It is so important today to carefully monitor what you eat. One group says one thing and another group claims something else. We always seem to discover after the fact that something said to be factual a few decades ago is full of inconsistencies and in fact much of the original conclusions are not true. And it still pays to be cautious.
We are seeing this with fat and diets in blogs by David Mendosa. True, many people will not believe that these have changed. Many will continue to believe because this is being ignored by the media of today. Not only is the media ignoring these important issues, but the health community in general and this includes the associations and groups of the different medical and medical related specialties.
Next, I feel quite sure will be our worship of whole grains, which seems to be the mantra for the medical community and related supporting organizations. There are holes being punched in this already. Granted, most of the comments I read are from one doctor, but he states his case quite well. Other doctors will realize that he needs to be taken seriously. Here are four blogs of Dr. William Davis: blog 1; blog 2; blog 3; blog 4. I have blogged about wheat and the myth of whole grains.
Although some doctors are beginning to realize that our high sodium foods are doing much damage to our cardiovascular system, the American Medical Association has not changed their total recommendations to account for the need for people to reduce their sodium intake, but do allow lower sodium levels. The American Heart Association has changed their position to allow and encourage people with cardiovascular problems with high blood pressure to use levels of sodium below 2400 milligrams.
With this in mind, I am being very careful about which fats I consume, but increasing fat intake, staying away from diets, reducing the whole grains in my food consumption, and limiting salt (and all forms of sodium) in the foods I consume. I urge everyone to find what works for them and follow it carefully. Be aware of what is being published, but read with a jaundiced view, and stay away from the latest food and diet fads.
Yes, you should talk to your doctor, but be prepared to have them advise you along the guidelines of their professional organization. I observe how I am doing by looking at the results of my lab tests and keep them in a spreadsheet to see trends – good or bad. Lately, mine have been holding in the middle of the normal range. Surprising, my doctors have noticed this as well and are asking me what I am doing.
I tell them that I am taking my medications and lowering my carbohydrate consumption to the lower side of the mid-range. My heart doctor did ask if I knew what my daily sodium intake was. He just said I must be doing something right and did not go further when I said I was trying to limit my sodium to less that 1800 mg per day. Actually I try to keep it between 1200 to 1500 mg and less than 1800 mg. Occasionally I get below 1200 mg, but not as a regular basis. I have set my absolute lower limit at 600 mg.
I have only one study from 2000 that I use to guide me. It is this study by the National Institutes of Health. This is about the “DASH Diet”. I do not follow the diet, but use it as a guide, taking ideas that work and discarding the rest. I do not recommend this for others, but this study is worth reading.
There are other articles about sodium showing the advantages of limiting it, but that is another blog. There are enough links in this already and a lot of reading.
08 January 2011
07 January 2011
Medicare – Make Way for the Baby Boomers
When you read this, I think you will decide like I did that their title of the article is a misnomer. After reading the article, it is basically laying out the problems that Medicare will be facing with the baby boomers.
The first of them will turn 65 this year and will put a strain on an already overburdened Medicare system. It is expected the baby boomers will have more health problems and more expectations than their parents and generations before them.
Much of the problems facing our new seniors will be the lack of geriatricians and primary care physicians. They need to spend more time with patients and they get the least amount of reimbursement. This is the reason that almost no one is is going into geriatrics today.
According to the American Geriatrics Society, there are now 7029 board certified geriatricians in the United States. With the increasing elderly population the ratio is expected to double to one geriatrician per 5549 seniors by 2030. And with the primary care physicians also experiencing a shortage, the problems are only going to increase for the elderly.
Then it is very important to note that 40 percent of the physicians are approaching retirement. With many physicians, especially in small private practices, not taking Medicare patients because it is not economical for them, where is the approximately 75 million baby boomers going to turn for medical care?
Now comes the rub – the baby boomers, as a group, have tremendous political clout, think it is in their best interest to beef up the medical system, and want things addressed as they move into this group.
We will definitely have some conflicts as Medicare is striving to reduce spending and forcing congress to overrule their actions on a reoccurring basis. With the baby boomers expecting the medical care to be there for them, you can bet that the dwindling support by the smaller generations behind them are going to resist being burdened by their medical needs.
No wonder the current legislation is becoming so contentious and they want more control in the hands of the government. This is only speculation, but I have a feeling that legal euthanasia is going to be a hotly debated topic in the next ten to twenty years.
