28,000 students who received mental health services in fall 2008.
Each counseling center asked clients to answer standardized questions, with the data pooled nationally. All data were anonymous.
Among the study's findings:
• One percent of students who answered a question about binge drinking reported going on a binge 10 or more times in the previous two weeks. Nearly half of those respondents said they had seriously considered suicide in the past.
• The vast majority (93 percent) of students who responded to a question about campus violence had little to no fear of losing control and acting violently.
• The 7 percent considered to have strong fears were most likely to be male and said they had previously harmed another person. They also tended to have experienced a cluster of other symptoms, such as a fear of having a panic attack or suicidal thoughts.
The results "don't translate into a guaranteed assessment or reliable profile at any point, but they offer a starting point in assessing risk in counseling center clients," Locke said.
The center has received $45,000 in funding over the past five years, Locke said. The Jed Foundation, a nonprofit that describes itself as trying to reduce suicides and emotional distress among college students, is listed as a past contributor.
The center also requires members to pay a $150 annual fee. In addition, researchers have received about $100,000 in in-kind funding from Titanium Software.
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AP IMPACT: Tons of released drugs taint US water
U.S. manufacturers, including major drugmakers, have legally released at least 271 million pounds of pharmaceuticals into waterways that often provide drinking water — contamination the federal government has consistently overlooked, according to an Associated Press investigation.
Hundreds of active pharmaceutical ingredients are used in a variety of manufacturing, including drugmaking: For example, lithium is used to make ceramics and treat bipolar disorder; nitroglycerin is a heart drug and also used in explosives; copper shows up in everything from pipes to contraceptives.
Federal and industry officials say they don't know the extent to which pharmaceuticals are released by U.S. manufacturers because no one tracks them — as drugs. But a close analysis of 20 years of federal records found that, in fact, the government unintentionally keeps data on a few, allowing a glimpse of the pharmaceuticals coming from factories.
As part of its ongoing PharmaWater investigation about trace concentrations of pharmaceuticals in drinking water, AP identified 22 compounds that show up on two lists: the EPA monitors them as industrial chemicals that are released into rivers, lakes and other bodies of water under federal pollution laws, while the Food and Drug Administration classifies them as active pharmaceutical ingredients.
The data don't show precisely how much of the 271 million pounds comes from drugmakers versus other manufacturers; also, the figure is a massive undercount because of the limited federal government tracking.
To date, drugmakers have dismissed the suggestion that their manufacturing contributes significantly to what's being found in water. Federal drug and water regulators agree.
But some researchers say the lack of required testing amounts to a 'don't ask, don't tell' policy about whether drugmakers are contributing to water pollution.
"It doesn't pass the straight-face test to say pharmaceutical manufacturers are not emitting any of the compounds they're creating," said Kyla Bennett, who spent 10 years as an EPA enforcement officer before becoming an ecologist and environmental attorney.
Pilot studies in the U.S. and abroad are now confirming those doubts.
Last year, the AP reported that trace amounts of a wide range of pharmaceuticals — including antibiotics, anti-convulsants, mood stabilizers and sex hormones — have been found in American drinking water supplies. Including recent findings in Dallas, Cleveland and Maryland's Prince George's and Montgomery counties, pharmaceuticals have been detected in the drinking water of at least 51 million Americans.
Most cities and water providers still do not test. Some scientists say that wherever researchers look, they will find pharma-tainted water.
Consumers are considered the biggest contributors to the contamination. We consume drugs, then excrete what our bodies don't absorb. Other times, we flush unused drugs down toilets. The AP also found that an estimated 250 million pounds of pharmaceuticals and contaminated packaging are thrown away each year by hospitals and long-term care facilities.
Researchers have found that even extremely diluted concentrations of drugs harm fish, frogs and other aquatic species. Also, researchers report that human cells fail to grow normally in the laboratory when exposed to trace concentrations of certain drugs. Some scientists say they are increasingly concerned that the consumption of combinations of many drugs, even in small amounts, could harm humans over decades.
