Health for life

Researchers publishing in the journal Nutrition show that Omega-3 fatty acids found in fish and natural foods including nuts and seeds can lower levels of dangerous homocysteine, an amino acid linked with increased risk of cardiovascular disease and dementia. Reviewing data from eleven trials including more than 720 study participants, scientists found that introducing Omega-3 fats from dietary or supplemental sources were associated with significantly lowered levels of plasma homocysteine.

Laurel Miller, via Salon.com, reviewed Mark Bittmans new cookbook, "Food Matters: A Guide to Conscious Eating With More Than 75 Recipes." (Bittman writes a food column for the New York Times and blogs for the NYTs at Bitten.)

How To Live What Michael Pollan Preaches, Salon.com, January 2009

Here are some excerpts from her article:

"[Bittmans book is] an unusual blend of manifesto, self-help manual and cookbook designed to convince people that they can drastically improve their diets with relatively little discomfort."

Bittmans formula: "Eat less of certain foods, specifically animal products, ined carbs, and junk food; and more of others, specifically plants, in close to their natural state."

"At 57, [Bittman had] gained 50 pounds over his college weight and had developed high cholesterol, high blood sugar (especially scary for someone with a family history of diabetes) and sleep apnea, a condition caused by his excess weight."

Bittmans specific tactics ...

"With a colleague, Kerri Conan, Bittman devised a plan they called "vegan until six." They ate almost no animal products at all until dinnertime, no simple carbohydrates and no junk food. (Simple carbs are sugars, white flours and other processed grains like white rice.) At dinner, they ate as they had before, although in time Bittman found that even his evening meals came to include more "vegetables, fruits, legumes and whole grains and less meat, sugar, junk food, and overined carbohydrates."

"It was easy, and in a matter of months hed lost 35 pounds, lowered his cholesterol and blood sugar, and had no trouble sleeping through the night. Most important, he continues to eat this way and is content to do so for the rest of his life."

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1. Using traditional research to detect a "statistically significant" decrease in insurance claims expense is notoriously difficult.

2. Theres scientific statistical proof and then there is a reasonable business assurance.  The latter may be enough for business-minded health insurers.

3. The conclusion is based on published research.  Unpublished "in house" data have convinced many insurers to include the medical home in their covered benefit.  They know something AHRQ doesnt.

4. While medical homes alone may be insufficient to save money, that doesnt mean that medical homes that are part of a package of interventions (value-based purchasing, P4P, vendor-based population health management or an ACO) are unnecessary.

5. While there is no evidence of savings, there is also no consistent evidence of increased cost. That means the quality associated with the medical home represents high value.

That being said, the U.S. Agency for Healthcare Research and Quality (AHRQ) Evidence Report Technology Assessment on the Patient Centered Medical Home says:

"Based on a combination of good- and fair-quality studies, there is a low strength of evidence that PCMH implementation may lead to lower utilization (inpatient and emergency department) for some subgroups of patients, but this effect was not uniform. Moreover, total costs were not lowered in the reviewed studies.

However, three observational studies specifically designed to test PCMH do report lower inpatient and emergency department utilization among patients in the PCMH program. However, total costs were not statistically different for PCMH and non-PCMH patients in the three studies. None of the clinical trials of functional PCMH interventions had statistically significant differences between intervention and control arms for inpatient or emergency department utilization.

No studies reported statistically significant cost savings among PCMH patients. In fact, when taking into account program costs, two studies, one good-quality trial and one fair-quality observational study, reported greater total costs among intervention patients."

 Image from Wikipedia

Stroke is a debilitating and often deadly condition that strikes more than 800,000 people each year and ranks as the third leading cause of death. A stroke is caused by a blockage of blood flow to the brain from either a clot or blood vessel constriction.

A large new American Cancer Society study adds to increasing evidence that physical activity reduces the risk of breast cancer in postmenopausal women. Researchers say moderate recreational activity was associated with a 14 percent lower risk and high physical activity with a 25 percent lower risk of breast cancer compared to women who were active at the lowest level. The study appears early online in Cancer Epidemiology, Biomarkers, and Prevention.

