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Who is managing type 1 diabetes holistically without medication?

When I was diagnosed with type 1 diabetes at the age of 22, I asked that exact same question.The year was 2002, and no matter where I turned, all signs pointed towards eating a low-carbohydrate diet as the only solution to managing blood glucose and insulin use in type 1 diabetes.So began my journey into understanding the optimal diet for people living with type 1 diabetes, type 1.5 diabetes, pre diabetes, type 2 diabetes and gestational diabetes.At the age of 22, I was the first to admit that I didn’t know anything about diabetes, only that it had something to do with old people and chocolate cake.For the first time in my life, I was faced with a series of challenging questions for which I had no answers:How do I inject insulin?How much insulin do I need?How often should I inject insulin?What is an appropriate amount of insulin?What are the dangers of too much insulin?What are the dangers of too little insulin?What should I eat to control my blood glucose?What should I NOT eat?When should I eat?Can I still exercise?How much should I exercise?What happens if I don't eat?What's going to happen to me in 5 years? 10 years? 20 years?Am I destined for a heart attack?Am I going to gain weight on a low-carbohydrate diet?Plagued with chronically high blood glucose, excessive thirst, low energy, bad breath and constant anxiety, I listened to everything that my doctors and nutritionist told me at the time. Without reservation, they recommended that I eat a low-carbohydrate diet, because that was “the only way to manage blood glucose.”So I did. I minimized my carbohydrate intake, and did my best to avoid fruits, breads, cereals, pastas and rice. Instead, I increased my intake of foods containing fat and protein, including peanut butter, cheese, milk, fish, eggs, poultry and vegetables.“Great,” I thought to myself, “My doctors are prescribing my favorite foods!”During the first year of my diagnosis with type 1 diabetes, even though I was eating a low-carbohydrate diet and enjoying my food very much, I noticed a few things that were very alarming:My blood glucose was extremely hard to controlMy blood glucose meter was effectively a random number generatorMy insulin use seemed quite high (35-42 units per day)My energy levels fluctuated rapidly and randomlyMy breath was terribleI was very irritableI knew that something was terribly wrong, I just had no idea how to fix the problem. Because I was trained as a mechanical engineer, I decided to take a scientific approach to answering finding the solution. I researched all types of diets, and decided to try a plant-based approach, given that it made the most logical sense.I switched from eating a low-carbohydrate diet to a low-fat diet comprised mostly of plants. I began eating large quantities of fruits and vegetables, and minimized my intake of fat-rich foods like avocados, nuts, seeds, coconuts and olives.I ate more fruits and vegetables than I had ever eaten in my life, which directly refuted the anti-carbohydrate wisdom that was all around me. I was nervous that my blood glucose would increase, due to an increase in carbohydrate intake, and I was also nervous that my insulin use with skyrocket.What actually happened? In the first 3 months, I achieved the following:My total daily dose of insulin fell from about 42 units/day to about 25 units/day, a reduction of more than 45%My blood glucose stabilized and became significantly easier to controlMy A1c fell from about 7.5% to 6.2%My energy levels increased dramaticallyI returned to playing soccer, weight lifting, cycling and runningMy anxiety about my diabetes health reduced significantlyThe Truth About InsulinAfter seeing such positive change in my personal health, I attended graduate school to earn a PhD in Nutritional Biochemistry from UC Berkeley, to study the molecular level details of insulin resistance and carbohydrate metabolism.In the process of more than 5 years of research, I learned the ins-and-outs of many holistic approaches to manage diabetes. What I learned was nothing short of mind-blowing.Most medical professionals will argue that the #1 goal of any treatment program for people with type 1 diabetes is to minimize your total insulin use, and drive it down as close to zero as possible. As a result of this, millions of people across the planet living with type 1 diabetes have the same and goal in mind: minimize or eliminate insulin altogether.What most people don't realize is that insulin is a required biological hormone for life, and that without insulin, you and I would die. Period.All mammals require insulin, and humans are no different. Take a look around - all mammals have a biological requirement for insulin, including your pets and human friends:Dogs secrete insulinMonkeys secrete insulinCats secrete insulinMice secrete insulinPigs secrete insulinGoats secrete insulinYour non-diabetic friends secrete insulinIf you believe that insulin is the enemy, then you are tricking yourself into believing erroneous biology, which may lead you towards a low-carbohydrate diet that increases your risk for chronic diseases and all-cause mortality.The goal of any good type 1 diabetes management program is not to eliminate insulin injections, but to inject your physiologically normal amount of insulin. Excess insulin increases your risk for chronic disease in the long term, and eliminating insulin injections altogether can lead to premature death.Your goal as a person with type 1 diabetes is to inject a physiologically normal amount of insulin, not to eliminate insulin injections altogether.Holistic Approach #1: The Ketogenic DietKetogenic diets are considered very-low-carbohydrate diets, and advocate eating a maximum of 30 grams of carbohydrate per day. By doing so, you achieve a metabolic state known as ketosis, in which your liver converts fatty acids into ketone bodies, then uses those ketone bodies as your primary fuel source.Those eating ketogenic diets consume foods like:MeatFull-fat diary products (cheese, butter, milk, ice cream etc.)PoultryFishEggsOlive oilNon-starchy vegetablesLeafy greensAvocadoesNuts and seedsMost of these foods are very high in saturated fat, even if they come from grass-fed animals.Those on a ketogenic diet are told to stay away from the following:FruitsStarchy vegetables (potatoes, squash, root vegetables)RiceQuionaWhole grainsCornThe main benefits of a ketogenic diet for those living with