Beauty Health for Life

Health conscious individuals have been closely following Vitamin D research for the past decade as volumes of scientific evidence prove this prohormone has been selected through our evolution to provide critical protection against many inflammatory and immune mediated diseases.

"Should I er out of network?"

What is the secret health orm sauce of those famous large integrated medical groups?  Come to think of it, do they even have secret sauce?

To better understand the apparent success of household names like Dean, Geisinger, Group Health, and Mayo, Rob Mechanic and Darren Zinner surveyed and then interviewed the CEO or the Chief Medical Officer (CMO) of 21 famous large provider groups to understand their operational approach to risk based contracting.
 
Thats important because emerging payment public and private insurer orm will include "bundled payments," upside risk-sharing and forms of capitation.  In these kinds of arrangements, the financial "risk" from high overhead, overutilization or excess costs will be the provider groups problem, not the insurers.

In other words, if ACO wannabes want to succeed when it comes to risk-based contracting, they may learn about the good and the bad of the large integrated group business model.

The authors discovered that about half of these groups had less than a third of their income coming from risk-based contracting (RBC).  In these ten groups, an average 88% of income was fee-for-service.

The other half (eleven) had more than a third of their income coming from risk based contracting.  In these groups, 71% of income was risk-based.

The authors then compared the approaches of the "low" risk and "high" risk groups.

While Disease Management Care Blog readers will be very familiar with elements making up the "good" secret sauce of risk-based contracting, they may be surprised at the reemergence of two bad downsides.

The good ingredients included 1) blunted physician financial incentives to "churn" patient visits, 2) a slight but significant increased emphasis on using quality measures to reward physicians and 3) a significant investment in data warehousing, analytics, patient registries and point-of-care patient-tracking.

In particular:

9 out of 10 low risk contracting groups based the "majority" of physician income on productivity. In contrast, five of the capitated groups paid 80% of their PCPs with a salary, while the other half paid 80% of income based on productivity

"Quality" measures drove a small percent of PCP income in both groups, though it was higher in the capitated groups (5% vs. 12%)

85% of all groups had invested in electronic health records; 100% of the capitated groups had invested in data warehouses with analytic software and two thirds had patient registries.  Only one of the FFS groups had those capabilities. While both types of groups had a low rate of "patient engagement" programs, the high risk groups were more likely to have care management programs in place. 

And the bad? 

The DMCB was surprised to read that the risk-based groups were far more likely to have mechanisms in place to limit their patients out of network utilization (90 vs. 20%) and 2/3 vs. 1/3 had perred relationships with "efficient" hospitals and providers.  In other words, these role-model and state-of-the-art organizations could be limiting patient choice and economically credentialing their provider groups.

Much depends on the details.  Insurers have probably not forgotten the abuses and resulting backlash that arose from unfettered capitation.  Good risk contracting typically includes quality and satisfaction metrics side by side with utilization targets and specifically prohibits windfall profits. Modern consumer protections at the state and federal oversight level are also far more rigorous.

That being said, the DMCB points out that its no accident that this study shows risk-based contracting is associated with limits on choice and restricted networks.  We may not call it "managed care," but in many respects it is.

Sweet readers!

The response to yesterdays Call for Guest Posts, er, post has been really wonderful. There are a ton of great ideas, and its going to take a little while to wade through all of them, but I cant wait to read the finished pieces. I think well have more than enough content moving forward.

Thank you so much.

Veggie Might coming soon!

Osteoarthritis (a.k.a "degenerative arthritis) of the hip and knee just... sucks. Characterized by activity-related pain in the affected joint, many otherwise physically fit persons have to resort to pills, injections and, finally, an appointment with an orthopedic surgeon to talk about joint replacement surgery.

What is less appreciated is that osteoarthritis can have a waxing and waning course with periods of relative remissions. Whats more, conservative treatment options can lessen or delay the need for surgery. Last but not least, the surgery itself involves months of recovery and the possibility of a nasty complication.

The primary care physician Disease Management Care Blog presided over this many times with its arthritis patients.  It was generally reluctant to er a patient to an orthopedic surgeon because it knew that the patients would be more interested in the potential benefits and pay less attention to the downsides of surgery.

Enter shared decision making (SDM). Defined as care that is respectful of and responsive to individual patient perences, needs, and values and ensures that patient values guide all clinical decisions, the premise is that by giving patients the information they need, theyll be able to ultimately determine the course of their care.  That would include patients with severe hip or knee osteoarthritis who are thinking about surgery but who also need to consider the option of conservative management.

Thats why this just-published Health Affairs study is noteworthy. All the 27 orthopedic surgeons in the 5 Group Health Cooperative clinics introduced shared decision making (SDM) for patients who were being evaluated with knee or hip osteoarthritis.  The intervention consisted of DVDs and booklets (from this company) that were ordered by the surgeon prior to an appointment.  The materials could also be viewed on Group Healths website at any time.

The study itself was quasi-experimental.  To be included in the study, patients had to 1) have knee or hip arthritis, 2) ) be continuously enrolled in the Group Health Plan for 12 months prior to the orthopedic clinic visit and 3) have a visit itself that was first index visit by the patient for that problem being evaluated by that particular specialty.

Outcomes from the 18 months of the SDM intervention period (January 2009 through July of 2010) were compared to the observation period of January 2007 through July of 2008.

Recall that the surgeon had to proactively order the SDM prior to the visit.  As a result, only 41% of the hip patients and 28% of the knee patients received the DVD, pamphlet or viewed the on-line materials.
 
Nonetheless, during the 6 months after the initial visit, the SDM patient population had 0.34 hip operations per 180 person-days (your DMCB offers an explanation of this counter-intuitive metric below*), compared to the control population of 0.46.  The difference was statistically significant. 

