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."

Its been too long since Ive spoken about cholesterol, too long I tell you. For those of you who dont know, I would sum up my view on cholesterol like this: its the most overhyped risk factor for heart disease there is. All you hear in the media is "Watch your cholesterol!" or "Cheerios lower cholesterol!" or "This food is cholesterol-free, so its good for you!". Bollocks. Bollocks I say.

First of all, the cholesterol in the food you eat barely has any effect on the cholesterol in your blood, if it has any effect at all. And second, lets set the record straight on "high cholesterol"... please for the love of God, quit worrying about it. Your total cholesterol is just about meaningless unless its taken in context with your triglycerides, HDL, and LDL... even better, your LDL particle number. Despite having no real, accurate clinical implications though, "high cholesterol" has taken on this sort-of boogey man role, scaring every health-conscious person into Lipitor land.

Anyway, I came across something today that was just too good not to write about; this stuff needs to be shared. This study was designed to analyze lipid-lowering therapy, but thats not the part I want to talk about here; its the cholesterol levels of the patients that piqued my interest. The researchers examined 65,396 patients hospitalized for heart disease (heart attack or angina) across the United States. Below youll find a screenshot of the baseline blood lipid data, taken within the first 24 hours of admission. You would expect, based on what you think you know, that heart disease patients must have had high cholesterol, right?

Average blood lipid values upon admission among all study participants.

Nope. On average, their cholesterol was 170.1 mg/dl, well below the high limit of 200. If any of these people had visited the doctor for a check-up a week before their hospitalization, the doc would have looked at these numbers and said "Steve, your cholesterol is great! Keep up the great work!" Assuming his name is Steve.

But things werent great. Each of these people experienced an acute coronary event that required hospitalization and very well could have ended their lives. Its irresponsible that were putting so much stock into cholesterol values when they clearly are NOT a good indicator of heart disease risk.

Sometimes it only takes one little piece of data, like this one, to completely change your beliefs on cholesterol and heart disease. I hope this provided the baseball to your brand new home window.

But what does this mean??
Now, theres an excellent chance that many of these people were already taking a cholesterol-lowering drug. Theres no data in the study to show whether this is true, but since so many people are on them, its very likely. So lets say for a moment that they were on statins. Say their normal cholesterol levels are around 220 mg/dl, and the statins bring it down to a more friendly-looking 170. Well, this only destroys the cholesterol and heart disease connection even more doesnt it? First off, it doesnt say much about the efficacy of the drugs. But also, it shows that reducing cholesterol from "high" back into "normal", at least via these mechanisms, is useless.

Okay, let me say it another way... if high cholesterol is the cause of our problems, lowering it should reduce our risk, regardless of the manner by which we do so. If it is not the cause, and it is just an indicator of a problem, then pharmacologically lowering it will NOT reduce our risk. It will, in fact, just make things appear to be fine when they are not.

Its sort of like when we get sick and we get a fever. We may take over-the-counter meds to reduce the fever; it makes us feel better and it takes away one of the symptoms of our illness. But we forget that the fever is an important part of our bodys defense mechanism to fight a bacterial infection... bacteria dont like the heat. We may feel a little better, but we remain just as sick as we were before, and weve now likely prolonged our sickness by messing with our bodys natural defense mechanisms.

The fever is like cholesterol, the symptom. The bacterial infection is the root cause. Got it? Okay its not a perfect analogy, but you get the point.


What is the root cause of heart disease then? If not total cholesterol, what should we focus on? Well thats a big can of worms... there are many factors that go into it. Stay tuned next week for a comprehensive guide on how to prevent heart disease!

Thats the question. What is the most common inflammatory arthritis in men (in Western countries)?

Guess.
No Googling.
Ill be back.

Answer: See here.
________

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.

Today’s question comes straight outta Brooklyn:

Q: Being folks who like food, eating, chopping, and such, we probably all have a small collection of cookbooks. I have about 15 or 20 myself, but only use a few with any frequency.