type 1 diabetes are the following:Flatline blood glucose (easier to control your blood glucose)Decreased need for insulinWeight lossKetogenic diets were originally invented for epileptics, and are effective at reducing seizure incidence. However, ample evidence shows that ketogenic diets come with a laundry list of unwanted side effects that simply cannot be overlooked.These side effects are chronic health conditions that are fueled by a diet low in carbohydrates, high in fat, high in protein and low in water, antioxidants, vitamins, fiber and water. Most importantly, low-carb diets increase your risk for all-cause mortality, which increases your risk of death from any cause.The list of ketogenic diet side effects is here:DiarrheaNauseaConstipationVomitingAcid refluxHair lossKidney stonesMuscle cramps or weaknessHypoglycemiaLow platelet countImpaired cognitionInability to concentrateImpaired moodRenal tubular acidosisDisordered mineral metabolismStunted growth in childrenIncreased risk for bone fracturesOsteopenia and osteoporosisIncreased bruisingSepsisPneumoniaAcute pancreatitisHyperlipidemiaHigh cholesterolInsulin resistanceElevated cortisolIncreased risk for cardiovascular diseaseIncreased risk for atherosclerosisCardiomyopathyHeart arrhythmiaMyocardial infarctionMenstrual irregularitiesAmenorrhea (loss of period)Increased risk for all-cause mortalityIt is important to understand that even though a ketogenic diet makes your blood glucose easier to control in the short-term, in the long-term it significantly increases your risk for a wide variety of chronic health conditions that may ultimately shorten lifespan and decrease your quality of life.Holistic Approach #2: The Low-Carbohydrate DietSimilar to the ketogenic diet, a low-carbohydrate diet involves minimizing your intake of carbohydrate-rich foods, and maximizing your intake of fat-rich in protein-rich foods.The main difference between a low-carbohydrate diet and a ketogenic diet is in the total quantity of carbohydrates. Those on a ketogenic diet usually keep their total carbohydrate intake below 30 grams per day, while those on a low-carbohydrate may eat as much as 75 grams of carbohydrate per day.Those on a low-carbohydrate diet may not enter a state of ketosis if their carbohydrate intake exceeds 30 grams per day. In this case, their carbohydrate intake is low, and they are still able to use carbohydrates (glucose) for energy without the need to synthesize ketone bodies.The main problem with low-carbohydrate diets is that even though they promote weight loss in the short-term, they increase the risk for all chronic disease in the long-term, including insulin resistance, type 2 diabetes, heart disease, atherosclerosis, high cholesterol, many types of cancer, and all-cause mortality (death from any cause).Dr. Michael Greger from NutritionFacts.org refers to low-carb diets as equivalent to being obese.Holistic Approach #3: High-Fat Raw Food DietPioneered by Dr. Gabriel Cousens, the high-fat raw food diet is a blend between a plant-based diet and a ketogenic diet. This diet incorporates 100% plant foods, and focuses on eating high-fat plants such as:Nuts and seeds (often sprouted)AvocadoesCoconuts and coconut oilOlives and olive oilFoods that are not allowed on his program include the following:All animal productsAll grainsPeanuts, pistachiosCornWhite potatoesMushroomsSugarAlcoholCoffeeProcessed vegetable oilsSoy sauceHis program is divided into 3 phases, including:Phase 1 (very low-carbohydrate)Phase 1.5 (low-carbohydrate, includes low glycemic index plants like berries and carrots)Phase 2 (increase raw vegetable consumption and higher glycemic index fruits as an occasional treat)People with type 1 diabetes are recommended to follow phase 1 for 3 months before transitioning to phase 1.5 or phase 2.The benefits of following this approach are similar to the benefits of a ketogenic diet:Flatline blood glucose (easier to control your blood glucose)Decreased need for insulinWeight lossDr. Cousens has helped some people with type 1 diabetes become insulin free, claiming that a 100% plant-based approach is the most powerful weapon against diabetes, and the most effective way to minimize your need for insulin.Dr. Cousen’s Phase ChartHolistic Approach #4: Low-Fat, Plant-Based, Whole-Food DietA low-fat, plant-based, whole-food diet is the most effective method of minimizing insulin resistance, a condition that is present across all forms of diabetes, including type 1 diabetes, type 1.5 diabetes, prediabetes and type 2 diabetes. Insulin resistance results in an increasing need for insulin over time, resulting in excessive insulin use.Insulin resistance is a risk factor for many chronic health conditions, including heart disease, high blood pressure (hypertension), high cholesterol, cancer, diabetes, Alzheimer’s disease, kidney failure, stroke and nerve damage.Adopting a low-fat, plant-based, whole-food approach is the single most effective way to increase your insulin sensitivity, which allows you to eat more carbohydrate for less insulin.The most effective method of maximizing your insulin sensitivity is to reduce your total fat intake to between 20-30 grams per day, depending on your height, weight and activity level.Take a look at the following graphic for an illustration of green light, yellow light and red light foods on a low-fat, plant-based, whole-food diet:The benefits of adopting a low-fat, plant-based, whole-food diet in type 1 diabetes (as well as all forms of diabetes), is that your can achieve the following:25-60% reduced insulin usePredictable blood glucoseReduced A1c (1.0-6.5%)Consistent weight loss over time (5-150 pounds)Significantly more energyImproved athletic performance and recoveryImproved mental clarityReduced risk for chronic diseases, including heart disease, atherosclerosis, high cholesterol, insulin resistance, type 2 diabetes, gestational diabetes, cancer, autoimmune disease and obesityTake Home MessagesAs you can see, there are a number of holistic approaches to managing your diet living with type 1 diabetes.While each approach has its pros and cons, it is extremely important to not only control your blood glucose living with type 1 diabetes, but to develop a long-term plan that minimizes your risk for the development of other chronic diseases.References1. Arcidiacono B, Iiritano S, Nocera A, Possidente K, Nevolo MT, Ventura V, et al. Insulin Resistance and Cancer Risk: An Overview of the Pathogenetic Mechanisms. Exp Diabetes Res [Internet]. 