March is National Nutrition Month: 'Get Your Plate in Shape'

We all know we have to eat better and exercise more, but sometimes we need vivid reminders, especially after a series of holidays that encourage eating the wrong foods, along with calorie-rich desserts.  To underscore how to "get your plate in shape,"  the National  Academy of Nutrition and Dietetics has proclaimed March National Nutrition Month with a public information and education campaign that focuses attention on the importance of making informed food choices and developing good physical activity habits.  The theme of this year's campaign encourages consumers to eat the recommended amounts of fruits, vegetables, grains, protein foods and dairy each day.
"The Academy of Nutrition and Dietetics is committed to improving the nutritional health of consumers by translating sound, science- and evidence-based research into messages they can understand and apply to their everyday lives," said registered dietitian and Academy President Sylvia Escott-Stump. She said the campaign aims to help people make the simple changes to their daily eating plans that will benefit them
throughout their lives.

In 2011, the U.S. Department of Agriculture launched the program MyPlate, which  replaced MyPyramid as the government's primary food group symbol.  It is a visual cue to help consumers adopt healthy eating habits consistent with the 2010 Dietary Guidelines. It divides the plate into four sections: fruits, vegetables, grains and proteins, as well as a glass representing dairy products.

To further educate the public,  the Academy's National Nutrition Month website includes helpful tips, promotional tools, games and nutrition education resources designed to foster good nutrition around the "Get Your Plate in Shape" theme.

What You Can Do:  Get your own plates in shape by visiting the National Nutrition Month web site and by making a conscious effort to eat more fruits, vegetables, nuts and low-fat dairy products while adding moderate exercise to your daily routines.

Couch potatoes beware: Prolonged sitting can lead to health problems

A new study suggests that being a couch or computer potato for long periods is hazardous to your cardiovascular health.  Overweight people who sit for prolonged periods, whether in front of the TV or working at a computer, should stop and take short walking breaks every 20 minutes to avoid spikes in glucose and insulin levels, according to a new study in the March issue of Diabetes Care.  The 19 overweight or obese subjects in this trial were subjected to three different trial situations.  The first involved a long period (up to seven hours) of uninterrupted sitting; the second kept them seated with  2 minutes of of light-intensity walking every 20 minutes; and in the third, they were seated with 2-minutes of moderate-intensity walking every 20 minutes. Each subject received a high sugar, high fat test drink after an initial 2-hour period of uninterrupted sitting and then glucose and insulin levels were measured for each of the three treatments. In both the light intensity and moderate-intensity treatment sessions, the obese/overweight subjects had lower glucose and insulin levels than when they were in the uninterrupted sitting session.

The researchers, led by Dr. David Dunston of the Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia, conclude that when sitting for long hours, periodic breaks can help reduce cardiovascular risks and can potentially be an important public health intervention strategy.

What you can do:  If you sit for long hours at a computer desk or another "desk" job, or if you like to spend your entire evening in front of the TV, get up and take a walk (or exercise in place) every 20 minutes, for several minutes.  It will not only burn some calories, but could possibly lower your risk of cardiovascular disease.

Flavinoid in cocoa could help rebuild skeletal muslce in heart failure, diabetes patients

Maybe there is another good reason for most of us to love chocolate, especially the dark variety. A new study reports that treatment with epicatechin-enriched cocoa, a flavonoid in dark chocolate, showed improvement in the mitochondria of skeletal muscles after that mitochrondia had been damaged by the effects of Type 2 diabetes and heart failure.  Mitochondia are structures responsible for most of the energy produced in our cells.   In a small clinical trial at the University of California at San Diego, researchers found that patients with advanced heart failure and type 2 diabetes showed improved mitochondrial structure after three months of treatment with epicatechin-enriched cocoa. As a result of their diseases, these five patients had experienced significant damage to skeletal muscle mitochondria before treatment.  These "fuel cells"  had become dysfunctional as a result of both diseases, leading to abnormalities in skeletal muscle.  The patients suffered from shortness of breath, lack of energy and inability to walk longer distances.

