Tuesday, August 31, 2010

Workplace wellness programs SAVE moulah!

Here's my write-up for the American College of Prev Med weekly newsletter...

A new longitudinal study of workplace wellness plans, overseen by Principal Investigator, Dr. Dee Edington at the University of Michigan, found significant cost-savings with the programs. The study, which analyzed expenses and savings of a utility company in the Midwest over nine years, estimated savings of $12.1 million in association with the company’s participation with the wellness program as opposed to the $7.3 million it spent on the program. Indirect costs, such as those for recruitment and for changing food menus, as well as all pharmacy and medical costs were assessed. Cost-savings were further demonstrated using very conservative figures. This study illustrates the importance of wellness plans in the workplace as a cost-savings tool. Of note, Dr. Edington was the ACPM’s KBS Guest Lecturer in 2009.
View a write-up of the article at http://www.ns.umich.edu/htdocs/releases/story.php?id=7928

Monday, August 30, 2010

For the love of chocolate...

A recent study done by Harvard Medical School, Harvard School of Public Health and Sweden's Institute of Environmental Medicine found some disappointing findings in regards to women's chocolate intake and heart health. The article, published in Circulation, found that only a MODERATE amount of dark chocolate would improve woman's odds of not developing heart failure (HF) as opposed to a larger amount.The researchers found a rate ratio (odds ratio) of HF was 26% lower among those who consumed 1-3 servings of chocolate per month and 32% lower among those who consumed 1-2 servings of chocolate per week, but the rate of HF was similar among women with no regular chocolate intake and those who consumed chocolate 3-6 servings per week and those who consumed one or more servings per day. The horror!!!!!!!!!!!

This deeply saddens me, as I have been convinced that dark chocolate (more than 60% cocoa) in any amount would improve my health...despite the saturated fat and calories it brings with it. Oh well...another delectable treat bites the dust in my eyes.

(Ok, so I'm being a bit sarcastic...never truly believed a large amount of chocolate in any form is beneficial...I just dreamt it was!)


Saturday, August 28, 2010

Medicare to cover smoking cessation (quitting) as part of the Affordable Care Act (ACA)

Article from MedPage Today, courtesy of my friend, Dr. Mike Green. This is good news as smoking cessation can be quite costly., according to my patients. Patches, gum and medications are NOT generic...and must be used either daily or weekly. So...here's to a good thing from health care reform! In addition, evidence-based screening techniques will be completely covered by insurance (ie, colonoscopies, mammograms, etc). That is a win-win situation! 

See below for more on smoking cessation coverage...

WASHINGTON - Good news for seniors who want to quit smoking --
Medicare will now cover tobacco cessation counseling -- the Department
of Health and Human Services announced.

The new coverage was mandated by the Affordable Care Act (ACA), which
contains a number of measures that focus on preventing diseases before
they occur, such as paying for cancer screenings, and annual no-cost
wellness checkups.

"For too long, many tobacco users with Medicare coverage were denied
access to evidence-based tobacco cessation counseling," HHS Secretary
Kathleen Sebelius said in a statement announcing the new benefit.
"Most Medicare beneficiaries want to quit their tobacco use. Now,
older adults and other Medicare beneficiaries can get the help they
need to successfully overcome tobacco dependence."

Of the 46 million Americans who smoke, about 4.5 million are Medicare
beneficiaries over age 65, and another million receive Medicare
benefits because of a disability, according to HHS.

Previously, Medicare only covered smoking cessation counseling if a
recipient had already been diagnosed with a tobacco-related disease or
showed symptoms of such a disease.

All Medicare beneficiaries already have access to smoking-cessation
prescription medication through Medicare's prescription drug program,
Part D.

Under the new coverage -- which applies to Medicare Part A and Part B
-- any Medicare beneficiary who smokes will be able to receive
counseling from a "qualified physician or other Medicare-recognized
practitioner" who can help them quit smoking.

The benefit will cover up to two separate tobacco cessation attempts
per year -- and each stint in stop-smoking counseling can include up
to four sessions.

"Giving older Americans and persons with disabilities who rely on
Medicare the coverage they need for counseling treatments that can aid
them in quitting will have a positive impact on their health and
quality of life," said CMS Administrator Don Berwick, MD, in a
prepared statement. "As a result, all Medicare beneficiaries now have
more help to avoid the painful -- and often deadly -- consequences of
tobacco use."

