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Prostate cancer options for Veterans – for one VA doctor, it’s personal

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Prostate Cancer


Lifework inspired by grandfather’s illness

While at Northwestern Medical School, Dr. Stacy Loeb learned that her grandfather was diagnosed with prostate cancer. His struggle with the illness inspired her to take on the professional challenge of becoming a clinician and researcher in the field of urology.

She was committed to finding better ways to treat this very common disease for which treatment options often came with difficult side effects. While treatment is usually less traumatic than it was even ten years ago, Dr. Loeb’s research continually looks for even better ways to manage prostate cancer.

Loeb is the daughter of a Navy Veteran and granddaughter of a Veteran who served in the Air Force in WW II.

She is a urologist at VA NY Harbor Healthcare System (Manhattan Campus) and assistant professor in the urology and population health departments at NYU School of Medicine.

She currently splits her time between seeing patients and research for multiple studies. She says she, “loves the combination,” explaining that it allows her to experience in a “full circle way,” the results of each discussion with a patient in the exam room, leading to new research ideas and then bringing the results back to the clinic to help improve patient care. Her time spent in each of these areas can lend itself, in real-time fashion, to immediate results.

All in the VA family

Loeb is proud to be working with VA at the forefront of these studies. Prostate cancer treatment and research are never far from her mind. Her husband, Dr. James Borin, is also a VA New York urologist who directs the robotic urology program for patients pursuing surgical management.

Funded by research grants from the National Institutes of Health, the New York State Department of Health, and the Prostate Cancer Foundation, Loeb and her team are able to advance the research of prostate

cancer. They are specifically studying a recent trend of what is known as “active surveillance” or “watchful waiting,” that reduces the rush to treatment and opts out of immediate surgery or radiation. For men with low-risk prostate cancer, this is a safe option that can preserve the quality of life. Personal goals and quality of life vary greatly from patient to patient and treatment options need to be tailored to these preferences.

Loeb’s research is garnering national attention. Research for which she was a primary investigator was published in the May 15 issue of Journal of the American Medical Association (JAMA). Record numbers of Veterans diagnosed with non-aggressive prostate cancer are heeding the advice of international medical experts and opting out of immediate surgery or radiation to treat their cancer.

Postponing surgery: watchful waiting

Instead, according to a study led by Loeb and her colleagues from the Manhattan campus of the VA NY Harbor Healthcare System, NYU School of Medicine, and its Perlmutter Cancer Center, increasing numbers of these men are electing to postpone additional therapy unless their symptoms worsen — a passive practice called watchful waiting — or they are choosing so-called active surveillance.

This program relies on regular check-ups, including blood tests, physical exams, and the occasional needle sampling of prostate tissue to check for any signs of a tumor getting worse, such as fast growth, before aggressive treatment is considered.

One of the largest studies of its kind, it involved a review of the medical records of 125,083 former servicemen, mostly over the age of 55, who were newly diagnosed with low-risk prostate cancer between 2005 and 2015.

Taking this research to the next step, Loeb and her team are developing a complex mathematical model guide to best practices on the type and frequency of testing to be used during active surveillance. Their hope is that this research can expand the use of active surveillance and help more men with favorable risk prostate cancer avoid unnecessary treatment.


Blood pressure medication recalled because it gives you cancer instead

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Blood Pressure


If you’re on a drug for high blood pressure or heart failure, it’s pretty likely that you’re doing your best to keep your body in working order. However, some patients with heart issues have recently found themselves trading one life-threatening condition with the risk of another.

VA and IBM Watson Health Extend Partnership to Support Veterans With Cancer

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IBM Watson


Today the U.S. Department of Veterans Affairs (VA) and IBM Watson Health announced the extension of a public-private partnership to apply artificial intelligence (AI) to help interpret cancer data in the treatment of Veteran patients.

VA Prostate Cancer Program Update - Watchful Waiting May Be Best Option

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Prostate Cancer


When Ben Pfeiffer was diagnosed with prostate cancer in April, his urologist noted in the biopsy report that he was leaning toward recommending that Pfeiffer have his prostate surgically removed. But Pfeiffer, 58, a married construction supervisor from Las Vegas with two grown daughters, said his wife insisted that he get a second opinion. It’s a good thing she did. The doctors Pfeiffer subsequently visited at the University of California Los Angeles (UCLA) and the University Of California San Francisco (UCSF) did not believe surgery was needed. Pfeiffer said the results of the tests, which included genomic testing, showed he had a nonaggressive cancer that made him a good candidate for something called active surveillance, also known as “watchful waiting.” In other words: No need for surgery or radiation at this time. And perhaps never.

How to Manage Your Type 2 Diabetes with Diet

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In 2015 9,4 % of the American population had diabetes, according to the American Diabetes Association. That is 30 million people with diabetes and the organization also reported that 84,1 million Americans had prediabetes, meaning they have elevated blood glucose levels, but not high enough to be considered diabetic. 1,5 million Americans are diagnosed with type 2 diabetes every year and diabetes is the 7th leading cause of death in America. Type 2 diabetics make up the majority of people with diabetes. Furthermore, an estimated 415 million people worldwide had been diagnosed with diabetes.

The signs of having diabetes can be various and the consequences can plentiful. Diabetes is an illness that can be debilitating, lower your life quality, and even have fatal consequences as a result of the additional diseases and conditions you can develop if your diabetes is not managed properly – but did you know, that diabetes be managed through your diet?

You Are What You Eat

The food you consume and the fluids you ingest impact your body in numerous ways. Sugar of one kind or another are present in most foods, in varying amounts. This sugar, be it sucrose, fructose, or galactose, needs to be separated from the food in order to be broken down and used by the body. This happens with the help of insulin. In short, insulin is a pancreatic hormone that transports sugar from food into the body’s cells to be used for fuel when needed. The body’s resistance to insulin is measured by its ability to remove glucose (sugar) from the blood and thereby maintaining stable blood glucose levels.

Diabetes is a medical condition that occurs when your body is unable to produce enough insulin to regulate the blood glucose levels, or if your body cannot use its produced insulin efficiently enough. This causes the sugar to stay in the blood stream instead of entering the cells, thus resulting in high blood glucose levels.

There are three types of diabetes: Type 1, type 2, and gestational diabetes. Type 1 diabetes is a genetic, auto-immune disease where the body turns on itself, instructing the immune system to falsely deactivate the pancreas rendering it unable to produce insulin. This type of diabetes usually runs in the family and cannot be prevented or modified with diet or exercise, although a healthy diet is recommended to help prevent additional illnesses that often occur in the wake of diabetes. People with type 1 diabetes depend on daily insulin injections or an insulin pump to help their body turn glucose into energy.

