Health for life

The overall pattern of food that a person eats is more important to a healthy diet than focusing on single foods or individual nutrients, according to the Academy of Nutrition and Dietetics in its newly updated position paper "Total Diet Approach to Healthy Eating."

According to the position paper: "In contrast to the total diet approach, classification of specific foods as good or bad is overly simplistic and may foster unhealthy eating behaviors." The Academys position paper stresses that moderation, portion size and exercise are the key concepts for balancing food and beverage intakes.

The position paper has been published in the February Journal of the Academy of Nutrition and Dietetics and can be found on the Academys website. It states:

It is the position of the Academy of Nutrition and Dietetics that the total diet or overall pattern of food eaten is the most important focus of healthy eating. All foods can fit within this pattern, if consumed in moderation with appropriate portion size and combined with physical activity. The Academy strives to communicate healthy eating messages that emphasize a balance of food and beverages within energy needs, rather than any one food or meal.

The Academys position paper has been updated to lect the most current nutrition guidance, such as the 2010 Dietary Guidelines for Americans and the USDAs MyPlate food guidance system; the White Houses Lets Move! campaign to reduce childhood obesity and Healthy People 2020. Each of these public policies and dietary patterns supports the total diet approach.

According to the position paper, while studies including the Academys "Nutrition and You" national consumer survey show Americans are "conscious of the importance of healthy diets and physical activity," most people do not meet the recommendations of the Dietary Guidelines. For example, large majorities do not eat fruit (68 percent) or vegetables (74 percent) more than twice a day, and a substantial number (36 percent) engage in no leisure-time physical activity.

In that environment, according to the Academy: "Labeling specific foods in an overly simplistic manner as good foods and bad foods is not only inconsistent with the total diet approach, but it may cause many people to abandon efforts to make dietary improvements."

The position paper adds: "In 2011, 82 percent of U.S. adults cited not wanting to give up foods they like as a reason for not eating healthier. For these reasons, the concepts of moderation and proportionality are necessary components of a practical, action-oriented understanding of the total diet approach."

The Academys position paper notes that the most recent Dietary Reference Intakes use a total diet approach because it allows for a broad range of foods to meet a persons nutrition needs over time. Theore, a person can make diet choices based on individual perences, genetic background, personal health status and food availability.

The position paper was written by registered dietitians Jeanne Freeland-Graves, Bess Heflin Centennial Professor in the department of nutritional sciences at the University of Texas -- Austin; and Susan Nitzke, professor emerita and extension specialist in nutritional sciences at the University of Wisconsin -- Madison.

The Academys position paper contains advice and recommendations for health professionals as well as consumers. It explains how food and nutrition practitioners can use behavioral theories and models to develop effective nutrition communications; and how food and beverage choices are affected by multiple factors that influence peoples ability to make use of expert advice on healthy eating.

Updated sections of the position paper look at new indicators of nutrient quality, such as the Nutrient Rich Food Index, the European Union Nutrient Profiling System and the Overall Nutrient Quality Index. In addition, the Social Ecological model, used in the Dietary Guidelines, is incorporated into the Academys position as "a guide for understanding why we eat what we do."

According to the Academys position paper: "Food and nutrition practitioners have a responsibility to communicate unbiased food and nutrition information that is culturally sensitive, scientifically accurate, medically appropriate and tailored to the needs and perences of the target audience. Some health and nutrition professionals and many pseudo-experts promote specific types of foods to choose or avoid. A more responsible and effective approach is to help consumers understand and apply the principles of healthy diet and lifestyle choices. Unless there are extenuating circumstances (severe cognitive or physical limitations), the total diet approach is perred because it is more consistent with research on effective communication and inclusive of cultural/personal differences."

A new study by Queen’s University researchers has determined that adults who accumulated 150 minutes of exercise on a few days of the week were not any less healthy than adults who exercised more frequently throughout the week.

Ian Janssen and his graduate student Janine Clarke studied 2,324 adults from across Canada to determine whether the frequency of physical activity throughout the week is associated with risk factors for diabetes, heart disease and stroke.