Utilities say the water is safe. Scientists, doctors and the EPA say there are no confirmed human risks associated with consuming minute concentrations of drugs. But those experts also agree that dangers cannot be ruled out, especially given the emerging research.
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Two common industrial chemicals that are also pharmaceuticals — the antiseptics phenol and hydrogen peroxide — account for 92 percent of the 271 million pounds identified as coming from drugmakers and other manufacturers. Both can be toxic and both are considered to be ubiquitous in the environment.
However, the list of 22 includes other troubling releases of chemicals that can be used to make drugs and other products: 8 million pounds of the skin bleaching cream hydroquinone, 3 million pounds of nicotine compounds that can be used in quit-smoking patches, 10,000 pounds of the antibiotic tetracycline hydrochloride. Others include treatments for head lice and worms.
Residues are often released into the environment when manufacturing equipment is cleaned.
A small fraction of pharmaceuticals also leach out of landfills where they are dumped. Pharmaceuticals released onto land include the chemo agent fluorouracil, the epilepsy medicine phenytoin and the sedative pentobarbital sodium. The overall amount may be considerable, given the volume of what has been buried — 572 million pounds of the 22 monitored drugs since 1988.
In one case, government data shows that in Columbus, Ohio, pharmaceutical maker Boehringer Ingelheim Roxane Inc. discharged an estimated 2,285 pounds of lithium carbonate — which is considered slightly toxic to aquatic invertebrates and freshwater fish — to a local wastewater treatment plant between 1995 and 2006. Company spokeswoman Marybeth C. McGuire said the pharmaceutical plant, which uses lithium to make drugs for bipolar disorder, has violated no laws or regulations. McGuire said all the lithium discharged, an annual average of 190 pounds, was lost when residues stuck to mixing equipment were washed down the drain.
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Pharmaceutical company officials point out that active ingredients represent profits, so there's a huge incentive not to let any escape. They also say extremely strict manufacturing regulations — albeit aimed at other chemicals — help prevent leakage, and that whatever traces may get away are handled by onsite wastewater treatment.
"Manufacturers have to be in compliance with all relevant environmental laws," said Alan Goldhammer, a scientist and vice president at the industry trade group Pharmaceutical Research and Manufacturers of America.
Goldhammer conceded some drug residues could be released in wastewater, but stressed "it would not cause any environmental issues because it was not a toxic substance at the level that it was being released at."
Several big drugmakers were asked this simple question: Have you tested wastewater from your plants to find out whether any active pharmaceuticals are escaping, and if so what have you found?
No drugmaker answered directly.
"Based on research that we have reviewed from the past 20 years, pharmaceutical manufacturing facilities are not a significant source of pharmaceuticals that contribute to environmental risk," GlaxoSmithKline said in a statement.
AstraZeneca spokeswoman Kate Klemas said the company's manufacturing processes "are designed to avoid, or otherwise minimize the loss of product to the environment" and thus "ensure that any residual losses of pharmaceuticals to the environment that do occur are at levels that would be unlikely to pose a threat to human health or the environment."
One major manufacturer, Pfizer Inc., acknowledged that it tested some of its wastewater — but outside the United States.
The company's director of hazard communication and environmental toxicology, Frank Mastrocco, said Pfizer has sampled effluent from some of its foreign drug factories. Without disclosing details, he said the results left Pfizer "confident that the current controls and processes in place at these facilities are adequately protective of human health and the environment."
It's not just the industry that isn't testing.
FDA spokesman Christopher Kelly noted that his agency is not responsible for what comes out on the waste end of drug factories. At the EPA, acting assistant administrator for water Mike Shapiro — whose agency's Web site says pharmaceutical releases from manufacturing are "well defined and controlled" — did not mention factories as a source of pharmaceutical pollution when asked by the AP how drugs get into drinking water.
"Pharmaceuticals get into water in many ways," he said in a written statement. "It's commonly believed the majority come from human and animal excretion. A portion also comes from flushing unused drugs down the toilet or drain; a practice EPA generally discourages."