The first of them will turn 65 this year and will put a strain on an already overburdened Medicare system. It is expected the baby boomers will have more health problems and more expectations than their parents and generations before them.
Much of the problems facing our new seniors will be the lack of geriatricians and primary care physicians. They need to spend more time with patients and they get the least amount of reimbursement. This is the reason that almost no one is is going into geriatrics today.
According to the American Geriatrics Society, there are now 7029 board certified geriatricians in the United States. With the increasing elderly population the ratio is expected to double to one geriatrician per 5549 seniors by 2030. And with the primary care physicians also experiencing a shortage, the problems are only going to increase for the elderly.
Then it is very important to note that 40 percent of the physicians are approaching retirement. With many physicians, especially in small private practices, not taking Medicare patients because it is not economical for them, where is the approximately 75 million baby boomers going to turn for medical care?
Now comes the rub – the baby boomers, as a group, have tremendous political clout, think it is in their best interest to beef up the medical system, and want things addressed as they move into this group.
We will definitely have some conflicts as Medicare is striving to reduce spending and forcing congress to overrule their actions on a reoccurring basis. With the baby boomers expecting the medical care to be there for them, you can bet that the dwindling support by the smaller generations behind them are going to resist being burdened by their medical needs.
No wonder the current legislation is becoming so contentious and they want more control in the hands of the government. This is only speculation, but I have a feeling that legal euthanasia is going to be a hotly debated topic in the next ten to twenty years.
06 January 2011
Obama's Death Panels
Has our president realized that his death panels will not win him reelection? Doubtful! But for the second time he has pulled Medicare reimbursement for end-of-life counseling. Comments by Sarah Palin caused the first one enacted in 2009 to be pulled.
Now the second one introduced as a regulation in November 2010 has been pulled. This one reemerged after the passage of the Accountable Care Act and was also to have reimbursed physicians for an annual wellness visit with Medicare patients, an extension of the of the welcome to Medicare visit already in place. It went into effect on January 1, 2011, but on January 4, 2011, it was suddenly pulled.
I cannot help but wonder how long before it will again be placed back on the books and our president will undoubtedly try to sneak it in again. We can only hope that the new congress will carefully watch this and kill it if again it is put on the books as law by the Centers for Medicare and Medicaid Services.
Read the article here and decide for yourself if you are in favor of these “death panels” or legal euthanasia.
Now the second one introduced as a regulation in November 2010 has been pulled. This one reemerged after the passage of the Accountable Care Act and was also to have reimbursed physicians for an annual wellness visit with Medicare patients, an extension of the of the welcome to Medicare visit already in place. It went into effect on January 1, 2011, but on January 4, 2011, it was suddenly pulled.
I cannot help but wonder how long before it will again be placed back on the books and our president will undoubtedly try to sneak it in again. We can only hope that the new congress will carefully watch this and kill it if again it is put on the books as law by the Centers for Medicare and Medicaid Services.
Read the article here and decide for yourself if you are in favor of these “death panels” or legal euthanasia.
05 January 2011
Bright Light May Ease Depression in Elderly
Do you suffer from depression? I do, although lately I have been keeping a few more lights burning to combat the lack of sunshine from the dreary winter days. This is apparently what I should be doing if I read this study correctly.
Although I am not sure what type of lights and specially designed light boxes the study used, it apparently improved the symptoms of depression by about 54 percent in older adults with depression.
Also not mentioned was the type of depression it relieved. Was it mild or severe depression? From the tone of the article in WebMd, it could have been severe depression. The bright light therapy improves sleep and optimizes levels of the neurotransmitter serotonin. Low levels of serotonin is often targeted by antidepressant drugs.
The study indicates that light therapy may provide an alternative for patients who refuse, resist, or do not tolerate antidepressant treatment. The study was used by 89 adults over the age of 60 and diagnosed with depression. They were divide into two groups. One group had bright light for an hour in the early morning hours and the other half exposed to a dim red light treatment.
After three weeks the bright light group showed a 43 percent improvement and the red light only a 36 percent improvement. At the end of six weeks the bright light group shows a 54 percent improvement compared to 33 percent for the red light people.
The results also showed level of decreased stress hormone cortisol and improved sleep quality in the bright light therapy group. This compares to improvements found with people using antidepressant drug treatment.