2012 [cited 2014 May 21];2012. Available from: Insulin Resistance and Cancer Risk: An Overview of the Pathogenetic Mechanisms2. Griffin ME, Marcucci MJ, Cline GW, Bell K, Barucci N, Lee D, et al. Free fatty acid-induced insulin resistance is associated with activation of protein kinase C theta and alterations in the insulin signaling cascade. Diabetes. 1999 Jun;48(6):1270–4.3. Yu C, Chen Y, Cline GW, Zhang D, Zong H, Wang Y, et al. Mechanism by which fatty acids inhibit insulin activation of insulin receptor substrate-1 (IRS-1)-associated phosphatidylinositol 3-kinase activity in muscle. J Biol Chem. 2002 Dec 27;277(52):50230–6.4. Hirabara SM, Curi R, Maechler P. Saturated fatty acid-induced insulin resistance is associated with mitochondrial dysfunction in skeletal muscle cells. J Cell Physiol. 2010 Jan;222(1):187–94.5. Yuzefovych L, Wilson G, Rachek L. Different effects of oleate vs. palmitate on mitochondrial function, apoptosis, and insulin signaling in L6 skeletal muscle cells: role of oxidative stress. Am J Physiol Endocrinol Metab. 2010 Dec;299(6):E1096–1105.6. Hirabara SM, Silveira LR, Abdulkader F, Carvalho CRO, Procopio J, Curi R. Time-dependent effects of fatty acids on skeletal muscle metabolism. J Cell Physiol. 2007 Jan;210(1):7–15.7. Massao Hirabara S, de Oliveira Carvalho CR, Mendonça JR, Piltcher Haber E, Fernandes LC, Curi R. Palmitate acutely raises glycogen synthesis in rat soleus muscle by a mechanism that requires its metabolization (Randle cycle). FEBS Lett. 2003 Apr 24;541(1-3):109–14.8. Hirabara SM, Silveira LR, Alberici LC, Leandro CVG, Lambertucci RH, Polimeno GC, et al. Acute effect of fatty acids on metabolism and mitochondrial coupling in skeletal muscle. Biochim Biophys Acta. 2006 Jan;1757(1):57–66.9. Shulman GI. Cellular mechanisms of insulin resistance. J Clin Invest. 2000 Jul;106(2):171–6.10. Randle PJ, Garland PB, Hales CN, Newsholme EA. The glucose fatty-acid cycle. Its role in insulin sensitivity and the metabolic disturbances of diabetes mellitus. Lancet. 1963 Apr 13;1(7285):785–9.11. Roden M, Price TB, Perseghin G, Petersen KF, Rothman DL, Cline GW, et al. Mechanism of free fatty acid-induced insulin resistance in humans. J Clin Invest. 1996 Jun 15;97(12):2859–65.12. Brehm A, Krssak M, Schmid AI, Nowotny P, Waldhäusl W, Roden M. Increased lipid availability impairs insulin-stimulated ATP synthesis in human skeletal muscle. Diabetes. 2006 Jan;55(1):136–40.13. Martins AR, Nachbar RT, Gorjao R, Vinolo MA, Festuccia WT, Lambertucci RH, et al. Mechanisms underlying skeletal muscle insulin resistance induced by fatty acids: importance of the mitochondrial function. Lipids Health Dis. 2012;11:30.14. Kusminski CM, Shetty S, Orci L, Unger RH, Scherer PE. Diabetes and apoptosis: lipotoxicity. Apoptosis Int J Program Cell Death. 2009 Dec;14(12):1484–95.15. Boden G. Fatty acid-induced inflammation and insulin resistance in skeletal muscle and liver. Curr Diab Rep. 2006 Jun;6(3):177–81.16. Goran MI, Dumke K, Bouret SG, Kayser B, Walker RW, Blumberg B. The obesogenic effect of high fructose exposure during early development. Nat Rev Endocrinol. 2013 Jun 4;17. Stanhope KL, Schwarz JM, Keim NL, Griffen SC, Bremer AA, Graham JL, et al. Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans. J Clin Invest. 2009 May;119(5):1322–34.18. Akram M, Hamid A. Mini review on fructose metabolism. Obes Res Clin Pract. 2013 Apr;7(2):e89–e94.19. Zuñiga YLM, Rebello SA, Oi PL, Zheng H, Lee J, Tai ES, et al. Rice and noodle consumption is associated with insulin resistance and hyperglycaemia in an Asian population. Br J Nutr. 2014 Mar 28;111(6):1118–28.20. Wang L, Mascher H, Psilander N, Blomstrand E, Sahlin K. Resistance exercise enhances the molecular signaling of mitochondrial biogenesis induced by endurance exercise in human skeletal muscle. J Appl Physiol Bethesda Md 1985. 2011 Nov;111(5):1335–44.21. Little JP, Safdar A, Benton CR, Wright DC. Skeletal muscle and beyond: the role of exercise as a mediator of systemic mitochondrial biogenesis. Appl Physiol Nutr Metab Physiol Appliquée Nutr Métabolisme. 2011 Oct;36(5):598–607.22. Kirwan JP, Solomon TPJ, Wojta DM, Staten MA, Holloszy JO. Effects of 7 days of exercise training on insulin sensitivity and responsiveness in type 2 diabetes mellitus. Am J Physiol - Endocrinol Metab. 2009 Jul 1;297(1):E151–E156.23. Fuchsjäger-Mayrl G, Pleiner J, Wiesinger GF, Sieder AE, Quittan M, Nuhr MJ, et al. Exercise Training Improves Vascular Endothelial Function in Patients with Type 1 Diabetes. Diabetes Care. 2002 Oct 1;25(10):1795–801.24. Boulé NG, Haddad E, Kenny GP, Wells GA, Sigal RJ. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: A meta-analysis of controlled clinical trials. JAMA. 2001 Sep 12;286(10):1218–27.25. Thomas D, Elliott EJ, Naughton GA. Exercise for type 2 diabetes mellitus. Cochrane Database of Systematic Reviews [Internet]. John Wiley & Sons, Ltd; 1996 [cited 2013 Oct 18]. Available from: Exercise for type 2 diabetes mellitus26. Jensen TE, Richter EA. Regulation of glucose and glycogen metabolism during and after exercise. J Physiol. 2012 Mar 1;590(Pt 5):1069–76.27. Goodpaster BH, He J, Watkins S, Kelley DE. Skeletal muscle lipid content and insulin resistance: evidence for a paradox in endurance-trained athletes. J Clin Endocrinol Metab. 2001 Dec;86(12):5755–61.28. Hawley JA, Lessard SJ. Exercise training-induced improvements in insulin action. Acta Physiol Oxf Engl. 2008 Jan;192(1):127–35.29. Hawley JA. Exercise as a therapeutic intervention for the prevention and treatment of insulin resistance. Diabetes Metab Res Rev. 2004 Oct;20(5):383–93.30. Suo C, Liao J, Lu X, Fang K, Hu Y, Chen L, et al. Efficacy and safety of the ketogenic diet in Chinese children. Seizure - European Journal of Epilepsy. 2013 Apr 1;22(3):174–8.31. Kang HC, Chung DE, Kim DW, Kim HD. Early- and Late-onset Complications of the Ketogenic Diet for Intractable Epilepsy. Epilepsia. 2004 Sep 1;45(9):1116–23.32. Research paper (PDF): The ketogenic diet: From molecular mechanisms to clinical effects [Internet]. ResearchGate. [cited 2017 Apr 6]. Available from: https://www.researchgate.net/publication/7253814_The_ketogenic_diet_From_molecular_mechanisms_to_clinical_effects

What's the one thing about life everyone should know?