The trial participants ate dark chocolate bars and a beverage with a total epicatechin content of about  100 mg per day for three months. After three months of treatment, the researchers looked at changes in mitochondria volume and the abundance of cristae, which are internal compartments of mitochondria that are necessary for efficient function of the mitochondria, and measurable by electron microscopy.  Before treament, these cristae had been severely damaged, the researchers said, but after threatment a recovery was seen and cristae numbers were returned to almost  normal levels.  The researchers also saw increases in several molecular indicators involved in new mitochondria production.

The study appears this week in the journal Clinical and Translational Science (Volume 5, Issue 1, February 2012, Pages: 43–47).  The researchers said they will conduct a larger study to see if the cocoa flavinoid can help improve exercise capacity in similar patients.

If you occasionally indulge in a square of dark chocolate, perhaps you don't have to feel guilty, after all. You may be feeding your skeletal muscles.

Food and Drug Administration relabels some cholesterol-lowering drugs on safety risks involving memory loss and diabetes

The U.S. Food and Drug Administration has changed the label on a group of statin drugs commonly used to lower bad cholesterol.  Added to the the labels of these drugs is information that some patients have experienced memory loss and confusion. The effects were not considered serious and the patients’ symptoms were reversed by stopping the statin, the new label says. However, patients should still alert their health care professional if these symptoms occur. 

The drugs involved in the label change include: Lipitor (atorvastatin), Lescol (fluvastatin), Mevacor (lovastatin), Altoprev (lovastatin extended-release), Livalo (pitavastatin), Pravachol (pravastatin), Crestor (rosuvastatin), and Zocor (simvastatin). Combination products include: Advicor (lovastatin/niacin extended-release), Simcor (simvastatin/niacin extended-release), and Vytorin (simvastatin/ezetimibe).
Another potential risk added to the label involves blood glucose levels.  Increases in blood sugar levels (hyperglycemia) have been reported with statin use, according to the FDA announcement. The agency notes that some studies have reported that patients being treated with statins "may have a small increased risk of increased blood sugar levels and of being diagnosed with type 2 diabetes mellitus". The new labels warn healthcare professionals and patients of this potential risk.

For those of you taking cholesterol drugs and receiving routine blood tests four times a year to monitor for liver function, you should be aware of a label change in that area as well, removing the need for periodic exams.  The FDA now recommends that liver enzyme tests should be performed before  a patient starts statin therapy, and then only as clinically indicated thereafter. FDA said  in its press release on the changes that serious liver injury with statins is rare and unpredictable in individual patients, and that routine periodic monitoring of liver enzymes does not appear to be effective in detecting or preventing this rare side effect.

If you are taking Mevachor (lovastatin), you should note that the label will now warn that Mevachor can interact with some drugs to increase the risk of muscle injury and recommends against taking the drug with drugs used to treat HIV (protease inhibitors) and those used to treat certain bacterial and fungal infections.

What you can do:
If you have symptoms of muscle weakness, memory loss, or suspected high blood sugar, contact your physician and report confirmed side effects to FDA's Medwatch system.  If you know you are pre-diabetic, you may want to ask your doctor to continue periodic exams to be sure your blood sugar is not pushed up into the diabetes range.

Medicare now covers yoga for heart health

One of the genuine improvements in Medicare as a result of the Affordable Care Act (ObamaCare) is the accent on programs that promote prevention, particularly in the areas of heart disease, such as cholesterol screening and blood glucose control tests. More than 25 million people participating in traditional Medicare during 2011 took advantage of at least one of the 21preventive testing programs available.  To fortify the commitment to prevention in the cardiovascular area, hospitals are now allowed to bill Medicare for their patient's yoga and group discussion sessions that are part of the Dean Ornish Program for Reversing Heart Disease.  The Ornish program is an approved intensive cardiac rehabilitation program.  Ornish  directed scientific research studies reporting that the progression of coronary heart disease can often be reversed by making significant lifestyle changes, including a very low-fat meat-free diet, moderate exercise, various stress management techniques including yoga-based stretching, breathing, meditation, and imagery; and enhanced love and social support, which may include support groups.