A large body of evidence shows that women taking part in regular physical activity have an approximately 25 percent lower risk of breast cancer compared to the most inactive. But still unclear are issues such as whether moderate intensity activity, like walking, imparts a benefit in the absence of vigorous exercise. Also unclear is whether the association differs based on tumor features, such as hormone receptor status, or by individual factors such as a womans body mass index (BMI), weight status, and use of postmenopausal hormones. In addition, while prolonged periods of sitting have been associated with the risk of some cancers, the relation between sitting time and postmenopausal breast cancer risk is not well understood.

To learn more, American Cancer Society researchers led by Alpa Patel, Ph.D. compared exercise and breast cancer status in 73,615 postmenopausal women taking part in in the CPS-II Nutrition Cohort, a prospective study of cancer incidence established by the American Cancer Society in 1992. During the 17-year study, 4,760 women in the study were diagnosed with breast cancer.

About one in ten (9.2 percent) women reported no recreational physical activity at the beginning of the study. Among those who were active, the average expenditure was equivalent to 3.5 hours per week of moderately-paced walking. Physically active women engaged primarily in moderate intensity activities, like walking, cycling, aerobics, and dancing rather than vigorous-intensity activities like running, swimming, and tennis. Among all women, 47 percent reported walking as their only recreational activity. Physically active women tended to be leaner, more likely to maintain or lose weight during adulthood, more likely to drink alcohol, and less likely to currently smoke. They were also more likely to use postmenopausal hormone therapy and to have had a mammogram in the past year.

Among those who reported walking as their only activity, those who walked at least seven hours per week had a 14 percent lower risk of breast cancer compared to those who walked three or fewer hours per week. Consistent with most prior studies, the most active women had 25 percent lower risk of breast cancer than the least active. The associations did not differ by hormone receptor status, BMI, weight gain, or postmenopausal hormone use. Also, sitting time was not associated with risk.

"Our results clearly support an association between physical activity and postmenopausal breast cancer, with more vigorous activity having a stronger effect," said Dr. Patel. "Our findings are particularly relevant, as people struggle with conflicting information about how much activity they need to stay healthy. Without any other recreational physical activities, walking on average of at least one hour per day was associated with a modestly lower risk of breast cancer. More strenuous and longer activities lowered the risk even more."

Current guidelines recommend adults get at least two-and-a-half hours per week of moderate-intensity activity, or 75 minutes per week of vigorous-intensity aerobic activity for overall health. But studies indicate less than half of U.S. adult women are active at these minimum levels. "Given that more than 60 percent of women report some daily walking, promoting walking as a healthy leisure-time activity could be an effective strategy for increasing physical activity among postmenopausal women," added Dr. Patel.

Increasing incidence of high blood pressure continues to be the most significant factor in death from a heart attack and advancing cardiovascular disease. Elevated blood pressure readings cause thickening of the coronary arteries as micro-cracks develop that the body attempts to correct with deposits of coronary plaque.

A heart-healthy diet helped men at high risk for heart disease reduce their bad cholesterol, regardless of whether they lost weight, in a study presented at the American Heart Association’s Arteriosclerosis, Thrombosis and Vascular Biology 2013 Scientific Sessions.

The 19 24- to 62-year-old men in the study had metabolic syndrome, which ers to three or more significant risk factors for heart disease and stroke. The risk factors included in this study were high waist circumference, high blood pressure, high levels of triglycerides and fasting glucose and low levels of high density lipoprotein or HDL “good” cholesterol.

For five weeks, the men followed a standard North American diet which is high in fats, carbohydrates, ined sugar and red meat. For a second five weeks, they ate a Mediterranean-style diet, which is high in fruits, vegetables and whole grains, and low in red meat. It also includes olive oil and moderate wine drinking.

The men then went on a 20-week weight-loss regime, then another five weeks of Mediterranean eating.

Regardless of whether patients lost weight, following the Mediterranean-style diet resulted in a 9 percent decrease in levels of low density lipoprotein (LDL) known as “bad” cholesterol. Similarly, blood concentrations of the protein part of the lipoprotein, called apolipoproteinB, dropped 9 percent after eating Mediterranean-style. Apolipoprotein plays an important role in lipid transport and metabolism.

“The Mediterranean-style diet, or MedDiet, may be recommended for effective management of the metabolic syndrome and its related risk of cardiovascular disease,” said Caroline Richard, M.Sc., study lead author and a registered dietician and Ph.D. candidate in nutrition.