His position echoes that of a line of federal drug and water regulators as well as drugmakers, who concluded in the 1990s — before highly sensitive tests now used had been developed — that manufacturing is not a meaningful source of pharmaceuticals in the environment.
Pharmaceutical makers typically are excused from having to submit an environmental review for new products, and the FDA has never rejected a drug application based on potential environmental impact. Also at play are pressures not to delay potentially lifesaving drugs. What's more, because the EPA hasn't concluded at what level, if any, pharmaceuticals are bad for the environment or harmful to people, drugmakers almost never have to report the release of pharmaceuticals they produce.
"The government could get a national snapshot of the water if they chose to," said Jennifer Sass, a senior scientist for the Natural Resources Defense Council, "and it seems logical that we would want to find out what's coming out of these plants."
Ajit Ghorpade, an environmental engineer who worked for several major pharmaceutical companies before his current job helping run a wastewater treatment plant, said drugmakers have no impetus to take measurements that the government doesn't require.
"Obviously nobody wants to spend the time or their dime to prove this," he said. "It's like asking me why I don't drive a hybrid car? Why should I? It's not required."
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After contacting the nation's leading drugmakers and filing public records requests, the AP found two federal agencies that have tested.
Both the EPA and the U.S. Geological Survey have studies under way comparing sewage at treatment plants that receive wastewater from drugmaking factories against sewage at treatment plants that do not.
Preliminary USGS results, slated for publication later this year, show that treated wastewater from sewage plants serving drug factories had significantly more medicine residues. Data from the EPA study show a disproportionate concentration in wastewater of an antibiotic that a major Michigan factory was producing at the time the samples were taken.
Meanwhile, other researchers recorded concentrations of codeine in the southern reaches of the Delaware River that were at least 10 times higher than the rest of the river.
The scientists from the Delaware River Basin Commission won't have to look far when they try to track down potential sources later this year. One mile from the sampling site, just off shore of Pennsville, N.J., there's a pipe that spits out treated wastewater from a municipal plant. The plant accepts sewage from a pharmaceutical factory owned by Siegfried Ltd. The factory makes codeine.
"We have implemented programs to not only reduce the volume of waste materials generated but to minimize the amount of pharmaceutical ingredients in the water," said Siegfried spokeswoman Rita van Eck.
Another codeine plant, run by Johnson & Johnson subsidiary Noramco Inc., is about seven miles away. A Noramco spokesman acknowledged that the Wilmington, Del., factory had voluntarily tested its wastewater and found codeine in trace concentrations thousands of times greater than what was found in the Delaware River. "The amounts of codeine we measured in the wastewater, prior to releasing it to the City of Wilmington, are not considered to be hazardous to the environment," said a company spokesman.
In another instance, equipment-cleaning water sent down the drain of an Upsher-Smith Laboratories, Inc. factory in Denver consistently contains traces of warfarin, a blood thinner, according to results obtained under a public records act request. Officials at the company and the Denver Metro Wastewater Reclamation District said they believe the concentrations are safe.
Warfarin, which also is a common rat poison and pesticide, is so effective at inhibiting growth of aquatic plants and animals it's actually deliberately introduced to clean plants and tiny aquatic animals from ballast water of ships.
"With regard to wastewater management we are subject to a variety of federal, state and local regulation and oversight," said Joel Green, Upsher-Smith's vice president and general counsel. "And we work hard to maintain systems to promote compliance."
Baylor University professor Bryan Brooks, who has published more than a dozen studies related to pharmaceuticals in the environment, said assurances that drugmakers run clean shops are not enough.
"I have no reason to believe them or not believe them," he said. "We don't have peer-reviewed studies to support or not support their claims."
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Associated Press Writer Don Mitchell in Denver contributed to this report.
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The AP National Investigative Team can be reached at investigate (at) ap.org
Studies find factories release pharmaceuticals
Federal scientists testing for pharmaceuticals in water have been finding significantly more medicine residues in sewage downstream from public treatment facilities that handle waste from drugmakers.