So I will continue to use more lights when I feel depressed and hope that I continue to get the results that I have felt with this. Read the study article here.
Although I am not sure what type of lights and specially designed light boxes the study used, it apparently improved the symptoms of depression by about 54 percent in older adults with depression.
Also not mentioned was the type of depression it relieved. Was it mild or severe depression? From the tone of the article in WebMd, it could have been severe depression. The bright light therapy improves sleep and optimizes levels of the neurotransmitter serotonin. Low levels of serotonin is often targeted by antidepressant drugs.
The study indicates that light therapy may provide an alternative for patients who refuse, resist, or do not tolerate antidepressant treatment. The study was used by 89 adults over the age of 60 and diagnosed with depression. They were divide into two groups. One group had bright light for an hour in the early morning hours and the other half exposed to a dim red light treatment.
After three weeks the bright light group showed a 43 percent improvement and the red light only a 36 percent improvement. At the end of six weeks the bright light group shows a 54 percent improvement compared to 33 percent for the red light people.
The results also showed level of decreased stress hormone cortisol and improved sleep quality in the bright light therapy group. This compares to improvements found with people using antidepressant drug treatment.
So I will continue to use more lights when I feel depressed and hope that I continue to get the results that I have felt with this. Read the study article here.
04 January 2011
CPAP Therapy Reduces Fatigue
This is so true. Like many others reported in this study, I can attest to the correctness of this. Continuous Positive Airway Pressure (CPAP) therapy does wonders for feeling rested when waking in the morning.
The study reported in the January issue of the journal SLEEP provides the evidence of these reports. The study shows that in three weeks of CPAP therapy does significantly reduce fatigue and increases the energy in patients with obstructive sleep apnea (OSA).
I have a problem with the number of people that have sleep apnea that do nothing to improve their situation. Many do not even know they have the problem. So if you are always tired during waking hours, you should talk to your doctor or sleep medicine physician to see if you have sleep apnea.
Sleep apnea is common, even if you are unaware it is happening. When you pause in breathing, called an apnea, this can last for a few seconds to even more than a minute. These apneas can occur from five times to over 100 times in an hour. Thus in a night's sleep you can have hundreds of apneas. Each apnea causes the brain to arouse people to resume breathing. This in turn causes sleep to be extremely fragmented and of poor quality. This unrestful sleep results in day time fatigue. Your body needs restful sleep to function proficiently.
Unless your spouse or sleep partner notices these apneas and gasps for air as you resume breathing, they can go unreported and undetected for several years. With approximately 18 million Americans undiagnosed as reported by the National Institute of Health, the US has about one in 15 people suffering from sleep apnea.
OSA, is the most common type and affects about 90% of total sufferers. It can impact one's daily routine and be fatal in some instances. Untreated, sleep apnea can cause high blood pressure and other cardiovascular disease, memory problems, weight gain, impotency, and headaches. Untreated sleep apnea may be responsible for job impairment and motor vehicle crashes. Sleep apnea can put you at risk for Type 2 diabetes.
With the improvements in CPAP equipment and accessories, everyone that may have sleep apnea should be tested in a sleep study to determine if they have sleep apnea. I have written about this in other blogs and the types of equipment. See blog 1, blog 2, blog 3, and blog 4.
Also read about the study here and here. Also read about sleep apnea here.
The study reported in the January issue of the journal SLEEP provides the evidence of these reports. The study shows that in three weeks of CPAP therapy does significantly reduce fatigue and increases the energy in patients with obstructive sleep apnea (OSA).
I have a problem with the number of people that have sleep apnea that do nothing to improve their situation. Many do not even know they have the problem. So if you are always tired during waking hours, you should talk to your doctor or sleep medicine physician to see if you have sleep apnea.
Sleep apnea is common, even if you are unaware it is happening. When you pause in breathing, called an apnea, this can last for a few seconds to even more than a minute. These apneas can occur from five times to over 100 times in an hour. Thus in a night's sleep you can have hundreds of apneas. Each apnea causes the brain to arouse people to resume breathing. This in turn causes sleep to be extremely fragmented and of poor quality. This unrestful sleep results in day time fatigue. Your body needs restful sleep to function proficiently.
Unless your spouse or sleep partner notices these apneas and gasps for air as you resume breathing, they can go unreported and undetected for several years. With approximately 18 million Americans undiagnosed as reported by the National Institute of Health, the US has about one in 15 people suffering from sleep apnea.
