Thursday, February 28, 2008

Childhood Obesity Studies - The "Hispanic Paradox" and More

A new study has found that overweight Hispanic children and adolescents already display risk factors for the development of diabetes and cardiovascular disease. Though Diabetes type II and obesity have been seen in this population, Latinos typically have a lower risk of heart disease, a phenomenon called the “Hispanic paradox”. This study shows a possible reversal in this trend and it is the first study that has been performed comparing obese and lean Latino children for risk factors that lead to chronic illness.

Dr A. Enrique Caballero (Joslin Diabetes Center, Boston, MA) and colleagues compared 21 children who were overweight to 17 lean Latino children for early markers of heart disease and diabetes. The average age of the group was 13. The study can be found in the March 2008 of Diabetes Care. Measurements of C-reactive protein (a blood test that measure inflammation in the body), triglycerides, and blood pressure were found to be higher in the children who were overweight.

Dr. Caballero explained, "Our youngsters are now developing higher rates of obesity and type 2 diabetes, something that we didn't see very often before, and we wondered whether the overweight kids, even before they had any problems with their blood sugar, their blood pressure, and their cholesterol, already had problems in their circulation.” He says that if the Hispanic paradox were true, the findings would show that Hispanic children are not at risk, but this does not seem to be the case.
Dr. Caballero recommends a shift in focus.. "we need to prevent and treat childhood obesity in the Latino community. We tend to think that having an overweight kid means he is strong and healthy and eating well, which is part of our Hispanic culture, and that's wrong. That's not the right approach."

Data from the National Child Measurement Program shows that one in three children is overweight by the time they reach sixth grade, indicating that the problem is getting worse. The National Child Measurement Program was established two years ago to bring awareness about healthy lifestyles for children to families and professionals. You can read more from this study here.

It’s important to know that children can be taught healthy lifestyles. In fact, another recent study funded by the National Institute of Health shows that elementary school children can be educated about obesity and diabetes and that they retain the information for nine months. The results of this particular study come from Program ENERGY, and were presented at Prevention Medicine 2008.

Program advocate, Art Campfield, PhD, food and nutrition researcher at Colorado State University, Fort Collins says, "Kids need to know how their bodies work so they can make appropriate health decisions. He feels that programs for kids geared toward diabetes prevention lack "any notion of energy balance, the science of the human body, blood glucose regulation, how you prevent [these diseases], and body image and self esteem." Dr. Campbell’s focus has been Hispanic, Native American, and African-American students.

Once again we see that obesity is a serious issue. When you consider the future of our children’s health it’s time to wake up and really get involved.


Acute Coronary Syndrome Linked to High Blood Sugar – American Heart Association Calls for National Studies

Dr Prakash Deedwania

The American Heart Association has issued a strong statement calling for studies from the National Institute of Health and other national bodies to systematically study the relationship between elevated blood sugar and acute coronary syndrome. The statement is published online, February 25, 2008 in Circulation.

Lead study author, Dr Prakash Deedwania (University of California, San Francisco), says “There is plenty of evidence that hyperglycemia is a frequent problem in patients with ACS arriving at the hospital — as many as 25% to 50% are affected — but elevated blood sugar is frequently ignored despite being strongly associated with increased mortality." He believes we are ignoring “this prognostic indicator”. We are treating the problem of elevated blood sugar without even knowing the outcomes.

Dr. Deedwania points out that we still haven’t defined a good target for managing blood glucose levels in the setting of acute coronary syndrome. He takes it further by saying that we’ve spent “millions of dollars” studying the problem, and more money on establishing hospital protocols even though our knowledge regarding the problem is limited.

The current guidelines state that blood sugar levels should be kept between 80 and 140mg/dl. In the hospital, blood sugar levels are controlled in the ICU using intravenous Insulin. Dr. Deedwania states that “while we recognize that this is currently the most effective way of controlling glucose in this setting, we don't know whether insulin is the right way to do it." He references the recent ACCORD trial but says that study only shows that hypoglycemia was potentially harmful in the patient population involved in the ACCORD trials. He is not convinced that we should not be treating hyperglycemia.