There was also a statistically significant reduction in knee operations: 0.09 per 180 person-days vs 0.16 per 180 person-days. 

All the differences held up after the authors statistically adjusted for differences in age, sex, obesity, co-morbid conditions, use of prior x-rays, joint injections, insurance factors and the clinic site.

Like all good authors writing in a high quality journal, they point out that this research was not pristine. The comparison period may not have been a representative baseline and, from 2008 to 2009, other factors may have caused a drop in hip and knee surgeries.

Nonetheless, this is an example of a "real world" study that credibly demonstrates that when osteoarthritis patients are exposed to SDM, more will opt for conservative management.  While that helps decrease health care utilization and ultimately costs, thats not the most important point: the patients who really wanted surgery got it and the patients who were less sure about the benefits of surgery chose not to have it.  Whats more, this didnt involve a lot of expensive face-to-face care management, it involved some DVDs.

The DMCB cautions that this successful study was carried out in a highly integrated delivery system and may not be transferable to other practice settings.  That being said, as Accountable Care Organizations struggle to meet their patients expectations and save money, this application of SDM may represent an important option.

*The DMCB interprets "180 patient days" as one patient being followed for the entire 6 months of the study.  If thats correct, the average SDM knee patient erred to a Group Health orthopedist had a 34% chance of getting surgery versus a 46% chance in the prior control group.  For the knee patients, it was 9% vs. 16%

BYETTA, the new injectable drug from Amylin and Lilly, popularly know for being derived from the venom of the Gila monster (a large, slow-moving orange and black lizard that inhabits the deserts of southwestern US and northwestern Mexico) hits drug stores today. Available by prescription.

________
For an overview of the drug:
FDA Approves of BYETTA™ (Exenatide) Injection for Type 2 Diabetes

Photo thanks to Indianapolis Zoo.

Yesterday i was eagerly waiting to see our this months South vs North Challenge an event owned by Divya Pramil, unfortunately we the South Indian Team came to know about our challenge very late in nite. Eventhough before leaving to bed, i checked the recipe and its our family favourite Falooda, this drink is in my  to do list since ages, but somehow i couldnt able to make them earlier. This time how can i skip this drink, whenever we go to Indian restaurant, my daughter will definitely order this chilled and sweet beverage and we love to have a sip from hers. Everytime she yells on us for finishing wat she ordered but who cares and everytime we do the same. Obviously when i prepared her favourite drink at home, she had this drink after her lunch and enjoyed finally a tall glass of this falooda completely by herself.

Do you know Falooda or Faluda is a cold and sweet beverage containing many ingredients which is very popular in South Asia. Traditionally it is made by mixing rose syrup with vermicelli, basil (sabza/takmaria) seeds, jelly pieces and tapioca pearls along with either milk or icecream.Falooda vermicelli are often made from arrowroot rather than wheat. The rose syrup may be substituted with another flavoured base like mango,chocolate, saffron or else with any other fruit syrup but my choice is always rose syrup.Nowadays faluda is a popular summer drink throughout Pakistan, India, Bangladesh, Sri Lanka, Myanmar, and the Middle East and is readily available in restaurants and beach stalls.Thanks to this months North team Minnie of The Lady8home for challenging the South team (which i belongs) with this incredible beverage while Vijayalakshmi of our South team challenged the opposite North team with Ellu Poorna Kuzhakattai, a must for the upcoming Ganesh chathurthi in every South Indians home.Minnie suggested us two versions of falooda one with icecream and second one with malai kulfi, somehow i went for the icecream one.



2cups Chilled milk
1cup Milk (warm milk)
1/2tsp Saffron
2tbsp Rose water
5nos Almonds (sliced)
15nos Pistachios (sliced)
1tbsp Chironji/Charoli
Few Cashew (chopped)
4tbsp Rose Sryup
 A Handful of Falooda noodles
3Cups Water (for cooking the noodles)
1/2cup Basil seeds
Few scoops Vanilla icecream or Malai Kulfi

Add the rose syrup to the chilled milk and place it in fridge.

Meanwhile soak the basil seeds in a cup of water, it will take an hour to plump.

In a cup of warm milk,soak the saffron,rose water,cover and keep it in fridge for an hour.

Boil the noodles in 3cups water until soft, drain the water.

Now immerse the noodles in saffron soaked milk and place it in fridge until assembling.


To Assemble:
In  two tall glasses, drop the 3/4 of chilled noodles with quarter cup of saffon milk.

Top it with 2tablespoons of basil seeds.

Pour in the chilled rose syrup into the glass.

Top it again with two scoops of vanilla icecream.

Now pour in the remaining saffron milk and rest of the noodles.

Garnish it with the choped nuts.

If you want more sweet, drizzle a little more rose syrup.

Ive got another fun find from the farmers market this week: callaloo. Im a sucker for leafy greens‚ especially one Ive never tried before.

Turns out Id had callaloo before; also known as amaranth greens, which Ive received in CSA shares past, callaloo is a Caribbean green similar in taste to and a tad heartier than spinach. Once you rinse away the dirt and cast off the stems, the deep green leaves are ready for any recipe that calls for leafy greens.

Since I spent the last month away from my stove, I was inspired to dig out an old favorite cookbook and fire up the hot box. I found the perfect recipe: Jamaican Cook-up Rice from Jay Solomons The Global Vegetarian. It combines traditional Caribbean flavors and whatever you’ve got hanging around your kitchen into a one-pot wonder.

I added some roasted tofu with a simple marinade to the party. If you want to keep things simple and all-in-one pot‚ stick with Solomons protein of choice: red beans or pigeon peas. And you can use any vegetables you like too; choose your own root veg, greens, and/or sub the eggplant with summer squash or zucchini.