Alzheimer’s disease cases are growing at an unprecedented rate with new cases expected to double by the year 2030. A news release from Alzheimer’s Disease International considers this the single most significant health and social crisis of the 21st century. There is much confusion about the factors that lead to Alzheimer’s and what can be done to prevent and reduce the risk of developing this insidious affliction.

The evidence continues to mount on the benefits of resistant starch and soluble fiber (beta-glucan).

In a study published in the May issue of Diabetes Care, researchers saw:

Reductions in after-meal glucose:

• From resistant starch - 24%
  
• From soluble fiber - 17%
  
• From a combination of resistant starch and soluble fiber - 33%

Reductions in after-meal insulin:

• From resistant starch - 38%
  
• From soluble fiber - 33%
  
• From a combination of resistant starch and soluble fiber - 59%

Our previous post on resistant starch includes a description and food sources.

Beta-glucan, the type of soluble fiber tested in this study, is found naturally in foods such as oats, barley, dried beans and peas, mushrooms, flax seed, psyllium seed husks, and bakers yeast.

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For the study:
Consumption of Both Resistant Starch and ß-Glucan Improves Postprandial Plasma Glucose and Insulin in Women

Blood pressure is effectively lowered by mindfulness-based stress reduction (MBSR) for patients with borderline high blood pressure or "prehypertension." This finding is reported in the October issue of Psychosomatic Medicine: Journal of Biobehavioral Medicine, the official journal of the American Psychosomatic Society. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

"Our results provide evidence that MBSR, when added to lifestyle modification advice, may be an appropriate complementary treatment for BP in the prehypertensive range," writes Joel W. Hughes, PhD, of Kent State (Ohio) University and colleagues.

Mindfulness Practice Leads to Drop in Blood Pressure

The study included 56 women and men diagnosed with prehypertension -- blood pressure that was higher than desirable, but not yet so high that antihypertensive drugs would be prescribed. Prehypertension receives increasing attention from doctors because it is associated with a wide range of heart disease and other cardiovascular problems. About 30% of Americans have prehypertension and may be prescribed medications for this condition.

One group of patients was assigned to a program of MBSR: eight group sessions of 2½ hours per week. Led by an experienced instructor, the sessions included three main types of mindfulness skills: body scan exercises, sitting meditation, and yoga exercises. Patients were also encouraged to perform mindfulness exercises at home.

The other "comparison" group received lifestyle advice plus a muscle-relaxation activity. This "active control" treatment group was not expected to have lasting effects on blood pressure. Blood pressure measurements were compared between groups to determine whether the mindfulness-based intervention reduced blood pressure in this group of people at risk of cardiovascular problems.

Patients in the mindfulness-based intervention group had significant reductions in clinic-based blood pressure measurements. Systolic blood pressure (the first, higher number) decreased by an average of nearly 5 millimeters of mercury (mm Hg), compared to less than 1 mm Hg with in the control group who did not receive the mindfulness intervention.

Diastolic blood pressure (the second, lower number) was also lower in the mindfulness-based intervention group: a reduction of nearly 2 mm Hg, compared to an increase of 1 mm Hg in the control group.

Mindfulness-based interventions Could Prevent or Delay Need for Antihypertensive Drugs Ambulatory monitoring is an increasingly used alternative to clinic-based blood pressure measurements. However, 24-hour ambulatory blood pressure monitoring showed no significant difference in blood pressure with the mindfulness-based intervention.

"Mindfulness-based stress reduction is an increasingly popular practice that has been purported to alleviate stress, treat depression and anxiety, and treat certain health conditions," according to Dr Hughes and coauthors. It has been suggested that MBSR and other types of meditation may be useful in lowering blood pressure. Previous studies have reported small but significant reductions in blood pressure with Transcendental Meditation; the new study is the first to specifically evaluate the blood pressure effects of mindfulness-based intervention in patients with prehypertension.

Although the blood pressure reductions associated with mindfulness-based interventions are modest, they are similar to many drug interventions and potentially large enough to lead to reductions in the risk of heart attack or stroke. Further studies are needed to see if the blood pressure-lowering effects are sustained over time.

The researchers argue that mindfulness-based interventions may provide a useful alternative to help "prevent or delay" the need for antihypertensive medications in patients with borderline high blood pressure.