Sleepless in more cities than Seattle: New study tracks sleep disorders in 36 states

Where you live may affect how you sleep, according to researchers from the Perelman School of Medicine at the University of Pennsylvania.  People living in Southern states suffer from more sleep disturbances and daytime fatigue than other regions, while residents on the West Coast report the fewest number of problems, the research team reported in a study published online  in the Journal of Clinical Sleep Medicine. Looking at nationwide data collected in 36 states by the Centers for Disease Control and Prevention (CDC), the researchers developed a state-by-state sleep map. Among the states where data was collected, Oklahoma, Arkansas, Mississippi, Alabama and West Virginia ranked in the highest bracket for each category. Many of the states reporting the worst sleep and fatigue problems are the same states that tend to report higher prevalence of other conditions, such as obesity.  The pattern differed slightly between men and women.
Some of the factors that may play a role in sleep disturbances include demographics, obesity, health and even weather and sunlight patterns in different states.  They found that regional differences in mental health, race and ethnic origin and access to medical care were the streongest factors that explain these regional differences.  The Penn research team suggests that for regions with the worst sleep patterns, public health programs focused on healthy sleep patterns and increased screening programs for sleeplessness symptoms may guide those suffering from sleeplessness to receive the appropriate medical care.
 
What you can do:  If you think you have a sleep disorder, you can find more information at the Center for Sleep and Circadian Neurobiology and the WebMD's Sleep Disorders Health Center.

Healthier lifestyles and diet could prevent millions of cases of cancer; compliance with meds could save lives

The World Cancer Research Fund reports that healthier lifestyles and diet could prevent up to 2.8 million cases of cancer each year.  Inactivity is contributing to poor health and higher mortality for those who are obese, suffering from diabetes or on the brink of racking up those high glucose numbers. If more people walked just 20 to 30 minutes a day, or followed a routine exercise regimen, they can lose or maintain a healthy weight and avoid illnesses.  Stopping smoking can help to reduce cancers of the lung. 

On another front,  lack of health insurance leads to 45,000 deaths annually, according to the American Public Health Association.  Each year, thousands of people fail to go to a doctor when they are ill or fail to fill a prescription due to the high costs of healthcare.  In some cases,  faililng to get that prescription  could result in catastrophic infections or mortality from heart-releated or diabetes complications.

Prevention and wellness education is becoming more important, but the price of health insurance is still a deterrent to those who are just above the poverty line.  The working class poor without health insurance are often in worse shape healthwise than those on Medicaid.  While the U.S. has taken a stab at health care coverage for all, there are many that still won't be able to afford it, even when it becomes mandatory in 2014.  We should start thinking now about how to fix that problem, instead of watiting until it happens.

Obamacare: In critical condition but expected to survive

The Patient Protection and Affordable Care Act is moving through its first full year of implementation in 2011, faced with a court challenge to the constitutionality of mandatory health insurance and the everyday pitfalls of partisan politics. It appears to be following the path of other reform measures that were considered problematic - Social Security and Medicare, most notably. At the time they were passed, many critics predicted they wouldn't last a decade, and while our current economic crisis appears to threaten their solvency, these institutions have so far survived the test of time. Once again, as time and history will tell us, health reform could offer Americans positive opportunities in the areas of prevention and early intervention. The new law requires insurance companies to offer at no cost to the insured preventive screenings for certain conditions. This move is expected to save money over time and will also result in earlier treatment and hopefully, fewer adverse effects that can lead to costly hospitalizations. In Medicare, for example, enrollees are entitled to a wellness checkup once a year and personalized prevention plans. All new Medicare plans offer prevention services with no out-of-pocket costs. It's an evolving process that could save time and lives over time and one of the brightest spots in the somewhat confusing list of new measures Americans will face in the coming years. Still to be decided: the constitutionality of mandatory health insurance...Stay tuned.

U.S. House of Representatives passes health care reform legislation

In a historic vote and a major victory for President Obama and Speaker of the House Nancy Pelosi, the U.S. House of Representatives has passed health care reform legislation, giving final approval of the Senate bill by a vote of 219-212. The new legislation is likely to reshape the way Americans deal with medical conditions and prevention measures. It is expected to cost $940 billion and to be implemented over a 10-year period. The measure will provide health insurance for more than 30 million uninsured and will provide protections for millions more against losing their coverage. In a last-ditch effort to kill or stall the bill, there was a Republican motion to recommit the bill to change some language, particularly on abortion, but the move to recommit failed to pass by a vote of 232-199. A reconciliation bill (HR4872)that will allow amendments to the legislation also passed by a slim margin. Republicans have argued that the package is too expensive and promotes excess government powers. Democrats consider the legislation comparable historically to enactment of Social Security after the Great Depression of the 1930s and Medicare in the 1960s. One move that helped secure the victory was President Obama's executive order stating that the healthcare bill would not interfere with an existing ban on federal funding for abortions. That helped change the votes of at least seven pro-life Democrats, led by Rep. Bart Stupak of Michigan. The reconciliation bill now goes to the Senate, where it cannot be filibustered. Acknowledging that the vote was not an easy one for some House members, President Obama said "we proved that the government...still works for the people." He called it a victory of "common sense." One thing remains certain...the debate and disagreement over this legislation is likely to continue for years.