CB, my cutie pal JBF, and I loved it. Rice, vegetables, and warm spices make this dish a perfect, stick-with-you lunch or supper. And it goes great alongside corn-on-the-cob thats perfectly in season.

Have you tried callaloo before? Whats your favorite leafy green? Spill in the comments! I could talk about greens all day.

~~~

If you dig this recipe, you may fancy

• Tunisian-style Beans and Greens
• Gumbo Zherbes
• Pasta with Nettles, Sorrel, and Lemon

~~~

Jamaican Cook-up Rice with Callaloo and Roasted Tofu
Makes 5 servings.
Adapted from The Global Vegetarian by Jay Solomon


1 tbsp canola oil
1 medium white onion, diced
1 medium green bell pepper, diced
6 small Japanese eggplants (about 12 oz), diced
1 habanero pepper, seeded and minced
2 cups vegetable stock
1 cup almond milk
1 cup brown rice
2 cups carrots, diced
1/4 cup fresh parsley, chopped
2 tsp fresh thyme, minced
1 tsp dried allspice
2 tsp salt
6 cups callaloo greens or spinach, torn

Caribbean Roasted Tofu
14 oz roasted tofu, cubed
2 tsp fresh thyme, minced
1 tsp dried allspice
1 tsp salt
black pepper to taste
1 tbsp lime juice
2 tsp canola oil

1) Preheat oven to 400F. Combine 2 tsp fresh thyme, 1 tsp allspice, salt, pepper, lime juice, and canola oil in a medium mixing bowl.

2) Toss cubed tofu in marinade until coated.

3) Spread evenly over baking sheet.

4) Bake for 30 minutes, stirring once.

5) In a large saucepan or stewpot, heat oil over medium heat. Combine onion, green and habanero peppers, and eggplant in pot and sauté for 7 minutes or until soft.

6) Add liquids (almond milk and veggie stock), rice, carrots, and spices. Cover and simmer over medium-low heat for 20 minutes or until rice is cooked through and liquid is absorbed, stirring occassionally. Add water as necessary to keep rice from sticking to the pot.

7) Stir in greens and tofu (or beans), and cook until greens are wilted. Serve warm with corn-on-the-cob.

8) Rejoice.

Approximate Calories, Fat, Fiber, Protein, and Price per Serving
348.4 calories, 8.9g fat, 13.6g fiber, 27.25g protein, $1.61

Calculations
Jamaican Cook-up Rice
1 tbsp canola oil: 120 calories, 14g fat, 0g fiber, 0g protein, $0.08
1 medium white onion: 40 calories, 0.2g fat, 0g fiber, 0g protein, $0.50
1 medium green bell pepper: 33 calories, 0g fat, 3g fiber, 1g protein, $0.49
12 oz Japanese eggplants: 79.5 calories, 0.75g fat, 11.25g fiber, 3.75g protein, $1.50
1 habanero pepper: 2.75 calories, 0g fat, 0g fiber, 0.25g protein, $0.12
2 cups vegetable stock: 40 calories, 0.2g fat, 0g fiber, 0g protein, $0.38
1 cup almond milk: 40 calories, 3g fat, 1g fiber, 1g protein, $0.50
1 cup brown rice: 720 calories, 6g fat, 12g fiber, 12g protein, $0.76
2 cups carrots: 100 calories, 0g fat, 8g fiber, 4g protein, $0.64
1/4 cup fresh parsley: 5.2 calories, 0g fat, 0g fiber, 0g protein, $0.28
2 tsp fresh thyme: 2 calories, 0g fat, 0g fiber, 0g protein, $0.08
1 tsp dried allspice: negligible calories, fat, fiber, protein, $0.02
2 tsp salt: negligible calories, fat, fiber, protein, $0.02
6 cups callaloo: 36 calories, 0g fat, 4.5g fiber, 2.25g protein, $1.50

Caribbean Roasted Tofu
14 oz tofu: 437.5 calories, 22.4g fat, 28g fiber, 112g protein, $0.98
2 tsp fresh thyme: 2 calories, 0g fat, 0g fiber, 0g protein, $0.08
1 tsp dried allspice: negligible calories, fat, fiber, protein, $0.02
1 tbsp lime juice: 4.75 calories, 0.02g fat, 0g fiber, 0g protein, $0.05
2 tsp canola oil: 79.2 calories, 9.2g fat, 0g fiber, 0g protein, $0.05
1 tsp salt: negligible calories, fat, fiber, protein, $0.02
Totals: 1741.9 calories, 44.57g fat, 67.75g fiber, 136.25g protein, $8.07
Per serving: 348.4 calories, 8.9g fat, 13.6g fiber, 27.25g protein, $1.61

Earlier this year, a study in the American Heart Associations journal Circulation reported an increased risk of heart attack with use of nonsteroidal anti-inflammatory drugs (NSAIDs) in healthy individuals (over 1 million individuals included in the analysis).¹ It wasnt the first study to find this risk with NSAIDS; however, prior studies looked at those who had heart disease or were at increased risk for it, not apparently healthy people.

Last month at the European Society of Cardiologys 2010 Congress, the same authors reported an increased risk for stroke with use of NSAIDS in a similar large and healthy Danish population. Speaking to Heartwire, Dr. Gunnar Gislason, one of the authors said:

"This is very serious, as these drugs are very widely used, with many available over the counter. ... We need to get the message out to healthcare authorities that these drugs need to be regulated more caully."

Gislason thinks NSAIDS need better management, perring they not be available without a prescription:

"If half the population takes these drugs, even on an occasional basis, then this could be responsible for a 50% to 100% increase in stroke risk. It is an enormous effect."

Examples of NSAIDS currently available in the US without prescription are ibuprofen (e.g. Motrin and Advil) and naproxen (Aleve). Diclofenac (e.g. Voltaren and Cataflam), celecoxib (Celebrex), and rofecoxib (Vioxx, now withdrawn) are NSAIDS that require a prescription.