Early results from two pivotal federal studies compare wastewater at treatment plants that handle sewage from drugmakers with those that do not. The studies cover just a small fraction of the 1,886 pharmaceutical manufacturing facilities counted in a 2006 U.S. Census report.
In one study, samples taken at two treatment plants down the sewer line from drugmaking factories contained a range of pharmaceuticals — among them opiates, a barbiturate and a tranquilizer at "much higher detection frequencies and concentrations" than samples taken at other plants, according to preliminary research by the U.S. Geological Survey.
One drug, the muscle relaxant metaxalone, was measured in treated sewage at concentrations hundreds of times higher than the level at which federal regulators can order a review of a drug's environmental impact.
Based on secrecy agreements with the researchers, the treatment plants were not identified.
USGS researcher Herb Buxton, who co-chairs a White House task force on pharmaceuticals in the environment, said it's important that federal scientists test the pharmaceutical industry's claims that their wastewater is not a meaningful source of pharmaceuticals in water.
"It's critical that those types of assumptions are confirmed through real testing," said Buxton.
In another study, Environmental Protection Agency researchers tested sewage at a municipal wastewater treatment plant in Kalamazoo, Mich., that serves a major Pfizer Inc. factory. Bruce Merchant, Kalamazoo's public services director, provided data that showed unusually high concentrations of the antibiotic lincomycin entering the plant, a drug the factory was producing around the time samples were collected.
"There's some product going down the drain," said Merchant.
While nearly all the lincomycin was removed during wastewater treatment, some did survive. According to a separate 2008 study, lincomycin combined in minute concentrations with several other drugs that also have been detected in surface water made human cancer and kidney cells and fish liver cells proliferate.
Biologist Francesco Pomati, at the University of New South Wales in Sydney, Australia, was so concerned with the findings that he and his colleagues warned that chronic exposure to the combination of drugs via drinking water could be "a potential hazard for particular human conditions, such as pregnancy or infancy."
In earlier experiments, lincomycin acted as a mutagen, changing genetic information in bacteria, algae, microscopic aquatic animals and fish.
Pfizer spokesman Rick Chambers said that while the company does not test wastewater from the facility for the drugs made on site, "compliance with all environmental, health and safety laws is imperative to our business operations worldwide."
The two domestic studies follow a burst of recent research in Asia and Europe that has started to link factories to the presence in water of drugs including the antibiotic sulfamethoxazole, the pain reliever diclofenac and the anticonvulsant carbamazepine, as well as an antihistamine, female sex hormones and aspirin.
Researchers in India, where multinational companies have increasingly turned for the manufacture of raw pharmaceutical ingredients, found that 100 pounds a day of the antibiotic ciprofloxacin enters a river from a wastewater treatment plant that processes sewage from dozens of pharmaceutical makers.
In Switzerland, a study sponsored by drugmaking giant Roche documented that 0.2 percent of active pharmaceutical ingredients escape during its own processing. That kind of loss rate doesn't sound like a lot until it's projected out over the entire annual production of drugs worldwide. Studies in Taiwan and China also suggest drugmaking plants discharge product.
All of which raises questions about U.S. manufacturing.
"Is it as bad in the U.S. as it is in India? Probably not. But it does make me think we should test," said Kyla Bennett, a former EPA enforcement officer who is now an ecologist and environmental attorney.
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Diabetes? Some beat it, but are they cured?
JoAnne Zoller Wagner's diagnosis as prediabetic wasn't enough to compel her to change her habits and lose 30 pounds. Not even with the knowledge her sister had died because of diabetes.
"I didn't have that sense of urgency," said the Pasadena, Md., woman.
But nine months later, doctors told Wagner her condition had worsened. She, too, now had Type 2 diabetes.
That scared her into action.
Now, two years later, the 55-year-old woman has slimmed down. She exercises regularly and her blood sugar levels are back in the healthy, normal range. Thanks to her success, she was able to avoid diabetes medication.