Type 2 diabetes is usually caused by lifestyle choices and circumstances. While you are definitely at a greater risk of developing type 2 diabetes if there is a family history of diabetes, the risk greatly increases if you are overweight or obese, physically inactive, or aging. These risk factors mean that where there used to be a prevalence of older people getting type 2 diabetes due to aging, now there is a surge in diabetes in children and teenagers due to poor dietary choices and an inactive lifestyle.

Certain ethnic groups, such as Pacific Islanders, Indians, Native Americans, and Mexican Americans are also at a higher risk of developing type 2 diabetes.

Type 2 diabetes is a progressive illness and the treatment is dependent on the stage at which it is diagnosed. Symptoms include pronounced dizziness, an involuntary increase in weight, a constant feeling of hunger and thirst, frequent urination, headaches, and mood swings. While there is no cure for diabetes, preventative measures can be taken if you are diagnosed as prediabetic, and there are multiple steps you can take to manage it after being diagnosed with type 2 diabetes.

The last type of diabetes is gestational diabetes, which can occur during pregnancy. Pregnant women are especially vulnerable to the condition if they have a family history of diabetes, are overweight, if they are over the age of thirty, or if they have experienced gestational diabetes in previous pregnancies. The condition rarely requires insulin treatment and can usually be managed with diet. Most often gestational diabetes disappears again after birth.

While a healthy, active lifestyle is also important in order to live a healthy life with type 1 diabetes and gestational diabetes, this article will for all intents and purposes focus on type 2 diabetes. During the course of this article you will learn what diabetes is and how you can tweak your diet to help you manage it and increase your chances of avoiding diabetes complications such as glaucoma, cardiovascular disease, and strokes.

Nutrients for the Body

In order to understand diabetes, it is important to understand how different nutrients affect our bodies. All food consists of one or more macronutrients and a variety of micronutrients. Macronutrients are the major nutritional players such as carbohydrates, fatty acids, and protein, whereas micronutrients are vitamins and minerals.

The human body needs both macro- and micronutrients on a daily basis to thrive. The different nutrients serve different purposes within the body, but they each provide your body with the fuel it needs to perform optimally. Let’s break it down, starting with carbohydrates (the remaining nutrients will be covered later in the article), which is one of the key components in diabetes management. Understanding how carbohydrates is digested and absorbed and thereby affecting your body is paramount to understanding diabetes and learning how to manage it through your diet.


Carbohydrates are molecular structures comprised of carbon, hydrogen, and oxygen atoms. They serve many key functions in the human body including controlling blood glucose levels, aid in cell metabolism and regulate insulin metabolism, and they serve as a primary source of energy.

Carbs are found in such foods as fruit, vegetables, beans, legumes, bread, oats and pasta, and as mentioned they help regulate your blood glucose levels and the glycogen levels in the muscles and give you energy. This happens as you ingest carbs and the body starts breaking it down into glucose, which is then stored as glycogen in the liver and muscles where from it is released as energy when needed.

Carbs can be either simple or complex depending on how complex their molecular structure is:

  • A monosaccharide is the simplest form of carbs. This basic sugar structure forms the basis for more complex carbs and can by itself be found as glucose in molasses, fructose in various fruits, and galactose in yoghurt for instance. This is a fast, easily digested source of energy.
  • Comprised of glucose and fructose bound together a disaccharide is also a simple carb. Disaccharides are found in foods containing sucrose (white sugar) or lactose such as dairy products. Disaccharides are also easily digested and provides a quick burst of energy.

Generally speaking, mono- and disaccharides can be found in sweets, juices, honey, corn syrup.

Vegetables, grains and beans contain complex carbohydrates.

  • Oligosaccharides and polysaccharides are more complex types of carbohydrates, consisting of three to ten strains of monosaccharides. They are found in fruits, grains and vegetables, and starchy foods. These complex carbs also contain fibre as opposed to the simple carbs. Fibre is a non-digestible complex carb essential in maintaining stable blood glucose levels and keeping your gut and colon healthy. They can be soluble or insoluble.

Carbohydrate Digestion and Absorption

The main function of a carbohydrate is to provide your body with energy. No matter what type of carbohydrate you ingest the digestive process begins in the mouth. Your saliva contains an enzyme known as salivary amylase, which begins breaking down the carbohydrates as you are chewing them up, mixing them with saliva. The food is then swallowed and transported to the stomach and on through to the small intestine known as the duodenum.

Once nestled in the duodenum, a substance called pancreatic amylase is released by the pancreas, hence the name. This pancreatic enzyme proceeds to break down polysaccharides into disaccharides, which is then broken down even further by enzymes produced by the duodenum itself. These enzymes, lactase, sucrase and maltase break down the disaccharides into monosaccharides readily absorbed by the body. The actual absorption happens in the duodenum and the energy is stored in the liver and muscle tissue.

At this point most of the carbohydrates from your meal has been broken down, absorbed by your body and stores accordingly. There are, however, some carbohydrates which cannot be broken down the duodenum and these are instead transported to the large intestine, the colon. Here the ones that can be broken down into smaller pieces are done so by the intestinal bacteria that flourishes in our colon. Some nutrients are, however, non-digestible and are therefore excreted through bowel movements. This is true for insoluble fibres, for instance, which serve the main purpose of keeping our bowels healthy by absorbing water to aid in a smooth digestion and regular bowel movements.

Blood Glucose, Glycogen, and Insulin

Having covered the various types of carbohydrates as well as fibre it is time to look at why exactly that is relevant when addressing the issue of type 2 diabetes.

Here is what we know so far: The body converts carbohydrates into glucose to be used for energy. The glucose levels in the blood are regulated by insulin, a hormone produced by the pancreas. Type 2 diabetes is a condition where the person has constantly high blood glucose levels because the pancreas is unable to produce sufficient amounts of insulin.

After you ingest a meal there will naturally be a spike in your blood glucose levels as insulin is released to direct the glucose into the liver and muscle cells for storage, thereby preventing your blood glucose levels from rising too much. When the glucose is stored in the liver and muscle cells it changes into a readily available form of energy called glycogen. Then, when needed, glycogen is converted back to glucose and released back into the bloodstream. Your blood glucose levels are called glycemia and when the body is unable to produce sufficient insulin to regulate it, you might get hyperglycaemia, meaning you have unusually high blood glucose levels.