It is suggested that hospitals vigorously screen patients with Acute Coronary Syndrome for high blood sugar. Follow up testing should be performed regarding new onset diabetes. Dr. Deedwania says we need to know “whether elevated blood glucose is a marker or a mediator of more severe myocardial damage."

The challenge here is one of action - the initiation of properly performed studies. The authors of this statement have stressed that there is value in treating hyperglycemia in the presence of acute coronary syndrome, but past studies have fallen short of the mark regarding initial evaluation, screening for new onset diabetes before hospital discharge and proper follow up after acute treatment for hyperglycemia in the ICU.

As a Nurse, I also can't say enough about advocating for yourself - this is your personal challenge. It's important to be fully informed about your own health status. Ask questions. If you or a loved one suffers a heart attack, write down questions for your doctor. Find out what treatments have been provided in the hospital and never be afraid to ask for follow up testing. Ask questions about ongoing care and stay informed of current health studies. You can never have too much information when it comes to your own well being.


Tuesday, February 26, 2008

Flu Vaccine Due for Major Changes – First Time Recommendation from Government Advisory Board

Predicting the flu is not all scientific. Well, it is, but only in part. This year, for instance,experts missed the mark. The strain of Influenza A that has dominated this winter has accounted for 60%of influenza cases and the vaccine provided by manufacturers was not a match.

Experts had a notion that this may occur, but they were unable to find samples of the strain that would grow properly, thwarting efforts to manufacture the right vaccine. Nancy Cox, PhD, head of the CDC's influenza division says "We simply came up empty-handed.”

Influenza vaccine targets three different strains of the H3N2, or Influenza A virus to provide a broad base of protection. Now experts are recommending that the vaccine receive a complete overhaul by replacing all three strains.

Determinations regarding which vaccines are needed each year are based on samples taken from the Far East where influenza normally starts. It is a guess as to whether the same strains will prevail, but most of the time the predictions are accurate. Obviously, that wasn’t the case this winter, causing concerns that the current flu vaccine is ineffective.

The challenge will be for manufacturers to get the vaccine out in time for next year’s flu season. They will have to grow and massively produce the vaccine fairly quickly, something that may be a bit unpredictable. For now, Norman Baylor, PhD, head of the office of vaccines research and review at the FDA says people should take the current vaccine “even though the strain is off”. Those with healthy immune systems are likely to respond well to available flu vaccine, but it may not be as effective for infants, those who are chronically ill or for elders.

Dr. Cox points out vaccine manufacturers will "have a jump on the situation" because recommendations were made September, 2007 regarding two of the three new vaccine strains.


Sunday, February 24, 2008

Why we Overeat - Are we Merely Products of our Environment?

You might surmise that eating is a conscious choice, but a recent publication from the Center for Disease Control and Prevention suggests that we may have little control over our eating habits. Study authors, Deborah A. Cohen, MD, MPH, and Thomas A. Farley, MD, MPH, discuss how overeating may be influenced by our environment. They describe why overeating should be viewed as an automatic response and not necessarily a conscious choice. Curbing the obesity epidemic might be more successful if we take a close look at the dynamics that surround eating.

The authors propose that by limiting food advertising, making pre-packaged foods less available to the public, reducing the amount of snack foods from vendors in schools and workplaces, and by limiting portions, we may find our “best hope for controlling the obesity epidemic.

When you look at automatic behaviors in general, the following points are made:

Humans are programmed for survival – if you put food in front of us we will eat.

We perceive features of our environment without even being aware. One example involved a study showing that when French music is played in a wine store, more French wine is sold. When German music is played, more German wine is sold. The concept is called priming, and the results can be profound, such as when we are primed to eat large portions and foods that are unhealthy.

People are not usually aware of how much they are eating. Surveys show that those who eat large portions have no conception that they’ve eaten more than someone who has eaten a normal sized meal.

Attempts at controlling our eating habits are found to be effective, but only short term. You can refuse to eat certain foods, but when you try to continue it becomes more difficult. Studies have shown that refusing food when others are eating is actually fatiguing. In one study, three groups of people were observed; one group ate cookies, one could only eat radishes, and one group was instructed not to eat. Afterwards, the group was given an unsolvable puzzle. The group who ate the cookies showed the greatest amount of perseverance. They quit after 21 minutes but the group who had no food gave up after only eight minutes. The conclusion is that refusing food takes a lot of mental effort.