This is a list of fundamental things which will be good for adults to know in our modern era. While choosing the topics my approach was something like: “you don’t need to learn all the details if you are not interested but it is really useful at least to have heard of what it is”Some of the topics may be too obvious and some of them may seem very unnecessary. I have done my best to find a compromise. Since this is a study which I have prepared according to my own knowledge depth, there will be for sure some missing points and mistakes. I have checked some books, some old school encyclopedias, several websites, similar lists and consolidated / filtered / summarized all I found with my own vision. Also, I’m not a native speaker (which you can see easily) so there will be some inevitable language mistakes. Ok, let’s go!Main CategoriesNatural Sciences & MathematicsSocial SciencesPsychology & SpiritualityArtsHealthTechnologyDaily Life SkillsSoft SkillsBig IdeasNATURAL SCIENCES & MATHEMATICSMathematics: Let’s start with the mathematics. Everybody starts learning math when they start primary school. And we continue learning it until we graduate. Basic maths is indispensable (four operations, fractions, decimals, ratios and proportions and so on) You may be a dancer, poet or farmer and you will still need it when you make a monthly personal budget or calculate the interest rates of the credit you took from your bank.But besides the very basics, I think it will be very good and interesting to learn a bit more advanced topics like: the difference between the linear growth and exponential growth (Bacterial growth - Wikipedia), modular arithmetic (how computers work and what are those famous 1s and 0s in matrix wallpapers), reading charts (x-axis, y-axis) and much more. I sometimes see very enjoyable books explaining daily life topics with mathematics in bookstores but I don’t remember now to recommend any. (feel free to comment any recommendations)One more thing about mathematics is: logic and paradoxes. If you’ve never heard what is a paradox, you should definitely check a few. They are mind-blowing and really fascinating! (10 Mind-Boggling Paradoxes)Biology: The science of living beings. Humans have systems in their bodies working coordinately like departments of a company. Bats are the only flying mammals. But what is a mammal? What is a cell? What is a DNA? We see DNA tests in many movies but how do they understand whether that child is her’s with only one hair string? What is a virus? Is it living or non-living? Ever heard of photosynthesis? Why are trees said to be lungs of the earth? Oh, what is lung anyway?Chemistry: Atoms. Molecules. Chemical reactions. States of matter. What is a gas, what is boiling? Did you know you cannot boil an egg on top of the Everest because boiling temperature will not be enough? And this topic is pretty related to how pressure cookers work. Speaking about water, why do they say H2O to the water? Why not H5O? Do you remember periodic table from high school classes? It seems very colorful and fancy but why is it important? What is an atom? What is in it?Physics: Force. Forces. Machines. Wheel. Light. Mirrors. Lenses. Pressure. Electronics. Waves. Dynamics. Energy. Sun. Planets. All these and much more fall into physics and it is up to you how much you want to learn. Maybe you don’t need to go into quantum physics or general relativity but it may be nice to have an idea what entropy is. It is interesting. Also, cosmology, astrophysics, planet orbits, stars, possibility of time travel, wormholes, light-year, galaxies are also very interesting to learn and read about.There are great youtube channels about all these topics. And one of my personal favourite:Ok, this is enough for the first part. Let’s move on to social sciences..SOCIAL SCIENCESHistory / World History: Most of us learn a lot about our own country’s history. But in fact, all our history is interconnected. So I see it essential to learn world history. The USA was not always there, they are pretty new. Roman Empire was one of the largest empires ever but why did they fail to continue? What happened in world war I-II? If you know the history, it will be eaiser to understand what is happening in the middle east today. What is cold war? How did the Soviet Union collapse? Who discovered the America and what they have done? How did China manage to preserve its borders this long? We hear about Aztecs, Incas but where are they now? Why do they call the UK The empire on which the sun never sets? What was the purpose of Hitler? If Germany and Japan lost the world war, how they became two of the most powerful countries in such a short time? Ever heard Napoleon? Or Mahatma Gandhi? Or Atatürk? History is an ocean..Geography / World Geography: Guessing the country from its flag is a fun game. But geography is much more from country flags. It is very surprising how less some people know about the country locations (Ohh, is Japan an island?!) Ok maybe you dont need to know where exactly is Barbados but an adult should be able to visualize the world map roughly, with the continents set apart, where is China, where is Europe, where is Atlantic Ocean etc.Basic geography knowledge also contains the landforms of earth. What is a desert, what is a river delta or a rain forest? You should be able to read the maps, understand a bit what legend says (scaling?). Climate information, animals and plants for a specific type of climate regions, weather conditions, what type of winds are there, earth formation, how disasters occur and many more.Sociology / Culture: Why societies act the way they do? How do we interact with each other? What is culture? Why do we create families? What is ethics? (by the way, ethics is one of my favourite sub-topic. It can be very interesting sometimes. For example, should people be allowed to clone themselves or should we take immigrants into our country etc.)Besides socilogy topics, I also think everybody should have a general idea about the different cultures all around the world. This is very stimulating. East Asia is quite different than Europe, so is South Africa or Brazil. Earth is huge and people do not act everywhere in a way you do. For example, you may be thinking that calling your parents with their names is very normal but in some regions, it is very rude and unacceptable. It is not because they or you are idiots but there are reasons for that. It is very fun to see what kind of traditions people have in different places.This is an interesting documentary film showing a day of many different people from all around the world. Worth to watch.Politics & Forms of Government: We all used to hear about communism and capitalism in the past decades. But that’s just a drop in the bucket. The