Mechanism

NSAIDS are thought to increase cardiovascular and cerebrovascular risk via:

• Increased coagulative effect, with risk of thrombus.
  
• Increased bleeding, especially associated with stroke.
  
• Increased blood pressure. (This is an effect of all NSAIDS.)²
  
• Adverse effects on kidneys. (NSAIDS can lead to sodium and water retention, and a decrease in glomerular filtration rate (GFR).)³

Sometimes benefit outweighs risk. NSAIDS are effective pain relievers. The decision to start NSAIDs should be based on an individuals cardiovascular risk and the specific need for pain relief.
________
¹ Cause-Specific Cardiovascular Risk Associated With Nonsteroidal Antiinflammatory Drugs Among Healthy Individuals, Circulation, 2010
² NSAIDs, Coxibs, and Cardio-Renal Physiology: A Mechanism-Based Evaluation: Coxibs and Hypertension, Medscape, 2002
³ Renal Effects Of Cyclooxygyenase-2-Selective Inhibitors, Journal of Pain and Symptom Management, 2002

"[NSAIDS] are associated with adverse renal effects caused by the reduction in synthesis of renal prostaglandins through inhibition of cyclooxygenase (COX)."

Calcium or combination supplement reduces osteoporosis risk

While calcium supplements noticeably improved bone health in postmenopausal women, vitamin D supplements did not reduce bone turnover, according to a recent study accepted for publication in The Endocrine Societys Journal of Clinical Endocrinology & Metabolism (JCEM).

Bone turnover is the bodys natural process for breaking down old bone. In young people, the body forms enough new bone to replace what is lost. After age 30, however, bone mass in women begins to decline and the process speeds up after menopause. Osteoporosis develops when the body cannot replace bone as fast as it is broken down.

"Vitamin D and calcium interact to suppress bone turnover by decreasing parathyroid hormone levels," said the studys lead author, John Aloia, MD, of Winthrop University Hospital in Mineola, NY. "This can be beneficial in women who are vitamin D deficient. In women who already are receiving the recommended daily allowance of vitamin D, however, the study found there was no advantage to adding a vitamin D supplement."

The double-blind, placebo-controlled, parallel group, longitudinal factorial design study divided 159 postmenopausal women into four groups. One group received a combination of vitamin D and calcium, one was given 1,200 milligrams of calcium daily, one took 4,000 IU of vitamin D daily and the last group received placebos. To measure the effect supplements had on bone health, researchers measured bone turnover markers, such as parathyroid hormone levels in the blood, over the course of six months. In all, 120 women completed the study.

Researchers found a significant decline in bone turnover markers among women who were given daily calcium supplements. The vitamin D supplements did not have any effect on bone turnover markers, although the supplements did decrease parathyroid hormone levels.

"These findings suggest that vitamin D supplements over the recommended dietary allowance (RDA) do not protect bone health, whereas calcium supplements do have an effect," Aloia said. "Women do need to be cautious about the possibility of vascular side effects from too much calcium and should consult their physicians about whether their diet is adequate or whether they should take supplements at all."

University of Illinois scientists have evidence that lifelong exposure to genistein, a bioactive component in soy foods, protects against colon cancer by repressing a signal that leads to accelerated growth of cells, polyps, and eventually malignant tumors.

"In our study, we report a change in the expression of three genes that control an important signaling pathway," said Hong Chen, a U of I professor of food science and human nutrition.

The cells in the lining of the human gut turn over and are completely replaced weekly, she noted. "However, in 90 percent of colon cancer patients, an important growth-promoting signal is always on, leading to uncontrolled growth and malignancies. Our study suggests that the aberrant Wnt signaling during the development of colon cancer can be regulated by soy-rich diets."

"The good news is that a diet rich in soy genistein represses those signals through epigenetic modifications at the regulatory regions of those genes," said Yukun Zhang, a doctoral student in Chens laboratory.

Nice medical home laptop, but how do I feel about it?

Over the years, the Disease Management Care Blog has repeatedly reminded the spouse of her particularly good fortune in marriage. Her lingering skepticism, however, has prompted the DMCB to amass further evidence of her marital bliss by

a) asking other spouses in similar relationships if they feel as fortunate and, if so,

b) collecting data about the DMCB-like personality traits in their husbands.

Bonhomie? Check.

Willingness to share the TV remote? Check.

Cooking the occasional meal at great personal sacrifice? Check.

Announcing how good that meal is? Check.

Yet, when confronted with the indisputable statistical associations that correlate nuptial happiness and DMCB"ness," the spouse has remained stubbornly unmoved. At the spouses pointed request, the DMCB is rechecking the math.

Readers will probably also remain unmoved about this publication that uses a similar approach to examining the impact of the Patient Centered Medical Home (PCMH) on clinic staff morale, satisfaction and burnout. Sara Lewis and colleagues surveyed the staff of 65 "safety net" clinics participating in a "5 Year Safety Net Medical Home Initiative" that had been co-funded by the Commonwealth Fund.

At the time of the survey, the 65 clinics were in the process of implementing becoming PCMHs but had not yet attained that status. The authors used a Likert-style survey to assess PCMH-"like" attributes among these non-PCMH clinics, such as patient access, data tracking, care management and quality improvement.  The survey also asked about staff morale, satisfaction and burnout.  The authors then correlated whether individual scores or a total roll-up score of all the PCMH-like attributes correlated with better clinic morale, higher satisfaction and less burn out.

There were 773 providers and staff members and 603 (78%) responded. 33% rated morale as good, 54% rated job satisfaction as very good and 40% had some burnout.  Based on an analysis of odds ratios, some features of a PCMH - particularly quality improvement - resulted in up to a three fold improvement in the three measures. However, while the total PCMH score was associated with better morale, it looked like there was also a greater association with worse burn-out, which had a statistically significant lower odds ratio of .48.