We have a limited capacity for awareness. What we see and what we perceive on an unconscious level occurs at a rate of 11 million bits per second. Conscious processing occurs at a rate of only 40-60 bits per second. Routines are given low priority in our processing system, allowing our unconscious perceptions to remain dominant.

Past studies have supported the fact that eating should indeed be viewed as an automatic behavior.

Perhaps we can stop blaming ourselves for being overweight. It is easy to blame the obesity epidemic on a lack of personal responsibility, but perhaps the authors are right on target when they suggest that we should view eating as an automatic behavior. It certainly makes sense. We have come to accept most anything that is presented with a smile and it’s not always been to our advantage.

Mr. Box, I've got your number now. You've been priming me.

Ref: ◦

Friday, February 22, 2008

Monetary Health Incentives Show Cost Effectiveness and Improved Productivity in the Workplace

We now know what can motivate people to take responsibility for their health – it is money, pure and simple. The results of a pilot program have been presented at the annual conference of the American College of Preventive Medicine. DIRECTV has seen significant improvement in the health of their employees, as well as definite cost benefits after participating in an aggressive health program for their employees.
The incentive provided was $50 per employee to participate in a health screening program.

Those who were found to have health risk factors were given a $200 health insurance credit for continued participation in the program. Those with no health risks were also given the $200 credit. The study was conducted over a three year period in 2003 - the results were positive – 42% of employees with three health risk factors had no health risks at the end of the study. Disability decreased by 16%; the company saved money in medical expenditures and the employees shared those cost savings.

Matria Healthcare initiated the study in conjunction with investigators from Harvard and Cornell Universities. Support came from the Centers for Disease Control and Prevention, and Ron Loeppke, MD, MPH, a vice president with Matria, presented the initial findings.

The financial benefit to DIRECTV is translated as follows: “Reducing the number of "lost" days per employee from 8 to 7 (12%) would be the equivalent of increasing gross sales by $76 million”.

Health problems that may not draw attention in the workplace include depression, fatigue, back and neck pain, chronic pain, insomnia, high cholesterol, high blood pressure, obesity and anxiety, all of which contribute to decreased productivity on the job: absenteeism is not always the problem.

Physicians who met evidence based guidelines were also rewarded, creating a “profit sharing” environment. Additional rewards were given to employees for even greater health improvements.

I’m not sure why I’m surprised that money should be such a motivating factor toward good health. Good health just isn’t enough, as evidenced by statistics reflecting the incidence of hypertension, obesity and metabolic syndrome among the general population.

Researchers have made a multitude of proposals to provide public solutions for curbing unhealthy lifestyles and toward health risk management. It seems that this business model should be viewed as completely implementable. It is certainly encouraging, especially when everyone benefits. I’m so impressed that I’m going to order DIRECTV.

Kudos to the employees,their dependents and to the company.


Wednesday, February 20, 2008

Overhead Aircraft, Snoring and Traffic Increase Night Time Blood Pressure

The Hypertension and Exposure to Noise near Airports (HYENA) study, published in the European Heart Journal Online, February 12, 2008, shows that blood pressure spikes occur during sleep following exposure to snoring, noise from aircraft and traffic. More intense noise was found to cause even greater blood pressure elevations. Exposure to noise over an extended period has been previously implicated as a contributing factor for high blood pressure.

Identifying the role of stress on the cardiovascular system is part of a growing area of research. The World Health Organization will publish a study on aircraft noise later this year in an effort to help define stressors that affect public health.

Dr Alexandros S. Haralabidis (National and Kapodistrian University of Athens, Greece) and colleagues studied 140 volunteers living near major airports. Various noises were recorded and then correlated with blood pressure response. The blood pressure spikes were seen about fifteen minutes following noise exposure. The mean spike was 6.2mm/Hg. systolic and 7.4mm/Hg. diastolic. Noise levels were not significant enough to even wake the volunteers, but the blood pressure changes were seen acutely and long term.