So, what is the fuss, you may ask. Well, as explained, hyperglycaemia means that your blood glucose levels are too high. It is a condition that develops over a few days or a week, and it can have quite severe consequences if not treated. Early symptoms are:

  • Frequent urination
  • Headaches and dizziness
  • Extreme thirst
  • Blurred vision and fatigue

These are the early signs of hyperglycaemia and if treated appropriately it can be brought back under control. If you are diabetic, refer to your doctor’s instructions and how to administer your insulin. If you have not been diagnosed with diabetes, consult your doctor and inform him of your symptoms. If these early signs are not treated, hyperglycaemia will develop further and can cause the build-up of ketones in your blood and urine and can lead to ketoacidosis. Later symptoms include:

  • Breath that smells fruity
  • Confusion and weakness
  • Stomach pains
  • Nausea
  • Diabetic coma

If hyperglycaemia goes untreated for long periods of time, such as if a person’s diabetic condition is not managed properly, it can have consequences such as cataract, blindness, bone and joint problems, and trouble healing wounds and sores. If you are experiencing any of these symptoms in a manner that concerns you, please see your general health provider and talk to them about your concerns. They will be able to do a blood test to determine if you have diabetes.

You can also experience hypoglycaemia, a condition where your blood glucose levels drop below average, causing dizziness, nausea, trembling, hunger, paleness, and sweating. If you measure your blood glucose levels and they are below 4mmol/L it is important to act on it. Hypoglycaemia can be caused by strenuous exercise, not eating enough carbohydrates in a meal, injecting too much insulin, or drinking a large amount of alcohol. If acted upon quickly, it can usually be remedied swiftly by ingesting a sugary snack, followed by a meal with slow acting carbohydrates once your blood glucose levels have stabilized.

The Glycaemic Index (GI)

As it has been established, different types of carbohydrates are digested by the body at different speeds. Fast-acting carbs such as sugary snacks and beverages, white bread and potatoes, raise your blood glucose levels at a high speed, while slow-acting carbs such as soy products, lentils, grains, porridge and fruit are digested slower and therefore helps keep your blood glucose levels stable. A scale has been established to help differentiate between foods that elevate your blood glucose levels and foods that help keep your levels stabile. This is called The Glycaemic Index (GI).

The GI is a sliding way of rating foods based on how they affect your blood glucose levels over a period of time; usually a period of two hours. The scale goes from 0-100 and food is measured against the reference foods glucose or white bread, which have a GI score of 100. The scale compares the different foods to the reference food, measuring it gram for gram. A food item with a GI score less than 55 is considered low GI. A medium GI score is between 55 and 70 and a high GI score is 70 and above, ranking the foods on this end of the spectre the as having the most impact on your blood glucose levels.

There are a number of factors that can affect a foods GI score. These include things such as texture, size, ripeness, fibre and fat content, and the way a food is processed or cooked. To make matters more complicated, most meals are usually made up of various foods with different GI scores, which means that they affect each other. Mixing different foods can actually mean that a food with a high GI score can end up with a low GI score when partnered with the right type of food.

Below is a short (and by no means complete) list of foods with low GI scores.

Foods with a low GI score:

  • Dairy products (reduced or low-fat products are recommended for people with diabetes)
  • Porridge and natural muesli.
  • Wholegrain bread and grains in general, such as barley and bulgur
  • Pasta and noodles
  • Legumes (beans, lentils, peas)
  • Vegetables and fruit

Managing Your Diabetes

So, let us get down to brass tacks: How do you successfully manage and live with a diabetes diagnosis?

When you have type 2 diabetes your pancreas is usually still working to some extent, as opposed to type 1 where the immune system has erroneously, but effectively, killed off most, if not all, of the insulin producing pancreatic cells. This means that type 2 diabetes is a progressive condition where the body will grow more and more insulin resistant and while you might be able to successfully manage it and function with a healthy diet and exercise, you may require insulin injections as the diabetes progresses and the body’s ability to regulate its insulin production fails additionally. Therefore, it is paramount that you adopt a somewhat healthy diet to help your body manage its blood glucose levels.

A Healthy Diet

A healthy dietary routine is recommended for everyone regardless of whether or not they have diabetes, but it is especially important for diabetics. Now, that does not mean that you can’t have your favourite treats once in a while, it just means that you have to put a bit more aware of what you eat.

The type of diet you choose will depend on your personal preferences and your lifestyle. In essence it is all about balance. A well-balanced diet is one consisting mainly of quality macro- and micronutrients from wholefoods such as wholegrain bread, vegetables, fruit, nuts, dairy, beans, legumes, meat and fish, but it also leaves a little room for the things you like to indulge in, such as chocolate for instance.

What is important is that you form realistic dietary habits that can be sustained long-term and incorporated into your daily routine. You should aim to eat three main meals and two snacks a day to keep your blood glucose levels stabile and you should hydrate with water frequently. We will have a look at a few ways to structure your meals throughout the day and a couple of dietary plans that are recommended for diabetics, but before diving into that, let’s have a look at the other macronutrients, as well as some of the important micronutrients.


Protein is an important macronutrient, playing a role in all cellular processes in the body. Proteins are made up of amino acids. There are 22 amino acids, which can be utilised by the human body. Of these 22 amino acids, the body can only synthesise 13, leaving the remaining 9. These 9 amino acids are known as essential amino acids and can only be found in food.

Proteins serve a lot of different functions in the body. Their main function is building, maintaining and restoring muscle tissue and cells. While protein can actually be found in most foods, quality sources are preferred. These include various beans, tofu, fish, lean meats, poultry, eggs and dairy products. The recommended daily intake is 0.8 grams per kilogram body weight. Protein is filling and helps keep you satiated longer.

Fatty acids

Fatty acids are hydrocarbon chains with a tail of carboxylic acid groups. They are hydrophobic, which is why fat and water do not mix. Fatty acids serve several important functions in the human body, including providing vital fuel for the body’s cell and serving as a storage unit for energy within the adipose tissue.

There are different types of fats. Some are beneficial for the body and some are harmful. When you are diabetic, you have a higher risk of heart problems, which is typically associated with a high blood cholesterol count. Foods rich in saturated fats raise your blood cholesterol level, making you more vulnerable to heart problems. Instead, choosing healthy fats can actually help lower your risk of having a stroke.