The DMCB finds these up and down results about the PCMH in nonPCMH clinics unconvincing.  It believes the attributes of a PCMH, if carried out as envisioned, should add up to more than the sum of its parts.  While some of the parts that are outside of a medical home seem, according to this paper, to correlate with morale, satisfaction and burnout, this gives little insight on how medical staff would really react to the transformation of a primary care clinic.  By the way, this is not the first time a PCMH-"like: methodology has been used, which makes the DMCB wonder if fully functioning PCMHs are less common than we think.

What is striking, however, are the basic measures of morale, stress and burnout. Based on these data, it would appear that these safety net clinics have some serious staff issues with 67% not having good morale, 46% not having good job satisfaction and just under half having burn out.

More evidence of primary cares travails says the DMCB.

The good news is that the DMCB remains optimistic that the math will eventually bring the DMCB spouse around.  Maybe the enthusiasm - and the math - about the PCMH will similarly prevail someday.  Until then, this papers approach doesnt lend much insight about the real potential of the PCMH. Last but not least, if these 65 clinics are representative of primary care morale, satisfaction and burnout in general, the DMCB far less optimistic about their future with or without the PCMH.

Google last week debuted a new project called Knol, a term Google defines as "unit of knowledge". It is a collection of web pages, or articles, on specific topics. There are just a few hundred Knols so far, but they include a couple on diabetes that are worth a visit:

Type 1 Diabetes

Type 2 Diabetes

Anyone may write a Knol. These particular two were written by Anne Peters MD, FACP, CDE, a diabetologist and director of the USC Clinical Diabetes Programs in Los Angeles, CA.

Anyone may rate, comment on, or suggest edits to Knols, too. So, stop by. Maybe theres something youd like to contribute.
________

The chip is programmed to open security doors to his lab - and ensure only he is able to switch on and use his mobile phone.
But Dr Gasson deliberately infected the chip with a computer virus, which was then automatically transmitted to the lab security system.
"Once the system is infected, anybody accessing the building with their passcard would be infected too," he told Sky News.
The virus on his chip is benign. But malicious computer code could give criminals access to a building.
Dr Gasson says his experiment also exposes the vulnerability of chips now routinely implanted in patients.

Heart pacemakers contain mini-computers that control the heartbeat, and communicate with doctors via a special reader held against the skin.
But if a virus was transmitted to the device which stopped it working properly, the consequences for the patient could be fatal.
"The devices will have to start to use security encryption," said Dr Gasson.
"Medical devices should have some kind of password protection as well. Theyre basic security precautions. Its surprising these devices dont have them already."

According to the World Health Organization (WHO), 63 percent of the deaths that occurred in 2008 were attributed to non-communicable chronic diseases such as cardiovascular disease, certain cancers, Type 2 diabetes and obesity—for which poor diets are contributing factors. Yet people that live in societies that eat healthy, plant-based diets rarely fall victim to these ailments. Research studies have long indicated that a high consumption of plant foods is associated with lower incidents of chronic disease. In an article entitled The Chronic Disease Food Remedy in the October issue of Food Technology magazine, Senior Writer/Editor Toni Tarver discusses recent discoveries in nutritional genomics that explain how plant-based diets are effective at warding off disease.

The article indicates that bioactive compounds in plant foods play a role in controlling genetic and other biological factors that lead to chronic disease. For example, antioxidants in plant foods counter free radicals that can cause chronic inflammation and damage cells. And other plant compounds help control a gene linked to cardiovascular disease and plaque buildup in arteries and the genes and other cellular components responsible for forming and sustaining tumors.

William W. Li, M.D., President and Medical Director of the Angiogenesis Foundation in Cambridge, Mass., says that all consumers should look at their diets as if food is the medicine necessary to maintain healthy, disease-free lives. “Prevention is always better than a cure,” said Li. Foods that may help prevent cancer and other chronic diseases include artichokes, black pepper, cinnamon, garlic, lentils, olives, pumpkin, rosemary, thyme, watercress, and more. For a more comprehensive list of medicinal foods, read “The Chronic Disease Food Remedy” in the October 2012 issue of Food Technology.

Having diabetes disposes you to a unique set of periodic check-ups, e.g. foot exams and kidney tests. (See Mark It On Your Calendar).

Yet even if you dont have diabetes there are several screenings that health professionals recommend we all get as we age.

The US Dept. of Health and Human Services lists the following guidelines for men and women at average risk for most diseases:

Womens Screenings:
Screening Tests and Immunizations Guidelines for Women

Mens Screenings:
Screening Tests and Immunizations Guidelines for Men

If youre over 45 and never been diagnosed with diabetes, its advisable to get your blood sugar checked at least every 3 years, or more frequently if any of the following conditions apply:

• Youre overweight.
  
• You have a family history of diabetes.
  
• You live a sedentary lifestyle.
  
• You have a history of gestational diabetes.
  
• Youve been diagnosed with high blood pressure.
  
• Youre a member of one of these ethnic groups: Hispanic/Latino, Native American, African American, Asian American, Pacific Islander.
  
• You have any of these symptoms:
  • Frequent urination
    
  • Excessive thirst
    
  • Unusual hunger
    
  • Fatigue
    
  • Unexplained weight loss
    
  • Blurry vision
    
  • Poor healing of wounds

Scientists reported new evidence today that a component of egg whites — already popular as a substitute for whole eggs among health-conscious consumers concerned about cholesterol in the yolk — may have another beneficial effect in reducing blood pressure. Their study was part of the 245th National Meeting & Exposition of the American Chemical Society (ACS), the worlds largest scientific society, which continues here through Thursday.