Senior author on the study, Dr Lars Järup (Imperial College London, UK says "it would make sense to have more restrictions on nighttime flights, when blood-pressure responses to aircraft noise are greatest." Some of the airports in Europe have already limited their night flights.

Dr. Järup also points out that this is just one of many risks for hypertension, but “the more risk factors you can eliminate, the better, and this is one of them."

I’m encouraged by the recent trends I’ve seen regarding health research. There is advocacy toward changing the status quo that I personally feel is long overdue. I sincerely hope that public health issues can take a forefront to economy driven decisions in the future. ◦

Monday, February 18, 2008

Tracking Cloned Meat – Are Consumers Afraid of the Unknown?

The FDA persists in their refusal to label cloned meat. Speculation exists that consumers are wary due to “fear of the unknown”, despite repeated reassurance that cloned meat is safe. Is it really just the unknown factor? Given the FDA’s record of mishaps and recalls, don’t we have a right to fear something that speaks to us as so unnatural?

Patrick Cunningham, PhD, chief science adviser to the Irish government and a founding executive of the company IdentiGEN is supporting public wariness by proposing a DNA tracking system for cloned meat. The meat tracking system would require that companies who clone animals keep records of the animal’s DNA. This would allow consumers to submit meat for testing. It’s possible that even traces of cloned meat can show up in anything from soups to various cuts of beef, making labeling somewhat encompassing. In the UK and Ireland, several large retailers and food producers offer IdentiGEN to consumers for certification and to aid in safety recalls, another consideration of value.

Mark Walton, PhD, president of ViaGen, a company that clones animals for use in agriculture, says: "It's hard to imagine a scientific reason or a health reason that you would need to follow animals at all. Dr. Walton says consumers possess “fear of the unknown” when it comes to consuming cloned meat. He calls it nothing more than a “breeding technology”. He points out that a prize stud can only produce so much semen. The "prize" would be cloned for his semen, and we would eat his superior children.

This is entirely believable because a cloned steer costs $13,500 versus $1,000 for a normal steer. (Should that read an “abnormal steer” costs $13,500?) Walton says his company has cloned “about 400-500” animals in the past four years. What’s 100 clones, give or take? $1,350,000, to be exact.

Of interest, the United States has no method in place to trace processed foods back to specific animals, a system that both Europe and Canada have in place.

Is the urge to consume huge quantities of beef so strong that this could become a conventional breeding method? I think any sane person would agree there are friendlier options for the economy, the environment and as a solution for our starving world populations, not to mention our natural systems. Where are we going, or rather, how did we get here?

We know we are losing our connection with nature, but we’ve let ourselves believe otherwise by listening rather than sensing. We are no longer a co-evolved food chain, and in spite of what I’ve been told, I “feel” the difference and I see it reflected in emerging health issues.

Ref: ◦

Wednesday, February 13, 2008

Beetroot Juice Helps High Blood Pressure

A novel study has been performed in the UK that may explain the beneficial effects of certain foods on the cardiovascular system. The study involves beet juice for lowering blood pressure.

In the study, people who drank 500ml of beet juice daily experienced significantly lower blood pressure within one hour of ingestion. The lowest blood pressure was seen 2.5 hours after drinking beet juice, and it stayed that way for twenty four hours.

We already know that foods rich with inorganic nitrates benefit the heart. People who are placed on fruit and vegetable diets show improvement in cardiovascular health, but the mechanism isn't completely understood. Previous research has tied the benefits to the antioxidant effect of fruits and vegetables, yet studies cannot reproduce this with antioxidant supplements. Antioxidant supplements have even been shown be harmful in recent large studies.

Researchers, Dr. Andrew Webb and colleagues, from Barts and the London School of Medicine and Dentistry, UK may have discovered how this works.

Nitric oxide (NO) has been exhaustively researched as it relates to vascular health. Viagra works on this very premise. Viagra regulates the blood vessels by making them relax. It increases the availability of nitric oxide, enhancing penile blood flow. Another example is Nitroglycerin, used to treat angina. Nitroglycerin relaxes blood vessels, improving blood flow and lowering blood pressure. Several pharmaceuticals rely on this premise for disease management.