HHS will issue guidance in the next few months on a Medicaid provision
in the ACA that requires states to help pregnant women quit smoking.

Friday, August 27, 2010

What is Preventive Medicine??

From the American College of Preventive Medicine website (because, who am I to reinvent the wheel??):

Physicians who are board certified in Preventive Medicine hold a variety of positions from chief medical officers of private corporations, to directors of state/local health departments, to policy makers within governmental organizations, to program developers for multi-national NGOs, to many other positions. Career paths include managed care, public health, occupational medicine, aerospace medicine, clinical medicine, informatics, policy development, academic medicine, international medicine, and research. These positions are located in all levels of government, educational institutions, organized medical care programs in industry, as well as voluntary health agencies and professional health organizations. Preventive Medicine physicians operate in a variety of settings, but common to these settings is an approach to health that looks at systemic and population-based interventions to improve the health of individuals.

For more info, check out https://www.theabpm.org/  (American Board of Preventive Medicine) or http://acpm.org/index.htm (American College of Preventive Medicine...where I'm currently working).

Low-fat vs Low-carb diet??

That is the million dollar question. As described in a recent study in The Annals of Internal Medicine (August 3rd edition) by Foster, et al., people on both diets in combination with a comprehensive lifestyle modification program lost weight, however, they differed in measures of cholesterol and triglycerides.

The low-fat group had a significantly greater decrease in LDL cholesterol (bad, damaging cholesterol) level than the low-carb group at 3 and 6 months, but the difference did not persist beyond 6 months. Early decreases in triglyceride level (another type of fat in the blood, want them to be as low as possible) and increases in HDL cholesterol (good, protective cholesterol) level were significantly greater in the low-carb group than in the low-fat group, but only the difference in HDL level remained significant at 2 years. Blood pressure fell with weight loss in both diet groups but did not differ significantly between the groups at any time point. Early decreases in triglyceride level and increases in HDL cholesterol level were significantly greater in the low-carb group than in the low-fat group, but only the difference in HDL level remained significant at 2 years.

The take-home point...either weight-loss plan is good, as long as you committ to it in a safe way (no more than 2-3 pounds per week). An interesting point that these authors found was a significant increase in "adverse symptoms" and a higher drop-out rate (42% vs 32%)  in the low-carb group in comparison to the low-fat group. This is likely due to the "low" blood sugar feeling people not eating carbs can get. In fact, when you stop eating carbs alltogether (ie, the Atkins Diet), your body starts producing another type of fuel called ketones. Ketones aren't necessarily bad for your body, however, they are not the preferred type of fuel for your brain..it MUCH prefers sugar (ie, glucose)! So, some people don't tolerate the diet well, but most people I know, have no problems with it. It is, very difficult to live without carbs in this increasingly carb-friendly world.

Now that's food for thought...

Thursday, August 26, 2010

Exercise as medicine...a tool for personal well-being

We all know exercise is good for us. But the science of exercise is finally getting the recognition it deserves. The benefits are far-reaching! Not only is exercise great for weight loss, it also decreases blood pressure, increases glucose tolerance in the body (how well your body uses the sugars in your blood), increases joint motion, can decrease risk of cancer and can be used as treatment for depression (see below). That being said, doctors are forlorn on how to prescribe such an intervention, besides telling patients to go to the gym 3-4 times a week. I attended a lecture on prescribing exercise (writing out specific recommendations for patients) 2 years ago at the annual American College of Preventive Medicine conference in LA and was blown away.

Check out http://www.exerciseismedicine.org/ for more info!

Also read about yoga as a treatment for mild to moderate depression... 

Direct from Dr. Andy Weil's website:

Daily aerobic exercise is a reliable and effective treatment for mild to moderate depression, but new research suggests that yoga may work even better. A study from Boston University School of Medicine showed that practicing yoga increased levels of GABA (gamma-aminobutyric) in the brain. Low levels of GABA, a neurotransmitter, are associated with depression and anxiety disorders. Investigators followed two randomized groups of healthy volunteers for 12 weeks. One group performed an hour of yoga three times a week, while the other group walked for an hour three times a week. Before and after the last session, the researchers compared the GABA levels of each of the volunteers using magnetic resonance spectroscopic imaging. They found increased GABA levels and decreased anxiety among the participants in the yoga group, who also reported a significantly greater decrease in anxiety and more improved mood over the course of the study than did the volunteers in the walking group. The study was published online by the Journal of Alternative and Complementary Medicine.

