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Around the same time that the Diabetes Prevention Program in 1992 proved that losing a moderate amount of weight (7%--about 10 or 15 pounds for many people who are overweight) and getting 30 minutes of physical activity five times a week can possibly prevent diabetes, the Finns ran a similar study and came up with similar results.

But there the similarity ends. The Finns actually did something about it. For the past 15 years they’ve been building parks and bicycle paths, changing foods available in schools and restaurants: they've been making healthy choices easier to make. And people have been losing weight, getting fitter and lowering the incidence of type 2 diabetes in Finland. 

As Dr. Pekka Puska, Director General of the National Public Health Institute says in Dr. Francine Kaufman’s documentary, Diabetes Global Epidemic, “You can give people all kinds of information but unless you make the healthy choice the easy choice, it’s not going to be the one people make." The key is connecting the dots from information to action, so in Finland city planning has changed direction so people can more easily be physically active. The central lesson from Finland’s success is it’s human nature to make the easy choice and when you make the easy choice the healthy choice, people will follow: fitness trails now fill Finland's cities and people who otherwise would not be, are on them.

I had the opportunity to reflect on this last week when out of my home town of New York City I was in the heartland, attending a conference in St. Louis. The first morning I was abruptly reminded and saddened to see how poor the choices are across much of America to make healthy choices when it comes to eating. Lodged at a very lovely, star-studded hotel, I was frankly appalled at the dismal breakfast buffet. It appeared the best way to make a healthy choice was to get on line for the fresh omelets. So I did. I got a spinach omelet dripping in butter and when I asked for lettuce and tomato instead of potatoes both grill chefs looked at me like I was speaking a foreign language.

Surveying the breakfast buffet, on tap were gummy scrambled eggs, fruits in canned syrup, bacon, sausage, biscuits with coagulated gravy, sweetened, flavored yogurt, frosted cold cereals and only instant oatmeal in only sweetened flavors like Apple and Cinnamon, Maple Syrup and Brown Sugar. 

My whole four days were an enormous effort to work around the unhealthy selection of foods plentifully available and try to find a few nutritious choices. The one evening my colleagues and I went off premises we took a short ride into historic downtown St. Charles for dinner. Having asked our driver for a good restaurant that offered a variety of foods he recommended Lewis & Clark. It appeared to be a typical family restaurant chain like a Fridays or Houstons. Scanning the menu I immediately saw almost everything was fried. We settled on what I thought would be the healthiest choices: guacamole and a spinach-artichoke dip for appetizers. Both came creamed and with a mound of corn chips. Luckily there were two fish entrees which you could order grilled with steamed veggies which I did. If this is how America eats because this is what we're offered, how can we expect people will not be fat?

The straw that broke my back was breakfast at the St. Louis airport the day I left. In the new concourse there was only one place to sit and eat a meal, at the bar. I ordered scrambled eggs which came with sausage, only white sourdough bread, and when I asked if they could substitute lettuce and tomato for the hash browns, I got my second startled lettuce-and-tomato look. The eggs tasted like they came out of a plastic container not a chicken, the sausage was so salty I'm sure it spiked my blood pressure right then and there, the coffee incidentally was burnt. I felt almost sick after that meal, physically and spiritually. 

Understand, I’m not picking on St. Louis and I’m not saying everyone in this country makes poor health choices; I am saying I experienced how difficult it was to make healthy choices in the course of a day in an ordinary American city, and that it's shameful to hawk at us on morning news programs and magazines that we have to change our eating habits and then make it almost impossible to do so. 

America, shape up--and I'm not talking to those of you who have pounds to lose--but our agriculturalists, industrialists and politicians who let the food industry and big business get away with murder--because frankly they're killing us.

While I'm not going to get into the argument whether pharma companies want to keep people sick to sell drugs, there was an interesting item at the AADE conference to help patients lower their blood pressure--without drugs.

It's called Resperate and claims to be the only non-drug solution to high blood pressure available as an over the counter treatment to lower blood pressure. 

Resp@rate as you can see from the photo is a device that trains you to do therapeutic breathing exercises to slow your breathing so that you your breath intake from 14 to 19 breaths per minute--down to what they call a "therapeutic zone"--just under 10 breaths/minute. The physiological result is muscles surrounding the small blood vessels in your body relax and dilate; blood flows more freely and pressure lowers. 