historical progress of politics is quite interesting. And it is always changing inevitably! We still couldn’t find the best government form. We even aren’t sure if we really need governments. For example we praise democracy as a signal of civilization and modernity, right? Do you know what do experts say about democracy: “Democracy is the worst form of Government except all those others” (Trump is elected with it :)Anyway, let’s don’t leave our topic. There are lots of things to be known for an adult in this area. For example how elections work? What does prime minister do? Who decides how to change the education system? What is a parliament? What about international relations? What is UN, NATO, EU, Trade agreements, borders etc.Basic Law & Rights: I guess this is one of the most missed/ignored subjects if you are not specifically working in this area. But this is too important to miss! Ok, knowing where Nigeria is on world map is nice but it probably won’t save your life. However, knowing your rights/limits/obligations before police knocks on your door could be very helpful. And leave aside the basic legal system knowledge, most of us are even not aware of our personal rights.Ok this was the easy part. Most of us somehow know these rights. But what about responsibilities? For example you have to pay your taxes, you cannot drink and drive, you have to take care of your children, you have to vote. Do you know what you can do / cannot do if you are arrested? Or what if you encounter a thief at your home? Can you shoot him/her? Does it differ if he is at your bedroom? What is counted as self-defence? Do you smoke weed? Or do you use drugs? Is it legal where you live? Do you know the consequences? Or another question: if you see someone kills a person are you obliged to report that to the police? Do you use copyrighted material on your website? Do you know the consequences? There are many questions like this and I don’t know most of these myself either. Unfortunately, we learn these things the hard way: experience.Also take a look at: Your Rights - RightsInfoBesides personal rights, there are essential information every adult should know regarding the legal system. For example, do you know what are the differences between a lawyer, attorney general and judge? Where can you apply for an official complaint? How do you sue someone? Does it cost anything? What is constitution?Economics: Oh yeah! Economics is a large subject which has a world on its own. But we are talking about the basics here. So, let’s try to keep on the track.There are lots of sub-topics which fall under economics. How do currencies work? What is inflation? What is the relation between the interest rates-inflation-currencies-exports/imports. How stock exchange works? Why did we create this? How banks work and where do they earn money from? Why $100 today is more valuable than $100 tomorrow (time value of money)? What is opportunity cost?Besides these basic concepts, I also note down some related topics which may be good to have an idea about:General knowledge about main occupations/jobs. What does an accountant do in a daily life? Or a carpenter, commissioner or a web developer?Nice to know how companies work? Which departments do what in general? What is does human resources or logistics department do? What is a CEO of CFO? What are the biggest companies in the world? How many employees do they employ? How much revenue they generate and how much profit they create? Ohh what is the difference between revenue and profit?Personal finance. How to make a monthly/yearly budget? Where should we invest our money and how? How should we save money for future?For those who want to go a bit deeper, I would definitely recommend this Crash Course channel (they are really cool):Economics - CrashCourse - YouTubeLet’s finish this section with a bit fun:Two Cows Explain Economics Better Than Any ClassMIND AND SOULPsychology: We are not talking about the pure deep knowledge here which will help you pass the exams and make you psychologist. Rather than that, we are talking about general knowledge which will be helpful if “anyone” knows a bit. Considering this, what I would say as a foremost information about psychology is: your brain also gets sick and that can be cured. I still see lots of people who are unaware of this fact and continue living with their own problems. They don’t even think that is a problem which ruins their life. Anyway, that’s not the issue at the moment.Psychology is a very broad topic and I’m not an expert, but I quite enjoy reading about main theories, some experiments and related studies. For example, there are famous studies and behaviours like Stockholm syndrome (starting to feel empathy to (even like) our kidnapper), Dunning–Kruger effect (everybody thinks they are above average) or The Paradox of Choice (the more choices we have the less likely we are to be happy with our decision) and many more.. You have probably heard but do you know what is Maslow's Hierarchy or Pavlov’s Dog? It would be nice to get an idea..Many fascinating movies use psychological studies in their scenarios or completely based on an experiment. Check this out for The 25 Most Influential Psychological Experiments in History. And in Quora these are one of the most followed topics I have seen: What psychological tricks and hacks are useful to know? and What are some cool psychological hacks?Besides all these, psychology works mainly on our mind problems. What is depression, why does it happen, am I having a panic-attack, my child is hyperactive is this a good thing? Do I have a social phobia or just an introvert? I am a porn/drugs/smoking/gambling addict, how to get rid off it? Can someone have schizophrenia if didn’t have before? How to overcome my anxiety about sex. Oh talking about sex, what did Freud say about it?Philosophy: Ever heard Sophie's World? It is a novel about the history of philosophy and was the best-selling book in the world around mid 90s. You may think: “How come a book about philosophy becomes the best-seller globally?” But in fact, philosophy is damn intriguing! Everybody should know a little bit about it.What is knowledge? What is “something” and Why Is There Something Rather Than Nothing? Am I really here in this physical world or is this all an imagination of someone (god?) What is Cogito ergo sum? Who is Descartes, Kant, Plato, Aristotle, Socrates, Nietzsche? What is dualism, nihilism or pragmatism? Who is septic, materialistic or hedonist?Aaaaand ladies and