Thanks for Publishing my Photo, in D.C.’s Most Hyperlocal Elected Officials Want More Support For Their Neighborhoods | DCist

2017.03.19 Ivy City, Washington, DC USA 01707
2017.03.19 Ivy City, Washington, DC USA 01707 (View on Flickr.com)

Thanks for publishing my photo, @DCist.

It’s of our favorite flag, taken in (still) one of the most up and coming neighborhoods in the District, Ivy City. Enjoy.

Two D.C. Council bills up for consideration next month have prompted citywide discussion about the role of ANCs and the challenges they face with limited resources.

Source: D.C.’s Most Hyperlocal Elected Officials Want More Support For Their Neighborhoods | DCist

Slide update: This food, served by and to health professionals, is supported by current dietary guidelines & Insulin is now the 7th most expensive liquid on 🌎 behind Chanel No. 5. This is how we make sure more people need it.

2019.09.25 Unhealthy Food at Health Professionals Meeting, Washington, DC USA 268 04012-2
2019.09.25 Unhealthy Food at Health Professionals Meeting, Washington, DC USA 268 04012-2 (View on Flickr.com)

I call this an example of a “Meat: No, Diabetes: Yes” policy. It’s colorful, refined, plant-based, insulinogenic, and supported by current dietary guidelines.

2019.09.25 Unhealthy Food at Health Professionals Meeting, Washington, DC USA 268 04015
2019.09.25 Unhealthy Food at Health Professionals Meeting, Washington, DC USA 268 04015 (View on Flickr.com)
2019.09.25 Unhealthy Food at Health Professionals Meeting, Washington, DC USA 268 04014
2019.09.25 Unhealthy Food at Health Professionals Meeting, Washington, DC USA 268 04014 (View on Flickr.com)

Insulin is now the 7th most expensive liquid on earth ($13,100/gallon), behind Chanel No. 5 ($23,300/gallon).

Unfortunately, this scene is still very common in meetings catered for and by health professionals. It’s professional to give feedback with ❤️, which I did. It was a high quality dialogue, we’re all here to spread health.

2018.05 Low Carb and Low Carbon - Ted Eytan MD-1001 788
2018.05 Low Carb and Low Carbon – Ted Eytan MD-1001 788 (View on Flickr.com)

My suggestion for improvement is not to cater any food to

  1. Eliminate waste (30% of 🌎 food is wasted, number is higher for fruits, vegetables and cereals, lower for meat and dairy)
  2. Keep meetings affordable
  3. Mitigate #ClimateChange caused by increased pharmaceutical and health care use from feeding humans this food ✌️.

As I’ve posted before, I am not the only doctor with concerns:

2018.05 Low Carb and Low Carbon - Ted Eytan MD 7-1001-610
2018.05 Low Carb and Low Carbon – Ted Eytan MD 7-1001-610 (View on Flickr.com)

Understanding Food Waste

Food Waste

For example, Webber (2012) estimates that food waste represents 2.5 percent of U.S. energy consumption per year, and Hall et al. (2009) estimate that the production of this wasted food required the expenditure of around 300 million barrels of oil and over 25 percent of the total freshwater consumed by agriculture in the United States. A more detailed understanding of the resource implications of food loss in the United States, including estimates of the land used to produce wasted food, is not available.Source: USDA ERS – The Estimated Amount, Value, and Calories of Postharvest Food Losses at the Retail and Consumer Levels in the United States

We’re in the era of diabetes reversal, why don’t more doctors know?

Thanks for Publishing my Photo, in The High Line at 10 | Architect Magazine

2019.05.16 The Vessel, New York City, NY USA 0494
2019.05.16 The Vessel, New York City, NY USA 0494 (View on Flickr.com)

Thank you for publishing my photograph, Architect Magazine (@architectmag), in this piece on the High Line.

It was taken at (on top of) the Vessel Sculpture. You can see more of my photos from the vessel in this post – Photos Friday: The Vessel and The Stonewall Inn, New York City, NY USA

Enjoy.

Manhattan’s elevated walkway inspired both a movement and a backlash. A decade later, Karrie Jacobs revisits the project and discovers a surprising truth.