  • Monounsaturated fats: A general rule of thumb is that unsaturated fats are good for your body, because they help lower your LDL cholesterol, which is the type of cholesterol that increases your risk of heart problems. Monounsaturated fats are liquid at room temperature but turn solid when put in the fridge for instance. Foods rich in monounsaturated fats include avocado, olive oil and olives, various nuts, safflower oil, and herring.
  • Polyunsaturated fats: Like monounsaturated fats, polyunsaturated fats are also good for your body and your heart. Try to make these types of fats the majority of fats in your diet. polyunsaturated fats are also heart healthy, helps lower your LDL cholesterol and provides the body with healthy and important vitamins and omega-6 and omega-3 fatty acids. Foods high in polyunsaturated fats include tofu, sunflower oil, walnuts, chia and flax seeds, and salmon.
  • Saturated fat and trans fatty acids: Try to keep these types of fat out of your diet as far as possible. The nature of their molecular structure means that they raise your blood cholesterol level, thereby increasing your risk of heart disease. Foods to avoid includes butter, high-fat dairy and meat products like bacon, hot dogs and sausages, highly processed foods such as chips and baked goods, lard, and palm oil. You may think that avoiding these items is easy, but look at the ingredients list next time you go shopping and you might be surprised to learn how prevalent these types of foods really are.


Let’s have a look at those small, but important micronutrients. Micronutrients are a blanket term for all the various vitamins and minerals that are present in food. If you eat a wholesome, healthy varied diet based on whole foods and plants, you will most likely get all your required micronutrients, with a couple of exceptions. If you want to be sure you are getting everything you need, a multi-vitamin is a good choice to supplement your diet. A multivitamin covers pretty much all your bases and tops of a well-rounded diet.

Vitamin D

Vitamin D is a very important vitamin, especially if you live in a country where the sun does not shine a lot. Vitamin D is a fat-soluble vitamin, meaning it is stored in the body’s fatty tissue and you can build up a small reserve in the body. Your body synthesizes the vitamin in the liver and kidney from an inactive form of the vitamin that comes from sunlight and is found in various foods. Vitamin D is actually a hormone and it is essential for a healthy, thriving body as it controls the calcium levels in the body and is needed to absorb calcium from the food. It is vital for maintaining strong bones and muscles, and for an overall good health.

In the summertime you will probably get enough vitamin D if you spend time outside with any exposed skin. Remember, however, to be sun safe. Because vitamin D is stored in the body it can only be absorbed in small doses. Spending an extended time in the sun will therefore not increase the amount of vitamin D absorbed, but it will increase your risk of melanoma from exposure to harmful ultraviolet rays. In the winter it is recommended that you take a supplement. Foods high in vitamin D include fatty fish such as salmon, mackerel, and sardines and it can also be found in eggs, mushrooms, and caviar.


Calcium is important in maintaining healthy bones and is best absorbed when eating with a source of vitamin D. Try, as far as possible, to eat foods containing the two vitamins, together. Calcium is found in dairy products, almonds, tofu, oats, and green leafy vegetables.


Iron is another important micronutrient one and while actually being a mineral, and not a vitamin, iron is important because it is the main part of haemoglobin. Haemoglobin is the part of the red blood cells that obtains the oxygen in the lungs and transports it around the body, and a sufficient iron supply is important to ensure that this process happens correctly. If you are lacking in iron your body will lack enough healthy, red blood cells and they will have a hard time transporting the amount of oxygen required by the body to function properly. This will leave you fatigued and disoriented. Especially women are in danger of becoming iron deficient and it is recommended that they take a supplement.

Iron can be found in meat, spinach and other leafy, green vegetables, tofu, and fortified cereals. It is best absorbed when consumed with a source of vitamin C. If you are supplementing with iron tablets, try washing them down with a glass of water with lemon juice squeezed in.

Vitamin C

Vitamin C is also known as ascorbic acid and like mentioned above, this vitamin helps the absorption of iron and strengthens the immune system. It is a water-soluble vitamin, meaning it is not stored in the body and needs to be replenished regularly. Vitamin C can be found in lemons and limes, kiwi fruits, berries, leafy green vegetables, tomatoes and potatoes.

B vitamins

B vitamins are a group of collection of micronutrients that all have important functions in the body. The group consists of eight different vitamins:

  • Thiamin (B1) helps convert glucose into energy and serves an important role in a functioning nervous system. Good sources of thiamin include sesame seeds, legumes, nuts, and yeast.
  • Riboflavin (B2) is vital for healthy skin and a strong vision. Sources include dairy products such as cottage cheese and yoghurt, egg white, lean meats, wholegrain bread and cereals.
  • Niacin (B3) assists in energy conversion and aids in maintaining healthy nervous and digestive systems. Niacin can be found where there is protein present. It is also found in nuts, mushrooms, and most type of meats.
  • Pantothenic acid (B5) also plays a part in energy conversion as well as being a crucial aid in producing red blood cells and steroid hormones. B5 is found in foods such as legumes, liver, kidney, eggs, and peanuts.
  • Pyridoxine B6 is an important vitamin because besides assisting in protein and carbohydrate metabolism, it also influences brain development, and the immune system. It is abundant in meat, fish and shellfish, nuts, and leafy vegetables.
  • Biotin (B7) is also used for energy metabolism, as well as fat and glycogen synthesis, and amino acid metabolism. It can be found in egg yolks, peanuts, liver, and chicken.
  • Folic acid (B9 or folate) is instrumental in foetal development (pregnant women should take a supplement or be highly aware of their folate intake through diet), cell growth, and the forming of red blood cells. Folic acid is the synthetic form available through supplements, while the organic form known as ‘folate’ can be found in legumes, seeds, leafy green vegetables, poultry, eggs, and cereals.
  • Cyanocobalamin (B12) is especially important and contributes to the forming of new red blood cells, maintaining myelin around cells, and energy conversion. If you are vegan, vegetarian or eat a plant-based diet, it is important that you take a daily B12 supplement as the vitamin is only found in animal products.

Most of these vitamins are water-soluble (with the exception of B12 and folic acid), so just like vitamin C they need to be replenished on a daily basis because they are only stored in the body for a short amount of time.


For many people a bit of alcohol is a way to unwind after a long day. They might enjoy a glass of wine while cooking dinner, a beer before bedtime, or a night out with their friends, but where does alcohol figure in the diet of someone living with diabetes? The answer is not a straight-forward as you may think. According to the American Diabetes Association people with diabetes can indeed enjoy a drink every now and then, but they should be aware of the risks. Here are a few guidelines to ensure that you can safely enjoy a drink or two:

  • The recommended alcohol intake is no more than one drink per day for women and two drinks per day for men.
  • Alcohol blocks the liver’s ability to turn glycogen into glucose to release into the bloodstream, making it hard for your body to try and self-regulate if your blood glucose levels get too low.
  • If you are taking any medications be sure to check with your doctor so you know how those medications interact with alcohol and with your diabetes.
  • Get a diabetes ID that lets people around you know that you have diabetes in case you become hypoglycaemic and need assistance.
  • Plan ahead. If you know you are going to be drinking later, have a meal consisting of slow-acting carbohydrates, lean protein, and healthy fats. Alcohol can lower your blood glucose levels and cause hypoglycaemia and the risk increases if you drink on an empty stomach.
  • If you are going to be drinking fun mixed drinks, aim for diet versions of the mixers as sugar-laden drinks will raise your blood glucose levels.
  • Don’t drink and drive.