gentlemen, please welcome: Prisoner’s DilemmaDid you like this? Ok, you can continue here: Game theoryReligion: Whether you believe in god, in buddha, in sun or be an atheist everybody has an idea about religion. You may be thinking it is the opium of the masses or is way to happiness. One thing is certain: it is one of the most controversial area in our humanity. From “knowledge point of view” it is a very good idea to learn about other beliefs of people all around the world. Christianity, Islam, Hinduism, Buddhism, atheism, Scientology or anything you care. If we learn others, this will make us more humble, indulgent and easy to empathize.Nowadays many people try to learn mindfulness. Actually it is nothing new. In many religions, these meditation methods are being applied for centuries. Did you know Yoga is actually a prayer method and it has many similarities with others in different religions? (e.g. Salat in Islam)I really love learning about Sufism and it says if the subject comes to spirituality than your intelligence is useless anymore. You should continue with your heart. The words are not enough to explain.** If you are interested in sufism I can recommend a book here:Amazon.com: The Forty Rules of Love: A Novel of Rumi by Elif ShafakARTPainting: I would be really happy to take a private lesson from a painting expert who would explain me why Monalisa is damn famous or what is special with Picasso’s paintings. Yes I can read about them, check the images from internet, read the history and so on. But isn’t it a very good idea to go to museums together with the expert and he/she will tell me about how fascinating are the stories behind those paintings? :)I don’t know about visual arts so I can’t understand the real value of paintings or sculptures. However, I sense the stories behind and willing to learn in the future. Oh sorry for my personal opinions and let’s get back to the “knowledge” part.Baroque, impressionism, cubism, expressionism, Van Gogh, modern art, The Last Supper, Salvador Dali and The Persistence Of Memory..Architecture: Our design approach reflects our life style. So does architecture of our buildings. They have stories. And I believe there are lots of things to learn in this. Everybody knows Eiffel Tower but do you have any idea why it has that shape? Ever heard of Sagrada Família? (It has started in 1882 and its construction is still in progress!) What about Colosseum, Taj Mahal, Kremlin or Hagia Sophia? I am far from being an expert but I love looking at them..Literature: Shakespeare. Dickens. Tolstoy. Mark Twain. Kafka. Dostoyevsky and many many more. Did you read Animal Farm, Anna Karenina or Hamlet? Most of us are watching movies/tv series instead of reading books nowadays but books offer a much more fulfilling experience.Books That Everyone Should Read At Least Once In Their LivesBesides these classics, it is also good to learn how to read poems, how to read books, how to understand and interpret them. Speed reading techniques may be also worth to consider.Music: Everybody loves music. But besides listening your favourite songs, wouldn’t it be good to know a bit about the background? For example, if you know what a bass guitar does or to be able to understand how complicated the drums of that particular song may enhance your listening experience. You “may” enjoy with a different view from the concerts you go. But I say “may” for this part because I am not very sure whether knowing more about the instruments will give you more joy or is it better to “just listen”.Personally, while raising kids they should be given opportunity at least to try playing a few instruments. They don’t need to be experts in any of them but I believe just playing a guitar or a flute or a piano will extend their vision about life, arts and music.By the way, let’s don’t forget the legendary songs. Your legendary can be from Metallica, Vivaldi or Rihanna. But just checking out different types of music may help you to find some new songs you didn’t know you may like.And before we finish this section, just spare 20 minutes of today for this:HEALTHFirst Aid: Everybody should know first aid. Period. But it is not easy to learn it by reading or watching videos, it should be practiced. I don’t know why they don’t teach it at schools. It is not optional. What will you do if someone you love is having a heart attack, or shocked by electricity, or heavily bleeding or choking and you are alone? It may be too late for an ambulance.Basic Anatomy: Do you know what your liver is actually doing? Or your kidneys? What do doctors mean when they say your hormones or enzymes? I think everybody should know about our anatomy at least in the basic terms.InnerBody.com | Your Interactive Guide to Human AnatomyEmergency/Survival Info: What to do in a terrorist attack? What to do during an earthquake? Fire? Animal attack in a forest? One little piece of information you may have read somewhere can literally save your life someday.Basic Pharmaceutical Knowledge: You won’t keep asking your mom which pills you should take when you burn your hand, catch flu or have a headache, will you? Every adult should be aware of some basics about medicines. For example what does an antibiotic do to your body and how you should use it? Which cream you should apply to relieve muscle pain? Did you know you should never drink alcohol with any medication? Is it ok to give Asprin to your child? You are using some pills for your reflux but are you aware of short/long time side effects? Ever heard what active ingredient is?What are the names of some basic medicines that everybody should know about?