Dr Amrita Ahluwalia, (Barts and the London School of Medicine and Dentistry), has noted recent studies. Nitric oxide may not just produce waste as previously thought, so it was decided to test this theory further. Higher levels of circulating nitrites and nitrates were measureable after consuming beet juice.

A very interesting piece of the study includes the way saliva acts to concentrate nitrates. Participants in the study who spit out their saliva did not experience lower blood pressures. Apparently, bacteria on the back of the tongue provide a nifty service by converting nitrate to nitrite. The process seems to go on for hours. This effect was measured by having some of the group spit out their saliva for a period of three hours. The effect of lower blood pressure was not seen.

We've come to a likely conclusion - consuming nitrate rich foods may very well play a role in blood pressure management through the chemical reduction of nitrite to nitrous oxide.

Though the study was done with people who had normal blood pressure, the authors feel the results should be even more impressive in the presence of hypertension.

Their proposal includes incorporating beetroot juice as an adjunct for controlling high blood pressure - sans spitting. It makes sense to me!


Flu Shots for Elders

Previous studies have shown that perhaps senior citizens are not well protected by standard flu shots, even though elders are highly targeted as recipients. Studies have been ongoing regarding the aging immune response.

The drug manufacturer, Sanofi has produced a vaccine for senior citizens with a new type of flu shot, and so far the results are excellent. The new vaccine has shown superior immune response against all strains of flu.

The injection is delivered just below the skin and the vaccine is readily delivered to an area that is rich in immune cells.

So far, 7000 trials have been conducted, and Sanofi is seeking European approval of the new vaccine.

This is good news considering the annual death toll from influenza, especially among senior citizens.

Related Article:
Are Flu Shots Beneficial to Elders?

Tuesday, February 12, 2008

High Blood Pressure Rates in the U.S. Found to be “Deplorable”

We know how to treat high blood pressure, yet a recent study shows that the incidence of hypertension in this country is not on the decline. In fact, it is on the rise among women, and has plateaued in men. This is being called "deplorable" by researchers.

AHA president, Dr. Dan Jones, has issued a call to action by saying that “Public-health officials, policy makers, health professionals, and the American public need to respond."

A recent analysis indicates that one in every four women in Washington DC and the Southern states has high blood pressure. Researchers find this unsatisfactory because there are so many treatment options available for hypertension. Pharmaceuticals are more cost effective than ever and lifestyle changes are attainable, making it difficult to understand why the problem persists.

In the seventies and eighties, the incidence of high blood pressure in the US was on the decline. Now we see that in spite of treatment advances, little and no progress has been seen in eliminating the problem.

Lead study author, Dr Majid Ezzati feels that high blood pressure is one of the largest issues affecting human health. He also reasons that women may not have access to good health care, or perhaps hypertension is so prevalent because of the obesity epidemic. Dr. Ezzati wonders if there is not enough emphasis from family physicians regarding salt intake, or perhaps a more aggressive approach to blood pressure management is needed from healthcare providers.

The mortality risk associated with high blood pressure is seen when tracking deaths caused by uncontrolled hypertension in states where it is the worst. For example, male deaths in Washington DC from uncontrolled high blood pressure are double in comparison to Utah - 410 per 100,000 vs. 210 per 100,000.

In a recent commentary from The Medscape Journal of Medicine, Dr. Larry Grouse has advocated for a National health television network for patients and physicians. Dr. Grouse, Executive Director of the ARIA Initiative of the World Health Organization, believes that health alerts through messaging and via the Internet could offer ongoing education to patients and physicians alike. Proposed topics include disease prevention, management and lifestyle tips. Physicians could tune in for the latest treatment modalities, keeping everyone current.

We’re obviously in need of some sort of intervention to help curb this health problem, and as a country, we face many more. It seems to me there is plenty of information regarding the ravages of high blood pressure and disease prevention in general. Is it just that we don’t want to listen? I don’t know, but I can’t help but wonder.

For starters – Back away from the salt shaker, and go take a walk.


Related Posts:
Blood Pressure Management for Women

Thursday, February 7, 2008

Chronic Pain Causes Brain Freeze

Your poor brain doesn’t like pain at all. Not only is it distracting, uncomfortable and depressing, but a recent study shows that chronic pain causes your brain to "freeze". Chronic pain is now shown to actually cause harm to the brain.