“The findings indicate that it does not matter how adults choose to accumulate their 150 weekly minutes of physical activity,” says Dr. Janssen. “For instance, someone who did not perform any physical activity on Monday to Friday but was active for 150 minutes over the weekend would obtain the same health benefits from their activity as someone who accumulated 150 minutes of activity over the week by doing 20-25 minutes of activity on a daily basis.”

Physical activity was measured continuously throughout the week by having research participants wear accelerometers on their waists. Accelerometers are tiny electrical devices (about the size of a small package of matches) that record how much a person moves every minute.

Dr. Janssen divided the adults who met the physical activity guidelines (more than 150 minutes per week of aerobic activity) into those who were frequently active (active five to seven days of the week) and infrequently active (active one to four days of the week).

“The important message is that adults should aim to accumulate at least 150 minutes of weekly physical activity in whatever pattern that works for their schedule.”

The paper was published today in Applied Physiology, Nutrition and Metabolism

Important, Muscle Pain Treatment | Pain by the common people regarded as trivial and treated potluck. In fact, chronic pain can worsen health.

It is delivered by Aida Tantri of the Department of Anesthesia and Intensive Care, Faculty of Medicine RSCM Jakarta, Saturday (10/3), the International Forum on Pain Management held Joint Commission International (JCI), institutional providers of health care accreditation and certification, as well as pharmaceutical companies Pfizer Indonesia.

Chronic pain has become a major health problem especially in the Asia Pacific region. This disorder affects one in five adults worldwide. Chronic pain is predicted to be one of the critical health issues in the Asia Pacific region with increases in the elderly population.

Unfortunately, the disease is often overlooked because of a lack of understanding of the community. In fact, chronic pain can limit the quality of life and well-being of patients and can drastically heavy burden on the health care system, Aida explained.

Acute pain is usually considered a symptom of disease or injury. Chronic pain in the long term or after an injury or disease difficult to cure. In this case, the pain becomes chronic health problems that are specific, physiological and psychosocial related problems.

Chronic pain can worsen the quality of life for patients because it would reduce the ability to work, cause sleep disturbances, anxiety, frustration, and depression, lack of appetite, increased susceptibility to disease, have a negative impact on the attitudes and lifestyles, as well as dependence on drugs and medical care.

Postoperative survey data at the RSCM, according to Aida, showing persistent pain experienced by 16.6 percent of patients. Degree of pain perceived weight 16.67 per cent of patients, pain was 41.7 percent, and the remainder mild pain.

Chronic pain often associated with diabetes, cancer, HIV / AIDS, and depression. In addition, also associated with diseases of old age, such as shingles, arthritis, back pain, and muscle aches. "Its time to educate patients, health professionals and the public about the need to reduce chronic pain and prolonged pain," says Aida.

Reduce and cope with pain is an important goal for medical personnel. Controlling pain can help patients to recover more quickly. "In addition, reducing the risk of complications after surgery, such as pneumonia and blood clots," said Paul Chand, Managing Director of JCI Asia Pacific. In JCI, pain management becomes an integral part of the accreditation process for safety and quality of patient care.

To improve the quality of pain management and hospital management, the Government of Indonesia in cooperation with Dow and Pfizer Indonesia to improve the quality of management in the hospital.

Health providers and local hospitals or the prevention protocol introduced effective pain management. During this time, monitoring of medical conditions is performed by measuring height and weight as well as a variety of vital indications of health conditions, such as blood pressure, pulse, respiratory rate, and body temperature.

JCI international forum aimed advise physicians to evaluate and improve disease management procedures and implementation of international standards of health care in Indonesia.

In Indonesia, in cooperation with JCI Ministry of Health and public health agencies to evaluate and improve patient care, said Chairul Radjab Nasution, Director of the Ministry of Health Reference Health Efforts. [kompas]

When accountability fails

"Accountability."  Everyone wants it, right?

While its one thing for health care providers to be "accountable" for costs, its another for them to actually make money at it.  The Disease Management Care Blog is continuously amazed at how many physicians and administrators believe that dollops of "primary care," "prevention" and "wellness" will empty hospital beds and cause insurance money to appear like the morning dew on a windshield of a physician specialists BMW. 