OSA, is the most common type and affects about 90% of total sufferers. It can impact one's daily routine and be fatal in some instances. Untreated, sleep apnea can cause high blood pressure and other cardiovascular disease, memory problems, weight gain, impotency, and headaches. Untreated sleep apnea may be responsible for job impairment and motor vehicle crashes. Sleep apnea can put you at risk for Type 2 diabetes.
With the improvements in CPAP equipment and accessories, everyone that may have sleep apnea should be tested in a sleep study to determine if they have sleep apnea. I have written about this in other blogs and the types of equipment. See blog 1, blog 2, blog 3, and blog 4.
Also read about the study here and here. Also read about sleep apnea here.
03 January 2011
Is There a Need for Team Treatments?
Yes, research is proving the need for people specially trained to work with people with diabetes. In this case it is nurses. Anyone that has special training to work with people with diabetes and in this case depression and heart disease can have an effect on the health of these individuals. Nurses without special training often cause more problems than aiding people with diabetes.
In the study being published in the New England Journal of Medicine, these nurses worked closely with the patients to coordinate their health care needs. They were trained to pay special attention to optimizing treatment of depression, blood pressure, blood glucose, and cholesterol.
As they say, the proof is in the outcome. In this they showed that after one year, the patients who worked with the nurse coaches had less depression and managed their diabetes and heart disease risk factors better than patients who got standard care.
One participant in the study stated that “the biggest difference was that I have one person who knows everything that is going on with me.”
As those of us with Type 2 diabetes already know, depression can be part of our lives. However, its total impact is not as well known or understood. In general, those of us with diabetes can experience more of the complications. Having a nurse case manager whose role is to integrate depression and diabetes treatment can have a more positive outcome.
In the study, the nurse coaches adjusted medications as needed and worked with the patients to set and achieve attainable health goals. This positive influence with more frequent adjustments to insulin dosages, medications for depression, blood pressure, and cholesterol had a very positive effect.
The researchers are now conducting a cost-benefit analysis if the intervention and they are saying that the savings to the health care system could be substantial.
I feel that this is a study that needs attention to serve as an incentive for the new rules and regulations coming out of the Affordable Care Act. This along with the Share Medical Appointments (SMAs) that I blogged about here could have some real and not imaginary help in obtaining better health outcomes at a significant reduction in overall costs.
To go along with this, I also think there is room for other groups like peer-to-peer help. I have blogged about this here. Although the results are not as great as this study, it still would be possible to get good results and could possibly have greater results with more training for the peer-to-peer groups. With the peer-to-peer groups, these are all volunteer and therefore the cost effectiveness could even be greater.
In the study being published in the New England Journal of Medicine, these nurses worked closely with the patients to coordinate their health care needs. They were trained to pay special attention to optimizing treatment of depression, blood pressure, blood glucose, and cholesterol.
As they say, the proof is in the outcome. In this they showed that after one year, the patients who worked with the nurse coaches had less depression and managed their diabetes and heart disease risk factors better than patients who got standard care.
One participant in the study stated that “the biggest difference was that I have one person who knows everything that is going on with me.”
As those of us with Type 2 diabetes already know, depression can be part of our lives. However, its total impact is not as well known or understood. In general, those of us with diabetes can experience more of the complications. Having a nurse case manager whose role is to integrate depression and diabetes treatment can have a more positive outcome.
In the study, the nurse coaches adjusted medications as needed and worked with the patients to set and achieve attainable health goals. This positive influence with more frequent adjustments to insulin dosages, medications for depression, blood pressure, and cholesterol had a very positive effect.
The researchers are now conducting a cost-benefit analysis if the intervention and they are saying that the savings to the health care system could be substantial.
I feel that this is a study that needs attention to serve as an incentive for the new rules and regulations coming out of the Affordable Care Act. This along with the Share Medical Appointments (SMAs) that I blogged about here could have some real and not imaginary help in obtaining better health outcomes at a significant reduction in overall costs.
To go along with this, I also think there is room for other groups like peer-to-peer help. I have blogged about this here. Although the results are not as great as this study, it still would be possible to get good results and could possibly have greater results with more training for the peer-to-peer groups. With the peer-to-peer groups, these are all volunteer and therefore the cost effectiveness could even be greater.
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