The resting brain is in a perfect state of balance, or in Default Mode Network (DMN). When we perform an activity the balance shifts – one area of the brain becomes active while others deactivate. In the presence of chronic pain, DMN mode is always active. The brain "freezes" then goes through a process of reorganization - perhaps to compensate. This may lead to permanent brain alterations.

Past studies have shown that taking antidepressants for chronic pain may not be useful, but this research may challenge current thinking. In order to maintain brain harmony and equilibrium, it may be prudent to treat all of the symptoms that accompany chronic pain, such as sleep disturbance and depression.

This study may pave the way to new approaches in pain management. Early and aggressive intervention could prove to be more successful. This is good news considering the number of people who suffer from chronic pain conditions such as arthritis, chronic back pain, osteoporosis and fibromyalgia.

Women are more commonly afflicted with chronic pain than men. Estimates show that three times as many women as men experience chronic pain.

We should all look forward to further studies and advances in pain management. Life is precious, but it’s the quality that really counts.

Ref: J Neurosci. 2008;28:1398-1403. ◦

Wednesday, February 6, 2008

Men Who Enjoy Soft Drinks Found To Be At Greater Risk For Gout.

A recent study shows that men who consume soft drinks containing fructose and sugar are more likely to develop gout. This comes from the Online First issue of the BMJ.
Gout used to be called the “rich man’s” disease. It was associated with the upper crust, believing to stem from foods that were rich in purines. Men who experienced gout attacks were generally sedentary, drank alcohol, and ate well. Gout was seen “later in life”, around age 45. Back then, the average life expectancy was only about thirty years. Thomas Jefferson suffered from gout as did Benjamin Franklin, making the association with elevated social status credible.

We know more about gout now of course. We can treat gout with medications and conservative measures, but as usual, prevention is much more desirable. Gout is a very painful form of arthritis that affects men. If you’ve ever had a gout attack you know what I mean. It can be intolerable, and develops because of excess uric acid in the bloodstream.

The study shows a strong association between gout and soft drink consumption. After consuming soda there is an immediate rise in uric acid levels. The risk of gout associated with soft drinks is as significant as that seen with the intake of meats that are high in purines.

Interestingly, the incidence of gout doubled at about the same time that soft drink consumption increased. If you already have gout, the risks are even greater that soft drinks will lead to a full blown attack. Diet soft drinks did not produce the same results.

Obviously, any increase in sugar and fructose intake will heighten your risk of gout. The message is perhaps another blow to the soft drink industry.

This is just another indication that we need to get back to basics for the maintenance of good health.

Ref: BMJ. Published online February 1, 2008.

Helpful links:
Low purine diet
Gout and Hyperuricemia

Tuesday, February 5, 2008

Study Shows that Patients who Listen to Music Need Fewer Drugs

Music or drugs: which is better? You said drugs, hands down, right? Well, it seems that music potentiates the effects of sedatives.

It appears that listening to Mozart has a definite sedative effect on the body; with defined benefits. The news comes from study author Claudius Conrad, MD, PhD, Senior Surgical Resident, Massachusetts General Hospital; Harvard Medical School.

We now have measureable proof that our body responds favorably to music. The physiologic mechanisms have not been previously known. These results yielded such positive information that further study is planned.

The analysis was performed on critically ill patients who were free of sedation while music was provided. Data was collected before and after the patient's exposure to Mozart. Measurements of heart rate, blood pressure, stress hormone levels, and cytokine release were performed.

The results were a pleasant surprise – the patients required much less sedation than normal to achieve the same level of comfort. Lower blood pressure and heart rate was seen as the result of decreased levels of stress hormones.

The study was performed only on patients who were on ventilators and deemed severely ill. They were exposed to one hour of Mozart’s slow movement piano sonatas. Because the patients were so ill, and the only music offered was from Mozart, questions remain about whether or not the same effect would be found in other patient populations; with different music.

Physicians who have been studied have also responded favorably to music. Studies are cited showing that surgeons were able to perform mental subraction more quickly while listening to their favorite music. Models are developed to find ways to integrate 'musical sedation' into clinical practice.