*** Never use medicines without knowing their side effects. Follow your doctor’s advice before going in a medical treatment ***Diseases: Everyone should know, at least roughly, what is AIDS and how do you get infected, what is diabetes, what is cancer and how does it occur. If you hear someone near you had tuberculosis, you should be aware of that it is contagious.I want to share something I always find very interesting. We are always talking about war, bombings, terrorist attacks and so on. It feels like people are mainly dying from these. In fact, that’s the very small percentage of causes of death. Look at this:Of course those intentional injuries have a large psychologic effect on society because we think they are preventable. However, we can also prevent lots of diseases. (Yes, the chart above also contains old people too and we are going to die somehow but that doesn’t make it less worthy to learn)Alternative Medicines: You may not believe alternative treatment methods. But nowadays, even doctors recommend some of them as well. For example, if you have migraine you very well know that modern medicine science is not able to understand and solve it completely (yet). But you may try acupuncture meanwhile. Or instead of running to the pills cabinet when you snuffle, you may try some herbs. If you are not even aware of these treatment methods, how will you decide to try someday?Foods / Healthy Eating: What do we eat? Where do they come from? What is all the fuss about fast-food? What do we know about the basics of nutrition? What is carbonhydrate, protein, fat, vitamins, minerals? Is being a vegetarian healthy? How do they bring that meat to your table? Which processes do these foods are passed? Do you know where strawberries grow? Is this organic food trend being exaggerated? Why we should limit using salt and added sugar as much as we can? Can you read nutrition facts label?There are lots of documentaries about our food industry. Watch one of them if you haven’t done so far. It will change your perspective. I recommend:Food, Inc. (2008)Sports: We mentioned about the importance of knowing how human body works before. But when it comes to exercising, there are some basic moves everyone should do in daily life. Walking and jogging is great but ever heard about plank, squat and push-ups? I liked this article about these basic exercises.Knowing some fitness terminology can be helpful as well: cardio, biceps, triceps, body mass index, lactic acid, heart rate, warm up and so on.I am pretty sure you know soccer, basketball, tennis but you may also want to check what is pilates, power yoga, martial arts, functional training, zumba.Losing weight is one of the most popular topics nowadays. Combined with nutritional knowledge you will be able to know what you are doing.Lastly, dancing! Be it tango, samba or popping. They are all fun and a great way to keep your body fit and healthy. Not only learning what they are but also trying a few is something you won’t regret.TECHNOLOGYHow stuff works: We are all living in the technology era. We use smartphones, TVs, dishwashers, computers, planes, cars, internet. Of course most of us don’t need to understand how printed circuits work but having a general knowledge about this technology world is essential.This website used to be very popular a decade ago and still worth to check today: HowStuffWorks. But there are lots of great resources to learn the basics today. Make a list like this and start checking from time to time: How internet works? How computers work? Engines, cell phones, printers, white appliances, watch, camera, microphone, electric guitar, GPS, radio, telephone, planes, satellites and whatever you like.Computers / Internet: You always hear a program called Photoshop but do you know what it is? How do you open .zip files? What is a pdf file? You probably heard about Microsoft Excel but you will be surprised to know the things that can be done with Excel. Using computers is inevitable today and you should know at least the basics even though you don’t master any of it.Besides using software, you should also be familiar with some terminology. For example what is a search engine? What is a browser? What is IP? How big is 100 MB and how many MBs a movie occupy on our hard disk? What is hosting and servers, why do we need servers anyway? What is cookie, spam, firewall and CAPTCHA? What is a computer virus and will it get infected if I use my computer when I have the sniffles?!And there are some websites you should be at least visited once. Without knowing what it is, you cannot tell if you will like it. Websites like TED, Duolingo, Khan Academy, World Factbook, IMDB, Groupon, Trello, Skyscanner, Deviantart and many more are really worth to check out.Quora is full of tech/computer geniuses, so I am not going to go into more detail. But I will leave one link here which I think is enough (you will understand why if you visit):Deepak Mehta (दीपक मेहता)'s answer to What are the most productive ways to spend time on the Internet?This is what is happening on the internet every 60 seconds. Mind blowing!DAILY LIFE SKILLSSwimming: Earth is 71% water. You will certainly need it!How to Cook: This is not only for ladies. Cooking is some kind of therapy. It also lets you know and appreciate the meals that come to your table.Dancing: Mentioned this in sports section too. Just give it a try.How to fix a car, change tyre, refill oil: Oh yes, you take your car to the service, but these are still needed.Housework / DIYs: Can you iron? Or use a screwdriver? Paint the wall? You won’t hire someone everytime you need to change the bulb, will you?How to Makeup Correctly (yes, for ladies): I don’t know why I put this here :)Gardening: We all dream of leaving our corporate jobs, moving to a countryside and dealing with gardening, don’t we? Put aside the dreams it is a fact that we need to touch the soil more. It takes your stress and makes you feel more natural and happier. If you have the land by your house, don’t hesitate to get your hands dirty!Sewing: It is just a little button fell of. That should be easy to fix, right?Cleaning: According to very deep and scientific studies (!) 86% of men do not know how to use washing machine. They don’t even know the difference between bleach and detergent. Oh, by the way can I use this liquid to clean the kitchen sink??How to Whistle Loud: This skill is a must! You will need it when you miss that cab or bus. It is also very useful at a match.Tie up / Fastening / String skills: Ok you know how to do up your shoelace. But what about a tie? What if you need to make a strong tie? Can you knot? Not everything is wireless yet, you may need these:Personal Time Management: This is a bit related to that person’s character. Some people are very organized and planned whereas some of them are quite spontaneous. But whatever character trait you have, you will still need a bit time management skills. There are great online tools and mobile apps. Check those if you feel lost sometimes.Basic Security Issues: This may seem too obvious to some of you but there are still lots of people out there who give their credit card password to the person on phone. Banks never ask your password. Regarding passwords, there are some best practices like not using the same password for everywhere, recording them in secured apps and so on.There are also lots of security rules