"Our research suggests that there may be another reason to call it the incredible, edible egg," said study leader Zhipeng Yu, Ph.D., of Jilin University. "We have evidence from the laboratory that a substance in egg white — its a peptide, one of the building blocks of proteins — reduces blood pressure about as much as a low dose of Captopril, a high-blood-pressure drug."

Yu and colleagues, who are with Clemson University, used a peptide called RVPSL. Scientists previously discovered that the substance, like the family of medications that includes Captopril, Vasotec and Monopril, was an angiotensin-converting-enzyme (ACE) inhibitor. It has a powerful ability to inhibit or block the action of ACE, a substance produced in the body that raises blood pressure.

They set out to further document RVPSLs effects, using laboratory rats that develop high blood pressure and are stand-ins for humans in such early research on hypertension. The results of feeding the substance were positive, showing that RVPSL did not have apparent toxic effects and lowered blood pressure by amounts comparable to low doses of Captopril.

"Our results support and enhance previous findings on this topic," Yu said. "They were promising enough to move ahead with further research on the effects of the egg white peptide on human health."

Yu noted that the research was done with a version of the peptide that was heated to almost 200 degrees Fahrenheit during preparation — less than the temperatures typically used to cook eggs. He cited evidence from other research, however, that egg whites may retain their beneficial effects on blood pressure after cooking.

One, for instance, published in the ACS Journal of Agricultural and Food Chemistry, showed that fried egg protein, cooked at high temperatures, actually showed greater ability to reduce blood pressure than eggs boiled at 212 degrees F.

Yu believes that egg white peptides, either in eggs or as a supplement, could become useful as an adjunct to high-blood-pressure medication. For now, he said people with high blood pressure should consult their health care provider before making any changes.

And he noted that findings about egg white and high blood pressure add to the emerging nutritional image of eggs. Once regarded as a food to avoid in a healthy diet, studies in recent years have concluded that many people can eat eggs without raising their blood cholesterol levels, benefiting from an inexpensive food low in calories and rich in protein, vitamins and other nutrients.

Copyright © 2010 Julie King  / Gleeful Things. All Rights Reserved.

So, today, a new diabetes alarmist article is making its rounds on Yahoo! Shine, earning it a Moldy Cupcake Award. The article makes some tremendously sweeping generalizations, about some supposed research from France, showing that diet soda causes diabetes, and that high consumption of sugar causes diabetes.

#1 Where is the link for this research? Id like to read it for myself, thank you. I dont need someone else interpreting it for me. As readers, and advocates, we deserve to be able to double check your sources.

#2. Sugar, nor high consumption of sugar, causes diabetes. It never has, and it never will. One has to have a genetic predisposition, and weight gain, to perhaps trigger the illness, but no consumption of any specific foods causes diabetes. Sugar is no different than any other carbohydrate. High fructose corn syrup, however, is a different matter. Why dont you do us all a favor, and tackle that, for a change?

#3. "Furthermore, aspartame, one of the main artificial sweeteners used today, causes an increase in glycaemia and consequently a rise in the insulin level in comparison to that produced by sucrose." WHERE ARE YOUR SOURCES? Aspartame DOES NOT raise blood glucose. Honestly, I dont know how you dare report that. That is irresponsible journalism. Aspartame does NOT raise blood glucose. It has no calories, and no nutritional value like sugar -- it does NOT raise blood glucose. Some of us who already have diabetes would be in a lot of trouble if it did. Wheres your evidence? You have NONE.

#4. The only thing diet sodas have been LOOSELY shown to do is increase the craving for sweet things, in some people, who then go on to overeat, and then could go on to gain a lot of weight -- which if they have the genetic predisposition for getting diabetes -- could lead them to develop the disease. This is not extensive research, nor is it unequivocal. So no. It is an extreme grasping at straws to say that diet soda causes weight gain, much less diabetes. Dont believe me? Ask WebMD!

#5 Why not report on how overconsumption of soda (diet or otherwise) can cause a person to not give its body enough of the proper hydration it needs? How it might make the body swell from dehydration, if one gets severely dehydrated? Oh, heres an idea, why not instead promote moderation??? You fail to see, Yahoo! Shine, that people who are diagnosed with such a life altering, and deadly disease, as diabetes, need transitional foods, and foods that given them a semblance of normalcy. Why? BECAUSE IT IS DAMN HARD, THATS WHY! Dont like soda, dont drink it. But dont LIE about it to get readership.

#6 "Type 2 diabetes—which can be controlled by diet and exercise rather than a daily insulin injection ... " Why cant you people ever, at least, talk to a doctor, advocate, or some expert when it comes to describing diabetes?  Do you now how simplistic, and moronic, this statement is??? Type 2 diabetes is NOT the same for every individual, and if they are on insulin, it is often NOT because they dont want to follow a good diet and exercise regimen. For many, many people, diet and exercise, alone, are NOT an option! Diabetes is a progressive condition in which treatments often need to be altered or changed, in order to keep up with a failing pancreas... and that includes insulin! And newsflash, I wish it were just one simple daily insulin injection! Obviously, you dont really know much about how a pancreas works, and the amount of insulin (basal, and bolus) that a body needs. No, no, but thats okay. Dont let your ignorance hit you in the ass on your way to misinforming people.

As a dedicated frugalist and aficionado of tree-like vegetables, I’m forever in search of ways to enliven broccoli. There are fewer cheaper, more nutritious foods in the produce aisle, and honestly, it’s tough to pretend you’re a forest giant with blueberries.

Heres one way to jazz it up:



And you can stir fry it, sure. And broccoli goes pretty well in pasta. But otherwise, if you don’t dig the Cruciferae smothered in cheese or doused in lemon, you’re kinda out of luck.