A recent small study from the Cochrane review also found that music may be effective for treating depression. The confidence level regarding the result is low because only five studies were included in this particular review. High quality studies would further define if music might also be an effective treatment for depression, but these preliminary reviews certainly suggest the possibility.

Now you can perform your own study – go listen to Mozart, or other music to your liking, and see how you feel before; then after. Enjoy!


Monday, February 4, 2008

Curbing the Obesity Epidemic - Is it the Government's Responsibility?

Should the government spend money addressing the obesity epidemic?

Despite widespread public knowledge regarding the obesity epidemic in the U.S., the perception remains that incentives toward weight loss are necessary. Multiple suggestions are currently proposed as a means to eliminate this widespread problem.

The health consequences and economic impact associated with obesity are far reaching. According to recent studies there are untapped markets that can be used to promote healthier lifestyles. Much effort is being spent to provide solutions - but is this really the responsibility of government and public agencies? It seems we have lost control.

The Department of Health and Human Services' Health People 2010 has a goal to see a 15% reduction in the incidence of obesity. The impetus would engage legislators, health care providers, citizens and public health advocates in the struggle. This is indeed a sad statement regarding our lack individual initiative toward better health.

Health care providers will be asked to counsel patients, set guidelines and monitor these outcomes. Emphasis will turn to exercise, personal attainment of weight loss goals and dietary counseling, something previously emphasized by special interest groups. I do agree that healthcare providers should become very involved. Weight loss centers are costly and their success rates are underwhelming.

Further objectives include incentive funding for public education, healthier school meals, nutritious food in hospital cafeterias, and campaigns to target news and media groups who propagate unhealthy behavior through misleading advertising. It’s suggested that fast food chains stop including toys with meals purchases. Closer scrutiny of public vending machines is proposed.

There is a push toward encouraging the public to purchase locally grown, organic foods to eliminate the adverse effects of pesticides and help eliminate greenhouse gas emissions from long distance food transporation.

Some states are actually considering class act lawsuits against fast food chains; following in the footsteps of the tobacco industry.

There is increased awareness that Bariatric Surgery for obesity is underutilized. Various types of weight loss surgeries are available for individuals who meet the criteria, yet in 2002 only 6% of weight loss surgery was performed on those eligible. There are risks associated with Bariatric surgery but the health benefits have thus far outweighed the risks. Weight loss of 70% is seen, with a 77% decrease in the incidence of diabetes following weight loss surgical procedures.

I’m not sure I want to see Federal monies spent on a problem that can be corrected through individual action, nor do I wish to see our courts tied up with lawsuits against fast food chains.

We all have the tools and information needed to make healthy choices. As parents, how difficult is it to teach healthy lifestyles to our children?

Reduce your caloric intake, exercise, get a good nights sleep and make the choice to change your patterns of behavior. Adults should receive 45% to 65% of their calories from carbohydrates, 20% to 35% from fat, and 10% to 35% from protein.

Should this really be public issue?
Do you want to see govenment spending directed at the obesity epidemic?
Post your stories and thoughts, please!


Saturday, February 2, 2008

Health Maintenance for Rigorous Training – Take Vitamin C

Nobody wants to go to the doctor when they have a cold. It's only normal to look for alternative treatments, such as Vitamin C, chicken soup and over the counter cold remedies.

One of the more popular, yet controversial supplements for cold prevention is Vitamin C - but is it useful?

Here’s a bit of clarification to help you decide when to spend you money on Vitamin C supplements.

According to the latest review from Cochrane, you can save your money if you are using Vitamin C on a routine basis to prevent colds. It is not likely to help when taken on a regular basis. There is an exception however.

If you’ve found yourself down and out during periods of intense physical training, or during ski season when you just can’t get enough of the brisk outdoors, there is good evidence that you may be the type of person who will benefit from Vitamin C supplements. This is good news for those of you who intermittently train hard, and may be especially valuable during the winter months when your vulnerability is at peak levels.

Once cold symptoms develop, Vitamin C is shown to provide no relief for shortening the duration or severity of a cold. The most consistent boost for cold prevention from Vitamin C supplements is seen in a test subgroup of marathon runners, skiers, and military personnel who were undergoing training in cold weather.