Wednesday, August 25, 2010

Urge the House to pass the Child Nutrition Act!! Important!!!

Schools are back in session, but the House of Representatives must still pass the Child Nutrition Act to give our kids healthier options at school. Urge your Rep. to prioritize the health of our kids- http://bit.ly/acBU4Z

Tuesday, August 24, 2010

Direct from the CDC website...

Eggs are making headlines around the world these days...mainly for their delicious taste and versatility (the egg-white omelette with various veggies is my personal favorite!) and occasionally for their excessive cholesterol content. But now, also for the an outbreak of Salmonella cases traced back to 2 U.S. farms.  

Check out how to reduce your risk of getting Salmonella from those delicious oval edibles...straight from the horse's mouth...


Oh, the incredible, edible egg! How I still love thee (and plan to eat you when I feel like it) : )

Sunday, August 22, 2010

Green Leafy Vegetables Actually Lower Diabetes Risk! Amazing!

Increased consumption of leafy green vegetables is associated with lower risk for developing type 2 diabetes, a British Medical Journal meta-analysis finds. (A meta-analysis surveys studies that have already been done and compiles their results in a systematic way). Researchers examined data from six prospective cohort studies (studies with compared likely compared 2 groups of people, matched in age, race, gender, etc) that measured individual consumption of fruits and vegetables. The studies also assessed the development of diabetes over a median of 13 years. Intake of fruit or vegetables, either alone or combined, was not associated with lower risk. In the four studies that specifically measured the intake of leafy green vegetables, a 14% reduction in diabetes risk was apparent between the highest and lowest levels of consumption. 

The authors cite the antioxidant effects of beta-carotene, polyphenols, and vitamin C as possible mechanisms for this effect. Editorialists comment that dietary advice "may be just as beneficial, if not more so, than prescribing drugs" to patients at risk.


Recurrent Headaches in Teens Linked to Unhealthy Lifestyle

From the American College of Preventive Medicine website...

Adolescents who smoke, are overweight, or are inactive face increased risk for recurrent headaches, according to a cross-sectional study in Neurology. Nearly 6000 teenagers in Norway completed headache interviews and lifestyle questionnaires and underwent clinical examinations. After adjustment for confounders, smoking conferred a 50% increased risk for recurrent headache (migraine, tension-type, or nonclassifiable); overweight, a 40% increased risk; and physical inactivity, a 20% increased risk. The more unhealthy lifestyle factors a teen had, the greater the risk. Editorialists note that given its design, the study could not determine whether smoking, overweight, and inactivity are headache risk factors, exacerbating factors, or trigger factors. Still, they conclude that the report "sets the stage for lifestyle interventions" for headache disorders in adolescents.

Friday, August 20, 2010

Sugary drinks linked to Diabetes, but not only because they lead to weight gain

In a seemingly obvious way, sugary drinks (ie, non-diet sodas, juices, sports drinks, energy drinks, etc) lead to Metabolic Syndrome (ie, bad cholesterol, obesity, pre-diabetes) and full-blown Diabetes Mellitus. However, recent research from the Harvard School of Public Health found an association between these sugary drinks and "increased dietary glycemic load"...that leads to "insulin resistance, beta-cell dysfunction, and inflammation."

What this means is that these drinks not only cause you to gain weight, but they also disrupt the way sugar (glucose) is broken down and absorbed in your body, leading to excess circulating sugars and insulin (the hormone that enables the cells to take the sugar into cells, enabling its use) in the blood. Over the long term, this "impaired glucose tolerance" (as we say in the medical field) can wreak havoc on your pancreas, nerves and blood vessels, causing diabetes and/or it's complications, respectively. Medical practitioners have known this for a while, however, the concept gets lost in translation in the clinic...practitioners say 'don't drink sodas' but fail to explain exactly why or how they can negatively affect health. It is my belief, that this lack of understanding is what truly inhibits patients' willingness to change. So, here is yet another reason to avoid sodas and other fructose-laden drinks.

Not to mention...sugary drinks are AWFUL for your teeth : )

Props for UTMB study on when to take supplements (before or after working out)

The jist..."muscle protein synthesis was significantly greater in the PRE supplement group, primarily because of an increased delivery of amino acids, the building blocks for the protein found in muscles"...take that to the gym!


The dirty and clean of organic shopping...