Because alcohol consumption can cause hypoglycaemia up till 24 hours after drinking, you should always check your blood glucose levels before you drink, while you are drinking, before you go to bed, once or twice throughout the night, and frequently the following day. Generally, you should speak to your health care provider about how alcohol can affect you and what precautions you should take if you are insulin-dependent or take other medications.

Other Beverages

It’s important to stay hydrated and while you should definitely indulge in water throughout the day, it can be a bit tricky to figure out what other beverages are okay to consume. In general, try to stay away from sugar-filled drinks such as regular sodas, energy drinks, juices, etc. They all contain copious amounts of sugary carbohydrates, which will raise your blood glucose levels. Instead, opt for unsweetened teas and coffee, low-fat milk, and water, or try a delicious matcha tea with abundant health benefits.

Water should be the main part of your daily fluid intake, but if you are getting a bit bored with plain old water, try putting lemon or lime in it, or maybe a few herb leaves such as mint.

Now, let’s have a look at how you can structure your meals to ensure stable blood glucose levels throughout the day, while keeping you full and nourished. When constructing your meal plan, try opting for the mono- and polyunsaturated fats that you can find in for instance fish, avocado, walnuts, chia and flax seeds, and avoid the saturated and trans fatty acids found in heavily processed products and deep-fried foods. Go for those slow-acting, low GI carbohydrates for blood glucose stability and choose good quality, lean meats, fish and shellfish. Drink water throughout the day to stay hydrated.

Eating Patterns and Meal Plans

Generally, you should try to aim for natural, whole foods, meaning foods that have not been altered from their natural state or processed in any way. Alternatively, go for the foods with the least amount of processing. Think vegetables, fruit, beans and legumes, and go for foods with a low GI score to avoid unstable blood glucose levels. Whole foods do not contain additives like sodium, fats or preservatives and they contain natural vitamins and minerals.

Choose lean meats such as fish or chicken filets instead of processed cold cuts, which can be full of preservatives, fats, sodium, and flavouring agents, and choose fresh fruits, berries and yoghurt and nuts for a breakfast smoothie instead of processed and sugar filled cereals.

Constructing a physical plan with your meals for the week is generally a good idea. Sit down, get out a pen and paper and write down what you (and your family) are going to eat the coming week. It helps make things manageable in a busy everyday life and ensures that you eat a varied diet. Here are nine simple guidelines to keep in mind when constructing a meal plan:

  1. Know your GI scores. Look up the GI scores for some of the foods you eat on a regular basis and know where to look to find information on a new food when you need it. You will find the most comprehensive guide on the Glycaemic Index Foundation’s website. Here you can also find extensive information about managing diabetes as well as examples of various meal plans.
  2. Make your foundation plant-based. Choosing to base your diet primarily on plants may not be such a bad idea when measured on a number of issues. Studies show that people who eat a plant-based diet have lower blood pressure and cholesterol levels; they have an easier time maintaining a steady weight (something that is also important for diabetics) and they are able to keep their blood glucose levels more stable than people who does not eat a plant-based diet.
  3. Choose quality sources of protein. Supplement your plant-based diet with good protein sources from white meat and fish. White meat includes poultry and is generally more lean than dark meat, making it low-fat and low-calorie. Fish also comes with a myriad of health benefits, such as being rich in poly-unsaturated fatty acids and high in vitamin D. Aim at making fish a part of your meal plan at least 2-3 times a week.
  4. Cut out the simple carbs as much as possible. As mentioned previously, fast, sugary carbohydrates will raise your blood glucose levels fast and leave them unstable. Try to avoid sugary and processed foods.
  5. Eliminate saturated fats and trans-fats. It’s been established that diabetics have a greater risk of developing heart disease and suffering strokes. As saturated fats increase your blood cholesterol and trans-fat have been linked to heart disease and cancer, cut those out of your diet for a more heart healthy lifestyle. These fatty acids can be found in such foods as pastries and baked goods and fried foods of all kinds.
  6. Eat breakfast. It is true what they say about breakfast being the most important meal of the day. What you choose to consume in the morning will be what will fuel you for the first part of the day and it is the meal that breaks the fast of the night. A healthy breakfast that starts the day out right with stable blood glucose levels contains healthy fats, protein and complex carbs. An example could be smashed avocado on wholegrain bread with a boiled egg on the side, hold the salt. Don’t forget to drink water first thing in the morning.
  7. Fill up on beans. Whether you are trying to decrease your intake of meat or just want to switch up your diet a bit and try something new, beans contain lots of good protein and fibres, and they are tasty and filling. Kidney beans, chickpeas, butter beans, whatever your preference, cook them up and try them in a meatless tortilla or toss up a five-bean salad for lunch.
  8. Go easy on the salt. Too much salt can cause hypertension, which is something you want to avoid when you have diabetes. Try other ways to season your food such as various herbs and spices.
  9. Stay hydrated. Starting your day with a large glass of water is a great idea. It kickstarts your metabolism, which has been laying low while you were sleeping, and it gives you a fresh start to the day. It is important to keep hydrated by drinking water regularly throughout the day, so aim to drink eight to ten glasses of water daily. Try it with a few slices of lemon or lime for a fresh twist.

Sometimes it can be a bit hard to pinpoint exactly what constitutes a “healthy, varied diet good for diabetics”, but luckily the American Diabetes Association has a few recommendations for what to eat. Here are two examples of healthy diets recommended for people with diabetes.

The Mediterranean Diet

With its abundance of fruit and vegetables and its focus on mono- and polyunsaturated fatty acids from fish and olive oil, this way of eating has been hailed one the healthiest around and it is a great way to eat if you are diabetic. As the name suggests, this way of eating and viewing food stems from the countries in the Mediterranean and it is a diet that focuses on choosing whole foods over processed foods.

The diet is rich in vegetables, fruit, nuts and seeds, legumes, whole grains, and a wide variety of seafood, and olive oil as well as different variations of olives themselves are added to the meals in abundance.

Herbs and spices are generously sprinkled in the cooking and food is usually drizzled with healthy quantities of extra virgin olive oil and eaten with whole grain bread and a good quality feta. Meat, including both red meat and poultry, eggs, and dairy is used scarcely, and sugary drinks, refined oils, and processed foods rarely ever eaten.