Let the patient participate in drug-safety reporting, NEJM commentary says

There's an interesting "Perspective" on drug-safety reporting in the March 11 issue of The New England Journal of Medicine. The article, by Dr. Evan Baugh of Mount Sinai Hospital in New York, notes that when a patient wants to know about symptoms related to a prescription drug he is taking, he might consult the information on the label or in the package insert. However, this information on side effects is based mostly on clinical trials and clinicians' impressions of their patients' symptoms, rather than on the firsthand reports of patients taking the drug. Yet,a substantial body of evidence contradicts the assumption that this information is truly representative of the patient experience. Instead, Baugh says, research indicates that clinicians systematically downgrade the severity of patients' symptoms, that patients' self-reports frequently report side effects that clinicians miss, and that clinicians' failure to note these symptoms results in the occurrence of preventable adverse effects. Patient self-reporting offers one solution that would enhance the capture of subjective elements of safety information. Baugh believes patient-reported adverse events provide both clinical and scientific value and arutes that patients are entitled to know the impressions of their peers. Scientist, regulators, and clinicians should have access to patient impressions when evaluating drugs, Baugh says. He also suggests that administrative efficiency might actually improve if patients reported adverse events before clinical interactions. Self-reports, Baugh concludes, are more sensitive to underlying changes in patients' functional status than are clinicians' reports. The patient is more likely to identify symptoms earlier during a course of treatment. It seems like a common sense approach to drug-safety reporting.

Stents as effective as surgery for clearing neck arteries, study says

While surgical treatment (carotid endarterectomy) has been the gold standard for removing plaque from clogged neck arteries to prevent stokes, a new study shows that the less invasive method of using stents to open blocked neck arteries, can be just as effective, according to WebMd. This new finding could mean that cardiologists now can offer patients two options for treating these problems. The study, presented at the American Stroke Association's (ASA) International Stroke Conference, reported that in the weeks after the procedure, patients who received stents suffered slightly more strokes, and patients who underwent surgery had slightly more heart attacks. However, after an average of 2.5 years, "there was no significant difference in the number of events between the two groups," said researcher Dr.Wayne Clark of Oregon Health & Science University. The study also reported another interesting finding: patients under age 70 appeared to benefit slightly more from stents, while older patients benefited slightly more from surgery. A similar European study presented at the same conference found stenting somewhat inferior to surgery, but one doctor notes that patient selection could have accounted for the disparate results, along with differences in they types of stents used.

While FDA and Glaxo fiddle over Avandia, patients remain at risk

As a debate over the safety of Avandia has brewed for more than two years, patients still taking the drug have remained guinea pigs for science. This week the New York Times issued a report suggesting Glaxo, the maker of the billion dollar a year diabetes drug knew the drug had significant side effects, but maneuvered to keep the drug on the market. Dr. Steven Nissen, a cardiologist with the Cleveland Clinic, who raised the initial red flag concerning Avandia's cardiac risks, renewed his attack against the drug and its manufacturer, telling The Times that the medical community is still waiting for Glaxo to publish results of a safety study and suggesting the company is trying to whitewash reports of adverse events. HNe criticized the company for failing to publish a followup study, saying the results of Glaxo's Avandia study appear only on the company's web site. To fuel the debate, Nissen gave The Times a secret recording of a 2007 meeting with Glaxo executives. A 2007 study by Nissen found that the risk of cardiac death increased by 64% among patients on Avandia, a finding the company refuses to embrace. Nissen said in an interview that a taped recording of his meeting with Glaxo executives in 2007 showed the excecutives trying to persuade him not to publish his study, suggesting that they had contradictory information they would share with him in a joint study. Nissen said Glaxo did not have any contradictory data. Glaxo executives maintain they visited with Nissen to discuss a possible collaborative study. Meanwhile, the U.S. FDA has failed to take any action to truly protect patients, even after two officials from the FDA issued a report recommending the drug be removed from the market. Glaxo issued a press release refuting the charges in The Times article. When in doubt and when patients health is at stake, shouldn't the U.S. FDA err on the side of overprotection and pull this product, at least temporarily, before more innocent patients are harmed needlessly? If further studies definitively prove Avandia's cardiac safety, then the product can return to market. The FDA needs to adopt a common sense approach to safety in order to prevent any further adverse effects. One death is one too many.