Cook’s Illustrated Best 30-Minute Recipe sees the most traffic in my home, though Ina Gartens’s first cookbook isn’t far behind. If I owned Moosewood’s Simple Suppers (which I checked out from the library once and adored), it would probably be right up there, as well.

So, of all the cookbooks in YOUR kitchen, which one gets the greatest amount of play?

A: Sweet readers! This one’s all you! What single cookbook (not blog, not periodical) do you use most often?

Want to ask the interweb a question? Post one in the comment section, or write to Cheaphealthygood@gmail.com. Then, tune in next Tuesday for an answer/several answers from the good people of the World Wide Net.

The day I lost my car... I became an avid pedestrian. Every local place became THE place to go for any goods and services. I really didnt want to lose my car, but the many months of being sick and at home, on leave from work and with no paycheck, left me struggling to make ends meet -- and well, car payments were not a priority. I let the car go.

Then shortly thereafter, I was diagnosed with type 2 diabetes. November 17th, 2009.

I thus began to get acquainted with a certain place a lot more often than I would have liked. A certain pharmacy. God, I hate pharmacies. I hate their smell, I hate their lights, I hate the waiting... and the lectures you get every time you get your prescription illed as if you hadnt heard them before for like the billionth time. Ive also never cared for the chit-chat. You know, the chit-chat cashiers always give you when youre ready to go. Im sort of this anti-social who just wants to grab the crap she needs, and be on her way. No eye contact, no talking... bah humbug.

But, alas, there was Sally. (Sally is not her real name.)

Sally loves and loves to talk. Sally is very social. Sally always has something to say, and engages well with customers. Sally loves talking a little too much with her customers. I think she may have even gotten a bit in trouble for it before. Its not easy to leave Sallys side, by the register. Heck, she sometimes even comes over to you while youre in the isle to talk to you while you shop! Shes always full of stories -- about the weather, about how things used to be in Ames, about her cat, about how things used to be in her hometown, about whats on sale, about what the best and most addicting snacks are, about her younger years when she used to have a career in social work, etc. Needless to say, Sally is very annoying.

Some days, when Rod and I used to go into the pharmacy together, wed find ways to try and avoid Sally -- especially if we were in a hurry. Sometimes, wed just want to shop in peace. Sometimes, we might have even gone to a different place altogether. But... in Iowa, politeness reigns. If we failed avoiding her, wed still listen to Sally. Conversation began to get so involved... that now wed be telling Sally our own woes.

Sally knew when I had no job or when I was underemployed with few hours, or when we were sick; when we had many, many struggles. Sally has often given us career advice, and even advocated for us.

In 2010, a devastating flood of epic proportions (the last of its kind seen 500 years ago), hit Iowa. It affected the resources and properties of many folk. Our town lost a lot of water mains and pipes, and the water supply became contaminated. The advice was: purchase water, and if youre poor, please go to these local water dispensing sites weve set up. The problem was the water dispensing sites were SO far away, we couldnt get to them. Buses werent going by certain areas either, because of flooding. Rod and I bought what little water we could, but then had no money left over for actual food. (And you know, with type 2 diabetes thats being treated with only diet, thats a rough ride... you have to seriously mind your carbohydrate consumption and you just cant survive on ramen noodles like someone else with a working pancreas could.)

Local Target stores parking lot, during the floods of 2010

I dont recall why we were at the pharmacy that day... but Sally asked about our day, and how we were faring with the floods, and well... we told her our woes, as had become usual. Sally, as it turns out, had been worried about us. Sally took us to the Red Cross -- Sally got us more water, and Sally took us to the supermarket and bought us food. Sally had endeared herself to us. Her quirky little self got into our hearts. She still, would sometimes, annoy the crap out of us... but our appreciation for her glossed over all that stuff. The stuff of being ourselves, squeaky wheels and all.

