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   Dr. Bralow’s Bulletin
September 17th, 2021
Edition #133 – est 3/2020

This week’s Bulletin discusses Prediabetes, along with the latest updates on COVID-19:

Prediabetes = Preventdiabetes

Prediabetes is a serious health condition where blood sugar levels are higher than normal, but not yet high enough to be diagnosed as type 2 diabetes. Approximately 88 million American adults—more than 1 in 3—have prediabetes. Of those with prediabetes, more than 84% don’t even know they have it.

So why is prediabetes so serious if your doctor hasn’t even put you on medicine and, in fact, you don’t have actual diabetes? Prediabetes is serious because:

  1. People with prediabetes alone are still 50% more likely to develop heart disease or stroke compared to people without prediabetes.
  2. You are also at high risk of developing type 2 diabetes which doubles your risk of developing heart disease and stroke according to the American Heart Association.

For people with type 2 diabetes, heart disease is the most common cause of death. So if you always thought that high cholesterol was the biggest culprit for developing heart disease, then you need to understand why prediabetes and diabetes pose an even higher risk. Understanding the connection between diabetes and your blood vessels is the first step toward prevention.

Blood vessels are like a network of pipelines in your body. This network helps transport blood to all body parts, which in turn delivers oxygen and other nutrients like glucose to the body’s cells. Your body has three main types of vessels: arteries, veins, and capillaries. The structure of vessels is layered like the rings of an onion. The innermost ring is called the endothelium,  and it helps promote a steady blood flow through your blood vessels. Diabetes damages the body’s blood vessels in several different ways. For instance:

  1. It damages the endothelium –  A healthy endothelium is necessary for blood to flow freely in your blood vessels. High blood sugar in diabetes damages the endothelium. This impairs the steady flow of blood inside blood vessels.
  2. Diabetes decreases the release of Nitric Oxide from blood vessels – Your blood vessels release a chemical called Nitric Oxide (NO). NO is important as it helps your vessels relax. Without it, the vessels become narrow and the flow of blood in them decreases as well.
  3. It accelerates the process of atherosclerosis – Cholesterol and fats are two important substances in your blood. When their levels increase, they start to clog and harden your blood vessels. Atherosclerosis is the term doctors use to describe this process. Diabetes speeds up the process of atherosclerosis. As a result, your vessels harden and narrow down as well.

These changes to the body’s large and small blood vessels caused by diabetes and prediabetes decreases the supply of blood to different body parts leading to complications like:

  • Poor vision or loss of vision
  • An increased risk of heart attack or stroke
  • Heart failure
  • High blood pressure
  • Kidney failure
  • poor skin healing
  • numbness and pain in fingers and toes

According to the American Diabetes Association, prediabetes is diagnosed when:

  • A Hemoglobin A1C reading is between 5.7-6.4 percent
  • A fasting blood glucose is between 100 -125 mg/dl
  • An oral glucose tolerance 2 hour blood glucose reading is between 140 mg/dl-199 mg/dl

You are most at risk for prediabetes if you’re African American, Hispanic/Latino American or if you have any of these risk factors:

  • Being overweight
  • Being 45 years or older
  • Having a parent, brother, or sister with type 2 diabetes
  • Being physically active less than 3 times a week
  • Having gestational diabetes (diabetes during pregnancy) or giving birth to a baby who weighed more than 9 pounds

A diagnosis of prediabetes usually indicates insulin resistance, which means your body doesn’t use insulin properly. Insulin regulates your body’s usage and storage of sugar and fat.

When your body uses insulin properly, it works like this:

  • Your glucose (blood sugar) rises after you eat.
  • Your pancreas releases insulin, which unlocks your cells.
  • Your unlocked cells are then able to use the glucose for energy.

If your body is insulin resistant, here’s what happens:

  • Your glucose (blood sugar) rises after you eat.
  • Your pancreas releases insulin, but your cells resist the insulin and the glucose isn’t introduced to the cells efficiently.
  • The glucose stays in your blood (keeping your blood sugar levels high) because your cells aren’t burning the glucose for energy.

Prediabetes can be stopped from turning into Type 2 diabetes – and this doesn’t involve expensive medications or invasive hospital procedures. Of course you know I’m talking about “lifestyle modifications”. But before you roll your eyes and say to yourself that you’re too busy to change up your usual eating and shopping routine or you want to lose weight but it’s not working or you hate gyms…just give yourself a little shake. The reality is that small changes in your lifestyle will lower your risk by 60% of developing a disease that is deadly, will cost a lot of money for medications and will impact the quality of your life forever.

