Beauty Health for Life

Having to pay for a portion of any health care leads to decreased access. Electronic medical records result in increased quality.  Primary care causes lower costs.  The Disease Management Care Blog is responsible for the DMCB spouses migraines.  While each assertion may be technically true, the real underlying question is "By how much?"

Thats why this New England Journal paper "Neighborhoods, Obesity and Diabetes - A Randomized Social Experiment" by Jens Ludwig and colleagues that examines the association between poverty and diabetes is important.  Researchers have known that low income can lead to perence for the "cheap calories" in ined and high fat foods which, in turn, lead to a high rate of obesity among indigent persons.  Now we have a better idea on how much.

Ever hear of the "Moving to Opportunity" demonstration project?  Neither did the Disease Management Care Blog, but this was a demo designed to test the long term impact of housing and poverty on health and well-being.  In the study, females with children who were candidates for public housing assistance were entered into a lottery that randomly assigned participants to one of three groups:

1) a low poverty voucher group that could use their vouchers to rent housing in a census tract with less than a 10% poverty rate (N=1425).  After one year, persons assigned this group could move anywhere they wished;

2) a traditional voucher group that could be used anywhere (N=657);

3) a control group that was SOL (N=1104).

The women were asked questions about their health at baseline, including height, weight and also provided blood samples to check an A1c to assess the presence of diabetes mellitus.  They were then followed for approximately 10 years.

Not all persons completed the follow up, so the authors used an "intention-to treat" analysis.  The rates of poverty are here, while the rates of obesity and diabetes are here.  The low poverty voucher group not only had lower rates of obesity (defined as a BMI greater than 35) but a lower rate of abnormal A1cs (16.3% vs. 20% in the control).  The traditional voucher group had lower numbers vs. the controls but they failed to achieve statistical significance.  It appears, based on this study, that living in a low poverty neighborhood reduces the rate of obesity and diabetes in the absolute range of 3% to 4%.

The authors correctly point out that not all persons in the study completed the follow-up, which could have biased the results.  In addition, the A1c results dont account for the possibility that more persons in the voucher group may have had their diabetes successfully treated.  Last but not least, much of the data were self reported.

The DMCB was surprised that poverty seemed to directly account for a relatively small amount of "new" disease.  On the other hand, an additional 3-4% involving millions of U.S. citizens represents a public health disaster.  Based on these data, we have a better insight on the role of poverty in diabetes and can point to at least one Federal program where taxpayers appear to have gotten their moneys worth.

A new study by the Centers for Disease Control and Prevention (CDC) links too little sleep (six hours or less) and too much sleep (10 or more hours) with chronic diseases – including coronary heart disease, diabetes, anxiety and obesity – in adults age 45 and older. The American Academy of Sleep Medicine (AASM) encourages patients suffering from these common chronic conditions to speak with a sleep medicine physician who can evaluate their sleep patterns.

“It’s critical that adults aim for seven to nine hours of sleep each night to receive the health benefits of sleep, but this is especially true for those battling a chronic condition,” said Dr. M. Safwan Badr, president of the AASM. “Common sleep illnesses – including sleep apnea and insomnia – occur frequently in people with a chronic disease and can hinder your ability to sleep soundly. So if you’re waking up exhausted, speak with a sleep physician to see if there’s a problem. If you are diagnosed with a sleep illness, treating it could significantly improve disease symptoms and your quality of life.”

“Some of the relationships between unhealthy sleep durations and chronic diseases were partially explained by frequent mental distress and obesity,” said study co-author Janet B. Croft, PhD, senior chronic disease epidemiologist in CDC’s Division of Population Health. “This suggests that physicians should consider monitoring mental health and body weight in addition to sleep health for patients with chronic diseases.”

In the study, published in the October issue of the Journal SLEEP, short sleepers reported a higher prevalence of coronary heart disease, stroke and diabetes, in addition to obesity and frequent mental distress, compared with optimal sleepers who reported sleeping seven to nine hours on average in a 24-hour period. The same was true for long sleepers, and the associations with coronary heart disease, stroke and diabetes were even more pronounced with more sleep.

“Sleeping longer doesn’t necessarily mean you’re sleeping well. It is important to understand that both the quality and quantity of sleep impact your health,” said Badr. “A healthy, balanced lifestyle is not limited to diet and fitness; when and how you sleep is just as important as what you eat or how you exercise.”

The study involved more than 54,000 participants age 45 or older in 14 states. Nearly one third of participants (31 percent) were identified as short sleepers, meaning they reported sleeping six hours or less on average. More than 64 percent were classified as optimal sleepers, and only 4 percent of participants were long sleepers.

Researchers reporting in the November, 2008 issue of the American Journal of Physiology, Endocrinology and Metabolism, found improvements in blood glucose levels in mice fed resistant starch.¹

Resistant starch (RS) is simply starch that resists digestion and travels to the colon where it undergoes fermentation by resident bacteria.

It is the fermentation of that starch that is thought to offer benefit.

During fermentation, colonic bacteria produce short chain fatty acids (SCFAs). These SCFAs were found to stimulate secretion of two gut hormones: Glucagon-like peptide-1 (GLP-1) and peptide YY (PYY).

These hormones can slow gastric emptying and encourage insulin secretion - keeping blood glucose levels in check. They are also know to reduce appetite.

Specifically, the authors found that:

1. RS stimulates GLP-1 and PYY secretion in a substantial day-long manner, independent of meal effect or changes in dietary glycemia.
   
2. Fermentation and the liberation of SCFAs in the lower gut are associated with increased proglucagon and PYY gene expression.
   
3. Glucose tolerance, an indicator of increased active forms of GLP-1 and PYY, was improved in RS-fed diabetic mice.

Food Sources For Resistant Starch

The HealthyEatingClub.com lists these foods as containing resistant starch:

• Intact wholegrain cereals/seeds/nuts, e.g. oats, rye, wheat, barley, semolina, corn, linseed, sesame
  
• Processed starchy foods, e.g. some breakfast cereals (cornflakes), white bread, rice, pasta
  
• Processed starchy foods with added RS called Hi-Maize (derived from corn)
  
• Legumes, e.g. lentils, beans (Legumes have the highest content of RS.)
  
• Unripe fruit, especially banana
  
• Cooked cold rice, cold pasta salad, cold boiled potato salad (Cooking and cooling food can increase RS content.)

________¹ Dietary Resistant Starch Upregulates Total GLP-1 And PYY In A Sustained Day-Long Manner Through Fermentation In Rodents