I dont believe in a god... and I dont believe that god is love. I believe that LOVE is God. I believe WE are God to one another, when we are in need, and our humanity calls... and we respond with love. And that day, when we needed her most, Sally WAS God. Sally helped us see another healthy tomorrow... and not struggle for today. Sally was also... our advocate. Sally KNEW we had type 2 diabetes... Sally RESPONDED to those needs. (WE can be patient advocates to ANYONE with a chronic illness, with their needs, ANY given day of the week. The opportunities are everywhere. Look for them. THIS is also part of advocacy. Being the glue that connects everything... when all else has failed.) 

Now... about a few weeks ago, I started noticing something wrong in my daily trips to the pharmacy. I really didnt see Sally as often, anymore, and she didnt seem as chatty as her usual self, anymore either. She seemed tired, and I thought to myself, "She looks like shes aging pretty fast; she looks a lot older than she was a month ago." (I didnt say anything.) I really had begun to MISS my daily encounters with Sally, and that daily inconvenience of having to stop and talk to her... while in a hurry to God knows where. "Maybe shes just cut back on hours," I had wondered... or maybe shes got a second job...  or maybe she was spending more time with visiting family. (She always spoke fondly of family far away -- or with annoyance -- depending on who the family member was. lol)

But today, walking home from work, I heard a voice yelling at me from a block behind "Why are you walking in such a hurry?! I cant catch up with you!" I stopped, and turned around. I saw it was Sally... and I got a little annoyed that I had to stop, and wait for her... It had been a pretty tiring day for me, and my carpal tunnel was worse for the wear. Sally lives a block from where I live, and she wanted to chat while we walked. Fine, I could entertain this.

She asked me about ME, first. How I was doing... how Rod was doing. How we were coping along with life. She pointed to her new hair cut... and how she wanted it shorter, for its getting so fine these days, its harder to style. I dont really care, but I politely listen anyway... (Ever the eternal Oscar the Grouch.) Then she gently eases into the topic... The chemotherapy has been really hard... and Sally cant manage it anymore. I am one of the special, chosen people in her world, that she has decided to tell... and no one else. Sally only has 4 months left to live.

I politely listen... offer my company... offer to spend time with her when shes stir-crazy at home, if anything. Sally cant drive anymore, which is just the same... because honestly, I still dont have a car. We can ride the bus together, she says. Itll be good. Itll be fun.

I offer to walk her all the way to her place, but she declines. I give her my cell phone number. We say our goodbyes, and I go home. I reach the bathroom, and undress. I break down and cry, and cry... and cry...

I dont know Sallys real name. Ive never asked.

Finding the Most Effective Skin Whitening and Lightening Cream

Imagine being able to have more even, sensual skin, with the reduction of liver spots, and other skin discolorations that become noticeable as we age, and troubling. What if you could have a fair and flawless skin that made you look years younger? You can!

You can have not only have an even skin tone, you can have an overall brighter, lighter complexion thats healthier and leaves people guessing what your real age is. One of the most effective ingredients appears to be alpha arbutin, and now it is readily available at a very affordable price.

Alpha arbutin may not be something you are familiar with but when it comes to bleaching cream it is certainly one you should consider and know about as it is effective, and has a good safety record. Like some of the other good ingredients it seems to be effective and work rather quickly.

Funny thing is that everyone seems to like having whiter skin. Even those with fair skin want to keep their skin tone as white as possible, and Asians are fond of whiter skin so they use all kinds of products to skin lighten and whiten much lighter than their natural skin tone.

There are all kinds of lotions, creams, and treatments on the market that whiten and lighten skin. Many are designed for those that have a darker complexion either as a result of ethnicity or because their skin has gotten darker from years of sun tanning, pollution, and age. Darker skin produces more melanin, which makes the skin appear darker. Skin whitening can lighten that skin.

Depending on the bleaching cream or skin whitening product, they might contain aloe vera, lemon extracts, bleach, and ingredients such as alpha arbutin. Some products work a little bit, some dont work at all, and some work very well. If you are considering using one of these products, you should take the time to do your homework so you are not wasting your money.