Enter Broccoli with Roasted Red Peppers. A buttery, sweet twist on a usually staid side dish, the recipe takes about ten minutes if you have jarred roasted red peppers handy. If you don’t, roasting your own pepper will add 20 to 30 minutes to the cooking time, and could be well worth the effort.

To those whove never done it before, the process can be somewhat intimidating. Trust: it’s not so bad. Simply follow these exciting rules:

• Preheat your broiler.
• Wash and dry the pepper, taking care to remove any stickers. While delicious raw, roasted stickers possess an unfortunate poison flavor.
• Place the pepper on a small pan and stick it under the broiler. When the skin becomes blackened, use tongs to turn it over.
• When the whole pepper becomes blackened, remove it from the oven, place it in a bowl, and cover the bowl with tin foil or plastic wrap. Walk away and do something awesome for a few minutes. Suggested: Settlers of Catan, knitting, cartwheels.
• Once the pepper is cool enough to handle, peel it, seed it, and use the flesh for your own nefarious purposes.
• Dance.

By the third and fourth time you roast your own pepper, it’s practically a trip to Disneyworld. (Minus the lines!)

Before we get to the recipe itself, two quick notes on the process: First, I made this at my parents house. (Hi, Ma and Pa!) While they have an excellent pantry and fine selection of produce, they’re not Safeway, and rarely carry fresh herbs. Fortunately, a teaspoon of dried substituted quite nicely. Second, nutrition numbers were provided by All Recipes, and are listed below. Only the price calculations are my own.

Sweet readers, how do you make broccoli less boring? If it involves ranch dressing, open flame, or mangoes, I’m all ears.

~~~
If you like this recipe, you’ll surely enjoy:

• Broccoli Cheddar Soup
• Broccoli with Parmesan and Lemon
• Pasta with Broccoli and Chickpeas

~~~

Broccoli with Roasted Red Peppers
Makes 6 servings, 2/3 cup each.
Adapted from All Recipes/Taste of Home.


5 cups broccoli florets, cut small
1 clove garlic, minced
1 tablespoon butter
1/4 cup roasted red pepper, diced (or more, if you like)
1 tablespoon minced fresh parsley OR 1 teaspoon dried parsley
1/2 teaspoon salt
1/8 teaspoon pepper

NOTE: If roasting your own pepper, please use the instructions in the above post. If using jarred peppers, read on.

1) Steam broccoli, either in your microwave or on your stovetop. For stovetop: Fill a small pot with 1 or 2 inches water. Place a steamer basket in pot. Add broccoli to basket. Cover, leaving a crack. Steam 3 to 6 minutes, until broccoli is crisp-tender (not limp).

2) While that’s happening, melt butter in a medium pan over medium heat. Add garlic and sauté until fragrant, 30 to 60 seconds. Add peppers, parsley, salt, and pepper. Warm through. Remove from heat.

3) In a medium bowl, combine broccoli and pepper mixture. Stir to coat. Add more salt or pepper if you like. Enjoy!

Approximate Calories, Fat, Fiber, and Price Per Serving
41 calories, 2 g fat, 1 g fiber, $0.34

Calculations
5 cups broccoli florets, cut small: $1.48 (Broccoli on sale for $0.99/bunch.)
1 clove garlic, minced: $0.04
1 tablespoon butter: $0.08
1/4 cup roasted red pepper, diced: $0.39
1 tablespoon minced fresh parsley OR 1 teaspoon dried parsley: $0.01 (dried)
1/2 teaspoon salt: $0.01
1/8 teaspoon pepper: $0.01
TOTAL: $2.02
PER SERVING (TOTAL/6): $0.34

Consuming omega-3 fish oils can help to prevent skin cancer, according to the first clinical trial exploring the influence of fish oils on the skin immunity of humans.

The study was conducted by a team of researchers from the University of Manchester and funded by the Association for International Cancer Research, and examined the effect of taking omega-3 on 79 healthy participants.

Findings of the study, published in The American Journal of Clinical Nutrition, revealed that consuming regular doses of fish oils increases immunity to sunlight.

It directly decreases sunlight-induced immunity suppression - called immunosuppression - which affects the bodys power to combat skin cancer and infection.

Professor Lesley Rhodes, Professor of Experimental Dermatology from the Photobiology Unit Dermatology Centre at the Universitys School of Medicine and Salford Royal NHS Foundation Trust, said their study was the first of its kind conducted using humans:

"There has been research in this area carried out on mice in the past but this is the first time that there has been a clinical trial directly in people. It has taken a number of years to get to this stage and the findings are very exciting. This study adds to the evidence that omega-3 is a potential nutrient to protect against skin cancer. Although the changes we found when someone took the oil were small, they suggest that a continuous low level of chemoprevention from taking omega-3 could reduce the risk of skin cancer over an individuals lifetime."

The volunteers consumed a 4g dose of omega-3 - approximately one and a half portions of oily fish each day. Then they were exposed to either 8, 15, or 30 minutes of summer midday sun in Manchester using a specific light machine.

A number of other participants took a placebo before being exposed to the sunlight machine.

Immunosuppression was shown to be 50 percent lower in the subjects that took the omega-3 and were exposed to 8 and 15 minutes of sunshine compared with the volunteers who did not take the supplement. Little to no impact on those in the 30 minute group was shown.

The conclusions from this study are significant in the battle against skin cancer, because earlier studies have always shown that sunscreens are frequently applied incorrectly and only worn on vacation.

However, Professor Rhodes points out omega-3 is not a substitute for suntan lotion or physical protection, and that it should be seen as additional protection factor to help keep the skin from burning.

Historically, fish oil has already been associated with health benefits like protecting against cardiovascular disease, helping prevent age-related vision loss, and even slowing the growth of prostate cancer cells.