Dirty dozen you SHOULD buy organic - http://www.thedailygreen.com/healthy-eating/eat-safe/Dirty-Dozen-Foods

Clean ones you DON'T - http://www.thedailygreen.com/healthy-eating/eat-safe/Save-on-Sustainable-Gallery-44032808

Wednesday, August 18, 2010

1 in 5 teenagers suffer some degree of hearing loss; not music to my ears!

Sorry for the technical tone to this post...I wrote it up as part of a newsletter for the American College of Preventive Medicine. Enjoy and feel free to comment or ask questions. :)

According to a cross-sectional study published in this week’s JAMA, the prevalence of slight to mild hearing loss among US adolescents is on the rise. The Harvard-affiliated researchers compared the most recent National Health and Nutrition Examination Survey (NHANES) data, from 2005-2006, to NHANES III data from 1988-1994, citing a 31% increased prevalence in hearing loss among subjects since NHANES III. This increase in prevalence was observed in all, high-frequency, unilateral, and bilateral hearing loss of slight or mild or greater intensity. It was not observed with low-frequency hearing loss. The prevalence of mild or worse hearing loss (defined by a decrease in hearing by 25 decibels or more) was significantly higher (P < .001) in NHANES 2005-2006 than in the 1988-1994 survey, representing a 77% increase in prevalence. No significant differences, including self-reported number of ear infections, exposure to more than or equal to 5 hours of loud noise per week and exposure to firearms, existed between the two groups surveyed.

These findings were unexpected given numerous public health measures to reduce hearing loss among children and adolescents, including vaccination against Haemophilus influenzae and Streptococcus pneumoniae as well as greater awareness of music-induced hearing loss. Although it is unclear as to the etiology of these findings, a possible connection between loud personal music systems and hearing loss cannot be ruled out and must be further investigated. The implications of the study are important for the fields of education, public health and child development.


Tuesday, August 17, 2010

Meat lovers beware!

It is somewhat intuitive...people who eat meat have the potential to weigh more. This is what the authors found. However, what was most interesting from this article, is the fact that the researchers found that those who ate poultry had the highest association with weight gain! That's completely counter-intuitive and I will have to explore the article a little more to see to what they attribute this finding.

Another interesting tidbit they found...a person who cut their meat consumption by 250 grams daily (about a half-pound) could conceivably reduce their 5-year weight gain by around 4 pounds. That is not so much to ask...if I do say so myself! I have successfully decreased the amount of meat I eat to 1 serving a day and I feel healthy and energetic. Not to mention, I feel like I am doing something positive in terms of decreasing my carbon footprint. See the Facebook page - "I'm helping my health, animals, and the environment by eating less meat!" for more information.


Report from The President's Cancer Panel 2010

This lengthy report sheds some light (although not a spotlight as the evidence is still up in the air...pun intended) on the impact of various potentially cancer-causing environmental toxins. It includes hormone-disrupting perfumes, home cleaners, etc., and really puts our consumer-driven beauty and cleaning markets into perspective. 

From NY Times reviewer, Nicholas D. Kristof:
'The President’s Cancer Panel is the Mount Everest of the medical mainstream, so it is astonishing to learn that it is poised to join ranks with the organic food movement and declare: chemicals threaten our bodies.'
 Check it out!


Some inspiration for those who've been fighting the lifelong battle of obesity

It is possible to change!

Monday, August 16, 2010

NIH "Going Green with Nutrition" pamphlet


Moderate exercise

Directly from my NIH cancer prevention course - regular moderate exercise is strongly shown to decrease risk of developing colon and breast cancers. Also, moderately shown to decrease risk of endometrial and lung ca's. So, get up people!! Official article to follow.

Obesity takes over

Obesity rates in the U.S. are trending upward more quickly than expected. CDC’s recently-released report, “State-Specific Obesity Prevalence Among Adults – United States, 2009,” 2.4 million more Americans became obese from 2007 to 2009. The report estimates the medical costs of obesity to be as high as $147 billion a year, and stated that medical costs for obese people were $1,429 higher than those of normal weight.

Scary! How can you help in promoting healthy behaviors? Get involved with your community! 

 - Volunteer at a local health fair
 - Maintain your sidewalk and streets so that others can use them for exercise
 - Contact local authorities and urge them to take actions to improve your neighborhood by making it more walker-friendly if your neighborhood needs it
 - Discuss actions to improve health of school lunches and increase recess time with school board members

The opportunities are endless...You can easily be a part of the solution!

Toxic receipts


Interesting non-scientific article