The company says practicing 15 minutes, 3 to 4 times/week can create a significant all-day reduction in blood pressure. I don't endorse products, especially when I haven't tried them, as I don't have high blood pressure, but it seems worth investigating if you do. 

Of course doing any relaxation technique like meditation or yoga, or right now just slowing down your breathing and taking deeper breaths likely creates a similar effect (including getting the anger out of your life). The trouble with slowing your breath sans device is it's easy to get distracted, but I have done meditation for decades and can attest to the benefits at slowing breathing and clearing the head and taking a break to recharge--and look mom, "no drugs."

As promised, here’s my brief report of the 35^th annual conference of the American Association of Diabetes Educators (AADE). 4,000 educators from around the U.S. and a sprinkling from outside the U.S. convened at the Convention Center in Washington D.C. for four days of lectures to earn credits and learn the latest news regarding drugs, devices and behavioral practices to better help their patients. They are an impassioned group truly wanting to make a difference. Having a concern of my own, why I’m getting red dots every time I inject, each educator I asked went right to work examining the problem and investigating my behavior truly wanting to help, and yes, I did take advantage of my circumstances.   Unfortunately, diabetes educators are dwindling in number each year while patients are increasing, making their work ever-more demanding.

My husband and I descended upon Washington together both eager to hear what educators are learning, teaching, what’s new in the field and how patients are being served and responding. I also wanted to thank, in person, the many experts who were speaking there and have been helping me with the book I’m currently writing, debunking diabetes myths. Arriving the night before the conference began our first self-assigned task was to find fruit for the husband’s next morning breakfast. Within a 20 block radius of downtown D.C. there is not a banana, orange or apple to be had. Trust me, I know; I asked shopkeepers, restauranteurs, passers-by and the hotel concierge. The closest we came was Tang, a powdered orange juice like drink at a CVS drugstore, but alas, not a single piece of fruit. I found it remarkable that blocks away 4,000 people had convened to learn how to help patients improve their diet and eating habits, and yet in our nation’s capital I could not find a piece of fruit. Proving once again diabetes is not just a medical issue, not just a behavioral issue, but also a systemic issue: our society's infrastructure does not support practicing the healthy behaviors we hear about daily on the morning news.

But, forgive me, I digress. The conference was opened by Amparo Gonzalez, current president of the AADE. Her lilting accent welcomed everyone in the huge basement hall where I sat amid a sea of largely Caucasian, middle-aged women, with perhaps one man to every 50 women. Elizabeth Edwards, the key-note speaker, gave an hour long, impassioned address sharing her own experience of living with cancer and built a bridge between all of us who live with a chronic illness. She was real, warm, bright, funny, engaging, shared her darker days with cancer and spent the last 15 minutes comparing Senators McCain and Obama’s health plans. While she promised to be impartial, which I believe she was, she gave both plans low grades letting us know neither is as workable as either politician would have us believe. I left concerned that our already broken health care system is not getting fixed anytime soon. Unfortunately, two days later her broken marriage was being aired on the Convention Center’s TV monitors every few feet.

Here’s what educators are learning:

1. New medicines, largely that deal with type 2 diabetes, and more meds on the horizon indicate diabetes is not merely an insulin problem, gastric hormones are getting more and more attention.
2. The artificial pancreas is inching ever forward in trials largely due to the efforts of  the Juvenile Diabetes Research Foundation.
3. Diabetes educators’ largest hurdle is getting patients to change behaviors: adopt healthier eating habits and exercise.
4. Educators’ second biggest hurdle is once they’ve gotten patients to adopt healthier behaviors, getting them to sustain them. The drop off seems to occur 4-6 weeks later.
5. Educators are being encouraged to shift from being “teachers” instructing patients to being “coaches” partnering with patients.
6. "Peers for Progress" is a new AADE initiative getting underway to utilize patient mentors. We knew it was coming, too many patients for too few educators.
7. Personal note: My book, The ABCs Of Loving Yourself With Diabetes, initially declined by the AADE bookstore because it wasn’t deemed something educators would find useful, sold out in the first few days.