about our cars and houses. Every adult should know the meanings of warning signs on the roads. Balconies are dangerous for your kids and pets. Never leave pills and little pieces at places reachable by little kids. Unplug your electrical device when you leave home or even not using it.Saying: “oohh! I didn’t know that” will not fix the situation later on.Terminology: There are looots of terms being used in many different areas. We cannot know them all and we don’t need them all. But knowing some basics will be helpful, like: lol, wtf, ppc, seo, NATO, GDP, btw, NSFW, asap, ceo, cfo, ps, diy, etc. Check internet abbreviations as well as economics, technology, companies, countries and so on. This is a good and short list I have found:List of Commonly Used AbbreviationsSOFT SKILLSCommunication: Being able to express your ideas in a clear manner. Active listening. Understanding body language. Questioning. Giving a speech in front of an audience. Being polite. Be able to act politically. Controlling your anger. These skills are not easy to learn by reading or watching videos. You will rather practice it as you live.While we discuss, debate, defend our opinion we use some techniques (rhetoric), mostly instinctively. And inevitably most of us fall into logical fallacies sometimes. It is helpful to know this:Communication with Opposite Gender: Check Quora for several types of “I love him/her. How should I approach and tell that I have a crush?”How to Tip Correctly: Restaurant, cafe, bar, car valet, pizza delivery guy or anybody. You don’t need to get stressed at that moment.Making a ReservationKeeping Your Marriage HappyThere are many more soft skills but it will be better to cut it here and put some links:87 Soft Skills (The Big List)Badass Skills: Soft skills are very important and they really define the happiness of a society. However, I am more interested in badass skills (or I don’t know what are they called) For example, being able to bribe! Don’t flame me but I’m pretty sure lots of people here have heard how he got off from traffic police control without getting a fine by crossing a few bucks. Or promoting yourself at a company to get ahead of your colleagues. Or snubbing a bully. I am not praising these skills but life is cruel and someday you may need to switch to dark side, temporarily ;)BIG IDEASOn this last part, I am just going to put some big ideas/theories/subjects/concepts which may be quite interesting to learn about. These are mostly controversial topics and it is really stimulating to listen thoughts of both sides. Here you go:Evolution TheoryGlobalizationDeterminism and Free WillGame TheoryQuantum MechanicsRacismPareto RuleArtificial IntelligenceMachine LearningBig DataGlobal WarmingGlobal TerrorEuthanasiaNuclear EnergyAnimal RightsHomeschoolingCloningEthicsVegetarianismGay MarriageAbortionCivil Unions, Right to StrikeSocialism, Communism, Imperialism, CapitalismDark WebCittaslowDrugs LegalizationSweat ShopsGuns CarriageCrowdfunding3D PrintersTravel to MarsLife After Death (Reincarnation)Phew! It went far too comprehensive than I anticipated in the beginning. But I still tried to keep in my main categories. Most of the images from Google and I especially chose the ones with the references on them. Also I tried to give links to all info I shared here.Hope this helps!

How is it there is such a paucity of communication, note and record sharing between primary and specialized physicians?

Only few countries in the world, e.g. Estonia, have national medical records that all clinics and hospitals connect to. Instead, every clinic and hospital maintains a closed medical record using a number of different medical record keeping programs that rarely communicate with other programs. Sometimes records can be transferred if two clinics happen to be using the same software, but for the most part records stay with the clinic. Sending the entire record as print paper or PDF isn't a viable option either: primary care records extend decades back and sifting through old laboratory results from the 1990s serves no other function than to drown relevant information.Consequently the only information communicated is what the doctor deems fit to include in what's essentially a letter, be it referral or discharge summary. Doctors are always operating under time constraints and crafting letters can feel like the least important part of the job, so busy doctors sometimes neglect this part. Sometimes frustration becomes an attitude problem: "What does a GP know of surgery anyway?" or "What does the 'bonesmith' care about recent glucose control?"Actually, a lot.The best model for health care is for every patient to have one personal primary care physician who gets to know them well. Your GP can treat over 90% of your medical concerns without the aid of specialists and knows when you need to consult one. They are specialists of the big picture, recognising the entire biopsychosocial construct rather than a particular system or organ. Obviously you can't be a specialist of everything: when out of their depth about the heart, primary care physicians are happy to consult a cardiologist. But that does not mean they are done with the patient's heart - it's still a part of the big picture they are looking after and it's absolutely vital they are kept posted of any changes made to the management plan by the specialist. It's absolutely infuriating to consult a specialist and never hear back from them; to rely on patient recollections of what the specialist might've suggested. I can imagine specialists will feel something similar when accepting a new patient and having no health summary to work with - they care whether the patient is, say, diabetic no matter what their specialty is but it's a waste of, say, an orthopaedist's time to tease that information out of the patient when their expertise lie with the surgical aspect.This is by no means a new problem. I have hoped for a national medical record as long as I've practiced medicine and both countries I have worked in are currently working toward achieving that but looks like the dream is still ages away in Finland and Australia. Until technology steps in to help us, it’s up to the doctors to write good letters. It’s a show of respect to provide colleagues with concise, comprehensive letters and I try to teach my medical students to take pride in their communication. It saves other doctors so much unnecessary effort and, you know, saves lives.

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