Source: The High Line at 10 | Architect Magazine

Photos from Yesterday, Washington, DC USA – Climate is an Emergency

2019.09.23 Climate Strike DC, Washington, DC USA 266 20021-Edit
2019.09.23 Climate Strike DC, Washington, DC USA 266 20021-Edit (View on Flickr.com)

Photos from Washington, DC, taken via active transportation (of course).

2019.09.23 Climate Strike DC, Washington, DC USA 266 20026
2019.09.23 Climate Strike DC, Washington, DC USA 266 20026 (View on Flickr.com)
  • Climate is an emergency
  • It is known what can be done to mitigate climate change, and it’s probably bigger than arguing over what we eat
  • Physicians and the health care system have an important (and accountable) role to our generation and the generations who come after us

Here’s what our nation’s capital city is seeing in terms of climate:

2018.05 Low Carb and Low Carbon - Ted Eytan MD-1001-781
2018.05 Low Carb and Low Carbon – Ted Eytan MD-1001-781 (View on Flickr.com)
2018.05 Low Carb and Low Carbon - Ted Eytan MD-1001-780
2018.05 Low Carb and Low Carbon – Ted Eytan MD-1001-780 (View on Flickr.com)

Here’s the nexus with health care:

2017.03.23 Impacts of Healthcare on the Environment 0157014
Fig 1. Time series of life cycle GHG emissions from US health care activities. Shown for 2003–2013, in absolute terms (orange bars) and as a share of U.S. national emissions (blue line). Mt = million metric tons.

Eckelman MJ, Sherman J (2016) Environmental Impacts of the U.S. Health Care System and Effects on Public Health. PLoS ONE 11(6): e0157014. doi:10.1371/journal.pone.0157014

2017.03.23 Impacts of Healthcare on the Environment (View on Flickr.com)

2018.05 Low Carb and Low Carbon - Ted Eytan MD 1001-766
2018.05 Low Carb and Low Carbon – Ted Eytan MD 1001-766 (View on Flickr.com)

And data about global methane emissions, a component of of our global warming situation

2018.05 Low Carb and Low Carbon - Ted Eytan MD-1001 776
2018.05 Low Carb and Low Carbon – Ted Eytan MD-1001 776 (View on Flickr.com)

See posts:

Additional photos below. Artist credit: Werk for Peace (@WerkForPeace)

Part 11: Wearing a Continuous Glucose Monitor as a non-diabetic Physician: The Experience (Updated for 2019)

2018.11.21 CGM Sensor 5 with iPhone scanning, Washington, DC USA 08283
2018.11.21 CGM Sensor 5 with iPhone scanning, Washington, DC USA 08283 (View on Flickr.com)

In Part 1 (2018) of this series, I described why a physician without diabetes (me) would wear a continuous glucose monitor (CGM): Why I decided to wear a continuous glucose monitor as a non-diabetic physician

I followed up with a Part 2, which this post updates based on the change in technology.

Disclaimer/Caveats

2018.11.07 Low Carb and Low Carbon 583
2018.11.07 Low Carb and Low Carbon 583 (View on Flickr.com)

Acquiring the device

In the United States, a physician order is required to purchase the device, even if using personal funds (which I did – no health care premium dollars were used to subsidize this experiment). In Canada, this is not the case, as physician colleagues there have been able to purchase the device over the counter. The manufacturer will assist by providing the wording of the order that the physician needs to write to allow access at a retail pharmacy.

The device was initially sold as two devices, a reader and a sensor. The reader is still available, but no longer necessary as the sensor now communicates directly with an iPhone via NFC.

Installation and Operation

2018.09.11 Continuous Glucose Monitoring, Washington, DC USA 1285
It stays put, and it doesn’t hurt. 2018.09.11 Continuous Glucose Monitoring, Washington, DC USA 1285 (View on Flickr.com)

The system is ingeniously put together. I assume it has to be for something as sensitive as diabetes management. The sensor comes with an applicator that pushes a close to 1″ needle into your upper arm, in my case my triceps muscle. The sensor will stay there 24/7 for 14 days. It is safe to bathe, swim, or workout with the sensor in place. I did all of these things, sometimes quite intensively, and the sensor worked for the entire time.

I have now had incidents of sensor loss either due to scraping my arm against a hard object like a door or another person. I tend to walk in a protection stance when I am wearing the device.