Here are 3 things you can easily incorporate into your lifestyle that will prevent diabetes and reverse prediabetes:

Move more
Activity is a key factor in diabetes prevention. I guarantee you will not lose weight because you exercise unless you spend hours a day at high-intensity workouts. The benefit of physical activity for prediabetes is that your muscle can take up and burn sugar without insulin, taking pressure off the pancreas. According to the American Diabetes Association (ADA), moderate activity can reduce blood sugar for up to 24 hours after you’re done being active . So you don’t need to start running marathons or joining a gym – you just don’t want to be a couch potato 24/7. What you should strive for is getting @30 minutes of moderate activity for five days a week. This can be done at one time or broken up throughout the day. Use the “talk test” to gauge if you’re being active at a moderate intensity. (If you’re a bit breathless and can talk while you’re being active but you can’t sing, then you’re right on track.) Many daily activities – taking the stairs, gardening, walking the dog, walking to work, clearing out the garage, housecleaning and playing sports all count towards the general goal of getting those 30 minutes of exercise each day.

Lose a little weight
Here’s where people get discouraged because they’re thinking, “I have 50 pounds to lose and I’ll never do it.” The reality, though, is that losing between 5% and 10% of your body weight can help do the trick. If you weigh 200 pounds, losing 5% to 10% of your weight would mean losing 10 to 20 pounds. Losing weight isn’t easy, but aiming to lose a small amount can seem more doable. In people who are overweight, the body may need two to three times more insulin than it would at a healthy weight. When the pancreas tries to produce that much additional insulin, it can be pushed beyond its capacity, and insulin-producing cells start to die. That worsens the situation because the pancreas then has even fewer cells with which to make insulin. Research also has shown that the fat cells of people who are obese and who have more abdominal fat release molecules that can harm the pancreas. So the more abdominal fat you have, the higher the risk of damage to your pancreas.

Just eat better – independent of weight loss
If you have prediabetes then carbohydrate-containing foods, including candy, baked goods, bread, potatoes, corn, rice, grains, fruits, milk and yogurt, have the most impact on blood sugar because these are foods that either contain a lot of sugar or will turn into sugar when metabolized after eaten. Controlling the level of carbs you eat at each meal helps keep blood sugar under control. Carbohydrate counting will help you control carb intake. Click here for more carb-counting information. Eating less processed foods, more vegetables and fruit, more whole grains, less dairy and reducing sweets should become your way of eating forever. This does not mean eliminating the “bad” foods, but these should be treats, not part of your everyday diet. If you clean-up your everyday eating (and you know exactly what I mean), then your risk of developing prediabetes and diabetes will be very low.

 In 1958 there were 1.58 million people with diabetes (0.93% of population). In 1995, there were 23.35 people with diabetes (7.4% of population). Although the world benefits from the advances we’ve made in science and technology, our bodies unfortunately have not. Cars have reduced our activity levels – both by using them too much rather than walking as well as allowing us to live in the city suburbs where nobody walks like they do when you live in a city. Processed foods save us time but are laden with unneeded sugars and fats as well as chemicals. Weight gain has been happening gradually over many years between lack of activity and eating higher calorie foods – today the average woman weighs 167 pounds and the average man weighs 195 pounds. In 1950, her average weight was 140 pounds and his average weight was 167 pounds – today’s women weigh as much as men did in 1950!

So if you’re someone who is prediabetic or at risk for developing prediabetes, you can stop that train and reverse it. As Leo Tolstoy said, “Everyone thinks of changing the world, but no one thinks of changing themselves.” Let’s prove him wrong.

Bindle is a new app that allows you to securely store your COVID-19 test and vaccine records on your cell phone so you can easily access your health status whenever going into a shared space.
Click here for more information.


Fully vaccinated individuals have a much greater chance of not being impacted by this virus, whether that impact is via infection, hospitalization, or death.


  • Of the 1,184 Philadelphians who have died from COVID-19 in 2021, 98.2 % were unvaccinated, Philadelphia’s acting health commissioner, Dr. Cheryl Bettigole, said, stressing the importance and efficacy of vaccines. Philadelphia saw only one-tenth the number of total deaths in August than it did than January. In addition, the unvaccinated make up 96.5% of coronavirus hospitalizations, as opposed to the only 3.5% of hospitalizations from so-called breakthrough infections among the fully vaccinated, she said. Nearly 68% of adults in Philadelphia are fully vaccinated, while 82.6% have received at least one dose. Though breakthrough infections – which happen despite someone being fully vaccinated – do occur, they have made up less than 5% of all infections in the city since January.