Believe that and the DMCB has an ORD-SFO United Airlines upgrade "departure management card" it would like to sell you.

If the DMCB could do only one thing to reduce costs within one fiscal year for a health care system , it wouldnt be PCPs, wellness or prevention. Instead, it would place one vastly overpaid case manager in every emergency room in the network.  His or her job would be to find alternative levels of care for persons that dont really need to be in the hospital and begin discharge planning for those who do.

The second thing the DMCB would do is implement predictive modeling.  Thats why its immodestly tooting its horn and suggesting research like this is so important.  In this web first publication, Chris Hollenbeak, Mark Chirumbole, Benjamin Novinger, Frank Din and your humble DMCB examined the baseline demographic data and medical conditions that can predict the likelihood of a future high cost hospitalization within a Medicaid population.  Armed with knowing which of its patients are at risk ahead of time is a critical level of intelligence for any newly "accountable" hospital, clinic, IPA, PHO or IDN.  By reaching out to high risk individuals prior to any crisis, physicians and administrators can engage these patients in outpatient settings and keep them away from the emergency room.

The good news is that the art and science of predictive modeling is within reach of most data bases, desk-top computers, statistical software packages and trained analysts.  The bad news is that interpreting and executing on that information remains a daunting challenge. 

Health systems like HealthCare Partners is a good example of how it can work well.  As this "accountability" movement in health care evolves, the DMCB will undoubtedly learn about other good examples. 

The systems that rely on vague notions about primary care, fail to understand the role of case management and ignore the business case for predictive modeling will form the bad examples.

Its that time again, folks.  The best time of the year.  Thanksgiving, Christmas, and New Years... the holiday season.  Theres just nothing like it... turkey dinners, Christmas trees, the snow, the gift of giving, the time spent with family.  I look forward to it every year.  But step inside the psyche of any health-conscious person this time of year, and you may find a war zone:

"I love apple pie, but I dont want any.  I dont want it.  It goes right to my butt.  God, look at it... its gawking at me.  Ahhh okay Ill have a slice.  ONE slice.  Just one slice and Ill stop.  This is the year I keep my weight under control during the holidays.  Oh god that was good.  Shit girl, give me another.  This is better than sex, oh my god.  The apple pie god.  I love him, he who created apple pie.  Screw butt fat, whatever.  Men like big butts anyway... they cannot lie."

Right?  We all know the holiday season presents a problem.  Excessively yummy food + great people + alcohol = weight gain.  It happens every year... and come the New Year?  Resolutions abound.  Gyms explode with new members, we eat less, and we try to right the wrongs of the past few months.  But, as anyone who has done this probably knows, that weight doesnt come off with the same ease at which it was put on, and rarely does it stay off.

And thats the point of this post.  I want to explain to you why that weight wont stay off, and why, consequently, its so important to prevent the weight gain to begin with.  Saddle up partner...


Body fat set point and the regulation of body weight
In order for this to make sense, we have to first talk about the concept of the "body fat set point".  The body fat set point is the idea that our bodies "defend" a certain level of fat on the body.  Think about how a thermostat works... if you set the temperature to 70, the system will heat or cool your house accordingly to maintain the temperature at 70 degrees.  Our physiology uses a similar system to regulate body fat.  If a man overeats one day, his body will adjust accordingly in the following few days by decreasing hunger.  In the end, his body weight evens out.  The same would be true if he starved himself one day; his body would compensate by increasing hunger in the days to follow.  Over the course of a week or two, caloric intake tends to balance out with caloric expenditure (1).  Through a system involving the hormone leptin, the brain senses a change in body fat, whether it has lost or gained, and alters hunger accordingly, in an attempt to return to the set point (2). 


In the vast majority of us, this system works well.  But this all rests on one assumption... that we eat when were hungry, and we stop eating when were full.  And this is where the problem comes in.  In todays society and food environment, its becoming increasingly difficult to stop eating.  Weve got access to food wherever we go, its more palatable than in the past, it comes in larger portion sizes than ever before, and its advertised to us at every turn.  How can we avoid buying a soft, warm, melts-in-your-mouth Cinnabon at the airport when we have an hour to kill and nothing to do but wait?