I don’t mind being asked what it is wherever I go. It’s a good test to see how much the population knows about this technology (not very much at all) or the experience of having diabetes. Currently 88% of the US population does not have diabetes. In a future iteration, it might be nice to have a flesh colored sensor that doesn’t stand out as much. In my situation, though, I’ve loved every conversation started with the device.

This brand of meter arrives calibrated; it will be 1 hour before you get your first reading, and then readings will occur every 15 minutes if you don’t do anything. You can acquire readings more frequently if you’d like, up to 1 a minute.

The sensor will store 8 hours of readings, which means you need to scan the sensor at least that often, or you will lose data. This experience, of being tethered to a device like this, was a good experience for me to have. Why? Because all I needed to do was wand the sensor every 8 hours. This is a fraction of the work that a person living with diabetes must do to maintain their health and prevent life threatening complications.

When a reading is scanned, there’s an option to include information about food (carbohydrate counts), exercise, or other custom notes. The device keeps track of pre-meal and post-prandial readings, which is nice.

The Interface and the Software

The iPhone app has a fairly simple interface and will do some basic trending.

There are two official software options to analyze the data: A desktop software program, and web-based one. The desktop software only works with the older reader-version of the kit. I now exclusively use the web-based version of the software. The phone automatically uploads all readings to the manufacturer’s cloud for analysis.

The iOS software is more elegant in terms of setup and manages a few issues that I noticed with the desktop software’s assumptions about target glucose level and carbs per meal.

The interesting thing is, there’s really no reference on what a glucose level should be for a non-diabetic person on a 24/7 basis. There’s this guidance from Richard Bernstein, MD:

“Keep Your Glucose Levels Tightly Controlled Between 70 and 100 mg/dl all day long, everyday… or else you will pay the consequences.”Source

I am managing to do that quite well, and where I used to do sophisticated analysis with the raw data, I find I can tell stories from the data that’s presented day by day, like this one:

Isn’t it amazing how the liver can shovel glucose into the tissues at high speed, on demand, even though none (glucose) has been eaten (it is):

2019.09.18 Grass Finished Beef, Washington, DC USA 261 01012
2019.09.18 Grass Finished Beef, Washington, DC USA 261 01012 (View on Flickr.com) See post: Recipe: Beef Meatballs – Grass Fed, Grass Finished
2018.05 Low Carb and Low Carbon - Ted Eytan MD 2-1002 756
2018.05 Low Carb and Low Carbon – Ted Eytan MD 2-1002 756 (View on Flickr.com) See post: Part 10: Wearing a Continuous Glucose Monitor as a non-diabetic Physician: Impact of a (mostly) meat diet; Learning about the lives of people with diabetes

New Insights, Much Wonderment

2018.09.11 Continuous Glucose Monitoring, Washington, DC USA 1198
2018.09.11 Continuous Glucose Monitoring, Washington, DC USA 1198 (View on Flickr.com)

To be able to see how your body regulates glucose is really a thing of wonder that we haven’t been able to do until now. I am in awe of what the body can do, and do it well. At the same time, I am also in awe of the impact of the body failing to do what it needs to do well, and how serious a situation that can be, especially if worsened by the nutrition/advice given by the health profession(s).

The photo to the right is one of my first measurements, from the old (reader) kit

88% of people with prediabetes don’t know it

I understand that things like ECGs are being integrated into the wearable world, but really, they don’t hold a candle to the impact of understanding one of the most important risk factors for health and life. This is especially true in a country where the majority (88%) of people with pre-diabetes don’t know they have it, and are therefore very likely to progress to fulminant diabetes.

2018.05.29 Low Carbohydrate Meetup Washington, DC Presentation  454
2018.05.29 Low Carbohydrate Meetup Washington, DC Presentation 454 (View on Flickr.com)

This paper shows a graphic of the incubation period – up to 10 years before glucose intolerance shows in normal screening

2018.10.24 Low Carb and Low Carbon 572
2018.10.24 Low Carb and Low Carbon 572 (View on Flickr.com)

The future

The old reader has now been integrated into our mobile phone. I’m sure the engineers in Cupertino will be able to tell us what will happen to the sensor… 🙂

Should every human wear a continuous glucose monitor? I’m not sure. Should they wear it episodically to see how they’re doing? Maybe. I previously posted on a paper describing today’s use of CGM in medical practice, and its gaps in not recognizing this device as a part of a diabetes pre-emption strategy.

