Health for life

A study due in the upcoming July 15 issue of the American Heart Association journal Circulation will be reporting that: ¹

"Greater adherence to the prudent pattern [of eating] may reduce the risk of cardiovascular and total mortality, whereas greater adherence to the Western pattern may increase the risk among initially healthy women."

What did the researchers define as a "prudent pattern"?

"High prudent pattern scores represented high intakes of vegetables, fruit, legumes, fish, poultry, and whole grains, whereas high Western pattern scores lected high intakes of red meat, processed meat, ined grains, French fries, and sweets/desserts."

It was a large prospective evaluation of the diets of 72,113 women who participated in the Nurses Health Study. They were followed for 18 years.

The prudent diet reduced risk of cardiovascular death by 28% when compared to the Western diet. It reduced risk of all-cause death by 17%.

The Western diet increased risk of cardiovascular death by 22%, cancer death by 16%, and all-cause death by 21%.

These findings are similar to those reported earlier this year in the same journal.² In that study, the diets of 9,514 participants of the ARIC cohort (Atherosclerosis Risk in Communities study) were evaluated over the course of 9 years. Those men or women who ate a Western pattern - high in meat and fried foods - had a higher risk of developing metabolic syndrome. Metabolic syndrome is a constellation of risk factors for heart disease. These include insulin resistance, diabetes, hypertension, high blood lipids, high uric acid levels, and obesity - especially weight carried around the waist.

________
¹ Dietary Patterns And Risk Of Mortality From Cardiovascular Disease, Cancer, And All Causes In A Prospective Cohort Of Women, Circulation, 2008

² Dietary Intake And The Development Of The Metabolic Syndrome. The Atherosclerosis Risk In Communities Study, Circulation, 2008

Eating fish may reduce the risk of heart attack, but it is important to steer clear from the type of fish that contains the most amounts of mercury, according to experts from Umeå University in Sweden.

The researchers have worked together with teams from Finland and other countries in order to assess whether the advantages of heathy fatty acids outweigh the risks of mercury proportion.

Previous research has said that individuals who consume fish have a decreased risk of heart disease, compared to those who eat none or very little. However, certain types of fish carry pollutants from the environment, which can be detrimental to the health of humans.

Methyl mercury, which can be found in many types of fish, may actually raise the risk of cardiovascular disease. Theore, consuming fish with a lot of mercury, or with ample amounts of pollutants, can severely increase the risk of heart problems. However, if people are too health conscious of fish, they increase their risk of the disease because they are not receiving the benefits of healthy fish.

A recent study said that tuna, which has high levels of mercury, should be given to children less often.

The current research, which will be published in the October 2012 issue of American Journal of Clinical Nutrition (AJCN), was carried out with the intention of finding a middle point between not eating any fish and eating too much, or types that are unhealthy.

The authors analyzed why heart attack risk is linked to the amount of mercury and omega-3 fats in the body due to fish consumption. They did so by measuring hair and blood samples of volunteers who had been involved in other trials in eastern Finland and northern Sweden. The blood samples of the Swedes were taken from the Medical Biobank in Umeå. Researchers compared blood from the patients who had suffered a heart attack after their check-up appointments and those who remained in good health with no heart attacks.

They found that while mercury content increased the chance of heart attack, omega-3 fatty acids decreased the risk. The researchers noted that higher risk of heart attack due to mercury consumption was only prevalent when there was a large amount of pollutants found in the body. If there was a high level of omega-3 fatty acids, the risk was low.

The findings suggest that it is important and beneficial to reach an equilibrium between healthy and unhealthy content found in fish. In this particular study, the environmental pollutant used was mercury. However, in regards to organic pollutants, such as dioxin and PCD, the results are the same. The authors note, though, that there has been no trial done thus far concerning these substances.

According to the Swedish National Food Agency, 2-3 servings of fish should be consumed per week. However, Swedes tend to eat predatory fish, which have a high amount of mercury and should not be eaten on a regular basis. In addition, a study conducted by the National Food Agency revealed that 7 out of 10 people in Sweden do not eat enough fish.

A 2011 study said that people who eat fish on a regular basis have lower blood glucose concentrations, and a lower risk of cardiovascular disease and type 2 diabetes. The researchers conclude that it is safe, as well as beneficial, to eat fish, but staying away from fish with high levels of pollutants is important in avoiding health problems.