Diabetics like Wagner who manage to turn things around, getting their blood sugar under control — either escaping the need for drugs or improving enough to quit taking them — are drawing keen interest from the medical community.
This summer an American Diabetes Association task force will focus on this group of patients and whether they can be considered "cured." Among the points of interest:
_What blood sugar range qualifies as a cure and how long would it have to be maintained?
_How might blood pressure and cholesterol, both linked to diabetes, figure into the equation?
_And what if a "cured" diabetic's blood sugar soars again?
"For right now, we're not saying they're cured, but the bottom line is ... good glucose control, less infections," said Sue McLaughlin, president of health care and education for the American Diabetes Association. The organization has no estimate of how many people fall into that category.
Being overweight is the leading risk for Type 2 diabetes. Genetics also plays a role, and blacks, Hispanics and American Indians are at greater risk than whites.
Nearly 57 million Americans are prediabetic. Another 18 million have been diagnosed with diabetes, while the diabetes association estimates almost 6 million more Americans have diabetes and don't know it. About 90 to 95 percent of diabetics have Type 2, the kind linked to obesity.
The future is potentially even gloomier, with one study estimating that one of every three children born in the U.S. in 2000 will eventually develop diabetes.
But the news isn't all bad. Thirty minutes of daily exercise and a 5 to 10 percent loss in body weight can lower the odds of diabetes by nearly 60 percent and is more effective than medicine in delaying its onset, according to a diabetes prevention study.
Still, such lifestyle changes are often difficult.
"It sounds like such a nonmedical recommendation, and yet it's the thing people say is the toughest to implement," said McLaughlin, the diabetes association official.
For Wagner, it meant changing not just her diet, but her lifestyle. A teacher, she now cooks most of her meals at home and avoids the sweets in the school lounge. She also tries not to stay late at work, using the extra time to exercise and make healthy meals.
Alice Stern describes a similar journey back to health since her diabetes diagnosis in 2007. The 50-year-old Boston woman was able to avoid diabetes drugs through diet and exercise, managing to trim 40 pounds off her 5-foot-2 frame.
"It is about willpower. That's how you make the changes," said Stern.
Even diabetics who have resorted to weight loss surgery have seen their blood sugar levels return to normal.
Lucy Cain, 61, of Dallas tried to control her diabetes through diet and exercise after she was diagnosed in 2004. But she found it difficult, and two years later had gastric bypass surgery. The 5-foot-7 Cain, who once weighed over 300 pounds, is down to about 185, still losing weight and is off diabetes medication.
Whatever the route, weight loss is key, doctors say.
"There is no special diet. You've got to eat fewer calories than your body burns," said Dr. Robert Rizza, a Mayo Clinic endocrinologist and former president of the American Diabetes Association.
Many doctors stop short of calling these successful patients cured.
Dr. Philipp Scherer, director of the diabetes research center at University of Texas Southwestern, describes diabetes as a one-way road. He said it can be stopped in its tracks with diet and exercise, but there's no turning back.
Dr. Kevin Niswender, an assistant professor in the department of medicine at Vanderbilt Medical Center, said "technically, you could call somebody cured," but that patient still needs to be followed closely.
Doctors caution that, for some diabetics, lowering blood sugar may be only temporary. Stress, weight gain and other factors can push it back to unhealthy levels.
"Blood sugars can come down to normal. Then the issue is how long does that last?" said Dr. Sue Kirkman, vice president of clinical affairs for the diabetes association. "Sometimes people start putting weight back on and their blood sugars come back up."
In other cases, patients are diagnosed so late that blood sugar levels can't be brought back to normal, even with weight loss, she said. As the disease progresses, even those who made diet and lifestyle changes might eventually have to go on medications.
That's one reason Wagner and some other diabetics who've managed their disease through diet and exercise are also reluctant to consider themselves "cured."
"American culture, our environment, is not conducive to having good health," said Wagner. She believes diabetes will always be lurking in the background, waiting for her to slip.
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On the Net:
American Diabetes Association: http://www.diabetes.org/
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