The dose of Vitamin C used in the study was 2 Grams (2000 mg.) or more per day. Lesser doses were not considered. The review was carried out to establish the truth surrounding the use of Vitamin C for cold prevention - a debate that has existed for over 60 years!

There is solid evidence supporting the limited use of Vitamin C for cold prevention during times of stress and exposure to the cold weather.

Don’t forget to include whole foods rich in Vitamin C such as citrus fruit, tomatoes, and green leafy vegetables. You won’t know exactly how much Vitamin C you’re getting from food intake, but every little bit should help. There’s no doubt that whole foods may provide your immune system with the extra boost needed to keep you off the couch in the winter months and training hard.

Now we know more than we did yesterday, right?

Ref: Cochrane Database of Systematic Reviews 2008 Issue 1 ◦

Friday, February 1, 2008

Anti-Inflammatory Diet Reduces Heart Disease Risk

I was told a long time ago that it can be deadly to eat at a fish fry, complete with hush puppies and ice cream. Local wisdom found the combination of foods very bad. I was advised to eliminate the ice cream. It was explained to me that is how heart attacks occur.

Well, that was about thirty years ago. This wisdom was passed on to me from a "good ol' boy" in South Carolina, and apparently the advice was prudent.

We've learned more than ever about the role of inflammation and heart disease. When inflammation occurs in the lining of the blood vessels, it promotes the formation of plaque, leading to clots, then heart disease and heart attacks.

Studies are constantly being performed to find ways to reduce the incidence of heart disease. Dietary modification and medications are used in combination to reduce inflammation and prevent the onset and worsening of cardiovascular disease. Fish oil is recommended, cholesterol lowering medications and aspirin for this very purpose. Individual CRP levels, indicating inflammation, are measured to help determine a person's risk for heart disease: the role of inflammation is strong. We have learned much over the years about cardiovascular health.

According to a review published in the January 22 issue of The Journal of the American College of Cardiology, inflammatory foods cause immediate and significant increases in glucose and lipid (cholesterol) levels, promoting oxidative stress in the body. Even though these changes are not long lasting, the effects produce enough inflammation to do major harm and increase the risk of future heart disease. The changes seen when we eat inflammatory foods include an increased tendency for the blood to clot, dysfunction of the lining of the blood vessels (endothelial dysfunction) and stimulation of sympathetic fibers - a combination that could lead to disaster, especially in the presence of existing heart disease.

Eating fatty foods can increase your triglyceride levels - immediately. By reducing your level of triglycerides, you can cut your risk of heart disease by 40%. Exercise, combined with some specific dietary interventions can significantly counteract the effects of dietary indiscretion.

Here are some recommendations that everyone can incorporate into their lifestyle:

If you have no history of substance abuse, or religious restrictions, consider a glass of alcohol before or with your evening meal.

Keep your waist measurement 1/2 of your height through exercise and limiting caloric intake.

Perform moderate intensity activity at least thirty minutes a day.

Eat a daily salad with vinegar and olive oil. Vinegar helps you to feel full and reduces spikes in blood sugar levels.

Reduce oxidative stress and inflammation by consuming berries, dark chocolate, tea, pomegranates and red wine.

Eat nuts five times a week. They slow emptying of the stomach, and cut the impact of high glycemic foods by half. Eating nuts reduces your risk of heart disease and diabetes by 20-50%.

Consume lean protein with all meals.

Have cinnamon with a high glycemic meal; it slows down the release of glucose into the blood stream and decreases the time it takes the stomach to empty.

Avoid processed carbohydrates - include green leafy vegetables such as broccoli and spinach and fruits such as grapefruits and cherries.

All foods should be minimally processed.

Avoid food and beverages containing corn syrup, sugar, white flour and trans fats.

Limit your portions

These dietary changes are recommended for primary prevention of cardiovascular disease. Further benefits are seen when you include exercise and weight loss.

Everyone should be able to follow these simple guidelines. The recommendations provided here will yield immediate and long lasting health benefits.

Ref: J Am Coll Cardiol. 2008;51:249-255 ◦