The key to mastering this way of eating and turning it into a healthy, delicious way of managing your diabetes, is thinking in terms of whole, single ingredient foods. This is a recommended way of eating for diabetics because it is nutritious and healthy, it is high in mono- and polyunsaturated fats and low in sugar, sodium, and saturated and trans fats. Due to its abundance of healthy fats from olive oil, avocados, nuts and fish it is a heart healthy diet that lowers LDL cholesterol in the blood, thereby lowering the risk of heart problems and cardiovascular disease.

While this diet is healthy and great for people with diabetes there is, however, something you need to be mindful of. Adopting a Mediterranean way of eating comes with great health benefits, but it can also come with a high calorie count. Olives, olive oil, fatty fish, feta, and so on are all high-calorie foods, so be mindful of your intake to avoid gaining unwanted pounds.

A Healthy Diet for Diabetic Vegans or Vegetarians

Many Americans are going either vegetarian or vegan for a myriad of reasons, including making an effort to have a lower carbon footprint, taking a stand against conventional farming, or simply for health reasons. If you are living a plant-based lifestyle and foregoing the meat and maybe even dairy products as well, you may be wondering if that is a healthy lifestyle for someone with diabetes.

According to the American Diabetes Association a vegetarian or vegan diet is good choice for someone with diabetes as it is usually abundant in fruit and vegetables, and thereby full of vitamins and minerals. The base foods are usually rich in carbohydrates, but if you fill up on those slow-acting, low GI carbs, it can be a really nutritious and healthy way to eat. Choose beans, grains, legumes, tofu, and all the greens you can eat and enjoy a heart healthy, fibre-rich, inexpensive way of eating that will lower your cholesterol levels and keep your blood glucose levels steady.

The Diabetes Plate Method

Besides the two eating patterns suggested above, there are a whole range of other diets that might be suitable for diabetics. Whichever way you choose to fulfil your dietary needs, you can structure your meals after the Diabetes Plate Method for a quick, easy-to-remember way of eating healthy.

The idea is that you divide your plate in three: Half your plate is filled with non-starchy vegetables such as asparagus, green beans, cabbage, celery, cauliflower and mushroom. One quarter is filled with low GI grains and starchy foods, for instance bulgur, barley, brown rice or whole meal pasta. The last quarter is filled with lean protein, a food group that includes skinless chicken or turkey, various beans, fish and shellfish, tofu, nuts, and nut butters.

Meal Plan Examples

So, now that you have this vast knowledge of nutrition and how you can manage your blood glucose levels with the foods you choose, let’s put it into a meal plan. Below are two examples on what an average day might look like.

Mediterranean Style Meal Plan

  • Breakfast: Green smoothie breakfast bowl

Try a quick, easy-to-make, delicious smoothie bowl for a scrumptious morning tea to start your day off. Enjoy with a tall glass of water and maybe a cup of green tea.

  • Morning snack: One banana and a handful of almonds and walnuts will help tide you over until lunch.
  • Lunch: Grilled shrimp pitas

This is another quick treat that will satisfy your umami-craving palate and your hungry stomach by loading you up with delicious feta cheese, succulent grilled shrimps, and cooling gazpacho soup.

  • Afternoon snack: For most people the afternoon is where the cravings start to set in. Try to stay ahead of the curve by snacking on cucumber sticks, sliced carrots and celery sticks dipped in a yummy avocado-cucumber dip. Add a couple of garlic-chili soaked olives for a small dose of healthy fats.
  • Dinner: Greek salad pizza

Eating healthy does not have to be boring, and this delicious Greek style pizza is sure to satisfy your senses. Top with smoked salmon and serve with homemade tzatziki.

  • If you are craving something sweet at the end of the evening, try cutting up an apple and a couple of carrots and enjoying them with a bit of tzatziki or avocado-cucumber dip.

Vegetarian Style Meal Plan

  • Breakfast: Try a healthy smoothie with almond, blueberries and flax seeds for a nutritious, fulfilling breakfast treat packed with Omega-3 fatty acids and fibre.
  • Morning snack: A handful of mixed nuts, an apple, or a banana and maybe half an avocado with cottage cheese.
  • Lunch: This bibb and bean burrito bowl is a fun way to eat beans. Beans are full of protein and nutrients and they help manage your blood glucose levels.
  • Afternoon snack: Make your own delicious hummus and enjoy it with a selection of sliced vegetables.
  • Dinner: These yummy falafels will have your mouth watering while you’re cooking. Try them in a wrap with lettuce, tomatoes, avocado, purple onion, cucumber and salsa, or dip them in hummus.


Holiday Hints for Alzheimer's Caregivers

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Alzheimer Caregiver


Holidays can be meaningful, enriching times for both the person with Alzheimer’s disease and his or her family. Maintaining or adapting family rituals and traditions helps all family members feel a sense of belonging and family identity. For a person with Alzheimer’s, this link with a familiar past is reassuring.

However, when celebrations, special events, or holidays include many people, this can cause confusion and anxiety for a person with Alzheimer’s. He or she may find some situations easier and more pleasurable than others. The tips below can help you and the person with Alzheimer’s visit and reconnect with family, friends, and neighbors during holidays.

Finding the Right Balance

Many caregivers have mixed feelings about holidays. They may have happy memories of the past, but they also may worry about the extra demands that holidays make on their time and energy.

Here are some ways to balance doing many holiday-related activities while taking care of your own needs and those of the person with Alzheimer’s disease:

  • Celebrate holidays that are important to you. Include the person with Alzheimer’s as much as possible.
  • Set your own limits, and be clear about them with others. You do not have to live up to the expectations of friends or relatives. Your situation is different now.
  • Involve the person with Alzheimer’s in simple holiday preparations, or have him or her observe your preparations. Observing you will familiarize him or her with the upcoming festivities. Participating with you may give the person the pleasure of helping and the fun of anticipating and reminiscing.
  • Consider simplifying your holidays around the home. For example, rather than cooking an elaborate dinner, invite family and friends for a potluck. Instead of elaborate decorations, consider choosing a few select items.
  • Encourage friends and family to visit even if it’s difficult. Limit the number of visitors at any one time, or have a few people visit quietly with the person in a separate room. Plan visits when the person usually is at his or her best.
  • Prepare quiet distractions to use, such as a family photo album, if the person with Alzheimer’s becomes upset or overstimulated.
  • Make sure there is a space where the person can rest when he or she goes to larger gatherings.
  • Try to avoid situations that may confuse or frustrate the person with Alzheimer’s, such as crowds, changes in routine, and strange places. Also try to stay away from noise, loud conversations, loud music, lighting that is too bright or too dark, and having too much rich food or drink (especially alcohol).
  • Find time for holiday activities you like to do. If you receive invitations to celebrations that the person with Alzheimer’s cannot attend, go yourself. Ask a friend or family member to spend time with the person while you’re out.