  • Upward of 30 Greater Philadelphia theaters have signed on to a new policy requiring audience members either be fully vaccinated against Covid-19 or provide either a negative PCR test ​​taken within 72 hours of a performance’s start time or a negative antigen test taken within six hours of showtime in order to attend in-person, indoor shows for the 2021-22 season. Results from home tests won’t be accepted. At least 12 regional theaters have taken the guidelines a step further and are only allowing patrons that have been fully vaccinated to attend shows. Those organizations include The Wilma Theater, FringeArts, Curio Theatre Co., ​​Philadelphia Theatre Co. and Theatre Exile. An updating list of the regional theaters adhering to Theatre Philadelphia’s policy is available here.


  • The Philadelphia School District has asked outside agencies — including the Pennsylvania National Guard and Amazon — to help solve the school bus driver shortage that has plagued the district since the year started, sometimes stranding children at stops for hours, Superintendent William R. Hite Jr. said Wednesday. The district has also doubled the amount it’s offering to families to transport their children in lieu of taking yellow bus service, paying $300 per month instead of $150. And it’s explored the idea of giving SEPTA fare cards to additional children and to adults who don’t have cars as a way to get more kids to school on time, Hite said.


  • A female ring-tailed lemur named Charlie this week became the first animal to receive a special COVID-19 vaccination at the Philadelphia Zoo. In the coming weeks, 113 animals at the zoo will each receive the two-dose vaccine from a shipment of 240 doses provided by Zoetis, a former subsidiary of Pfizer headquartered in New Jersey that develops drugs for animals. Officials at the Philadelphia Zoo said they are designing their vaccination schedule based on factors like prioritizing higher-risk animals, vaccinating animals trained to receive injections voluntarily, and identifying animals who are already scheduled for routine physical exams. Animals at the Philadelphia Zoo already get other vaccinations. Gorillas and orangutans get annual flu shots. Big cats are given yearly shots for distemper, a highly contagious viral disease.

  • Atlantic City’s casinos and racetrack sports betting outlets are bouncing back convincingly from financial woes brought on by the coronavirus pandemic, taking in 31% more in August than they did a year earlier, after COVID-19-related closures ended. The improvement was vast, spanning all three major categories. In-person gambling revenue was $262.4 million, up nearly 32% from Aug. 2020; internet gambling revenue was $113.2 million, up 29% from a year earlier; and sports betting revenue was $52 million, also up nearly 32%.


  • For many, the term “misinformation” conjures up images of conspiracy-theory chat forums and Russian bots. But an alarming amount of it is reaching audiences in the health and wellness realms. Many social media influencers who focus on natural remedies, holistic health and new age spirituality have been sharing posts and videos questioning the wisdom of vaccinating against the coronavirus. Of course, not all yoga instructors and holistic healers are anti-vaxxers, and many actively promote vaccines and support medical science. But tight links have developed between groups focused on anti-vaccine messages and those dedicated to parenting, alternative health practices and concerns over genetically modified food, according to a study published online in February from George Washington University’s Institute for Data, Democracy and Politics.


  • As the nation’s covid death toll exceeded 663,000 this week, it meant roughly 1 in every 500 Americans had succumbed to the disease caused by the coronavirus. While covid’s death toll overwhelms the imagination, even more stunning is the deadly efficiency with which it has targeted Black, Latino, American Indian and Alaska Native people in their 30s, 40s and 50s:

            Culture                          One death in…

  1. Native Americans           240 people
  2. Hispanics                       390 people
  3. Blacks                            480 people
  4. Asians                            1,300 people
  5. Whites                            1,300 people

  • Preventable COVID-19 hospitalizations cost $5.7 billion from June to August in 2021. HHS and CDC data indicates there were 32,000 preventable COVID-19 hospitalizations in June, 68,000 preventable COVID-19 hospitalizations in July, and another 187,000 preventable COVID-19 hospitalizations among unvaccinated adults in the U.S. in August, for a total of 287,000 across the three months. If each of these preventable hospitalizations cost roughly $20,000, on average, that would mean these largely avoidable hospitalizations have already cost billions of dollars since the beginning of June. Only a small share of the cost of a COVID-19 hospitalization is paid directly by patients themselves. The monetary cost of treating unvaccinated people for COVID-19 is borne not only by patients but also by society more broadly, including taxpayer-funded public programs and private insurance premiums paid by workers, businesses, and individual purchasers.


