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Friday, July 23, 2010

Get Off Your Can!

A study in online July 22 in the American Journal of Epidemiology by Alpa Patel and colleagues concludes that sitting shortens our lives, even after considering impact of being overweight and how much we exercise. The study collected questionnaire data for 14 years (1993-2006) from 123,216 healthy people (53,440 men and 69,776 women) in the American' Cancer Society's Cancer Prevention II study.

Even after considering body mass index (BMI) and smoking, women who spent six hours a day sitting had a 37 percent higher risk of dying than those who sat for less than three hours a day. Men had a 17% higher risk. Exercise lowered the risk of sitting, but more sitting meant a higher risk of death even among those who exercised. And for those who didn't exercise, sitting a lot was even worse: women who sat a lot had a 94% higher risk of dying than women who didn't, and for men, sitting conferred a 49% higher risk of death.

So start moving; you can still read this blog on your mobile while moving! Disclaimer: Don't read while walking out in the street! More dangerous to your health than sitting....

probiotics reduce pregnancy diabetes

More good news about probiotics. An article in the British Journal of Clinical Nutrition describes a randomized clinical trial of an intervention consisting of dietary counselling and probiotics. Women in the intervention group had less than half the rate of development of pregnancy diabetes, a great outcome.

Thursday, July 15, 2010

probiotics reduce kids' infections but not missed school days

A recently published study authored by Dr. Dan Merenstein (a family doc and researcher whose mentor I am honored to have been when he was doing his fellowship at Johns Hopkins), and his colleagues from Georgetown University, demonstrated that yogurt with active probiotic cultures taken daily for 120 days reduced gastrointestinal and respiratory infections (including strep throat and colds) substantially but did not result in children missing fewer days of school or day care. Just another demonstration of how truly sick children have to be these days in order for their parents to keep them home!

News reports seemed to stress the fact that there was no difference in days of school missed. Wouldn't we all go out and buy something that gave our children more days free of diarrhea and strep throat, regardless of whether they went to school or not? If you agree, go out and get your child some DanActive or other probiotic... Dr. Merenstein recommends yogurt or foods supplemented with at least 3 different active probiotic cultures.

Monday, July 12, 2010

Monterey Bay Aquarium rates seafood

Here's a link to the Monterey Bay Aquarium's West Coast Seafood Watch pocket guide. Here you will find lists of seafood which are best from the point of view of 3 considerations: Avoiding overfished species, avoiding species with high levels of mercury, and nutritional considerations such as levels of omega-3 fatty acids.

Sunday, July 11, 2010

More dark chocolate benefits

It seems like I'm running an ad for dark chocolate, but there just seems to be a lot of good news lately from studies of it. Perhaps there's an evolutionary survival reason why we humans seem to love the stuff..."Flavanol-rich" cocoa products (otherwise known as dark chocolate) may help to reduce blood pressure a little bit in people with high blood pressure, according to the results of a meta-analysis (a study that puts together the results of other studies rather than collecting new date) by a team led by Karin Ried from the University of Adelaide in Australia and reported in the June 28 issue of BMC Medicine.

Interestingly the chocolate did not reduce blood pressure in people with normal blood pressure, only those with high blood pressure.

The size of the effect in people with high blood pressure was about 5 and 3 mmHg (millimeters of mercury) for diastolic and systolic blood pressure respectively. MmHg are the usual units in which blood pressure is measured. Controlling both systolic and diastolic blood pressure is important for prevention of heart disease and stroke. Reducing blood pressure by 5 mm Hg is a clinically important effect which lowers the risk of heart attack and stroke measurably.

Again one must be cautious about these results because if one ingested the chocolate with a lot of extra sugar, such as in a hot chocolate or cocoa drink, its effects might be counteracted by the increased calories.

Also in interviews reported by Medscape, the authors were careful to caution that flavanol-rich chocolate did not significantly reduce mean blood pressure below 140 mmHg systolic or 80 mmHg diastolic.

Thursday, July 8, 2010

Don Berwick to Head CMS

Don Berwick, whom I'm honored to have worked with in the past, has been appointed by President Obama to head CMS (Center for Medicare and Medicaid Services). Don is a mesmerizing speaker and a wonderful physician and human being who has encouraged an entire generation of physicians to bring industrial quality improvement methods to health care. Don founded and has headed the Institute for Healthcare Improvement since leaving Harvard in the 1990s. He has a broad constituency in medicine across many disciplines. I believe he's an excellent physician who is committed to high quality health care in the U.S. in a non-partisan way, despite my having read that Republicans criticize him for having written positive things about England's national health insurance system. Don has praised England's recent emphasis on quality and performance improvement, and it would be pretty hard to argue with that change, whether one favors a single-payer system or not (I do only if it is structured to preserve competition among and choice of providers based on quality of care).

I am hopeful that Don's insight will help Medicare implement the healthcare reform legislation in a way that will promote and preserve quality of care in Medicare as well as the private insurance system. I am encouraged by Don's background in clinical medicine (he is a pediatrician by training although I don't know when he last practiced), and quality of care. Don is an excellent choice and I hope his philosophy can filter down to CMS' day to day operations. As we know, sometimes leaders of federal agencies don't influence their own bureaucracies too much, because managers of individual departments can subvert the intent of the agencies' directors. Don, however, is an inspiring leader who has been an effective leader in several organizations in the past, and I wish him all the best at CMS.

Don't use quninine for leg cramps

The FDA has issued a new warning
against using quinine for leg cramps because of severe hematologic (blood) problems that can result from quinine. So don't!

Wednesday, July 7, 2010

Implantable Telescope for Macular Degeneration

If you have macular degeneration, you probably aren't reading this blog. However, you might have a family member with macular degeneration. The FDA has now approved the first device, an implantable telescope, that in preliminary studies by the company has helped improve vision for patients with macular degeneration. There is an ongoing study of another several hundred patients to see how they fare. I tend not to be an early adopter for things like this, preferring to look at the complications and outcomes for a few thousand patients studied independently of the company making the device. If this technology works and does not cause a lot of retinal damage itself over time, it may be very helpful in a disease which we can do little about right now.

New Formula for Females for Maximal Workout Heart Rate

A new formula for women to calculate their maximal heart rates for workouts has been put forth by researchers at Northwestern in a study published in Circulation this week. This new formula was based on a study of 5500 healthy women who took treadmill tests in 1992 and who were followed for mortality. This formula is the first which used women to look at how heart rates with exercise were related to mortality rates, and is therefore likely to be much more accurate than the usual formula for peak heart rate which exercise professionals had used (220 minus age). The new formula, 206 - 88% of age, is a little harder to calculate. For example, for a 50 year old woman, the new formula's peak heart rate is 206 - (.88x50) = 162. If one uses 65% - 85% of the maximal heart rate of 162 for the target heart rate range for workouts, a 50 year old woman should be able to get to 138 as she becomes more fit but would not reduce, and might increase, her cardiovascular mortality by pushing herself further than that.

This study provides valuable guidance for women as they endeavor to become fit and will be a relief to women who have been trying to push themselves to the old formula's upper limit target rate.