Medical journal retracts research paper that linked autism to MMR vaccine -- 12 years later

The British medical journal, The Lancet, has issued a full retraction of a research paper it published 12 years ago, linking a cause of autism to the vaccine for measles, mumps and rubella (MMR). A BBC report says the journal has now accepted that the report was false. The move came after Britain's General Medical Council ruled last week that Dr Andrew Wakefield, the lead researcher in the 1998 paper, broke research rules. After the study appeared, a controversy erupted in the UK over vaccinations and many parents were afraid to vaccinate their children. As a result, the measles rate increased. The paper had been partially retracted years ago after the journal learned that Dr. Wakefield had accepted money from attorneys who represented parents who believed their children were harmed by the MMR vaccine. The full retraction goes further, saying saying the research was fundamentally flawed because of a lack of ethical approval and the way the children's illnesses were presented. Dr Wakefield, who now lives and works in the U.S. said the findings were "unjust and unfounded." As one doctor commented, the entire episode makes doctors and the media realize that they must be very certain of the strength of a study that affects public health before publishing it.

Low-carb diets may help to lower blood pressure

If you are looking to shed some pounds AND lower your blood pressure you might want to try a low-carbohydrate diet, according to a new study appearing in the current issue of the Archives of Internal Medicine. The study found that twice as many people on a low-carb diet lowered their blood pressure than those who were taking the diet drug orlistat (the active ingredient in over-the-counter Alli and the prescription drug Roche's Xenical.) Both approaches were equally effective at improving cholesterol and glucose levels, as well as reducing waist size and weight, the researchers from Duke University and the Veterans Administration reported. (See also: BBC News report)

Counterfeiting hits the OTC diet drug market with fake versions of Alli

Reports this week that there were counterfeit versions of the over-the-counter weight loss drug known as Alli were compounded by the news that the fake versions were contaminated with another weight loss drug known as subutramine. Subutramine is the active ingredient in Abbott's weight-loss prescription drug known as Meridia. The counterfeit Alli contained twice the normal amount of subutramine in Meridia and could have caused considerable adverse effects in some individuals, according to the U.S. Food and Drug Administration. The drug apparently can interact with other drugs to cause adverse effects and needs to be closely monitored. GlaxoSmithKline, the manufacturer of Alli, ran some preliminary tests on the counterfeit Alli and found it did not contain any of the GSK active ingredient, orlistat, but instead contained the dangerous levels of subutramine. It's amazing how sophisticated counterfeiting has become, because Alli comes in a distinctive larger package than most drugs and one would have thought it would be harder to reproduce the packaging, but in this modern age of electronic magic, everything is fair game. Fortunately, the counterfeiters failed to put a fake lot number and expiration date on the box and those are the clues that the packages are counterfeit. This is a case where a drug we would not expect to become life-threatening is counterfeited into a substance that threatens many unsuspecting individuals. So far it is believed that the counterfeit Alli has been sold only over the Internet and has not made its way to drug stores or other retail outlets.

A New Year, new health resolutions?