Will these be integrated into wearable devices eventually anyway? Probably.

I’ve since purchased many more sensors and there are now many parts to this story, which you can access here

My Why (am I doing this)?

I get asked this a lot. Read:

Feel free to ask questions or add comments in the comments.

My disclosures

I have none. You may see a full accounting on this page.

Recipe: Beef Meatballs – Grass Fed, Grass Finished

2019.09.18 Grass Fed Beef Meatballs, Washington, DC USA261 23208
2019.09.18 Grass Fed Beef Meatballs, Washington, DC USA261 23208 (View on Flickr.com)

Recipe time…

This is the last nose-to-tail sourced meal of group I experimented with in the last month or so. I’m learning a lot about regenerative grazing, ruminant agriculture, and respect for the spectrum of humanity working to achieve metabolic health.

When it comes to diet, one size does not fit all – we should not add “as long as it’s our size.” It’s healthy people healthy planet, not one or the other.

The Recipe

It turns out there are a plethora of meatball recipes online. I wanted something very simple, with real food, so I simply took a pound of 78% ground beef, added a real egg, and baked for 20 minutes at 400 degrees.

The blood glucose levels

As predicted, this meal, and every one like it, did not raise blood glucose levels.

Isn’t the human body amazing?

We’re in the era of diabetes reversal, why don’t more doctors know?

2019.09.18 Grass Finished Beef, Washington, DC USA 261 01012
2019.09.18 Grass Finished Beef, Washington, DC USA 261 01012 (View on Flickr.com)

Thanks for Publishing my Photo, PoPville , in “Mayor Bowser Calls On Congress to Grant DC Residents Their Full Democratic Rights by Making Washington, DC the 51st State”

2019.09.14 DC People and Places, Washington, DC USA 257 27038
2019.09.14 DC People and Places, Washington, DC USA 257 27038 (View on Flickr.com)

Thanks (again) for publishing my photo, @Popville, in this piece on the potential of DC Statehood.

This is another view from one of DC’s newest rooftops, in the NoMA neighborhood. Enjoy the photo.

Photo by PoPville flickr user Ted EytanFrom the Mayor’s Office:”Today, Mayor Muriel Bowser testified before the House Oversight and Reform Committee at a hearing on the Washington, DC Admission Act (H.R. 51), the first House hearing on DC statehood in over 25 years. H.R. 51 has been cosponso

Source: PoPville » “Mayor Bowser Calls On Congress to Grant DC Residents Their Full Democratic Rights by Making Washington, DC the 51st State”

Thanks for Publishing my Photo, in The Past, Present, And (Potential) Future Of D.C. Statehood, Explained | DCist

2017.11.23 DC People and Places 0676
2017.11.23 DC People and Places 0676 (View on Flickr.com)

Thank you for publishing my photograph, @DCist, in this timely and informative piece on DC Statehood – it’s an informative read.

The photograph was taken in the Shaw neighborhood in Washington, DC, home and former home to many civil rights leaders/revolutionaries.

Enjoy.

We’ve got answers to all the questions you were afraid to ask about the District’s bid to become the 51st state.

Source: The Past, Present, And (Potential) Future Of D.C. Statehood, Explained | DCist

Thanks for Publishing my Photo, PoPville 

2019.09.14 DC People and Places, Washington, DC USA 257 27015
2019.09.14 DC People and Places, Washington, DC USA 257 27015 (View on Flickr.com)

Thanks for publishing my photograph, @Popville.

The mural in the photo is called “28 Blocks” and you can read about it here: See: Northeast D.C. Gets A New Mural Honoring The Workers Who Built The Lincoln Memorial Statue | WAMU

My photograph was taken from one of Washington, DC’s newest rooftops, of the NoMA neighborhood, which is rapidly transforming (again). It’s why I call it “NoMAgical”

Photo by PoPville flickr user Ted EytanYou can talk about whatever is on your mind – quality of life issues, a beautiful tree you spotted, scuttlebutt, or any random questions/thoughts you may have. But please no personal attacks and no need to correct people’s grammar. This is a place to vent a

Source: PoPville » Random Reader Rant and/or Revel