Guideline experts at work

Max Levin of the Health Diplomat Blog isnt sure about the DMCBs suggestion that guideline interpretation for health care coverage decisions (including preventive care)be decentralized.  While pushing responsibility down to the local health plans and provider organizations would certainly defang the powerful special interests, Max points out that without a nationally recognized guideline "Good Housekeeping" seal of approval, charlatans and hucksters will be able to foist their pseudo-clinical recommendations on an unsophisticated and unsuspecting public.

Max has a point, but the DMCB isnt changing its mind:

1. When one big national guideline gets it wrong, the damage involving thousands of patients can be considerable. Examples include years of supporting preventive estrogen for post-menopausal women and aggressive blood glucose control among persons with diabetes.

2. While advocates and lobbyists are just as able to swindle unsuspecting managed care and ACO leaders, theyd need to do so among hundreds of provider organizations.  When power is concentrated in Washington DC, all they have to do is convince one Congressman.

3. In the DMCBs experience, health insurers and ACOs are not only highly expert, but more skeptical when it comes to interpreting clinical trial data and deciding the fit in coverage decisions. For an example of their first-do-no-harm conservatism, recall how managed care used to cover bone marrow transplants for breast cancer.

4. Last but not least, even Atul Gawande pointed out how "local" health care is.  Its up to communities to create working systems out of the complex fragments of health care that best fits the local population.

The Feds should assure guidelines are incorporated in coverage decision-making.  They can accomplish that through the regulatory process, periodic audits and during the appeals process.  Otherwise, says the DMCB, they should stay out of the way.

This might seem silly... I know. I know I dont have to try hard, or go far, to ask my readers to imagine for a moment being a person with diabetes. (Naw... You dont say!) ☺

But still...! Imagine, for a moment that youre a person living with diabetes, and have lived with it for many, many years... Imagine its been challenging. Youve gone through many phases of burn out, and phases of challenge. Its been a deep struggle, for various reasons:

1. Managing this crap every day is a roller coaster, and well, it seldom likes to actually do what we expect it to do. Einstein once said that "doing the same thing over and over again and expecting different results" was the definition of insanity. I like to call it... Diabetes.
2. You have some white coat person always reminding you if you dont take care of yourself, youre going to die. And NOT in uncertain terms, either. 
1. Youll get retinopathy... 
2. Youll get nephropathy... 
3. Youll get neuropathy... 
4. All the opathies... 
5. Youll get your limbs amputated... 
6. Youll lose bladder function... 
7. Youll be impotent... 
8. Youll have congestive heart failure, or a stroke...
9. Youll go into DKA, or insulin shock...  
10. Youll DIE. 
3. You may not necessarily have many close friendships, in your immediate circle of acquaintances, that can actually understand you. 
4. You have some family members constantly reminding you of the things the white coat person was reminding you... 
5. You have friends, coworkers, and other relatives, wanting you to FORGET about what the white coats, and the other family members, keep reminding you, and then just go live life with them... "just live a little." (And its always living thats centered around food, or alcohol.)  
6. You have your own deep desires to want to just be NORMAL, or as close to normal as you can be... and "just live a little."
7. Youve carried the heavy load of discipline, and care, however individualized your load might be, for a long, long time. You are very AWARE of how serious it is if you dont carry the load. 
8. You get tired...  You burn out. You drop the load.

These days, more and more people are seeking the health benefits of a diet rich in plant-based foods; foods that are now easily found on the shelves of neighborhood grocery stores.

According to the American Dietetic Association, approximately 2.5% of the U.S. adult population eats a diet free of meat, poultry, and fish. And a growing number of people are embracing the flexitarian way of life, which offers many of the health benefits of a vegetarian diet while still allowing occasional meat, fish, and/or poultry.

Of course, some people follow a vegetarian diet for religious or ethical reasons. But enjoying an eating plan rich in plant foods also has many health benefits, ranging from aiding weight loss to preventing disease, experts say.
The American Cancer Society, American Institute for Cancer Research, and American Heart Association all recommend a diet rich in plant-based foods. Such a diet contains an abundance of antioxidants, phytochemicals, and fiber, with low levels of saturated fat and cholesterol.
Indeed, the 2005 U.S. Dietary Guidelines and updated food pyramid (myPyramid.gov) promote a diet rich in whole grains, fruits, vegetables, beans, and low-fat dairy -- foods that are the foundation of most vegetarian diets.
Veggie Lingo

"Vegetarian" can mean lots of different things. The various types of vegetarian diets include:

Vegan. Strictest of all, eats only plant products.

Lacto-vegetarian. Eats dairy products along with a plant-based diet.

Ovo-vegetarian. Eats eggs along with a plant-based diet.

Lacto-ovo vegetarian (the most common type). Eats both dairy products and eggs.

