Health for life

Consumption of whole walnuts or their extracted oil can reduce cardiovascular risk through a mechanism other than simply lowering cholesterol, according to a team of Penn State, Tufts University and University of Pennsylvania researchers.

"We already know that eating walnuts in a heart-healthy diet can lower blood cholesterol levels," said Penny Kris-Etherton, Distinguished Professor of Nutrition, Penn State. "But, until now, we did not know what component of the walnut was providing this benefit. Now we understand additional ways in which whole walnuts and their oil components can improve heart health."

In a randomized-controlled trial, the researchers gave 15 participants with elevated blood cholesterol one of four treatments -- either 85 grams of whole walnuts, 6 grams of skin, 34 grams of defatted nutmeat, or 51 grams of oil. The team evaluated biochemical and physiological responses in the participants before the treatments were administered and again 30 minutes, one hour, two hours, four hours and six hours after administering the treatments. The researchers repeated this process for each of the remaining three treatments.

Results -- which will appear in the June 1 issue of the Journal of Nutrition and are now online -- showed that a one-time consumption of the oil component in walnuts favorably affected vascular health. In addition, consumption of whole walnuts helped HDL -- good cholesterol -- perform more effectively in transporting and removing excess cholesterol from the body.

"Our study showed that the oil found in walnuts can maintain blood vessel function after a meal, which is very important given that blood vessel integrity is often compromised in individuals with cardiovascular disease," said Claire Berryman, graduate student in nutritional sciences, Penn State. "The walnut oil was particularly good at preserving the function of endothelial cells, which play an important role in cardiovascular health."

According to the researchers, walnuts contain alpha-linolenic acid, gamma-tocopherol and phytosterols, which may explain the positive effects of the walnut oil treatment.

"Implications of this finding could mean improved dietary strategies to fight heart disease," said Berryman. "The science around HDL functionality is very new, so to see improvements in this outcome with the consumption of whole walnuts is promising and worth investigating further."

Further studies are needed to determine the mechanisms that account for cardiovascular disease risk reduction with walnut consumption, according to Kris-Etherton.

"Our study indicates that simple dietary changes, such as incorporating walnuts and/or their oil in a heart healthy diet, may reduce the risk of heart disease," she said.

Talk about a compelling story that went ignored.
In the November 19 issue of the Annals of Internal Medicine, Caroline Lubick Goldzweig and colleagues examined the published science on the purported advantages of electronic health record (EHR) portals.

Recall that portals are web-based entryways that on-line health consumers can reportedly use to access their records, request medications, correspond with their doctors, manage their health conditions, reduce health care costs, increase U.S. life expectancy, reduce our national dependency on jumbo-sized sugary drinks and fix everything else that ails the U.S. health system.

Unfortunately, facts have intruded.  After looking at fourteen randomized prospective trials, 21 observational, hypothesis-testing studies, five descriptive studies and six qualitative studies, the authors concluded...

 "...evidence that patient portals improve health outcomes, cost, or utilization is insufficient."

Ouch. 

In particular, any impact on diabetes care was short-lived or nonexistent, patients with heart failure had no meaningful improvement, blood pressure control did not improve and adherence to prevention recommendations were marginal.  One observational study found persons with heart failure were more likely to use the emergency room.  The only study that found any benefit involved a single randomized control trial that examined the impact of portals in the co-management of depression.

After looking at this review, depressed advocates of EHR portals may have to personally use their own portals to communicate with their docs health care medical neighborhood.

The only good news is that there were some data that suggested that a substantial number of consumers liked using the portals.  But the DMCB likes channel surfing too, but that doesnt mean that the spouse agrees that its television-watching quality has improved or that the cost of all those premium channels is moderating.

The authors pointed out that it was difficult to isolate the impact of a portal vs. a portal plus care management.  To the DMCB, that means that portals are at best a means-to-an-end of enabling care managers to better communicate with their enrollees. 

To the thousands of DMCB readers, that is not a surprise.

In the meantime, the Feds and the NCQA have one more reason to re-examine their many cherished assumptions about health information technology and the stand-alone electronic record. The last time the DMCB looked, the federal government continues to extoll portals stand-alone virtues. The National Committee on Quality Assurance (NCQA) still includes two way communication for appointments, errals and prescription errals as a standard for the medical home.  Finally, the Feds promotion of the electronic health record (EHR) approves of portals as an option in meeting meaningful use criteria.

Image from Wikipedia

Swedish researchers at the Sahlgrenska Academy, University of Gothenburg, Sweden, report that a simple habit may give significant protection against allergy development, namely, the parental sucking on the babys pacifier.

Allergies are very common in industrialized countries. It has been suggested that exposure to harmless bacteria during infancy may be protective against the development of allergy. However, it has been difficult to pinpoint which bacteria a baby should be exposed to, and at what time and by which route this exposure should ideally occur.

Swedish researchers at the Sahlgrenska Academy, University of Gothenburg, now report that a simple habit may give significant protection against allergy development, namely, the parental sucking on the babys pacifier.

In a group of 184 children, who were followed from birth, the researchers registered how many infants used a pacifier in the first 6 months of life and how the parents cleaned the pacifier. Most parents rinsed the pacifier in tap water before giving it to the baby, e.g., after it had fallen on the floor. However, some parents also boiled the pacifier to clean it. Yet other parents had the habit of putting the babys pacifier into their mouth and cleaning it by sucking, before returning it to the baby.

It was found that children whose parents habitually sucked the pacifier were three times less likely to suffer from eczema at 1.5 years of age, as compared with the children of parents who did not do this. When controlled for other factors that could affect the risk of developing allergy, such as allergy in the parents and delivery by Caesarean section, the beneficial effect of parental sucking on the pacifier remained.

Pacifier use per se had no effect on allergy development in the child. Boiling the pacifier also did not affect allergy development in a statistically proven fashion.

No more upper respiratory infections were seen in the children whose parents sucked on their dummies, as compared with the other children, as evidenced by diaries kept by the parents in which they noted significant events, such as infections.

Saliva is a very rich source of bacteria and viruses, and the researchers believe that oral commensal microbes are transferred from parent to infant when they suck on the same pacifier. When the composition of the bacterial flora in the mouth was compared between infants whose parents sucked on their pacifiers and those whose parent did not, it was found to differ, supporting this hypothesis.

According to "the hygiene hypothesis", the development of allergy can be attributed in part to a paucity of microbial stimulation during early infancy.

"Early establishment of a complex oral microflora might promote healthy maturation of the immune system, thereby counteracting allergy development", says professor Agnes Wold who led the study.

The study, which is published in the scientific journal Pediatrics, was performed by a team that consisted of paediatricians specialized in allergic diseases, as well as microbiologists and immunologists. The research team has previously conducted large-scale studies on the gut microbiota in relation to allergy development and showed in 2009 that a complex gut microbiota very early in life reduces the risk of allergy development.