Preparing Guests

Explain to guests that the person with Alzheimer’s disease does not always remember what is expected and acceptable. Give examples of unusual behaviors that may take place such as incontinence, eating food with fingers, wandering, or hallucinations.

If this is the first visit since the person with Alzheimer’s became severely impaired, tell guests that the visit may be painful. The memory-impaired person may not remember guests’ names or relationships but can still enjoy their company.

  • Explain that memory loss is the result of the disease and is not intentional.
  • Stress that the meaningfulness of the moment together matters more than what the person remembers.

Preparing the Person with Alzheimer’s

Here are some tips to help the person with Alzheimer’s disease get ready for visitors:

  • Begin showing a photo of the guest to the person a week before arrival. Each day, explain who the visitor is while showing the photo.
  • Arrange a phone call for the person with Alzheimer’s and the visitor. The call gives the visitor an idea of what to expect and gives the person with Alzheimer’s an opportunity to become familiar with the visitor.
  • Keep the memory-impaired person’s routine as close to normal as possible.
  • During the hustle and bustle of the holiday season, guard against fatigue and find time for adequate rest.

For More Information About Holidays and Alzheimer's


NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center

1-800-438-4380 (toll-free)

This email address is being protected from spambots. You need JavaScript enabled to view it.

The National Institute on Aging’s ADEAR Center offers information and free print publications about Alzheimer’s disease and related dementias for families, caregivers, and health professionals. ADEAR Center staff answer telephone, email, and written requests and make referrals to local and national resources.


Hypertension Upgraded in Latest Biennial Review of Research on Health Problems in Veterans That May Be Linked to Agent Orange Exposure During Vietnam War

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Hypertension 001


WASHINGTON – The latest in a series of congressionally mandated biennial reviews of the evidence of health problems that may be linked to exposure to Agent Orange and other herbicides used during the Vietnam War found sufficient evidence of an association for hypertension and monoclonal gammopathy of undetermined significance (MGUS). The committee that carried out the study and wrote the report, Veterans and Agent Orange: Update 11 (2018), focused on the scientific literature published between Sept. 30, 2014, and Dec. 31, 2017.

From 1962 to 1971, the U.S. military sprayed herbicides over Vietnam to strip the thick jungle canopy that could conceal opposition forces, destroy crops that those forces might depend on, and clear tall grass and bushes from the perimeters of U.S. bases and outlying encampments. The most commonly used chemical mixture sprayed was Agent Orange, which was contaminated with the most toxic form of dioxin. These and the other herbicides sprayed during the war constituted the chemicals of interest for the committee. The exact number of U.S. military personnel who served in Vietnam is unknown because deployment to the theater was not specifically recorded in military records, but estimates range from 2.6 million to 4.3 million.

Hypertension was moved to the category of “sufficient” evidence of an association from its previous classification in the “limited or suggestive” category. The sufficient category indicates that there is enough epidemiologic evidence to conclude that there is a positive association. A finding of limited or suggestive evidence means that epidemiologic research results suggest an association between exposure to herbicides and a particular outcome, but a firm conclusion is limited because chance, bias, and confounding factors could not be ruled out with confidence. The committee came to this conclusion in part based on a recent study of U.S. Vietnam Veterans by researchers from the U.S. Department of Veterans Affairs (VA), which found that self-reported hypertension rates were highest among former military personnel who had the greatest opportunity for exposure to these chemicals.

The committee concluded that there was sufficient evidence of an association between exposure to at least one of the chemicals of interest and MGUS, a newly considered condition. This finding is based on a recent study in which investigators found a statistically significant higher prevalence of MGUS in Vietnam Veterans involved in herbicide spray operations than in comparison Veterans. MGUS is a clinically silent condition that is a precursor to the cancer multiple myeloma, but only an estimated 1 percent of MGUS cases progress to multiple myeloma each year.

While some new studies suggest an association might exist between exposure to the chemicals of interest and Type 2 diabetes, the committee could not come to a consensus on whether this and the other available evidence continued to be limited or suggestive, or merited elevation to sufficient. Both newly and previously reviewed studies consistently show a relationship between well-characterized exposures to dioxin and dioxin-like chemicals and measures of diabetes health outcomes in diverse cohorts, including Vietnam Veteran populations. The risk factors for diabetes, such as age, obesity, and family history of the disease, were controlled for in the analyses of most studies reviewed. However, some members of the committee believed that the lack of exposure specificity and the potential for residual uncontrolled confounding influences complicated attribution of the outcome to the chemicals of interest.

In addition, VA asked the committee to focus on three health outcomes: possible generational health effects that may be the result of herbicide exposure among male Vietnam Veterans, myeloproliferative neoplasms, and glioblastoma multiforme. The evidence of association for exposure to the chemicals of interest and glioblastoma (and other brain cancers) remains inadequate or insufficient, the committee concluded. While it is appropriate for VA be mindful of the concerns raised about the possible association between Vietnam service and glioblastoma, the outcome is so rare and the information concerning herbicide exposures so imprecise, that it is doubtful that any logistically and economically feasible epidemiologic study of Veterans would produce meaningful results regarding the association between exposures and the disease. For this reason, the committee recommended that VA should focus on fostering advancements to inform improved glioblastoma treatment options.

There are relatively few studies on the health effects of paternal chemical exposures on their descendants, and none address Vietnam Veterans specifically. Therefore, the committee recommended further specific study of the health of descendants of male Vietnam Veterans.

Myeloproliferative neoplasms and myelodysplastic syndromes are diseases of the blood cells and bone marrow. The committee’s search of epidemiologic literature yielded only one relevant paper on these diseases -- a study of these cancers in Vietnam Veterans that was reviewed in a previous update. Given this paucity of research, the committee recommended that investigators should examine existing databases on myeloid diseases to determine whether there are data available that would allow for an evaluation of myeloproliferative neoplasms in Vietnam Veterans and others who have been exposed to dioxin and the other chemicals of interest.

Although progress has been made in understanding the health effects of military herbicide exposure and the mechanisms underlying these effects, significant gaps in knowledge remain. The committee restated recommendations for research activities outlined in previous updates in this series, including toxicologic, mechanistic, and epidemiologic research. Such work should include efforts to gain more complete knowledge through the integration of information in existing U.S. Department of Defense and VA databases.

The committee noted that the difficulty in conducting research on Vietnam Veteran health issues should not act as a barrier to carrying out such work. There are many questions regarding Veterans’ health that can only be adequately answered by examining Veterans themselves, thereby properly accounting for the totality of the military service experience.