Pesco-vegetarian. Eats fish along with a plant-based diet.

Flexitarian. While theres no formal definition, this generally ers to a lacto-ovo vegetarian who occasionally eats meat, fish, or poultry. Sometimes called semi-vegetarian.

The Nutrition Low-Down

Vegetarian diets were once thought to be lacking in certain nutrients. But experts say that with a little planning, vegetarians can easily meet all their nutritional needs.
"You can get all the nutrients you need from a well-planned vegetarian diet, along with all the health benefits of a diet that contains lots of vitamins, minerals, fiber, and protein, yet tends to be low in fat and calories -- a perfect combination for losing weight and promoting good health," says Cynthia Sass, MPH, MA, RD, a spokeswoman for the American Dietetic Association.
To ensure adequate nutrition, Sass recommends that vegetarians eat a wide variety of foods, including unprocessed whole grains, fruits, vegetables, nuts, seeds, beans, and soy products. She recommends using myfoodpyramid.com to help plan meals.
Vegans may find it a little trickier to get enough vitamin B12, omega-3 fatty acids, protein, zinc, vitamin D, and calcium. But a registered dietitian can help devise an adequate vegan meal plan

Healthy Benefits


Vegetarians have lower rates of almost all chronic diseases, including obesity, says Sass. They are less likely to have high blood pressure or high cholesterol, and their eating style helps thwart the development of type 2 diabetes, heart disease, and some types of cancer.



Recent studies have shown that in general, vegetarians have lower body mass indexes (BMIs), lower percentages of body fat, and lower waist-to-hip ratios than nonvegetarians, Sass says.



"Vegetarian foods tend to be more filling due to the fiber and protein and theore it makes it easier to eat less and lose weight," Sass says.



But not all vegetarian diets will result in weight loss. While many vegetarians per nutritious foods, vegetarian diets can still be high in fat and calories.



"If you fill your plate with high-fat selections like French fries and eat too many calories, your vegetarian eating plan can cause weight gain," says Connie Diekman, RD, MEd, president elect of the ADA.



Instead, she advises eating plenty of fruits, vegetables, whole grains, beans, nuts, and low-fat dairy.



10 Tips for Eating Meatless

Its easy to be a vegetarian these days, with so many meatless food products on the market, along with all kinds of vegetarian cookbooks and magazines.



If you want to become a sometime vegetarian or just enjoy a meatless meal once in a while, there are ways to do it without learning a whole new way of cooking and eating. First, start by substituting beans for meat or poultry in your favorite dishes, advises Diekman.



"The easiest way to transition into a more plant-based diet is to use familiar recipes substituting vegetarian ingredients," she says.



She recommends making these substitutions in dishes that have strong flavors, such as those with a sweet and sour or marinara sauce. Once you get used to more beans in your diet, experiment with meat substitutes, which look and taste like meat but are made of plant products.



Your second step: The next time youre at the grocery store, pick up one of the many pre-prepared vegetarian convenience foods. Sample several options to find the ones you enjoy.



Here are eight other tips for working more vegetarian meals into your eating plan while meeting all your nutritional needs:



Look for foods that are fortified with extra nutrients for a nutritional boost. Choose soy products that are fortified with calcium, vitamin D and B12.

Try tofu and soy crumbles, which are mild-tasting and absorb the seasonings and flavor of whatever you cook them with.

Eat plenty of dark, leafy greens, which are rich in iron and provide calcium.

Top salads, soups, stews, and omelets with beans, nuts, or seeds to add protein.

Add a once-daily multivitamin/mineral for nutritional insurance. See your doctor or registered dietitian if you are pregnant or have any other condition that could require extra supplementation.

Choose low- and nonfat dairy products.

Boost the healthy omega-3 fatty acids in your diet by eating fatty fish (if you include fish in your diet), enriched eggs, walnuts, flaxseed, and canola oil.

Try going meatless one day a week at first. You dont have to cook elaborate vegetarian meals; it can be as simple as having a veggie burger and salad for dinner.

Vegetarianism is a healthy lifestyle, but experts point out that lean meat, fish, and poultry also have nutritional benefits -- as long as you keep your portions moderate. To gain the health benefits of a vegetarian diet and still enjoy animal products, think of the meat, fish, or poultry as a side dish and fill the rest of your plate with plant foods. And be sure to choose the leanest cuts when you do buy meat.

Here at Cheap Healthy Good, we usually reserve Wednesdays for long, academic posts in which the conclusions inevitably boil down to “eat more vegetables” and/or “do what’s best for you.” (The internet: where non-answers are the best answers.)