We can overeat at one meal or on one day without harm, as long as we listen to our hunger cues and compensate later.   But overeating without compensation, for any reason, over a period of a few months or more, can be a problem.  In overfeeding studies that are designed to induce weight gain, some subjects will return to their normal weight after the study is over, but many do not.  Some of the subjects end up hanging on to a little fat, indicating that the body fat set point has increased.  This phenomenon has been observed in both animals (3,4) and humans (5,6).  Once you establish a higher set point, it becomes extremely difficult to lose that fat.  Take, for instance, the fact that when obese people lose body fat, their body goes into a starvation response, despite having plenty more fat to lose (7).  Their bodies want that fat.

Back to the holidays...
So how does this relate to the holiday season?  Because around the holidays, our food environment takes steroids.  We have even MORE delicious treats, MORE palatable food, and MORE drive to eat.  Grandmas making you a pie every Tuesday, Christmas cookies permeate the office, there are Christmas parties, theres candy everywhere... its excessive.  Delicious... festive... but excessive.

Given that, this shouldnt be a surprise:  According to a recent study, half of annual weight gain in the United States happens during the holidays via voluntary overeating (8).  HALF OF IT.  And the news nobody wants to hear... people who gain weight during the holidays lose some of it in January, but they hold on to most of it long-term.  Thats a problem.  That means you have a new, higher set point.  Your body is now "happy" with more body fat, even if youre not.  And once this happens, getting back to the weight you want to be at is made exceedingly more difficult.

We may not gain 20 pounds in one holiday season; according to the study, its only about a pound on average.  But that weight stays on.  If you imagine this happening every holiday season for years and years, its not a stretch to say that you can become overweight or obese from holiday eating alone.  All you have to do is overeat for a few months each year.  Its likely a major contributor to the obesity epidemic.


The Solution
Of course, theres a solution hidden in there... dont allow yourself to gain any weight to begin with over the holidays, and you wont have to worry about any of this!  Its not easy, but its better than the alternative if youre trying to avoid gaining weight.  For a few good tips on how to accomplish this, check out "3 tips for preventing holiday weight gain" by Chris Kresser.

So try to practice some balance this holiday season.  Even though were already halfway through it (Im inexcusably late with this post), try to listen to your body.  If you want some pie and cookies, have some pie and cookies.  But either practice moderation or be in tune to your bodys hunger/satiety signals in the days that follow. 

Hope this helps you out this year!  Happy Holidays!

You’ve probably seen “a good source of omega 3′s” imprinted on various boxes and bags around the super market and wondered “what are omega 3′s and why should I give a damn?

Omega-3 fatty acids are considered essential fatty acids: Omega 3′s come from a family of unsaturated fatty acids.  Even the healthiest diets need a moderate amount of healthy fats, and omega 3′s are crucial to healthy, sustainable living.  They’re considered “essential” fats – Essential fats are so defined as they are vital for, but cannot be made by, the human body. Only plants can make the vital omega 3 and 6 parent fatty acids, human enzymes can then convert these to other fatty acids such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) which are building blocks of the brain and nervous system. 

Omega 3 Source

 They are needed for the integrity of every cell membrane in the body so particulalry important for the health of vital organs such as the heart and brain.They are necessary for human health but the body can t make them -- you have to get them through food. Omega-3 fatty acids can be found in fish, such as salmon, tuna, and halibut, other seafood including algae and krill and there are plenty of vegan sources of Omega 3′s including spirulina (algae), nuts, flax, and vegetables. Vegan sources of omega-3s include canola oil, broccoli, cantaloupe, kidney beans, spinach, grape leaves, Chinese cabbage, cauliflower, spirulina, and walnuts.

Research shows that omega-3 fatty acids reduce inflammation and may help reduce the risk of chronic diseases such as heart disease, cancer and arthritis.The omega 3 parent fatty acid is called alpha linolenic acid (LNA or ALA) and comes from vegan seeds such as flax, hemp and pumpkin, from nuts such as walnuts, and to a lesser extent from soya and green vegetables. 