  • More than 18 months into the coronavirus pandemic, a number of countries have decided it’s time to open up and adopt a “living with Covid” model:
  1. Denmark: The Danish government lifted all remaining coronavirus restrictions in the country on September 10, saying Covid-19 was no longer “an illness which is a critical threat to society.” Danes can now enter nightclubs and restaurants without showing a “Covid passport,” use public transport without wearing a face covering and meet in large numbers without restrictions — essentially returning to pre-pandemic life. The key to Denmark’s success lies partly in its vaccination rollout: as of September 13, over 74% of Denmark’s population was fully vaccinated against Covid-19, according to Our World in Data.
  2. Singapore: Singapore’s government announced in June that it was planning to move toward a living with Covid strategy — attempting to control outbreaks with vaccines and monitoring hospitalizations rather than restricting citizens’ lives. “The bad news is that Covid-19 may never go away. The good news is that it is possible to live normally with it in our midst,” Singapore’s top Covid-19 officials wrote in an op-ed at the time. They have one of the highest Covid-19 vaccination rates in the world, with 81% of the population fully vaccinated.
  3. Thailand: plans to reopen Bangkok and other popular destinations to foreign visitors next month, officials said last week, as the southeast Asian nation tries to revive its crucial tourism industry despite rising infection numbers. Just under 18% of the Thai population were fully vaccinated against Covid-19 as of September 13, according to Our World in Data, with a further 21% partially vaccinated.
  4. Chile: Chile has been internationally praised for its smooth and successful vaccination campaign. According to the health ministry’s latest reports, almost 87% of eligible Chileans are fully vaccinated.Despite the threat posed by the Delta variant, the government on Wednesday announced moves to reopen the country to international tourism from October 1, just in time for the southern hemisphere nation’s summer season.


  • The U.S. now ranks among the lowest vaccination rates for wealthy countries. Some wealthy countries like Australia are still struggling, with just 33.79% of its population vaccinated, but that’s way up from 12.18% back in late July. Japan is another rich country that has struggled with its vaccine rollout, currently ranking below the U.S. at only 49.96% fully vaccinated. Sadly, the U.S. has slipped from 18th place to 40th, with many wealthy countries getting vaccines in arms much faster than America over the past few months. China, for example, has vaccinated over 69% of its population of 1.4 billion people, well above the U.S., which has a population of just 328 million people. Here’s the percentage of each country’s population that’s been vaccinated, based on data from Johns Hopkins University.


  • Pfizer and BioNTech plan to file for Food and Drug Administration (FDA) emergency authorization in November for their COVID-19 vaccine for children younger than 5, Pfizer Chief Financial Officer Frank D’Amelio said this week. Pfizer has previously said the company expects to file in early October for emergency use authorization in children ages 5 to 11. Presenting during an industry conference Tuesday, D’Amelio said the company plans to file for emergency use authorization for younger kids “in a month shortly thereafter,” so long as all the data is positive.


  • 26 of the 50 largest public university campuses in the U.S. are not mandating that students be vaccinated, according to an analysis by The Associated Press. Universities with vaccine mandates are concentrated in the Northeast and California. Approaches on enforcement vary widely even among universities that do have vaccine mandates, with some offering leniency for students who opt out and others expelling those who do not comply. Administrators are emphasizing high numbers for student vaccinations as key to bringing some normalcy back to campus and keeping instruction in classrooms rather than online. Where mandates face political opposition, schools are relying on incentives and outreach to get more students vaccinated.


  • For the first time in 550 days, an audience was inside the auditorium at Lincoln Center for the Performing Arts on Saturday night, attending a poignant performance of the Verdi Requiem. The night was in commemoration of the 20th anniversary of the Sept. 11, 2001, terror attacks but in fact marked much more. The company was performing in its home for the first time since hundreds of thousands of deaths caused by the coronavirus pandemic, including Met violist Vincent Lionti, assistant conductor Joel Revzen and chorister Antoine Hodge. The pandemic caused the Met to cancel more than 275 performances, including its entire 2020-21 season, plus an international tour. The gap was the longest since the company began in 1883.