Today, we figured we’d try something a little different: a quiz. It’s designed to determine whether you should start, continue, or stop reading this blog. In a way, it’s kind of like asking, “How good are you at applying all this stuff?” or "Kale is awesome, right?"

So, using a pencil and a piece of paper, record your answers as you go along (or, you know, just remember them). At the end of the post, evaluate yourself using the provided key.

Have fun and good luck.

1. You have five dollars to feed yourself for two days. You buy:

• A) Bananas, carrots, sweet potatoes, beans, peanut butter, bread, and a dozen eggs. What? You had coupons.
• B) Two boxes of pasta, a jar of decent sauce, and a bag of salad. Breakfast is gonna be weird, but you’ll get by.
• C) Five junior cheeseburgers off the $1 menu. Then, you load up on ketchup and salt when your cashier is distracted by the senior bus tour.
• D) The latest issue of Maxim. Hopefully, it will keep you so distracted you won’t need to eat.

 2. It’s Friday night after work. In your fridge are two eggs, half a jar of salsa, and a hunk of bread. What’s your reaction?

• A) Time for Shaksouka! With herbs from my victory garden, of course.
• B) Scrambled eggs with salsa and toast. Not too shabby, sports fans.
• C) “Hello, is this Kam Sing? … Yes, I’d like a pint of Pork Chow Fun … yes, a pint … of Pork Chow Fun … Pork Chow Fun … a pint … one pint … Pork Chow Fun … No. Pork Chow Fun … one pint … Pork Cho- … Fried Rice is fine. Thanks.”
• D) What’s an “egg”?

3. Your favorite food publication is:

• A) Saveur. So beautiful. So erudite. You want to make crazy tantric Sting love to it.
• B) Cook’s Illustrated. So practical. So methodical. You want to spoon and make it a mix tape.
• C) Every Day with Rachael Ray. So colorful. So fun. You want to give it a friendly high five and a girly, non-boob-touching hug.
• D) Highlights Magazine. So Gallant. So Goofus. You want to learn math and simple decision-making skills from it.

4. Your favorite food is:

• A) Tout plat favorisée par des paysans français. Ils sont les meilleurs, cest exact?
• B) Turkey Chili. It’s delicious, surprisingly filling, and uses all the odds and ends lying around your rigerator.
• C) Kraft Macaroni and Cheese. If you use skim milk and halve the butter, it’s not so bad. Plus, it comes in Shrek shapes! I can eat that damn cat!
• D) Cigarettes. Mmm … tabacco-y.

5. Given five bucks and a choice of chocolate bar, you’d buy:

• A) Theo. It’s free trade organic cage free humanely raised Omega-3 other words.
• B) Lindt’s. Delicious, a little upscale. A real treat.
• C) Hershey’s. IT’S ALL YOU KNOW.
• D) A 40 of malt liquor with an M&M accidentally dropped in the bottle.

6. Your favorite Food Network show is:

• A) Baoot Contessa. You would kidnap Ina Garten and keep her in your basement if you were sure it wouldn’t upset Jeffrey.
• B) Everday Italian. Giada knows what she’s doing. Also? Claw hand.
• C) Quick Fix Meals. You don’t necessarily like it, but it’s tough to break from Robin Millers uncomfortably intense stare.
• D) Down Home with the Neelys. HAHAHAHAHAHA, PAT, AH LUUUUUUUV YOU BABY, AND NOW WE’RE GONNA MAKE SOME ITALIAN BARBECUE, RIGHT BABY? IT’S REGULAR BARBECUE, BUT WITH A BASIL LEAF. HAHAHA, BABY? (*Pat shoots self in face*)

7. Your definition of healthy food is:

• A) Organic, whole foods bought from local vendors and/or free trade organizations, prepared simply with a little oil. Julienned if possible, just because you like the word.
• B) Anything that will eventually decompose.
• C) Diet Coke and Weight Watchers Amaretto Cheesecake Yogurt.
• D) Moonshine without too much dirt.

8. The biggest problem with the American food system is:

• A) Not enough fennel.
• B) Too many chemicals. Useless government regulations and regulators. Unchecked corporations. Food deserts. False nutritional claims. Marketing junk to kids. … Wow, this is depressing.
• C) Um … well, Hot Pockets are kind of gross.
• D) Not enough heroin.

9. Quick! Make up a haiku about food!

• A) Pastured, grass-fed cattle / Mooing gently on the plain / Tomorrow’s sirloin.
• B) Though I loathe salad / I know it must be consumed / For good aorta.
• C) Long Island Iced Tea / has iced tea in it so it / has to be good, right?
• D) Beans. Beans. They make you / smart. The more you eat. The more / you … uh … umm … like art.