The study was sponsored by the U.S. Department of Veterans Affairs. The National Academies of Sciences, Engineering, and Medicine are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln. For more information, visit A committee roster follows.


Sharing decisions helps Veterans manage Diabetes

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Manage Diabetes


Patients with diabetes have a lot to manage to stay healthy – paying close attention to their diet, making sure they get plenty of exercises, often managing multiple medications, and ensuring their numbers (blood glucose, blood pressure, and cholesterol) are within their goal range. It is important for patients with diabetes to be active members of their health care team and have a voice and ownership in the decisions made about their care.

A Shared Decision Making (SDM) encounter occurs when the patient, his loved ones and the health care team discuss together what treatment options best address the patient’s goals. Managing diabetes on a day to day basis is a family affair. The decision-making process takes into account evidence-based information about available options, the health care team’s knowledge and experience, and the patient’s values and preferences.

Important role of Shared Decision Making

In 2017, Department of Veterans Affairs and the Department of Defense recognized the important role SDM plays in managing diabetes when they updated their Clinical Practice Guideline for the Management of Type 2 Diabetes Mellitus in Primary Care.

The guideline stated that “when properly executed, SDM may decrease patient anxiety, increase trust in clinicians, and improve treatment adherence.” Improved patient-clinician communication can be used to convey openness to discuss any future concerns.

The Agency for Healthcare Research and Quality (AHRQ) is a national leader in SDM, offering the SHARE Approach model and curriculum for training clinicians to implement SDM in practice using a team-based approach. SHARE is a major component of a Federal Interagency Workgroup to improve hypoglycemic safety in support of the National Action Plan for Adverse Drug Event Prevention.

Led by the Department of Health and Human Services Office of Disease Prevention and Health Promotion, agencies across the Federal Government are working to encourage the use of SDM and related principles such as health literacy and numeracy in treating patients with diabetes.

Tool helps to prevent hypoglycemic events

The Veterans Health Administration (VHA), the Department of Defense and the Indian Health Service recommend AHRQ’s SHARE Approach as a tool to be used by clinicians to assist patients in developing individualized glycemic goals to prevent hypoglycemic events.

VHA has developed a national voluntary program, the Choosing Wisely Hypoglycemic Safety Initiative to identify Veterans at high risk for hypoglycemia who may be overtreated with hypoglycemic agents at the time of a clinical visit based upon a clinical reminder in the electronic medical record.

The VA Employee Education System has partnered with AHRQ to develop a series of videos for patients, their families, and all clinicians to increase awareness of hypoglycemia and the importance of using shared decision making in discussing treatment goals with their healthcare team.

They will be shown on closed-circuit televisions in VA waiting rooms across the country and are available to the public. The SHARE Approach curriculum and materials have also been adapted for use in the VA’s online education platform.

Diabetes and complications such as low blood sugars can be difficult for a patient and his or her family. Applying SDM principles to managing diabetes can help care teams be more responsive to a patient’s situation, needs, and preferences while putting them directly at the center of their care.

November is National Diabetes Month.


A pain in the brain may be a migraine

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For sufferers of migraines, the term “bad headache” doesn’t come close to describing their experience. The pounding, pulsing ache can take over the entire head. Migraines can be relentless, affecting vision and balance, coursing to the stomach and beyond, and lasting for days or weeks if untreated.

“A higher percentage of women than men suffer from migraines,” said Briana Todd, clinical psychologist, Psychological Health Center of Excellence. “Research suggests women experience them approximately two to three times more frequently.”

According to National Institute of Health National Institute of Neurological Disorders and Stroke, researchers believe migraines result from fundamental neurological abnormalities caused by genetic mutations at work in the brain. Navy Lt. Cmdr. Kent Werner, who recently served as chief of the neurology clinic at Ft. Belvoir Community Hospital, said migraines are caused when a circuit in the brain fires when it should not.

“The location of the pain is likely dependent on which circuit is active, but sometimes the active circuitry spreads, like a fire, to other nerve centers that control balance, nausea, sensitivity to light, hearing, and balance and vertigo,” said Werner. “It’s quite an interesting disease and the range of presentations is broad.”

The National Institutes of Health reports 18 percent of all adult women in the U.S. suffer from migraines. According to Todd, many migraines in women are related to a drop in estrogen levels, particularly around a woman’s menstrual cycle. It’s just one of the triggers and warning signs that may precede a migraine.

“Tracking triggers is a key component of managing migraines,” said Todd. “Many times people feel as though they are coming out of nowhere.”

According to the U.S. National Library of Medicine, triggers may include aged cheese and meats, alcohol, monosodium glutamate or MSG, citrus fruits, chocolate, spicy foods, or foods or drinks containing aspartame. Caffeine can also be a trigger, although acute treatment of headaches with caffeine is sometimes effective.

Todd said there are many strategies to managing migraines, such as avoiding or limiting the triggers and promoting relaxation.

“A trigger in one person may not be a trigger for another,” said Werner. “Disruption of sleep and elevated stress are known to increase migraines, and those triggers run rampant in the military.”

Todd said triggers are personalized for each individual, and in the case of a women’s menstrual cycle impacting migraines, there are things the woman can do around that time, such as adjust lifestyle factors.

Werner agrees simple lifestyle changes can reduce the frequency of migraines. For example, he said the NIH has linked exercise to reductions in migraines. In addition, regular, adequate sleep (seven to eight hours a night) leads to fewer headaches. Managing anxiety and stress can also significantly reduce migraines. Some service members have found success with acupuncture, acupressure, and diet change, said Werner.

Conventional approaches can also help. Werner typically starts his patients with supplements, such as vitamin B-2, magnesium, or coenzyme q10. These are available over the counter and have been effective for some participants in clinical trials.

However, if lifestyle changes and the other approaches described are ineffective, medications are available. Werner said some women have found success controling migraines with birth control pills. In addition, several over-the-counter medications have proved effective as a timed strategy just before menstruation.

Prescription blood pressure and anti-seizure drugs can be prescribed by a primary care provider. In addition, Botox injections or other medications have been used, and last year, Werner said, the U.S. Food and Drug Administration approved the first medication developed specifically to prevent migraines.

If the pain associated with a migraine persists and interferes with your daily routine, Werner suggests you go to urgent care or the emergency room. A primary care doctor can also refer service members to a neurology specialist for further tests.

“Doctors are actively pursuing novel therapies and testing them in clinical trials, which is important to keep in mind,” Werner said. “We do not stop until we help you find the treatment that is right for you.”


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