A new study demonstrates what researchers consider conclusive evidence that the red wine compound resveratrol directly activates a protein that promotes health and longevity in animal models. Whats more, the researchers have uncovered the molecular mechanism for this interaction, and show that a class of more potent drugs currently in clinical trials act in a similar fashion. Pharmaceutical compounds similar to resveratrol may potentially treat and prevent diseases related to aging in people, the authors contend.

These findings are published in the March 8 issue of Science.

For the last decade, the science of aging has increasingly focused on sirtuins, a group of genes that are believed to protect many organisms, including mammals, against diseases of aging. Mounting evidence has demonstrated that resveratrol, a compound found in the skin of grapes as well as in peanuts and berries, increases the activity of a specific sirtuin,SIRT1, that protects the body from diseases by revving up the mitochondria, a kind of cellular battery that slowly runs down as we age. By recharging the batteries, SIRT1 can have profound effects on health.

Mice on resveratrol have twice the endurance and are relatively immune from effects of obesity and aging. In experiments with yeast, nematodes, bees, flies and mice, lifespan has been extended.

"In the history of pharmaceuticals, there has never been a drug that binds to a protein to make it run faster in the way that resveratrol activates SIRT1," said David Sinclair, Harvard Medical School professor of genetics and senior author on the paper. "Almost all drugs either slow or block them."

In 2006, Sinclairs group published a study showing that resveratrol could extend the lifespan of mice, and the company Sirtris Pharmaceuticals, which was started by HMS researchers, was founded to make drugs more potent than resveratrol. (Sinclair is a co-founder of Sirtris, a GlaxoSmithKline company, and remains a scientific advisor. Sirtris currently has a number of sirtuin-activating compounds in clinical trials.)

But while numerous studies, from Sinclairs lab and elsewhere, underscored a direct causal link between resveratrol and SIRT1, some scientists claimed the studies were flawed.

The contention lay in the way SIRT1 was studied in vitro, using a specific chemical group attached to the targets of SIRT1 that fluoresces more brightly as SIRT1 activity increases. This chemical group, however, is synthetic and does not exist in cells or in nature, and without it the experiments did not work. As a response to this, a paper published in 2010 surmised that resveratrols activation of SIRT1 was an experimental artifact, one that existed in the lab, but not in an actual animal. SIRT1 activity in mice was, the paper claimed, at best an indirect result of resveratrol, and perhaps even a sheer coincidence.

As a result, a debate erupted over the particular pathway that resveratrol and similar compounds affected. Does resveratrol directly activate SIRT1 or is the effect indirect? "We had six years of work telling us that this was most definitely not an artifact," said Sinclair. "Still, we needed to figure out precisely how resveratrol works. The answer was extremely elegant."

Sinclair and Basil Hubbard, then a doctoral student in the lab, teamed up with a group of researchers from both the National Institutes of Health and Sirtris Pharmaceuticals to address this question.

First, the team addressed the problem of the fluorescent chemical group. Why was it required for resveratrol to rev up SIRT1 in the test tube? Instead of dismissing the result as an artifact, the researchers surmised that the chemical might be mimicking molecules found naturally in the cell. These turned out to be a specific class of amino acid, the building blocks of proteins. In nature, there are three amino acids that resemble the fluorescent chemical group, one of which is tryptophan, a molecule abundant in turkey and notable for inducing drowsiness. When researchers repeated the experiment, swapping the fluorescing chemical group on the substrate with a tryptophan residue, resveratrol and similar molecules were once again able to activate SIRT1.

"We discovered a signature for activation that is in fact found in the cell and doesnt require these other synthetic groups," said Hubbard, first author of the study. "This was a critical result, which allowed us to bridge the gap between our biochemical and physiological findings.

"Next, we needed to identify precisely how resveratrol presses on SIRT1s accelerator," said Sinclair. The team tested approximately 2,000 mutants of the SIRT1 gene, eventually identifying one mutant that completely blocked resveratrols effect. The particular mutation resulted in the substitution of a single amino acid residue, out of the 747 that make up SIRT1. The researchers also tested hundreds of other molecules from the Sirtris library, many of which are far more powerful than resveratrol, against this mutant SIRT1. All failed to activate it.

The authors propose a model for how resveratrol works: When the molecule binds, a hinge flips, and SIRT1 becomes hyperactive.

Although these experiments occurred in a test tube, once the researchers identified the precise location of the accelerator pedal on SIRT1—and how to break it—they could test their ideas in a cell. They replaced the normal SIRT1 gene in muscle and skin cells with the accelerator-dead mutant. Now they could test precisely whether resveratrol and the drugs in development work by tweaking SIRT1 (in which case they would not work) or one of the thousands of other proteins in a cell (in which they would work). While resveratrol and the drugs tested revved up mitochondria in normal cells (an effect caused activating by SIRT1), the mutant cells were completely immune.

"This was the killer experiment," said Sinclair. "There is no rational alternative explanation other than resveratrol directly activates SIRT1 in cells. Now that we know the exact location on SIRT1 where and how resveratrol works, we can engineer even better molecules that more precisely and effectively trigger the effects of resveratrol."

This one fails to support the benefit of cinnamon for blood glucose management.

The study appeared in Septembers issue of Diabetes Care:

Effect of Cinnamon on Glucose and Lipid Levels in Non–Insulin-Dependent Type 2 Diabetes

It was a small study - 43 adults with type 2 diabetes. The intervention group took 2, 500 mg capsules of cinnamon daily. (One gram ground cinnamon is about 3/4 teaspoon.) The placebo group took capsules filled with wheat flour.

After three months, the cinnamon users failed to show improvements in blood glucose, insulin, or cholesterol levels.

One sticking point, participants in the current study were taking diabetes medications. Participants in the promising Pakistani study were not.

The jury is still out on cinnamon use.
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