It's a new year, a new decade and that means it's time for many of us to take a look at our health and to make some lifestyle changes that could help add a few more years to our lives. After two weeks of "happy eating" that we all blame on the holidays, most of us want to change our bad habits. Some promise to exercise more often, to eat more of the healthful food groups in place of the empty calories of snacks and fast food. Others have made a vow to lower their blood pressure and their stress levels and to re-evaluate their time expenditures for work vs. family and fun. As we decide to change about our lifestyles in the new year, we should set aside time to achieve the goal, so that the resolutions don't fade into oblivion by the Ides of March! Health information on the Internet can help many of us change our evil ways. A new diet doesn't have to be drastic, nor does an exercise program. We all can start small by just picking one bad food habit to eliminate and by starting with excercise of 10 minutes a day, even if it is a few leg kicks after you get up in the morning or running in place in the bathroom as you brush your teeth. We can add some low fat dairy products, such as yogurt and fruits to our morning breakfast and skip the bagel or corn muffin. We can cut our stress by better time management. A bit of cinnamon and mustard instead of mayonnaise can help lower blood pressure and better regulate blood glucose, some studies show. Changing isn't easy, but the rewards are great when we see the pounds disappear or when we feel better because we've reduced our stress. Good luck with you resolutions in this year. You can change, you really can!

Top Health Stories of 2009: Alzheimer's test tops the Medscape list

A new test that may help detect Alzheimer's disease leads Medscape's list of top medical stories of 2009. The cognitive test examines 10 skills and can detect up to 93% of Alzheimer's cases, according to the Medscape report. The study was published June 10 in the British Medical Journal. Other stories making the list discuss a single screening question that may accurately identify unhealthy alcohol use, naproxen as the best Non-steroidal anti-inflammatory for heart-disease patients and the side effects of cholinesterase inhibitors in older aldults with dementia. Other stories concern a new ingrown toenail treatment, new sleep environment risk factors for sudden infant death syndrome, WHO guidelines for antiviral treatment of swine flu and other influenza and the American Academy of Pediatrics' revised guidelines for treatment of pediatric flu.

Cancer drug might help treat type 1 diabetes

There is hopeful news on the diabetes front this week. A new report in the November 25 issue of The New England Journal of Medicine says a drug used to treat cancer and rheumatoid arthritis helped type 1 diabetes patients keep producing some of their own insulin, even though the disease had destroyed some of their pancreatic beta cells. These are the cells that produce insulin. However, another researcher warned that the study does not show the drug Rituxan to be a "cure" for diabetes, but rather, a modest improvement in insulin levels. More research will be needed and it will take several years to test whether the treatment is feasible, but it's the beginning of another area of potential treatment and continued research might help lead to better control and ultimately to a cure.

Latest breast cancer screening recommendations leave women confused

Most of us had never heard of the US Preventive Services Task Force before last week, but now we expect to hear about its recommendations on breast cancer screening for many months to come. The task force recommends that women not begin getting annual mammographies until age 50 or older. Previous recommendations for screening targeted women 40 and older. Why the change and why now? Of course, it has turned into a political debate, as well as a medical one. Health and Human Services Secretary Kathleen Sebelius distanced the Obama Administration from the decision, saying the panelists joined the Task Force during the Bush Administration. Republicans point to the Democrats saying this is an example of how the new healthcare system would compromise public health. The waters are muddy in this debate, but one thing is clear to me. Women in their 30s and 40s get breast cancer. Most of the people I know who have had breast cancer contracted it during their 30s or 40s, so why would we want to make women guinea pigs (again) for a new approach that is bound to cost some people their lives? It appears that the breast cancer movement has another cause for which it needs pink ribbons...Don't change it, if it saves lives. If women in their 30s and 40s have to pay for mammograms, lives will be lost because in the current economy, many will delay spending the money. Let's be sensible and keep the old recommendations and let this band of questionable "experts" re-evaluate their decision. If one woman dies because of this new absurdity, it's one life too many.

Friends make a positive difference

After a wonderful mini-vacation and the start of a new consulting project, I am returning to blogging about health issues feeling renewed and refreshed. I definitely recommend a long weekend with old friends as a spiritual renewal therapy. We flew to Las Vegas and enjoyed the warm desert sun, the crazy action of the casinos, the wonderful stage shows of Bette Midler, Cirque du Soleil and Donnie and Marie Osmond and the zany company of six friends whom I have known since I was 17. This is good mental health in action! But don't take my word for the benefits of good friends. An Australian study reports that among 1,500 older people studied for 10 years, those who had a large network of friends outlived those with the fewest friends by 22%, according to WebMD. That's a great result! So, I feel blessed that I have good friends who are willing to share my joys and struggles. We are already talking about our next trip together, so I guess that will add another few months to our lives, according to the study!