10. Your favorite food book is:

• A) Anything by Michael Pollan. In fact? Yesterday, you snuck into his office at UC Berkeley, stole his diary, and were startled to discover it reads exactly like the script for Taxi Driver.
• B) Kitchen Confidential. It inspired you to quit your job, start washing dishes for Babbo, and buy a Ramones box set.
• C) Cloudy With a Chance of Meatballs. They’re meatballs! But they’re also rain! From the sky! Yay!
• D) Me no read book. Me eat book. Book good. Book have fiber. Book make butt feel good.

KEY

If you answered mostly A, you should start your own food and frugality blog. Your favorite activities include calculating unit costs and taking landscape photographs of the Whole Foods bulk section. Your coupon organizational skills would put Encyclopedia Britannica to shame. It’s entirely possible you spent your formative years hidden in a cupboard in America’s Test Kitchen. You are most likely a chef, a mother of ten working off a $13/week budget, or Christopher Kimball.

If you answered mostly B, you should continue reading Cheap Healthy Good. While you enjoy a fulfilling life packed with engaging activities, you occasionally spend an hour contemplating the financial and flavor advantages of cremini over button mushrooms. Your worst enemies are jarred garlic, bottled water, and late-era Paula Deen (though you would still like to visit her at Christmas). You have used your food savings to pay your mortgage. You are most likely a single person in an urban area, a married person in a rural or suburban area, Johnny Depp, or my friend M.

If you answered mostly C, you should start reading Cheap Healthy Good. When it comes to feeding yourself, you have the best of intentions, but they’re often usurped by insatiable cravings for Lunchables. In a mental smackdown between convenience and frugality/health, the former leaves the latter naked and bleeding in a sewer grate. You are most likely a college intern, somebody on Glee, or my brother.

If you answered mostly D, you are obviously in the wrong place. It’s entirely possible you were searching for Cheap Healthy Dudes or Keep Wealthy Moods or something similar. You are most likely a poor speller, a third grader, or a tad unsavory.

Thats it, sweet readers. Thanks for playing, and stick around for Wheel of Fortune!

~~~

If you enjoyed this post, you might also dig:

• 2 Oatmeal Recipes: 1 Sweet, 1 Savory (Plus, a Quiz!)
• Brunch Clafouti: The Pop Quiz
• The SATs of Cranberry Zinger Muffins

(Photo from DK Presents.)

While the Governors Mansion in Pennsylvania is currently under the control of the Republicans, the Disease Management Care Blog knows the states Insurance Department is relatively apolitical. Thats why this September statement by Pennsylvania Commissioner Consedine before the U.S. House Ways and Means Subcommittee on Health is quite telling. 

In it, Mr. Consedine describes how the Keystone state is encountering difficulties implementing an health insurance exchange. As DMCB readers will recall, exchanges are a key feature of the Affordable Care Act, because theyll provide an online market that will enable individuals to obtain coverage.

According to Mr Consedine, CMS is failing to support a good law with the many regulatory details that turn a vague idea into a functioning reality. These failings include:

1. "Interim," not "final" rules on eligibility, tax credit calculations, cost sharing and the role of brokers

2. Little formal guidance on the determination of the essential health benefit.

3. Delays in issuance of regulations on how states and Uncle Sam will split or mutually indemnify the myriad costs of the exchange and the Federal Data Hub.

4. Delays in the issuance of regulations on how states can exit a federally run exchange to set up one of their own.

5. Lack of clarification of CMS impact on insurance markets operating outside the exchanges.

6. Little understanding of whos in charge of consumer protection statutes.

7. Confusion over reconciliation of multiple states insurance laws and regulations in multi-state exchanges.

8. No guidance on how to roll long-extablished and well functioning state-subsidized insurance programs into the exchanges.

9. Concern that funding of the information technology could be clawed back if Medicaid eligibility does not meet CMS criteria.

10. Little guidance on whether exchanges will need to provide consumers with a list of providers who are accepting new patients.

The concerns are also damning in the context of the the normal tug of war between the states and Washington DC. Thats because in his testimony, Mr. Consedine states he wrote to HHS weeks ago and has not received a reply.  While its not unusual for the Feds to stiff politically inconvenient inquiries, the Disease Management Care Blog is fearful that the reason why HHS seems unwilling to provide a timely reply is because it doesnt know the answers.

If Pennsylvanias experience is typical, that means the roll out of the exchanges could be significantly delayed.

You read it here first.

9/26/12 Update: Senator Hatch agrees with the DMCB