  • In wake of a growing number of zoo animals contracting COVID-19 this year — such as a troop of eight gorillas at the San Diego Zoo Safari Park — veterinary pharmaceutical company Zoetis donated more than 11,000 doses of its experimental vaccine for animals to about 70 zoos, sanctuaries, conservatories, academic institutions, and governmental operations. Zoo Atlanta announced some of their 20 western lowland gorillas experienced symptoms of “coughing, nasal discharge, and minor changes in appetite.” and tested positive for COVID-19. Zoo Atlanta had been on the waitlist to receive Zoetis, which is why their gorillas hadn’t been vaccinated. However, the vaccines have now arrived at the facility and they plan to administer them once the animals recover. They also plan to vaccinate their Bornean and Sumatran orangutans, Sumatran tigers, African lions, and clouded leopard.


  • According to the NFL, 93.5% of all players and more than 99% of all club personnel are vaccinated. There are 17 teams above 95% and 27 clubs have 90% or more of all players vaccinated. The lowest club is at 80% and there are three teams between 80-85%. The onboarding process for free agents is set up to incentivize vaccination, with non-vaxxed players needing five days until they fully join a new club.


  • There are @4,500 prisoners on home confinement after a memo in March 2020 directing the bureau to prioritize releasing inmates who were deemed to have especially serious health issues that put them at higher risk for severe illness caused by Covid-19. Now these prisoners are facing the possibility of being returned to prison once the pandemic recedes. In an email to NBC News, a BOP spokesman said the bureau may choose to keep inmates on home confinement post-pandemic if their sentence is nearly over. As for “more difficult cases,” in which inmates have many more years to serve, “the BOP is focused right now on the expanded criteria for home confinement and taking steps to ensure individualized review of more inmates who might be transferred,” the spokesman said.


  • COVID-19 infections are taking a deadly toll on pregnant people and fetuses in Mississippi. Officials announced on Wednesday that the rate of stillbirths in the state has doubled since the pandemic began last year. Mississippi State Health Officer Dr. Thomas Dobbs said on Wednesday that while “COVID is especially dangerous and problematic for pregnant women,” it can also be “deadly for the baby in the womb. With COVID, we’ve seen a doubling of the rate of fetal demise, or the death of the baby in the womb after 20 weeks,” Dobbs said. “It’s been a real tragedy.” Research shows that unvaccinated pregnant people are at an “increased risk of severe illness and pregnancy complications related to COVID-19,” and that those who are vaccinated do not face an increased risk of miscarriage.  CDC data shows that less than a quarter of all pregnant people in the U.S. are at least partially vaccinated as of early September.


  • According to the NFL, 93.5% of all players and more than 99% of all club personnel are vaccinated. There are 17 teams above 95% and 27 clubs have 90% or more of all players vaccinated. The lowest club is at 80% and there are three teams between 80-85%. The onboarding process for free agents is set up to incentivize vaccination, with non-vaxxed players needing five days until they fully join a new club.


  • A third dose of Pfizer’s Covid vaccine six months after a second shot restores protection from infection to 95% in a real-world setting in Israel, according to data submitted by the company to the Food and Drug Administration. While the effectiveness of the mRNA vaccine wanes over time, a booster shot was shown to elicit an immune response similar to the protection generated after a second dose, Pfizer said in a 52-page presentation released by the agency Wednesday.


  • US federal health officials have announced plans to offer booster doses this fall, starting September 20, subject to authorization from the FDA and consent from the CDC. The FDA’s Vaccines and Related Biological Products Advisory Committee is meeting on Friday to discuss the application by vaccine makers Pfizer and BioNTech to administer their Covid-19 vaccine as a third dose, or “booster” shot, to people ages 16 and older.


  • Side effects from Covid vaccine booster shots are similar to those felt after the second dose and are more likely to affect younger people, Pfizer said in new data submitted to the Food and Drug Administration as it seeks approval to distribute booster shots across the U.S. There were 300 participants from ages 18 to 55, and it was found that 63.7% experienced fatigue after getting their boosters, 48.4% had headaches and 39.1% felt muscle pain. The majority of reactions to the booster were mild or moderate in severity



Bralow Medical Group Office Information
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If you are my patient then you know to contact me directly on my cell phone 24/7 if you have any  medical concerns. You can also email me at with general questions.

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Please stay safe and be smart,
Dr Bralow

Dr. Vicki Bralow
834 South Street
Philadelphia, Pa 19147


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