There are a number of ingredients that have shown great results when it comes to minimizing liver spots, Hyperpigmentation and evening your skin tone overall. Some products certainly work faster at skin lightening than others. Look for a product that can give you results at least within one month compared to products on the market that take a very long time to show any type of effect.

Alpha arbutin gets a great deal of attention because of the available studies. One study with alpha arbutin was conducted over a three month duration, a skin lighten cream formula of two percent alpha arbutin was used to minimize liver spots with more than 40 percent of those seeing results.

You need to know what the active ingredients are in the product you are thinking about using that promotes skin lightening and evens skin tones. A product that works on all types of skin is best. A quality bleaching cream, will show you results much quicker than you might think. Not all skin whitening and bleaching cream options are created equal.

If you require advanced treatments, you may have to see a dermatologist or cosmetologist who can do peels on your skin, which can lighten your skin significantly. Some treatments cannot be used on sensitive skin.
Bleaching cream can also reduce scars not just your skin pigmentation. Whether you are using bleaching cream to reduce scars, liver spots, or reduce the skins shade it needs to be done with great caution or it could lead to burns to the skin.

There are some bleaching creams available that are designed for sensitive skin. You need to learn how to apply bleach correctly if you are going to be using these products on your skin at home. Always read all of the instructions that come with a product, and never leave on any longer than the instructions say.

Skin whitening products that work well become very popular quickly, especially when they are affordable. For example, Ageless Derma is one company that offers an affordable skin lightening cream. It is also readily available online where you can search for the best pricing. To skin lighten at home you need to be patient and let the products work slowly and effectively. You should always buy products based on your skin type.

Its an exciting time - skin whitening products whether they include alpha arbutin or other active ingredients that work great in the bleaching cream, are increasingly popular because of the results they produce. You can have brighter and lighter, younger looking skin in no time.


Dr. Farid Mostamand, author of ageless skin obsession and founder of Focus Medical Spa bring you the latest research in Anti aging skin care. Look for these ingredients in any facial cream, eye cream, wrinkle cream and face whitening cream.

Article by : Dr. Farid Mostamand, Source : http://EzineArticles.com/?expert=Dr._Farid_Mostamand

A recent study in the Archives of Internal Medicine investigated the effect of combined lifestyle factors on the development of type 2 diabetes in older adults.¹

Researchers analyzed data from participants of the Cardiovascular Health Study:

• 4883 men and women 65 years or older
  
• Followed for a 10-year period (1989-1998)

Five lifestyle factors were studied:

• Physical activity level.
  
• Dietary score. A low-risk score lected:
  • Higher fiber intake
    
  • Higher polyunsaturated-to-saturated fat ratio
    
  • Lower trans-fat intake
    
  • Lower glycemic index
• Smoking. Never smoked or former smoker greater than 20 years lected low-risk.
  
• Alcohol use. Light or moderate intake lected low-risk.
  
• Body fat. Low-risk lected:
  • BMI less than 25 (Calculate your BMI here.)
    
  • Waist circumference 88 cm or less for women (34.6 in), 92 cm for men (36.2 in)

The study found:

"The rate of incident diabetes was 35% lower for each 1 additional lifestyle factor in the low-risk group.

Participants whose physical activity level and dietary, smoking, and alcohol habits were all in the low-risk group had an 82% lower incidence of diabetes.

When absence of adiposity (either body mass index < 25 or waist circumference ≤ 88/92 cm for women/men) was added to the other 4 low-risk lifestyle factors, incidence of diabetes was 89% lower.

Overall, 9 of 10 new cases of diabetes appeared to be attributable to these 5 lifestyle factors."

The authors concluded:

"Even later in life, combined lifestyle factors are associated with a markedly lower incidence of new-onset diabetes mellitus."

________
¹ Lifestyle Risk Factors And New-Onset Diabetes Mellitus In Older Adults, Archives of Internal Medicine, April 27, 2009