Health for life

While the Disease Management Care Blog tries to be an equal opportunity cynic and generally sides with policy underdogs and lost causes, it supposes that its conservative leanings sometimes comes through in its writing. 

That was enough to prompt a series of well-written email exchanges with Greg Brown, a retired educator from the Kansas City area. He did a great job of compactly summarizing the views of supporters of the current version of health orm. 

It seems to boil down to five main arguments:

1. Medicare and Social Security: While passage of these landmark safety net programs was likewise met with deep concerns about the erosion of liberty, their ultimate success cannot be denied.  Most of the persons who are against the Affordable Care Act are ironically happy to have the feds appropriate a portion of their income in exchange for economic security in their old age. They cant have it both ways.

2. This is not buying shoes:  One role of the federal government is to step in when markets fail, and that has been amply demonstrated when it comes to health insurance. While its difficult enough to remember to even buy a product that you may not need, shopping for the best value in commercial insurance is practically impossible.  Proposals to expand this unworkable solution are a pipedream.

3. The public good: Keeping people from going bankrupt in the course of an unexpected illness is everyones interest.  Its ultimately a better bargain for society to proactively manage this with near-universal insurance than to deal with poverty after the fact.

4. Purchasing power: To date, Washington DC has chosen to not flex its purchasing power with providers.  Think of how much cheaper drugs would be if Medicare leveraged this for Part D.  Just wait until the happens in the rest of health care system and how much all of us will all benefit. 

4. Status quo: Even if you dont accept the track record of Medicare, the realities of buying insurance, the merits of a public good and the advantages of purchasing power, the status quo has led the U.S., compared to the rest of the developed world, to be a unsustainable per-capita cost outlier.  Something has to change. and theACA is doing just that.

I am not an expert by any stretch. I am just an interested layman. I really wish Obama had pushed for a single payer or at least a strong government alternative delivery system. But here we are and as imperfect as it is, it is the best thing I see on the horizon right now. It does at least attempt some cost controls, it broadens access, and it may lead to better quality with a focus on health outcomes rather than billable procedures. At least it attempts to address all three.

Image from Wikipedia

Theres no question that high levels of good cholesterol—also known as high-density lipoprotein (HDL)—seem to be protective against heart disease. Rather than depositing fat into the blood vessels the way the "bad" cholesterol (low-density lipoprotein (LDL)) does, HDL appears to carry cholesterol away from blood vessels to the liver. From there, the liver processes it for removal from the body.

However, adequate levels of HDL might not be enough. Several recent studies have suggested that many cases of heart disease occur in people with normal levels of HDL cholesterol. Consequently, some researchers believe that even if people have adequate amounts of HDL cholesterol, it might not work well. Such HDL may not fulfill this molecules other important duties in the body, such as reducing inflammation and acting as an antioxidant.

Because exercise has the potential to protect against heart disease in a variety of ways, Christian K. Roberts and his colleagues at UCLA tested whether HDL in men who weight trained regularly behaved in a healthier way than HDL in sedentary men. They found that the men who didnt exercise were more likely than those who weight trained to have dysfunctional HDL. Having faulty HDL was associated with numerous other risk factors for heart disease, including high triglycerides and a higher trunk fat mass. This finding held true regardless of the mens weight, which suggests that maintaining a "healthy" weight isnt as important for healthy cholesterol function as being active by regularly performing strength training.

The article is entitled "Untrained Young Men Have Dysfunctional HDL Compared to Strength Trained Men Irrespective of Body Weight Status." It appears in the Articles in PresS section of Journal of Applied Physiology, published by the American Physiological Society. It is available online at http://bit.ly/1eQgZ1u.

Methodology

The researchers worked with 90 men between the ages of 18 and 30 who already had established exercise habits. They separated these participants into three groups: lean men who weight trained at least four times each week, overweight men who also weight trained at least four times each week, and overweight men who had no structured exercise regimen. The researchers took some basic physical measurements from the volunteers, including height and weight, waist circumference, blood pressure, and body composition. They tested the volunteers muscle strength and their carotid artery thickness (a sign of heart disease), and they took a blood sample. The researchers analyzed that sample for a variety of different molecules present, including cholesterol, insulin, various markers for heart disease including triglycerides and C-reactive protein, and sex hormones. They also checked the volunteers HDL to see how well it functioned as an antioxidant, a sign of how well their HDL works in general.

Results

The study authors found that HDL functioned better in the participants who had a regular weight-lifting program, regardless of their weight—overweight exercisers HDL has similar effectiveness as an antioxidant as the lean exercisers HDL cholesterol. Both groups HDL performed significantly better than those who didnt exercise. Such dysfunctional HDL was associated with numerous other factors associated with heart disease, such as elevated triglycerides and trunk fat mass.

Importance of the Findings

These findings suggest that regular weight training might improve HDL function and protect against heart disease, even in those who remain overweight. Although indices of weight were associated with HDL cholesterol function, differences in fitness, the authors say, may be a better measure of who has healthier functioning HDL cholesterol, and theore, who is at risk of heart disease.

"The role of obesity in the risk of coronary heart disease may indeed be largely accounted for by differences in fitness," the authors say.