Through a series of enzyme-controlled reactions the human body converts this LNA into a number of vital fatty acids including EPA and DHA. Among their many roles EPA is needed for brain function, concentration, and vision, and is also converted into a powerful anti-inflammatory agent. DHA is needed as a building material , particularly for brain structure and so is especially important in pregnancy for the baby’s brain and nervous system development, infants who do not get enough omega-3 fatty acids from their mothers during pregnancy are at risk for developing vision problems and nerve damage.



Additionally, the benefits of omega-3s include reducing the risk of heart disease and stroke while helping to reduce symptoms of hypertension, depression, attention deficit hyperactivity disorder (ADHD), joint pain and other rheumatoid problems, as well as certain skin ailments. Some research has even shown that omega-3s can boost the immune system and help protect us from an array of illnesses including Alzheimer’s disease.

Fish contain unsaturated fatty acids, which, when substituted for saturated fatty acids such as those in meat, may lower your cholesterol. But the main beneficial nutrient appears to be omega-3 fatty acids in fatty fish. Omega-3 fatty acids are a type of unsaturated fatty acid thats thought to reduce inflammation throughout the body. Inflammation in the body can damage your blood vessels and lead to heart disease.

Omega-3 fatty acids may decrease triglycerides, lower blood pressure, reduce blood clotting, boost immunity and improve arthritis symptoms, and in children may improve learning ability. Eating one to two servings a week of fish, particularly fish thats rich in omega-3 fatty acids, appears to reduce the risk of heart disease, particularly sudden cardiac death.

Alzheimers
Polyunsaturated fatty acids found in many fish may prevent damage to brain cells. Eating fish can also reduce the risk of high blood pressure, which is linked with dementia. A French study of 2000 people showed that those who ate seafood at least once a week had a significantly lower risk of dementia over a seven-year period than those who didnt.

Dementia - elderly people who eat fish or seafood at least once a week may have a lower risk of developing dementia, including Alzheimers disease.

Cardiovascular disease - eating fish every week reduces the risk of heart disease and stroke by reducing blood clots and inflammation, improving blood vessel elasticity, lowering blood pressure, lowering blood fats and boosting good cholesterol.

Cancer - the omega 3 fatty acids in fish may reduce the risk of many types of cancers by 30 to 50 per cent, especially of the oral cavity, oesophagus, colon, breast, ovary and prostate.

Asthma - children who eat fish may be less likely to develop asthma.    

Just how do omega-3s perform so many health “miracles” in people? One way, experts say, is by encouraging the production of body chemicals that help control inflammation — in the joints, the bloodstream, and the tissues

But even as important is their ability to reduce the negative impact of yet another essential type of fatty acid known as omega-6s. Found in foods such as eggs, poultry, cereals, vegetable oils, baked goods, and margarine, omega-6s are also considered essential. They support skin health, lower cholesterol, and help make our blood “sticky” so it is able to clot. But when omega-6s aren’t balanced with sufficient amounts of omega-3s, problems can ensue.  In general, Americans eat too much Omega 6 and not enough Omega 3.
You can replace some omega-6s from cooking oils with a third fatty acid known as omega-9 (oleonic acid). This is a monounsaturated fat found primarily in olive oil.

If you think you can get all of your omega 3′s only through fish oil supplements?  Think again.  There are other healthy components of whole foods containing Omega 3′s that make it better for your body and soul – flax, for example, is heavy in fiber which helps lower cholesterol, regulate blood sugars, and improve digestion. 
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If you have diabetes, including more omega-3s in your diabetic meal planner can reduce your risk of certain diabetic complications, as well as:

• Decrease insulin resistance
• Improve mood and lower rates of depression
• Improve symptoms of inflammatory diseases, like asthma and lupus
• Reduce apoproteins, cholesterol and triglyceride levels
• Reduce risk of heart attack
• Reduce risk of macular degeneration
• Reduce risk of some types of cancer
• Reduce risk of stroke.

So just add some Omega 3′s to your diet today!